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How Do You Treat Benign Cardiac Palpitations in Your Practice? Med Acupunct 2024; 36:113-115. [PMID: 38659725 PMCID: PMC11037022 DOI: 10.1089/acu.2024.29251.cpl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
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2
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Seitler S, Dimopoulos K, Ernst S, Price LC. Medical Emergencies in Pulmonary Hypertension. Semin Respir Crit Care Med 2023; 44:777-796. [PMID: 37595615 DOI: 10.1055/s-0043-1770120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
The management of acute medical emergencies in patients with pulmonary hypertension (PH) can be challenging. Patients with preexisting PH can rapidly deteriorate due to right ventricular decompensation when faced with acute physiological challenges that would usually be considered low-risk scenarios. This review considers the assessment and management of acute medical emergencies in patients with PH, encompassing both pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH), acknowledging these comprise the more severe groups of PH. Management protocols are described in a systems-based approach. Respiratory emergencies include pulmonary embolism, airways disease, and pneumonia; cardiac emergencies including arrhythmia and chest pain with acute myocardial infarction are discussed, alongside PH-specific emergencies such as pulmonary artery dissection and extrinsic coronary artery compression by a dilated proximal pulmonary artery. Other emergencies including sepsis, severe gastroenteritis with dehydration, syncope, and liver failure are also considered. We propose management recommendations for medical emergencies based on available evidence, international guidelines, and expert consensus. We aim to provide advice to the specialist alongside the generalist, and emergency doctors, nurses, and acute physicians in nonspecialist centers. A multidisciplinary team approach is essential in the management of patients with PH, and communication with local and specialist PH centers is paramount. Close hemodynamic monitoring during medical emergencies in patients with preexisting PH is vital, with early referral to critical care recommended given the frequent deterioration and high mortality in this setting.
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Affiliation(s)
- Samuel Seitler
- National Pulmonary Hypertension Service, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Konstantinos Dimopoulos
- National Pulmonary Hypertension Service, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Adult Congenital Heart Disease Service, Royal Brompton Hospital, London, United Kingdom
| | - Sabine Ernst
- Adult Congenital Heart Disease Service, Royal Brompton Hospital, London, United Kingdom
| | - Laura C Price
- National Pulmonary Hypertension Service, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
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Moore BM, Al-Kaisy A, Joshi SB, Lui E, Grigg LE, Kalman JM. Noninvasive ECG imaging of the intrinsic atrial pacemaker and atrial activation in surgically repaired or palliated congenital heart disease. J Cardiovasc Electrophysiol 2023; 34:1859-1868. [PMID: 37526234 DOI: 10.1111/jce.16027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 07/19/2023] [Accepted: 07/22/2023] [Indexed: 08/02/2023]
Abstract
INTRODUCTION Sinus node location, function, and atrial activation are often abnormal in patients with congenital heart disease (CHD), due to anatomical, surgical, and acquired factors. We aimed to perform noninvasive electrocardiographic imaging (ECGI) of the intrinsic atrial pacemaker and atrial activation in patients with surgically repaired or palliated CHD, compared with control patients with structurally normal hearts. METHODS AND RESULTS Atrial ECGI was performed in eight CHD patients with prespecified diagnoses (Fontan circulation, dextro transposition of the great arteries post Mustard/Senning, tetralogy of Fallot), and three controls. Activation and propagation maps were constructed in presenting rhythm. Wavefront propagation was analyzed to identify (1) intrinsic atrial pacemaker breakout site, (2) morphological right atrial (RA) activation pattern, (3) morphological left atrial (LA) breakout sites (i.e., interatrial connections), (4) LA activation pattern, and (5) putative lines of block. Physiologically appropriate atrial activation and propagation maps were able to be constructed. In the majority of patients, atrial breakouts were in keeping with the sinus node, observed in a crescent-shaped distribution from the anterior superior vena cava to the posterior RA. Ectopic atrial pacemaker sites were demonstrated in the atriopulmonary (AP) Fontan patient (very diffuse posterolateral RA) and Mustard patient (very posterior RA competing with a low RA focus). RA propagation was laminar in controls, but suggested either a line of block or conduction slowing consistent with an atriotomy scar in the tetralogy of Fallot (TOF) patients. Putative lines of block were more complex and RA propagation more abnormal in the atrial switch and AP Fontan patients, compared with the TOF patients. RA activation in the extracardiac Fontan patients was relatively laminar. Earliest LA breakout was most commonly observed in the region of Bachmann's Bundle in both controls and CHD patients, except for posterior LA breakouts in two patients. LA activation was typically more homogeneous than RA activation in CHD patients. CONCLUSION ECGI can be utilized to create a noninvasive mapping model of atrial activation in postsurgical CHD, demonstrating atrial pacemaker location, putative lines of block and interatrial connections. Once validated invasively, this may have clinical implications in predicting risk of sinus node dysfunction and atrial arrhythmias, or in guiding catheter ablation.
