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Brooks-Pearson R, Pilling K, Ormston B, MacKenzie L, Huntley C, Kerr A, Crouch R, Richmond N, van der Putten M, Atherton P. Cardiac SABR: Image matching techniques for accurate treatment delivery. Radiography (Lond) 2024:S1078-8174(24)00201-3. [PMID: 39214787 DOI: 10.1016/j.radi.2024.08.007] [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: 02/20/2024] [Revised: 07/12/2024] [Accepted: 08/06/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Ventricular tachycardia is an irregular heartbeat conventionally treated using invasive cardiac catheter ablation and medication. However, when standard treatments have been exhausted, cardiac SABR provides a final treatment option to this high-mortality condition. Complex diagnostic mapping and planning scans enable multi-disciplinary target delineation for a 25Gy single fraction. However, organs at risk (OAR) near the target make this treatment challenging to plan and deliver. Publications from cardiologists report the efficacy of cardiac SABR, however there is limited data on the treatment delivery and image matching of this complex procedure. METHODS Four specialist therapeutic radiographers experienced in cardiac SABR reviewed 40 CBCTs from 10 patients treated in the UK. Each therapeutic radiographer conducted five image matches: a manual match (manual), an automatic match to the heart structure (auto) and the auto match followed by manual adjustment to the PTV (PTV), all using three degrees of freedom (DoF) only. The auto and PTV matches were also repeated using 6DoF. Inter-observer variability was quantified using 95% limits of agreement from a modified Bland-Altman analysis. RESULTS The limits of agreement were smallest in the automatic matches suggesting the algorithm is reliable. A manual adjustment from the auto match to the PTV is clinically appropriate to optimise target coverage. The limits of agreement were smaller in the 6DoF PTV match 1.06 mm, 1.24 mm, 1.68 mm than the 3DoF PTV match 1.57 mm, 2.06 mm, 2.11 mm (lateral, vertical, longitudinal). CONCLUSION The 6DoF CBCT image match has less variability and therefore suggest using a 6DoF couch for treatment delivery. IMPLICATIONS FOR PRACTICE Cardiac SABR CBCT image matching at treatment delivery is complex, optimisation of CBCT acquisition parameters and therapeutic radiographer training is essential prior to implementation.
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Affiliation(s)
- R Brooks-Pearson
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom; Translational and Clinical Research Institute, Newcastle University, United Kingdom.
| | - K Pilling
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom.
| | - B Ormston
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom.
| | - L MacKenzie
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom.
| | - C Huntley
- South Tees Hospitals NHS Foundation Trust, Radiotherapy, James Cook University Hospital, Middlesbrough, United Kingdom.
| | - A Kerr
- South Tees Hospitals NHS Foundation Trust, Radiotherapy, James Cook University Hospital, Middlesbrough, United Kingdom.
| | - R Crouch
- Sheffield Teaching Hospitals NHS Foundation Trust, Radiotherapy, Weston Park Hospital, Sheffield, United Kingdom.
| | - N Richmond
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom.
| | - M van der Putten
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom.
| | - P Atherton
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom.
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Guichard JB, Regany-Closa M, Vázquez-Calvo S, Zazu B, Pellicer Sendra B, Serrano-Campaner J, Molero-Pereira S, Borràs R, Ortiz JT, Falzone PV, Eulogio F, Reventos-Presmanes J, Garre P, Arbelo E, Althoff TF, Guasch E, Tolosana JM, Brugada J, Mont L, Porta-Sánchez A, Roca-Luque I. Substrate Mapping for Ventricular Tachycardia Ablation Through High-Density Whole-Chamber Double Extra Stimuli: The S3 Protocol. JACC Clin Electrophysiol 2024; 10:1534-1547. [PMID: 38819348 DOI: 10.1016/j.jacep.2024.04.023] [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: 02/26/2024] [Revised: 04/25/2024] [Accepted: 04/27/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND A partial delineation of targets for ablation of ventricular tachycardia (VT) during a stable rhythm is likely responsible for a suboptimal success rate. The abnormal low-voltage near-field functional components may be hidden within the high-amplitude far-field signal. OBJECTIVES The aim of this study was to evaluate the benefit and feasibility of functional substrate mapping using a full-ventricle S3 protocol and to assess its colocalization with arrhythmogenic conducting channels (CCs) on late gadolinium enhancement cardiac magnetic resonance. METHODS An S3 mapping protocol with a drive train of S1 followed by S2 (effective refractory period + 30 ms) and S3 (effective refractory period + 50 ms) from the right ventricular apex was performed in 40 consecutive patients undergoing scar-related VT ablation. Deceleration zones (DZs) and areas of late potentials (LPs) were identified for all maps. A preprocedural noninvasive substrate assessment was done using late gadolinium enhancement cardiac magnetic resonance and postprocessing with automated CC identification. RESULTS The S3 protocol was completed in 34 of the 40 procedures (85.0%). The S3 protocol enhanced the identification of VT isthmus on the basis of DZ (89% vs 62%; P < 0.01) and LP (93% vs 78%; P = 0.04) assessment. The percentage of CCs unmasked by DZs and LPs using S3 maps was significantly higher than the ones using S2 and S1 maps (78%, 65%, and 48% [P < 0.001] and 88%, 81%, and 68% [P < 0.01], respectively). The functional substrate identified during S3 activation mapping was significantly more extensive than the one identified using S2 and S1, including a greater number of DZs (2.94, 2.47, and 1.82, respectively; P < 0.001) and a wider area of LPs (44.1, 38.2, and 29.4 cm2, respectively; P < 0.001). After VT ablation, 77.9% of patients have been VT free during a median follow-up period of 13.6 months. CONCLUSIONS The S3 protocol was feasible in 85% of patients, allows a better identification of targets for ablation, and might improve VT ablation results.
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Affiliation(s)
- Jean-Baptiste Guichard
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain; INSERM, SAINBIOSE U1059, University Hospital of Saint-Étienne, Saint-Étienne, France; Cardiology Department, University Hospital of Saint-Étienne, Saint-Étienne, France
| | - Mariona Regany-Closa
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Sara Vázquez-Calvo
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Blanca Zazu
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Berta Pellicer Sendra
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Jaume Serrano-Campaner
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Sílvia Molero-Pereira
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Roger Borràs
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red e Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
| | - José Tomás Ortiz
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Pasquale Valerio Falzone
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Frida Eulogio
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Jana Reventos-Presmanes
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; ITACA Institute, Universitat Politècnica de València, Valencia, Spain
| | - Paz Garre
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Elena Arbelo
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Till F Althoff
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Eduard Guasch
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Jose María Tolosana
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Josep Brugada
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Lluís Mont
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Andreu Porta-Sánchez
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Ivo Roca-Luque
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
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Kancharla K, Olson A, Salavatian S, Kuwabara Y, Martynyuk Y, Dutta P, Vasamsetti S, Mahajan A, Howard-Quijano K, Saba S. Ventricular arrhythmia inducibility in porcine infarct model after stereotactic body radiation therapy. Heart Rhythm 2024; 21:1154-1160. [PMID: 38395245 DOI: 10.1016/j.hrthm.2024.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Ventricular arrhythmia (VA) is the primary mechanism of sudden death in patients with structural heart disease. Cardiac stereotactic body radiation therapy (SBRT) delivered to the scar in the left ventricle significantly reduces the burden of VA. OBJECTIVE The goal of this study was to investigate the impact of SBRT on scar morphology and VA inducibility in a porcine infarct model. METHODS Myocardial infarction (MI) was created in 10 Yorkshire pigs involving the left anterior descending artery territory. Cardiac positron emission tomography and computed tomography were performed for targeted SBRT. Alternative pigs received SBRT at 25 Gy in a single fraction. The terminal experiment included endocardial mapping, programmed ventricular stimulation, and tissue harvesting. RESULTS Of the 10 pigs infarcted, 2 died prematurely after MI and 8 (4 MI and 4 MI+SBRT) survived. Mean time from MI to SBRT was 48 ± 12 days, and mean time from SBRT to harvest was 32 ± 12 days. Scar was localized on intracardiac mapping in all pigs, and the scar was denser in the MI+SBRT compared with the MI-only group (33% ± 20% vs 14% ± 11%; P = .07). All 4 MI pigs had inducible VA during programmed stimulation, whereas only 1 of 4 pigs had inducible VA in the MI+SBRT arm (100% vs 25%; P = .07). No myocardial fibrosis was seen in the remote areas in either group. CONCLUSION SBRT reduced VA inducibility in pigs with scarring after MI. Endocardial mapping revealed denser scar in pigs receiving SBRT compared with those that did not, suggesting that SBRT suppresses VA inducibility through better scar homogenization.
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Affiliation(s)
- Krishna Kancharla
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. https://twitter.com/Krishkancharla
| | - Adam Olson
- Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. https://twitter.com/AdamOlsonMD
| | - Siamak Salavatian
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Yuki Kuwabara
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Partha Dutta
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sathish Vasamsetti
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Aman Mahajan
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Kimberley Howard-Quijano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Samir Saba
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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Kovacs B, Lehmann HI, Manninger M, Saguner AM, Futyma P, Duncker D, Chun J. Stereotactic arrhythmia radioablation and its implications for modern cardiac electrophysiology: results of an EHRA survey. Europace 2024; 26:euae110. [PMID: 38666444 PMCID: PMC11086561 DOI: 10.1093/europace/euae110] [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: 03/20/2024] [Accepted: 04/23/2024] [Indexed: 05/12/2024] Open
Abstract
Stereotactic arrhythmia radioablation (STAR) is a treatment option for recurrent ventricular tachycardia/fibrillation (VT/VF) in patients with structural heart disease (SHD). The current and future role of STAR as viewed by cardiologists is unknown. The study aimed to assess the current role, barriers to application, and expected future role of STAR. An online survey consisting of 20 questions on baseline demographics, awareness/access, current use, and the future role of STAR was conducted. A total of 129 international participants completed the survey [mean age 43 ± 11 years, 25 (16.4%) female]. Ninety-one (59.9%) participants were electrophysiologists. Nine participants (7%) were unaware of STAR as a therapeutic option. Sixty-four (49.6%) had access to STAR, while 62 (48.1%) had treated/referred a patient for treatment. Common primary indications for STAR were recurrent VT/VF in SHD (45%), recurrent VT/VF without SHD (7.8%), or premature ventricular contraction (3.9%). Reported main advantages of STAR were efficacy in the treatment of arrhythmias not amenable to conventional treatment (49%) and non-invasive treatment approach with overall low expected acute and short-term procedural risk (23%). Most respondents have foreseen a future clinical role of STAR in the treatment of VT/VF with or without underlying SHD (72% and 75%, respectively), although only a minority expected a first-line indication for it (7% and 5%, respectively). Stereotactic arrhythmia radioablation as a novel treatment option of recurrent VT appears to gain acceptance within the cardiology community. Further trials are critical to further define efficacy, patient populations, as well as the appropriate clinical use for the treatment of VT.
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Affiliation(s)
- Boldizsar Kovacs
- Department of Cardiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, 48109 MI, USA
- Department of Cardiology, University Heart Center Zurich, Raemistrasse 100, Zurich 8091, Switzerland
| | - Helge Immo Lehmann
- Department of Cardiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, 48109 MI, USA
- Corrigan Minehan Heart Center, Massachusetts General Hospital, 55 Fruit St, Boston, 02114 MA, USA
| | - Martin Manninger
- Division of Cardiology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Ardan Muammer Saguner
- Department of Cardiology, University Heart Center Zurich, Raemistrasse 100, Zurich 8091, Switzerland
| | - Piotr Futyma
- Medical College, University of Rzeszów and St. Joseph’s Heart Rhythm Center, Rzeszów, Poland
| | - David Duncker
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Julian Chun
- Cardioangiologisches Centrum Bethanien, Agaplesion Bethanien Krankenhaus, Frankfurt, Germany
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5
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Saba S, Kancharla K. Stereotactic body radiotherapy for refractory ventricular tachycardia: Still paving the road to randomized trials…. Heart Rhythm 2024; 21:25-26. [PMID: 37852562 DOI: 10.1016/j.hrthm.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 10/20/2023]
Affiliation(s)
- Samir Saba
- Heart and Vascular Institute, Department of Medicine at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| | - Krishna Kancharla
- Heart and Vascular Institute, Department of Medicine at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Zhang S, Chou YT, Zhang J, Chen J, Xiong Y, Lu J, Chen C, Xu Y, Liu Y. Experience in applied veno-arterial extracorporeal membrane oxygenation to support catheter ablation of malignant ventricular tachycardia. IJC HEART & VASCULATURE 2023; 49:101283. [PMID: 37908623 PMCID: PMC10613908 DOI: 10.1016/j.ijcha.2023.101283] [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: 07/26/2023] [Revised: 10/08/2023] [Accepted: 10/14/2023] [Indexed: 11/02/2023]
Abstract
Background An electrical storm due to malignant ventricular tachycardia (VT) is a life-threatening condition that requires catheter ablation (CA). Most VT arrhythmias evolve over time after acute myocardial infarction, coronary artery bypass grafting, or chronic heart failure. Clinically, only radiofrequency ablation can identify and block all arrhythmia origin points. The procedure necessitates continuous VT induction in patients, resulting in hemodynamic instability; therefore, extracorporeal membrane oxygenation (ECMO) support is required. Earlier studies have reported substantial mortality rates; however, our results are significantly more favorable. In this study, we combined the minimally invasive extracorporeal circulation (MiECC) approach with ECMO to preserve an appropriate ECMO flow rate, thus reducing intraoperative left heart afterload. We report 21 cases illustrating the usefulness of modified veno-arterial (VA)-ECMO in this scenario. Methods Data of 21 patients supported by the modified VA-ECMO system (MiECC approach combined with the ECMO system) during VT CA in the Wuhan Asia Heart Hospital between June 2020 and July 2021 were reviewed retrospectively. Results Successful ablation was achieved in 20 out of 21 patients (95%). The median time for ECMO implantation was 206 min. Only two patients experienced complications post-treatment. All patients made complete recovery and were discharged. All patients were alive at the 1-year-follow-up. Conclusions Our modified VA-ECMO system helped restore systemic circulation in patients experiencing an electrical storm, thus achieving greater electrical stability during VT CA. Pre-insertion of VA-ECMO can achieve even better results.
