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Verheul LM, Groeneveld SA, Stoks J, Hoeksema WF, Cluitmans MJM, Postema PG, Wilde AAM, Volders PGA, Hassink RJ. The Dutch Idiopathic Ventricular Fibrillation Registry: progress report on the quest to identify the unidentifiable. Neth Heart J 2024; 32:238-244. [PMID: 38653923 PMCID: PMC11143118 DOI: 10.1007/s12471-024-01870-y] [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] [Accepted: 02/26/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Idiopathic ventricular fibrillation (iVF) is a rare cause of sudden cardiac arrest and, by definition, a diagnosis of exclusion. Due to the rarity of the disease, previous and current studies are limited by their retrospective design and small patient numbers. Even though the incidence of iVF has declined owing to the identification of new disease entities, an important subgroup of patients remains. AIM To expand the existing Dutch iVF Registry into a large nationwide cohort of patients initially diagnosed with iVF, to reveal the underlying cause of iVF in these patients, and to improve arrhythmia management. METHODS The Dutch iVF Registry includes sudden cardiac arrest survivors with an initial diagnosis of iVF. Clinical data and outcomes are collected. Outcomes include subsequent detection of a diagnosis other than 'idiopathic', arrhythmia recurrence and death. Non-invasive electrocardiographic imaging is used to investigate electropathological substrates and triggers of VF. RESULTS To date, 432 patients have been included in the registry (median age at event 40 years (interquartile range 28-52)), 61% male. During a median follow-up of 6 (2-12) years, 38 patients (9%) received a diagnosis other than 'idiopathic'. Eleven iVF patients were characterised with electrocardiographic imaging. CONCLUSION The Dutch iVF Registry is currently the largest of its kind worldwide. In this heterogeneous population of index patients, we aim to identify common functional denominators associated with iVF. With the implementation of non-invasive electrocardiographic imaging and other diagnostic modalities (e.g. echocardiographic deformation, cardiac magnetic resonance), we advance the possibilities to reveal pro-fibrillatory substrates.
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Affiliation(s)
- Lisa M Verheul
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - Sanne A Groeneveld
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Job Stoks
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Wiert F Hoeksema
- Department of Cardiology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands
| | - Matthijs J M Cluitmans
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Pieter G Postema
- Department of Cardiology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands
| | - Arthur A M Wilde
- Department of Cardiology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands
| | - Paul G A Volders
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Rutger J Hassink
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
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Reisqs JB, Moreau A, Sleiman Y, Boutjdir M, Richard S, Chevalier P. Arrhythmogenic cardiomyopathy as a myogenic disease: highlights from cardiomyocytes derived from human induced pluripotent stem cells. Front Physiol 2023; 14:1191965. [PMID: 37250123 PMCID: PMC10210147 DOI: 10.3389/fphys.2023.1191965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/02/2023] [Indexed: 05/31/2023] Open
Abstract
Arrhythmogenic cardiomyopathy (ACM) is an inherited cardiomyopathy characterized by the replacement of myocardium by fibro-fatty infiltration and cardiomyocyte loss. ACM predisposes to a high risk for ventricular arrhythmias. ACM has initially been defined as a desmosomal disease because most of the known variants causing the disease concern genes encoding desmosomal proteins. Studying this pathology is complex, in particular because human samples are rare and, when available, reflect the most advanced stages of the disease. Usual cellular and animal models cannot reproduce all the hallmarks of human pathology. In the last decade, human-induced pluripotent stem cells (hiPSC) have been proposed as an innovative human cellular model. The differentiation of hiPSCs into cardiomyocytes (hiPSC-CM) is now well-controlled and widely used in many laboratories. This hiPSC-CM model recapitulates critical features of the pathology and enables a cardiomyocyte-centered comprehensive approach to the disease and the screening of anti-arrhythmic drugs (AAD) prescribed sometimes empirically to the patient. In this regard, this model provides unique opportunities to explore and develop new therapeutic approaches. The use of hiPSC-CMs will undoubtedly help the development of precision medicine to better cure patients suffering from ACM. This review aims to summarize the recent advances allowing the use of hiPSCs in the ACM context.
