Publications by authors named "Vanita Arora"

19 Publications

  • Page 1 of 1

Physiological pacing to improve cardiac resynchronization therapy non-responder and a tryst with calcified septum-a case report.

Egypt Heart J 2021 Mar 18;73(1):27. Epub 2021 Mar 18.

SGL Multispeciality Hospital, Jalandhar, Punjab, India.

Background: As per the literature, patients with intraventricular conduction delay (IVCD) do not respond well to cardiac resynchronization therapy (CRT) alone. They need advanced technological approach and out of the box thinking for a good response.

Case: Ours is a case of ischemic cardiomyopathy with wide QRS-IVCD, a non-responder to CRT. While planning for replacement of the device for early replacement indicator (ERI), we decided to do His-optimized CRT/left bundle optimized CRT (HOT-CRT/LOT-CRT) for the patient.

Conclusion: The challenges we faced with the present available hardware paved a way for insisting on the limitation of the available lumenless lead to penetrate calcified the septum and importance of the pre-procedure evaluation of intraventricular septum (IVS) for calcification by more than just echocardiography.
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http://dx.doi.org/10.1186/s43044-021-00145-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7973335PMC
March 2021

Alternate method for endocardial pacemaker lead implantation: A hybrid mini-thoracotomy approach.

Indian Pacing Electrophysiol J 2021 May-Jun;21(3):178-181. Epub 2021 Jan 22.

Department of Cardiology, Max Superspeciality Hospital, New Delhi, India. Electronic address:

Although the conventional methods for endo-cardial pacemaker lead implantation via subclavian or cephalic or axillary vein routes is common, but sometimes due to anatomical variations it is not feasible to access these veins Emergence of newer techniques are useful for lead implantation. This case report focuses on a hybrid approach of combined mini-thoracotomy for endocardial pacemaker lead implantation. This fluoroscopy guided minimal thoracotomy approach with endocardial MRI compatible lead placement had the benefits of simple procedural, minimal hospital stay, low early complication rates and economically viable to the patient.
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http://dx.doi.org/10.1016/j.ipej.2021.01.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8116752PMC
January 2021

A rare case of hypoplastic coronary sinus partially draining into right superior vena cava: A case report.

Pacing Clin Electrophysiol 2021 01 29;44(1):178-180. Epub 2020 Nov 29.

Max Super Speciality Hospital, New Delhi, India.

Background: The hypoplastic coronary sinus (CS) is a rare anomaly of the cardiac venous system, wherein some of the tributaries fail to join the CS. These tributaries usually drain into atrial chambers through dilated thebesian channels. We report the first case where the tributaries are draining into the right superior vena cava (SVC).

Case Summary: A case of ischemic cardiomyopathy with severe LV systolic dysfunction with NYHA class III symptoms was taken for CRTD implantation. CS venogram after direct cannulation from left subclavian access revealed a hypoplastic CS. The part of CS beyond the attachment of the oblique vein of the left atrium to CS (distal to the posterolateral vein) formed a common channel and was draining into the right-sided SVC. The posterolateral vein was of sufficient caliber so that an left ventricle (LV) lead could be implanted, and the CRTD procedure could be completed.

Discussion: Hypoplastic CS though has no pathological significance in the normal population but for CRT it can become a significant limitation. Tributaries of CS draining into right SVC are the rarest of the finding, the channel draining most likely is a remnant of the splanchnic plexus around the embryonic foregut that usually has a temporary communication with cardinal veins during intrauterine growth. This communication somehow has persisted and resulted in a channel between coronary vein and the SVC, which may be referred to as coronary veno-cardinal vein.
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http://dx.doi.org/10.1111/pace.14116DOI Listing
January 2021

Left bundle branch pacing: A comprehensive review.

J Cardiovasc Electrophysiol 2020 09 30;31(9):2462-2473. Epub 2020 Jul 30.

Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, Geisinger Heart Institute, Wilkes-Barre, Pennsylvania, USA.

