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Zhu C, Hu B, Li X, Han W, Liang Y, Ma X. A Case Report of Mycoplasma pneumoniae-induced fulminant myocarditis in a 15-year-old male leading to cardiogenic shock and electrical storm. Front Cardiovasc Med 2024; 11:1347885. [PMID: 38689858 PMCID: PMC11058217 DOI: 10.3389/fcvm.2024.1347885] [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: 12/05/2023] [Accepted: 03/28/2024] [Indexed: 05/02/2024] Open
Abstract
Mycoplasma pneumoniae (M. pneumoniae) is a well-recognized pathogen primarily associated with respiratory tract infections. However, in rare instances, it can lead to extrapulmonary manifestations, including myocarditis. We present a case of a 15-year-old male who developed fulminant myocarditis, cardiogenic shock, and cardiac electrical storm attributed to M. pneumoniae infection. He underwent a combination of intra-aortic balloon pump (IABP) and veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for cardiac support, ultimately surviving despite the intracardiac thrombus formation and embolic stroke. Following comprehensive treatment and rehabilitation, he was discharged in stable condition. This case underscores the importance of considering atypical pathogens as potential etiological factors in patients presenting with cardiac complications, especially in the adolescents. It also emphasizes the need for clinical vigilance and effective support for potential cardiac complications arising from M. pneumoniae infection.
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Affiliation(s)
| | | | | | | | | | - Xiaochun Ma
- Department of Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, China
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2
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Guarracini F, Bonvicini E, Zanon S, Martin M, Casagranda G, Mochen M, Coser A, Quintarelli S, Branzoli S, Mazzone P, Bonmassari R, Marini M. Emergency Management of Electrical Storm: A Practical Overview. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020405. [PMID: 36837606 PMCID: PMC9963509 DOI: 10.3390/medicina59020405] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 02/08/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023]
Abstract
Electrical storm is a medical emergency characterized by ventricular arrythmia recurrence that can lead to hemodynamic instability. The incidence of this clinical condition is rising, mainly in implantable cardioverter defibrillator patients, and its prognosis is often poor. Early acknowledgment, management and treatment have a key role in reducing mortality in the acute phase and improving the quality of life of these patients. In an emergency setting, several measures can be employed. Anti-arrhythmic drugs, based on the underlying disease, are often the first step to control the arrhythmic burden; besides that, new therapeutic strategies have been developed with high efficacy, such as deep sedation, early catheter ablation, neuraxial modulation and mechanical hemodynamic support. The aim of this review is to provide practical indications for the management of electrical storm in acute settings.
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Affiliation(s)
- Fabrizio Guarracini
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy
- Correspondence: ; Tel.: +39-(0)461-903121; Fax: +39-(0)461-903122
| | - Eleonora Bonvicini
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy
- Department of Cardiology, University of Verona, 37126 Verona, Italy
| | - Sofia Zanon
- Department of Cardiology, University of Verona, 37126 Verona, Italy
| | - Marta Martin
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy
| | | | - Marianna Mochen
- Department of Radiology, Santa Chiara Hospital, 38122 Trento, Italy
| | - Alessio Coser
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy
| | | | - Stefano Branzoli
- Cardiac Surgery Unit, Santa Chiara Hospital, 38122 Trento, Italy
- Department of Cardiac Surgery, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Patrizio Mazzone
- Cardiothoracovascular Department, Electrophysiology Unit, Niguarda Hospital, 20162 Milan, Italy
| | | | - Massimiliano Marini
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, 1090 Brussel, Belgium
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3
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Baldi E, Conte G, Zeppenfeld K, Lenarczyk R, Guerra JM, Farkowski MM, de Asmundis C, Boveda S. Contemporary management of ventricular electrical storm in Europe: results of a European Heart Rhythm Association Survey. Europace 2022; 25:1277-1283. [PMID: 36196613 PMCID: PMC10105853 DOI: 10.1093/europace/euac151] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
Electrical storm (ES) is a predictor of mortality, and its treatment is challenging. Moreover, not all potential therapeutic strategies are available in all hospitals, and a standardized approach among European centres is lacking. The aim of this European Heart Rhythm Association (EHRA) survey was to assess the current management of patients with ES both in the acute and post-acute phases in 102 different European centres. A 20-item online questionnaire was sent out to the EHRA Research Network Centres. The median number of patients with ES treated annually per centre is 10 (IQR 5-15). The possibility of using autonomic modulation (e.g. percutaneous stellate ganglion block or thoracic epidural anaesthesia) for the acute ES treatment is available in only 29.3% of the centres. Moreover, although over 80% of centres perform ventricular tachycardia ablation, this procedure is available 24/7 in only 16.5% of the hospitals. There is a significant heterogeneity among centres regarding the availability of AADs and their use before deciding to proceed with a non-AAD strategy; specifically, 4.4% of centres use only one drug, 33.3% use two drugs, and 12.2% >two drugs, while about 50% of the centres decide based on individual patient's characteristics. Regarding the type of AADs used for the acute and post-acute management of ES patients, important variability is reported depending upon the underlying heart disease. Most patients considered for percutaneous ablation have structural heart disease. Only 46% of centres refer patients to psychological counselling after ES.
