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Yan SP, Song X, Wei L, Gong YS, Hu HY, Li YQ. Performance of heart rate adjusted heart rate variability for risk stratification of sudden cardiac death. BMC Cardiovasc Disord 2023; 23:144. [PMID: 36949420 PMCID: PMC10032001 DOI: 10.1186/s12872-023-03184-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/14/2023] [Indexed: 03/24/2023] Open
Abstract
PURPOSE As a non-invasive tool for the assessment of cardiovascular autonomic function, the predictive value of heart rate variability (HRV) for sudden cardiac death (SCD) risk stratification remains unclear. In this study, we investigated the performance of the individualized heart rate (HR) adjusted HRV (HRVI) for SCD risk stratification in subjects with diverse risks. METHODS A total of 11 commonly used HRV metrics were analyzed in 192 subjects, including 88 healthy controls (low risk group), 82 hypertrophic cardiomyopathy (HCM) patients (medium risk group), and 22 SCD victims (high risk group). The relationship between HRV metrics and HR was examined with long-term and short-term analysis. The performance HRVI was evaluated by area under the receiver operating characteristic curve (AUC) and covariance of variation (CV). RESULTS Most of the HRV metrics were exponentially decayed with the increase of HR, while the exponential power coefficients were significantly different among groups. The HRVI metrics discriminated low, medium and high risk subjects with a median AUC of 0.72[0.11], which was considerably higher than that of the traditional long-term (0.63[0.04]) and short-term (0.58[0.05]) HRV without adjustment. The average CV of the HRVI metrics was also significantly lower than traditional short-term HRV metrics (0.09 ± 0.02 vs. 0.24 ± 0.13, p < 0.01). CONCLUSIONS Subjects with diverse risks of SCD had similar exponential decay relationship between HRV metrics and HR, but with different decaying rates. HRVI provides reliable and robust estimation for risk stratification of SCD.
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Affiliation(s)
- Su-Peng Yan
- Department of Biomedical Engineering and Imaging Medicine, Army Medical University, 30 Gaotanyan Main Street, Chongqing, 400038, China
| | - Xin Song
- Department of Biomedical Engineering and Imaging Medicine, Army Medical University, 30 Gaotanyan Main Street, Chongqing, 400038, China
| | - Liang Wei
- Department of Biomedical Engineering and Imaging Medicine, Army Medical University, 30 Gaotanyan Main Street, Chongqing, 400038, China
| | - Yu-Shun Gong
- Department of Biomedical Engineering and Imaging Medicine, Army Medical University, 30 Gaotanyan Main Street, Chongqing, 400038, China
| | - Hou-Yuan Hu
- Department of Cardiology, Southwest Hospital, Army Medical University, Chongqing, 400038, China
| | - Yong-Qin Li
- Department of Biomedical Engineering and Imaging Medicine, Army Medical University, 30 Gaotanyan Main Street, Chongqing, 400038, China.
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Abbas R, Abbas A, Khan TK, Sharjeel S, Amanullah K, Irshad Y. Sudden Cardiac Death in Young Individuals: A Current Review of Evaluation, Screening and Prevention. J Clin Med Res 2023; 15:1-9. [PMID: 36755763 PMCID: PMC9881489 DOI: 10.14740/jocmr4823] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 01/04/2023] [Indexed: 01/26/2023] Open
Abstract
Sudden cardiac death (SCD) can affect all age groups, including young persons. While less common in the age < 35 population, the occurrence of SCD in the young raises concern, with multiple possible etiologies and often unanswered questions. While coronary artery disease is the leading cause in those > 35 years of age, the younger population faces a different subset of pathologies associated with SCD, including arrhythmias and cardiomyopathies. The tragic nature of SCD in the young entails that we explore and implement available screening methods for this population, and perform the necessary investigations such as electrocardiography (ECG) and echocardiography. In this review, we not only explore the vast etiology associated with SCD in those age < 35, but emphasize evaluation methods, who is at risk, and delve into screening of SCD in potential victims and their family members, in an attempt to prevent this traumatic event. Future research must work towards establishing preventative measures in order to reduce SCD, particularly unexplained SCD in the young.
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Affiliation(s)
- Ramsha Abbas
- Institute of Molecular Cardiology, Department of Medicine, University of Louisville, Louisville, KY, USA,Corresponding Author: Ramsha Abbas, Institute of Molecular Cardiology, Department of Medicine, University of Louisville, Louisville, KY, USA.
