1
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Lynch PT, Maloof A, Badjatiya A, Safavi-Naeini P, Segar MW, Kim JA, Marashly Q, Molina-Razavi JE, Simpson L, Oberton SB, Xie LX, Civitello A, Mathuria N, Cheng J, Rasekh A, Saeed M, Razavi M, Nair A, Chelu MG. Mortality in Recipients of Durable Left Ventricular Assist Devices Undergoing Ventricular Tachycardia Ablation. JACC Clin Electrophysiol 2024:S2405-500X(24)00457-2. [PMID: 39023485 DOI: 10.1016/j.jacep.2024.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 04/25/2024] [Accepted: 04/27/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Left ventricular assist device (LVAD) recipients have a higher incidence of ventricular tachycardia (VT). However, the role of VT ablation in this population is not well-established. OBJECTIVES This single-center retrospective cohort study sought to examine the impact of post-LVAD implant VT ablation on survival. METHODS This retrospective study examined a cohort of patients that underwent LVAD implantation at Baylor St. Luke's Medical Center and Texas Heart Institute between January 2011 and January 2021. All-cause estimated mortality was compared across LVAD recipients based on the incidence of VT, timing of VT onset, and the occurrence and timing of VT ablation utilizing Kaplan-Meier survival analysis and Cox proportional hazards models. RESULTS Post-implant VT occurred in 53% of 575 LVAD recipients. Higher mortality was seen among patients with post-implant VT within a year of implantation (HR: 1.62 [95% CI: 1.15-2.27]). Among this cohort, patients who were treated with a catheter ablation had superior survival compared with patients treated with medical therapy alone for the 45 months following VT onset (HR: 0.48 [95% CI: 0.26-0.89]). Moreover, performance of an ablation in this population aligned mortality rates with those who did not experience post-implant VT (HR: 1.18 [95% CI: 0.71-1.98]). CONCLUSIONS VT occurrence within 1 year of LVAD implantation was associated with worse survival. However, performance of VT ablation in this population was correlated with improved survival compared with medical management alone. Among patients with refractory VT, catheter ablation aligned survival with other LVAD participants without post-implant VT. Catheter ablation of VT is associated with improved survival in LVAD recipients, but further prospective randomized studies are needed to compare VT ablation to medical management in LVAD recipients.
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Affiliation(s)
- Patrick T Lynch
- Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA.
| | - Alexandra Maloof
- Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Anish Badjatiya
- Department of Medicine (Division of Cardiology), Baylor College of Medicine, Houston, Texas, USA
| | - Payam Safavi-Naeini
- Department of Medicine (Division of Cardiology), Baylor College of Medicine, Houston, Texas, USA
| | - Matthew W Segar
- Department of Medicine (Division of Cardiology), Baylor College of Medicine, Houston, Texas, USA; Texas Heart Institute, Houston, Texas, USA
| | - Jitae A Kim
- Division of Cardiovascular Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Qussay Marashly
- Department of Cardiology, Montefiore Medical Center, New York, New York, USA
| | - Joanna E Molina-Razavi
- Department of Medicine (Division of Cardiology), Baylor College of Medicine, Houston, Texas, USA; Texas Heart Institute, Houston, Texas, USA
| | - Leo Simpson
- Department of Medicine (Division of Cardiology), Baylor College of Medicine, Houston, Texas, USA; Texas Heart Institute, Houston, Texas, USA
| | - Selby B Oberton
- Department of Medicine (Division of Cardiology), Baylor College of Medicine, Houston, Texas, USA; Texas Heart Institute, Houston, Texas, USA
| | - Lola X Xie
- Department of Medicine (Division of Cardiology), Baylor College of Medicine, Houston, Texas, USA; Texas Heart Institute, Houston, Texas, USA
| | - Andrew Civitello
- Department of Medicine (Division of Cardiology), Baylor College of Medicine, Houston, Texas, USA; Texas Heart Institute, Houston, Texas, USA; Cardiovascular Research Institute, Baylor College of Medicine, Houston, Texas, USA
| | - Nilesh Mathuria
- Department of Medicine (Division of Cardiology), Baylor College of Medicine, Houston, Texas, USA
| | - Jie Cheng
- Department of Medicine (Division of Cardiology), Baylor College of Medicine, Houston, Texas, USA; Texas Heart Institute, Houston, Texas, USA
| | - Abdi Rasekh
- Department of Medicine (Division of Cardiology), Baylor College of Medicine, Houston, Texas, USA; Texas Heart Institute, Houston, Texas, USA; Cardiovascular Research Institute, Baylor College of Medicine, Houston, Texas, USA
| | - Mohammad Saeed
- Department of Medicine (Division of Cardiology), Baylor College of Medicine, Houston, Texas, USA; Texas Heart Institute, Houston, Texas, USA; Cardiovascular Research Institute, Baylor College of Medicine, Houston, Texas, USA
| | - Mehdi Razavi
- Department of Medicine (Division of Cardiology), Baylor College of Medicine, Houston, Texas, USA; Texas Heart Institute, Houston, Texas, USA; Cardiovascular Research Institute, Baylor College of Medicine, Houston, Texas, USA
| | - Ajith Nair
- Department of Medicine (Division of Cardiology), Baylor College of Medicine, Houston, Texas, USA; Texas Heart Institute, Houston, Texas, USA; Cardiovascular Research Institute, Baylor College of Medicine, Houston, Texas, USA
| | - Mihail G Chelu
- Department of Medicine (Division of Cardiology), Baylor College of Medicine, Houston, Texas, USA; Texas Heart Institute, Houston, Texas, USA; Cardiovascular Research Institute, Baylor College of Medicine, Houston, Texas, USA.
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2
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Soni B, Gopinathannair R. Managing ventricular arrhythmias and implantable cardiac defibrillator shocks after left ventricular assist device implantation. J Cardiovasc Electrophysiol 2024; 35:592-600. [PMID: 38013210 DOI: 10.1111/jce.16142] [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: 09/22/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023]
Abstract
Continuous flow left ventricular assist devices (CF-LVADs) have been shown to reduce mortality and morbidity in patients with advanced heart failure with reduced ejection fraction. However, ventricular arrhythmias (VA) are common, are mostly secondary to underlying myocardial scar, and have a higher incidence in patients with pre-LVAD VA. Sustained VA is well tolerated in the LVAD patient but can result in implantable defibrillator (ICD) shocks, right ventricular failure, hospitalizations, and reduced quality of life. There is limited data regarding best practices for the medical management of VA as well as the role for procedural interventions in patients with uncontrolled VA and/or ICD shocks. Vast majority of CF-LVAD patients have a preexisting cardiovascular implantable electronic device (CIED) and ICD and/or cardiac resynchronization therapies are continued in many. Several questions, however, remain regarding the efficacy of ICD and CRT following CF-LVAD. Moreover, optimal CIED programming after CF-LVAD implantation. Therefore, the primary objective of this review article is to provide the most up-to-date evidence and to provide guidance on the clinical significance, pathogenesis, predictors, and management strategies for VA and ICD therapies in the CF-LVAD population. We also discuss knowledge gaps as well as areas for future research.
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Affiliation(s)
- Bosky Soni
- Department of Medicine, University of Pittsburgh School of Medicine, Harrisburg, Pennsylvania, USA
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3
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Załucka L, Świerżyńska E, Orczykowski M, Dutkowski K, Szymański J, Kuriata J, Dąbrowski R, Kołsut P, Szumowski Ł, Sterliński M. Ventricular Arrhythmias in Left Ventricular Assist Device Patients-Current Diagnostic and Therapeutic Considerations. SENSORS (BASEL, SWITZERLAND) 2024; 24:1124. [PMID: 38400282 PMCID: PMC10893394 DOI: 10.3390/s24041124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/18/2024] [Accepted: 01/28/2024] [Indexed: 02/25/2024]
Abstract
Left ventricular assist devices (LVAD) are used in the treatment of advanced left ventricular heart failure. LVAD can serve as a bridge to orthotopic heart transplantation or as a destination therapy in cases where orthotopic heart transplantation is contraindicated. Ventricular arrhythmias are frequently observed in patients with LVAD. This problem is further compounded as a result of diagnostic difficulties arising from presently available electrocardiographic methods. Due to artifacts from LVAD-generated electromagnetic fields, it can be challenging to assess the origin of arrhythmias in standard ECG tracings. In this article, we will review and discuss common mechanisms, diagnostics methods, and therapeutic strategies for ventricular arrhythmia treatment, as well as numerous problems we face in LVAD implant patients.