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Affiliation(s)
- Enrico Baldi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giulio Conte
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, Lugano 6900, Switzerland
| | - Katja Zeppenfeld
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Leiden, The Netherlands
| | - Radosław Lenarczyk
- Division of Medical Sciences in Zabrze, Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, The Medical University of Silesia, Zabrze, Poland
| | - Jose M Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, IIB SANT PAU, CIBERCV, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Michal M Farkowski
- II Department of Heart Arrhythmia, National Institute of Cardiology, Warsaw, Poland
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Serge Boveda
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium.,Cardiology-Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
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4
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Tsuji Y, Dobrev D. Chronic Total occlusion of infarct-related artery: A bystander or a risk factor of electrical storm? Int J Cardiol 2022; 359:36-37. [DOI: 10.1016/j.ijcard.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 04/04/2022] [Indexed: 11/28/2022]
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5
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Elsokkari I, Tsuji Y, Sapp JL, Nattel S. Recent insights into mechanisms and clinical approaches to electrical storm. Can J Cardiol 2021; 38:439-453. [PMID: 34979281 DOI: 10.1016/j.cjca.2021.12.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/21/2021] [Accepted: 12/30/2021] [Indexed: 12/14/2022] Open
Abstract
Electrical storm, characterized by repetitive ventricular tachycardia/fibrillation (VT/VF) over a short period, is becoming commoner with widespread use of implantable cardioverter-defibrillator (ICD) therapy. Electrical storm, sometimes called "arrhythmic storm" or "VT-storm", is usually a medical emergency requiring hospitalization and expert management, and significantly affects short- and long-term outcomes. This syndrome typically occurs in patients with underlying structural heart disease (ischemic or non-ischemic cardiomyopathy) or inherited channelopathies. Triggers for electrical storm should be sought but are often unidentifiable. Initial management is dictated by the hemodynamic status, while subsequent management typically involves ICD interrogation and reprogramming to reduce recurrent shocks, identification/management of triggers like electrolyte abnormalities, myocardial ischemia, or decompensated heart failure, and antiarrhythmic-drug therapy or catheter ablation. Sympathetic nervous system activation is central to the initiation and maintenance of arrhythmic storm, so autonomic modulation is a cornerstone of management. Sympathetic inhibition can be achieved with medications (particularly beta-adrenoreceptor blockers), deep sedation, or cardiac sympathetic denervation. More definitive management targets the underlying ventricular arrhythmia substrate to terminate and prevent recurrent arrhythmia. Arrhythmia targeting can be achieved with antiarrhythmic medications, catheter ablation or more novel therapies such as stereotactic radiation therapy that targets the arrhythmic substrate. Mechanistic studies point to adrenergic activation and other direct consequences of ICD-shocks in promoting further arrhythmogenesis and hypocontractility. Here, we review the pathophysiologic mechanisms, clinical features, prognosis, and therapeutic options for electrical storm. We also outline a clinical approach to this challenging and complex condition, along with its mechanistic basis.
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Affiliation(s)
- Ihab Elsokkari
- University of Sydney, Nepean Blue Mountains local health district, Australia
| | - Yukiomi Tsuji
- Department of Physiology of Visceral Function, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - John L Sapp
- Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada.
| | - Stanley Nattel
- Departments of Medicine and Research Center, Montreal Heart Institute and Université de Montréal and Pharmacology and Therapeutics McGill University, Montreal, Quebec, Canada; Institute of Pharmacology, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany; IHU LIYRC Institute, Bordeaux, France.
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Network Pharmacology-Based Systematic Analysis of Molecular Mechanisms of Dingji Fumai Decoction for Ventricular Arrhythmia. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:5535480. [PMID: 34046076 PMCID: PMC8128550 DOI: 10.1155/2021/5535480] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/31/2021] [Accepted: 04/28/2021] [Indexed: 12/19/2022]
Abstract
Background Dingji Fumai Decoction (DFD), a traditional herbal mixture, has been widely used to ventricular arrhythmia (VA) in clinical practice in China. However, research on the bioactive components and underlying mechanisms of DFD in VA is still scarce. Methods Components of DFD were collected from TCMSP, ETCM, and literature. The chemical structures of each component were obtained from PubChem. Next, SwissADME and SwissTargetPrediction were applied for compounds screening and targets prediction of DFD; meanwhile, targets of VA were collected from DrugBank and Online Mendelian Inheritance in Man (OMIM). Then, the H-C-T-D network and the protein-protein interaction (PPI) network were constructed based on the data obtained above. CytoNCA was utilized to filter hub genes and VarElect was used to analyze the relationship between genes and diseases. At last, Metascape was employed for systematic analysis on the potential targets of herbals against VA, and AutoDock was applied for molecular docking to verify the results. Results A total of 434 components were collected, 168 of which were qualified, and there were 28 shared targets between DFD and VA. Three function modules of DFD were found from the PPI network. Further systematic analysis of shared genes and function modules explained the potential mechanism of DFD in the treatment of VA; molecular docking has verified the interactions. Conclusions DFD could be employed for VA through mechanisms, including complex interactions between related components and targets, as predicted by network pharmacology and molecular docking. This work confirmed that DFD could apply to the treatment of VA and promoted the explanation of DFD for VA in the molecular mechanisms.