| | - Aiza Abbas
- Medical College, Aga Khan University, Karachi, Sindh, Pakistan
| | - Talha Kamran Khan
- Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Salal Sharjeel
- Dow Medical College, Dow University of Health Sciences, Karachi, Sindh, Pakistan
| | - Khadija Amanullah
- Medical College, National University of Medical Sciences, Rawalpindi, Punjab, Pakistan
| | - Yusra Irshad
- Division of Infectious Diseases, Department of Medicine, University of Louisville, Louisville, KY, USA
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3
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Clinical Phenotypes of Cardiovascular and Heart Failure Diseases Can Be Reversed? The Holistic Principle of Systems Biology in Multifaceted Heart Diseases. CARDIOGENETICS 2022. [DOI: 10.3390/cardiogenetics12020015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
Recent advances in cardiology and biological sciences have improved quality of life in patients with complex cardiovascular diseases (CVDs) or heart failure (HF). Regardless of medical progress, complex cardiac diseases continue to have a prolonged clinical course with high morbidity and mortality. Interventional coronary techniques together with drug therapy improve quality and future prospects of life, but do not reverse the course of the atherosclerotic process that remains relentlessly progressive. The probability of CVDs and HF phenotypes to reverse can be supported by the advances made on the medical holistic principle of systems biology (SB) and on artificial intelligence (AI). Studies on clinical phenotypes reversal should be based on the research performed in large populations of patients following gathering and analyzing large amounts of relative data that embrace the concept of complexity. To decipher the complexity conundrum, a multiomics approach is needed with network analysis of the biological data. Only by understanding the complexity of chronic heart diseases and explaining the interrelationship between different interconnected biological networks can the probability for clinical phenotypes reversal be increased.
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4
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Edinoff AN, Ellis ED, Nussdorf LM, Hill TW, Cornett EM, Kaye AM, Kaye AD. Antipsychotic Polypharmacy-Related Cardiovascular Morbidity and Mortality: A Comprehensive Review. Neurol Int 2022; 14:294-309. [PMID: 35324580 PMCID: PMC8954521 DOI: 10.3390/neurolint14010024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 11/16/2022] Open
Abstract
Schizophrenia is a psychotic disorder that exists at the more extreme end of a spectrum of diseases, and significantly affects daily functioning. Cardiovascular adverse effects of antipsychotic medications are well known, and include changes in blood pressure and arrhythmias. Sudden cardiac death is the leading cause of death worldwide, and antipsychotic medications are associated with numerous cardiac side effects. A possible link exists between antipsychotic medications and sudden cardiac death. Common prescribing patterns that may influence cardiovascular events include the use of multiple antipsychotics and/or additional drugs commonly prescribed to patients on antipsychotics. The results of this review reflect an association between antipsychotic drugs and increased risk of ventricular arrhythmias and sudden cardiac death by iatrogenic prolongation of the QTc interval. QTc prolongation and sudden cardiac death exist in patients taking antipsychotic monotherapy. The risk increases for the concomitant use of specific drugs that prolong the QTc interval, such as opioids, antibiotics, and illicit drugs. However, evidence suggests that QTc intervals may not adequately predict sudden cardiac death. In considering the findings of this narrative review, we conclude that it is unclear whether there is a precise association between antipsychotic polypharmacy and sudden cardiac death with QTc interval changes. The present narrative review warrants further research on this important potential association.
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Affiliation(s)
- Amber N. Edinoff
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Science Center Shreveport, 1501 Kings Hwy, Shreveport, LA 71103, USA
- Correspondence: ; Tel.: +1-(318)-675-8969
| | - Emily D. Ellis
- School of Medicine, Louisiana State University Shreveport, Shreveport, LA 71103, USA; (E.D.E.); (L.M.N.); (T.W.H.)
| | - Laura M. Nussdorf
- School of Medicine, Louisiana State University Shreveport, Shreveport, LA 71103, USA; (E.D.E.); (L.M.N.); (T.W.H.)
| | - Taylor W. Hill
- School of Medicine, Louisiana State University Shreveport, Shreveport, LA 71103, USA; (E.D.E.); (L.M.N.); (T.W.H.)
| | - Elyse M. Cornett
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (E.M.C.); (A.D.K.)
| | - Adam M. Kaye
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA 95211, USA;
| | - Alan D. Kaye
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (E.M.C.); (A.D.K.)
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5
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van der Burgh AC, Stricker BH, Rizopoulos D, Ikram MA, Hoorn EJ, Chaker L. Kidney function and the risk of sudden cardiac death in the general population. Clin Kidney J 2022; 15:1524-1533. [PMID: 35892020 PMCID: PMC9308098 DOI: 10.1093/ckj/sfac049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background Chronic kidney disease increases sudden cardiac death (SCD) risk, but the association between kidney function and SCD in a general population is largely unknown. Therefore, we investigated the association between kidney function and SCD in a general middle-aged and elderly population. Methods We included individuals aged ≥45 years from a prospective population-based cohort study. The association between kidney function assessments [estimated glomerular filtration rate based on serum creatinine (eGFRcreat), cystatin C (eGFRcys) or both (eGFRcreat-cys)] and SCD was investigated using Cox proportional-hazards and joint models. Absolute 10-year risks were computed using competing risk analyses. Mediation analyses were performed using a four-way decomposition method. Results We included 9687 participants (median follow-up 8.9 years; mean age 65.3 years; 56.7% women; 243 SCD cases). Lower eGFRcys and eGFRcreat-cys were associated with increased SCD risk [hazard ratio (HR) 1.23, 95% confidence interval (CI) 1.12–1.34 and HR 1.17, 95% CI 1.06–1.29, per 10 mL/min/1.73 m2 eGFR decrease]. A significant trend (P = 0.001) across eGFRcys categories was found, with an HR of 2.11 (95% CI 1.19–3.74) for eGFRcys <60 compared with eGFRcys >90 mL/min/1.73 m2. Comparing eGFRcys of 90 to 60 mL/min/1.73 m2, absolute 10-year risk increased from 1.0% to 2.5%. Identified subgroups at increased risk included older participants and participants with atrial fibrillation. The associations were not mediated by coronary heart disease, hypertension or diabetes. Conclusions Reduced kidney function is associated with increased SCD risk in the general population, especially with eGFRcys. eGFRcys could be added to prediction models and screening programmes for SCD prevention.
