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Article: A Hidden Recess of Atrial Tachycardia.

Vaishnav, Aditi S / Vyas, Aniruddha / Lokhandwala, Yash

The Journal of innovations in cardiac rhythm management

2021 Volume 12, Issue 1, Page(s) 4372–4374

Abstract: We present a case of regular narrow complex tachycardia in a 59-year-old woman with frequent paroxysmal palpitations, a normal electrocardiogram (ECG) in sinus rhythm, and a structurally normal heart. During electrophysiology study, a long R-P ... ...

Abstract	We present a case of regular narrow complex tachycardia in a 59-year-old woman with frequent paroxysmal palpitations, a normal electrocardiogram (ECG) in sinus rhythm, and a structurally normal heart. During electrophysiology study, a long R-P tachycardia was present at baseline, with P-waves superimposed on the T-waves and appearing to be positive in the inferior leads. Intracardiac recordings showed the atrial activation to be early in the para-Hisian region. The diagnosis of atrial tachycardia was confirmed by ventricular overdrive pacing, which showed ventriculoatrial dissociation without perturbing the atrial rate. The precise P-wave morphology was brought out in the pause, which followed rapidly delivered ventricular extrastimuli during tachycardia. Based on this information, activation mapping was conducted in the para-Hisian region, high atrial septal regions on the right and left sides, and aortic sinuses. Tachycardia was successfully ablated at one of these sites.
Language	English
Publishing date	2021-01-15
Publishing country	United States
Document type	Case Reports
ISSN	2156-3977
ISSN	2156-3977
DOI	10.19102/icrm.2021.120103
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Article ; Online: Paroxysmal Atrial Fibrillation With Both Triggers and Rotational Drivers Within the Right Atrial Appendage.

Marcus, Marshall B / Shein, Jamie A / Vaishnav, Aditi S / Mountantonakis, Stavros E

JACC. Case reports

2019 Volume 1, Issue 4, Page(s) 607–611

Abstract: A 48-year-old woman with paroxysmal atrial fibrillation (AF) underwent an electrophysiology study after 2 previous failed ablations. Noninvasive mapping suggested AF initiation from the right atrial appendage (RAA) with rotational drivers of AF in the ... ...

Abstract	A 48-year-old woman with paroxysmal atrial fibrillation (AF) underwent an electrophysiology study after 2 previous failed ablations. Noninvasive mapping suggested AF initiation from the right atrial appendage (RAA) with rotational drivers of AF in the RAA. Invasive mapping confirmed these findings. The patient was successfully treated with cryoballoon RAA isolation. (
Language	English
Publishing date	2019-11-13
Publishing country	Netherlands
Document type	Case Reports
ISSN	2666-0849
ISSN (online)	2666-0849
DOI	10.1016/j.jaccas.2019.09.014
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Article ; Online: Refractory atrial fibrillation effectively treated with ranolazine.

Vaishnav, Aditi / Vaishnav, Avani / Lokhandwala, Yash

Indian heart journal

2014 Volume 66, Issue 1, Page(s) 115–118

Abstract: Atrial fibrillation is the most common sustained cardiac arrhythmia which is often troublesome to manage. Currently, rhythm and rate control medications are the mainstays of therapy. In 2 amiodarone-refractory highly symptomatic patients, an innovative ... ...

Abstract	Atrial fibrillation is the most common sustained cardiac arrhythmia which is often troublesome to manage. Currently, rhythm and rate control medications are the mainstays of therapy. In 2 amiodarone-refractory highly symptomatic patients, an innovative approach using ranolazine, which selectively acts on Na+ channels and delays atrial depolarization, was tried successfully.
MeSH term(s)	Acetanilides/administration & dosage ; Atrial Fibrillation/diagnosis ; Atrial Fibrillation/drug therapy ; Atrial Fibrillation/etiology ; Cardiomyopathy, Hypertrophic/complications ; Cardiomyopathy, Hypertrophic/diagnosis ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Electrocardiography/methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Piperazines/administration & dosage ; Ranolazine ; Recurrence ; Severity of Illness Index ; Treatment Outcome
Chemical Substances	Acetanilides ; Piperazines ; Ranolazine (A6IEZ5M406)
Language	English
Publishing date	2014-01-04
Publishing country	India
Document type	Case Reports ; Journal Article ; Review
ZDB-ID	604366-5
ISSN	2213-3763 ; 0019-4832
ISSN (online)	2213-3763
ISSN	0019-4832
DOI	10.1016/j.ihj.2013.12.024
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Zs.A 616: Show issues

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Article ; Online: Surface unipolar electrogram characteristics to predict site of origin of outflow tract arrhythmias using noninvasive mapping.

