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  1. Article ; Online: Incidence and predictors of super-response to cardiac resynchronization therapy.

    Rohit, Manoj Kumar / Krishnappa, Darshan

    Indian heart journal

    2019  Volume 71, Issue 4, Page(s) 334–337

    Abstract: Objectives: Cardiac resynchronization therapy (CRT) has significantly improved management of patients with heart failure with reduced ejection fraction (HFrEF). A significant number of patients have a dramatic response and have been termed "super- ... ...

    Abstract Objectives: Cardiac resynchronization therapy (CRT) has significantly improved management of patients with heart failure with reduced ejection fraction (HFrEF). A significant number of patients have a dramatic response and have been termed "super-responders". The characteristics of this subset of patients in Indian and Asian population have not been well studied. In this study, we sought to assess the prevalence and clinical characteristics of this cohort of patients.
    Methods: This was a retrospective study involving patients undergoing CRT. Changes in ejection fraction and LVESV at the end of one year of follow-up following device implantation were assessed, and patients were stratified into non-responders, responders, and super-responders. Responders had a 15-29% decrease in LVESV while super-responders had a >30% decrease in LVESV.
    Results: Of the 74 patients who had undergone CRT-P/CRT-D implantation, 16 patients did not have echocardiograms at the end of one year of follow-up and were excluded from the analysis. Thus, 58 patients were enrolled for analysis. We identified 16 patients (27.6%) to be super-responders, 26 patients (44.8%) to be responders, and 16 patients (27.6%) to be non-responders. Factors associated with a super-response were a diagnosis of dilated cardiomyopathy as against ischemic cardiomyopathy (93.7% vs 6.3%; p - 0.01), prior right ventricular (RV) apical pacing (25% vs 2.4%; p - 0.02) and absence of a prior history of myocardial infarction (MI) (0% vs 33.3%; p - 0.02).
    Conclusion: In our study, 27.6% of patients were super-responders, and a diagnosis of dilated cardiomyopathy, absence of a prior history of MI and prior RV apical pacing predicted a super-response to CRT.
    MeSH term(s) Cardiac Resynchronization Therapy ; Female ; Heart Failure/therapy ; Humans ; Incidence ; Male ; Middle Aged ; Predictive Value of Tests ; Retrospective Studies ; Stroke Volume ; Treatment Outcome
    Language English
    Publishing date 2019-09-09
    Publishing country India
    Document type Journal Article
    ZDB-ID 604366-5
    ISSN 2213-3763 ; 0019-4832
    ISSN (online) 2213-3763
    ISSN 0019-4832
    DOI 10.1016/j.ihj.2019.09.007
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  2. Article ; Online: Sinus arrest: A rare observation during radiofrequency ablation along the coronary sinus roof.

    Nantsupawat, Teerapat / Krishnappa, Darshan / Benditt, David G

    Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc

    2020  Volume 26, Issue 1, Page(s) e12772

    Abstract: Catheter-based radiofrequency (RF) ablation targeting segments of the cardiac conduction system and/or selected regions of myocardium is an accepted treatment for many cardiac arrhythmias. On the other hand, while purposeful extension of RF ablation to ... ...

    Abstract Catheter-based radiofrequency (RF) ablation targeting segments of the cardiac conduction system and/or selected regions of myocardium is an accepted treatment for many cardiac arrhythmias. On the other hand, while purposeful extension of RF ablation to include nearby cardiac neural elements, particularly epicardial ganglionated plexi (GP), remains a subject of ongoing study, inadvertent stimulation of such structures may occur during an otherwise conventional RF ablation procedure. Thus, asystolic pauses have been observed during RF ablation of left ventricular free-wall accessory pathways, slow AV node pathways, and the left superior pulmonary vein. In this report, sinus arrest occurred within 3.3 s of RF application (40 W at 50°C) along the coronary sinus roof for treatment of an atypical "slow-slow" atrioventricular nodal reentrant tachycardia. Energy delivery was immediately terminated, but asystole persisted for 4.7 s followed by sinus bradycardia. The procedure was temporarily halted, but later was successfully resumed. Given the latency from terminating RF to return of sinus node function, the sinus arrest was likely a centrally mediated reflex vagal response. Consequently, while parasympathetic ganglia near the CS os are believed to principally innervate the AV node, not the sinus node, our observation highlights the neural cross-communications that likely exist in this region of the heart.
    MeSH term(s) Adult ; Catheter Ablation/methods ; Coronary Sinus/diagnostic imaging ; Coronary Sinus/physiopathology ; Echocardiography/methods ; Electrocardiography/methods ; Female ; Humans ; Tachycardia/surgery
    Language English
    Publishing date 2020-07-16
    Publishing country United States
    Document type Case Reports
    ZDB-ID 1325530-7
    ISSN 1542-474X ; 1082-720X
    ISSN (online) 1542-474X
    ISSN 1082-720X
    DOI 10.1111/anec.12772
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  3. Article: Hyperlocal Postcode Based Crowdsourced Surveillance Systems in the COVID-19 Pandemic Response.