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Affiliation(s)
- Benjamin M Moore
- Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Ahmed Al-Kaisy
- Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Subodh B Joshi
- Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Elaine Lui
- Department of Medical Imaging, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Radiology, University of Melbourne, Melbourne, Victoria, Australia
| | - Leanne E Grigg
- Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Jonathan M Kalman
- Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Diller GP, Arvanitaki A, Opotowsky AR, Jenkins K, Moons P, Kempny A, Tandon A, Redington A, Khairy P, Mital S, Gatzoulis MΑ, Li Y, Marelli A. Lifespan Perspective on Congenital Heart Disease Research: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 77:2219-2235. [PMID: 33926659 DOI: 10.1016/j.jacc.2021.03.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/04/2021] [Accepted: 03/09/2021] [Indexed: 12/19/2022]
Abstract
More than 90% of patients with congenital heart disease (CHD) are nowadays surviving to adulthood and adults account for over two-thirds of the contemporary CHD population in Western countries. Although outcomes are improved, surgery does not cure CHD. Decades of longitudinal observational data are currently motivating a paradigm shift toward a lifespan perspective and proactive approach to CHD care. The aim of this review is to operationalize these emerging concepts by presenting new constructs in CHD research. These concepts include long-term trajectories and a life course epidemiology framework. Focusing on a precision health, we propose to integrate our current knowledge on the genome, phenome, and environome across the CHD lifespan. We also summarize the potential of technology, especially machine learning, to facilitate longitudinal research by embracing big data and multicenter lifelong data collection.
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Affiliation(s)
- Gerhard-Paul Diller
- Department of Cardiology III-Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany; Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield National Health Service Foundation Trust, Imperial College London, London, UK; National Register for Congenital Heart Defects, Berlin, Germany.
| | - Alexandra Arvanitaki
- Department of Cardiology III-Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany; Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield National Health Service Foundation Trust, Imperial College London, London, UK; First Department of Cardiology, American Hellenic Educational Progressive Association University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Alexander R Opotowsky
- The Cincinnati Adult Congenital Heart Disease Program, Cincinnati Children's Hospital, Cincinnati, Ohio, USA; Heart Institute, Cincinnati Children's Hospital and University of Cincinnati, Cincinnati, Ohio, USA
| | - Kathy Jenkins
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Philip Moons
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium; Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Alexander Kempny
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield National Health Service Foundation Trust, Imperial College London, London, UK
| | - Animesh Tandon
- Pediatric Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas, USA; Department of Radiology, University of Texas Southwestern Children's Medical Center, Dallas, Texas, USA
| | - Andrew Redington
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
| | - Paul Khairy
- Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
| | - Seema Mital
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Michael Α Gatzoulis
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield National Health Service Foundation Trust, Imperial College London, London, UK
| | - Yue Li
- Department of Computer Science, McGill University, Montréal, Québec, Canada
| | - Ariane Marelli
- McGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit), Department of Medicine, McGill University, Montréal, Québec, Canada.
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Le Bloa M, Abadir S, Nair K, Mondésert B, Khairy P. New developments in catheter ablation for patients with congenital heart disease. Expert Rev Cardiovasc Ther 2020; 19:15-26. [PMID: 33153326 DOI: 10.1080/14779072.2021.1847082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Introduction: There are numerous challenges to catheter ablation in patients with congenital heart disease (CHD), including access to cardiac chambers, distorted anatomies, displaced conduction systems, multiple and/or complex arrhythmia substrates, and excessively thickened walls, or interposed material. Areas covered: Herein, we review recent developments in catheter ablation strategies for patients with CHD that are helpful in addressing these challenges. Expert opinion: Remote magnetic navigation overcomes many challenges associated with vascular obstructions, chamber access, and catheter contact. Patients with CHD may benefit from a range of ablation catheter technologies, including irrigated-tip and contact-force radiofrequency ablation and focal and balloon cryoablation. High-density mapping, along with advances in multipolar catheters and interpolation algorithms, is contributing to new mechanistic insights into complex arrhythmias. Ripple mapping allows the activation wave front to be tracked visually without prior assignment of local activation times or window of interest, and without interpolations of unmapped regions. There is growing interest in measuring conduction velocities to identify arrhythmogenic substrates. Noninvasive mapping with a multielectrode-embedded vest allows prolonged bedside monitoring, which is of particular interest in those with non-sustained or multiple arrhythmias. Further studies are required to assess the role of radiofrequency needle catheters and stereotactic radiotherapy in patients with CHD.
