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Krumerman A, Di Biase L, Gerstenfeld E, Dickfeld T, Verma N, Liberman L, Amara R, Kacorri A, Crosson L, Wilk A, Ferrick KJ. Premature ventricular complexes: Assessing burden density in a large national cohort to better define optimal ECG monitoring duration. Heart Rhythm 2024; 21:1289-1295. [PMID: 38641221 DOI: 10.1016/j.hrthm.2024.04.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Premature ventricular contraction (PVC) burden is a risk factor for heart failure and cardiovascular death in patients with structural heart disease. Long-term electrocardiographic monitoring can have a significant impact on PVC burden evaluation by further defining PVC distribution patterns. OBJECTIVE This study aimed to ascertain the optimal duration of electrocardiographic monitoring to characterize PVC burden and to understand clinical characteristics associated with frequent PVCs and nonsustained ventricular tachycardia in a large US cohort. METHODS Commercial data (iRhythm's Zio patch) from June 2011 to April 2022 were analyzed. Inclusion criteria were age >18 years, PVC burden ≥5%, and wear period ≥13 days. PVC burden cutoffs were determined on the basis of AHA/ACC/HRS guidelines for very frequent PVCs (10,000-20,000 during 24 hours). Patients were assigned to categories by PVC densities: low, <10%; moderate, 10% to <20%; and high, ≥20%. Mean measured error was assessed at baseline and daily until the wear period's end for overall PVC burden and different PVC densities. RESULTS Analysis of 106,705 patch monitors revealed a study population with mean age of 70.6 ± 14.6 years (33.6% female). PVC burden was higher in male patients and those >65 years of age. PVC burden mean error decreased from 2.9% at 24 hours to 1.3% at 7 days and 0.7% at 10 days. Number of ventricular tachycardia episodes per patient increased with increasing PVC burden (P < .0001). CONCLUSION Extending ambulatory monitoring beyond 24 hours to 7 days or more improves accuracy of assessing PVC burden. Ventricular tachycardia frequency and duration vary by initial PVC density, highlighting the need for prolonged cardiac monitoring.
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Affiliation(s)
| | | | | | - Timm Dickfeld
- University of Maryland Medical Center, Baltimore, Maryland
| | - Nishant Verma
- Northwestern University Medical Center, Chicago, Illinois
| | | | - Richard Amara
- University of Maryland Medical Center, Baltimore, Maryland
| | | | | | - Alan Wilk
- iRhythm Technologies, San Francisco, California
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Desai D, Maheta DK, Agrawal SP, Abouarab AG, Frishman WH, Aronow WS. Understanding Arrhythmia-Induced Cardiomyopathy: Symptoms and Treatments. Cardiol Rev 2024:00045415-990000000-00302. [PMID: 39023247 DOI: 10.1097/crd.0000000000000755] [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: 07/20/2024]
Abstract
Arrhythmia-induced cardiomyopathy is a complex condition that causes a decline in heart function as a result of irregular heart rhythms. This disorder highlights the link between irregular heart rhythm and heart failure, necessitating prompt identification and intervention. It often occurs due to ongoing fast heart rhythms like atrial fibrillation or tachycardia. Understanding the mechanisms, symptoms, and available treatments is essential for enhancing patient outcomes given the complicated nature of the condition. This article delves into various aspects of arrhythmia-induced cardiomyopathy, including pathogenesis, clinical presentation, diagnostic methods, epidemiology, typical arrhythmias associated with the condition, and management options. It assesses patients' future outlook and necessary follow-up, aiming to provide healthcare providers with a comprehensive understanding of how to handle this intricate condition. The article emphasizes the important effect an integrative approach can have on both patients' lives and the clinical consequences of diagnosing and treating this condition. This extensive understanding enhances the resources at the disposal of physicians, enabling targeted treatments that enhance cardiomyopathy by targeting arrhythmia regulation. More research and development are needed in the field of cardiomyopathy and arrhythmia relationship. The presentation urges the medical field to delve deeper into the complexities of illness by emphasizing the need for continuous research and a multifaceted treatment plan. By combining these understandings, our goal is to enhance patient outcomes and create opportunities for further studies on cardiovascular wellness.
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Affiliation(s)
- Dev Desai
- From the Department of Medicine, Smt. NHL Municipal Medical College, Ahmedabad, India
| | | | - Siddharth Pravin Agrawal
- Department of Internal Medicine, New York Medical College/Landmark Medical Center, Woonsocket, RI
| | | | | | - Wilbert S Aronow
- Departments of Cardiology and Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY
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Domínguez F, Adler E, García-Pavía P. Alcoholic cardiomyopathy: an update. Eur Heart J 2024; 45:2294-2305. [PMID: 38848133 PMCID: PMC11231944 DOI: 10.1093/eurheartj/ehae362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 03/15/2024] [Accepted: 05/22/2024] [Indexed: 06/09/2024] Open
Abstract
Alcohol-induced cardiomyopathy (AC) is an acquired form of dilated cardiomyopathy (DCM) caused by prolonged and heavy alcohol intake in the absence of other causes. The amount of alcohol required to produce AC is generally considered as >80 g/day over 5 years, but there is still some controversy regarding this definition. This review on AC focuses on pathogenesis, which involves different mechanisms. Firstly, the direct toxic effect of ethanol promotes oxidative stress in the myocardium and activation of the renin-angiotensin system. Moreover, acetaldehyde, the best-studied metabolite of alcohol, can contribute to myocardial damage impairing actin-myosin interaction and producing mitochondrial dysfunction. Genetic factors are also involved in the pathogenesis of AC, with DCM-causing genetic variants in patients with AC, especially titin-truncating variants. These findings support a double-hit hypothesis in AC, combining genetics and environmental factors. The synergistic effect of alcohol with concomitant conditions such as hypertension or liver cirrhosis can be another contributing factor leading to AC. There are no specific cardiac signs and symptoms in AC as compared with other forms of DCM. However, natural history of AC differs from DCM and relies directly on alcohol withdrawal, as left ventricular ejection fraction recovery in abstainers is associated with an excellent prognosis. Thus, abstinence from alcohol is the most crucial step in treating AC, and specific therapies are available for this purpose. Otherwise, AC should be treated according to current guidelines of heart failure with reduced ejection fraction. Targeted therapies based on AC pathogenesis are currently being developed and could potentially improve AC treatment in the future.
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Affiliation(s)
- Fernando Domínguez
- Department of Cardiology, Heart Failure and Inherited Cardiac Diseases Unit, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, CIBERCV, Manuel de Falla, 2, Majadahonda, Madrid 28222, Spain
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Calle de Melchor Fernández Almagro, 3, Madrid, Spain
| | - Eric Adler
- Section Head of Heart Failure, University of California, San Diego, CA, USA
| | - Pablo García-Pavía
- Department of Cardiology, Heart Failure and Inherited Cardiac Diseases Unit, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, CIBERCV, Manuel de Falla, 2, Majadahonda, Madrid 28222, Spain
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Calle de Melchor Fernández Almagro, 3, Madrid, Spain
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Ventrella N, Schiavone M, Bianchini L, Sicuso R, Dessanai MA, Di Biase L, Tondo C. Catheter ablation for focal atrial tachycardias during pregnancy: A systematic review. Int J Cardiol 2024; 413:132333. [PMID: 38972492 DOI: 10.1016/j.ijcard.2024.132333] [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: 03/18/2024] [Revised: 05/29/2024] [Accepted: 07/01/2024] [Indexed: 07/09/2024]
Abstract
OBJECTIVE Pregnancy can trigger maternal tachycardias, and the onset of recurrent or incessant focal atrial tachycardia (AT) can lead to tachycardia-induced cardiomyopathy. Medical interventions are commonly employed, but they carry potential fetal and maternal risks. Catheter ablation (CA), particularly with non-fluoroscopic navigation systems, may be considered as an alternative. This systematic review aims to explore the feasibility and outcomes of CA for focal AT during pregnancy. METHODS A thorough literature search was conducted until September 30th, 2023, on PubMed, Embase, and Cochrane databases. Included articles described maternal focal ATs diagnosed through electrophysiological studies and treated with CA. Data derived from these studies were organized into tables and subsequently analyzed. RESULTS Out of 278 papers reviewed, 15 articles involving 24 patients were retrieved. CA, utilizing radiofrequency energy achieved acute success in 95.8% of cases. Sixteen patients (66.7%) underwent complete fluoroless procedures, with two adverse events directly related to the procedure reported. Long-term follow-up revealed minimal AT recurrences, with a 0.06% arrhythmia burden in one case. CONCLUSION Focal ATs during pregnancy can be incessant and refractory to medical intervention, precipitating an acute decline in left ventricular ejection fraction. In this setting, CA emerges as an efficacious treatment modality, particularly in cases of tachycardia-induced cardiomyopathies. Whenever feasible, it is advisable to perform these procedures with minimal or no fluoroscopy guidance. Larger studies are needed to establish the safety and the efficacy of CA for focal ATs during pregnancy, as current research consists of case reports or small case series.
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Affiliation(s)
- Nicoletta Ventrella
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy.
| | - Marco Schiavone
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Lorenzo Bianchini
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Rita Sicuso
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Maria Antonietta Dessanai
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Luigi Di Biase
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Claudio Tondo
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
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Yano M, Egami Y, Kawanami S, Ukita K, Kawamura A, Yasumoto K, Tsuda M, Okamoto N, Matsunaga-Lee Y, Nishino M. ST-segment depression and left ventricular systolic function recovery post-atrial fibrillation ablation in heart failure. ESC Heart Fail 2024. [PMID: 38967121 DOI: 10.1002/ehf2.14946] [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: 09/10/2023] [Revised: 05/16/2024] [Accepted: 06/20/2024] [Indexed: 07/06/2024] Open
Abstract
AIMS Catheter ablation (CA) of atrial fibrillation (AF) improves left ventricular ejection fraction (LVEF) in patients with heart failure with reduced ejection fraction (HFrEF). The impact of ST-segment depression before CA on LVEF recovery and clinical outcomes remains unknown. In the present study, we aimed to investigate the relationship between ST-segment depression during AF rhythm before CA and improvement in the LVEF and clinical outcomes in persistent atrial fibrillation (PerAF) patients with HFrEF. METHODS AND RESULTS The present study included 122 PerAF patients (male; 98 patients, 80%, mean age: 69 [56, 76] years) from the Osaka Rosai Atrial Fibrillation ablation (ORAF) registry who had LVEF < 50% and underwent an initial ablation. The patients who underwent percutaneous coronary intervention or coronary artery bypass grafting within the past 1 month were not included in the enrolled patients. We assigned the patients based on the presence of ST-segment depression before CA during AF rhythm and evaluated improvement in the LVEF (LVEF ≥ 15%) 1 year after CA and the relationship between ST-segment depression and heart failure (HF) hospitalization/major adverse cardiovascular events (MACE), which are defined as a composite of HF hospitalization, cardiovascular death, hospitalization due to coronary artery disease, ventricular arrhythmia requiring hospitalization and stroke. The percentage of patients with improvement in the LVEF 1 year after CA was significantly lower in the patients with ST-segment depression than those without (58.6% vs. 79.7%, P = 0.012). Multiple regression analysis showed ST-segment depression was independently and significantly associated with improvement in the LVEF 1 year after CA (HR: 0.35; 95% CI: 0.129-0.928, P = 0.035). Kaplan-Meier analysis showed that the patients with ST-segment depression significantly had higher risk of HF hospitalization and MACE than those without (log rank P = 0.022 and log rank P = 0.002, respectively). Multivariable Cox proportional hazards analysis showed that ST-segment depression was independently and significantly associated with a higher risk of MACE (HR: 2.82; 95% CI: 1.210-6.584, P = 0.016). CONCLUSIONS ST-segment depression before CA during AF rhythm was useful prognostic predictor of improvement in the LVEF and clinical outcomes including HF hospitalization and MACE in PerAF patients with HFrEF.
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Affiliation(s)
- Masamichi Yano
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Yasuyuki Egami
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | | | - Kohei Ukita
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Akito Kawamura
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Koji Yasumoto
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Masaki Tsuda
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | | | | | - Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
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Pedro B, Mavropoulou A, Oyama MA, Linney C, Neves J, Dukes‐McEwan J, Fontes‐Sousa AP, Gelzer AR. Longitudinal analysis of echocardiographic and cardiac biomarker variables in dogs with atrial fibrillation: The optimal rate control in dogs with atrial fibrillation II study. J Vet Intern Med 2024; 38:2076-2088. [PMID: 38877661 PMCID: PMC11256134 DOI: 10.1111/jvim.17120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/07/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Rate control (RC; meanHRHolter ≤ 125 bpm) increases survival in dogs with atrial fibrillation (AF). The mechanisms remain unclear. HYPOTHESIS/OBJECTIVES Investigate echocardiographic and biomarker differences between RC and non-RC (NRC) dogs. Determine if changes post-anti-arrhythmic drugs (AAD) predict successful RC in subsequent Holter monitoring. Evaluate if early vs late RC affects survival. ANIMALS Fifty-two dogs with AF. METHODS Holter-derived mean heart rate, echocardiographic and biomarker variables from dogs receiving AAD were analyzed prospectively at each re-evaluation and grouped into RC or NRC. The primary endpoint was successful RC. Between group comparisons of absolute values, magnitude of change from admission to re-evaluations and end of study were performed using Mann-Whitney tests or unpaired t-tests. Logistic regression explored variables associated with inability to achieve RC at subsequent visits. Kaplan-Meier survival analysis was used to compare survival time of early vs late RC. RESULTS At visit 2, 11/52 dogs were RC; at visit 3, 14/52 were RC; and at visit 4, 4/52 were RC. At the end of study, 25/52 remained NRC. At visit 2, both groups had increased cardiac dimensions, but NRC dogs had larger dimensions; biomarkers did not differ. At the end of study, RC showed decreased cardiac dimensions and end-terminal pro-brain natriuretic peptide (NT-proBNP) compared with NRC. No variables were useful at predicting RC success in subsequent visits. Survival analysis found no differences between early vs late RC. CONCLUSIONS AND CLINICAL IMPORTANCE The RC dogs had decreased cardiac dimensions and NT-proBNP, suggesting HR-mediated reverse-remodeling might benefit survival, even with delayed RC achievement. Pursuit of RC is crucial despite initial failures.
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Affiliation(s)
- Brigite Pedro
- Willows Veterinary Centre and Referral Service, Highlands Road, ShirleySolihull, West Midlands B90 4NHUnited Kingdom
- Hospital Veterinário do Bom Jesus, Avenida General Carrilho da Silva Pinto 52Braga 4715‐380Portugal
- Virtual Veterinary Specialists Ltd, 166 College RoadHarrow, Middlesex HA1 1BHUnited Kingdom
- ICBAS – Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, R. Jorge Viterbo Ferreira 228Porto 4050‐313Portugal
| | - Antonia Mavropoulou
- Plakentia Veterinary Clinic, Al. Panagouli 31, Ag. ParaskeviAthens 153 43Greece
| | - Mark A. Oyama
- Department of Clinical Studies and Advanced Medicine, School of Veterinary MedicineUniversity of Pennsylvania, 3900 Delancey St.Philadelphia, Pennsylvania 19104USA
| | - Christopher Linney
- Willows Veterinary Centre and Referral Service, Highlands Road, ShirleySolihull, West Midlands B90 4NHUnited Kingdom
- Paragon Veterinary ReferralsParagon Business Village, Paragon Way, Red Hall CresWakefield WF1 2DFUnited Kingdom
| | - João Neves
- Willows Veterinary Centre and Referral Service, Highlands Road, ShirleySolihull, West Midlands B90 4NHUnited Kingdom
- Hospital Veterinário do Bom Jesus, Avenida General Carrilho da Silva Pinto 52Braga 4715‐380Portugal
- Virtual Veterinary Specialists Ltd, 166 College RoadHarrow, Middlesex HA1 1BHUnited Kingdom
- Hospital Veterinario de Aveiro, Avenida da Universidade 215Aveiro 3810‐489Portugal
| | - Joanna Dukes‐McEwan
- Small Animal Teaching Hospital, Department of Small Animal Clinical ScienceUniversity of Liverpool Leahurst Campus, Chester High RoadNeston CH64 2UQUnited Kingdom
| | - Ana P. Fontes‐Sousa
- Department of Immuno‐Physiology and Pharmacology, Center for Pharmacological Research and Drug Innovation (MedInUP), Veterinary Hospital of the University of Porto (UPVET), ICBAS – Abel Salazar Institute of Biomedical SciencesUniversity of PortoPortoPortugal
| | - Anna R. Gelzer
- Department of Clinical Studies and Advanced Medicine, School of Veterinary MedicineUniversity of Pennsylvania, 3900 Delancey St.Philadelphia, Pennsylvania 19104USA
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Paludan-Müller C, Vad OB, Stampe NK, Diederichsen SZ, Andreasen L, Monfort LM, Fosbøl EL, Køber L, Torp-Pedersen C, Svendsen JH, Olesen MS. Atrial fibrillation: age at diagnosis, incident cardiovascular events, and mortality. Eur Heart J 2024; 45:2119-2129. [PMID: 38592444 PMCID: PMC11212824 DOI: 10.1093/eurheartj/ehae216] [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: 10/02/2023] [Revised: 02/19/2024] [Accepted: 03/20/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND AND AIMS Patients with atrial fibrillation (AF) are at increased risks of cardiovascular diseases and mortality, but risks according to age at diagnosis have not been reported. This study investigated age-specific risks of outcomes among patients with AF and the background population. METHODS This nationwide population-based cohort study included patients with AF and controls without outcomes by the application of exposure density matching on the basis of sex, year of birth, and index date. The absolute risks and hazard rates were stratified by age groups and assessed using competing risk survival analyses and Cox regression models, respectively. The expected differences in residual life years among participants were estimated. RESULTS The study included 216 579 AF patients from year 2000 to 2020 and 866 316 controls. The mean follow-up time was 7.9 years. Comparing AF patients with matched controls, the hazard ratios among individuals ≤50 years was 8.90 [95% confidence interval (CI), 7.17-11.0] for cardiomyopathy, 8.64 (95% CI, 7.74-9.64) for heart failure, 2.18 (95% CI, 1.89-2.52) for ischaemic stroke, and 2.74 (95% CI, 2.53-2.96) for mortality. The expected average loss of life years among individuals ≤50 years was 9.2 years (95% CI, 9.0-9.3) years. The estimates decreased with older age. CONCLUSIONS The findings show that earlier diagnosis of AF is associated with a higher hazard ratio of subsequent myocardial disease and shorter life expectancy. Further studies are needed to determine causality and whether AF could be used as a risk marker among particularly younger patients.