    Hegde, Ajay / Masthi, Ramesh / Krishnappa, Darshan

    Frontiers in public health

    2020  Volume 8, Page(s) 286

    Abstract: The SARS-CoV-2 pandemic has rapidly saturated healthcare resources across the globe and has led to a restricted screening process, hindering efforts at comprehensive case detection. This has not only facilitated community spread but has also resulted in ... ...

    Abstract The SARS-CoV-2 pandemic has rapidly saturated healthcare resources across the globe and has led to a restricted screening process, hindering efforts at comprehensive case detection. This has not only facilitated community spread but has also resulted in an underestimation of the true incidence of disease, a statistic which is useful for policy making aimed at controlling the current pandemic and in preparing for future outbreaks. In this perspective, we present a crowdsourced platform developed by us for the true estimation of all SARS-CoV-2 infections in the community, through active self-reporting and layering other authentic datasets. The granularity of data captured by this system could prove to be useful in assisting governments to identify SARS-CoV-2 hotspots in the community facilitating lifting of restrictions in a controlled fashion.
    MeSH term(s) COVID-19/epidemiology ; Crowdsourcing ; Disease Outbreaks ; Geographic Information Systems ; Humans ; Mass Screening ; Population Surveillance ; Public Health ; SARS-CoV-2 ; Self Report
    Keywords covid19
    Language English
    Publishing date 2020-06-09
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2711781-9
    ISSN 2296-2565
    ISSN 2296-2565
    DOI 10.3389/fpubh.2020.00286
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  4. Article ; Online: ST-Segment Changes After Loss of Consciousness.

    Agdamag, Arianne Clare / Krishnappa, Darshan / Benditt, David G

    Circulation

    2019  Volume 141, Issue 1, Page(s) 80–82

    MeSH term(s) Accidental Falls ; Aged, 80 and over ; Arrhythmias, Cardiac/physiopathology ; Electrocardiography ; Female ; Humans ; Hypertension/physiopathology ; Subarachnoid Hemorrhage/physiopathology ; Unconsciousness/physiopathology
    Language English
    Publishing date 2019-12-30
    Publishing country United States
    Document type Case Reports ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 80099-5
    ISSN 1524-4539 ; 0009-7322 ; 0069-4193 ; 0065-8499
    ISSN (online) 1524-4539
    ISSN 0009-7322 ; 0069-4193 ; 0065-8499
    DOI 10.1161/CIRCULATIONAHA.119.044403
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  5. Article: Impact of Denervation by Heart Transplantation on Post-operative Atrial Fibrillation Susceptibility.

    Sathnur, Neeraj / Li, Jian-Ming / Krishnappa, Darshan / G Benditt, David

    Journal of atrial fibrillation

    2020  Volume 13, Issue 1, Page(s) 2397

    Abstract: Atrial fibrillation is common following cardiac and non-cardiac thoracic surgery and is associated with poorer outcomes, including: increased risk of stroke, hemodynamic instability, prolonged hospital stay, and increased mortality. Current understanding ...

    Abstract Atrial fibrillation is common following cardiac and non-cardiac thoracic surgery and is associated with poorer outcomes, including: increased risk of stroke, hemodynamic instability, prolonged hospital stay, and increased mortality. Current understanding suggests that post-op atrial fibrillation results from the interplay of local and systemic operative inflammation, increased sympathetic activity, perhaps the release of free radical species in the perioperative period, and the patient's underlying cardiac substrate. Cardiac denervation following orthotopic heart transplant (OHT) using modern bicaval techniques presents a unique opportunity to study the relative contribution of the autonomic nervous system to post-op atrial fibrillation susceptibility. Observational studies show a reduced incidence of post-operative atrial fibrillation following orthotopic heart transplant compared to other cardiac and thoracic surgeries. Moreover, comparison of atrial fibrillation rates with double lung transplant recipients suggests that cardiac denervation has a contribution apart from surgical pulmonary vein isolation alone. This report reviews current concepts of the mechanisms of post-op atrial fibrillation with a focus on the role of the autonomic nervous system, the autonomic regulation of the native heart, and evidence regarding the impact of cardiac denervation following OHT.
    Language English
    Publishing date 2020-06-30
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2451936-4
    ISSN 1941-6911
    ISSN 1941-6911
    DOI 10.4022/jafib.2397
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  6. Article ; Online: Hyperlocal Postcode Based Crowdsourced Surveillance Systems in the COVID-19 Pandemic Response