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Affiliation(s)
| | - Yueh-ting Chou
- Wuhan Asia Heart Hospital, Wuhan, China
- National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | | | - Jin Chen
- Wuhan Asia Heart Hospital, Wuhan, China
| | | | - Juan Lu
- Wuhan Asia Heart Hospital, Wuhan, China
| | - Chao Chen
- Wuhan Asia Heart Hospital, Wuhan, China
| | - Yue Xu
- Wuhan Asia Heart Hospital, Wuhan, China
| | - Yan Liu
- Wuhan Asia Heart Hospital, Wuhan, China
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7
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Wang S, Luo H, Mao T, Xiang C, Hu H, Zhao J, Wang X, Wang J, Liu H, Yu L, Jiang H. Stereotactic arrhythmia radioablation: A novel therapy for cardiac arrhythmia. Heart Rhythm 2023; 20:1327-1336. [PMID: 37150313 DOI: 10.1016/j.hrthm.2023.04.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 04/27/2023] [Accepted: 04/27/2023] [Indexed: 05/09/2023]
Abstract
Cardiac arrhythmia is a global health problem, and catheter ablation has been one of its main treatments for decades. However, catheter ablation is an invasive method that cannot reach the deep myocardium, and it carries a considerable risk of side effects and recurrence. Therefore, it is necessary to explore a novel approach. Stereotactic body radiotherapy, which has been widely used in the field of radiation oncology, has recently expanded in the treatment of cardiac arrhythmia; when used in this context, it is known as stereotactic arrhythmia radioablation (STAR). As a noninvasive, effective, and well-tolerated treatment, STAR may be a suitable alternative method for patients with cardiac arrhythmia who are resistant or intolerant to catheter ablation. The main particles used to deliver energy in STAR are photons, protons, and carbon ions. Most studies have shown the short-term effectiveness of STAR, but problems such as a high long-term recurrence rate with a cumulative ventricular tachycardia-free survival rate from the published literature of 38.6% and related complications have also emerged. Therefore, in this article, we review the application of stereotactic body radiotherapy in cardiac arrhythmia, analyze its potential problems, and explore methods for improvement.
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Affiliation(s)
- Songyun Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, P.R. China; Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, P.R. China; Cardiovascular Research Institute, Wuhan University, Wuhan, P.R. China; Hubei Key Laboratory of Cardiology, Wuhan, P.R. China
| | - Hao Luo
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, P.R. China; Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, P.R. China; Cardiovascular Research Institute, Wuhan University, Wuhan, P.R. China; Hubei Key Laboratory of Cardiology, Wuhan, P.R. China
| | - Tianlong Mao
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, P.R. China; Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, P.R. China; Cardiovascular Research Institute, Wuhan University, Wuhan, P.R. China; Hubei Key Laboratory of Cardiology, Wuhan, P.R. China
| | - Chunrong Xiang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, P.R. China; Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, P.R. China; Cardiovascular Research Institute, Wuhan University, Wuhan, P.R. China; Hubei Key Laboratory of Cardiology, Wuhan, P.R. China
| | - Haoyuan Hu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, P.R. China; Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, P.R. China; Cardiovascular Research Institute, Wuhan University, Wuhan, P.R. China; Hubei Key Laboratory of Cardiology, Wuhan, P.R. China
| | - Jiahui Zhao
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, P.R. China; Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, P.R. China; Cardiovascular Research Institute, Wuhan University, Wuhan, P.R. China; Hubei Key Laboratory of Cardiology, Wuhan, P.R. China
| | - Xinqi Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, P.R. China; Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, P.R. China; Cardiovascular Research Institute, Wuhan University, Wuhan, P.R. China; Hubei Key Laboratory of Cardiology, Wuhan, P.R. China
| | - Jiale Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, P.R. China; Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, P.R. China; Cardiovascular Research Institute, Wuhan University, Wuhan, P.R. China; Hubei Key Laboratory of Cardiology, Wuhan, P.R. China
| | - Huafen Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, P.R. China; Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, P.R. China; Cardiovascular Research Institute, Wuhan University, Wuhan, P.R. China; Hubei Key Laboratory of Cardiology, Wuhan, P.R. China
| | - Lilei Yu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, P.R. China; Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, P.R. China; Cardiovascular Research Institute, Wuhan University, Wuhan, P.R. China; Hubei Key Laboratory of Cardiology, Wuhan, P.R. China
| | - Hong Jiang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, P.R. China; Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, P.R. China; Cardiovascular Research Institute, Wuhan University, Wuhan, P.R. China; Hubei Key Laboratory of Cardiology, Wuhan, P.R. China.
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8
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Jentzer JC, Noseworthy PA, Kashou AH, May AM, Chrispin J, Kabra R, Arps K, Blumer V, Tisdale JE, Solomon MA. Multidisciplinary Critical Care Management of Electrical Storm: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 81:2189-2206. [PMID: 37257955 PMCID: PMC10683004 DOI: 10.1016/j.jacc.2023.03.424] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/14/2023] [Indexed: 06/02/2023]
Abstract
Electrical storm (ES) reflects life-threatening cardiac electrical instability with 3 or more ventricular arrhythmia episodes within 24 hours. Identification of underlying arrhythmogenic cardiac substrate and reversible triggers is essential, as is interrogation and programming of an implantable cardioverter-defibrillator, if present. Medical management includes antiarrhythmic drugs, beta-adrenergic blockade, sedation, and hemodynamic support. The initial intensity of these interventions should be matched to the severity of ES using a stepped-care algorithm involving escalating treatments for higher-risk presentations or recurrent ventricular arrhythmias. Many patients with ES are considered for catheter ablation, which may require the use of temporary mechanical circulatory support. Outcomes after ES are poor, including frequent ES recurrences and deaths caused by progressive heart failure and other cardiac causes. A multidisciplinary collaborative approach to the management of ES is crucial, and evaluation for heart transplantation or palliative care is often appropriate, even for patients who survive the initial episode.
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Affiliation(s)
- Jacob C Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | - Peter A Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Anthony H Kashou
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Adam M May
- Cardiovascular Division, Washington University School of Medicine, St Louis, Missouri, USA
| | - Jonathan Chrispin
- Clinical Cardiac Electrophysiology, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rajesh Kabra
- Kansas City Heart Rhythm Institute, Overland Park, Kansas, USA
| | - Kelly Arps
- Cardiac Electrophysiology Section, Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Vanessa Blumer
- Department of Cardiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - James E Tisdale
- College of Pharmacy, Purdue University, West Lafayette, Indiana, USA; School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Michael A Solomon
- Critical Care Medicine Department, National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, Maryland, USA; Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
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9
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McCabe MD, Cervantes R, Kewcharoen J, Sran J, Garg J. Quelling the Storm: A Review of the Management of Electrical Storm. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00338-5. [PMID: 37296026 DOI: 10.1053/j.jvca.2023.05.029] [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: 04/12/2023] [Accepted: 05/17/2023] [Indexed: 06/12/2023]
Abstract
Heightened sympathetic input to the myocardium potentiates cardiac electrical instability and may herald an electrical storm. An electrical storm is characterized by 3 or more episodes of ventricular tachycardia, ventricular fibrillation, or appropriate internal cardiac defibrillator shocks within 24 hours. Management of electrical storms is resource-intensive and inevitably requires careful coordination between multiple subspecialties. Anesthesiologists have an important role in acute, subacute, and long-term management. Identifying the phase of an electrical storm and understanding the characteristics of each morphology may help the anesthesiologist anticipate the management approach. In the acute phase, management of an electrical storm is aimed at providing advanced cardiac life support and identifying reversible causes. After initial stabilization, subacute management focuses on dampening the sympathetic surge with sedation, thoracic epidural, or stellate ganglion blockade. Definitive long-term management with surgical sympathectomy or catheter ablation also may be warranted. Our objective is to provide an overview of electrical storms and the anesthesiologist's role in management.
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Affiliation(s)
- Melissa D McCabe
- Department of Anesthesiology, Loma Linda University School of Medicine, Loma Linda, California.
| | - Richard Cervantes
- Department of Anesthesiology, Loma Linda University School of Medicine, Loma Linda, California
| | - Jakrin Kewcharoen
- Cardiac Arrhythmia Service, Loma Linda University School of Medicine, Loma Linda, California
| | - Jasmine Sran
- Department of Anesthesiology, Loma Linda University School of Medicine, Loma Linda, California
| | - Jalaj Garg
- Cardiac Arrhythmia Service, Loma Linda University School of Medicine, Loma Linda, California
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10
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Vázquez-Calvo S, Casanovas JM, Garre P, Ferró E, Sánchez-Somonte P, Quinto L, Guasch E, Porta-Sanchez A, Tolosana JM, Borras R, Arbelo E, Ortiz-Pérez JT, Brugada J, Mont L, Roca-Luque I. Evolution of Deceleration Zones During Ventricular Tachycardia Ablation and Relation With Cardiac Magnetic Resonance. JACC Clin Electrophysiol 2023. [DOI: 10.1016/j.jacep.2022.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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11
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Kawamura I, Reddy VY, Santos-Gallego CG, Wang BJ, Chaudhry HW, Buck ED, Mavroudis G, Jerrell S, Schneider CW, Speltz M, Dukkipati SR, Koruth JS. Electrophysiology, Pathology, and Imaging of Pulsed Field Ablation of Scarred and Healthy Ventricles in Swine. Circ Arrhythm Electrophysiol 2023; 16:e011369. [PMID: 36595634 DOI: 10.1161/circep.122.011369] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Pulsed field ablation (PFA) has recently been shown to penetrate ischemic scar, but details on its efficacy, risk of arrhythmias, and imaging insights are lacking. In a porcine model of myocardial scar, we studied the ability of ventricular PFA to penetrate scarred tissue, induce ventricular arrhythmias, and assess the influence of QRS gating during pulse delivery. METHODS Of a total of 6 swine, 5 underwent coronary occlusion and 1 underwent radiofrequency ablation to create infarct scar and iatrogenic scar models, respectively. Two additional swine served as healthy controls. An 8 Fr focal PFA catheter was used to deliver bipolar, biphasic PFA (2.0 kV) lesions guided by electroanatomical mapping, fluoroscopy, and intracardiac echocardiography over both scarred and healthy myocardium. Swine underwent magnetic resonance imaging 2-7 days post-PFA. RESULTS PFA successfully penetrated scar without significant difference in lesion depth between lesion at the infarct border (5.9±1.0 mm, n=41) and healthy myocardium (5.7±1.3 mm, n=26; P=0.53). PFA penetration of both infarct and iatrogenic radiofrequency abalation scar was observed in all examined sections. Sustained ventricular arrhythmias requiring defibrillation occurred in 4 of 187 (2.1%) ungated applications, whereas no ventricular arrhythmias occurred during gated PFA applications (0 of 64 [0%]). Dark-blood late-gadolinium-enhanced sequences allowed for improved endocardial border detection as well as lesion boundaries compared with conventional bright-blood late-gadolinium-enhanced sequences. CONCLUSIONS PFA penetrates infarct and iatrogenic scar successfully to create deep lesions. Gated delivery eliminates the occurrence of ventricular arrhythmias observed with ungated porcine PFA. Optimized magnetic resonance imaging sequences can be helpful in detecting lesion boundaries.
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Affiliation(s)
- Iwanari Kawamura
- Helmsley Electrophysiology Center (I.K., V.Y.R., S.R.D., J.S.K.)
| | - Vivek Y Reddy
- Helmsley Electrophysiology Center (I.K., V.Y.R., S.R.D., J.S.K.)
| | | | - Bingyan J Wang
- Cardiovascular Regenerative Medicine, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.J.W., H.W.C.)
| | - Hina W Chaudhry
- Cardiovascular Regenerative Medicine, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.J.W., H.W.C.)
| | - Eric D Buck
- FARAPULSE, Menlo Park, CA (E.D.B., G.M., S.J., C.W.S.). R. & M. Speltz, LLC, Pathology Services, Stanchfield, MN
| | - George Mavroudis
- FARAPULSE, Menlo Park, CA (E.D.B., G.M., S.J., C.W.S.). R. & M. Speltz, LLC, Pathology Services, Stanchfield, MN
| | - Samantha Jerrell
- FARAPULSE, Menlo Park, CA (E.D.B., G.M., S.J., C.W.S.). R. & M. Speltz, LLC, Pathology Services, Stanchfield, MN
| | - Christopher W Schneider
- FARAPULSE, Menlo Park, CA (E.D.B., G.M., S.J., C.W.S.). R. & M. Speltz, LLC, Pathology Services, Stanchfield, MN
| | | | | | - Jacob S Koruth
- Helmsley Electrophysiology Center (I.K., V.Y.R., S.R.D., J.S.K.)
