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Sanghvi HA, Patel RH, Agarwal A, Gupta S, Sawhney V, Pandya AS. A deep learning approach for classification of COVID and pneumonia using DenseNet-201. Int J Imaging Syst Technol 2022; 33:IMA22812. [PMID: 36249091 PMCID: PMC9537800 DOI: 10.1002/ima.22812] [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] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/24/2022] [Accepted: 09/09/2022] [Indexed: 05/27/2023]
Abstract
In the present paper, our model consists of deep learning approach: DenseNet201 for detection of COVID and Pneumonia using the Chest X-ray Images. The model is a framework consisting of the modeling software which assists in Health Insurance Portability and Accountability Act Compliance which protects and secures the Protected Health Information . The need of the proposed framework in medical facilities shall give the feedback to the radiologist for detecting COVID and pneumonia though the transfer learning methods. A Graphical User Interface tool allows the technician to upload the chest X-ray Image. The software then uploads chest X-ray radiograph (CXR) to the developed detection model for the detection. Once the radiographs are processed, the radiologist shall receive the Classification of the disease which further aids them to verify the similar CXR Images and draw the conclusion. Our model consists of the dataset from Kaggle and if we observe the results, we get an accuracy of 99.1%, sensitivity of 98.5%, and specificity of 98.95%. The proposed Bio-Medical Innovation is a user-ready framework which assists the medical providers in providing the patients with the best-suited medication regimen by looking into the previous CXR Images and confirming the results. There is a motivation to design more such applications for Medical Image Analysis in the future to serve the community and improve the patient care.
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Affiliation(s)
| | - Riki H. Patel
- Department of CEECSFlorida Atlantic UniversityBoca RatonFloridaUSA
| | - Ankur Agarwal
- Department of CEECSFlorida Atlantic UniversityBoca RatonFloridaUSA
| | - Shailesh Gupta
- Department of Clinical Trials and ResearchSpecialty Retina CenterCoral SpringsFloridaUSA
| | - Vivek Sawhney
- Department of Clinical Trials and ResearchSpecialty Retina CenterCoral SpringsFloridaUSA
| | - Abhijit S. Pandya
- Department of CEECSFlorida Atlantic UniversityBoca RatonFloridaUSA
- Department of Clinical Trials and ResearchSpecialty Retina CenterCoral SpringsFloridaUSA
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2
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Maclean E, Mahtani K, Roelas M, Vyas R, Butcher C, Ahluwalia N, Honarbakhsh S, Creta A, Finlay M, Chow A, Earley MJ, Sporton S, Lowe MD, Sawhney V, Ezzat V, Ahsan S, Khan F, Dhinoja M, Lambiase PD, Schilling RJ, Hunter RJ, Segal OR. Transseptal puncture for left atrial ablation: risk factors for cardiac tamponade and a proposed causative classification system. J Cardiovasc Electrophysiol 2022; 33:1747-1755. [PMID: 35671359 PMCID: PMC9543389 DOI: 10.1111/jce.15590] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/28/2022] [Accepted: 04/06/2022] [Indexed: 12/01/2022]
Abstract
Aims Cardiac tamponade is a high morbidity complication of transseptal puncture (TSP). We examined the associations of TSP‐related cardiac tamponade (TRCT) for all patients undergoing left atrial ablation at our center from 2016 to 2020. Methods and Results Patient and procedural variables were extracted retrospectively. Cases of cardiac tamponade were scrutinized to adjudicate TSP culpability. Adjusted multivariate analysis examined predictors of TRCT. A total of 3239 consecutive TSPs were performed; cardiac tamponade occurred in 51 patients (incidence: 1.6%) and was adjudicated as TSP‐related in 35 (incidence: 1.1%; 68.6% of all tamponades). Patients of above‐median age [odds ratio (OR): 2.4 (1.19–4.2), p = .006] and those undergoing re‐do procedures [OR: 1.95 (1.29–3.43, p = .042] were at higher risk of TRCT. Of the operator‐dependent variables, choice of transseptal needle (Endrys vs. Brockenbrough, p > .1) or puncture sheath (Swartz vs. Mullins vs. Agilis vs. Vizigo vs. Cryosheath, all p > .1) did not predict TRCT. Adjusting for operator, equipment and demographics, failure to cross the septum first pass increased TRCT risk [OR: 4.42 (2.45–8.2), p = .001], whilst top quartile operator experience [OR: 0.4 (0.17–0.85), p = .002], transoesophageal echocardiogram [TOE prevalence: 26%, OR: 0.51 (0.11–0.94), p = .023], and use of the SafeSept transseptal guidewire [OR: 0.22 (0.08–0.62), p = .001] reduced TRCT risk. An increase in transseptal guidewire use over time (2016: 15.6%, 2020: 60.2%) correlated with an annual reduction in TRCT (R2 = 0.72, p < .001) and was associated with a relative risk reduction of 70%. Conclusions During left atrial ablation, the risk of TRCT was reduced by operator experience, TOE‐guidance, and use of a transseptal guidewire, and was increased by patient age, re‐do procedures, and failure to cross the septum first pass.
