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Lyle M, Miranda WR, Vaidya VR, Rose CH, Melduni RM, Connolly HM, Young KA. Pregnancy Outcomes in Left Ventricular Noncompaction. Am J Cardiol 2023; 209:154-155. [PMID: 37848172 DOI: 10.1016/j.amjcard.2023.09.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 09/20/2023] [Accepted: 09/20/2023] [Indexed: 10/19/2023]
Affiliation(s)
- Melissa Lyle
- Division of Advanced Heart Failure and Transplantation, Department of Transplant, Mayo Clinic, Jacksonville, Florida
| | - William R Miranda
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
| | - Vaibhav R Vaidya
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Carl H Rose
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Rowlens M Melduni
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Heidi M Connolly
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Katie A Young
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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Ezzeddine FM, Siontis KC, Giudicessi J, Ackerman MJ, Killu AM, Deshmukh AJ, Madhavan M, van Zyl M, Vaidya VR, Karki R, Tseng A, Munger TM, McLeod CJ, Asirvatham SJ, Del-Carpio Munoz F. Substrate Characterization and Outcomes of Catheter Ablation of Ventricular Arrhythmias in Patients With Mitral Annular Disjunction. Circ Arrhythm Electrophysiol 2022; 15:e011088. [PMID: 36074649 DOI: 10.1161/circep.122.011088] [Citation(s) in RCA: 6] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mitral annular disjunction (MAD) has recently been recognized as an arrhythmogenic entity. Data on the electrophysiological substrate as well as the outcomes of catheter ablation of ventricular arrhythmias in patients with MAD is limited. METHODS Forty patients with MAD (mean age 47±15 years; 70% female) underwent catheter ablation for ventricular arrhythmias. Detailed clinical, electrocardiographic, cardiac imaging, and procedural data were collected. Clinical outcomes were compared between patients who had substrate modification in the MAD area and those who did not. RESULTS Twenty-three (57.5%) patients had ablation for premature ventricular contractions, 10 (25%) patients for sustained ventricular tachycardia, and 7 (17.5%) patients for premature ventricular contraction-triggered ventricular fibrillation ablation. Mean end-systolic MAD length was 10.58±3.49 mm on transthoracic echocardiography. Seventeen (42.5%) patients had preprocedural cardiac magnetic resonance imaging, and 5 (29%) patients had late gadolinium enhancement. Among the 18 (45%) patients who had abnormal local electrograms (low voltage, long-duration, fractionated, isolated mid-diastolic potentials) during electroanatomical mapping, 10 (25%) patients had abnormal electrograms in the anterolateral mitral annulus or MAD area. Substrate modification was performed in 10 (25%) patients. Catheter ablation was acutely successful in 36 (90%) patients (elimination of premature ventricular contraction or noninducibility of ventricular tachycardia). After a median follow-up duration of 54.08 (interquartile range, 10.67-89.79) months, premature ventricular contraction burden decreased from a median of 9.75% (interquartile range, 3.25-14) before the ablation to a median of 4% (interquartile range, 1-7.75) after the ablation (P=0.03 [95% CI, 0.055-6.5]). Eight (20.5%) patients had repeat ablation for ventricular arrhythmias. Substrate modification of the MAD was associated with a trend toward lower rates of repeat ablation (0% versus 26.7%; P=0.16). CONCLUSIONS Patients with MAD have a complex arrhythmogenic substrate, and catheter ablation is effective in reducing recurrence of ventricular arrhythmias. Substrate mapping and ablation may be considered in these patients.
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Affiliation(s)
- Fatima M Ezzeddine
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (F.M.E., K.C.S., J.G., M.J.A., A.M.K., A.J.D., M.M., M.v.Z., V.R.V., R.K., A.T., T.M.M., S.J.A., F.D.-C.M.)
| | - Konstantinos C Siontis
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (F.M.E., K.C.S., J.G., M.J.A., A.M.K., A.J.D., M.M., M.v.Z., V.R.V., R.K., A.T., T.M.M., S.J.A., F.D.-C.M.)
| | - John Giudicessi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (F.M.E., K.C.S., J.G., M.J.A., A.M.K., A.J.D., M.M., M.v.Z., V.R.V., R.K., A.T., T.M.M., S.J.A., F.D.-C.M.)
| | - Michael J Ackerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (F.M.E., K.C.S., J.G., M.J.A., A.M.K., A.J.D., M.M., M.v.Z., V.R.V., R.K., A.T., T.M.M., S.J.A., F.D.-C.M.)
| | - Ammar M Killu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (F.M.E., K.C.S., J.G., M.J.A., A.M.K., A.J.D., M.M., M.v.Z., V.R.V., R.K., A.T., T.M.M., S.J.A., F.D.-C.M.)
| | - Abhishek J Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (F.M.E., K.C.S., J.G., M.J.A., A.M.K., A.J.D., M.M., M.v.Z., V.R.V., R.K., A.T., T.M.M., S.J.A., F.D.-C.M.)
| | - Malini Madhavan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (F.M.E., K.C.S., J.G., M.J.A., A.M.K., A.J.D., M.M., M.v.Z., V.R.V., R.K., A.T., T.M.M., S.J.A., F.D.-C.M.)
| | - Martin van Zyl
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (F.M.E., K.C.S., J.G., M.J.A., A.M.K., A.J.D., M.M., M.v.Z., V.R.V., R.K., A.T., T.M.M., S.J.A., F.D.-C.M.)
| | - Vaibhav R Vaidya
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (F.M.E., K.C.S., J.G., M.J.A., A.M.K., A.J.D., M.M., M.v.Z., V.R.V., R.K., A.T., T.M.M., S.J.A., F.D.-C.M.)
| | - Roshan Karki
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (F.M.E., K.C.S., J.G., M.J.A., A.M.K., A.J.D., M.M., M.v.Z., V.R.V., R.K., A.T., T.M.M., S.J.A., F.D.-C.M.)
| | - Andrew Tseng
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (F.M.E., K.C.S., J.G., M.J.A., A.M.K., A.J.D., M.M., M.v.Z., V.R.V., R.K., A.T., T.M.M., S.J.A., F.D.-C.M.)
| | - Thomas M Munger
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (F.M.E., K.C.S., J.G., M.J.A., A.M.K., A.J.D., M.M., M.v.Z., V.R.V., R.K., A.T., T.M.M., S.J.A., F.D.-C.M.)
| | | | - Samuel J Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (F.M.E., K.C.S., J.G., M.J.A., A.M.K., A.J.D., M.M., M.v.Z., V.R.V., R.K., A.T., T.M.M., S.J.A., F.D.-C.M.).,Department of Pediatric and Adolescent Medicine, Mayo Clinic College of Medicine, Rochester, MN (S.J.A.)
| | - Freddy Del-Carpio Munoz
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (F.M.E., K.C.S., J.G., M.J.A., A.M.K., A.J.D., M.M., M.v.Z., V.R.V., R.K., A.T., T.M.M., S.J.A., F.D.-C.M.)
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Vaidya VR. The knowns and unknowns of leadless pacing in 2022. Indian Pacing Electrophysiol J 2022; 22:87-90. [PMID: 35272855 PMCID: PMC8981136 DOI: 10.1016/j.ipej.2022.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Vaidya VR, Asirvatham R, Kowlgi GN, Dai MY, Cochuyt JJ, Hodge DO, Deshmukh AJ, Cha YM. Trends in Cardiovascular Implantable Electronic Device Insertion Between 1988 and 2018 in Olmsted County. JACC Clin Electrophysiol 2022; 8:88-100. [PMID: 34454890 PMCID: PMC9339254 DOI: 10.1016/j.jacep.2021.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 08/17/2020] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES This study sought to describe trends in cardiovascular implantable electronic device (CIED) insertion over the past 3 decades in Olmsted County. BACKGROUND Trends in CIED insertion in the United States have not been extensively studied. METHODS The Rochester Epidemiology Project is a medical records linkage system comprising the records of all residents of Olmsted County from 1966 to the present. CIED insertion between 1988 and 2018 was determined using International Classification of Diseases-Ninth Revision, International Classification of Diseases-10th Revision, and Current Procedural Terminology codes. Age- and sex-adjusted incidence rates, adjusted to the 2010 US White population, were calculated. Trends in incidence over time, across age groups, and between sex are estimated using Poisson regression models. RESULTS The age- and sex-adjusted incidence of device implants for the study period were as follows: overall CIED: 82.4 (95% CI: 79.2-85.6); permanent pacemaker (PPM): 62.9 (95% CI: 60.0-65.7); implantable cardioverter-defibrillator (ICD): 14.0 (95% CI: 12.6-15.3); and cardiac resynchronization therapy (CRT): 5.6 (95% CI: 4.7-6.4) per 100,000 per year. The overall incidence of CIED insertion increased between 1988 to 1993 and 2000 to 2005 and then decreased between 2000 to 2005 and 2012 to 218 (P < 0.0001). PPM and ICD insertion incidence followed these trends, whereas the incidence of CRT insertion increased between 2000 to 2005 and 2012 to 2018. CIED insertion incidence increased with age (P < 0.0001). CIED insertion incidence was greater in men (116.3 vs 57.3 per 100,000 per year in men vs women; P < 0.0001). The overall survival of CRT recipients improved (P = 0.0044). CONCLUSIONS The incidence values for PPM and ICD implants are decreasing, while the incidence of CRT implants is increasing. CIEDs are increasingly inserted in the elderly, men, and patients with higher comorbidities.
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Affiliation(s)
- Vaibhav R. Vaidya
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Roshini Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Gurukripa N. Kowlgi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Ming-Yan Dai
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA,Cardiovascular Research Institute and Department of Cardiology, Renmin Hospital of Wuhan University, Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Jordan J. Cochuyt
- Department of Quantitative Heath Sciences, Mayo Clinic, Jacksonville, FL 32224, USA
| | - David O. Hodge
- Department of Quantitative Heath Sciences, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | - Yong Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Vaidya VR. Catheter ablation for atrioventricular nodal reentrant tachycardia: When all is not right, ablate what is left. Indian Pacing Electrophysiol J 2021; 21:11-13. [PMID: 33518193 PMCID: PMC7854378 DOI: 10.1016/j.ipej.2021.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Vaibhav R Vaidya
- Department of Cardiovascular Diseases, Mayo Clinic Health Systems, Eau Claire, WI, United States; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States
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Jain CC, Pedrotty D, Araoz PA, Sugrue A, Vaidya VR, Padmanabhan D, Arunachalam SP, Lerman LO, Asirvatham SJ, Borlaug BA. Sustained Improvement in Diastolic Reserve Following Percutaneous Pericardiotomy in a Porcine Model of Heart Failure With Preserved Ejection Fraction. Circ Heart Fail 2021; 14:e007530. [PMID: 33478242 DOI: 10.1161/circheartfailure.120.007530] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Heart failure with preserved ejection fraction is increasing in prevalence, but few effective treatments are available. Elevated left ventricular (LV) diastolic filling pressures represent a key therapeutic target. Pericardial restraint contributes to elevated LV end-diastolic pressure, and acute studies have shown that pericardiotomy attenuates the rise in LV end-diastolic pressure with volume loading. However, whether these acute effects are sustained chronically remains unknown. METHODS Minimally invasive pericardiotomy was performed percutaneously using a novel device in a porcine model of heart failure with preserved ejection fraction. Hemodynamics were assessed at baseline and following volume loading with pericardium intact, acutely following pericardiotomy, and then again chronically after 4 weeks. Cardiac structure was assessed by magnetic resonance imaging. RESULTS The increase in LV end-diastolic pressure with volume loading was mitigated by 41% (95% CI, 27%-45%, P<0.0001; ΔLV end-diastolic pressure reduced from +9±3 mm Hg to +5±3 mm Hg, P=0.0003, 95% CI, -2.2 to -5.5). The effect was sustained at 4 weeks (+5±2 mm Hg, P=0.28 versus acute). There was no statistically significant effect of pericardiotomy on ventricular remodeling compared with age-matched controls. None of the animals developed hemodynamic or pathological indicators of pericardial constriction or frank systolic dysfunction. CONCLUSIONS The acute hemodynamic benefits of pericardiotomy are sustained for at least 4 weeks in a swine model of heart failure with preserved ejection fraction, without excessive chamber remodeling, pericarditis, or clinically significant systolic dysfunction. These data support trials evaluating minimally invasive pericardiotomy as a novel treatment for heart failure with preserved ejection fraction in humans.
