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Awad SS, Azeez EF, Taha MO, El-Naggar WM, El-Damaty A. Arrhythmogenicity of anti-tachycardia pacing in patients with implantable cardioverter defibrillator. Egypt Heart J 2023; 75:44. [PMID: 37266828 DOI: 10.1186/s43044-023-00369-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 05/16/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Anti-tachycardia pacing therapy (ATP) has shown comparable efficacy to shock therapy in ventricular tachycardia (VT) termination with better quality of life. However, some ATPs may lead to VT acceleration or degeneration to ventricular fibrillation (VF), which will result in more ICD shocks. The aim of this study was to investigate the predictors of VT acceleration by ATP therapy in a real-life patient cohort. RESULTS We retrospectively reviewed 448 monomorphic VT episodes that required ATP therapy in 60 patients with structural heart diseases implanted with ICD or CRTD. The clinical data of the patients and the episodes' details were evaluated. We found that patients with a higher ejection fraction (EF) were more likely to be cardioverted by ATP therapy (P: 0.024). VT acceleration was more frequent in patients with lower EF (mean 31.24 ± 4.08) compared with the non-accelerated patients with higher EF (mean 37.00 ± 9.4, P: 0.016). The percentage of accelerated episodes was 8.5%. VT episodes with a mean cycle length (CL) < 310 ms are more likely to accelerate (sensitivity 76.3%, specificity 67.7%, PPV value 45%, NPV 86%, and AUC 0.790). There was a statistically significant difference in the accelerated VT episodes as compared to non-accelerated episodes regarding the number of ATP bursts (mean 3.66 ± 2.22 vs. 1.76 ± 1.35, P: < 0.001), ramp (23.7% vs. 4.2%, P: < 0.001), scanning (55.3% vs. 31.3%, P: 0.003) and burst adaptive cycle length (mean 83.55 ± 2.92 vs. 84.64 ± 2.61, P: 0.016). In a multivariate analysis, the VT CL, number of ATP bursts and ramp pacing predicted VT acceleration by ATP therapy. CONCLUSIONS Ventricular tachycardia in patients with low LV EF and fast VTs with a CL less than 310 ms were more likely to accelerate with ATP therapy. The number of ATP bursts and the use of ramp had a significant effect on VT acceleration. To avoid VT acceleration by ATP therapy, ramp pacing better be avoided, especially in fast VTs, and lesser number of bursts should be delivered.
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Affiliation(s)
- Sherien Samy Awad
- Egyptian Ministry of Health, Al Kasr Al Aini Street, Old Cairo, 11562, Cairo Governorate, Egypt.
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Sunwoo SH, Cha MJ, Han SI, Kang H, Cho YS, Yeom DH, Park CS, Park NK, Choi SW, Kim SJ, Cha GD, Jung D, Choi S, Oh S, Nam GB, Hyeon T, Kim DH, Lee SP. Ventricular tachyarrhythmia treatment and prevention by subthreshold stimulation with stretchable epicardial multichannel electrode array. SCIENCE ADVANCES 2023; 9:eadf6856. [PMID: 37000879 PMCID: PMC10065438 DOI: 10.1126/sciadv.adf6856] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/28/2023] [Indexed: 05/24/2023]
Abstract
The implantable cardioverter-defibrillator (ICD) is an effective method to prevent sudden cardiac death in high-risk patients. However, the transvenous lead is incompatible with large-area electrophysiological mapping and cannot accommodate selective multichannel precision stimulations. Moreover, it involves high-energy shocks, resulting in pain, myocardial damage, and recurrences of ventricular tachyarrhythmia (VTA). We present a method for VTA treatment based on subthreshold electrical stimulations using a stretchable epicardial multichannel electrode array, which does not disturb the normal contraction or electrical propagation of the ventricle. In rabbit models with myocardial infarction, the infarction was detected by mapping intracardiac electrograms with the stretchable epicardial multichannel electrode array. Then, VTAs could be terminated by sequential electrical stimuli from the epicardial multichannel electrode array beginning with low-energy subthreshold stimulations. Last, we used these subthreshold stimulations to prevent the occurrence of additional VTAs. The proposed protocol using the stretchable epicardial multichannel electrode array provides opportunities toward the development of innovative methods for painless ICD therapy.
