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Rajagopalan B, Lakkireddy D, Al-Ahmad A, Chrispin J, Cohen M, Di Biase L, Gopinathannair R, Nasr V, Navara R, Patel P, Santangeli P, Shah R, Sotomonte J, Sridhar A, Tzou W, Cheung JW. Management of Anesthesia for Procedures in the Cardiac Electrophysiology Laboratory. Heart Rhythm 2024:S1547-5271(24)02822-4. [PMID: 38942104 DOI: 10.1016/j.hrthm.2024.06.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 06/16/2024] [Accepted: 06/23/2024] [Indexed: 06/30/2024]
Abstract
The complexity of cardiac electrophysiology procedures has increased significantly over the past three decades. Anesthesia requirements of these procedures can be different based on patient- and procedure-specific factors. This manuscript outlines various anesthesia strategies for cardiac implantable electronic devices and electrophysiology procedures including pre-procedural, procedural and post-procedural management. A team-based approach with collaboration between cardiac electrophysiologists and anesthesiologists is required with careful pre-procedural and intra-procedural planning. Given the recent advances in electrophysiology, there is a need for specialized cardiac electrophysiology anesthesia care to improve the efficacy and safety of the procedures.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Parin Patel
- Ascension St. Vincent's Hospital, Indianapolis, IN
| | | | - Ronak Shah
- University of Pennsylvania, Philadelphia, PA
| | | | | | | | - Jim W Cheung
- Weill Cornell Medicine - New York Presbyterian, New York, NY
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2
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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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Zhao L, Li R, Bai L, Zhang J, Lu J, Yang X, Liu D, Cui W. Lead I R-wave indexes: A novel electrocardiographic criterion for distinguishing the origin of idiopathic premature ventricular contractions from the three subregions of the aortic sinus cusps. J Electrocardiol 2023; 81:176-185. [PMID: 37741272 DOI: 10.1016/j.jelectrocard.2023.09.005] [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: 06/15/2023] [Revised: 08/15/2023] [Accepted: 09/11/2023] [Indexed: 09/25/2023]
Abstract
PURPOSE The current study was conducted to investigate the electrocardiographic (ECG) characteristics of idiopathic premature ventricular contractions (PVCs) originating from the aortic sinus cusp (ASC) and establish a novel ECG criterion to discriminate PVCs originating from the right coronary cusp (RCC), left coronary cusp (LCC), and the left and right coronary cusp junction (LRJ). METHODS A retrospective analysis was performed on a total of 133 patients with idiopathic PVCs who underwent successful mapping and ablation. The sites of origin (SOO) were confirmed using fluoroscopy and a three-dimensional mapping system during radiofrequency catheter ablation (RFCA). Among the patients, 69 had PVCs originating from the LCC, 39 from the RCC, and 25 from the LRJ. Characteristics of surface 12‑lead electrocardiograms (ECGs) recorded during PVCs were analyzed. Q-, R-, S, and R'-wave amplitudes were measured in lead I, and the lead I R-wave indexes (IRa, IRb, IRc, IRd, and IRe) were derived by employing multiplication, subtraction, sum, and division operations on these ECG measurements. Notably, IRb and IRe demonstrated usefulness as ECG indexes for discriminating PVCs originating from RCC, LCC, and LRJ in the ASC. RESULTS The R- and S-wave amplitudes in lead I exhibited statistically significant differences among the three groups (P < 0.001 and P < 0.001, respectively). In discriminating PVCs originating from the RCC from the other two groups, IRb showed the largest area under the curve (AUC) of 0.813, as assessed by receiver operating characteristic (ROC) analysis, with a cutoff value of ≤0.5 indicating PVCs of RCC origin. The sensitivity and specificity were 80.3% and 78.7%, respectively. For discriminating PVCs arising from the LCC from those in the LRJ group, IRe exhibited the largest AUC of 0.801, with an optimal cutoff value of 0. An IRe value >0 indicated PVCs originating from the LRJ, while an IRe value ≤0 indicated PVCs originating from the LCC. The sensitivity and specificity of the IRe index were 84.0% and 70.7%, respectively. CONCLUSION Lead I R-wave indexes provided simple and useful ECG criteria for discriminating PVCs originating from the LCC, RCC, and LRJ in the left ventricular outflow tract (LVOT).
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Affiliation(s)
- Lei Zhao
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Ruibin Li
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Long Bai
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jidong Zhang
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jingchao Lu
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xiaohong Yang
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Demin Liu
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Wei Cui
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
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Yoshida Y, Jin Z, Nakanishi K, Matsumoto K, Homma S, Mannina C, Shames S, Elkind MSV, Rundek T, Di Tullio MR. Subclinical Left Ventricular Dysfunction and Ventricular Arrhythmias in Older Adults With Normal Ejection Fraction. J Am Heart Assoc 2023; 12:e030274. [PMID: 37577940 PMCID: PMC10492955 DOI: 10.1161/jaha.123.030274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/18/2023] [Indexed: 08/15/2023]
Abstract
Background Premature ventricular contractions (PVCs) and nonsustained ventricular tachycardia (NSVT) are known to be associated with reduced left ventricular (LV) ejection fraction and adverse outcomes in patients with structural heart disease. The relationship between subclinical LV dysfunction and ventricular arrhythmias in the general population is not established. Methods and Results Participants in the SAFARIS (Subclinical Atrial Fibrillation and Risk of Ischemic Stroke) study with normal left ventricular ejection fraction (n=503; mean age 77 years, 63% women) underwent 14-day electrocardiographic monitoring and 2-dimensional echocardiography. Frequent PVCs were defined as PVCs >500 per 24 hours and NSVT as ≥4 consecutive ventricular ectopic beats. Reduced LV global longitudinal strain (GLS) was used as an indicator of subclinical LV dysfunction. Seventy-six participants (15.1%) had PVCs >500/d, 117 (23.3%) had NSVT episodes. LV GLS was significantly reduced in both frequent PVCs and NSVT groups (P<0.01). In multivariable analyses, lower LV GLS was associated with frequent PVCs (adjusted odds ratio [aOR], 1.19 [95% CI, 1.09-1.30 per unit reduction]; P<0.001) and NSVT (aOR, 1.09 [95% CI, 1.01-1.17]; P=0.036) independently of established risk factors and other echocardiographic parameters. Abnormal LV GLS (>-15.8%) carried a 2-fold increase in risk of ventricular arrhythmias (aOR, 2.18, P=0.029 for PVCs; aOR, 2.09, P=0.026 for NSVT). Conclusions PVCs and NSVT episodes were frequent in this community-based elderly cohort with normal left ventricular ejection fraction and were independently associated with lower LV GLS. The association between LV dysfunction and ventricular arrhythmias is present at an early, subclinical stage, an observation that carries possible preventative implications.
