Publications by authors named "Yash Lokhandwala"

135 Publications

Can Simple Laboratory Parameter in Acute Coronary Syndrome Help Predict in Stent Restenosis?

J Assoc Physicians India 2021 Nov;69(11):11-12

Professor, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra.

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November 2021

Arrhythmia spectrum and outcome in children with myocarditis.

Ann Pediatr Cardiol 2021 Jul-Sep;14(3):366-371. Epub 2021 Aug 26.

Department of Cardiology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India.

Introduction: Myocarditis remains an under-diagnosed entity among children. We evaluated the spectrum of electrocardiogram (ECG) changes and arrhythmias in children with myocarditis.

Methods: A single-center prospective observational study was conducted over a period of 18 months at a public university hospital, which included all cases with myocarditis from the ages of 1 month to 12 years. Myocarditis was diagnosed according to standard criteria. Arrhythmias were detected by 12-lead ECG or by multiparameter monitors.

Results: There were 63 children with myocarditis. Sinus tachycardia remained the most important ECG finding (61, 96.8%) followed by ST-T changes (30, 47.6%), low voltage QRS complexes (23, 36.5%), and premature complexes (11, 17.4%). Sustained arrhythmias were seen in 14/63 (22.2%) of the children (Group A), while the remaining 49 patients were designated as Group B. There were 11 (17.5%) cases with sustained tachyarrhythmias, comprising 5 with supraventricular tachycardia, 4 with ventricular tachycardia, and 2 with atrial flutter/fibrillation. Bradyarrhythmias were seen in 3 patients, including 2 children with atrioventricular block and 1 with severe sinus bradycardia. A longer hospital stay of 18.5 (4.75) days vs. 13 (4) days, = 0.001), and more ST-T changes [12 (85.7%) vs. 18 (36.73%), = 0.003] were seen in Group A. Multivariate regression analysis found only the presence of ST-T changes as predictors for arrhythmia.

Conclusions: A variety of arrhythmias and other ECG changes were commonly seen in children with myocarditis. Sustained arrhythmias were seen in one-fifth of the patients, being associated with ST-T changes and a longer hospital stay.
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http://dx.doi.org/10.4103/apc.apc_207_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8457292PMC
August 2021

Assessment of a widely applicable torso ECG in acute coronary syndrome.

Indian Heart J 2021 Jul-Aug;73(4):487-491. Epub 2021 Apr 6.

LTMG Hospital, Sion, Mumbai, India.

Introduction: The time from symptom onset to arrival at healthcare facility, and door to reperfusion time in treatment of acute coronary syndrome (ACS) can be improved significantly if the patient or the relatives can record a 12-lead ECG at home and transmit it to the physician for prompt interpretation. To make this widely applicable, the 12-lead ECG recording device has to be simple and user friendly. In this regard, torso ECG (T-ECG) electrode positions that are less cumbersome than the conventional ECG (C-ECG) electrode positions are an alternative worthy of consideration.

Objective: and setting: To study the utility of T-ECG versus C-ECG in ACS patients.

Design: and intervention: We proposed torso electrode positions in which upper limb electrodes were placed in the respective deltopectoral grooves below the lateral end of the clavicle; the right lower limb electrode was placed 2 finger breadths above the umbilicus and the left lower limb electrode, 2 finger breadths to the left of the umbilicus. We then studied the ECGs recorded, to ascertain whether T-ECGs miss or over-diagnose ACS changes. Twelve lead ECGs were recorded by both techniques (C-ECG & T-ECG) in 1361 patientsfrom the coronary care unit & out-patient department of a tertiary care hospital. A total of 1526 sets of ECGs (each set consisting of one C-ECG and one T -ECG) were read by two trained cardiologists independently and in a blinded fashion. There were 457 ECG sets from 342 patients with ACS. Of these, 116 ECG sets from 112 patients of anterior infarction who had changes restricted to precordial leads were excluded. Finally, 341 ECG sets from 230 patients with ACS and 324 sets of patients diagnosed to be normal on C-ECG were considered for the purpose of this study.

