Rushil Shah, MBBS, DNB, MHS is actively pursuing a Post-Doctoral Fellowship in Cardiovascular Medicine at Stanford University, CA awarded by the prestigious American Heart Association AF SFRN.
Rushil Shah is currently engaged in several significant research projects at Stanford University such as Purkinje Fiber Modulation for treating Ventricular Fibrillation (VF), Magnetocardiography in patients with cardiac arrhythmias, MRI-guided Stereotactic Radio ablation for Ventricular Tachycardia, Creating an MRI-compatible Large animal isolated heart model (Langendorff’s Apparatus), and pulsed field ablation (PFA) of the heart. Up until now they were also working on developing a Shared Decision-Making Tool for AF Stroke Prevention as part of the ENHANCE-AF trial under Paul J. Wang, MD.
Rushil recently completed another three-year long Post-Doctoral Research Fellowship in Cardiac Electrophysiology at Johns Hopkins Medical Institutions, Baltimore, MD, United States. Rushil conducted translational research centered on advancements in Cardiac Magnetic Resonance Imaging, VT Ablation, Atrial Fibrillation, Cardiac Sarcoidosis, Cardiac Sympathetic Denervation and Hypothermia Induction in the animal experiment lab at Johns Hopkins under the supervision of Harikrishna Tandri, MD, FACC.
Rushil secured his master’s degree in Medical Immunology & Molecular Microbiology from the Johns Hopkins University Bloomberg School in Baltimore, MD, USA.
Previously, Rushil attended medical school at the Topiwala National Medical College & B.Y.L Nair Hospital in Mumbai, India and subsequently, completed his three-years of medicine residency there. Additionally, Dr. Shah has some experience of working as a Hospitalist in a Cardiology Care Unit (CCU) under the supervision of Yash Lokhandwala, MD, DM at Bandra HFH in Mumbai.
Dr. Shah recently got ECFMG-certified to actively practice medicine in the United States. Rushil is a member of the American Heart Association, Dallas, TX and the Heart Rhythm Society in Washington DC. Rushil aspires to complete his cardiology training and become a cardiac electrophysiologist here in the United States.
Honors & Awards
ECFMG Certification, Education Commission for Foreign Medical Graduates (December 06, 2022)
United States Medical Licensing Examination (USMLE) Step 2CK, Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME) (October 31, 2022)
United States Medical Licensing Examination (USMLE) Step I, Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME) (March 30, 2022)
DNB Medicine (f), Andheri Holy Spirit Hospital, Mumbai, India, Internal Medicine
MBBS, Topiwala National Medical College and BYL Nair Hospital, Mumbai, India, Medicine
MHS, Johns Hopkins University, Baltimore, MD USA, Medical Immunology & Molecular Microbiology (2018)
Paul Wang, Postdoctoral Faculty Sponsor
- Effects of Intraluminal Content on Esophageal Lesion Formation During Radiofrequency Catheter Ablation: Preliminary Data. Circulation. Arrhythmia and electrophysiology 2023: e012404
- Who Are We Missing? Reporting of Transgender and Gender-Expansive Populations in Clinical Trials. Journal of the American Heart Association 2023: e030209
- Disabilities Reporting in Cardiac Clinical Trials: How Are We Doing? Journal of the American Heart Association 2023: e029726
Determinants of acute irreversible electroporation lesion characteristics after pulsed field ablation: the role of voltage, contact, and adipose interference.
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
BACKGROUND: Pulsed field ablation (PFA) is a non-thermal ablative approach in which cardiomyocyte death is obtained through irreversible electroporation (IRE). Data correlating biophysical characteristics of IRE and lesion characteristics are limited.OBJECTIVES: To assess the effect of different procedural parameters (voltage, number of cycles (NoC), and contact) on lesion characteristics in a vegetal and animal model for IRE.METHODS: Two hundred four Russet potatoes were used. PFA lesions were delivered on 3-cm cored potato specimens using a multi-electrode circular catheter with its dedicated IRE generator. Different voltage (from 300 to 1200 V) and NoC (from 1x to 5x) protocols were used. Impact of 0.5 mm and 1 mm catheter-to-specimen distance was tested. A swine animal model was then used to validate results observed in the vegetable model. Association between V, NoC, distance and lesion depth were assessed through linear regression.RESULTS: An almost perfect linear association between lesion depth and voltage was observed (R2=0.95; p<0.001). A similarly linear relationship was observed between the NoC and lesion depth (R2=0.73; p<0.001). Compared with controls at full contact, a significant dampening on lesion depth was observed at 0.5 mm distance (1000V 2x: 2.11±0.12 vs 0.36±0.04, p<0.001; 2.63±0.10 vs 0.43±0.08, p<0.001). No lesions were observed at 1.0 mm distance.CONCLUSION: In a vegetal and animal model for IRE assessment, PFA lesion characteristics were found to be strongly dependent on voltage settings and NoC, with a quasi-linear relationship. Lack of catheter contact was associated with dampening in lesion depth.
