1
|
Bekiaridou A, Coleman KM, Sharma N, George D, Liu Y, Gianos E, Rosen S, Mieres JH, Mountantonakis SE. Clinical Significance of Supraventricular Tachycardia During Pregnancy in Healthy Women. JACC Clin Electrophysiol 2024; 10:1304-1312. [PMID: 38661600 DOI: 10.1016/j.jacep.2024.03.014] [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: 11/15/2023] [Revised: 02/06/2024] [Accepted: 03/07/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Supraventricular tachycardias (SVT) are the most frequently encountered arrhythmias in pregnancy with unclear clinical significance. OBJECTIVES This study sought to report the prevalence, describe the management, and explore the association between SVT and adverse obstetric outcomes. METHODS Cohort study of primiparous and multiparous women without history of Cesarean section (CS), and with structurally normal hearts admitted in labor. The study group consisted of women with at least 1 SVT episode during pregnancy, and the control group was randomly selected in a 4:1 ratio. RESULTS Of 141,769 women meeting the inclusion criteria, SVT diagnosis was confirmed in 122. A total of 76 (age 33.2 ± 4.8 years) had at least 1 symptomatic and documented episode during pregnancy. In women with a known SVT diagnosis before pregnancy, medical therapy was not associated with a lower risk of SVT recurrence (OR: 1.07; 95% CI: 0.41-2.80). However, catheter ablation before pregnancy was associated with significantly lower risk of SVT recurrence (OR: 0.09; 95% CI: 0.04-0.23). Women with SVT during pregnancy had higher incidence of CS (39.5% vs 27.0%; P = 0.03), and preterm labor (PTL) (30.3% vs 8.6%; P < 0.001). Adjusting for age and parity, SVT during pregnancy was an independent predictor of CS (OR: 1.80; 95% CI: 1.03-3.10), particularly planned CS (OR: 2.89; 95% CI: 1.06-7.89) and PTL (OR: 4.37; 95% CI: 2.30-8.31). CONCLUSIONS SVT during pregnancy is associated with increased risk for CS and PTL in healthy women. History of SVT should be sought as early as preconception counseling, and a multidisciplinary approach is warranted for both prevention and management of SVT occurrence.
Collapse
Affiliation(s)
- Alexandra Bekiaridou
- Northwell Health, New Hyde Park, New York, USA; Elmezzi Graduate School of Molecular Medicine, Manhasset, New York, USA; Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Kristie M Coleman
- Northwell Health, New Hyde Park, New York, USA; Northwell Cardiovascular Institute, New York, New York, USA; Lenox Hill Hospital, New York, New York, USA. https://twitter.com/keepinrhythm
| | - Nikhil Sharma
- Northwell Health, New Hyde Park, New York, USA; Feinstein Institute for Medical Research, Manhasset, New York, USA; Northwell Cardiovascular Institute, New York, New York, USA
| | - Deepika George
- Northwell Health, New Hyde Park, New York, USA; Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Yan Liu
- Northwell Health, New Hyde Park, New York, USA; Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Eugenia Gianos
- Northwell Health, New Hyde Park, New York, USA; Northwell Cardiovascular Institute, New York, New York, USA; Lenox Hill Hospital, New York, New York, USA
| | - Stacey Rosen
- Northwell Health, New Hyde Park, New York, USA; Northwell Cardiovascular Institute, New York, New York, USA
| | - Jennifer H Mieres
- Northwell Health, New Hyde Park, New York, USA; Northwell Cardiovascular Institute, New York, New York, USA
| | - Stavros E Mountantonakis
- Northwell Health, New Hyde Park, New York, USA; Northwell Cardiovascular Institute, New York, New York, USA; Lenox Hill Hospital, New York, New York, USA.
| |
Collapse
|
2
|
Jeong SY, Chen A, Wu YL, Lee MS. Gender and Age Differences in the Evaluation and Clinical Outcomes of Patients with Palpitations. J Gen Intern Med 2024:10.1007/s11606-024-08860-1. [PMID: 38886321 DOI: 10.1007/s11606-024-08860-1] [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: 12/28/2023] [Accepted: 06/06/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Palpitations represent a common clinic complaint. OBJECTIVE To explore gender and age differences in the evaluation and outcomes of patients with palpitations in outpatient settings. DESIGN/PARTICIPANTS This is a retrospective observational study of 58,543 patients with no known structural cardiac disease or arrythmias presenting to primary care and cardiology clinics in an integrated health system in California with palpitations between January 2017 and December 2021. The primary and secondary endpoints were hospitalization for arrhythmia and all-cause mortality at 1 year. Multivariable logistic regression models evaluated the association between gender, age, and outcomes. RESULTS Men and women were equally as likely to be started on beta-blockers (adjusted OR 0.96, 95% CI 0.90-1.02) and evaluated with electrocardiograms (adjusted OR 0.95, 95% CI 0.90-1.01) and cardiac monitors (adjusted OR 1.04, 95% CI 0.99-1.08). Patients who completed Holter or event monitors had a lower rate of hospitalization for cardiovascular disease at 1 year than those without (2.3% vs. 2.7%, p = 0.001). At 1 year, women had a lower risk of all-cause mortality (adjusted OR 0.47, 95% CI 0.35-0.64) and hospitalization for atrial fibrillation (adjusted OR 0.47, 95% CI 0.30-0.72) and arrhythmias (adjusted OR 0.73, 95% CI 0.58-0.91) compared to men. Among older women and men (≥ 80 years), there was no significant difference in 1-year all-cause mortality (adjusted OR 0.57, 95% CI 0.29-1.12), hospitalization for atrial fibrillation (adjusted OR 0.58, 95% CI 0.17-1.97), or arrhythmias (adjusted OR 1.15, 95% CI 0.12-11.07). CONCLUSIONS There were no gender differences in referrals for cardiac monitoring or prescriptions for beta-blockers. Women had a better prognosis with a lower risk of hospitalization for arrhythmias and death at 1 year compared to men. However, 1-year risks for mortality and hospitalization for arrythmias among older women were comparable to those of older men, underscoring the importance of considering age and gender in managing patients with palpitations.
Collapse
Affiliation(s)
- Sun Young Jeong
- Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA.
| | - Aiyu Chen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Yi-Lin Wu
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Ming-Sum Lee
- Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| |
Collapse
|
3
|
Zeng R, Li F, Jiang J, Cui K, Yang Q, Gao J, Zhu X, Shi T, Li W, Tong Y, Zhang Q, Hu H, Fu H. The Safety and Feasibility of Pulsed-Field Ablation in Atrioventricular Nodal Re-Entrant Tachycardia: First-in-Human Pilot Trial. JACC Clin Electrophysiol 2024; 10:82-92. [PMID: 37831032 DOI: 10.1016/j.jacep.2023.08.030] [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: 04/12/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND The incidence of atrioventricular conduction system damage during the catheter ablation procedure has long been a safety concern in patients with atrioventricular nodal re-entrant tachycardia (AVNRT). Pulsed-field ablation (PFA) with high tissue selectivity is a promising technique to address this problem in patients with AVNRT. OBJECTIVES This study aimed to evaluate the safety and feasibility of PFA in patients with AVNRT. METHODS This was an investigator-initiated, single-center, single-arm, prospective study performed in West China Hospital, Sichuan University. Patients diagnosed with AVNRT by electrophysiological examination were included and treated using PFA. The primary outcome was the ability to achieve acute ablation success. The secondary outcomes were ablation success after 6 months and safety incidents reported. RESULTS A total of 30 patients with AVNRT with a mean age of 47.9 ± 13.9 years were included and underwent PFA. Acute ablation success was achieved in all patients. The skin-to-skin procedure time was 109.1 ± 32.1 minutes, and fluoroscopy time was 4.1 ± 0.9 minutes. A median of 8 (range: 6.5 to 11.0) PFA applications were delivered. The average distance of the closest ablation site to the His bundle was 6.5 ± 2.5 mm, with a minimum distance of 2.0 mm. All patients maintained sinus rhythm after 6 months. No adverse events occurred in any patient during the ablation or the 6-month follow-up. CONCLUSIONS PFA showed favorable feasibility and safety in patients with AVNRT in this pilot study. Further study with larger population and longer follow-up time is warranted to verify the results.
Collapse
Affiliation(s)
- Rui Zeng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Fanghui Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jian Jiang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Kaijun Cui
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qing Yang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jinnian Gao
- Sichuan Jinjiang Electronic Science and Technology Co, Ltd, Chengdu, China
| | - Xiaolin Zhu
- Sichuan Jinjiang Electronic Science and Technology Co, Ltd, Chengdu, China
| | - Tiancai Shi
- Sichuan Jinjiang Electronic Science and Technology Co, Ltd, Chengdu, China
| | - Wentao Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yao Tong
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qing Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hongde Hu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
| | - Hua Fu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
| |
Collapse
|
4
|
Alghadeer SM, Almohammed OA, Alshaya AI, Alsaif S, Albogami S, Althunayyan SM. Adenosine response and failure to convert paroxysmal supraventricular tachycardia in the emergency department. Eur J Emerg Med 2023; 30:341-346. [PMID: 37310949 DOI: 10.1097/mej.0000000000001050] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND IMPORTANCE Although adenosine is the recommended first-line therapy for patients with paroxysmal supraventricular tachycardia (SVT), it may fail to restore normal sinus rhythm. The factors associated with this failure remain unclear. OBJECTIVE To assess the response rate to adenosine and identify the factors causing adenosine failure in the management of paroxysmal SVT. DESIGN, SETTING, AND PARTICIPANTS This retrospective study was conducted on adult patients diagnosed with paroxysmal SVT and treated with adenosine in the emergency departments of two large tertiary hospitals between June 2015 and June 2021. OUTCOME MEASURE AND ANALYSIS The primary outcome of the study was the patient response to adenosine, defined as the restoration of sinus rhythm documented in the patients' files. Backward-stepwise multivariate logistic regression was used to examine the predictors of adenosine failure based on the overall response to adenosine therapy. MAIN RESULTS A total of 404 patients, with a mean age of 49 (SD 15) years and a BMI of 32 (SD 8) kg/m 2 , and treated with adenosine for paroxysmal SVT, were included. Sixty-nine percent of patients were women. The overall response rate to any adenosine dose was 86% (n = 347). The baseline heart rate did not significantly differ between adenosine responders and non-responders (179.6 ± 23.1 vs. 183.2 ± 23.4). An association was observed between the history of paroxysmal SVT and successful response to adenosine (odds ratio = 2.08; 95% confidence interval 1.05-4.11). CONCLUSION The findings of this retrospective study suggested that the use of adenosine restored normal sinus rhythm in 86% of patients with paroxysmal SVT. Furthermore, a history of paroxysmal SVT and older age were associated with an increased chance of adenosine success.
Collapse
Affiliation(s)
- Sultan M Alghadeer
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University
| | - Omar A Almohammed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University
- Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University
| | - Abdulrahman I Alshaya
- Pharmacy Practice Department, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard - Health Affairs
| | - Sara Alsaif
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University
| | - Sara Albogami
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University
| | - Saqer M Althunayyan
- Department of Trauma, Prince Sultan bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
5
|
Ortega FJ, Campos FN, Mercedes B. Hypomagnesemia Caused by Chronic Use of Over-the-Counter Proton Pump Inhibitor as a Possible Cause of Supraventricular Tachycardia. Cureus 2023; 15:e42606. [PMID: 37641741 PMCID: PMC10460536 DOI: 10.7759/cureus.42606] [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] [Accepted: 07/27/2023] [Indexed: 08/31/2023] Open
Abstract
Magnesium is an important co-factor that helps regulates the movement of ions through voltage-mediated channels within myocardial tissues by the membrane sodium-potassium pump, and its deficiency can reduce the pump's activity, leading to partial depolarization and changes in the activity of many potential-dependent membrane channels leading to arrhythmias. In this case report, we are looking to establish the direct relationship between hypomagnesemia caused by proton pump inhibitors (PPIs), which could lead to cardiac arrhythmias. Here, we present a 45-year-old Hispanic female, with a known past medical history of supraventricular tachycardia (SVT), hiatal hernia on proton pump inhibitor (PPI), and chronic smoking, who presented to the emergency department complaining of dizziness and palpitations that started two hours prior arrival to the hospital. At triage, the patient was found to have a heart rate of 190 beats per minute (bpm), and an electrocardiogram (EKG) revealed supraventricular tachycardia with a heart rate of 185 bpm. During the review of this case, no other confounding factors besides hypomagnesemia were noted, leaving this one to be the most likely cause of the arrhythmia. Patients on long-term PPI therapy are at higher risk of developing hypomagnesemia, which could lead to cardiac arrhythmia.
