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Bhalla JS, Miranda W, Jain CC, Egbe A, Asirvatham SJ, Connolly H, Madhavan M. Atrial and Ventricular Arrhythmia in Adults With Shone Complex: A Single-Center Cohort Study. JACC. ADVANCES 2024; 3:100715. [PMID: 38939811 PMCID: PMC11198055 DOI: 10.1016/j.jacadv.2023.100715] [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: 09/26/2022] [Revised: 08/31/2023] [Accepted: 10/03/2023] [Indexed: 06/29/2024]
Abstract
Background Multilevel obstruction in left ventricular inflow and outflow predisposes to arrhythmias in Shone's complex (SC). Objectives The purpose of this study was to study the prevalence and outcomes (heart failure [HF] hospitalization, cardiac transplant, death) of cardiac arrhythmias in adults with SC. Methods Adults with SC (defined as ≥2 lesions out of supramitral ring, parachute mitral valve, subvalvular/valvular aortic stenosis (AS), and aortic coarctation) seen at Mayo Clinic between January 1999 and March 2020 were identified and evaluated for the presence of sustained atrial fibrillation, atrial flutter, and ventricular arrhythmias (VA). Kaplan-Meier survival analysis was used to calculate the occurrence of these arrhythmias. Results Seventy-three patients with SC (mean age at first visit 33 ± 13 years) were identified. Most common anomalies were valvular AS (88%), coarctation (85%), parachute mitral valve (44%), subvalvular AS (44%), and supramitral ring (25%). Atrial arrhythmias were diagnosed in 24 patients (33%) at a mean age of 34.6 ± 12.7 years. Patients with atrial fibrillation and atrial flutter had higher number of surgeries, left atrial size, right ventricular systolic pressure, and HF hospitalizations. A rhythm control approach was used in majority of patients (75% on antiarrhythmic drugs and 50% underwent catheter ablation). Sustained VA occurred in 6 of 73 patients of whom 4 had an ejection fraction <40%. Death and cardiac transplantation occurred in 11 and 3 patients, respectively, during a median follow-up of 7.3 ± 6.0 years. Conclusions In adults with SC, atrial arrhythmias occurred in one-third of patients, were associated with more HF hospitalizations, and frequently required rhythm control. Prevalence of sustained VA was 8% and implantable cardioverter-defibrillator implantation should be considered in those with reduced ejection fraction.
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Affiliation(s)
- Jaideep S. Bhalla
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - William Miranda
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - C. Charles Jain
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Alexander Egbe
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Heidi Connolly
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Malini Madhavan
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
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Li J, Kong MW, Xie YY, Wang ZB, Xu L, He GX. Efficacy and prognostic impact of Pericarpium Trichosanthis injection combined with nicorandil for intractable angina pectoris in elderly patients: A retrospective study. World J Cardiol 2023; 15:633-641. [PMID: 38173907 PMCID: PMC10758601 DOI: 10.4330/wjc.v15.i12.633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/15/2023] [Accepted: 11/30/2023] [Indexed: 12/25/2023] Open
Abstract
BACKGROUND Coronary artery disease (CAD) is a leading cause of global cardiovascular mortality. Refractory angina pectoris, a manifestation of CAD, requires effective drug treatments. Pericarpium Trichosanthis injection, a traditional Chinese medicine, improves cardiovascular symptoms, while nicorandil alleviates spasms and angina. Both have potential in treating CAD. AIM To investigate the therapeutic effects of combining Pericarpium Trichosanthis injection and nicorandil in elderly patients suffering from refractory angina caused by coronary heart disease. METHODS A retrospective analysis was conducted on the data of 130 patients diagnosed with refractory coronary heart disease. Based on the different treatment regimens administered during hospitalization, the patients were divided into a control group (58 cases) and a study group (72 cases). The control group received conventional treatment, which included aspirin, statins, and nitrate vasodilators. In addition to the conventional medication, the study group received a combination treatment of Pericarpium Trichosanthis injection and nicorandil. RESULTS After treatment, the study group showed significantly higher left ventricular ejection fraction and cardiac output, and lower brain natriuretic peptide and C-reactive protein levels compared to the control group. The study group also exhibited improvements in angina, quality of life, exercise endurance, and lipid profiles. Multivariate logistic regression analysis revealed a relationship of lipid levels and heart function with the combined treatment. Some patients in the study group experienced headaches during treatment, but no significant adverse reactions were observed. Follow-up showed that the treatment was well-tolerated, with no drug-related adverse reactions detected. CONCLUSION Combination of Pericarpium Trichosanthis injection and nicorandil is more effective than conventional treatment in improving symptoms and heart function in elderly patients with refractory angina pectoris.
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Affiliation(s)
- Jun Li
- Department of Cardiology, Guiqian International General Hospital, Guiyang 550018, Guizhou Province, China
| | - Mo-Wei Kong
- Department of Cardiology, Guiqian International General Hospital, Guiyang 550018, Guizhou Province, China.
| | - Yu-Yu Xie
- Department of Dermatology, Guiqian International General Hospital, Guiyang 550018, Guizhou Province, China
| | - Ze-Bi Wang
- Department of Cardiology, Guiqian International General Hospital, Guiyang 550018, Guizhou Province, China
| | - Li Xu
- Department of Cardiology, Guiqian International General Hospital, Guiyang 550018, Guizhou Province, China
| | - Guo-Xiang He
- Department of Cardiology, Guiqian International General Hospital, Guiyang 550018, Guizhou Province, China
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Stankovic I, Voigt JU, Burri H, Muraru D, Sade LE, Haugaa KH, Lumens J, Biffi M, Dacher JN, Marsan NA, Bakelants E, Manisty C, Dweck MR, Smiseth OA, Donal E. Imaging in patients with cardiovascular implantable electronic devices: part 1-imaging before and during device implantation. A clinical consensus statement of the European Association of Cardiovascular Imaging (EACVI) and the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J Cardiovasc Imaging 2023; 25:e1-e32. [PMID: 37861372 DOI: 10.1093/ehjci/jead272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 10/15/2023] [Accepted: 10/15/2023] [Indexed: 10/21/2023] Open
Abstract
More than 500 000 cardiovascular implantable electronic devices (CIEDs) are implanted in the European Society of Cardiology countries each year. The role of cardiovascular imaging in patients being considered for CIED is distinctly different from imaging in CIED recipients. In the former group, imaging can help identify specific or potentially reversible causes of heart block, the underlying tissue characteristics associated with malignant arrhythmias, and the mechanical consequences of conduction delays and can also aid challenging lead placements. On the other hand, cardiovascular imaging is required in CIED recipients for standard indications and to assess the response to device implantation, to diagnose immediate and delayed complications after implantation, and to guide device optimization. The present clinical consensus statement (Part 1) from the European Association of Cardiovascular Imaging, in collaboration with the European Heart Rhythm Association, provides comprehensive, up-to-date, and evidence-based guidance to cardiologists, cardiac imagers, and pacing specialists regarding the use of imaging in patients undergoing implantation of conventional pacemakers, cardioverter defibrillators, and resynchronization therapy devices. The document summarizes the existing evidence regarding the use of imaging in patient selection and during the implantation procedure and also underlines gaps in evidence in the field. The role of imaging after CIED implantation is discussed in the second document (Part 2).
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Affiliation(s)
- Ivan Stankovic
- Clinical Hospital Centre Zemun, Department of Cardiology, Faculty of Medicine, University of Belgrade, Vukova 9, 11080 Belgrade, Serbia
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University Hospitals Leuven/Department of Cardiovascular Sciences, Catholic University of Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Haran Burri
- Cardiac Pacing Unit, Cardiology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Denisa Muraru
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Leyla Elif Sade
- University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, PA, USA
- Department of Cardiology, University of Baskent, Ankara, Turkey
| | - Kristina Hermann Haugaa
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Faculty of Medicine Karolinska Institutet AND Cardiovascular Division, Karolinska University Hospital, StockholmSweden
| | - Joost Lumens
- Cardiovascular Research Center Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Mauro Biffi
- Department of Cardiology, IRCCS, Azienda Ospedaliero Universitaria Di Bologna, Policlinico Di S.Orsola, Bologna, Italy
| | - Jean-Nicolas Dacher
- Department of Radiology, Normandie University, UNIROUEN, INSERM U1096 - Rouen University Hospital, F 76000 Rouen, France
| | - Nina Ajmone Marsan
- Department of Cardiology, Heart and Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Elise Bakelants
- Cardiac Pacing Unit, Cardiology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Charlotte Manisty
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Little France Crescent, Edinburgh EH16 4SB, United Kingdom
| | - Otto A Smiseth
- Institute for Surgical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Erwan Donal
- University of Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, Rennes, France
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Kohli U, von Alvensleben J, Srinivasan C. Subcutaneous Implantable Cardioverter Defibrillators in Pediatrics and Congenital Heart Disease. Card Electrophysiol Clin 2023; 15:e1-e16. [PMID: 38030336 DOI: 10.1016/j.ccep.2023.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Subcutaneous implantable cardioverter defibrillators (S-ICDs) are being used with increased frequency in children and patients with congenital heart disease. Vascular access complexities, intracardiac shunts, and specific anatomies make these devices particularly appealing for some of these patients. Alternative screening, implantation, and programming techniques should be considered based on patient size, body habitus, anatomy, procedural history, and preference. Appropriate and inappropriate shock rates are generally comparable to those seen with transvenous devices. Complications such as infection can occur, although their severity is likely to be less than that seen with transvenous devices. Technical advances are likely to further broaden S-ICD applicability.
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Affiliation(s)
- Utkarsh Kohli
- Division of Pediatric Cardiology, Department of Pediatrics, West Virginia University School of Medicine and West Virginia University Children's Heart Center, 64 Medical Center Drive, Robert C. Byrd Health Science Center, PO Box 9214, Morgantown, WV 26506-9214, USA.
| | - Johannes von Alvensleben
- Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, Aurora, CO 80045 720-777-1234, USA
| | - Chandra Srinivasan
- The Children's Hospital of Philadelphia; University of Perelman School of Medicine, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
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105
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Yao J, Gao J, Yan JF, Fang S. Cardiac contractility modulation and subcutaneous defibrillator (S-ICD): First experience with simultaneous implantation. Pacing Clin Electrophysiol 2023; 46:1595-1598. [PMID: 36938703 DOI: 10.1111/pace.14695] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/08/2023] [Accepted: 03/07/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUNDS Two technologies, cardiac contractility modulation (CCM) and subcutaneous implantable cardioverter-defibrillator (S-ICD), can be successfully combined and applied to patients with advanced heart failure (HF) with reduced left ventricular ejection fraction (LVEF). CASE REPORT We reported a case of a 51-year-old man with reduced ejection fraction (LVEF = 33%) and a narrow QRS complex who first underwent simultaneous implantation of CCM and S-ICD. CONCLUSION Our case report aimed to reveal that the simultaneous implantation of CCM and S-ICD could be successfully used in patients with advanced HF, which could significantly improve the clinical symptoms of such patients during one surgery.
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Affiliation(s)
- Juan Yao
- Cardiology Department, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Jie Gao
- Cardiology Department, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Jian-Feng Yan
- Cardiology Department, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Shu Fang
- Cardiology Department, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
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Galos G, Szabados E, Rabai M, Szalai R, Ferkai LA, Papp I, Toth K, Sandor B. Evaluation of Incidence and Risk Factors of Sudden Cardiac Death in Patients with Chronic Coronary Syndrome Attending Physical Training. Cardiol Ther 2023; 12:689-701. [PMID: 37803155 DOI: 10.1007/s40119-023-00331-8] [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: 07/11/2023] [Accepted: 09/04/2023] [Indexed: 10/08/2023] Open
Abstract
INTRODUCTION Regular physical activity is recommended to patients with chronic coronary syndrome (CCS). However, vigorous physical exercise occurs as a risk factor of sudden cardiac death (SCD). The effect of short-term and irregular exercise is controversial. The aim of this research is to assess the role of regular training in the incidence of SCD and to identify risk factors among patients with CCS participating in a long-term training program. METHODS Data of risk factors, therapy, and participation were collected retrospectively for a 10-year period, assessing the length and regularity of participation. The incidence of SCD and related mortality was registered. ANOVA, χ2 test, and multinominal logistic regression and stepwise analysis were performed. RESULTS The Incidence of chronic kidney disease (CKD) was higher (p < 0.01) and taking beta-blockers (BBs) was lower (p = 0.04) in the SCD group. Irregular training, lack of BBs, smoking, and CKD increased the risk of SCD, while female sex, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers (ACEI/ARBs), and BBs decreased the risk of SCD. CONCLUSIONS Taking ACEI/ARBs and BBs proved to be a protective factor, emphasizing the use of optimal medical therapy. Assessment of cardiac risk factors and control of comorbidities also proved to be important. The occurrence of SCD was connected to irregular physical activity, probably relating to the adverse effects of ad hoc exercising.
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Affiliation(s)
- Gergely Galos
- Division of Cardiology, 1st Department of Medicine, Medical School, University of Pecs, 7624, Pecs, Hungary
- Division of Preventive Cardiology and Rehabilitation, 1st Department of Medicine, Medical School, University of Pecs, 13 Ifjusag Str., Pecs, 7624, Hungary
| | - Eszter Szabados
- Division of Preventive Cardiology and Rehabilitation, 1st Department of Medicine, Medical School, University of Pecs, 13 Ifjusag Str., Pecs, 7624, Hungary
| | - Miklos Rabai
- Division of Cardiology, 1st Department of Medicine, Medical School, University of Pecs, 7624, Pecs, Hungary
| | - Rita Szalai
- Division of Cardiology, 1st Department of Medicine, Medical School, University of Pecs, 7624, Pecs, Hungary
- Division of Preventive Cardiology and Rehabilitation, 1st Department of Medicine, Medical School, University of Pecs, 13 Ifjusag Str., Pecs, 7624, Hungary
| | - Luca Anna Ferkai
- Doctoral School of Health Sciences, University of Pecs, 7621, Pecs, Hungary
| | - Ildiko Papp
- Division of Preventive Cardiology and Rehabilitation, 1st Department of Medicine, Medical School, University of Pecs, 13 Ifjusag Str., Pecs, 7624, Hungary
| | - Kalman Toth
- Division of Cardiology, 1st Department of Medicine, Medical School, University of Pecs, 7624, Pecs, Hungary
| | - Barbara Sandor
- Division of Preventive Cardiology and Rehabilitation, 1st Department of Medicine, Medical School, University of Pecs, 13 Ifjusag Str., Pecs, 7624, Hungary.
