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Kawamura I, Batul SA, Vijayaraman P, Needelman B, Choy A, Martinez J, Tung R, Khera S, Kini A, Sharma S, Reddy VY, Koruth JS. ECG characteristics of "true" left bundle branch block: Insights from transcatheter aortic valve-related LBBB and His-Purkinje conduction system pacing-correctable LBBB. Heart Rhythm 2023; 20:1659-1666. [PMID: 37696443 DOI: 10.1016/j.hrthm.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/29/2023] [Accepted: 09/01/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Left bundle branch block (LBBB) pattern on the electrocardiogram includes patients with both complete conduction block in the His-Purkinje system as well as nonspecific left ventricular conduction delay without discrete block. OBJECTIVE The purpose of this study was to characterize electrocardiographic morphological features of LBBB patterns in patients with (1) LBBB after transcatheter aortic valve replacement (TAVR) and (2) LBBB correctable by conduction system pacing (CSP). METHODS Consecutive patients with post-TAVR (n = 123) or CSP-correctable LBBB (n = 58) from 2 centers were included in this retrospective evaluation. QRS durations as well as detailed morphological features, including notching and slurring, of QRS complexes in leads I, aVL, V1, V2, V5, and V6 and in all 3 inferior leads were recorded. RESULTS The mean age of the entire cohort was 78.3 ± 10.1 years, with 48% of the cohort being male (87/181). In the CSP-correctable group (n = 58), 14 (24.1%) underwent His-bundle pacing and 44 (75.9%) left bundle branch area pacing. A total of 17 of 181 (9.4%) of the combined cohort failed to completely meet the Strauss criteria. QRS morphology in lead V1/V2 was always either rS or QS, and there were no q/Q waves noted in lead V5/V6. Although dominant R waves were seen in leads I and aVL of 176 of 181 (97.2%), q/Q waves were present in only 21 of 181 (11.6%). Importantly, notched or slurred QRS complexes were identified in at least 1 lead of 4 leads I, aVL, V5, and V6 in 181 of 181 (100%). CONCLUSION Strauss criteria and QRS notching are highly prevalent in LBBB after TAVR and in LBBB correctable by CSP.
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Affiliation(s)
- Iwanari Kawamura
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Syeda Atiqa Batul
- Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, Wilkes-Barre, Pennsylvania
| | - Pugazhendhi Vijayaraman
- Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, Wilkes-Barre, Pennsylvania
| | - Brandon Needelman
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alex Choy
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jake Martinez
- The University of Arizona College of Medicine, Banner-University Medical Center, Phoenix, Arizona
| | - Roderick Tung
- The University of Arizona College of Medicine, Banner-University Medical Center, Phoenix, Arizona
| | - Sahil Khera
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Annapoorna Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samin Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Vivek Y Reddy
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jacob S Koruth
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York.
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Cano Ó, Navarrete-Navarro J, Zalavadia D, Jover P, Osca J, Bahadur R, Izquierdo M, Navarro J, Subzposh FA, Ayala HD, Martínez-Dolz L, Vijayaraman P, Batul SA. Acute performance of stylet driven leads for left bundle branch area pacing: A comparison with lumenless leads. Heart Rhythm O2 2023; 4:765-776. [PMID: 38204462 PMCID: PMC10774671 DOI: 10.1016/j.hroo.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
Background Lumenless leads (LLLs) are widely used for left bundle branch area pacing (LBBAP). Recently, stylet-driven leads (SDLs) have also been used for LBBAP. Objective The purpose of this study was to evaluate the acute performance of SDLs during LBBAP in comparison with LLLs. Methods Consecutive patients undergoing LBBAP for bradycardia or cardiac resynchronization therapy indications at 2 high-volume, early conduction system pacing adopters, tertiary centers were included from January 2019 to July 2023. Patients received either SDLs or LLLs at the discretion of the implanting physician. Acute performance and follow-up data of both lead types were evaluated. Results A total of 925 LBBAP implants were included, 655 using LLLs and 270 using SDLs. Overall, LBBAP acute success was significantly higher with LLLs than SDLs (95.3% vs 85.1%, respectively; P <.001) even after the learning curve (97% vs 86%; P = .013). LLLs were implanted in more mid-basal septal positions in comparison with SDLs, which tended to be implanted in more inferior and mid-apical septal positions. Acute lead-related complications were higher with SDLs than LLLs (15.9% vs 6.1%, respectively; P <.001) with 15 cases of lead damage during implant (4.4% vs 0.5%; P <.001) but decreased with acquired experience and were comparable in the last 100 patients included in each group. Lead implant and fluoroscopy times were shorter for SDLs, with lead dislodgment occurring in 0.9% with LLLs and 1.5% with SDLs (P = .489). Conclusion Acute lead performance proved to be different between LLLs and SDLs. A specific learning curve should be considered for SDLs even for implanters with extensive previous experience with LLLs.
