Publications by authors named "Kartikeya Bhargava"

40 Publications

Wilms tumor with Mulibrey Nanism: A case report and review of literature.

Cancer Rep (Hoboken) 2021 Jul 26:e1512. Epub 2021 Jul 26.

Pediatric Hematology Oncology and Bone Marrow Transplant Unit, Cancer Institute, Medanta The Medicity Hospital, Gurgaon, Haryana, India.

Background: Mulibrey-Nanism (Muscle-liver-brain-eye Nanism = dwarfism; MUL) is a rare genetic syndrome. The underlying TRIM37 mutation predisposes these children to develop tumors frequently. In the largest published series of MUL, 8% patients were reported to develop Wilms tumor (WT). The published literature lacks data regarding the best treatment protocol and outcome of this cohort of children with WT and MUL. We report here a 2-year-old boy with WT and MUL and present a review of literature on WT in MUL.

Case: Our patient had associated cardiac problems of atrial septal defect, atrial flutter and an episode of sudden cardiac arrest. We managed him successfully with chemotherapy, surgery and multi-speciality care. He is alive and in remission at follow-up of 6 months.

Conclusion: A total of 14 cases (including present case) of WT have been reported in MUL and treatment details were available for six cases. They were managed primarily with surgery, chemotherapy with/without radiotherapy, and all achieved remission. The outcome data is available only for two cases, one has been followed up till 15 years post treatment for WT and other is our patient.
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http://dx.doi.org/10.1002/cnr2.1512DOI Listing
July 2021

Sudden unexpected improvement in the atrioventricular conduction. What is the mechanism?

Indian Pacing Electrophysiol J 2021 Jul-Aug;21(4):248-250. Epub 2021 May 8.

Department of Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India. Electronic address:

The 12-lead electrocardiogram (ECG) of a 79-year-old male patient with recurrent pre-syncope showed irregular sinus rhythm with constant PR interval and left bundle branch block (LBBB) with intermittently blocked P waves. The beat following the blocked P wave had a narrower QRS with a shorter PR interval. The phenomenon of bilateral bundle branch block explains the sudden improvement in the atrioventricular conduction.
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http://dx.doi.org/10.1016/j.ipej.2021.05.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8263326PMC
May 2021

Regularly irregular, regular and irregularly irregular - All at the same time!

J Electrocardiol 2020 Sep - Oct;62:30-32. Epub 2020 Aug 6.

Department of Cardiology, Medanta-the Medicity, Gurgaon, Haryana, India. Electronic address:

An interesting case of dual tachycardia with coexisting atrial fibrillation and idiopathic left ventricular tachycardia is presented wherein transient ventricular bigeminal rhythm was observed.
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http://dx.doi.org/10.1016/j.jelectrocard.2020.08.004DOI Listing
June 2021

Narrow QRS tachycardia in a patient with first-degree atrioventricular block: What is the mechanism?

Pacing Clin Electrophysiol 2020 08 3;43(8):875-878. Epub 2020 Jul 3.

Department of Cardiac Electrophysiology and Pacing, Medanta Heart Institute, Medanta-The Medicity, Gurugram, India.

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http://dx.doi.org/10.1111/pace.13993DOI Listing
August 2020

Inappropriate automatic mode switch causing transient interruption of biventricular pacing: What is the mechanism?

Pacing Clin Electrophysiol 2020 05 22;43(5):518-519. Epub 2020 Apr 22.

Department of Cardiology, Medanta-The Medicity, Gurugram, India.

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http://dx.doi.org/10.1111/pace.13911DOI Listing
May 2020

Evaluation, Management, and Outcomes of Patients Poorly Responsive to Cardiac Resynchronization Device Therapy.

J Am Coll Cardiol 2019 11;74(21):2588-2603

Cardiocentro Ticino, Lugano, Switzerland.

Background: "Nonresponse" to cardiac resynchronization therapy (CRT) is recognized, but definition(s) applied in practice, treatment(s), and their consequences are little known.

Objectives: The authors sought to assess nonresponse in the prospective, international, ADVANCE CRT registry (Advance Cardiac Resynchronization Therapy Registry).

Methods: Each subject's response was assessed at 6 months post-implantation using site-specific definitions and compared with the independently derived clinical composite score (CCS). Treatment(s) and hospitalization(s) were tracked during the following 6 months.

