80 results on '"Valay Parikh"'
Search Results
2. Impact of ultra‐conservative ICD programming in patients with LVADs: Avoiding potentially unnecessary tachy‐therapies
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Alexander Robinson, Valay Parikh, Mohammad‐Ali Jazayeri, Michael Pierpoline, Y. Madhu Reddy, Martin Emert, Rhea Pimentel, Raghuveer Dendi, Loren Berenbom, Amit Noheria, Rigoberto Ramirez, Andrew J. Sauer, Zubair Shah, Travis Abicht, Nicholas Haglund, and Seth H. Sheldon
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Male ,Primary Prevention ,Tachycardia, Ventricular ,Humans ,Female ,Heart-Assist Devices ,General Medicine ,Middle Aged ,Cardiology and Cardiovascular Medicine ,Defibrillators, Implantable ,Retrospective Studies - Abstract
Patients with left ventricular assist devices (LVAD) often tolerate ventricular arrhythmias (VA). We aim to assess the frequency and outcomes of ICD therapies averted by ultraconservative ICD programming (UCP) in LVAD patients.This single center, retrospective cohort study included patients with LVADs and ICDs implanted from 2015 to 2019 that had UCP. The aim for UCP was to maximally delay VA treatments and maximize anti-tachycardia pacing (ATP) prior to ICD shocks. VA events were reviewed after UCP and evaluated under prior conservative programming to assess for potentially averted events (that would have resulted in either ATP or defibrillation with prior programming).Fifty patients were included in the study with follow-up of median 16 ± 10.2 months after UCP. The median time from LVAD implantation to reprogramming was 7 days (IQR 5-9 days). Fourteen patients (28%) had potentially averted VA events that would have been treated with their prior ICD programming (82 total events, median two events per patient, IQR 1-10 events). Treated VA events occurred in 15 patients (30%). Eleven of the 14 patients with potentially averted VAs had treated events as well. Only one patient reported definitive symptoms of self-limited "dizziness" during a potentially averted event that did not result in hospitalization. No patients died of complications from or needed emergent care/hospitalization due a potentially averted VA.UCP in LVAD patients likely prevented unnecessary VA treatments in many patients with minimal reported symptoms during these potentially averted events. Prospective studies are necessary to confirm these findings.
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- 2022
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3. Electromagnetic interference from left ventricular assist devices detected in patients with implantable cardioverter‐defibrillators
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Moghniuddin Mohammed, Andrew J. Sauer, Valay Parikh, Seth H. Sheldon, Alexander Robinson, Y. Madhu Reddy, Nicholas Haglund, Michael Pierpoline, Mohammad-Ali Jazayeri, and Amit Noheria
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Male ,medicine.medical_specialty ,Heart Ventricles ,medicine.medical_treatment ,Ventricular tachycardia ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,In patient ,Heart Failure ,Ischemic cardiomyopathy ,Heartmate ii ,business.industry ,Significant difference ,equipment and supplies ,medicine.disease ,Implantable cardioverter-defibrillator ,Defibrillators, Implantable ,Median time ,Child, Preschool ,Cardiology ,Female ,Heart-Assist Devices ,Cardiology and Cardiovascular Medicine ,business ,Electromagnetic Phenomena - Abstract
Introduction Electromagnetic interference (EMI) from left ventricular assist devices (LVADs) can cause implantable cardioverter-defibrillator (ICD) oversensing. We sought to assess the frequency of inappropriate shocks/oversensing due to LVAD-related EMI and prospectively compare integrated (IB) versus dedicated bipolar (DB) sensing in patients with LVADs. Methods Single-center study in LVAD patients with Medtronic or Abbott ICDs between September 2017 and March 2020. We excluded patients that were pacemaker dependent. Measurements were obtained of IB and DB sensing and noise to calculate a signal-to-noise ratio (SNR). Device checks were reviewed to assess appropriate and inappropriate sensing events. Results Forty patients (age 52 ± 14 years, 75% men, 38% ischemic cardiomyopathy) were included with the median time between LVAD implantation and enrollment of 6.7 months [2.3, 11.4 months]. LVAD subtypes included: HeartWare (n=22, 55%), Heartmate II (n=10, 25%), and Heartmate III (n=8, 20%). Over a follow-up duration of 21.6 ± 12.9 months after LVAD implantation, 5% of patients (n=2) had oversensing of EMI from the LVAD (both with HeartWare LVADs and Abbott ICDs) at 4 days and 10.8 months after LVAD implantation. Both patients underwent adjustment of ventricular sensing with resolution of oversensing and no further events over 5 and 15 months of further follow-up. The SNR was similar between IB and DB sensing (50 [29-67] and 57 [41-69], p=0.89). Conclusion ICD oversensing of EMI from LVADs is infrequent and can be managed with reprogramming the sensitivity. There was no significant difference in the R-wave SNR with IB versus DB ICD leads. This article is protected by copyright. All rights reserved.
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- 2021
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4. Outcomes of junctional ectopic tachycardia ablation in adult population—a multicenter experience
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Andrea Natale, Valay Parikh, Rakesh Gopinathannair, Carola Gianni, Mohit K. Turagam, Tawseef Dar, Dhanunjaya Lakkireddy, T. Jared Bunch, Jayasree Pillarisetti, Bharath Yarlagadda, Moussa Mansour, Sanghamitra Mohanty, and Luigi Di Biase
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medicine.medical_specialty ,business.industry ,Radiofrequency ablation ,medicine.medical_treatment ,Cryoablation ,Catheter ablation ,Retrospective cohort study ,030204 cardiovascular system & hematology ,Ablation ,medicine.disease ,Surgery ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Refractory ,law ,Physiology (medical) ,Junctional ectopic tachycardia ,medicine ,030212 general & internal medicine ,Supraventricular tachycardia ,Cardiology and Cardiovascular Medicine ,business - Abstract
Idiopathic junctional ectopic tachycardia (JET) is typically refractory to antiarrhythmic agents. Catheter ablation for JET is feasible but is associated with high risk of unintended atrioventricular (AV) block. There is limited data on the appropriate procedural technique and clinical outcomes with catheter ablation for idiopathic JET in adults. This is a multicenter, retrospective study of all adult patients (age ≥ 18 years) who underwent catheter ablation for idiopathic JET. Patient, procedural characteristics, and long-term outcomes were evaluated. Fifteen patients [radiofrequency ablation (RF) = 14 and cryoablation = 1) were treated with catheter ablation. The median age was 58 years with 67% males. All patients underwent mapping of the right atrium and the aortic cusps prior to energy delivery. The location of earliest activation in relation to the atrioventricular (AV) node was postero-superior in 73% (11/15), posterior in 13% (2/15), and superior in 13% (2/15) respectively. Acute success was 100%. Arrhythmia recurrence occurred in 53% (8/15) all of whom underwent a repeat ablation. High-grade AV block requiring permanent pacemaker occurred in 20% (3/15). At 12-month follow-up in the redo-ablation group, 37.5% (3/8) had recurrence of the arrhythmia two of which underwent a third ablation procedure. Catheter ablation of idiopathic JET in adults is associated with a high rate of recurrence requiring multiple procedures and high risk of AV block requiring a permanent pacemaker. Mapping and ablation of the non-coronary cusp can be considered as the arrhythmia was controlled in 3 patients with no inadvertent AV block.
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- 2020
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5. Economics and laboratory efficiency of atrial fibrillation ablation
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Rina Shah, Philippe Akhrass, Valay Parikh, and Marcin Kowalski
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medicine.medical_specialty ,business.industry ,Defibrillation ,medicine.medical_treatment ,Atrial fibrillation ,Catheter ablation ,medicine.disease ,Ablation ,Cryosurgery ,Review article ,Cost reduction ,Treatment Outcome ,Health care ,Atrial Fibrillation ,Catheter Ablation ,Medicine ,Humans ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine ,health care economics and organizations ,Cryoballoon ablation - Abstract
PURPOSE OF REVIEW Atrial fibrillation is a growing public health problem and is associated with an increased risk of comorbidities with enormous socioeconomic implications. This review article focuses on fiscal burden of atrial fibrillation on the healthcare system and economic value of atrial fibrillation ablations brought to the patient and the payers by improvement in outcomes and reduction in treatment costs. RECENT FINDINGS This article summarizes the recently published studies evaluating the economic impact of atrial fibrillation treatment. Catheter ablation have shown to be the most successful strategy for treatment of defibrillation. However, repeat ablation is associated with higher costs, over and above any subsequent procedural costs, compared with a single ablation procedure for atrial fibrillation. Cryoballoon ablation has been shown to have fewer repeat ablations than radiofrequency ablations, which resulted in overall cost reduction. Improvement in laboratory efficiency, better utilization of laboratory resources and same-day discharge strategy can lead to further healthcare savings and increase in value to all stakeholders. SUMMARY The value of healthcare delivery for patient with atrial fibrillation can be improved by advancement in technology that demonstrates cost reduction to the health system and outcomes improvements. Implementation of tactics that decrease cost and improve outcomes can alleviate some of the financial strain on healthcare systems, which is of extreme importance in the current climate.
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- 2021
6. Safety and outcomes of catheter ablation for atrial fibrillation in adults with congenital heart disease: A multicenter registry study
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Pasquale Santangeli, Francis E. Marchlinski, Joseph Kay, Andrea Natale, Duy T. Nguyen, Valay Parikh, Sanghamitra Mohanty, Edward P. Gerstenfeld, Jackson J. Liang, William H. Sauer, Kathryn K. Collins, Judit Szilagyi, Jeremy P. Moore, J. David Burkhardt, Dhanujaya Lakkireddy, and David S. Frankel
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Adult ,Heart Defects, Congenital ,Male ,medicine.medical_specialty ,Heart disease ,Registry study ,medicine.medical_treatment ,Catheter ablation ,030204 cardiovascular system & hematology ,Pulmonary vein ,03 medical and health sciences ,0302 clinical medicine ,Heart Rate ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,030212 general & internal medicine ,Major complication ,Retrospective Studies ,Paroxysmal AF ,business.industry ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Ablation ,United States ,Outcome and Process Assessment, Health Care ,Catheter Ablation ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Anti-Arrhythmia Agents - Abstract
Background An increasing number of adults with congenital heart disease (CHD) are undergoing catheter ablation for atrial fibrillation (AF). Data on ablation strategy and outcomes in CHD are limited. Rhythm control is often believed to be of greater importance among patients with complex CHD. Objective The purpose of this study was to examine the safety and efficacy of AF ablation in adult patients with CHD. Methods A multicenter retrospective analysis was performed of CHD patients undergoing AF ablation. Clinical data were collected, including AF and CHD type, procedural data, and outcomes. Patients were divided into 3 groups (simple, moderate, and severe) based on CHD complexity, as defined by the 2014 PACES/HRS (Pediatric and Congenital Electrophysiology Society/Heart Rhythm Society) consensus statement. One-year procedural success was defined as freedom from recurrent AF, off antiarrhythmic drugs (complete) or off/on previously failed antiarrhythmic drugs (partial). Results Overall, 84 CHD patients (mean age 51.5 ± 12.1 years; 65.5% male; 45.2% with paroxysmal AF) undergoing AF ablation (51 simple, 22 moderate, 11 severe complexity) were included. Pulmonary vein isolation was performed in 80 (95.2%), of whom 30 (35.7%) underwent pulmonary vein isolation alone. Overall, complete and complete/partial freedom was achieved at 1 year in 53.1% and 71.6%, respectively, with no significant differences between those with simple, moderate, or severe complexity. There were no major complications and 7 minor complications, and 2 patients died during follow-up. Conclusion There are dramatic differences in the degree of CHD complexity among patients referred for AF ablation. When performed at experienced centers, AF ablation is safe and effective even among patients with the most complex forms of CHD.