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Affiliation(s)
- Laura Załucka
- Department of Cardiac Surgery and Transplantology, National Institute of Cardiology, 42 Alpejska Street, 04-628 Warsaw, Poland; (L.Z.); (J.S.); (P.K.)
| | - Ewa Świerżyńska
- 1st Department of Arrhythmia, National Institute of Cardiology, 42 Alpejska Street, 04-628 Warsaw, Poland
- Doctoral School, Medical University of Warsaw, 61 Zwirki I Wigury Street, 02-091 Warsaw, Poland
| | - Michał Orczykowski
- 1st Department of Arrhythmia, National Institute of Cardiology, 42 Alpejska Street, 04-628 Warsaw, Poland
| | - Krzysztof Dutkowski
- Department of Cardiac Surgery and Transplantology, National Institute of Cardiology, 42 Alpejska Street, 04-628 Warsaw, Poland; (L.Z.); (J.S.); (P.K.)
| | - Jarosław Szymański
- Department of Cardiac Surgery and Transplantology, National Institute of Cardiology, 42 Alpejska Street, 04-628 Warsaw, Poland; (L.Z.); (J.S.); (P.K.)
| | - Jarosław Kuriata
- Department of Cardiac Surgery and Transplantology, National Institute of Cardiology, 42 Alpejska Street, 04-628 Warsaw, Poland; (L.Z.); (J.S.); (P.K.)
| | - Rafał Dąbrowski
- Department of Coronary Artery Disease and Cardiac Rehabilitation, National Institute of Cardiology, 42 Alpejska Street, 04-628 Warsaw, Poland
| | - Piotr Kołsut
- Department of Cardiac Surgery and Transplantology, National Institute of Cardiology, 42 Alpejska Street, 04-628 Warsaw, Poland; (L.Z.); (J.S.); (P.K.)
| | - Łukasz Szumowski
- 1st Department of Arrhythmia, National Institute of Cardiology, 42 Alpejska Street, 04-628 Warsaw, Poland
| | - Maciej Sterliński
- 1st Department of Arrhythmia, National Institute of Cardiology, 42 Alpejska Street, 04-628 Warsaw, Poland
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4
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Benali K, Lloyd MS, Petrosyan A, Rigal L, Quivrin M, Bessieres I, Vlachos K, Hammache N, Bellec J, Simon A, Laurent G, Higgins K, Garnier F, de Crevoisier R, Martins R, Da Costa A, Guenancia C. Cardiac stereotactic radiation therapy for refractory ventricular arrhythmias in patients with left ventricular assist devices. J Cardiovasc Electrophysiol 2024; 35:206-213. [PMID: 38018417 DOI: 10.1111/jce.16139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 11/30/2023]
Abstract
Left ventricular assist device (LVAD) implantation is an established treatment for patients with advanced heart failure refractory to medical therapy. However, the incidence of ventricular arrhythmias (VAs) is high in this population, both in the acute and delayed phases after implantation. About one-third of patients implanted with an LVAD will experience sustained VAs, predisposing these patients to worse outcomes and complicating patient management. The combination of pre-existing myocardial substrate and complex electrical remodeling after LVAD implantation account for the high incidence of VAs observed in this population. LVAD patients presenting VAs refractory to antiarrhythmic therapy and catheter ablation procedures are not rare. In such patients, treatment options are extremely limited. Stereotactic body radiation therapy (SBRT) is a technique that delivers precise and high doses of radiation to highly defined targets, reducing exposure to adjacent normal tissue. Cardiac SBRT has recently emerged as a promising alternative with a growing number of case series reporting the effectiveness of the technique in reducing the VA burden in patients with arrhythmias refractory to conventional therapies. The safety profile of cardiac SBRT also appears favorable, even though the current clinical experience remains limited. The use of cardiac SBRT for the treatment of refractory VAs in patients implanted with an LVAD are even more scarce. This review summarizes the clinical experience of cardiac SBRT in LVAD patients and describes technical considerations related to the implementation of the SBRT procedure in the presence of an LVAD.
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Affiliation(s)
- Karim Benali
- Department of Cardiac Electrophysiology, Saint-Etienne University Hospital Center, Saint-Etienne, France
- Department of Signal Analysis, IHU LIRYC, Electrophysiology and Heart Modelling Institute, Bordeaux University, Bordeaux, France
- LTSI-UMR 1099, Rennes, France
| | - Michael S Lloyd
- Department of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Andranik Petrosyan
- Department of Cardiac Surgery, Saint-Etienne University Hospital Center, Saint-Etienne, France
| | - Louis Rigal
- Department of Signal Analysis, IHU LIRYC, Electrophysiology and Heart Modelling Institute, Bordeaux University, Bordeaux, France
| | - Magali Quivrin
- Department of Radiation Oncology, Centre Georges Francois Leclerc, Dijon, France
| | - Igor Bessieres
- Department of Radiation Oncology, Centre Georges Francois Leclerc, Dijon, France
| | | | - Nefissa Hammache
- Department of Cardiac Electrophysiology, Nancy University Hospital Center, Nancy, France
| | - Julien Bellec
- Department of Radiation Oncology, Centre Eugene Marquis, Rennes, France
| | - Antoine Simon
- Department of Signal Analysis, IHU LIRYC, Electrophysiology and Heart Modelling Institute, Bordeaux University, Bordeaux, France
| | - Gabriel Laurent
- Department of Cardiac Electrophysiology, Dijon University Hospital Center, Dijon, France
| | - Kristin Higgins
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Fabien Garnier
- Department of Cardiac Electrophysiology, Dijon University Hospital Center, Dijon, France
| | | | - Raphaël Martins
- Department of Signal Analysis, IHU LIRYC, Electrophysiology and Heart Modelling Institute, Bordeaux University, Bordeaux, France
- Department of Cardiac Electrophysiology, Rennes University Hospital Center, Rennes, France
| | - Antoine Da Costa
- Department of Cardiac Electrophysiology, Saint-Etienne University Hospital Center, Saint-Etienne, France
| | - Charles Guenancia
- Department of Radiation Oncology, Centre Eugene Marquis, Rennes, France
- PEC 2 EA 7460, University of Burgundy and Franche-Comté, Dijon, France
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5
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Huang DT, Gosev I, Wood KL, Vidula H, Stevenson W, Marchlinski F, Supple G, Zalawadiya SK, Weiss JP, Tung R, Tzou WS, Moss JD, Kancharla K, Chaudhry S, Patel PJ, Khan AM, Schuger C, Rozen G, Kiernan MS, Couper GS, Leacche M, Molina EJ, Shah AD, Lloyd M, Sroubek J, Soltesz E, Shivkumar K, White C, Tankut S, Johnson BA, McNitt S, Kutyifa V, Zareba W, Goldenberg I. Design and characteristics of the prophylactic intra-operative ventricular arrhythmia ablation in high-risk LVAD candidates (PIVATAL) trial. Ann Noninvasive Electrocardiol 2023; 28:e13073. [PMID: 37515396 PMCID: PMC10475893 DOI: 10.1111/anec.13073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/25/2023] [Accepted: 06/27/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The use of a Left Ventricular Assist Device (LVAD) in patients with advanced heart failure refractory to optimal medical management has progressed steadily over the past two decades. Data have demonstrated reduced LVAD efficacy, worse clinical outcome, and higher mortality for patients who experience significant ventricular tachyarrhythmia (VTA). We hypothesize that a novel prophylactic intra-operative VTA ablation protocol at the time of LVAD implantation may reduce the recurrent VTA and adverse events postimplant. METHODS We designed a prospective, multicenter, open-label, randomized-controlled clinical trial enrolling 100 patients who are LVAD candidates with a history of VTA in the previous 5 years. Enrolled patients will be randomized in a 1:1 fashion to intra-operative VTA ablation (n = 50) versus conventional medical management (n = 50) with LVAD implant. Arrhythmia outcomes data will be captured by an implantable cardioverter defibrillator (ICD) to monitor VTA events, with a uniform ICD programming protocol. Patients will be followed prospectively over a mean of 18 months (with a minimum of 9 months) after LVAD implantation to evaluate recurrent VTA, adverse events, and procedural outcomes. Secondary endpoints include right heart function/hemodynamics, healthcare utilization, and quality of life. CONCLUSION The primary aim of this first-ever randomized trial is to assess the efficacy of intra-operative ablation during LVAD surgery in reducing VTA recurrence and improving clinical outcomes for patients with a history of VTA.
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Affiliation(s)
- David T. Huang
- Division of CardiologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Igor Gosev
- Division of Cardiothoracic SurgeryUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Katherine L. Wood
- Division of Cardiothoracic SurgeryUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Hima Vidula
- Division of CardiologyUniversity of Pennsylvania Medical CenterPhiladelphiaPennsylvaniaUSA
| | - William Stevenson
- Division of Cardiovascular MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Frank Marchlinski
- Division of CardiologyUniversity of Pennsylvania Medical CenterPhiladelphiaPennsylvaniaUSA
| | - Gregory Supple
- Division of CardiologyUniversity of Pennsylvania Medical CenterPhiladelphiaPennsylvaniaUSA
| | - Sandip K. Zalawadiya
- Division of Cardiovascular MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - J. Peter Weiss
- The University of Arizona College of Medicine‐Phoenix, Banner University Medical CenterPhoenixArizonaUSA
| | - Roderick Tung
- The University of Arizona College of Medicine‐Phoenix, Banner University Medical CenterPhoenixArizonaUSA
| | - Wendy S. Tzou
- Division of CardiologyUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Joshua D. Moss
- Division of CardiologyUniversity of California‐San FranciscoSan FranciscoCaliforniaUSA
| | - Krishna Kancharla
- Department of MedicineHeart and Vascular Institute, University of Pittsburgh Medical Center and School of MedicinePittsburghPennsylvaniaUSA
| | - Sunit‐Preet Chaudhry
- Division of CardiologyAscension St. Vincent Heart CenterIndianapolisIndianaUSA
- Ascension St. Vincent Cardiovascular Research InstituteIndianapolisIndianaUSA
| | - Parin J. Patel
- Division of CardiologyAscension St. Vincent Heart CenterIndianapolisIndianaUSA
- Ascension St. Vincent Cardiovascular Research InstituteIndianapolisIndianaUSA
| | - Arfaat M. Khan
- Henry Ford Heart and Vascular Institute, Henry Ford HospitalDetroitMichiganUSA
| | - Claudio Schuger
- Henry Ford Heart and Vascular Institute, Henry Ford HospitalDetroitMichiganUSA
| | - Guy Rozen
- Cardiovascular Center, Tufts Medical CenterBostonMassachusettsUSA
| | | | | | - Marzia Leacche
- Department of Cardiothoracic SurgerySpectrum HealthGrand RapidsMichiganUSA
| | - Ezequiel J. Molina
- Department of Cardiothoracic SurgeryPiedmont Heart InstituteAtlantaGeorgiaUSA
| | - Anand D. Shah
- Section of Cardiac ElectrophysiologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Michael Lloyd
- Section of Cardiac ElectrophysiologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Jakub Sroubek
- Heart Vascular and Thoracic Institute, Cleveland ClinicClevelandOhioUSA
| | - Edward Soltesz
- Department of Thoracic and Cardiovascular SurgeryCleveland ClinicClevelandOhioUSA
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Casey White
- Division of CardiologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Sinan Tankut
- Division of CardiologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Brent A. Johnson
- Department of Biostatistics and Computational BiologyUniversity of RochesterRochesterNew YorkUSA
| | - Scott McNitt
- Clinical Cardiovascular Research CenterUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Valentina Kutyifa
- Clinical Cardiovascular Research CenterUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Wojciech Zareba
- Clinical Cardiovascular Research CenterUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Ilan Goldenberg
- Clinical Cardiovascular Research CenterUniversity of Rochester Medical CenterRochesterNew YorkUSA
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6
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Wang R, Mainville DJ, Vacaru A, Pasca I. Iatrogenic Hypoxemia and Atrial Septal Defect Due to Electrical Storm Ablation After Left Ventricular Assist Device: A Case Report. Cureus 2023; 15:e39418. [PMID: 37362482 PMCID: PMC10287845 DOI: 10.7759/cureus.39418] [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] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
A 59-year-old male with an implantable cardiac defibrillator, left ventricular assist device, and refractory ventricular tachycardia presented with hypoxemia due to a post-ablation iatrogenic atrial septal defect. Left ventricular assist devices generate pressure gradients that may exacerbate intracardiac shunts and can precipitate significant hypoxemia.