Results: Of 1,524 subjects enrolled in 69 centers (68 ± 12 years of age, 32% female, ischemic disease 39%), 74.3% received CRT-defibrillator devices, using mainly quadripolar LV leads (75%) deployed laterally (78%). Indications for CRT were wider than past trials. Among 1,327 evaluable subjects, site-defined nonresponse was 20.0% (greater age, comorbidities, ischemic cardiomyopathy, non-left bundle branch block, and lower %CRT pacing vs. responders). Site definitions used mainly clinical criteria (echocardiography infrequently), and underestimated nonresponders by 35% compared with CCS (58% sensitivity vs. CCS). Overall, more site-defined nonresponders received treatment (55.9% vs. 38.3% of responders; p < 0.001) using medication changes and heart failure education, but device programming less frequently. Intensification of in-clinic/remote evaluations and involvement of heart failure specialists remained minimal. Remarkably, 44% of site-defined nonresponders received no additional treatment. Frequency and duration of hospitalizations, and death, among site-defined nonresponders was significantly higher than responders.

Conclusions: A high incidence of CRT nonresponders persists despite good patient selection and LV lead position, but site identification methods have modest sensitivity. Following diagnosis, nonresponders are often passively managed, without specialty care, with poor outcome. ADVANCE CRT exposes a vulnerable group of heart failure patients. (Advance Cardiac Resynchronization Therapy Registry [ADVANCE CRT]; NCT01805154).
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http://dx.doi.org/10.1016/j.jacc.2019.09.043DOI Listing
November 2019

Prevention of sudden cardiac death in athletes, sportspersons and marathoners in India.

Indian Heart J 2018 Jan - Feb;70(1):137-145. Epub 2017 Dec 15.

Medanta-The Medicity, Gurugram, India.

The annual incidence of sudden cardiac death (SCD) in athletes is significantly lower than the general population. However, when SCD occurs in an athlete during sporting event or training, it sends shockwaves in the society and raises questions about cardiovascular effects of sports and exercise. This document reviews the causes and mechanism of SCD in sports and exercise in young and older athletes. In the Indian context, we suggest a 'pre-participation screening' of young and older athletes and consider a 'supervised, graded exercise regime' for the uninitiated, older sports participant. Finally, the document proposes medical infrastructure required to successfully revive a victim of sudden cardiac arrest during a sporting event.
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http://dx.doi.org/10.1016/j.ihj.2017.12.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5903013PMC
July 2018

Clinical safety and performance of a MRI conditional pacing system in patients undergoing cardiac MRI.

Pacing Clin Electrophysiol 2017 Dec 5;40(12):1389-1395. Epub 2017 Dec 5.

Medanta - The Medicity, Gurgaon, India.

Background: Utilization of cardiac magnetic resonance imaging (cMRI) as an imaging modality in clinical practice is rapidly increasing. More evidence from randomized studies establishing clinical safety and performance of pacing systems in patients undergoing a cMRI scan is needed.

Objectives: The purpose of this prospective, multicenter, randomized study was to demonstrate safety and efficacy of the Accent MRI™ conditional pacing systems (St. Jude Medical, St. Paul, MN, USA) in patients undergoing cMRI scan.

Methods: Patients (n  =  283) indicated for dual-chamber pacemaker implant were randomized to either the MRI Group (MG) (n  =  140) or the Control Group (CG) (n  =  143) after successful device implantation of the Accent MRI™ system. Clinical evaluation and device interrogation were performed at pre- and post-MRI scan, and 1 month post-MRI for all patients. At 9-12 weeks postimplant, patients in MG underwent a nondiagnostic cMRI scan at 1.5 Tesla (T), while patients in CG underwent device interrogation and clinical evaluation twice with a 45-minute waiting period in between. The safety endpoint was freedom from MRI scan-related complications and that for efficacy was significant changes in right atrial/ventricular capture threshold and sensing amplitude between right before MRI, immediately after MRI, and 1 month post-MRI.

Results: Results showed 100% freedom from MRI scan-related complications. There were no significant changes in device performance between pre-MRI scan and 1 month post-MRI scan time points in both study groups.