Main Results: All 341 ECG sets from the 230 patients of ACS diagnosed by C-ECG were correctly diagnosed by T-ECG (100% sensitivity) and all 324 normal ECGs on C-ECG were also identified as normal on T-ECG (100% specificity). Of the ACS ECGs, ST elevation was seen in 234 ECGs and ST depressions 154 ECGs. The localizations of ST elevation and ST depression were also accurately diagnosed by the T-ECG.

Conclusion: The ECG recorded by our novel proposed torso electrode positions is comparable to a conventional ECG for the diagnosis of ACS.
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http://dx.doi.org/10.1016/j.ihj.2021.03.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8424276PMC
November 2021

QRS alternans during right ventricular pacing while ablating a concealed left sided accessory pathway.

Indian Pacing Electrophysiol J 2021 Sep-Oct;21(5):324-326. Epub 2021 Jun 23.

Department of Cardiology, Holy Family Hospital and Research Centre, Bandra West, Mumbai, India.

A 16-year-old boy was referred for an electrophysiological study for documented regular narrow complex tachycardia. A diagnosis of a concealed left lateral accessory pathway was made with an eccentric atrial activation sequence both during tachycardia and right ventricular (RV) pacing. The pathway was mapped at the left posterior mitral vestibule during RV pacing, performed through the distal tip of the His bundle catheter pushed into right ventricular outflow tract. An unusual response to ventricular stimulation with alternation of QRS complex width and morphology was noted. The possible mechanisms are hereby discussed.
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http://dx.doi.org/10.1016/j.ipej.2021.05.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8414319PMC
June 2021

Persistent left superior caval vein draining into right atrium, but not through the coronary sinus.

Indian Pacing Electrophysiol J 2021 Jul-Aug;21(4):255-256. Epub 2021 May 19.

Holy Family Hospital, Bandra West, Mumbai, India. Electronic address:

Persistence of the left superior caval vein is the most commonly reported thoracic venous anomaly. The vein usually drains into the right atrium through the coronary sinus, reflecting its developmental origin. We describe an unusual variant, in which the vein drained directly into the right atrium.
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http://dx.doi.org/10.1016/j.ipej.2021.05.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8263332PMC
May 2021

Correlation of newer indices of dyssynchrony with clinical response in patients undergoing cardiac resynchronisation therapy.

Indian Heart J 2021 Mar-Apr;73(2):223-227. Epub 2020 Dec 31.

Holy Family Hospital and Research Centre, Mumbai, India.

The benefits of CRT in select subsets of systolic heart failure patients with LBBB are proven. We prospectively evaluated conventional and newer echocardiographic parameters of left ventricular dyssynchrony in 35 patients who underwent CRT and were followed up after 6 months. Of the 33 surviving patients, 21 were echocardiographic responders and 24 were clinical responders. The parameters in clinical responders and non-responders were compared. The anatomic M Mode parameters of delays improved, while the radial strain and the mitral valve velocity time integral (MVVTI) did not show any significant change after CRT.
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http://dx.doi.org/10.1016/j.ihj.2020.12.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8065358PMC
November 2021

How significant is the radiation exposure during electrophysiology study and ablation procedures for supraventricular tachycardia?

Indian Heart J 2021 Mar-Apr;73(2):221-222. Epub 2021 Mar 17.

Department of Cardiology, Holy Family Hospital, Bandra West, Mumbai, India.

Radiation exposure during electrophysiology procedures has been a point of discussion. We measured the ionising radiation dosage during ablation procedures for supraventricular tachycardia. This was compared with coronary angiographies performed via the radial route to put it in perspective. We found that the radiation dosage during the ablation procedure was far lower, less than forty percent of that during coronary angiography (Air Kerma 249.1 mGy ± 266.95 mGy v/s 671.9 mGy ± 328.6 mGy; p < 0.001).
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http://dx.doi.org/10.1016/j.ihj.2021.03.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8065359PMC
November 2021

Is the right ventricular function affected by permanent pacemaker?

Pacing Clin Electrophysiol 2021 May 16;44(5):929-935. Epub 2021 Apr 16.

Department of Cardiology, Holy Family Hospital, Mumbai, Maharashtra, India.

Aims: The effect of right ventricular (RV) pacing on left ventricular (LV) function has been extensively evaluated, but the effect on RV function per se has not been evaluated systematically. We aimed to assess the effect of dual chamber pacemaker on RV function.

