The precise localization of the site of origin of a premature ventricular contraction (PVC) prior to ablation can facilitate the planning and execution of the electrophysiological procedure. In clinical practice, the targeted ablation... more
The precise localization of the site of origin of a premature ventricular contraction (PVC) prior to ablation can facilitate the planning and execution of the electrophysiological procedure. In clinical practice, the targeted ablation site is estimated from the standard 12-lead ECG. The accuracy of this qualitative estimation has limitations, particularly in the localization of PVCs originating from the papillary muscles. Clinical available electrocardiographic imaging (ECGi) techniques that incorporate patient-specific anatomy may improve the localization of these PVCs, but require body surface maps with greater specificity for the epicardium. The purpose of this report is to demonstrate that a novel cardiac isochrone positioning system (CIPS) program can accurately detect the specific location of the PVC on the papillary muscle using only a 12-lead ECG. Cardiac isochrone positioning system uses three components: (i) endocardial and epicardial cardiac anatomy and torso geometry der...
Research Interests: Electrophysiology, Magnetic Resonance Imaging, Medicine, Electrocardiography, Echocardiography, and 15 moreHumans, Female, Feasibility Studies, Male, Heart rate, Clinical Sciences, Middle Aged, Adult, Ablation, Reproducibility of Results, Catheter ablation, Pilot Projects, Action Potentials, Papillary Muscles, and Predictive value of tests
We report three cases of vascular injury during laser lead extractions, requiring urgent surgical correction. Immediate sternotomy and cardiopulmonary bypass were possible because of an institutional collaboration where cardiac surgeon... more
We report three cases of vascular injury during laser lead extractions, requiring urgent surgical correction. Immediate sternotomy and cardiopulmonary bypass were possible because of an institutional collaboration where cardiac surgeon and cardiac electrophysiologist jointly perform these cases, and all patients survived. We propose this joint approach is ultimately the best option for patients undergoing lead extraction.
Research Interests: Treatment Outcome, Adolescent, Cardiac Surgery, Cardiac Electrophysiology, Humans, and 14 moreLasers, Female, Male, Physicians, Clinical Sciences, Aged, Adult, Patient Care Team, Emergencies, Surgeons, Implantable defibrillators-cardioverters, Cooperative Behavior, Thoracic Surgery, and Cardiopulmonary bypass
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In 194 patients presenting with acute abdominal pain from whom sequential serum samples were taken, the frequency of yersiniosis, established serologically, was significantly higher (23%) than in 320 control subjects (2%). Yersiniosis... more
In 194 patients presenting with acute abdominal pain from whom sequential serum samples were taken, the frequency of yersiniosis, established serologically, was significantly higher (23%) than in 320 control subjects (2%). Yersiniosis occurred in 31% of patients with acute appendicitis. Acute-phase serum samples only, obtained in a further 307 patients, yielded a falsely low frequency of yersiniosis (4%). Y pseudotuberculosis was five times more common than Y enterocolitica, and Y pseudotuberculosis type IV was the most common serotype, accounting for 43% of Yersinia infections. Yersinia may play a more important part in the aetiology of acute abdominal pain, and particularly acute appendicitis, than has been previously appreciated. Antibody titres to both Y enterocolitica and Y pseudotuberculosis frequently rise late in infections causing abdominal pain. Consequently analysis of acute-phase serum samples alone leads to underdiagnosis of yersiniosis.
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ABSTRACT Proton NMR measurements of T1, T1π and T2 in “Nafion” perfluorosulphonate membranes, together with neutron- scattering and dielectric data, show that the aqueous phase in Nafion solidifies at a glass transformation whose... more
ABSTRACT Proton NMR measurements of T1, T1π and T2 in “Nafion” perfluorosulphonate membranes, together with neutron- scattering and dielectric data, show that the aqueous phase in Nafion solidifies at a glass transformation whose temperature Tg is 168 K in water-saturated acid membranes. Tg is higher for the salt forms. Mo¨ssbauer measurements on Eu3+ Nafion confirm that the cations are present in an aqueous phase with Tg ≈ 220 K.
