Biomedical subjects
Publications and source records attributed to Anoop K Gupta.
Superior vena cava (SVC) syndrome often presents with slowly progressive symptoms worsening over weeks or may cause abrupt symptoms and constitute a true medical emergency. Percutaneous intervention is the treatment of choice. We report a case of SVC stenting in a middle-aged woman with SVC obstruction secondary to portacath insertion for chemotherapy.
Ectopic automatic atrial tachycardia, an uncommon type of supraventricular tachycardia in children and adults, has been reported to be resistant to medical therapy unlike reentrant supraventricular tachycardia. We report a case of incessant atrial tachycardia in an infant, which was successfully treated with radiofrequency catheter ablation.
Cardiac disease is the most common cause of death in the United States, and sudden cardiac arrest frequently claims the lives of men and women during their most productive years. It is believed that much better survival rates can be achieved for victims of cardiac arrest through optimizing the "chain of survival" as described by the American Heart Association. The relative and incremental benefit of full prehospital ACLS over basic life support and defibrillation is unproven, however. This is an important issue in this era of cost containment. Some of the ongoing studies including the OPALS study may clarify the cost effectiveness and relative efficacy of rapid defibrillation and full ACLS programs for victims of prehospital cardiac arrest [6].
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VF was observed in four patients (group A) with preexcited AF presenting to the emergency department who had been given 12 mg of adenosine. These patients were resuscitated and underwent electrophysiological study and catheter ablation of the accessory pathway (AP). In a control (group B) of five patients with manifest AP, sustained AF was induced by rapid atrial pacing during electrophysiological study and 12 mg of adenosine was administered. The ECG and electrophysiologic features in the two groups were compared. All patients had a single manifest AP. In group A, three patients had a left free-wall AP and one patient had a posteroseptal AP, while in the control group all had left free-wall APs. The antegrade AP effective refractory period (ERP) in groups A and B was 227 +/- 29 and 289 +/- 37 ms, respectively (P < 0.05). The atrial ERP was 210 +/- 17 versus 219 +/- 21 ms, respectively, in groups A and B (P > 0.05). The shortest R-R interval during AF in group A was 246 +/- 51 ms and 301 +/- 60 ms in group B (P value < 0.05). After adenosine, no patient in group B developed VF. Adenosine may cause VF when administered during preexcited AF. This phenomenon is seen in patients having APs with short refractory periods.
Fascicular VT and RVOT tachycardia are sometimes difficult to induce by programmed electrical stimulation (PES), despite pharmacologic provocation. In such instances, catheter mapping is hampered and efficacy of catheter ablation is difficult to judge. The study included nine patients who presented with incessant idiopathic VT and were directly taken to the electrophysiological laboratory for RF ablation. During the same period, elective ablation was performed on 108 patients with idiopathic VT. The success rate, procedural and fluoroscopy times number of energies, and the peak temperature were evaluated and compared. Of the nine patients, seven had incessant fascicular VT and two had RVOT tachycardia. The mean VT cycle length was 356 +/- 32 ms and the earliest endocardial activation time during VT was 23.6 +/- 6 ms relative to surface QRS complexes. A fascicular potential was not seen in three of the seven patients with fascicular VT. The mean procedural time was 71 +/- 32 minutes and 144 +/- 40 minutes (P = 0.023) while the fluoroscopy time was 14.6 +/- 4.6 minutes and 30 +/- 16 minutes (P < 0.001), respectively, in the primary ablation and elective groups. The total number of RF energies delivered was 2.0 +/- 1.3 versus 7.4 +/- 5.6 (P = 0.07), respectively. The significantly increased procedural time during elective ablation was largely due to time spent in fascicular VT induction. All patients in the primary ablation group were successfully ablated and none had a recurrence. Primary ablation is a safe and effective option in patients with incessant idiopathic VT. Moreover, in fascicular VT, it is superior to elective ablation in terms of success, fluoroscopy and procedural times.
BACKGROUND: Sudden cardiac death in patients on a liquid protein diet has been suggested to be related to repolarization abnormalities. Although increased QT dispersion is also associated with sudden cardiac death, it has not been examined in the setting of weight loss using liquid protein diet. METHODS AND RESULTS: Sixty-three patients (mean age 42 years, 18 men) with a mean initial weight of 116 kg were randomly chosen from patients who had completed 26 weeks of liquid protein diet therapy. QT, corrected QT interval, QT dispersion and corrected QT dispersion were measured blindly along with serum albumin and electrolytes at the beginning and end of 26 weeks of liquid protein diet therapy. In 57 patients (89.5%) (group 1), QT dispersion shortened after weight loss while it was prolonged in 6 patients (10.5%) (group 2). The mean weight loss (group 1: 115+/-21 to 91+/-16 kg; group 2: 122+/-21 to 98+/-13 kg), and serum albumin and electrolyte levels before weight loss were the same in both groups. The decrease in QT dispersion in group 1 was due to increase in the minimum QT interval (350+/-22 v. 375+/-21 mis, p<0.01) after weight loss. However, the QT dispersion increase in group 2 was due to prolongation of the maximum QT interval (402+/-27 v. 441+/-19 ms, p<0.05) after weight loss. This suggests that shortening of the minimum QT interval causes the increased QT dispersion in obesity. Half the patients in group 2 showed a drop in the serum albumin level and 2 patients had an abnormally high phosphorous level at the end of the treatment. CONCLUSIONS: QT dispersion shortens in most patients (89.5%) using liquid protein diet for weight loss. However, increase of QT dispersion is seen in 10.5% of patients. The cause of increased QT dispersion in obesity (before weight loss) differs from that in patients after weight-loss using liquid protein diet. QT dispersion changes observed in this study may explain the risk of sudden cardiac death in these patients.
An anomalous origin of the coronary artery is an infrequent finding on coronary angiogram. Percutaneous coronary intervention may sometimes be difficult in such situations. We report two cases of anomalous coronary arteries in whom direct stenting was done via the radial approach.
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Stent dislodgment during percutaneous coronary intervention is a rare complication. We report a case of successful retrieval of a dislodged stent from the left main coronary artery. It was retrieved via the transradial route using a 6 F coronary guiding catheter supported by an inflated percutaneous transluminal coronary angioplasty balloon distal to the stent.
Catheter ablation for atrial tachycardia is limited by its low success rate and prolonged procedure time because of difficulties in mapping the site of the tachycardia. A new three-dimensional mapping system, the Cardiac Pathways mapping system, using an ultrasound transducer, has recently become available. We report a case of focal atrial tachycardia ablation with this system.