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Hybrid Convergent Ablation of Atrial Fibrillation With Left Atrial Appendage Exclusion Improves Blood Pressure Control [Meeting Abstract]

Malyshev, Yury; Tsutsumi, Ayaka; Greenberg, Yisachar; Yang, Felix
ISSN: 0009-7322
CID: 5376172

Initial Experience with High-density Mapping of Ischemic Ventricular Tachycardia Using a Narrow 0.1-mV to 0.25-mV Border-zone Window

Yang, Felix; Roy, Jordan; Saxena, Abhinav; Kulbak, Guy; Greenberg, Yisachar
This study sought to determine (1) whether the use of a narrow border-zone voltage of 0.1 to 0.25 mV predicts the ventricular tachycardia (VT) exit site better than when using the conventional 0.5 to 1.5 mV window and (2) the feasibility of utilizing the Rhythmia mapping system (Boston Scientific, Natick, MA, USA) to map hemodynamically unstable VT without hemodynamic support. The Ablation of ischemic VT is challenging especially in the setting of hemodynamic instability, yet efficient and accurate mapping of VT and VT substrate is critical for procedural success. In this study, a total of 24 patients with ischemic cardiomyopathy and recurrent monomorphic VT underwent mapping and ablation using the Rhythmia system. Contact-force sensing ablation catheters were use in two cases. In patients with mappable VTs, the distance between the exit site and border zone was calculated for border zone-voltage windows of 0.5 to 1.5 mV and 0.1 to 0.25 mV. The percentage of LV scar for each patient was visually estimated into quartiles of scar burden in both windows. Twenty patients were inducible into VT, while 15 patients had mappable VTs for a total of 16 VTs (11 stable VTs and five unstable VTs). There were no adverse complications in patients who underwent mapping in unstable VT. The mean distance from the VT exit site to the border zone was 13.3 mm in the conventional window and 3.4 mm in the narrow window (95% confidence interval: 4.0-15.8; p = 0.003). Separately, 94% (15/16) of the VTs were mapped to the narrow border-zone voltage versus 31% (5/16) using the conventional border zone (p = 0.0006). The use of a narrow 0.1- to 0.25-mV border-zone window highlights relevant scar and constitutes a border zone where VT exit sites are frequently located. We also found that exit sites of hemodynamically unstable VTs can be identified without an increase in procedural complications using the Orion catheter (Boston Scientific, Natick, MA, USA).
PMID: 33123413
ISSN: 2156-3977
CID: 5376032

The Convergent Atrial Fibrillation Ablation Procedure: Evolution of a Multidisciplinary Approach to Atrial Fibrillation Management

Wats, Karan; Kiser, Andy; Makati, Kevin; Sood, Nitesh; DeLurgio, David; Greenberg, Yisachar; Yang, Felix
The treatment of AF has evolved over the past decade with increasing use of catheter ablation in patients refractory to medical therapy. While pulmonary vein isolation using endocardial catheter ablation has been successful in paroxysmal AF, the results have been more controversial in patients with long-standing persistent AF where extrapulmonary venous foci are increasingly recognised in the initiation and maintenance of AF. Hybrid ablation is the integration of minimally invasive epicardial ablation with endocardial catheter ablation, and has been increasingly used in this population with better results. The aim of this article was to analyse and discuss the evidence for the integration of catheter and minimally invasive surgical approaches to treat AF with specific focus on convergent ablation and exclusion of the left atrial appendage using a surgically applied clip.
PMID: 32983530
ISSN: 2050-3369
CID: 5376012

Convergent ablation for atrial fibrillation: a systematic review and meta-analysis [Meeting Abstract]

Shrestha, Suvash; Kiser, Andy; DeLurgio, David; Greenberg, Yisachar; Yang, Felix
ISSN: 1045-3873
CID: 5376132

Hybrid Convergent Ablation for Atrial Fibrillation: Updated Systematic Review and Meta-analysis [Meeting Abstract]

Shrestha, Suvash; DeLurgio, David; Kiser, Andy; Oza, Saumil; Greenberg, Yisachar; Yang, Felix
ISSN: 0009-7322
CID: 5376152

Catheter-driven His bundle pacemaker lead implantation

Yang, Felix; Paciga, Christopher
Delivery of leads to the His bundle pacing region is most commonly performed with non-deflectable or deflectable sheaths and a His lead with an exposed helix. We present a technique where any pacing lead may be delivered to the His region utilizing a catheter- and snare-delivered approach.
PMID: 30689837
ISSN: 1532-2092
CID: 5376002

Dizziness spells: Should one suspect the pacemaker? [Case Report]

Elsheshtawy, Moustafa; Yang, Felix; Prabhu, Sudhakar
A 52-year-old lady presented to the emergency department with recurrent episodes of dizziness and near-syncope on awakening up or swinging her left arm. Initial rhythm strips demonstrated intermittently non-conducted p waves corresponding to inappropriate pacemaker inhibition and oversensing malfunction. Pacemaker was interrogated in the ED showing ventricular lead noise and decreased lead impedance over a one year period. The patient was diagnosed with pacemaker lead failure supported by correlating pacemaker lead variation with homolateral arm movement. The patient was referred to an electrophysiologist and underwent new right ventricular lead placement with the resolution of symptoms.
PMID: 30581029
ISSN: 1532-8171
CID: 5375992

Electrosurgery in the EP Lab: A Review

Shrestha, Suvash; Kulbak, Guy; Greenberg, Yisachara; Yang, Felix
ISSN: 1535-2226
CID: 5428882

Hypothyroidism and congenital long QT: additive effect causing torsades? [Case Report]

Elsheshtawy, Moustafa; Yang, Felix; Khanna, Ashok
PMID: 29016752
ISSN: 1532-2092
CID: 5375952

Redefining the VT Border Zone: The 0.1-0.25mV Border Zone Voltage Window [Meeting Abstract]

Yang, Felix; Saxena, Abhinav; Kulbak, Guy; Greenberg, Yisachar
ISSN: 0009-7322
CID: 5376142