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Affiliation(s)
- Anna C van der Burgh
- Department of Internal Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bruno H Stricker
- Department of Internal Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ewout J Hoorn
- Department of Internal Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Layal Chaker
- Department of Internal Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
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6
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Ben Abderrahim S, Gharbaoui M, Békir O, Hamdoun M, Allouche M. Sudden death related to the gastrointestinal system in Tunisia: A 13 year autopsy study. J Forensic Sci 2021; 67:596-604. [PMID: 34897679 DOI: 10.1111/1556-4029.14953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/21/2021] [Accepted: 11/29/2021] [Indexed: 12/20/2022]
Abstract
Sudden gastrointestinal (GI) death is an unexpected death due to digestive system causes mainly found after autopsy. The literature is rich in articles that studied sudden death due to cardiac causes while sudden GI deaths remain less well-documented. We retrospectively investigated all cases of gastrointestinal death at the Department of Forensic Medicine in Tunis, over 13 years (January 1, 2006 to December 31, 2018). Two hundred and eight cases were collected. The mean age of our series was 51.06 ± 20.99 years. No history of digestive disorders was reported in 78.4%, and no family history of sudden death was found in any cases. A male predominance was found in most epidemiological characteristics of the sample with a significant statistical rate in some features. Non-specific abdominal pain was the most described symptom (n = 92). Perforation of GI tract was the common mechanism involved in the death of 55 cases, of which 44 were related to ulcer perforation. These ulcer perforations were statistically more reported in smokers and people suffering from schizophrenia. Intestinal obstruction was the second commonest cause of death, mainly found in the elderly. Sudden death in children was most frequently caused by acute intussusception. This study highlights that systematic study of sudden death due to GI causes might provide opportunities to identify avenues for overall health improvement.
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Affiliation(s)
- Sarra Ben Abderrahim
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia
| | - Meriem Gharbaoui
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia
| | - Olfa Békir
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia
| | - Moncef Hamdoun
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia
| | - Mohamed Allouche
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia
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7
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Sudden Cardiac Death in Systemic Sclerosis: Diagnostics to Assess Risk and Inform Management. Diagnostics (Basel) 2021; 11:diagnostics11101781. [PMID: 34679479 PMCID: PMC8534599 DOI: 10.3390/diagnostics11101781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 11/16/2022] Open
Abstract
Cardiac disease is a leading cause of death in systemic sclerosis (SSc) and sudden cardiac death (SCD) is thought to occur more commonly in SSc than in the general population. Diffuse myocardial fibrosis, myocarditis and ischaemic heart disease are all prevalent in SSc and can be reasonably hypothesised to contribute to an increased risk of SCD. Despite this, SCD remains a relatively understudied area of SSc with little understood about SSc-specific risk factors and opportunities for primary prevention. In this review, we present an overview of the possible mechanisms of SCD in SSc and our current understanding of how each of these mechanisms may contribute to cardiac death. This review highlights the need for a future research agenda that addresses the underlying epidemiology of SCD in SSc and identifies opportunities for intervention to modify the disease course of heart disease in SSc.
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8
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Wang Q, Wang Y, Liu S, Sha X, Song X, Dai Y, Zhao M, Cai L, Xu K, Li J. Theranostic nanoplatform to target macrophages enables the inhibition of atherosclerosis progression and fluorescence imaging of plaque in ApoE(-/-) mice. J Nanobiotechnology 2021; 19:222. [PMID: 34320994 PMCID: PMC8317354 DOI: 10.1186/s12951-021-00962-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/12/2021] [Indexed: 12/03/2022] Open
Abstract
Background Rupture of atherosclerotic plaque can cause acute malignant heart and cerebrovascular events, such as acute coronary heart disease, stroke and so on, which seriously threaten the safety of human life and property. Therefore, the early diagnosis and inhibition of atherosclerotic plaque progress still be a vital task. Results In this study, we presented the development of composite mesoporous silica nanoparticle (Ru(bpy)3@SiO2-mSiO2, CMSN)-based nanomedicines (NMs) (Ru(bpy)3@SiO2-mSiO2@SRT1720@AntiCD36, CMSN@SRT@Anti) for accurate diagnosis and treatment of atherosclerosis (AS). In vitro cell experiments showed that both RAW264.7 and oxidized low density lipoprotein (ox-LDL)-stimulated RAW264.7 cells could significantly uptake CMSN@SRT@Anti. Conversely, little fluorescence signal could be observed in CMSN@SRT group, showing the excellent targeting ability of CMSN@SRT@Anti to Class II scavenger receptor, CD36 on macrophage. Additionally, such fluorescence signal was significantly stronger in ox-LDL-stimulated RAW264.7 cells, which might benefit from the upregulated expression of CD36 on macrophages after ox-LDL treatment. For another, compared with free SRT1720, CMSN@SRT@Anti had a better and more significant effect on the inhibition of macrophage foaming process, which indicated that drug-carrying mesoporous silicon with targeting ability could enhance the efficacy of SRT1720. Animal experimental results showed that after the abdominal injection of CMSN@SRT@Anti, the aortic lesions of ApoE-/-mice could be observed with obvious and persistent fluorescence signals. After 4 weeks post-treatment, the serum total cholesterol, aortic plaque status and area were significantly improved in the mouse, and the effect was better than that in the free SRT1720 group or the CMSN@SRT group. Conclusions The designed CMSN@SRT@Anti with excellent biocompatibility, high-performance and superior atherosclerosis-targeting ability has great potential for accurate identification and targeted therapy of atherosclerotic diseases. Graphic abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s12951-021-00962-w.