Collapse
|
6
|
Tseng WC, Wu MH, Lu CW, Wu KL, Wang JK, Lin MT, Chen CA, Chiu SN. Combination of Slow Pathway Late Activation Maps and Voltage Gradient Maps in Guidance of Atrioventricular Nodal Reentry Tachycardia Cryoablation. Heart Rhythm 2023:S1547-5271(23)02105-7. [PMID: 37075960 DOI: 10.1016/j.hrthm.2023.04.006] [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: 02/12/2023] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND The optimal strategy for electroanatomic mapping-guided cryoablation of atrioventricular nodal reentry tachycardia (AVNRT) remains unclear. OBJECTIVE To investigate the effectiveness of slow pathway late activation mapping (SPLAM) and voltage gradient mapping for AVNRT cryoablation. METHODS From June 2020 to February 2022, all consecutive patients with AVNRT underwent SPLAM to define the wave collision point and voltage gradient mapping to define the low voltage bridge (LVB). Conventional procedures performed from August 2018 to May 2020 served as control. RESULTS The study and control groups comprised 36 (aged 16.5±8.2 years) and 37 patients (aged 15.5±7.3 years), respectively. Total procedural times were comparable, and acute success rates were 100% in both groups. Compared to controls, number of cryomapping attempts (median 3 vs. 5, p=0.012) and cryoablation applications (median 1 vs. 2, p<0.001) were significantly lower in the study group. At a median follow-up of 14.6 and 18.3 months, recurrence rates were 5.6% (2 patients) and 10.8% (4 patients) in the study and control groups (p=0.402), respectively. Mapping of Koch's triangle took 11.8±3.6 min, in which 1562±581 points were collected. In SPLAM, wave collision points were defined and compatible with the final successful lesion sites in all patients, including those with multiple slow pathways. LVB could not be defined in 6 patients (16.7%), and LVB was not compatible with the final successful lesion in another 6 (16.7%). CONCLUSIONS For AVNRT cryoablation, SPLAM could effectively guide the localization of slow pathway ablation sites and was particularly beneficial in patients with multiple slow pathways.
Collapse
Affiliation(s)
- Wei-Chieh Tseng
- Department of Emergency Medicine, National Taiwan University Hospital/National Taiwan University Children's Hospital. No 7 & 8, Chun-Shan South Road, Taipei 100, Taiwan; Department of Pediatrics, National Taiwan University Hospital/National Taiwan University Children's Hospital. No 7 & 8, Chun-Shan South Road, Taipei 100, Taiwan
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital/National Taiwan University Children's Hospital. No 7 & 8, Chun-Shan South Road, Taipei 100, Taiwan
| | - Chun-Wei Lu
- Department of Pediatrics, National Taiwan University Hospital/National Taiwan University Children's Hospital. No 7 & 8, Chun-Shan South Road, Taipei 100, Taiwan
| | - Kun-Lang Wu
- Department of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan. No. 320, Xuguang Rd., Changhua City, Changhua County 500, Taiwan
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital/National Taiwan University Children's Hospital. No 7 & 8, Chun-Shan South Road, Taipei 100, Taiwan
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital/National Taiwan University Children's Hospital. No 7 & 8, Chun-Shan South Road, Taipei 100, Taiwan
| | - Chun-An Chen
- Department of Pediatrics, National Taiwan University Hospital/National Taiwan University Children's Hospital. No 7 & 8, Chun-Shan South Road, Taipei 100, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital/National Taiwan University Children's Hospital. No 7 & 8, Chun-Shan South Road, Taipei 100, Taiwan.
| |
Collapse
|
7
|
Sagawa K, Suzuki T, Takei K, Miura M, Ueda H, Horigome H, Ono H, Ohashi N, Sato S, Fukunaga H, Aoki H, Miyazaki A, Sakaguchi H, Morishima E, Oki K, Sumitomo N. Control of Heart Rate in Infant and Child Tachyarrhythmia With Reduced Cardiac Function Using Landiolol (HEARTFUL) - Results of a Prospective, Multicenter, Uncontrolled Clinical Study. Circ J 2022; 87:130-138. [PMID: 35979562 DOI: 10.1253/circj.cj-21-0967] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The prospective Control of HEART rate in inFant and child tachyarrhythmia with reduced cardiac function Using Landiolol (HEARTFUL) study investigated the effectiveness and safety of landiolol, a short-acting β1 selective blocker, in children.Methods and Results: Twenty-five inpatients aged ≥3 months to <15 years who developed supraventricular tachyarrhythmias (atrial fibrillation, atrial flutter, supraventricular tachycardia, and inappropriate sinus tachycardia) were treated with landiolol. The primary endpoint, the percent of patients with a reduction in heart rate ≥20% from the initial rate of tachycardia, or termination of tachycardia at 2 h after starting landiolol, was achieved in 12/25 patients (48.0%; 95% CI 28.4-67.6), which exceeded the predetermined threshold (38.0%). At 2 h after starting landiolol administration, heart rate had decreased by ≥20% in 45.8% (11/24) and recovery to sinus rhythm was achieved in 40.0% (6/15) of the patients. Adverse reactions (ARs) occurred in 24.0% (6/25) of patients, and the study was discontinued in 4.0% (1/25) of the patients; however, none of these ARs were considered serious. The most common AR was hypotension (20.0% [5/25] of patients). CONCLUSIONS The HEARTFUL study has demonstrated the efficacy of landiolol, by reducing heart rate or terminating tachycardia, in pediatric patients with supraventricular tachyarrhythmias. Although serious ARs and concerns were not identified in this study, physicians should be always cautious of circulatory collapse due to hypotension.
Collapse
Affiliation(s)
- Koichi Sagawa
- Department of Pediatric Cardiology, Cardiovascular Center, Fukuoka Children's Hospital
| | - Tsugutoshi Suzuki
- Department of Pediatric Electrophysiology, Osaka City General Hospital
| | - Kohta Takei
- Department of Pediatric Cardiology, Nagano Children's Hospital
| | - Masaru Miura
- Division of Cardiology, Tokyo Metropolitan Children's Medical Center
| | - Hideaki Ueda
- Department of Cardiology, Kanagawa Children's Medical Center
| | - Hitoshi Horigome
- Department of Child Health, Faculty of Medicine, University of Tsukuba
| | - Hiroshi Ono
- Division of Cardiology, National Center for Child Health and Development
| | - Naoki Ohashi
- Department of Pediatric Cardiology, Japan Community Healthcare Organization Chukyo Hospital
| | - Seiichi Sato
- Department of Pediatric Cardiology, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center
| | - Hideo Fukunaga
- Department of Pediatrics, Juntendo University Faculty of Medicine
| | - Hisaaki Aoki
- Department of Pediatric Cardiology, Osaka Women's and Children's Hospital
| | - Aya Miyazaki
- Division of Congenital Heart Disease, Department of Transition Medicine, Shizuoka General Hospital
| | - Heima Sakaguchi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | | | - Kaori Oki
- Clinical Development Planning, Ono Pharmaceutical Co., Ltd
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| |
Collapse
|
8
|
Antiarrhythmic Drug Therapy in the Treatment of Acute and Chronic Atrial Flutter. Card Electrophysiol Clin 2022; 14:533-545. [PMID: 36153132 DOI: 10.1016/j.ccep.2022.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In the present article, we will focus on the pharmacologic treatment of atrial flutter aimed either at restoring/maintaining sinus rhythm or controlling the ventricular response during tachyarrhythmia. To provide a comprehensive description we will start discussing the electroanatomic substrate underlying the development of atrial flutter and the complex relationship with atrial fibrillation. We will then describe the available drugs for the treatment of atrial flutter on the bases of their electrophysiological effects and data from available clinical studies. We will conclude by discussing the general principles of rhythm and rate control treatment during atrial flutter.
Collapse
|
9
|
Arrhythmias and Heart Failure in Pregnancy: A Dialogue on Multidisciplinary Collaboration. J Cardiovasc Dev Dis 2022; 9:jcdd9070199. [PMID: 35877562 PMCID: PMC9320047 DOI: 10.3390/jcdd9070199] [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: 05/26/2022] [Revised: 06/17/2022] [Accepted: 06/18/2022] [Indexed: 02/04/2023] Open
Abstract
The prevalence of CVD in pregnant people is estimated to be around 1 to 4%, and it is imperative that clinicians that care for obstetric patients can promptly and accurately diagnose and manage common cardiovascular conditions as well as understand when to promptly refer to a high-risk obstetrics team for a multidisciplinary approach for managing more complex patients. In pregnant patients with CVD, arrhythmias and heart failure (HF) are the most common complications that arise. The difficulty in the management of these patients arises from variable degrees of severity of both arrhythmia and heart failure presentation. For example, arrhythmia-based complications in pregnancy can range from isolated premature ventricular contractions to life-threatening arrhythmias such as sustained ventricular tachycardia. HF also has variable manifestations in pregnant patients ranging from mild left ventricular impairment to patients with advanced heart failure with acute decompensated HF. In high-risk patients, a collaboration between the general obstetrics, maternal-fetal medicine, and cardiovascular teams (which may include cardio-obstetrics, electrophysiology, adult congenital, or advanced HF)—physicians, nurses and allied professionals—can provide the multidisciplinary approach necessary to properly risk-stratify these women and provide appropriate management to improve outcomes.
Collapse
|
10
|
Ahmed A, Pothineni NVK, Charate R, Garg J, Elbey M, de Asmundis C, LaMeir M, Romeya A, Shivamurthy P, Olshansky B, Russo A, Gopinathannair R, Lakkireddy D. Inappropriate Sinus Tachycardia: Etiology, Pathophysiology, and Management: JACC Review Topic of the Week. J Am Coll Cardiol 2022; 79:2450-2462. [PMID: 35710196 DOI: 10.1016/j.jacc.2022.04.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 12/21/2022]
Abstract
Inappropriate sinus tachycardia (IST) is a clinical syndrome that generally affects young patients and is associated with distressing symptoms. Although the most common symptom is palpitations, it can be accompanied by a myriad of symptoms, including anxiety, dizziness, presyncope, and syncope. The pathogenesis of IST is not well understood and considered multifactorial, with autonomic dysfunction being the central abnormality. IST is a diagnosis of exclusion. Management presents a clinical challenge. The overall efficacy of lifestyle modifications and medical therapy may be limited. Recent advances in catheter and surgical sinus node sparing ablation techniques have led to improvement in outcomes. In addition, increased focus has led to development of multimodality team-based interventions to improve outcomes in this group of patients. In this review, we discuss the mechanistic basis of IST, review current approaches to diagnosis, and outline contemporary therapeutic approaches.
