56 results on '"Turagam M"'
Search Results
2. Management of peri-device leaks after left atrial appendage closure using endovascular coils and/or amplatzer plugs and radiofrequency ablation
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Maan, A, primary, Ambesh, P A, additional, Mirza, J M, additional, Kawamura, I K, additional, Stanton, E S, additional, Vashistha, K V, additional, Musikantow, D M, additional, Turagam, M T, additional, Koruth, J K, additional, Miller, M M, additional, Lampert, J L, additional, Whang, W W, additional, Dukkipati, S D, additional, and Reddy, V R, additional
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- 2024
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3. Peri-device leak after left atrial appendage closure: echocardiographic characteristics and thromboembolism risk
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Maan, A, primary, Kawamura, I K, additional, Musikantow, D M, additional, Turagam, M T, additional, Needelman, B N, additional, Lampert, J L, additional, Koruth, J K, additional, Miller, M M, additional, Whang, W W, additional, Langan, N L, additional, Dukkipati, S D, additional, and Reddy, V R, additional
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- 2023
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4. Noninvasive tissue adhesive for cardiac implantable electronic device pocket closure: the TAPE pilot study
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Koerber, S. M., Loethen, T., Turagam, M., Payne, J., Weachter, R., Flaker, G., Gold, M. R., and Gautam, S.
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- 2019
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5. Comparing direct oral anticoagulants versus vitamin K antagonist in patients with atrial fibrillation after transcatheter aortic valve replacement: an updated meta-analysis
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Dhaliwal, A, primary, Kaur, A, additional, Konje, S, additional, Bhatia, K, additional, Sohal, S, additional, Rawal, H, additional, Turagam, M, additional, Gwon, Y, additional, Mamas, M, additional, Dominguez, A, additional, Bhatt, D, additional, and Velagapudi, P, additional
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- 2022
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6. To compare efficacy and safety of direct oral anticoagulants in patients with concurrent atrial fibrillation and bioprosthetic heart valve repair or replacement: a systematic review and meta-analysis
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Kaur, A, primary, Dhaliwal, A, additional, Khandait, H, additional, Konje, S, additional, Bhatia, K, additional, Sohal, S, additional, Turagam, M, additional, Gwon, Y, additional, Mamas, M, additional, Dominguez, A, additional, Bhatt, D, additional, and Velagapudi, P, additional
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- 2022
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7. Noninvasive tissue adhesive for cardiac implantable electronic device pocket closure: the TAPE pilot study
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Koerber, S. M., primary, Loethen, T., additional, Turagam, M., additional, Payne, J., additional, Weachter, R., additional, Flaker, G., additional, Gold, M. R., additional, and Gautam, S., additional
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- 2018
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8. Meloxicam-induced enteropathy of the small bowel
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Are, C., primary, Turagam, M., additional, Aucar, J. A., additional, and Greenberg, E., additional
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- 2010
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9. Stroke prevention in the elderly atrial fibrillation patient with comorbid conditions: focus on non-vitamin K antagonist oral anticoagulants
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Turagam MK, Velagapudi P, and Flaker GC
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Non-vitamin K antagonist oral anticoagulants ,novel oral anticoagulants ,warfarin ,dabigatran ,rivaroxaban ,apixaban ,edoxaban ,Geriatrics ,RC952-954.6 - Abstract
Mohit K Turagam, Poonam Velagapudi, Greg C FlakerDivision of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, MO, USAAbstract: Stroke prevention in elderly atrial fibrillation patients remains a challenge. There is a high risk of stroke and systemic thromboembolism but also a high risk of bleeding if anticoagulants are prescribed. The elderly have increased chronic kidney disease, coronary artery disease, polypharmacy, and overall frailty. For all these reasons, anticoagulant use is underutilized in the elderly. In this manuscript, the benefits of non-vitamin K antagonist oral anticoagulants compared with warfarin in the elderly patient population with multiple comorbid conditions are reviewed.Keywords: non-vitamin K antagonist oral anticoagulants, novel oral anticoagulants, warfarin, dabigatran, rivaroxaban, apixaban, edoxaban
- Published
- 2015
10. Occam's razor or Hickam's dictum: a rare case of pulmonary embolism after myocardial infarction and stroke from aortic arch thrombi.
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Velagapudi, P., Turagam, M. K., and Dohrmann, M.
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PARSIMONIOUS models , *THORACIC aorta , *PULMONARY embolism , *MYOCARDIAL infarction , *STROKE patients , *PATIENTS , *PHYSIOLOGY - Published
- 2015
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11. Safety of oral anticoagulants in patients undergoing left ventricular arrhythmia ablation.
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Kewcharoen J, Shah K, Mandapati R, Bhardwaj R, Turagam M, Contractor T, Lakkireddy D, and Garg J
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- Humans, Administration, Oral, Female, Male, Treatment Outcome, Tachycardia, Ventricular surgery, Middle Aged, Anticoagulants adverse effects, Anticoagulants therapeutic use, Catheter Ablation methods, Catheter Ablation adverse effects
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- 2024
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12. Short-term safety and feasibility of a practical approach to combined atrial and ventricular physiological pacing: An initial single-center experience.
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Watanabe K, Nies M, Whang W, Jin C, Mann A, Musikantow D, Lampert J, Miller M, Turagam M, Hannon S, Langan MN, Dukkipati S, Reddy VY, and Koruth J
- Abstract
Background: Traditional right atrial appendage (RAA) pacing accentuates conduction disturbances as opposed to Bachmann bundle pacing (BBP)., Objective: The purpose of this study was to evaluate the feasibility, efficacy, and safety of routine anatomically guided high right atrial septal (HRAS) pacing with activation of Bachmann bundle combined with routine left bundle branch area pacing (LBBAP)., Methods: This retrospective single-center study included 96 consecutive patients who underwent 1 of 2 strategies: physiological pacing (PP) (n = 32) with HRAS and LBBAP leads and conventional pacing (CP) (n = 64) with traditional RAA and right ventricular apical leads. Baseline characteristics, sensing, pacing thresholds, and impedances were recorded at implantation and follow-up., Results: The PP and CP cohorts were of similar age (74.2 ± 13.8 years vs 73.9 ± 9.9 years) and sex (28.1% vs 40.6% female). There were no differences in procedural time (95.0 ± 31.4 minutes vs 86.5 ± 33.3 minutes; P = .19) or fluoroscopy time (12.1 ± 4.5 minutes vs 12.3 ± 13.5 minutes; P = .89) between cohorts. After excluding patients who received >2 leads, these parameters became significantly shorter in the CP cohort. The PP cohort exhibited higher atrial pacing thresholds (1.5 ± 1.1 mV vs 0.8 ± 0.3 mV; P <.001) and lower p waves (1.8 ± 0.8 mV vs 3.8 ± 2.3 mV; P <.001) at implantation and at follow-up. In the PP cohort, 72% of implants met criteria for BBP; of the ventricular leads, 94% demonstrated evidence of LBBAP. One lead-related complication occurred in each cohort., Conclusion: Routine placement of leads in the HRAS is a feasible and safe alternative to standard RAA pacing, allowing for BBP in 72% of patients. HRAS pacing can be combined with LBBAP as a routine strategy., (© 2024 Heart Rhythm Society. Published by Elsevier Inc.)
- Published
- 2024
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13. Nitroglycerin to Ameliorate Coronary Artery Spasm During Focal Pulsed-Field Ablation for Atrial Fibrillation.
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Malyshev Y, Neuzil P, Petru J, Funasako M, Hala P, Kopriva K, Schneider C, Achyutha A, Vanderper A, Musikantow D, Turagam M, Dukkipati SR, and Reddy VY
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- Humans, Male, Middle Aged, Female, Aged, Vasodilator Agents therapeutic use, Vasodilator Agents administration & dosage, Coronary Angiography, Coronary Vessels drug effects, Coronary Vessels surgery, Coronary Vessels physiopathology, Atrial Fibrillation surgery, Nitroglycerin administration & dosage, Nitroglycerin therapeutic use, Coronary Vasospasm prevention & control, Catheter Ablation methods, Catheter Ablation adverse effects
- Abstract
Background: In treating atrial fibrillation, pulsed-field ablation (PFA) has comparable efficacy to conventional thermal ablation, but with important safety advantages: no esophageal injury or pulmonary vein stenosis, and rare phrenic nerve injury. However, when PFA is delivered in proximity to coronary arteries using a pentaspline catheter, which generates a broad electrical field, severe vasospasm can be provoked., Objectives: The authors sought to study the vasospastic potential of a focal PFA catheter with a narrower electrical field and develop a preventive strategy with nitroglycerin., Methods: During atrial fibrillation ablation, a focal PFA catheter was used for cavotricuspid isthmus ablation. Angiography of the right coronary artery (some with fractional flow reserve measurement) was performed before, during, and after PFA. Beyond no nitroglycerin (n = 5), and a few testing strategies (n = 8), 2 primary nitroglycerin administration strategies were studied: 1) multiple boluses (3-2 mg every 2 min) into the right atrium (n = 10), and 2) a bolus (3 mg) into the right atrium with continuous peripheral intravenous infusion (1 mg/min; n = 10)., Results: Without nitroglycerin, cavotricuspid isthmus ablation provoked moderate-severe vasospasm in 4 of 5 (80%) patients (fractional flow reserve 0.71 ± 0.08). With repetitive nitroglycerin boluses, severe spasm did not occur, and mild-moderate vasospasm occurred in only 2 of 10 (20%). Using the bolus + infusion strategy, severe and mild-moderate spasm occurred in 1 and 3 of 10 patients (aggregate 40%). No patient had ST-segment changes., Conclusions: Ablation of the cavotricuspid isthmus using a focal PFA catheter routinely provokes right coronary vasospasm. Pretreatment with high doses of parenteral nitroglycerin prevents severe spasm., Competing Interests: Funding Support and Author Disclosures This study was supported by Boston Scientific Inc. Dr Neuzil has received grant support and consulting from Farapulse-Boston Scientific, as well as grant support from Adagio and Kardium; and grant support and consulting from Abbott, Biosense Webster, BTL, Cardiofocus, and Medtronic. Mr Schneider, Ms Achyutha, and Ms Vanderper are employees of Boston Scientific. Dr Dukkipati has equity in Farapulse-Boston Scientific, and unrelated to this manuscript, equity in Manual Surgical Sciences, and serves as a consultant to Biosense Webster. Dr Reddy has received consulting fees (and equity—now divested) from Farapulse Inc and is a consultant for Boston Scientific Inc; serves as a consultant for and has equity in Ablacon, Acutus Medical, Affera-Medtronic, Anumana, Apama Medical-Boston Scientific, APN Health, Aquaheart, Atacor, Autonomix, Axon Therapies, Backbeat, BioSig, CardiaCare, Cardiofocus, CardioNXT / AFTx, Circa Scientific, CoRISMA, Corvia Medical, Dinova-Hangzhou DiNovA EP Technology, East End Medical, EPD-Philips, EP Frontiers, Epix Therapeutics-Medtronic, EpiEP, Eximo, Field Medical, Focused Therapeutics, HRT, Intershunt, Javelin, Kardium, Keystone Heart, Laminar, LuxMed, Medlumics, Middlepeak, Neutrace, Nuvera-Biosense Webster, Oracle Health, Restore Medical, Sirona Medical, SoundCath, Valcare; unrelated to this work; has served as a consultant for Abbott, Adagio Medical, AtriAN, Biosense-Webster, BioTel Heart, Biotronik, Cairdac, Cardionomic, CoreMap, Fire1, Gore & Associates, Impulse Dynamics, Medtronic, Novartis, Novo Nordisk, Philips, Pulse Biosciences; and has equity in DRS Vascular, Manual Surgical Sciences, Newpace, Nyra Medical, Surecor, and Vizaramed. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
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14. First-in-human clinical series of a novel conformable large-lattice pulsed field ablation catheter for pulmonary vein isolation.
