Joseph de Bono

Joseph de Bono
University Hospitals Birmingham NHS Foundation Trust | uhb · Department of Cardiology

About

85
Publications
12,347
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2,912
Citations
Citations since 2017
13 Research Items
1397 Citations
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2017201820192020202120222023050100150200250
2017201820192020202120222023050100150200250
2017201820192020202120222023050100150200250

Publications

Publications (85)
Article
Full-text available
Purpose of review: Ventricular arrhythmias are common in patients with heart failure. Their management especially in the context of decompensated heart failure poses a clinical challenge to modern cardiologists. In this review article, we aim to summarise the current evidence on the epidemiology, pathophysiology, and management of ventricular tach...
Article
Full-text available
Aims: It is recommended to perform atrial fibrillation ablation with continuous anticoagulation. Continuous apixaban has not been tested. Methods and results: We compared continuous apixaban (5 mg b.i.d.) to vitamin K antagonists (VKA, international normalized ratio 2-3) in atrial fibrillation patients at risk of stroke a prospective, open, mult...
Conference Paper
Purpose The subcutaneous implantable cardiac defibrillator ICD (S-ICD) has been developed to reduce the risk of lead complications in patients requiring prophylactic ICDs. It has also been recommended for patients with adult congenital heart disease (ACHD) who are at risk of sudden cardiac death (SCD) and often have complex cardiac anatomy, prevent...
Article
Full-text available
AMPK is a conserved serine/threonine kinase whose activity maintains cellular energy homeostasis. Eukaryotic AMPK exists as αβγ complexes, whose regulatory γ subunit confers energy sensor function by binding adenine nucleotides. Humans bearing activating mutations in the γ2 subunit exhibit a phenotype including unexplained slowing of heart rate (br...
Article
Background: Cardiac resynchronisation therapy (CRT) is a well-recognised treatment in systolic heart failure. There is limited evidence in congenital patients with univentricular hearts or systemic right ventricles. In 2014 PACES/HRS published a consensus statement recommending CRT if ventricular ejection fraction (EF)≤35%, QRS duration≥150ms (wit...
Article
Full-text available
Arrhythmias are common in adults with congenital heart disease and account for a large proportion of hospitalizations. The complex anatomical heterogeneity, often in the presence of a delicate hemodynamic system, presents a significant electrophysiological challenge. This review outlines current clinical practice and advances in maximizing the effe...
Article
Introduction Atrial arrhythmias are strongly associated with thromboembolism with 1 in 5 strokes being attributed to atrial fibrillation (AF). Patients with adult congenital heart disease (ACHD) are at an increased risk of developing atrial arrhythmias compared to those with structurally normal hearts either due to the inherent cardiac anomaly or d...
Article
Aims Ventricular arrhythmias are a major cause of mortality in adult congenital heart disease (ACHD) patients. The European Society of Cardiology guidelines state that implantable cardioverter-defibrillators (ICD) should be considered in patients with congenital heart disease following spontaneous sustained ventricular tachycardia (VT) or cardiac a...
Article
Introduction Atrial tachyarrhythmia is regarded as a late consequence of the Fontan circulation, particularly in those with an AP Fontan and is associated with significant morbidity and mortality. Developing methods to recognise those at the highest risk will allow early intervention, improving patient outcomes. Purpose To establish relationship be...
Article
Background Atrial fibrillation (AF) has a prevalence of 1.6% in the UK and significantly increases the risk of developing a stroke. Adults with congenital heart disease have an increased risk of developing arrhythmias, a leading cause of morbidity and mortality in these patients. CHADSVASC scoring system is a recommended tool for assessing thromboe...
Article
Background Atrial fibrillation (AF) is one of the most common sustained tachyarrhythmias. It increases risk of developing stroke by up to five times. There is an increased incidence in patients with adult congenital heart disease (ACHD). The CHA2DS2VASC scoring system is validated for assessing the risk of ischaemic stroke in AF in the general popu...
Chapter
This chapter first provides a background of atrial fibrillation (AF), and then deals with the management of a patient with AF and prevention of complications. AF is the most common cardiac arrhythmia, and its increases with advancing age. The adverse consequences of AF are related to reduced cardiac output and to thromboembolic manifestations. The...
Article
Full-text available
Aims The clinical response to cardiac resynchronization therapy (CRT) is variable. Multipoint left ventricular (LV) pacing could achieve more effective haemodynamic response than single-point LV pacing. Deployment of an LV lead over myocardial scar is associated with a poor haemodynamic response to and clinical outcome of CRT. We sought to determin...
