Publications (8)17.57 Total impact
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Article: Intraprocedural and long-term incomplete occlusion of the left atrial appendage following placement of the WATCHMAN device: a single center experience.
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ABSTRACT: Transcatheter left atrial appendage (LAA) closure with the WATCHMAN device has become one of the therapeutic options in atrial fibrillation (AF) patients who are at high risk for ischemic stroke. However, the incidence and evolution of incomplete occlusion of the LAA during and after placement of the WATCHMAN device has not been reported. Fifty-eight consecutive patients who had undergone WATCHMAN device implant were included in the study. Intraprocedural, 45-day and 12-month transesophageal echocardiogram images were reviewed and analyzed. Peridevice gap was noted in 16 (27.6%), 17 (29.3%), and 20 (34.5%) patients across the 3 time points. Intraprocedural gaps are more likely to be persistent until 12 months and become larger in size over time. New gap also occurs during follow-up even if the LAA was completely sealed at implantation. One patient had an ischemic stroke 4.7 months after implant; another patient developed a left atrial thrombus over the device 21.6 months after implant. Both patients had intraprocedural gap and discontinued warfarin therapy after the 45-day evaluation. Incomplete LAA occlusion with a gap between the WATCHMAN device surface and the LAA wall is relatively common. Intraprocedural gaps are more likely to become bigger over time and persist, while new gaps also occur during follow-up. Further studies are warranted to verify whether the presence and persistence of a peridevice gap is associated with increased risk of thromboembolic event in AF patients implanted with a WATCHMAN device.Journal of Cardiovascular Electrophysiology 11/2011; 23(5):455-61. · 3.06 Impact Factor -
Article: Left atrial appendage studied by computed tomography to help planning for appendage closure device placement.
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ABSTRACT: To quantitatively study various morphologic parameters of the left atrial appendage (LAA) by computed tomography (CT) to aid the preoperative planning and implantation of left atrial appendage closure devices. In 612 cases of patients with or without atrial fibrillation (AF), a cardiac CT study was performed. The classification of general LAA morphology included ChickenWing type (18.3%), WindSock (46.7%), Cauliflower type (29.1%), and Cactus type (5.9%). Anatomical relationship of the LAA to the left superior pulmonary vein (LSPV) were classified as high type (superior to LSPV, 30.2%), mid type (parallel to LSPV, 58.1%), and low type (inferior to LSPV, 11.7%). LAA ostium could be classified into 5 types including oval (68.9%), foot-like (10%), triangular (7.7%), water drop-like (7.7%), and round (5.7%). Two-dimensional (2D) orthogonal method was obviously not accurate for determining the LAA orifice because the measurement was often unparallel to the LAA orifice. Two-dimensional oblique method was better than 3-dimensional method in reproducibility to determine the size of LAA ostium. The diameter calculated from the perimeter of the LAA ostium was superior to the diameter from direct measurement of the LAA ostium for selecting the occluder. The morphology of the LAA and the LA ostium are extremely complex and heterogeneous. Sixty-four-channel cardiac CT could assist preoperative planning of LAA closure device placement. The diameter of the LAA ostium calculated from the perimeter is the best parameter for sizing the LAA occluder.Journal of Cardiovascular Electrophysiology 09/2010; 21(9):973-82. · 3.06 Impact Factor -
Article: The impact of statins and renin-angiotensin-aldosterone system blockers on pulmonary vein antrum isolation outcomes in post-menopausal females.
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ABSTRACT: To assess whether treatment with statins or renin-angiotensin-aldosterone system (RAAS) inhibitors as potential procedural 'augmenting agents' improved atrial fibrillation (AF) catheter ablation recurrence rates in post-menopausal females (PMFS). Five hundred and eighteen consecutive female patients had undergone AF catheter ablation from January 2005 to May 2008. Post-menopausal females were selected and procedure outcomes were compared between cohorts of PMFS treated with statins or RAAS inhibitors to untreated PMFS. Out of 408 PMFS, 36 (8.8%) were treated with a combination of RAAS inhibitors and statins, thus were excluded leaving a total of 372 (91.2%) patients in the study. Out of 372 patients, 111 (29.8%) were on statins (Group 1), 59 (15.9%) on RAAS inhibitors (Group 2), and 202 (54.3%) without RAAS inhibitors or statins [(Group 3) control population]. Over a mean follow-up time of 24 +/- 8.3 (median 25) months, 78 (70.6%) in Group 1, 38 (65.4%) in Group 2, and 139 (68.8%) in Group 3 had procedural success. Statin or RAAS inhibitor use did not predict lower recurrence rates [hazard ratio (HR): 1.26, P = 0.282 and HR: 1.14, P = 0.728, respectively]. When compared with controls, no difference in the cumulative incidence of recurrence was found with statin or RAAS inhibitors use (P = 0.385 and P = 0.761, respectively). Treatment with statins or RAAS inhibitors did not improve catheter ablation success rates among PMFS. Thereby, from a clinical standpoint, PMFS should not be started on these treatments as a procedural 'augmenting agent' at this time.Europace 03/2010; 12(3):322-30. · 1.98 Impact Factor -
Article: Long-term functional and neurocognitive recovery in patients who had an acute cerebrovascular event secondary to catheter ablation for atrial fibrillation.