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Affiliation(s)
- Ryan Wang
- Anesthesiology, Loma Linda University Health, Loma Linda, USA
| | - Darcy J Mainville
- Critical Care Medicine, Loma Linda University Health, Loma Linda, USA
| | | | - Ioana Pasca
- Anesthesiology, Riverside University Health System, Moreno Valley, USA
- Critical Care Medicine, Loma Linda University Health, Loma Linda, USA
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7
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Nof E, Peichl P, Stojadinovic P, Arceluz M, Maury P, Katz M, Tedrow UB, Singh RM, Narui R, John RM, Stevenson WG, Beinart R, Grupper A, Sternik L, Lavee J, Sacher F, Kautzner J, Sabbag A. HeartMate 3: new challenges in ventricular tachycardia ablation. Europace 2021; 24:598-605. [PMID: 34791165 DOI: 10.1093/europace/euab272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 10/27/2021] [Indexed: 11/14/2022] Open
Abstract
AIM To describe clinical characteristics, procedural details, specific challenges, and outcomes in patients with HeartMate3™ (HM3), a left ventricular assist device system with a magnetically levitated pump, undergoing ventricular tachycardia ablation (VTA). METHODS AND RESULTS Data were collected from patients with an HM3 system who underwent VTA in seven tertiary centres. Data included baseline patient characteristics, procedural data, mortality, and arrhythmia-free survival. The study cohort included 19 patients with cardiomyopathy presenting with ventricular tachycardia (VT) (53% with VT storm). Ventricular tachycardias were induced in 89% of patients and a total of 41 VTs were observed. Severe electromagnetic interference was present on the surface electrocardiogram. Hence, VT localization required analysis of intra-cardiac signals or the use of filter in the 40-20 Hz range. The large house pump HM3 design obscured the cannula inflow and therefore multi imaging modalities were necessary to avoid catheter entrapment in the cannula. A total of 32 VTs were mapped and were successfully ablated (31% to the anterior wall, 38% to the septum and only 9% to the inflow cannula region). Non-inducibility of any VT was reached in 11 patients (58%). Over a follow-up of 429 (interquartile range 101-692) days, 5 (26%) patients underwent a redo VT ablation due to recurrent VTA and 2 (11%) patients died. CONCLUSIONS Ventricular tachycardia ablation in patients with HM3 is feasible and safe when done in the appropriate setup. Long-term arrhythmia-free survival is acceptable but not well predicted by non-inducibility at the end of the procedure.
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Affiliation(s)
- Eyal Nof
- Davidai Arrhythmia Center, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Petr Peichl
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Predrag Stojadinovic
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Martin Arceluz
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Philippe Maury
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Moshe Katz
- Davidai Arrhythmia Center, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Usha B Tedrow
- Cardiovascular Division, Brigham and Women's Hospital, 75, Boston, MA, USA
| | - Robin M Singh
- Cardiovascular Division, Brigham and Women's Hospital, 75, Boston, MA, USA
| | - Ryohsuke Narui
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Roy M John
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - William G Stevenson
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Roy Beinart
- Davidai Arrhythmia Center, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avishay Grupper
- Davidai Arrhythmia Center, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Leonid Sternik
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Cardiac Surgery, Sheba Medical Center, Ramat Gan, Israel
| | - Jacob Lavee
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Cardiac Surgery, Sheba Medical Center, Ramat Gan, Israel
| | - Frédéric Sacher
- LIRYC Institute, Bordeaux University Hospital, Pessac, France; Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital, Pessac, France
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Avi Sabbag
- Davidai Arrhythmia Center, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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8
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Sisti N, Santoro A, Carreras G, Valente S, Donzelli S, Mandoli GE, Sciaccaluga C, Cameli M. Ablation therapy for ventricular arrhythmias in patients with LVAD: Multiple faces of an electrophysiological challenge. J Arrhythm 2021; 37:535-543. [PMID: 34141004 PMCID: PMC8207352 DOI: 10.1002/joa3.12542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 03/12/2021] [Accepted: 04/04/2021] [Indexed: 12/15/2022] Open
Abstract
Left ventricular assist device implantation is a recognized treatment option for patients with advanced heart failure refractory to medical therapy and can be used both as bridge to transplantation and as destination therapy. The risk of ventricular arrhythmias is common after left ventricular assist device implantation and is influenced by pre-, peri and post-operative determinants. The management of ventricular arrhythmias can be a challenge when they become refractory to medication or to device therapy and their impact on prognosis can be detrimental despite the mechanical support. In this setting, catheter ablation is being increasingly recognized as a feasible option for patients in which standard therapeutic strategies fail, but also with preventive purpose. Catheter ablation is being increasingly considered for the management of ventricular arrhythmias in patients with left ventricular assist device despite complex clinical and technical peculiarities due to the characteristics of the mechanical support. Much conflicting data exist regarding the predictors of success of the procedure and the rate of recurrence. In this review we discuss the latest evidences regarding catheter ablation of ventricular arrhythmias in this subset of patients, focusing on clinical characteristics, arrhythmia etiology, technical aspects and postprocedural features which must be considered by the electrophysiologist.
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Affiliation(s)
- Nicolò Sisti
- Department of Cardiovascular DiseasesUniversity of SienaSienaItaly
| | - Amato Santoro
- Department of Cardiovascular DiseasesUniversity of SienaSienaItaly
| | | | - Serafina Valente
- Department of Cardiovascular DiseasesUniversity of SienaSienaItaly
| | | | | | | | - Matteo Cameli
- Department of Cardiovascular DiseasesUniversity of SienaSienaItaly
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9
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Grinstein J, Garan AR, Oesterle A, Fried J, Imamura T, Mai X, Kalantari S, Sayer G, Kim GH, Sarswat N, Raikhelkar J, Adatya S, Jeevanandam V, Flatley E, Moss J, Uriel N. Increased Rate of Pump Thrombosis and Cardioembolic Events Following Ventricular Tachycardia Ablation in Patients Supported With Left Ventricular Assist Devices. ASAIO J 2021; 66:1127-1136. [PMID: 33136600 PMCID: PMC10024475 DOI: 10.1097/mat.0000000000001155] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Ventricular arrhythmias are common following left ventricular assist device implantation (LVAD), and the effects of ventricular tachycardia (VT) ablation on thrombosis and embolic events are unknown. We aimed to assess LVAD thrombosis, stroke, and embolic event rates after VT ablation. Left ventricular assist device implantation patients from two academic centers who underwent endocardial VT ablation between 2009 and 2016 were compared to a control group with VT who were not ablated and followed for one year. The primary composite outcome was confirmed or suspected LVAD thrombosis, stroke, or other embolic event. Survival analysis was conducted with Kaplan-Meier curves, log-rank tests, and Cox regression. Forty-three LVAD patients underwent VT ablation, and 73 LVAD patients had VT but were not ablated. Patients who were ablated were more likely have VT prior to LVAD (p = 0.04), monomorphic VT (p < 0.01), and to be on antiarrhythmics (p < 0.01). Fifty-eight percent of the patients in the ablation group experienced the primary composite outcome (11% had confirmed device thrombosis [DT], 41% suspected DT, 39% had a stroke or embolic event) compared to 30% in the control group (12% with confirmed DT, 11% with suspected DT, 14% with stroke or embolic event) (p = 0.002). In multivariable regression, ablation was an independent predictor of the primary composite outcome (hazard ratios, 2.24; 95% confidence interval, 1.09-4.61; p = 0.03). Patients with LVADs referred for endocardial VT ablation had elevated rates of DT and embolic events.
