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A new trick to a routine procedure: taking the fear out of the axillary vein stick using the 35° caudal view

Yang, Felix; Kulbak, Guy
AIMS/OBJECTIVE:The axillary vein is frequently used to implant pacemaker and defibrillator leads. We describe a technique utilizing the caudal fluoroscopic view to facilitate axillary venous access without contrast. METHODS AND RESULTS/RESULTS:Outcomes of device implants or upgrades utilizing this technique were examined during a 1-year period at our institution. Of 229 consecutive implants, only 9 patients required an alternate technique for lead implantation. There were zero cases of pneumothorax. CONCLUSIONS:The caudal view allows for optimal appreciation of the anterior border of the lung and the first rib. This simple technique increases the implanter's appreciation of and control over the access needle depth relative to the lung and first rib, thereby reducing pneumothorax risk.
PMID: 25969438
ISSN: 1532-2092
CID: 5375872

Escape Mapping: Rapid Identification of Pulmonary Vein Isolation Gaps Utilizing an Ablation Catheter

Yang, Felix; Murphy, Tom
PMID: 29600781
ISSN: 2405-5018
CID: 5375982

Mapping the unmappable: local vector mapping

Yang, Felix
Arrhythmias are commonly mapped using a timing reference signal. There are a number of situations where mapping may be difficult or even impossible using conventional reference-based mapping. Wobbling arrhythmias or those who do not maintain a 1:1 relationship with the reference signal are problematic. Local vector mapping may be performed in these situations to map arrhythmias without the use of a reference signal.
PMID: 28204462
ISSN: 1532-2092
CID: 5375932

Editorial Comment to: Perioperative complications after pacemaker implantation: Higher complication rates with subclavian vein puncture than with cephalic vein cut-down (Hasan et al.) [Editorial]

Malyshev, Yury; Yang, Felix
PMID: 35501623
ISSN: 1572-8595
CID: 5376052

Hybrid epicardial-endocardial ablation for long-standing persistent atrial fibrillation: A subanalysis of the CONVERGE Trial

DeLurgio, David B; Blauth, Christopher; Halkos, Michael E; Crossen, Karl J; Talton, David; Oza, Saumil R; Magnano, Anthony R; Mostovych, Mark A; Billakanty, Sreedhar; Duff, Steven; Stees, Christopher; Sperling, Jason; Ahsan, Syed; Yap, John; Shults, Christian; Pederson, David; Garrison, James; Tabereaux, Paul; Gilligan, David M; Bundy, Graham; Costantini, Otto; Espinal, Eric; La Pietra, Angelo; Yang, Felix; Greenberg, Yisachar; Jacobowitz, Israel; Gill, Jaswinder
BACKGROUND/UNASSIGNED:Favorable clinical outcomes are difficult to achieve in long-standing persistent atrial fibrillation (LSPAF) with catheter ablation (CA). The CONVERGE (Convergence of Epicardial and Endocardial Ablation for the Treatment of Symptomatic Persistent Atrial FIbrillation) trial evaluated the effectiveness of hybrid convergent (HC) ablation vs endocardial CA. OBJECTIVE/UNASSIGNED:The study sought to evaluate the safety and effectiveness of HC vs CA in the LSPAF subgroup from the CONVERGE trial. METHODS/UNASSIGNED:The CONVERGE trial was a prospective, multicenter, randomized trial that enrolled 153 patients at 27 sites. A post hoc analysis was performed on LSPAF patients. The primary effectiveness was freedom from atrial arrhythmias off new or increased dose of previously failed or intolerant antiarrhythmic drugs (AADs) through 12 months. The primary safety endpoint was major adverse event incidence through 30 days with HC. Key secondary effectiveness measures included (1) percent of patients achieving ≥90% AF burden reduction vs baseline and (2) AF freedom. RESULTS/UNASSIGNED:.038). Three (7.9%) major adverse events occurred within 30 days of HC. CONCLUSION/UNASSIGNED:Post hoc analysis demonstrated effectiveness and acceptable safety of HC compared with CA in LSPAF.
PMID: 36873309
ISSN: 2666-5018
CID: 5428142