    Hegde, Ajay / Masthi, Ramesh / Krishnappa, Darshan

    Frontiers in Public Health

    2020  Volume 8

    Keywords covid19
    Publisher Frontiers Media SA
    Publishing country ch
    Document type Article ; Online
    ZDB-ID 2711781-9
    ISSN 2296-2565
    ISSN 2296-2565
    DOI 10.3389/fpubh.2020.00286
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  7. Article: Hyperlocal Postcode Based Crowdsourced Surveillance Systems in the COVID-19 Pandemic Response

    Hegde, Ajay / Masthi, Ramesh / Krishnappa, Darshan

    Front. Public Health

    Abstract: The SARS-CoV-2 pandemic has rapidly saturated healthcare resources across the globe and has led to a restricted screening process, hindering efforts at comprehensive case detection. This has not only facilitated community spread but has also resulted in ... ...

    Abstract The SARS-CoV-2 pandemic has rapidly saturated healthcare resources across the globe and has led to a restricted screening process, hindering efforts at comprehensive case detection. This has not only facilitated community spread but has also resulted in an underestimation of the true incidence of disease, a statistic which is useful for policy making aimed at controlling the current pandemic and in preparing for future outbreaks. In this perspective, we present a crowdsourced platform developed by us for the true estimation of all SARS-CoV-2 infections in the community, through active self-reporting and layering other authentic datasets. The granularity of data captured by this system could prove to be useful in assisting governments to identify SARS-CoV-2 hotspots in the community facilitating lifting of restrictions in a controlled fashion.
    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #615590
    Database COVID19

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  8. Article ; Online: Cardiac mucormycosis: a case report.

    Krishnappa, Darshan / Naganur, Sanjeev / Palanisamy, Dinesh / Kasinadhuni, Ganesh

    European heart journal. Case reports

    2018  Volume 3, Issue 3

    Abstract: Background: Mucormycosis is an invasive fungal infection (IFI) most commonly seen in immunocompromised patients. Diabetic ketoacidosis, haematopoietic transplantation, iron overload states, and deferoxamine therapy are considered to be some of the ... ...

    Abstract Background: Mucormycosis is an invasive fungal infection (IFI) most commonly seen in immunocompromised patients. Diabetic ketoacidosis, haematopoietic transplantation, iron overload states, and deferoxamine therapy are considered to be some of the classical risk factors. While cutaneous and rhino-sinusoidal forms may be seen in immunocompetent (IC) individuals, cardiac and mediastinal involvement is rare. In this report, we describe a young patient without predisposing factors who presented as mediastinal mucormycosis with extensive cardiac involvement.
    Case summary: A 19-year-old male presented with complaints of dry cough and dyspnoea on exertion over the last 4 months. Echocardiography showed diffuse infiltration of both atria along with multiple pedunculated freely mobile masses. A computed tomography chest was done to further delineate the true extent of the disease and revealed diffuse infiltration of the mediastinum, bilateral atria and interatrial septum, pulmonary veins, and superior vena cava. A fine needle aspiration cytology from a mediastinal mass revealed broad aseptate fungal hyphae with right angled branching consistent with Mucor. Extensive evaluation could not find any predisposing factors. The patient was started on Amphotericin B and surgical debridement was contemplated. However, owing to the diffuse infiltration around the heart and mediastinal vasculature, debridement could not be performed and the patient eventually succumbed to the illness.
    Discussion: Mediastinal mucormycosis though rare in IC patients, is a rapidly progressive condition with a high fatality. A high index of suspicion needs to be maintained in individuals presenting with infiltrative disorders of the mediastinum for early diagnosis and prompt treatment.
    Language English
    Publishing date 2018-06-07
    Publishing country England
    Document type Journal Article
    ISSN 2514-2119
    ISSN (online) 2514-2119
    DOI 10.1093/ehjcr/ytz130
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  9. Article ; Online: Wide to narrow complex tachycardia: What is the diagnosis?