Cardiac pacing is the only effective therapy for patients with symptomatic bradyarrhythmia. Traditional right ventricular apical pacing causes electrical and mechanical dyssynchrony resulting in left ventricular dysfunction, recurrent heart failure, and atrial arrhythmias. Physiological pacing activates the normal cardiac conduction, thereby providing synchronized contraction of ventricles. Though His bundle pacing (HBP) acts as an ideal physiological pacing modality, it is technically challenging and associated with troubleshooting issues during follow-up. Left bundle branch pacing (LBBP) has been suggested as an effective alternative to overcome the limitations of HBP as it provides low and stable pacing threshold, lead stability, and correction of distal conduction system disease. This paper will focus on the implantation technique, troubleshooting, clinical implications, and a review of published literature of LBBP.
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http://dx.doi.org/10.1111/jce.14681DOI Listing
September 2020

Consensus statement for implantation and follow-up of cardiac implantable electronic devices in India.

Indian Pacing Electrophysiol J 2018 Nov - Dec;18(6):188-192. Epub 2018 Nov 2.

Pushpawati Singhania Research Institute & Heart Institute, New Delhi, India.

Cardiac implantable electronic device (CIED) procedures are being done by many operators/centers and it is projected that this therapy will remarkably increase in India in the coming years. This document by IHRS, aims at guiding the Indian medical community in the appropriate use and method of implantation with emphasis on implanter training and center preparedness to deliver a safe and effective therapy to patients with cardiac rhythm disorders and heart failure.
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http://dx.doi.org/10.1016/j.ipej.2018.10.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6303166PMC
November 2018

Pilot evaluation of an integrated monitor-adhesive patch for long-term cardiac arrhythmia detection in India.

Expert Rev Cardiovasc Ther 2014 Jan 10;12(1):25-35. Epub 2013 Dec 10.

India Medtronic Private Limited, 1241 Solitaire Corporate Park, Andheri-Ghatkopar Link Road, Andheri East, Mumbai 400 093, India.

Electrocardiographic monitoring represents one of the most reliable and time-tested methods for reducing ambiguity in cardiac arrhythmia diagnosis. In India, the resting ECG is generally the first tool of choice for in-clinic diagnosis. The external loop recorder (ELR) is another useful tool that compounds the advantages of traditional tools by coupling ambulatory monitoring with a long-term window. Thus, the objective was to test the use of a 7-day ELR for arrhythmia diagnosis in India for a broad range of presenting symptoms. In this study set in the Indian healthcare environment, an auto-triggered, wireless patch-type ELR was used with 125 patients (62.5 ┬▒ 16.7 years, 76 males) presenting a broad range of symptoms. Eighty percent of the symptoms were related to syncope, presyncope or palpitations. Patients were administered an ELR for 7-28 days depending on the physician's prescription. Prespecified significant arrhythmias included sinus pause >2 s, symptomatic bradycardia <40 b.p.m., second-degree (and higher) AV block, complete heart block, ventricular fibrillation, sustained/nonsustained ventricular tachycardia (>3 beats), atrial fibrillation (chronic or paroxysmal), atrial flutter and supraventricular tachycardia (SVT) >130 b.p.m. Diagnostic yield was 38% when a stringent tabulation methodology considering only clinically significant arrhythmia was used. When first-degree AV block, premature atrial and ventricular beats, couplets (both atrial and ventricular in origin), bigeminy or trigeminy, or sudden changes in rate (noted as sinus arrhythmia) were included in the calculation, diagnostic yield was 80%. Patient compliance was 98%; patients wore the patch for the entire prescribed monitoring period without disruption. Seventy percent of the reported symptoms corresponded with an arrhythmia. Use of the ELR led to therapy change in 24% of patients: 15 patients went on to receive an implantable cardioverter defibrillator or pacemaker, 4 received ablation therapy and 11 altered their medication after diagnosis. This study demonstrates that a high diagnostic yield for clinically significant arrhythmias and high patient compliance can be achieved with a wearable patch monitor in Indian patients suffering from a variety of symptoms.
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http://dx.doi.org/10.1586/14779072.2013.867807DOI Listing
January 2014

An unusual tachy-brady syndrome. Torsades de pointes.

Indian Heart J 2010 Jul-Aug;62(4):356

Departement of Cardiac Electrophysiology, Max Superspeciality Hospital, Saket, New Delhi.

