Introduction: The IMPACT study established the role of controlled esophageal cooling in preventin... more Introduction: The IMPACT study established the role of controlled esophageal cooling in preventing esophageal thermal injury during radiofrequency (RF) ablation for atrial fibrillation (AF). The effect of esophageal cooling on ablation lesion delivery and procedural and patient outcomes had not been previously studied. The objective was to determine the effect of esophageal cooling on the formation of RF lesions, the ability to achieve procedural endpoints, and clinical outcomes. Methods: Participants in the IMPACT trial underwent AF ablation guided by Ablation Index (30 W at 350-400 AI posteriorly, 40 W at ≥450 AI anteriorly). A blinded 1:1 randomization assigned patients to the use of the ensoETM ® device to keep esophageal temperature at 4°C during ablation or standard practice using a single-sensor temperature probe. Ablation parameters and clinical outcomes were analyzed. Results: Procedural data from 188 patients were analyzed. Procedure and fluoroscopy times were similar, and all pulmonary veins were isolated. First-pass pulmonary vein isolation and reconnection at the end of the waiting period were similar in both randomized groups (51/64 vs.
We here present a case of a 54-year-old man with longstanding persistent atrial fibrillation refr... more We here present a case of a 54-year-old man with longstanding persistent atrial fibrillation refractory to direct current electrical cardioversion who underwent a concurrent convergent ablation and Atriclip exclusion of left atrial appendage. His preoperative echocardiography revealed dilated 5.8 cm left atrium with a normal left ventricular ejection fraction of 50%. Transmural isolation of pulmonary veins was performed through a subxiphoid approach, and 3 left-sided video-assisted thoracoscopic surgery ports were utilised to occlude the base of the left atrium appendage with the Atriclip device. A peri-operative transoesophageal echocardiogram confirmed left atrium appendage base occlusion, and the patient was in sinus rhythm after having a single 200 kJ direct current cardioversion shock. The postoperative period was uneventful, and the patient was discharged with preprocedural anticoagulant after 24 hours of the procedure and advised to come for follow up after 3 months.
The burden of AF is increasing in prevalence and healthcare resource usage in the UK and worldwid... more The burden of AF is increasing in prevalence and healthcare resource usage in the UK and worldwide. It can result in impaired quality of life for affected patients, as well as increased risk of stroke, heart failure and mortality. A holistic, integrated approach to AF management is recommended, which may include a focus on reducing risk factors and on medical management with anticoagulation and anti-arrhythmic drugs. There are also various ablation strategies that may be considered when anti-arrhythmic drugs fail to alleviate symptoms and reduce AF burden. These ablation techniques range from standalone percutaneous endocardial catheter ablation to open surgical ablation procedures concomitant with cardiac surgery. More recently, hybrid ablation that combines aspects of both surgical and electrophysiologically targeted ablation has been described. This article reviews the evolution of ablation strategies, beginning with the origin of the Cox maze IV procedure and continuing to the r...
Background: Cardiac implantable electronic device (CIED)-related perforation is uncommon but pote... more Background: Cardiac implantable electronic device (CIED)-related perforation is uncommon but potentially lethal. Management typically includes the use of computed tomography (CT) scanning and often involves cardiac surgery. Methods: Patients presenting to a single referral centre with CIED-related cardiac perforation between 2013 and 2019 were identified. Demographics, diagnostic modalities, the method of lead revision and 30-day complications were examined. Results: Forty-six cases were identified; median time from implantation to diagnosis was 14 days (IQR= 4-50). Most were females (29/46, 63%), 9/46 (20%) had cancer,18 patients (39%) used oral anticoagulants and no patients had prior cardiac surgery. Active fixation was involved in 98% of cases; 9% involved an ICD lead. Thirty-seven leads perforated the right ventricle (apex: 24) and 9 punctured the right atrium (lateral wall: 5). Abnormal electrical parameters were noted in 95% of interrogated cases. Perforation was visualized in 41% and 6% of cases with CXR and transthoracic echocardiography, respectively. CXR revealed a perforation, gross lead displacement or left-sided pleural effusion in 74% of cases. Pericardial effusion occurred in 26 patients (57%) of whom 11 (24%) developed tamponade, successfully drained percutaneously. Pre-extraction CT scan was performed in 19 patients but was essential in 4 cases. Transvenous lead revision (TLR) was successfully performed in all cases with original leads repositioned in 6 patients, without recourse to surgery. Thirty-day mortality and complications were low (0% & 26%, respectively). Conclusion: CT scanning provides incremental diagnostic value in a minority of CIEDrelated perforations. TLR is a safe and effective strategy.
