Imperial College London

Dr P Boon Lim

Faculty of MedicineNational Heart & Lung Institute

Honorary Senior Lecturer
 
 
 
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Contact

 

+44 (0)20 3313 2115p.b.lim Website

 
 
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Location

 

Cardiology DepartmentBlock B Hammersmith HospitalHammersmith Campus

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Summary

 

Publications

Publication Type
Year
to

95 results found

Shun-Shin MJ, Leong KMW, Ng FS, Linton NWF, Whinnett ZI, Koa-Wing M, Qureshi N, Lefroy DC, Harding SE, Lim PB, Peters NS, Francis DP, Varnava AM, Kanagaratnam Pet al., 2019, Ventricular conduction stability test: a method to identify and quantify changes in whole heart activation patterns during physiological stress., Europace

AIMS: Abnormal rate adaptation of the action potential is proarrhythmic but is difficult to measure with current electro-anatomical mapping techniques. We developed a method to rapidly quantify spatial discordance in whole heart activation in response to rate cycle length changes. We test the hypothesis that patients with underlying channelopathies or history of aborted sudden cardiac death (SCD) have a reduced capacity to maintain uniform activation following exercise. METHODS AND RESULTS: Electrocardiographical imaging (ECGI) reconstructs >1200 electrograms (EGMs) over the ventricles from a single beat, providing epicardial whole heart activation maps. Thirty-one individuals [11 SCD survivors; 10 Brugada syndrome (BrS) without SCD; and 10 controls] with structurally normal hearts underwent ECGI vest recordings following exercise treadmill. For each patient, we calculated the relative change in EGM local activation times (LATs) between a baseline and post-exertion phase using custom written software. A ventricular conduction stability (V-CoS) score calculated to indicate the percentage of ventricle that showed no significant change in relative LAT (<10 ms). A lower score reflected greater conduction heterogeneity. Mean variability (standard deviation) of V-CoS score over 10 consecutive beats was small (0.9 ± 0.5%), with good inter-operator reproducibility of V-CoS scores. Sudden cardiac death survivors, compared to BrS and controls, had the lowest V-CoS scores post-exertion (P = 0.011) but were no different at baseline (P = 0.50). CONCLUSION: We present a method to rapidly quantify changes in global activation which provides a measure of conduction heterogeneity and proof of concept by demonstrating SCD survivors have a reduced capacity to maintain uniform activation following exercise.

JOURNAL ARTICLE

Leong KMW, Ng FS, Jones S, Chow J-J, Qureshi N, Koa-Wing M, Linton NWF, Whinnett ZI, Lefroy DC, Davies DW, Lim PB, Peters NS, Kanagaratnam P, Varnava AMet al., 2019, Prevalence of spontaneous type I ECG pattern, syncope, and other risk markers in sudden cardiac arrest survivors with Brugada syndrome, PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, Vol: 42, Pages: 257-264, ISSN: 0147-8389

JOURNAL ARTICLE

Sutton R, Lim PB, 2019, Cardioneuroablation: Present status as a tenable therapy for vasovagal syncope., Turk Kardiyol Dern Ars, Vol: 47, Pages: 1-3

JOURNAL ARTICLE

Arnold AD, Shun-Shin MJ, Keene D, Howard JP, Sohaib SMA, Wright IJ, Cole GD, Qureshi NA, Lefroy DC, Koa-Wing M, Linton NWF, Lim PB, Peters NS, Davies DW, Muthumala A, Tanner M, Ellenbogen KA, Kanagaratnam P, Francis DP, Whinnett ZIet al., 2018, His Resynchronization Versus Biventricular Pacing in Patients With Heart Failure and Left Bundle Branch Block, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, Vol: 72, Pages: 3112-3122, ISSN: 0735-1097

JOURNAL ARTICLE

Kim M-Y, Sikkel MB, Hunter RJ, Haywood GA, Tomlinson DR, Tayebjee MH, Ali RL, Cantwell CD, Gonna H, Sandler BC, Lim E, Furniss G, Panagopoulos D, Begg G, Dhillon G, Hill NJ, O'Neill J, Francis DP, Lim PB, Peters NS, Linton NWF, Kanagaratnam Pet al., 2018, A novel approach to mapping the atrial ganglionated plexus network by generating a distribution probability atlas, JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Vol: 29, Pages: 1624-1634, ISSN: 1045-3873

