[Show abstract][Hide abstract] ABSTRACT: To review the clinical experience, complications and outcome of Cardiac Electrophysiology Studies and Catheter Radiofrequency Ablation in treatment of supraventricular tachycardias in Karachi.
A retrospective review of records of all patients who underwent an electrophysiological study and radiofrequency ablation at National Institute of Cardiovascular Diseases and Aga Khan University Hospital from 2005 to 2007 was performed. Patient's demographics, disease and procedural data were collected and analyzed using SPSS.V.II.
We enrolled 168 patients, 150 (89%) from National Institute of Cardiovascular Diseases and 18 (11%) from Aga Khan University Hospital. Sample had 86 (51%) male participants. The mean age was 43 +/- 15 years. Indications for procedure were recurrent supraventricular tachycardias (89.9%), Wolff Parkinson White Syndrome with atrial fibrillation (5.9%), syncope (2.4%), and wide QRS tachycardia (1.8%). Final diagnosis was Wolff Parkinson White Syndrome in 80 (48%) and Atriovetricular Nodal Reentrant Tachycardia in 88 (52%). The accessory pathway in Wolff Parkinson White Syndrome was located on left side in 61% of cases and on right side in 39% of cases. Overall acute success rate for Radio Frequency ablation was 90%. Success rate for ablation of accessory pathway in Wolff Parkinson White Syndrome was 85% while that for ablation of slow pathway in AV node re-entrant tachycardia was 95%. Complications occurred in one case.
Electro Physiology Studies and Radiofrequency ablation proved to be a safe and effective method for diagnosis and treatment of supraventricular tachycardias in our patients.
Journal of the Pakistan Medical Association 02/2011; 61(2):173-5. · 0.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Cardiac pacing is a recognized and widely used treatment for patients presenting with bradycardia. Physicians expect patients to return to normal activities almost immediately post implantation. However, patients themselves may perceive interference to pacemaker function by various routine activities and devices, and hence continue to lead restricted, disabled lives. The aim of this study is to determine if routine activities are perceived by pacemaker patients to interfere with their device function.
A descriptive cross sectional survey was carried out on consecutive patients at the pacemaker clinic at a public hospital in Karachi, Pakistan. A 47-question tool was developed and tested. Patients' perceptions of safety of performing various routine activities, along with socio-demographic data were recorded.
The final sample included 93 adult patients (45% males). 41% were illiterate. 77.4% recalled receiving counselling at implantation, predominantly from the implanting physician and house staff. A considerable proportion of patients considered many routine activities unsafe including driving automobiles (28%), passing through metal detectors (31%), bending over (37%), and sleeping on the side of the pacemaker (30%). Also considered unsafe were operation of household appliances--TV/VCR (television/video cassette recorders) (53%), irons (55%)) and electrical wall switches (56%). For nearly all variables neither literacy nor history of counselling improved incorrect perceptions.
This study shows that our pacemaker patients perceive many routine activities as unsafe, potentially leading to disabling life style modifications. The tremendous investment in pacemaker technology to improve patient performance is not going to pay dividends if patients continue to remain disabled due to incorrect perceptions. Further studies are required to determine the reasons for these misperceptions, and to determine if these problems also exist in, and hinder, other patient populations.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the safety and role of prophylactic administration of magnesium in preventing arrhythmias.
This double blind randomized placebo controlled clinical trial was conducted at Aga Khan University Hospital on coronary artery bypass surgery patients. All patients were connected to holter monitor before induction of anaesthesia and this monitoring continued for 24 hours. Study drug containing either 2-grams of magnesium or normal saline was given after intubation. Levels of serum magnesium was checked preoperatively and then in ICU at 0, 6, 12, and 24 hours. Independent t-test and chi square test were used for analysis. Statistical significance was defined as p-value < 0.05.
