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A Need For Long-Term Results of LMCA-CTO-PCI [Comment]

Cepas-Guillen, Pedro; Vásquez, Sara; Fernandez-Valledor, Andrea; San Antonio, Rodolfo; Flores-Umanzor, Eduardo; Martin-Yuste, Victoria; Xenogiannis, Iosif; Karmpaliotis, Dimitri; Alaswad, Khaldoon; Basir, Mir B; Yeh, Robert W; Tamez, Hector; Patel, Mitul; Mahmud, Ehtisham; Choi, James W; Burke, M Nicholas; Doing, Anthony H; Dattilo, Phil; Khatri, Jaikirshan J; Sheikh, Abdul M; Malik, Bilal A; Greene, Mary E; Abi Rafeh, Nidal; Maalouf, Assaad; Abou Jaoudeh, Fadi; Moses, Jeffrey W; Lembo, Nicholas J; Parikh, Manish; Kirtane, Ajay J; Ali, Ziad A; Gkargkoulas, Fotis; Russo, Juan; Hakemi, Emad; Tajti, Peter; Hall, Allison B; Vemmou, Evangelia; Nikolakopoulos, Ilias; Rangan, Bavana V; Abdullah, Shuaib; Banerjee, Subhash; Brilakis, Emmanouil S
PMID: 31671069
ISSN: 1557-2501
CID: 4583942

Left Main Chronic Total Occlusion Percutaneous Coronary Intervention: A Case Series

Xenogiannis, Iosif; Karmpaliotis, Dimitri; Alaswad, Khaldoon; Basir, Mir B; Yeh, Robert W; Tamez, Hector; Patel, Mitul; Mahmud, Ehtisham; Choi, James W; Burke, M Nicholas; Doing, Anthony H; Dattilo, Phil; Khatri, Jaikirshan J; Sheikh, Abdul M; Malik, Bilal A; Greene, Mary E; Abi Rafeh, Nidal; Maalouf, Assaad; Abou Jaoudeh, Fadi; Moses, Jeffrey W; Lembo, Nicholas J; Parikh, Manish; Kirtane, Ajay J; Ali, Ziad A; Gkargkoulas, Fotis; Russo, Juan; Hakemi, Emad; Tajti, Peter; Hall, Allison B; Vemmou, Evangelia; Nikolakopoulos, Ilias; Rangan, Bavana V; Abdullah, Shuaib; Banerjee, Subhash; Brilakis, Emmanouil S
BACKGROUND:Left main coronary artery (LMCA) chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. METHODS:We reviewed 4436 CTO-PCIs performed in 4340 patients between 2012 and 2018 at 25 sites. LMCA-CTO-PCI was performed in 20 cases (0.45%). We examined the clinical and angiographic characteristics and procedural outcomes of these cases. RESULTS:Mean patient age was 68 ± 11 years and 65% were men. Most patients (85%) had undergone prior coronary artery bypass graft surgery and had a protected left main. Mean J-CTO score was 2.7 ± 1.3, mean PROGRESS-CTO score was 1.3 ± 1.1, and mean PROGRESS-CTO Complications score was 3.8 ± 1.9. Antegrade-wire escalation was the most common successful crossing strategy (50%), followed by retrograde crossing (30%) and antegrade dissection/re-entry (10%). Technical and procedural success rates were both 85%. One patient with failed LMCA-CTO-PCI had periprocedural myocardial infarction. Median procedure time was 178 minutes (interquartile range [IQR], 123-250 minutes), median contrast volume was 190 mL (IQR, 133-339 mL), and patient air kerma radiation dose was 2.6 Gray (IQR, 1.3-3.9 Gray). CONCLUSIONS:LMCA-CTO-PCI is infrequent, is performed mostly in patients with prior coronary artery bypass graft surgery, and is associated with good procedural outcomes.
PMID: 31257217
ISSN: 1557-2501
CID: 4583932

Change in P wave morphology after convergent atrial fibrillation ablation

Shrestha, Suvash; Chen, On; Greene, Mary; John, Jinu Jacob; Greenberg, Yisachar; Yang, Felix
Convergent atrial fibrillation ablation involves extensive epicardial as well as endocardial ablation of the left atrium. We examined whether it changes the morphology of the surface P wave. We reviewed electrocardiograms of 29 patients who underwent convergent ablation for atrial fibrillation. In leads V1, II and III, we measured P wave duration, area and amplitude before ablation, and at 1, 3 and 6 months from ablation. After ablation, there were no significant changes in P wave amplitude, area, or duration in leads II and III. There was a significant reduction in the area of the terminal negative deflection of the P wave in V1 from 0.38 mm(2) to 0.13 mm(2) (p = 0.03). There is also an acute increase in the amplitude and duration of the positive component of the P wave in V1 followed by a reduction in both by 6 months. Before ablation, 62.5% of the patients had biphasic P waves in V1. In 6 months, only 39.2% of them had biphasic P waves. Hybrid ablation causes a reduction of the terminal negative deflection of the P wave in V1 as well as temporal changes in the duration and amplitude of the positive component of the P wave in V1. This likely reflects the reduced electrical contribution of the posterior left atrium after ablation as well as anatomical and autonomic remodeling. Recognition of this altered sinus P wave morphology is useful in the diagnosis of atrial arrhythmias in this patient population.
PMCID:4936606
PMID: 27485559
ISSN: 0972-6292
CID: 5375902