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Affiliation(s)
| | | | | | - Justin Fried
- Division of Cardiology, Columbia University, New York, NY
| | | | - Xingchen Mai
- Division of Cardiology, Columbia University, New York, NY
| | - Sara Kalantari
- Department of Medicine, University of Chicago, Chicago, IL
| | - Gabriel Sayer
- Division of Cardiology, Columbia University, New York, NY
| | - Gene H. Kim
- Department of Medicine, University of Chicago, Chicago, IL
| | | | | | - Sirtaz Adatya
- Kaiser Permanente Advanced Heart Failure, Santa Clara, CA
| | - Valluvan Jeevanandam
- Department of Surgery, University of Chicago Medical Center, University of Chicago, Chicago, IL
| | - Erin Flatley
- Division of Cardiology, University of California San Francisco, San Francisco, CA
| | - Joshua Moss
- Division of Cardiology, University of California San Francisco, San Francisco, CA
| | - Nir Uriel
- Division of Cardiology, Columbia University, New York, NY
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10
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Sáenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Europace 2020; 21:1143-1144. [PMID: 31075787 DOI: 10.1093/europace/euz132] [Citation(s) in RCA: 220] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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11
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Bella PD, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. J Interv Card Electrophysiol 2020; 59:145-298. [PMID: 31984466 PMCID: PMC7223859 DOI: 10.1007/s10840-019-00663-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, IN, USA
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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12
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Pal JD, Cleveland J, Reece BT, Byrd J, Pierce CN, Brieke A, Cornwell WK. Cardiac Emergencies in Patients with Left Ventricular Assist Devices. Heart Fail Clin 2020; 16:295-303. [PMID: 32503753 DOI: 10.1016/j.hfc.2020.02.003] [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] [Indexed: 11/20/2022]
Abstract
Continuous-flow left ventricular assist devices are frequently used for management of patients with advanced heart failure with reduced ejection fraction. Although technologic advancements have contributed to improved outcomes, several complications arise over time. These complications result from several factors, including medication effects, physiologic responses to chronic exposure to circulatory support that is minimally/entirely nonpulsatile, and dysfunction of the device itself. Clinical presentation can range from chronic and indolent to acute, life-threatening emergencies. Several areas of uncertainty exist regarding best practices for managing complications; however, growing awareness has led to development of new guidelines to reduce risk and improve outcomes.
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Affiliation(s)
- Jay D Pal
- Department of Medicine-Cardiology, University of Colorado Anschutz Medical Campus, 12631 East 17th Avenue, B130, Office 7107, Aurora, CO 80045, USA
| | - Joseph Cleveland
- Department of Medicine-Cardiology, University of Colorado Anschutz Medical Campus, 12631 East 17th Avenue, B130, Office 7107, Aurora, CO 80045, USA
| | - Brett T Reece
- Department of Medicine-Cardiology, University of Colorado Anschutz Medical Campus, 12631 East 17th Avenue, B130, Office 7107, Aurora, CO 80045, USA
| | - Jessica Byrd
- Department of Medicine-Cardiology, University of Colorado Anschutz Medical Campus, 12631 East 17th Avenue, B130, Office 7107, Aurora, CO 80045, USA
| | - Christopher N Pierce
- Department of Medicine-Cardiology, University of Colorado Anschutz Medical Campus, 12631 East 17th Avenue, B130, Office 7107, Aurora, CO 80045, USA
| | - Andreas Brieke
- Department of Medicine-Cardiology, University of Colorado Anschutz Medical Campus, 12631 East 17th Avenue, B130, Office 7107, Aurora, CO 80045, USA
| | - William K Cornwell
- Department of Medicine-Cardiology, University of Colorado Anschutz Medical Campus, 12631 East 17th Avenue, B130, Office 7107, Aurora, CO 80045, USA.
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13
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Santangeli P, Marchlinski FE. Ablation Therapy for Refractory Ventricular Arrhythmias. Annu Rev Med 2020; 71:177-190. [PMID: 31747356 DOI: 10.1146/annurev-med-041818-020033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Recurrent ventricular arrhythmias (VAs) are a leading cause of cardiovascular morbidity and mortality. In the last three decades, important advancements have occurred in the understanding of the mechanisms of recurrent VAs, their prognostic implications in different clinical contexts, and their treatment options. VAs occur in structurally normal hearts as well as in patients with underlying heart disease, but the latter group has a particularly high risk of recurrent VAs. Catheter ablation offers the possibility of cure for a substantial proportion of patients. Research has focused on identifying optimal targets for ablation, correlating the underlying structural abnormalities with the site of origin of VAs, and determining the optimal procedural approach. Ablation therapy can be life-saving in select patients with high burden of repetitive VAs or advanced heart failure syndromes. This article focuses on clinical aspects of catheter ablation of VAs, particularly the selection and clinical management of patients undergoing catheter ablation procedures and expected outcomes.
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Affiliation(s)
- Pasquale Santangeli
- Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA; ,
| | - Francis E Marchlinski
- Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA; ,
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14
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Ahmed A, Amin M, Boilson BA, Killu AM, Madhavan M. Ventricular Arrhythmias in Patients With Left Ventricular Assist Device (LVAD). CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:75. [PMID: 31773322 DOI: 10.1007/s11936-019-0783-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Left ventricular assist device (LVAD) implantation is a well-known treatment option for patients with advanced heart failure refractory to medical therapy and is recognized both as bridge to transplant and a destination therapy. The risk of ventricular arrhythmias (VAs) is common after LVAD implantation. We review the pathophysiology and recent advances in the management of VA in LVAD patients. RECENT FINDINGS VAs are most likely to occur in the early post-operative periods after LVAD implantation and a prior history of VA is the most important risk factor. Post-LVAD VAs are usually well tolerated with less morbidity and decreased risk of sudden cardiac death. However, risk of right heart failure in the setting of persistent VAs is being increasingly recognized. The mechanisms of post-LVAD VAs may vary depending on the time from LVAD implantation. Electrical remodeling may play an important role in the immediate post-implant phase. Preexisting myocardial scar and to a lesser extent mechanical irritation from the LVAD cannula are important in the later phases. Most LVAD patients have a previously placed implantable cardioverter-defibrillator (ICD). The benefit of implanting a new ICD in LVAD patients is unknown and should be individualized. For ICD programming, a conservative strategy with higher detection zones and prolonged time to detection is usually recommended aiming to minimize ICD shocks. More aggressive programming is appropriate if the VA results in hemodynamic instability. Antiarrhythmic drugs including amiodarone, mexiletine, and beta blockers are usually the first-line therapy for VAs. Catheter ablation has been shown to be safe and effective in LVAD recipients with recurrent VAs not responsive to antiarrhythmic drugs. LVAD-related VA is most frequently reentrant secondary to myocardial scar and usually well tolerated. Management options include antiarrhythmic drugs and catheter ablation.
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Affiliation(s)
- Azza Ahmed
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Mustapha Amin
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Barry A Boilson
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Ammar M Killu
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Malini Madhavan
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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15
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Alvarez CK, Cronin E, Baker WL, Kluger J. Heart failure as a substrate and trigger for ventricular tachycardia. J Interv Card Electrophysiol 2019; 56:229-247. [PMID: 31598875 DOI: 10.1007/s10840-019-00623-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 09/06/2019] [Indexed: 02/06/2023]
Abstract
Heart failure (HF) is a major cause of morbidity and mortality with more than 5.1 million individuals affected in the USA. Ventricular tachyarrhythmias (VAs) including ventricular tachycardia and ventricular fibrillation are common in patients with heart failure. The pathophysiology of these mechanisms as well as the contribution of heart failure to the genesis of these arrhythmias is complex and multifaceted. Myocardial hypertrophy and stretch with increased preload and afterload lead to shortening of the action potential at early repolarization and lengthening of the action potential at final repolarization which can result in re-entrant ventricular tachycardia. Myocardial fibrosis and scar can create the substrate for re-entrant ventricular tachycardia. Altered calcium handling in the failing heart can lead to the development of proarrhythmic early and delayed after depolarizations. Various medications used in the treatment of HF such as loop diuretics and angiotensin converting enzyme inhibitors have not demonstrated a reduction in sudden cardiac death (SCD); however, beta-blockers (BB) are effective in reducing mortality and SCD. Amongst patients who have HF with reduced ejection fraction, the angiotensin receptor-neprilysin inhibitor (sacubitril/valsartan) has been shown to reduce cardiovascular mortality, specifically by reducing SCD, as well as death due to worsening HF. Implantable cardioverter-defibrillator (ICD) implantation in HF patients reduces the risk of SCD; however, subsequent mortality is increased in those who receive ICD shocks. Prophylactic ICD implantation reduces death from arrhythmia but does not reduce overall mortality during the acute post-myocardial infarction (MI) period (less than 40 days), for those with reduced ejection fraction and impaired autonomic dysfunction. Furthermore, although death from arrhythmias is reduced, this is offset by an increase in the mortality from non-arrhythmic causes. This article provides a review of the aforementioned mechanisms of arrhythmogenesis in heart failure; the role and impact of HF therapy such as cardiac resynchronization therapy (CRT), including the role, if any, of CRT-P and CRT-D in preventing VAs; the utility of both non-invasive parameters as well as multiple implant-based parameters for telemonitoring in HF; and the effect of left ventricular assist device implantation on VAs.
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Affiliation(s)
- Chikezie K Alvarez
- Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA.
| | - Edmond Cronin
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - William L Baker
- University of Connecticut School of Pharmacy, Storrs, CT, USA
| | - Jeffrey Kluger
- Hartford Healthcare Heart and Vascular Institute, Hartford Hospital, Hartford, CT, USA
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16
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Devabhaktuni SR, Shirazi JT, Miller JM. Mapping and Ablation of Ventricle Arrhythmia in Patients with Left Ventricular Assist Devices. Card Electrophysiol Clin 2019; 11:689-697. [PMID: 31706475 DOI: 10.1016/j.ccep.2019.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Ventricular arrhythmias (VA) constitute well-known problems in patients with left ventricular assist devices (LVADs), with incidence ranging from 18% to as high as 52%. Catheter ablation has become a common therapeutic intervention to treat drug-refractory VA, particularly with the increase and more widespread use of durable LVADs to bridge patients to transplantation or as destination therapy. In this article, we focus on etiology, mechanisms, periprocedural management, and mapping and ablation techniques in patients with LVADs and VA.
