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Roukoz H, Tholakanahalli V. Epicardial ablation of ventricular tachycardia in ischemic cardiomyopathy: A review and local experience. Indian Pacing Electrophysiol J 2024; 24:84-93. [PMID: 38340957 PMCID: PMC11010455 DOI: 10.1016/j.ipej.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 10/29/2023] [Accepted: 02/07/2024] [Indexed: 02/12/2024] Open
Abstract
Myocardial scar in ischemic cardiomyopathy is predominantly endocardial, however, between 5% and 15% of these patients have an arrhythmogenic epicardial substrate. Percutaneous epicardial ablation should be considered in patients with ICM and VT especially if they failed an endocardial ablation. Simultaneous epicardial and endocardial ablation of VT in ICM may reduce short- and medium-term VT recurrence compared with an endocardial only approach. Cardiac imaging could be used to help guide patient selection for a combined epi-endo approach. Complications related to epicardial access can happen in up to 7% of patients. Epicardial ablation in these patients should be referred to experienced tertiary centers. We review the literature and share interesting cases.
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Arenal Á, Ríos-Muñoz GR, Carta-Bergaz A, Ruiz-Hernández PM, Pérez-David E, Crisóstomo V, Loughlin G, Sanz-Ruiz R, Fernández-Portales J, Acosta A, Báez-Díaz C, Blanco-Blázquez V, Ledesma-Carbayo MJ, Pareja M, Fernández-Santos ME, Sánchez-Margallo FM, Casado JG, Fernández-Avilés F. Effects of Cardiac Stem Cell on Postinfarction Arrhythmogenic Substrate. Int J Mol Sci 2022; 23:16211. [PMID: 36555857 PMCID: PMC9781106 DOI: 10.3390/ijms232416211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/26/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
Clinical data suggest that cardiosphere-derived cells (CDCs) could modify post-infarction scar and ventricular remodeling and reduce the incidence of ventricular tachycardia (VT). This paper assesses the effect of CDCs on VT substrate in a pig model of postinfarction monomorphic VT. We studied the effect of CDCs on the electrophysiological properties and histological structure of dense scar and heterogeneous tissue (HT). Optical mapping and histological evaluation were performed 16 weeks after the induction of a myocardial infarction by transient occlusion of the left anterior descending (LAD) artery in 21 pigs. Four weeks after LAD occlusion, pigs were randomized to receive intracoronary plus trans-myocardial CDCs (IC+TM group, n: 10) or to a control group. Optical mapping (OM) showed an action potential duration (APD) gradient between HT and normal tissue in both groups. CDCs increased conduction velocity (53 ± 5 vs. 45 ± 6 cm/s, p < 0.01), prolonged APD (280 ± 30 ms vs. 220 ± 40 ms, p < 0.01) and decreased APD dispersion in the HT. During OM, a VT was induced in one and seven of the IC+TM and control hearts (p = 0.03), respectively; five of these VTs had their critical isthmus located in intra-scar HT found adjacent to the coronary arteries. Histological evaluation of HT revealed less fibrosis (p < 0.01), lower density of myofibroblasts (p = 0.001), and higher density of connexin-43 in the IC+TM group. Scar and left ventricular volumes did not show differences between groups. Allogeneic CDCs early after myocardial infarction can modify the structure and electrophysiology of post-infarction scar. These findings pave the way for novel therapeutic properties of CDCs.
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Affiliation(s)
- Ángel Arenal
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
- Center for Biomedical Research in Cardiovascular Disease Network (CIBERCV), 28029 Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Gonzalo R Ríos-Muñoz
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
- Center for Biomedical Research in Cardiovascular Disease Network (CIBERCV), 28029 Madrid, Spain
- BSEL-Biomedical Sciences and Engineering Laboratory, Bioengineering Department, Universidad Carlos III de Madrid, 28911 Madrid, Spain
| | - Alejandro Carta-Bergaz
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
- Center for Biomedical Research in Cardiovascular Disease Network (CIBERCV), 28029 Madrid, Spain
| | - Pablo M Ruiz-Hernández
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Esther Pérez-David
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
- Center for Biomedical Research in Cardiovascular Disease Network (CIBERCV), 28029 Madrid, Spain
| | - Verónica Crisóstomo
- Center for Biomedical Research in Cardiovascular Disease Network (CIBERCV), 28029 Madrid, Spain
- Centro de Cirugía de Mínima Invasión Jesús Usón, 10071 Cáceres, Spain
| | - Gerard Loughlin
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
- Center for Biomedical Research in Cardiovascular Disease Network (CIBERCV), 28029 Madrid, Spain
| | - Ricardo Sanz-Ruiz
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
- Center for Biomedical Research in Cardiovascular Disease Network (CIBERCV), 28029 Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | | | - Alejandra Acosta
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Claudia Báez-Díaz
- Center for Biomedical Research in Cardiovascular Disease Network (CIBERCV), 28029 Madrid, Spain
- Centro de Cirugía de Mínima Invasión Jesús Usón, 10071 Cáceres, Spain
| | - Virginia Blanco-Blázquez
- Center for Biomedical Research in Cardiovascular Disease Network (CIBERCV), 28029 Madrid, Spain
- Centro de Cirugía de Mínima Invasión Jesús Usón, 10071 Cáceres, Spain
| | - María J Ledesma-Carbayo
- Departamento Ingeniería Electrónica, Universidad Politécnica de Madrid and CIBER-BBN, 28040 Madrid, Spain
| | - Miriam Pareja
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
- Center for Biomedical Research in Cardiovascular Disease Network (CIBERCV), 28029 Madrid, Spain
| | - María E Fernández-Santos
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
- Center for Biomedical Research in Cardiovascular Disease Network (CIBERCV), 28029 Madrid, Spain
| | - Francisco M Sánchez-Margallo
- Center for Biomedical Research in Cardiovascular Disease Network (CIBERCV), 28029 Madrid, Spain
- Centro de Cirugía de Mínima Invasión Jesús Usón, 10071 Cáceres, Spain
| | - Javier G Casado
- Center for Biomedical Research in Cardiovascular Disease Network (CIBERCV), 28029 Madrid, Spain
- Centro de Cirugía de Mínima Invasión Jesús Usón, 10071 Cáceres, Spain
- Immunology Unit, University of Extremadura, 10003 Cáceres, Spain
| | - Francisco Fernández-Avilés