Article
The Fontan procedure provides palliation for patients with complex congenital heart disease. A late complication is the development of a pro-arrhythmogenic environment. Modifications to the surgical technique try and reduce the incidence of late arrhythmia. This study aims to establish incidence and outcome of arrhythmias in Fontan patients with lo...
Article
Full-text available
Chemokine signalling drives monocyte recruitment in atherosclerosis and aortic aneurysms. The mechanisms that lead to retention and accumulation of macrophages in the vascular wall remain unclear. Regulator of G-Protein Signalling-1 (RGS1) deactivates G-protein signalling, reducing the response to sustained chemokine stimulation. Here we show that...
Article
The number of percutaneous coronary interventions (PCI) performed annually has increased rapidly over the last two decades. Coronary angioplasties are now commonly complemented with the insertion of coronary artery stents. Initially bare metal stents (BMS) were developed with drug-eluting stents (DES) subsequently being introduced. Drug-eluting ste...
Article
Full-text available
Atrial fibrillation (AF) is a global health problem. The condition brings an increased risk of stroke, systemic embolism, and heart failure (HF) and is associated with impaired quality of life, frequent hospitalizations, and mortality.[1][1] Observational studies have been the main source of
Article
Introduction The Fontan procedure provides effective palliation to support the systemic circulation in patients with a functionally single ventricle. It is associated with the formation of a pro-arrhythmogenic environment, due to surgical scar and subsequent haemodynamic abnormalities. These patients now survive into late adulthood, but a significa...
Article
Background Sustained ventricular tachycardia (VT) and cardiac arrest are a major cause of mortality in adult congenital heart disease patients. Implantable cardioverter defibrillators (ICD) can protect against this. ESC guidelines state that ICDs should be considered following spontaneous sustained VT and in all survivors of cardiac arrest; and in...
Conference Paper
Full-text available
The regulation of macrophage recruitment and retention into the vascular wall is critical in the progression of atherosclerosis and aortic aneurysm formation. This can be mediated by chemokine activation of multiple G-protein coupled receptors. The Regulator of G-Protein Signalling-1 (RGS1) acts to deactivate the intracellular response to sustained...
Article
Full-text available
Aims The current challenge in atrial fibrillation (AF) treatment is to develop effective, efficient, and safe ablation strategies. This randomized controlled trial assesses the medium-term efficacy of duty-cycled radiofrequency ablation via the circular pulmonary vein ablation catheter (PVAC) vs. conventional electro-anatomically guided wide-area c...
Article
Full-text available
Despite the advent of non-fluoroscopic technology, fluoroscopy remains the cornerstone of imaging in most interventional electrophysiological procedures, from diagnostic studies over ablation interventions to device implantation. Moreover, many patients receive additional X-ray imaging, such as cardiac computed tomography and others. More and more...
Article
Arrhythmias in adults with congenital heart disease, most commonly related to previous surgical procedures, are a frequent comorbidity in this growing population thanks to the improved outcome of surgical techniques. Re-entrant circuits around areas of scarring and natural barriers, combined with abnormal haemodynamics and the underlying anatomy, a...
Article
Full-text available
Atrial fibrillation (AF) is generally considered a progressive disease, typically evolving from paroxysmal through persistent to 'permanent' forms, a process attributed to electrical and structural remodelling related to both the underlying disease and AF itself. Medical treatment has yet to demonstrate clinical efficacy in preventing progression....
Article
Full-text available
Aims Absolute risk reduction (ARR) and number needed to treat (NNT) are considered by many to be the most appropriate figures to use for the informed consent process, yet the results of published implantable cardioverter defibrillators (ICD) trials are frequently presented as relative risk reduction or odds ratio. The period over which risk reducti...
Article
Rationale: Creatine is thought to be involved in the spatial and temporal buffering of ATP in energetic organs such as heart and skeletal muscle. Creatine depletion affects force generation during maximal stimulation, while reduced levels of myocardial creatine are a hallmark of the failing heart, leading to the widely held view that creatine is i...
Article
Full-text available
Clinical markers of cardiac autonomic function, such as heart rate and response to exercise, are important predictors of cardiovascular risk. Tetrahydrobiopterin (BH4) is a required cofactor for enzymes with roles in cardiac autonomic function, including tyrosine hydroxylase and nitric oxide synthase. Synthesis of BH4 is regulated by GTP cyclohydro...
