Nicholas Sunderland

Verified

Nicholas verified their affiliation via an institutional email.

Learn more

Verified

Nicholas verified their affiliation via an institutional email.

Learn more

• MA, BMBCh, MRCP
• PhD Student at University of Bristol

Over the last few years, several groups have evaluated the potential of microRNAs (miRNAs) as biomarkers for cardiometabolic disease. In this review, we discuss the emerging literature on the role of miRNAs and other small noncoding RNAs in platelets and in the circulation, and the potential use of miRNAs as biomarkers for platelet activation. Plat...

Aims Dual-coil implantable cardioverter defibrillator (ICD) leads have traditionally been used over single-coil leads due to concerns regarding high defibrillation thresholds (DFT) and consequent poor shock efficacy. However, accumulating evidence suggests that this position may be unfounded and that dual-coil leads may also be associated with high...

Purpose Randomised trials have shown that empiric ICD programming, using long detection times and high detection zones, reduces device therapy in ICD recipients. However, there is less data on its effectiveness in a “real-world” setting, especially secondary prevention patients. Our aim was to evaluate the introduction of a standardised programming...

Rationale: Platelets shed microRNAs (miRNAs). Plasma miRNAs change upon platelet inhibition. It is unclear if plasma miRNA levels correlate with platelet function. Objective: To link small RNAs to platelet reactivity. Methods and results: Next-generation sequencing of small RNAs in plasma revealed two peaks at 22-23 and 32-33 nucleotides corre...

Large-scale implantable cardioverter defibrillator (ICD) trials have unequivocally shown a reduction in mortality in appropriately selected patients with heart failure and depressed left ventricular function. However, there is a strong association between shocks and increased mortality in ICD recipients. It is unclear if shocks are merely a marker...

Background Out-of-hospital cardiac arrest (OHCA) is associated with very poor clinical outcomes. An optimal pathway of care is yet to be defined, but prognostication is likely to assist in the challenging decision-making required for treatment of this high-risk patient cohort. The MIRACLE2 score provides a simple method of neuro-prognostication but...

Background: Although electronic health records (EHR) provide useful insights into disease patterns and patient treatment optimisation, their reliance on unstructured data presents a difficulty. Echocardiography reports, which provide extensive pathology information for cardiovascular patients, are particularly challenging to extract and analyse, be...

Background Between 50-90% of patients suffering from out-of-hospital cardiac arrest (OHCA) have a primary cardiac aetiology of arrest with the presence of a culprit coronary lesion. However, recent trials have failed to show a benefit from an early invasive angiographic approach following OHCA. Identification of patients with high likelihood of a c...

Background: Although electronic health records (EHR) provide useful insights into disease patterns and patient treatment optimisation, their reliance on unstructured data presents a difficulty. Because of their narrative structure, echocardiography reports, which provide extensive pathology information for cardiovascular patients, are particularly...

Objective/background: We compared the discrimination performance of the MIRACLE2 score, downtime and current randomized control trial (RCT) recruitment criteria in predicting poor neurological outcome after out-of-hospital cardiac arrest (OHCA). Methods: We used the European Cardiac Arrest Registry (EUCAR), a retrospective cohort from 6 centres...

Background: We aimed to develop a machine learning algorithm to predict the presence of a culprit lesion in patients with out-of-hospital cardiac arrest (OHCA). Methods: We used the King's Out-of-Hospital Cardiac Arrest Registry, a retrospective cohort of 398 patients admitted to King's College Hospital between May 2012 and December 2017. The pr...

Aims To define the cohort of adult congenital heart disease (ACHD) patients undergoing catheter ablation for supraventricular arrhythmia in a large tertiary centre, characterise outcomes, and determine factors associated with arrhythmia recurrence. Methods Single centre retrospective study of all catheter ablations for atrial arrhythmias in ACHD p...

Atrial fibrillation (AF) is the most common cardiac dysrhythmia and percutaneous catheter ablation is widely used to treat it. Panoramic mapping with multi-electrode catheters has been used to identify ablation targets in persistent AF but is limited by poor contact and inadequate coverage of the left atrial cavity. In this paper, we investigate th...

Introduction: Atrial fibrillation (AF) is the most prevalent cardiac dysrhythmia and percutaneous catheter ablation is widely used to treat it. Panoramic mapping with multi-electrode catheters can identify ablation targets in persistent AF, but is limited by poor contact and inadequate coverage. Objective: To investigate the accuracy of inverse map...