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Reddy VY, Anter E, Peichl P, Rackauskas G, Petru J, Funasako M, Koruth JS, Marinskis G, Turagam M, Aidietis A, Kautzner J, Natale A, and Neuzil P
- Subjects
- Humans, Male, Female, Middle Aged, Aged, Treatment Outcome, Equipment Design, Electrophysiologic Techniques, Cardiac, Time Factors, Heart Rate, Action Potentials, Pulmonary Veins surgery, Atrial Fibrillation surgery, Atrial Fibrillation physiopathology, Atrial Fibrillation diagnosis, Catheter Ablation methods, Catheter Ablation instrumentation, Recurrence, Cardiac Catheters
- Abstract
Aims: Pulsed field ablation (PFA) has significant advantages over conventional thermal ablation of atrial fibrillation (AF). This first-in-human, single-arm trial to treat paroxysmal AF (PAF) assessed the efficiency, safety, pulmonary vein isolation (PVI) durability and one-year clinical effectiveness of an 8 Fr, large-lattice, conformable single-shot PFA catheter together with a dedicated electroanatomical mapping system., Methods and Results: After rendering the PV anatomy, the PFA catheter delivered monopolar, biphasic pulse trains (5-6 s per application; ∼4 applications per PV). Three waveforms were tested: PULSE1, PULSE2, and PULSE3. Follow-up included ECGs, Holters at 6 and 12 months, and symptomatic and scheduled transtelephonic monitoring. The primary and secondary efficacy endpoints were acute PVI and post-blanking atrial arrhythmia recurrence, respectively. Invasive remapping was conducted ∼75 days post-ablation. At three centres, PVI was performed by five operators in 85 patients using PULSE1 (n = 30), PULSE2 (n = 20), and PULSE3 (n = 35). Acute PVI was achieved in 100% of PVs using 3.9 ± 1.4 PFA applications per PV. Overall procedure, transpired ablation, PFA catheter dwell and fluoroscopy times were 56.5 ± 21.6, 10.0 ± 6.0, 19.1 ± 9.3, and 5.7 ± 3.9 min, respectively. No pre-defined primary safety events occurred. Upon remapping, PVI durability was 90% and 99% on a per-vein basis for the total and PULSE3 cohort, respectively. The Kaplan-Meier estimate of one-year freedom from atrial arrhythmias was 81.8% (95% CI 70.2-89.2%) for the total, and 100% (95% CI 80.6-100%) for the PULSE3 cohort., Conclusion: Pulmonary vein isolation (PVI) utilizing a conformable single-shot PFA catheter to treat PAF was efficient, safe, and effective, with durable lesions demonstrated upon remapping., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)
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- 2024
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15. A Novel ECG-Based Deep Learning Algorithm to Predict Cardiomyopathy in Patients With Premature Ventricular Complexes.
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Lampert J, Vaid A, Whang W, Koruth J, Miller MA, Langan MN, Musikantow D, Turagam M, Maan A, Kawamura I, Dukkipati S, Nadkarni GN, and Reddy VY
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- Adult, Humans, Female, Middle Aged, Aged, Aged, 80 and over, Stroke Volume, Ventricular Function, Left, Algorithms, Electrocardiography, Deep Learning, Ventricular Premature Complexes diagnosis, Ventricular Premature Complexes surgery, Cardiomyopathies complications, Cardiomyopathies diagnosis
- Abstract
Background: Premature ventricular complexes (PVCs) are prevalent and, although often benign, they may lead to PVC-induced cardiomyopathy. We created a deep-learning algorithm to predict left ventricular ejection fraction (LVEF) reduction in patients with PVCs from a 12-lead electrocardiogram (ECG)., Objectives: This study aims to assess a deep-learning model to predict cardiomyopathy among patients with PVCs., Methods: We used electronic medical records from 5 hospitals and identified ECGs from adults with documented PVCs. Internal training and testing were performed at one hospital. External validation was performed with the others. The primary outcome was first diagnosis of LVEF ≤40% within 6 months. The dataset included 383,514 ECGs, of which 14,241 remained for analysis. We analyzed area under the receiver operating curves and explainability plots for representative patients, algorithm prediction, PVC burden, and demographics in a multivariable Cox model to assess independent predictors for cardiomyopathy., Results: Among the 14,241-patient cohort (age 67.6 ± 14.8 years; female 43.8%; White 29.5%, Black 8.6%, Hispanic 6.5%, Asian 2.2%), 22.9% experienced reductions in LVEF to ≤40% within 6 months. The model predicted reductions in LVEF to ≤40% with area under the receiver operating curve of 0.79 (95% CI: 0.77-0.81). The gradient weighted class activation map explainability framework highlighted the sinus rhythm QRS complex-ST segment. In patients who underwent successful PVC ablation there was a post-ablation improvement in LVEF with resolution of cardiomyopathy in most (89%) patients., Conclusions: Deep-learning on the 12-lead ECG alone can accurately predict new-onset cardiomyopathy in patients with PVCs independent of PVC burden. Model prediction performed well across sex and race, relying on the QRS complex/ST-segment in sinus rhythm, not PVC morphology., Competing Interests: Funding Support and Author Disclosures Dr Lampert has served as a consultant for Viz.AI. Dr Reddy has served as a consultant for and has equity in Ablacon, Acutus Medical, Affera-Medtronic, Anumana, Apama Medical-Boston Scientific, APN Health, Aquaheart, Atacor, Autonomix, Axon Therapies, Backbeat, BioSig, CardiaCare, CardioNXT/AFTx, Circa Scientific, CoRISMA, Corvia Medical, Dinova-Hangzhou DiNovA EP Technology, East End Medical, EPD-Philips, EP Frontiers, Epix Therapeutics-Medtronic, EpiEP, Eximo, Farapulse-Boston Scientific, Field Medical, Focused Therapeutics, HRT, Intershunt, Javelin, Kardium, Keystone Heart, LuxMed, Medlumics, Middlepeak, Neutrace, Nuvera-Biosense Webster, Oracle Health, Restore Medical, Sirona Medical, SoundCath, Valcare unrelated to this work; has served as a consultant for Abbott, AtriAN, Biosense-Webster, BioTel Heart, Biotronik, Boston Scientific, Cairdac, Cardiofocus, Cardionomic, CoreMap, Fire1, Gore & Associates, Impulse Dynamics, Medtronic, Novartis, Philips, and Pulse Biosciences; and has equity in Manual Surgical Sciences, Newpace, Nyra Medical, Surecor, and Vizaramed. Dr Nadkarni reports consultancy agreements with AstraZeneca, BioVie, GLG Consulting, Pensieve Health, Reata, Renalytix, Siemens Healthineers and Variant Bio; has received research funding from Goldfinch Bio, and Renalytix; has received honoraria from AstraZeneca, BioVie, Lexicon, Daiichi Sankyo, Meanrini Health, and Reata; has patents or royalties with Renalytix; owns equity and stock options in Pensieve Health and Renalytix as a scientific cofounder; owns equity in Verici Dx; has received financial compensation as a scientific board member and advisor to Renalytix; has served on the advisory board of Neurona Health; and has served in an advisory or leadership role for Pensieve Health and Renalytix. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2023
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16. Interatrial Block Association With Adverse Cardiovascular Outcomes in Patients Without a History of Atrial Fibrillation.
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Lampert J, Power D, Havaldar S, Govindarajulu U, Kawamura I, Maan A, Miller MA, Menon K, Koruth J, Whang W, Bagiella E, Bayes-Genis A, Musikantow D, Turagam M, Bayes de Luna A, Halperin J, Dukkipati SR, Vaid A, Nadkarni G, Glicksberg B, Fuster V, and Reddy VY
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- Humans, Interatrial Block complications, Interatrial Block epidemiology, Retrospective Studies, Electrocardiography, Atrial Fibrillation complications, Atrial Fibrillation epidemiology, Stroke epidemiology, Stroke etiology, Atrial Flutter complications, Atrial Flutter epidemiology, Thromboembolism epidemiology, Thromboembolism etiology
- Abstract
Background: Interatrial block (IAB) is associated with thromboembolism and atrial arrhythmias. However, prior studies included small patient cohorts so it remains unclear whether IAB predicts adverse outcomes particularly in context of atrial fibrillation (AF)/atrial flutter (AFL)., Objectives: This study sought to determine whether IAB portends increased stroke risk in a large cohort in the presence or absence of AFAF/AFL., Methods: We performed a 5-center retrospective analysis of 4,837,989 electrocardiograms (ECGs) from 1,228,291 patients. IAB was defined as P-wave duration ≥120 ms in leads II, III, or aVF. Measurements were extracted as .XML files. After excluding patients with prior AF/AFL, 1,825,958 ECGs from 458,994 patients remained. Outcomes were analyzed using restricted mean survival time analysis and restricted mean time lost., Results: There were 86,317 patients with IAB and 355,032 patients without IAB. IAB prevalence in the cohort was 19.6% and was most common in Black (26.1%), White (20.9%), and Hispanic (18.5%) patients and least prevalent in Native Americans (9.2%). IAB was independently associated with increased stroke probability (restricted mean time lost ratio coefficient [RMTLRC]: 1.43; 95% CI: 1.35-1.51; tau = 1,895), mortality (RMTLRC: 1.14; 95% CI: 1.07-1.21; tau = 1,924), heart failure (RMTLRC: 1.94; 95% CI: 1.83-2.04; tau = 1,921), systemic thromboembolism (RMTLRC: 1.62; 95% CI: 1.53-1.71; tau = 1,897), and incident AF/AFL (RMTLRC: 1.16; 95% CI: 1.10-1.22; tau = 1,888). IAB was not associated with stroke in patients with pre-existing AF/AFL., Conclusions: IAB is independently associated with stroke in patients with no history of AF/AFL even after adjustment for incident AF/AFL and CHA
2 DS2 -VASc score. Patients are at increased risk of stroke even when AF/AFL is not identified., Competing Interests: Funding Support and Author Disclosures This project was internally funded. Dr Reddy has served as a consultant to Kardium Inc (including Equity); is a consultant to Abbott, Ablacon, Acutus Medical, Affera-Medtronic, Apama Medical-Boston Scientific, APN Health, Aquaheart, Atacor, AtiAN, Autonomix, Axon Therapies, Backbeat, BioSig, Biosense-Webster, BioTel Heart, Biotronik, Boston Scientific, Cairdac, CardiaCare, Cardiofocus, Cardionomic, CardioNXT / AFTx, Circa Scientific, CoreMap, CoRISMA, Corvia Medical, Dinova-Hangzhou DiNovA EP Technology, East End Medical, EBR, EPD-Philips, EP Frontiers, Epix Therapeutics, EpiEP, Eximo, Farapulse-Boston Scientific, Fire1, Focused Therapeutics, Gore & Associates, HRT, Impulse Dynamics, Intershunt, Javelin, Keystone Heart, LuxMed, Medlumics, Medtronic, Middlepeak, Neutrace, Nuvera-Biosense Webster, Oracle Health, Philips, Pulse Biosciences, Restore Medical, Sirona Medical, SoundCath, and Valcare; and has equity from Ablacon, Acutus Medical, Affera-Medtronic, Apama Medical-Boston Scientific, APN Health, Aquaheart, Atacor, Autonomix, Axon Therapies, Backbeat, BioSig, CardiaCare, CardioNXT / AFTx, Circa Scientific, CoRISMA, Corvia Medical, Dinova-Hangzhou DiNovA EP Technology, East End Medical, EPD-Philips, EP Frontiers, Epix Therapeutics, EpiEP, Eximo, Farapulse-Boston Scientific, Focused Therapeutics, HRT, Intershunt, Javelin, Keystone Heart, LuxMed, Manual Surgical Sciences, Medlumics, Middlepeak, Neutrace, Newpace, Nuvera-Biosense Webster, Nyra Medical, Oracle Health, Restore Medical, Sirona Medical, SoundCath, Surecor, Valcare, and Vizaramed. Dr Fuster serves as the Editor-in-Chief of JACC. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)- Published
- 2023
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17. Preventing Atrial Fibrillation in Patients After Coronary Artery Bypass Grafting: A Role of Posterior Pericardiotomy- ELECTRAM Investigators.