View details for DOI 10.1093/europace/euad257
View details for PubMedID 37649337
WHO ARE WE MISSING? REPORTING OF TRANSGENDER AND GENDER EXPANSIVE POPULATIONS IN CLINICAL TRIALS
ELSEVIER SCIENCE INC. 2023: 119
View details for Web of Science ID 000990866100120
DISABILITIES REPORTING IN CLINICAL TRIALS. HOW ARE WE DOING?
ELSEVIER SCIENCE INC. 2023: 172
View details for Web of Science ID 000990866100173
Clinical Trial to Evaluate an Atrial Fibrillation Stroke Prevention Shared DecisionMaking Pathway
LIPPINCOTT WILLIAMS & WILKINS. 2022: E582-E583
View details for Web of Science ID 000928164500042
A Randomized Clinical Trial to Evaluate an Atrial Fibrillation Stroke Prevention Shared Decision-Making Pathway.
Journal of the American Heart Association
Background Oral anticoagulation (OAC) reduces stroke and disability in atrial fibrillation (AF) but is underutilized. We evaluated the effects of a novel patient-clinician shared decision-making (SDM) tool in reducing OAC patient's decisional conflict as compared to usual care. Methods and Results We designed and evaluated a new digital decision aid in a multicenter, randomized, comparative effectiveness trial, ENHANCE-AF (Engaging Patients to Help Achieve Increased Patient Choice and Engagement for AF Stroke Prevention). The digital AF SDM Toolkit was developed using patient-centered design with clear health communication principles (e.g. meaningful images, limited text). Available in English and Spanish, the toolkit included the following: 1) a brief animated video; 2) interactive questions with answers; 3) a quiz to check on understanding; 4) a worksheet to be used by the patient during the encounter; and 5) an online guide for clinicians. The study population included English or Spanish speakers with non-valvular AF and a CHA2DS2-VASc stroke score ≥1 for men or ≥2 for women. Participants were randomized in a 1:1 ratio to either Usual Care (UC) or the SDM Toolkit. The primary endpoint was the validated 16-item Decisional Conflict Scale (DCS) at 1 month. Secondary outcomes included DCS at 6 months and the 10-item Decision Regret Scale (DRS) at 1 and 6 months as well as a weighted average of Mann-Whitney U-statistics for both DCS and DRS. A total of 1001 participants were enrolled and followed at 5 different sites in the United States between 12/18/19 and 8/17/22. The mean patient age was 69 ±10years (40% females, 16.9% Black, 4.5% Hispanic, 3.6% Asian), and 50% of participants had CHA2DS2-VASc scores ≥3 (M) or ≥4 (F). The primary endpoint at 1 month showed a clinically meaningful reduction in decisional conflict: a 7-point difference in median scores between the two arms (16.4 v 9.4; Mann-Whitney U-statistics=0.550; p-value=0.007). For the secondary endpoint of 1-month DRS, the difference in median scores between arms was 5 points in the direction of less decisional regret (p-value of 0.078). The treatment effects lessened over time: at 6 months the difference in medians was 4.7 points for DCS (p-value=0.060) and 0 points for DRS (p-value=0.35). Conclusions Implementation of a novel, Shared Decision-Making Toolkit (afibguide.com; afibguide.com/clinician) achieved significantly lower decisional conflict compared to usual care in patients with AF.
View details for DOI 10.1161/JAHA.122.028562
View details for PubMedID 36342828
Quality assessment of cardiac magnetic resonance myocardial scar imaging prior to ventricular arrhythmia ablation.