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Affiliation(s)
- E Maclean
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK.,William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - K Mahtani
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - M Roelas
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - R Vyas
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - C Butcher
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - N Ahluwalia
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - S Honarbakhsh
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - A Creta
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - M Finlay
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - A Chow
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - M J Earley
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - S Sporton
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - M D Lowe
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - V Sawhney
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - V Ezzat
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - S Ahsan
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - F Khan
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - M Dhinoja
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - P D Lambiase
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - R J Schilling
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK.,William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - R J Hunter
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK.,William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - O R Segal
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
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3
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Hecht JR, Shergill A, Goldstein MG, Fang B, Cho MT, Lenz HJ, Berim LD, Oberstein PE, Safyan RA, Sawhney V, Soares HP, Spigel DR, Spira AI, Ferguson AR, Chauder B, Starodub A. Phase 2/3, randomized, open-label study of an individualized neoantigen vaccine (self-amplifying mRNA and adenoviral vectors) plus immune checkpoint blockade as maintenance for patients with newly diagnosed metastatic colorectal cancer (GRANITE). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps3635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS3635 Background: Treatment options for most patients with metastatic colorectal cancer (mCRC) are largely limited to cytotoxic chemotherapy, with little advancement in the last decade. Encouragingly, a small subset of patients deficient in mismatch repair (dMMR/MSI-hi) benefit from checkpoint inhibitors (CPI) whereas those proficient in mismatch repair (pMMR/MSS) do not. The absence of clinical benefit in patients with pMMR/MSS mCRC may relate to a lack of neoantigen-specific T cells and immune infiltration. An individualized neoantigen vaccine that induces CD8 T cells capable of tumor lysis has the potential to expand the number of patients with mCRC who may benefit from immunotherapy. Data from a Phase 1/2 study evaluating neoantigen vaccines in combination with CPIs in patients with previously treated mCRC demonstrated a 44% molecular response (MR) rate (≥50% decrease in ctDNA relative to baseline) in 4/9 patients; this correlated with improvement in OS relative to those without a MR. To further investigate neoantigen vaccines in earlier lines of treatment, a Phase 2/3 study in the1L maintenance setting in mCRC was initiated. Methods: GO-010 is a Phase 2/3, randomized, open-label, multi-center study evaluating the efficacy and safety of 2 neoantigen-containing vectors (GRT-C901-adenoviral vector plus GRT-R902-self-amplifying mRNA vector) as prime/boost in combination with CPIs as an add-on to fluoropyrimidine/bevacizumab (bev) following 1L therapy with FOLFOX/bev in patients with mCRC. During Phase 2, up to 90 patients will be randomized 1:1 to the vaccine or control arm with a primary objective of assessing efficacy by MR. During Phase 3, up to 226 patients will be randomized with a primary objective of assessing PFS per iRECIST in a blinded, independent manner. There are two stages to the study. In the vaccine production stage, while patients receive FOLFOX/bev 1L therapy, neoantigen prediction is performed using a tumor biopsy and Gritstone’s EDGE™ neoantigen prediction model. For patients in the vaccine arm the top 20 predicted neoantigens are included in the vaccine vectors. After completing oxaliplatin, patients will enter the study treatment stage. Patients in the control arm will continue with maintenance therapy whereas patients in the vaccine arm will add the vaccine regimen to maintenance therapy. The vaccine regimen consists of GRT-C901/GRT-R902 as well as SC ipilimumab (30 mg) and IV atezolizumab (1680 mg). Over the first year of treatment, 6 vaccinations will occur. Ipilimumab will be administered SC with the first doses of GRT-C901 and GRT-R902. Atezolizumab will be administered every 4 weeks for up to 2 years. Study assessments include imaging, ctDNA, safety, immunogenicity and exploratory biomarker analysis. Clinical trial information: NCT05141721.
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Affiliation(s)
- J. Randolph Hecht
- David Geffen School of Medicine at UCLA, Santa Monica, Los Angeles, CA
| | - Ardaman Shergill
- The University of Chicago, Medical and Biological Sciences, Chicago, IL
| | | | | | | | - Heinz-Josef Lenz
- Division of Medical Oncology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | | | | | | | | | | | - David R. Spigel
- Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN
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4
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Prabhu S, Ahluwalia N, Tyebally SM, Dennis ASC, Malomo SO, Abiodun AT, Tyrlis A, Dhillon G, Segan L, Graham A, Honarbakhsh S, Sawhney V, Sporton S, Lowe M, Finlay M, Earley MJ, Lambiase P, Schilling RJ, Hunter RJ. ERRATUM. J Cardiovasc Electrophysiol 2022; 33:567. [PMID: 35166413 DOI: 10.1111/jce.15312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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5
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Wong G, Ahmed D, Creta A, Honarbakhsh S, Kanthasamy V, Maclean E, Sawhney V, Earley M, Hunter R, Schilling RJ, Finlay M. ProGlide venous closure device facilitates early ambulation following cryoablation of atrial fibrillation. Europace 2021. [DOI: 10.1093/europace/euab116.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Heart Foundation
Background
Same-day discharge following atrial fibrillation (AF) ablation is increasingly common. ProGlide device suture-mediated vascular closure (PD) offers a technique that may expedite mobilisation following large-bore (>12F) venous access. The utility of PD closure following cryoablation of AF has not been reported.
Purpose
We sought to evaluate haemostasis and early ambulation outcomes in patients receiving the ProGlide compared with conventional techniques.
Methods
104 consecutive patients undergoing cryoballoon pulmonary vein isolation (PVI) for paroxysmal or persistent at a single high-volume institution were included. PVI was performed via a standardised approach including sedation, ultrasound-guided vascular access for 14F Cryosheath and second 7F sheath, anticoagulation protocol, transeptal puncture, 28mm cryoballoon and nurse-led same-day discharge protocol. Haemostasis was achieved using the Perclose Proglide device (PD) in the 14F access point ("pre-closure" technique) plus 5 minutes manual pressure at the 7F sheath site. Alternatively, a figure-of-eight/Z-suture (ZS) was employed for closure according to operator preference. Protamine was used for heparin reversal in all patients. Safety outcomes of major bleeding, haematoma and minor bleeding were assessed. Time to ambulation (TTA), time to discharge (TTD), same-day discharge and complications at initial follow-up were measured.
Results
Overall, mean age was 64 ± 11 years, 65 (64%) were male and 52 (50%) of patients had paroxysmal AF, there were no significant differences between group demographics, with 31 patients (30%) in the PD group and 73 (70%) in the ZS group. All patients had uninterrupted oral anticoagulation throughout the periprocedural period. No major femoral bleeding complications requiring intervention occurred in either group. Haematomas occurred in none of the PD group compared with 2 (2.8%) in the ZS group. Incidence of minor bleeding was not significantly different between groups (PD: 3 [9.7%] vs ZS: 2 [2.7%], p = 0.155). Mean TTA was significantly shorter in the PD group (3.3 ± 1.1 vs 4.1 ± 1.7 hrs, p = 0.025). However, there was no significant difference in same-day discharge (PD: 25 [81%] vs ZS: 53 [73%], p = 0.386) and TTD (5.0 ± 3.6 vs 6.1 ± 4.2 hrs, p = 0.275) between groups. 1 patient complained of groin pain which delayed discharge in the ZS group not seen in the PD group. After a mean follow-up of 2.2 ± 1.4 months, there were no differences in major or minor complications.