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Affiliation(s)
- Christian Paludan-Müller
- Department of Cardiology, The Heart Center, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark
| | - Oliver B Vad
- Department of Cardiology, The Heart Center, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niels K Stampe
- Department of Cardiology, The Heart Center, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark
| | - Søren Z Diederichsen
- Department of Cardiology, The Heart Center, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark
| | - Laura Andreasen
- Department of Cardiology, The Heart Center, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark
| | - Laia M Monfort
- Department of Cardiology, The Heart Center, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Emil L Fosbøl
- Department of Cardiology, The Heart Center, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Center, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Copenhagen University Hospital—North Zealand Hospital, Hillerød, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jesper H Svendsen
- Department of Cardiology, The Heart Center, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Morten S Olesen
- Department of Cardiology, The Heart Center, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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8
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William J, Kistler Mbbd PM, Kalman JM, Scheinman M, Sugumar H, Prabhu S, Ling LH, Vedantham V, Tseng Z, Moss J, Gerstenfeld EP, Voskoboinik A. Aberrancy masquerading as ventricular tachycardia: Importance of invasive electrophysiology study for diagnosis of wide complex tachycardias. J Electrocardiol 2024; 85:50-57. [PMID: 38852223 DOI: 10.1016/j.jelectrocard.2024.05.099] [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: 04/10/2024] [Revised: 04/30/2024] [Accepted: 05/20/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Differentiation between ventricular tachycardia (VT) and supraventricular tachycardia (SVT) with aberrancy based on the 12‑lead ECG alone can be imprecise. Implantable cardiac defibrillators (ICD) may be inserted for presumed VT, particularly in patients with syncopal presentation or atypical aberrancy patterns. Accurate diagnosis of these patients facilitated by an electrophysiology study (EPS) may alter diagnosis and management. METHODS We present a prospective collection of cases across 3 cardiac centers of consecutive patients with WCT presumed to be VT who were referred for consideration of an ICD, and in whom further evaluation including an EPS ultimately demonstrated SVT with aberrancy as the culprit arrhythmia. RESULTS 22 patients were identified (17 male, mean age 50±13 years. Available rhythm data at the time of referral was presumptively diagnosed as monomorphic VT in 16 patients and polymorphic VT in 6 patients. Underlying structural heart disease was present in 20 (91%). EPS resulted in a diagnosis of SVT with aberrancy in all cases: comprising AV nodal re-entry tachycardia (n=10), orthodromic reciprocating tachycardia (n=3), focal atrial tachycardia (n=3), AF/AFL (n=3) and 'double fire' tachycardia (n=2). 21 (95%) patients underwent successful ablation. All patients remained free of arrhythmia recurrence at a median of 3.4 years of follow-up. ICD insertion was obviated in 18 (82%) patients, with 1 patient proceeding to ICD extraction. CONCLUSION SVT with atypical aberrancy may mimic monomorphic or polymorphic VT. Careful examination of all available rhythm data and consideration of an EPS can confirm SVT and obviate the need for ICD therapy.
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Affiliation(s)
- Jeremy William
- The Alfred Hospital, Melbourne, Australia; Department of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia
| | - Peter M Kistler Mbbd
- The Alfred Hospital, Melbourne, Australia; Department of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia
| | - Jonathan M Kalman
- The Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Melvin Scheinman
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Hariharan Sugumar
- The Alfred Hospital, Melbourne, Australia; Department of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Sandeep Prabhu
- The Alfred Hospital, Melbourne, Australia; Department of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Liang-Han Ling
- The Alfred Hospital, Melbourne, Australia; Department of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Vasath Vedantham
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Zian Tseng
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Joshua Moss
- Department of Medicine, University of California, San Francisco, CA, USA
| | | | - Aleksandr Voskoboinik
- The Alfred Hospital, Melbourne, Australia; Department of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia; The Royal Melbourne Hospital, Melbourne, Australia.
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Dai M, Chen Y, Qin J. Atrioventricular re-entrant tachycardia and atrioventricular node re-entrant tachycardia in a patient with cancer under chemotherapy: a case report and literature review. Front Cardiovasc Med 2024; 11:1367893. [PMID: 38911514 PMCID: PMC11190324 DOI: 10.3389/fcvm.2024.1367893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 05/21/2024] [Indexed: 06/25/2024] Open
Abstract
Cardio-oncology is a new field of interest in cardiology focusing on the detection and treatment of cardiovascular diseases, such as arrhythmias, myocarditis, and heart failure, as side-effects of chemotherapy and radiotherapy. The association between chemotherapeutic agents and arrhythmias has previously been established. Atrial tachyarrhythmias, particularly atrial fibrillation, are most common, but ventricular arrhythmias, including those related to treatment-induced QT prolongation, and bradyarrhythmias can also occur. However, the association between chemotherapeutic agents and atrioventricular re-entrant tachycardia (AVRT)/atrioventricular node re-entrant tachycardia (AVNRT) remains poorly understood. Here, we report a patient with new-onset AVRT/AVNRT and lung cancer who underwent chemotherapy. We considered that chemotherapy or cancer itself may have been a trigger for the initiation of paroxysmal AVRT/AVNRT, and that radiofrequency catheter ablation was effective in treating this type of tachycardia. Here, possible mechanisms and potential genes (mostly ion channels) involved in AVRT/AVNRT are summarized and the mechanisms underlying the possible regulatory patterns of cancer cells and chemotherapy on ion channels are reviewed. Finally, we considered that ion channel abnormalities may link cancer or chemotherapy to the onset of AVRT/AVNRT. The aim of the present study was to highlight the association between chemotherapeutic agents and AVRT/AVNRT and to provide new insights for future research. Understanding the intermediate mechanisms between chemotherapeutic agents and AVRT/AVNRT may be beneficial in preventing chemotherapy-evoked AVRT/AVNRT (and/or other arrhythmias) in future.
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Affiliation(s)
- Meiyan Dai
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yue Chen
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jin Qin
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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10
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Shoureshi P, Tan AY, Koneru J, Ellenbogen KA, Kaszala K, Huizar JF. Arrhythmia-Induced Cardiomyopathy: JACC State-of-the-Art Review. J Am Coll Cardiol 2024; 83:2214-2232. [PMID: 38811098 DOI: 10.1016/j.jacc.2024.03.416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 05/31/2024]
Abstract
Arrhythmias frequently accompany heart failure and left ventricular dysfunction. Tachycardias, atrial fibrillation, and premature ventricular contractions can induce a reversible form of dilated cardiomyopathy (CM) known as arrhythmia-induced CM (AiCM). The intriguing question is why certain individuals are more susceptible to AiCM, despite similar arrhythmia burdens. The primary challenge is determining the extent of arrhythmias' contribution to left ventricular systolic dysfunction. AiCM should be considered in patients with a mean heart rate of >100 beats/min, atrial fibrillation, or a PVC burden of >10%. Confirmation of AiCM occurs when CM reverses upon eliminating the responsible arrhythmia. Therapy choice depends on the specific arrhythmia, patient comorbidities, and preferences. After left ventricular function is restored, ongoing follow-up is essential if an abnormal myocardial substrate persists. Accurate diagnosis and treatment of AiCM have the potential to enhance patients' quality of life, improve clinical outcomes, and reduce hospital admissions and overall health care costs.
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Affiliation(s)
- Pouria Shoureshi
- Virginia Commonwealth University/Pauley Heart Center, Richmond, Virginia, USA; Central Virginia Veterans Affair Health Care System, Richmond, Virginia, USA
| | - Alex Y Tan
- Virginia Commonwealth University/Pauley Heart Center, Richmond, Virginia, USA; Central Virginia Veterans Affair Health Care System, Richmond, Virginia, USA
| | - Jayanthi Koneru
- Virginia Commonwealth University/Pauley Heart Center, Richmond, Virginia, USA
| | | | - Karoly Kaszala
- Virginia Commonwealth University/Pauley Heart Center, Richmond, Virginia, USA; Central Virginia Veterans Affair Health Care System, Richmond, Virginia, USA
| | - Jose F Huizar
- Virginia Commonwealth University/Pauley Heart Center, Richmond, Virginia, USA; Central Virginia Veterans Affair Health Care System, Richmond, Virginia, USA.
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11
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Sakai T, Tsuboi K, Takarada S, Okabe M, Nakaoka H, Ibuki K, Ozawa SW, Hata Y, Ichimata S, Nishida N, Hirono K. Tachycardia-Induced Cardiomyopathy in an Infant with Atrial Flutter and Prolonged Recovery of Cardiac Function. J Clin Med 2024; 13:3313. [PMID: 38893024 PMCID: PMC11172730 DOI: 10.3390/jcm13113313] [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: 04/27/2024] [Revised: 05/21/2024] [Accepted: 05/31/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Tachycardia-induced cardiomyopathy (TIC) is caused by prolonged tachycardia, leading to left ventricular dilatation and systolic dysfunction with heart failure. Although TIC is more common in adults, it is rare in early infancy. Methods: Clinical testing was performed as part of medical evaluation and management. Next-generation sequencing (NGS) was conducted for a patient with TIC. A literature review on TIC was also conducted. Results: The case involved a 5-month-old infant referred to the hospital due to symptoms of heart failure lasting at least two months. The infant's heart rate was 200 beats per minute, the left ventricular ejection fraction fell below 14%, and electrocardiograms showed atrial flutter, suggesting TIC. After cardioversion, there was no recurrence of atrial flutter, and cardiac function improved 98 days after tachycardia arrest. The NGS did not identify any pathogenic variants. The literature review identified eight early infantile cases of TIC. However, no previous reports described a case with such a prolonged duration of TIC as ours. Conclusions: This is the first report of a case of prolonged TIC in a child with the documented time to recover normal cardiac function. The improvement of cardiac function depends on the duration of TIC. Early recognition and intervention in TIC are essential to improve outcomes for infantile patients, as timely treatment offers the potential for recovery.
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Affiliation(s)
- Tomohide Sakai
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan; (T.S.)
| | - Kaori Tsuboi
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan; (T.S.)
| | - Shinya Takarada
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan; (T.S.)
| | - Mako Okabe
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan; (T.S.)
| | - Hideyuki Nakaoka
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan; (T.S.)
| | - Keijiro Ibuki
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan; (T.S.)
| | - Sayaka W. Ozawa
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan; (T.S.)
| | - Yukiko Hata
- Department of Legal Medicine, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Shojiro Ichimata
- Department of Legal Medicine, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Naoki Nishida
- Department of Legal Medicine, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Keiichi Hirono
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan; (T.S.)
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12
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Zhang Y, Zhang Z, Qu Z. Curvature-mediated source and sink effects on the genesis of premature ventricular complexes in long QT syndrome. Am J Physiol Heart Circ Physiol 2024; 326:H1350-H1365. [PMID: 38551483 DOI: 10.1152/ajpheart.00004.2024] [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: 01/02/2024] [Revised: 03/13/2024] [Accepted: 03/25/2024] [Indexed: 05/08/2024]
Abstract
Premature ventricular complexes (PVCs) are spontaneous excitations occurring in the ventricles of the heart that are associated with ventricular arrhythmias and sudden cardiac death. Under long QT conditions, PVCs can be mediated by repolarization gradient (RG) and early afterdepolarizations (EADs), yet the effects of heterogeneities or geometry of the RG or EAD regions on PVC genesis remain incompletely understood. In this study, we use computer simulation to systematically investigate the effects of the curvature of the RG border region on PVC genesis under long QT conditions. We show that PVCs can be either promoted or suppressed by negative or positive RG border curvature depending on the source and sink conditions. When the origin of oscillation is in the source region and the source is too strong, a positive RG border curvature can promote PVCs by causing the source area to oscillate. When the origin of oscillation is in the sink region, a negative RG border curvature can promote PVCs by causing the sink area to oscillate. Furthermore, EAD-mediated PVCs are also promoted by negative border curvature. We also investigate the effects of wavefront curvature and show that PVCs are promoted by convex but suppressed by concave wavefronts; however, the effect of wavefront curvature is much smaller than that of RG border curvature. In conclusion, besides the increase of RG and occurrence of EADs caused by QT prolongation, the geometry of the RG border plays important roles in PVC genesis, which can greatly increase the risk of arrhythmias in cardiac diseases.NEW & NOTEWORTHY The effects of the curvature or geometry of the repolarization gradient region and wavefront curvature on the genesis of premature ventricular complexes are systematically investigated using computer modeling and simulation. Premature ventricular complexes can be promoted by either positive or negative curvature of the gradient region depending on the source and sink conditions. The underlying mechanisms of the curvature effects are revealed, which provides mechanistic insights into arrhythmogenesis in cardiac diseases.
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Affiliation(s)
- Yuhao Zhang
- Department of Physics, School of Physical Science and Technology, Ningbo University, Ningbo, People's Republic of China
| | - Zhaoyang Zhang
- Department of Physics, School of Physical Science and Technology, Ningbo University, Ningbo, People's Republic of China
| | - Zhilin Qu
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, United States
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13
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Yen KC, Chan YH, Wang CL. Number of Premature Ventricular Complexes Predicts Long-Term Outcomes in Patients with Persistent Atrial Fibrillation. Biomedicines 2024; 12:1149. [PMID: 38927356 PMCID: PMC11200947 DOI: 10.3390/biomedicines12061149] [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: 04/14/2024] [Revised: 05/14/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Premature ventricular complexes (PVCs) are common electrocardiographic abnormalities and may be a prognosticator in predicting mortality in patients with structurally normal hearts or chronic heart diseases. Whether PVC burden was associated with mortality in patients with chronic atrial fibrillation (AF) remained unknown. We investigated the prognostic value of PVC burden in patients with persistent AF. METHODS A retrospective analysis of 24 h Holter recordings of 1767 patients with persistent AF was conducted. Clinical characteristics, 24 h average heart rate (HR), and PVC measures, including 24 h PVC burden and the presence of consecutive PVCs (including any PVC couplet, triplet, or non-sustained ventricular tachycardia) were examined for the prediction of all-cause and cardiovascular mortality using the Cox proportional hazards model. RESULTS After a median follow-up time of 30 months, 286 (16%) patients died and 1481 (84%) patients survived. Multivariate analysis revealed that age, heart failure, stroke, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, beta-blocker, digoxin, oral anticoagulant use, and estimated glomerular filtration rate were significant baseline predictors of all-cause mortality and cardiovascular mortality. Twenty-four-hour PVC burden and the presence of consecutive PVCs were significantly associated with all-cause and cardiovascular mortality after adjusting for significant clinical factors. When compared to the first quartile of PVC burden (<0.003%/day), the highest quartile (>0.3%/day) was significantly associated with an increased risk of all-cause mortality (hazard ratio, 2.46; 95% CI, 1.77-3.42) and cardiovascular mortality (hazard ratio: 2.67; 95% CI, 1.76-4.06). CONCLUSIONS Twenty-four-hour PVC burden is independently associated with all-cause and cardiovascular mortality in patients with persistent AF.
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Affiliation(s)
- Kun-Chi Yen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan; (K.-C.Y.); (C.-L.W.)
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Yi-Hsin Chan
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan; (K.-C.Y.); (C.-L.W.)
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Microscopy Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taoyuan 33305, Taiwan
| | - Chun-Li Wang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan; (K.-C.Y.); (C.-L.W.)
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
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14
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Preda A, Falco R, Tognola C, Carbonaro M, Vargiu S, Gallazzi M, Baroni M, Gigli L, Varrenti M, Colombo G, Zanotto G, Giannattasio C, Mazzone P, Guarracini F. Contemporary Advances in Cardiac Remote Monitoring: A Comprehensive, Updated Mini-Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:819. [PMID: 38793002 PMCID: PMC11122881 DOI: 10.3390/medicina60050819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/09/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024]
Abstract
Over the past decade, remote monitoring (RM) has become an increasingly popular way to improve healthcare and health outcomes. Modern cardiac implantable electronic devices (CIEDs) are capable of recording an increasing amount of data related to CIED function, arrhythmias, physiological status and hemodynamic parameters, providing in-depth and updated information on patient cardiovascular function. The extensive use of RM for patients with CIED allows for early diagnosis and rapid assessment of relevant issues, both clinical and technical, as well as replacing outpatient follow-up improving overall management without compromise safety. This approach is recommended by current guidelines for all eligible patients affected by different chronic cardiac conditions including either brady- and tachy-arrhythmias and heart failure. Beyond to clinical advantages, RM has demonstrated cost-effectiveness and is associated with elevated levels of patient satisfaction. Future perspectives include improving security, interoperability and diagnostic power as well as to engage patients with digital health technology. This review aims to update existing data concerning clinical outcomes in patients managed with RM in the wide spectrum of cardiac arrhythmias and Hear Failure (HF), disclosing also about safety, effectiveness, patient satisfaction and cost-saving.
