John Roshan

Christian Medical College Vellore, Velluru, Tamil Nādu, India

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Publications (6)6.61 Total impact

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    ABSTRACT: Atrial septal defects (ASD), including patent foramen ovale, have been linked to an increased prevalence of migraine headaches in the general population. A similar association with migraine is speculated for iatrogenic ASD due to atrial septal puncture during catheter ablation for atrial fibrillation (AF). A total of 2,069 patients who underwent catheter ablation for AF at Mayo Clinic, Rochester, MN between January 2001 and December 2008 were scheduled for follow-up at least at 3 months and annually thereafter. Data were collected from the questionnaires patients answered at follow-up inquiring about presence and characteristics of any headaches following the procedure and further chart review. Definite migraine was diagnosed based on clinical features per the International Classification of Headache Disorder-II definition. Twenty-two patients (1.1%) had a new-onset definite migraine, 12 (0.6%) had a new-onset probable migraine, ten (0.5%) with a previous history of migraine had worsened headaches, and four (0.2%) had headache due to an alternate identifiable cause; a total of 48 patients (2.3%) reported post-procedural headaches. Nineteen of 22 patients (86%) with definite migraine had complete resolution of symptoms at 1- to 2-year follow-up. New-onset migraine is an uncommon and usually temporary side effect of catheter ablation for AF. The mechanism for post-procedure headache remains unclear.
    Journal of Interventional Cardiac Electrophysiology 10/2010; 30(3):227-32. · 1.39 Impact Factor
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    ABSTRACT: Ablation for ventricular tachycardia remains a challenge with suboptimal procedural success rates. One of the major causes of difficulty is precipitous hypotension when ventricular tachycardia is induced precluding even rapid mapping of the arrhythmia. We report the successful use of the Impella microcirculatory axial blood flow pump in 3 patients with hemodynamically unstable ventricular tachycardia that allowed successful completion of the procedure. In these 3 patients, there was no evidence of Impella-related valvular disturbance, iatrogenic ventricular arrhythmias, or interference with mapping and ablation catheter movement.
    Journal of Cardiovascular Electrophysiology 04/2010; 21(4):458-61. · 3.48 Impact Factor
  • John Roshan, Yash Lokhandwala
    Pacing and Clinical Electrophysiology 07/2009; 32(6):788-90. · 1.75 Impact Factor
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    ABSTRACT: Coronary sinus cannulation during an electrophysiology study can be quite challenging. This article describes a new technique that we use to cannulate the coronary sinus in cases where cannulation is not easy. The technique involves using a deflectable quadripolar catheter as a buddy to enable the decapolar catheter to slip in. It is easy and quickly performed. It also avoids the use of contrast. We hence, recommend that this method be adopted to place the decapolar catheter in the coronary sinus in all difficult cases.
    Indian heart journal 01/2008; 60(1):67-8.
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    ABSTRACT: We report the case of a middle aged lady with dilated cardiomyopathy, presenting with recurrent syncope due to torsade de pointes. Further evaluation revealed that she had a pheochromocytoma which caused the arrhythmia.
    Indian heart journal 56(3):248-9.
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    ABSTRACT: To test whether patients with left bundle branch block (LBBB) and low ejection fraction (EF) have greater dyssynchrony than those with LBBB and normal LV systolic function. From a group of patients with LBBB, 38 patients with low EF (<50%) and 31 with normal LV systolic function (EF > or = 50%), all comparable in age and sex underwent standard Doppler echo, ECG and tissue Doppler imaging (TDI). The precontraction time (PCTm) was calculated as an index of myocardial systolic activation in 5 different basal myocardial segments (LV anterior, inferior, septal, lateral walls and RV lateral wall). Intraventricular systolic dyssynchrony was analyzed by difference of PCTm in different LV myocardial segments. Interventricular activation delay was calculated by the difference of PCTm between the most delayed LV segment and RV lateral wall. Patients with low LV EF showed increased QRS duration, intraventricular delay (p = 0.03) and interventricular dyssynchrony (p = 0.006). Patients with normal EF also had evidence of some dyssynchrony. The LV basal lateral segment was significantly delayed when compared to all other segments in the low EF group. The PCTm was greater for those with low EF when compared to the normal EF group. All patients with LBBB on baseline ECG had some degree of cardiac dyssynchrony; those with lower EF had more dyssynchrony. TDI is an effective non-invasive technique for assessing the severity of regional delay in activation of ventricular walls in patients with LBBB.
    Indian heart journal 60(6):567-73.