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MESH Headings
- Rabbits
- Animals
- Tachycardia, Ventricular/therapy
- Tachycardia, Ventricular/epidemiology
- Tachycardia, Ventricular/etiology
- Defibrillators, Implantable/adverse effects
- Heart Ventricles
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Death, Sudden, Cardiac/epidemiology
- Myocardial Infarction/therapy
- Myocardial Infarction/etiology
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Affiliation(s)
- Sung-Hyuk Sunwoo
- Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul 08826, Republic of Korea
- School of Chemical and Biological Engineering and Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 03080, Republic of Korea
| | - Myung-Jin Cha
- Departments of Cardiology and Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Sang Ihn Han
- Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul 08826, Republic of Korea
- School of Chemical and Biological Engineering and Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
| | - Hyejeong Kang
- Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul 08826, Republic of Korea
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Ye Seul Cho
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Da-Hae Yeom
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Chan Soon Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Na Kyeong Park
- Department of Physiology, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Seong Woo Choi
- Department of Physiology, Dongguk University College of Medicine, Gyeongju 38066, Republic of Korea
| | - Sung Joon Kim
- Department of Physiology, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Gi Doo Cha
- Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul 08826, Republic of Korea
- School of Chemical and Biological Engineering and Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
| | - Dongjun Jung
- Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul 08826, Republic of Korea
- School of Chemical and Biological Engineering and Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
| | - Suji Choi
- Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul 08826, Republic of Korea
- School of Chemical and Biological Engineering and Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
| | - Seil Oh
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Gi-Byoung Nam
- Departments of Cardiology and Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Taeghwan Hyeon
- Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul 08826, Republic of Korea
- School of Chemical and Biological Engineering and Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
| | - Dae-Hyeong Kim
- Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul 08826, Republic of Korea
- School of Chemical and Biological Engineering and Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
- Department of Materials Science and Engineering, Seoul National University, Seoul 08826, Republic of Korea
| | - Seung-Pyo Lee
- Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul 08826, Republic of Korea
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
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Stegemann E, Weidmann M, Miyazawa AA, Shun-Shin MJ, Leyva F, Zegard A, Stegemann B. Laser Doppler flow for the hemodynamic differentiation of tachycardia. Pacing Clin Electrophysiol 2023; 46:114-124. [PMID: 36385259 DOI: 10.1111/pace.14618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/15/2022] [Accepted: 10/31/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Implantable cardioverter defibrillators (ICDs) offer effective therapy for the prevention of sudden cardiac death (SCD) due to ventricular arrhythmias. However, inappropriate shocks have detrimental effects on survival and quality of life. The addition of hemodynamic monitoring may be useful in discriminating clinically important ventricular arrhythmias. OBJECTIVE In this study, we assess the ability of laser Doppler flowmetry to assess the hemodynamic effect of paced atrial and ventricular arrhythmias using mean arterial blood pressure as the reference. METHODS In this acute human study in patients undergoing an elective electrophysiological study, laser Doppler flowmetry, arterial blood pressure, and surface ECG were acquired during high-rate atrial and ventricular pacing to simulate supraventricular and ventricular tachycardias. RESULTS Arterial blood pressure and laser Doppler flow signals correlated well during atrial and ventricular pacing (rho = 0.694, p < .001). The hemodynamic impairment detected by both methods was greater during ventricular pacing than atrial pacing (-1.0% vs. 19.0%, p < .001). Laser Doppler flowmetry performed better than rate alone to identify hemodynamic impairments. CONCLUSION In this acute study, laser Doppler flowmetry tissue perfusion served as a good surrogate measure for arterial pressure, which could be incorporated into future ICDs.
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Affiliation(s)
- Emilia Stegemann
- Clinic for Internal Medicine & Angiology, Agaplesion Diakonie Kliniken Kassel, Kassel, Germany.,Klinik für Kardiologie und Angiologie, Medizinische Fakultät der Philipps-Universität Marburg, Marburg, Germany
| | - Mia Weidmann
- Medizinische Klinik II, Klinikum Kassel, Kassel, Germany
| | - Alejandra A Miyazawa
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, United Kingdom
| | - Matthew J Shun-Shin
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, United Kingdom
| | - Francisco Leyva
- Aston Medical School, Aston University, Birmingham, United Kingdom.,Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Abbasin Zegard
- Aston Medical School, Aston University, Birmingham, United Kingdom.,Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Berthold Stegemann
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, United Kingdom.,Aston Medical School, Aston University, Birmingham, United Kingdom.,Queen Elizabeth Hospital, Birmingham, United Kingdom
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Tsukahara K, Oginosawa Y, Fujino Y, Honda T, Kikuchi K, Nozoe M, Uchida T, Minamiguchi H, Sonoda K, Ogawa M, Ideguchi T, Kizaki Y, Nakamura T, Oba K, Higa S, Yoshida K, Yagyu K, Miyamoto T, Yamagishi Y, Ohe H, Kohno R, Kataoka M, Otsuji Y, Abe H. RR interval variability in the evaluation of ventricular tachycardia and effects of implantable cardioverter defibrillator therapy. J Arrhythm 2021; 37:1052-1060. [PMID: 34386132 PMCID: PMC8339111 DOI: 10.1002/joa3.12551] [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: 02/11/2021] [Revised: 04/13/2021] [Accepted: 04/21/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND An implantable cardioverter defibrillator (ICD) is the most reliable therapeutic device for preventing sudden cardiac death in patients with sustained ventricular tachycardia (VT). Regarding its effectiveness, targeted VT is defined based on the tachyarrhythmia cycle length. However, variations in RR interval variability of VTs may occur. Few studies have reported on VT characteristics and effects of ICD therapy according to the RR interval variability. We aimed to identify the clinical characteristics of VTs and ICD therapy effects according to the RR interval variability. METHODS We analyzed 821 VT episodes in 69 patients with ICDs or cardiac resynchronization therapy defibrillators. VTs were classified as irregular when the difference between two successive beats was >20 ms in at least one of 10 RR intervals; otherwise, they were classified as regular. We evaluated successful termination using anti-tachycardia pacing (ATP)/shock therapy, spontaneous termination, and acceleration between regular and irregular VTs. The RR interval variability reproducibility rates were evaluated. RESULTS Regular VT was significantly more successfully terminated than irregular VT by ATP. No significant difference was found in shock therapy or VT acceleration between the regular and irregular VTs. Spontaneous termination occurred significantly more often in irregular than in regular VT cases. The reproducibility rates of RR interval variability in each episode and in all episodes were 89% and 73%, respectively. CONCLUSIONS ATP therapy showed greater effectiveness for regular than for irregular VT. Spontaneous termination was more common in irregular than in regular VT. RR interval variability of VTs seems to be reproducible.
