Papers by Antonis Manolis
Nuclear Medicine Communications, Dec 13, 2021
Objective Regadenoson is the first Food and Drug Administration-approved selective A2A adenosine ... more Objective Regadenoson is the first Food and Drug Administration-approved selective A2A adenosine receptor agonist used in myocardial perfusion imaging. Its main benefits are its simplified and brief protocol, along with the ability to be administered safely in patients with asthma or chronic obstructive pulmonary disease of moderate severity. This study aims to identify any potential benefits of regadenoson, regarding the frequency of adverse reactions and its tolerability, over dipyridamole. Methods This is a randomized controlled study of 200 patients scheduled for medium to high-risk noncardiac surgery, of whom 100 were stressed with regadenoson (study group) and the rest with dipyridamole (control group). Results A greater proportion of adverse reactions was recorded in the regadenoson group as compared to the dipyridamole group (53 vs. 36%; P = 0.023), though the duration of most adverse reactions was shorter in the regadenoson group. Dyspnea (P < 0.001) and gastrointestinal disturbances (P = 0.001) were significantly more frequent in the regadenoson group. The use of aminophylline in patients who developed any adverse events was similar in the two groups (P > 0.05). When multiple regression analyses were performed, differences in adverse reactions between the two groups were no longer significant (odds ratio = 1.96; 95% confidence interval, 0.88–3.25; P = 0.11). Conclusion In our group of patients scheduled for myocardial perfusion imaging for preoperative assessment, the two agents, regadenoson and dipyridamole, have no significant differences in the frequency of mild adverse reactions and in aminophylline use, with regadenoson also having the advantage of faster symptom resolution. Nevertheless, dipyridamole can be considered as a well-tolerated and low-cost alternative.
Hospital chronicles, Sep 29, 2014
A 59-year-old patient with dilated cardiomyopathy, severe systolic left ventricular dysfunction a... more A 59-year-old patient with dilated cardiomyopathy, severe systolic left ventricular dysfunction and drug-refractory advanced heart failure (New York Heart Association-NYHA class III-IV symptoms) and prior history of mitral valve replacement was scheduled for implantation of a biventricular pacing system (cardiac resynchronization therapy-defibrillator or CRT-D device). The coronary sinus was cannulated after some effort and a venous coronary angiogram was performed (Panel A). Although a posterolateral cardiac venous branch (Panel A, arrow) was identified to accommodate the left ventricular pacing lead, placement of the lead in this tributary (Panel B) was accompanied by phrenic nerve stimulation, which could not be remedied by moving to more proximal positions where the lead could not be stabilized. Having no other IMAGES IN MEDICINE
Hospital chronicles, Nov 4, 2016
Oral anticoagulants (OAC) decrease the thromboembolic risk of non-valvular atrial fibrillation (A... more Oral anticoagulants (OAC) decrease the thromboembolic risk of non-valvular atrial fibrillation (AF) at the expense of increased bleeding. Over the years, several risk stratification schemes for both stroke and bleeding risk have been devised, among which lately the respective CHA2DS2-VASc and HAS-BLED scores predominate. However, even when the bleeding risk score is high, the guidelines recommend not to withhold OAC at least for patients with high stroke risk, but to attempt to concomitantly modify the conditions contributing to the high bleeding risk. The CHA2DS2-VASc score has been considered more reliable than other scores in identifying "truly low-risk" patients who do not require OAC, in whom the risk of bleeding may negate the protective effect of OAC. Some have suggested more complex schemes to better identify very low risk patients, but these schemes may lead to more extensive and costly assessments to decide on a relatively simple question, i.e. the need or not for anticoagulation therapy. In the era of non-vitamin K oral anticoagulants (NOACs), this may not be necessary any more, and a simple recommendation of providing every AF patient with OAC therapy may turn out to be a more practical and realistic approach, as long as these newer agents remain safe and effective.