Collapse
Affiliation(s)
- Adnan Ahmed
- Kansas City Heart Rhythm Institute, Overland Park, Kansas, USA
| | | | - Rishi Charate
- Kansas City Heart Rhythm Institute, Overland Park, Kansas, USA
| | - Jalaj Garg
- Loma Linda University Hospital, Heart Arrythmia and Electrophysiology, Loma Linda, California, USA
| | - Mehmet Elbey
- Kansas City Heart Rhythm Institute, Overland Park, Kansas, USA
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Mark LaMeir
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Ahmed Romeya
- Kansas City Heart Rhythm Institute, Overland Park, Kansas, USA
| | | | | | - Andrea Russo
- Copper University Health Care, Camden, New Jersey, USA
| | | | | |
Collapse
|
11
|
Nelson AR, Cone DC, Aydin A, Burns K, Cicero MX, Couturier K, Rollins M, Shapiro M, Joseph D. An Evaluation of Prehospital Adenosine Use. PREHOSP EMERG CARE 2022; 27:343-349. [PMID: 35639665 DOI: 10.1080/10903127.2022.2084579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Adenosine has been safely used by paramedics for the treatment of stable supraventricular tachycardia since the mid-1990s. However, there continues to be variability in paramedics' ability to identify appropriate indications for adenosine administration. As the first of a planned series of studies aimed at improving the accuracy of SVT diagnosis and successful administration of adenosine by paramedics, this study details the current usage patterns of adenosine by paramedics. METHODS This cross-sectional retrospective study investigated adenosine use within a large northeast EMS region from January 1, 2019, through September 30, 2021. Excluding pediatric and duplicate case reports, we created a dataset containing patient age, sex, and vital signs before, during, and after adenosine administration; intravenous line location; and coded medical history from paramedic narrative documentation, including a history of atrial fibrillation, suspected arrhythmia diagnosis, and effect of adenosine. In cases with available prehospital electrocardiograms (EKGs) for review, two physicians independently coded the arrhythmia diagnosis and outcome of adenosine administration. Statistical analysis included interrater reliability with Cohen's kappa statistic. RESULTS One hundred eighty-three cases were included for final analysis, 84 did not have a documented EKG for review. Categorization of presenting rhythms in these cases occurred by a physician reviewing EMS narrative and documentation. Forty of these 84 cases (48%) were adjudicated as SVT likely, 32 (38%) as SVT unlikely and 12 (14%) as uncategorized due to lack of supporting documentation. Of the 99 cases with EKGs available to review, there was substantial agreement of arrhythmia diagnosis interpretation between physician reviewers (Cohen's kappa 0.77-1.0); 54 cases were adjudicated as SVT by two physician reviewers. Other identified cardiac rhythms included atrial fibrillation (16), sinus tachycardia (11), and ventricular tachycardia (2). Adenosine cardioversion occurred in 47 of the 99 cases with EKGs available for physician review (47.5%). Adenosine cardioversion was also deemed to occur in 87% (47/54) of cases when the EKG rhythm was physician adjudicated SVT. CONCLUSIONS This study supports the use of adenosine as a prehospital treatment for SVT while highlighting the need for continued efforts to improve paramedics' identification and management of tachyarrhythmias.
Collapse
Affiliation(s)
- Alexander R Nelson
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - David C Cone
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Ani Aydin
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Kevin Burns
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mark X Cicero
- Department of Pediatrics, Section of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Katherine Couturier
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mark Rollins
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Matthew Shapiro
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Daniel Joseph
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
12
|
Kaneko Y, Nakajima T, Tamura S, Nagashima K, Kobari T, Hasegawa H, Ishii H. Discrimination of atypical atrioventricular nodal reentrant tachycardia from atrial tachycardia by the V-A-A-V response. Pacing Clin Electrophysiol 2022; 45:839-852. [PMID: 35661184 DOI: 10.1111/pace.14540] [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: 01/13/2022] [Revised: 04/25/2022] [Accepted: 05/22/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The electrophysiological discrimination between fast-slow (F/S-) atrioventricular (AV) nodal reentrant tachycardia (NRT) and atrial tachycardia (AT) originating from the interatrial septum remains challenging. While a V-A-A-V response may occur immediately after ventricular induction or entrainment of either tachycardia, the electrophysiological dissimilarities in that response between the two tachycardias remain unclear. The purpose of this study was to identify a diagnostic indicator discriminating F/S-AVNRT from AT by examining the difference in the V-A-A-V response between the two tachycardias. METHODS This retrospective study included 17 patients with F/S-AVNRT [7 with common-form F/S-AVNRT using a typical slow pathway (SP) and 10 with superior type F/S-AVNRT using a superior SP] and 10 patients with reentrant AT. All 27 patients presented with long RP supraventricular tachycardia and an initial V-A-A-V response upon ventricular induction or entrainment. The V-A-A-V response in patients with F/S-AVNRT was due to dual atrial responses. We measured the interval between the first (A1) and second atrial electrogram (A2) of V-A-A-V and calculated ΔAA by subtracting A1-A2 from the tachycardia cycle length. RESULTS V-A-A-V responses were observed most often upon ventricular induction of F/S-AVNRT (6±5 times) as well as AT (6±6 times; P = 0.87). The V-A-A-V response upon ventricular entrainment was observed in a single patient with F/S-AVNRT versus 10 all patients with AT (P<0.001). ΔAA ranged between -80 and 228 ms in F/S-AVNRT and between -184 and 26 ms in AT. A ΔAA >26 ms predicted a diagnosis of F/S-AVNRT with a 76% sensitivity and 100% specificity, while a ΔAA ←80 ms predicted a diagnosis of AT with a 50% sensitivity and 100% specificity. CONCLUSIONS ΔAA is a useful, confirmatory, diagnostic indicator of F/S-AVNRT versus AT associated with the V-A-A-V response. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Yoshiaki Kaneko
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tadashi Nakajima
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Shuntaro Tamura
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Koichi Nagashima
- Division of Cardiology, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Takashi Kobari
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hiroshi Hasegawa
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| |
Collapse
|
13
|
Moccetti F, Yadava M, Latifi Y, Strebel I, Pavlovic N, Knecht S, Asatryan B, Schaer B, Kühne M, Henrikson CA, Stephan FP, Osswald S, Sticherling C, Reichlin T. Simplified Integrated Clinical and Electrocardiographic Algorithm for Differentiation of Wide QRS-Complex Tachycardia. JACC Clin Electrophysiol 2022; 8:831-839. [DOI: 10.1016/j.jacep.2022.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 11/29/2022]
|
14
|
Wu G, Luo Q, Bao Y, Wei Y, Lin C, Zhang N, Ling T, Chen K, Pan W, Wu L, Xie Y, Jin Q. The feasibility of using remote magnetic navigation system as the primary technological training tool for novice cardiac electrophysiology operators in the catheter ablation of left-sided accessory pathway. Cardiol J 2022; 30:VM/OJS/J/87161. [PMID: 35373327 PMCID: PMC10713225 DOI: 10.5603/cj.a2022.0015] [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: 11/28/2021] [Revised: 03/19/2022] [Accepted: 03/21/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND For novice operators, mastering catheter ablation of left-sided accessory pathway (LSAP) in a short duration of time without compromising efficacy and safety remains a challenge. In this study an attempt to shorten the learning curve by using robotics via a remote magnetic navigation (RMN) system was performed. METHODS Novice physician fellows without prior catheter ablation experience initiated their process of learning LSAP ablation using the Niobe™ RMN system. Their procedure parameters were recorded and compared with experienced operators using RMN and manual catheter navigation (MCN). RESULTS Novice operators quickly shortened the total procedure time after their first five procedures. In subsequent procedures, no significant difference in procedure time, fluoroscopy exposure or ablation time was observed between novice and experienced RMN operators. When compared to MCN operators, novice operators avoided excessive radiation exposure beginning with their first RMN procedure, while lower fluoroscopy doses were noted after five procedures. It was observed that procedure parameters did not differ significantly according to LSAP location. CONCLUSION The RMN system is a practical and easy to use tool for novice electrophysiology operators to quickly master LSAP ablation, without compromising efficacy or safety. Additionally, when compared to MCN it also protects the operators and patients from excessive radiation exposure during the procedure.
Collapse
Affiliation(s)
- Guanhua Wu
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingzhi Luo
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yangyang Bao
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yue Wei
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Changjian Lin
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ning Zhang
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tianyou Ling
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kang Chen
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenqi Pan
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liqun Wu
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yun Xie
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Qi Jin
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
15
|
Amuthan R, Curtis AB. Sex-Specific Considerations in Drug and Device Therapy of Cardiac Arrhythmias. J Am Coll Cardiol 2022; 79:1519-1529. [DOI: 10.1016/j.jacc.2021.11.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/05/2021] [Indexed: 12/28/2022]
|
16
|
Muresan L, Cismaru G, Muresan C, Rosu R, Gusetu G, Puiu M, Mada RO, Martins RP. Beta blockers for the treatment of arrhythmias: Bisoprolol - a systematic review. ANNALES PHARMACEUTIQUES FRANÇAISES 2022; 80:617-634. [PMID: 35093388 DOI: 10.1016/j.pharma.2022.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 09/25/2021] [Accepted: 01/12/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Beta blockers have long been successfully used for the treatment of both supraventricular and ventricular arrhythmias. However, differences exist between their chemical structure, pharmacokinetic and pharmacodynamic properties (absorption, bioavailability, metabolism, hydrophilic or lipophilic character, selective or non-selective nature, the presence or absence of intrinsic sympathomimetic activity), which may confer different antiarrhythmic properties to different beta blockers. The aim of this study was to analyze the current existing evidence for bisoprolol for the treatment of both supraventricular and ventricular arrhythmias. MATERIAL AND METHODS Using the keywords "bisoprolol" and "arrhythmias" or "atrial fibrillation" or "ventricular tachycardia" or "premature ventricular complexes" or "ventricular fibrillation", the Medline database was searched for articles in English or French until April 2020 assessing the role of bisoprolol in the treatment of arrhythmias. Data was then analyzed according to the type of arrhythmia treated and the quality of evidence using the GRADE approach. RESULTS A total of 325 studies were identified, of which 28 were considered relevant to the current topic. Among these studies, 19 assessed the role of bisoprolol for the treatment of supraventricular arrhythmias, 8 its role in treating ventricular arrhythmias and 1 its role in supraventricular and ventricular arrhythmias. The quality of evidence varied from low (7 studies) to high (5 studies). CONCLUSION Current evidence exists supporting the use of bisoprolol for the treatment of supraventricular arrhythmias, especially for rate control during atrial fibrillation. Evidence also exists for its efficacy in the treatment of ventricular arrhythmias, both in primary and in secondary prevention.
Collapse
Affiliation(s)
- Lucian Muresan
- "Emile Muller" Hospital, Cardiology Department, 68100 Mulhouse, France.
| | - Gabriel Cismaru
- Rehabilitation Hospital, Cardiology Department, 400347 Cluj-Napoca, Romania
| | - Crina Muresan
- "Emile Muller" Hospital, Cardiology Department, 68100 Mulhouse, France
| | - Radu Rosu
- Rehabilitation Hospital, Cardiology Department, 400347 Cluj-Napoca, Romania
| | - Gabriel Gusetu
- Rehabilitation Hospital, Cardiology Department, 400347 Cluj-Napoca, Romania
| | - Mihai Puiu
- Rehabilitation Hospital, Cardiology Department, 400347 Cluj-Napoca, Romania
| | - Razvan Olimpiu Mada
- "Niculae Stancioiu" Heart Institute, Cardiology Department, 400005 Cluj-Napoca, Romania
| | - Raphaël Pedro Martins
- Centre Hospitalier Universitaire de Rennes, Cardiology Department, 35000 Rennes, France
| |
Collapse
|
17
|
Tamirisa KP, Elkayam U, Briller JE, Mason PK, Pillarisetti J, Merchant FM, Patel H, Lakkireddy DR, Russo AM, Volgman AS, Vaseghi M. Arrhythmias in Pregnancy. JACC Clin Electrophysiol 2022; 8:120-135. [PMID: 35057977 DOI: 10.1016/j.jacep.2021.10.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/06/2021] [Accepted: 10/13/2021] [Indexed: 12/18/2022]
Abstract
Increasing maternal mortality and incidence of arrhythmias in pregnancy have been noted over the past 2 decades in the United States. Pregnancy is associated with a greater risk of arrhythmias, and patients with a history of arrhythmias are at significant risk of arrhythmia recurrence during pregnancy. The incidence of atrial fibrillation in pregnancy is rising. This review discusses the management of tachyarrhythmias and bradyarrhythmias in pregnancy, including management of cardiac arrest. Management of fetal arrhythmias are also reviewed. For patients without structural heart disease, β-blocker therapy, especially propranolol and metoprolol, and antiarrhythmic drugs, such as flecainide and sotalol, can be safely used to treat tachyarrhythmias. As a last resort, catheter ablation with minimal fluoroscopy can be performed. Device implantation can be safely performed with minimal fluoroscopy and under echocardiographic or ultrasound guidance in patients with clear indications for devices during pregnancy. Because of rising maternal mortality in the United States, which is partly driven by increasing maternal age and comorbidities, a multidisciplinary and/or integrative approach to arrhythmia management from the prepartum to the postpartum period is needed.
