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Kataoka N, Imamura T, Uchida K, Koi T, Kinugawa K. Significance of J waves in unexplained ventricular fibrillation among elderly populations with various comorbidities. Heart Rhythm O2 2024; 5:417-420. [PMID: 38984359 PMCID: PMC11228269 DOI: 10.1016/j.hroo.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024] Open
Affiliation(s)
- Naoya Kataoka
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Teruhiko Imamura
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Keisuke Uchida
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Takahisa Koi
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Koichiro Kinugawa
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
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2
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Kocsis L, Pap Z, László SA, Gábor-Kelemen H, Szabó IA, Heidenhoffer E, Frigy A. Exercise-Induced Electrocardiographic Changes in Healthy Young Males with Early Repolarization Pattern. Diagnostics (Basel) 2024; 14:980. [PMID: 38786277 PMCID: PMC11119175 DOI: 10.3390/diagnostics14100980] [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: 04/18/2024] [Revised: 05/04/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024] Open
Abstract
Background: Exercise-induced modifications in ECG parameters among individuals with an early repolarization pattern (ERP) have not been evaluated in detail. We aimed to assess this phenomenon, with potential associations with arrhythmogenesis. Methods: Twenty-three young, healthy males with ERP (ERP+) participated in this study, alongside a control group, which consisted of nineteen healthy males without ERP (ERP-). ECGs at baseline, at peak exercise (Bruce protocol), and during the recovery phase were analyzed and compared between the two groups. Results: The treadmill test demonstrated strong cardiovascular fitness, with similar chronotropic and pressor responses in both groups. In the baseline ECGs, the QRS complex and the QT interval were shorter in the ERP+ group. During exercise, the P-wave duration was significantly longer and the QRS was narrower in the ERP+ group. In the recovery phase, there was a longer P wave and a narrower QRS in the ERP+ group. During the treadmill test, the J wave disappeared or did not meet the criteria required for ERP diagnosis. Conclusions: The slowed intra-atrial conduction found during exercise could be predictive of atrial arrhythmogenesis in the setting of ERP. The disappearing of J waves during exercise, due to increased sympathetic activity, has potential clinical significance.
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Affiliation(s)
- Loránd Kocsis
- Department of Cardiology, Clinical County Hospital Mures, 540103 Targu Mures, Romania; (L.K.); (H.G.-K.); (I.A.S.); (E.H.); (A.F.)
- Department of Anatomy and Embryology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540103 Targu Mures, Romania
| | - Zsuzsanna Pap
- Department of Anatomy and Embryology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540103 Targu Mures, Romania
| | | | - Hunor Gábor-Kelemen
- Department of Cardiology, Clinical County Hospital Mures, 540103 Targu Mures, Romania; (L.K.); (H.G.-K.); (I.A.S.); (E.H.); (A.F.)
| | - István Adorján Szabó
- Department of Cardiology, Clinical County Hospital Mures, 540103 Targu Mures, Romania; (L.K.); (H.G.-K.); (I.A.S.); (E.H.); (A.F.)
| | - Erhard Heidenhoffer
- Department of Cardiology, Clinical County Hospital Mures, 540103 Targu Mures, Romania; (L.K.); (H.G.-K.); (I.A.S.); (E.H.); (A.F.)
| | - Attila Frigy
- Department of Cardiology, Clinical County Hospital Mures, 540103 Targu Mures, Romania; (L.K.); (H.G.-K.); (I.A.S.); (E.H.); (A.F.)
- Department of Internal Medicine IV, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540103 Targu Mures, Romania
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3
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Renard E, Surget E, Walton RD, Michel C, Benoist D, Dubes V, Guillot B, Martinez ME, Hocini M, Haïssaguerre M, Bernus O. Distinct Electrogram Features and Ventricular Arrhythmia Induction Modes Between Repolarization and Conduction Heterogeneities. JACC Clin Electrophysiol 2024:S2405-500X(24)00180-4. [PMID: 38661605 DOI: 10.1016/j.jacep.2024.03.002] [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: 10/04/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Recent clinical studies have indicated the presence of localized electrical abnormalities in idiopathic ventricular fibrillation and J-wave syndrome patients. OBJECTIVES This study aims to characterize the specific electrical signatures of localized repolarization and conduction heterogeneities and their respective role in vulnerability to arrhythmias. METHODS Optical mapping was performed in porcine right ventricles with local: 1) repolarization shortening; 2) conduction slowing; or 3) structural heterogeneity induced by locally perfusing: 1) pinacidil (20 μmol/L, n = 13); or 2) flecainide (2 μmol/L, n = 13) via an epicardial catheter; or 3) by local epicardial tissue destruction (9 radiofrequency lesions n = 12). Electrograms were recorded (n = 5 in each group) and spontaneous and induced arrhythmias were quantified and optically mapped. RESULTS Electrograms were normal in (1) but showed local fragmentation in 40% of preparations in (2) with greater effects observed at high pacing frequencies dependent on the wavefront direction. In (3), the structural substrate alone increased the width and number of peaks in the electrograms, and addition of flecainide induced pronounced fragmentation (≥3 peaks and ≥70 ms) in all cases. Occurrence of spontaneous arrhythmias was significantly increased in (1) and (2) (P < 0.0001 and 0.05, respectively, vs baseline) and were triggered by ectopies. Vulnerability to arrhythmias at high pacing frequencies (≥2 Hz) was the lowest in (1) and greatest in (2). CONCLUSIONS Microstructural substrates have the most pronounced impact on electrograms, especially when combined with sodium channel blockers, whereas local action potential duration shortening does not lead to electrogram fragmentation even though it is associated with the highest prevalence of spontaneous arrhythmias.
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Affiliation(s)
- Estelle Renard
- IHU LIRYC, L'Institut des maladies du RYthme Cardiaque, Fondation Bordeaux Université, Bordeaux, France; University of Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France.
| | - Elodie Surget
- IHU LIRYC, L'Institut des maladies du RYthme Cardiaque, Fondation Bordeaux Université, Bordeaux, France; University of Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - Richard D Walton
- IHU LIRYC, L'Institut des maladies du RYthme Cardiaque, Fondation Bordeaux Université, Bordeaux, France; University of Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - Cindy Michel
- IHU LIRYC, L'Institut des maladies du RYthme Cardiaque, Fondation Bordeaux Université, Bordeaux, France; University of Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - David Benoist
- IHU LIRYC, L'Institut des maladies du RYthme Cardiaque, Fondation Bordeaux Université, Bordeaux, France; University of Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - Virginie Dubes
- IHU LIRYC, L'Institut des maladies du RYthme Cardiaque, Fondation Bordeaux Université, Bordeaux, France; University of Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - Bastien Guillot
- IHU LIRYC, L'Institut des maladies du RYthme Cardiaque, Fondation Bordeaux Université, Bordeaux, France; University of Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - Marine E Martinez
- IHU LIRYC, L'Institut des maladies du RYthme Cardiaque, Fondation Bordeaux Université, Bordeaux, France; University of Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - Mélèze Hocini
- IHU LIRYC, L'Institut des maladies du RYthme Cardiaque, Fondation Bordeaux Université, Bordeaux, France; University of Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France; CHU de Bordeaux, Département d'électrophysiologie et de stimulation cardiaques, Hôpital Cardiologique du Haut-Lévêque, Pessac, France
| | - Michel Haïssaguerre
- IHU LIRYC, L'Institut des maladies du RYthme Cardiaque, Fondation Bordeaux Université, Bordeaux, France; University of Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France; CHU de Bordeaux, Département d'électrophysiologie et de stimulation cardiaques, Hôpital Cardiologique du Haut-Lévêque, Pessac, France
| | - Olivier Bernus
- IHU LIRYC, L'Institut des maladies du RYthme Cardiaque, Fondation Bordeaux Université, Bordeaux, France; University of Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
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Vacher E, Gourraud JB, Probst V. When to ablate in Brugada and early repolarization syndromes. Expert Rev Cardiovasc Ther 2024; 22:19-26. [PMID: 38427316 DOI: 10.1080/14779072.2024.2326549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/29/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Mapping advances have expanded both the feasibility and benefits of ablation as a therapeutic approach, including in the treatment of two heart conditions that contribute to sudden cardiac death in young people: Brugada syndrome (BrS) and early repolarization syndrome (ERS). Although these conditions share a number of similarities, debates persist regarding the underlying pathophysiology and origin of the ventricular arrhythmias associated with them. AREAS COVERED By synthesizing available data (PubMed), including current recommendations, pathophysiological insights and case reports, patient registries, our aim is to elucidate and establish the nuanced role of radiofrequency ablation (RFA) in therapeutic management. EXPERT OPINION RFA is a particularly promising approach in BrS, with a proven long-term benefit. Concerning ERS, RFA seems to be interesting at the price of more complex procedures with more nuanced results.
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Affiliation(s)
- Eloi Vacher
- Centre Hospitalier Universitaire d'Angers, Service de Cardiologie, Angers, France
| | - Jean Baptiste Gourraud
- Centre Hospitalier Universitaire de Nantes, Institut du Thorax, Service de Cardiologie, Nantes, France
| | - Vincent Probst
- Centre Hospitalier Universitaire de Nantes, Institut du Thorax, Service de Cardiologie, Nantes, France
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William J, Voskoboinik A. PVC Triggers in Early Repolarization Syndrome: A New Wave of Knowledge. JACC Clin Electrophysiol 2024; 10:13-15. [PMID: 38267166 DOI: 10.1016/j.jacep.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 01/26/2024]
Affiliation(s)
- Jeremy William
- Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia
| | - Aleksandr Voskoboinik
- Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia.
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Miyamoto M, Morita H, Mizuno T, Masuda T, Ueoka A, Asada S, Kawada S, Nakagawa K, Nishii N. Significance of left posterior extension of early repolarization in patients with J-wave syndrome. Heart Rhythm 2023; 20:1729-1736. [PMID: 37634559 DOI: 10.1016/j.hrthm.2023.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/22/2023] [Accepted: 08/22/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND J waves in the inferior or lateral leads are characteristic electrocardiographic (ECG) changes in patients with early repolarization syndrome (ERS). However, the presence of J waves in the left posterior region has not yet been evaluated. OBJECTIVE The purpose of this study was to clarify the significance of J waves in the posterior left ventricle using leads V7-V9 and a body surface mapping (BSM) system. METHODS Forty patients diagnosed with ERS were included. All patients exhibited J waves in either the contiguous inferior, lateral, or posterior leads. We evaluated the incidence of J waves in the inferolateral and posterior leads using a 15-lead ECG with synthesized V7-V9 and an 87-lead BSM. Additionally, we assessed the arrhythmogenicity of the posterior regions based on the morphology of the premature ventricular complexes (PVCs) associated with ventricular fibrillation (VF). RESULTS J waves were observed in the lateral, inferior, and posterior leads of 26 (65%), 31 (78%), and 39 (97%) patients, respectively. J waves were found only in the posterior leads of 5 patients. BSM was evaluated in 9 patients, all of whom exhibited a positive area on the posterior region. PVCs associated with VF were recorded in 5 patients. Among patients with inferolateral and posterior J waves, all except 1 patient who displayed left bundle branch block morphology showed PVCs originating from the posterior left ventricular region. CONCLUSION Posterior J waves are common in ERS patients. This abnormality can be detected using leads V7-V9 and the BSM system and may be associated with arrhythmogenesis.
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Affiliation(s)
- Masakazu Miyamoto
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan
| | - Hiroshi Morita
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
| | - Tomofumi Mizuno
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan
| | - Takuro Masuda
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan
| | - Akira Ueoka
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan
| | - Saori Asada
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan
| | - Satoshi Kawada
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan
| | - Koji Nakagawa
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan
| | - Nobuhiro Nishii
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan; Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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7
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Maruyama T, Uesako H. Lessons Learnt from Case Series of Out-of-hospital Cardiac Arrest and Unexpected Death after COVID-19 Vaccination. Intern Med 2023; 62:3267-3275. [PMID: 37612082 DOI: 10.2169/internalmedicine.2298-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Abstract
Vaccination against COVID-19 has raised concerns about myocarditis in young men, as out-of-hospital cardiac arrest (OHCA) or sudden death after vaccination has been reported sporadically. Common features of these cases are occurrence in young men, within a few weeks after vaccination, in patients with no structural heart diseases. Cases of unexplained nocturnal death showed fibrotic or hypertrophied myocardium, and one case of OHCA presented ventricular fibrillation (VF) triggered by a prominent J wave on an automated external defibrillator and histopathologic findings compatible with myocarditis. Both myocarditis and J waves are prevalent in young men, and these cases imply that myocarditis augments J waves, which trigger VFs, and primary electrical disorders are a leading cause of death. To prevent such issues, artificial intelligence (AI)-assisted interpretation of historical electrocardiogram findings may help predict future J wave formation leading to VF, as digital electrocardiogram (ECG) findings are well suited for AI interpretation.