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Affiliation(s)
- J. B. Reisqs
- Cardiovascular Research Program, VA New York Harbor Healthcare System, Brooklyn, NY, United States
| | - A. Moreau
- Université de Montpellier, Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientifique, PhyMedExp, Montpellier, France
| | - Y. Sleiman
- Cardiovascular Research Program, VA New York Harbor Healthcare System, Brooklyn, NY, United States
| | - M. Boutjdir
- Cardiovascular Research Program, VA New York Harbor Healthcare System, Brooklyn, NY, United States
- Department of Medicine, Cell Biology and Pharmacology, State University of New York Downstate Health Sciences University, NY, United States
- Department of Medicine, New York University School of Medicine, NY, United States
| | - S. Richard
- Université de Montpellier, Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientifique, PhyMedExp, Montpellier, France
| | - P. Chevalier
- Neuromyogene Institute, Claude Bernard University, Lyon 1, Villeurbanne, France
- Service de Rythmologie, Hospices Civils de Lyon, Lyon, France
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State-of-the-Art Multimodality Imaging in Sudden Cardiac Arrest with Focus on Idiopathic Ventricular Fibrillation: A Review. J Clin Med 2022; 11:jcm11164680. [PMID: 36012918 PMCID: PMC9410297 DOI: 10.3390/jcm11164680] [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: 07/15/2022] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022] Open
Abstract
Idiopathic ventricular fibrillation is a rare cause of sudden cardiac arrest and a diagnosis by exclusion. Unraveling the mechanism of ventricular fibrillation is important for targeted management, and potentially for initiating family screening. Sudden cardiac arrest survivors undergo extensive clinical testing, with a growing role for multimodality imaging, before diagnosing “idiopathic” ventricular fibrillation. Multimodality imaging, considered as using multiple imaging modalities as diagnostics, is important for revealing structural myocardial abnormalities in patients with cardiac arrest. This review focuses on combining imaging modalities (echocardiography, cardiac magnetic resonance and computed tomography) and the electrocardiographic characterization of sudden cardiac arrest survivors and discusses the surplus value of multimodality imaging in the diagnostic routing of these patients. We focus on novel insights obtained through electrostructural and/or electromechanical imaging in apparently idiopathic ventricular fibrillation patients, with special attention to non-invasive electrocardiographic imaging.
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Chevalier P, Moreau A, Richard S, Janin A, Millat G, Bessière F, Delinière A. Short QT interval as a harbinger of an arrhythmogenic cardiomyopathy. HeartRhythm Case Rep 2021; 7:734-738. [PMID: 34820269 PMCID: PMC8602084 DOI: 10.1016/j.hrcr.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Philippe Chevalier
- Institut NeuroMyoGène - CNRS UMR 5310 - INSERM U1217 - Université de Lyon, Lyon, France.,Service de Rythmologie, Centre national de référence des troubles du rythme cardiaque d'origine héréditaire, Hôpital Cardiovasculaire et Pneumologique Louis Pradel, Hospices Civils de Lyon, Bron Cedex, France
| | - Adrien Moreau
- INSERM U1046, CNRS UMR9214, PhyMedExp, Université de Montpellier, Montpellier, France
| | - Sylvain Richard
- INSERM U1046, CNRS UMR9214, PhyMedExp, Université de Montpellier, Montpellier, France
| | - Alexandre Janin
- Laboratoire de Cardiogénétique Moléculaire, Centre de Biologie et Pathologie Est, Bron, France
| | - Gilles Millat
- Laboratoire de Cardiogénétique Moléculaire, Centre de Biologie et Pathologie Est, Bron, France
| | - Francis Bessière
- Service de Rythmologie, Centre national de référence des troubles du rythme cardiaque d'origine héréditaire, Hôpital Cardiovasculaire et Pneumologique Louis Pradel, Hospices Civils de Lyon, Bron Cedex, France
