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Wasco C, Khan Z, Willett A, Volio A, Carter C, Kesari A, Kothari S, Scheidemantel A, Bennett K, Schafer J, Lockhart M, Chopra N. Incidence and prevalence of hypertension in 18-40-year-old patients referred for palpitations with normal cardiac monitor findings. J Clin Hypertens (Greenwich) 2024. [PMID: 38641880 DOI: 10.1111/jch.14813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 04/21/2024]
Abstract
Sixteen percent of patients referred for cardiology evaluation are found to have no cause for palpitations. Studies show that hypertension intricately influences "heart rate" and "contractility,?" the key components of "palpitation." While the prevalence of hypertension is 22.4% in 18-39-year-olds, the relationship between palpitations and hypertension remains unknown in this age group. In our study, we assessed the incidence and prevalence of hypertension over 5 years in 18-40-year-olds referred for palpitations who had no known arrhythmic cause for palpitations between January 1, 206 and December 31, 2017. We found that over a period of 2.2 (0.7-4.1) years, an additional 56% patients were diagnosed with stage 1 (65/130) and stage 2 (28/130) hypertension, increasing the prevalence from 16% at the start of the study period to 72% at the end of the study period (p < .0001). Hypertensive patients were obese (BMI: 29 [24-36] kg/m2 vs. 25 [22-31] kg/m2; p = .03), used nonsteroidal anti-inflammatory drugs (NSAIDs) (62 vs. 35%; p = .04), had a stronger family history of hypertension (55 vs. 4%; p < .0001) and exhibited higher systolic (124[120-130] mmHg vs. 112[108-115] mmHg; p < .0001) and diastolic (80[76-83] mmHg vs. 72[69-75] mmHg; p < .0001) blood pressures. Hypertension is commonly diagnosed in 18-40-year-old predominantly white female patients referred for palpitations without a known arrhythmic cause. The possibility of untreated hypertension causing palpitations in this cohort needs further evaluation.
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Affiliation(s)
- Christopher Wasco
- Department of Internal Medicine, Riverside Methodist Hospital, Columbus, Ohio, USA
| | - Zeryab Khan
- Department of Internal Medicine, OhioHealth Doctors Hospital, Columbus, Ohio, USA
| | - Aimee Willett
- Department of Internal Medicine, Riverside Methodist Hospital, Columbus, Ohio, USA
| | - Andrew Volio
- Department of Internal Medicine, OhioHealth Doctors Hospital, Columbus, Ohio, USA
| | - Cody Carter
- Department of Internal Medicine, OhioHealth Doctors Hospital, Columbus, Ohio, USA
| | - Aditya Kesari
- Department of Internal Medicine, Riverside Methodist Hospital, Columbus, Ohio, USA
| | - Shaili Kothari
- Department of Internal Medicine, Riverside Methodist Hospital, Columbus, Ohio, USA
| | - Andrew Scheidemantel
- Department of Internal Medicine, OhioHealth Doctors Hospital, Columbus, Ohio, USA
| | - Katelyn Bennett
- Department of Internal Medicine, OhioHealth Doctors Hospital, Columbus, Ohio, USA
| | - Jessalyn Schafer
- Department of Internal Medicine, OhioHealth Doctors Hospital, Columbus, Ohio, USA
| | - Marie Lockhart
- Department of Pharmacy, Riverside Methodist Hospital, Columbus, Ohio, USA
| | - Nagesh Chopra
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, Ohio, USA
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Adejuyigbe EA, Agyeman I, Anand P, Anyabolu HC, Arya S, Assenga EN, Badhal S, Brobby NW, Chellani HK, Chopra N, Debata PK, Dube Q, Dua T, Gadama L, Gera R, Hammond CK, Jain S, Kantumbiza F, Kawaza K, Kija EN, Lal P, Mallewa M, Manu MK, Mehta A, Mhango T, Naburi HE, Newton S, Nyanor I, Nyako PA, Oke OJ, Patel A, Phlange-Rhule G, Sehgal R, Singhal R, Wadhwa N, Yiadom AB. Evaluation of the impact of continuous Kangaroo Mother Care (KMC) initiated immediately after birth compared to KMC initiated after stabilization in newborns with birth weight 1.0 to < 1.8 kg on neurodevelopmental outcomes: Protocol for a follow-up study. Trials 2023; 24:265. [PMID: 37038239 PMCID: PMC10088121 DOI: 10.1186/s13063-023-07192-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 02/20/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Preterm birth or low birth weight is the single largest cause of death in newborns, however this mortality can be reduced through newborn care interventions, including Kangaroo Mother Care (KMC). Previously, a multi-country randomized controlled trial, coordinated by the World Health Organization (WHO), reported a significant survival advantage with initiation of continuous KMC immediately after birth compared with initiation of continuous KMC a few days after birth when the baby is considered clinically stable. Whether the survival advantage would lead to higher rates of neurodevelopmental morbidities, or the immediate KMC will also have a beneficial effect on cognitive development also, has not been investigated. We therefore propose to test the hypothesis that low-birth-weight infants exposed to immediate KMC will have lower rates of neurodevelopmental impairment in comparison to traditional KMC-treated infants, by prospectively following up infants already enrolled in the immediate KMC trial for the first 2 years of life, and assessing their growth and neurodevelopment. METHODS This prospective cohort study will enroll surviving neonates from the main WHO immediate KMC trial. The main trial as well as this follow-up study are being conducted in five low- and middle-income countries in South Asia and sub-Saharan Africa. The estimated sample size for comparison of the risk of neurodevelopmental impairment is a total of 2200 children. The primary outcome will include rates of cerebral palsy, hearing impairment, vision impairment, mental and motor development, and epilepsy and will be assessed by the age of 3 years. The analysis will be by intention to treat. DISCUSSION Immediate KMC can potentially reduce low-birth-weight-associated complications such as respiratory disease, hypothermia, hypoglycemia, and infection that can result in impaired neurocognitive development. Neuroprotection may also be mediated by improved physiological stabilization that may lead to better maturation of neural pathways, reduced risk of hypoxia, positive parental impact, improved sleep cycles, and improved stress responses. The present study will help in evaluating the overall impact of KMC by investigating the long-term effect on neurodevelopmental impairment in the survivors. TRIAL REGISTRATION Clinical Trials Registry-India CTRI/2019/11/021899. Registered on 06 November 2019. Trials registration of parent trial: ACTRN12618001880235; Clinical Trials Registry-India: CTRI/2018/08/015369.
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Affiliation(s)
- E A Adejuyigbe
- Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, 220005, Nigeria
| | - I Agyeman
- Komfo Anokye Teaching Hospital, P.O. Box 1934, Adum, Kumasi, Ghana
| | - P Anand
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - H C Anyabolu
- Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, 220005, Nigeria
| | - S Arya
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - E N Assenga
- Department of Paediatrics and Child Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, 255, Tanzania
| | - S Badhal
- Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - N W Brobby
- Department of Child Health, Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - H K Chellani
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India.
| | - N Chopra
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - P K Debata
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - Q Dube
- Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - T Dua
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - L Gadama
- Department of Obstetrics and Gynaecology, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - R Gera
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - C K Hammond
- Department of Child Health, Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - S Jain
- Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - F Kantumbiza
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - K Kawaza
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - E N Kija
- Department of Paediatrics and Child Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, 255, Tanzania
| | - P Lal
- Atal Bihari Vajpayee Institute of Medical Sciences &, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - M Mallewa
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - M K Manu
- Komfo Anokye Teaching Hospital, P.O. Box 1934, Adum, Kumasi, Ghana
| | - A Mehta
- Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - T Mhango
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - H E Naburi
- Department of Paediatrics and Child Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, 255, Tanzania
| | - S Newton
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - I Nyanor
- Research and Development, Komfo Anokye Teaching Hospital, P.O. Box 1934, Adum, Kumasi, Ghana
| | - P A Nyako
- Department of Psychiatry, Child And Adolescent Mental Health, Komfo Anokye Teaching Hospital, P.O. Box 1934, Adum, Kumasi, Ghana
| | - O J Oke
- Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, 220005, Nigeria
| | - A Patel
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
- Division of Epilepsy & Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, USA
| | - G Phlange-Rhule
- Clinical Development Services Agency (CDSA), Translational Health Science and Technology Institute (THSTI), NCR Biotech Science Cluster, PO Box #04, Faridabad, 121001, India
| | - R Sehgal
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - R Singhal
- Translational Health Science and Technology Institute (THSTI), NCR Biotech Science Cluster, PO Box #04, 121001, Faridabad, India
| | - N Wadhwa
- Faridabad-Gurgaon Expressway, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, 3Rd MilestonePost Box #04, Faridabad, Haryana, 121001, India.
| | - A B Yiadom
- Department of Child Health, Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Robinson A, Chopra N, Badin AG, Billakanty SR, Cooper K, Fu EY, James J, Murnane V, Swinning J, Stelzer M, Tyler JD, Amin AK. Impact of a dedicated atrial fibrillation clinic on diagnosis-to-ablation time. Heart Rhythm O2 2022; 3:639-646. [PMID: 36589916 PMCID: PMC9795309 DOI: 10.1016/j.hroo.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Outcomes following catheter ablation (CA) for atrial fibrillation (AF) improve as the diagnosis-to-ablation time (DAT) shortens. Use of a protocol-based integrated care model through a dedicated atrial fibrillation clinic (AFC) may serve to standardize treatment pathways and decrease DAT. Objective To evaluate the DAT and clinical characteristics of patients with AF referred from an AFC vs a conventional electrophysiology clinic (EC). Methods Retrospective analysis was completed in consecutive patients undergoing index AF ablation at Riverside Methodist Hospital in 2019 with minimum 1 year follow-up. Patients were categorized based off their CA referral source (AFC vs EC) and where the initial visit following index diagnosis of AF occurred (AFC vs EC). Results A total of 182 patients (mean age 65 years, 64% male) were reviewed. Patients referred from an AFC (21%) had a median DAT of 342 days (interquartile range [IQR], 125-855 days) compared to patients referred from EC (79%) with a median DAT of 813 days (IQR, 241-1444 days; P = .01). Patients with their index visit following AF diagnosis occurring in the AFC (9%) had significantly shorter median DAT (127 days [IQR, 95-188 days]) compared to EC (91%) (789 days [IQR, 253-1503 days]; P = .002). Patients with DAT <1 year had lower AF recurrence than patients with DAT >1 year (P = .04, hazard ratio = 0.58, 95% confidence interval 0.3418-1.000). Conclusion DAT is a modifiable factor that may affect CA outcomes. Significant reductions in DAT were observed in patients evaluated through a dedicated AF clinic.