Lesion Index-guided workflow for the treatment of paroxysmal atrial fibrillation is safe and effective - Final results from the LSI Workflow Study

Venkatesh Prasad, Karthik; Bonso, Aldo; Woods, Christopher E; Goya, Masahiko; Matsuo, Seiichiro; Padanilam, Benzy J; Kreis, Ingo; Yang, Felix; Williams, Christopher G; Tranter, John H; Verbick, Laura Zitella; Sarver, Anne E; Almendral, Jesus
BACKGROUND/UNASSIGNED:Pulmonary vein isolation (PVI) ablation is a standard therapy for paroxysmal atrial fibrillation (PAF). Lesion Index (LSI) is a metric to guide radiofrequency (RF) ablation using the TactiCath Ablation Catheter, Sensor Enabled with the EnSite Cardiac Mapping System (Abbott). OBJECTIVE/UNASSIGNED:This study (NCT-03906461) was designed to capture best practices using LSI-guided catheter ablation to treat PAF subjects in a real-world setting. METHODS/UNASSIGNED:This prospective single-arm observational study enrolled 143 PAF subjects in the United States, Europe, and Japan undergoing de novo PVI with RF ablation. PVI lesions were assigned to 10 anatomically defined segments. Mean LSIs achieved for all lesions were analyzed. Follow-up was conducted between 3-6 months and 12 months after the procedure. RESULTS/UNASSIGNED:Pulmonary veins were isolated in all subjects. The mean achieved LSI was 4.9, with lower values in Europe (4.4) and Japan (4.5) than the United States (5.5). First-pass success, defined as no gaps requiring touch-up ablation after 20 minutes post isolation, was achieved in 76.2% of subjects. Use of high LSI (≥5) resulted in shorter procedure, RF, and fluoroscopy times and fewer touch-up ablations compared to low LSI (<5). At 12 months, 99.3% of subjects were free from procedure- or device-related serious adverse events and 95.7% (112/117) (35.0% on antiarrhythmic drugs) were free from recurrence and/or a repeat ablation procedure for atrial fibrillation / atrial flutter / atrial tachycardia. CONCLUSION/UNASSIGNED:LSI-guided ablation strategies proved safe and effective despite differences in LSI workflows. Use of high LSI values resulted in shorter procedure, RF, and fluoroscopy times and fewer touch-up ablations compared to low LSI.
PMID: 36340486
ISSN: 2666-5018
CID: 5376072

Hybrid Convergent ablation for atrial fibrillation: A systematic review and meta-analysis

Shrestha, Suvash; Plasseraud, Kristen M; Makati, Kevin; Sood, Nitesh; Killu, Ammar M; Contractor, Tahmeed; Ahsan, Syed; De Lurgio, David B; Shults, Christian C; Eldadah, Zayd A; Russo, Andrea M; Knight, Bradley; Greenberg, Yisachar Jesse; Yang, Felix
BACKGROUND/UNASSIGNED:Hybrid Convergent ablation for atrial fibrillation (AF) combines minimally invasive surgical (epicardial) and catheter (endocardial) ablation. The procedural goal is to achieve more extensive, enduring ablation of AF substrate around the pulmonary veins, posterior wall, and vestibule of the posterior wall left atrium. OBJECTIVE/UNASSIGNED:To perform a systematic review and meta-analysis on safety and effectiveness of contemporary Hybrid Convergent procedures. METHODS/UNASSIGNED:PubMed, Embase, and manual searches identified primary research articles on Hybrid Convergent. Inclusion criteria focused on contemporary practices (epicardial ablation device and lesions). Clinical outcomes at 1 year or later follow-up, patient population, procedural details, and major adverse events (MAE) were recorded. RESULTS/UNASSIGNED:Of 249 records, 6 studies (5 observational, 1 randomized controlled trial) including 551 patients were included. Endocardial energy sources included radiofrequency and cryoballoon. Hybrid Convergent ablation was mostly performed in patients with drug-refractory persistent and longstanding persistent AF. Mean preprocedural AF duration ranged between 2 and 5.1 years. Most patients (∼92%) underwent Hybrid Convergent in a single hospitalization. At 1 year follow-up or later, 69% (95% confidence interval [CI]: 61%-78%, n = 523) were free from atrial arrhythmias and 50% (95% CI: 42%-58%, n = 343) were free from atrial arrhythmias off antiarrhythmic drugs. Thirty-day MAE rate was 6% (95% CI: 3%-8%, n = 551). CONCLUSION/UNASSIGNED:Hybrid Convergent ablation is an effective ablation strategy for persistent and longstanding persistent AF. Contemporary procedural approaches and published strategies aim to mitigate complications reported in early experience and address delayed inflammatory effusions.
PMID: 36097459
ISSN: 2666-5018
CID: 5376062

