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Author Gaurav A Upadhyay

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Left Bundle Branch Block: Characterization, Definitions, and Recent Insights into Conduction System Physiology.

Margarida Pujol-López, José M Tolosana, Gaurav A Upadhyay, Lluís Mont, Roderick Tung,

Left bundle branch block (LBBB) is not just a simple electrocardiogram alteration. The intricacies of this general terminology go beyond simple conduction block. This review puts together current knowledge on the historical concept of LBBB, clinical significance, and recent insights into the pathophysiology of human LBBB. LBBB is an entity ... Read more >>

Card Electrophysiol Clin (Cardiac electrophysiology clinics)
[2021, 13(4):671-684]

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Efficacy and Safety of Appropriate Shocks and Antitachycardia Pacing in Transvenous and Subcutaneous Implantable Defibrillators: An Analysis of All Appropriate Therapy in the PRAETORIAN trial.

Reinoud E Knops, Willeke van der Stuijt, Peter Paul H M Delnoy, Lucas V A Boersma, Juergen Kuschyk, Mikhael F El-Chami, Hendrik Bonnemeier, Elijah R Behr, Tom F Brouwer, Stefan Kaab, Suneet Mittal, Anne-Floor B E Quast, Lonneke Smeding, Jan G P Tijssen, Nick R Bijsterveld, Sergio Richter, Marc A Brouwer, Joris R de Groot, Kirsten M Kooiman, Pier D Lambiase, Petr Neuzil, Kevin Vernooy, Marco Alings, Timothy R Betts, Frank A L E Bracke, Martin C Burke, Jonas S S G de Jong, David J Wright, Ward P J Jansen, Zachary I Whinnett, Peter Nordbeck, Michael Knaut, Berit T Philbert, Jurren M van Opstal, Alexandru B Chicos, Cornelis P Allaart, Alida E Borger van der Burg, Jude F Clancy, Jose M Dizon, Marc A Miller, Dmitry Nemirovsky, Ralf Surber, Gaurav A Upadhyay, Raul Weiss, Anouk de Weger, Arthur A M Wilde, Louise R A Olde Nordkamp, ,

<b>Background:</b> The PRAETORIAN trial showed non-inferiority of the subcutaneous implantable cardioverter-defibrillator (S-ICD) compared to the transvenous ICD (TV-ICD) with regard to inappropriate shocks and complications. In contrast to the TV-ICD, the S-ICD cannot provide antitachycardia pacing (ATP) for monomorphic ventricular tachycardia (VT). This pre-specified secondary analysis evaluates appropriate therapy and ... Read more >>

Circulation (Circulation)
[2021, :]

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Implantation of cardiac electronic devices in active COVID-19 patients: Results from an international survey.

Oholi Tovia-Brodie, Moshe Rav Acha, Bernard Belhassen, Alessio Gasperetti, Marco Schiavone, Giovanni Battista Forleo, Milton E Guevara-Valdivia, David Valdeolivar Ruiz, Nicolas Lellouche, David Hamon, Davide Castagno, Matteo Bellettini, Gaetano M De Ferrari, Mikael Laredo, Jean-Baptiste Carvès, Barbara Ignatiuk, Giampaolo Pasquetto, Paolo De Filippo, Giovanni Malanchini, Behzad B Pavri, Craig Raphael, Luigi Rivetti, Roberto Mantovan, Jason Chinitz, Melissa Harding, Giuseppe Boriani, Edoardo Casali, Elaine Y Wan, Angelo Biviano, Carlos Macias, Stepan Havranek, Pietro Enea Lazzerini, Antonio M Canu, Marco Zardini, Giulio Conte, Óscar Cano, Michela Casella, Boris Rudic, Alexander Omelchenko, Nilesh Mathuria, Gaurav A Upadhyay, Asaf Danon, Arie Lorin Schwartz, Philippe Maury, Shiro Nakahara, Gustavo Goldenberg, Nicolas Schaerli, Sergiy Bereza, Angelo Auricchio, Michael Glikson, Yoav Michowitz,

<h4>Background</h4>Cardiac implantable electronic device (CIED) implantation rates as well as the clinical and procedural characteristics and outcomes in patients with known active coronavirus disease 2019 (COVID-19) are unknown.<h4>Objective</h4>The purpose of this study was to gather information regarding CIED procedures during active COVID-19, performed with personal protective equipment, based on an ... Read more >>

Heart Rhythm (Heart rhythm)
[2021, :]

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The Burden of Proof in Defining Conduction Pacing Criteria: Back to Fundamental Electrophysiology.