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17
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Berg DD, Vaduganathan M, Upadhyay GA, Singh JP, Mehra MR, Stewart GC. Cardiac Implantable Electronic Devices in Patients With Left Ventricular Assist Systems. J Am Coll Cardiol 2019; 71:1483-1493. [PMID: 29598870 DOI: 10.1016/j.jacc.2018.01.061] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/08/2018] [Accepted: 01/28/2018] [Indexed: 01/11/2023]
Abstract
Recent progress and evolution in device engineering, surgical implantation practices, and periprocedural management have advanced the promise of durable support with left ventricular assist systems (LVAS) in patients with stage D heart failure. With greater uptake of LVAS globally, a growing population of LVAS recipients have pre-existing cardiac implantable electronic devices (CIEDs). Strategies for optimal clinical management of CIEDs in patients with durable LVAS are evolving, and clinicians will increasingly face complex decisions regarding implantation, programming, deactivation, and removal of CIEDs. Traditional decision-making pathways for CIEDs may not apply to LVAS-supported patients, as few patients die of arrhythmic causes and many arrhythmias may be well tolerated. Given limited data, treatment decisions must be individualized and made collaboratively among electrophysiologists, advanced heart failure specialists, and patients and their caregivers. Large, prospective, well-conducted studies are needed to better understand the contemporary utility of CIEDs in patients with newer-generation LVAS.
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Affiliation(s)
- David D Berg
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts
| | - Gaurav A Upadhyay
- Heart and Vascular Center, University of Chicago Medicine, Chicago, Illinois
| | - Jagmeet P Singh
- Cardiac Arrhythmia Service, Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mandeep R Mehra
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts
| | - Garrick C Stewart
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts.
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18
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Gopinathannair R, Cornwell WK, Dukes JW, Ellis CR, Hickey KT, Joglar JA, Pagani FD, Roukoz H, Slaughter MS, Patton KK. Device Therapy and Arrhythmia Management in Left Ventricular Assist Device Recipients: A Scientific Statement From the American Heart Association. Circulation 2019; 139:e967-e989. [DOI: 10.1161/cir.0000000000000673] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Left ventricular assist devices (LVADs) are an increasingly used strategy for the management of patients with advanced heart failure with reduced ejection fraction. Although these devices effectively improve survival, atrial and ventricular arrhythmias are common, predispose these patients to additional risk, and complicate patient management. However, there is no consensus on best practices for the medical management of these arrhythmias or on the optimal timing for procedural interventions in patients with refractory arrhythmias. Although the vast majority of these patients have preexisting cardiovascular implantable electronic devices or cardiac resynchronization therapy, given the natural history of heart failure, it is common practice to maintain cardiovascular implantable electronic device detection and therapies after LVAD implantation. Available data, however, are conflicting on the efficacy of and optimal device programming after LVAD implantation. Therefore, the primary objective of this scientific statement is to review the available evidence and to provide guidance on the management of atrial and ventricular arrhythmias in this unique patient population, as well as procedural interventions and cardiovascular implantable electronic device and cardiac resynchronization therapy programming strategies, on the basis of a comprehensive literature review by electrophysiologists, heart failure cardiologists, cardiac surgeons, and cardiovascular nurse specialists with expertise in managing these patients. The structure and design of commercially available LVADs are briefly reviewed, as well as clinical indications for device implantation. The relevant physiological effects of long-term exposure to continuous-flow circulatory support are highlighted, as well as the mechanisms and clinical significance of arrhythmias in the setting of LVAD support.
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19
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Heart Rhythm 2019; 17:e2-e154. [PMID: 31085023 PMCID: PMC8453449 DOI: 10.1016/j.hrthm.2019.03.002] [Citation(s) in RCA: 179] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Indexed: 01/10/2023]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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Moss JD, Oesterle A, Raiman M, Flatley EE, Beaser AD, Jeevanandam V, Klein L, Ota T, Wieselthaler G, Uriel N, Tung R. Feasibility and utility of intraoperative epicardial scar characterization during left ventricular assist device implantation. J Cardiovasc Electrophysiol 2018; 30:183-192. [PMID: 30516301 DOI: 10.1111/jce.13803] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 10/29/2018] [Accepted: 11/06/2018] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Ventricular arrhythmias (VA) after left ventricular assist device (LVAD) placement are associated with increased morbidity and mortality. We sought to assess epicardial voltage characteristics at the time of LVAD implantation and investigate relationships between scar burden and postimplant VA. METHODS AND RESULTS Consecutive patients underwent open chest epicardial electroanatomic mapping immediately before LVAD implantation. Areas of low voltage and sites with local abnormal potentials were identified. Patients were followed prospectively for postimplant VA and clinical outcomes. Between 2015 and 2017, 36 patients underwent high-density intraoperative epicardial voltage mapping; 15 had complete maps suitable for analysis. Mapping required a median of 11.8 (interquartile range [IQR], 8.5-12.7) minutes, with a median of 2650 (IQR, 2139-3191) points sampled per patient. Over a median follow-up of 311 (IQR, 168-469) postoperative days, four patients (27%) experienced sustained VA. Patients with postimplant VA were more likely to have had preimplant implantable cardioverter defibrillator shocks (100% vs 27%; P = 0.03), ventricular tachycardia storm (75% vs 9%; P = 0.03), and lower ejection fraction (13.5 vs 19.0%, P = 0.05). Patients with postimplant VA also had a significantly higher burden of epicardial low bipolar voltage points: 55.4% vs 24.9% of points were less than 0.5 mV (P = 0.01), and 88.9% vs 63.7% of points less than 1.5 mV (P = 0.004). CONCLUSIONS Intraoperative high-density epicardial mapping during LVAD implantation is safe and efficient, facilitating characterization of a potentially arrhythmogenic substrate. An increased burden of the epicardial scar may be associated with a higher incidence of postimplant VA. The role of empiric intraoperative epicardial ablation to mitigate risk of postimplant VA requires further study.
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Affiliation(s)
- Joshua D Moss
- Department of Medicine, Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Francisco, San Francisco, California
| | - Adam Oesterle
- Department of Medicine, Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Francisco, San Francisco, California
| | | | - Erin E Flatley
- Department of Medicine, Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Francisco, San Francisco, California
| | - Andrew D Beaser
- Department of Medicine, Section of Cardiology, Center for Arrhythmia Care, University of Chicago Medicine, Chicago, Illinois
| | - Valluvan Jeevanandam
- Department of Surgery, Section of Cardiac and Thoracic Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Liviu Klein
- Department of Medicine, Division of Cardiology, Section of Heart Failure, University of California San Francisco, San Francisco, California
| | - Takeyoshi Ota
- Department of Surgery, Section of Cardiac and Thoracic Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Georg Wieselthaler
- Department of Surgery, Division of Adult Cardiothoracic Surgery, University of California San Francisco, San Francisco, California
| | - Nir Uriel
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, Chicago, IL
| | - Roderick Tung
- Department of Medicine, Section of Cardiology, Center for Arrhythmia Care, University of Chicago Medicine, Chicago, Illinois
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Catheter Ablation of Ventricular Tachycardia in Patients With a Ventricular Assist Device: A Systematic Review of Procedural Characteristics and Outcomes. JACC Clin Electrophysiol 2018; 5:39-51. [PMID: 30678785 DOI: 10.1016/j.jacep.2018.08.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/07/2018] [Accepted: 08/17/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVES This is a systematic review summarizing the procedural characteristics and outcomes of ventricular assist device (VAD)-related ventricular tachycardia (VT) ablation. BACKGROUND Drug-refractory VT refractory commonly develops post-VAD implantation. Procedural and outcome data come from small series or case reports. METHODS An electronic search was performed using major databases. Primary outcomes were VT recurrence, mortality, and cardiac transplantation. Secondary endpoints were acute procedural success and procedural complications. RESULTS Eighteen studies were included, with a total of 110 patients (mean age 59.6 ± 11 years, 89% men; VT storm 34%). Scar-related re-entry was the predominant mechanism of VT (90.3%) and cannula-related VT in 19.3% cases. Electroanatomical mapping interference occurred in 1.8% of cases; there were no reports of catheter entrapment. Noninducibility of clinical VT was achieved in 77.9%; procedural complications occurred in 9.4%. At a mean follow-up of 263.5 ± 267.0 days, VT recurred in 43.6%, 23.4% underwent cardiac transplant, and 48.1% died. There were no procedural-related deaths and no death was directly related to ventricular arrhythmia. In follow-up, there was a significant reduction in implantable cardioverter-defibrillator therapies or shocks (57.1% vs. 23.8%). Ablation allowed VT storm termination in 90% of patients. CONCLUSIONS VAD-related VT is predominantly related to pre-existing intrinsic myocardial scar rather than inflow cannula site insertion. Catheter ablation is a reasonable treatment strategy, albeit with expectedly high rate of recurrence, transplantation, and mortality related to severe underlying disease.