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Affiliation(s)
- Qi Wang
- School of Medical Imaging, Xuzhou Medical University, Xuzhou, 221006, China
| | - Yong Wang
- School of Medical Imaging, Xuzhou Medical University, Xuzhou, 221006, China
| | - Siwen Liu
- School of Medical Imaging, Xuzhou Medical University, Xuzhou, 221006, China
| | - Xuan Sha
- School of Medical Imaging, Xuzhou Medical University, Xuzhou, 221006, China
| | - Xiaoxi Song
- School of Medical Imaging, Xuzhou Medical University, Xuzhou, 221006, China
| | - Yue Dai
- School of Medical Imaging, Xuzhou Medical University, Xuzhou, 221006, China
| | - Mingming Zhao
- School of Medical Imaging, Xuzhou Medical University, Xuzhou, 221006, China
| | - Lulu Cai
- School of Medical Imaging, Xuzhou Medical University, Xuzhou, 221006, China
| | - Kai Xu
- School of Medical Imaging, Xuzhou Medical University, Xuzhou, 221006, China. .,Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221004, China.
| | - Jingjing Li
- School of Medical Imaging, Xuzhou Medical University, Xuzhou, 221006, China. .,Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221004, China.
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9
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Kléber AG, Jin Q. Coupling between cardiac cells-An important determinant of electrical impulse propagation and arrhythmogenesis. ACTA ACUST UNITED AC 2021; 2:031301. [PMID: 34296210 DOI: 10.1063/5.0050192] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 06/09/2021] [Indexed: 01/30/2023]
Abstract
Cardiac arrhythmias are an important cause of sudden cardiac death-a devastating manifestation of many underlying causes, such as heart failure and ischemic heart disease leading to ventricular tachyarrhythmias and ventricular fibrillation, and atrial fibrillation causing cerebral embolism. Cardiac electrical propagation is a main factor in the initiation and maintenance of cardiac arrhythmias. In the heart, gap junctions are the basic unit at the cellular level that host intercellular low-resistance channels for the diffusion of ions and small regulatory molecules. The dual voltage clamp technique enabled the direct measurement of electrical conductance between cells and recording of single gap junction channel openings. The rapid turnover of gap junction channels at the intercalated disk implicates a highly dynamic process of trafficking and internalization of gap junction connexons. Recently, non-canonical roles of gap junction proteins have been discovered in mitochondria function, cytoskeletal organization, trafficking, and cardiac rescue. At the tissue level, we explain the concepts of linear propagation and safety factor based on the model of linear cellular structure. Working myocardium is adequately represented as a discontinuous cellular network characterized by cellular anisotropy and connective tissue heterogeneity. Electrical propagation in discontinuous cellular networks reflects an interplay of three main factors: cell-to-cell electrical coupling, flow of electrical charge through the ion channels, and the microscopic tissue structure. This review provides a state-of-the-art update of the cardiac gap junction channels and their role in cardiac electrical impulse propagation and highlights a combined approach of genetics, cell biology, and physics in modern cardiac electrophysiology.
