1
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Boniface S, Critchlow N, Severi K, MacKintosh AM, Hooper L, Thomas C, Vohra J. Underage Adolescents' Reactions to Adverts for Beer and Spirit Brands and Associations with Higher Risk Drinking and Susceptibility to Drink: A Cross-Sectional Study in the UK. Alcohol Alcohol 2022; 57:347-356. [PMID: 33887764 PMCID: PMC9086752 DOI: 10.1093/alcalc/agab018] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/18/2021] [Accepted: 02/24/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS In the UK, adolescents under the minimum legal purchasing age (<18 years) are aware of a variety of alcohol marketing activities. It is therefore important to examine how such marketing appeals and how it might shape consumption. This study assessed the relationships between positive reactions to alcohol adverts and susceptibility to drink among never drinkers and higher-risk drinking among current drinkers. METHODS Online cross-sectional survey of 11-17 year olds (n = 2582) in the UK. Adolescents were shown three video alcohol adverts (Fosters Radler/Haig Club Clubman/Smirnoff). Reactions to each were measured by eight scale-items (e.g. 1 = makes [Brand] seem unappealing to 5 = makes [Brand] seem appealing), which were combined into a composite score (coded: positive versus other). Logistic regressions assessed associations between overall positive advert reactions and drinking behaviours. RESULTS Half of adolescents had overall positive reactions to the Smirnoff (52%) and Fosters (53%) adverts, and a third (34%) had a positive reaction to the Haig Club advert. Across all three adverts, positive reactions were associated with ~1.5 times increased odds of being susceptible to drink among never drinkers. Among current drinkers, positive reactions to the Foster's Radler and Haig Club adverts were associated with around 1.4 times increased odds of being a higher-risk drinker. CONCLUSIONS These alcohol advertisements commonly appealed to underage adolescents, and these reactions were associated with susceptibility among never drinkers and higher-risk consumption among current drinkers. Regulatory consideration should be given to what messages are permitted in alcohol advertising, including international alternatives (e.g. only factual information).
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Affiliation(s)
- S Boniface
- Institute of Alcohol Studies, Alliance House, 12 Caxton Street, London SW1H 0QS, UK
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - N Critchlow
- Institute for Social Marketing and Health, University of Stirling, Stirling FK9 4LA, UK
- Cancer Policy Research Centre, Cancer Research UK, 2 Redman Place, London E20 1JQ, UK
| | - K Severi
- Institute of Alcohol Studies, Alliance House, 12 Caxton Street, London SW1H 0QS, UK
| | - A M MacKintosh
- Institute for Social Marketing and Health, University of Stirling, Stirling FK9 4LA, UK
| | - L Hooper
- Cancer Policy Research Centre, Cancer Research UK, 2 Redman Place, London E20 1JQ, UK
| | - C Thomas
- Cancer Policy Research Centre, Cancer Research UK, 2 Redman Place, London E20 1JQ, UK
| | - J Vohra
- Cancer Policy Research Centre, Cancer Research UK, 2 Redman Place, London E20 1JQ, UK
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Do J, Yeates L, Butters A, Sarina T, Nowak N, Burns C, Connell V, Hunt L, Berkman J, Ingrey A, Kevin L, Thompson T, Macciocca I, Kawa J, McTaggart D, Zentner D, Pflaumer A, Ogden K, Smith J, Turner C, Ronan A, Davis A, Weintraub R, Vohra J, Winship I, McGaughran J, Atherton J, Semsarian C, Ingles J. 591 The Australian Genetic Heart Disease Registry: 13 Years on. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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3
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Rosenberg G, Thomas C, Hooper L, Vohra J. Building a Weight of Evidence to Prevent Cancer in Later Life. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.52700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Obesity is the largest preventable risk factor for cancer in the UK after smoking. Being overweight as an adult is linked to 13 types of cancer, and overweight children are more likely to become overweight adults. Routine data shows that around one in three children leave primary school in the UK (aged 12) overweight or obese, with the children from the most deprived communities twice as likely to be so. Cancer Research UK is campaigning for restrictions on the marketing of foods high in salt sugar and fat (HFSS foods) to children as part of a comprehensive population level strategy to prevent obesity-related cancers in the future. Aim: To undertake a mixed methods program of research aimed at building a body of evidence to directly inform policy to address childhood obesity. Methods: Individual studies included: a national cross-sectional survey to investigate obesity and cancer awareness in the UK adult population; a modeling study to predict future obesity-related cancer cases; and qualitative and quantitative studies to explore obesity-linked behaviors and exposure to HFSS marketing in children. A narrative synthesis of results from individual studies was conducted to identify key themes and develop recommendations for policy. Results: Cancer was not at the forefront of people's minds when thinking about obesity, with only 26% of UK adults reporting (unprompted) awareness of the link. However, results from modeling identified that the projected impact of obesity on cancer is high: if current trends continue it will lead to a further 670,000 cases in the UK over the next 20 years. Qualitative research identified a high awareness of junk food marketing in children aged 8-19. This influenced their behavior using a variety of persuasive marketing techniques, including catchy slogans and jingles, celebrity endorsements or by referencing youth culture. Logistic regression modeling associated commercial TV screen time with an increased risk of high junk food consumption (OR 1.8, P = 0.002). Furthermore, recalling one extra broadcast advert predicted a significant increase in HFSS consumption, approximately 18,000 extra calories/person/year. Conclusion: These linked studies have informed Cancer Research UK's campaign on obesity, and results have been used to inform work with the media, coalition building and influencing. Findings that HFSS food marketing influenced children's consumption behaviors were published on the charity's lobbying day in parliament where the research was discussed with almost 170 members of parliament. To achieve further HFSS marketing restrictions, research evidence is essential to making the case for policy change and this approach from a large UK cancer charity could inform similar efforts in other countries.