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Affiliation(s)
- Toru Maruyama
- Professor Emeritus in Kyushu University, Kyushu University Hospital, Japan
- Haradoi Hospital, Japan
| | - Hayata Uesako
- Department of Internal Medicine, Suwa Central Hospital, Japan
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8
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Kawada S, Morita H, Miyamoto M, Asada S, Nakagawa K, Nishii N. Ventricular arrhythmias induced by phase 2 reentry in a patient with J-wave syndrome. HeartRhythm Case Rep 2023; 9:629-633. [PMID: 37746567 PMCID: PMC10511901 DOI: 10.1016/j.hrcr.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Affiliation(s)
- Satoshi Kawada
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroshi Morita
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Masakazu Miyamoto
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Saori Asada
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Koji Nakagawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Nobuhiro Nishii
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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9
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Renard E, Walton RD, Benoist D, Brette F, Bru-Mercier G, Chaigne S, Charron S, Constantin M, Douard M, Dubes V, Guillot B, Hof T, Magat J, Martinez ME, Michel C, Pallares-Lupon N, Pasdois P, Récalde A, Vaillant F, Sacher F, Labrousse L, Rogier J, Kyndt F, Baudic M, Schott JJ, Barc J, Probst V, Sarlandie M, Marionneau C, Ashton JL, Hocini M, Haïssaguerre M, Bernus O. Functional Epicardial Conduction Disturbances Due to a SCN5A Variant Associated With Brugada Syndrome. JACC Clin Electrophysiol 2023; 9:1248-1261. [PMID: 37227351 PMCID: PMC10406612 DOI: 10.1016/j.jacep.2023.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/06/2023] [Accepted: 03/10/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Brugada syndrome is a significant cause of sudden cardiac death (SCD), but the underlying mechanisms remain hypothetical. OBJECTIVES This study aimed to elucidate this knowledge gap through detailed ex vivo human heart studies. METHODS A heart was obtained from a 15-year-old adolescent boy with normal electrocardiogram who experienced SCD. Postmortem genotyping was performed, and clinical examinations were done on first-degree relatives. The right ventricle was optically mapped, followed by high-field magnetic resonance imaging and histology. Connexin-43 and NaV1.5 were localized by immunofluorescence, and RNA and protein expression levels were studied. HEK-293 cell surface biotinylation assays were performed to examine NaV1.5 trafficking. RESULTS A Brugada-related SCD diagnosis was established for the donor because of a SCN5A Brugada-related variant (p.D356N) inherited from his mother, together with a concomitant NKX2.5 variant of unknown significance. Optical mapping demonstrated a localized epicardial region of impaired conduction near the outflow tract, in the absence of repolarization alterations and microstructural defects, leading to conduction blocks and figure-of-8 patterns. NaV1.5 and connexin-43 localizations were normal in this region, consistent with the finding that the p.D356N variant does not affect the trafficking, nor the expression of NaV1.5. Trends of decreased NaV1.5, connexin-43, and desmoglein-2 protein levels were noted; however, the RT-qPCR results suggested that the NKX2-5 variant was unlikely to be involved. CONCLUSIONS This study demonstrates for the first time that SCD associated with a Brugada-SCN5A variant can be caused by localized functionally, not structurally, impaired conduction.
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Affiliation(s)
- Estelle Renard
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France.
| | - Richard D Walton
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - David Benoist
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Fabien Brette
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Gilles Bru-Mercier
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Sébastien Chaigne
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Sabine Charron
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Marion Constantin
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Matthieu Douard
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Virginie Dubes
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Bastien Guillot
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Thomas Hof
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Julie Magat
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Marine E Martinez
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Cindy Michel
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Néstor Pallares-Lupon
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Philippe Pasdois
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Alice Récalde
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Fanny Vaillant
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Frédéric Sacher
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France; Centre Hospitalier Universitaire de Bordeaux, Département d'électrophysiologie et de stimulation cardiaques, Hôpital Cardiologique du Haut-Lévêque, Pessac, France
| | - Louis Labrousse
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Centre Hospitalier Universitaire de Bordeaux, Département de chirurgie cardiovasculaire, Hôpital Cardiologique du Haut-Lévêque, Pessac, France
| | - Julien Rogier
- Centre Hospitalier Universitaire de Bordeaux, Coordination des prélèvements d'organes et de tissus, Bordeaux, France
| | - Florence Kyndt
- Nantes Université, Centre Hospitalier Universitaire Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France; Centre Hospitalier Universitaire Nantes, Service de génétique médicale, Nantes, France
| | - Manon Baudic
- L'Institut du thorax, INSERM, CNRS, Université Nantes, Nantes, France
| | - Jean-Jacques Schott
- Nantes Université, Centre Hospitalier Universitaire Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Julien Barc
- Nantes Université, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Vincent Probst
- Nantes Université, Centre Hospitalier Universitaire Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Marine Sarlandie
- L'Institut du thorax, INSERM, CNRS, Université Nantes, Nantes, France
| | - Céline Marionneau
- L'Institut du thorax, INSERM, CNRS, Université Nantes, Nantes, France
| | - Jesse L Ashton
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Mélèze Hocini
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France; Centre Hospitalier Universitaire de Bordeaux, Département d'électrophysiologie et de stimulation cardiaques, Hôpital Cardiologique du Haut-Lévêque, Pessac, France
| | - Michel Haïssaguerre
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France; Centre Hospitalier Universitaire de Bordeaux, Département d'électrophysiologie et de stimulation cardiaques, Hôpital Cardiologique du Haut-Lévêque, Pessac, France
| | - Olivier Bernus
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
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10
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Zhou X, Ren L, Huang J, Zhang Y, Cai Y, Pu J. Novel SCN5A frame‑shift mutation underlying in patient with idiopathic ventricular fibrillation manifested with J wave in inferior lead and prolonged S‑wave in precordial lead. Exp Ther Med 2023; 25:287. [PMID: 37206574 PMCID: PMC10189605 DOI: 10.3892/etm.2023.11986] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 02/01/2023] [Indexed: 05/21/2023] Open
Abstract
Mutations in the SCN5A gene has been recognized as resulting in a series of life-threatening arrhythmias. However, it also causes idiopathic ventricular fibrillation (IVF) with J wave in inferior leads and prolonged S-wave upstroke in precordial leads, which has not been previously reported. The present study aimed to study the mechanisms of a patient with IVF manifested with J wave in inferior leads and prolonged S-wave upstroke in precordial leads. The electrocardiograms (ECG) of the proband were recorded and genetic testing was conducted. Patch-clamp and immunocytochemical studies were performed in heterologously transfected 293 cells. The VF attacks was documented in a 55-year-old male proband with syncope episodes. 12-lead ECG shown the transient J wave in the inferior leads and prolonged S-wave upstroke in precordial V1-V3 leads in the same timeframe. Genetic analysis revealed a novel 1 base deletion (G) at position 839 in exon 2 in SCN5A gene (C280S*fs61), which causes a severe truncation of the sodium channel. The functional study revealed that in 293 cells transfected with mutant channel, no sodium current could be recorded even though the immunocytochemical experiment confirmed the truncated sodium channel existed in cytosol. The kinetics of the wild-type (WT) channel were not altered when co-transfected with C280S*fs61 mutant which suggested a haploinsufficiency effect of sodium channel in the cells. The present study identified a novel C280Sfs*61 mutation that caused the 'loss of function' of the sodium channel by haploinsufficiency mechanism. The reduced sodium channel function in the heart may cause conduction delay that may underlie the manifestation of J wave and prolonged S-wave upstroke associated with IVF.
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Affiliation(s)
- Xiaoqian Zhou
- Department of Cardiology, Shanghai East Hospital, Tongji University, Shanghai 100123, P.R. China
| | - Lan Ren
- Department of Cardiology, Beijing Jishuitan Hospital, Beijing 100035, P.R. China
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100037, P.R. China
| | - Jian Huang
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100037, P.R. China
| | - Yinhui Zhang
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100037, P.R. China
| | - Ying Cai
- Department of Cardiology, Shanghai East Hospital, Tongji University, Shanghai 100123, P.R. China
- Correspondence to: Professor Jielin Pu and Professor Ying Cai, Department of Cardiology, Shanghai East Hospital, Tongji University, 1800 Yuntai Road, Pudong, Shanghai 100123, P.R. China
| | - Jielin Pu
- Department of Cardiology, Shanghai East Hospital, Tongji University, Shanghai 100123, P.R. China
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100037, P.R. China
- Correspondence to: Professor Jielin Pu and Professor Ying Cai, Department of Cardiology, Shanghai East Hospital, Tongji University, 1800 Yuntai Road, Pudong, Shanghai 100123, P.R. China
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11
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Christie S, Idris S, Bennett RG, Deyell MW, Roston T, Laksman Z. Trigger and Substrate Mapping and Ablation for Ventricular Fibrillation in the Structurally Normal Heart. J Cardiovasc Dev Dis 2023; 10:jcdd10050200. [PMID: 37233167 DOI: 10.3390/jcdd10050200] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 04/28/2023] [Accepted: 04/29/2023] [Indexed: 05/27/2023] Open
Abstract
Sudden cardiac death (SCD) represents approximately 50% of all cardiovascular mortality in the United States. The majority of SCD occurs in individuals with structural heart disease; however, around 5% of individuals have no identifiable cause on autopsy. This proportion is even higher in those <40 years old, where SCD is particularly devastating. Ventricular fibrillation (VF) is often the terminal rhythm leading to SCD. Catheter ablation for VF has emerged as an effective tool to alter the natural history of this disease among high-risk individuals. Important advances have been made in the identification of several mechanisms involved in the initiation and maintenance of VF. Targeting the triggers of VF as well as the underlying substrate that perpetuates these lethal arrhythmias has the potential to eliminate further episodes. Although important gaps remain in our understanding of VF, catheter ablation has become an important option for individuals with refractory arrhythmias. This review outlines a contemporary approach to the mapping and ablation of VF in the structurally normal heart, specifically focusing on the following major conditions: idiopathic ventricular fibrillation, short-coupled ventricular fibrillation, and the J-wave syndromes-Brugada syndrome and early-repolarization syndrome.
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Affiliation(s)
- Simon Christie
- Faculty of Medicine, Division of Cardiology, University of British Columbia, Gordon & Leslie Diamond Health Care Centre, 2775 Laurel St., 9th Floor, Vancouver, BC V5Z 1M9, Canada
| | - Sami Idris
- Faculty of Medicine, Division of Cardiology, University of British Columbia, Gordon & Leslie Diamond Health Care Centre, 2775 Laurel St., 9th Floor, Vancouver, BC V5Z 1M9, Canada
| | - Richard G Bennett
- Faculty of Medicine, Division of Cardiology, University of British Columbia, Gordon & Leslie Diamond Health Care Centre, 2775 Laurel St., 9th Floor, Vancouver, BC V5Z 1M9, Canada
| | - Marc W Deyell
- Faculty of Medicine, Division of Cardiology, University of British Columbia, Gordon & Leslie Diamond Health Care Centre, 2775 Laurel St., 9th Floor, Vancouver, BC V5Z 1M9, Canada
| | - Thomas Roston
- Faculty of Medicine, Division of Cardiology, University of British Columbia, Gordon & Leslie Diamond Health Care Centre, 2775 Laurel St., 9th Floor, Vancouver, BC V5Z 1M9, Canada
| | - Zachary Laksman
- Faculty of Medicine, Division of Cardiology, University of British Columbia, Gordon & Leslie Diamond Health Care Centre, 2775 Laurel St., 9th Floor, Vancouver, BC V5Z 1M9, Canada
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12
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Crescenzi C, Silvetti E, Romeo F, Martino A, Bressi E, Panattoni G, Stefanini M, Stazi A, Danza ML, Rebecchi M, Canestrelli S, Fedele E, Lanza O, Lanzillo C, Fusco A, Golia P, De Ruvo E, Calò L. The electrocardiogram in non-ischaemic-dilated cardiomyopathy. Eur Heart J Suppl 2023; 25:C179-C184. [PMID: 37125290 PMCID: PMC10132560 DOI: 10.1093/eurheartjsupp/suad043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
This article summarizes the main electrocardiogram (ECG) findings in dilated cardiomyopathy (DCM) patients. Recent reports are described in the great 'pot' of DCM peculiar ECG patterns that are typical of specific forms of DCM. Patients with late gadolinium enhancement on CMR, who are at greatest arrhythmic risk, have also distinctive ECG features. Future studies in large DCM populations should evaluate the diagnostic and prognostic value of the ECG.
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Affiliation(s)
- Cinzia Crescenzi
- Corresponding author. Tel: +39 06 23188406, Fax: +39 06 23188410,
| | - Elisa Silvetti
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Roma, Italy
| | - Fabiana Romeo
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Roma, Italy
| | - Annamaria Martino
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Roma, Italy
| | - Edoardo Bressi
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Roma, Italy
| | - Germana Panattoni
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Roma, Italy
| | - Matteo Stefanini
- Division of Radiology, Policlinico Casilino, Via Casilina 1049, 00169 Roma, Italy
| | - Alessandra Stazi
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Roma, Italy
| | - Maria Ludovica Danza
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Roma, Italy
| | - Marco Rebecchi
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Roma, Italy
| | - Stefano Canestrelli
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Roma, Italy
| | - Elisa Fedele
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Roma, Italy
| | - Oreste Lanza
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Roma, Italy
| | - Chiara Lanzillo
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Roma, Italy
| | - Armando Fusco
- Division of Radiology, Policlinico Casilino, Via Casilina 1049, 00169 Roma, Italy
| | - Paolo Golia
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Roma, Italy
| | - Ermenegildo De Ruvo
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Roma, Italy
| | - Leonardo Calò
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Roma, Italy
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13
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Pappone C, Boccellino A, Ciconte G. Ablation of ventricular arrhythmias in cardiogenetic diseases. Eur Heart J Suppl 2023; 25:B123-B125. [PMID: 37091655 PMCID: PMC10120943 DOI: 10.1093/eurheartjsupp/suad090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Sudden cardiac death is a leading cause of mortality, claiming millions of lives every year. Recent advances in cardiac arrhythmia mapping have demonstrated that the ventricular epicardial region has a critical arrhythmogenic role in some inherited cardiogenetic diseases. Historically, electroanatomic abnormalities have been identified in the ventricular epicardium of patients with arrhythmogenic right ventricular cardiomyopathy. More recently, epicardial pathological substrates have been identified also in electrical disease (Brugada syndrome, early repolarization syndrome) and currently in long QT syndrome. In light of these findings, the epicardial area has emerged as an important determinant in sudden cardiac death-related cardiomyopathies.
