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Trohman RG. Etiologies, Mechanisms, Management, and Outcomes of Electrical Storm. J Intensive Care Med 2024; 39:99-117. [PMID: 37731333 DOI: 10.1177/08850666231192050] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Electrical storm (ES) is characterized by three or more discrete sustained ventricular tachyarrhythmia episodes occurring within a limited time frame (generally ≤ 24 h) or an incessant ventricular tachyarrhythmia lasting > 12 h. In patients with an implantable cardioverterdefibrillator (ICD), ES is defined as three or more appropriate device therapies, separated from each other by at least 5 min, which occur within a 24-h period. ES may constitute a medical emergency, depending on the number arrhythmic episodes, their duration, the type, and the cycle length of the ventricular arrhythmias, as well as the underlying ventricular function. This narrative review was facilitated by a search of MEDLINE to identify peer-reviewed clinical trials, randomized controlled trials, meta-analyses, and other clinically relevant studies. The search was limited to English-language reports published between 1999 and 2023. ES was searched using the terms mechanisms, genetics, channelopathies, management, pharmacological therapy, sedation, neuraxial modulation, cardiac sympathetic denervation, ICDs, and structural heart disease. Google and Google scholar as well as bibliographies of identified articles were reviewed for additional references. This manuscript examines the current strategies available to treat ES and compares pharmacological and invasive treatment strategies to diminish ES recurrence, morbidity, and mortality.
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Affiliation(s)
- Richard G Trohman
- Section of Electrophysiology, Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
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2
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Skeete J, Huang HD, Mazur A, Sharma PS, Engelstein E, Trohman RG, Larsen TR. Evolving Concepts in Cardiac Physiologic Pacing in the Era of Conduction System Pacing. Am J Cardiol 2024; 212:51-66. [PMID: 38012990 DOI: 10.1016/j.amjcard.2023.11.023] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/22/2023] [Accepted: 11/11/2023] [Indexed: 11/29/2023]
Abstract
Cardiac physiologic pacing (CPP) has become a well-established therapy for patients with cardiomyopathy (left ventricular ejection fraction <35%) in the presence of a left bundle branch block. In addition, CPP can be highly beneficial in patients with pacing-induced cardiomyopathy and patients with existing cardiomyopathy expected to have a right ventricular pacing burden of >40%. The benefits of CPP with traditional biventricular pacing are only realized if adequate resynchronization can be achieved. However, left ventricular lead implantation can be limited by individual anatomic variation within the coronary venous system and can be adversely affected by underlying abnormal myocardial substrate (i.e., scar tissue), especially if located within the basal lateral wall. In the last 7 years the investigation of conduction system pacing (CSP) and its potential salutary benefits are being realized and have led to a rapid evolution in the field of cardiac resynchronization pacing. However, supportive evidence for CSP for patients eligible for cardiac resynchronization remains limited compared with data available for biventricular cardiac resynchronization, mostly derived from leading CSP investigative centers. In this review, we perform an up-to-date comprehensive review of the available literature on CPP.
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Affiliation(s)
- Jamario Skeete
- Division of Cardiac Electrophysiology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Henry D Huang
- Division of Cardiac Electrophysiology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Alex Mazur
- Division of Cardiac Electrophysiology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Parikshit S Sharma
- Division of Cardiac Electrophysiology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Erica Engelstein
- Division of Cardiac Electrophysiology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Richard G Trohman
- Division of Cardiac Electrophysiology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Timothy R Larsen
- Division of Cardiac Electrophysiology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois.
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Trohman RG. Understanding and Managing the Impact of Atrial High-Rate Episodes: Still a Work in Progress. Am J Cardiol 2023; 205:517-519. [PMID: 37612216 DOI: 10.1016/j.amjcard.2023.07.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 08/25/2023]
Affiliation(s)
- Richard G Trohman
- Section of Electrophysiology, Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois..
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Trohman RG, Huang HD, Sharma PS. Atrial fibrillation: primary prevention, secondary prevention, and prevention of thromboembolic complications: part 1. Front Cardiovasc Med 2023; 10:1060030. [PMID: 37396596 PMCID: PMC10311453 DOI: 10.3389/fcvm.2023.1060030] [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] [Received: 10/02/2022] [Accepted: 03/14/2023] [Indexed: 07/04/2023] Open
Abstract
Atrial fibrillation (AF), is the most common sustained cardiac arrhythmia. It was once thought to be benign as long as the ventricular rate was controlled, however, AF is associated with significant cardiac morbidity and mortality. Increasing life expectancy driven by improved health care and decreased fertility rates has, in most of the world, resulted in the population aged ≥65 years growing more rapidly than the overall population. As the population ages, projections suggest that the burden of AF may increase more than 60% by 2050. Although considerable progress has been made in the treatment and management of AF, primary prevention, secondary prevention, and prevention of thromboembolic complications remain a work in progress. This narrative review was facilitated by a MEDLINE search to identify peer-reviewed clinical trials, randomized controlled trials, meta-analyses, and other clinically relevant studies. The search was limited to English-language reports published between 1950 and 2021. Atrial fibrillation was searched via the terms primary prevention, hyperthyroidism, Wolff-Parkinson-White syndrome, catheter ablation, surgical ablation, hybrid ablation, stroke prevention, anticoagulation, left atrial occlusion and atrial excision. Google and Google scholar as well as bibliographies of identified articles were reviewed for additional references. In these two manuscripts, we discuss the current strategies available to prevent AF, then compare noninvasive and invasive treatment strategies to diminish AF recurrence. In addition, we examine the pharmacological, percutaneous device and surgical approaches to prevent stroke as well as other types of thromboembolic events.
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Trohman RG, Huang HD, Sharma PS. Atrial fibrillation: Primary prevention, secondary prevention, and prevention of thromboembolic complications: Part 2. Front Cardiovasc Med 2023; 9:1060096. [PMID: 36969508 PMCID: PMC10036779 DOI: 10.3389/fcvm.2022.1060096] [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] [Received: 10/02/2022] [Accepted: 11/14/2022] [Indexed: 03/12/2023] Open
Abstract
Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, once thought to be benign as long as the ventricular rate was controlled, is associated with significant cardiac morbidity and mortality. Increasing life expectancy driven by improved health care and decreased fertility rates has, in most of the world, resulted in the population aged ≥65 years growing more rapidly than the overall population. As the population ages, projections suggest that the burden of AF may increase more than 60% by 2050. Although considerable progress has been made in the treatment and management of AF, primary prevention, secondary prevention, and prevention of thromboembolic complications remain a work in progress. This narrative review was facilitated by a search of MEDLINE to identify peer-reviewed clinical trials, randomized controlled trials, meta-analyses, and other clinically relevant studies. The search was limited to English-language reports published between 1950 and 2021. Atrial fibrillation was searched using the terms primary prevention, hyperthyroidism, Wolff-Parkinson-White syndrome, catheter ablation, surgical ablation, hybrid ablation, stroke prevention, anticoagulation, left atrial occlusion and atrial excision. Google and Google scholar as well as bibliographies of identified articles were reviewed for additional references. In these two manuscripts, we discuss the current strategies available to prevent AF, then compare non-invasive and invasive treatment strategies to diminish AF recurrence. In addition, we examine the pharmacological, percutaneous device and surgical approaches to prevent stroke as well as other types of thromboembolic events.
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Ravi V, Winterfield J, Liang J, Larsen T, Dye C, Sanders D, Skeete J, Payne J, Trohman RG, Aksu T, Sharma PS, Huang HD. Solving the Reach Problem: A Review of Present and Future Approaches for Addressing Ventricular Arrhythmias Arising from Deep Substrate. Arrhythm Electrophysiol Rev 2023; 12:e04. [PMID: 37600155 PMCID: PMC10433105 DOI: 10.15420/aer.2022.28] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/26/2022] [Indexed: 08/22/2023] Open
Abstract
Ventricular tachycardia (VT) is a significant cause of morbidity and mortality in patients with ischaemic and non-ischaemic cardiomyopathies. In most patients, the primary strategy of VT catheter ablation is based on the identification of critical components of reentry circuits and modification of abnormal substrate which can initiate reentry. Despite technological advancements in catheter design and improved ability to localise abnormal substrates, putative circuits and site of origins of ventricular arrhythmias (VAs), current technologies remain inadequate and durable success may be elusive when the critical substrate is deep or near to critical structures that are at risk of collateral damage. In this article, we review the available and potential future non-surgical investigational approaches for treatment of VAs and discuss the viability of these modalities.
