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Browsing by Author "Dandamudi, Gopi"
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Item A Novel Orderset Driven Emergency Department Atrial Fibrillation Algorithm to Increase Discharge and Risk-appropriate Anticoagulation.(Wolters Kluwer, 2022-09) Roumpf, Steven K.; Kline, Jeffrey A.; Dandamudi, Gopi; Schaffer, Jason T.; Flack, Tara; Gallaher, Wesley; Weaver, Allison M.; Hunt, Ina; Thinnes, Erynn; Strachan, Christian C.; Hall, Cassandra; Pafford, Carl; Hunter, Benton R.; Emergency Medicine, School of MedicineIntroduction: Patients with atrial fibrillation (AF) are frequently admitted from the emergency department (ED), and when discharged, are not reliably prescribed indicated anticoagulation. We report the impact of a novel computerized ED AF pathway orderset on discharge rate and risk-appropriate anticoagulation in patients with primary AF. Methods: The orderset included options for rate and rhythm control of primary AF, structured risk assessment for thrombotic complications, recommendations for anticoagulation as appropriate, and follow up with an electrophysiologist. All patients discharged from the ED in whom the AF orderset was utilized over an 18-month period comprised the primary study population. The primary outcome was the rate of appropriate anticoagulation or not according to confirmed CHADS-VASC and HASBLED scores. Additionally, the percentage of primary AF patients discharged directly from the ED was compared in the 18-month periods before and after introduction of the orderset. Results: A total of 56 patients, average age 57.8 years and average initial heart rate 126 beats/minute, were included in the primary analysis. All 56 (100%; 95% confidence interval, 94-100) received guideline-concordant anticoagulation. The discharge rates in the pre- and postorderset implementation periods were 29% and 41%, respectively (95% confidence interval for 12% difference, 5-18). Conclusions: Our novel AF pathway orderset was associated with 100% guideline-concordant anticoagulation in patients discharged from the ED. Availability of the orderset was associated with a significant increase in the proportion of ED AF patients discharged.Item Circadian variability patterns predict and guide premature ventricular contraction ablation procedural inducibility and outcomes(Elsevier, 2017) Hamon, David; Abehsira, Guillaume; Gu, Kai; Liu, Albert; Sadron, Marie Blaye-Felice; Billet, Sophie; Kambur, Thomas; Swid, Mohammed Amer; Boyle, Noel G.; Dandamudi, Gopi; Maury, Philippe; Chen, Minglong; Miller, John M.; Lellouche, Nicolas; Shivkumar, Kalyanam; Bradfield, Jason S.; Department of Medicine, School of MedicineBackground Infrequent intraprocedural premature ventricular complexes (PVCs) may impede radiofrequency catheter ablation (RFA) outcome, and pharmacologic induction is unpredictable. Objective The purpose of this study was to determine whether PVC circadian variation could help predict drug response. Methods Consecutive patients referred for RFA with detailed Holter monitoring and frequent monomorphic PVCs were included. Patients were divided into 3 groups based on hourly PVC count relationship to corresponding mean heart rate (HR) during each of the 24 hours on Holter: fast-HR-dependent PVC (F-HR-PVC) type for a positive correlation (Pearson, P <.05), slow-HR-dependent PVC (S-HR-PVC) type for a negative correlation, and independent-HR-PVC (I-HR-PVC) when no correlation was found. Results Fifty-one of the 101 patients (50.5%) had F-HR-PVC, 39.6% I-HR-PVC, and 9.9% S-HR-PVC; 30.7% had infrequent intraprocedural PVC requiring drug infusion. The best predictor of infrequent PVC was number of hours with PVC count <120/h on Holter (area under the curve 0.80, sensitivity 83.9%, specificity 74.3%, for ≥2 h). Only F-HR-PVC patients responded to isoproterenol. Isoproterenol washout or phenylephrine infusion was successful for the 3 S-HR-PVC patients, and no drug could increase PVC frequency in the 12 I-HR-PVC patients. Long-term RFA success rate in patients with frequent PVCs at baseline (82.9%) was similar to those with infrequent PVC who responded to a drug (77.8%; P = .732) but significantly higher than for those who did not respond to any drug (15.4%; P <.0001). Conclusion A simple analysis of Holter PVC circadian variability provides incremental value to guide pharmacologic induction of PVCs during RFA and predict outcome. Patients with infrequent I-HR-PVC had the least successful outcomes from RF ablation.Item Healthcare Utilization and Quality of Life Improvement after Ablation for Paroxysmal AF in Younger and Older Patients(Wiley, 2017-04) Biviano, Angelo B.; Hunter, Tina D.; Dandamudi, Gopi; Fishel, Robert S.; Gidney, Brett; Herweg, Bengt; Oza, Saumil R.; Patel, Anshul Mahendra; Wang, Huijian; Pollak, Scott J.; Medicine, School of MedicineBackground Atrial fibrillation (AF) prevalence increases significantly with age. Little is known about the