Methods And Results: All consecutive patients undergoing dual chamber pacemaker from January 2018 to March 2019 for AV block with a structurally normal heart were included. They underwent pre-procedure detailed echocardiography (including three-dimensional [3D] RV ejection fraction [RVEF]), a screening echocardiogram 2 days after pacemaker implantation and again a detailed echocardiogram at 6-month follow-up. We compared the baseline echocardiographic RV parameters with those 6 months after the pacemaker implantation. A total of 60 patients underwent successful pacemaker implantation. At 6 months, most of the patients were pacemaker dependent with pacing percentage of 98.9% ± 2.4%; there was a significant increase in TR and a mean drop in RVEF by 2.8 ± 5%, with 23 (38.3%) having at least a 5% decrease in RVEF. The drop in RVEF positively correlated with TR vena contracta at 6 months but did not correlate with pulmonary artery systolic pressure at 6 months.

Conclusion: Our study shows the presence of demonstrable RV dysfunction as early as 6 months in a majority of patients who have undergone pacemaker implantation.
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http://dx.doi.org/10.1111/pace.14240DOI Listing
May 2021

Persistent atypical atrial flutter after device closure of the atrial septal defect in a young man.

Ann Pediatr Cardiol 2021 Jan-Mar;14(1):79-81. Epub 2020 Oct 19.

Department of Cardiology, Holy Family Hospital, Mumbai, Maharashtra, India.

Atrial flutter is uncommon in young patients with uncorrected atrial septal defect (ASD). Although rare, it has been reported in the younger population following device closure of ASD/patent foramen ovale. We describe a case of persistent atypical atrial flutter following device closure of ASD in a young man and discuss the management strategy given the various underlying dilemmas.
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http://dx.doi.org/10.4103/apc.APC_72_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7918033PMC
October 2020

Adenosine-A drug with myriad utility in the diagnosis and treatment of arrhythmias.

J Arrhythm 2021 Feb 18;37(1):103-112. Epub 2020 Dec 18.

Department of Cardiology North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences Shillong India.

Adenosine has been used in the emergency treatment of arrhythmia for more than nine decades. However, cardiologists are often unfamiliar about its basic mechanism and various diagnostic and therapeutic uses, considering it mainly as a therapeutic drug for supraventricular tachycardia. This article discusses the role of adenosine relevant to emergency physicians, cardiologists, and electrophysiologists. Understanding of the mechanisms of adenosine and its electrophysiological effects is discussed first, followed by dosing, side effects, diagnostic, and therapeutic uses. Finally, the role of adenosine in the electrophysiology laboratory is discussed.
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http://dx.doi.org/10.1002/joa3.12453DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7896475PMC
February 2021

Long-term clinical outcomes of cardiac sympathetic denervation in patients with refractory ventricular arrhythmias.

J Cardiovasc Electrophysiol 2021 04 25;32(4):1065-1074. Epub 2021 Feb 25.

Department of Cardiology, Holy Family Heart Institute, Bandra, Mumbai, India.

Background: Cardiac sympathetic denervation (CSD) is a useful therapeutic option in patients with structural heart disease (SHD) and ventricular tachycardia (VT) who are otherwise refractory to standard antiarrhythmic drug (AAD) therapy or catheter ablation (CA). In this study, we sought to retrospectively analyze the long-term outcomes of CSD in patients with refractory VT and/or VT storm with a majority of the patients being taken up for CSD ahead of CA.

Methods: We included consecutive patients with SHD who underwent CBD from 2010 to 2019 owing to refractory VT. A complete response to CSD was defined as a greater than 75% reduction in the frequency of ICD shocks for VT.

Results: A total of 65 patients (50 male, 15 female) were included. The underlying VT substrate was ischemic heart disease (IHD) in 30 (46.2%) patients while the remaining 35 (53.8%) patients had other nonischemic causes. The mean duration of follow-up was 27 ± 24 months. A complete response to CSD was achieved in 47 (72.3%) patients. There was a significant decline in the number of implantable cardioverter-defibrillator (ICD) or external defibrillator shocks post-CSD (24 ± 37 vs. 2 ± 4, p < .01). Freedom from a combined endpoint of ICD shock or death at 2 years was 51.5%. An advanced New York Heart Association class (III and IV) was the only parameter found to be associated with this combined endpoint.