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Affiliation(s)
| | - Antonio Boccellino
- Cardiology Unit, Vita-Salute San Raffaele University, Milan, Italy
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, Milan, Italy
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14
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Ramlugun GS, Kulkarni K, Pallares-Lupon N, Boukens BJ, Efimov IR, Vigmond EJ, Bernus O, Walton RD. A comprehensive framework for evaluation of high pacing frequency and arrhythmic optical mapping signals. Front Physiol 2023; 14:734356. [PMID: 36755791 PMCID: PMC9901579 DOI: 10.3389/fphys.2023.734356] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 01/09/2023] [Indexed: 01/24/2023] Open
Abstract
Introduction: High pacing frequency or irregular activity due to arrhythmia produces complex optical mapping signals and challenges for processing. The objective is to establish an automated activation time-based analytical framework applicable to optical mapping images of complex electrical behavior. Methods: Optical mapping signals with varying complexity from sheep (N = 7) ventricular preparations were examined. Windows of activation centered on each action potential upstroke were derived using Hilbert transform phase. Upstroke morphology was evaluated for potential multiple activation components and peaks of upstroke signal derivatives defined activation time. Spatially and temporally clustered activation time points were grouped in to wave fronts for individual processing. Each activation time point was evaluated for corresponding repolarization times. Each wave front was subsequently classified based on repetitive or non-repetitive events. Wave fronts were evaluated for activation time minima defining sites of wave front origin. A visualization tool was further developed to probe dynamically the ensemble activation sequence. Results: Our framework facilitated activation time mapping during complex dynamic events including transitions to rotor-like reentry and ventricular fibrillation. We showed that using fixed AT windows to extract AT maps can impair interpretation of the activation sequence. However, the phase windowing of action potential upstrokes enabled accurate recapitulation of repetitive behavior, providing spatially coherent activation patterns. We further demonstrate that grouping the spatio-temporal distribution of AT points in to coherent wave fronts, facilitated interpretation of isolated conduction events, such as conduction slowing, and to derive dynamic changes in repolarization properties. Focal origins precisely detected sites of stimulation origin and breakthrough for individual wave fronts. Furthermore, a visualization tool to dynamically probe activation time windows during reentry revealed a critical single static line of conduction slowing associated with the rotation core. Conclusion: This comprehensive analytical framework enables detailed quantitative assessment and visualization of complex electrical behavior.
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Affiliation(s)
- Girish S. Ramlugun
- IHU-Liryc, Fondation Bordeaux Université, Pessac-Bordeaux, France,Univ. Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique, Bordeaux, France
| | - Kanchan Kulkarni
- IHU-Liryc, Fondation Bordeaux Université, Pessac-Bordeaux, France,Univ. Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique, Bordeaux, France
| | - Nestor Pallares-Lupon
- IHU-Liryc, Fondation Bordeaux Université, Pessac-Bordeaux, France,Univ. Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique, Bordeaux, France
| | - Bastiaan J. Boukens
- Department of Physiology, Cardiovascular Research Institute Maastricht, University Maastricht, Maastricht, Netherlands,Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Igor R. Efimov
- Department of Biomedical Engineering, The George Washington University, Washington, DC, United States,Department of Biomedical Engineering, Northwestern University, Chicago, IL, United States,Department of Medicine, Northwestern University, Chicago, IL, United States
| | - Edward J. Vigmond
- IHU-Liryc, Fondation Bordeaux Université, Pessac-Bordeaux, France,Univ. Bordeaux, Centre National de la Recherche Scientifique (CNRS), Institut de Mathématiques de Bordeaux, UMR5251, Bordeaux, France
| | - Olivier Bernus
- IHU-Liryc, Fondation Bordeaux Université, Pessac-Bordeaux, France,Univ. Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique, Bordeaux, France
| | - Richard D. Walton
- IHU-Liryc, Fondation Bordeaux Université, Pessac-Bordeaux, France,Univ. Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique, Bordeaux, France,*Correspondence: Richard D. Walton,
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15
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Fragmented QRS complex with an additional R-wave attenuated by short RR interval in a patient with acute pulmonary embolism and cardiogenic shock. J Geriatr Cardiol 2022; 19:995-1000. [PMID: 36632202 PMCID: PMC9807400 DOI: 10.11909/j.issn.1671-5411.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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16
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Cardiac Morphofunctional Characteristics of Individuals with Early Repolarization Pattern: A Literature Review. J Cardiovasc Dev Dis 2022; 10:jcdd10010004. [PMID: 36661899 PMCID: PMC9861558 DOI: 10.3390/jcdd10010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
The early repolarization pattern (ERP) is an electrocardiographic phenomenon characterized by the appearance of a distinct J-wave or J-point elevation at the terminal part of the QRS complex. ERP is associated with an increased risk of ventricular arrhythmias in susceptible individuals. The cardiac morphofunctional parameters in subjects with ERP have been characterized mainly by imaging techniques, which suggests that certain changes could be identified in the background of the electrical pathomechanism: however, in this regard, current data are often contradictory or insufficiently detailed. For clarification, a more comprehensive cardiac imaging evaluation of a large patient population is necessary. This review summarizes and analyses the data from the literature related to cardiac morphofunctional characteristics in individuals with ERP.
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17
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Radford D, Chou OHI, Bazoukis G, Letsas K, Liu T, Tse G, Lee S. Electrocardiographic features in SCN5A mutation-positive patients with Brugada and early repolarization syndromes: a systematic review and meta-analysis. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2022. [DOI: 10.1186/s42444-022-00066-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Early repolarization syndrome (ERS) and Brugada syndrome (BrS) are both J-wave syndromes. Both can involve mutations in the SCN5A gene but may exhibit distinct electrocardiographic (ECG) differences. The aim of this systematic review and meta-analysis is to investigate possible differences in ECG markers between SCN5A-positive patients with ERS and BrS.
Methods
PubMed and Embase were searched from their inception to 20 October 2021 for human studies containing the search terms “SCN5A” and “variant” and “early repolarization” or “Brugada”, with no language restrictions. Continuous variables were expressed as mean±standard deviation. PR interval, QRS duration, QTc and heart rate from the included studies were pooled to calculate a mean for each variable amongst BrS and ERS patients. A two-tailed Student’s t test was then performed to for comparisons.
Results
A total of 328 studies were identified. After full-text screening, 12 studies met our inclusion criteria and were included in this present study. One hundred and four ERS patients (mean age 30.86±14.45) and 2000 BrS patients (mean age 36.17±11.39) were studied. Our meta-analysis found that ERS patients had shorter QRS duration (90.40±9.97 vs. 114.79±20.10, P = 0.0001) and shorter corrected QT intervals (QTc) with borderline significance (393.63±40.04 vs. 416.82±37.43, P = 0.052). By contrast, no significant differences in baseline heart rate (65.15±18.78 vs. 76.06±18.78, P = 0.068) or PR intervals (197.40±34.69 vs. 191.88±35.08, P = 0.621) were observed between ERS and BrS patients.
Conclusion
BrS patients with positive SCN5A mutations exhibited prolonged QRS, indicating conduction abnormalities, whereas ERS patients with positive SCN5A mutations showed normal QRS. By contrast, whilst QTc intervals were longer in BrS than in ERS SCN5A positive patients, they were within normal limits. Further studies are needed to examine the implications of these findings for arrhythmic risk stratification.
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18
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Wilde AAM, Semsarian C, Márquez MF, Shamloo AS, Ackerman MJ, Ashley EA, Sternick EB, Barajas-Martinez H, Behr ER, Bezzina CR, Breckpot J, Charron P, Chockalingam P, Crotti L, Gollob MH, Lubitz S, Makita N, Ohno S, Ortiz-Genga M, Sacilotto L, Schulze-Bahr E, Shimizu W, Sotoodehnia N, Tadros R, Ware JS, Winlaw DS, Kaufman ES. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) Expert Consensus Statement on the state of genetic testing for cardiac diseases. Europace 2022; 24:1307-1367. [PMID: 35373836 PMCID: PMC9435643 DOI: 10.1093/europace/euac030] [Citation(s) in RCA: 112] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Arthur A M Wilde
- Heart Centre, Department of Cardiology, Amsterdam Universitair Medische
Centra, Amsterdam, location AMC, The Netherlands
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute,
University of Sydney, Sydney, Australia
| | - Manlio F Márquez
- Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de
México, Mexico
- Member of the Latin American Heart Rhythm Society (LAHRS)
| | | | - Michael J Ackerman
- Departments of Cardiovascular Medicine, Pediatric and Adolescent Medicine,
and Molecular Pharmacology & Experimental Therapeutics; Divisions of Heart Rhythm
Services and Pediatric Cardiology; Windland Smith Rice Genetic Heart Rhythm Clinic and
Windland Smith Rice Sudden Death Genomics Laboratory, Mayo
Clinic, Rochester, MN, USA
| | - Euan A Ashley
- Department of Cardiovascular Medicine, Stanford University,
Stanford, California, USA
| | - Eduardo Back Sternick
- Arrhythmia and Electrophysiology Unit, Biocor Institute,
Minas Gerais, Brazil; and
Member of the Latin American Heart Rhythm Society (LAHRS)
| | - Héctor Barajas-Martinez
- Cardiovascular Research, Lankenau Institute of Medical
Research, Wynnewood, PA, USA; and Member of the Latin American Heart Rhythm Society (LAHRS)
| | - Elijah R Behr
- Cardiovascular Clinical Academic Group, Institute of Molecular and Clinical
Sciences, St. George’s, University of London; St. George’s University Hospitals NHS
Foundation Trust, London, UK; Mayo Clinic Healthcare, London
| | - Connie R Bezzina
- Amsterdam UMC Heart Center, Department of Experimental
Cardiology, Amsterdam, The
Netherlands
| | - Jeroen Breckpot
- Center for Human Genetics, University Hospitals Leuven,
Leuven, Belgium
| | - Philippe Charron
- Sorbonne Université, APHP, Centre de Référence des Maladies Cardiaques
Héréditaires, ICAN, Inserm UMR1166, Hôpital
Pitié-Salpêtrière, Paris, France
| | | | - Lia Crotti
- Center for Cardiac Arrhythmias of Genetic Origin,
Istituto Auxologico Italiano, IRCCS, Milan, Italy
- Cardiomyopathy Unit and Cardiac Rehabilitation Unit, San Luca Hospital,
Istituto Auxologico Italiano, IRCCS, Milan,
Italy
- Department of Medicine and Surgery, University of
Milano-Bicocca, Milan, Italy
| | - Michael H Gollob
- Inherited Arrhythmia and Cardiomyopathy Program, Division of Cardiology,
University of Toronto, Toronto, ON, Canada
| | - Steven Lubitz
- Cardiac Arrhythmia Service, Massachusetts General Hospital and Harvard
Medical School, Boston, MA, USA
| | - Naomasa Makita
- National Cerebral and Cardiovascular Center, Research
Institute, Suita, Japan
| | - Seiko Ohno
- Department of Bioscience and Genetics, National Cerebral and Cardiovascular
Center, Suita, Japan
| | - Martín Ortiz-Genga
- Clinical Department, Health in Code, A
Coruña, Spain; and Member of the Latin
American Heart Rhythm Society (LAHRS)
| | - Luciana Sacilotto
- Arrhythmia Unit, Instituto do Coracao, Hospital das Clinicas HCFMUSP,
Faculdade de Medicina, Universidade de Sao Paulo, Sao
Paulo, Brazil; and Member of the Latin
American Heart Rhythm Society (LAHRS)
| | - Eric Schulze-Bahr
- Institute for Genetics of Heart Diseases, University Hospital
Münster, Münster, Germany
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon
Medical School, Bunkyo-ku, Tokyo, Japan
| | - Nona Sotoodehnia
- Cardiovascular Health Research Unit, Division of Cardiology, Department of
Medicine, University of Washington, Seattle, WA,
USA
| | - Rafik Tadros
- Cardiovascular Genetics Center, Department of Medicine, Montreal Heart
Institute, Université de Montréal, Montreal,
Canada
| | - James S Ware
- National Heart and Lung Institute and MRC London Institute of Medical
Sciences, Imperial College London, London,
UK
- Royal Brompton & Harefield Hospitals, Guy’s
and St. Thomas’ NHS Foundation Trust, London, UK
| | - David S Winlaw
- Cincinnati Children's Hospital Medical Centre, University of
Cincinnati, Cincinnati, OH, USA
| | - Elizabeth S Kaufman
- Metrohealth Medical Center, Case Western Reserve University,
Cleveland, OH, USA
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19
