51
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Romero JE, Diaz JC, Zei PC, Steiger NA, Koplan BA, Matos CD, Alviz I, Hoyos C, Marín JE, Duque M, Aristizabal J, Kapur S, Nyman CB, Niño CD, Bastidas O, Tadros TM, Martin DT, Tedrow UB, Sauer WH. Sustained Apnea for Epicardial Access With Right Ventriculography: The SAFER Epicardial Approach. JACC Clin Electrophysiol 2023; 9:1487-1499. [PMID: 37486280 DOI: 10.1016/j.jacep.2023.05.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/11/2023] [Accepted: 05/11/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Epicardial access (EA) has emerged as an increasingly important approach for the treatment of ventricular arrhythmias and to perform other interventional cardiology procedures. EA is frequently underutilized because the current approach is challenging and carries a high risk of life-threatening complications. OBJECTIVE The purpose of this study was to determine the efficacy and safety of the SAFER (Sustained Apnea for Epicardial Access With Right Ventriculography) epicardial approach. METHODS Consecutive patients who underwent EA with the SAFER technique were included in this multicenter study. The primary efficacy outcome was the successful achievement of EA. The primary safety outcomes included right ventricular (RV) perforation, major hemorrhagic pericardial effusion (HPE), and bleeding requiring surgical intervention. Secondary outcomes included procedural characteristics and any complications. Our results were compared with those from previous studies describing other EA techniques to assess differences in outcomes. RESULTS A total of 105 patients undergoing EA with the SAFER approach from June 2021 to February 2023 were included. EA was used for ventricular tachycardia ablation in 98 patients (93.4%), left atrial appendage closure in 6 patients (5.7%), and phrenic nerve displacement in 1 patient (0.9%). EA was successful in all subjects (100%). The median time to EA was 7 minutes (IQR: 5-14 minutes). No cases of RV perforation, HPE, or need of surgical intervention were observed in this cohort. Comparing our results with previous studies about EA, the SAFER epicardial approach resulted in a significant reduction in major pericardial bleeding. CONCLUSIONS The SAFER epicardial approach is a simple, efficient, effective, and low-cost technique easily reproducible across multiple centers. It is associated with lower complication rates than previously reported techniques for EA.
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Affiliation(s)
- Jorge E Romero
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | - Juan C Diaz
- Cardiac Arrythmia Center, Division of Cardiology, Clinica Las Vegas, Universidad CES, Medellín, Colombia
| | - Paul C Zei
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nathaniel A Steiger
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bruce A Koplan
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carlos D Matos
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Isabella Alviz
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carolina Hoyos
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jorge E Marín
- Cardiac Arrhythmia Institute, Division of Cardiology, Department of Medicine, Clinica Las Americas, Medellin, Colombia
| | - Mauricio Duque
- Cardiac Arrythmia Center, Division of Cardiology, Clinica Las Vegas, Universidad CES, Medellín, Colombia
| | - Julian Aristizabal
- Cardiac Arrhythmia Institute, Division of Cardiology, Department of Medicine, Clinica Las Americas, Medellin, Colombia
| | - Sunil Kapur
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Charles B Nyman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Cesar D Niño
- Cardiac Arrhythmia Institute, Division of Cardiology, Department of Medicine, Clinica Las Americas, Medellin, Colombia
| | - Oriana Bastidas
- Cardiac Arrythmia Center, Division of Cardiology, Clinica Las Vegas, Universidad CES, Medellín, Colombia
| | - Thomas M Tadros
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David T Martin
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Usha B Tedrow
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - William H Sauer
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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52
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Tedrow UB, Kurata M, Kawamura I, Batnyam U, Dukkipati S, Nakamura T, Tanigawa S, Fuji A, Richardson TD, Kanagasundram AN, Koruth JS, John RM, Hasegawa K, Abdelwahab A, Sapp J, Reddy VY, Stevenson WG. Worldwide Experience With an Irrigated Needle Catheter for Ablation of Refractory Ventricular Arrhythmias: Final Report. JACC Clin Electrophysiol 2023; 9:1475-1486. [PMID: 37278684 DOI: 10.1016/j.jacep.2023.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 05/11/2023] [Accepted: 05/11/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND We previously reported feasibility of irrigated needle ablation (INA) with a retractable 27-G end-hole needle catheter to treat nonendocardial ventricular arrhythmia substrate, an important cause of ablation failure. OBJECTIVES The purpose of this study was to report outcomes and complications in our entire INA-treated population. METHODS Patients with recurrent sustained monomorphic ventricular tachycardia (VT) or high-density premature ventricular contractions (PVCs) despite radiofrequency ablation were prospectively enrolled at 4 centers. Endpoints included a 70% decrease in VT frequency or PVC burden decrease to <5,000/24 h at 6 months. RESULTS INA was performed in 111 patients (median: 2 failed prior ablations, 71% nonischemic heart disease, and left ventricular ejection fraction 36% ± 14%). INA acutely abolished targeted PVCs in 33 of 37 patients (89%), and PVCs were reduced to <5,000/day in 29 patients (78%). During 6-month follow-up, freedom from hospitalization was observed in 50 of 72 patients with VT (69%), and improvement or abolition of VT occurred in 47%. All patients received multiple INA applications, with more in the VT group than in the PVC group (median: 12 [IQR: 7-19] vs 7 [5-15]; P < 0.01). After INA, additional endocardial standard radiofrequency ablation was required in 23% of patients. Adverse events included 4 pericardial effusions (3.5%), 3 cases of (anticipated) atrioventricular block (2.6%), and 3 heart failure exacerbations (2.6%). During 6-month follow-up, 5 deaths occurred; none were procedure-related. CONCLUSIONS INA achieves improved arrhythmia control in 78% of patients with PVCs and avoids hospitalization in 69% of patients with VT refractory to standard ablation at 6-month follow-up. Procedural risks are acceptable. (Intramural Needle Ablation for Ablation of Recurrent Ventricular Tachycardia, NCT01791543; Intramural Needle Ablation for the Treatment of Refractory Ventricular Arrhythmias, NCT03204981).
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Affiliation(s)
- Usha B Tedrow
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Masaaki Kurata
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Iwanari Kawamura
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Uyanga Batnyam
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Srinivas Dukkipati
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Shinichi Tanigawa
- Cardiovascular Division, Department of Medicine, Jikei University Katsushika Medical Center, Tokyo, Japan
| | - Akira Fuji
- Hoshinooka Cardiovascular Clinic, Ehime, Japan
| | - Travis D Richardson
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Arvindh N Kanagasundram
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jacob S Koruth
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roy M John
- Cardiovascular Division, Stanford University Medical Center, Stanford, California, USA
| | - Kanae Hasegawa
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amir Abdelwahab
- Heart Rhythm Service, Department of Medicine, Division of Cardiology, QEⅡ Health Sciences Center and Dalhousie University Halifax, Nova Scotia, Canada
| | - John Sapp
- Heart Rhythm Service, Department of Medicine, Division of Cardiology, QEⅡ Health Sciences Center and Dalhousie University Halifax, Nova Scotia, Canada
| | - Vivek Y Reddy
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - William G Stevenson
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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53
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Takigawa M, Sacher F, Martin C, Cheniti G, Duchateau J, Pambrun T, Derval N, Cochet H, Hocini M, Yamamoto T, Nishimura T, Tao S, Miyazaki S, Goya M, Sasano T, Haissaguierre M, Jais P. Impact of filter configurations on bipolar EGMs: An optimal filter setting for identifying VT substrates. J Cardiovasc Electrophysiol 2023; 34:1708-1717. [PMID: 37431258 DOI: 10.1111/jce.15997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/21/2023] [Accepted: 06/26/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND The impact of filtering on bipolar electrograms (EGMs) has not been systematically examined. We tried to clarify the optimal filter configuration for ventricular tachycardia (VT) ablation. METHODS Fifteen patients with VT were included. Eight different filter configurations were prospectively created for the distal bipoles of the ablation catheter: 1.0-250, 10-250, 100-250, 30-50, 30-100, 30-250, 30-500, and 30-1000 Hz. Pre-ablation stable EGMs with good contact (contact force > 10 g) were analyzed. Baseline fluctuation, baseline noise, bipolar peak-to-peak voltage, and presence of local abnormal ventricular activity (LAVA) were compared between different filter configurations. RESULTS In total, 2276 EGMs with multiple bipolar configurations in 246 sites in scar and border areas were analyzed. Baseline fluctuation was only observed in the high-pass filter of (HPF) ≤ 10 Hz (p < .001). Noise level was lowest at 30-50 Hz (0.018 [0.012-0.029] mV), increased as the low-pass filter (LPF) extended, and was highest at 30-1000 Hz (0.047 [0.041-0.061] mV) (p < .001). Conversely, the HPF did not affect the noise level at ≤30 Hz. As the HPF extended to 100 Hz, bipolar voltages significantly decreased (p < .001), but were not affected when the LPF was extended to ≥100 Hz. LAVAs were most frequently detected at 30-250 Hz (207/246; 84.2%) and 30-500 Hz (208/246; 84.6%), followed by 30-1000 Hz (205/246; 83.3%), but frequently missed at LPF ≤ 100 Hz or HPF ≤ 10 Hz (p < .001). A 50-Hz notch-filter reduced the bipolar voltage by 43.9% and LAVA-detection by 34.5% (p < .0001). CONCLUSION Bipolar EGMs are strongly affected by filter settings in scar/border areas. In all, 30-250 or 30-500 Hz may be the best configuration, minimizing the baseline fluctuation, baseline noise, and detecting LAVAs. Not applying the 50-Hz notch filter may be beneficial to avoid missing VT substrate.
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Affiliation(s)
- Masateru Takigawa
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Advanced Arrhythmia Research, Tokyo Medical and Dental University, Tokyo, Japan
| | - Frederic Sacher
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Claire Martin
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France
- Royal Papworth Hospital, Cambridge, UK
- Department of Medicine, Cambridge University, Cambridge, UK
| | - Ghassen Cheniti
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Josselin Duchateau
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Thomas Pambrun
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Nicolas Derval
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Hubert Cochet
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Meleze Hocini
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Tasuku Yamamoto
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takuro Nishimura
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Susumu Tao
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Advanced Arrhythmia Research, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masahiko Goya
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Michel Haissaguierre
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Pierre Jais
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
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Park EH, Kim JM, Seong E, Lee E, Chang K, Choi Y. Effects of Mesenchymal Stem Cell Injection into Healed Myocardial Infarction Scar Border Zone on the Risk of Ventricular Tachycardia. Biomedicines 2023; 11:2141. [PMID: 37626638 PMCID: PMC10452743 DOI: 10.3390/biomedicines11082141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023] Open
Abstract
The scar border zone is a main source of reentry responsible for ischemic ventricular tachycardia (VT). We evaluated the effects of mesenchymal stem cell (MSC) injection into the scar border zone on arrhythmic risks in a post-myocardial infarction (MI) animal model. Rabbit MI models were generated by left descending coronary artery ligation. Surviving rabbits after 4 weeks underwent left thoracotomy and autologous MSCs or phosphate-buffered saline (PBS) was administered to scar border zones in two rabbits in each group. Another rabbit without MI underwent a sham procedure (control). An implantable loop recorder (ILR) was implanted in the left chest wall in all animals. Four weeks after cell injections, ventricular fibrillation was induced in 1/2 rabbit in the PBS group by electrophysiologic study, and no ventricular arrhythmia was induced in the MSC group or control. Spontaneous VT was not detected during ILR analysis in any animal for 4 weeks. Histologic examination showed restoration of connexin 43 (Cx43) expression in the MSC group, which was higher than in the PBS group and comparable to the control. In conclusion, MSC injections into the MI scar border zone did not increase the risk of VT and were associated with favorable Cx43 expression and arrangement.
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Affiliation(s)
- Eun-Hye Park
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (E.-H.P.); (J.-M.K.); (E.S.); (E.L.); (K.C.)
| | - Jin-Moo Kim
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (E.-H.P.); (J.-M.K.); (E.S.); (E.L.); (K.C.)
| | - EunHwa Seong
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (E.-H.P.); (J.-M.K.); (E.S.); (E.L.); (K.C.)
| | - Eunmi Lee
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (E.-H.P.); (J.-M.K.); (E.S.); (E.L.); (K.C.)
| | - Kiyuk Chang
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (E.-H.P.); (J.-M.K.); (E.S.); (E.L.); (K.C.)
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Young Choi
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (E.-H.P.); (J.-M.K.); (E.S.); (E.L.); (K.C.)
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
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Park SM, Lee SY, Jung MH, Youn JC, Kim D, Cho JY, Cho DH, Hyun J, Cho HJ, Park SM, Choi JO, Chung WJ, Kang SM, Yoo BS. Korean Society of Heart Failure Guidelines for the Management of Heart Failure: Management of the Underlying Etiologies and Comorbidities of Heart Failure. INTERNATIONAL JOURNAL OF HEART FAILURE 2023; 5:127-145. [PMID: 37554691 PMCID: PMC10406556 DOI: 10.36628/ijhf.2023.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/01/2023] [Accepted: 07/11/2023] [Indexed: 08/10/2023]
Abstract
Most patients with heart failure (HF) have multiple comorbidities, which impact their quality of life, aggravate HF, and increase mortality. Cardiovascular comorbidities include systemic and pulmonary hypertension, ischemic and valvular heart diseases, and atrial fibrillation. Non-cardiovascular comorbidities include diabetes mellitus (DM), chronic kidney and pulmonary diseases, iron deficiency and anemia, and sleep apnea. In patients with HF with hypertension and left ventricular hypertrophy, renin-angiotensin system inhibitors combined with calcium channel blockers and/or diuretics is an effective treatment regimen. Measurement of pulmonary vascular resistance via right heart catheterization is recommended for patients with HF considered suitable for implantation of mechanical circulatory support devices or as heart transplantation candidates. Coronary angiography remains the gold standard for the diagnosis and reperfusion in patients with HF and angina pectoris refractory to antianginal medications. In patients with HF and atrial fibrillation, long-term anticoagulants are recommended according to the CHA2DS2-VASc scores. Valvular heart diseases should be treated medically and/or surgically. In patients with HF and DM, metformin is relatively safer; thiazolidinediones cause fluid retention and should be avoided in patients with HF and dyspnea. In renal insufficiency, both volume status and cardiac performance are important for therapy guidance. In patients with HF and pulmonary disease, beta-blockers are underused, which may be related to increased mortality. In patients with HF and anemia, iron supplementation can help improve symptoms. In obstructive sleep apnea, continuous positive airway pressure therapy helps avoid severe nocturnal hypoxia. Appropriate management of comorbidities is important for improving clinical outcomes in patients with HF.
