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Thakkar AB, Scheinman M, Goldschlager N. Ventricular Preexcitation in a Patient Found to Have Wolff-Parkinson-White Pattern. JAMA Intern Med 2021; 181:262-263. [PMID: 33315092 DOI: 10.1001/jamainternmed.2020.6847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Cheung CC, Sarcon A, Belhassen B, Scheinman M. Twirling around the block-A complex case of cardiac sarcoidosis. Heart Rhythm 2021; 18:151-153. [PMID: 33413950 DOI: 10.1016/j.hrthm.2020.08.012] [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: 08/06/2020] [Revised: 08/15/2020] [Accepted: 08/19/2020] [Indexed: 11/26/2022]
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Voskoboinik A, Hadjis A, Alhede C, Im SI, Park H, Moss J, Marcus GM, Hsia H, Lee B, Tseng Z, Lee R, Scheinman M, Vedantham V, Vittinghoff E, Park KM, Gerstenfeld EP. Predictors of adverse outcome in patients with frequent premature ventricular complexes: The ABC-VT risk score. Heart Rhythm 2020; 17:1066-1074. [DOI: 10.1016/j.hrthm.2020.02.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 02/14/2020] [Indexed: 12/21/2022]
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Zhang J, Zanella F, Lyon R, Mezzano V, Roberts J, Ursell P, Carromeu C, Gu Y, Martin J, Muotri AR, Scheinman M, Peterson KL, Sheikh F. Connexin43 as a Therapeutic To Restore Cardiac Structure in Arrhythmogenic Heart Disease. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.06280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kalantarian S, Scheinman M. J-WAVE SYNDROMES WITH OVERLAPPING PHENOTYPIC EXPRESSION MIMICKING BRUGADA SYNDROME AND EARLY REPOLARIZATION SYNDROME. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)33241-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Hammami Bomholtz S, Refaat M, Buur Steffensen A, David J, Espinosa K, Nussbaum R, Wojciak J, Hjorth Bentzen B, Scheinman M, Schmitt N. Functional phenotype variations of two novel K
V
7.1 mutations identified in patients with Long QT syndrome. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:210-216. [DOI: 10.1111/pace.13870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/20/2019] [Accepted: 12/29/2019] [Indexed: 11/30/2022]
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Liang Y, Lyon RC, Pellman J, Mezzano V, Gu Y, Dalton N, Bradford W, Bogomolovas J, Lee M, Iwakuma T, Nigam V, Scheinman M, Peterson K, Sheikh F. Discovery of Protein Degradation Machinery at the Desmosome Reveals Novel Triggers of the Desmosomal Disease, Arrhythmogenic Right Ventricular Cardiomyopathy. FASEB J 2019. [DOI: 10.1096/fasebj.2019.33.1_supplement.829.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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He BJ, Boyden P, Scheinman M. Ventricular arrhythmias involving the His-Purkinje system in the structurally abnormal heart. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1051-1059. [PMID: 30084120 DOI: 10.1111/pace.13465] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/28/2018] [Accepted: 07/05/2018] [Indexed: 12/01/2022]
Abstract
His-Purkinje-related ventricular arrhythmias are a subset of ventricular tachycardias that use the specialized cardiac conduction system. These arrhythmias can occur in various different forms of structural heart disease. Here, we review the basic science discoveries and their analogous clinical observations that implicate the His-Purkinje system as a crucial component of the arrhythmia circuit. While mutations serve the molecular basis for arrhythmias in the heritable cardiomyopathies, transcriptional and posttranslational changes constitute the adverse remodeling leading to arrhythmias in acquired structural heart disease. Additional studies on the electrical properties of the His-Purkinje network and its interactions with the surrounding myocardium will improve the clinical diagnosis and treatment of these arrhythmias.