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Affiliation(s)
| | - Zhezhen Jin
- Department of BiostatisticsColumbia UniversityNew YorkNY
| | - Koki Nakanishi
- Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
| | | | | | | | - Sofia Shames
- Department of MedicineColumbia UniversityNew YorkNY
| | - Mitchell S. V. Elkind
- Department of Neurology, Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNY
- Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew YorkNY
| | - Tatjana Rundek
- Department of Neurology, Evelyn F. McKnight Brain Institute, Miller School of MedicineUniversity of MiamiFL
- Department of Public Health SciencesUniversity of MiamiFL
- Clinical and Translational Science Institute, Miller School of MedicineUniversity of MiamiFL
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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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Hwang J, Oh YS, Park HS, Choi JI, Lee YS, Choi EK, Shin DG, On YK, Kim TH, Park HW, Cho MS, Bae MH, Han S. Comparing the Efficacy of Carvedilol and Flecainide on the Treatment of Idiopathic Premature Ventricular Complexes from Ventricular Outflow Tract: A Multicenter, Randomized, Open-Label Pilot Study. J Clin Med 2023; 12:jcm12082887. [PMID: 37109225 PMCID: PMC10144596 DOI: 10.3390/jcm12082887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/10/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
The mechanism of premature ventricular complexes (PVC) occurring in the ventricular outflow tract (OT) is related to an intracellular calcium overload and delayed afterdepolarizations that lead to triggered activity. The guidelines recommend using beta-blockers and flecainide for idiopathic PVCs, but they also acknowledge the limited evidence supporting this recommendation. We conducted a multicenter, randomized, open-label pilot study comparing the effect of carvedilol and flecainide on OT PVC, which are widely used to treat this arrhythmia. Patients with a 24 h Holter recording a PVC burden ≥ 5%, which showed positive R waves in leads II, III, and aVF, and without structural heart disease were enrolled. They were randomly assigned to the carvedilol or flecainide group, and the maximum tolerated dose was administered for 12 weeks. A total of 103 participants completed the protocol: 51 with carvedilol and 52 with flecainide. After 12 weeks of treatment, the mean PVC burden significantly decreased in both groups: 20.3 ± 11.5 to 14.6 ± 10.8% with carvedilol (p < 0.0001) and 17.1 ± 9.9 to 6.6 ± 9.9% with flecainide (p < 0.0001). Both carvedilol and flecainide effectively suppressed OT PVCs in patients without structural heart disease, with flecainide showing a superior efficacy compared to carvedilol.
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Affiliation(s)
- Jongmin Hwang
- Cardiovascular Center, Keimyung University Dongsan Hospital, Daegu 42601, Republic of Korea
| | - Yong-Seog Oh
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Hyoung-Seob Park
- Cardiovascular Center, Keimyung University Dongsan Hospital, Daegu 42601, Republic of Korea
| | - Jong-Il Choi
- Arrhythmia Center, Korea University Medical Center Anam Hospital, Seoul 02841, Republic of Korea
| | - Young Soo Lee
- Department of Cardiology, Catholic University of Daegu, Daegu 42472, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Dong-Gu Shin
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu 42415, Republic of Korea
| | - Young Keun On
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Hyung Wook Park
- Department of Cardiology, Chonnam National University Hospital, Gwangju 61469, Republic of Korea
| | - Min Soo Cho
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea
| | - Myung Hwan Bae
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu 41944, Republic of Korea
| | - Seongwook Han
- Cardiovascular Center, Keimyung University Dongsan Hospital, Daegu 42601, Republic of Korea
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Abstract
The global burden caused by cardiovascular disease is substantial, with heart disease representing the most common cause of death around the world. There remains a need to develop better mechanistic models of cardiac function in order to combat this health concern. Heart rhythm disorders, or arrhythmias, are one particular type of disease which has been amenable to quantitative investigation. Here we review the application of quantitative methodologies to explore dynamical questions pertaining to arrhythmias. We begin by describing single-cell models of cardiac myocytes, from which two and three dimensional models can be constructed. Special focus is placed on results relating to pattern formation across these spatially-distributed systems, especially the formation of spiral waves of activation. Next, we discuss mechanisms which can lead to the initiation of arrhythmias, focusing on the dynamical state of spatially discordant alternans, and outline proposed mechanisms perpetuating arrhythmias such as fibrillation. We then review experimental and clinical results related to the spatio-temporal mapping of heart rhythm disorders. Finally, we describe treatment options for heart rhythm disorders and demonstrate how statistical physics tools can provide insights into the dynamics of heart rhythm disorders.
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Affiliation(s)
- Wouter-Jan Rappel
- Department of Physics, University of California San Diego, La Jolla, CA 92037
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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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Conte E, Carbucicchio C, Catto V, Kochi AN, Mushtaq S, De Iuliis PG, Guglielmo M, Baggiano A, Sattin T, Pontone G, Pepi M, Tondo C, Andreini D. Live integration of comprehensive cardiac CT with electroanatomical mapping in patients with refractory ventricular tachycardia. J Cardiovasc Comput Tomogr 2021; 16:262-265. [PMID: 34991995 DOI: 10.1016/j.jcct.2021.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/13/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Aim of the present study was to verify the feasibility and accuracy of live integration of myocardial fibrosis evaluated at CCT with EAM (electro-anatomical mapping). METHODS We prospectively enrolled a consecutive cohort of patients with clinical indication to EAM before radiofrequency catheter ablation (RFCA) of refractory ventricular tachycardia (VT) and an absolute contraindication to cardiac magnetic resonance. All patients underwent per protocol CCT for myocardial fibrosis and coronary anatomy evaluation. Diagnostic performance was assessed for myocardial fibrosis evaluation with CCT vs EAM. Live integration feasibility of CCT vs EAM was evaluated for every patients. RESULTS A total of 19 patients were included in the present study with 323 myocardial segments analyzed for myocardial fibrosis at CCT. In all patients CCT data were successfully integrated with EAM during RFCA procedure. All patients had myocardial fibrosis correctly identified at CCT vs EAM on a per-patients basis. A diagnostic accuracy on a per-segment basis of 94.1% for detection of any type of myocardial fibrosis at CCT vs EAM was recorded. CONCLUSIONS CCT identification of myocardial fibrosis is feasible and accurate vs EAM in a very selected high risk patients with clinical indication to RFCA of VT and contraindication to CMR.
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Affiliation(s)
- Edoardo Conte
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | | | | | | | | | | | - Andrea Baggiano
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | | | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Claudio Tondo
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy.
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10
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Creta A, Earley MJ, Schilling RJ, Finlay M, Sporton S, Dhinoja M, Hunter RJ, Papageorgiou N, Ang R, Chow A, Lowe M, Segal OR, Lambiase PD, Providência R. Ethanol Ablation for Ventricular Arrhythmias: A Systematic Review and Meta-analysis. J Cardiovasc Electrophysiol 2021; 33:510-526. [PMID: 34921464 DOI: 10.1111/jce.15336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 10/11/2021] [Accepted: 11/18/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Ethanol ablation (EA) is as an alternative option for subjects with ventricular arrhythmias (VAs) refractory to conventional medical and ablative treatment. However, data on efficacy and safety of EA remain sparse. METHODS A systematic literature search was conducted. The primary outcomes were 1) freedom from the targeted VA and 2) freedom from any VAs post EA. Additional safety outcomes were also analysed. RESULTS Ten studies were selected accounting for a population of 174 patients (62.3±12.5 years, 94% male) undergoing 185 procedures. The overall acute success rate of EA was 72.4% (CI95% 65.6-78.4). After a mean follow-up of 11.3±5.5 months, the incidence of relapse of the targeted VA was 24.4% (CI95% 17.1-32.8), while any VAs post EA occurred in 41.3% (CI95% 33.7-49.1). The overall incidence of procedural complications was 14.1% (CI95% 9.8-19.8), with pericardial complications and complete atrioventricular block being the most frequent. An anterograde transarterial approach was associated with a higher rate of VA recurrences and complications compared to a retrograde transvenous route; however, differences in the baseline population characteristics and in the targeted ventricular areas should be accounted. CONCLUSION EA is a valuable therapeutic option for VAs refractory to conventional treatment and can result in 1-year freedom from VA recurrence in 60 to 75% of the patients. However, anatomical or technical challenges preclude acute success in almost 30% of the candidates and the rate of complication is not insignificant, highlighting the importance of well-informed patient selection. The certainty of the evidence is low, and further research is necessary. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Antonio Creta
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Mark J Earley
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | | | - Malcolm Finlay
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Simon Sporton
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Mehul Dhinoja
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Ross J Hunter
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | | | - Richard Ang
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Anthony Chow
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Martin Lowe
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Oliver R Segal
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Pier D Lambiase
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom.,Institute of Cardiovascular Science, University College of London, London, UK
| | - Rui Providência
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom.,Institute of Health Informatics Research, University College of London, London, UK
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11
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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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12
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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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13
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Guckel D, Niemann S, Ditzhaus M, Molatta S, Bergau L, Fink T, Sciacca V, El Hamriti M, Imnadze G, Steinhauer P, Braun M, Khalaph M, Nölker G, Sommer P, Sohns C. Long-Term Efficacy and Impact on Mortality of Remote Magnetic Navigation Guided Catheter Ablation of Ventricular Arrhythmias. J Clin Med 2021; 10:jcm10204695. [PMID: 34682822 PMCID: PMC8540658 DOI: 10.3390/jcm10204695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/06/2021] [Accepted: 10/11/2021] [Indexed: 01/01/2023] Open
Abstract
Remote magnetic navigation (RMN) facilitates ventricular arrhythmia (VA) ablation. This study aimed to evaluate the long-term efficacy of RMN-guided ablation for ventricular tachycardia (VT) and premature ventricular contractions (PVC). A total of 176 consecutive patients (mean age 53.23 ± 17.55 years, 37% female) underwent VA ablation for PVC (132 patients, 75%) or VT (44 patients, 25%). The cohort consisted of 119 patients (68%) with idiopathic VA, 31 (18%) with ischemic (ICM), and 26 (15%) with dilated cardiomyopathy (DCM). VA recurrence was observed in 69 patients (39%, mean age 51.71 ± 19.91 years, 23% female) during a follow-up period of 5.48 years (first quartile 770.50 days, second quartile 1101.50 days, third quartile 1615.50 days). Left ventricular ejection fraction <40% lead to a significantly increased risk for VA (p = 0.031*). Multivariate analyses found DCM to be an independent predictor (IP) for VA recurrence (p < 0.001*, hazard ratio (HR) 3.74, confidence interval (CI) 1.58-8.88). ICM resulted in a lower increase in VA recurrence (p = 0.221, HR 1.49, CI 0.79-2.81). Class I/III/IV antiarrhythmic drug therapy (AADs) was also identified as IP for recurrence (p = 0.030*, HR 2.48, CI 1.11-5.68). A total of 16 patients (9%) died within the observational period. RMN-guided ablation of VA lead to acceptable long-term results. An impaired LV function, DCM, and AADs were associated with a significant risk for VA recurrence. Personalized paths are needed to improve efficacy and outcome.