effect of AF ablation on quality of life and healthcare utilization in the elderly. The objective of this study was to quantify the healthcare utilization and quality of life benefits of catheter ablation for AF, for patients ≥65 years compared to patients <65 years. Methods Two multicenter U.S. registry studies enrolled patients with paroxysmal AF. Baseline characteristics and acute outcomes were collected for 736 patients receiving catheter ablation with the Navistar® ThermoCool® SF Catheter (Biosense Webster, Inc., Diamond Bar, CA, USA). Healthcare utilization and quality of life outcomes were collected through 1 year postablation for 508 patients. Results The rates of acute pulmonary vein isolation were high and similar between patients ≥65 years and <65 years (97.5% vs 95.8%, P = 0.2130). Length of stay for the index procedure was similar between age groups with 82.2% of the older group and 83.2% of the younger group having one-day hospitalization. Disease-specific quality of life instrument scores improved significantly and similarly for older and younger patients at 1 year postablation, compared to baseline. AF-related hospitalizations and emergency department visits were similar or lower in older patients compared to younger patients, as reported at 1 year postablation. Conclusion For older patients undergoing catheter ablation for paroxysmal AF, healthcare utilization parameters were lower or not significantly different than for younger patients, and quality of life outcomes were similarly improved. These findings support the use of catheter ablation as a treatment option in older patients with paroxysmal AF.Item His Corrective Pacing or Biventricular Pacing for Cardiac Resynchronization in Heart Failure(Elsevier, 2019-07) Upadhyay, Gaurav A.; Vijayaraman, Pugazhendi; Nayak, Hemal M.; Verma, Nishant; Dandamudi, Gopi; Sharma, Parikshit S.; Saleem, Moeen; Mandrola, John; Genovese, Davide; Tung, Roderick; Medicine, School of MedicineItem An Interesting Case of Permanent His-Bundle Pacing and a Review of the Current Literature(MediaSphere Medical, 2017-04-01) Ezzeddine, Fatima; Dandamudi, Gopi; Medicine, School of MedicinePermanent His-bundle pacing (HBP) is a true physiological form of ventricular pacing that has been shown in recent years to be both safe and feasible in clinical practice. However, there are limited data about its long-term performance, especially when compared with both right ventricular and biventricular pacing. In this article, we present a thought-provoking case study that illustrates the usefulness of permanent HBP in a patient with long-standing complete infranodal heart block and progressive heart failure, and discuss the current literature highlighting the evidence behind this form of permanent pacing.Item Left Bundle Branch Block–Induced Cardiomyopathy in a Transplanted Heart Treated With His Bundle Pacing(Elsevier, 2020-08-12) Khaira, Kavita B.; Singh, Rajeev; Devabhaktuni, Subodh; Simon, Joel W.; Dandamudi, Gopi; Medicine, School of MedicineA 70-year-old male with prior orthotopic heart transplant developed left bundle branch block followed by new-onset left ventricular systolic dysfunction. He underwent His bundle pacing for cardiac resynchronization therapy with complete normalization of his ejection fraction. This is the first reported case of left bundle branch block–induced cardiomyopathy in a transplanted heart.Item My Approach to Choosing Ventricular Pacing Sites in Patients With Severe Heart Failure(Elsevier, 2017) Dandamudi, Gopi; Department of Medicine, IU School of MedicineItem On-treatment comparison between corrective His bundle pacing and biventricular pacing for cardiac resynchronization: A secondary analysis of His-SYNC(Elsevier, 2019) Upadhyay, Gaurav A.; Vijayaraman, Pugazhendi; Nayak, Hemal M.; Verma, Nishant; Dandamudi, Gopi; Sharma, Parikshit S.; Saleem, Moeen; Mandrola, John; Genovese, Davide; Oren, Jess W.; Subzposh, Faiz A.; Aziz, Zaid; Beaser, Andrew; Shatz, Dalise; Besser, Stephanie; Lang, Roberto M.; Trohman, Richard G.; Knight, Bradley P.; Tung, Roderick; Medicine, School of MedicineBackground The His-SYNC pilot trial was the first randomized comparison between His bundle pacing in lieu of a left ventricular lead for cardiac resynchronization therapy (His-CRT) and biventricular pacing (BiV-CRT), but was limited by high rates of crossover. Objective To evaluate the results of the His-SYNC pilot trial utilizing treatment-received (TR) and per-protocol (PP) analyses. Methods The His-SYNC pilot was a multicenter, prospective, single-blinded, randomized, controlled trial comparing His-CRT vs BiV-CRT in patients meeting standard indications for CRT (eg, NYHA II–IV patients with QRS >120 ms). Crossovers were required based on prespecified criteria. The primary endpoints analyzed included improvement in QRS duration, left ventricular ejection fraction (LVEF), and freedom from cardiovascular (CV) hospitalization and mortality. Results Among 