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Affiliation(s)
- Óscar Cano
- Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
- Centro de Investigaciones Biomédicas en RED en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Javier Navarrete-Navarro
- Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | | | - Pablo Jover
- Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - Joaquín Osca
- Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
- Centro de Investigaciones Biomédicas en RED en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | - Maite Izquierdo
- Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
- Centro de Investigaciones Biomédicas en RED en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Josep Navarro
- Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Hebert D. Ayala
- Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - Luis Martínez-Dolz
- Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
- Centro de Investigaciones Biomédicas en RED en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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Batul SA, Vijayaraman P. Intracardiac Echocardiography Guidance for Left Bundle Pacing: An Expensive Adjunct or Necessity for Optimal Lead Placement? Circ Arrhythm Electrophysiol 2023; 16:e011931. [PMID: 36951088 PMCID: PMC10473020 DOI: 10.1161/circep.123.011931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Affiliation(s)
- Syeda Atiqa Batul
- Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, Wilkes-Barre, PA
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Batul SA, Mahajan A, Subzposh FA, Young W, Mathew A, Pokharel P, Storm R, Oren J, Vijayaraman P. Coronary Venous Visualization During Deep Septal Lead Placement: An Unexpected Finding. JACC Case Rep 2022; 4:101622. [PMID: 36684033 PMCID: PMC9847232 DOI: 10.1016/j.jaccas.2022.08.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/16/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022]
Abstract
Left bundle branch area pacing has emerged as a safe and feasible alternative to conventional pacing. Acute septal injury, septal perforation, and arteriovenous fistula are potential risks of deep septal implants. Contrast drainage through the lesser cardiac veins and subsequent filling of major epicardial vessels may be benign observations noted during forceful hand injection. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Syeda Atiqa Batul
- Address for correspondence: Dr Syeda Atiqa Batul, Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, 1000 E Mountain Boulevard, Wilkes-Barre, Pennsylvania 18711, USA. @BatulAtiqa
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Vijayaraman P, Batul SA. Left Bundle Branch Pacing for Cardiac Resynchronization: Are We Ready for a Leap of Faith? J Am Coll Cardiol 2022; 80:1217-1219. [PMID: 36137671 DOI: 10.1016/j.jacc.2022.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/05/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Pugazhendhi Vijayaraman
- Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, Wilkes-Barre, Pennsylvania, USA.
| | - Syeda Atiqa Batul
- Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, Wilkes-Barre, Pennsylvania, USA
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Vijayaraman P, Zalavadia D, Haseeb A, Dye C, Madan N, Skeete JR, Vipparthy SC, Young W, Ravi V, Rajakumar C, Pokharel P, Larsen T, Huang HD, Storm RH, Oren JW, Batul SA, Trohman RG, Subzposh FA, Sharma PS. Clinical outcomes of conduction system pacing compared to biventricular pacing in patients requiring cardiac resynchronization therapy. Heart Rhythm 2022; 19:1263-1271. [PMID: 35500791 DOI: 10.1016/j.hrthm.2022.04.023] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) with biventricular pacing (BVP) is well-established therapy in patients with reduced left ventricular ejection fraction (LVEF) and bundle branch block or indication for pacing. Conduction system pacing (CSP) using His-bundle pacing (HBP) or left bundle branch area pacing (LBBAP) has been shown to be a safe and more physiological alternative to BVP. OBJECTIVE The purpose of this study was to compare the clinical outcomes between CSP and BVP among patients undergoing CRT. METHODS This observational study included consecutive patients with LVEF ≤35% and class I or II indications for CRT who underwent successful BVP or CSP at 2 major health care systems. The primary outcome was the composite endpoint of time to death or heart failure hospitalization (HFH). Secondary outcomes included subgroup analysis in left bundle branch block as well as individual endpoints of death and HFH. RESULTS A total of 477 patients (32% female) met inclusion criteria (BVP 219; CSP 258 [HBP 87, LBBAP 171]). Mean age was 72 ± 12 years, and mean LVEF was 26% ± 6%. Comorbidities included hypertension 70%, diabetes mellitus 45%, and coronary artery disease 52%. Paced QRS duration in CSP was significantly narrower than BVP (133 ± 21 ms vs 153 ± 24 ms; P <.001). LVEF improved in both groups during mean follow-up of 27 ± 12 months and was greater after CSP compared to BVP (39.7% ± 13% vs 33.1% ± 12%; P <.001). Primary outcome of death or HFH was significantly lower with CSP vs BVP (28.3% vs 38.4%; hazard ratio 1.52; 95% confidence interval 1.082-2.087; P = .013). CONCLUSION CSP improved clinical outcomes compared to BVP in this large cohort of patients with indications for CRT.