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Affiliation(s)
- Sang Min Park
- Division of Cardiology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Soo Youn Lee
- Department of Cardiology, Cardiovascular Center, Incheon Sejong Hospital, Incheon, Korea
| | - Mi-Hyang Jung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong-Chan Youn
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Darae Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Yeong Cho
- Department of Cardiovascular Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Dong-Hyuk Cho
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University Medicine, Seoul, Korea
| | - Junho Hyun
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun-Jai Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seong-Mi Park
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University Medicine, Seoul, Korea
| | - Jin-Oh Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wook-Jin Chung
- Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Seok-Min Kang
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byung-Su Yoo
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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Park SM, Lee SY, Jung MH, Youn JC, Kim D, Cho JY, Cho DH, Hyun J, Cho HJ, Park SM, Choi JO, Chung WJ, Kang SM, Yoo BS. Korean Society of Heart Failure Guidelines for the Management of Heart Failure: Management of the Underlying Etiologies and Comorbidities of Heart Failure. Korean Circ J 2023; 53:425-451. [PMID: 37525389 PMCID: PMC10406530 DOI: 10.4070/kcj.2023.0114] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/01/2023] [Accepted: 07/11/2023] [Indexed: 08/02/2023] Open
Abstract
Most patients with heart failure (HF) have multiple comorbidities, which impact their quality of life, aggravate HF, and increase mortality. Cardiovascular comorbidities include systemic and pulmonary hypertension, ischemic and valvular heart diseases, and atrial fibrillation. Non-cardiovascular comorbidities include diabetes mellitus (DM), chronic kidney and pulmonary diseases, iron deficiency and anemia, and sleep apnea. In patients with HF with hypertension and left ventricular hypertrophy, renin-angiotensin system inhibitors combined with calcium channel blockers and/or diuretics is an effective treatment regimen. Measurement of pulmonary vascular resistance via right heart catheterization is recommended for patients with HF considered suitable for implantation of mechanical circulatory support devices or as heart transplantation candidates. Coronary angiography remains the gold standard for the diagnosis and reperfusion in patients with HF and angina pectoris refractory to antianginal medications. In patients with HF and atrial fibrillation, long-term anticoagulants are recommended according to the CHA2DS2-VASc scores. Valvular heart diseases should be treated medically and/or surgically. In patients with HF and DM, metformin is relatively safer; thiazolidinediones cause fluid retention and should be avoided in patients with HF and dyspnea. In renal insufficiency, both volume status and cardiac performance are important for therapy guidance. In patients with HF and pulmonary disease, beta-blockers are underused, which may be related to increased mortality. In patients with HF and anemia, iron supplementation can help improve symptoms. In obstructive sleep apnea, continuous positive airway pressure therapy helps avoid severe nocturnal hypoxia. Appropriate management of comorbidities is important for improving clinical outcomes in patients with HF.
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Affiliation(s)
- Sang Min Park
- Division of Cardiology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Soo Youn Lee
- Department of Cardiology, Cardiovascular Center, Incheon Sejong Hospital, Incheon, Korea
| | - Mi-Hyang Jung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong-Chan Youn
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Darae Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Yeong Cho
- Department of Cardiovascular Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Dong-Hyuk Cho
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University Medicine, Seoul, Korea
| | - Junho Hyun
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun-Jai Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seong-Mi Park
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University Medicine, Seoul, Korea
| | - Jin-Oh Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wook-Jin Chung
- Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Seok-Min Kang
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byung-Su Yoo
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
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57
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Tschabrunn CM, Callans DJ. A New Look at Impedance in the Electrophysiology Laboratory: Local Tissue Impedance to Identify VT Substrate. JACC Clin Electrophysiol 2023; 9:776-778. [PMID: 37380312 DOI: 10.1016/j.jacep.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/04/2023] [Indexed: 06/30/2023]
Affiliation(s)
- Cory M Tschabrunn
- Cardiac Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David J Callans
- Cardiac Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Nissan J, Sabbag A, Beinart R, Nof E. Inducibility of Multiple Ventricular Tachycardia's during a Successful Ablation Procedure Is a Marker of Ventricular Tachycardia Recurrence. J Clin Med 2023; 12:jcm12113660. [PMID: 37297854 DOI: 10.3390/jcm12113660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/14/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
Even after a successful ventricular tachycardia ablation (VTA), some patients have recurrent ventricular tachycardia (VT) during their follow-up. We assessed the long-term predictors of recurrent VT after having a successful VTA. The patients who underwent a successful VTA (defined as the non-inducibility of any VT at the procedure's end) in 2014-2021 at our center in Israel were retrospectively analyzed. A total of 111 successful VTAs were evaluated. Out of them, 31 (27.9%) had a recurrent event of VT after the procedure during a median follow-up time of 264 days. The mean left ventricular ejection fraction (LVEF) was significantly lower among patients with recurrent VT events (28.9 ± 12.67 vs. 23.53 ± 12.224, p = 0.048). A high number of induced VTs (>two) during the procedure was found to be a significant predictor of VT recurrence (24.69% vs. 56.67%, 20 vs. 17, p = 0.002). In a multivariate analysis, a lower LVEF (HR, 0.964; p = 0.037) and a high number of induced VTs (HR, 2.15; p = 0.039) were independent predictors of arrhythmia recurrence. The inducibility of more than two VTs during a VTA procedure remains a predictor of VT recurrence even after a successful VT ablation. This group of patients remains at high risk for VT and should be followed up with and treated more vigorously.
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Affiliation(s)
- Johnatan Nissan
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan 52621, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Avi Sabbag
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Roy Beinart
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Eyal Nof
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Ramat Gan 52621, Israel
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Bennett RG, Garikapati K, Campbell TG, Kotake Y, Turnbull S, Bhaskaran A, De Silva K, Kanawati J, Zhou J, Wong MS, Kumar S. Mortality after catheter ablation of structural heart disease related ventricular tachycardia. Int J Cardiol 2023:S0167-5273(23)00728-3. [PMID: 37225093 DOI: 10.1016/j.ijcard.2023.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/02/2023] [Accepted: 05/19/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND There is a paucity of data describing mortality after catheter ablation of ventricular tachycardia (VT). OBJECTIVES We describe the causes and predictors of cardiac transplant and/or mortality following catheter ablation of structural heart disease (SHD) related VT. METHODS Over 10-years, 175 SHD patients underwent VT ablation. Clinical characteristics, and outcomes, were compared between patients undergoing transplant and/or dying and those surviving. RESULTS During 2.8 (IQR 1.9-5.0) years follow-up, 37/175 (21%) patients underwent transplant and/or died following VT ablation. Prior to ablation, these patients were older (70.3 ± 11.1 vs. 62.1 ± 13.9 years, P = 0.001), had lower left ventricular ejection fraction ([LVEF] 30 ± 12% vs. 44 ± 14%, P < 0.001), and were more likely to have failed amiodarone (57% vs. 39%, P = 0.050), compared to those that survived. Predictors of transplant and/or mortality included LVEF≤35% (HR 4.71 [95% CI 2.18-10.18], P < 0.001), age ≥ 65 years (HR 2.18 [95% CI 1.01-4.73], P = 0.047), renal impairment (HR 3.73 [95% CI 1.80-7.74], P < 0.001), amiodarone failure (HR 2.67 [95% CI 1.27-5.63], P = 0.010) and malignancy (HR 3.09 [95% CI 1.03-9.26], P = 0.043). Ventricular arrhythmia free survival at 6-months was lower in the transplant and/or deceased, compared to non-deceased group (62% vs. 78%, P = 0.010), but was not independently associated with transplant and/or mortality. The risk score, MORTALITIES-VA, accurately predicted transplant and/or mortality (AUC: 0.872 [95% CI 0.810-0.934]). CONCLUSIONS Cardiac transplant and/or mortality after VT ablation occurred in 21% of patients. Independent predictors included LVEF≤35%, age ≥ 65 years, renal impairment, malignancy, and amiodarone failure. The MORTALITIES-VA score may identify patients at high-risk of transplant and/or dying after VT ablation.
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Affiliation(s)
- Richard G Bennett
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Australia
| | - Kartheek Garikapati
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Australia
| | - Timothy G Campbell
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Australia
| | - Yasuhito Kotake
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Australia
| | - Samual Turnbull
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Australia
| | - Ashwin Bhaskaran
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Australia
| | - Kasun De Silva
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Australia
| | - Juliana Kanawati
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Australia
| | - Julia Zhou
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Australia
| | - Mary S Wong
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Australia.
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Baldazzi G, Orrù M, Viola G, Pani D. Computer-aided detection of arrhythmogenic sites in post-ischemic ventricular tachycardia. Sci Rep 2023; 13:6906. [PMID: 37106017 PMCID: PMC10140038 DOI: 10.1038/s41598-023-33866-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/20/2023] [Indexed: 04/29/2023] Open
Abstract
Nowadays, catheter-based ablation in patients with post-ischemic ventricular tachycardia (VT) is performed in arrhythmogenic sites identified by electrophysiologists by visual inspection during electroanatomic mapping. This work aims to present the development of machine learning tools aiming at supporting clinicians in the identification of arrhythmogenic sites by exploiting innovative features that belong to different domains. This study included 1584 bipolar electrograms from nine patients affected by post-ischemic VT. Different features were extracted in the time, time scale, frequency, and spatial domains and used to train different supervised classifiers. Classification results showed high performance, revealing robustness across the different classifiers in terms of accuracy, true positive, and false positive rates. The combination of multi-domain features with the ensemble tree is the most effective solution, exhibiting accuracies above 93% in the 10-time 10-fold cross-validation and 84% in the leave-one-subject-out validation. Results confirmed the effectiveness of the proposed features and their potential use in a computer-aided system for the detection of arrhythmogenic sites. This work demonstrates for the first time the usefulness of supervised machine learning for the detection of arrhythmogenic sites in post-ischemic VT patients, thus enabling the development of computer-aided systems to reduce operator dependence and errors, thereby possibly improving clinical outcomes.
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Affiliation(s)
- Giulia Baldazzi
- Medical Devices and Signal Processing (MeDSP) Lab, Department of Electrical and Electronic Engineering (DIEE), University of Cagliari, Cagliari, Italy.
- Department of Informatics, Bioengineering, Robotics and Systems Engineering (DIBRIS), University of Genoa, Genoa, Italy.
| | - Marco Orrù
- Medical Devices and Signal Processing (MeDSP) Lab, Department of Electrical and Electronic Engineering (DIEE), University of Cagliari, Cagliari, Italy
- Department of Informatics, Bioengineering, Robotics and Systems Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - Graziana Viola
- Department of Cardiology, Santissima Annunziata Hospital, Sassari, Italy
| | - Danilo Pani
- Medical Devices and Signal Processing (MeDSP) Lab, Department of Electrical and Electronic Engineering (DIEE), University of Cagliari, Cagliari, Italy
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Grehn M, Mandija S, Miszczyk M, Krug D, Tomasik B, Stickney KE, Alcantara P, Alongi F, Anselmino M, Aranda RS, Balgobind BV, Boda-Heggemann J, Boldt LH, Bottoni N, Cvek J, Elicin O, De Ferrari GM, Hassink RJ, Hazelaar C, Hindricks G, Hurkmans C, Iotti C, Jadczyk T, Jiravsky O, Jumeau R, Kristiansen SB, Levis M, López MA, Martí-Almor J, Mehrhof F, Møller DS, Molon G, Ouss A, Peichl P, Plasek J, Postema PG, Quesada A, Reichlin T, Rordorf R, Rudic B, Saguner AM, ter Bekke RMA, Torrecilla JL, Troost EGC, Vitolo V, Andratschke N, Zeppenfeld K, Blamek S, Fast M, de Panfilis L, Blanck O, Pruvot E, Verhoeff JJC. STereotactic Arrhythmia Radioablation (STAR): the Standardized Treatment and Outcome Platform for Stereotactic Therapy Of Re-entrant tachycardia by a Multidisciplinary consortium (STOPSTORM.eu) and review of current patterns of STAR practice in Europe. Europace 2023; 25:1284-1295. [PMID: 36879464 PMCID: PMC10105846 DOI: 10.1093/europace/euac238] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/18/2022] [Indexed: 03/08/2023] Open
Abstract
The EU Horizon 2020 Framework-funded Standardized Treatment and Outcome Platform for Stereotactic Therapy Of Re-entrant tachycardia by a Multidisciplinary (STOPSTORM) consortium has been established as a large research network for investigating STereotactic Arrhythmia Radioablation (STAR) for ventricular tachycardia (VT). The aim is to provide a pooled treatment database to evaluate patterns of practice and outcomes of STAR and finally to harmonize STAR within Europe. The consortium comprises 31 clinical and research institutions. The project is divided into nine work packages (WPs): (i) observational cohort; (ii) standardization and harmonization of target delineation; (iii) harmonized prospective cohort; (iv) quality assurance (QA); (v) analysis and evaluation; (vi, ix) ethics and regulations; and (vii, viii) project coordination and dissemination. To provide a review of current clinical STAR practice in Europe, a comprehensive questionnaire was performed at project start. The STOPSTORM Institutions' experience in VT catheter ablation (83% ≥ 20 ann.) and stereotactic body radiotherapy (59% > 200 ann.) was adequate, and 84 STAR treatments were performed until project launch, while 8/22 centres already recruited VT patients in national clinical trials. The majority currently base their target definition on mapping during VT (96%) and/or pace mapping (75%), reduced voltage areas (63%), or late ventricular potentials (75%) during sinus rhythm. The majority currently apply a single-fraction dose of 25 Gy while planning techniques and dose prescription methods vary greatly. The current clinical STAR practice in the STOPSTORM consortium highlights potential areas of optimization and harmonization for substrate mapping, target delineation, motion management, dosimetry, and QA, which will be addressed in the various WPs.
