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Liulu X, Balaji P, Barber J, De Silva K, Murray T, Hickey A, Campbell T, Harris J, Gee H, Ahern V, Kumar S, Hau E, Qian PC. Radiation therapy for ventricular arrhythmias. J Med Imaging Radiat Oncol 2024. [PMID: 38698577 DOI: 10.1111/1754-9485.13662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/15/2024] [Indexed: 05/05/2024]
Abstract
Ventricular arrhythmias (VA) can be life-threatening arrhythmias that result in significant morbidity and mortality. Catheter ablation (CA) is an invasive treatment modality that can be effective in the treatment of VA where medications fail. Recurrence occurs commonly following CA due to an inability to deliver lesions of adequate depth to cauterise the electrical circuits that drive VA or reach areas of scar responsible for VA. Stereotactic body radiotherapy is a non-invasive treatment modality that allows volumetric delivery of energy to treat circuits that cannot be reached by CA. It overcomes the weaknesses of CA and has been successfully utilised in small clinical trials to treat refractory VA. This article summarises the current evidence for this novel treatment modality and the steps that will be required to bring it to the forefront of VA treatment.
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Affiliation(s)
- Xingzhou Liulu
- Cardiology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Poornima Balaji
- Cardiology Department, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jeffrey Barber
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Kasun De Silva
- Cardiology Department, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Tiarne Murray
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
| | - Andrew Hickey
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
| | - Timothy Campbell
- Cardiology Department, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jill Harris
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
| | - Harriet Gee
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Verity Ahern
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Saurabh Kumar
- Cardiology Department, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Eric Hau
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Translational Radiation Biology and Oncology Laboratory, Centre for Cancer Research, The Westmead Institute for Medical Research, Sydney, New South Wales, Australia
- Blacktown Hematology and Cancer Centre, Blacktown Hospital, Blacktown, New South Wales, Australia
| | - Pierre C Qian
- Cardiology Department, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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2
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van der Ree MH, Hoeksema WF, Luca A, Visser J, Balgobind BV, Zumbrink M, Spier R, Herrera-Siklody C, Lee J, Bates M, Daniel J, Peedell C, Boda-Heggemann J, Rudic B, Merten R, Dieleman EM, Rinaldi CA, Ahmad S, Whitaker J, Bhagirath P, Hatton MQ, Riley S, Grehn M, Schiappacasse L, Blanck O, Hohmann S, Pruvot E, Postema PG. Stereotactic arrhythmia radioablation: A multicenter pre-post intervention safety evaluation of the implantable cardioverter-defibrillator function. Radiother Oncol 2023; 189:109910. [PMID: 37709052 DOI: 10.1016/j.radonc.2023.109910] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 09/08/2023] [Accepted: 09/08/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Stereotactic arrhythmia radioablation (STAR) appears to be beneficial in selected patients with therapy-refractory ventricular tachycardia (VT). However, high-dose radiotherapy used for STAR-treatment may affect functioning of the patients' implantable cardioverter defibrillator (ICD) by direct effects of radiation on ICD components or cardiac tissue. Currently, the effect of STAR on ICD functioning remains unknown. METHODS A retrospective pre-post multicenter study evaluating ICD functioning in the 12-month before and after STAR was performed. Patients with (non)ischemic cardiomyopathies with therapy-refractory VT and ICD who underwent STAR were included and the occurrence of ICD-related adverse events was collected. Evaluated ICD parameters included sensing, capture threshold and impedance. A linear mixed-effects model was used to investigate the association between STAR, radiotherapy dose and changes in lead parameters over time. RESULTS In total, 43 patients (88% male) were included in this study. All patients had an ICD with an additional right atrial lead in 34 (79%) and a ventricular lead in 17 (40%) patients. Median ICD-generator dose was 0.1 Gy and lead tip dose ranged from 0-32 Gy. In one patient (2%), a reset occurred during treatment, but otherwise, STAR and radiotherapy dose were not associated with clinically relevant alterations in ICD leads parameters. CONCLUSIONS STAR treatment did not result in major ICD malfunction. Only one radiotherapy related adverse event occurred during the study follow-up without patient harm. No clinically relevant alterations in ICD functioning were observed after STAR in any of the leads. With the reported doses STAR appears to be safe.
