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Postoperative performance of the QuartetÂ® left ventricular heart lead. - Journal of cardiovascular electrophysiology
The Quartet(Â®) left ventricular (LV) lead is the first with 4 pacing electrodes (tip and 3 rings) that enables pacing from 10 different pacing vectors. Postoperative performance of this lead was evaluated in a prospective, nonrandomized, multicenter IDE study.Patients with standard indications for CRT-D were enrolled. Electrical performance and presence of phrenic nerve stimulation (PNS) were assessed during pacing from each of 10 vectors at predischarge (within 7 days), 1 month, and 3 months postimplant.The Quartet LV lead was implanted successfully in 170 patients (95.5% implant success rate, 68 Â± 11 years, 68.5% male, LVEF: 25 Â± 7%, NYHA class III: 98.3% and class IV: 1.7%). Mean follow-up was 4.7 Â± 1.9 months. Capture threshold and impedance for each of the 10 LV lead pacing vectors remained stable during follow-up. LV lead dislodgement occurred in 6 (3.5%) patients and PNS was observed in 23 (13.5%) patients. PNS was resolved noninvasively in all 23 (100%) patients, either by reprogramming to pace from the additional LV lead pacing vectors alone (13 pts, 56.5%), reprogramming to pace from the additional LV lead pacing vectors and reprogramming pacing output (4 pts, 17.4%), or by reprogramming pacing output alone (6 pts, 26.1%).The Quartet LV lead electrical performance was stable and was associated with a high implant success and low dislodgement rate during 3-month follow-up. In all patients with PNS, the 10 pacing vectors combined with reduced output programming enabled the elimination of PNS noninvasively.Â© 2013 Wiley Periodicals, Inc.
Impact of shock energy and ventricular rhythm on the success of first shock therapy: the ALTITUDE first shock study. - Heart rhythm : the official journal of the Heart Rhythm Society
The efficacy of shock in converting different ventricular tachyarrhythmias has not been well characterized in a large natural-practice setting.To determine shock success rate by energy and ventricular rhythm in a large cohort of patients with implantable cardioverter-defibrillators.Two thousand patients with 5279 shock episodes were randomly sampled for analysis from the LATITUDE remote monitoring system. Within an episode, the rhythm preceding therapy (shock or antitachycardia pacing [ATP]) was adjudicated. Patients who died after unsuccessful implantable cardioverter-defibrillator shocks did not transmit final remote monitoring data and were not included in the study.Of 3677 shock episodes for ventricular tachyarrhythmia, 2679 were treated with shock initially and were classified as monomorphic ventricular tachycardia ( n = 1544), polymorphic/monomorphic ventricular tachycardia (n = 371), or ventricular fibrillation (n = 764). The success rate after the first, second, and final shock averaged 90.3%, 96.4%, and 99.8%, respectively. After unsuccessful initial ATP (n = 998), the first, second, and final shock was successful in 84.8%, 92.9%, and 100% of the episodes. The success rate after the first or second shock was significantly lower after failed ATP compared to shock as first therapy (both P<.001). Among episodes treated initially with shock, the success rate for monomorphic ventricular tachycardia (89.2%) when treated with energy level â‰¤ 20 J was significantly higher than that for ventricular fibrillation (80.8%) (P = .04). The level of shock energy was a significant predictor of the success of the first shock (odds ratio 1.16; 95% confidence interval 1.03-1.30; P = .013).The success rate of first shock as first therapy is approximately 90%, but was lower after failed ATP. Programming a higher level of energy after ATP is suggested.Copyright Â© 2013. Published by Elsevier Inc.
Noise, artifact, and oversensing related inappropriate ICD shock evaluation: ALTITUDE noise study. - Pacing and clinical electrophysiology : PACE
Approximately 12-21% of implantable cardioverter defibrillator (ICD) patients receive inappropriate shocks. We sought to determine the incidence and causes of noise/artifact and oversensing (NAO) resulting in ICD shocks.A random sample of 2,000 patients who received ICD and cardiac resynchronization therapy defibrillator shocks and were followed by a remote monitoring system was included. Seven electrophysiologists analyzed stored electrograms from the 5,279 shock episodes. Episodes were adjudicated as appropriate or inappropriate shocks.Of the 5,248 shock episodes with complete adjudication, 1,570 (30%) were judged to be inappropriate shocks. Of these 1,570, 134 (8.5%) were a result of NAO. The 134 NAO episodes were determined to be due to external noise in 76 (57%), lead connector-related in 37 (28%), muscle noise in 11 (8%), oversensing of atrium in seven (5%), T-wave oversensing in two (2%), and other noise in one (1%). The ICD shock itself resulted in a marked decrease in the level of noise in 60 of 134 (45%) NAO episodes, and the magnitude of this effect varied with the type of NAO (58% for external noise, 35% for muscle, 27% for lead/connector, and 0% for oversensing; P = 0.03). There was no significant difference in NAO likelihood based on type of lead (integrated bipolar 89/1,802 vs dedicated bipolar 9/140, P = 0.67).External noise and lead/connector noise were the primary causes, while T-wave oversensing was the least common cause of NAO resulting in ICD shock. Noise/artifact decreased immediately after a shock in nearly half of episodes. The specific ICD lead type did not impact the likelihood of NAO.Â©2012, The Authors. Journal compilation Â©2012 Wiley Periodicals, Inc.
