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Biomedical subjects

Yash Lokhandwala

Publications and source records attributed to Yash Lokhandwala.

8 recordsLinked to original sources
PubMed2004

Left ventricular hypertrophy in hypertensive patients in Indian primary care: prevalence and effect of treatment with sustained release indapamide.

OBJECTIVE: Epidemiologic studies indicate an ethnic determinant of left ventricular hypertrophy (LVH), but its prevalence in hypertensive Asian Indians at diagnosis is not known. The observation that LVH regression reduces cardiovascular risk independent of blood pressure, suggests that initial antihypertensive treatment, which also regresses LVH is a desirable goal. This study investigates the prevalence of LVH and its regression with indapamide sustained release (Natrilix SR) in untreated Indian hypertensive patients managed in the primary care setting. DESIGN AND METHODS: Randomly selected physicians serving a defined population recruited untreated hypertensive patients to determine prevalence of LVH. All patients then received indapamide SR treatment for 6 months. LVH was assessed by echocardiography. All measurements were centralized and interpreted by a single blinded observer. MAIN OUTCOME MEASURES: The primary treatment outcomes were the percentage of patients whose LVH regressed with treatment and the number of patients who achieved a blood pressure below 140/90 mmHg. RESULTS: Of the 86 patients recruited, 21 (24.4%, 95% confidence interval (CI) 15.3-33.8) had LVH. There were 11 cases (26.2%) in men, 10 (22.7%) in women, and 15 (32.6%) in those above 50 years. Treatment regressed LVH in 16 (76.2%, 95%CI, 58.0-94.4) by a mean of 25.4 g/m2 (95%CI, 2.8-47.7, p< 0.05). Blood pressure was controlled in 71 (82.6%, 95%CI, 74.5-90.6) patients. CONCLUSION: Prevalence of LVH in untreated Indian hypertensive patients is similar to that in white western populations. Initial indapamide SR treatment is effective in both controlling blood pressure and regressing LVH in the primary care setting.

Antihypertensive Agents↗
PubMed2003

Tachyarrhythmias: the era of cure.

Radiofrequency ablation for tachyarrhythmias is a treatment modality, in the recent times, which has permanently cured the patients. The subject is discussed here in some details.

Catheter Ablation↗
PubMedDate not supplied

Slow pathway ablation without femoral access.

An 80-year-old woman presented with almost daily episodes of tachycardia. She was found to have drug refractory atrioventricular nodal re-entry tachycardia. As she was found to have bilateral common iliac vein occlusion, radiofrequency ablation of the slow pathway was performed via the subclavian vein. This unique experience raises technical issues for catheter positioning.

Aged↗
PubMedDate not supplied

Effect of weight loss on QT dispersion in obesity.

BACKGROUND: Sudden cardiac death in patients on a liquid protein diet has been suggested to be related to repolarization abnormalities. Although increased QT dispersion is also associated with sudden cardiac death, it has not been examined in the setting of weight loss using liquid protein diet. METHODS AND RESULTS: Sixty-three patients (mean age 42 years, 18 men) with a mean initial weight of 116 kg were randomly chosen from patients who had completed 26 weeks of liquid protein diet therapy. QT, corrected QT interval, QT dispersion and corrected QT dispersion were measured blindly along with serum albumin and electrolytes at the beginning and end of 26 weeks of liquid protein diet therapy. In 57 patients (89.5%) (group 1), QT dispersion shortened after weight loss while it was prolonged in 6 patients (10.5%) (group 2). The mean weight loss (group 1: 115+/-21 to 91+/-16 kg; group 2: 122+/-21 to 98+/-13 kg), and serum albumin and electrolyte levels before weight loss were the same in both groups. The decrease in QT dispersion in group 1 was due to increase in the minimum QT interval (350+/-22 v. 375+/-21 mis, p<0.01) after weight loss. However, the QT dispersion increase in group 2 was due to prolongation of the maximum QT interval (402+/-27 v. 441+/-19 ms, p<0.05) after weight loss. This suggests that shortening of the minimum QT interval causes the increased QT dispersion in obesity. Half the patients in group 2 showed a drop in the serum albumin level and 2 patients had an abnormally high phosphorous level at the end of the treatment. CONCLUSIONS: QT dispersion shortens in most patients (89.5%) using liquid protein diet for weight loss. However, increase of QT dispersion is seen in 10.5% of patients. The cause of increased QT dispersion in obesity (before weight loss) differs from that in patients after weight-loss using liquid protein diet. QT dispersion changes observed in this study may explain the risk of sudden cardiac death in these patients.

Adult↗
PubMedDate not supplied

Does device-based testing save time during automatic implantable cardioverter-defibrillator implantation?

BACKGROUND: Defibrillation testing can be done either via an external cardiac defibrillator or directly via the implanted defibrillator during implantation (device-based testing). The advantage of one testing methodology over the other has not been adequately studied. METHODS AND RESULTS: Seventy-four patients (72% men) were randomized into two groups depending on the defibrillation testing methodology used--external cardiac defibrillation and device-based testing groups. R-wave, pacing threshold, pacing impedance, defibrillation threshold, defibrillation pathway impedance and total procedure time were not significantly different between the two groups. CONCLUSIONS: Device-based testing did not significantly reduce the procedure time. Lead and defibrillation parameters were similar in both the groups; lead repositioning and replacement were required in three patients in the external cardiac defibrillation group.

Aged↗
PubMedDate not supplied

Control of rate versus rhythm in rheumatic atrial fibrillation: a randomized study.

BACKGROUND: Patients with rheumatic heart disease and atrial fibrillation incur significant morbidity and mortality. It is not known which approach, rate control or maintenance of sinus rhythm might be most appropriate. The present study was undertaken to compare the strategy of ventricular rate control versus maintenance of sinus rhythm in rheumatic atrial fibrillation, and to evaluate the role of amiodarone in this patient population. METHODS AND RESULTS: We prospectively studied 144 patients with chronic rheumatic atrial fibrillation in a double-blind protocol-rhythm control (group I: 48 patients each with amiodarone -group Ia; and placebo -group Ib) and compared the effects with the ventricular rate control (group II) by diltiazem (n=48, open-label). Direct current cardioversion was attempted in group I. The mean age of the study population was 38.6+/-10.3 years, left atrial size was 4.7+/-0.6 cm, atrial fibrillation duration was 6.1+/-5.4 years, and 72.9% patients had undergone valvular interventions. At 1 year, 45 patients with sinus rhythm in group I compared to 48 patients in group II demonstrated significant increase in exercise to sinus rhythm time, had improvement in functional class and quality of life score. There was no difference in hospitalization rates, systemic bleeds or incidence of thromboembolism. Five patients died in group II but none in group I (p=0.02). In group I, 73/87 (83.9%) patients converted, and 45/86 (52.3%) patients maintained sinus rhythm at 1 year. Conversion rates were 38/43 (88.4%) with amiodarone versus 34/44 (77.3%) with placebo (p=0.49): corresponding rate for maintaining sinus rhythm was 29/42 (69.1%) versus 16/44 (36.4%), p=0.008 respectively. CONCLUSIONS: Maintenance of sinus rhythm appeared to be superior to ventricular rate control in patients with rheumatic atrial fibrillation in terms of an effect on mortality and morbidity. Sinus rhythm could be restored in the majority and amiodarone was superior to placebo in this regard.

Adult↗