Paul Lelorier - Academia.edu (original) (raw)

Papers by Paul Lelorier

Research paper thumbnail of Ablation of accessory pathway from right atrial appendage to anatomic left ventricle in L-Transposition of the Great Arteries

HeartRhythm Case Reports, Nov 30, 2023

Research paper thumbnail of ECG of the month: a subtle sign of dual atrioventricular nodal pathways. Sinus rhythm with second-degree atrioventricular (AV) block, Type I, with each Wenckebach sequence being terminated by a premature, retrograde, reentrant P wave; left ventricular hypertrophy with repolarization changes

Research paper thumbnail of ECG of the month. Bigeminal rhythm VIII. Sinus rhythm with normal antegrade atrioventricular (A-V) conduction and slow retrograde conduction back to the atria, producing atrial reentry or echo complexes and suggesting dual A-V nodal pathways or an accessory A-V pathway that conducts slowly from t...

PubMed, Jan 26, 2012

A 55-year-old woman came to the emergency department because of an episode of post-prandial upper... more A 55-year-old woman came to the emergency department because of an episode of post-prandial upper abdominal pain radiating to her back and associated with nausea and vomiting. The pain had been recurring intermittently for approximately six months. While in the emergency department, she had another episode of pain and felt lightheaded. Her pulse rate at that point was between 30 and 40 beats per minute, and an electrocardiogram was recorded (Figure).

Research paper thumbnail of Ablation of Rare Accessory Pathway from Right Atrial Appendage Diverticulum to Anatomic Left Ventricle in CC-Tga

Journal of the American College of Cardiology, Mar 1, 2023

Research paper thumbnail of Ventricular Arrhythmia and Sinus Pause in the Setting of COVID-19

Journal of the American College of Cardiology

Research paper thumbnail of Ranolazine in High-Risk Patients With Implanted Cardioverter-Defibrillators: The RAID Trial

Journal of the American College of Cardiology, Jan 7, 2018

Ventricular tachycardia (VT) and ventricular fibrillation (VF) remain a challenging problem in pa... more Ventricular tachycardia (VT) and ventricular fibrillation (VF) remain a challenging problem in patients with implantable cardioverter-defibrillators (ICDs). This study aimed to determine whether ranolazine administration decreases the likelihood of VT, VF, or death in patients with an ICD. This was double-blind, placebo-controlled clinical trial in which high-risk ICD patients with ischemic or nonischemic cardiomyopathy were randomized to 1,000 mg ranolazine twice a day or placebo. The primary endpoint was VT or VF requiring appropriate ICD therapy or death, whichever occurred first. Pre-specified secondary endpoints included ICD shock for VT, VF, or death and recurrent VT or VF requiring ICD therapy. Among 1,012 ICD patients (510 randomized to ranolazine and 502 to placebo) the mean age was 64 ± 10 years and 18% were women. During 28 ± 16 months of follow-up there were 372 (37%) patients with primary endpoint, 270 (27%) patients with VT or VF, and 148 (15%) deaths. The blinded stud...

Research paper thumbnail of Atrial tachycardia: mechanisms and management

Expert Review of Cardiovascular Therapy, 2008

Research paper thumbnail of Correlation of signal averaged electrocardiography findings with fibrosis on cardiac magnetic resonance imaging

European Heart Journal, 2021

Background Signal averaged electrocardiogram (SAECG) is a non invasive test to record delayed dep... more Background Signal averaged electrocardiogram (SAECG) is a non invasive test to record delayed depolarization of myocardium with slow conduction that can potentially be the substrate for monomorphic ventricular tachycardia in high risk patients. Cardiac magnetic resonance imaging (cMRI) techniques for fibrosis imaging using late gadolinium enhancement (LGE) and T1 mapping remain the gold standard for characterization of myocardial tissue and triaging patients for risk of ventricular arrhythmias. However, cMRI remains unavailable in some areas, is time consuming, expensive and impossible for some patients to obtain due to claustrophobia, renal impairment or implanted hardware. To date, data is lacking with regards to correlation of findings between these two modalities. Purpose To investigate whether late potentials identified by SAECG correlate with the presence of fibrosis seen with cMRI. If correlation is established, SAECG could potentially be used as a non-invasive, cheaper, more...