Cardiac resynchronization therapy: double cannulation approach to coronary venous lead placement via a prominent thebesian valve. - Pacing and clinical electrophysiology : PACE
We report identification of a prominent Thebesian valve by cardiovascular computed tomography (CT) angiography impeding cannulation of the coronary sinus, with subsequent successful coronary venous lead placement with cannulation of the coronary sinus ostium via a transvenous femoral vein approach and subsequent cannulation of the ostium with the coronary venous lead with a left subclavian approach. A 57-year-old man with nonischemic dilated cardiomyopathy, New York Heart Association Class III heart failure, left bundle branch block, and an ejection fraction of 15%, underwent an attempted cardiac resynchronization therapy implantable cardiac defibrillator (ICD). As the coronary sinus ostium could not be cannulated, a dual chamber ICD was placed. The patient subsequently underwent cardiovascular CT angiography, which identified a prominent Thebesian valve at the coronary sinus ostium as the anatomic obstacle to cannulation. Reattempted transvenous cardiac resynchronization therapy was accomplished successfully with a double cannulation approach: cannulation of the coronary sinus ostium with a catheter via a transvenous femoral vein approach and subsequent cannulation with the coronary venous lead via a left subclavian approach. When a prominent Thebesian valve is identified as an obstacle to transvenous left ventricular lead placement, cannulation of the coronary sinus by an alternate venous approach may allow for a coronary venous route rather than necessitate an epicardial approach.Â©2012, The Authors. Journal compilation Â©2012 Wiley Periodicals, Inc.
Unoperated congenitally corrected transposition of the great arteries, nonrestrictive ventricular septal defect, and pulmonary stenosis in middle adulthood: do multiple wrongs make a right? - World journal for pediatric & congenital heart surgery
Submitted May 6, 2011; Accepted August 3, 2011. The survival into adulthood of patients with unoperated complex congenital heart disease with anomalies often considered life threatening in infancy and childhood requires a complex interplay of "balanced" defects allowing for cardiovascular physiology compatible with long-term survival. We report on a series of three cases from our advanced imaging database of middle-aged adults presenting with multiple similar defects providing a hemodynamically balanced circulation. The constellation of defects seen in each of these patients included congenitally corrected transposition of the great arteries, a large nonrestrictive ventricular septal defect, valvular pulmonary stenosis, and in two cases anomalous coronary arteries. Cardiovascular computed tomographic angiography (CCTA) and cardiovascular magnetic resonance imaging (CMR) were important to the characterization of the multiple defects and their three-dimensional relationships in these cases. Treatment decisions in patients with this constellation of findings are challenging, given the limited data due to the rarity of survival of patients with these defects into middle adulthood and the paucity of data related to decisions and approaches to medical management, surgical correction, or transplantation.
Impact of relaxation training on patient-perceived measures of anxiety, pain, and outcomes after interventional electrophysiology procedures. - Pacing and clinical electrophysiology : PACE
Electrophysiology procedures vary in invasiveness, duration, and anesthesia utilized. While complications are low and efficacy high, cases are elective and patient experiences related to anxiety, pain, and perceived outcomes are not well studied. We sought to determine if a 30-minute audio compact disc (CD) that teaches relaxation techniques and wellness perception prior to an elective procedure impacts validated measures of anxiety, pain, and procedural outcomes.Sixty-one patients were randomly assigned to a control group (CG) (N(CG) = 31) or interventional group (IG) (N(IG) = 30). Both groups answered a baseline Hospital Anxiety and Depression Scale (HADS-A) survey consisting only of anxiety assessment questions. The IG listened to the CD the night prior to their procedure. Heart rate and blood pressure were monitored on admission and prior to the procedure. Postprocedure, both groups completed two HADS-A surveys as well as two Patient Experience Surveys (PES). There was no statistical difference in the demographics and the rate of procedural complications between the groups. The statistical significance of our data was determined using a Student's t-test and Ï‡(2) test.At baseline, both groups had equal amounts of anxiety prior to their procedures (P = 0.2). The patients in the IG had lower systolic blood pressures during admission and prior the administration of analgesics in comparison to the CG. Postprocedure, results from administering the HADS-A demonstrated that the IG had 33% lower anxiety (P = 0.02) than CG patients.The implementation of basic relaxation teaching techniques prior to planned electrophysiology procedures lowers systolic blood pressure and postprocedural anxiety.Â©2011, The Authors. Journal compilation Â©2011 Wiley Periodicals, Inc.