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- 2019
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7. Intramural anterolateral mitral annular idiopathic ventricular tachycardia successfully ablated from the atrium
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Valay Parikh, Seth H. Sheldon, Bharath Yarlagadda, Tawseef Dar, and Y. Madhu Reddy
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Intramural ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Case Report ,Ventricular tachycardia ,Ablation ,medicine.disease ,Mitral annulus ,Atrium ,medicine.anatomical_structure ,Internal medicine ,Cardiology ,Medicine ,Atrium (heart) ,Cardiology and Cardiovascular Medicine ,business - Published
- 2019
8. Temporal relationships between esophageal injury type and progression in patients undergoing atrial fibrillation catheter ablation
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Andrea Natale, Mohit K. Turagam, Philipp Halfbass, Pasquale Santangeli, David J. Wilber, Tawseef Dar, Vivek Y. Reddy, Bharath Yarlagadda, Jeremy N. Ruskin, James R. Edgerton, Dhanunjaya Lakkireddy, Andrea M. Russo, T. Deneke, Swathi Paleti, Srijoy Mahapatra, Srinivas R. Dukkipati, Moussa Mansour, Douglas L. Packer, Luigi DiBiase, Jie Cheng, and Valay Parikh
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medicine.medical_specialty ,Erythema ,Fistula ,medicine.medical_treatment ,Perforation (oil well) ,Catheter ablation ,030204 cardiovascular system & hematology ,Esophageal Diseases ,03 medical and health sciences ,Esophagus ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,Physiology (medical) ,Atrial Fibrillation ,medicine ,Humans ,Endoscopy, Digestive System ,030212 general & internal medicine ,business.industry ,Incidence (epidemiology) ,Atrial fibrillation ,medicine.disease ,Ablation ,Surgery ,Catheter Ablation ,Disease Progression ,Esophageal injury ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - 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.
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- 2019
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9. Same-Day Discharge after Cryoballoon Ablation of Atrial Fibrillation: A Multicenter Experience
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Hae W. Lim, Arash Aryana, Padraig Gearoid O’Neill, Laurence M Epstein, Jose R Salcido, Andre Gauri, Nagib Chalfoun, Rina Shah, Philippe Akhrass, Marcin Kowalski, Kendra M. Braegelmann, Soad Bekheit, Mark R. Bowers, Valay Parikh, and Alfred Albano
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Male ,musculoskeletal diseases ,medicine.medical_specialty ,medicine.medical_treatment ,Catheter ablation ,030204 cardiovascular system & hematology ,Cryosurgery ,03 medical and health sciences ,0302 clinical medicine ,Hematoma ,Physiology (medical) ,Atrial Fibrillation ,Humans ,Medicine ,Mass index ,030212 general & internal medicine ,Cryoballoon ablation ,Retrospective Studies ,Same day discharge ,business.industry ,Atrial fibrillation ,Hospital cost ,medicine.disease ,Patient Discharge ,Surgery ,Treatment Outcome ,Pulmonary Veins ,Catheter Ablation ,Cardiology and Cardiovascular Medicine ,business ,Complication - Abstract
BACKGROUND It is common practice to observe patients during an overnight stay (ONS) following a catheter ablation procedure for the treatment of atrial fibrillation (AF). OBJECTIVES To investigate the safety and economic impact of a same-day discharge (SDD) protocol after cryoballoon ablation for treatment of AF in high-volume, geographically diverse US hospitals. METHODS We retrospectively reviewed 2374 consecutive patients (1119 SDD and 1180 ONS) who underwent cryoballoon ablation for AF at three US centers. Baseline characteristics, acute procedure-related complications, and longer-term evaluations of safety were recorded during routine clinical follow-up. The mean cost of an ONS was used in a one-way sensitivity analysis to evaluate yearly cost savings as a function of the percentage of SDD cases per year. RESULTS The SDD and ONS cohorts were predominately male (69% vs. 67%; p = .3), but SDD patients were younger (64 ± 11 vs. 66 ± 10; p
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- 2020
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10. PROXIMITY OF CORONARY ARTERIES TO RVOT AS DETERMINED BY COMPUTED TOMOGRAPHY
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Samer Saouma, Philippe Akhrass, Marcin Kowalski, Rina Shah, Ruben Kandov, Ravi Patel, James C. Lafferty, Valay Parikh, Mitchell D. Weinberg, and Harout Yacoub
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Cardiology and Cardiovascular Medicine - Published
- 2022
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11. Feasibility, safety, and efficacy of a novel preshaped nitinol esophageal deviator to successfully deflect the esophagus and ablate left atrium without esophageal temperature rise during atrial fibrillation ablation: The DEFLECT GUT study
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Venkat Vuddanda, Valay Parikh, Tawseef Dar, Andrea Natale, Vijay Swarup, Jacob D. Hantla, Luigi Di Biase, Bharath Yarlagadda, Dhanunjaya Lakkireddy, and Amin Al-Ahmad
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Male ,medicine.medical_specialty ,Time Factors ,Radiofrequency ablation ,medicine.medical_treatment ,Left atrium ,Catheter ablation ,030204 cardiovascular system & hematology ,Body Temperature ,law.invention ,03 medical and health sciences ,Esophagus ,Postoperative Complications ,0302 clinical medicine ,law ,Monitoring, Intraoperative ,Physiology (medical) ,Atrial Fibrillation ,Alloys ,medicine ,Humans ,Fluoroscopy ,Heart Atria ,030212 general & internal medicine ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Ablation ,Treatment Outcome ,medicine.anatomical_structure ,Pulmonary Veins ,Catheter Ablation ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Complication ,Echocardiography, Transesophageal ,Follow-Up Studies - Abstract
Esophageal thermal injury is a feared complication of radiofrequency ablation for atrial fibrillation (AF). Rise in luminal esophageal temperature (LET) limits the ability to deliver radiofrequency energy on the posterior wall of the left atrium.The purpose of this study was to evaluate the feasibility, safety, and efficacy of a mechanical esophageal deviation (ED) tool during AF ablation.We evaluated 687 patients who underwent radiofrequency ablation for AF. In 209 patients, the EsoSure (Northeast Scientific) was used to deflect the esophagus away from the ablation site. Propensity score matching was performed to obtain 180 patients each in the ED and non-ED arms. ED was used for LET rise seen in 61.7% of patients (111/180) and was used if the esophagus was in the line of ablation on fluoroscopy in 38.3% of patients (69/180).Mean deviation of trailing edge of esophagus with EsoSure was 2.45 ± 0.9 cm (range 1-4.5). LET rise1°C was significantly lower in the ED than non-ED group (3% vs 79.4%; P .001). Mean LET rise was also lower in the ED arm (ED 0.34 ± 0.59 vs non-ED 1.66 ± 0.54; P.001). Intraprocedural success of pulmonary vein antral isolation, was slightly improved in the ED arm than in the non-ED arm without statistical significance. AF recurrence was lower in the ED arm at 3-month, 6-month, and 1-year follow-up than in the non-ED arm. No ED-related complications were noted.Mechanical displacement of the esophagus with EsoSure seems to be feasible, safe, and efficacious in enabling adequate radiofrequency energy delivery to the posterior wall of the left atrium without significant LET rise and obvious clinical signs of esophageal injury.
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- 2018
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12. Management of cardiac implantable electronic devices in the presence of left ventricular assist devices
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Seth H. Sheldon, Andrew J. Sauer, Valay Parikh, and Paul A. Friedman
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Heart Failure ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Cardiac resynchronization therapy ,Disease Management ,030204 cardiovascular system & hematology ,Implantable cardioverter-defibrillator ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Underlying disease ,Heart Conduction System ,Physiology (medical) ,Heart failure ,medicine ,Humans ,In patient ,Cardiac Resynchronization Therapy Devices ,Heart-Assist Devices ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business ,Adverse effect - Abstract
Left ventricular assist devices (LVAD) are increasingly used in the management of patients with advanced heart failure. Many of these patients have or will be considered for a cardiac implantable electronic device (CIED) such as an implantable cardioverter-defibrillator or a cardiac resynchronization therapy device. Frequent interplay is often encountered due to the complexity of these devices and the underlying disease states. Proactive management strategies and an awareness of interactions may help reduce adverse events. Here we review the current literature, present management recommendations, and discuss potential future investigations for CIEDs in patients with LVADs.
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- 2018
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13. Perioperative hematoma with subcutaneous ICD implantation: Impact of anticoagulation and antiplatelet therapies
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Seth H. Sheldon, Ryan Cunnane, Valay Parikh, Donita Atkins, Raghuveer Dendi, Rhea Pimentel, Martin Emert, Loren Berenbom, Dhanunjaya Lakkireddy, Yeruva Madhu Reddy, and Madhav Lavu
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Male ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,Prosthesis Implantation ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Hematoma ,Risk Factors ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Retrospective Studies ,Aspirin ,business.industry ,Warfarin ,Anticoagulants ,General Medicine ,Perioperative ,Odds ratio ,Middle Aged ,Clopidogrel ,medicine.disease ,Defibrillators, Implantable ,Icd implantation ,Surgery ,Female ,Cardiology and Cardiovascular Medicine ,business ,Hospital stay ,Platelet Aggregation Inhibitors ,medicine.drug - Abstract
BACKGROUND The safety of perioperative anticoagulation (AC) and antiplatelet (AP) therapy with subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation is unknown. The purpose of this study was to identify the risk factors associated with hematoma complicating S-ICD implantation. METHODS Records were retrospectively reviewed from 200 consecutive patients undergoing S-ICD implantation at two academic medical centers. A hematoma was defined as a device site blood accumulation requiring surgical evacuation, extended hospital stay, or transfusion. RESULTS Among 200 patients undergoing S-ICD implantation (age 49 ± 17 years, 67% men), 10 patients (5%) had a hematoma, which required evacuation in six patients (3%). Warfarin was bridged or uninterrupted in 12 and 13 patients, respectively (6% and 6.5%). Four of 12 patients with warfarin and bridging AC (33%) and two of 13 patients with uninterrupted warfarin (15%) developed a hematoma. Neither of the two patients with uninterrupted DOAC had a hematoma. No patients on interrupted AC without bridging (n = 26, 13 with warfarin, 13 with DOAC) developed a hematoma. A hematoma was also more likely with the use of clopidogrel (n = 4/10 vs 10/190, 40% vs 5.3%, P
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- 2018
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14. B-PO05-100 SAFETY AND EFFICACY OF CRYOBALLOON ABLATION OF ATRIAL FIBRILLATION IN PATIENTS WITH MECHANICAL MITRAL VALVE
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Krzysztof Kaczmarek, Maria Bilińska, Valay Parikh, Phillipe Akhrass, Adam Gorlo, Marcin Kowalski, Piotr Urbanek, Rina Shah, Lukasz Szumowski, Robert Bodalski, Paweł Derejko, Laurence M. Epstein, Paweł Ptaszyński, Artur Zalewski, Andrzej Głowniak, and Michał Orczykowski
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medicine.medical_specialty ,Mechanical Mitral Valve ,business.industry ,Physiology (medical) ,Internal medicine ,Cardiology ,Medicine ,In patient ,Atrial fibrillation ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease ,Cryoballoon ablation - Published
- 2021
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15. Systemic Octreotide Therapy in Prevention of Gastrointestinal Bleeds Related to Arteriovenous Malformations and Obscure Etiology in Atrial Fibrillation
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Valay Parikh, Madhav Lavu, Venkat Vuddanda, Mohit K. Turagam, Mojtaba Olyaee, Donita Atkins, Vijay Swarup, Luigi Di Biase, Mohammad-Ali Jazayeri, Dhanunjaya Lakkireddy, Madhu Reddy Yeruva, Rakesh Gopinathannair, Andrea Natale, Sudharani Bommana, Jie Cheng, and Vijay Ivaturi
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Male ,medicine.medical_specialty ,Injections, Subcutaneous ,medicine.medical_treatment ,Octreotide ,030204 cardiovascular system & hematology ,Risk Assessment ,Arteriovenous Malformations ,03 medical and health sciences ,0302 clinical medicine ,Gastrointestinal Agents ,Atrial Fibrillation ,medicine ,Humans ,Atrial Appendage ,Stroke ,Colectomy ,Aged ,business.industry ,Incidence (epidemiology) ,Atrial fibrillation ,Middle Aged ,Bleed ,medicine.disease ,Surgery ,Discontinuation ,Etiology ,Female ,030211 gastroenterology & hepatology ,Gastrointestinal Hemorrhage ,business ,Follow-Up Studies ,medicine.drug - Abstract
Objectives The present study describes the use of octreotide (OCT) in patients with atrial fibrillation (AF) receiving oral anticoagulation (OAC) who have gastrointestinal (GI) bleeding related to arteriovenous malformations (AVMs), as well as its effect on OAC tolerance and subsequent rebleeding. Background AVMs cause significant GI bleeding, especially in patients with AF who are receiving OAC for stroke prevention. OCT has been shown to minimize recurrent GI bleeds related to AVMs. Methods In a multicenter, observational study, 38 AF patients with contraindications to OAC because of AVM-related GI bleeding were started on 100 μg of subcutaneous OCT twice daily. OAC was resumed in all patients within 48 h. Incidence of recurrent GI bleeds was calculated, and hemoglobin levels were recorded at enrollment and at 3 and 6 months’ follow-up. Results After a median follow-up of 8 months, 36 patients (mean age 69 ± 8.0 years; mean CHA2DS2-VASc score 3 ± 1 and mean HAS-BLED score 3 ± 1) were available for analysis. All were able to successfully resume OAC, and 28 of 36 (78%) remained on OAC at the conclusion of the study, whereas 8 underwent left atrial appendage closure with subsequent OAC discontinuation. No systemic thromboembolic events occurred in follow-up. Of the 28 patients who continued receiving OAC, 19 (68%) were free of recurrent GI bleed, 4 had minor GI bleeds, 4 required transfusion, and 1 required colectomy for GI bleeding. Mean hemoglobin levels in all patients receiving OAC were significantly higher at 3- and 6-month follow-up than at baseline (p Conclusions Subcutaneous OCT therapy is an attractive option in AF patients receiving OAC who have AVM-related GI bleeds. It allows successful reinitiation of OAC as a bridge to left atrial appendage exclusion or short-term relief from bleeding.