JOURNAL ARTICLE

Ferreira-Martins J, Howard J, Al-Khayatt B, Shalhoub J, Sohaib A, Shun-Shin MJ, Novak PG, Leather R, Sterns LD, Lane C, Lim PB, Kanagaratnam P, Peters NS, Francis DP, Sikkel MBet al., 2018, Outcomes of paroxysmal atrial fibrillation ablation studies are affected more by study design and patient mix than ablation technique, JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Vol: 29, Pages: 1471-1479, ISSN: 1045-3873

JOURNAL ARTICLE

Handa BS, Roney CH, Houston C, Qureshi NA, Li X, Pitcher DS, Chowdhury RA, Lim PB, Dupont E, Niederer SA, Cantwell CD, Peters NS, Ng FSet al., 2018, Analytical approaches for myocardial fibrillation signals, COMPUTERS IN BIOLOGY AND MEDICINE, Vol: 102, Pages: 315-326, ISSN: 0010-4825

JOURNAL ARTICLE

Virag N, Erickson M, Taraborrelli P, Vetter R, Lim PB, Sutton R, Lim PB, Sutton Ret al., 2018, Predicting vasovagal syncope from heart rate and blood pressure: A prospective study in 140 subjects, HEART RHYTHM, Vol: 15, Pages: 1404-1410, ISSN: 1547-5271

JOURNAL ARTICLE

Kyriacou A, Rajkumar CA, Pabari PA, Sohaib SMA, Willson K, Peters NS, Lim PB, Kanagaratnam P, Hughes AD, Mayet J, Whinnett ZI, Francis DPet al., 2018, Distinct impacts of heart rate and right atrial-pacing on left atrial mechanical activation and optimal AV delay in CRT, PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, Vol: 41, Pages: 959-966, ISSN: 0147-8389

JOURNAL ARTICLE

Shun-Shin M, Arnold A, Keene D, Howard J, Sohaib A, Lim PB, Tanner M, Lefroy D, Peters N, Kanagaratnam P, Davies DW, Francis D, Whinnett Zet al., 2018, The magnitude of LV activation time reduction with His bundle pacing over biventricular pacing in LBBB predicts the incremental improvement in acute cardiac function, European-Society-of-Cardiology Congress, Publisher: OXFORD UNIV PRESS, Pages: 385-385, ISSN: 0195-668X

CONFERENCE PAPER

, 2018, B-AB01-01 to B-AB42-05, Pages: S1-S107, ISSN: 1547-5271

CONFERENCE PAPER

Luther V, Qureshi N, Lim PB, Koa-Wing M, Jamil-Copley S, Ng FS, Whinnett Z, Davie DW, Peters NS, Kanagaratnam P, Linton Net al., 2018, Isthmus sites identified by Ripple Mapping are usually anatomically stable: A novel method to guide atrial substrate ablation?, JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Vol: 29, Pages: 404-411, ISSN: 1045-3873

JOURNAL ARTICLE

Leong KMW, Chow J-J, Ng FS, Falaschetti E, Qureshi N, Koa-Wing M, Linton NWF, Whinnett ZI, Lefroy DC, Davies DW, Lim PB, Peters NS, Kanagaratnam P, Varnava AMet al., 2018, Comparison of the Prognostic Usefulness of the European Society of Cardiology and American Heart Association/American College of Cardiology Foundation Risk Stratification Systems for Patients With Hypertrophic Cardiomyopathy, AMERICAN JOURNAL OF CARDIOLOGY, Vol: 121, Pages: 349-355, ISSN: 0002-9149

JOURNAL ARTICLE

Sau A, Taraborrelli P, Moore P, Lim PBet al., 2018, Cardioinhibitory and vasodepressor responses to different stressors on head-up tilt, EUROPACE, Vol: 20, Pages: 115-115, ISSN: 1099-5129

JOURNAL ARTICLE

Leong KMW, Ng FS, Roney C, Cantwell C, Shun-Shin MJ, Linton NWF, Whinnett ZI, Lefroy DC, Davies DW, Harding SE, Lim PB, Francis D, Peters NS, Varnava AM, Kanagaratnam Pet al., 2018, Repolarization abnormalities unmasked with exercise in sudden cardiac death survivors with structurally normal hearts, JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Vol: 29, Pages: 115-126, ISSN: 1045-3873