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Ramchand J, Wallis M, Farouque O, Trainer A, Macciocca I, Lynch E, Martyn M, Phelan D, Chong B, Zentner D, Vohra J, James P, Hare D. A Prospective Evaluation of Whole-Exome Sequencing in Idiopathic Dilated Cardiomyopathy and Related Phenotypes. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.016] [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: 10/28/2022]
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5
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Fogwill CJ, Turney CSM, Golledge NR, Etheridge DM, Rubino M, Thornton DP, Baker A, Woodward J, Winter K, van Ommen TD, Moy AD, Curran MAJ, Davies SM, Weber ME, Bird MI, Munksgaard NC, Menviel L, Rootes CM, Ellis B, Millman H, Vohra J, Rivera A, Cooper A. Antarctic ice sheet discharge driven by atmosphere-ocean feedbacks at the Last Glacial Termination. Sci Rep 2017; 7:39979. [PMID: 28054598 PMCID: PMC5215443 DOI: 10.1038/srep39979] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 11/29/2016] [Indexed: 11/17/2022] Open
Abstract
Reconstructing the dynamic response of the Antarctic ice sheets to warming during the Last Glacial Termination (LGT; 18,000–11,650 yrs ago) allows us to disentangle ice-climate feedbacks that are key to improving future projections. Whilst the sequence of events during this period is reasonably well-known, relatively poor chronological control has precluded precise alignment of ice, atmospheric and marine records, making it difficult to assess relationships between Antarctic ice-sheet (AIS) dynamics, climate change and sea level. Here we present results from a highly-resolved ‘horizontal ice core’ from the Weddell Sea Embayment, which records millennial-scale AIS dynamics across this extensive region. Counterintuitively, we find AIS mass-loss across the full duration of the Antarctic Cold Reversal (ACR; 14,600–12,700 yrs ago), with stabilisation during the subsequent millennia of atmospheric warming. Earth-system and ice-sheet modelling suggests these contrasting trends were likely Antarctic-wide, sustained by feedbacks amplified by the delivery of Circumpolar Deep Water onto the continental shelf. Given the anti-phase relationship between inter-hemispheric climate trends across the LGT our findings demonstrate that Southern Ocean-AIS feedbacks were controlled by global atmospheric teleconnections. With increasing stratification of the Southern Ocean and intensification of mid-latitude westerly winds today, such teleconnections could amplify AIS mass loss and accelerate global sea-level rise.
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Affiliation(s)
- C J Fogwill
- PANGEA Research Centre, University of New South Wales, 2052, Australia.,Climate Change Research Centre, School of Biological Earth and Environmental Sciences, University of New South Wales, 2052, Australia
| | - C S M Turney
- PANGEA Research Centre, University of New South Wales, 2052, Australia.,Climate Change Research Centre, School of Biological Earth and Environmental Sciences, University of New South Wales, 2052, Australia
| | - N R Golledge
- Antarctic Research Centre, Victoria University of Wellington, Wellington 6140, New Zealand.,GNS Science, Avalon, Lower Hutt, New Zealand
| | - D M Etheridge
- CSIRO Climate Science Centre, Oceans and Atmosphere, Aspendale, Victoria, 3195 Australia
| | - M Rubino
- CSIRO Climate Science Centre, Oceans and Atmosphere, Aspendale, Victoria, 3195 Australia.,Dipartimento di Matematica e Fisica, Università della Campania - Luigi Vanvitelli, viale Lincoln, 5-81100 Caserta, Italy
| | - D P Thornton
- CSIRO Climate Science Centre, Oceans and Atmosphere, Aspendale, Victoria, 3195 Australia
| | - A Baker
- PANGEA Research Centre, University of New South Wales, 2052, Australia
| | - J Woodward
- Department of Geography, Faculty of Engineering and Environment, Northumbria University, Newcastle upon Tyne, NE1 8ST, United Kingdom
| | - K Winter
- Department of Geography, Faculty of Engineering and Environment, Northumbria University, Newcastle upon Tyne, NE1 8ST, United Kingdom
| | - T D van Ommen
- Australian Antarctic Division, 203 Channel Highway, Kingston, Tasmania 7050, Australia.,Antarctic Climate &Ecosystems Cooperative Research Centre, University of Tasmania, Private Bag 80, Hobart, Tasmania 7001, Australia
| | - A D Moy
- Australian Antarctic Division, 203 Channel Highway, Kingston, Tasmania 7050, Australia.,Antarctic Climate &Ecosystems Cooperative Research Centre, University of Tasmania, Private Bag 80, Hobart, Tasmania 7001, Australia
| | - M A J Curran
- Australian Antarctic Division, 203 Channel Highway, Kingston, Tasmania 7050, Australia.,Antarctic Climate &Ecosystems Cooperative Research Centre, University of Tasmania, Private Bag 80, Hobart, Tasmania 7001, Australia
| | - S M Davies
- Department of Geography, College of Science, Swansea University, Swansea, United Kingdom
| | - M E Weber
- Department of Earth Sciences, University of Cambridge, Drummond Street, Cambridge, United Kingdom.,Steinmann Institute, University of Bonn, Poppelsdorfer Schloss, Bonn, Germany
| | - M I Bird
- Centre for Tropical Environmental and Sustainability Science, College of Science and Engineering, James Cook University, Cairns, Australia
| | - N C Munksgaard
- Centre for Tropical Environmental and Sustainability Science, College of Science and Engineering, James Cook University, Cairns, Australia.,Research Institute for the Environment and Livelihoods, Charles Darwin University, Australia
| | - L Menviel
- PANGEA Research Centre, University of New South Wales, 2052, Australia.,Climate Change Research Centre, School of Biological Earth and Environmental Sciences, University of New South Wales, 2052, Australia
| | - C M Rootes
- Department of Geography, University of Sheffield, United Kingdom
| | - B Ellis
- Research School of Earth Sciences, Australian National University, Canberra, Australia
| | - H Millman
- Climate Change Research Centre, School of Biological Earth and Environmental Sciences, University of New South Wales, 2052, Australia
| | - J Vohra
- PANGEA Research Centre, University of New South Wales, 2052, Australia.,Climate Change Research Centre, School of Biological Earth and Environmental Sciences, University of New South Wales, 2052, Australia
| | - A Rivera
- Glaciology and Climate Change Laboratory, Centro de Estudios Cientficos, Valdivia, Arturo Prat 514, Chile.,Department of Geography, University of Chile, Santiago, Chile
| | - A Cooper
- Australian Centre for Ancient DNA, University of Adelaide, 5005, Australia
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Zentner D, Thompson T, Taylor J, Bogwitz M, Trainer A, Vohra J, Winship I, James P. Predicting Yield From Cardiac Genetic Testing–A Clinically Achievable Way to Achieve Equity and Triage Appropriately. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.611] [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: 11/24/2022]
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7
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Yao J, Peters S, Zentner D, Vohra J. Inappropriate Sinus Tachycardia Presenting with Palpitations and Syncope During Pregnancy. Successful Treatment with Metoprolol. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.285] [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] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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8
