Browsing by Author "Namboodiri, N"

Now showing 1 - 20 of 36
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    Autonomic dysfunction in first ever ischemic stroke: Prevalence, predictors and short term neurovascular outcome
    (CLINICAL NEUROLOGY AND NEUROSURGERY, 2016) Nayani, S; Sreedharan, SE; Namboodiri, N; Sarma, PS; Sylaja, PN
    Objectives: Central autonomic dysfunction(AD) is reported post-stroke. Very few studies have looked at its impact on neurovascular outcome. We sought to study the prevalence and predictors of autonomic dysfunction in patients with first ever acute ischemic stroke and its impact on discharge and short term outcome. Patients and methods: Consecutive patients who presented between 2-4 weeks post stroke were prospectively recruited. Study period was April 2012-March 2014 (2 years). Subjects underwent clinical autonomic function testing using Ewing's battery at bedside and 24 h Holter analysis for heart rate variability(HRV). HRV parameters studied included both time domain and frequency domain measures. Neurological and cardiovascular outcomes were assessed at discharge,3 months and 1 year. Results: Of 101 patients of mean age 63yrs, 72% were men.Majority had moderate to severe strokes at onset (Mean NIHSS-13.9,MRS-3.1). Clinical bedside autonomic testing criteria were comparable to Holter detected dysautonomia in our study population (p value 0.3). Clinical autonomic dysfunction had a positive association with male gender whereas onset stroke severity and Insular involvement were associated with significantly higher incidence of autonomic dysfunction with both methodology. Those with autonomic dysfunction had more stroke severity at discharge, which was independent of onset severity. Increasing age, hemispheric laterality or presence of comorbidities had no impact on post-stroke dysautonomia. Conclusions: Insular involvement and higher disability at onset are associated with greater incidence of autonomic dysfunction post-stroke. Those with AD had higher chance of infarct expansion and in hospital cardiovascular complications and poorer outcome at 1 year, independent of onset stroke severity. (C) 2016 Elsevier B.V. All rights reserved.
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    BALLOON MITRAL VALVOTOMY FOR PATIENTS WITH MITRAL STENOSIS IN ATRIAL FIBRILLATION: IMMEDIATE AND LONG-TERM RESULTS
    (JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2011) Nair, KKM; Sivadasanpillai, H; Thajudeen, A; Tharakan, JM; Titus, T; Valaparambil, A; Sivasubramonian, S; Mahadevan, KK; Namboodiri, N; Sasidharan, B; Ganapathy, S
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    Cardiac malformations are increased in infants of mothers with epilepsy
    (PEDIATRIC CARDIOLOGY, 2008)
    We aimed to ascertain the prevalence of cardiac malformation (CM) and its association with antenatal exposure to an antiepileptic drug (AED) in infants of mothers with epilepsy (IMEs). Women with epilepsy (WWE) are enrolled in Kerala Registry of Epilepsy and Pregnancy (KREP) in the prepregnancy or early pregnancy period and are followed up with a standard protocol until the IMEs are 6 years old. At 3 months postpartum, a cardiologist, blinded to the AED exposure, carried out a clinical examination and echocardiography on all live-born babies. Patent foramen ovale (PFO) and interatrial septal defects of < 5 mm in size were excluded from CM. Details of maternal epilepsy, folate usage, AED exposure in the first trimester, and newborn characteristics were abstracted from the records of the KREP. We examined 462 babies. Maternal epilepsy was generalized in 201 (43.50%) or localization related in 241 (52.2%). The AED exposure was monotherapy in 262 (56.7%)-carbamazepine (112), valproate (71), phenobarbitone (43), phenytoin (31), and clonazepam (2)-and polytherapy in 126 (27.3%). Seventy-four infants (16.01%) had no AED exposure. There were 36 infants with CM (7.8%; 95% confidence interval: 5.5-10.6). CMs included atrial septal defect (26; 72.2%), tetrology of Fallot (3; 8.3%), patent ductus arteriosus and pulmonic stenosis (2 each; 5.6%), and ventricular septal defect, tricuspid regurgitation, transposition of great arteries (1 each; 2.8%). CMs were significantly more for IMEs with premature birth (p < .003). There was no association between CM and maternal age, epilepsy syndrome, seizure frequency during pregnancy, and folate use. CMs were more frequent with polytherapy (13; 10.3%) compared to monotherapy (17; 6.5%). Those with valproate exposure had a trend (not statistically significant) toward higher frequency of CM compared to IMEs on other AEDs as monotherapy.
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    CASE 10-2015 Cardiac Resynchronization Therapy: Role of Intraoperative Real-Time Three-Dimensional Transesophageal Echocardiography
    (JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2015) Varma, PK; Namboodiri, N; Raman, SP; Pappu, UK; Gadhinglajkar, SV; Ho, J; Owais, K; Mahmood, F
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    Classical Response in a Pre-excited Tachycardia: What Are the Pathways Involved?
    (CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY, 2013) Thajudeen, A; Namboodiri, N; Choudhary, D; Valaparambil, AK; Tharakan, JA
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    Comments on "Atrial septal aneurysm and spontaneous echo contrast: An association with higher embolic risk?"