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Affiliation(s)
- André G Kléber
- Department of Pathology, Harvard Medical School, Boston, Massachusetts 02215, USA
| | - Qianru Jin
- Disease Biophysics Group, John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, Massachusetts 02134, USA
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10
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Lee S, Wong WT, Wong ICK, Mak C, Mok NS, Liu T, Tse G. Ventricular Tachyarrhythmia Risk in Paediatric/Young vs. Adult Brugada Syndrome Patients: A Territory-Wide Study. Front Cardiovasc Med 2021; 8:671666. [PMID: 34179137 PMCID: PMC8225934 DOI: 10.3389/fcvm.2021.671666] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/18/2021] [Indexed: 12/22/2022] Open
Abstract
Introduction: Brugada syndrome (BrS) is a cardiac ion channelopathy with a higher prevalence in Asia compared to the Western populations. The present study compared the differences in clinical and electrocardiographic (ECG) presentation between paediatric/young (≤25 years old) and adult (>25 years) BrS patients. Method: This was a territory-wide retrospective cohort study of consecutive BrS patients presenting to public hospitals in Hong Kong. The primary outcome was spontaneous ventricular tachycardia/ventricular fibrillation (VT/VF). Results: The cohort consists of 550 consecutive patients (median age of initial presentation = 51 ± 23 years; female = 7.3%; follow-up period = 83 ± 80 months), divided into adult (n = 505, mean age of initial presentation = 52 ± 19 years; female = 6.7%; mean follow-up period = 83 ± 80 months) and paediatric/young subgroups (n = 45, mean age of initial presentation = 21 ± 5 years, female = 13.3%, mean follow-up period = 73 ± 83 months). The mean annual VT/VF incidence rate were 17 and 25 cases per 1,000 patient-year, respectively. Multivariate analysis showed that initial presentation of type 1 pattern (HR = 1.80, 95% CI = [1.02, 3.15], p = 0.041), initial asymptomatic presentation (HR = 0.26, 95% CI = [0.07, 0.94], p = 0.040) and increased P-wave axis (HR = 0.98, 95% CI = [0.96, 1.00], p = 0.036) were significant predictors of VT/VF for the adult subgroup. Only initial presentation of VT/VF was predictive (HR = 29.30, 95% CI = [1.75, 492.00], p = 0.019) in the paediatric/young subgroup. Conclusion: Clinical and ECG presentation of BrS vary between the paediatric/young and adult population in BrS. Risk stratification and management strategies for younger patients should take into consideration and adopt an individualised approach.
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Affiliation(s)
- Sharen Lee
- Cardiovascular Analytics Group, Laboratory of Cardiovascular Physiology, Hong Kong, China
| | - Wing Tak Wong
- State Key Laboratory of Agrobiotechnology (CUHK), School of Life Sciences, Chinese University of Hong Kong, Hong Kong, China
| | - Ian Chi Kei Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,School of Pharmacy, University College London, London, United Kingdom
| | - Chloe Mak
- Department of Pathology, Hong Kong Children's Hospital, Hong Kong, China
| | - Ngai Shing Mok
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China.,Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom.,Kent and Medway Medical School, Canterbury, United Kingdom
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11
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Wu TT, Yang DL, Li H, Guo YS. Development and validation of a nomogram to predict in-hospital cardiac arrest among patients admitted with acute coronary syndrome. Am J Emerg Med 2021; 49:240-248. [PMID: 34153931 DOI: 10.1016/j.ajem.2021.05.082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 05/25/2021] [Accepted: 05/29/2021] [Indexed: 12/22/2022] Open
Abstract
AIM This study aimed to develop and validate a nomogram to recognize in-hospital cardiac arrest (CA) in patients with acute coronary syndrome (ACS). METHODS This multicenter case-control study reviewed 164 ACS patients who had in-hospital CA and randomly selected 521 ACS patients with no CA experience. We randomly assigned 80% of the participants to a development cohort, 20% of those to an independent validation cohort. The least absolute shrinkage and selection operator (LASSO) regression model was used for data dimension reduction, and multivariable logistic regression analysis was used to develop the CA prediction nomogram. Nomogram performance was assessed with respect to discrimination, calibration, and clinical usefulness. RESULTS Seven parameters, including chest pain, Killip class, potassium, BNP, arrhythmia, platelet count, and NEWS, were used to create individualized CA prediction nomograms. The CA prediction nomogram showed good discrimination (C-index of 0.896, 95%CI, 0.865-0.927) and calibration. Application of the CA prediction nomogram in assessments of the validation cohort improved discrimination (C-index of 0.914, 95%CI, 0.873-0.967) and calibration. The results of decision curve analysis demonstrated that the CA prediction nomogram was clinically useful. CONCLUSION Our study generated a friendly risk score to recognize in-hospital CA with good discrimination and calibration. Further studies need to establish a pathway to guide the application of the risk score in clinical practice.
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Affiliation(s)
- Ting-Ting Wu
- The School of Nursing, Fujian Medical University, Fujian, China
| | - Dong-Liang Yang
- Department of General Education Courses, Cangzhou Medical College, Hebei, China
| | - Hong Li
- Department of Nursing, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian, China.