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Affiliation(s)
- Mathieu Le Bloa
- Montreal Heart Institute, Université De Montréal , Montreal, Canada.,Electrophysiology Service, Centre Hospitalier Universitaire Vaudois , Lausanne, Switzerland
| | - Sylvia Abadir
- Montreal Heart Institute, Université De Montréal , Montreal, Canada
| | - Krishnakumar Nair
- University Health Network, Toronto General Hospital , Toronto, Canada
| | | | - Paul Khairy
- Montreal Heart Institute, Université De Montréal , Montreal, Canada
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Ernst S, Cazzoli I, Guarguagli S. An initial experience of high-density mapping-guided ablation in a cohort of patients with adult congenital heart disease. Europace 2020; 21:i43-i53. [PMID: 30801127 PMCID: PMC6388091 DOI: 10.1093/europace/euy188] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 10/31/2018] [Indexed: 12/21/2022] Open
Abstract
Aims In the management of both ventricular and supraventricular tachycardia in patients with congenital heart disease (CHD) catheter ablation has now been recognized as one of the mainstays. Methods and results We review our initial experience of using the Rhythmia mapping system in a cohort of 12 adult CHD patients presenting with multiple arrhythmia substrates. A total of 78 arrhythmia maps were attempted in a total of 15 procedures, but possible due to the dilatation of the target chamber only 44% of maps were able to reconstruct the entire arrhythmia. All patients underwent pre-procedure 3D imaging (either cardiac magnetic resonance or computed tomography), but image integration was suboptimal. A median of two maps per patient were finally analysed and acquisition took in median 22 min with a median number of 12 574 (8230–18 167) mapping points. Procedural data with a total duration amounting to in median 285 (194–403) min, with a median total fluoroscopy exposure of 7.5 (5.2–10.7) min. After a median of 1.5 procedures [median of 12 (8–16 months)], nine patients remained in stable sinus rhythm or atrial paced rhythm, while three patients had further sustained recurrences. One of these passed away in end-staged heart failure. Conclusion This initial experience of using high-density mapping for arrhythmia management in patients with CHD allowed rapid acquisition of multiple maps with high accuracy to identify surgical scars and fibrosis, however, it was limited by large atrial volumes and a high percentage of incomplete maps resulting in modest clinical success.
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Affiliation(s)
- Sabine Ernst
- Department of Cardiology, Royal Brompton and Harefield Hospital, Imperial College London, Sydney Street, SW3 6NP London, UK
| | - Ilaria Cazzoli
- Department of Cardiology, Royal Brompton and Harefield Hospital, Imperial College London, Sydney Street, SW3 6NP London, UK
| | - Silvia Guarguagli
- Department of Cardiology, Royal Brompton and Harefield Hospital, Imperial College London, Sydney Street, SW3 6NP London, UK.,Division Of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,School of Cardiovascular Disease, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Rottner L, Bellmann B, Lin T, Reissmann B, Tönnis T, Schleberger R, Nies M, Jungen C, Dinshaw L, Klatt N, Dickow J, Münkler P, Meyer C, Metzner A, Rillig A. Catheter Ablation of Atrial Fibrillation: State of the Art and Future Perspectives. Cardiol Ther 2020; 9:45-58. [PMID: 31898209 PMCID: PMC7237603 DOI: 10.1007/s40119-019-00158-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Indexed: 12/11/2022] Open
Abstract
PURPOSE OF REVIEW Atrial fibrillation (AF), the most common sustained arrhythmia, is associated with high rates of morbidity and mortality. Maintenance of stable sinus rhythm (SR) is the intended treatment target in symptomatic patients, and catheter ablation aimed at isolating the pulmonary veins provides the most effective treatment option, supported by encouraging clinical outcome data. A variety of energy sources and devices have been developed and evaluated. In this review, we summarize the current state of the art of catheter ablation of AF and describe future perspectives. RECENT FINDINGS Catheter ablation is a well-established treatment option for patients with symptomatic AF and is more successful at maintaining SR than antiarrhythmic drugs. Antral pulmonary vein isolation (PVI) as a stand-alone ablation strategy results in beneficial clinical outcomes and is therefore recommended as first-line strategy for both paroxysmal and persistent AF. While radiofrequency-based PVI in conjunction with a three-dimensional mapping system was for many years considered to be the "gold standard", the cryoballoon has emerged as the most commonly used alternative AF ablation tool, especially in patients with paroxysmal AF. Patients with persistent or long-standing persistent AF and with arrhythmia recurrence after previous PVI may benefit from additional ablation strategies, such as substrate modification of various forms or left atrial appendage isolation. New technologies and techniques, such as identification of the AF sources and magnetic resonance imaging-guided substrate modification, are on the way to further improve the success rates of catheter ablation for selected patients and might help to further reduce arrhythmia recurrence. CONCLUSIONS Pulmonary vein isolation is the treatment of choice for symptomatic patients with paroxysmal and persistent drug-refractory AF. The reconnection of previously isolated pulmonary veins remains the major cause of AF recurrence. Novel ablation tools, such as balloon technologies or alternative energy sources, might help to overcome this limitation. Patients with non-paroxysmal AF and with AF recurrence might benefit from alternative ablation strategies. However, further studies are warranted to further improve our knowledge of the underlying mechanisms of AF and to obtain long-term clinical outcomes on new ablation techniques.