Roderick Tung, Gaurav A Upadhyay,

JACC Clin Electrophysiol (JACC. Clinical electrophysiology)
[2021, 7(9):1178-1181]

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Rapid Exclusion of COVID Infection With the Artificial Intelligence Electrocardiogram.

Zachi I Attia, Suraj Kapa, Jennifer Dugan, Naveen Pereira, Peter A Noseworthy, Francisco Lopez Jimenez, Jessica Cruz, Rickey E Carter, Daniel C DeSimone, John Signorino, John Halamka, Nikhita R Chennaiah Gari, Raja Sekhar Madathala, Pyotr G Platonov, Fahad Gul, Stefan P Janssens, Sanjiv Narayan, Gaurav A Upadhyay, Francis J Alenghat, Marc K Lahiri, Karl Dujardin, Melody Hermel, Paari Dominic, Karam Turk-Adawi, Nidal Asaad, Anneli Svensson, Francisco Fernandez-Aviles, Darryl D Esakof, Jozef Bartunek, Amit Noheria, Arun R Sridhar, Gaetano A Lanza, Kevin Cohoon, Deepak Padmanabhan, Jose Alberto Pardo Gutierrez, Gianfranco Sinagra, Marco Merlo, Domenico Zagari, Brenda D Rodriguez Escenaro, Dev B Pahlajani, Goran Loncar, Vladan Vukomanovic, Henrik K Jensen, Michael E Farkouh, Thomas F Luescher, Carolyn Lam Su Ping, Nicholas S Peters, Paul A Friedman, ,

<h4>Objective</h4>To rapidly exclude severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection using artificial intelligence applied to the electrocardiogram (ECG).<h4>Methods</h4>A global, volunteer consortium from 4 continents identified patients with ECGs obtained around the time of polymerase chain reaction-confirmed COVID-19 diagnosis and age- and sex-matched controls from the same sites. Clinical characteristics, ... Read more >>

Mayo Clin Proc (Mayo Clinic proceedings)
[2021, 96(8):2081-2094]

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Impact of physiological pacing on functional mitral regurgitation in systolic dysfunction: Initial echocardiographic remodeling findings after His bundle pacing.

Gaurav A Upadhyay, Michael Henry, Davide Genovese, Parth Desai, Jonathan Lattell, Hannah Wey, Stephanie A Besser, Zaid Aziz, Andrew D Beaser, Cevher Ozcan, Hemal M Nayak, Roberto M Lang, Roderick Tung,

<h4>Background</h4>Although His bundle pacing (HBP) has been shown to improve left ventricular ejection fraction (LVEF), its impact on mitral regurgitation (MR) remains uncertain.<h4>Objectives</h4>The aim of this study was to evaluate change in functional MR after HBP in patients with left ventricular (LV) systolic dysfunction.<h4>Methods</h4>Paired echocardiograms were retrospectively assessed in patients ... Read more >>

Heart Rhythm O2 (Heart rhythm O2)
[2021, 2(5):446-454]

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Atypical pathogens associated with cardiac implantable electronic device infections.

Utkarsh Kohli, Aniruddha Hazra, Ahmed Shahab, Andrew D Beaser, Zaid A Aziz, Gaurav A Upadhyay, Cevher Ozcan, Roderick Tung, Hemal M Nayak,

<h4>Background</h4>Cardiovascular implantable electronic device (CIED) infections are associated with significant morbidity and mortality making the identification of the causative organism critical. The vast majority of CIED infections are caused by Staphylococcal species. CIED infections associated with atypical pathogens are rare and have not been systematically investigated. The objective of this ... Read more >>

Pacing Clin Electrophysiol (Pacing and clinical electrophysiology : PACE)
[2021, 44(9):1549-1561]

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Double loop ventricular tachycardia activation patterns with single loop mechanisms: Asymmetric entrainment responses during "pseudo-figure-of-eight" reentry.