Coleman, Kristie M / Saleh, Moussa / Makker, Parth / Vaishnav, Aditi S / Atteya, Gourg / Shein, Jamie / Bhullar, Amarbir / Skipitaris, Nicholas T / Mountantonakis, Stavros E

Journal of cardiovascular electrophysiology

2021 Volume 32, Issue 2, Page(s) 391–399

Abstract: Background: Noninvasive electroanatomic mapping (NIEAM) demonstrate patterns of depolarization that are useful in identifying the chamber of origin (COO) in outflow tract ventricular arrhythmias (OTVA). However, its use in predicting exact site of ... ...

Abstract	Background: Noninvasive electroanatomic mapping (NIEAM) demonstrate patterns of depolarization that are useful in identifying the chamber of origin (COO) in outflow tract ventricular arrhythmias (OTVA). However, its use in predicting exact site of origin (SOO) has not yet been validated. Methods: NIEAMs (CardioInsight, Medtronic) from 40 patients (age 62.5 ± 2.6) undergoing ablation for OTVA were reviewed for diagnostic accuracy in predicting the SOO. Earliest arrhythmia breakout and directionality of earliest instantaneous unipolar electrograms (uEGMs) on NIEAMs were evaluated subjectively by two observers for quality and amplitude. Sites with most negative earliest uEGMs on right and left ventricular outflow tracts, as well as epicardial surface were manually identified. Using NIEAM-based activation timing of the lateral mitral annulus and basal septum COO was identified for each OTVA. Predictions of SOO using NIEAMs was compared with true SOO from invasive study. NIEAMs SOO predictions were compared with subjective 12 lead electrocardiogram (ECG) review by two observers. Results: Review of arrhythmia breakout and signal directionality had poor diagnostic value in predicting SOO in OTVA (50.6% and 49.4%, 56.6% and 43.4%, respectively) and underperformed compared with ECG interpretation (59.1% and 80.5%). After excluding uEGMs with poor characteristics, the uEGM with most negative amplitude at the COO was predictive of the true SOO with 96.4% sensitivity and specificity. Conclusion: We propose a stepwise approach when interpreting NIEAMs for OTVA where patterns of activation are evaluated first to determine the COO, followed by identification of the site with most negative amplitude instantaneous uEGM to determine SOO.
MeSH term(s)	Aged ; Arrhythmias, Cardiac/diagnosis ; Arrhythmias, Cardiac/surgery ; Catheter Ablation ; Electrocardiography ; Heart Ventricles/diagnostic imaging ; Heart Ventricles/surgery ; Humans ; Middle Aged ; Sensitivity and Specificity ; Tachycardia, Ventricular/diagnosis ; Tachycardia, Ventricular/surgery
Language	English
Publishing date	2021-01-06
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1025989-2
ISSN	1540-8167 ; 1045-3873
ISSN (online)	1540-8167
ISSN	1045-3873
DOI	10.1111/jce.14857
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Zs.A 2863: Show issues

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Article: Pre-hospital thrombolysis.

Vaishnav, Aditi / Vaishnav, Avani / Khandekar, Santosh / Vaishnav, Sudhir

The Journal of the Association of Physicians of India

2011 Volume 59 Suppl, Page(s) 14–18

Abstract: Coronary heart disease (CHD) is a major cause of mortality in India. Patients in India, who have acute coronary syndromes, have a higher rate of STEMI than do patients in developed countries. Since most of these patients are poor, they are less likely to ...