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Huq AJ, Pertile MD, Davis AM, Landon H, James PA, Kline CF, Vohra J, Mohler PJ, Delatycki MB. A Novel Mechanism for Human Cardiac Ankyrin-B Syndrome due to Reciprocal Chromosomal Translocation. Heart Lung Circ 2016; 26:612-618. [PMID: 27916589 DOI: 10.1016/j.hlc.2016.09.013] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 09/23/2016] [Accepted: 09/27/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cardiac rhythm abnormalities are a leading cause of morbidity and mortality in developed countries. Loss-of-function variants in the ANK2 gene can cause a variety of cardiac rhythm abnormalities including sinus node dysfunction, atrial fibrillation and ventricular arrhythmias (called the "ankyrin-B syndrome"). ANK2 encodes ankyrin-B, a molecule critical for the membrane targeting of key cardiac ion channels, transporters, and signalling proteins. METHODS AND RESULTS Here, we describe a family with a reciprocal chromosomal translocation between chromosomes 4q25 and 9q26 that transects the ANK2 gene on chromosome 4 resulting in loss-of-function of ankyrin-B. Select family members with ankyrin-B haploinsufficiency due to the translocation displayed clinical features of ankyrin-B syndrome. Furthermore, evaluation of primary lymphoblasts from a carrier of the translocation showed altered levels of ankyrin-B as well as a reduced expression of downstream ankyrin-binding partners. CONCLUSIONS Thus, our data conclude that, similar to previously described ANK2 loss-of-function "point mutations", large chromosomal translocations resulting in ANK2 haploinsufficiency are sufficient to cause the human cardiac ankyrin-B syndrome. The unexpected ascertainment of ANK2 dysfunction via the discovery of a chromosomal translocation in this family, the determination of the familial phenotype, as well as the complexities in formulating screening and treatment strategies are discussed.
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Affiliation(s)
- A J Huq
- Department of Clinical Genetics, Austin Hospital, Melbourne, Vic, Australia; Department of Genetic Medicine, Royal Melbourne Hospital, Melbourne, Vic, Australia.
| | - M D Pertile
- Victorian Clinical Genetics Services, Melbourne, Vic, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Vic, Australia
| | - A M Davis
- Department of Cardiology, Royal Children's Hospital, Melbourne, Vic, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Vic, Australia; Murdoch Childrens Research Institute, Melbourne, Vic, Australia
| | - H Landon
- Dorothy M. Davis Heart and Lung Research Institute; Departments of Physiology & Cell Biology and Internal Medicine; Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - P A James
- Department of Genetic Medicine, Royal Melbourne Hospital, Melbourne, Vic, Australia; Department of Pathology, University of Melbourne, Melbourne, Vic, Australia
| | - C F Kline
- Dorothy M. Davis Heart and Lung Research Institute; Departments of Physiology & Cell Biology and Internal Medicine; Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - J Vohra
- Department of Genetic Medicine, Royal Melbourne Hospital, Melbourne, Vic, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - P J Mohler
- Dorothy M. Davis Heart and Lung Research Institute; Departments of Physiology & Cell Biology and Internal Medicine; Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - M B Delatycki
- Department of Clinical Genetics, Austin Hospital, Melbourne, Vic, Australia; Victorian Clinical Genetics Services, Melbourne, Vic, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Vic, Australia; Bruce Lefroy Centre, Murdoch Childrens Research Institute, Melbourne, Vic, Australia
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9
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Blusztein D, Jayadeva P, Thompson T, Zentner D, Trainer A, James P, Winship I, Kalman J, Vohra J. Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC): Genotype and Phenotype Analysis of a Cohort of Probands. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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10
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Peters S, Vohra J, Sparks P. Short-Coupled Polymorphic Ventricular Tachycardia/Ventricular Fibrillation in Left Ventricular Non-Compaction Cardiomyopathy. Complicated by Quinidine Associated Thrombocytopenia and Successfully Treated with Disopyramide. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.318] [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: 10/21/2022]
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11
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Zentner D, Thompson T, Taylor J, Bogwitz M, Macciocca I, Trainer A, Winship I, Vohra J, James P. The Advent of Gene Panel Testing: Has It Changed the Outcome of Mutation Detection Gene Testing in a Cardiac Genetics Clinic? Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.669] [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: 11/16/2022]
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13
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Nalliah C, Mahajan R, Haqqani H, Lau D, Vohra J, Morton J, Kalman J, Sanders P. Mitral valve prolapse and sudden death: a systematic review. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.163] [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: 11/26/2022]
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14
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Wong M, Kalman J, Pedagogos E, Toussaint N, Vohra J, Sparks P, Sanders P, Kistler P, Halloran K, Lee G, Joseph S, Morton J. Long term prevalence and follow up of atrial fibrillation in chronic kidney disease. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.636] [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: 10/23/2022]
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15
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Wong M, Kalman J, Pedagogos E, Toussaint N, Vohra J, Sparks P, Sanders P, Kistler P, Halloran K, Lee G, Joseph S, Morton J. Autonomic tone and ventricular repolarisation characteristics in renal transplant recipients. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.614] [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: 10/23/2022]
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Wong M, Kalman J, Pedagogos E, Toussaint N, Vohra J, Sparks P, Sanders P, Kistler P, Halloran K, Lee G, Joseph S, Morton J. Long-term follow up of arrhythmic events in chronic kidney disease. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Pang B, Haqqani H, Kalman J, Mond H, Wong M, Vohra J, Morton J. Implications for Cardiac Resynchronisation Therapy: An ECG Algorithm to Predict the Latest Site of Left Ventricular Activation in Cardiomyopathy Patients With Left Bundle Branch Block. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.269] [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: 11/25/2022]
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18