Journal of the American College of Cardiology, 2002
S-Hypertension, Vascular Disease, and Prevention 229A were each strongly enhanced (up to 5 fold) ... more S-Hypertension, Vascular Disease, and Prevention 229A were each strongly enhanced (up to 5 fold) by ultrasound exposure. (** p<0.05 vs. acoustic lipid + DNA) Conclusions: Ultrasound in conjunction with ultrasound-reflective lipoplexes improves gene transfer. Acoustic liposomes conjugated to antibodies have independently been shown to target to vascular disease sites in vivo; thus, using ultrasound, it becomes feasible to both identify a disease site and activate a therapeutic agent in situ. Uptake and expression of I$-Gal DNA in <vascular smooth muscle cells and BHK cells ¢-O 2000°-0o, akeo, o.A 120000 i 15000 ,~, Expression of boat ~ I 15000 1 10000 ~ 10000 15°°°o oooog A~ipid Acobstic Lipid o ¢~.
Journal of the American College of Cardiology, 2003
278). pore region (279-354), and post-pore region including C-terminus (>354). Cardiac events obs... more 278). pore region (279-354), and post-pore region including C-terminus (>354). Cardiac events observed during follow-up from bilth till age of last contact 01 age 40 years were defined as syncope, cardiac arrest, or sudden death. Results. There were 117 (54%) LQTl patients with pre-pore mutations, 84 (39%) patients with pore mutations, and 15 (7%) patients with post-pore mutation. Table shows a comparison of clinical, ECG and cardiac events data between three groups: no slgnificant differences were observed between groups. Conclusions. There are no significant differences in clinical presentation, ECG parameters, and cardiac events among LQTl patients with different locatlon of KCNQl mutation. These findings indicate that other modulation factors than location of mutation influence variable pewtrance of the gene in LQTI patients. sarcolemma and T-tubules. Conclusions: PLM modulates cardiac myocyte contractility in part by altering NCXl function. We also speculate that overexpression of PLM may play a role in the contractile abnormalities obsewed in post infarction cardiac myocyies. LQTI Patients by Mutation Locatmn Females Pre-Pore (Il=ll7) 56 (48%) Pore Post-Pore (n=i 5) (n&l) 49 9 (60%) (56%) Mean QTc (ms) Cardiac Events 491 489 508 57 (50%) 33 4 (31%) (39%) Mean age at 1 st cardiac event (years) 11 12 12 1132-125 Connexin 43 Expression Is Elevated in Human Chronic
Journal of Molecular and Cellular Cardiology, 2001
Congestive heart failure is associated with a high risk of life-threatening ventricular re-entran... more Congestive heart failure is associated with a high risk of life-threatening ventricular re-entrant arrhythmias. Down-regulation of the principal gap-junctional protein of the ventricular myocytes, connexin43, has previously been implicated in arrhythmia in ischaemic heart disease, but it is not known whether connexin43 is similarly reduced in heart failure due to idiopathic dilated cardiomyopathy, whether disease-related connexin43 down-regulation occurs at the level of transcription or translation, or whether the expression of other connexin isotypes is altered in congestive heart failure. We therefore investigated the expression of the four connexins expressed in the heart-connexins 43, 40, 45 and 37-at the mRNA and protein levels in explanted hearts from transplant patients with end-stage heart failure (NYHA class 4) by immunoconfocal analysis, and northern and western blotting. Connexin43 mRNA and protein were markedly downregulated in the left ventricle in end-stage heart failure due both to ischaemic cardiomyopathy and idiopathic dilated cardiomyopathy. Connexin43 content was spatially heterogeneous in the diseased ventricle. Connexin40 mRNA was increased in the ischaemic group, more so in the left ventricle than the right. This correlated with an increased depth of connexin40 protein expression in myocytes at the endocardial surface. Connexin45 mRNA and protein, present only in very low quantities, followed a similar trend to connexin43, while connexin37 (exclusively expressed in endothelium) showed no change. Our findings show that congestive heart failure is associated with significantly reduced levels of the principal gap junction protein, connexin43, in the left ventricle, potentially contributing to enhanced arrhythmogenicity and contractile dysfunction. This down-regulation is due predominantly to a reduced transcript steady-state level. Elevated connexin40 may represent a compensatory response that improves the spread of depolarization in the otherwise compromised ischaemic ventricle.