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Affiliation(s)
- C Charles Jain
- Department of Cardiovascular Medicine (C.C.J., A.S., V.R.V., D. Padmanabhan, S.J.A., B.A.B.), Mayo Clinic Rochester, MN
| | - Dawn Pedrotty
- Division of Cardiovascular Disease, Mayo Clinic Arizona (D. Pedrotty)
| | - Philip A Araoz
- Department of Radiology (P.A.A., S.P.A.), Mayo Clinic Rochester, MN
| | - Alan Sugrue
- Department of Cardiovascular Medicine (C.C.J., A.S., V.R.V., D. Padmanabhan, S.J.A., B.A.B.), Mayo Clinic Rochester, MN
| | - Vaibhav R Vaidya
- Department of Cardiovascular Medicine (C.C.J., A.S., V.R.V., D. Padmanabhan, S.J.A., B.A.B.), Mayo Clinic Rochester, MN
| | - Deepak Padmanabhan
- Department of Cardiovascular Medicine (C.C.J., A.S., V.R.V., D. Padmanabhan, S.J.A., B.A.B.), Mayo Clinic Rochester, MN
| | | | - Lilach O Lerman
- Division of Nephrology and Hypertension (L.O.L.), Mayo Clinic Rochester, MN
| | - Samuel J Asirvatham
- Department of Cardiovascular Medicine (C.C.J., A.S., V.R.V., D. Padmanabhan, S.J.A., B.A.B.), Mayo Clinic Rochester, MN
| | - Barry A Borlaug
- Department of Cardiovascular Medicine (C.C.J., A.S., V.R.V., D. Padmanabhan, S.J.A., B.A.B.), Mayo Clinic Rochester, MN
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Vaidya VR, Lyle M, Miranda WR, Farwati M, Isath A, Patlolla SH, Hodge DO, Asirvatham SJ, Kapa S, Deshmukh AJ, Foley TA, Michelena HI, Connolly HM, Melduni RM. Long-Term Survival of Patients With Left Ventricular Noncompaction. J Am Heart Assoc 2021; 10:e015563. [PMID: 33441029 PMCID: PMC7955291 DOI: 10.1161/jaha.119.015563] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [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: 01/06/2023]
Abstract
Background The prognosis of left ventricular noncompaction (LVNC) remains elusive despite its recognition as a clinical entity for >30 years. We sought to identify clinical and imaging characteristics and risk factors for mortality in patients with LVNC. Methods and Results 339 adults with LVNC seen between 2000 and 2016 were identified. LVNC was defined as end‐systolic noncompacted to compacted myocardial ratio >2 (Jenni criteria) and end‐diastolic trough of trabeculation‐to‐epicardium (X):peak of trabeculation‐to‐epicardium (Y) ratio <0.5 (Chin criteria) by echocardiography; and end‐diastolic noncompacted:compacted ratio >2.3 (Petersen criteria) by magnetic resonance imaging. Median age was 47.4 years, and 46% of patients were female. Left ventricular ejection fraction <50% was present in 57% of patients and isolated apical noncompaction in 48%. During a median follow‐up of 6.3 years, 59 patients died. On multivariable Cox regression analysis, age (hazard ratio [HR] 1.04; 95% CI, 1.02–1.06), left ventricular ejection fraction <50% (HR, 2.37; 95% CI, 1.17–4.80), and noncompaction extending from the apex to the mid or basal segments (HR, 2.11; 95% CI, 1.21–3.68) were associated with all‐cause mortality. Compared with the expected survival for age‐ and sex‐matched US population, patients with LVNC had reduced overall survival (P<0.001). However, patients with LVNC with preserved left ventricular ejection fraction and patients with isolated apical noncompaction had similar survival to the general population. Conclusions Overall survival is reduced in patients with LVNC compared with the expected survival of age‐ and sex‐matched US population. However, survival rate in those with preserved left ventricular ejection fraction and isolated apical noncompaction was comparable with that of the general population.
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Affiliation(s)
| | - Melissa Lyle
- Department of Cardiovascular Diseases Mayo Clinic Rochester MN
| | | | - Medhat Farwati
- Department of Cardiovascular Diseases Mayo Clinic Rochester MN
| | - Ameesh Isath
- Department of Cardiovascular Diseases Mayo Clinic Rochester MN
| | | | - David O Hodge
- Department of Cardiovascular Diseases Mayo Clinic Jacksonville FL
| | - Samuel J Asirvatham
- Department of Cardiovascular Diseases Mayo Clinic Rochester MN.,Department of Pediatrics and Adolescent Medicine Mayo Clinic Rochester MN
| | - Suraj Kapa
- Department of Cardiovascular Diseases Mayo Clinic Rochester MN
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Abudan AA, Vaidya VR, Tripathi B, Noseworthy PA, DeSimone DC, Egbe A, Arora S, Sridhar H, DeSimone CV, Mulpuru S, Deshmukh AJ. Burden of arrhythmia in hospitalized HIV patients. Clin Cardiol 2020; 44:66-77. [PMID: 33295667 PMCID: PMC7803370 DOI: 10.1002/clc.23506] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/19/2020] [Accepted: 10/29/2020] [Indexed: 02/02/2023] Open
Abstract
Background The improved life expectancy observed in patients living with human immunodeficiency virus (HIV) infection has made age‐related cardiovascular complications, including arrhythmias, a growing health concern. Hypothesis We describe the temporal trends in frequency of various arrhythmias and assess impact of arrhythmias on hospitalized HIV patients using the Nationwide Inpatient Sample (NIS). Methods Data on HIV‐related hospitalizations from 2005 to 2014 were obtained from the NIS database using International Classification of Diseases, 9th Revision (ICD‐9) codes. Data was further subclassified into hospitalizations with associated arrhythmias and those without. Baseline demographics and comorbidities were determined. Outcomes including in‐hospital mortality, cost of care, and length of stay were extracted. SAS 9.4 (SAS Institute Inc., Cary, NC) was utilized for analysis. A multivariable analysis was performed to identify predictors of arrhythmias among hospitalized HIV patients. Results Among 2 370 751 HIV‐related hospitalizations identified, the overall frequency of any arrhythmia was 3.01%. Atrial fibrillation (AF) was the most frequent arrhythmia (2110 per 100 000). The overall frequency of arrhythmias increased over time by 108%, primarily due to a 132% increase in AF. Arrhythmias are more frequent among older males, lowest income quartile, and nonelective admissions. Patients with arrhythmias had a higher in‐hospital mortality rate (9.6%). In‐hospital mortality among patients with arrhythmias decreased over time by 43.8%. The cost of care and length of stay associated with arrhythmia‐related hospitalizations were mostly unchanged. Conclusions Arrhythmias are associated with significant morbidity and mortality in hospitalized HIV patients. AF is the most frequent arrhythmia in hospitalized HIV patients.
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Affiliation(s)
- Anas A Abudan
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States.,Department of Internal Medicine, University of Kansas School of Medicine, Kansas City, Kansas, United States
| | - Vaibhav R Vaidya
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States
| | - Byomesh Tripathi
- Department of Medicine, Mount Sinai St Luke's-Roosevelt Hospital, New York, New York, United States
| | - Peter A Noseworthy
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States
| | - Daniel C DeSimone
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States.,Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Alexander Egbe
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States
| | - Shilpkumar Arora
- Department of Medicine, Mount Sinai St Luke's-Roosevelt Hospital, New York, New York, United States
| | - Haarini Sridhar
- University of California, Berkeley, California, United States
| | | | - Siva Mulpuru
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States
| | - Abhishek J Deshmukh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States
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Abstract
To characterize cardiac activity and arrhythmias, electrophysiologists can record the electrical activity of the heart in relation to its anatomy through a process called cardiac mapping (electroanatomic mapping, EAM). A solid understanding of the basic cardiac biopotentials, called electrograms, is imperative to construct and interpret the cardiac EAM correctly. There are several mapping approaches available to the electrophysiologist, each optimized for specific arrhythmia mechanisms. This article provides an overview of the fundamentals of EAM.
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Affiliation(s)
- Thomas P Ladas
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, USA
| | - Alan Sugrue
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, USA
| | - John Nan
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, USA
| | - Vaibhav R Vaidya
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, USA
| | - Deepak Padmanabhan
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, USA
| | - K L Venkatachalam
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Jacksonville, Florida, USA
| | - Samuel J Asirvatham
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, USA; Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA; Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA.
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Sugrue A, Vaidya VR, Livia C, Padmanabhan D, Abudan A, Isath A, Witt T, DeSimone CV, Stalboerger P, Kapa S, Asirvatham SJ, McLeod CJ. Feasibility of selective cardiac ventricular electroporation. PLoS One 2020; 15:e0229214. [PMID: 32084220 PMCID: PMC7034868 DOI: 10.1371/journal.pone.0229214] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/31/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction The application of brief high voltage electrical pulses to tissue can lead to an irreversible or reversible electroporation effect in a cell-specific manner. In the management of ventricular arrhythmias, the ability to target different tissue types, specifically cardiac conduction tissue (His-Purkinje System) vs. cardiac myocardium would be advantageous. We hypothesize that pulsed electric fields (PEFs) can be applied safely to the beating heart through a catheter-based approach, and we tested whether the superficial Purkinje cells can be targeted with PEFs without injury to underlying myocardial tissue. Methods In an acute (n = 5) and chronic canine model (n = 6), detailed electroanatomical mapping of the left ventricle identified electrical signals from myocardial and overlying Purkinje tissue. Electroporation was effected via percutaneous catheter-based Intracardiac bipolar current delivery in the anesthetized animal. Repeat Intracardiac electrical mapping of the heart was performed at acute and chronic time points; followed by histological analysis to assess effects. Results PEF demonstrated an acute dose-dependent functional effect on Purkinje, with titration of pulse duration and/or voltage associated with successful acute Purkinje damage. Electrical conduction in the insulated bundle of His (n = 2) and anterior fascicle bundle (n = 2), was not affected. At 30 days repeat cardiac mapping demonstrated resilient, normal electrical conduction throughout the targeted area with no significant change in myocardial amplitude (pre 5.9 ± 1.8 mV, 30 days 5.4 ± 1.2 mV, p = 0.92). Histopathological analysis confirmed acute Purkinje fiber targeting, with chronic studies showing normal Purkinje fibers, with minimal subendocardial myocardial fibrosis. Conclusion PEF provides a novel, safe method for non-thermal acute modulation of the Purkinje fibers without significant injury to the underlying myocardium. Future optimization of this energy delivery is required to optimize conditions so that selective electroporation can be utilized in humans the treatment of cardiac disease.