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Tsuji Y, Dobrev D. Implantable cardioverter-defibrillator therapy in primary versus secondary prevention: Reliable prediction of appropriate therapies and mortality is still an unmet need. IJC HEART & VASCULATURE 2021; 32:100740. [PMID: 33681454 PMCID: PMC7910703 DOI: 10.1016/j.ijcha.2021.100740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 01/31/2021] [Accepted: 02/08/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Yukiomi Tsuji
- Department of Physiology of Visceral Function and Body Fluid, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
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Kalarus Z, Svendsen JH, Capodanno D, Dan GA, De Maria E, Gorenek B, Jędrzejczyk-Patej E, Mazurek M, Podolecki T, Sticherling C, Tfelt-Hansen J, Traykov V, Lip GYH, Fauchier L, Boriani G, Mansourati J, Blomström-Lundqvist C, Mairesse GH, Rubboli A, Deneke T, Dagres N, Steen T, Ahrens I, Kunadian V, Berti S. Cardiac arrhythmias in the emergency settings of acute coronary syndrome and revascularization: an European Heart Rhythm Association (EHRA) consensus document, endorsed by the European Association of Percutaneous Cardiovascular Interventions (EAPCI), and European Acute Cardiovascular Care Association (ACCA). Europace 2020; 21:1603-1604. [PMID: 31353412 DOI: 10.1093/europace/euz163] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/14/2019] [Indexed: 12/22/2022] Open
Abstract
Despite major therapeutic advances over the last decades, complex supraventricular and ventricular arrhythmias (VAs), particularly in the emergency setting or during revascularization for acute myocardial infarction (AMI), remain an important clinical problem. Although the incidence of VAs has declined in the hospital phase of acute coronary syndromes (ACS), mainly due to prompt revascularization and optimal medical therapy, still up to 6% patients with ACS develop ventricular tachycardia and/or ventricular fibrillation within the first hours of ACS symptoms. Despite sustained VAs being perceived predictors of worse in-hospital outcomes, specific associations between the type of VAs, arrhythmia timing, applied treatment strategies and long-term prognosis in AMI are vague. Atrial fibrillation (AF) is the most common supraventricular tachyarrhythmia that may be asymptomatic and/or may be associated with rapid haemodynamic deterioration requiring immediate treatment. It is estimated that over 20% AMI patients may have a history of AF, whereas the new-onset arrhythmia may occur in 5% patients with ST elevation myocardial infarction. Importantly, patients who were treated with primary percutaneous coronary intervention for AMI and developed AF have higher rates of adverse events and mortality compared with subjects free of arrhythmia. The scope of this position document is to cover the clinical implications and pharmacological/non-pharmacological management of arrhythmias in emergency presentations and during revascularization. Current evidence for clinical relevance of specific types of VAs complicating AMI in relation to arrhythmia timing has been discussed.
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Affiliation(s)
- Zbigniew Kalarus
- SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland.,Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Jesper Hastrup Svendsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Davide Capodanno
- Division of Cardiology, CAST, P.O. "Rodolico", Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Gheorghe-Andrei Dan
- "Carol Davila" University of Medicine, Colentina University Hospital, Bucharest, Romania
| | - Elia De Maria
- Ramazzini Hospital, Cardiology Unit, Carpi (Modena), Italy
| | | | - Ewa Jędrzejczyk-Patej
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Michał Mazurek
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Tomasz Podolecki
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jacob Tfelt-Hansen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Vassil Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Clinic of Cardiology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Université de Tours, Faculté de Médecine., Tours, France
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | | | | | - Georges H Mairesse
- Department of Cardiology - Electrophysiology, Cliniques du Sud Luxembourg - Vivalia, Arlon, Belgium
| | - Andrea Rubboli
- Department of Cardiovascular Diseases - AUSL Romagna, Division of Cardiology, Ospedale S. Maria delle Croci, Ravenna, Italy
| | - Thomas Deneke
- Clinic for Electrophysiology, Rhoen-Clinic Campus Bad Neustadt, Germany
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Torkel Steen
- Department of Cardiology, Pacemaker- & ICD-Centre, Oslo University Hospital Ullevaal, Oslo, Norway
| | - Ingo Ahrens
- Department of Cardiology & Intensive Care, Augustinerinnen Hospital, Cologne, Germany
| | - Vijay Kunadian
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sergio Berti
- Department of Cardiology, Fondazione C.N.R. Reg. Toscana G. Monasterio, Heart Hospital, Massa, Italy
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Extracorporeal Membrane Oxygenation to Support Life-Threatening Drug-Refractory Electrical Storm. Crit Care Med 2020; 48:e856-e863. [DOI: 10.1097/ccm.0000000000004490] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Müller J, Behnes M, Ellguth D, Schupp T, Mashayekhi K, Borggrefe M, Akin I. Prognostic impact of recurrences in patients with electrical storm. SCAND CARDIOVASC J 2019; 53:71-76. [PMID: 30958708 DOI: 10.1080/14017431.2019.1605095] [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] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The study sought to assess the prognostic impact of recurrences of electrical storm (ES-R) on mortality, rehospitalization and major adverse cardiac events (MACE). BACKGROUND Data on the prognostic impact of ES-R is rare. METHODS All consecutive ES patients with an implantable cardioverter defibrillator (ICD) were included retrospectively from 2002 to 2016. Patients with ES-R were compared to patients without ES-R. The primary endpoint was all-cause mortality, secondary endpoints were in-hospital mortality, rehospitalization and MACE. RESULTS A total of 87 consecutive ES patients with an ICD were included, of which 26% presented with ES-R at 2.5 years of follow-up. ES-R patients revealed lower LVEF compared to non-ES-R patients (91% vs. 61%; p = .081). There was a numerically higher rate of the primary endpoint of all-cause mortality