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Markman TM, Marchlinski FE, Callans DJ, Frankel DS. Programmed Ventricular Stimulation: Risk Stratification and Guiding Antiarrhythmic Therapies. JACC Clin Electrophysiol 2024; 10:1489-1507. [PMID: 38661601 DOI: 10.1016/j.jacep.2024.02.034] [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: 01/16/2024] [Accepted: 02/13/2024] [Indexed: 04/26/2024]
Abstract
Electrophysiologic testing with programmed ventricular stimulation (PVS) has been utilized to induce ventricular tachycardia (VT), thereby improving risk stratification for patients with ischemic and nonischemic cardiomyopathies and determining the effectiveness of antiarrhythmic therapies, especially catheter ablation. A variety of procedural aspects can be modified during PVS in order to alter the sensitivity and specificity of the test including the addition of multiple baseline pacing cycle lengths, extrastimuli, and pacing locations. The definition of a positive result is also critically important, which has varied from exclusively sustained monomorphic VT (>30 seconds) to any ventricular arrhythmia regardless of morphology. In this review, we discuss the history of PVS and evaluate its role in sudden cardiac death risk stratification in a variety of patient populations. We propose an approach to future investigations that will capitalize on the unique ability to vary the sensitivity and specificity of this test. We then discuss the application of PVS during and following catheter ablation. The strategies that have been utilized to improve the efficacy of intraprocedural PVS are highlighted during a discussion of the limitations of this probabilistic strategy. The role of noninvasive programmed stimulation is also reviewed in predicting recurrent VT and informing management decisions including repeat ablations, modifications in antiarrhythmic drugs, and implantable cardioverter-defibrillator programming. Based on the available evidence and guidelines, we propose an approach to future investigations that will allow clinicians to optimize the use of PVS for risk stratification and assessment of therapeutic efficacy.
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Affiliation(s)
- Timothy M Markman
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Francis E Marchlinski
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David J Callans
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David S Frankel
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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2
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Ailoaei S, Sorodoc L, Ureche C, Sandu G, Sîtari N, Ceasovschih A, Grecu M, Sascău RA, Stătescu C. Role of Cardiac Magnetic Resonance in the Assessment of Patients with Premature Ventricular Contractions: A Narrative Review. Anatol J Cardiol 2024; 28:467-478. [PMID: 38832526 PMCID: PMC11460551 DOI: 10.14744/anatoljcardiol.2024.4314] [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: 02/07/2024] [Accepted: 05/07/2024] [Indexed: 06/05/2024] Open
Abstract
Premature ventricular contractions (PVCs) are a common finding in clinical practice, requiring a full diagnostic work-up in order to exclude an underlying cardiomyopathy. Still, in a substantial proportion of patients, these investigations do not identify any substrate, and the PVCs are labelled as idiopathic. Cardiac magnetic resonance (CMR) has proven in the last decades as the method of choice for the exploration of patients with cardiomyopathies, since it can identify subtle changes in the myocardial tissue and help with risk stratification. In patients with idiopathic PVCs and a high PVC burden, several studies report the presence of late gadolinium enhancement (LGE) at CMR, which can offer additional diagnostic and prognostic benefits, as well as assistance in catheter ablation procedures, as the risk for adverse cardiac and risk for arrhythmic events events is higher compared to patients without scar. This paper focuses on the impact of the presence of LGE in patients with idiopathic PVCs, reviewing all the relevant studies published so far, including randomized controlled clinical trials, prospective or retrospective cohort studies, case series and case reports as well as systematic reviews.
