146 Publications

418 citations     h-index 10     i10-index 11     updated on 02-02-2022 *
567 citations     h-index 12     i10-index 17     updated on 26-05-2022 **

Researchgate    Google Scholar


* Data obtained from Open Alex api. May not be entirely accurate.

** Data obtained from Google Scholar.

Copy as text


1. Wide QRS tachycardia in a young patient. What is the mechanism?. Dinakar Bootla, Ashish Jain, Raja J. Selvaraj. Journal of Cardiovascular Electrophysiology 2022; : -


Not cited yet   DOI   Pubmed   Open Alex

Abstract: A young patient presented with regular wide QRS tachycardia. During electrophysiology study, a wide QRS tachycardia was induced. Decremental atrial extrastimulus produced increase in AH and AV intervals with appearance of pre-excitation. What is the mechanism of tachycardia? This article is protected by copyright. All rights reserved.

2. Coumel's sign reversed: What is the mechanism?. Dinakar Bootla, Ashish Jain, Gaurav kumar Mittal, Raja J. Selvaraj. Indian pacing and electrophysiology journal 2021; 22: 115- 117


Not cited yet   DOI   Pubmed   Open Alex

Abstract: A patient presented with documented narrow QRS tachycardia. During electrophysiological study, he has orthodromic reciprocating tachycardia with atrial activation consistent with left free wall accessory pathway. With induction of tachycardia, beats with LBBB morphology have shorter cycle length than those with narrow QRS. What is the mechanism?

3. Wide complex tachycardia: What is the mechanism?. Ashish Jain, Prashant Gangwar, Raja J. Selvaraj. Journal of Cardiovascular Electrophysiology 2021; : -


Not cited yet   DOI   Open Alex

Abstract:

4. Consensus statement on cardiac electrophysiology practices during the coronavirus disease 2019 (COVID-19) pandemic: From the Indian Heart Rhythm Society.. Narayanan Namboodiri, Kartikeya Bhargava, Deepak Padmanabhan, Raja J. Selvaraj, Ulhas M. Pandurangi, Vanita Arora, Vivek Chaturvedi, Ashish Nabar, Ameya Udyavar, R D Yadave, Yash Lokhandwala. Indian pacing and electrophysiology journal 2021; 21: 281- 290


Not cited yet   DOI   Pubmed   Open Alex

Abstract:

5. Solving Inverse Problem in Magnetocardiography by Pattern Search Method. Pragyna Parimita Swain, S. Sengottuvel, Rajesh Patel, Awadhesh Mani, Raja J. Selvaraj, Santhosh Satheesh. Iete Journal of Research 2021; : 1- 11


Not cited yet   DOI   Open Alex

Abstract: In this paper, we report a novel way of choosing the initial estimates for solving magnetocardiographic inverse problems using the pattern search method. As opposed to the conventional choice of ps...

6. Paradoxical correction of bundle branch block-What is the mechanism?. Ashish Jain, Sakthivel Ramasamy, Raja J. Selvaraj. Journal of Cardiovascular Electrophysiology 2021; 32: 1199- 1201


Not cited yet   DOI   Pubmed   Open Alex

Abstract: A 14-year-old boy with recurrent palpitations and no preexcitation in the electrocardiogram (ECG) was taken up for an electrophysiology study. This article is protected by copyright. All rights reserved.

7. An epoch based methodology to denoise magnetocardiogram (MCG) signals and its application to measurements on subjects with implanted devices.. S. Sengottuvel, S Shenbaga Devi, M Sasikala, Santhosh Satheesh, Raja J. Selvaraj. Biomedical Physics & Engineering Express 2021; 7: 035006-


Not cited yet   DOI   Pubmed   Open Alex

Abstract: Magnetocardiograms (MCG) provide clinically useful diagnostic information in a variety of cardiac dysfunctions. Low frequency baseline drifts and high frequency noise are inevitably present in routine MCG even for those measured inside magnetically shielded rooms. These interferences sometimes exceed subtle cardiac features in MCG recorded on subjects with implanted devices like cardiac pacemakers; this makes interpretation of cardiac magnetic fields difficult. The present study proposes a correlation-based beat-by-beat approach and principal component analysis to eliminate drifts and high frequency noise respectively; the approach is suitable for denoising both single and multi-channel MCG data. The methodology is critically evaluated on simulated noisy measurements using a 37 channel MCG system, when objects such as implantable permanent pacemaker and stainless-steel wire are sequentially kept externally on the chests of five healthy subjects. By characterizing the noise introduced by each of these objects, the deterioration in the quality of MCG and its subsequent restoration by using the proposed method is assessed. The performance of the proposed method is also compared with other conventional denoising techniques namely, bandpass filters, wavelets and ensemble empirical mode decomposition. The proposed method not only exhibits least distortion, but also preserves the beat-by-beat dynamics of cardiac time series. The method has also been illustrated on actual MCG measurements on two subjects with implanted pacemaker which highlight the ability of the proposed method for denoising MCG in general and during extremely noisy measurement situations. Keywords: Magnetocardiography (MCG), pacemaker, baseline correction, PCA.

8. Sudden death and its predictors in myocardial infarction survivors in an Indian population.. Raja J. Selvaraj, Sasinthar Rangasamy, Dhivya Priya, Sreekumaran Nair, Ajith Ananthakrishna Pillai, Santhosh Satheesh, Balachander Jayaraman. Indian pacing and electrophysiology journal 2021; 21: 82- 87


Cited 2 times   DOI   Pubmed   Open Alex

Abstract: Abstract Objective This study was conducted to assess the incidence of sudden cardiac death (SCD) in post myocardial infarction patients and to determine the predictive value of various risk markers in identifying cardiac mortality and SCD. Methods Left ventricular function, arrhythmias on Holter and microvolt T wave alternans (MTWA) were assessed in patients with prior myocardial infarction and ejection fraction ≤ 40%. The primary outcome was a composite of cardiac death and resuscitated cardiac arrest during follow up. Secondary outcomes included total mortality and SCD. Results Fifty-eight patients were included in the study. Eight patients (15.5%) died during a mean follow-up of 22.3 ± 6.6 months. Seven of them (12.1%) had SCD. Among the various risk markers studied, left ventricular ejection fraction (LVEF) ≤ 30% (Hazard ratio 5.6, 95% CI 1.39 to 23) and non-sustained ventricular tachycardia (NSVT) in holter (5.7, 95% CI 1.14 to 29) were significantly associated with the primary outcome in multivariate analysis. Other measures, including QRS width, heart rate variability, heart rate turbulence and MTWA showed no association. Conclusions Among patients with prior myocardial infarction and reduced left ventricular function, the rate of cardiac death was substantial, with most of these being sudden cardiac death. Both LVEF ≤30% and NSVT were associated with cardiac death whereas only LVEF predicted SCD. Other parameters did not appear useful for prediction of events in these patients. These findings have implications for decision making for the use of implantable cardioverter defibrillators for primary prevention in these patients.

9. Arrhythmia-Induced Cardiomyopathy:. Ashish Jain, Raja J. Selvaraj. Indian journal of clinical cardiology 2021; 2: 90- 96


Not cited yet   DOI   Open Alex

Abstract: Tachycardia is one of the important reversible causes of ventricular dysfunction. More recently, it has been recognized that premature ventricular complexes and atrial fibrillation can result in or...

10. Paradoxical atrial capture during a wide complex tachycardia.. Ashish Jain, Sakthivel Ramasamy, Raja J. Selvaraj. Journal of Cardiovascular Electrophysiology 2021; 32: 1202- 1204


Not cited yet   DOI   Pubmed   Open Alex

Abstract:

11. IPEJ - The little journal that dreamt big. Note from the incoming Editor.. Raja J. Selvaraj. Indian pacing and electrophysiology journal 2021; 21: 1- 2


Not cited yet   DOI   Pubmed   Open Alex

Abstract:

12. Short term Outcome with Dual Chamber Pacing Versus Single Chamber Ventricular Pacing for Atrioventricular Block- A Randomized Controlled Crossover Trial. Ragavendra Sakthivel, Ashish Jain, Joseph Theodore, Raja J. Selvaraj. Indian pacing and electrophysiology journal 2021; 21: 47-


Not cited yet   DOI   Open Alex

Abstract:

13. Catheter ablation of scar based ventricular tachycardia - Procedural characteristics and outcomes.. Ashutosh Yadav, Sakthivel Ramasamy, Joseph Theodore, Avinash Anantharaj, Ajith Ananthakrishna Pillai, Santhosh Satheesh, Raja J. Selvaraj. Indian heart journal 2020; 72: 563- 569


Not cited yet   DOI   Pubmed   Open Alex

Abstract: Abstract Background Ventricular tachycardia (VT) is a major cause of morbidity in patients with cardiomyopathy. Radiofrequency ablation has emerged as the mainstay of the management of recurrent sustained VT in these patients. We describe the clinical characteristics, procedural and medium term outcomes of patients undergoing ablation of scar VT in a tertiary care center in India. Methods This was a single-center descriptive cohort study. All patients who underwent ablation for scar related VT were included. Endpoints were immediate procedural success, procedural complications and recurrence during follow up. Results A total of 72 patients with scar VT underwent ablation with electroanatomic mapping. Previous myocardial infarction (MI) was the commonest etiology (69.4%) with arrhythmogenic right ventricular cardiomyopathy (ARVC) being the next common (19.4%). Acute procedural success was achieved in 69.4% patients, partial success in 9.7% and failure in 1 patient (1.4%). Outcome was labeled indeterminate in 19.4% who did not undergo post ablation VT induction. Procedural complications were seen in 4%. Follow up data was available in 95% of the patients with a mean follow up of 28.9 ± 22.8 months. At one year, freedom from VT was 83.8% and mortality was 13.2%. Overall mortality during follow up was 22.1% while VT recurrence was seen in 35.3%. Recurrence rate was higher in ARVC as compared to previous MI. Conclusions Ablation of scar VT has high acute success rates. Ablation is safe with low risk of major complications. Rates of recurrence are higher in patients with ARVC as compared to post MI VT.

14. Magnetocardiography for identification of coronary ischemia in patients with chest pain and normal resting 12-lead electrocardiogram.. Raja Ramesh, Sengottuvel Senthilnathan, Santhosh Satheesh, Pragyna Parimita Swain, Rajesh Patel, Ajith Ananthakrishna Pillai, Gireesan Katholil, Raja J. Selvaraj. Annals of Noninvasive Electrocardiology 2020; 25: -


Cited 1 times   DOI   Pubmed   Open Alex

Abstract: BACKGROUND Identification of coronary ischemia in patients presenting with chronic chest pain is difficult as resting ECG can be normal. Diagnosis of coronary ischemia requires evaluation during exercise or pharmacological stress. A noninvasive test to identify coronary ischemia at rest without the need for exercise is desirable. We studied the diagnostic accuracy of magnetocardiography (MCG) at rest to detect coronary ischemia in these patients. METHODS Patients with chronic chest pain and suspected coronary ischemia with a normal ECG were included. Patients underwent treadmill test (TMT) and were divided into TMT positive and TMT negative groups. MCG was recorded in a magnetically shielded room. Iso-field contour maps generated at the T-wave peak were compared between the groups. From the magnetic field map (MFM), the magnetic field angle at T-wave peak was calculated and was also compared across the two groups. RESULTS There were a total of 29 patients, 12 with positive TMT and 17 with negative TMT. An abnormal magnetic field angle was more common in the TMT positive group (72% vs. 6%). Abnormal contour maps in the form of nondipole patterns or abnormal orientation were seen in 81.8% (9/11) patients in TMT positive group and 6.8% (1/17) patients in the TMT negative group (p < .001). CONCLUSION Abnormal magnetic field angle and abnormal magnetic field maps in MCG recorded at rest are able to identify the presence of coronary ischemia in patients with chronic chest pain and a normal resting ECG.

15. Atrial fibrillation and preexcitation - A licence to kill.. R. Sakthivel, Raja J. Selvaraj. Indian pacing and electrophysiology journal 2020; 20: 1- 2


Cited 1 times   DOI   Pubmed   Open Alex

Abstract: Abstract Atrial fibrillation becomes a potentially lethal arrhythmia in the presence of preexcitation because the rapid ventricular activation can result in ventricular fibrillation. Fortunately, radiofrequency ablation is an effective treatment for these patients. Specific points of interest regarding this association are the mechanism of increased incidence of atrial fibrillation and the current management of patients presenting in atrial fibrillation. These are discussed in this editorial.

16. Leadless pacemaker implantation in a young patient with recurrent pacing system infection. Joseph Theodore, Hemachandran Munusamy, Ram Shankar, Prakash Kumar Hazra, Raja J. Selvaraj. IHJ Cardiovascular Case Reports (CVCR) 2020; 4: 21- 23


Cited 1 times   DOI   Open Alex

Abstract: Abstract A nine year old girl weighing only 24 kg with complete heart block after surgical closure of perimembranous ventricular septal defect presented with recurrent pacemaker infection. As she was too small for the conventional femoral approach, leadless pacemaker (Micra, Medtronic) was implanted by an external iliac venous cut down. Device was implanted successfully and patient is doing well on follow up.

17. Coronary venous anatomy relevant to cardiac resynchronization therapyan angiographic study. Priyanka Ramanathan, Girija Agarwal, Raja J. Selvaraj, Veeramani Raveendranath. European journal of anatomy 2020; 24: 357- 361


Not cited yet Open Alex

Abstract: Cardiac resynchronization therapy (CRT) in-volves placing a lead through the coronary sinus to pace the left ventricle. However, technical prob-lems arise in the procedure either due to variant anatomy or due to the presence of valves. Infor-mation on coronary venous anatomy is scarce in the South Indian population. The aim of this study was to describe the coronary sinus anatomy in patients undergoing CRT implant. Coronary sinus angiograms were used to study the following pa-rameters: (a) Dimensions of coronary sinus (b) Number and distribution of tributaries (excluding middle and great cardiac veins) (c) Diameter of major veins at the origin (d) Angulation of tributar-ies with CS. Measurements were made using cali-pers in the dicom viewer.Out of the 24 angiograms studied, only a single tributary of adequate size was noted in 70.8% (17/24) of the cases, which was most commonly a midlateral vein (76.5%). Two prominent tributaries were noted in 29.2% (7/24) of cases. The average diameter of the veins was 3.93 mm and 80.6% of the veins had an obtuse angle of drainage. Ana-tomical variations in the coronary venous systemin this population suggest that the majority of pa-tients have a single suitable tributary and this is most often the midlateral vein, which is known to have the most favorable outcome. Data obtained in this study will guide clinicians in left ventricular lead placement in the South Indian population leading to greater procedural success.