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Affiliation(s)
- Denise Guckel
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany; (D.G.); (S.N.); (S.M.); (L.B.); (T.F.); (V.S.); (M.E.H.); (G.I.); (M.B.); (M.K.); (G.N.); (P.S.)
| | - Sarah Niemann
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany; (D.G.); (S.N.); (S.M.); (L.B.); (T.F.); (V.S.); (M.E.H.); (G.I.); (M.B.); (M.K.); (G.N.); (P.S.)
| | - Marc Ditzhaus
- Fakultät Statistik, Technische Universität Dortmund, 44227 Dortmund, Germany; (M.D.); (P.S.)
| | - Stephan Molatta
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany; (D.G.); (S.N.); (S.M.); (L.B.); (T.F.); (V.S.); (M.E.H.); (G.I.); (M.B.); (M.K.); (G.N.); (P.S.)
| | - Leonard Bergau
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany; (D.G.); (S.N.); (S.M.); (L.B.); (T.F.); (V.S.); (M.E.H.); (G.I.); (M.B.); (M.K.); (G.N.); (P.S.)
| | - Thomas Fink
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany; (D.G.); (S.N.); (S.M.); (L.B.); (T.F.); (V.S.); (M.E.H.); (G.I.); (M.B.); (M.K.); (G.N.); (P.S.)
| | - Vanessa Sciacca
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany; (D.G.); (S.N.); (S.M.); (L.B.); (T.F.); (V.S.); (M.E.H.); (G.I.); (M.B.); (M.K.); (G.N.); (P.S.)
| | - Mustapha El Hamriti
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany; (D.G.); (S.N.); (S.M.); (L.B.); (T.F.); (V.S.); (M.E.H.); (G.I.); (M.B.); (M.K.); (G.N.); (P.S.)
| | - Guram Imnadze
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany; (D.G.); (S.N.); (S.M.); (L.B.); (T.F.); (V.S.); (M.E.H.); (G.I.); (M.B.); (M.K.); (G.N.); (P.S.)
| | - Philipp Steinhauer
- Fakultät Statistik, Technische Universität Dortmund, 44227 Dortmund, Germany; (M.D.); (P.S.)
| | - Martin Braun
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany; (D.G.); (S.N.); (S.M.); (L.B.); (T.F.); (V.S.); (M.E.H.); (G.I.); (M.B.); (M.K.); (G.N.); (P.S.)
| | - Moneeb Khalaph
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany; (D.G.); (S.N.); (S.M.); (L.B.); (T.F.); (V.S.); (M.E.H.); (G.I.); (M.B.); (M.K.); (G.N.); (P.S.)
| | - Georg Nölker
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany; (D.G.); (S.N.); (S.M.); (L.B.); (T.F.); (V.S.); (M.E.H.); (G.I.); (M.B.); (M.K.); (G.N.); (P.S.)
- Clinic for Internal Medicine II/Cardiology, Christliches Klinikum Unna Mitte, 59423 Unna, Germany
| | - Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany; (D.G.); (S.N.); (S.M.); (L.B.); (T.F.); (V.S.); (M.E.H.); (G.I.); (M.B.); (M.K.); (G.N.); (P.S.)
| | - Christian Sohns
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany; (D.G.); (S.N.); (S.M.); (L.B.); (T.F.); (V.S.); (M.E.H.); (G.I.); (M.B.); (M.K.); (G.N.); (P.S.)
- Correspondence:
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14
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Jimenez-Juan L, Ben-Dov N, Goncalves Frazao CV, Tan NS, Singh SM, Dorian P, Angaran P, Oikonomou A, Kha LCT, Roifman I, Chacko B, Connelly KA, Kirpalani A, Deva D, Yan AT. Right Ventricular Function at Cardiac MRI Predicts Cardiovascular Events in Patients with an Implantable Cardioverter-Defibrillator. Radiology 2021; 301:322-329. [PMID: 34402663 DOI: 10.1148/radiol.2021210246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Right ventricular ejection fraction (RVEF) is an independent predictor of death and adverse cardiovascular outcomes in patients with various cardiac conditions. Purpose To investigate whether RVEF, measured with cardiac MRI, is a predictor of appropriate shock or death in implantable cardioverter-defibrillator (ICD) recipients for primary and secondary prevention of sudden cardiac death. Materials and Methods This retrospective, multicenter, observational study included patients who underwent cardiac MRI before ICD implantation between January 2007 and May 2017. Right ventricular end-diastolic and end-systolic volumes and RVEF were measured with cardiac MRI. The primary end point was a composite of all-cause mortality or appropriate ICD shock. The secondary end point was all-cause mortality. The association between RVEF and primary and secondary outcomes was evaluated by using multivariable Cox regression analysis. Potential interactions were tested between primary prevention, ischemic cause, left ventricular ejection fraction (LVEF), and RVEF. Results Among 411 patients (mean age ± standard deviation, 60 years; 315 men) during a median follow-up of 63 months, 143 (35%) patients experienced an appropriate ICD shock or died. In univariable analysis, lower RVEF was associated with greater risks for appropriate ICD shock or death and for death alone (log-rank trend test, P = .003 and .005 respectively). In multivariable Cox regression analysis adjusting for age at ICD implantation, LVEF, ICD indication (primary vs secondary), ischemic heart disease, and late gadolinium enhancement, RVEF was an independent predictor of the primary outcome (hazard ratio [HR], 1.21 per 10% lower RVEF; 95% CI: 1.04, 1.41; P = .01) and all-cause mortality (HR, 1.25 per 10% lower RVEF; 95% CI: 1.01, 1.55; P = .04). No evidence of significant interactions was found between RVEF and primary or secondary prevention (HR, 1.11 ± 0.17 [standard deviation]; P = .49), ischemic heart disease (HR, 1.02 ± 0.15; P = .78), and LVEF (HR, 0.91 ± 0.8; P = .29). Conclusion Right ventricular ejection fraction measured with cardiac MRI was a predictor of appropriate implantable cardioverter-defibrillator shock or death. © RSNA, 2021 See also the editorial by Nazarian and Zghaib in this issue.
