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Article: Defibrillator-associated gonococcal endocarditis.

Martinez-Parachini, Jose R / Amaral, Ansel P / Yoneda, Zachary T / Siegrist, Kara K / Saavedra, Pablo J / Richardson, Travis D

HeartRhythm case reports

2022 Volume 9, Issue 2, Page(s) 118–120

Language	English
Publishing date	2022-12-09
Publishing country	United States
Document type	Case Reports
ZDB-ID	2834871-0
ISSN	2214-0271
ISSN	2214-0271
DOI	10.1016/j.hrcr.2022.12.004
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Article ; Online: Safety of ventricular arrhythmia radiofrequency ablation with half-normal saline irrigation.

Hasegawa, Kanae / Yoneda, Zachary T / Powers, Edward M / Tokutake, Kenichi / Kurata, Masaaki / Richardson, Travis D / Montgomery, Jay A / Shen, Sharon / Estrada, Juan C / Saavedra, Pablo J / Emerson, Amy / Walker, Marilyn L / Tandri, Harikrishna / Michaud, Gregory F / Kanagasundram, Arvindh N / Stevenson, William G

Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology

2024 Volume 26, Issue 2

Abstract: Aims: Failure of radiofrequency (RF) ablation of ventricular arrhythmias is often due to inadequate lesion size. Irrigated RF ablation with half-normal saline (HNS) has the potential to increase lesion size and reduce sodium delivery to the patient if ... ...

Abstract	Aims: Failure of radiofrequency (RF) ablation of ventricular arrhythmias is often due to inadequate lesion size. Irrigated RF ablation with half-normal saline (HNS) has the potential to increase lesion size and reduce sodium delivery to the patient if the same volume of RF irrigant were used for normal saline (NS) and HNS but could increase risks related to steam pops and lesion size. This study aims to assess periprocedural complications and acute ablation outcome of ventricular arrhythmias ablation with HNS. Methods and results: Prospective assessment of outcomes was performed in 1024 endocardial and/or epicardial RF ablation procedures in 935 consecutive patients (median age 64 years, 71.2% men, 73.4% cardiomyopathy, 47.2% sustained ventricular tachycardia). Half-normal saline was selected at the discretion of the treating physician. Radiofrequency ablation power was generally titrated to a ≤15 Ω impedance fall with intracardiac echocardiography monitoring. Half-normal saline was used in 900 (87.9%) and NS in 124 (12.1%) procedures. Any adverse event within 30 days occurred in 13.0% of patients treated with HNS RF ablation including 4 (0.4%) strokes/transient ischaemic attacks and 34 (3.8%) pericardial effusions requiring treatment (mostly related to epicardial access). Two steam pops with perforation required surgical repair (0.2%). Patients who received NS irrigation had less severe disease and arrhythmias. In multivariable models, adverse events and acute success of the procedure were not related to the type of irrigation. Conclusion: Half-normal saline irrigation RF ablation with power guided by impedance fall and intracardiac echocardiography has an acceptable rate of complications and acute ablation success while administering half of the saline load expected for NS irrigation.
MeSH term(s)	Male ; Humans ; Middle Aged ; Female ; Saline Solution/adverse effects ; Steam ; Prospective Studies ; Arrhythmias, Cardiac/diagnosis ; Arrhythmias, Cardiac/surgery ; Radiofrequency Ablation ; Catheter Ablation/adverse effects ; Catheter Ablation/methods ; Tachycardia, Ventricular/surgery ; Therapeutic Irrigation/adverse effects
Chemical Substances	Saline Solution ; Steam
Language	English
Publishing date	2024-02-17
Publishing country	England
Document type	Journal Article
ZDB-ID	1449879-0
ISSN	1532-2092 ; 1099-5129
ISSN (online)	1532-2092
ISSN	1099-5129
DOI	10.1093/europace/euae018
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Zs.A 5434: Show issues

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Article ; Online: Stroke and Bleeding Risks of Endocardial Ablation for Ventricular Arrhythmias.