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Affiliation(s)
- Venkatesh Ravi
- Saint Francis Heart and Vascular Institute, Tulsa, OK, US
| | - Jeffrey Winterfield
- Department of Cardiology, Medical University of South Carolina, Charleston, SC, US
| | - Jackson Liang
- Department of Cardiology, University of Michigan, Ann Arbor, MI, US
| | - Timothy Larsen
- Department of Cardiology, Rush University Medical Center, Chicago, IL, US
| | - Cicely Dye
- Department of Cardiology, Rush University Medical Center, Chicago, IL, US
| | - David Sanders
- Department of Cardiology, Rush University Medical Center, Chicago, IL, US
| | - Jamario Skeete
- Department of Cardiology, Rush University Medical Center, Chicago, IL, US
| | - Josh Payne
- Department of Cardiology, University of Michigan, Ann Arbor, MI, US
| | - Richard G Trohman
- Department of Cardiology, Rush University Medical Center, Chicago, IL, US
| | - Tolga Aksu
- Department of Cardiology, Yeditepe University Hospital, Istanbul, Turkey
| | - Parikshit S Sharma
- Department of Cardiology, Rush University Medical Center, Chicago, IL, US
| | - Henry D Huang
- Department of Cardiology, Rush University Medical Center, Chicago, IL, US
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Ravi V, Poudyal A, Khanal S, Khalil C, Vij A, Sanders D, Larsen T, Trohman RG, Aksu T, Tung R, Santangeli P, Winterfield J, Sharma PS, Huang HD. A systematic review and meta-analysis comparing radiofrequency catheter ablation with medical therapy for ventricular tachycardia in patients with ischemic and non-ischemic cardiomyopathies. J Interv Card Electrophysiol 2023; 66:161-175. [PMID: 35759160 DOI: 10.1007/s10840-022-01287-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/20/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND In patients with cardiomyopathy, radiofrequency catheter ablation (CA) for ventricular tachycardia (VT) is an adjunctive and alternative treatment option to long-term anti-arrhythmic drug therapy. We sought to compare CA with medical therapy for the management of VT in patients with ischemic and non-ischemic cardiomyopathies. METHODS MEDLINE, Cochrane, and ClinicalTrials.gov databases were evaluated for relevant studies. RESULTS Eleven studies with 2126 adult patients were included (711 in CA, 1415 in medical therapy). In the randomized controlled trial (RCT) analysis, CA reduced risk of recurrent VT (risk ratio (RR) 0.79 [95% CI 0.67 to 0.93], p = 0.005), ICD shocks (RR 0.64 [95% CI 0.45 to 0.89] p = 0.008), and cardiac hospitalizations (RR 0.76 [95% CI 0.63 to 0.92] p = 0.005). There was no difference in all-cause mortality (RR 0.94, p = 0.71). In combined RCT and observational study analysis, there was a trend for reduction in all-cause mortality (RR 0.75 [95% CI 0.55 to 1.02] p = 0.07). In subgroup analysis of studies with mean left ventricular ejection fraction (LVEF) < 35%, CA demonstrated reduction in mortality (RR 0.71, p = 0.004), ICD shocks (RR 0.63, p = 0.03), VT recurrence (RR 0.76, p = 0.004), and cardiac hospitalizations (RR 0.75, p = 0.02). The subgroup of early CA prior to ICD shocks demonstrated reduction in ICD shocks (RR 0.57, p < 0.001) and VT recurrence (RR 0.74, p = 0.01). CONCLUSIONS CA for VT demonstrated a lower risk of VT recurrence, ICD shocks, and hospitalization in comparison to medical therapy. The subgroups of early CA and LVEF < 35% demonstrated better outcomes.
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Affiliation(s)
- Venkatesh Ravi
- Warren Clinic Cardiology, Saint Francis Health System, 6151 South Yale Ave, Tulsa, OK, 74136, USA.
| | | | - Smriti Khanal
- Division of Cardiology, Cook County Health, Chicago, USA
| | - Charl Khalil
- Division of Cardiology, Cook County Health, Chicago, USA
| | - Aviral Vij
- Division of Cardiology, Cook County Health, Chicago, USA
| | - David Sanders
- Section of Electrophysiology, Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, USA
| | - Timothy Larsen
- Section of Electrophysiology, Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, USA
| | - Richard G Trohman
- Section of Electrophysiology, Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, USA
| | - Tolga Aksu
- Department of Cardiology, Yeditepe University Hospital, Istanbul, Turkey
| | - Roderick Tung
- Section of Electrophysiology, Division of Cardiology, University of Arizona College of Medicine, Phoenix, USA
| | - Pasquale Santangeli
- Electrophysiology Section, Cardiovascular Division, Hospital of University of Pennsylvania, Philadelphia, USA
| | - Jeffrey Winterfield
- Section of Electrophysiology, Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, USA
| | - Parikshit S Sharma
- Section of Electrophysiology, Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, USA
| | - Henry D Huang
- Section of Electrophysiology, Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, USA
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Vijayaraman P, Zalavadia D, Haseeb A, Dye C, Madan N, Skeete JR, Vipparthy SC, Young W, Ravi V, Rajakumar C, Pokharel P, Larsen T, Huang HD, Storm RH, Oren JW, Batul SA, Trohman RG, Subzposh FA, Sharma PS. Clinical outcomes of conduction system pacing compared to biventricular pacing in patients requiring cardiac resynchronization therapy. Heart Rhythm 2022; 19:1263-1271. [PMID: 35500791 DOI: 10.1016/j.hrthm.2022.04.023] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) with biventricular pacing (BVP) is well-established therapy in patients with reduced left ventricular ejection fraction (LVEF) and bundle branch block or indication for pacing. Conduction system pacing (CSP) using His-bundle pacing (HBP) or left bundle branch area pacing (LBBAP) has been shown to be a safe and more physiological alternative to BVP. OBJECTIVE The purpose of this study was to compare the clinical outcomes between CSP and BVP among patients undergoing CRT. METHODS This observational study included consecutive patients with LVEF ≤35% and class I or II indications for CRT who underwent successful BVP or CSP at 2 major health care systems. The primary outcome was the composite endpoint of time to death or heart failure hospitalization (HFH). Secondary outcomes included subgroup analysis in left bundle branch block as well as individual endpoints of death and HFH. RESULTS A total of 477 patients (32% female) met inclusion criteria (BVP 219; CSP 258 [HBP 87, LBBAP 171]). Mean age was 72 ± 12 years, and mean LVEF was 26% ± 6%. Comorbidities included hypertension 70%, diabetes mellitus 45%, and coronary artery disease 52%. Paced QRS duration in CSP was significantly narrower than BVP (133 ± 21 ms vs 153 ± 24 ms; P <.001). LVEF improved in both groups during mean follow-up of 27 ± 12 months and was greater after CSP compared to BVP (39.7% ± 13% vs 33.1% ± 12%; P <.001). Primary outcome of death or HFH was significantly lower with CSP vs BVP (28.3% vs 38.4%; hazard ratio 1.52; 95% confidence interval 1.082-2.087; P = .013). CONCLUSION CSP improved clinical outcomes compared to BVP in this large cohort of patients with indications for CRT.
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Affiliation(s)
- Pugazhendhi Vijayaraman
- Geisinger Heart Institute, Wilkes Barre, Pennsylvania; Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania.
| | | | - Abdul Haseeb
- Geisinger Heart Institute, Wilkes Barre, Pennsylvania
| | - Cicely Dye
- Rush University Medical Center, Chicago, Illinois
| | - Nidhi Madan
- Rush University Medical Center, Chicago, Illinois
| | | | | | - Wilson Young
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania; Geisinger Heart Institute, Scranton, Pennsylvania
| | | | | | | | | | | | | | - Jess W Oren
- Geisinger Heart Institute, Danville, Pennsylvania
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Chiang C, Vipparthy S, Ayub MT, Trohman RG, Larsen TR, Huang HD, Krishnan K, Engelstein ED, Haw JM, Sharma PS, Wasserlauf J. Comparison of electrocautery platforms for pulse generator replacement procedures. J Interv Card Electrophysiol 2022; 64:557-558. [PMID: 35668166 DOI: 10.1007/s10840-022-01261-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/26/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Caleb Chiang
- Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, 1717 W. Congress Pkwy., Suite 331, Chicago, IL, 60612, USA
| | - Sharath Vipparthy
- Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, 1717 W. Congress Pkwy., Suite 331, Chicago, IL, 60612, USA
| | - Muhammad Talha Ayub
- Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, 1717 W. Congress Pkwy., Suite 331, Chicago, IL, 60612, USA
| | - Richard G Trohman
- Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, 1717 W. Congress Pkwy., Suite 331, Chicago, IL, 60612, USA
| | - Timothy R Larsen
- Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, 1717 W. Congress Pkwy., Suite 331, Chicago, IL, 60612, USA
| | - Henry D Huang
- Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, 1717 W. Congress Pkwy., Suite 331, Chicago, IL, 60612, USA
| | | | - Erica D Engelstein
- Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, 1717 W. Congress Pkwy., Suite 331, Chicago, IL, 60612, USA
| | - Janet M Haw
- Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, 1717 W. Congress Pkwy., Suite 331, Chicago, IL, 60612, USA
| | - Parikshit S Sharma
- Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, 1717 W. Congress Pkwy., Suite 331, Chicago, IL, 60612, USA
| | - Jeremiah Wasserlauf
- Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, 1717 W. Congress Pkwy., Suite 331, Chicago, IL, 60612, USA.
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Trohman RG. A Brief Introduction to Management of LQTS. Rev Cardiovasc Med 2022. [DOI: 10.31083/j.rcm2305164] [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: 11/06/2022] Open
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Ravi V, Sharma PS, Patel NR, Dommaraju S, Zalavadia DV, Garg V, Larsen TR, Naperkowski AM, Wasserlauf J, Krishnan K, Young W, Pokharel P, Oren JW, Storm RH, Trohman RG, Huang HD, Subzposh FA, Vijayaraman P. New-Onset Atrial Fibrillation in Left Bundle Branch Area Pacing Compared With Right Ventricular Pacing. Circ Arrhythm Electrophysiol 2022; 15:e010710. [PMID: 35333096 DOI: 10.1161/circep.121.010710] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Venkatesh Ravi
- Division of Cardiac Electrophysiology, Rush University Medical Center, Chicago, IL (V.R., P.S.S., V.G., T.R.L., J.W., K.K., R.G.T., H.G.H.)
| | - Parikshit S Sharma
- Division of Cardiac Electrophysiology, Rush University Medical Center, Chicago, IL (V.R., P.S.S., V.G., T.R.L., J.W., K.K., R.G.T., H.G.H.)
| | - Neil R Patel
- Wright Center for GME, Scranton, PA (N.R.P., S.D.)
| | | | - Dipen V Zalavadia
- Geisinger Heart Institute, Wilkes Barre, PA (D.V.Z., A.M.N., F.A.S., P.V.)
| | - Varun Garg
- Division of Cardiac Electrophysiology, Rush University Medical Center, Chicago, IL (V.R., P.S.S., V.G., T.R.L., J.W., K.K., R.G.T., H.G.H.)
| | - Timothy R Larsen
- Division of Cardiac Electrophysiology, Rush University Medical Center, Chicago, IL (V.R., P.S.S., V.G., T.R.L., J.W., K.K., R.G.T., H.G.H.)
| | | | - Jeremiah Wasserlauf
- Division of Cardiac Electrophysiology, Rush University Medical Center, Chicago, IL (V.R., P.S.S., V.G., T.R.L., J.W., K.K., R.G.T., H.G.H.)
| | - Kousik Krishnan
- Division of Cardiac Electrophysiology, Rush University Medical Center, Chicago, IL (V.R., P.S.S., V.G., T.R.L., J.W., K.K., R.G.T., H.G.H.)
| | | | - Parash Pokharel
- Geisinger Heart Institute, Danville, PA (P.P., J.W.O., R.H.S.)
| | - Jess W Oren
- Geisinger Heart Institute, Danville, PA (P.P., J.W.O., R.H.S.)
| | - Randle H Storm
- Geisinger Heart Institute, Danville, PA (P.P., J.W.O., R.H.S.)
| | - Richard G Trohman
- Division of Cardiac Electrophysiology, Rush University Medical Center, Chicago, IL (V.R., P.S.S., V.G., T.R.L., J.W., K.K., R.G.T., H.G.H.)
| | - Henry D Huang
- Division of Cardiac Electrophysiology, Rush University Medical Center, Chicago, IL (V.R., P.S.S., V.G., T.R.L., J.W., K.K., R.G.T., H.G.H.)
| | - Faiz A Subzposh
- Geisinger Heart Institute, Wilkes Barre, PA (D.V.Z., A.M.N., F.A.S., P.V.)