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Chaudhary R, Ajibawo T, Kirchoff R, Turagam M, Lakkireddy D, and Garg J
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- Humans, Pericardiectomy, Coronary Artery Bypass adverse effects, Postoperative Complications etiology, Postoperative Complications prevention & control, Atrial Fibrillation
- Abstract
Competing Interests: The authors have no conflicts of interest to declare.
- Published
- 2023
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18. Clinical outcomes of radiofrequency catheter ablation of ventricular tachycardia in patients with hypertrophic cardiomyopathy.
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Garg J, Kewcharoen J, Shah K, Turagam M, Bhardwaj R, Contractor T, Mandapati R, and Lakkireddy D
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- Male, Humans, Adult, Middle Aged, Aged, Female, Recurrence, Treatment Outcome, Tachycardia, Ventricular diagnosis, Tachycardia, Ventricular surgery, Tachycardia, Ventricular etiology, Cardiomyopathy, Hypertrophic diagnosis, Cardiomyopathy, Hypertrophic diagnostic imaging, Catheter Ablation methods, Heart Failure etiology
- Abstract
Background: Monomorphic ventricular tachycardia (VT) is rare in patients with hypertrophic cardiomyopathy (HCM), management of which is challenging. Limited data exists on the utility of catheter ablation for the treatment of VT in this population., Objectives: We aimed to assess clinical outcomes of catheter ablation for VT in HCM patients., Methods: A systematic search, without language restriction, using PubMed, EMBASE, SCOPUS, Google Scholar, and ClinicalTrials.gov was performed. The meta-analysis was performed using a meta-package for R version 4.0/RStudio version 1.2 and Freeman Tukey double arcsine method to establish the variance of raw proportions. Outcomes measured included (1) acute procedure success (defined as noninducible for clinical VT), (2) freedom from VT at follow-up, (3) mortality., Results: This systematic review of six studies (three from the United States and three from Japan) incorporated a total of 68 drug-refractory HCM patients who underwent VT radiofrequency catheter ablation (mean age 57.6 ± 13.3 years, mean LVEF 45.8 ± 15.4%, 85% men, maximum septal wall thickness 17.4 ± 4.6 mm, and 32.3% with an apical aneurysm). Acute procedural success was achieved in 84.5% patients (95% confidence interval [CI]: 70.6%-95.2%) with 27.9% patients had recurrent VT requiring multiple ablations (median 1, IQR 1-3). During the follow-up period (18.3 ± 11.7 months), the pooled incidence of freedom from recurrent VT after index procedure was 70.2% (95% CI: 51.9%-86.2%), while after the last ablation was 82.8% (95% CI: 57%-99.2%). There were two deaths during follow-up, one from heart failure and one from SCD 0.8% (95% CI: 0%-5.8%)., Conclusion: The results of our pooled analysis demonstrated that catheter ablation for VT in HCM patients was associated with high acute procedural success, and reduced VT recurrence-findings comparable to previously published reports in other disease substrates., (© 2022 The Authors. Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC.)
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- 2023
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19. Evaluation of Multimodality LAA Leak Closure Methods Following Incomplete Occlusion: The LAA Leak Study.
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Charate R, Ahmed A, Della Rocca DG, Bloom S, Garg J, Pothineni NVK, DiBiase L, Turagam M, Gopinathannair R, Horton R, Kar S, Fontana G, Doshi SK, Swarup V, Finn A, Reddy V, Natale A, and Lakkireddy D
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- Male, Humans, Middle Aged, Aged, Aged, 80 and over, Female, Treatment Outcome, Echocardiography, Transesophageal, Cardiac Catheterization adverse effects, Atrial Appendage, Atrial Fibrillation diagnostic imaging, Atrial Fibrillation therapy, Atrial Fibrillation complications, Septal Occluder Device
- Abstract
Background: Incomplete left atrial appendage (LAA) closure is an evolving topic of clinical significance and thromboembolic potential, with recent long-term studies suggesting lower cutoffs for relevant leak size., Objectives: The aim of this prospective observational study was to assess 3 different closure techniques for persistent peridevice leaks after incomplete LAA closure and compare their efficacy and safety outcomes., Methods: We studied 160 patients (mean age 72 ± 9 years; 71% men) who underwent 1 of the 3 available modalities (detachable embolization coils, vascular plugs or septal occluders, and radiofrequency ablation) for residual central or eccentric leak closure. Both acute postprocedural success (closure or <1-mm leak at the end of the procedure) and closure at 1-year follow-up transesophageal echocardiography imaging were evaluated., Results: Of 160 patients, 0.6%, 41.3%, and 58.1% had mild (1-2 mm), moderate (3-5 mm), and severe (≥5 mm) leaks, respectively. Baseline LAA closure type was 72.5% Watchman FLX, 16.3% Lariat, 5.6% surgical ligation, 1.9% AtriClip, and 1.9% Amulet. Successful closure (0- or <1-mm leak) was seen in 100% of patients in all cohorts following intervention, with overall complete closure (0-1 mm) or mild or minimal leaks (1-2 mm) on 1-year follow-up transesophageal echocardiography seen in 100% of the atrial septal occluder or vascular plug cohort, 85.9% of the coil cohort, and 83.3% of the radiofrequency ablation cohort (P < 0.001). Two patients (1.3%) experienced cardiac tamponade, and there were no deaths or other complications., Conclusions: Peridevice leaks can safely and effectively be closed using 3 different modalities depending on size and location., Competing Interests: Funding Support and Author Disclosures Dr Garg is a consultant to Biosense Webster. Dr Pothineni is a consultant to Boston Scientific. Dr DiBiase is a consultant to Biosense Webster, Abbott, Atricure, Boston Scientific, Medtronic, and Biotronik. Dr Turagam is a consultant to Biosense Webster and Boston Scientific. Dr Gopinathannair is a consultant to Biotronik, Boston Scientific, and Abbott. Dr Horton is a consultant to Abbott, Biosense Webster, Biotronick. Dr Kar is a consultant to Boston Scientific, and Edwards. Dr Fontana is a consultant to Boston Scientific, Abbott, Atricure, and Edwards. Dr Doshi is a consultant to Biosense Webster, Abbott, Atricure, Boston Scientific, Medtronic, and Biotronik. Dr Swarup is a consultant to Biosense Webster, Abbott, Atricure, Boston Scientific, Medtronic, and Biotronik. Dr Finn is a consultant to Boston Scientific and Abbott. Dr Reddy is a consultant to Biosense Webster, Abbott, Atricure, Boston Scientific, and Medtronic. Dr Natale is a consultant to Biosense Webster, Abbott, Atricure, Boston Scientific, Medtronic, and Biotronik. Dr Lakkireddy is a consultant to Biosense Webster, Abbott, Atricure, Boston Scientific, and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
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- 2022
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20. Left atrial appendage occlusion in patients with blood cell dyscrasia.
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Kewcharoen J, Shah K, Bhardwaj R, Contractor T, Turagam M, Mandapati R, Lakkireddy D, and Garg J
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- Humans, Blood Cells, Treatment Outcome, Atrial Appendage surgery, Atrial Fibrillation surgery, Septal Occluder Device, Stroke
- Published
- 2022
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21. Periprocedural and long-term safety and feasibility of direct oral anticoagulants in patients with biological valve undergoing radiofrequency catheter ablation for atrial fibrillation: a prospective multicenter study.
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Di Biase L, Romero J, Briceno D, Lakkireddy D, Trivedi C, Mohanty P, Mohanty S, Horton R, Hranitzky P, Gallinghouse GJ, Alviz I, Turagam M, Gopinathannair R, Della Rocca DG, Beheiry S, Burkhardt JD, Viles-Gonzales J, and Natale A
- Subjects
- Administration, Oral, Anticoagulants therapeutic use, Feasibility Studies, Female, Humans, Male, Prospective Studies, Treatment Outcome, Atrial Fibrillation drug therapy, Atrial Fibrillation surgery, Catheter Ablation
- Abstract
Background: Direct oral anticoagulants (DOACs) are contraindicated in patients with atrial fibrillation (AF) and mechanical cardiac valves. However, safety and efficacy are controversial in patients with biological cardiac valves., Objective: We report the safety and feasibility of periprocedural and long-term treatment with DOACs in patients with biological valves undergoing ablation for AF., Methods: A total of 127 patients with AF and biological cardiac valve undergoing CA on uninterrupted DOAC were matched by gender and age with 127 patients with AF and biological cardiac valves undergoing CA on uninterrupted warfarin. All patients were anticoagulated for at least 3-4 weeks prior to ablation with either rivaroxaban (70%) or apixaban (30%), which were continued for at least 3 months and subsequently based on CHA
2 DS2 -VASc score., Results: Mean age of the study population was 63.0 ± 10.9 with 66% being male. The majority of patients on NOACs had aortic valve replacement (59%), while mitral valve was replaced in 41% of patients, which did not differ from the matched cohort on coumadin (aortic valve 57% and mitral valve 43%, (p = 0.8) (p = 0.8), respectively). The CHADS2 score was ≥ 2 in 90 patients (71.0%) on DOAC and 86 patients in (68%) the control (p = 0.6) group. Patients underwent ablation predominantly with uninterrupted rivaroxaban [89 (70%)], while the remaining 38 patients (30%) underwent ablation while on apixaban. Two groin hematomas were observed periprocedurally in both groups. No stroke/transient ischemic attack (TIA) was observed both periprocedurally and at long-term follow-up in either group., Conclusion: Periprocedural and long-term administration of DOACs in patients with biological cardiac valves undergoing AF ablation appears as safe as warfarin therapy., (© 2020. Springer Science+Business Media, LLC, part of Springer Nature.)- Published
- 2021
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22. Effects of permanent cardiac pacing on ventricular repolarization when compared to cardioneuroablation.