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- 2017
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16. Catheter Ablation for Atrial Fibrillation in Patients With Watchman Left Atrial Appendage Occlusion Device: Results from a Multicenter Registry
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Mohammad-Ali Jazayeri, Rodney Horton, Madhav Lavu, Rong Bai, Valay Parikh, Donita Atkins, Sudharani Bommana, Muhammad R. Afzal, Dhanunjaya Lakkireddy, Jie Cheng, Venkat Vuddanda, Mohit K. Turagam, Andrea Natale, Vijay Swarup, and Luigi Di Biase
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Tachycardia ,Leak ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Catheter ablation ,Atrial fibrillation ,030204 cardiovascular system & hematology ,medicine.disease ,Left atrial appendage occlusion ,Pulmonary vein ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Left atrial ,Physiology (medical) ,Internal medicine ,medicine ,Cardiology ,In patient ,030212 general & internal medicine ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background There have been an increasing number of atrial fibrillation (AF) patients with Watchman® left atrial appendage occlusion (LAAO) device, requiring catheter ablation (CA) for maintenance of normal sinus rhythm. In this study, we describe our experience with the feasibility and safety of CA in patients with a preexisting Watchman LAAO device. Methods This was a retrospective multicenter AF registry of 60 patients with Watchman® LAAO device who underwent CA for AF. Baseline clinical and procedural characteristics of the included subjects were retrieved from review of medical records and were analyzed. Results The mean age was 72.7±4.9 years and the mean CHADS2 score was 2.3±0.6. All patients had successful pulmonary vein isolation (PVI). The left atrial appendage (LAA) was electrically active in 34 (56%) while reentrant tachycardia and AF triggers were seen in 17 (28%) patients. Electrical isolation was attempted in these 17 patients with only 10 achieving complete LAA isolation. Repeat imaging showed new peri-device leaks in 30% (12/40) patients, while new significant peri-device leaks (≥5 mm) were noted in 10% (10/40) of patients after RFA, respectively, requiring continuation of oral anticoagulation. There were a higher proportion of patients with severe peri-device leaks (≥5 mm) after LAA isolation. However, >50% of those leaks sealed off on follow-up TEE. Conclusion AF ablation is a feasible and safe in patients with preexisting Watchman LAAO device. Electrical isolation of the LAA could be difficult and when attempted can result in increased risk of short-term peri device leak and recurrence of AT/AF in almost all patients. This article is protected by copyright. All rights reserved
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- 2017
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17. An interesting case of reverse electrical remodeling of the left atrium after radiofrequency ablation
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Dhanunjaya Lakkireddy, Bharath Yarlagadda, Tawseef Dar, and Valay Parikh
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medicine.medical_specialty ,business.industry ,Radiofrequency ablation ,Left atrium ,Atrial fibrillation ,030204 cardiovascular system & hematology ,medicine.disease ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,law ,Internal medicine ,medicine ,Cardiology ,Electrical Remodeling ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Atrial Remodeling - Published
- 2018
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18. Dofetilide Initiation and Implications of Deviation From the Standard Protocol – A Real World Experience
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Venkat Vuddanda, Dhanunjaya Lakkireddy, Bharath Yarlagadda, Lesley Bravin, Valay Parikh, Bader Madoukh, Madhu Reddy, Tawseef Dar, and Ghulam Murtaza
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medicine.medical_specialty ,business.industry ,Incidence (epidemiology) ,Protocol Deviation ,Retrospective cohort study ,Dofetilide ,Atrial fibrillation ,030204 cardiovascular system & hematology ,medicine.disease ,QT interval ,Clinical trial ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Medicine ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Adverse effect ,Original Research ,medicine.drug - Abstract
Background Manufacturer/federal drug administration (FDA) recommends inpatient initiation of dofetilide with the manufacturer providing an initiation algorithm. The outcomes of algorithm deviation have not been reported outside of clinical trials. Objective We sought to perform a chart review of all the patients admitted for inpatient initiation of dofetilide to report on the incidence of protocol deviations and their implications. Methods We performed a retrospective review of all patients over a 15-month periodwho were initiated on dofetilide for the very first time or reinitiated on dofetilide after a break of three months or more at our institution. We assessed data about patients who were given dofetilide without adherence to the protocol (i.e. protocol deviation). Results A total of 189 patients were included in the study with a median age of 66 ± 9 years. Mean baseline QTc interval was 436 ± 32 msec, and 61% (116/189) were in atrial fibrillation (AF) at the time of dofetilide initiation. In 9% (17/189) of patients, the drug was discontinued due to intolerance or inefficacy. Therapy in 49% (93/189) of patients was noted to deviate from manufacturer recommended protocol with deviations more than once in some patients during the same hospitalization. Baseline QTc exceeding 440 msec(>500msec in conduction abnormalities) was the most frequent deviation (25%; 47/189).Ventricular tachyarrhythmia occurred in 4% (7/189) of patients, did not differ between patients, and occurred with and without protocol deviations (5% vs 2%; p = 0.27). Conclusions In our retrospective study, there were frequent deviations from the manufacturer-recommended algorithm guidelines for dofetilideinitation, primarily due to prolonged baseline QTc interval. The impact of these protocol deviations on drug discontinuation was uncertain; however, significant adverse events were higher in the deviation group compared to the group that fully adhered to the protocol. Further multicenter studies are warranted to clarify our findings.
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- 2019
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19. Myocarditis Causing Premature Ventricular Contractions
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Valay Parikh, Mark J. Hamblin, Luigi Di Biase, Dhanunjaya Lakkireddy, Sanghamitra Mohanty, Sudharani Bommana, Heidi Carroll, Mohit K. Turagam, Donita Atkins, Thomas Rosamond, Megan Krause, Tawseef Dar, Cheri Nydegger, Bharath Yarlagadda, Andrea Natale, Rakesh Gopinathannair, and Louis Wetzel
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,Myocarditis ,Biopsy ,medicine.medical_treatment ,Catheter ablation ,Inflammation ,Ventricular Function, Left ,Fluorodeoxyglucose F18 ,Heart Rate ,Risk Factors ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Registries ,Aged ,medicine.diagnostic_test ,business.industry ,Disease progression ,Stroke Volume ,Recovery of Function ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Ventricular Premature Complexes ,United States ,Treatment Outcome ,Positron emission tomography ,Positron-Emission Tomography ,Catheter Ablation ,Cardiology ,Female ,Radiopharmaceuticals ,medicine.symptom ,Presentation (obstetrics) ,Cardiology and Cardiovascular Medicine ,business ,Immunosuppressive Agents - Abstract
Background: Premature ventricular contractions are a common clinical presentation that drives further diagnostic workup. We hypothesize the presence of underlying inflammation is often unrecognized in these patients with a potential for continued disease progression if not diagnosed and treated early in the disease course. Methods: This is a single-center, prospective study including 107 patients with frequent symptomatic premature ventricular contractions (>5000/24 h) and no known ischemic heart disease. Patients underwent a combination of laboratory testing, 18F-fluorodeoxyglucose positron emission tomography scan, cardiac magnetic resonance imaging, and biopsy. Patients were diagnosed with myocarditis based on a multidisciplinary approach and treated with immunosuppressive therapy. Results: The mean age of the cohort was 57±15 years, 41% were males, and left ventricular ejection fraction was 47±11.8%. Positive positron emission tomography scan was seen in 51% (55/107), of which 51% (28/55) had preserved left ventricle function. Based on clinical profile, 18F-fluorodeoxyglucose—positron emission tomography imaging, cardiac magnetic resonance, and histological data 58% patients (32/55) received immunosuppressive therapy alone and 25.4% (14/55) received immunosuppressive therapy and catheter ablation. Optimal response was seen in 67% (31/46) over a mean follow-up of 6±3 months. In patients with left ventricle systolic dysfunction, 37% (10/27) showed an improvement in mean left ventricular ejection fraction of 13±6%. Conclusions: Approximately 51% of patients presenting with frequent premature ventricular contractions have underlying myocardial inflammation in this cohort. 18F-fluorodeoxyglucose—positron emission tomography scan can be a useful modality for early diagnosis and treatment with immunosuppressive therapy in selected patients can improve clinical outcomes.