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
- Center for Biomedical Research in Cardiovascular Disease Network (CIBERCV), 28029 Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
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3
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Carta-Bergaz A, Ríos-Muñoz GR, Crisóstomo V, Sánchez-Margallo FM, Ledesma-Carbayo MJ, Bermejo-Thomas J, Fernández-Avilés F, Arenal-Maíz Á. Intrapericardial cardiosphere-derived cells hinder epicardial dense scar expansion and promote electrical homogeneity in a porcine post-infarction model. Front Physiol 2022; 13:1041348. [PMID: 36457311 PMCID: PMC9705343 DOI: 10.3389/fphys.2022.1041348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 10/11/2022] [Indexed: 11/14/2023] Open
Abstract
The arrhythmic substrate of ventricular tachycardias in many structural heart diseases is located in the epicardium, often resulting in poor outcomes with currently available therapies. Cardiosphere-derived cells (CDCs) have been shown to modify myocardial scarring. A total of 19 Large White pigs were infarcted by occlusion of the mid-left anterior descending coronary artery for 150 min. Baseline cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement sequences was obtained 4 weeks post-infarction and pigs were randomized to a treatment group (intrapericardial administration of 300,000 allogeneic CDCs/kg), (n = 10) and to a control group (n = 9). A second CMR and high-density endocardial electroanatomical mapping were performed at 16 weeks post-infarction. After the electrophysiological study, pigs were sacrificed and epicardial optical mapping and histological studies of the heterogeneous tissue of the endocardial and epicardial scars were performed. In comparison with control conditions, intrapericardial CDCs reduced the growth of epicardial dense scar and epicardial electrical heterogeneity. The relative differences in conduction velocity and action potential duration between healthy myocardium and heterogeneous tissue were significantly smaller in the CDC-treated group than in the control group. The lower electrical heterogeneity coincides with heterogeneous tissue with less fibrosis, better cardiomyocyte viability, and a greater quantity and better polarity of connexin 43. At the endocardial level, no differences were detected between groups. Intrapericardial CDCs produce anatomical and functional changes in the epicardial arrhythmic substrate, which could have an anti-arrhythmic effect.
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Affiliation(s)
- Alejandro Carta-Bergaz
- Gregorio Marañón Health Research Institute (IiSGM), Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Centre for Biomedical Research in Cardiovascular Disease Network (CIBERCV), Madrid, Spain
| | - Gonzalo R. Ríos-Muñoz
- Gregorio Marañón Health Research Institute (IiSGM), Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Centre for Biomedical Research in Cardiovascular Disease Network (CIBERCV), Madrid, Spain
- Department of Bioengineering and Space Engineering, Universidad Carlos III de Madrid, Madrid, Spain
| | - Verónica Crisóstomo
- Centre for Biomedical Research in Cardiovascular Disease Network (CIBERCV), Madrid, Spain
- Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| | - Francisco M. Sánchez-Margallo
- Centre for Biomedical Research in Cardiovascular Disease Network (CIBERCV), Madrid, Spain
- Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| | - María J. Ledesma-Carbayo
- Biomedical Image Technologies, ETSI Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain
- CIBER-BBN, Instituto de Salud Carlos III, Madrid, Spain
| | - Javier Bermejo-Thomas
- Gregorio Marañón Health Research Institute (IiSGM), Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Centre for Biomedical Research in Cardiovascular Disease Network (CIBERCV), Madrid, Spain
- Medical School, Universidad Complutense de Madrid, Madrid, Spain
| | - Francisco Fernández-Avilés
- Gregorio Marañón Health Research Institute (IiSGM), Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Centre for Biomedical Research in Cardiovascular Disease Network (CIBERCV), Madrid, Spain
- Medical School, Universidad Complutense de Madrid, Madrid, Spain
| | - Ángel Arenal-Maíz
- Gregorio Marañón Health Research Institute (IiSGM), Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Centre for Biomedical Research in Cardiovascular Disease Network (CIBERCV), Madrid, Spain
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4
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A novel ECG finding in patients with epicardial infarct-associated ventricular tachycardia: a case series. Herzschrittmacherther Elektrophysiol 2022; 33:217-223. [PMID: 35277790 DOI: 10.1007/s00399-022-00849-9] [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: 12/25/2021] [Accepted: 02/01/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This study analyzes the incidence, characteristics, and ECG morphology of ventricular tachycardia (VT) in post-infarction patients undergoing epicardial VT ablation. BACKGROUND Ablation of recurrent VTs in patients with ischemic cardiomyopathy is typically performed endocardially. In rare cases, epicardial access is required to achieve non-inducibility. METHODS AND RESULTS The study evaluated the baseline characteristics, procedural data, and ECG morphology of clinical VT in patients undergoing epicardial VT ablation. From the initial 491 patients with coronary heart disease (CHD) and recurrent VTs undergoing ablation at the Heart Center of Leipzig, Germany, between 2012 and 2020, only 39 patients required an additional epicardial access. In 17 patients, the VTs were associated with infarction scar, while the remaining patients had concomitant CHD without infarction-associated scar and were excluded from the analysis. A propensity match study was performed at a 1:2 ratio for these 17 patients, with 34 patients of the initial cohort as a control group to evaluate the differences in baseline characteristics, procedural data, and ECG morphology of the VTs. The specific VT morphology of negative concordance and superior axis in patients with inferior scar as well as the history of VT ablation were independent predictors of the need for epicardial access. CONCLUSIONS In addition to previous endocardial ablation, VT ECG morphology with negative concordance and superior axis in post-infarction patients with inferior scar predicted the need for epicardial VT ablation.