The international journal of cardiovascular imaging
High-resolution scar characterization using late gadolinium enhancement cardiac magnetic resonance imaging (LGE-CMR) is useful for guiding ventricular arrhythmia (VA) treatment. However, imaging study quality may be degraded by breath-holding difficulties, arrhythmias, and implantable cardioverter-defibrillators (ICDs). We evaluated the effect of image quality on left ventricle (LV) base to apex scar interpretation in pre-VA ablation LGE-CMR. 43 consecutive patients referred for VA ablation underwent gradient-recalled-echo LGE-CMR. In ICD patients (n = 24), wide-bandwidth inversion-recovery suppressed ICD artifacts. In non-ICD patients, single-shot steady-state free-precession LGE-CMR could also be performed to reduce respiratory motion/arrhythmia artifacts. Study quality was assessed for adequate/limited scar interpretation due to cardiac/respiratory motion artifacts, ICD-related artifacts, and image contrast. 28% of non-ICD patients had studies where image quality limited scar interpretation in at least one image compared to 71% of ICD patient studies (p = 0.012). A median of five image slices had limited quality per ICD patient study, compared to 0 images per non-ICD patient study. Poorer quality in ICD patients was largely due to motion-related artifacts (54% ICD vs 6% non-ICD studies, p = 0.001) as well as ICD-related image artifacts (25% of studies). In VA ablation patients with ICDs, conventional CMR protocols frequently have image slices with limited scar interpretation, which can limit whole-heart scar assessment. Motion artifacts contribute to suboptimal image quality, particularly in ICD patients. Improved methods for motion and ICD artifact suppression may better delineate high-resolution LGE scar features of interest for guiding VA ablation.
View details for DOI 10.1007/s10554-022-02734-5
View details for PubMedID 36331683
Assessment of an ECG-Based System for Localizing Ventricular Arrhythmias in Patients With Structural Heart Disease.
Journal of the American Heart Association
Background We have previously developed an intraprocedural automatic arrhythmia-origin localization (AAOL) system to identify idiopathic ventricular arrhythmia origins in real time using a 3-lead ECG. The objective was to assess the localization accuracy of ventricular tachycardia (VT) exit and premature ventricular contraction (PVC) origin sites in patients with structural heart disease using the AAOL system. Methods and Results In retrospective and prospective case series studies, a total of 42 patients who underwent VT/PVC ablation in the setting of structural heart disease were recruited at 2 different centers. The AAOL system combines 120-ms QRS integrals of 3 leads (III, V2, V6) with pace mapping to predict VT exit/PVC origin site and projects that site onto the patient-specific electroanatomic mapping surface. VT exit/PVC origin sites were clinically identified by activation mapping and/or pace mapping. The localization error of the VT exit/PVC origin site was assessed by the distance between the clinically identified site and the estimated site. In the retrospective study of 19 patients with structural heart disease, the AAOL system achieved a mean localization accuracy of 6.5±2.6mm for 25 induced VTs. In the prospective study with 23 patients, mean localization accuracy was 5.9±2.6mm for 26 VT exit and PVC origin sites. There was no difference in mean localization error in epicardial sites compared with endocardial sites using the AAOL system (6.0 versus 5.8mm, P=0.895). Conclusions The AAOL system achieved accurate localization of VT exit/PVC origin sites in patients with structural heart disease; its performance is superior to current systems, and thus, it promises to have potential clinical utility.
View details for DOI 10.1161/JAHA.121.022217
View details for PubMedID 34612085
Incidence and Predictors of Sudden Cardiac Arrest in Sarcoidosis: A Nationwide Analysis.
JACC. Clinical electrophysiology
2021; 7 (9): 1087-1095
OBJECTIVES: This study sought to identify electrocardiographic (ECG) and clinical predictors of sudden cardiac arrest (SCA) in sarcoidosis.BACKGROUND: Sudden cardiac death (SCD) is the leading cause of death in cardiac sarcoidosis (CS) and may be the earliest manifestation of disease. Widespread or repeated advanced imaging is a challenging solution to this problem. ECG is an affordable and widely accessible modality that could help guide diagnostic approaches and risk stratification.METHODS: Data were obtained from the National Inpatient Sample (2005-2017) using International Classification of Diseases-9th Revision and -10th Revision-Clinical Modification. The primary outcome was to identify predictors of SCA, whereas predictors of SCA in young individuals and those with normal ventricular function served as secondary measures. Furthermore, temporal trends in sarcoidosis as well as SCA were also analyzed. Logistic regression analysis was used to calculate odds ratios, following which a multivariable regression was used to adjust for potential confounders.RESULTS: Electrocardiographic markers of AV node dysfunction or bundle branch block are associated with substantially increased risk of SCA in a limited proportion of patients (8.6%). This association is also observed among younger patients (<40 years) and those with normal ventricular function.CONCLUSIONS: ECG evidence of AV nodal dysfunction or distal conduction disease should raise suspicion for cardiac involvement in patients with sarcoidosis and are associated with increased risk of SCA. ECG markers could help identify patients who would benefit from advanced imaging. The sensitivity of ECGs is, however, limited and presence of a normal ECG does not reflect a low risk of SCA.