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12
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Atreya AR, Yalagudri SD, Subramanian M, Rangaswamy VV, Saggu DK, Narasimhan C. Best Practices for the Catheter Ablation of Ventricular Arrhythmias. Card Electrophysiol Clin 2022; 14:571-607. [PMID: 36396179 DOI: 10.1016/j.ccep.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Techniques for catheter ablation have evolved to effectively treat a range of ventricular arrhythmias. Pre-operative electrocardiographic and cardiac imaging data are very useful in understanding the arrhythmogenic substrate and can guide mapping and ablation. In this review, we focus on best practices for catheter ablation, with emphasis on tailoring ablation strategies, based on the presence or absence of structural heart disease, underlying clinical status, and hemodynamic stability of the ventricular arrhythmia. We discuss steps to make ablation safe and prevent complications, and techniques to improve the efficacy of ablation, including optimal use of electroanatomical mapping algorithms, energy delivery, intracardiac echocardiography, and selective use of mechanical circulatory support.
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Affiliation(s)
- Auras R Atreya
- Electrophysiology Section, AIG Hospitals Institute of Cardiac Sciences and Research, Hyderabad, India; Division of Cardiovascular Medicine, Electrophysiology Section, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sachin D Yalagudri
- Electrophysiology Section, AIG Hospitals Institute of Cardiac Sciences and Research, Hyderabad, India
| | - Muthiah Subramanian
- Electrophysiology Section, AIG Hospitals Institute of Cardiac Sciences and Research, Hyderabad, India
| | | | - Daljeet Kaur Saggu
- Electrophysiology Section, AIG Hospitals Institute of Cardiac Sciences and Research, Hyderabad, India
| | - Calambur Narasimhan
- Electrophysiology Section, AIG Hospitals Institute of Cardiac Sciences and Research, Hyderabad, India.
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13
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Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA, Charron P, Corrado D, Dagres N, de Chillou C, Eckardt L, Friede T, Haugaa KH, Hocini M, Lambiase PD, Marijon E, Merino JL, Peichl P, Priori SG, Reichlin T, Schulz-Menger J, Sticherling C, Tzeis S, Verstrael A, Volterrani M. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J 2022; 43:3997-4126. [PMID: 36017572 DOI: 10.1093/eurheartj/ehac262] [Citation(s) in RCA: 858] [Impact Index Per Article: 429.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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14
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Cueva-Parra A, Neach-De La Vega D, Yañez-Guerrero P, Bustillos-García G, Gómez-Flores J, Levinstein M, Morales JL, Iturralde-Torres P, Márquez MF, Nava S. [Not Available]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2022; 3:179-187. [PMID: 37284562 PMCID: PMC10241329 DOI: 10.47487/apcyccv.v3i4.236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/12/2022] [Indexed: 01/11/2024]
Abstract
OBJECTIVE . To report the results of ventricular tachycardia (VT) catheter ablation in ischemic heart disease (IHD), and to identify risk factors associated with recurrence in a Mexican center. MATERIALS AND METHODS . We made a retrospective review of the cases of VT ablation performed in our center from 2015 to 2022. We analyzed the characteristics of the patients and those of the procedures separately and we determined factors associated with recurrence. RESULTS . Fifty procedures were performed in 38 patients (84% male; mean age 58.1 years). Acute success rate was 82%, with a 28% of recurrences. Female sex (OR 3.33, IC 95% 1.66-6.68, p=0.006), atrial fibrillation (OR 3.5, IC 95% 2.08-5.9, p=0.012), electrical storm (OR 2.4, IC 95% 1.06-5.41, p=0.045), functional class greater than II (OR 2.86, IC 95% 1.34-6.10, p=0.018) were risk factors for recurrence and the presence of clinical VT at the time of ablation (OR 0.29, IC 95% 0.12-0.70, p=0.004) and the use of more than 2 techniques for mapping (OR 0.64, IC 95% 0.48-0.86, p=0.013) were protective factors. CONCLUSIONS . Ablation of ventricular tachycardia in ischemic heart disease has had good results in our center. The recurrence is similar to that reported by other authors and there are some factors associated with it.
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Affiliation(s)
- Angel Cueva-Parra
- Departamento de Electrofisiología, Instituto Nacional de Cardiología «Ignacio Chávez». Mexico City, Mexico.Departamento de ElectrofisiologíaInstituto Nacional de Cardiología «Ignacio ChávezMexico CityMexico
| | - Diego Neach-De La Vega
- Departamento de Electrofisiología, Instituto Nacional de Cardiología «Ignacio Chávez». Mexico City, Mexico.Departamento de ElectrofisiologíaInstituto Nacional de Cardiología «Ignacio ChávezMexico CityMexico
| | - Paola Yañez-Guerrero
- Departamento de Electrofisiología, Instituto Nacional de Cardiología «Ignacio Chávez». Mexico City, Mexico.Departamento de ElectrofisiologíaInstituto Nacional de Cardiología «Ignacio ChávezMexico CityMexico
| | - Gabriela Bustillos-García
- Departamento de Electrofisiología, Instituto Nacional de Cardiología «Ignacio Chávez». Mexico City, Mexico.Departamento de ElectrofisiologíaInstituto Nacional de Cardiología «Ignacio ChávezMexico CityMexico
| | - Jorge Gómez-Flores
- Departamento de Electrofisiología, Instituto Nacional de Cardiología «Ignacio Chávez». Mexico City, Mexico.Departamento de ElectrofisiologíaInstituto Nacional de Cardiología «Ignacio ChávezMexico CityMexico
| | - Moisés Levinstein
- Departamento de Electrofisiología, Instituto Nacional de Cardiología «Ignacio Chávez». Mexico City, Mexico.Departamento de ElectrofisiologíaInstituto Nacional de Cardiología «Ignacio ChávezMexico CityMexico
| | - José L. Morales
- Departamento de Electrofisiología, Instituto Nacional de Cardiología «Ignacio Chávez». Mexico City, Mexico.Departamento de ElectrofisiologíaInstituto Nacional de Cardiología «Ignacio ChávezMexico CityMexico
| | - Pedro Iturralde-Torres
- Departamento de Electrofisiología, Instituto Nacional de Cardiología «Ignacio Chávez». Mexico City, Mexico.Departamento de ElectrofisiologíaInstituto Nacional de Cardiología «Ignacio ChávezMexico CityMexico
| | - Manlio F. Márquez
- Departamento de Electrofisiología, Instituto Nacional de Cardiología «Ignacio Chávez». Mexico City, Mexico.Departamento de ElectrofisiologíaInstituto Nacional de Cardiología «Ignacio ChávezMexico CityMexico
| | - Santiago Nava
- Departamento de Electrofisiología, Instituto Nacional de Cardiología «Ignacio Chávez». Mexico City, Mexico.Departamento de ElectrofisiologíaInstituto Nacional de Cardiología «Ignacio ChávezMexico CityMexico
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15
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Cueva-Parra A, Neach-De La Vega D, Yañez-Guerrero P, Bustillos-García G, Gómez-Flores J, Levinstein M, Morales JL, Iturralde-Torres P, Márquez MF, Nava S. Acute and long-term success of ventricular tachycardia ablation in patients with ischemic heart disease in a Mexican center. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2022; 3:179-187. [PMID: 37284562 PMCID: PMC10241329 DOI: 10.47487/apcyccv.v3i2.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/12/2022] [Indexed: 06/08/2023]
Abstract
Objective . To report the results of ventricular tachycardia (VT) catheter ablation in ischemic heart disease (IHD), and to identify risk factors associated with recurrence in a Mexican center. Materials and methods . We made a retrospective review of the cases of VT ablation performed in our center from 2015 to 2022. We analyzed the characteristics of the patients and those of the procedures separately and we determined factors associated with recurrence. Results . Fifty procedures were performed in 38 patients (84% male; mean age 58.1 years). Acute success rate was 82%, with a 28% of recurrences. Female sex (OR 3.33, IC 95% 1.66-6.68, p=0.006), atrial fibrillation (OR 3.5, IC 95% 2.08-5.9, p=0.012), electrical storm (OR 2.4, IC 95% 1.06-5.41, p=0.045), functional class greater than II (OR 2.86, IC 95% 1.34-6.10, p=0.018) were risk factors for recurrence and the presence of clinical VT at the time of ablation (OR 0.29, IC 95% 0.12-0.70, p=0.004) and the use of more than 2 techniques for mapping (OR 0.64, IC 95% 0.48-0.86, p=0.013) were protective factors. Conclusions . Ablation of ventricular tachycardia in ischemic heart disease has had good results in our center. The recurrence is similar to that reported by other authors and there are some factors associated with it.
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Affiliation(s)
- Angel Cueva-Parra
- Departamento de Electrofisiología, Instituto Nacional de Cardiología «Ignacio Chávez». Mexico City, Mexico.Departamento de ElectrofisiologíaInstituto Nacional de Cardiología «Ignacio ChávezMexico CityMexico
| | - Diego Neach-De La Vega
- Departamento de Electrofisiología, Instituto Nacional de Cardiología «Ignacio Chávez». Mexico City, Mexico.Departamento de ElectrofisiologíaInstituto Nacional de Cardiología «Ignacio ChávezMexico CityMexico
| | - Paola Yañez-Guerrero
- Departamento de Electrofisiología, Instituto Nacional de Cardiología «Ignacio Chávez». Mexico City, Mexico.Departamento de ElectrofisiologíaInstituto Nacional de Cardiología «Ignacio ChávezMexico CityMexico
| | - Gabriela Bustillos-García
- Departamento de Electrofisiología, Instituto Nacional de Cardiología «Ignacio Chávez». Mexico City, Mexico.Departamento de ElectrofisiologíaInstituto Nacional de Cardiología «Ignacio ChávezMexico CityMexico
| | - Jorge Gómez-Flores
- Departamento de Electrofisiología, Instituto Nacional de Cardiología «Ignacio Chávez». Mexico City, Mexico.Departamento de ElectrofisiologíaInstituto Nacional de Cardiología «Ignacio ChávezMexico CityMexico
| | - Moisés Levinstein
- Departamento de Electrofisiología, Instituto Nacional de Cardiología «Ignacio Chávez». Mexico City, Mexico.Departamento de ElectrofisiologíaInstituto Nacional de Cardiología «Ignacio ChávezMexico CityMexico
| | - José L. Morales
- Departamento de Electrofisiología, Instituto Nacional de Cardiología «Ignacio Chávez». Mexico City, Mexico.Departamento de ElectrofisiologíaInstituto Nacional de Cardiología «Ignacio ChávezMexico CityMexico
| | - Pedro Iturralde-Torres
- Departamento de Electrofisiología, Instituto Nacional de Cardiología «Ignacio Chávez». Mexico City, Mexico.Departamento de ElectrofisiologíaInstituto Nacional de Cardiología «Ignacio ChávezMexico CityMexico
| | - Manlio F. Márquez
- Departamento de Electrofisiología, Instituto Nacional de Cardiología «Ignacio Chávez». Mexico City, Mexico.Departamento de ElectrofisiologíaInstituto Nacional de Cardiología «Ignacio ChávezMexico CityMexico
| | - Santiago Nava
- Departamento de Electrofisiología, Instituto Nacional de Cardiología «Ignacio Chávez». Mexico City, Mexico.Departamento de ElectrofisiologíaInstituto Nacional de Cardiología «Ignacio ChávezMexico CityMexico
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Presentation and Management of a Giant Coronary Artery Aneurysm with a Fistula to the Right Ventricle. Case Rep Cardiol 2022; 2022:7700086. [PMID: 35531354 PMCID: PMC9072029 DOI: 10.1155/2022/7700086] [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: 12/01/2021] [Accepted: 04/02/2022] [Indexed: 11/24/2022] Open
Abstract
A 27-year-old female presented to our emergency department in ventricular tachycardia. During her workup, she was found to have an extremely rare giant aneurysmal left anterior descending artery (LAD) ending in a coronary fistula to the right ventricle (RV). After stabilization, a variety of treatment options were considered, as there is no standard first-line treatment.
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17
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Elliott MK, Costa CM, Whitaker J, Gemmell P, Mehta VS, Sidhu BS, Gould J, Williams SE, O'Neill M, Razavi R, Niederer S, Bishop MJ, Rinaldi CA. Effect of scar and pacing location on repolarization in a porcine myocardial infarction model. Heart Rhythm O2 2022; 3:186-195. [PMID: 35496454 PMCID: PMC9043407 DOI: 10.1016/j.hroo.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background The effect of chronic ischemic scar on repolarization is unclear, with conflicting results from human and animal studies. An improved understanding of electrical remodeling within scar and border zone tissue may enhance substrate-guided ablation techniques for treatment of ventricular tachycardia. Computational modeling studies have suggested increased dispersion of repolarization during epicardial, but not endocardial, left ventricular pacing, in close proximity to scar. However, the effect of endocardial pacing near scar in vivo is unknown. Objective The purpose of this study was to investigate the effect of scar and pacing location on local repolarization in a porcine myocardial infarction model. Methods Six model pigs underwent late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) imaging followed by electroanatomic mapping of the left ventricular endocardium. LGE-CMR images were registered to the anatomic shell and scar defined by LGE. Activation recovery intervals (ARIs), a surrogate for action potential duration, and local ARI gradients were calculated from unipolar electrograms within areas of late gadolinium enhancement (aLGE) and healthy myocardium. Results There was no significant difference between aLGE and healthy myocardium in mean ARI (304.20 ± 19.44 ms vs 300.59 ± 19.22 ms; P = .43), ARI heterogeneity (23.32 ± 11.43 ms vs 24.85 ± 12.99 ms; P = .54), or ARI gradients (6.18 ± 2.09 vs 5.66 ± 2.32 ms/mm; P = .39). Endocardial pacing distance from scar did not affect ARI gradients. Conclusion Our findings suggest that changes in ARI are not an intrinsic property of surviving myocytes within scar, and endocardial pacing close to scar does not affect local repolarization.