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Affiliation(s)
- Alan Sugrue
- Division of Heart Rhythm Services, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States of America
| | - Vaibhav R. Vaidya
- Division of Heart Rhythm Services, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States of America
| | - Christopher Livia
- Department of Cardiovascular Medicine and Department of Molecular Pharmacology and Experimental Therapeutics, Center for Regenerative Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Deepak Padmanabhan
- Division of Heart Rhythm Services, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States of America
| | - Anas Abudan
- Division of Heart Rhythm Services, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States of America
| | - Ameesh Isath
- Division of Heart Rhythm Services, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States of America
| | - Tyra Witt
- Department of Cardiovascular Medicine and Department of Molecular Pharmacology and Experimental Therapeutics, Center for Regenerative Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Christopher V. DeSimone
- Division of Heart Rhythm Services, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States of America
| | - Paul Stalboerger
- Department of Cardiovascular Medicine and Department of Molecular Pharmacology and Experimental Therapeutics, Center for Regenerative Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Suraj Kapa
- Division of Heart Rhythm Services, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States of America
| | - Samuel J. Asirvatham
- Division of Heart Rhythm Services, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States of America
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Christopher J. McLeod
- Division of Heart Rhythm Services, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States of America
- * E-mail:
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11
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Asirvatham RS, Vaidya VR, Thome TM, Friedman PA, Cha YM. Nanostim leadless pacemaker retrieval and simultaneous micra leadless pacemaker replacement: a single-center experience. J Interv Card Electrophysiol 2019; 57:125-131. [DOI: 10.1007/s10840-019-00647-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 10/14/2019] [Indexed: 11/29/2022]
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12
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Bong J, Yasin O, Vaidya VR, Park J, Attia ZI, Padmanabhan D, Cho SJ, Asirvatham R, Schneider N, Lee J, Kim EM, Friedman PA, Ma Z. Injectable Flexible Subcutaneous Electrode Array Technology for Electrocardiogram Monitoring Device. ACS Biomater Sci Eng 2019; 6:2652-2658. [DOI: 10.1021/acsbiomaterials.9b01102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jihye Bong
- Department of Electrical and Computer Engineering, University of Wisconsin−Madison, Madison, Wisconsin 53706, United States
| | - Omar Yasin
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, United States
| | - Vaibhav R. Vaidya
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, United States
| | - Jeongpil Park
- Department of Electrical and Computer Engineering, University of Wisconsin−Madison, Madison, Wisconsin 53706, United States
| | - Zachi I. Attia
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, United States
| | - Deepak Padmanabhan
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, United States
| | - Sang June Cho
- Department of Electrical and Computer Engineering, University of Wisconsin−Madison, Madison, Wisconsin 53706, United States
| | - Roshini Asirvatham
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, United States
| | - Noah Schneider
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, United States
| | - Juhwan Lee
- Department of Electrical and Computer Engineering, University of Wisconsin−Madison, Madison, Wisconsin 53706, United States
| | - Eun Mee Kim
- Department of Emergency Medical Technology, Korea Nazarene University, Cheonan 31172, South Korea
| | - Paul A. Friedman
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, United States
| | - Zhenqiang Ma
- Department of Electrical and Computer Engineering, University of Wisconsin−Madison, Madison, Wisconsin 53706, United States
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13
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Affiliation(s)
- Walid Barake
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Chance M. Witt
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | - Yong-Mei Cha
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
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14
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Vaidya VR, Asirvatham SJ. Epicardial access: Adjusting the approach as we discover complications. J Cardiovasc Electrophysiol 2019; 30:1341-1344. [DOI: 10.1111/jce.14036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 06/05/2019] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Vaibhav R. Vaidya
- Department of Cardiovascular DiseasesMayo Clinic Rochester Minnesota
| | - Samuel J. Asirvatham
- Department of Cardiovascular DiseasesMayo Clinic Rochester Minnesota
- Department of Pediatrics and Adolescent MedicineMayo Clinic Rochester Minnesota
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15
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Caluori G, Wojtaszczyk A, Yasin O, Pesl M, Wolf J, Belaskova S, Crha M, Sugrue A, Vaidya VR, Naksuk N, DeSimone CV, Killu AM, Padmanabhan D, Asirvatham SJ, Stárek Z. Comparing the incidence of ventricular arrhythmias during epicardial ablation in swine versus canine models. Pacing Clin Electrophysiol 2019; 42:862-867. [PMID: 30989679 DOI: 10.1111/pace.13698] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 03/14/2019] [Accepted: 04/11/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Choosing the appropriate animal model for development of novel technologies requires an understanding of anatomy and physiology of these different models. There are little data about the characteristics of different animal models for the study of technologies used for epicardial ablation. We aimed to compare the incidence of ventricular arrhythmias during epicardial radiofrequency ablation between swine and canine models using novel epicardial ablation catheters. METHODS We conducted a retrospective study using data obtained from epicardial ablation experiments performed on swine (Sus Scrofa) and canine (Canis familiaris) models. We compared the incidence of ventricular arrhythmias during ablation between swine and canine using multivariate regression analysis. Six swine and six canine animals underwent successful epicardial radiofrequency ablation. A total of 103 ablation applications were recorded. RESULTS Ventricular arrhythmias requiring cardioversion occurred in 13.11% of radiofrequency ablation applications in swine and 9.75% in canine (relative risk: 117.6%, 95% confidence interval [CI]: 83.97-164.69, animal-based odds ratio [OR]: .55, 95% CI: .23-61.33; P = .184). When adjusting for application position, duration of ablation and power, the odds of developing potentially lethal ventricular arrhythmia in swine increased significantly compared to canine (OR: 3.60, 95% CI: 1.35-9.55; P = .010). CONCLUSIONS The swine myocardium is more susceptible to developing ventricular arrhythmias compared to canine model during epicardial ablation. This issue should be carefully considered in future studies.
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Affiliation(s)
- Guido Caluori
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic.,CEITEC, Masaryk University, Brno, Czech Republic
| | - Adam Wojtaszczyk
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic.,3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Omar Yasin
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - Martin Pesl
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic.,First Department of Internal Medicine/Cardioangiology, St. Anne´s Hospital, Masaryk University, Brno, Czech Republic.,Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiří Wolf
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Silvie Belaskova
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Michal Crha
- University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic
| | - Alan Sugrue
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - Vaibhav R Vaidya
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - Niyada Naksuk
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | | | - Ammar M Killu
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | | | - Samuel J Asirvatham
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota.,Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Zdeněk Stárek
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic.,First Department of Internal Medicine/Cardioangiology, St. Anne´s Hospital, Masaryk University, Brno, Czech Republic
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16
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Pedrotty DM, Kuzmenko V, Karabulut E, Sugrue AM, Livia C, Vaidya VR, McLeod CJ, Asirvatham SJ, Gatenholm P, Kapa S. Three-Dimensional Printed Biopatches With Conductive Ink Facilitate Cardiac Conduction When Applied to Disrupted Myocardium. Circ Arrhythm Electrophysiol 2019; 12:e006920. [DOI: 10.1161/circep.118.006920] [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: 12/31/2022]
Affiliation(s)
- Dawn M. Pedrotty
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (D.M.P., A.M.S., C.L., V.R.V., C.J.M., S.J.A., S.K.)
- Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania, Philadelphia (D.M.P.)
| | - Volodymyr Kuzmenko
- Department of Microtechnology (V.K.), Nanoscience and Wallenberg Wood Science Center, Chalmers University, Gothenburg, Sweden
| | - Erdem Karabulut
- Department of Chemistry and Chemical Engineering (E.K., P.G.), Nanoscience and Wallenberg Wood Science Center, Chalmers University, Gothenburg, Sweden
| | - Alan M. Sugrue
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (D.M.P., A.M.S., C.L., V.R.V., C.J.M., S.J.A., S.K.)
| | - Christopher Livia
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (D.M.P., A.M.S., C.L., V.R.V., C.J.M., S.J.A., S.K.)
| | - Vaibhav R. Vaidya
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (D.M.P., A.M.S., C.L., V.R.V., C.J.M., S.J.A., S.K.)
| | - Christopher J. McLeod
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (D.M.P., A.M.S., C.L., V.R.V., C.J.M., S.J.A., S.K.)
| | - Samuel J. Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (D.M.P., A.M.S., C.L., V.R.V., C.J.M., S.J.A., S.K.)
| | - Paul Gatenholm
- Department of Chemistry and Chemical Engineering (E.K., P.G.), Nanoscience and Wallenberg Wood Science Center, Chalmers University, Gothenburg, Sweden
- CELLHEAL, Blacksburg, VA (P.G.)
| | - Suraj Kapa
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (D.M.P., A.M.S., C.L., V.R.V., C.J.M., S.J.A., S.K.)
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17
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Vaidya VR, Dai M, Asirvatham SJ, Rea RF, Thome TM, Srivathsan K, Mulpuru SK, Kusumoto F, Venkatachalam KL, Ryan JD, Friedman PA, Cha YM. Real-world experience with leadless cardiac pacing. Pacing Clin Electrophysiol 2019; 42:366-373. [DOI: 10.1111/pace.13601] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 12/27/2018] [Accepted: 01/06/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Vaibhav R. Vaidya
- Department of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
| | - Mingyan Dai
- Department of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
| | - Samuel J. Asirvatham
- Department of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
- Department of Pediatrics and Adolescent Medicine; Mayo Clinic; Rochester Minnesota
| | - Robert F. Rea
- Department of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
| | - Trena M. Thome
- Department of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
| | | | - Siva K. Mulpuru
- Department of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
| | - Fred Kusumoto
- Department of Cardiovascular Diseases; Mayo Clinic; Jacksonville Florida
| | | | - James D. Ryan
- Department of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
| | - Paul A. Friedman
- Department of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
| | - Yong-Mei Cha
- Department of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
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18
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Abstract
The His bundle (conduction system) is an attractive target for physiologic pacing because it uses the native conduction system. Although the potential benefits of conduction system pacing were recognized in the 1970s, in the past 2 decades, it has grown in interest as a potentially preferred method of ventricular stimulation in appropriate patients. This review provides an appraisal of conduction system pacing, with focus on anatomy, physiology, tools, and techniques as well as an appraisal of current published data and thoughts on future directions.
