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Gula LJ, Skanes AC, Klein GJ, Jenkyn KB, Redfearn DP, Manlucu J, Roberts JD, Yee R, Tang AS, Leong-Sit P. Atrial flutter and atrial fibrillation ablation – sequential or combined? A cost-benefit and risk analysis of primary prevention pulmonary vein ablation. Heart Rhythm 2016; 13:1441-8. [DOI: 10.1016/j.hrthm.2016.02.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Indexed: 10/22/2022]
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Abstract
Studies suggest clinically manifest cardiac involvement occurs in 5% of patients with pulmonary/systemic sarcoidosis. The principal manifestations of cardiac sarcoidosis (CS) are conduction abnormalities, ventricular arrhythmias, and heart failure. Data indicate that an 20% to 25% of patients with pulmonary/systemic sarcoidosis have asymptomatic (clinically silent) cardiac involvement. An international guideline for the diagnosis and management of CS recommends that patients be screened for cardiac involvement. Most studies suggest a benign prognosis for patients with clinically silent CS. Immunosuppression therapy is advocated for clinically manifest CS. Device therapy, with implantable cardioverter defibrillators, is recommended for some patients.
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Laksman Z, Momciu B, Seong YW, Burrows P, Conacher S, Manlucu J, Leong-Sit P, Gula LJ, Skanes AC, Yee R, Klein GJ, Krahn AD. A detailed description and assessment of outcomes of patients with hospital recorded QTc prolongation. Am J Cardiol 2015; 115:907-11. [PMID: 25665761 DOI: 10.1016/j.amjcard.2015.01.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 01/05/2015] [Accepted: 01/05/2015] [Indexed: 11/24/2022]
Abstract
Corrected QT (QTc) interval prolongation has been shown to be an independent predictor of mortality in many clinical settings and is a common finding in hospitalized patients. The causes and outcomes of patients with extreme QTc interval prolongation during a hospital admission are poorly described. The aim of this study was to prospectively identify patients with automated readings of QTc intervals >550 ms at 1 academic tertiary hospital. One hundred seventy-two patients with dramatic QTc interval prolongation (574 ± 53 ms) were identified (mean age 67.6 ± 15.1 years, 48% women). Most patients had underlying heart disease (60%), predominantly ischemic cardiomyopathy (43%). At lease 1 credible and presumed reversible cause associated with QTc interval prolongation was identified in 98% of patients. The most common culprits were QTc interval-prolonging medications, which were deemed most responsible in 48% of patients, with 25% of these patients taking ≥2 offending drugs. Two patients were diagnosed with congenital long-QT syndrome. Patients with electrocardiograms available before and after hospital admission demonstrated significantly lower preadmission and postdischarge QTc intervals compared with the QTc intervals recorded in the hospital. In conclusion, in-hospital mortality was high in the study population (29%), with only 4% of patients experiencing arrhythmic deaths, all of which were attributed to secondary causes.
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Gula LJ, Skanes AC. A bitter pill to swallow: esophageal lesions after PVI may not be what we expected. J Cardiovasc Electrophysiol 2014; 26:127-8. [PMID: 25495704 DOI: 10.1111/jce.12594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hanninen M, Klein GJ, Laksman Z, Conacher SS, Skanes AC, Yee R, Gula LJ, Leong-Sit P, Manlucu J, Krahn AD. Reduced Uptake of Family Screening in Genotype-Negative Versus Genotype-Positive Long QT Syndrome. J Genet Couns 2014; 24:558-64. [PMID: 25273952 DOI: 10.1007/s10897-014-9776-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 09/12/2014] [Indexed: 01/08/2023]
Abstract
The acceptance and yield of family screening in genotype-negative long QT syndrome (LQTS) remains incompletely characterized. In this study of family screening for phenotype-definite Long QT Syndrome (LQTS, Schwartz score ≥3.5), probands at a regional Inherited Cardiac Arrhythmia clinic were reviewed. All LQTS patients were offered education by a qualified genetic counselor, along with materials for family screening including electronic and paper correspondence to provide to family members. Thirty-eight qualifying probands were identified and 20 of these had family members who participated in cascade screening. The acceptance of screening was found to be lower among families without a known pathogenic mutation (33 vs. 77 %, p = 0.02). A total of 52 relatives were screened; fewer relatives were screened per index case when the proband was genotype-negative (1.7 vs. 3.1, p = 0.02). The clinical yield of screening appeared to be similar irrespective of gene testing results (38 vs. 33 %, p = 0.69). Additional efforts to promote family screening among gene-negative long QT families may be warranted.