Takuro Nishimura, Gaurav A Upadhyay, Zaid A Aziz, Andrew D Beaser, Dalise Y Shatz, Hemal M Nayak, Roderick Tung,

<h4>Background</h4>The classical paradigm of scar-related reentrant ventricular tachycardia (VT) features a circuit with a double loop figure-of-eight (F8) activation pattern.<h4>Objective</h4>The purpose of this study was to interrogate VT circuits with F8 activation patterns by entrainment mapping to differentiate an active loop from a passive loop.<h4>Methods</h4>Sixty VT circuits with >90% of ... Read more >>

Heart Rhythm (Heart rhythm)
[2021, 18(9):1548-1556]

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Bradyarrhythmias and Physiologic Pacing in the ICU.

Jonathan Lattell, Gaurav A Upadhyay,

Bradyarrhythmias represent a common pathology in the intensive care unit (ICU) with etiologies of varying severity. Treatment has often been focused on correcting underlying causes and may require pacing for urgent hemodynamic support. In recent years, there has been interest in physiologic pacing modalities which avoid the dyssynchrony from right ... Read more >>

J Intensive Care Med (Journal of intensive care medicine)
[2021, :885066621992740]

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Spatial and transmural properties of the reentrant ventricular tachycardia circuit in arrhythmogenic right ventricular cardiomyopathy: Simultaneous epicardial and endocardial recordings.

Ruhong Jiang, Takuro Nishimura, Andrew D Beaser, Zaid A Aziz, Gaurav A Upadhyay, Dalise Y Shatz, Hemal M Nayak, Hongtao Liao, Xianzhang Zhan, Fa Po Chung, Yumei Xue, Shulin Wu, Roderick Tung,

<h4>Background</h4>While advances in the characterization of the structural substrate in arrhythmogenic right ventricular cardiomyopathy (ARVC) have been made, the ventricular tachycardia (VT) circuit remains incompletely described.<h4>Objective</h4>The purpose of this study was to delineate the reentrant VT circuit with simultaneous epicardial and endocardial mapping (SEEM) in ARVC.<h4>Methods</h4>Twenty-three consecutive patients with ARVC ... Read more >>

Heart Rhythm (Heart rhythm)
[2021, 18(6):916-925]

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Indirect and Direct Evidence for 3-D Activation During Left Atrial Flutter: Anatomy of Epicardial Bridging.

Hemal M Nayak, Zaid A Aziz, Agatha Kwasnik, Elliot Lee, Dalise Y Shatz, Rocio Tenorio, Stephanie A Besser, Andrew D Beaser, Cevher Ozcan, Gaurav A Upadhyay, Roderick Tung,

<h4>Objectives</h4>This study sought to describe arrhythmia characteristics using ultra-high density (UHD) mapping of macro-re-entrant left atrial flutter (LAFL) which propagate via epicardial bridging (EB), and highlight regional anatomy that poses challenges to ablation.<h4>Background</h4>Three-dimensional propagation via EB may contribute to the maintenance and complexity of LAFL.<h4>Methods</h4>UHD activation maps of macro-re-entrant LAFL ... Read more >>

JACC Clin Electrophysiol (JACC. Clinical electrophysiology)
[2020, 6(14):1812-1823]

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Late presentation of recurrent syncope after permanent pacemaker implantation due to Lead-Header malapposition.

Steven Mazzone, Utkarsh Kohli, Zaid A Aziz, Andrew D Beaser, Gaurav A Upadhyay, Roderick Tung, Hemal M Nayak,

Permanent pacemaker (PPM) malfunction due to electrical connection problems such as a loose set screw or lead-header malapposition is extremely rare. We present a patient with complete heart block (CHB) who had PPM malfunction and recurrent syncope, late (14 months) after initial implantation, which was caused by the ventricular lead ... Read more >>

Indian Pacing Electrophysiol J (Indian pacing and electrophysiology journal)
[2021, 21(2):124-127]

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Prognostic value of cardiac magnetic resonance septal late gadolinium enhancement patterns for periaortic ventricular tachycardia ablation: Heterogeneity of the anteroseptal substrate in nonischemic cardiomyopathy.