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- 2019
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20. Outcomes of junctional ectopic tachycardia ablation in adult population-a multicenter experience
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Tawseef, Dar, Mohit K, Turagam, Bharath, Yarlagadda, Valay, Parikh, Jayasree, Pillarisetti, Rakesh, Gopinathannair, Carola, Gianni, Sanghamitra, Mohanty, Moussa, Mansour, Luigi, Di Biase, T Jared, Bunch, Andrea, Natale, and Dhanunjaya, Lakkireddy
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Adult ,Male ,Tachycardia, Ectopic Junctional ,Atrioventricular Node ,Catheter Ablation ,Infant, Newborn ,Humans ,Tachycardia, Atrioventricular Nodal Reentry ,Female ,Cryosurgery ,Retrospective Studies - Abstract
Idiopathic junctional ectopic tachycardia (JET) is typically refractory to antiarrhythmic agents. Catheter ablation for JET is feasible but is associated with high risk of unintended atrioventricular (AV) block. There is limited data on the appropriate procedural technique and clinical outcomes with catheter ablation for idiopathic JET in adults.This is a multicenter, retrospective study of all adult patients (age ≥ 18 years) who underwent catheter ablation for idiopathic JET. Patient, procedural characteristics, and long-term outcomes were evaluated.Fifteen patients [radiofrequency ablation (RF) = 14 and cryoablation = 1) were treated with catheter ablation. The median age was 58 years with 67% males. All patients underwent mapping of the right atrium and the aortic cusps prior to energy delivery. The location of earliest activation in relation to the atrioventricular (AV) node was postero-superior in 73% (11/15), posterior in 13% (2/15), and superior in 13% (2/15) respectively. Acute success was 100%. Arrhythmia recurrence occurred in 53% (8/15) all of whom underwent a repeat ablation. High-grade AV block requiring permanent pacemaker occurred in 20% (3/15). At 12-month follow-up in the redo-ablation group, 37.5% (3/8) had recurrence of the arrhythmia two of which underwent a third ablation procedure.Catheter ablation of idiopathic JET in adults is associated with a high rate of recurrence requiring multiple procedures and high risk of AV block requiring a permanent pacemaker. Mapping and ablation of the non-coronary cusp can be considered as the arrhythmia was controlled in 3 patients with no inadvertent AV block.
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- 2019
21. 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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Mohit K. Turagam, Jie Cheng, Luigi DiBiase, Bharath Yarlagadda, Dhanunjaya Lakkireddy, Heidi Carroll, Sudha Bommana, Tawseef Dar, Courtney Jeffery, Sanghamitra Mohanty, Abdi Rasekh, Misty Jaeger, Randal J. Lee, Rodney Horton, Rakesh Gopinnathanair, Andrea Natale, Valay Parikh, Cheri Nydegger, and Donita Atkins
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Epicardial Mapping ,Male ,medicine.medical_specialty ,Radiofrequency ablation ,medicine.medical_treatment ,Catheter ablation ,030204 cardiovascular system & hematology ,Pulmonary vein ,law.invention ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Left atrial ,law ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,Atrial Appendage ,030212 general & internal medicine ,Ligation ,Aged ,Retrospective Studies ,Radiofrequency Ablation ,business.industry ,Atrial fibrillation ,Ablation ,medicine.disease ,Pulmonary Veins ,Cardiology ,Female ,Patient Safety ,Cardiology and Cardiovascular Medicine ,business - Abstract
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). 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. 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. 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 CHA2DS2-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. 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.
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- 2019
22. Peri-procedural use of direct anticoagulation agents during cardiac device implantation: vitamin K antagonists vs direct oral anticoagulants
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Ryan Maybrook, Sandeep Reddy, Carola Gianni, Valay Parikh, Nivedita Adabala, Andrea Natale, Madhu Reddy, Luigi Di Biase, Sanjeev Saksena, Sudharani Bommana, Mehdi Khalafi, Prajwala Lakkireddy, Dhanunjaya Lakkireddy, Rakesh Gopinathannair, Jayasree Pillarisetti, and Sanghamitra Mohanty
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Male ,Vitamin K ,Pyridones ,Administration, Oral ,030204 cardiovascular system & hematology ,Dabigatran ,03 medical and health sciences ,0302 clinical medicine ,Hematoma ,Rivaroxaban ,Physiology (medical) ,Atrial Fibrillation ,Medicine ,Humans ,030212 general & internal medicine ,Stroke ,Aged ,Aged, 80 and over ,business.industry ,Warfarin ,Anticoagulants ,Heparin ,Middle Aged ,medicine.disease ,Discontinuation ,Defibrillators, Implantable ,Anesthesia ,Apixaban ,Female ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Warfarin is deemed safe compared to bridging with heparin in the peri-procedure setting while implanting cardiac devices. The timing of discontinuation and re-initiation of direct anticoagulant agents (DOACs) such as dabigatran, apixaban, and rivaroxaban in the peri-procedural setting in comparison to warfarin is not well studied. We wanted to compare three DOAC agents with warfarin during cardiac device implantation. Consecutive patients on treatment with dabigatran, rivaroxaban, or apixaban (group A) undergoing a cardiac device generator change, upgrade, or new implantation procedure were compared to those on warfarin (group B). Incidence of hematoma, infection, effusion, stroke, and other complications were noted at 1 day, 1 week, and 3 months. A total of 311 patients in group A underwent the above procedures with 73 patients on dabigatran, 153 on rivaroxaban, and 85 on apixaban. There were 467 patients on warfarin in group B. Mean age of the total population was 68 ± 12 years with 67% males and > 80% Caucasians. The last dose of the DOAC was the night prior to the procedure and resumed the night of the procedure (single dose interruption for apixaban and dabigatran and no un-interruption for rivaroxaban). There was no difference noted in the incidence of minor or major hematoma (9% vs 8.5%, p = 0.7). No stroke occurred in either group. Use of DOAC agents with transient interruption of one dose is as safe as warfarin in the peri-procedural setting during implantation of cardiac devices.
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- 2019
23. Long-term clinical outcomes from real-world experience of left atrial appendage exclusion with LARIAT device
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Jie Cheng, Bogusław Kapelak, Krzysztof Bartus, Abdi Rasekh, Maciej Brzeziński, Nitish Badhwar, Mohit K. Turagam, Magdalena Bartus, Dhanunjaya Lakkireddy, Suneet Mittal, Valay Parikh, Jakub Podolec, Randall J. Lee, Radosław Litwinowicz, Dan Musat, and Jerzy Sadowski
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Male ,medicine.medical_specialty ,Time Factors ,Action Potentials ,Hemorrhage ,030204 cardiovascular system & hematology ,Risk Assessment ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Fibrinolytic Agents ,Left atrial ,law ,Heart Rate ,Risk Factors ,Physiology (medical) ,Thromboembolism ,Atrial Fibrillation ,medicine ,Effective treatment ,Humans ,In patient ,Routine clinical practice ,Atrial Appendage ,030212 general & internal medicine ,Prospective Studies ,Registries ,Cardiac Surgical Procedures ,Stroke ,Ligation ,Oral anticoagulation ,Aged ,business.industry ,Incidence ,Atrial fibrillation ,Middle Aged ,medicine.disease ,United States ,Surgery ,Treatment Outcome ,Atrial Function, Left ,Female ,Poland ,Cardiology and Cardiovascular Medicine ,business - Abstract
BACKGROUND Left atrial appendage closure (LAAC) with LARIAT has emerged as one of the alternatives to oral anticoagulation (OAC) in patients with nonvalvular atrial fibrillation (AF). Our aim was to study long-term outcomes in patients undergoing LARIAT procedure. METHODS We analyzed patients screened for LARIAT device in four centers between December 2009 and June 2012. Out of these, patients who didn't undergo LAAC with the LARIAT device due to unfavorable LAA morphology and other preprocedural contraindications were included in control group. We analyzed thromboembolism, bleeding events, and mortality between LAA and control group. RESULTS About 153 patients were screened. Out of these, 108 (70.6%) patients underwent LARIAT placement (LAA arm) and 45 (29.4%) excluded patients were included in control arm. There were no differences in CHADS2 and CHA2 DS2 -VASc score. Mean HAS-BLED score was significantly higher in the LARIAT group (3.5 ± 1.06 vs 3.09 ± 1.22, P = .04). Mean follow-up time (in years) was 6.56 ± 0.84 in LAA and 6.5 ± 1.26 in control arm. During follow-up period, the LARIAT group was associated with significantly less thromboembolic events (1.9% vs 24%, P
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- 2019
24. Five years of keeping a watch on the left atrial appendage—how has the WATCHMAN fared?
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Mohammad-Ali Jazayeri, Valay Parikh, Venkat Vuddanda, Madhav Lavu, Y. Madhu Reddy, Donita Atkins, Dhanunjaya Lakkireddy, and Jayant Nath
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Percutaneous ,business.industry ,Atrial Appendage ,Atrial fibrillation ,030204 cardiovascular system & hematology ,medicine.disease ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Left atrial ,Stroke prevention ,medicine ,In patient ,030212 general & internal medicine ,business ,Stroke ,Oral anticoagulation - Abstract
Left atrial appendage closure (LAAC) is a promising site-directed therapy for stroke prevention in patients with non-valvular atrial fibrillation (AF) who are ineligible or contraindicated for long-term oral anticoagulation. A variety of LAAC modalities are available, including percutaneous endocardial occluder devices such as WATCHMAN TM (Boston Scientific Corp., Marlborough, MA, USA), and an ever-increasing body of evidence is helping to define the optimal use of each technique. Similarly increased experience with LAAC has revealed challenges such as device-related thrombi and peri-device leaks for which the long-term significance and appropriate management are areas of active investigation. We review the evolution and long-term outcomes with the WATCHMAN TM device with particular emphasis on the nuances of its use and its role in the broader landscape of appendageology.
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- 2016
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25. Predictors, Trends, and Outcomes (Among Older Patients ≥65 Years of Age) Associated With Beta-Blocker Use in Patients With Stable Angina Undergoing Elective Percutaneous Coronary Intervention
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Abhiram Prasad, J. Dawn Abbott, Debabrata Mukherjee, David Dai, Valay Parikh, Matthew T. Roe, and Apurva A. Motivala
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medicine.medical_specialty ,education.field_of_study ,Ejection fraction ,business.industry ,medicine.drug_class ,medicine.medical_treatment ,Hazard ratio ,Population ,Percutaneous coronary intervention ,030204 cardiovascular system & hematology ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Heart failure ,Conventional PCI ,Cardiology ,Medicine ,030212 general & internal medicine ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business ,education ,Beta blocker - Abstract
Objectives This study sought to examine predictors, trends, and outcomes associated with β-blocker prescriptions at discharge in patients with stable angina without prior history of myocardial infarction (MI) or systolic heart failure (HF) undergoing elective percutaneous coronary intervention (PCI). Background The benefits of β-blockers in patients with MI and/or systolic HF are well established. However, whether β-blockers affect outcomes in patients with stable angina, especially after PCI, remains uncertain. Methods We included patients with stable angina without prior history of MI, left ventricular systolic dysfunction (left ventricular ejection fraction Results A total of 755,215 patients from 1,443 sites were studied, and 71.4% population of our cohort was discharged on β-blockers. At 3-year follow-up among patients ≥65 years of age with CMS data linkage (16.3% of the studied population), there was no difference in adjusted mortality rate (14.0% vs. 13.3%; adjusted hazard ratio [HR]: 1.00; 95% confidence interval [CI]: 0.96 to 1.03; p = 0.84), MI (4.2% vs. 3.9%; adjusted HR: 1.00; 95% CI: 0.93 to 1.07; p = 0.92), stroke (2.3% vs. 2.0%; adjusted HR: 1.08; 95% CI: 0.98 to 1.18; p = 0.14) or revascularization (18.2% vs. 17.8%; adjusted HR: 0.97; 95% CI: 0.94 to 1.01; p = 0.10) with β-blocker prescription. However, discharge on β-blockers was associated with more HF readmissions at 3-year follow-up (8.0% vs. 6.1%; adjusted HR: 1.18; 95% CI: 1.12 to 1.25; p Conclusions Among patients ≥65 years of age with history of stable angina without prior MI, systolic HF or left ventricular ejection fraction
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- 2016
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26. Gender, Racial, and Health Insurance Differences in the Trend of Implantable Cardioverter-Defibrillator (ICD) Utilization: A United States Experience Over the Last Decade
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Nileshkumar J. Patel, Paul A. Friedman, Marcin Kowalski, Sushruth Edla, Nilay Patel, Achint Patel, Apurva Badheka, Raul D. Mitrani, Badal Thakkar, Valay Parikh, Nish Patel, Nikhil Nalluri, Juan F. Viles-Gonzalez, Deepak Asti, Kanishk Agnihotri, Abhishek Deshmukh, Ronak Bhimani, Peter A. Noseworthy, Hakan Paydak, Shilpkumar Arora, and Chirag Savani
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Gerontology ,education.field_of_study ,business.industry ,medicine.medical_treatment ,Significant difference ,Procedure code ,Population ,General Medicine ,Population demographics ,030204 cardiovascular system & hematology ,Implantable cardioverter-defibrillator ,Icd implantation ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Health insurance ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,education ,business ,Socioeconomic status ,Demography - Abstract
Prior studies have highlighted disparities in cardiac lifesaving procedure utilization, particularly among women and in minorities. Although there has been a significant increase in implantable cardioverter-defibrillator (ICD) insertion, socioeconomic disparities still exist in the trend of ICD utilization. With the use of the Nationwide Inpatient Sample from 2003 through 2011, we identified subjects with ICD insertion (procedure code 37.94) and cardiac resynchronization defibrillator (procedure code 00.50, 00.51) as codified by the International Classification of Diseases, Ninth Revision, Clinical Modification. Overall, 1 020 076 ICDs were implanted in the United States from 2003 to 2011. We observed an initial increase in ICD utilization by 51%, from 95 062 in 2003 to 143 262 in 2006, followed by a more recent decline. The majority of ICDs were implanted in men age ≥65 years. Implantation of ICDs was 2.5× more common in men than in women (402 per million vs 163 per million). Approximately 95% of the ICDs were implanted in insured patients, and 5% were used in the uninsured population. There has been a significant increase in ICD implantation in blacks, from 162 per million in 2003 to 291 per million in 2011. We found a significant difference in the volume of ICD implants between the insured and the uninsured patient populations. Racial disparities have narrowed significantly in comparison with those noted in earlier studies and are now more reflective of the population demographics at large. On the other hand, significant gender disparities continue to exist.
