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Caudal-Tilt Ultrasound Guided Axillary Venous Access for Transvenous Pacing Lead Implant

Kaul, Risheek; Yang, Felix; Jankelson, Lior; Knotts, Robert J; Holmes, Douglas; Aizer, Anthony; Chinitz, Larry A; Barbhaiya, Chirag R
PMID: 38266750
ISSN: 1556-3871
CID: 5624992

Conduction velocity is reduced in the posterior wall of hypertrophic cardiomyopathy patients with normal bipolar voltage undergoing ablation for paroxysmal atrial fibrillation

Zahid, Sohail; Malik, Tahir; Peterson, Connor; Tarabanis, Constantine; Dai, Matthew; Katz, Moshe; Bernstein, Scott A; Barbhaiya, Chirag; Park, David S; Knotts, Robert J; Holmes, Douglas S; Kushnir, Alexander; Aizer, Anthony; Chinitz, Larry A; Jankelson, Lior
OBJECTIVES/OBJECTIVE:We investigated characteristics of left atrial conduction in patients with HCM, paroxysmal AF and normal bipolar voltage. BACKGROUND:Patients with hypertrophic cardiomyopathy (HCM) exhibit abnormal cardiac tissue arrangement. The incidence of atrial fibrillation (AF) is increased fourfold in patients with HCM and confers a fourfold increased risk of death. Catheter ablation is less effective in HCM, with twofold increased risk of AF recurrence. The mechanisms of AF perpetuation in HCM are poorly understood. METHODS:We analyzed 20 patients with HCM and 20 controls presenting for radiofrequency ablation of paroxysmal AF normal left atrial voltage(> 0.5 mV). Intracardiac electrograms were extracted from the CARTO mapping system and analyzed using Matlab/Python code interfacing with Core OpenEP software. Conduction velocity maps were calculated using local activation time gradients. RESULTS: = 0.13, p = 0.03). CONCLUSIONS:Atrial conduction velocity is significantly reduced in patients with HCM and paroxysmal AF, possibly contributing to arrhythmia persistence after catheter ablation.
PMID: 36952090
ISSN: 1572-8595
CID: 5523872

A Hard Look at EASY AF [Editorial]

Kaul, Risheek; Barbhaiya, Chirag R
PMID: 38069974
ISSN: 2405-5018
CID: 5589752

Sex differences in outcomes of transvenous lead extraction: insights from National Readmission Database

Khalil, Mahmoud; Maqsood, Muhammad Haisum; Maraey, Ahmed; Elzanaty, Ahmed; Saeyeldin, Ayman; Ong, Kenneth; Barbhaiya, Chirag R; Chinitz, Larry A; Bernstein, Scott; Shokr, Mohamed
BACKGROUND:With the growing use of implantable cardiac devices, the need for transvenous lead extraction has increased, which translates to increased procedural volumes. Sex differences in lead extraction outcomes are not well studied. OBJECTIVE:The present study aims at evaluating the impact of sex on outcomes of lead extraction. METHODS:We identified 71,754 patients who presented between 2016 and 2019 and underwent transvenous lead extraction. Their clinical data were retrospectively accrued from the National Readmission Database (NRD) using the corresponding diagnosis codes. We compared clinical outcomes between male and female patients. Odds ratios (ORs) for the primary and secondary outcomes were calculated, and multivariable regression analysis was utilized to adjust for confounding variables. RESULTS:Compared to male patients, female patients had higher in-hospital complications including pneumothorax (OR 1.26, 95% CI (1.07-1.4), P < 0.01), hemopericardium (OR 1.39, 95% CI (1.02-1.88), P = 0.036), injury to superior vena cava and innominate vein requiring repair (OR 1.88, 95% CI (1.14-3.1), P = 0.014; OR 3.4, 95% CI (1.8-6.5), P < 0.01), need for blood transfusion (OR 1.28, 95% CI (1.18-1.38), P < 0.01), and pericardiocentesis (OR 1.6, 95% CI (1.3-2), P < 0.01). Thirty-day readmission was also significantly higher in female patients (OR 1.09, 95% CI (1.02-1.17), P < 0.01). There was no significant difference regarding in-hospital mortality (OR 0.99, 95% CI (0.87-1.14), P = 0.95). CONCLUSION/CONCLUSIONS:In female patients, lead extraction is associated with worse clinical outcomes and higher 30-day readmission rate.
PMID: 36445605
ISSN: 1572-8595
CID: 5373942

High Power Short Duration: Is There a Chink in the Armor? [Editorial]

Garber, Leonid; Barbhaiya, Chirag
PMID: 37115118
ISSN: 2405-5018
CID: 5465552

Comparison of combined substrate-based mapping techniques to identify critical sites for ventricular tachycardia ablation

Khan, Hassan; Bonvissuto, Matthew R; Rosinski, Elizabeth; Shokr, Mohamed; Metcalf, Kara; Jankelson, Lior; Kushnir, Alexander; Park, David S; Bernstein, Scott A; Spinelli, Michael A; Aizer, Anthony; Holmes, Douglas; Chinitz, Larry A; Barbhaiya, Chirag R
BACKGROUND:Established electroanatomic mapping techniques for substrate mapping for ventricular tachycardia (VT) ablation includes voltage mapping, isochronal late activation mapping (ILAM), and fractionation mapping. Omnipolar mapping (Abbott Medical, Inc.) is a novel optimized bipolar electrogram creation technique with integrated local conduction velocity annotation. The relative utilities of these mapping techniques are unknown. OBJECTIVE:The purpose of this study was to evaluate the relative utility of various substrate mapping techniques for the identification of critical sites for VT ablation. METHODS:Electroanatomic substrate maps were created and retrospectively analyzed in 27 patients in whom 33 VT critical sites were identified. RESULTS:. CONCLUSION/CONCLUSIONS:ILAM, fractionation, and CV mapping each identified distinct critical sites and provided a smaller area of interest than did voltage mapping alone. The sensitivity of novel mapping modalities improved with greater local point density.
PMID: 36863636
ISSN: 1556-3871
CID: 5462332