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Rosario KF, Karra R, Amos K, Landstrom AP, Lakdawala NK, Brezitski K, Kim H, Devore AD. LMNA Cardiomyopathy: Important Considerations for the Heart Failure Clinician. J Card Fail 2023; 29:1657-1666. [PMID: 37659618 DOI: 10.1016/j.cardfail.2023.08.016] [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] [Received: 05/24/2023] [Revised: 07/23/2023] [Accepted: 08/17/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND A diagnosis of Lamin proteins A and C cardiomyopathy (LMNA-CM) not only impacts disease prognosis, but also leads to specific guideline-recommended treatment options for these patients. This etiology is fundamentally different from other genetic causes of dilated CM. METHODS AND RESULTS LMNA-CM often presents early in the third to fourth decades and there is an age-dependent penetrance of nearly 90% among those with a positive genotype for LMNA-CM. Oftentimes, electrical abnormalities with either conduction disturbances and/or either atrial or ventricular arrhythmias manifest before there is imaging evidence of left ventricular dysfunction. Given these subtle early findings, cardiac magnetic resonance provides helpful guidance regarding patterns of enhancement associated with LMNA-CM, often before there is significant left ventricular dilation and/or a decrease in the ejection fraction and could be used for further understanding of risk stratification and prognosis of asymptomatic genotype-positive individuals. Among symptomatic patients with LMNA-CM, approximately one-quarter of individuals progress to needing advanced heart failure therapies such as heart transplantation. CONCLUSIONS In the era of precision medicine, increased recognition of clinical findings associated with LMNA-CM and increased detection by genetic testing among patients with idiopathic nonischemic CM is of increasing importance. Not only does a diagnosis of LMNA-CM have implications for management and risk stratification, but new gene-based therapies continue to be evaluated for this group. Clinicians must be aware not only of the general indications for genetic testing in arrhythmogenic and dilated cardiomyopathies and of when to suspect LMNA-CM, but also of the clinical trials underway targeted toward the different genetic cardiomyopathies.
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Affiliation(s)
| | - Ravi Karra
- Duke University Medical Center, Durham, North Carolina
| | - Kaitlyn Amos
- Duke University Medical Center, Durham, North Carolina
| | | | - Neal K Lakdawala
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kyla Brezitski
- Duke University School of Medicine, Durham, North Carolina
| | - Han Kim
- Duke University Medical Center, Durham, North Carolina
| | - Adam D Devore
- Duke University Medical Center, Durham, North Carolina.
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Zeman J, Pettinato AM, Ladha FA, Lico I, Crespo EM, Givertz MM. Recurrent premature ventricular complex-triggered idiopathic polymorphic ventricular arrhythmias in a patient with a structurally normal heart. HeartRhythm Case Rep 2023; 9:888-892. [PMID: 38204821 PMCID: PMC10774531 DOI: 10.1016/j.hrcr.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Affiliation(s)
- Jan Zeman
- Department of Internal Medicine, University of Connecticut, Farmington, Connecticut
| | - Anthony M. Pettinato
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Feria A. Ladha
- Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ina Lico
- Department of Internal Medicine, University of Connecticut, Farmington, Connecticut
| | - Eric M. Crespo
- Department of Electrophysiology, Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut
| | - Michael M. Givertz
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Ge Y, Antiochos P, Seno A, Qamar I, Blankstein R, Steigner M, Aghayev A, Jerosch-Herold M, Tedrow UB, Stevenson WG, Kwong RY. Diagnostic Impact and Prognostic Value of Cardiac Magnetic Resonance in Patients With Ventricular Arrhythmias. JACC Cardiovasc Imaging 2023; 16:1536-1549. [PMID: 37318392 DOI: 10.1016/j.jcmg.2023.04.008] [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: 05/16/2022] [Revised: 03/10/2023] [Accepted: 04/27/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) characterizes myocardial substrate relevant to sudden cardiac death (SCD). However, its clinical value in patients presenting with ventricular arrhythmias is still being defined. OBJECTIVES The authors sought to examine the diagnostic and prognostic value of multiparametric CMR in a cohort of consecutive patients referred for assessment of ventricular arrhythmias. METHODS Consecutive patients undergoing CMR for nonsustained ventricular tachycardia (NSVT) (n = 345) or sustained ventricular tachycardia (VT)/aborted SCD (n = 297) were followed over a median of 4.4 years. Major adverse cardiac events included death, recurrent VT/ventricular fibrillation requiring therapy, and hospitalization for congestive heart failure. RESULTS Of the 642 patients, 256 were women (40%), mean age was 54 ± 15 years, and median left ventricular ejection fraction was 58% (IQR: 49%-63%). A structurally abnormal heart by CMR assessment was detected in 40% of patients with NSVT and 66% in those with VT/SCD (P < 0.001). CMR assessment yielded a diagnostic change in 27% of NSVT patients vs 41% of those with VT/SCD (P < 0.001). During follow-up, 51 patients (15%) with NSVT and 104 patients (35%) with VT/SCD experienced major adverse cardiac events (MACE). An abnormal CMR was associated with a higher annual rate for MACE for both NSVT (0.7% vs 7.7%; P < 0.001) and VT/SCD (3.8% vs 13.3%; P < 0.001) patients. In a multivariate model including left ventricular ejection fraction, an abnormal CMR remained strongly associated with MACE in NSVT (HR: 5.23 [95% CI: 2.28-12.0]; P < 0.001) and VT/SCD (HR: 1.88 [95% CI: 1.07-3.30]; P = 0.03). Adding CMR assessment to the multivariable model for MACE yielded a significant improvement in the integrated discrimination improvement and an improvement in the C-statistic in the NSVT cohort. CONCLUSIONS In patients presenting with ventricular arrhythmias, multiparametric CMR assessment provides diagnostic clarification and effective risk stratification beyond current standard of care.
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Affiliation(s)
- Yin Ge
- Cardiovascular Imaging Program, Cardiovascular Division of Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Panagiotis Antiochos
- Cardiovascular Imaging Program, Cardiovascular Division of Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Cardiovascular Division, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Ayako Seno
- Cardiovascular Imaging Program, Cardiovascular Division of Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Iqra Qamar
- Cardiovascular Imaging Program, Cardiovascular Division of Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ron Blankstein
- Cardiovascular Imaging Program, Cardiovascular Division of Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael Steigner
- Cardiovascular Imaging Program, Cardiovascular Division of Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ayaz Aghayev
- Cardiovascular Imaging Program, Cardiovascular Division of Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael Jerosch-Herold
- Cardiovascular Imaging Program, Cardiovascular Division of Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Usha B Tedrow
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - William G Stevenson
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Raymond Y Kwong
- Cardiovascular Imaging Program, Cardiovascular Division of Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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Moreno JD, Weinberg SH. Bacterial sodium channels as gene therapy for cardiac arrhythmia: slow (activation and inactivation kinetics) and steady wins the race. Am J Physiol Heart Circ Physiol 2023; 325:H1412-H1414. [PMID: 37889251 DOI: 10.1152/ajpheart.00676.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 10/28/2023]
Affiliation(s)
- Jonathan D Moreno
- Section of Advanced Heart Failure and Cardiac Transplant, Division of Cardiovascular Medicine, John T. Milliken Department of Medicine, Barnes-Jewish Hospital, Washington University in St. Louis, St. Louis, Missouri, United States
| | - Seth H Weinberg
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio, United States
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111
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Maddali MM, Al Habsi AS, Al Dhamri MJ, Jayapal SK, Al Kindi HN. Sudden Cardiac Death in Patients Under 49 Years Including Adolescents: A single-centre study from Oman. Sultan Qaboos Univ Med J 2023; 23:16-21. [PMID: 38161762 PMCID: PMC10754306 DOI: 10.18295/squmj.12.2023.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/16/2023] [Accepted: 09/19/2023] [Indexed: 01/03/2024] Open
Abstract
Objectives This study aimed to identify the incidence of sudden cardiac death (SCD0 in adult patients under the age of 49 years, including adolescents with an out-of-hospital cardiac arrest that presented to the emergency department of a tertiary care hospital. Methods This retrospective cross-sectional study was conducted at the Royal Hospital, Muscat, Oman, between January 2015 and December 2019. All patients with out-of-hospital cardiac arrest were enrolled. The incidence of SCD was evaluated. Information about the patient's demographic data, the site of cardiac arrest, the mode of arrival, the duration of pre-arrest symptoms and if cardiopulmonary resuscitation was performed was gathered. Survival data at 3-year follow-up was obtained. Results A total of 117 out of 769 (15%) patients met the criteria for SCD. Male gender was predominant, with a median age of 33 years. In about 79.5% of the patients, cardiac arrest was witnessed. Only 43 patients (36.8%) received cardiopulmonary resuscitation at the arrest site; 21 patients (17.9%) had a shockable rhythm and 96 patients (82.1%) had a non-shockable rhythm. Spontaneous circulation was returned in 15 patients (12.8%). Nine patients (7.7%) were discharged from the hospital and 8 (6.8%) survived at least 36 months. Conclusion The study findings indicate the prevalence of SCD among patients who experienced a cardiac arrest outside the hospital. Unfortunately, only a small number of patients were able to survive in the long term. By implementing preemptive screening for individuals and their families, it may be possible to prevent SCD and improve outcomes for those affected.
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Affiliation(s)
| | - Ahmed S. Al Habsi
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Mariya J. Al Dhamri
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | | | - Hamood N. Al Kindi
- Cardiothoracic Surgery, The National Heart Center, The Royal Hospital, Muscat, Oman
- Division of Cardiothoracic Surgery, Department of Surgery, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
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Ghanta SN, Alotaibi B, Paydak H, Mounsey JP, Vallurupalli S, Devabhaktuni S. Inappropriate Subcutaneous Implantable Cardioverter-defibrillator Shocks-A Rare Case of Triple Counting. J Innov Card Rhythm Manag 2023; 14:5670-5674. [PMID: 38155720 PMCID: PMC10752427 DOI: 10.19102/icrm.2023.14121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/20/2023] [Indexed: 12/30/2023] Open
Abstract
Sudden cardiac death (SCD) caused by ventricular tachyarrhythmias is a significant contributor to cardiovascular deaths worldwide. Implantable cardioverter-defibrillators (ICDs) have shown efficacy in preventing and reducing mortality from SCD, but traditional transvenous ICDs have inherent challenges and drawbacks, such as lead fractures, lead-associated endocarditis, and lead failure. To address these issues, subcutaneous ICDs (S-ICDs) have been developed. S-ICDs lack pacing capacity but are a valid alternative for patients at high risk for infection or with difficult venous access. Pre-implantation screening can help prevent inappropriate device shocks. We present a case in which a patient received inappropriate S-ICD therapy, which was attributed to the triple counting of P-, R-, and T-waves in a patient with sinus rhythm. This is an unusual occurrence, and, to the best of our knowledge, there are only a limited number of case reports documenting inappropriate shocks due to the oversensing of P-waves and T-waves.
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Affiliation(s)
- Sai Nikhila Ghanta
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Bader Alotaibi
- Department of Medicine, Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Hakan Paydak
- Department of Medicine, Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - J. Paul Mounsey
- Department of Medicine, Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Srikanth Vallurupalli
- Department of Medicine, Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Subodh Devabhaktuni
- Department of Medicine, Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Qiao M, Lei C, Tan C, Lu C, Chen Z, Zhang Q, Wang Z. Efficacy and safety of berberine for premature ventricular contractions: a meta-analysis and systematic review of randomized controlled trials. PHARMACEUTICAL BIOLOGY 2023; 61:1474-1483. [PMID: 37855412 PMCID: PMC10588516 DOI: 10.1080/13880209.2023.2248167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 08/09/2023] [Indexed: 10/20/2023]
Abstract
CONTEXT Berberine is a potential drug that can effectively treat cardiovascular diseases, including premature ventricular contractions (PVCs). OBJECTIVE This study was conducted to assess the efficacy and safety of berberine for PVCs. METHODS The literature was searched using PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), Wanfang, and Chinese Biomedical Literature Database (CBM) for randomized controlled trials (RCTs) from inception to October 1, 2022. The risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomized trials, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was adopted to assess the quality of evidence. RESULTS Ten RCTs with 896 participants were included in the meta-analysis. The results showed that compared to antiarrhythmic drugs (AD), berberine (BE) combined with AD had a higher effective rate (RR = 1.26; 95% CI:1.12, 1.42; p = 0.0001) with no significant incidence of adverse reactions (RR = 0.93; 95% CI:0.33, 2.57; p = 0.88), and BE alone had no significant difference in effective rate (RR = 0.91; 95% CI:0.77, 1.07; p = 0.23), and a lower incidence of adverse reactions (RR = 0.38; 95% CI:0.15, 0.97; p = 0.04) and recurrence rate (RR = 0.40; 95% CI:0.18, 0.88; p = 0.02). CONCLUSIONS The results suggest that BE is an effective and safe adjunctive method for PVCs. In addition, BE is recommended for patients with PVCs who had severe adverse reactions after administrating AD as an alternative therapy.