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- 2016
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27. Abstract 17325: Initial False Positive Episodes and Outcomes of Programming Changes With a Novel Implantable Loop Recorder
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Ethan Hacker, Rhea Pimentel, Y. Madhu Reddy, Martin Emert, Tawseef Dar, Bharath Yarlagadda, Loren Berenbom, Seth H. Sheldon, Brandon Wise, Valay Parikh, and Raghu Dendi
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Loop (topology) ,business.industry ,Physiology (medical) ,Implantable loop recorder ,Medicine ,Atrial arrhythmias ,Cardiology and Cardiovascular Medicine ,business ,psychological phenomena and processes ,Computer hardware - Abstract
Introduction: Management of voluminous data from implantable cardiac devices is resource intensive. False positive events can be especially problematic with implantable loop recorders (ILRs). We sought to describe our early experience with a novel ILR. Hypothesis: Sensitivity adjustment to Methods: A single center retrospective study was performed in patients with the Abbott Confirm RX ILR. Tachycardia, atrial fibrillation (AF), bradycardia, and pause events were reviewed to determine whether they were true or false positives. Results: The study included 13 patients (age 67 ±15.8 years, 62% men). The reasons for implant included: AF (n=7, 54%), syncope(n=3, 23%), palpitations (n=2, 15%), and stroke (n=1, 8%). The median follow-up duration was 3.1 months (IQR 1.3-4.4 months). There was no change in serial R waves during mean follow-up of 0.58 months (pre 0.62±0.22 mV, post 0.63±0.22 mV, p=0.52). Tachycardia detection occurred in 6 patients (46%), with only 1 patient having a false positive episode. AF detection occurred in 8 patients (62%), with only 2 patients having true AF episodes. Pause/bradycardia episodes were detected in 5 patients (39%), with false positive episodes in 4 patients. There was no difference in R waves at implant among patients with and without false positive bradycardia/pauses episodes (0.66 ±0.27 vs. 0.44 ± 0.28 mV, p=0.21). The max sensitivity was higher among patients with than without false positive bradycardia/pause episodes (0.14 ±0.01, 0.07 ±0.02 mV, p Conclusion: Programming the novel ILR to a sensitivity of
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- 2018
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28. Safety and Efficacy of Inpatient Initiation of Dofetilide versus Sotalol for atrial fibrillation
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Tawseef Dar, Venkat Vuddanda, Mohit K. Turagam, Madhav Lavu, Donita Atkins, Sindhu Avula, Valay Parikh, Sudharani Bommana, Rakesh Gopinathannair, Dhanunjaya Lakkireddy, Madhu Reddy Yeruva, Bharath Yarlagadda, and Mohammad-Ali Jazayeri
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Sotalol ,Drug intolerance ,Atrial fibrillation ,Dofetilide ,Torsades de pointes ,030204 cardiovascular system & hematology ,medicine.disease ,Cardioversion ,QT interval ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Cardiology ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,Adverse effect ,business ,medicine.drug ,Original Research - Abstract
Background: We sought to investigate and compare the safety and efficacy of two commonly used antiarrhythmic drugs, Dofetilide (DF) and Sotalol (SL), during inpatient drug initiation in patients with symptomatic atrial fibrillation (AF). Methods: We performed a single center retrospective study of consecutive patients, admitted for initiation of either DF or SL, for AF between 2012 and 2015. Rates of successful cardioversion, QT interval prolongation, adverse events and drug discontinuations were calculated and compared. A two-tailed p value less than 0.05 was considered statistically significant. Results: Of 378 patients, 298 (78.8%) received DF and 80 (21.2%) SL, mean age was 64 ± 11 years, 90% were Caucasians and 66% were males. Among the patients who remained in AF upon admission (DF: 215/298 (72%) vs. SL: 48/80 (60%)), no significant differences were noted in pharmacological cardioversion rates (DF: 125/215(58%) vs. SL: 30/48 (62.5%); p = 0.58). Baseline QTc was similar between the groups, with higher dose dependent QTc prolongation with DF (472.25± 31.3 vs. 458± 27.03; p = 0.008). There were no significant differences in the rates of adverse events such as bradycardia (7.4% vs. 11.3%; p = 0.26), Torsades de pointes (1.3% vs. 1.2%; p = 1.00), and drug discontinuation (9.0% vs. 5.0%; p = 0.47) between the two groups. Conclusion: In our large, single center experience, we found that the use of Dofetilide resulted in significantly higher QTc without differences in the rates of successful cardioversion, adverse events, and drug intolerance when compared to Sotalol in AF patients.
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- 2017
29. Abstract 21359: Safety of Repeat Radiofrequency Ablation in Atrial Fibrillation Patients With Moderate Pulmonary Vein Stenosis
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Mohammad-Ali Jazayeri, Venkat Vuddanda, Jaya Pitchika, Mounika Gangireddy, Saisree Reddy Adla Jala, Madhav Lavu, Valay Parikh, Mohit K Turagam, Sudharani Bommana, Donita Atkins, Rhaguveer Dendi, Martin P Emert, Rhea C Pimentel, Seth H Sheldon, Loren Berenbom, Dhanunjaya R Lakkireddy, and Madhu Reddy
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
Introduction: Radiofrequency catheter ablation (RFCA), an effective treatment for atrial fibrillation (AF), is rarely complicated by severe pulmonary vein stenosis (PVS) requiring intervention. We sought to evaluate the safety of repeat RFCA in AF patients with moderate PVS after index RFCA. Hypothesis: We hypothesized, in patients with moderate PVS, repeat RFCA would not result in significant progression of PVS. Methods: We performed a retrospective, observational study of all patients who developed moderate PVS (decrease in the PV cross sectional area ≥50% but Results: Of a total of 2550 AF patients who underwent RFCA from 2011-2016, 165 (6.4%) developed moderate PVS of at least one PV. Mean age was 65 ± 11 years, with 130 (79%) males and 113 (68%) with paroxysmal AF. Right superior, right inferior, left superior and left inferior PVs were involved in 31%, 29%, 41%, and 20% of patients, respectively. Of these 165 patients, 78 (47%) underwent repeat CT scan (with or without redo ablation), and 48 (29%) underwent redo RFCA in the antrum of the involved PV. Mean times between CT1-CT2 and CT2-CT3 were 6 and 11 months, respectively. On repeat CT, 6 (8%) developed severe PVS of at least one PV. There was no statistical difference in the incidence of severe PV stenosis between those who underwent repeat ablation compared to those who did not (4.2 vs. 14.3 respectively; p = 0.185) Conclusions: Repeat RFCA for AF in patients with prior moderate PV stenosis appears to be safe with an acceptable risk (4.2%) of developing severe PV stenosis.
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- 2017
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30. Abstract 20927: Use of a Novel Pre-Shaped Nitinol Esophageal Deviator (EsoSure®) to Successfully Ablate the Left Atrium Without Esophageal Temperature Rise During Atrial Fibrillation Ablation: The DEFLECT GUT Study
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Dhanunjaya Lakkireddy, Valay Parikh, Madhu Reddy, Vijay Swarup, Jacob Hantla, Luigi Di Biase, Amin Al-Ahmed, and Andrea Natale
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
Background: Esophageal injury is a feared complication of atrial fibrillation (AF) ablation. Esophageal temperature monitoring has been used as a surrogate marker for potential esophageal thermal injury. Often times, rise in esophageal temperature during radiofrequency ablation (RFA) for AF limits the ability to deliver RF energy. Objective: The aim of this study was to evaluate the safety and efficacy of the EsoSure® (Northeast Scientific, Inc., Waterbury, CT), a mechanical esophageal deviation tool, during RFA for AF. Methods: In this prospective observational series, we evaluated 135 consecutive patients from 4 centers in whom luminal esophageal temperature (LET) rise or likely rise was limiting RFA lesion delivery on the posterior wall of the LA. EsoSure® was used to deflect the esophagus away from the ablation site in the LA. Light Barium was used to visualize and confirm esophageal displacement in all patients. Baseline demographics, procedural variables and complication rates were collected and evaluated. Patients were followed up to 3 months for clinical signs and symptoms of esophageal injury. Results: The mean age of our sample was 64 ± 10 years and 77 (57%) patients were males. Mean CHA2DS2-VASc score was 2.72 ± 1 and 97 (74 %) patients had paroxysmal AF. The mean deviation of the trailing edge of the esophagus with EsoSure® was 2.6 ± 1 cm (range: 0.8 - 4.5 cm). Successful intra-procedural end point, defined as successful pulmonary vein isolation, was achieved in 100% of patients. Among the 96 (71%) patients in whom EsoSure® was used after an increase in LET, the mean peak rise of LET was 1.3 ± 0.2° C prior to the EsoSure® use and 0.2 ± 0.1° C after the EsoSure® use (p Conclusions: Mechanical displacement of the esophagus with EsoSure® device appears to be safe and efficacious in enabling adequate RF energy delivery to the posterior wall of the LA during RFA for AF without significant luminal temperature rise and obvious clinical signs or symptoms of esophageal injury up to 3 months of follow up.