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Aksu T, Turagam M, Gautam S, Futyma P, Akella K, Baysal E, Bozyel S, Yalin K, Padmanabhan D, Shenthar J, Natale A, Lakkireddy D, and Gopinathannair R
- Subjects
- Adult, Electrocardiography, Female, Heart Rate, Humans, Male, Middle Aged, Tilt-Table Test, Catheter Ablation, Syncope, Vasovagal surgery
- Abstract
Introduction: The impact of cardioneuroablation (CNA) on ventricular repolarization by using corrected QT interval (QTc) measurements has been recently demonstrated. The effects of cardiac pacing (CP) on ventricular repolarization have not been studied in patients with vasovagal syncope (VVS). We sought to compare ventricular repolarization effects of CNA (group 1) with CP (group 2) in patients with VVS., Methods: We enrolled 69 patients with age 38 ± 13 years (53.6% male), n = 47 in group 1 and n = 22 in group 2. Clinical diagnosis of cardioinhibitory type was supported by cardiac monitoring or tilt testing. QTc was calculated at baseline (time-1), at 24 h after ablation (time-2), and at 9-12 months (time-3) in the follow-up., Results: In the group 1, from time-1 to time-2, a significant shortening in QTcFredericia (from 403 ± 27 to 382 ± 27 ms, p < 0.0001), QTcFramingham (from 402 ± 27 to 384 ± 27 ms, p < 0.0001), and QTcHodges (from 405 ± 26 to 388 ± 24 ms, p < 0.0001) was observed which remained lower than baseline in time-3 (373 ± 29, 376 ± 27, and 378 ± 27 ms, respectively). Although the difference between measurements in time-1 and time-2 was not statistically significant for QTcBazett, a significant shortening was detected between time-1 and time-3 (from 408 ± 30 to 394 ± 33, p = 0.005). In the group 2, there was no time-based changes on QTc measurements. In the linear mixed model analysis, the longitudinal reduction tendency in the QTcFredericia and QTcFramingham was more pronounced in group 1., Conclusions: Our results demonstrate that CNA reduces QTc levels through neuromodulation effect whereas CP has no effect on ventricular repolarization in patients with VVS., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2021 Elsevier Inc. All rights reserved.)
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- 2021
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23. Active Implantable cardioverter-defibrillators in Continuous-flow Left Ventricular Assist Device Recipients.
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Shah K, Chaudhary R, K Turagam M, Shah M, Patel B, Lanier G, Lakkireddy D, and Garg J
- Abstract
Introduction: Implantable cardioverter-defibrillator (ICD) in patients with heart failure with reduced ejection fraction reduces mortality secondary to malignant arrhythmias. Whether end-stage heart failure (HF) with continuous-flow left ventricular assist device (cf-LVAD) derive similar benefits remains controversial., Methods: We performed a systematic literature review and meta-analysis of all published studies that examined the association between active ICDs and survival in advanced HF patients with cfLVAD. We searched PubMed, Medline, Embase, Ovid, and Cochrane for studies reporting the association between ICD and all-cause mortality in advanced HF patients with cfLVAD. Mantel-Haenszel risk ratio (RR) random-effects model was used to summarize data., Results: Ten studies (9 retrospective and one prospective) with a total of 7,091 patients met inclusion criteria. There was no difference in all-cause mortality (RR 0.84, 95% CI 0.65-1.10, p=0.20, I
2 =62.40%), likelihood of survival to transplant (RR 1.07, 95% CI 0.98-1.17, p= 0.13, I2 =0%), RV failure (RR 0.74, 95% CI 0.44-1.25, p = 0.26, I2 =34%) between Active ICD and inactive/no ICD groups, respectively. Additionally, 27.5% received appropriate ICD shocks, while 9.5% received inappropriate ICD shocks. No significant difference was observed in terms of any complications between the two groups., Conclusions: All-cause mortality, the likelihood of survival to transplant, and worsening RV failure were not significantly different between active ICD and inactive/no ICD in cf-LVAD recipients. A substantial number of patients received appropriate ICD shocks suggesting a high-arrhythmia burden. The risks and benefits of ICDs must be carefully considered in patients with cf-LVAD.- Published
- 2021
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24. Diagnostic Utility of Smartwatch Technology for Atrial Fibrillation Detection - A Systematic Analysis.
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Elbey MA, Young D, Kanuri SH, Akella K, Murtaza G, Garg J, Atkins D, Bommana S, Sharma S, Turagam M, Pillarisetti J, Park P, Tummala R, Shah A, Koerber S, Shivamurthy P, Vasamreddy C, Gopinathannair R, and Lakkireddy D
- Abstract
Background: Smartphone technologies have been recently developed to assess heart rate and rhythm, but their role in accurately detecting atrial fibrillation (AF) remains unknown., Objective: We sought to perform a meta-analysis using prospective studies comparing Smartwatch technology with current monitoring standards for AF detection (ECG, Holter, Patch Monitor, ILR)., Methods: We performed a comprehensive literature search for prospective studies comparing Smartwatch technology simultaneously with current monitoring standards (ECG, Holter, and Patch monitor) for AF detection since inception to November 25th, 2019. The outcome studied was the accuracy of AF detection. Accuracy was determined with concomitant usage of ECG monitoring, Holter monitoring, loop recorder, or patch monitoring., Results: A total of 9 observational studies were included comparing smartwatch technology, 3 using single-lead ECG monitoring, and six studies using photoplethysmography with routine AF monitoring strategies. A total of 1559 patients were enrolled (mean age 63.5 years, 39.5% had an AF history). The mean monitoring time was 75.6 days. Smartwatch was non-inferior to composite ECG monitoring strategies (OR 1.06, 95% CI 0.93 - 1.21, p=0.37), composite 12 lead ECG/Holter monitoring (OR 0.90, 95% CI 0.62 - 1.30, p=0.57) and patch monitoring (OR 1.28, 95% CI 0.84 - 1.94, p=0.24) for AF detection. The sensitivity and specificity for AF detection using a smartwatch was 95% and 94%, respectively., Conclusions: Smartwatch based single-lead ECG and photoplethysmography appear to be reasonable alternatives for AF monitoring.
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- 2021
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25. Left Atrial Appendage Occlusion Device Embolization (The LAAODE Study): Understanding the Timing and Clinical Consequences from a Worldwide Experience.
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Murtaza G, K Turagam M, Dar T, Akella K, Yarlagadda B, Gloekler S, Meier B, Saw J, Kim JS, Lim HE, Fabian N, Gabriels J, V Boersmaj L, J Swaans M, Tantary M, Llah ST, Tzikas A, Gopinathannair R, and Lakkireddy D
- Abstract
Background: Left atrial appendage occlusion device embolization (LAAODE) is rare but can have substantial implications on patient morbidity and mortality. Hence, we sought to perform an analysis to understand the timing and clinical consequences of LAAODE., Methods: A comprehensive search of PubMed and Web of Science databases for LAAODE cases was performed from October 2nd, 2014 to November 1st, 2017. Prior to that, we included published LAAODE cases until October 1st, 2014 reported in the systematic review by Aminian et al., Results: 103 LAAODE cases including Amplatzer cardiac plug (N=59), Watchman (N=31), Amulet (N=11), LAmbre (N=1) and Watchman FLX (N=1) were included. The estimated incidence of device embolization was 2% (103/5,000). LAAODE occurred more commonly in the postoperative period compared with intraoperative (61% vs. 39%). The most common location for embolization was the descending aorta 30% (31/103) and left atrium 24% (25/103) followed by left ventricle 20% (21/103). Majority of cases 75% (77/103) were retrieved percutaneously. Surgical retrieval occurred most commonly for devices embolized to the left ventricle, mitral apparatus and descending aorta. Major complications were significantly higher with postoperative LAAODE compared with intraoperative (44.4% vs. 22.5%, p=0.03)., Conclusions: LAAODE is common with a reported incidence of 2% in our study. Post-operative device embolization occurred more frequently and was associated with a higher rate of complications than intraoperative device embolizations. Understanding the timings and clinical sequelae of DE can aid physicians with post procedural follow-up and also in the selection of patients for these procedures.
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- 2021
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26. Evaluating the role of transesophageal echocardiography (TEE) or intracardiac echocardiography (ICE) in left atrial appendage occlusion: a meta-analysis.
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Akella K, Murtaza G, Turagam M, Sharma S, Madoukh B, Amin A, Gopinathannair R, and Lakkireddy D
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- Cardiac Catheterization, Humans, Predictive Value of Tests, Treatment Outcome, Atrial Appendage diagnostic imaging, Atrial Appendage surgery, Atrial Fibrillation diagnostic imaging, Atrial Fibrillation surgery, Echocardiography, Transesophageal
- Abstract
Purpose: Intracardiac echocardiography (ICE) is increasingly common among periprocedural imaging modalities used during complex cardiac procedures. We sought to perform a meta-analysis comparing transesophageal echocardiography (TEE) and ICE in endocardial left atrial appendage occlusion (LAAO)., Methods: We searched PubMed and Google Scholar regarding abstracts and manuscripts using keywords: atrial fibrillation, left atrial appendage occlusion, Watchman, Amplatzer Cardiac Plug, Amulet, intracardiac echocardiography, and transesophageal echocardiography from their inception to July 12, 2019. Data extraction was performed using standard form for the following: title, year of publication, sample size, comorbid conditions, LAAO device, type of pre-procedural imaging, intraprocedural imaging, and clinical outcomes including the following: acute procedural success, fluoroscopy, and total procedure time and complications., Results: A total of 42 relevant studies were screened resulting in inclusion of 8 observational studies comparing TEE and ICE in endocardial LAAO. Outcomes assessed including procedural success (RR 1.00, 95% CI (0.97-1.03, p = 0.98)), complications (RR 0.77, 95% CI (0.52 to 1.15, p = 0.20)), fluoroscopy time (mean difference - 0.40, 95% CI (-3.12-2.32, p = 0.77)), and procedural time (mean difference - 8.02, 95% CI (-22.81 to 6.76, p = 0.29)) were found to be similar between both groups., Conclusions: While TEE is the gold standard for perioperative imaging with LAAO, ICE is a feasible and safe alternative that reduces exposure to general anesthesia and associated potential risks.
- Published
- 2021
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27. Cardiac Resynchronization Therapy in continuous flow Left Ventricular Assist Device Recipients: A Systematic Review and Meta-analysis from ELECTRAM Investigators.