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Laksman Z, Yee R, Stirrat J, Gula LJ, Skanes AC, Leong-Sit P, Manlucu J, McCarty D, Turkistani Y, Scholl D, Rajchl M, Goela A, Islam A, Thompson RT, Drangova M, White JA. Model-based navigation of left and right ventricular leads to optimal targets for cardiac resynchronization therapy: a single-center feasibility study. Circ Arrhythm Electrophysiol 2014; 7:1040-7. [PMID: 25221334 DOI: 10.1161/circep.114.001729] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Left ventricular (LV) and right ventricular pacing site characteristics have been shown to influence response to cardiac resynchronization therapy (CRT). This study aimed to determine the clinical feasibility of image-guided lead delivery using a 3-dimensional navigational model displaying both LV and right ventricular (RV) pacing targets. Serial echocardiographic measures of clinical response and procedural metrics were evaluated. METHODS AND RESULTS Thirty-one consecutive patients underwent preimplant cardiac MRI with the generation of a 3-dimensional navigational model depicting optimal segmental targets for LV and RV leads. Lead delivery was guided by the model in matched views to intraprocedural fluoroscopy. Blinded assessment of final lead tip location was performed from postprocedural cardiac computed tomography. Clinical and LV remodeling response criteria were assessed at baseline, 3 months, and 6 months using a 6-minute hall walk, quality of life questionnaire, and echocardiography. Mean age and LV ejection fraction was 66 ± 8 years and 26 ± 8%, respectively. LV leads were successfully delivered to a target or adjacent segment in 30 of 31 patients (97%), 68% being nonposterolateral. RV leads were delivered to a target or adjacent segment in 30 of 31 patients (97%), 26% being nonapical. Twenty-three patients (74%) met standard criteria for response (LV end-systolic volume reduction ≥ 15%), 18 patients (58%) for super-response (LV end-systolic volume reduction ≥ 30%). LV ejection fraction improved at 6 months (31 ± 8 versus 26 ± 8%, P=0.04). CONCLUSIONS This study demonstrates clinical feasibility of dual cardiac resynchronization therapy lead delivery to optimal targets using a 3-dimensional navigational model. High procedural success, acceptable procedural times, and a low rate of early procedural complications were observed. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT01640769.
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Gula LJ, Skanes AC. Dissociated pulmonary vein potentials: let sleeping dogs lie. J Cardiovasc Electrophysiol 2014; 26:14-5. [PMID: 25201590 DOI: 10.1111/jce.12537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 09/02/2014] [Indexed: 11/30/2022]
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Gula LJ, Leong-Sit P, Skanes AC. Primary prevention PVI for atrial fibrillation—Weighing the risks and benefits. Heart Rhythm 2014; 11:1573-4. [DOI: 10.1016/j.hrthm.2014.05.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Indexed: 10/25/2022]
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Gula LJ, Wells GA, Yee R, Koehler J, Sarkar S, Sharma V, Skanes AC, Sapp JL, Redfearn DP, Manlucu J, Tang ASL. A novel algorithm to assess risk of heart failure exacerbation using ICD diagnostics: validation from RAFT. Heart Rhythm 2014; 11:1626-31. [PMID: 24846373 DOI: 10.1016/j.hrthm.2014.05.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND The integrated diagnostics (ID) algorithm is an implantable device-based tool that collates data pertaining to heart rhythm, heart rate, intrathoracic fluid status, and activity, producing a risk score that correlates with 30-day risk of heart failure (HF) hospitalization. OBJECTIVE We sought to validate the ID algorithm using the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial. METHODS Diagnostic measures of the algorithm include OptiVol fluid index, nighttime heart rate, minutes of patient activity, heart rate variability, and combined measure of cardiac rhythm and biventricular pacing. Monthly evaluations of ID parameters were assessed for the development of HF symptoms and hospitalization for HF. RESULTS A total of 1224 patients were included: 741 (61%) with cardiac resynchronization therapy with defibrillator devices and 483 (39%) with implanted cardioverter-defibrillator only. The mean age was 66 ± 9 years, and 1013 (83%) were men. A total of 37,861 months of follow-up data were available, with 258 HF hospitalizations (event rate 0.68% per month). There were 33 HF hospitalizations during low-risk months (0.21% per month), 123 during medium-risk months (0.66% per month), and 102 during high-risk months (2.61% per month). Compared with low-risk months, and 95% confidence intervals) of HF hospitalizations during medium-risk months was 2.9 (2.0-4.4) and during high-risk months was 10.7 (6.9-16.6). Multivariable analysis demonstrated that each ID variable had independent association with HF hospitalization. CONCLUSION The risk of HF as determined by the ID algorithm correlated with HF hospitalization and several HF signs and symptoms among patients in the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial. This may present a useful adjunct to detect early signs of HF and adjust therapy to reduce morbidity and costs involved with hospital admission.
