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Aguiar-Neves I, Sá Carvalho A, Diaz SO, Ribeiro Silva M, Santos Silva G, Teixeira R, Lopes Fernandes S, Cruz I, Almeida JG, Fonseca P, Oliveira M, Gonçalves H, Saraiva F, Barros AS, Dias Ferreira N, Sampaio F, Primo J, Fontes-Carvalho R. Sex-based differences and risk of recurrence in patients with atrial fibrillation undergoing pulmonary vein isolation. Int J Cardiol 2024; 409:132161. [PMID: 38744339 DOI: 10.1016/j.ijcard.2024.132161] [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: 02/29/2024] [Revised: 04/28/2024] [Accepted: 05/10/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Studies suggest increased likelihood of atrial fibrillation (AF) recurrence after catheter ablation (CA) in women than in men, indicating that sex may be an independent risk factor for recurrence. Nevertheless, the influence of sex on AF recurrence and underlying mechanisms remains unclear. METHODS Retrospective, single-centre study including patients undergoing AF CA between 2017 and 2021. Late recurrence (LR) was defined as AF recurrence ≥90 days after ablation, whereas early recurrence (ER) occurred within 90 days. RESULTS 656 patients (32% women) were included, with a median follow-up period of 26 months. Compared to men, women undergoing CA were older, had higher body mass indexes, and had higher rates of hypertension, thyroid dysfunction, and valvular disease. Women also had increased LR risk after CA (HR 1.76, 95% CI [1.19, 2.59]). A time-split multivariable analysis at one year of follow-up showed no difference in LR risk during the first 12 months after CA (HR 1.19, 95% CI [0.73, 1.94]); however, LR risk increased in women (HR 2.90, 95% CI [1.68, 5.01]) after 12 months. In a sex-stratified analysis, coronary calcium score (CCS) >100 was associated with increased LR risk in men (HR 1.81, 95% CI [1.06, 3.08]), but not in women. Cardiac adipose tissue volume was not associated with increased LR risk. CONCLUSIONS Fewer women underwent CA than men and LR was more frequent in women, particularly one year after the procedure. CCS was associated with increased LR risk in men.
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Affiliation(s)
- Inês Aguiar-Neves
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Rua Conceição Fernandes, 4434-532, Vila Nova de Gaia, Portugal.
| | - Augusto Sá Carvalho
- Cardiovascular R&D Centre, UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Sílvia O Diaz
- Cardiovascular R&D Centre, UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Mariana Ribeiro Silva
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Rua Conceição Fernandes, 4434-532, Vila Nova de Gaia, Portugal
| | - Gualter Santos Silva
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Rua Conceição Fernandes, 4434-532, Vila Nova de Gaia, Portugal
| | - Rafael Teixeira
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Rua Conceição Fernandes, 4434-532, Vila Nova de Gaia, Portugal
| | | | - Inês Cruz
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Rua Conceição Fernandes, 4434-532, Vila Nova de Gaia, Portugal; Cardiovascular R&D Centre, UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - João G Almeida
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Rua Conceição Fernandes, 4434-532, Vila Nova de Gaia, Portugal
| | - Paulo Fonseca
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Rua Conceição Fernandes, 4434-532, Vila Nova de Gaia, Portugal
| | - Marco Oliveira
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Rua Conceição Fernandes, 4434-532, Vila Nova de Gaia, Portugal
| | - Helena Gonçalves
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Rua Conceição Fernandes, 4434-532, Vila Nova de Gaia, Portugal
| | - Francisca Saraiva
- Cardiovascular R&D Centre, UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - António S Barros
- Cardiovascular R&D Centre, UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Nuno Dias Ferreira
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Rua Conceição Fernandes, 4434-532, Vila Nova de Gaia, Portugal
| | - Francisco Sampaio
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Rua Conceição Fernandes, 4434-532, Vila Nova de Gaia, Portugal; Cardiovascular R&D Centre, UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - João Primo
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Rua Conceição Fernandes, 4434-532, Vila Nova de Gaia, Portugal
| | - Ricardo Fontes-Carvalho
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Rua Conceição Fernandes, 4434-532, Vila Nova de Gaia, Portugal; Cardiovascular R&D Centre, UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
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Mohanty S, Natale A. Stereotactic Radiotherapy in Refractory Ventricular Tachycardia: Is it Truly a Rising "STAR"? JACC Clin Electrophysiol 2024; 10:667-669. [PMID: 38456858 DOI: 10.1016/j.jacep.2024.102337] [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: 01/12/2024] [Accepted: 01/20/2024] [Indexed: 03/09/2024]
Affiliation(s)
- Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA; Interventional Electrophysiology, Scripps Clinic, San Diego, California, USA; Metro Health Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
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Meter M, Borovac JA. A Refractory Electrical Storm after Acute Myocardial Infarction: The Role of Temporary Ventricular Overdrive Pacing as a Bridge to ICD Implantation. PATHOPHYSIOLOGY 2024; 31:44-51. [PMID: 38251048 PMCID: PMC10801483 DOI: 10.3390/pathophysiology31010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 01/23/2024] Open
Abstract
An electrical storm (ES) is defined as the presence of at least three episodes of sustained ventricular tachycardia or ventricular fibrillation within 24 h. This patient had a previously known arterial hypertension, type II diabetes mellitus, and chronic kidney disease and has presented to the Emergency Department (ED) with symptoms of retrosternal chest pain lasting for several hours prior. The initial 12-lead electrocardiogram revealed ST segment elevation in the anterior leads (V1-V6). Emergent coronary angiography revealed an acute occlusion of the proximal left anterior descending artery (pLAD) and percutaneous coronary intervention was performed with successful implantation of one drug-eluting stent in the pLAD. On day 8 of hospitalization, the patient developed a refractory ES for which he received 50 DC shocks and did not respond to multiple lines of antiarrhythmic medications. Due to a failure of medical therapy, we decided to implant a temporary pacemaker and initiate ventricular overdrive pacing (VOP) that was successful in terminating ES. Following electrical stabilization, the patient underwent a successful ICD implantation. This case demonstrates that VOP can contribute to hemodynamic and electrical stabilization of a patient that suffers from refractory ES and this treatment modality might serve as a temporary bridge to ICD implantation.