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Chiang C, Ayub MT, Krishnan K, Trohman RG, Larsen TR, Huang HD, Sharma PS, Haw JM, Wasserlauf J. COMPARISON OF ELECTROCAUTERY PLATFORMS FOR PULSE GENERATOR REPLACEMENTS PROCEDURES. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01137-8] [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: 10/18/2022]
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Larsen T, Du‐Fay‐de‐Lavallaz JM, Winterfield JR, Ravi V, Rhodes P, Wasserlauf J, Trohman RG, Sharma PS, Huang HD. Comparison of Ablation Index versus Time‐Guided Radiofrequency Energy Dosing using Normal and Half‐normal Saline Irrigation in a Porcine Left Ventricular Model. J Cardiovasc Electrophysiol 2022; 33:698-712. [DOI: 10.1111/jce.15379] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/11/2021] [Accepted: 11/28/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Timothy Larsen
- Division of CardiologyRush University Medical CenterChicagoIL
| | | | | | - Venkatesh Ravi
- Division of CardiologyRush University Medical CenterChicagoIL
| | | | | | | | | | - Henry D. Huang
- Division of CardiologyRush University Medical CenterChicagoIL
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Larsen T, Winterfield J, Ravi V, Du-Fey-de-Lavallaz JM, Wasserlauf J, Trohman RG, Sharma PS, Huang HD. Comparison of Radiofrequency Ablation from the Coronary Cusps and Endocardial Left Ventricular Outflow Tract for Left Ventricular Summit Ventricular Arrhythmias in a Porcine and Infrared Thermal Model. J Cardiovasc Electrophysiol 2022; 33:551-556. [PMID: 35032079 DOI: 10.1111/jce.15360] [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: 07/12/2021] [Revised: 09/27/2021] [Accepted: 11/28/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The coronary cusps (CCs) are utilized as an alternative vantage point for radiofrequency catheter ablation (RFCA) of left ventricular (LV) summit ventricular arrhythmias (VA) but is sometimes a challenge despite favorable activation timing and pace mapping. METHODS Ex-vivo experiments were performed in 12 intact porcine hearts submerged in a 37o C saline bath. RF applications were delivered with an irrigated contact force sensing catheter oriented 45o to the endocardial LVOT surface and nadir of the CCs using different dosing parameters. Sections were stained in 2% triphenyltetrazolium chloride and lesion dimensions were measured. Thermal infrared imaging analysis was used to compare time-to-lethal tissue temperature and depth/area of lethal isotherms. RESULTS A total of 60 RF applications were performed under different dosing parameters for (1) 30, 40, and 50 Watts (W) x 30 seconds and (2) 40W x 30, 45, and 60 seconds. Lesion depth was greater with RFCA from LVOT than from the CCs (maximum depth 6.11 mm vs 2.68 mm). Longer RF duration led to larger lesion volume in the CC group (40Wx30 sec: 8.1±0.4 vs. 40Wx60 sec: 10.1±0.96 mm; p=0.002). One steam pop occurred in both the LVOT (50Wx30 seconds) and CC groups (40Wx60 seconds). Time-to-reach lethal temperature of 58 o C was longer in the CC group than the LVOT group (4.7 vs. 11.3 seconds; p=0.02) CONCLUSIONS: RFCA from the CC led comparatively to shallower lesion depth than from the LVOT. Longer RF duration led to an increase in lesion volume during ablation from CCs. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Timothy Larsen
- Department of Cardiology, Section of Electrophysiology, Rush University Medical Center, Chicago, IL
| | - Jeffrey Winterfield
- Department of Cardiology, Section of Electrophysiology, Medical University of South Carolina, Charleston, SC
| | - Venkatesh Ravi
- Department of Cardiology, Section of Electrophysiology, Rush University Medical Center, Chicago, IL
| | | | - Jeremiah Wasserlauf
- Department of Cardiology, Section of Electrophysiology, Rush University Medical Center, Chicago, IL
| | - Richard G Trohman
- Department of Cardiology, Section of Electrophysiology, Rush University Medical Center, Chicago, IL
| | - Parikshit S Sharma
- Department of Cardiology, Section of Electrophysiology, Rush University Medical Center, Chicago, IL
| | - Henry D Huang
- Department of Cardiology, Section of Electrophysiology, Rush University Medical Center, Chicago, IL
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Trohman RG. My Double Trouble: An Autobiographical Case Report of Psoriasis and Psoriatic Arthritis. Cureus 2021; 13:e20617. [PMID: 34956807 PMCID: PMC8694657 DOI: 10.7759/cureus.20617] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 11/23/2022] Open
Abstract
Psoriasis and psoriatic arthritis are overlapping, related, but distinct entities. Each occurs as a result of a complex combination of precipitants, genetic predispositions, and variable expression of a self-sustaining proinflammatory state. My case history and clinical course are outlined below. In addition, the epidemiology, pathogenesis, and the expanding armamentarium of treatment options, including their strengths and weaknesses, are discussed in detail.
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Affiliation(s)
- Richard G Trohman
- Cardiac Electrophysiology, Rush University Medical Center, Chicago, USA
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Ravi V, Poudyal A, Lin L, Larsen T, Wasserlauf J, Trohman RG, Krishnan K, Sharma P, Huang HD. Mortality benefit of catheter ablation versus medical therapy in atrial fibrillation: An RCT only meta-analysis. J Cardiovasc Electrophysiol 2021; 33:178-193. [PMID: 34911150 DOI: 10.1111/jce.15330] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 08/23/2021] [Revised: 10/17/2021] [Accepted: 11/10/2021] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Catheter ablation for atrial fibrillation (AF) in comparison to medical therapy alone is known to improve freedom from arrhythmia and quality of life, but the benefit regarding mortality is unclear. The publication of several recent large randomized controlled trials (RCT) comparing ablation with medical therapy has warranted an updated meta-analysis. METHODS We sought to compare the effectiveness of catheter ablation versus medical therapy only in patients with AF. MEDLINE, Cochrane, and ClinicalTrials.gov databases were searched from inception until 04/30/2021. Relevant RCTs comparing catheter ablation versus medical therapy in patients with AF were selected. RESULTS A total of 24 RCTs involving 5730 adult patients were included (2992 in catheter ablation and 2738 in medical therapy). There was a reduction in all-cause mortality with catheter ablation compared with medical therapy only (risk ratio (RR) 0.70 [95% confidence interval (CI) 0.55-0.89]; p = .003). Catheter ablation also demonstrated a reduction in hospitalizations (RR 0.50 [95% CI 0.36-0.70]; p < .001), improvement in left ventricular ejection fraction (LVEF) (mean difference [MD] + 5.94% [95% CI 0.40-11.48] p = .04), greater freedom from atrial arrhythmia (RR 2.23 [95% CI 1.79-2.76]; p < .001), and AF (RR 1.95 [95% CI 1.44-2.66]; p < .001). In subgroup analysis, catheter ablation demonstrated a significant reduction in mortality and hospitalizations among patients with reduced LVEF, and when ablation was compared with antiarrhythmic drug use. CONCLUSIONS In comparison to medical therapy only, catheter ablation for atrial fibrillation reduces mortality, hospitalizations, and increases freedom from arrhythmia.