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Affiliation(s)
- Laura Jimenez-Juan
- From the Departments of Radiology (L.J.J., A.K., D.D.) and Cardiology (N.S.T., P.D., P.A., K.A.C., A.T.Y.), St Michael's Hospital, 30 Bond St, Toronto, ON, Canada M5B 1W8; and Departments of Radiology (C.V.G.F., A.O., L.C.T.K., B.C.) and Cardiology (N.B.D., S.M.S., I.R.), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Nissan Ben-Dov
- From the Departments of Radiology (L.J.J., A.K., D.D.) and Cardiology (N.S.T., P.D., P.A., K.A.C., A.T.Y.), St Michael's Hospital, 30 Bond St, Toronto, ON, Canada M5B 1W8; and Departments of Radiology (C.V.G.F., A.O., L.C.T.K., B.C.) and Cardiology (N.B.D., S.M.S., I.R.), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Caio V Goncalves Frazao
- From the Departments of Radiology (L.J.J., A.K., D.D.) and Cardiology (N.S.T., P.D., P.A., K.A.C., A.T.Y.), St Michael's Hospital, 30 Bond St, Toronto, ON, Canada M5B 1W8; and Departments of Radiology (C.V.G.F., A.O., L.C.T.K., B.C.) and Cardiology (N.B.D., S.M.S., I.R.), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Nigel S Tan
- From the Departments of Radiology (L.J.J., A.K., D.D.) and Cardiology (N.S.T., P.D., P.A., K.A.C., A.T.Y.), St Michael's Hospital, 30 Bond St, Toronto, ON, Canada M5B 1W8; and Departments of Radiology (C.V.G.F., A.O., L.C.T.K., B.C.) and Cardiology (N.B.D., S.M.S., I.R.), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Sheldon M Singh
- From the Departments of Radiology (L.J.J., A.K., D.D.) and Cardiology (N.S.T., P.D., P.A., K.A.C., A.T.Y.), St Michael's Hospital, 30 Bond St, Toronto, ON, Canada M5B 1W8; and Departments of Radiology (C.V.G.F., A.O., L.C.T.K., B.C.) and Cardiology (N.B.D., S.M.S., I.R.), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Paul Dorian
- From the Departments of Radiology (L.J.J., A.K., D.D.) and Cardiology (N.S.T., P.D., P.A., K.A.C., A.T.Y.), St Michael's Hospital, 30 Bond St, Toronto, ON, Canada M5B 1W8; and Departments of Radiology (C.V.G.F., A.O., L.C.T.K., B.C.) and Cardiology (N.B.D., S.M.S., I.R.), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Paul Angaran
- From the Departments of Radiology (L.J.J., A.K., D.D.) and Cardiology (N.S.T., P.D., P.A., K.A.C., A.T.Y.), St Michael's Hospital, 30 Bond St, Toronto, ON, Canada M5B 1W8; and Departments of Radiology (C.V.G.F., A.O., L.C.T.K., B.C.) and Cardiology (N.B.D., S.M.S., I.R.), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Anastasia Oikonomou
- From the Departments of Radiology (L.J.J., A.K., D.D.) and Cardiology (N.S.T., P.D., P.A., K.A.C., A.T.Y.), St Michael's Hospital, 30 Bond St, Toronto, ON, Canada M5B 1W8; and Departments of Radiology (C.V.G.F., A.O., L.C.T.K., B.C.) and Cardiology (N.B.D., S.M.S., I.R.), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Lan-Chau T Kha
- From the Departments of Radiology (L.J.J., A.K., D.D.) and Cardiology (N.S.T., P.D., P.A., K.A.C., A.T.Y.), St Michael's Hospital, 30 Bond St, Toronto, ON, Canada M5B 1W8; and Departments of Radiology (C.V.G.F., A.O., L.C.T.K., B.C.) and Cardiology (N.B.D., S.M.S., I.R.), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Idan Roifman
- From the Departments of Radiology (L.J.J., A.K., D.D.) and Cardiology (N.S.T., P.D., P.A., K.A.C., A.T.Y.), St Michael's Hospital, 30 Bond St, Toronto, ON, Canada M5B 1W8; and Departments of Radiology (C.V.G.F., A.O., L.C.T.K., B.C.) and Cardiology (N.B.D., S.M.S., I.R.), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Binita Chacko
- From the Departments of Radiology (L.J.J., A.K., D.D.) and Cardiology (N.S.T., P.D., P.A., K.A.C., A.T.Y.), St Michael's Hospital, 30 Bond St, Toronto, ON, Canada M5B 1W8; and Departments of Radiology (C.V.G.F., A.O., L.C.T.K., B.C.) and Cardiology (N.B.D., S.M.S., I.R.), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Kim A Connelly
- From the Departments of Radiology (L.J.J., A.K., D.D.) and Cardiology (N.S.T., P.D., P.A., K.A.C., A.T.Y.), St Michael's Hospital, 30 Bond St, Toronto, ON, Canada M5B 1W8; and Departments of Radiology (C.V.G.F., A.O., L.C.T.K., B.C.) and Cardiology (N.B.D., S.M.S., I.R.), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Anish Kirpalani
- From the Departments of Radiology (L.J.J., A.K., D.D.) and Cardiology (N.S.T., P.D., P.A., K.A.C., A.T.Y.), St Michael's Hospital, 30 Bond St, Toronto, ON, Canada M5B 1W8; and Departments of Radiology (C.V.G.F., A.O., L.C.T.K., B.C.) and Cardiology (N.B.D., S.M.S., I.R.), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Djeven Deva
- From the Departments of Radiology (L.J.J., A.K., D.D.) and Cardiology (N.S.T., P.D., P.A., K.A.C., A.T.Y.), St Michael's Hospital, 30 Bond St, Toronto, ON, Canada M5B 1W8; and Departments of Radiology (C.V.G.F., A.O., L.C.T.K., B.C.) and Cardiology (N.B.D., S.M.S., I.R.), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Andrew T Yan
- From the Departments of Radiology (L.J.J., A.K., D.D.) and Cardiology (N.S.T., P.D., P.A., K.A.C., A.T.Y.), St Michael's Hospital, 30 Bond St, Toronto, ON, Canada M5B 1W8; and Departments of Radiology (C.V.G.F., A.O., L.C.T.K., B.C.) and Cardiology (N.B.D., S.M.S., I.R.), Sunnybrook Health Sciences Centre, Toronto, Canada
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15
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Prognostic value of time dependent voltage abatement during remote magnetic navigation guided ablation in idiopathic right ventricular outflow tract arrhythmias. COR ET VASA 2021. [DOI: 10.33678/cor.2020.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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16
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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] [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 Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Lennart J Blom
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Peter Loh
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Rutger J Hassink
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
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17
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Wang J, Miao C, Yang G, Xu L, Xing R, Jia Y, Zhang R, Wang Y, Huang L, Liu S. Lead I R-wave amplitude to distinguish ventricular arrhythmias with lead V 3 transition originating from the left versus right ventricular outflow tract. Clin Cardiol 2020; 44:100-107. [PMID: 33300652 PMCID: PMC7803356 DOI: 10.1002/clc.23511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/02/2020] [Accepted: 11/02/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The electrophysiology algorithm for localizing left or right origins of outflow tract ventricular arrhythmias (OT-VAs) with lead V3 transition still needs further investigation in clinical practice. HYPOTHESIS Lead I R-wave amplitude is effective in distinguishing the left or right origin of OT-VAs with lead V3 transition. METHODS We measured lead I R-wave amplitude in 82 OT-VA patients with lead V3 transition and a positive complex in lead I who underwent successful catheter ablation from the right ventricular outflow tract (RVOT) and left ventricular outflow tract (LVOT). The optimal R-wave threshold was identified, compared with the V2 S/V3 R index, transitional zone (TZ) index, and V2 transition ratio, and validated in a prospective cohort study. RESULTS Lead I R-wave amplitude for LVOT origins was significantly higher than that for RVOT origins (0.55 ± 0.13 vs. 0.32 ± 0.15 mV; p < .001). The area under the curve (AUC) for lead I R-wave amplitude as assessed by receiver operating characteristic (ROC) analysis was 0.926, with a cutoff value of ≥0.45 predicting LVOT origin with 92.9% sensitivity and 88.2% specificity, superior to the V2 S/V3 R index, TZ index, and V2 transition ratio. VAs in the LVOT group mainly originated from the right coronary cusp (RCC) and left and right coronary cusp junction (L-RCC). In the prospective study, lead I R-wave amplitude identified the LVOT origin with 92.3% accuracy. CONCLUSION Lead I R-wave amplitude provides a useful and simple criterion to identify RCC or L-RCC origin in OT-VAs with lead V3 transition.