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Affiliation(s)
- Mijo Meter
- Cardiovascular Diseases Department, University Hospital of Split (KBC Split), Spinciceva 1, 21000 Split, Croatia;
| | - Josip Andelo Borovac
- Cardiovascular Diseases Department, University Hospital of Split (KBC Split), Spinciceva 1, 21000 Split, Croatia;
- Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, 21000 Split, Croatia
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Di Monaco A, Gregucci F, Bonaparte I, Romanazzi I, Troisi F, Surgo A, Vitulano N, Quadrini F, Valenti N, Carbonara R, Di Guglielmo FC, Ludovico E, Calbi R, Guida P, Ciliberti MP, Fiorentino A, Grimaldi M. Linear accelerator-based stereotactic arrhythmia radioablation for paroxysmal atrial fibrillation in elderly: a prospective phase II trial. Europace 2023; 25:euad344. [PMID: 37988294 PMCID: PMC10700012 DOI: 10.1093/europace/euad344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/13/2023] [Accepted: 11/17/2023] [Indexed: 11/23/2023] Open
Abstract
AIMS Stereotactic arrhythmia radioablation (STAR) is a novel therapeutic approach for cardiac arrhythmias. The aim of this trial is to investigate the feasibility of STAR for the treatment of paroxysmal atrial fibrillation (AF) in elderly patients. METHODS AND RESULTS Inclusion criteria were age >70 years, symptomatic AF, antiarrhythmic drugs failure, or intolerance. All patients underwent to 4D cardiac computed tomography simulation. The clinical target volume was identified in the area around pulmonary veins (PV). Stereotactic arrhythmia radioablation was performed with a total dose of 25 Gy (single fraction) delivered in 3 min. Twenty patients were enrolled and 18 underwent STAR. One patient withdrew informed consent before treatment and one patient was excluded due to unfavourable oesophagus position. With a median follow-up (FU) of 16 months (range 12-23), no acute toxicity more than Grade 3 was reported. Five patients had a Grade 1 oesophagitis 24 h after STAR; eight patients had an asymptomatic Grade 1 pericardial effusion, and one patient had a torsade de pointes treated effectively by electrical cardioversion and subsequent cardiac implantable cardioverter-defibrillator implantation. Most patients had a significant reduction in AF episodes. Five patients, due to arrhythmias recurrences after STAR, performed electrophysiological study documenting successful PV isolation. Finally, a significant improvement of quality of life was documented (48 ± 15 at enrolment vs. 75 ± 15 at 12 months FU; P < 0.001). CONCLUSION The present phase II trial demonstrated the feasibility of STAR in paroxysmal AF elderly patients and its potential role in increasing the quality of life. Surely, more robust data are needed about safety and efficacy. TRIAL REGISTRATION ClinicalTrials.gov: NCT04575662.