at 2.5 years (50% vs. 32%; log-rank p = .137). Furthermore, ES-R was associated with increasing rates of rehospitalization (64% vs. 37%; p = .031; HR 1.985; 95% CI 1.025-3.845; log-rank p = .042), especially of acute heart failure (32% vs. 12%; p = .001; HR 3.262; 95% CI 1.180-9.023; log rank p = .023). MACE were higher in ES-R patients (55% vs. 35%; p = .113; log rank p = .141). ES patients with LVEF ≤35% were 12.4 times more likely to develop ES-R (HR 12.417; 95% CI 1.329-115.997; p = .027). CONCLUSION At long-term follow-up of 2.5 years, ES-R was associated with numerically higher rates of long-term all-cause mortality and significantly higher rates of rehospitalization due to acute heart failure. LVEF ≤35% was associated with increased risk of ES-R. Condensed Abstract This study examined retrospectively the impact of recurrences of electrical storm (ES-R) on survival in 87 patients. ES-R was associated with numerically higher long-term all-cause mortality, whereas significantly higher rates of rehospitalization, respectively of acute heart failure were observed. Highlights ES-R is associated with numerically higher rates of all-cause mortality at long-term follow-up. ES-R is associated with significantly higher rates of rehospitalization and numerically higher rates of MACE at long-term follow-up, mainly due to acute heart failure. Patients with LVEF ≤35% were 12.4 times more likely to develop ES-R.
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Affiliation(s)
- Julian Müller
- a First Department of Medicine , University Medical Center Mannheim, University of Heidelberg , Mannheim , Germany.,b DZHK (German Center for Cardiovascular Research) partner site , Mannheim , Germany
| | - Michael Behnes
- a First Department of Medicine , University Medical Center Mannheim, University of Heidelberg , Mannheim , Germany.,b DZHK (German Center for Cardiovascular Research) partner site , Mannheim , Germany
| | - Dominik Ellguth
- a First Department of Medicine , University Medical Center Mannheim, University of Heidelberg , Mannheim , Germany.,b DZHK (German Center for Cardiovascular Research) partner site , Mannheim , Germany
| | - Tobias Schupp
- a First Department of Medicine , University Medical Center Mannheim, University of Heidelberg , Mannheim , Germany.,b DZHK (German Center for Cardiovascular Research) partner site , Mannheim , Germany
| | - Kambis Mashayekhi
- c Department of Cardiology and Angiology II , University Heart Center Freiburg - Bad Krozingen , Bad Krozingen , Germany
| | - Martin Borggrefe
- a First Department of Medicine , University Medical Center Mannheim, University of Heidelberg , Mannheim , Germany.,b DZHK (German Center for Cardiovascular Research) partner site , Mannheim , Germany
| | - Ibrahim Akin
- a First Department of Medicine , University Medical Center Mannheim, University of Heidelberg , Mannheim , Germany.,b DZHK (German Center for Cardiovascular Research) partner site , Mannheim , Germany
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11
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2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Heart Rhythm 2018; 15:e73-e189. [DOI: 10.1016/j.hrthm.2017.10.036] [Citation(s) in RCA: 177] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Indexed: 02/07/2023]
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12
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Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2018; 138:e272-e391. [PMID: 29084731 DOI: 10.1161/cir.0000000000000549] [Citation(s) in RCA: 249] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | - William G Stevenson
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Michael J Ackerman
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - William J Bryant
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - David J Callans
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Anne B Curtis
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Barbara J Deal
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Timm Dickfeld
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Michael E Field
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Gregg C Fonarow
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Anne M Gillis
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Christopher B Granger
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Stephen C Hammill
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Mark A Hlatky
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - José A Joglar
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - G Neal Kay
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Daniel D Matlock
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Robert J Myerburg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Richard L Page
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
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13
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Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2018; 72:e91-e220. [PMID: 29097296 DOI: 10.1016/j.jacc.2017.10.054] [Citation(s) in RCA: 676] [Impact Index Per Article: 112.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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14
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Insufficient left ventricular unloading after extracorporeal membrane oxygenation : A case-series observational study. Herz 2018; 45:186-191. [PMID: 29777285 DOI: 10.1007/s00059-018-4711-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 04/23/2018] [Accepted: 04/23/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) is a method widely used to support circulation in patients with fulminant myocarditis (FM). However, a common complication associated with ECMO is left ventricular (LV) overload. METHODS This case series observed the effects of intra-aortic balloon pump (IABP) and beta-blockers for the treatment of LV overload after ECMO. The cases of eight patients with FM who underwent ECMO from September 2009 to July 2016 were reviewed. RESULTS Six of the eight patients survived. After ECMO treatment, insufficient LV unloading occurred in six patients. Among these six patients, three experienced electrical storm but spontaneous circulation returned after interventions with beta-blockers and IABP. The survivors demonstrated full recovery of cardiac function. CONCLUSION Beta-blockers may prevent the occurrence of electrical storm, and IABP is feasible for the treatment of LV overload after ECMO application.
