Nicholas Sunderland

NIHR Bristol Cardiovascular Biomedical Research Unit

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In patients with an enlarged left atrium does left atrial size reduction improve maze surgery success?

Interactive Cardiovascular and Thoracic Surgery (2011)

Nicholas Sunderland Myura Nagendran Mahiben Maruthappu

A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was: In [adults undergoing a maze procedure for Atrial Fibrillation (AF)], [does Left Atrial size reduction] compared to [maze surgery alone] improve [maze surgery success]? A total of 58 papers were found using the reported search, of which eight represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Four out of eight papers compared a volume reduction technique as an adjunct to the maze procedure to a maze procedure alone – all four papers reported that atrial volume reduction significantly increased restoration of sinus rhythm: 89.3% vs. 67.2%, P<0.001; 85% vs. 68%, P<0.05; 84% vs. 68%, P<0.05; 90% vs. 69%, P<0.05. Three out of eight papers had no control group but reported good rates of sinus rhythm restoration at last follow-up – 90%, 92% and 89%, respectively – despite the study population including atrial enlargement, a risk factor for failure of a maze procedure. One paper reported no benefit of an atrial reduction plasty in patients with a left atrium (LA) >70 mm. An enlarged LA is a risk factor for failure of a maze procedure, and various models of AF suggest that reducing atrial mass and/or diameter may help to abolish the re-entry circuits underlying AF. Furthermore, AF is uncommon when left atrial diameter is <40 mm, so there is at least some physiological basis for atrial reduction surgery in aiding the success of a maze procedure. The evidence suggests that patients with an enlarged (≥55 mm) or giant (≥75 mm) LA who are at risk of failing to obtain sinus conversion after a standard maze procedure may derive benefit from concomitant atrial reduction surgery using either a tissue excision or a tissue plication technique. However, the evidence is not strong since the papers available are not readily comparable owing to substantial variations in the populations and procedures involved. We therefore, emphasise the need for prospective randomised studies in this area.

Left atrial enlargement

Cardiothoracic surgery

10.1510/icvts.2011.275511

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Citations (18)

28 A meta-analysis on the impact of contact force sensing catheters on outcomes in atrial fibrillation ablation: a focus on study design

Amit Kaura Nicholas Sunderland Francis Murgatroyd Para Dhillon Paul A. Scott

Background

One determinant of failure of atrial fibrillation (AF) ablation is the lack of transmural lesions. Contact force sensing (CFS) catheters enable real-time assessment of the amount of force applied at the catheter-tissue interface, with higher contact force associated with lesions of greater size. Previous meta-analyses have pooled results from randomized controlled trials (RCTs) and observational studies (OSs) and concluded that CFS catheters improve clinical outcomes. This meta-analysis sought to compare the efficacy and safety of CFS catheters with non-CFS catheters for AF radiofrequency ablation.

Methods

A total of 28 studies were identified using Embase and Medline databases; 8 RCTs and 20 OSs. For the primary outcome of atrial tachyarrhythmia recurrence, data from RCTs and OSs were analysed according to study design. Secondary outcomes included ablation time and all procedure-related complications. Summary estimates for each variable were calculated using the random-effects model based on DerSimonian and Laird's meta-analytic statistical method.

Results

In the 8 RCTs there were a total of 844 patients (419 in CF group and 425 in non-CF group). In the 20 OS there were 3900 patients (1523 in CF group and 2377 in non-CF group). The median age of patients was 60.3 years (59.0 years in RCTs and 60.7 years in OSs). The majority were male (74.0% in RCTs and 69.6% in OSs). The median follow-up time post-AF ablation was 12 months in both RCTs and OSs. While CFS did not lead to a significant reduction in atrial tachyarrhythmia recurrence in RCTs (n=844, risk ratio (RR) 0.98, 95% confidence interval (CI) 0.80 to 1.19, p=0.81), a significant reduction was observed in OSs (n=2,259, RR 0.74, 95% CI 0.65 to 0.84, p<0.0001), both at a median follow-up of 12 months. Data on ablation time were available for 6 RCTs (n=751) and 14 OSs (n=3,152). The use of CFS catheters had no significant impact on ablation time in both RCTs (-0.36 minutes, 95% CI -3.32 to 2.59, p=0.81) and OSs (-3.68 minutes, 95% CI -7.91 to 0.55, p=0.09). For both RCTs (n=706) and OSs (n=3,427), the incidence of all procedure-related complications was similar in the CFS and non-CFS groups (RCTs, RR 0.99, 95% CI 0.55 to 1.78, p=0.97; OSs, RR 0.78, 95% CI 0.53 to 1.16, p=0.22).