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Affiliation(s)
- Pugazhendhi Vijayaraman
- Geisinger Heart Institute, Wilkes Barre, Pennsylvania; Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania.
| | | | - Abdul Haseeb
- Geisinger Heart Institute, Wilkes Barre, Pennsylvania
| | - Cicely Dye
- Rush University Medical Center, Chicago, Illinois
| | - Nidhi Madan
- Rush University Medical Center, Chicago, Illinois
| | | | | | - Wilson Young
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania; Geisinger Heart Institute, Scranton, Pennsylvania
| | | | | | | | | | | | | | - Jess W Oren
- Geisinger Heart Institute, Danville, Pennsylvania
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7
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Vijayaraman P, Herweg B, Verma A, Sharma PS, Batul SA, Ponnusamy SS, Schaller RD, Cano O, Molina-Lerma M, Curila K, Huybrechts W, Wilson DR, Rademakers LM, Sreekumar P, Upadhyay G, Vernooy K, Subzposh FA, Huang W, Jastrzebski M, Ellenbogen KA. Rescue left bundle branch area pacing in coronary venous lead failure or nonresponse to biventricular pacing: Results from International LBBAP Collaborative Study Group. Heart Rhythm 2022; 19:1272-1280. [PMID: 35504539 DOI: 10.1016/j.hrthm.2022.04.024] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 04/18/2022] [Accepted: 04/22/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) using biventricular pacing (BVP) is effective in patients with heart failure, left bundle branch block (LBBB), and reduced left ventricular function. Left bundle branch area pacing (LBBAP) has been reported as an alternative option for CRT. OBJECTIVE The purpose of this study was to assess the feasibility and outcomes of LBBAP in patients who failed conventional BVP because of coronary venous (CV) lead complications or who were nonresponders to BVP. METHODS At 16 international centers, LBBAP was attempted in patients with conventional CRT indication who failed BVP because of CV lead complications or lack of therapeutic response to BVP. Heart failure hospitalization (HFH) and death, echocardiographic outcomes, procedural data, pacing parameters, and lead complications including CV lead failure are reported. RESULTS LBBAP was successfully performed in 200 patients (CV lead failures 156; nonresponders 44) (age 68 ± 11 years; female 35%; LBBB 55%; right ventricular pacing 23%; ischemic cardiomyopathy 28%; nonischemic cardiomyopathy 63%; left ventricular ejection fraction [LVEF] ≤35% in 80%). Procedural duration was 119.5 ± 59.6 minutes, and fluoroscopy duration was 25.7 ± 18.5 minutes. LBBAP threshold and R-wave amplitudes were 0.68 ± 0.35 V @ 0.45 ms and 10.4 ± 5 mV at implant, respectively, and remained stable during mean follow-up of 12 ± 10.1 months. LBBAP resulted in significant QRS narrowing from 170 ± 28 ms to 139 ± 25 ms (P <.001) with V6 R-wave peak times of 85 ± 17 ms. LVEF improved from 29% ± 10% at baseline to 40% ± 12% (P <.001) during follow-up. The risk of death or HFH was lower in those with CV lead failure than in nonresponders (hazard ratio 0.357; 95% confidence interval 0.168-0.756; P = .007) CONCLUSION: LBBAP is a viable alternative to CRT in patients who failed conventional BVP due to CV lead failure or who were nonresponders.