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15
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Tsuji Y, Dobrev D. Prognostic impact of electrical storm in patients with implantable cardioverter defibrillators: Mechanistic and therapeutic considerations to reduce the risk of death. Int J Cardiol 2018; 255:101-102. [PMID: 29425546 PMCID: PMC6478154 DOI: 10.1016/j.ijcard.2017.12.085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 12/21/2017] [Indexed: 11/21/2022]
Affiliation(s)
- Yukiomi Tsuji
- Department of Molecular Physiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Dobromir Dobrev
- Institute for Pharmacology, West German Heart and Vascular Centre, University of Duisburg-Essen, Essen, Germany
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16
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Do DH, Bradfield J, Ajijola OA, Vaseghi M, Le J, Rahman S, Mahajan A, Nogami A, Boyle NG, Shivkumar K. Thoracic Epidural Anesthesia Can Be Effective for the Short-Term Management of Ventricular Tachycardia Storm. J Am Heart Assoc 2017; 6:JAHA.117.007080. [PMID: 29079570 PMCID: PMC5721785 DOI: 10.1161/jaha.117.007080] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Novel therapies aimed at modulating the autonomic nervous system, including thoracic epidural anesthesia (TEA), have been shown in small case series to be beneficial in treating medically refractory ventricular tachycardia (VT) storm. However, it is not clear when these options should be considered. We reviewed a multicenter experience with TEA in the management of VT storm to determine its optimal therapeutic use. Methods and Results Data for 11 patients in whom TEA was instituted for VT storm between July 2005 and March 2016 were reviewed to determine the clinical characteristics, outcomes, and role in management. The clinical presentation was incessant VT in 7 (64%), with polymorphic VT in 3 (27%) and monomorphic VT in 8 (73%). The underlying conditions were nonischemic cardiomyopathy in 5 (45%), ischemic cardiomyopathy in 3 (27%), and hypertrophic cardiomyopathy, Brugada syndrome, and cardiac lipoma in 1 (9%) each. Five (45%) had a complete and 1 (9%) had a partial response to TEA; 4 of the complete responders had incessant VT. All 4 patients with a documented response to deep sedation demonstrated a complete response to TEA. Conclusions More than half of the patients with VT storm in our series responded to TEA. TEA may be effective and should be considered as a therapeutic option in patients with VT storm, especially incessant VT, who are refractory to initial management. Improvement in VT burden with deep sedation may suggest that sympathoexcitation plays a key role in perpetuating VT and predict a positive response to TEA.
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Affiliation(s)
- Duc H Do
- UCLA Cardiac Arrhythmia Center and Neurocardiology Center of Excellence UCLA Health System David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Jason Bradfield
- UCLA Cardiac Arrhythmia Center and Neurocardiology Center of Excellence UCLA Health System David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Olujimi A Ajijola
- UCLA Cardiac Arrhythmia Center and Neurocardiology Center of Excellence UCLA Health System David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Marmar Vaseghi
- UCLA Cardiac Arrhythmia Center and Neurocardiology Center of Excellence UCLA Health System David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - John Le
- UCLA Department of Anesthesiology, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Siamak Rahman
- UCLA Department of Anesthesiology, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Aman Mahajan
- UCLA Department of Anesthesiology, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | - Noel G Boyle
- UCLA Cardiac Arrhythmia Center and Neurocardiology Center of Excellence UCLA Health System David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center and Neurocardiology Center of Excellence UCLA Health System David Geffen School of Medicine at UCLA, Los Angeles, CA
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17
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Leal RT, Monteiro GC, da Silva Menezes Júnior A. Catheter ablation in the treatment of electrical storm: Integrative review. Indian Pacing Electrophysiol J 2017; 17:140-145. [PMID: 29192590 PMCID: PMC5652274 DOI: 10.1016/j.ipej.2017.07.012] [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] [Received: 05/28/2017] [Revised: 07/20/2017] [Accepted: 07/26/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The incidence of electrical storm (ES) has been increasing with the rise of the indicated uses of implantable cardioverter defibrillators (ICDs). It is estimated that 20% of patients will evolve to have this complication. Ablative therapy stands out as the treatment for this condition when it is refractory to antiarrhythmic treatment. The objective was to define the current role of catheter ablation in the treatment of electrical storm. METHODS An integrative literature review was performed using the PubMed and BVS databases. All identified articles were screened and verified for eligibility by the authors. RESULTS Twenty-five out of the initial 951 articles were used in the final analysis. The categories listed for analysis included indication for ablation in ES, modality of the approach, therapeutic success, complications related to the procedure, mortality and cardiovascular follow-up and alternative therapeutic modalities by frequency of these categories in the articles researched. CONCLUSION Catheter ablation is the initial therapy for patients with ischemic cardiomyopathy (ICM) and ES. The endocardial approach presents more relevant success rates than the other therapeutic methods presented.