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Affiliation(s)
- Alberto Preda
- Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy (M.V.)
| | - Raffaele Falco
- Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy (M.V.)
| | - Chiara Tognola
- Clinical Cardiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy
| | - Marco Carbonaro
- Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy (M.V.)
| | - Sara Vargiu
- Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy (M.V.)
| | - Michela Gallazzi
- Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy (M.V.)
| | - Matteo Baroni
- Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy (M.V.)
| | - Lorenzo Gigli
- Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy (M.V.)
| | - Marisa Varrenti
- Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy (M.V.)
| | - Giulia Colombo
- Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy (M.V.)
| | - Gabriele Zanotto
- Department of Cardiology, Ospedale Magalini di Villafranca, 37069 Villafranca di Verona, Italy
| | - Cristina Giannattasio
- Clinical Cardiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Patrizio Mazzone
- Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy (M.V.)
| | - Fabrizio Guarracini
- Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy (M.V.)
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15
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Trimarchi G, Teresi L, Licordari R, Pingitore A, Pizzino F, Grimaldi P, Calabrò D, Liotta P, Micari A, de Gregorio C, Di Bella G. Transient Left Ventricular Dysfunction from Cardiomyopathies to Myocardial Viability: When and Why Cardiac Function Recovers. Biomedicines 2024; 12:1051. [PMID: 38791012 PMCID: PMC11117605 DOI: 10.3390/biomedicines12051051] [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: 04/15/2024] [Revised: 04/30/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Transient left ventricular dysfunction (TLVD), a temporary condition marked by reversible impairment of ventricular function, remains an underdiagnosed yet significant contributor to morbidity and mortality in clinical practice. Unlike the well-explored atherosclerotic disease of the epicardial coronary arteries, the diverse etiologies of TLVD require greater attention for proper diagnosis and management. The spectrum of disorders associated with TLVD includes stress-induced cardiomyopathy, central nervous system injuries, histaminergic syndromes, various inflammatory diseases, pregnancy-related conditions, and genetically determined syndromes. Furthermore, myocardial infarction with non-obstructive coronary arteries (MINOCA) origins such as coronary artery spasm, coronary thromboembolism, and spontaneous coronary artery dissection (SCAD) may also manifest as TLVD, eventually showing recovery. This review highlights the range of ischemic and non-ischemic clinical situations that lead to TLVD, gathering conditions like Tako-Tsubo Syndrome (TTS), Kounis syndrome (KS), Myocarditis, Peripartum Cardiomyopathy (PPCM), and Tachycardia-induced cardiomyopathy (TIC). Differentiation amongst these causes is crucial, as they involve distinct clinical, instrumental, and genetic predictors that bode different outcomes and recovery potential for left ventricular function. The purpose of this review is to improve everyday clinical approaches to treating these diseases by providing an extensive survey of conditions linked with TLVD and the elements impacting prognosis and outcomes.
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Affiliation(s)
- Giancarlo Trimarchi
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, 98100 Messina, Italy; (L.T.); (P.G.); (D.C.); (P.L.); (C.d.G.); (G.D.B.)
| | - Lucio Teresi
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, 98100 Messina, Italy; (L.T.); (P.G.); (D.C.); (P.L.); (C.d.G.); (G.D.B.)
| | - Roberto Licordari
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, 98100 Messina, Italy; (R.L.); (A.M.)
| | - Alessandro Pingitore
- Istituto di Fisiologia Clinica, Clinical Physiology Institute, CNR, 56124 Pisa, Italy;
| | - Fausto Pizzino
- Cardiology Unit, Heart Centre, Fondazione Gabriele Monasterio—Regione Toscana, 54100 Massa, Italy;
| | - Patrizia Grimaldi
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, 98100 Messina, Italy; (L.T.); (P.G.); (D.C.); (P.L.); (C.d.G.); (G.D.B.)
| | - Danila Calabrò
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, 98100 Messina, Italy; (L.T.); (P.G.); (D.C.); (P.L.); (C.d.G.); (G.D.B.)
| | - Paolo Liotta
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, 98100 Messina, Italy; (L.T.); (P.G.); (D.C.); (P.L.); (C.d.G.); (G.D.B.)
| | - Antonio Micari
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, 98100 Messina, Italy; (R.L.); (A.M.)
| | - Cesare de Gregorio
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, 98100 Messina, Italy; (L.T.); (P.G.); (D.C.); (P.L.); (C.d.G.); (G.D.B.)
| | - Gianluca Di Bella
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, 98100 Messina, Italy; (L.T.); (P.G.); (D.C.); (P.L.); (C.d.G.); (G.D.B.)
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16
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Serban T, Badertscher P, du Fay de Lavallaz J, Providencia R, Migliore F, Mugnai G, Penela D, Perrotta L, Kühne M, Sticherling C, Chun KRJ. Definition and management of arrhythmia-induced cardiomyopathy: findings from the European Heart Rhythm Association survey. Europace 2024; 26:euae112. [PMID: 38693772 PMCID: PMC11094751 DOI: 10.1093/europace/euae112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/25/2024] [Indexed: 05/03/2024] Open
Abstract
AIMS Arrhythmia-induced cardiomyopathy (AiCM) represents a subtype of acute heart failure (HF) in the context of sustained arrhythmia. Clear definitions and management recommendations for AiCM are lacking. The European Heart Rhythm Association Scientific Initiatives Committee (EHRA SIC) conducted a survey to explore the current definitions and management of patients with AiCM among European and non-European electrophysiologists. METHODS AND RESULTS A 25-item online questionnaire was developed and distributed among EP specialists on the EHRA SIC website and on social media between 4 September and 5 October 2023. Of the 206 respondents, 16% were female and 61% were between 30 and 49 years old. Most of the respondents were EP specialists (81%) working at university hospitals (47%). While most participants (67%) agreed that AiCM should be defined as a left ventricular ejection fraction (LVEF) impairment after new onset of an arrhythmia, only 35% identified a specific LVEF drop to diagnose AiCM with a wide range of values (5-20% LVEF drop). Most respondents considered all available therapies: catheter ablation (93%), electrical cardioversion (83%), antiarrhythmic drugs (76%), and adjuvant HF treatment (76%). A total of 83% of respondents indicated that adjuvant HF treatment should be started at first HF diagnosis prior to antiarrhythmic treatment, and 84% agreed it should be stopped within six months after LVEF normalization. Responses for the optimal time point for the first LVEF reassessment during follow-up varied markedly (1 day-6 months after antiarrhythmic treatment). CONCLUSION This EHRA Survey reveals varying practices regarding AiCM among physicians, highlighting a lack of consensus and heterogenous care of these patients.
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Affiliation(s)
- Teodor Serban
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Patrick Badertscher
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Jeanne du Fay de Lavallaz
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Rui Providencia
- Department of Cardiology, St Bartholomew’s Hospital, London, UK
| | - Federico Migliore
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Giacomo Mugnai
- Department of Cardiology, University Hospital of Verona, Verona, Italy
| | - Diego Penela
- Department of Cardiology, Medical Centre Teknon, Grupo Quironsalud, Barcelona, Spain
| | - Laura Perrotta
- Department of Cardiology, Careggi University Hospital, Florence, Italy
| | - Michael Kühne
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Kyoung-Ryul Julian Chun
- Department of Electrophysiology, Cardiology and Angiology Center Bethanien, Frankfurt, Germany
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17
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van der Lingen ALCJ, Verstraelen TE, van Erven L, Meeder JG, Theuns DA, Vernooy K, Wilde AAM, Maass AH, Allaart CP. Assessment of ICD eligibility in non-ischaemic cardiomyopathy patients: a position statement by the Task Force of the Dutch Society of Cardiology. Neth Heart J 2024; 32:190-197. [PMID: 38634993 DOI: 10.1007/s12471-024-01859-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 04/19/2024] Open
Abstract
International guidelines recommend implantation of an implantable cardioverter-defibrillator (ICD) in non-ischaemic cardiomyopathy (NICM) patients with a left ventricular ejection fraction (LVEF) below 35% despite optimal medical therapy and a life expectancy of more than 1 year with good functional status. We propose refinement of these recommendations in patients with NICM, with careful consideration of additional risk parameters for both arrhythmic and non-arrhythmic death. These additional parameters include late gadolinium enhancement on cardiac magnetic resonance imaging and genetic testing for high-risk genetic variants to further assess arrhythmic risk, and age, comorbidities and sex for assessment of non-arrhythmic mortality risk. Moreover, several risk modifiers should be taken into account, such as concomitant arrhythmias that may affect LVEF (atrial fibrillation, premature ventricular beats) and resynchronisation therapy. Even though currently no valid cut-off values have been established, the proposed approach provides a more careful consideration of risks that may result in withholding ICD implantation in patients with low arrhythmic risk and substantial non-arrhythmic mortality risk.
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Affiliation(s)
- Anne-Lotte C J van der Lingen
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Tom E Verstraelen
- Department of Cardiology, Heart Centre, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Lieselot van Erven
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Joan G Meeder
- Department of Cardiology, VieCuri Medical Centre Noord-Limburg, Venlo, The Netherlands
| | - Dominic A Theuns
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Arthur A M Wilde
- Department of Cardiology, Heart Centre, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Alexander H Maass
- Department of Cardiology, University Medical Centre Groningen, Heart Centre, University of Groningen, Groningen, The Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
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18
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Borges-Rosa J, Sousa PA, António N, Elvas L, Gonçalves L. Predictors of systolic function recovery after atrial fibrillation ablation in heart failure patients. Rev Port Cardiol 2024:S0870-2551(24)00115-X. [PMID: 38701967 DOI: 10.1016/j.repc.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/21/2023] [Accepted: 02/06/2024] [Indexed: 05/06/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES Atrial fibrillation (AF) and heart failure (HF) often coexist. AF catheter ablation improves left ventricular ejection fraction (LVEF), but its impact varies between patients. We aimed to identify predictors of LVEF improvement in HF patients with impaired LVEF undergoing AF ablation. METHODS We conducted a retrospective single-center study in HF patients with LVEF <50% undergoing AF catheter ablation between May 2016 and May 2022. The primary endpoint was the LVEF recovery rate ('responders'). Secondary endpoints were one-year safety and effectiveness. We also aimed to validate a prediction model for LVEF recovery. RESULTS The study included 100 patients (79% male, median age 60 years, 70% with probable tachycardia-induced cardiomyopathy [TIC], mean LVEF 37%, 29% with paroxysmal AF). After a median follow-up of 12 months after catheter ablation, LVEF improved significantly (36±10% vs. 53±10%, p<0.001), with an 82% responder rate. A suspected diagnosis of TIC (OR 4.916 [95% CI 1.166-20.732], p=0.030), shorter QRS duration (OR 0.969 [95% CI 0.945-0.994], p=0.015), and smaller left ventricle (OR 0.893 [95% CI 0.799-0.999], p=0.049) were independently associated with LVEF improvement. Freedom from any documented atrial arrhythmia was 86% (64% under antiarrhythmic drugs), and the rate of adverse events was 2%. The prediction model had a good discriminative performance (AUC 0.814 [95% CI 0.681-0.947]). CONCLUSION In AF patients with HF and impaired LVEF, suspected TIC, shorter QRS duration, and smaller LV diameter were associated with LVEF recovery following AF catheter ablation.
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Affiliation(s)
- João Borges-Rosa
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Pedro A Sousa
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - Natália António
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; iCBR, Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
| | - Luís Elvas
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Lino Gonçalves
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; iCBR, Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
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19
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Schach C, Körtl T, Zeman F, Luttenberger B, Mühleck F, Baum P, Lavall D, Vosshage NH, Resch M, Ripfel S, Meindl C, Ücer E, Hamer OW, Baessler A, Arzt M, Koller M, Sohns C, Maier LS, Wachter R, Sossalla S. Clinical Characterization of Arrhythmia-Induced Cardiomyopathy in Patients With Tachyarrhythmia and Idiopathic Heart Failure. JACC Clin Electrophysiol 2024; 10:870-881. [PMID: 38483417 DOI: 10.1016/j.jacep.2024.102332] [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: 07/31/2023] [Revised: 01/18/2024] [Accepted: 01/20/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Arrhythmia-induced cardiomyopathy (AIC) is a known entity, but prospective evidence for its characterization is limited. OBJECTIVES This study aimed to: 1) determine the relative frequency of the pure form of AIC in the clinically relevant cohort of patients with newly diagnosed, otherwise unexplained left ventricular systolic dysfunction (LVSD) and tachyarrhythmia; 2) assess the time to recovery from LVSD; and 3) identify parameters for an early diagnosis of AIC. METHODS Patients were prospectively included, underwent effective rhythm restoration, and were followed-up at 2, 4, and 6 months to evaluate clinical characteristics, biomarkers, and cardiac imaging including cardiac magnetic resonance imaging. Patients with recurred arrhythmia were excluded from analysis. RESULTS 41 of 50 patients were diagnosed with AIC 6 months after rhythm restoration. Left ventricular (LV) ejection fraction increased 2 months after rhythm restoration from 35.4% ± 8.2% to 52.7% ± 8.0% in AIC patients vs 37.0% ± 9.5% to 43.3% ± 7.0% in non-AIC patients. From month 2 to 6, LV ejection fraction continued to increase in AIC patients (57.2% ± 6.1%; P < 0.001) but remained stable in non-AIC patients (44.0% ± 7.8%; P = 0.628). Multivariable logistic regression analysis revealed that lower LV end-diastolic diameter at baseline could be used for early diagnosis of AIC, whereas biomarkers and other morphological or functional parameters, including late LV gadolinium enhancement, did not show suitability for early diagnosis. CONCLUSIONS We observed a high prevalence of AIC in patients with otherwise unexplained LVSD and concomitant tachyarrhythmia, suggesting that this condition may be underdiagnosed in clinical practice. Most patients recovered fast, within months, from LVSD. A low initial LV end-diastolic diameter may constitute an early marker for diagnosis of AIC.
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Affiliation(s)
- Christian Schach
- Universitäres Herzzentrum Regensburg, Klinik und Poliklinik für Innere Medizin II, Abteilung für Kardiologie, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Thomas Körtl
- Universitäres Herzzentrum Regensburg, Klinik und Poliklinik für Innere Medizin II, Abteilung für Kardiologie, Universitätsklinikum Regensburg, Regensburg, Germany; Justus-Liebig-Universität Giessen, Medizinische Klinik I, Gießen, Germany
| | - Florian Zeman
- Universitätsklinikum Regensburg, Zentrum für Klinische Studien, Regensburg, Germany
| | - Bianca Luttenberger
- Universitäres Herzzentrum Regensburg, Klinik und Poliklinik für Innere Medizin II, Abteilung für Kardiologie, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Franziska Mühleck
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Kardiologie, Leipzig, Germany
| | - Paul Baum
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Kardiologie, Leipzig, Germany
| | - Daniel Lavall
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Kardiologie, Leipzig, Germany
| | - Nicola H Vosshage
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Kardiologie, Leipzig, Germany
| | - Markus Resch
- Caritas Krankenhaus St. Josef, Abteilung für Kardiologie, Regensburg, Germany
| | - Sarah Ripfel
- Universitäres Herzzentrum Regensburg, Klinik und Poliklinik für Innere Medizin II, Abteilung für Kardiologie, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Christine Meindl
- Universitäres Herzzentrum Regensburg, Klinik und Poliklinik für Innere Medizin II, Abteilung für Kardiologie, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Ekrem Ücer
- Universitäres Herzzentrum Regensburg, Klinik und Poliklinik für Innere Medizin II, Abteilung für Kardiologie, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Okka W Hamer
- Universitäres Herzzentrum Regensburg, Institut für Röntgendiagnostik, Regensburg, Germany
| | - Andrea Baessler
- Universitäres Herzzentrum Regensburg, Klinik und Poliklinik für Innere Medizin II, Abteilung für Kardiologie, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Michael Arzt
- Universitäres Herzzentrum Regensburg, Klinik und Poliklinik für Innere Medizin II, Abteilung für Kardiologie, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Michael Koller
- Universitätsklinikum Regensburg, Zentrum für Klinische Studien, Regensburg, Germany
| | - Christian Sohns
- Ruhr-Universität Bochum, Klinik für Elektrophysiologie, Bad Oeynhausen, Germany
| | - Lars S Maier
- Universitäres Herzzentrum Regensburg, Klinik und Poliklinik für Innere Medizin II, Abteilung für Kardiologie, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Rolf Wachter
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Kardiologie, Leipzig, Germany
| | - Samuel Sossalla
- Universitäres Herzzentrum Regensburg, Klinik und Poliklinik für Innere Medizin II, Abteilung für Kardiologie, Universitätsklinikum Regensburg, Regensburg, Germany; Justus-Liebig-Universität Giessen, Medizinische Klinik I, Gießen, Germany; Campus der Universität Giessen, Kerckhoff-Klinik, Abteilung für Kardiologie, Bad Nauheim, Germany.