Conclusion

Although OSs have demonstrated positive results, data from RCTs have failed to show any significant benefit from CFS catheters in terms of procedural success in AF ablation. The safety profile of CFS catheters was similar to non-CFS catheters in both RCTs and OSs.

Conflict of Interest

No conflicts on interest

Cardiac Ablation

Contact force

10.1136/heartjnl-2019-bcs.27

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Citations (0)

MicroRNA Biomarkers and Platelet Reactivity

Circulation Research (2017)

Nicholas Sunderland Philipp Skroblin Temo Barwari Rachael P. Huntley Ruifang Lu

Over the last few years, several groups have evaluated the potential of microRNAs (miRNAs) as biomarkers for cardiometabolic disease. In this review, we discuss the emerging literature on the role of miRNAs and other small noncoding RNAs in platelets and in the circulation, and the potential use of miRNAs as biomarkers for platelet activation. Platelets are a major source of miRNAs, YRNAs, and circular RNAs. By harnessing multiomics approaches, we may gain valuable insights into their potential function. Because not all miRNAs are detectable in the circulation, we also created a gene ontology annotation for circulating miRNAs using the gene ontology term extracellular space as part of blood plasma. Finally, we share key insights for measuring circulating miRNAs. We propose ways to standardize miRNA measurements, in particular by using platelet-poor plasma to avoid confounding caused by residual platelets in plasma or by adding RNase inhibitors to serum to reduce degradation. This should enhance comparability of miRNA measurements across different cohorts. We provide recommendations for future miRNA biomarker studies, emphasizing the need for accurate interpretation within a biological and methodological context.

10.1161/circresaha.116.309303

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Citations (174)

MIRACLE2 Score Compared With Downtime and Current Selection Criterion for Invasive Cardiovascular Therapies After OHCA

КАРДИОЛОГИЯ УЗБЕКИСТАНА (2023)

Robert Aldous Roman Roy Antonio Cannatà Muhamad Abd Razak Shamika Mohanan

Downtime

Clinical endpoint

10.1016/j.jcin.2023.08.010

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Citations (5)

Poster session 2Morphogenetic mechanisms290MiR-133 regulates retinoic acid pathway during early cardiac chamber specification291Bmp2 regulates atrial differentiation through miR-130 during early heart looping formationDevelopmental genetics294Association of deletion allele of insertion/deletion polymorphism in alpha 2B adrenoceptor gene and hypertension with or without type 2 diabetes mellitus295Association of G1359A polymorphism of the endocannabinoid type 1 receptor (CNR1) with coronary …

Cardiovascular Research (2016)

Virginio García‐Martínez C Lopez Sanchez W. Hamed W. Hamed JH Hsu

Introduction:We have previously demonstrated the ability of retinoic acid to regulate the expression the atrial specific markers AMHC-1 and Tbx5 during early cardiac chamber specification.However, the molecular mechanisms responsible for this process still remain unclear.At present, microRNAs represent a novel layer of complexity in the regulatory networks controlling gene expression during cardiovascular development.Purpose: The aim of this work is to study the intrinsic mechanism involved in this signaling pathway, since miR-133 has demonstrated to be involved in other earliest cardiac developmental processes.Methods: Our model is focused on developing chick at gastrula stages by in vitro electroporation of miR-133, a microRNA which is has been shown expressed at the level of linear cardiac tube.Results: Our results show the miR-133 expression at the level of the primitive heart tube.Moreover, or work reveals that overexpression of miR-133 suppresses AMHC-1 and Tbx5 expression.Conclusion: These data support that miR-133, a putative microRNA that targets RARB 3 ´UTR, regulates the early cardiac chamber specification via retinoic acid pathway.