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Affiliation(s)
- Laura Rottner
- Universitäres Herzzentrum Hamburg-Eppendorf, Hamburg, Germany.
| | | | - Tina Lin
- GenesisCare, East Melbourne, VIC, Australia
| | - Bruno Reissmann
- Universitäres Herzzentrum Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias Tönnis
- Universitäres Herzzentrum Hamburg-Eppendorf, Hamburg, Germany
| | | | - Moritz Nies
- Universitäres Herzzentrum Hamburg-Eppendorf, Hamburg, Germany
| | | | - Leon Dinshaw
- Universitäres Herzzentrum Hamburg-Eppendorf, Hamburg, Germany
| | - Niklas Klatt
- Universitäres Herzzentrum Hamburg-Eppendorf, Hamburg, Germany
| | - Jannis Dickow
- Universitäres Herzzentrum Hamburg-Eppendorf, Hamburg, Germany
| | - Paula Münkler
- Universitäres Herzzentrum Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Meyer
- Universitäres Herzzentrum Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Metzner
- Universitäres Herzzentrum Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Rillig
- Universitäres Herzzentrum Hamburg-Eppendorf, Hamburg, Germany
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Kim Y, Chen S, Ernst S, Guzman CE, Han S, Kalarus Z, Labadet C, Lin Y, Lo L, Nogami A, Saad EB, Sapp J, Sticherling C, Tilz R, Tung R, Kim YG, Stiles MK. 2019 APHRS expert consensus statement on three-dimensional mapping systems for tachycardia developed in collaboration with HRS, EHRA, and LAHRS. J Arrhythm 2020; 36:215-270. [PMID: 32256872 PMCID: PMC7132207 DOI: 10.1002/joa3.12308] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 01/20/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Young‐Hoon Kim
- Department of Internal MedicineArrhythmia CenterKorea University Medicine Anam HospitalSeoulRepublic of Korea
| | - Shih‐Ann Chen
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Sabine Ernst
- Department of CardiologyRoyal Brompton and Harefield HospitalImperial College LondonLondonUK
| | | | - Seongwook Han
- Division of CardiologyDepartment of Internal MedicineKeimyung University School of MedicineDaeguRepublic of Korea
| | - Zbigniew Kalarus
- Department of CardiologyMedical University of SilesiaKatowicePoland
| | - Carlos Labadet
- Cardiology DepartmentArrhythmias and Electrophysiology ServiceClinica y Maternidad Suizo ArgentinaBuenos AiresArgentina
| | - Yenn‐Jian Lin
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Li‐Wei Lo
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Akihiko Nogami
- Department of CardiologyFaculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Eduardo B. Saad
- Center for Atrial FibrillationHospital Pro‐CardiacoRio de JaneiroBrazil
| | - John Sapp
- Division of CardiologyDepartment of MedicineQEII Health Sciences CentreDalhousie UniversityHalifaxNSCanada
| | | | - Roland Tilz
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine)University Hospital Schleswig‐Holstein (UKSH) – Campus LuebeckLuebeckGermany
| | - Roderick Tung
- Center for Arrhythmia CarePritzker School of MedicineUniversity of Chicago MedicineChicagoILUSA
| | - Yun Gi Kim
- Department of Internal MedicineArrhythmia CenterKorea University Medicine Anam HospitalSeoulRepublic of Korea
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Cazzoli I, Gunturiz-Beltran C, Guarguagli S, Alonso-Gonzalez R, Babu-Narayan SV, Dimopoulos K, Swan L, Uebing A, Gatzoulis MA, Ernst S. Catheter ablation for patients with end-stage complex congenital heart disease or cardiomyopathy considered for transplantation: Trials and tribulations. Int J Cardiol 2020; 301:127-134. [PMID: 31604655 DOI: 10.1016/j.ijcard.2019.09.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/27/2019] [Accepted: 09/06/2019] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Arrhythmia contributes significantly to morbidity and mortality of patients with congenital heart disease (CHD) or cardiomyopathy (CMP). It also has the potential to worsen symptoms and is particularly detrimental to patients with advanced heart failure awaiting cardiac transplantation. We report our experience using catheter ablation to treat recurrent arrhythmia in patients with CHD or CMP considered for transplantation. METHODS Five consecutive patients (3 female, mean age 47.8 ± 12.8 years) with complex CHD or CMP (tricuspid atresia, mitral atresia, double inlet left ventricle, arrhythmogenic right ventricular cardiomyopathy, left ventricular non-compaction) presented with either atrial (n = 3) or ventricular (n = 2) arrhythmias. All ablations were guided by three-dimensional (3D) electro-anatomical mapping, plus remote magnetic navigation in 3 patients. RESULTS Patients underwent a median of 2 ablation procedures for a total number of 26 tachycardias. None of the 5 patients experienced further arrhythmia at a median of 939 days (range 4-1375) from their last ablation. During a median follow up of 31 months (range 1-70), three patients underwent successful transplantation at 1375, 1062 and 321 days following their last ablation. One patient with a Fontan circulation died from hepatic cancer and one from end-stage heart failure despite urgent transplant listing. CONCLUSIONS Catheter ablation is feasible in complex cardiac patients considered for heart transplantation and should be offered for rhythm management and patient optimization until a suitable donor is found.