Abstract	Coronary heart disease (CHD) is a major cause of mortality in India. Patients in India, who have acute coronary syndromes, have a higher rate of STEMI than do patients in developed countries. Since most of these patients are poor, they are less likely to get evidence-based treatments, and have a greater 30-day mortality. Reduction of delays in access to hospital and provision of affordable treatments could reduce this. Treatment regimes for AMI should aim to open the artery as soon as possible and as wide as possible. In patients suitable for thrombolytic treatment, time is critical and reperfusion should be initiated as soon as possible. Some adjunctive therapies are also beneficial, in particular, the antiplatelet agent aspirin, which should be given in the prehospital setting when a diagnosis of AMI is suspected. Despite availability of good treatment, mortality from AMI is showing no further reduction due to the prehospital phase and in-hospital delays. Thrombolysis is almost always delivered to patients after arriving in hospital, losing valuable time (and hence heart muscle). Newer drugs combined with recognition of improved outcomes have prompted attempts to decrease the time from symptom onset to treatment delivery via Pre Hospital Thrombolysis (PHT). However, PHT is significantly superior to in-hospital thrombolysis (IHT). This is especially important in regions where PCI is not available. In the RIKS-HIA and NRMI, PHT had better outcomes than IHT, but patients who received PPCI had lower mortality and re-infarction rates. They concluded that within 2 h of symptom onset, patients should receive PHT only if PPCI is not available within 4 h. In CAPTIM, which compared PPCI and PHT followed by PCI if thrombolysis failed and in GRACIA-1 trial, which tested the role of systematic PCI within 24 h of thrombolysis, the policy of systematic PCI following thrombolysis yielded better results than conservative management. The American Heart Association (AHA) and the American College of Cardiology (ACC) favour the use of PHT over PCI, placing the emphasis on the time factor rather than on the method of reperfusion. However, if PHT cannot be administered, the patient should be treated with PPCI within 90 min of first medical contact or therapy within 30 min such that the total ischaemic time is 120 min. The National Institute for Clinical Excellence supports reperfusion with fibrinolytics, recommending PHT using the newer agents, reteplase and tenecteplase, whose bolus application simplifies administration. PHT constitutes one of the means to shorten delays before the administration of reperfusion therapy. However, it poses several organizational problems that can find different answers according to each regional/national system of care. A number of barriers exist that limit the actual use of PHT. Thus the system of care chosen is likely to have a definite impact on the percentage of STEMI patients in whom PHT can be delivered.
MeSH term(s)	Emergency Medical Services ; Fibrinolytic Agents/therapeutic use ; Humans ; India ; Myocardial Infarction/diagnosis ; Myocardial Infarction/drug therapy ; Myocardial Reperfusion ; Thrombolytic Therapy ; Time Factors ; Treatment Outcome
Chemical Substances	Fibrinolytic Agents
Language	English
Publishing date	2011-12
Publishing country	India
Document type	Journal Article
ZDB-ID	800766-4
ISSN	0004-5772
ISSN	0004-5772
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Zs.B 313: Show issues

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Article ; Online: Intracardiac echocardiography guided nonocclusive balloon cryothermal applications to achieve antral isolation during pulmonary vein isolation.

Saleh, Moussa / Coleman, Kristie M / Vaishnav, Aditi S / Shein, Jamie / Makker, Parth / Skipitaris, Nicholas / Mountantonakis, Stavros E

Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing

2020 Volume 62, Issue 2, Page(s) 329–336

Abstract: Objective: Ablation for atrial fibrillation (AF) requires electrical isolation of the pulmonary veins (PV) by wide-area circumferential PV antral isolation (PVAI). Cryoballoon ablation delivers cryoenergy circumferentially after occlusion of the PV by ... ...