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Affiliation(s)
- Meng Qiao
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, PR China
| | - Chao Lei
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, PR China
| | - Chaoren Tan
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Science, Beijing, PR China
| | - Cuncun Lu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, PR China
| | - Zijia Chen
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, PR China
| | - Qiang Zhang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, PR China
| | - Zhifei Wang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, PR China
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114
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Calvagna GM, Valsecchi S. Simultaneous subcutaneous implantable cardioverter-defibrillator and leadless pacemaker implantation for patients at high risk of infection: a retrospective case series report. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01684-9. [PMID: 37938506 DOI: 10.1007/s10840-023-01684-9] [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: 07/26/2023] [Accepted: 10/25/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND The subcutaneous implantable cardioverter defibrillator (S-ICD) and leadless pacemaker (LP) are alternative options for patients at high risk of infection requiring ICD and pacing therapy. In this analysis, we described the simultaneous implantation of S-ICD and LP in patients with high infectious risk. METHODS The study cohort comprised patients referred to our institution for ICD implantation due to high-risk factors of infection. RESULTS Between 2018 and 2022, 13 patients were referred, including 11 with infected ICD and 2 for first ICD implantation in the presence of high-risk factors. In cases of infected ICD, successful extraction was performed using a mechanical dilatation technique. Reimplantation was delayed until resolution of infection with antibiotic therapy. The devices were implanted during a single procedure, with S-ICD implantation following LP placement for verification of sensing adequacy through surface ECG screening. Suitable vectors for sensing during inhibited and ventricular pacing were identified in all patients. Defibrillation testing was effective, and no issues with double counting or undersensing were observed. The postoperative period was uneventful, and during a median follow-up of 35 months, no complications or infections were reported. The median ventricular pacing percentage was 5%, and a single inappropriate shock episode due to myopotential interference was reported and resolved by reprogramming the sensing vector. CONCLUSION Simultaneous implantation of S-ICD and LP is feasible and safe in patients at high risk of infection requiring both ICD and pacing therapy. This combined approach provides an effective solution for these patients.
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Kadoya Y, Abtahi SS, Sritharan S, Omaygenc MO, Nehmeh A, Yam Y, Small GS, Chow BJW. The estimation of left ventricular function using prospective ECG-triggered coronary CT angiography. J Cardiovasc Comput Tomogr 2023; 17:429-435. [PMID: 37777389 DOI: 10.1016/j.jcct.2023.09.004] [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: 06/13/2023] [Revised: 08/23/2023] [Accepted: 09/20/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Coronary computed tomography angiography (CCTA) is vital for diagnosing coronary artery disease; however, prospective ECG-triggered acquisition, minimizing radiation exposure, limits left ventricular (LV) ejection fraction (EF) evaluation. We aimed to assess the feasibility and utility of LVEF100msec, a new index for estimating LV function using volumetric changes during 100 msec within systole. METHODS This retrospective study analyzed patients who underwent prospective ECG-triggered CCTA with systolic acquisition between January 2015 and June 2022. The LVEF100msec was calculated using the maximum and minimum LV volumes among the three phases (300, 350, and 400 msec post-QRS) and expressed as a percentage. Patients were classified into normal, mild-moderately reduced, or severely reduced LV function categories based on the reference test. The LVEF100msec was compared among groups, and the optimal cutoff value of LVEF100msec for predicting severe LV dysfunction was investigated. RESULTS The study included 271 patients (median age = 58 years, 52% male). LVEF was normal in 188 (69.4%), mild-moderately reduced in 57 (21.0%), and severely reduced in 26 (9.6%) patients. Median LVEF100msec value was 9.0 (6.7-12.6) for normal LV function, 4.7 (3.1-8.8) for mild-moderately reduced, and 2.9 (1.5-3.8) for severely reduced LV function. LVEF100msec values significantly differed among categories (p < 0.001). The optimal LVEF100msec cutoff for severe LV dysfunction was 4.3%, with an AUC of 0.924, sensitivity of 88%, and specificity of 89%. CONCLUSION The LVEF100msec may serve as a valuable indicator of severe LV dysfunction.
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Affiliation(s)
- Yoshito Kadoya
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, K1Y 4W7, Canada
| | - Shahin Sean Abtahi
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, K1Y 4W7, Canada
| | - Shankavi Sritharan
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, K1Y 4W7, Canada
| | - Mehmet Onur Omaygenc
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, K1Y 4W7, Canada
| | - Amal Nehmeh
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, K1Y 4W7, Canada
| | - Yeung Yam
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, K1Y 4W7, Canada
| | - Gary S Small
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, K1Y 4W7, Canada
| | - Benjamin J W Chow
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, K1Y 4W7, Canada.
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Uzunoglu EC, Liu K, Spragg D, Suryanarayana PG, Khan ZZ, Elayi CS, Catanzaro JN. Skipping sarcoidosis: When ventricular arrhythmia arises immediately post-permanent pacemaker implantation. HeartRhythm Case Rep 2023; 9:844-847. [PMID: 38023674 PMCID: PMC10667126 DOI: 10.1016/j.hrcr.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Affiliation(s)
- Ekin C. Uzunoglu
- University of Florida Health Science Center, Jacksonville, Florida
| | - Kevin Liu
- University of Florida Health Science Center, Jacksonville, Florida
| | - David Spragg
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Zoobia Z. Khan
- Department of Pathology and Laboratory Medicine, University of Florida College of Medicine, Jacksonville, Florida
| | | | - John N. Catanzaro
- Department of Cardiovascular Sciences, East Carolina University Health, East Carolina University, Greenville, North Carolina
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117
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Saxena A, Karim A, Saini H, Alam MS. Follow-up ICD generator explantation in tuberculous myocarditis induced ventricular tachycardia patient. BMJ Case Rep 2023; 16:e256480. [PMID: 37914176 PMCID: PMC10626888 DOI: 10.1136/bcr-2023-256480] [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: 11/03/2023] Open
Abstract
A rare case of ventricular tachycardia caused by extrapulmonary tuberculosis has been followed up. Automatic implantable cardioverter defibrillator implantation was done at the time of presentation. Following this, the patient is clinically well without any episodes of ventricular tachycardia and is considered for an implantable cardioverter defibrillator explantation.
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Affiliation(s)
- Anil Saxena
- Department of Cardiology, Fortis Escorts Heart Institute and Research Centre, New Delhi, Delhi, India
| | - Azmat Karim
- Jawaharlal Nehru Medical College and Hospital, Department of TB & Respiratory Diseases, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
- Pulmonary Medicine, Fortis Escorts Heart Institute and Research Centre, New Delhi, Delhi, India
| | - Himanshu Saini
- Pulmonary Medicine, Fortis Escorts Heart Institute and Research Centre, New Delhi, Delhi, India
| | - Mohammad Shadab Alam
- Department of Cardiology, Fortis Escorts Heart Institute and Research Centre, New Delhi, Delhi, India
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Garg M, Gupta M, Patel NN, Bansal K, Lam PH, Sheikh FH. Predictors and Outcomes of Sudden Cardiac Arrest in Heart Failure With Preserved Ejection Fraction: A Nationwide Inpatient Sample Analysis. Am J Cardiol 2023; 206:277-284. [PMID: 37725853 DOI: 10.1016/j.amjcard.2023.08.145] [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: 04/21/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 09/21/2023]
Abstract
Sudden cardiac arrest (SCA) is the leading cause of cardiovascular mortality in heart failure with preserved ejection fraction (HFpEF), contributing to around 25% of deaths observed in pivotal HFpEF trials. However, predictors and outcomes of in-hospital SCA in HFpEF have not been well characterized. We queried the Nationwide Inpatient Sample (2016 to 2017) to identify adult hospitalizations with a diagnosis of HFpEF. Patients with acute or chronic conditions associated with SCA (e.g., acute myocardial infarction, acute pulmonary embolism, sarcoidosis) were excluded. We ascertained whether SCA occurred during these hospitalizations, identified predictors of SCA using multivariate logistic regression, and determined outcomes of SCA in HFpEF. Of 2,909,134 hospitalizations, SCA occurred in 1.48% (43,105). The mean age of the SCA group was 72.3 ± 12.4 years, 55.8% were women, and 66.4% were White. Presence of third-degree atrioventricular block (odds ratio [OR] 5.95, 95% confidence interval [CI] 5.31 to 6.67), left bundle branch block (OR 1.96, 95% CI 1.72 to 2.25), and liver disease (OR 1.87, 95% CI 1.73 to 2.02) were the leading predictors of SCA in HFpEF. After excluding patients with do-not-resuscitate status, the SCA group versus those without SCA had higher mortality (25.9% vs 1.6%), major bleeding complications (4.1% vs 1.7%), increased use of percutaneous coronary intervention (2.5% vs 0.7%), and mechanical circulatory assist device (1.2% vs 0.1%). These observational inpatient data suggest identifiable risk factors for SCA in HFpEF including cardiac arrhythmias. Further research is warranted to identify the best tools to risk-stratify patients with HFpEF to implement targeted SCA prevention strategies.
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Affiliation(s)
- Mohil Garg
- Department of Internal Medicine, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Mohak Gupta
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Neel N Patel
- Department of Internal Medicine, New York Medical College, Landmark Medical Center, Woonsocket, Rhode Island
| | - Kannu Bansal
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts
| | - Phillip H Lam
- Advanced Heart Failure Program, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Farooq H Sheikh
- Advanced Heart Failure Program, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, District of Columbia.
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Turner S, Allen VM, Carson G, Graves L, Tanguay R, Green CR, Cook JL. Guideline No. 443b: Opioid Use Throughout Women's Lifespan: Opioid Use in Pregnancy and Breastfeeding. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:102144. [PMID: 37977721 DOI: 10.1016/j.jogc.2023.05.012] [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: 11/19/2023]
Abstract
OBJECTIVE To provide health care providers the best evidence on opioid use and women's health. Areas of focus include pregnancy and postpartum care. TARGET POPULATION The target population includes all women currently using or contemplating using opioids. OUTCOMES Open, evidence-informed dialogue about opioid use will improve patient care. BENEFITS, HARMS, AND COSTS Exploring opioid use through a trauma-informed approach provides the health care provider and patient with an opportunity to build a strong, collaborative, and therapeutic alliance. This alliance empowers women to make informed choices about their own care. It also allows for the diagnosis and possible treatment of opioid use disorders. Opioid use should not be stigmatized, as stigma leads to poor "partnered care" (i.e., the partnership between the patient and care provider). Health care providers need to understand the effect opioids can have on pregnant women and support them to make knowledgeable decisions about their health. EVIDENCE A literature search was designed and carried out in PubMed and the Cochrane Library databases from August 2018 until March 2023 using following MeSH terms and keywords (and variants): opioids, opioid agonist therapy, illicit drugs, fertility, pregnancy, fetal development, neonatal abstinence syndrome, and breastfeeding. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). INTENDED AUDIENCE All health care providers who care for pregnant and/or post-partum women and their newborns. TWEETABLE ABSTRACT Opioid use during pregnancy often co-occurs with mental health issues and is associated with adverse maternal, fetal, and neonatal outcomes; treatment of opioid use disorder with agonist therapy for pregnant women can be safe during pregnancy where the risks outnumber the benefits. SUMMARY STATEMENTS RECOMMENDATIONS.
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Prisco AR, Castro JR, Roukoz H, Tholakanahalli VN. Premature Ventricular Complexes: Benign versus Malignant - How to approach? Indian Pacing Electrophysiol J 2023; 23:189-195. [PMID: 37714513 PMCID: PMC10685167 DOI: 10.1016/j.ipej.2023.09.004] [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: 04/06/2023] [Revised: 08/22/2023] [Accepted: 09/12/2023] [Indexed: 09/17/2023] Open
Abstract
Premature Ventricular Complexes (PVCs) refer to electrical activity arising from ventricles resulting in ventricular contraction independent of the native rhythm. PVCs by themselves are common in the general population but based on the origin of the PVCs, either related to anatomical or electrical substrate, the disease process has a widely varied presentation and prognosis. The clinical presentation of symptoms may vary from being extremely benign, or very severe (malignant). Benign PVCs include those that are asymptomatic or induce very mild symptoms including palpitations, lightheadedness, chest discomfort, or the sensation of skipped beats. The middle range of PVCs present as heart failure or heart failure complicated by PVCs. The malignant variety may present as syncope, or sudden cardiac death. In this review we describe the multiple facets of PVC presentation and strategies of clinical management.
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Affiliation(s)
- Anthony R Prisco
- University of Minnesota, Department of Medicine, Division of Cardiology, USA
| | - Jorge Reyes Castro
- University of Minnesota, Department of Medicine, Division of Cardiology, USA
| | - Henri Roukoz
- University of Minnesota, Department of Medicine, Division of Cardiology, USA
| | - Venkatakrishna N Tholakanahalli
- University of Minnesota, Department of Medicine, Division of Cardiology, USA; Minneapolis VA Health Care System, Department of Medicine, Division of Cardiology, USA.
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Turner S, Allen VM, Carson G, Graves L, Tanguay R, Green CR, Cook JL. Directive clinique n o 443b : Opioïdes aux différentes étapes de la vie des femmes : Grossesse et allaitement. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:102146. [PMID: 37977719 DOI: 10.1016/j.jogc.2023.05.014] [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: 11/19/2023]
Abstract
OBJECTIF Présenter aux professionnels de la santé les données probantes concernant l'utilisation des opioïdes et la santé des femmes. Les domaines d'intérêt sont la grossesse et les soins post-partum. POPULATION CIBLE Toutes les femmes qui utilisent des opioïdes. RéSULTATS: Un dialogue ouvert et éclairé sur l'utilisation des opioïdes améliorera les soins aux patientes. BéNéFICES, RISQUES ET COûTS: L'exploration de l'utilisation d'opioïdes par une approche tenant compte des traumatismes antérieurs donne au professionnel de la santé et à la patiente l'occasion de bâtir une alliance solide, collaborative et thérapeutique. Cette alliance permet aux femmes de faire des choix éclairés. Elle favorise le diagnostic et le traitement possible du trouble lié à l'utilisation d'opioïdes. L'utilisation ne doit pas être stigmatisée, puisque la stigmatisation affaiblit le partenariat (le partenariat entre patiente et professionnel de la santé). Les professionnels de la santé ceus-ci doivent comprendre l'effet potentiel des opioïdes sur la santé les femmes enceintes et les aider à prendre des décisions éclairées sur leur santé. DONNéES PROBANTES: Une recherche a été conçue puis effectuée dans les bases de données PubMed et Cochrane Library pour la période d'août 2018 à mars 2023 des termes MeSH et mots clés suivants (et variantes) : opioids, opioid agonist therapy, illicit drugs, fertility, pregnancy, fetal development, neonatal abstinence syndrome et breastfeeding. MéTHODES DE VALIDATION: Les auteurs ont évalué la qualité des données probantes et la force des recommandations en utilisant le cadre méthodologique GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Voir l'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et conditionnelles [faibles]). PROFESSIONNELS CONCERNéS: Tous les professionnels de la santé qui prodiguent des soins aux femmes et aux nouveaux-nés. RéSUMé POUR TWITTER: La consommation d'opioïdes pendant la grossesse coïncide souvent avec des problèmes de santé mentale et est associée à des conséquences néfastes pour la mère, le fœtus et le nouveau-né ; le traitement des troubles liés à la consommation d'opioïdes par agonistes peut être sûr pendant la grossesse lorsque les risques sont plus nombreux que les avantages. DÉCLARATIONS SOMMAIRES: RECOMMANDATIONS.