| | - Antoine Delinière
- Institut NeuroMyoGène - CNRS UMR 5310 - INSERM U1217 - Université de Lyon, Lyon, France.,Service de Rythmologie, Centre national de référence des troubles du rythme cardiaque d'origine héréditaire, Hôpital Cardiovasculaire et Pneumologique Louis Pradel, Hospices Civils de Lyon, Bron Cedex, France
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Groeneveld SA, van der Ree MH, Taha K, de Bruin-Bon RHA, Cramer MJ, Teske AJ, Bouma BJ, Amin AS, Wilde AAM, Postema PG, Hassink RJ. Echocardiographic deformation imaging unmasks global and regional mechanical dysfunction in patients with idiopathic ventricular fibrillation: A multicenter case-control study. Heart Rhythm 2021; 18:1666-1672. [PMID: 34058391 DOI: 10.1016/j.hrthm.2021.05.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/14/2021] [Accepted: 05/25/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Idiopathic ventricular fibrillation (IVF) is diagnosed in patients with sudden onset of ventricular fibrillation of unidentified origin. New diagnostic tools that can detect subtle abnormalities are needed to diagnose and treat patients with an underlying substrate. OBJECTIVE The purpose of this study was to explore echocardiographic deformation characteristics in IVF patients. METHODS Echocardiograms were analyzed with deformation imaging by 2-dimensional speckle tracking. Global and regional measurements of the left ventricle (LV) and right ventricle (RV) were performed. Regional LV deformation patterns were evaluated for the presence of postsystolic shortening. Regional RV deformation patterns were classified as type I (normal) or type II/III (abnormal). RESULTS In total, 47 IVF patients (mean age 45 years; left ventricular ejection fraction [LVEF] 56%) and 47 healthy controls (mean age 41 years; LVEF 60%) were included. IVF patients showed more global deformation abnormalities as indicated by lower LV global longitudinal strain (18.5% ± 2.6% vs 21.6% ± 1.8%; P <.001) and higher LV mechanical dispersion (41 ± 12 ms vs 26 ± 6 ms; P <.001). In addition, IVF patients showed more regional LV postsystolic shortening compared to healthy controls (50% vs 11%; P <.001). Abnormal RV deformation patterns were observed in 16% of IVF patients and in none of the control subjects (P <.001). CONCLUSION We were able to show both regional and global echocardiographic deformation abnormalities in IVF patients. This study provides evidence that localized myocardial disease is present in a subset of IVF patients.
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Affiliation(s)
- Sanne A Groeneveld
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Martijn H van der Ree
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Karim Taha
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rianne H A de Bruin-Bon
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Maarten J Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Arco J Teske
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Berto J Bouma
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Ahmad S Amin
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Arthur A M Wilde
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Pieter G Postema
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Rutger J Hassink
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