| | - Yan-Song Guo
- Department of Cardiovascular Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian, China
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12
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van Weperen VYH, Dunnink A, Bossu A, Beekman JDM, Meijborg VMF, de Bakker JMT, Coronel R, Varkevisser R, van der Heyden MAG, Vos MA. Severe Bradycardia Increases the Incidence and Severity of Torsade de Pointes Arrhythmias by Augmenting Preexistent Spatial Dispersion of Repolarization in the CAVB Dog Model. Front Physiol 2021; 12:642083. [PMID: 33981248 PMCID: PMC8110054 DOI: 10.3389/fphys.2021.642083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/17/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Torsade de pointes arrhythmias (TdP) in the chronic atrioventricular block (CAVB) dog model result from proarrhythmic factors, which trigger TdP and/or reinforce the arrhythmic substrate. This study investigated electrophysiological and arrhythmogenic consequences of severe bradycardia for TdP. METHODS Dofetilide (25 μg/kg per 5 min) was administered to eight anesthetized, idioventricular rhythm (IVR) remodeled CAVB dogs in two serial experiments: once under 60 beats per minute (bpm), right ventricular apex paced (RVA60) conditions, once under more bradycardic IVR conditions. Recordings included surface electrocardiogram and short-term variability (STV) of repolarization from endocardial unipolar electrograms. TdP inducibility (three or more episodes within 10 min after start of dofetilide) and arrhythmic activity scores (AS) were established. Mapping experiments in 10 additional dogs determined the effect of lowering rate on STV and spatial dispersion of repolarization (SDR) in baseline. RESULTS IVR-tested animals had longer baseline RR-interval (1,403 ± 271 ms) and repolarization intervals than RVA60 animals. Dofetilide increased STV similarly under both rhythm strategies. Nevertheless, TdP inducibility and AS were higher under IVR conditions (6/8 and 37 ± 27 vs. 1/8 and 8 ± 12 in RVA60, respectively, both p < 0.05). Mapping: Pacing from high (128 ± 10 bpm) to middle (88 ± 10 bpm) to experimental rate (61 ± 3 bpm) increased all electrophysiological parameters, including interventricular dispersion, due to steeper left ventricular restitution curves, and intraventricular SDR: maximal cubic dispersion from 60 ± 14 (high) to 69 ± 17 (middle) to 84 ± 22 ms (p < 0.05 vs. high and middle rate). CONCLUSION In CAVB dogs, severe bradycardia increases the probability and severity of arrhythmic events by heterogeneously causing electrophysiological instability, which is mainly reflected in an increased spatial, and to a lesser extent temporal, dispersion of repolarization.
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Affiliation(s)
| | - Albert Dunnink
- Department of Medical Physiology, Universitair Medisch Centrum Utrecht, Utrecht, Netherlands
| | - Alexandre Bossu
- Department of Medical Physiology, Universitair Medisch Centrum Utrecht, Utrecht, Netherlands
| | - Jet D. M. Beekman
- Department of Medical Physiology, Universitair Medisch Centrum Utrecht, Utrecht, Netherlands
| | - Veronique M. F. Meijborg
- Department of Clinical and Experimental Cardiology, Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
| | - Jacques M. T. de Bakker
- Department of Clinical and Experimental Cardiology, Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
| | - Ruben Coronel
- Department of Clinical and Experimental Cardiology, Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
| | - Rosanne Varkevisser
- Department of Medical Physiology, Universitair Medisch Centrum Utrecht, Utrecht, Netherlands
| | | | - Marc A. Vos
- Department of Medical Physiology, Universitair Medisch Centrum Utrecht, Utrecht, Netherlands
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Tian M, Xue J, Dai C, Jiang E, Zhu B, Pang H. CircSLC8A1 and circNFIX can be used as auxiliary diagnostic markers for sudden cardiac death caused by acute ischemic heart disease. Sci Rep 2021; 11:4695. [PMID: 33633191 PMCID: PMC7907149 DOI: 10.1038/s41598-021-84056-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 02/11/2021] [Indexed: 12/16/2022] Open
Abstract
Sudden cardiac death (SCD) caused by acute ischemic heart disease (IHD) is a major cause of sudden death worldwide. Circular RNAs (circRNAs) are abundant in the heart and play important roles in cardiovascular diseases, but the role of circRNAs as biomarkers in the forensic diagnosis of SCD caused by acute IHD remains poorly characterized. To investigate the potential of two heart-enriched circRNAs, circNFIX and circSLC8A1, we explored the expression of these two circRNAs in different kinds of commonly used IHD models, and further verified their expressions in forensic autopsy cases. The results from both the IHD rat and H9c2 cell models revealed that circSlc8a1 level was upregulated, while the circNfix level was elevated in the early stage of ischemia and subsequently downregulated. The time-dependent expression patterns of the two circRNAs suggested their potential as SCD biomarkers. In autopsy cases, the results showed that the expression of these two circRNAs in the myocardium with acute IHD-related SCDs corresponded to the observations in the ischemic models. Further analysis related to myocardial ischemia indicated that circSLC8A1 showed high sensitivity and specificity for myocardial infarction and was positively correlated with creatine kinase MB in pericardial fluid. Downregulated circNFIX level could indicate the ischemic myocardial damage, and it was negatively correlated with the coronary artery stenosis grade. The combination of circSLC8A1 and circNFIX had better performance to discriminate IHD-related SCDs. The results suggested that circSLC8A1 and circNFIX may be used as auxiliary diagnostic markers for SCD caused by acute IHD in forensic medicine.
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Affiliation(s)
- Meihui Tian
- Department of Forensic Genetics and Biology, School of Forensic Medicine, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, P.R. China
| | - Jiajia Xue
- Department of Forensic Pathology, School of Forensic Medicine, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, P.R. China
| | - Cuiyun Dai
- Department of Forensic Genetics and Biology, School of Forensic Medicine, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, P.R. China
| | - Enzhu Jiang
- Department of Forensic Genetics and Biology, School of Forensic Medicine, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, P.R. China
| | - Baoli Zhu
- Department of Forensic Pathology, School of Forensic Medicine, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, P.R. China
| | - Hao Pang
- Department of Forensic Genetics and Biology, School of Forensic Medicine, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, P.R. China.