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Olleik F, Kamareddine MH, Spears J, Tse G, Liu T, Yan GX. Mexiletine: Antiarrhythmic mechanisms, emerging clinical applications and mortality. Pacing Clin Electrophysiol 2023; 46:1348-1356. [PMID: 37846818 DOI: 10.1111/pace.14846] [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: 07/30/2023] [Revised: 09/19/2023] [Accepted: 10/07/2023] [Indexed: 10/18/2023]
Abstract
Mexiletine, a class Ib antiarrhythmic drug, exhibits its major antiarrhythmic effect via inhibition of the fast and late Na+ currents in myocardial tissues that are dependent on the opening of Na+ channels for their excitation. Through a comprehensive examination of mexiletine's therapeutic benefits and potential risks, we aim to provide valuable insights that reinforce its role as a vital therapeutic option for patients with ventricular arrhythmias, long QT syndrome, and other heart rhythm disorders. This review will highlight the current understandings of the antiarrhythmic effects and rationales for recent off-label use and address the mortality and proarrhythmic effects of mexiletine utilizing published basic and clinical studies over the past five decades.
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Affiliation(s)
- Farah Olleik
- Lankenau Medical Center and Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | | | - Jenna Spears
- Lankenau Medical Center and Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Gary Tse
- Tianjin Key Laboratory of Ion-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, PR China
- Kent and Medway Medical School, Canterbury, Kent, UK
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, PR China
| | - Tong Liu
- Tianjin Key Laboratory of Ion-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, PR China
| | - Gan-Xin Yan
- Lankenau Medical Center and Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
- Fuwai Huazhong Hospital, Chinese Academy of Medical Sciences, Zhengzhou, PR China
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Hsue W, Gagnon AL. Treating Stubborn Cardiac Arrhythmias-Looking Toward the Future. Vet Clin North Am Small Anim Pract 2023; 53:1415-1428. [PMID: 37541824 DOI: 10.1016/j.cvsm.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
As animals can develop significant side effects or remain refractory while on antiarrhythmic medical therapy for tachyarrhythmias, interventional therapies are progressively being explored. This review will highlight the principles and utilities of implantable cardioverter-defibrillators, electrophysiological mapping and catheter ablation, three-dimensional electroanatomical mapping, and stereotactic arrhythmia radiotherapy. In particular, three-dimensional electroanatomical mapping is emerging as an adjunct electrophysiology tool to facilitate activation, substrate, and pace mapping for intuitive analysis of complex tachyarrhythmias. Unlike antiarrhythmic medications, these modalities offer potential for decreasing risk of sudden death and even permanent termination of tachyarrhythmias.
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Affiliation(s)
- Weihow Hsue
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, 930 Campus Road, Ithaca, NY 14853, USA.
| | - Allison L Gagnon
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California - Davis, One Shields Avenue, Davis, CA 95616, USA.
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Bockus LB, Jensen PN, Fretts AM, Hoofnagle AN, McKnight B, Sitlani CM, Siscovick DS, King IB, Psaty BM, Sotoodehnia N, Lemaitre RN. Plasma Ceramides and Sphingomyelins and Sudden Cardiac Death in the Cardiovascular Health Study. JAMA Netw Open 2023; 6:e2343854. [PMID: 37976059 PMCID: PMC10656644 DOI: 10.1001/jamanetworkopen.2023.43854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/09/2023] [Indexed: 11/19/2023] Open
Abstract
Importance Sphingolipids, including ceramides and sphingomyelins, may influence the pathophysiology and risk of sudden cardiac death (SCD) through multiple biological activities. Whether the length of the fatty acid acylated to plasma sphingolipid species is associated with SCD risk is not known. Objective To determine whether the saturated fatty acid length of plasma ceramides and sphingomyelins influences the association with SCD risk. Design, Setting, and Participants In this cohort study, multivariable Cox proportional hazards regression models were used to examine the association of sphingolipid species with SCD risk. The study population included 4612 participants in the Cardiovascular Health Study followed up prospectively for a median of 10.2 (IQR, 5.5-11.6) years. Baseline data were collected from January 1992 to December 1995 during annual examinations. Data were analyzed from February 11, 2020, to September 9, 2023. Exposures Eight plasma sphingolipid species (4 ceramides and 4 sphingomyelins) with saturated fatty acids of 16, 20, 22, and 24 carbons. Main Outcome and Measure Association of plasma ceramides and sphingomyelins with saturated fatty acids of different lengths with SCD risk. Results Among the 4612 CHS participants included in the analysis (mean [SD] age, 77 [5] years; 2724 [59.1%] women; 6 [0.1%] American Indian; 4 [0.1%] Asian; 718 [15.6%] Black; 3869 [83.9%] White, and 15 [0.3%] Other), 215 SCD cases were identified. In adjusted Cox proportional hazards regression analyses, plasma ceramides and sphingomyelins with palmitic acid (Cer-16 and SM-16) were associated with higher SCD risk per higher SD of log sphingolipid levels (hazard ratio [HR] for Cer-16, 1.34 [95% CI, 1.12-1.59]; HR for SM-16, 1.37 [95% CI, 1.12-1.67]). Associations did not differ by baseline age, sex, race, or body mass index. No significant association of SCD with sphingolipids with very-long-chain saturated fatty acids was observed after correction for multiple testing (HR for ceramide with arachidic acid, 1.06 [95% CI, 0.90-1.24]; HR for ceramide with behenic acid, 0.92 [95% CI, 0.77-1.10]; HR for ceramide with lignoceric acid, 0.92 [95% CI, 0.77-1.09]; HR for sphingomyelin with arachidic acid, 0.83 [95% CI, 0.71-0.98]; HR for sphingomyelin with behenic acid, 0.84 [95% CI, 0.70-1.00]; HR for sphingomyelin with lignoceric acid, 0.86 [95% CI, 0.72-1.03]). Conclusions and Relevance The findings of this large, population-based cohort study of SCD identified that higher plasma levels of Cer-16 and SM-16 were associated with higher risk of SCD. Future studies are needed to examine the underlying mechanism of these associations.
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Affiliation(s)
- Lee B Bockus
- Department of Medicine, University of Washington, Seattle
| | - Paul N Jensen
- Department of Medicine, University of Washington, Seattle
| | - Amanda M Fretts
- Department of Epidemiology, University of Washington, Seattle
| | - Andrew N Hoofnagle
- Departments of Laboratory Medicine and Pathology, University of Washington, Seattle
| | | | | | | | - Irena B King
- Department of Internal Medicine, University of New Mexico, Albuquerque
| | - Bruce M Psaty
- Department of Medicine, University of Washington, Seattle
- Department of Epidemiology, University of Washington, Seattle
- Department of Health Systems and Population Health, University of Washington, Seattle
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Kutlu E, Avci E, Acar K. Postmortem biochemistry in deaths from ischemic heart disease. J Forensic Leg Med 2023; 100:102599. [PMID: 37839363 DOI: 10.1016/j.jflm.2023.102599] [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] [Received: 06/20/2023] [Revised: 09/05/2023] [Accepted: 10/07/2023] [Indexed: 10/17/2023]
Abstract
Ischemic heart disease (IHD) is one of the leading causes of morbidity and sudden cardiac death worldwide and is an important public health problem. The presence of ischemia in clinical applications can be detected by ECG, biochemical markers, and radiological methods. Myocardial infarction is also frequently encountered in forensic autopsies. Postmortem diagnosis is determined as a result of histopathological examinations and additional exclusionary examinations (toxicology, microbiology, etc.). However, routine histopathological examinations are insufficient, especially when death occurs in the early period of ischemia. It creates a problem for forensic pathologists and forensic medicine specialists in such cases of sudden cardiac death. Postmortem biochemistry is one of the important and promising disciplines in which forensic applications work in order to diagnose these cases correctly. The issue of whether biomarkers used in the diagnosis of myocardial infarction in clinical studies can be used reliably in postmortem cases has been discussed by forensic medicine researchers for some time. This manuscript aims to review and summarize biomarkers belonging to various categories that have been studied in IHD-related deaths, in biological fluids taken at autopsy, or in animal experiments. Our study shows that the postmortem use of biochemical markers in the diagnosis of IHD yields promising results. However, it should not be forgotten that postmortem biochemistry is different from clinical applications due to its dynamics and that the body causes unpredictable changes in markers in the postmortem process. Therefore, comprehensive studies are needed to evaluate the postmortem stability of these markers in different biological fluids, their significance among various causes of death, and whether they are affected by any variable (Cardiopulmonary resuscitation, Postmortem interval, medications, etc.) before they are routinely applied. It is suggested by the authors that the cut-off values of biomarkers whose significance has been proven by these studies should be determined and that they should be used in this way in routine applications.
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Affiliation(s)
- Erdi Kutlu
- Department of Forensic Medicine, Ministry of Health Harakani State Hospital, Kars, Turkey.
| | - Esin Avci
- Department of Biochemistry, Faculty of Medicine, Pamukkale University, Denizli, Turkey.
| | - Kemalettin Acar
- Department of Forensic Medicine, Faculty of Medicine, Pamukkale University, Denizli, Turkey.
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Vedia O, Almendro-Delia M, López-País J, Pérez-Castellanos A, Uribarri A, Duran-Cambra A, Martín-García A, Núñez-Gil IJ. [Heart rate disorders in patients with Tako-tsubo syndrome]. Med Clin (Barc) 2023; 161:330-337. [PMID: 37507244 DOI: 10.1016/j.medcli.2023.05.017] [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] [Received: 09/25/2022] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVES This study sought to evaluate the incidence, prognosis and treatment of heart rhythm disorders (HRD) in Tako-tsubo syndrome (TTS). BACKGROUND TTS is associated with HRD. The HRD prognostic value is not well characterized in TTS yet. METHODS The HRD of patients included in the National Registry of Tako-tsubo syndrome, admitted between 2002 and 2018 and coming from 38 hospitals throughout the country, was analyzed. We analyzed any heart rhythm disorder in patients presented before admission, at admission and in long-term follow-up. RESULTS All types of HRD were described in 259 (23.5%) cases, from a cohort of 1,097 consecutive patients with TTS. HRD was more associated with diabetes mellitus, smoking, hyperuricemia, sleep apnea, anemia with a worse LVEF on admission. The most frequent HRD was a new onset of atrial fibrillation. During hospitalization, patients with HRD showed more complications such as shock on admission, major bleeding, acute renal failure, and combined infections. At follow-up, they presented higher mortality and more major adverse cardiac events, but with a non-significant correlation. CONCLUSIONS The incidence of HRD in patients with TTS is not infrequent. TTS, when associated with HRD, presents more complications and a worse prognosis both in hospital and in the long term.
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Affiliation(s)
- Oscar Vedia
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, España; Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España.
| | | | - Javier López-País
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago, Ourense, España
| | - Alberto Pérez-Castellanos
- Servicio de Cardiología, Instituto de Investigación Sanitaria Islas Baleares (IdISBa), Hospital Universitario Son Espases, Palma, España
| | - Aitor Uribarri
- Vall d'Hebron Institut de Recerca (VHIR), CIBER-CV, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - Albert Duran-Cambra
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Agustín Martín-García
- Servicio de Cardiología, Complejo Asistencial Universitario de Salamanca, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Salamanca, España
| | - Iván J Núñez-Gil
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, España; Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España
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Cai C, Wu N, Yang G, Yang S, Liu W, Chen M, Po SS. Transcutaneous electrical vagus nerve stimulation to suppress premature ventricular complexes (TREAT PVC): study protocol for a multi-center, double-blind, randomized controlled trial. Trials 2023; 24:683. [PMID: 37872628 PMCID: PMC10591365 DOI: 10.1186/s13063-023-07713-2] [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] [Received: 08/06/2022] [Accepted: 10/07/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND The autonomic nervous system can be responsible for the initiation and maintenance of arrhythmias. Low-level tragus stimulation (LLTS), a noninvasive form of autonomic neuromodulation, has been shown to be effective in treating atrial fibrillation. We intended to treat frequent premature ventricular complexes (PVCs) with LLTS. METHODS AND DESIGN The present study will be a prospective multicenter, double-blind, randomized, controlled trial to assess the antiarrhythmic effects of LLTS on frequent PVCs in patients without structured heart disease (SHD). A total of 100 patients with PVC burden > 10% will be randomly assigned to the active or sham LLTS in 1:1 fashion and receive the proposed intervention for 6 months. The primary outcome is PVC burden at 6 months as assessed by 10 days of continuous ambulatory electrocardiographic monitoring. Secondary outcomes include heart rate variability (HRV), quality of life, skin sympathetic nerve activity, and inflammatory markers. Adverse events will also be recorded. DISCUSSION The present trial will be the first to evaluate the effect of LLTS on frequent PVCs on patients without SHD. LLTS may serve as a low-cost, minimal-risk, and non-invasive alternative to conventional antiarrhythmic therapy. TRIAL REGISTRATION ClinicalTrial.gov NCT04909528. Registered on 17 June 2021. World health organization trial registration data set was shown in Supplementary Table 1.
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Affiliation(s)
- Cheng Cai
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Nan Wu
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Gang Yang
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Shu Yang
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Wenjie Liu
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Minglong Chen
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
| | - Sunny S Po
- Heart Rhythm Institute, Section of Cardiovascular Diseases, The University of Oklahoma Health Sciences Center, Oklahoma, USA.