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Bennett MT, Gula LJ, Klein GJ, Skanes AC, Yee R, Leong-Sit P, Chattha I, Sy R, Jones DL, Krahn AD. Effect of beta-blockers on QT dynamics in the long QT syndrome: measuring the benefit. ACTA ACUST UNITED AC 2014; 16:1847-51. [DOI: 10.1093/europace/euu086] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Subbiah R, Chia PL, Gula LJ, Klein GJ, Skanes AC, Yee R, Krahn AD. Cardiac monitoring in patients with syncope: making that elusive diagnosis. Curr Cardiol Rev 2014; 9:299-307. [PMID: 23228074 PMCID: PMC3941093 DOI: 10.2174/1573403x10666140214120056] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 11/27/2012] [Accepted: 11/28/2012] [Indexed: 11/25/2022] Open
Abstract
Elucidating the cause of syncope is often a diagnostic challenge. At present, there is a myriad of ambulatory
cardiac monitoring modalities available for recording cardiac rhythm during spontaneous symptoms. We provide a comprehensive
review of these devices and discuss strategies on how to reach the elusive diagnosis based on current evidencebased
recommendations.
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Leather RA, Gardner M, Green MS, Kavanagh K, Macle L, Ahmad K, Gray C, Ayala-Paredes F, Guerra PG, O'Hara G, Essebag V, Sturmer M, Baranchuk A, Hruczkowski T, Lahevsky I, Novak P, Chakrabarti S, Harris L, Gula LJ, Morillo C, Sanatani S, Hamilton RM, Gow RM, Krahn AD. Charting a course for cardiac electrophysiology training in Canada: the vital role of fellows in advanced cardiovascular care. Can J Cardiol 2014; 29:1527-30. [PMID: 24182759 DOI: 10.1016/j.cjca.2013.08.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 08/30/2013] [Accepted: 08/30/2013] [Indexed: 11/18/2022] Open
Abstract
Canadian electrophysiology (EP) fellowship programs have evolved in an ad hoc fashion over 30 years. This evolution has occurred in many fields in medicine and is natural when innovators and pioneers attract research fellows who help change the status quo from predominantly research to a predominantly clinical application and focus. Fellows not only push their supervisors and their centres into new areas of inquiry but also function at the most advanced level to encourage and teach junior trainees and to provide examples of excellence to residents, medical students, and other health professionals. Funding for fellows has never been provided in the traditional way through the Ministry of Health or the Ministry of Advanced Education. Each Canadian centre has over the years found novel ways to fund fellowship programs, and many centres have used value-adds from procurement programs. These sources of funding are eroding as provincial government agencies are beginning to assume procurement responsibilities and local flexibility to fund fellowships is lost. In particular, provincial government agencies feel that valuable financial resources should be restricted to Canadian trainees only, despite the international consensus that fellowship is an essential time for advanced trainees to travel abroad to acquire a broad a range of experience, learn new techniques and approaches, make lifelong research connections, and hopefully return home with these skills and expertise. This article summarizes the long history of EP fellowship training in Canada, as well as EP fellowship experiences at home and abroad by Canadian electrophysiologists, in an attempt to contextualize these new realities.