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Efimova E, Fischer J, Bertagnolli L, Dinov B, Kircher S, Rolf S, Sommer P, Bollmann A, Richter S, Meyer A, Garbade J, Hindricks G, Arya A. Predictors of ventricular arrhythmia after left ventricular assist device implantation: A large single-center observational study. Heart Rhythm 2017; 14:1812-1819. [DOI: 10.1016/j.hrthm.2017.07.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Indexed: 11/28/2022]
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Abstract
PURPOSE OF REVIEW Ventricular tachycardia occurrence in implantable cardioverter defibrillator (ICD) patients may result in shock delivery and is associated with increased morbidity and mortality. In addition, shocks may have deleterious mechanical and psychological effects. Prevention of ventricular tachycardia (VT) recurrence with the use of antiarrhythmic drugs or catheter ablation may be warranted. Antiarrhythmic drugs are limited by incomplete efficacy and an unfavorable adverse effect profile. Catheter ablation can be effective but acute complications and long-term VT recurrence risk necessitating repeat ablation should be recognized. A shared clinical decision process accounting for patients' cardiac status, comorbidities, and goals of care is often required. RECENT FINDINGS There are four published randomized trials of catheter ablation for sustained monomorphic VT (SMVT) in the setting of ischemic heart disease; there are no randomized studies for non-ischemic ventricular substrates. The most recent trial is the VANISH trial which randomly allocated patients with ICD, prior infarction, and SMVT despite first-line antiarrhythmic drug therapy to catheter ablation or more aggressive antiarrhythmic drug therapy. During 28 months of follow-up, catheter ablation resulted in a 28% relative risk reduction in the composite endpoint of death, VT storm, and appropriate ICD shock (p = 0.04). In a subgroup analysis, patients having VT despite amiodarone had better outcomes with ablation as compared to increasing amiodarone dose or adding mexiletine. There is evidence for the effectiveness of both catheter ablation and antiarrhythmic drug therapy for patients with myocardial infarction, an implantable defibrillator, and VT. If sotalol is ineffective in suppressing VT, either catheter ablation or initiation of amiodarone is a reasonable option. If VT occurs despite amiodarone therapy, there is evidence that catheter ablation is superior to administration of more aggressive antiarrhythmic drug therapy. Early catheter ablation may be appropriate in some clinical situations such as patients presenting with relatively slow VT below ICD detection, electrical storms, hemodynamically stable VT, or in very selected patients with left ventricular assist devices. The optimal first-line suppressive therapy for VT, after ICD implantation and appropriate programming, remains to be determined. Thus far, there has not been a randomized controlled trial to compare catheter ablation to antiarrhythmic drug therapy as a first-line treatment; the VANISH-2 study has been initiated as a pilot to examine this question.
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Affiliation(s)
- Amir AbdelWahab
- QEII Health Sciences Centre, Room 2501 B/F Halifax Infirmary 1796 Summer Street, Halifax, NS, B3H 3A7, Canada
| | - John Sapp
- QEII Health Sciences Centre, Room 2501 B/F Halifax Infirmary 1796 Summer Street, Halifax, NS, B3H 3A7, Canada.
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Moss JD, Flatley EE, Beaser AD, Shin JH, Nayak HM, Upadhyay GA, Burke MC, Jeevanandam V, Uriel N, Tung R. Characterization of Ventricular Tachycardia After Left Ventricular Assist Device Implantation as Destination Therapy: A Single-Center Ablation Experience. JACC Clin Electrophysiol 2017; 3:1412-1424. [PMID: 29759673 DOI: 10.1016/j.jacep.2017.05.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/30/2017] [Accepted: 05/31/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study sought to report mechanisms of ventricular tachycardia (VT) and outcomes of VT ablation in patients with a left ventricular assist device (LVAD) as destination therapy. BACKGROUND Continuous flow LVAD implantation plays a growing role in the management of end-stage heart failure, and VT is common. There are limited reports of VT ablation in patients with a destination LVAD. METHODS Patients with a continuous-flow LVAD referred for VT ablation from 2010 to 2016 were analyzed retrospectively. Baseline patient characteristics, procedural data, and clinical follow-up were evaluated. Arrhythmia-free survival was assessed. RESULTS Twenty-one patients (90% male, 62 ± 10 years) underwent catheter ablation of VT at a median of 191 days (interquartile range: 55 to 403 days) after LVAD implantation (15 HeartMate II, 6 HeartWare HVAD). Five patients (24%) had termination (n = 4) or slowing (n = 1) of VT with ablation near the apical inflow cannula, and 3 (14%) had bundle-branch re-entry. Freedom from recurrent VT among surviving patients was 64% at 1 year, with overall survival 67% at 1 year for patients without arrhythmia recurrence and 29% for patients with recurrence (p = 0.049). One patient had suspected pump thrombosis within 30 days of the ablation procedure, with no other major acute complications. CONCLUSIONS In this relatively large, single-center experience of VT ablation in destination LVAD, freedom from recurrent VT and implantable cardioverter-defibrillator shocks was associated with improved 1-year survival. Bundle branch re-entry was more prevalent than anticipated, and cannula-adjacent VT was less common. This challenging population remains at risk for late pump thrombosis and mortality.
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Affiliation(s)
- Joshua D Moss
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California-San Francisco, San Francisco, California.
| | - Erin E Flatley
- Heart and Vascular Center, University of Chicago Medicine, Chicago, Illinois
| | - Andrew D Beaser
- Heart and Vascular Center, University of Chicago Medicine, Chicago, Illinois
| | - John H Shin
- Mid-Atlantic Permanente Medical Group, Rockville, Maryland
| | - Hemal M Nayak
- Heart and Vascular Center, University of Chicago Medicine, Chicago, Illinois
| | - Gaurav A Upadhyay
- Heart and Vascular Center, University of Chicago Medicine, Chicago, Illinois
| | | | | | - Nir Uriel
- Heart and Vascular Center, University of Chicago Medicine, Chicago, Illinois
| | - Roderick Tung
- Heart and Vascular Center, University of Chicago Medicine, Chicago, Illinois
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Santangeli P, Rame JE, Birati EY, Marchlinski FE. Management of Ventricular Arrhythmias in Patients With Advanced Heart Failure. J Am Coll Cardiol 2017; 69:1842-1860. [DOI: 10.1016/j.jacc.2017.01.047] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 01/19/2017] [Accepted: 01/23/2017] [Indexed: 02/08/2023]
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Snipelisky D, Reddy YNV, Manocha K, Patel A, Dunlay SM, Friedman PA, Munger TM, Asirvatham SJ, Packer DL, Cha YM, Kapa S, Brady PA, Noseworthy PA, Maleszewski JJ, Mulpuru SK. Effect of Ventricular Arrhythmia Ablation in Patients With Heart Mate II Left Ventricular Assist Devices: An Evaluation of Ablation Therapy. J Cardiovasc Electrophysiol 2016; 28:68-77. [PMID: 27766717 DOI: 10.1111/jce.13114] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 09/28/2016] [Accepted: 10/10/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients with advanced heart failure (HF) are predisposed to ventricular arrhythmias (VAs), particularly following implantation of a left ventricular assist device (LVAD). There is minimal evidence for appropriate management strategies. OBJECTIVES This study aimed to compare the burden of VA and response to ablation performed either before or following LVAD implantation. METHODS We created a retrospective cohort of patients who underwent both VA ablation and Heart Mate II (Thoratec, Pleasanton, CA, USA) LVAD implantation at Mayo Clinic (Rochester, MN, USA). Patients were stratified based on whether they underwent VA ablation before (pre-LVAD) or after LVAD (post-LVAD) implantation. Descriptive analyses assessed 6-month arrhythmia burden in relation to LVAD implantation and VA ablation. RESULTS A total of 9 patients underwent both LVAD implantation and VA ablation. There were 3 and 6 patients, respectively, in the pre-LVAD and post-LVAD cohorts. Among patients in the pre-LVAD cohort, the median number of VAs tended to increase after ablation (9 vs. 72) and decreased after LVAD implantation (72 vs. 63). Similarly among patients in the post-LVAD cohort, the median burden of VAs increased after LVAD implantation (1 vs. 22) and the median burden decreased after ablation (22 vs. 13). Two of 6 patients had substrate related to the LVAD inflow cannula site, while other substrate was not related directly to the cannula. CONCLUSIONS In patients with progressive HF and LVAD implantation, ablation is associated with reduced VA rates. In LVAD patients, most VAs arise from substrate unrelated to the inflow cannula site.