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20
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Attachaipanich T, Thiravetyan B, Tribuddharat N, Jaroonpipatkul S, Navaravong L. Premature Ventricular Contraction-Induced Cardiomyopathy: Contemporary Evidence from Risk Stratification, Pathophysiology, and Management. J Clin Med 2024; 13:2635. [PMID: 38731164 PMCID: PMC11084868 DOI: 10.3390/jcm13092635] [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: 03/18/2024] [Revised: 04/16/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
Premature ventricular complexes (PVCs) are commonly encountered problems in clinical settings. The range of symptoms can be from asymptomatic to palpitations, fatigue, or heart failure symptoms. A higher burden of PVCs is a risk factor for development of PVC-induced cardiomyopathy (PIC). Rhythm evaluation by 12-lead ECG and an ambulatory monitoring device are essential. Currently, several imaging modalities, such as echocardiography and cardiac magnetic resonance imaging, are utilized to evaluate the underlying structure that may be related to PIC. Beta blockers and antiarrhythmic drugs are typically part of the initial management strategy. If these fail, catheter ablation of PVCs is typically the next step. The purpose of this article is to summarize the current evidence/knowledge about PIC.
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Affiliation(s)
- Tanawat Attachaipanich
- Cardiac Electrophysiology Research and Training Center, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Ben Thiravetyan
- Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand;
| | | | - Surachat Jaroonpipatkul
- Division of Cardiology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok 10400, Thailand;
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21
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Okabe Y, Murakoshi N, Kurebayashi N, Inoue H, Ito Y, Murayama T, Miyoshi C, Funato H, Ishii K, Xu D, Tajiri K, Qin R, Aonuma K, Murakata Y, Song Z, Wakana S, Yokoyama U, Sakurai T, Aonuma K, Ieda M, Yanagisawa M. An inherited life-threatening arrhythmia model established by screening randomly mutagenized mice. Proc Natl Acad Sci U S A 2024; 121:e2218204121. [PMID: 38621141 PMCID: PMC11047072 DOI: 10.1073/pnas.2218204121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/27/2024] [Indexed: 04/17/2024] Open
Abstract
Inherited arrhythmia syndromes (IASs) can cause life-threatening arrhythmias and are responsible for a significant proportion of sudden cardiac deaths (SCDs). Despite progress in the development of devices to prevent SCDs, the precise molecular mechanisms that induce detrimental arrhythmias remain to be fully investigated, and more effective therapies are desirable. In the present study, we screened a large-scale randomly mutagenized mouse library by electrocardiography to establish a disease model of IASs and consequently found one pedigree that exhibited spontaneous ventricular arrhythmias (VAs) followed by SCD within 1 y after birth. Genetic analysis successfully revealed a missense mutation (p.I4093V) of the ryanodine receptor 2 gene to be a cause of the arrhythmia. We found an age-related increase in arrhythmia frequency accompanied by cardiomegaly and decreased ventricular contractility in the Ryr2I4093V/+ mice. Ca2+ signaling analysis and a ryanodine binding assay indicated that the mutant ryanodine receptor 2 had a gain-of-function phenotype and enhanced Ca2+ sensitivity. Using this model, we detected the significant suppression of VA following flecainide or dantrolene treatment. Collectively, we established an inherited life-threatening arrhythmia mouse model from an electrocardiogram-based screen of randomly mutagenized mice. The present IAS model may prove feasible for use in investigating the mechanisms of SCD and assessing therapies.
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Affiliation(s)
- Yuta Okabe
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba305-8575, Japan
| | - Nobuyuki Murakoshi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba305-8575, Japan
| | - Nagomi Kurebayashi
- Department of Cellular and Molecular Pharmacology, Juntendo University Graduate School of Medicine, Tokyo113-8421, Japan
| | - Hana Inoue
- Department of Physiology, Tokyo Medical University, Tokyo160-8402, Japan
| | - Yoko Ito
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba305-8575, Japan
| | - Takashi Murayama
- Department of Cellular and Molecular Pharmacology, Juntendo University Graduate School of Medicine, Tokyo113-8421, Japan
| | - Chika Miyoshi
- International Institute for Integrative Sleep Medicine, University of Tsukuba, Tsukuba305-8575, Japan
| | - Hiromasa Funato
- International Institute for Integrative Sleep Medicine, University of Tsukuba, Tsukuba305-8575, Japan
| | - Koichiro Ishii
- Department of Cellular and Molecular Pharmacology, Juntendo University Graduate School of Medicine, Tokyo113-8421, Japan
| | - Dongzhu Xu
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba305-8575, Japan
| | - Kazuko Tajiri
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba305-8575, Japan
| | - Rujie Qin
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba305-8575, Japan
| | - Kazuhiro Aonuma
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba305-8575, Japan
| | - Yoshiko Murakata
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba305-8575, Japan
| | - Zonghu Song
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba305-8575, Japan
| | - Shigeharu Wakana
- Technology and Development Team for Mouse Phenotype Analysis, RIKEN BioResource Center, Tsukuba305-0074, Japan
- Department of Animal Experimentation, Foundation for Biomedical Research and Innovation at Kobe, Kobe650-0047, Japan
| | - Utako Yokoyama
- Department of Physiology, Tokyo Medical University, Tokyo160-8402, Japan
| | - Takashi Sakurai
- Department of Cellular and Molecular Pharmacology, Juntendo University Graduate School of Medicine, Tokyo113-8421, Japan
| | - Kazutaka Aonuma
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba305-8575, Japan
| | - Masaki Ieda
- Department of Cardiology, Keio University School of Medicine, Tokyo160-8582, Japan
| | - Masashi Yanagisawa
- International Institute for Integrative Sleep Medicine, University of Tsukuba, Tsukuba305-8575, Japan
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22
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Serban T, Hennings E, Strebel I, Knecht S, du Fay de Lavallaz J, Krisai P, Arnet R, Völlmin G, Osswald S, Sticherling C, Kühne M, Badertscher P. Biomarkers to predict improvement of left ventricular ejection fraction after atrial fibrillation ablation. Heart Rhythm 2024:S1547-5271(24)02371-3. [PMID: 38614192 DOI: 10.1016/j.hrthm.2024.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 03/27/2024] [Accepted: 04/04/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Atrial fibrillation (AF) and heart failure frequently coexist. Prediction of left ventricular ejection fraction (LVEF) recovery after catheter ablation (CA) for AF remains difficult. OBJECTIVE The purpose of this study was to evaluate the value of biomarkers, alone and in combination with the Antwerp score, to predict LVEF recovery after CA for AF. METHODS Patients undergoing CA for AF with depressed LVEF (<50%) were included. Plasma levels of 13 biomarkers were measured immediately before CA. Patients were categorized into "responders" and "nonresponders" in a similar fashion to the Antwerp score performance derivation and validation cohorts. The predictive power of the biomarkers alone and combined in outcome prediction was evaluated. RESULTS A total of 208 patients with depressed LVEF were included (median age 63 years; 39-19% female; median indexed left atrial volume 42 (33-52) mL/m2; median LVEF 43 (38-46)%). At a median follow-up time of 30 (20-34) months, 161 (77%) were responders and 47 (23%) were nonresponders. Of 13 biomarkers, -4-angiopoietin 2 (ANG2), growth differentiation factor 15 (GDF15), fibroblast growth factor 23, and myosin binding protein C3-were significantly different between responders and nonresponders (P ≤ .001) and their combination could predict the end point with an area under the curve of 0.72 (95% confidence interval [CI] 0.64-0.81) overall, 0.69 (95% CI 0.59-0.78) in heart failure with mildly reduced ejection fraction, and 0.88 (95% CI 0.77-0.98) in heart failure with reduced ejection fraction. Only ANG2 and GDF15 remained significantly associated with LVEF recovery after adjustment for age, sex, and Antwerp score and significantly improved the accuracy of the Antwerp score predictions (P < .001). The area under the curve of the Antwerp score in the outcome prediction improved from 0.75 (95% CI 0.67-0.83) to 0.78 (95% CI 0.70-0.86). CONCLUSION A biomarker panel (ANG2 and GDF15) significantly improved the accuracy of the Antwerp score.
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Affiliation(s)
- Teodor Serban
- Cardiovascular Research Institute, Basel, Switzerland; Department of Cardiology, University Hospital of Basel, Switzerland
| | - Elisa Hennings
- Cardiovascular Research Institute, Basel, Switzerland; Department of Cardiology, University Hospital of Basel, Switzerland
| | - Ivo Strebel
- Cardiovascular Research Institute, Basel, Switzerland; Department of Cardiology, University Hospital of Basel, Switzerland
| | - Sven Knecht
- Cardiovascular Research Institute, Basel, Switzerland; Department of Cardiology, University Hospital of Basel, Switzerland
| | - Jeanne du Fay de Lavallaz
- Cardiovascular Research Institute, Basel, Switzerland; Department of Cardiology, University Hospital of Basel, Switzerland
| | - Philipp Krisai
- Cardiovascular Research Institute, Basel, Switzerland; Department of Cardiology, University Hospital of Basel, Switzerland
| | - Rebecca Arnet
- Cardiovascular Research Institute, Basel, Switzerland; Department of Cardiology, University Hospital of Basel, Switzerland
| | - Gian Völlmin
- Cardiovascular Research Institute, Basel, Switzerland; Department of Cardiology, University Hospital of Basel, Switzerland
| | - Stefan Osswald
- Cardiovascular Research Institute, Basel, Switzerland; Department of Cardiology, University Hospital of Basel, Switzerland
| | - Christian Sticherling
- Cardiovascular Research Institute, Basel, Switzerland; Department of Cardiology, University Hospital of Basel, Switzerland
| | - Michael Kühne
- Cardiovascular Research Institute, Basel, Switzerland; Department of Cardiology, University Hospital of Basel, Switzerland
| | - Patrick Badertscher
- Cardiovascular Research Institute, Basel, Switzerland; Department of Cardiology, University Hospital of Basel, Switzerland.
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23
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Awindaogo F, Acheamfour-Akowuah E, Doku A, Kokuro C, Agyekum F, Owusu IK. Assessing and Improving the Care of Patients With Heart Failure in Ghana: Protocol for a Prospective Observational Study and the Ghana Heart Initiative-Heart Failure Registry. JMIR Res Protoc 2024; 13:e52616. [PMID: 38588528 PMCID: PMC11036190 DOI: 10.2196/52616] [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: 09/10/2023] [Revised: 12/23/2023] [Accepted: 12/24/2023] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Heart failure (HF) is a leading cause of morbidity and mortality globally, with a high disease burden. The prevalence of HF in Ghana is increasing rapidly, but epidemiological profiles, treatment patterns, and survival data are scarce. The national capacity to diagnose and manage HF appropriately is also limited. To address the growing epidemic of HF, it is crucial to recognize the epidemiological characteristics and medium-term outcomes of HF in Ghana and improve the capability to identify and manage HF promptly and effectively at all levels of care. OBJECTIVE This study aims to determine the epidemiological characteristics and medium-term HF outcomes in Ghana. METHODS We conducted a prospective, multicenter, multilevel cross-sectional observational study of patients with HF from January to December 2023. Approximately 5000 patients presenting with HF to 9 hospitals, including teaching, regional, and municipal hospitals, will be recruited and evaluated according to a standardized protocol, including the use of an echocardiogram and an N-terminal pro-brain natriuretic peptide (NT-proBNP) test. Guideline-directed medical treatment of HF will be initiated for 6 months, and the medium-term outcomes of interventions, including rehospitalization and mortality, will be assessed. Patient data will be collated into a HF registry for continuous assessment and monitoring. RESULTS This intervention will generate the necessary information on the etiology of HF, clinical presentations, the diagnostic yield of various tools, and management outcomes. In addition, it will build the necessary capacity and support for HF management in Ghana. As of July 30, 2023, the training and onboarding of all 9 centers had been completed. Preliminary analyses will be conducted by the end of the second quarter of 2024, and results are expected to be publicly available by the middle of 2024. CONCLUSIONS This study will provide the necessary data on HF, which will inform decisions on the prevention and management of HF and form the basis for future research. TRIAL REGISTRATION ISRCTN Registry (United Kingdom) ISRCTN18216214; https:www.isrctn.com/ISRCTN18216214. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52616.
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Affiliation(s)
| | | | - Alfred Doku
- Department of Medicine and Therapeutics, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | - Collins Kokuro
- Department of Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Francis Agyekum
- Department of Medicine and Therapeutics, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | - Isaac Kofi Owusu
- Department of Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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24
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Lalario A, Rossi M, Allegro V, Gagno G, Perotto M, De Luca A, Merlo M, Sanna GD, Sinagra G. Abnormal conduction-induced cardiomyopathy: a poorly explored entity. Eur Heart J Suppl 2024; 26:i117-i122. [PMID: 38867859 PMCID: PMC11167964 DOI: 10.1093/eurheartjsupp/suae028] [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] [Indexed: 06/14/2024]
Abstract
A dyssynchronous biventricular activation, which can be determined by left bundle branch block, chronic right ventricular pacing, frequent premature ventricular complexes, or pre-excitation, can cause a global abnormal contractility, thus leading to systolic dysfunction and left ventricular remodelling in a unique nosological entities: abnormal conduction-induced cardiomyopathies. In this clinical scenario, the mainstay therapy is eliminating or improving LV dyssynchrony, removing the trigger. This usually ensures the improvement and even recovery of cardiac geometry and left ventricular function, especially in the absence of genetic background. A multidisciplinary approach, integrating advanced multimodal imaging, is essential for the systematic aetiological definition and the subsequent evaluation and aetiology-guided therapies of patients and their families. This review aims to describe mechanisms, prevalence, risk factors, and diagnostic and therapeutic approach to the various abnormal conduction-induced cardiomyopathies, starting from reasonable certainties and then analysing the grey areas requiring further studies.
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Affiliation(s)
- Andrea Lalario
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste
- European Reference Network for rare, low prevalence and complex diseases of the heart (ERN GUARD-Heart), Italy
| | - Maddalena Rossi
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste
- European Reference Network for rare, low prevalence and complex diseases of the heart (ERN GUARD-Heart), Italy
| | - Valentina Allegro
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste
- European Reference Network for rare, low prevalence and complex diseases of the heart (ERN GUARD-Heart), Italy
| | - Giulia Gagno
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste
- European Reference Network for rare, low prevalence and complex diseases of the heart (ERN GUARD-Heart), Italy
| | - Maria Perotto
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste
- European Reference Network for rare, low prevalence and complex diseases of the heart (ERN GUARD-Heart), Italy
| | - Antonio De Luca
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste
- European Reference Network for rare, low prevalence and complex diseases of the heart (ERN GUARD-Heart), Italy
| | - Marco Merlo
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste
- European Reference Network for rare, low prevalence and complex diseases of the heart (ERN GUARD-Heart), Italy
| | | | - Gianfranco Sinagra
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste
- European Reference Network for rare, low prevalence and complex diseases of the heart (ERN GUARD-Heart), Italy
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25
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Tu C, Caudal A, Liu Y, Gorgodze N, Zhang H, Lam CK, Dai Y, Zhang A, Wnorowski A, Wu MA, Yang H, Abilez OJ, Lyu X, Narayan SM, Mestroni L, Taylor MRG, Recchia FA, Wu JC. Tachycardia-induced metabolic rewiring as a driver of contractile dysfunction. Nat Biomed Eng 2024; 8:479-494. [PMID: 38012305 PMCID: PMC11088531 DOI: 10.1038/s41551-023-01134-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 10/15/2023] [Indexed: 11/29/2023]
Abstract
Prolonged tachycardia-a risk factor for cardiovascular morbidity and mortality-can induce cardiomyopathy in the absence of structural disease in the heart. Here, by leveraging human patient data, a canine model of tachycardia and engineered heart tissue generated from human induced pluripotent stem cells, we show that metabolic rewiring during tachycardia drives contractile dysfunction by promoting tissue hypoxia, elevated glucose utilization and the suppression of oxidative phosphorylation. Mechanistically, a metabolic shift towards anaerobic glycolysis disrupts the redox balance of nicotinamide adenine dinucleotide (NAD), resulting in increased global protein acetylation (and in particular the acetylation of sarcoplasmic/endoplasmic reticulum Ca2+-ATPase), a molecular signature of heart failure. Restoration of NAD redox by NAD+ supplementation reduced sarcoplasmic/endoplasmic reticulum Ca2+-ATPase acetylation and accelerated the functional recovery of the engineered heart tissue after tachycardia. Understanding how metabolic rewiring drives tachycardia-induced cardiomyopathy opens up opportunities for therapeutic intervention.
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Affiliation(s)
- Chengyi Tu
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Arianne Caudal
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Yu Liu
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Nikoloz Gorgodze
- Aging + Cardiovascular Discovery Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Hao Zhang
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Chi Keung Lam
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Yuqin Dai
- Sarafan ChEM-H, Stanford University, Stanford, CA, USA
| | - Angela Zhang
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
- Greenstone Biosciences, Palo Alto, CA, USA
| | - Alexa Wnorowski
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Matthew A Wu
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
- Greenstone Biosciences, Palo Alto, CA, USA
| | - Huaxiao Yang
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Oscar J Abilez
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Xuchao Lyu
- Department of Pathology, Stanford University, Stanford, CA, USA
| | | | - Luisa Mestroni
- Human Medical Genetics and Genomics, University of Colorado, Aurora, CO, USA
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado, Aurora, CO, USA
| | - Matthew R G Taylor
- Human Medical Genetics and Genomics, University of Colorado, Aurora, CO, USA
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado, Aurora, CO, USA
| | - Fabio A Recchia
- Aging + Cardiovascular Discovery Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
- Scuola Superiore Sant'Anna, Pisa, Italy
- Institute of Clinical Physiology of the National Research Council, Pisa, Italy
| | - Joseph C Wu
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA.
- Department of Medicine, Stanford University, Stanford, CA, USA.
- Department of Radiology, Stanford University, Stanford, CA, USA.