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Shah K, Karpe V, K Turagam M, Shah M, Natale A, Gopinathannair R, Lakkireddy D, and Garg J
- Abstract
Introduction: Whether cardiac resynchronization therapy (CRT) continues to augment left ventricular remodeling in patients with the continuous-flow left ventricular assist device (cf-LVAD) remains unclear., Methods: We performed a systematic review and meta-analysis of all clinical studies examining the role of continued CRT in end-stage heart failure patients with cf-LVAD reporting all-cause mortality, ventricular arrhythmias, and ICD shocks. Mantel-Haenszel risk ratio (RR) random-effects model was used to summarize data., Results: Eight studies (7 retrospective and 1 randomized) with a total of 1,208 unique patients met inclusion criteria. There was no difference in all-cause mortality (RR 1.08, 95% CI 0.86 - 1.35, p = 0.51, I2=0%), all-cause hospitalization (RR 1.01, 95% CI 0.76-1.34, p = 0.95, I
2 =11%), ventricular arrhythmias (RR 1.08, 95% CI 0.83 - 1.39, p = 0.58, I2 =50%) and ICD shocks (RR 0.87, 95% CI 0.57 - 1.33, p = 0.52, I2 =65%) comparing CRT versus non-CRT. Subgroup analysis demonstrated significant reduction in ventricular arrhythmias (RR 0.76, 95% CI 0.64 - 0.90, p = 0.001) and ICD shocks (RR 0.65, 95% CI 0.44 - 0.97, p = 0.04) in "CRT on" group versus "CRT off" group., Conclusions: CRT was not associated with a reduction in all-cause mortality or increased risk of ventricular arrhythmias and ICD shocks compared to non-CRT in cf-LVAD patients. It remains to be determined which subgroup of cf-LVAD patients benefit from CRT. The findings of our study are intriguing, and therefore, larger studies in a randomized prospective manner should be undertaken to address this specifically.- Published
- 2020
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28. Guidance for cardiac electrophysiology during the COVID-19 pandemic from the Heart Rhythm Society COVID-19 Task Force; Electrophysiology Section of the American College of Cardiology; and the Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology, American Heart Association.
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Lakkireddy DR, Chung MK, Gopinathannair R, Patton KK, Gluckman TJ, Turagam M, Cheung JW, Patel P, Sotomonte J, Lampert R, Han JK, Rajagopalan B, Eckhardt L, Joglar J, Sandau KE, Olshansky B, Wan E, Noseworthy PA, Leal M, Kaufman E, Gutierrez A, Marine JE, Wang PJ, and Russo AM
- Subjects
- Arrhythmias, Cardiac etiology, COVID-19, Coronavirus Infections complications, Coronavirus Infections epidemiology, Humans, Infection Control organization & administration, Pneumonia, Viral complications, Pneumonia, Viral epidemiology, SARS-CoV-2, Telemedicine organization & administration, Triage organization & administration, Arrhythmias, Cardiac diagnosis, Arrhythmias, Cardiac therapy, Betacoronavirus, Coronavirus Infections prevention & control, Electrocardiography, Electrophysiologic Techniques, Cardiac, Pandemics prevention & control, Pneumonia, Viral prevention & control
- Abstract
Coronavirus disease 2019 (COVID-19) is a global pandemic that is wreaking havoc on the health and economy of much of human civilization. Electrophysiologists have been impacted personally and professionally by this global catastrophe. In this joint article from representatives of the Heart Rhythm Society, the American College of Cardiology, and the American Heart Association, we identify the potential risks of exposure to patients, allied healthcare staff, industry representatives, and hospital administrators. We also describe the impact of COVID-19 on cardiac arrhythmias and methods of triage based on acuity and patient comorbidities. We provide guidance for managing invasive and noninvasive electrophysiology procedures, clinic visits, and cardiac device interrogations. In addition, we discuss resource conservation and the role of telemedicine in remote patient care along with management strategies for affected patients., (Copyright © 2020. Published by Elsevier Inc.)
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- 2020
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29. Prophylactic Catheter Ablation of Ventricular Tachycardia in Ischemic Cardiomyopathy: a systematic review and meta-analysis of randomized controlled trials Electrophysiology Collaborative Consortium for Metaanalysis - ELECTRAM Investigators.
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Shah K, Turagam M, Patel B, Natale A, Lakkireddy D, and Garg J
- Abstract
Aims: Catheter ablation is an effective strategy for drug-refractory ventricular tachycardia (VT) in ischemic cardiomyopathy. We aimed to perform a systematic review and meta-analysis of outcomes of prophylactic catheter ablation (PCA) of Ventricular Tachycardia (VT) in ischemic cardiomyopathy patients., Methods: We performed a comprehensive literature search through February 10, 2020, for all eligible randomized controlled trials that compared "PCA" versus "No PCA" for VT. Primary efficacy outcomes included - appropriate ICD therapy (composite of anti-tachycardia pacing and ICD shock), appropriate ICD shocks, electrical storm, cardiac mortality, and all-cause mortality. The primary safety outcome was any adverse events., Results: Four randomized controlled trials (N = 505) met inclusion criteria. Prophylactic catheter ablation was associated significant reduction in appropriate ICD therapies (RR 0.70; 95% CI 0.55 - 0.89, p = 0.004), appropriate ICD shocks (RR 0.57 95% CI 0.40 - 0.80, p = 0.001) with a trend towards reduced risk of electrical storm (RR 0.64; CI 0.39 - 1.05; p = 0.075) compared to "No PCA". There was no significant difference in cardiac mortality (RR 0.66, 95% CI 0.31 - 1.43, p = 0.29) and all-cause mortality (RR 0.98, 95% CI 0.52 - 1.82, p = 0.94) with similar adverse events (RR 1.46, 95% CI 0.73 - 2.95, p = 0.29) between two groups., Conclusions: Prophylactic catheter ablation in ischemic cardiomyopathy patients was associated with a lower risk of ICD therapies, including ICD shocks and VT storm with no difference in cardiac and all-cause mortality.
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- 2020
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30. Impact of left atrial appendage occlusion on left atrial function-The LAFIT Watchman study.
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Murtaza G, Vuddanda V, Akella K, Della Rocca DG, Sharma S, Li L, Kutty S, Turagam M, Kar S, Holmes D, and Lakkireddy D
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- Atrial Function, Left, Echocardiography, Female, Heart Atria diagnostic imaging, Heart Atria surgery, Humans, Infant, Newborn, Male, Atrial Appendage diagnostic imaging, Atrial Appendage surgery, Cardiac Surgical Procedures
- Abstract
Background: Left atrial (LA) strain and strain rate (SR) analysis by two-dimensional speckle tracking echocardiography is a novel way of LA function assessment. From prior study, we know that LA appendage closure with LARIAT appears to improve LA function., Objective: The purpose of this study was to assess the impact of LAA closure via Watchman device on LA function via strain and volumetric analyses using two-dimensional speckle tracking echocardiography (2D-STE)., Methods: Twenty-five patients who underwent Watchman device implantation (WDI) were included. LA function parameters (volumetric, strain indices) were calculated from apical four chamber views with the reference point set at QRS using 2D-STE before and after WDI. LA expansion index, strain and strain rate during ventricular systole represent LA reservoir function. Passive emptying fraction, strain and strain rate during early ventricular diastole represent LA conduit function., Results: Mean age was 76 ± 6.9 years with 60% males. There was significant improvement in conduit function (LA passive emptying fraction; post 28.6 (21.9-35.9) vs pre 21.0 (13.8-34.7), p = 0.032), reservoir function (LA expansion index; post 75.3 (52.3-98.0) vs pre 58.1 (37.8-85.2), p = 0.026), and booster function (LA active emptying fraction; post 13.3 (9.7-29.9) vs pre 12.6 (8.8-25.5), p = 0.04) by volumetric indices. No significant improvement was noted with strain indices in conduit function (SRe; post - 0.56 (0.43-0.93) vs pre - 0.58 (0.46-0.87); p = 0.518) and reservoir function (SRs; post + 0.58 (0.28-0.40) vs pre + 0.52 (0.35-0.86); p = 0.851)., Conclusions: WDI resulted in discrepancy of volumetric and strain indices in LA function assessment.
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- 2020
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31. Impact of Yoga on Cardiac Autonomic Function and Arrhythmias.
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Akella K, Kanuri SH, Murtaza G, G Della Rocca D, Kodwani N, K Turagam M, Shenthar J, Padmanabhan D, Basu Ray I, Natale A, Gopinathannair R, and Lakkireddy D
- Abstract
With the expanding integration of complementary and alternative medicine (CAM) practices in conjunction with modern medicine, yoga has quickly risen to being one of the most common CAM practices across the world. Despite widespread use of yoga, limited studies are available, particularly in the setting of dysrhythmia. Preliminary studies demonstrate promising results from integration of yoga as an adjunct to medical therapy for management of dysrhythmias. In this review, we discuss the role of autonomic nervous system in cardiac arrhythmia,interaction of yoga with autonomic tone and its subsequent impact on these disease states. The role of yoga in specific disease states, and potential future direction for studies assessing the role of yoga in dysrhythmia.
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- 2020
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32. Exclusion of electrical and mechanical function of the left atrial appendage in patients with persistent atrial fibrillation: differences in efficacy and safety between endocardial ablation vs epicardial LARIAT ligation (the EXCLUDE LAA study).
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Parikh V, Rasekh A, Mohanty S, Yarlagadda B, Atkins D, Bommana S, Turagam M, Jeffery C, Carroll H, Nydegger C, Jaeger M, Dar T, Cheng J, Gopinnathanair R, Dibiase L, Lee R, Horton R, Natale A, and Lakkireddy D
- Subjects
- Aged, Atrial Appendage physiopathology, Atrial Fibrillation physiopathology, Epicardial Mapping, Female, Humans, Ligation instrumentation, Male, Patient Safety, Pulmonary Veins surgery, Retrospective Studies, Atrial Appendage surgery, Atrial Fibrillation surgery, Radiofrequency Ablation methods
- Abstract
Background: Electrical isolation of the left atrial appendage (LAA) may provide incremental benefits for arrhythmia management in patients undergoing radiofrequency ablation (RFA) for persistent atrial fibrillation (AF)., Objective: The aim of this study was to compare efficacy and safety of endocardial ablation and LAA exclusion with LARIAT device for electrical and mechanical exclusion of LAA., Methods: We compared patients who underwent endocardial LAA isolation during index RFA for persistent AF and underwent a repeat RFA to patients who underwent LAA exclusion with LARIAT device followed by RFA for AF in this multicenter registry. Efficacy of electrical and mechanical isolation of LAA was assessed., Results: We included 182 patients of which 91 patients underwent endocardial LAA isolation during RFA for AF, and 91 patients underwent LAA exclusion with LARIAT device followed by RFA for AF. Baseline characteristics were similar except for higher CHA
2 DS2- VASc score, coronary artery disease, and prior stroke rate in LARIAT arm. Persistence of electrical isolation (measured at beginning of second procedure) after LARIAT procedure was higher than one-time AF-RFA (96.7% vs 52.8%, p < 0.01). Acute pulmonary vein isolation rates were similar in both arms. AF recurrence rate after second isolation attempts at 1 year was similar in both arms. No difference in major complications was noted between both arms., Conclusions: LAA exclusion with LARIAT device appears to be more efficacious as compared to one-time endocardial ablation, but not compared to repeat isolation, in achieving complete electrical isolation of LAA for persistent AF.- Published
- 2020
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33. Direct oral anticoagulants: a review on the current role and scope of reversal agents.