Conclusion
Use of the Proglide closure device was associated with significant reductions in time to ambulation compared with Z-suture haemostasis following cryoablation of AF, and groin access complications were uncommon across groups. PD closure may contribute to further streamlining patient pathways in day-case AF ablation.
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Affiliation(s)
- G Wong
- St Bartholomew"s Hospital, Department of Cardiac Electrophysiology, London, United Kingdom of Great Britain & Northern Ireland
| | - D Ahmed
- St Bartholomew"s Hospital, Department of Cardiac Electrophysiology, London, United Kingdom of Great Britain & Northern Ireland
| | - A Creta
- St Bartholomew"s Hospital, Department of Cardiac Electrophysiology, London, United Kingdom of Great Britain & Northern Ireland
| | - S Honarbakhsh
- St Bartholomew"s Hospital, Department of Cardiac Electrophysiology, London, United Kingdom of Great Britain & Northern Ireland
| | - V Kanthasamy
- St Bartholomew"s Hospital, Department of Cardiac Electrophysiology, London, United Kingdom of Great Britain & Northern Ireland
| | - E Maclean
- St Bartholomew"s Hospital, Department of Cardiac Electrophysiology, London, United Kingdom of Great Britain & Northern Ireland
| | - V Sawhney
- St Bartholomew"s Hospital, Department of Cardiac Electrophysiology, London, United Kingdom of Great Britain & Northern Ireland
| | - M Earley
- St Bartholomew"s Hospital, Department of Cardiac Electrophysiology, London, United Kingdom of Great Britain & Northern Ireland
| | - R Hunter
- St Bartholomew"s Hospital, Department of Cardiac Electrophysiology, London, United Kingdom of Great Britain & Northern Ireland
| | - RJ Schilling
- St Bartholomew"s Hospital, Department of Cardiac Electrophysiology, London, United Kingdom of Great Britain & Northern Ireland
| | - M Finlay
- St Bartholomew"s Hospital, Department of Cardiac Electrophysiology, London, United Kingdom of Great Britain & Northern Ireland
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6
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Prabhu S, Ahluwalia N, Tyebally SM, Dennis ASC, Malomo SO, Abiodun AT, Tyrlis A, Dhillon G, Segan L, Graham A, Honarbakhsh S, Sawhney V, Sporton S, Lowe M, Finlay M, Earley MJ, Lambiase P, Schilling RJ, Hunter RJ. Long-term outcomes of index cryoballoon ablation or point-by-point radiofrequency ablation in patients with atrial fibrillation and systolic heart failure. J Cardiovasc Electrophysiol 2021; 32:941-948. [PMID: 33527562 DOI: 10.1111/jce.14923] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 10/05/2020] [Revised: 12/29/2020] [Accepted: 01/20/2021] [Indexed: 11/29/2022]
Abstract
Catheter ablation is an established effective approach for the treatment of atrial fibrillation (AF) in patients with heart failure, however, the role of cryoablation in this setting is unclear. Procedural success and left ventricular systolic dysfunction (LVEF) improvement in patients with LVEF ≤ 45% undergoing index catheter ablation with cryoablation were evaluated. Freedom from AF recurrence was seen in 43% rising to 59% following repeat procedure. There were significant improvements in LVEF and functional status at long-term follow-up. Results were comparable to a contemporaneous cohort of heart failure patients undergoing index ablation with radiofrequency ablation. Cryoablation is an effective first-line AF ablation approach in the setting of heart failure.
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Affiliation(s)
- S Prabhu
- Department of Cardiology, St Bartholomew's Hospital, London, UK.,Baker Heart and Diabetes Research Institute, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - N Ahluwalia
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - S M Tyebally
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - A S C Dennis
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - S O Malomo
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - A T Abiodun
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - A Tyrlis
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - G Dhillon
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - L Segan
- Baker Heart and Diabetes Research Institute, Melbourne, Australia
| | - A Graham
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - S Honarbakhsh
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - V Sawhney
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - S Sporton
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - M Lowe
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - M Finlay
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - M J Earley
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - P Lambiase
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - R J Schilling
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - R J Hunter
- Department of Cardiology, St Bartholomew's Hospital, London, UK
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7
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Chowdhary S, Sawhney V, Pandya A, Sambhav K, Gupta SK. Central Retinal Artery Occlusion After Nasosinal Surgery - an Insight. Int Med Case Rep J 2020; 13:211-215. [PMID: 32547258 PMCID: PMC7247723 DOI: 10.2147/imcrj.s247275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 04/07/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To describe a case of central retinal artery occlusion (CRAO) after nasosinal surgery and subject's subsequent response to hyperbaric oxygen therapy (HBOT). Design Observational case report. Results We describe a subject with diagnosed CRAO after septoplasty, bilateral inferior turbinate reduction and balloon sinuplasty, who was given hyperbaric oxygen treatment after four days of onset of CRAO with an improvement in visual acuity and visual field. Conclusion Even though CRAO has been rarely reported after ENT procedures and HBOT has been previously described for the treatment, this is the case report where hyperbaric oxygen was given after four days of onset, with a possible improvement.