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Affiliation(s)
- Mark K Elliott
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Caroline Mendonca Costa
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - John Whitaker
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Philip Gemmell
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Vishal S Mehta
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Baldeep S Sidhu
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Justin Gould
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Steven E Williams
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Mark O'Neill
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Martin J Bishop
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Spectral characterisation of ventricular intracardiac potentials in human post-ischaemic bipolar electrograms. Sci Rep 2022; 12:4782. [PMID: 35314732 PMCID: PMC8938475 DOI: 10.1038/s41598-022-08743-7] [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: 10/07/2021] [Accepted: 03/11/2022] [Indexed: 11/08/2022] Open
Abstract
AbstractAbnormal ventricular potentials (AVPs) are frequently referred to as high-frequency deflections in intracardiac electrograms (EGMs). However, no scientific study performed a deep spectral characterisation of AVPs and physiological potentials in real bipolar intracardiac recordings across the entire frequency range imposed by their sampling frequency. In this work, the power contributions of post-ischaemic physiological potentials and AVPs, along with some spectral features, were evaluated in the frequency domain and then statistically compared to highlight specific spectral signatures for these signals. To this end, 450 bipolar EGMs from seven patients affected by post-ischaemic ventricular tachycardia were retrospectively annotated by an experienced cardiologist. Given the high variability of the morphologies observed, three different sub-classes of AVPs and two sub-categories of post-ischaemic physiological potentials were considered. All signals were acquired by the CARTO® 3 system during substrate-guided catheter ablation procedures. Our findings indicated that the main frequency contributions of physiological and pathological post-ischaemic EGMs are found below 320 Hz. Statistical analyses showed that, when biases due to the signal amplitude influence are eliminated, not only physiological potentials show greater contributions below 20 Hz whereas AVPs demonstrate higher spectral contributions above ~ 40 Hz, but several finer differences may be observed between the different AVP types.
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Zheng J, Fu G, Struppa D, Abudayyeh I, Contractor T, Anderson K, Chu H, Rakovski C. A High Precision Machine Learning-Enabled System for Predicting Idiopathic Ventricular Arrhythmia Origins. Front Cardiovasc Med 2022; 9:809027. [PMID: 35360041 PMCID: PMC8962834 DOI: 10.3389/fcvm.2022.809027] [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: 11/04/2021] [Accepted: 02/15/2022] [Indexed: 11/22/2022] Open
Abstract
Background Radiofrequency catheter ablation (CA) is an efficient antiarrhythmic treatment with a class I indication for idiopathic ventricular arrhythmia (IVA), only when drugs are ineffective or have unacceptable side effects. The accurate prediction of the origins of IVA can significantly increase the operation success rate, reduce operation duration and decrease the risk of complications. The present work proposes an artificial intelligence-enabled ECG analysis algorithm to estimate possible origins of idiopathic ventricular arrhythmia at a clinical-grade level accuracy. Method A total of 18,612 ECG recordings extracted from 545 patients who underwent successful CA to treat IVA were proportionally sampled into training, validation and testing cohorts. We designed four classification schemes responding to different hierarchical levels of the possible IVA origins. For every classification scheme, we compared 98 distinct machine learning models with optimized hyperparameter values obtained through extensive grid search and reported an optimal algorithm with the highest accuracy scores attained on the testing cohorts. Results For classification scheme 4, our pioneering study designs and implements a machine learning-based ECG algorithm to predict 21 possible sites of IVA origin with an accuracy of 98.24% on a testing cohort. The accuracy and F1-score for the left three schemes surpassed 99%. Conclusion In this work, we developed an algorithm that precisely predicts the correct origins of IVA (out of 21 possible sites) and outperforms the accuracy of all prior studies and human experts.
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Affiliation(s)
- Jianwei Zheng
- Schmid College of Science and Technology, Chapman University, Orange, CA, United States
| | - Guohua Fu
- Arrhythmia Center, Ningbo First Hospital, Zhejiang University, Ningbo, China
| | - Daniele Struppa
- Schmid College of Science and Technology, Chapman University, Orange, CA, United States
| | - Islam Abudayyeh
- Interventional Cardiology, Loma Linda University Health, Loma Linda, CA, United States
| | - Tahmeed Contractor
- Interventional Cardiology, Loma Linda University Health, Loma Linda, CA, United States
| | - Kyle Anderson
- Schmid College of Science and Technology, Chapman University, Orange, CA, United States
| | - Huimin Chu
- Arrhythmia Center, Ningbo First Hospital, Zhejiang University, Ningbo, China
- *Correspondence: Huimin Chu
| | - Cyril Rakovski
- Schmid College of Science and Technology, Chapman University, Orange, CA, United States
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20
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Peichl P, Rafaj A, Kautzner J. Management of ventricular arrhythmias in heart failure: Current perspectives. Heart Rhythm O2 2022; 2:796-806. [PMID: 34988531 PMCID: PMC8710622 DOI: 10.1016/j.hroo.2021.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Congestive heart failure (HF) is a progressive affliction defined as the inability of the heart to sufficiently maintain blood flow. Ventricular arrhythmias (VAs) are common in patients with HF, and conversely, advanced HF promotes the risk of VAs. Management of VA in HF requires a systematic, multimodality approach that comprises optimization of medical therapy and use of implantable cardioverter-defibrillator and/or device combined with cardiac resynchronization therapy. Catheter ablation is one of the most important strategies with the potential to abolish or decrease the number of recurrences of VA in this population. It can be a curative strategy in arrhythmia-induced cardiomyopathy and may even save lives in cases of an electrical storm. Additionally, modulation of the autonomic nervous system and stereotactic radiotherapy have been introduced as novel methods to control refractory VAs. In patients with end-stage HF and refractory VAs, an institution of the mechanical circulatory support device and cardiac transplant may be considered. This review aims to provide an overview of current evidence regarding management strategies of VAs in HF with an emphasis on interventional treatment.
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Affiliation(s)
- Petr Peichl
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Adam Rafaj
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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21
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Ciaccio EJ, Anter E, Coromilas J, Wan EY, Yarmohammadi H, Wit AL, Peters NS, Garan H. Structure and function of the ventricular tachycardia isthmus. Heart Rhythm 2022; 19:137-153. [PMID: 34371192 DOI: 10.1016/j.hrthm.2021.08.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/22/2021] [Accepted: 08/01/2021] [Indexed: 12/24/2022]
Abstract
Catheter ablation of postinfarction reentrant ventricular tachycardia (VT) has received renewed interest owing to the increased availability of high-resolution electroanatomic mapping systems that can describe the VT circuits in greater detail, and the emergence and need to target noninvasive external beam radioablation. These recent advancements provide optimism for improving the clinical outcome of VT ablation in patients with postinfarction and potentially other scar-related VTs. The combination of analyses gleaned from studies in swine and canine models of postinfarction reentrant VT, and in human studies, suggests the existence of common electroanatomic properties for reentrant VT circuits. Characterizing these properties may be useful for increasing the specificity of substrate mapping techniques and for noninvasive identification to guide ablation. Herein, we describe properties of reentrant VT circuits that may assist in elucidating the mechanisms of onset and maintenance, as well as a means to localize and delineate optimal catheter ablation targets.
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Affiliation(s)
- Edward J Ciaccio
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York; ElectroCardioMaths Programme, Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom.
| | - Elad Anter
- Department of Cardiovascular Medicine, Cardiac Electrophysiology, Cleveland Clinic, Cleveland, Ohio
| | - James Coromilas
- Department of Medicine, Division of Cardiovascular Disease and Hypertension, Rutgers University, New Brunswick, New Jersey
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Hirad Yarmohammadi
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Andrew L Wit
- Department of Pharmacology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Nicholas S Peters
- ElectroCardioMaths Programme, Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom
| | - Hasan Garan
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York
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22
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Whitaker J, Neji R, Kim S, Connolly A, Aubriot T, Calvo JJ, Karim R, Roney CH, Murfin B, Richardson C, Morgan S, Ismail TF, Harrison J, de Vos J, Aalders MCG, Williams SE, Mukherjee R, O'Neill L, Chubb H, Tschabrunn C, Anter E, Camporota L, Niederer S, Roujol S, Bishop MJ, Wright M, Silberbauer J, Razavi R, O'Neill M. Late Gadolinium Enhancement Cardiovascular Magnetic Resonance Assessment of Substrate for Ventricular Tachycardia With Hemodynamic Compromise. Front Cardiovasc Med 2021; 8:744779. [PMID: 34765656 PMCID: PMC8576410 DOI: 10.3389/fcvm.2021.744779] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The majority of data regarding tissue substrate for post myocardial infarction (MI) VT has been collected during hemodynamically tolerated VT, which may be distinct from the substrate responsible for VT with hemodynamic compromise (VT-HC). This study aimed to characterize tissue at diastolic locations of VT-HC in a porcine model. Methods: Late Gadolinium Enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging was performed in eight pigs with healed antero-septal infarcts. Seven pigs underwent electrophysiology study with venous arterial-extra corporeal membrane oxygenation (VA-ECMO) support. Tissue thickness, scar and heterogeneous tissue (HT) transmurality were calculated at the location of the diastolic electrograms of mapped VT-HC. Results: Diastolic locations had median scar transmurality of 33.1% and a median HT transmurality 7.6%. Diastolic activation was found within areas of non-transmural scar in 80.1% of cases. Tissue activated during the diastolic component of VT circuits was thinner than healthy tissue (median thickness: 5.5 mm vs. 8.2 mm healthy tissue, p < 0.0001) and closer to HT (median distance diastolic tissue: 2.8 mm vs. 11.4 mm healthy tissue, p < 0.0001). Non-scarred regions with diastolic activation were closer to steep gradients in thickness than non-scarred locations with normal EGMs (diastolic locations distance = 1.19 mm vs. 9.67 mm for non-diastolic locations, p < 0.0001). Sites activated late in diastole were closest to steep gradients in tissue thickness. Conclusions: Non-transmural scar, mildly decreased tissue thickness, and steep gradients in tissue thickness represent the structural characteristics of the diastolic component of reentrant circuits in VT-HC in this porcine model and could form the basis for imaging criteria to define ablation targets in future trials.
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Affiliation(s)
- John Whitaker
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom
| | - Radhouene Neji
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom.,Siemens Healthcare, Frimley, United Kingdom
| | - Steven Kim
- Abbott Medical, St Paul, MN, United States
| | - Adam Connolly
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom
| | | | - Justo Juliá Calvo
- Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Rashed Karim
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom
| | - Caroline H Roney
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom
| | - Brendan Murfin
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Carla Richardson
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Stephen Morgan
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Tevfik F Ismail
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom.,Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - James Harrison
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom
| | - Judith de Vos
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Maurice C G Aalders
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Steven E Williams
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom.,Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Rahul Mukherjee
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom
| | - Louisa O'Neill
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom
| | - Henry Chubb
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom
| | - Cory Tschabrunn
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Elad Anter
- Cleveland Clinic, Cleveland, OH, United States
| | - Luigi Camporota
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom
| | - Sébastien Roujol
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom
| | - Martin J Bishop
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom
| | - Matthew Wright
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - John Silberbauer
- Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom
| | - Mark O'Neill
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom
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23
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Grimaldi M, Marino MM, Vitulano N, Quadrini F, Troisi F, Caporusso N, Perniciaro V, Caruso R, Duni N, Cecere G, Martinelli A, Guida P, Del Monte V, Langialonga T, Di Biase L, Di Monaco A. Cardiopulmonary Support During Catheter Ablation of Ventricular Arrhythmias With Hemodynamic Instability: The Role of Inducibility. Front Cardiovasc Med 2021; 8:747858. [PMID: 34746263 PMCID: PMC8563579 DOI: 10.3389/fcvm.2021.747858] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Catheter ablation is a treatment option for sustained ventricular tachycardias (VTs) that are refractory to pharmacological treatment; however, patients with fast VT and electrical storm (ES) are at risk for cardiogenic shock. We report our experience using cardiopulmonary support with extracorporeal membrane oxygenation (ECMO) during catheter ablation of VT. Methods: Sixty-two patients (mean age 68 ± 9 years; 94% male) were referred to our center for catheter ablation of repeated episodes of hemodynamically unstable ventricular arrhythmias. ES was defined as the occurrence of three or more VT/ventricular fibrillation episodes requiring electrical cardioversion or defibrillation in a 24-h period. All patients had hemodynamically unstable VTs. Results: Thirty-one patients (group 1) performed catheter ablation without ECMO support and 31 patients (group 2) with ECMO support. At the end of the procedure, ventricular inducibility was not performed in 16 patients of group 1 (52%) due to significant hemodynamic instability. Ventricular inducibility was performed in the other 15 patients (48%); polymorphic VTs were inducible in eight patients. In group 2, VTs were not inducible in 29 patients (93%); polymorphic VTs were inducible in two patients. The median follow-up duration was 24 months. Four patients of group 1 (13%) and five patients of group 2 (16%) died due to refractory heart failure. An implantable cardioverter-defibrillator intervention (shock or antitachycardia pacing) was documented in 13 patients of group 1 (42%) and six patients of group 2 (19%). Conclusions: Extracorporeal membrane oxygenation support during catheter ablation for hemodynamically unstable VTs is a useful tool to prevent acute procedural heart failure and to reduce arrhythmic burden.