18. Effectiveness of T wave alternans testing for risk stratification of ventricular tachyarrhythmias and sudden death in patients with cardiomyopathy. Behnaz Ghoraani, Adrian Suszko, Raja J. Selvaraj, Anandaraja Subramanian, Sridhar Krishnan, Vijay S. Chauhan. Journal of Electrocardiology 2019; 57: -


Not cited yet   DOI   Open Alex

Abstract:

19. Letter to the Editor regarding "Importance of over-reading ambulatory ECG-based microvolt T-wave alternans to eliminate three main sources of measurement error".. Raja J. Selvaraj. Annals of Noninvasive Electrocardiology 2019; 24: -


Not cited yet   DOI   Pubmed   Open Alex

Abstract:

20. A paradoxical response to para-hisian pacing. Pramod Pawar, Joseph Theodore, Nagendra Singh Thalor, Raja J. Selvaraj. Pacing and Clinical Electrophysiology 2019; 42: 1396- 1397


Not cited yet   DOI   Pubmed   Open Alex

Abstract:

21. Upper loop re-entrant flutter.. Raja J. Selvaraj, Joseph Theodore. Europace 2019; 21: 1192- 1192


Not cited yet   DOI   Pubmed   Open Alex

Abstract:

22. Diagnostic accuracy of apex-pulse deficit for detecting atrial fibrillation. Anjali Rajkumar, Aditya Bhattacharjee, Raja J. Selvaraj. International journal of advanced medical & health research 2019; 6: 52-


Not cited yet   DOI   Open Alex

Abstract: Background: Screening for asymptomatic atrial fibrillation (AF) can identify patients at risk of stroke and help initiate treatment. Apex-pulse deficit, the difference between apex beat rate and peripheral pulse rate, has been described as a clinical sign to identify AF. However, the accuracy of this measure to identify AF has not been studied before. Aims: The primary aim of this study was to determine the sensitivity and specificity of apex-pulse deficit more than 10, measured over 1 min, to identify AF using 12-lead electrocardiogram (ECG) as the gold standard. Methods: This was a prospective cross-sectional study. Subjects were those above 30 years of age with known AF (cases) or not in AF (controls). Apex-pulse deficit was measured in each of them and correlated with rhythm detected in 12-lead ECG. Results: A total of 70 patients were studied, 35 cases and 35 controls. Apex-pulse deficit was significantly larger for cases as compared to controls and was a good discriminant to identify AF. Receiver operating characteristic curve analysis showed an area under the curve of 0.86. With a cutoff of 10, sensitivity and specificity to identify AF were 62.8% and 85.7%, respectively. Using a cutoff of 5 increased the sensitivity to 80%. Counting over 30 s was significantly less accurate than counting over one full minute. Conclusion: Apex-pulse deficit is a low-cost method to identify AF and may be useful for screening. A cutoff of 5 may enhance the sensitivity of measurement as compared to the traditional cutoff of 10.

23. An unusual form of pre-excitation.. Raja J. Selvaraj, Pramod Pawar, Devender Sharma, Anandaraja Subramanian. Journal of Cardiovascular Electrophysiology 2019; 30: 976- 977


Not cited yet   DOI   Pubmed   Open Alex

Abstract:

24. Body surface distribution of T wave alternans is modulated by heart rate and ventricular activation sequence in patients with cardiomyopathy.. Behnaz Ghoraani, Adrian Suszko, Raja J. Selvaraj, Anandaraja Subramanian, Sridhar Krishnan, Vijay S. Chauhan. PLOS ONE 2019; 14: -


Cited 1 times   DOI   Pubmed   Open Alex

Abstract: BACKGROUND T wave alternans (TWA) is an electrocardiographic marker of heightened sudden death risk from ventricular tachyarrhythmias in patients with cardiomyopathy. TWA is evaluated from the 12-lead electrocardiogram, Frank lead, or Holter lead recordings, however these clinical lead configurations will not record TWA from adjacent regions of the body torso. OBJECTIVE We tested the hypothesis that changing heart rate or ventricular activation may alter the body surface distribution of TWA such that the clinical ECG leads fail to detect TWA in some patients; thereby producing a false-negative test. METHODS In 28 cardiomyopathy patients (left ventricular ejection fraction 28±6%), 114 unipolar electrograms were recorded across the body torso during incremental atrial pacing, followed by atrioventricular pacing at 100, 110 and 120bpm. TWA was measured from each unipolar electrogram using the spectral method. A clinically positive TWA test was defined as TWA magnitude (Valt) ≥1.9 uV with k ≥3 at ≤110bpm. RESULTS Maximum Valt (TWAmax) was greater from the body torso than clinical leads during atrial (p<0.005) and atrioventricular pacing (p<0.005). TWAmax was most prevalent in the right lower chest with atrial pacing 100 bpm and shifted to the left lower chest at 120 bpm. TWAmax was most prevalent in left lower chest with atrioventricular pacing at 100 bpm and shifted to the left upper chest at 120 bpm. Using the body torso as a gold standard, the false-negative rate for clinically positive TWA with clinical leads was 21% during atrial and 11% during atrioventricular pacing. Due to TWA signal migration outside the clinical leads, clinically positive TWA became false-negative when pacing mode was switched (atrial→atrioventricular pacing) in 21% of patients. CONCLUSIONS The body surface distribution of TWA is modulated by heart rate and the sequence of ventricular activation in patients with cardiomyopathy, which can give rise to modest false-negative TWA signal

25. Ablation of post-operative atrial flutter in the presence of interrupted IVC.. Pramod Pawar, Raja J. Selvaraj. Indian pacing and electrophysiology journal 2019; 19: 23- 26


Not cited yet   DOI   Pubmed   Open Alex

Abstract:

26. Effects of conscious sedation on tachycardia inducibility and patient comfort during ablation of supraventricular tachycardia: a double blind randomized controlled study.. Raja J. Selvaraj, Subhash Dukiya, Ajith Ananthakrishna Pillai, Santhosh Satheesh, Jayaraman Balachander. Europace 2019; 21: 142- 146


Cited 2 times   DOI   Pubmed   Open Alex

Abstract: Aims Sedation is not consistently used during electrophysiology procedures because of concerns regarding effects on tachycardia inducibility. We designed this study to assess the effect of conscious sedation on tachycardia inducibility and patient comfort during supraventricular tachycardia ablation. Methods and results Patients with narrow QRS tachycardia and no pre-excitation undergoing an electrophysiology study were randomly assigned to sedation or placebo group. Patients in the sedation group received intermittent doses of midazolam and fentanyl, while those in the placebo group received normal saline as placebo. The physician and the patient were blinded to the allocation. Information was collected on tachycardia inducibility, patient discomfort, and complications. A total of 103 patients were included in the study. Proportion of patients with difficult tachycardia induction (27.4% vs. 32.7%) or with non-inducibility (5.8% vs. 3.8%) were not different between the sedation and placebo groups. Patient discomfort as measured by the Wong-Baker scale was significantly less in the sedation group (1.45 ± 1.08 vs. 2.24 ± 1.2, P < 0.0007) compared to the placebo group. There was no difference in incidence of hypotension or hypoxia between the two groups. Conclusions Conscious sedation with intermittent midazolam- and fentanyl-reduced patient discomfort during electrophysiology study and ablation of supraventricular tachycardia without affecting tachycardia inducibility. Sedation administered in the absence of an anaesthetist was safe.

27. Hydatid cyst of the interventricular septum - A rare cause of heart block.. Bhagwati Prasad Pant, Ananthakrishnan Ramesh, Raja J. Selvaraj. Indian pacing and electrophysiology journal 2019; 19: 79- 80


Cited 3 times   DOI   Pubmed   Open Alex

Abstract:

28. Procedural and follow-up clinical outcomes after chronic total occlusion revascularization: Data from an Indian public hospital.. Ajith Ananthakrishna Pillai, Sakthivel Ramasamy, Kabilan S. Jagadheesan, Santhosh Satheesh, Raja J. Selvaraj, Balachander Jayaraman. Indian heart journal 2019; 71: 65- 73


Cited 1 times   DOI   Pubmed   Open Alex

Abstract: BACKGROUND Chronic total occlusion (CTO) continues to be challenging lesion subset for percutaneous intervention. Last decade has seen tremendous increase in percutaneous coronary intervention (PCI) in this subset owing to improved understanding of the anatomy and enhanced skillset with availability of dedicated hardware. We sought to study the outcomes of CTO PCI in an Indian public hospital. METHODS This was a single-center non-randomized descriptive follow-up study on CTO PCI. The end-points were procedural success, immediate, and late adverse cardiovascular events [major adverse cardiac event (MACE)] and change in angina and left ventricular function at follow-up. RESULTS A total 389 CTO lesions were treated with a success rate of 87% (339/389). The mean Japanese chronic total occlusion (J-CTO) score was 1.78 ± 0.12 (mean ± standard deviation). Multivariate analysis of different angiographic components of J-CTO score identified tortuosity (p = 0.001), calcifications (p ≤ 0.001), and blunt stump (p = 0.007) as independent predictors of procedural failure. The periprocedural mortality was less than 1%, and the non-life threatening complications were about 4%. The MACE rate was significantly higher in the procedural failure group (60%) than in the procedural success group (5.3%, p < 0.001). An increase in left ventricular ejection fraction (LVEF) was noted following successful CTO PCI after complete revascularization. CONCLUSIONS The success rates for CTO PCI in this registry were about 87%. Immediate and long-term clinical outcomes were better with lower MACE (5%) after a successful procedure. A key outcome variable included an increase in LVEF among patients after a successful CTO PCI. The overall periprocedural complications were about 5.5%, but majority were non-life threatening.

29. Device detected arrhythmias - Staying afloat in the data deluge.. Girija Agarwal, Raja J. Selvaraj. Indian pacing and electrophysiology journal 2019; 19: 90- 91


Not cited yet   DOI   Pubmed   Open Alex

Abstract:

30. Consensus statement for implantation and follow-up of cardiac implantable electronic devices in India.. Shomu Bohora, Amit N. Vora, Aditya Kapoor, Vanita Arora, Nitish Naik, Raja J. Selvaraj, Narayan Namboodiri, Anil Saxena, Ajay Naik, Balbir Singh, C Narsimhan, Mohan Nair, T.S. Kler. Indian pacing and electrophysiology journal 2018; 18: 188- 192


Cited 1 times   DOI   Pubmed   Open Alex

Abstract: Cardiac implantable electronic device (CIED) procedures are being done by many operators/centers and it is projected that this therapy will remarkably increase in India in the coming years. This document by IHRS, aims at guiding the Indian medical community in the appropriate use and method of implantation with emphasis on implanter training and center preparedness to deliver a safe and effective therapy to patients with cardiac rhythm disorders and heart failure.

31. Low power ablation for left coronary cusp ventricular tachycardia—Efficacy and long-term outcome. Kabilan S. Jagadheesan, Santhosh Satheesh, Ajith Ananthakrishna Pillai, Balachander Jayaraman, Raja J. Selvaraj. Indian heart journal 2018; 70: -


Cited 1 times   DOI   Pubmed   Open Alex

Abstract: Abstract Background The left coronary cusp is an uncommon but well-known site for the ablation of idiopathic ventricular tachycardia (VT). Proximity to the left coronary ostium makes ablation of this arrhythmia challenging. Different power settings have been described by various operators. Our objective was to describe the outcomes with low power ablation. Methods Once mapping confirmed origin from the left coronary cusp, ablation was performed if the best site was situated at least 5 mm from the left coronary ostium. Ablation was started at 15 W and, if successful, was stopped after 30 s. When required, higher powers were used up to 30 W. Results Ten patients with VT or premature ventricular beats mapped to the left coronary cusp were included in the study. No ablation was performed in one patient because of proximity to the left coronary ostium. Successful ablation was performed in eight of the other nine patients with a mean power of 18.1 ± 5.3 W and duration of 42.2 ± 13.5 s. There were no complications. All the eight patients remained free of recurrence at 16.8 ± 16.5 months of follow-up. Conclusions VT can be ablated from the left coronary cusp close to the left coronary ostium. Ablation with low power is effective in achieving immediate success which is also durable with time while avoiding complications.

32. Percutaneous closure of iatrogenic arteriovenous fistula after pacemaker implantation. Praveen K. Gupta, Santhosh Satheesh, Raja J. Selvaraj. Heart Asia 2018; 10: -


Cited 2 times   DOI   Pubmed   Open Alex

Abstract: A 76-year-old man presented with swelling of the left upper limb that started 1 year after pacemaker implantation. During the procedure, a single-pass VDD lead was introduced through an axillary vein puncture and was positioned in the right ventricular apex. Pitting oedema of the left upper limb was seen, with reddish-brown skin pigmentation, scaling and thickening (figure 1A). Subclavian …

33. Submitral aneurysm in adults: A rare entity with varied presentations. Baban Kumar, Santhosh Satheesh, Raja J. Selvaraj. IHJ Cardiovascular Case Reports (CVCR) 2018; 2: 119- 122


Cited 1 times   DOI   Open Alex

Abstract: Abstract Submitral aneurysm is a rare cardiac entity, initially described in African black patients but rarely also reported in Indian population. Patients may be entirely asymptomatic for many years or have varied clinical manifestations. We are presenting a case series on 4 cases of submitral aneurysm which came to our institution, each of them having varied presentations.

34. Demonstration of dual AV nodal physiology - More than one way to skin a cat?. Raja J. Selvaraj. Indian pacing and electrophysiology journal 2018; 18: 47- 48


Not cited yet   DOI   Pubmed   Open Alex

Abstract:

35. A young female with cyanosis and clubbing.. Praveen K. Gupta, Raja J. Selvaraj. European Journal of Internal Medicine 2018; 54: -


Not cited yet   DOI   Pubmed   Open Alex

Abstract:

36. Honeycomb-like appearance on optical coherence tomography in right coronary artery.. Praveen K. Gupta, Ajith Ananthakrishna Pillai, Santhosh Satheesh, Raja J. Selvaraj, Jayaram Balachander. International Journal of Cardiovascular Imaging 2018; 34: 343- 344


Cited 1 times   DOI   Pubmed   Open Alex

Abstract:

37. Wide to narrow complex tachycardia: What is the diagnosis?. Manojkumar Rohit, Darshan Krishnappa, Raja J. Selvaraj. Journal of Cardiovascular Electrophysiology 2018; 29: 487- 488


Cited 1 times   DOI   Pubmed   Open Alex

Abstract:

38. Biological Pacemakers – A Review. Velvizhi Gunasekaran, Raja J. Selvaraj. International journal of cardiovascular practice 2018; 3: 1- 5


Not cited yet   DOI   Open Alex

Abstract: Slow heart rates, due to sinus node disease or atrioventricular conduction block, are a significant problem for many patients. Currently, these patients are treated with electronic pacemakers, which provide effective therapy, but are also associated with many problems. Use of biological pacemakers is an attractive solution to these problems. Approaches for the creation of such pacemakers include either the injection of cells that have pacemaker activity (cell-based approach) or modification of cells in the heart to induce pacemaker activity by delivering genes (gene-based approach). This article reviews the progress in the development of biological pacemakers.