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Affiliation(s)
- Martijn H van der Ree
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, the Netherlands; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Wiert F Hoeksema
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Adrian Luca
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Jorrit Visser
- Amsterdam UMC location University of Amsterdam, Department of Radiation Oncology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Brian V Balgobind
- Amsterdam UMC location University of Amsterdam, Department of Radiation Oncology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Michiel Zumbrink
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Raymond Spier
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Meibergdreef 9, Amsterdam, the Netherlands
| | | | - Justin Lee
- Department of Cardiology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Matthew Bates
- Department of Cardiology, South Tees Hospitals NHS Foundation Trust, Middleborough, UK
| | - Jim Daniel
- Department of Radiation Oncology, South Tees Hospitals NHS Foundation Trust, Middlesborough, UK
| | - Clive Peedell
- Department of Radiation Oncology, South Tees Hospitals NHS Foundation Trust, Middlesborough, UK
| | - Judit Boda-Heggemann
- Department of Radiation Oncology, University Medical Center Mannheim University of Heidelberg, Mannheim, Germany
| | - Boris Rudic
- Department of Cardiology, University Medical Center Mannheim University of Heidelberg, Mannheim, Germany
| | - Roland Merten
- Department of Radiation Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Edith M Dieleman
- Amsterdam UMC location University of Amsterdam, Department of Radiation Oncology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Cristopher A Rinaldi
- Department of Cardiology, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Shahreen Ahmad
- Department of Radiation Oncology, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - John Whitaker
- Department of Cardiology, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Pranav Bhagirath
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Meibergdreef 9, Amsterdam, the Netherlands; Department of Cardiology, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Matthew Q Hatton
- Department of Clinical Oncology, Weston Park Hospital, Sheffield, UK
| | - Stephen Riley
- Department of Clinical Oncology, Weston Park Hospital, Sheffield, UK
| | - Melanie Grehn
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Luis Schiappacasse
- Department of Radiation Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | - Oliver Blanck
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Stephan Hohmann
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Etienne Pruvot
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Pieter G Postema
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Meibergdreef 9, Amsterdam, the Netherlands.
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3
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Balgobind BV, Visser J, Grehn M, Marquard Knap M, de Ruysscher D, Levis M, Alcantara P, Boda-Heggemann J, Both M, Cozzi S, Cvek J, Dieleman EMT, Elicin O, Giaj-Levra N, Jumeau R, Krug D, Algara López M, Mayinger M, Mehrhof F, Miszczyk M, Pérez-Calatayud MJ, van der Pol LHG, van der Toorn PP, Vitolo V, Postema PG, Pruvot E, Verhoeff JC, Blanck O. Refining critical structure contouring in STereotactic Arrhythmia Radioablation (STAR): Benchmark results and consensus guidelines from the STOPSTORM.eu consortium. Radiother Oncol 2023; 189:109949. [PMID: 37827279 DOI: 10.1016/j.radonc.2023.109949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/05/2023] [Accepted: 10/09/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND AND PURPOSE In patients with recurrent ventricular tachycardia (VT), STereotactic Arrhythmia Radioablation (STAR) shows promising results. The STOPSTORM.eu consortium was established to investigate and harmonise STAR treatment in Europe. The primary goals of this benchmark study were to standardise contouring of organs at risk (OAR) for STAR, including detailed substructures of the heart, and accredit each participating centre. MATERIALS AND METHODS Centres within the STOPSTORM.eu consortium were asked to delineate 31 OAR in three STAR cases. Delineation was reviewed by the consortium expert panel and after a dedicated workshop feedback and accreditation was provided to all participants. Further quantitative analysis was performed by calculating DICE similarity coefficients (DSC), median distance to agreement (MDA), and 95th percentile distance to agreement (HD95). RESULTS Twenty centres participated in this study. Based on DSC, MDA and HD95, the delineations of well-known OAR in radiotherapy were similar, such as lungs (median DSC = 0.96, median MDA = 0.1 mm and median HD95 = 1.1 mm) and aorta (median DSC = 0.90, median MDA = 0.1 mm and median HD95 = 1.5 mm). Some centres did not include the gastro-oesophageal junction, leading to differences in stomach and oesophagus delineations. For cardiac substructures, such as chambers (median DSC = 0.83, median MDA = 0.2 mm and median HD95 = 0.5 mm), valves (median DSC = 0.16, median MDA = 4.6 mm and median HD95 = 16.0 mm), coronary arteries (median DSC = 0.4, median MDA = 0.7 mm and median HD95 = 8.3 mm) and the sinoatrial and atrioventricular nodes (median DSC = 0.29, median MDA = 4.4 mm and median HD95 = 11.4 mm), deviations between centres occurred more frequently. After the dedicated workshop all centres were accredited and contouring consensus guidelines for STAR were established. CONCLUSION This STOPSTORM multi-centre critical structure contouring benchmark study showed high agreement for standard radiotherapy OAR. However, for cardiac substructures larger disagreement in contouring occurred, which may have significant impact on STAR treatment planning and dosimetry evaluation. To standardize OAR contouring, consensus guidelines for critical structure contouring in STAR were established.