Collapse
Affiliation(s)
| | - Uri Elkayam
- Keck School of Medicine, University of Southern California, California; Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, California, USA
| | - Joan E Briller
- Division of Cardiology, University of Illinois, Chicago, Illinois, USA
| | - Pamela K Mason
- Division of Cardiology/Electrophysiology, University of Virginia, Charlottesville, Virginia
| | | | - Faisal M Merchant
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Hena Patel
- University of Chicago, Chicago, Illinois, USA
| | | | | | | | - Marmar Vaseghi
- UCLA Cardiac Arrhythmia Center, University of California, Los Angeles, California, USA.
| |
Collapse
|
18
|
Pfaller B, Wichert-Schmitt B, Spears D, D'Souza R, Silversides CK. Tachycardia-induced cardiomyopathy in three consecutive pregnancies. Obstet Med 2021; 14:269-271. [PMID: 34880944 DOI: 10.1177/1753495x20958853] [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: 02/27/2020] [Accepted: 08/25/2020] [Indexed: 11/16/2022] Open
Abstract
Tachycardia-induced cardiomyopathy is rare during pregnancy and is reversible when the underlying arrhythmia is effectively treated. Management can be complex due to the risks of antiarrhythmic medications and cardiac interventions on the developing fetus. The care requires a well-coordinated multidisciplinary team of cardiologists, electrophysiologists, and maternal-fetal specialists. In this report, we describe a case of recurrent atrial tachycardia-induced cardiomyopathy in pregnancy.
Collapse
Affiliation(s)
- Birgit Pfaller
- Department of Medicine, Division of Cardiology, University of Toronto Pregnancy and Heart Disease Program and Obstetric Medicine Program, Mount Sinai and Toronto General Hospitals, Toronto, Ontario, Canada
| | - B Wichert-Schmitt
- Department of Medicine, Division of Cardiology, University of Toronto Pregnancy and Heart Disease Program and Obstetric Medicine Program, Mount Sinai and Toronto General Hospitals, Toronto, Ontario, Canada.,Faculty of Medicine, Department of Cardiology and Medical Intensive Care, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Danna Spears
- Department of Medicine, Division of Cardiology, University of Toronto Pregnancy and Heart Disease Program and Obstetric Medicine Program, Mount Sinai and Toronto General Hospitals, Toronto, Ontario, Canada
| | - Rohan D'Souza
- Faculty of Medicine, Department of Cardiology and Medical Intensive Care, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Candice K Silversides
- Department of Medicine, Division of Cardiology, University of Toronto Pregnancy and Heart Disease Program and Obstetric Medicine Program, Mount Sinai and Toronto General Hospitals, Toronto, Ontario, Canada
| |
Collapse
|
19
|
Bendaram S, Elkattawy S, Atif Masood Noori M, Fichadiya H, Ayad S, Kaur P, Pullatt R, Shamoon F. Management of Wolff-Parkinson-White syndrome in a patient with peripartum cardiomyopathy. J Community Hosp Intern Med Perspect 2021; 11:839-842. [PMID: 34804402 PMCID: PMC8604443 DOI: 10.1080/20009666.2021.1978155] [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] [Received: 07/11/2021] [Accepted: 09/03/2021] [Indexed: 12/03/2022] Open
Abstract
Wolf-Parkinson-White (WPW) syndrome is a congenital heart condition in which the atrioventricular (AV) node is bypassed by an accessory pathway that connects the atria and ventricle directly along with symptoms of syncope or palpitations. WPW syndrome in patients with a history of peripartum cardiomyopathy (pregnancy-related cardiomyopathy) is associated with a high risk of morbidity and mortality secondary to failure of the pump and the conduction system of the heart. Management of these cases deals with arrhythmia and systolic heart failure, which becomes more challenging in pregnant patients as it requires treatment methods that minimize risks to the fetus. We report a case of a young female patient with WPW syndrome and peripartum cardiomyopathy presenting with symptomatic arrhythmias (tachycardia).
Collapse
|
20
|
Kurt E, AK R, Eke Kurt ŞZ, Bahadırlı S, Cimilli Öztürk T. The correlation of 30- and 90-day mortality rates with Hs-troponin I values measured in patients diagnosed with paroxysmal supraventricular tachycardia in emergency service. HONG KONG J EMERG ME 2021; 28:355-360. [DOI: 10.1177/1024907919871421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Background: This study aims to determine the relationship between troponin levels and 30- and 90-day mortality rates in patients who applied to emergency service with paroxysmal supraventricular tachycardia. Materials and methods: The data of our study were obtained from the retrospective screening of the files of 321 patients who applied to the emergency department between 1 January 2015 and 31 December 2016 with International Classification of Diseases diagnosis with I47.1 (supraventricular tachycardia). Unstable patients, patients under 18 years, and patients with comorbidities that could increase troponin levels did not participate in the study. A total of 159 patients diagnosed with paroxysmal supraventricular tachycardia were included in the study. These patients’ files were examined, and their examination and anamnesis information at the time of admission to hospital, demographic characteristics, and applied treatments were analyzed. The 30- and 90-day mortality rates of the patients were examined. Results: The study was carried out with 159 patients. Troponin was positive in 25 (15.7%) cases, while it was negative in 134 (84.3%) cases. There was no significant difference between the two groups in terms of 30- and 90-day mortality rates. Coronary artery disease was found to be higher in patients with positive troponin than patients with negative troponin. Conclusion: No significant difference was found between patients with positive troponin values compared to patients with negative troponin values in terms of 30- and 90-day mortality rates. We believe that prospective observational studies or large-scale retrospective studies will better elucidate this issue.
Collapse
Affiliation(s)
- Erdem Kurt
- Kahta Public Hospital, Adıyaman, Turkey
- Department of Emergency Medicine, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - Rohat AK
- Department of Emergency Medicine, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
- Department of Emergency Medicine, Kartal Dr. Lütfi Kırdar Education and Research Hospital, Istanbul, Turkey
| | - Şebnem Zeynep Eke Kurt
- Department of Emergency Medicine, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
- Department of Emergency Medicine, Adıyaman Education and Research Hospital, Adıyaman, Turkey
| | - Suphi Bahadırlı
- Department of Emergency Medicine, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
- Beylikdüzü Public Hospital, Istanbul, Turkey
| | - Tuba Cimilli Öztürk
- Department of Emergency Medicine, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| |
Collapse
|
21
|
Iacopino S, Colella J, Pesce F, Artale P, Fabiano G, Petretta A. Delta wave automatic mapping and catheter ablation without fluoroscopy in patients with overt accessory pathway: A new workflow. HeartRhythm Case Rep 2021; 7:674-678. [PMID: 34712563 PMCID: PMC8530811 DOI: 10.1016/j.hrcr.2021.06.015] [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: 11/29/2022] Open
Affiliation(s)
- Saverio Iacopino
- Electrophysiology Unit, Maria Cecilia Hospital, Cotignola, Italy
| | - Jacopo Colella
- Electrophysiology Unit, Maria Cecilia Hospital, Cotignola, Italy
| | - Francesca Pesce
- Electrophysiology Unit, Maria Cecilia Hospital, Cotignola, Italy
| | - Paolo Artale
- Electrophysiology Unit, Città di Lecce Hospital, Lecce, Italy
| | - Gennaro Fabiano
- Electrophysiology Unit, Maria Cecilia Hospital, Cotignola, Italy
| | - Andrea Petretta
- Electrophysiology Unit, Maria Cecilia Hospital, Cotignola, Italy
| |
Collapse
|
22
|
Ramia P, Ollaik F, Hilal L, Jalbout W, AlJaroudi W, Al Ahmad A, Sfeir P, Jurjus A, Refaat M, Youssef B. Stereotactic Radiosurgery for Atrioventricular Node Ablation in Swine: A Study on Efficacy and Dosimetric Evaluation of Organs at Risk. Cureus 2021; 13:e18785. [PMID: 34804652 PMCID: PMC8592376 DOI: 10.7759/cureus.18785] [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] [Accepted: 10/04/2021] [Indexed: 11/07/2022] Open
Abstract
Introduction Stereotactic radiosurgery (SRS) delivered to arrhythmogenic foci within the heart is a promising treatment modality. We dosimetrically evaluated the radiation dose to the organs at risk of four swine that were successfully treated with linear-accelerator-based SRS for atrioventricular (AV) node ablation. Materials and methods Single-chamber pacemakers were implanted in four large white breed swine. Cardiac computed tomography simulation scans were performed to localize the AV node and organs at risk. SRS (35-40 Gy) was delivered to the AV node, and the pigs were followed up with pacemaker interrogations. One-sample t-tests were used to evaluate Dmax of great vessels, esophagus, and chest wall as compared to known normal tissue constraints as per RTOG 0631 and AAPM Task Group 101. Results All pigs had disturbances of AV conduction with progressive transition into complete heart block. Macroscopic and microscopic evaluation showed fibrosis in the AV node but did not reveal any changes in non-nodal cardiac tissue or vessels. The mean Dmax±SD (p-value) of the chest wall (14.7±3.3 (0.02)), esophagus (10.7±1.1 (<0.01)) superior vena cava (3.3±4.1 (<0.01)), right pulmonary artery (16.1±6.4 (<0.01)), right pulmonary vein (15.7± 5 (<0.01)), left pulmonary artery (11.1±1.7 (<0.01)) and left pulmonary vein (14.1±2.6 (<0.01)), and the inferior vena cava (33.68±1.6 (0.026)) were significantly below the normal tissue constraint cutoffs. Mean±SD (p-value) of the ascending aorta (19.4±16.1 (0.12)) was not significantly different than normal tissue constraint cutoffs. One swine model treated at 40 Gy had small area of hotspot in the ascending aorta (40.65 (0.4 cc)). Conclusion We have demonstrated in our swine models that SRS using 35-40 Gy can be done without exceeding known human normal tissue constraints to the chest wall, esophagus, and great vessels.
Collapse
Affiliation(s)
- Paul Ramia
- Radiation Oncology, American University of Beirut, Beirut, LBN
| | - Farah Ollaik
- Radiation Oncology, American University of Beirut, Beirut, LBN
| | - Lara Hilal
- Radiation Oncology, American University of Beirut, Beirut, LBN
| | - Wassim Jalbout
- Radiation Oncology, American University of Beirut, Beirut, LBN
| | | | - Amin Al Ahmad
- Cardiology, Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, USA
| | - Pierre Sfeir
- Cardiothoracic Surgery, American University of Beirut, Beirut, LBN
| | - Abdo Jurjus
- Anatomy, American University of Beirut, Beirut, LBN
| | - Marwan Refaat
- Cardiovascular Disease, American University of Beirut, Beirut, LBN
| | - Bassem Youssef
- Radiation Oncology, American University of Beirut, Beirut, LBN
| |
Collapse
|
23
|
Ibetoh CN, Stratulat E, Liu F, Wuni GY, Bahuva R, Shafiq MA, Gattas BS, Gordon DK. Supraventricular Tachycardia in Pregnancy: Gestational and Labor Differences in Treatment. Cureus 2021; 13:e18479. [PMID: 34659918 PMCID: PMC8494174 DOI: 10.7759/cureus.18479] [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: 06/07/2021] [Accepted: 10/04/2021] [Indexed: 11/28/2022] Open
Abstract
Supraventricular tachycardia (SVT) is a tachyarrhythmia characterized by a heart rate above 120 beats per minute (BPM). Patients with SVT exhibit the following symptoms: palpitations, shortness of breath, chest pain, hemodynamic instability, or possibly asymptomatic. The increase in cardiac output and the increase in resting heart rate during pregnancy predispose pregnant women to SVT. The management of SVT in pregnancy, although remarkably similar, varies slightly based on the trimester of pregnancy. Atenolol and verapamil are effective methods of treating SVT, which can be used during the second and third trimesters. Both medications are contraindicated in the first trimester. At the same time, intravenous adenosine can be used in all three trimesters, including labor. Electrical cardioversion is an effective treatment method for hemodynamically unstable or drug-refractory patients, which has proven to be safe in all three trimesters, including labor but can result in pre-term labor in the third trimester. Non-fluoroscopic ablation proved to be the only treatment method that definitively resolved SVT without recurrence.