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Affiliation(s)
- Massimo Grimaldi
- Ospedale Generale Regionale "F. Miulli," Dipartimento di Cardiologia, Bari, Italy
| | | | - Nicola Vitulano
- Ospedale Generale Regionale "F. Miulli," Dipartimento di Cardiologia, Bari, Italy
| | - Federico Quadrini
- Ospedale Generale Regionale "F. Miulli," Dipartimento di Cardiologia, Bari, Italy
| | - Federica Troisi
- Ospedale Generale Regionale "F. Miulli," Dipartimento di Cardiologia, Bari, Italy
| | - Nicola Caporusso
- Ospedale Generale Regionale "F. Miulli," Dipartimento di Anestesia e Rianimazione, Bari, Italy
| | - Vera Perniciaro
- Ospedale Generale Regionale "F. Miulli," Dipartimento di Cardiologia, Bari, Italy
| | - Rosa Caruso
- Ospedale Generale Regionale "F. Miulli," Dipartimento di Cardiologia, Bari, Italy
| | - Nicola Duni
- Ospedale Generale Regionale "F. Miulli," Dipartimento di Cardiologia, Bari, Italy
| | - Giacomo Cecere
- Ospedale Generale Regionale "F. Miulli," Dipartimento di Cardiologia, Bari, Italy
| | - Alberto Martinelli
- Ospedale Generale Regionale "F. Miulli," Dipartimento di Cardiologia, Bari, Italy
| | - Pietro Guida
- Ospedale Generale Regionale "F. Miulli," Dipartimento di Cardiologia, Bari, Italy
| | - Vito Del Monte
- Ospedale Generale Regionale "F. Miulli," Dipartimento di Anestesia e Rianimazione, Bari, Italy
| | - Tommaso Langialonga
- Ospedale Generale Regionale "F. Miulli," Dipartimento di Cardiologia, Bari, Italy
| | - Luigi Di Biase
- St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, TX, United States.,Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Antonio Di Monaco
- Ospedale Generale Regionale "F. Miulli," Dipartimento di Cardiologia, Bari, Italy.,Dipartimento di Medicina Clinica e Sperimentale, Universitá di Foggia, Foggia, FG, Italy
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24
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Rozen G, Elbaz-Greener G, Andria N, Heist EK, Ruskin JN, Wijeysundera HC, Carasso S, Birati E, Amir O, Marai I. Ventricular arrhythmia ablation in the presence of mechanical valve utilization and complications of catheter ablation for ventricular arrhythmia in patients with mechanical prosthetic valves. J Cardiovasc Electrophysiol 2021; 32:3165-3172. [PMID: 34664743 DOI: 10.1111/jce.15271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/25/2021] [Accepted: 09/11/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Catheter ablation (CA) for ventricular arrhythmias (VAs) is increasingly utilized in recent years. We aimed to investigate the nationwide trends in utilization and procedural complications of CA for VAs in patients with mechanical valve (MV) prosthesis. METHODS We drew data from the US National Inpatient Sample database to identify cases of VA ablations, including premature ventricular contraction and ventricular tachycardia, in patients with MVs, between 2003 and 2015. Sociodemographic and clinical data were collected and the incidence of catheter ablation complications, mortality, and length of stay were analyzed. We compared the outcomes to a propensity-matched cohort of patients without prior valve surgery. RESULTS The study population included a weighted total of 647 CA cases in patients with prior MVs. The annual number of ablations almost doubled, from 34 ablations on average during the "early years" (2003-2008) to 64 on average during the "late years" (2009-2015) of the study (p = .001). Length of stay at the hospital did not differ significantly between patients with MVs and 649 matched patients without prior MVs (5.4 ± 0.4, 4.7 ± 0.3 days, respectively, p = .12). The data revealed a trend toward a higher incidence of complications (12.6% vs. 7.5% respectively, p = .14) and mortality (3.7% vs. 0.7%, respectively, p = .087) among patients with MVs compared to the matched control group, not reaching statistical significance. CONCLUSION The data show increased utilization of VA ablations in patients with MVs and a trend toward a higher incidence of in-hospital mortality and complications compared to the propensity-matched control group without MVs.
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Affiliation(s)
- Guy Rozen
- Cardiology Division, Hillel Yaffe Medical Center, Hadera, Israel.,Faculty of Medicine, The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.,Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gabby Elbaz-Greener
- Department of Cardiology, Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nizar Andria
- Division of Cardiovascular Medicine, Baruch Padeh Medical Center, Poriya, Israel.,Faculty of Medicine, The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - E Kevin Heist
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jeremy N Ruskin
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Harindra C Wijeysundera
- Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Shemy Carasso
- Division of Cardiovascular Medicine, Baruch Padeh Medical Center, Poriya, Israel.,Faculty of Medicine, The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Edo Birati
- Division of Cardiovascular Medicine, Baruch Padeh Medical Center, Poriya, Israel.,Faculty of Medicine, The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Offer Amir
- Department of Cardiology, Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel.,Division of Cardiovascular Medicine, Baruch Padeh Medical Center, Poriya, Israel.,Faculty of Medicine, The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Ibrahim Marai
- Division of Cardiovascular Medicine, Baruch Padeh Medical Center, Poriya, Israel.,Faculty of Medicine, The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
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25
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Advances in Mapping of Ventricular Tachycardia. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-021-00951-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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26
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Flecainide in Ventricular Arrhythmias: From Old Myths to New Perspectives. J Clin Med 2021; 10:jcm10163696. [PMID: 34441994 PMCID: PMC8397118 DOI: 10.3390/jcm10163696] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/10/2021] [Accepted: 08/18/2021] [Indexed: 11/21/2022] Open
Abstract
Flecainide is an IC antiarrhythmic drug (AAD) that received in 1984 Food and Drug Administration approval for the treatment of sustained ventricular tachycardia (VT) and subsequently for rhythm control of atrial fibrillation (AF). Currently, flecainide is mainly employed for sinus rhythm maintenance in AF and the treatment of idiopathic ventricular arrhythmias (IVA) in absence of ischaemic and structural heart disease on the basis of CAST data. Recent studies enrolling patients with different structural heart diseases demonstrated good effectiveness and safety profile of flecainide. The purpose of this review is to assess current evidence for appropriate and safe use of flecainide, 30 years after CAST data, in the light of new diagnostic and therapeutic tools in the field of ischaemic and non-ischaemic heart disease.
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27
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Brugada-Terradellas C, Hellemans A, Brugada P, Smets P. Sudden cardiac death: A comparative review of humans, dogs and cats. Vet J 2021; 274:105696. [PMID: 34148018 DOI: 10.1016/j.tvjl.2021.105696] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/22/2021] [Accepted: 05/24/2021] [Indexed: 01/14/2023]
Abstract
Sudden death is one of the most common causes of death in humans in Western countries. Approximately 85% of these cases are of cardiac origin. In dogs and cats, sudden cardiac death (SCD) also commonly occurs, but fewer pathophysiological and prevalence data are available. Both structural, primarily 'electrical' and ischemic heart diseases are known to cause SCD, many of which share similar underlying arrhythmogenic mechanisms between humans and companion animals. As for underlying genetics, numerous mutations on multiple loci have been related to SCD in humans, but only a few mutations associated with dilated cardiomyopathy and SCD have been identified in dogs, e.g. in the phospholamban and titin genes. Information published from human medicine can therefore inform future veterinary studies, but also dogs and cats could act as spontaneous models of SCD in humans. Further research in both fields is therefore warranted to better understand the pathophysiology, genetics, and prevention of SCD.
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Affiliation(s)
- Celine Brugada-Terradellas
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium.
| | - Arnaut Hellemans
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium
| | - Pedro Brugada
- Pedro Brugada, Cardiovascular Division, UZ Brussel - VUB, Avenue du Laerbeek 101, 1090 Brussels, Belgium
| | - Pascale Smets
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium
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28
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Ho LT, Chen JLY, Chan HM, Huang YC, Su MY, Kuo SH, Chang YC, Lin JL, Chen WJ, Lee WJ, Lin LY. First Asian population study of stereotactic body radiation therapy for ventricular arrhythmias. Sci Rep 2021; 11:10360. [PMID: 33990651 PMCID: PMC8121933 DOI: 10.1038/s41598-021-89857-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/22/2021] [Indexed: 12/31/2022] Open
Abstract
We report the first Asian series on stereotactic body radiation (SBRT) for refractory ventricular arrhythmia (VA) in Taiwanese patients. Three-dimensional electroanatomic maps, delayed-enhancement magnetic resonance imaging (DE-MRI), and dual-energy computed tomography (CT) were used to identify scar substrates. The main target volume was treated with a single radiation dose of 25 Gy and the margin volume received 20 Gy using simultaneous integrated boost delivered by the Varian TrueBeam system. Efficacy was assessed according to VA events recorded by an implantable cardioverter-defibrillator (ICD) or a 24-h Holter recorder. Pre- and post-radiation therapy imaging studies were performed. From February 2019 to December 2019, seven patients (six men, one woman; mean age, 55 years) were enrolled and treated. One patient died of hepatic failure. In the remaining six patients, at a median follow-up of 14.5 months, the VA burden and ICD shocks significantly decreased (only one patient with one ICD shock after treatment). Increased intensity on DE-MRI might be associated with a lower risk for VA recurrence, whereas dual-energy CT had lower detection sensitivity. No acute or minimal late adverse events occurred. In patients with refractory VA, SBRT is associated with a marked reduction in VA burden and ICD shocks, and DE-MRI might be useful for monitoring treatment effects.
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Affiliation(s)
- Li-Ting Ho
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, No. 7, Chuang-Shan South Road, Taipei, 100, Taiwan.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No. 7, Chuang-Shan South Road, Taipei, 100, Taiwan
| | - Jenny Ling-Yu Chen
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, No. 7, Chuang-Shan South Road, Taipei, 100, Taiwan.,Department of Radiology, National Taiwan University College of Medicine, No. 7, Chuang-Shan South Road, Taipei, 100, Taiwan
| | - Hsing-Min Chan
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, No. 7, Chuang-Shan South Road, Taipei, 100, Taiwan
| | - Yu-Cheng Huang
- Department of Radiology, National Taiwan University College of Medicine, No. 7, Chuang-Shan South Road, Taipei, 100, Taiwan.,Department of Medical Imaging, National Taiwan University College of Medicine and Hospital, No. 7, Chuang-Shan South Road, Taipei, 100, Taiwan
| | - Mao-Yuan Su
- Department of Medical Imaging, National Taiwan University College of Medicine and Hospital, No. 7, Chuang-Shan South Road, Taipei, 100, Taiwan
| | - Sung-Hsin Kuo
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, No. 7, Chuang-Shan South Road, Taipei, 100, Taiwan
| | - Yeun-Chung Chang
- Department of Radiology, National Taiwan University College of Medicine, No. 7, Chuang-Shan South Road, Taipei, 100, Taiwan.,Department of Medical Imaging, National Taiwan University College of Medicine and Hospital, No. 7, Chuang-Shan South Road, Taipei, 100, Taiwan
| | - Jiunn-Lee Lin
- Cardiovascular Center, Taipei Medical University Shuang Ho Hospital, No. 7, Chuang-Shan South Road, Taipei, 100, Taiwan
| | - Wen-Jone Chen
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, No. 7, Chuang-Shan South Road, Taipei, 100, Taiwan
| | - Wen-Jeng Lee
- Department of Radiology, National Taiwan University College of Medicine, No. 7, Chuang-Shan South Road, Taipei, 100, Taiwan. .,Department of Medical Imaging, National Taiwan University College of Medicine and Hospital, No. 7, Chuang-Shan South Road, Taipei, 100, Taiwan.
| | - Lian-Yu Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, No. 7, Chuang-Shan South Road, Taipei, 100, Taiwan.
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29
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Whitaker J, Mak RH, Zei PC. Non-invasive ablation of arrhythmias with stereotactic ablative radiotherapy. Trends Cardiovasc Med 2021; 32:287-296. [PMID: 33951498 DOI: 10.1016/j.tcm.2021.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/14/2021] [Accepted: 04/25/2021] [Indexed: 12/31/2022]
Abstract
Stereotactic ablative radiotherapy (SABR), or stereotactic body radiotherapy (SBRT), has recently been applied in the field of arrhythmia management. It has been most widely assessed in the treatment of ventricular tachycardia (VT) but may also have potential in the treatment of other arrhythmias as well, often termed stereotactic arrhythmia radiotherapy (STAR). The non-invasive delivery of treatment for VT has the potential to spare an often physiologically vulnerable group of patients the burden of long catheter ablation procedures with the potential for prolonged periods of hemodynamic instability. Cardiac SABR also has the capacity to direct ablative therapy at substrate that is inaccessible using current transchatheter techniques. For these reasons cardiac SABR has generated significant enthusiasm as an emerging treatment modality for VT. We consider in review the pre-clinical data pertaining to the use of SABR in cardiac tissue and recent clinical evidence regarding the application of SABR in the field of arrhythmia management.
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Affiliation(s)
- John Whitaker
- Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Raymond H Mak
- Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Paul C Zei
- Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
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30
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Miszczyk M, Jadczyk T, Gołba K, Wojakowski W, Wita K, Bednarek J, Blamek S. Clinical Evidence behind Stereotactic Radiotherapy for the Treatment of Ventricular Tachycardia (STAR)-A Comprehensive Review. J Clin Med 2021; 10:jcm10061238. [PMID: 33802802 PMCID: PMC8002399 DOI: 10.3390/jcm10061238] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/14/2021] [Accepted: 03/15/2021] [Indexed: 12/31/2022] Open
Abstract
The electrophysiology-guided noninvasive cardiac radioablation, also known as STAR (stereotactic arrhythmia radioablation) is an emerging treatment method for persistent ventricular tachycardia. Since its first application in 2012 in Stanford Cancer Institute, and a year later in University Hospital Ostrava, Czech Republic, the authors from all around the world have published case reports and case series, and several prospective trials were established. In this article, we would like to discuss the available clinical evidence, analyze the potentially clinically relevant differences in methodology, and address some of the unique challenges that come with this treatment method.