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Affiliation(s)
- Melanie Grehn
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel 24105, Germany
| | - Stefano Mandija
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Marcin Miszczyk
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Ul. Wybrzeze Armii Krajowej, Gliwice 44102, Poland
| | - David Krug
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel 24105, Germany
| | - Bartłomiej Tomasik
- Department of Radiotherapy, Maria Skłodowska-Curie National Research Institute of Oncology, Ul. Wybrzeze Armii Krajowej, Gliwice 44102, Poland
- Department of Oncology and Radiotherapy, Faculty of Medicine, Medical University of Gdansk, M. Sklodowskiel-Curie 3a, Gdansk 80210, Poland
| | - Kristine E Stickney
- Research Support Office, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Pino Alcantara
- Department of Radiation Oncology, Hospital Clínico San Carlos, Faculty of Medicine, University Complutense of Madrid, Profesor Martin Lagos, Madrid 28040, Spain
| | - Filippo Alongi
- Department of Advanced Radiation Oncology, IRCCS Sacro Cuore Don Calabria Hospital, University of Brescia, Via San Zeno in Monte 23, Verona 37129, Italy
| | - Matteo Anselmino
- Division of Cardiology, Cardiovascular and Thoracic Department, ‘Città della Salute e della Scienza’ Hospital, Via Giuseppe Verdi 8, Torino 10124, Italy
- Department of Medical Sciences, University of Turin, Via Verdi 8, Torino 10124, Italy
| | - Ricardo Salgado Aranda
- Electrophysiology Unit, Department of Cardiology, Hospital Clínico San Carlos Madrid, Professor Martin Lagos, Madrid 28040, Spain
| | - Brian V Balgobind
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Meibergdreef 15, Amsterdam 1105AZ, The Netherlands
| | - Judit Boda-Heggemann
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim 68167, Germany
| | - Leif-Hendrik Boldt
- Department of Rhythmology, Charité—University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Nicola Bottoni
- Cardiology Arrhythmology Center, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, Reggio Emilia 42100, Italy
| | - Jakub Cvek
- Department of Oncology, University Hospital and Faculty of Medicine, Listopadu 1790, Ostrava Poruba 70852, Czech Republic
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, Bern 3010, Switzerland
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, ‘Città della Salute e della Scienza’ Hospital, Via Giuseppe Verdi 8, Torino 10124, Italy
| | - Rutger J Hassink
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Colien Hazelaar
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, P. Debyelaan 25, Maastricht 6229 HX, The Netherlands
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany
| | - Coen Hurkmans
- Department of Radiation Oncology, Catharina Hospital, Michelangelolaan 2, Eindhoven 5623 EJ, The Netherlands
| | - Cinzia Iotti
- Radiation Oncology Unit, Clinical Cancer Centre, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, Reggio Emilia 42100, Italy
| | - Tomasz Jadczyk
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ul. Poniatowskiego 15, Katowice 40055, Poland
- Interventional Cardiac Electrophysiology Group, International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
| | - Otakar Jiravsky
- Cardiocenter, Hospital Agel Trinec Podlesi and Masaryk University, Konska 453, Trinec 73961, Czech Republic
| | - Raphaël Jumeau
- Department of Radio-Oncology, Lausanne University Hospital, Rue du Bugnon 21, Lausanne 1011, Switzerland
| | - Steen Buus Kristiansen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus 8200, Denmark
| | - Mario Levis
- Department of Oncology, University of Torino, Via Giuseppe Verdi 8, Torino 10124, Italy
| | - Manuel Algara López
- Department of Radiation Oncology, Hospital del Mar, Universitat Pompeu Fabra, Institut Hospital del Mar d'Investigacions Mèdiques, Paseo Maritim 25-29, Barcelona 08003, Spain
| | - Julio Martí-Almor
- Department of Cardiology, Hospital del Mar, Universitat Pompeu Fabra, Institut Hospital del Mar d'Investigacions Mèdiques, Paseo Maritim 25-29, Barcelona 08003, Spain
| | - Felix Mehrhof
- Department for Radiation Oncology, Charité—Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Ditte Sloth Møller
- Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus 8200, Denmark
| | - Giulio Molon
- Department of Cardiology, IRCCS Sacro Cuore Don Calabria Hospital, Via San Zeno in Monte 23, Verona 37129, Italy
| | - Alexandre Ouss
- Department of Cardiology, Catharina Hospital, Michelangelolaan 2, Eindhoven 5623 EJ, The Netherlands
| | - Petr Peichl
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Videnska 9, Prague 14000, Czech Republic
| | - Jiri Plasek
- Department of Cardiovascular Medicine, University Hospital Ostrava, Listopadu 1790. Ostrava Poruba 70852, Czech Republic
| | - Pieter G Postema
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 15, Amsterdam 1105AZ, The Netherlands
| | - Aurelio Quesada
- Arrhythmia Unit, Department of Cardiology, Consorcio Hospital General Universitario de Valencia, Av Tres Cruces 2, Valencia 46014, Spain
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, Bern 3010, Switzerland
| | - Roberto Rordorf
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Camillo Golgi Avenue 5, Pavia 27100, Italy
| | - Boris Rudic
- Department of Medicine I, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim 68167, Germany
| | - Ardan M Saguner
- Arrhythmia Unit, Department of Cardiology, University Hospital Zurich, Ramistrasse 71, Zurich 8006, Switzerland
| | - Rachel M A ter Bekke
- Department of Cardiology, Maastricht University Medical Center, P. Debyelaan 25, Maastricht 6229 HX, The Netherlands
| | - José López Torrecilla
- Department of Radiation Oncology, Hospital General Valencia, Av Tres Cruces 2, Valencia 46014, Spain
| | - Esther G C Troost
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, Dresden 01307, Germany
- OncoRay—National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus. Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstrasse 74, Dresden 01307, Germany
- Institute of Radiooncology - OncoRay, Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstr. 400, Dresden 01328, Germany
| | - Viviana Vitolo
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Strada Campeggi 53, Pavia PV27100, Italy
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital of Zurich, Ramistrasse 71, Zurich 8006, Switzerland
| | - Katja Zeppenfeld
- Unit of Clinical Electrophysiology, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, The Netherlands
| | - Slawomir Blamek
- Department of Radiotherapy, Maria Skłodowska-Curie National Research Institute of Oncology, Ul. Wybrzeze Armii Krajowej, Gliwice 44102, Poland
| | - Martin Fast
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Ludovica de Panfilis
- Bioethics Unit, Azienda Unità Sanitaria Locale—IRCCS, Via Amendola 2, Reggio Emilia 42100, Italy
| | - Oliver Blanck
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel 24105, Germany
| | - Etienne Pruvot
- Heart and Vessel Department, Service of Cardiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 21, Lausanne 1011, Switzerland
| | - Joost J C Verhoeff
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
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Qiu J, Dai M, Bai Y, Chen G. Potential Application of Pulsed Field Ablation in Ventricular Arrhythmias. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040723. [PMID: 37109681 PMCID: PMC10143478 DOI: 10.3390/medicina59040723] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/20/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023]
Abstract
Pulsed field ablation (PFA) is a new ablative method for the therapy of arrhythmia. Recent preclinical and clinical studies have already demonstrated the feasibility and safety of PFA for the treatment of atrial fibrillation (AF). However, the application of PFA may not be limited to the above fields. There are some data on the application of PFA on ventricular arrhythmias (VAs), such as ventricular fibrillation (VF) and ventricular tachycardia (VT). Further, a case report about PFA has been published recently, in which PFA was successfully applied to the ablation of premature ventricular contractions (PVCs) from the right ventricular outflow tract. Thus, we aimed to review recent research findings of PFA in ventricular ablation and evaluate the possibility of its application in VAs.
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Affiliation(s)
- Jie Qiu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave., Wuhan 430030, China
| | - Meiyan Dai
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave., Wuhan 430030, China
| | - Yang Bai
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave., Wuhan 430030, China
| | - Guangzhi Chen
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave., Wuhan 430030, China
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Salter BS, Gross CR, Weiner MM, Dukkipati SR, Serrao GW, Moss N, Anyanwu AC, Burkhoff D, Lala A. Temporary mechanical circulatory support devices: practical considerations for all stakeholders. Nat Rev Cardiol 2023; 20:263-277. [PMID: 36357709 PMCID: PMC9649020 DOI: 10.1038/s41569-022-00796-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2022] [Indexed: 11/12/2022]
Abstract
Originally intended for life-saving salvage therapy, the use of temporary mechanical circulatory support (MCS) devices has become increasingly widespread in a variety of clinical settings in the contemporary era. Their use as a short-term, prophylactic support vehicle has expanded to include procedures in the catheterization laboratory, electrophysiology suite, operating room and intensive care unit. Accordingly, MCS device design and technology continue to develop at a rapid pace. In this Review, we describe the functionality, indications, management and complications associated with temporary MCS, together with scenario-specific utilization, goal-directed development and bioengineering of future devices. We address various considerations for the use of temporary MCS devices in both prophylactic and rescue scenarios, with input from stakeholders from various cardiovascular specialties, including interventional and heart failure cardiology, electrophysiology, cardiothoracic anaesthesiology, critical care and cardiac surgery.
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Affiliation(s)
- Benjamin S Salter
- Department of Anaesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Caroline R Gross
- Department of Anaesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Menachem M Weiner
- Department of Anaesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Srinivas R Dukkipati
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gregory W Serrao
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai, New York, NY, USA
| | - Noah Moss
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai, New York, NY, USA
| | - Anelechi C Anyanwu
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Anuradha Lala
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Mount Sinai, New York, NY, USA
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64
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Martínez-Solano J, Martínez-Sellés M. Sudden Death in Men Versus Women with Heart Failure. Curr Heart Fail Rep 2023; 20:129-137. [PMID: 36881322 DOI: 10.1007/s11897-023-00596-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE OF REVIEW Sudden cardiac death (SCD) represents the most feared complication of heart failure (HF). This review intends to provide insight on our current knowledge of sex differences in SCD mechanisms, prevention, and management in HF patients. RECENT FINDINGS Women with HF present a better prognosis than men and have a lower incidence of SCD, irrespective of the presence of ischemic heart disease and age. The influence of sex hormones, sex differences in intracellular calcium handling, and a differential myocardial remodeling may explain such a gap between men and women. Both HF drugs and ventricular arrhythmias ablation seems also useful for the management of women at risk of SCD, but special care must be taken with the use of antiarrhythmic QT-prolonging drugs. However, implantable cardioverter defibrillator (ICD) use has not been shown to be equally effective in women than men. Sex-specific recommendations regarding SCD in HF are still lacking due to the scarcity of information and the under-representation of women in clinical trials. Further investigation is required to provide specific risk stratification models in women. Cardiac magnetic resonance imaging, genetics development, and personalized medicine will probably play an increasing role in this evaluation.
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Affiliation(s)
- Jorge Martínez-Solano
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo, 46, 28007, Madrid, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo, 46, 28007, Madrid, Spain. .,Universidad Europea, Universidad Complutense, Madrid, Spain.
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Catheter Ablation of Ventricular Arrhythmia in Patients With an Implantable Cardioverter-Defibrillator: A Systematic Review and Meta-analysis. Can J Cardiol 2023; 39:250-262. [PMID: 36521729 DOI: 10.1016/j.cjca.2022.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/13/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Implantable cardioverter-defibrillator (ICD) shocks are associated with higher rates of mortality and reduced quality of life. In this study we aimed to investigate the effectiveness of catheter ablation (CA) of ventricular tachycardia in patients with an ICD. METHODS An electronic literature search was conducted to identify randomized controlled trials that compared CA vs control. The primary outcomes were recurrence of ventricular arrhythmia (ventricular tachycardia or ventricular fibrillation) and mortality. Kaplan-Meier curves for these outcomes were digitized to obtain individual patient data, which were pooled in a 1-stage meta-analysis to determine hazard ratios (HRs) and 95% confidence intervals (CIs). Secondary outcomes included cardiac hospitalization, electrical storm, syncope, appropriate ICD therapies, appropriate ICD shocks, and inappropriate shocks. For these, study-level HRs or risk ratios were obtained and pooled in random effects meta-analyses. Subgroup analysis was performed for trials that investigated prophylactic CA (before or during ICD implantation). RESULTS Data on 9 studies and 1103 patients were retrieved. CA significantly reduced ventricular tachycardia/ventricular fibrillation recurrence compared with control (shared frailty HR, 0.63; 95% CI, 0.49-0.81; P < 0.001) but not mortality (shared frailty HR, 0.84; 95% CI, 0.57-1.23; P = 0.361). CA was associated with significantly lower rates of cardiac hospitalization, electrical storm, appropriate ICD therapies and shocks, but not syncope or inappropriate shocks. Subgroup analysis showed similar results for prophylactic CA except that no significant difference was observed for cardiac hospitalizations. CONCLUSIONS CA is associated with reduced ventricular arrhythmia recurrence, appropriate ICD therapies/shocks, electrical storm, and cardiac hospitalization, and might be effective in preventing future morbidity. Future trials are needed to support the continued benefit of these promising results, and to investigate the optimal timing of ablation.