Collapse
Affiliation(s)
- Crystal N Ibetoh
- Family Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Eugeniu Stratulat
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Fan Liu
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - George Y Wuni
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ronak Bahuva
- Internal Medicine, California Institute of Behavioral Neuroscience & Psychology, Fairfield, USA
- Internal Medicine, University at Buffalo, Buffalo, USA
| | - Muhammad A Shafiq
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, Rawalpindi Medical University, Islamabad, PAK
| | - Boula S Gattas
- Internal Medicine, California Institute of Behavioral Neuroscience & Psychology, Fairfield, USA
| | - Domonick K Gordon
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, Scarborough General Hospital, Scarborough, TTO
| |
Collapse
|
24
|
Lee DU, Fan GH, Hastie DJ, Addonizio EA, Karagozian R. The clinical impact of paroxysmal arrhythmias on the hospital outcomes of patients admitted with cirrhosis: propensity score matched analysis of 2011-2017 US hospitals. Expert Rev Cardiovasc Ther 2021; 19:947-956. [PMID: 34493127 DOI: 10.1080/14779072.2021.1978841] [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] [Indexed: 10/20/2022]
Abstract
BACKGROUND We evaluate the effects of paroxysmal arrhythmia on the hospital outcomes of patients admitted with cirrhosis. RESEARCH DESIGN AND METHODS 2011-2017 National Inpatient Sample was used to isolate patients with decompensated/compensated cirrhosis, stratified by paroxysmal arrhythmia (supraventricular: PSVT and ventricular: PVT). The cohorts were matched using propensity-score matching and compared to mortality, length of stay, cost, and cardiac complications (cardioversion, cardiogenic shock, cardiac arrest, and ventricular fibrillation). RESULTS In compensated cirrhosis, 2,453 had PSVT with matched controls; 5,274 had PVT with matched controls. Those with PSVT had higher mortality (aOR 1.55 95%CI 1.23-1.95) and higher rates of cardioversion and cardiogenic shock; likewise, those with PVT had higher mortality (aOR 2.41 95%CI 2.09-2.78) and higher rates of all complications. In decompensated cirrhosis, 1,598 had PSVT with matched controls; 4,178 had PVT with matched controls. Those with PSVT had higher mortality (aOR 1.57 95%CI 1.28-1.93) and higher rates of cardioversion, cardiogenic shock, cardiac arrest; those with PVT had higher mortality (aOR 2.25 95%CI 1.98-2.56) and higher rates of all complications. CONCLUSION The findings from this study show that in either decompensated or compensated cohort, those with paroxysmal arrhythmias are at a higher risk of in-hospital mortality and adverse cardiac outcomes.
Collapse
Affiliation(s)
- David Uihwan Lee
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, MA, USA
| | - Gregory Hongyuan Fan
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, MA, USA
| | - David Jeffrey Hastie
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, MA, USA
| | - Elyse Ann Addonizio
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, MA, USA
| | - Raffi Karagozian
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, MA, USA
| |
Collapse
|
25
|
Zhou B, Zhu YJ, Zhai ZQ, Weng SX, Ma YZ, Yu FY, Qi YJ, Jiang YZ, Gao X, Xu XQ, Jiang X, Jing ZC, Tang M. Radiofrequency Catheter Ablation of Supraventricular Tachycardia in Patients With Pulmonary Hypertension: Feasibility and Long-Term Outcome. Front Physiol 2021; 12:674909. [PMID: 34220537 PMCID: PMC8249814 DOI: 10.3389/fphys.2021.674909] [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: 03/07/2021] [Accepted: 05/24/2021] [Indexed: 11/13/2022] Open
Abstract
Background Supraventricular tachycardia (SVT) occurs commonly and is strongly correlated with clinical deterioration in patients with pulmonary hypertension (PH). This study aimed to investigate the feasibility and long-term outcome of radiofrequency catheter ablation (RFCA) in PH patients with SVT. Materials and Methods Consecutive PH patients with SVT who were scheduled to undergo electrophysiological study and RFCA between September 2010 and July 2019 were included. The acute results and long-term success of RFCA were assessed after the procedure. Results In total, 71 PH patients with 76 episodes of SVT were analyzed. Cavotricuspid isthmus-dependent atrial flutter (n = 33, 43.5%) was the most common SVT type, followed by atrioventricular nodal reentrant tachycardia (n = 16, 21.1%). Of the 71 patients, 60 (84.5%) underwent successful electrophysiological study and were subsequently treated by RFCA. Among them, acute sinus rhythm was restored in 54 (90.0%) patients, and procedure-related complications were observed in 4 (6.7%) patients. Univariate logistic regression analysis showed that cavotricuspid isthmus-independent atrial flutter [odds ratio (OR) 25.00, 95% confidence interval (CI) 3.45–180.98, p = 0.001] and wider pulmonary artery diameter (OR 1.19, 95% CI 1.03–1.38; p = 0.016) were associated with RFCA failure. During a median follow-up of 36 (range, 3–108) months, 7 patients with atrial flutter experienced recurrence, yielding a 78.3% 3-year success rate for RFCA treatment. Conclusion The findings suggest that RFCA of SVT in PH patients is feasible and has a good long-term success rate. Cavotricuspid isthmus-independent atrial flutter and a wider PAD could increase the risk for ablation failure.
Collapse
Affiliation(s)
- Bin Zhou
- State Key Lab of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Cardiology, Zhujiang Hospital, Laboratory of Heart Center, Southern Medical University, Guangzhou, China
| | - Yong-Jian Zhu
- State Key Laboratory of Complex Severe and Rare Diseases, Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zheng-Qin Zhai
- State Key Lab of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Si-Xian Weng
- State Key Lab of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ya-Zhe Ma
- State Key Lab of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feng-Yuan Yu
- State Key Lab of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying-Jie Qi
- State Key Lab of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi-Zhou Jiang
- State Key Lab of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Gao
- State Key Lab of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xi-Qi Xu
- State Key Laboratory of Complex Severe and Rare Diseases, Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Jiang
- State Key Laboratory of Complex Severe and Rare Diseases, Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhi-Cheng Jing
- State Key Laboratory of Complex Severe and Rare Diseases, Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min Tang
- State Key Lab of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
26
|
Brugada J, Katritsis DG, Arbelo E, Arribas F, Bax JJ, Blomström-Lundqvist C, Calkins H, Corrado D, Deftereos SG, Diller GP, Gomez-Doblas JJ, Gorenek B, Grace A, Ho SY, Kaski JC, Kuck KH, Lambiase PD, Sacher F, Sarquella-Brugada G, Suwalski P, Zaza A. 2019 ESC Guidelines for the management of patients with supraventricular tachycardiaThe Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC). Eur Heart J 2021; 41:655-720. [PMID: 31504425 DOI: 10.1093/eurheartj/ehz467] [Citation(s) in RCA: 522] [Impact Index Per Article: 174.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
|
27
|
Aykan AÇ, Karabay CY, Yıldız M. Evaluation of cardiac functions after catheter ablation of atrioventricular nodal reentrant tachycardia. Turk J Med Sci 2021; 51:589-594. [PMID: 33021754 PMCID: PMC8203167 DOI: 10.3906/sag-2005-254] [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] [Received: 05/20/2020] [Accepted: 10/03/2020] [Indexed: 11/03/2022] Open
Abstract
Background/aim Radiofrequency catheter ablation (RFA) is the most effective method of supraventricular tachycardia therapy. Recurrent supraventricular tachycardia causes systolic dysfunction and dilated cardiomyopathy. The aim of this study was to evaluate the long-term alterations of atrial and ventricular functions after RFAof typical atrioventricular nodal reentrant tachycardia (AVNRT). Materials and methods This cross-sectional study included 55 consecutive patients with symptomatic drug-resistant AVNRT who had had an invasive electrophysiology study and RFA. Speckle-tracking–based echocardiographic assessment was performed shortly before and 1 year after the operation. Left ventricle (LV) and right ventricle (RV) peak systolic strain (PSS) and atrial strain measurements were performed. Results RFA successfully eliminatedtachyarrhythmia in all patients. LV apical 4-chamber PSS –20.8% (–24.7 to –16.0) vs. –22.8% (–26.6 to –17.0, P < 0.001), LV apical 2-chamber PSS –21.5% (–26.8 to –10.1) vs. –22.0% (–27.8 to –13.7, P < 0.001), LV global PSS –20.4% (–26.4 to –14.4) vs. –23.0% (–27.1 to –2.3, P < 0.001), RV global PSS –26.0% (–30.0 to –18.0) vs. –26.5% (–32.1 to –19.7, P < 0.001), and peak left atrial longitudinal strain 41.0% (19.0–71.8) vs. 54.0% (25.6–82.0, P < 0.001) were significantly improved 1 year after RFA. Conclusion RFA of AVNRT not only provides relief of palpitations but also improves cardiac functions.
Collapse
Affiliation(s)
- Ahmet Çağrı Aykan
- Department of Cardiology, Faculty of Medicine, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
| | - Can Yücel Karabay
- Department of Cardiology, Siyami Ersek Education and Research Hospital, İstanbul, Turkey
| | - Mustafa Yıldız
- Department of Cardiology, İstanbul Cerrahpaşa University Haseki Cardiology Institute, İstanbul, Turkey
| |
Collapse
|
28
|
Bergonti M, Dello Russo A, Sicuso R, Ribatti V, Compagnucci P, Catto V, Gasperetti A, Zucchetti M, Cellucci S, Vettor G, Dessanai MA, Majocchi B, Moltrasio M, Russo E, Stronati G, Guerra F, Di Biase L, Natale A, Tondo C, Casella M. Long-Term Outcomes of Near-Zero Radiation Ablation of Paroxysmal Supraventricular Tachycardia: A Comparison With Fluoroscopy-Guided Approach. JACC Clin Electrophysiol 2021; 7:1108-1117. [PMID: 33933407 DOI: 10.1016/j.jacep.2021.02.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to assess the long-term outcomes of minimally fluoroscopic approach (MFA) compared with conventional fluoroscopic ablation (ConvA) in terms of recurrences of arrhythmia and long-term complications. BACKGROUND Catheter ablation (CA) of supraventricular tachycardia (SVT) with an MFA, under the guidance of electroanatomic mapping (EAM) systems, results in a significant reduction in exposure to ionizing radiations without impairing acute procedural success and complication rate. However, data regarding long-term outcomes of MFA compared with ConvA are lacking. METHODS This is a retrospective observational study. All patients undergoing MFA CA of SVT (atrioventricular nodal re-entrant tachycardia and atrioventricular re-entrant tachycardia) between 2010 and 2015 were enrolled and were compared with matched subjects (1 MFA: 2 ConvA) undergoing ConvA during the same period. The 2 co-primary outcomes were recurrence of arrhythmias and long-term complications. RESULTS Six-hundred eighteen patients (mean age 38 ± 15 years, 60% female) were enrolled. MFA included 206 patients, whereas 412 were treated with ConvA. Acute success (99% vs. 97%; p = 0.10) and acute complications (2.4% vs. 5.3%; p = 0.14) were similar in the 2 groups. During a median follow-up of 4.4 years, 5.9% of patients experienced recurrence of arrhythmias. At multivariate analysis, ConvA (hazard ratio [HR]: 3.03) and procedural success (HR: 0.10) were independently associated with recurrence of arrhythmias. Late complications (i.e., advance atrioventricular block and need for pacemaker implantation) occurred more frequently in ConvA (3.4% vs. 0.5%; p = 0.03) compared with MFA. CONCLUSIONS CA guided by EAM systems with MFA provided better long-term results and reduced risk of complications compared with ConvA.
