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Open Access Publications from the University of California

Scholarly Works (23 results)

  • Article
  • Peer Reviewed
UC San Diego Previously Published Works (2021)
A 51-year-old male developed recurrent episodes of palpitations and pre-syncope after surgical aortic valve replacement. Electrocardiograms after surgery revealed a wide complex tachycardia with alternating left bundle branch and right bundle branch block morphologies. An electrophysiology study (EPS) demonstrated typical bundle branch reentry ventricular tachycardia (BBRVT) treated successfully with right bundle ablation. We demonstrate the key diagnostic features of BBRVT on EPS, describe the circuit of BBRVT with explanation of the HV pseudointerval, and highlight the association of BBRVT and valve replacement.
    Cover page: Alternating wide complex tachycardia after surgical aortic valve replacement
    • Article
    • Peer Reviewed
    UC San Diego Previously Published Works (2023)
      Creative Commons 'BY-NC-ND' version 4.0 license
      • Article
      • Peer Reviewed
      UC San Diego Previously Published Works (2020)
      A 67-year-old man presented with dizziness secondary to ventricular tachycardia (VT) originating from the moderator band. The VT was refractory to multiple antiarrhythmic medications requiring extracorporeal membrane oxygenation and eventual curative ablation. We highlight a malignant form of idiopathic VT, unique electrocardiogram characteristics, and ablation considerations. (Level of Difficulty: Intermediate.).
        Cover page: Ventricular Tachycardia Storm Originating From Moderator Band Requiring Extracorporeal Membrane Oxygenation
        • Article
        • Peer Reviewed
        UC San Diego Previously Published Works (2017)
          Cover page: A surgeon with symptomatic ventricular tachycardia while operating and exacerbated by left lateral decubitus position: Too much of a stretch?
          • Article
          • Peer Reviewed
          UC San Diego Previously Published Works (2018)

          For patients with end-stage heart failure, the use of mechanical circulatory support has increased in the last decade due to improved outcomes with durable left ventricular assist devices. The management of these complex patients requires coordinated care by a multidisciplinary team including cardiac electrophysiologists because atrial and ventricular arrhythmias are prevalent in this population. There have been an increasing number of studies that attempt to address issues regarding arrhythmia management in patients with left ventricular assist devices. The purpose of this review is to provide electrophysiologists with an evidence-based approach to manage a broad spectrum of arrhythmia issues in these patients.

            Cover page: Management of Arrhythmias and Cardiac Implantable Electronic Devices in Patients With Left Ventricular Assist Devices.
            • Article
            • Peer Reviewed
            UC San Diego Previously Published Works (2023)
            In patients presenting with refractory ventricular tachycardia (VT) and aortic and mitral mechanical prosthetic valves, traditional catheter ablation is challenging. We describe a case in which a novel noninvasive computational electrocardiogram mapping algorithm localized VT sources originating from substrate near the mechanical valves, in which stereotactic ablative radiotherapy eliminated VT in 1.5-year follow-up. (Level of Difficulty: Advanced.).
              Cover page: Successful Noninvasive 12-Lead ECG Mapping-Guided Radiotherapy of Inaccessible Ventricular Tachycardia Substrate Due to Mechanical Valves
              • Article
              • Peer Reviewed
              UC San Diego Previously Published Works (2020)

              Ventricular arrhythmias (VAs) are common in patients after left ventricular assist device (LVAD) implant and are associated with worse outcomes. However, the prevalence and impact of VA in patients with durable biventricular assist device (BIVAD) is unknown. We performed a retrospective cohort study of patients with BIVADs to evaluate the prevalence of VA and their clinical outcomes.

              Consecutive patients who received a BIVAD between June 2014 and July 2017 at our medical center were included. The prevalence of VA, defined as sustained ventricular tachycardia or fibrillation requiring defibrillation or ICD therapy, was compared between BIVAD patients and a propensity-matched population of patients with LVAD from our center. The occurrence of adverse clinical events was compared between BIVAD patients with and without VA.

              Of the 13 patients with BIVADs, 6 patients (46%) experienced clinically significant VA, similar to a propensity-matched LVAD population (38%, p = 1.00). There were no differences in baseline characteristics between the two cohorts, except patients in the non-VA group who had worse hemodynamics (mitral regurgitation and right-sided indices), had less history of VA, and were younger. BIVAD patients with VA had a higher incidence of major bleeding (MR 3.05 (1.07-8.66), p = 0.036) and worse composite outcomes (log-rank test, p = 0.046). The presence of VA was associated with worse outcomes in both LVAD and BIVAD groups.

              Ventricular arrhythmias are common in patients with BIVADs and are associated with worse outcomes. Future work should assess whether therapies such as ablation improve the outcome of BIVAD patients with VA.

                Cover page: Ventricular arrhythmias in patients with biventricular assist devices.
                • Article
                • Peer Reviewed
                UC San Diego Previously Published Works (2022)

                Purpose

                Mitral annular flutter (MAF) is a common arrhythmia after atrial fibrillation ablation. We sought to compare the efficacy and safety of catheter ablation utilizing either a left atrial anterior wall (LAAW) line or a lateral mitral isthmus (LMI) line.