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Affiliation(s)
- Andrea Robinson
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, Ohio,Address reprint requests and correspondence: Ms Andrea Robinson, Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, 3535 Olentangy River Rd, Columbus, OH 43214.
| | - Nagesh Chopra
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, Ohio
| | - Auroa G. Badin
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, Ohio
| | - Sreedhar R. Billakanty
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, Ohio
| | - Keaira Cooper
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, Ohio
| | - Eugene Y. Fu
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, Ohio
| | - Jennifer James
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, Ohio
| | - Victoria Murnane
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, Ohio
| | - Jill Swinning
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, Ohio
| | - Mitchell Stelzer
- Department of Internal Medicine, OhioHealth Doctors Hospital, Columbus, Ohio
| | - Jaret D. Tyler
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, Ohio
| | - Anish K. Amin
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, Ohio
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Stelzer M, Blankenship J, Luli J, Kleman JM, Fu EY, Billakanty SR, Chopra N, Badin A, Tyler J, Amin AK. PO-626-08 LEFT ATRIAL APPENDAGE OCCLUSION WITH LEFT ATRIAL FOUR DIMENSIONAL INTRACARDIAC ECHOCARDIOGRAPHY. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Stelzer M, Robinson A, Billakanty SR, Chopra N, Kleman JM, Blankenship J, Luli J, Badin A, Tyler J, Yakubov S, Amin AK. PO-671-03 LEFT ATRIAL APPENDAGE EARLY EXPERIENCE USING FOUR DIMENSIONAL INTRACARDIAC ECHOCARDIOGRAPHY. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Robinson A, Badin A, Billakanty SR, Chopra N, Fu EY, James JL, Kleman JM, Loessin B, Murnane V, Swinning J, Tyler J, Amin AK. PO-627-04 THREE YEAR COST SAVINGS OF AN ACUTE ATRIAL FIBRILLATION PATHWAY. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Khan ZA, LaBreck ME, Luli J, Roberts C, Smith A, El-Zein R, Tyler JD, Fu EY, Billakanty SR, Amin AK, Chopra N. Longitudinal QT c Stability and Impact of Baseline Cardiac Rhythm on Discharge Dose in Dofetilide-treated Patients. J Cardiovasc Electrophysiol 2022; 33:1281-1289. [PMID: 35362175 DOI: 10.1111/jce.15483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 03/03/2022] [Accepted: 03/30/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dofetilide suppresses AF in a dose-dependent fashion. The protective effect of AF against QTc prolongation induced torsades de pointe and transient post-cardioversion QTc prolongation may result in dofetilide under-dosing during initiation. Thus, the optimal timing of cardioversion for AF patients undergoing dofetilide initiation to optimize discharge dose remains unknown as does the longitudinal stability of QTc . OBJECTIVE To evaluate the impact of baseline rhythm on dofetilide dosing during initiation and assess the longitudinal stability of QTc-all (Bazzett, Fridericia, Framingham, and Hodges) over time. METHODS Medical records of patients who underwent pre-planned dofetilide loading at a tertiary care center between January 2016-2019 were reviewed. RESULTS A total of 198 patients (66±10 years, 32% female, CHADS2 -Vasc 3 [2-4]) presented for dofetilide loading in either AF (59%) or SR (41%). Neither presenting rhythm, nor spontaneous conversion to SR impacted discharge dose. The cumulative dofetilide dose prior to cardioversion moderately correlated (r=0.36; p=0.0001) with discharge dose. Post-cardioversion QTc-all prolongation (p<0.0001) prompted discharge dose reduction (890±224mcg vs 552±199mcg; p<0.0001) in 30% patients. QTc-all in SR prolonged significantly during loading (p<0.0001). All patients displayed QTc-all reduction (p<0.0001) from discharge to short-term (46 [34-65] days) that continued at long-term (360 [296-414] days) follow-ups. The extent of QTc-all reduction over time moderately correlated with discharge QTc-all (r=0.54-0.65; p<0.0001). CONCLUSION Dofetilide initiation prior to cardioversion is equivalent to initiation during SR. Significant QTc reduction proportional to discharge QTc is seen over time in all dofetilide-treated patients. QTc returns to pre-loading baseline during follow-up in patients initiated in SR. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Zeryab A Khan
- Department of Internal Medicine, OhioHealth Doctors Hospital, 5100 West Broad Street Columbus, OH, 43228
| | - Megan E LaBreck
- Department of Pharmacy, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH, 43214
| | - Jordan Luli
- Department of Internal Medicine, OhioHealth Doctors Hospital, 5100 West Broad Street Columbus, OH, 43228
| | - Chelsea Roberts
- Department of Pharmacy, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH, 43214
| | - Alexander Smith
- Department of Internal Medicine, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH, 43214, USA
| | - Rayan El-Zein
- Department of Internal Medicine, OhioHealth Doctors Hospital, 5100 West Broad Street Columbus, OH, 43228
| | - Jaret D Tyler
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH, 43214, USA
| | - Eugene Y Fu
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH, 43214, USA
| | - Sreedhar R Billakanty
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH, 43214, USA
| | - Anish K Amin
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH, 43214, USA
| | - Nagesh Chopra
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH, 43214, USA
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Smith A, Amin AK, El‐Zein R, Billakanty SR, Chopra N. Relationship between Surpoint Tag Index, a Radiofrequency Ablation lesion quality indicator, and Atrial wall thickness in Cavotricuspid isthmus Ablations exhibiting bidirectional block. J Arrhythm 2021; 38:118-125. [PMID: 35222758 PMCID: PMC8851572 DOI: 10.1002/joa3.12662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/28/2021] [Accepted: 11/11/2021] [Indexed: 11/16/2022] Open
Abstract
Background An RFA lesion quality indicator, Surpoint Tag Index® (TI) incorporates key factors: power, time, and contact force, impacting lesion quality. TI accurately estimates lesion depth in animal studies. However, the relationship between TI and in‐vivo atrial wall thickness in patients exhibiting bidirectional block remains unknown. Objective To describe the relationship between atrial wall thickness and TI in CTI exhibiting bidirectional block. Methods Data from 492 RFA lesions from 25 patients undergoing PVI and CTI ablations in SR with point‐by‐point RF lesions (<45 W) utilizing a Thermocool Smarttouch® SF ablation catheter and CARTO‐3 mapping were retrospectively analyzed. Operators were blinded to TI data and CTI thickness. CTI thickness was obtained using ICE images on Cartosound pre‐ablation. Durable lesions were defined as part of a lesion set exhibiting bidirectional block of >30 min. Results In lesions exhibiting bidirectional block, the thinnest (1–2 mm; 5% lesions) and thickest (8–10 mm; 6% lesions) portions of the CTI correlated with the lowest (429 ± 75) and highest (516 ± 64) TI. The bulk of thickness (2–6 mm; 80%) correlated with a TI of 455 ± 72 (p = 0.001). There was a weak but positive correlation between TI and CTI thickness (r = 0.2; p ≤ 0.01). Examined in sectors, the anterior 1/3rd CTI was the thickest (4.8 ± 1.9 mm) but correlated with a similar TI value (479 ± 75 vs. 471 ± 70; p = 0.34) as the thinner middle 1/3rd (3.8 ± 1.7 mm; p ≤ 0.0001). Conclusion A mean TI value of 455 correlates with bidirectional block across the bulk of CTI with lower and higher values needed for the thinner and thicker portions, respectively. Tissue composition, aside from wall thickness, influences TI values for the creation of the bidirectional block.