Journal of Molecular and Cellular Cardiology, 2001
Brief episodes of ischacmia (I) pr&d the mywwdlpm aga;lst longer minds of I bv the me&m& of isclw... more Brief episodes of ischacmia (I) pr&d the mywwdlpm aga;lst longer minds of I bv the me&m& of isclwmic r~reconditionit~ (PC). PC ~UI.Y not been &did up to now in the iscba&ic myocard& &l&b this is a patbolo&al mnditiob &en encoulltorsd in clinical practice. The aim of this study was to bnwt&te whether precomlitioning capacity ia presewed in iba isolated iscbwmic rJ heart model. Methods Male wistar rats were ud fa ibis study. Isolated normal rat hsartsweropomusdintho~mods.RiortolOminofzero flow global i&aomia (I) followed by 45 mln of rep&i&n (R), hearts was subjedsdti: a) 20 min of I followed by 28 min of R; Group A n=S. b)20minofIfollowedby15minofRand2cyoIesofPC(3minI,5 minR5minIand5minR)GmupB,n=lO. c) 2 cycIes of PC followed by 20 min of I and 10 min of R Cimup C, n=7
Journal of Interventional Cardiac Electrophysiology, 2011
There is an increasing need for catheter ablation procedures to treat complex atrial tachycardias... more There is an increasing need for catheter ablation procedures to treat complex atrial tachycardias (AT) and atrial fibrillation (AF), often requiring detailed endocardial mapping. The sequential point-to-point contact mapping of complex arrhythmias is time-consuming and may not always be feasible. We assessed the utility of a novel spiral duo-decapolar high-density (HD) mapping catheter to delineate complex arrhythmia substrates for ablation. The patients underwent HD mapping using a spiral catheter (AFocusII) and the EnSite NavX system, during catheter ablation procedures, to treat atrial arrhythmias. In 26 patients, a total of 32 atrial arrhythmias were mapped and ablated, comprising of five focal AT, eight macroreentrant AT, 11 persistent AF and eight paroxysmal AF. The HD catheter was used to acquire endocardial surface geometries in all cases and to map the pulmonary veins in patients undergoing AF ablation. In persistent AF, HD catheter mapping permitted the creation of highly detailed complex fractionated electrogram maps (left atrium 449 ± 128 points in 7.2 ± 2.6 min; right atrium 411 ± 113 points in 6.7 ± 1.6 min). In AT, activation mapping was performed with the acquisition of 305 ± 158 timing points in 7.3 ± 2.6 min, guiding successful ablation in all cases. During the follow-up of 7.0 ± 2.6 months, all AT patients remained free of significant arrhythmia. High-density contact mapping with a novel spiral multipolar catheter allows rapid assessment of focal and macroreentrant AT, and complex fractionated electrical activity in the atria. It has further multi-functional capabilities as a pulmonary vein mapping catheter and for accurate geometry creation when used with a 3D mapping system.
