A5056131250- Cardiac Arrhythmias and Treatments
- Atrial Fibrillation Management and Outcomes
- Cardiac electrophysiology and arrhythmias
- Cardiac pacing and defibrillation studies
- Cardiac Imaging and Diagnostics
- Cardiovascular Function and Risk Factors
- Advanced MRI Techniques and Applications
- Ultrasound in Clinical Applications
- Radiomics and Machine Learning in Medical Imaging
- Advanced X-ray and CT Imaging
- Cardiovascular Syncope and Autonomic Disorders
- Venous Thromboembolism Diagnosis and Management
- Cardiovascular Disease and Adiposity
- Medical Image Segmentation Techniques
- Healthcare cost, quality, practices
- Clinical practice guidelines implementation
- Antiplatelet Therapy and Cardiovascular Diseases
- Meta-analysis and systematic reviews
- Heart Rate Variability and Autonomic Control
- Cardiac, Anesthesia and Surgical Outcomes
- Coronary Interventions and Diagnostics
- ECG Monitoring and Analysis
- Biomedical and Chemical Research
- Cardiovascular and Diving-Related Complications
- Cardiovascular Effects of Exercise
University of Nottingham
2020-2024
Nottingham University Hospitals NHS Trust
2010-2023
Nottingham City Hospital
2021-2023
Queen's Medical Centre
2023
Nottingham Biomedical Research Centre
2023
Imperial College Healthcare NHS Trust
2012-2021
Imperial College London
2012-2014
Centro Cardiologico Monzino
2014
Hammersmith Hospital
2014
San Raffaele University of Rome
2014
The evaluation of ventricular function is important for the diagnosis cardiovascular diseases. It typically involves measurement left (LV) mass and LV cavity volume. Manual delineation myocardial contours time-consuming dependent on subjective experience expert observer. In this paper, a multi-atlas method proposed cardiac magnetic resonance (MR) image segmentation. novel in two aspects. First, it formulates patch-based label fusion model Bayesian framework. Second, improves registration...
BackgroundFor late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) assessment of atrial scar to guide management and targeting ablation in fibrillation (AF), an objective, reproducible method identifying is required.ObjectiveTo describe automated for operator-independent quantification LGE that correlates with colocated endocardial voltage clinical outcomes.MethodsLGE CMR imaging was performed at 2 centers, before 3 months after pulmonary vein isolation paroxysmal AF (n...
BackgroundLocalizing the origin of outflow tract ventricular tachycardias (OTVT) is hindered by lack accuracy electrocardiographic (ECG) algorithms and infrequent spontaneous premature complexes (PVCs) during electrophysiological studies.ObjectivesTo prospectively assess performance noninvasive mapping (ECM) in pre-/periprocedural localization OTVT to guide ablation compare ECM with that published ECG algorithms.MethodsPatients symptomatic OTVT/PVCs undergoing clinically indicated were...
Background— Left atrial (LA) ganglionated plexi (GP) are part of the intrinsic cardiac autonomic nervous system and implicated in pathogenesis fibrillation. High frequency stimulation is used to identify GP sites humans. The effect ablation on neural pathways connecting GPs humans unknown. Methods Results— Thirty patients undergoing LA with modification were recruited. In persistent fibrillation, endocardial continuous high identified producing AV block. After right lower (N=5), 2 15...
Background— Ripple mapping (RM) displays each electrogram at its 3-dimensional coordinate as a bar changing in length according to voltage–time relationship with fiduciary reference. We applied RM left ventricular ischemic scar for evidence of slow-conducting channels that may act tachycardia (VT) substrate. Methods and Results— CARTO-3© (Biosense Webster Inc, Diamond Bar, CA) maps patient undergoing VT ablation were analyzed on an offline MatLab system. Scar was assessed sequential movement...
Background— Post-infarct ventricular tachycardia is associated with channels of surviving myocardium within scar characterized by fractionated and low-amplitude signals usually occurring late during sinus rhythm. Conventional automated algorithms for 3-dimensional electro-anatomic mapping cannot differentiate the delayed local signal conduction from initial far-field generated surrounding healthy tissue. Ripple displays every deflection an electrogram, thereby providing fully informative...
Abstract Aims To assess the real world impact of updated clinical guidelines and literature on management patients undergoing stress echocardiography for assessment inducible ischaemia across a national health service. Methods Results A total 13,819 from 32 UK hospitals, referred between 2015-2023, were analysed two phases: phase 1 (2015-2020) 2 (2020-2023). Follow-up data one year was available 4,920 participants through NHS Digital. Patients in younger, presented with higher cardiovascular...