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Ingles J, Sarina T, Evans A, Yeates L, Kawa J, Hunt L, Connell V, Gray B, Armstrong C, Ogden K, Davis A, Weintraub R, Vohra J, McTaggart D, Winship I, McGaughran J, Atherton J, Semsarian C. The National Genetic Heart Disease Registry: An Update. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.667] [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: 10/28/2022]
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Ingles J, Yeates L, Kawa J, Armstrong C, Thompson T, Connell V, DeSilva D, Davis A, Weintraub R, Vohra J, Winship I, McTaggart D, McGaughran J, Atherton J, Semsarian C. The Australian National Genetic Heart Disease Registry: An Update. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.05.544] [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: 10/18/2022]
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20
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Medi C, Sparks P, Kistler P, Morton J, Teh A, Lee G, Halloran K, Vohra J, Kalman J. Cerebral Microembolism is Seen in Association with Cognitive Decline in Patients Post-atrial Fibrillation Ablation. Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.06.899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Teh A, Kalman J, Kistler P, Medi C, Lee G, Sutherland F, Morton J, Vohra J, Sparks P. What is the Significance of Complex Fractionated Signals in the Coronary Sinus? Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.06.889] [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: 10/19/2022]
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22
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Teh A, Kistler P, Lee G, Medi C, Sparks P, Morton J, Vohra J, Kalman J. What is the Relationship Between Complex Fractionated Electrograms and Atrial Low Voltage Zones During Atrial Fibrillation and Sinus Rhythm? Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.06.888] [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: 10/19/2022]
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23
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Lee G, Sparks P, Morton J, Kistler P, Vohra J, Medi C, Rosso R, Teh A, Halloran K, Kalman J. The Safety and Utility of Routine General Anesthesia and Trans-esophageal Echocardiography in AF Ablation. Experience from 500 Consecutive Procedures. Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.06.933] [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: 11/25/2022]
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Medi C, Sparks P, Kistler P, Morton J, Teh A, Lee G, Halloran K, Vohra J, Kalman J. Abnormalities in Neurocognitive Function after Atrial Fibrillation Ablation. Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.06.892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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Lee G, Sparks P, Morton J, Kistler P, Vohra J, Medi C, Rosso R, Teh A, Halloran K, Kalman J. Very Low Risk of Major Complications Associated with Antral Pulmonary Vein Isolation for Atrial Fibrillation. Results of 500 Consecutive Ablation Procedures in Young Patients with Low Prevalence of SHD from a Single Centre. Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.06.941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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26
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Teh A, Kistler P, Lee G, Medi C, Sparks P, Morton J, Vohra J, Kalman J. Electroanatomic Properties of the Pulmonary Veins in AF Patients: Slowed Conduction and Low Voltage as a Marker of Arrhythmogenicity. Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.06.870] [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: 10/19/2022]
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Teh A, Medi C, Sparks P, Kistler P, Lee G, Morton J, Vohra J, Halloran K, Kalman J. Long-term Outcome Following Ablation of Atrial Arrhythmias Occurring Late After Atrial Septal Defect Repair. High Incidence of Late Atrial Fibrillation. Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.06.919] [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: 11/26/2022]
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28
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Ingles J, Yeates L, Connell V, Thompson T, Cheng J, Macciocca I, McGaughran J, Davis A, Weintraub R, Vohra J, Winship I, Atherton J, Semsarian C. The National Genetic Heart Disease Registry: Progress to Date. Heart Lung Circ 2009. [DOI: 10.1016/j.hlc.2009.05.184] [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: 11/26/2022]
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Singh S, Singh A, Singh P, Gupta V, Kumar S, Vohra J. Sero-prevalence of paratuberculosis in young kids using ‘Bison type’, Mycobacterium avium subsp. paratuberculosis antigen in plate ELISA. Small Rumin Res 2007. [DOI: 10.1016/j.smallrumres.2005.11.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
PURPOSE Implantable cardioverters defibrillators (ICDs) are increasingly used in the management of life-threatening arrhythmias. Correct recognition of a treatable arrhythmia is crucial to this application. However, the computational power of microprocessors currently used in ICDs limits the range of traditional algorithms available for this application. METHODS Classification based on fuzzy inference systems (FIS) were trained to recognize different cardiac rhythms (AF, VF, SVT, VT) from the Ann Arbor Electrogram Library. The FIS used were designed using adaptive-network-based fuzzy inference methods to optimize the classification procedure. Only computational techniques suitable for ICD design were used. RESULTS After pretraining with the ANFIS correct rhythm classification was observed for the rhythms studied. CONCLUSION In this preliminary study, successful rhythm classification was demonstrated using fuzzy logic techniques. In view of the computational efficiency this may have application in ICD design.
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Affiliation(s)
- J Usher
- Department of Electronic Engineering, Biomedical Engineering, La Trobe University, Melbourne, Victoria, Australia
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Hua W, Vohra J, Mond H. Clinical use of nonthoracotomy cardioversion-defibrillation system. Chin Med J (Engl) 1998; 111:648-51. [PMID: 11245056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
OBJECTIVE To summarize our experience in 22 patients who had attempted nonthoracotomy implantable cardioverter-defibrillators (ICD) for malignant ventricular arrhythmias (VA). METHODS Indications for implantation were ventricular fibrillation (VF) in 17 patients and refractory ventricular tachycardia in 5. Thirteen patients of them had underlying ischaemic heart disease. Seven had dilated cardiomyopathy and two had arrhythmogenic right ventricular dysplasia. RESULTS 20 out of 22 patients were successfully implanted nonthoracotomic ICD with defibrillating threshold of 16.7 J. The mean hospital stay was 7.8 days. The complications included chest wall haematoma and ventricular lead dislodgment requiring repositioning. In the follow-up period of 10.1 +/- 8 months, 6 patients with VA were treated successfully by ICD. CONCLUSION Nonthoracotomy ICD is possible in a vast majority of patients (91%) and should be considered in all patients requiring ICD without concomitant surgery.