JACC. Clinical electrophysiology

2023 Volume 10, Issue 2, Page(s) 193–202

Abstract: Background: Risks of radiofrequency catheter ablation for ventricular arrhythmias include emboli and bleeding complications but data on antithrombotic regimens are limited and guidelines do not specify a systematic approach.: Objectives: This study ... ...

Abstract	Background: Risks of radiofrequency catheter ablation for ventricular arrhythmias include emboli and bleeding complications but data on antithrombotic regimens are limited and guidelines do not specify a systematic approach. Objectives: This study sought to assess embolic and bleeding complications in relation to pre-periprocedure and post-periprocedure antithrombotic regimens. Methods: Prospective assessment for complications was performed for 663 endocardial radiofrequency catheter ablation procedures in 616 consecutive patients (median age 64 years [Q1-Q3: 54-73 years], 70.3% men, 71.6% with cardiomyopathy, 44.5% with sustained ventricular tachycardia). Results: There were 2 strokes (0.3%; 95% CI: 0.0%-0.8%), 1 transient ischemic attack (0.15%), and 2 pulmonary emboli (0.3%). There were 39 bleeding complications (5.9%) including 11 pericardial effusions (1.7%), and 28 related to vascular access (4.2%). Consistent with the prevalence of coronary artery disease (47.5%), atrial fibrillation (30.0%), and prior stroke (10.6%), preprocedure, 464 patients (70.0%) were taking antithrombotic agents including 220 (33.2%) taking aspirin alone (ASA), and 163 (24.6%) taking warfarin or a direct acting oral anticoagulant (DOAC). Preprocedure non-ASA antiplatelet use (OR: 2.846; P = 0.011) and DOAC use (OR: 2.585; P = 0.032) were associated with risk of bleeding complications. Following ablation, 49.8% of patients were treated with ASA 325 mg/d and 30.3% received DOACs or warfarin. New DOAC or warfarin administration was initiated in only 6.6% of patients. Overall, 39.7% of patients continued the same preprocedure antithrombotic regimen. Conclusions: Stroke is a rare complication of radiofrequency catheter ablation for ventricular arrhythmia using ASA 325 mg/d as a minimal postprocedure regimen with more potent regimens for selected patients.
MeSH term(s)	Male ; Humans ; Middle Aged ; Female ; Warfarin/adverse effects ; Anticoagulants/adverse effects ; Hemorrhage/etiology ; Hemorrhage/chemically induced ; Fibrinolytic Agents ; Prospective Studies ; Stroke/etiology ; Stroke/epidemiology ; Atrial Fibrillation/surgery ; Aspirin/adverse effects
Chemical Substances	Warfarin (5Q7ZVV76EI) ; Anticoagulants ; Fibrinolytic Agents ; Aspirin (R16CO5Y76E)
Language	English
Publishing date	2023-12-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	2846739-5
ISSN	2405-5018 ; 2405-500X ; 2405-500X
ISSN (online)	2405-5018 ; 2405-500X
ISSN	2405-500X
DOI	10.1016/j.jacep.2023.10.011
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Article ; Online: Durable pulmonary vein isolation with diffuse posterior left atrial ablation using low-flow, median power, short-duration strategy.

Li, Dan L / El-Harasis, Majd / Montgomery, Jay A / Richardson, Travis D / Kanagasundram, Arvindh / Estrada, Juan Carlos / Lean, Michael / Shoemaker, M Benjamin / Saavedra, Pablo J / Touchton, Steven / Patel, Bindiya / Herrmann, Tarrah / John, Roy M / Michaud, Gregory F

Journal of cardiovascular electrophysiology

2022 Volume 33, Issue 8, Page(s) 1655–1664

Abstract: Introduction: To target posterior wall isolation (PWI) in atrial fibrillation (AF) ablation, diffuse ablation theoretically confers a lower risk of conduction recovery compared to box set. We sought to assess the safety and efficacy of diffuse PWI with ... ...