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Merino-Caviedes S, Gutierrez LK, Alfonso-Almazán JM, Sanz-Estébanez S, Cordero-Grande L, Quintanilla JG, Sánchez-González J, Marina-Breysse M, Galán-Arriola C, Enríquez-Vázquez D, Torres C, Pizarro G, Ibáñez B, Peinado R, Merino JL, Pérez-Villacastín J, Jalife J, López-Yunta M, Vázquez M, Aguado-Sierra J, González-Ferrer JJ, Pérez-Castellano N, Martín-Fernández M, Alberola-López C, Filgueiras-Rama D. Time-efficient three-dimensional transmural scar assessment provides relevant substrate characterization for ventricular tachycardia features and long-term recurrences in ischemic cardiomyopathy. Sci Rep 2021; 11:18722. [PMID: 34580343 PMCID: PMC8476552 DOI: 10.1038/s41598-021-97399-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/17/2021] [Indexed: 11/21/2022] Open
Abstract
Delayed gadolinium-enhanced cardiac magnetic resonance (LGE-CMR) imaging requires novel and time-efficient approaches to characterize the myocardial substrate associated with ventricular arrhythmia in patients with ischemic cardiomyopathy. Using a translational approach in pigs and patients with established myocardial infarction, we tested and validated a novel 3D methodology to assess ventricular scar using custom transmural criteria and a semiautomatic approach to obtain transmural scar maps in ventricular models reconstructed from both 3D-acquired and 3D-upsampled-2D-acquired LGE-CMR images. The results showed that 3D-upsampled models from 2D LGE-CMR images provided a time-efficient alternative to 3D-acquired sequences to assess the myocardial substrate associated with ischemic cardiomyopathy. Scar assessment from 2D-LGE-CMR sequences using 3D-upsampled models was superior to conventional 2D assessment to identify scar sizes associated with the cycle length of spontaneous ventricular tachycardia episodes and long-term ventricular tachycardia recurrences after catheter ablation. This novel methodology may represent an efficient approach in clinical practice after manual or automatic segmentation of myocardial borders in a small number of conventional 2D LGE-CMR slices and automatic scar detection.
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Affiliation(s)
| | - Lilian K Gutierrez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Myocardial Pathophysiology Area, Madrid, Spain
| | | | | | - Lucilio Cordero-Grande
- Universidad Politécnica de Madrid, Biomedical Image Technologies, ETSI Telecomunicación, Madrid, Spain.,Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - Jorge G Quintanilla
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Myocardial Pathophysiology Area, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | - Manuel Marina-Breysse
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Myocardial Pathophysiology Area, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Carlos Galán-Arriola
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Myocardial Pathophysiology Area, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Daniel Enríquez-Vázquez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Myocardial Pathophysiology Area, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain
| | - Carlos Torres
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain
| | - Gonzalo Pizarro
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Myocardial Pathophysiology Area, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Hospital Ruber Juan Bravo Quironsalud UEM, Cardiology Department, Madrid, Spain
| | - Borja Ibáñez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Myocardial Pathophysiology Area, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,IIS-University Hospital Fundación Jiménez Díaz, Cardiology Department, Madrid, Spain
| | - Rafael Peinado
- Hospital Universitario La Paz, Cardiology Department, Madrid, Spain
| | - Jose Luis Merino
- Hospital Universitario La Paz, Cardiology Department, Madrid, Spain
| | - Julián Pérez-Villacastín
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Madrid, Spain
| | - José Jalife
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Myocardial Pathophysiology Area, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | - Mariano Vázquez
- Barcelona Supercomputing Center (BSC), Barcelona, Spain.,ELEM Biotech SL., Barcelona, Spain
| | | | - Juan José González-Ferrer
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Nicasio Pérez-Castellano
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Madrid, Spain
| | | | | | - David Filgueiras-Rama
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Myocardial Pathophysiology Area, Madrid, Spain. .,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain. .,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
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6
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de Riva M, Naruse Y, Ebert M, Watanabe M, Scholte AJ, Wijnmaalen AP, Trines SA, Schalij MJ, Montero-Cabezas JM, Zeppenfeld K. Myocardial calcification is associated with endocardial ablation failure of post-myocardial infarction ventricular tachycardia. Europace 2021; 23:1275-1284. [PMID: 33550383 DOI: 10.1093/europace/euab003] [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: 06/30/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS In patients with post-myocardial infarction (post-MI) ventricular tachycardia (VT), the presence of myocardial calcification (MC) may prevent heating of a subepicardial VT substrate contributing to endocardial ablation failure. The aims of this study were to assess the prevalence of MC in patients with post-MI VT and evaluate the impact of MC on outcome after endocardial ablation. METHODS AND RESULTS In 158 patients, the presence of MC was retrospectively assessed on fluoroscopy recordings in seven standard projections obtained during pre-procedural coronary angiograms. Myocardial calcification, defined as a distinct radiopaque area that moved synchronously with the cardiac contraction, was detected in 30 patients (19%). After endocardial ablation, only 6 patients (20%) with MC were rendered non-inducible compared with 56 (44%) without MC (P = 0.033) and of importance, 8 (27%) remained inducible for the clinical VT [compared with 9 (6%) patients without MC; P = 0.003] requiring therapy escalation. After a median follow-up of 31 months, 61 patients (39%) had VT recurrence and 47 (30%) died. Patients with MC had a lower survival free from the composite endpoint of VT recurrence or therapy escalation at 24-month follow-up (26% vs. 59%; P = 0.003). Presence of MC (HR 1.69; P = 0.046), a lower LV ejection fraction (HR 1.03 per 1% decrease; P = 0.017), and non-complete procedural success (HR 2.42; P = 0.002) were independently associated with a higher incidence of VT recurrence or therapy escalation. CONCLUSION Myocardial calcification was present in 19% of post-MI patients referred for VT ablation and was associated with a high incidence of endocardial ablation failure.