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- 2017
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31. Leaks after left atrial appendage ligation with Lariat device: Incidence, pathophysiology, clinical implications and methods of closure- A case based discussion
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Tawseef Dar, Dhanunjaya Lakkireddy, Valay Parikh, and Bharath Yarlagadda
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Leak ,medicine.medical_specialty ,Percutaneous ,business.industry ,medicine.medical_treatment ,Atrial fibrillation ,030204 cardiovascular system & hematology ,medicine.disease ,Surgery ,03 medical and health sciences ,Catheter ,0302 clinical medicine ,Suture (anatomy) ,Medicine ,030212 general & internal medicine ,Embolization ,Thrombus ,Cardiology and Cardiovascular Medicine ,business ,Ligation ,Original Research - Abstract
Catheter based left atrial appendage (LAA) closure techniques are emerging as a promising alternative for stroke prevention in patients who cannot tolerate oral anticoagulation. Lariat procedure involves percutaneous catheter based epicardial ligation of the LAA with a suture via an endo-epicardial hybrid approach. It offers the advantage of not leaving behind a focus for thrombus formation or embolization. Similar to surgical ligation of the left atrial appendage, Lariat ligation is limited by leaks in a small percentage of patients. The incidence of leaks is variable and can be seen in the immediate post procedure period or during follow up. The electrical and mechanical implications of leaks are still under debate. In this review, we discuss the incidence, pathophysiology, clinical implications and methods of closure of leaks after Lariat. In the end, we present a case of a Lariat leak closed with an Amplatzer septal occluder.
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- 2017
32. Early feasibility of hypoglossal nerve upper airway stimulator in patients with cardiac implantable electronic devices and continuous positive airway pressure-intolerant severe obstructive sleep apnea
- Author
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M. Boyd Gillespie, Ryan J. Soose, Shaun A. Nguyen, Masanari Kato, Suzanne Stevens, Erica R. Thaler, Christopher G. Larsen, Dhanunjaya Lakkireddy, Kirk Withrow, David A. Calhoun, Madhu Reddy, Valay Parikh, and Damien Stevens
- Subjects
Male ,Hypoglossal Nerve ,Time Factors ,medicine.medical_treatment ,Polysomnography ,Cardiac resynchronization therapy ,Electric Stimulation Therapy ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,medicine ,Humans ,In patient ,Continuous positive airway pressure ,Aged ,Retrospective Studies ,Sleep Apnea, Obstructive ,Continuous Positive Airway Pressure ,business.industry ,Sleep apnea ,medicine.disease ,Defibrillators, Implantable ,Obstructive sleep apnea ,Treatment Outcome ,Anesthesia ,Feasibility Studies ,Female ,Implant ,Cardiology and Cardiovascular Medicine ,Airway ,business ,Hypoglossal nerve ,030217 neurology & neurosurgery ,Follow-Up Studies - Abstract
Background Implantable hypoglossal nerve upper airway stimulation (HNS) is a novel strategy approved by the US Food and Drug Administration for the management of moderate-to-severe obstructive sleep apnea (OSA) in patients with continuous positive airway pressure therapy intolerance or failure. Because of the proximity of a cardiac implantable electronic device (CIED) to this stimulator, interaction between these devices is theoretically possible. Objective The purpose of this study was to assess interactions between an implantable HNS device and a CIED. Methods We retrospectively analyzed 14 ad hoc patients with continuous positive airway pressure-intolerant, moderate-to-severe OSA and pre-existing transvenous CIEDs undergoing HNS implantation (Inspire II, Inspire Medical Systems). We assessed these devices for their pre and postimplant OSA outcomes and for possible device–device interaction. All patients were followed up for 1 year. Results Of the 14 patients, 9 had a pacemaker (8 dual-chamber, 1 single-chamber), 4 had an implantable cardioverter-defibrillator (2 dual-chamber, 1 single-chamber), and 1 had a cardiac resynchronization therapy device. All the HNS devices were implanted on the opposite side of the CIED. All CIEDs were programmed bipolar. HNS were programmed either unipolar or bipolar. During implant, intraoperative testing was performed to confirm that bipolar and unipolar HNS stimulation did not impact CIED sensing. During the follow-up period, no oversensing episodes were noted on the CIEDs. Conclusion In this early experience, simultaneous use of a novel hypoglossal nerve upper airway stimulation device with transvenous CIEDs seems to be safe, effective, and without any device–device interactions.
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- 2017
33. Safety profiles of percutaneous left atrial appendage closure devices: An analysis of the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database from 2009 to 2016
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Andrea Natale, Venkat Vuddanda, Valay Parikh, Mohit K. Turagam, Donita Atkins, Matthew Earnest, Madhav Lavu, Mohammad-Ali Jazayeri, Yeruva Madhu Reddy, Dhanunjaya Lakkireddy, Luigi Di Biase, and David J. Wilber
- Subjects
medicine.medical_specialty ,Cardiac Catheterization ,Percutaneous ,Time Factors ,Databases, Factual ,medicine.medical_treatment ,Action Potentials ,030204 cardiovascular system & hematology ,computer.software_genre ,Left atrial appendage occlusion ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Heart Rate ,Risk Factors ,Physiology (medical) ,Atrial Fibrillation ,Medicine ,Humans ,Cumulative incidence ,Atrial Appendage ,030212 general & internal medicine ,Myocardial infarction ,Stroke ,Database ,business.industry ,United States Food and Drug Administration ,Atrial fibrillation ,Equipment Design ,medicine.disease ,United States ,Cardiac surgery ,Treatment Outcome ,Pericardiocentesis ,Atrial Function, Left ,Patient Safety ,Cardiology and Cardiovascular Medicine ,business ,computer - Abstract
Background Percutaneous left atrial appendage closure (LAAC) is a viable option for AF patients who are unable to tolerate long-term oral anticoagulation (OAC). Objective We sought to assess the safety of two commonly used percutaneous devices for LAA closure in the United States by analysis of surveillance data from the FDA Manufacturer and User Facility Device Experience (MAUDE) database. Methods The MAUDE database was queried between May 1, 2006 and May 1, 2016 for LARIAT® (SentreHEART Inc., Redwood City, CA, USA) and WATCHMAN™ (Boston Scientific Corp., Marlborough, MA, USA) devices. Among 622 retrieved medical device reports, 356 unique and relevant reports were analyzed. The cumulative incidence of safety events was calculated over the study period and compared between the two devices. Results LAAC was performed with LARIAT in 4,889 cases. WATCHMAN was implanted in 2,027 patients prior to FDA approval in March 2015 and 3,822 patients postapproval. The composite outcome of stroke/TIA, pericardiocentesis, cardiac surgery, and death occurred more frequently with WATCHMAN (cumulative incidence, 1.93% vs. 1.15%; P = 0.001). The same phenomenon was observed when comparing the WATCHMAN pre- and postapproval experiences for the composite outcome, as well as device embolization, cardiac surgery, and myocardial infarction. Conclusions MAUDE-reported data show that postapproval, new technology adoption is fraught with increased complications. Improved collaboration between operators, device manufacturers, and regulators can better serve patients through increased transparency and practical postmarket training and monitoring mechanisms.
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- 2017
34. Corrigendum to 'Contrast media use in patients with chronic kidney disease undergoing coronary angiography: A systematic review and meta-analysis of randomized trials' [Int. J. Cardiol. (2017) 137-144]
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Jean M. Chalhoub, Suzanne El-Sayegh, Sainath Gaddam, Sripal Bangalore, Jonathan Spagnola, Marc Bogin, James Lafferty, Valay Parikh, Bhavi Pandya, and Ruben Kandov
- Subjects
Coronary angiography ,medicine.medical_specialty ,business.industry ,media_common.quotation_subject ,medicine.disease ,030218 nuclear medicine & medical imaging ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,030220 oncology & carcinogenesis ,Meta-analysis ,Media use ,medicine ,Contrast (vision) ,In patient ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Kidney disease ,media_common - Published
- 2017
35. Replacing warfarin with a novel oral anticoagulant: Risk of recurrent bleeding and stroke in patients with warfarin ineligible or failure in patients with atrial fibrillation (The ROAR study)
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Madhu Reddy, Mohit K. Turagam, Valay Parikh, Muhammad R. Afzal, Donita Atkins, Calambur Narasimhan, Rakesh Gopinathannair, Dhanunjaya Lakkireddy, Courtney Jeffery, Arun Kanmanthareddy, Jie Cheng, Andrea Natale, Sudharani Bommana, Sanghamitra Mohanty, Pasquale Santangeli, Madhav Lavu, Jayasree Pillarisetti, Melissa Jaeger, and Luigi Di Biase
- Subjects
Male ,medicine.medical_specialty ,Gastrointestinal bleeding ,Administration, Oral ,Hemorrhage ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Recurrence ,Risk Factors ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Treatment Failure ,Stroke ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Drug Substitution ,Warfarin ,Anticoagulants ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Surgery ,Oral anticoagulant ,Recurrent bleeding ,Female ,Cardiology and Cardiovascular Medicine ,business ,Major bleeding ,medicine.drug ,Follow-Up Studies - Abstract
Background A significant proportion of patients treated with warfarin for atrial fibrillation (AF) become warfarin ineligible (WI) due to major bleeding events (MBE) or systemic thromboembolism (STE). We report a large multicenter real-world experience of the use of DOACs in these WI patients. Methods We report the outcomes of 263 WI patients treated with DOACs. The primary objective was to evaluate clinical outcomes of STE and MBE with DOACs. Secondary objective was to assess clinical predictors of repeat MBE and STE on DOACs. Results 63% (166/263) patients had a repeat MBE on DOACs. Repeat MBE was significantly higher in patients with prior gastrointestinal bleeding (74.5% vs 30%, p
- Published
- 2017
36. Recordings of diaphragmatic electromyograms during cryoballoon ablation for atrial fibrillation accurately predict phrenic nerve injury
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Nikhil Goyal, Soad Bekheit, Marcin Kowalski, Faisal B Saiful, Mayur Lakhani, and Valay Parikh
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Diaphragm ,Diaphragmatic breathing ,Comorbidity ,Cryosurgery ,Phrenic Nerve Injury ,Pulmonary vein ,Electrocardiography ,Predictive Value of Tests ,Risk Factors ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,Humans ,Medicine ,Phrenic nerve ,Electromyography ,business.industry ,Cryoablation ,Atrial fibrillation ,Balloon Occlusion ,Middle Aged ,medicine.disease ,Ablation ,Compound muscle action potential ,Phrenic Nerve ,Treatment Outcome ,Echocardiography ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Cryoballoon ablation has been associated with a significant incidence of phrenic nerve injury (PNI).The purpose of this study was to evaluate whether recordings of diaphragmatic compound motor action potentials (CMAP) on a modified lead I during cryoballoon ablation can predict PNI.Cryoballoon ablation was performed in 109 patients with atrial fibrillation (AF). During ablation of the right-sided pulmonary veins, the phrenic nerve was paced from the superior vena cava. The right and left arm electrodes from a 12-lead ECG were positioned 5 cm above the xiphoid process and 16 cm along the right costal margin. The amplitude of CMAP was recorded on lead I during ablation.Cryoballoon was applied 424 times in 211 right-sided veins. PNI occurred in 7 (6.4%) patients. The average CMAP amplitude did not significantly change in patients without PNI from the initial average CMAP amplitude of 0.34 ± 0.18 mV to 0.32 ± 0.17 mV (P = .58). In patients who developed PNI, there was a significant decrease in the initial average CMAP amplitude during the ablation from 0.33 ± 0.14 mV to 0.09 ± 0.05 mV (P.001). The maximal percent change in the average CMAP amplitude in patients with PNI was higher (70% ± 10%) than in patients without PNI (7.6% ± 7%; P.001). In any patient without PNI, the CMAP amplitude did not decrease more than 35% from baseline.Recording of CMAP amplitude on a modified lead I is reliable and could be early and sensitive method for predicting PNI in patients undergoing cryoballoon ablation for AF.