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Affiliation(s)
- Jue Wang
- Department of Cardiology, Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Chenglong Miao
- Department of Cardiology, Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Guangmin Yang
- Department of Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lu Xu
- Department of Cardiology, Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ru Xing
- Department of Cardiology, Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yan Jia
- Department of Cardiology, Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ruining Zhang
- Department of Cardiology, Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yanwei Wang
- Department of Cardiology, Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Liu Huang
- Department of Cardiology, Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Suyun Liu
- Department of Cardiology, Second Hospital of Hebei Medical University, Shijiazhuang, China
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18
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Prospective Multicenter Assessment of a New Intraprocedural Automated System for Localizing Idiopathic Ventricular Arrhythmia Origins. JACC Clin Electrophysiol 2020; 7:395-407. [PMID: 33736758 DOI: 10.1016/j.jacep.2020.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/31/2020] [Accepted: 09/06/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The objective of this study was to present a new system, the Automatic Arrhythmia Origin Localization (AAOL) system, which used incomplete electroanatomic mapping (EAM) for localization of idiopathic ventricular arrhythmia (IVA) origin on the patient-specific geometry of left ventricular, right ventricular, and neighboring vessels. The study assessed the accuracy of the system in localizing IVA source sites on cardiac structures where pace mapping is challenging. BACKGROUND An intraprocedural automated site of origin localization system was previously developed to identify the origin of early left ventricular activation by using 12-lead electrocardiograms (ECGs). However, it has limitations, as it could not identify the site of origin in the right ventricle and relied on acquiring a complete EAM. METHODS Twenty patients undergoing IVA catheter ablation had a 12-lead ECG recorded during clinical arrhythmia and during pacing at various locations identified on EAM geometries. The new system combined 3-lead (III, V2, and V6) 120-ms QRS integrals and patient-specific EAM geometry with pace mapping to predict the site of earliest ventricular activation. The predicted site was projected onto EAM geometry. RESULTS Twenty-three IVA origin sites were clinically identified by activation mapping and/or pace mapping (8, right ventricle; 15, left ventricle, including 8 from the posteromedial papillary muscle, 2 from the aortic root, and 1 from the distal coronary sinus). The new system achieved a mean localization accuracy of 3.6 mm for the 23 mapped IVAs. CONCLUSIONS The new intraprocedural AAOL system achieved accurate localization of IVA origin in ventricles and neighboring vessels, which could facilitate ablation procedures for patients with IVAs.
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19
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Brett CL, Cook JA, Aboud AA, Karim R, Shinohara ET, Stevenson WG. Novel Workflow for Conversion of Catheter-Based Electroanatomic Mapping to DICOM Imaging for Noninvasive Radioablation of Ventricular Tachycardia. Pract Radiat Oncol 2020; 11:84-88. [PMID: 32416269 DOI: 10.1016/j.prro.2020.04.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/06/2020] [Accepted: 04/17/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE A recent clinical trial has demonstrated that noninvasive radioablation (NIRA) has the potential to reduce recurrent ventricular tachycardia (VT) that is refractory to drugs and standard catheter ablation. Electroanatomic mapping (EAM) that would be useful for planning is obtained during catheter ablation, but incompatibility between EAM and DICOM formats required for radiation planning has impeded the use of existing catheter-based mapping to guide NIRA and is an important hurdle for its wider adoption. In this paper we define a process to facilitate the fusion of catheter-based EAM with DICOM imaging for radiation planning. METHOD AND MATERIALS The raw data export of the CARTO3 EAM system (version 6.0.45.171, ".mesh" file) was processed with a MATLAB script to generate 3-dimensional (3D) visual took kit files containing X, Y, Z coordinates obtained during mapping and corresponding impedance, voltage, and other point-based information. The image could then be visualized with standard image processing software (3D Slicer) and the target outlined on the image surface. This structure was in turn converted to a DICOM image and fused with patient thoracic imaging using anatomic landmarks. Robustness of the workflow was assessed through implementation with a second magnetic resonance imaging based VT ablation planning system, ADAS-VT. RESULTS This process facilitated the fusion of EAM and DICOM imaging to inform selection of NIRA targets. The workflow was found to be robust and compatible with a second VT ablation planning system. CONCLUSIONS The conversion of catheter-based EAM to a DICOM compatible format permits the fusion of images for radiation planning and provides an avenue for the wider application of NIRA. Further improvements in the compatibility of these imaging formats would be expected to improve quality and reproducibility of image fusion.
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Affiliation(s)
- Christopher L Brett
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Jason A Cook
- Department of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Asad A Aboud
- Department of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rashed Karim
- National Heart & Lung Institute, Imperial College of London, United Kingdom
| | - Eric T Shinohara
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - William G Stevenson
- Department of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
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20
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Okada DR, Miller J, Chrispin J, Prakosa A, Trayanova N, Jones S, Maggioni M, Wu KC. Substrate Spatial Complexity Analysis for the Prediction of Ventricular Arrhythmias in Patients With Ischemic Cardiomyopathy. Circ Arrhythm Electrophysiol 2020; 13:e007975. [PMID: 32188287 PMCID: PMC7207018 DOI: 10.1161/circep.119.007975] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Transition zones between healthy myocardium and scar form a spatially complex substrate that may give rise to reentrant ventricular arrhythmias (VAs). We sought to assess the utility of a novel machine learning approach for quantifying 3-dimensional spatial complexity of grayscale patterns on late gadolinium enhanced cardiac magnetic resonance images to predict VAs in patients with ischemic cardiomyopathy. METHODS One hundred twenty-two consecutive ischemic cardiomyopathy patients with left ventricular ejection fraction ≤35% without prior history of VAs underwent late gadolinium enhanced cardiac magnetic resonance images. From raw grayscale data, we generated graphs encoding the 3-dimensional geometry of the left ventricle. A novel technique, adapted to these graphs, assessed global regularity of signal intensity patterns using Fourier-like analysis and generated a substrate spatial complexity profile for each patient. A machine learning statistical algorithm was employed to discern which substrate spatial complexity profiles correlated with VA events (appropriate implantable cardioverter-defibrillator firings and arrhythmic sudden cardiac death) at 5 years of follow-up. From the statistical machine learning results, a complexity score ranging from 0 to 1 was calculated for each patient and tested using multivariable Cox regression models. RESULTS At 5 years of follow-up, 40 patients had VA events. The machine learning algorithm classified with 81% overall accuracy and correctly classified 86% of those without VAs. Overall negative predictive value was 91%. Average complexity score was significantly higher in patients with VA events versus those without (0.5±0.5 versus 0.1±0.2; P<0.0001) and was independently associated with VA events in a multivariable model (hazard ratio, 1.5 [1.2-2.0]; P=0.002). CONCLUSIONS Substrate spatial complexity analysis of late gadolinium enhanced cardiac magnetic resonance images may be helpful in refining VA risk in patients with ischemic cardiomyopathy, particularly to identify low-risk patients who may not benefit from prophylactic implantable cardioverter-defibrillator therapy. Visual Overview: A visual overview is available for this article.