Abstract	Objective: Ablation for atrial fibrillation (AF) requires electrical isolation of the pulmonary veins (PV) by wide-area circumferential PV antral isolation (PVAI). Cryoballoon ablation delivers cryoenergy circumferentially after occlusion of the PV by the cryoballoon; thus, it is likely that the level of isolation, determined by adequate balloon-tissue contact, depends on PV anatomy. We sought to examine the need for nonocclusive segmental cryoballoon ablation in achieving antral isolation, describe methods of accurate visualization of the cryoballoon using intracardiac echocardiography (ICE), and provide data on biophysical characteristics of an effective nonocclusive cryothermal lesion. Methods: Forty consecutive patients undergoing catheter ablation with a second-generation 28-mm cryoballoon and electroanatomic mapping (EAM) were included. Balloon was visualized with ICE, and its location was registered in EAM using available technology (CARTOSOUND, Biosense Webster). Need for delivery of nonocclusive lesions was based on level of isolation post occlusive lesions. Results: Nonocclusive lesions to PVAI was required in 26 of 40 patients (65%) or 46 out of 148 veins (31%). Left PVs > 19.4 ± 2.9 mm, right superior PV > 20.2 ± 4.7mm, funnel-shaped PVs, and right PVs not converging to a carina were more likely to require nonocclusive lesions to achieve an antral level of isolation. Projection of balloon contour on EAM using CARTOSOUND successfully predicted level of isolation by voltage mapping. Conclusion: Nonocclusive cryoballoon applications are commonly required to achieve antral isolation. Use of ICE can be helpful in determining the accurate location of the balloon and in predicting the level of isolation by voltage map.
MeSH term(s)	Atrial Fibrillation/diagnostic imaging ; Atrial Fibrillation/surgery ; Catheter Ablation ; Cryosurgery ; Echocardiography ; Humans ; Pulmonary Veins/diagnostic imaging ; Pulmonary Veins/surgery ; Treatment Outcome
Language	English
Publishing date	2020-10-27
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	1329179-8
ISSN	1572-8595 ; 1383-875X
ISSN (online)	1572-8595
ISSN	1383-875X
DOI	10.1007/s10840-020-00905-9
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Article ; Online: A standardized protocol to reliably visualize the left atrial appendage with intracardiac echocardiography: Importance of multiple imaging sites.

Basman, Craig / Alderwish, Edris / Rambhatla, Tarak / Vaishnav, Aditi / Kronzon, Itzhak / Mountantonakis, Stavros E

Echocardiography (Mount Kisco, N.Y.)

2018 Volume 35, Issue 10, Page(s) 1635–1640

Abstract: Background: Currently, there is no accepted protocol for left atrial appendage (LAA) imaging with intracardiac echocardiography (ICE).: Objective: This study aimed to assess the utility of ICE to reliably visualize the entire cavity of the LAA and ... ...

Abstract	Background: Currently, there is no accepted protocol for left atrial appendage (LAA) imaging with intracardiac echocardiography (ICE). Objective: This study aimed to assess the utility of ICE to reliably visualize the entire cavity of the LAA and propose a specific procedural protocol to achieve the above objective. Methods: We created a three-dimensional reconstruction of the LAA, using two-dimensional ICE sections obtained from three different location (the right atrium [RA], right ventricle inflow [RVI], and right ventricular outflow [RVOT]). We then compared the three-dimensional LAA reconstruction by ICE with one obtained by cardiac computed tomography angiography (CCTA) for morphological and volume differences. Results: Three-dimensional reconstruction with ICE could reliably reproduce the LAA as visualized with CCTA but only when ICE sampling was performed from at least two catheter positions. There was no statistically significant difference between LAA volumes obtained with ICE and CCTA (P = 0.33). The contribution of each anatomical location to the total volume was 17% ± 16.6%, 74% ± 13.3%, and 33% ± 26% for RA, RVI, and RVOT, respectively. Conclusion: In comparison with CCTA, the LAA can be reliably visualized in its entity by ICE, but only if multiple imaging positions (RA, RV inflow, and RVOT) are used.
MeSH term(s)	Aged ; Atrial Appendage/diagnostic imaging ; Atrial Appendage/surgery ; Atrial Fibrillation/diagnostic imaging ; Atrial Fibrillation/surgery ; Catheter Ablation ; Echocardiography/methods ; Female ; Heart Atria/diagnostic imaging ; Heart Ventricles/diagnostic imaging ; Humans ; Male ; Reproducibility of Results
Language	English
Publishing date	2018-07-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	843645-9
ISSN	1540-8175 ; 0742-2822
ISSN (online)	1540-8175
ISSN	0742-2822
DOI	10.1111/echo.14104
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Zs.MO 359: Show issues

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Article ; Online: Clinical predictors of heart block during atrioventricular nodal reentrant tachycardia ablation: A multicenter 18-year experience.

