Aman Makhija

Hormone sensitive idiopathic ventricular tachycardia associated with pregnancy: successful induction with progesterone and radiofrequency ablation.

Successful Induction With Progesterone and Radiofrequency Ablation. Verapamil‐sensitive idiopathic left ventricular tachycardia in pregnancy is a rare diagnosis. We report a case of a primigravida female with new onset fascicular ventricular tachycardia that was managed with oral verapamil. Post pregnancy, the tachycardia was not inducible in the electrophysioplogy lab. Progesterone, a hormone associated with pregnant state, was used to successfully induce the tachycardia, which was ablated. This is the first reported case of an idiopathic ventricular tachycardia associated with pregnancy that could be induced later by recreating the hormonal milieu associated with pregnant state. (J Cardiovasc Electrophysiol, Vol. 22, pp. 95‐98, January 2011)

Eustachian valve - Masquerading ASD rim

A 34-year-old male presented with shortness of breath on moderate exertion since 2 months. Electrocardiogram was suggestive of right axis deviation and right bundle branch block. Transthoracic echocardiographic evaluation reported atrial septal defect (ASD) with left to right shunt. Qp:Qs was 2:1. Size of the defect reported was 21 mm. The patient was referred to our center for ASD device closure. Before undergoing device closure procedure, transesophageal

A rare case of left ventricular lead stabilization utilizing a coronary stent placement during CRT-D implantation

During cardiac resynchronization therapy implantation, left ventricular lead placement involves transvenous placement of leads via the coronary sinus and into a tributary branch. At present, the most widely used method for left ventricular (LV) lead placement involves a transvenous LV lead placement via the coronary sinus into a tributary branch. Lead dislodgement is a common cause for reoperation. We describe a case where a coronary stent was placed to stabilize the lead against the vessel wall.

To study the effect of high dose Atorvastatin 40 mg versus 80 mg in patients with dyslipidemia

Objective Primary objective was to compare the effects of atorvastatin 40 mg vs 80 mg on LDL-C in Indian patients with atherosclerotic dyslipidemia. Secondary objectives were to compare the effects of atorvastatin 40 mg vs 80 mg on HDL-C and triglycerides and also comparing of side effects (myopathy, hepatotoxicity and new onset diabetes mellitus) of both doses. Method This Study is A Prospective, randomized, open-label, comparative study. This study was conducted on 240 patients of dyslipidemia (as per ACC/AHA 2013 lipid guidelines) attending the OPD/wards/CCU of department of cardiology, Sir Ganga Ram Hospital. They were randomly divided into 2 groups of 120 each. Group A consisted patients who received Atorvastatin 40 mg daily and Group B Atorvastatin 80 mg daily. The follow up period was 6 months. Results At 3 and 6 month follow up, Atorvastatin 40 mg leads to mean LDL cholesterol reduction of 47.18 ± 20.81 & 50.03 ± 18.06 respectively. While Atorvastatin 80 mg results in LDL reduction as 50.11 ± 15.85 & 52.30 ± 13.72. The comparison between two doses revealed a non-significant difference (p = .118 & p = .149 respectively). At 6 months of follow up, few patients reported myalgia (2 in group A and 7 in Group B). The difference between groups was significant (p = .045). Although none of our patient had significant elevation of CPK. Conclusion This study concluded that both doses of atorvastatin (40 & 80 mg) are equally efficacious in improving dyslipidemia but higher dose leads to more incidence of myalgia.

Late Fragmentation of Coronary Sinus Lead and Perforation with Retained Guide Wire after Cardiac Resynchronization Therapy

Passive fixation of coronary sinus leads is an imperfect technique with a high incidence of intraoperative and post-operative dislocations. The retained guide wire technique has been proposed for stabilizing the left ventricular lead. Long term effects of retained guide wire on lead parameters are unknown. We describe two cases in which guide wire was retained in coronary sinus lead because of recurrent intraoperative lead dislocations. Both patients at 9-12 months of followup showed marked rise in left ventricular lead impedance with loss of capture. Fluoroscopy revealed multiple sites of lead fragmentation. The retained guide wire causes lead degradation and should be removed.

Three dimensional epicardial mapping and ablation of recurrent non-ischaemic ventricular tachycardia

Radiofrequency ablation is a therapeutic option for recurrent ventricular tachycardia (VT) in both ischaemic and non-ischaemic subsets. Usually this is attempted by mapping endocardially; however, in some situations epicardial approach may be needed to access the VT circuit. We report two cases in which epicardial approach was used to successfully ablate the VT, when endocardial ablation was ineffective.