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Affiliation(s)
- Marcin Miszczyk
- IIIrd Department of Radiotherapy and Chemotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland
- Correspondence: ; Tel.: +48-663-040-809
| | - Tomasz Jadczyk
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-055 Katowice, Poland; (T.J.); (W.W.)
- International Clinical Research Center, Interventional Cardiac Electrophysiology Group, St. Anne’s University Hospital Brno, 664/53 Brno, Czech Republic
| | - Krzysztof Gołba
- Upper-Silesian Heart Center, Department of Electrocardiology, 40-055 Katowice, Poland;
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, 40-055 Katowice, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-055 Katowice, Poland; (T.J.); (W.W.)
| | - Krystian Wita
- First Department of Cardiology, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Jacek Bednarek
- Department of Electrocardiology, John Paul II Hospital, 31-202 Cracow, Poland;
| | - Sławomir Blamek
- Department of Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland;
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Lv W, Barrett CD, Arai T, Bapat A, Armoundas AA, Cohen RJ, Lee K. Use of the inverse solution guidance algorithm method for RF ablation catheter guidance. J Cardiovasc Electrophysiol 2021; 32:1281-1289. [PMID: 33625757 DOI: 10.1111/jce.14965] [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: 11/24/2020] [Revised: 02/05/2021] [Accepted: 02/13/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION We previously introduced the inverse solution guidance algorithm (ISGA) methodology using a Single Equivalent Moving Dipole model of cardiac electrical activity to localize both the exit site of a re-entrant circuit and the tip of a radiofrequency (RF) ablation catheter. The purpose of this study was to investigate the use of ISGA for ablation catheter guidance in an animal model. METHODS Ventricular tachycardia (VT) was simulated by rapid ventricular pacing at a target site in eleven Yorkshire swine. The ablation target was established using three different techniques: a pacing lead placed into the ventricular wall at the mid-myocardial level (Type-1), an intracardiac mapping catheter (Type-2), and an RF ablation catheter placed at a random position on the endocardial surface (Type-3). In each experiment, one operator placed the catheter/pacing lead at the target location, while another used the ISGA system to manipulate the RF ablation catheter starting from a random ventricular location to locate the target. RESULTS The average localization error of the RF ablation catheter tip was 0.31 ± 0.08 cm. After analyzing approximately 35 cardiac cycles of simulated VT, the ISGA system's accuracy in locating the target was 0.4 cm after four catheter movements in the Type-1 experiment, 0.48 cm after six movements in the Type-2 experiment, and 0.67 cm after seven movements in the Type-3 experiment. CONCLUSION We demonstrated the feasibility of using the ISGA method to guide an ablation catheter to the origin of a VT focus by analyzing a few beats of body surface potentials without electro-anatomic mapping.
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Affiliation(s)
- Wener Lv
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Conor D Barrett
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Tatsuya Arai
- Department of Aeronautics and Astronautics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Aneesh Bapat
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts, USA.,Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Antonis A Armoundas
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Richard J Cohen
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Kichang Lee
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts, USA.,Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
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32
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Conte E, Mushtaq S, Carbucicchio C, Piperno G, Catto V, Mancini ME, Formenti A, Annoni A, Guglielmo M, Baggiano A, Muscogiuri G, Belmonte M, Cattani F, Pontone G, Jereczek-Fossa BA, Orecchia R, Tondo C, Andreini D. State of the art paper: Cardiovascular CT for planning ventricular tachycardia ablation procedures. J Cardiovasc Comput Tomogr 2021; 15:394-402. [PMID: 33563533 DOI: 10.1016/j.jcct.2021.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/22/2020] [Accepted: 01/21/2021] [Indexed: 10/22/2022]
Abstract
In the last 20 years coronary computed tomography angiography (CCTA) gained a pivotal role in the evaluation of patients with suspected coronary artery disease (CAD) as finally recognized by the ESC guidelines on stable CAD. Technological advances have progressively improved the temporal resolution of CT scanners, contemporary reducing acquisition time, radiation dose and contrast volume needed for the whole heart volume acquisition, further expanding the role of cardiac CT beyond coronary anatomy evaluation. Aim of the present review is to discuss use and benefit of cardiac CT for the planning and preparation of VT ablation.
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Affiliation(s)
| | | | | | - Gaia Piperno
- Division of Radiotherapy IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | | | | | | | | | | | | | | | | | - Federica Cattani
- Unit of Medical Physics, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | | | - Barbara Alicja Jereczek-Fossa
- Unit of Medical Physics, IEO European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Roberto Orecchia
- Scientific Directorate, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Claudio Tondo
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy.
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33
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Groeneveld SA, Blom LJ, van der Heijden JF, Loh P, Hassink RJ. Follow-up after hemodynamically not tolerated ventricular tachycardia in patients with midrange reduced to normal ejection fraction: A retrospective single-centre case series. Eur J Clin Invest 2021; 51:e13359. [PMID: 32705678 PMCID: PMC7757240 DOI: 10.1111/eci.13359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/17/2020] [Accepted: 07/19/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The benefit of implantable cardioverter-defibrillator (ICD) implantation in patients with hemodynamically not tolerated ventricular tachycardia (VT) and midrange reduced to normal ejection fraction (LVEF >35%) is currently unclear. The purpose of this study was to investigate follow-up after hemodynamically not tolerated VT in patients with LVEF >35%. In addition, we aimed to find possible predictive factors to identify who will benefit from ICD implantation. METHODS In a retrospective single-centre case series, all patients with hemodynamically not tolerated VT and LVEF >35% that underwent electrophysiological study (EPS) and/or radiofrequency VT ablation were included. RESULTS Forty-two patients (5 women, median age 68 years) with hemodynamically not tolerated VT and LVEF >35% underwent EPS. VT ablation was performed in thirty-one patients, which was considered successful in twenty-three patients. Nineteen patients had an ICD at discharge while 23 patients were discharged without an ICD. The severity of hemodynamic compromise, LVEF and ablation success played an important role in the decision-making for ICD implantation. Six patients (14.3%) had recurrence of VT, all hemodynamically tolerated. CONCLUSIONS In this small case series, patients with hemodynamically not tolerated VT and LVEF >35% had a relatively low recurrence rate and all recurrences were nonfatal. Based on our results, we hypothesize that the severity of hemodynamic compromise, LVEF and ablation success might modify the risk for VA recurrence. A prospective study to determine the prognostic value of these factors in patients with hemodynamically not tolerated VT and LVEF >35% is necessary.
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Affiliation(s)
- Sanne A. Groeneveld
- Department of CardiologyUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - Lennart J. Blom
- Department of CardiologyUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | | | - Peter Loh
- Department of CardiologyUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - Rutger J. Hassink
- Department of CardiologyUniversity Medical Centre UtrechtUtrechtThe Netherlands
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34
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Barake W, Giudicessi JR, Asirvatham SJ, Ackerman MJ. Purkinje system hyperexcitability and ventricular arrhythmia risk in type 3 long QT syndrome. Heart Rhythm 2020; 17:1768-1776. [PMID: 32454217 DOI: 10.1016/j.hrthm.2020.05.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/01/2020] [Accepted: 05/11/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Gain-of-function variants in the SCN5A-encoded Nav1.5 sodium channel cause type 3 long QT syndrome (LQT3) and multifocal ectopic Purkinje-related premature contractions. Although the Purkinje system is uniquely sensitive to the action potential-prolonging effects of LQT3-causative variants, the existence of additional Purkinje phenotype(s) in LQT3 is unknown. OBJECTIVE The purpose of this study was to determine the prevalence and clinical implications of frequent fascicular/Purkinje-related premature ventricular contractions (PVCs) and short-coupled ventricular arrhythmias (VAs), suggestive of Purkinje system hyperexcitability (PSH), in a single-center LQT3 cohort. METHODS A retrospective analysis of 177 SCN5A-positive patients was performed to identify individuals with a LQT3 phenotype. Available electrocardiographic, electrophysiology study, device, and genetic data from 91 individuals with LQT3 were reviewed for evidence of presumed fascicular PVCs and short-coupled VAs. The relationship between PSH and ventricular fibrillation events was assessed by Kaplan-Meier and Cox regression analyses. RESULTS Overall, 30 of 91 patients with LQT3 (33%) exhibited evidence of presumed PSH (fascicular PVCs 30 of 30 [100%]; short-coupled VAs 17 of 30 [56%]). Kaplan-Meier and Cox regression analyses demonstrated an increased risk of ventricular fibrillation events in individuals with LQT3 and PSH (log-rank, P < .03; hazard ratio 3.95; 95% confidence interval 1.15-15.7; P = .03). Interestingly, variants in the voltage-sensing domain regions of Nav1.5 were more frequently observed in patients with LQT3 and PSH than those without (19 of 30 [63%] vs 9 of 61 [15%]; P < .0001). CONCLUSION This study demonstrates that a discernible Purkinje phenotype is present in one-third of LQT3 cases and increases the risk of potentially lethal VAs. Further study is needed to determine whether a distinct cellular electrophysiology phenotype underlies this phenomenon.
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Affiliation(s)
- Walid Barake
- Division of Heart Rhythm Services, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - John R Giudicessi
- Clinician Investigator Training Program, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Windland Smith Rice Sudden Death Genomics Laboratory, Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
| | - Samuel J Asirvatham
- Division of Heart Rhythm Services, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Michael J Ackerman
- Division of Heart Rhythm Services, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Windland Smith Rice Sudden Death Genomics Laboratory, Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota; Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota.
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35
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Blanck O, Buergy D, Vens M, Eidinger L, Zaman A, Krug D, Rudic B, Boda-Heggemann J, Giordano FA, Boldt LH, Mehrhof F, Budach V, Schweikard A, Olbrich D, König IR, Siebert FA, Vonthein R, Dunst J, Bonnemeier H. Radiosurgery for ventricular tachycardia: preclinical and clinical evidence and study design for a German multi-center multi-platform feasibility trial (RAVENTA). Clin Res Cardiol 2020; 109:1319-1332. [PMID: 32306083 PMCID: PMC7588361 DOI: 10.1007/s00392-020-01650-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 04/08/2020] [Indexed: 12/25/2022]
Abstract
Background Single-session high-dose stereotactic radiotherapy (radiosurgery) is a new treatment option for otherwise untreatable patients suffering from refractory ventricular tachycardia (VT). In the initial single-center case studies and feasibility trials, cardiac radiosurgery has led to significant reductions of VT burden with limited toxicities. However, the full safety profile remains largely unknown. Methods/design In this multi-center, multi-platform clinical feasibility trial which we plan is to assess the initial safety profile of radiosurgery for ventricular tachycardia (RAVENTA). High-precision image-guided single-session radiosurgery with 25 Gy will be delivered to the VT substrate determined by high-definition endocardial electrophysiological mapping. The primary endpoint is safety in terms of successful dose delivery without severe treatment-related side effects in the first 30 days after radiosurgery. Secondary endpoints are the assessment of VT burden, reduction of implantable cardioverter defibrillator (ICD) interventions [shock, anti-tachycardia pacing (ATP)], mid-term side effects and quality-of-life (QoL) in the first year after radiosurgery. The planned sample size is 20 patients with the goal of demonstrating safety and feasibility of cardiac radiosurgery in ≥ 70% of the patients. Quality assurance is provided by initial contouring and planning benchmark studies, joint multi-center treatment decisions, sequential patient safety evaluations, interim analyses, independent monitoring, and a dedicated data and safety monitoring board. Discussion RAVENTA will be the first study to provide the initial robust multi-center multi-platform prospective data on the therapeutic value of cardiac radiosurgery for ventricular tachycardia. Trial registration number NCT03867747 (clinicaltrials.gov). Registered March 8, 2019. The study was initiated on November 18th, 2019, and is currently recruiting patients. Graphic abstract ![]()
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Affiliation(s)
- Oliver Blanck
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus 50, 24105, Kiel, Germany.
| | - Daniel Buergy
- Klinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Mannheim, Universität Heidelberg, Medizinische Fakultät Mannheim, Mannheim, Germany
| | - Maren Vens
- Universität zu Lübeck, Zentrum für Klinische Studien, Lübeck, Germany.,Institut für Medizinische Biometrie und Statistik, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Lina Eidinger
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus 50, 24105, Kiel, Germany.,Klinik für Innere Medizin III, Abteilung für Elektrophysiologie und Rhythmologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Adrian Zaman
- Klinik für Innere Medizin III, Abteilung für Elektrophysiologie und Rhythmologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - David Krug
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus 50, 24105, Kiel, Germany
| | - Boris Rudic
- Medizinische Klinik I, Abteilung für Elektrophysiologie und Rhythmologie, Universitätsmedizin Mannheim, Universität Heidelberg, Medizinische Fakultät Mannheim, Mannheim, Germany
| | - Judit Boda-Heggemann
- Klinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Mannheim, Universität Heidelberg, Medizinische Fakultät Mannheim, Mannheim, Germany
| | - Frank A Giordano
- Klinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Mannheim, Universität Heidelberg, Medizinische Fakultät Mannheim, Mannheim, Germany
| | - Leif-Hendrik Boldt
- Medizinische Klinik mit Schwerpunkt Kardiologie (CVK), Abteilung für Elektrophysiologie und Rhythmologie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Mehrhof
- Klinik für Radioonkologie und Strahlentherapie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Volker Budach
- Klinik für Radioonkologie und Strahlentherapie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Achim Schweikard
- Institut für Robotik und Kognitive Systeme, Universität zu Lübeck, Lübeck, Germany
| | - Denise Olbrich
- Universität zu Lübeck, Zentrum für Klinische Studien, Lübeck, Germany
| | - Inke R König
- Institut für Medizinische Biometrie und Statistik, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Frank-Andre Siebert
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus 50, 24105, Kiel, Germany
| | - Reinhard Vonthein
- Institut für Medizinische Biometrie und Statistik, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Jürgen Dunst
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus 50, 24105, Kiel, Germany
| | - Hendrik Bonnemeier
- Klinik für Innere Medizin III, Abteilung für Elektrophysiologie und Rhythmologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
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36
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Willems S, Tilz RR, Steven D, Kääb S, Wegscheider K, Gellér L, Meyer C, Heeger CH, Metzner A, Sinner MF, Schlüter M, Nordbeck P, Eckardt L, Bogossian H, Sultan A, Wenzel B, Kuck KH, Piorkowski C, Lebedev D, Kautzner J, Sticherling C, Deneke T, Rostock T, Ukena C, Kuniss M, Makimoto H, Hindricks G, Bänsch D, Schreieck J, Kolb C, Geller J, Pokushalov E, Gutleben K, Sommer P, Boldt L, Parwani A. Preventive or Deferred Ablation of Ventricular Tachycardia in Patients With Ischemic Cardiomyopathy and Implantable Defibrillator (BERLIN VT). Circulation 2020; 141:1057-1067. [DOI: 10.1161/circulationaha.119.043400] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Catheter ablation for ventricular tachycardia (VT) reduces the recurrence of VT in patients with implantable cardioverter-defibrillators (ICDs). The appropriate timing of VT ablation and its effects on mortality and heart failure progression remain a matter of debate. In patients with life-threatening arrhythmias necessitating ICD implantation, we compared outcomes of preventive VT ablation (undertaken before ICD implantation to prevent ICD shocks for VT) and deferred ablation after 3 ICD shocks for VT.