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Chaudhary R, Sharma T, Garg J, Sukhi A, Bliden K, Tantry U, Turagam M, Lakkireddy D, and Gurbel P
- Subjects
- Administration, Oral, Anticoagulants adverse effects, Blood Coagulation physiology, Clinical Trials as Topic methods, Hemorrhage chemically induced, Hemorrhage drug therapy, Humans, Antibodies, Monoclonal, Humanized administration & dosage, Anticoagulants administration & dosage, Blood Coagulation drug effects, Factor Xa administration & dosage, Recombinant Proteins administration & dosage
- Abstract
New guideline recommendations prefer direct oral anticoagulants (DOACs) over warfarin in DOAC-eligible patients with atrial fibrillation and patients with venous thromboembolism. As expected with all antithrombotic agents, there is an associated increased risk of bleeding complications in patients receiving DOACs that can be attributed to the DOAC itself, or other issues such as acute trauma, invasive procedures, or underlying comorbidities. For the majority of severe bleeding events, the widespread approach is to withdraw the DOAC, then provide supportive measures and "watchful waiting" with the expectation that the bleeding event will resolve with time. However, urgent reversal of anticoagulation may be advantageous in patients with serious or life-threatening bleeding or in those requiring urgent surgery or procedures. Until recently, the lack of specific reversal agents, has affected the uptake of these agents in clinical practice despite a safer profile compared to warfarin in clinical trials. In cases of life-threatening or uncontrolled bleeding or when patients require emergency surgery or urgent procedures, idarucizumab has been recently approved for reversal of anticoagulation in dabigatran-treated patients and andexanet alfa for factor Xa inhibitor-treated treated patients. The current review summarizes the current clinical evidence and scope of these agents with the potential impact on DOAC use in clinical practice.
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- 2020
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34. Safety of rapid switching from amiodarone to dofetilide in atrial fibrillation patients with an implantable cardioverter-defibrillator.
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Sharma SP, Turagam M, Atkins D, Bommana S, Jeffrey C, Newton D, Nydegger C, Carroll H, Gopinathannair R, Natale A, and Lakkireddy D
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- Aged, Female, Hospitalization, Humans, Male, Middle Aged, Retrospective Studies, Amiodarone administration & dosage, Anti-Arrhythmia Agents administration & dosage, Atrial Fibrillation drug therapy, Defibrillators, Implantable, Phenethylamines administration & dosage, Sulfonamides administration & dosage
- Abstract
Background: Dofetilide is a class III antiarrhythmic drug commonly used for treatment of atrial fibrillation. Drug guidelines mandate a 3-month waiting period before initiating dofetilide after amiodarone use. Whether patients with an implantable cardioverter-defibrillator (ICD) can be rapidly switched from amiodarone to dofetilide is not known., Objective: The purpose of this study was to evaluate whether rapid switching from amiodarone to dofetilide is safe in atrial fibrillation patients with an ICD., Methods: In this retrospective observational study, we assessed the feasibility and the short- and long-term safety of rapid switching from amiodarone to dofetilide in hospitalized atrial fibrillation with an ICD., Results: The study included a total of 179 patients who were followed for 12.6 ± 2.2 months. All patients had drug initiation during hospitalization. Dofetilide resulted in successful cardioversion in 66% (118/179). Twenty percent of patients (36/179) required dofetilide dose adjustments in the initiation phase because of QT prolongation and decreased creatinine clearance. A total of 6.1% of patients (11/179) required drug discontinuation. The incidence of torsades de pointes was 1.1% (2/179) during initiation. One patient (0.5%) had self-terminating ventricular tachycardia at follow-up. No other significant adverse events were noted during follow-up., Conclusion: Atrial fibrillation patients with an ICD can be rapidly switched to dofetilide after 7 days of discontinuation of amiodarone without significant arrhythmia-related complications. Prospective studies with large sample sizes, especially of women, should be performed to further validate these findings., (Copyright © 2019. Published by Elsevier Inc.)
- Published
- 2019
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35. Role of Prophylactic Magnesium Supplementation in Prevention of Postoperative Atrial Fibrillation in Patients Undergoing Coronary Artery Bypass Grafting: a Systematic Review and Meta-Analysis of 20 Randomized Controlled Trials.
- Author
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Chaudhary R, Garg J, Turagam M, Chaudhary R, Gupta R, Nazir T, Bozorgnia B, Albert C, and Lakkireddy D
- Abstract
Background: Several randomized trials have evaluated the efficacy of prophylactic magnesium (Mg) supplementation in prevention of post-operative atrial fibrillation (POAF) in patients undergoing cardiac artery bypass grafting (CABG). We aimed to determine the role of prophylactic Mg in 3 different settings (intraoperative, postoperative, intraoperative plus postoperative) in prevention of POAF., Methods: A systemic literature search was performed (until January 19, 2019) using PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials to identify trials evaluating Mg supplementation post CABG. Primary outcome of our study was reduction in POAF post CABG., Results: We included a total of 2,430 participants (1,196 in the Mg group and 1,234 in the placebo group) enrolled in 20 randomized controlled trials. Pooled analysis demonstrated no reduction in POAF between the two groups (RR 0.90; 95% CI, 0.79-1.03; p=0.13; I2=42.9%). In subgroup analysis, significant reduction in POAF was observed with postoperative Mg supplementation (RR 0.76; 95% CI, 0.58-0.99; p=0.04; I2=17.6%) but not with intraoperative or intraoperative plus postoperative Mg supplementation (RR 0.77; 95% CI, 0.49-1.22; p = 0.27; I2=49% and RR 0.92; 95% CI, 0.68-1.24; p = 0.58; I2=51.8%, respectively)., Conclusions: Magnesium supplementation, especially in the postoperative period, is an effective strategy in reducing POAF following CABG.
- Published
- 2019
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36. Intramyocardial autologous CD34+ cell therapy for refractory angina: A meta-analysis of randomized controlled trials.
- Author
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Velagapudi P, Turagam M, Kolte D, Khera S, Hyder O, Gordon P, Aronow HD, Leopold J, and Abbott JD
- Subjects
- Angina Pectoris metabolism, Angina Pectoris mortality, Angina Pectoris physiopathology, Exercise Tolerance, Health Status, Humans, Randomized Controlled Trials as Topic, Recovery of Function, Risk Factors, Time Factors, Transplantation, Autologous, Treatment Outcome, Angina Pectoris surgery, Antigens, CD34 metabolism, Neovascularization, Physiologic, Stem Cell Transplantation adverse effects, Stem Cell Transplantation mortality, Stem Cells metabolism
- Abstract
Background: Previous studies have demonstrated that intramyocardial human CD34+ cells may relieve symptoms and improve clinical outcomes in chronic refractory angina unresponsive to optimal medical therapy or not amenable to revascularization., Methods: We performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the impact of human CD34+ cells compared with placebo in chronic refractory angina. Primary efficacy outcomes in our analysis were angina frequency and exercise time. Primary safety outcomes included major adverse cardiovascular events such as myocardial infarction (MI), stroke and death., Results: Three eligible randomized trials including 269 patients (placebo = 90, CD34+ = 179) were included. Dose of auto-CD34+ cells ranged from 5 × 10
4 to 5 × 105 cells/kg. Follow-up ranged from 6 to 24 months. In a pooled analysis, administration of CD34+ cells decreased the risk of all-cause mortality [OR 0.24, 95% CI (0.08-0.73), p = 0.01], reduced angina frequency [mean difference -2.91, 95% CI (-4.57 to -1.25), p = 0.0006] and improved exercise time [mean difference 58.62 s, 95% CI (21.19 to 96.06), p = 0.02] compared with control group. However, there was no significant difference in the risk of myocardial infarction (MI) and stroke between groups., Conclusion: In a meta-analysis, intra-myocardial CD34+ cell therapy was superior to placebo in improving risk of all - cause mortality, angina frequency with an increase in exercise time, without a significant increase in adverse events. This analysis supports further trials of CD34+ cell therapy for ischemic heart disease., (Copyright © 2018 Elsevier Inc. All rights reserved.)- Published
- 2019
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37. Temporal relationships between esophageal injury type and progression in patients undergoing atrial fibrillation catheter ablation.
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Yarlagadda B, Deneke T, Turagam M, Dar T, Paleti S, Parikh V, DiBiase L, Halfbass P, Santangeli P, Mahapatra S, Cheng J, Russo A, Edgerton J, Mansour M, Ruskin J, Dukkipati S, Wilber D, Reddy V, Packer D, Natale A, and Lakkireddy D
- Subjects
- Catheter Ablation methods, Disease Progression, Endoscopy, Digestive System, Esophageal Diseases diagnosis, Esophagus diagnostic imaging, Humans, Risk Factors, Atrial Fibrillation surgery, Catheter Ablation adverse effects, Esophageal Diseases etiology, Esophagus injuries, Postoperative Complications
- Abstract
Background: Currently, little is known about the onset, natural progression, and management of esophageal injuries after atrial fibrillation (AF) ablation., Objectives: We sought to provide a systematic review on esophageal injury after AF ablation and identify temporal relationships between various types of esophageal lesions, their progression, and clinical outcomes., Methods: A comprehensive search of PubMed and Web of Science was conducted until September 21, 2017. All AF ablation patients who underwent upper gastrointestinal endoscopy within 1 week of the procedure were included. Patients with esophageal lesions were classified into 3 types by using our novel Kansas City classification: type 1: erythema; type 2a: superficial ulcers; type 2b: deep ulcers; type 3a: perforation without communication with the atria; and type 3b: perforation with atrioesophageal fistula., Results: Thirty studies met our inclusion criteria. Of the 4473 patients, 3921 underwent upper gastrointestinal evaluation. The overall incidence of esophageal injuries was 15% (570). There were 206 type 1 lesions (36%), 222 type 2a lesions (39%), and 142 type 2b lesions (25%). Six of 142 type 2b lesions (4.2%) progressed further to type 3, of which, 5 were type 3a and 1 was type 3b. All type 1 and type 2a and most type 2b lesions resolved with conservative management. One type 3a and 1 type 3b lesions were fatal., Conclusion: Based on our classification, all type 1 and most type 2 lesions resolved with conservative management. A small percentage (4.2% [6 of 142]) of type 2b lesions progressed to perforation and/or fistula formation, and these patients need to be followed closely., (Copyright © 2018. Published by Elsevier Inc.)
- Published
- 2019
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38. Arrhythmic Mitral Valve Prolapse: JACC Review Topic of the Week.
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Miller MA, Dukkipati SR, Turagam M, Liao SL, Adams DH, and Reddy VY
- Subjects
- Arrhythmias, Cardiac physiopathology, Death, Sudden, Cardiac epidemiology, Death, Sudden, Cardiac prevention & control, Defibrillators, Implantable trends, Electrocardiography trends, Humans, Mitral Valve Prolapse physiopathology, Prospective Studies, Retrospective Studies, Arrhythmias, Cardiac epidemiology, Arrhythmias, Cardiac therapy, Mitral Valve Prolapse epidemiology, Mitral Valve Prolapse therapy
- Abstract
There is an increasing awareness of the association between mitral valve prolapse and sudden cardiac death. There are several clinical risk factors associated with an increased risk of mitral valve prolapse-related sudden cardiac death, most of which can be evaluated with noninvasive diagnostic modalities. For example, characteristic changes on the electrocardiogram (T-wave inversions in the inferior leads), complex ventricular ectopy, a spiked configuration of the lateral annular velocities by echocardiography, and evidence of myocardial fibrosis by cardiac magnetic resonance imaging have all been implicated as markers of risk. Herein, the authors review the reported incidence of sudden death to mitral valve prolapse, the clinical profile of at-risk patients, and the basic components necessary to initiate and perpetuate ventricular arrhythmias (substrate and trigger) as well as potential interventions to consider for those at highest risk., (Copyright © 2018. Published by Elsevier Inc.)