Objectives The purpose of this study was to evaluate the impact of performing immediate coronary angiography (CAG) after out-of-hospital cardiac arrest (OHCA) with stratification of predicted neurologic injury and cardiogenic shock on arrival to a center. Background The role of immediate CAG for patients with OHCA is unclear, which may in part be...

Background: Early prediction of long-term outcomes after out-of-hospital cardiac arrest (OOHCA) remains a diagnostic challenge. MIRACLE2 is a points-based risk score that has been derived as a simple tool to aid clinicians in prognosticating those at high risk of poor neurological outcomes. To date, the score has been validated in two independent c...

Funding Acknowledgements Type of funding sources: None. Background Heart rhythm disorders are an important cause of morbidity and emergency hospitalisation in patients with adult congenital heart disease (ACHD), and this is due to a combination of surgical scar, residual haemodynamic lesions, and cardiac chamber dilatation. The most effective avai...

Background The Gerbode defect is a rare abnormal communication between the left ventricle (LV) and right atrium (RA). The lesion is either congenital or acquired. Acquired defects are largely iatrogenic or infective in origin. We present two cases of acquired Gerbode defects with similar clinical presentations but very different outcomes. Case su...

Background Life-threatening arrhythmias (LTAs) can trigger sudden cardiac death or provoke implantable cardioverter-defibrillator (ICD) discharges that escalate morbidity and mortality. Longitudinal myofibrils predominate in the subendocardium, which is uniquely sensitive to arrhythmogenic triggers. In this study, we test the hypothesis that mitral...

Background Life threatening arrhythmias (LTA) can trigger sudden cardiac death, or provoke implantable cardioverter defibrillator (ICD) discharges that escalate morbidity and mortality. Longitudinal myofibrils predominate in the subendocardium which is uniquely sensitive to arrhythmogenic triggers. Objectives To test the hypothesis that mitral ann...

Background One determinant of failure of atrial fibrillation (AF) ablation is the lack of transmural lesions. Contact force sensing (CFS) catheters enable real-time assessment of the amount of force applied at the catheter-tissue interface, with higher contact force associated with lesions of greater size. Previous meta-analyses have pooled results...

BACKGROUND: ST2 is a circulating biomarker that is well established for predicting outcome in heart failure (HF). This is the first study to look at ST2 concentrations in optimally treated patients with stable but significant left ventricular systolic dysfunction (LVSD) compared to patients with severe aortic stenosis (AS). METHODS: Two cohorts wer...

An 83-year-old woman, with a background of treated squamous cell oesophageal cancer, presented with a 3-week history of stridor. Of note, the patient had no risk factors for oesophageal cancer other than age. Clinical examination was unremarkable apart from stridor. Laboratory investigations, including arterial blood gas on room air, were unremarka...

Background: Hypertensive urgency is defined as a severely elevated systolic blood pressure (SBP) of ≥ 180 mmHg and/or diastolic blood pressure (DBP) of ≥ 120 mmHg, in the absence of end organ damage. It is known that there are racial differences in prevalence and severity of hypertension but there is a dearth of studies looking at hypertensive urg...

Management of hypertensive urgencies

Hypertensive Urgency (HU) is characterised by a severely elevated systolic blood pressure (SBP greater than or equal to180/DBP greater than or equal to120 mmHg), in the absence of life-threatening end-organ damage HU is common in the Black population. Methods: We conducted a single central retrospective cohort study of consecutive Black and Afro-C...

Purpose: Patients at high non-sudden cardiac death risk may gain no significant benefit from implantable cardioverter-defibrillator (ICD) therapy. A number of approaches have been proposed to identify these patients, including single clinical markers and more complex scoring systems. The aims of this study were to use the proposed scoring systems...

Aims Dual-coil implantable cardioverter defibrillator (ICD) leads have traditionally been used over single-coil leads due to concerns regarding high defibrillation thresholds (DFT) and consequent poor shock efficacy. However, accumulating evidence suggests that this position may be unfounded and that dual-coil leads may also be associated with high...

Background With subcutaneous ICDs (S-ICD) not offering the same range of pacing therapies as transvenous systems (T-ICD), it is unclear how many ICD recipients may be suitable for a S-ICD. In addition, the benefit from ICD therapy is dependent on non-sudden cardiac death (SCD) risk. The study aims were to [1] establish how many ICD recipients may b...

NSAID-related AKI. A cautionary tale of NSAID use in hypovolaemic septic patients.

