Below the Knee Intervention

Percutaneous interventions for below the knee arterial stenosis. 

Heart Valve Changed Without Bypass Heart Surgery in KIMS for the First Time in Odisha

Catheter Ablation of Post-Infarction Ventricular Tachycardia

Post-Infarction Ventricular Tachycardia is a significant cause of sudden cardiac death and frequent ICD shocks. I found a good article on VT ablation.
http://www.heartrhythmcasereports.com/article/S2214-0271(16)30042-2/fulltext

A nice article about Post-Infarction VT Ablation

Asia Pacific Heart Rhythm Society 2016

I had this great opportunity to attend the 9th Asia Pacific Heart Rhythm Society Annual Conference 2016, at Seoul, South Korea. It was a great experience to listen to renowned authorities in the field of Cardiac Electrophysiology.

It was attended by around 3000 delegates from around the world.

That's my mentor, Prof. Young-Hoon Kim. A great electrophysiologist and human being also the principal force behind the successful organization of APHRS.

I had the opportunity to participate in a session on Difficult Transseptal Punctures.

That's me

The best part for me was that I got a Young Investigator award for our study on repeat VT ablations

 Wow, that was an experience to remember.

Finally there was a live case of AF ablation from our center.

The conference concluded on 15th October 2016, but the lasting impression will remain with me for a long time.

Dr. Anupam Jena

Interventional Cardiologist and Electrophysiologist

Kalinga institute of Medical Sciences

Bhubaneswar, Odisha, India

Email: drjena@live.com

Ventricular Tachycardia - Patient Information

Ventricular tachycardia (VT) is a type of cardiac arrhythmia or heart rhythm disorder. VT causes abnormally fast beating of heart.

Symptoms: 

• Feeling of palpitation inside chest
• Lightheadedness
• Dizziness
• Loss of consciousness
• even sudden death

Conditions increasing the risk of VT

• Any previous history of Myocardial infarction (Heart attack), Coronary artery disease
• Reduced pumping function of heart (reduced ejection fraction)
• Many Congenital heart diseases (with or without surgery)
• Cardiomyopathies (Diseases of heart muscles)
• Some electrical diseases of heart like Long QT syndrome, Brugada syndrome. These diseases usually have family history of sudden cardiac death.

Diagnosis:

(By W.G. de Voogt, MD, PhD, SLAZ, The Netherlands - W.G. de Voogt, MD, PhD, SLAZ, The Netherlands, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=24366354)

• ECG - ECG gives the diagnosis of VT. (shown above)
• In some cases where ECG is not available, but cardiac arrhythmia is suspected, other modalities like - Holter monitoring, Event recorders, Electrophysiological study - are done.

Management:

1. Acute management: When a patient presents to the emergency dept. with ongoing VT, electrical cardioversion (shock) is usually done. In some cases when the patient is hemodynamically stable treatment with medications can  be tried.
2. Long term management: include

• Medications
• Catheter ablation of VT - It is a safe and effective method for management of VT. Catheter ablation is curative in some cases. In some cases recurrence of VT can occur, where repeat ablation can be done.
• ICD (Implantable cardioverter defibrillator) : Is highly effective in preventing sudden death in patients with history of VT or reduced ejection capacity of heart (EF<35%).

(The materials on this blog are provided to educate the public about heart and heart diseases. The informations provided on the blog are not intended nor recommended as a substitute for professional medical advice, is for general information only, and is designed to support, not replace, the relationship that exists between you and your physician. This blog does not provide medical services or advice as part of this website and nothing contained on this blog is intended to be used for medical diagnosis or treatment. Always talk with your doctor if you have questions about your symptoms, diagnosis and treatment.)

Dr. Anupam Jena

Consultant Interventional Cardiologist and Electrophysiologist

Kalinga institute of Medical Sciences

Bhubaneswar, Odisha, India

Email: drjena@live.com

Heart Disease In Odisha : An Insight

Odisha the rich poor-state of India is caught in unique cross roads as related to heart diseases. According to Odisha economic survey 2014-15 (the latest I could get online) cardiac diseases are responsible for the majority of deaths excluding senility. Whereas senility was responsible for 36.4% of deaths, heart disease is the single most common treatable cause of death accounting for 10.8% of deaths: that is more than 25000 deaths per year. Considering the prevalence of Heart disease to be around 5% in the general population, Odisha has 25 lac patients with heart disease. Now I am not sure about the underlying diagnoses in the deaths due to senility but among available diagnoses heart diseases are the single most common cause of death in Odisha.  This is particularly of concern because majority of those deaths due to heart disease can be prevented by timely prevention and treatment. Another disturbing fact is that many of those dying of heart disease are young and middle aged in their 40s and 50s. So the loss of productive years and income also adds hugely to the economic burden as well as is disastrous to the families. While it is prudent to expect the state to implement public health measures and some kind of health insurance, it is of utmost importance that we as responsible individuals understand the seriousness of the situation and start taking care of our own health. We Indians are genetically predisposed to heart diseases. In India coronary artery diseases occur approximately 10 years earlier as compared to westerners, also the disease more extensively involves multiple coronary arteries. So Indians as a whole are hit early and hit harder by heart diseases. But as I have said earlier heart diseases can be prevented to a great extent by following healthy life styles. Heart diseases can also be effectively treated by timely diagnoses and management. 
This blog is an attempt to create awareness among the general population about diseases and management options for cardiac conditions especially in the Indian perspective. We will examine each and every issue related to heart disease in the coming days. 