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Winchester DE, Maron DJ, Blankstein R, Chang IC, Kirtane AJ, Kwong RY, Pellikka PA, Prutkin JM, Russell R, Sandhu AT. ACC/AHA/ASE/ASNC/ASPC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2023 Multimodality Appropriate Use Criteria for the Detection and Risk Assessment of Chronic Coronary Disease. J Cardiovasc Magn Reson 2023; 25:58. [PMID: 37858155 PMCID: PMC10585920 DOI: 10.1186/s12968-023-00958-5] [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] [Received: 08/01/2023] [Accepted: 08/11/2023] [Indexed: 10/21/2023] Open
Abstract
The American College of Cardiology (ACC) Foundation, along with key specialty and subspecialty societies, conducted an appropriate use review of stress testing and anatomic diagnostic procedures for risk assessment and evaluation of known or suspected chronic coronary disease (CCD), formerly referred to as stable ischemic heart disease (SIHD). This document reflects an updating of the prior Appropriate Use Criteria (AUC) published for radionuclide imaging, stress echocardiography (echo), calcium scoring, coronary computed tomography angiography (CCTA), stress cardiac magnetic resonance (CMR), and invasive coronary angiography for SIHD. This is in keeping with the commitment to revise and refine the AUC on a frequent basis. As with the prior version of this document, rating of test modalities is provided side-by-side for a given clinical scenario. These ratings are explicitly not considered competitive rankings due to the limited availability of comparative evidence, patient variability, and the range of capabilities available in any given local setting1-4.This version of the AUC for CCD is a focused update of the prior version of the AUC for SIHD4. Key changes beyond the updated ratings based on new evidence include the following: 1. Clinical scenarios related to preoperative testing were removed and will be incorporated into another AUC document under development. 2. Some clinical scenarios and tables were removed in an effort to simplify the selection of clinical scenarios. Additionally, the flowchart of tables has been reorganized, and all clinical scenario tables can now be reached by answering a limited number of clinical questions about the patient, starting with the patient's symptom status. 3. Several clinical scenarios have been revised to incorporate changes in other documents such as pretest probability assessment, atherosclerotic cardiovascular disease (ASCVD) risk assessment, syncope, and others. ASCVD risk factors that are not accounted for in contemporary risk calculators have been added as modifiers to certain clinical scenarios. The 64 clinical scenarios rated in this document are limited to the detection and risk assessment of CCD and were drawn from common applications or anticipated uses, as well as from current clinical practice guidelines.5 These clinical scenarios do not specifically address patients having acute chest pain episodes. They may, however, be applicable in the inpatient setting if the patient is not having an acute coronary syndrome and warrants evaluation for CCD.Using standardized methodology, clinical scenarios were developed to describe common patient encounters in clinical practice focused on common applications and anticipated uses of testing for CCD. Where appropriate, the scenarios were developed on the basis of the most current ACC/American Heart Association guidelines. A separate, independent rating panel scored the clinical scenarios in this document on a scale of 1 to 9, following a modified Delphi process consistent with the recently updated AUC development methodology. Scores of 7 to 9 indicate that a modality is considered appropriate for the clinical scenario presented, midrange scores of 4 to 6 indicate that a modality may be appropriate for the clinical scenario, and scores of 1 to 3 indicate that a modality is rarely appropriate.
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Affiliation(s)
| | | | - Ron Blankstein
- Society of Cardiovascular Computed Tomography, Washington, USA
| | | | - Ajay J Kirtane
- Society for Cardiovascular Angiography and Interventions, Washington, USA
| | - Raymond Y Kwong
- Society for Cardiovascular Magnetic Resonance, Washington, USA
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Zolezzi M, Elhakim A, Qubaiah IA, Mahmoud DE, Homs S, Elamin W, Tawfik ES, Abdallah O, Eltorki Y, Al-Khuzaei N. Assessment of Drug-Induced QTc Prolongation in Mental Health Practice: Validation of an Evidence-Based Algorithm. Risk Manag Healthc Policy 2023; 16:2113-2124. [PMID: 37854638 PMCID: PMC10581389 DOI: 10.2147/rmhp.s426591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/04/2023] [Indexed: 10/20/2023] Open
Abstract
Background Drug-induced QTc interval prolongation (QTcIP) can lead to serious consequences and is often a concern for mental health practitioners, as access to experts such as cardiologists, for consultation is time-limiting and can delay treatment decisions. This research aimed at validating the content of an algorithm for the assessment, management and monitoring of drug-induced QTcIP in mental health practice. Methods Following an initial face validity by content experts, a cross-sectional survey of mental health care practitioners with a 4-point Likert-type scale was used to assess the validity of the decision steps on the QTcIP algorithm (QTcIPA) by estimating the content validity index (CVI) and the modified kappa statistic (κ*). Participants' open-ended comments were also thematically analyzed. Results Mental health practitioners found the QTcIPA to be appropriate, safe, and evidence-based, as indicated by the high individual item CVI scores ranging from 0.89 to 1 for all of the steps/decision statements in the three domains assessed: appropriateness, safety and reliability of the references used. Five themes emerged from the qualitative analysis of the open-ended comments, of which three were identified as strengths, including practical usability, reliable references and beneficial for pharmacists. Two themes were recognized as limitations, namely, the need for additional clinical content and application barriers. Conclusion These results suggest that the QTcIPA may be a useful tool for mental health clinicians at the time of prescribing medications with potential risk of QTcIP. Future research will explore the implementation of the QTcIPA into clinical practice using computerized decision support tools through web-based and mobile applications.
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Affiliation(s)
- Monica Zolezzi
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Athar Elhakim
- College of Health Sciences, University of Doha for Science and Technology, Doha, Qatar
| | - Iman A Qubaiah
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | | | - Shorouq Homs
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Waad Elamin
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | | | - Oraib Abdallah
- Pharmacy Department, Mental Health Services, Hamad Medical Corporation, Doha, Qatar
| | - Yassin Eltorki
- Pharmacy Department, Mental Health Services, Hamad Medical Corporation, Doha, Qatar
| | - Noriya Al-Khuzaei
- Pharmacy Department, Mental Health Services, Hamad Medical Corporation, Doha, Qatar
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Theisen B, Holtz A, Rajagopalan V. Noncoding RNAs and Human Induced Pluripotent Stem Cell-Derived Cardiomyocytes in Cardiac Arrhythmic Brugada Syndrome. Cells 2023; 12:2398. [PMID: 37830612 PMCID: PMC10571919 DOI: 10.3390/cells12192398] [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] [Received: 07/22/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/14/2023] Open
Abstract
Hundreds of thousands of people die each year as a result of sudden cardiac death, and many are due to heart rhythm disorders. One of the major causes of these arrhythmic events is Brugada syndrome, a cardiac channelopathy that results in abnormal cardiac conduction, severe life-threatening arrhythmias, and, on many occasions, death. This disorder has been associated with mutations and dysfunction of about two dozen genes; however, the majority of the patients do not have a definite cause for the diagnosis of Brugada Syndrome. The protein-coding genes represent only a very small fraction of the mammalian genome, and the majority of the noncoding regions of the genome are actively transcribed. Studies have shown that most of the loci associated with electrophysiological traits are located in noncoding regulatory regions and are expected to affect gene expression dosage and cardiac ion channel function. Noncoding RNAs serve an expanding number of regulatory and other functional roles within the cells, including but not limited to transcriptional, post-transcriptional, and epigenetic regulation. The major noncoding RNAs found in Brugada Syndrome include microRNAs; however, others such as long noncoding RNAs are also identified. They contribute to pathogenesis by interacting with ion channels and/or are detectable as clinical biomarkers. Stem cells have received significant attention in the recent past, and can be differentiated into many different cell types including those in the heart. In addition to contractile and relaxational properties, BrS-relevant electrophysiological phenotypes are also demonstrated in cardiomyocytes differentiated from stem cells induced from adult human cells. In this review, we discuss the current understanding of noncoding regions of the genome and their RNA biology in Brugada Syndrome. We also delve into the role of stem cells, especially human induced pluripotent stem cell-derived cardiac differentiated cells, in the investigation of Brugada syndrome in preclinical and clinical studies.
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Affiliation(s)
- Benjamin Theisen
- Department of Biomedical and Anatomical Sciences, New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, Jonesboro, AR 72401, USA
| | - Austin Holtz
- Department of Biomedical and Anatomical Sciences, New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, Jonesboro, AR 72401, USA
| | - Viswanathan Rajagopalan
- Department of Biomedical and Anatomical Sciences, New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, Jonesboro, AR 72401, USA
- Arkansas Biosciences Institute, Jonesboro, AR 72401, USA
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Fast MF, Lydiard S, Boda-Heggemann J, Tanadini-Lang S, Muren LP, Clark CH, Blanck O. Precision requirements in stereotactic arrhythmia radioablation for ventricular tachycardia. Phys Imaging Radiat Oncol 2023; 28:100508. [PMID: 38026083 PMCID: PMC10679852 DOI: 10.1016/j.phro.2023.100508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Affiliation(s)
- Martin F Fast
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Judit Boda-Heggemann
- Department of Radiation Oncology, University Medicine Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- DKFZ Hector Cancer Institute at the University Medical Center Mannheim, Germany
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland
| | - Ludvig P Muren
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Catharine H Clark
- Radiotherapy Physics, University College London Hospital, 250 Euston Rd, London NW1 2PG, UK
- Department of Medical Physics and Bioengineering, University College London, Malet Place, London WC1E 6BT, UK
- Medical Physics Dept, National Physical Laboratory, Hampton Rd, London TW11 0PX, UK
| | - Oliver Blanck
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel 24105, Germany
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Davies RA, Ladouceur VB, Green MS, Joza J, Juurlink DN, Krahn AD, McMurtry MS, Roberts JD, Roston TM, Sanatani S, Steinberg C, MacIntyre C. The 2023 Canadian Cardiovascular Society Clinical Practice Update on Management of the Patient With a Prolonged QT Interval. Can J Cardiol 2023; 39:1285-1301. [PMID: 37827588 DOI: 10.1016/j.cjca.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 10/14/2023] Open
Abstract
A prolonged QT interval on the electrocardiogram is associated with an increased risk of the torsades de pointes form of ventricular arrhythmia resulting in syncope, sudden cardiac arrest or death, or misdiagnosis as a seizure disorder. The cause of QT prolongation can be congenital and inherited as an autosomal dominant variant, or it can be transient and acquired, often because of QT-prolonging drugs or electrolyte abnormalities. Automated measurement of the QT interval can be inaccurate, especially when the baseline electrocardiogram is abnormal, and manual verification is recommended. In this clinical practice update we provide practical tips about measurement of the QT interval, diagnosis, and management of congenital long QT syndrome and acquired prolongation of the QT interval. For congenital long QT syndrome, certain β-adrenergic-blocking drugs are highly effective, and implantable defibrillators are infrequently required. Many commonly prescribed drugs such as antidepressants and antibiotics can prolong the QT interval, and recommendations are provided on their safe use.
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Affiliation(s)
- Ross A Davies
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
| | | | - Martin S Green
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - David N Juurlink
- University of Toronto, ICES, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Andrew D Krahn
- Center for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Jason D Roberts
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Thomas M Roston
- Center for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shubhayan Sanatani
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christian Steinberg
- Institut universitaire de cardiologie et de pneumologie de Québec, Laval University, Québec, Québec, Canada
| | - Ciorsti MacIntyre
- Dalhousie University, Halifax, Nova Scotia, Canada; Mayo Clinic, Rochester, Minnesota, USA
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Rodriguez CP, Economy KE, Duarte VE, Mehta N, Duncan ME, Chandler S, Gauvreau K, Easter SR, Wu F, Lachtrupp C, Tedrow U, Valente AM, Tadros T. Mobile Cardiac Telemetry Use to Predict Adverse Pregnancy Outcomes in Patients With Congenital Heart Disease. JACC. ADVANCES 2023; 2:100593. [PMID: 38938332 PMCID: PMC11198184 DOI: 10.1016/j.jacadv.2023.100593] [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: 01/30/2023] [Revised: 06/07/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2024]
Abstract
Background Patients with congenital heart disease (CHD) have a higher incidence of arrhythmias during pregnancy, yet the utility of mobile cardiac telemetry (MCT) to predict adverse outcomes is unknown. Objectives The purpose of this study is to determine whether arrhythmias on screening MCT correlate with adverse pregnancy outcomes. Methods Patients with CHD prospectively enrolled in the Standardized Outcomes in Reproductive Cardiovascular Care initiative underwent 24-hour MCT (within 18 months prior to pregnancy). Positive findings on MCT were defined as episodes of bradyarrhythmia, symptomatic atrioventricular block, ectopic atrial or ventricular activity, and supraventricular or ventricular tachycardia. Clinically significant arrhythmia events (CSAEs) were those requiring medical or device intervention or an emergency room visit. Clinical events during the antepartum, intrapartum, and postpartum periods were compared using Fisher's exact test. Analyses were performed using Stata version 16. Results In 141 pregnancies in 118 patients with CHD, MCT detected positive findings in 17%. Adverse cardiac outcomes occurred in 11% of pregnancies, of which CSAE occurred in 3.5%. Positive MCT was significantly associated with subsequent CSAE (21% vs 0%, P < 0.001) and cumulative adverse maternal cardiac outcomes (33% vs 7%, P = 0.001) but did not correlate with obstetric (46% vs 41%, P = 0.660) or neonatal outcomes (33% vs 31%, P = 0.810). Of the patients with CSAE, 75% had ≥moderate CHD complexity. Conclusions Patients with CHD had a high rate of positive MCT findings. This was associated with CSAE and adverse maternal cardiac outcomes. Patients with ≥moderate CHD complexity may benefit from screening MCT to improve preconceptual counseling and planning.