41 patients enrolled (aged 64 ± 13 years, 38% female, LVEF 28%, QRS 168 ± 18 ms), 21 were randomized to His-CRT and 20 to BiV-CRT. Crossover occurred in 48% of His-CRT and 26% of BiV-CRT. The most common reason for crossover from His-CRT was inability to correct QRS owing to nonspecific intraventricular conduction delay (n = 5). Patients treated with His-CRT demonstrated greater QRS narrowing compared to BiV (125 ± 22 ms vs 164 ± 25 ms [TR], P < .001;124 ± 19 ms vs 162 ± 24 ms [PP], P < .001). A trend toward higher echocardiographic response was also observed (80 vs 57% [TR], P = .14; 91% vs 54% [PP], P = .078). No significant differences in CV hospitalization or mortality were observed. Conclusions Patients receiving His-CRT on-treatment demonstrated superior electrical resynchronization and a trend toward higher echocardiographic response than BiV-CRT. Larger prospective studies may be justifiable with refinements in patient selection and implantation techniques to minimize crossovers.Item Permanent His Bundle Pacing in Patients With Congenital Complete Heart Block: A Multicenter Experience(Elsevier, 2021-04) Dandamudi, Gopi; Simon, Joel; Cano, Oscar; Master, Vivak; Koruth, Jacob S.; Naperkowski, Angela; Kean, Adam C.; Schaller, Robert; Ellenbogen, Kenneth A.; Kron, Jordana; Vijayaraman, Pugazhendhi; Pediatric Dentistry, School of DentistryObjectives This study retrospectively assessed the safety and efficacy of permanent His bundle pacing (HBP) in patients with congenital complete heart block (CCHB). Background HBP has become an accepted form of pacing in adults. Its role in CCHB is not known. Methods Seventeen patients with CCHB who underwent successful HBP were analyzed at 6 academic centers between 2016 and 2019. Nine patients had de novo implants, and 8 patients had previous right ventricular (RV) leads. Three RV paced patients had reduced left ventricular ejection fractions at the time of HBP. Implant/follow-up device parameters, New York Heart Association functional class, QRS duration, and left ventricular ejection fraction data were analyzed. Results Patients’ mean age was 27.4 ± 11.3 years, 59% were women, and mean follow-up was 385 ± 279 days. The following parameters were found to be statistically significant between implant and follow-up, respectively: impedance, 602 ± 173 Ω versus 460 ± 80 Ω (p < 0.001); and New York Heart Association functional class, 1.7 ± 0.9 versus 1.1 ± 0.3 (p = 0.014). In patients with previous RV pacing, HBP resulted in a significant decrease in QRS duration: 167.1 ± 14.3 ms versus 118.3 ± 13.9 ms (p < 0.0001). In de novo implants, HBP resulted in increases in QRS duration compared with baseline: 111.1 ± 19.4 ms versus 91.0 ± 4.8 ms (p = 0.016). Other parameters exhibited no statistically significant differences. During follow-up, 2 patients required lead revision due to elevated pacing thresholds. Conclusions HBP seems to be safe and effective, with improvement in clinical outcomes in patients with CCHB. Larger studies with longer follow-up periods are required to confirm our findings.Item Permanent His Bundle Pacing: Electrophysiological and Echocardiographic Observations From Long-Term Follow-Up(Wiley, 2017-07) Vijayaraman, Pugazhendhi; Dandamudi, Gopi; Lustgarten, Daniel; Ellenbogen, Kenneth A.; Department of Medicine, IU School of MedicineBackground Permanent His bundle pacing (HBP) is a physiological alternative to right ventricular pacing. It is not known whether HBP can cause His-Purkinje conduction (HPC) disease. The aim of our study is to assess His bundle capture and its effect on left ventricular (LV) function in long-term follow-up and to determine HPC at the time of pulse generator change (GC) in patients with chronic HBP. Methods HB electrograms were recorded from the pacing lead at implant and GC. HBP QRS duration (QRSd), His-ventricular (HV) intervals, and HB pacing thresholds at GC were compared with implant measurements. HPC was assessed by pacing at cycle lengths of 700 ms, 600 ms, and 500 ms at GC. LV internal diameters, ejection fraction (EF), and valve dysfunction at baseline were compared with echocardiography during follow-up. Results GC was performed in 20 patients (men 13; age 74 ± 14 years) with HBP at 70 ± 24 months postimplant. HV intervals remained unchanged from initial implant (44 ± 4 ms vs 45 ± 4 ms). During HBP at 700 ms, 600 ms, and 500 ms (n = 17), consistent 1:1 HPC was present. HBP QRSd remained unchanged during follow-up (117 ± 20 ms vs 118 ± 23 ms). HBP threshold at implant and GC was 1.9 ± 1.1 V and 2.5 ± 1.2 V @ 0.5 ms. Despite high pacing burden (77 ± 13%), there was no significant change in LVEF (50 ± 14% at implant) during follow-up (55 ± 6%, P = 0.06). Conclusions HBP does not appear to cause new HPC abnormalities and is associated with stable HBP QRSd during long-term follow-up. Despite high pacing burden, HBP did not result in deterioration of left ventricular systolic function or cause new valve dysfunction.