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Research Interests: Survival Analysis, Treatment Outcome, Risk assessment, Comorbidity, Heart Failure, and 20 moreHumans, Congestive Heart Failure, Female, Male, Atrial Fibrillation, Heart rate, Incidence, Anticoagulants, Risk factors, Left Ventricular Dysfunction, Minerva Medica, Prognosis, Risk Factors, Risk Assessment, Catheter ablation, Cardiomyopathies, Digoxin, Angiotensin Converting Enzyme Inhibitors, Tachycardia, and Randomized Controlled Trials as Topic
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Ventricular function is readily evaluated using magnetic resonance imaging (MRI) techniques. Previous studies have focused on systolic contraction and imaging myocardial strain. However, tempo- rally resolved quantitative data on... more
Ventricular function is readily evaluated using magnetic resonance imaging (MRI) techniques. Previous studies have focused on systolic contraction and imaging myocardial strain. However, tempo- rally resolved quantitative data on ventricular wall stress (WS) over the entire cardiac cycle, although essential to fully understand cardiac mechanics and power consumption, has not been available.
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ABSTRACT The primary purpose of lesion-forming technologies in atrial fibrillation is to create safe and effective myocardial lesions in a reasonable time frame while avoiding collateral damage. The complex anatomy of the left atrium... more
ABSTRACT The primary purpose of lesion-forming technologies in atrial fibrillation is to create safe and effective myocardial lesions in a reasonable time frame while avoiding collateral damage. The complex anatomy of the left atrium creates unique difficulties for any lesion-forming technology employed in the ablation of atrial fibrillation. Unfortunately, the ideal energy source for the treatment of atrial fibrillation has yet to be developed, and thus multiple different technologies are still used. Lesion-forming technologies currently employed in the treatment of atrial fibrillation include radio-frequency energy, cryothermal energy, and high-intensity focused ultrasound. This review touches on the basic principles behind each of these technologies and highlights the advantages and limitations of their use in the treatment of atrial fibrillation. Finally, we briefly review some evolving strategies for the treatment of atrial fibrillation, including the use of lasers, microwaves, and Beta-irradiation as well as the injection of autologous fibroblasts. KeywordsBiophysics–Catheter ablation energy source–Lesion formation–Radio frequency
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... European Heart Journal (1995) 16, 1162-1164 Sudden cardiac death, circadian rhythms and defibrillators NG BOYLE AND ME JOSEPHSON ... References [1] d'Avila A, Wellens F, Andries E, Brugada P. At what time are implantable... more
... European Heart Journal (1995) 16, 1162-1164 Sudden cardiac death, circadian rhythms and defibrillators NG BOYLE AND ME JOSEPHSON ... References [1] d'Avila A, Wellens F, Andries E, Brugada P. At what time are implantable defibrillator shocks delivered? ...
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Atrial fibrillation (AF) is the most common arrhythmia prompting clinical presentation, is associated with significant morbidity and mortality. The incidence and prevalence of this arrhythmia is expected to grow significantly in the... more
Atrial fibrillation (AF) is the most common arrhythmia prompting clinical presentation, is associated with significant morbidity and mortality. The incidence and prevalence of this arrhythmia is expected to grow significantly in the coming decades. Of the available pharmacologic and non-pharmacologic treatment options, the fastest growing and most intensely studied is catheter-based ablation therapy for AF. Given the varying success rates for AF ablation, the increasingly complex factors that need to be taken into account when deciding to proceed with ablation, as well as varying definitions of procedural success, accurate detection of arrhythmia recurrence and its burden is of significance. Detecting and monitoring AF recurrence following catheter ablation is therefore an important consideration. Multiple studies have demonstrated the close relationship between the intensity of rhythm monitoring with wearable ambulatory cardiac monitors, or implantable cardiac rhythm monitors and the detection of arrhythmia recurrence. Other studies have employed algorithms dependent on intensive monitoring and arrhythmia detection in the decision tree on whether to proceed with repeat ablation or medical therapy. In this review, we discuss these considerations, types of monitoring devices, and implications for monitoring AF recurrence following catheter ablation.
1. Am Heart J. 1995 Jan;129(1):191-3. Papillary muscle rupture complicating inferior myocardial infarction: identification with transesophageal echocardiography. Manning WJ, Waksmonski CA, Boyle NG. Beth Israel Hospital, Boston, MA 02215.... more
1. Am Heart J. 1995 Jan;129(1):191-3. Papillary muscle rupture complicating inferior myocardial infarction: identification with transesophageal echocardiography. Manning WJ, Waksmonski CA, Boyle NG. Beth Israel Hospital, Boston, MA 02215. ...