Hospital chronicles, Mar 23, 2012
Hellenic Journal of Cardiology, May 1, 2016
Journal of Interventional Cardiology, Aug 7, 2017
Percutaneous coronary intervention and stenting of tandem lesions of the left anterior descending... more Percutaneous coronary intervention and stenting of tandem lesions of the left anterior descending coronary artery, one of which was a chronic total occlusion, was successfully performed in a symptomatic patient with extensive ischemia on myocardial scintigraphy with use of a standard antegrade approach and routine tools without the need to resort to elaborate techniques and sophisticated tools.
PubMed, Mar 1, 2001
Background: Recently, several newer generation stents have become available promising to improve ... more Background: Recently, several newer generation stents have become available promising to improve upon the results of coronary angioplasty (PTCA) with its attendant acute and chronic complications. The aim of this study was to prospectively review the results of a preliminary experience with the newer generation R stent in a series of 56 patients. Methods: This study included 47 men and 9 women, aged 57 +/- 10 years, who presented with stable angina and/or positive exercise testing (n = 12), unstable angina (n = 42), or acute myocardial infarction (n = 2). A consistent approach by a single operator for implantation of the R stent (Orbus Inc., The Netherlands) included stent oversizing (by 0.5 mm) and high pressure (> 12--16 bar) deployment. Dilated vessels comprised the left anterior descending (n = 37) including the diagonal branch in 2 patients, the right coronary artery (n = 17), the left circumflex (n = 13), or a saphenous vein graft (n = 1). The mean left ventricular ejection fraction was 52 +/- 8% and the initial coronary artery stenosis was 85 +/- 8%. Stents were implanted for dissection and/or suboptimal PTCA result or electively. Results: The procedure was successful in all 56 patients (100%). The residual stenosis was < 0--10%. Direct stenting without balloon predilation was performed in 21 patients. Single stents were used in 36 patients and > or = 2 stents in 20 patients. Abciximab (n = 22), eptifibatide (n = 8) or tirofiban (n = 1) was administered in 31 patients (55%). A stent-related complication was noted in one patient (stent misplacement). All patients were discharged alive without infarct or need for surgery. There were no events of subacute stent thrombosis; all patients received combined therapy with aspirin and clopidogrel, the latter for 1 month. In one patient who had received abciximab, severe thrombocytopenia (0 platelet count) was detected at 3 days after discharge but it was fully reversible with no sequelae. Over 5.2 +/- 2.8 (range, 1--11) months, there was one sudden death and two clinical restenoses; no other late complication occurred. Conclusion: Initial experience with 73 R stents in 56 patients and a consistent approach by a single operator of stent oversizing and high-pressure deployment resulted in high procedural success (100%), lack of stent thrombosis (0%), and a low stent-related complication rate (1.8%), while the design and profile of the R stent allowed for direct stenting in 37.5% of patients. One should be vigilant for the sporadic occurrence of severe thrombocytopenia with use of IIb/IIIa inhibitors.
Journal of Arrhythmia, May 12, 2021
IntroductionAfter mitral isthmus (ΜΙ) catheter ablation, perimitral atrial flutter (PMF) circuits... more IntroductionAfter mitral isthmus (ΜΙ) catheter ablation, perimitral atrial flutter (PMF) circuits can be maintained due to the preservation of residual myocardial connections, even if conventional pacing criteria for complete MI block are apparently met (MI pseudo‐block). We aimed to study the incidence, the electrophysiological characteristics, and the long‐term outcome of these patients.MethodsSeventy‐two consecutive patients (mean age 62.4 ± 10.2, 62.5% male) underwent MI ablation, either as part of an atrial fibrillation (AF) ablation strategy (n = 35), or to treat clinical reentrant atrial tachycardia (AT) (n = 32), or to treat AT that occurred during ablation for AF (n = 5). Ιn all patients, the electrophysiological characteristics of PMF circuits were studied by high‐density mapping.ResultsMitral isthmus block was successfully achieved in 69/72 patients (95.6%). Five patients developed PMF after confirming MI block. In these patients, high‐density mapping during the PMF showed a breakthrough in MI with extremely low impulse conduction velocity (CV). In contrast, in usual PMF circuits that occurred after AF ablation, the lowest CV of the reentrant circuit was of significantly higher value (0.07 ± 0.02 m/s vs 0.25 ± 0.07 m/s, respectively; P < .001). Patients presented with clinical AT had better prognosis in maintaining sinus rhythm after MI ablation compared with patients presented with AF.ConclusionPerimitral atrial flutter with MI pseudo‐block may be present after MI ablation and has specific electrophysiological features characterized by remarkably slow CV in the MI. Thus, even after MI block is achieved, a more detailed mapping in the boundaries of the ablation line or reinduction attempts may be needed to exclude residual conduction.