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Denti F, Bentzen BH, Wojciak J, Thomsen NM, Scheinman M, Schmitt N. Multiple genetic variations in sodium channel subunits in a case of sudden infant death syndrome. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:620-626. [PMID: 29572929 DOI: 10.1111/pace.13328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 02/15/2018] [Accepted: 02/25/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Dysfunction of NaV 1.5 encoded by SCN5A accounts for approximately half of the channelopathic SIDS cases. We investigated the functional effect of two gene variants identified in the same patient, one in SCN5A and one in SCN1Bb. The aim of the study was to risk stratify the proband's family. METHODS The family was referred for cardiovascular genetic evaluation to assess familial risk of cardiac disease. Functional analysis of the identified variants was performed with patch-clamp electrophysiology in HEK293 cells. RESULTS A 16-month-old healthy boy died suddenly in the context of nonspecific illness and possible fever. Postmortem genetic testing revealed variants in the SCN5A and SCN1Bb genes. The proband's father carries the same variants but is asymptomatic. Electrophysiological analysis of the NaV 1.5_1281X truncation revealed complete loss-of-function of the channel. Coexpression of NaV 1.5 with NaV β1b significantly increased INa density when compared to NaV 1.5 alone. The NaV β1b _V268I variant abolished this INa density increase. Moreover, it shifted the activation curve toward more depolarized potentials. CONCLUSIONS Genetic variation of both sodium channel and its modifiers may contribute to sudden unexplained death in childhood. However, the asymptomatic father suggests that genetic variation of these genes is not sufficient to cause sudden death or clinically detectable SCN5A phenotypes.
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Tracy CM, Crossley GH, Bunch TJ, Chow GV, Leiserowitz A, Indik JH, Kusumoto F, Mendes LA, Munger TM, Murali S, Patton KK, Russo AM, Scheinman M, Schoenhard JA, Winterfield JR. 2017 ACC/HRS lifelong learning statement for clinical cardiac electrophysiology specialists. Heart Rhythm 2018; 15:e17-e34. [DOI: 10.1016/j.hrthm.2017.11.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Indexed: 11/29/2022]
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Tracy CM, Crossley GH, Bunch TJ, Chow GV, Leiserowitz A, Indik JH, Kusumoto F, Mendes LA, Munger TM, Murali S, Patton KK, Russo AM, Scheinman M, Schoenhard JA, Winterfield JR. 2017 ACC/HRS Lifelong Learning Statement for Clinical Cardiac Electrophysiology Specialists. J Am Coll Cardiol 2018; 71:231-250. [DOI: 10.1016/j.jacc.2017.11.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Scheinman M. ELECTROPHYSIOLOGICAL FOUNDATIONS OF CARDIAC ARRHYTHMIAS Andrew L. Wit Hein J. Wellens Mark E. Josephson Cardiotext Publishing, LLC, ISBN: 978-0-9790164-5-5, 648. Pacing Clin Electrophysiol 2017. [DOI: 10.1111/pace.13198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hsia HH, Scheinman M. Pulmonary sinus of Valsalva arrhythmias: A new twist to an old story. Heart Rhythm 2017; 15:46-47. [PMID: 28917567 DOI: 10.1016/j.hrthm.2017.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Indexed: 11/15/2022]
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Refaat M, Bomholtz S, Steffensen A, David J, Espinosa K, Bentzen B, Nussbaum R, Wojciak J, Scheinman M, Schmitt N. P5859Genotype-phenotype correlation of novel KV7.1 mutations identified in patients with Long QT syndrome. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Szilágyi J, Marcus GM, Badhwar N, Lee BK, Lee RJ, Vedantham V, Tseng ZH, Walters T, Scheinman M, Olgin J, Gerstenfeld EP. Cover Image, Volume 28, Issue 7. J Cardiovasc Electrophysiol 2017. [DOI: 10.1111/jce.13305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Szilágyi J, Marcus GM, Badhwar N, Lee BK, Lee RJ, Vedantham V, Tseng ZH, Walters T, Scheinman M, Olgin J, Gerstenfeld EP. Atrial fibrillation patients with isolated pulmonary veins: Is sinus rhythm achievable? J Cardiovasc Electrophysiol 2017; 28:754-761. [PMID: 28429499 DOI: 10.1111/jce.13230] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/01/2017] [Accepted: 04/05/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The cornerstone of atrial fibrillation (AF) ablation is isolation of the pulmonary veins (PVs). Patients with recurrent AF undergoing repeat ablation usually have PV reconnection (PVr). The ablation strategy and outcome of patients undergoing repeat ablation who have persistent isolation of all PVs (PVi) at the time of repeat ablation is unknown. METHODS AND RESULTS We studied consecutive patients with recurrent AF undergoing repeat ablation and compared patients with PVi to those with PVr. One hundred fifty-two patients underwent repeat ablation, and of these, 25 patients (16.4%) had PVi. Patients with PVi underwent ablation targeting any isoproterenol induced AF triggers, atrial substrate, or inducible atrial tachycardias or flutters. Patients with PVi compared to PVr were more likely to have a history of persistent AF (64% vs. 26%; P < 0.0001), obesity (BMI 30.4 vs. 28.2; P = 0.05), and prior use of contact force sensing catheters (28% vs. 0.8%, P < 0.0001). After a mean follow-up of 19 ± 15 months, 56% of PVi patients remained in sinus rhythm compared to 76.3% of PVr patients (P = 0.036). In a multivariable model, PVi patients and those with cardiomyopathy had a higher risk of recurrent atrial tachyarrhythmias (HR = 3.6 95%, CI 1.6-8.3, P = 0.002 and HR = 6.2, 95% CI 2.3-16.3, P < 0.0001, respectively). CONCLUSION In patients who have all PVs isolated at the time of the redo AF ablation, a strategy of targeting non-PV AF triggers and inducible flutters can still lead to AF freedom in more than half of patients. Patients with PVr, however, have a better long-term outcome.
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Scheinman M. SVT Therapy – Yesterday, Today and Tomorrow? J Atr Fibrillation 2016; 9:1506. [DOI: 10.4022/jafib.1506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 12/19/2016] [Accepted: 12/25/2016] [Indexed: 11/10/2022]
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Durrani SA, Sung R, Scheinman M. Bidirectional Ventricular Tachycardia Due to a Mixture of Focal Fascicular Firing and Reentry. Card Electrophysiol Clin 2016; 8:753-764. [PMID: 27837895 DOI: 10.1016/j.ccep.2016.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Bidirectional ventricular tachycardia (BDVT) is a well-known phenomenon since it was first described in 1922. Various mechanisms have been proposed for BDVT, including digitalis toxicity, hypokalemia, Anderson-Tawil syndrome, acute myocarditis, and catecholaminergic polymorphic ventricular tachycardia. It is characterized by rapid, wide complex electrocardiogram pattern with alternating QRS morphology and axis. The alternation of the QRS is usually right bundle branch block with 180° swings in the frontal plane axis or, less commonly, alternation of right bundle branch and left bundle branch forms. Most of the proposed mechanisms involve triggered activity or enhanced automaticity. We describe a unique BDVT, with characteristics of both re-entry and triggered activity, which terminated with a focal Rf lesion.
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Abstract
Fascicular arrhythmias encompass a wide spectrum of ventricular arrhythmias that depend on the specialized conduction system of the right and left ventricles. These arrhythmias include premature ventricular complexes, monomorphic ventricular tachycardia, polymorphic ventricular tachycardia, and ventricular fibrillation. These arrhythmias may be organized by mechanism, including intrafascicular reentry, interfascicular reentry, and focal. Mapping and ablation of the fascicular system can result in high cure rates of debilitating and potentially life-threatening arrhythmias. When approaching these arrhythmias, careful consideration of the structure of the His Purkinje system as well as their electrophysiologic properties may help guide even the most complex of arrhythmias.