Page 1. www.SCIENCEPOSTERS.co.uk Atrial fibrillation-induced Connexin 43 redistribution in atria ... more Page 1. www.SCIENCEPOSTERS.co.uk Atrial fibrillation-induced Connexin 43 redistribution in atria of the Goat Chowdhury R, Dhillon P, Kaba R, Hall MC*, Kirubakaran S*, Garratt CJ* and Peters NS Imperial College London, UK, *Manchester Heart Centre, Manchester, UK ...
The mouse is currently widely used as a model organism in the analysis of gene function but how d... more The mouse is currently widely used as a model organism in the analysis of gene function but how developmentally regulated patterns of connexin gene expression in the mouse compare with those in the human is unclear. Here we compare the patterns of connexin expression in the heart during the development of the mouse (from embryonic day 12.5 to 6 weeks postpartum) and the human (at 9 weeks gestation and adult stage). The extent of connexin43 expression in the ventricles progressively increased during development of the mouse heart. The developmental pattern of expression for connexins 40 and 45 in the mouse heart was similar, but not identical, and in the ventricles showed a progressive and preferential expression in the conduction system. In general, these dynamic changes of connexins 43, 40 and 45 during mouse cardiac development appear to be mirrored in the human.
Journal of Biomedical Research & Environmental Sciences
The most common age range for Atrial Fibrillation (AF) prevalence over the coming decades will po... more The most common age range for Atrial Fibrillation (AF) prevalence over the coming decades will potentially be in those over 75 years old. However, despite widespread recognition of the strong association between AF burden and age, the elderly are under-represented within trials evaluating invasive rhythm control strategies. We report the outcomes of a gentleman in his late eighties that underwent Convergent hybrid ablation for highly symptomatic and longstanding persistent AF. Now four years later and into his nineties, he remains in sinus rhythm and enjoys good cardiac health without the need for anti-arrhythmic drugs or further intervention. To our knowledge, this case report is the oldest patient to have successfully undergone Convergent ablation with enduring sinus rhythm with long-term follow-up, despite significant risk factors for AF recurrence. As the overall population ages, the emergence of this minimally invasive multidisciplinary ablation technique for AF may offer to si...
Introduction: The IMPACT study established the role of controlled esophageal cooling in preventin... more Introduction: The IMPACT study established the role of controlled esophageal cooling in preventing esophageal thermal injury during radiofrequency (RF) ablation for atrial fibrillation (AF). The effect of esophageal cooling on ablation lesion delivery and procedural and patient outcomes had not been previously studied. The objective was to determine the effect of esophageal cooling on the formation of RF lesions, the ability to achieve procedural endpoints, and clinical outcomes. Methods: Participants in the IMPACT trial underwent AF ablation guided by Ablation Index (30 W at 350-400 AI posteriorly, 40 W at ≥450 AI anteriorly). A blinded 1:1 randomization assigned patients to the use of the ensoETM ® device to keep esophageal temperature at 4°C during ablation or standard practice using a single-sensor temperature probe. Ablation parameters and clinical outcomes were analyzed. Results: Procedural data from 188 patients were analyzed. Procedure and fluoroscopy times were similar, and all pulmonary veins were isolated. First-pass pulmonary vein isolation and reconnection at the end of the waiting period were similar in both randomized groups (51/64 vs.
We here present a case of a 54-year-old man with longstanding persistent atrial fibrillation refr... more We here present a case of a 54-year-old man with longstanding persistent atrial fibrillation refractory to direct current electrical cardioversion who underwent a concurrent convergent ablation and Atriclip exclusion of left atrial appendage. His preoperative echocardiography revealed dilated 5.8 cm left atrium with a normal left ventricular ejection fraction of 50%. Transmural isolation of pulmonary veins was performed through a subxiphoid approach, and 3 left-sided video-assisted thoracoscopic surgery ports were utilised to occlude the base of the left atrium appendage with the Atriclip device. A peri-operative transoesophageal echocardiogram confirmed left atrium appendage base occlusion, and the patient was in sinus rhythm after having a single 200 kJ direct current cardioversion shock. The postoperative period was uneventful, and the patient was discharged with preprocedural anticoagulant after 24 hours of the procedure and advised to come for follow up after 3 months.
