141 results found
Luther V, Linton NW, Koa-Wing M, et al., 2016, A Prospective Study of Ripple Mapping in Atrial Tachycardias: A Novel Approach to Interpreting Activation in Low-Voltage Areas., Circulation: Arrhythmia and Electrophysiology, Vol: 9, ISSN: 1941-3149
BACKGROUND: Post ablation atrial tachycardias are characterized by low-voltage signals that challenge current mapping methods. Ripple mapping (RM) displays every electrogram deflection as a bar moving from the cardiac surface, resulting in the impression of propagating wavefronts when a series of bars move consecutively. RM displays fractionated signals in their entirety thereby helping to identify propagating activation in low-voltage areas from nonconducting tissue. We prospectively used RM to study tachycardia activation in the previously ablated left atrium. METHODS AND RESULTS: Patients referred for atrial tachycardia ablation underwent dense electroanatomic point collection using CARTO3v4. RM was played over a bipolar voltage map and used to determine the voltage "activation threshold" that differentiated functional low voltage from nonconducting areas for each map. Ablation was guided by RM, but operators could perform entrainment or review the isochronal activation map for diagnostic uncertainty. Twenty patients were studied. Median RM determined activation threshold was 0.3 mV (0.19-0.33), with nonconducting tissue covering 33±9% of the mapped surface. All tachycardias crossed an isthmus (median, 0.52 mV, 13 mm) bordered by nonconducting tissue (70%) or had a breakout source (median, 0.35 mV) moving away from nonconducting tissue (30%). In reentrant circuits (14/20) the path length was measured (87-202 mm), with 9 of 14 also supporting a bystander circuit (path lengths, 147-234 mm). In breakout tachycardias, splitting of wavefronts resulted in 2 to 4 incomplete circuits. RM-guided ablation interrupted the tachycardia in 19 of 20 cases with the first ablation set. CONCLUSIONS: RM helps to define activation through low-voltage regions and aids ablation of atrial tachycardias.
Kim M-Y, Ng FS, Ariff B, et al., 2015, Extensive Intramural Esophageal Hematoma After Transesophageal Echocardiography During Atrial Fibrillation Ablation, CIRCULATION, Vol: 132, Pages: 1847-1849, ISSN: 0009-7322
Sohaib SMA, Wright I, Lim E, et al., 2015, Atrioventricular Optimized Direct His Bundle Pacing Improves Acute Hemodynamic Function in Patients With Heart Failure and PR Interval Prolongation Without Left Bundle Branch Block, JACC: Clinical electrophysiology, Vol: 1, Pages: 582-591, ISSN: 2405-5018
ObjectivesThe purpose of this study was to investigate whether heart failure patients with narrow QRS duration (or right bundle branch block) but with long PR interval gain acute hemodynamic benefit from atrioventricular (AV) optimization. We tested this with biventricular pacing and (to deliver pure AV shortening) direct His bundle pacing.BackgroundBenefits of pacing for heart failure have previously been indicated by acute hemodynamic studies and verified in outcome studies. A new target for pacing in heart failure may be PR interval prolongation, which is associated with 58% higher mortality regardless of QRS duration.MethodsWe enrolled 16 consecutive patients with systolic heart failure, PR interval prolongation (mean, 254 ± 62 ms) and narrow QRS duration (n = 13; mean QRS duration: 119 ± 17 ms) or right bundle branch block (n = 3; mean, QRS duration: 156 ± 18 ms). We successfully delivered temporary direct His bundle pacing in 14 patients and temporary biventricular pacing in 14 participants. We performed AV optimization using invasive systolic blood pressure obtaining parabolic responses (mean R2: 0.90 for His, and 0.85 for biventricular pacing).ResultsThe mean increment in systolic BP compared with intrinsic ventricular conduction was 4.1 mm Hg (95% confidence interval [CI]: +1.9 to +6.2 mm Hg for His and 4.3 mm Hg [95% CI: +2.0 to +6.5 mm Hg] for biventricular pacing. QRS duration lengthened with biventricular pacing (change = +22 ms [95% CI: +18 to +25 ms]) but not with His pacing (change = +0.5 ms [95% CI: −2.6 to +3.6 ms).ConclusionsAV-optimized pacing improves acute hemodynamic function in patients with heart failure and long PR interval without left bundle branch block. That it can be achieved by single-site His pacing shows that its mechanism is AV shortening. The improvement is ∼60% of the effect size previously reported for biventricular pacing in left bundle branch block. Randomized, blinded trials are warranted to tes
Dehbi H-M, Jones S, Sohaib SMA, et al., 2015, A novel curve fitting method for AV optimisation of biventricular pacemakers, PHYSIOLOGICAL MEASUREMENT, Vol: 36, Pages: 1889-1900, ISSN: 0967-3334