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Affiliation(s)
- Alan Sugrue
- Division of Heart Rhythm, Department of Cardiovascular Diseases, Mayo Clinic, 200 1st Street South West, Rochester, MN 55902, USA
| | - Subir Bhatia
- Division of Internal Medicine, Department of Medicine, Mayo Clinic, 200 1st Street South West, Rochester, MN 55902, USA
| | - Vaibhav R Vaidya
- Division of Heart Rhythm, Department of Cardiovascular Diseases, Mayo Clinic, 200 1st Street South West, Rochester, MN 55902, USA
| | - Ugur Kucuk
- Division of Heart Rhythm, Department of Cardiovascular Diseases, Mayo Clinic, 200 1st Street South West, Rochester, MN 55902, USA
| | - Siva K Mulpuru
- Division of Heart Rhythm, Department of Cardiovascular Diseases, Mayo Clinic, 200 1st Street South West, Rochester, MN 55902, USA
| | - Samuel J Asirvatham
- Division of Heart Rhythm, Department of Cardiovascular Diseases, Mayo Clinic, 200 1st Street South West, Rochester, MN 55902, USA.
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19
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May AM, Brenes-Salazar JA, DeSimone CV, Vaidya VR, Ternus BW, Hodge DO, Lin G, Mulpuru SK, Deshmukh AJ, Noseworthy PA, Brady PA. Electrocardiogram algorithms used to differentiate wide complex tachycardias demonstrate diagnostic limitations when applied by non-cardiologists. J Electrocardiol 2018; 51:1103-1109. [DOI: 10.1016/j.jelectrocard.2018.09.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/09/2018] [Accepted: 09/29/2018] [Indexed: 11/16/2022]
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20
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Sugrue A, Rohatgi RK, Bos M, Vaidya VR, Asirvatham SJ, Noseworthy PA, Ackerman MJ. Clinical Significance of Early Repolarization in Long QT Syndrome. JACC Clin Electrophysiol 2018; 4:1238-1244. [DOI: 10.1016/j.jacep.2018.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 05/30/2018] [Accepted: 06/07/2018] [Indexed: 11/16/2022]
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21
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Vaidya VR, Sugrue A, Padmanabhan D, Killu AM, Naksuk N, Al‐Masry AA, Isath A, Pedersen J, Yngsdal L, Ladewig DJ, Friedman PA, Asirvatham SJ. Percutaneous epicardial pacing using a novel transverse sinus device. J Cardiovasc Electrophysiol 2018; 29:1308-1316. [DOI: 10.1111/jce.13661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 04/13/2018] [Revised: 05/23/2018] [Accepted: 05/29/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | - Alan Sugrue
- Department of Cardiovascular DiseasesMayo Clinic Rochester MN USA
| | | | - Ammar M. Killu
- Department of Cardiovascular DiseasesMayo Clinic Rochester MN USA
| | - Niyada Naksuk
- Department of Cardiovascular DiseasesMayo Clinic Rochester MN USA
| | | | - Ameesh Isath
- Department of Cardiovascular DiseasesMayo Clinic Rochester MN USA
| | - Joanne Pedersen
- Department of Cardiovascular SurgeryMayo Clinic Rochester MN USA
| | - Lisa Yngsdal
- Department of Cardiovascular SurgeryMayo Clinic Rochester MN USA
| | | | - Paul A. Friedman
- Department of Cardiovascular DiseasesMayo Clinic Rochester MN USA
| | - Samuel J. Asirvatham
- Department of Cardiovascular DiseasesMayo Clinic Rochester MN USA
- Department of Pediatrics and Adolescent MedicineMayo Clinic Rochester MN USA
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22
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Affiliation(s)
- Omar Z. Yasin
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA
| | | | | | - Samuel J. Asirvatham
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA
- Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
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23
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Agnihotri K, Pothineni N, Charilaou P, Vaidya VR, Thakkar B, Goyal V, Kadavath S, Patel N, Badheka A, Noseworthy P, Kapa S, Friedman P, Gersh B, Paydak H, Deshmukh A. Impact of atrial fibrillation on outcomes with motor vehicle accidents. Int J Cardiol 2018; 250:128-132. [DOI: 10.1016/j.ijcard.2017.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/07/2017] [Accepted: 10/02/2017] [Indexed: 11/30/2022]
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24
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Vaidya VR, Sugure A, Asirvatham SJ. Innovations in Clinical Cardiac Electrophysiology: Challenges and Upcoming Solutions in 2018 and Beyond. J Innov Card Rhythm Manag 2017; 8:2943-2955. [PMID: 32477763 PMCID: PMC7252723 DOI: 10.19102/icrm.2017.081206] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/25/2022] Open
Affiliation(s)
- Vaibhav R. Vaidya
- Division of Cardiac Electrophysiology, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Alan Sugure
- Division of Cardiac Electrophysiology, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Samuel J. Asirvatham
- Division of Cardiac Electrophysiology, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
- Department of Pediatrics, Mayo Clinic, Rochester, MN, USA
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25
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Asirvatham SJ, Vaidya VR. MY APPROACH to the pregnant patient with a supraventricular tachycardia ⁎. Trends Cardiovasc Med 2017; 28:231-232. [PMID: 29056501 DOI: 10.1016/j.tcm.2017.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 09/25/2017] [Accepted: 09/27/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Samuel J Asirvatham
- Consultant, Division of Cardiovascular Diseases and Internal Medicine, Division of Pediatric Cardiology, Professor of Medicine and Pediatrics Mayo Clinic College of Medicine, Program Director EP Fellowship Program, Director of Strategic Collaborations Center for Innovation, Mayo Clinic, Rochester, MN.
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26
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Vaidya VR, Prueksaritanond S, Bois JP, Nadipalli A, Borgeson DD, Melduni RM. Impact of acute left ventricular apical thrombus on cardioversion for atrial fibrillation. Echocardiography 2017; 34:1708-1711. [PMID: 28942610 DOI: 10.1111/echo.13706] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Among patients undergoing cardioversion for atrial fibrillation, the presence of left ventricular thrombus is a relatively uncommon and challenging clinical dilemma. While left atrial appendage thrombus is a contraindication to cardioversion, there is paucity of data regarding the safety of cardioversion in with the presence of left ventricular apical thrombus. Also, thrombus characteristics such as protrusion and mobility on echocardiography are known risk factors for systemic embolism. In this article, we present a case highlighting the management of atrial fibrillation in the setting of left ventricular dysfunction, acute heart failure, and echocardiographic evidence of acute left ventricular apical thrombus.
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Affiliation(s)
- Vaibhav R Vaidya
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - John P Bois
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Abhinav Nadipalli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Daniel D Borgeson
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rowlens M Melduni
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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27
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Vaidya VR, Arora S, Patel N, Badheka A, Patel N, Agnihotri K, Billimoria Z, Turakhia MP, Friedman PA, Madhavan M, Kapa S, Noseworthy PA, Cha YM, Gersh B, Asirvatham SJ, Deshmukh AJ. Response by Vaidya et al to Letter Regarding Article, "Burden of Arrhythmia in Pregnancy". Circulation 2017; 136:244-245. [PMID: 28696274 DOI: 10.1161/circulationaha.117.028571] [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] [Indexed: 11/16/2022]
Affiliation(s)
- Vaibhav R Vaidya
- From Departments of Medicine (V.R.V., P.A.F., M.M., S.K., P.A.N., Y.-M.C., B.G., S.J.A., A.J.D.), Pediatric and Adolescent Medicine (S.J.A.), and Physiology and Biomedical Engineering (S.J.A.), and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.A.N.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Heart and Circulation, Mount Sinai's St Luke Roosevelt Hospital Center, New York City, NY (S.A.); Leonard M. Miller School of Medicine, University of Miami, FL (N.P.); Department of Heart and Vascular (Cardiology), The Everett Clinic, WA (A.B.); Department of Internal Medicine, Saint Peter's University Hospital, New Brunswick, NJ (N.P., K.A.); Section of Neonatology, Department of Pediatrics, University of Washington, Seattle (Z.B.); and Stanford University School of Medicine, CA (M.P.T.)
| | - Shilpkumar Arora
- From Departments of Medicine (V.R.V., P.A.F., M.M., S.K., P.A.N., Y.-M.C., B.G., S.J.A., A.J.D.), Pediatric and Adolescent Medicine (S.J.A.), and Physiology and Biomedical Engineering (S.J.A.), and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.A.N.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Heart and Circulation, Mount Sinai's St Luke Roosevelt Hospital Center, New York City, NY (S.A.); Leonard M. Miller School of Medicine, University of Miami, FL (N.P.); Department of Heart and Vascular (Cardiology), The Everett Clinic, WA (A.B.); Department of Internal Medicine, Saint Peter's University Hospital, New Brunswick, NJ (N.P., K.A.); Section of Neonatology, Department of Pediatrics, University of Washington, Seattle (Z.B.); and Stanford University School of Medicine, CA (M.P.T.)
| | - Nileshkumar Patel
- From Departments of Medicine (V.R.V., P.A.F., M.M., S.K., P.A.N., Y.-M.C., B.G., S.J.A., A.J.D.), Pediatric and Adolescent Medicine (S.J.A.), and Physiology and Biomedical Engineering (S.J.A.), and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.A.N.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Heart and Circulation, Mount Sinai's St Luke Roosevelt Hospital Center, New York City, NY (S.A.); Leonard M. Miller School of Medicine, University of Miami, FL (N.P.); Department of Heart and Vascular (Cardiology), The Everett Clinic, WA (A.B.); Department of Internal Medicine, Saint Peter's University Hospital, New Brunswick, NJ (N.P., K.A.); Section of Neonatology, Department of Pediatrics, University of Washington, Seattle (Z.B.); and Stanford University School of Medicine, CA (M.P.T.)
| | - Apurva Badheka
- From Departments of Medicine (V.R.V., P.A.F., M.M., S.K., P.A.N., Y.-M.C., B.G., S.J.A., A.J.D.), Pediatric and Adolescent Medicine (S.J.A.), and Physiology and Biomedical Engineering (S.J.A.), and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.A.N.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Heart and Circulation, Mount Sinai's St Luke Roosevelt Hospital Center, New York City, NY (S.A.); Leonard M. Miller School of Medicine, University of Miami, FL (N.P.); Department of Heart and Vascular (Cardiology), The Everett Clinic, WA (A.B.); Department of Internal Medicine, Saint Peter's University Hospital, New Brunswick, NJ (N.P., K.A.); Section of Neonatology, Department of Pediatrics, University of Washington, Seattle (Z.B.); and Stanford University School of Medicine, CA (M.P.T.)
| | - Nilay Patel
- From Departments of Medicine (V.R.V., P.A.F., M.M., S.K., P.A.N., Y.-M.C., B.G., S.J.A., A.J.D.), Pediatric and Adolescent Medicine (S.J.A.), and Physiology and Biomedical Engineering (S.J.A.), and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.A.N.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Heart and Circulation, Mount Sinai's St Luke Roosevelt Hospital Center, New York City, NY (S.A.); Leonard M. Miller School of Medicine, University of Miami, FL (N.P.); Department of Heart and Vascular (Cardiology), The Everett Clinic, WA (A.B.); Department of Internal Medicine, Saint Peter's University Hospital, New Brunswick, NJ (N.P., K.A.); Section of Neonatology, Department of Pediatrics, University of Washington, Seattle (Z.B.); and Stanford University School of Medicine, CA (M.P.T.)