Conclusions: cMRI scanning with 1.5 T scanners is safe in patients implanted with the Accent MRI™ conditional pacing system and has no significant effect on the electrical parameters of the device and leads.
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http://dx.doi.org/10.1111/pace.13232DOI Listing
December 2017

Role of Ibutilide in Atrial Fibrillation.

J Assoc Physicians India 2016 Aug;64(8 Suppl):27-30

Senior Consultant Cardiologist and Cardiac Electrophysiologist, Medanta-The Medicity, Gurgaon, Haryana.

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August 2016

Identifying the predictors of hematoma after device implantation: Closing in on the suspects with an aim to prevent the menace?

Indian Pacing Electrophysiol J 2016 Sep - Oct;16(5):157-158. Epub 2016 Dec 1.

Cardiology, Medanta-The Medicity, India. Electronic address:

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http://dx.doi.org/10.1016/j.ipej.2016.11.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5153436PMC
December 2016

Tilt test in paced patients: Is it worth the effort?

Indian Pacing Electrophysiol J 2015 Jul-Aug;15(4):189-92. Epub 2015 Oct 29.

Medanta-The Medicity, Gurgaon, Delhi-NCR, Haryana, India.

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http://dx.doi.org/10.1016/j.ipej.2015.10.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4750131PMC
March 2016

DF-4 Lead Connector: Innovative Technology, Unexpected Problems and Novel Solutions.

Indian Pacing Electrophysiol J 2014 May 25;14(3):108-11. Epub 2014 May 25.

Senior Consultant Cardiology, Medanta-The Medicity, Gurgaon, Delhi- NCR, Haryana, India.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4032777PMC
http://dx.doi.org/10.1016/s0972-6292(16)30751-3DOI Listing
May 2014

Cardiac Sarcoidosis - Arrhythmias, Inflammation and Anti-inflammatory Drug Therapy.

Indian Pacing Electrophysiol J 2012 Nov 2;12(6):234-6. Epub 2012 Dec 2.

Senior Consultant Cardiology, Medanta-The Medicity, Gurgaon, Delhi- NCR, Haryana, India.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3513237PMC
http://dx.doi.org/10.1016/s0972-6292(16)30562-9DOI Listing
November 2012

Markedly varying PR intervals during second degree atrioventricular block: possible mechanisms.

Indian Heart J 2012 May-Jun;64(3):329-30

Senior Consultant Cardiology, Division of Cardiac Electrophysiology and Pacing, Medanta Heart Institute, Medanta-The Medicity, Gurgaon - 122001, Haryana, India.

A case of second degree atrioventricular block following mitral valve replacement is presented during which varying PR intervals with sudden marked increase in PR interval in consecutive beats was seen. The electrocardiogram is discussed and various hypotheses to explain the possible electrophysiological mechanism are presented.
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http://dx.doi.org/10.1016/S0019-4832(12)60097-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3861048PMC
August 2013

What is your diagnosis?

Indian Heart J 2012 Mar-Apr;64(2):222-3. Epub 2012 Apr 28.

Division of Cardiac Electrophysiology and Pacing, Medanta Heart Institute, Medanta-The Medicity, Haryana, India.

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http://dx.doi.org/10.1016/S0019-4832(12)60076-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3861301PMC
July 2013

Entrainment during Ablation of Ischemic Ventricular Tachycardia. What is explanation for Post Pacing Interval shorter than the tachycardia cycle length?

Indian Pacing Electrophysiol J 2011 Nov 15;11(6):167-8. Epub 2011 Nov 15.

Division of Cardiac Electrophysiology and Pacing, Medanta Heart Institute, Medanta, The Medicity, Gurgaon, Delhi NCR, India.

Entrainment mapping of ischemic ventricular tachycardia at a site in the left ventricle where radiofrequency ablation was successful in terminating the tachycardia revealed a post-pacing interval shorter than the tachycardia cycle length. The reason for the same is explained in the current report.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3214613PMC
November 2011

Intermittent single nontracked P waves immediately after dual-chamber pacemaker implantation for complete AV block. What is the mechanism?

Pacing Clin Electrophysiol 2011 Sep 22;34(9):1158-60. Epub 2010 Nov 22.

Division of Cardiac Electrophysiology and Pacing, Medanta Heart Institute, Medanta, The Medicity, Gurgaon, Haryana, India.

