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Papers by Manoj Michelle Obeyesekere

Research paper thumbnail of Right ventricular outflow tract ventricular tachycardia ablation post-Rastelli repair

Europace, Apr 19, 2011

We present a case of right ventricular outflow tract (RVOT) ventricular tachycardia (VT) ablation... more We present a case of right ventricular outflow tract (RVOT) ventricular tachycardia (VT) ablation following remote Rastelli repair. The patient was born with a double-outlet right ventricle (RV), D-transposition of the great arteries (D-TGA), a perimembranous sub-aortic ventricular septal defect (VSD), and valvular and sub-valvular pulmonary stenosis. A Blalock–Taussig shunt was created in the neonatal period, followed by a Rastelli-type repair at the age of 7 years. The latter consisted of tunnelling left ventricular flow along the patch-repaired VSD to the aorta and directing RV flow to the pulmonary artery by means of a valved homograft. The native RVOT had not been over-sewn. At the age of 21 years, the patient presented with a haemodynamically tolerated VT consistent with RVOT origin. Despite treatment with Sotalol the patient experienced a second episode with pre-syncope. Investigations included echocardiography and cardiac magnetic resonance imaging. An electrophysiology study was undertaken of all medication under minimal sedation. A decapolar catheter was inserted into the coronary sinus and quadrapolar catheters were placed at the His bundle region and at the RV apex. Atrio-ventricular Wenkebach occurred at 340 ms with no aberrant conduction. No supraventricular tachycardia was inducible with atrial programmed electrical stimulation (PES; incremental …

Research paper thumbnail of Faculty Opinions recommendation of Age-dependence of relative change in circulating epinephrine and norepinephrine concentrations during tilt-induced vasovagal syncope

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Dec 12, 2012

Research paper thumbnail of Faculty Opinions recommendation of Reduction in inappropriate therapy and mortality through ICD programming

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Dec 20, 2012

Research paper thumbnail of Preventing Sudden Death in Asymptomatic Wolf-Parkinson-White Patients

JACC: Clinical Electrophysiology, Apr 1, 2018

Research paper thumbnail of Faculty Opinions recommendation of Rate-adaptive AV delay and exercise performance following cardiac resynchronization therapy

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, May 13, 2013

Research paper thumbnail of Faculty Opinions recommendation of Use of primary prevention implantable cardioverter-defibrillators in a population-based cohort is associated with a significant survival benefit

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Oct 8, 2012

Research paper thumbnail of Faculty Opinions recommendation of Effects of flecainide on exercise-induced ventricular arrhythmias and recurrences in genotype-negative patients with catecholaminergic polymorphic ventricular tachycardia

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Apr 22, 2013

Research paper thumbnail of Faculty Opinions recommendation of Not all beta-blockers are equal in the management of long QT syndrome types 1 and 2: higher recurrence of events under metoprolol

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Dec 29, 2012

Research paper thumbnail of Concealed Conduction

Journal of Cardiovascular Electrophysiology, May 4, 2011

Research paper thumbnail of Faculty Opinions recommendation of Does EuroSCORE II perform better than its original versions? A multicentre validation study

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Oct 16, 2012

Research paper thumbnail of Faculty Opinions recommendation of Generator exchange is associated with an increased rate of Sprint Fidelis lead failure

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Jun 3, 2013

Research paper thumbnail of Faculty Opinions recommendation of Rhythm versus rate control therapy and subsequent stroke or transient ischemic attack in patients with atrial fibrillation

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Dec 13, 2012

Research paper thumbnail of Faculty Opinions recommendation of The relationship between contact force and clinical outcome during radiofrequency catheter ablation of atrial fibrillation in the TOCCATA study

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, May 13, 2013

Research paper thumbnail of Faculty Opinions recommendation of Prediction of mortality in clinical practice for medicare patients undergoing defibrillator implantation for primary prevention of sudden cardiac death