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Accessory pathways can lie near or within the coronary sinus (CS). Radiofrequency catheter ablation of accessory pathways is a well-established treatment option, but this procedure can cause damage to adjacent coronary arteries. The... more
Accessory pathways can lie near or within the coronary sinus (CS). Radiofrequency catheter ablation of accessory pathways is a well-established treatment option, but this procedure can cause damage to adjacent coronary arteries. The purpose of this study was to evaluate the anatomic relationship between the coronary arteries and the CS. Retrospective data of patients who underwent catheter ablation of supraventricular tachycardia between June 2011 and August 2013 was reviewed. In addition, detailed analysis of coronary computed tomographic angiography (CTA) data from 50 patients was performed. Between June 2011 and August 2013, 427 patients underwent catheter ablation of supraventricular tachycardia, of whom 105 (age 28 ± 17 years, 60% male) had accessory pathway-mediated tachycardia. Of these, 23 patients had accessory pathways near the CS, and 60% (N = 14) underwent concurrent coronary angiography. In 4 patients, the posterolateral (inferolateral) branch (PLA) of the right coronar...
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ABSTRACT In this article, specific ECG criteria to diagnose epicardial ventricular arrhythmia are reviewed. Four general measurement criteria are used: (1) the pseudo-δ wave, (2) intrinsicoid deflection time, (3) the shortest RS complex,... more
ABSTRACT In this article, specific ECG criteria to diagnose epicardial ventricular arrhythmia are reviewed. Four general measurement criteria are used: (1) the pseudo-δ wave, (2) intrinsicoid deflection time, (3) the shortest RS complex, and (4) the QRS complex duration. Additional criteria, including precordial maximal deflection index, precordial pattern break, and analysis of the Q wave pattern in lead I and the inferior leads, were derived in populations of patients with nonischemic cardiomyopathy. Algorithms on how to approach patients with suspected epicardial ventricular tachycardia are reviewed. ECG findings suggestive of epicardial accessory pathways in Wolff-Parkinson-White syndrome are reviewed.
Patient monitors in modern hospitals have become ubiquitous but they generate an excessive number of false alarms causing alarm fatigue. Our previous work showed that combinations of frequently co-occurring monitor alarms, called... more
Patient monitors in modern hospitals have become ubiquitous but they generate an excessive number of false alarms causing alarm fatigue. Our previous work showed that combinations of frequently co-occurring monitor alarms, called SuperAlarm patterns, were capable of predicting in-hospital code blue events at a lower alarm frequency. In the present study, we extend the conceptual domain of a SuperAlarm to incorporate laboratory test results along with monitor alarms so as to build an integrated data set to mine SuperAlarm patterns. We propose two approaches to integrate monitor alarms with laboratory test results and use a maximal frequent itemsets mining algorithm to find SuperAlarm patterns. Under an acceptable false positive rate FPRmax, optimal parameters including the minimum support threshold and the length of time window for the algorithm to find the combinations of monitor alarms and laboratory test results are determined based on a 10-fold cross-validation set. SuperAlarm ca...
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A 57-year-old female with recurrent atrial flutter (AFL) was referred for catheter ablation. The surface electrocardiogram (ECG) suggested clockwise AFL with positive F-waves in II, III, and AVF, and negative F-wave in V1. The complete... more
A 57-year-old female with recurrent atrial flutter (AFL) was referred for catheter ablation. The surface electrocardiogram (ECG) suggested clockwise AFL with positive F-waves in II, III, and AVF, and negative F-wave in V1. The complete absence of an R-wave in lead I was noted. The chest x-ray demonstrated dextrocardia, and echocardiography established complete situs inversus with otherwise normal intracardiac anatomy.