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Affiliation(s)
- Ilaria Cazzoli
- Department of Cardiology, Royal Brompton and Harefield Hospital, Imperial College London, United Kingdom
| | - Clara Gunturiz-Beltran
- Department of Cardiology, Royal Brompton and Harefield Hospital, Imperial College London, United Kingdom; Electrophysiology Unit, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Silvia Guarguagli
- Department of Cardiology, Royal Brompton and Harefield Hospital, Imperial College London, United Kingdom
| | - Rafael Alonso-Gonzalez
- Adult and Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton and Harefield Hospital, London, United Kingdom
| | - Sonya V Babu-Narayan
- Department of Cardiology, Royal Brompton and Harefield Hospital, Imperial College London, United Kingdom; Cardiovascular Research Center, Royal Brompton and Harefield Hospital, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Konstantinos Dimopoulos
- Adult and Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton and Harefield Hospital, London, United Kingdom
| | - Lorna Swan
- Adult and Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton and Harefield Hospital, London, United Kingdom
| | - Anselm Uebing
- Electrophysiology Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Department of Paediatric Cardiology, University of Muenster, Muenster, Germany
| | - Michael A Gatzoulis
- Adult and Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton and Harefield Hospital, London, United Kingdom
| | - Sabine Ernst
- Department of Cardiology, Royal Brompton and Harefield Hospital, Imperial College London, United Kingdom.
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10
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Kwok S, Yung T, Ho N, Hai J, Tsao S, Tse H. Missing pouches in high-density mapping of atrial tachyarrhythmia in congenital heart diseases. J Arrhythm 2019; 35:821-829. [PMID: 31844473 PMCID: PMC6898558 DOI: 10.1002/joa3.12251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/05/2019] [Accepted: 09/28/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The use of high-density electroanatomical mapping in the Chinese population for congenital heart disease (CHD) is not well reported. METHODS Retrospective review of consecutive transcatheter ablation of atrial tachyarrhythmia using high-density mapping for CHD patients (at least moderate complexity) in the only tertiary congenital heart center in the territory from January 2017 to January 2019 was conducted. Orion mapping catheter in Rhythmia system (Boston Scientific) was used to create activation and voltage maps. Parameters including mechanism of arrhythmia, acute success, and follow-up data were recorded. RESULTS Eight patients were identified (median age 35.5 years) who underwent transcatheter ablation of atrial arrhythmia. More than one reentry circuits of IART were identified in five patients. It took a median of 32.4 minutes with 15,952 (IQR 13,395-18,530) mapping points per map. Cavo-annulus isthmus-dependent mechanism was the predominant reentry mechanism. Acute success with the elimination of all inducible tachycardia was achieved in six patients (75%), and partial success in two patients. There was recurrence of atrial arrhythmia in four patients (50%), in which three patients could be maintained in sinus rhythm with low-dose antiarrhythmic medication. Targeted substrate ablation was performed in six patients with multiple IART circuits. Critical anatomical pouches were identified in three patients, which were missed in the initial mapping using Orion basket mapping catheter. CONCLUSIONS High acute success rate of atrial arrhythmia ablation can be achieved using high-density anatomical mapping in CHD. Substrate ablation was required with multiple IART circuits identified. Vigilance should be sought to identify anatomical pouches.