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26
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Ali SR, Sadek HA. Cardiomyocyte DNA Damage Predicts Functional Recovery in Heart Failure Patients. JACC. HEART FAILURE 2024; 12:662-664. [PMID: 38569820 DOI: 10.1016/j.jchf.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 01/23/2024] [Indexed: 04/05/2024]
Affiliation(s)
- Shah R Ali
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA.
| | - Hesham A Sadek
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern, Dallas, Texas, USA; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
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27
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Dai Z, Ko T, Fujita K, Nomura S, Uemura Y, Onoue K, Hamano M, Katoh M, Yamada S, Katagiri M, Zhang B, Hatsuse S, Yamada T, Inoue S, Kubota M, Sawami K, Heryed T, Ito M, Amiya E, Hatano M, Takeda N, Morita H, Yamanishi Y, Saito Y, Komuro I. Myocardial DNA Damage Predicts Heart Failure Outcome in Various Underlying Diseases. JACC. HEART FAILURE 2024; 12:648-661. [PMID: 37930291 DOI: 10.1016/j.jchf.2023.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Reliable predictors of treatment efficacy in heart failure have been long awaited. DNA damage has been implicated as a cause of heart failure. OBJECTIVES The purpose of this study was to investigate the association of DNA damage in myocardial tissue with treatment response and prognosis of heart failure. METHODS The authors performed immunostaining of DNA damage markers poly(ADP-ribose) (PAR) and γ-H2A.X in endomyocardial biopsy specimens from 175 patients with heart failure with reduced ejection fraction (HFrEF) of various underlying etiologies. They calculated the percentage of nuclei positive for each DNA damage marker (%PAR and %γ-H2A.X). The primary outcome was left ventricular reverse remodeling (LVRR) at 1 year, and the secondary outcome was a composite of cardiovascular death, heart transplantation, and ventricular assist device implantation. RESULTS Patients who did not achieve LVRR after the optimization of medical therapies presented with significantly higher %PAR and %γ-H2A.X. The ROC analysis demonstrated good performance of both %PAR and %γ-H2A.X for predicting LVRR (AUCs: 0.867 and 0.855, respectively). There was a negative correlation between the mean proportion of DNA damage marker-positive nuclei and the probability of LVRR across different underlying diseases. In addition, patients with higher %PAR or %γ-H2A.X had more long-term clinical events (PAR HR: 1.63 [95% CI: 1.31-2.01]; P < 0.001; γ-H2A.X HR: 1.48 [95% CI: 1.27-1.72]; P < 0.001). CONCLUSIONS DNA damage determines the consequences of human heart failure. Assessment of DNA damage is useful to predict treatment efficacy and prognosis of heart failure patients with various underlying etiologies.
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Affiliation(s)
- Zhehao Dai
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. https://twitter.com/ZhehaoDai_Cards
| | - Toshiyuki Ko
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Kanna Fujita
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Seitaro Nomura
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; Department of Frontier Cardiovascular Science, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
| | - Yukari Uemura
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kenji Onoue
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Momoko Hamano
- Department of Bioscience and Bioinformatics, Faculty of Computer Science and Systems Engineering, Kyushu Institute of Technology, Iizuka, Japan
| | - Manami Katoh
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Shintaro Yamada
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Mikako Katagiri
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Bo Zhang
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Satoshi Hatsuse
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Takanobu Yamada
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Shunsuke Inoue
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Masayuki Kubota
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Kosuke Sawami
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Tuolisi Heryed
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Masamichi Ito
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Eisuke Amiya
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Masaru Hatano
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; Advanced Medical Center for Heart Failure, University of Tokyo Hospital, Tokyo, Japan
| | - Norifumi Takeda
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yoshihiro Yamanishi
- Department of Bioscience and Bioinformatics, Faculty of Computer Science and Systems Engineering, Kyushu Institute of Technology, Iizuka, Japan; Department of Complex Systems Science, Graduate School of Informatics, Nagoya University, Nagoya, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan; Nara Prefectural Seiwa Medical Center, Nara Prefectural Hospital Organization, Nara, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; Department of Frontier Cardiovascular Science, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; International University of Health and Welfare, Tokyo, Japan.
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28
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Keefe JA, Garber R, McCauley MD, Wehrens XHT. Tachycardia and Atrial Fibrillation-Related Cardiomyopathies: Potential Mechanisms and Current Therapies. JACC. HEART FAILURE 2024; 12:605-615. [PMID: 38206235 DOI: 10.1016/j.jchf.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/06/2023] [Accepted: 11/28/2023] [Indexed: 01/12/2024]
Abstract
Atrial fibrillation (AF) is associated with an increased risk of new-onset ventricular contractile dysfunction, termed arrhythmia-induced cardiomyopathy (AIC). Although cardioembolic stroke remains the most feared and widely studied complication of AF, AIC is also a clinically important consequence of AF that portends significant morbidity and mortality to patients with AF. Current treatments are aimed at restoring sinus rhythm through catheter ablation and rate and rhythm control, but these treatments do not target the underlying molecular mechanisms driving the progression from AF to AIC. Here, we describe the clinical features of the various AIC subtypes, discuss the pathophysiologic mechanisms driving the progression from AF to AIC, and review the evidence surrounding current treatment options. In this review, we aim to identify key knowledge gaps that will enable the development of more effective AIC therapies that target cellular and molecular mechanisms.
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Affiliation(s)
- Joshua A Keefe
- Cardiovascular Research Institute, Baylor College of Medicine, Houston, Texas, USA; Department of Integrative Physiology, Baylor College of Medicine, Houston, Texas, USA
| | - Rebecca Garber
- Division of Cardiology, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Mark D McCauley
- Division of Cardiology, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA; Department of Physiology and Biophysics and the Center for Cardiovascular Research, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA; Jesse Brown VA Medical Center, Chicago, Illinois, USA.
| | - Xander H T Wehrens
- Cardiovascular Research Institute, Baylor College of Medicine, Houston, Texas, USA; Department of Integrative Physiology, Baylor College of Medicine, Houston, Texas, USA; Departments of Pediatrics, Medicine, and Neuroscience, and Center for Space Medicine, Baylor College of Medicine, Houston, Texas, USA.
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29
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Bawaskar P, Thomas N, Ismail K, Guo Y, Chhikara S, Athwal PSS, Ranum A, Jadhav A, Mendez AH, Nadkarni I, Frerichs D, Velangi P, Ergando T, Akram H, Kanda A, Shenoy C. Nonischemic or Dual Cardiomyopathy in Patients With Coronary Artery Disease. Circulation 2024; 149:807-821. [PMID: 37929565 PMCID: PMC10951941 DOI: 10.1161/circulationaha.123.067032] [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: 09/05/2023] [Accepted: 11/02/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Randomized trials in obstructive coronary artery disease (CAD) have largely shown no prognostic benefit from coronary revascularization. Although there are several potential reasons for the lack of benefit, an underexplored possible reason is the presence of coincidental nonischemic cardiomyopathy (NICM). We investigated the prevalence and prognostic significance of NICM in patients with CAD (CAD-NICM). METHODS We conducted a registry study of consecutive patients with obstructive CAD on coronary angiography who underwent contrast-enhanced cardiovascular magnetic resonance imaging for the assessment of ventricular function and scar at 4 hospitals from 2004 to 2020. We identified the presence and cause of cardiomyopathy using cardiovascular magnetic resonance imaging and coronary angiography data, blinded to clinical outcomes. The primary outcome was a composite of all-cause death or heart failure hospitalization, and secondary outcomes were all-cause death, heart failure hospitalization, and cardiovascular death. RESULTS Among 3023 patients (median age, 66 years; 76% men), 18.2% had no cardiomyopathy, 64.8% had ischemic cardiomyopathy (CAD+ICM), 9.3% had CAD+NICM, and 7.7% had dual cardiomyopathy (CAD+dualCM), defined as both ICM and NICM. Thus, 16.9% had CAD+NICM or dualCM. During a median follow-up of 4.8 years (interquartile range, 2.9, 7.6), 1116 patients experienced the primary outcome. In Cox multivariable analysis, CAD+NICM or dualCM was independently associated with a higher risk of the primary outcome compared with CAD+ICM (adjusted hazard ratio, 1.23 [95% CI, 1.06-1.43]; P=0.007) after adjustment for potential confounders. The risks of the secondary outcomes of all-cause death and heart failure hospitalization were also higher with CAD+NICM or dualCM (hazard ratio, 1.21 [95% CI, 1.02-1.43]; P=0.032; and hazard ratio, 1.37 [95% CI, 1.11-1.69]; P=0.003, respectively), whereas the risk of cardiovascular death did not differ from that of CAD+ICM (hazard ratio, 1.15 [95% CI, 0.89-1.48]; P=0.28). CONCLUSIONS In patients with CAD referred for clinical cardiovascular magnetic resonance imaging, NICM or dualCM was identified in 1 of every 6 patients and was associated with worse long-term outcomes compared with ICM. In patients with obstructive CAD, coincidental NICM or dualCM may contribute to the lack of prognostic benefit from coronary revascularization.
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Affiliation(s)
- Parag Bawaskar
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Nicholas Thomas
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Khaled Ismail
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Yugene Guo
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Sanya Chhikara
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Pal Satyajit Singh Athwal
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Alison Ranum
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Achal Jadhav
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Abel Hooker Mendez
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Ishan Nadkarni
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Dominic Frerichs
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Pratik Velangi
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Tesfatsiyon Ergando
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Hassan Akram
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Adinan Kanda
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Chetan Shenoy
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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30
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Newman JD, O'Meara E, Böhm M, Savarese G, Kelly PR, Vardeny O, Allen LA, Lancellotti P, Gottlieb SS, Samad Z, Morris AA, Desai NR, Rosano GMC, Teerlink JR, Giraldo CS, Lindenfeld J. Implications of Atrial Fibrillation for Guideline-Directed Therapy in Patients With Heart Failure: JACC State-of-the-Art Review. J Am Coll Cardiol 2024; 83:932-950. [PMID: 38418008 DOI: 10.1016/j.jacc.2023.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/29/2023] [Accepted: 12/18/2023] [Indexed: 03/01/2024]
Abstract
Atrial fibrillation (AF) and heart failure (HF) are common cardiovascular conditions that frequently coexist. Among patients with HF, more than one-half also have AF. Both are associated with significant morbidity and mortality. Moreover, the prevalence of each is increasing globally, and this trend is expected to continue owing to an aging population and increased life expectancy. Diagnosis of AF in a patient with HF is associated with greater symptom burden, more frequent hospitalizations, and a worse prognosis. Guideline-directed medical therapy (GDMT) for HF can affect the incidence of AF. Once present, AF can influence the efficacy of some components of GDMT for HF. In this review, we discuss the effect of GDMT for HF across the spectrum of ejection fraction on prevention of AF as well as the benefit of GDMT in patients with vs without AF.
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Affiliation(s)
| | - Eileen O'Meara
- Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Michael Böhm
- University of the Saarland, Homberg/Saar, Germany
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institute, Stockholm, Sweden; Heart and Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | | | - Orly Vardeny
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Larry A Allen
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Stephen S Gottlieb
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA; Baltimore Veterans Administration Medical Center, Baltimore, Maryland, USA
| | | | | | - Nihar R Desai
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Giuseppe M C Rosano
- Center for Clinical and Basic Research, IRCCS San Raffaele Pisana, Rome, Italy
| | | | | | - JoAnn Lindenfeld
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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31
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Pundi K, Marcus GM. Predictors and possible mechanisms of premature ventricular contraction induced cardiomyopathy. J Cardiovasc Electrophysiol 2024; 35:569-573. [PMID: 37724798 DOI: 10.1111/jce.16070] [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: 07/31/2023] [Revised: 08/30/2023] [Accepted: 09/08/2023] [Indexed: 09/21/2023]
Abstract
Premature ventricular complexes (PVCs) are encountered frequently in clinical practice. While PVCs may have various causes, a small number of individuals with PVCs develop cardiomyopathy in the absence of other potential etiologies. When correctly identified, patients with PVC-incuded cardiomyopathy can have dramatic improvement of their cardiomyopathy with treatment of their PVCs. In this focused review, we discuss potential predictors of PVC-induced cardiomyopathy, including PVC frequency, PVC characteristics, and modifiable patient risk factors. We also review some proposed mechanisms of PVC-induced cardiomyopathy and conclude with future directions for research and clinical practice.
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Affiliation(s)
- Krishna Pundi
- Division of Cardiology, University of California, San Francisco, San Francisco, California, USA
| | - Gregory M Marcus
- Division of Cardiology, University of California, San Francisco, San Francisco, California, USA
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32
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De Larochellière H, Brouillette F, Lévesque P, Dognin N, St-Germain R, Rimac G, Lemay S, Philippon F, Sénéchal M. Severity of Left Ventricular Dysfunction in Patients With Tachycardia-Induced Cardiomyopathy: Impacts on Remodeling After Atrial Flutter Ablation. Am J Cardiol 2024; 213:132-139. [PMID: 38114044 DOI: 10.1016/j.amjcard.2023.11.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/12/2023] [Accepted: 11/24/2023] [Indexed: 12/21/2023]
Abstract
Tachycardia-induced cardiomyopathy is defined as a reversible left ventricular (LV) systolic dysfunction (SeD) resulting from a sustained fast heart rate. LV remodeling in patients with severe LV dysfunction at diagnosis remains poorly understood. In this retrospective cohort study, we described LV remodeling in 50 patients who underwent atrial flutter ablation. These patients were divided into severe LV SeD (LV ejection fraction [EF] ≤30%) and LV nonsevere SeD (LVEF 31% to 50%) at baseline. All continuous variables are expressed as median and interquartile range. LVEF was 18% (13 to 25) and 38% (34 to 41) in the SeD (n = 29) and LV nonsevere SeD (n = 21) groups, respectively. At baseline, patients with SeD had higher LV end-diastolic diameter (56 [54 to 59] vs 49 mm [47 to 52], p <0.01), LV end-systolic diameter (48 [43 to 51] vs 36 mm [34 to 41], p <0.01), LV end-diastolic volume (71 [64 to 85] vs 56 ml/m2 [46 to 68], p <0.01), LV end-systolic volume (56 [53 to 70] vs 36 ml/m2 [27 to 42], p <0.01), and lower tricuspid annular plane systolic excursion (12 [10 to 13] vs 16 mm [13 to 19], p <0.01). At last follow-up, LVEF was not statistically significantly different between groups. However, LV end-systolic diameter (36 [34 to 39] vs 32 mm [32 to 34], p = 0.01) and LV end-systolic volume (29 [26 to 35] vs 25 ml/m2 [20 to 29], p = 0.02) remained larger in the SeD group. Seven patients (14%), all from the SeD group, had a LVEF ≤35% 2 months after rhythm control, and reverse remodeling was observed up to 9 months. In conclusion, more than half of patients with tachycardia-induced cardiomyopathy and atrial flutter had LVEF ≤30% at baseline. LVEF recovery and LV remodeling were observed beyond 2 months, highlighting the importance of rhythm control and early guideline-directed medical therapy in these patients.
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Affiliation(s)
- Hugo De Larochellière
- Division of Cardiology, Institut Universitaire de Cardiologie et Pneumologie de Québec (IUCPQ), Université Laval, Québec City, Québec, Canada
| | - François Brouillette
- Division of Cardiology, Institut Universitaire de Cardiologie et Pneumologie de Québec (IUCPQ), Université Laval, Québec City, Québec, Canada
| | - Patrick Lévesque
- Division of Cardiology, Institut Universitaire de Cardiologie et Pneumologie de Québec (IUCPQ), Université Laval, Québec City, Québec, Canada
| | - Nicolas Dognin
- Division of Cardiology, Institut Universitaire de Cardiologie et Pneumologie de Québec (IUCPQ), Université Laval, Québec City, Québec, Canada
| | - Raphaël St-Germain
- Division of Cardiology, Institut Universitaire de Cardiologie et Pneumologie de Québec (IUCPQ), Université Laval, Québec City, Québec, Canada
| | - Goran Rimac
- Division of Cardiology, Institut Universitaire de Cardiologie et Pneumologie de Québec (IUCPQ), Université Laval, Québec City, Québec, Canada
| | - Sylvain Lemay
- Division of Cardiology, Institut Universitaire de Cardiologie et Pneumologie de Québec (IUCPQ), Université Laval, Québec City, Québec, Canada
| | - François Philippon
- Division of Cardiology, Institut Universitaire de Cardiologie et Pneumologie de Québec (IUCPQ), Université Laval, Québec City, Québec, Canada
| | - Mario Sénéchal
- Division of Cardiology, Institut Universitaire de Cardiologie et Pneumologie de Québec (IUCPQ), Université Laval, Québec City, Québec, Canada.