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Gilge JL, Joshi SA, Nair GV, Clark BA, Prystowsky EN, Patel PJ. Ripple mapping in ventricular tachycardia substrate mapping and ablation of nonischemic ventricular tachycardia. J Cardiovasc Electrophysiol 2023; 34:652-661. [PMID: 36640431 DOI: 10.1111/jce.15814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 12/26/2022] [Accepted: 12/28/2022] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Substrate-based ablation for ventricular tachycardia (VT) using Ripple map (RM) is an effective treatment strategy for patients with ischemic cardiomyopathy but has yet to be evaluated in patients with nonischemic cardiomyopathy (NICMO). The aim of this study is to determine the feasibility and effectiveness of an RM-based ablation for NICMO patients. METHODS AND RESULTS This was a single-center, retrospective study including all NICMO patients undergoing VT ablation at St Vincent Hospital between January 1, 2018 and January 12, 2019. Retrospective RM analysis was performed on those that had a substrate-based ablation to identify the location and number of Ripple channels as well as their proximity to ablation lesions. Thirty-three patients met the inclusion criteria and had a median age of 65 (58, 73.5) with 15.2% of the population being female, and were followed for a median duration of 451 (217.5, 586.5) days. Of these patients, 23 (69.7%) had a substrate-based ablation with a median procedural duration of 196.4 (186.8, 339) min, 1946 (517, 2750) points collected per map, and 277 (141, 554) points were within the scar. Two (8.6%) procedural complications occurred, and 7 (30.4%) patients had VT recurrence during follow-up. RM analysis revealed an average of two Ripple channels and the patients without VT recurrence had ablation performed closer to the Ripple channels: 0 (0, 4.7) versus 14.3 (0, 23.5) cm; p = .02. CONCLUSION An RM-based substrate ablation can be performed in NICMO patients and ablation within Ripple channels is a predictor of VT freedom.
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Affiliation(s)
- Jasen L Gilge
- Department of Internal Medicine, Division of Cardiology, Ascension St Vincent Medical Group, Indianapolis, Indiana, USA
| | - Sandeep A Joshi
- Department of Internal Medicine, Division of Cardiology, Ascension St Vincent Medical Group, Indianapolis, Indiana, USA
| | - Girish V Nair
- Department of Internal Medicine, Division of Cardiology, Ascension St Vincent Medical Group, Indianapolis, Indiana, USA
| | - Bradley A Clark
- Department of Internal Medicine, Division of Cardiology, Ascension St Vincent Medical Group, Indianapolis, Indiana, USA
| | - Eric N Prystowsky
- Department of Internal Medicine, Division of Cardiology, Ascension St Vincent Medical Group, Indianapolis, Indiana, USA
| | - Parin J Patel
- Department of Internal Medicine, Division of Cardiology, Ascension St Vincent Medical Group, Indianapolis, Indiana, USA
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Scott M, Baykaner T, Bunch TJ, Piccini JP, Russo AM, Tzou WS, Zeitler EP, Steinberg BA. Contemporary trends in cardiac electrophysiology procedures in the United States, and impact of a global pandemic. Heart Rhythm O2 2023; 4:193-199. [PMID: 36569386 PMCID: PMC9767878 DOI: 10.1016/j.hroo.2022.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/12/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Background There are limited data on trends in nationwide cardiac electrophysiology (EP) procedures in the United States before and during the global COVID-19 pandemic. Objective We aimed to understand contemporary EP procedural trends and how the COVID-19 pandemic impacted them. Methods Trends were obtained from publicly reported Centers for Medicare and Medicaid Services data from 2013 to 2020 (latest available). Rates of catheter-based EP procedures (EP studies and ablations) and cardiac implantable electronic device (CIED) procedures were analyzed. All procedural rates were calculated per 100,000 Medicare beneficiaries (year specific). Procedure physician subspecialty was also reported. Results From 2013 to 2019, annual rate of all cardiac EP procedures increased from 817.91 to 1089.68 per 100,000 beneficiaries. Catheter-based EP procedures increased from 323.73 to 675.01, while CIED rates decreased from 494.18 to 414.67. While all ablation procedures increased over time, relative proportion of ablation procedures being pulmonary vein isolation (PVI) increased (9.9% of ablations in 2013, to 18.2% in 2019). In 2020, rates of both catheter-based EP procedures and CIED procedures decreased; however, PVI share of ablation continued to increase in 2020 comprising 25.2% of ablation procedures. Conclusion Rates of EP procedures have increased among Medicare beneficiaries, with catheter-based procedures now eclipsing CIEDs. Additionally, a greater proportion of catheter-based EP procedures are PVI, but they still represent a minority of all ablations. In 2020, rates of EP procedures were attenuated, yet the proportion of PVI ablations increased to over one-fourth of ablation procedures. These data have important implications for the EP workforce.
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Affiliation(s)
- Monte Scott
- Department of Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Tina Baykaner
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - T. Jared Bunch
- Department of Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Jonathan P. Piccini
- Department of Medicine, Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina
| | - Andrea M. Russo
- Cooper Medical School of Rowan University, Camden, New Jersey
| | - Wendy S. Tzou
- Department of Medicine, University of Colorado Anschutz Medical Center, Aurora, Colorado
| | - Emily P. Zeitler
- Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Benjamin A. Steinberg
- Department of Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah
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Aktaa S, Tzeis S, Gale CP, Ackerman MJ, Arbelo E, Behr ER, Crotti L, d'Avila A, de Chillou C, Deneke T, Figueiredo M, Friede T, Leclercq C, Merino JL, Semsarian C, Verstrael A, Zeppenfeld K, Tfelt-Hansen J, Reichlin T. European Society of Cardiology quality indicators for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Europace 2023; 25:199-210. [PMID: 36753478 PMCID: PMC10103575 DOI: 10.1093/europace/euac114] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 05/27/2022] [Indexed: 02/09/2023] Open
Abstract
To develop a suite of quality indicators (QIs) for the management of patients with ventricular arrhythmias (VA) and the prevention of sudden cardiac death (SCD). The Working Group comprised experts in heart rhythm management including Task Force members of the 2022 European Society of Cardiology (ESC) Clinical Practice Guidelines for the management of patients with VA and the prevention of SCD, members of the European Heart Rhythm Association, international experts, and a patient representative. We followed the ESC methodology for QI development, which involves (i) the identification of the key domains of care for the management of patients with VA and the prevention of SCD by constructing a conceptual framework of care, (ii) the development of candidate QIs by conducting a systematic review of the literature, (iii) the selection of the final set of QIs using a modified-Delphi method, and (iv) the evaluation of the feasibility of the developed QIs. We identified eight domains of care for the management of patients with VA and the prevention of SCD: (i) structural framework, (ii) screening and diagnosis, (iii) risk stratification, (iv) patient education and lifestyle modification, (v) pharmacological treatment, (vi) device therapy, (vii) catheter ablation, and (viii) outcomes, which included 17 main and 4 secondary QIs across these domains. Following a standardized methodology, we developed 21 QIs for the management of patients with VA and the prevention of SCD. The implementation of these QIs will improve the care and outcomes of patients with VA and contribute to the prevention of SCD.
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Affiliation(s)
- Suleman Aktaa
- Leeds Institute for Data Analytics, University of Leeds, Leeds LS29JT, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS29JT, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK
| | | | - Chris P Gale
- Leeds Institute for Data Analytics, University of Leeds, Leeds LS29JT, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS29JT, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK
| | - Michael J Ackerman
- Departments of Cardiovascular Medicine, Pediatric and Adolescent Medicine, and Molecular Pharmacology & Experimental Therapeutics, Divisions of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Genetic Heart Rhythm Clinic and Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN 55905, USA
| | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona 08007, Spain
- IDIBAPS, Institut d’Investigació August Pi i Sunyer (IDIBAPS), Barcelona 08036, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid 28029, Spain
| | - Elijah R Behr
- Cardiovascular Clinical Academic Group and Cardiology Research Centre, St. George’s, University of London, London SW17 0RE, UK
- St. George’s University Hospitals NHS Foundation Trust, London SW17 0QT, UK
| | - Lia Crotti
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan 20149, Italy
- Departments of Medicine and Surgery, University of Milano-Bicocca, Milan 20126, Italy
| | - Andre d'Avila
- Director – Cardiac Arrhythmia Service The Harvard Thorndike EP Institute Beth Israel Deaconess Medical Center Harvard Medical School, Boston, MA 02215, USA
| | - Christian de Chillou
- Department of Cardiology, University Hospital Nancy,Vandœuvre lès Nancy 54500, France
| | - Thomas Deneke
- Heart Center Rhön-Clinic Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt 97616, Germany
| | - Márcio Figueiredo
- Cardiology, Electrophysiology Service, University of Campinas (UNICAMP) Hospital, Campinas 13083-888, Brazil
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen,Göttingen, Germany; and DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen 10785, Germany
| | | | - Jose L Merino
- La Paz University Hospital, IdiPaz, Autonoma University, Madrid 28046, Spain
| | - Chris Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, University of Sydney, Sydney 2050, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney 2050, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney 2050, Australia
| | | | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden 2333, TheNetherlands
| | - Jacob Tfelt-Hansen
- Section of genetics, Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen 2100, Denmark
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet 2100, Denmark
| | - Tobias Reichlin
- Department of Cardiology, Inselspial Bern, Bern University Hospital, University of Bern, Bern 3010, Switzerland
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Vázquez-Calvo S, Casanovas JM, Garre P, Ferró E, Sánchez-Somonte P, Quinto L, Guasch E, Porta-Sanchez A, Tolosana JM, Borras R, Arbelo E, Ortiz-Pérez JT, Brugada J, Mont L, Roca-Luque I. Evolution of Deceleration Zones During Ventricular Tachycardia Ablation and Relation With Cardiac Magnetic Resonance. JACC Clin Electrophysiol 2023. [DOI: 10.1016/j.jacep.2022.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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Tschabrunn CM, Callans DJ. Identifying the ventricular tachycardia arrhythmogenic substrate: The quest for the holy grail continues. Heart Rhythm 2023; 20:272-273. [PMID: 36336302 DOI: 10.1016/j.hrthm.2022.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Cory M Tschabrunn
- Cardiac Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David J Callans
- Cardiac Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
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71
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Deshmukh A, Gunda S, Siontis KC, Ghannam M, Liang J, Latchamsetty R, Jongnarangsin K, Morady F, Bogun F. Comparison of warfarin with direct oral anticoagulants for thromboembolic prophylaxis after catheter ablation of ventricular tachycardia. J Cardiovasc Electrophysiol 2023; 34:967-972. [PMID: 36655538 DOI: 10.1111/jce.15827] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/10/2023] [Accepted: 01/14/2023] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Thromboembolic events after catheter ablation of ventricular tachycardia (VT) can result in significant morbidity. Thromboembolic prophylaxis after catheter ablation can be achieved by the use of antiplatelet agents, vitamin K antagonists, or direct oral anticoagulants (DOACs). The relative safety and efficacy of these modes of prophylaxis are uncertain. We sought to compare the outcomes of patients who received warfarin or DOACs for thromboembolic prophylaxis after catheter ablation of VT. METHODS AND RESULTS Anticoagulation with DOACS was started after left ventricular VT ablation in a series of 42 consecutive patients with structural heart disease (67 ± 11 years, 3 women, ejection fraction 32 ± 14%). Duration of hospital stay, bleeding episodes, and thromboembolic events were compared to a historic consecutive group of patients (n = 38, 65 ± 13 years, 14 women, ejection fraction 36 ± 13%) in whom anticoagulation with a formerly described protocol of heparin and vitamin K antagonist was used after VT ablation procedures. Hospital stay was significantly shorter in the group where DOACs were used as compared to vitamin K antagonists (3.3 ± 1.8 vs. 5.0 ± 2.5 days postablation; p = 0.001) without an increase of bleeding or thromboembolic events. CONCLUSION Anticoagulation with DOACs is safe and shortens hospital stay in patients with structural heart disease undergoing left ventricular VT ablation procedures.
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Affiliation(s)
- Amrish Deshmukh
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, Michigan, USA
| | - Sampath Gunda
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Michael Ghannam
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, Michigan, USA
| | - Jackson Liang
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, Michigan, USA
| | - Rakesh Latchamsetty
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, Michigan, USA
| | - Krit Jongnarangsin
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, Michigan, USA
| | - Fred Morady
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, Michigan, USA
| | - Frank Bogun
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, Michigan, USA
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De Potter T, Balt JC, Boersma L, Sacher F, Neuzil P, Reddy V, Grigorov I, Verma A. First-in-Human Experience With Ultra-Low Temperature Cryoablation for Monomorphic Ventricular Tachycardia. JACC Clin Electrophysiol 2023; 9:686-691. [PMID: 36752466 DOI: 10.1016/j.jacep.2022.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/10/2022] [Accepted: 11/20/2022] [Indexed: 01/20/2023]
Abstract
Ultra-low temperature cryoablation (ULTC) using near-critical nitrogen (-196ºC) has been shown to produce durable, contiguous, transmural lesions in ventricles of animal models. This report summarizes acute experience with ULTC in the first-ever 13 patients with recurrent monomorphic ventricular tachycardias (VTs) of both ischemic cardiomyopathy and nonischemic etiologies enrolled in the CryoCure-VT (Cryoablation for Monomorphic Ventricular Tachycardia; NCT04893317) clinical trial. After an average of 9.6 ± 4.6 endocardial ULTC lesions per patient, no clinical ventricular tachycardias were inducible in 91% of patients. Two procedure-related serious adverse events recorded in 2 patients resolved post-procedurally without clinical sequelae. Further investigation of both acute and chronic outcomes is warranted and ongoing.