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Affiliation(s)
- Stefan Ailoaei
- Department of Cardiology, Institute for Cardiovascular Diseases, Iași, Romania
- University of Medicine and Pharmacy, Iași, Romania
| | - Laurentiu Sorodoc
- University of Medicine and Pharmacy, Iași, Romania
- Internal Medicine Clinic, Emergency Clinical County Hospital, Iași, Romania
| | - Carina Ureche
- Department of Cardiology, Institute for Cardiovascular Diseases, Iași, Romania
- University of Medicine and Pharmacy, Iași, Romania
| | - Gabriel Sandu
- Department of Cardiology, Institute for Cardiovascular Diseases, Iași, Romania
| | - Nicolae Sîtari
- Department of Cardiology, Institute for Cardiovascular Diseases, Iași, Romania
| | - Alexandr Ceasovschih
- University of Medicine and Pharmacy, Iași, Romania
- Internal Medicine Clinic, Emergency Clinical County Hospital, Iași, Romania
| | - Mihaela Grecu
- Department of Cardiology, Institute for Cardiovascular Diseases, Iași, Romania
| | - Radu-Andy Sascău
- Department of Cardiology, Institute for Cardiovascular Diseases, Iași, Romania
- University of Medicine and Pharmacy, Iași, Romania
| | - Cristian Stătescu
- Department of Cardiology, Institute for Cardiovascular Diseases, Iași, Romania
- University of Medicine and Pharmacy, Iași, Romania
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3
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Lalario A, Rossi M, Allegro V, Gagno G, Perotto M, De Luca A, Merlo M, Sanna GD, Sinagra G. Abnormal conduction-induced cardiomyopathy: a poorly explored entity. Eur Heart J Suppl 2024; 26:i117-i122. [PMID: 38867859 PMCID: PMC11167964 DOI: 10.1093/eurheartjsupp/suae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
A dyssynchronous biventricular activation, which can be determined by left bundle branch block, chronic right ventricular pacing, frequent premature ventricular complexes, or pre-excitation, can cause a global abnormal contractility, thus leading to systolic dysfunction and left ventricular remodelling in a unique nosological entities: abnormal conduction-induced cardiomyopathies. In this clinical scenario, the mainstay therapy is eliminating or improving LV dyssynchrony, removing the trigger. This usually ensures the improvement and even recovery of cardiac geometry and left ventricular function, especially in the absence of genetic background. A multidisciplinary approach, integrating advanced multimodal imaging, is essential for the systematic aetiological definition and the subsequent evaluation and aetiology-guided therapies of patients and their families. This review aims to describe mechanisms, prevalence, risk factors, and diagnostic and therapeutic approach to the various abnormal conduction-induced cardiomyopathies, starting from reasonable certainties and then analysing the grey areas requiring further studies.
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Affiliation(s)
- Andrea Lalario
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste
- European Reference Network for rare, low prevalence and complex diseases of the heart (ERN GUARD-Heart), Italy
| | - Maddalena Rossi
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste
- European Reference Network for rare, low prevalence and complex diseases of the heart (ERN GUARD-Heart), Italy
| | - Valentina Allegro
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste
- European Reference Network for rare, low prevalence and complex diseases of the heart (ERN GUARD-Heart), Italy
| | - Giulia Gagno
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste
- European Reference Network for rare, low prevalence and complex diseases of the heart (ERN GUARD-Heart), Italy
| | - Maria Perotto
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste
- European Reference Network for rare, low prevalence and complex diseases of the heart (ERN GUARD-Heart), Italy
| | - Antonio De Luca
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste
- European Reference Network for rare, low prevalence and complex diseases of the heart (ERN GUARD-Heart), Italy
| | - Marco Merlo
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste
- European Reference Network for rare, low prevalence and complex diseases of the heart (ERN GUARD-Heart), Italy
| | | | - Gianfranco Sinagra
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste
- European Reference Network for rare, low prevalence and complex diseases of the heart (ERN GUARD-Heart), Italy
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4
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Nikolaidou C, Ormerod JO, Ziakas A, Neubauer S, Karamitsos TD. The Role of Cardiovascular Magnetic Resonance Imaging in Patients with Cardiac Arrhythmias. Rev Cardiovasc Med 2023; 24:252. [PMID: 39076394 PMCID: PMC11262447 DOI: 10.31083/j.rcm2409252] [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] [Received: 05/11/2023] [Revised: 06/05/2023] [Accepted: 06/12/2023] [Indexed: 07/31/2024] Open
Abstract
Cardiac arrhythmias are associated with significant morbidity, mortality and poor quality of life. Cardiovascular magnetic resonance (CMR) imaging, with its unsurpassed capability of non-invasive tissue characterisation, high accuracy, and reproducibility of measurements, plays an integral role in determining the underlying aetiology of cardiac arrhytmias. CMR can reliably diagnose previous myocardial infarction, non-ischemic cardiomyopathy, characterise congenital heart disease and valvular pathologies, and also detect the underlying substrate concealed on conventional investigations in a significant proportion of patients with arrhythmias. Determining the underlying substrate of arrhythmia is of paramount importance for treatment planning and prognosis. However, CMR imaging in patients with irregular heart rates can be problematic. Understanding the different ways to overcome the limitations of CMR in arrhythmia is essential for providing high-quality imaging, comprehensive information, and definitive answers in this diverse group of patients.