Collapse
Affiliation(s)
- Marco Bergonti
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Lancisi-Salesi," Marche Polytechnic University, Ancona, Italy; Department of Biomedical Sciences and Public Health, University Hospital "Umberto I-Lancisi-Salesi," Marche Polytechnic University, Ancona, Italy
| | - Rita Sicuso
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Valentina Ribatti
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Lancisi-Salesi," Marche Polytechnic University, Ancona, Italy; Department of Biomedical Sciences and Public Health, University Hospital "Umberto I-Lancisi-Salesi," Marche Polytechnic University, Ancona, Italy
| | - Valentina Catto
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Alessio Gasperetti
- Department of Biomedical Sciences and Public Health, University Hospital "Umberto I-Lancisi-Salesi," Marche Polytechnic University, Ancona, Italy
| | - Martina Zucchetti
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Selene Cellucci
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Giulia Vettor
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Maria Antonietta Dessanai
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Benedetta Majocchi
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Massimo Moltrasio
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Eleonora Russo
- Department of Cardiovascular Disease, Division of Cardiac Surgery, Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy
| | - Giulia Stronati
- Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Lancisi-Salesi," Marche Polytechnic University, Ancona, Italy; Department of Biomedical Sciences and Public Health, University Hospital "Umberto I-Lancisi-Salesi," Marche Polytechnic University, Ancona, Italy
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Lancisi-Salesi," Marche Polytechnic University, Ancona, Italy; Department of Biomedical Sciences and Public Health, University Hospital "Umberto I-Lancisi-Salesi," Marche Polytechnic University, Ancona, Italy
| | - Luigi Di Biase
- Montefiore Medical Center, Albert-Einstein College of Medicine, Bronx, New York, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute (TCAI), St. David's Hospital, Austin, Texas, USA
| | - Claudio Tondo
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy; Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Lancisi-Salesi," Marche Polytechnic University, Ancona, Italy; Department of Clinical, Special and Dental Sciences, University Hospital "Umberto I-Lancisi-Salesi," Marche Polytechnic University, Ancona, Italy
| |
Collapse
|
29
|
Soar J, Böttiger BW, Carli P, Couper K, Deakin CD, Djärv T, Lott C, Olasveengen T, Paal P, Pellis T, Perkins GD, Sandroni C, Nolan JP. European Resuscitation Council Guidelines 2021: Adult advanced life support. Resuscitation 2021; 161:115-151. [PMID: 33773825 DOI: 10.1016/j.resuscitation.2021.02.010] [Citation(s) in RCA: 454] [Impact Index Per Article: 151.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
These European Resuscitation Council Advanced Life Support guidelines, are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the prevention of and ALS treatments for both in-hospital cardiac arrest and out-of-hospital cardiac arrest.
Collapse
Affiliation(s)
- Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
| | - Bernd W Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Pierre Carli
- SAMU de Paris, Centre Hospitalier Universitaire Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, and Université Paris Descartes, Paris, France
| | - Keith Couper
- Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Warwick Medical School, University of Warwick, Coventry,UK
| | - Charles D Deakin
- University Hospital Southampton NHS Foundation Trust, Southampton, UK; South Central Ambulance Service NHS Foundation Trust, Otterbourne,UK
| | - Therese Djärv
- Dept of Acute and Reparative Medicine, Karolinska University Hospital, Stockholm, Sweden, Department of Medicine Solna, Karolinska Institutet,Stockholm, Sweden
| | - Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-Universitaet Mainz, Germany
| | - Theresa Olasveengen
- Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Tommaso Pellis
- Department of Anaesthesia and Intensive Care, Azienda Sanitaria Friuli Occidentale, Italy
| | - Gavin D Perkins
- University of Warwick, Warwick Medical School and University Hospitals Birmingham NHS Foundation Trust, Coventry, UK
| | - Claudio Sandroni
- Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy; Institute of Anaesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jerry P Nolan
- University of Warwick, Warwick Medical School, Coventry, CV4 7AL; Royal United Hospital, Bath, UK
| |
Collapse
|
30
|
Enhanced detection of cardiac arrhythmias utilizing 14-day continuous ECG patch monitoring. Int J Cardiol 2021; 332:78-84. [PMID: 33727122 DOI: 10.1016/j.ijcard.2021.03.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 02/28/2021] [Accepted: 03/08/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND To evaluate the performance of a single‑lead, 14-day continuous electrocardiogram (ECG) patch for the detection of arrhythmias compared to conventional 24-h monitoring. METHODS This prospective clinical trial enrolled patients suspected of arrhythmias but not diagnosed by 12‑lead ECGs. Each patient underwent a 24-h Holter and 14-day ECG patch simultaneously. Seven types of arrhythmias were classified: supraventricular tachycardia (SVT, repetitive atrial beats >4 beats), irregular SVT without P wave (>4 beats), AF/AFL (irregular SVT without P wave ≥30 s), pause ≥3 s, atrioventricular block (AVB; Mobitz type II, third-degree, two to one or high degree AVB), ventricular tachycardia (VT), and polymorphic VT. RESULTS A total of 158 patients were recruited (mean wear time:12.3 ± 3.2 days). The overall arrhythmia detection rate was higher with 14-day ECG patches (59.5%) compared to 24-h Holter (19.0%, P < 0.001). Up to 87.2% of arrhythmias recorded with 14-day ECG patches were not associated with symptoms. The 14-day ECG patch was associated with higher detection rates compared to the 24-h Holter in patients with SVT (52.5% versus 15.8%, P < 0.001), irregular SVT without P wave (12.7% versus 4.4%, P = 0.002), AF/AFL (9.5% versus 3.8%, P = 0.042), and critical arrhythmias (pause ≥3 s, AVB, VT, polymorphic VT) (16.5% versus 2.5%, P < 0.001). The 14-day ECG patch detected more than 2 types of arrhythmias in 5.1% of patients. No serious adverse events in patients wearing the 14-day ECG patch were reported. CONCLUSIONS The 14-day ECG patch outperformed 24-h Holter to detect overall, asymptomatic, critical and multiple arrhythmias. It is safe and has the potential to identify individuals with hidden arrhythmias, especially those with critical arrhythmias.
Collapse
|
31
|
Katritsis DG, Chokesuwattanaskul R, Zografos T, Jame S, Paxinos G, Morady F. A simplified differential pacing technique for the evaluation of bidirectional cavo-tricuspid isthmus block during ablation of typical atrial flutter. J Interv Card Electrophysiol 2021; 63:109-114. [PMID: 33550494 DOI: 10.1007/s10840-020-00935-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 12/27/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Bidirectional block of the cavo-tricuspid isthmus (CTI) is an established endpoint of CTI-dependent atrial flutter (AFl) ablation. Differential pacing has been used to evaluate the CTI block. The purpose of this study is to describe a modified differential pacing technique to evaluate the CTI block. METHODS Sixty-two patients underwent radiofrequency (RF) ablation of CTI-dependent AFl. The acute endpoints were non-inducibility of the AFl, and verification of the bidirectional CTI block by our methodology. Pacing was performed in the CS with an ablation catheter positioned immediately lateral to the CTI ablation line, and then 1-2 cm more laterally. The stimulus-to-ablation catheter atrial electrogram intervals were measured at these sites (StimCS-Abl1 and StimCS-Abl2, respectively). Pacing with the ablation catheter also was performed at these 2 sites, and the stimulus-to-CS electrogram intervals (StimABL1-CS and StimABL2-CS) were measured. The criteria for the bidirectional block were StimCS-Abl1 > StimCS-Abl2, and StimABL1-CS > StimABL2-CS. Clinical efficacy was defined as freedom from recurrent AFl during follow-up. RESULTS Following 12.2 ± 3.7 min of RF delivery across the CTI, intervals were StimCS-Abl1 = 181.2 ± 22.7 ms and StimABL1-CS = 181.0 ± 23.6 ms, and StimCS-Abl2 = 152.2 ± 26.5 ms and StimABL2-CS = 151.2 ± 22.7 (P < 0.001). Atrial flutter was rendered not inducible in all patients, and no procedural complications were encountered. During the next 15.9 ± 0.7 months, two patients were lost to follow-up, and among the 62 other patients, one (1.7%) had flutter recurrence. CONCLUSIONS The bidirectional CTI block can be assessed quickly and easily using only the ablation and CS catheters for differential pacing.
Collapse
Affiliation(s)
| | | | | | - Sina Jame
- University of Michigan Health System, Ann Arbor, MI, USA
| | - George Paxinos
- Hygeia Hospital, 4 Erythrou Stavrou Str, 15123, Athens, Greece
| | - Fred Morady
- University of Michigan Health System, Ann Arbor, MI, USA
| |
Collapse
|
32
|
Littmann L, Norton HJ. Risk of intravenous amiodarone in patients with atrial fibrillation and ventricular preexcitation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:566-567. [PMID: 33491814 DOI: 10.1111/pace.14176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 11/29/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Laszlo Littmann
- Department of Internal Medicine, Atrium Health - Carolinas Medical Center, Charlotte, North Carolina, USA
| | - H James Norton
- Professor Emeritus, Department of Biostatistics, Atrium Health - Carolinas Medical Center, Charlotte, North Carolina, USA
| |
Collapse
|
33
|
Cosgun M, Gunes Y, Sincer I, Mansiroglu AK. Assessment of the hemogram parameters in patients with paroxysmal supraventricular tachycardia: a retrospective study. Rev Assoc Med Bras (1992) 2020; 66:1371-1375. [PMID: 33174929 DOI: 10.1590/1806-9282.66.10.1371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/21/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Inflammation has been suggested as a potential mechanism in the pathogenesis of arrhythmia. Hemogram parameters such as monocyte count to high-density lipoprotein cholesterol ratio (MHR), neutrophil/lymphocyte ratio (NLR), and monocyte/lymphocyte ratio (MLR) have been considered to be markers of inflammation and new cardiovascular risk predictors. This retrospective study aimed to investigate the relationship between MHR, NLR, and MLR in patients with paroxysmal supraventricular tachycardia (PSVT). METHODS A retrospective study conducted at a university hospital in Bolu, Turkey, between 2017 and 2019. Our study included 196 patients who underwent electrophysiological study (EPS) due to palpitation or documented PSVT on electrocardiography (ECG). Patients having documented atrioventricular nodal re-entrant tachycardia (AVNRT) on ECG or inducible AVNRT on EPS were included in the PSVT group (n=130), and patients with palpitation but without inducible arrhythmia on EPS (n=66) were included in the control group. Routine biochemical and hemogram tests were performed before the EPS procedure. RESULTS When hemogram parameters were compared, there was no statistically significant difference in MHR values [0.010 (0.001-0.030) vs 0.010 (0.001-0.020) p =0.67]. Additionally, both NLR [2.21(0.74-11.36) vs 1.98(0.72-24.87) p=0.13] and MLR [0.25 (0.03-1.05) vs 0.24(0.07-1.39) p=0.41] were not statistically significant between the two groups. CONCLUSION There is no significant difference in PSVT patients regarding hemogram parameters including white blood cell subtypes, MLR, NLR, and MHR. Therefore the evaluation of hemogram parameters may not be clinically relevant for PSVT patients.
Collapse
Affiliation(s)
- Mehmet Cosgun
- Assistant Professor, Department of Cardiology, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Yilmaz Gunes
- Professor, Department of Cardiology, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Isa Sincer
- Associate Professor, Department of Cardiology, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | | |
Collapse
|
34
|
|
35
|
Leung LWM, Gallagher MM. Review paper on WPW and athletes: Let sleeping dogs lie? Clin Cardiol 2020; 43:897-905. [PMID: 32592213 PMCID: PMC7403723 DOI: 10.1002/clc.23399] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/18/2020] [Accepted: 05/21/2020] [Indexed: 11/09/2022] Open
Abstract
Accessory pathways are present in 1 in 300 young individuals. They are often asymptomatic and potentially lethal arrhythmias may be the first presentation. During long-term follow-up, up to 20% of asymptomatic individuals with pre-excitation go on to develop an arrhythmia and the absence of traditional clinical and electrophysiological high-risk markers does not guarantee the "safe" nature of an accessory pathway. The widespread availability of permanent cure for the condition at low risk by catheter ablation, creates an incentive to screen for accessory pathways with a 12-lead ECG, particularly in individuals who are perceived to be at increased risk, such as athletes and high-risk professions. We review the existing literature on the assessment and management of accessory pathways (Wolff-Parkinson-White [WPW] syndrome) and discuss its implications for the young athletic population.