Article
This editorial refers to ‘Propofol sedation administered by cardiologists without assisted ventilation for long cardiac interventions: an assessment of 1000 consecutive patients undergoing atrial fibrillation ablation’ by T.V. Salukhe et al. , on page 325 The recent unfortunate death of the singer Michael Jackson as a result of suspected propofol...
Article
Regular physical exercise reduces the risk of cardiovascular disease and improves outcome in patients with cardiovascular diseases. The dynamic changes in blood pressure and heart rate with acute exercise are independently predictive of prognosis. Quantification of the haemodynamic response to exercise training in genetically modified mouse models...
Article
Full-text available
Mitral isthmus (MI) ablation is technically challenging, requiring long endocardial ablation times and frequently coronary sinus (CS) ablation. The circumflex artery lies in the epicardium in close proximity to the CS and the mitral annulus and may potentially be injured during radiofrequency ablation. Fifty-four patients underwent catheter ablatio...
Article
Full-text available
Ensuring complete block after left atrial (LA) linear lesions is important as partial block may be pro-arrhythmic. Techniques to confirm roof line block may be time consuming and challenging and have not been well described. This study investigates whether local activation times (LAT) during left atrial appendage (LAA) pacing help in the assessment...
Article
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Mitral isthmus ablation is technically challenging, often requiring both endocardial and epicardial coronary sinus (CS) ablation. Blood flow in the CS and circumflex artery may act as a 'heat sink' and reduce the efficacy of radiofrequency ablation. This study investigates how the CS and circumflex artery diameters affect mitral isthmus ablation. T...
Article
Mitral isthmus ablation is challenging. Blood flow in the coronary sinus (CS) may act as a heat sink and reduce the efficacy of radiofrequency ablation. This study investigates whether balloon occlusion of CS facilitates mitral isthmus ablation. This single-center, prospective, randomized controlled trial included patients undergoing ablation for a...
Article
Full-text available
A 40-year-old male pilot presented to the emergency department of his local hospital after experiencing palpitations. His symptoms had started 6 h earlier, while playing cricket for the village team. He reported feeling generally unwell and lightheaded, but denied chest pain or breathlessness. He had no chronic medical problems, was a non-smoker, d...
Article
Arrhythmias in adults with congenital heart disease, most commonly related to previous surgical procedures, are a frequent comorbidity in this growing population thanks to the improved outcome of surgical techniques. Re-entrant circuits around areas of scarring and natural barriers, combined with abnormal haemodynamics and the underlying anatomy, a...
Article
Cardiac devices play an important role in the treatment of heart failure. Implantable cardioverter defibrillators (ICDs) prevent sudden cardiac death from ventricular arrhythmias and prolong life in specific subgroups of patients. This article explains how to identify appropriate primary and secondary prevention patients, based on left ventricular...
Article
Full-text available
Atrial flutter (AFl) and atrial fibrillation (AFib) share many clinical risk factors and potential mechanisms with atherosclerosis. Despite this, an association between stable coronary artery disease (CAD) and atrial arrhythmias has not previously been documented. To investigate this hypothesis we measured the incidence of occult coronary atheroma...
Article
Increasing numbers of patients taking oral anticoagulation are presenting for device implantation. Cessation of anticoagulation in the perioperative period may expose patients to increased risk of thromboembolic events, while continuing anticoagulation may increase the risk of bleeding. There are few guidelines or randomized controlled trials to gu...
Article
Mitral isthmus (MI) ablation for treatment of perimitral flutter is often performed during atrial fibrillation (AF) ablation but is technically challenging. Traditional assessment of MI conduction by left atrial activation mapping while pacing from either side of the line is time-consuming, and cannot be performed during ongoing ablation. Analysis...
Article
The transcriptional adaptive response of motoneurons and muscles to voluntary exercise has been investigated by using laser capture microdissection and microarray analysis. Our results show that motoneurons respond to physical activity by activating a complex transcriptional plan, with changes involved in neurotrophic factor signalling, electrophys...
Article
Full-text available
Background: One of the recognised complications of left atrial ablation for atrial fibrillation (AF) is stroke. Left atrial (LA) thrombus, which may be dislodged by catheter manipulation, is an absolute contraindication to ablation. It is unclear whether imaging of the left atrial appendage (LAA) by transesophageal echo (TEE) is mandatory to exclud...
Article
Full-text available
Background: One of the recognised complications of left atrial ablation for atrial fibrillation (AF) is stroke. Left atrial (LA) thrombus, which may be dislodged by catheter manipulation, is an absolute contraindication to ablation. It is unclear whether imaging of the left atrial appendage (LAA) by transesophageal echo (TEE) is mandatory to exclud...