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A 59-year-old male was referred for radiofrequency catheter ablation of atrial flutter and atrial fibrillation. He had a 3-year history of highly symptomatic paroxysmal atrial fibrillation that failed to respond to multiple medications.... more
A 59-year-old male was referred for radiofrequency catheter ablation of atrial flutter and atrial fibrillation. He had a 3-year history of highly symptomatic paroxysmal atrial fibrillation that failed to respond to multiple medications. He underwent catheter-based radiofrequency ablation (RFA) with pulmonary vein isolation and subsequently a modified left- and right-sided surgical maze procedure after recurrence of atrial fibrillation. Following the
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A 30-year-old female with primary pulmonary hypertension had recurrent atrial flutter despite amiodarone treatment and multiple cardioversions. Because of worsened dyspnea resulting from atrial flutter, she was referred for... more
A 30-year-old female with primary pulmonary hypertension had recurrent atrial flutter despite amiodarone treatment and multiple cardioversions. Because of worsened dyspnea resulting from atrial flutter, she was referred for electrophysiology study and catheter ablation. Preprocedural surface electrocardiograms, both recorded during the month prior to ablation, showed organized atrial activity with variable flutter wave morphology (Fig. 49.1). Based on the 12-lead
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A 52-year-old male with history of hypertension, diabetes, and coronary artery disease status post coronary artery bypass grafting was recently seen for palpitations and dyspnea. Surface electrocardiogram showed a regular supraventricular... more
A 52-year-old male with history of hypertension, diabetes, and coronary artery disease status post coronary artery bypass grafting was recently seen for palpitations and dyspnea. Surface electrocardiogram showed a regular supraventricular tachycardia at a rate of approximately 250 per minute, with 2:1 conduction to the ventricles (Fig. 55.1). He was referred for electrophysiology study and catheter ablation. Based on this
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A 79-year-old male with a history of hypertension, coronary artery bypass grafting, and implantable cardioverter-defibrillator for ventricular fibrillation, presented with symptomatic supraventricular tachycardia. He had failed... more
A 79-year-old male with a history of hypertension, coronary artery bypass grafting, and implantable cardioverter-defibrillator for ventricular fibrillation, presented with symptomatic supraventricular tachycardia. He had failed antiarrhythmic medications and cardioversion attempts, and was referred for electrophysiology study and catheter ablation. Twelve-lead electrocardiogram showed organized atrial activity with positive flutter waves in lead V1 and inferior leads, not suggestive of typical
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A 79-year-old male with a history of hypertension, diabetes, coronary artery bypass grafting, recently diagnosed with atrial flutter and referred for electrophysiology study and catheter ablation. Initial 12-lead electrocardiogram (Fig.... more
A 79-year-old male with a history of hypertension, diabetes, coronary artery bypass grafting, recently diagnosed with atrial flutter and referred for electrophysiology study and catheter ablation. Initial 12-lead electrocardiogram (Fig. 52.1) showed organized atrial activity with a cycle length of approximately 220 ms with negative F waves in leads II, III, and aVF, positive F waves in V1, suggesting typical
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A 59-year-old male with ischemic cardiomyopathy who underwent heart transplantation three years earlier was repeatedly hospitalized for atrial flutter (AFL) (Fig. 12.1, panel A) refractory to rate control and antiarrhythmic drugs. Left... more
A 59-year-old male with ischemic cardiomyopathy who underwent heart transplantation three years earlier was repeatedly hospitalized for atrial flutter (AFL) (Fig. 12.1, panel A) refractory to rate control and antiarrhythmic drugs. Left ventricular ejection fraction was normal by echocardiography. He was referred for electrophysiology study and ablation.
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The purpose of this study was to define the role coronary arteriography (venous phase) for improving the success of left ventricular (LV) lead implantation and to define the value of identifying the pericardiophrenic vein for optimal LV... more
The purpose of this study was to define the role coronary arteriography (venous phase) for improving the success of left ventricular (LV) lead implantation and to define the value of identifying the pericardiophrenic vein for optimal LV lead placement in biventricular (bi-v) device implantation. Seventy-seven patients underwent bi-v device implantation between July 2002 and October 2003. If the coronary sinus (CS) could not be accessed, then left coronary arteriography was performed during the same procedure. CS access was guided by venous phase images of the coronary arteriogram. The pericardiophrenic vein was identified by selective cannulation or direct visualization. Patients with Cr > 1.5 had gadolinium used as the contrast agent. Seventy-five successful implants were performed (97%). In seven patients (9%) repeated attempts at retrograde cannulation of the CS failed (attempt time 130 +/- 20 minute, mean +/- SD). In these patients, coronary arteriography helped define the location of the CS, which was subsequently successfully cannulated. In six patients the pericardiophrenic vein was identified either during occlusion venography of the CS (postthoracotomy, veno-venous collaterals, n = 2) or during selective cannulation of the pericardiophrenic vein (using a DAIG Csl catheter, n = 4). The vein was directly visualized in three patients who underwent surgical LV lead implantation. LV leads in all these cases were implanted in areas not overlying the preidentified pericardiophrenic vein. During follow-up, none of these patients had evidence of phrenic nerve stimulation. Intraoperative left coronary arteriography increases the success of CS cannulation. Identification of the pericardiophrenic vein is a useful method to avoid phrenic nerve stimulation.