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33
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Higuchi S, Voskoboinik A, Im SI, Lee A, Olgin J, Arbil A, Afzal J, Marcus GM, Stillson C, Bibby D, Abraham T, Wilson E, Gerstenfeld EP. Frequent Premature Atrial Contractions Lead to Adverse Atrial Remodeling and Atrial Fibrillation in a Swine Model. Circulation 2024; 149:463-474. [PMID: 37994608 PMCID: PMC10872765 DOI: 10.1161/circulationaha.123.065874] [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: 06/10/2023] [Accepted: 10/26/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Frequent premature atrial complexes (PACs) are associated with future incident atrial fibrillation (AF), but whether PACs contribute to development of AF through adverse atrial remodeling has not been studied. This study aimed to explore the effect of frequent PACs from different sites on atrial remodeling in a swine model. METHODS Forty swine underwent baseline electrophysiologic studies and echocardiography followed by pacemaker implantations and paced PACs (50% burden) at 250-ms coupling intervals for 16 weeks in 4 groups: (1) lateral left atrium (LA) PACs by the coronary sinus (Lat-PAC; n=10), (2) interatrial septal PACs (Sep-PAC; n=10), (3) regular LA pacing at 130 beats/min (Reg-130; n=10), and (4) controls without PACs (n=10). At the final study, repeat studies were performed, followed by tissue histology and molecular analyses focusing on fibrotic pathways. RESULTS Lat-PACs were associated with a longer P-wave duration (93.0±9.0 versus 74.2±8.2 and 58.8±7.6 ms; P<0.001) and greater echocardiographic mechanical dyssynchrony (57.5±11.6 versus 35.7±13.0 and 24.4±11.1 ms; P<0.001) compared with Sep-PACs and controls, respectively. After 16 weeks, Lat-PACs led to slower LA conduction velocity (1.1±0.2 versus 1.3±0.2 [Sep-PAC] versus 1.3±0.1 [Reg-130] versus 1.5±0.2 [controls] m/s; P<0.001) without significant change in atrial ERP. The Lat-PAC group had a significantly increased percentage of LA fibrosis and upregulated levels of extracellular matrix proteins (lysyl oxidase and collagen 1 and 8), as well as TGF-β1 (transforming growth factor-β1) signaling proteins (latent and monomer TGF-β1 and phosphorylation/total ratio of SMAD2/3; P<0.05). The Lat-PAC group had the longest inducible AF duration (terminal to baseline: 131 [interquartile range 30, 192] seconds versus 16 [6, 26] seconds [Sep-PAC] versus 22 [11, 64] seconds [Reg-130] versus -1 [-16, 7] seconds [controls]; P<0.001). CONCLUSIONS In this swine model, frequent PACs resulted in adverse atrial structural remodeling with a heightened propensity to AF. PACs originating from the lateral LA produced greater atrial remodeling and longer induced AF duration than the septal-origin PACs. These data provide evidence that frequent PACs can cause adverse atrial remodeling as well as AF, and that the location of ectopic PACs may be clinically meaningful.
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Affiliation(s)
- Satoshi Higuchi
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco
| | - Aleksandr Voskoboinik
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco
| | - Sung Il Im
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco
| | - Adam Lee
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco
| | - Jeffrey Olgin
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco
| | - Ayla Arbil
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco
| | - Junaid Afzal
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco
| | - Gregory M Marcus
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco
| | - Carol Stillson
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco
| | - Dwight Bibby
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco
| | - Theodore Abraham
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco
| | - Emily Wilson
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco
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34
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Domengé O, Fayol A, Ladouceur M, Wahbi K, Amar L, Carette C, Hagège A, Hulot JS. Trends in prevalence of major etiologies leading to heart failure in young patients: An integrative review. Trends Cardiovasc Med 2024; 34:80-88. [PMID: 36155830 DOI: 10.1016/j.tcm.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 09/19/2022] [Accepted: 09/19/2022] [Indexed: 10/14/2022]
Abstract
The prevalence of Heart failure (HF) is increasing with the aging of the population but it is estimated that 10% of HF patients are younger than 50 years-old. HF development in this population is characterized with a fast-growing prevalence, and important disparities according to underlying etiologies or gender. These observations highlight the need to identify specific and preventable factors in these patients, a topic that is under-studied. Here we provide an overview of trends in prevalence of major etiologies leading to HF in young subjects, including genetic factors associated with cardiomyopathies, premature vascular dysfunction and related ischemia, metabolic stress, cardio-toxic responses to different agents, and myocarditis. We also highlight the increasing influence of major risk factors that are driving HF in younger patients, such as obesity, diabetes or arterial hypertension.
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Affiliation(s)
- Orianne Domengé
- Université de Paris, INSERM, PARCC, Paris F-75006, France; CIC1418 and DMU CARTE, AP-HP: Assistance Publique - Hopitaux de Paris, PARCC, Hôpital Européen Georges-Pompidou, 56 Rue Leblanc, Paris F-75015, France
| | - Antoine Fayol
- Université de Paris, INSERM, PARCC, Paris F-75006, France; CIC1418 and DMU CARTE, AP-HP: Assistance Publique - Hopitaux de Paris, PARCC, Hôpital Européen Georges-Pompidou, 56 Rue Leblanc, Paris F-75015, France
| | - Magalie Ladouceur
- Université de Paris, INSERM, PARCC, Paris F-75006, France; Adult Congenital Heart Disease Unit, Department of Cardiology, AP-HP, Hôpital Européen Georges Pompidou and Necker Hospital, Paris, France
| | - Karim Wahbi
- Cardiology Department, Centre de Référence de Pathologie Neuromusculaire, AP-HP, Hôpital Cochin, Paris, France
| | - Laurence Amar
- Université de Paris, INSERM, PARCC, Paris F-75006, France; Hypertension Department and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, Paris F-75015, France
| | - Claire Carette
- CIC1418 and DMU CARTE, AP-HP: Assistance Publique - Hopitaux de Paris, PARCC, Hôpital Européen Georges-Pompidou, 56 Rue Leblanc, Paris F-75015, France; Service de nutrition, Centre Spécialisé Obésité, AP-HP, Hôpital Européen Georges-Pompidou, Paris F-75015, France
| | - Albert Hagège
- Department of Cardiology and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, Paris F-75015, France
| | - Jean-Sébastien Hulot
- Université de Paris, INSERM, PARCC, Paris F-75006, France; CIC1418 and DMU CARTE, AP-HP: Assistance Publique - Hopitaux de Paris, PARCC, Hôpital Européen Georges-Pompidou, 56 Rue Leblanc, Paris F-75015, France.
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35
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Siow YK, Lin CY, Chung FP, Lin YJ, Chang SL, Lo LW, Hu YF, Liao JN, Chang TY, Tuan TC, Kuo L, Wu CI, Liu CM, Liu SH, Li GY, Kuo MJ, Wu SJ, Bautista JA, Huang YS, Nguyen DSN, Chen SA. Catheter ablation in patients with atrial fibrillation and dilated cardiomyopathy. Front Cardiovasc Med 2024; 11:1305485. [PMID: 38292242 PMCID: PMC10825578 DOI: 10.3389/fcvm.2024.1305485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 01/03/2024] [Indexed: 02/01/2024] Open
Abstract
Introduction Catheter ablation is an effective and safe strategy for treating atrial fibrillation patients. Nevertheless, studies on the long-term outcomes of catheter ablation in patients with dilated cardiomyopathy are limited. This study aimed to assess the electrophysiological characteristics of atrial fibrillation patients with dilated cardiomyopathy and compare the long-term clinical outcomes between patients undergoing catheter ablation and medical therapy. Method Patient baseline characteristics and electrophysiological parameters were examined to identify the predictors of atrial fibrillation recurrence following catheter ablation. The clinical outcomes of catheter ablation and medical therapy were compared using the propensity score matched method. Results A total of 343 patients were enrolled, with 46 in the catheter ablation group and 297 in the medical therapy group. Among the catheter ablation group, 58.7% (n = 27) had persistent atrial fibrillation. The recurrence rate of atrial arrhythmia was 30.4% (n = 14) after an average follow-up duration of 7.7 years following catheter ablation. The only predictive factor for atrial fibrillation recurrence after catheter ablation was the left atrial diameter. When compared to medical therapy, catheter ablation demonstrated significantly better outcomes in terms of overall survival, freedom from heart failure hospitalization, improvement in left ventricular ejection fraction, and a greater reduction in left ventricular diameter and left atrial diameter after propensity score matching. Conclusions Therefore, catheter ablation proves to be effective in providing long-term control of atrial fibrillation in patients with dilated cardiomyopathy. In addition to standard heart failure care, catheter ablation significantly enhanced both morbidity and mortality outcomes and reversed structural remodeling when compared to heart failure medication alone.
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Affiliation(s)
- Yoon-Kee Siow
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Cardiology, Serdang Hospital, Selangor, Malaysia
| | - Chin-Yu Lin
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Fa-Po Chung
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Lin Chang
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Li-Wei Lo
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Feng Hu
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jo-Nan Liao
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ting-Yung Chang
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ta-Chuan Tuan
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ling Kuo
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Cheng-I Wu
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Min Liu
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shin-Huei Liu
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Guan-Yi Li
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming-Jen Kuo
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shang-Ju Wu
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Yu-Shan Huang
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medicine, National Chung Hsing University, Taichung, Taiwan
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36
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Wahlberg KJ, Infeld M, Plante TB, Novelli AE, Habel N, Burkhoff D, Barrett T, Lustgarten D, Meyer M. Effects of Continuous Accelerated Pacing on Cardiac Structure and Function in Patients With Heart Failure With Preserved Ejection Fraction: Insights From the myPACE Randomized Clinical Trial. J Am Heart Assoc 2024; 13:e032873. [PMID: 38156545 PMCID: PMC10863817 DOI: 10.1161/jaha.123.032873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/27/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Heart failure with preserved ejection fraction ≥50% is prevalent with few evidence-based therapies. In a trial of patients with heart failure with preserved ejection fraction with specialized pacemakers, treatment with accelerated personalized pacing averaging 75 bpm (myPACE) markedly improved quality of life, NT-proBNP (N-terminal pro-brain natriuretic peptide), physical activity, and atrial fibrillation burden compared with the standard lower rate setting of 60 bpm (usual care). METHODS AND RESULTS In this exploratory study, provider-initiated echocardiographic studies obtained before and after the trial were assessed for changes in left ventricular (LV) structure and function among participants who continued their pacing assignment. The analytic approach aimed to detect differences in standard and advanced echocardiographic parameters within and between study arms. Of the 100 participants, 16 myPACE and 20 usual care arm had a qualifying set of echocardiograms performed a mean (SD) 3 (2.0) years apart. Despite similar baseline echocardiogram measures, sustained exposure to moderately accelerated pacing resulted in reduced septal wall thickness (in cm: myPACE 1.1 [0.2] versus usual care 1.2 [0.2], P=0.008) and lower LV mass to systolic volume ratio (in g/mL: myPACE 4.8 [1.9] versus usual care 6.8 [3.1], P=0.038) accompanied by a minor reduction in LV ejection fraction (in %: myPACE 55 [5] versus usual care 60 [5], P=0.015). These changes were paralleled by improvements in heart failure-related quality of life (myPACE Minnesota Living with Heart Failure Questionnaire improved by 16.1 [13.9] points, whereas usual care worsened by 6.9 [11.6] points, P<0.001). Markers of diastolic function and LV performance were not affected. CONCLUSIONS Exposure to continuous accelerated pacing in heart failure with preserved ejection fraction is associated with a reduced LV wall thickness and a small amount of LV dilation with small reduction in ejection fraction.
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Affiliation(s)
- Kramer J. Wahlberg
- Department of MedicineUniversity of Vermont Larner College of MedicineBurlingtonVT
| | - Margaret Infeld
- Department of MedicineUniversity of Vermont Larner College of MedicineBurlingtonVT
| | - Timothy B. Plante
- Department of MedicineUniversity of Vermont Larner College of MedicineBurlingtonVT
| | - Alexandra E. Novelli
- Department of MedicineUniversity of Vermont Larner College of MedicineBurlingtonVT
| | - Nicole Habel
- Department of MedicineUniversity of Vermont Larner College of MedicineBurlingtonVT
| | | | - Trace Barrett
- Department of MedicineUniversity of Vermont Larner College of MedicineBurlingtonVT
| | - Daniel Lustgarten
- Department of MedicineUniversity of Vermont Larner College of MedicineBurlingtonVT
| | - Markus Meyer
- Department of MedicineUniversity of Vermont Larner College of MedicineBurlingtonVT
- Department of MedicineLillehei Heart Institute, University of Minnesota College of MedicineMinneapolisMN
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37
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Ali H, Passarelli I, Cappato R. Irregular Rhythm in a Middle-Aged Man Presenting With New-Onset Heart Failure. JAMA Cardiol 2024; 9:91-92. [PMID: 37966819 DOI: 10.1001/jamacardio.2023.4249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
A man in his 50s with recurrent palpitations, fatigue, and progressive exertion dyspnea had irregular narrow-QRS tachycardia in an incessant, repetitive fashion with heart rates up to 180 beats per minute and occasional short runs of wide-QRS tachycardia on Holter monitoring and 12-lead electrocardiogram. What would you do next?
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Affiliation(s)
- Hussam Ali
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Ilaria Passarelli
- Cardiology Department, Bassini Hospital, Cinesello Balsamo, Milan, Italy
| | - Riccardo Cappato
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
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38
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Galrinho A. A challenging dilemma: Can we predict which premature ventricular contractions may cause cardiomyopathy? Rev Port Cardiol 2024; 43:33-34. [PMID: 37454970 DOI: 10.1016/j.repc.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 07/18/2023] Open
Affiliation(s)
- Ana Galrinho
- Serviço de Cardiologia, Centro Hospitalar Universitário de Lisboa Central, Hospital de Santa Marta, Lisboa, Portugal.
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39
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Velliou M, Sanidas E, Diakantonis A, Ventoulis I, Parissis J, Polyzogopoulou E. The Optimal Management of Patients with Atrial Fibrillation and Acute Heart Failure in the Emergency Department. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2113. [PMID: 38138216 PMCID: PMC10744575 DOI: 10.3390/medicina59122113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023]
Abstract
Atrial fibrillation (AF) and acute heart failure (AHF) are two closely interrelated conditions that frequently coexist in a manifold manner, with AF serving either as the causative factor or as the consequence or even as an innocent bystander. The interplay between these two clinical conditions is complex, given that they share common pathophysiological pathways and they can reciprocally exacerbate each other, thus triggering a vicious cycle that worsens the prognosis and increases the thromboembolic risk. The optimal management of AF in the context of AHF in the emergency department remains a challenge depending on the time onset, as well as the nature and the severity of the associated symptoms. Acute rate control, along with early rhythm control, when indicated, and anticoagulation represent the main pillars of the therapeutic intervention. The purpose of this review is to elucidate the pathophysiological link between AF and AHF and accordingly present a stepwise algorithmic approach for the management of AF in AHF patients in the emergency setting.
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Affiliation(s)
- Maria Velliou
- Emergency Medicine Department, Attikon University Hospital, 12462 Athens, Greece; (M.V.); (A.D.); (J.P.)
| | - Elias Sanidas
- Department of Cardiology, Laiko General Hospital, 11527 Athens, Greece;
| | - Antonis Diakantonis
- Emergency Medicine Department, Attikon University Hospital, 12462 Athens, Greece; (M.V.); (A.D.); (J.P.)
| | - Ioannis Ventoulis
- Department of Occupational Therapy, University of Western Macedonia, 50200 Ptolemaida, Greece;
| | - John Parissis
- Emergency Medicine Department, Attikon University Hospital, 12462 Athens, Greece; (M.V.); (A.D.); (J.P.)
| | - Effie Polyzogopoulou
- Emergency Medicine Department, Attikon University Hospital, 12462 Athens, Greece; (M.V.); (A.D.); (J.P.)
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40
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Wang X, Yu Q, Liao X, Fan M, Liu X, Liu Q, Wang M, Wu X, Huang CK, Tan R, Yuan J. Mitochondrial Dysfunction in Arrhythmia and Cardiac Hypertrophy. Rev Cardiovasc Med 2023; 24:364. [PMID: 39077079 PMCID: PMC11272842 DOI: 10.31083/j.rcm2412364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 08/18/2023] [Accepted: 09/04/2023] [Indexed: 07/31/2024] Open
Abstract
Arrhythmia and cardiac hypertrophy are two very common cardiovascular diseases that can lead to heart failure and even sudden death, thus presenting a serious threat to human life and health. According to global statistics, nearly one million people per year die from arrhythmia, cardiac hypertrophy and other associated cardiovascular diseases. Hence, there is an urgent need to find new treatment targets and to develop new intervention measures. Recently, mitochondrial dysfunction has been examined in relation to heart disease with a view to lowering the incidence of arrhythmia and cardiac hypertrophy. The heart is the body's largest energy consuming organ, turning over about 20 kg of adenosine triphosphate (ATP) per day in the mitochondria. Mitochondrial oxidative phosphorylation (OXPHOS) produces up to 90% of the ATP needed by cardiac muscle cells for contraction and relaxation. Dysfunction of heart mitochondria can therefore induce arrhythmia, cardiac hypertrophy and other cardiovascular diseases. Mitochondrial DNA (mtDNA) mutations cause disorders in OXPHOS and defects in the synthesis of muscle contraction proteins. These lead to insufficient production of secondary ATP, increased metabolic requirements for ATP by the myocardium, and the accumulation of reactive oxygen species (ROS). The resulting damage to myocardial cells eventually induces arrhythmia and cardiac hypertrophy. Mitochondrial damage decreases the efficiency of energy production, which further increases the production of ROS. The accumulation of ROS causes mitochondrial damage and eventually leads to a vicious cycle of mitochondrial damage and low efficiency of mitochondrial energy production. In this review, the mechanism underlying the development of arrhythmia and cardiac hypertrophy is described in relation to mitochondrial energy supply, oxidative stress, mtDNA mutation and Mitochondrial dynamics. Targeted therapy for arrhythmia and cardiac hypertrophy induced by mitochondrial dysfunction is also discussed in terms of its potential clinical value. These strategies should improve our understanding of mitochondrial biology and the pathogenesis of arrhythmia and cardiac hypertrophy. They may also identify novel strategies for targeting mitochondria in the treatment of these diseases.