Article
Background: One of the recognised complications of left atrial ablation for atrial fibrillation (AF) is stroke. Left atrial (LA) thrombus, which may be dislodged by catheter manipulation, is an absolute contraindication to ablation. It is unclear whether imaging of the left atrial appendage (LAA) by transesophageal echo (TEE) is mandatory to exclud...
Article
Unlabelled: Discrepant results for the phenotype of mitochondrial creatine kinase knockout mice (Mt-CK(-/-)) could be due to mixed genetic background and use of non-littermate controls. We therefore backcrossed with C57BL/6J for >8 generations, followed by extensive in vivo cardiac phenotyping. Echocardiography and in vivo LV haemodynamics were pe...
Article
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Cell culture studies have implicated the oxygen-sensitive hypoxia-inducible factor (HIF) prolyl hydroxylase PHD3 in the regulation of neuronal apoptosis. To better understand this function in vivo, we have created PHD3−/− mice and analyzed the neuronal phenotype. Reduced apoptosis in superior cervical ganglion (SCG) neurons cultured from PHD3−/− mi...
Article
Full-text available
The most well-described example of an inherited speech and language disorder is that observed in the multigenerational KE family, caused by a heterozygous missense mutation in the FOXP2 gene. Affected individuals are characterized by deficits in the learning and production of complex orofacial motor sequences underlying fluent speech and display im...
Article
Full-text available
Galectin-3 (Gal-3) is a 26-kDa lectin known to regulate many aspects of inflammatory cell behavior. We assessed the hypothesis that increased levels of Gal-3 contribute to atherosclerotic plaque progression by enhancing monocyte chemoattraction through macrophage activation. Gal-3 was found to be upregulated in unstable plaque regions of carotid en...
Article
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The utility of interventional cardiology has developed significantly over the last two decades with the introduction of coronary angioplasty and stenting, with the associated antiplatelet medications. Acute coronary stent occlusion carries a high morbidity and mortality, and the adoption of therapeutic strategies for prophylaxis against stent throm...
Article
Vascular disease states are associated with endothelial dysfunction and increased production of reactive oxygen species (ROS) derived from vascular NADPH oxidases in both vascular smooth muscle cells (VSMCs) and endothelial cells. Recent evidence suggests an important role for VSMC NADPH oxidases in vascular ROS production. However, it is unclear w...
Article
Full-text available
Nitric oxide (NO) plays a key role in vascular homeostasis. Accurate measurement of NO production by endothelial nitric oxide synthase (eNOS) is critical for the investigation of vascular disease mechanisms using genetically modified animal models. Previous assays of NO production measuring the conversion of arginine to citrulline have required hom...
Article
Endothelium-dependent relaxation in conduit vessels is mediated largely by nitric oxide (NO), produced by the enzyme endothelial nitric oxide synthase (eNOS) in the presence of the cofactor tetrahydrobiopterin (BH4) and mediated through a cGMP-dependent downstream signalling cascade. Endothelial NOS regulates blood pressure in vivo, and impaired en...
Conference Paper
Full-text available
Mouse models are now widely used for studying gene function and facilitating drug discovery and development within the pharmaceutical industry. The availability of murine biomedical signals brings new challenges in terms of obtaining recordings, signal processing and analysis. Heart rate variability (HRV) is predictive of prognosis in cardiovascula...
Article
The circulating form of folic acid, 5-methyltetrahydrofolate (5-MTHF), may have beneficial effects on endothelial function; however, its mechanisms of action remain uncertain. Decreased nitric oxide (NO) bioavailability and increased vascular superoxide production in vascular disease states are due in part to endothelial NO synthase (eNOS) uncoupli...
Article
Full-text available
Regular physical exercise has beneficial effects in many human disease states, including cardiovascular diseases, cancer, and depression. Exercise training of genetically modified mouse models may provide insight into the molecular mechanisms that underlie the beneficial effects of exercise. Presently, there is relatively little understanding of th...
Article
Background: Aortic coarctation is associated with significant abnormalities of the underlying vasculature. Surgical repair, although relieving obstruction, is not a cure; patients continue to have a high risk of complications with a significantly reduced life expectancy. It has become increasingly apparent that they require regular specialised fol...
Article
Many common cardiovascular conditions preclude patients from driving for a period of time. These regulations often affect previously fit people and may have far-reaching consequences for an individual. The doctors caring for these patients are responsible for informing them of any relevant driving restrictions. We present a survey of general physic...