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Affiliation(s)
- Sit‐Yee Kwok
- Department of Paediatric CardiologyQueen Mary HospitalHong Kong
| | - Tak‐Cheung Yung
- Department of Paediatric CardiologyQueen Mary HospitalHong Kong
| | - Ngai‐Lun Ho
- Department of Paediatric CardiologyQueen Mary HospitalHong Kong
| | - Jo‐Jo Hai
- Cardiology DivisionDepartment of MedicineQueen Mary HospitalThe University of Hong KongHong Kong
| | - Sabrina Tsao
- Department of Paediatric CardiologyQueen Mary HospitalHong Kong
| | - Hung‐Fat Tse
- Cardiology DivisionDepartment of MedicineQueen Mary HospitalThe University of Hong KongHong Kong
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11
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Alken FA, Klatt N, Muenkler P, Scherschel K, Jungen C, Akbulak RO, Kahle AK, Gunawardene M, Jularic M, Dinshaw L, Hartmann J, Eickholt C, Willems S, Stute F, Mueller G, Blankenberg S, Rickers C, Sinning C, Zengin-Sahm E, Meyer C. Advanced mapping strategies for ablation therapy in adults with congenital heart disease. Cardiovasc Diagn Ther 2019; 9:S247-S263. [PMID: 31737533 DOI: 10.21037/cdt.2019.10.02] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Ultra-high density mapping (HDM) is a promising tool in the treatment of patients with complex arrhythmias. In adults with congenital heart disease (CHD), rhythm disorders are among the most common complications but catheter ablation can be challenging due to heterogenous anatomy and complex arrhythmogenic substrates. Here, we describe our initial experience using HDM in conjunction with novel automated annotation algorithms in patients with moderate to great CHD complexity. Methods We studied a series of consecutive adult patients with moderate to great CHD complexity and an indication for catheter ablation due to symptomatic arrhythmia. HDM was conducted using the Rhythmia™ mapping system and a 64-electrode mini-basket catheter for identification of anatomy, voltage, activation pattern and critical areas of arrhythmia for ablation guidance. To investigate novel advanced mapping strategies, postprocedural signal processing using the Lumipoint™ software was applied. Results In 19 patients (53±3 years; 53% male), 21 consecutive ablation procedures were conducted. Procedures included ablation of atrial fibrillation (n=7; 33%), atrial tachycardia (n=11; 52%), atrioventricular accessory pathway (n=1; 5%), the atrioventricular node (n=1; 5%) and ventricular arrhythmias (n=4; 19%). A total of 23 supraventricular and 8 ventricular arrhythmias were studied with the generation of 56 complete high density maps (atrial n=43; ventricular n=11, coronary sinus n=2) and an average of 12,043±1,679 mapping points. Multiple arrhythmias were observed in n=7 procedures (33% of procedures; range of arrhythmias detected 2-4). A total range of 1-4 critical areas were defined per procedure and treated within a radiofrequency application time of 16 (interquartile range 12-45) minutes. Postprocedural signal processing using Lumipoint™ allowed rapid annotation of fractionated signals within specific windows of interest. This supported identification of a practical critical isthmus in 20 out of 27 completed atrial and ventricular tachycardia activation maps. Conclusions Our findings suggest that HDM in conjunction with novel automated annotation algorithms provides detailed insights into arrhythmia mechanisms and might facilitate tailored catheter ablation in patients with moderate to great CHD complexity.
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Affiliation(s)
- Fares-Alexander Alken
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Niklas Klatt
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Paula Muenkler
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Katharina Scherschel
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Christiane Jungen
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Ruken Oezge Akbulak
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Ann-Kathrin Kahle
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Melanie Gunawardene
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Mario Jularic
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Leon Dinshaw
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Jens Hartmann
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Christian Eickholt
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Stephan Willems
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Fridrike Stute
- Department of Pediatric Cardiology/Pediatric Cardiac Surgery, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Goetz Mueller
- Department of Pediatric Cardiology/Pediatric Cardiac Surgery, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Stefan Blankenberg
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.,Department of General and Interventional Cardiology, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Carsten Rickers
- Department of Pediatric Cardiology/Pediatric Cardiac Surgery, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,Adults with Congenital Heart Disease Section, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Christoph Sinning
- Department of General and Interventional Cardiology, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Elvin Zengin-Sahm
- Department of General and Interventional Cardiology, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Christian Meyer
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
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12
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Cheniti G, Puyo S, Martin CA, Frontera A, Vlachos K, Takigawa M, Bourier F, Kitamura T, Lam A, Dumas-Pommier C, Pillois X, Pambrun T, Duchateau J, Klotz N, Denis A, Derval N, Cochet H, Sacher F, Dubois R, Jais P, Hocini M, Haissaguerre M. Noninvasive Mapping and Electrocardiographic Imaging in Atrial and Ventricular Arrhythmias (CardioInsight). Card Electrophysiol Clin 2019; 11:459-471. [PMID: 31400870 DOI: 10.1016/j.ccep.2019.05.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Electrocardiographic imaging is a mapping technique aiming to noninvasively characterize cardiac electrical activity using signals collected from the torso to reconstruct epicardial potentials. Its efficacy has been demonstrated clinically, from mapping premature ventricular complexes and accessory pathways to of complex arrhythmias. Electrocardiographic imaging uses a standardized workflow. Signals should be checked manually to avoid automatic processing errors. Reentry is confirmed in the presence of local activation covering the arrhythmia cycle length. Focal breakthroughs demonstrate a QS pattern associated with centrifugal activation. Electrocardiographic imaging offers a unique opportunity to better understand the mechanism of cardiac arrhythmias and guide ablation.