Abstract	Introduction: To target posterior wall isolation (PWI) in atrial fibrillation (AF) ablation, diffuse ablation theoretically confers a lower risk of conduction recovery compared to box set. We sought to assess the safety and efficacy of diffuse PWI with low-flow, medium-power, and short-duration (LF-MPSD) ablation, and evaluate the durability of pulmonary vein isolation (PVI) and PWI among patients undergoing repeat ablations. Methods: We retrospectively studied patients undergoing LF-MPSD ablation for AF (PVI + diffuse PWI) between August 2017 and December 2019. Clinical characteristics were collected. Kaplan-Meier survival analysis was performed to study AF/atrial flutter (AFL) recurrence. Ablation data were analyzed in patients who underwent a repeat AF/AFL ablation. Results: Of the 463 patients undergoing LF-MPSD AF ablation (PVI alone, or PVI + diffuse PWI), 137 patients had PVI + diffuse PWI. Acute PWI with complete electrocardiogram elimination was achieved in 134 (97.8%) patients. Among the 126 patients with consistent follow-up, 38 (30.2%) patients had AF/AFL recurrence during a median duration of 14 months. Eighteen patients underwent a repeat AF/AFL ablation after PVI + diffuse PWI, and 16 (88.9%) patients had durable PVI, in contrast to 10 of 45 (23.9%) patients who had redo ablation after LF-MPSD PVI alone. Seven patients (38.9%) had durable PWI, while 11 patients had partial electrical recovery at the posterior wall. The median percentage of area without electrical activity at the posterior wall was 70.7%. Conduction block across the posterior wall was maintained in 16 (88.9%) patients. Conclusion: There was a high rate of PVI durability in patients undergoing diffuse PWI and PVI. Partial posterior wall electrical recovery was common but conduction block across the posterior wall was maintained in most patients.
MeSH term(s)	Atrial Fibrillation/diagnosis ; Atrial Fibrillation/etiology ; Atrial Fibrillation/surgery ; Atrial Flutter/diagnosis ; Atrial Flutter/etiology ; Atrial Flutter/surgery ; Catheter Ablation/adverse effects ; Humans ; Pulmonary Veins/surgery ; Recurrence ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2022-06-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	1025989-2
ISSN	1540-8167 ; 1045-3873
ISSN (online)	1540-8167
ISSN	1045-3873
DOI	10.1111/jce.15550
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Zs.A 2863: Show issues

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Article ; Online: Quinidine in the Management of Recurrent Ventricular Arrhythmias: A Reappraisal.

Li, Dan L / Cox, Zachary L / Richardson, Travis D / Kanagasundram, Arvindh N / Saavedra, Pablo J / Shen, Sharon T / Montgomery, Jay A / Murray, Katherine T / Roden, Dan M / Stevenson, William G

JACC. Clinical electrophysiology

2021 Volume 7, Issue 10, Page(s) 1254–1263

Abstract: Objectives: This study aimed to review the utility of quinidine in patients presenting with recurrent sustained ventricular arrhythmia (VA) and limited antiarrhythmic drug (AAD) options.: Background: Therapeutic options are often limited in patients ... ...