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Affiliation(s)
- Tom De Potter
- Cardiovascular Center, OLV Hospital, Aalst, Belgium.
| | - Jippe C Balt
- St Antonius Hospital, Nieuwegein, the Netherlands
| | | | | | | | - Vivek Reddy
- Mount Sinai Hospital, New York, New York, USA
| | | | - Atul Verma
- McGill University, Montreal, Quebec, Canada
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Tan NY, Maeda S, Siontis KC. A timely update on catheter ablation of scar-related ventricular tachycardia. J Interv Card Electrophysiol 2023; 66:177-178. [PMID: 35895221 DOI: 10.1007/s10840-022-01309-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 10/16/2022]
Affiliation(s)
- Nicholas Y Tan
- Department of Cardiovascular Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Shingo Maeda
- Arrhythmia Advanced Therapy Center, AOI Universal Hospital, Kawasaki, Japan
| | - Konstantinos C Siontis
- Department of Cardiovascular Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
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Shah R, Sharma A, Assis F, De Vasconcellos HD, Alugubelli N, Pandey P, Akhtar T, Gasperetti A, Zhou S, Halperin H, Zimmerman SL, Tandri H, Kolandaivelu A. Quality assessment of cardiac magnetic resonance myocardial scar imaging prior to ventricular arrhythmia ablation. Int J Cardiovasc Imaging 2023; 39:411-421. [PMID: 36331683 PMCID: PMC9870828 DOI: 10.1007/s10554-022-02734-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 09/24/2022] [Indexed: 11/06/2022]
Abstract
High-resolution scar characterization using late gadolinium enhancement cardiac magnetic resonance imaging (LGE-CMR) is useful for guiding ventricular arrhythmia (VA) treatment. However, imaging study quality may be degraded by breath-holding difficulties, arrhythmias, and implantable cardioverter-defibrillators (ICDs). We evaluated the effect of image quality on left ventricle (LV) base to apex scar interpretation in pre-VA ablation LGE-CMR. 43 consecutive patients referred for VA ablation underwent gradient-recalled-echo LGE-CMR. In ICD patients (n = 24), wide-bandwidth inversion-recovery suppressed ICD artifacts. In non-ICD patients, single-shot steady-state free-precession LGE-CMR could also be performed to reduce respiratory motion/arrhythmia artifacts. Study quality was assessed for adequate/limited scar interpretation due to cardiac/respiratory motion artifacts, ICD-related artifacts, and image contrast. 28% of non-ICD patients had studies where image quality limited scar interpretation in at least one image compared to 71% of ICD patient studies (p = 0.012). A median of five image slices had limited quality per ICD patient study, compared to 0 images per non-ICD patient study. Poorer quality in ICD patients was largely due to motion-related artifacts (54% ICD vs 6% non-ICD studies, p = 0.001) as well as ICD-related image artifacts (25% of studies). In VA ablation patients with ICDs, conventional CMR protocols frequently have image slices with limited scar interpretation, which can limit whole-heart scar assessment. Motion artifacts contribute to suboptimal image quality, particularly in ICD patients. Improved methods for motion and ICD artifact suppression may better delineate high-resolution LGE scar features of interest for guiding VA ablation.
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Affiliation(s)
- Rushil Shah
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Carnegie 528, 600 N. Wolfe St, Baltimore, MD 21287 USA
| | - Apurva Sharma
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Carnegie 528, 600 N. Wolfe St, Baltimore, MD 21287 USA
| | - Fabrizio Assis
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Carnegie 528, 600 N. Wolfe St, Baltimore, MD 21287 USA
| | - Henrique Doria De Vasconcellos
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Carnegie 528, 600 N. Wolfe St, Baltimore, MD 21287 USA
| | - Navya Alugubelli
- Division of Cardiology, Department of Medicine, Creighton University, Omaha, NE USA
| | - Pallavi Pandey
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Tauseef Akhtar
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Carnegie 528, 600 N. Wolfe St, Baltimore, MD 21287 USA
| | - Alessio Gasperetti
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Carnegie 528, 600 N. Wolfe St, Baltimore, MD 21287 USA
| | - Shijie Zhou
- Department of Chemical, Paper and Biomedical Engineering, Miami University, Oxford, OH USA ,Department of Electrical and Chemical Engineering, Miami University, Oxford, OH USA
| | - Henry Halperin
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Carnegie 528, 600 N. Wolfe St, Baltimore, MD 21287 USA
| | - Stefan L. Zimmerman
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Harikrishna Tandri
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Carnegie 528, 600 N. Wolfe St, Baltimore, MD 21287 USA
| | - Aravindan Kolandaivelu
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Carnegie 528, 600 N. Wolfe St, Baltimore, MD 21287 USA
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STereotactic Arrhythmia Radioablation: current status of the art. The old world and the new world connected. JOURNAL OF RADIOTHERAPY IN PRACTICE 2023. [DOI: 10.1017/s1460396922000401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Kučera T, Jedličková K, Šramko M, Peichl P, Cvek J, Knybel L, Hurník P, Neuwirth R, Jiravský O, Voska L, Kautzner J. Inflammation and fibrosis characterize different stages of myocardial remodeling in patients after stereotactic body radiotherapy of ventricular myocardium for recurrent ventricular tachycardia. Cardiovasc Pathol 2023; 62:107488. [PMID: 36206914 PMCID: PMC9760563 DOI: 10.1016/j.carpath.2022.107488] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/29/2022] [Accepted: 09/29/2022] [Indexed: 01/03/2023] Open
Abstract
We performed a histological and immunohistochemical analysis of myocardia from 3 patients who underwent radiosurgery and died for various reasons 3 months to 9 months after radiotherapy. In Case 1 (death 3 months after radiotherapy) we observed a sharp transition between relatively intact and irradiated regions. In the myolytic foci, only scattered cardiomyocytes were left and the area was infiltrated by immune cells. Using immunohistochemistry we detected numerous inflammatory cells including CD68+/CD11c+ macrophages, CD4+ and CD8+ T-lymphocytes and some scattered CD20+ B-lymphocytes. Mast cells were diminished in contrast to viable myocardium. In Case 2 and Case 3 (death 6 and 9 months after radiotherapy, respectively) we found mostly fibrosis, infiltration by adipose tissue and foci of calcification. Inflammatory infiltrates were less pronounced. Our observations are in accordance with animal experimental studies and confirm a progress from myolysis to fibrosis. In addition, we demonstrate a role of pro-inflammatory macrophages in the earlier stages of myocardial remodeling after stereotactic radioablation for ventricular tachycardia.
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Affiliation(s)
- Tomáš Kučera
- Institute of Histology and Embryology, First Faculty of Medicine, Charles University, Albertov 4, 120 00, Prague, Czech Republic,Corresponding author: Tomáš Kučera, MD, Ph.D. Institute of Histology and Embryology, First Faculty of Medicine, Charles University, Albertov 4, 120 00, Prague, Czech Republic, Phone Number: +420224968130.
| | - Kristína Jedličková
- Department of Pathology, Institute for Clinical and Experimental Medicine (IKEM), Vídeňská 1958, 140 21, Prague, Czech Republic
| | - Marek Šramko
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Vídeňská 1958, 140 21, Prague, Czech Republic
| | - Petr Peichl
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Vídeňská 1958, 140 21, Prague, Czech Republic
| | - Jakub Cvek
- Department of Oncology, University Hospital Ostrava, 17. listopadu 1790, 708 52, Ostrava, Czech Republic
| | - Lukáš Knybel
- Department of Oncology, University Hospital Ostrava, 17. listopadu 1790, 708 52, Ostrava, Czech Republic
| | - Pavel Hurník
- Institute of Clinical and Molecular Pathology and Medical Genetics, University Hospital Ostrava, 17. listopadu 1790, 708 52, Ostrava, Czech Republic
| | - Radek Neuwirth
- Faculty of Medicine, Masaryk University, Brno, Kamenice 753/5, 625 00 Brno,Agel Hospital Třinec Podlesí a.s., Konská 453, 739 61 Třinec, Czech Republic
| | - Otakar Jiravský
- Faculty of Medicine, Masaryk University, Brno, Kamenice 753/5, 625 00 Brno,Agel Hospital Třinec Podlesí a.s., Konská 453, 739 61 Třinec, Czech Republic
| | - Luděk Voska
- Department of Pathology, Institute for Clinical and Experimental Medicine (IKEM), Vídeňská 1958, 140 21, Prague, Czech Republic
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Vídeňská 1958, 140 21, Prague, Czech Republic
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Cellini F, Narducci ML, Pavone C, Bencardino G, Perna F, Pinnacchio G, Chiesa S, Massaccesi M, Gambacorta MA, Manfrida S, Longo S, Mannocci A, Di Gregorio G, Boldrini L, Tagliaferri L, Indovina L, Placidi L, Stimato G, Spera FR, Scacciavillani R, Crea F, Valentini V, Pelargonio G. Ventricular tachycardia ablation through radiation therapy (VT-ART) consortium: Concept description of an observational multicentric trial via matched pair analysis. Front Cardiovasc Med 2023; 10:1020966. [PMID: 36923954 PMCID: PMC10008881 DOI: 10.3389/fcvm.2023.1020966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 01/13/2023] [Indexed: 03/01/2023] Open
Abstract
Introduction Monomorphic ventricular tachycardia (VT) is a life-threatening condition often observed in patients with structural heart disease. Ventricular tachycardia ablation through radiation therapy (VT-ART) for sustained monomorphic ventricular tachycardia seems promising, effective, and safe. VT-ART delivers focused, high-dose radiation, usually in a single fraction of 25 Gy, allowing ablation of VT by inducing myocardial scars. The procedure is fully non-invasive; therefore, it can be easily performed in patients with contraindications to invasive ablation procedures. Definitive data are lacking, and no direct comparison with standard procedures is available. Discussion The aim of this multicenter observational study is to evaluate the efficacy and safety of VT-ART, comparing the clinical outcome of patients undergone to VT-ART to patients not having received such a procedure. The two groups will not be collected by direct, prospective accrual to avoid randomization among the innovative and traditional arm: A retrospective selection through matched pair analysis will collect patients presenting features similar to the ones undergone VT-ART within the consortium (in each center independently). Our trial will enroll patients with optimized medical therapy in whom endocardial and/or epicardial radiofrequency ablation (RFA), the gold standard for VT ablation, is either unfeasible or fails to control VT recurrence. Our primary outcome is investigating the difference in overall cardiovascular survival among the group undergoing VT-ART and the one not exposed to the innovative procedure. The secondary outcome is evaluating the difference in ventricular event-free survival after the last procedure (i.e., last RFA vs. VT-ART) between the two groups. An additional secondary aim is to evaluate the reduction in the number of VT episodes comparing the 3 months before the procedure to the ones recorded at 6 months (from the 4th to 6th month) following VT-ART and RFA, respectively. Other secondary objectives include identifying the benefits of VT-ART on cardiac function, as evaluated through an electrocardiogram, echocardiographic, biochemical variables, and on patient quality of life. We calculated the sample size (in a 2:1 ratio) upon enrolling 149 patients: 100 in the non-exposed control group and 49 in the VT-ART group. Progressively, on a multicentric basis supervised by the promoting center in the VT-ART consortium, for each VT-ART patient enrollment, a matched pair patient profile according to the predefined features will be shared with the consortium to enroll a patient that has not undergone VT-ART. Conclusion Our trial will provide insight into the efficacy and safety of VT-ART through a matched pair analysis, via an observational, multicentric study of two groups of patients with or without VT-ART in the multicentric consortium (with subgroup stratification into dynamic cohorts).
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Affiliation(s)
- Francesco Cellini
- Dipartimento Universitario Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy.,Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Maria Lucia Narducci
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Chiara Pavone
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gianluigi Bencardino
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Perna
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gaetano Pinnacchio
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Silvia Chiesa
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Mariangela Massaccesi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Maria Antonietta Gambacorta
- Dipartimento Universitario Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy.,Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Stefania Manfrida
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Silvia Longo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alice Mannocci
- Faculty of Economics, Universitas Mercatorum, Rome, Italy
| | - Giuseppe Di Gregorio
- Dipartimento Universitario Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Boldrini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luca Tagliaferri
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luca Indovina
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Lorenzo Placidi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gerardina Stimato
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Raffaele Spera
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Roberto Scacciavillani
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Filippo Crea
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Istituto di Cardiologia, Universitá Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Valentini
- Dipartimento Universitario Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy.,Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gemma Pelargonio
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Howell SJ, Moss JD. Adding epicardial ablation for ventricular tachycardia: a 1-2 punch, or simply 3rd time's the charm? J Interv Card Electrophysiol 2023; 66:95-97. [PMID: 35403928 DOI: 10.1007/s10840-022-01216-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/05/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Stacey J Howell
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco, CA, USA
| | - Joshua D Moss
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco, CA, USA.
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Complications of catheter ablation for ventricular tachycardia. JOURNAL OF INTERVENTIONAL CARDIAC ELECTROPHYSIOLOGY : AN INTERNATIONAL JOURNAL OF ARRHYTHMIAS AND PACING 2023; 66:221-233. [PMID: 36053374 DOI: 10.1007/s10840-022-01357-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 08/20/2022] [Indexed: 11/09/2022]
Abstract
With the increasing literature demonstrating benefits of catheter ablation for ventricular tachycardia (VT), the number of patients undergoing VT ablation has increased dramatically. As VT ablation is being performed more routinely, operators must be aware of potential complications of VT ablation. This review delves deeper into the practice of VT ablation with a focus on periprocedural complications.