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Affiliation(s)
- Ghassen Cheniti
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France.
| | - Stephane Puyo
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Claire A Martin
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Antonio Frontera
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Konstantinos Vlachos
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Masateru Takigawa
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Felix Bourier
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Takeshi Kitamura
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Anna Lam
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Carole Dumas-Pommier
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France
| | - Xavier Pillois
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France
| | - Thomas Pambrun
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Josselin Duchateau
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Nicolas Klotz
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Arnaud Denis
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Nicolas Derval
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Hubert Cochet
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France; Department of Cardiovascular Imaging, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France
| | - Frederic Sacher
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Remi Dubois
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Pierre Jais
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Meleze Hocini
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Michel Haissaguerre
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
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13
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Abstract
Besides antiarrhythmic medication, there are now very good options for a potentially curative therapy by catheter ablation targeting the origin of the underlying arrhythmias in patients with complex congenital heart disease. Three-dimensional (3D) reconstruction of tomographic imaging (MRI or computed tomography) is helpful to understand the underlying cardiac anatomy, identify the most likely target chamber, and help with planning access. Use of the available 3D mapping systems (sequential or simultaneous acquisition) and (if available) more advanced navigation systems, such as remote magnetic navigation, can improve the acute and long-term outcomes of catheter ablation in congenital heart disease.
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Affiliation(s)
- Sabine Ernst
- Cardiology Department, National Heart and Lung Institute, Royal Brompton and Harefield Hospital, Imperial College, Sydney Street, London SW3 6NP, UK.
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14
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ROTTNER LAURA, METZNER ANDREAS, OUYANG FEIFAN, HEEGER CHRISTIAN, HAYASHI KENTARO, FINK THOMAS, LEMES CHRISTINE, MATHEW SHIBU, MAURER TILMAN, REIßMANN BRUNO, REXHA ENIDA, RIEDL JOHANNES, SAGUNER ARDANM, SANTORO FRANCESCO, KUCK KARLHEINZ, SOHNS CHRISTIAN. Direct Comparison of Point-by-Point and Rapid Ultra-High-Resolution Electroanatomical Mapping in Patients Scheduled for Ablation of Atrial Fibrillation. J Cardiovasc Electrophysiol 2017; 28:289-297. [DOI: 10.1111/jce.13160] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 12/15/2016] [Accepted: 12/27/2016] [Indexed: 11/29/2022]
Affiliation(s)
- LAURA ROTTNER
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - ANDREAS METZNER
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - FEIFAN OUYANG
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - CHRISTIAN HEEGER
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - KENTARO HAYASHI
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - THOMAS FINK
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - CHRISTINE LEMES
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - SHIBU MATHEW
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - TILMAN MAURER
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - BRUNO REIßMANN
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - ENIDA REXHA
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - JOHANNES RIEDL
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - ARDAN M. SAGUNER
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - FRANCESCO SANTORO
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - KARL-HEINZ KUCK
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - CHRISTIAN SOHNS
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
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15
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Health Care Costs for Adults With Congenital Heart Disease in the United States 2002 to 2012. Am J Cardiol 2016; 118:590-6. [PMID: 27476099 DOI: 10.1016/j.amjcard.2016.05.056] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 05/23/2016] [Accepted: 05/23/2016] [Indexed: 11/22/2022]
Abstract
More adults than children with congenital heart disease (CHD) are alive today. Few studies have evaluated adult congenital heart disease (ACHD) health care utilization in the United States. Data from the National Inpatient Sample from 2002 to 2012, using International Classification of Diseases, Ninth Revision, codes for moderate and complex CHD were analyzed. Hospital discharges, total billed and reimbursed amounts, length of stay, and gender/age disparities were evaluated. There was an increase in CHD discharges (moderate CHD: 4,742 vs 6,545; severe CHD: 807 vs 1,115) and total billed and reimbursed dollar amounts across all CHD (billed: $2.7 vs $7.0 billion, 155% increase; reimbursed: $1.3 vs $2.3 billion, 99% increase) and in the ACHD subgroup (billed: $543 million vs $1.5 billion, 178% increase; reimbursed: $221 vs $433 million, 95% increase). Women comprised more discharges in 2002 but not in 2012 (men:women, 2002: 6,503 vs 7,805; 2012: 7,715 vs 7,200, p = 0.39). Gender-based billed amounts followed similar trends (2002: $263 vs $280 million; 2012: $845 vs $662 million, p = 0.006) as did reimbursements (2002: $108 vs $114 million; 2012: $243 vs $190 million, p = 0.008). All age subgroups demonstrated increased health care expenditures, including the >44 versus 18- to 44-year-old age subgroup (billed: $618 vs $347 million, p <0.001; reimbursed: $136 vs $75 million, p <0.001). Our results reveal increased ACHD billed and reimbursed amounts and hospital discharges with a shift in gender-based ACHD hospitalizations: men now account for more hospitalizations in the United States. In conclusion, increased health care expenditure in older patients with ACHD is likely to increase further as health care system use and costs continue to grow.