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Affiliation(s)
- Keita Tsukahara
- The Second Department of Internal MedicineUniversity of Occupational and Environment HealthKitakyushuJapan
| | - Yasushi Oginosawa
- The Second Department of Internal MedicineUniversity of Occupational and Environment HealthKitakyushuJapan
| | - Yoshihisa Fujino
- The Department of Environmental Epidemiology Institute of Industrial Ecological SciencesUniversity of Occupational and Environmental HealthKitakyushuJapan
| | - Toshihiro Honda
- Division of CardiologyKumamoto Junkankika HospitalKumamotoJapan
| | - Kan Kikuchi
- Division of CardiologyJapan Community Healthcare OrganizationKyushu HospitalKitakyusyuJapan
| | - Masatsugu Nozoe
- Division of CardiologySaiseikai Fukuoka General HospitalFukuokaJapan
| | - Takayuki Uchida
- Department of Cardiovascular SurgeryIizuka HospitalIizukaJapan
| | | | - Koichiro Sonoda
- Department of CardiologySasebo City General HospitalSaseboJapan
| | - Masahiro Ogawa
- Department of CardiologyFukuoka University School of MedicineFukuokaJapan
| | - Takeshi Ideguchi
- Department of Internal Medicine, Circulatory and Body Fluid RegulationFaculty of MedicineUniversity of MiyazakiMiyazakiJapan
| | | | - Toshihiro Nakamura
- Department of CardiologyNational Hospital Organization Kyushu Medical CenterFukuokaJapan
| | - Kageyuki Oba
- Department of CardiologyYuai Medical CenterOkinawaJapan
| | - Satoshi Higa
- Cardiac Electrophysiology and Pacing LaboratoryDivision of Cardiovascular MedicineMakiminato Central HospitalOkinawaJapan
| | - Keiki Yoshida
- Department of CardiologySaga‐ken Medical Centre KoseikanSagaJapan
| | - Keishiro Yagyu
- The Second Department of Internal MedicineUniversity of Occupational and Environment HealthKitakyushuJapan
| | - Taro Miyamoto
- The Second Department of Internal MedicineUniversity of Occupational and Environment HealthKitakyushuJapan
| | - Yasunobu Yamagishi
- The Second Department of Internal MedicineUniversity of Occupational and Environment HealthKitakyushuJapan
| | - Hisaharu Ohe
- The Second Department of Internal MedicineUniversity of Occupational and Environment HealthKitakyushuJapan
| | - Ritsuko Kohno
- Department of Heart Rhythm ManagementUniversity of Occupational and Environment HealthKitakyusyuJapan
| | - Masaharu Kataoka
- The Second Department of Internal MedicineUniversity of Occupational and Environment HealthKitakyushuJapan
| | - Yutaka Otsuji
- The Second Department of Internal MedicineUniversity of Occupational and Environment HealthKitakyushuJapan
| | - Haruhiko Abe
- Department of Heart Rhythm ManagementUniversity of Occupational and Environment HealthKitakyusyuJapan
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Kumar SK, Thomas GR, Singh SM. ATP - A friend with benefits. J Electrocardiol 2021; 65:102-104. [PMID: 33588256 DOI: 10.1016/j.jelectrocard.2021.01.017] [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: 12/01/2020] [Revised: 01/22/2021] [Accepted: 01/22/2021] [Indexed: 11/15/2022]
Abstract
Anti-tachycardia pacing (ATP) has gained widespread acceptance to treat ventricular tachyarrhythmias and prevent implantable defibrillator shocks. A 63-year-old lady with nonischemic cardiomyopathy underwent insertion of a primary prevention biventricular implantable cardioverter defibrillator (BIV-ICD). Post implant she was found to have recurrent episodes of atrioventricular nodal re-entry tachycardia (AVNRT) based on device electrograms. In this report, we describe the use of anti-tachycardia pacing to manage this tachycardia.
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Affiliation(s)
- Sharath K Kumar
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Garry R Thomas
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Sheldon M Singh
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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