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Affiliation(s)
- David R Okada
- Division of Cardiology, Department of Medicine (D.R.O., J.C., S.J., K.C.W.)
| | | | - Jonathan Chrispin
- Division of Cardiology, Department of Medicine (D.R.O., J.C., S.J., K.C.W.)
| | | | | | - Steven Jones
- Division of Cardiology, Department of Medicine (D.R.O., J.C., S.J., K.C.W.)
| | - Mauro Maggioni
- Department of Applied Mathematics (J.A., M.M.).,Department of Mathematics, Johns Hopkins University, Baltimore, MD (M.M.)
| | - Katherine C Wu
- Division of Cardiology, Department of Medicine (D.R.O., J.C., S.J., K.C.W.)
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König S, Ueberham L, Müller-Röthing R, Wiedemann M, Ulbrich M, Sause A, Tebbenjohanns J, Schade A, Shin DI, Staudt A, Andrié R, Neuser H, Kuhlen R, Arya A, Hindricks G, Bollmann A. Catheter ablation of ventricular arrhythmias and in-hospital mortality: insights from the German-wide Helios hospital network of 5052 cases. Europace 2020; 22:100-108. [PMID: 31638643 DOI: 10.1093/europace/euz260] [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: 08/01/2019] [Accepted: 08/27/2019] [Indexed: 11/13/2022] Open
Abstract
AIMS Catheter ablation (CA) of ventricular arrhythmias is one of the most challenging electrophysiological interventions with an increasing use over the last years. Several benefits must be weighed against the risk of potentially life-threatening complications which necessitates a steady reevaluation of safety endpoints. Therefore, the aims of this study were (i) to investigate overall in-hospital mortality in patients undergoing such procedures and (ii) to identify variables associated with in-hospital mortality in a German-wide hospital network. METHODS AND RESULTS Between January 2010 and September 2018, administrative data provided by 85 Helios hospitals were screened for patients with main or secondary discharge diagnosis of ventricular tachycardia (VT) or premature ventricular contractions (PVCs) in combination with an arrhythmia-related CA using ICD- and OPS codes. In 5052 cases (mean age 60.9 ± 14.3 years, 30.1% female) of 30 different hospitals, in-hospital mortality was 1.27% with a higher mortality in patients ablated for VT (1.99%, n = 2, 955) compared to PVC (0.24%, n = 2, 097, P < 0.01). Mortality rates were 2.06% in patients with ischaemic heart disease (IHD, n = 2, 137), 1.47% in patients with non-ischaemic structural heart disease (NIHD, n = 1, 224), and 0.12% in patients without structural heart disease (NSHD, n = 1, 691). Considering different types of hospital admission, mortality rates were 0.35% after elective (n = 2, 825), 1.60% after emergency admission/hospital transfer <24 h (n = 1, 314) and 3.72% following delayed hospital transfer >24 h after initial admission (n = 861, P < 0.01 vs. elective admission and emergency admission/hospital transfer <24 h). In multivariable analysis, a delayed hospital transfer >24 h [odds ratio (OR) 2.28, 95% confidence interval (CI) 1.59-3.28, P < 0.01], the occurrence of procedure-related major adverse events (OR 6.81, 95% CI 2.90-16.0, P < 0.01), Charlson Comorbidity Index (CCI, OR 2.39, 95% CI 1.56-3.66, P < 0.01) and its components congestive heart failure (OR 8.04, 95% CI 1.71-37.8, P < 0.01), and diabetes mellitus (OR 1.59, 95% CI 1.13-2.22, P < 0.01) were significantly associated with in-hospital death. CONCLUSIONS We reported in-hospital mortality rates after CA of ventricular arrhythmias in the largest multicentre, administrative dataset in Germany which can be implemented in quality management programs. Aside from comorbidities, a delayed hospital transfer to a CA performing centre is associated with an increased in-hospital mortality. This deserves further studies to determine the optimal management strategy.
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Affiliation(s)
- Sebastian König
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | - Laura Ueberham
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | | | - Michael Wiedemann
- Department of Cardiology, Helios Hospital Berlin-Buch, Berlin, Germany
| | - Michael Ulbrich
- Department of Internal Medicine I, Helios Hospital München West, München, Germany
| | - Armin Sause
- Department of Cardiology, Helios University Hospital Wuppertal, Wuppertal, Germany
| | | | - Anja Schade
- Department of Cardiology, Helios Hospital Erfurt, Erfurt, Germany
| | - Dong-In Shin
- Department of Cardiology, Helios Hospital Krefeld, Krefeld, Germany
| | - Alexander Staudt
- Department of Cardiology and Angiology, Helios Hospital Schwerin, Schwerin, Germany
| | - René Andrié
- Department of Cardiology, Helios Hospital Siegburg, Siegburg, Germany
| | - Hans Neuser
- Department of Internal Medicine II, Helios Hospital Plauen, Plauen, Germany
| | | | - Arash Arya
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
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22
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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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23
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Electrocardiographic features, mapping and ablation of idiopathic outflow tract ventricular arrhythmias. J Interv Card Electrophysiol 2019; 57:207-218. [PMID: 31650457 DOI: 10.1007/s10840-019-00617-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/27/2019] [Indexed: 01/01/2023]
Abstract
PURPOSE Idiopathic outflow tract ventricular arrhythmias are ventricular tachycardias or premature ventricular contractions presumably not related to myocardial scar or disorders of ion channels. These arrhythmias have focal origin and display characteristic electrocardiographic features. The purpose of this article is to review the state of the art of diagnosis and treatment of idiopathic outflow tract ventricular arrhythmias. METHODS We systematically reviewed scientific literature about idiopathic outflow tract ventricular arrhythmias selecting the most relevant papers on this topic. RESULTS The right ventricle outflow tract is the most common site of origin for outflow tract ventricular arrhythmias, but also left ventricle outflow tract can harbour these arrhythmias. Outflow tract ventricular arrhythmias are generally benign and may require treatment if they are symptomatic, incessant or give rise to cardiomyopathy. Radiofrequency catheter ablation is an effective and safe therapeutic strategy. A successful procedure requires a thorough preoperative analysis of the 12-lead electrocardiogram of the spontaneous arrhythmia combined with a detailed electroanatomical mapping and intracardiac echocardiography. CONCLUSIONS Idiopathic outflow tract arrhythmias are frequent in daily clinical practice and can be successfully eliminated through discrete radiofrequency catheter ablation with low rates of complications.