| | - Kanishk Agnihotri
- From Departments of Medicine (V.R.V., P.A.F., M.M., S.K., P.A.N., Y.-M.C., B.G., S.J.A., A.J.D.), Pediatric and Adolescent Medicine (S.J.A.), and Physiology and Biomedical Engineering (S.J.A.), and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.A.N.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Heart and Circulation, Mount Sinai's St Luke Roosevelt Hospital Center, New York City, NY (S.A.); Leonard M. Miller School of Medicine, University of Miami, FL (N.P.); Department of Heart and Vascular (Cardiology), The Everett Clinic, WA (A.B.); Department of Internal Medicine, Saint Peter's University Hospital, New Brunswick, NJ (N.P., K.A.); Section of Neonatology, Department of Pediatrics, University of Washington, Seattle (Z.B.); and Stanford University School of Medicine, CA (M.P.T.)
| | - Zeenia Billimoria
- From Departments of Medicine (V.R.V., P.A.F., M.M., S.K., P.A.N., Y.-M.C., B.G., S.J.A., A.J.D.), Pediatric and Adolescent Medicine (S.J.A.), and Physiology and Biomedical Engineering (S.J.A.), and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.A.N.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Heart and Circulation, Mount Sinai's St Luke Roosevelt Hospital Center, New York City, NY (S.A.); Leonard M. Miller School of Medicine, University of Miami, FL (N.P.); Department of Heart and Vascular (Cardiology), The Everett Clinic, WA (A.B.); Department of Internal Medicine, Saint Peter's University Hospital, New Brunswick, NJ (N.P., K.A.); Section of Neonatology, Department of Pediatrics, University of Washington, Seattle (Z.B.); and Stanford University School of Medicine, CA (M.P.T.)
| | - Mintu P Turakhia
- From Departments of Medicine (V.R.V., P.A.F., M.M., S.K., P.A.N., Y.-M.C., B.G., S.J.A., A.J.D.), Pediatric and Adolescent Medicine (S.J.A.), and Physiology and Biomedical Engineering (S.J.A.), and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.A.N.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Heart and Circulation, Mount Sinai's St Luke Roosevelt Hospital Center, New York City, NY (S.A.); Leonard M. Miller School of Medicine, University of Miami, FL (N.P.); Department of Heart and Vascular (Cardiology), The Everett Clinic, WA (A.B.); Department of Internal Medicine, Saint Peter's University Hospital, New Brunswick, NJ (N.P., K.A.); Section of Neonatology, Department of Pediatrics, University of Washington, Seattle (Z.B.); and Stanford University School of Medicine, CA (M.P.T.)
| | - Paul A Friedman
- From Departments of Medicine (V.R.V., P.A.F., M.M., S.K., P.A.N., Y.-M.C., B.G., S.J.A., A.J.D.), Pediatric and Adolescent Medicine (S.J.A.), and Physiology and Biomedical Engineering (S.J.A.), and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.A.N.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Heart and Circulation, Mount Sinai's St Luke Roosevelt Hospital Center, New York City, NY (S.A.); Leonard M. Miller School of Medicine, University of Miami, FL (N.P.); Department of Heart and Vascular (Cardiology), The Everett Clinic, WA (A.B.); Department of Internal Medicine, Saint Peter's University Hospital, New Brunswick, NJ (N.P., K.A.); Section of Neonatology, Department of Pediatrics, University of Washington, Seattle (Z.B.); and Stanford University School of Medicine, CA (M.P.T.)
| | - Malini Madhavan
- From Departments of Medicine (V.R.V., P.A.F., M.M., S.K., P.A.N., Y.-M.C., B.G., S.J.A., A.J.D.), Pediatric and Adolescent Medicine (S.J.A.), and Physiology and Biomedical Engineering (S.J.A.), and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.A.N.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Heart and Circulation, Mount Sinai's St Luke Roosevelt Hospital Center, New York City, NY (S.A.); Leonard M. Miller School of Medicine, University of Miami, FL (N.P.); Department of Heart and Vascular (Cardiology), The Everett Clinic, WA (A.B.); Department of Internal Medicine, Saint Peter's University Hospital, New Brunswick, NJ (N.P., K.A.); Section of Neonatology, Department of Pediatrics, University of Washington, Seattle (Z.B.); and Stanford University School of Medicine, CA (M.P.T.)
| | - Suraj Kapa
- From Departments of Medicine (V.R.V., P.A.F., M.M., S.K., P.A.N., Y.-M.C., B.G., S.J.A., A.J.D.), Pediatric and Adolescent Medicine (S.J.A.), and Physiology and Biomedical Engineering (S.J.A.), and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.A.N.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Heart and Circulation, Mount Sinai's St Luke Roosevelt Hospital Center, New York City, NY (S.A.); Leonard M. Miller School of Medicine, University of Miami, FL (N.P.); Department of Heart and Vascular (Cardiology), The Everett Clinic, WA (A.B.); Department of Internal Medicine, Saint Peter's University Hospital, New Brunswick, NJ (N.P., K.A.); Section of Neonatology, Department of Pediatrics, University of Washington, Seattle (Z.B.); and Stanford University School of Medicine, CA (M.P.T.)
| | - Peter A Noseworthy
- From Departments of Medicine (V.R.V., P.A.F., M.M., S.K., P.A.N., Y.-M.C., B.G., S.J.A., A.J.D.), Pediatric and Adolescent Medicine (S.J.A.), and Physiology and Biomedical Engineering (S.J.A.), and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.A.N.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Heart and Circulation, Mount Sinai's St Luke Roosevelt Hospital Center, New York City, NY (S.A.); Leonard M. Miller School of Medicine, University of Miami, FL (N.P.); Department of Heart and Vascular (Cardiology), The Everett Clinic, WA (A.B.); Department of Internal Medicine, Saint Peter's University Hospital, New Brunswick, NJ (N.P., K.A.); Section of Neonatology, Department of Pediatrics, University of Washington, Seattle (Z.B.); and Stanford University School of Medicine, CA (M.P.T.)
| | - Yong-Mei Cha
- From Departments of Medicine (V.R.V., P.A.F., M.M., S.K., P.A.N., Y.-M.C., B.G., S.J.A., A.J.D.), Pediatric and Adolescent Medicine (S.J.A.), and Physiology and Biomedical Engineering (S.J.A.), and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.A.N.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Heart and Circulation, Mount Sinai's St Luke Roosevelt Hospital Center, New York City, NY (S.A.); Leonard M. Miller School of Medicine, University of Miami, FL (N.P.); Department of Heart and Vascular (Cardiology), The Everett Clinic, WA (A.B.); Department of Internal Medicine, Saint Peter's University Hospital, New Brunswick, NJ (N.P., K.A.); Section of Neonatology, Department of Pediatrics, University of Washington, Seattle (Z.B.); and Stanford University School of Medicine, CA (M.P.T.)
| | - Bernard Gersh
- From Departments of Medicine (V.R.V., P.A.F., M.M., S.K., P.A.N., Y.-M.C., B.G., S.J.A., A.J.D.), Pediatric and Adolescent Medicine (S.J.A.), and Physiology and Biomedical Engineering (S.J.A.), and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.A.N.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Heart and Circulation, Mount Sinai's St Luke Roosevelt Hospital Center, New York City, NY (S.A.); Leonard M. Miller School of Medicine, University of Miami, FL (N.P.); Department of Heart and Vascular (Cardiology), The Everett Clinic, WA (A.B.); Department of Internal Medicine, Saint Peter's University Hospital, New Brunswick, NJ (N.P., K.A.); Section of Neonatology, Department of Pediatrics, University of Washington, Seattle (Z.B.); and Stanford University School of Medicine, CA (M.P.T.)
| | - Samuel J Asirvatham
- From Departments of Medicine (V.R.V., P.A.F., M.M., S.K., P.A.N., Y.-M.C., B.G., S.J.A., A.J.D.), Pediatric and Adolescent Medicine (S.J.A.), and Physiology and Biomedical Engineering (S.J.A.), and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.A.N.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Heart and Circulation, Mount Sinai's St Luke Roosevelt Hospital Center, New York City, NY (S.A.); Leonard M. Miller School of Medicine, University of Miami, FL (N.P.); Department of Heart and Vascular (Cardiology), The Everett Clinic, WA (A.B.); Department of Internal Medicine, Saint Peter's University Hospital, New Brunswick, NJ (N.P., K.A.); Section of Neonatology, Department of Pediatrics, University of Washington, Seattle (Z.B.); and Stanford University School of Medicine, CA (M.P.T.)
| | - Abhishek J Deshmukh
- From Departments of Medicine (V.R.V., P.A.F., M.M., S.K., P.A.N., Y.-M.C., B.G., S.J.A., A.J.D.), Pediatric and Adolescent Medicine (S.J.A.), and Physiology and Biomedical Engineering (S.J.A.), and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.A.N.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Heart and Circulation, Mount Sinai's St Luke Roosevelt Hospital Center, New York City, NY (S.A.); Leonard M. Miller School of Medicine, University of Miami, FL (N.P.); Department of Heart and Vascular (Cardiology), The Everett Clinic, WA (A.B.); Department of Internal Medicine, Saint Peter's University Hospital, New Brunswick, NJ (N.P., K.A.); Section of Neonatology, Department of Pediatrics, University of Washington, Seattle (Z.B.); and Stanford University School of Medicine, CA (M.P.T.)
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Egbe AC, Asirvatham SJ, Connolly HM, Kapa S, Desimone CV, Vaidya VR, Deshmukh AJ, Khan AR, McLeod CJ, Melduni RM, Ammash NM. Outcomes of Direct Current Cardioversion in Adults With Congenital Heart Disease. Am J Cardiol 2017; 119:1468-1472. [PMID: 28262200 DOI: 10.1016/j.amjcard.2017.01.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/23/2017] [Accepted: 01/23/2017] [Indexed: 11/30/2022]
Abstract
Few data exist on direct current cardioversion (DCCV) in adult patients with congenital heart disease (CHD). This is a retrospective case-control study of 279 adults with CHD and 279 adults without CHD (control group) who had elective DCCV for atrial arrhythmias at Mayo Clinic, 2001 to 2013. Control patients were matched by gender and arrhythmia type. The objective was to compare DCCV procedural failure (failure to terminate the presenting arrhythmia) and arrhythmia recurrence (AR). In the CHD group (mean age 55 ± 20 years; men 166 [59%]), the most common diagnosis was Fontan palliation (61; 22%). Transesophageal echocardiography was performed before DCCV in 216 patients (77%); 162 (58%) had atrial flutter, and 117 (42%) had atrial fibrillation. Procedural failure and AR between the case and the control groups were more common in the CHD group (14% vs 7%, p = 0.01) and (83% vs 66% at 60 months, p = 0.001) respectively. There were no deaths or thromboembolic complications. The multivariable risk factors for procedural failure were Fontan palliation and spontaneous echocardiographic contrast; the risk factors for AR were Fontan palliation and atrial fibrillation. When patients with Fontan palliation were excluded from the analysis, the outcome of DCCV (failure and recurrence rates) was similar for the CHD and non-CHD groups despite the age difference between the cohorts. In conclusion, the present study showed that DCCV outcomes were similar for CHD and non-CHD patients, with the exception of patients with Fontan palliation.