39. Electrocardiogram in Mitral Stenosis. Krishnakumar Nair, Diego Chemello, Raja J. Selvaraj. None 2018; : 71- 71


Not cited yet   DOI   Open Alex

Abstract:

40. A deadly mix - rheumatic mitral stenosis, preexcited atrial fibrillation, left atrial appendage thrombus and left atrial appendage accessory pathway.. Kabilan S. Jagadheesan, Sasinthar Rangasamy, Raja J. Selvaraj. Indian pacing and electrophysiology journal 2017; 17: 183- 185


Cited 2 times   DOI   Pubmed   Open Alex

Abstract:

41. Long-term outcomes following left main bifurcation stenting in Indian population-Analysis based on SYNTAX I and II scores.. Ajith Ananthakrishna Pillai, Saranya Gousy, Harichandrakumar Kottyath, Santhosh Satheesh, Raja J. Selvaraj, Balachander Jayaraman. Indian heart journal 2017; 70: 394- 398


Cited 1 times   DOI   Pubmed   Open Alex

Abstract: Abstract Background Syntax 1 and recently Syntax 2 (SS2) scores are validated risk prediction models in coronary disease. Objectives To find out the long term outcomes following stenting for unprotected left main bifurcation disease (LMD) and to validate and compare the performance of the SYNTAX scores 1 and 2 (SS1 and SS2 PCI) for predicting major adverse cardiac events (MACE) in Indian population. Methods Single-center, retrospective, observational study involving patients who underwent percutaneous coronary intervention (PCI) with at least one stent implanted for the LMD. Discrimination and calibration models were assessed by ROC curve and the Hosmer-Lemeshow test. Results Data of 103 patients were analyzed. The mean SS1 and SS2 scores were 27.9 and 30.7 and MACE was 16.5% at 4 years. The target lesion revascularization (TLR) rate at 4 years was 11(10.7%). There were 4 deaths (3.8%). The mean left ventricular ejection fraction (LVEF) was the only variable in SS2, which predicted cardiac events. ROC curve analysis showed both models to be accurate in predicting TLR and mortality following LM PCI. SS2 score showed a better risk prediction than SSI with AUC for TLR (SSI 0.560 and SS2PCI 0.625) and AUC for mortality (SS1 0.674 and SS2PCI 0.833). Hosmer-Lemeshow test validated the accuracy of both the risk models in predicting the events. Conclusions Both risk models were applicable for Indian patients. The SS2 score was a better predictor for mortality and TLR. In the SS2 score, the LVEF was the most useful predictor of events after LM PCI.

42. Intra vascular ultrasound findings in drug eluting stent restenosis following emergent PCI for acute coronary syndrome – Gender based analysis. Ajith Ananthakrishna Pillai, Saranya Gousy, Raja J. Selvaraj, Balachander Jayaraman. Journal of Indian College of Cardiology 2017; 7: 78- 84


Cited 1 times   DOI   Open Alex

Abstract: Abstract Background Optimal stent deployment attaining larger lumen area with image guidance (IVUS/OCT) may reduce the risk of re-stenosis. However imaging based optimization is often not performed in emergency procedures. We planned to prospectively evaluate intra vascular ultrasound (IVUS) findings in patients with in stent restenosis (ISR) who underwent emergency PCI for ACS. Methods To find out the intra vascular ultrasound findings in drug eluting stent restenosis (DES-ISR). We enrolled consecutive patients with DES-ISR who had index PCI for ACS (NSTEMI/STEMI). IVUS analysis of individual lesions was performed for sub optimal stent deployment. Results Of the 1823 patients who had ACS PCI during the 5-year period, 172 patients {74 (9.4%) females and 88 males (8.4%)} had ISR. Eighty-two lesions in women were compared with 84 ISR lesions men. Baseline characteristics were similar except for presence of diabetes mellitus and multivessel disease. Females had more focal ISR (48 focal, 34 diffuse) compared to males (23 focal, 61 diffuse) ( P P  = 0.2). Conclusions The occurrence of ISR was higher in women. Women had higher TLR and lower mean vessel size. In 46% of women and 39% men, a mechanical factor with sub optimal stent deployment was found. Longer stented length, diffuse disease, calcification and Type B/C lesion type were associated with under expanded and undersized stents.

43. Noninvasive Determination of HV Interval Using Magnetocardiography.. Sengottuvel Senthilnathan, Raja J. Selvaraj, Rajesh Patel, Santhosh Satheesh, Gireesan Katholil, M. P. Janawadkar, T. S. Radhakrishnan. Pacing and Clinical Electrophysiology 2017; 40: 568- 577


Cited 5 times   DOI   Pubmed   Open Alex

Abstract: Background The His-ventricular (HV) interval is an important index of atrioventricular conduction, but at present can be reliably measured only during an invasive electrophysiology (EP) study. Magnetocardiography (MCG) is a noninvasive measurement of weak magnetic fields generated by the heart. We compared HV interval noninvasively assessed using MCG with the corresponding values measured directly in an EP study. Methods MCG was measured using a 37-channel system inside a magnetically shielded room in patients who had previously undergone an EP study. His-bundle potential was identified in the PR segment after signal averaging. Magnetic field maps representing the spatial distribution of ramp-like signals in the PR segment generated at various instants of time were used to identify His-bundle signals in cases where the deflection representing the His was ambiguous. Results The study included 23 patients (14 male, nine female) with a wide range of HV intervals measured during EP study (49 ± 17 ms, range 35–120 ms). In 21 (91%) subjects, discernible His-bundle signals are observed in the PR segment of MCG traces. HV intervals measured between the two methods showed a correlation (r2 = 0.87, P < 0.0001) with a mean difference of 5.4 ± 3.2 ms. Conclusion With the use of new criteria to identify the His-bundle deflection in signal-averaged MCG signals, we report a high success rate in noninvasive HV interval measurement and a good agreement with those from EP study. The results encourage the use of MCG as a noninvasive method for measurement of the HV interval.

44. Which side are you on? - Deducing the chamber of origin of atrial tachycardia.. Raja J. Selvaraj, Krishna Sarin, Raveendranath Veeramani. Indian pacing and electrophysiology journal 2017; 17: 54- 57


Not cited yet   DOI   Pubmed   Open Alex

Abstract: Atrial arrhythmias rising from the regions of the atria that are in close proximity to each other may pose a challenge in identifying the chamber to map and ablate in. In this report, we discuss a patient with left atrial tachycardia which initially mimicked right atrial tachycardia. We discuss the origins of the abnormal electrograms in the right atrium and how this provides a general understanding of the mechanism of double potentials.

45. Clinical presentation, management, and outcomes in the Indian Heart Rhythm Society-Atrial Fibrillation (IHRS-AF) registry.. A M Vora, Aditya Kapoor, Mohan Nair, Yash Lokhandwala, C Narsimhan, A G Ravikishore, Sudhanshu Kumar Dwivedi, Narayanan Namboodiri, R Hygriv, Anita Saxena, Ashish Nabar, Satish K. Garg, N Bardoloi, Ram Naresh Yadav, A Nambiar, Ulhas M. Pandurangi, D Jhala, Ajay Naik, Nagmallesh, S Rajagopal, Raja J. Selvaraj, Vineet M. Arora, A Thachil, Joy M. Thomas, Gopi Krishna Panicker. Indian heart journal 2017; 69: 43- 47


Cited 16 times   DOI   Pubmed   Open Alex

Abstract: Abstract Aim A national atrial fibrillation (AF) registry was conducted under the aegis of the Indian Heart Rhythm Society (IHRS), to capture epidemiological data-type of AF, clinical presentation and comorbidities, current treatment practices, and 1-year follow-up outcomes. Methods A total of 1537 patients were enrolled from 24 sites in India in the IHRS-AF registry from July 2011 to August 2012. Their baseline characteristics and follow-up data were recorded in case report forms and subsequently analyzed. Results The average age of Indian AF patients was 54.7 years. There was a marginal female preponderance – 51.5% females and 48.5% males. At baseline, 20.4% had paroxysmal AF; 33% had persistent AF; 35.1% had permanent AF and 11% had first AF episode. At one-year follow-up, 45.6% patients had permanent AF. Rheumatic valvular heart disease (RHD) was present in 47.6% of patients. Hypertension, heart failure, coronary artery disease, and diabetes were seen in 31.4%, 18.7%, 16.2%, and 16.1%, respectively. Rate control was the strategy used in 75.2% patients, digoxin and beta-blockers being the most frequently prescribed rate-control drugs. Oral anticoagulation (OAC) drugs were used in 70% of patients. The annual mortality was 6.5%, hospitalization 8%, and incidence of stroke 1%. Conclusions In India, AF patients are younger and RHD is still the most frequent etiology. Almost two-third of the patients have persistent/permanent AF. At one-year follow-up, there is a significant mortality and morbidity in AF patients in India.

46. Infra‐His Block during Atrial Pacing—Functional or Pathological?. Raja J. Selvaraj, Binay Kumar, Sasinthar Rangasamy. Pacing and Clinical Electrophysiology 2017; 40: 69- 71


Not cited yet   DOI   Pubmed   Open Alex

Abstract: The significance of infra-His conduction abnormalities observed in the electrophysiology lab can be difficult to assess. In this report we show infra-His conduction block during programmed atrial stimulation in a patient and discuss if this should be considered functional or pathological.

47. Reuse of pacemakers, defibrillators and cardiac resynchronisation devices. Raja J. Selvaraj, R. Sakthivel, Santhosh Satheesh, Ajith Ananthakrishna Pillai, Pascal Sagnol, Xavier Jouven, B. Dodinot, Jayaraman Balachander. Heart Asia 2017; 9: 30- 33


Cited 13 times   DOI   Pubmed   Open Alex

Abstract: Objective Access to pacemakers remains poor among many patients in low/middle-income countries. Reuse of explanted pacemakers is a possible solution, but is still not widespread because of concerns regarding outcomes, especially infection. Our objective was to study early outcomes with implants using reused devices and compare them with those with implants using new devices. Methods We studied all patients who underwent implantation of a new or reused pacemaker, cardiac resynchronisation therapy (CRT) device or implantable cardioverter defibrillator (ICD) in the last 5 years at a single institution. We analysed outcomes related to infection, device malfunction and device-related death within 6 months after initial implantation. Results During the study period, 887 patients underwent device implant, including 127 CRT devices or ICDs. Of these, 260 devices (29.3%) were reused and the others were new. At 6 months, there were three device-related infections in implants using a new device. There were no infections among patients receiving a reused device. There were no device malfunctions or device-related deaths in either group. Conclusions We found no difference in rate of infection or device malfunction among patients getting a reused device as compared with those with a new device. This study reinforces the safety of reusing devices for implant including CRT and ICDs.

48. Fighting sudden cardiac death in India – Knowing your enemy is half the battle. Raja J. Selvaraj. Indian pacing and electrophysiology journal 2016; 16: 120- 120


Not cited yet   DOI   Pubmed   Open Alex

Abstract:

49. Change of Heart: Altered Atrial Activation Following an Atrial Extrastimulus.. Raja J. Selvaraj, Santhosh Satheesh, Jayaraman Balachander. Journal of Cardiovascular Electrophysiology 2016; 27: 618- 620


Not cited yet   DOI   Pubmed   Open Alex

Abstract:

50. A young female with recurrent syncope. Mahadeva Swamy B, Deepak Amalnathan, Raja J. Selvaraj. Heart Asia 2016; 8: 54- 55


Not cited yet   DOI   Pubmed   Open Alex

Abstract: A 23-year-old woman presented with multiple episodes of palpitations and loss of consciousness within a 48 h period. She gave a history of similar episodes since childhood and had been previously diagnosed as suffering from epilepsy. While being monitored in the hospital, she was found to have rapid polymorphic ventricular tachycardia (PVT) during the episodes. She required repeated cardioversion as the arrhythmia recurred despite administration of intravenous amiodarone and lignocaine. Prolonged monitoring showed frequent premature ventricular complexes (PVC) (figure 1A), couplets and short runs of ventricular tachycardia (figure 1B) and longer runs of ventricular tachycardia, which were associated with her clinical symptoms (figure 1C). Echocardiography showed no structural …

51. Radiofrequency ablation of posteroseptal accessory pathways associated with coronary sinus diverticula.. Raja J. Selvaraj, Krishna Sarin, Vivek Raj Singh, Santhosh Satheesh, Ajith Ananthakrishna Pillai, Mahesh Kumar, Jayaraman Balachander. Journal of Interventional Cardiac Electrophysiology 2016; 47: 253- 259


Cited 5 times   DOI   Pubmed   Open Alex

Abstract: Posteroseptal accessory pathways may be associated with a coronary sinus (CS) diverticulum. Our purpose was to describe the clinical characteristics, mapping and ablation of these pathways. This was a retrospective study of all patients who underwent ablation of posteroseptal accessory pathways in a single centre. Patients with a diverticulum of the CS or one of its tributaries were included in group I, while the other patients formed group II. Clinical presentation, ablation procedure and outcome were compared between the two groups. A total of 51 patients were included, 16 in group I and 35 in group II. There were no significant differences in age or sex distribution. Atrial fibrillation (AF) and previous unsuccessful ablation were more common in group I. A negative delta wave in lead II was the ECG finding with best sensitivity and specificity for the presence of a diverticulum. A pathway potential was common at the successful site in group I, and the interval between local ventricular electrogram and delta wave onset was shorter (19.5 ± 8 vs 33.1 ± 7.6 ms, p < 0.001). There was a trend toward lower procedural success rate and higher recurrence rate in group I, although this was not significant. CS diverticula should be suspected in patients with manifest posteroseptal accessory pathways who have a previous failed ablation, documented AF or typical electrocardiographic signs. A discrete potential is frequently seen at the successful site, but the local ventricular electrogram is not as early as in other accessory pathways.