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- 2014
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37. Neutrophil lymphocyte ratio significantly improves the Framingham risk score in prediction of coronary heart disease mortality: Insights from the National Health and Nutrition Examination Survey-III
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Ankit Rathod, James Lafferty, Nileshkumar J. Patel, Abhishek Deshmukh, Nilay Patel, Neeraj Shah, Valay Parikh, and Apurva Badheka
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Adult ,Male ,medicine.medical_specialty ,National Health and Nutrition Examination Survey ,Neutrophils ,General Population Cohort ,Coronary Disease ,Asymptomatic ,Cohort Studies ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,Post-hoc analysis ,medicine ,Clinical endpoint ,Humans ,Lymphocytes ,Aged ,Retrospective Studies ,Framingham Risk Score ,Proportional hazards model ,business.industry ,fungi ,Middle Aged ,Nutrition Surveys ,Surgery ,Cross-Sectional Studies ,Cohort ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Neutrophil lymphocyte ratio (NLR) has been shown to predict cardiovascular events in several studies. We sought to study if NLR predicts coronary heart disease (CHD) in a healthy US cohort and if it reclassifies the traditional Framingham risk score (FRS) model.We performed post hoc analysis of National Health and Nutrition Examination Survey-III (1998-94) including subjects aged 30-79 years free from CHD or CHD equivalent at baseline. Primary endpoint was death from ischemic heart disease. NLR was divided into four categories:1.5, ≥1.5 to3.0, 3.0-4.5 and4.5. Statistical analyses involved multivariate Cox proportional hazards models as well as discrimination, calibration and reclassification.We included 7363 subjects with a mean follow up of 14.1 years. There were 231 (3.1%) CHD deaths, more in those with NLR4.5 (11%) compared to NLR1.5 (2.4%), p0.001. Adjusted hazard ratio of NLR4.5 was 2.68 (95% CI 1.07-6.72, p=0.035). There was no significant improvement in C-index (0.8709 to 0.8713) or area under curve (0.8520 to 0.8531) with addition of NLR to FRS model. Model with NLR was well calibrated with Hosmer-Lemeshow chi-square of 8.57 (p=0.38). Overall net reclassification index (NRI) was 6.6% (p=0.003) with intermediate NRI of 10.1% (p0.001) and net upward reclassification of 5.6%. Absolute integrated discrimination index (IDI) was 0.003 (p=0.039) with relative IDI of 4.3%.NLR can independently predict CHD mortality in an asymptomatic general population cohort. It reclassifies intermediate risk category of FRS, with significant upward reclassification. NLR should be considered as an inflammatory biomarker of CHD.
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- 2014
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38. IMPACT OF ULTRA-CONSERVATIVE IMPLANTABLE CARDIOVERTER DEFIBRILLATOR PROGRAMMING IN PATIENTS WITH LEFT VENTRICULAR ASSIST DEVICES: AVOIDING UNNECESSARY TACHY-THERAPIES
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Katie Christensen, Alexander Robinson, Madhu Reddy, Mohammad-Ali Jazayeri, Nicholas A. Haglund, Loren Berenbom, Raghuveer Dendi, Martin Emert, Rhea Pimentel, Valay Parikh, Travis Abicht, Zubair Shah, Seth H. Sheldon, Michael Pierpoline, and Andrew J. Sauer
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,medicine ,In patient ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,Implantable cardioverter-defibrillator ,business - Published
- 2019
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39. Impact of Radiofrequency Ablation of Atrial Fibrillation on Pulmonary Vein Cross Sectional Area: Implications for the Diagnosis of Pulmonary Vein Stenosis
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Venkat Vuddanda, Subba Reddy Vanga, James L. Vacek, Thomas Rosamond, Mohit Turagam, Donita Atkins, Jayant Nath, Mohammad-Ali Jazayeri, Sudharani Bommana, Dhanunjaya Lakkireddy, Valay Parikh, Y. Madhu Reddy, and Madhav Lavu
- Subjects
Radiofrequency ablation ,business.industry ,medicine.medical_treatment ,Atrial fibrillation ,Retrospective cohort study ,030204 cardiovascular system & hematology ,medicine.disease ,Ablation ,Pulmonary vein ,law.invention ,03 medical and health sciences ,Stenosis ,0302 clinical medicine ,law ,Cohort ,medicine ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,Nuclear medicine ,business ,Pulmonary vein stenosis ,Original Research - 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 cm2. 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.
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- 2016
40. Esophageal Temperature Monitoring During Radiofrequency Ablation of Atrial Fibrillation: A Meta-Analysis
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Mark Pollet, Nilesh Mathuria, Ketan Koranne, Dhanunjaya Lakkireddy, Valay Parikh, Jie Cheng, Suwei Wang, and Indranill Basu-Ray
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medicine.medical_specialty ,medicine.diagnostic_test ,Esophagogastroduodenoscopy ,Radiofrequency ablation ,business.industry ,Fistula ,Ablation of atrial fibrillation ,Atrial fibrillation ,Odds ratio ,030204 cardiovascular system & hematology ,medicine.disease ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Meta-analysis ,cardiovascular system ,medicine ,030212 general & internal medicine ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Original Research - Abstract
Objective: Atrio-esophageal fistula is an infrequent but devastating complication of catheter-based ablation of atrial fibrillation (AF). Thermal esophageal injury may be the precursor of atrio-esophageal fistula. Here, we evaluated the role of esophageal temperature monitoring in preventing thermal esophageal injury during pulmonary vein isolation for AF with radiofrequency energy. Methods: In this meta-analysis, we searched the PubMed, Cochrane, Scopus, Embase, and Refworks databases for all published studies from January 2004 to June 2016 to evaluate the role of esophageal temperature monitoring. We searched for terms esophageal temperature monitoring, AF, radiofrequency ablation, atrio-esophageal fistula, and thermal esophageal injury. We included studies comparing luminal esophageal temperature (LET) monitoring with no LET monitoring during radiofrequency ablation of AF. We excluded studies in which post-ablation esophagogastroduodenoscopy (EGD) was not performed to identify esophageal thermal injuries. To perform the meta-analysis, we used Review Manager statistical software and a fixed-effects modeling to derive the outcomes. Given significant heterogeneity between the studies, we used meta-regression analysis to adjust for age and sex. Results: We identified 4 non-randomized controlled trials that met our search criteria and included a total of 411 patients (n=235 in the LET monitoring group; n=176 in the no LET monitoring group) in the analysis. There were 21 (8.9%) patients with thermal esophageal injury in the LET monitoring group and 12 (6.8%) in the no LET monitoring group. The pooled odds ratio was 0.66 (0.23-1.89), indicating no statistically significant differences between the 2 groups with regard to esophageal injury. Because of the small sample size and the non-randomized nature of the trials, we observed significant heterogeneity in outcomes among the trials. Conclusion: The role of esophageal temperature monitoring in reducing the risk of esophageal thermal lesions during pulmonary vein isolation for AF has not been established, and more studies including randomized controlled trials are needed to assess its true impact.
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- 2016
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41. Percutaneous left atrial appendage closure: current state of the art
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Dhanunjaya Lakkireddy, Valay Parikh, Mohammad-Ali Jazayeri, and Venkat Vuddanda
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medicine.medical_specialty ,Cardiac Catheterization ,Percutaneous ,030204 cardiovascular system & hematology ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Left atrial ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,Atrial Appendage ,030212 general & internal medicine ,Randomized Controlled Trials as Topic ,Appendage ,Modalities ,business.industry ,General surgery ,Anticoagulants ,Atrial fibrillation ,Prostheses and Implants ,medicine.disease ,Europe ,Stroke ,Treatment Outcome ,Stroke prevention ,Cardiology ,Systemic anticoagulation ,Cardiology and Cardiovascular Medicine ,business - Abstract
Purpose of review The authors reviewed the seminal and more recent literature surrounding the major modalities for percutaneous left atrial appendage closure used in contemporary practice, with particular emphasis on safety and efficacy, technical challenges, and future developments. Recent findings Along with the continued practice of surgical left atrial appendage closure, which has evolved substantially with the advent of clipping techniques, a number of percutaneous methods have been developed to close the left atrial appendage with endocardial, epicardial, and hybrid approaches. The last 18 months has seen the Food and Drug Administration approval of the WATCHMAN device for stroke prevention in the United States, the initiation of a randomized controlled trial to further examine the LARIAT device, and an increasing body of literature surrounding use of the AMPLATZER Amulet in Europe. Summary Left atrial appendage closure is a promising alternative to systemic anticoagulation for stroke prevention in appropriate atrial fibrillation patients. The wealth of available data for the various modalities sheds light on the strengths and limitations of each, postprocedural complications and their management, and new areas for exploration. With a plethora of new devices on the horizon, it is a very exciting time in the field of 'appendage-ology' as we pursue new avenues to optimize care for atrial fibrillation patients.
- Published
- 2016
42. Reply: Effect of Pre-Procedural β-Blocker in Patients Undergoing Percutaneous Coronary Intervention
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Apurva A, Motivala, Valay, Parikh, Matthew, Roe, David, Dai, J Dawn, Abbott, Abhiram, Prasad, and Debabrata, Mukherjee
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Percutaneous Coronary Intervention ,Treatment Outcome ,Adrenergic beta-Antagonists ,Myocardial Infarction ,Humans - Published
- 2016
43. Catheter Ablation for Atrial Fibrillation in Patients With Watchman Left Atrial Appendage Occlusion Device: Results from a Multicenter Registry
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Mohit K, Turagam, Madhav, Lavu, Muhammad R, Afzal, Venkat, Vuddanda, Mohammad-Ali, Jazayeri, Valay, Parikh, Donita, Atkins, Sudharani, Bommana, Luigi, DI Biase, Rodney, Horton, Rong, Bai, Vijay, Swarup, Jie, Cheng, Andrea, Natale, and Dhanunjaya, Lakkireddy
- Subjects
Male ,Cardiac Catheterization ,Time Factors ,Septal Occluder Device ,Action Potentials ,Prosthesis Design ,Heart Septal Defects, Atrial ,United States ,Treatment Outcome ,Echocardiography ,Heart Rate ,Recurrence ,Risk Factors ,Atrial Fibrillation ,Catheter Ablation ,Feasibility Studies ,Humans ,Atrial Appendage ,Female ,Registries ,Electrophysiologic Techniques, Cardiac ,Aged ,Retrospective Studies - Abstract
There have been an increasing number of atrial fibrillation (AF) patients with Watchman left atrial appendage occlusion (LAAO) device, requiring catheter ablation (CA) for maintenance of normal sinus rhythm. In this study, we describe our experience with the feasibility and safety of CA in patients with a preexisting Watchman LAAO device.This was a retrospective multicenter AF registry of 60 patients with Watchman LAAO device who underwent CA for AF. Baseline clinical and procedural characteristics of the included subjects were retrieved from review of medical records and were analyzed.The mean age was 72.7 ± 4.9 years and the mean CHADS2 score was 2.3 ± 0.6. All patients had successful pulmonary vein isolation (PVI). The left atrial appendage (LAA) was electrically active in 34 (56%) while reentrant tachycardia and AF triggers were seen in 17 (28%) patients. Electrical isolation was attempted in these 17 patients with only 10 achieving complete LAA isolation. Repeat imaging showed new peri-device leaks in 30% (12/40) patients, while new significant peri-device leaks (≥5 mm) were noted in 10% (10/40) of patients after RFA, respectively, requiring continuation of oral anticoagulation. There were a higher proportion of patients with severe peri-device leaks (≥5 mm) after LAA isolation. However,50% of those leaks sealed off on follow-up transesophageal echocardiogram.AF ablation is a feasible and safe in patients with preexisting Watchman LAAO device. Electrical isolation of the LAA could be difficult and when attempted can result in increased risk of short-term peri-device leak and recurrence of AT/AF in almost all patients.