Research paper thumbnail of Abstract P099: Atrial Flutter - Clinical Correlates and Adverse Outcomes in the Framingham Heart Study

Circulation, 2015

Introduction: There has been little study of atrial flutter (AFl), distinct from atrial fibrillat... more Introduction: There has been little study of atrial flutter (AFl), distinct from atrial fibrillation, in community-based, epidemiologic cohorts. We determined the clinical correlates of AFl and its associated outcomes in the Framingham Heart Study. Methods: We adjudicated electrocardiograms from study exams, and ambulatory and hospital records to identify typical AFl in participants without prevalent atrial fibrillation or AFl. We compared individuals with AFl to participants with neither atrial fibrillation nor AFl. We identified factors associated with a new diagnosis of AFl. We examined the 10-year risks of atrial fibrillation, myocardial infarction, heart failure, stroke, and all-cause mortality in Cox proportional hazards models with adjustment for age, sex, body mass index, systolic and diastolic blood pressures, hypertension treatment, diabetes mellitus and prevalent cardiovascular disease. Results: During a follow-up of 33.0±12.2 years, 112 individuals developed AFl. In age-...

Research paper thumbnail of Demonstrating new-onset or worsened sudomotor function post-COVID-19 on comparative analysis of autonomic function pre-and post-SARS-CoV-2 infection

eNeurologicalSci

Background: Autonomic dysfunction including sudomotor abnormalities have been reported in associa... more Background: Autonomic dysfunction including sudomotor abnormalities have been reported in association with SARS-CoV-2 infection. Objective: There are no previous studies that have compared autonomic function objectively in patients pre-and post-SARS-CoV-2 infection. We aimed to identify if SARS-CoV-2 virus is triggering and/or worsening dysautonomia by comparing autonomic function tests in a group of patients pre-and post-SARS-CoV-2 infection. Design/methods: Six participants were enrolled and divided into two groups. The first group of 4 participants reported worsened autonomic symptoms post-SARS-CoV-2 infection. These individuals had their first autonomic test prior to COVID-19 pandemic outbreak (July 2019-December 2019). Autonomic function testing was repeated in these participants, 6 months to 1-year post-SARS-CoV-2 infection (June 2021). The second group of 2 participants reported new-onset autonomic symptoms post-COVID-19 infection and were also tested within 6 months post-SARS-CoV-2 infection. All participants had mild COVID-19 infection per WHO criteria. They had no evidence of large fiber neuropathy as demonstrated by normal neurophysiological studies (EMG/NCS). They were all screened for known causes of autonomic dysfunction and without risk factors of hypertension/hyperlipidemia, thyroid dysfunction, diabetes/ prediabetes, vitamin deficiencies, history of HIV, hepatitis, or syphilis, prior radiation or chemical exposure or evidence of monoclonal gammopathy, or autoimmune condition. Results: Participants were female (age: 21-37y) and all endorsed orthostatic intolerance (6/6). Gastrointestinal symptoms (5 / 6), new-onset paresthesias, (3/6), and sexual dysfunction (2/6) were reported. Parasympathetic autonomic function remained stable 6-months to 1-year post-COVID-19 infection and no parasympathetic dysfunction was demonstrated in participants with new-onset dysautonomia symptoms. Postural orthostatic tachycardia was noted in half of the patients, being observed in one patient pre-SARS-CoV-2 infection and persisting post-SARS-CoV-2 infection; while new-onset postural tachycardia was observed in 1/3rd of patients. Sympathetic cholinergic (sudomotor) dysfunction was demonstrated in ALL participants. Worsened, or newonset, sudomotor dysfunction was demonstrated in those with mild or normal sudomotor function on pre-COVID-19 autonomic testing. Conclusions: Sympathetic adrenergic and cholinergic dysautonomia probably account for some of the symptoms of Long COVID-19. Sudomotor dysfunction was demonstrated as consistently worsened or new-sequelae to COVID-19 infection. COVID-19 may be responsible for triggering new-onset or worsened small-fiber neuropathy

Research paper thumbnail of McGill-Medicine Student Initiative

e three students spent 6 weeks in several loca-tions throughout Argen-tina to observe its com-ple... more e three students spent 6 weeks in several loca-tions throughout Argen-tina to observe its com-plex medical system and the role primary care physicians play in such a setting. This project, part of the McGill-Medicine Student Initiative, was partially funded by The Canadian Society for International Health. By being immersed in the system, we hoped that we would get an accu-rate picture of the strengths and weaknesses of the country's health care system- we did. The myriad problems that plague the system were evident: lack of universal access to medical education, limited residency positions, lack of continuing medical education, and poor distribution of funds and physicians. In addition, the impact that pri-mary care practitioners can have on the health of a population was underlined. We left the country with a heightened awareness of Argentina's difficulties and obstacles, those that are universal to struggling health care systems around the world