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Affiliation(s)
- Ricardo Teixeira Leal
- Pontifícia Universidade Católica de Goiás, Escola de Ciências Médicas, Farmacêuticas e Biomédicas, Avenida Universitária 1440, Goiânia, Goiás, Brazil
| | - Gabriel Costa Monteiro
- Pontifícia Universidade Católica de Goiás, Escola de Ciências Médicas, Farmacêuticas e Biomédicas, Avenida Universitária 1440, Goiânia, Goiás, Brazil
| | - Antônio da Silva Menezes Júnior
- Pontifícia Universidade Católica de Goiás, Escola de Ciências Médicas, Farmacêuticas e Biomédicas, Avenida Universitária 1440, Goiânia, Goiás, Brazil.
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Heijman J, Ghezelbash S, Dobrev D. Investigational antiarrhythmic agents: promising drugs in early clinical development. Expert Opin Investig Drugs 2017; 26:897-907. [PMID: 28691539 PMCID: PMC6324729 DOI: 10.1080/13543784.2017.1353601] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Although there have been important technological advances for the treatment of cardiac arrhythmias (e.g., catheter ablation technology), antiarrhythmic drugs (AADs) remain the cornerstone therapy for the majority of patients with arrhythmias. Most of the currently available AADs were coincidental findings and did not result from a systematic development process based on known arrhythmogenic mechanisms and specific targets. During the last 20 years, our understanding of cardiac electrophysiology and fundamental arrhythmia mechanisms has increased significantly, resulting in the identification of new potential targets for mechanism-based antiarrhythmic therapy. Areas covered: Here, we review the state-of-the-art in arrhythmogenic mechanisms and AAD therapy. Thereafter, we focus on a number of antiarrhythmic targets that have received significant attention recently: atrial-specific K+-channels, the late Na+-current, the cardiac ryanodine-receptor channel type-2, and the small-conductance Ca2+-activated K+-channel. We highlight for each of these targets available antiarrhythmic agents and the evidence for their antiarrhythmic effect in animal models and early clinical development. Expert opinion: Targeting AADs to specific subgroups of well-phenotyped patients is likely necessary to detect improved outcomes that may be obscured in the population at large. In addition, specific combinations of selective AADs may have synergistic effects and may enable a mechanism-based tailored antiarrhythmic therapy.
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Affiliation(s)
- Jordi Heijman
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Shokoufeh Ghezelbash
- Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
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19
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Effectiveness of Extracorporeal Life Support for Patients With Cardiogenic Shock Due To Intractable Arrhythmic Storm. Crit Care Med 2017; 45:e281-e289. [DOI: 10.1097/ccm.0000000000002089] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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20
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Rivard L, Andrade J. Innovative Approaches to Arrhythmic Storm: The Growing Role of Interventional Procedures. Can J Cardiol 2017; 33:44-50. [DOI: 10.1016/j.cjca.2016.10.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 10/09/2016] [Accepted: 10/09/2016] [Indexed: 10/20/2022] Open
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21
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Kumar S, Fujii A, Kapur S, Romero J, Mehta NK, Tanigawa S, Epstein LM, Koplan BA, Michaud GF, John RM, Stevenson WG, Tedrow UB. Beyond the Storm: Comparison of Clinical Factors, Arrhythmogenic Substrate, and Catheter Ablation Outcomes in Structural Heart Disease Patients With versus Those Without a History of Ventricular Tachycardia Storm. J Cardiovasc Electrophysiol 2016; 28:56-67. [PMID: 27781325 DOI: 10.1111/jce.13117] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 10/01/2016] [Accepted: 10/17/2016] [Indexed: 01/11/2023]
Abstract
AIMS Catheter ablation can be lifesaving in ventricular tachycardia (VT) storm, but the underlying substrate in patients with storm is not well characterized. We sought to compare the clinical factors, substrate, and outcomes differences in patients with sustained monomorphic VT who present for catheter ablation with VT storm versus those with a nonstorm presentation. METHODS Consecutive ischemic (ICM; n = 554) or nonischemic cardiomyopathy patients (NICM; n = 369) with a storm versus nonstorm presentation were studied (ICM storm 186; NICM storm 101). RESULTS In ICM, storm compared with nonstorm patients had significantly lower left ventricular (LV) ejection fraction (EF), greater number of antiarrhythmic drug (AAD) failures, slower VTs, greater number of scarred LV segments, higher incidence of anterior, septal, and apical endocardial LV scar (all P < 0.05). However, outcomes in follow-up were similar (12-month ventricular arrhythmia [VA]-free survival: 51% vs. 52%, P = 0.6; survival free of death/transplant 75% vs. 87%, P = 0.7). In addition to the above differences, NICM storm patients were also older; however, the extent and distribution of scar was similar except for a higher incidence of lateral endocardial scar in storm patients (P = 0.05). VA-free survival (36% vs. 47%, P = 0.004) and survival free of death/transplant, however, were worse in NICM storm than nonstorm patients (72% vs. 88%, P = 0.001). NICM storm patients had worse VA-free survival than ICM storm patients. CONCLUSION There are differences in clinical factors and scar patterns in patients undergoing VT ablation who present with VT storm versus those with a nonstorm presentation. Clinical outcomes are worse in NICM storm patients.