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Affiliation(s)
- Brian V Balgobind
- Department of Radiation Oncology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands.
| | - Jorrit Visser
- Department of Radiation Oncology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Melanie Grehn
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | | | - Dirk de Ruysscher
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University, Maastricht, the Netherlands
| | - Mario Levis
- Department of Oncology, University of Torino, Torino, Italy
| | - Pino Alcantara
- Department of Radiation Oncology, Hospital Clínico San Carlos, Faculty of Medicine, University Complutense of Madrid, Madrid, Spain
| | - Judit Boda-Heggemann
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Marcus Both
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Salvatore Cozzi
- Radiation Oncology Unit, Azienda USL-IRCCS, Reggio Emilia, Italy; Radiation Oncology Department, Centre Léon Bérard, Lyon, France
| | - Jakub Cvek
- Department of Oncology, University Hospital and Faculty of Medicine, Ostrava, Czech Republic
| | - Edith M T Dieleman
- Department of Radiation Oncology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Niccolò Giaj-Levra
- Department of Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Raphaël Jumeau
- Department of Radio-Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | - David Krug
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Manuel Algara López
- Department of Radiotherapy, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain
| | - Michael Mayinger
- Department of Radiation Oncology, University Hospital of Zurich, Zurich, Switzerland
| | - Felix Mehrhof
- Department for Radiation Oncology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marcin Miszczyk
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | | | - Luuk H G van der Pol
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Viviana Vitolo
- Radiation Oncology Clinical Department, National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Pieter G Postema
- Department of Cardiology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Etienne Pruvot
- Heart and Vessel Department, Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Joost C Verhoeff
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Oliver Blanck
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
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4
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van der Ree MH, Dieleman EMT, Visser J, Planken RN, Boekholdt SM, de Bruin-Bon RHA, Rasch CRN, Hoeksema WF, de Jong RMAJ, Kemme MJB, Balt JC, Wilde AAM, Balgobind BV, Postema PG. Non-invasive stereotactic arrhythmia radiotherapy for ventricular tachycardia: results of the prospective STARNL-1 trial. Europace 2023; 25:1015-1024. [PMID: 36746553 PMCID: PMC10062344 DOI: 10.1093/europace/euad020] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/09/2023] [Indexed: 02/08/2023] Open
Abstract
AIMS Stereotactic arrhythmia radiotherapy (STAR) is suggested as potentially effective and safe treatment for patients with therapy-refractory ventricular tachycardia (VT). However, the current prospective knowledge base and experience with STAR is limited. In this study we aimed to prospectively evaluate the efficacy and safety of STAR. METHODS AND RESULTS The StereoTactic Arrhythmia Radiotherapy in the Netherlands no.1 was a pre-post intervention study to prospectively evaluate efficacy and safety of STAR. In patients with therapy-refractory VT, the pro-arrhythmic region was treated with a 25 Gy single radiotherapy fraction. The main efficacy measure was a reduction in the number of treated VT-episodes by ≥50%, comparing the 12 months before and after treatment (or end of follow-up, excluding a 6-week blanking period). The study was deemed positive when ≥50% of patients would meet this criterion. Safety evaluation included left ventricular ejection fraction, pulmonary function, and adverse events. Six male patients with an ischaemic cardiomyopathy were enrolled, and median age was 73 years (range 54-83). Median left ventricular ejection fraction was 38% (range 24-52). The median planning target volume was 187 mL (range 93-372). Four (67%) patients completed the 12-month follow-up, and two patients died (not STAR related) during follow-up. The main efficacy measure of ≥50% reduction in treated VT-episodes at the end of follow-up was achieved in four patients (67%). The median number of treated VT-episodes was reduced by 87%. No reduction in left ventricular ejection fraction or pulmonary function was observed. No treatment related serious adverse events occurred. CONCLUSIONS STAR resulted in a ≥ 50% reduction in treated VT-episodes in 4/6 (67%) patients. No reduction in cardiac and pulmonary function nor treatment-related serious adverse events were observed during follow-up. CLINICAL TRIAL REGISTRATION Netherlands Trial Register-NL7510.