A total of 104 patients consented to participate in the study, 53 patients were randomly allocated in magnesium (Mg) group and 51 in placebo group. Two (3.77%) patients in magnesium group and five patients (9.8%) in placebo group developed atrial fibrillation. Incidence of ventricular and supraventricular tachycardia was also slightly higher in placebo. Mg level after arrival in CICU (Cardiac Intensive Care Unit) showed mean of 2.1 in magnesium group and 1.6 in placebo group (p = 0.6).
Low magnesium levels were noticed in the placebo group after cardiopulmonary bypass and although prophylactic administration of magnesium sulphate was relatively safe but significant benefit on prevention of arrhythmias could not be attained.
Journal of the Pakistan Medical Association 01/2008; 58(1):22-7. · 0.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To assess whether a test of stair climbing ability could be used to predict the risk of developing postoperative cardiopulmonary complications in patients undergoing general anesthesia.
The Aga Khan University Hospital, Karachi. The duration of the study was from December 2003 to December 2004.
This study was carried out on consecutive, adult patients presenting for elective thoracic or abdominal surgery under general anesthesia. Pre-operatively, patients were asked to climb a standard staircase. Number of steps climbed was recorded. Those unable to climb stairs due to debilitating cardiac, pulmonary or rheumatologic disease were categorized as 0 stairs climbed. Outcome variables were postoperative cardiopulmonary complications or mortality. Period of follow-up was until hospital discharge.
Seventy-eight patients were enrolled, 59 (75.6%) climbed 1 flight of stairs, 19 (24.3%) climbed < 1 flight. All-cause cardiopulmonary complications rate was 26 %. The most frequent complication was lobar atelectasis, followed by bronchospasm and acute MI. The complication rate was 22.8% in those able to climb 1 flight and 40% in those patients who climbed < 1 flight. The group that climbed < 1 flight tended to have complications associated with poor reserves of the cardiopulmonary systems, i.e. pulmonary edema, exacerbation of underlying lung disease. The relative risk of developing complications, if unable to climb at least 1 flight of stairs, was calculated to be 1.8 (95% CI 0.7 - 4.6).
Stair climbing can be a useful pre-operative tool to predict the risk of postoperative cardiopulmonary complications.
Journal of the College of Physicians and Surgeons--Pakistan: JCPSP 12/2005; 15(12):761-4. · 0.32 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Clinical and echocardiographic features of significant pericardial effusion (PE) have been reported from the west. Currently there is lack of published data from this part of the world, we reviewed all consecutive cases of significant PE requiring echocardiographic assisted pericardiocentesis to analyze the clinical and echocardiographic features of these patients.
Forty four consecutive patients who underwent echocardiography assisted pericardiocentesis at the Aga Khan University Hospital (AKUH) between January 1988 and May 2001" re included in this review.
Most common presenting symptoms were dyspnea (89%) and fever (36%). Elevated JVP and pulsus paradoxus were documented in 59% and 41% of patients respectively. Sinus tachycardia (75%) and low voltage (34%) were the most common ECG findings. Malignancy (45-51%) and tuberculosis (27%) were among the most frequent causes of PE. One patient died during echocardiography-assisted pericardiocentesis.
The symptoms and physical findings of haemodynamically significant PE are frequently nonspecific. Transthoracic echocardiography is the gold standard for rapid and confirmatory diagnosis of PE and cardiac tamponade. The most common cause of PE was malignancy followed by tuberculosis. Pericardiocentesis under echocardiographic guidance is a safe and effective treatment for significant PE.
Journal of the Pakistan Medical Association 03/2005; 55(2):66-70. · 0.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Intra-aortic balloon counterpulsation (IABC) has an established role in the treatment of patients presenting with critical cardiac illnesses, including cardiogenic shock, refractory ischemia and for prophylaxis and treatment of complications of percutaneous coronary interventions (PCI). Patients requiring IABC represent a high-risk subset with an expected high mortality. There are virtually no data on usage patterns as well as outcomes of patients in the Indo-Pakistan subcontinent who require IABC. This is the first report on a sizeable experience with IABC from Pakistan.