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24
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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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Chung FP, Vicera JJB, Lin YJ, Chang SL, Lo LW, Hu YF, Lin CY, Tuan TC, Chao TF, Liao JN, Chang TY, Salim S, Liu CM, Chuang CM, Chen CC, Chin CG, Wu CI, Chou CY, Chen SA. Clinical efficacy of open-irrigated electrode cooled with half-normal saline for initially failed radiofrequency ablation of idiopathic outflow tract ventricular arrhythmias. J Cardiovasc Electrophysiol 2019; 30:1508-1516. [PMID: 31257650 DOI: 10.1111/jce.14057] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/04/2019] [Accepted: 06/24/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Acute failure of radiofrequency ablation (RFA) of ventricular arrhythmias (VAs) occur in 10%-20% of patients and is partly attributed to inadequate lesion depth acquired with standard ablation protocols. Half-normal saline (HNS)-irrigation is a promising strategy to improve the success rate of VA ablation. OBJECTIVE This study investigated the efficacy of HNS-irrigated ablation after a failed standard plain normal saline solution (PNSS)-irrigated ablation on idiopathic outflow tract ventricular arrhythmia (OT-VA). METHOD This is a prospective observational study of consecutive patients undergoing RFA of idiopathic OT-VA comparing the efficacy of additional HNS-irrigated ablation for failed standard PNSS-irrigated ablation. Acute failure was defined as persistence of spontaneous VA or persistent inducibility of the clinical VA. RESULTS Out of 160 OT-VA cases (51 ± 15-year-old, 62 males), 31 underwent HNS irrigation after a failed standard PNSS-irrigated ablation. The HNS group had a significantly longer procedure time (60.06 ± 43.83 vs 37.51 ± 33.40 minutes; P = .013) and higher radiation exposure (31.45 ± 20.24 vs 17.22 ± 15.25 minutes; P = .001) than the PNSS group but provided an additional acute success in 21 of 31 (67.7%) patients. Over a follow-up duration of 7.8 ± 4.6 months, 24 recurrences were identified, including 8 (25.8%) in the HNS and 16 (12.4%) in the PNSS group, with lower freedom from recurrence in the HNS group (log rank P = .009). No major complication was observed. CONCLUSION HNS-irrigated ablation after failed standard PNSS-irrigated ablation is safe and additionally improves acute ablation success by 67.7% for idiopathic OT-VA but with a higher rate of recurrence on follow-up. Whether the application of HNS as initial irrigant could result in better outcome requires further investigation.
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Affiliation(s)
- Fa-Po Chung
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Jennifer Jeanne B Vicera
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Shih-Lin Chang
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Li-Wei Lo
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yu-Feng Hu
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Chin-Yu Lin
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Ta-Chuan Tuan
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Tze-Fan Chao
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Jo-Nan Liao
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Ting-Yung Chang
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Simon Salim
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Internal Medicine, Rumah Sakit Bethsaida Tangerang, Kabupaten Tangerang, Banten, Indonesia
| | - Chih-Min Liu
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Chieh-Mao Chuang
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Division of Pediatric Cardiology, China Medical University Children's Hospital, China Medical University, Taichung, Taiwan
| | - Chun-Chao Chen
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Internal Medicine, Division of Cardiology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chye Gen Chin
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Internal Medicine, Division of Cardiovascular Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Internal Medicine, Division of Cardiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Cheng-I Wu
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ching-Yao Chou
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Internal Medicine, Division of Cardiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Shih-Ann Chen
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
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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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Tandri H, Okada DR. Ventricular Arrhythmias in Ischemic Cardiomyopathy: Is Imaging-Based Entropy a Biologically Relevant Risk Marker? JACC Clin Electrophysiol 2019; 5:490-492. [PMID: 31000103 DOI: 10.1016/j.jacep.2018.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 11/29/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Harikrishna Tandri
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - David R Okada
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Finding the right pathway is the key to success. HeartRhythm Case Rep 2019; 5:187-190. [PMID: 30997331 PMCID: PMC6453558 DOI: 10.1016/j.hrcr.2018.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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30
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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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31
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Ciuca C, Ragni L, Hasan T, Balducci A, Angeli E, Prandstraller D, Egidy-Assenza G, Donti A, Bonvicini M, Gargiulo GD. Dilated cardiomyopathy in a pediatric population: etiology and outcome predictors - a single-center experience. Future Cardiol 2019; 15:95-107. [PMID: 30848673 DOI: 10.2217/fca-2018-0030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
AIM The aim of the study was to assess predictors of outcome in patients hospitalized for dilated cardiomyopathy (DCM) and severe left ventricular dysfunction. Patients & methods: 83 pediatric patients hospitalized for heart failure due to DCM with coexistent left ventricular dysfunction were enrolled. RESULTS Overall, 5-year survival free from heart transplantation was 69.8%. Normalization of left ventricular function was achieved in 39.8% of patients during follow-up: younger age, less necessity of inotropic support and other than idiopathic DCM predicted left ventricular function, while familial history for cardiac disease or sudden death and inotropic support during hospitalization were associated with poorer outcome. CONCLUSION Almost 40% of patients with DCM experienced a complete normalization of cardiac function. Outcome was extremely variable according to the type of DCM.
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Affiliation(s)
- Cristina Ciuca
- Pediatric Cardiology & GUCH Unit, Cardiothoracic-Vascular Department, University Hospital S. Orsola-Malpighi, Bologna, 40138, Italy
| | - Luca Ragni
- Pediatric Cardiology & GUCH Unit, Cardiothoracic-Vascular Department, University Hospital S. Orsola-Malpighi, Bologna, 40138, Italy
| | - Tammam Hasan
- Pediatric Cardiology & GUCH Unit, Cardiothoracic-Vascular Department, University Hospital S. Orsola-Malpighi, Bologna, 40138, Italy
| | - Anna Balducci
- Pediatric Cardiology & GUCH Unit, Cardiothoracic-Vascular Department, University Hospital S. Orsola-Malpighi, Bologna, 40138, Italy
| | - Emanuela Angeli
- Pediatric & Grown-up Congenital Cardiac Surgery Unit, Cardiothoracic-Vascular Department, University Hospital S. Orsola-Malpighi, Bologna, 40138, Italy
| | - Daniela Prandstraller
- Pediatric Cardiology & GUCH Unit, Cardiothoracic-Vascular Department, University Hospital S. Orsola-Malpighi, Bologna, 40138, Italy
| | - Gabriele Egidy-Assenza
- Pediatric Cardiology & GUCH Unit, Cardiothoracic-Vascular Department, University Hospital S. Orsola-Malpighi, Bologna, 40138, Italy
| | - Andrea Donti
- Pediatric Cardiology & GUCH Unit, Cardiothoracic-Vascular Department, University Hospital S. Orsola-Malpighi, Bologna, 40138, Italy
| | - Marco Bonvicini
- Pediatric Cardiology & GUCH Unit, Cardiothoracic-Vascular Department, University Hospital S. Orsola-Malpighi, Bologna, 40138, Italy
| | - Gaetano D Gargiulo
- Pediatric & Grown-up Congenital Cardiac Surgery Unit, Cardiothoracic-Vascular Department, University Hospital S. Orsola-Malpighi, Bologna, 40138, Italy
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Kawamura I, Fukamizu S, Arai M, Inagaki D, Miyabe T, Miyazawa S, Kitamura T, Hojo R, Nishizaki M, Sakurada H, Hiraoka M. Characteristics of ventricular intracardiac electrograms of ventricular tachycardias originating from the epicardia in patients with an implantable cardioverter defibrillator. J Cardiovasc Electrophysiol 2019; 30:575-581. [PMID: 30710406 DOI: 10.1111/jce.13854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/27/2018] [Accepted: 01/07/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION While characteristic waveforms of 12-lead electrocardiograms have been reported to predict the epicardial origin of ventricular tachycardia (VT), it has not been fully examined whether ventricular intracardiac electrograms (VEGMs) recorded from the implantable cardioverter defibrillator (ICD) via telemetry can determine the origin of VT or not. The aim of this study was to investigate the VEGM characteristics of VT originating from the epicardia. METHOD AND RESULTS Intracardiac VEGMs of the induced VTs, with detected sites of origin during the VT study, were recorded in 15 (23 VTs) of the 46 patients. The characteristics of the 23 VTs were evaluated using far-field and near-field VEGMs recorded via telemetry. Five of 23 VTs were found to be focused on the epicardial site (epi group) and 18 VTs were focused on the endocardium (endo group). VTs of the epi group had longer VEGM duration in far-field EGM than those of the endo group (epi group: 240 ± 49 ms vs endo group: 153 ± 45 ms; P = 0.002) and the duration from the onset to the peak of VEGM was also longer than that of the endo group (epi group: 153 ± 53 ms vs endo group: 63 ± 28 ms; P < 0.001). There was no difference in the V wave duration in tip-ring EGM between both groups (epi group: 122 ± 52 ms vs endo group: 98 ± 6 ms; P = 0.377). CONCLUSION Evaluation of intracardiac VEGM before VT ablation may be helpful to predict the epicardial origin of VT in patients with an ICD.