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Affiliation(s)
- Venkatesh Ravi
- Division of Cardiology, Department of Medicine, Section of Electrophysiology, Rush University Medical Center, Chicago, USA.,Department of Cardiovascular Science, Warren Clinic Cardiology, Saint Francis Heart Hospital, Tulsa, USA
| | - Abhushan Poudyal
- Department of Medicine, John H Stroger Hospital of Cook County, Chicago, USA
| | - Li Lin
- Department of Medicine, John H Stroger Hospital of Cook County, Chicago, USA
| | - Timothy Larsen
- Division of Cardiology, Department of Medicine, Section of Electrophysiology, Rush University Medical Center, Chicago, USA
| | - Jeremiah Wasserlauf
- Division of Cardiology, Department of Medicine, Section of Electrophysiology, Rush University Medical Center, Chicago, USA
| | - Richard G Trohman
- Division of Cardiology, Department of Medicine, Section of Electrophysiology, Rush University Medical Center, Chicago, USA
| | - Kousik Krishnan
- Division of Cardiology, Department of Medicine, Midwest Cardiovascular Institute, Naperville, USA
| | - Parikshit Sharma
- Division of Cardiology, Department of Medicine, Section of Electrophysiology, Rush University Medical Center, Chicago, USA
| | - Henry D Huang
- Division of Cardiology, Department of Medicine, Section of Electrophysiology, Rush University Medical Center, Chicago, USA
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Sharma PS, Patel NR, Ravi V, Zalavadia DV, Dommaraju S, Garg V, Larsen TR, Naperkowski AM, Wasserlauf J, Krishnan K, Young W, Pokharel P, Oren JW, Storm RH, Trohman RG, Huang HD, Subzposh FA, Vijayaraman P. Clinical outcomes of left bundle branch area pacing compared to right ventricular pacing: Results from the Geisinger-Rush Conduction System Pacing Registry. Heart Rhythm 2021; 19:3-11. [PMID: 34481985 DOI: 10.1016/j.hrthm.2021.08.033] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [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: 07/16/2021] [Revised: 08/09/2021] [Accepted: 08/30/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Left bundle branch area pacing (LBBAP) has been shown to be a feasible option for patients requiring ventricular pacing. OBJECTIVE The purpose of this study was to compare clinical outcomes between LBBAP and RVP among patients undergoing pacemaker implantation METHODS: This observational registry included patients who underwent pacemaker implantations with LBBAP or RVP for bradycardia indications between April 2018 and October 2020. The primary composite outcome included all-cause mortality, heart failure hospitalization (HFH), or upgrade to biventricular pacing. Secondary outcomes included the composite endpoint among patients with a prespecified burden of ventricular pacing and individual outcomes. RESULTS A total of 703 patients met inclusion criteria (321 LBBAP and 382 RVP). QRS duration during LBBAP was similar to baseline (121 ± 23 ms vs 117 ± 30 ms; P = .302) and was narrower compared to RVP (121 ± 23 ms vs 156 ± 27 ms; P <.001). The primary composite outcome was significantly lower with LBBAP (10.0%) compared to RVP (23.3%) (hazard ratio [HR] 0.46; 95%T confidence interval [CI] 0.306-0.695; P <.001). Among patients with ventricular pacing burden >20%, LBBAP was associated with significant reduction in the primary outcome compared to RVP (8.4% vs 26.1%; HR 0.32; 95% CI 0.187-0.540; P <.001). LBBAP was also associated with significant reduction in mortality (7.8% vs 15%; HR 0.59; P = .03) and HFH (3.7% vs 10.5%; HR 0.38; P = .004). CONCLUSION LBBAP resulted in improved clinical outcomes compared to RVP. Higher burden of ventricular pacing (>20%) was the primary driver of these outcome differences.
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Affiliation(s)
- Parikshit S Sharma
- Division of Cardiac Electrophysiology, Rush University Medical Center, Chicago, Illinois
| | | | - Venkatesh Ravi
- Division of Cardiac Electrophysiology, Rush University Medical Center, Chicago, Illinois
| | | | | | - Varun Garg
- Division of Cardiac Electrophysiology, Rush University Medical Center, Chicago, Illinois
| | - Timothy R Larsen
- Division of Cardiac Electrophysiology, Rush University Medical Center, Chicago, Illinois
| | | | - Jeremiah Wasserlauf
- Division of Cardiac Electrophysiology, Rush University Medical Center, Chicago, Illinois
| | - Kousik Krishnan
- Division of Cardiac Electrophysiology, Rush University Medical Center, Chicago, Illinois
| | - Wilson Young
- Geisinger Heart Institute, Scranton, Pennsylvania
| | | | - Jess W Oren
- Geisinger Heart Institute, Danville, Pennsylvania
| | | | - Richard G Trohman
- Division of Cardiac Electrophysiology, Rush University Medical Center, Chicago, Illinois
| | - Henry D Huang
- Division of Cardiac Electrophysiology, Rush University Medical Center, Chicago, Illinois
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Ravi V, Poudyal A, Abid QUA, Larsen T, Krishnan K, Sharma PS, Trohman RG, Huang HD. High-power short duration vs. conventional radiofrequency ablation of atrial fibrillation: a systematic review and meta-analysis. Europace 2021; 23:710-721. [PMID: 33523184 DOI: 10.1093/europace/euaa327] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [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: 07/04/2020] [Accepted: 09/28/2020] [Indexed: 01/10/2023] Open
Abstract
AIMS We sought to compare the effectiveness and safety of high-power short-duration (HPSD) radiofrequency ablation (RFA) with conventional RFA in patients with atrial fibrillation (AF). METHODS AND RESULTS MEDLINE, Cochrane, and ClinicalTrials.gov databases were searched until 15 May 2020 for relevant studies comparing HPSD vs. conventional RFA in patients undergoing initial catheter ablation for AF. A total of 15 studies involving 3718 adult patients were included in our meta-analysis (2357 in HPSD RFA and 1361 in conventional RFA). Freedom from atrial arrhythmia was higher in HPSD RFA when compared with conventional RFA [odds ratio (OR) 1.44, 95% confidence interval (CI) 1.10-1.90; P = 0.009]. Acute PV reconnection was lower (OR 0.56, P = 0.005) and first-pass isolation was higher (OR 3.58, P < 0.001) with HPSD RFA. There was no difference in total complications between the two groups (P = 0.19). Total procedure duration [mean difference (MD) -37.35 min, P < 0.001], fluoroscopy duration (MD -5.23 min, P = 0.001), and RF ablation time (MD -16.26 min, P < 0.001) were all significantly lower in HPSD RFA. High-power short-duration RFA also demonstrated higher freedom from atrial arrhythmia in the subgroup analysis of patients with paroxysmal AF (OR 1.80, 95% CI 1.29-2.50; P < 0.001), studies with ≥50 W protocol in the HPSD RFA group (OR 1.53, 95% CI 1.08-2.18; P = 0.02] and studies with contact force sensing catheter use (OR 1.65, 95% CI 1.21-2.25; P = 0.002). CONCLUSION High-power short-duration RFA was associated with better procedural effectiveness when compared with conventional RFA with comparable safety and shorter procedural duration.
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Affiliation(s)
- Venkatesh Ravi
- Section of Electrophysiology, Division of Cardiology, Department of Medicine, Rush University Medical Center, 1717 W Congress Pkwy Suite 317 Kellogg, Chicago, IL 60612, USA
| | - Abhushan Poudyal
- Division of Cardiology, Department of Medicine, John H. Stroger Hospital of Cook County, Chicago, IL, USA
| | - Qurrat-Ul-Ain Abid
- Section of Electrophysiology, Division of Cardiology, Department of Medicine, Rush University Medical Center, 1717 W Congress Pkwy Suite 317 Kellogg, Chicago, IL 60612, USA
| | - Timothy Larsen
- Section of Electrophysiology, Division of Cardiology, Department of Medicine, Rush University Medical Center, 1717 W Congress Pkwy Suite 317 Kellogg, Chicago, IL 60612, USA
| | - Kousik Krishnan
- Section of Electrophysiology, Division of Cardiology, Department of Medicine, Rush University Medical Center, 1717 W Congress Pkwy Suite 317 Kellogg, Chicago, IL 60612, USA
| | - Parikshit S Sharma
- Section of Electrophysiology, Division of Cardiology, Department of Medicine, Rush University Medical Center, 1717 W Congress Pkwy Suite 317 Kellogg, Chicago, IL 60612, USA
| | - Richard G Trohman
- Section of Electrophysiology, Division of Cardiology, Department of Medicine, Rush University Medical Center, 1717 W Congress Pkwy Suite 317 Kellogg, Chicago, IL 60612, USA
| | - Henry D Huang
- Section of Electrophysiology, Division of Cardiology, Department of Medicine, Rush University Medical Center, 1717 W Congress Pkwy Suite 317 Kellogg, Chicago, IL 60612, USA
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Huang HD, Du-Fay-de-Lavallaz JM, Rhodes P, Ravi V, Sharma PS, Winterfield JR, Krishnan K, Wasserlauf J, Trohman RG, Larsen TR. B-PO03-130 COMPARISON BETWEEN TIME AND ABLATION INDEX-BASED RADIOFREQUENCY ENERGY DOSING DURING ABLATION IN LEFT VENTRICULAR PORCINE MODEL. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.604] [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: 11/15/2022]
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20
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Ravi V, Huang HD, Larsen TR, Wasserlauf J, Krishnan K, Trohman RG, Vijayaraman P, Sharma PS. B-AB09-04 INTRA-PROCEDURAL ASSESSMENT OF IDEAL CARDIAC RESYNCHRONIZATION THERAPY STRATEGY USING LV LATERAL WALL ACTIVATION. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.056] [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: 11/30/2022]
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Huang HD, Du Fay de Lavallaz JM, Macias C, Ravi V, Krishnan K, Sharma PS, Larsen TR, Wasserlauf J, Trohman RG, Kenigsberg DN. B-PO02-078 PROSPECTIVE RANDOMIZED MULTICENTER COMPARISON OF THIRD GENERATION CRYOBALLOON AND LASER BALLOON CATHETERS FOR PULMONARY VEIN ISOLATION ABLATION IN PATIENTS WITH PAROXYSMAL ATRIAL FIBRILLATION. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.333] [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: 11/29/2022]
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Garg V, Obeid FA, Ravi V, Ayub MT, Larsen TR, Wasserlauf J, Huang HD, Krishnan K, Trohman RG, Sharma PS. B-PO03-060 THE EFFECT OF HIS BUNDLE PACING LEAD THRESHOLDS AT IMPLANT ON LONG TERM LEAD PERFORMANCE. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.535] [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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23
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Huang HD, Macias C, Du-Fay-de-Lavallaz JM, Krishnan K, Sharma PS, Kenigsberg S, Trohman RG, Larsen TR, Wasserlauf J, Kenigsberg DN. B-PO04-100 A PROSPECTIVE, MULTICENTER COMPARISON OF RADIOFREQUENCY, CRYOBALLOON, AND LASER BALLOON ABLATION FOR PULMONARY VEIN ISOLATION IN PATIENTS WITH ATRIAL FIBRILLATION: ACUTE PROCEDURAL FINDINGS. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.917] [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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Madan N, Trohman RG. Three-dimensional echocardiography definitively delineates a malpositioned permanent pacing lead in a patient with chronic chest pain. Pacing Clin Electrophysiol 2021; 44:1646-1650. [PMID: 34107078 DOI: 10.1111/pace.14285] [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] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/22/2021] [Accepted: 05/30/2021] [Indexed: 11/30/2022]
Abstract
Inadvertent malpositioning of a cardiac pacing lead into the left heart chambers is a rare complication of transvenous pacing. We report a patient with a history of a transient ischemic attack and chronic chest pain whose left atrial pacing lead location was revealed by transesophageal three-dimensional (3D) echocardiography during evaluation of an inter-atrial shunt.
