Subbarao Choudry

Bipolar radiofrequency catheter ablation for refractory ventricular outflow tract arrhythmias.

Standard unipolar radiofrequency ablation (RFA) is typically successful in eliminating premature ventricular contractions (PVCs) originating from the ventricular outflow tract region. In a minority of cases, this approach may be ineffective. We report 4 cases where bipolar RFA was attempted after failed unipolar RFA.

Left Atrial Appendage Closure Under Intracardiac Echocardiographic Guidance: Feasibility and Comparison With Transesophageal Echocardiography.

Background Transcatheter left atrial appendage closure is an alternative therapy for stroke prevention in atrial fibrillation patients. These procedures are currently guided with transesophageal echocardiography and fluoroscopy in most centers. As intracardiac echocardiography (ICE) is commonly used in other catheter‐based procedures, we sought to determine the safety and effectiveness of intracardiac echocardiography–guided left atrial appendage closure with the Watchman device. Methods and Results A total of 27 patients (11 males, 77.0±8.5 years) with atrial fibrillation receiving Watchman left atrial appendage closure under intracardiac echocardiography guidance at a single center were investigated. All patients were implanted successfully. There were no major procedural complications. The overall procedure‐related complication rate was 14.8%, mainly due to access site hematoma. Transesophageal echocardiography demonstrated successful closure of the left atrial appendage in all patients at 45 days after device implant. Conclusions Transcatheter left atrial appendage closure with intracardiac echocardiography guidance is safe and feasible.

Subcutaneous Implantable Cardioverter-Defibrillator Implantation Without Defibrillation Testing

Defibrillation testing (DT) does not improve shock efficacy or reduce the risk for arrhythmic death in patients undergoing routine transvenous implantable cardioverter-defibrillator (ICD) placement and is no longer compulsory for left pectoral transvenous ICDs [(1)][1]. The subcutaneous ICD (S-ICD)

Outcomes of Ventricular Tachycardia Ablation Using Percutaneous Left Ventricular Assist Devices

Background— Although percutaneous left ventricular assist devices (pLVADs) facilitate mapping and ablation of hemodynamically unstable ventricular tachycardia (VT), there is limited data whether clinical outcomes are improved. We sought to retrospectively compare the outcomes of patients undergoing scar-related VT ablation with and without pLVAD support. Methods and Results— The study population comprised 194 patients (109 pLVAD and 85 non-pLVAD). The pLVAD group more often had dilated cardiomyopathy (33% versus 13%; P=0.001), New York Heart Association heart failure class ≥III (51% versus 25%; P<0.001), lower left ventricular ejection fractions (26±10% versus 39±16%; P<0.001), and electrical storm (49% versus 34%; P=0.04). Procedure times (422±112 versus 330±92 minutes; P<0.001), postablation VT inducibility (20% versus 7%; P=0.02), and length of subsequent hospitalization (median 6 versus 4 days; P=0.001) were all higher in the pLVAD group. During median follow-up of 215 days, the primary end point (recurrent VT, heart transplantation, or death) occurred in 36% of the pLVAD versus 26% of the non-pLVAD groups (P=0.14). After propensity matching for differences between groups, no differences were seen between groups for both acute procedural outcomes and the primary end point. Conclusions— In this large single-center scar-related VT ablation experience, despite the worse clinical status of the patients selected for pLVAD support, clinical outcomes were better than expected and were similar to healthier patients not receiving hemodynamic support. Patients with dilated cardiomyopathy presenting with electrical storm, advanced heart failure, and severe left ventricular dysfunction most frequently received hemodynamic support during VT ablation.

Feasibility of subcutaneous implantable cardioverter-defibrillator implantation with opioid sparing truncal plane blocks and deep sedation: MILLER et al.

The subcutaneous implantable cardioverter‐defibrillator (S‐ICD) is most commonly implanted under general anesthesia (GA), due to the intraoperative discomfort associated with tunneling and dissection. Postoperative pain can be substantial and is often managed with opioids. There is a growing interest in transitioning away from the routine use of GA during S‐ICD implantation, while also controlling perioperative discomfort without the use of narcotics. As such, we assessed the feasibility of a multimodal analgesia regimen that included regional anesthesia techniques in patients undergoing S‐ICD implantation.

Septal Accessory Pathway and the Value of Para-Hisian Entrainment

However, this diagnostic maneuver has its limitations in slowly conducting accessory pathways. Introduction Ventricular overdrive pacing from the right ventricular (RV) apex is used to establish the mechanism of supraventricular tachycardia (SVT) in the electrophysiology lab. The difference between the postpacing interval (PPI) and tachycardia cycle length (TCL) has been shown to differentiate atypical atrioventricular nodal reentrant tachycardia (AVNRT) from orthodromic reciprocating tachycardia (ORT) using a septal accessory pathway. We present a case that illustrates the limitation of this diagnostic maneuver and shows the utility of para-Hisian entrainment for this purpose.