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80
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Matos D, Adragão P, Pisani C, Hatanaka V, Freitas P, Costa F, Chokr M, Hardy C, Ferreira AM, Carmo P, Laura S, Morgado F, Cavaco D, Mendes M, Scanavacca M. Outcomes of a combined vs non-combined endo-epicardial ventricular tachycardia ablation strategy. J Interv Card Electrophysiol 2023; 66:87-94. [PMID: 35258753 DOI: 10.1007/s10840-022-01175-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 02/28/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Direct comparisons of combined (C-ABL) and non-combined (NC-ABL) endo-epicardial ventricular tachycardia (VT) ablation outcomes are scarce. We aimed to investigate the long-term clinical efficacy and safety of these 2 strategies in ischemic heart disease (IHD) and non-ischemic cardiomyopathy (NICM) populations. METHODS Multicentric observational registry included 316 consecutive patients who underwent catheter ablation for drug-resistant VT between January 2008 and July 2019. Primary and secondary efficacy endpoints were defined as VT-free survival and all-cause death after ablation. Safety outcomes were defined by 30-day mortality and procedure-related complications. RESULTS Most of the patients were male (85%), with IHD (67%) and mean age of 63 ± 13 years. During a mean follow-up of 3 ± 2 years, 117 (37%) patients had VT recurrence and 73 (23%) died. Multivariate survival analysis identified electrical storm (ES) at presentation, IHD, left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) functional class III / IV, and C-ABL as independent predictors of VT recurrence. In 135 patients undergoing repeated procedures, only C-ABL and ES were independent predictors of relapse. The identified independent predictors of mortality were C-ABL, ES, LVEF, age, and NYHA class III / IV. C-ABL survival benefit was only seen in patients with a previous ablation (P for interaction = 0.04). Mortality at 30 days was similar between NC-ABL and C-ABL (4% vs. 2%, respectively, P = 0.777), as was complication rate (10.3% vs. 15.1%, respectively, P = 0.336). CONCLUSION A combined or sequential endo-epicardial VT ablation strategy was associated with lower VT recurrence and lower all-cause death in IHD and NICM patients undergoing repeated procedures. Both approaches seemed equally safe.
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Affiliation(s)
- Daniel Matos
- Cardiology and Eletrophysiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Reinaldo Dos Santos, 2790-134, Carnaxide, Portugal.
| | - Pedro Adragão
- Cardiology and Eletrophysiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Reinaldo Dos Santos, 2790-134, Carnaxide, Portugal
| | - Cristiano Pisani
- Heart Institute (Incor), University of São Paulo Medical School, São Paulo, Brazil
| | - Vinicius Hatanaka
- Heart Institute (Incor), University of São Paulo Medical School, São Paulo, Brazil
| | - Pedro Freitas
- Cardiology and Eletrophysiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Reinaldo Dos Santos, 2790-134, Carnaxide, Portugal
| | - Francisco Costa
- Cardiology and Eletrophysiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Reinaldo Dos Santos, 2790-134, Carnaxide, Portugal
| | - Muhiedinne Chokr
- Heart Institute (Incor), University of São Paulo Medical School, São Paulo, Brazil
| | - Carina Hardy
- Heart Institute (Incor), University of São Paulo Medical School, São Paulo, Brazil
| | - António Miguel Ferreira
- Cardiology and Eletrophysiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Reinaldo Dos Santos, 2790-134, Carnaxide, Portugal
| | - Pedro Carmo
- Cardiology and Eletrophysiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Reinaldo Dos Santos, 2790-134, Carnaxide, Portugal
| | - Sissy Laura
- Heart Institute (Incor), University of São Paulo Medical School, São Paulo, Brazil
| | - Francisco Morgado
- Cardiology and Eletrophysiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Reinaldo Dos Santos, 2790-134, Carnaxide, Portugal
| | - Diogo Cavaco
- Cardiology and Eletrophysiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Reinaldo Dos Santos, 2790-134, Carnaxide, Portugal
| | - Miguel Mendes
- Cardiology and Eletrophysiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Reinaldo Dos Santos, 2790-134, Carnaxide, Portugal
| | - Maurício Scanavacca
- Heart Institute (Incor), University of São Paulo Medical School, São Paulo, Brazil
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81
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Nakahara S. Catheter ablation of ventricular tachycardia associated with structural heart disease: Current status and perspectives. J Cardiol 2023; 81:57-62. [PMID: 36174816 DOI: 10.1016/j.jjcc.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/06/2022] [Indexed: 11/25/2022]
Abstract
Catheter ablation is an effective and safe treatment for ventricular tachycardia attributable to structural heart disease, reducing the risk of recurrent arrhythmias and defibrillator shock therapy. Advances in medical technology and an accumulation of data have led to the development of detailed guidelines. Successful ablation requires accurate identification of the arrhythmia substrate and effective delivery of radiofrequency energy to the target tissue. Modern practice requires use of traditional electrophysiological mapping processes such as entrainment mapping and three-dimensional activation sequence mapping in combination with newer functional mapping techniques for which there is growing support. Thorough non-invasive preoperative assessment is also necessary before an invasive procedure is undertaken. In this review, we summarize contemporary practice and recent randomized controlled trials underpinning the latest developments in mapping and ablation and discuss potential future developments in this field.
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Affiliation(s)
- Shiro Nakahara
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan.
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82
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Abstract
Sex and racial disparities in the presentation, diagnosis, and management of cardiac arrhythmias are recognized. Sex-specific differences in electrophysiological parameters are well known and are predominantly related to differences in ion channel expression and the influence of sex hormones. However, the relationship between hormonal or racial influence and arrhythmia mechanisms, presentation, and management needs to be better defined. Women and racial and ethnic groups are less likely to undergo catheter ablation procedures for treatment of cardiac arrhythmias. Underrepresentation of women and racial/ethnic groups in clinical trials has resulted in significant knowledge gaps. Whether sex and racial disparities in arrhythmia management reflect barriers in access to care, physician bias, patient values, and preferences or other factors requires further study.
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Affiliation(s)
- Bert Vandenberk
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Derek S. Chew
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ratika Parkash
- Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Anne M. Gillis
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,Address reprint requests and correspondence: Dr Anne M. Gillis, Libin Cardiovascular Institute, University of Calgary, Foothills Medical Centre, 1403–29 St NW, Calgary T2N 2T9, Alberta, Canada.
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83
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Sex differences on outcomes of catheter ablation of ventricular tachycardia in patients with structural heart disease: A real-world systematic review and meta-analysis. Heart Rhythm O2 2022; 3:847-856. [PMID: 36588991 PMCID: PMC9795314 DOI: 10.1016/j.hroo.2022.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Sex differences have diversely affected cardiac diseases. Little is known whether these differences impact outcomes of catheter ablation of ventricular tachycardia (VT). Objectives To assess the impact of sex differences on outcomes of catheter ablation of VT. Methods Databases were searched from inception through December 2021. Effect estimates from individual studies were extracted and combined using the random-effects, generic inverse variance method of DerSimonian and Laird. The outcomes of interest included VT recurrence rates, all-cause mortality, and composite outcomes of mortality, left ventricular assistant device use, and heart transplantation following VT ablation. Results Our analysis included 22 observational studies. There were 10,206 patients, of which 12.8% were women. We found no statistical difference between sexes for VT recurrence rate (pooled hazard ratio [HR] 1.04, P = .57, I 2 = 14.9%). Similarly, there was statistical difference in neither all-cause mortality nor composite outcomes (pooled HR 0.93, P = .75, I 2 = 59.1% and pooled HR 0.9, P = .33, I 2 = 0%, respectively). There was a trend toward an increase in women undergoing VT ablation in the recent registries (P = .071). Conclusion Our contemporary analysis suggests that sex may have no impact on clinical outcomes of catheter ablation of VT in patients with structural heart disease, though women are the underrepresented. However, recent VT ablation registries have involved more women in their studies. Future studies with a higher proportion of women are encouraged to verify the current perception.
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84
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Kipp R, Kalscheur M, Sheehy AM, Bartels CM, Kind AJH, Powell WR. Race, Sex, and Neighborhood Socioeconomic Disparities in Ablation of Ventricular Tachycardia Within a National Medicare Cohort. J Am Heart Assoc 2022; 11:e027093. [PMID: 36515242 PMCID: PMC9798800 DOI: 10.1161/jaha.122.027093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Ventricular tachycardia (VT) ablation significantly improves our ability to control VT, yet little is known about whether disparities exist in delivery of this technology. Methods and Results Using a national 100% Medicare inpatient data set of beneficiaries admitted with VT from January 1, 2014, through November 30, 2014, multivariable logistic regression techniques were used to examine the sociodemographic and clinical characteristics associated with receiving ablation. Census block group-level neighborhood socioeconomic disadvantage was measured for each patient by the Area Deprivation Index, a composite measure of socioeconomic disadvantage consisting of education, income, housing, and employment factors. Among 131 645 patients admitted with VT, 2190 (1.66%) received ablation. After adjustment for comorbidities, hospital characteristics, and sociodemographics, female sex (odds ratio [OR], 0.75 [95% CI, 0.67-0.84]), identifying as Black race (OR, 0.75 [95% CI, 0.62-0.90] compared with identifying as White race), and living in a highly socioeconomically disadvantaged neighborhood (national Area Deprivation Index percentile of >85%) (OR, 0.81 [95% CI, 0.69-0.95] versus Area Deprivation Index ≤85%) were associated with significantly lower odds of receiving ablation. Conclusions Female patients, patients identifying as Black race, and patients living in the most disadvantaged neighborhoods are 19% to 25% less likely to receive ablation during hospitalization with VT. The cause of and solutions for these disparities require further investigation.
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Affiliation(s)
- Ryan Kipp
- Division of Cardiovascular Medicine, Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWI,William S. Middleton Memorial Veterans HospitalMadisonWI
| | - Matthew Kalscheur
- Division of Cardiovascular Medicine, Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWI,William S. Middleton Memorial Veterans HospitalMadisonWI
| | - Ann M. Sheehy
- Division of Hospitalist Medicine, Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWI
| | - Christie M. Bartels
- Division of Rheumatology, Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWI
| | - Amy J. H. Kind
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public HealthMadisonWI,Division of Geriatric Medicine, Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWI
| | - W. Ryan Powell
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public HealthMadisonWI
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Tóth P, Komlósi F, Vámosi P, Arnóth B, Szegedi N, Salló Z, Piros K, Perge P, Osztheimer I, Ábrahám P, Széplaki G, Merkely B, Gellér L, Nagy KV. Sex differences in one-year recurrence and all-cause mortality following catheter ablation of ventricular tachycardia in structural heart disease. Front Cardiovasc Med 2022; 9:1061471. [PMID: 36561769 PMCID: PMC9763270 DOI: 10.3389/fcvm.2022.1061471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
Aims We aimed to establish sex-specific predictors for 1-year VT recurrence and 1-year all-cause mortality in patients with structural heart disease undergoing catheter ablation. Methods We analyzed data of 299 patients recorded in our structured registry. These included medical history, echocardiography parameters, laboratory results, VT properties, procedural data. Results Out of the 299 patients, 34 (11%) were female. No significant difference was found between women and men in terms of VT recurrence (p = 0.74) or mortality (p = 0.07). In females, severe mitral regurgitation (MR), tricuspid regurgitation (TR), presentation with incessant VT, and preprocedural electrical storm (ES) were associated with increased risk of VT recurrence. Diabetes, implanted CRT, VT with hemodynamic instability, ES and advanced MR were the risk factors of mortality in women. ACEi/ARB use predicted a favorable outcome in both endpoints among females. In men, independent predictors of VT recurrence were the composite parameter of ES and multiple ICD therapies, presentation with incessant VT, severe MR, while independent predictors of mortality were age, LVEF, creatinine and previously implanted CRT. Conclusion According to our investigation, there are pronounced sex differences in predictors of recurrence and mortality following VT ablation.
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Affiliation(s)
- Patrik Tóth
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Ferenc Komlósi
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Péter Vámosi
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bence Arnóth
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary,Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Nándor Szegedi
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Zoltán Salló
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Katalin Piros
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Péter Perge
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Pál Ábrahám
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Gábor Széplaki
- Mater Private Hospital, Dublin, Ireland,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - László Gellér
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Klaudia Vivien Nagy
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary,*Correspondence: Klaudia Vivien Nagy
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Prasitlumkum N, Navaravong L, Desai A, Desai D, Cheungpasitporn W, Rattanawong P, Bunch TJ, Jongnarangsin K, Chokesuwattanaskul R. Impact of early ventricular tachycardia ablation in patients with an implantable cardioverter-defibrillator: An updated systematic review and meta-analysis of randomized controlled trials. Heart Rhythm 2022; 19:2054-2061. [PMID: 35820619 DOI: 10.1016/j.hrthm.2022.07.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/29/2022] [Accepted: 07/04/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND There is limited information on whether early catheter ablation (CA) for ventricular tachycardia (VT) is associated with better outcomes compared with alternative strategies in patients with implantable cardioverter-defibrillator (ICD). OBJECTIVE The purpose of this article was to assess the efficacy of early VT CA in patients with ICD. METHODS EMBASE, PubMed, and Cochrane were searched from inception to April 2022. Randomized controlled trials comparing the efficacy of early VT CA with control groups, both in patients with ICD, were included in the analysis. Data on effect estimates in individual studies were extracted and combined via random effects meta-analysis using the DerSimonian and Laird method, a generic inverse variance strategy. RESULTS Nine randomized controlled trials with 1106 patients (n = 1018, 92.1% with ischemic cardiomyopathy and n = 88, 7.9% with nonischemic cardiomyopathy) were evaluated. VT CA was associated with reduced VT recurrences (odds ratio [OR] 0.64; P = .007), appropriate ICD shocks (OR 0.53; P = .002), ICD therapies (OR 0.54; P = .002), and cardiovascular hospitalization (OR 0.67; P = .004). However, no significant differences were observed in terms of mortality rate, heart failure hospitalization, and quality of life between the early VT CA and control groups. CONCLUSION Early CA was beneficial in reducing VT burden and ICD therapies. However, it did not affect mortality rate and quality of life. Since most patients in the included studies presented with ischemic cardiomyopathy, further studies on nonischemic cardiomyopathy should be conducted to validate if early CA has similar outcomes.