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Affiliation(s)
- David Snipelisky
- Division of Cardiovascular Diseases, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Yogesh N V Reddy
- Division of Cardiovascular Diseases, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Kevin Manocha
- Division of Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Aalok Patel
- Division of Cardiovascular Diseases, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Shannon M Dunlay
- Division of Cardiovascular Diseases, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul A Friedman
- Division of Cardiovascular Diseases, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas M Munger
- Division of Cardiovascular Diseases, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Samuel J Asirvatham
- Division of Cardiovascular Diseases, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Douglas L Packer
- Division of Cardiovascular Diseases, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Yong-Mei Cha
- Division of Cardiovascular Diseases, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Suraj Kapa
- Division of Cardiovascular Diseases, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter A Brady
- Division of Cardiovascular Diseases, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter A Noseworthy
- Division of Cardiovascular Diseases, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph J Maleszewski
- Division of Cardiovascular Diseases, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Siva K Mulpuru
- Division of Cardiovascular Diseases, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
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Mikovčák J, Neuwirth R, Střítecký J, Branny M. Catheter ablation of incessant ventricular tachycardia in a patient with mechanical cardiac support: A case report. COR ET VASA 2016. [DOI: 10.1016/j.crvasa.2015.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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28
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PATEL MEHUL, ROJAS FRANCIA, SHABARI FARSHADRAISSI, SIMPSON LEO, COHN WILLIAM, FRAZIER O, MALLIDI HARI, CHENG JIE, MATHURIA NILESH. Safety and Feasibility of Open Chest Epicardial Mapping and Ablation of Ventricular Tachycardia During the Period of Left Ventricular Assist Device Implantation. J Cardiovasc Electrophysiol 2015; 27:95-101. [DOI: 10.1111/jce.12839] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 08/20/2015] [Accepted: 09/01/2015] [Indexed: 11/28/2022]
Affiliation(s)
- MEHUL PATEL
- Baylor St. Luke's Medical Center/Texas Heart Institute; Baylor College of Medicine; Houston Texas USA
| | - FRANCIA ROJAS
- Baylor St. Luke's Medical Center/Texas Heart Institute; Baylor College of Medicine; Houston Texas USA
| | - FARSHAD RAISSI SHABARI
- Baylor St. Luke's Medical Center/Texas Heart Institute; Baylor College of Medicine; Houston Texas USA
| | - LEO SIMPSON
- Division of Cardiology; Baylor College of Medicine; Houston Texas USA
| | - WILLIAM COHN
- Division of Cardiovascular Surgery; Baylor College of Medicine; Houston Texas USA
| | - O.H. FRAZIER
- Division of Cardiovascular Surgery; Baylor College of Medicine; Houston Texas USA
| | - HARI MALLIDI
- Division of Cardiovascular Surgery; Baylor College of Medicine; Houston Texas USA
| | - JIE CHENG
- Baylor St. Luke's Medical Center/Texas Heart Institute; Baylor College of Medicine; Houston Texas USA
| | - NILESH MATHURIA
- Baylor St. Luke's Medical Center/Texas Heart Institute; Baylor College of Medicine; Houston Texas USA
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29
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Romano G, Raffa GM, Ruggieri A, Sgarito G, Falletta C, Sciacca S, Pilato M, Clemenza F. Recurrent ventricular tachycardia in a patient with continuous flow left ventricle assist device: Successful management with radiofrequency ablation and medical treatment. Int J Cardiol 2015; 190:198-200. [DOI: 10.1016/j.ijcard.2015.04.141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 04/16/2015] [Indexed: 10/23/2022]
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31
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Mulukutla V, Lam W, Simpson L, Mathuria N. Successful catheter ablation of hemodynamically significant ventricular tachycardia in a patient with biventricular assist device support. HeartRhythm Case Rep 2015; 1:209-212. [PMID: 28491550 PMCID: PMC5419334 DOI: 10.1016/j.hrcr.2015.02.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
| | - Wilson Lam
- Baylor St. Luke's Medical Center/Texas Heart Institute, Houston, TX
| | - Leo Simpson
- Section of Cardiology, Baylor College of Medicine, Houston, TX.,Baylor St. Luke's Medical Center/Texas Heart Institute, Houston, TX
| | - Nilesh Mathuria
- Baylor St. Luke's Medical Center/Texas Heart Institute, Houston, TX
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Sacher F, Reichlin T, Zado ES, Field ME, Viles-Gonzalez JF, Peichl P, Ellenbogen KA, Maury P, Dukkipati SR, Picard F, Kautzner J, Barandon L, Koneru JN, Ritter P, Mahida S, Calderon J, Derval N, Denis A, Cochet H, Shepard RK, Corre J, Coffey JO, Garcia F, Hocini M, Tedrow U, Haissaguerre M, d'Avila A, Stevenson WG, Marchlinski FE, Jais P. Characteristics of ventricular tachycardia ablation in patients with continuous flow left ventricular assist devices. Circ Arrhythm Electrophysiol 2015; 8:592-7. [PMID: 25870335 DOI: 10.1161/circep.114.002394] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 03/30/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Left ventricular assist devices (LVADs) are increasingly used as a bridge to cardiac transplantation or as destination therapy. Patients with LVADs are at high risk for ventricular arrhythmias. This study describes ventricular arrhythmia characteristics and ablation in patients implanted with a Heart Mate II device. METHODS AND RESULTS All patients with a Heart Mate II device who underwent ventricular arrhythmia catheter ablation at 9 tertiary centers were included. Thirty-four patients (30 male, age 58±10 years) underwent 39 ablation procedures. The underlying cardiomyopathy pathogenesis was ischemic in 21 and nonischemic in 13 patients with a mean left ventricular ejection fraction of 17%±5% before LVAD implantation. One hundred and ten ventricular tachycardias (VTs; cycle lengths, 230-740 ms, arrhythmic storm n=28) and 2 ventricular fibrillation triggers were targeted (25 transseptal, 14 retrograde aortic approaches). Nine patients required VT ablation <1 month after LVAD implantation because of intractable VT. Only 10/110 (9%) of the targeted VTs were related to the Heart Mate II cannula. During follow-up, 7 patients were transplanted and 10 died. Of the remaining 17 patients, 13 were arrhythmia-free at 25±15 months. In 1 patient with VT recurrence, change of turbine speed from 9400 to 9000 rpm extinguished VT. CONCLUSIONS Catheter ablation of VT among LVAD recipients is feasible and reasonably safe even soon after LVAD implantation. Intrinsic myocardial scar, rather than the apical cannula, seems to be the dominant substrate.
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Affiliation(s)
- Frederic Sacher
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.).
| | - Tobias Reichlin
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Erica S Zado
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Michael E Field
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Juan F Viles-Gonzalez
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Petr Peichl
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Kenneth A Ellenbogen
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Philippe Maury
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Srinivas R Dukkipati
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Francois Picard
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Josef Kautzner
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Laurent Barandon
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Jayanthi N Koneru
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Philippe Ritter
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Saagar Mahida
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Joachim Calderon
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Nicolas Derval
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Arnaud Denis
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Hubert Cochet
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Richard K Shepard
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Jerome Corre
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - James O Coffey
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Fermin Garcia
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Meleze Hocini
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Usha Tedrow
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Michel Haissaguerre
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Andre d'Avila
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - William G Stevenson
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Francis E Marchlinski
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Pierre Jais
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
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Pedersen CT, Kay GN, Kalman J, Borggrefe M, Della-Bella P, Dickfeld T, Dorian P, Huikuri H, Kim YH, Knight B, Marchlinski F, Ross D, Sacher F, Sapp J, Shivkumar K, Soejima K, Tada H, Alexander ME, Triedman JK, Yamada T, Kirchhof P, Lip GY, Kuck KH, Mont L, Haines D, Indik J, Dimarco J, Exner D, Iesaka Y, Savelieva I. EHRA/HRS/APHRS expert consensus on ventricular arrhythmias. J Arrhythm 2014. [DOI: 10.1016/j.joa.2014.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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Pedersen CT, Kay GN, Kalman J, Borggrefe M, Della-Bella P, Dickfeld T, Dorian P, Huikuri H, Kim YH, Knight B, Marchlinski F, Ross D, Sacher F, Sapp J, Shivkumar K, Soejima K, Tada H, Alexander ME, Triedman JK, Yamada T, Kirchhof P, Lip GYH, Kuck KH, Mont L, Haines D, Indik J, Dimarco J, Exner D, Iesaka Y, Savelieva I. EHRA/HRS/APHRS expert consensus on ventricular arrhythmias. Europace 2014; 16:1257-83. [PMID: 25172618 DOI: 10.1093/europace/euu194] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Kumar S, Stevenson WG, John RM. Catheter ablation for premature ventricular contractions and ventricular tachycardia in patients with heart failure. Curr Cardiol Rep 2014; 16:522. [PMID: 25059465 DOI: 10.1007/s11886-014-0522-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Ventricular arrhythmias (VA) are a significant contributor to morbidity and mortality in patients with heart failure (HF). Implantable cardioverter defibrillators are effective in reducing mortality, but do not prevent arrhythmia recurrence. There is increasing recognition that frequent premature ventricular contractions or repetitive ventricular tachycardia may also lead to new onset ventricular dysfunction or deterioration of ventricular function in patients with pre-existing HF. Suppression of the arrhythmia may lead to recovery of ventricular function. Catheter ablation has emerged as a safe and effective treatment option for reducing arrhythmia recurrence and for suppression of PVCs but its efficacy is governed by the nature of the arrhythmias, the underlying HF substrate and the accessibility of the arrhythmia substrates to ablation.
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Affiliation(s)
- Saurabh Kumar
- Cardiac Arrhythmia Service, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
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Nazer B, Gerstenfeld EP. Catheter ablation of ventricular tachycardia in patients with post-infarction cardiomyopathy. Korean Circ J 2014; 44:210-7. [PMID: 25089131 PMCID: PMC4117840 DOI: 10.4070/kcj.2014.44.4.210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Monomorphic ventricular tachycardia (VT) in patients with post-infarction cardiomyopathy (CMP) is caused by reentry through slowly conducting tissue with in areas of myocardial scar. The use of implantable cardioverter-defibrillators (ICDs) has helped to decrease the risk of arrhythmic death in patients with post-infarction CMP, but the symptomatic and psychological burden of ICD shocks remains significant. Experience with catheter ablation has progressed substantially in the past 20 years, and is now routinely used to treat patients with post-infarction CMP who experience VT or receive ICD therapy. Depending on the hemodynamic tolerance of VT, a variety of mapping techniques may be used to identify sites for catheter ablation, including activation and entrainment mapping for mappable VTs, or substrate mapping for unmappable VTs. In this review, we discuss the pathophysiology of VT in post-infarction CMP patients, and the contemporary practice of catheter ablation.
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Affiliation(s)
- Babak Nazer
- Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Edward P Gerstenfeld
- Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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Catheter Ablation for Ventricular Tachyarrhythmias in Patients Supported by Continuous-Flow Left Ventricular Assist Devices. ASAIO J 2014; 60:311-6. [DOI: 10.1097/mat.0000000000000061] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Effect of counter-pulsation control of a pulsatile left ventricular assist device on working load variations of the native heart. Biomed Eng Online 2014; 13:35. [PMID: 24708625 PMCID: PMC3976558 DOI: 10.1186/1475-925x-13-35] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 03/26/2014] [Indexed: 11/10/2022] Open
Abstract
Background When using a pulsatile left ventricular assist device (LVAD), it is important to reduce the cardiac load variations of the native heart because severe cardiac load variations can induce ventricular arrhythmia. In this study, we investigated the effect of counter-pulsation control of the LVAD on the reduction of cardiac load variation. Methods A ventricular electrocardiogram-based counter-pulsation control algorithm for a LVAD was implemented, and the effects of counter-pulsation control of the LVAD on the reduction of the working load variations of the left ventricle were determined in three animal experiments. Results Deviations of the working load of the left ventricle were reduced by 51.3%, 67.9%, and 71.5% in each case, and the beat-to-beat variation rates in the working load were reduced by 84.8%, 82.7%, and 88.2% in each ease after counter-pulsation control. There were 3 to 12 premature ventricle contractions (PVCs) before counter-pulsation control, but no PVCs were observed during counter-pulsation control. Conclusions Counter-pulsation control of the pulsatile LVAD can reduce severe cardiac load variations, but the average working load is not markedly affected by application of counter-pulsation control because it is also influenced by temporary cardiac outflow variations. We believe that counter-pulsation control of the LVAD can improve the long-term safety of heart failure patients equipped with LVADs.