Background— Post ablation atrial tachycardias are characterized by low-voltage signals that challenge current mapping methods. Ripple (RM) displays every electrogram deflection as a bar moving from the cardiac surface, resulting in impression of propagating wavefronts when series bars move consecutively. RM fractionated their entirety thereby helping to identify activation areas nonconducting tissue. We prospectively used study tachycardia previously ablated left atrium. Methods and Results—...
Abstract Aims Stress echocardiography is widely used to identify obstructive coronary artery disease (CAD). High accuracy reported in expert hands but dependent on operator training and image quality. The EVAREST study provides UK-wide data evaluate real-world performance of stress echocardiography. Methods results Participants undergoing for CAD were recruited from 31 hospitals. followed up through health records which underwent adjudication. Cardiac outcome was defined as anatomically or...
Three-dimensional (3D) mapping is often used to guide ablation in atrial tachycardia (AT), but maps can be susceptible annotation and interpolation errors. Ripple Mapping (RM) a technique that displays electrogram time-voltage data simultaneously as dynamic bars on the surface shell overcome these limitations.We hypothesized RM would superior established 3D activation mapping.CARTO-XP™ of ATs were collected without any manual studied CARTO-based offline system. Paired unannotated CARTO-XP...
Ripple mapping (RM) is an alternative approach to activation of atrial tachycardia (AT) that avoids electrogram annotation. We tested whether RM superior conventional annotation based local time (LAT) for AT diagnosis in a randomized and multicenter study.Patients with were either or LAT using the CARTO3v4 CONFIDENSE system. Operators determined assigned 3D arm alone, before being permitted single confirmatory entrainment manuever if needed. A planned ablation lesion set was defined. The...
Recurrent arrhythmias after ablation procedures are often caused by recovery of ablated tissue. Robotic catheter manipulation systems increase tip stability which improves energy delivery and could produce more transmural lesions. We tested this assertion using bipolar voltage attenuation as a marker lesion quality comparing robotic manual circumferential pulmonary vein for atrial fibrillation (AF). Twenty patients were randomly assigned to or AF at standard radiofrequency (RF) settings our...
Abstract Aims Stress echocardiography is widely used to assess patients with chest pain. The clinical value of a positive or negative test result inform on likely longer-term outcomes when applied in real-world practice across healthcare system has not been previously reported. Methods and results Five thousand five hundred three recruited 32 UK NHS hospitals between 2018 2022, participating the EVAREST/BSE-NSTEP prospective cohort study, data medical up 2023 available from England were...
Accurate, rapid quantification of ventricular scar using cardiac magnetic resonance imaging (CMR) carries importance in arrhythmia management and patient prognosis. Artificial intelligence (AI) has been applied to other radiological challenges with success.
Abstract Background Postablation reentrant ATs depend upon conducting isthmuses bordered by scar. Bipolar voltage maps highlight scar as sites of low voltage, but the amplitude an electrogram depends myocardial activation sequence. Furthermore, a threshold that defines atrial is unknown. We used Ripple Mapping (RM) to test whether these were anatomically fixed between different vectors and rates. Methods studied post‐AF ablation where >1 rhythm was mapped. Multipolar catheters with CARTO...
We report the case of a man found unconscious three weeks following atrial fibrillation (AF) ablation. Cranial and thoracic imaging demonstrated multiple areas pneumo-embolic infarction secondary to an atrio-oesophageal fistula (AEF). AEF is recognised, but rare, complication AF ablation.(1-8) Early recognition critical as mortality 100% without surgical intervention. consider postulated mechanisms formation, spectrum clinical presentation, investigations treatment.
Abstract Purpose of Review It was previously believed that the presence myocardial viability in patients with significant coronary artery disease improved outcomes following revascularisation, but landmark STITCH trial found no correlation between and overall survival. However, study used single photon emission contrast tomography or dobutamine stress echocardiography for assessment, late gadolinium enhanced cardiac magnetic resonance imaging (LGE-CMR) has since become gold standard...
Postural orthostatic tachycardia syndrome (POTS) is characterized by inappropriate increase in heart rate on assuming upright position from a supine without necessary drop blood pressure. Etiology of this condition complex and multifactorial. Autonomic dysfunction,[1] hypovolemia,[2] hyper responsiveness beta adrenergic receptors[3] with associated elevations plasma norepinephrine levels have been implicated as underlying pathophysiologic mechanisms. Beta blockers previously used to treat...
Research utilising artificial intelligence (AI) and cardiovascular magnetic resonance (CMR) is rapidly evolving with various objectives, however AI model development, generalisation performance may be hindered by availability of robust training datasets including contrast enhanced images. NotIs CMR a large UK, prospective, multicentre, observational cohort study to guide the development biventricular scar model. Patients ischaemic heart disease undergoing clinically indicated...