Dr Anupam Jena
Consultant Interventional Cardiologist and Electrophysiologist 
Kalinga Institute of Medical Sciences
Bhubaneswar
Odisha, India

Catheter Ablation of Atrial Fibrillation

Atrial fibrillation (AF) results in irregular and sometimes fast beating of the heart. The aim of treating AF are

1. Reduction of symptoms due to irregular heart beat
2. Preventing stroke
3. Preventing long term deterioration in cardiac function

Catheter ablation of AF is a newer modality of treatment where radiofrequency lesions are given inside the heart to convert the AF to normal sinus rhythm. It has been shown in studies to maintain normal sinus rhythm, reduces the symptoms and improves the quality of life. While there are encouraging data on stroke prevention and reduction of overall mortality.


These images are some sample figures showing how an AF ablation is done. Multiple catheters are put inside the heart and the images of the heart are created. Radiofrequency lesions are given to terminate the tachycardia.

Early repolarization pattern & Early repolarization syndrome

The early repolarization (ER) pattern (ERP), initially described as elevation of the ST segment of ≥1 leads on the 12-lead ECG, has long been considered a benign phenomenon. However, more recent studies have demonstrated positive, negative, and neutral associations between an ERP and various end points, including all-cause, cardiac, and arrhythmic mortality. However there is still substantial uncertainty prevails about the definition, evaluation and management of individuals showing EP pattern in ECG. A recent scientific statement from American Heart Association tries to address some of these areas of doubt. Published observational studies suggest that the prevalence of ERP ranges between 1% and 18% in the general population.

DEFINITION:

There is no universal definition of ER pattern. Previous studies have used various definitions covering differing morphologies. The new statement has defined ER pattern as: Any one of the following

1. ST-segment elevation in the absence of chest pain

2. Terminal QRS slur or

3. Terminal QRS notch.

Figure: Examples of ER patterns

Early repolarization syndrome: Defined as occurring in patients with ERP who have survived idiopathic VF with clinical evaluation unrevealing for other  explanations. 

Features That May Raise Suspicion for a Malignant and Heritable Form of ER:

1. Family history of sudden cardiac arrest or early unexplained death
2. Personal evaluation and workup suggestive of a channelopathy (eg, short-QT syndrome, Brugada syndrome).
3. Personal history of unheralded syncope suggestive of an arrhythmogenic pathogenesis (particularly when at rest or recumbent)
    (ER indicates early repolarization)

4. ECG features suggestive of high risk:

- Tall J waves with limited ST-segment elevation, mainly in the inferior leads

- Augmentation of J-wave amplitude immediately after sudden pauses. J-wave amplitude should be evaluated during Holter recordings because patients with idiopathic VF demonstrate significantly taller J waves during slow heart rate at night.

-The pattern of J waves followed by a horizontal or descending ST segment is associated with increased arrhythmic risk.

Management:

Class I:

-ICD implantation is recommended in patients with a diagnosis of ER syndrome who have survived a cardiac arrest.

Class IIa:

- Isoproterenol infusion can be useful in suppressing electrical storms in patients with a diagnosis of ER syndrome.
-Quinidine in addition to an ICD can be useful for secondary prevention of VF in patients with a diagnosis of ER syndrome.

Class IIb:

-ICD implantation may be considered in symptomatic family members of ER syndrome patients with a history of syncope in the presence of ST-segment elevation >1 mm in 2 or more inferior or lateral leads.
-ICD implantation may be considered in asymptomatic individuals who demonstrate a high-risk ER ECG pattern( high J-wave amplitude, horizontal/descending ST segment) in the presence of a strong family history of juvenile unexplained sudden death with or without a pathogenic mutation.

Class III:

- ICD implantation is not recommended in asymptomatic  patients with an isolated ER ECG pattern.

References:

1. http://circ.ahajournals.org/content/early/2016/03/07/CIR.0000000000000388.full.pdf

2. HRS/EHRA/APHRS Expert Consensus Statement on the Diagnosis and Management of Patients with Inherited Primary Arrhythmia Syndromes. 

(Heart Rhythm, Vol 10, No12, December 2013)

MCQ 15.04.2015

All of the following arrhythmias are usually seen in structurally normal hearts except

A. Right ventricular outflow tract
B. Fascicular reentry ventricular tachycardia
C. Catecholaminergic polymorphic ventricular tachycardia
D. Bundle branch reentry ventricular tachycardia

Answers please.

TOP TEN CARDIOLOGY ARTICLES OF THE WEEK

TOP TEN CARDIOLOGY ARTICLES OF THE WEEK (10.11.14-16.11.14)

1. The optimal management of anti-thrombotic therapy after valve replacement: certainties and uncertainties

2. Ivabradine in Stable Coronary Artery Disease without Clinical Heart Failure


3. The Unnatural History of Tetralogy of Fallot: Prospective Follow-Up of 40 Years After Surgical Correction


4. Clinical Outcomes and Improved Survival in Patients With Protein-Losing Enteropathy After the Fontan Operation


5.Immediate and midterm outcomes following primary PCI with bioresorbable vascular scaffold implantation in patients with ST-segment myocardial
infarction: insights from the multicentre “Registro ABSORB Italiano” (RAI registry)


6.Second-Generation Drug-Eluting Stent Implantation Followed by 6- Versus 12-Month Dual Antiplatelet Therapy. The SECURITY Randomized Clinical Trial


7. Short- and Long-Term Cause of Death in Patients Treated With Primary PCI for STEMI


8.The QT Interval Is Associated With Incident Cardiovascular Events


9.Endovascular Treatment of Mycotic Aortic Aneurysms: A European Multicenter Study


10.Intracoronary Delivery of Injectable Bioabsorbable Scaffold (IK-5001) to Treat Left Ventricular Remodeling After ST-Elevation Myocardial Infarction. A First-in-Man Study