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Affiliation(s)
- Chrysovalantou Nikolaidou
- Oxford Centre for Clinical Magnetic Resonance Research, University of
Oxford, John Radcliffe Hospital, Headington, OX3 9DU Oxford, UK
| | - Julian O.M. Ormerod
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine,
University of Oxford, John Radcliffe Hospital, Headington, OX3 9DU
Oxford, UK
| | - Antonios Ziakas
- First Department of Cardiology, AHEPA Hospital, School of Medicine,
Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636
Thessaloniki, Greece
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, University of
Oxford, John Radcliffe Hospital, Headington, OX3 9DU Oxford, UK
| | - Theodoros D. Karamitsos
- Oxford Centre for Clinical Magnetic Resonance Research, University of
Oxford, John Radcliffe Hospital, Headington, OX3 9DU Oxford, UK
- First Department of Cardiology, AHEPA Hospital, School of Medicine,
Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636
Thessaloniki, Greece
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5
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Prognostic implications of structural heart disease and premature ventricular contractions in recovery of exercise. Sci Rep 2022; 12:10265. [PMID: 35715698 PMCID: PMC9205997 DOI: 10.1038/s41598-022-14535-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/08/2022] [Indexed: 11/11/2022] Open
Abstract
Premature ventricular contractions (PVCs) during recovery of exercise stress testing are associated with increased cardiovascular mortality, but the cause remains unknown. We aimed to evaluate the association of PVCs during recovery with echocardiographic abnormalities, and their combined prognostic performance. Echocardiographic abnormalities [reduced left ventricular (LV) ejection fraction, valvular heart disease, LV dilatation, LV hypertrophy, or increased filling pressures] and PVCs during recovery were identified among patients having undergone both echocardiography and exercise stress test. Among included patients (n = 3106, age 59 ± 16 years, 55% males), PVCs during recovery were found in 1327 (43%) patients, among which the prevalence of echocardiographic abnormalities was increased (58% vs. 43%, p < 0.001). Overall, PVCs during recovery were associated with increased cardiovascular mortality (219 total events, 7.9 [5.4–11.1] years follow-up; adjusted hazard ratio (HR [95% confidence interval]) 1.6 [1.2–2.1], p < 0.001). When analyzed in combination with either presence or absence of echocardiographic abnormalities, PVCs during recovery were associated with increased risk when such were present (HR 3.3 [1.9–5.5], p < 0.001) but not when absent (HR 1.5 [0.8–2.8], p = 0.22), in reference to those with neither. Our findings provide mechanistic insights to the increased CV risk reported in patients with PVCs during recovery.