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Wilde AAM, Semsarian C, Márquez MF, Sepehri Shamloo A, Ackerman MJ, Ashley EA, Sternick Eduardo B, Barajas‐Martinez H, Behr ER, Bezzina CR, Breckpot J, Charron P, Chockalingam P, Crotti L, Gollob MH, Lubitz S, Makita N, Ohno S, Ortiz‐Genga M, Sacilotto L, Schulze‐Bahr E, Shimizu W, Sotoodehnia N, Tadros R, Ware JS, Winlaw DS, Kaufman ES, Aiba T, Bollmann A, Choi J, Dalal A, Darrieux F, Giudicessi J, Guerchicoff M, Hong K, Krahn AD, Mac Intyre C, Mackall JA, Mont L, Napolitano C, Ochoa Juan P, Peichl P, Pereira AC, Schwartz PJ, Skinner J, Stellbrink C, Tfelt‐Hansen J, Deneke T. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) Expert Consensus Statement on the state of genetic testing for cardiac diseases. J Arrhythm 2022; 38:491-553. [PMID: 35936045 PMCID: PMC9347209 DOI: 10.1002/joa3.12717] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Arthur A. M. Wilde
- Heart Centre, Department of Cardiology, Amsterdam Universitair Medische CentraAmsterdamThe Netherlands
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary InstituteUniversity of SydneySydneyAustralia
| | - Manlio F. Márquez
- Instituto Nacional de Cardiología Ignacio ChávezCiudad de MéxicoMexico
| | | | - Michael J. Ackerman
- Departments of Cardiovascular Medicine, Pediatric and Adolescent Medicine, and Molecular Pharmacology & Experimental Therapeutics; Divisions of Heart Rhythm Services and Pediatric Cardiology; Windland Smith Rice Genetic Heart Rhythm Clinic and Windland Smith Rice Sudden Death Genomics Laboratory, Mayo ClinicRochesterMNUSA
| | - Euan A. Ashley
- Department of Cardiovascular MedicineStanford UniversityStanfordCAUSA
| | | | | | - Elijah R. Behr
- Cardiovascular Clinical Academic Group, Institute of Molecular and Clinical Sciences, St. George’sUniversity of London; St. George’s University Hospitals NHS Foundation TrustLondonUKMayo Clinic HealthcareLondon
| | - Connie R. Bezzina
- Amsterdam UMC Heart Center, Department of Experimental CardiologyAmsterdamThe Netherlands
| | - Jeroen Breckpot
- Center for Human GeneticsUniversity Hospitals LeuvenLeuvenBelgium
| | | | | | - Lia Crotti
- Center for Cardiac Arrhythmias of Genetic Origin, Istituto Auxologico Italiano, IRCCSMilanItaly
- Cardiomyopathy Unit and Cardiac Rehabilitation Unit, San Luca Hospital, Istituto Auxologico Italiano, IRCCSMilanItaly
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMilanItaly
| | - Michael H. Gollob
- Inherited Arrhythmia and Cardiomyopathy Program, Division of CardiologyUniversity of TorontoTorontoONCanada
| | - Steven Lubitz
- Cardiac Arrhythmia ServiceMassachusetts General Hospital and Harvard Medical SchoolBostonMAUSA
| | - Naomasa Makita
- National Cerebral and Cardiovascular CenterResearch InstituteSuitaJapan
| | - Seiko Ohno
- Department of Bioscience and Genetics, National Cerebral and Cardiovascular CenterSuitaJapan
| | | | - Luciana Sacilotto
- Arrhythmia Unit, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao PauloBrazil
| | - Eric Schulze‐Bahr
- Institute for Genetics of Heart DiseasesUniversity Hospital MünsterMünsterGermany
| | - Wataru Shimizu
- Department of Cardiovascular MedicineGraduate School of MedicineTokyoJapan
| | - Nona Sotoodehnia
- Cardiovascular Health Research Unit, Division of Cardiology, Department of MedicineUniversity of WashingtonSeattleWAUSA
| | - Rafik Tadros
- Cardiovascular Genetics Center, Department of Medicine, Montreal Heart InstituteUniversité de MontréalMontrealCanada
| | - James S. Ware
- National Heart and Lung Institute and MRC London Institute of Medical SciencesImperial College LondonLondonUK
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation TrustLondonUK
| | - David S. Winlaw
- Cincinnati Children's Hospital Medical CentreUniversity of CincinnatiCincinnatiOHUSA
| | | | - Takeshi Aiba
- Department of Clinical Laboratory Medicine and Genetics, National Cerebral and Cardiovascular Center, SuitaOsakaJapan
| | - Andreas Bollmann
- Department of ElectrophysiologyHeart Center Leipzig at University of LeipzigLeipzigGermany
- Leipzig Heart InstituteLeipzigGermany
| | - Jong‐Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University Anam HospitalKorea University College of MedicineSeoulRepublic of Korea
| | - Aarti Dalal
- Department of Pediatrics, Division of CardiologyVanderbilt University School of MedicineNashvilleTNUSA
| | - Francisco Darrieux
- Arrhythmia Unit, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São PauloSão PauloBrazil
| | - John Giudicessi
- Department of Cardiovascular Medicine (Divisions of Heart Rhythm Services and Circulatory Failure and the Windland Smith Rice Genetic Heart Rhythm Clinic), Mayo ClinicRochesterMNUSA
| | - Mariana Guerchicoff
- Division of Pediatric Arrhythmia and Electrophysiology, Italian Hospital of Buenos AiresBuenos AiresArgentina
| | - Kui Hong
- Department of Cardiovascular MedicineThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Andrew D. Krahn
- Division of CardiologyUniversity of British ColumbiaVancouverCanada
| | - Ciorsti Mac Intyre
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Windland Smith Rice Genetic Heart Rhythm Clinic, Mayo ClinicRochesterMNUSA
| | - Judith A. Mackall
- Center for Cardiac Electrophysiology and Pacing, University Hospitals Cleveland Medical CenterCase Western Reserve University School of MedicineClevelandOHUSA
| | - Lluís Mont
- Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS). Barcelona, Spain; Centro de Investigacion Biomedica en Red en Enfermedades Cardiovasculares (CIBERCV), MadridSpain
| | - Carlo Napolitano
- Molecular Cardiology, Istituti Clinici Scientifici Maugeri, IRCCSPaviaItaly
- Department of Molecular MedicineUniversity of PaviaPaviaItaly
| | - Pablo Ochoa Juan
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), MadridSpain
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de HierroMadridSpain
- Centro de Investigacion Biomedica en Red en Enfermedades Cariovasculares (CIBERCV), MadridSpain
| | - Petr Peichl
- Department of CardiologyInstitute for Clinical and Experimental MedicinePragueCzech Republic
| | - Alexandre C. Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart InstituteUniversity of São Paulo Medical SchoolSão PauloBrazil
- Hipercol Brasil ProgramSão PauloBrazil
| | - Peter J. Schwartz
- Center for Cardiac Arrhythmias of Genetic Origin, Istituto Auxologico Italiano, IRCCSMilanItaly
| | - Jon Skinner
- Sydney Childrens Hospital NetworkUniversity of SydneySydneyAustralia
| | - Christoph Stellbrink
- Department of Cardiology and Intensive Care MedicineUniversity Hospital Campus Klinikum BielefeldBielefeldGermany
| | - Jacob Tfelt‐Hansen
- The Department of Cardiology, the Heart Centre, Copenhagen University Hospital, Rigshopitalet, Copenhagen, Denmark; Section of genetics, Department of Forensic Medicine, Faculty of Medical SciencesUniversity of CopenhagenDenmark
| | - Thomas Deneke
- Heart Center Bad NeustadtBad Neustadt a.d. SaaleGermany
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20
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Yakkali S, Teresa Selvin S, Thomas S, Bikeyeva V, Abdullah A, Radivojevic A, Abu Jad AA, Ravanavena A, Ravindra C, Igweonu-Nwakile EO, Ali S, Paul S, Hamid P. Why Is There an Increased Risk for Sudden Cardiac Death in Patients With Early Repolarization Syndrome? Cureus 2022; 14:e26820. [PMID: 35971350 PMCID: PMC9374281 DOI: 10.7759/cureus.26820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/13/2022] [Indexed: 11/29/2022] Open
Abstract
The last two decades have changed the viewpoint on early repolarization syndrome (ERS). The prevalence of the early repolarization pattern is variable and ranges between 3-24% depending upon age, gender, and criteria used for J-point upliftment from baseline (0.05mV vs. 1 mV). While this pattern was previously linked with a benign result, multiple recent investigations have found a link between early repolarization and Sudden Cardiac Death (SCD) by causing life-threatening arrhythmias like Ventricular tachycardia/Ventricular fibrillation, a condition known as early repolarization syndrome. The syndrome falls under a broader bracket of J wave syndromes, which can be caused by early repolarization or depolarization abnormalities. The characteristics of early repolarization that are considered high risk for Sudden Cardiac Death include the amplitude of J-point upliftment from baseline ( > 0.2 mV), Inferior-lateral location of Early Repolarization pattern, and horizontal and downsloping ST-segment. Patients with symptomatic early repolarisation patterns on ECG are more likely to have repeated cardiac episodes. Implantable Cardioverter-Defibrillator (ICD) implantation and isoproterenol are the recommended treatments in symptomatic patients. On the other hand, asymptomatic patients with early repolarization patterns are prevalent and have a better outcome. Risk categorization is still obscure in asymptomatic early repolarization patterns. This traditional review outlines the known knowledge of pathophysiology behind the increased risk of sudden cardiac death, risk stratification of patients with ERS, and the treatment guidelines for patients with ERS. Further prospective studies are recommended to elucidate the exact mechanism for ventricular arrhythmogenesis in ERS patients and to risk stratifying asymptomatic patients with ERS.
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21
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Wilde AAM, Semsarian C, Márquez MF, Sepehri Shamloo A, Ackerman MJ, Ashley EA, Sternick EB, Barajas-Martinez H, Behr ER, Bezzina CR, Breckpot J, Charron P, Chockalingam P, Crotti L, Gollob MH, Lubitz S, Makita N, Ohno S, Ortiz-Genga M, Sacilotto L, Schulze-Bahr E, Shimizu W, Sotoodehnia N, Tadros R, Ware JS, Winlaw DS, Kaufman ES, Aiba T, Bollmann A, Choi JI, Dalal A, Darrieux F, Giudicessi J, Guerchicoff M, Hong K, Krahn AD, MacIntyre C, Mackall JA, Mont L, Napolitano C, Ochoa JP, Peichl P, Pereira AC, Schwartz PJ, Skinner J, Stellbrink C, Tfelt-Hansen J, Deneke T. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) Expert Consensus Statement on the State of Genetic Testing for Cardiac Diseases. Heart Rhythm 2022; 19:e1-e60. [PMID: 35390533 DOI: 10.1016/j.hrthm.2022.03.1225] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 03/25/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Arthur A M Wilde
- Heart Centre, Department of Cardiology, Amsterdam Universitair Medische Centra, Amsterdam, location AMC, The Netherlands.
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, University of Sydney, Sydney, Australia.
| | - Manlio F Márquez
- Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, Mexico; and Member of the Latin American Heart Rhythm Society (LAHRS).
| | | | - Michael J Ackerman
- Departments of Cardiovascular Medicine, Pediatric and Adolescent Medicine, and Molecular Pharmacology & Experimental Therapeutics; Divisions of Heart Rhythm Services and Pediatric Cardiology; Windland Smith Rice Genetic Heart Rhythm Clinic and Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Euan A Ashley
- Department of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | - Eduardo Back Sternick
- Arrhythmia and Electrophysiology Unit, Biocor Institute, Minas Gerais, Brazil; and Member of the Latin American Heart Rhythm Society (LAHRS)
| | | | - Elijah R Behr
- Cardiovascular Clinical Academic Group, Institute of Molecular and Clinical Sciences, St. George's, University of London; St. George's University Hospitals NHS Foundation Trust, London, UK; Mayo Clinic Healthcare, London
| | - Connie R Bezzina
- Amsterdam UMC Heart Center, Department of Experimental Cardiology, Amsterdam, The Netherlands
| | - Jeroen Breckpot
- Center for Human Genetics, University Hospitals Leuven, Leuven, Belgium
| | - Philippe Charron
- Sorbonne Université, APHP, Centre de Référence des Maladies Cardiaques Héréditaires, ICAN, Inserm UMR1166, Hôpital Pitié-Salpêtrière, Paris, France
| | | | - Lia Crotti
- Center for Cardiac Arrhythmias of Genetic Origin, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Cardiomyopathy Unit and Cardiac Rehabilitation Unit, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Michael H Gollob
- Inherited Arrhythmia and Cardiomyopathy Program, Division of Cardiology, University of Toronto, Toronto, ON, Canada
| | - Steven Lubitz
- Cardiac Arrhythmia Service, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Naomasa Makita
- National Cerebral and Cardiovascular Center, Research Institute, Suita, Japan
| | - Seiko Ohno
- Department of Bioscience and Genetics, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Martín Ortiz-Genga
- Clinical Department, Health in Code, A Coruña, Spain; and Member of the Latin American Heart Rhythm Society (LAHRS)
| | - Luciana Sacilotto
- Arrhythmia Unit, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil; and Member of the Latin American Heart Rhythm Society (LAHRS)
| | - Eric Schulze-Bahr
- Institute for Genetics of Heart Diseases, University Hospital Münster, Münster, Germany
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Nona Sotoodehnia
- Cardiovascular Health Research Unit, Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Rafik Tadros
- Cardiovascular Genetics Center, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - James S Ware
- National Heart and Lung Institute and MRC London Institute of Medical Sciences, Imperial College London, London, UK; Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - David S Winlaw
- Cincinnati Children's Hospital Medical Centre, University of Cincinnati, Cincinnati, OH, USA
| | - Elizabeth S Kaufman
- Metrohealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.