Conclusion: The current retrospective analysis re-emphasizes the role of surgical CSD and explores its role ahead of CA in the treatment of patients with refractory VT or VT storm.
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http://dx.doi.org/10.1111/jce.14947DOI Listing
April 2021

A Hidden Recess of Atrial Tachycardia.

J Innov Card Rhythm Manag 2021 Jan 15;12(1):4372-4374. Epub 2021 Jan 15.

Holy Family Hospital, Mumbai, India.

We present a case of regular narrow complex tachycardia in a 59-year-old woman with frequent paroxysmal palpitations, a normal electrocardiogram (ECG) in sinus rhythm, and a structurally normal heart. During electrophysiology study, a long R-P tachycardia was present at baseline, with P-waves superimposed on the T-waves and appearing to be positive in the inferior leads. Intracardiac recordings showed the atrial activation to be early in the para-Hisian region. The diagnosis of atrial tachycardia was confirmed by ventricular overdrive pacing, which showed ventriculoatrial dissociation without perturbing the atrial rate. The precise P-wave morphology was brought out in the pause, which followed rapidly delivered ventricular extrastimuli during tachycardia. Based on this information, activation mapping was conducted in the para-Hisian region, high atrial septal regions on the right and left sides, and aortic sinuses. Tachycardia was successfully ablated at one of these sites.
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http://dx.doi.org/10.19102/icrm.2021.120103DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7834042PMC
January 2021

Which Way to the Summit?

J Innov Card Rhythm Manag 2020 Dec 15;11(12):4313-4316. Epub 2020 Dec 15.

Holy Family Hospital and Research Center, Mumbai, India.

A 57-year-old man presented with palpitations and dizziness for one day. He reported a history of similar short-lasting, self-limiting episodes in the past. Evaluation showed a hemodynamically stable, ongoing monomorphic ventricular tachycardia (VT) with positive concordance in the precordial leads and inferior axis. A structurally normal heart was seen on echocardiography. The VT was cardioverted to normal sinus rhythm with a biphasic 100-J direct-conversion shock under mild sedation, only to spontaneously start over again. In view of the patient's structurally normal heart, a previous history of similar complaints in the past, and no obvious trigger including ischemia for VT, he subsequently underwent an electrophysiology study (EPS).
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http://dx.doi.org/10.19102/icrm.2020.111201DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7769508PMC
December 2020

Pneumothorax leading to pneumopericardium after transvenous lead implantation in a patient with previous epicardial lead.

Pacing Clin Electrophysiol 2021 03 18;44(3):545-547. Epub 2020 Dec 18.

Holy Family Hospital, Mumbai, India.

A 44-year-old lady, a follow-up case of idiopathic dilated cardiomyopathy and cardiac resynchronization therapy defibrillator device implantation with epicardial left ventricular (LV) lead, underwent a transvenous LV lead revision in view of epicardial lead malfunction. A chest X-ray after this, done for worsening dyspnea, revealed pneumopericardium along with left pneumothorax. The computed tomography (CT) revealed a communication between the left pleural and pericardial cavities, around the old epicardial lead. Drainage of the left pleural cavity resolved both the pneumothorax and pneumopericardium and the patient remained well on follow up.
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http://dx.doi.org/10.1111/pace.14136DOI Listing
March 2021

Uncommon modes of initiation of 'A on V' narrow QRS tachycardia: What are the mechanisms?

Pacing Clin Electrophysiol 2021 01 30;44(1):145-147. Epub 2020 Nov 30.

Department of Cardiology, Bandra Holy Family Hospital and Research Centre, Mumbai, India.

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http://dx.doi.org/10.1111/pace.14127DOI Listing
January 2021

Where Is the Level of Atrioventricular Block?

Circulation 2020 10 26;142(17):1684-1686. Epub 2020 Oct 26.

Holy Family Hospital and Research Centre, Mumbai, India (C.R., Y.L.).

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http://dx.doi.org/10.1161/CIRCULATIONAHA.120.050344DOI Listing
October 2020

Ventricular tachycardia as the presenting feature in two patients with cardiac lipoma and cardiac fibroma.