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Affiliation(s)
- Xiaomei Wang
- College of Basic Medical, Jining Medical University, 272067 Jining,
Shandong, China
| | - Qianxue Yu
- College of Basic Medical, Jining Medical University, 272067 Jining,
Shandong, China
- Collaborative Innovation Center for Birth Defect Research and
Transformation of Shandong Province, Jining Medical University, 272067 Jining,
Shandong, China
| | - Xuemei Liao
- Collaborative Innovation Center for Birth Defect Research and
Transformation of Shandong Province, Jining Medical University, 272067 Jining,
Shandong, China
- College of Second Clinical Medicine, Jining Medical University, 272067
Jining, Shandong, China
| | - Mengying Fan
- Collaborative Innovation Center for Birth Defect Research and
Transformation of Shandong Province, Jining Medical University, 272067 Jining,
Shandong, China
- College of Second Clinical Medicine, Jining Medical University, 272067
Jining, Shandong, China
| | - Xibin Liu
- College of Basic Medical, Jining Medical University, 272067 Jining,
Shandong, China
- Collaborative Innovation Center for Birth Defect Research and
Transformation of Shandong Province, Jining Medical University, 272067 Jining,
Shandong, China
| | - Qian Liu
- College of Basic Medical, Jining Medical University, 272067 Jining,
Shandong, China
- Collaborative Innovation Center for Birth Defect Research and
Transformation of Shandong Province, Jining Medical University, 272067 Jining,
Shandong, China
| | - Manru Wang
- Collaborative Innovation Center for Birth Defect Research and
Transformation of Shandong Province, Jining Medical University, 272067 Jining,
Shandong, China
- College of Second Clinical Medicine, Jining Medical University, 272067
Jining, Shandong, China
| | - Xinyu Wu
- Collaborative Innovation Center for Birth Defect Research and
Transformation of Shandong Province, Jining Medical University, 272067 Jining,
Shandong, China
- College of Second Clinical Medicine, Jining Medical University, 272067
Jining, Shandong, China
| | - Chun-Kai Huang
- Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University,
School of Medicine, 200025 Shanghai, China
| | - Rubin Tan
- College of Basic Medical, Xuzhou Medical University, 221004 Xuzhou,
Jiangsu, China
| | - Jinxiang Yuan
- Collaborative Innovation Center for Birth Defect Research and
Transformation of Shandong Province, Jining Medical University, 272067 Jining,
Shandong, China
- Lin He's Academician Workstation of New Medicine and Clinical Translation,
Jining Medical University, 272067 Jining, Shandong, China
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Balderas-Villalobos J, Medina-Contreras JML, Lynch C, Kabadi R, Hayles J, Ramirez RJ, Tan AY, Kaszala K, Samsó M, Huizar JF, Eltit JM. Mechanisms of adaptive hypertrophic cardiac remodeling in a large animal model of premature ventricular contraction-induced cardiomyopathy. IUBMB Life 2023; 75:926-940. [PMID: 37427864 PMCID: PMC10592397 DOI: 10.1002/iub.2765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 06/13/2023] [Indexed: 07/11/2023]
Abstract
Frequent premature ventricular contractions (PVCs) promoted eccentric cardiac hypertrophy and reduced ejection fraction (EF) in a large animal model of PVC-induced cardiomyopathy (PVC-CM), but the molecular mechanisms and markers of this hypertrophic remodeling remain unexplored. Healthy mongrel canines were implanted with pacemakers to deliver bigeminal PVCs (50% burden with 200-220 ms coupling interval). After 12 weeks, left ventricular (LV) free wall samples were studied from PVC-CM and Sham groups. In addition to reduced LV ejection fraction (LVEF), the PVC-CM group showed larger cardiac myocytes without evident ultrastructural alterations compared to the Sham group. Biochemical markers of pathological hypertrophy, such as store-operated Ca2+ entry, calcineurin/NFAT pathway, β-myosin heavy chain, and skeletal type α-actin were unaltered in the PVC-CM group. In contrast, pro-hypertrophic and antiapoptotic pathways including ERK1/2 and AKT/mTOR were activated and/or overexpressed in the PVC-CM group, which appeared counterbalanced by an overexpression of protein phosphatase 1 and a borderline elevation of the anti-hypertrophic factor atrial natriuretic peptide. Moreover, the potent angiogenic and pro-hypertrophic factor VEGF-A and its receptor VEGFR2 were significantly elevated in the PVC-CM group. In conclusion, a molecular program is in place to keep this structural remodeling associated with frequent PVCs as an adaptive pathological hypertrophy.
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Affiliation(s)
| | - JML Medina-Contreras
- Department of Physiology and Biophysics, School of Medicine, Virginia Commonwealth University
| | - Christopher Lynch
- Department of Physiology and Biophysics, School of Medicine, Virginia Commonwealth University
| | - Rajiv Kabadi
- Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Janée Hayles
- Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Rafael J. Ramirez
- Department of Physiology and Biophysics, School of Medicine, Virginia Commonwealth University
| | - Alex Y. Tan
- Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States of America
- Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, United States of America
| | - Karoly Kaszala
- Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States of America
- Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, United States of America
| | - Montserrat Samsó
- Department of Physiology and Biophysics, School of Medicine, Virginia Commonwealth University
| | - Jose F. Huizar
- Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States of America
- Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, United States of America
| | - Jose M. Eltit
- Department of Physiology and Biophysics, School of Medicine, Virginia Commonwealth University
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42
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Tung R, Burri H. Role of conduction system pacing in ablate and pace strategies for atrial fibrillation. Eur Heart J Suppl 2023; 25:G56-G62. [PMID: 37970516 PMCID: PMC10637833 DOI: 10.1093/eurheartjsupp/suad119] [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] [Indexed: 11/17/2023]
Abstract
With the advent of conduction system pacing, the threshold for performing 'ablate and pace' procedures for atrial fibrillation has gone down markedly in many centres due to the ability to provide a simple and physiological means of pacing the ventricles. This article reviews the technical considerations for this strategy as well as the current evidence, recognized indications, and future perspectives.
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Affiliation(s)
- Roderick Tung
- The University of Arizona College of Medicine, Banner-University Medical Center, 755 E McDowell Road, Phoenix, AZ 85006, USA
| | - Haran Burri
- Cardiac Pacing Unit, Cardiology Department, University Hospital of Geneva, Switzerland
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43
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Seferović PM, Polovina M, Rosano G, Bozkurt B, Metra M, Heymans S, Mullens W, Bauersachs J, Sliwa K, de Boer RA, Farmakis D, Thum T, Olivotto I, Rapezzi C, Linhart A, Corrado D, Tschöpe C, Milinković I, Bayes Genis A, Filippatos G, Keren A, Ašanin M, Krljanac G, Maksimović R, Skouri H, Ben Gal T, Moura B, Volterrani M, Abdelhamid M, Lopatin Y, Chioncel O, Coats AJS. State-of-the-art document on optimal contemporary management of cardiomyopathies. Eur J Heart Fail 2023; 25:1899-1922. [PMID: 37470300 DOI: 10.1002/ejhf.2979] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 06/27/2023] [Accepted: 07/05/2023] [Indexed: 07/21/2023] Open
Abstract
Cardiomyopathies represent significant contributors to cardiovascular morbidity and mortality. Over the past decades, a progress has occurred in characterization of the genetic background and major pathophysiological mechanisms, which has been incorporated into a more nuanced diagnostic approach and risk stratification. Furthermore, medications targeting core disease processes and/or their downstream adverse effects have been introduced for several cardiomyopathies. Combined with standard care and prevention of sudden cardiac death, these novel and emerging targeted therapies offer a possibility of improving the outcomes in several cardiomyopathies. Therefore, the aim of this document is to summarize practical approaches to the treatment of cardiomyopathies, which includes the evidence-based novel therapeutic concepts and established principles of care, tailored to the individual patient aetiology and clinical presentation of the cardiomyopathy. The scope of the document encompasses contemporary treatment of dilated, hypertrophic, restrictive and arrhythmogenic cardiomyopathy. It was based on an expert consensus reached at the Heart Failure Association online Workshop, held on 18 March 2021.
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Affiliation(s)
- Petar M Seferović
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - Marija Polovina
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | | | - Biykem Bozkurt
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Marco Metra
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Stephane Heymans
- Department of Cardiology, CARIM, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Wilfried Mullens
- Hasselt University, Hasselt, Belgium
- Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Karen Sliwa
- Cape Heart Institute, Division of Cardiology, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Rudolf A de Boer
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover, Germany
- Fraunhofer Cluster of Excellence Immune-Mediated Diseases (CIMD), Hannover, Germany
- Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Hannover, Germany
| | - Iacopo Olivotto
- Department of Experimental and Clinical Medicine, University of Florence, Meyer Children's Hospital and Careggi University Hospital, Florence, Italy
| | - Claudio Rapezzi
- Cardiology Centre, University of Ferrara, Ferrara, Italy
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Aleš Linhart
- Second Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Domenico Corrado
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Carsten Tschöpe
- Berlin Institute of Health (BIH) at Charité-Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany
- German Centre for Cardiovascular Research, Berlin, Germany
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ivan Milinković
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Antoni Bayes Genis
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, CIBERCV, Universidad Autónoma de Barcelona, Badalona, Spain
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens, School of Medicine, Department of Cardiology, Attikon University Hospital, Athens, Greece
| | - Andre Keren
- Heart Institute, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Milika Ašanin
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Gordana Krljanac
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Ružica Maksimović
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Center for Radiology and Magnetic Resonance, University Clinical Center of Serbia, Belgrade, Serbia
| | - Hadi Skouri
- Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Tuvia Ben Gal
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Brenda Moura
- Armed Forces Hospital, Porto, & Faculty of Medicine, University of Porto, Porto, Portugal
| | - Maurizio Volterrani
- IRCCS San Raffaele Pisana, Rome, Italy
- Department of Human Science and Promotion of Quality of Life, San Raffaele Open University of Rome, Rome, Italy
| | - Magdy Abdelhamid
- Department of Cardiovascular Medicine, Faculty of Medicine, Kasr Al Ainy, Cairo University, Giza, Egypt
| | - Yuri Lopatin
- Volgograd Medical University, Cardiology Centre, Volgograd, Russian Federation
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. Dr. C.C. Iliescu' Bucharest; University for Medicine and Pharmacy 'Carol Davila' Bucharest, Bucharest, Romania
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Matos CD, Hoyos C, Miranda-Arboleda AF, Diaz JC, Hincapie D, Patino C, Hernadez RH, Zei PC, Romero JE, Osorio J. Pulsed Field Ablation of Atrial Fibrillation: A Comprehensive Review. Rev Cardiovasc Med 2023; 24:337. [PMID: 39076426 PMCID: PMC11272841 DOI: 10.31083/j.rcm2411337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/26/2023] [Accepted: 08/31/2023] [Indexed: 07/31/2024] Open
Abstract
Pulsed-field ablation (PFA) has emerged as a promising nonthermal ablation alternative for treating atrial fibrillation (AF). By delivering ultra-rapid high-energy electrical pulses, PFA induces irreversible electroporation, selectively targeting myocardial tissue while sparing adjacent structures from thermal or other damage. This article provides a comprehensive review of multiple pre-clinical studies, clinical studies, and clinical trials evaluating the safety, efficacy, and long-term outcomes of PFA in various settings and patient populations. Overall, the reviewed evidence highlights PFA's potential as a revolutionary ablation strategy for AF treatment. Offering comparable procedural efficacy to conventional ablation methods, PFA distinguishes itself with shorter procedure times and reduced risks of complications such as phrenic nerve palsy and potential esophageal injury. While further research is warranted to establish long-term efficacy, PFA's distinct advantages and evolving clinical evidence suggest a promising future for this novel nonthermal ablation approach. As PFA continues to advance, it has the potential to transform AF ablation procedures, providing a safer alternative for patients with atrial fibrillation.
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Affiliation(s)
- Carlos D. Matos
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA 02115, USA
| | - Carolina Hoyos
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA 02115, USA
| | - Andres F. Miranda-Arboleda
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA 02115, USA
| | - Juan C. Diaz
- Cardiac Arrhythmia Center, Division of Cardiology, Las Vegas, Medellin 050021, Colombia
| | - Daniela Hincapie
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA 02115, USA
| | - Carlos Patino
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA 02115, USA
| | | | - Paul C. Zei
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA 02115, USA
| | - Jorge E. Romero
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA 02115, USA
| | - Jose Osorio
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA 02115, USA
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Bautista JAL, Lin CY, Lu CT, Lo LW, Lin YJ, Chang SL, Hu YF, Chung FP, Tuan TC, Chao TF, Liao JN, Chang TY, Kuo L, Liu CM, Liu SH, Wu CI, Kuo MJ, Li GY, Huang YS, Wu SJ, Siow YK, Son NND, Tran DC, Chen SA. Clinical significance of substrate characteristics and ablation outcomes in patients with atrial fibrillation and significant functional mitral regurgitation. Front Cardiovasc Med 2023; 10:1265890. [PMID: 37953760 PMCID: PMC10634397 DOI: 10.3389/fcvm.2023.1265890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/11/2023] [Indexed: 11/14/2023] Open
Abstract
Background Atrial fibrillation (AF) and mitral regurgitation (MR) have a complex interplay. Catheter ablation (CA) of AF may be a potential method to improve the severity of MR in AF patients. Methods Patients with symptomatic AF and moderate to severe MR who underwent catheter ablation from 2011 to 2021 were retrospectively included in the study. Patients' baseline characteristics and electrophysiological features were examined. These patients were classified as group 1 with improved MR and group 2 with refractory MR after CA. Results Fifty patients (age 60.2 ± 11.6 years, 29 males) were included in the study (32 in group 1 and 18 in group 2). Group 1 patients had a lower CHA2DS2-VASc score (1.7 ± 1.5 vs. 2.7 ± 1.5, P = 0.005) and had a lower incidence of hypertension (28.1% vs. 66.7%, P = 0.007) and diabetes mellitus (3.1% vs. 22.2%, P = 0.031) as compared to group 2 patients. Electroanatomic three-dimensional (3D) mapping showed that group 1 patients demonstrated less scars on the posterior bottom of the left atrium compared to group 2 patients (12.5% vs. 66.7%, P < 0.001). AF recurrence was not different between the two groups. After multivariate logistic regression analysis, a posterior bottom scar in the left atrium independently predicted refractory MR despite successful AF ablation. Conclusion Most patients with AF and MR showed improvement of MR after AF ablation. A scar involving the posterior bottom of the left atrium is associated with poor recovery of MR.
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Affiliation(s)
- Jose Antonio L. Bautista
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Section of Clinical Cardiac Electrophysiology, Heart Institute, St. Luke’s Medical Center – Global City, Taguig City, Philippines
| | - Chin-Yu Lin
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Chi-Ting Lu
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Li-Wei Lo
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Shih-Lin Chang
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Yu-Feng Hu
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Fa-Po Chung
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Ta-Chuan Tuan
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Jo-Nan Liao
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Ting-Yung Chang
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Ling Kuo
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Chih-Min Liu
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Shin-Huei Liu
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Cheng-I Wu
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Ming-Jen Kuo
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
- Department of Cardiology, Taichung Veterans General Hospital, Taichung City, Taiwan
| | - Guan-Yi Li
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Yu-Shan Huang
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Shang-Ju Wu
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Department of Cardiology, Taichung Veterans General Hospital, Taichung City, Taiwan
| | - Yoon Kee Siow
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Department of Cardiology, Serdang Hospital, Selangor, Malaysia
| | - Ngoc Nguyen Dinh Son
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Department of Medicine, University Medical Center, Ho Chi Minh City, Vietnam
| | - Dat Cao Tran
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Department of Medicine, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
- Department of Cardiology, Taichung Veterans General Hospital, Taichung City, Taiwan
- Department of Medicine, National Chung Hsing University, Taichung City, Taiwan
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Orlov O, Asfour A, Shchekochikhin D, Magomedova Z, Bogdanova A, Komarova A, Podianov M, Gromyko G, Pershina E, Nesterov A, Shilova A, Ionina N, Andreev D. Cardiac Magnetic Resonance in Patients with Suspected Tachycardia-Induced Cardiomyopathy: The Impact of Late Gadolinium Enhancement and Epicardial Fat Tissue. J Pers Med 2023; 13:1440. [PMID: 37888051 PMCID: PMC10607955 DOI: 10.3390/jpm13101440] [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: 07/02/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/28/2023] Open
Abstract
Tachycardia-induced cardiomyopathy (TIC) is a reversible subtype of dilated cardiomyopathy (DCM) resulting from sustained supraventricular or ventricular tachycardia and diagnosed by the normalization of left ventricular ejection fraction (LVEF) after stable sinus rhythm restoration. The aim of this study was to determine the contribution of cardiac magnetic resonance (CMR) to the differential diagnosis of TIC and DCM with persistent atrial arrythmias in patients hospitalized for the first time with heart failure (HF) with reduced LVEF of nonischemic origin. A total of 29 patients (age: 58.2 ± 16.9 years; males: 65.5%; average EF: 37.0 ± 9.5%) with persistent atrial tachyarrhythmia and first decompensation of HF without known coronary artery diseases were included in this study. The patients successfully underwent cardioversion and were observed for 30 days. The study population was divided into groups of responders (TIC patients; N = 16), which implies achieving FF > 50% or its increase > 10% in 30 days of TIC, and non-responders (N = 13). The increase in left ventricle (LV) volumes measured using CMR was significantly higher in the non-responder group when compared with the responders (114.8 mL ± 25.1 vs. 68.1 mL ± 10.5, respectively, p < 0.05). Non-responders also demonstrated decreased interventricular septum thickness (9.1 ± 0.8 vs.11.5 ± 1.3, respectively, p < 0.05). Late gadolinium enhancement (LGE) was observed in 12 patients (41.4%). The prevalence of LGE was increased in the non-responder group (25.0% vs. 65.1%, respectively, p = 0.046). Notably, a septal mid-wall LGE pattern was found exclusively in the non-responders. Epicardial adipose tissue thickness was decreased in the non-responder group versus the TIC patients. Conclusion: Patients with TIC were found to have smaller atrial and ventricular dimensions in comparison to patients with DCM. In addition, LGE was more common in DCM patients.