Abstract	Objectives: This study aimed to review the utility of quinidine in patients presenting with recurrent sustained ventricular arrhythmia (VA) and limited antiarrhythmic drug (AAD) options. Background: Therapeutic options are often limited in patients with structural heart disease and recurrent VAs. Quinidine has an established role in rare arrhythmic syndromes, but its potential use in other difficult VAs has not been assessed in the present era. Methods: We performed a retrospective analysis of 37 patients who had in-hospital quinidine initiation after multiple other therapies failed for VA suppression at our tertiary referral center. Clinical data and outcomes were obtained from the medical record. Results: Of 30 patients with in-hospital quantifiable VA episodes, quinidine reduced acute VA from a median of 3 episodes (interquartile range [IQR]: 2 to 7.5) to 0 (IQR: 0 to 0.5) during medians of 3 days before and 4 days after quinidine initiation (p < 0.001). VA events decreased from a median of 10.5 episodes per day (IQR: 5 to 15) to 0.5 episodes (IQR: 0 to 4) after quinidine initiation in the 12 patients presenting with electrical storm (p = 0.004). Among the 24 patients discharged on quinidine, 13 (54.2%) had VA recurrence during a median of 138 days. Adverse effects in 9 of the 37 patients (24.3%) led to drug discontinuation, most commonly gastrointestinal intolerance. Conclusions: In patients with recurrent VAs and structural heart disease who have limited treatment options, quinidine can be useful, particularly as a short-term therapy.
MeSH term(s)	Anti-Arrhythmia Agents/therapeutic use ; Arrhythmias, Cardiac/drug therapy ; Humans ; Quinidine/therapeutic use ; Retrospective Studies ; Ventricular Fibrillation/drug therapy
Chemical Substances	Anti-Arrhythmia Agents ; Quinidine (ITX08688JL)
Language	English
Publishing date	2021-06-30
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2846739-5
ISSN	2405-5018 ; 2405-500X ; 2405-500X
ISSN (online)	2405-5018 ; 2405-500X
ISSN	2405-500X
DOI	10.1016/j.jacep.2021.03.024
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Article ; Online: Cardiovascular effects of noncardiovascular drugs.

Raj, Satish R / Stein, C Michael / Saavedra, Pablo J / Roden, Dan M

Circulation

2009 Volume 120, Issue 12, Page(s) 1123–1132

MeSH term(s)	Animals ; Arrhythmias, Cardiac/chemically induced ; Atherosclerosis/chemically induced ; Cardiovascular Diseases/chemically induced ; Drug Interactions ; Heart Defects, Congenital/chemically induced ; Heart Failure/chemically induced ; Heart Valve Diseases/chemically induced ; Humans ; Hypertension/chemically induced ; Hypertension, Pulmonary/chemically induced ; Hypotension/chemically induced ; Myocardial Infarction/chemically induced
Language	English
Publishing date	2009-09-21
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Review
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.107.728576
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Ui IV Zs.60: Show issues

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Article ; Online: Arrhythmogenic Munchausen syndrome culminating in caffeine-induced ventricular tachycardia.

Vaglio, Joseph C / Schoenhard, John A / Saavedra, Pablo J / Williams, Saralyn R / Raj, Satish R

Journal of electrocardiology

2011 Volume 44, Issue 2, Page(s) 229–231

Abstract: We report a patient with numerous abnormal electrocardiograms (ECGs) in both inpatient and outpatient settings. Our patient both simulated and stimulated her arrhythmias with an ECG rhythm generator and intentional caffeine intoxication. To our knowledge, ...

Abstract	We report a patient with numerous abnormal electrocardiograms (ECGs) in both inpatient and outpatient settings. Our patient both simulated and stimulated her arrhythmias with an ECG rhythm generator and intentional caffeine intoxication. To our knowledge, this is the first report of caffeine overdose for arrhythmogenesis.
MeSH term(s)	Adult ; Caffeine/toxicity ; Central Nervous System Stimulants/toxicity ; Female ; Humans ; Munchausen Syndrome/chemically induced ; Munchausen Syndrome/diagnosis ; Tachycardia, Ventricular/chemically induced ; Tachycardia, Ventricular/diagnosis
Chemical Substances	Central Nervous System Stimulants ; Caffeine (3G6A5W338E)
Language	English
Publishing date	2011-03
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	410286-1
ISSN	1532-8430 ; 0022-0736
ISSN (online)	1532-8430
ISSN	0022-0736
DOI	10.1016/j.jelectrocard.2010.08.006
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Zs.A 701: Show issues

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Article ; Online: Efficacy of a Bio-Absorbable Antibacterial Envelope to Prevent Cardiac Implantable Electronic Device Infections in High-Risk Subjects.

