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Atul Prakash

Bio: Atul Prakash is an academic researcher from Atlantic Health System. The author has contributed to research in topics: Atrial fibrillation & Coronary sinus. The author has an hindex of 14, co-authored 24 publications receiving 1096 citations.

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Journal ArticleDOI
TL;DR: Dual-site right atrial pacing is safe, achieves long-term rhythm control in most patients, decreases the need for cardioversion, and antithrombotic therapy can be selectively reduced.

244 citations

Journal ArticleDOI
TL;DR: Dual-site RA provides superior symptomatic and asymptomatic AF prevention compared with high RA in patients with symptomatic AF frequency of < or =1/week and is safe and better tolerated than high RA and SP.

180 citations

Journal ArticleDOI
TL;DR: Dual-site right atrial pacing from the high right atrium and coronary sinus ostium can suppress inducible AF or atrial flutter elicited after single-site high rightAtrial pacing in selected patients.

124 citations

Journal ArticleDOI
TL;DR: The activation of the right atrium and left atrium by pacing from different atrial sites using several single- and dual-site atrial pacing modes in patients with atrial fibrillation or flutter is examined to identify distinct global and regional electrophysiologic effects that may mediate the variable antiarrhythmic effects of different and novel atrial paced methods.
Abstract: We examined the activation of the right atrium and left atrium by pacing from different atrial sites using several single- and dual-site atrial pacing modes in patients with atrial fibrillation or flutter. We also analyzed the effect of these pacing modes on fixed coupled extrastimuli in this population. Patients underwent detailed mapping of regional right atrial (RA) and left atrial (LA) sites. Bipolar pacing was performed individually from the high right atrium, coronary sinus ostium, and the distal coronary sinus, and simultaneously from the high right atrium and coronary sinus ostium (dual-site RA pacing) or high right atrium and distal coronary sinus (biatrial pacing). Extrastimuli were delivered from the high right atrium at fixed coupling intervals of 350 and 250 ms. Twenty patients with atrial fibrillation were studied. P-wave duration during pacing was significantly abbreviated by both dual-site RA and biatrial pacing (p

95 citations

Journal ArticleDOI
TL;DR: Low atrial defibrillation thresholds correlated with absence of heart disease, higher ejection fraction, and smaller left ventricular end-diastolic diameter.
Abstract: We undertook a prospective randomized clinical trial evaluating efficacy and safety of internal atrial defibrillation in patients with drug-refractory atrial fibrillation (AF). Consecutive patients with paroxysmal or chronic AF were randomly tested with 3 internal atrial defibrillation lead configurations and biphasic shocks. Patients with implanted cardiac pacemakers were tested with the right atrium (RA) and left pulmonary artery or coronary sinus (CS) configuration. Shocks were initially delivered without anesthesia to assess parient tolerance. The need for backup ventricular defibrillation and pacing support was evaluated. Eighteen patients with (n = 15) or without (n = 3) structural heart disease, mean left ventricular ejection fraction 36 ± 14%, and mean left atrial diameter 4.5 ± 0.6 cm were studied. The mean defibrillation threshold in the best randomized lead configuration was 9.9 ± 7.7 J. Mean defibrillation threshold for the right ventricle (RV) and superior vena cava configuration was 13.3 ± 5 J, which was significantly lower than the RA and axilla configuration (20.1 ± 7.4 J, p 0.2). The mean defibrillation threshold using the RA-left pulmonary artery/ CS configuration was 8.9 ± 9 J (p > 0.2 vs RV-superior vena cava). There was a bimoaal distribution of defibrillation thresholds. Low atrial defibrillation thresholds correlated with absence of heart disease, higher ejection fraction, and smaller left ventricular end-diastolic diameter. Shocks were hemodynamically well tolerated, but 18 patients (11%) had nonsustained ventricular tachycardia after shock delivery. Eighteen patients (33%) had postshock brad/arrhythmias. Fourteen of 16 patients perceived shocks ≥3 J as intolerable. We conclude that internal atrial defibrillation is clinically effective at energies ≤20 J using existing nonthoracotomy lead systems. Specific lead configurations may achieve lower defibrillation thresholds. Shocks are hemodynamically well tolerated but can induce bradyarrhythmias ana ventricular arrhythmias. Backup ventricular pacing and defibrillation are desirable. Patient tolerance for shocks >2 J is limited. Thus, this technique is applicable for infrequent application. Adjunctive therapy will be needed in patients with frequent or drugrefractory AF.

86 citations


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Journal ArticleDOI
01 Nov 2016-Europace
TL;DR: The Task Force for the management of atrial fibrillation of the European Society of Cardiology has been endorsed by the European Stroke Organisation (ESO).
Abstract: The Task Force for the management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC Endorsed by the European Stroke Organisation (ESO)

5,255 citations

Journal ArticleDOI
TL;DR: Sidney C. Smith, Jr., MD, FACC, FAHA, FESC, Chair; Alice K. Jacobs, MD, FAC, FAH, Vice-Chair; Cynthia D. Adams, MSN, APRN-BC, FAGA; Jeffery L. Anderson, MD.
Abstract: Sidney C. Smith, Jr, MD, FACC, FAHA, FESC, Chair; Alice K. Jacobs, MD, FACC, FAHA, Vice-Chair; Cynthia D. Adams, MSN, APRN-BC, FAHA; Jeffery L. Anderson, MD, FACC, FAHA; Elliott M. Antman, MD, FACC, FAHA[‡][1]; Jonathan L. Halperin, MD, FACC, FAHA; Sharon Ann Hunt, MD, FACC, FAHA; Rick Nishimura,

2,591 citations

Journal ArticleDOI
01 Sep 2006-Europace
TL;DR: This guideline is pleased to have this guideline developed in conjunction with the European Society of Cardiology (ESC) and to have been selected from all 3 organizations to examine subject-specific data and write guidelines.
Abstract: It is important that the medical profession plays a significant role in critically evaluating the use of diagnostic procedures and therapies as they are introduced and tested in the detection, management, or prevention of disease states. Rigorous and expert analysis of the available data documenting absolute and relative benefits and risks of those procedures and therapies can produce helpful guidelines that improve the effectiveness of care, optimize patient outcomes, and favorably affect the overall cost of care by focusing resources on the most effective strategies. The American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) have jointly engaged in the production of such guidelines in the area of cardiovascular disease since 1980. The ACC/AHA Task Force on Practice Guidelines, whose charge is to develop, update, or revise practice guidelines for important cardiovascular diseases and procedures, directs this effort. The Task Force is pleased to have this guideline developed in conjunction with the European Society of Cardiology (ESC). Writing committees are charged with the task of performing an assessment of the evidence and acting as an independent group of authors to develop or update written recommendations for clinical practice. Experts in the subject under consideration have been selected from all 3 organizations to examine subject-specific data and write guidelines. The process includes additional representatives from other medical practitioner and specialty groups when appropriate. Writing committees are specifically charged to perform a formal literature review, weigh the strength of evidence for or against a particular treatment or procedure, and include estimates of expected health outcomes where data exist. Patient-specific modifiers, comorbidities, and issues of patient preference that might influence the choice of particular tests or therapies are considered as well as frequency of follow-up and cost effectiveness. When available, information from studies on cost will be considered; however, review …

2,476 citations