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Affiliation(s)
- Alexander Smith
- Department of Internal Medicine Riverside Methodist Hospital Columbus Ohio USA
| | - Anish K. Amin
- Section of Cardiac Electrophysiology Department of Cardiology OhioHealth Heart and Vascular PhysiciansRiverside Methodist Hospital Columbus Ohio USA
| | - Rayan El‐Zein
- Department of Internal Medicine OhioHealth Doctors Hospital Columbus Ohio USA
| | - Sreedhar R. Billakanty
- Section of Cardiac Electrophysiology Department of Cardiology OhioHealth Heart and Vascular PhysiciansRiverside Methodist Hospital Columbus Ohio USA
| | - Nagesh Chopra
- Section of Cardiac Electrophysiology Department of Cardiology OhioHealth Heart and Vascular PhysiciansRiverside Methodist Hospital Columbus Ohio USA
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Amir T, Sheri A, Newby J, King J, Chopra N. 198P Complications associated with prolonged GCSF with dose-dense EC chemotherapy for early breast cancer patients. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Stelzer M, Speakman B, Stahl WK, Billakanty SR, Chopra N, Fu EY, Kidwell GA, Kleman JM, Nelson SD, Nichols AJ, Swinning J, Robinson A, Amin AK. B-PO05-047 EVALUATION OF MECHANICAL PLACEMENT, IMPEDANCE, AND LOW VOLTAGE MEASUREMENT COROLLARY STUDY (EMILY STUDY) FOR THE S-ICD. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Swinning J, Sprott K, Reeser T, Amin AK, Basuray A, Castle L, Chopra N, Fu EY, Kidwell GA, Kleman JM, Nelson SD, Nichols AJ, Saha N, Tyler J, Billakanty S, Billakanty SR. B-PO04-187 CARDIAC RESYNCHRONIZATION THERAPY-HEART FAILURE CLINIC: A NOVEL MODEL OF CARE. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Khan Z, Labreck M, Luli J, Roberts C, Smith A, El-Zein R, Billakanty SR, Amin AK, Chopra N. B-PO02-146 IMPACT OF DOFETILIDE LOADING DURING ATRIAL FIBRILLATION ON DISCHARGE DOSE AND QTC STABILITY OVER 1-YEAR FOLLOW-UP. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Robinson A, Amin AK, Billakanty SR, Fu EY, James J, Kidwell GA, Kleman JM, Murnane V, Nelson SD, Nichols AJ, Smith A, Swinning J, Stelzer M, Tyler J, Chopra N. B-PO04-110 IMPACT OF A DEDICATED ATRIAL FIBRILLATION CLINIC ON DIAGNOSIS-TO-ABLATION TIME. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Serra Elizalde V, Llop-Guevara A, Pearson A, Cruz C, Castroviejo-Bermejo M, Chopra N, Tovey H, Toms C, Kriplani D, Gevensleben H, Roylance R, Chan S, Tutt A, Skene A, Evans A, Davies H, Bliss J, Nik-Zainal S, Balmaña J, Turner N. 1O Detection of homologous recombination repair deficiency (HRD) in treatment-naive early triple-negative breast cancer (TNBC) by RAD51 foci and comparison with DNA-based tests. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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15
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El-Zein RS, Amin AK, Billakanty SR, Fu EY, Nichols AJ, Nelson SD, Kleman JM, Kidwell GA, Chopra N. Relationship between right ventricular pacing and non-sustained ventricular arrhythmias in patients with dual-chamber pacemaker and normal range left ventricular ejection fraction. Int J Arrhythm 2020. [DOI: 10.1186/s42444-020-00022-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Right ventricular pacing (RVP) increases heart failure, AF, and death rates in pacemaker patients and ventricular arrhythmias (VAs) in defibrillator patients. However, the impact of RVP on VAs burden and its clinical significance in pacemaker patients with normal range LVEF of > 50–55% remains unknown. We sought to evaluate the relationship of RVP and VAs and its clinical impact in a pacemaker patient population.
Methods
Records of 105 patients who underwent denovo dual-chamber pacemaker implant or a generator change (Medtronic™ or Boston Scientific™) for AV block and sinus node disease at a tertiary care center between September 1, 2015, and September 1, 2016, were retrospectively reviewed.
Results
Data from 105 patients (51% females, mean age 76 ± 1 years, mean LVEF 61 ± 0.7%) without history of VAs (98.2%) were reviewed over 1044 ± 23 days. Dependent patients (100% RVP) exhibited the lowest VAs burden when compared to < 100% RVP (isolated PVCs, PVC runs of < 4 beats, and NSVT; p ≤ 0.001). Patients with < 1% RVP also exhibited low VA burden with intermediate RVP (1–99.9%) being most arrhythmogenic for PVC runs (p = 0.04) and for isolated PVCs (p = 0.006). Antiarrhythmics/beta and calcium channel blockers use and stress tests performed to evaluate VAs which were positive requiring intervention did not differ significantly. Burden of > 1/h of PVC runs and increasing PVC runs/h were significantly associated with hospitalization (p = 0.04) and all-cause mortality (p = 0.03), respectively.
Conclusions
In pacemaker patients with normal range LVEF (> 50–55%), 100% RVP is associated with the lowest burden of NSVT. Furthermore, patients with < 1% RVP also exhibit low VA burden; however, intermittent RVP seems to significantly correlate with non-sustained VAs.
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Wu A, Sng C, Benafif S, Chopra N, Galazi M, Lee A, Ottaviani D, Soosaipillai G, Wong Y, Shaw H. 1704P COVID-19 mortality in patients receiving anti-cancer therapy in a UK national cancer centre. Ann Oncol 2020. [PMCID: PMC7506396 DOI: 10.1016/j.annonc.2020.08.1768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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17
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Soosaipillai G, Sureda A, Maluquer Artigal C, Benafif S, Chopra N, Harbeck N, Wuerstlein R, Mesia Nin R, Felip E, Ottaviani D, Galazi M, Lee A, Salazar R, Sharkey R, Reyes R, Evans J, Carmona Garcia M, Tabernero J, Prat A, Pinato D. 1671MO Provision of palliative care for patients with cancer and SARS-CoV-2 infection. Ann Oncol 2020. [PMCID: PMC7506333 DOI: 10.1016/j.annonc.2020.08.1736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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18
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Lam J, Bridgewater J, Alani M, Mullamitha S, Braun M, Kunene V, Baijal S, Holden C, Aboud K, Chopra N, Escola CL, Rao A, Samuel L, Denton A, Grumett S, Melcher L, Muthuramalingam S, Sankey P, Saunders M, Shiu KK. 502P Nivolumab, alone or with ipilimumab, for mismatch repair deficient metastatic colorectal cancer: A United Kingdom multicentre analysis of patient outcomes. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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19
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Swinning J, Fox K, Billakanty S, Brown S, Chopra N, Fu E, James J, Kidwell G, Kleman J, Murnane V, Nelson S, Nichols A, Nichols SK, Robinson A, Amin A. Same-day Discharge after Subcutaneous Implantable Cardioverter-defibrillator Implantation is Safe and Cost-effective. J Innov Card Rhythm Manag 2020; 11:4123-4125. [PMID: 32596027 PMCID: PMC7313622 DOI: 10.19102/icrm.2020.110602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 12/02/2019] [Indexed: 11/17/2022] Open
Abstract
The feasibility and safety of same-day discharge after transvenous implantable cardioverter-defibrillator implantation is well-established. However, subcutaneous ICDs (S-ICDs) are now increasingly being implanted, and the feasibility, safety, and potential cost savings associated with same-day discharge after S-ICD placement has not been widely investigated. In a small cohort of patients (n = 24) who underwent S-ICD implantation at our institution, 54% were successfully discharged on the same day as their implant procedure. Procedure-related complications were not apparent in this sampling and the reduction in health care costs was high, suggesting this protocol has immense benefit in today’s health care environment. As such, same-day discharge of S-ICD patients is appropriate to consider and should receive further attention.
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Affiliation(s)
- Jill Swinning
- OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, OH, USA
| | - Kelli Fox
- OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, OH, USA
| | - Sreedhar Billakanty
- OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, OH, USA
| | - Shannon Brown
- OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, OH, USA
| | - Nagesh Chopra
- OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, OH, USA
| | - Eugene Fu
- OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, OH, USA
| | - Jennifer James
- OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, OH, USA
| | - Gregory Kidwell
- OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, OH, USA
| | - James Kleman
- OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, OH, USA
| | - Victoria Murnane
- OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, OH, USA
| | - Steven Nelson
- OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, OH, USA
| | - Allan Nichols
- OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, OH, USA
| | - S Kay Nichols
- OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, OH, USA
| | - Andrea Robinson
- OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, OH, USA
| | - Anish Amin
- OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, OH, USA
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20
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Miyashita H, Mikami T, Chopra N, Yamada T, Chernyavsky S, Rizk D, Cruz C. Do patients with cancer have a poorer prognosis of COVID-19? An experience in New York City. Ann Oncol 2020; 31:1088-1089. [PMID: 32330541 PMCID: PMC7172785 DOI: 10.1016/j.annonc.2020.04.006] [Citation(s) in RCA: 286] [Impact Index Per Article: 71.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
- H Miyashita
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, NY, USA.
| | - T Mikami
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, NY, USA
| | - N Chopra
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, NY, USA
| | - T Yamada
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, NY, USA
| | - S Chernyavsky
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, NY, USA
| | - D Rizk
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, NY, USA
| | - C Cruz
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, NY, USA
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21
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El-Zein R, Stelzer M, Hatanelas J, Thomas G, Billakanty S, Chopra N, Fu E, Nelson SD, Nichols AJ, Kidwell G, Kleman J, Calnon DA, Grewal KS, Matros TG, Mukherjee JT, Richards DR, Wada A, Amin A. A GHOST LEFT BEHIND AFTER TRANSVENOUS LEAD EXTRACTION: A FINDING TO BE FEARED. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)33226-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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22
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Closier P, Chopra N, Mark F, Jenner A, McCartney T, Copson E. A National Retrospective Multicentre Audit of Long-term Trastuzumab Use in Metastatic Breast Cancer: Breast Cancer Trainees Research Collaborative Group (BCTRCG). Clin Oncol (R Coll Radiol) 2019. [DOI: 10.1016/j.clon.2019.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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Chopra N, Amin AK, Gupta A, Fu EY, Nichols AJ, Nelson SD, Kleman JM, Kleman JM, Kidwell GA, Billakanty SR. Clinical Impact of Saline Volume Infused Through Irrigated-Tip Ablation Catheter in Low Acuity Paroxysmal Atrial Fibrillation Ablation Patients. J Atr Fibrillation 2019; 11:2093. [PMID: 31139287 DOI: 10.4022/jafib.2093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 08/19/2017] [Accepted: 09/14/2018] [Indexed: 11/10/2022]
Abstract
Background Radio-Frequency ablation (RFA) to achieve pulmonary vein isolation (PVI) remains mainstay therapy for symptomatic paroxysmal atrial fibrillation (PAF). The clinical consequences of large saline infusions during AF ablation have not been systematically studied. We utilized the differential flow-rates of the two commercially available ablation catheters (AC): 'ThermoCool' (TCAC) and 'Surround Flow' (SFAC) from Biosense-Webster to evaluate the clinical impact of the saline infused in the immediate post-ablation period. Methods Consecutive charts of PAF patients between 18 and 81 years who underwent RFA procedure at a tertiary care hospital were reviewed. Results Forty-seven patients were included in the study (33Males, 65±11years, LVEF 58±7% and left atrial diameter 44±7.5mm, 23TCAC-use). The saline volume infused through the AC was significantly higher with TCAC vs SFAC use (1277±316vs697±299 ml; p<0.001), with no difference in volume infused from other sources, total procedure or RFA times (p>0.05). This led to significant increase in post-ablation weight gain (96±23 vs 97.5±24kg; p=0.002), furosemide usage (39% vs 0%; p=0.0006), urine production (120±79 vs 63±31ml/hr; p=0.003) and post-RFA potassium reduction (4.4±0.42 vs 4±0.32mmol/l; p<0.001) with TCAC use. Significant post-RFA reduction in magnesium, calcium and creatinine, associated hyperchloremic metabolic acidosis and a modest QTc prolongation were also observed with use of both ACs albeit only moderate to weakly correlated with saline volume infused through the AC. No clinical adverse outcomes were encountered. Conclusions Higher saline-volume infusing AC use in PAF ablation causes significant post-ablation weight gain despite higher furosemide use, larger urine production and associated post-RFA potassium reduction without increasing morbidity in lower acuity patients. Furthermore, an array of post-ablation electrolyte disturbances causes a modest and clinically insignificant QTc prolongation.