| | - Takeshi Aiba
- Department of Clinical Laboratory Medicine and Genetics, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig Heart Digital, Leipzig, Germany
| | - Jong-Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Aarti Dalal
- Department of Pediatrics, Division of Cardiology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Francisco Darrieux
- Arrhythmia Unit, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - John Giudicessi
- Department of Cardiovascular Medicine (Divisions of Heart Rhythm Services and Circulatory Failure and the Windland Smith Rice Genetic Heart Rhythm Clinic), Mayo Clinic, Rochester, MN, USA
| | - Mariana Guerchicoff
- Division of Pediatric Arrhythmia and Electrophysiology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Kui Hong
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Andrew D Krahn
- Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Ciorsti MacIntyre
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Windland Smith Rice Genetic Heart Rhythm Clinic, Mayo Clinic, Rochester, MN, USA
| | - Judith A Mackall
- Center for Cardiac Electrophysiology and Pacing, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Lluís Mont
- Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigacion Biomedica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Carlo Napolitano
- Molecular Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Juan Pablo Ochoa
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain; Centro de Investigacion Biomedica en Red en Enfermedades Cariovasculares (CIBERCV), Madrid, Spain
| | - Petr Peichl
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Alexandre C Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute, University of São Paulo Medical School, São Paulo 05403-000, Brazil; Hipercol Brasil Program, São Paulo, Brazil
| | - Peter J Schwartz
- Center for Cardiac Arrhythmias of Genetic Origin, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Jon Skinner
- Sydney Childrens Hospital Network, University of Sydney, Sydney, Australia
| | - Christoph Stellbrink
- Department of Cardiology and Intensive Care Medicine, University Hospital Campus Klinikum Bielefeld, Bielefeld, Germany
| | - Jacob Tfelt-Hansen
- The Department of Cardiology, the Heart Centre, Copenhagen University Hospital, Rigshopitalet, Copenhagen, Denmark; Section of Genetics, Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Denmark
| | - Thomas Deneke
- Heart Center Bad Neustadt, Bad Neustadt a.d. Saale, Germany
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22
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Mareddy C, ScM MT, McDaniel G, Monfredi O. Exercise in the Genetic Arrhythmia Syndromes - A Review. Clin Sports Med 2022; 41:485-510. [PMID: 35710274 DOI: 10.1016/j.csm.2022.02.008] [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] [Indexed: 11/15/2022]
Abstract
Provide a brief summary of your article (100-150 words; no references or figures/tables). The synopsis appears only in the table of contents and is often used by indexing services such as PubMed. Genetic arrhythmia syndromes are rare, yet harbor the potential for highly consequential, often unpredictable arrhythmias or sudden death events. There has been historical uncertainty regarding the correct advice to offer to affected patients who are reasonably wanting to participate in sporting and athletic endeavors. In some cases, this had led to abundantly cautious disqualifications, depriving individuals from participation unnecessarily. Societal guidance and expert opinion has evolved significantly over the last decade or 2, along with our understanding of the genetics and natural history of these conditions, and the emphasis has switched toward shared decision making with respect to the decision to participate or not, with patients and families becoming better informed, and willing participants in the decision making process. This review aims to give a brief update of the salient issues for the busy physician concerning these syndromes and to provide a framework for approaching their management in the otherwise aspirational or keen sports participant.
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Affiliation(s)
- Chinmaya Mareddy
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, 1215 Lee St, Charlottesville, VA 22908, USA
| | - Matthew Thomas ScM
- Department of Pediatrics, P.O. Box 800386, Charlottesville, VA 22908, USA
| | - George McDaniel
- Department of Pediatric Cardiology, Battle Building 6th Floor, 1204 W. Main St, Charlottesville, VA 22903, USA
| | - Oliver Monfredi
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, 1215 Lee St, Charlottesville, VA 22908, USA.
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23
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Liu LJ, Tang N, Bi WT, Zhang M, Deng XQ, Cheng YJ. Association Between Temporal Changes in Early Repolarization Pattern With Long-Term Cardiovascular Outcome: A Population-Based Cohort Study. J Am Heart Assoc 2022; 11:e022848. [PMID: 35261294 PMCID: PMC9075315 DOI: 10.1161/jaha.121.022848] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background The prognostic value of early repolarization pattern (ERP) remains controversial. We aim to test the hypothesis that temporal changes in ERP are associated with increased risks for sudden cardiac death (SCD) and cardiovascular death. Methods and Results A total of 14 679 middle‐aged participants from the prospective, population‐based cohort were included in this analysis, with ERP status recorded at baseline and during 3 follow‐up visits in the ARIC (Atherosclerosis Risk in Communities) study. We related baseline ERP, time‐varying ERP, and temporal changes in ERP to cardiovascular outcomes. Cox models were used to estimate the hazard ratios (HRs) adjusted for possible confounding factors. With a median follow‐up of 22.5 years, there were 5033 deaths, 1239 cardiovascular deaths, and 571 SCDs. Time‐varying ERP was associated with increased risks of SCD (HR, 1.59 [95% CI, 1.25–2.02]), cardiovascular death (HR, 1.70 [95% CI, 1.44–2.00]), and death from any cause (HR, 1.16 [95% CI, 1.05–1.27]). Baseline ERP was also associated with 3 outcomes. Compared with those with consistently normal ECG findings, subjects with new‐onset ERP or consistent ERP experienced increased risks of developing SCD and cardiovascular death. The time‐varying ERP in women, White subjects, and anterior leads and J‐wave amplitudes ≥0.2 mV appeared to indicate poorer cardiovascular outcomes. Conclusions Our findings suggest that baseline ERP, time‐varying ERP, new‐onset ERP, and consistent ERP were independent predictors of SCD and cardiovascular death in the middle‐aged biracial population. Repeated measurements of the ERP might improve its use as a risk indicator for SCD.
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Affiliation(s)
- Li-Juan Liu
- Department of Cardiology The First Affiliated HospitalSun Yat-Sen University Guangzhou China.,NHC Key Laboratory of Assisted Circulation Sun Yat-Sen University Guangzhou China
| | - Na Tang
- Cardiovascular Medicine Department Affiliated Hospital of Xiangnan University Chenzhou China
| | - Wen-Tao Bi
- Department of Cardiology The First Affiliated HospitalSun Yat-Sen University Guangzhou China.,NHC Key Laboratory of Assisted Circulation Sun Yat-Sen University Guangzhou China
| | - Ming Zhang
- Department of Cardiology Beijing Anzhen HospitalCapital Medical University Beijing China
| | - Xue-Qiong Deng
- Department of Cardiology The First Affiliated HospitalSun Yat-Sen University Guangzhou China.,NHC Key Laboratory of Assisted Circulation Sun Yat-Sen University Guangzhou China
| | - Yun-Jiu Cheng
- Department of Cardiology The First Affiliated HospitalSun Yat-Sen University Guangzhou China.,NHC Key Laboratory of Assisted Circulation Sun Yat-Sen University Guangzhou China
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24
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Sakaguchi Y, Sato T, Sato A, Fuse K, Aizawa Y, Okabe M, Aizawa Y. Incidence and Implications of J waves Observed During Coronary Angiography. Am J Cardiol 2022; 163:32-37. [PMID: 34774283 DOI: 10.1016/j.amjcard.2021.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/18/2021] [Accepted: 09/21/2021] [Indexed: 11/01/2022]
Abstract
J waves may be observed during coronary angiography (CAG), but they have not been fully studied. We investigated the characteristics of J waves in 100 consecutive patients during CAG. The patients and their family members had no history of cardiac arrest. Approximately 60% of patients had ischemic heart disease, previous myocardial infarction, or angina pectoris, but at the time of this study, the right coronary artery was shown to be normal or patent after stenting. Electrocardiogram was serially recorded to monitor J waves and alteration of the QRS complex during CAG. In 12 patients (12%), J waves (0.249 ± 0.074 mV) newly appeared during right CAG, and in another 13 patients (13%), preexisting J waves increased from 0.155 ± 0.060 mV to 0.233 ± 0.133 mV during CAG. Left CAG induced no J waves or augmentation of J waves. Distinct alterations were observed in the QRS complex during CAG of both coronary arteries. Mechanistically, myocardial ischemia induced by contrast medium was considered to result in a local conduction delay, and when it occurred in the inferior wall, the site of the late activation of the ventricle, the conduction delay was manifested as J waves. In conclusion, J waves were confirmed to emerge or increase during angiography of the right but not the left coronary artery. Myocardial ischemia induced by contrast medium caused a local conduction delay that was manifested as J waves in the inferior wall, the site of the late activation of the ventricle.
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25
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Abstract
BACKGROUND The short-coupled variant of torsade de pointes (sc-TdP) is a malignant arrhythmia that frequently presents with ventricular fibrillation (VF) electrical storm. Verapamil is considered the first-line therapy of sc-TdP while catheter ablation is not widely adopted. The aim of this study was to determine the origin of sc-TdP and to assess the outcome of catheter ablation using 3D-mapping. METHODS AND RESULTS We retrospectively analyzed five patients with sc-TdP who underwent 3D-mapping and ablation of sc-TdP at five different institutions. Four patients initially presented with sudden cardiac arrest, one patient experienced recurrent syncope as the first manifestation. All patients demonstrated a monomorphic premature ventricular contraction (PVC) with late transition left bundle branch block pattern, superior axis, and a coupling interval of less than 300 ms. triggering recurrent TdP and VF. In four patients, the culprit PVC was mapped to the free wall insertion of the moderator band (MB) with a preceding Purkinje potential in two patients. Catheter ablation using 3D-mapping and intracardiac echocardiography eliminated sc-TdP in all patients, with no recurrence at mean 2.7 years (range 6 months to 8 years) of follow-up. CONCLUSION 3D-mapping and intracardiac echocardiography demonstrate that sc-TdP predominantly originates from the MB free wall insertion and its Purkinje network. Catheter ablation of the culprit PVC at the MB free wall junction leads to excellent short- and long-term results and should be considered as first-line therapy in recurrent sc-TdP or electrical storm.
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26
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Epicardial substrate ablation in early repolarization syndrome patient with recurrent ventricular fibrillation. HeartRhythm Case Rep 2021; 7:731-733. [PMID: 34820268 PMCID: PMC8602123 DOI: 10.1016/j.hrcr.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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27
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Zhang ZH, Barajas-Martínez H, Xia H, Li B, Capra JA, Clatot J, Chen GX, Chen X, Yang B, Jiang H, Tse G, Aizawa Y, Gollob MH, Scheinman M, Antzelevitch C, Hu D. Distinct Features of Probands With Early Repolarization and Brugada Syndromes Carrying SCN5A Pathogenic Variants. J Am Coll Cardiol 2021; 78:1603-1617. [PMID: 34649698 DOI: 10.1016/j.jacc.2021.08.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/06/2021] [Accepted: 08/10/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Two major forms of inherited J-wave syndrome (JWS) are recognized: early repolarization syndrome (ERS) and Brugada syndrome (BrS). OBJECTIVES This study sought to assess the distinct features between patients with ERS and BrS carrying pathogenic variants in SCN5A. METHODS Clinical evaluation and next-generation sequencing were performed in 262 probands with BrS and 104 with ERS. Nav1.5 and Kv4.3 channels were studied with the use of patch-clamp techniques. A computational model was used to investigate the protein structure. RESULTS The SCN5A+ yield in ERS was significantly lower than in BrS (9.62% vs 22.90%; P = 0.004). Patients diagnosed with ERS displayed shorter QRS and QTc than patients with BrS. More than 2 pathogenic SCN5A variants were found in 5 probands. These patients displayed longer PR intervals and QRS duration and experienced more major arrhythmia events (MAE) compared with those carrying only a single pathogenic variant. SCN5A-L1412F, detected in a fever-induced ERS patient, led to total loss of function, destabilized the Nav1.5 structure, and showed a dominant-negative effect, which was accentuated during a febrile state. ERS-related SCN5A-G452C did not alter the inward sodium current (INa) when SCN5A was expressed alone, but when coexpressed with KCND3 it reduced peak INa by 44.52% and increased the transient outward potassium current (Ito) by 106.81%. CONCLUSIONS These findings point to SCN5A as a major susceptibility gene in ERS as much as it is in BrS, whereas the lower SCN5A+ ratio in ERS indicates the difference in underlying electrophysiology. These findings also identify the first case of fever-induced ERS and demonstrate a critical role of Ito in JWS and a higher risk for MAE in JWS probands carrying multiple pathogenic variants in SCN5A.
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Affiliation(s)
- Zhong-He Zhang
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, Hubei, China; Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Hector Barajas-Martínez
- Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA; Lankenau Heart Institute, Wynnewood, Pennsylvania, USA; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Hao Xia
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, Hubei, China; Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Bian Li
- Department of Biological Sciences, Center for Structural Biology, Vanderbilt University, Nashville, Tennessee, USA; Vanderbilt Genetics Institute, Vanderbilt University, Nashville, Tennessee, USA
| | - John A Capra
- Bakar Computational Health Sciences Institute, University of California, San Francisco, California, USA
| | - Jerome Clatot
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Gan-Xiao Chen
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, Hubei, China; Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Xiu Chen
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, Hubei, China; Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Bo Yang
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, Hubei, China; Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Hong Jiang
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, Hubei, China; Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China; Kent and Medway Medical School, Canterbury, Kent, United Kingdom
| | - Yoshiyasu Aizawa
- Department of Cardiovascular Medicine, School of Medicine 4-3, International University of Health and Welfare, Kozunomori, Narita, Chiba, Japan
| | - Michael H Gollob
- Department of Physiology and Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
| | - Melvin Scheinman
- Department of Cardiac Electrophysiology, University of California, San Francisco, California, USA
| | - Charles Antzelevitch
- Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA; Lankenau Heart Institute, Wynnewood, Pennsylvania, USA; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Dan Hu
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, Hubei, China; Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China.
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Behr ER. J-Wave Syndromes, SCN5A, and Cardiac Conduction Reserve: Two Sides of the Same Coin? J Am Coll Cardiol 2021; 78:1618-1620. [PMID: 34649699 DOI: 10.1016/j.jacc.2021.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 09/02/2021] [Indexed: 12/19/2022]
Affiliation(s)
- Elijah R Behr
- Institute of Molecular and Clinical Sciences, St. George's, University of London, St. George's University Hospitals, NHS Foundation Trust, London, United Kingdom; Mayo Clinic Healthcare, London, United Kingdom.