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Affiliation(s)
- Marta de Riva
- Department of Cardiology, Leiden University Medical Center, C-05-P, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Yoshihisa Naruse
- Department of Cardiology, Leiden University Medical Center, C-05-P, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Micaela Ebert
- Department of Cardiology, Leiden University Medical Center, C-05-P, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Masaya Watanabe
- Department of Cardiology, Leiden University Medical Center, C-05-P, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Arthur J Scholte
- Department of Cardiology, Leiden University Medical Center, C-05-P, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Adrianus P Wijnmaalen
- Department of Cardiology, Leiden University Medical Center, C-05-P, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Serge A Trines
- Department of Cardiology, Leiden University Medical Center, C-05-P, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Center, C-05-P, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Jose M Montero-Cabezas
- Department of Cardiology, Leiden University Medical Center, C-05-P, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, C-05-P, PO Box 9600, 2300 RC Leiden, The Netherlands
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7
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Briceño DF, Romero J, Patel K, Liaqat W, Zhang XD, Alviz I, Yang R, Rodriguez D, Lakkireddy D, Rocca DD, Tarantino N, Gopinathannair R, Natale A, Di Biase L. First-line ablation of ventricular tachycardia in ischemic cardiomyopathy: stratification of outcomes by left ventricular function. J Interv Card Electrophysiol 2020; 62:391-400. [PMID: 33179155 DOI: 10.1007/s10840-020-00912-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/01/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE First-line catheter ablation of ventricular tachycardia/ventricular fibrillation (VT/VF) in patients with ischemic cardiomyopathy (ICM) has been associated with improved outcomes; however, most benefit seems to be in patients with moderately depressed left ventricular ejection fraction (LVEF). Herein, outcomes were stratified based on LVEF. METHODS A meta-analysis of randomized controlled trials (RCTs) evaluating first-line ablation versus medical therapy in patients with VT and ICM was performed. Risk estimates and 95% confidence intervals (CI) were measured. RESULTS Four RCTs with a total of 505 patients (mean age 66 ± 9 years, 89% male, 80% with previous revascularization) were included. Mean LVEF was 35 ± 8%. At a mean follow-up of 24 ± 9 months, a significant benefit in survival-free from appropriate implantable cardioverter-defibrillator (ICD) therapies was observed in all patients undergoing first-line catheter ablation compared with medical management (RR 0.70, 95% CI 0.56-0.86). In patients with moderately depressed LVEF (> 30-50%), first-line VT ablation was associated with a statistically significant reduction in the composite endpoint of survival free from VT/VF and appropriate ICD therapies (HR 0.52, 95% CI 0.36-0.76), whereas there was no difference in patients with severely depressed LVEF (≤30%) (HR 0.56, 95% CI 0.24-1.32). Funnel plots did not show asymmetry suggesting lack of bias. CONCLUSIONS Patients with ICM and VT undergoing first-line ablation have a significantly lower rate of appropriate ICD therapies without a mortality difference compared with patients receiving an initial approach based on medical therapy. The beneficial effect of a first-line ablation approach was only observed in patients with moderately depressed LVEF (> 30-50%).
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Affiliation(s)
- David F Briceño
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA
| | - Jorge Romero
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA
| | - Kavisha Patel
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA
| | - Wasla Liaqat
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA
| | - Xiao-Dong Zhang
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA
| | - Isabella Alviz
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA
| | - Ruike Yang
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA
- Division of Cardiology, Department of Medicine, Henan Provincial People's Hospital, Zhengzhou, China
| | - Daniel Rodriguez
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA
| | | | | | - Nicola Tarantino
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Luigi Di Biase
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA.
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA.
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8
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Mukherjee RK, Roujol S, Chubb H, Harrison J, Williams S, Whitaker J, O'Neill L, Silberbauer J, Neji R, Schneider R, Pohl T, Lloyd T, O'Neill M, Razavi R. Epicardial electroanatomical mapping, radiofrequency ablation, and lesion imaging in the porcine left ventricle under real-time magnetic resonance imaging guidance-an in vivo feasibility study. Europace 2019; 20:f254-f262. [PMID: 29294008 PMCID: PMC6140436 DOI: 10.1093/europace/eux341] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 10/16/2017] [Indexed: 12/03/2022] Open
Abstract
Aims Magnetic resonance imaging (MRI) is the gold standard for defining myocardial substrate in 3D and can be used to guide ventricular tachycardia ablation. We describe the feasibility of using a prototype magnetic resonance-guided electrophysiology (MR-EP) system in a pre-clinical model to perform real-time MRI-guided epicardial mapping, ablation, and lesion imaging with active catheter tracking. Methods and results Experiments were performed in vivo in pigs (n = 6) using an MR-EP guidance system research prototype (Siemens Healthcare) with an irrigated ablation catheter (Vision-MR, Imricor) and a dedicated electrophysiology recording system (Advantage-MR, Imricor). Following epicardial access, local activation and voltage maps were acquired, and targeted radiofrequency (RF) ablation lesions were delivered. Ablation lesions were visualized in real time during RF delivery using MR-thermometry and dosimetry. Hyper-acute and acute assessment of ablation lesions was also performed using native T1 mapping and late-gadolinium enhancement (LGE), respectively. High-quality epicardial bipolar electrograms were recorded with a signal-to-noise ratio of greater than 10:1 for a signal of 1.5 mV. During epicardial ablation, localized temperature elevation could be visualized with a maximum temperature rise of 35 °C within 2 mm of the catheter tip relative to remote myocardium. Decreased native T1 times were observed (882 ± 107 ms) in the lesion core 3–5 min after lesion delivery and relative location of lesions matched well to LGE. There was a good correlation between ablation lesion site on the iCMR platform and autopsy. Conclusion The MR-EP system was able to successfully acquire epicardial voltage and activation maps in swine, deliver, and visualize ablation lesions, demonstrating feasibility for intraprocedural guidance and real-time assessment of ablation injury.