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Wei Y, Zhu Y, Wen X, Rui Q, Hu W. Intracavitary Electrocardiogram Guidance Aids Excavation of Rhythm Abnormalities in Patients with Occult Heart Disease. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:2230383. [PMID: 34691372 PMCID: PMC8536431 DOI: 10.1155/2021/2230383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 11/17/2022]
Abstract
In this paper, the analysis of intracavitary electrocardiograms is used to guide the mining of abnormal cardiac rhythms in patients with hidden heart disease, and the algorithm is improved to address the data imbalance problem existing in the abnormal electrocardiogram signals, and a weight-based automatic classification algorithm for deep convolutional neural network electrocardiogram signals is proposed. By preprocessing the electrocardiogram data from the MIT-BIH arrhythmia database, the experimental dataset training algorithm model is obtained, and the algorithm model is migrated into the project. In terms of system design and implementation, by comparing the advantages and disadvantages of the electrocardiogram monitoring system platform, the overall design of the system was carried out in terms of functional and performance requirements according to the system realization goal, and a mobile platform system capable of classifying common abnormal electrocardiogram signals was developed. The system is capable of long-term monitoring and can invoke the automatic classification algorithm model of electrocardiogram signals for analysis. In this paper, the functional logic test and performance test were conducted on the main functional modules of the system. The test results show that the system can run stably and monitor electrocardiogram signals for a long time and can correctly call the deep convolutional neural network-based automatic electrocardiogram signal classification algorithm to analyze the electrocardiogram signals and achieve the requirements of displaying the electrocardiogram signal waveform, analyzing the heartbeat type, and calculating the average heart rate, which achieves the goal of real-time continuous monitoring and analysis of the electrocardiogram signals.
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Affiliation(s)
- Yanli Wei
- Department of Critical Care Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 370000, China
| | - Ying Zhu
- Department of Critical Care Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 370000, China
| | - Xin Wen
- Department of Critical Care Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 370000, China
| | - Qing Rui
- Department of Critical Care Medicine, The First People's Hospital of Chang Zhou, Changzhou, Jiangsu 213003, China
| | - Wei Hu
- Department of Critical Care Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 370000, China
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Diagnosis and Treatment of Idiopathic Premature Ventricular Contractions: A Stepwise Approach Based on the Site of Origin. Diagnostics (Basel) 2021; 11:diagnostics11101840. [PMID: 34679539 PMCID: PMC8534438 DOI: 10.3390/diagnostics11101840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 12/30/2022] Open
Abstract
Premature ventricular contractions in the absence of structural heart disease are among the most common arrhythmias in clinical practice, with well-defined sites of origin in the right and left ventricle. In this review, starting from the electrocardiographic localization of premature ventricular contractions, we investigated the mechanisms, prevalence in the general population, diagnostic work-up, prognosis and treatment of premature ventricular contractions, according to current scientific evidence.
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8
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Scorza R, Jansson A, Sörensson P, Rosenqvist M, Frykman V. Magnetic Resonance Detects Structural Heart Disease in Patients with Frequent Ventricular Ectopy and Normal Echocardiographic Findings. Diagnostics (Basel) 2021; 11:1505. [PMID: 34441439 PMCID: PMC8392672 DOI: 10.3390/diagnostics11081505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/16/2021] [Accepted: 08/19/2021] [Indexed: 02/02/2023] Open
Abstract
The prognosis of patients with ventricular ectopy and a normal heart, as evaluated by echocardiography, is virtually unknown. Cardiac magnetic resonance (CMR) can detect focal ventricular anomalies that could act as a possible site of origin for premature ventricular contractions (PVCs). The aim of this study was to investigate the presence of cardiac anomalies in patients with normal findings at echocardiogram. METHODS Fifty-one consecutive patients (23 women, 28 men, mean age 59 years) with very high PVC burden (>10,000 PVC/day) and normal findings at standard echocardiography and exercise test were examined with CMR. The outcome was pathologic findings, defined as impaired ejection fraction, regional wall motion abnormalities, abnormal ventricular volume, myocardial edema and fibrosis. RESULTS Sixteen out of 51 patients (32%) had structural ventricular abnormalities at CMR. In five patients CMR showed impairment of the left ventricular and/or right ventricular systolic function, and six patients had a dilated left and/or right ventricle. Regional wall motion abnormalities were seen in six patients and fibrosis in four. No patient had CMR signs of edema or met CMR criteria for arrhythmogenic right ventricular cardiomyopathy. Five patients had extra-ventricular findings (enlarged atria in three cases, enlarged thoracic aorta in one case and pericardial effusion in one case). CONCLUSIONS In this study 16 out of 51 patients with a high PVC burden and normal findings at echocardiography showed signs of pathology in the ventricles with CMR. These findings indicate that CMR should be considered in evaluating patients with a high PVC burden and a normal standard investigation.