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Derval N, Skanes AC, Gula LJ, Gray C, Denis A, Lim HS, Krahn AD, Yee R, Sacher F, Haïssaguerre M, Klein GJ. Differential sequential septal pacing: A simple maneuver to differentiate nodal versus extranodal ventriculoatrial conduction. Heart Rhythm 2013; 10:1785-91. [DOI: 10.1016/j.hrthm.2013.09.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Indexed: 10/26/2022]
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40
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Hanninen M, Laksman Z, Conacher SS, Skanes AC, Yee R, Gula LJ, Klein GJ, Leong-Sit P, Manlucu J, Krahn AD. Yield of Family Screening Is Similar in Gene-Negative and Gene-Positive Long-QT Syndrome. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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41
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Laksman Z, Saklani P, Cassagneau R, Moxey L, Conacher S, Yee R, Skanes A, Leong-Sit P, Manlucu J, Gula LJ, Klein G, Krahn AD. Early Repolarization Is a Cofactor Predicting Risk of Symptoms in Patients With Long QT Syndrome. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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42
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Thomas K, Wright GA, Gula LJ, Skanes AC. The Use of Ibutelide to Improve Atrial Fibrillation Ablation Outcomes. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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43
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Wong JA, Yee R, Stirrat J, Scholl D, Krahn AD, Gula LJ, Skanes AC, Leong-Sit P, Klein GJ, McCarty D, Fine N, Goela A, Islam A, Thompson T, Drangova M, White JA. Influence of pacing site characteristics on response to cardiac resynchronization therapy. Circ Cardiovasc Imaging 2013; 6:542-50. [PMID: 23741053 DOI: 10.1161/circimaging.111.000146] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Transmural scar occupying left ventricular (LV) pacing regions has been associated with reduced response to cardiac resynchronization therapy (CRT). However, spatial influences of lead tip delivery relative to scar at both pacing sites remain poorly explored. This study evaluated scar distribution relative to LV and right ventricular (RV) lead tip placement through coregistration of late gadolinium enhancement MRI and cardiac computed tomographic (CT) findings. Influences on CRT response were assessed by serial echocardiography. METHODS AND RESULTS Sixty patients receiving CRT underwent preimplant late gadolinium enhancement MRI, postimplant cardiac CT, and serial echocardiography. Blinded segmental evaluations of mechanical delay, percentage scar burden, and lead tip location were performed. Response to CRT was defined as a reduction in LV end-systolic volume ≥15% at 6 months. The mean age and LV ejection fraction were 64±9 years and 25±7%, respectively. Mean scar volume was higher among CRT nonresponders for both the LV (23±23% versus 8±14% [P=0.01]) and RV pacing regions (40±32% versus 24±30% [P=0.04]). Significant pacing region scar was identified in 13% of LV pacing regions and 37% of RV pacing regions. Absence of scar in both regions was associated with an 81% response rate compared with 55%, 25%, and 0%, respectively, when the RV, LV, or both pacing regions contained scar. LV pacing region dyssynchrony was not predictive of response. CONCLUSIONS Myocardial scar occupying the LV pacing region is associated with nonresponse to CRT. Scar occupying the RV pacing region is encountered at higher frequency and seems to provide a more intermediate influence on CRT response.
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Manian U, Yee R, Nevis I, McCarty D, Stirrat J, Scholl D, Gula LJ, Leong-Sit P, Drangova M, White JA. Predictors of response to cardiac resynchronization therapy on pre-implantation cardiovascular magnetic resonance imaging. J Cardiovasc Magn Reson 2013. [PMCID: PMC3559369 DOI: 10.1186/1532-429x-15-s1-e40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Kathirgamanathan K, Angaran P, Lazo-Langner A, Gula LJ. Cardiac Conduction Block at Multiple Levels Caused by Arsenic Trioxide Therapy. Can J Cardiol 2013; 29:130.e5-6. [DOI: 10.1016/j.cjca.2012.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 04/05/2012] [Accepted: 04/05/2012] [Indexed: 10/28/2022] Open
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Haley CL, Gula LJ, Miranda R, Michael KA, Baranchuk AM, Simpson CS, Abdollah H, West AJ, Akl SG, Redfearn DP. Validation of a novel algorithm for quantification of the percentage of signal fractionation in atrial fibrillation. ACTA ACUST UNITED AC 2012; 15:447-52. [DOI: 10.1093/europace/eus361] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Krahn AD, Healey JS, Chauhan VS, Birnie DH, Champagne J, Sanatani S, Ahmad K, Ballantyne E, Gerull B, Yee R, Skanes AC, Gula LJ, Leong-Sit P, Klein GJ, Gollob MH, Simpson CS, Talajic M, Gardner M. Epinephrine Infusion in the Evaluation of Unexplained Cardiac Arrest and Familial Sudden Death. Circ Arrhythm Electrophysiol 2012; 5:933-40. [DOI: 10.1161/circep.112.973230] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Epinephrine infusion may unmask latent genetic conditions associated with cardiac arrest, including long-QT syndrome and catecholaminergic polymorphic ventricular tachycardia (VT).