52. Pathophysiology and pharmacology of cardiovascular disease. Raja J. Selvaraj. Journal of Pharmacology and Pharmacotherapeutics 2016; 7: 55- 55


Not cited yet Open Alex

Abstract:

53. Pace mapping in the atrium using bipolar electrograms from widely spaced electrodes. Raja J. Selvaraj, Sreekanth Yerram, Pradeep Kumar, Santhosh Satheesh, Ajith Ananthakrishna Pillai, Mahesh Kumar Saktheeswaran, Jayaraman Balachander. Journal of Arrhythmia 2015; 31: 274- 278


Cited 2 times   DOI   Pubmed   Open Alex

Abstract: Background Pace mapping is a useful tool but is of limited utility for the atrium because of poor spatial resolution. We investigated the use of bipolar electrograms recorded from widely spaced electrodes in order to improve the resolution of pace mapping.

54. Werner Syndrome with Heart Block. Raja J. Selvaraj, Amarnath Upadhyay. The American Journal of Medicine 2015; 128: -


Cited 1 times   DOI   Pubmed   Open Alex

Abstract:

55. Cardiac syndrome X: Clinical characteristics revisited. Babu Ezhumalai, Ajith Ananthakrishnapillai, Raja J. Selvaraj, Santhosh Satheesh, Balachander Jayaraman. Indian heart journal 2015; 67: 328- 331


Cited 5 times   DOI   Pubmed   Open Alex

Abstract: Abstract Background Cardiac syndrome X includes a heterogenous group of patients with angina but normal epicardial coronaries in angiography. Objective Our objective was to study the clinical characteristics of patients with cardiac syndrome X. Methods Data of patients who underwent coronary angiography over a period of one year was retrospectively analyzed. Those with normal or non-obstructive coronaries in angiography with chest pain were included in this study. Results 1203 patients underwent coronary angiography during the study period. 105 (8.7%) patients fulfilled the inclusion criteria. There were 52 (49.5%) males and 53 (50.5%) females including 31 (29.5%) postmenopausal women. Many patients had atherosclerotic risk factors. Typical angina and atypical chest pain were reported by 63 (60%) and 42 (40%) patients, respectively. ECG was normal in 46 (43.8%) and abnormal in 59 (56.2%) patients. The most common abnormal finding in ECG was ST-T changes seen in 49 (46.7%) patients. Regional wall motion abnormality with mild left ventricular systolic dysfunction was seen in 4 (3.8%) patients while 101 (96.2%) patients had normal ventricular function in echocardiography. TMT was positive for inducible ischemia in 35 (33.3%) patients and inconclusive in 10 (9.5%) patients. Angiography showed normal epicardial coronaries in 85 (80.9%) patients. Conclusions Cardiac syndrome X constitutes a significant subset of patients undergoing coronary angiography. It is essential to identify and treat them specifically for microvascular angina. Many of them have atherosclerotic risk factors but their presentation is different from those with obstructive coronaries.

56. Diagnostic Dilemma in a Narrow Complex Tachycardia.. Raja J. Selvaraj, Vivek Raj Singh, Jayaraman Balachander. Pacing and Clinical Electrophysiology 2015; 38: 887- 890


Not cited yet   DOI   Pubmed   Open Alex

Abstract:

57. Syncope with Heart Disease - Provoke and See or Wait and Watch ?. Raja J. Selvaraj. Indian pacing and electrophysiology journal 2015; 15: 30- 31


Not cited yet   DOI   Pubmed   Open Alex

Abstract: Syncope is common in the young, but is usually reflex syncope and has a benign outcome except in the setting of strucural heart disease which is uncommon in this age group. After decreasing in adulthood and middle age, incidence of syncope again peaks in older patients where it is more often a multifactorial problem that can be associated with significant morbidity and is difficult to manage.

58. Complete atrioventricular block in pregnancy: report of seven pregnancies in a patient without pacemaker.. Anish Keepanasseril, Dilip Kumar Maurya, Yavana J Suriya, Raja J. Selvaraj. Case Reports 2015; 2015: -


Cited 5 times   DOI   Pubmed   Open Alex

Abstract: Obstetric management of a woman with a permanent pacemaker in situ is well reported in the literature; but those who present without pacing are still debatable. The necessity for setting the optimal timing or rate of temporary artificial pacing, specifically for labour, has not been objectively assessed. Temporary pacing in most cases reported in the literature might be to withstand the variations in haemodynamic status during delivery and labour. We report a case of a patient with complete heart block without any pacing who had seven pregnancies without any significant changes in haemodynamic status during labour and delivery. Managing a pregnancy without pacing might be an appropriate alternative for women without any underlying cardiac disorder, as it will not lead to significant changes in the haemodynamic system.

59. Seckel syndrome with severe sinus bradycardia.. Chandramohan Ramasamy, Santhosh Satheesh, Raja J. Selvaraj. Indian Journal of Pediatrics 2015; 82: 292- 293


Cited 5 times   DOI   Pubmed   Open Alex

Abstract: Seckel syndrome is an uncommon form of microcephalic dwarfism. The authors report a young boy with Seckel syndrome who presented with severe sinus bradycardia with symptoms of syncope and presyncope. Implantation of a permanent pacemaker was necessary in view of the severe symptoms. Although uncommon, cardiac abnormalities have been rarely reported in Seckel syndrome. This is the one of the few reports of rhythm abnormalities in this condition.

60. Jumping Across the Gap - A Series of Atrial Extrastimuli. Mahadeva Swamy, Deepak Katyal, Raja J. Selvaraj. Indian pacing and electrophysiology journal 2015; 15: 73- 75


Cited 1 times   DOI   Pubmed   Open Alex

Abstract: The gap phenomenon is an unusual phenomenon in electrophysiology arising from the interaction of different refractory periods of different levels of the conduction system. We present a case where there is an interesting interaction between AV conduction gap and AH jump due to the coexistence of dual AV nodal physiology. We also briefly discuss the other mechanisms of gap phenomenon that have been described in this setting.

61. Balloon valvuloplasty in rheumatic aortic valve stenosis: immediate and long-term results. Ajith Ananthakrishna Pillai, Chandramohan Ramasamy, Maheshkumar Saktheeshwaran, Raja J. Selvaraj, Santhosh Satheesh, Balachander Jayaraman. Cardiovascular Intervention and Therapeutics 2015; 30: 45- 50


Cited 5 times   DOI   Pubmed   Open Alex

Abstract: To study the immediate and long-term results of balloon aortic valvuloplasty (BAV) in a large cohort of patients with rheumatic valvular aortic stenosis. Single tertiary care center retrospective data analysis of immediate and long-term outcomes in patients following BAV from 2000 to 2008. Ninety-two patients with rheumatic aortic stenosis (AS) were studied who underwent BAV. Mean age of patients was 21.7 years (95 % CI 14.3–28.9) with mean follow-up period of 5.7 years (±SD 1.3). Intervention resulted in successful BAV (more than 50 % reduction in baseline gradient) in 79 (85.9 %) subjects (Group A) and partially successful BPV (  0.05). The need for surgery was much lower in Group A (2.5 %) compared to Group B (50 %) and C (100 %). BAV is an effective treatment strategy in dominant AS in multi valvular rheumatic disease situations. Combined aortic and mitral valvuloplasty was performed in one-fourth of study patients.

62. Chapter-05 T and U Waves. Anandaraja Subramanian, Raja J. Selvaraj. None 2015; : 39- 44


Not cited yet   DOI   Open Alex

Abstract:

63. Chapter-08 Ectopic Beats, Escape Beats and Rhythms. Anandaraja Subramanian, Raja J. Selvaraj. None 2015; : 60- 71


Not cited yet   DOI   Open Alex

Abstract:

64. Chapter-01 Basics of ECG. Anandaraja Subramanian, Raja J. Selvaraj. None 2015; : 1- 5


Cited 1 times   DOI   Open Alex

Abstract:

65. Chapter-04 QRS Complex. Anandaraja Subramanian, Raja J. Selvaraj. None 2015; : 22- 38


Not cited yet   DOI   Open Alex

Abstract:

66. Chapter-10 Coronary Artery Disease. Anandaraja Subramanian, Raja J. Selvaraj. None 2015; : 82- 91


Not cited yet   DOI   Open Alex

Abstract:

67. Chapter-06 ST and PR Segments. Anandaraja Subramanian, Raja J. Selvaraj. None 2015; : 45- 50


Not cited yet   DOI   Open Alex

Abstract:

68. Chapter-02 Heart Rate. Anandaraja Subramanian, Raja J. Selvaraj. None 2015; : 6- 12


Not cited yet   DOI   Open Alex

Abstract:

69. Chapter-03 P Wave. Anandaraja Subramanian, Raja J. Selvaraj. None 2015; : 13- 21


Not cited yet   DOI   Open Alex

Abstract:

70. Chapter-11 Heart Blocks. Anandaraja Subramanian, Raja J. Selvaraj. None 2015; : 92- 105


Not cited yet   DOI   Open Alex

Abstract:

71. Chapter-09 Chamber Enlargement and Hypertrophy. Anandaraja Subramanian, Raja J. Selvaraj. None 2015; : 72- 81


Not cited yet   DOI   Open Alex

Abstract:

72. Chapter-13 Miscellaneous Conditions. Anandaraja Subramanian, Raja J. Selvaraj. None 2015; : 120- 126


Not cited yet   DOI   Open Alex

Abstract:

73. Chapter-14 Synopsis. Anandaraja Subramanian, Raja J. Selvaraj. None 2015; : 127- 136


Not cited yet   DOI   Open Alex

Abstract:

74. Chapter-15 Appendix. Anandaraja Subramanian, Raja J. Selvaraj. None 2015; : 137- 144


Not cited yet   DOI   Open Alex

Abstract:

75. Chapter-12 Arrhythmias. Anandaraja Subramanian, Raja J. Selvaraj. None 2015; : 106- 119


Not cited yet   DOI   Open Alex

Abstract:

76. Chapter-07 PR and QT Intervals. Anandaraja Subramanian, Raja J. Selvaraj. None 2015; : 51- 59


Not cited yet   DOI   Open Alex

Abstract:

77. EP/Device Rounds Jumping Across the Gap - A Series of Atrial Extrastimuli. Mahadeva Swamy, Deepak Katyal, Raja J. Selvaraj. None 2015; : -


Not cited yet Open Alex

Abstract: The is an interesting phenomenon in electrophysiology arising from the differences in refractory periods at two or more levels of the atrioventricular (AV) conduction system. We present a patient with dual AV nodal physiology in whom the AH jump mediates the gap phenomenon. We also briefly discuss the other mechanisms of gap phenomenon that have been described in this setting.

78. Phytochemicals: Do They Hold the Future in Stem Cell Differentiation?. R. Narasimha Raghavan, G. Vignesh, B. Santhosh Kumar, Raja J. Selvaraj, B. J. Dare. None 2015; : -


Cited 7 times   DOI   Open Alex

Abstract:

79. ECG for Beginners. Anandaraja Subramanian, Raja J. Selvaraj. None 2015; : -


Not cited yet   DOI   Open Alex

Abstract:

80. Peritricuspid reentrant ventricular tachycardia in Ebstein's anomaly. Senthil Kumar, Anandaraja Subramanian, Raja J. Selvaraj. Europace 2014; 16: 1633- 1633


Cited 1 times   DOI   Pubmed   Open Alex

Abstract: A 40-year-old woman with Ebstein's anomaly of the tricuspid valve presented with recurrent palpitations. Electrocardiogram during the episode showed a regular broad complex tachycardia at 150 beats per minute with left bundle branch abnormality morphology, left axis deviation …

81. Parasystole in a Mahaim Accessory Pathway. Chandramohan Ramasamy, Senthil Kumar, Raja J. Selvaraj. Indian pacing and electrophysiology journal 2014; 14: 223- 226


Not cited yet   DOI   Pubmed   Open Alex

Abstract: Automaticity has been described in Mahaim pathways, both spontaneously and during radiofrequency ablation. We describe an unusual case of automatic rhythm from a Mahaim pathway presenting as parasystole. The parasystolic beats were also found to initiate tachycardia, resulting in initial presentation with incessant tachycardia and tachycardia induced cardiomyopathy.

82. Balloon pulmonary valvuloplasty in adults: immediate and long-term outcomes.. Ajith Ananthakrishna, Vidhyakar Rangasamy Balasubramonium, Harichandrakumar Kottyen Thazhath, Maheshkumar Saktheeshwaran, Raja J. Selvaraj, Santhosh Satheesh, Balachander Jayaraman. Journal of Heart Valve Disease 2014; 23: 511- 515


Cited 4 times Pubmed   Open Alex

Abstract: Background and aim of the study The study aim was to determine the immediate and long-term outcomes of balloon pulmonary valvuloplasty (BPV) in a large cohort of adult patients (aged ≥ 18 years) with congenital valvular pulmonic stenosis. Methods A retrospective data analysis was conducted of the immediate and long-term outcomes of adult patients who had undergone BPV between 2000 and 2012 at a single tertiary care center. Results A total of 132 patients (mean age 27.7 years; 95% CI 21.12-34.76) underwent BPV, with a mean follow up period of 5.7 years (95% CI 4.37-6.98). Intervention resulted in successful BPV (> 50% reduction in baseline gradient) in 124 patients (94%), and a partially successful BPV (20-50% reduction in baseline gradient) in eight patients (6%). The mean right ventricular (RV) systolic pressure was decreased from 90.6 mmHg (95% CI 84.90-96.33) to 50.9 mmHg (95% CI 47.17-54.61) (p 0.05). Pulmonary valve regurgitation was reported in 17.4% of patients, and was not related to either successful outcome or balloon size. The gradient reductions were maintained after five and 10 years of follow up. Two patients (1.5%) developed restenosis that required repeat BPV. There was no referral for urgent surgery. Conclusion BPV in adults produced excellent long-term clinical results, there being no gender-related difference in outcome. In addition, the need for reintervention was very low.