The burden of AF is increasing in prevalence and healthcare resource usage in the UK and worldwid... more The burden of AF is increasing in prevalence and healthcare resource usage in the UK and worldwide. It can result in impaired quality of life for affected patients, as well as increased risk of stroke, heart failure and mortality. A holistic, integrated approach to AF management is recommended, which may include a focus on reducing risk factors and on medical management with anticoagulation and anti-arrhythmic drugs. There are also various ablation strategies that may be considered when anti-arrhythmic drugs fail to alleviate symptoms and reduce AF burden. These ablation techniques range from standalone percutaneous endocardial catheter ablation to open surgical ablation procedures concomitant with cardiac surgery. More recently, hybrid ablation that combines aspects of both surgical and electrophysiologically targeted ablation has been described. This article reviews the evolution of ablation strategies, beginning with the origin of the Cox maze IV procedure and continuing to the r...
Background: Cardiac implantable electronic device (CIED)-related perforation is uncommon but pote... more Background: Cardiac implantable electronic device (CIED)-related perforation is uncommon but potentially lethal. Management typically includes the use of computed tomography (CT) scanning and often involves cardiac surgery. Methods: Patients presenting to a single referral centre with CIED-related cardiac perforation between 2013 and 2019 were identified. Demographics, diagnostic modalities, the method of lead revision and 30-day complications were examined. Results: Forty-six cases were identified; median time from implantation to diagnosis was 14 days (IQR= 4-50). Most were females (29/46, 63%), 9/46 (20%) had cancer,18 patients (39%) used oral anticoagulants and no patients had prior cardiac surgery. Active fixation was involved in 98% of cases; 9% involved an ICD lead. Thirty-seven leads perforated the right ventricle (apex: 24) and 9 punctured the right atrium (lateral wall: 5). Abnormal electrical parameters were noted in 95% of interrogated cases. Perforation was visualized in 41% and 6% of cases with CXR and transthoracic echocardiography, respectively. CXR revealed a perforation, gross lead displacement or left-sided pleural effusion in 74% of cases. Pericardial effusion occurred in 26 patients (57%) of whom 11 (24%) developed tamponade, successfully drained percutaneously. Pre-extraction CT scan was performed in 19 patients but was essential in 4 cases. Transvenous lead revision (TLR) was successfully performed in all cases with original leads repositioned in 6 patients, without recourse to surgery. Thirty-day mortality and complications were low (0% & 26%, respectively). Conclusion: CT scanning provides incremental diagnostic value in a minority of CIEDrelated perforations. TLR is a safe and effective strategy.
Journal of the American College of Cardiology, 2002
S-Hypertension, Vascular Disease, and Prevention 229A were each strongly enhanced (up to 5 fold) ... more S-Hypertension, Vascular Disease, and Prevention 229A were each strongly enhanced (up to 5 fold) by ultrasound exposure. (** p<0.05 vs. acoustic lipid + DNA) Conclusions: Ultrasound in conjunction with ultrasound-reflective lipoplexes improves gene transfer. Acoustic liposomes conjugated to antibodies have independently been shown to target to vascular disease sites in vivo; thus, using ultrasound, it becomes feasible to both identify a disease site and activate a therapeutic agent in situ. Uptake and expression of I$-Gal DNA in <vascular smooth muscle cells and BHK cells ¢-O 2000°-0o, akeo, o.A 120000 i 15000 ,~, Expression of boat ~ I 15000 1 10000 ~ 10000 15°°°o oooog A~ipid Acobstic Lipid o ¢~.