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Affiliation(s)
- Raffaele Scorza
- Cardiovascular Unit, Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, 18288 Stockholm, Sweden; (A.J.); (M.R.); (V.F.)
| | - Anders Jansson
- Cardiovascular Unit, Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, 18288 Stockholm, Sweden; (A.J.); (M.R.); (V.F.)
| | - Peder Sörensson
- Department of Medicine, Solna, Karolinska University Hospital, Karolinska Institutet, 17177 Stockholm, Sweden;
| | - Mårten Rosenqvist
- Cardiovascular Unit, Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, 18288 Stockholm, Sweden; (A.J.); (M.R.); (V.F.)
| | - Viveka Frykman
- Cardiovascular Unit, Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, 18288 Stockholm, Sweden; (A.J.); (M.R.); (V.F.)
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9
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Gasperetti A, Sicuso R, Dello Russo A, Zucchelli G, Saguner AM, Notarstefano P, Soldati E, Bongiorni MG, Della Rocca DG, Mohanty S, Carbucicchio C, Duru F, Di Biase L, Natale A, Tondo C, Casella M. Prospective use of ablation index for the ablation of right ventricle outflow tract premature ventricular contractions: a proof of concept study. Europace 2021; 23:91-98. [PMID: 33063099 DOI: 10.1093/europace/euaa228] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/09/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS Radiofrequency catheter ablation (RFCA) represents an effective option for idiopathic premature ventricular contractions (PVCs) treatment. Ablation Index (AI) is a novel ablation marker incorporating RF power, contact force, and time of delivery into a single weighted formula. Data regarding AI-guided PVCs RFCA are currently lacking. Aim of the study was to compare AI-guided and standard RFCA outcomes in patients with PVCs originating from the right ventricle outflow tract (RVOT). METHODS AND RESULTS Consecutive patients undergoing AI-guided RFCA of RVOT idiopathic PVCs were prospectively enrolled. Radiofrequency catheter ablation was performed following per-protocol target cut-offs of AI, depending on targeted area (RVOT free wall AI cut-off: 590; RVOT septum AI cut-off: 610). A multi-centre cohort of propensity-matched (age, sex, ejection fraction, and PVC site) patients undergoing standard PVCs RFCA was used as a comparator. Sixty AI-guided patients (44.2 ± 18.0 years old, 58% male, left ventricular ejection fraction 56.2 ± 3.8%) were enrolled; 34 (57%) were ablated in RVOT septum and 26 (43%) patients in the RVOT free wall area. Propensity match with 60 non-AI-guided patients was performed. Acute outcomes and complications resulted comparable. At 6 months, arrhythmic recurrence was more common in non-AI-guided patients whether in general (28% vs. 7% P = 0.003) or by ablated area (RVOT free wall: 27% vs. 4%, P = 0.06; RVOT septum 29% vs. 9% P = 0.05). Ablation Index guidance was associated with improved survival from arrhythmic recurrence [overall odds ratio 6.61 (1.95-22.35), P = 0.001; RVOT septum 5.99 (1.21-29.65), P = 0.028; RVOT free wall 11.86 (1.12-124.78), P = 0.039]. CONCLUSION Ablation Index-guidance in idiopathic PVCs ablation was associated with better arrhythmic outcomes at 6 months of follow-up.