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Mar 22, 2013

Objectives-The aim of this study was to derive and validate a practical risk model to predict dea... more Objectives-The aim of this study was to derive and validate a practical risk model to predict death within 4 years of primary prevention implantable cardioverter-defibrillator (ICD) implantation. Background-ICDs for the primary prevention of sudden cardiac death improve survival, but recent data suggest that a patient subset with high mortality and minimal ICD benefit may be identified. Methods-Data from a development cohort (n = 17,991) and validation cohort (n = 27,893) of Medicare beneficiaries receiving primary prevention ICDs from 2005 to 2007 were merged with outcomes data through mid-2010 to construct and validate complete and abbreviated risk models for all-cause mortality using Cox proportional hazards regression. Results-Over a median follow-up period of 4 years, 6,741 (37.5%) development and 8,595 (30.8%) validation cohort patients died. The abbreviated model was based on 7 clinically relevant predictors of mortality identified from complete model results, referred to as the "SHOCKED" predictors: 75 years of age or older (hazard ratio [HR]: 1.70; 95% confidence interval [CI]: 1.62 to 1.79), heart failure (

Research paper thumbnail of Application of the 2015 ACC/AHA/HRS guidelines for risk stratification for sudden death in adult patients with asymptomatic pre-excitation

Journal of Cardiovascular Electrophysiology, Jun 22, 2017

The management of the asymptomatic pre-excited patient largely hinges on risk stratification and ... more The management of the asymptomatic pre-excited patient largely hinges on risk stratification and individual patient considerations and choice. A high threshold to treat patients may lead to a small overall risk of death while a low threshold clearly leads to increased invasive testing and ablation with associated cost and procedural risk. A firm recommendation to uniformly assess all by electrophysiology study or, alternatively, reassure all is inappropriate and unjustified by data as reflected in the recent guideline recommendations. The use of non-invasive and invasive parameters to identify the potentially at-risk individual with surveillance for symptoms in those comfortable with this approach or ablation for those choosing this alternative for individual reasons remains the cornerstone of best practice.

Research paper thumbnail of Early Repolarisation – What Should the Clinician Do?

Arrhythmia & Electrophysiology Review, 2015

The early repolarisation (ER) pattern is a common ECG finding. Most individuals with the ER patte... more The early repolarisation (ER) pattern is a common ECG finding. Most individuals with the ER pattern are at minimal risk for arrhythmic events. In others, ER increases the arrhythmic risk of underlying cardiac pathology. Rarely ER syndrome will manifest as a primary arrhythmogenic disorder causing ventricular fibrillation (VF). ER syndrome is defined as syncope attributed to ventricular arrhythmias or cardiac arrest attributed to ER following systematic exclusion of other etiologies. Some ECG features associated with ER portend a higher risk. However, clinically useful risk-stratifying tools to identify the asymptomatic patient at high risk are lacking. Patients with asymptomatic ER and no family history of malignant ER should be reassured. All patients with ER should continue to have modifiable cardiac risk factors addressed. Symptomatic patients should be systematically investigated, directed by symptoms.

Research paper thumbnail of Faculty of 1000 evaluation for The mode of death in implantable cardioverter-defibrillator and cardiac resynchronization therapy with defibrillator patients: Results from routine clinical practice

F1000 - Post-publication peer review of the biomedical literature, 2012

Research paper thumbnail of Faculty of 1000 evaluation for Efficacy and safety of apixaban compared with warfarin at different levels of predicted international normalized ratio control for stroke prevention in atrial fibrillation

F1000 - Post-publication peer review of the biomedical literature, 2013

Research paper thumbnail of Faculty of 1000 evaluation for Net clinical benefit of warfarin in patients with atrial fibrillation: a report from the Swedish atrial fibrillation cohort study

F1000 - Post-publication peer review of the biomedical literature, 2012

Research paper thumbnail of Faculty of 1000 evaluation for Syncope in Brugada syndrome patients: Prevalence, characteristics, and outcome