View details for DOI 10.1016/j.jacep.2021.01.022
View details for PubMedID 33812830
Trans-nasal high-flow dehumidified air in acute migraine headaches: A randomized controlled trial.
Cephalalgia : an international journal of headache
2021; 41 (9): 968-978
Intranasal high flow of dehumidified (dry) air results in evaporative cooling of nasal passages. In this randomized clinical trial, we investigated the effect of dry gas induced nasal cooling on migraine headaches.In this single-blind study, acute migraineurs were randomized to either nasal high-flow dry oxygen, dry air, humidified oxygen or humidified air (control) at 15 L/min for 15 min. All gases were delivered at 37°C. Severity of headache and other migraine associated symptoms (International Classification for Headache Disorders, 3rd edition criteria) were recorded before and after therapy. The primary endpoint was change in pain scores, while changes in nausea, photosensitivity and sound sensitivity scores served as secondary endpoints. A linear regression model was employed to estimate the impact of individual treatment components and their individual interactions.Fifty-one patients (48 ± 15 years of age, 82% women) were enrolled. When compared to the control arm (humidified air), all therapeutic arms showed a significantly greater reduction in pain scores (primary endpoint) at 2 h of therapy with dry oxygen (-1.6 [95% CI -2.3, -0.9]), dry air (-1.7 [95% CI -2.6, -0.7)]), and humidified oxygen (-2.3 [95% CI -3.5, -1.1]). A significantly greater reduction in 2-h photosensitivity scores was also noted in all therapeutic arms (-1.8 [95% CI -3.2, -0.4], dry oxygen; -1.7 [95% CI -2.9, -0.4], dry air; (-2.1 [95% CI -3.6, -0.6], humidified oxygen) as compared to controls. The presence of oxygen and dryness were independently associated with significant reductions in pain and photosensitivity scores. No adverse events were reported.Trans-nasal high-flow dry gas therapy may have a role in reducing migraine associated pain.Clinical Trial registration: NCT04129567.
View details for DOI 10.1177/0333102421997766
View details for PubMedID 33631965
Effects of High-Flow Transesophageal Dry Air on Core Temperature: A Novel Method of Therapeutic Hypothermia.
Therapeutic hypothermia and temperature management
2021; 11 (2): 88-95
Therapeutic hypothermia (TH) is one of the few proven neuroprotective modalities in clinical practice. However, current methods to achieve TH are suboptimal. We investigated a novel esophageal device that utilizes high-flow transesophageal dry air to achieve TH via evaporating cooling. Seven Yorkshire pigs (n = 7) underwent hypothermia therapy using a novel esophageal device that compartmentalizes a segment of esophagus through which high-flow dry air freely circulates in and out of the esophagus. Efficacy (primary objective) and safety (secondary objective) were evaluated in all animals. Safety assessment was divided into two sequential phases: (1) acute safety assessment (n = 5; terminal studies) to evaluate adverse events occurring during therapy, and (2) chronic safety assessment (n = 2; survival studies) to evaluate adverse events associated with therapy within 1 week of follow-up. After 1 hour of esophageal cooling (mean airflow rate = 64.2 ± 3.5 L/min), a significant reduction in rectal temperature was observed (37.3 ± 0.2°C → 36.3 ± 0.4°C, p = 0.002). The mean rectal temperature reduction was 1 ± 0.4°C. In none of the seven animals was oral or pharyngeal mucosa injury identified at postprocedural visual examination. In the two animals that survived, no reduction of food ingestion, signs of swallowing dysfunction or discomfort, or evidence of gastrointestinal bleeding was observed during the 1-week follow-up period. Open-chest visual inspection in those two animals did not show damage to the esophageal mucosa or surrounding structures. A novel esophageal device, utilizing high-flow transesophageal dry air, was able to efficiently induce hypothermia despite external heating. Therapy was well-tolerated, and no acute or chronic complications were found.