    (EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY, 2006) Krishnamoorthy, KM; Namboodiri, N
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    Comparative study on safety, efficacy, and midterm results of balloon mitral valvotomy performed with triple lumen and double lumen mitral valvotomy catheters
    (Cardiovasc Interv., 2012-11) Nair, KKM; Pillai, H S; Thajudeen, A; Tharakan, J; Titus, T; Valaparambil, A; Sivasubramonian, S; Mahadevan, KK; Namboodiri, N; Sasidharan, B; Ganapathi, S
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    Comparative Study on Safety, Efficacy, and Midterm Results of Balloon Mitral Valvotomy Performed With Triple Lumen and Double Lumen Mitral Valvotomy Catheters
    (CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, 2012) Nair, KKM; Pillai, HS; Thajudeen, A; Tharakan, J; Titus, T; Valaparambil, A; Sivasubramonian, S; Mahadevan, KK; Namboodiri, N; Sasidharan, B; Ganapathi, S
    Background: The triple lumen Inoue balloon is routinely used for Balloon Mitral Valvotomy (BMV) in India. Its major limitation is the high cost. The double lumen Accura balloon is less expensive, making it an attractive alternative in the developing countries. The study was meant to assess the safety, efficacy and midterm results of Accura balloon with respect to the Inoue balloon. Patients and Methods: 816 consecutive patients, who underwent elective BMV in this Institute from 1997 to 2003, were included in the study. The data of 487 patients who underwent BMV with Accura balloon was compared with 329 patients who underwent BMV with Inoue balloon. The clinical, echocardiographic, and hemodynamic data of these patients were analyzed retrospectively to assess the safety and efficacy of Accura balloon with respect to the Inoue balloon. Results: Immediate procedural success (93.9% in Inoue group and 91.6% in Accura group p. NS) and complications (6.6% in Inoue group and 5.6% in Accura group p. NS) were comparable between the study groups. The two study population had similar restenosis rate and events at 1 year after BMV. Both balloons could be reused multiple times without compromising on the safety and effectiveness. Accura balloons were less costly than Inoue balloon. The reusability with Accura was slightly more and found to be more cost-effective. Conclusions: Both Accura and Inoue balloon mitral valvotomy balloons are effective in providing relief from hemodynamically significant mitral stenosis in terms of gain in valve area and reduction in trans mitral gradient. Both groups have similar procedural success and complication rates, restenosis, and follow-up events at 1 year. Both balloons could be reused multiple times and Accura balloon is found to be more cost effective. (C) 2012 Wiley Periodicals Inc.
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    Congenital lymphedema: Another unique and gender specific stigmata of tuberous sclerosis?
    (INDIAN PEDIATRICS, 2012) Sukulal, K; Namboodiri, N
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    Duality of Conduction in an Atriofascicular Pathway During Antidromic Tachycardia
    (PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 2009) Namboodiri, N; Sharma, G; Sanders, P
    (PACE 2009; e7-e8).
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    Ebstein's anomaly, Wolff-Parkinson-White syndrome and rheumatic mitral stenosis: role for combined electrophysiological and surgical management.
    (Singapore medical journal, 2007)
    The coexistence of rheumatic mitral stenosis, Ebstein's anomaly and Wolff-Parkinson-White syndrome is an uncommon entity. To our knowledge, the successful management of this combination of lesions has not been previously described. We report a 23-year-old woman with the combination of these abnormalities. She was managed with preoperative electrophysiological study, followed by mitral valve replacement and Danielson's repair of tricuspid valve. The management issues involved are discussed in detail.
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    ECG Challenge: Single or Double Tachycardia?
    (PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 2016) Nair, KKM; Thajudeen, A; Namboodiri, N; Valaparambil, A; Tharakan, J
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    Hemodynamic performance evaluation of TTK Chitra heart valve prosthesis in the aortic position using Doppler echocardiography
    (INTERNATIONAL JOURNAL OF CARDIOLOGY, 2010) Namboodiri, N; Shajeem, O; Tharakan, J; Sankarkumar, R; Titus, T; Ajitkumar, V; Sivasankaran, S; Krishnamoorthy, KM; Harikrishnan, SP
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    Immediate and Long-term Results Following Balloon Mitral Valvotomy in Patients With Atrial Fibrillation
    (CLINICAL CARDIOLOGY, 2012) Nair, KKM; Pillai, HS; Thajudeen, A; Krishnamoorthy, KM; Sivasubramonian, S; Namboodiri, N; Sasidharan, B; Ganapathy, S; Varaparambil, A; Titus, T; Tharakan, J
    Background: The purpose of this study was to examine the influence of atrial fibrillation (AF) on the immediate and long-term outcome of patients undergoing balloon mitral valvotomy (BMV). Hypothesis: Patients with atrial fibrillation fair poorly after balloon mitral valvotomy. Methods: There were a total of 818 consecutive patients who underwent elective BMV in this institute from 1997 to 2003, with either double-lumen or triple-lumen BMV catheters included in the study. Of them, 95 were with AF. The clinical, echocardiographic, and hemodynamic data of these patients were compared with those of 723 patients in normal sinus rhythm (NSR). Immediate procedural results and long-term events were compared between the 2 study groups. Results: Patients with AF were older (39.9 +/- 9.9 years vs 29.4 +/- 10.1, P < 0.001) and presented more frequently with New York Heart Association (NYHA) class III-IV (53.7% vs 32.9%, P < 0.001), echocardiographic score >8 (47.4% vs 24.9%, P < 0.001), and with history of previous surgical commissurotomy (33.7% vs 11.5%, P < 0.001). In patients with AF, BMV resulted in inferior immediate and long-term outcomes, as reflected in a lesser post-BMV mitral valve area (1.3 +/- 0.4 vs 1.6 +/- 0.4 cm2, P = 0.032) and higher event rate on follow-up. Conclusions: Patients with AF were older, sicker, and had advanced rheumatic mitral valve disease. They had a higher incidence of stroke, new onset heart failure, and need for reinterventions on long-term follow-up. These patients need intense and more frequent follow-up. Clin. Cardiol. 2011 DOI: 10.1002/clc.22068 The authors have no funding, financial relationships, or conflicts of interest to disclose.