F1000 - Post-publication peer review of the biomedical literature, 2012

Research paper thumbnail of Right ventricular outflow tract ventricular tachycardia ablation post-Rastelli repair

Europace, Apr 19, 2011

We present a case of right ventricular outflow tract (RVOT) ventricular tachycardia (VT) ablation... more We present a case of right ventricular outflow tract (RVOT) ventricular tachycardia (VT) ablation following remote Rastelli repair. The patient was born with a double-outlet right ventricle (RV), D-transposition of the great arteries (D-TGA), a perimembranous sub-aortic ventricular septal defect (VSD), and valvular and sub-valvular pulmonary stenosis. A Blalock–Taussig shunt was created in the neonatal period, followed by a Rastelli-type repair at the age of 7 years. The latter consisted of tunnelling left ventricular flow along the patch-repaired VSD to the aorta and directing RV flow to the pulmonary artery by means of a valved homograft. The native RVOT had not been over-sewn. At the age of 21 years, the patient presented with a haemodynamically tolerated VT consistent with RVOT origin. Despite treatment with Sotalol the patient experienced a second episode with pre-syncope. Investigations included echocardiography and cardiac magnetic resonance imaging. An electrophysiology study was undertaken of all medication under minimal sedation. A decapolar catheter was inserted into the coronary sinus and quadrapolar catheters were placed at the His bundle region and at the RV apex. Atrio-ventricular Wenkebach occurred at 340 ms with no aberrant conduction. No supraventricular tachycardia was inducible with atrial programmed electrical stimulation (PES; incremental …

Research paper thumbnail of Faculty Opinions recommendation of Age-dependence of relative change in circulating epinephrine and norepinephrine concentrations during tilt-induced vasovagal syncope

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Dec 12, 2012

Research paper thumbnail of Faculty Opinions recommendation of Reduction in inappropriate therapy and mortality through ICD programming

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Dec 20, 2012

Research paper thumbnail of Preventing Sudden Death in Asymptomatic Wolf-Parkinson-White Patients

JACC: Clinical Electrophysiology, Apr 1, 2018

Research paper thumbnail of Faculty Opinions recommendation of Rate-adaptive AV delay and exercise performance following cardiac resynchronization therapy

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, May 13, 2013

Research paper thumbnail of Faculty Opinions recommendation of Use of primary prevention implantable cardioverter-defibrillators in a population-based cohort is associated with a significant survival benefit

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Oct 8, 2012

Research paper thumbnail of Faculty Opinions recommendation of Effects of flecainide on exercise-induced ventricular arrhythmias and recurrences in genotype-negative patients with catecholaminergic polymorphic ventricular tachycardia

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Apr 22, 2013

Research paper thumbnail of Faculty Opinions recommendation of Not all beta-blockers are equal in the management of long QT syndrome types 1 and 2: higher recurrence of events under metoprolol

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Dec 29, 2012

Research paper thumbnail of Concealed Conduction

Journal of Cardiovascular Electrophysiology, May 4, 2011

Research paper thumbnail of Faculty Opinions recommendation of Does EuroSCORE II perform better than its original versions? A multicentre validation study

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Oct 16, 2012

Research paper thumbnail of Faculty Opinions recommendation of Generator exchange is associated with an increased rate of Sprint Fidelis lead failure

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Jun 3, 2013

Research paper thumbnail of Faculty Opinions recommendation of Rhythm versus rate control therapy and subsequent stroke or transient ischemic attack in patients with atrial fibrillation

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Dec 13, 2012

Research paper thumbnail of Faculty Opinions recommendation of The relationship between contact force and clinical outcome during radiofrequency catheter ablation of atrial fibrillation in the TOCCATA study

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, May 13, 2013

Research paper thumbnail of Faculty Opinions recommendation of Prediction of mortality in clinical practice for medicare patients undergoing defibrillator implantation for primary prevention of sudden cardiac death