                Methods

                We performed a systematic review for all studies that compared LAAW versus LMI lines. Risk ratio (RR) and mean difference (MD) 95% confidence intervals were measured for dichotomous and continuous variables, respectively.

                Results

                Four studies with a total of 594 patients were included, one of which was a randomized control trial. In the LMI ablation group, 40% of patients required CS ablation. There were no significant differences in bidirectional block (RR 1.26; 95% CI, 0.94-1.69) or ablation time (MD -1.5; 95% CI, -6.11-3.11), but LAAW ablation was associated with longer ablation line length (MD 11.42; 95% CI, 10.69-12.14) and longer LAA activation delay (MD 67.68; 95% CI, 33.47-101.89.14) when compared to LMI. There was no significant difference in pericardial effusions (RR 0.36; 95% CI, 0.39-20.75) between groups and more patients were maintained sinus rhythm (RR 1.19; 95% CI, 1.03-1.37, p = 0.02) who underwent LAAW compared to LMI.

                Conclusion

                Ablation of mitral annular flutter with a LAAW line compared to a LMI line showed no difference in rates of acute bidirectional block, ablation time, or pericardial effusion. However, LAAW ablation required a longer ablation line length, resulted in greater LAA activation delayed and was associated with more sinus rhythm maintenance, with the added advantage of avoiding ablation in the CS.
                  Cover page: Ablation of mitral annular flutter ablation utilizing a left atrial anterior line versus a lateral mitral isthmus line: a systematic review and meta-analysis
                  • Article
                  • Peer Reviewed
                  UC San Diego Previously Published Works (2023)

                  Background

                  High-dose isoproterenol infusion is a useful provocative maneuver to elicit triggers of atrial fibrillation (AF) during ablation. We evaluated whether the use of isoproterenol infusion to elicit triggers of AF after ablation is associated with differential outcomes.

                  Methods

                  We performed a retrospective study of all patients who underwent de novo radiofrequency catheter ablation of AF enrolled in the University of California, San Diego AF Ablation Registry. The primary outcome was freedom from atrial arrhythmias on or off antiarrhythmic drugs (AAD).

                  Results

                  Of 314 patients undergoing AF ablation, 235 (74.8%) received isoproterenol while 79 (25.2%) did not. Among those who received isoproterenol, 11 (4.7%) had additional triggers identified. There were no statistically significant differences in procedure time (p = 0.432), antiarrhythmic drug use (p = 0.289), procedural complications (p = 0.279), recurrences of atrial arrhythmias on or off AAD [adjusted hazard ratio (AHR) 0.92 (95% CI 0.58-1.46); p = 0.714], all-cause hospitalizations [AHR 1.00 (95% CI 0.60-1.67); p = 0.986], or all-cause mortality [AHR 0.14 (95% CI 0.01-3.52); p = 0.229] between groups.

                  Conclusions

                  In this registry analysis, use of isoproterenol is safe but was not associated with a reduction in recurrence of atrial arrhythmias.
                    Cover page: Association of isoproterenol infusion during catheter ablation of atrial fibrillation with outcomes: insights from the UC San Diego AF Ablation Registry
                    • Article
                    • Peer Reviewed
                    UC San Diego Previously Published Works (2019)

                    Obesity and atrial fibrillation (AF) are growing epidemics with significant overlap in co-morbidities. Multiple smaller studies have evaluated the effects of weight loss and risk factor modification on recurrence of AF, reduction in AF burden and improvement in AF symptom severity. The objective of this study was to determine if a modest weight loss of ≥10% of initial body weight is enough to improve outcomes in overweight or obese patients with established AF. We performed an extensive literature search and systematic review of studies that compared weight loss of ≥10% versus weight loss of less than 10% or weight gain and assessed outcomes including recurrence of AF as determined through a Holter monitor, AF burden and improvement in AF symptom severity. Risk ratio 95% confidence intervals (CI) were measured for dichotomous variables and mean difference (MD) 95% CI were measured for continuous variables, where MD >0 favors the group with ≥10% weight loss. Five studies with a total of 548 patients were included. Patients who lost ≥10% of their initial body weight experienced less recurrence of AF (risk ratio 0.29; 95% CI 0.19 to 0.44) and a larger reduction in reported event frequency (MD 1.74; 95% CI 0.70 to 2.79), episode duration (MD 2.14; 95% CI 0.04 to 4.23), global episode severity (MD 1.89; 95% CI 1.34 to 2.45), and symptom severity (MD 5.36; 95% CI 3.75 to 6.97). In conclusion, weight loss is associated with less risk of recurrent AF, reduction in AF burden, and improvement in AF symptom severity.

                      Cover page: Meta-analysis of Effect of Modest (≥10%) Weight Loss in Management of Overweight and Obese Patients With Atrial Fibrillation.
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