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Heart Failure in Patients with Arrhythmogenic Cardiomyopathy. J Clin Med 2021; 10:jcm10204782. [PMID: 34682905 PMCID: PMC8540844 DOI: 10.3390/jcm10204782] [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: 09/07/2021] [Revised: 10/10/2021] [Accepted: 10/14/2021] [Indexed: 02/07/2023] Open
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a rare inherited cardiomyopathy characterized as fibro-fatty replacement, and a common cause for sudden cardiac death in young athletes. Development of heart failure (HF) has been an under-recognized complication of ACM for a long time. The current clinical management guidelines for HF in ACM progression have nowadays been updated. Thus, a comprehensive review for this great achievement in our understanding of HF in ACM is necessary. In this review, we aim to describe the research progress on epidemiology, clinical characteristics, risk stratification and therapeutics of HF in ACM.
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Belhassen B, Shmilovich H, Nof E, Milman A. A case report of arrhythmogenic ventricular cardiomyopathy presenting with sustained ventricular tachycardia arising from the right and the left ventricles before structural changes are documented. Eur Heart J Case Rep 2020; 4:1-7. [PMID: 32128479 PMCID: PMC7047046 DOI: 10.1093/ehjcr/ytz239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 09/19/2019] [Accepted: 12/13/2019] [Indexed: 12/29/2022]
Abstract
Background Arrhythmogenic ventricular cardiomyopathy (AC) is a genetic progressive disease characterized by fibro-fatty replacement of either ventricles in isolation or in combination. Arrhythmogenic ventricular cardiomyopathy is frequently associated with ventricular tachycardia (VT) having a left bundle branch block (LBBB) morphology and much more rarely with VT having right bundle branch block (RBBB) morphology even when the left ventricle is involved. Cardiac magnetic resonance (CMR) imaging plays a key role in the diagnosis of AC. Sustained VT in AC may occur in the concealed stage of the disease before the manifestation of morphological abnormalities on echocardiogram; however, they almost always are accompanied by structural abnormalities of the ventricles on CMR. Case summary A 54-year-old man presented with sustained VT of LBBB configuration consistent with the diagnosis of AC but with no right ventricular (RV) anomalies at repeat CMR. Ten years later, he developed sustained VT with RBBB morphology and structural changes at CMR compatible with RV involvement in the setting of AC. Two years later, he suffered from recurrent identical sustained RBBB-VT with typical CMR signs of left ventricular involvement. Genetic analysis was negative for any known mutation. Discussion In the present report, we describe a patient with AC who first exhibited LBBB- and 10 years later RBBB-sustained VT. Contrasting with what is usually observed in patients with AC, documentations of the VT's arising from either ventricle were found to precede the structural anomalies in the respective cardiac chambers. This case highlights that normal CMR does not exclude underlying AC contrary to the perceptions of many clinicians. In addition, it strongly encourages repeating CMR after 1-2 years when the diagnosis of AC is highly suspected.
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Affiliation(s)
- Bernard Belhassen
- Heart Institute, Hadassah University Hospital, Kiriat Hadassah, PO Box 12000, Jerusalem 91120, Israel.,Sackler School of Medicine, PO Box 39049, Ramat Aviv, Tel-Aviv 69978, Israel
| | - Haim Shmilovich
- Sackler School of Medicine, PO Box 39049, Ramat Aviv, Tel-Aviv 69978, Israel.,Department of Cardiology, Tel Aviv Sourasky Medical Center, Weizman Street 6, PO Box 6423906, Tel-Aviv, Israel.,Department of Radiology, Tel Aviv Sourasky Medical Center, Weizman Street 6, PO Box 6423906, Tel-Aviv, Israel
| | - Eyal Nof
- Sackler School of Medicine, PO Box 39049, Ramat Aviv, Tel-Aviv 69978, Israel.,Department of Cardiology, Leviev Heart Institute, The Chaim Sheba Medical Center, Derech Sheba 2, PO Box 52621, Ramat Gan,Tel Hashomer, Israel
| | - Anat Milman
- Sackler School of Medicine, PO Box 39049, Ramat Aviv, Tel-Aviv 69978, Israel.,Department of Cardiology, Leviev Heart Institute, The Chaim Sheba Medical Center, Derech Sheba 2, PO Box 52621, Ramat Gan,Tel Hashomer, Israel
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Sinner G, Omar HR, Lin YW, Elayi SC, Guglin ME. Response to cardiac resynchronization therapy in non-ischemic cardiomyopathy is unrelated to medical therapy. Clin Cardiol 2018; 42:143-150. [PMID: 30467886 DOI: 10.1002/clc.23123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/20/2018] [Accepted: 11/17/2018] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Current guidelines recommend at least 3 months of guideline-directed medical therapy (GDMT) for patients with a new onset of non-ischemic cardiomyopathy (NICM) and left bundle branch block (LBBB) prior to cardiac resynchronization therapy (CRT). For patients who do not receive optimal GDMT, response to CRT is unknown. METHODS Patients with NICM and LBBB with QRS ≥ 120 ms were identified among all patients who underwent CRT. Patients who received GDMT for ≥ 3 months before CRT were compared to those who did not. Among 38 patients who met inclusion criteria, 24 received optimal GDMT prior to implantation (Group 1) and 14 did not (Group 2). RESULTS QRS narrowing occurred in Group 1 (160 ± 9 ms to 138 ± 20 ms, P = 0.001) and Group 2 (160 ± 17 ms to 139 ± 30 ms, P = 0.021). Left ventricular ejection fraction (LVEF) improvement occurred in Group 1 (21.3 ± 5.9% to 34.4 ± 13.9%, P < 0.001) and Group 2 (18.8 ± 4.7% to 31.1 ± 13%, P = 0.010). QRS interval and LVEF changes were similar between groups (P = NS). There was a trend towards greater CRT response in women than in men, although differences did not reach statistical significance. CONCLUSION In patients with NICM and LBBB, CRT is associated with improvements in LV size and function independent of prior GDMT. The ability of resynchronization to improve LVEF without GDMT suggests that CRT without waiting 3 months for GDMT optimization may benefit some patients with NICM and LBBB.