Methods and Results—
Patients with unexplained cardiac arrest (normal left ventricular function and QT interval) and selected family members from the Cardiac Arrest Survivors with Preserved Ejection Fraction Registry (CASPER) registry underwent epinephrine challenge at doses of 0.05, 0.10, and 0.20 μg/kg per minute. A test was considered positive for long-QT syndrome if the absolute QT interval prolonged by ≥30 ms at 0.10 μg/kg per minute and borderline if QT prolongation was 1 to 29 ms. Catecholaminergic polymorphic VT was diagnosed if epinephrine provoked ≥3 beats of polymorphic or bidirectional VT and borderline if polymorphic couplets, premature ventricular contractions, or nonsustained monomorphic VT was induced. Epinephrine infusion was performed in 170 patients (age, 42±16 years; 49% men), including 98 patients with unexplained cardiac arrest. Testing was positive for long-QT syndrome in 31 patients (18%) and borderline in 24 patients (14%). Exercise testing provoked an abnormal QT response in 42% of tested patients with a positive epinephrine response. Testing for catecholaminergic polymorphic VT was positive in 7% and borderline in 5%. Targeted genetic testing of abnormal patients was positive in 17% of long-QT syndrome patients and 13% of catecholaminergic polymorphic VT patients.
Conclusions—
Epinephrine challenge provoked abnormalities in a substantial proportion of patients, most commonly a prolonged QT interval. Exercise and genetic testing replicated the diagnosis suggested by the epinephrine response in a small proportion of patients. Epinephrine infusion combined with exercise testing and targeted genetic testing is recommended in the workup of suspected familial sudden death syndromes.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00292032.
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Obeyesekere MN, Leong-Sit P, Krahn AD, Gula LJ, Yee R, Skanes AC, Klein GJ. Asymptomatic Wolff-Parkinson-White Syndrome: Who Should Be Treated? Card Electrophysiol Clin 2012; 4:273-280. [PMID: 26939946 DOI: 10.1016/j.ccep.2012.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This article discusses the merits of electrophysiology study (EPS) and/or ablation for asymptomatic preexcitation Wolff-Parkinson-White (WPW) ECG pattern. Sudden deaths in asymptomatic patients are too few to merit broad screening and aggressive intervention. It also discusses the risks of ablation and the low predictive accuracy of EPS. When WPW is an incidental finding, the decision to proceed with investigation and ablation can be made considering patients' situations and preferences. An invasive strategy is targeted at patients concerned about the low risk of life-threatening arrhythmia as a first presentation after a discussion of the risks and benefits.
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Obeyesekere MN, Leong-Sit P, Massel D, Manlucu J, Krahn AD, Skanes AC, Yee R, Gula LJ, Klein GJ. Incidence of atrial fibrillation and prevalence of intermittent pre-excitation in asymptomatic Wolff–Parkinson–White patients: A meta-analysis. Int J Cardiol 2012; 160:75-7. [DOI: 10.1016/j.ijcard.2012.05.078] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 05/25/2012] [Accepted: 05/27/2012] [Indexed: 11/15/2022]
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Obeyesekere MN, Leong-Sit P, Gula LJ, Yee R, Skanes AC, Klein GJ, Krahn AD. The Evaluation of a Borderline Long QT Interval in an Asymptomatic Patient. Card Electrophysiol Clin 2012; 4:227-238. [PMID: 26939820 DOI: 10.1016/j.ccep.2012.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
QT prolongation on resting electrocardiography (ECG) is common, and the clinician is often challenged by the dilemma of excluding acquired causes and recognizing potential congenital long QT syndrome (LQTS). The hallmark of LQTS is an abnormally long QT interval. However, a normal or borderline long QT interval may be observed in up to 50% of patients with LQTS because of the intermittent nature of QT prolongation. This review presents an approach to evaluating the asymptomatic patient with a borderline long QT interval, which incorporates a comprehensive clinical assessment, rest and provocative ECG testing, and genetic testing when appropriate.
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