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Affiliation(s)
- Martijn H van der Ree
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Meibergdreef 9, Amsterdam, the Netherlands.,Amsterdam Cardiovascular Sciences, Heart Failure and arrhythmias, Amsterdam, the Netherlands
| | - Edith M T Dieleman
- Amsterdam UMC location University of Amsterdam, Department of Radiation Oncology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Jorrit Visser
- Amsterdam UMC location University of Amsterdam, Department of Radiation Oncology, Meibergdreef 9, Amsterdam, The Netherlands
| | - R Nils Planken
- Amsterdam UMC location University of Amsterdam, Department of Radiology, Meibergdreef 9, Amsterdam, The Netherlands
| | - S Matthijs Boekholdt
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Meibergdreef 9, Amsterdam, the Netherlands.,Amsterdam Cardiovascular Sciences, Heart Failure and arrhythmias, Amsterdam, the Netherlands
| | - Rianne H A de Bruin-Bon
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Meibergdreef 9, Amsterdam, the Netherlands.,Amsterdam Cardiovascular Sciences, Heart Failure and arrhythmias, Amsterdam, the Netherlands
| | - Coen R N Rasch
- Leiden UMC, University of Leiden, Department of Radiation Oncology, Albinusdreef 2, Leiden, The Netherlands
| | - Wiert F Hoeksema
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Meibergdreef 9, Amsterdam, the Netherlands.,Amsterdam Cardiovascular Sciences, Heart Failure and arrhythmias, Amsterdam, the Netherlands
| | - Rianne M A J de Jong
- Amsterdam UMC location University of Amsterdam, Department of Radiation Oncology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Michiel J B Kemme
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Clinical and Experimental Cardiology, Boelelaan 1117, Amsterdam, The Netherlands
| | - Jippe C Balt
- St. Antonius Hospital, Department of Cardiology, Koekoekslaan 1, Nieuwegein, The Netherlands
| | - Arthur A M Wilde
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Meibergdreef 9, Amsterdam, the Netherlands.,Amsterdam Cardiovascular Sciences, Heart Failure and arrhythmias, Amsterdam, the Netherlands
| | - Brian V Balgobind
- Amsterdam UMC location University of Amsterdam, Department of Radiation Oncology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Pieter G Postema
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Meibergdreef 9, Amsterdam, the Netherlands.,Amsterdam Cardiovascular Sciences, Heart Failure and arrhythmias, Amsterdam, the Netherlands
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5
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Bodin A, Labas V, Bisson A, Teixeira-Gomes AP, Blasco H, Tomas D, Combes-Soia L, Marcelo P, Miquelestorena-Standley E, Baron C, Angoulvant D, Babuty D, Clementy N. Acute pathophysiological myocardial changes following intra-cardiac electrical shocks using a proteomic approach in a sheep model. Sci Rep 2020; 10:20252. [PMID: 33219330 PMCID: PMC7679418 DOI: 10.1038/s41598-020-77346-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/04/2020] [Indexed: 12/18/2022] Open
Abstract
Implantable cardioverter-defibrillators (ICD) are meant to fight life-threatening ventricular arrhythmias and reduce overall mortality. Ironically, life-saving shocks themselves have been shown to be independently associated with an increased mortality. We sought to identify myocardial changes at the protein level immediately after ICD electrical shocks using a proteomic approach. ICD were surgically implanted in 10 individuals of a healthy male sheep model: a control group (N = 5) without any shock delivery and a shock group (N = 5) with the delivery of 5 consecutive shocks at 41 J. Myocardial tissue samples were collected at the right-ventricle apex near to the lead coil and at the right ventricle basal free wall region. Global quantitative proteomics experiments on myocardial tissue samples were performed using mass spectrometry techniques. Proteome was significantly modified after electrical shock and several mechanisms were associated: protein, DNA and membrane damages due to extreme physical conditions induced by ICD-shock but also due to regulated cell death; metabolic remodeling; oxidative stress; calcium dysregulation; inflammation and fibrosis. These proteome modifications were seen in myocardium both “near” and “far” from electrical shock region. N-term acetylated troponin C was an interesting tissular biomarker, significantly decreased after electrical shock in the “far” region (AUC: 0.93). Our data support an acute shock-induced myocardial tissue injury which might be involved in acute paradoxical deleterious effects such as heart failure and ventricular arrhythmias.