View details for DOI 10.1089/ther.2019.0037
View details for PubMedID 32326838
Long-Term Outcomes of Bilateral Cardiac Sympathetic Denervation for Refractory Ventricular Tachycardia
2021; 7 (4): 463-470
This study sought to explore the long-term arrhythmic outcomes of bilateral cardiac sympathetic denervation (BCSD).BCSD has been associated with improved arrhythmic outcomes in patients with refractory ventricular arrhythmias. However, whether BCSD antiarrhythmic effects are sustained long after the procedure is still uncertain.We included consecutive patients who underwent BCSD because of refractory ventricular tachycardia (VT) and had at least 18 months of follow-up. VT recurrence after BCSD was evaluated to assess arrhythmic outcomes. The occurrence of VT episodes within the first 12 weeks after the procedure was assessed to explore the impact of early VT recurrence on late arrhythmia-free survival.Twenty patients (42 ± 16 years; 55% male) were included in the analysis. Nineteen (95%) patients had structural heart disease (left ventricular ejection fraction: 0.46 ± 0.14). Class I or class III drugs failed for all patients, and the mean number of VT ablation procedures was 2.5 ± 1.6. Over a mean follow-up of 1,300 ± 321 days (median: 1,276 days [Interquartile range (IQR): 1,181 to 1,480 days), 11 (55%) patients remained VT free after sympathectomy. Freedom from sustained VT or implantable cardioverter-defibrillator shock was 60% (95% confidence interval: 0.35 to 0.77) and 54.5% (95% confidence interval: 0.31 to 0.73) after BCSD at 1 and 4 years. Early VT recurrence was not associated with worse late arrhythmia-free survival rates.BCSD was associated with longstanding antiarrhythmic effects in patients with refractory ventricular arrhythmias. The occurrence of VT episodes early after the procedure was not associated with worse late arrhythmic outcomes.
View details for DOI 10.1016/j.jacep.2021.02.003
View details for Web of Science ID 000642000400006
View details for PubMedID 33812839
Long-term clinical outcomes of cardiac sympathetic denervation in patients with refractory ventricular arrhythmias
JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY
2021; 32 (4): 1065-1074
Cardiac sympathetic denervation (CSD) is a useful therapeutic option in patients with structural heart disease (SHD) and ventricular tachycardia (VT) who are otherwise refractory to standard antiarrhythmic drug (AAD) therapy or catheter ablation (CA). In this study, we sought to retrospectively analyze the long-term outcomes of CSD in patients with refractory VT and/or VT storm with a majority of the patients being taken up for CSD ahead of CA.We included consecutive patients with SHD who underwent CBD from 2010 to 2019 owing to refractory VT. A complete response to CSD was defined as a greater than 75% reduction in the frequency of ICD shocks for VT.A total of 65 patients (50 male, 15 female) were included. The underlying VT substrate was ischemic heart disease (IHD) in 30 (46.2%) patients while the remaining 35 (53.8%) patients had other nonischemic causes. The mean duration of follow-up was 27 ± 24 months. A complete response to CSD was achieved in 47 (72.3%) patients. There was a significant decline in the number of implantable cardioverter-defibrillator (ICD) or external defibrillator shocks post-CSD (24 ± 37 vs. 2 ± 4, p < .01). Freedom from a combined endpoint of ICD shock or death at 2 years was 51.5%. An advanced New York Heart Association class (III and IV) was the only parameter found to be associated with this combined endpoint.The current retrospective analysis re-emphasizes the role of surgical CSD and explores its role ahead of CA in the treatment of patients with refractory VT or VT storm.