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http://dx.doi.org/10.1111/j.1540-8159.2010.02977.xDOI Listing
September 2011

Unusual response to His-synchronous ventricular extra-stimulation during a supraventricular tachycardia: what is the mechanism?

Pacing Clin Electrophysiol 2011 May 11;34(5):612-3. Epub 2010 Nov 11.

Division of Cardiac Electrophysiology and Pacing, Medanta Heart Institute, Medanta, The Medicity, Gurgaon, Delhi-NCR, India.

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http://dx.doi.org/10.1111/j.1540-8159.2010.02946.xDOI Listing
May 2011

Regarding Article 'Multiple Episodes of Presyncope in a Pacemaker Dependent Patient: What is the Diagnosis?'.

Indian Pacing Electrophysiol J 2010 Jul 20;10(7):322-3. Epub 2010 Jul 20.

Division of Electrophysiology, Medanta Heart Institute, Medanta, The Medicity.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907093PMC
July 2010

A tachycardia classified as supraventricular by a cardiac resynchronization therapy-defibrillator device. What is the mechanism?

Pacing Clin Electrophysiol 2011 Jan;34(1):107-10

Division of Cardiac Electrophysiology and Pacing, Medanta Heart Institute, Medanta, The Medicity, Gurgaon, Haryana, India.

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http://dx.doi.org/10.1111/j.1540-8159.2010.02830.xDOI Listing
January 2011

Letter to the Editor--SVT with delayed atrial depolarization after His-synchronous ventricular stimulation.

Heart Rhythm 2012 Dec 30;9(12):e28; author reply e28-9. Epub 2010 Mar 30.

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http://dx.doi.org/10.1016/j.hrthm.2010.03.040DOI Listing
December 2012

Implantation of Dual-Chamber Cardioverter-Defibrillator through Left Iliac Vein in a Patient with Occluded Superior Vena Cava.

Indian Heart J 2006 Nov-Dec;58(6):454-7

Department of Cardiac Arrhythmia Services and Department of Peripheral Vascular Surgery, Escorts Heart Institute and Research Centre, New Delhi.

The occlusion of the superior vena cava is a known complication of repeated procedures related to pacemaker and implantable cardioverter-defibrillator devices. The insertion of implantable cardioverter-defibrillators in patients with this complication entails the practical problem of how to gain access to the heart. Surgical placement of epicardial leads and patches, using thoracotomy,is an established alternative but has its inherent problems, including high surgical risk. Also, the necessary hardware is not easily available. The existing literature has few reports of the insertion of implantable cardioverter-defibrillators through alternative transvenous routes. We report a case of implantation of a dual-chamber implantable cardioverter-defibrillator through the left iliac vein in a patient with arrhythmogenic right ventricular dysplasia, recurrent ventricular tachycardia and an occluded superior vena cava.
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November 2015

Protein C deficiency leading to pulmonary thromboembolism in a patient with hereditary spherocytosis.

Indian Heart J 2006 Nov-Dec;58(6):444-6

Department of Cardiology, Escorts Heart Institute and Research Centre, New Delhi.

Hereditary protein C deficiency results in a hypercoagulable state that can manifest itself as venous thrombosis and pulmonary embolism. The prevalence of this condition, even among patients with familial thrombosis, is quite low. We report a case of protein C deficiency presenting as massive pulmonary thromboembolism in a patient with hereditary spherocytosis, an uncommon hemolytic disorder not usually associated with increased thrombotic risk. A review of the literature revealed only a few cases of thrombosis associated with hereditary spherocytosis, and none of them had protein C deficiency. This makes the present case the first of its kind to be reported.
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November 2015

Narrow QRS incessant tachycardia in a patient with recent myocardial infarction: what is the mechanism?

Heart Rhythm 2008 Dec 17;5(12):1758-9. Epub 2008 Jan 17.

Department of Cardiac Arrhythmia Services, Escorts Heart Institute and Research Centre, New Delhi, India.

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http://dx.doi.org/10.1016/j.hrthm.2008.01.010DOI Listing
December 2008

Narrow QRS tachycardia with alternate wide QRS beats: what is the mechanism?

Indian Pacing Electrophysiol J 2008 Aug 1;8(3):234-7. Epub 2008 Aug 1.

Department of Cardiac Arrhythmia Services, Escorts Heart Institute and Research Centre, New Delhi, India.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2490811PMC
August 2008
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