    Rohit, Manojkumar / Krishnappa, Darshan / Selvaraj, Raja J

    Journal of cardiovascular electrophysiology

    2018  Volume 29, Issue 3, Page(s) 487–488

    MeSH term(s) Ablation Techniques ; Accessory Atrioventricular Bundle ; Action Potentials ; Bundle-Branch Block/diagnosis ; Bundle-Branch Block/etiology ; Bundle-Branch Block/physiopathology ; Bundle-Branch Block/surgery ; Cardiac Pacing, Artificial ; Ebstein Anomaly/complications ; Ebstein Anomaly/diagnosis ; Ebstein Anomaly/physiopathology ; Electrocardiography ; Heart Rate ; Humans ; Male ; Predictive Value of Tests ; Tachycardia, Atrioventricular Nodal Reentry/diagnosis ; Tachycardia, Atrioventricular Nodal Reentry/etiology ; Tachycardia, Atrioventricular Nodal Reentry/physiopathology ; Tachycardia, Atrioventricular Nodal Reentry/surgery ; Tachycardia, Ventricular/diagnosis ; Tachycardia, Ventricular/etiology ; Tachycardia, Ventricular/physiopathology ; Tachycardia, Ventricular/surgery ; Time Factors ; Young Adult
    Language English
    Publishing date 2018-01-23
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 1025989-2
    ISSN 1540-8167 ; 1045-3873
    ISSN (online) 1540-8167
    ISSN 1045-3873
    DOI 10.1111/jce.13417
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    Zs.A 2863: Show issues Location:
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  10. Article ; Online: Outcomes in congenital and childhood complete atrioventricular block: A meta-analysis.

    Deshpande, Saurabh / Shenthar, Jayaprakash / Khanra, Dibbendhu / Isath, Ameesh / Banavalikar, Bharatraj / Reddy, Satish / Krishnappa, Darshan / Khan, Hassan / Kella, Danesh / Padmanabhan, Deepak

    Journal of cardiovascular electrophysiology

    2022  Volume 33, Issue 3, Page(s) 493–501

    Abstract: Background: The long-term outcomes of patients with congenital and childhood complete atrioventricular block (CCAVB/CAVB) after pacemaker implantation are unclear.: Methods: We performed a meta-analysis of all the studies of CCAVB. A systematic ... ...

    Abstract Background: The long-term outcomes of patients with congenital and childhood complete atrioventricular block (CCAVB/CAVB) after pacemaker implantation are unclear.
    Methods: We performed a meta-analysis of all the studies of CCAVB. A systematic search of PubMed and CENTRAL databases from January 1, 1967 to January 31, 2020 was performed. The quality of studies included was critically appraised using the Newcastle-Ottawa scale, and outcome data were analyzed using the restricted maximum likelihood function.
    Results: Twenty-nine studies were eligible for analysis, with a total of 1553 patients. The all-cause-mortality was 5.7% (95% confidence interval [CI]: 2.5%-9.9%), while pacing-induced cardiomyopathy (PICM) was seen in 3.8% (95% CI: 1.2-7.2). Diagnosis at birth (effect size [ES] [95%CI]: -2.23 [-0.36 to -0.10]; p < .001), presence of congenital heart disease (ES [95%CI]: -0.67 [0.41-0.93]; p < .001), younger age at pacemaker implantation (ES [95%CI]: -0.01 [-0.02 to -0.001]; p = .02), and duration of pacing (ES [95%CI]: -0.03 [-0.05 to -0.003]; p = .03), were associated with an higher mortality on binominal logistic regression. None of the parameters were significant on multivariate analysis.
    Conclusion: Pooled proportional mortality in patients with CCAVB and CAVB is 5.7% with an infrequent incidence of PICM (3.8%) in the paced patients with AVB suggesting that pacing in these patients is an effective management strategy with a low incidence of long-term side effects. Registry and randomized data can throw additional light regarding the natural history and appropriate management strategy in these patients.
    MeSH term(s) Atrioventricular Block/diagnosis ; Atrioventricular Block/therapy ; Cardiac Pacing, Artificial/adverse effects ; Cardiomyopathies ; Child ; Humans ; Incidence ; Infant, Newborn ; Multivariate Analysis ; Pacemaker, Artificial/adverse effects ; Retrospective Studies
    Language English
    Publishing date 2022-01-27
    Publishing country United States
    Document type Journal Article ; Meta-Analysis
    ZDB-ID 1025989-2
    ISSN 1540-8167 ; 1045-3873
    ISSN (online) 1540-8167
    ISSN 1045-3873
    DOI 10.1111/jce.15358
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