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Affiliation(s)
- Carla P. Rodriguez
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Katherine E. Economy
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Valeria E. Duarte
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nishaki Mehta
- Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Madeline E. Duncan
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Stephanie Chandler
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah Rae Easter
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Fred Wu
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Cara Lachtrupp
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Usha Tedrow
- Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anne Marie Valente
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas Tadros
- Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Zipse MM. Editorial commentary: Cardiac sarcoidosis in contemporary practice: Forward progress, but clinical quandaries persist. Trends Cardiovasc Med 2023; 33:456-457. [PMID: 35798173 DOI: 10.1016/j.tcm.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 06/30/2022] [Indexed: 10/17/2022]
Affiliation(s)
- Matthew M Zipse
- From the Division of Cardiology, Section of Cardiac Electrophysiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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Tan JL, Tan BEX, Cheung JW, Ortman M, Lee JZ. Update on cardiac sarcoidosis. Trends Cardiovasc Med 2023; 33:442-455. [PMID: 35504422 DOI: 10.1016/j.tcm.2022.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 04/20/2022] [Accepted: 04/27/2022] [Indexed: 12/17/2022]
Abstract
Cardiac sarcoidosis is an inflammatory myocardial disease of unknown etiology. It is characterized by the deposition of non-caseating granulomas that may involve any part of the heart. Cardiac sarcoidosis is often under-diagnosed or recognized partly due to the heterogeneous clinical presentation of the disease. The three most frequent clinical manifestations of cardiac sarcoidosis are atrioventricular block, ventricular arrhythmias, and heart failure. A definitive diagnosis of cardiac sarcoidosis can be made with histology findings from an endomyocardial biopsy. However, the diagnosis in the majority of cases is based on findings from the clinical presentation and advanced imaging due to the low sensitivity of endomyocardial biopsy. The Heart Rhythm Society (HRS) 2014 expert consensus statement and the Japanese Ministry of Health and Welfare criteria are the two most commonly used diagnostic criteria sets. This review article summarizes the available evidence on cardiac sarcoidosis, focusing on the diagnostic criteria and stepwise approach to its management.
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Affiliation(s)
- Jian Liang Tan
- Division of Cardiovascular Disease, Cooper University Health Care/Cooper Medical School of Rowan University, Camden, New Jersey.
| | - Bryan E-Xin Tan
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY
| | - Jim W Cheung
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Matthew Ortman
- Division of Cardiovascular Disease, Cooper University Health Care/Cooper Medical School of Rowan University, Camden, New Jersey
| | - Justin Z Lee
- Department of Cardiology, Mayo Clinic Arizona, Phoenix, Arizona, USA
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136
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Oesterle A, Dhruva SS, Pellegrini CN, Liem B, Raitt MH. Ventricular arrhythmia detection for contemporary Biotronik and Abbott implantable cardioverter defibrillators with markedly prolonged detection in Biotronik devices. J Interv Card Electrophysiol 2023; 66:1679-1691. [PMID: 36737506 DOI: 10.1007/s10840-023-01498-9] [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: 10/27/2022] [Accepted: 01/27/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Implantable cardioverter defibrillators (ICDs) are typically programed with both ventricular tachycardia (VT) and ventricular fibrillation (VF) treatment zones. Biotronik and Abbott ICDs do not increment the VT counter when the tachycardia accelerates to the VF zone, which could result in a prolonged delay in tachycardia detection. METHODS Patients with Biotronik and Abbott ICDs receiving care at Veterans Affairs facilities in Northern California were identified. Patient information and device tracings for patients with any ICD therapies were examined to assess for possible delayed tachycardia detection. RESULTS Among 52 patients with Biotronik ICDs, 8 (15%) experienced appropriate ICD therapy over a median follow-up of 29 months. Among 68 patients with Abbott ICDs, 26 (38%) experienced appropriate ICD therapy over a median follow-up of 83 months. Three of the patients with Biotronik ICDs who received appropriate therapy experienced a delay in VT/VF detection due to the tachycardia rate oscillating between the VT and VF treatment zones (longest 31.2 s on detection), compared with four of the patients with Abbott ICDs (longest 4.1 s on the detection and 8 s on redetect). One of the patients with a Biotronik ICD experienced recurrent syncope associated with delayed detection and another died on the day of delayed detection. One of the patients with an Abbott ICD experienced syncope. CONCLUSIONS Because contemporary Biotronik and Abbott ICDs freeze the VT counters when tachycardia is in the VF zone, ICD therapies can be markedly delayed when the tachycardia oscillates between the VT and VF zone.
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Affiliation(s)
- Adam Oesterle
- Division of Cardiology, Department of Medicine, University of California San Francisco - Veterans Affairs San Francisco Health Care System, 4150 Clement Street, Building 203, Room 2A-25, San Francisco, CA, 94121, USA.
| | - Sanket S Dhruva
- Division of Cardiology, Department of Medicine, University of California San Francisco - Veterans Affairs San Francisco Health Care System, 4150 Clement Street, Building 203, Room 2A-25, San Francisco, CA, 94121, USA
| | - Cara N Pellegrini
- Division of Cardiology, Department of Medicine, University of California San Francisco - Veterans Affairs San Francisco Health Care System, 4150 Clement Street, Building 203, Room 2A-25, San Francisco, CA, 94121, USA
| | - Bing Liem
- Division of Cardiology, Department of Medicine, University of California San Francisco - Veterans Affairs San Francisco Health Care System, 4150 Clement Street, Building 203, Room 2A-25, San Francisco, CA, 94121, USA
| | - Merritt H Raitt
- Division of Cardiology, Veterans Affairs Portland Health Care System, Portland, OR, USA
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Liu T, Shi J, Fu Y, Zhang Y, Bai Y, He S, Deng W, Jin Q, Chen Y, Fang L, He L, Li Y, Yang Y, Zhang L, Lv Q, Wang J, Xie M. New trends in non-pharmacological approaches for cardiovascular disease: Therapeutic ultrasound. Trends Cardiovasc Med 2023; 33:431-440. [PMID: 35461990 DOI: 10.1016/j.tcm.2022.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 04/05/2022] [Accepted: 04/19/2022] [Indexed: 11/30/2022]
Abstract
Significant advances in application of therapeutic ultrasound have been reported in the past decades. Therapeutic ultrasound is an emerging non-invasive stimulation technique. This approach has shown high potential for treatment of various disease including cardiovascular disease. In this review, application principle and significance of the basic parameters of therapeutic ultrasound are summarized. The effects of therapeutic ultrasound in myocardial ischemia, heart failure, myocarditis, arrhythmias, and hypertension are explored, with key focus on the underlying mechanism. Further, the limitations and challenges of ultrasound therapy on clinical translation are evaluated to promote application of the novel strategy in cardiovascular diseases.
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Affiliation(s)
- Tianshu Liu
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Clinical Research Center for Medical Imaging, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Jiawei Shi
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Clinical Research Center for Medical Imaging, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yanan Fu
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Clinical Research Center for Medical Imaging, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yichan Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Clinical Research Center for Medical Imaging, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Ying Bai
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Clinical Research Center for Medical Imaging, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Shukun He
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Clinical Research Center for Medical Imaging, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Wenhui Deng
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Clinical Research Center for Medical Imaging, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Qiaofeng Jin
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Clinical Research Center for Medical Imaging, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yihan Chen
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Clinical Research Center for Medical Imaging, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Lingyun Fang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Clinical Research Center for Medical Imaging, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Lin He
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Clinical Research Center for Medical Imaging, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yuman Li
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Clinical Research Center for Medical Imaging, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yali Yang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Clinical Research Center for Medical Imaging, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Li Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Clinical Research Center for Medical Imaging, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Qing Lv
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Clinical Research Center for Medical Imaging, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Jing Wang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Clinical Research Center for Medical Imaging, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China.
| | - Mingxing Xie
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Clinical Research Center for Medical Imaging, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China.
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Wang Y, Zhao ZG, Chai Z, Fang JC, Chen M. Electromagnetic field and cardiovascular diseases: A state-of-the-art review of diagnostic, therapeutic, and predictive values. FASEB J 2023; 37:e23142. [PMID: 37650634 DOI: 10.1096/fj.202300201rr] [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] [Received: 02/04/2023] [Revised: 07/20/2023] [Accepted: 08/02/2023] [Indexed: 09/01/2023]
Abstract
Despite encouraging advances in early diagnosis and treatment, cardiovascular diseases (CVDs) remained a leading cause of morbidity and mortality worldwide. Increasing evidence has shown that the electromagnetic field (EMF) influences many biological processes, which has attracted much attention for its potential therapeutic and diagnostic modalities in multiple diseases, such as musculoskeletal disorders and neurodegenerative diseases. Nonionizing EMF has been studied as a therapeutic or diagnostic tool in CVDs. In this review, we summarize the current literature ranging from in vitro to clinical studies focusing on the therapeutic potential (external EMF) and diagnostic potential (internal EMF generated from the heart) of EMF in CVDs. First, we provided an overview of the therapeutic potential of EMF and associated mechanisms in the context of CVDs, including cardiac arrhythmia, myocardial ischemia, atherosclerosis, and hypertension. Furthermore, we investigated the diagnostic and predictive value of magnetocardiography in CVDs. Finally, we discussed the critical steps necessary to translate this promising approach into clinical practice.
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Affiliation(s)
- Yan Wang
- Laboratory of Heart Valve Disease, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhen-Gang Zhao
- Laboratory of Heart Valve Disease, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zheng Chai
- Laboratory of Heart Valve Disease, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jian-Cheng Fang
- School of Instrumentation Science and Opto-Electronics Engineering, Beihang University, Beijing, China
| | - Mao Chen
- Laboratory of Heart Valve Disease, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Trytell A, Osekowski M, Zentner D, Nehme Z, James P, Pflaumer A, Semsarian C, Ingles J, Stub D, La Gerche A, Paratz ED. Prevalence of illicit drug use in young patients with sudden cardiac death. Heart Rhythm 2023; 20:1349-1355. [PMID: 37295741 DOI: 10.1016/j.hrthm.2023.06.004] [Citation(s) in RCA: 6] [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: 04/07/2023] [Revised: 05/21/2023] [Accepted: 06/04/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Illicit drug use may accelerate coronary disease and cardiac hypertrophy or stimulate arrhythmias. Rates of illicit drug use in young patients with sudden cardiac death (SCD) are uncertain. OBJECTIVE The purpose of this study was to identify rates of illicit drug use in young patients with SCD. METHODS A prospective statewide registry identified out-of-hospital patients with cardiac arrest aged 18-50 years from April 2019 to April 2021. Clinical characteristics were compared between patients with and without illicit drug use (defined by toxicological results or reported regular use). Illicit drugs included amphetamine-type substances, cocaine, heroin, cannabis, and other drugs. RESULTS A total of 554 (40.2%) of 1378 patients had confirmed cardiac cause of out-of-hospital cardiac arrest, with 523 undergoing toxicological assessment. There were 170 patients (32.5%) having either positive toxicology for illicit drugs (n = 138) or negative toxicology but reported regular drug use (n = 32). Patients with SCD and illicit drug use were more commonly male (81.2% vs 72.3%; P = .028), smokers (38.8% vs 19.8%; P ≤ .0001), and excess alcohol drinkers (30.6% vs 20.6%; P = .012) and had a psychiatric diagnosis (38.8% vs 25.7%; P = .002), lower body mass index (29.4 kg/m2 vs 31.7 kg/m2; P = .0063), and lower rates of hypertension (10.6% vs 18.6%; P = .019). Death commonly occurred while sedentary (47.5%) or during sleep (45.8%). Accounting for these baseline differences, there were no differences in rates of coronary disease or cardiomyopathy. Cannabis (n = 106) was the most common illicit drug identified and polysubstance abuse occurred frequently (n = 25). CONCLUSION Approximately one-third of young patients with SCD have positive toxicology at the time of death or reported frequent use of illicit drugs, with high rates of polysubstance abuse.
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Affiliation(s)
- Adam Trytell
- Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Michael Osekowski
- Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Dominica Zentner
- Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Cardiology, Royal Melbourne Hospital Clinical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Ziad Nehme
- Ambulance Victoria, Doncaster, Victoria, Australia; Department of Paramedicine, Monash University, Melbourne, Victoria, Australia; Department of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Paul James
- Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Andreas Pflaumer
- Department of Cardiology, The Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Chris Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Jodie Ingles
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Dion Stub
- Ambulance Victoria, Doncaster, Victoria, Australia; Department of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, Alfred Hospital, Prahran, Victoria, Australia
| | - Andre La Gerche
- Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Department of Cardiology, Alfred Hospital, Prahran, Victoria, Australia; Baker Heart and Diabetes Institute, Prahran, Victoria, Australia; Department of Medicine, Dentistry and Health Sciences, Melbourne University, Parkville, Victoria, Australia
| | - Elizabeth D Paratz
- Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Department of Cardiology, Alfred Hospital, Prahran, Victoria, Australia; Baker Heart and Diabetes Institute, Prahran, Victoria, Australia; Department of Medicine, Dentistry and Health Sciences, Melbourne University, Parkville, Victoria, Australia.
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Henriquez E, Hernandez EA, Mundla SR, Wankhade DH, Saad M, Ketha SS, Penke Y, Martinez GC, Ahmed FS, Hussain MS. Catecholaminergic Polymorphic Ventricular Tachycardia and Gene Therapy: A Comprehensive Review of the Literature. Cureus 2023; 15:e47974. [PMID: 38034271 PMCID: PMC10686237 DOI: 10.7759/cureus.47974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an inherited channelopathy. In this review, we summarize the epidemiology, pathophysiology, clinical characteristics, diagnostics, genetic mutations, standard treatment, and the emergence of potential gene therapy. This inherited cardiac arrhythmia presents in a bimodal distribution with no association between sex or ethnicity. Six different CPVT genes have been identified, however, most of the cases are related to a heterozygous, gain-of-function mutation on the ryanodine receptor-2 gene (RyR2) and calsequestrin-2 gene (CASQ2) that causes delayed after-depolarization. The diagnosis is clinically based, seen in patients presenting with syncope after exercise or stress-related emotions, as well as cardiac arrest with full recovery or even sudden cardiac death. Standard treatment relies on beta-blockers, with add-on therapy, flecainide, and cardiac sympathetic denervation as second-line treatments. An implantable cardioverter-defibrillator is indicated for patients who have suffered a cardiac arrest. Potential gene therapy has emerged in the last 20 years and accelerated because of associated viral vector application in increasing the efficiency of prolonged cardiac gene expression. Nevertheless, human trials for gene therapy for CPVT have been limited as the population is rare, and an excessive amount of funding is required.