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ABSTRACT: Cerebral thromboembolic event (CTE) is a possible complication of pulmonary vein antrum isolation (PVAI). The objective of this study was to report long-term functional and neurocognitive recovery in patients who had a CTE during or within 48 hours of catheter ablation. We screened 3,060 patients who underwent PVAI between January 2000 and June 2007. Out the 3,060 patients, 26 patients (0.8%) (61 +/- 8 years, 88% males) had a CTE during or within 48 hours of the procedure. We followed these 26 patients (study group) over time and assessed their functional and neurocognitive recovery status. No preferential vascular territory for the site of obstruction was found; right anterior circulation-5 patients (26%), left anterior circulation-5 patients (26%), posterior circulation-3 patients (16%), and 2 or more territories-6 patients (32%), (P-value = 0.8). The average international normalized ratio at the time of CTE was 1.33 +/- 0.4. Two patients died during the study period. At the end of 38.4 +/- 24 months follow-up, most surviving patients had complete neurocognitive and functional recovery irrespective of the severity of periprocedural stroke. Periprocedural stroke in the setting of catheter ablation for atrial fibrillation is relatively rare. When it occurs, complete functional and neurocognitive recovery over time is the likely outcome for most patients.Journal of Cardiovascular Electrophysiology 11/2009; 21(4):412-7. · 3.06 Impact Factor -
Article: Outcomes and complications of catheter ablation for atrial fibrillation in females.
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ABSTRACT: Most atrial fibrillation (AF) ablation studies have consisted predominantly of males; accordingly, there is a paucity of information on the safety and efficacy of catheter ablation in a large cohort of female AF patients. The purpose of this study was to evaluate catheter ablation for AF in female patients. From January 2005 to May 2008, 3265 females underwent pulmonary vein antrum isolation. Success rates, patient profiles, and complications were collected. Approximately 16% of our population was female (P <.001). Females were older (59 +/- 13 vs. 56 +/- 19 years; P <.01) and had a lower prevalence of paroxysmal atrial fibrillation (PAF; 46% vs. 55%; P <.001). Females failed more antiarrhythmics (4 +/- 1 vs. 2 +/- 3; P = .04) and were referred later for catheter ablation (6.51 +/- 7 vs. 4.85 +/- 6.5 years; P = .02) than males. More females failed ablation (31.5% vs. 22.5%; P = .001) and had nonantral sites of firing than males (P <.001). Female patients had 11 (2.1%) hematomas versus 27 (0.9%) in males. Five times as many males underwent catheter ablation than females. Females failed more ablations possibly because of a higher prevalence of nonantral firing, non-PAF, and longer history of AF. Females had more bleeding complications than males.Heart rhythm: the official journal of the Heart Rhythm Society 10/2009; 7(2):167-72. · 4.56 Impact Factor -
Article: Catheter ablation for atrial fibrillation: a promising therapy for congestive heart failure.
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ABSTRACT: Atrial fibrillation (AF) and congestive heart failure (CHF) are cardiovascular epidemics. Catheter ablation of AF is increasingly performed in patients with CHF. Atrioventricular junction ablation (AVJA) and pulmonary vein isolation are the two predominant ablation strategies used to treat AF patients who are refractory to drugs. In patients with CHF refractory to drugs, AVJA with a biventricular device is associated with improvement in exercise capacity and quality of life. However, in a head-to-head comparison, pulmonary vein antrum ablation was shown to be superior to AVJA. Cure of AF in patients with CHF resulted in more significant morphological and functional improvements than AVJA.Expert Review of Cardiovascular Therapy 08/2009; 7(7):779-87. -
Article: Chronicling the evolution of catheter ablation for atrial fibrillation and ventricular tachycardia.
The Journal of invasive cardiology 06/2009; 21(5):239-43. · 1.84 Impact Factor -
Article: Omega-3 polyunsaturated Fatty Acid supplementation reduced atrial fibrillation recurrence after pulmonary vein antrum isolation.
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ABSTRACT: To assess if patients treated with omega-3(n-3) polyunsaturated fatty acids (PUFAS) had lower procedural failure rates compared to an untreated population. From January 2004 to 2007, 1500 PVAI patients underwent catheter ablation. Two hundred and eighty five (19%) patients were treated with PUFAs. These patients were matched in a nested case controlled analysis. After matching, there were 129 patients in the PUFA group and 129 in the control group. Thirty-five (27.1%) patients in the study group had early recurrence vs. 57 (44.1%) in the control group p-value< 0.0001. Twenty-nine (23.2%) patients in the PUFA group vs. 41 (31.7%) in the non-PUFA group had procedural failure (p-value < 0.003). There were no significant differences in complications in the PUFA and non-PUFA groups. Patients treated with PUFAs had lower incidences of early recurrence and procedural failure compared to an untreated population.Indian pacing and electrophysiology journal 01/2009; 9(6):292-8.
Top Journals
Institutions
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2010–2011
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St. David's North Austin Medical Center
Austin, TX, USA
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