Collapse
Affiliation(s)
- Lisa W M Leung
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, St. George's University of London, London, UK
| | - Mark M Gallagher
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, St. George's University of London, London, UK
| |
Collapse
|
36
|
Chubb H, Ceresnak SR. A proposed approach to the asymptomatic pediatric patient with Wolff-Parkinson-White pattern. HeartRhythm Case Rep 2020; 6:2-7. [PMID: 31956492 PMCID: PMC6962761 DOI: 10.1016/j.hrcr.2019.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/01/2019] [Accepted: 09/05/2019] [Indexed: 01/02/2023] Open
Affiliation(s)
| | - Scott R. Ceresnak
- Address reprint requests and correspondence: Dr Scott R. Ceresnak, Department of Pediatrics - Division of Pediatric Cardiology, 750 Welch Rd, Suite 305, Palo Alto, CA 94304.
| |
Collapse
|
37
|
Tamargo J. After a long time, the new ESC Guidelines for the management of patients with supraventricular tachycardia are here. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2020; 6:3-5. [PMID: 31800023 DOI: 10.1093/ehjcvp/pvz068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Juan Tamargo
- Department of Pharmacology and Toxicology, School of Medicine, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, CIBERCV, Madrid, Spain
| |
Collapse
|
38
|
Gwag HB, Jun JE, Park Y, Lee SS, Park SJ, Kim JS, Park KM, On YK. Thyroid dysfunction in patients with suspected or documented supraventricular tachyarrhythmia. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2019. [DOI: 10.1186/s42444-019-0008-x] [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 and objectives
The association between thyroid dysfunction and supraventricular tachyarrhythmia (SVT) other than atrial fibrillation (AF) is not well elucidated. We hypothesized that patients with suspected or documented SVT have undetected thyroid dysfunction more frequently than general population.
Subjects and methods
Patients with symptoms suggestive of SVT other than AF who were planned to undergo an EP study at our center were eligible for this study. Patients with known thyroid disease, medications affecting thyroid function test (TFT) or atrial fibrillation were excluded. The primary outcome was prevalence of TFT abnormalities in the study population. The secondary outcome was prevalence of clinically significant arrhythmia during the EP study.
Results
A total of 533 patients were analyzed. Patients were divided into the two groups according to TFT results. Fifty-six (10.5%) patients had abnormal TFT results (thyroid dysfunction group), while 477 (89.5%) had normal thyroid function (euthyroidism group). The overall prevalence of thyroid dysfunction was 10.5%. The thyroid dysfunction group showed a tendency for higher induction of clinically significant SVT than the euthyroidism group. However, thyroid dysfunction was not an independent predictor of clinically significant SVT during EP study.
Conclusion
In this study, patients with suspected SVT who were planned for EP study had a relatively high incidence of thyroid dysfunction. Clinically significant arrhythmia tended to be induced more frequently in the thyroid dysfunction group than in the euthyroidism group. Further investigations are needed to verify the clinical implications of TFT in patients with SVT other than AF.
Collapse
|
39
|
Houck CA, Chandler SF, Bogers AJJC, Triedman JK, Walsh EP, de Groot NMS, Abrams DJ. Arrhythmia Mechanisms and Outcomes of Ablation in Pediatric Patients With Congenital Heart Disease. Circ Arrhythm Electrophysiol 2019; 12:e007663. [PMID: 31722541 DOI: 10.1161/circep.119.007663] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In contrast to the adult population with congenital heart disease (CHD), arrhythmia mechanisms and outcomes of ablation in pediatric patients with CHD in recent era have not been studied in detail. Aims of this study were to determine arrhythmia mechanisms and to evaluate procedural and long-term outcomes in pediatric patients with CHD undergoing catheter ablation. METHODS Consecutive patients <18 years of age with CHD undergoing catheter ablation over an 11-year period (2007-2018) were included. Procedural outcome included complete or partial success, failure or empirical ablation. Long-term outcome included arrhythmia recurrence and burden according to a 12-point clinical arrhythmia severity score. RESULTS The study population consisted of 232 patients (11.7 years [0.01-17.8], 33.5 kg [2.2-130.1]). The most common diagnoses were Ebstein's anomaly (n=44), septal defects (n=39), and single ventricle (n=36). Arrhythmia mechanisms included atrioventricular reentry tachycardia (n=104, 90 patients), atrioventricular nodal reentry tachycardia (n=33, 29 patients), twin atrioventricular nodal tachycardia (n=3, 2 patients), macroreentrant atrial tachycardia (n=59, 56 patients), focal atrial tachycardia (n=33, 25 patients), ventricular ectopy (n=10, 8 patients), and ventricular tachycardia (n=15, 13 patients). Fifty-six arrhythmias (39 patients) were undefined. Outcomes included complete success (n=189, 81%), partial success (n=7, 3%), failure (n=16, 7%), or empirical ablation (n=20, 9%). Over 3.6 years (0.3-10.7) arrhythmia recurred in 49%. Independent of arrhythmia recurrence, arrhythmia scores decreased from 4 (0-10) at baseline to 0.5 (0-8) at 4 years follow-up (P<0.001). In 23/51 repeat procedures (45%), a different arrhythmia substrate was found. Overall adverse event rate was 9.4%, although only 1.6% (n=4) were of major severity and 0.8% (n=2) of moderate severity. CONCLUSIONS Pediatric patients with CHD demonstrate a broad spectrum of arrhythmia mechanisms. Despite recurrence and emergence of novel mechanisms after a successful procedure, ablation can be performed safely and successfully resulting in decreased arrhythmia burden.
Collapse
Affiliation(s)
- Charlotte A Houck
- Department of Cardiology (C.A.H., N.M.S.d.G.), Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Cardio-Thoracic Surgery (C.A.H., A.J.J.C.B.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Stephanie F Chandler
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA (S.F.C., J.K.T., E.P.W., D.J.A.)
| | - Ad J J C Bogers
- Department of Cardio-Thoracic Surgery (C.A.H., A.J.J.C.B.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - John K Triedman
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA (S.F.C., J.K.T., E.P.W., D.J.A.)
| | - Edward P Walsh
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA (S.F.C., J.K.T., E.P.W., D.J.A.)
| | - Natasja M S de Groot
- Department of Cardiology (C.A.H., N.M.S.d.G.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Dominic J Abrams
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA (S.F.C., J.K.T., E.P.W., D.J.A.)
| |
Collapse
|
40
|
Eerikainen LM, Bonomi AG, Schipper F, Dekker LRC, de Morree HM, Vullings R, Aarts RM. Detecting Atrial Fibrillation and Atrial Flutter in Daily Life Using Photoplethysmography Data. IEEE J Biomed Health Inform 2019; 24:1610-1618. [PMID: 31689222 DOI: 10.1109/jbhi.2019.2950574] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Photoplethysmography (PPG) enables unobtrusive heart rate monitoring, which can be used in wrist-worn applications. Its potential for detecting atrial fibrillation (AF) has been recently presented. Besides AF, another cardiac arrhythmia increasing stroke risk and requiring treatment is atrial flutter (AFL). Currently, the knowledge about AFL detection with PPG is limited. The objective of our study was to develop a model that classifies AF, AFL, and sinus rhythm with or without premature beats from PPG and acceleration data measured at the wrist in daily life. METHODS A dataset of 40 patients was collected by measuring PPG and accelerometer data, as well as electrocardiogram as a reference, during 24-hour monitoring. The dataset was split into 75%-25% for training and testing a Random Forest (RF) model, which combines features from PPG, inter-pulse intervals (IPI), and accelerometer data, to classify AF, AFL, and other rhythms. The performance was compared to an AF detection algorithm combining traditional IPI features for determining the robustness of the accuracy in presence of AFL. RESULTS The RF model classified AF/AFL/other with sensitivity and specificity of 97.6/84.5/98.1% and 98.2/99.7/92.8%, respectively. The results with the IPI-based AF classifier showed that the majority of false detections were caused by AFL. CONCLUSION The PPG signal contains information to classify AFL in the presence of AF, sinus rhythm, or sinus rhythm with premature contractions. SIGNIFICANCE PPG could indicate presence of AFL, not only AF.
Collapse
|
41
|
Bautista WF, Crozier I, Sorgente A. An Electrocardiogram That Never Grows Old: Atrial Fibrillation in the Context of Manifest Atrioventricular Pre-Excitation. JACC Case Rep 2019; 1:405-406. [PMID: 34316837 PMCID: PMC8288780 DOI: 10.1016/j.jaccas.2019.08.008] [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: 11/25/2022]
Affiliation(s)
- William F. Bautista
- Department of Electrophysiology, Santa Sofía Departmental University Hospital, Caldas-Manizales, Colombia
| | - Ian Crozier
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Antonio Sorgente
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| |
Collapse
|
42
|
Attia ZI, Noseworthy PA, Lopez-Jimenez F, Asirvatham SJ, Deshmukh AJ, Gersh BJ, Carter RE, Yao X, Rabinstein AA, Erickson BJ, Kapa S, Friedman PA. An artificial intelligence-enabled ECG algorithm for the identification of patients with atrial fibrillation during sinus rhythm: a retrospective analysis of outcome prediction. Lancet 2019; 394:861-867. [PMID: 31378392 DOI: 10.1016/s0140-6736(19)31721-0] [Citation(s) in RCA: 655] [Impact Index Per Article: 131.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/10/2019] [Accepted: 06/13/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Atrial fibrillation is frequently asymptomatic and thus underdetected but is associated with stroke, heart failure, and death. Existing screening methods require prolonged monitoring and are limited by cost and low yield. We aimed to develop a rapid, inexpensive, point-of-care means of identifying patients with atrial fibrillation using machine learning. METHODS We developed an artificial intelligence (AI)-enabled electrocardiograph (ECG) using a convolutional neural network to detect the electrocardiographic signature of atrial fibrillation present during normal sinus rhythm using standard 10-second, 12-lead ECGs. We included all patients aged 18 years or older with at least one digital, normal sinus rhythm, standard 10-second, 12-lead ECG acquired in the supine position at the Mayo Clinic ECG laboratory between Dec 31, 1993, and July 21, 2017, with rhythm labels validated by trained personnel under cardiologist supervision. We classified patients with at least one ECG with a rhythm of atrial fibrillation or atrial flutter as positive for atrial fibrillation. We allocated ECGs to the training, internal validation, and testing datasets in a 7:1:2 ratio. We calculated the area under the curve (AUC) of the receiver operatoring characteristic curve for the internal validation dataset to select a probability threshold, which we applied to the testing dataset. We evaluated model performance on the testing dataset by calculating the AUC and the accuracy, sensitivity, specificity, and F1 score with two-sided 95% CIs. FINDINGS We included 180 922 patients with 649 931 normal sinus rhythm ECGs for analysis: 454 789 ECGs recorded from 126 526 patients in the training dataset, 64 340 ECGs from 18 116 patients in the internal validation dataset, and 130 802 ECGs from 36 280 patients in the testing dataset. 3051 (8·4%) patients in the testing dataset had verified atrial fibrillation before the normal sinus rhythm ECG tested by the model. A single AI-enabled ECG identified atrial fibrillation with an AUC of 0·87 (95% CI 0·86-0·88), sensitivity of 79·0% (77·5-80·4), specificity of 79·5% (79·0-79·9), F1 score of 39·2% (38·1-40·3), and overall accuracy of 79·4% (79·0-79·9). Including all ECGs acquired during the first month of each patient's window of interest (ie, the study start date or 31 days before the first recorded atrial fibrillation ECG) increased the AUC to 0·90 (0·90-0·91), sensitivity to 82·3% (80·9-83·6), specificity to 83·4% (83·0-83·8), F1 score to 45·4% (44·2-46·5), and overall accuracy to 83·3% (83·0-83·7). INTERPRETATION An AI-enabled ECG acquired during normal sinus rhythm permits identification at point of care of individuals with atrial fibrillation. FUNDING None.
Collapse
Affiliation(s)
- Zachi I Attia
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Bernard J Gersh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rickey E Carter
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - Xiaoxi Yao
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | | | - Suraj Kapa
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
43
|
Abstract
A 12-lead electrocardiogram (ECG) is the most commonly ordered cardiac test. Although data are not robust, guidelines recommend against performing an ECG in patients who are asymptomatic, even if they have a higher risk of developing cardiovascular disease in the long term. Conversely, patients with cardiac symptoms, including chest pain, dyspnea, palpitation, and syncope, should have an ECG performed in the office. Computerized algorithms exist ubiquitously to guide interpretation, but they can be the source of erroneous information. A stepwise approach is given to guide the primary care physician's approach to the systematic interpretation of ECG tracings.