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Affiliation(s)
| | - Bengt Herweg
- Division of Cardiology, University of South Florida, Tampa, Florida
| | - Atul Verma
- South Lake Regional Health Center, University of Toronto, Toronto, Canada
| | | | | | - Shunmuga Sundaram Ponnusamy
- Department of Cardiology, Velammal Medical College Hospital and Research Institute, Velammal Village, Madurai, Tamil Nadu, India
| | - Robert D Schaller
- Division of Cardiovascular Medicine, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Oscar Cano
- Hospital Universitari i Politècnic La Fe, Valencia, Spain, and Centro de Investigaciones Biomédicas en RED en Enfermedades Cardiovasculares (CIBERCV)
| | | | - Karol Curila
- Cardiocenter, University Hospital Kralovske Vinohrady and 3rd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Wim Huybrechts
- Department of Cardiology, University Hospital Antwerp, Belgium
| | - David R Wilson
- Division of Cardiology, University of South Florida, Tampa, Florida
| | | | - Praveen Sreekumar
- Electrophysiology Unit, Department of Cardiology Aster Medcity, Kochi, Kerala, India
| | | | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
| | | | - Weijian Huang
- Department of Cardiology, the First Affiliated Hospital of Wenzhou Medical University, and The Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, China
| | - Marek Jastrzebski
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland
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Mathew AJ, Subzposh FA, Naperkowski AM, Young W, Pokharel P, Batul SA, Storm RH, Oren JW, Vijayaraman P. CI-523-01 CONDUCTION SYSTEM PACING VERSUS CONVENTIONAL PACING IN PATIENTS UNDERGOING AV NODE ABLATION: NON-RANDOMIZED, ON-TREATMENT COMPARISON. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.107] [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: 11/26/2022]
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Batul SA, Gopinathannair R. Femoral venous hemostasis after atrial fibrillation ablation: Is figure-of-eight suture the way to go? Indian Pacing Electrophysiol J 2017; 17:132-133. [PMID: 29192588 PMCID: PMC5652322 DOI: 10.1016/j.ipej.2017.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Syeda Atiqa Batul
- Division of Cardiovascular Medicine, Mount Sinai Hospital, New York, NY, USA
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Batul SA, Gopinathannair R. Atrial Fibrillation in Heart Failure: a Therapeutic Challenge of Our Times. Korean Circ J 2017; 47:644-662. [PMID: 28955382 PMCID: PMC5614940 DOI: 10.4070/kcj.2017.0040] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 03/27/2017] [Indexed: 11/11/2022] Open
Abstract
Atrial fibrillation (AF) and heart failure (HF) are growing cardiovascular disease epidemics worldwide. There has been an exponential increase in the prevalence of AF and HF correlating with an increased burden of cardiac risk factors and improved survival rates in patients with structural heart disease. AF is associated with adverse prognostic outcomes in HF and is most evident in mild-to-moderate left ventricular (LV) dysfunction where the loss of "atrial kick" translates into poorer quality of life and increased mortality. In the absence of underlying structural heart disease, arrhythmia can independently contribute to the development of cardiomyopathy. Together, these 2 conditions carry a high risk of thromboembolism due to stasis, inflammation and cellular dysfunction. Stroke prevention with oral anticoagulation (OAC) remains a mainstay of treatment. Pharmacologic rate and rhythm control remain limited by variable efficacy, intolerance and adverse reactions. Catheter ablation for AF has resulted in a paradigm shift with evidence indicating superiority over medical therapy. While its therapeutic success is high for paroxysmal AF, it remains suboptimal in persistent AF. A better mechanistic understanding of AF as well as innovations in ablation technology may improve patient outcomes in the future. Refractory cases may benefit from atrioventricular junction ablation and biventricular pacing. The value of risk factor modification, especially with regard to obesity, sleep apnea, hypertension and diabetes, cannot be emphasized enough. Close interdisciplinary collaboration between HF specialists and electrophysiologists is an essential component of good long-term outcomes in this challenging population.
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Affiliation(s)
- Syeda Atiqa Batul
- Division of Cardiology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY USA
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Abstract
Ventricular arrhythmias are an important cause of cardiovascular morbidity and mortality, particularly in those with structural heart disease, inherited cardiomyopathies, and channelopathies. The goals of ventricular arrhythmia management include symptom relief, improving quality of life, reducing implantable cardioverter defibrillator shocks, preventing deterioration of left ventricular function, reducing risk of arrhythmic death, and potentially improving overall survival. Guideline-directed medical therapy and implantable cardioverter defibrillator implantation remain the mainstay of therapy to prevent sudden cardiac death in patients with ventricular arrhythmias in the setting of structural heart disease. Recent advances in imaging modalities and commercial availability of genetic testing panels have enhanced our mechanistic understanding of the disease processes and, along with significant progress in catheter-based ablative therapies, have enabled a tailored and more effective management of drug-refractory ventricular arrhythmias. Several gaps in our knowledge remain and require further research. In this article, we review the recent advances in the diagnosis and management of ventricular arrhythmias.