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Affiliation(s)
- W Hua
- Fu Wai Hospital, Peking Union Medical College, Beijing 100037, China
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32
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Abstract
BACKGROUND Inappropriate sinus tachycardia (IST) is a rare form of supraventricular arrhythmia. It can cause disabling symptoms and may be refractory to medical treatment. In symptomatic drug refractory patients, sinus node excision or total ablation of the sinus node with permanent pacemaker implantation was the only therapeutic option. Recently, radiofrequency (RF) modification of the sinus node has been reported to be an effective treatment for this condition. AIM To present our experience with sinus node modification using RF energy in the management of IST. METHODS Between 1989 to 1996 three patients (two females and one male), aged 28-36 years were diagnosed with symptomatic IST. All had failed multiple drugs and hence underwent sinus node modification using RF. In the first two patients, the site of RF application was guided by anatomical landmarks using fluoroscopy to localise the presumed most superior portion of the crista terminalis and also the earliest site of atrial activation. In the third patient, a 20 pole electrode catheter was used to map the crista terminalis and guide the ablation. Success was defined by 20-30% reduction in the heart rate with normal atrial activation sequence after ablation. RESULTS The three patients described here had IST by clinical, electrocardiographic and electrophysiological criteria and were refractory to multiple antiarrhythmic drugs. The number of RF applications were 11, 15, and three applied at the site of earliest atrial activation for the control of heart rates. Patient 3 had a early recurrence at one month and underwent repeat sinus node modification (five RF applications). All three patients who underwent RF modification of the sinus node had a successful outcome. The procedure was uncomplicated and the patients remain asymptomatic during follow up (20, 12 and three months) with satisfactory control of heart rate, although one patient requires atenolol which was previously ineffective. CONCLUSIONS RF modification of the sinus node is feasible and effective for IST, and should be the treatment of choice in patients refractory to medical therapy.
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Affiliation(s)
- S Jayaprakash
- Department of Cardiology, Royal Melbourne Hospital, Vic
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Affiliation(s)
- J Vohra
- Royal Melbourne Hospital, Victoria, Australia
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34
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Abstract
BACKGROUND Radiofrequency ablation (RFA) has been shown to be very effective in the treatment of supraventricular tachycardias and has replaced surgical ablation. Only a few reports of RFA for idiopathic ventricular tachycardia (VT) have appeared in the literature during the last two years. AIM This paper presents our experience with RFA for idiopathic VT in 19 patients. MATERIAL The age range of patients was 22-60, with a mean of 37.9 years. Twelve out of 19 were females, two patients had cardiac failure due to almost incessant VT while the rest had normal left ventricular function. Twelve patients had VT arising from the right ventricle (RV); of these, nine were from the outflow tract, two from the RV apex, and one from the mid-anterior RV. Seven patients had VT arising from the left ventricle (LV); of these, five were from the inferobasal portion of the septum and two were from the anterolateral area. METHODS In all patients the diagnostic study and therapeutic RFA were combined in a single procedure. Pacemapping was used to guide the site of RFA in patients with VT arising from the RV. Local activation time (LAT), Purkinje potentials (PP) and pacemapping were used to guide RFA in those patients with LV septal tachycardias. RESULTS A total of 21 RF procedures were performed in 19 patients and 15 out of 19 patients had successful VT ablation. Ten of the 12 patients with RV tachycardias and all five patients with LV septal (left axis, right bundle branch block) tachycardias were successfully ablated. One patient with mid anterior RV VT required two attempts for successful ablation. One patient with RV outflow tract (RVOT) VT could not be ablated despite two attempts. Two patients with LV tachycardias arising from the antero-lateral LV could also not be ablated. During a follow up period of two to 16 months none of the successful patients had recurrence of VT. The number of RF applications was one to 27, mean 10; fluoroscopy times were four to 75, mean 26.9 minutes. CONCLUSION Idiopathic VT frequently arises from the RVOT and inferobasal portion of the LV septum. These tachycardias can be diagnosed on clinical and ECG grounds. RFA for idiopathic VT arising from these areas has a high success rate and this mode of treatment should be considered as a nonpharmacological curative treatment for symptomatic patients.
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Affiliation(s)
- J Vohra
- Department of Cardiology, Royal Melbourne Hospital, Vic
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35
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Wong J, Vohra J, Chan W, Mond HG, Lichtenstein M, Kritharides L, Warren RJ. Assessment of left ventricular function after radiofrequency and direct current atrioventricular node ablation. Aust N Z J Med 1996; 26:82-8. [PMID: 8775533 DOI: 10.1111/j.1445-5994.1996.tb02911.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is limited information available regarding the effect of catheter ablation of the antioventricular (AV) junction on left ventricular (LV) function. Both deterioration and improvement in LV function have been reported following direct current (DC) ablation of the AV junction. The deterioration of LV function following DC ablation of the AV junction may be due to the accompanying barotrauma, DC arcing and direct coagulation, or even the effects of chronic ventricular pacing. If this deterioration of LV function was a result of the accompanying effects of DC shock, the use of radiofrequency ablation (RF) should not result in deterioration of LV function. AIM To study LV function before and after different methods of AV junction ablation and in patients with chronic ventricular pacing without AV junction ablation. MATERIAL This study assessed LV function in patients following RF ablation, low energy DC ablation of the AV junction and compared the results with our previously reported finding in patients who had AV junction ablation using high energy DC shock. A group of patients undergoing permanent single chamber ventricular pacemaker implantation without AV junction ablation were selected as controls. METHODS All patients were paced in the ventricle at 110 beats/minute during LV function assessment by radionuclide angiography. Global LV function and segmental wall motion abnormalities were assessed before, immediately following and three months after ablation. RESULTS In the high energy DC ablation group, a fall in global LV function (50 +/- 3.0% to 43 +/- 3.0%, p = 0.02) and impairment of segmental wall motion were detected. Low energy DC ablation resulted in segmental wall motion impairment similar to high energy DC but without affecting global ejection fraction (47.0% +/- 6.7 to 45.5% +/- 3.1, p > 0.05). Neither RF ablation (44.0% +/- 3.3 to 45.3% +/- 3.5, p > 0.05), nor chronic pacing (46.7% +/- 4.9 to 47.0% +/- 2.9 p > 0.05) had any effect on global or segmental LV function. CONCLUSIONS Low energy DC or RF ablation of the AV junction does not affect global LV ejection fraction. The deterioration of global LV function after high energy DC shock ablation appears to be related to the accompanying effects of DC energy and not to the effects of chronic ventricular pacing.