83. Chasing red herrings: making sense of the colors while mapping.. Raja J. Selvaraj, Bhima Shankar, Anandaraja Subramanian, Krishnakumar Nair. Circulation-arrhythmia and Electrophysiology 2014; 7: 553- 556


Cited 6 times   DOI   Pubmed   Open Alex

Abstract: A 50-year-old man presented with sustained wide complex tachycardia and was treated with cardioversion. He gave a history of 2 such episodes within the past 7 years, requiring cardioversion each time. Ten years previously, he had undergone surgical repair of tetralogy of Fallot. Review of operative notes indicated that the procedure included patch closure of the ventricular septal defect, right ventricular outflow tract resection, repair with a transannular patch, and pulmonary valve replacement with a porcine valve. Editor’s Perspective see p 557 ECG recorded during the tachycardia showed a regular wide complex tachycardia at a rate of 240 beats per minute of left bundle branch block morphology with left axis deviation. ECG in sinus rhythm showed PR interval of 200 ms, right bundle branch block with normal axis, and QRS duration of 170 ms. Echocardiography showed mild right ventricular dilatation with normal left and right ventricular function. The ventricular septum was intact, there was no pulmonary regurgitation, and the peak gradient across the pulmonary valve was 32 mm Hg. Mapping was performed using an electroanatomic system (CARTO 3, Biosense Webster, Diamond Bar, CA). Wide complex tachycardia at a cycle length of 260 ms with the same morphology as the clinical tachycardia was induced during catheter placement and could not be pace terminated. ventriculo-atrial dissociation and negative His-ventricular interval confirmed ventricular tachycardia. Surface ECG was used …

84. Utility of balloon assisted technique in trans catheter closure of very large (≥35 mm) atrial septal defects.. Ajith Ananthakrishna Pillai, Vidhyakar Rangaswamy Balasubramanian, Raja J. Selvaraj, Maheshkumar Saktheeswaran, Santhosh Satheesh, Balachander Jayaraman. Cardiovascular diagnosis and therapy 2014; 4: 21- 27


Cited 14 times   DOI   Pubmed   Open Alex

Abstract: Background: Very few published data is available on the outcomes of balloon assisted techniques (BATs) for trans catheter closure (TCC) of very large (Defined as ≥35 mm size) ostium secundum atrial septal defect (ASD). Objective: To study the utility of BAT as against conventional techniques (CT) in TCC of very large ostium secundum ASD (≥35 mm) over the past 5-year period and to find out the association of different morphological features of the defects in relation to TCC outcomes. Study design and methods: Descriptive single center retrospective study of patients with very large ostium secundum ASD (≥35 mm size) who were subjected to TCC. Results: Thirty-three out of 36 patients with ≥35 mm ASD and complex morphological features underwent successful TCC. The study patients had high prevalence of absent aortic and posterior rims with posterior mal-alignment of the septum. BAT was successful in 28/31 (90.3%) patients while CT had a success rate of 16%. The mean trans-esophageal echocardiography (TEE) ASD size with BAT success 37 (SD 1.3) mm and CT failure 36.2 (SD 1.1) mm was not different (P=0.06). On univariate analysis of different morphological features, posterior mal alignment of the septum was associated failure of CT (P=0.01). There was no urgent referral for surgery and patients did well on follow up. Conclusions: Balloon assisted device closure of (≥35 mm) ASD had 90% success rate. BAT helps in controlled delivery and device alignment in very large ASD with posterior malalignment of the septum and is often helpful when CT fails.

85. Wide Complex Tachycardia: What Is the Mechanism?. Chandramohan Ramasamy, Senthil Kumar, Jayaraman Balachander, Raja J. Selvaraj. Journal of Cardiovascular Electrophysiology 2014; 25: 220- 221


Cited 1 times   DOI   Pubmed   Open Alex

Abstract:

86. Techniques and outcomes of transcatheter closure of complex atrial septal defects – Single center experience. Ajith Ananthakrishna Pillai, Santhosh Satheesh, Gobu Pakkirisamy, Raja J. Selvaraj, Balachander Jayaraman. Indian heart journal 2014; 66: 38- 44


Cited 8 times   DOI   Pubmed   Open Alex

Abstract: Abstract Objective To prospectively study the techniques and outcomes of transcatheter closure of complex Atrial septal defects (ASD). Study design and settings Prospective single center study with experience in catheter closure of ASD. All patients with complex ASD suitable for device closure. Objective Analysis of outcomes of transcatheter closure of complex ASD in JIPMER Hospital over the past 5-year period. Methods Complex ASD was predefined and patients satisfying inclusion and exclusion criteria are included. All the patients had meticulous Transesophageal echocardiography (TEE) imaging beforehand. Modifications of the conventional techniques were allowed on a case per case basis according to operator preference. Successfully intervened patients were followed up clinically. Results Out of the 75 patients enrolled, 69 patients had successful device closure (success rate 92%) despite challenging anatomy. Fifty-six (74%) patients had ASD ≥25 mm. Fifteen patients (20%) had defect size ≥35 mm and 20 patients (26.6%) had devices implanted with ≥35 mm waist size. Fifty percent of patients had complete absence of aortic rim and 25% had deficient posterior rim. Twenty percent of patients had malaligned septum. Mean follow up period was 3.2 years. Conclusions Trans catheter closure is feasible in anatomically complex substrates of Secundum ASD. Careful case selection, scrupulous imaging protocol, and expertise in modified techniques are mandatory for successful outcomes.

87. Heart Failure and Pulsus Alternans An Unusual Presentation of First-Degree Heart Block. Pradeep Kumar Kandaswamy, Ajith Anantha, Jayaraman Balachander, Raja J. Selvaraj. Circulation-heart Failure 2014; 7: 227- 228


Cited 1 times   DOI   Pubmed   Open Alex

Abstract: Pacemaker syndrome is the development of fatigue and dyspnea in patients with ventricular pacing caused by VA conduction and the resultant atrial contraction against a closed AV valve. First-degree AV block with a very prolonged PR interval has also been reported to present with symptoms of pacemaker syndrome and has sometimes been described as pseudopacemaker syndrome or pacemaker-like syndrome.1 We report a case of pacemaker-like syndrome who presented with florid heart failure and alternans that were abolished with AV pacing. A 65-year-old woman presented with few months history of dyspnoea on exertion gradually progressing to New York Heart Association class IV. She was admitted twice at the emergency department over a period of a …

88. PORCINE CIRCOVIRUS - 2 AN EMERGING DISEASE OF CROSSBRED PIGS IN TAMIL NADU, INDIA. S. Krishna Kumar, Raja J. Selvaraj, T. Hariharan, Y. Krishna, Mohan Reddy. None 2014; : -


Cited 3 times Open Alex

Abstract: A crossbred private pig farm was maintained at poosaripalayam village of Tirupur district, Tamil Nadu, India and reported with the history of reproductive failure and increased mortality rate in neonates. Stillbirth and neonatal mortality rates were 20.00% and 88.46% respectively. During postmortem investigation, samples were collected from piglets and subjected to polymerase chain reaction (PCR) for swine fever, brucellosis and PCV 2. None of the samples were positive for swine fever and brucellosis. Porcine circovirus 2 was confirmed in pooled organ samples by PCR. Histopathological revealed the presence of reticular cell hyperplasia in spleen, necrotic enteritis, nephorosis and toxic hepatitis. Present study suggests that PCV2 is an emerging viral pathogen which causes for reproductive failure in swine farming but not recognized so far in India and warrants detailed epidemiology study to trace back the source of infection.

89. Coronary sinus diameter by echocardiography to differentiate atrioventricular nodal reentrant tachycardia from atrioventricular reentrant tachycardia.. Babu Ezhumalai, Santhosh Satheesh, Ajith Anantha, Gobu Pakkirisamy, Jayaraman Balachander, Raja J. Selvaraj. Cardiology Journal 2014; 21: 273- 278


Cited 6 times   DOI   Pubmed   Open Alex

Abstract: Background: Coronary sinus (CS) has been shown to be larger in patients with atrioventricular nodal reentrant tachycardia (AVNRT). We sought to determine if echocardiographically measured CS diameter can help identify the mechanism of tachycardia in patients with narrow complex tachycardia without preexcitation before the invasive electrophysiology study. Methods: Forty four patients with documented narrow complex, short RP tachycardia who were scheduled for an electrophysiology study were included. Based on the electrophysiology study, patients were divided into those with AVNRT and those with a concealed accessory pathway and atrioventricular reentrant tachycardia (AVRT). Proximal CS diameter (CSp) measured at the ostium and mid CS diameter (CSm) 1 cm distal to the ostium using transthoracic echocardiography. Results: CSp was significantly larger in patients with AVNRT than AVRT (14.1 ± 5 vs. 9.9 ± 2 mm, p 11.2 mm identified AVNRT with a sensitivity of 92.6% and specificity of 76.9%. CSp was a better discriminant (AUC 0.89, 95% CI 0.75–0.97) compared to age (AUC 0.74, 95% CI 0.58–0.87) or tachycardia rate (AUC 0.60, 95% CI 0.44–0.76). Conclusions: Echocardiographic measurement of the diameter of CS ostium can help in identifying the mechanism of the tachycardia before the invasive electrophysiology study.

90. Case Report Parasystole in a Mahaim Accessory Pathway. Chandramohan Ramasamy, Senthil Kumar, Raja J. Selvaraj. None 2014; : -


Not cited yet Open Alex

Abstract: Automaticity has been described in Mahaim pathways, both spontaneously and during radiofrequency ablation. We describe an unusual case of automatic rhythm from a Mahaim pathway presenting as parasystole. The parasystolic beats were also found to initiate tachycardia, resulting in initial presentation with incessant tachycardia and tachycardia induced cardiomyopathy.

91. Comparative fertility evaluation of Cycas circinalis. L. and Ionidium suffruticosum Ging. on stress induced sterility of male Wister albino rats. B Senthil Kumar J Vijaya Kumar, Raja J. Selvaraj. Alternative & Integrative Medicine 2013; : -


Not cited yet   DOI   Open Alex

Abstract: F is an important factor for male and female in life. In our day to day life, the stress and strain are the causes of male infertility. Spermatogenesis was suppressed at all the stages of cell division and maturity due to stress. Many natural nontoxic herbs were found to enhance the fertility in male. This study involves the effect of the herbs, Cycas circinalis and Ionidium suffruticosum in improving the fertility of stress induced male albino rats. A total of 50 healthy young male albino rats (1012 weeks) were selected and are subjected to cold water swimming stress for 10 minutes, a day for a period of one month to check the stress induced status and serum corticosterone was analyzed. Cycas and Ionidium extract 200 mg/kg body weight were administered orally to the experimental albino rats E-1 (n=10) and E-2 (n=10) respectively and compared to the positive control albino rats C-1 (n=10) administered with testosterone 10 mg/kg body weight subcutaneously, biweekly with that of the stressed control rats C-2 (n=10) using various parameters such as sexual behaviour, weight of animals, dimension of testes, hormonal and semen analysis, histological analysis of testes and histomorphometry of testes. The drug’s efficacy was proved by the restitution of fertility by comparing with the normal fertile controls C-3 (n=10). The administration of the drug showed significant improvement in all the parameters in experimental rats when compared to control rats. The herb was found to be effective on the gonads of stress induced sterile male albino rats. B. Senthil Kumar et al., Altern Integ Med 2013, 2:10 http://dx.doi.org/10.4172/2327-5162.S1.003

92. Transient bradycardia induced by thiopentone sodium: a unique challenge in the management of refractory status epilepticus.. Sushma Sharma, Pradeep Pankajakshan Nair, Aditya Murgai, Raja J. Selvaraj. Case Reports 2013; 2013: -


Cited 1 times   DOI   Pubmed   Open Alex

Abstract: Thiopentone sodium is one of the important drugs in the armamentarium for terminating refractory status epilepticus, a neurological emergency. We report a case of thiopentone-related bradycardia during the management of the new onset refractory status epilepticus in a young man, which was circumvented by prophylactic insertion of temporary pacemaker while thiopentone infusion was continued. A systematic approach was employed to manage the status epilepticus, including infusion of thiamine and glucose followed by antiepileptic drugs. The patient was ventilated and infused with lorazepam, phenytoin, sodium valproate, levetiracetam and midazolam followed by thiopentone sodium. With the introduction of thiopentone the seizures could be controlled but the patient developed severe bradycardia and junctional rhythm. The bradycardia disappeared when thiopentone was withdrawn and reappeared when the drug was reintroduced. Propofol infusion was tried with no respite in seizures. Later thiopentone sodium was reintroduced after inserting temporary cardiac pacemaker. Seizure was controlled and patient was weaned off the ventilator.

93. An unusual response to para-Hisian pacing: what is the explanation?. Raja J. Selvaraj, Sreekanth Yerram, Chandramohan Ramasamy, Jayaraman Balachander. Heart Rhythm 2013; 10: 1586- 1588


Cited 1 times   DOI   Pubmed   Open Alex

Abstract: Case presentation A young man presented with recurrent left bundle branch block morphology tachycardia. Baseline electrocardiogram showed preexcitation suggestive of a posteroseptal accessory pathway. During electrophysiology study, ventricular programmed stimulation showed ventriculoatrial (VA) conduction with earliest atrial activation at the proximal coronary sinus and decrement in VA time at shorter coupling intervals. Para-Hisian pacing was performed by pacing from the distal His bipole and altering the output (Figure 1). What is the interpretation?

94. Premature ventricular complexes and left atrial appendage dysfunction - another head on a many-headed hydra ?. Raja J. Selvaraj. Indian pacing and electrophysiology journal 2013; 13: 134- 135


Cited 2 times   DOI   Pubmed   Open Alex

Abstract: Premature ventricular complexes (PVCs) in the absence of structural heart disease are often, but not always benign. They may require treatment for symptoms produced by the PVCs themselves or for intermittent sustained ventricular tachycardia. Even in the absence of symptoms, frequent premature ventricular complexes may lead to the development of left ventricular systolic dysfunction as a form of tachycardia induced cardiomyopathy (1). Therefore treatment of PVCs is indicated in the presence of LV dilatation and dysfunction or with sufficient frequency of PVCs where development of ventricular dysfunction in the future is considered highly likely. This, however, may not be the only consequence of frequent PVCs.

95. Sequential Anterograde and Retrograde Conduction Block during Radiofrequency Ablation of an Accessory Pathway.. Chandramohan Ramasamy, Rahul Ramteke, Jayaraman Balachander, Raja J. Selvaraj. Indian pacing and electrophysiology journal 2013; 13: 148- 150


Cited 1 times   DOI   Pubmed   Open Alex

Abstract: We present an interesting image showing sequential loss of anterograde, and subsequently, retrograde conduction during radiofrequency ablation of an accessory pathway. We discuss the possible mechanisms and prior literature concerning this interesting finding.