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Affiliation(s)
- Alexander C Egbe
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
| | | | - Heidi M Connolly
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Suraj Kapa
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | | | - Vaibhav R Vaidya
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | | | - Arooj R Khan
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | | | - Rowlens M Melduni
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Naser M Ammash
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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Ponamgi SP, Vaidya VR, Desimone CV, Noheria A, Hodge DO, Slusser JP, Ammash NM, Bruce CJ, Rabinstein AA, Friedman PA, Asirvatham SJ. Endocardial Device Leads in Patients with Patent Foramen Ovale: Echocardiographic Correlates of Stroke/TIA and Mortality. Pacing Clin Electrophysiol 2017; 40:310-322. [PMID: 27943333 DOI: 10.1111/pace.12985] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 10/24/2016] [Accepted: 11/02/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Echocardiographically detected patent foramen ovale (PFO) has been associated with stroke/transient ischemic attack (TIA) in patients with cardiac implantable electronic devices (CIEDs). We sought to evaluate the relationship between echocardiographic characteristics and risk of stroke/TIA and mortality in CIED patients with PFO. METHODS In 6,086 device patients, PFO was detected in 319 patients. A baseline echocardiogram was present in 250 patients, with 186 having a follow-up echocardiogram. RESULTS Of 250 patients with a baseline echocardiogram, 9.6% (n = 24) had a stroke/TIA during mean follow-up of 5.3 ± 3.1 years; and 42% (n = 105) died over 7.1 ± 3.7 years. Atrial septal aneurysm, prominent Eustachian valve, visible shunting across PFO, baseline or change in estimated right ventricular systolic pressure (RVSP)/tricuspid regurgitation (TR), or maximum RVSP were not associated with postimplant stroke/TIA (P > 0.05). An exploratory multivariate analysis using time-dependent Cox models showed increased hazard of death in patients with increase in TR ≥2 grades (hazard ratio [HR] 1.780, 95% confidence interval [CI] 1.447-2.189, P < 0.0001), or increase in RVSP by >10 mm Hg (HR 2.018, 95% CI 1.593-2.556, P < 0.0001), or maximum RVSP in follow-up (HR 1.432, 95% CI 1.351-1.516, P < 0.0001). A significant increase (P < 0.001) in TR was also noted during follow-up. CONCLUSIONS In patients with CIED and PFO, structural and hemodynamic echocardiographic markers did not predict future stroke/TIA. However, a significantly higher TR or RVSP was associated with higher mortality.
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Affiliation(s)
- Shiva P Ponamgi
- Division of Hospital Internal Medicine, Mayo Clinic Health System, Austin, Minnesota
| | - Vaibhav R Vaidya
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | | | - Amit Noheria
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri
| | - David O Hodge
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida
| | - Joshua P Slusser
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Naser M Ammash
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Charles J Bruce
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | | | - Paul A Friedman
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Samuel J Asirvatham
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.,Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
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Vaidya VR, Arora S, Patel N, Badheka AO, Patel N, Agnihotri K, Billimoria Z, Turakhia MP, Friedman PA, Madhavan M, Kapa S, Noseworthy PA, Cha YM, Gersh B, Asirvatham SJ, Deshmukh AJ. Burden of Arrhythmia in Pregnancy. Circulation 2017; 135:619-621. [DOI: 10.1161/circulationaha.116.026681] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Vaibhav R. Vaidya
- From Department of Medicine, Division of Cardiovascular Diseases (V.R.V., P.A.F., M.M., S.K., P.A.N., Y.-M.C., B.G., S.J.A.); Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.A.N.); Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology (S.J.A.); and Departments of Physiology and Biomedical Engineering (S.J.A.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Heart and Circulation, Mount Sinai’s St Luke Roosevelt Hospital Center,
| | - Shilpkumar Arora
- From Department of Medicine, Division of Cardiovascular Diseases (V.R.V., P.A.F., M.M., S.K., P.A.N., Y.-M.C., B.G., S.J.A.); Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.A.N.); Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology (S.J.A.); and Departments of Physiology and Biomedical Engineering (S.J.A.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Heart and Circulation, Mount Sinai’s St Luke Roosevelt Hospital Center,
| | - Nileshkumar Patel
- From Department of Medicine, Division of Cardiovascular Diseases (V.R.V., P.A.F., M.M., S.K., P.A.N., Y.-M.C., B.G., S.J.A.); Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.A.N.); Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology (S.J.A.); and Departments of Physiology and Biomedical Engineering (S.J.A.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Heart and Circulation, Mount Sinai’s St Luke Roosevelt Hospital Center,
| | - Apurva O. Badheka
- From Department of Medicine, Division of Cardiovascular Diseases (V.R.V., P.A.F., M.M., S.K., P.A.N., Y.-M.C., B.G., S.J.A.); Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.A.N.); Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology (S.J.A.); and Departments of Physiology and Biomedical Engineering (S.J.A.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Heart and Circulation, Mount Sinai’s St Luke Roosevelt Hospital Center,
| | - Nilay Patel
- From Department of Medicine, Division of Cardiovascular Diseases (V.R.V., P.A.F., M.M., S.K., P.A.N., Y.-M.C., B.G., S.J.A.); Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.A.N.); Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology (S.J.A.); and Departments of Physiology and Biomedical Engineering (S.J.A.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Heart and Circulation, Mount Sinai’s St Luke Roosevelt Hospital Center,
| | - Kanishk Agnihotri
- From Department of Medicine, Division of Cardiovascular Diseases (V.R.V., P.A.F., M.M., S.K., P.A.N., Y.-M.C., B.G., S.J.A.); Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.A.N.); Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology (S.J.A.); and Departments of Physiology and Biomedical Engineering (S.J.A.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Heart and Circulation, Mount Sinai’s St Luke Roosevelt Hospital Center,
| | - Zeenia Billimoria
- From Department of Medicine, Division of Cardiovascular Diseases (V.R.V., P.A.F., M.M., S.K., P.A.N., Y.-M.C., B.G., S.J.A.); Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.A.N.); Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology (S.J.A.); and Departments of Physiology and Biomedical Engineering (S.J.A.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Heart and Circulation, Mount Sinai’s St Luke Roosevelt Hospital Center,
| | - Mintu P. Turakhia
- From Department of Medicine, Division of Cardiovascular Diseases (V.R.V., P.A.F., M.M., S.K., P.A.N., Y.-M.C., B.G., S.J.A.); Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.A.N.); Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology (S.J.A.); and Departments of Physiology and Biomedical Engineering (S.J.A.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Heart and Circulation, Mount Sinai’s St Luke Roosevelt Hospital Center,
| | - Paul A. Friedman
- From Department of Medicine, Division of Cardiovascular Diseases (V.R.V., P.A.F., M.M., S.K., P.A.N., Y.-M.C., B.G., S.J.A.); Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.A.N.); Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology (S.J.A.); and Departments of Physiology and Biomedical Engineering (S.J.A.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Heart and Circulation, Mount Sinai’s St Luke Roosevelt Hospital Center,
| | - Malini Madhavan
- From Department of Medicine, Division of Cardiovascular Diseases (V.R.V., P.A.F., M.M., S.K., P.A.N., Y.-M.C., B.G., S.J.A.); Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.A.N.); Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology (S.J.A.); and Departments of Physiology and Biomedical Engineering (S.J.A.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Heart and Circulation, Mount Sinai’s St Luke Roosevelt Hospital Center,
| | - Suraj Kapa
- From Department of Medicine, Division of Cardiovascular Diseases (V.R.V., P.A.F., M.M., S.K., P.A.N., Y.-M.C., B.G., S.J.A.); Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.A.N.); Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology (S.J.A.); and Departments of Physiology and Biomedical Engineering (S.J.A.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Heart and Circulation, Mount Sinai’s St Luke Roosevelt Hospital Center,
| | - Peter A. Noseworthy
- From Department of Medicine, Division of Cardiovascular Diseases (V.R.V., P.A.F., M.M., S.K., P.A.N., Y.-M.C., B.G., S.J.A.); Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.A.N.); Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology (S.J.A.); and Departments of Physiology and Biomedical Engineering (S.J.A.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Heart and Circulation, Mount Sinai’s St Luke Roosevelt Hospital Center,
| | - Yong-Mei Cha
- From Department of Medicine, Division of Cardiovascular Diseases (V.R.V., P.A.F., M.M., S.K., P.A.N., Y.-M.C., B.G., S.J.A.); Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.A.N.); Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology (S.J.A.); and Departments of Physiology and Biomedical Engineering (S.J.A.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Heart and Circulation, Mount Sinai’s St Luke Roosevelt Hospital Center,
| | - Bernard Gersh
- From Department of Medicine, Division of Cardiovascular Diseases (V.R.V., P.A.F., M.M., S.K., P.A.N., Y.-M.C., B.G., S.J.A.); Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.A.N.); Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology (S.J.A.); and Departments of Physiology and Biomedical Engineering (S.J.A.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Heart and Circulation, Mount Sinai’s St Luke Roosevelt Hospital Center,
| | - Samuel J. Asirvatham
- From Department of Medicine, Division of Cardiovascular Diseases (V.R.V., P.A.F., M.M., S.K., P.A.N., Y.-M.C., B.G., S.J.A.); Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.A.N.); Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology (S.J.A.); and Departments of Physiology and Biomedical Engineering (S.J.A.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Heart and Circulation, Mount Sinai’s St Luke Roosevelt Hospital Center,
| | - Abhishek J. Deshmukh
- From Department of Medicine, Division of Cardiovascular Diseases (V.R.V., P.A.F., M.M., S.K., P.A.N., Y.-M.C., B.G., S.J.A.); Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.A.N.); Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology (S.J.A.); and Departments of Physiology and Biomedical Engineering (S.J.A.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Heart and Circulation, Mount Sinai’s St Luke Roosevelt Hospital Center,
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Naksuk N, Syed FF, Krittanawong C, Anderson MJ, Ebrille E, DeSimone CV, Vaidya VR, Ponamgi SP, Suri RM, Ackerman MJ, Nkomo VT, Asirvatham SJ, Noseworthy PA. The effect of mitral valve surgery on ventricular arrhythmia in patients with bileaflet mitral valve prolapse. Indian Pacing Electrophysiol J 2016; 16:187-191. [PMID: 28401865 PMCID: PMC5219837 DOI: 10.1016/j.ipej.2016.10.009] [Citation(s) in RCA: 24] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 10/21/2016] [Indexed: 11/16/2022] Open
Abstract
Background Bileaflet mitral valve prolapse (biMVP) is associated with frequent ventricular ectopy (VE) and malignant ventricular arrhythmia. We examined the effect of mitral valve (MV) surgery on VE burden in biMVP patients. Methods We included 32 consecutive patients undergoing MV surgery for mitral regurgitation secondary to biMVP between 1993 and 2012 at Mayo Clinic who had available pre- and post-operative Holter monitoring data. Characteristics of patients with a significant reduction in postoperative VE (group A, defined as >10% reduction in VE burden compared to baseline) were compared with the rest of study patients (group B). Results In the overall cohort, VE burden was unchanged after the surgery (41 interquartile range [16, 196] pre-surgery vs. 40 interquartile range [5186] beats/hour [bph] post-surgery; P = 0.34). However, in 17 patients (53.1%), VE burden decreased by at least 10% after the surgery. These patients (group A) were younger than the group B (59 ± 15 vs. 68 ± 7 years; P = 0.04). Other characteristics including pre- and postoperative left ventricular function and size were similar in both groups. Age <60 years was associated with a reduction in postoperative VE (odds ratio 5.8; 95% confidence interval, 1.1–44.7; P = 0.03). Furthermore, there was a graded relationship between age and odds of VE reduction with surgery (odds ratio 1.9; 95% confidence interval 1.04–4.3 per 10-year; P = 0.04). Conclusions MV surgery does not uniformly reduce VE burden in patients with biMVP. However, those patients who do have a reduction in VE burden are younger, perhaps suggesting that early surgical intervention could modify the underlying electrophysiologic substrate.