Clinical Cardiology, 1997
A hypothesis was formulated that regional delayed activation of the right ventricle, as seen in i... more A hypothesis was formulated that regional delayed activation of the right ventricle, as seen in incomplete right bundle-branch (IRBBB) aberrancy, may simulate late potential activity and may be responsible for abnormal signal-averaged electrocardiograms (SAECGs). No previous studies have specifically addressed this issue in this particular group of patients (with IRBBB). Therefore, the aim of the present study was to investigate the incidence of abnormal SAECGs in patients with IRBBB. If this were confirmed, our purpose would further be to investigate ways of reducing the false positive results. The study group included 53 patients (28 men and 25 women), aged 53 +/- 13 years, with no history of previous myocardial infarction or ventricular tachycardia and who had an electrocardiogram (ECG) showing IRBBB. An SAECG was also performed in a control group of 19 age-matched individuals with a normal ECG. Time domain analysis was performed using a band pass filter of 40-250 Hz. The following parameters were considered normal: filtered QRS duration (QRSD) &lt; 114 ms, root mean square of the voltage of the last 40 ms of the QRS complex (RMS) &gt; 20 microV, and the duration of the low amplitude signal (&lt; 40 microV) at the terminal portion of the QRS (LAS) &lt; 38 ms. An SAECG was considered abnormal if any two of these criteria were abnormal. The mean values of the SAECG parameters were: QRSD 101 +/- 11 ms, RMS 32 +/- 20 microV, LAS 32 +/- 12 ms, and noise 0.29 +/- 0.13 microV. Abnormal SAECGs with at least two criteria satisfied were present in 16 of 53 (30%) patients compared with 0 (0%) of 19 individuals in the control group (p = 0.02). Abnormal values included the combination of RMS and LAS in 12 patients and all three parameters in 4 patients. However, if the definition of late potentials were limited to the combination of abnormal QRSD and either RMS or LAS values, the incidence of false positive results (4 patients) (7.5%) would be significantly decreased (p = 0.007). At 21 months of follow-up, no arrhythmic events occurred. Delayed terminal conduction observed in IRBBB may cause a high incidence of false positive late potentials on SAECGs. Based on this study, we propose that this can be largely remedied if the optimal criteria for the presence of late potentials in patients with IRBBB always include the combination of QRSD and either RMS or LAS.
Pacing and Clinical Electrophysiology, 2017
Cardiac implantable electronic device (CIED) infections can have devastating implications for pat... more Cardiac implantable electronic device (CIED) infections can have devastating implications for patient morbidity and mortality. Over the past decade, the infection rate has risen out of proportion to implant rates, and has prompted the development of innovative solutions designed to reduce infections. The first section of this review provides a summary of the contemporary knowledge regarding the incidence, prevalence, microbiology, and risk factors for cardiac implantable electronic device infections. The second section addresses prevention with an emphasis on the potential role of novel procedural approaches, such as capsulectomy and the antibacterial envelope, in reducing CIED infection.
Archives of internal medicine, Nov 1, 1988
Thirty-four drug addicts with endocarditis were studied to evaluate the prognostic significance o... more Thirty-four drug addicts with endocarditis were studied to evaluate the prognostic significance of vegetation size and its short-term changes, as determined by two-dimensional echocardiography. Among 43 episodes of endocarditis, vegetations were detected in 27 (63%), confined to the tricuspid valve in 20 patients, mitral valve in one, aortic valve in two, and both tricuspid and mitral valves in four. All vegetations were large (greater than or equal to 1 cm) (mean maximal dimension, 1.7 +/- 0.5 cm). Medical cure was achieved in all 16 patients without vegetations and in 18 (90%) of 20 patients with tricuspid valve vegetations. One patient with tricuspid vegetation and polymicrobial infection died of respiratory failure. Surgery was required for one patient with tricuspid vegetation, all three patients with isolated left-sided endocarditis, and two of four patients with multivalve involvement. Short-term changes of tricuspid valve vegetations during therapy (one to eight weeks) did not correlate with clinical outcome. Although large tricuspid vegetations may occasionally identify a subset at risk for complications, most patients with isolated tricuspid valve endocarditis have a benign prognosis.