Hidden in Plain Sight: A Case of Arrhythmic Mitral Valve Prolapse Presenting as Cardiac Arrest [Case Report]

Malyshev, Yury; Borisov, Miron; Shrestha, Suvash; Sadiq, Adnan; Patel, Rohan; Yang, Felix
Mitral valve prolapse (MVP) is a well-studied, mostly benign, phenomenon; however, arrhythmic mitral valve prolapse (AMVP) is a rare subtype that can precipitate sudden cardiac death (SCD). Herein, we present a case of a young female with sudden cardiac arrest. Extensive multimodality imaging and follow-up helped establish the diagnosis of AMVP.
PMID: 34900495
ISSN: 2168-8184
CID: 5376042

Combined epicardial and endocardial ablation for atrial fibrillation: Best practices and guide to hybrid convergent procedures

Makati, Kevin J; Sood, Nitesh; Lee, Lawrence S; Yang, Felix; Shults, Christian C; DeLurgio, David B; Melichercik, Juraj; Gill, Jaswinder S; Kaba, Riyaz A; Ahsan, Syed; Weerasooriya, Rukshen; Joshi, Pragnesh; Lellouche, Nicolas; Blaauw, Yuri; Zannis, Konstantinos; Sebag, Frederic A; Gauri, Andre; Zembala, Michael O; Tondo, Claudio; Steinberg, Jonathan S
The absence of strategies to consistently and effectively address nonparoxysmal atrial fibrillation by nonpharmacological interventions has represented a long-standing treatment gap. A combined epicardial/endocardial ablation strategy, the hybrid Convergent procedure, was developed in response to this clinical need. A subxiphoid incision is used to access the pericardial space facilitating an epicardial ablation directed at isolation of the posterior wall of the left atrium. This is followed by an endocardial ablation to complete isolation of the pulmonary veins and for additional ablation as needed. Experience gained with the hybrid Convergent procedure during the last decade has led to the development and adoption of strategies to optimize the technique and mitigate risks. Additionally, a surgical and electrophysiology "team" approach including comprehensive training is believed critical to successfully develop the hybrid Convergent program. A recently completed randomized clinical trial indicated that this ablation strategy is superior to an endocardial-only approach for patients with persistent atrial fibrillation. In this review, we propose and describe best practice guidelines for hybrid Convergent ablation on the basis of a combination of published data, author consensus, and expert opinion. A summary of clinical outcomes, emerging evidence, and future perspectives is also given.
PMID: 33045430
ISSN: 1556-3871
CID: 5376022

Meta-Analysis of Contemporary Hybrid Convergent Ablation Outcomes [Meeting Abstract]

Shrestha, Suvash; Plasseraud, Kristen; Makati, Kevin; Sood, Nitesh; DeLurgio, David; Greenberg, Yisachar; Yang, Felix
ISSN: 0009-7322
CID: 5376162