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Affiliation(s)
- Niyada Naksuk
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Faisal F Syed
- Division of Internal Medicine Cardiology, Medical School, University of Michigan, 500 S. State Street, Ann Arbor, MI 48109, USA
| | - Chayakrit Krittanawong
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Mark J Anderson
- Deapartment of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Elisa Ebrille
- Division of Cardiology, Città della Salute e della Scienza, University of Turin, Corso Bramante, 88, 10126 Turin, Italy
| | - Christopher V DeSimone
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Vaibhav R Vaidya
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Shiva P Ponamgi
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic Health System - Albert Lea and Austin, 1000 First Drive NW, Austin, MN 55912, USA
| | - Rakesh M Suri
- Department of Cardiovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Michael J Ackerman
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Division of Pediatric Cardiology, Department of Pediatrics, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Vuyisile T Nkomo
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Samuel J Asirvatham
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Division of Pediatric Cardiology, Department of Pediatrics, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Peter A Noseworthy
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Vaidya VR, Asirvatham R, Tri J, Asirvatham SJ. Left atrial appendage exclusion for atrial fibrillation: does the protection from stroke prevail in the long-term? J Thorac Dis 2016; 8:E1260-E1267. [PMID: 27867603 PMCID: PMC5107547 DOI: 10.21037/jtd.2016.10.16] [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] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 08/06/2016] [Indexed: 07/30/2023]
Affiliation(s)
- Vaibhav R. Vaidya
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Jason Tri
- Mayo Clinic Summer Internship, Mayo Clinic, Rochester, Minnesota, USA
| | - Samuel J. Asirvatham
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Pediatrics, Mayo Clinic, Rochester, Minnesota, USA
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Ebrille E, DeSimone CV, Vaidya VR, Chahal AA, Nkomo VT, Asirvatham SJ. Ventricular pacing - Electromechanical consequences and valvular function. Indian Pacing Electrophysiol J 2016; 16:19-30. [PMID: 27485561 PMCID: PMC4936653 DOI: 10.1016/j.ipej.2016.02.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Although great strides have been made in the areas of ventricular pacing, it is still appreciated that dyssynchrony can be malignant, and that appropriately placed pacing leads may ameliorate mechanical dyssynchrony. However, the unknowns at present include: 1. The mechanisms by which ventricular pacing itself can induce dyssynchrony; 2. Whether or not various pacing locations can decrease the deleterious effects caused by ventricular pacing; 3. The impact of novel methods of pacing, such as atrioventricular septal, lead-less, and far-field surface stimulation; 4. The utility of ECG and echocardiography in predicting response to therapy and/or development of dyssynchrony in the setting of cardiac resynchronization therapy (CRT) lead placement; 5. The impact of ventricular pacing-induced dyssynchrony on valvular function, and how lead position correlates to potential improvement. This review examines the existing literature to put these issues into context, to provide a basis for understanding how electrical, mechanical, and functional aspects of the heart can be distorted with ventricular pacing. We highlight the central role of the mitral valve and its function as it relates to pacing strategies, especially in the setting of CRT. We also provide future directions for improved pacing modalities via alternative pacing sites and speculate over mechanisms on how lead position may affect the critical function of the mitral valve and thus overall efficacy of CRT.
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Affiliation(s)
- Elisa Ebrille
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA; Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | - Vaibhav R Vaidya
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Anwar A Chahal
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA; Clinical and Translational Science, Mayo Graduate School, Rochester, MN, USA
| | - Vuyisile T Nkomo
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Samuel J Asirvatham
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA; Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.
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Hu TY, Vaidya VR, Asirvatham SJ. Reversing anticoagulant effects of novel oral anticoagulants: role of ciraparantag, andexanet alfa, and idarucizumab. Vasc Health Risk Manag 2016; 12:35-44. [PMID: 26937198 PMCID: PMC4762436 DOI: 10.2147/vhrm.s89130] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [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] [Indexed: 12/14/2022] Open
Abstract
Novel oral anticoagulants (NOACs) are increasingly used in clinical practice, but lack of commercially available reversal agents is a major barrier for mainstream use of these therapies. Specific antidotes to NOACs are under development. Idarucizumab (aDabi-Fab, BI 655075) is a novel humanized mouse monoclonal antibody that binds dabigatran and reverses its anticoagulant effect. In a recent Phase III study (Reversal Effects of Idarucizumab on Active Dabigatran), a 5 g intravenous infusion of idarucizumab resulted in the normalization of dilute thrombin time in 98% and 93% of the two groups studied, with normalization of ecarin-clotting time in 89% and 88% patients. Two other antidotes, andexanet alfa (PRT064445) and ciraparantag (PER977) are also under development for reversal of NOACs. In this review, we discuss commonly encountered management issues with NOACs such as periprocedural management, laboratory monitoring of anticoagulation, and management of bleeding. We review currently available data regarding specific antidotes to NOACs with respect to pharmacology and clinical trials.
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Affiliation(s)
- Tiffany Y Hu
- Mayo Medical School, Department of Internal Medicine, Rochester, MN, USA
| | - Vaibhav R Vaidya
- Division of Cardiovascular Diseases, Department of Internal Medicine, Rochester, MN, USA
| | - Samuel J Asirvatham
- Division of Cardiovascular Diseases, Department of Internal Medicine, Rochester, MN, USA; Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
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Vaidya VR, DeSimone CV, Damle N, Naksuk N, Syed FF, Ackerman MJ, Ponamgi SP, Nkomo VT, Suri RM, Noseworthy PA, Asirvatham SJ. Reduction in malignant ventricular arrhythmia and appropriate shocks following surgical correction of bileaflet mitral valve prolapse. J Interv Card Electrophysiol 2016; 46:137-43. [PMID: 26768434 DOI: 10.1007/s10840-015-0090-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [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: 09/16/2015] [Accepted: 12/08/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Bileaflet mitral valve prolapse (MVP) can be associated with malignant ventricular arrhythmias. It is unknown whether surgical correction alone of this mitral valve pathology leads to a reduction in ventricular dysrhythmias. METHODS We retrospectively analyzed 4477 patients who underwent mitral valve surgery from 1993-2013 at Mayo Clinic in Rochester, MN. Among these, eight patients with bileaflet MVP who had an internal cardioverter defibrillator (ICD) in place both pre- and post-surgery were identified. ICD interrogation records were evaluated for episodes of ventricular tachycardia (VT), ventricular fibrillation (VF), and appropriate ICD shock therapy. RESULTS Of these eight patients, five had a malignant ventricular arrhythmia prior to surgery. Data was available 4.6 ± 2.9 years before versus 6.6 ± 4.2 years following surgical intervention. Among these patients, there was a reduction in VF (0.6 versus 0.14 events per-person-year pre- and post-surgery, respectively), VT (0.4 versus 0.05 events per-person-year pre- and post-surgery, respectively), and ICD shocks (0.95 versus 0.19 events per-person-year pre- and post-surgery) following mitral valve surgery. CONCLUSIONS We report a series of cases where the surgical correction of bileaflet MVP alone was associated with a reduction in malignant arrhythmia and appropriate shocks. These early observations merit further investigation involving larger cohorts to further evaluate the association between abnormal mechanical forces in degenerative mitral valve disease and ventricular dysrhythmias.
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Affiliation(s)
- Vaibhav R Vaidya
- Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Christopher V DeSimone
- Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | | | - Niyada Naksuk
- Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Faisal F Syed
- Division of Cardiovascular Diseases, University of Michigan, Ann Arbor, MI, USA
| | - Michael J Ackerman
- Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Rochester, MN, USA
| | - Shiva P Ponamgi
- Division of Internal Medicine, Mayo Clinic Health System, Austin, MN, USA
| | - Vuyisile T Nkomo
- Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Rakesh M Suri
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Peter A Noseworthy
- Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Samuel J Asirvatham
- Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA. .,Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.
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Noheria A, Ponamgi SP, Desimone CV, Vaidya VR, Aakre CA, Ebrille E, Hu T, Hodge DO, Slusser JP, Ammash NM, Bruce CJ, Rabinstein AA, Friedman PA, Asirvatham SJ. Pulmonary embolism in patients with transvenous cardiac implantable electronic device leads. Europace 2015; 18:246-52. [PMID: 25767086 DOI: 10.1093/europace/euv038] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 02/02/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cardiac implantable electronic devices (CIEDs) are commonly associated with transvenous lead-related thrombi that can cause pulmonary embolism (PE). METHODS AND RESULTS We retrospectively evaluated all patients with transvenous CIED leads implanted at Mayo Clinic Rochester between 1 January 2000, and 25 October 2010. Pulmonary embolism outcomes during follow-up were screened using diagnosis codes and confirmed with imaging study reports. Of 5646 CIED patients (age 67.3 ± 16.3 years, 64% men, mean follow-up 4.69 years) 88 developed PE (1.6%), incidence 3.32 [95% confidence interval (CI) 2.68-4.07] per 1000 person-years [men: 3.04 (95% CI 2.29-3.96) per 1000 person-years; women: 3.81 (95% CI 2.72-5.20) per 1000 person-years]. Other than transvenous CIED lead(s), 84% had another established risk factor for PE such as deep vein thrombosis (28%), recent surgery (27%), malignancy (25%), or prior history of venous thromboembolism (15%). At the time of PE, 22% had been hospitalized for ≥ 48 h, and 59% had been hospitalized in the preceding 30 days. Pulmonary embolism occurred in 22% despite being on systemic anticoagulation therapy. Out of 88 patients with PE, 45 subsequently died, mortality rate 93 (95% CI 67-123) per 1000 person-years (hazard ratio 2.0, 95% CI 1.5-2.7, P < 0.0001). CONCLUSIONS Though lead-related thrombus is commonly seen in patients with transvenous CIED leads, clinical PE occurs with a low incidence. It is possible that embolism of lead thrombus is uncommon or emboli are too small to cause consequential pulmonary infarction.