American Heart Journal, Nov 1, 1994
The aim of this study was to compare the efficacy of transaortic (n = 54) and transseptal (n = 28... more The aim of this study was to compare the efficacy of transaortic (n = 54) and transseptal (n = 28) techniques during radiofrequency (RF) ablation of left accessory pathways (n = 75) in both left posteroseptal and free-wall locations in 73 consecutive patients (mean age 32 +/- 15 years). The transseptal approach included transseptal puncture and use of a retained long sheath in the left atrium (n = 24) or direct insertion of the mapping/ablation catheter via a patent foramen ovale (n = 4). Transseptal RF ablation was used as the primary method in 23 patients or at a separate session after the transaortic RF ablation failed in 5 patients. Transaortic RF ablation was used as primary method in 50 patients and after failed transseptal ablation in 4 patients. Transaortic ablation was successful in 47 (87%) of 54 procedures, transseptal ablation in 24 (86%) of 28 procedures, with total RF ablation success in 70 (96%) of 73 patients. The transseptal puncture/long sheath method was successful in 23 (96%) of 24 patients. This latter technique resulted in more stable positioning and easier manipulation of the ablation catheter. Switching from transseptal puncture/long sheath to transaortic technique was needed in 1 of 24 patients, from transseptal/patent foramen ovale approach to the transaortic route in 3 of 4 patients, and from the transaortic to the transseptal approach at a separate session in 5 patients. The age of patients and number of RF lesions were similar in the two groups. Fluoroscopy time was lower for the transseptal group (81 +/- 57 vs 121 +/- 81 min; p &lt; 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Pacing and Clinical Electrophysiology, Apr 1, 1997
The feasibility and efficacy of radiofrequency catheter ablation of medically resistant supravent... more The feasibility and efficacy of radiofrequency catheter ablation of medically resistant supraventricular tachycardia is a promising technique with applications in the pediatric age group. The limitations of this procedure in the pediatric population, however, have yet to be delineated. We herein report a case of incessant reentrant supraventricular tachycardia in a two month old infant which was resistant to pharmacologic therapy, yet successfully treated by radiofrequency catheter ablation.
A patient with an implanted dual-chamber pacemaker (DDDR) for sick sinus syndrome had a pulse gen... more A patient with an implanted dual-chamber pacemaker (DDDR) for sick sinus syndrome had a pulse generator exchange due to battery depletion. Apropos with the procedure, it was noted that the patient had continuous ventricular pacing via a pacing lead located at the right ventricular apex. In order to avoid possible deleterious effects of the iatrogenic dyssynchrony conferred by this kind of pacing, the algorithm of ventricular pace suppression function was activated in the new device that practically led to functional AAI pacing, deemed a more physiologic mode of pacing that could prevent the potential harmful effects of right ventricular apical pacing. Rhythmos 2018;13(3):59-61.
Hospital chronicles, 2008
Several electrocardiographic (ECG) changes have been described with pneumothorax, most often left... more Several electrocardiographic (ECG) changes have been described with pneumothorax, most often left-sided. We present a case of spontaneous right-sided pneumothorax, presenting with an ECG suggesting an old myocardial infarction. A chest X-ray confirmed the diagnosis of pneumothorax, while an echocardiogram and serial cardiac enzyme testing excluded myocardial infarction. ECG changes returned to normal after chest tube insertion. Physicians should be familiar with the ECG changes that can be caused by pneumothorax in order to avoid diagnostic and therapeutic pitfalls.
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Papers by Antonis Manolis