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Mar 22, 2013

Objectives-The aim of this study was to derive and validate a practical risk model to predict dea... more Objectives-The aim of this study was to derive and validate a practical risk model to predict death within 4 years of primary prevention implantable cardioverter-defibrillator (ICD) implantation. Background-ICDs for the primary prevention of sudden cardiac death improve survival, but recent data suggest that a patient subset with high mortality and minimal ICD benefit may be identified. Methods-Data from a development cohort (n = 17,991) and validation cohort (n = 27,893) of Medicare beneficiaries receiving primary prevention ICDs from 2005 to 2007 were merged with outcomes data through mid-2010 to construct and validate complete and abbreviated risk models for all-cause mortality using Cox proportional hazards regression. Results-Over a median follow-up period of 4 years, 6,741 (37.5%) development and 8,595 (30.8%) validation cohort patients died. The abbreviated model was based on 7 clinically relevant predictors of mortality identified from complete model results, referred to as the "SHOCKED" predictors: 75 years of age or older (hazard ratio [HR]: 1.70; 95% confidence interval [CI]: 1.62 to 1.79), heart failure (

Research paper thumbnail of Application of the 2015 ACC/AHA/HRS guidelines for risk stratification for sudden death in adult patients with asymptomatic pre-excitation

Journal of Cardiovascular Electrophysiology, Jun 22, 2017

The management of the asymptomatic pre-excited patient largely hinges on risk stratification and ... more The management of the asymptomatic pre-excited patient largely hinges on risk stratification and individual patient considerations and choice. A high threshold to treat patients may lead to a small overall risk of death while a low threshold clearly leads to increased invasive testing and ablation with associated cost and procedural risk. A firm recommendation to uniformly assess all by electrophysiology study or, alternatively, reassure all is inappropriate and unjustified by data as reflected in the recent guideline recommendations. The use of non-invasive and invasive parameters to identify the potentially at-risk individual with surveillance for symptoms in those comfortable with this approach or ablation for those choosing this alternative for individual reasons remains the cornerstone of best practice.

Research paper thumbnail of Early Repolarisation – What Should the Clinician Do?

Arrhythmia & Electrophysiology Review, 2015

The early repolarisation (ER) pattern is a common ECG finding. Most individuals with the ER patte... more The early repolarisation (ER) pattern is a common ECG finding. Most individuals with the ER pattern are at minimal risk for arrhythmic events. In others, ER increases the arrhythmic risk of underlying cardiac pathology. Rarely ER syndrome will manifest as a primary arrhythmogenic disorder causing ventricular fibrillation (VF). ER syndrome is defined as syncope attributed to ventricular arrhythmias or cardiac arrest attributed to ER following systematic exclusion of other etiologies. Some ECG features associated with ER portend a higher risk. However, clinically useful risk-stratifying tools to identify the asymptomatic patient at high risk are lacking. Patients with asymptomatic ER and no family history of malignant ER should be reassured. All patients with ER should continue to have modifiable cardiac risk factors addressed. Symptomatic patients should be systematically investigated, directed by symptoms.

Research paper thumbnail of Faculty of 1000 evaluation for The mode of death in implantable cardioverter-defibrillator and cardiac resynchronization therapy with defibrillator patients: Results from routine clinical practice

F1000 - Post-publication peer review of the biomedical literature, 2012

Research paper thumbnail of Faculty of 1000 evaluation for Efficacy and safety of apixaban compared with warfarin at different levels of predicted international normalized ratio control for stroke prevention in atrial fibrillation

F1000 - Post-publication peer review of the biomedical literature, 2013

Research paper thumbnail of Faculty of 1000 evaluation for Net clinical benefit of warfarin in patients with atrial fibrillation: a report from the Swedish atrial fibrillation cohort study

F1000 - Post-publication peer review of the biomedical literature, 2012

Research paper thumbnail of Faculty of 1000 evaluation for Syncope in Brugada syndrome patients: Prevalence, characteristics, and outcome

F1000 - Post-publication peer review of the biomedical literature, 2012