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Affiliation(s)
- Amit Noheria
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Shiva P Ponamgi
- Division of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN, USA
| | - Christopher V Desimone
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | | | | | - Elisa Ebrille
- Division of Cardiology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | - David O Hodge
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - Joshua P Slusser
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Naser M Ammash
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Charles J Bruce
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | | | - Paul A Friedman
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Samuel J Asirvatham
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
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Hai JJ, Chahal AA, Friedman PA, Vaidya VR, Syed FF, DeSimone CV, Nanda S, Brady PA, Madhavan M, Cha YM, McLeod CJ, Mulpuru S, Munger TM, Packer DL, Asirvatham SJ. Electrophysiologic characteristics of ventricular arrhythmias arising from the aortic mitral continuity-potential role of the conduction system. J Cardiovasc Electrophysiol 2015; 26:158-63. [PMID: 25425429 DOI: 10.1111/jce.12587] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [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: 03/21/2014] [Revised: 10/02/2014] [Accepted: 10/14/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Catheter ablation of ventricular arrhythmia (VA) at the fibrous aortic mitral continuity (AMC) has been described, yet the nature of the arrhythmogenic substrate remains unknown. METHODS Procedural records of 528 consecutive patients undergoing ablation of VA at Mayo Clinic, Rochester, MN, were reviewed. The electrocardiographic and electrophysiologic characteristics of patients with successful ablation at the AMC were analyzed to characterize the underlying arrhythmogenic substrate. RESULTS Of the 21 patients (mean age 53.2 ± 13.4 years, 47.6% male) who underwent ablation of VA at the AMC with acute success, prepotentials (PPs) were found at the ablation sites preceding the ventricular electrogram (VEGM) during arrhythmias in 13 (61.9%) patients and during sinus rhythm in 7 (53.8%) patients. VAs with PPs were associated with a significantly higher burden of premature ventricular complexes (PVCs; 26.1 ± 10.9% vs. 14.9 ± 10.1%, P = 0.03), shorter VEGM to QRS intervals (9.0 ± 28.5 milliseconds vs. 33.1 ± 8.8 milliseconds, P = 0.03), lower pace map scores (8.7 ± 1.6 vs. 11.4 ± 0.8, P = 0.001), and a trend toward shorter V-H intervals during VA (32.1 ± 38.6 milliseconds vs. 76.3 ± 11.1 milliseconds, P = 0.06) as compared to those without PP. A strong and positive correlation was found between V-H interval and QRS duration during arrhythmia in those with PPs (B = 2.11, R(2) = 0.97, t = 13.7, P < 0.001) but not in those without PPs. CONCLUSION Local EGM characteristics and relative activation time of the His bundle suggest the possibility of conduction tissue as the origin for VA arising from the fibrous AMC. Specific identification and targeting of PPs when ablating VAs at this location may improve procedural success.
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Affiliation(s)
- Jo Jo Hai
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, Hong Kong
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DeSimone CV, Friedman PA, Noheria A, Ackerman MJ, Asirvatham SJ, DeSimone DC, Aakre CA, Vaidya VR, Noheria A, Patel NA, Bdeir S, Slusser JP, Hodge DO, Rabinstein AA. Response to letters regarding article, "Stroke or transient ischemic attack in patients with transvenous pacemaker or defibrillator and echocardiographically detected patent foramen ovale". Circulation 2014; 130:e13-4. [PMID: 25001630 DOI: 10.1161/circulationaha.114.009351] [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] [Indexed: 11/16/2022]
Affiliation(s)
| | - Paul A Friedman
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Amit Noheria
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | - Amit Noheria
- Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - Sami Bdeir
- Mayo Graduate School of Medicine Visiting Scholars Program, Mayo Clinic, Rochester, MN
| | | | - David O Hodge
- Department of Statistics, Mayo Clinic, Rochester, MN
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Desimone CV, Hu T, Ebrille E, Syed FF, Vaidya VR, Cha YM, Valverde AM, Friedman PA, Suri RM, Asirvatham SJ. Catheter ablation related mitral valve injury: the importance of early recognition and rescue mitral valve repair. J Cardiovasc Electrophysiol 2014; 25:971-975. [PMID: 24758402 DOI: 10.1111/jce.12439] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 03/20/2014] [Accepted: 04/11/2014] [Indexed: 01/31/2023]
Abstract
INTRODUCTION An increasing number of catheter ablations involve the mitral annular region and valve apparatus, increasing the risk of catheter interaction with the mitral valve (MV) complex. We review our experience with catheter ablation-related MV injury resulting in severe mitral regurgitation (MR) to delineate mechanisms of injury and outcomes. METHODS We searched the Mayo Clinic MV surgical database over a 19-year period (1993-2012) and the electrophysiologic procedures database over a 23-year period (1990-2013) and identified 9 patients with catheter ablation related MV injury requiring clinical intervention. RESULTS Indications for ablation included atrial fibrillation (AF) [n = 4], ventricular tachycardia (VT) [n = 3], and left-sided accessory pathways [n = 2]. In all 4 AF patients, a circular mapping catheter entrapped in the MV apparatus was responsible for severe MR. In all 3 VT patients, radiofrequency energy delivery led to direct injury to the MV apparatus. In the 2 patients with accessory pathways, both mechanisms were involved (1 per patient). Six patients required surgical intervention (5 MV repair, 1 catheter removal). One patient developed severe functional MR upon successful endovascular catheter disentanglement that improved spontaneously. Two VT patients with persistent severe postablation MR were managed nonsurgically, 1 of whom died 3 months postprocedure. CONCLUSION Circular mapping catheter entrapment and ablation at the mitral annulus are the most common etiologies of MV injury during catheter ablation. Close surveillance of the MV is needed during such procedures and early surgical repair is important for successful salvage if significant injury occurs.
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Affiliation(s)
- Christopher V Desimone
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Tiffany Hu
- Mayo Clinic School of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Elisa Ebrille
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Department of Internal Medicine, Division of Cardiovascular Diseases, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Faisal F Syed
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Vaibhav R Vaidya
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Yong-Mei Cha
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Arturo M Valverde
- Department of Cardiovascular Disease, Mayo Clinic Health System, Eau Claire, Wisconsin, USA
| | - Paul A Friedman
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Rakesh M Suri
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Samuel J Asirvatham
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Vaidya VR, Desimone CV, Madhavan M, Noheria A, Shahid M, Walters J, Ladewig DJ, Mikell SB, Johnson SB, Suddendorf SH, Asirvatham SJ. Compatibility of electroanatomical mapping systems with a concurrent percutaneous axial flow ventricular assist device. J Cardiovasc Electrophysiol 2014; 25:781-6. [PMID: 24758340 DOI: 10.1111/jce.12437] [Citation(s) in RCA: 13] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 04/15/2014] [Accepted: 04/17/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hemodynamic instability hinders activation and entrainment mapping during ventricular tachycardia ablation. The Impella 2.5 microaxial flow device (MFD; Abiomed Inc., Danvers, MA, USA) is used to prevent hemodynamic instability during electrophysiologic study. However, electromagnetic interference (EMI) generated by this device can preclude accurate electroanatomic mapping. METHODS Impella was placed in the left ventricle of 7 canines for circulatory support. Electroanatomic mapping during sinus rhythm, ventricular pacing, and ventricular fibrillation (VF) was performed using magnet- (CARTO3, Biosense Webster Inc., Diamond Bar, CA, USA) and impedance- (EnSite Velocity System/EnSite NavX, St. Jude Medical Inc., St. Paul, MN, USA) based systems. Distance from device to points with severe EMI precluding acquisition was compared to points with mild/no EMI. Two methods were used to reduce EMI: (1) titration of MFD performance, and (2) impedance-only mapping combined with manual annotation of activation. RESULTS Severe EMI did not occur during impedance-based mapping. Severe EMI was observed using CARTO3 at 9.4% of all points attempted at maximum performance level (P8) of device. Severe EMI occurred at points closer to device (40.1 ± 16.8 mm) versus (55.5 ± 20.0 mm) for mild/no EMI, P < 0.0001. Severe EMI using CARTO3 was resolved by either (1) reduction of performance from P8 to P6 or (2) impedance-only mapping with manual annotation. CONCLUSION Concurrent use of MFD caused EMI to prevent acquisition of points with magnet-based mapping. Predictors for EMI were distance from device and performance level. Temporary reductions to P6 or impedance-only mapping are 2 methods to resolve EMI.
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Affiliation(s)
- Vaibhav R Vaidya
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Vaidya VR, DeSimone CV, Asirvatham SJ, Chandra VM, Noheria A, Hodge DO, Slusser JP, Rabinstein AA, Friedman PA. Implanted endocardial lead characteristics and risk of stroke or transient ischemic attack. J Interv Card Electrophysiol 2014; 41:31-8. [PMID: 24771226 DOI: 10.1007/s10840-014-9900-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 03/24/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Patent foramen ovale (PFO) has been recently implicated as a strong predictor of stroke or transient ischemic attack (TIA) in patients with implanted pacemaker or defibrillation leads. Leads in the right heart can form thrombi that embolize to the pulmonary circulation and raise pulmonary pressure. This increases right-to-left shunting through PFO or intrapulmonary shunts and can result in paradoxical embolism. We sought to determine whether certain lead characteristics confer a higher thrombogenic risk resulting in stroke/TIAs in patients either with or without a PFO. METHODS We retrospectively analyzed 5,646 patients (mean age 67.3 ± 16.3 years, 64 % male) who had endocardial device leads implanted in 2000-2010. We performed univariate and multivariate-adjusted proportional hazards models to determine association of lead characteristics with stroke/TIA during follow-up. RESULTS On univariate analysis, passively fixated tined leads were associated with more stroke/TIAs (HR 1.77, 95 % CI 1.27, 2.47; p<0.001), whereas presence of defibrillation coil was associated with fewer stroke/TIAs (HR 0.59, 95 % CI 0.42-0.84; p=0.003). Number of leads per patient, presence of atrial lead, maximum lead size, tip shape, and type of insulating material were not associated with stoke/TIA. On multivariate analyses adjusting for age, sex, diagnosis of PFO, and prior history of stroke/TIA, the presence of tined leads was associated with stroke/TIA (HR 1.41, 95 % CI 1.00-1.97; p=0.049). Defibrillation coils were no longer associated with lower stroke/TIA on multivariate analysis. CONCLUSIONS Most physical characteristics of contemporary leads do not impact rate of stroke/TIA among patients receiving implantable devices. The presence of a PFO is a major risk factor for stroke/TIA in patients with endovascular leads.
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Affiliation(s)
- Vaibhav R Vaidya
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Vaidya VR, Cha YM, Asirvatham SJ, Pellikka PA, Pislaru SV. To shock or not to shock? Parasystole of the left atrial appendage mimicking sinus rhythm at TEE-guided cardioversion. Eur Heart J Cardiovasc Imaging 2014; 15:833. [PMID: 24497516 DOI: 10.1093/ehjci/jeu012] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 11/12/2022] Open
Affiliation(s)
- Vaibhav R Vaidya
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Yong-Mei Cha
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Samuel J Asirvatham
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Patricia A Pellikka
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Sorin V Pislaru
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Hai JJ, Desimone CV, Vaidya VR, Asirvatham SJ. Endocavitary structures in the outflow tract: anatomy and electrophysiology of the conus papillary muscles. J Cardiovasc Electrophysiol 2013; 25:94-8. [PMID: 24102678 DOI: 10.1111/jce.12291] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [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: 07/11/2013] [Revised: 09/03/2013] [Accepted: 09/10/2013] [Indexed: 12/01/2022]
Abstract
Catheter ablation is an increasingly used and successful treatment choice for right ventricular outflow tract (RVOT) arrhythmias. While the role of endocavitary structures and the regional morphology of the ventricular inflow tract and the right atrium as a cause for difficulty with successful ablation are well described, similar issues within the RVOT are not well understood. It is also not commonly appreciated that one of the papillary muscles is located within the proximal RVOT. We report 3 patients in which ventricular arrhythmia was targeted and ablated in the conus papillary muscle. The anatomic features, potential role of the fascicular conduction system, and unique challenges with mapping arrhythmia arising from this structure are discussed.
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Affiliation(s)
- Jo Jo Hai
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, Hong Kong
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