Indian Pacing Electrophysiol J 2021 Jan-Feb;21(1):62-64. Epub 2020 Oct 15.

Department of Cardiology, Holy Family Hospital, Bandra, Mumbai, India.

We hereby present two patients with benign cardiac tumours presenting as ventricular tachycardia (VT). Most such tumours have a favorable prognosis, unless complicated by arrhythmias. Intracavitary tumours are easily diagnosed by echocardiography. Intramural tumours as in our patients may be missed at times by echocardiography. Multimodality imaging helped confirm the diagnosis and etiology, since biopsy was not safe. Surgical removal was not feasible due to extensive infiltration. The patients are so far doing well on medical therapy.
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http://dx.doi.org/10.1016/j.ipej.2020.10.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7854368PMC
October 2020

In-hospital and intermediate term outcome of ventricular tachycardia storm.

Indian Heart J 2020 Jul - Aug;72(4):299-301. Epub 2020 Jul 11.

Department of Cardiology, Holy Family Hospital and Research Institute, Bandra, Mumbai, 400050, India.

Real world data on management and outcomes of ventricular tachycardia (VT) storm are scarce. This prospective study evaluates the clinical profile, in-hospital outcome and intermediate outcome in patients presenting with VT Storm. A majority (36/50, 72%) were male and the age was 54 ± 15 years. Scar VT was the most common underlying substrate for VT stormand pleomorphic VT was the predominant morphology. Twenty-one (42%) patients underwent cardiac sympathetic denervation, 6 (12%) patients underwent radiofrequency ablation (RFA), 3 (6%) patients amongst these underwent both the precedures in addition to conventional medical management. The overall mortality was 18% and VT free survival was 54%at 6 months follow up. VT recurrence was more common with severe LV dysfunction.
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http://dx.doi.org/10.1016/j.ihj.2020.07.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7474119PMC
March 2021

Professor Hein JJ Wellens, In memoriam.

Indian Pacing Electrophysiol J 2020 Sep - Oct;20(5):213-214. Epub 2020 Aug 6.

LTMG Hospital, Mumbai, India.

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http://dx.doi.org/10.1016/j.ipej.2020.07.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7517541PMC
August 2020

Changing atrial activation patterns during narrow complex tachycardia.

J Cardiovasc Electrophysiol 2020 09 29;31(9):2519-2521. Epub 2020 Jul 29.

Department of Cardiology, Bandra Holy Family Hospital and Research Centre, Mumbai, Maharashtra, India.

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http://dx.doi.org/10.1111/jce.14685DOI Listing
September 2020

Acute hemodynamics of cardiac sympathetic denervation.

Indian Pacing Electrophysiol J 2020 Nov - Dec;20(6):237-242. Epub 2020 Jun 14.

Holy Family Hospital, Bandra West, Mumbai, 400050, India.

Introduction: We aimed to study the immediate hemodynamic effects of thoracoscopic bilateral cardiac sympathetic denervation (CSD) for recurrent ventricular tachycardia (VT) or VT storm.

Method: We studied a group of 18 adults who underwent bilateral thoracoscopic CSD; the blood pressure (BP) and Heart Rate (HR) were continuously monitored during the surgery and up to 6 h post-operatively.

Results: Immediately on removal of the sympathetic ganglia, the patients had a drop in both the systolic (110 mm Hg to 95.8 mm Hg, p < 0.001) and diastolic BP (69.4 mm Hg to65 mm Hg, p = 0.007) along with a drop in the HR (81.6 bpm to 61.2 bpm, p < 0.001).At 6 h after CSD, the systolic and diastolic BP did not recover significantly, while there was recovery in HR (61.2 bpm to 66 bpm, p = 0.02). There was no significant difference between those with and without left ventricular (LV) systolic dysfunction.

Conclusion: The acute hemodynamic changes during the perioperative period of CSD are significant but not serious. Awareness of this is useful for peri-operative management.
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http://dx.doi.org/10.1016/j.ipej.2020.06.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7691767PMC
June 2020

Arrhythmia in Children and Adolescents and Outcome of Radiofrequency Ablation for Tachyarrhythmias - A Single Center Experience Over 16 Years.

Indian Pediatr 2020 Dec 12;57(12):1127-1130. Epub 2020 Jun 12.