Research paper thumbnail of Cardiac Manifestations in a Case of Severe Hyperkalemia

Cureus, 2021

Severe hyperkalemia is a life-threatening electrolyte imbalance that may lead to fatal arrhythmia... more Severe hyperkalemia is a life-threatening electrolyte imbalance that may lead to fatal arrhythmias. ECG (electrocardiogram) and serum potassium levels are vital for diagnosing and stratifying the risk. Management involves shifting potassium intracellularly and eliminating it through renal and gastrointestinal routes. Failure to diagnose early and manage severe hyperkalemia requires emergent hemodialysis.

Research paper thumbnail of A Case of Intermittent Left Bundle Branch Block

Cureus, 2021

An 82-year-old woman with uncontrolled hypertension and occasional exertional dyspnea was found t... more An 82-year-old woman with uncontrolled hypertension and occasional exertional dyspnea was found to be in intermittent left bundle branch block (LBBB). Her laboratory results, echocardiogram, and ischemic workup were unremarkable. This case highlights that intermittent LBBB is not always associated with coronary ischemia, vasospasm, blunt cardiac injury, drugs, and high catecholaminergic or inflammatory states.

Research paper thumbnail of Diffuse ST-Segment Elevation With Idiopathic Malignant Ventricular Arrhythmia

Circulation, 2021

St Bartholomew's Hospital: founded almost 900 years ago and currently the largest cardiovascular ... more St Bartholomew's Hospital: founded almost 900 years ago and currently the largest cardiovascular centre in Europe. As a hospital only 2 years away from its 900th anniversary, summarizing the history of St Bartholomew's is challenging. Founded just outside the medieval City of London in 1123 by a courtier of King Henry I, "Bart's" quickly became known as a place of healing and safety, for patients, foundlings, orphans, pilgrims, and travellers. In 1546, following a period of uncertainty after the dissolution of religious houses by King Henry VIII, St Bartholomew's was refounded as a secular institution, and the hospital has had a physician and surgeon on staff ever since. William Harvey, the first person to describe the circulation of the blood, was physician to the hospital for much of his life. The square at the centre of the original hospital site, surrounded by the 18th century wings designed by James Gibbs, remains the heart of the modern hospital site. Today, Barts Heart Centre is the largest cardiovascular centre in Europe providing specialist care to a population of 6 million patients, with state-of-the-art facilities including 9 cardiac operating theatres, 10 cardiac catheter laboratories, and 3 cardiac MRI scanners. Focus is on partnership between academic and clinical medicine, to deliver world-class cardiovascular care to patients-hopefully for many centuries more. Images show St Bartholomew's Hospital through the ages-the hospital site, 1720 (top left), view of Henry VIII gatehouse entrance to the hospital, 1939 (top right), patients being nursed in their beds in the main hospital quadrangle, 1934 (lower left), the interior of the hospital today (lower right).

Research paper thumbnail of Malignant Early Repolarization

The American journal of cardiology, Jan 15, 2018

A 27-year-old man presents with successfully resuscitated ventricular fibrillation. Structural an... more A 27-year-old man presents with successfully resuscitated ventricular fibrillation. Structural and electrical causes of ventricular fibrillation in the young are presented along with a diagnostic strategy. Electrocardiographic features of malignant early repolarization are discussed.

Research paper thumbnail of Transvenous Before Surgical Hybrid Procedure

The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society

Historically, persistent atrial fibrillation (PeAF) and long standing persistent atrial fibrillat... more Historically, persistent atrial fibrillation (PeAF) and long standing persistent atrial fibrillation (LSPeAF) have demonstrated limited clinical success despite hybrid approaches. We describe our experience with the endocardial-before-epicardial approach defined by a comprehensive endovascular approach preceding and guiding the epicardial approach which includes an extensive posterior wall ablation. 40 patients were followed over a 12 month period. The procedure was performed in a single center. Patients had a mean duration of atrial fibrillation of 6.0 ± 4.5 years with 22.5% having undergone prior ablations. Mean age was 61.7 ± 7.9 years with a mean left atrial volume of 131.5 ± 46.9 mL. The endovascular procedure remained uniform with antral pulmonary vein isolation, posterior left atrial roof and right atrial cavo-tricuspid isthmus (CTI) linear lesions with mapping and ablation of left atrial complex electrograms (CFAEs) and prior existing atrial arrhythmias. The epicardial proce...