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Affiliation(s)
- Nidhi Madan
- Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Richard G Trohman
- Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
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Skeete JR, Du-Fay-de-Lavallaz JM, Kenigsberg D, Macias C, Winterfield JR, Sharma PS, Trohman RG, Huang HD. Clinical Applications of Laser Technology: Laser Balloon Ablation in the Management of Atrial Fibrillation. Micromachines (Basel) 2021; 12:mi12020188. [PMID: 33673330 PMCID: PMC7917803 DOI: 10.3390/mi12020188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/03/2021] [Accepted: 02/08/2021] [Indexed: 11/24/2022]
Abstract
Catheter-based ablation techniques have a well-established role in atrial fibrillation (AF) management. The prevalence and impact of AF is increasing globally, thus mandating an emphasis on improving ablation techniques through innovation. One key area of ongoing evolution in this field is the use of laser energy to perform pulmonary vein isolation during AF catheter ablation. While laser use is not as widespread as other ablation techniques, such as radiofrequency ablation and cryoballoon ablation, advancements in product design and procedural protocols have demonstrated laser balloon ablation to be equally safe and effective compared to these other modalities. Additionally, strategies to improve procedural efficiency and decrease radiation exposure through low fluoroscopy protocols make this technology an increasingly promising and exciting option.
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Affiliation(s)
- Jamario R. Skeete
- Division of Cardiology, Rush University Medical Center, Chicago, IL 60612, USA; (J.R.S.); (P.S.S.); (R.G.T.)
| | | | - David Kenigsberg
- Division of Cardiology, Nova Southeastern University, Fort Lauderdale-Davie, FL 33314, USA;
| | - Carlos Macias
- Section of Cardiology, Ronald Reagan University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA;
| | - Jeffrey R. Winterfield
- Division of Cardiology, Medical University of South Carolina, Charleston, SC 29425, USA;
| | - Parikshit S. Sharma
- Division of Cardiology, Rush University Medical Center, Chicago, IL 60612, USA; (J.R.S.); (P.S.S.); (R.G.T.)
| | - Richard G. Trohman
- Division of Cardiology, Rush University Medical Center, Chicago, IL 60612, USA; (J.R.S.); (P.S.S.); (R.G.T.)
| | - Henry D. Huang
- Division of Cardiology, Rush University Medical Center, Chicago, IL 60612, USA; (J.R.S.); (P.S.S.); (R.G.T.)
- Correspondence:
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Swearingen S, du Fay de Lavallaz JM, Rana N, Abid QUA, Wasserlauf J, Krishnan K, Sharma PS, Trohman RG, Huang HD. Correlation Between Exercise Metabolic Equivalents and Risk Factors in Nonathletes With Atrial Fibrillation. Am J Cardiol 2021; 138:128-129. [PMID: 33075282 DOI: 10.1016/j.amjcard.2020.10.028] [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] [Received: 10/06/2020] [Accepted: 10/12/2020] [Indexed: 10/23/2022]
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Ravi V, Beer D, Pietrasik GM, Hanifin JL, Ooms S, Ayub MT, Larsen T, Huang HD, Krishnan K, Trohman RG, Vijayaraman P, Sharma PS. Development of New-Onset or Progressive Atrial Fibrillation in Patients With Permanent HIS Bundle Pacing Versus Right Ventricular Pacing: Results From the RUSH HBP Registry. J Am Heart Assoc 2020; 9:e018478. [PMID: 33174509 PMCID: PMC7763709 DOI: 10.1161/jaha.120.018478] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Conventional right ventricular pacing (RVP) has been associated with an increased incidence of atrial fibrillation (AF). We sought to compare the occurrence of new‐onset AF and assessed AF disease progression during long‐term follow‐up between His bundle pacing (HBP) and RVP. Methods and Results We included patients undergoing initial dual‐chamber pacemaker implants at Rush University Medical Center between January 1, 2016, and June 30, 2019. A total of 360 patients were evaluated, and 225 patients (HBP, n=105; RVP, n=120) were included in the study. Among the 148 patients (HBP, n=72; RVP, n=76) with no history of AF, HBP demonstrated a lower risk of new‐onset AF (adjusted hazard ratio [HR], 0.53; 95% CI, 0.28–0.99; P=0.046) compared with traditional RVP. This benefit was observed with His or RVP burden exceeding 20% (HR, 0.29; 95% CI, 0.13–0.64; P=0.002), ≥40% (HR, 0.31; P=0.007), ≥60% (HR, 0.35; P=0.015), and ≥80% (HR, 0.40; P=0.038). There was no difference with His or RV pacing burden <20% (HR, 0.613; 95% CI, 0.213–1.864; P=0.404). In patients with a prior history of AF, there was no difference in AF progression (P=0.715); however, in a subgroup of patients with a pacing burden ≥40%, HBP demonstrated a trend toward a lower risk of AF progression (HR, 0.19; 95% CI, 0.03–1.16; P=0.072). Conclusions HBP demonstrated a lower risk of new‐onset AF compared with RVP, which was primarily observed at a higher pacing burden.
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Affiliation(s)
- Venkatesh Ravi
- Division of Cardiology Department of Medicine Rush University Medical Center Chicago IL
| | - Dominik Beer
- Division of Cardiology Department of Medicine Geisinger Heart Institute Wilkes-Barre PA
| | - Grzegorz M Pietrasik
- Division of Cardiology Department of Medicine John H Stroger Jr Hospital of Cook County Chicago IL
| | - Jillian L Hanifin
- Division of Cardiology Department of Medicine Rush University Medical Center Chicago IL
| | - Sara Ooms
- Division of Cardiology Department of Medicine Rush University Medical Center Chicago IL
| | - Muhammad Talha Ayub
- Division of Cardiology Department of Medicine Rush University Medical Center Chicago IL
| | - Timothy Larsen
- Division of Cardiology Department of Medicine Rush University Medical Center Chicago IL
| | - Henry D Huang
- Division of Cardiology Department of Medicine Rush University Medical Center Chicago IL
| | - Kousik Krishnan
- Division of Cardiology Department of Medicine Rush University Medical Center Chicago IL
| | - Richard G Trohman
- Division of Cardiology Department of Medicine Rush University Medical Center Chicago IL
| | | | - Parikshit S Sharma
- Division of Cardiology Department of Medicine Rush University Medical Center Chicago IL
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Abstract
BACKGROUND Left bundle branch pacing (LBBP) has recently emerged as a promising alternative modality for conduction system pacing. However, limited real-world data exists on the advantages and complications associated with LBBP. We analyzed the Rush conduction system pacing registry on LBBP to assess the success rates and complications associated with LBBP. METHODS All patients with an indication for permanent pacemaker or cardiac resynchronization therapy that underwent LBBP for various reasons from June 2018 to April 2020 were included in the analysis. RESULTS A total of 57 of 59 patients underwent successful LBBP (success rate 97%). The average follow-up duration was 6.2±5 months. The implanted devices included 38 dual-chamber pacemakers, 17 cardiac resynchronization therapy defibrillators, and 2 cardiac resynchronization therapy pacing systems. The most common reason for performing LBBP was a high His-Bundle pacing threshold (n=23) at implant. The mean LBBP capture threshold at implant was 0.62±0.21 V at 0.4 ms which remained stable during follow-up at 0.65±0.68 V at 0.4ms. In 21 patients with cardiomyopathy, there was a significant improvement in left ventricle ejection fraction from 30±11% to 42±15%. A total of 7 lead-related complications (12.3%) were noted in the follow-up period. Three patients (5.3%) required lead revision during the follow-up period. Interventricular septal perforation occurred (as late sequela) after 2 weeks in one patient. CONCLUSIONS LBBP can be achieved with a high success rate and low capture thresholds. Left ventricular dysfunction improved significantly during follow-up. Lead-related complications were relatively common occurring in 12.3% of initially successful implants. Lead revision was required in 3 (5%) of patients.
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Affiliation(s)
- Venkatesh Ravi
- Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL
| | - Jillian L Hanifin
- Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL
| | - Timothy Larsen
- Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL
| | - Henry D Huang
- Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL
| | - Richard G Trohman
- Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL
| | - Parikshit S Sharma
- Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL
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Huang HD, Krishnan K, Sharma PS, Kavinsky CJ, Rodriguez J, Ravi V, Larsen TR, Trohman RG. Cryoballoon Ablation and Bipolar Voltage Mapping in Patients With Left Atrial Appendage Occlusion Devices. Am J Cardiol 2020; 135:99-104. [PMID: 32866447 DOI: 10.1016/j.amjcard.2020.08.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/08/2020] [Accepted: 08/11/2020] [Indexed: 01/20/2023]
Abstract
Left atrial appendage occlusion is utilized as a second line therapy to long-term oral anticoagulation in appropriately selected patients with atrial fibrillation (AF). We examined the feasibility of cryoballoon (CB) pulmonary vein isolation (PVI) subsequent to Watchman device implantation. The study prospectively identified patients with Watchman devices (>90 days old) who underwent CB-PVI ablation between 2018 and 2019. Twelve consecutive patients (male 50%; mean age 71 ± 9 years; CHA2DS2-VASc score 3.4 ± 1.1) underwent CB-PVI procedures after Watchman device implantation (mean 182 ± 82 days). Acute PVI was achieved in 100% of patients. All patients had evidence of complete (n = 9) or partial (n = 3) endothelialization of the surface of the Watchman device with conductive tissue properties demonstrated during electrophysiologic testing. There were no major procedure-related complications including death, stroke, pericardial effusion, device dislodgment, device thrombus, or new or increasing peri-device leak. Mean peri-device leak size (45-day postimplant: 0.06 ± 0.09 mm vs Post-PVI: 0.04 ± 0.06 mm; p = 0.61) remained unchanged. Two patients had recurrence of AF after the 90-day blanking period (13.2 ± 6.6 months). One patient underwent a redo ablation procedure for recurrent AF. This pilot study suggests the potential feasibility of CB-PVI ablation in patients with chronic Watchman left atrial appendage occlusion devices. Larger prospective studies are needed to confirm the clinical efficacy and safety of this approach.