Collapse
Affiliation(s)
- John Hornick
- Cardiovascular Disease, Summa Health System, 95 Arch Street, Suite 300, Akron, OH 44304, USA
| | - Otto Costantini
- Cardiovascular Disease Fellowship, Summa Health Heart and Vascular Institute, Summa Health System, 95 Arch Street, Suite 350, Akron, OH 44304, USA.
| |
Collapse
|
44
|
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.
Collapse
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.
| |
Collapse
|
45
|
High prevalence of hyperlipidaemia in patients with AV re-entry tachycardia and AV nodal re-entry tachycardia. Sci Rep 2019; 9:11502. [PMID: 31395917 PMCID: PMC6687730 DOI: 10.1038/s41598-019-47940-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 07/24/2019] [Indexed: 01/11/2023] Open
Abstract
Diet rich in lipids and hyperlipidaemia increases incidence of atrial premature beats and all supraventricular arrhythmias. The aim of the study was to investigate the prevalence of hyperlipidaemia in patients with AV re-entry tachycardia (AVRT) and AV nodal re-entry tachycardia (AVNRT). We conducted a retrospective, cross-sectional, case-control study that included all consecutive patients for whom AVRT or AVNRT was confirmed during electrophysiology study. Age and gender-matched patients admitted to hospital or outpatient clinic for various reasons were randomly included and served as a control group. Hyperlipidaemia was defined according to 2016 European Society of Cardiology guidelines. A total of 1448 subjects were included: 725 patients with AVRT/AVNRT and 723 controls. AVRT/AVNRT patients had high hyperlipidaemia prevalence, which was significantly higher when compared to the control group (50.1 vs. 35.8%, p < 0.001). AVRT patients, with median age of 37.5 years, had hyperlipidaemia prevalence of 45.7%. In a multivariate analysis, hyperlipidaemia was independently associated with AVRT/AVNRT (OR 2.128, p < 0.001), both with AVNRT (OR 1.878, p < 0.001) and AVRT (OR 2.786, p < 0.001). Hypercholesterolemia was significantly more prevalent in patients with AVNRT and AVRT, while this was not the case for hypertriglyceridemia. There were no differences between the AVRT and AVNRT patients regarding hyperlipidaemia prevalence (51.9 vs. 45.7%, p = 0.801), even though AVRT patients were significantly younger (37.5 vs. 48.5, p < 0.001). In conclusion, this is the first study that investigated hyperlipidaemia prevalence in patients with AVRT or AVNRT. AVRT/AVNRT patients had higher prevalence of hyperlipidaemia and higher total and LDL cholesterol levels.
Collapse
|
46
|
Luani B, Rauwolf T, Genz C, Schmeißer A, Wiemer M, Braun-Dullaeus RC. Intracardiac echocardiography versus fluoroscopy for endovascular and endocardial catheter navigation during cryo-ablation of the slow pathway in AVNRT patients. Cardiovasc Ultrasound 2019; 17:12. [PMID: 31186001 PMCID: PMC6560740 DOI: 10.1186/s12947-019-0162-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 05/30/2019] [Indexed: 11/29/2022] Open
Abstract
Background A new zero-fluoroscopy technique for electrophysiology catheter navigation relying on intracardiac echocardiography (ICE) has been recently reported (Ice&ICE trial). We investigated potential differences in efficacy, safety or procedural performance between conventional fluoroscopy- and ICE-guided cryothermal ablation (CA) in symptomatic AVNRT patients. Methods Clinical and electrophysiological data of AVNRT patients included in the Ice&ICE trial (22 patients, 16 females; =zero-fluoroscopy group) were compared to those of consecutive AVNRT patients, who underwent fluoroscopy-guided CA (25 patients, 17 females; = fluoroscopy group) during the last 2 years in our institution. Results Slow pathway ablation or modulation was successful in all patients. Fluoroscopy time and radiation dose in the fluoroscopy group were 11.2 ± 9.0 min and 20.3 ± 16.2Gycm2, whereas no fluoroscopy was used in the opposite group (p < 0.001, respectively). EPS duration was not different between the groups (zero-fluoroscopy:101.6 ± 40.2 min, fluoroscopy:99.4 ± 37.2 min, p = n.s.). Catheter placement time was significantly shorter in the fluoroscopy group (2.2 ± 1.6 min vs. 12.0 ± 7.5 min, p < 0.05), whereas cryo-application duration (from the first cryo-mapping to the last CA) was significantly shorter in the zero-fluoroscopy group (27.5 ± 37.0 min vs. 38.1 ± 33.9 min, p < 0.05). Mean cryo-mapping and CA applications were numerically lower in the zero-fluoroscopy group (CM:7.5 ± 5.7 vs. 8.8 ± 6.2; CA:3.1 ± 1.7 vs. 3.2 ± 2.0, p = n.s.). No major adverse events occurred in both groups. After 15.0 ± 4.2 months, arrhythmia recurrence was not different between the groups (4.5% vs. 8.0%, p = n.s.). Conclusions Zero-fluoroscopy ICE-guided EP catheter navigation shows comparable efficacy and safety to fluoroscopic guidance during CA in AVNRT patients. ICE visualization of catheters and endocardial structures within the triangle of Koch shortens the cryo-application duration, though time needed for catheter placement is longer, when compared with conventional fluoroscopic guidance, which results in similar mean EPS duration with both navigation techniques. Trial registration (German Clinical Trials Register ID: DRKS00011360; Registration Date 14.12.2016) Electronic supplementary material The online version of this article (10.1186/s12947-019-0162-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Blerim Luani
- Department of Cardiology and Intensive Care Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Hans-Nolte-Str. 1, 32429, Minden, Germany.
| | - Thomas Rauwolf
- Department of Internal Medicine, Division of Cardiology and Angiology, Magdeburg University, Leipzigerstr. 44, 39120, Magdeburg, Germany
| | - Conrad Genz
- Department of Internal Medicine, Division of Cardiology and Angiology, Magdeburg University, Leipzigerstr. 44, 39120, Magdeburg, Germany
| | - Alexander Schmeißer
- Department of Internal Medicine, Division of Cardiology and Angiology, Magdeburg University, Leipzigerstr. 44, 39120, Magdeburg, Germany
| | - Marcus Wiemer
- Department of Cardiology and Intensive Care Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Hans-Nolte-Str. 1, 32429, Minden, Germany
| | - Rüdiger C Braun-Dullaeus
- Department of Internal Medicine, Division of Cardiology and Angiology, Magdeburg University, Leipzigerstr. 44, 39120, Magdeburg, Germany
| |
Collapse
|
47
|
Affiliation(s)
- Sana M Al-Khatib
- Division of Cardiology and Duke Clinical Research Institute, Duke University Hospital, Durham, North Carolina
| | - Richard L Page
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison
| |
Collapse
|
48
|
Yum B, Archambault A, Levitan EB, Dharamdasani T, Kneifati-Hayek J, Hanlon JT, Diaz I, Maurer MS, Lachs MS, Safford MM, Goyal P. Indications for β-Blocker Prescriptions in Heart Failure with Preserved Ejection Fraction. J Am Geriatr Soc 2019; 67:1461-1466. [PMID: 31095736 DOI: 10.1111/jgs.15977] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/13/2019] [Accepted: 04/15/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To better understand indications for β-blocker (BB) prescriptions among older adults hospitalized with heart failure with preserved ejection fraction (HFpEF). DESIGN/SETTING Retrospective observational study of hospitalizations derived from the geographically diverse Reasons for Geographic and Racial Differences in Stroke cohort. PARTICIPANTS We examined Medicare beneficiaries aged 65 years or older with an expert-adjudicated hospitalization for HFpEF (left ventricular ejection fraction = 50% or greater). MEASUREMENTS Discharge medications and indications for BBs were abstracted from medical records. RESULTS Of 306 hospitalizations for HFpEF, BBs were prescribed at discharge in 68%. Among hospitalizations resulting in BB prescriptions, 60% had a compelling indication for BB-44% had arrhythmias, and 29% had myocardial infarction (MI) history. Among the 40% with neither indication, 57% had coronary artery disease (CAD) without MI and 38% had hypertension alone (without arrhythmia, MI, or CAD), both clinical scenarios with little supportive evidence of benefit of BBs. Among hospitalizations resulting in BB prescription at discharge, 69% had geriatric conditions (functional limitation, cognitive impairment, hypoalbuminemia, or history of falls). There were no significant differences in the prevalence of geriatric conditions between hospitalizations of individuals with compelling indications for BBs and hospitalizations of individuals with noncompelling indications. CONCLUSIONS BBs are commonly prescribed following a hospitalization for HFpEF, even in the absence of compelling indications. This occurs even for hospitalizations of individuals with geriatric conditions, a subpopulation who may be at elevated risk for experiencing harm from BBs.
Collapse
Affiliation(s)
- Brian Yum
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | | | - Emily B Levitan
- Department of Epidemiology, University of Alabama-Birmingham, Birmingham, Alabama
| | | | - Jerard Kneifati-Hayek
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Joseph T Hanlon
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ivan Diaz
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York
| | - Mathew S Maurer
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Mark S Lachs
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Monika M Safford
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine, New York, New York
| |
Collapse
|
49
|
Catheter ablation of atrioventricular nodal re-entrant tachycardia: Humans versus machines? Rev Port Cardiol 2019; 38:193-194. [PMID: 30992175 DOI: 10.1016/j.repc.2019.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
50
|
Liu Y, Chen X, Wang F, Liang Y, Deng H, Liao H, Zhang Q, Zhang B, Zhan X, Fang X, Shehata M, Wang X, Xue Y, Wu S. Prevalence and clinical characteristics of Danon disease among patients with left ventricular hypertrophy and concomitant electrocardiographic preexcitation. Mol Genet Genomic Med 2019; 7:e638. [PMID: 30929317 PMCID: PMC6503070 DOI: 10.1002/mgg3.638] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/17/2019] [Accepted: 02/18/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Cardiac involvement in Danon disease typically manifests as left ventricular hypertrophy (LVH) and ventricular preexcitation. This study aimed to identify patients with Danon disease among patients with LVH and concurrent electrocardiographic preexcitation. METHODS Electrocardiographic preexcitation was identified in 10 of 197 patients with unexplained LVH in whom genetic testing was performed using next-generation sequencing. RESULTS Three (3/10, 30%) patients with Danon disease were found in association with different mutations in the gene of lysosome-associated membrane protein 2 (LAMP2). Compared to seven patients without Danon disease, these three patients presented with distinctive clinical phenotypes, including onset at an earlier age (20 ± 2 years vs. 53 ± 9 years, p < 0.001), more neurological involvements (100% vs. 0, p = 0.008), higher electrocardiographic voltages (10 ± 1 mV vs. 5 ± 1 mV, p < 0.001), wider QRS complexes (163 ± 5 ms vs. 115 ± 20 ms, p = 0.006), less common asymmetric hypertrophy (0% vs. 86%, p = 0.033), and more frequent elevation of three serum enzymes (creatine kinase, aspartate aminotransferase, and lactate dehydrogenase). Intracellular vacuoles accumulation with deficiencies of LAMP2 protein was found in both cardiac and skeletal myocytes of patients with Danon disease. CONCLUSION In patients with coexistent LVH and ventricular preexcitation, Danon disease is common with distinctive clinical presentations. Comprehensive assessment of these resemble patients can provide valuable findings for early identification and clinical decision making of patients with Danon disease.
Collapse
Affiliation(s)
- Yang Liu
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xin Chen
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Feng Wang
- Department of Geriatrics, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yingcong Liang
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hai Deng
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hongtao Liao
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qianhuan Zhang
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Bin Zhang
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xianzhang Zhan
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xianhong Fang
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Michael Shehata
- Heart Institute, Cedars Sinai Medical Center, Los Angeles, California
| | - Xunzhang Wang
- Heart Institute, Cedars Sinai Medical Center, Los Angeles, California
| | - Yumei Xue
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shulin Wu
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| |
Collapse
|