Research paper thumbnail of Dynamic ST-Segment Abnormality

The American journal of cardiology, Jan 2, 2017

A 37-year-old man came to the emergency department because of several days of intermittent chest ... more A 37-year-old man came to the emergency department because of several days of intermittent chest pain. An electrocardiogram (ECG) showed sinus rhythm, left atrial and left ventricular enlargement, and an early repolarization pattern. A second ECG recorded 10 minutes later was strikingly different, with ST-segment elevation and large upright T waves in the anterior precordial leads, interpreted as evidence of an ST-segment elevation myocardial infarction, and the cardiac catheterization team was activated. Closer inspection of the ECG, however, disclosed that the changes were because of intermittent ventricular pre-excitation of the Wolff-Parkinson-White type, and no electrocardiographic, echocardiographic, or serum markers of myocardial infarction were found.

Research paper thumbnail of Postinduction Paced Pulseless Electrical Activity in a Patient With a History of Oropharyngeal Instrumentation-Induced Reflex Circulatory Collapse

The Ochsner journal, 2016

Reflex hypotension and bradycardia have been reported to occur following administration of severa... more Reflex hypotension and bradycardia have been reported to occur following administration of several drugs associated with administration of anesthesia and also following a variety of procedural stimuli. A 54-year-old postmenopausal female with a history of asystole associated with sedated upper gastrointestinal endoscopy and post-anesthetic-induction tracheal intubation received advanced cardiac resuscitation after insertion of a temporary transvenous pacemaker failed to prevent pulseless electrical activity. The patient's condition stabilized, and she underwent successful cataract extraction, intraocular lens implantation, and pars plana vitrectomy. Cardiac pacemaker insertion prior to performance of a procedure historically associated with reflex circulatory collapse can be expected to protect a patient from bradycardia but not necessarily hypotension.

Research paper thumbnail of Pacemaker with neurocardiogenic syncope detection and therapy utilizing minute ventilation input

Research paper thumbnail of Asymptomatic ECG Abnormalities

Electrophysiological Disorders of the Heart, 2005

Research paper thumbnail of Ablation of accessory pathway from right atrial appendage to anatomic left ventricle in L-Transposition of the Great Arteries

HeartRhythm Case Reports, Nov 30, 2023

Research paper thumbnail of ECG of the month: a subtle sign of dual atrioventricular nodal pathways. Sinus rhythm with second-degree atrioventricular (AV) block, Type I, with each Wenckebach sequence being terminated by a premature, retrograde, reentrant P wave; left ventricular hypertrophy with repolarization changes

Research paper thumbnail of ECG of the month. Bigeminal rhythm VIII. Sinus rhythm with normal antegrade atrioventricular (A-V) conduction and slow retrograde conduction back to the atria, producing atrial reentry or echo complexes and suggesting dual A-V nodal pathways or an accessory A-V pathway that conducts slowly from t...

PubMed, Jan 26, 2012

A 55-year-old woman came to the emergency department because of an episode of post-prandial upper... more A 55-year-old woman came to the emergency department because of an episode of post-prandial upper abdominal pain radiating to her back and associated with nausea and vomiting. The pain had been recurring intermittently for approximately six months. While in the emergency department, she had another episode of pain and felt lightheaded. Her pulse rate at that point was between 30 and 40 beats per minute, and an electrocardiogram was recorded (Figure).

Research paper thumbnail of Ablation of Rare Accessory Pathway from Right Atrial Appendage Diverticulum to Anatomic Left Ventricle in CC-Tga

Journal of the American College of Cardiology, Mar 1, 2023

Research paper thumbnail of Ventricular Arrhythmia and Sinus Pause in the Setting of COVID-19

Journal of the American College of Cardiology

Research paper thumbnail of Ranolazine in High-Risk Patients With Implanted Cardioverter-Defibrillators: The RAID Trial