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Affiliation(s)
- Nagesh Chopra
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH 43214, USA
| | - Anish K Amin
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH 43214, USA
| | - Anand Gupta
- OhioHealth Research and Innovation Institute (OHRI), 3545 Olentangy River Road, Suite 310, Columbus, OH 43214, USA
| | - Eugene Y Fu
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH 43214, USA
| | - Allan J Nichols
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH 43214, USA
| | - Steven D Nelson
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH 43214, USA
| | - James M Kleman
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH 43214, USA
| | - James M Kleman
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH 43214, USA
| | - Gregory A Kidwell
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH 43214, USA
| | - Sreedhar R Billakanty
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH 43214, USA
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24
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Battisti NML, True V, Chaabouni N, Chopra N, Lee K, Shepherd S, Shapira-Rotenberg T, Joshi R, Mohammed K, Allen M, Ring A. Abstract P1-15-08: Pathologic complete response rates following neoadjuvant systemic therapy in 794 patients with early breast cancer: The Royal Marsden experience. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-15-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
The presence and extent of residual invasive cancer after neoadjuvant treatment (NACT) is a strong prognostic factor for risk of recurrence, especially in triple-negative (TN) and human epidermal growth factor receptor 2-positive (HER2+) breast cancer (BC). Recent advances in the standard-of-care NACT improved pathological complete response (pCR) rates in published clinical trials.
We evaluated the pCR rates, defined as ypT0-is ypN0, in our real-world BC population and in estrogen receptor-positive [ER+] HER2-, HER2+ and TN subgroups and their association with tumour, patients' characteristics and disease-free survival (DFS).
Methods
We retrospectively identified early BC patients receiving NACT between January 2013 and December 2017. Demographics, patient and disease characteristics, pathological responses, toxicities, dose delays and reductions were recorded. Simple statistics, Fisher's exact test, chi-squared method and Cox regression were used as appropriate.
Results
794 patients identified had median age of 50 years (range 24-87) and 93.9% (745 patients) ECOG performance status (PS) 0. 3.0% (24) had clinical stage I disease, 68.0% (540) stage II and 29.0% (230) stage III. 71.0% (564) had grade 3 disease and 91.8% (729) ductal histology. 33.7% (257) had ER+/HER2-, 25.8% (205) had TN and 38.0% (301) HER2+ disease. Overall, 6.8% (54) patients received platinum. 36.6% (291) patients had dose reductions and 24.3% (193) dose delays. Along with NACT, 51.6% (147) of the HER2+ patients received Trastuzumab and Pertuzumab and 48.4% (138) Trastuzumab alone.
pCR rate was 33.1% in the overall population and significantly different in ER+/HER2-, HER2+ and TN subgroups (12.84% versus 52.0% versus 28.43% respectively, p<0.001). pCR was influenced by grade (1: 0%; 2: 24.3%; 3: 36.1%, p 0.005) and histology (ductal: 34.2%; lobular: 10.0%; mixed 25.0%; p 0.01). In the HER2+ subgroup, there was a trend for improved pCR rates for patients receiving Pertuzumab and Trastuzumab (57.0%) versus Trastuzumab alone (51.0%). No statistically significant differences were seen based on patients' characteristics including age and PS or in case of treatment dose reductions and delays. Early discontinuation of NACT was associated with lower pCR rates (20.5% vs 36.29%, p <0.001).
Of interest, pCR rates remained consistent across the period 2013-2017 in the overall population. We observed a trend for improved pCR in the HER2+ (2013: 47.5%; 2014: 44.4%; 2015: 66.7%; 2016: 51.0%; 2017: 51.4%) and TN cohorts (2013: 23.5%; 2014: 25.0%; 2015: 25.0%; 2016: 33.3%; 2017: 34.1%) but not in the ER+/HER2- group.
Median DFS was 83.8 months (95% CI 62.0-NR) in the overall population. Although not reached in the TN cohort, median DFS was different according to disease subgroups (HER2+: 83.78 months; TN: NR; ER+/HER2-: 62.0 months, p <0.0001).
Conclusions
In our analysis pCR rates are consistent with data published in literature and higher in HER2+ and TN disease. The impact of new agents had a relatively low impact on pCR rates in our overall population over the last 5 years, although they produced gradual improvements in the HER2+ and TN subgroups.
Citation Format: Battisti NML, True V, Chaabouni N, Chopra N, Lee K, Shepherd S, Shapira-Rotenberg T, Joshi R, Mohammed K, Allen M, Ring A. Pathologic complete response rates following neoadjuvant systemic therapy in 794 patients with early breast cancer: The Royal Marsden experience [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-15-08.
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Affiliation(s)
- NML Battisti
- The Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom
| | - V True
- The Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom
| | - N Chaabouni
- The Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom
| | - N Chopra
- The Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom
| | - K Lee
- The Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom
| | - S Shepherd
- The Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom
| | | | - R Joshi
- The Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom
| | - K Mohammed
- The Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom
| | - M Allen
- The Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom
| | - A Ring
- The Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom
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25
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Turner N, Garcia-Murillas I, Chopra N, Comino-Mendez I, Beaney M, Tovey H, Cutts R, Swift C, Kriplani D, Afentakis M, Hrebien S, Walsh G, Johnston S, Ring A, Russell S, Evans A, Skene A, Wheatley D, Dowsett M, Smith I. Abstract P4-01-01: Molecular residual disease detection with circulating tumor DNA analysis predicts relapse in patients with early stage breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-01-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background. Detection of circulating tumor DNA (ctDNA) after treatment of early stage breast cancer may identify molecular residual disease. In a prior proof-of-principle study we demonstrated that detection of ctDNA predicted relapse with high accuracy (Garcia-Murillas et al Science Trans Med 2015). We conducted an independent, prospective, multi-centre validation study.
Methods. In this validation study, a cohort of 170 early stage breast cancer patients were recruited from five hospitals into two prospective sample collection studies. Patients were scheduled to receive standard chemotherapy, surgery +/- radiotherapy, adjuvant endocrine therapy and HER2 antibodies as appropriate. Plasma samples were collected for ctDNA analysis at baseline, post-surgery, three monthly for the first year of follow-up, and six monthly thereafter and shipped to a central lab for processing. Using previously established criteria, tumor was sequenced to identify somatic mutations that were tracked by digital PCR in DNA extracted from 4mls of plasma at all available time points. Buffy coat DNA was analysed at all time-points to control for clonal haematopoesis of indeterminate potential (CHIP) detection. The primary endpoint was to compare invasive disease free survival between patients with and without detection of ctDNA after treatment. A combined analysis of this validation study, and the prior proof-of-principle study, was also conducted to analyse secondary endpoints.
Results. After tumor sequencing, 101 patients from the validation study had at least one mutation to track. At median 35.5 months follow-up, ctDNA was detected in plasma of 15.8% (16/101) patients. Detection of ctDNA strongly predicted relapse, hazard ratio 24.5 (95% CI 6.5 to 93.2, P<0.001 time-dependent Cox model), and was predictive of relapse in all tumor subtypes.
In the combined analysis (N=144), lead-time between ctDNA detection and relapse was 10.7 months (95% CI 7.7-17.0). Six patients had a clinical relapse that was not detected by ctDNA prior to relapse. These patients had a distinct pattern of oligo-metastatic relapse, 3 patients with brain-only metastases (P=0.0068), 1 ovarian oligo-metastasis and 2 local disease recurrence. The level of ctDNA in baseline plasma, prior to treatment, was associated with tumor subtype, highest in triple negative breast cancer (P=0.0036).
Conclusion. Detection of ctDNA after treatment is associated with a high risk of future relapse in early-stage breast cancer. Prospective studies are required to assess the potential of molecular residual disease detection to guide adjuvant therapy.
Citation Format: Turner N, Garcia-Murillas I, Chopra N, Comino-Mendez I, Beaney M, Tovey H, Cutts R, Swift C, Kriplani D, Afentakis M, Hrebien S, Walsh G, Johnston S, Ring A, Russell S, Evans A, Skene A, Wheatley D, Dowsett M, Smith I. Molecular residual disease detection with circulating tumor DNA analysis predicts relapse in patients with early stage breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-01-01.