Department of Electrophysiology, Holy Family Hospital, Mumbai, India.

Objective: Radiofrequency (RF) ablation for tachycardia in children poses challenges in view of slender veins and delicate cardiac structures in close proximity.

Methods: We reviewed hospital records for patients below 18 years,who underwent RF ablation from August, 2001 to February, 2017 at a single hospital.

Results: Among 214 patients (134 males, age12.5 (4.6) years), there were 221 tachycardia substrates: accessory pathways in 85 patients (39%), AV nodal re-entrant tachycardia in 79 patients (36%), ventricular tachycardia in 28 patients (13%) and atrial tachycardia in 21 patients (9.6%).The overall success rate of RF ablation was 95% (204/214). Success rate in those younger than 6 years was similar to those in older age groups. There were no major complication.

Conclusions: RF ablation below 18 years of age has a high success rates and low complications.
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December 2020

Two tachycardias, wide and narrow-more than a coincidence?

J Cardiovasc Electrophysiol 2020 Jun 13;31(6):1553-1556. Epub 2020 Apr 13.

Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.

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http://dx.doi.org/10.1111/jce.14486DOI Listing
June 2020

Intermediate term outcome after electrogram guided segmental ostial pulmonary vein isolation using an 8 mm tip catheter for paroxysmal atrial fibrillation.

Indian Heart J 2019 Sep - Oct;71(5):381-386. Epub 2019 Dec 6.

Department of Cardiology, Holy Family Hospital and Research Institute, Bandra West, Mumbai, India. Electronic address:

Introduction: Pulmonary vein isolation (PVI) is the most widely used procedure for ablation in patients with paroxysmal atrial fibrillation (AF). Not withstanding recent advancements in this field, including sophisticated three-dimensional (3D) based imaging and advanced ablation catheters with contact force technology, many patients and healthcare systems in developing countries will not afford such an expensive therapeutic procedure. There are no data from India analyzing the efficacy of PVI for PAF using conventional mapping and ablation. In this article, we have summarized the intermediate term outcome following PVI in patients with PAF using electrogram-based mapping and a 8 mm tip ablation catheter.

Method: A total of 42 consecutive patients who underwent PVI for symptomatic PAF not controlled with at least one antiarrhythmic drug were studied in a tertiary care institute from March 2011 to June 2018. Patients with rheumatic AF were excluded. The pulmonary vein (PV) anatomy was assessed by pulmonary angiography during the ablation procedure. Using conventional electrophysiologic mapping, a variable curve Lasso catheter placed in the PVs was used to guide the earliest site of breakthrough. The segmental ostial PVI was performed using a 8 mm tip radiofrequency (RF) ablation catheter. Elimination of all PV ostial potentials and complete entrance block into the PV were considered indicative of complete electrical isolation. Follow-up visits were scheduled at one, three, and six months after the procedure, and every six months thereafter. History, symptom review, clinical examination, and 12-lead ECG were performed at each follow-up.

Results: At pre-discharge, 34 patients (81%) were in sinus rhythm, while eight patients (19%) continued to have atrial fibrillation. The age of the study population was 51.5 ± 11.7 yrs. The mean follow-up duration was 44 ± 21 months (range 6-84 months). The number of PVs isolated included one (five patients, 11.9%), two (20 patients, 47.6%), three (12 patients, 28.6%), and four (five patients, 11.9%). In 42 patients, a total of 101 PVs were isolated. The right superior PV (RSPV) was isolated in 37 patients, the left superior PV (LSPV) was isolated in 39 patients, the left inferior PV (LIPV) was isolated in 14 patients, and the right inferior PV (RIPV) was isolated in six patients. The procedure duration was 125 ± 29 min and the fluoroscopy time was 47 ± 13 min. The number of patients who remained in sinus rhythm at 1, 6, 12, and 24 months were 34 (81%), 32 (76%), 30 (71%), and 26 (62%), respectively. Two patients of these underwent repeat PVI, which was successful, and they had freedom from AF episodes. Complications were rare. One patient had a minor pericardial effusion, and one patient had transient sinus pauses, which were conservatively managed.