- Published
- 2018
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39. Left Atrial Appendage Closure and Systemic Homeostasis: The LAA HOMEOSTASIS Study.
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Lakkireddy D, Turagam M, Afzal MR, Rajasingh J, Atkins D, Dawn B, Di Biase L, Bartus K, Kar S, Natale A, and Holmes DJ Jr
- Subjects
- Aged, Biomarkers blood, Correlation of Data, Female, Homeostasis, Humans, Male, Middle Aged, Monitoring, Physiologic methods, Prospective Studies, United States epidemiology, Aldosterone blood, Atrial Appendage diagnostic imaging, Atrial Appendage surgery, Atrial Fibrillation metabolism, Atrial Fibrillation physiopathology, Atrial Fibrillation surgery, Epinephrine blood, Natriuretic Peptide, Brain blood, Septal Occluder Device classification, Thromboembolism prevention & control
- Abstract
Background: The impact of left atrial appendage (LAA) exclusion, comparing an epicardial LAA or an endocardial LAA device, on systemic homeostasis remains unknown., Objectives: This study compared the effects of epicardial or endocardial LAA devices on the neurohormonal profiles of patients, emphasizing the roles of the renin-angiotensin-aldosterone system and the autonomic nervous system., Methods: This is a prospective, single-center, observational study including 77 patients who underwent LAA closure by an epicardial (n = 38) or endocardial (n = 39) device. Key hormones involved in the adrenergic system (adrenaline, noradrenaline), renin-angiotensin-aldosterone system (aldosterone, renin), metabolic system (adiponectin, free fatty acids, insulin, β-hydroxybutyrate, and free glycerols), and natriuresis (atrial and B-type natriuretic peptides) were assessed immediately before the procedure, immediately after device deployment, at 24 h, and at 3 months follow-up., Results: In the endocardial LAA device group, when compared with baseline blood adrenaline, noradrenaline and aldosterone were significantly lower at 24 h and 3 months (p < 0.05). There was no significant change in levels post-endocardial LAA device implantation. After epicardial LAA device implantation, there were significant increases in adiponectin and insulin, with decreased free fatty acids at 3 months. There was no significant change in these levels post-endocardial LAA device. N-terminal pro-A-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide were significantly decreased in the acute phase after epicardial LAA device implantation, which subsequently normalized at 3 months. Post endocardial LAA device implantation, the levels increased immediately and normalized after 24 h. Systemic blood pressure was also significantly lower at all time points after epicardial LAA device implantation, which was not seen post-endocardial LAA device implantation., Conclusions: There are substantial differences in hemodynamics and neurohormonal effects of LAA exclusion with epicardial and endocardial devices. Further studies are required to elucidate the underlying mechanism of these physiological changes., (Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
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40. Less than two versus greater than two hour invasive strategy in non-ST elevation myocardial infarction: a meta-analysis of randomized controlled trials.
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Velagapudi P, Turagam M, Kolte D, Khera S, Parikh P, Hyder O, Aronow H, and Abbott JD
- Subjects
- Coronary Angiography, Hemorrhage etiology, Humans, Randomized Controlled Trials as Topic, Treatment Outcome, Coronary Artery Bypass methods, Myocardial Infarction surgery, Percutaneous Coronary Intervention methods
- Abstract
Background: Optimal timing for an invasive strategy in non-ST elevation myocardial infarction (NSTEMI) is unclear. Whether clinical outcomes are improved with a less than two (LT2) compared with greater than two hour (GT2) invasive strategy remains to be determined. We performed a meta-analysis of randomized controlled trials (RCTs) comparing LT2 vs GT2 for NSTEMI., Methods: A comprehensive literature search for RCTs comparing LT2 vs. GT2 in NSTEMI patients was performed. Three eligible studies consisting of 1,075 patients (LT2: 537, GT2: 538) with NSTEMI were identified. Follow-up ranged from 1 to 12 months., Results: Time from randomization to sheath insertion ranged from 0.5-2.2 and 14.0-85.0 hours in the LT2 and GT2 groups. More percutaneous coronary interventions and fewer coronary artery bypass grafting were performed in the LT2 vs. GT2 group. There was no significant difference in all-cause mortality, myocardial infarction (MI), and major bleeding between the two groups. LT2 was numerically, but not statistically superior to GT2 at preventing recurrent ischemia/urgent revascularization/refractory ischemia., Conclusion: Our meta-analysis found no significant difference in outcomes between less than two versus greater than two hours invasive strategy for NSTEMI. The differences observed in the mode of revascularization according to timing of catheterization deserve further study.
- Published
- 2018
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41. Anatomical and electrical remodeling with incomplete left atrial appendage ligation: Results from the LAALA-AF registry.
- Author
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Turagam M, Atkins D, Earnest M, Lee R, Nath J, Ferrell R, Bartus K, Badhwar N, Rasekh A, Cheng J, Di Biase L, Natale A, Wilber D, and Lakkireddy D
- Subjects
- Aged, Atrial Appendage physiopathology, Atrial Appendage surgery, Atrial Fibrillation physiopathology, Atrial Fibrillation surgery, Catheter Ablation methods, Female, Follow-Up Studies, Heart Atria diagnostic imaging, Heart Atria physiopathology, Heart Atria surgery, Humans, Male, Middle Aged, Prospective Studies, Atrial Appendage diagnostic imaging, Atrial Fibrillation diagnostic imaging, Atrial Remodeling physiology, Imaging, Three-Dimensional methods, Registries, Tomography, X-Ray Computed methods
- Abstract
Background: The anatomical, electrical, and clinical impact of incomplete Lariat left atrial appendage ligation remains unclear., Methods: We studied LAA anatomy pre- and postligation using contrast enhanced-computed tomography (CT) scans in 91 patients with atrial fibrillation (AF) who subsequently underwent catheter ablation (CA)., Results: Eleven patients had an incomplete exclusion (12%) with a central leak ranging from 1 to 5 mm. Despite incomplete ligation; the LAA volume were reduced by 67% postprocedurally when compared to preprocedure. In 7 patients with a leak between 1 and 3 mm, there was a 77% reduction in LAA volume beyond the ligation site suggestive of remodeling of the LAA. In 4 patients with larger (4-5 mm) leak the LAA remnants (LAARs) were slightly larger than those with smaller leaks on follow-up CT scan. Three out of the 4 demonstrated LAA electrical activity during CA and underwent isolation of the LAA ostium. Follow-up imaging showed two of these LAARs completely sealed with no communication with the left atrium. There was no significant difference in the AF recurrence rates between the patients who had a leak versus those with complete ligation (4 of 11 [36%] vs. 22 of 80 [27%]; P = 0.6). Oral anticoagulation was discontinued in all patients with small leaks and 2 patients with large leaks that sealed completely upon follow-up imaging. There were no strokes or TIAs at 12 months., Conclusion: Despite incomplete LAA ligation by Lariat device there is significant anatomical and electrical remodeling that resulted in reduction in LAA size, volume, and electrical activity., (© 2017 Wiley Periodicals, Inc.)
- Published
- 2017
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42. Impact of Radiofrequency Ablation of Atrial Fibrillation on Pulmonary Vein Cross Sectional Area: Implications for the Diagnosis of Pulmonary Vein Stenosis.
- Author
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Jazayeri MA, Vanga SR, Vuddanda V, Turagam M, Parikh V, Lavu M, Bommana S, Atkins D, Nath J, Rosamond T, Vacek J, Madhu Reddy Y, and Lakkireddy D
- Abstract
Introduction: Restoration of normal sinus rhythm by radiofrequency ablation (RFA) in atrial fibrillation (AF) patients can result in a reduction of left atrial (LA) volume and pulmonary vein (PV) dimensions. It is not clear if this PV size reduction represents a secondary effect of overall LA volume reduction or true PV stenosis. We assessed the relationship between LA volume reduction and PV orifice area pre- and post-RFA., Methods: A retrospective cohort study was conducted at a tertiary care academic hospital. Pre- and post-RFA cardiac computed tomography (CT) studies of 100 consecutive AF patients were reviewed. Studies identifying obvious segmental PV narrowing were excluded. Left atrial volumes and PV orifice cross-sectional areas (PVOCA) were measured using proprietary software from the CT scanner vendor (GE Healthcare, Waukesha, WI)., Results: The cohort had a mean age of 60 ± 8 years, 73% were male, and 90% were Caucasian. Non-paroxysmal AF was present in 76% of patients with a mean duration from diagnosis to RFA of 55 ± 54 months. Mean procedural time was 244 ± 70 min. AF recurred in 27% at 3 month follow-up. Pre-RFA LA volumes were 132 ± 60 ml and mean PVOCA was 2.89 ± 2.32 cm
2 . In patients with successful ablation, mean LA volume decreased by 10% and PVOCA decreased by 21%. PVOCA was significantly reduced in patients with successful RFA compared to those who had recurrence (2.18 ± 1.12 vs. 2.8 ± 1.9 cm2 , p = 0.04) but reduction in LA volume between groups was not significant (118 ± 42 vs. 133 ± 54 ml, p=0.15)., Conclusions: The study demonstrates that both PV orifice dimensions and LA volume are reduced after successful AF ablation. These data warrant a reassessment of criteria for diagnosing PV stenosis based on changes in PV caliber alone, ideally incorporating LA volume changes.- Published
- 2017
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43. Adjunctive ablation strategies improve the efficacy of pulmonary vein isolation in non-paroxysmal atrial fibrillation: a systematic review and meta-analysis.
- Author
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Afzal MR, Samanta A, Chatta J, Ansari B, Atherton S, Sabzwari S, Turagam M, Lakkireddy D, and Houmsse M
- Subjects
- Atrial Fibrillation physiopathology, Electrophysiologic Techniques, Cardiac, Humans, Pulmonary Veins physiopathology, Randomized Controlled Trials as Topic, Recurrence, Treatment Outcome, Atrial Fibrillation surgery, Catheter Ablation methods, Pulmonary Veins surgery
- Abstract
Background: Pulmonary vein (PV) isolation (PVI) has suboptimal outcomes in patients with non-paroxysmal atrial fibrillation (AF). Adjunctive strategies employed to ablate non-PV triggers have shown favorable outcomes., Aims: To delineate the incremental benefit of adjunctive ablation in patients with non-paroxysmal AF through a meta-analysis., Methods and Results: Database searches through August 2016 identified five non-randomized and seven randomized controlled trials (enrolling 1694 patients). The adjunctive strategies employed for non-PV ablation included focal impulse and rotor modulation; empirical linear lines, ablation of complex fractionated atrial electrograms and ganglionated plexi. The risk ratio (RR) for AF recurrence, calculated with random effects meta-analysis showed a 36% reduction of AF recurrence at a median follow up of 12 months (RR: 0.64, 95% Confidence interval: 0.48 to 0.85; p = 0.003). The benefits persisted during longer follow up when assessed in subgroup analysis., Conclusions: Addition of adjunctive ablation to PVI improves outcomes.
- Published
- 2017
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44. Use of Oral Steroid and its Effects on Atrial Fibrillation Recurrence and Inflammatory Cytokines Post Ablation - The Steroid AF Study.