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Affiliation(s)
- Gregory Sinner
- Gill Heart Institute, University of Kentucky, Lexington, Kentucky
| | - Hesham R Omar
- Internal Medicine Department, Mercy Medical Center, Clinton, Iowa
| | - You W Lin
- Gill Heart Institute, University of Kentucky, Lexington, Kentucky
| | - Samy C Elayi
- Gill Heart Institute, University of Kentucky, Lexington, Kentucky
| | - Maya E Guglin
- Gill Heart Institute, University of Kentucky, Lexington, Kentucky
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Shanks M, Delgado V, Bax JJ. Cardiac Resynchronization Therapy in Non-Ischemic Cardiomyopathy. J Atr Fibrillation 2016; 8:1362. [PMID: 27909478 DOI: 10.4022/jafib.1362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 02/04/2016] [Accepted: 02/05/2016] [Indexed: 12/12/2022]
Abstract
Cardiac resynchronization therapy (CRT) is an established therapy for heart failure patients who remain symptomatic despite optimal medical therapy, have reduced left ventricular ejection fraction (<35%) and wide QRS duration (>120 ms), preferably with left bundle branch block morphology. The response to CRT depends on the cardiac substrate: presence of correctable left ventricular mechanical dyssynchrony, presence of myocardial fibrosis (scar) and position of the left ventricular pacing lead. Patients with non-ischemic cardiomyopathy have shown higher response rates to CRT compared with patients with ischemic cardiomyopathy. Differences in myocardial substrate may partly explain this disparity. Multimodality imaging plays an important role to assess the cardiac substrate and the pathophysiological determinants of response to CRT.
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Affiliation(s)
- Miriam Shanks
- University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (Canada) and Heart Lung Center, Leiden University Medical Center, Leiden (The Netherlands)
| | - Victoria Delgado
- University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (Canada) and Heart Lung Center, Leiden University Medical Center, Leiden (The Netherlands)
| | - Jeroen J Bax
- University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (Canada) and Heart Lung Center, Leiden University Medical Center, Leiden (The Netherlands)
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Havranek S, Palecek T, Kovarnik T, Vitkova I, Psenicka M, Linhart A, Wichterle D. Arrhythmogenic substrate at the interventricular septum as a target site for radiofrequency catheter ablation of recurrent ventricular tachycardia in left dominant arrhythmogenic cardiomyopathy. BMC Cardiovasc Disord 2015; 15:18. [PMID: 25887693 PMCID: PMC4359501 DOI: 10.1186/s12872-015-0010-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 02/18/2015] [Indexed: 01/24/2023] Open
Abstract
Background Left dominant arrhythmogenic cardiomyopathy (LDAC) is a rare condition characterised by progressive fibrofatty replacement of the myocardium of the left ventricle (LV) in combination with ventricular arrhythmias of LV origin. Case presentation A thirty-five-year-old male was referred for evaluation of recurrent sustained monomorphic ventricular tachycardia (VT) of 200 bpm and right bundle branch block (RBBB) morphology. Cardiac magnetic resonance imaging showed late gadolinium enhancement distributed circumferentially in the epicardial layer of the LV free wall myocardium including the rightward portion of the interventricular septum (IVS). The clinical RBBB VT was reproduced during the EP study. Ablation at an LV septum site with absence of abnormal electrograms and a suboptimum pacemap rendered the VT of clinical morphology noninducible. Three other VTs, all of left bundle branch block (LBBB) pattern, were induced by programmed electrical stimulation. The regions corresponding to abnormal electrograms were identified and ablated at the mid-to-apical RV septum and the anteroseptal portion of the right ventricular outflow tract. No abnormalities were found at the RV free wall including the inferolateral peritricuspid annulus region. Histological examination confirmed the presence of abnormal fibrous and adipose tissue with myocyte reduction in endomyocardial samples taken from both the left and right aspects of the IVS. Conclusion LDAC rarely manifests with sustained monomorphic ventricular tachycardia. In this case, several VTs of both RBBB and LBBB morphology were amenable to endocardial radiofrequency catheter ablation.
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Affiliation(s)
- Stepan Havranek
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, Prague, 128 08, Czech Republic.
| | - Tomas Palecek
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, Prague, 128 08, Czech Republic.
| | - Tomas Kovarnik
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, Prague, 128 08, Czech Republic.
| | - Ivana Vitkova
- Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Studnickova 2, 128 00, Prague, Czech Republic.
| | - Miroslav Psenicka
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, Prague, 128 08, Czech Republic.
| | - Ales Linhart
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, Prague, 128 08, Czech Republic.
| | - Dan Wichterle
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Videnska 1958/9, Prague, 140 21, Czech Republic.
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Masarone D, Limongelli G, Ammendola E, Del Giorno G, Colimodio F, D’Andrea A, Pacileo G, Santangelo L, Lambiase PD. Cardiac resynchronization therapy in cardiomyopathies. J Cardiovasc Med (Hagerstown) 2014; 15:92-9. [DOI: 10.2459/jcm.0b013e3283637ff2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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