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Affiliation(s)
- Alessio Gasperetti
- Heart Rhythm Center, Centro Cardiologico Monzino, IRCCS, Milan, IT, Italy.,Cardiology Department, Heart Center University Hospital Zürich, Zürich, CH, Switzerland
| | - Rita Sicuso
- Heart Rhythm Center, Centro Cardiologico Monzino, IRCCS, Milan, IT, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, Department of Biomedical Sciences and Public Health, University Hospital "Umberto I-Lancisi-Salesi", Marche Polytechnic University, Ancona, IT, Italy
| | - Giulio Zucchelli
- Second Division of Cardiovascular Diseases, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, IT, Italy
| | - Ardan Muammer Saguner
- Cardiology Department, Heart Center University Hospital Zürich, Zürich, CH, Switzerland
| | | | - Ezio Soldati
- Second Division of Cardiovascular Diseases, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, IT, Italy
| | - Maria Grazia Bongiorni
- Second Division of Cardiovascular Diseases, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, IT, Italy
| | | | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, TX, USA
| | | | - Firat Duru
- Cardiology Department, Heart Center University Hospital Zürich, Zürich, CH, Switzerland
| | - Luigi Di Biase
- Cardiology Department, Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Alber Einstein College of Medicine, Bronx, NY, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, TX, USA
| | - Claudio Tondo
- Heart Rhythm Center, Centro Cardiologico Monzino, IRCCS, Milan, IT, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, IT, Italy
| | - Michela Casella
- Heart Rhythm Center, Centro Cardiologico Monzino, IRCCS, Milan, IT, Italy.,Cardiology and Arrhythmology Clinic, Department of Clinical, Special and Dental Sciences, University Hospital "Umberto I-Lancisi-Salesi" Marche Polytechnic University, Ancona, Italy
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10
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Nikolaidou C, Kotanidis CP, Wijesurendra R, Leal-Pelado J, Kouskouras K, Vassilikos VP, Karvounis H, Ntusi N, Antoniades C, Neubauer S, Karamitsos TD. Cardiac Magnetic Resonance to Detect the Underlying Substrate in Patients with Frequent Idiopathic Ventricular Arrhythmias. Diagnostics (Basel) 2021; 11:1109. [PMID: 34207123 PMCID: PMC8233842 DOI: 10.3390/diagnostics11061109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/15/2021] [Accepted: 06/15/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND A routine diagnostic work-up does not identify structural abnormalities in a substantial proportion of patients with idiopathic ventricular arrhythmias (VAs). We investigated the added value of cardiac magnetic resonance (CMR) imaging in this group of patients. METHODS A single-centre prospective study was undertaken of 72 patients (mean age 46 ± 16 years; 53% females) with frequent premature ventricular contractions (PVCs ≥ 500/24 h) and/or non-sustained ventricular tachycardia (NSVT), an otherwise normal electrocardiogram, normal echocardiography and no coronary artery disease. RESULTS CMR provided an additional diagnostic yield in 54.2% of patients. The most prevalent diagnosis was previous myocarditis (23.6%) followed by possible PVC-related cardiomyopathy (20.8%), non-ischaemic cardiomyopathy (8.3%) and ischaemic heart disease (1.4%). The predictors of abnormal CMR findings were male gender, age and PVCs/NSVT non-outflow tract-related or with multiple morphologies. Patients with VAs had an impaired peak left ventricular (LV) global radial strain (GRS) compared with the controls (28.88% (IQR: 25.87% to 33.97%) vs. 36.65% (IQR: 33.19% to 40.2%), p < 0.001) and a global circumferential strain (GCS) (-17.66% (IQR: -19.62% to -16.23%) vs. -20.66% (IQR: -21.72% to -19.6%), p < 0.001). CONCLUSION CMR reveals abnormalities in a significant proportion of patients with frequent idiopathic VAs. Male gender, age and non-outflow tract PVC origin can be clinical indicators for CMR referral.
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Affiliation(s)
- Chrysovalantou Nikolaidou
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford OX3 9DU, UK; (C.N.); (R.W.); (J.L.-P.); (S.N.)