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Affiliation(s)
- N Turner
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - I Garcia-Murillas
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - N Chopra
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - I Comino-Mendez
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - M Beaney
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - H Tovey
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - R Cutts
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - C Swift
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - D Kriplani
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - M Afentakis
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - S Hrebien
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - G Walsh
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - S Johnston
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - A Ring
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - S Russell
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - A Evans
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - A Skene
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - D Wheatley
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - M Dowsett
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - I Smith
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
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Chopra N, Tong MS, Yakubov SJ. Very late occurrence of complete heart block without preexisting atrioventricular conduction abnormalities: A rare complication after transaortic valvular replacement. HeartRhythm Case Rep 2018; 4:77-81. [PMID: 29876294 PMCID: PMC5988476 DOI: 10.1016/j.hrcr.2017.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Nagesh Chopra
- OhioHealth Heart & Vascular Physicians, Section of Cardiac Electrophysiology, Department of Cardiology, Riverside Methodist Hospital, Columbus, Ohio
| | - Matthew S Tong
- Department of Cardiology, OhioHealth Doctors Hospital, Columbus, Ohio
| | - Steven J Yakubov
- Interventional Cardiology/Structural Heart Disease, OhioHealth Heart & Vascular Physicians, Columbus, Ohio
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Turner NC, Garcia-Murillas I, Chopra N, Beaney M, Cutts RJ, Swift C, Kriplani D, Morden J, Hrebien S, Comino-Mendez I, Afentakis M, Bliss J, Skene A, Wheatley D, Russell S, Evans A, Dowsett M, Smith IE. Abstract P2-02-01: Withdrawn. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-02-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was withdrawn by the authors.
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Affiliation(s)
- NC Turner
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Clinical Trials & Statistics Unit, The Institute of Cancer Research, London, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Hichingbrooke Hospital, Hungtindon, United Kingdom; Poole Hospital, Poole, United Kingdom
| | - I Garcia-Murillas
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Clinical Trials & Statistics Unit, The Institute of Cancer Research, London, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Hichingbrooke Hospital, Hungtindon, United Kingdom; Poole Hospital, Poole, United Kingdom
| | - N Chopra
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Clinical Trials & Statistics Unit, The Institute of Cancer Research, London, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Hichingbrooke Hospital, Hungtindon, United Kingdom; Poole Hospital, Poole, United Kingdom
| | - M Beaney
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Clinical Trials & Statistics Unit, The Institute of Cancer Research, London, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Hichingbrooke Hospital, Hungtindon, United Kingdom; Poole Hospital, Poole, United Kingdom
| | - RJ Cutts
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Clinical Trials & Statistics Unit, The Institute of Cancer Research, London, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Hichingbrooke Hospital, Hungtindon, United Kingdom; Poole Hospital, Poole, United Kingdom
| | - C Swift
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Clinical Trials & Statistics Unit, The Institute of Cancer Research, London, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Hichingbrooke Hospital, Hungtindon, United Kingdom; Poole Hospital, Poole, United Kingdom
| | - D Kriplani
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Clinical Trials & Statistics Unit, The Institute of Cancer Research, London, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Hichingbrooke Hospital, Hungtindon, United Kingdom; Poole Hospital, Poole, United Kingdom
| | - J Morden
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Clinical Trials & Statistics Unit, The Institute of Cancer Research, London, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Hichingbrooke Hospital, Hungtindon, United Kingdom; Poole Hospital, Poole, United Kingdom
| | - S Hrebien
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Clinical Trials & Statistics Unit, The Institute of Cancer Research, London, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Hichingbrooke Hospital, Hungtindon, United Kingdom; Poole Hospital, Poole, United Kingdom
| | - I Comino-Mendez
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Clinical Trials & Statistics Unit, The Institute of Cancer Research, London, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Hichingbrooke Hospital, Hungtindon, United Kingdom; Poole Hospital, Poole, United Kingdom
| | - M Afentakis
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Clinical Trials & Statistics Unit, The Institute of Cancer Research, London, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Hichingbrooke Hospital, Hungtindon, United Kingdom; Poole Hospital, Poole, United Kingdom
| | - J Bliss
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Clinical Trials & Statistics Unit, The Institute of Cancer Research, London, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Hichingbrooke Hospital, Hungtindon, United Kingdom; Poole Hospital, Poole, United Kingdom
| | - A Skene
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Clinical Trials & Statistics Unit, The Institute of Cancer Research, London, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Hichingbrooke Hospital, Hungtindon, United Kingdom; Poole Hospital, Poole, United Kingdom
| | - D Wheatley
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Clinical Trials & Statistics Unit, The Institute of Cancer Research, London, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Hichingbrooke Hospital, Hungtindon, United Kingdom; Poole Hospital, Poole, United Kingdom
| | - S Russell
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Clinical Trials & Statistics Unit, The Institute of Cancer Research, London, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Hichingbrooke Hospital, Hungtindon, United Kingdom; Poole Hospital, Poole, United Kingdom
| | - A Evans
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Clinical Trials & Statistics Unit, The Institute of Cancer Research, London, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Hichingbrooke Hospital, Hungtindon, United Kingdom; Poole Hospital, Poole, United Kingdom
| | - M Dowsett
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Clinical Trials & Statistics Unit, The Institute of Cancer Research, London, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Hichingbrooke Hospital, Hungtindon, United Kingdom; Poole Hospital, Poole, United Kingdom
| | - IE Smith
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Clinical Trials & Statistics Unit, The Institute of Cancer Research, London, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Hichingbrooke Hospital, Hungtindon, United Kingdom; Poole Hospital, Poole, United Kingdom
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Amin AK, Billakanty SR, Chopra N, Fu EY, Nichols AJ, Kleman JM, Kidwell GA. Premature ventricular contraction-induced polymorphic ventricular tachycardia after leadless pacemaker implantation: A unique adverse effect of leadless pacing. HeartRhythm Case Rep 2018; 4:180-183. [PMID: 29915713 PMCID: PMC6003784 DOI: 10.1016/j.hrcr.2018.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Anish K Amin
- OhioHealth Heart & Vascular Physicians, Section of Cardiac Electrophysiology, Department of Cardiology, Riverside Methodist Hospital, Columbus, Ohio
| | - Sreedhar R Billakanty
- OhioHealth Heart & Vascular Physicians, Section of Cardiac Electrophysiology, Department of Cardiology, Riverside Methodist Hospital, Columbus, Ohio
| | - Nagesh Chopra
- OhioHealth Heart & Vascular Physicians, Section of Cardiac Electrophysiology, Department of Cardiology, Riverside Methodist Hospital, Columbus, Ohio
| | - Eugene Y Fu
- OhioHealth Heart & Vascular Physicians, Section of Cardiac Electrophysiology, Department of Cardiology, Riverside Methodist Hospital, Columbus, Ohio
| | - Allan J Nichols
- OhioHealth Heart & Vascular Physicians, Section of Cardiac Electrophysiology, Department of Cardiology, Riverside Methodist Hospital, Columbus, Ohio
| | - James M Kleman
- OhioHealth Heart & Vascular Physicians, Section of Cardiac Electrophysiology, Department of Cardiology, Riverside Methodist Hospital, Columbus, Ohio
| | - Gregory A Kidwell
- OhioHealth Heart & Vascular Physicians, Section of Cardiac Electrophysiology, Department of Cardiology, Riverside Methodist Hospital, Columbus, Ohio
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Yang Z, Prinsen JK, Bersell KR, Shen W, Yermalitskaya L, Sidorova T, Luis PB, Hall L, Zhang W, Du L, Milne G, Tucker P, George AL, Campbell CM, Pickett RA, Shaffer CM, Chopra N, Yang T, Knollmann BC, Roden DM, Murray KT. Azithromycin Causes a Novel Proarrhythmic Syndrome. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.115.003560. [PMID: 28408648 DOI: 10.1161/circep.115.003560] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 01/26/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND The widely used macrolide antibiotic azithromycin increases risk of cardiovascular and sudden cardiac death, although the underlying mechanisms are unclear. Case reports, including the one we document here, demonstrate that azithromycin can cause rapid, polymorphic ventricular tachycardia in the absence of QT prolongation, indicating a novel proarrhythmic syndrome. We investigated the electrophysiological effects of azithromycin in vivo and in vitro using mice, cardiomyocytes, and human ion channels heterologously expressed in human embryonic kidney (HEK 293) and Chinese hamster ovary (CHO) cells. METHODS AND RESULTS In conscious telemetered mice, acute intraperitoneal and oral administration of azithromycin caused effects consistent with multi-ion channel block, with significant sinus slowing and increased PR, QRS, QT, and QTc intervals, as seen with azithromycin overdose. Similarly, in HL-1 cardiomyocytes, the drug slowed sinus automaticity, reduced phase 0 upstroke slope, and prolonged action potential duration. Acute exposure to azithromycin reduced peak SCN5A currents in HEK cells (IC50=110±3 μmol/L) and Na+ current in mouse ventricular myocytes. However, with chronic (24 hour) exposure, azithromycin caused a ≈2-fold increase in both peak and late SCN5A currents, with findings confirmed for INa in cardiomyocytes. Mild block occurred for K+ currents representing IKr (CHO cells expressing hERG; IC50=219±21 μmol/L) and IKs (CHO cells expressing KCNQ1+KCNE1; IC50=184±12 μmol/L), whereas azithromycin suppressed L-type Ca++ currents (rabbit ventricular myocytes, IC50=66.5±4 μmol/L) and IK1 (HEK cells expressing Kir2.1, IC50=44±3 μmol/L). CONCLUSIONS Chronic exposure to azithromycin increases cardiac Na+ current to promote intracellular Na+ loading, providing a potential mechanistic basis for the novel form of proarrhythmia seen with this macrolide antibiotic.
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Affiliation(s)
- Zhenjiang Yang
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Joseph K Prinsen
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Kevin R Bersell
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Wangzhen Shen
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Liudmila Yermalitskaya
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Tatiana Sidorova
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Paula B Luis
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Lynn Hall
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Wei Zhang
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Liping Du
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Ginger Milne
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Patrick Tucker
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Alfred L George
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Courtney M Campbell
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Robert A Pickett
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Christian M Shaffer
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Nagesh Chopra
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Tao Yang
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Bjorn C Knollmann
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Dan M Roden
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Katherine T Murray
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN.