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Affiliation(s)
- Rahul K Mukherjee
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London, UK
| | - Sébastien Roujol
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London, UK
| | - Henry Chubb
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London, UK
| | - James Harrison
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London, UK
| | - Steven Williams
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London, UK
| | - John Whitaker
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London, UK
| | - Louisa O'Neill
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London, UK
| | - John Silberbauer
- Department of Cardiology, Brighton and Sussex University Hospital NHS Trust, Eastern Road, Brighton, UK
| | - Radhouene Neji
- Siemens Healthcare, Sir William Siemens Square, Frimley, Camberley, UK
| | | | | | - Tom Lloyd
- Imricor Medical Systems, 400 Gateway Blvd, Burnsville, MN, USA
| | - Mark O'Neill
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London, UK
| | - Reza Razavi
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London, UK
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Vroomen M, Maesen B, La Meir M, Luermans JGL, Vernooy K, Maessen JG, Crijns HJ, Pison L. Hybrid Ablation of Ventricular Tachycardia: a Single-Centre Experience. J Atr Fibrillation 2019; 11:2118. [PMID: 31139299 DOI: 10.4022/jafib.2118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 07/25/2018] [Accepted: 12/10/2018] [Indexed: 11/10/2022]
Abstract
Background The long-term results of endocardial and percutaneous epicardial catheter ablation of ventricular tachycardia (VT) in patients with structural heart disease are disappointing. Arrhythmia recurrence after ablation and VTs with an epicardial substrate remain a clinical challenge. The purpose of this manuscript is to elaborate on feasibility and potential advantages of a surgical hybrid ablation (i.e., combined endocardial and surgical epicardial ablation) based on our initial experience consisting of five cases. Methods Endocardial electro-anatomical voltage and activation maps were created (Carto, Biosense Webster, California, USA), and endocardial radiofrequency (RF) applications were applied at exit sites, low voltage areas and isthmi. Next, after surgical access, epicardial voltage and activation maps were produced in combination with visual assessment of the epicardial substrate. Epicardial low voltage areas, isthmi and exit sites were identified and ablated using RF energy. Results After the procedure, VT was non-inducible in 80% of the cases (4/5, in one case no induction was performed). No peri-procedural complications occurred. After a mean follow-up of 18 months, one patient remained in sinus rhythm without, and 2 with use of antiarrhythmic drugs. One patient needed a redo procedure after 21 months, and in one patient the amiodarone dose was raised because of 2 sustained VTs. After this additional treatment, both kept sinus rhythm. Conclusions Hybrid VT ablation is a safe and effective patient tailored procedure that comprises the major advantage of combining direct anatomical visualization and enhanced catheter stability with high-density 3D mapping. As a consequence, this procedure should be considered as a valid treatment option in complex VT management.
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Affiliation(s)
| | - Bart Maesen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Mark La Meir
- Department of Cardiac Surgery, UZ Brussel, Brussels, Belgium
| | | | | | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
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10
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Papageorgiou N, Providência R, Bronis K, Dechering DG, Srinivasan N, Eckardt L, Lambiase PD. Catheter ablation for ventricular tachycardia in patients with cardiac sarcoidosis: a systematic review. Europace 2019; 20:682-691. [PMID: 28444174 DOI: 10.1093/europace/eux077] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 02/22/2017] [Indexed: 12/22/2022] Open
Abstract
Aims Cardiac sarcoidosis (CS) is associated with a poor prognosis. Important features of CS include heart failure, conduction abnormalities, and ventricular arrhythmias. Ventricular tachycardia (VT) is often refractory to antiarrhythmic drugs (AAD) and immunosuppression. Catheter ablation has emerged as a treatment option for recurrent VT. However, data on the efficacy and outcomes of VT ablation in this context are sparse. Methods and results A systematic search was performed on PubMed, EMBASE, and Cochrane database (from inception to September 2016) with included studies providing a minimum of information on CS patients undergoing VT ablation: age, gender, VT cycle length, CS diagnosis criteria, and baseline medications. Five studies reporting on 83 patients were identified. The mean age of patients was 50 ± 8 years, 53/30 (males/females) with a maximum of 56 patients receiving immunosuppressive therapy, mean ejection fraction was 39.1 ± 3.1% and 94% had an implantable cardioverter defibrillator in situ. The median number of VTs was 3 (2.6-4.9)/patient, mean cycle length of 360 ms (326-400 ms). Hundred percent of VTs received endocardial ablation, and 18% required epicardial ablation. The complication rates were 4.7-6.3%. Relapse occurred in 45 (54.2%) patients with an incidence of relapse 0.33 (95% confidence interval 0.108-0.551, P < 0.004). Employing a less stringent endpoint (i.e. freedom from arrhythmia or reduction of ventricular arrhythmia burden), 61 (88.4%) patients improved following ablation. Conclusions These data support the utilization of catheter ablation in selected CS cases resistant to medical treatment. However, data are derived from observational non-controlled case series, with low-methodological quality. Therefore, future well-designed, randomized controlled trials, or large-scale registries are required.
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Affiliation(s)
- Nikolaos Papageorgiou
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK.,Institute of Cardiovascular Science, University College London, Gower St, London WC1E 6BT, UK
| | - Rui Providência
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Konstantinos Bronis
- Cardiology Department, Royal Brompton Hospital, Sydney St, SW3 6NP, London, UK
| | - Dirk G Dechering
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Neil Srinivasan
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Lars Eckardt
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Pier D Lambiase
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK.,Institute of Cardiovascular Science, University College London, Gower St, London WC1E 6BT, UK
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11
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Romero J, Cerrud-Rodriguez RC, Di Biase L, Diaz JC, Alviz I, Grupposo V, Cerna L, Avendano R, Tedrow U, Natale A, Tung R, Kumar S. Combined Endocardial-Epicardial Versus Endocardial Catheter Ablation Alone for Ventricular Tachycardia in Structural Heart Disease. JACC Clin Electrophysiol 2019; 5:13-24. [DOI: 10.1016/j.jacep.2018.08.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/13/2018] [Accepted: 08/15/2018] [Indexed: 01/06/2023]
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12
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Guler TE, Yalin K, Aksu T, Golcuk E, Sanli S, Kaya Bilge A, Adalet K. Prognostic value role of radiofrequency lesion size by cardiac magnetic resonance imaging on outcomes of ablation in patients with ischemic scar-related ventricular tachycardia: A single center pilot study. Medicine (Baltimore) 2018; 97:e12955. [PMID: 30431569 PMCID: PMC6257390 DOI: 10.1097/md.0000000000012955] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Inadequate ablation lesion formation may be responsible for post-ablation ventricular tachycardia (VT) recurrences.We aimed to evaluate whether visualisation of radiofrequency (RF) lesion size by cardiac magnetic resonance imaging (CMR) has any role in predicting adequacy of lesion and in estimating outcome.Retrospective pilot studyNine consecutive patients (8 male, age 60 ± 13 years) underwent ablation for sustained VT because of ischemic scar were evaluated for pre- and post-procedure scar tissue by CMR to characterize ablation lesions. Microvascular obstruction (MVO) surrounded by late gadolinium enhancement was defined as irreversible RF lesion. All patients were followed for at least 6 months for recurrences.Five of the patients had previous inferior myocardial infarction (MI), whereas remaining 4 had anterior MI. Acute procedural success, as defined by termination of the arrhythmia without recurrence in 30 minutes, was attained in all patients. Contrast enhancement and wall motion abnormality in presumed infarction area were confirmed by pre-ablation CMR images. MVO was detected at the reported ablation site in 6/9 patients, all arrhythmia- and symptom-free at median 24 months (range 8-38 months) follow-up. In remaining 3 patients who had VT recurrence (clinical VT in 2, sustain VT with a new morphology in 1), MVO was not detected despite achievement of acute procedural success. There was no correlation with pre-ablation scar size and clinical arrhythmia recurrence.CMR is a useful imaging modality to guide ablation procedures by detecting scar tissue. Additionally MVO seen by post-procedural imaging may be related to adequacy of RF ablation lesions and may correlate with clinical outcome.