Takuro Nishimura, Hena N Patel, Shuo Wang, Gaurav A Upadhyay, Heather L Smith, Cevher Ozcan, Dalise Y Shatz, Hemal M Nayak, Amit R Patel, Roderick Tung,

<h4>Background</h4>Ventricular tachycardia (VT) from the anteroseptal subtype of nonischemic cardiomyopathy has a high probability of recurrence after catheter ablation.<h4>Objective</h4>The purpose of this study was to determine the predictive value of septal scar patterns by late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) on ablation outcomes in patients with VT arising ... Read more >>

Heart Rhythm (Heart rhythm)
[2021, 18(4):579-588]

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Circuit Determinants of Ventricular Tachycardia Cycle Length: Characterization of Fast and Unstable Human Ventricular Tachycardia.

Takuro Nishimura, Gaurav A Upadhyay, Zaid A Aziz, Andrew D Beaser, Dalise Y Shatz, Hemal M Nayak, Roderick Tung,

<h4>Background</h4>Fast ventricular tachycardias (VTs) have historically been attributed to shorter path lengths with smaller reentrant circuit dimensions in animal models. The relationship between the dimensions of the reentrant VT circuit and tachycardia cycle length (TCL) has not been examined in humans. This study aimed to analyze the determinants of the ... Read more >>

Circulation (Circulation)
[2021, 143(3):212-226]

Cited: 2 times

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Left ventricle and mitral valve reverse remodeling in response to cardiac resynchronization therapy in nonischemic cardiomyopathy.

Christos G Mihos, Evin Yucel, Gaurav A Upadhyay, Mary P Orencole, Jagmeet P Singh, Michael H Picard,

<h4>Background</h4>Cardiac resynchronization therapy (CRT) improves left heart geometry and function in nonischemic cardiomyopathy (NICMP). We aimed to detail the effects of CRT on left ventricular (LV) and mitral valve (MV) remodeling using 2-dimensional transthoracic echocardiography.<h4>Methods</h4>Forty-five consecutive patients with NICMP who underwent CRT implantation between 2009 and 2012, and had pre-CRT ... Read more >>

Echocardiography (Echocardiography (Mount Kisco, N.Y.))
[2020, 37(10):1557-1565]

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Subcutaneous or Transvenous Defibrillator Therapy.

Reinoud E Knops, Louise R A Olde Nordkamp, Peter-Paul H M Delnoy, Lucas V A Boersma, Jürgen Kuschyk, Mikhael F El-Chami, Hendrik Bonnemeier, Elijah R Behr, Tom F Brouwer, Stefan Kääb, Suneet Mittal, Anne-Floor B E Quast, Lonneke Smeding, Willeke van der Stuijt, Anouk de Weger, Koen C de Wilde, Nick R Bijsterveld, Sergio Richter, Marc A Brouwer, Joris R de Groot, Kirsten M Kooiman, Pier D Lambiase, Petr Neuzil, Kevin Vernooy, Marco Alings, Tim R Betts, Frank A L E Bracke, Martin C Burke, Jonas S S G de Jong, David J Wright, Jan G P Tijssen, Arthur A M Wilde, ,

<h4>Background</h4>The subcutaneous implantable cardioverter-defibrillator (ICD) was designed to avoid complications related to the transvenous ICD lead by using an entirely extrathoracic placement. Evidence comparing these systems has been based primarily on observational studies.<h4>Methods</h4>We conducted a noninferiority trial in which patients with an indication for an ICD but no indication for ... Read more >>

N Engl J Med (The New England journal of medicine)
[2020, 383(6):526-536]

Cited: 24 times

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Characterization of Lead Adherence Using Intravascular Ultrasound to Assess Difficulty of Transvenous Lead Extraction.

Andrew D Beaser, Zaid Aziz, Stephanie A Besser, Christopher I Jones, Zenith Jameria, Arun Kannan, Gaurav A Upadhyay, Michael T Broman, Cevher Ozcan, Roderick Tung, Hemal M Nayak,

BACKGROUND:Clinical factors associated with development of intravascular lead adherence (ILA) are unreliable predictors. Because vascular injury in the superior vena cava-right atrium during transvenous lead extraction is more likely to occur in segments with higher degrees of ILA, reliable and accurate assessment of ILA is warranted. We hypothesized that intravascular ... Read more >>

Circ Arrhythm Electrophysiol (Circulation. Arrhythmia and electrophysiology)
[2020, 13(8):e007726]

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Real-world safety of magnetic resonance imaging after His bundle pacemaker implantation.