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Turner NC, Garcia-Murillas I, Chopra N, Beaney M, Kilburn L, Cutts R, Osin P, Nerurkar A, Schiavon G, Hrebien S, Bliss J, Dowsett M, Smith I. Abstract P1-02-01: Circulating tumor DNA analysis to predict relapse and overall survival in early breast cancer – Longer follow-up of a proof-of-principle study. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-02-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
In a previous proof-of-principle study we demonstrated that detection of circulating tumour DNA (ctDNA) in the adjuvant setting, after completion of surgery and chemotherapy for early stage breast cancer, was associated with a high risk of early relapse. Here we present longer follow-up of the same series, to define the predictive power of ctDNA analysis for disease free survival, and assess the potential to predict overall survival.
Methods
We recruited a cohort of 55 women presenting with early stage, primary breast cancer, who were all scheduled to receive neo-adjuvant chemotherapy. The primary tumour was sequenced to identify somatic mutations, identifying at least one mutation in 43 patients. Mutations were tracked with digital PCR to identify ctDNA, in plasma samples taken either at a single post-surgical time point (2-6 weeks post-surgery) or with serial plasma samples taken every 6 months in the adjuvant setting.
Results
At a median 31.7 months follow-up, 42% (18/43) patients had relapsed. Detection of ctDNA at the single post-surgical time point was associated with poor disease free survival, HR=13.6 95%CI (4.5, 41.2) p<0.001, and overall survival HR=84.7 95%CI (9.8, 730.4) p<0.001. All patients with ctDNA detected in a single post-surgical time point relapsed and died in the follow-up period (7/7, 100% specificity), although the single post-surgery time point had modest 39% (7/18) sensitivity for relapse. Detection of ctDNA at any point in serial sampling was associated with poor disease free survival HR=25.7 95%CI (8.3, 79.8) p<0.001 and overall survival HR=47.1 95%CI (6.1, 366.1) p<0.001. All patients with ctDNA detected in a serial mutation tracking relapsed in the follow-up period (14/14, 100% specificity), with 78% (14/18) sensitivity for relapse. Sensitivity was limited by 3 cases of brain only relapse and one case of solitary ovarian relapse. Detection of ctDNA in serial sampling had a median lead-time of 8.1 months over clinical relapse.
Conclusion
Detection of ctDNA in the adjuvant setting has a high predictive power for future relapse and death from breast cancer. Therapeutic trials are required to determine whether mutation tracking identifies relapse sufficiently early to allow for further adjuvant therapy.
Citation Format: Turner NC, Garcia-Murillas I, Chopra N, Beaney M, Kilburn L, Cutts R, Osin P, Nerurkar A, Schiavon G, Hrebien S, Bliss J, Dowsett M, Smith I. Circulating tumor DNA analysis to predict relapse and overall survival in early breast cancer – Longer follow-up of a proof-of-principle study [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-02-01.
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Affiliation(s)
- NC Turner
- Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - I Garcia-Murillas
- Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - N Chopra
- Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - M Beaney
- Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - L Kilburn
- Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - R Cutts
- Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - P Osin
- Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - A Nerurkar
- Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - G Schiavon
- Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - S Hrebien
- Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - J Bliss
- Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - M Dowsett
- Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - I Smith
- Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
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Thomas BE, Sridevi K, Chopra N, Haq W, Rao DN. Inducing a cell-mediated immune response against peptides of thePlasmodium vivaxcircumsporozoite protein. Annals of Tropical Medicine & Parasitology 2016. [DOI: 10.1080/00034983.2001.11813672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Toms C, Chopra N, Houlton L, Jarman K, Kilburn L, Bliss J, Turner N. Window study of the PARP inhibitor rucaparib in patients with primary triple negative or BRCA1/2 related breast cancer (RIO). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw364.75] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Chopra N. A unique case of pulmonary embolism presenting as a paroxysmal atrial tachycardia instigated only by recumbency and stooping. HeartRhythm Case Rep 2016; 2:404-406. [PMID: 28491721 PMCID: PMC5419948 DOI: 10.1016/j.hrcr.2016.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Chopra N, Chillery T, McCutchan E, Chowdhury P, Smith C, Lister C. SU-F-I-56: High-Precision Gamma-Ray Analysis of Medical Isotopes. Med Phys 2016. [DOI: 10.1118/1.4955884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Reichlin T, Lane C, Nagashima K, Nof E, Chopra N, Ng J, Barbhaiya C, Tadros T, John RM, Stevenson WG, Michaud GF. Feasibility, efficacy, and safety of radiofrequency ablation of atrial fibrillation guided by monitoring of the initial impedance decrease as a surrogate of catheter contact. J Cardiovasc Electrophysiol 2015; 26:390-396. [PMID: 25588901 DOI: 10.1111/jce.12621] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 12/26/2014] [Accepted: 12/30/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND The initial impedance decrease during radiofrequency (RF) ablation is an indirect marker of catheter contact and lesion formation. We aimed to assess feasibility, efficacy, and safety of an ablation approach guided by initial impedance decrease. METHODS A total of 25 patients with paroxysmal AF had point-by-point, wide antral pulmonary vein (PV) isolation. RF applications were aborted if a decrease of at least 5 Ω did not occur in the first 10 seconds; otherwise, ablation was continued for at least 20 seconds. Power was 30 Watts and reduced to 15-25 Watts on the posterior wall. RESULTS A total of 28% of RF applications were terminated because of inadequate impedance decrease. The remaining lesions showed a median decrease of 7.6 Ω (IQR 5.0-10.7) at 10 seconds and median duration of RF lesions was 38 seconds. Note that, 100 PVs were isolated with 49 rings. PVI occurred before anatomic completion of the ablation ring of adequate lesions in 39/49 (80%) and concurrent with ring completion in 7/49 (14%). Additional lesions were required in 3/49 (6%) rings. After PVI, additional lesions were required to eliminate dormant conduction in 2/47 (4%) and pace-capture on the ablation line in 24/49 vein pairs (49%). During short-term follow-up, 3 nonfatal esophageal injuries and 2 late pericardial effusions occurred. During a mean follow-up of 431 ± 87 days, 21/25 patients (84%) remained free of recurrent symptomatic atrial arrhythmias. CONCLUSIONS PVI guided by initial impedance decrease is feasible and results in PVI concurrent with or before completion of the ablation ring in 94% of patients. Single procedure efficacy after one year of follow-up was 84%. Near-term complications suggest that deeper lesions are created, indicating that further reduction of RF-power and duration is warranted.
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Affiliation(s)
- Tobias Reichlin
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Division of Cardiology, University Hospital, Basel, Switzerland
| | - Christopher Lane
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Koichi Nagashima
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Eyal Nof
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Nagesh Chopra
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Justin Ng
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Chirag Barbhaiya
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Tomas Tadros
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Roy M John
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - William G Stevenson
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Gregory F Michaud
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Reichlin T, Knecht S, Lane C, Kühne M, Nof E, Chopra N, Tadros TM, Reddy VY, Schaer B, John RM, Osswald S, Stevenson WG, Sticherling C, Michaud GF. Initial impedance decrease as an indicator of good catheter contact: insights from radiofrequency ablation with force sensing catheters. Heart Rhythm 2013; 11:194-201. [PMID: 24177370 DOI: 10.1016/j.hrthm.2013.10.048] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Good catheter-tissue contact force (CF) is critical for transmural and durable lesion formation during radiofrequency (RF) ablation but is difficult to assess in clinical practice. Tissue heating during RF application results in an impedance decrease at the catheter tip. OBJECTIVE The purpose of this study was to correlate achieved CF and initial impedance decreases during atrial fibrillation (AF) ablation. METHODS We correlated achieved CF and initial impedance decreases in patients undergoing ablation for AF with two novel open-irrigated CF-sensing RF catheters (Biosense Webster SmartTouch, n = 647 RF applications; and Endosense TactiCath, n = 637 RF applications). We then compared those impedance decreases to 691 RF applications with a standard open-irrigated RF catheter (Biosense Webster ThermoCool). RESULTS When RF applications with the CF-sensing catheters were analyzed according to an achieved average CF <5 g, 5-10 g, 10-20 g, and >20 g, the initial impedance decreases during ablation were larger with greater CF. Corresponding median values at 20 seconds were 5 Ω (interquartile range [IQR] 2-7), 8 Ω (4-11), 10 Ω (7-16), and 14 Ω (10-19) with the SmartTouch and n/a, 4 Ω (0-10), 8 Ω (5-12), and 13 Ω (8-18) with the TactiCath (P <.001 between categories for both catheters). When RF applications with the SmartTouch (CF-sensing catheter, median achieved CF 12 g) and ThermoCool (standard catheter) were compared, the initial impedance decrease was significantly greater in the CF-sensing group with median decreases of 10 Ω (6-14 Ω) vs 5 Ω (2-10 Ω) at 20 seconds (P <.001 between catheters). CONCLUSION The initial impedance decrease during RF applications in AF ablations is larger when greater catheter contact is achieved. Monitoring of the initial impedance decrease is a widely available indicator of catheter contact and may help to improve formation of durable ablation lesions.