AIM We aimed to assess the performance of an age-adjusted cut-off value for D-dimer in the management of patients with suspected Pulmonary Embolism (PE), and the potential impact on the number of Computed Tomography Pulmonary Angiogram (CTPA) scans requested. METHODS & RESULTS We conducted a retrospective cohort study of 434 consecutive patients un...

A 56-year-old man presented having had two falls at home. He had a background of multiple sclerosis. After his second fall, during which he had fallen onto the toilet injuring his right chest, he was brought into the emergency department reporting pleuritic chest discomfort. Immediately evident was extensive swelling from his forehead to his thighs...

Obtaining vascular access presents a challenge in certain hospital patients, and junior doctors are often tasked with cannulating such patients. Ultrasound (US) technology is a tool becoming increasingly available in this setting. A novel course was delivered in order to provide junior doctors with an introduction to US equipment and hands-on exper...

CASE: An 83-year-old female with a background of treated oesophageal cancer presented with a three-week history of stridor (refer to voice-clip). Clinical evaluation was unremarkable. Radiology (see below) revealed a 4.5 x 3.5 x 3.6cm mass involving the posterior trachea and invading the tracheal orifice. Subsequent bronchoscopy confirmed 90% airwa...

Introduction Severe Aortic stenosis (AS) and non-valvular heart failure (HF) appear to have different pathological processes, and therefore cardiac remodelling is likely to involve different pathways. Novel biomarkers have been developed to assess prognosis, response to treatment and also to understand the underlying mechanism of cardiac remodellin...

Aims Randomised trials have shown that empiric ICD programming, using long detection times and high detection zones, reduces device therapy in ICD recipients. However, there is less data on its effectiveness in a “real-world” setting, especially secondary prevention patients. Our aim was to evaluate the introduction of a standardised programming pr...

Aims: Randomised trials have shown that empiric ICD programming, using long detection times and high detection zones, reduces device therapy in ICD recipients. However, there is less data on its effectiveness in a “real-world” setting, especially secondary prevention patients. Our aim was to evaluate the introduction of a standardised programming p...

Re-expansion pulmonary oedema (REPO) is a rare complication of pleural fluid thoracocentesis and has been associated with a high mortality rate. There is limited evidence to inform on its most effective management. We present two cases of large volume thoracocentesis resulting in acute respiratory decompensation that was treated by reintroducing th...

YouTube contains a large volume of medical educational material. This study assessed the quality of respiratory auscultation videos contained in YouTube. Videos were searched for using the terms 'breath sounds', 'respiratory sounds', 'respiratory auscultation' and/or 'lung sounds'. In total, 6,022 videos were located, 36 of which were considered su...

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and its prevalence is similar to 1-2% of the general population, but higher with increasing age and in patients with concomitant heart disease. The Cox-maze III procedure was a groundbreaking development and remains the surgical intervention with the highest cure rate, but due...

YouTube is a highly utilized Web site that contains a large amount of medical educational material. Although some studies have assessed the education material contained on the Web site, little analysis of cardiology content has been made. This study aimed to assess the quality of videos relating to heart sounds and murmurs contained on YouTube. We...

Background: Despite being the gold-standard for investigations, randomised controlled trials can deliver biased results if methodology is flawed. The CONSORT statements are intended to guide the reporting of trials. We assessed the reporting quality of anti-arrhythmic drug trials over the last decade. Methods: Medline and Embase databases were s...

A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was: In [adults undergoing a maze procedure for atrial fibrillation (AF)], [does left atrial size reduction] compared to [maze surgery alone] improve [maze surgery success]? A total of 58 papers were found using the reported search...

A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was in adults with atrial fibrillation (AF), what preoperative size of left atrium impairs maze surgery success in terms of recurrence of AF. Altogether 422 papers were found using the reported search, of which 12 represented the b...

Hypertension is associated with heightened cardiac sympathetic drive whilst statins reduce angiotensin II (ATII) signalling, superoxide anion production and increase nitric oxide bioavailability, events that can potentially reduce peripheral cardiac sympathetic neurotransmission. We therefore investigated whether pravastatin alters peripheral cardi...

Hypertension is associated with heightened sympathetic tone and increased renin‐angiotensin system activity. Recent evidence suggests statins can reduce angiotensin 2 (AT2) signalling independent of cholesterol lowering. We therefore investigated whether 2 weeks treatment with pravastatin (100mg/L in drinking water, n=41 v's n=32 control) could alt...