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16
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Ernst S, Yen Ho S, McCarthy K. [Arrhythmia in adults with congenital heart defects : Atrial tachycardia]. Herzschrittmacherther Elektrophysiol 2016; 27:122-30. [PMID: 27250726 DOI: 10.1007/s00399-016-0432-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 04/12/2016] [Indexed: 11/25/2022]
Abstract
Atrial arrhythmias are frequently encountered in patients with congenital heart disease (CHD) with or without corrective surgery and respond to pharmacological therapies with only limited success. This review describes the technologies currently available for performing successful ablation procedures in this very complex patient cohort. In addition to an understanding of the underlying anatomy, which can be supplemented by 3D imaging with the aid of magnetic resonance imaging (MRI) or computed tomography (CT), the choice between the different 3D mapping systems (sequential versus simultaneous) is presented. Finally, conventional manual navigation is compared with magnetic navigation and then discussed with regard to the respective arrhythmias encountered with the different forms of CHD.
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Affiliation(s)
- Sabine Ernst
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, SW3 6NP, London, UK.
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and National Heart and Lung Institute, Imperial College London, London, UK.
| | - Siew Yen Ho
- Brompton Cardiac Morphology Unit, Imperial College London, London, UK
| | - Karen McCarthy
- Brompton Cardiac Morphology Unit, Imperial College London, London, UK
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17
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ROY KARINE, GOMEZ-PULIDO FEDERICO, ERNST SABINE. Remote Magnetic Navigation for Catheter Ablation in Patients With Congenital Heart Disease: A Review. J Cardiovasc Electrophysiol 2016; 27 Suppl 1:S45-56. [DOI: 10.1111/jce.12903] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 12/15/2015] [Accepted: 12/15/2015] [Indexed: 11/28/2022]
Affiliation(s)
- KARINE ROY
- Department of Cardiology; Royal Brompton and Harefield NHS Foundation Trust; London UK
| | - FEDERICO GOMEZ-PULIDO
- Department of Cardiology; Royal Brompton and Harefield NHS Foundation Trust; London UK
| | - SABINE ERNST
- Department of Cardiology; Royal Brompton and Harefield NHS Foundation Trust; London UK
- Biomedical Research Unit, National Heart and Lung Institute; Imperial College London; London UK
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18
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Thomas PE, Macicek SL. Catheter Ablation to Treat Supraventricular Arrhythmia in Children and Adults With Congenital Heart Disease: What We Know and Where We Are Going. Ochsner J 2016; 16:290-6. [PMID: 27660579 PMCID: PMC5024812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Catheter ablation has been used to manage supraventricular arrhythmia in children since 1990. This article reviews the history of catheter ablation used to treat arrhythmia in children and discusses new frontiers in the field. We also address ablation in adult patients with a history of congenital heart disease (CHD) that was diagnosed and initially treated in childhood. METHODS We conducted an evidence-based literature review to gather available data on ablation for supraventricular tachycardia in children and adult patients with CHD. RESULTS Ablations can be performed safely and effectively in children. Complication rates are higher in children <4 years and <15 kg. In one study, the overall success rate of radiofrequency ablation in pediatrics was 95.7%, with the highest success rate in left free wall pathways (97.8%). Recurrence was higher in septal pathways. Cryoablation has been reported to have a 93% acute success rate for atrioventricular (AV) nodal reentrant tachycardia and septal pathways with no risk of AV block and a 5%-9% risk of recurrence. Three-dimensional mapping, intracardiac echocardiography, remote magnetic navigation, and irrigated catheter ablation are new technologies used to treat pediatric and adult patients with CHD. The population of adult patients with CHD is growing, and these patients are at particularly high risk for arrhythmia. A paucity of data is available on ablation in adult patients with CHD. CONCLUSION Electrophysiology for pediatric and adult patients with CHD is a rapidly growing and progressing field. We benefit from continuous development of ablation techniques for adults with structurally normal hearts and have the unique challenge and responsibility to ensure the safe and effective application of these techniques in the vulnerable population of pediatric and adult patients with CHD.
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Affiliation(s)
- Patricia E. Thomas
- Department of Pediatric Cardiology, Ochsner Clinic Foundation, New Orleans, LA
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
| | - Scott L. Macicek
- Department of Pediatric Cardiology, Ochsner Clinic Foundation, New Orleans, LA
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