Raphael CE, Finegold JA, Barron AJ, et al., 2015, The effect of duration of follow-up and presence of competing risk on lifespan-gain from implantable cardioverter defibrillator therapy: who benefits the most?, EUROPEAN HEART JOURNAL, Vol: 36, Pages: 1676-1688, ISSN: 0195-668X
Sharp A, Sohaib A, Willson K, et al., 2015, SIGNAL-TO-NOISE RATIO DURING HAEMODYNAMIC OPTIMISATION OF AV DELAY IS IMPROVED MORE BY ATRIAL PACING THAN BY INCREASING HEART RATE, British-Cardiac-Society (BCS) Annual Conference on Hearts and Genes, Publisher: BMJ PUBLISHING GROUP, Pages: A25-A26, ISSN: 1355-6037
Luther V, Jamil-Copley S, Koa-Wing M, et al., 2015, Non-randomised comparison of acute and long-term outcomes of robotic versus manual ventricular tachycardia ablation in a single centre ischemic cohort., Journal of Interventional Cardiac Electrophysiology, Vol: 43, Pages: 175-185, ISSN: 1572-8595
INTRODUCTION: Robotically guided radiofrequency (RF) ablation offers greater catheter stability that may improve lesion depth. We performed a non-randomised comparison of patients undergoing ventricular tachycardia (VT) ablation either manually or robotically using the Hansen Sensei system for recurrent implantable defibrillator (ICD) therapy. METHODS: Patients with infarct-related scar underwent VT ablation using the Hansen system to assess feasibility compared with patients undergoing manual VT ablation during a similar time period. Power delivery during robotic ablation was restricted to 30 W at 60 s. VT inducibility was checked at the end of the procedure. Pre-ablation ICD therapy burdens over 6 months were compared with post-ablation therapy averaged to a 6-month period. RESULTS: Twelve consecutive patients who underwent robotic VT ablation were compared to 12 consecutive patients undergoing a manual ablation. Patient demographics and comorbidities were similar in the two groups. A higher proportion of robotic cases were urgent (9/12 (75 %)) vs. manual (4/12 (33 %)) (p = 0.1). Post-ablation VT stimulation did not induce clinical VT in 11/12 (92 %) in each group. There were no peri-procedural complications related to ablation delivery. Patients were followed up for approximately 2 years. Averaged over 6 months, robotic ICD therapy burdens fell from 32 (5-400) events to 2.5 (0-11) (p = 0.015). Therapy burden fell from 14 (10-25) to 1 (0-5) (p = 0.023) in the manual group. There was no difference in long-term outcome (p = 0.60) and mortality (4/12 (33 %), p = 1.0). CONCLUSION: Robotically guided VT ablation is both feasible and safe when compared to manual ablation with good acute and long-term outcomes.
Sohaib SM, Kyriacou A, Jones S, et al., 2015, Evidence that conflict regarding size of haemodynamic response to interventricular delay optimization of cardiac resynchronization therapy may arise from differences in how atrioventricular delay is kept constant., Europace, Vol: 17, ISSN: 1532-2092
AIMS: Whether adjusting interventricular (VV) delay changes haemodynamic efficacy of cardiac resynchronization therapy (CRT) is controversial, with conflicting results. This study addresses whether the convention for keeping atrioventricular (AV) delay constant during VV optimization might explain these conflicts. METHOD AND RESULTS: Twenty-two patients in sinus rhythm with existing CRT underwent VV optimization using non-invasive systolic blood pressure. Interventricular optimization was performed with four methods for keeping the AV delay constant: (i) atrium and left ventricle delay kept constant, (ii) atrium and right ventricle delay kept constant, (iii) time to the first-activated ventricle kept constant, and (iv) time to the second-activated ventricle kept constant. In 11 patients this was performed with AV delay of 120 ms, and in 11 at AV optimum. At AV 120 ms, time to the first ventricular lead (left or right) was the overwhelming determinant of haemodynamics (13.75 mmHg at ±80 ms, P < 0.001) with no significant effect of time to second lead (0.47 mmHg, P = 0.50), P < 0.001 for difference. At AV optimum, time to first ventricular lead again had a larger effect (5.03 mmHg, P < 0.001) than time to second (2.92 mmHg, P = 0.001), P = 0.02 for difference. CONCLUSION: Time to first ventricular activation is the overwhelming determinant of circulatory function, regardless of whether this is the left or right ventricular lead. If this is kept constant, the effect of changing time to the second ventricle is small or nil, and is not beneficial. In practice, it may be advisable to leave VV delay at zero. Specifying how AV delay is kept fixed might make future VV delay research more enlightening.