Correction: Impact of chronic kidney disease on in-hospital mortality and clinical outcomes of catheter ablation of ventricular tachycardia: Insights from the national readmission database

Khalil, Mahmoud; Maraey, Ahmed; Aglan, Amro; Akintoye, Emmanuel; Salem, Mahmoud; Elzanaty, Ahmed M; Younes, Ahmed; Saeyeldin, Ayman; Barbhaiya, Chirag R; Shokr, Mohamed
PMID: 37009939
ISSN: 1572-8595
CID: 5463582

Correction to: Outcomes of conventional pacemaker implantation in patients with dementia: insights from the National Readmission Database

Khalil, Mahmoud; Hashim, Ahmed; Maraey, Ahmed; Saeyeldin, Ayman; Elzanaty, Ahmed M; Biskupski, Patrick; Ong, Kenneth; Barbhaiya, Chirag R; Shokr, Mohamed
PMID: 37009940
ISSN: 1572-8595
CID: 5463592

Catheter ablation of atrioventricular nodal reentrant tachycardia with an irrigated contact-force sensing radiofrequency ablation catheter

Panday, Priya; Holmes, Douglas; Park, David S; Jankelson, Lior; Bernstein, Scott A; Knotts, Robert; Kushnir, Alexander; Aizer, Anthony; Chinitz, Larry A; Barbhaiya, Chirag R
INTRODUCTION/BACKGROUND:Radiofrequency ablation (RFA) slow pathway modification for catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT) is traditionally performed using a 4-mm nonirrigated (NI) RF ablation catheter. Slow pathway modification using irrigated, contact-force sensing (ICFS) RFA catheters has been described in case reports, but the outcomes have not been systematically evaluated. METHODS:Acute procedural outcomes of 200 consecutive patients undergoing slow pathway modification for AVNRT were analyzed. A 3.5-mm ICFS RFA catheter (ThermoCool SmartTouch STSF, Biosense Webster, Inc.) was utilized in 134 patients, and a 4-mm NI RFA catheter (EZ Steer, Biosense Webster, Inc.) was utilized in 66 patients. Electroanatomic maps were retrospectively analyzed in a blinded fashion to determine the proximity of ablation lesions to the His region. RESULTS:The baseline characteristics of patients in both groups were similar. Total RF time was significantly lower in the ICFS group compared to the NI group (5.53 ± 4.6 vs. 6.24 ± 4.9 min, p = 0.03). Median procedure time was similar in both groups (ICFS, 108.0 (87.5-131.5) min vs. NI, 100.0 (85.0-125.0) min; p = 0.2). Ablation was required in closer proximity to the His region in the NI group compared to the ICFS group (14.4 ± 5.9 vs. 16.7 ± 6.4 mm, respectively, p = 0.01). AVNRT was rendered noninducible in all patients, and there was no arrhythmia recurrence during follow-up in both groups. Catheter ablation was complicated by AV block in one patient in the NI group. CONCLUSION/CONCLUSIONS:Slow pathway modification for catheter ablation of AVNRT using an ICFS RFA catheter is feasible, safe, and may facilitate shorter duration ablation while avoiding ablation in close proximity to the His region.
PMID: 36738141
ISSN: 1540-8167
CID: 5420642

Temporal trends in atrial fibrillation ablation procedures at an academic medical center: 2011-2021

Kushnir, Alexander; Barbhaiya, Chirag R; Aizer, Anthony; Jankelson, Lior; Holmes, Douglas; Knotts, Robert; Park, David; Spinelli, Michael; Bernstein, Scott; Chinitz, Larry A
INTRODUCTION/BACKGROUND:Radiofrequency ablation technology for treating atrial fibrillation (AF) has evolved rapidly over the past decade. We investigated the impact of technological and procedural advances on procedure times and ablation outcomes at a major academic medical center over a 10-year period. METHODS:Clinical data was collected from patients who presented to NYU Langone Health between 2011 and 2021 for a first-time AF ablation. Time to redo AF ablation or direct current cardioversion (DCCV) for recurrent AF during a 3-year follow-up period was determined and correlated with ablation technology and practices, antiarrhythmic medications, and patient comorbid conditions. RESULTS:From 2011 to 2021, the cardiac electrophysiology lab adopted irrigated-contact force ablation catheters, high-power short duration ablation lesions, steady-pacing, jet ventilation, and eliminated stepwise linear ablation for AF ablation. During this time the number of first time AF ablations increased from 403 to 1074, the percentage of patients requiring repeat AF-related intervention within 3-years of the index procedure dropped from 22% to 14%, mean procedure time decreased from 271 ± 65 to 135 ± 36 min, and mean annual major adverse event rate remained constant at 1.1 ± 0.5%. Patient comorbid conditions increased during this time period and antiarrhythmic use was unchanged. CONCLUSION/CONCLUSIONS:Rates of redo-AF ablation or DCCV following an initial AF ablation at a single center decreased 36% over a 10-year period. Procedural and technological changes likely contributed to this improvement, despite increased AF related comorbidities.
PMID: 36738147
ISSN: 1540-8167
CID: 5420652