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Affiliation(s)
- Tümer Erdem Guler
- University of Health Sciences, Kocaeli Derince Education and Research Hospital, Department of Cardiology, Kocaeli
| | - Kivanç Yalin
- Usak University, Faculty of Medicine, Department of Cardiology, Usak
| | - Tolga Aksu
- University of Health Sciences, Kocaeli Derince Education and Research Hospital, Department of Cardiology, Kocaeli
| | - Ebru Golcuk
- Balikesir University, Faculty of Medicine, Department of Cardiology, Balikesir
| | | | - Ahmet Kaya Bilge
- Istanbul University, Istanbul Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Kamil Adalet
- Istanbul University, Istanbul Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
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Spartalis M, Spartalis E, Tzatzaki E, Tsilimigras DI, Moris D, Kontogiannis C, Livanis E, Iliopoulos DC, Voudris V, Theodorakis GN. Novel approaches for the treatment of ventricular tachycardia. World J Cardiol 2018; 10:52-59. [PMID: 30079151 PMCID: PMC6068734 DOI: 10.4330/wjc.v10.i7.52] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 03/24/2018] [Accepted: 06/27/2018] [Indexed: 02/06/2023] Open
Abstract
Ventricular tachycardia (VT) is a crucial cause of sudden cardiac death (SCD) and a primary cause of mortality and morbidity in patients with structural cardiac disease. VT includes clinical disorders varying from benign to life-threatening. Most life-threatening episodes are correlated with coronary artery disease, but the risk of SCD varies in certain populations, with various underlying heart conditions, specific family history, and genetic variants. The targets of VT management are symptom alleviation, improved quality of life, reduced implantable cardioverter defibrillator shocks, prevention of reduction of left ventricular function, reduced risk of SCD, and improved overall survival. Antiarrhythmic drug therapy and endocardial catheter ablation remains the cornerstone of guideline-endorsed VT treatment strategies in patients with structural cardiac abnormalities. Novel strategies such as epicardial ablation, surgical cryoablation, transcoronary alcohol ablation, pre-procedural imaging, and stereotactic ablative radiotherapy are an appealing area of research. In this review, we gathered all recent advances in innovative therapies as well as experimental evidence focusing on different aspects of VT treatment that could be significant for future favorable clinical applications.
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Affiliation(s)
- Michael Spartalis
- ESC Working Group on Cardiac Cellular Electrophysiology, Sophia Antipolis Cedex 06903, France
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Eleftherios Spartalis
- Laboratory of Experimental Surgery and Surgical Research, University of Athens Medical School, Athens 11527, Greece
| | - Eleni Tzatzaki
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Diamantis I Tsilimigras
- Laboratory of Experimental Surgery and Surgical Research, University of Athens Medical School, Athens 11527, Greece
| | - Demetrios Moris
- Department of Surgery, Duke University, Durham, NC 27710, United States
| | - Christos Kontogiannis
- Department of Clinical Therapeutics, “Alexandra” Hospital, University of Athens, Athens 11528, Greece
| | - Efthimios Livanis
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Dimitrios C Iliopoulos
- Laboratory of Experimental Surgery and Surgical Research, University of Athens Medical School, Athens 11527, Greece
| | - Vassilis Voudris
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens 17674, Greece
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14
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Deng D, Arevalo HJ, Prakosa A, Callans DJ, Trayanova NA. A feasibility study of arrhythmia risk prediction in patients with myocardial infarction and preserved ejection fraction. Europace 2017; 18:iv60-iv66. [PMID: 28011832 DOI: 10.1093/europace/euw351] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 08/17/2016] [Indexed: 12/27/2022] Open
Abstract
AIM To predict arrhythmia susceptibility in myocardial infarction (MI) patients with left ventricular ejection fraction (LVEF) >35% using a personalized virtual heart simulation approach. METHODS AND RESULTS A total of four contrast enhanced magnetic resonance imaging (MRI) datasets of patient hearts with MI and average LVEF of 44.0 ± 2.6% were used in this study. Because of the preserved LVEF, the patients were not indicated for implantable cardioverter defibrillator (ICD) insertion. One patient had spontaneous ventricular tachycardia (VT) prior to the MRI scan; the others had no arrhythmic events. Simulations of arrhythmia susceptibility were blind to clinical outcome. Models were constructed from patient MRI images segmented to identify myocardium, grey zone, and scar based on pixel intensity. Grey zone was modelled as having altered electrophysiology. Programmed electrical stimulation (PES) was performed to assess VT inducibility from 19 bi-ventricular sites in each heart model. Simulations successfully predicted arrhythmia risk in all four patients. For the patient with arrhythmic event, in-silico PES resulted in VT induction. Simulations correctly predicted that VT was non-inducible for the three patients with no recorded VT events. CONCLUSIONS Results demonstrate that the personalized virtual heart simulation approach may provide a novel risk stratification modality to non-invasively and effectively identify patients with LVEF >35% who could benefit from ICD implantation.