- Author
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Iskandar S, Reddy M, Afzal MR, Rajasingh J, Atoui M, Lavu M, Atkins D, Bommana S, Umbarger L, Jaeger M, Pimentel R, Dendi R, Emert M, Turagam M, Di Biase L, Natale A, and Lakkireddy D
- Abstract
Background: Use of corticosteroids before and after atrial fibrillation (AF) ablation can decrease acute inflammation and reduce AF recurrence., Purpose: To assess the efficacy of oral prednisone in improving the outcomes of pulmonary vein isolation with radiofrequency ablation and its effect on inflammatory cytokine., Methods: A total of 60 patients with paroxysmal AF undergoing radiofrequency ablation were randomized (1:1) to receive either 3 doses of 60 mg daily of oral prednisone or a placebo. Inflammatory cytokine levels (TNF-α, IL-1, IL6, IL-8) were measured at baseline, prior to ablation, immediately after ablation, and 24 hours post ablation. Patients underwent 30 day event monitoring at 3 months, 6 months and 12 months post procedure., Results: Immediate post ablation levels of inflammatory cytokines were lower in the steroid group when compared to the placebo group; IL-6: 9.0 ±7 vs 15.8 ±13 p=0.031; IL-8: 10.5 ±9 vs 15.3 ±8; p=0.047 respectively. Acute PV reconnection rates during the procedure (7/23% vs 10/36%; p = 0.39), and RF ablation time (51±13 vs 56±11 min, p = 0.11) trended to be lower in the placebo group than the steroid group. There was no difference in the incidence of early recurrence of AF during the blanking period and freedom from AF off AAD at 12 months between both groups (5/17% vs 8/27%; p = 0.347 and 21/70% vs 18/60%; p=0.417 in placebo and steroid groups respectively)., Conclusion: Although oral corticosteroids have significant effect in lowering certain cytokines, it did not impact the clinical outcomes of AF ablation.
- Published
- 2017
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45. Cardiac Resynchronization Therapy prevents progression of renal failure in heart failure patients.
- Author
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Jeevanantham V, Turagam M, Shanberg D, Reddy M, Atoui M, Daubert JP, Dawn B, and Lakkireddy D
- Abstract
Background: The goal of this study is to assess the effect of cardiac resynchronization therapy (CRT) over time on renal function and its impact on mortality. The effect of CRT on renal function in patients with heart failure is not well understood., Methods: All patients who underwent CRT implantation at University of Kansas between year 2000 and 2009 were reviewed and patients who had pre and post CRT renal function studied were included in our study. Stages of chronic kidney disease (CKD) were defined based on Kidney Disease Outcome Quality Initiative (KDOQI) guidelines. The effect of CRT on renal and cardiac function were studied at short term (≤6 months post implantation) and long term (>6 months)., Results: A total of 588 patients with mean age of 67 ± 12 yrs were included in the study. CRT responders (defined by increase in LVEF ≥ 5%) were 54% during short term follow-up and 65% on long term follow-up. When compared to baseline, there was no significant deterioration in mean Glomerular Filtration Rate (GFR) during follow up. When analyzed based on the stages of CKD, there was significant improvement of renal function in patients with advanced kidney disease. Multivariate logistic regression analysis showed that stable GFR or an improvement in GFR independently predicted mortality after adjusting for co-morbidities., Conclusions: CRT was associated with stabilization of renal function in patients with severe LV dysfunction and improvement in stage 4 and 5 CKD. Improved renal function was associated with a lower mortality., (Copyright © 2016 Indian Heart Rhythm Society. Production and hosting by Elsevier B.V. All rights reserved.)
- Published
- 2016
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46. The SHARP trial: lessons learnt; answers and more questions!
- Author
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Turagam M and Velagapudi P
- Subjects
- Atherosclerosis blood, Atherosclerosis etiology, Atherosclerosis prevention & control, Azetidines therapeutic use, Clinical Trials as Topic, Drug Combinations, Ezetimibe, Simvastatin Drug Combination, Humans, Kidney Failure, Chronic blood, Kidney Failure, Chronic complications, Simvastatin therapeutic use, Hypolipidemic Agents therapeutic use, Kidney Failure, Chronic drug therapy, Learning
- Published
- 2012
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47. Cardiac arrhythmias and sudden unexpected death in epilepsy (SUDEP).
- Author
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Velagapudi P, Turagam M, Laurence T, and Kocheril A
- Subjects
- Anticonvulsants adverse effects, Anticonvulsants therapeutic use, Arrhythmias, Cardiac etiology, Arrhythmias, Cardiac genetics, Autonomic Nervous System physiopathology, Cerebral Cortex physiopathology, Channelopathies drug therapy, Channelopathies genetics, Channelopathies physiopathology, Death, Sudden epidemiology, Electrocardiography, Epilepsy drug therapy, Epilepsy genetics, Epilepsy physiopathology, Female, Heart Rate genetics, Heart Rate physiology, Humans, Male, Risk Factors, Arrhythmias, Cardiac mortality, Death, Sudden etiology, Epilepsy mortality
- Abstract
Sudden unexpected death in epilepsy (SUDEP) is a major clinical problem in epilepsy patients in the United States, especially those with chronic, uncontrolled epilepsy. Several pathophysiological events contributing to SUDEP include cardiac arrhythmias, respiratory dysfunction, and dysregulation of systemic or cerebral circulation. There is a significant body of literature suggesting the prominent role of cardiac arrhythmias in the pathogenesis of SUDEP. There is evidence to say that long-standing epilepsy can cause physiological and anatomical autonomic instability resulting in life-threatening arrhythmias. Tachyarrhythmias, bradyarrhythmias, and asystole are commonly seen during ictal, interictal, and postictal phase in epilepsy patients. It is unclear if these rhythm disturbances need attention as some of them may be just benign findings. Evidence regarding prolonged cardiovascular monitoring or the benefit of pacemaker/defibrillator implantation for primary or secondary prevention in epilepsy patients is limited. Awareness regarding pathophysiology, cardiac effects, and management options of SUDEP will become useful in guiding more individualized treatment in the near future. (PACE 2011; 1-8)., (©2011, The Authors. Journal compilation ©2011 Wiley Periodicals, Inc.)
- Published
- 2012
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48. Small bowel obstruction due to mycosis fungoides: an unusual presentation.
- Author
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Velagapudi P, Turagam M, Uzoaru I, and Graham D
- Subjects
- Administration, Cutaneous, Aged, 80 and over, Fatal Outcome, Female, Glucocorticoids administration & dosage, Humans, Intestinal Neoplasms complications, Intestinal Neoplasms secondary, Intestinal Neoplasms surgery, Intestinal Obstruction surgery, Mycosis Fungoides pathology, Mycosis Fungoides therapy, Neoplasm Staging, Skin Neoplasms pathology, Skin Neoplasms therapy, Anti-Inflammatory Agents administration & dosage, Clobetasol administration & dosage, Intestinal Obstruction etiology, Intestine, Small pathology, Mycosis Fungoides complications, Mycosis Fungoides diagnosis, Skin Neoplasms complications, Skin Neoplasms diagnosis
- Abstract
Visceral involvement usually occurs in the late stages of mycosis fungoides (MF). Small bowel involvement in MF is uncommon. When involved, it could cause significant morbidity and mortality. In this study, the authors present an 89-year-old woman diagnosed with T1, N0, B1, M0; stage 1A MF, treated with topical temovate with good response who presented 3 months later with small bowel obstruction due to biopsy-proven localization of MF in the gastrointestinal tract.
- Published
- 2011
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49. Meloxicam-induced enteropathy of the small bowel.
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Are C, Turagam M, Aucar JA, and Greenberg E
- Subjects
- Anti-Inflammatory Agents, Non-Steroidal administration & dosage, Endoscopy, Gastrointestinal methods, Enterocolitis physiopathology, Female, Follow-Up Studies, Humans, Intestinal Mucosa pathology, Intestine, Small drug effects, Meloxicam, Middle Aged, Risk Assessment, Thiazines administration & dosage, Thiazoles administration & dosage, Anti-Inflammatory Agents, Non-Steroidal adverse effects, Enterocolitis chemically induced, Intestine, Small pathology, Thiazines adverse effects, Thiazoles adverse effects
- Published
- 2011
- Full Text
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50. "A forgotten disease": a case of Lemierre syndrome.
- Author
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Velagapudi P, Turagam M, Are C, Patel H, and Yekkirala L
- Subjects
- Female, Fusobacterium Infections microbiology, Humans, Neck diagnostic imaging, Thrombophlebitis microbiology, Tomography, X-Ray Computed, Young Adult, Fusobacterium Infections diagnosis, Fusobacterium necrophorum isolation & purification, Thrombophlebitis diagnosis
- Abstract
Lemierre's syndrome is a rare but a life threatening condition which affects young healthy individuals, was first described by Dr.Andre Lemierre in 1936. Incidence rates are between 0.6 and 2.3 per million population. It is found more commonly in males, with a male to female ratio of approximately 2:1. Its pathogenesis consists of the development of infectious thrombophlebitis in the internal jugular vein or one of its branches caused by a focal sepsis, mostly localized in the oropharynx, leading to generalized multiorgan metastatic infections, generally to the lung. This computerized tomography (CT) neck with intravenous contrast is from a 24 year old female who presented with a two day history of fever, hypotension and respiratory failure. The physical exam was positive for diminished breath sounds bilaterally on lung exam. Complete blood count revealed a leukocytosis of 16,200 u/L with 70% neutrophils and 9% bands, hemoglobin of 13.4mg/dl and severe thrombocytopenia with a platelet count of 34,000 u/L; comprehensive metabolic panel revealed sodium 140mmol/L, potassium 2.9mmol/L, bicarbonate 26mmol/L, blood urea nitrogen (BUN) 16mg/dl, creatinine 0.8mg/dl, calcium 7.2 mg/dl, albumin 2.4g/dl, total bilurubin 3.1mg/dl, AST 81 U/L, ALK 101 U/L, ALT 35U/L. CT chest revealed multiple cavitary opacities in both lungs. Blood cultures were positive for Fusobacterium necrophorum. CT scan neck showed a filling defect of the right internal jugular vein consistent with a thrombus and multiple enlarged cervical lymph nodes. Treatment is medical with intravenous antibiotics and anticoagulation. References: 1. Carlson ER, Bergamo DF, Coccia CT. Lemierre's syndrome: two cases of a forgotten disease. J Oral Maxillofac Surg 1994; 52:74-78. 2. Moore-Gillon J, Lee TH, Eykyn SJ, Phillips I. Necrobacillosis: a forgotten disease. BMJ 1984;288:1526-1527. 3. Jones C, Siva TM, Seymour FK, O'Reilly BJ. Lemierre's syndrome presenting with peritonsillar abscess and VIth cranial nerve palsy. J Laryngol Otol 2006;120:502-504 4. Mohammed Iqbal Syed et al. Lemierre Syndrome: Two Cases and a Review. Laryngoscope, 117:1605-1610, 2007 5. Vohra A, Saiz E, Ratzan KR. A young woman with a sore throat, septicaemia, and respiratory failure. Lancet 1997; 350:928.
- Published
- 2009
- Full Text
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