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Affiliation(s)
- Elvis Henriquez
- Miscellaneous, Facultad de Medicina, Universidad de Ciencias Medicas, Las Tunas, CUB
| | - Edwin A Hernandez
- Miscellaneous, Faculty of Medicine, Universidad de El Salvador, San Salvador, SLV
| | - Sravya R Mundla
- Internal Medicine, Apollo Institute of Medical Sciences and Research, Hyderabad, IND
| | | | - Muhammad Saad
- Internal Medicine, Fatima Memorial College (FMH) of Medicine and Dentistry, Lahore, PAK
| | - Sagar S Ketha
- Internal Medicine, Government Medical College, Srikakulam, IND
| | - Yasaswini Penke
- Internal Medicine, Government Medical College, Srikakulam, IND
| | - Gabriela C Martinez
- Internal Medicine, Faculty of Medicine, Universidad Nacional Autonoma de Honduras, San Pedro Sula, HND
| | - Faiza S Ahmed
- Internal Medicine, Advocate Lutheran General Hospital, Park Ridge, USA
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Rattanawong P, Mattanapojanat N, Mead-Harvey C, Van Der Walt C, Kewcharoen J, Kanitsoraphan C, Vutthikraivit W, Prasitlumkum N, Putthapiban P, Chintanavilas K, Sahasthas D, Ngarmukos T, Thakkinstian A, Sorajja D, Makarawate P, Shen WK. Predicting arrhythmic event score in Brugada syndrome: Worldwide pooled analysis with internal and external validation. Heart Rhythm 2023; 20:1358-1367. [PMID: 37355026 DOI: 10.1016/j.hrthm.2023.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 06/02/2023] [Accepted: 06/16/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Brugada syndrome is an inherited arrhythmic disease associated with major arrhythmic events (MAE). Risk predictive scores were previously developed with various performances. OBJECTIVE The purpose of this study was to create a novel score-Predicting Arrhythmic evenT (PAT)-with internal and external validation. METHODS A systematic review was performed to identify risk factors for MAE. The odds ratios (ORs) of each factor were pooled across studies. The PAT scoring scheme was developed based on pooled ORs. The PAT score was internally validated with published 105 Asian patients (follow-up 8.0 ± 4.1 [SD] years) and externally validated with unpublished 164 multiracial patients (82.3% White, 14.6% Asian, 3.2% Black; mean follow-up 8.0 ± 6.9 years) with Brugada syndrome. Performances were assessed and compared with previous scores using receiver operating characteristic curve (ROC) analysis. RESULTS Sixty-seven studies published between 2002 and 2022 from 26 countries (7358 patients) were included. Pooled ORs were estimated, indicating that 15 of 23 risk factors were significant. The PAT score was then developed accordingly. The PAT score had significantly better discrimination (ROC 0.9671) than the BRUGADA-RISK score (ROC 0.7210; P = .006), Shanghai Score System (ROC 0.7079; P = .003), and Sieira et al score (ROC 0.8174; P = .026) in an external validation cohort. PAT score ≥ 10 predicted the first MAE with 95.5% sensitivity and 89.1% specificity (ROC 0.9460) and the recurrent MAE (ROC 0.7061) with 15.4% sensitivity and 93.3% specificity. CONCLUSION The PAT score was shown to be useful in predicting MAE for primary prevention in patients with Brugada syndrome.
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Affiliation(s)
- Pattara Rattanawong
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona; Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Carolyn Mead-Harvey
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona
| | | | - Jakrin Kewcharoen
- Division of Cardiology, Department of Medicine, Loma Linda University, Loma Linda, California
| | | | - Wasawat Vutthikraivit
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Iowa, Iowa City, Iowa
| | - Narut Prasitlumkum
- Department of Cardiology, University of California Riverside, Riverside, California
| | - Prapaipan Putthapiban
- Division of Cardiology, Department of Medicine, Loma Linda University, Loma Linda, California
| | - Kumpol Chintanavilas
- Cardiology Department, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand
| | | | - Tachapong Ngarmukos
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Dan Sorajja
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona
| | | | - Win-Kuang Shen
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona.
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Arbelo E, Protonotarios A, Gimeno JR, Arbustini E, Barriales-Villa R, Basso C, Bezzina CR, Biagini E, Blom NA, de Boer RA, De Winter T, Elliott PM, Flather M, Garcia-Pavia P, Haugaa KH, Ingles J, Jurcut RO, Klaassen S, Limongelli G, Loeys B, Mogensen J, Olivotto I, Pantazis A, Sharma S, Van Tintelen JP, Ware JS, Kaski JP. 2023 ESC Guidelines for the management of cardiomyopathies. Eur Heart J 2023; 44:3503-3626. [PMID: 37622657 DOI: 10.1093/eurheartj/ehad194] [Citation(s) in RCA: 371] [Impact Index Per Article: 371.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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143
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Lee S, Chung CTS, Radford D, Chou OHI, Lee TTL, Ng ZMW, Roever L, Rajan R, Bazoukis G, Letsas KP, Zeng S, Liu FZ, Wong WT, Liu T, Tse G. Secular trends of health care resource utilization and costs between Brugada syndrome and congenital long QT syndrome: A territory-wide study. Clin Cardiol 2023; 46:1194-1201. [PMID: 37489866 PMCID: PMC10577540 DOI: 10.1002/clc.24102] [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: 04/15/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Health care resource utilization (HCRU) and costs are important metrics of health care burden, but they have rarely been explored in the setting of cardiac ion channelopathies. HYPOTHESIS This study tested the hypothesis that attendance-related HCRUs and costs differed between patients with Brugada syndrome (BrS) and congenital long QT syndrome (LQTS). METHODS This was a retrospective cohort study of consecutive BrS and LQTS patients at public hospitals or clinics in Hong Kong, China. HCRUs and costs (in USD) for Accident and Emergency (A&E), inpatient, general outpatient and specialist outpatient attendances were analyzed between 2001 and 2019 at the cohort level. Comparisons were made using incidence rate ratios (IRRs [95% confidence intervals]). RESULTS Over the 19-year period, 516 BrS (median age of initial presentation: 51 [interquartile range: 38-61] years, 92% male) and 134 LQTS (median age of initial presentation: 21 [9-44] years, 32% male) patients were included. Compared to LQTS patients, BrS patients had lower total costs (2 008 126 [2 007 622-2 008 629] vs. 2 343 864 [2 342 828-2 344 900]; IRR: 0.857 [0.855-0.858]), higher costs for A&E attendances (83 113 [83 048-83 177] vs. 70 604 [70 487-70 721]; IRR: 1.177 [1.165-1.189]) and general outpatient services (2,176 [2,166-2,187] vs. 921 [908-935]; IRR: 2.363 [2.187-2.552]), but lower costs for inpatient stay (1 391 624 [1 391 359-1 391 889] vs. 1 713 742 [1 713 166-1 714 319]; IRR: 0.812 [0.810-0.814]) and lower costs for specialist outpatient services (531 213 [531 049-531 376] vs. 558 597 [558268-558926]; IRR: 0.951 [0.947-0.9550]). CONCLUSIONS Overall, BrS patients consume 14% less health care resources compared to LQTS patients in terms of attendance costs. BrS patients require more A&E and general outpatient services, but less inpatient and specialist outpatient services than LQTS patients.
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Affiliation(s)
- Sharen Lee
- Cardiac Electrophysiology Unit, Cardiovascular Analytics GroupPowerHealth LimitedHong KongChina
| | - Cheuk To Skylar Chung
- Cardiac Electrophysiology Unit, Cardiovascular Analytics GroupPowerHealth LimitedHong KongChina
| | - Danny Radford
- Kent and Medway Medical SchoolUniversity of Kent and Canterbury Christ Church UniversityCanterburyKentUK
| | - Oscar Hou In Chou
- Cardiac Electrophysiology Unit, Cardiovascular Analytics GroupPowerHealth LimitedHong KongChina
| | - Teddy Tai Loy Lee
- Cardiac Electrophysiology Unit, Cardiovascular Analytics GroupPowerHealth LimitedHong KongChina
| | - Zita Man Wai Ng
- Cardiac Electrophysiology Unit, Cardiovascular Analytics GroupPowerHealth LimitedHong KongChina
| | - Leonardo Roever
- Department of Clinical ResearchFederal University of UberlandiaUberlandiaBrazil
| | - Rajesh Rajan
- Department of CardiologySabah Al Ahmed Cardiac CentreKuwait CityKuwait
| | - George Bazoukis
- Second Department of CardiologyEvangelismos General Hospital of AthensAthensGreece
| | | | - Shaoying Zeng
- Guangdong Cardiovascular InstituteGuangdong Provincial People's HospitalGuangzhouChina
| | - Fang Zhou Liu
- Department of Cardiology, Atrial Fibrillation Center, Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina
| | - Wing Tak Wong
- State Key Laboratory of Agrobiotechnology (CUHK), School of Life SciencesChinese University of Hong KongHong KongChina
| | - Tong Liu
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular Disease, Department of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina
| | - Gary Tse
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular Disease, Department of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina
- Division of Natural Sciences, Kent and Medway Medical SchoolUniversity of KentCanterburyKentUK
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Ballantyne BA, Vandenberk B, Dykstra S, Labib D, Chew DS, Lydell C, Howarth A, Heydari B, Fine N, Howlett J, White JA, Miller R. Patients with non-ischemic cardiomyopathy and mid-wall striae have similar arrhythmic outcomes as ischemic cardiomyopathy. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:2005-2014. [PMID: 37421578 DOI: 10.1007/s10554-023-02904-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/16/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE While implantable cardioverter-defibrillator (ICD) therapy provides clear benefit in patients with ischemic cardiomyopathy (ICM), this is less clear in patients with non-ischemic cardiomyopathy (NICM). Mid-wall striae (MWS) fibrosis is an established cardiovascular magnetic resonance (CMR) risk marker observed in patients with NICM. We evaluated whether patients with NICM and MWS have similar risk of arrhythmia-related cardiovascular events as patients with ICM. METHODS We studied a cohort of patients undergoing CMR. The presence of MWS was adjudicated by experienced physicians. The primary outcome was a composite of implantable cardioverter-defibrillator (ICD) implant, hospitalization for ventricular tachycardia, resuscitated cardiac arrest, or sudden cardiac death. Propensity-matched analysis was performed to compare outcomes for patients NICM with MWS and ICM. RESULTS A total of 1,732 patients were studied, 972 NICM (706 without MWS, 266 with MWS) and 760 ICM. NICM patients with MWS were more likely to experience the primary outcome versus those without MWS (unadjusted subdistribution hazard ratio (subHR) 2.26, 95% confidence interval [CI] 1.51-3.41) with no difference versus ICM patients (unadjusted subHR 1.32, 95% CI 0.93-1.86). Similar results were seen in a propensity-matched population (adjusted subHR 1.11, 95% CI 0.63-1.98, p = 0.711). CONCLUSION Patients with NICM and MWS demonstrate significantly higher arrhythmic risk compared to NICM without MWS. After adjustment, the arrhythmia risk of patients with NICM and MWS was similar to patients with ICM. Accordingly, physicians could consider the presence of MWS when making clinical decisions regarding arrhythmia risk management in patients with NICM.
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Affiliation(s)
- Brennan A Ballantyne
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Bert Vandenberk
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Steven Dykstra
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Dina Labib
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Derek S Chew
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Carmen Lydell
- Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Andrew Howarth
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Bobak Heydari
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Nowell Fine
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Jonathan Howlett
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - James A White
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Robert Miller
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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Mesnier J, Ternacle J, Cheema AN, Campelo-Parada F, Urena M, Veiga-Fernandez G, Nombela-Franco L, Munoz-Garcia AJ, Vilalta V, Regueiro A, Del Val D, Asmarats L, Del Trigo M, Serra V, Bonnet G, Jonveaux M, Rezaei E, Matta A, Himbert D, de la Torre Hernandez JM, Tirado-Conte G, Fernandez-Nofrerias E, Vidal P, Alfonso F, Gutierrez-Alonso L, Oteo JF, Belahnech Y, Mohammadi S, Philippon F, Modine T, Rodés-Cabau J. Cardiac Death After Transcatheter Aortic Valve Replacement With Contemporary Devices. JACC Cardiovasc Interv 2023; 16:2277-2290. [PMID: 37758382 DOI: 10.1016/j.jcin.2023.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 06/14/2023] [Accepted: 07/09/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND The burden of cardiac death after transcatheter aortic valve replacement (TAVR), particularly from advanced heart failure (HF) and sudden cardiac death (SCD), remains largely unknown. OBJECTIVES This study sought to evaluate the incidence and predictors of SCD and HF-related death in TAVR recipients treated with newer-generation devices. METHODS This study included a total of 5,421 consecutive patients who underwent TAVR with newer-generation devices using balloon (75.7%) or self-expandable (24.3%) valves. RESULTS After a median follow-up of 2 (IQR: 1-3) years, 976 (18.0%) patients had died, 50.8% from cardiovascular causes. Advanced HF and SCD accounted for 11.6% and 7.5% of deaths, respectively. Independent predictors of HF-related death were atrial fibrillation (HR: 2.17; 95% CI: 1.47-3.22; P < 0.001), prior pacemaker (HR: 1.79; 95% CI: 1.10-2.92; P = 0.01), reduced left ventricular ejection fraction (HR: 1.08 per 5% decrease; 95% CI: 1.01-1.14; P = 0.02), transthoracic approach (HR: 2.50; 95% CI: 1.37-4.55; P = 0.003), and new-onset persistent left bundle branch block (HR: 1.85; 95% CI: 1.14-3.02; P = 0.01). Two baseline characteristics (diabetes, HR: 1.81; 95% CI: 1.13-2.89; P = 0.01; and chronic kidney disease, HR: 1.72; 95% CI: 1.02-2.90; P = 0.04) and 3 procedural findings (valve in valve, HR: 2.17; 95% CI: 1.01-4.64; P = 0.04; transarterial nontransfemoral approach, HR: 2.23; 95% CI: 1.23-4.48; P = 0.01; and periprocedural ventricular arrhythmia, HR: 7.19; 95% CI: 2.61-19.76; P < 0.001) were associated with an increased risk of SCD after TAVR. CONCLUSIONS Advanced HF and SCD accounted for a fifth of deaths after TAVR in contemporary practice. Potentially treatable factors leading to increased risk of HF deaths and SCD were identified, such as arrhythmia/dyssynchrony factors for HF and valve-in-valve TAVR or periprocedural ventricular arrhythmias for SCD.