- First Department of Cardiology, AHEPA Hospital, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece;
| | - Christos P. Kotanidis
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford OX3 9DU, UK; (C.P.K.); (C.A.)
| | - Rohan Wijesurendra
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford OX3 9DU, UK; (C.N.); (R.W.); (J.L.-P.); (S.N.)
| | - Joana Leal-Pelado
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford OX3 9DU, UK; (C.N.); (R.W.); (J.L.-P.); (S.N.)
| | - Konstantinos Kouskouras
- Department of Radiology, AHEPA Hospital, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece;
| | - Vassilios P. Vassilikos
- Third Department of Cardiology, Hippokration Hospital, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, 546 43 Thessaloniki, Greece;
| | - Haralambos Karvounis
- First Department of Cardiology, AHEPA Hospital, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece;
| | - Ntobeko Ntusi
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, 7925 Cape Town, South Africa;
| | - Charalambos Antoniades
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford OX3 9DU, UK; (C.P.K.); (C.A.)
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford OX3 9DU, UK; (C.N.); (R.W.); (J.L.-P.); (S.N.)
| | - Theodoros D. Karamitsos
- First Department of Cardiology, AHEPA Hospital, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece;
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Compagnucci P, Volpato G, Falanga U, Cipolletta L, Conti M, Grifoni G, Verticelli L, Schicchi N, Giovagnoni A, Casella M, Guerra F, Dello Russo A. Recent advances in three-dimensional electroanatomical mapping guidance for the ablation of complex atrial and ventricular arrhythmias. J Interv Card Electrophysiol 2020; 61:37-43. [PMID: 32451799 DOI: 10.1007/s10840-020-00781-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/11/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To provide a brief overview of some relevant technological advances in the field of three-dimensional electroanatomical mapping (3D-EAM) that have recently entered the clinical arena and their role in guiding catheter ablation (CA) of complex atrial and ventricular arrhythmias. METHODS In this technical report, we describe the general features of three novel algorithms featured in the updated CARTO PRIME™ mapping module for CARTO®3 version 7 3D-EAM system (Biosense Webster Inc., Diamond Bar, CA, USA): local activation time (LAT) hybrid, coherent mapping and map replay modules. We also report three challenging arrhythmia cases in which CA was successfully guided by these softwares. RESULTS The LAT hybrid module was used in a case of premature ventricular complex originating from the right coronary cusp. This algorithm facilitated safe positioning of the ablation catheter away from the right coronary ostium, avoiding potential harm to this vital structure. The coherent mapping module helped to identify the critical as well as a bystander isthmus of an atrial macro-re-entrant tachycardia in a grown-up patient with congenital heart disease. The map replay module allowed rapid retrospective activation mapping of two unstable ventricular tachycardias in a case of nonischemic cocaine-associated cardiomyopathy. CONCLUSION 3D-EAM systems offer significant advantages in the management of challenging arrhythmias, and the introduction of novel algorithms underpins improvements in patients' outcomes. Given the increasing sophistication of these systems, however, a close collaboration among cardiac electrophysiologists, engineers and technicians is highly needed in order to get the best from the available technology.
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Affiliation(s)
- Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti Umberto I - Lancisi - Salesi", Ancona, Italy.