Kolek, Matthew J / Patel, Neel J / Clair, Walter K / Whalen, S Patrick / Rottman, Jeffrey N / Kanagasundram, Arvindh / Shen, Sharon T / Saavedra, Pablo J / Estrada, Juan C / Abraham, Robert L / Ellis, Christopher R

Journal of cardiovascular electrophysiology

2015 Volume 26, Issue 10, Page(s) 1111–1116

Abstract: Introduction: Cardiac implantable electronic device (CIED) infections are potentially preventable complications associated with high morbidity, mortality, and cost. A recently developed bio-absorbable antibacterial envelope (TYRX™-A) might prevent CIED ... ...

Abstract	Introduction: Cardiac implantable electronic device (CIED) infections are potentially preventable complications associated with high morbidity, mortality, and cost. A recently developed bio-absorbable antibacterial envelope (TYRX™-A) might prevent CIED infections in high-risk subjects. However, data regarding safety and efficacy have not been published. Methods and results: In a single-center retrospective cohort study, we compared the prevalence of CIED infections among subjects with ≥2 risk factors treated with the TYRX™-A envelope (N = 135), the nonabsorbable TYRX™ envelope (N = 353), and controls who did not receive an envelope (N = 636). Infection was ascertained by individual chart review. The mean (95% confidence interval) number of risk factors was 3.08 (2.84-3.32) for TYRX™-A, 3.20 (3.07-3.34) for TYRX™, and 3.09 (2.99-3.20) for controls, P = 0.3. After a minimum 300 days follow-up, the prevalence of CIED infection was 0 (0%) for TYRX™-A, 1 (0.3%) for TYRX™, and 20 (3.1%) for controls (P = 1 for TYRX™-A vs. TYRX™, P = 0.03 for TYRX™-A vs. controls, and P = 0.002 for TYRX™ vs. controls). In a propensity score-matched cohort of 316 recipients of either envelope and 316 controls, the prevalence of infection was 0 (0%) and 9 (2.8%), respectively, P = 0.004. When limited to 122 TYRX™-A recipients and 122 propensity-matched controls, the prevalence of CIED infections was 0 (0%) and 5 (4.1%), respectively, P = 0.024. Conclusions: Among high-risk subjects, the TYRX™-A bio-absorbable envelope was associated with a very low prevalence of CIED related infections that was comparable to that seen with the nonabsorbable envelope.
MeSH term(s)	Absorbable Implants/statistics & numerical data ; Aged ; Anti-Bacterial Agents/administration & dosage ; Causality ; Cohort Studies ; Defibrillators, Implantable/statistics & numerical data ; Delayed-Action Preparations/administration & dosage ; Drug Implants/administration & dosage ; Female ; Humans ; Male ; Middle Aged ; Pacemaker, Artificial/statistics & numerical data ; Prevalence ; Prosthesis-Related Infections/diagnosis ; Prosthesis-Related Infections/epidemiology ; Prosthesis-Related Infections/prevention & control ; Retrospective Studies ; Risk Factors ; Sex Distribution ; Survival Rate ; Tennessee/epidemiology ; Treatment Outcome
Chemical Substances	Anti-Bacterial Agents ; Delayed-Action Preparations ; Drug Implants
Language	English
Publishing date	2015-10
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1025989-2
ISSN	1540-8167 ; 1045-3873
ISSN (online)	1540-8167
ISSN	1045-3873
DOI	10.1111/jce.12768
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Article ; Online: Placement of the TandemHeart percutaneous left ventricular assist device.

Pretorius, Mias / Hughes, Alexander K / Stahlman, Matthew B / Saavedra, Pablo J / Deegan, Robert J / Greelish, James P / Zhao, David X

Anesthesia and analgesia

2006 Volume 103, Issue 6, Page(s) 1412–1413

MeSH term(s)	Adult ; Echocardiography, Transesophageal ; Female ; Heart-Assist Devices ; Humans ; Shock, Cardiogenic/surgery
Language	English
Publishing date	2006-12
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	80032-6
ISSN	1526-7598 ; 0003-2999
ISSN (online)	1526-7598
ISSN	0003-2999
DOI	10.1213/01.ane.0000243330.74987.28
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