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Affiliation(s)
- Narut Prasitlumkum
- Department of Cardiology, University of California Riverside, Riverside, California
| | - Leenhapong Navaravong
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Aditya Desai
- Department of Internal Medicine, University of California Riverside, Riverside, California
| | - Darshi Desai
- Department of Internal Medicine, University of California Riverside, Riverside, California
| | | | | | - T Jared Bunch
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Krit Jongnarangsin
- Division of Cardiovascular Medicine, Frankel Cardiovascular Center, University of Michigan Health, Ann Arbor, Michigan
| | - Ronpichai Chokesuwattanaskul
- Division of Cardiovascular Medicine, Department of Medicine, Cardiac Center, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
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Mirwais M, Supple GE. Early ventricular tachycardia ablation: For some, but not for all? Heart Rhythm 2022; 19:2062-2063. [PMID: 35940459 DOI: 10.1016/j.hrthm.2022.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 07/21/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Maiwand Mirwais
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
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Ono K, Iwasaki Y, Akao M, Ikeda T, Ishii K, Inden Y, Kusano K, Kobayashi Y, Koretsune Y, Sasano T, Sumitomo N, Takahashi N, Niwano S, Hagiwara N, Hisatome I, Furukawa T, Honjo H, Maruyama T, Murakawa Y, Yasaka M, Watanabe E, Aiba T, Amino M, Itoh H, Ogawa H, Okumura Y, Aoki‐Kamiya C, Kishihara J, Kodani E, Komatsu T, Sakamoto Y, Satomi K, Shiga T, Shinohara T, Suzuki A, Suzuki S, Sekiguchi Y, Nagase S, Hayami N, Harada M, Fujino T, Makiyama T, Maruyama M, Miake J, Muraji S, Murata H, Morita N, Yokoshiki H, Yoshioka K, Yodogawa K, Inoue H, Okumura K, Kimura T, Tsutsui H, Shimizu W. JCS/JHRS 2020 Guideline on Pharmacotherapy of Cardiac Arrhythmias. J Arrhythm 2022; 38:833-973. [PMID: 36524037 PMCID: PMC9745564 DOI: 10.1002/joa3.12714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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89
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Maher T, Clarke JR, Virk Z, d'Avila A. Patient Selection, Techniques, and Complication Mitigation for Epicardial Ventricular Tachycardia Ablation. Card Electrophysiol Clin 2022; 14:657-677. [PMID: 36396183 DOI: 10.1016/j.ccep.2022.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Percutaneous epicardial ventricular tachycardia ablation can decrease implanted cardioverter defibrillator shocks and hospitalizations; proper patient selection and procedural technique are imperative to maximize the benefit-risk ratio. The best candidates for epicardial ventricular tachycardia will depend on history of prior ablation, type of cardiomyopathy, and specific electrocardiogram and cardiac imaging findings. Complications include hemopericardium, hemoperitoneum, coronary vessel injury, and phrenic nerve injury. Modern epicardial mapping techniques provide new understandings of the 3-dimensional nature of reentrant ventricular tachycardia circuits across cardiomyopathy etiologies. Where epicardial access is not feasible, alternative techniques to reach epicardial ventricular tachycardia sources may be necessary.
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Affiliation(s)
- Timothy Maher
- Harvard Thorndike Electrophysiology Institute and Arrhythmia Service, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Palmer 4, Boston, MA 02215, USA; Harvard Medical School, Boston, MA, USA
| | - John-Ross Clarke
- Harvard Thorndike Electrophysiology Institute and Arrhythmia Service, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Palmer 4, Boston, MA 02215, USA; Harvard Medical School, Boston, MA, USA
| | - Zain Virk
- Harvard Medical School, Boston, MA, USA; Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN, USA
| | - Andre d'Avila
- Harvard Thorndike Electrophysiology Institute and Arrhythmia Service, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Palmer 4, Boston, MA 02215, USA; Harvard Medical School, Boston, MA, USA.
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90
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Ghannam M, Bogun F. Improving Outcomes in Ventricular Tachycardia Ablation Using Imaging to Identify Arrhythmic Substrates. Card Electrophysiol Clin 2022; 14:609-620. [PMID: 36396180 DOI: 10.1016/j.ccep.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Ventricular tachycardia (VT) ablation is limited by modest acute and long-term success rates, in part due to the challenges in accurately identifying the arrhythmogenic substrate. The combination of multimodality imaging along with information from electroanatomic mapping allows for a more comprehensive assessment of the arrhythmogenic substrate which facilitates VT ablation, and the use of preprocedural imaging has been shown to improve long-term ablation outcomes. Beyond regional recognition of the arrhythmogenic substrate, advanced imaging techniques can be used to create tailored ablation strategies preprocedurally. This review will focus on how imaging can be used to guide ablation planning and execution with a focus on clinical applications aimed at improving the outcome of VT ablation procedures.
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Affiliation(s)
- Michael Ghannam
- Division of Cardiovascular Medicine, University of Michigan, 1500 E. Medical Center Dr., SPC5853, Ann Arbor, Michigan 48109-5853, USA.
| | - Frank Bogun
- Division of Cardiovascular Medicine, University of Michigan, 1500 E. Medical Center Dr., SPC5853, Ann Arbor, Michigan 48109-5853, USA
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91
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Valderrábano M, Rojas SCF, Lador A, Patel A, Schurmann PA, Tapias C, Rodríguez D, Sáenz LC, Malahjfi M, Shah DJ, Mathuria N, Dave AS. Substrate Ablation by Multivein, Multiballoon Coronary Venous Ethanol for Refractory Ventricular Tachycardia in Structural Heart Disease. Circulation 2022; 146:1644-1656. [PMID: 36321460 PMCID: PMC9712228 DOI: 10.1161/circulationaha.122.060882] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/15/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Ablation of ventricular tachycardia (VT) in the setting of structural heart disease often requires extensive substrate elimination that is not always achievable by endocardial radiofrequency ablation. Epicardial ablation is not always feasible. Case reports suggest that venous ethanol ablation (VEA) through a multiballoon, multivein approach can lead to effective substrate ablation, but large data sets are lacking. METHODS VEA was performed in 44 consecutive patients with ablation-refractory VT (ischemic, n=21; sarcoid, n=3; Chagas, n=2; idiopathic, n=18). Targeted veins were selected by mapping coronary veins on the epicardial aspect of endocardial scar (identified by bipolar voltage <1.5 mV), using venography and signal recording with a 2F octapolar catheter or by guidewire unipolar signals. Epicardial mapping was performed in 15 patients. Vein segments in the epicardial aspect of VT substrates were treated with double-balloon VEA by blocking flow with 1 balloon while injecting ethanol through the lumen of the second balloon, forcing (and restricting) ethanol between balloons. Multiple balloon deployments and multiple veins were used as needed. In 22 patients, late gadolinium enhancement cardiac magnetic resonance imaged the VEA scar and its evolution. RESULTS Median ethanol delivered was 8.75 (interquartile range, 4.5-13) mL. Injected veins included interventricular vein (6), diagonal (5), septal (12), lateral (16), posterolateral (7), and middle cardiac vein (8), covering the entire range of left ventricular locations. Multiple veins were targeted in 14 patients. Ablated areas were visualized intraprocedurally as increased echogenicity on intracardiac echocardiography and incorporated into 3-dimensional maps. After VEA, vein and epicardial ablation maps showed elimination of abnormal electrograms of the VT substrate. Intracardiac echocardiography demonstrated increased intramural echogenicity at the targeted region of the 3-dimensional maps. At 1 year of follow-up, median of 314 (interquartile range, 198-453) days of follow-up, VT recurrence occurred in 7 patients, for a success of 84.1%. CONCLUSIONS Multiballoon, multivein intramural ablation by VEA can provide effective substrate ablation in patients with ablation-refractory VT in the setting of structural heart disease over a broad range of left ventricular locations.
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Affiliation(s)
- Miguel Valderrábano
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | | | - Adi Lador
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Apoor Patel
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Paul A. Schurmann
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | | | | | | | - Maan Malahjfi
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Dipan J. Shah
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Nilesh Mathuria
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Amish S. Dave
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
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Ammar A, Sharief M, Abouelmagd K, Riad O, Ibrahim M. Outcomes of catheter ablation of ventricular tachycardia in non-ischemic idiopathic dilated cardiomyopathy: A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9:1007392. [DOI: 10.3389/fcvm.2022.1007392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 10/31/2022] [Indexed: 11/12/2022] Open
Abstract
ObjectiveTo perform a systematic review and meta-analysis of available trials regarding the outcomes of ventricular tachycardia (VT) ablation in patients with non-ischemic dilated cardiomyopathy (NIDCM).MethodsA comprehensive database search of large four electronic databases, including PubMed, Cochrane, Scopus, and Institute for Scientific Information network meta-analysis, identified five studies enrolling 666 patients for patients with idiopathic dilated cardiomyopathy (IDCM) underwent catheter ablation (CA) for VT. The short-term outcomes assessed included procedural success, VT non-inducibility and procedural complications, whereas the long-term outcomes assessed included VT recurrence, heart transplantation, antiarrhythmic drugs (AAD) use after ablation and death.ResultsA total of 5 observational studies reported outcomes in 666 patients with NIDCM undergoing VT CA. The complete procedural success was moderately high; 65.5% of the patients (95% CI 0.402- 0.857, p < 0.001) and the procedural complications occurred in 5.8% of the patients (95% CI 0.040–0.076, P = 0.685). Epicardial mapping and ablation were performed among 61.5% and 37% of patients with NIDCM respectively. During a follow up period of 12 to 45 months, there were VT recurrence in 34.2% of the patients (95% CI 0.301–0.465, p < 0.080), death in 20.2% of the patients (95% CI 0.059–0.283, p < 0.017) and heart transplantation in 12.9% of the patients (95% CI −0.026–0.245, P < 0.012).ConclusionVentricular tachycardia CA is effective and safe approach for management of patients with NIDCM with the epicardial approach to be considered as initial strategy especially in presence of ECG and CMR findings suggestive of epicardial substrate. A multicenter randomized trial is crucial to look at the short- and long-term outcomes of VT ablation in NIDCM especially with the advances in mapping and ablation techniques and predictors of success.
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93
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Computational Re-Entry Vulnerability Index Mapping to Guide Ablation in Patients With Post-Myocardial Infarction Ventricular Tachycardia. JACC Clin Electrophysiol 2022; 9:301-310. [PMID: 36752477 DOI: 10.1016/j.jacep.2022.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/07/2022] [Accepted: 10/03/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Ventricular tachycardias (VTs) in patients with myocardial infarction (MI) are often treated with catheter ablation. However, the VT induction during this procedure does not always identify all of the relevant activation pathways or may not be possible or tolerated. The re-entry vulnerability index (RVI) quantifies regional activation-repolarization differences and can detect multiple regions susceptible to re-entry without the need to induce the arrhythmia. OBJECTIVES This study aimed to further develop and validate the RVI mapping in patient-specific computational models of post-MI VTs. METHODS Cardiac magnetic resonance imaging data from 4 patients with post-MI VTs were used to induce VTs in a computational electrophysiological model by pacing. The RVI map of a premature beat in each patient model was used to guide virtual ablations. We compared our results with those of clinical ablation in the same patients. RESULTS Single-site virtual RVI-guided ablation prevented VT induction in 3 of 9 cases. Multisite virtual ablations guided by RVI mapping successfully prevented re-entry in all cases (9 of 9). Overall, virtual ablation required 15-fold fewer ablation sites (235.5 ± 97.4 vs 17 ± 6.8) and 2-fold less ablation volume (5.34 ± 1.79 mL vs 2.11 ± 0.65 mL) than the clinical ablation. CONCLUSIONS RVI mapping allows localization of multiple regions susceptible to re-entry and may help guide VT ablation. RVI mapping does not require the induction of arrhythmia and may result in less ablated myocardial volumes with fewer ablation sites.
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Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA, Charron P, Corrado D, Dagres N, de Chillou C, Eckardt L, Friede T, Haugaa KH, Hocini M, Lambiase PD, Marijon E, Merino JL, Peichl P, Priori SG, Reichlin T, Schulz-Menger J, Sticherling C, Tzeis S, Verstrael A, Volterrani M. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J 2022; 43:3997-4126. [PMID: 36017572 DOI: 10.1093/eurheartj/ehac262] [Citation(s) in RCA: 885] [Impact Index Per Article: 442.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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95
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Sung E, Prakosa A, Zhou S, Berger RD, Chrispin J, Nazarian S, Trayanova NA. Fat infiltration in the infarcted heart as a paradigm for ventricular arrhythmias. NATURE CARDIOVASCULAR RESEARCH 2022; 1:933-945. [PMID: 36589896 PMCID: PMC9802586 DOI: 10.1038/s44161-022-00133-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Infiltrating adipose tissue (inFAT) has been recently found to co-localize with scar in infarcted hearts and may contribute to ventricular arrhythmias (VAs), a life-threatening heart rhythm disorder. However, the contribution of inFAT to VA has not been well-established. We investigated the role of inFAT versus scar in VA through a combined prospective clinical and mechanistic computational study. Using personalized computational heart models and comparing the results from simulations of VA dynamics with measured electrophysiological abnormalities during the clinical procedure, we demonstrate that inFAT, rather than scar, is a primary driver of arrhythmogenic propensity and is frequently present in critical regions of the VA circuit. We determined that, within the VA circuitry, inFAT, as opposed to scar, is primarily responsible for conduction slowing in critical sites, mechanistically promoting VA. Our findings implicate inFAT as a dominant player in infarct-related VA, challenging existing paradigms and opening the door for unexplored anti-arrhythmic strategies.