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Affiliation(s)
- Oleg Orlov
- Department of Cardiology, Functional and Ultrasound Diagnostics, N.V. Sklifosovsky Institute of Clinical Medicine, I. M. Sechenov First Moscow State Medical University, 8 Trubetskaya Str., 119991 Moscow, Russia; (O.O.); (Z.M.); (E.P.)
| | - Aref Asfour
- Department of Cardiology, Functional and Ultrasound Diagnostics, N.V. Sklifosovsky Institute of Clinical Medicine, I. M. Sechenov First Moscow State Medical University, 8 Trubetskaya Str., 119991 Moscow, Russia; (O.O.); (Z.M.); (E.P.)
| | - Dmitry Shchekochikhin
- Department of Cardiology, Functional and Ultrasound Diagnostics, N.V. Sklifosovsky Institute of Clinical Medicine, I. M. Sechenov First Moscow State Medical University, 8 Trubetskaya Str., 119991 Moscow, Russia; (O.O.); (Z.M.); (E.P.)
- Moscow State Healthcare Institution, City Clinical Hospital №1, 8 Leninsky Ave., 119049 Moscow, Russia; (A.N.); (A.S.)
- Department Intervention Cardiology and Cardiac Rehabilitation, Pirogov Russian National Research Medical University, 1 Ostrovitianinova Str., 117997 Moscow, Russia
| | - Zainab Magomedova
- Department of Cardiology, Functional and Ultrasound Diagnostics, N.V. Sklifosovsky Institute of Clinical Medicine, I. M. Sechenov First Moscow State Medical University, 8 Trubetskaya Str., 119991 Moscow, Russia; (O.O.); (Z.M.); (E.P.)
| | - Alexandra Bogdanova
- Department of Cardiology, Functional and Ultrasound Diagnostics, N.V. Sklifosovsky Institute of Clinical Medicine, I. M. Sechenov First Moscow State Medical University, 8 Trubetskaya Str., 119991 Moscow, Russia; (O.O.); (Z.M.); (E.P.)
- Moscow State Healthcare Institution, City Clinical Hospital №1, 8 Leninsky Ave., 119049 Moscow, Russia; (A.N.); (A.S.)
- Department Intervention Cardiology and Cardiac Rehabilitation, Pirogov Russian National Research Medical University, 1 Ostrovitianinova Str., 117997 Moscow, Russia
| | - Anna Komarova
- Department of Cardiology, Functional and Ultrasound Diagnostics, N.V. Sklifosovsky Institute of Clinical Medicine, I. M. Sechenov First Moscow State Medical University, 8 Trubetskaya Str., 119991 Moscow, Russia; (O.O.); (Z.M.); (E.P.)
| | - Maxim Podianov
- Department of Cardiology, Functional and Ultrasound Diagnostics, N.V. Sklifosovsky Institute of Clinical Medicine, I. M. Sechenov First Moscow State Medical University, 8 Trubetskaya Str., 119991 Moscow, Russia; (O.O.); (Z.M.); (E.P.)
| | - Grigory Gromyko
- Department of Endovascular Diagnostics and Treatment, Russian Biotechnological University (ROSBIOTECH), 33 Talalikhina Str., 109029 Moscow, Russia
| | - Ekaterina Pershina
- Department of Cardiology, Functional and Ultrasound Diagnostics, N.V. Sklifosovsky Institute of Clinical Medicine, I. M. Sechenov First Moscow State Medical University, 8 Trubetskaya Str., 119991 Moscow, Russia; (O.O.); (Z.M.); (E.P.)
- Moscow State Healthcare Institution, City Clinical Hospital №1, 8 Leninsky Ave., 119049 Moscow, Russia; (A.N.); (A.S.)
- World-Class Research Center, “Digital Biodesign and Personalized Healthcare”, I. M. Sechenov First Moscow State Medical University, 8 Trubetskaya Str., 119991 Moscow, Russia
| | - Alexey Nesterov
- Moscow State Healthcare Institution, City Clinical Hospital №1, 8 Leninsky Ave., 119049 Moscow, Russia; (A.N.); (A.S.)
- Department Intervention Cardiology and Cardiac Rehabilitation, Pirogov Russian National Research Medical University, 1 Ostrovitianinova Str., 117997 Moscow, Russia
| | - Alexandra Shilova
- Moscow State Healthcare Institution, City Clinical Hospital №1, 8 Leninsky Ave., 119049 Moscow, Russia; (A.N.); (A.S.)
- Department Intervention Cardiology and Cardiac Rehabilitation, Pirogov Russian National Research Medical University, 1 Ostrovitianinova Str., 117997 Moscow, Russia
| | - Natalya Ionina
- Department of Cardiology, Functional and Ultrasound Diagnostics, N.V. Sklifosovsky Institute of Clinical Medicine, I. M. Sechenov First Moscow State Medical University, 8 Trubetskaya Str., 119991 Moscow, Russia; (O.O.); (Z.M.); (E.P.)
| | - Dennis Andreev
- Department of Cardiology, Functional and Ultrasound Diagnostics, N.V. Sklifosovsky Institute of Clinical Medicine, I. M. Sechenov First Moscow State Medical University, 8 Trubetskaya Str., 119991 Moscow, Russia; (O.O.); (Z.M.); (E.P.)
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Katz M, Meitus A, Arad M, Aizer A, Nof E, Beinart R. Reply to Kataoka, N.; Imamura, T. How to Improve Clinical Outcomes in Patients with Tachycardia-Induced Cardiomyopathy. Comment on "Katz et al. Long-Term Outcomes of Tachycardia-Induced Cardiomyopathy Compared with Idiopathic Dilated Cardiomyopathy. J. Clin. Med. 2023, 12, 1412". J Clin Med 2023; 12:5849. [PMID: 37762791 PMCID: PMC10531737 DOI: 10.3390/jcm12185849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/24/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
In a letter to the editor titled "How to improve clinical outcomes in patients with tachycardia-induced cardiomyopathy", Dr. Naoya Kataoka and Dr. Teruhiko Imamura [...].
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Affiliation(s)
- Moshe Katz
- Sheba Medical Center, Ramat Gan 5266202, Israel; (M.A.); (E.N.); (R.B.)
- School of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel;
- NYU Grossman School of Medicine, New York, NY 10016, USA;
| | - Amit Meitus
- School of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel;
| | - Michael Arad
- Sheba Medical Center, Ramat Gan 5266202, Israel; (M.A.); (E.N.); (R.B.)
- School of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel;
| | - Anthony Aizer
- NYU Grossman School of Medicine, New York, NY 10016, USA;
| | - Eyal Nof
- Sheba Medical Center, Ramat Gan 5266202, Israel; (M.A.); (E.N.); (R.B.)
- School of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel;
| | - Roy Beinart
- Sheba Medical Center, Ramat Gan 5266202, Israel; (M.A.); (E.N.); (R.B.)
- School of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel;
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Cherbi M, Bonnefoy E, Lamblin N, Gerbaud E, Bonello L, Roubille F, Levy B, Champion S, Lim P, Schneider F, Elbaz M, Khachab H, Bourenne J, Seronde MF, Schurtz G, Harbaoui B, Vanzetto G, Combaret N, Labbe V, Marchandot B, Lattuca B, Biendel-Picquet C, Leurent G, Puymirat E, Maury P, Delmas C. One-year outcomes in cardiogenic shock triggered by supraventricular tachycardia: an analysis of the FRENSHOCK multicenter prospective registry. Front Cardiovasc Med 2023; 10:1167738. [PMID: 37731529 PMCID: PMC10507701 DOI: 10.3389/fcvm.2023.1167738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 08/11/2023] [Indexed: 09/22/2023] Open
Abstract
Background Cardiogenic shock (CS) is the most severe form of heart failure (HF), resulting in high early and long-term mortality. Characteristics of CS secondary to supraventricular tachycardia (SVT) are poorly reported. Based on a large registry of unselected CS, we aimed to compare 1-year outcomes between SVT-triggered and non-SVT-triggered CS. Methods FRENSHOCK is a French prospective registry including 772 CS patients from 49 centers. For each patient, the investigator could report 1-3 CS triggers from a pre-established list (ischemic, mechanical complications, ventricular/supraventricular arrhythmia, bradycardia, iatrogenesis, infection, non-compliance, and others). In this study, 1-year outcomes [rehospitalizations, mortality, heart transplantation (HTx), ventricular assist devices (VAD)] were analyzed and adjusted for independent predictive factors. Results Among 769 CS patients included, 100 were SVT-triggered (13%), of which 65 had SVT as an exclusive trigger (8.5%). SVT-triggered CS patients exhibited a higher proportion of male individuals with a more frequent history of cardiomyopathy or chronic kidney disease and more profound CS (biventricular failure and multiorgan failure). At 1 year, there was no difference in all-cause mortality (43% vs. 45.3%, adjusted HR 0.9 (95% CI 0.59-1.39), p = 0.64), need for HTx or VAD [10% vs. 10%, aOR 0.88 (0.41-1.88), p = 0.74], or rehospitalizations [49.4% vs. 44.4%, aOR 1.24 (0.78-1.98), p = 0.36]. Patients with SVT as an exclusive trigger presented more 1-year rehospitalizations [52.8% vs. 43.3%, aOR 3.74 (1.05-10.5), p = 0.01]. Conclusion SVT is a frequent trigger of CS alone or in association in more than 10% of miscellaneous CS cases. Although SVT-triggered CS patients were more comorbid with more pre-existing cardiomyopathies and HF incidences, they presented similar rates of mortality, HTx, and VAD at 1 year, arguing for a better overall prognosis. Clinical Trial Registration https://clinicaltrials.gov, identifier: NCT02703038.
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Affiliation(s)
- Miloud Cherbi
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France
- Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France
| | - Eric Bonnefoy
- Intensive Cardiac Care Unit, Lyon Brom University Hospital, Lyon, France
| | - Nicolas Lamblin
- Urgences et Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, Lille, France
| | - Edouard Gerbaud
- Intensive Cardiac Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, Pessac, France
- Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, Hôpital Xavier Arnozan, Pessac, France
| | - Laurent Bonello
- Cardiology Department, Hopital Nord, AP-HM, Aix-Marseille Université, Marseille, France
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
| | - François Roubille
- Cardiology Department, PhyMedExp, Université de Montpellier, INSERM, CNRS, INI-CRT, CHU de Montpellier, Montpellier, France
| | - Bruno Levy
- Réanimation Médicale Brabois, CHRU Nancy, Vandoeuvre-les Nancy, France
| | - Sebastien Champion
- Anesthesiology and Intensive Care Department, Clinique de Parly 2, Ramsay Générale de Santé, Le Chesnay, France
| | - Pascal Lim
- Univ Paris Est Créteil, INSERM, IMRB, Créteil, France
- Cardiology Department, AP-HP, Hôpital Universitaire Henri-Mondor, Service de Cardiologie, Créteil, France
| | - Francis Schneider
- Médecine Intensive-Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Meyer Elbaz
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France
- Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France
| | - Hadi Khachab
- Intensive Cardiac Care Unit, Cardiology Department, CH d'Aix-en-Provence, Aix-en-Provence, France
| | - Jeremy Bourenne
- Service de Réanimation des Urgences, AP-HM, Hôpital de La Timone, Marseille, France
| | | | - Guillaume Schurtz
- Urgences et Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, Lille, France
| | - Brahim Harbaoui
- Cardiology Department, Hôpital Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
- University of Lyon, CREATIS, UMR5220, INSERM U1044, INSA-15, Lyon, France
| | - Gerald Vanzetto
- Department of Cardiology, Hôpital de Grenoble, La Tronche, France
| | - Nicolas Combaret
- Department of Cardiology, CHU Clermont-Ferrand, CNRS, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Vincent Labbe
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Tenon,Paris, France
| | - Benjamin Marchandot
- Université de Strasbourg, Pôle D'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Benoit Lattuca
- Department of Cardiology, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Caroline Biendel-Picquet
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France
- Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France
| | - Guillaume Leurent
- Department of Cardiology, CHU Rennes, Inserm, LTSI—UMR 1099, Univ Rennes 1, Rennes, France
| | - Etienne Puymirat
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Paris, France
- Université de Paris, Paris, France
| | - Philippe Maury
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France
- Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France
- Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France
- REICATRA, Institut Saint Jacques, CHU de Toulouse, ToulouseFrance
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Shoureshi P, Kabadi R, James N, Torrado JF, Airapetov S, Hundley W, Kaszala K, Ellenbogen KA, Tan AY, Huizar JF. Left ventricular remodeling in premature ventricular contraction-induced cardiomyopathy: Effect of coupling intervals and atrioventricular dissociation. Heart Rhythm O2 2023; 4:556-564. [PMID: 37744937 PMCID: PMC10513922 DOI: 10.1016/j.hroo.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Background Left ventricular dyssynchrony (LVD) and postextrasystolic potentiation (PESP) associated with premature ventricular contractions (PVCs) may play a role in the development of premature ventricular contraction-induced cardiomyopathy (PVC-CM). Long-coupled (LC) PVCs have a greater LVD than short-coupled (SC) PVCs, whereas SC-PVCs have a stronger PESP than LC-PVCs. Objective The purpose of this study was to compare SC-PVCs and LC-PVCs to evaluate the roles of LVD, PESP, and atrioventricular dissociation (AVD) in the development of PVC-CM. Methods Thirty-six canines underwent pacemaker implantation to induce bigeminal right ventricular apical epicardial PVCs (50% burden) for 12 weeks. Telemetry assessed PVC burden and AVD. Animals were grouped as SC-PVC (coupling interval [CI] 200-220ms), LC-PVC (CI 330 ms), or sham (control). Echocardiographic changes, AVD, and hemodynamics were monitored for 12 weeks. Results PVC burden was similar between SC-PVC and LC-PVC groups but was statistically higher in the SC-PVC group (50% vs 47.5%; P = .028). After 12 weeks, left ventricular ejection fraction (LVEF) significantly decreased in both SC-PVC and LC-PVC groups (47.1% ± 1.4% and 45.5% ± 2%, respectively) compared to sham group (61% ± 1.6%; P <.001). Overall AVD was similar between SC-PVC and LC-PVC groups, and there was no significant correlation between AVD and reduction in LVEF at 12 weeks (r = 0.09, P = .5; and r = 0.06, P = .8, respectively). Additionally, both SC-PVC and LC-PVC groups experienced substantial declines in max and min dP/dt after 12 weeks compared to baseline. Conclusion Neither PVC CI nor AVD played an independent role in the development or severity of PVC-CM. LVD and PESP make equal relative contributions to the development of PVC-CM.
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Affiliation(s)
- Pouria Shoureshi
- Department of Internal Medicine, Cardiology Division, Central Virginia VA Health Care System/McGuire Veterans Affairs Medical Center, Richmond, Virginia
- Department of Internal Medicine, Cardiology Division/Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Rajiv Kabadi
- Department of Internal Medicine, Cardiology Division, Central Virginia VA Health Care System/McGuire Veterans Affairs Medical Center, Richmond, Virginia
| | - Nicholas James
- Department of Internal Medicine, Cardiology Division/Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Juan F. Torrado
- Department of Internal Medicine, Cardiology Division, Central Virginia VA Health Care System/McGuire Veterans Affairs Medical Center, Richmond, Virginia
| | - Sergei Airapetov
- Department of Internal Medicine, Cardiology Division, Central Virginia VA Health Care System/McGuire Veterans Affairs Medical Center, Richmond, Virginia
- Department of Internal Medicine, Cardiology Division/Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - William Hundley
- Department of Internal Medicine, Cardiology Division/Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Karoly Kaszala
- Department of Internal Medicine, Cardiology Division, Central Virginia VA Health Care System/McGuire Veterans Affairs Medical Center, Richmond, Virginia
- Department of Internal Medicine, Cardiology Division/Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Kenneth A. Ellenbogen
- Department of Internal Medicine, Cardiology Division/Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Alex Y. Tan
- Department of Internal Medicine, Cardiology Division, Central Virginia VA Health Care System/McGuire Veterans Affairs Medical Center, Richmond, Virginia
- Department of Internal Medicine, Cardiology Division/Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Jose F. Huizar
- Department of Internal Medicine, Cardiology Division, Central Virginia VA Health Care System/McGuire Veterans Affairs Medical Center, Richmond, Virginia
- Department of Internal Medicine, Cardiology Division/Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
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Serban T, du Fay du Lavallaz J, Barker DC, Sticherling C, Kühne M, Badertscher P. Validation of a novel score to predict which patients with atrial fibrillation and depressed left ventricular ejection fraction will respond to catheter ablation. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:745-748. [PMID: 37085115 DOI: 10.1016/j.rec.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/23/2023] [Indexed: 04/23/2023]
Affiliation(s)
- Teodor Serban
- Department of Cardiology, University Hospital Basel. Cardiovascular Research Institute Basel, Basel, Switzerland
| | - Jeanne du Fay du Lavallaz
- Department of Cardiology, University Hospital Basel. Cardiovascular Research Institute Basel, Basel, Switzerland
| | - David Charles Barker
- Department of Cardiology, University Hospital Basel. Cardiovascular Research Institute Basel, Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel. Cardiovascular Research Institute Basel, Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital Basel. Cardiovascular Research Institute Basel, Basel, Switzerland
| | - Patrick Badertscher
- Department of Cardiology, University Hospital Basel. Cardiovascular Research Institute Basel, Basel, Switzerland.
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