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Affiliation(s)
- J Wong
- Department of Cardiology, Royal Melbourne Hospital, Vic
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36
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Abstract
BACKGROUND Catheter ablation of the atrioventricular (AV) junction using stored direct current (DC) energy from a standard DC Cardioverter defibrillator was first reported in 1982. Since then many patients have been treated using this procedure for refractory supraventricular arrhythmias, usually atrial fibrillation and flutter. Undesirable thermal effects such as barotrauma and arcing are largely responsible for complications associated with the use of DC energy. This report details our experience of catheter ablation of the AV junction using radiofrequency (RF) energy in a series of 30 consecutive patients. METHODS RF ablations were performed using steerable Mansfield (Webster Laboratories) 4 mm tipped electrodes and locally assembled RF energy delivery system. RESULTS The procedure was successful in 27/30 (90%) patients using RF energy, while three patients required DC energy to achieve successful AV junction ablation. General anaesthesia was required in nine patients, six of whom required this for cardioversion to sinus rhythm so that an adequate His Bundle spike could be recorded and three for DC ablation. Dual chamber permanent pacemakers with automatic mode switching were implanted in four patients who had paroxysmal atrial fibrillation or flutter and the remainder had ventricular rate responsive pacemakers. CONCLUSIONS In patients with drug refractory paroxysmal atrial fibrillation and flutter and in patients with established atrial fibrillation where control of the ventricular rate is difficult, catheter ablation of the AV junction using RF energy is a safe and effective procedure with a high success rate.
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Affiliation(s)
- J Wong
- Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia
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37
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Sathe S, Sebastian M, Vohra J, Valentine P. Bail-out stenting for left main coronary artery occlusion following diagnostic angiography. Cathet Cardiovasc Diagn 1994; 31:70-2. [PMID: 8118861 DOI: 10.1002/ccd.1810310114] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We report a case of acute left main coronary artery occlusion treated with stenting of the left main artery. The patient had a severe ostial left main stenosis and after diagnostic coronary angiography developed a total occlusion of the left main artery with life threatening hemodynamic consequences. Stenting of the unprotected left main coronary artery was successfully performed as a salvage procedure.
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Affiliation(s)
- S Sathe
- Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia
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38
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Sathe S, Vohra J, Chan W, Wong J, Gerloff J, Riters A, Hall R, Hunt D. Radiofrequency catheter ablation for paroxysmal supraventricular tachycardia: a report of 135 procedures. Aust N Z J Med 1993; 23:317-24. [PMID: 8352714 DOI: 10.1111/j.1445-5994.1993.tb01748.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Paroxysmal Supraventricular Tachycardia (PSVT) is a common condition which until recently has been treated with anti-arrhythmic drugs or surgery. Radiofrequency (RF) catheter ablation is a new mode of treatment which provides a cure of this condition. AIMS To present our early experience of RF catheter ablation for PSVT. METHODS One hundred and thirty-five procedures were performed in 117 patients. The diagnostic study and therapeutic catheter ablation were performed as a combined electrophysiological procedure in 74 patients (63%). In 58 patients (50%), PSVT was due to Atrio-ventricular junctional (nodal) re-entrant tachycardia (AVJRT). Twenty-five of the 58 patients underwent a fast pathway ablation while 33 had ablation of their slow pathway. The mean number of radiofrequency pulses delivered was ten for a mean duration of 25 seconds. Radiofrequency ablation of accessory pathways was attempted in 58 patients; pathways were left-sided in 29 patients, postero-septal in 21, midseptal in five, Mahaim connection in two, antero-septal in one and right free wall in one patient. One patient with incessant automatic atrial tachycardia also underwent a successful RF ablation. RESULTS Using RF ablation cure of PSVT was achieved in 90% of patients. Cure of AVJRT was achieved in 95% (55/58) of patients using either fast or slow pathway ablation. Only one patient required permanent pacemaker implantation for Mobitz type I AV block following fast pathway ablation. The overall success rate for ablation of accessory pathways was 85%. There is an operator learning curve for this procedure suggested by the fact that the success rate for accessory pathway ablation at first attempt was 63% in the first 29 patients and 93% in the remaining 29. There was no significant morbidity or mortality during or after the procedure. In a mean follow-up of nine months in the patients with successful ablation only two patients with AVJRT had a recurrence of documented PSVT. Both these patients had successful repeat RF ablation. Catheter ablation using radiofrequency energy is an effective and safe therapeutic option for patients with symptomatic PSVT.