Journal of the American College of Cardiology, 2003
278). pore region (279-354), and post-pore region including C-terminus (>354). Cardiac events obs... more 278). pore region (279-354), and post-pore region including C-terminus (>354). Cardiac events observed during follow-up from bilth till age of last contact 01 age 40 years were defined as syncope, cardiac arrest, or sudden death. Results. There were 117 (54%) LQTl patients with pre-pore mutations, 84 (39%) patients with pore mutations, and 15 (7%) patients with post-pore mutation. Table shows a comparison of clinical, ECG and cardiac events data between three groups: no slgnificant differences were observed between groups. Conclusions. There are no significant differences in clinical presentation, ECG parameters, and cardiac events among LQTl patients with different locatlon of KCNQl mutation. These findings indicate that other modulation factors than location of mutation influence variable pewtrance of the gene in LQTI patients. sarcolemma and T-tubules. Conclusions: PLM modulates cardiac myocyte contractility in part by altering NCXl function. We also speculate that overexpression of PLM may play a role in the contractile abnormalities obsewed in post infarction cardiac myocyies. LQTI Patients by Mutation Locatmn Females Pre-Pore (Il=ll7) 56 (48%) Pore Post-Pore (n=i 5) (n&l) 49 9 (60%) (56%) Mean QTc (ms) Cardiac Events 491 489 508 57 (50%) 33 4 (31%) (39%) Mean age at 1 st cardiac event (years) 11 12 12 1132-125 Connexin 43 Expression Is Elevated in Human Chronic
Journal of Molecular and Cellular Cardiology, 2001
Congestive heart failure is associated with a high risk of life-threatening ventricular re-entran... more Congestive heart failure is associated with a high risk of life-threatening ventricular re-entrant arrhythmias. Down-regulation of the principal gap-junctional protein of the ventricular myocytes, connexin43, has previously been implicated in arrhythmia in ischaemic heart disease, but it is not known whether connexin43 is similarly reduced in heart failure due to idiopathic dilated cardiomyopathy, whether disease-related connexin43 down-regulation occurs at the level of transcription or translation, or whether the expression of other connexin isotypes is altered in congestive heart failure. We therefore investigated the expression of the four connexins expressed in the heart-connexins 43, 40, 45 and 37-at the mRNA and protein levels in explanted hearts from transplant patients with end-stage heart failure (NYHA class 4) by immunoconfocal analysis, and northern and western blotting. Connexin43 mRNA and protein were markedly downregulated in the left ventricle in end-stage heart failure due both to ischaemic cardiomyopathy and idiopathic dilated cardiomyopathy. Connexin43 content was spatially heterogeneous in the diseased ventricle. Connexin40 mRNA was increased in the ischaemic group, more so in the left ventricle than the right. This correlated with an increased depth of connexin40 protein expression in myocytes at the endocardial surface. Connexin45 mRNA and protein, present only in very low quantities, followed a similar trend to connexin43, while connexin37 (exclusively expressed in endothelium) showed no change. Our findings show that congestive heart failure is associated with significantly reduced levels of the principal gap junction protein, connexin43, in the left ventricle, potentially contributing to enhanced arrhythmogenicity and contractile dysfunction. This down-regulation is due predominantly to a reduced transcript steady-state level. Elevated connexin40 may represent a compensatory response that improves the spread of depolarization in the otherwise compromised ischaemic ventricle.