Methods:
The BERLIN VT study (Preventive Ablation of Ventricular Tachycardia in Patients With Myocardial Infarction) was a prospective, open, parallel, randomized trial performed at 26 centers. Patients with stable ischemic cardiomyopathy, a left ventricular ejection fraction between 30% and 50%, and documented VT were randomly assigned 1:1 to a preventive or deferred ablation strategy. The primary outcome was a composite of all-cause death and unplanned hospitalization for either symptomatic ventricular arrhythmia or worsening heart failure. Secondary outcomes included sustained ventricular tachyarrhythmia and appropriate ICD therapy. We hypothesized that preventive ablation strategy would be superior to deferred ablation strategy in the intention-to-treat population.
Results:
During a mean follow-up of 396±284 days, the primary end point occurred in 25 (32.9%) of 76 patients in the preventive ablation group and 23 (27.7%) of 83 patients in the deferred ablation group (hazard ratio, 1.09 [95% CI, 0.62–1.92];
P
=0.77). On the basis of prespecified criteria for interim analyses, the study was terminated early for futility. In the preventive versus deferred ablation group, 6 versus 2 patients died (7.9% versus 2.4%;
P
=0.18), 8 versus 2 patients were admitted for worsening heart failure (10.4% versus 2.3%;
P
=0.062), and 15 versus 21 patients were hospitalized for symptomatic ventricular arrhythmia (19.5% versus 25.3%;
P
=0.27). Among secondary outcomes, the proportions of patients with sustained ventricular tachyarrhythmia (39.7% versus 48.2%;
P
=0.050) and appropriate ICD therapy (34.2% versus 47.0%;
P
=0.020) were numerically reduced in the preventive ablation group.
Conclusions:
Preventive VT ablation before ICD implantation did not reduce mortality or hospitalization for arrhythmia or worsening heart failure during 1 year of follow-up compared with the deferred ablation strategy.
Registration:
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT02501005.
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Affiliation(s)
| | - Roland Richard Tilz
- University Hospital Lübeck, Med.Klinik II, and German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Germany (R.R.T., C.-H.H.)
| | - Daniel Steven
- University Heart Center Cologne, Germany (D.S., A.S.)
| | - Stefan Kääb
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilian’s University Munich and German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (S.K., M.F.S.)
| | - Karl Wegscheider
- Institute of Medical Biometry and Epidemiology, University Medical Center Eppendorf, Hamburg, Germany (K.W.)
| | - László Gellér
- Semmelweis Medical University, Budapest, Hungary (L.G.)
| | | | - Christian-Hendrik Heeger
- University Hospital Lübeck, Med.Klinik II, and German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Germany (R.R.T., C.-H.H.)
| | | | - Moritz F. Sinner
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilian’s University Munich and German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (S.K., M.F.S.)
| | | | | | | | | | - Arian Sultan
- University Heart Center Cologne, Germany (D.S., A.S.)
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Abstract
PURPOSE OF REVIEW To provide a framework for approaching ventricular arrhythmias in the setting of cardiomyopathy, outline the latest evidence-based recommendations for catheter ablation and device therapy, and discuss novel treatment strategies. RECENT FINDINGS Risk stratification of ventricular arrhythmias in systolic heart failure has evolved, with an increasing role for cardiac magnetic resonance imaging to identify underlying substrate and scar burden. Medical therapy for heart failure has greatly improved, and the role of primary prevention defibrillators in nonischemic cardiomyopathy has become more ambiguous. Catheter ablation is superior to medical therapy for arrhythmia control and should be considered early, particularly for premature ventricular complex mediated cardiomyopathy. Novel technologies to deliver energy to previously inaccessible sites include high-impedance catheter irrigants, multicatheter bipolar ablation, specialized catheters with extendable needles, transcoronary ethanol infusion, and stereotactic body radiation therapy. SUMMARY Assessment and management of ventricular arrhythmias in systolic heart failure requires a systematic, multimodality approach aimed at identifying the underlying cause and reversible causes, optimizing medical therapy, assessing need for an implantable cardioverter defibrillator, and considering catheter ablation. Further research will focus on prevention of disease progression, improved risk stratification, and ablation technologies that minimize procedure duration and enable delivery of durable lesions.
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38
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Ye J, Wang Y, Wang Z, Liu L, Yang Z, Wang M, Xu Y, Ye D, Zhang J, Lin Y, Ji Q, Wan J. Roles and Mechanisms of Interleukin-12 Family Members in Cardiovascular Diseases: Opportunities and Challenges. Front Pharmacol 2020; 11:129. [PMID: 32194399 PMCID: PMC7064549 DOI: 10.3389/fphar.2020.00129] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 01/30/2020] [Indexed: 12/19/2022] Open
Abstract
Cardiovascular diseases represent a complex group of clinical syndromes caused by a variety of interacting pathological factors. They include the most extensive disease population and rank first in all-cause mortality worldwide. Accumulating evidence demonstrates that cytokines play critical roles in the presence and development of cardiovascular diseases. Interleukin-12 family members, including IL-12, IL-23, IL-27 and IL-35, are a class of cytokines that regulate a variety of biological effects; they are closely related to the progression of various cardiovascular diseases, including atherosclerosis, hypertension, aortic dissection, cardiac hypertrophy, myocardial infarction, and acute cardiac injury. This paper mainly discusses the role of IL-12 family members in cardiovascular diseases, and the molecular and cellular mechanisms potentially involved in their action in order to identify possible intervention targets for the prevention and clinical treatment of cardiovascular diseases.
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Affiliation(s)
- Jing Ye
- Hubei Key Laboratory of Cardiology, Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute, Wuhan University, Wuhan, China
| | - Yuan Wang
- Department of Thyroid Breast Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhen Wang
- Hubei Key Laboratory of Cardiology, Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute, Wuhan University, Wuhan, China
| | - Ling Liu
- Department of Cardiology, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Zicong Yang
- Department of Cardiology, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Menglong Wang
- Hubei Key Laboratory of Cardiology, Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute, Wuhan University, Wuhan, China
| | - Yao Xu
- Hubei Key Laboratory of Cardiology, Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute, Wuhan University, Wuhan, China
| | - Di Ye
- Hubei Key Laboratory of Cardiology, Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute, Wuhan University, Wuhan, China
| | - Jishou Zhang
- Hubei Key Laboratory of Cardiology, Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute, Wuhan University, Wuhan, China
| | - Yingzhong Lin
- Department of Cardiology, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Qingwei Ji
- Department of Cardiology, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Jun Wan
- Hubei Key Laboratory of Cardiology, Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute, Wuhan University, Wuhan, China
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Clinical experience of stereotactic body radiation for refractory ventricular tachycardia in advanced heart failure patients. Heart Rhythm 2020; 17:415-422. [DOI: 10.1016/j.hrthm.2019.09.028] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Indexed: 12/31/2022]
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Substrate for Ventricular Arrhythmia. JACC Cardiovasc Imaging 2020; 13:532-534. [DOI: 10.1016/j.jcmg.2020.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Trayanova NA, Doshi AN, Prakosa A. How personalized heart modeling can help treatment of lethal arrhythmias: A focus on ventricular tachycardia ablation strategies in post-infarction patients. WILEY INTERDISCIPLINARY REVIEWS-SYSTEMS BIOLOGY AND MEDICINE 2020; 12:e1477. [PMID: 31917524 DOI: 10.1002/wsbm.1477] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 12/18/2022]
Abstract
Precision Cardiology is a targeted strategy for cardiovascular disease prevention and treatment that accounts for individual variability. Computational heart modeling is one of the novel approaches that have been developed under the umbrella of Precision Cardiology. Personalized computational modeling of patient hearts has made strides in the development of models that incorporate the individual geometry and structure of the heart as well as other patient-specific information. Of these developments, one of the potentially most impactful is the research aimed at noninvasively predicting the targets of ablation of lethal arrhythmia, ventricular tachycardia (VT), using patient-specific models. The approach has been successfully applied to patients with ischemic cardiomyopathy in proof-of-concept studies. The goal of this paper is to review the strategies for computational VT ablation guidance in ischemic cardiomyopathy patients, from model developments to the intricacies of the actual clinical application. To provide context in describing the road these computational modeling applications have undertaken, we first review the state of the art in VT ablation in the clinic, emphasizing the benefits that personalized computational prediction of ablation targets could bring to the clinical electrophysiology practice. This article is characterized under: Analytical and Computational Methods > Computational Methods Models of Systems Properties and Processes > Organ, Tissue, and Physiological Models Translational, Genomic, and Systems Medicine > Translational Medicine.
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Affiliation(s)
- Natalia A Trayanova
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland.,Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Ashish N Doshi
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland
| | - Adityo Prakosa
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland
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Chang S, Tzou WS. Advances in Technologies to Improve Ventricular Ablation Safety and Efficacy. CURRENT CARDIOVASCULAR RISK REPORTS 2019. [DOI: 10.1007/s12170-019-0628-7] [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]
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Kheiri B, Barbarawi M, Zayed Y, Hicks M, Osman M, Rashdan L, Kyi HH, Bachuwa G, Hassan M, Stecker EC, Nazer B, Bhatt DL. Antiarrhythmic Drugs or Catheter Ablation in the Management of Ventricular Tachyarrhythmias in Patients With Implantable Cardioverter-Defibrillators: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Circ Arrhythm Electrophysiol 2019; 12:e007600. [PMID: 31698933 DOI: 10.1161/circep.119.007600] [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: 12/31/2022]
Abstract
BACKGROUND In patients with an implantable cardioverter-defibrillator (ICD), shocks are associated with increased morbidity and mortality. Therefore, we conducted this study to evaluate the efficacy and safety of antiarrhythmic drugs and catheter ablation (CA) in the treatment of ventricular tachyarrhythmias (VT) in patients with an ICD. METHODS An electronic database search for randomized controlled trials that evaluated antiarrhythmic drugs and CA in patients with ICD was conducted. The primary outcome was recurrent VT. Secondary outcomes were ICD shocks and any deaths. Bayesian and frequentist network meta-analyses were performed to calculate hazard ratios (HRs) and 95% credible intervals (CrIs)/CIs. RESULTS Twenty-two randomized controlled trials were identified (3828 total patients; age 64.3±11.4; 79% males). The use of amiodarone was associated with a significantly reduced rate of VT recurrence compared with control (HR=0.34 [95% CrI=0.15-0.74]; absolute risk difference=-0.23 [95% CrI=-0.23 to -0.09]; number needed to treat=4). Sotalol was associated with increased risk of VT recurrence compared with amiodarone (HR=2.88 [95% CrI=1.35-6.46]). Compared with control, amiodarone (HR=0.33 [95% CrI=0.15-0.76]; absolute risk difference=-0.17 [95% CrI=-0.32 to -0.06]; number needed to treat=6) and CA (HR=0.52 [95% CrI=0.30-0.89; absolute risk difference=-0.12 [95% CrI=-0.24 to -0.03]; number needed to treat=8) were associated with significantly reduced ICD shocks. Compared with amiodarone, sotalol was associated with significantly increased ICD shocks (HR=2.70 [95% CrI=1.17-6.71]). The rate of death was not significantly different between the competing strategies. The node-splitting method showed no inconsistency. CONCLUSIONS Among patients with an ICD, amiodarone significantly reduced VT recurrence and ICD shocks, while CA reduced ICD shocks. Sotalol significantly increased VT recurrence and ICD shocks compared with amiodarone. The long-term side effects of amiodarone and early complications of CA should be weighed carefully according to specific patient characteristics.