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Mezzano V, Liang Y, Wright AT, Lyon RC, Pfeiffer E, Song MY, Gu Y, Dalton ND, Scheinman M, Peterson KL, Evans SM, Fowler S, Cerrone M, McCulloch AD, Sheikh F. Desmosomal junctions are necessary for adult sinus node function. Cardiovasc Res 2016; 111:274-86. [PMID: 27097650 DOI: 10.1093/cvr/cvw083] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 04/08/2016] [Indexed: 12/20/2022] Open
Abstract
AIMS Current mechanisms driving cardiac pacemaker function have focused on ion channel and gap junction channel function, which are essential for action potential generation and propagation between pacemaker cells. However, pacemaker cells also harbour desmosomes that structurally anchor pacemaker cells to each other in tissue, but their role in pacemaker function remains unknown. METHODS AND RESULTS To determine the role of desmosomes in pacemaker function, we generated a novel mouse model harbouring cardiac conduction-specific ablation (csKO) of the central desmosomal protein, desmoplakin (DSP) using the Hcn4-Cre-ERT2 mouse line. Hcn4-Cre targets cells of the adult mouse sinoatrial node (SAN) and can ablate DSP expression in the adult DSP csKO SAN resulting in specific loss of desmosomal proteins and structures. Dysregulation of DSP via loss-of-function (adult DSP csKO mice) and mutation (clinical case of a patient harbouring a pathogenic DSP variant) in mice and man, respectively, revealed that desmosomal dysregulation is associated with a primary phenotype of increased sinus pauses/dysfunction in the absence of cardiomyopathy. Underlying defects in beat-to-beat regulation were also observed in DSP csKO mice in vivo and intact atria ex vivo. DSP csKO SAN exhibited migrating lead pacemaker sites associated with connexin 45 loss. In vitro studies exploiting ventricular cardiomyocytes that harbour DSP loss and concurrent early connexin loss phenocopied the loss of beat-to-beat regulation observed in DSP csKO mice and atria, extending the importance of DSP-associated mechanisms in driving beat-to-beat regulation of working cardiomyocytes. CONCLUSION We provide evidence of a mechanism that implicates an essential role for desmosomes in cardiac pacemaker function, which has broad implications in better understanding mechanisms underlying beat-to-beat regulation as well as sinus node disease and dysfunction.
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Ito H, Badhwar N, Kawamura M, Vedantham V, Tseng Z, Lee B, Lee R, Marcus G, Gerstenfeld E, Scheinman M. POST-SHOCK ELECTROMECHANICAL DISSOCIATION DURING DEFIBRILLATION THRESHOLD TESTING. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30784-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Brugada syndrome might stay undetected in patients until surviving cardiac arrest. Despite the prominent advances in exploring the disease in the past 2 decades, many questions remain unanswered and the controversies continue. Despite all mutations identified to be associated with the disease, two-thirds of cases have a negative genetic test. Future studies should be more directed on modulating factors and their impact on patients' risk for sudden death to help physicians in risk stratifying their patients and optimally implementing an implantable cardioverter defibrillator to prevent sudden cardiac death.
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Scheinman M. Challenging Cases, Match Wits with the Masters. Card Electrophysiol Clin 2016; 8:xxi. [PMID: 26920204 DOI: 10.1016/j.ccep.2015.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Refaat MM, El Hage L, Steffensen AB, Hotait M, Schmitt N, Scheinman M, Badhwar N. Iron Overload Leading to Torsades de Pointes in β-Thalassemia and Long QT Syndrome. Card Electrophysiol Clin 2016; 8:247-256. [PMID: 26920202 DOI: 10.1016/j.ccep.2015.10.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The authors present a unique case of torsades de pointes in a β-thalassemia patient with early iron overload in the absence of any structural abnormalities as seen in hemochromatosis. Genetic testing showed a novel KCNQ1 gene mutation 1591C>T [Gln531Ter(X)]. Testing of the gene mutation in Xenopus laevis oocytes showed loss of function of the IKs current. The authors hypothesize that iron overload combined with the KCNQ1 gene mutation leads to prolongation of QTc and torsades de pointes.
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Refaat MM, Scheinman M, Badhwar N. Narrow Complex Tachycardia: What is the Mechanism? Card Electrophysiol Clin 2016; 8:67-9. [PMID: 26920172 DOI: 10.1016/j.ccep.2015.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article presents a diagnostic dilemma in which atrioventricular nodal reentrant tachycardia (AVNRT) and junctional tachycardia (JT) were differentiated based on tachycardia initiation with atrial extrastimulus as well as on the response to progressive decremental atrial extrastimuli. The progressive increase in A2H2' and H2H2' in response to atrial extrastimuli favors reentry as the mechanism of the tachycardia. This is a novel mechanistic differentiation of AVNRT from focal JT.
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