Journal of the American College of Cardiology, Jan 7, 2018

Ventricular tachycardia (VT) and ventricular fibrillation (VF) remain a challenging problem in pa... more Ventricular tachycardia (VT) and ventricular fibrillation (VF) remain a challenging problem in patients with implantable cardioverter-defibrillators (ICDs). This study aimed to determine whether ranolazine administration decreases the likelihood of VT, VF, or death in patients with an ICD. This was double-blind, placebo-controlled clinical trial in which high-risk ICD patients with ischemic or nonischemic cardiomyopathy were randomized to 1,000 mg ranolazine twice a day or placebo. The primary endpoint was VT or VF requiring appropriate ICD therapy or death, whichever occurred first. Pre-specified secondary endpoints included ICD shock for VT, VF, or death and recurrent VT or VF requiring ICD therapy. Among 1,012 ICD patients (510 randomized to ranolazine and 502 to placebo) the mean age was 64 ± 10 years and 18% were women. During 28 ± 16 months of follow-up there were 372 (37%) patients with primary endpoint, 270 (27%) patients with VT or VF, and 148 (15%) deaths. The blinded stud...

Research paper thumbnail of Atrial tachycardia: mechanisms and management

Expert Review of Cardiovascular Therapy, 2008

Research paper thumbnail of Correlation of signal averaged electrocardiography findings with fibrosis on cardiac magnetic resonance imaging

European Heart Journal, 2021

Background Signal averaged electrocardiogram (SAECG) is a non invasive test to record delayed dep... more Background Signal averaged electrocardiogram (SAECG) is a non invasive test to record delayed depolarization of myocardium with slow conduction that can potentially be the substrate for monomorphic ventricular tachycardia in high risk patients. Cardiac magnetic resonance imaging (cMRI) techniques for fibrosis imaging using late gadolinium enhancement (LGE) and T1 mapping remain the gold standard for characterization of myocardial tissue and triaging patients for risk of ventricular arrhythmias. However, cMRI remains unavailable in some areas, is time consuming, expensive and impossible for some patients to obtain due to claustrophobia, renal impairment or implanted hardware. To date, data is lacking with regards to correlation of findings between these two modalities. Purpose To investigate whether late potentials identified by SAECG correlate with the presence of fibrosis seen with cMRI. If correlation is established, SAECG could potentially be used as a non-invasive, cheaper, more...

Research paper thumbnail of Abstract P099: Atrial Flutter - Clinical Correlates and Adverse Outcomes in the Framingham Heart Study

Circulation, 2015

Introduction: There has been little study of atrial flutter (AFl), distinct from atrial fibrillat... more Introduction: There has been little study of atrial flutter (AFl), distinct from atrial fibrillation, in community-based, epidemiologic cohorts. We determined the clinical correlates of AFl and its associated outcomes in the Framingham Heart Study. Methods: We adjudicated electrocardiograms from study exams, and ambulatory and hospital records to identify typical AFl in participants without prevalent atrial fibrillation or AFl. We compared individuals with AFl to participants with neither atrial fibrillation nor AFl. We identified factors associated with a new diagnosis of AFl. We examined the 10-year risks of atrial fibrillation, myocardial infarction, heart failure, stroke, and all-cause mortality in Cox proportional hazards models with adjustment for age, sex, body mass index, systolic and diastolic blood pressures, hypertension treatment, diabetes mellitus and prevalent cardiovascular disease. Results: During a follow-up of 33.0±12.2 years, 112 individuals developed AFl. In age-...

Research paper thumbnail of Demonstrating new-onset or worsened sudomotor function post-COVID-19 on comparative analysis of autonomic function pre-and post-SARS-CoV-2 infection