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Affiliation(s)
- Jules Mesnier
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Julien Ternacle
- Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Asim N Cheema
- Southlake Regional Health Centre, St. Michael's Hospital Toronto, Newmarket, Ontario, Canada
| | | | - Marina Urena
- Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, Spain
| | - Antonio J Munoz-Garcia
- Hospital Universitario Virgen de la Victoria, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Málaga, Spain
| | - Victoria Vilalta
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Ander Regueiro
- Cardiology Department, Instituto Clínic Cardiovascular, Hospital Clínic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - David Del Val
- Department of Cardiology, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria La Princesa, CIBER-CV, Madrid, Spain
| | - Lluis Asmarats
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Maria Del Trigo
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Vicenç Serra
- Vall d'Hebron Research Institute, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Guillaume Bonnet
- Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Melchior Jonveaux
- Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Effat Rezaei
- Southlake Regional Health Centre, St. Michael's Hospital Toronto, Newmarket, Ontario, Canada
| | | | - Dominique Himbert
- Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Gabriela Tirado-Conte
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, Spain
| | | | - Pablo Vidal
- Cardiology Department, Instituto Clínic Cardiovascular, Hospital Clínic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria La Princesa, CIBER-CV, Madrid, Spain
| | | | - Juan Francisco Oteo
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Yassin Belahnech
- Vall d'Hebron Research Institute, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Siamak Mohammadi
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - François Philippon
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Thomas Modine
- Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Cardiology Department, Instituto Clínic Cardiovascular, Hospital Clínic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
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Wang J, Huang P, Yu Q, Lu J, Liu P, Yang Y, Feng Z, Cai J, Yang G, Yuan H, Tang H, Lu Y. Epilepsy and long-term risk of arrhythmias. Eur Heart J 2023; 44:3374-3382. [PMID: 37602368 PMCID: PMC10499547 DOI: 10.1093/eurheartj/ehad523] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 06/26/2023] [Accepted: 08/03/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND AND AIMS Previous evidence has mainly supported transient changes in cardiac function during interictal or peri-ictal phases in people with epilepsy, but the long-term risk of cardiac arrhythmias is poorly described. This study aimed to assess the long-term association of epilepsy with cardiac arrhythmias, considering the potential role of genetic predisposition and antiseizure medications (ASMs) in any associations observed. METHODS This population-based study evaluated UK Biobank data for individuals recruited between 2006 and 2010. Cox proportional hazards models and competing risk models were used to examine the association of epilepsy history with the long-term incidence risk of cardiac arrhythmias and arrhythmias subtypes. Polygenic risk scores (PRS) were calculated to investigate the effect of genetic susceptibility. The role of ASMs was also evaluated by integrating observational and drug target Mendelian randomization (MR) evidence. RESULTS The study included 329 432 individuals, including 2699 people with epilepsy. Compared with those without epilepsy, people with epilepsy experienced an increased risk of all cardiac arrhythmias [hazard ratio (HR) 1.36, 95% confidence interval (CI) 1.21-1.53], atrial fibrillation (HR 1.26, 95% CI 1.08-1.46), and other cardiac arrhythmias (HR 1.56, 95% CI 1.34-1.81). The associations were not modified by genetic predisposition as indicated by PRS. Competing and sensitivity analyses corroborated these results. Individuals with epilepsy using ASMs, especially carbamazepine and valproic acid, were at a higher risk for cardiac arrhythmias. This observation was further supported by drug target MR results (PSMR < .05 and PHEIDI > .05). CONCLUSION This study revealed the higher risk of cardiac arrhythmias persists long term in people with epilepsy, especially among those using carbamazepine and valproic acid. These findings highlight the need for regular heart rhythm monitoring and management in people with epilepsy in order to reduce the risk of further cardiovascular complications.
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Affiliation(s)
- Jie Wang
- Clinical Research Center, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan 410013, China
- Department of Cardiology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan 410013, China
| | - Peiyuan Huang
- MRC Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK
| | - Qingwei Yu
- Clinical Research Center, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan 410013, China
- Department of Neurosurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan 410008, China
| | - Jun Lu
- Clinical Research Center, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan 410013, China
| | - Pinbo Liu
- Clinical Research Center, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan 410013, China
| | - Yiping Yang
- Clinical Research Center, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan 410013, China
| | - Zeying Feng
- Clinical Research Center, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan 410013, China
| | - Jingjing Cai
- Clinical Research Center, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan 410013, China
- Department of Cardiology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan 410013, China
| | - Guoping Yang
- Clinical Research Center, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan 410013, China
| | - Hong Yuan
- Clinical Research Center, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan 410013, China
- Department of Cardiology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan 410013, China
| | - Haibo Tang
- Department of Metabolic and Bariatric Surgery, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
| | - Yao Lu
- Clinical Research Center, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan 410013, China
- Department of Cardiology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan 410013, China
- Faculty of Life Sciences & Medicine, King's College London, 150 Stamford Street, London SE1 9NH, UK
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147
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Pujol-Lopez M, Du Fay de Lavallaz J, Rangan P, Beaser A, Aziz Z, Upadhyay GA, Nayak H, Weiss JP, Zawaneh M, Bai R, Su W, Tung R. Vasovagal Responses to Human Monomorphic Ventricular Tachycardia: Hemodynamic Implications From Sinus Rate Analysis. J Am Coll Cardiol 2023; 82:1096-1105. [PMID: 37673510 DOI: 10.1016/j.jacc.2023.06.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/30/2023] [Accepted: 06/12/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Factors determining hemodynamic stability during human ventricular tachycardia (VT) are incompletely understood. OBJECTIVES The purposes of this study were to characterize sinus rate (SR) responses during monomorphic VT in association with hemodynamic stability and to prospectively assess the effects of vagolytic therapy on VT tolerance. METHODS This is a retrospective analysis of patients undergoing scar-related VT ablation. Vasovagal responses were evaluated by analyzing sinus cycle length before VT induction and during VT. SR responses were classified into 3 groups: increasing (≥5 beats/min, sympathetic), decreasing (≥5 beats/min, vagal), and unchanged, with the latter 2 categorized as inappropriate SR. In a prospective cohort (n = 30) that exhibited a failure to increase SR, atropine was administered to improve hemodynamic tolerance to VT. RESULTS In 150 patients, 261 VT episodes were analyzed (29% untolerated, 71% tolerated) with median VT duration 1.6 minutes. A total of 52% of VT episodes were associated with a sympathetic response, 31% had unchanged SR, and 17% of VTs exhibited a vagal response. A significantly higher prevalence of inappropriate SR responses was observed during untolerated VT (sustained VT requiring cardioversion within 150 seconds) compared with tolerated VT (84% vs 34%; P < 0.001). Untolerated VT was significantly different between groups: 9% (sympathetic), 82% (vagal), and 32% (unchanged) (P < 0.001). Atropine administration improved hemodynamic tolerance to VT in 70%. CONCLUSIONS Nearly one-half of VT episodes are associated with failure to augment SR, indicative of an under-recognized pathophysiological vasovagal response to VT. Inappropriate SR responses were more predictive of hemodynamic instability than VT rate and ejection fraction. Vagolytic therapy may be a novel method to augment blood pressure during VT.
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Affiliation(s)
- Margarida Pujol-Lopez
- University of Chicago Medicine, Center for Arrhythmia Care, Pritzker School of Medicine, Section of Cardiology, Chicago, Illinois, USA; University of Arizona College of Medicine, Banner-University Medical Center, Division of Cardiology, Phoenix, Arizona, USA
| | - Jeanne Du Fay de Lavallaz
- University of Chicago Medicine, Center for Arrhythmia Care, Pritzker School of Medicine, Section of Cardiology, Chicago, Illinois, USA
| | - Pooja Rangan
- University of Arizona College of Medicine, Banner-University Medical Center, Division of Cardiology, Phoenix, Arizona, USA
| | - Andrew Beaser
- University of Chicago Medicine, Center for Arrhythmia Care, Pritzker School of Medicine, Section of Cardiology, Chicago, Illinois, USA
| | - Zaid Aziz
- University of Chicago Medicine, Center for Arrhythmia Care, Pritzker School of Medicine, Section of Cardiology, Chicago, Illinois, USA
| | - Gaurav A Upadhyay
- University of Chicago Medicine, Center for Arrhythmia Care, Pritzker School of Medicine, Section of Cardiology, Chicago, Illinois, USA
| | - Hemal Nayak
- University of Chicago Medicine, Center for Arrhythmia Care, Pritzker School of Medicine, Section of Cardiology, Chicago, Illinois, USA
| | - J Peter Weiss
- University of Arizona College of Medicine, Banner-University Medical Center, Division of Cardiology, Phoenix, Arizona, USA
| | - Michael Zawaneh
- University of Arizona College of Medicine, Banner-University Medical Center, Division of Cardiology, Phoenix, Arizona, USA
| | - Rong Bai
- University of Arizona College of Medicine, Banner-University Medical Center, Division of Cardiology, Phoenix, Arizona, USA
| | - Wilber Su
- University of Arizona College of Medicine, Banner-University Medical Center, Division of Cardiology, Phoenix, Arizona, USA
| | - Roderick Tung
- University of Arizona College of Medicine, Banner-University Medical Center, Division of Cardiology, Phoenix, Arizona, USA.
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148
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d'Avila A, D'Angelo RN. Vasovagal Responses to Human Monomorphic Ventricular Tachycardia: Atropine to the Rescue. J Am Coll Cardiol 2023; 82:1106-1107. [PMID: 37673511 DOI: 10.1016/j.jacc.2023.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 06/21/2023] [Indexed: 09/08/2023]
Affiliation(s)
- Andre d'Avila
- Harvard-Thorndike Electrophysiology Institute, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
| | - Robert N D'Angelo
- Harvard-Thorndike Electrophysiology Institute, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. https://twitter.com/rdangeloMD
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149
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MacDonald BJ, Turgeon RD. Incorporation of Shared Decision-Making in International Cardiovascular Guidelines, 2012-2022. JAMA Netw Open 2023; 6:e2332793. [PMID: 37676658 PMCID: PMC10485733 DOI: 10.1001/jamanetworkopen.2023.32793] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/01/2023] [Indexed: 09/08/2023] Open
Abstract
Importance Shared decision-making (SDM) is a key component of the provision of ethical care, but prior reviews have indicated that clinical practice guidelines seldom promote or facilitate SDM. It is currently unknown whether these findings extend to contemporary cardiovascular guidelines. Objective To identify and characterize integration of SDM in contemporary cardiovascular guideline recommendations using a systematic classification system. Design, Setting, and Participants This cross-sectional study assessed the latest guidelines or subsequent updates that included pharmacotherapy recommendations and were published between January 2012 and December 2022 by the American College of Cardiology (ACC), Canadian Cardiovascular Society (CCS), and European Society of Cardiology (ESC). Data were analyzed from February 21 to July 21, 2023. Main Outcomes and Measures All pharmacotherapy recommendations were identified within each guideline. Recommendations that incorporated SDM were rated according to a systematic rating framework to evaluate the quality of SDM incorporation based on directness (range, 1-3; assessing whether SDM was incorporated directly and impartially into the recommendation's text, with 1 indicating direct and impartial incorporation of SDM into the recommendation's text) and facilitation (range, A-D; assessing whether decision aids or quantified benefits and harms were provided, with A indicating that a decision aid quantifying benefits and harms was provided). The proportion of recommendations incorporating SDM was also analyzed according to guideline society and category (eg, general cardiology, heart failure). Results Analyses included 65 guideline documents, and 33 documents (51%) incorporated SDM either in a general statement or within specific recommendations. Of 7499 recommendations, 2655 (35%) recommendations addressed pharmacotherapy, and of these, 170 (6%) incorporated SDM. By category, general cardiology guidelines contained the highest proportion of pharmacotherapy recommendations incorporating SDM (86 of 865 recommendations [10%]), whereas heart failure and myocardial disease contained the least (9 of 315 recommendations [3%]). The proportion of pharmacotherapy recommendations incorporating SDM was comparable across societies (ACC: 75 of 978 recommendations [8%]; CCS: 29 of 333 recommendations [9%]; ESC: 67 of 1344 recommendations [5%]), with no trend for change over time. Only 5 of 170 SDM recommendations (3%) were classified as grade 1A (impartial recommendations for SDM supported by a decision aid), whereas 114 of 170 recommendations (67%) were grade 3D (SDM mentioned only in supporting text and without any tools or information to facilitate SDM). Conclusions and Relevance In this cross-sectional study across guidelines published by 3 major cardiovascular societies over the last decade, 51% of guidelines mentioned the importance of SDM, yet only 6% of recommendations incorporated SDM in any form, and fewer adequately facilitated SDM.
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Affiliation(s)
- Blair J. MacDonald
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ricky D. Turgeon
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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Marmerstein J, Reddy R, Whittington RH, Dukes J. Evaluation of a novel PVC and PAC detection algorithm in an implantable cardiac monitor for longitudinal risk monitoring. Heart Rhythm O2 2023; 4:592-596. [PMID: 37744934 PMCID: PMC10513916 DOI: 10.1016/j.hroo.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Affiliation(s)
| | - Ravi Reddy
- Micro Systems Engineering, Inc, Lake Oswego, Oregon
| | | | - Jonathan Dukes
- Cardiology Associates Medical Group, Inc, Ventura, California
- Community Memorial Hospital, Ventura, California
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