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Affiliation(s)
- Dongdong Deng
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, 3400 North Charles Street, Hackerman 216, Baltimore, MD 21218, USA
| | - Hermenegild J Arevalo
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, 3400 North Charles Street, Hackerman 216, Baltimore, MD 21218, USA
| | - Adityo Prakosa
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, 3400 North Charles Street, Hackerman 216, Baltimore, MD 21218, USA
| | - David J Callans
- Division of Cardiovascular Medicine, Electrophysiology Section, University of Pennsylvania, 3400 Spruce St, 9 Founders Pavillion, Philadelphia, PA 19104
| | - Natalia A Trayanova
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, 3400 North Charles Street, Hackerman 216, Baltimore, MD 21218, USA
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15
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Batul SA, Olshansky B, Fisher JD, Gopinathannair R. Recent advances in the management of ventricular tachyarrhythmias. F1000Res 2017; 6:1027. [PMID: 28721212 PMCID: PMC5497814 DOI: 10.12688/f1000research.11202.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/26/2017] [Indexed: 01/14/2023] Open
Abstract
Ventricular arrhythmias are an important cause of cardiovascular morbidity and mortality, particularly in those with structural heart disease, inherited cardiomyopathies, and channelopathies. The goals of ventricular arrhythmia management include symptom relief, improving quality of life, reducing implantable cardioverter defibrillator shocks, preventing deterioration of left ventricular function, reducing risk of arrhythmic death, and potentially improving overall survival. Guideline-directed medical therapy and implantable cardioverter defibrillator implantation remain the mainstay of therapy to prevent sudden cardiac death in patients with ventricular arrhythmias in the setting of structural heart disease. Recent advances in imaging modalities and commercial availability of genetic testing panels have enhanced our mechanistic understanding of the disease processes and, along with significant progress in catheter-based ablative therapies, have enabled a tailored and more effective management of drug-refractory ventricular arrhythmias. Several gaps in our knowledge remain and require further research. In this article, we review the recent advances in the diagnosis and management of ventricular arrhythmias.
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Affiliation(s)
- Syeda Atiqa Batul
- Arrhythmia Division, Montefiore Medical Center, Bronx, New York, USA
| | | | - John D Fisher
- Arrhythmia Division, Montefiore Medical Center, Bronx, New York, USA
| | - Rakesh Gopinathannair
- Division of Cardiovascular Medicine, University of Louisville School of Medicine, Louisville, USA
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16
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Nguyên UC, Maffessanti F, Mafi-Rad M, Conte G, Zeemering S, Regoli F, Caputo ML, van Stipdonk AMW, Bekkers SCAM, Suerder D, Moccetti T, Krause R, Prinzen FW, Vernooy K, Auricchio A. Evaluation of the use of unipolar voltage amplitudes for detection of myocardial scar assessed by cardiac magnetic resonance imaging in heart failure patients. PLoS One 2017; 12:e0180637. [PMID: 28678875 PMCID: PMC5498065 DOI: 10.1371/journal.pone.0180637] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 06/19/2017] [Indexed: 11/23/2022] Open
Abstract
Background Validation of voltage-based scar delineation has been limited to small populations using mainly endocardial measurements. The aim of this study is to compare unipolar voltage amplitudes (UnipV) with scar on delayed enhancement cardiac magnetic resonance imaging (DE-CMR). Methods Heart failure patients who underwent DE-CMR and electro-anatomic mapping were included. Thirty-three endocardial mapped patients and 27 epicardial mapped patients were investigated. UnipV were computed peak-to-peak. Electrograms were matched with scar extent of the corresponding DE-CMR segment using a 16-segment/slice model. Non-scar was defined as 0% scar, while scar was defined as 1–100% scar extent. Results UnipVs were moderately lower in scar than in non-scar (endocardial 7.1 [4.6–10.6] vs. 10.3 [7.4–14.2] mV; epicardial 6.7 [3.6–10.5] vs. 7.8 [4.2–12.3] mV; both p<0.001). The correlation between UnipV and scar extent was moderate for endocardial (R = -0.33, p<0.001), and poor for epicardial measurements (R = -0.07, p<0.001). Endocardial UnipV predicted segments with >25%, >50% and >75% scar extent with AUCs of 0.72, 0.73 and 0.76, respectively, while epicardial UnipV were poor scar predictors, independent of scar burden (AUC = 0.47–0.56). UnipV in non-scar varied widely between patients (p<0.001) and were lower in scar compared to non-scar in only 9/22 (41%) endocardial mapped patients and 4/19 (21%) epicardial mapped patients with scar. Conclusion UnipV are slightly lower in scar compared to non-scar. However, significant UnipV differences between and within patients and large overlap between non-scar and scar limits the reliability of accurate scar assessment, especially in epicardial measurements and in segments with less than 75% scar extent.
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Affiliation(s)
- Uyên Châu Nguyên
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
- Center for Computational Medicine in Cardiology, Institute of Computational Science, Università della Svizzera italiana, Lugano, Switzerland
- * E-mail:
| | - Francesco Maffessanti
- Center for Computational Medicine in Cardiology, Institute of Computational Science, Università della Svizzera italiana, Lugano, Switzerland
| | - Masih Mafi-Rad
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Giulio Conte
- Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Stef Zeemering
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - François Regoli
- Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Maria Luce Caputo
- Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | | | | | - Daniel Suerder
- Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Tiziano Moccetti
- Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Rolf Krause
- Center for Computational Medicine in Cardiology, Institute of Computational Science, Università della Svizzera italiana, Lugano, Switzerland
| | - Frits W. Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
- Center for Computational Medicine in Cardiology, Institute of Computational Science, Università della Svizzera italiana, Lugano, Switzerland
| | - Kevin Vernooy
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Angelo Auricchio
- Center for Computational Medicine in Cardiology, Institute of Computational Science, Università della Svizzera italiana, Lugano, Switzerland
- Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
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Peinado R, Ruiz-Mateas F, Izquierdo M, Arana E, Robledo M, Arias MA, Jiménez-Jáimez J, Rodríguez-Mañero M, Chimeno J. Selección de temas de actualidad en arritmias y estimulación cardiaca 2015. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2015.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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18
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Common swine models of cardiovascular disease for research and training. Lab Anim (NY) 2016; 45:67-74. [DOI: 10.1038/laban.935] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 09/28/2015] [Indexed: 12/14/2022]
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19
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Peinado R, Ruiz-Mateas F, Izquierdo M, Arana E, Robledo M, Arias MA, Jiménez-Jáimez J, Rodríguez-Mañero M, Chimeno J. Cardiac Arrhythmias and Pacing 2015: A Selection of Topical Issues. ACTA ACUST UNITED AC 2016; 69:167-75. [PMID: 26778594 DOI: 10.1016/j.rec.2015.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/02/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Rafael Peinado
- Unidad de Arritmias y Electrofisiología Cardiaca, Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain.