eNeurologicalSci

Background: Autonomic dysfunction including sudomotor abnormalities have been reported in associa... more Background: Autonomic dysfunction including sudomotor abnormalities have been reported in association with SARS-CoV-2 infection. Objective: There are no previous studies that have compared autonomic function objectively in patients pre-and post-SARS-CoV-2 infection. We aimed to identify if SARS-CoV-2 virus is triggering and/or worsening dysautonomia by comparing autonomic function tests in a group of patients pre-and post-SARS-CoV-2 infection. Design/methods: Six participants were enrolled and divided into two groups. The first group of 4 participants reported worsened autonomic symptoms post-SARS-CoV-2 infection. These individuals had their first autonomic test prior to COVID-19 pandemic outbreak (July 2019-December 2019). Autonomic function testing was repeated in these participants, 6 months to 1-year post-SARS-CoV-2 infection (June 2021). The second group of 2 participants reported new-onset autonomic symptoms post-COVID-19 infection and were also tested within 6 months post-SARS-CoV-2 infection. All participants had mild COVID-19 infection per WHO criteria. They had no evidence of large fiber neuropathy as demonstrated by normal neurophysiological studies (EMG/NCS). They were all screened for known causes of autonomic dysfunction and without risk factors of hypertension/hyperlipidemia, thyroid dysfunction, diabetes/ prediabetes, vitamin deficiencies, history of HIV, hepatitis, or syphilis, prior radiation or chemical exposure or evidence of monoclonal gammopathy, or autoimmune condition. Results: Participants were female (age: 21-37y) and all endorsed orthostatic intolerance (6/6). Gastrointestinal symptoms (5 / 6), new-onset paresthesias, (3/6), and sexual dysfunction (2/6) were reported. Parasympathetic autonomic function remained stable 6-months to 1-year post-COVID-19 infection and no parasympathetic dysfunction was demonstrated in participants with new-onset dysautonomia symptoms. Postural orthostatic tachycardia was noted in half of the patients, being observed in one patient pre-SARS-CoV-2 infection and persisting post-SARS-CoV-2 infection; while new-onset postural tachycardia was observed in 1/3rd of patients. Sympathetic cholinergic (sudomotor) dysfunction was demonstrated in ALL participants. Worsened, or newonset, sudomotor dysfunction was demonstrated in those with mild or normal sudomotor function on pre-COVID-19 autonomic testing. Conclusions: Sympathetic adrenergic and cholinergic dysautonomia probably account for some of the symptoms of Long COVID-19. Sudomotor dysfunction was demonstrated as consistently worsened or new-sequelae to COVID-19 infection. COVID-19 may be responsible for triggering new-onset or worsened small-fiber neuropathy

Research paper thumbnail of McGill-Medicine Student Initiative

e three students spent 6 weeks in several loca-tions throughout Argen-tina to observe its com-ple... more e three students spent 6 weeks in several loca-tions throughout Argen-tina to observe its com-plex medical system and the role primary care physicians play in such a setting. This project, part of the McGill-Medicine Student Initiative, was partially funded by The Canadian Society for International Health. By being immersed in the system, we hoped that we would get an accu-rate picture of the strengths and weaknesses of the country's health care system- we did. The myriad problems that plague the system were evident: lack of universal access to medical education, limited residency positions, lack of continuing medical education, and poor distribution of funds and physicians. In addition, the impact that pri-mary care practitioners can have on the health of a population was underlined. We left the country with a heightened awareness of Argentina's difficulties and obstacles, those that are universal to struggling health care systems around the world

Research paper thumbnail of Cardiac Manifestations in a Case of Severe Hyperkalemia

Cureus, 2021

Severe hyperkalemia is a life-threatening electrolyte imbalance that may lead to fatal arrhythmia... more Severe hyperkalemia is a life-threatening electrolyte imbalance that may lead to fatal arrhythmias. ECG (electrocardiogram) and serum potassium levels are vital for diagnosing and stratifying the risk. Management involves shifting potassium intracellularly and eliminating it through renal and gastrointestinal routes. Failure to diagnose early and manage severe hyperkalemia requires emergent hemodialysis.

Research paper thumbnail of A Case of Intermittent Left Bundle Branch Block

Cureus, 2021

An 82-year-old woman with uncontrolled hypertension and occasional exertional dyspnea was found t... more An 82-year-old woman with uncontrolled hypertension and occasional exertional dyspnea was found to be in intermittent left bundle branch block (LBBB). Her laboratory results, echocardiogram, and ischemic workup were unremarkable. This case highlights that intermittent LBBB is not always associated with coronary ischemia, vasospasm, blunt cardiac injury, drugs, and high catecholaminergic or inflammatory states.

Research paper thumbnail of Diffuse ST-Segment Elevation With Idiopathic Malignant Ventricular Arrhythmia