Implantable cardioverter defibrillator electrogram adjudication for device registries: methodology and observations from ALTITUDE. - Pacing and clinical electrophysiology : PACE
The increasing use of remote monitoring with the associated large retrievable databases provides a unique opportunity to analyze observations on implantable cardioverter-defibrillator (ICD) therapies. Adjudication of a large number of stored ICD electrograms (EGMs) presents a unique challenge. The ALTITUDE study group was designed to use the LATITUDE remote monitoring system to evaluate ICD patient outcomes across the United States.Of 81,081 patients on remote monitoring, a random sample of 2,000 patients having 5,279 shock episodes was selected. The ALTITUDE EGM review committee was comprised of seven electrophysiologists from four institutions. An online EGM adjudication system was designed. Episodes were classified as appropriate (70% of shock episodes) or inappropriate ICD therapies (30%). Light's Kappa was used to assess agreement. Interobserver and intraobserver Kappa scores for dual-chamber ICDs were 0.84 (0.71-0.91) and 0.89 (0.82-0.95), consistent with substantial agreement. Interobserver and intraobserver Kappa scores for single-chamber ICDs were 0.61 (0.54-0.67) and 0.69 (0.59-0.79). The rhythm categories of "nonsustained arrhythmia" and "polymorphic and monomorphic ventricular tachycardia" resulted in the greatest degree of discordant adjudication between reviewers.This method of adjudication of a large volume of stored EGM data prior to device therapies will allow new observations in regards to device performance and has the potential to improve device programming and design. There was substantial interreviewer agreement for rhythm classification. Agreement was greater for dual-chamber compared to single-chamber devices, indicating the atrial lead adds diagnostic value in rhythm interpretation.Â©2011, The Authors. Journal compilation Â©2011 Wiley Periodicals, Inc.
Treatment of ventricular tachycardia in patients with heart failure. - Current cardiology reports
Heart failure is a major public health concern that is frequently complicated by ventricular arrhythmias. Sustained ventricular tachycardia is associated with an increased risk for progressive heart failure and sudden death. We summarize the current management strategies for ventricular tachycardia in heart failure patients, including implantable cardioverter-defibrillator therapy, pharmacologic therapy, catheter ablation techniques, ventricular assist device therapy, and heart transplantation.
Ventricular tachycardia in the era of ventricular assist devices. - Journal of cardiovascular electrophysiology
Sustained ventricular tachycardia (VT) in patients with advanced cardiomyopathy is a potentially life-threatening arrhythmia. Newer treatment strategies have evolved that combine the use of catheter ablation to target the substrate for VT and ventricular assist devices (VADs) to hemodynamically support the failing ventricle. This editorial is targeted to the practicing clinician caring for these difficult patients. The current article reviews the use of percutaneous VADs to support catheter ablation of VT, the use of durable VADs to support the failing heart in patients with recurrent VT, ventricular arrhythmias in patients with durable VADs, and the use of catheter ablation to treat VT in patients with durable VADs.Â© 2010 Wiley Periodicals, Inc.
Taser-induced rapid ventricular myocardial capture demonstrated by pacemaker intracardiac electrograms. - Journal of cardiovascular electrophysiology
A Taser weapon is designed to incapacitate violent individuals by causing temporary neuromuscular paralysis due to current application. We report the first case of a Taser application in a person with a dual-chamber pacemaker demonstrating evidence of Taser-induced myocardial capture.Device interrogation was performed in a 53-year-old man with a dual-chamber pacemaker who had received a Taser shot consisting of two barbs delivered simultaneously. Assessment of pacemaker function after Taser application demonstrated normal sensing, pacing thresholds, and lead impedances. Stored event data revealed two high ventricular rate episodes corresponding to the exact time of the Taser application.This report describes the first human case of ventricular myocardial capture at a rapid rate resulting from a Taser application. This raises the issue as to whether conducted energy devices can cause primary myocardial capture or capture only in association with cardiac devices providing a preferential pathway of conduction to the myocardium.
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9203 Highway 6 S Houston, TX 77083
9220 Highway 6 South Suite E
8145 Highway 6 S Suite 108