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Moreau A, Reisqs J, Delanoe‐Ayari H, Pierre M, Janin A, Deliniere A, Bessière F, Meli AC, Charrabi A, Lafont E, Valla C, Bauer D, Morel E, Gache V, Millat G, Nissan X, Faucherre A, Jopling C, Richard S, Mejat A, Chevalier P. Deciphering DSC2 arrhythmogenic cardiomyopathy electrical instability: From ion channels to ECG and tailored drug therapy. Clin Transl Med 2021; 11:e319. [PMID: 33784018 PMCID: PMC7908047 DOI: 10.1002/ctm2.319] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Severe ventricular rhythm disturbances are the hallmark of arrhythmogenic cardiomyopathy (ACM), and are often explained by structural conduction abnormalities. However, comprehensive investigations of ACM cell electrical instability are lacking. This study aimed to elucidate early electrical myogenic signature of ACM. METHODS We investigated a 41-year-old ACM patient with a missense mutation (c.394C>T) in the DSC2 gene, which encodes desmocollin 2. Pathogenicity of this variant was confirmed using a zebrafish DSC2 model system. Control and DSC2 patient-derived pluripotent stem cells were reprogrammed and differentiated into cardiomyocytes (hiPSC-CM) to examine the specific electromechanical phenotype and its modulation by antiarrhythmic drugs (AADs). Samples of the patient's heart and hiPSC-CM were examined to identify molecular and cellular alterations. RESULTS A shortened action potential duration was associated with reduced Ca2+ current density and increased K+ current density. This finding led to the elucidation of previously unknown abnormal repolarization dynamics in ACM patients. Moreover, the Ca2+ mobilised during transients was decreased, and the Ca2+ sparks frequency was increased. AAD testing revealed the following: (1) flecainide normalised Ca2+ transients and significantly decreased Ca2+ spark occurrence and (2) sotalol significantly lengthened the action potential and normalised the cells' contractile properties. CONCLUSIONS Thorough analysis of hiPSC-CM derived from the DSC2 patient revealed abnormal repolarization dynamics, prompting the discovery of a short QT interval in some ACM patients. Overall, these results confirm a myogenic origin of ACM electrical instability and provide a rationale for prescribing class 1 and 3 AADs in ACM patients with increased ventricular repolarization reserve.
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Affiliation(s)
- Adrien Moreau
- PhyMedExpINSERM U1046CNRS UMR9214Université de MontpellierMontpellierFrance
| | - Jean‐Baptiste Reisqs
- PhyMedExpINSERM U1046CNRS UMR9214Université de MontpellierMontpellierFrance
- Neuromyogene InstitutClaude Bernard University, Lyon 1VilleurbanneFrance
| | | | - Marion Pierre
- PhyMedExpINSERM U1046CNRS UMR9214Université de MontpellierMontpellierFrance
| | - Alexandre Janin
- Neuromyogene InstitutClaude Bernard University, Lyon 1VilleurbanneFrance
- Service de RythmologieHospices Civils de LyonLyonFrance
- Laboratoire de Cardiogénétique moléculaireCentre de biologie et pathologie EstBronFrance
| | | | | | - Albano C. Meli
- PhyMedExpINSERM U1046CNRS UMR9214Université de MontpellierMontpellierFrance
| | - Azzouz Charrabi
- PhyMedExpINSERM U1046CNRS UMR9214Université de MontpellierMontpellierFrance
| | - Estele Lafont
- Neuromyogene InstitutClaude Bernard University, Lyon 1VilleurbanneFrance
| | - Camille Valla
- Neuromyogene InstitutClaude Bernard University, Lyon 1VilleurbanneFrance
| | - Delphine Bauer
- Neuromyogene InstitutClaude Bernard University, Lyon 1VilleurbanneFrance
| | - Elodie Morel
- Neuromyogene InstitutClaude Bernard University, Lyon 1VilleurbanneFrance
| | - Vincent Gache
- Neuromyogene InstitutClaude Bernard University, Lyon 1VilleurbanneFrance
| | - Gilles Millat
- Neuromyogene InstitutClaude Bernard University, Lyon 1VilleurbanneFrance
- Service de RythmologieHospices Civils de LyonLyonFrance
- Laboratoire de Cardiogénétique moléculaireCentre de biologie et pathologie EstBronFrance
| | | | | | - Chris Jopling
- IGF, CNRS, INSERMUniversité de MontpellierMontpellierFrance
| | - Sylvain Richard
- PhyMedExpINSERM U1046CNRS UMR9214Université de MontpellierMontpellierFrance
| | - Alexandre Mejat
- Neuromyogene InstitutClaude Bernard University, Lyon 1VilleurbanneFrance
| | - Philippe Chevalier
- Neuromyogene InstitutClaude Bernard University, Lyon 1VilleurbanneFrance
- Service de RythmologieHospices Civils de LyonLyonFrance
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