JOURNAL ARTICLE

Sau A, Sikkel MB, Luther V, Wright I, Guerrero F, Koa-Wing M, Lefroy D, Linton N, Qureshi N, Whinnett Z, Lim PB, Kanagaratnam P, Peters NS, Davies DWet al., 2017, The sawtooth EKG pattern of typical atrial flutter is not related to slow conduction velocity at the cavotricuspid isthmus, JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Vol: 28, Pages: 1445-1453, ISSN: 1045-3873

JOURNAL ARTICLE

Su J, Manisty C, Parker KH, Simonsen U, Nielsen-Kudsk JE, Mellemkjaer S, Connolly S, Lim PB, Whinnett ZI, Malik IS, Watson G, Davies JE, Gibbs S, Hughes AD, Howard Let al., 2017, Wave Intensity Analysis Provides Novel Insights Into Pulmonary Arterial Hypertension and Chronic Thromboembolic Pulmonary Hypertension, JOURNAL OF THE AMERICAN HEART ASSOCIATION, Vol: 6, ISSN: 2047-9980

JOURNAL ARTICLE

Leong KMW, Ng FS, Yao C, Roney C, Taraborrelli P, Linton NWF, Whinnett ZI, Lefroy DC, Davies DW, Lim PB, Harding SE, Peters NS, Kanagaratnam P, Varnava AMet al., 2017, ST-Elevation Magnitude Correlates With Right Ventricular Outflow Tract Conduction Delay in Type I Brugada ECG, CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY, Vol: 10, ISSN: 1941-3149

JOURNAL ARTICLE

Leong KMW, Ng FS, Patil S, Lim PBet al., 2017, An electrocardiogram opinion from an National Health Service walk-in centre: Pneumothorax, EMERGENCY MEDICINE JOURNAL, Vol: 34, Pages: 620-+, ISSN: 1472-0205

JOURNAL ARTICLE

Leong KMW, Guerrero F, Lim PB, 2017, Cavotricuspid-Isthmus Dependent Flutter or Left-Sided Atrial Tachycardia?, JOURNAL OF INVASIVE CARDIOLOGY, Vol: 29, Pages: E92-E93, ISSN: 1042-3931

JOURNAL ARTICLE

Masoud S, Lim PB, Kitas GD, Panoulas Vet al., 2017, Sudden cardiac death in patients with rheumatoid arthritis, WORLD JOURNAL OF CARDIOLOGY, Vol: 9, Pages: 562-573, ISSN: 1949-8462

JOURNAL ARTICLE

Sikkel MB, Luther V, Sau A, Guerrero F, Ng FS, Lim PBet al., 2017, High-Density Electroanatomical Mapping to Identify Point of Epicardial to Endocardial Breakthrough in Perimitral Flutter., JACC Clin Electrophysiol, Vol: 3, Pages: 637-639

JOURNAL ARTICLE

Jawad ZAR, Fajardo-Puerta AB, Lefroy D, Todd J, Lim PB, Jiao LRet al., 2017, Complete laparoscopic excision of a giant retroperitoneal paraganglioma, ANNALS OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND, Vol: 99, Pages: E148-E150, ISSN: 0035-8843

JOURNAL ARTICLE

Roney CH, Cantwell CD, Bayer JD, Qureshi NA, Lim PB, Tweedy JH, Kanagaratnam P, Peters NS, Vigmond EJ, Ng FSet al., 2017, Spatial Resolution Requirements for Accurate Identification of Drivers of Atrial Fibrillation, CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY, Vol: 10, ISSN: 1941-3149

JOURNAL ARTICLE

Li Kam Wa ME, Taraborrelli P, Hayat S, Lim PBet al., 2017, Respiration driven excessive sinus tachycardia treated with clonidine., BMJ Case Rep, Vol: 2017

A 26-year-old man presented to our syncope service with debilitating daily palpitations, shortness of breath, presyncope and syncope following a severe viral respiratory illness 4 years previously. Mobitz type II block had previously been identified, leading to a permanent pacemaker and no further episodes of frank syncope. Transthoracic echocardiography, electophysiological study and repeated urine metanepherines were normal. His palpitations and presyncope were reproducible on deep inspiration, coughing, isometric hand exercise and passive leg raises. We demonstrated rapid increases in heart rate with no change in morphology on his 12 lead ECG. His symptoms were resistant to fludrocortisone, flecainide, β blockers and ivabradine. Initiation of clonidine in combination with ivabradine led to rapid resolution of his symptoms. We suggest that an excessive respiratory sinus arrhythmia was responsible for his symptoms and achieved an excellent response with the centrally acting sympatholytic clonidine, where previous peripherally acting treatments had failed.

