Journal of the American College of Cardiology 12/2012; 60(24):e43. · 14.16 Impact Factor
Article: A comparison of lead placement through the subclavian vein technique with fluoroscopy-guided axillary vein technique for permanent pacemaker insertion.Gautam Sharma, Nagendra Boopathy Senguttuvan, Ajit Thachil, Darryl Leong, Nitish Naik, Rakesh Yadav, Rajnish Juneja, Vinay K Bahl[show abstract] [hide abstract]
ABSTRACT: The intrathoracic subclavian venous technique for pacemaker implantation may be associated with serious complications. We describe an alternative technique for obtaining venous access for pacemaker implantation through axillary vein under fluoroscopic guidance and compare it with the conventional, subclavian approach. We conducted a single-centre, prospective, nonrandomized study. All adult patients with indication for permanent pacing who consented were recruited during a 3-year period. To access the axillary vein, we used the alternative technique with a new fluoroscopic landmark. The subclavian access was obtained as per the usual approach. We studied 478 lead placements during 3 years; 315 lead placements through axillary venous technique (group 1) were compared with 163 lead placements through subclavian venous technique (group 2). Both routes had a high and comparable success rate, 98.09% in group 1 and 96.93% in group 2. The axillary approach was successful at the first attempt in 194 punctures (61.6%), as vs 60 in group 2 (36.8%) P < 0.0001. The average number of attempts in group 1 was 2.06 per patient and 2.56 in group 2 (P < 0.001). There were 3 (2.94%) pneumothoraxes in group 2 and none in group 1. During a mean follow-up period of 3.2 months in group1 and 3.7 months in group 2, 1 patient in group 2 had a lead fracture. The fluoroscopically guided axillary venous approach for implanting permanent pacemakers is equivalent to the traditional anatomic landmark-guided intrathoracic subclavian approach and has fewer complications and shorter procedural time to access the vein.The Canadian journal of cardiology 05/2012; 28(5):542-6. · 3.36 Impact Factor
Article: Genetics of sudden death.Nitish Naik, Rakesh Yadav[show abstract] [hide abstract]
ABSTRACT: Recent advances in molecular biology have advanced our understanding of the genetic substrate predisposing to sudden death, especially in monogenic disorders. Numerous ion channels along with membrane structural proteins have been extensively investigated for their role in the genesis of serious ventricular tachyarrhythmias. The complex interplay of various biological pathways culminating in the more prevalent form of sudden death due to coronary artery disease however still remains to be unraveled. The concept of multi-factorial causation of arrhythmias where a second clinical or environmental factor is necessary for expression of an underlying genetic susceptibility to ventricular arrhythmias is a serious possibility. This article briefly outlines the current understanding about the role of genetics in sudden cardiac death.The Indian journal of medical research 11/2010; 132:579-83. · 1.84 Impact Factor
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ABSTRACT: Subclavian route is a standard way of performing a permanent pacemaker. However in cases with superior vena caval or bilateral subclavian occlusion and bilateral infection of pacemaker site, alternative site is warranted. Epicardial route needs general anesthesia and has its own problems. Iliofemoral route has been used previously but has more lead related problems and patient discomfort. Here we are reporting a case in which transiliac pacing was done due to both right and left pacemaker site active infection and to avoid the chance of lead dislodgement, an alpha loop was made in the right atrium.Indian pacing and electrophysiology journal 02/2009; 9(2):108-11.
Article: Radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia associated with anomalous drainage of both superior vena cava into coronary sinus.[show abstract] [hide abstract]
ABSTRACT: Total upper body drainage via left superior vena cava into coronary sinus (i.e. absent right superior vena cava) is a rare anomaly and distorts the anatomy of coronary sinus and triangle of Koch. Herewith we are reporting the first report of ablation in a patient with superior vena cava draining into coronary sinus totally. This patient with atrioventricular nodal re-entrant tachycardia, baseline left bundle branch block, transient complete heart block during electrophysiological study and total upper body venous drainage into coronary sinus had successful slow pathway ablation using anatomical approach.Indian pacing and electrophysiology journal 01/2009; 9(5):278-82.