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Trohman RG, Huang HD, Larsen T, Krishnan K, Sharma PS. Sensors for rate-adaptive pacing: How they work, strengths, and limitations. J Cardiovasc Electrophysiol 2020; 31:3009-3027. [PMID: 32877004 DOI: 10.1111/jce.14733] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 04/01/2020] [Revised: 07/19/2020] [Accepted: 08/19/2020] [Indexed: 12/21/2022]
Abstract
Chronotropic incompetence is the inability of the sinus node to increase heart rate commensurate with increased metabolic demand. Cardiac pacing alone may be insufficient to address exercise intolerance, fatigue, dyspnea on exertion, and other symptoms of chronotropic incompetence. Rate-responsive (adaptive) pacing employs sensors to detect physical or physiological indices and mimic the response of the normal sinus node. This review describes the development, strengths, and limitations of a variety of sensors that have been employed to address chronotropic incompetence. A mini-tutorial on programming rate-adaptive parameters is included along with emphasis that patients' lifestyles and underlying medical conditions require careful consideration. In addition, special sensor applications used to respond prophylactically to physiologic signals are detailed and an in-depth discussion of sensors as a potential aid in heart failure management is provided.
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Affiliation(s)
- Richard G Trohman
- Department of Medicine, Section of Electrophysiology, Arrhythmia and Pacemaker Services, Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Henry D Huang
- Department of Medicine, Section of Electrophysiology, Arrhythmia and Pacemaker Services, Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Timothy Larsen
- Department of Medicine, Section of Electrophysiology, Arrhythmia and Pacemaker Services, Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Kousik Krishnan
- Department of Medicine, Section of Electrophysiology, Arrhythmia and Pacemaker Services, Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Parikshit S Sharma
- Department of Medicine, Section of Electrophysiology, Arrhythmia and Pacemaker Services, Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
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Ravi V, Poudyal A, Pulipati P, Larsen T, Krishnan K, Trohman RG, Sharma PS, Huang HD. A systematic review and meta-analysis comparing second-generation cryoballoon and contact force radiofrequency ablation for initial ablation of paroxysmal and persistent atrial fibrillation. J Cardiovasc Electrophysiol 2020; 31:2559-2571. [PMID: 32671920 DOI: 10.1111/jce.14676] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 05/12/2020] [Revised: 07/12/2020] [Accepted: 07/13/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Cryoballoon ablation (CBA) and radiofrequency ablation (RFA) are the preferred modalities for catheter ablation of atrial fibrillation (AF). Technological advances have improved procedural outcomes, warranting an updated comparison. We sought to evaluate the efficacy and safety of CBA-2nd generation (CBA-2G) in comparison to RFA-contact force (RFA-CF) in patients with AF. METHODS MEDLINE, Cochrane, and ClinicalTrials.gov databases were searched until 03/01/2020 for relevant studies comparing CBA-2G versus RFA-CF in patients undergoing initial catheter ablation for AF. RESULTS A total of 17 studies, involving 11 793 patients were included. There was no difference between the two groups in the outcomes of freedom from atrial arrhythmia (p = .67) and total procedural complications (p = .65). There was a higher incidence of phrenic nerve palsy in CBA-2G (odds ratio: 10.7; 95% confidence interval [CI]: 5.85 to 19.55; p < .001). Procedure duration was shorter (mean difference: -31.32 min; 95% CI: -40.73 to -21.92; p < .001) and fluoroscopy duration was longer (+3.21 min; 95% CI: 1.09 to 5.33; p = .003) in CBA-2G compared to RFA-CF. In the subgroup analyses of patients with persistent AF and >1 freeze lesion delivered per vein, there was no difference in freedom from atrial arrhythmia. CONCLUSIONS In AF patients undergoing initial ablation, CBA-2G and RFA-CF were equally efficacious. The procedure duration was shorter, but with a higher incidence of phrenic nerve palsy in CBA-2G. In patients with persistent AF, there was no difference in the efficacy between CBA-2G or RFA-CF techniques.
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Affiliation(s)
- Venkatesh Ravi
- Division of Electrophysiology, Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Abhushan Poudyal
- Division of Cardiology, Department of Medicine, John H Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Priyanjali Pulipati
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Timothy Larsen
- Division of Electrophysiology, Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Kousik Krishnan
- Division of Electrophysiology, Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Richard G Trohman
- Division of Electrophysiology, Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Parikshit S Sharma
- Division of Electrophysiology, Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Henry D Huang
- Division of Electrophysiology, Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
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Pietrasik GM, Huang HD, Rodriguez JM, Sharma PS, Trohman RG, Krishnan K. Safety and feasibility of radiofrequency redo pulmonary vein isolation ablation for atrial fibrillation after Amulet implantation and device electrical characteristics. HeartRhythm Case Rep 2020; 6:415-418. [PMID: 32695590 PMCID: PMC7361168 DOI: 10.1016/j.hrcr.2020.03.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 11/17/2022] Open
Affiliation(s)
- Grzegorz M Pietrasik
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois.,Division of Cardiology, Cook County Health, Chicago, Illinois
| | - Henry D Huang
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Jason M Rodriguez
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Parikshit S Sharma
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Richard G Trohman
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Kousik Krishnan
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
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Huang HD, Pietrasik G, Abid QUA, Sharma PS, Krishnan K, Larsen TR, Trohman RG. Supplemental Radiofrequency Ablation After Acutely Unsuccessful Cryoballoon Pulmonary Vein Isolation is Associated With Increased Risk of Recurrent Atrial Fibrillation. J Am Heart Assoc 2020; 9:e015979. [PMID: 32394797 PMCID: PMC7660892 DOI: 10.1161/jaha.120.015979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Cryoballoon (CB) ablation is widely performed for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). Anatomic variations in patient pulmonary vein (PV) anatomy are believed to impact short‐ and long‐term procedural success of CB PVI. Methods and Results We hypothesized that failure of initial PV isolation with a standard technique (ie, requiring >2 freeze cycles per PV and/or radiofrequency ablation [RFA] to achieve PV isolation) during index CB PVI procedures would be associated with decreased freedom from AF. We examined a cohort of 177 consecutive patients with drug‐refractory AF who underwent CB PVI with a 28‐mm balloon second‐generation CB device. Mean follow‐up time was 19±9 months. Forty‐three patients had AF recurrence after the 90‐day blanking period after ablation. In 40 patients, acute isolation of one or more PVs could not be achieved by CB ablation with the standard technique (single freeze with or without bonus freeze). To obtain complete acute PVI, 15 patients received extra freeze applications, 20 required supplemental RFA, and 5 received both extra freeze applications and supplemental RFA. Multivariate regression analysis revealed supplemental RFA use during index CB PVI procedures was independently associated with a threefold increased risk of AF recurrence (adjusted hazard ratio, 3.01; 1.45–10.87; P=0.003). Conclusions Use of supplemental RFA during CB PVI procedures to assist with isolation of one or more PVs was independently associated with increased risk of AF recurrence. Use of additional freezes to achieve PVI did not increase the risk for recurrent AF.
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Affiliation(s)
- Henry D Huang
- Division of Cardiology Rush University Medical Center Chicago IL
| | | | | | | | - Kousik Krishnan
- Division of Cardiology Rush University Medical Center Chicago IL
| | - Timothy R Larsen
- Division of Cardiology Rush University Medical Center Chicago IL
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Huang HD, Rodriguez JM, Serafini NJ, Macias C, Winterfield J, Sharma PS, Larsen T, Krishnan K, Trohman RG. Comparison between minimal fluoroscopy and conventional approaches for visually guided laser balloon pulmonary vein isolation ablation. J Cardiovasc Electrophysiol 2020; 31:1608-1615. [PMID: 32406100 DOI: 10.1111/jce.14546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/28/2020] [Revised: 04/17/2020] [Accepted: 05/10/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Although balloon-based techniques, such as the laser balloon (LB) ablation have simplified pulmonary vein isolation (PVI), procedural fluoroscopy usage remains higher in comparison to radiofrequency PVI approaches due to limited 3-dimensional mapping system integration. METHODS In this prospective study, 50 consecutive patients were randomly assigned in alternating fashion to a low fluoroscopy group (LFG; n = 25) or conventional fluoroscopy group (CFG; n = 25) and underwent de novo PVI procedures using visually guided LB technique. RESULTS There was no statistical difference in baseline characteristics or cross-overs between treatment groups. Acute PVI was accomplished in all patients. Mean follow up was 318 ± 69 days. Clinical recurrence of atrial fibrillation after PVI was similar between groups (CFG: 19% vs LFG: 15%; P = .72). Total fluoroscopy time was significantly lower in the LFG than the CFG (1.7 ± 1.4 vs 16.9 ± 5.9 minutes; P < .001) despite similar total procedure duration (143 ± 22 vs 148 ± 22 minutes; P = .42) and mean LA dwell time (63 ± 15 vs 59 ± 10 minutes; P = .28). Mean dose area product was significantly lower in the LFG (181 ± 125 vs 1980 ± 750 μGym2 ; P < .001). Fluoroscopy usage after transseptal access was substantially lower in the LFG (0.63 ± 0.43 vs 11.70 ± 4.32 minutes; P < .001). Complications rates were similar between both groups (4% vs 2%; P = .57). CONCLUSIONS This study demonstrates that LB PVI can be safely achieved using a novel low fluoroscopy protocol while also substantially reducing fluoroscopy usage and radiation exposure in comparison to conventional approaches for LB ablation.