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Affiliation(s)
- Iwanari Kawamura
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Seiji Fukamizu
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Marina Arai
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Dai Inagaki
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Tomonori Miyabe
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Satoshi Miyazawa
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Takeshi Kitamura
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Rintaro Hojo
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Mitsuhiro Nishizaki
- Health Care Center, Internal Medicine and Cardiology, Kanto Gakuin University, Yokohama, Kanagawa, Japan
| | - Harumizu Sakurada
- Department of Cardiology, Tokyo Metropolitan Health and Medical Treatment Corporation Ohkubo Hospital, Tokyo, Japan
| | - Masayasu Hiraoka
- Department of Cardiology, Tokyo Medical and Dental, University, Tokyo, Japan
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Viles-Gonzalez JF, Arora S, Deshmukh A, Atti V, Agnihotri K, Patel N, Dave M, Anter E, Garcia F, Santangeli P, Goldberger JJ, Dukkipati S, d'Avila A, Natale A, Di Biase L. Outcomes of patients admitted with ventricular arrhythmias and sudden cardiac death in the United States. Heart Rhythm 2018; 16:358-366. [PMID: 30236610 DOI: 10.1016/j.hrthm.2018.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Mortality caused by ventricular arrhythmias (VAs) remains a problem of epidemic proportions. Understanding current trends on admission of VA, patient characteristics, morbidity, mortality, and health care utilization could help us improve allocation of health care resources and risk prediction. OBJECTIVE The purpose of this study was to investigate clinical outcomes of VA, including ventricular tachycardia (VT), implantable cardioverter-defibrillator (ICD) shocks, and sudden cardiac death (SCD); and to identify predictors of morbidity and mortality, patterns of utilization of ICD and VT ablation, and the impact of such metrics on overall health care utilization. METHODS From 2010-2015, we identified 290,998 VA hospitalizations, which were stratified into group 1: normal heart; group 2: ischemic heart disease (IHD); group 3: nonischemic heart disease (non-IHD); group 4: ICD shocks; and group 5: SCD (cardiac arrest without ICD shock). RESULTS The number of admissions for VA decreased during the study period (except for patients with SCD and ICD shock, which increased); in-hospital mortality in patients admitted with VA and SCD increased; utilization of VT ablation in patients with ICD shocks and IHD increased; ICD implantation decreased in non-IHD patients and IHD patients; and admission for SCD was the strongest predictor of in-hospital mortality, followed by patients with non-IHD, patients with ICD shocks, and all patients with a Charlson comorbidity index ≥2. CONCLUSION We report a decrease in admissions for VA, decreased ICD utilization, a change in pattern of VT ablation utilization, and an increase of in-hospital mortality in SCD patients. Predictors of adverse outcomes identified in our study should be considered when developing risk models for patients undergoing risk assessment for SCD.
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Affiliation(s)
| | - Shilpkumar Arora
- Department of Cardiology, Mount Sinai St Luke's Hospital and Mount Sinai West Hospital, New York, New York
| | | | - Varunsiri Atti
- Department of Cardiology, Michigan State University, Lansing, Michigan
| | - Kanishk Agnihotri
- Department of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | - Mihir Dave
- Department of Cardiology, Mount Sinai St Luke's Hospital and Mount Sinai West Hospital, New York, New York
| | - Elad Anter
- Department of Cardiology, Harvard Medical School, Boston, Massachusetts
| | - Fermin Garcia
- Department of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Pasquale Santangeli
- Department of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Andre d'Avila
- Department of Cardiology, Cardio SOS Hospital, Florianopolis, Santa Catarina, Brazil
| | - Andrea Natale
- Department of Cardiology, St. David's Medical Center, Austin, Texas
| | - Luigi Di Biase
- Department of Cardiology, Montefiore Medical Center, New York, New York
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Spartalis M, Spartalis E, Tzatzaki E, Tsilimigras DI, Moris D, Kontogiannis C, Livanis E, Iliopoulos DC, Voudris V, Theodorakis GN. Novel approaches for the treatment of ventricular tachycardia. World J Cardiol 2018; 10:52-59. [PMID: 30079151 PMCID: PMC6068734 DOI: 10.4330/wjc.v10.i7.52] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 03/24/2018] [Accepted: 06/27/2018] [Indexed: 02/06/2023] Open
Abstract
Ventricular tachycardia (VT) is a crucial cause of sudden cardiac death (SCD) and a primary cause of mortality and morbidity in patients with structural cardiac disease. VT includes clinical disorders varying from benign to life-threatening. Most life-threatening episodes are correlated with coronary artery disease, but the risk of SCD varies in certain populations, with various underlying heart conditions, specific family history, and genetic variants. The targets of VT management are symptom alleviation, improved quality of life, reduced implantable cardioverter defibrillator shocks, prevention of reduction of left ventricular function, reduced risk of SCD, and improved overall survival. Antiarrhythmic drug therapy and endocardial catheter ablation remains the cornerstone of guideline-endorsed VT treatment strategies in patients with structural cardiac abnormalities. Novel strategies such as epicardial ablation, surgical cryoablation, transcoronary alcohol ablation, pre-procedural imaging, and stereotactic ablative radiotherapy are an appealing area of research. In this review, we gathered all recent advances in innovative therapies as well as experimental evidence focusing on different aspects of VT treatment that could be significant for future favorable clinical applications.
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Affiliation(s)
- Michael Spartalis
- ESC Working Group on Cardiac Cellular Electrophysiology, Sophia Antipolis Cedex 06903, France
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Eleftherios Spartalis
- Laboratory of Experimental Surgery and Surgical Research, University of Athens Medical School, Athens 11527, Greece
| | - Eleni Tzatzaki
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Diamantis I Tsilimigras
- Laboratory of Experimental Surgery and Surgical Research, University of Athens Medical School, Athens 11527, Greece
| | - Demetrios Moris
- Department of Surgery, Duke University, Durham, NC 27710, United States
| | - Christos Kontogiannis
- Department of Clinical Therapeutics, “Alexandra” Hospital, University of Athens, Athens 11528, Greece
| | - Efthimios Livanis
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Dimitrios C Iliopoulos
- Laboratory of Experimental Surgery and Surgical Research, University of Athens Medical School, Athens 11527, Greece
| | - Vassilis Voudris
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens 17674, Greece
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Fuster V. Editor-in-Chief's Top Picks From 2017. J Am Coll Cardiol 2018; 71:890-934. [PMID: 29471941 DOI: 10.1016/j.jacc.2018.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Each week, I record audio summaries for every article in JACC, as well as an issue summary. While this process has been time-consuming, I have become quite familiar with every paper that we publish. Thus, I personally select papers (both original investigations and review articles) from 15 distinct specialties each year for your review. In addition to my personal choices, I have included manuscripts that have been the most accessed or downloaded on our websites, as well as those selected by the JACC Editorial Board members. In order to present the full breadth of this important research in a consumable fashion, we will present these manuscripts in this issue of JACC. The highlights comprise the following sections: Basic & Translational Research, Cardiac Failure, Cardiomyopathies/Myocardial & Pericardial Diseases, Cardio-oncology, Congenital Heart Disease, Coronary Disease & Interventions, CVD Prevention & Health Promotion, Hypertension, Imaging, Metabolic & Lipid Disorders, Rhythm Disorders, Valvular Heart Disease, and Vascular Medicine (1-110).
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