View details for DOI 10.1111/jce.14947
View details for Web of Science ID 000621422500001
View details for PubMedID 33570234
Safety and Feasibility of a Novel Transnasal Cooling Device to Induce Normothermia in Febrile Cerebrovascular Patients
2021; 34 (2): 500-507
Inducing normothermia with surface cooling temperature modulating devices (TMDs) is cumbersome and often associated with significant shivering. We tested the safety and feasibility of a novel transnasal evaporative cooling device to induce and maintain normothermia in febrile patients following ischemic and hemorrhagic stroke.A single-center study utilizing the CoolStat® transnasal cooling device was used to achieve core temperature reduction in mechanically ventilated stroke patients with fever (T ≥ 38.3 C) refractory to acetaminophen by inducing an evaporative cooling energy exchange in the nasal turbinates thru a high flow of dehumidified air into the nasal cavity and out through the mouth. Continuous temperature measurements were obtained from tympanic and core (esophageal or bladder) temperature monitors. Safety assessments included continuous monitoring for hypertension, tachycardia, and raised intracranial pressure (when monitored). Otolaryngology (ENT) evaluations were monitored for any device-related nasal mucosal injury with a pre- and post-visual examination. Shivering was assessed every 30 min using the Bedside Shivering Assessment Scale (BSAS). Duration of device use was limited to 8 h, at which time patients were transitioned to routine care for temperature management.Ten subjects (median age: 54 years, BMI: 32.5 kg/m2, 60% men) were enrolled with normothermia achieved in 90% of subjects. One subject did not achieve normothermia and was later refractory to other TMDs. Median baseline temperature was 38.5 ± 0.1 C, with a reduction noted by 4 h (38.5 ± 0.1 vs 37.3 ± 0.8, P < 0.001) and sustained at 8 h (38.5 ± 0.1 vs 37.1 ± 0.7, P = 0.001). Time to normothermia was 2.6 ± 1.9 h. The median BSAS was 0 (range 0-1) with only 4 episodes necessitating meperidine across 76 h of study monitoring. No treatment was discontinued due to safety concerns. ENT evaluations noted no device-related adverse findings.Inducing normothermia with a novel transnasal TMD appears to be safe, feasible and not associated with significant shivering. A multicenter trial testing the ability of the CoolStat to maintain normothermia for 24 h is currently underway.
View details for DOI 10.1007/s12028-020-01044-9
View details for Web of Science ID 000548759500001
View details for PubMedID 32666372
Prospective Assessment of an Automated Intraprocedural 12-Lead ECG-Based System for Localization of Early Left Ventricular Activation.
Circulation. Arrhythmia and electrophysiology
2020; 13 (7): e008262
To facilitate ablation of ventricular tachycardia (VT), an automated localization system to identify the site of origin of left ventricular activation in real time using the 12-lead ECG was developed. The objective of this study was to prospectively assess its accuracy.The automated site of origin localization system consists of 3 steps: (1) localization of ventricular segment based on population templates, (2) population-based localization within a segment, and (3) patient-specific site localization. Localization error was assessed by the distance between the known reference site and the estimated site.In 19 patients undergoing 21 catheter ablation procedures of scar-related VT, site of origin localization accuracy was estimated using 552 left ventricular endocardial pacing sites pooled together and 25 VT-exit sites identified by contact mapping. For the 25 VT-exit sites, localization error of the population-based localization steps was within 10 mm. Patient-specific site localization achieved accuracy of within 3.5 mm after including up to 11 pacing (training) sites. Using 3 remotes (67.8±17.0 mm from the reference VT-exit site), and then 5 close pacing sites, resulted in localization error of 7.2±4.1 mm for the 25 identified VT-exit sites. In 2 emulated clinical procedure with 2 induced VTs, the site of origin localization system achieved accuracy within 4 mm.In this prospective validation study, the automated localization system achieved estimated accuracy within 10 mm and could thus provide clinical utility.
View details for DOI 10.1161/CIRCEP.119.008262
View details for PubMedID 32538133
View details for PubMedCentralID PMC7375941
Esophageal injury associated with catheter ablation for atrial fibrillation: Determinants of risk and protective strategies
JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY
2020; 31 (6): 1364-1376
Catheter ablation has become an important element in the management of atrial fibrillation. Several technical advances allowed for better safety profiles and lower recurrence rates, leading to an increasing number of ablations worldwide. Despite that, major complications are still reported, and esophageal thermal injury remains a significant concern as atrioesophageal fistula (AEF) is often fatal. Recognition of the mechanisms involved in the process of esophageal lesion formation and the identification of the main determinants of risk have set the grounds for the development and improvement of different esophageal protective strategies. More sensitive esophageal temperature monitoring, safer ablation parameters and catheters, and different energy sources appear to collectively reduce the risk of esophageal thermal injury. Adjunctive measures such as the prophylactic use of proton-pump inhibitors, as well as esophageal cooling or deviation devices, have emerged as complementary methods with variable but promising results. Nevertheless, as a multifactorial problem, no single esophageal protective measure has proven to be sufficiently effective to eliminate the risk, and further investigation is still warranted. Early screening in the patients at risk and prompt intervention in the cases of AEF are important risk modifiers and yield better outcomes.