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Affiliation(s)
- Eric Sung
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA.,Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, MD, USA
| | - Adityo Prakosa
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA.,Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, MD, USA
| | - Shijie Zhou
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA.,Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, MD, USA
| | - Ronald D. Berger
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, MD, USA.,Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Jonathan Chrispin
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, MD, USA.,Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD, USA.,These authors jointly supervised this work: Jonathan Chrispin, Saman Nazarian, Natalia A. Trayanova
| | - Saman Nazarian
- Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,These authors jointly supervised this work: Jonathan Chrispin, Saman Nazarian, Natalia A. Trayanova
| | - Natalia A. Trayanova
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA.,Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, MD, USA.,These authors jointly supervised this work: Jonathan Chrispin, Saman Nazarian, Natalia A. Trayanova.,Correspondence and requests for materials should be addressed to Natalia A. Trayanova.
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Abstract
The global burden caused by cardiovascular disease is substantial, with heart disease representing the most common cause of death around the world. There remains a need to develop better mechanistic models of cardiac function in order to combat this health concern. Heart rhythm disorders, or arrhythmias, are one particular type of disease which has been amenable to quantitative investigation. Here we review the application of quantitative methodologies to explore dynamical questions pertaining to arrhythmias. We begin by describing single-cell models of cardiac myocytes, from which two and three dimensional models can be constructed. Special focus is placed on results relating to pattern formation across these spatially-distributed systems, especially the formation of spiral waves of activation. Next, we discuss mechanisms which can lead to the initiation of arrhythmias, focusing on the dynamical state of spatially discordant alternans, and outline proposed mechanisms perpetuating arrhythmias such as fibrillation. We then review experimental and clinical results related to the spatio-temporal mapping of heart rhythm disorders. Finally, we describe treatment options for heart rhythm disorders and demonstrate how statistical physics tools can provide insights into the dynamics of heart rhythm disorders.
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Affiliation(s)
- Wouter-Jan Rappel
- Department of Physics, University of California San Diego, La Jolla, CA 92037
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97
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Zeppenfeld K, Wijnmaalen AP, Ebert M, Baldinger SH, Berruezo A, Catto V, Vaseghi M, Arya A, Kumar S, de Riva M, Deneke T, Gaspar T, Soejima K, van Rein N, Tedrow UB, Piorkowski C, Shivkumar K, Carbucicchio C, Hindricks G, Stevenson WG. Clinical Outcomes in Patients With Dilated Cardiomyopathy and Ventricular Tachycardia. J Am Coll Cardiol 2022; 80:1045-1056. [PMID: 36075673 DOI: 10.1016/j.jacc.2022.06.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/31/2022] [Accepted: 06/09/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Recurrent ventricular tachycardia (VT) due to dilated cardiomyopathy (DCM) is difficult to treat, and long-term outcome data are limited. OBJECTIVES The aim of this study was to identify predictors of mortality or heart transplantation (HTx) and VT recurrence. METHODS Consecutive patients with DCM accepted for radiofrequency catheter ablation (RFCA) of VT at 9 centers were prospectively enrolled and followed. RESULTS Of 281 consecutive patients (mean age 60 ± 13 years, 85% men, mean left ventricular ejection fraction [LVEF] 36% ± 12%), 35% had VT storm, 20% had incessant VT, and amiodarone was unsuccessful in 68%. During follow-up of 21 months (IQR: 6-30 months), 67 patients (24%) died or underwent HTx, and 138 (49%) had VT recurrence (45 within 30 days, defined as early); the 4-year rate of VT recurrence or mortality or HTx was 70%. Independent predictors of mortality or HTx were early VT recurrence (HR: 2.92; 95% CI: 1.37-6.21; P < 0.01), amiodarone at discharge (HR: 3.23; 95% CI: 1.43-7.33; P < 0.01), renal dysfunction (HR: 1.92; 95% CI: 1.01-3.64; P = 0.046), and LVEF (HR: 1.36; 95% CI: 1.0-1.84; P = 0.052). LVEF ≤32% identified patients at risk for mortality or HTx (area under the curve: 0.75). Mortality or HTx per 100 person-years was 40.4 events after early, compared with 14.2 events after later VT recurrence and 8.5 events with no VT recurrence after RFCA (P < 0.01 for both). Patients with early recurrence and LVEFs ≤32% had a 1-year rate of mortality or HTx of 55%. VT recurrence was predicted by prior implantable cardioverter-defibrillator shocks, basal anteroseptal VT origin, and procedural failure but not LVEF. CONCLUSIONS Patients with DCM needing RFCA for VT are a high-risk group. Following RFCA, approximately one-half remain free of VT recurrence. Early VT recurrence with LVEF ≤32% identifies those at very high risk for mortality or HTx, and screening for mechanical support or HTx should be considered. Late VT recurrence after RFCA does not predict worse outcome.
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Affiliation(s)
- Katja Zeppenfeld
- Department of Cardiology, Willem Einthoven Center of Arrhythmia Research and Management, Leiden University Medical Center, Leiden, the Netherlands.
| | - Adrianus P Wijnmaalen
- Department of Cardiology, Willem Einthoven Center of Arrhythmia Research and Management, Leiden University Medical Center, Leiden, the Netherlands. https://twitter.com/HWijnmaalen
| | - Micaela Ebert
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany. https://twitter.com/micaela_ebert
| | - Samuel H Baldinger
- Department of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Antonio Berruezo
- Cardiovascular Institute Hospital Clinic and Heart Institute, Teknon Medical Center, Spain Cardiovascular Institute Hospital Clinic, Barcelona, Spain. https://twitter.com/DrBerruezo
| | - Valentina Catto
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Marmar Vaseghi
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Arash Arya
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany. https://twitter.com/ArashArya_EP
| | - Saurabh Kumar
- Department of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Marta de Riva
- Department of Cardiology, Willem Einthoven Center of Arrhythmia Research and Management, Leiden University Medical Center, Leiden, the Netherlands. https://twitter.com/martaderiva
| | - Thomas Deneke
- Heartcenter Bad Neustadt, Bad Neustadt, Germany. https://twitter.com/EPDeneke
| | | | | | - Nienke van Rein
- Departments of Epidemiology and Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, the Netherlands
| | - Usha B Tedrow
- Department of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts, USA. https://twitter.com/utedrow
| | | | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA. https://twitter.com/shivkumarmd
| | - Corrado Carbucicchio
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Gerhard Hindricks
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany. https://twitter.com/gerdhindricks
| | - William G Stevenson
- Department of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA. https://twitter.com/wgstevenson1
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Vázquez-Calvo S, Roca-Luque I, Porta-Sánchez A. Ventricular Tachycardia Ablation Guided by Functional Substrate Mapping: Practices and Outcomes. J Cardiovasc Dev Dis 2022; 9:jcdd9090288. [PMID: 36135433 PMCID: PMC9501404 DOI: 10.3390/jcdd9090288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 11/16/2022] Open
Abstract
Catheter ablation of ventricular tachycardia has demonstrated its important role in the treatment of ventricular tachycardia in patients with structural cardiomyopathy. Conventional mapping techniques used to define the critical isthmus, such as activation mapping and entrainment, are limited by the non-inducibility of the clinical tachycardia or its poor hemodynamic tolerance. To overcome these limitations, a voltage mapping strategy based on bipolar electrograms peak to peak analysis was developed, but a low specificity (30%) for VT isthmus has been described with this approach. Functional mapping strategy relies on the analysis of the characteristics of the electrograms but also their propagation patterns and their response to extra-stimulus or alternative pacing wavefronts to define the targets for ablation. With this review, we aim to summarize the different functional mapping strategies described to date to identify ventricular arrhythmic substrate in patients with structural heart disease.
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99
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Levis M, Dusi V, Magnano M, Cerrato M, Gallio E, Depaoli A, Ferraris F, De Ferrari GM, Ricardi U, Anselmino M. A case report of long-term successful stereotactic arrhythmia radioablation in a cardiac contractility modulation device carrier with giant left atrium, including a detailed dosimetric analysis. Front Cardiovasc Med 2022; 9:934686. [PMID: 36072883 PMCID: PMC9441661 DOI: 10.3389/fcvm.2022.934686] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/25/2022] [Indexed: 12/25/2022] Open
Abstract
Introduction Catheter ablation (CA) is the current standard of care for patients suffering drug-refractory monomorphic ventricular tachycardias (MMVTs). Yet, despite significant technological improvements, recurrences remain common, leading to increased morbidity and mortality. Stereotactic arrhythmia radioablation (STAR) is increasingly being adopted to overcome the limitations of conventional CA, but its safety and efficacy are still under evaluation. Case presentation We hereby present the case of a 73-year-old patient implanted with a mitral valve prosthesis, a cardiac resynchronization therapy-defibrillator, and a cardiac contractility modulation device, who was successfully treated with STAR for recurrent drug and CA-resistant MMVT in the setting of advanced heart failure and a giant left atrium. We report a 2-year follow-up and a detailed dosimetric analysis. Conclusion Our case report supports the early as well as the long-term efficacy of 25 Gy single-session STAR. Despite the concomitant severe heart failure, with an overall heart minus planned target volume mean dosage below 5 Gy, no major detrimental cardiac side effects were detected. To the best of our knowledge, our dosimetric analysis is the most accurate reported so far in the setting of STAR, particularly for what concerns cardiac substructures and coronary arteries. A shared dosimetric planning among centers performing STAR will be crucial in the next future to fully disclose its safety profile.
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Affiliation(s)
- Mario Levis
- Department of Oncology, University of Turin, Turin, Italy
| | - Veronica Dusi
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Massimo Magnano
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Marzia Cerrato
- Department of Oncology, University of Turin, Turin, Italy
| | - Elena Gallio
- Medical Physics Unit, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Alessandro Depaoli
- Department of Radiology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Federico Ferraris
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
- *Correspondence: Gaetano Maria De Ferrari
| | | | - Matteo Anselmino
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
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Vázquez-Calvo S, Garre P, Sanchez-Somonte P, Borras R, Quinto L, Caixal G, Pujol-Lopez M, Althoff T, Guasch E, Arbelo E, Tolosana JM, Brugada J, Mont L, Roca-Luque I. Orthogonal high-density mapping with ventricular tachycardia isthmus analysis vs. pure substrate ventricular tachycardia ablation: A case-control study. Front Cardiovasc Med 2022; 9:912335. [PMID: 35979023 PMCID: PMC9376368 DOI: 10.3389/fcvm.2022.912335] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/04/2022] [Indexed: 11/29/2022] Open
Abstract
Background Substrate-based ablation has become a successful technique for ventricular tachycardia (VT) ablation. High-density (HD) mapping catheters provide high-resolution electroanatomical maps and better discrimination of local abnormal electrograms. The HD Grid Mapping Catheter is an HD catheter with the ability to map orthogonal signals on top of conventional bipolar signals, which could provide better discrimination of the arrhythmic substrate. On the other hand, conventional mapping techniques, such as activation mapping, when possible, help to identify the isthmus of the tachycardia. Aim The purpose of this study was to compare clinical outcomes after using two different VT ablation strategies: one based on extensive mapping with the HD Grid Mapping Catheter, including VT isthmus analysis, and the other based on pure substrate ablation. Methods Forty consecutive patients undergoing VT ablation with extensive HD mapping method in the hospital clinic (November 2018–November 2019) were included. Clinical outcomes were compared with a historical cohort of 26 consecutive patients who underwent ablation using a scar dechanneling technique before 2018. Results The density of mapping points was higher in the extensive mapping group (2370.24 ± 920.78 vs. 576.45 ± 294.46; p < 0.001). After 1 year of follow-up, VT recurred in 18.4% of patients in the extensive mapping group vs. 34.6% of patients in the historical control group (p = 0.14), with a significantly greater reduction of VT burden: VT episodes (81.7 ± 7.79 vs. 43.4 ± 19.9%, p < 0.05), antitachycardia pacing (99.45 ± 2.29 vs. 33.9 ± 102.5%, p < 0.001), and implantable cardioverter defibrillator (ICD) shocks (99 ± 4.5 vs. 64.7 ± 59.9%, p = 0.02). Conclusion The use of a method based on extensive mapping with the HD Grid Mapping Catheter and VT isthmus analysis allows better discrimination of the arrhythmic substrate and could be associated with a greater decrease in VT burden.
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Affiliation(s)
- Sara Vázquez-Calvo
- Department of Cardiology, Cardiovascular Clinical Institute, Arrythmia Section, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Paz Garre
- Department of Cardiology, Cardiovascular Clinical Institute, Arrythmia Section, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Paula Sanchez-Somonte
- Department of Cardiology, Cardiovascular Clinical Institute, Arrythmia Section, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Roger Borras
- Department of Cardiology, Cardiovascular Clinical Institute, Arrythmia Section, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Levio Quinto
- Department of Cardiology, Cardiovascular Clinical Institute, Arrythmia Section, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Gala Caixal
- Department of Cardiology, Cardiovascular Clinical Institute, Arrythmia Section, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Margarida Pujol-Lopez
- Department of Cardiology, Cardiovascular Clinical Institute, Arrythmia Section, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Till Althoff
- Department of Cardiology, Cardiovascular Clinical Institute, Arrythmia Section, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Eduard Guasch
- Department of Cardiology, Cardiovascular Clinical Institute, Arrythmia Section, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Elena Arbelo
- Department of Cardiology, Cardiovascular Clinical Institute, Arrythmia Section, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - José Maria Tolosana
- Department of Cardiology, Cardiovascular Clinical Institute, Arrythmia Section, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Josep Brugada
- Department of Cardiology, Cardiovascular Clinical Institute, Arrythmia Section, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Lluís Mont
- Department of Cardiology, Cardiovascular Clinical Institute, Arrythmia Section, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Ivo Roca-Luque
- Department of Cardiology, Cardiovascular Clinical Institute, Arrythmia Section, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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