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Affiliation(s)
- S Sathe
- Department of Cardiology, Royal Melbourne Hospital, Vic., Australia
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39
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Abstract
Mitral valve prolapse (MVP) is a common disorder that, in general, has a good prognosis. Rare occasions of sudden death have been reported in patients with MVP and it is presumed that the basis of sudden death is arrhythmic. We report seven patients with moderate to severe MVP and malignant ventricular arrhythmias. All patients had trivial to mild mitral regurgitation and normal left ventricular function. Three patients presented with syncope, two with out-of-hospital cardiac arrest, and three with recurrent palpitations and presyncope. In a mean follow-up period of 2.5 years (range 6 months to 5 years), two patients died suddenly despite successful control of their nonsustained ventricular tachycardia (VT) with sotalol as shown by ambulatory monitoring. Two patients, who had sustained VT despite antiarrhythmic drug therapy, had mitral valve surgery, however, monomorphic VT could be induced in both even after surgery. The arrhythmias in the remaining three patients are controlled on antiarrhythmic drugs. We conclude that a selected subset of patients with MVP, malignant ventricular arrhythmias, and mild mitral regurgitation are at risk of sudden death. Syncope, inferolateral repolarization changes, complex ventricular ectopy, and a markedly myxomatous valve may be pointers to higher risk of sudden death and mitral valve surgery may not provide control of ventricular arrhythmias.
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Affiliation(s)
- J Vohra
- Department of Cardiology, Royal Melbourne Hospital, Victoria, Australia
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Vohra J, Sathe S, Tatoulis J, Fenelon T, Chan W, Hamer A, Kertes P, Graham D, Riter A, Hunt D. Clinical experience with surgery for paroxysmal supraventricular tachycardia: a report of 103 cases. Aust N Z J Med 1992; 22:134-8. [PMID: 1530534 DOI: 10.1111/j.1445-5994.1992.tb02792.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
One-hundred-and-three patients underwent surgery for paroxysmal supraventricular tachycardia (PSVT). In eighty-three patients (81%), PSVT was due to an accessory atrioventricular pathway (Group I) and in 20 (19%) to Atrioventricular Junctional (AV nodal) Reentrant Tachycardia (AVJRT:Group II). Initial surgery successfully divided 77 of 83 accessory pathways, including 58 of 60 left free wall pathways, 12 of 15 posteroseptal pathways, six of seven right free wall pathways and one anteroseptal pathway. Twenty patients had successful surgery for AVJRT. Surgery was performed with low morbidity and no early or late mortality in either group. One patient in each group required permanent pacemaker implantation. Immediate (within one week) postoperative electrophysiological study using epicardial wires was performed in 96% of patients and repeat electrophysiological study six months later was possible in 65/103 (63%) patients. Patients with surgery for accessory pathways were followed-up for a mean 34 +/- 23 months, while those with surgery for AVJRT for a mean of 13 +/- seven months. No patient with successful surgery has had a clinical recurrence of PSVT. Thus the results indicate that surgery is a safe and curative therapy for patients with PSVT.
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Affiliation(s)
- J Vohra
- Department of Cardiology, Royal Melbourne Hospital, Vic
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41
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Kritharides L, Vohra J. Late development of conduction block over the Mahaim fibers after electrical atrioventricular junction ablation for Mahaim fiber tachycardia. Pacing Clin Electrophysiol 1992; 15:256-61. [PMID: 1372718 DOI: 10.1111/j.1540-8159.1992.tb06493.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A patient suffering from so called "Mahaim fiber" tachycardia is presented who developed complete heart block over Mahaim fibers after 18 months of AV junction ablation. Antegrade conduction along the Mahaim fiber was intact immediately after the procedure. This finding has not been previously described and suggests that permanent pacemaker implantation is mandatory in such patients.
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Affiliation(s)
- L Kritharides
- Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia
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42
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Abstract
OBJECTIVE To review poisoning with tricyclic antidepressants. DATA SOURCE English language literature search using Australian Medlars Service (1977-1989), manual search of journals and review of bibliographies in identified articles. STUDY SELECTION Approximately 250 articles, abstracts and book chapters were selected for analysis. DATA EXTRACTION The literature was reviewed and 93 articles were selected as representative of important advances. DATA SYNTHESIS The major features of overdose are neurological, cardiac, respiratory and anticholinergic. Life-threatening complications develop within six hours of overdose or not at all. All patients seen within six hours of overdose should have their stomachs emptied. All patients should receive activated charcoal. Coma, convulsions, respiratory depression and hypotension are treated with standard resuscitation techniques and drugs. Treat patients with significant cardiotoxicity or cardiac arrest with alkalinisation by sodium bicarbonate or hyperventilation, aiming for an arterial pH of 7.45-7.55. Lignocaine is used for ventricular arrhythmias. Other antiarrhythmic drugs are contraindicated (Class 1A, Class 1C), potentially lethal (Class II), of no benefit (phenytoin) or of unproven efficacy (Class III and Class IV). Physostigmine has no role at all. Haemodialysis and haemoperfusion are of no benefit. CONCLUSION The death rate of those who reach hospital is 2%-3%. Most of these deaths are cardiac in origin, and are caused by direct depression of myocardial function rather than cardiac arrhythmias.
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Affiliation(s)
- L J Dziukas
- Emergency Department, Alfred Hospital, Prahran, VIC
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43
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Abstract
Electrical ablation of a posteroseptal accessory pathway by delivery of direct current electrical energy at the coronary sinus ostium was attempted in six patients. As a result of 12 procedures in these six patients, the posteroseptal accessory pathway was successfully ablated in one patient. Retrograde conduction only was affected in a further three patients, abolishing paroxysmal supraventricular tachycardia in two and reducing the tachycardia rate in one. One of the six patients developed coronary sinus perforation requiring prompt pericardial aspiration. The procedure is complicated, time consuming, of limited efficacy and coronary sinus perforation is a significant risk. Surgery remains the preferred option as a curative procedure for arrhythmias due to posteroseptal accessory pathway.