Journal of Molecular and Cellular Cardiology, 2001
Brief episodes of ischacmia (I) pr&d the mywwdlpm aga;lst longer minds of I bv the me&m& of isclw... more Brief episodes of ischacmia (I) pr&d the mywwdlpm aga;lst longer minds of I bv the me&m& of isclwmic r~reconditionit~ (PC). PC ~UI.Y not been &did up to now in the iscba&ic myocard& &l&b this is a patbolo&al mnditiob &en encoulltorsd in clinical practice. The aim of this study was to bnwt&te whether precomlitioning capacity ia presewed in iba isolated iscbwmic rJ heart model. Methods Male wistar rats were ud fa ibis study. Isolated normal rat hsartsweropomusdintho~mods.RiortolOminofzero flow global i&aomia (I) followed by 45 mln of rep&i&n (R), hearts was subjedsdti: a) 20 min of I followed by 28 min of R; Group A n=S. b)20minofIfollowedby15minofRand2cyoIesofPC(3minI,5 minR5minIand5minR)GmupB,n=lO. c) 2 cycIes of PC followed by 20 min of I and 10 min of R Cimup C, n=7
Journal of Interventional Cardiac Electrophysiology, 2011
There is an increasing need for catheter ablation procedures to treat complex atrial tachycardias... more There is an increasing need for catheter ablation procedures to treat complex atrial tachycardias (AT) and atrial fibrillation (AF), often requiring detailed endocardial mapping. The sequential point-to-point contact mapping of complex arrhythmias is time-consuming and may not always be feasible. We assessed the utility of a novel spiral duo-decapolar high-density (HD) mapping catheter to delineate complex arrhythmia substrates for ablation. The patients underwent HD mapping using a spiral catheter (AFocusII) and the EnSite NavX system, during catheter ablation procedures, to treat atrial arrhythmias. In 26 patients, a total of 32 atrial arrhythmias were mapped and ablated, comprising of five focal AT, eight macroreentrant AT, 11 persistent AF and eight paroxysmal AF. The HD catheter was used to acquire endocardial surface geometries in all cases and to map the pulmonary veins in patients undergoing AF ablation. In persistent AF, HD catheter mapping permitted the creation of highly detailed complex fractionated electrogram maps (left atrium 449 ± 128 points in 7.2 ± 2.6 min; right atrium 411 ± 113 points in 6.7 ± 1.6 min). In AT, activation mapping was performed with the acquisition of 305 ± 158 timing points in 7.3 ± 2.6 min, guiding successful ablation in all cases. During the follow-up of 7.0 ± 2.6 months, all AT patients remained free of significant arrhythmia. High-density contact mapping with a novel spiral multipolar catheter allows rapid assessment of focal and macroreentrant AT, and complex fractionated electrical activity in the atria. It has further multi-functional capabilities as a pulmonary vein mapping catheter and for accurate geometry creation when used with a 3D mapping system.
Page 1. www.SCIENCEPOSTERS.co.uk Atrial fibrillation-induced Connexin 43 redistribution in atria ... more Page 1. www.SCIENCEPOSTERS.co.uk Atrial fibrillation-induced Connexin 43 redistribution in atria of the Goat Chowdhury R, Dhillon P, Kaba R, Hall MC*, Kirubakaran S*, Garratt CJ* and Peters NS Imperial College London, UK, *Manchester Heart Centre, Manchester, UK ...
The mouse is currently widely used as a model organism in the analysis of gene function but how d... more The mouse is currently widely used as a model organism in the analysis of gene function but how developmentally regulated patterns of connexin gene expression in the mouse compare with those in the human is unclear. Here we compare the patterns of connexin expression in the heart during the development of the mouse (from embryonic day 12.5 to 6 weeks postpartum) and the human (at 9 weeks gestation and adult stage). The extent of connexin43 expression in the ventricles progressively increased during development of the mouse heart. The developmental pattern of expression for connexins 40 and 45 in the mouse heart was similar, but not identical, and in the ventricles showed a progressive and preferential expression in the conduction system. In general, these dynamic changes of connexins 43, 40 and 45 during mouse cardiac development appear to be mirrored in the human.
Journal of Biomedical Research & Environmental Sciences
The most common age range for Atrial Fibrillation (AF) prevalence over the coming decades will po... more The most common age range for Atrial Fibrillation (AF) prevalence over the coming decades will potentially be in those over 75 years old. However, despite widespread recognition of the strong association between AF burden and age, the elderly are under-represented within trials evaluating invasive rhythm control strategies. We report the outcomes of a gentleman in his late eighties that underwent Convergent hybrid ablation for highly symptomatic and longstanding persistent AF. Now four years later and into his nineties, he remains in sinus rhythm and enjoys good cardiac health without the need for anti-arrhythmic drugs or further intervention. To our knowledge, this case report is the oldest patient to have successfully undergone Convergent ablation with enduring sinus rhythm with long-term follow-up, despite significant risk factors for AF recurrence. As the overall population ages, the emergence of this minimally invasive multidisciplinary ablation technique for AF may offer to si...
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Papers by Riyaz Kaba