| | - Francisco Ruiz-Mateas
- Unidad de Estimulación Cardiaca, Área de Cardiología, Hospital Costa del Sol, Marbella, Malaga, Spain
| | - Maite Izquierdo
- Unidad de Arritmias, Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Eduardo Arana
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Maria Robledo
- Sección de Arritmias, Servicio de Cardiología, Hospital Universitario Araba, Vitoria, Álava, Spain
| | - Miguel Angel Arias
- Unidad de Arritmias y Electrofisiología Cardiaca, Servicio de Cardiología, Hospital Virgen de la Salud, Toledo, Spain
| | - Juan Jiménez-Jáimez
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Moisés Rodríguez-Mañero
- Unidad de Arritmias, Departamento de Cardiología, Complejo Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Javier Chimeno
- Sección de Cardiología, Hospital Virgen de la Concha, Zamora, Spain
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Ávila P, Pérez-David E, Izquierdo M, Rojas-González A, Sánchez-Gómez JM, Ledesma-Carbayo MJ, López-Lereu MP, Loughlin G, Monmeneu JV, González-Torrecilla E, Atienza F, Datino T, Bravo L, Bermejo J, Fernández-Avilés F, Ruíz-Granel R, Arenal Á. Scar Extension Measured by Magnetic Resonance–Based Signal Intensity Mapping Predicts Ventricular Tachycardia Recurrence After Substrate Ablation in Patients With Previous Myocardial Infarction. JACC Clin Electrophysiol 2015; 1:353-365. [DOI: 10.1016/j.jacep.2015.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 07/20/2015] [Accepted: 07/30/2015] [Indexed: 11/29/2022]
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21
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Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, Elliott PM, Fitzsimons D, Hatala R, Hindricks G, Kirchhof P, Kjeldsen K, Kuck KH, Hernandez-Madrid A, Nikolaou N, Norekvål TM, Spaulding C, Van Veldhuisen DJ. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC)Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Europace 2015; 17:1601-87. [PMID: 26318695 DOI: 10.1093/europace/euv319] [Citation(s) in RCA: 217] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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22
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Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, Elliott PM, Fitzsimons D, Hatala R, Hindricks G, Kirchhof P, Kjeldsen K, Kuck KH, Hernandez-Madrid A, Nikolaou N, Norekvål TM, Spaulding C, Van Veldhuisen DJ. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J 2015; 36:2793-2867. [PMID: 26320108 DOI: 10.1093/eurheartj/ehv316] [Citation(s) in RCA: 2563] [Impact Index Per Article: 284.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
MESH Headings
- Acute Disease
- Aged
- Anti-Arrhythmia Agents/therapeutic use
- Arrhythmias, Cardiac/genetics
- Arrhythmias, Cardiac/therapy
- Autopsy/methods
- Cardiac Resynchronization Therapy/methods
- Cardiomyopathies/complications
- Cardiomyopathies/therapy
- Cardiotonic Agents/therapeutic use
- Catheter Ablation/methods
- Child
- Coronary Artery Disease/complications
- Coronary Artery Disease/therapy
- Death, Sudden, Cardiac/prevention & control
- Defibrillators
- Drug Therapy, Combination
- Early Diagnosis
- Emergency Treatment/methods
- Female
- Heart Defects, Congenital/complications
- Heart Defects, Congenital/therapy
- Heart Transplantation/methods
- Heart Valve Diseases/complications
- Heart Valve Diseases/therapy
- Humans
- Mental Disorders/complications
- Myocardial Infarction/complications
- Myocardial Infarction/therapy
- Myocarditis/complications
- Myocarditis/therapy
- Nervous System Diseases/complications
- Nervous System Diseases/therapy
- Out-of-Hospital Cardiac Arrest/therapy
- Pregnancy
- Pregnancy Complications, Cardiovascular/therapy
- Primary Prevention/methods
- Quality of Life
- Risk Assessment
- Sleep Apnea, Obstructive/complications
- Sleep Apnea, Obstructive/therapy
- Sports/physiology
- Stroke Volume/physiology
- Terminal Care/methods
- Ventricular Dysfunction, Left/complications
- Ventricular Dysfunction, Left/therapy
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Yalin K, Golcuk E, Aksu T. Cardiac Magnetic Resonance for Ventricular Arrhythmia Therapies in Patients with Coronary Artery Disease. J Atr Fibrillation 2015; 8:1242. [PMID: 27957178 DOI: 10.4022/jafib.1242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 05/20/2015] [Accepted: 05/20/2015] [Indexed: 11/10/2022]
Abstract
Cardiac magnetic resonance (CMR) imaging is currently gold standard for myocardial tissue characterization and scar assessment. CMR serves potential prognostic information in patients with coronary artery disease (CAD) for both ventricular arrhythmia risk, as well as it may also be used for guiding VT ablation procedures. This review is focused on the usefulness of CMR for ventricular arrhythmia therapies in patients with CAD.
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Affiliation(s)
| | - Ebru Golcuk
- Derince Education and Research Hospital, Turkey
| | - Tolga Aksu
- Bursa State Hospital, Cardiology Clinic, Turkey
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