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29
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Çetin S, Zeynep Akgün E, Babaoğlu K. Evaluation of Early Repolarization Pattern in Male Teenage Competitive Athletes and Association With Left Ventricular Remodeling. Turk Arch Pediatr 2021; 56:485-491. [PMID: 35110119 PMCID: PMC8848852 DOI: 10.5152/turkarchpediatr.2021.21040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Early repolarization pattern (ERP) on electrocardiogram is more common among young athletes than in the general population, and has been considered a benign finding. However, ERP has been associated with increased risk of sudden cardiac death. The objectives of this study were to evaluate ERP in teenage athletes; investigate associations between ERP and echocardiographic findings of the left ventricle (LV); and to describe the impact of different sports disciplines on ERP. METHODS ERP was assessed in male teenage athletes from sports institutions for 5 different types of sport--basketball, swimming, football, wrestling, and tennis. All had been training for at least 3 hours per week for over at least 2 years. ERP was defined as J-point elevation ≥ 1 mV in 2 contiguous and/or lateral leads. A conventional echocardiography was performed in all athletes. RESULTS ERP was evaluated in 159 athletes with a mean age of 14 (range 10-18 years). It was more common in those training with combined exercise. There was no association between ERP and echocardiographic findings of left ventricular remodeling and geometric pattern. CONCLUSION ERP is a frequent finding among teenage athletes. However, frequency varies by sports type, being more common in those training with combined exercise. It is not associated with structural echocardiographic alterations and is primarily seen as an electrophysiological change.
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Affiliation(s)
- Süha Çetin
- Department of Cardiology, Istanbul Okan University School of Medicine, Istanbul, Turkey,Corresponding author:Süha Çetin ✉
| | - Eviç Zeynep Akgün
- Department of Pediatric Cardiology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Kadir Babaoğlu
- Department of Pediatric Cardiology, Kocaeli University School of Medicine, Kocaeli, Turkey
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30
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Halasz G, Cattaneo M, Piepoli M, Biagi A, Romano S, Biasini V, Villa M, Cassina T, Capelli B. Early Repolarization in Pediatric Athletes: A Dynamic Electrocardiographic Pattern With Benign Prognosis. J Am Heart Assoc 2021; 10:e020776. [PMID: 34387099 PMCID: PMC8475030 DOI: 10.1161/jaha.121.020776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Early repolarization pattern (ERP) is considered a common training‐related and benign ECG finding in young adult athletes. Few data exist on ERP in the pediatric athletes population. Therefore, we aimed to evaluate the ERP prevalence, characteristics, and prognosis in pediatric athletes aged ≤16 years. Methods and Results Eight‐hundred eighty‐six consecutive pediatric athletes engaged in 17 different sports (mean age, 11.7±2.5 years; 7–16 years) were enrolled and prospectively evaluated with medical history, physical examination, resting and exercise ECGs, and transthoracic echocardiography during their preparticipation screening. Known cardiovascular diseases associated with sudden cardiac death was considered exclusion criteria. Athletes were followed up yearly for 4 years. The prevalence of ERP was 117 (13.2%), equally distributed in both sexes (P=0.072), irrespectively of body mass index and classification of sports. The most common ERP localizations were inferolateral and inferior leads (53.8% and 27.3%, respectively). Notching J‐point morphology was the most prevalent (70%), and rapidly ascending ST elevation (96%) was the most common ST‐segment morphology. Athletes with ERP were older (P<0.001) had lower rest and recovery heart rates (P<0.001), increased precordial and limb R‐wave voltages (P<0.001), increased R/S Sokolow index (P<0.001), and longer PR interval (P=0.006) in comparison with the athletes without ERP. Neither major cardiovascular nor arrhythmic events, nor sudden cardiac death were recorded over a median follow‐up of 4.2 years. One hundred seventeen (80.3%) athletes with ERP exhibited a persistent ERP. ERP localization and J‐point morphology changed during follow‐up in 11 (11.7%) and 17 (18%) of athletes, respectively. Conclusions ERP is common in pediatric athletes. It was mostly located in the inferolateral leads and associated with concave ascending ST segment with other training‐related ECG changes. The lack of either sudden cardiac death or cardiomyopathies linked to sudden cardiac death over follow‐up suggests that in pediatric athletes, ERP may be considered a benign training‐related ECG phenomenon with a potential dynamic pattern.
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Affiliation(s)
- Geza Halasz
- Cardiology Department Guglielmo Da Saliceto Hospital Piacenza Italy.,Cardiology Department Cardiocentro Ticino Lugano Switzerland
| | - Mattia Cattaneo
- Cardiology Department Cardiocentro Ticino Lugano Switzerland
| | - Massimo Piepoli
- Cardiology Department Guglielmo Da Saliceto Hospital Piacenza Italy
| | - Andrea Biagi
- Cardiology Department Guglielmo Da Saliceto Hospital Piacenza Italy
| | - Silvio Romano
- Cardiology Department of Life Health & Environmental Sciences University of L'Aquila L'Aquila Italy
| | | | - Michele Villa
- Cardiovascular Intensive Care Unit Cardiocentro Ticino Lugano Switzerland
| | - Tiziano Cassina
- Cardiovascular Intensive Care Unit Cardiocentro Ticino Lugano Switzerland
| | - Bruno Capelli
- Sport and Exercise Medicine Cardiocentro Ticino Lugano Switzerland
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31
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Steinfurt J, Bezzina CR, Biermann J, Staudacher D, Marschall C, Trolese L, Faber TS, Duerschmied D, Zehender M, Bode C, Wilde AAM, Odening KE, Lodder EM. Two siblings with early repolarization syndrome: clinical and genetic characterization by whole-exome sequencing. Europace 2021; 23:775-780. [PMID: 33324992 PMCID: PMC8139820 DOI: 10.1093/europace/euaa357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/10/2020] [Indexed: 01/23/2023] Open
Abstract
Aims The early repolarization syndrome (ERS) can cause ventricular fibrillation (VF) and sudden death in young, otherwise healthy individuals. There are limited data suggesting that ERS might be heritable. The aim of this study was to characterize the clinical phenotype and to identify a causal variant in an affected family using an exome-sequencing approach. Methods and results Early repolarization syndrome was diagnosed according to the recently proposed Shanghai ERS Score. After sequencing of known ERS candidate genes, whole-exome sequencing (WES) was performed. The index patient (23 years, female) showed a dynamic inferolateral early repolarization (ER) pattern and electrical storm with intractable VF. Isoproterenol enabled successful termination of electrical storm with no recurrence on hydroquinidine therapy during 33 months of follow-up. The index patient’s brother (25 years) had a persistent inferior ER pattern with malignant features and a history of syncope. Both parents were asymptomatic and showed no ER pattern. While there was no pathogenic variant in candidate genes, WES detected a novel missense variant affecting a highly conserved residue (p. H2245R) in the ANK3 gene encoding Ankyrin-G in the two siblings and the father. Conclusion We identified two siblings with a malignant ERS phenotype sharing a novel ANK3 variant. A potentially pathogenic role of the novel ANK3 variant is suggested by the direct interaction of Ankyrin-G with the cardiac sodium channel, however, more patients with ANK3 variants and ERS would be required to establish ANK3 as novel ERS susceptibility gene. Our study provides additional evidence that ERS might be a heritable condition.
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Affiliation(s)
- Johannes Steinfurt
- Department of Cardiology and Angiology I, University Heart Center Freiburg - Bad Krozingen, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Connie R Bezzina
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands
| | - Jürgen Biermann
- Department of Cardiology and Angiology I, University Heart Center Freiburg - Bad Krozingen, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Dawid Staudacher
- Department of Cardiology and Angiology I, University Heart Center Freiburg - Bad Krozingen, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | | | - Luca Trolese
- Department of Cardiology and Angiology I, University Heart Center Freiburg - Bad Krozingen, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Thomas S Faber
- Department of Cardiology and Angiology I, University Heart Center Freiburg - Bad Krozingen, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Daniel Duerschmied
- Department of Cardiology and Angiology I, University Heart Center Freiburg - Bad Krozingen, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Manfred Zehender
- Department of Cardiology and Angiology I, University Heart Center Freiburg - Bad Krozingen, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Christoph Bode
- Department of Cardiology and Angiology I, University Heart Center Freiburg - Bad Krozingen, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Arthur A M Wilde
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands
| | - Katja E Odening
- Department of Cardiology and Angiology I, University Heart Center Freiburg - Bad Krozingen, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Elisabeth M Lodder
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands
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32
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Yonezu K, Shinohara T, Sato H, Hirota K, Kondo H, Fukui A, Teshima Y, Yufu K, Nakagawa M, Takahashi N. Role of fragmented QRS and Shanghai score system in recurrence of ventricular fibrillation in patients with early repolarization syndrome. Ann Noninvasive Electrocardiol 2021; 26:e12873. [PMID: 34232529 PMCID: PMC8588366 DOI: 10.1111/anec.12873] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/27/2021] [Accepted: 06/08/2021] [Indexed: 01/23/2023] Open
Abstract
Background The Shanghai Score System, which weighs electrocardiogram (ECG) findings reflecting repolarization abnormalities, has been proposed for diagnosis of early repolarization syndrome (ERS). However, recent studies have suggested the involvement of depolarization abnormalities in some ERS patients. The aim of this study was to validate the Shanghai Score System in predicting the recurrence of ventricular fibrillation (VF) in ERS patients. The predictive value of fragmented QRS (fQRS) was also investigated. Methods Fifteen consecutive ERS patients (14 males, median age of 47 years) with a history of VF were retrospectively reviewed. The Shanghai Score System points were calculated, and the presence of fQRS was evaluated. Results During the median follow‐up period of 79.2 months, five patients experienced VF recurrence. In the VF recurrence group, two patients showed augmented amplitude of J waves with horizontal ST‐segment, while the other three patients had dynamic changes in J‐wave amplitude. The Shanghai Score System points in the VF recurrence group were higher than those in the VF non‐recurrence group (6.5 [range: 5.8–6.8] vs. 4.5 [range: 4.0–4.5], p = 0.002). The presence of fQRS on standard 12‐lead ECG was more frequently observed in the VF recurrence group compared with the non‐recurrence group (100% vs. 10%, p = 0.002). Conclusions The present study demonstrated that the Shanghai Score System could effectively identify ERS patients at high risk for VF recurrence. The results also suggested that the presence of fQRS, a marker of depolarization abnormalities, may be useful for predicting VF recurrence in ERS patients.
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Affiliation(s)
- Keisuke Yonezu
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, Japan
| | - Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, Japan
| | - Hiroki Sato
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, Japan
| | - Kei Hirota
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, Japan
| | - Hidekazu Kondo
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, Japan
| | - Akira Fukui
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, Japan
| | - Yasushi Teshima
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, Japan
| | - Kunio Yufu
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, Japan
| | - Mikiko Nakagawa
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, Japan
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, Japan
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Sherafati A, Eslami M, Mollazadeh R. J wave syndrome: Benign or malignant? ARYA ATHEROSCLEROSIS 2021; 17:1-9. [PMID: 35685231 PMCID: PMC9137236 DOI: 10.22122/arya.v17i0.2259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 01/12/2021] [Indexed: 11/09/2022]
Abstract
J wave syndrome is an electrical disease of the heart due to pathologic early repolarization. It encompasses a clinical spectrum from aborted sudden cardiac death due to ventricular arrhythmia (VA) usually in young affected patients to self-terminating ventricular ectopies, and finally, asymptomatic relatives of probands detected during electrocardiography acquisition (early repolarization pattern). This syndrome consists of 2 phenotypes, early repolarization and Brugada syndrome. Herein, we first describe 2 patients with early repolarization and Brugada syndrome, then, discuss their definition, epidemiology, genetics, cellular mechanism, diagnosis, risk stratification, and finally, therapeutic challenges and options one by one in detail.
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Affiliation(s)
- Alborz Sherafati
- Assistant Professor, Department of Cardiology, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Eslami
- Associate Professor, Department of Cardiology, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Mollazadeh
- Associate Professor, Department of Cardiology, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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34
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Guía ESC 2020 sobre cardiología del deporte y el ejercicio en pacientes con enfermedad cardiovascular. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.11.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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35
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Pelliccia A, Sharma S, Gati S, Bäck M, Börjesson M, Caselli S, Collet JP, Corrado D, Drezner JA, Halle M, Hansen D, Heidbuchel H, Myers J, Niebauer J, Papadakis M, Piepoli MF, Prescott E, Roos-Hesselink JW, Graham Stuart A, Taylor RS, Thompson PD, Tiberi M, Vanhees L, Wilhelm M. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. Eur Heart J 2021; 42:17-96. [PMID: 32860412 DOI: 10.1093/eurheartj/ehaa605] [Citation(s) in RCA: 702] [Impact Index Per Article: 234.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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36
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Coronel R, Potse M, Haïssaguerre M, Derval N, Rivaud MR, Meijborg VMF, Cluitmans M, Hocini M, Boukens BJ. Why Ablation of Sites With Purkinje Activation Is Antiarrhythmic: The Interplay Between Fast Activation and Arrhythmogenesis. Front Physiol 2021; 12:648396. [PMID: 33833689 PMCID: PMC8021688 DOI: 10.3389/fphys.2021.648396] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/03/2021] [Indexed: 12/27/2022] Open
Abstract
Ablation of sites showing Purkinje activity is antiarrhythmic in some patients with idiopathic ventricular fibrillation (iVF). The mechanism for the therapeutic success of ablation is not fully understood. We propose that deeper penetrance of the Purkinje network allows faster activation of the ventricles and is proarrhythmic in the presence of steep repolarization gradients. Reduction of Purkinje penetrance, or its indirect reducing effect on apparent propagation velocity may be a therapeutic target in patients with iVF.