- Published
- 2016
44. Contrast media use in patients with chronic kidney disease undergoing coronary angiography: A systematic review and meta-analysis of randomized trials
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Sripal Bangalore, Suzanne El-Sayegh, Marc Bogin, Valay Parikh, James Lafferty, Bhavi Pandya, Sainath Gaddam, Ruben Kandov, Jonathan Spagnola, and Jean M. Chalhoub
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Contrast-induced nephropathy ,Urology ,Contrast Media ,Subgroup analysis ,Coronary Disease ,030204 cardiovascular system & hematology ,Coronary Angiography ,Kidney Function Tests ,law.invention ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Randomized controlled trial ,law ,Medicine ,Humans ,030212 general & internal medicine ,Renal Insufficiency, Chronic ,Creatinine ,Ejection fraction ,business.industry ,Incidence (epidemiology) ,Percutaneous coronary intervention ,medicine.disease ,chemistry ,Kidney Diseases ,Radiology ,Preventive Medicine ,Cardiology and Cardiovascular Medicine ,business ,Kidney disease - Abstract
Background Patients with chronic kidney disease (CKD) undergoing coronary angiography (CA), adequate hydration and minimizing volume of contrast media (CM) are class 1b recommendations for preventing contrast induced nephropathy (CIN). Current data are insufficient to justify specific recommendations about isoosmolar vs. low-osmolar contrast media by the ACCF/AHA/ SCA I guidelines. Methods Randomized trials comparing IOCM to LOCM in CKD stage 3 and above patients undergoing CA, and reporting incidence of CIN (defined by a rise in creatinine of 25% from baseline) were included in the analysis. The secondary outcome of the study was the incidence of serum creatinine increase by >1mg/dl. Results A total of 2839 patients were included in 10 trials, in which 1430 patients received IOCM and 1393 received LOCM. When compared to LOCM, IOCM was not associated with significant benefit in preventing CIN (OR=0.72, [CI: 0.50–1.04], P =0.08, I2=59%). Subgroup analysis revealed non-significant difference in incidence of CIN based on baseline use of N -acetylcystine (NAC), diabetes status, ejection fraction, and whether percutaneous coronary intervention vs coronary angiography alone was performed. The difference between IOCM and LOCM was further attenuated when restricted to studies with larger sample size (>250 patients) (OR=0.93; [CI: 0.66–1.30]) or when compared with non-ionic LOCM (OR=0.79, [CI: 0.52–1.21]). Conclusion In patients with CKD stage 3 and above undergoing coronary angiography, use of IOCM showed overall non-significant difference in incidence of CIN compared to LOCM. The difference was further attenuated when IOCM was compared with non-ionic LOCM.
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- 2016
45. Clinical Application of Fractional Flow Reserve-Guided Percutaneous Coronary Intervention for Stable Coronary Artery Disease
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Nileshkumar J. Patel, Kanishk Agnihotri, Valay Parikh, J. Dawn Abbott, and Sabeeda Kadavath
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Fractional flow reserve ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Revascularization ,Coronary Angiography ,Angina ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Percutaneous Coronary Intervention ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Myocardial infarction ,Coronary Artery Bypass ,Cardiac catheterization ,Randomized Controlled Trials as Topic ,business.industry ,Coronary Stenosis ,Hemodynamics ,Percutaneous coronary intervention ,medicine.disease ,Coronary arteries ,Fractional Flow Reserve, Myocardial ,medicine.anatomical_structure ,Treatment Outcome ,Cardiology ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Revascularization in stable ischemic heart disease (SIHD) is indicated in patients on optimal medical therapy with angina and/or demonstrable ischemia and a significant stenosis in one or more epicardial coronary arteries. Angiography alone, however, cannot accurately determine the hemodynamic significance of coronary lesions, particularly those of intermediate stenosis severity. A lesion may appear significant on coronary angiogram but may not have functional significance. Percutaneous coronary intervention (PCI) of functionally insignificant coronary artery lesions may have serious consequences; therefore, judicious decision-making in the cardiac catheterization laboratory is indicated. For this reason, it is becoming increasingly important to show that a stenosis is capable to induce myocardial ischemia prior to intervention. Fractional flow reserve (FFR) has emerged as a useful tool for this purpose. In this review, we will briefly discuss the principle of FFR, current evidence and rationale supporting its use, and comparison with other modalities.
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- 2016
46. Predictors, Trends, and Outcomes (Among Older Patients ≥65 Years of Age) Associated With Beta-Blocker Use in Patients With Stable Angina Undergoing Elective Percutaneous Coronary Intervention: Insights From the NCDR Registry
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Apurva A, Motivala, Valay, Parikh, Matthew, Roe, David, Dai, J Dawn, Abbott, Abhiram, Prasad, and Debabrata, Mukherjee
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Heart Failure ,Male ,Chi-Square Distribution ,Time Factors ,Adrenergic beta-Antagonists ,Age Factors ,Myocardial Infarction ,Drug Prescriptions ,Patient Readmission ,Patient Discharge ,United States ,Stroke ,Logistic Models ,Percutaneous Coronary Intervention ,Treatment Outcome ,Risk Factors ,Multivariate Analysis ,Odds Ratio ,Humans ,Female ,Angina, Stable ,Registries ,Practice Patterns, Physicians' ,Aged ,Retrospective Studies - Abstract
This study sought to examine predictors, trends, and outcomes associated with β-blocker prescriptions at discharge in patients with stable angina without prior history of myocardial infarction (MI) or systolic heart failure (HF) undergoing elective percutaneous coronary intervention (PCI).The benefits of β-blockers in patients with MI and/or systolic HF are well established. However, whether β-blockers affect outcomes in patients with stable angina, especially after PCI, remains uncertain.We included patients with stable angina without prior history of MI, left ventricular systolic dysfunction (left ventricular ejection fraction 40%) or systolic HF undergoing elective PCI between January 2005 and March 2013 from the hospitals enrolled in the National Cardiovascular Data Registry (NCDR) CathPCI registry. These patients were retrospectively analyzed for predictors and trends of β-blocker prescriptions at discharge. All-cause mortality (primary endpoint), revascularization, or hospitalization related to MI, HF, or stroke at 30-day and 3-year follow-up were analyzed among patients ≥65 years of age.A total of 755,215 patients from 1,443 sites were studied, and 71.4% population of our cohort was discharged on β-blockers. At 3-year follow-up among patients ≥65 years of age with CMS data linkage (16.3% of the studied population), there was no difference in adjusted mortality rate (14.0% vs. 13.3%; adjusted hazard ratio [HR]: 1.00; 95% confidence interval [CI]: 0.96 to 1.03; p = 0.84), MI (4.2% vs. 3.9%; adjusted HR: 1.00; 95% CI: 0.93 to 1.07; p = 0.92), stroke (2.3% vs. 2.0%; adjusted HR: 1.08; 95% CI: 0.98 to 1.18; p = 0.14) or revascularization (18.2% vs. 17.8%; adjusted HR: 0.97; 95% CI: 0.94 to 1.01; p = 0.10) with β-blocker prescription. However, discharge on β-blockers was associated with more HF readmissions at 3-year follow-up (8.0% vs. 6.1%; adjusted HR: 1.18; 95% CI: 1.12 to 1.25; p 0.001). Results at 30-day follow-up were broadly consistent as well. During the period between 2005 and 2013, there was a gradual increase in prescription of β-blockers at the index discharge in our cohort (p 0.001).Among patients ≥65 years of age with history of stable angina without prior MI, systolic HF or left ventricular ejection fraction 40% undergoing elective PCI, β-blocker use at discharge was not associated with any reduction in cardiovascular morbidity or mortality at 30-day and at 3-year follow-up. Over time, β-blockers use at discharge in this population has continued to increase.
- Published
- 2016
47. Unusual Presentation of Lemierre Syndrome
- Author
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Neeraj Shah, Neville Mobarakai, and Valay Parikh
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Microbiology (medical) ,medicine.medical_specialty ,Infectious Diseases ,business.industry ,medicine ,Lemierre Syndrome ,Presentation (obstetrics) ,business ,Dermatology - Published
- 2014
- Full Text
- View/download PDF
48. CORRELATION OF EKG BASED SITE OF ORIGIN OF VENTRICULAR ARRHYTHMIAS WITH SITE OF INFLAMMATION ON FDG-PET SCAN IN PATIENTS WITH ARRHYTHMOGENIC INFLAMMATORY CARDIOMYOPATHY
- Author
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Seth H. Sheldon, Rhea Pimentel, Andrea Natale, Roderick Tung, Tawseef Dar, Valay Parikh, Dhanunjaya Lakkireddy, Bharath Yarlagadda, Mohit Turagam, Kalyanam Shivkumar, Madhu Reddy, Raghuveer Dendi, Venkat Vuddanda, Loren Berenbom, Ali Jazayeri, Madhav Lavu, Luigi Di Biase, and Martin Emert
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medicine.medical_specialty ,business.industry ,Myocardial inflammation ,Cardiomyopathy ,Inflammation ,medicine.disease ,Internal medicine ,cardiovascular system ,medicine ,Cardiology ,In patient ,cardiovascular diseases ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Cardiac imaging ,Site of origin - Abstract
Patients presenting with frequent ventricular arrhythmias can have underlying myocardial inflammation as an inciting factor. We seek to determine whether the site of origin (SOO) of ventricular arrhythmias on 12 lead EKG correlate with areas of inflammation on FDG PET cardiac imaging in patients
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- 2018
- Full Text
- View/download PDF
49. RISK OF LEAD DISLODGEMENT WITH CATHETER ABLATION IN PATIENTS WITH RECENTLY IMPLANTED CARDIAC IMPLANTABLE ELECTRONIC DEVICE: A FIVE-YEAR EXPERIENCE
- Author
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Rhea Pimentel, Seth H. Sheldon, Martin Emert, Rhaguveer Dendi, Valay Parikh, Dhanunjaya Lakkireddy, Donita Atkins, Kevin Cokingtin, Loren Berenbom, Madhu Reddy, Mohammad-Ali Jazayeri, Brendan Cokingtin, Courtney Jeffery, Venkat Vuddanda, and Sudharani Bommana
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,cardiovascular system ,medicine ,Lead Dislodgement ,Catheter ablation ,In patient ,cardiovascular diseases ,Implant ,Cardiology and Cardiovascular Medicine ,business ,Surgery - Abstract
Patients with cardiac implantable electronic devices (CIEDs) frequently have arrhythmias warranting catheter ablation (CA). The risk of lead dislodgement with CA in patients with CIED implant within 1 year is uncertain. We retrospectively evaluated patients undergoing CA of arrhythmias at an
- Published
- 2018
- Full Text
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50. LEFT ATRIAL APPENDAGE OCCLUSION DEVICE EMBOLIZATION (LAAODE): UNDERSTANDING THE TIMING, MECHANISM AND OUTCOMES
- Author
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Seth H. Sheldon, James Gabriels, Steffen Gloekler, Tawseef Dar, Vaishnavi Veerapaneni, Bernhard Meier, Apostolos Tzikas, Dhanunjaya Lakkireddy, Bharath Yarlagadda, Kim Jung-Sun, Madhu Reddy, and Valay Parikh
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Left atrial appendage occlusion ,03 medical and health sciences ,0302 clinical medicine ,Left atrial ,Internal medicine ,Device Embolization ,medicine ,Cardiology ,030212 general & internal medicine ,Embolization ,Cardiology and Cardiovascular Medicine ,business - Abstract
Embolization of the left atrial appendage (LAA) closure devices is a very rare phenomenon. We sought to do a root cause analysis of all the device embolization cases that have occurred so far and its temporal relationship with the outcome. A comprehensive search of the PubMed and MAUDE data base
- Published
- 2018
- Full Text
- View/download PDF
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