Makker, Parth / Saleh, Moussa / Vaishnav, Aditi S / Coleman, Kristie M / Beldner, Stuart / Ismail, Haisam / Sharma, Nikhil / Jadonath, Ram / Goldner, Bruce / Mitra, Raman / Epstein, Laurence / John, Roy / Mountantonakis, Stavros E

Journal of cardiovascular electrophysiology

2021 Volume 32, Issue 6, Page(s) 1658–1664

Abstract: Background: Catheter ablation is considered the first-line treatment of symptomatic atrioventricular nodal reentrant tachycardia (AVNRT). It has been associated with a risk of heart block (HB) requiring a pacemaker. This study aims to determine ... ...

Abstract	Background: Catheter ablation is considered the first-line treatment of symptomatic atrioventricular nodal reentrant tachycardia (AVNRT). It has been associated with a risk of heart block (HB) requiring a pacemaker. This study aims to determine potential clinical predictors of complete heart block as a result AVNRT ablation. Methods: Consecutive patients undergoing catheter ablation for AVNRT from January 2001 to June 2019 at two tertiary hospitals were included. We defined ablation-related HB as the unscheduled implantation of pacemaker within a month of the index procedure. Use of electroanatomic mapping (EAM), operator experience, inpatient status, age, sex, fluoroscopy time, baseline PR interval, and baseline HV interval was included in univariate and multivariate models to predict HB post ablation. Results: In 1708 patients (56.4 ± 17.0 years, 61% females), acute procedural success was 97.1%. The overall incidence of HB was 1.3%. Multivariate analysis showed that age more than 70 (odds ratio [OR] 7.907, p ≤ .001, confidence interval [CI] 2.759-22.666), baseline PR ≥ 190 ms (OR 2.867, p = .026, CI 1.135-7.239) and no use of EAM (OR 0.306, p = .037, CI 0.101-0.032) were independent predictors of HB. Conclusion: Although the incidence of HB post AVNRT ablation is generally low, patients can be further stratified using three simple predictors.
MeSH term(s)	Atrioventricular Block ; Catheter Ablation/adverse effects ; Female ; Humans ; Male ; Tachycardia, Atrioventricular Nodal Reentry/diagnosis ; Tachycardia, Atrioventricular Nodal Reentry/surgery ; Tachycardia, Ventricular ; Treatment Outcome
Language	English
Publishing date	2021-04-21
Publishing country	United States
Document type	Journal Article ; Multicenter Study
ZDB-ID	1025989-2
ISSN	1540-8167 ; 1045-3873
ISSN (online)	1540-8167
ISSN	1045-3873
DOI	10.1111/jce.15037
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Zs.A 2863: Show issues

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Article ; Online: Conduction patterns of idiopathic arrhythmias from the endocardium and epicardium of outflow tracts: New insights with noninvasive electroanatomic mapping.

Mountantonakis, Stavros E / Vaishnav, Aditi S / Jacobson, Jeremy D / Bernstein, Neil E / Bhasin, Kabir / Coleman, Kristie M / Skipitaris, Nicholas T

Heart rhythm

2019 Volume 16, Issue 10, Page(s) 1562–1569

Abstract: Background: Idiopathic arrhythmias commonly arise from the septal right ventricular outflow tract (RVOT), sinuses of Valsalva (SoV), and great cardiac vein (GCV). Predicting the exact site of origin is important for preparation for catheter ablation.: ...