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Affiliation(s)
- Henry D Huang
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Jason M Rodriguez
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | | | - Carlos Macias
- Division of Cardiology, UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Jeffrey Winterfield
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Parikshit S Sharma
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Timothy Larsen
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Kousik Krishnan
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Richard G Trohman
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
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Hanifin JL, Ravi V, Trohman RG, Sharma PS. Permanent His Bundle Pacing: A programming and troubleshooting guide. Indian Pacing Electrophysiol J 2020; 20:121-128. [PMID: 32360610 PMCID: PMC7244879 DOI: 10.1016/j.ipej.2020.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 04/07/2020] [Accepted: 04/07/2020] [Indexed: 11/25/2022] Open
Abstract
Permanent His Bundle Pacing (HBP) has recently gained popularity. However, implanting physicians and those who perform the device checks must invest in additional education in order to accurately program these devices, identify changes in morphology and perform troubleshooting to help achieve the best outcomes for the patients. This paper reviews key aspects of HBP and provides the educational tools for successful HBP follow-up and troubleshooting.
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Huang HD, Serafini N, Rodriguez J, Sharma PS, Krishnan K, Trohman RG. Near-zero Fluoroscopic Approach for Laser Balloon Pulmonary Vein Isolation Ablation: A Case Study. J Innov Card Rhythm Manag 2020; 11:4069-4074. [PMID: 32368382 PMCID: PMC7192128 DOI: 10.19102/icrm.2020.110402] [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: 08/06/2019] [Accepted: 09/27/2019] [Indexed: 01/08/2023] Open
Abstract
Fluoroscopy remains a cornerstone imaging modality for catheter placement and positioning in electrophysiology device and ablation procedures. However, efforts are being made to reduce the cumulative exposure to radiation in the patient and physician alike. We present the case of a 59-year-old male patient with hypertension, chronic kidney disease, and paroxysmal atrial fibrillation who underwent successful near-fluoroless laser balloon (LB) pulmonary vein isolation (PVI) ablation. Though this case demonstrates the usage of a novel protocol for near-fluoroless LB ablation that resulted in successful, uncomplicated acute PVI, the feasibility and safety of this technique should be validated in a larger series or prospective comparative study.
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Affiliation(s)
- Henry D Huang
- Division of Internal Medicine, Section of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Nicholas Serafini
- Division of Internal Medicine, Section of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Jason Rodriguez
- Division of Internal Medicine, Section of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Parikshit S Sharma
- Division of Internal Medicine, Section of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Kousik Krishnan
- Division of Internal Medicine, Section of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Richard G Trohman
- Division of Internal Medicine, Section of Cardiology, Rush University Medical Center, Chicago, IL, USA
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Huang HD, Abid QUA, Ravi V, Sharma P, Larsen T, Krishnan K, Trohman RG. Meta-analysis of pulmonary vein isolation ablation for atrial fibrillation conventional vs low- and zero-fluoroscopy approaches. J Cardiovasc Electrophysiol 2020; 31:1403-1412. [PMID: 32202003 DOI: 10.1111/jce.14450] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 01/04/2020] [Revised: 02/15/2020] [Accepted: 02/25/2020] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Radiation exposure during catheter ablation procedures is a significant hazard for both patients and operators. Atrial fibrillation (AF) ablation procedures have been historically associated with higher fluoroscopy usage than other electrophysiology procedures. Recent efforts have been made to reduce dependence on fluoroscopy during pulmonary vein isolation (PVI) ablation procedures using alternative techniques. METHODS We performed a meta-analysis of studies comparing zero or low fluoroscopy (LF) vs conventional fluoroscopy (CF) approaches for AF ablation. Outcomes of interest included acute and 12-month procedural efficacy, safety, procedure duration, fluoroscopy time, and dose area product. Aggregated data were analyzed with random-effects models, using a Bayesian hierarchical approach. RESULTS A total of 2228 participants (LF, n = 1190 vs CF, n = 1038) from 15 studies were included in the meta-analysis. Risk of AF recurrence in 12 months (odds ratio [OR], 95% confidence interval [95% CI] = 1.343 [0.771-2.340]; P = .297), redo-ablation procedures (OR [95% CI] = 0.521 [0.198-1.323]; P = .186), and procedural complications (OR [95% CI] = 0.99 [0.485-2.204]; P = .979) were similar between LF- and CF-ablation groups. In comparison to CF ablation, LF ablation led to shorter procedure duration (weighted mean differences [WMDs] [95% CI] = -14.6 minutes [-22.5 to -6.8]; P < .001), fluoroscopy time (WMD [95% CI] = -8.8 minutes [-11.9 to -5.9]; P < .001), and dose area product (WMD [95% CI] = -1946 mGy/cm2 [-2685 to 1207]; P < .001). CONCLUSION LF approaches have similar clinical efficacy and safety as CF approaches for PVI. LF approaches are associated with shorter procedure time, fluoroscopy usage, and dose area product during PVI.
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Affiliation(s)
- Henry D Huang
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Qurrat-Ul-Ain Abid
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Venkatesh Ravi
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Parikshit Sharma
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Timothy Larsen
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Kousik Krishnan
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Richard G Trohman
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
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Upadhyay GA, Vijayaraman P, Nayak HM, Verma N, Dandamudi G, Sharma PS, Saleem M, Mandrola J, Genovese D, Oren JW, Subzposh FA, Aziz Z, Beaser A, Shatz D, Besser S, Lang RM, Trohman RG, Knight BP, Tung R. On-treatment comparison between corrective His bundle pacing and biventricular pacing for cardiac resynchronization: A secondary analysis of the His-SYNC Pilot Trial. Heart Rhythm 2019; 16:1797-1807. [DOI: 10.1016/j.hrthm.2019.05.009] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Indexed: 10/26/2022]
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Huang HD, Sharma PS, Nayak HM, Serafini N, Trohman RG. How to perform electroanatomic mapping-guided cardiac resynchronization therapy using Carto 3 and ESI NavX three-dimensional mapping systems. Europace 2019; 21:1742-1749. [PMID: 31435671 DOI: 10.1093/europace/euz229] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 05/27/2019] [Accepted: 07/23/2019] [Indexed: 02/03/2023] Open
Abstract
AIMS To examine the feasibility and safety of a novel protocol for low fluoroscopy, electroanatomic mapping (EAM)-guided Cardiac resynchronization therapy with a defibrillator (CRT-D) implantation and using both EnSite NavX (St. Jude Medical, St. Paul, MN, USA) and Carto 3 (Biosense Webster, Irvine, CA, USA) mapping systems. METHODS AND RESULTS Twenty consecutive patients underwent CRT implantation using either a conventional fluoroscopic approach (CFA) or EAM-guided lead placement with Carto 3 and EnSite NavX mapping systems. We compared fluoroscopy and procedural times, radiopaque contrast dose, change in QRS duration pre- and post-procedure, and complications in all patients. Fluoroscopy time was 86% lower in the EAM group compared to the conventional group [mean 37.2 min (CFA) vs. 5.5 min (EAM), P = 0.00003]. There was no significant difference in total procedural time [mean 183 min (CFA) vs. 161 min (EAM), P = 0.33] but radiopaque contrast usage was lower in the EAM group [mean 16 mL (CFA) vs. 4 mL (EAM), P = 0.006]. Likewise, there was no significant change in QRS duration with BiV pacing between the groups [mean -13 (CFA) vs. -25 ms (EAM), P = 0.09]. CONCLUSION Electroanatomic mapping-guided lead placement using either Carto or ESI NavX mapping systems is a feasible alternative to conventional fluoroscopic methods for CRT-D implantation utilizing the protocol described in this study.
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Affiliation(s)
- Henry D Huang
- Division of Cardiology, Rush University Medical Center, 1717 W. Congress Parkway, Suite 332, Kellogg, Chicago, IL, USA
| | - Parikshit S Sharma
- Division of Cardiology, Rush University Medical Center, 1717 W. Congress Parkway, Suite 332, Kellogg, Chicago, IL, USA
| | - Hemal M Nayak
- Division of Cardiology, University of Chicago, 5758 S. Maryland Avenue M/C 9024, Chicago, IL, USA
| | - Nicholas Serafini
- Division of Cardiology, Rush University Medical Center, 1717 W. Congress Parkway, Suite 332, Kellogg, Chicago, IL, USA
| | - Richard G Trohman
- Division of Cardiology, Rush University Medical Center, 1717 W. Congress Parkway, Suite 332, Kellogg, Chicago, IL, USA
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Trohman RG. Predicting appropriate therapies and mortality in implantable cardioverter-defibrillator recipients: a work in progress. Pol Arch Intern Med 2019; 129:657-658. [DOI: 10.20452/pamw.15038] [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: 11/23/2022]
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Trohman RG, Huang HD, Sharma PS. The Miniaturization of Cardiac Implantable Electronic Devices: Advances in Diagnostic and Therapeutic Modalities. Micromachines (Basel) 2019; 10:E633. [PMID: 31546646 PMCID: PMC6843667 DOI: 10.3390/mi10100633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 09/15/2019] [Accepted: 09/17/2019] [Indexed: 12/24/2022]
Abstract
The Fourth Industrial Revolution, characterized by an unprecedented fusion of technologies that is blurring the lines between the physical, digital, and biological spheres, continues the trend to manufacture ever smaller mechanical, optical and electronic products and devices. In this manuscript, we outline the way cardiac implantable electronic devices (CIEDs) have evolved into remarkably smaller units with greatly enhanced applicability and capabilities.
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Affiliation(s)
- Richard G Trohman
- Section of Electrophysiology, Arrhythmia and Pacemaker Services, Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL 60612, USA.
| | - Henry D Huang
- Section of Electrophysiology, Arrhythmia and Pacemaker Services, Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL 60612, USA.
| | - Parikshit S Sharma
- Section of Electrophysiology, Arrhythmia and Pacemaker Services, Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL 60612, USA.