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February 2011

A supraventricular tachycardia with two atrial activation sequences: what is the mechanism?

Heart Rhythm 2011 Aug 25;8(8):1299-301. Epub 2010 Sep 25.

Department of Cardiology, Max Heart and Vascular Institute, Saket, New Delhi 110017, India.

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http://dx.doi.org/10.1016/j.hrthm.2010.09.072DOI Listing
August 2011

B-type natriuretic peptide-a CPK for heart-failure and beyond (ischemia)?

Indian Heart J 2006 Mar-Apr;58(2):90-2

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March 2009

Persistent left superior vena cava opening directly into right atrium and mistaken for coronary sinus during biventricular pacemaker implantation.

Heart Rhythm 2007 Jun 16;4(6):810. Epub 2006 Sep 16.

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

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http://dx.doi.org/10.1016/j.hrthm.2006.09.018DOI Listing
June 2007

Newer mapping technology--when are they really needed?

Indian Heart J 2007 Jan-Feb;59(1 Suppl A):A41-50

Escorts Heart Institute and Research Centre, New Delhi, India.

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February 2009

Implantable cardioverter defibrillatory implantation in a patient with persistent left superior vena cava and right superior vena cava atresia.

Indian Heart J 2005 Nov-Dec;57(6):717-9

Escorts Heart Institute and Research Centre, New Delhi.

Persistence of a left superior vena cava has been observed in 0.3% of the general population as established by autopsy findings. In the adult population. it is an important anatomic finding if a left or right superior vena cava approach to the heart is considered for device implantation. We present a case with persistent left superior vena cava and right superior vena cava atresia in whom a dual chamber implantable cardioverter defibrillator was implanted and was technically challenging.
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April 2006

Absent left inferior pulmonary vein in a patient undergoing atrial fibrillation ablation.

J Cardiovasc Electrophysiol 2005 Aug;16(8):924-5

Electrophysiology Laboratories of Aurora Sinai/St. Luke's Medical Centers, University of Wisconsin Medical School-Milwaukee Clinical Campus, Wisconsin, USA.

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http://dx.doi.org/10.1046/j.1540-8167.2005.40834.xDOI Listing
August 2005

Right and left ventricular activation sequence in patients with heart failure and right bundle branch block: a detailed analysis using three-dimensional non-fluoroscopic electroanatomic mapping system.

J Cardiovasc Electrophysiol 2005 Feb;16(2):112-9; discussion 120-1

Division of Cardiology, University Hospital, Magdeburg, Germany.

Unlabelled: Three-dimensional mapping in RBBB and heart failure.

Introduction: Recently, right bundle branch block (RBBB) was proved to be an important predictor of mortality in heart failure (HF) patients as much as left bundle branch block (LBBB). We characterized endocardial right ventricular (RV) and left ventricular (LV) activation sequence in HF patients with RBBB using a three-dimensional non-fluoroscopic electroanatomic contact mapping system (3D-Map) in order to provide the electrophysiological background to understand whether these patients can benefit from cardiac resynchronization therapy (CRT).

Methods And Results: Using 3D-Map, RV and LV activation sequences were studied in 100 consecutive HF patients. Six of these patients presented with RBBB QRS morphology. The maps of these patients were analyzed and compared post hoc with those of the other 94 HF patients presenting with LBBB. Clinical and hemodynamic profile was significantly worse in RBBB group compared to LBBB. Patients with RBBB showed significantly longer time to RV breakthrough (P<0.001), longer activation times of RV anterior and lateral regions (P<0.001), and longer total RV endocardial activation time (P<0.02) compared to patients with LBBB. Time to LV breakthrough was significantly shorter in patients with RBBB (P<0.001), while total and regional LV endocardial activation times were not significantly different between the two groups.

Conclusions: Degree of LV activation delay is similar between HF patients with LBBB and RBBB. Moreover, patients with RBBB have larger right-sided conduction delay compared to patients with LBBB. The assessment of these electrical abnormalities is important to understand the rationale for delivering CRT in HF patients with RBBB.
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http://dx.doi.org/10.1046/j.1540-8167.2005.40777.xDOI Listing
February 2005
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