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Affiliation(s)
- Syeda Atiqa Batul
- Arrhythmia Division, Montefiore Medical Center, Bronx, New York, USA
| | | | - John D Fisher
- Arrhythmia Division, Montefiore Medical Center, Bronx, New York, USA
| | - Rakesh Gopinathannair
- Division of Cardiovascular Medicine, University of Louisville School of Medicine, Louisville, USA
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Briceño DF, Romero J, Villablanca PA, Londoño A, Diaz JC, Maraj I, Batul SA, Madan N, Patel J, Jagannath A, Mohanty S, Mohanty P, Gianni C, Della Rocca D, Sabri A, Kim SG, Natale A, Di Biase L. Long-term outcomes of different ablation strategies for ventricular tachycardia in patients with structural heart disease: systematic review and meta-analysis. Europace 2017; 20:104-115. [DOI: 10.1093/europace/eux109] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 04/07/2017] [Indexed: 11/14/2022] Open
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Batul SA, Gopinathannair R. Intravenous Sotalol - Reintroducing a Forgotten Agent to the Electrophysiology Therapeutic Arsenal. J Atr Fibrillation 2017; 9:1499. [PMID: 29250266 DOI: 10.4022/jafib.1499] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 11/09/2016] [Accepted: 01/23/2017] [Indexed: 01/21/2023]
Abstract
Sotalol is a racemic mixture possessing beta-blocker and class III anti arrhythmic properties. Approved by US food and drug administration (FDA) since 2009 based on its bioequivalence with oral sotalol, clinicians are less familiar with the potential uses of the intravenous form despite its re-launch in United States in 2015. Available literature suggests that intravenous sotalol in recommended doses can be safely administered in adult and pediatric population achieving rapid reliable therapeutic plasma concentration and without additional proarrhythmic effects when compared to its oral form as well as other antiarrhythmic medications. Intravenous sotalol may have potential uses as an alternative agent for highly symptomatic atrial fibrillation post cardiac surgery as well as in life threatening ventricular arrhythmias. As with its oral form, judicious use with close attention to QTc and renal function is warranted. Further studies are needed to better understand the safety, efficacy and different dosing regimens of parenteral sotalol in adults and children.
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Affiliation(s)
- Syeda Atiqa Batul
- Montefiore Medical Center, New York, NY and University of Louisville, Louisville, KY
| | - Rakesh Gopinathannair
- Montefiore Medical Center, New York, NY and University of Louisville, Louisville, KY
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14
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Wats K, Batul SA, Plawes Z, Sadiq A, Moskovits M. Nutritional therapy leads to complete recovery of left ventricular dysfunction in anorexia nervosa: A case report. ICFJ 2016. [DOI: 10.17987/icfj.v6i0.228] [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
<p>This case highlights the cardiac complications associated with anorexia nervosa and how early recognition and treatment significantly affects overall prognosis. A few cases have been reported in literature where cardiomyopathy associated with anorexia nervosa was reported but this is the first case where adequate medical management and metabolic support lead to complete recovery</p><p>A young female presented to our hospital with lethargy and dehydration with EKG changes notable for T wave inversions in precordial and inferior leads. Echocardiogram showed severely reduced left ventricular (LV) function. Patient was diagnosed with anorexia nervosa and started on high calorie diet as per metabolic recommendations, ace inhibitor, beta-blockers and statin. 10 month follow up showed a significant improvement in heart function showing the reversible nature of anorexia nervosa induced cardiac dysfunction</p><p>Cardiac abnormalities, specifically cardiomyopathy are known in patients with Anorexia nervosa and have been attributed to the deficiency of multitude of minerals, vitamins and electrolytes. It is important to recognize that patients with anorexia can develop cardiac dysfunction and early nutrition along with medical optimization can lead to complete reversal of cardiac dysfunction. Multi-disciplinary team approach involving cardiologist, metabolic support, internist, and psychiatrist is required for appropriate care of these patients.</p>
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