Circulation, 2021

St Bartholomew's Hospital: founded almost 900 years ago and currently the largest cardiovascular ... more St Bartholomew's Hospital: founded almost 900 years ago and currently the largest cardiovascular centre in Europe. As a hospital only 2 years away from its 900th anniversary, summarizing the history of St Bartholomew's is challenging. Founded just outside the medieval City of London in 1123 by a courtier of King Henry I, "Bart's" quickly became known as a place of healing and safety, for patients, foundlings, orphans, pilgrims, and travellers. In 1546, following a period of uncertainty after the dissolution of religious houses by King Henry VIII, St Bartholomew's was refounded as a secular institution, and the hospital has had a physician and surgeon on staff ever since. William Harvey, the first person to describe the circulation of the blood, was physician to the hospital for much of his life. The square at the centre of the original hospital site, surrounded by the 18th century wings designed by James Gibbs, remains the heart of the modern hospital site. Today, Barts Heart Centre is the largest cardiovascular centre in Europe providing specialist care to a population of 6 million patients, with state-of-the-art facilities including 9 cardiac operating theatres, 10 cardiac catheter laboratories, and 3 cardiac MRI scanners. Focus is on partnership between academic and clinical medicine, to deliver world-class cardiovascular care to patients-hopefully for many centuries more. Images show St Bartholomew's Hospital through the ages-the hospital site, 1720 (top left), view of Henry VIII gatehouse entrance to the hospital, 1939 (top right), patients being nursed in their beds in the main hospital quadrangle, 1934 (lower left), the interior of the hospital today (lower right).

Research paper thumbnail of Malignant Early Repolarization

The American journal of cardiology, Jan 15, 2018

A 27-year-old man presents with successfully resuscitated ventricular fibrillation. Structural an... more A 27-year-old man presents with successfully resuscitated ventricular fibrillation. Structural and electrical causes of ventricular fibrillation in the young are presented along with a diagnostic strategy. Electrocardiographic features of malignant early repolarization are discussed.

Research paper thumbnail of Transvenous Before Surgical Hybrid Procedure

The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society

Historically, persistent atrial fibrillation (PeAF) and long standing persistent atrial fibrillat... more Historically, persistent atrial fibrillation (PeAF) and long standing persistent atrial fibrillation (LSPeAF) have demonstrated limited clinical success despite hybrid approaches. We describe our experience with the endocardial-before-epicardial approach defined by a comprehensive endovascular approach preceding and guiding the epicardial approach which includes an extensive posterior wall ablation. 40 patients were followed over a 12 month period. The procedure was performed in a single center. Patients had a mean duration of atrial fibrillation of 6.0 ± 4.5 years with 22.5% having undergone prior ablations. Mean age was 61.7 ± 7.9 years with a mean left atrial volume of 131.5 ± 46.9 mL. The endovascular procedure remained uniform with antral pulmonary vein isolation, posterior left atrial roof and right atrial cavo-tricuspid isthmus (CTI) linear lesions with mapping and ablation of left atrial complex electrograms (CFAEs) and prior existing atrial arrhythmias. The epicardial proce...

Research paper thumbnail of Dynamic ST-Segment Abnormality

The American journal of cardiology, Jan 2, 2017

A 37-year-old man came to the emergency department because of several days of intermittent chest ... more A 37-year-old man came to the emergency department because of several days of intermittent chest pain. An electrocardiogram (ECG) showed sinus rhythm, left atrial and left ventricular enlargement, and an early repolarization pattern. A second ECG recorded 10 minutes later was strikingly different, with ST-segment elevation and large upright T waves in the anterior precordial leads, interpreted as evidence of an ST-segment elevation myocardial infarction, and the cardiac catheterization team was activated. Closer inspection of the ECG, however, disclosed that the changes were because of intermittent ventricular pre-excitation of the Wolff-Parkinson-White type, and no electrocardiographic, echocardiographic, or serum markers of myocardial infarction were found.

Research paper thumbnail of Postinduction Paced Pulseless Electrical Activity in a Patient With a History of Oropharyngeal Instrumentation-Induced Reflex Circulatory Collapse

The Ochsner journal, 2016

Reflex hypotension and bradycardia have been reported to occur following administration of severa... more Reflex hypotension and bradycardia have been reported to occur following administration of several drugs associated with administration of anesthesia and also following a variety of procedural stimuli. A 54-year-old postmenopausal female with a history of asystole associated with sedated upper gastrointestinal endoscopy and post-anesthetic-induction tracheal intubation received advanced cardiac resuscitation after insertion of a temporary transvenous pacemaker failed to prevent pulseless electrical activity. The patient's condition stabilized, and she underwent successful cataract extraction, intraocular lens implantation, and pars plana vitrectomy. Cardiac pacemaker insertion prior to performance of a procedure historically associated with reflex circulatory collapse can be expected to protect a patient from bradycardia but not necessarily hypotension.

Research paper thumbnail of Pacemaker with neurocardiogenic syncope detection and therapy utilizing minute ventilation input

Research paper thumbnail of Asymptomatic ECG Abnormalities

Electrophysiological Disorders of the Heart, 2005