Ploux S, Eschalier R, Whinnett ZI, et al., 2015, Electrical dyssynchrony induced by biventricular pacing: Implications for patient selection and therapy improvement, HEART RHYTHM, Vol: 12, Pages: 782-791, ISSN: 1547-5271
Sohaib SMA, Finegold JA, Nijjer SS, et al., 2015, Opportunity to Increase Life Span in Narrow QRS Cardiac Resynchronization Therapy Recipients by Deactivating Ventricular Pacing Evidence From Randomized Controlled Trials, JACC-HEART FAILURE, Vol: 3, Pages: 327-336, ISSN: 2213-1779
Finegold J, Bordachar P, Kyriacou A, et al., 2015, Atrioventricular delay optimization of cardiac resynchronisation therapy: Comparison of non-invasive blood pressure with invasive haemodynamic measures, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 180, Pages: 221-222, ISSN: 0167-5273
Eschalier R, Ploux S, Lumens J, et al., 2015, Detailed analysis of ventricular activation sequences during right ventricular apical pacing and left bundle branch block and the potential implications for cardiac resynchronization therapy, HEART RHYTHM, Vol: 12, Pages: 137-143, ISSN: 1547-5271
Jabbour RJ, Shun-Shin MJ, Finegold JA, et al., 2015, Effect of Study Design on the Reported Effect of Cardiac Resynchronization Therapy (CRT) on Quantitative Physiological Measures: Stratified Meta-Analysis in Narrow-QRS Heart Failure and Implications for Planning Future Studies, JOURNAL OF THE AMERICAN HEART ASSOCIATION, Vol: 4, ISSN: 2047-9980
Koa-Wing M, Jamil-Copley S, Ariff B, et al., 2014, Haemorrhagic cerebral air embolism from an atrio-oesophageal fistula following atrial fibrillation ablation., Perfusion, Vol: 30, Pages: 484-486, ISSN: 0935-0020
We report the case of a man found unconscious three weeks following atrial fibrillation (AF) ablation. Cranial and thoracic imaging demonstrated multiple areas of pneumo-embolic infarction secondary to an atrio-oesophageal fistula (AEF). AEF is a recognised, but rare, complication of AF ablation.(1-8) Early recognition is critical as the mortality is 100% without surgical intervention. We consider the postulated mechanisms of AEF formation, the spectrum of clinical presentation, investigations and treatment.
Jones S, Shun-Shin MJ, Cole GD, et al., 2014, Iterative method for atrioventricular optimization of cardiac resynchronization therapy: is beauty only in the eye of the beholder? Reply, EUROPACE, Vol: 16, Pages: 1866-1866, ISSN: 1099-5129
Sohaib SM, Jones S, Manoharan K, et al., 2014, 55Testing the validity of electrogram based AV optimization schemes using real world patient data., Europace, Vol: 16 Suppl 3
Manufacturers have each implemented manufacturer specific methods for electrogram based optimization of AV delay in CRT devices. Agreement between manufacturer algorithms has never been formally tested. Where the algorithms are fully published and available, we tested agreement between different device based AV optimisation scheme, and compared this to the AV optimum selected using non-invasive haemodynamic optimisation.
Luther V, Jamil-Copley S, Shun-Shin M, et al., 2014, 24Acute and long-term outcomes for patients undergoing radiofrequency catheter ablation of scar-related ventricular tachycardia by robotic catheter navigation., Europace, Vol: 16 Suppl 3
Robotically-guided ablation offers theoretical advantages with greater catheter stability that can improve lesion depth. We performed a non-randomised comparison of patients undergoing ventricular tachycardia (VT) ablation either manually or using the Hansen robotic system.