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Affiliation(s)
- Antonio Di Monaco
- Department of Cardiology, General Regional Hospital ‘F. Miulli’, Acquaviva delle Fonti 70021, Bari, Italy
- Department of Clinical and Experimental Medicine, University of Foggia, Viale Luigi Pinto 71122 Foggia, Italy
| | - Fabiana Gregucci
- Department of Radiation Oncology, General Regional Hospital ‘F. Miulli’, Acquaviva delle Fonti, Bari, Italy
| | - Ilaria Bonaparte
- Department of Radiation Oncology, General Regional Hospital ‘F. Miulli’, Acquaviva delle Fonti, Bari, Italy
| | - Imma Romanazzi
- Department of Cardiology, General Regional Hospital ‘F. Miulli’, Acquaviva delle Fonti 70021, Bari, Italy
| | - Federica Troisi
- Department of Cardiology, General Regional Hospital ‘F. Miulli’, Acquaviva delle Fonti 70021, Bari, Italy
| | - Alessia Surgo
- Department of Radiation Oncology, General Regional Hospital ‘F. Miulli’, Acquaviva delle Fonti, Bari, Italy
| | - Nicola Vitulano
- Department of Cardiology, General Regional Hospital ‘F. Miulli’, Acquaviva delle Fonti 70021, Bari, Italy
| | - Federico Quadrini
- Department of Cardiology, General Regional Hospital ‘F. Miulli’, Acquaviva delle Fonti 70021, Bari, Italy
| | - Noemi Valenti
- Department of Cardiology, General Regional Hospital ‘F. Miulli’, Acquaviva delle Fonti 70021, Bari, Italy
| | - Roberta Carbonara
- Department of Radiation Oncology, General Regional Hospital ‘F. Miulli’, Acquaviva delle Fonti, Bari, Italy
| | | | - Elena Ludovico
- Department of Radiology, General Regional Hospital ‘F. Miulli’, Acquaviva delle Fonti, Bari, Italy
| | - Roberto Calbi
- Department of Radiology, General Regional Hospital ‘F. Miulli’, Acquaviva delle Fonti, Bari, Italy
| | - Pietro Guida
- Department of Cardiology, General Regional Hospital ‘F. Miulli’, Acquaviva delle Fonti 70021, Bari, Italy
| | - Maria Paola Ciliberti
- Department of Radiation Oncology, General Regional Hospital ‘F. Miulli’, Acquaviva delle Fonti, Bari, Italy
| | - Alba Fiorentino
- Department of Radiation Oncology, General Regional Hospital ‘F. Miulli’, Acquaviva delle Fonti, Bari, Italy
- Department of Medicine and Surgery, LUM University, Casamassima, Bari, Italy
| | - Massimo Grimaldi
- Department of Cardiology, General Regional Hospital ‘F. Miulli’, Acquaviva delle Fonti 70021, Bari, Italy
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Hawryszko M, Sławiński G, Tomasik B, Lewicka E. Cardiac Arrhythmias in Patients Treated for Lung Cancer: A Review. Cancers (Basel) 2023; 15:5723. [PMID: 38136269 PMCID: PMC10741954 DOI: 10.3390/cancers15245723] [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: 10/29/2023] [Revised: 11/25/2023] [Accepted: 12/03/2023] [Indexed: 12/24/2023] Open
Abstract
Cardio-oncology currently faces one of the greatest challenges in the field of health care. The main goal of this discipline is to ensure that patients treated for cancer do not suffer or die from cardiovascular disease. The number of studies on the mechanisms of heart injury during cancer treatment is constantly increasing. However, there is insufficient data on heart rhythm disorders that may result from this treatment. This issue seems to be particularly important in patients with lung cancer, in whom anticancer therapy, especially radiotherapy, may contribute to the onset of cardiac arrhythmias. The observed relationship between cardiac dosimetry and radiotherapy-induced cardiotoxicity in lung cancer treatment may explain the increased mortality from cardiovascular causes in patients after chest irradiation. Further research is essential to elucidate the role of cardiac arrhythmias in this context. Conversely, recent reports have highlighted the application of stereotactic arrhythmia radioablation (STAR) in the treatment of ventricular tachycardia. This review of available studies on the epidemiology, pathogenesis, diagnosis, and treatment of arrhythmias in patients treated for lung cancer aims to draw attention to the need for regular cardiological monitoring in this group of patients. Improving cardiac care for patients with lung cancer has the potential to enhance their overall therapeutic outcomes.
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Affiliation(s)
- Maja Hawryszko
- Department of Cardiology and Heart Electrotherapy, Faculty of Medicine, Medical University of Gdansk, Smoluchowskiego 17 Street, 80-214 Gdansk, Poland; (M.H.); (E.L.)
| | - Grzegorz Sławiński
- Department of Cardiology and Heart Electrotherapy, Faculty of Medicine, Medical University of Gdansk, Smoluchowskiego 17 Street, 80-214 Gdansk, Poland; (M.H.); (E.L.)
| | - Bartłomiej Tomasik
- Department of Oncology and Radiotherapy, Faculty of Medicine, Medical University of Gdansk, Smoluchowskiego 17 Street, 80-214 Gdansk, Poland;
| | - Ewa Lewicka
- Department of Cardiology and Heart Electrotherapy, Faculty of Medicine, Medical University of Gdansk, Smoluchowskiego 17 Street, 80-214 Gdansk, Poland; (M.H.); (E.L.)
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