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Beer D, Sharma PS, Subzposh FA, Naperkowski A, Pietrasik GM, Durr B, Qureshi M, Panikkath R, Abdelrahman M, Williams BA, Hanifin JL, Zimberg R, Austin K, Macuch B, Trohman RG, Vanenkevort EA, Dandamudi G, Vijayaraman P. Clinical Outcomes of Selective Versus Nonselective His Bundle Pacing. JACC Clin Electrophysiol 2019; 5:766-774. [PMID: 31320004 DOI: 10.1016/j.jacep.2019.04.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 04/24/2019] [Accepted: 04/24/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of the study was to evaluate the clinical outcomes of nonselective (NS) His bundle pacing (HBP) compared with selective (S) HBP. BACKGROUND HBP is the most physiologic form of ventricular pacing. NS-HBP results in right ventricular septal pre-excitation due to fusion with myocardial capture in addition to His bundle capture resulting in widened QRS duration compared with S-HBP wherein there is exclusive His bundle capture and conduction. METHODS The Geisinger and Rush University HBP registries comprise 640 patients who underwent successful HBP. Our study population included 350 consecutive patients treated with HBP for bradyarrhythmic indications who demonstrated ≥20% ventricular pacing burden 3 months post-implantation. Patients were categorized into S-HBP or NS-HBP based on QRS morphology (NS-HBP n = 232; S-HBP n = 118) at the programmed output at the 3-month follow-up. The primary analysis outcome was a combined endpoint of all-cause mortality or heart failure hospitalization. RESULTS The NS-HBP group had a higher number of men (64% vs. 50%; p = 0.01), higher incidence of infranodal atrioventricular block (40% vs. 9%; p < 0.01), ischemic cardiomyopathy (24% vs. 14%; p = 0.03), and permanent atrial fibrillation (18% vs. 8%; p = 0.01). The primary endpoint occurred in 81 of 232 patients (35%) in the NS-HBP group compared with 23 of 118 patients (19%) in the S-HBP group (hazard ratio: 1.38; 95% confidence interval: 0.87 to 2.20; p = 0.17). Subgroup analyses of patients at greatest risk (higher pacing burden or lower left ventricular ejection fraction) revealed no incremental risk with NS-HBP. CONCLUSIONS NS-HBP was associated with similar outcomes of death or heart failure hospitalization when compared with S-HBP. Multicenter risk-matched clinical studies are needed to confirm these findings.
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Affiliation(s)
- Dominik Beer
- Division of Cardiology, Geisinger Heart Institute, Wilkes Barre, Pennsylvania
| | - Parikshit S Sharma
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Faiz A Subzposh
- Division of Cardiology, Geisinger Heart Institute, Wilkes Barre, Pennsylvania
| | - Angela Naperkowski
- Division of Cardiology, Geisinger Heart Institute, Wilkes Barre, Pennsylvania
| | | | - Brendan Durr
- Division of Cardiology, Geisinger Heart Institute, Wilkes Barre, Pennsylvania
| | - Maria Qureshi
- Division of Cardiology, Geisinger Heart Institute, Wilkes Barre, Pennsylvania
| | - Ragesh Panikkath
- Division of Cardiology, Geisinger Heart Institute, Wilkes Barre, Pennsylvania
| | - Mohamed Abdelrahman
- Division of Cardiology, Weil Cornell Medicine-New York Presbyterian Hospital, New York, New York
| | - Brent A Williams
- Division of Cardiology, Geisinger Heart Institute, Wilkes Barre, Pennsylvania
| | - Jillian L Hanifin
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Ryan Zimberg
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Kelly Austin
- Division of Cardiology, Geisinger Heart Institute, Wilkes Barre, Pennsylvania
| | - Brooke Macuch
- Division of Cardiology, Geisinger Heart Institute, Wilkes Barre, Pennsylvania
| | - Richard G Trohman
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | | | - Gopi Dandamudi
- Division of Cardiology, Indiana University, Indianapolis, Indiana
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Sharma PS, Huang HD, Trohman RG, Naperkowski A, Ellenbogen KA, Vijayaraman P. Low Fluoroscopy Permanent His Bundle Pacing Using Electroanatomic Mapping. Circ Arrhythm Electrophysiol 2019; 12:e006967. [DOI: 10.1161/circep.118.006967] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Henry D. Huang
- Rush University Medical Center, Chicago, IL (P.S.S., H.D.H., R.G.T.)
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45
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Huang HD, Pietrasik GM, Serafini NJ, Sharma PS, Krishnan K, Trohman RG. Drug-induced acute pneumonitis following initiation of flecainide therapy after pulmonary vein isolation ablation in a patient with mitral stenosis and previous chronic amiodarone use. HeartRhythm Case Rep 2018; 5:53-55. [PMID: 30693207 PMCID: PMC6342725 DOI: 10.1016/j.hrcr.2018.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 11/28/2022] Open
Affiliation(s)
- Henry D Huang
- Section of Electrophysiology, Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Grzegorz M Pietrasik
- Section of Electrophysiology, Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Nicholas J Serafini
- Section of Electrophysiology, Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Parikshit S Sharma
- Section of Electrophysiology, Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Kousik Krishnan
- Section of Electrophysiology, Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Richard G Trohman
- Section of Electrophysiology, Division of Cardiology, Rush University Medical Center, Chicago, Illinois
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46
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Trohman RG, Huang HD, Zimberg RM, Serafini NJ, Sharma PS. Managing Cardiac Resynchronization Therapy Nonresponse: Conventional and Unconventional Techniques. J Innov Card Rhythm Manag 2018; 9:3398-3405. [PMID: 32477789 PMCID: PMC7252654 DOI: 10.19102/icrm.2018.091107] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 02/25/2018] [Indexed: 11/29/2022] Open
Abstract
Cardiac resynchronization therapy (CRT) is an established option for select patients with systolic heart failure. Nonresponse to CRT remains a significant problem. We present five patients who were CRT nonresponders and discuss the conventional and nonconventional approaches employed to achieve CRT benefit.
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Affiliation(s)
- Richard G. Trohman
- Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
- Address correspondence to: Richard G. Trohman, MD, MBA, Rush University Medical Center, 1717 West Congress Parkway, Room 301 Kellogg, Chicago, IL 60612, USA.
| | - Henry D. Huang
- Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Ryan M. Zimberg
- Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Nicholas J. Serafini
- Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Parikshit S. Sharma
- Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
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47
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Trohman RG, Sharma PS, McAninch EA, Bianco AC. Amiodarone and thyroid physiology, pathophysiology, diagnosis and management. Trends Cardiovasc Med 2018; 29:285-295. [PMID: 30309693 DOI: 10.1016/j.tcm.2018.09.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [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: 02/01/2018] [Revised: 08/15/2018] [Accepted: 09/06/2018] [Indexed: 12/14/2022]
Abstract
Although amiodarone is considered the most effective antiarrhythmic agent, its use is limited by a wide variety of potential toxicities. The purpose of this review is to provide a comprehensive "bench to bedside" overview of the ways amiodarone influences thyroid function. We performed a systematic search of MEDLINE to identify peer-reviewed clinical trials, randomized controlled trials, meta-analyses, and other clinically relevant studies. The search was limited to English-language reports published between 1950 and 2017. Amiodarone was searched using the terms adverse effects, hypothyroidism, myxedema, hyperthyroidism, thyroid storm, atrial fibrillation, ventricular arrhythmia, and electrical storm. Google and Google scholar as well as bibliographies of identified articles were reviewed for additional references. We included 163 germane references in this review. Because amiodarone is one of the most frequently prescribed antiarrhythmic drugs in the United States, the mechanistic, diagnostic and therapeutic information provided is relevant for practicing clinicians in a wide range of medical specialties.
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Affiliation(s)
- Richard G Trohman
- Divisions of Cardiology and Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States.
| | - Parikshit S Sharma
- Divisions of Cardiology and Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Elizabeth A McAninch
- Divisions of Cardiology and Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Antonio C Bianco
- Divisions of Cardiology and Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
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48
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Abstract
Inadvertent malpositioning of a cardiac implantable electronic device lead into the left ventricle is a rare complication of transvenous pacing and defibrillation. Rapid identification of lead position is critical during implantation and just after the procedure, with immediate correction required if malpositioning is detected. If lead misplacement is discovered late after implantation, the lead should be surgically removed or chronic anticoagulation with warfarin should be instituted.
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Affiliation(s)
- Richard G Trohman
- Electrophysiology, Arrhythmia, and Pacemaker Section, Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA.
| | - Parikshit S Sharma
- Electrophysiology, Arrhythmia, and Pacemaker Section, Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
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49
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Patel P, Krishnan K, Saha S, Trohman RG. Novel Implantable Cardioverter-defibrillator Lead Placement in a Patient with a Prosthetic Tricuspid Valve. J Innov Card Rhythm Manag 2017; 8:2894-2897. [PMID: 32494432 PMCID: PMC7252841 DOI: 10.19102/icrm.2017.081103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 07/10/2017] [Accepted: 08/12/2017] [Indexed: 11/16/2022] Open
Abstract
As the placement of transvenous leads across a prosthetic tricuspid valve is preferentially avoided, one must consider alternative solutions to provide necessary pacing and/or defibrillator therapy. Here, we present a case of novel placement of an implantable cardioverter-defibrillator (ICD) lead in the right atrium, in order to provide safe ICD therapy in a patient with a prosthetic tricuspid valve.
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Affiliation(s)
- Pratik Patel
- Division of Cardiac Electrophysiology, Rush University Medical Center, Chicago, IL, USA
| | - Kousik Krishnan
- Division of Cardiac Electrophysiology, Rush University Medical Center, Chicago, IL, USA
| | - Sandeep Saha
- Division of Cardiac Electrophysiology, Rush University Medical Center, Chicago, IL, USA
| | - Richard G Trohman
- Division of Cardiac Electrophysiology, Rush University Medical Center, Chicago, IL, USA
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50
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Serafini N, Sharma PS, Madias C, Trohman RG. Wide complex tachycardia in a patient with congenital heart block: What is the mechanism? J Cardiovasc Electrophysiol 2017; 29:201-203. [DOI: 10.1111/jce.13340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 09/11/2017] [Accepted: 09/12/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Nicholas Serafini
- Division of Cardiology; Rush University Medical Center; Chicago IL USA
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