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Affiliation(s)
- Ruben Coronel
- Department of Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
| | - Mark Potse
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France.,UMR5251 Institut de mathématiques de Bordeaux, Talence, France.,Carmen Team, Inria Bordeaux - Sud-Ouest, Talence, France
| | - Michel Haïssaguerre
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
| | - Nicolas Derval
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
| | - Mathilde R Rivaud
- Department of Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Veronique M F Meijborg
- Department of Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Matthijs Cluitmans
- Department of Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Mélèze Hocini
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
| | - Bastiaan J Boukens
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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37
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Noheria A, Anderson J. Advances in Mapping and Ablation of Ventricular Fibrillation. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-021-00899-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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38
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Murugappan M, Murugesan L, Jerritta S, Adeli H. Sudden Cardiac Arrest (SCA) Prediction Using ECG Morphological Features. ARABIAN JOURNAL FOR SCIENCE AND ENGINEERING 2021. [DOI: 10.1007/s13369-020-04765-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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39
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J waves induced during coronary angiography in patients with vasospastic angina and its implication. J Electrocardiol 2020; 64:99-101. [PMID: 33421661 DOI: 10.1016/j.jelectrocard.2020.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/08/2020] [Accepted: 12/22/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND J waves may develop during coronary angiography (CAG). PATIENTS AND RESULTS Seven patients (61±6 years, 6 male) had vasospastic angina. ST-segment elevation and ventricular fibrillation were documented in all patients. CAG revealed normal arteries, but slurring or notching (J waves) with an amplitude of 0.20±0.06 mV appeared for the first time (n=6) or in an augmented manner (n=1) with distinct alterations in QRS morphology when contrast medium was injected into the right coronary artery. CONCLUSION In patients with vasospastic angina, J waves observed during CAG can be a manifestation of a local conduction delay caused by contrast medium-induced myocardial ischemia.
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40
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Qifang L, Jing H, Yidong Z, Long Y. Ablation of premature ventricular contraction triggering ventricular fibrillation in a patient with early repolarization syndrome. Ann Noninvasive Electrocardiol 2020; 26:e12792. [PMID: 33263215 PMCID: PMC7816805 DOI: 10.1111/anec.12792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/19/2020] [Accepted: 06/24/2020] [Indexed: 01/23/2023] Open
Abstract
Early repolarization syndrome is associated with an increased risk of arrhythmic death caused by ventricular fibrillation (VF). VF is usually initiated by premature ventricular contractions (PVCs), and PVCs commonly arise from Purkinje system, the ventricular outflow tract, and papillary muscles. We report the case of a patient with J wave syndromes and recurrent VF, triggered by PVCs originating from the tricuspid annular region. VF was successfully suppressed by catheter ablation of the triggering PVCs, and there has been no recurrence of VF during a follow‐up period of 6 months.
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Affiliation(s)
- Liu Qifang
- Cardiology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Huang Jing
- Cardiology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Zhao Yidong
- Cardiology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Yang Long
- Cardiology, Guizhou Provincial People's Hospital, Guiyang, China
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Tsvetkova AS, Azarov JE, Bernikova OG, Ovechkin AO, Vaykshnorayte MA, Demidova MM, Platonov PG. Contribution of Depolarization and Repolarization Changes to J-Wave Generation and Ventricular Fibrillation in Ischemia. Front Physiol 2020; 11:568021. [PMID: 33101054 PMCID: PMC7556294 DOI: 10.3389/fphys.2020.568021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 09/14/2020] [Indexed: 01/11/2023] Open
Abstract
Background: Activation delay in ischemic myocardium has been found to contribute to J-wave appearance and to predict ventricular fibrillation (VF) in experimental myocardial infarction. However, the role of ischemia-related repolarization abnormalities in J-wave generation remains unclear. Objectives: The objective of our study was to assess a contribution of myocardial repolarization changes to J-wave generation in the body surface ECG and VF in a porcine acute myocardial infarction model. Methods: In 22 anesthetized pigs, myocardial ischemia was induced by occlusion of the left anterior descending coronary artery (LAD, n = 14) and right coronary artery (RCA, n = 8). Body surface ECGs were recorded simultaneously with intramyocardial unipolar electrograms led from flexible electrodes positioned across the left ventricular (LV) wall, interventricular septum (IVS), and right ventricular (RV) wall at apical, middle and basal levels of the ventricles (a total of 48 leads). Local activation times (ATs) and activation-repolarization intervals (ARIs, differences between dV/dt maximum during T-wave and dV/dt minimum during QRS) were measured. Results: J-waves appeared in left precordial leads (in 11 out of 14 animals with LAD occlusion) and right precordial leads (in six out of eight animals with RCA occlusion). During ischemic exposure, ATs prolonged, and the activation delay was associated with J-wave development (OR = 1.108 95% CI 1.072-1.144; p < 0.001) and VF incidence (OR = 1.039 95% CI 1.008-1.072; p = 0.015). ARIs shortened in the ischemic regions (in the IVS under LAD-occlusion and the lateral RV base under RCA-occlusion). The difference between maximal ARI in normal zones and ARI in the ischemic zones (ΔARI) was associated with J-wave appearance (OR = 1.025 95% CI 1.016-1.033, p < 0.001) independently of AT delay in multivariate logistic regression analysis. Conclusions: Both AT delay and increase of ΔARIs contributed to the development of J-wave in body surface ECG. However, only AT delay was associated with VF occurrence.
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Affiliation(s)
- Alena S Tsvetkova
- Department of Cardiac Physiology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, Syktyvkar, Russia
| | - Jan E Azarov
- Department of Cardiac Physiology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, Syktyvkar, Russia.,Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.,Department of Biochemistry and Physiology, Institute of Medicine, Pitirim Sorokin Syktyvkar State University, Syktyvkar, Russia
| | - Olesya G Bernikova
- Department of Cardiac Physiology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, Syktyvkar, Russia
| | - Alexey O Ovechkin
- Department of Cardiac Physiology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, Syktyvkar, Russia.,Department of Biochemistry and Physiology, Institute of Medicine, Pitirim Sorokin Syktyvkar State University, Syktyvkar, Russia
| | - Marina A Vaykshnorayte
- Department of Cardiac Physiology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, Syktyvkar, Russia
| | - Marina M Demidova
- Department of Therapy, Institute of Medicine, Pitirim Sorokin Syktyvkar State University, Syktyvkar, Russia.,V. A. Almazov National Medical Research Center, Saint Petersburg, Russia
| | - Pyotr G Platonov
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.,Arrhythmia Clinic, Skåne University Hospital, Lund, Sweden
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Boukens BJ, Benjacholamas V, van Amersfoort S, Meijborg VM, Schumacher C, Jensen B, Haissaguerre M, Wilde A, Prechawat S, Huntrakul A, Nademanee K, Coronel R. Structurally Abnormal Myocardium Underlies Ventricular Fibrillation Storms in a Patient Diagnosed With the Early Repolarization Pattern. JACC Clin Electrophysiol 2020; 6:1395-1404. [PMID: 33121669 DOI: 10.1016/j.jacep.2020.06.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/12/2020] [Accepted: 06/16/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the mechanism underlying QRS-slurring in a patient with the early repolarization pattern in the electrocardiogram (ECG) and ventricular fibrillation (VF) storms. BACKGROUND The early repolarization pattern refers to abnormal ending of the QRS complex in subjects with structurally normal hearts and has been associated with VF. METHODS We studied a patient with slurring of the QRS complex in leads II, III, and aVF of the ECG and recurrent episodes of VF. Echocardiographic and imaging studies did not reveal any abnormalities. Endocardial mapping was normal but subxyphoidal epicardial access was not possible. Open chest epicardial mapping was performed. RESULTS Mapping showed that the inferior right ventricular free wall activated the latest with local J-waves in unipolar electrograms. The last moment of epicardial activation concurred with QRS-slurring in the ECG whereas the J-waves in the local unipolar electrograms occurred in the ST-segment of the ECG. Myocardial biopsies obtained from the late activated tissue showed severe fibrofatty alterations in the inferior right ventricular wall where fractionation and local J-waves were present. After ablation, the early repolarization pattern in the ECG disappeared and arrhythmias have been absent since (follow-up 18 months). CONCLUSIONS In this patient, the electrocardiographic early repolarization pattern was caused by late activation due to structurally abnormal myocardium. The late activated areas were marked by J-waves in local electrograms. Ablation of these regions prevented arrhythmia recurrence and normalized the ECG.
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Affiliation(s)
- Bastiaan J Boukens
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands; Department of Experimental Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Vichai Benjacholamas
- Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Shirley van Amersfoort
- Department of Experimental Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Veronique M Meijborg
- Department of Experimental Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Cees Schumacher
- Department of Experimental Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Bjarke Jensen
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Michel Haissaguerre
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - Arthur Wilde
- Department of Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Somchai Prechawat
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Anurut Huntrakul
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Koonlawee Nademanee
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Cardiac Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Ruben Coronel
- Department of Experimental Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.
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Abstract
The main inherited cardiac arrhythmias are long QT syndrome, short QT syndrome, catecholaminergic polymorphic ventricular tachycardia and Brugada syndrome. These rare diseases are often the underlying cause of sudden cardiac death in young individuals and result from mutations in several genes encoding ion channels or proteins involved in their regulation. The genetic defects lead to alterations in the ionic currents that determine the morphology and duration of the cardiac action potential, and individuals with these disorders often present with syncope or a life-threatening arrhythmic episode. The diagnosis is based on clinical presentation and history, the characteristics of the electrocardiographic recording at rest and during exercise and genetic analyses. Management relies on pharmacological therapy, mostly β-adrenergic receptor blockers (specifically, propranolol and nadolol) and sodium and transient outward current blockers (such as quinidine), or surgical interventions, including left cardiac sympathetic denervation and implantation of a cardioverter-defibrillator. All these arrhythmias are potentially life-threatening and have substantial negative effects on the quality of life of patients. Future research should focus on the identification of genes associated with the diseases and other risk factors, improved risk stratification and, in particular for Brugada syndrome, effective therapies.
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Haïssaguerre M, Duchateau J, Dubois R, Hocini M, Cheniti G, Sacher F, Lavergne T, Probst V, Surget E, Vigmond E, Welte N, Chauvel R, Derval N, Pambrun T, Jais P, Nademanee W, Bernus O. Idiopathic Ventricular Fibrillation: Role of Purkinje System and Microstructural Myocardial Abnormalities. JACC Clin Electrophysiol 2020; 6:591-608. [PMID: 32553208 PMCID: PMC7308805 DOI: 10.1016/j.jacep.2020.03.010] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/24/2020] [Accepted: 03/24/2020] [Indexed: 12/18/2022]
Abstract
Idiopathic ventricular fibrillation is diagnosed in patients who survived a ventricular fibrillation episode without any identifiable structural or electrical cause after extensive investigations. It is a common cause of sudden death in young adults. The study reviews the diagnostic value of systematic investigations and the new insights provided by detailed electrophysiological mapping. Recent studies have shown the high incidence of microstructural cardiomyopathic areas, which act as the substrate of ventricular fibrillation re-entries. These subclinical alterations require high-density endo- and epicardial mapping to be identified using electrogram criteria. Small areas are involved and located individually in various sites (mostly epicardial). Their characteristics suggest a variety of genetic or acquired pathological processes affecting cellular connectivity or tissue structure, such as cardiomyopathies, myocarditis, or fatty infiltration. Purkinje abnormalities manifesting as triggering ectopy or providing a substrate for re-entry represent a second important cause. The documentation of ephemeral Purkinje ectopy requires continuous electrocardiography monitoring for diagnosis. A variety of diseases affecting Purkinje cell function or conduction are potentially at play in their pathogenesis. Comprehensive investigations can therefore allow the great majority of idiopathic ventricular fibrillation to ultimately receive diagnoses of a cardiac disease, likely underlain by a mosaic of pathologies. Precise phenotypic characterization has significant implications for interpretation of genetic variants, the risk assessment, and individual therapy. Future improvements in imaging or electrophysiological methods may hopefully allow the identification of the subjects at risk and the development of primary prevention strategies.
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Affiliation(s)
- Michel Haïssaguerre
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France.
| | - Josselin Duchateau
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Remi Dubois
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Mélèze Hocini
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Ghassen Cheniti
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Frederic Sacher
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Thomas Lavergne
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
| | | | - Elodie Surget
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Ed Vigmond
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Nicolas Welte
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Remi Chauvel
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Nicolas Derval
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Thomas Pambrun
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Pierre Jais
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Wee Nademanee
- Cardiology Department, Bumrungrad International Hospital, Bangkok, Thailand
| | - Olivier Bernus
- Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
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Voskoboinik A, Hsia H, Moss J, Vedantham V, Tanel RE, Patel A, Wojciak J, Downs N, Scheinman MM. The many faces of early repolarization syndrome: A single-center case series. Heart Rhythm 2020; 17:273-281. [DOI: 10.1016/j.hrthm.2019.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Indexed: 01/23/2023]
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Teumer A, Trenkwalder T, Kessler T, Jamshidi Y, van den Berg ME, Kaess B, Nelson CP, Bastiaenen R, De Bortoli M, Rossini A, Deisenhofer I, Stark K, Assa S, Braund PS, Cabrera C, Dominiczak AF, Gögele M, Hall LM, Ikram MA, Kavousi M, Lackner KJ, Müller C, Münzel T, Nauck M, Padmanabhan S, Pfeiffer N, Spector TD, Uitterlinden AG, Verweij N, Völker U, Warren HR, Zafar M, Felix SB, Kors JA, Snieder H, Munroe PB, Pattaro C, Fuchsberger C, Schmidt G, Nolte IM, Schunkert H, Pramstaller PP, Wild PS, van der Harst P, Stricker BH, Schnabel RB, Samani NJ, Hengstenberg C, Dörr M, Behr ER, Reinhard W. KCND3 potassium channel gene variant confers susceptibility to electrocardiographic early repolarization pattern. JCI Insight 2019; 4:131156. [PMID: 31600170 PMCID: PMC6962032 DOI: 10.1172/jci.insight.131156] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 10/08/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUNDThe presence of an early repolarization pattern (ERP) on the surface ECG is associated with risk of ventricular fibrillation and sudden cardiac death. Family studies have shown that ERP is a highly heritable trait, but molecular genetic determinants are unknown.METHODSTo identify genetic susceptibility loci for ERP, we performed a GWAS and meta-analysis in 2,181 cases and 23,641 controls of European ancestry.RESULTSWe identified a genome-wide significant (P < 5 × 10-8) locus in the potassium voltage-gated channel subfamily D member 3 (KCND3) gene that was successfully replicated in additional 1,124 cases and 12,510 controls. A subsequent joint meta-analysis of the discovery and replication cohorts identified rs1545300 as the lead SNP at the KCND3 locus (OR 0.82 per minor T allele, P = 7.7 × 10-12) but did not reveal additional loci. Colocalization analyses indicate causal effects of KCND3 gene expression levels on ERP in both cardiac left ventricle and tibial artery.CONCLUSIONSIn this study, we identified for the first time to our knowledge a genome-wide significant association of a genetic variant with ERP. Our findings of a locus in the KCND3 gene provide insights not only into the genetic determinants but also into the pathophysiological mechanism of ERP, discovering a promising candidate for functional studies.FUNDINGThis project was funded by the German Center for Cardiovascular Research (DZHK Shared Expertise SE081 - STATS). For detailed funding information per study, see the Supplemental Acknowledgments.