96. RESTITUTION OF CERIC SULPHATE - INDUCED STERILITY IN MALE ALBINO RATS BY IONIDIUM SUFFRUTICOSUM.GING. B. Senthil Kumar, J. Vijaya kumar, Raja J. Selvaraj. Indo American Journal of Pharmaceutical Research 2013; 3: 4444- 4451


Not cited yet Open Alex

Abstract:

97. “Pseudo PJRT”—Fast-Slow AV Nodal Reentrant Tachycardia Presenting with Tachycardia-Induced Cardiomyopathy. Raja J. Selvaraj, Ajith Ananthakrishnapillai, Ravishankar Sadasivam, Jayaraman Balachander. Pacing and Clinical Electrophysiology 2013; 36: -


Cited 12 times   DOI   Pubmed   Open Alex

Abstract: A 52-year-old woman presented with left ventricular (LV) dysfunction and incessant narrow complex tachycardia. Electrocardiogram and clinical picture were suggestive of a permanent form of junctional reciprocating tachycardia, but electrophysiology study showed the tachycardia to be a fast-slow form of atrioventricular nodal reentrant tachycardia (AVNRT). Slow pathway ablation terminated the tachycardia and the LV dysfunction resolved completely at follow-up. Fast-slow AVNRT has not been reported to present in incessant form, and the mechanism in this patient was absent retrograde fast pathway conduction resulting in easy initiation and maintenance of tachycardia.

98. Anomalous left anterior descending artery from pulmonary artery: An extremely rare coronary anomaly. K. Geofi George, Pakkirisamy Gobu, Raja J. Selvaraj, Jayaraman Balachander. Indian heart journal 2013; 65: 88- 90


Not cited yet   DOI   Pubmed   Open Alex

Abstract: We report a rare coronary artery anomaly-anomalous origin of the left anterior descending artery from the pulmonary artery in a 40-year-old woman. The uniqueness of this case is the absence of any significant morbidity from this condition in adulthood which is in contrast to other reported cases where patients present with myocardial infarction, congestive heart failure, and sometimes death during the early infantile period.(1).

99. EVALUATION OF FERTILITY EFFICACY OF IONIDIUM SUFFRUTICOSUM EXTRACT ON SENILITY INDUCED STERILITY OF MALE ALBINO RATS. B. Senthil Kumar, J. Vijaya kumar, Raja J. Selvaraj. International journal of current research and review 2013; 5: 98- 103


Cited 3 times Open Alex

Abstract: Background: Ageing is associated with the diminished function of various tissues in the body. The gonadal function decreases with the increase in age. Testes undergo atrophy resulting in shrinkage of seminiferous tubules due to reduced testosterone hormone level in elderly male. The process of spermatogenesis decreases in old age when compared to young adults. Today’s lifestyle makes an adult sub fertile even in their earlier age of 30-40 years. To overcome this problem many non-hormonal preparations are in need, so an herbal trial was planned initially on animals which will be followed up to humans in future, if the herb proved to be safe. Objective: To evaluate the fertility efficacy of Ionidium suffruticosum extract on senility induced sterility of male albino rats. Research Methodology: A total of 16 healthy senile male albino rats weighing 300 to 330 gm were selected. Ionidium suffruticosum extract of 200mg/kg bodyweight were administered orally to the senile experimental albino rats (n=8) and compared to the senile control albino rats (n=8) using various parameters and the drug’s efficacy was proved by the restitution of fertility in senile rats. Results: The administration of the drug showed significant improvement of all the parameters in experimental rats when compared to control rats. The data’s were analyzed using student’s t test and found to be statistically significant. Conclusion: The herb was found to be effective on the gonads of senile male albino rats, regaining its fertility to normal, when compared to control rats.

100. Ablation of Atrioventricular Nodal Reentrant Tachycardia Using the Superior Approach in a Patient with IVC Interruption. Balasubramanian Vidhyakar, Ravishankar Sadasivam, Jayaraman Balachander, Raja J. Selvaraj. Journal of Cardiovascular Electrophysiology 2012; 23: 1393- 1394


Not cited yet   DOI   Pubmed   Open Alex

Abstract:

101. Latent microvolt T-wave alternans in survivors of unexplained cardiac arrest unmasked by epinephrine challenge. Danna A. Spears, Adrian Suszko, Andrew D. Krahn, Raja J. Selvaraj, Joan Ivanov, Vijay S. Chauhan. Heart Rhythm 2012; 9: 1076- 1082


Cited 4 times   DOI   Pubmed   Open Alex

Abstract: Background The arrhythmogenic substrate in survivors of unexplained cardiac arrest (UCA) has not been defined. Objectives To test the hypothesis that patients with UCA have latent repolarization abnormalities, in particular T-wave alternans (TWA), which may be unmasked with epinephrine (EPI) challenge. Methods We prospectively studied 10 UCA survivors (46 ± 9 years) and 11 first-degree relatives (FDRs) of sudden death victims (37 ± 14 years). Patients with UCA underwent standard clinical testing, which was normal. FDRs had normal clinical history and testing. All subjects underwent an EPI infusion (0.05, 0.1, and 0.2 μg/(kg·min), 5 minutes each dose) while recording continuous digital 12-lead electrocardiograms. Corrected QT interval and QT variability index were evaluated at each EPI dose. TWA magnitude (V alt ) was assessed at each dose by using the spectral method. Positive (+) TWA at each dose was defined as V alt > 0 with k ≥ 3 in 1 or more 128-beat segment in ≥2 electrocardiogram leads. A novel metric, TWA burden, reflecting V alt integrated over time (s), was also evaluated for each EPI dose. Results There was no difference between UCA survivors and FDRs with respect to heart rate, QT, corrected QT interval, or QT variability index at baseline or during EPI. At baseline, +TWA was similar between UCA survivors and FDRs (10% vs 0%; P = NS). During EPI, +TWA was more prevalent in UCA survivors than in FDRs (80% vs 18%; P = .009). TWA burden was greater in UCA survivors than in FDRs during EPI 0.1 ( P = .039) and EPI 0.2 μg/(kg·min) ( P = .009). Conclusions UCA survivors are more likely to demonstrate latent TWA compared with FDRs, which becomes manifest with EPI. This

102. Pseudodisappearance of atrial electrogram during accessory pathway ablation.. Raja J. Selvaraj, Satheesh Santhosh, Jayaraman Balachander. Europace 2012; 14: 993- 993


Not cited yet   DOI   Pubmed   Open Alex

Abstract: A concealed left free wall accessory pathway in a patient with palpitations showed only intermittent conduction. Isoprenaline infusion and left ventricular pacing from a …

103. Ventricular tachycardia in repaired double chambered right ventricle - identification of the substrate and successful ablation.. Raja J. Selvaraj, Pakkirisamy Gobu, Thulaseedharan Sarojadevi Ashida, Geofi George, Jayaraman Balachander. Indian pacing and electrophysiology journal 2012; 12: 27- 31


Cited 7 times   DOI   Pubmed   Open Alex

Abstract: A 35 year old female presented with recurrent ventricular tachycardia 5 years after she had undergone surgical repair of double chambered right ventricle. Electroanatomical mapping showed a localised scar in the apex with double potentials and good pace map. Ablation here resulted in non-inducibility of ventricular tachycardia. We hypothesise that the scarring in the apex is the result of sustained pressure overload and becomes arrhythmogenic similar to the apical scar in patients with mid-ventricular hypertrophic cardiomyopathy.

104. Submitral aneurysm: a rare cause of ventricular tachycardia.. Pradeep Kumar, Jayaraman Balachander, Raja J. Selvaraj. Heart Asia 2012; 4: 112- 113


Cited 1 times   DOI   Pubmed   Open Alex

Abstract: A 42-year-old male presented with sustained ventricular tachycardia of left bundle branch block (LBBB) morphology with left axis deviation (figure 1A) that terminated with amiodarone infusion. He gave a history of episodic palpitations associated with giddiness. Transthoracic and transoesophageal echocardiography showed a wide necked submitral aneurysm measuring 5×5 cm with severe mitral regurgitation (figure 1B,C). Figure 1 ECG at presentation and transoesophageal echocardiography (TEE). ECG at presentation showing ventricular tachycardia …

105. Ablation of ventricular tachycardia arising from the left coronary cusp. Raja J. Selvaraj, Satheesh Santhosh, Jayaraman Balachander. Heart 2011; 97: 1720- 1720


Not cited yet   DOI   Pubmed   Open Alex

Abstract: A 32-year-old man presented with episodic palpitations and presyncope since 3 years. Investigations showed frequent premature ventricular complexes (PVCs) with a right bundle branch block morphology and inferior axis on the electrocardiogram, non-sustained ventricular tachycardia during Holter monitoring and normal left …

106. 687 Searching for functional M cells in the intact whole human heart: Insights from human langendorff mapping. Krishnakumar Nair, Talha Farid, Raja J. Selvaraj, K. Umapathy, Stéphane Massé, E. Sevaptsidis, S. Watkins, John Asta, Kumaraswamy Nanthakumar. Canadian Journal of Cardiology 2011; 27: -


Not cited yet   DOI   Open Alex

Abstract:

107. Multiple inappropriate rate drop responses triggered by ventricular premature beats.. Ezhumalai Babu, Geofi George, Jayaraman Balachander, Raja J. Selvaraj. Europace 2011; 13: 1046- 1046


Cited 1 times   DOI   Pubmed   Open Alex

Abstract: We report the case of a 70-year-old patient presenting with palpitations who was found to have recurrent inappropriate rate drop responses on interrogation of his pacemaker. These were found to be triggered by interpolated premature ventricular complexes (PVCs). We discuss the drop detect algorithm and how interpolated PVCs triggered the rate drop response.

108. T wave alternans evaluation using adaptive time–frequency signal analysis and non-negative matrix factorization. Behnaz Ghoraani, Sridhar Krishnan, Raja J. Selvaraj, Vijay S. Chauhan. Medical Engineering & Physics 2011; 33: 700- 711


Cited 20 times   DOI   Pubmed   Open Alex

Abstract: Each year 400,000 North Americans die from sudden cardiac death (SCD). Identifying those patients at risk of SCD remains a formidable challenge. T wave alternans (TWA) evaluation is emerging as an important tool to risk stratify patients with heart diseases. TWA is a heart rate dependent phenomenon that manifests on the surface electrocardiogram (ECG) as a change in the shape or amplitude of the T wave every second heart beat. The presence of large magnitude TWA often presages lethal ventricular arrhythmias. Because the TWA signal is typically in the microvolt range, accurate detection algorithms are required to control for confounding noise and changing physiological conditions (i.e. data nonstationarity). In this study, we address the limitations of two common TWA estimation methods, spectral method (SM) and modified moving average (MMA). To overcome their limitations, we propose a modified TWA quantification framework, called Adaptive SM, that uses non-linear time-frequency distribution (TFD). In order to increase the robustness of TWA detection in ambulatory ECGs, we also propose a new technique, called non-negative matrix factorization (NMF)-Adaptive SM. We present the analytical background of these methods, and evaluate their accuracy in detecting synthetic TWA signal in simulated and real-world ambulatory ECG recordings under conditions of noise and data non-stationarity. The results of the numerical simulations support the effectiveness of the proposed approaches for TWA analysis, which may ultimately improve SCD risk assessment.

109. T-wave alternans monitoring in patients with acute coronary syndrome—letter to the editor. Raja J. Selvaraj. Europace 2011; 13: 907- 907


Cited 1 times   DOI   Pubmed   Open Alex

Abstract: I read with great interest the paper by Takasugi et al .1 on continuous T-wave alternans (TWA) monitoring in patients with acute coronary syndrome undergoing revascularization. I agree with the authors that continuous TWA monitoring is likely to have a major role to play in the management of patients with an unstable electrical state. The study includes a relatively small number of patients. Can the authors …

110. To the editor--Atrioventricular nodal reentrant tachycardia termination with two consecutive P waves.. Raja J. Selvaraj, Krishnakumar Nair. Heart Rhythm 2011; 8: -


Not cited yet   DOI   Pubmed   Open Alex

Abstract:

111. Modulated dispersion of activation and repolarization by premature beats in patients with cardiomyopathy at risk of sudden death. Anandaraja Subramanian, Adrian Suszko, Raja J. Selvaraj, Kumaraswamy Nanthakumar, Joan Ivanov, Vijay S. Chauhan. American Journal of Physiology-heart and Circulatory Physiology 2011; 300: -


Cited 5 times   DOI   Pubmed   Open Alex

Abstract: Premature beats can trigger ventricular arrhythmias in heart disease, but the mechanisms are not well defined. We studied the effect of premature beats on activation and repolarization dispersion i...

112. Anodal stimulation - the intrigue continues.. Raja J. Selvaraj, Krishnakumar Nair. Indian pacing and electrophysiology journal 2011; 11: 61- 63


Cited 2 times Pubmed   Open Alex

Abstract: When cardiac pacing is performed in the bipolar configuration, both the cathode (negatively charged electrode) and the anode (positively charged electrode) are in contact with the myocardium. Myocardial stimulation by the pacing stimulus typically occurs only at the interface with the cathode. This is because (i) given equal sized electrodes, anodal stimulation has a higher threshold compared to cathodal stimulation except for a dip at short coupling intervals [1] and (ii) the anode is usually designed as an electrode with a larger surface area making stimulation less likely. However, it has long been known that anodal stimulation is not uncommon with bipolar pacing systems because pacing output is usually programmed well above the stimulation threshold.