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Medical management of patients with continuous-flow left ventricular assist devices. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2014; 16:283. [PMID: 24398802 DOI: 10.1007/s11936-013-0283-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OPINION STATEMENT The prevalence of patients living with advanced heart failure continues to rise. For a subset of these patients, continuous-flow left ventricular assist devices (LVADs) are a life-saving therapy. Given the efficacy and durability of contemporary LVAD devices, their use has increased exponentially in recent years. The medical management of patients with an LVAD is an area of expertise for advanced heart failure clinicians, but a general understanding of the initial approach to, and stabilization of, LVAD patients is an important skillset for many health care providers. The rapidly changing field of the medical management of LVAD patients is largely based on clinical experience and limited published data. In this manuscript, we integrate the available published data on the medical management of LVAD patients with the growing clinical experience.
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Nakahara S, Chien C, Gelow J, Dalouk K, Henrikson CA, Mudd J, Stecker EC. Ventricular arrhythmias after left ventricular assist device. Circ Arrhythm Electrophysiol 2013; 6:648-54. [PMID: 23778248 DOI: 10.1161/circep.113.000113] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Shashima Nakahara
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
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Nayyar S, Ganesan AN, Brooks AG, Sullivan T, Roberts-Thomson KC, Sanders P. Venturing into ventricular arrhythmia storm: a systematic review and meta-analysis. Eur Heart J 2012; 34:560-71. [DOI: 10.1093/eurheartj/ehs453] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Shirazi JT, Lopshire JC, Gradus-Pizlo I, Hadi MA, Wozniak TC, Malik AS. Ventricular arrhythmias in patients with implanted ventricular assist devices: a contemporary review. Europace 2012; 15:11-7. [DOI: 10.1093/europace/eus364] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Herweg B, Ilercil A, Kristof-Kuteyeva O, Rinde-Hoffman D, Caldeira C, Mangar D, Karlnosky R, Barold SS. Clinical observations and outcome of ventricular tachycardia ablation in patients with left ventricular assist devices. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 35:1377-83. [PMID: 22946711 DOI: 10.1111/j.1540-8159.2012.03509.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ablation of ventricular tachycardia (VT) in patients with left ventricular assist devices (LVAD) is challenging and not well documented. This report describes our experience with endocardial VT ablation in six patients with an LVAD. METHODS We retrospectively reviewed the clinical records of LVAD patients who underwent an ablation procedure for refractory VT. RESULTS A total of eight ablation procedures were performed in six patients who, during the last 2 weeks before the ablation procedure, received a total of 101 appropriate shocks for VT. A closed aortic valve (n = 2) or aortic atheroma (n = 1) required a transseptal catheterization in three of six patients. The apical LVAD cannula served as a VT substrate in two of six patients. VT was eliminated in four patients and markedly reduced in two others. The latter two patients experienced a total of only four implantable cardioverter defibrillator (ICD) shocks during a follow-up of 130 and 493 days. Intravenous antiarrhythmic medications used in five of six patients before ablation were discontinued in all. The ablation procedures permitted hospital discharge in four of six patients. Five patients died during follow-up (228 ± 207 days after the procedure). The cause of death was unrelated to cardiac arrhythmias. One patient is still alive 1,205 days after the procedure. CONCLUSION Ablation of VT in LVAD patients is feasible and can result in a markedly decreased VT burden with a reduction of ICD shocks. The subsequent discontinuation of intravenous antiarrhythmic medications may facilitate hospital discharge.
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Affiliation(s)
- Bengt Herweg
- Divisions of Cardiology Cardiothoracic Surgery Anesthesiology, Tampa General Hospital, Tampa, FL 33606, USA.
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Cantillon DJ, Bianco C, Wazni OM, Kanj M, Smedira NG, Wilkoff BL, Starling RC, Saliba WI. Electrophysiologic characteristics and catheter ablation of ventricular tachyarrhythmias among patients with heart failure on ventricular assist device support. Heart Rhythm 2012; 9:859-64. [PMID: 22293139 DOI: 10.1016/j.hrthm.2012.01.018] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ventricular tachyarrhythmias (VT) are common among ventricular assist device (VAD) recipients, yet electrophysiologic (EP) characteristics and catheter ablation outcomes remain uncharacterized. OBJECTIVE To evaluate the EP characteristics and catheter ablation outcomes for VTs among heart failure patients on VAD support. METHODS The Cleveland Clinic registry of consecutive patients undergoing VAD placement in 1991-2010 with medically refractory, symptomatic VT referred for EP study and catheter ablation. RESULTS Among 611 recipients of VAD (mean age 53.3 ± 12.4 years, 80% men), 21 patients (3.4%) were referred for 32 EP procedures, including 11 patients (52%) presenting with implantable cardioverter-defibrillator therapy (13 shocks, 26 antitachycardia pacing). Data from 44 inducible tachycardias (mean cycle length 339 ± 59 ms) demonstrated monomorphic VT (n = 40, 91%; superior axis 52%, right bundle branch block morphology 41%) and polymorphic ventricular tachycardia (PMVT)/ventricular fibrillation (n = 4, 8%). Electroanatomic mapping of 28 tachycardias in 20 patients demonstrated reentrant VT related to intrinsic scar (n = 21 of 28, 75%) more commonly than the apical inflow cannulation site (n = 4 of 28, 14%), focal/microreentry VT (n = 2 of 28, 7%), or bundle branch reentry (n = 1 of 28, 3.5%). Catheter ablation succeeded in 18 of 21 patients (86%). VT recurred in 7 of 21 patients (33%) at a mean of 133 ± 98 days, and 6 patients (29%) required repeat procedures, with subsequent recurrence in 4 of 21 patients (19%). CONCLUSIONS Catheter ablation of VT is effective among recipients of VAD. Intrinsic myocardial scar, rather than the apical device cannulation site, appears to be the dominant substrate.
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Affiliation(s)
- Daniel J Cantillon
- Cleveland Clinic, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland, OH 44195, USA.
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Fong MW, Grazette L, Cesario D, Cao M, Saxon L. Treatment of ventricular tachycardia in patients with heart failure. Curr Cardiol Rep 2011; 13:203-9. [PMID: 21445560 DOI: 10.1007/s11886-011-0182-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Heart failure is a major public health concern that is frequently complicated by ventricular arrhythmias. Sustained ventricular tachycardia is associated with an increased risk for progressive heart failure and sudden death. We summarize the current management strategies for ventricular tachycardia in heart failure patients, including implantable cardioverter-defibrillator therapy, pharmacologic therapy, catheter ablation techniques, ventricular assist device therapy, and heart transplantation.
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Affiliation(s)
- Michael W Fong
- Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, Suite 322, Los Angeles, CA 90033, USA.
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Valderrábano M, Dave AS, Báez-Escudero JL, Rami T. Robotic catheter ablation of left ventricular tachycardia: initial experience. Heart Rhythm 2011; 8:1837-46. [PMID: 21802391 DOI: 10.1016/j.hrthm.2011.07.032] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Accepted: 07/22/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Catheter ablation of ventricular tachycardia (VT) can be technically challenging due to difficulty with catheter positioning in the left ventricle (LV) and achieving stable contact. The Hansen Sensei Robotic system (HRS) has been used in atrial fibrillation but its utility in VT is unclear. OBJECTIVE The purpose of this study was to test the technical feasibility of robotic catheter ablation of LV ventricular tachycardia (VT) using the HRS. METHODS Twenty-three patients underwent LV VT mapping and ablation with the HRS via a transseptal, transmitral valve approach. Nineteen patients underwent substrate mapping and ablation (18 had ischemic cardiomyopathy, 1 had an apical variant of hypertrophic cardiomyopathy). Four patients had focal VT requiring LV VT mapping and ablation. Procedural endpoints included substrate modification by endocardial scar border ablation and elimination of late potentials, or elimination of inducible focal VT. RESULTS Mapping and ablation were entirely robotic without requiring manual catheter manipulation in all patients and reaching all LV regions with stable contact. Fluoroscopy time of the LV procedure was 22.2 ± 11.2 minutes. Radiofrequency time was 33 ± 21 minutes. Total procedural times were 231 ± 76 minutes. Complications included a left groin hematoma (opposite to the HRS sheath), 1 pericardial effusion without tamponade that was drained successfully, and transient right ventricular failure in a patient with previous left ventricular assist device. At 13.4 ± 6.7 months of follow-up (range 1-19 months), recurrence of VT occurred in 3 of 23 patients. CONCLUSION Our initial experience suggests that the HRS allows successful mapping and ablation of LV VT.
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Affiliation(s)
- Miguel Valderrábano
- Methodist DeBakey Heart and Vascular Center and Methodist Hospital Research Institute, The Methodist Hospital, Houston, Texas 77030, USA.
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Braunschweig F, Boriani G, Bauer A, Hatala R, Herrmann-Lingen C, Kautzner J, Pedersen SS, Pehrson S, Ricci R, Schalij MJ. Management of patients receiving implantable cardiac defibrillator shocks: Recommendations for acute and long-term patient management. Europace 2010; 12:1673-90. [PMID: 20974757 DOI: 10.1093/europace/euq316] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Frieder Braunschweig
- Department of Cardiology, Karolinska University Hospital, S-171 76 Stockholm, Stockholm, Sweden.
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