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Circular RNAs in Sudden Cardiac Death Related Diseases: Novel Biomarker for Clinical and Forensic Diagnosis. Molecules 2021; 26:molecules26041155. [PMID: 33670057 PMCID: PMC7926443 DOI: 10.3390/molecules26041155] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 11/17/2022] Open
Abstract
The prevention and diagnosis of sudden cardiac death (SCD) are among the most important keystones and challenges in clinical and forensic practice. However, the diagnostic value of the current biomarkers remains unresolved issues. Therefore, novel diagnostic biomarkers are urgently required to identify patients with early-stage cardiovascular diseases (CVD), and to assist in the postmortem diagnosis of SCD cases without typical cardiac damage. An increasing number of studies show that circular RNAs (circRNAs) have stable expressions in myocardial tissue, and their time- and tissue-specific expression levels might reflect the pathophysiological status of the heart, which makes them potential CVD biomarkers. In this article, we briefly introduced the biogenesis and functional characteristics of circRNAs. Moreover, we described the roles of circRNAs in multiple SCD-related diseases, including coronary artery disease (CAD), myocardial ischemia or infarction, arrhythmia, cardiomyopathy, and myocarditis, and discussed the application prospects and challenges of circRNAs as a novel biomarker in the clinical and forensic diagnosis of SCD.
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15
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COVID-19, hydroxychloroquine and sudden cardiac death: implications for clinical practice in patients with rheumatic diseases. Rheumatol Int 2021; 41:257-273. [PMID: 33386447 PMCID: PMC7775739 DOI: 10.1007/s00296-020-04759-2] [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: 10/27/2020] [Accepted: 11/21/2020] [Indexed: 12/15/2022]
Abstract
Sudden cardiac death is commonly seen due to arrhythmias, which is a common cardiac manifestation seen in COVID-19 patients, especially those with underlying cardiovascular disease (CVD). Administration of hydroxychloroquine (HCQ) as a potential treatment option during SARS-CoV-2, initially gained popularity, but later, its safe usage became questionable due to its cardiovascular safety, largely stemming from instances of cardiac arrhythmias in COVID-19. Moreover, in the setting of rheumatic diseases, in which patients are usually on HCQ for their primary disease, there is a need to scale the merits and demerits of HCQ usage for the treatment of COVID-19. In this narrative review, we aim to address the association between usage of HCQ and sudden cardiac death in COVID-19 patients. MEDLINE, EMBASE, ClinicalTrials.gov and SCOPUS databases were used to review articles in English ranging from case reports, case series, letter to editors, systematic reviews, narrative reviews, observational studies and randomized control trials. HCQ is a potential cause of sudden cardiac death in COVID-19 patients. As opposed to the reduction in CVD with HCQ in treatment of systemic lupus erythematous, rheumatoid arthritis, and other rheumatic diseases, safe usage of HCQ in COVID-19 patients is unclear; whereby, it is observed to result in QTc prolongation and Torsades de pointes even in patients with no underlying cardiovascular comorbidity. This is occasionally associated with sudden cardiac death or cardiac arrest; hence, its clinical efficacy needs further investigation by large-scale clinical trials.
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Li J, Wang J, Shen Y, Dai C, Chen B, Huang Y, Xu S, Wu Y, Li Y. Hyperoxygenation With Cardiopulmonary Resuscitation and Targeted Temperature Management Improves Post-Cardiac Arrest Outcomes in Rats. J Am Heart Assoc 2020; 9:e016730. [PMID: 32964774 PMCID: PMC7792384 DOI: 10.1161/jaha.120.016730] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Oxygen plays a pivotal role in cardiopulmonary resuscitation (CPR) and postresuscitation intervention for cardiac arrest. However, the optimal method to reoxygenate patients has not been determined. This study investigated the effect of timing of hyperoxygenation on neurological outcomes in cardiac arrest/CPR rats treated with targeted temperature management. Methods and Results After induction of ventricular fibrillation, male Sprague-Dawley rats were randomized into 4 groups (n=16/group): (1) normoxic control; (2) O2_CPR, ventilated with 100% O2 during CPR; (3) O2_CPR+postresuscitation, ventilated with 100% O2 during CPR and the first 3 hours of postresuscitation; and (4) O2_postresuscitation, ventilated with 100% O2 during the first 3 hours of postresuscitation. Targeted temperature management was induced immediately after resuscitation and maintained for 3 hours in all animals. Postresuscitation hemodynamics, neurological recovery, and pathological analysis were assessed. Brain tissues of additional rats undergoing the same experimental procedure were harvested for ELISA-based quantification assays of oxidative stress-related biomarkers and compared with the sham-operated rats (n=6/group). We found that postresuscitation mean arterial pressure and quantitative electroencephalogram activity were significantly increased, whereas astroglial protein S100B, degenerated neurons, oxidative stress-related biomarkers, and neurologic deficit scores were significantly reduced in the O2_CPR+postresuscitation group compared with the normoxic control group. In addition, 96-hour survival rates were significantly improved in all of the hyperoxygenation groups. Conclusions In this cardiac arrest/CPR rat model, hyperoxygenation coupled with targeted temperature management attenuates ischemia/reperfusion-induced injuries and improves survival rates. The beneficial effects of high-concentration oxygen are timing and duration dependent. Hyperoxygenation commenced with CPR, which improves outcomes when administered during hypothermia.