Hospital charts of 95 patients (mean age 58.8 (+/- 10.4) years; 78.9% male) undergoing IABC between 2000-2002 were reviewed. Logistic regression was used to determine univariate and multivariate predictors of in-hospital mortality.
The most frequent indications for IABC were cardiogenic shock (48.4%) and refractory ischemia (24.2%). Revascularization (surgical or PCI) was performed in 74 patients (77.9%). The overall in-hospital mortality rate was 34.7%. Univariate predictors of in-hospital mortality included (odds ratio [95% CI]) age (OR 1.06 [1.01-1.11] for every year increase in age); diabetes (OR 3.68 [1.51-8.92]) and cardiogenic shock at presentation (OR 4.85 [1.92-12.2]). Furthermore, prior CABG (OR 0.12 [0.04-0.34]), and in-hospital revascularization (OR 0.05 [0.01-0.189]) was protective against mortality. In the multivariate analysis, independent predictors of in-hospital mortality were age (OR 1.13 [1.05-1.22] for every year increase in age); diabetes (OR 6.35 [1.61-24.97]) and cardiogenic shock at presentation (OR 10.0 [2.33-42.95]). Again, revascularization during hospitalization (OR 0.02 [0.003-0.12]) conferred a protective effect. The overall complication rate was low (8.5%).
Patients requiring IABC represent a high-risk group with substantial in-hospital mortality. Despite this high mortality, over two-thirds of patients do leave the hospital alive, suggesting that IABC is a feasible therapeutic device, even in a developing country.
[Show abstract][Hide abstract] ABSTRACT: To analyze the characteristics and in-hospital outcome of patients with cardiogenic shock (CS) complicating acute myocardial infarction (AMI) and to evaluate the influence of urgent coronary revascularization on in-hospital mortality.
Descriptive study. Place and Duration of Study: The Aga Khan University Hospital, Karachi. January 2001 to December 2001. Materials and Methods: All consecutive patients with AMI and CS, admitted at The Aga Khan University Hospital, Karachi Pakistan, during the year 2001 were reviewed. A pre-designed questionnaire was used for data collection. Analysis was done using the SPSS statistical package.
Out of 615 patients with AMI, 53 (8.6%) had CS. Mean age was 60.9 +10.7 years. 62.3% were men, 52.8% were hypertensive and 43.4% were diabetic. Most infarcts were anterior in location (56.6%). Thrombolytic therapy (Streptokinase) was administered to 43.5% of patients with ST segment elevation myocardial infarction. 64.2% required ventilatory support while swan ganz was used in 37.7%. Intra-aortic balloon pump was inserted in 39.6%. Ventricular tachycardia was the most common complication (39.6%). Overall in-hospital mortality was 54.7%. CS associated with mechanical complications had 80% in-hospital mortality. In patients without mechanical complications (n=48), in-hospital mortality was significantly lower in the revascularization group (31.6% vs. 65.5%, p-value = 0.021). However, there were significant differences in the baseline characteristics in the two groups because of the selection bias.
CS occurring in patients with AMI has an extremely poor prognosis. Patients selected for revascularization strategy has favorable in-hospital outcome.
Journal of the College of Physicians and Surgeons--Pakistan: JCPSP 02/2004; 14(1):6-9. · 0.32 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Pacemaker-mediated tachycardia (PMT) is an arrhythmia seen in patients implanted with dual-chamber pacemakers. It occurs when ventricular contraction is followed by retrograde conduction to the atrium, which is sensed by the pacemaker, leading to ventricular triggering. A vicious re-entry cycle is set up, leading to incessant tachycardia unless appropriately terminated. A common precipitant is a premature ventricular contraction (PVC). Although PVCs are frequently generated during ventriculography, PMT is an extremely rare event during cardiac catheterisation despite the fact that a large number of patients with implanted pacemakers do undergo the procedure. We report on a case and hope to highlight the possibility of PMT occurring during catheterisation, as well on therapeutic options.
Cardiovascular journal of Africa 19(1):31-2. · 0.79 Impact Factor