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Affiliation(s)
- Alexandre Bodin
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France. .,INRAE, CNRS, IFCE, UMR PRC, Université de Tours, 37380, Nouzilly, France.
| | - Valérie Labas
- INRAE, CNRS, IFCE, UMR PRC, Université de Tours, 37380, Nouzilly, France.,INRAE, CHU de Tours, Plate-Forme de Chirurgie Et D'Imagerie Pour La Recherche Et L'Enseignement, Université de Tours, 37380, Nouzilly, France
| | - Arnaud Bisson
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France
| | | | - Hélène Blasco
- Imagerie Et Cerveau - UMR 1253, Université de Tours, Tours, France
| | - Daniel Tomas
- INRAE, CNRS, IFCE, UMR PRC, Université de Tours, 37380, Nouzilly, France.,INRAE, CHU de Tours, Plate-Forme de Chirurgie Et D'Imagerie Pour La Recherche Et L'Enseignement, Université de Tours, 37380, Nouzilly, France
| | - Lucie Combes-Soia
- INRAE, CNRS, IFCE, UMR PRC, Université de Tours, 37380, Nouzilly, France.,INRAE, CHU de Tours, Plate-Forme de Chirurgie Et D'Imagerie Pour La Recherche Et L'Enseignement, Université de Tours, 37380, Nouzilly, France
| | - Paulo Marcelo
- Plate-Forme ICAP, Centre Universitaire de Recherche en Santé, Université de Picardie Jules Verne, 80054, Amiens, France
| | | | - Christophe Baron
- Transplantation, Immunologie et Inflammation T2i - EA 4245, Université de Tours, Tours, France
| | - Denis Angoulvant
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France.,Transplantation, Immunologie et Inflammation T2i - EA 4245, Université de Tours, Tours, France
| | - Dominique Babuty
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France
| | - Nicolas Clementy
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France.,Transplantation, Immunologie et Inflammation T2i - EA 4245, Université de Tours, Tours, France
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6
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Laslett DB, Cooper JM, Greenberg RM, Yesenosky GA, Basil A, Gangireddy C, Whitman IR. Electrolyte Abnormalities in Patients Presenting With Ventricular Arrhythmia (from the LYTE-VT Study). Am J Cardiol 2020; 129:36-41. [PMID: 32565090 DOI: 10.1016/j.amjcard.2020.04.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/20/2020] [Accepted: 04/24/2020] [Indexed: 11/15/2022]
Abstract
Electrolyte abnormalities are a known trigger for ventricular arrhythmia, and patients with heart disease on diuretic therapy may be at higher risk for electrolyte depletion. Our aim was to determine the prevalence of electrolyte depletion in patients presenting to the hospital with sustained ventricular tachycardia or ventricular fibrillation (VT/VF) versus heart failure, and identify risk factors for electrolyte depletion. Consecutive admissions to a tertiary care hospital for VT/VF were identified between July 2016 and October 2018 using the electronic medical record and compared with an equal number of consecutive admissions for heart failure (CHF). The study included 280 patients (140 patients in each group; mean age 63, 60% male, 59% African American). Average EF in the VT/VF and CHF groups was 30% and 33%, respectively. Hypokalemia (K < 3.5 mmol/L) and severe hypokalemia (K < 3.0 mmol/L) were present in 35.7% and 13.6%, respectively, of patients with VT/VF, compared to 12.9% and 2.7% of patients with CHF (p < 0.001 and p = 0.001, respectively, between groups). Hypomagnesemia was found in 7.8% and 5.8% of VT/VF and CHF patients, respectively (p = 0.46). Gastrointestinal illness and recent increases in diuretic dose were strongly associated with severe hypokalemia in VT/VF patients (odds ratio: 11.1 and 21.9, respectively; p < 0.001). In conclusion, hypokalemia is extremely common in patients presenting with VT/VF, much more so than in patients with CHF alone. Preceding gastrointestinal illness and increase in diuretic dose were strongly associated with severe hypokalemia in the VT/VF population, revealing a potential opportunity for early intervention and arrhythmia risk reduction.
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Affiliation(s)
- David B Laslett
- Department of Medicine, Section of Cardiac Electrophysiology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Joshua M Cooper
- Department of Medicine, Section of Cardiac Electrophysiology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Richard M Greenberg
- Department of Medicine, Section of Cardiac Electrophysiology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - George A Yesenosky
- Department of Medicine, Section of Cardiac Electrophysiology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Anuj Basil
- Department of Medicine, Section of Cardiac Electrophysiology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Chethan Gangireddy
- Department of Medicine, Section of Cardiac Electrophysiology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Isaac R Whitman
- Department of Medicine, Section of Cardiac Electrophysiology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania.
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Tedrow UB, Stevenson WG. Delay in catheter ablation for ventricular tachycardia: a missed opportunity? Europace 2020; 22:3-4. [PMID: 31782788 DOI: 10.1093/europace/euz307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Usha B Tedrow
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, USA
| | - William G Stevenson
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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Al-Khatib SM, Granger CB. The changing epidemiology of ventricular arrhythmias and sudden cardiac death: Is it a reality? Heart Rhythm 2019; 16:367-368. [DOI: 10.1016/j.hrthm.2018.09.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Indexed: 10/28/2022]
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