Jabbour R, Shun-Shin M, Finegold JA, et al., 2014, Meta-analysis identifying the source of conflict of differing reports of CRT patients with narrow QRS heart failure, Annual Meeting of the European-Society-of-Cardiology (ESC), Publisher: OXFORD UNIV PRESS, Pages: 167-167, ISSN: 0195-668X
Sohaib SMA, Jones S, Kyriacou A, et al., 2014, EVIDENCE THAT HAEMODYNAMIC RESPONSE TO VV DELAY OPTIMISATION OF CRT DEVICES MAY BE SIMPLY A FUNCTION OF THE METHOD OF PROGRAMMING AV DELAY, HEART, Vol: 100, Pages: A21-A22, ISSN: 1355-6037
Jabbour R, Shun-Shin M, Finegold J, et al., 2014, META-ANALYSIS IDENTIFYING THE SOURCE OF CONFLICT BETWEEN DIFFERENT TRIAL REPORTS ON THE EFFECT OF CRT IN HEART FAILURE WITH NARROW QRS COMPLEXES, HEART, Vol: 100, Pages: A23-A23, ISSN: 1355-6037
Finegold J, Bordachar P, Kyriacou A, et al., 2014, CORRELATION AND REPRODUCIBILITY OF INVASIVE AND NON-INVASIVE HAEMODYNAMIC PARAMETERS FOR IDENTIFYING OPTIMAL AV DELAY IN CARDIAC RESYNCHRONISATION THERAPY, HEART, Vol: 100, Pages: A22-A23, ISSN: 1355-6037
Finegold J, Cazeau S, Sohaib SMA, et al., 2014, THE EFFECT OF ALTERING AV DELAY ON THE PRE-EJECTION PERIOD IN PATIENTS WITH BIVENTRICULAR PACEMAKERS, HEART, Vol: 100, Pages: A22-A22, ISSN: 1355-6037
Whinnett ZI, Sohaib SMA, Jones S, et al., 2014, British randomised controlled trial of AV and VV optimization ("BRAVO") study: rationale, design, and endpoints, BMC CARDIOVASCULAR DISORDERS, Vol: 14, ISSN: 1471-2261
Jamil-Copley S, Bokan R, Kojodjojo P, et al., 2014, Noninvasive electrocardiographic mapping to guide ablation of outflow tract ventricular arrhythmias, HEART RHYTHM, Vol: 11, Pages: 587-594, ISSN: 1547-5271
Jones S, Shun-Shin MJ, Cole GD, et al., 2014, Applicability of the iterative technique for cardiac resynchronization therapy optimization: full-disclosure, 50-sequential-patient dataset of transmitral Doppler traces, with implications for future research design and guidelines, EUROPACE, Vol: 16, Pages: 541-550, ISSN: 1099-5129
Kyriacou A, Pabari PA, Mayet J, et al., 2014, Cardiac resynchronization therapy and AV optimization increase myocardial oxygen consumption, but increase cardiac function more than proportionally, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 171, Pages: 144-152, ISSN: 0167-5273
Bouri S, Whinnett ZI, Cole GD, et al., 2014, Definitions of Outcome, Response and Effect in Imaging Research to Avoid Confusion, JACC-CARDIOVASCULAR IMAGING, Vol: 7, Pages: 104-106, ISSN: 1936-878X
Finegold JA, Raphael CE, Levy WC, et al., 2013, Quantification of survival gain from cardiac resynchronization therapy: nonlinear growth with time, and greater gain in low-risk patients, make raw trial data an underestimate of real-world behavior., J Am Coll Cardiol, Vol: 62, Pages: 2406-2413
OBJECTIVES: The goal of this study was to examine the impact of calculation-window duration on lifespan gain (as observed in trials) and on who gains most. BACKGROUND: The landmark trials of biventricular pacing (cardiac resynchronization therapy [CRT]) typically ran for <1 device battery life, and they may therefore underestimate lifespan benefit over longer durations. METHODS: We conducted a meta-analysis of biventricular pacing trials to calculate lifespan gained: first, within the duration of randomized controlled trial data up to 2 years; second, over a 5-year typical battery life; and third, over >1 battery life. Importantly, we applied the Gompertz method for age-related increase in mortality from non-CRT-preventable causes. RESULTS: Five landmark trials (COMPANION [Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure], CARE-HF (CArdiac REsynchronization-Heart Failure), MADIT-CRT [Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy], REVERSE [Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction], RAFT (Resynchronization-Defibrillation for Ambulatory Heart Failure)) provided data for 2 years (6,561 patients), with an average hazard ratio of 0.71. Lifespan gained across all trials increased nonlinearly with time from 0.1 month at 1 year, to 0.5 month at 2 years, and a projected 6.5 months at 5 years (65 times more than at 1 year). After multiple devices, it reached 14 months, involving on average 1.6 devices (i.e., 8.8 months per device implanted). Moreover, while over a short window (e.g., 2 years), lower-mortality patients may gain less than higher-mortality patients (1.4 vs. 2.3 months), their positions reverse by 15 years (16.0 vs. 13.7 months). CONCLUSIONS: Lifespan gain from biventricular pacing rises nonlinearly with time. Early on, higher-risk patients exhibit more gain, but later, lower-risk patients exhibit more gain. Quantifying ga
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