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Affiliation(s)
- Tobias Reichlin
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts; University Hospital, Basel, Switzerland.
| | | | - Christopher Lane
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Eyal Nof
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts; Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Nagesh Chopra
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Thomas M Tadros
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Vivek Y Reddy
- Helmsley Electrophysiology Center, The Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York
| | | | - Roy M John
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - William G Stevenson
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Gregory F Michaud
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
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Lynch C, Tee N, Rouse H, Gordon A, Sati L, Zeiss C, Soygur B, Bassorgun I, Goksu E, Demir R, McGrath J, Groendahl ML, Thuesen L, Andersen AN, Loft A, Smitz J, Adriaenssens T, Vikesa J, Borup R, Mersy E, Kisters N, Macville MVE, Engelen JJM, Consortium SENN, Menheere PPCA, Geraedts JP, Coumans ABC, Frints SGM, Aledani T, Assou S, Traver S, Ait-ahmed O, Dechaud H, Hamamah S, Mizutani E, Suzumori N, Sugiyama C, Hattori Y, Sato T, Ando H, Ozaki Y, Sugiura-Ogasawara M, Wissing M, Kristensen SG, Andersen CY, Mikkelsen AL, Hoest T, Borup R, Groendahl ML, Velthut-Meikas A, Simm J, Metsis M, Salumets A, Palini S, Galluzzi L, De Stefani S, Primiterra M, Wells D, Magnani M, Bulletti C, Vogt PH, Frank-Herrmann P, Bender U, Strowitzki T, Besikoglu B, Heidemann P, Wunsch L, Bettendorf M, Jelinkova L, Vilimova S, Kosarova M, Sebek P, Volemanova E, Kruzelova M, Civisova J, Svobodova L, Sobotka V, Mardesic T, van de Werken C, Santos MA, Eleveld C, Laven JSE, Baart EB, Pylyp LY, Spinenko LA, Zukin VD, Perez-Sanz J, Matorras R, Arluzea J, Bilbao J, Gonzalez-Santiago N, Yeh N, Koff A, Barlas A, Romin Y, Manova-Todorova K, Hoz CDL, Mauri AL, Nascimento AM, Vagnini LD, Petersen CG, Ricci J, Massaro FC, Cavagna M, Pontes A, Oliveira JBA, Baruffi RLR, Franco JG, Wu EX, Ma S, Parriego M, Sole M, Boada M, Coroleu B, Veiga A, Kakourou G, Poulou M, Vrettou C, Destouni A, Traeger-Synodinos J, Kanavakis E, Yatsenko AN, Georgiadis AP, McGuire MM, Zorrilla M, Bunce KD, Peters D, Rajkovic A, Olszewska M, Kurpisz M, Gilbertson AZA, Ottolini CS, Summers MC, Sage K, Handyside AH, Thornhill AR, Griffin DK, Chung MK, Kim JW, Lee JH, Jeong HJ, Kim MH, Ryu MJ, Park SJ, Kang HY, Lee HS, Zimmermann B, Banjevic M, Hill M, Lacroute P, Dodd M, Sigurjonsson S, Lau P, Prosen D, Chopra N, Ryan A, Hall M, McAdoo S, Demko Z, Levy B, Rabinowitz M, Vereczeky A, Kosa ZS, Savay S, Csenki M, Nanassy L, Dudas B, Domotor ZS, Debreceni D, Rossi A, Alegretti JR, Cuzzi J, Bonavita M, Tanada M, Matunaga P, Fettback P, Rosa MB, Maia V, Hassun P, Motta ELA, Piccolomini M, Gomes C, Barros B, Nicoliello M, Matunaga P, Criscuolo T, Bonavita M, Alegretti JR, Miyadahira E, Cuzzi J, Hassun P, Motta ELA, Montjean D, Benkhalifa M, Berthaut I, Griveau JF, Morcel K, Bashamboo A, McElreavey K, Ravel C, Rubio C, Rodrigo L, Mateu E, Mercader A, Peinado V, Buendia P, Milan M, Delgado A, Al-Asmar N, Escrich L, Campos-Galindo I, Garcia-Herrero S, Poo ME, Mir P, Simon C, Reyes-Engel A, Cortes-Rodriguez M, Lendinez A, Perez-Nevot B, Palomares AR, Galdon MR, Ruberti A, Minasi MG, Biricik A, Colasante A, Zavaglia D, Iammarrone E, Fiorentino F, Greco E, Demir N, Ozturk S, Sozen B, Morales R, Lledo B, Ortiz JA, Ten J, Llacer J, Bernabeu R, Nagayoshi M, Tanaka A, Tanaka I, Kusunoki H, Watanabe S, Temel SG, Beyazyurek C, Ekmekci GC, Aybar F, Cinar C, Kahraman S, Nordqvist S, Karehed K, Akerud H, Ottolini CS, Griffin DK, Thornhill AR, Handyside AH, Gultomruk M, Tulay P, Findikli N, Yagmur E, Karlikaya G, Ulug U, Bahceci M, Bargallo MF, Arevalo MR, Salat MM, Barbat IV, Lopez JT, Algam ME, Boluda AB, de Oya GC, Tolmacheva EN, Kashevarova AA, Skryabin NA, Lebedev IN, Semaco E, Belo A, Riboldi M, Cuzzi J, Barros B, Luz L, Criscuolo T, Nobrega N, Matunaga P, Mazetto R, Alegretti JA, Bibancos M, Hassun P, Motta ELA, Serafini P, Neupane J, Vandewoestyne M, Heindryckx B, Deroo T, Lu Y, Ghimire S, Lierman S, Qian C, Deforce D, De Sutter P, Rodrigo L, Rubio C, Mateu E, Peinado V, Milan M, Viloria T, Al-Asmar N, Mercader A, Buendia P, Delgado A, Escrich L, Martinez-Jabaloyas JM, Simon C, Gil-Salom M, Capalbo A, Treff N, Cimadomo D, Tao X, Ferry K, Ubaldi FM, Rienzi L, Scott RT, Katzorke N, Strowitzki T, Vogt HP, Hehr A, Gassner C, Paulmann B, Kowalzyk Z, Klatt M, Krauss S, Seifert D, Seifert B, Hehr U, Minasi MG, Ruberti A, Biricik A, Lobascio M, Zavaglia D, Varricchio MT, Fiorentino F, Greco E, Rubino P, Bono S, Cotarelo RP, Spizzichino L, Biricik A, Colicchia A, Giannini P, Fiorentino F, Suhorutshenko M, Rosenstein-Tamm K, Simm J, Salumets A, Metsis M. Reproductive (epi)genetics. Hum Reprod 2013. [DOI: 10.1093/humrep/det220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Shi W, Venkatachalam K, Gavalas V, Qian D, Andrews R, Bachas LG, Chopra N. The role of plasma treatment on electrochemical capacitance of undoped and nitrogen doped carbon nanotubes. ACTA ACUST UNITED AC 2013. [DOI: 10.1680/nme.12.00033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Chopra N, Knollmann BC. Triadin regulates cardiac muscle couplon structure and microdomain Ca(2+) signalling: a path towards ventricular arrhythmias. Cardiovasc Res 2013; 98:187-91. [PMID: 23396608 DOI: 10.1093/cvr/cvt023] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Since the discovery of triadin >20 years ago as one of the major proteins located in the junctional sarcoplasmic reticulum, the field has come a long way in understanding the pivotal role of triadin in orchestrating sarcoplasmic reticulum Ca(2+)-release and hence excitation-contraction (EC) coupling. Building on the information gathered from earlier lipid bilayer and myocyte overexpression studies, the gene-targeted ablation of Trdn demonstrated triadin's indispensable role for maintaining the structural integrity of the couplon. More recently, the discovery of inherited and acquired diseases displaying altered expression and function of triadin has further emphasized the role of triadin in health and disease. Novel therapeutic approaches could be aimed at correcting the loss of triadin in diseased hearts, and thereby correcting the sub-cellular EC coupling defect. This review summarizes current concepts of the impact of triadin on cardiac EC coupling with a focus towards triadin's role for ventricular arrhythmia.
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Affiliation(s)
- Nagesh Chopra
- Division of Cardiovascular Medicine, Arrhythmia Unit, Brigham and Women's Hospital, Boston, MA, USA
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41
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Yang Z, Chopra N, Knollmann BC, George AL, Campbell CM, Roden DM, Murray KT. Electrophysiologic Effects of Azithromycin in Cardiomyocytes. Biophys J 2013. [DOI: 10.1016/j.bpj.2012.11.1591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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42
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Hoffmayer KS, Bhave PD, Marcus GM, James CA, Tichnell C, Chopra N, Moxey L, Krahn AD, Dixit S, Stevenson W, Calkins H, Badhwar N, Gerstenfeld EP, Scheinman MM. An electrocardiographic scoring system for distinguishing right ventricular outflow tract arrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy from idiopathic ventricular tachycardia. Heart Rhythm 2012; 10:477-82. [PMID: 23246596 DOI: 10.1016/j.hrthm.2012.12.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Ventricular arrhythmias in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) and idiopathic ventricular tachycardia (VT) can share a left bundle branch block/inferior axis morphology. We previously reported electrocardiogram characteristics during outflow tract ventricular arrhythmias that helped distinguish VT related to ARVD/C from idiopathic VT. OBJECTIVE To prospectively validate these criteria. METHODS We created a risk score by using a derivation cohort. Two experienced electrophysiologists blinded to the diagnosis prospectively scored patients with VT/premature ventricular contractions (PVCs) with left bundle branch block/inferior axis pattern in a validation cohort of 37 ARVD/C tracings and 49 idiopathic VT tracings. All patients with ARVD/C had their diagnosis confirmed based on the revised task force criteria. Patients with idiopathic VT were selected based on structurally normal hearts with documented right ventricular outflow tract VT successfully treated with ablation. The scoring system provides 3 points for sinus rhythm anterior T-wave inversions in leads V1-V3 and during ventricular arrhythmia: 2 points for QRS duration in lead I≥120 ms, 2 points for QRS notching, and 1 point for precordial transition at lead V5 or later. RESULTS A score of 5 or greater was able to correctly distinguish ARVD/C from idiopathic VT 93% of the time, with a sensitivity of 84%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 91%. CONCLUSIONS We describe a simple scoring algorithm that uses 12-lead electrocardiogram characteristics to effectively distinguish right ventricular outflow tract arrhythmias originating from patients with ARVD/C versus patients with idiopathic VT.