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Affiliation(s)
- Somya Chowdhary
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | | | | | - Kumar Sambhav
- Department of Ophthalmology, University of Florida, Jacksonville, FL, USA
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8
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Chowdhary S, Garg P, Sawhney V, Pandya A, Sambhav K, Gupta S. Unusual Missed Diagnosis of Foreign Body: A Case Report. Int Med Case Rep J 2020; 13:187-190. [PMID: 32547254 PMCID: PMC7245452 DOI: 10.2147/imcrj.s246924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/08/2020] [Indexed: 11/23/2022] Open
Abstract
Background Penetrating intraorbital foreign body (IOFB) is usually associated with high-velocity trauma forces around the eye. IOFB injury to globe or optic nerve is considered a surgical emergency; an immediate diagnosis and management plan is generally indicated. Methods A case report (design). The patient was a 78-year-old male presented with diminution of vision of the right eye following a high-velocity injury. The patient was noted to have a closed globe injury with associated retinal detachment and vitreous hemorrhage. An initial orbital CT scan did not reveal any IOFB, despite and intact globe. However, repeat a CT head and orbit scan revealed an intracranial magnetic foreign body lodged in the right frontal lobe. Conclusion A CT scan of the brain and paranasal sinuses should be obtained along with a CT orbit in case of high-velocity orbital/ocular trauma.
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Affiliation(s)
- Somya Chowdhary
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Pooja Garg
- Specialty Retina Centre, Coral Springs, FL, USA
| | | | | | - Kumar Sambhav
- Department of Ophthalmology, University of Florida, Jacksonville, FL, USA
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9
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Sawhney V, Mc Lellan A, Chatha S, Perera D, Aderonke A, Juno S, Whittaker-Axon S, Daw H, Garcia J, Lambiase PD, Cullen S, Bhan A, Von Klemperer K, Walker F, Pandya B, Lowe MD, Ezzat V. Outcome of ACHD patients with non-inducible versus inducible IART undergoing cavo-tricuspid isthmus ablation: the role of empiric ablation. J Interv Card Electrophysiol 2020; 60:49-56. [PMID: 31997041 DOI: 10.1007/s10840-019-00692-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 12/19/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Catheter ablation for supraventricular tachycardia (SVT) in adults with congenital heart disease (ACHD) is an important therapeutic option. Cavo-tricuspid isthmus (CTI)-dependent intraatrial re-entrant tachycardia (IART) is common. However, induction of sustained tachycardia at the time of ablation is not always possible. We hypothesised that performing an empiric CTI line in case of non-inducibility leads to good outcomes. Long-term outcomes of empiric versus entrained CTI ablation in ACHD patients were examined. METHODS Retrospective, single-centre, case-control study over 7 years. Arrhythmia-free survival after empiric versus entrained CTI ablation was compared. RESULTS Eighty-seven CTI ablations were performed in 85 ACHD patients between 2010 and 2017. The mean age of the cohort was 43 years and 48% were male. Underlying aetiology included ASD (31%), VSD (11.4%), AVSD (9.1%), AVR (4.8%), Fallot's (18.4%), Ebstein's (2.3%), Fontan's palliation (9.2%) and atrial switch (13.8%). CTI-dependent IART was entrained in 59 patients whereas it was non-inducible in 28. The latter had an empiric CTI ablation. Forty-three percent of procedures were performed under general anaesthesia. There were no reported procedural complications. There was no significant difference in the mean procedure or fluoroscopy times between the groups (empiric vs entrained CTI; 169.1 vs 183.3 and 28.1 vs 19.9 min). Arrhythmia-free survival was 64.3% versus 72.8% (p value 0.44) in the empiric and entrained groups at 21 months follow-up. CONCLUSIONS Long-term outcomes after empiric and entrained CTI ablation for IART in ACHD patients are comparable. This is a safe and effective therapeutic option. In the case of non-inducibility of IART, an empiric CTI line should be considered in this cohort.
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Affiliation(s)
- V Sawhney
- Department of Arrhythmia Services, Barts Heart Centre, St. Bartholomew's Hospital, EC1A 7BE, London, UK. .,Grown-up Congenital Heart Disease Services, Barts Heart Centre, St. Bartholomew's Hospital, London, UK.
| | - A Mc Lellan
- Department of Arrhythmia Services, Barts Heart Centre, St. Bartholomew's Hospital, EC1A 7BE, London, UK
| | - S Chatha
- Department of Arrhythmia Services, Barts Heart Centre, St. Bartholomew's Hospital, EC1A 7BE, London, UK
| | - D Perera
- Department of Arrhythmia Services, Barts Heart Centre, St. Bartholomew's Hospital, EC1A 7BE, London, UK
| | - A Aderonke
- Department of Arrhythmia Services, Barts Heart Centre, St. Bartholomew's Hospital, EC1A 7BE, London, UK
| | - S Juno
- Department of Arrhythmia Services, Barts Heart Centre, St. Bartholomew's Hospital, EC1A 7BE, London, UK
| | - S Whittaker-Axon
- Department of Arrhythmia Services, Barts Heart Centre, St. Bartholomew's Hospital, EC1A 7BE, London, UK
| | - H Daw
- Department of Arrhythmia Services, Barts Heart Centre, St. Bartholomew's Hospital, EC1A 7BE, London, UK.,Grown-up Congenital Heart Disease Services, Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | - J Garcia
- Department of Arrhythmia Services, Barts Heart Centre, St. Bartholomew's Hospital, EC1A 7BE, London, UK
| | - P D Lambiase
- Department of Arrhythmia Services, Barts Heart Centre, St. Bartholomew's Hospital, EC1A 7BE, London, UK
| | - S Cullen
- Grown-up Congenital Heart Disease Services, Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | - A Bhan
- Grown-up Congenital Heart Disease Services, Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | - K Von Klemperer