Conclusion: Conventional RF ablation using PV potential-based mapping and ablation with 8 mm tip catheters is safe for patients with PAF. The intermediate term outcome is satisfactory and cost-effective in our setting with limited resources.
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http://dx.doi.org/10.1016/j.ihj.2019.11.258DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7013183PMC
August 2020

What is the mechanism of paroxysmal atrioventricular block in a patient with recurrent syncope?

J Arrhythm 2019 Dec 27;35(6):870-872. Epub 2019 Sep 27.

Arrhythmia Associates Mumbai India.

Paroxysmal atrioventricular (AV) block is characterized by sudden appearance of complete heart block with no escape rhythm. Three types have been described having different mechanisms namely, vagally mediated, intrinsic, and idiopathic. A rare case scenario is being described with the occurrence of paroxysmal AV block of all three types in the same patient.
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http://dx.doi.org/10.1002/joa3.12245DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6898553PMC
December 2019

Unusual variants of pre-excitation: From anatomy to ablation: Part III-Clinical presentation, electrophysiologic characteristics, when and how to ablate nodoventricular, nodofascicular, fasciculoventricular pathways, along with considerations of permanent junctional reciprocating tachycardia.

J Cardiovasc Electrophysiol 2019 12 14;30(12):3097-3115. Epub 2019 Nov 14.

Post Graduation Department, Faculdade de Ciências Médicas, Belo Horizonte, Brazil.

The recognition of the presence, location, and properties of unusual accessory pathways for atrioventricular conduction is an exciting, but frequently a difficult, challenge for the clinical cardiac arrhythmologist. In this third part of our series of reviews, we discuss the different steps required to come to the correct diagnosis and management decision in patients with nodofascicular, nodoventricular, and fasciculo-ventricular pathways. We also discuss the concealed accessory atrioventricular pathways with the properties of decremental retrograde conduction that are associated with the so-called permanent form of junctional reciprocating tachycardia. Careful analysis of the 12-lead electrocardiogram during sinus rhythm and tachycardias should always precede the investigation in the catheterization room. When using programmed electrical stimulation of the heart from different intracardiac locations, combined with activation mapping, it should be possible to localize both the proximal and distal ends of the accessory connections. This, in turn, should then permit the determination of their electrophysiologic properties, providing the answer to the question "are they incorporated in a tachycardia circuit?". It is this information that is essential for decision-making with regard to the need for catheter ablation, and if necessary, its appropriate site.
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http://dx.doi.org/10.1111/jce.14247DOI Listing
December 2019

Part II-Clinical presentation, electrophysiologic characteristics, and when and how to ablate atriofascicular pathways and long and short decrementally conducting accessory pathways.

J Cardiovasc Electrophysiol 2019 12 16;30(12):3079-3096. Epub 2019 Oct 16.

Post Graduation Department, Faculdade de Ciências Médicas, Belo Horizonte, Brazil.

Recognition of the presence, location, and properties of unusual accessory pathways for atrioventricular conduction is an exciting, frequently difficult, challenge for the clinical cardiac arrhythmologist. In this second part of our series of reviews relative to this topic, we discuss the steps required to achieve the correct diagnosis and appropriate management in patients with the so-called "Mahaim" variants of pre-excitation. We indicate that, nowadays, it is recognized that these abnormal rhythms are manifest because of the presence of atriofascicular pathways. These anatomical substrates, however, need to be distinguished from the other long and short accessory pathways which produce decremental atrioventricular conduction. The atriofascicular pathways, along with the long decrementally conducting pathways, have their atrial components located within the vestibule of the tricuspid valve. The short decremental pathways, in contrast, can originate in the vestibules of either the mitral or tricuspid valves. As a starting point, careful analysis of the 12-lead electrocardiogram, taken during both sinus rhythm and tachycardias, should precede any investigation in the catheterization room. When assessing the patient in the electrophysiological laboratory, the use of programmed electrical stimulation from different intracardiac locations, combined with entrainment technique and activation mapping, should permit the establishment of the properties of the accessory pathways, and localization of its proximal and distal ends. This should provide the answer to the question "is the pathway incorporated into the circuit underlying the clinical tachycardia". That information is essential for decision-making with regard to need, and localization of the proper site, for catheter ablation.
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http://dx.doi.org/10.1111/jce.14203DOI Listing
December 2019
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