Spencer V Carter, Zenith Jameria, Ilya Karagodin, Roderick Tung, Gaurav A Upadhyay,

HeartRhythm Case Rep (HeartRhythm case reports)
[2020, 6(10):697-701]

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Left ventricular summit arrhythmias with an abrupt V3 transition: Anatomy of the aortic interleaflet triangle vantage point.

Hongtao Liao, Wei Wei, Kevin S Tanager, Frank Miele, Gaurav A Upadhyay, Andrew D Beaser, Zaid Aziz, Hemal M Nayak, Cevher Ozcan, Takuro Nishimura, Ruhong Jiang, Dalise Shatz, Aliya N Husain, Roderick Tung,

<h4>Background</h4>While early precordial electrocardiographic (ECG) characteristics are useful to differentiate left-sided from the right-sided outflow tract ventricular arrhythmia (OTVA), few patterns predict an origin from the septal margin of the left ventricular (LV) summit.<h4>Objective</h4>The purpose of this study was to report mapping and ablation characteristics of a new ECG pattern ... Read more >>

Heart Rhythm (Heart rhythm)
[2021, 18(1):10-19]

Cited: 3 times

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Catheter-Based Cardio-Neural Ablation for Refractory Vasovagal Syncope: First U.S. Report.

Yu Lu, Wei Wei, Gaurav A Upadhyay, Roderick Tung,

We highlight the feasibility and efficacy of a new application for catheter ablation to target atrial ganglionated plexi in a patient with refractory vasovagal syncope. We describe a physiologically guided technique and demonstrate 18-month freedom from syncope with 2 tilt-table tests to objectively assess reproducible elimination of symptomatology and underlying ... Read more >>

JACC Case Rep (JACC. Case reports)
[2020, 2(8):1161-1165]

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Defining Left Bundle Branch Block Patterns in Cardiac Resynchronisation Therapy: A Return to His Bundle Recordings.

Roderick Tung, Gaurav A Upadhyay,

Left bundle branch block (LBBB) is associated with improved outcome after cardiac resynchronisation therapy (CRT). One historical presumption of LBBB has been that the underlying pathophysiology involved diffuse disease throughout the distal conduction system. The ability to normalize wide QRS patterns with His bundle pacing (HBP) has called this notion ... Read more >>

Arrhythm Electrophysiol Rev (Arrhythmia & electrophysiology review)
[2020, 9(1):28-33]

Cited: 2 times

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His-bundle pacing is the best approach to physiological pacing.

Gaurav A Upadhyay, Pouyan Razminia, Roderick Tung,

Heart Rhythm O2 (Heart rhythm O2)
[2020, 1(1):68-75]

Cited: 1 time

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Periaortic ventricular tachycardia in structural heart disease: Evidence of localized reentrant mechanisms.

Takuro Nishimura, Andrew D Beaser, Zaid A Aziz, Gaurav A Upadhyay, Cevher Ozcan, Michael Raiman, Dalise Y Shatz, Stephanie A Besser, Nathan A Shatz, Hemal M Nayak, Roderick Tung,

<h4>Background</h4>The mechanisms for scar-related ventricular tachycardia (VT) originating from the periaortic region remain incompletely characterized.<h4>Objective</h4>The purpose of this study was to map the circuits responsible for periaortic VT in high resolution.<h4>Methods</h4>Cases with periaortic VT (2016-2020) were analyzed to characterize the substrate and mechanisms with multielectrode mapping. Periaortic VT was defined ... Read more >>

Heart Rhythm (Heart rhythm)
[2020, 17(8):1271-1279]

Cited: 4 times

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The Variable Arrangement of the Atrioventricular Conduction Axis Within the Triangle of Koch: Millimeters Matter.

Gaurav A Upadhyay,

JACC Clin Electrophysiol (JACC. Clinical electrophysiology)
[2020, 6(4):378-381]

Cited: 1 time

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Keeping pace with the competition: His bundle versus biventricular pacing in heart failure.

Gaurav A Upadhyay, Roderick Tung,

<h4>Purpose of review</h4>His bundle pacing (HBP) has emerged as a novel method to achieve electrical resynchronization in bundle branch block and as an alternative means to deliver cardiac resynchronization therapy (CRT). There are now data on HBP in CRT-eligible patients from cohort studies and a single pilot randomized controlled trial ... Read more >>

Curr Opin Cardiol (Current opinion in cardiology)
[2020, 35(3):295-307]

Cited: 2 times

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