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Affiliation(s)
- Kurt S Hoffmayer
- Division of Cardiology, University of California, San Francisco, CA 94143-1354, USA
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Frazier RM, Hough WL, Chopra N, Hathcock KW. Advances in graphene-related technologies: synthesis, devices and outlook. Recent Pat Nanotechnol 2012; 6:79-98. [PMID: 22455730 DOI: 10.2174/187221012800270153] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 01/07/2012] [Accepted: 01/31/2012] [Indexed: 05/31/2023]
Abstract
Graphene has been the subject of many scientific investigations since exfoliation methods facilitated isolation of the two-dimensional material. During this time, new synthesis methods have been developed which have opened technological opportunities previously hindered by synthetic constraints. An update on the recent advances in graphene-based technologies, including synthesis and applications into electrical, mechanical and thermal uses will be covered. A special focus on the patent space and commercial landscape will be given in an effort to identify current trends and future commercialization of graphene-related technologies.
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Affiliation(s)
- R M Frazier
- Alabama Innovation and Mentoring of Entrepreneurs Center, The University of Alabama, Tuscaloosa, 35487, USA.
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45
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Parvez B, Chopra N, Rowan S, Vaglio JC, Muhammad R, Roden DM, Darbar D. A common β1-adrenergic receptor polymorphism predicts favorable response to rate-control therapy in atrial fibrillation. J Am Coll Cardiol 2012; 59:49-56. [PMID: 22192668 DOI: 10.1016/j.jacc.2011.08.061] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Revised: 08/07/2011] [Accepted: 08/23/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVES In this study, we evaluated the impact of 2 common β1-adrenergic receptor (β1-AR) polymorphisms (G389R and S49G) in response to ventricular rate control therapy in patients with atrial fibrillation (AF). BACKGROUND Randomized studies have shown that ventricular rate control is an acceptable treatment strategy in patients with AF. However, identification of patients who will adequately respond to rate-control therapy remains a challenge. METHODS We studied 543 subjects (63% men; age 61.8 ± 14 years) prospectively enrolled in the Vanderbilt AF registry and managed with rate-control strategy. A "responder" displayed adequate ventricular rate control based on the AFFIRM (Atrial Fibrillation Follow-Up Investigation of Rhythm Management) criteria: average heart rate (HR) at rest ≤80 beats/min; and maximum HR during a 6-min walk test ≤110 beats/min or average HR during 24-h Holter ≤100 beats/min. RESULTS A total of 295 (54.3%) patients met the AFFIRM criteria. Baseline clinical characteristics were similar in responders and nonresponders except for mean resting HR (76 ± 20 beats/min vs. 70 ± 15 beats/min; p < 0.01) and smoking (6% vs. 1%; p < 0.01). Multiple clinical variables (age, gender, hypertension) failed to predict response to rate-control therapy. By contrast, carriers of Gly variant at 389 were more likely to respond favorably to rate-control therapy; 60% versus 51% in the Arg389Arg genotype, p = 0.04. This association persisted after correction for multiple clinical factors (odds ratio: 1.42, 95% confidence interval: 1.00 to 2.03, p < 0.05). Among responders, subjects carrying the Gly389 variant required the lowest doses of rate-control medications; atenolol: 92 mg versus 68 mg; carvedilol: 44 mg versus 20 mg; metoprolol: 80 mg versus 72 mg; diltiazem: 212 mg versus 180 mg, and verapamil: 276 mg versus 200 mg, respectively (p < 0.01 for all comparisons). CONCLUSIONS We have identified a common β1-AR polymorphism, G389R, that is associated with adequate response to rate-control therapy in AF patients. Gly389 is a loss-of-function variant; consequently, for the same adrenergic stimulation, it produces reduced levels of adenyl cyclase, and hence, attenuates the β-adrenergic cascade. Mechanistically, the effect of rate-control drugs will be synergistic with that of the Gly389 variant, which could possibly explain our findings. These findings represent a step forward in the development of a long-term strategy of selecting treatment options in AF based on genotype.
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Affiliation(s)
- Babar Parvez
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37323, USA
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47
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Drinnan N, Ghani K, Chopra N, Sarkar S, Le Roux P, Anderson C. UP-01.192 Nephroureterectomy for Upper Tract TCC: Can We Predict Outcome? Urology 2011. [DOI: 10.1016/j.urology.2011.07.742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Watanabe H, Yang T, Stroud DM, Lowe JS, Harris L, Atack TC, Wang DW, Hipkens SB, Leake B, Hall L, Kupershmidt S, Chopra N, Magnuson MA, Tanabe N, Knollmann BC, George AL, Roden DM. Striking In vivo phenotype of a disease-associated human SCN5A mutation producing minimal changes in vitro. Circulation 2011; 124:1001-11. [PMID: 21824921 DOI: 10.1161/circulationaha.110.987248] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The D1275N SCN5A mutation has been associated with a range of unusual phenotypes, including conduction disease and dilated cardiomyopathy, as well as atrial and ventricular tachyarrhythmias. However, when D1275N is studied in heterologous expression systems, most studies show near-normal sodium channel function. Thus, the relationship of the variant to the clinical phenotypes remains uncertain. METHODS AND RESULTS We identified D1275N in a patient with atrial flutter, atrial standstill, conduction disease, and sinus node dysfunction. There was no major difference in biophysical properties between wild-type and D1275N channels expressed in Chinese hamster ovary cells or tsA201 cells in the absence or presence of β1 subunits. To determine D1275N function in vivo, the Scn5a locus was modified to knock out the mouse gene, and the full-length wild-type (H) or D1275N (DN) human SCN5A cDNAs were then inserted at the modified locus by recombinase mediated cassette exchange. Mice carrying the DN allele displayed slow conduction, heart block, atrial fibrillation, ventricular tachycardia, and a dilated cardiomyopathy phenotype, with no significant fibrosis or myocyte disarray on histological examination. The DN allele conferred gene-dose-dependent increases in SCN5A mRNA abundance but reduced sodium channel protein abundance and peak sodium current amplitudes (H/H, 41.0±2.9 pA/pF at -30 mV; DN/H, 19.2±3.1 pA/pF, P<0.001 vs. H/H; DN/DN, 9.3±1.1 pA/pF, P<0.001 versus H/H). CONCLUSIONS Although D1275N produces near-normal currents in multiple heterologous expression experiments, our data establish this variant as a pathological mutation that generates conduction slowing, arrhythmias, and a dilated cardiomyopathy phenotype by reducing cardiac sodium current.
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Affiliation(s)
- Hiroshi Watanabe
- Department of Medicine, Vanderbilt University School of Medicine, 2215B Garland Ave, 1285 MRBIV Light Hall, Nashville, TN 37232-0575, USA
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Ypsilantis E, Courtney ED, Chopra N, Karthikesalingam A, Eltayab M, Katsoulas N, Tang TY, Ball RY. Importance of specimen length during temporal artery biopsy. Br J Surg 2011; 98:1556-60. [PMID: 21706476 DOI: 10.1002/bjs.7595] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2011] [Indexed: 11/07/2022]
Abstract
Abstract
Background
Variations in surgical technique of temporal artery biopsy (TAB) performed for diagnosis of giant cell arteritis (GCA) may contribute to high false-negative rates. This was a retrospective analysis of a large database that explored potential associations between specimen length and diagnostic sensitivity of TAB.
Methods
Histopathological reports and medical records of patients who underwent TAB in six hospitals between 2004 and 2009 were reviewed.
Results
A total of 966 biopsies were analysed. The median postfixation specimen length was 1 (range 0·1–8·5) cm and 207 biopsies (21·4 per cent) were positive for GCA. Significant variation in prebiopsy erythrocyte sedimentation rate (ESR), arterial specimen length and positive results was noted amongst hospitals. Multivariable analysis revealed that patient age, ESR value and specimen length were independent predictors of GCA. Positive biopsies had significantly longer median specimen length compared with negative biopsies: 1·2 (range 0·3–8·5) versus 1·0 (0·2–8·0) cm respectively (P = 0·001). Receiver operating characteristic (ROC) analysis identified postfixation specimen length of at least 0·7 cm as the cut-off length with highest positive predictive value for a positive biopsy (area under ROC curve 0·574). Biopsies with specimen length of 0·7 cm or more had a significantly higher rate of positive results than smaller specimens (24·8 versus 12·9 per cent respectively; odds ratio 2·17, P = 0·001).
Conclusion
Specimen length and ESR were independent prognostic factors of a positive TAB result. A uniform referral practice and standard specimen length of approximately 1 cm could help eliminate discrepancies in the results of TAB.
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Affiliation(s)
- E Ypsilantis
- Department of Surgery, Queen Elizabeth Hospital, King's Lynn, UK.
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Abstract
PURPOSE OF REVIEW To survey recent developments in the field of genetics encompassing discovery of new candidate genes, new diagnostic strategies, and new therapies for sudden cardiac death (SCD) syndromes. RECENT FINDINGS In addition to new mutations in known SCD genes, several novel genes not previously implicated in SCD causation have been found, particularly in long QT syndrome (e.g., KCNJ5, AKAP9, SNTA1), idiopathic ventricular fibrillation (e.g., DPP6, KCNJ8), dilated cardiomyopathy (e.g., NEBL), and hypertrophic cardiomyopathy (HCM; e.g., NEXN). Genetic SCD animal models have provided novel insights into the cellular mechanism and pathogenesis of nearly all the major SCD syndromes, which has led to several new drug therapies for patients with genetic arrhythmia syndromes (e.g., flecainide in catecholaminergic polymorphic ventricular tachycardia). Furthermore, genetic contributions to acquired heart diseases are increasingly being recognized. For example, a 21q21 locus is strongly associated with ventricular fibrillation after myocardial infarction. Near this locus is CXADR, a gene encoding a viral receptor implicated in myocarditis and dilated cardiomyopathy. Finally, common variants in cardiac ion channels and proteins likely contribute to common cardiac phenotypes. SUMMARY Major strides have been made in uncovering new genes, mechanisms, and syndromes that have significantly advanced the diagnosis and treatment of genetic SCD disorders.
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Affiliation(s)
| | - Björn C. Knollmann
- Division of Clinical Pharmacology, Departments of Medicine and Pharmacology
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