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Affiliation(s)
- Saurabh Kumar
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Akira Fujii
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sunil Kapur
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jorge Romero
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Nishaki K Mehta
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Shinichi Tanigawa
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Laurence M Epstein
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Bruce A Koplan
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Gregory F Michaud
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Roy M John
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - William G Stevenson
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Usha B Tedrow
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
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22
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Liu Z, Shan H, Huang J, Li N, Hou C, Pu J. A novel lamin A/C gene missense mutation (445 V > E) in immunoglobulin-like fold associated with left ventricular non-compaction. Europace 2016; 18:617-622. [PMID: 25829471 DOI: 10.1093/europace/euv044] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 02/08/2015] [Indexed: 01/22/2024] Open
Abstract
AIMS Two LMNA mutations (R644C and R190W) have been associated with familial and sporadic left ventricular non-compaction (LVNC). However, the mechanisms underlying these associations have not been elucidated. METHODS AND RESULTS Genomic DNA was isolated from peripheral blood leucocytes and analysed by direct sequencing. Human embryonic kidney 293 cells were transfected with either wild type or mutant LMNA and SCN5A for whole-cell patch-clamp experiment and fluorescence microscopy. Point mutation modeling for mutant LMNA was also performed. One novel LVNC-associated mutation (V445E) in β2 sheet of immunoglobulin (Ig)-like fold was found in the proband and his father. We also found that the peak current of sodium channel was markedly reduced in mutant LMNA compared with WT while the activation, inactivation, and recovery curves were not significantly altered. The mutant lamin A/C were aggregated into multiple highlighted particles. Three β sheets and multiple side chains in Ig-like fold were altered due to the replacement of a valine by glutamic acid. CONCLUSION Our data associated a novel lamin A/C mutation (V445E) with a sudden death form of familial LVNC. The reduced sodium current in mutant LMNA may account for the advent of malignant ventricular arrhythmias. The altered structures of three β sheets and side chains may partially explain the aggregation of lamin A/C protein subjacent to the nuclear envelope.
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MESH Headings
- Adolescent
- DNA Mutational Analysis
- Death, Sudden, Cardiac/etiology
- Echocardiography
- Electrocardiography
- Genetic Predisposition to Disease
- Glutamic Acid
- HEK293 Cells
- Heterozygote
- Humans
- Isolated Noncompaction of the Ventricular Myocardium/diagnosis
- Isolated Noncompaction of the Ventricular Myocardium/genetics
- Isolated Noncompaction of the Ventricular Myocardium/metabolism
- Isolated Noncompaction of the Ventricular Myocardium/physiopathology
- Lamin Type A/chemistry
- Lamin Type A/genetics
- Lamin Type A/metabolism
- Male
- Membrane Potentials
- Microscopy, Fluorescence
- Models, Molecular
- Mutagenesis, Site-Directed
- Mutation, Missense
- Phenotype
- Protein Aggregates
- Protein Conformation, beta-Strand
- Protein Folding
- Structure-Activity Relationship
- Tachycardia, Ventricular/diagnosis
- Tachycardia, Ventricular/genetics
- Tachycardia, Ventricular/metabolism
- Tachycardia, Ventricular/physiopathology
- Transfection
- Valine
- Ventricular Fibrillation/diagnosis
- Ventricular Fibrillation/genetics
- Ventricular Fibrillation/metabolism
- Ventricular Fibrillation/physiopathology
- Young Adult
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Affiliation(s)
- Zhouying Liu
- State Key Laboratory of Cardiovascular Disease, Physiology and Pathophysiology Laboratory, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Bei-Li-Shi Road, Xi-Cheng District, Beijing 100037, P.R. China
| | - Hong Shan
- Department of Biophysics, School of Basic Medical Sciences, Peking University, 38 Xue-Yuan Road, Hai-Dian District, Beijing 100191, P.R. China
| | - Jian Huang
- State Key Laboratory of Cardiovascular Disease, Physiology and Pathophysiology Laboratory, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Bei-Li-Shi Road, Xi-Cheng District, Beijing 100037, P.R. China
| | - Ning Li
- State Key Laboratory of Cardiovascular Disease, Physiology and Pathophysiology Laboratory, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Bei-Li-Shi Road, Xi-Cheng District, Beijing 100037, P.R. China
| | - Cuihong Hou
- State Key Laboratory of Cardiovascular Disease, Physiology and Pathophysiology Laboratory, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Bei-Li-Shi Road, Xi-Cheng District, Beijing 100037, P.R. China
| | - Jielin Pu
- State Key Laboratory of Cardiovascular Disease, Physiology and Pathophysiology Laboratory, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Bei-Li-Shi Road, Xi-Cheng District, Beijing 100037, P.R. China
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Hu W, Chen L, Liu C, Hu W, Lu J, Zhu Y, Wang J, Liu B. Three cases of electrical storm in fulminant myocarditis treated by extracorporeal membrane oxygenation. Am J Emerg Med 2015; 33:606.e3-8. [DOI: 10.1016/j.ajem.2014.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 10/11/2014] [Indexed: 11/26/2022] Open
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Hu W, Liu C, Chen L, Hu W, Lu J, Zhu Y, Wang J, Liu B. Combined intraaortic balloon counterpulsation and extracorporeal membrane oxygenation in 2 patients with fulminant myocarditis. Am J Emerg Med 2014; 33:736.e1-4. [PMID: 25468215 DOI: 10.1016/j.ajem.2014.10.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 10/18/2014] [Indexed: 12/20/2022] Open
Affiliation(s)
- Weihang Hu
- Department of Critical Care Medicine, Hangzhou First People's Hospital, Zhejiang 310006, China
| | - Changwen Liu
- Department of Critical Care Medicine, Hangzhou First People's Hospital, Zhejiang 310006, China
| | - Lan Chen
- Department of Electrocardiography, Hangzhou First People's Hospital, Hangzhou 310006, China.