| | - Giovanni Volpato
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti Umberto I - Lancisi - Salesi", Ancona, Italy
| | - Umberto Falanga
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti Umberto I - Lancisi - Salesi", Ancona, Italy
| | - Laura Cipolletta
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti Umberto I - Lancisi - Salesi", Ancona, Italy
| | - Manuel Conti
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti Umberto I - Lancisi - Salesi", Ancona, Italy
| | - Gino Grifoni
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti Umberto I - Lancisi - Salesi", Ancona, Italy
| | - Letizia Verticelli
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti Umberto I - Lancisi - Salesi", Ancona, Italy
| | - Nicolò Schicchi
- Radiology Department, University Hospital "Ospedali Riuniti Umberto I - Lancisi - Salesi", Ancona, Italy
| | - Andrea Giovagnoni
- Radiology Department, University Hospital "Ospedali Riuniti Umberto I - Lancisi - Salesi", Ancona, Italy.,Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti Umberto I - Lancisi - Salesi", Ancona, Italy.,Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti Umberto I - Lancisi - Salesi", Ancona, Italy.,Department of Biomedical Science and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti Umberto I - Lancisi - Salesi", Ancona, Italy.,Department of Biomedical Science and Public Health, Marche Polytechnic University, Ancona, Italy
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Bogun F. Advanced cardiac imaging is helpful to determine the true etiology of outflowtract ventricular arrhythmias. Indian Pacing Electrophysiol J 2020; 20:81-82. [PMID: 32278019 PMCID: PMC7244855 DOI: 10.1016/j.ipej.2020.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 11/03/2022] Open
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Sassone B, Muser D, Casella M, Luzi M, Virzì S, Balla C, Nucifora G. Detection of concealed structural heart disease by imaging in patients with apparently idiopathic premature ventricular complexes: A review of current literature. Clin Cardiol 2019; 42:1162-1169. [PMID: 31571249 PMCID: PMC6906994 DOI: 10.1002/clc.23271] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 01/02/2023] Open
Abstract
Background Premature ventricular complexes (PVCs) are the most common form of ventricular arrhythmia in the general population. While in most cases PVCs represent a primitive phenomenon with benign behavior, in a non‐negligible proportion of subjects frequent PVCs may be epiphenomenon of underlying occult heart diseases, requiring special medical attention since they have been resulted linked to increased total and cardiac mortality. Nevertheless, PVCs themselves, when incessantly frequent, may be responsible for left ventricular dysfunction in otherwise normal heart. Aim of this narrative review is to update current knowledge on the general approach to patients with frequent PVCs on the basis of available data, with a special focus on the value of imaging. Hypothesis Routine diagnostic work‐up not infrequently miss subtle concealed arrhythmic substrate, leading to erroneously refer to such arrhythmias as to “idiopathic”. Methods Literature search of PVCs articles was conducted in PubMed and Scopus electronic database. Results Conflicting data arise from literature about the true clinical significance of idiopathic PVCs. There is growing body of data providing evidence that more advanced non‐invasive imaging modalities, such as cardiac magnetic resonance, have an incremental diagnostic and prognostic value. On the other hand, in some cases the prognostic significance of isolated subtle myocardial structural abnormalities in patients with PVCs, still remains area of uncertainty. Conclusion In selected subjects with PVCs and high‐risk features for concealed arrhythmic substrate, traditional assessment to rule out the presence of heart disease, including surface ECG and transthoracic echocardiography, should be implemented with more advanced cardiovascular imaging modalities.
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Affiliation(s)
- Biagio Sassone
- Cardiology Division, SS.ma Annunziata Hospital, Department of Emergency, Azienda Unità Sanitaria Locale di Ferrara, Ferrara, Italy.,Cardiology Division, Delta Hospital, Department of Emergency, Azienda Unità Sanitaria Locale di Ferrara, Ferrara, Italy
| | - Daniele Muser
- Cardiothoracic Department, University Hospital, Piazzale Santa Maria della Misericordia 15, Udine, Italy
| | - Michela Casella
- Heart Rhythm Center, Centro Cardiologico Monzino, Milan, Italy
| | - Mario Luzi
- Cardiology Division, Ospedale Provinciale AREA VASTA 3, Macerata MC, Italy
| | - Santo Virzì
- Cardiology Division, SS.ma Annunziata Hospital, Department of Emergency, Azienda Unità Sanitaria Locale di Ferrara, Ferrara, Italy
| | - Cristina Balla
- Cardiology Department, S. Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Gaetano Nucifora
- Cardiology Department, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Wythenshawe, UK
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