JOURNAL ARTICLE

Roney CH, Cantwell CD, Qureshi NA, Chowdhury RA, Dupont E, Lim PB, Vigmond EJ, Tweedy JH, Ng FS, Peters NSet al., 2017, Rotor Tracking Using Phase of Electrograms Recorded During Atrial Fibrillation, ANNALS OF BIOMEDICAL ENGINEERING, Vol: 45, Pages: 910-923, ISSN: 0090-6964

JOURNAL ARTICLE

Luther V, Sikkel M, Bennett N, Guerrero F, Leong K, Qureshi N, Ng FS, Hayat SA, Sohaib SMA, Malcolme-Lawes L, Lim E, Wright I, Koa-Wing M, Lefroy DC, Linton NWF, Whinnett Z, Kanagaratnam P, Davies W, Peters NS, Lim PBet al., 2017, Visualizing Localized Reentry With Ultra-High Density Mapping in Iatrogenic Atrial Tachycardia Beware Pseudo-Reentry, CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY, Vol: 10, ISSN: 1941-3149

JOURNAL ARTICLE

Ng FS, Guerrero F, Luther V, Sikkel M, Lim PBet al., 2017, Microreentrant left atrial tachycardia circuit mapped with an ultra-high-density mapping system., HeartRhythm Case Rep, Vol: 3, Pages: 224-228, ISSN: 2214-0271

JOURNAL ARTICLE

Ng FS, Rashid M, Lim ZL, Lim PBet al., 2017, Mapping Signatures of Ventricular Ectopic Activity of Endocavitary Origin., JACC Clin Electrophysiol, Vol: 3, Pages: 186-188

JOURNAL ARTICLE

Rajkumar CA, Qureshi N, Ng FS, Panoulas VF, Lim PBet al., 2017, Adenosine induced ventricular fibrillation in a structurally normal heart: a case report., J Med Case Rep, Vol: 11

BACKGROUND: Adenosine is the first-line pharmacotherapy for termination of supraventricular tachycardia through its action on the atrioventricular node. However, pro-arrhythmic effects of adenosine are also recognised, most notably in the presence of pre-excited atrial fibrillation. In this case report, we describe the induction of ventricular fibrillation in a patient with no demonstrable accessory pathway, nor any other structural heart disease. This rare, idiosyncratic reaction has never previously been reported and is of relevance given the widespread and routine use of adenosine in clinical practice. CASE PRESENTATION: A 26-year-old woman of Cypriot origin presented to our emergency department with a sudden onset of palpitations and chest discomfort. She was healthy, with no previous medical history and no regular medications. An electrocardiogram demonstrated a narrow complex tachycardia with a rate of 194 beats per minute. Following failure of vagal maneuvers to terminate the tachycardia, the assessing physician administered a single intravenous dose of 6 mg adenosine. Our patient instantaneously developed coarse ventricular fibrillation and circulatory collapse. Cardiopulmonary resuscitation was initiated and our patient was rapidly defibrillated to sinus rhythm with a single 150 J direct current shock. A 900-mg loading dose of intravenous amiodarone was commenced and our patient was managed in the cardiac high dependency unit. No further arrhythmias were identified on continuous cardiac monitoring. On review, her presenting electrocardiogram had demonstrated rapidly conducted atrial fibrillation with no evidence of ventricular pre-excitation. Concordantly, her resting electrocardiogram was not suggestive of any accessory pathway. This was conclusively excluded on invasive electrophysiology study, with negative programmed ventricular stimulation up to three extrastimuli. Extensive laboratory investigations were unremarkable and failed to ident

JOURNAL ARTICLE

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