113. AS-130 Cardiac Syndrome X - Clinical and Angiographic Characteristics. Ezhumalai Babu, Ananthakrishna Ajith, Palamalai Arunprasath, Koonamavu Geofi George, Balakrishnan Karthikeyan, Packirisamy Gobu, Satheesh Santhosh, Raja J. Selvaraj, Jayaraman Balachander. American Journal of Cardiology 2011; 107: -


Not cited yet   DOI   Open Alex

Abstract:

114. AS-085 Balloon Pulmonary Valvuloplasty in Congenital Isolated Valvular Pulmonic Stenosis - A Follow Up Analysis of 107 Patients Over 22 Years. Ezhumalai Babu, Ananthakrishnapillai Ajith, Koonamavu Geofi George, Palamalai Arun Prasath, Balakrishnan Karthikeyan, Satheesh Santhosh, Packirisamy Gobu, Raja J. Selvaraj, Jayaraman Balachander. American Journal of Cardiology 2011; 107: -


Not cited yet   DOI   Open Alex

Abstract:

115. Prevention of postoperative atrial fibrillation - a stitch in time.. Raja J. Selvaraj. Indian pacing and electrophysiology journal 2011; 10: 526- 528


Cited 3 times Pubmed   Open Alex

Abstract: Atrial fibrillation (AF) is the most common arrhythmic complication in the postoperative period, occurring in about a third of patients undergoing coronary artery bypass graft surgery [1,2]. It is typically seen between the second and fourth postoperative days [3] and is associated with a significantly increased risk of postoperative stroke [1] and in-hospital mortality [4]. Treatment strategies are targeted at rate or rhythm control and anticoagulation for prevention of thromboembolic complications. However, treatment is often difficult and associated with significant morbidity, making this a classic situation where prevention is better than cure. Pharmacological interventions have been the mainstay of preventive therapy. Beta blockers have been shown to be the most effective preventive therapy and it is recommended now to continue or initiate beta blocker therapy for all patients in the perioperative period [5]. Amiodarone is also an effective drug, but the intravenous preparation is associated with a risk of hypotension [6] and oral therapy has to be begun several days before surgery [7]. Sotalol [8], magnesium [9], statins [10,11], N-3 polyunsaturated fatty acids [12] and anti-inflammatory agents [13] are other pharmacologic measures that have been shown to be useful in various trials. Atrial pacing is an attractive non-pharmacological intervention for the prevention of atrial fibrillation. Pacing in the postoperative period is easy to implement since it is only required for a short period and can therefore be performed using epicardial temporary pacing wires placed by the surgeon. The mechanisms by which atrial pacing is postulated to reduce the incidence of atrial fibrillation include reduction of bradycardia induced dispersion of atrial repolarization and overdrive suppression of atrial premature beats. Dual site atrial or biatrial pacing may result in additional benefit by promoting more synchronised atrial depolarization which results in reduced dispersion of atrial refractoriness and by altered atrial activation patterns that may prevent

116. Microscopic systolic pressure alternans in human cardiomyopathy: Noninvasive evaluation of a novel risk marker and correlation with microvolt T-wave alternans. Raja J. Selvaraj, Adrian Suszko, Anandaraja Subramanian, S. Mak, Rodrigo Wainstein, Vijay S. Chauhan. Heart Rhythm 2011; 8: 236- 243


Cited 10 times   DOI   Pubmed   Open Alex

Abstract: Background In patients with severe left ventricular (LV) dysfunction, visible pulsus alternans coincides with visible T-wave alternans (TWA), but a similar relationship has not been described for nonvisible microscopic systolic pressure alternans (MSPA) and microvolt TWA (MTWA). Objective The purpose of this study was to determine the prevalence of MSPA and its relationship to MTWA in patients with cardiomyopathy. Methods Using the spectral method, MSPA was measured from finger pressure during incremental atrial pacing and then validated against MSPA measured from the LV pressure in 12 patients. In 23 other patients with cardiomyopathy (LV ejection fraction Results MSPA ( Conclusion MSPA can be detected noninvasively in patients with cardiomyopathy and is coupled to MTWA, suggesting a common mechanism. The high signal-to-noise ratio of MSPA may provide a novel robust metric of sudden cardiac death risk in these patients.

117. To the Editor—His Capture and Entrainment. Krishnakumar Nair, Raja J. Selvaraj, Kah Len Ho, Kumaraswamy Nanthakumar. Heart Rhythm 2011; 8: -


Cited 3 times   DOI   Pubmed   Open Alex

Abstract:

118. Termination of a Broad Complex Tachycardia by a Premature Atrial Complex. Raja J. Selvaraj, Palamalai Arunprasath, Ezhumalai Babu, Jayaraman Balachander. Journal of Cardiovascular Electrophysiology 2011; 22: 100- 100


Not cited yet   DOI   Pubmed   Open Alex

Abstract:

119. To the Editor—ICD Implantation Early After Myocardial Infarction. Raja J. Selvaraj, Krishnakumar Nair. Heart Rhythm 2011; 8: -


Cited 2 times   DOI   Pubmed   Open Alex

Abstract:

120. Editorial Anodal Stimulation - The Intrigue Continues. Raja J. Selvaraj, Dnb, Krishnakumar Nair. None 2011; : -


Not cited yet Open Alex

Abstract:

121. Abstract 16871: Microscopic Systolic Pressure Alternans in Human Cardiomyopathy: Noninvasive Evaluation of a Novel Risk Marker and Correlation with Microvolt T wave Alternans. Raja J. Selvaraj, Adrian Suszko, Anandaraja Subramanian, S. Mak, Vijay S. Chauhan. Circulation 2010; 122: -


Not cited yet Open Alex

Abstract: Introduction: In patients with severe LV dysfunction, visible pulsus alternans accompanies visible T wave alternans, possibly due to abnormal intracellular calcium cycling. However, it is not known...

122. Uncommon presentation of a common tachycardia.. Raja J. Selvaraj, Palamalai Arunprasath, Balakrishnan Karthikeyan, Geofi George, Jayaraman Balachander. Indian pacing and electrophysiology journal 2010; 10: 426- 428


Cited 7 times Pubmed   Open Alex

Abstract: We describe a patient with an implanted pacemaker for impaired AV conduction who presented with an incessant tachycardia. EP study showed that the tachycardia was atrioventricular nodal reentrant tachycardia (AVNRT) with repeated spontaneous initiation because of poor or absent antegrade fast pathway conduction. Slow pathway ablation was successful in terminating the tachycardia and making it non-inducible.

123. Antidromic His Capture during Entrainment of Orthodromic AVRT. Krishnakumar Nair, Raja J. Selvaraj, Talha Farid, Kumaraswamy Nanthakumar. Pacing and Clinical Electrophysiology 2010; 33: 1153- 1156


Cited 5 times   DOI   Pubmed   Open Alex

Abstract: A narrow QRS tachycardia with eccentric atrial activation is presented with features favoring an orthodromic atrioventricular re-entrant tachycardia including an extranodal paraHisian response, and a short corrected post-pacing interval to tachycardia cycle length difference following right ventricular entrainment. However, during entrainment, the H-H interval was entrained by the pacing train several beats prior to the A-A interval which would suggest an atrioventricular nodal re-entry tachycardia. We discuss the diagnosis and its mechanism.

124. Does APD Gradient Indicate Dispersion of Repolarization. Raja J. Selvaraj, Krishnakumar Nair. Circulation Research 2010; 107: -


Not cited yet   DOI   Pubmed   Open Alex

Abstract: To the Editor: The article by Glukhov et al1 is a very important study, providing, as it does, direct measurement of action potential durations (APD) transmurally in the human heart. We commend the authors for providing the first evidence for M cells in the human heart. However, we dispute the assumption throughout the article that APD gradient is a measure of dispersion of repolarization (DOR). Gradient of …

125. A single atrial extrastimulus during a short RP tachycardia.. Raja J. Selvaraj, Krishnakumar Nair, Anandaraja Subramanian, Kumaraswamy Nanthakumar. Heart Rhythm 2010; 7: 997- 998


Cited 1 times   DOI   Pubmed   Open Alex

Abstract: A 26-year-old female underwent electrophysiological study for recurrent palpitations. She was in sinus rhythm at baseline with cycle length (CL), atrial-His (AH), and His-ventricular (HV) intervals of 802, 87, and 48 ms, respectively. Ventricular pacing showed decremental ventriculoatrial (VA) conduction with concentric atrial activation. Parahisian pacing showed VA prolongation with loss of His capture consistent with nodal conduction. Rapid atrial pacing induced a short RP tachycardia with a CL of 580 ms that corresponded to the tachycardia documented clinically (Figure 1). The VA interval was 30 ms during the tachycardia with the earliest atrial activation at the proximal coronary sinus. The short VA interval is not consistent with atrioventricular reentrant tachycardia, but atrial tachycardia (AT), atrioventricular nodal reentrant tachycardia (AVNRT), and junctional tachycardia (JT) are possible differential diagnoses. During tachycardia, a single premature atrial complex (PAC) was introduced from the proximal coronary sinus (Figure 2). Based on the response to the extra stimulus, what is the most likely mechanism of the tachycardia? Commentary The short RP tachycardia with a very short VA interval can represent AT with a long atrioventricular (AV) delay, typical slow-fast AVNRT, or JT. Although JT is an uncommon tachycardia mechanism in this setting, it becomes a distinct possibility due to the long CL of the tachycardia.

126. "Locked-in" sensitivity in the managed ventricular pacing mode.. Krishnakumar Nair, Raja J. Selvaraj, Sheila Watkins, Douglas Cameron. Heart Rhythm 2010; 7: 852- 855


Cited 2 times   DOI   Pubmed   Open Alex

Abstract: Two cases of locked-in sensitivity in the managed ventricular pacing mode are reported. Patient A was a 22-year-old man with a history of hypertrophic obstructive cardiomyopathy and a prophylactic dual-chamber automatic implantable cardioverter-defibrillator who manifested paradoxic T-wave oversensing on the ventricular lead at a sensitivity setting of 1.2 mV but not earlier when the sensitivity had been set to 0.9 mV. Patient B was a 74-year-old patient with ischemic cardiomyopathy and a dual-chamber defibrillator who presented with persistent paradoxic undersensing of the P wave on the atrial lead even at the maximal sensitivity of 0.15 mV, although P-wave sensing was normal earlier when sensitivity was set to 0.3 mV. The phenomenon and the mechanism for its behavior are described.

127. Letter Regarding “Assessment of Physiological Amplitude, Duration and Magnitude of ECG T-Wave Alternans”. Raja J. Selvaraj. Annals of Noninvasive Electrocardiology 2010; 15: 184- 184


Not cited yet   DOI   Pubmed   Open Alex

Abstract:

128. A tale of four atrioventricular intervals.. Anandaraja Subramanian, Raja J. Selvaraj, Douglas Cameron. Europace 2010; 12: 441- 442


Cited 4 times   DOI   Pubmed   Open Alex

Abstract: The introduction of new pacing algorithms for preserving intrinsic atrioventricular conduction has made the interpretation of normal pacemaker function at times challenging. Electrocardiographic (ECG) findings in a patient with apparent pacemaker malfunction is presented and interpretation given. During this process, the managed ventricular pacing algorithm is described to interpret the ECG findings and the potential pitfalls of this algorithm is discussed.

129. To the Editor—Response—T wave alterans. Raja J. Selvaraj, Vijay S. Chauhan. Heart Rhythm 2009; 6: -


Not cited yet   DOI   Open Alex

Abstract:

130. Adaptive time-frequency matrix features for T wave alternans analysis. Behnaz Ghoraani, Sridhar Krishnan, Raja J. Selvaraj, Vijay S. Chauhan. international conference of the ieee engineering in medicine and biology society 2009; 2009: 39- 42


Cited 2 times   DOI   Pubmed   Open Alex

Abstract: T wave alternans (TWA) has been associated with ventricular arrhythmias. Hence, TWA detection can risk stratify patients with heart disease who may experience sudden death from ventricular arhythmias. However, accurate TWA detection is technically challenging due to the low microvolt TWA signal and the confounding effect of biological noise such as movement, myopotentials or respiration. In this paper, we propose nonnegative matrix factorization (NMF)-Adaptive spectral method to increase the robustness of TWA detection in ambulatory electrocardiograms (ECGs). The proposed method applies a non-linear time-frequency (TF) analysis and NMF to the aligned ST-T waveforms. This method separates the TWA signal from the other non-desired ECG signal components, and detects TWA with high accuracy. The performance of our proposed method is validated in a clinical study using ECGs which confirms a TWA detection of 92% compared to 47% using the conventional spectral method.

131. Adrenergic stimulation increases repolarization dispersion and reduces activation-repolarization coupling along the RV endocardium of patients with cardiomyopathy.. Raja J. Selvaraj, Adrian Suszko, Anandaraja Subramanian, Kumaraswamy Nanthakumar, Vijay S. Chauhan. Europace 2009; 11: 1529- 1535


Cited 7 times   DOI   Pubmed   Open Alex

Abstract: Aims Dispersion of repolarization (DOR) in the human heart is minimized by activation–repolarization coupling. Adrenergic stimulation can be proarrhythmic in patients with impaired left-ventricular function and its effect on repolarization dispersion has not been systematically investigated. Our objective was to study the effect of dobutamine on repolarization dispersion and activation–repolarization coupling in patients with cardiomyopathy. Methods and results Activation recovery intervals (ARI) and activation times (AT) were measured from unipolar electrograms at 10 sites along the apicobasal right ventricle (RV) in 14 patients with cardiomyopathy (LVEF < 40%). These measurements were made during control, dobutamine 2.5–5.0 µg/kg/min, and a recontrol phase while maintaining constant heart rates with atrial pacing. Dispersion of repolarization was calculated from the total recovery time (TRT, AT+ARI). Activation–repolarization coupling was assessed by linear regression of ARI and AT. Dispersion of repolarization across all 10 sites and between adjacent sites increased with dobutamine compared with control (whole DOR: range 15 ± 2 vs. 12 ± 2 ms, P = 0.06 and standard deviation 5.5 ± 0.9 vs. 4.3 ± 0.9 ms, P = 0.04; adjacent DOR: 5.9 ± 0.8 vs. 4.5 ± 0.6 ms, P = 0.04). This was associated with shallower ARI/AT slopes (−0.3 ± 0.2 vs. −0.8 ± 0.2, P = 0.05) and a decrease in ARI–AT correlation ( R 2 0.4 ± 0.1 vs. 0.6 ± 0.1, P = 0.05) with dobutamine compared with control. Conclusion Adrenergic stimulation increases apicobasal RV DOR and reduces coupling between activation and repolarization in patients with cardiomyopathy. This may provide a mechanism for the proarrhythmic potential of heightened adrenergic states in these patients.