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Affiliation(s)
- Alexander Teumer
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.,German Center for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany
| | - Teresa Trenkwalder
- Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, School of Medicine, Technical University of Munich, Munich, Germany
| | - Thorsten Kessler
- Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, School of Medicine, Technical University of Munich, Munich, Germany
| | - Yalda Jamshidi
- Genetics Research Centre, Institute of Molecular and Clinical Sciences, Saint George's University of London, London, United Kingdom
| | - Marten E van den Berg
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Bernhard Kaess
- Medizinische Klinik I, St. Josefs-Hospital, Wiesbaden, Germany
| | - Christopher P Nelson
- Department of Cardiovascular Sciences, BHF Cardiovascular Research Centre, Leicester, United Kingdom.,National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Rachel Bastiaenen
- Cardiology Clinical Academic Group, Institute of Molecular and Clinical Sciences, Saint George's, University of London, London, United Kingdom
| | - Marzia De Bortoli
- Eurac Research, Institute for Biomedicine, affiliated with the University of Lübeck, Bolzano, Italy
| | - Alessandra Rossini
- Eurac Research, Institute for Biomedicine, affiliated with the University of Lübeck, Bolzano, Italy
| | - Isabel Deisenhofer
- Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, School of Medicine, Technical University of Munich, Munich, Germany
| | - Klaus Stark
- Department of Genetic Epidemiology, University Regensburg, Regensburg, Germany
| | - Solmaz Assa
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Peter S Braund
- Department of Cardiovascular Sciences, BHF Cardiovascular Research Centre, Leicester, United Kingdom.,National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Claudia Cabrera
- Clinical Pharmacology, William Harvey Research Institute, and.,NIHR Barts Cardiovascular Biomedical Research Centre, Barts and The London School of Medicine, Queen Mary University of London, London, United Kingdom.,Centre for Translational Bioinformatics, William Harvey Research Institute, Barts and the London, London, United Kingdom, and School of Medicine and Dentistry, Charterhouse Square, London, United Kingdom
| | - Anna F Dominiczak
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Martin Gögele
- Eurac Research, Institute for Biomedicine, affiliated with the University of Lübeck, Bolzano, Italy
| | - Leanne M Hall
- Department of Cardiovascular Sciences, BHF Cardiovascular Research Centre, Leicester, United Kingdom.,National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Karl J Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg, University Mainz, Mainz, Germany.,DZHK, partner site Rhine-Main, Mainz, Germany
| | | | - Christian Müller
- University Heart & Vascular Center Hamburg, Hamburg, Germany.,DZHK, partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Thomas Münzel
- DZHK, partner site Rhine-Main, Mainz, Germany.,Cardiology I, Center for Cardiology, University Medical Center of the Johannes Gutenberg, University Mainz, Mainz, Germany
| | - Matthias Nauck
- German Center for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany.,Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Sandosh Padmanabhan
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg, University Mainz, Mainz, Germany
| | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - Andre G Uitterlinden
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Niek Verweij
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Uwe Völker
- German Center for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany.,Interfaculty Institute for Genetics and Functional Genomics and
| | - Helen R Warren
- Clinical Pharmacology, William Harvey Research Institute, and.,NIHR Barts Cardiovascular Biomedical Research Centre, Barts and The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Mobeen Zafar
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Stephan B Felix
- German Center for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany.,Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Jan A Kors
- Department of Medical Informatics, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Harold Snieder
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Patricia B Munroe
- Clinical Pharmacology, William Harvey Research Institute, and.,NIHR Barts Cardiovascular Biomedical Research Centre, Barts and The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Cristian Pattaro
- Eurac Research, Institute for Biomedicine, affiliated with the University of Lübeck, Bolzano, Italy
| | - Christian Fuchsberger
- Eurac Research, Institute for Biomedicine, affiliated with the University of Lübeck, Bolzano, Italy
| | - Georg Schmidt
- Innere Medizin I, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.,DZHK, partner site Munich Heart Alliance, Munich, Germany
| | - Ilja M Nolte
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Heribert Schunkert
- Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, School of Medicine, Technical University of Munich, Munich, Germany.,DZHK, partner site Munich Heart Alliance, Munich, Germany
| | - Peter P Pramstaller
- Eurac Research, Institute for Biomedicine, affiliated with the University of Lübeck, Bolzano, Italy
| | - Philipp S Wild
- DZHK, partner site Rhine-Main, Mainz, Germany.,Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg, University Mainz, Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg, University Mainz, Mainz, Germany
| | - Pim van der Harst
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.,Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Renate B Schnabel
- University Heart & Vascular Center Hamburg, Hamburg, Germany.,DZHK, partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, BHF Cardiovascular Research Centre, Leicester, United Kingdom.,National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Marcus Dörr
- German Center for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany.,Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Elijah R Behr
- Cardiology Clinical Academic Group, Institute of Molecular and Clinical Sciences, Saint George's University of London, London, United Kingdom.,Saint George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Wibke Reinhard
- Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, School of Medicine, Technical University of Munich, Munich, Germany
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Haïssaguerre M, Nademanee W, Hocini M, Duchateau J, André C, Lavergne T, Takigawa M, Sacher F, Derval N, Pambrun T, Jais P, Walton R, Potse M, Vigmond E, Dubois R, Bernus O. The Spectrum of Idiopathic Ventricular Fibrillation and J-Wave Syndromes: Novel Mapping Insights. Card Electrophysiol Clin 2019; 11:699-709. [PMID: 31706476 DOI: 10.1016/j.ccep.2019.08.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Idiopathic ventricular fibrillation and J-wave syndromes are causes of sudden cardiac death (SCD) without any identified structural cardiac disease after extensive investigations. Recent data show that high-density electrophysiological mapping may ultimately offer diagnoses of subclinical diseases in most patients including those termed "unexplained" SCD. Three major conditions can underlie the occurrence of SCD: (1) localized depolarization abnormalities (due to microstructural myocardial alteration), (2) Purkinje abnormalities manifesting as triggering ectopy and inducible reentry; or (3) repolarization heterogeneities. Each condition may result from a spectrum of pathophysiologic processes with implications for individual therapy.
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Affiliation(s)
- Michel Haïssaguerre
- Electrophysiology and Cardiac Stimulation, Bordeaux University Hospital, 311 President Wilson Boulevard, Bordeaux 33200, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France; Univ Bordeaux, CRCTB, U1045, Bordeaux, France.
| | | | - Mélèze Hocini
- Electrophysiology and Cardiac Stimulation, Bordeaux University Hospital, 311 President Wilson Boulevard, Bordeaux 33200, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France; Univ Bordeaux, CRCTB, U1045, Bordeaux, France
| | - Josselin Duchateau
- Electrophysiology and Cardiac Stimulation, Bordeaux University Hospital, 311 President Wilson Boulevard, Bordeaux 33200, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Clementine André
- Electrophysiology and Cardiac Stimulation, Bordeaux University Hospital, 311 President Wilson Boulevard, Bordeaux 33200, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Thomas Lavergne
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Masa Takigawa
- Electrophysiology and Cardiac Stimulation, Bordeaux University Hospital, 311 President Wilson Boulevard, Bordeaux 33200, France
| | - Frederic Sacher
- Electrophysiology and Cardiac Stimulation, Bordeaux University Hospital, 311 President Wilson Boulevard, Bordeaux 33200, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Nicolas Derval
- Electrophysiology and Cardiac Stimulation, Bordeaux University Hospital, 311 President Wilson Boulevard, Bordeaux 33200, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Thomas Pambrun
- Electrophysiology and Cardiac Stimulation, Bordeaux University Hospital, 311 President Wilson Boulevard, Bordeaux 33200, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Pierre Jais
- Electrophysiology and Cardiac Stimulation, Bordeaux University Hospital, 311 President Wilson Boulevard, Bordeaux 33200, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Rick Walton
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Mark Potse
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Ed Vigmond
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Remi Dubois
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Olivier Bernus
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France; Univ Bordeaux, CRCTB, U1045, Bordeaux, France
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Cheniti G, Puyo S, Martin CA, Frontera A, Vlachos K, Takigawa M, Bourier F, Kitamura T, Lam A, Dumas-Pommier C, Pillois X, Pambrun T, Duchateau J, Klotz N, Denis A, Derval N, Cochet H, Sacher F, Dubois R, Jais P, Hocini M, Haissaguerre M. Noninvasive Mapping and Electrocardiographic Imaging in Atrial and Ventricular Arrhythmias (CardioInsight). Card Electrophysiol Clin 2019; 11:459-471. [PMID: 31400870 DOI: 10.1016/j.ccep.2019.05.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Electrocardiographic imaging is a mapping technique aiming to noninvasively characterize cardiac electrical activity using signals collected from the torso to reconstruct epicardial potentials. Its efficacy has been demonstrated clinically, from mapping premature ventricular complexes and accessory pathways to of complex arrhythmias. Electrocardiographic imaging uses a standardized workflow. Signals should be checked manually to avoid automatic processing errors. Reentry is confirmed in the presence of local activation covering the arrhythmia cycle length. Focal breakthroughs demonstrate a QS pattern associated with centrifugal activation. Electrocardiographic imaging offers a unique opportunity to better understand the mechanism of cardiac arrhythmias and guide ablation.
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Affiliation(s)
- Ghassen Cheniti
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France.
| | - Stephane Puyo
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Claire A Martin
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Antonio Frontera
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Konstantinos Vlachos
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Masateru Takigawa
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Felix Bourier
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Takeshi Kitamura
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Anna Lam
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Carole Dumas-Pommier
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France
| | - Xavier Pillois
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France
| | - Thomas Pambrun
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Josselin Duchateau
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Nicolas Klotz
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Arnaud Denis
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Nicolas Derval
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Hubert Cochet
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France; Department of Cardiovascular Imaging, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France
| | - Frederic Sacher
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Remi Dubois
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Pierre Jais
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Meleze Hocini
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Michel Haissaguerre
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
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Chen M, Wang Q, Sun J, Zhang PP, Li W, Mo BF, Li YG. Early repolarization in the inferior leads after accessory pathway ablation is highly correlated with atrial fibrillation in Wolff-Parkinson-White syndrome. J Cardiol 2019; 75:323-329. [PMID: 31445855 DOI: 10.1016/j.jjcc.2019.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 06/29/2019] [Accepted: 07/22/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Both atrial fibrillation (AF) and early repolarization (ER) are highly prevalent in patients with Wolff-Parkinson-White (WPW) syndrome. METHODS We retrospectively identified 123 WPW patients with manifest accessory pathway (mAP) and 105 patients with concealed accessory pathways (cAP) who underwent successful ablation of the APs. AF history prior to the ablation was investigated. The presence of ER was evaluated from the 12-lead electrocardiograms performed both before and immediately after the ablation. Patients were further followed up for AF occurrence after the AP ablation. RESULTS Compared with cAP patients, WPW patients presented with higher incidence of previous AF, as well as ER after the AP ablation. Compared with those without AF history, WPW patients with comorbid AF were more prone to presenting ER, especially in the inferior leads, after the mAP ablation. Regression analysis suggested that the post-ablation ER in the inferior leads was strongly associated with AF in WPW patients [OR = 5.85; 95% confidence interval (CI): 2.29-14.96], even after adjusting for age and left atrial diameter (OR = 5.14; 95% CI: 1.80-14.74). Moreover, post-ablation inferior-lead ER was predictive of AF recurrence after mAP ablation during the follow-up of 22.6 ± 11.1 months. In comparison, ER was correlated with neither AF history nor AF recurrence in patients undergoing cAP ablation. CONCLUSIONS ER in the inferior leads after the mAP ablation is highly correlated with AF history and recurrence in WPW patients.
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Affiliation(s)
- Mu Chen
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qunshan Wang
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jian Sun
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Peng-Pai Zhang
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Li
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bin-Feng Mo
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yi-Gang Li
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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50
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Inferolateral J-wave syndromes: A reflection of abnormal repolarization, depolarization, or both? Heart Rhythm 2019; 16:791-792. [DOI: 10.1016/j.hrthm.2018.11.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Indexed: 01/23/2023]
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