| | - Wei Hu
- Department of Critical Care Medicine, Hangzhou First People's Hospital, Zhejiang 310006, China
| | - Jun Lu
- Department of Critical Care Medicine, Hangzhou First People's Hospital, Zhejiang 310006, China
| | - Yin Zhu
- Department of Critical Care Medicine, Hangzhou First People's Hospital, Zhejiang 310006, China
| | - Jianrong Wang
- Department of Critical Care Medicine, Hangzhou First People's Hospital, Zhejiang 310006, China
| | - Bingwei Liu
- Department of Critical Care Medicine, Hangzhou First People's Hospital, Zhejiang 310006, China
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25
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Heijman J, Dobrev D. Rat engineered heart tissue: a novel tool in the safety pharmacology toolkit? Basic Res Cardiol 2014; 109:437. [DOI: 10.1007/s00395-014-0437-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 08/29/2014] [Indexed: 12/28/2022]
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27
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Li J, Maguy A, Duverger JE, Vigneault P, Comtois P, Shi Y, Tardif JC, Thomas D, Nattel S. Induced KCNQ1 autoimmunity accelerates cardiac repolarization in rabbits: potential significance in arrhythmogenesis and antiarrhythmic therapy. Heart Rhythm 2014; 11:2092-100. [PMID: 25087487 DOI: 10.1016/j.hrthm.2014.07.040] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Autoantibodies directed against various cardiac receptors have been implicated in cardiomyopathy and heart rhythm disturbances. In a previous study among patients with dilated cardiomyopathy, autoantibodies targeting the cardiac voltage-gated KCNQ1 K(+) channel were associated with shortened corrected QT intervals (QTc). However, the electrophysiologic actions of KCNQ1 autoimmunity have not been assessed experimentally in a direct fashion. OBJECTIVE The purpose of this study was to investigate the cardiac electrophysiologic effects of KCNQ1 autoantibody production induced by vaccination in a rabbit model. METHODS Rabbits were immunized with KCNQ1 channel peptide. ECG recordings were obtained during a 1-month follow-up period. Rabbits then underwent in vivo electrophysiologic study, after which cardiomyocytes were isolated for analysis of slow delayed rectifier current (IKs) and action potential properties via patch-clamp. RESULTS KCNQ1-immunized rabbits exhibited shortening of QTc compared to sham-immunized controls. Reduced ventricular effective refractory periods and increased susceptibility to ventricular tachyarrhythmia induction were noted in KCNQ1-immunized rabbits upon programmed ventricular stimulation. Action potential durations were shortened in cardiomyocytes isolated from KCNQ1-immunized rabbits compared to the sham group. IKs step and tail current densities were enhanced after KCNQ1 immunization. Functional and structural changes of the heart were not observed. The potential therapeutic significance of KCNQ1 immunization was then explored in a dofetilide-induced long QT rabbit model. KCNQ1 immunization prevented dofetilide-induced QTc prolongation and attenuated long QT-related arrhythmias. CONCLUSION Induction of KCNQ1 autoimmunity accelerates cardiac repolarization and increases susceptibility to ventricular tachyarrhythmia induction through IKs enhancement. On the other hand, vaccination against KCNQ1 ameliorates drug-induced QTc prolongation and might be useful therapeutically to enhance repolarization reserve in long QT syndrome.
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Affiliation(s)
- Jin Li
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada; Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Ange Maguy
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada
| | - James Elber Duverger
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada; Institute of Biomedical Engineering and Department of Physiology, University of Montreal; Montreal, Quebec, Canada
| | - Patrick Vigneault
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada
| | - Philippe Comtois
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada; Institute of Biomedical Engineering and Department of Physiology, University of Montreal; Montreal, Quebec, Canada
| | - Yanfen Shi
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada
| | - Jean-Claude Tardif
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada
| | - Dierk Thomas
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Stanley Nattel
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada.
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Heijman J, Heusch G, Dobrev D. Pleiotropic effects of antiarrhythmic agents: dronedarone in the treatment of atrial fibrillation. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2013; 7:127-40. [PMID: 23997577 PMCID: PMC3747997 DOI: 10.4137/cmc.s8445] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Atrial fibrillation remains the most common arrhythmia in clinical practice. Dronedarone is an antiarrhythmic drug for the maintenance of sinus rhythm in patients with atrial fibrillation. Dronedarone is an amiodarone derivative developed to reduce the number of extracardiovascular side effects. Dronedarone has undergone extensive experimental and clinical testing during the last decade. On the aggregate, these studies have highlighted a complex set of pleiotropic actions that may contribute to dronedarone's antiarrhythmic effects. In this review, we summarize the clinical studies that have evaluated dronedarone and provide an overview of dronedarone's electrophysiological and nonelectrophysiological pleiotropic actions.
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Affiliation(s)
- Jordi Heijman
- Institute of Pharmacology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Gerd Heusch
- Institute for Pathophysiology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Dobromir Dobrev
- Institute of Pharmacology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
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