10.1093/cvr/cvw149

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Citations (1)

Clinical characteristics of Black patients with hypertensive urgency

Irish Journal of Medical Science (1971 -) (2018)

Robert M. Maweni Nicholas Sunderland Zahra Rahim Emmanuella Odih Jins Kallampallil

Hypertensive emergency

Hypertensive heart disease

Outpatient clinic

Hypertensive retinopathy

End organ damage

Stroke

10.1007/s11845-018-1787-0

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Citations (4)

Outcomes with single-coil versus dual-coil implantable cardioverter defibrillators: a meta-analysis

EP Europace (2017)

Nicholas Sunderland Amit Kaura Francis Murgatroyd Para Dhillon Paul A. Scott

Dual-coil implantable cardioverter defibrillator (ICD) leads have traditionally been used over single-coil leads due to concerns regarding high defibrillation thresholds (DFT) and consequent poor shock efficacy. However, accumulating evidence suggests that this position may be unfounded and that dual-coil leads may also be associated with higher complication rates during lead extraction. This meta-analysis collates data comparing dual- and single-coil ICD leads. Electronic databases were systematically searched for randomized controlled trials (RCT) and non-randomized studies comparing single-coil and dual-coil leads. The mean differences in DFT and summary estimates of the odds-ratio (OR) for first-shock efficacy and the hazard-ratio (HR) for all-cause mortality were calculated using random effects models. Eighteen studies including a total of 138,124 patients were identified. Dual-coil leads were associated with a lower DFT compared to single coil leads (mean difference –0.83J; 95% confidence interval [CI] –1.39––0.27; P = 0.004). There was no difference in the first-shock success rate with dual-coil compared to single-coil leads (OR 0.74; 95%CI 0.45–1.21; P=0.22). There was a significantly lower risk of all-cause mortality associated with single-coil leads (HR 0.91; 95%CI 0.86–0.95; P < 0.0001). This meta-analysis suggests that single-coil leads have a marginally higher DFT but that this may be clinically insignificant as there appears to be no difference in first-shock efficacy when compared to dual-coil leads. The mortality benefit with single-coil leads most likely represents patient selection bias. Given the increased risk and complexity of extracting dual-coil leads, centres should strongly consider single-coil ICD leads as the lead of choice for routine new left-sided ICD implants.

Defibrillation threshold

10.1093/europace/euw438

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Citations (21)

MIRACLE2 Score and SCAI Grade to Identify Patients With Out-of-Hospital Cardiac Arrest for Immediate Coronary Angiography

КАРДИОЛОГИЯ УЗБЕКИСТАНА (2022)

Nilesh Pareek Nicholas Beckley‐Hoelscher Ritesh Kanyal Antonio Cannatà Peter Kordis

10.1016/j.jcin.2022.03.035

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Citations (23)

Re-expansion pulmonary oedema: a novel emergency therapeutic option

BMJ Case Reports (2016)

Nicholas Sunderland Robert M. Maweni Srikanth Akunuri Elena Karnovitch

Re-expansion pulmonary oedema (REPO) is a rare complication of pleural fluid thoracocentesis and has been associated with a high mortality rate. There is limited evidence to inform on its most effective management. We present two cases of large volume thoracocentesis resulting in acute respiratory decompensation that was treated by reintroducing the drained pleural fluid back into the pleural cavity. We also present a review of the literature specifically assessing the reported incidence rate of REPO after pleural fluid drainage. In both of our cases, symptoms and signs of respiratory instability were promptly reversed on reintroduction of the drained pleural fluid into the patient's pleural space—a therapy we have termed ‘rapid pleural space re-expansion’. This was not associated with any short-term adverse outcomes. The occurrence of REPO is a rare event with most cohort studies reporting an incidence of between 0% and 1%.

Pulmonary oedema

10.1136/bcr-2016-215076

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Citations (18)

Thoracic oesophageal cancer as a cause of stridor: a literature review

BMJ Case Reports (2018)

Robert M. Maweni Venughanan Manikavasagar Nicholas Sunderland Sajid Chaudhry

An 83-year-old woman, with a background of treated squamous cell oesophageal cancer, presented with a 3-week history of stridor. Of note, the patient had no risk factors for oesophageal cancer other than age. Clinical examination was unremarkable apart from stridor. Laboratory investigations, including arterial blood gas on room air, were unremarkable. Radiological examination revealed a 4.5×3.5×3.6 cm mass involving the posterior trachea and invading the tracheal orifice. Oesophagogastroduodenoscopy and rigid bronchoscopy confirmed an extensive tumour arising from the lower oesophagus and invading the trachea, causing 90% airway obstruction for a 6 mm length ending 1.5 cm above the carina. Biopsy revealed a poorly differentiated carcinoma with foci of squamous cell carcinoma. Unfortunately, the patient passed away 2 months after palliative tracheal stent placement.

Airway obstruction

Medical History

10.1136/bcr-2018-224872

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Citations (2)