View details for DOI 10.1111/jce.14513
View details for Web of Science ID 000534332100001
View details for PubMedID 32323383
Cardiac sympathetic denervation for refractory ventricular arrhythmias in patients with structural heart disease: A systematic review
2019; 16 (10): 1499-1505
Cardiac sympathetic denervation (CSD) is an important adjunctive option for patients with refractory ventricular arrhythmias (VAs). Reports of efficacy of CSD in patients with structural heart disease (SHD) and refractory VA vary widely in literature.The purpose of this study was to conduct a systematic review of arrhythmic outcomes and complications in patients with SHD who underwent CSD due to recurrent VAs.Electronic databases (Google Scholar and PubMed) were searched to identify reports on CSD in SHD using appropriate medical subject terms. No sample size restriction was applied. All patients with known channelopathies were excluded. Baseline demographic and surgical data, arrhythmic outcomes, and procedural complications were evaluated.A total of 13 studies and 173 patients were included. Of the 173 patients (121 [70%] male); pooled mean age 54.6 [95% confidence interval 52.6-56.7] years), 48 (28%) had ischemic cardiomyopathy, and 141 (82%) underwent bilateral CSD. Overall freedom from events ranged from 58% to 100%. Complications were reported in 49 patients(28%). Transient hypotension (9%), pneumothorax (5%), neuropathic pain (skin sensitivity) (4%), Horner syndrome (3%), sweating pattern changes (3%), and hemothorax (2%) were the most common complications. No procedure-related deaths were reported.CSD reduced the number of VA events in patients with SHD, and the benefit from the intervention seemed to be independent of the underlying SHD. Although overall rate of postprocedural complications was high, most of the complications were temporary. Major postprocedural complications after CSD were infrequent.
View details for DOI 10.1016/j.hrthm.2019.06.018
View details for Web of Science ID 000488200900008
View details for PubMedID 31252084
- Cardiac Sympathetic Denervation for Refractory Ventricular Arrhythmias (vol 69, pg 3070, 2017) JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 2017; 70 (6): 811
Cardiac Sympathetic Denervation for Refractory Ventricular Arrhythmias
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
2017; 69 (25): 3070-3080
Cardiac sympathetic denervation (CSD) has been shown to reduce the burden of implantable cardioverter-defibrillator (ICD) shocks in small series of patients with structural heart disease (SHD) and recurrent ventricular tachyarrhythmias (VT).This study assessed the value of CSD and the characteristics associated with outcomes in this population.Patients with SHD who underwent CSD for refractory VT or VT storm at 5 international centers were analyzed by the International Cardiac Sympathetic Denervation Collaborative Group. Kaplan-Meier analysis was used to estimate freedom from ICD shock, heart transplantation, and death. Cox proportional hazards models were used to analyze variables associated with ICD shock recurrence and mortality after CSD.Between 2009 and 2016, 121 patients (age 55 ± 13 years, 26% female, mean ejection fraction of 30 ± 13%) underwent left or bilateral CSD. One-year freedom from sustained VT/ICD shock and ICD shock, transplant, and death were 58% and 50%, respectively. CSD reduced the burden of ICD shocks from a mean of 18 ± 30 (median 10) in the year before study entry to 2.0 ± 4.3 (median 0) at a median follow-up of 1.1 years (p < 0.01). On multivariable analysis, pre-procedure New York Heart Association functional class III and IV heart failure and longer VT cycle lengths were associated with recurrent ICD shocks, whereas advanced New York Heart Association functional class, longer VT cycle lengths, and a left-sided-only procedure predicted the combined endpoint of sustained VT/ICD shock recurrence, death, and transplantation. Of the 120 patients taking antiarrhythmic medications before CSD, 39 (32%) no longer required them at follow-up.CSD decreased sustained VT and ICD shock recurrence in patients with refractory VT. Characteristics independently associated with recurrence and mortality were advanced heart failure, VT cycle length, and a left-sided-only procedure.
View details for DOI 10.1016/j.jacc.2017.04.035
View details for Web of Science ID 000403566900010
View details for PubMedID 28641796
View details for PubMedCentralID PMC6330109