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    Induction of atrioventricular nodal reentry tachycardia with intravenous adenosine.
    (Singapore medical journal, 2007)
    Adenosine, used to terminate paroxysmal supraventricular tachycardia (SVT), is often useful in understanding the mechanism of tachycardia. This case report describes induction of SVT with adenosine in a 36-year-old man presenting with recurrent palpitations. After a short run of conduction via both slow and fast pathways, SVT was induced following a long PR interval. The long PR interval resulted by conduction via the slow pathway due to the preferential conduction block by adenosine over fast pathway. The notching at the terminal part of QRS during antegrade slow pathway conduction and during tachycardia indicated activation of the atrium via retrograde fast pathway. This electrocardiographical feature confirmed the mechanism of the tachycardia as atrioventricular nodal reentrant tachycardia.
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    LBBB Tachycardia: What Is the Mechanism?
    (JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, 2016) Nair, KKM; Namboodiri, N; Banavalikar, B; Valaparambil, A; Thajudeen, A; Tharakan, J
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    LBBB to RBBB Tachycardia: What Is the Mechanism?
    (JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, 2016) Nair, KKM; Namboodiri, N; Valaparambil, A; Thajudeen, A; Tharakan, J
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    Left sympathetic cardiac denervation in managing electrical storm: acute outcome and long term follow up
    (JOURNAL OF INTERVENTIONAL CARDIAC ELECTROPHYSIOLOGY, 2016) Prabhu, MA; Prasad, SBV; Abhilash, SP; Thajudeen, A; Balasubramoniam, KR; Namboodiri, N
    Left sympathetic cardiac denervation (LSCD) may be beneficial in treating electrical storm (ES) of varied aetiologies. The present study analyse the outcome and long term follow up of LSCD in treating ES. This is a retrospective study of patients with ES who underwent LSCD. Nine patients (majority males (88.89 %), median age 52 years, IQR 50.5-56.5) underwent LSCD. Coronary artery disease was the commonest substrate (7 (77.78 %)). Five patients, who had hypotension and unstable hemodynamics, underwent percutaneous stellate ganglion blockade. Three of the survivors subsequently underwent surgical sympathectomy. In the remaining four, video assisted thoracoscopy (VATS) guided sympathectomy was performed. Five (55 %) and seven (77.78 %) had a > 90 and 80 % reduction in ventricular arrhythmias (VA), respectively. LSCD was ineffective in one patient, who succumbed to ES. There was no difference in outcome between patients with monomorphic versus polymorphic VA (60 vs 70 %, respectively, p = 0.82). One (11.1 %) patient had sudden death on the fifth day after LSCD. The median hospital stay was 13 days (IQR 11-16). During median 34 months of (IQR 18-46) follow up, one patient died of heart failure, and another had recurrence of ES. There was sustained reduction in VA burden in others. LSCD is effective in controlling ES and continues to reduce the incidence of VAs during long term follow up. Pharmacological LSCD needs particular emphasis, as it can be performed at bedside, and can be a bail-out procedure in centres where sophisticated procedures like VATS-guided LSCD or radiofrequency ablation are not readily available.
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    Narrow QRS Tachycardia in a Patient with Tachycardiomyopathy: What Is the Mechanism?
    (PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 2016) Nair, KKM; Namboodiri, N; Divakaramenon, S; Banavalikar, B; Abhilash, SP; Thajudeen, A; Valaparambil, A
    A 50-year-old female presented with incessant palpitation of 2 weeks duration. She was hemodynamically stable and there was no evidence of heart failure. A transthoracic echocardiogram showed mild left ventricular (LV) dysfunction with LV ejection fraction of 45%. Electrocardiogram (12 lead and rhythm strip) was taken during the palpitation. What is the mechanism?
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    Narrow QRS Tachycardia with Long RP Interval: What Is the Mechanism?
    (PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 2016) Nair, KKM; Namboodiri, N; Thajudeen, A; Valaparambil, A; Tharakan, J