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Affiliation(s)
- Babikir Kheiri
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR (B.K., E.C.S., B.N.)
| | - Mahmoud Barbarawi
- Department of Internal Medicine (M.B., Y.Z., L.R., H.H.K., G.B.), Hurley Medical Center/Michigan State University, Flint
| | - Yazan Zayed
- Department of Internal Medicine (M.B., Y.Z., L.R., H.H.K., G.B.), Hurley Medical Center/Michigan State University, Flint
| | - Michael Hicks
- Michigan Medicine, University of Michigan, Ann Arbor (M. Hicks)
| | - Mohammed Osman
- Division of Cardiology, West Virginia University School of Medicine, Morgantown (M.O.)
| | - Laith Rashdan
- Department of Internal Medicine (M.B., Y.Z., L.R., H.H.K., G.B.), Hurley Medical Center/Michigan State University, Flint
| | - Htay Htay Kyi
- Department of Internal Medicine (M.B., Y.Z., L.R., H.H.K., G.B.), Hurley Medical Center/Michigan State University, Flint
| | - Ghassan Bachuwa
- Department of Internal Medicine (M.B., Y.Z., L.R., H.H.K., G.B.), Hurley Medical Center/Michigan State University, Flint
| | - Mustafa Hassan
- Division of Cardiology (M. Hassan), Hurley Medical Center/Michigan State University, Flint
| | - Eric C Stecker
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR (B.K., E.C.S., B.N.)
| | - Babak Nazer
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR (B.K., E.C.S., B.N.)
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
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Stereotactic body radiotherapy for ventricular tachycardia (cardiac radiosurgery). Strahlenther Onkol 2019; 196:23-30. [DOI: 10.1007/s00066-019-01530-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 10/09/2019] [Indexed: 11/26/2022]
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Robinson CG, Samson PP, Moore KMS, Hugo GD, Knutson N, Mutic S, Goddu SM, Lang A, Cooper DH, Faddis M, Noheria A, Smith TW, Woodard PK, Gropler RJ, Hallahan DE, Rudy Y, Cuculich PS. Phase I/II Trial of Electrophysiology-Guided Noninvasive Cardiac Radioablation for Ventricular Tachycardia. Circulation 2019; 139:313-321. [PMID: 30586734 DOI: 10.1161/circulationaha.118.038261] [Citation(s) in RCA: 269] [Impact Index Per Article: 53.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Case studies have suggested the efficacy of catheter-free, electrophysiology-guided noninvasive cardiac radioablation for ventricular tachycardia (VT) using stereotactic body radiation therapy, although prospective data are lacking. METHODS We conducted a prospective phase I/II trial of noninvasive cardiac radioablation in adults with treatment-refractory episodes of VT or cardiomyopathy related to premature ventricular contractions (PVCs). Arrhythmogenic scar regions were targeted by combining noninvasive anatomic and electric cardiac imaging with a standard stereotactic body radiation therapy workflow followed by delivery of a single fraction of 25 Gy to the target. The primary safety end point was treatment-related serious adverse events in the first 90 days. The primary efficacy end point was any reduction in VT episodes (tracked by indwelling implantable cardioverter defibrillators) or any reduction in PVC burden (as measured by a 24-hour Holter monitor) comparing the 6 months before and after treatment (with a 6-week blanking window after treatment). Health-related quality of life was assessed using the Short Form-36 questionnaire. RESULTS Nineteen patients were enrolled (17 for VT, 2 for PVC cardiomyopathy). Median noninvasive ablation time was 15.3 minutes (range, 5.4-32.3). In the first 90 days, 2/19 patients (10.5%) developed a treatment-related serious adverse event. The median number of VT episodes was reduced from 119 (range, 4-292) to 3 (range, 0-31; P<0.001). Reduction was observed for both implantable cardioverter defibrillator shocks and antitachycardia pacing. VT episodes or PVC burden were reduced in 17/18 evaluable patients (94%). The frequency of VT episodes or PVC burden was reduced by 75% in 89% of patients. Overall survival was 89% at 6 months and 72% at 12 months. Use of dual antiarrhythmic medications decreased from 59% to 12% ( P=0.008). Quality of life improved in 5 of 9 Short Form-36 domains at 6 months. CONCLUSIONS Noninvasive electrophysiology-guided cardiac radioablation is associated with markedly reduced ventricular arrhythmia burden with modest short-term risks, reduction in antiarrhythmic drug use, and improvement in quality of life. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov/ . Unique identifier: NCT02919618.
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Affiliation(s)
- Clifford G Robinson
- Department of Radiation Oncology (C.G.R., P.P.S., G.D.H., N.K., S.M., S.M.G., D.E.H.), Washington University, St Louis, MO
| | - Pamela P Samson
- Department of Radiation Oncology (C.G.R., P.P.S., G.D.H., N.K., S.M., S.M.G., D.E.H.), Washington University, St Louis, MO
| | - Kaitlin M S Moore
- Department of Internal Medicine, Cardiovascular Division (K.M.S.M., D.H.C., M.F., A.N., T.W.S., P.S.C.), Washington University, St Louis, MO
| | - Geoffrey D Hugo
- Department of Radiation Oncology (C.G.R., P.P.S., G.D.H., N.K., S.M., S.M.G., D.E.H.), Washington University, St Louis, MO
| | - Nels Knutson
- Department of Radiation Oncology (C.G.R., P.P.S., G.D.H., N.K., S.M., S.M.G., D.E.H.), Washington University, St Louis, MO
| | - Sasa Mutic
- Department of Radiation Oncology (C.G.R., P.P.S., G.D.H., N.K., S.M., S.M.G., D.E.H.), Washington University, St Louis, MO
| | - S Murty Goddu
- Department of Radiation Oncology (C.G.R., P.P.S., G.D.H., N.K., S.M., S.M.G., D.E.H.), Washington University, St Louis, MO
| | - Adam Lang
- Department of Pathology (A.L.), Washington University, St Louis, MO
| | - Daniel H Cooper
- Department of Internal Medicine, Cardiovascular Division (K.M.S.M., D.H.C., M.F., A.N., T.W.S., P.S.C.), Washington University, St Louis, MO
| | - Mitchell Faddis
- Department of Internal Medicine, Cardiovascular Division (K.M.S.M., D.H.C., M.F., A.N., T.W.S., P.S.C.), Washington University, St Louis, MO
| | - Amit Noheria
- Department of Internal Medicine, Cardiovascular Division (K.M.S.M., D.H.C., M.F., A.N., T.W.S., P.S.C.), Washington University, St Louis, MO
| | - Timothy W Smith
- Department of Internal Medicine, Cardiovascular Division (K.M.S.M., D.H.C., M.F., A.N., T.W.S., P.S.C.), Washington University, St Louis, MO
| | - Pamela K Woodard
- Mallinckrodt Institute of Radiology (P.K.W., R.J.G.), Washington University, St Louis, MO
| | - Robert J Gropler
- Mallinckrodt Institute of Radiology (P.K.W., R.J.G.), Washington University, St Louis, MO
| | - Dennis E Hallahan
- Department of Radiation Oncology (C.G.R., P.P.S., G.D.H., N.K., S.M., S.M.G., D.E.H.), Washington University, St Louis, MO
| | - Yoram Rudy
- Departments of Biomedical Engineering, Cell Biology and Physiology, Medicine, Radiology, and Pediatrics (Y.R.), Washington University, St Louis, MO
| | - Phillip S Cuculich
- Department of Internal Medicine, Cardiovascular Division (K.M.S.M., D.H.C., M.F., A.N., T.W.S., P.S.C.), Washington University, St Louis, MO
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Lv W, Lee K, Arai T, Barrett CD, Hasan MM, Hayward AM, Marini RP, Barley ME, Galea A, Hirschman G, Armoundas AA, Cohen RJ. Accuracy of cardiac ablation catheter guidance by means of a single equivalent moving dipole inverse algorithm to identify sites of origin of cardiac electrical activation. J Interv Card Electrophysiol 2019; 58:323-331. [DOI: 10.1007/s10840-019-00605-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 08/02/2019] [Indexed: 12/19/2022]
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Chang S, Marzec L, Kay J, Khanna A, Sauer WH, Nguyen DT. VT arising from sub‐aortic muscular outflow tract structures: In two patients with ventricular septal defects. Pacing Clin Electrophysiol 2019; 42:1155-1157. [DOI: 10.1111/pace.13688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 03/31/2019] [Accepted: 04/02/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Shu Chang
- Electrophysiology Section, Division of CardiologyUniversity of Colorado Denver Colorado
| | - Lucas Marzec
- Electrophysiology Section, Division of CardiologyUniversity of Colorado Denver Colorado
| | - Joseph Kay
- Electrophysiology Section, Division of CardiologyUniversity of Colorado Denver Colorado
| | - Amber Khanna
- Electrophysiology Section, Division of CardiologyUniversity of Colorado Denver Colorado
| | - William H. Sauer
- Electrophysiology Section, Division of CardiologyUniversity of Colorado Denver Colorado
| | - Duy T. Nguyen
- Electrophysiology Section, Division of CardiologyUniversity of Colorado Denver Colorado
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Markman TM, Nazarian S. Treatment of ventricular arrhythmias: What's New? Trends Cardiovasc Med 2019; 29:249-261. [DOI: 10.1016/j.tcm.2018.09.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 09/19/2018] [Accepted: 09/19/2018] [Indexed: 12/17/2022]
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Di Monaco A, Quadrini F, Troisi F, Vitulano N, Caruso R, Duni N, Cecere G, Guida P, Langialonga T, Grimaldi M. Cardiopulmonary support in patients undergoing catheter ablation of poorly tolerated ventricular arrhythmias and electrical storm. J Cardiovasc Electrophysiol 2019; 30:1281-1286. [DOI: 10.1111/jce.13995] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/02/2019] [Accepted: 05/12/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Antonio Di Monaco
- Dipartimento di Cardiologia, Ospedale Generale Regionale “F. MiulliAcquaviva delle Fonti Bari Italy
| | - Federico Quadrini
- Dipartimento di Cardiologia, Ospedale Generale Regionale “F. MiulliAcquaviva delle Fonti Bari Italy
| | - Federica Troisi
- Dipartimento di Cardiologia, Ospedale Generale Regionale “F. MiulliAcquaviva delle Fonti Bari Italy
| | - Nicola Vitulano
- Dipartimento di Cardiologia, Ospedale Generale Regionale “F. MiulliAcquaviva delle Fonti Bari Italy
| | - Rosa Caruso
- Dipartimento di Cardiologia, Ospedale Generale Regionale “F. MiulliAcquaviva delle Fonti Bari Italy
| | - Nicola Duni
- Dipartimento di Cardiologia, Ospedale Generale Regionale “F. MiulliAcquaviva delle Fonti Bari Italy
| | - Giacomo Cecere
- Dipartimento di Cardiologia, Ospedale Generale Regionale “F. MiulliAcquaviva delle Fonti Bari Italy
| | - Piero Guida
- Dipartimento di Cardiologia, Ospedale Generale Regionale “F. MiulliAcquaviva delle Fonti Bari Italy
| | - Tommaso Langialonga
- Dipartimento di Cardiologia, Ospedale Generale Regionale “F. MiulliAcquaviva delle Fonti Bari Italy
| | - Massimo Grimaldi
- Dipartimento di Cardiologia, Ospedale Generale Regionale “F. MiulliAcquaviva delle Fonti Bari Italy
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Dang S, Jons C, Jacobsen PK, Pehrson S, Chen X. Feasibility of a novel mapping system combined with remote magnetic navigation for catheter ablation of premature ventricular contractions. J Arrhythm 2019; 35:244-251. [PMID: 31007789 PMCID: PMC6457387 DOI: 10.1002/joa3.12157] [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] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/10/2018] [Accepted: 12/20/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Remote magnetic navigation (RMN) is often used in combination with a 3-dimensional mapping system to perform catheter ablations. This study aim to investigate the feasibility and effectiveness of a novel 3D-mapping system, EnSite Precision, combined with RMN for catheter ablation of premature ventricular contractions (PVCs), and compared it to the procedures performed by CARTO3 with RMN. METHODS Forty-three consecutive PVC patients were either ablated with the guidance of EnSite Precision (n = 22) or CARTO (n = 21) navigated by RMN. Procedure-related details, acute and long-term success were assessed. RESULTS Patient characteristics between both the groups were similar (age: 47.1 ± 19.8 vs 47.1 ± 12.7, female: 63.6% vs 57.1%). No significant difference was found in the procedure time (99.5 ± 30.4 vs 92.9 ± 24.8 min, P = 0.436), mapping time (18.6 ± 12.8 vs 15.5 ± 10.2 min, P = 0.390), radiofrequency ablation time (333.4 ± 267.0 vs 469.3 ± 343.1 s, P = 0.154), fluoroscopy time (4.0 ± 1.9 vs 3.8 ± 2.0 min, P = 0.635), and X-ray dose (1.8 ± 1.4 vs 2.0 ± 1.2 Gycm2, P = 0.649) between the two groups. No significant procedural complication occurred in either group. In addition, there was no significant differences regarding the acute success rate (90.9% vs 90.5%, P = 0.961) and long-term success rate (86.4% vs 81.0%, P = 0.631) after 16.2 ± 6.2 months of follow-up between the two groups. CONCLUSIONS RMN combined with EnSite Precision mapping system is effective and safe for catheter ablation of PVCs.
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Affiliation(s)
- Shipeng Dang
- Department of CardiologyThe Heart CentreRigshospitaletCopenhagen University HospitalCopenhagenDenmark
- Department of CardiologyThe Affiliated Wuxi People's Hospital of Nanjing Medical UniversityWuxiChina
| | - Christian Jons
- Department of CardiologyThe Heart CentreRigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Peter Karl Jacobsen
- Department of CardiologyThe Heart CentreRigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Steen Pehrson
- Department of CardiologyThe Heart CentreRigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Xu Chen
- Department of CardiologyThe Heart CentreRigshospitaletCopenhagen University HospitalCopenhagenDenmark
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