Abstract	Background: Idiopathic arrhythmias commonly arise from the septal right ventricular outflow tract (RVOT), sinuses of Valsalva (SoV), and great cardiac vein (GCV). Predicting the exact site of origin is important for preparation for catheter ablation. Objective: The purpose of this study was to examine the diagnostic value of noninvasive electroanatomic mapping (NIEAM) to differentiate between septal RVOT, SoV, and GCV origin and compare it to that of 12-lead electrocardiography (ECG). Methods: NIEAM maps (CardioInsight, Medtronic) were generated during spontaneous ventricular premature depolarizations (VPDs) and threshold pacing from septal RVOT, SoV, and GCV. Origin prediction using NIEAM was compared to algorithmic ECG criteria (maximal deflection index; V Results: Sixty NIEAMs (18 spontaneous VPDs and 42 pace-maps) from 31 patients (age 56 ± 16 years) were analyzed. NIEAM showed distinct conduction patterns, best visualized at the base of the heart: septal RVOT VPDs propagate toward the tricuspid annulus, depolarizing the septum from inferior to superior; SoV VPDs engage the superior septum early; and GCV VPDs move laterally along the mitral annulus, depolarizing the heart from left to right. Activation of the lateral mitral annulus >60.50 ms and the superior basal septum <22.5 ms from onset predicts RVOT and SoV origin, respectively, in 100% of cases. NIEAM was superior to maximum deflection index in predicting GCV origin (100% vs 42.2% accuracy) and superior to V Conclusion: Arrhythmias arising from the outflow tracts follow distinct propagation patterns depending on the origin. A 2-step algorithm using activation timing by NIEAM yields 100% diagnostic accuracy in predicting origin.
MeSH term(s)	Adult ; Aged ; Arrhythmias, Cardiac/diagnostic imaging ; Arrhythmias, Cardiac/physiopathology ; Arrhythmias, Cardiac/surgery ; Body Surface Potential Mapping/methods ; Catheter Ablation/methods ; Electrocardiography/methods ; Electrophysiologic Techniques, Cardiac ; Endocardium/physiopathology ; Female ; Follow-Up Studies ; Heart Conduction System/physiopathology ; Humans ; Imaging, Three-Dimensional/methods ; Male ; Middle Aged ; Pericardium/physiopathology ; Predictive Value of Tests ; Prospective Studies ; Treatment Outcome ; Ventricular Premature Complexes/diagnostic imaging ; Ventricular Premature Complexes/physiopathology
Language	English
Publishing date	2019-04-17
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	2229357-7
ISSN	1556-3871 ; 1547-5271
ISSN (online)	1556-3871
ISSN	1547-5271
DOI	10.1016/j.hrthm.2019.04.026
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Article: Routine health check-ups: A boon or a burden?

Honnekeri, Bianca / Vyas, Aniruddha / Lokhandwala, Disha / Vaishnav, Avani / Vaishnav, Aditi / Singhal, Mayank / Barwad, Parag / Panicker, Gopi Krishna / Lokhandwala, Yash

The National medical journal of India

2016 Volume 29, Issue 1, Page(s) 18–21

Abstract: Healthcare provider institutions in India now offer structured health check-up 'packages' for routine screening of common diseases. While some tests included within their ambit are in keeping with international and Indian recommendations, some are ... ...

Abstract	Healthcare provider institutions in India now offer structured health check-up 'packages' for routine screening of common diseases. While some tests included within their ambit are in keeping with international and Indian recommendations, some are entirely unwarranted. Unnecessary and inappropriate screening tests may cause more harm than benefit. Besides financial and resource burden, there may be over-diagnosis and over-treatment, psychological distress due to false-positive test results, harm from invasive follow-up tests, and false reassurance due to false-negative test results. Clinicians must ensure a net benefit from tests and interventions in order to efficiently deliver preventive services. We reviewed current screening guidelines for cardiovascular disease and common cancers, and surveyed multiple 'packages' provided at 8 centres in Mumbai, India. We put forth our recommendations for routine health screening in asymptomatic adults in India.
MeSH term(s)	Adult ; Cardiovascular Diseases/diagnosis ; Female ; Humans ; India ; Male ; Mass Screening/economics ; Mass Screening/methods ; Middle Aged ; Neoplasms/diagnosis ; Predictive Value of Tests ; Risk Assessment
Language	English
Publishing date	2016-06-01
Publishing country	India
Document type	Journal Article ; Review
ZDB-ID	645116-0
ISSN	0970-258X
ISSN	0970-258X
DOI	10.4103/0970-258x.186908
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