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Affiliation(s)
- J Vohra
- Department of Cardiology, Royal Melbourne Hospital, Vic., Australia
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Vohra J, Plowright R. An appraisal of cardiovascular standards for Australian civilian flying licences. Aust N Z J Med 1989; 19:76-82. [PMID: 2669712 DOI: 10.1111/j.1445-5994.1989.tb01683.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This paper summarises recommendations drawn up at a meeting of a group of Cardiologists and Aviation Medical personnel to review cardiovascular standards for Australian Civil Flying Licences. Major recommendations were in the field of ischemic heart disease which remains the commonest cause of disqualification. The panel recommended consideration of coronary risk factors and increased attention to the high risk group as a preventive measure for loss of licence. Licensing, with appropriate safeguards and continued supervision, was considered permissible in carefully selected subjects with ischemic heart disease. Guidelines were also drawn up for various licence categories for subjects with valvular heart disease, cardiac arrhythmias, implanted pacemakers, cardiomyopathy and hypertension.
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Affiliation(s)
- J Vohra
- Aviation Medicine Branch, Civil Aviation Authority, Canberra
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46
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47
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Kertes P, Mond H, Sloman G, Vohra J, Hunt D. Comparison of lead complications with polyurethane tined, silicone rubber tined, and wedge tip leads: clinical experience with 822 ventricular endocardial lads. Pacing Clin Electrophysiol 1983; 6:957-62. [PMID: 6195617 DOI: 10.1111/j.1540-8159.1983.tb04419.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Lead-related complications have been prospectively studied for 602 unipolar tined endocardial ventricular pacemaker leads implanted over a five-year period. No differences were noted in overall complication rates between 238 polyurethane insulated leads (4.2%) and 364 silicone rubber insulated leads (3.6%). Comparing the total series of 602 tined leads to a retrospective survey of 220 wedge tip leads, a marked reduction in dislodgements (0.3% vs. 7.7%, P less than 0.001) and reoperations (2.0% vs 15.0%, P less than 0.001) was found using tined leads. We conclude that tined ventricular leads are far superior to wedge tip leads with respect to lead complications.
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48
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Abstract
Nine patients resuscitated from life-threatening ventricular arrhythmias (VA) within 3 months of an acute myocardial infarction (AMI) underwent electrophysiologic studies (EPS) with clinical follow-up for at least 12 months. Neither reinfarction, drug therapy, nor electrolyte imbalance was a precipitating factor. VA was induced by ventricular pacing in six of nine patients. Five patients were prescribed empiric drug therapy, while the four other patients had repeated EPS to select optimal drug therapy. One patient remained unstable and died of VA in the hospital. No patient was discharged and successfully maintained on a drug known to prevent induction of VA, yet only two patients (25%) had a further recurrence of VA, one fatal. Our findings suggested that either drug therapy that is determined empirically or found not to suppress the induction of VA during EPS can be associated with a successful outcome in some of these patients, or the natural history of VA after myocardial infarction is that they are self-limiting in the absence of a new ischemic event.
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49
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Abstract
Seventy patients surviving a myocardial infarction complicated by heart failure or arrhythmias, or both, were studied 7 to 20 days after the infarction. Twenty-four hour electrocardiographic ambulatory monitoring and intracardiac electrophysiologic studies were performed in each patient. Electrophysiologic studies included introduction of single right ventricular premature stimuli during sinus rhythm (70 patients), atrial pacing (35 patients) and ventricular pacing (70 patients) at a stimulating voltage of 2 V, with the use of higher stimulating voltages (up to 10 V), and double right ventricular premature stimuli in 33 patients and pacing at a second right ventricular site in 50 patients. A repetitive response was defined as two or more spontaneous ventricular depolarizations in response to the premature stimuli, with His bundle reentry and aberrant conduction of supraventricular impulses excluded by a His bundle recording. Repetitive responses were initiated in 20 patients, and 12 patients had responses that were either sustained ventricular tachycardia or self-terminating ventricular tachycardia of more than five complexes in duration. The finding of a repetitive response was not related to the occurrence of complex ventricular arrhythmias during ambulatory monitoring or in the coronary care unit. Five of the 12 patients with sustained or self-terminating responses of more than five complexes died during the 12 month follow-up period, 4 suddenly, and these responses were significantly associated with late sudden death (p less than 0.05), because only 1 of 25 patients with responses of fewer than five complexes or no response to maximal provocation died suddenly. It is concluded that induced responses of more than five complexes in duration may be an important indicator of a potentially reversible risk of sudden death after myocardial infarction.
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50
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Vohra J, Hamer A, Mond H, Sloman G, Hunt D. Patient initiated implantable pacemakers for paroxysmal supraventricular tachycardia. Aust N Z J Med 1981; 11:27-34. [PMID: 6941776 DOI: 10.1111/j.1445-5994.1981.tb03732.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Seven patients with recurrent paroxysmal supraventricular tachycardia (PSVT) resistant to standard drug therapy were treated with patient initiated implantable pacemakers. All patients had required frequent hospital admissions and cardioversions prior to pacemaker implantation. Two patients had Wolff-Parkinson-White (WPW) syndrome on their surface ECGs and five patients had no ECG evidence of preexcitation. All patients had detailed electrophysiological studies. Three patients had junctional tachycardia, one patients had reciprocating atrial tachycardia and in three, including one with normal surface ECG, retrogradely conducting accessory atrio-ventricular connections (AAVC) formed a part of the tachycardia circuit. Initiation and termination of tachycardia were re-checked at subsequent studies. On the basis of these studies, two patients with WPW syndrome had right ventricular endocardial leads and custom-built, magnet actuated pacemakers capable of delivering right ventricular coupled stimuli at fixed, present intervals of 200 and 400 ms. Both these pacemakers provided inconsistent reversions and proved unsatisfactory. In the remaining five patients, a unipolar tined J-shaped right atrial (RA) lead (Medtronic 6991) and a radiofrequency (RF) receiver (Medtronic 5998T) were implanted and enabled patients to overdrive ranged from 14 to 20 months. Several episodes of PSVT have been consistently reverted and none have required hospitalisation or cardio-version. Two patients had transient atrial fibrillation following the application of RF pacemaker. Three have required no antiarrhythmic drugs and in two the drug therapy has been greatly reduced and simplified. The Medtronic 6991 lead provided satisfactory RA stimulation without dislodgement. In carefully selected patients with PSVT, RF pacemakers provide a useful mode of treatment.
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