- Grown-up Congenital Heart Disease Services, Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | - F Walker
- Grown-up Congenital Heart Disease Services, Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | - B Pandya
- Grown-up Congenital Heart Disease Services, Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | - M D Lowe
- Department of Arrhythmia Services, Barts Heart Centre, St. Bartholomew's Hospital, EC1A 7BE, London, UK.,Grown-up Congenital Heart Disease Services, Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | - V Ezzat
- Department of Arrhythmia Services, Barts Heart Centre, St. Bartholomew's Hospital, EC1A 7BE, London, UK.,Grown-up Congenital Heart Disease Services, Barts Heart Centre, St. Bartholomew's Hospital, London, UK
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Sawhney V, Volkova E, Shaukat M, Khan F, Segal O, Ahsan S, Chow A, Ezzat V, Finlay M, Lambiase P, Lowe M, Dhinoja M, Sporton S, Earley MJ, Hunter RJ, Schilling RJ. Impact of attributed audit on procedural performance in cardiac electrophysiology catheter laboratory. J Interv Card Electrophysiol 2018; 56:199-203. [PMID: 29858762 DOI: 10.1007/s10840-018-0383-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/15/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE Audit has played a key role in monitoring and improving clinical practice. However, audit often fails to drive change as summative institutional data alone may be insufficient to do so. We hypothesised that the practice of attributed audit, wherein each individual's procedural performance is presented will have a greater impact on clinical practice. This hypothesis was tested in an observational study evaluating improvement in fluoroscopy times for AF ablation. METHODS Retrospective analyses of fluoroscopy times in AF ablations at the Barts Heart Centre (BHC) from 2012-2017. Fluoroscopy times were compared pre- and post- the introduction of attributed audit in 2012 at St Bartholomew's Hospital (SBH). In order to test the hypothesis, this concept was introduced to a second group of experienced operators from the Heart Hospital (HH) as part of a merger of the two institutions in 2015 and change in fluoroscopy times recorded. RESULTS A significant drop in fluoroscopy times (33.3 ± 9.14 to 8.95 ± 2.50, p < 0.0001) from 2012-2014 was noted after the introduction of attributed audit. At the time of merger, a significant difference in fluoroscopy times between operators from the two centres was seen in 2015. Each operator's procedural performance was shared openly at the audit meeting. Subsequent audits showed a steady decrease in fluoroscopy times for each operator with the fluoroscopy time (min, mean±SD) decreasing from 13.29 ± 7.3 in 2015 to 8.84 ± 4.8 (p < 0.0001) in 2017 across the entire group. CONCLUSIONS Systematic improvement in fluoroscopy times for AF ablation procedures was noted byevaluating individual operators' performance. Attributing data to physicians in attributed audit can promptsignificant improvement and hence should be adopted in clinical practice.
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Affiliation(s)
- V Sawhney
- EP Cardiac Research, Barts Heart Centre, 1 SMLG, London, EC1A 7BE, UK.
| | - E Volkova
- EP Cardiac Research, Barts Heart Centre, 1 SMLG, London, EC1A 7BE, UK
| | - M Shaukat
- EP Cardiac Research, Barts Heart Centre, 1 SMLG, London, EC1A 7BE, UK
| | - F Khan
- EP Cardiac Research, Barts Heart Centre, 1 SMLG, London, EC1A 7BE, UK
| | - O Segal
- EP Cardiac Research, Barts Heart Centre, 1 SMLG, London, EC1A 7BE, UK
| | - S Ahsan
- EP Cardiac Research, Barts Heart Centre, 1 SMLG, London, EC1A 7BE, UK
| | - A Chow
- EP Cardiac Research, Barts Heart Centre, 1 SMLG, London, EC1A 7BE, UK
| | - V Ezzat
- EP Cardiac Research, Barts Heart Centre, 1 SMLG, London, EC1A 7BE, UK
| | - M Finlay
- EP Cardiac Research, Barts Heart Centre, 1 SMLG, London, EC1A 7BE, UK
| | - P Lambiase
- EP Cardiac Research, Barts Heart Centre, 1 SMLG, London, EC1A 7BE, UK
| | - M Lowe
- EP Cardiac Research, Barts Heart Centre, 1 SMLG, London, EC1A 7BE, UK
| | - M Dhinoja
- EP Cardiac Research, Barts Heart Centre, 1 SMLG, London, EC1A 7BE, UK
| | - S Sporton
- EP Cardiac Research, Barts Heart Centre, 1 SMLG, London, EC1A 7BE, UK
| | - M J Earley
- EP Cardiac Research, Barts Heart Centre, 1 SMLG, London, EC1A 7BE, UK
| | - R J Hunter
- EP Cardiac Research, Barts Heart Centre, 1 SMLG, London, EC1A 7BE, UK
| | - R J Schilling
- EP Cardiac Research, Barts Heart Centre, 1 SMLG, London, EC1A 7BE, UK
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Honarbakhsh S, Schilling RJ, Providencia R, Dhillon G, Sawhney V, Martin CA, Keating E, Finlay M, Ahsan S, Chow A, Earley MJ, Hunter RJ. 79Panoramic atrial mapping with basket catheters: a quantitative analysis to optimise practice, patient selection and catheter choice. Europace 2017. [DOI: 10.1093/europace/eux283.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sawhney V, Shaukat M, Volkova E, Khan F, Segal O, Ashan S, Chow A, Ezzat V, Finlay M, Lambiase P, Lowe M, Dhinoja M, Earley MJ, Sporton S, Hunter RJ, Schilling RJ. 55Impact of open audit on procedural performance in electrophysiology catheter laboratory. Europace 2017. [DOI: 10.1093/europace/eux283.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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13
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Sawhney V, Shaukat M, Volkova E, Yao Q, Jones N, Honarbakhsh S, Dhillon G, Lowe M, Lambiase P, Dhinoja M, Finlay M, Sportan S, Earley MJ, Schilling RJ, Hunter RJ. 48Catheter ablation for atrial fibrillation on uninterrupted NOACs: a safe approach? Europace 2017. [DOI: 10.1093/europace/eux283.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sawhney V, Daw H, Whittaker-Axon S, Breitenstein A, Alan C, Lambiase P, Lowe M, Earley MJ, Sportan S, Hunter RJ, Schilling RJ, Dhinoja M. 95Fluoroscopy times in electrophysiology and device procedures: impact of single frame location fluoroscopy. Europace 2017. [DOI: 10.1093/europace/eux283.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sawhney V, Daw H, Lambiase P, Schilling RJ, Ezzat V, Lowe M. 45Atrial tachyarrhythmia ablation in lateral tunnel fontan patients: a case series. Europace 2017. [DOI: 10.1093/europace/eux283.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Sawhney V, McLellan A, Perera D, Izquierdo D, Babra D, Schilling RJ, Lambiase P, Ezzat V, Lowe M. 24Long-term outcomes of supraventricular tachycardia ablation in congenital heart disease: single centre UK experience. Europace 2017. [DOI: 10.1093/europace/eux283.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Martin CA, Sawhney V, Martin R, Takigawa M, Frontera A, Cheniti G, Thompson N, Massouillie G, Kitamura T, Wolf M, Duchateau J, Vlachos K, Denis A, Pambrun T, Sacher F, Hocini M, Jais P, Haissaguerre M, Ezzat V, Lowe MD, Derval N. 77USe of ultra-high density activation mapping to aid isthmus identification in atrial macro-reentrant tachycardias in complex congenital heart disease. Europace 2017. [DOI: 10.1093/europace/eux283.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sawhney V, McLellan A, Perera D, Babra D, Izquierdo D, Schilling RJ, Lambiase P, Lowe M, Ezzat V. 23Empiric versus entrained cavotricuspid isthmus line ablation in congenital heart disease: a single centre experience. Europace 2017. [DOI: 10.1093/europace/eux283.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Sawhney V, Domenichini G, Baker V, John S, Gamble J, FurnIss G, Panagopoulos D, Campbell N, Rajappan K, Lambiase P, Sporton S, Earley MJ, Dhinoja M, Haywood G, Hunter RJ, Schilling RJ. 21Thromboembolic events in left ventricular endocardial pacing: long-term outcomes from a Multicentre UK registry. Europace 2017. [DOI: 10.1093/europace/eux283.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Sawhney V, Domenichini G, Gamble J, Furniss G, Panagopoulos D, Campbell N, Lowe M, Lambiase P, Haywood G, Sporton S, Earley MJ, Dhinoja M, Hunter R, Betts T, Schilling RJ. 239Long-Term follow-up of thromboembolic complications in left ventricular endocardial pacing: outcomes from a multi centre uk registry. Europace 2017. [DOI: 10.1093/ehjci/eux139.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sawhney V, Shaukat M, Volkova E, Yao Q, Jones N, Ullah W, Honarbakhsh S, Lowe M, Lambiaise P, Dhinoja M, Finlay M, Sporton S, Earley MJ, Schilling RJ, Hunter RJ. P1726Catheter ablation for atrial fibrillation on uninterrupted NOACs: a safe approach? Europace 2017. [DOI: 10.1093/ehjci/eux161.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Breitenstein A, Sawhney V, Honarbakhsh S, Providencia R, Chow A, Rajappan K, Kalla M, Cassar M, Hall M, Temple IP, Bartoletti S, Panikker S, Kontogeorgis A, Wong T, Hunter RJ. 1168Long-term outcomes after catheter ablation of ventricular tachycardia in patients with structural heart disease: a Multicentre UK Study. Europace 2017. [DOI: 10.1093/ehjci/eux153.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sawhney V, Mclellan A, Perera D, Inquierdo D, Babra D, Schilling RJ, Lambiase P, Ezzat V, Lowe M. P1470Retrograde aortic access of the pulmonary venous atrium provides equivalent outcomes to right atrial or transeptal access of the left atrium in patients with congenital heart disease. Europace 2017. [DOI: 10.1093/ehjci/eux158.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sawhney V, Mclellan A, Perera D, Babra D, Izquierdo D, Schilling RJ, Lambiase P, Lowe M, Ezzat V. P1465A single centre experience of empiric versus entrained cavotricuspid isthmus line ablation in congenital heart disease. Europace 2017. [DOI: 10.1093/ehjci/eux158.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sawhney V, Mclellan A, Perera D, Izquierdo D, Babra D, Schilling RJ, Lambiase P, Ezzat V, Lowe M. 1166Long-term outcomes of supraventricular tachycardia ablation in congenital heart disease: single centre uk experience. Europace 2017. [DOI: 10.1093/ehjci/eux153.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Sawhney V, Bacuetes E, Wray M, Dhinoja M, Earley MJ, Schilling RJ, Sporton S. Moderate sedation in cardiac electrophysiology laboratory: a retrospective safety analysis. Heart 2017; 103:1210-1215. [PMID: 28249993 DOI: 10.1136/heartjnl-2016-310676] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 12/30/2016] [Accepted: 01/27/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Cardiac electrophysiology (EP) procedures can be performed under moderate sedation without the direct involvement of an anaesthetist. However, concerns have been raised over the safety of this approach. This study examines the use of a standardised nurse-led physician-directed sedation protocol for EP procedures to determine the safety of moderate sedation administered by non-anaesthesia personnel who have been trained in sedation techniques. METHODS AND RESULTS Consecutive EP procedures done under moderate sedation over 12 years at our institution were evaluated. Serious adverse events were defined as (i) procedural death related to sedation; (ii) intubation and ventilation; and (iii) hypotension requiring inotropic support. Reversal of sedation constituted a minor adverse event. Up to 7117 procedures were included. These comprised ablations (55%), devices (43%) and other procedures (2%). A majority of patients were men with a mean age of 61±10 years. 99.98% of procedures were completed successfully without sedation-related serious adverse events. Two patients (0.02%) required anaesthetic support for intubation. Sedation was reversed in 1.2% of procedures with less than 1% requiring reversal because of persistent drop in oxygen saturation, hypoventilation or markedly reduced level of consciousness. There was no significant difference in the patient characteristics, mean doses of sedative agents and procedure types in the group requiring reversal of sedation when compared with the whole cohort. CONCLUSIONS Our study demonstrates that nurse-led, physician-directed moderate sedation is safe. Anaesthesia services are not required routinely for invasive cardiac EP procedures and should be available on a need basis.
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Affiliation(s)
- V Sawhney
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - E Bacuetes
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - M Wray
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - M Dhinoja
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - M J Earley
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - R J Schilling
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - S Sporton
- Department of Cardiology, St Bartholomew's Hospital, London, UK
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Sawhney V, Breitenstein A, Ullah W, Finlay M, Sporton S, Earley M, Chow A, Dhinoja M, Lambiase P, Schilling R, Hunter R. Epicardial catheter ablation for ventricular tachycardia on uninterrupted warfarin: A safe approach for those with a strong indication for peri-procedural anticoagulation? Int J Cardiol 2016; 222:57-61. [DOI: 10.1016/j.ijcard.2016.07.113] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 06/27/2016] [Accepted: 07/07/2016] [Indexed: 10/21/2022]
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Sawhney V, Breitenstein A, Sporton S, Dhinoja M. Percutaneous lead extraction and venous recanalisation using spectranetics tight rail: A single centre experience. Indian Pacing Electrophysiol J 2016. [PMCID: PMC5197445 DOI: 10.1016/j.ipej.2016.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Aims Despite advances in lead extraction tools, percutaneous lead extraction remains a complex procedure associated with significant morbidity and mortality. Moreover, no standards or directives exist to guide physicians in the choice of their extraction tool or approach and all operators tend to have their own preferred method. The reporting of outcomes with existing and newly emerging extraction technology is therefore encouraged. Methods and results Four lead extraction procedures using the new spectranetics tight rail rotating dilator sheath are described here. All patients (n = 3) had chronically implanted leads (mean duration = 11.7 years) and the pre-procedure venogram showed occluded left subclavian and brachiocephalic veins with extensive collateralisation. All leads were extracted successfully using this newly designed rotating dilator sheath and vascular access was also retained by venous recanalisation using this kit. One patient required a second extraction procedure at four weeks due to diaphragmatic twitch without macroscopic coronary sinus (CS) lead displacement. This was replaced with a transseptal LV lead. There were no other procedure related complications and all patients remained well with good lead parameters at three months follow-up. Conclusion The use of this new tight rail extraction tool appears safe and effective in chronically implanted leads. Moreover, it helps to preserve the vascular access by recanalisation of long tortuous occlusions. Its use across various centres and larger number of patients will be required to confirm our results.
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Sawhney V, Campbell N, Brouilette S, Coppen S, Harbo M, Baker V, Ikebe C, Shintani Y, Hunter R, Dhinoja M, Johnston A, Earley M, Sporton S, Bendix L, Suzuki K, Schilling R. Telomere shortening and telomerase activity in ischaemic cardiomyopathy patients – Potential markers of ventricular arrhythmia. Int J Cardiol 2016; 207:157-63. [DOI: 10.1016/j.ijcard.2016.01.066] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 12/09/2015] [Accepted: 01/01/2016] [Indexed: 11/25/2022]
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Sawhney V, Diab I, Thomas G, Schilling RJ. Recurrent sepsis post-cardiac device removal. QJM 2014; 107:1009-10. [PMID: 24757094 DOI: 10.1093/qjmed/hcu091] [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: 11/14/2022] Open
Affiliation(s)
- V Sawhney
- From the Cardiology Research Department, First Floor, 60-Dominion House, St Bartholomew's Hospital, West Smithfields, London EC1A 7BE, UK
| | - I Diab
- From the Cardiology Research Department, First Floor, 60-Dominion House, St Bartholomew's Hospital, West Smithfields, London EC1A 7BE, UK
| | - G Thomas
- From the Cardiology Research Department, First Floor, 60-Dominion House, St Bartholomew's Hospital, West Smithfields, London EC1A 7BE, UK
| | - R J Schilling
- From the Cardiology Research Department, First Floor, 60-Dominion House, St Bartholomew's Hospital, West Smithfields, London EC1A 7BE, UK
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Affiliation(s)
- V Sawhney
- Department of Cardiology, 1st Floor, 60-Dominion House, St Bartholomew's Hospital, West Smithfields, London EC1A 7BE, UK.
| | - N Campbell
- Department of Cardiology, 1st Floor, 60-Dominion House, St Bartholomew's Hospital, West Smithfields, London EC1A 7BE, UK
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Lee G, Hunter R, Lovell M, Finlay M, Sawhney V, Ullah W, Diab I, Dhinoja M, Earley M, Sporton S, Schilling RJ, Williams SE, Linton NWF, Harrison J, Wright M, O'Neill M, Jamil-Copley S, Linton N, Koa-Wing M, Lim PB, Hayat S, Qureshi N, Whinnett Z, Davies W, Peters N, Francis D, Kanagaratnam P, Jamil-Copley S, Ryan B, Kojodjojo P, Qureshi N, Koa-Wing M, Hayat S, Kyriacou A, Sandler B, Sohaib A, Wright I, Davies W, Peters N, Whinnett Z, Kanagaratnam P, Lim PB, Qureshi NA, Bai W, Ariff B, Williams A, Monro C, Kim S, Jamil-Copley S, Hayat S, Kao-Wing M, Kyriacou A, Sandler B, Fu NS, Kanagaratnam P, Whinnett Z, Davies DW, Lefroy D, Peters NS, Lim PB, Ryan MJ, Ezzat VA, O'Leary J, Bull C, Chow A, Lambiase P, Lowe MD, Anwar AS, Collitt S, Iddon P, Rice N, Dodd M, Dunsdale A, Petkar S, Mudd J, Linker N, Fitzpatrick AP, Fraser S, Choo WK, Padfield G, Rushworth G, Bloe C, Forsyth P, Cross SJ, Leslie SJ, Phan TT, Dewhurst M, Lee D, Williams D, James S, Thornley A, de Belder M, Linker N, Turley A, Campbell NG, Cantor E, Sawhney V, Duncan ER, Demartini C, Baker V, Diab IG, Dhinoja M, Earley MJ, Sporton S, Davies LC, Schilling RJ, Pettit SJ, Randles DA, Shaw M, Hawkins NM, Wright DJ, Lambiase PD, Barr C, Knops R, Neuzil P, Theuns D, Johansen JB, Hood M, Pederson S, Reeve HL, Boersma L. ABSTRACTS FOR ORAL PRESENTATION, SESSION 3, HRC 2013. Europace 2013. [DOI: 10.1093/europace/eut316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Fabritz L, Fortmuller L, Vloumidi E, Yue TY, Syeda F, Kirchhof P, Leube R, Krusche C, Chin SH, Winter J, Brack KE, Ng GA, Ng FS, Holzem KM, Koppel AC, Janks D, Wit AL, Peters NS, Efimov IR, Chowdhury RA, El-Harasis MA, Dupont E, Terracciano CMN, Peters NS, Mellor GJ, Raju H, de Noronha SV, Papadakis M, Sharma S, Behr ER, Sheppard MN, Jamil-Copley S, Bai W, Ariff B, Lim PB, Koa-Wing M, Kyriacou A, Hayat S, Sohaib A, Qureshi N, Sandler B, O'Regan D, Whinnett Z, Davies W, Rueckert D, Kanagaratnam P, Peters N, Lambiase PD, Chow AW, Lowe MD, Segal OR, Ahsan S, de Bono J, Dhaliwal M, Mfuko C, Ng A, Sandilands A, Paisey J, Roberts P, Morgan JM, McCready J, Yue A, Ullah W, Hunter R, Lovell M, Dhinoja M, Sporton S, Earley M, Schilling R, Ghosh J, Martin A, Keech A, Chan KH, Gomes S, Singarayar S, McGuire M, Lee G, Hunter R, Berriman T, Diab I, Kamdar R, Richmond L, Baker V, Goromonzi F, Sawhney V, Duncan E, Unsworth B, Mayet J, Abrams D, Dhinoja M, Sporton S, Earley M, Schilling RJ, Bowers RW, Mulholland V, Balasubramaniam RN, Paisey JR, Sopher SM, Chu GS, Chin SH, Winter J, Armstrong S, Masca N, Almeida TP, Brown PD, Sandilands AJ, Schlindwein FS, Ng GA. ABSTRACTS FOR ORAL PRESENTATION, SESSION 2, HRC 2013. Europace 2013. [DOI: 10.1093/europace/eut315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hunter RJ, Berriman TJ, Diab I, Kamdar R, Richmond L, Baker V, Goromonzi F, Duncan E, Sawhney V, Unsworth B, Mayet J, Dhinoja M, Earley MJ, Sporton S, Schilling RJ. 057 A randomised controlled trial of catheter ablation vs medical treatment of atrial fibrillation in heart failure (the CAMTAF trial). Heart 2012. [DOI: 10.1136/heartjnl-2012-301877b.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Campbell NG, Kaneko M, Shintani Y, Ikebe C, Narita T, Sawhney V, Tano N, Coppen SR, Yashiro K, Nourshargh S, Mathur A, Suzuki K. 119 Size-dependent retention of stem cells following intracoronary injection. Heart 2012. [DOI: 10.1136/heartjnl-2012-301877b.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sawhney V, Thomas G, Webster P, Schilling R. Resolution of Brugada-pattern ECG after withdrawal of the selective serotonin reuptake inhibitor paroxetine. Heart 2010; 96:1165-6. [PMID: 20478856 DOI: 10.1136/hrt.2009.184630] [Citation(s) in RCA: 6] [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] [Indexed: 11/03/2022] Open
Affiliation(s)
- V Sawhney
- Barts and the London NHS Trust, London, UK
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Goswami SK, Das T, Chattopadhyay R, Sawhney V, Kumar J, Chaudhury K, Chakravarty BN, Kabir SN. A randomized single-blind controlled trial of letrozole as a low-cost IVF protocol in women with poor ovarian response: a preliminary report. Hum Reprod 2004; 19:2031-5. [PMID: 15217999 DOI: 10.1093/humrep/deh359] [Citation(s) in RCA: 322] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Use of letrozole, a selective inhibitor of aromatase, reduces the gonadotrophin dose required to induce follicular maturation. We evaluated whether incorporation of letrozole could be an effective low-cost IVF protocol for poor responders. METHODS A randomized, controlled, single-blind trial was conducted in the Assisted Reproduction Unit, Institute of Reproductive Medicine, Kolkata, India. Thirty-eight women with a history of poor ovarian response to gonadotrophins were recruited. Thirteen women (Let-FSH group) received letrozole 2.5 mg daily from day 3-7, and recombinant FSH (rFSH) 75 IU/day on days 3 and 8; and 25 women (GnRH-ag-FSH group) underwent long GnRH agonist protocol and stimulated with rFSH (300-450 IU/day). Ovulation was triggered by 10,000 IU of HCG followed by IVF-embryo transfer. The main outcome measures were total dose of rFSH (IU/cycle), terminal estradiol (E2) (pg/ml), numbers of follicles, oocytes retrieved and transferable embryo, endometrial thickness (mm), and pregnancy rate. RESULTS Compared with the GnRH-ag-FSH group (2865 +/- 228 IU), the Let-FSH group (150 +/- 0 IU) received a significantly (P < 0.001) lower total dose of FSH. Except for terminal E2, which was significantly higher (P < 0.001) in the GnRH-ag-FSH group (380 +/- 46 pg/ml) than the Let-FSH group (227 +/- 45 pg/ml), the treatment outcomes in all other respects, including pregnancy rate, were statistically comparable. CONCLUSIONS Adjunctive use of letrozole may form an effective means of low-cost IVF protocol in poorly responding women.
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Affiliation(s)
- S K Goswami
- Institute of Reproductive Medicine, Salt Lake, Kolkata 700091, India
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Sawhney V, Nicholas DJD. Sulphide-linked Nitrite Reductase from Thiobacillus denitrificans with Cytochrome Oxidase Activity: Purification and Properties. ACTA ACUST UNITED AC 1978. [DOI: 10.1099/00221287-106-1-119] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Sawhney V. Regulation of NADH-linked nitrate reductase by NAD+ and 5′-AMP in Thibacillus denitrificans. FEMS Microbiol Lett 1978. [DOI: 10.1016/0378-1097(78)90132-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Mittal OP, Sawhney V. XO type of sex mechanism in earwigs (Dermaptera). Cell Mol Life Sci 1977. [DOI: 10.1007/bf01920146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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