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Affiliation(s)
- Jingru Li
- Department of Biomedical Engineering and Imaging Medicine Army Medical University Chongqing China
| | - Jianjie Wang
- Department of Biomedical Engineering and Imaging Medicine Army Medical University Chongqing China
| | - Yiming Shen
- Department of Emergency Chongqing Emergency Medical Center Chongqing China
| | - Chenxi Dai
- Department of Biomedical Engineering and Imaging Medicine Army Medical University Chongqing China
| | - Bihua Chen
- Department of Biomedical Engineering and Imaging Medicine Army Medical University Chongqing China
| | - Yuanyuan Huang
- Department of Neurology Southwest Hospital Army Medical University Chongqing China
| | - Senlin Xu
- Institute of Pathology and Southwest Cancer Center Southwest Hospital Army Medical University Chongqing China
| | - Yi Wu
- Department of Biomedical Engineering and Imaging Medicine Army Medical University Chongqing China
| | - Yongqin Li
- Department of Biomedical Engineering and Imaging Medicine Army Medical University Chongqing China
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17
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Chen PH, Tsai SY, Pan CH, Chang HM, Chen YL, Su SS, Chen CC, Kuo CJ. Incidence and risk factors of sudden cardiac death in bipolar disorder across the lifespan. J Affect Disord 2020; 274:210-217. [PMID: 32469806 DOI: 10.1016/j.jad.2020.05.094] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/04/2020] [Accepted: 05/15/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Data on the incidence and risk factors of sudden cardiac death in patients with bipolar disorder are lacking in the literature. METHODS By using data from the Taiwan National Health Insurance Research Database and Department of Health Death Certification System between 2000 and 2016, we conducted a prospective national cohort study to determine the incidence and risk factors of sudden cardiac death in bipolar disorder patients. The study cohort included 46,490 patients with bipolar disorder, 467 of whom experienced sudden cardiac death. RESULTS Stratified analyses showed that the standardized mortality ratios (SMRs) of sudden cardiac death were all above 1.00 across each age interval, with the highest SMR in patients aged <30 years (31.96, 95% CI: 20.47-47.55). Notably, hypertension raised the risk of sudden cardiac death in both patients aged <50 years (1.85, 95% CI: 1.23-2.79) and aged ≥50 years (1.44, 95% CI: 1.14-1.83). In addition, venous and lymphatic disorders (1.97, 95% CI: 1.23-3.16), and alcohol use-related disorder (2.34, 95% CI: 1.62-3.38) elevated the risk of sudden cardiac death in patients aged <50 years. Congestive heart failure (1.59, 95% CI: 1.13-2.23) and dementia (1.75, 95% CI: 1.30-2.35) increased the risk of sudden cardiac death in patients aged ≥50 years. CONCLUSIONS The risk of sudden cardiac death is remarkably high in bipolar disorder patients across the lifespan. Prevention strategies specific to individuals with bipolar disorder are urgently required.
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Affiliation(s)
- Pao-Huan Chen
- Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shang-Ying Tsai
- Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chun-Hung Pan
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Hu-Ming Chang
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Yi-Lung Chen
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Sheng-Siang Su
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Chiao-Chicy Chen
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan; Department of Psychiatry, Mackay Medical College, Taipei, Taiwan
| | - Chian-Jue Kuo
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.
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18
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Middour TG, Rosenthal TM, Abi‐Samra FM, Bernard ML, Khatib S, Polin GM, Rogers PA, Bober RM, Morin DP. Positron emission tomography absolute stress myocardial blood flow for risk stratification in nonischemic cardiomyopathy. J Cardiovasc Electrophysiol 2020; 31:1137-1146. [DOI: 10.1111/jce.14395] [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: 12/13/2019] [Revised: 02/01/2020] [Accepted: 02/06/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Thomas G. Middour
- Department of Cardiology, Division of ElectrophysiologyOchsner Medical Center New Orleans Louisiana
| | - Todd M. Rosenthal
- Department of Cardiology, Division of ElectrophysiologyOchsner Medical Center New Orleans Louisiana
| | - Freddy M. Abi‐Samra
- Department of Cardiology, Division of ElectrophysiologyOchsner Medical Center New Orleans Louisiana
| | - Michael L. Bernard
- Department of Cardiology, Division of ElectrophysiologyOchsner Medical Center New Orleans Louisiana
| | - Sammy Khatib
- Department of Cardiology, Division of ElectrophysiologyOchsner Medical Center New Orleans Louisiana
| | - Glenn M. Polin
- Department of Cardiology, Division of ElectrophysiologyOchsner Medical Center New Orleans Louisiana
| | - Paul A. Rogers
- Department of Cardiology, Division of ElectrophysiologyOchsner Medical Center New Orleans Louisiana
| | - Robert M. Bober
- Department of Cardiology, Division of ElectrophysiologyOchsner Medical Center New Orleans Louisiana
| | - Daniel P. Morin
- Department of Cardiology, Division of ElectrophysiologyOchsner Medical Center New Orleans Louisiana
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