132. Short-term memory and restitution during ventricular fibrillation in human hearts: an in vivo study.. Satish C. Toal, Talha Farid, Raja J. Selvaraj, Vijay S. Chauhan, Stéphane Massé, Joan Ivanov, Louise Harris, Eugene Downar, Michael R. Franz, Kumaraswamy Nanthakumar. Circulation-arrhythmia and Electrophysiology 2009; 2: 562- 570


Cited 12 times   DOI   Pubmed   Open Alex

Abstract: Background— Action potential duration (APD) variation is an important determinant of wave break and reentry. The determinants of APD variability during early ventricular fibrillation (VF) in myopathic human hearts have not been studied. The objective of this study was to study the role of APD restitution and short-term cardiac memory on variation in human VF. Methods and Results— The study consisted of 7 patients (67±9 years old) with ejection fraction <35%. Monophasic action potentials were recorded from the right and/or left ventricular septum during VF. APD60/90 was measured in sinus beat preceding induction of VF, and its amplitude was used to define 60%/90% repolarization in VF. The monophasic action potential upstroke (dV/dtmax) was used to characterize local excitability. Simple linear regression showed that variability in APDn60 was determined by APD/diastolic interval restitution ( R 2=0.48, P <0.0001) and short-term memory (APD60 n−1, n−2, n−3, n−4; R 2=0.55, 0.40, 0.33, and 0.27 respectively; P <0.001). Using multiple stepwise regression, short-term memory and restitution accounted for 62% of variance in APD60 ( P <0.001). Individually, memory effect had the greatest contribution to APD variability ( R 2=0.55, P <0.0001). Conclusions— In early human VF, short-term memory and APD/diastolic interval restitution explain most of the APD variability, with memory effects predominating. This suggests that in early human VF, short-term cardiac memory may provide a novel therapeutic target to modulate progression of VF in myopathic patients. Received November 5, 2008; accepted June 1, 2009. # CLINICAL PERSPECTIVE {#article-title-2}

133. The dangling electrogram: discerning spatial from electrophysiological distance.. Raja J. Selvaraj, Krishnakumar Nair, Anandaraja Subramanian, Kumaraswamy Nanthakumar. Journal of Cardiovascular Electrophysiology 2009; 20: 1176- 1178


Cited 1 times   DOI   Pubmed   Open Alex

Abstract:

134. Wide complex tachycardia with RR and QRS alternans: what is the mechanism?. Anandaraja Subramanian, Raja J. Selvaraj, Krishnakumar Nair, Kumaraswamy Nanthakumar. Pacing and Clinical Electrophysiology 2009; 32: 1329- 1332


Cited 1 times   DOI   Pubmed   Open Alex

Abstract:

135. Body surface projection of action potential duration alternans: a combined clinical-modeling study with implications for improving T-wave alternans detection.. Raja J. Selvaraj, Adrian Suszko, Anandaraja Subramanian, Dhinesh Sivananthan, Ann Hill, Kumaraswamy Nanthakumar, Vijay S. Chauhan. Heart Rhythm 2009; 6: 1211- 1219


Cited 20 times   DOI   Pubmed   Open Alex

Abstract: Background Action potential duration alternans (APDA) can vary regionally in magnitude and phase. The influence of APDA heterogeneity on T-wave alternans (TWA) has not been defined. Objective Our objectives were: (1) to determine how APDA affects the magnitude and spatial distribution of TWA, and (2) to optimize electrocardiographic (ECG) lead configuration accordingly to improve TWA detection. Methods Global, regional, and discordant APDA were simulated in a 257-node heart model. Using a forward solution, body surface potentials were derived at 300 points on the thorax and TWA was computed at each point. In 22 patients with cardiomyopathy (left ventricular ejection fraction 28% ± 6%), TWA was measured from a 114-electrode body surface map using the spectral method during atrial pacing at 110 beats/min. Results An increase in global APDA from 4 to 12 ms resulted in an increase in maximum TWA from 10 to 30 μV. TWA magnitude varied with the size and location of the alternating myocardium, but was largest with discordant APDA compared with regional or global APDA. Irrespective of the location or phase of APDA, TWA was largest over the precordium and correlated with T-wave amplitude in the simulation (R 2 = 0.56 ± 0.24, P 2 = 0.45 ± 0.23, P Conclusion TWA magnitude is dependent on the interaction of concordant and discordant alternating sources within the heart. Maximum TWA consistently localizes to the precordium and a novel lead configuration using 12 precordial leads improves TWA quantification.

136. Adaptive time-frequency signal analysis and its case study in biomedical ecgwaveform analysis. Behnaz Ghoraani, Sridhar Krishnan, Raja J. Selvaraj, Vijay S. Chauhan. international conference on digital signal processing 2009; : 329- 333


Cited 6 times   DOI   Open Alex

Abstract: Traditional time-frequency (TF) signal representations are not appropriate for parametric analysis of most real world signals. In this study, we describe Adaptive time-frequency distribution (TFD) as a robust approach to TF signal decomposition for non-stationary signal processing. This approach has not been utilized for TF signal analysis other than feature extraction. We introduce T wave alternans (TWA) analysis as a new application for this approach. In order to test the robustness of the proposed technique, we challenge it under conditions of non-stationary dynamics that are expected with real world TWA. The results of the numerical simulation support the effectiveness of this approach for TWA estimation.

137. Effect of noise on T-wave alternans measurement in ambulatory ECGs using modified moving average versus spectral method.. Raja J. Selvaraj, Vijay S. Chauhan. Pacing and Clinical Electrophysiology 2009; 32: 632- 641


Cited 10 times   DOI   Pubmed   Open Alex

Abstract: Background: The modified moving average (MMA) and spectral method (SM) are commonly used to measure T-wave alternans (TWA), but their accuracy has not been compared in ambulatory electrocardiograms (ECGs) where TWA signal-to-noise ratio is low. Our objective was to compare the effect of noise and signal nonstationarity on the accuracy of TWA measurement using MMA versus SM when applied to synthetic and ambulatory ECGs. Methods: Periodic and nonperiodic noise were added to noiseless synthetic ECGs. Simulated TWA (0–20 μV) was added to synthetic ECGs and ambulatory ECG recordings. TWA was measured using SM and MMA, and the measurement error relative to added TWA was compared. An MMA ratio was used to discriminate TWA signal from noise. Signal nonstationarity was simulated by changing heart rate, TWA magnitude, and TWA phase. Results: With no added TWA, MMA falsely measured TWA in synthetic and ambulatory ECGs, while false measurement was not seen with SM. An MMA ratio > 1.2 eliminated false TWA detection. In the presence of low TWA magnitude (<10 μV), TWA was overestimated by MMA and underestimated by SM in proportion to the noise level. In synthetic ECGs with periodic noise and 10-μV added TWA, MMA was less accurate than SM. The effects of simulated signal nonstationarity on the TWA magnitude measured with MMA versus SM were similar using a 64-beat analysis window. Conclusions: In the presence of noise, MMA falsely detects or overestimates simulated TWA in ambulatory ECG recordings. In this setting, the proposed MMA ratio improves the specificity of MMA.

138. Defibrillator shock due to ventricular trigeminy.. Krishnakumar Nair, Raja J. Selvaraj, Vijay S. Chauhan. Europace 2009; 11: 374- 375


Cited 2 times   DOI   Pubmed   Open Alex

Abstract: A 56-year-old lady with arrhythmogenic right ventricular cardiomyopathy had a shock for ventricular trigeminy. The device diagnosed this as ventricular fibrillation because of its binning algorithm, which does not use a consecutive, or a proportional counter. A beat is binned as a fibrillation beat only if the current cycle length is in the fibrillation zone and the running average of the previous four cycle lengths are in the fibrillation or ventricular tachycardia zone. Reprogramming the device into a single detection zone will help prevent shocks in this situation.

139. Apparent ventricular lead malfunction--what is the mechanism?. Krishnakumar Nair, Raja J. Selvaraj, Vijay S. Chauhan. Journal of Cardiovascular Electrophysiology 2009; 20: 110- 112


Not cited yet   DOI   Pubmed   Open Alex

Abstract:

140. Human Ventricular Action Potential Duration Restitution. Raja J. Selvaraj, Vijay S. Chauhan. Journal of the American College of Cardiology 2008; 51: 1721- 1722


Cited 2 times   DOI   Pubmed   Open Alex

Abstract: We read with interest the paper by Narayan et al. ([1][1]) that related right ventricular (RV) action potential duration (APD) restitution slopes to the presence of T-wave alternans (TWA) and ventricular tachycardia (VT) inducibility in patients with left ventricular (LV) dysfunction (LV ejection

141. Atrial tracking with a single ICD lead in the ventricle.. Danna A. Spears, Raja J. Selvaraj, Rajesh Dhopeswarkar, Kumaraswamy Nanthakumar. Journal of Cardiovascular Electrophysiology 2008; 19: 440- 441


Cited 1 times   DOI   Pubmed   Open Alex

Abstract:

142. Steeper restitution slopes across right ventricular endocardium in patients with cardiomyopathy at high risk of ventricular arrhythmias. Raja J. Selvaraj, Peter Picton, Kumaraswamy Nanthakumar, Vijay S. Chauhan. American Journal of Physiology-heart and Circulatory Physiology 2007; 292: -


Cited 34 times   DOI   Pubmed   Open Alex

Abstract: Steep action potential duration (APD) restitution slopes (>1) and spatial APD restitution heterogeneity provide the substrate for ventricular fibrillation in computational models and experimental s...

143. Endocardial and Epicardial Repolarization Alternans in Human Cardiomyopathy Evidence for Spatiotemporal Heterogeneity and Correlation With Body Surface T-Wave Alternans. Raja J. Selvaraj, Peter Picton, Kumaraswamy Nanthakumar, S. Mak, Vijay S. Chauhan. Journal of the American College of Cardiology 2007; 49: 338- 346


Cited 77 times   DOI   Pubmed   Open Alex

Abstract: Objectives The aim of this study was to define the spatiotemporal distribution of intracardiac alternans and its relationship to body surface alternans in humans. Background Spatial heterogeneity of alternans exists in the animal heart owing to nonuniform calcium cycling and restitution kinetics. Patients with cardiomyopathy manifest similar myocardial substrate, which might influence the distribution of intracardiac alternans and its projection onto the body surface. Methods Repolarization alternans was simultaneously measured from unipolar electrograms in the right ventricular endocardium, left ventricular (LV) epicardium, and the surface electrocardiogram in patients with cardiomyopathy (n = 14, LV ejection fraction 29 ± 2%) during atrial pacing at cycle length (CL) 800, 600, and 500 ms. Alternans was determined from the entire JT interval as well as the early, mid, and late JT interval with spectral analysis. Results Alternans was not uniformly distributed within the heart, with alternating and nonalternating myocardial segments lying adjacent to one another. A greater number of epicardial sites exhibited alternans than endocardial sites at CL 600 ms. Temporal heterogeneity in alternans was present along the JT interval, and apical segments had proportionately less alternans in the late JT interval than mid or basal segments, resulting in apicobasal alternans heterogeneity in late JT interval. Discordant alternans was seen in 5 patients confined to the epicardium. Patients with surface alternans had a greater proportion of intracardiac sites with alternans when compared with those patients without surface alternans. Conclusions Spatiotemporal heterogeneity and discordant alternans are evident in patients with cardiomyopathy. Greater spatial distribution of intracardiac alternans is associated with measurable body surface alternans.

144. Utility of microvolt T-wave alternans to predict sudden cardiac death in patients with cardiomyopathy.. Vijay S. Chauhan, Raja J. Selvaraj. Current Opinion in Cardiology 2007; 22: 25- 32


Cited 4 times   DOI   Pubmed   Open Alex

Abstract: PURPOSE OF REVIEW Sudden cardiac death remains a major cause of mortality among patients with cardiomyopathy and implantable cardioverter-defibrillator therapy has been shown to improve survival in these patients. Effective use of prophylactic implantable cardioverter-defibrillator therapy requires accurate risk stratification beyond assessment of ejection fraction, however. Repolarization alternans is a harbinger of ventricular arrhythmias and its measurement from body-surface recordings, also known as microvolt T-wave alternans, is emerging as an effective prognostic tool in these patients based on recent clinical trials. RECENT FINDINGS We review the pathogenesis and determinants of repolarization alternans. The current techniques for measuring T-wave alternans from the body surface are compared, including the spectral and modified moving average methods. Recent clinical trials evaluating the prognostic utility of T-wave alternans in patients with ischemic and nonischemic cardiomyopathy and no prior arrhythmic events are summarized. The findings of these studies are discussed in the context of implantable cardioverter-defibrillator prophylaxis. Body-surface T-wave alternans is an evolving technique and its limitations are presented along with approaches to improve its predictive accuracy. SUMMARY Risk stratification with T-wave alternans has the potential to guide prophylactic implantable cardioverter-defibrillator therapy in a growing population of patients with cardiomyopathy.

145. Letter by Selvaraj and Chauhan Regarding Article, “Upsurge in T-Wave Alternans and Nonalternating Repolarization Instability Precedes Spontaneous Initiation of Ventricular Tachyarrhythmias in Humans”. Raja J. Selvaraj, Vijay S. Chauhan. Circulation 2006; 115: -


Not cited yet   DOI   Pubmed   Open Alex

Abstract: To the Editor: We read with interest the article by Shusterman et al1 concerning repolarization dynamics preceding spontaneous initiation of ventricular tachyarrhythmias in humans. Two related time-domain methods measured a larger magnitude of “alternans” at 30 minutes compared with 60 to 120 minutes preceding arrhythmia onset. Spectral analysis of T-wave amplitude showed a nonuniform increase in power in all frequency ranges. The authors interpret these findings as a surge in alternans and nonalternating repolarization complexity preceding the arrhythmia. An increase in sympathetic …

146. Abstract 2233: Effects of Restitution in Early In-Vivo Human Ventricular Fibrillation on the Endocardium. Satish Toal, Raja J. Selvaraj, Rajesh Dhopeshwarkar, Vijay S. Chauhan, Eugene Downar, Douglas Cameron, Kumarswamy Nanthakumar. Circulation 2006; 114: -


Not cited yet Open Alex

Abstract: Introduction: Classic diastolic interval (DI) restitution, conduction velocity restitution, and cardiac memory may determine action potential duration (APD) variation in ventricular fibrillation (VF). However classic diastolic interval (DI) restitution relationship has not been demonstrated in APD variation of in-situ swine VF. Objectives: To study APD-DI relationship in early in-vivo human VF on the endocardium. Methods: Monophasic action potentials (MAP) were recorded with a Franz catheter from the right and/or left ventricular apex in sinus rhythm and during VF induced as part of defibrillator threshold test in patients with an Automatic Implantable Cardioverter Defibrillator (AICD). APD90 was measured in sinus beat immediately preceding induction of VF (Panel A) and its amplitude were used to define 90% repolarization in VF (Panel B). DI was measured from end of APD90 to Vmax of next APD. APD to previous DI intervals were plotted (Panel C). Results: Six VF episodes from 4 patients were studied. The mean age of the patients was 67 ± 9 years. All were males with ejection fraction less then 20% and 3 had ischemic cardiomyopathy. The mean VF episode lasted for 10.7 ± 5 seconds. Mean APD was 131 ± 17 ms and DI was 76 ± 22 ms. A plot of DI versus APD over the entire VF episode formed a scattered cluster of points with a its linear slope negative for all episodes (Mean slope −0.6 ± −0.3, R 2 0.27 ± 0.25). Similar relationship was seen with APD60 also. Conclusions: In early human VF, similar to in-situ swine, APD-DI relationship does not follow classic diastolic interval (DI) restitution relationship with positive slope.

147. AB9-5: Endocardial and epicardial repolarization alternans in human cardiomyopathy: Evidence for spatiotemporal heterogeneity and discordance. Raja J. Selvaraj, Vijay S. Chauhan. Heart Rhythm 2006; 3: -


Not cited yet   DOI   Open Alex

Abstract: