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Arslan A, Özkaya ÖG, Aytemiz F, Altay H, Özcan EE, Küçükaksu DS, Bakuy V, Kozan Ö, Pehlivanoğlu S. Oral amiodarone and propranolol in maintenance therapy of postimplantation tachycardia: An observational study. Medicine (Baltimore) 2024; 103:e38839. [PMID: 38996090 PMCID: PMC11245262 DOI: 10.1097/md.0000000000038839] [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: 01/03/2024] [Accepted: 06/14/2024] [Indexed: 07/14/2024] Open
Abstract
Left ventricular assist devices (LVADs) are widely used as end-stage therapy in patients with advanced heart failure, whereas implantation increases the risks of development of sustained ventricular tachycardia at the later postimplantation stage. Therefore, this study aimed to evaluate the clinical efficacy of orally administered amiodarone and propranolol in 3 patients with ventricular tachycardia (VT) after LVAD implantation who were resistant to initial anti-antiarrhythmic drugs. This retrospective cohort study consisted of the initial evaluation of the clinical data of 14 adult patients who underwent implantation of LVAD between January 2019 and March 2021. A total of 3 patients with resistant VT were finally included. In all cases, the patients were initially administered amiodarone in the different doses intravenously to stabilize the critical condition, whereas its oral form along with that of propranolol was used as maintenance therapy in the first 2 cases. In the third case, amiodarone was withdrawn because of the risk of development of hyperthyroidism, while oral propranolol was used in the treatment. The assessment in the 16-month follow-up period after discharge did not show presence of non-sustained and sustained VT in all 3 cases. In the ventricular arrhythmia-free group, the total mortality rate within the follow-up period was 11.1 ± 7.78 months in the 3 patients. We suggest that maintenance oral therapy of propranolol and amiodarone can significantly decrease the risks of complications in patients with VT after implantation of ventricular assist device in the long term.
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Affiliation(s)
- Abdulla Arslan
- Cardiology Department, Baskent University Istanbul Medical and Research Center, Altunizade/Istanbul, Turkey
| | - Öykü Gülmez Özkaya
- Cardiology Department, Baskent University Istanbul Medical and Research Center, Altunizade/Istanbul, Turkey
| | - Fatih Aytemiz
- Cardiology Department, Manisa State Hospital, Manisa, Turkey
| | - Hakan Altay
- Cardiology Department, Baskent University Istanbul Medical and Research Center, Altunizade/Istanbul, Turkey
| | - Emin Evren Özcan
- Cardiology Department, Dokuz Eylül University Izmir Medical and Research Center, Balçova/Izmir, Turkey
| | - Deniz Süha Küçükaksu
- Cardiovascular Surgery Department, Baskent University Istanbul Medical and Research Center, Altunizade/Istanbul, Turkey
| | - Vedat Bakuy
- Cardiovascular Surgery Department, Baskent University Istanbul Medical and Research Center, Altunizade/Istanbul, Turkey
| | - Ömer Kozan
- Cardiology Department, Baskent University Istanbul Medical and Research Center, Altunizade/Istanbul, Turkey
| | - Seçkin Pehlivanoğlu
- Cardiology Department, Baskent University Istanbul Medical and Research Center, Altunizade/Istanbul, Turkey
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Lenarczyk R, Zeppenfeld K, Tfelt-Hansen J, Heinzel FR, Deneke T, Ene E, Meyer C, Wilde A, Arbelo E, Jędrzejczyk-Patej E, Sabbag A, Stühlinger M, di Biase L, Vaseghi M, Ziv O, Bautista-Vargas WF, Kumar S, Namboodiri N, Henz BD, Montero-Cabezas J, Dagres N. Management of patients with an electrical storm or clustered ventricular arrhythmias: a clinical consensus statement of the European Heart Rhythm Association of the ESC-endorsed by the Asia-Pacific Heart Rhythm Society, Heart Rhythm Society, and Latin-American Heart Rhythm Society. Europace 2024; 26:euae049. [PMID: 38584423 PMCID: PMC10999775 DOI: 10.1093/europace/euae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 04/09/2024] Open
Abstract
Electrical storm (ES) is a state of electrical instability, manifesting as recurrent ventricular arrhythmias (VAs) over a short period of time (three or more episodes of sustained VA within 24 h, separated by at least 5 min, requiring termination by an intervention). The clinical presentation can vary, but ES is usually a cardiac emergency. Electrical storm mainly affects patients with structural or primary electrical heart disease, often with an implantable cardioverter-defibrillator (ICD). Management of ES requires a multi-faceted approach and the involvement of multi-disciplinary teams, but despite advanced treatment and often invasive procedures, it is associated with high morbidity and mortality. With an ageing population, longer survival of heart failure patients, and an increasing number of patients with ICD, the incidence of ES is expected to increase. This European Heart Rhythm Association clinical consensus statement focuses on pathophysiology, clinical presentation, diagnostic evaluation, and acute and long-term management of patients presenting with ES or clustered VA.
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Affiliation(s)
- Radosław Lenarczyk
- Medical University of Silesia, Division of Medical Sciences, Department of Cardiology and Electrotherapy, Silesian Center for Heart Diseases, Skłodowskiej-Curie 9, 41-800 Zabrze, Poland
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jacob Tfelt-Hansen
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- The Department of Forensic Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Frank R Heinzel
- Cardiology, Angiology, Intensive Care, Städtisches Klinikum Dresden Campus Friedrichstadt, Dresden, Germany
| | - Thomas Deneke
- Clinic for Interventional Electrophysiology, Heart Center RHÖN-KLINIKUM Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
- Clinic for Electrophysiology, Klinikum Nuernberg, University Hospital of the Paracelsus Medical University, Nuernberg, Germany
| | - Elena Ene
- Clinic for Interventional Electrophysiology, Heart Center RHÖN-KLINIKUM Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | - Christian Meyer
- Division of Cardiology/Angiology/Intensive Care, EVK Düsseldorf, Teaching Hospital University of Düsseldorf, Düsseldorf, Germany
| | - Arthur Wilde
- Department of Cardiology, Amsterdam UMC University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and arrhythmias, Amsterdam, the Netherlands
| | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; IDIBAPS, Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Ewa Jędrzejczyk-Patej
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Avi Sabbag
- The Davidai Center for Rhythm Disturbances and Pacing, Chaim Sheba Medical Center, Tel Hashomer, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Markus Stühlinger
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Luigi di Biase
- Albert Einstein College of Medicine at Montefiore Hospital, New York, NY, USA
| | - Marmar Vaseghi
- UCLA Cardiac Arrythmia Center, Division of Cardiology, Department of Medicine, University of California, Los Angeles, CA, USA
| | - Ohad Ziv
- Case Western Reserve University, Cleveland, OH, USA
- The MetroHealth System Campus, Cleveland, OH, USA
| | | | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | | | - Benhur Davi Henz
- Instituto Brasilia de Arritmias-Hospital do Coração do Brasil-Rede Dor São Luiz, Brasilia, Brazil
| | - Jose Montero-Cabezas
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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3
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Soni B, Gopinathannair R. Managing ventricular arrhythmias and implantable cardiac defibrillator shocks after left ventricular assist device implantation. J Cardiovasc Electrophysiol 2024; 35:592-600. [PMID: 38013210 DOI: 10.1111/jce.16142] [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: 09/22/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023]
Abstract
Continuous flow left ventricular assist devices (CF-LVADs) have been shown to reduce mortality and morbidity in patients with advanced heart failure with reduced ejection fraction. However, ventricular arrhythmias (VA) are common, are mostly secondary to underlying myocardial scar, and have a higher incidence in patients with pre-LVAD VA. Sustained VA is well tolerated in the LVAD patient but can result in implantable defibrillator (ICD) shocks, right ventricular failure, hospitalizations, and reduced quality of life. There is limited data regarding best practices for the medical management of VA as well as the role for procedural interventions in patients with uncontrolled VA and/or ICD shocks. Vast majority of CF-LVAD patients have a preexisting cardiovascular implantable electronic device (CIED) and ICD and/or cardiac resynchronization therapies are continued in many. Several questions, however, remain regarding the efficacy of ICD and CRT following CF-LVAD. Moreover, optimal CIED programming after CF-LVAD implantation. Therefore, the primary objective of this review article is to provide the most up-to-date evidence and to provide guidance on the clinical significance, pathogenesis, predictors, and management strategies for VA and ICD therapies in the CF-LVAD population. We also discuss knowledge gaps as well as areas for future research.
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Affiliation(s)
- Bosky Soni
- Department of Medicine, University of Pittsburgh School of Medicine, Harrisburg, Pennsylvania, USA
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Załucka L, Świerżyńska E, Orczykowski M, Dutkowski K, Szymański J, Kuriata J, Dąbrowski R, Kołsut P, Szumowski Ł, Sterliński M. Ventricular Arrhythmias in Left Ventricular Assist Device Patients-Current Diagnostic and Therapeutic Considerations. SENSORS (BASEL, SWITZERLAND) 2024; 24:1124. [PMID: 38400282 PMCID: PMC10893394 DOI: 10.3390/s24041124] [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: 12/14/2023] [Revised: 01/18/2024] [Accepted: 01/28/2024] [Indexed: 02/25/2024]
Abstract
Left ventricular assist devices (LVAD) are used in the treatment of advanced left ventricular heart failure. LVAD can serve as a bridge to orthotopic heart transplantation or as a destination therapy in cases where orthotopic heart transplantation is contraindicated. Ventricular arrhythmias are frequently observed in patients with LVAD. This problem is further compounded as a result of diagnostic difficulties arising from presently available electrocardiographic methods. Due to artifacts from LVAD-generated electromagnetic fields, it can be challenging to assess the origin of arrhythmias in standard ECG tracings. In this article, we will review and discuss common mechanisms, diagnostics methods, and therapeutic strategies for ventricular arrhythmia treatment, as well as numerous problems we face in LVAD implant patients.
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Affiliation(s)
- Laura Załucka
- Department of Cardiac Surgery and Transplantology, National Institute of Cardiology, 42 Alpejska Street, 04-628 Warsaw, Poland; (L.Z.); (J.S.); (P.K.)
| | - Ewa Świerżyńska
- 1st Department of Arrhythmia, National Institute of Cardiology, 42 Alpejska Street, 04-628 Warsaw, Poland
- Doctoral School, Medical University of Warsaw, 61 Zwirki I Wigury Street, 02-091 Warsaw, Poland
| | - Michał Orczykowski
- 1st Department of Arrhythmia, National Institute of Cardiology, 42 Alpejska Street, 04-628 Warsaw, Poland
| | - Krzysztof Dutkowski
- Department of Cardiac Surgery and Transplantology, National Institute of Cardiology, 42 Alpejska Street, 04-628 Warsaw, Poland; (L.Z.); (J.S.); (P.K.)
| | - Jarosław Szymański
- Department of Cardiac Surgery and Transplantology, National Institute of Cardiology, 42 Alpejska Street, 04-628 Warsaw, Poland; (L.Z.); (J.S.); (P.K.)
| | - Jarosław Kuriata
- Department of Cardiac Surgery and Transplantology, National Institute of Cardiology, 42 Alpejska Street, 04-628 Warsaw, Poland; (L.Z.); (J.S.); (P.K.)
| | - Rafał Dąbrowski
- Department of Coronary Artery Disease and Cardiac Rehabilitation, National Institute of Cardiology, 42 Alpejska Street, 04-628 Warsaw, Poland
| | - Piotr Kołsut
- Department of Cardiac Surgery and Transplantology, National Institute of Cardiology, 42 Alpejska Street, 04-628 Warsaw, Poland; (L.Z.); (J.S.); (P.K.)
| | - Łukasz Szumowski
- 1st Department of Arrhythmia, National Institute of Cardiology, 42 Alpejska Street, 04-628 Warsaw, Poland
| | - Maciej Sterliński
- 1st Department of Arrhythmia, National Institute of Cardiology, 42 Alpejska Street, 04-628 Warsaw, Poland
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Oates CP, Lam PH, Lawrence L, Bigham G, Meda NS, Basyal B, Hadadi CA, Rao SD, Hockstein M, Shah M, Sheikh FH. Early Ventricular Arrhythmias After Left Ventricular Assist Device Implantation. J Card Fail 2023:S1071-9164(23)00912-0. [PMID: 38103723 DOI: 10.1016/j.cardfail.2023.11.018] [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: 09/01/2023] [Revised: 11/14/2023] [Accepted: 11/14/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Although sustained ventricular arrhythmias (VAs) are a common complication after durable left ventricular assist device (LVAD) implantation, the incidence, risk factors, and prognostic implications of postoperative early VAs (EVAs) in contemporary patients with LVAD are poorly understood. METHODS AND RESULTS A single-center retrospective analysis was performed of patients who underwent LVAD implantation from October 1, 2006, to October 1, 2022. EVA was defined as an episode of sustained VA identified ≤30 days after LVAD implantation. A total of 789 patients underwent LVAD implantation (mean age 62.9 ± 0. years 5, HeartMate 3 41.4%, destination therapy 43.3%). EVAs occurred in 100 patients (12.7%). A history of end-stage renal disease (odds ratio [OR] 5.6, 95% confidence interval [CI] 1.45-21.70), preoperative electrical storm (OR 2.82, 95% CI 1.11-7.16), and appropriate implantable cardiac defibrillator therapy before implantation (OR 2.8, 95% CI 1.26-6.19) are independently associated with EVAs. EVA was associated with decreased 30-day survival (hazard ratio 3.02, 95% CI 1.1-8.3, P = .032). There was no difference in transplant-free survival time between patients with and without EVAs (hazard ratio 0.82, 95% CI 0.5-1.4, P = .454). CONCLUSIONS EVAs are common after durable LVAD implantation and are associated with an increased risk of 30-day mortality.
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Affiliation(s)
- Connor P Oates
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC; Georgetown University School of Medicine, Washington, DC.
| | - Phillip H Lam
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC; Georgetown University School of Medicine, Washington, DC
| | - Luke Lawrence
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC; Georgetown University School of Medicine, Washington, DC
| | - Grace Bigham
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC; Georgetown University School of Medicine, Washington, DC
| | - Namratha S Meda
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC; Georgetown University School of Medicine, Washington, DC
| | - Binaya Basyal
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC; Georgetown University School of Medicine, Washington, DC
| | - Cyrus A Hadadi
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC; Georgetown University School of Medicine, Washington, DC
| | - Sriram D Rao
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC; Georgetown University School of Medicine, Washington, DC
| | - Michael Hockstein
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC; Georgetown University School of Medicine, Washington, DC
| | - Manish Shah
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC; Georgetown University School of Medicine, Washington, DC
| | - Farooq H Sheikh
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC; Georgetown University School of Medicine, Washington, DC
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Kataoka N, Imamura T. Catheter Ablation for Tachyarrhythmias in Left Ventricular Assist Device Recipients: Clinical Significance and Technical Tips. J Clin Med 2023; 12:7111. [PMID: 38002723 PMCID: PMC10672548 DOI: 10.3390/jcm12227111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/07/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
The demand for durable left ventricular assist devices (LVADs) has been increasing worldwide in tandem with the rising population of advanced heart failure patients. Especially in cases of destination therapy, instead of bridges to transplantation, LVADs require a lifelong commitment. With the increase in follow-up periods after implantation and given the lack of donor hearts, the need for managing concomitant tachyarrhythmias has arisen. Atrial and ventricular arrhythmias are documented in approximately 20% to 50% of LVAD recipients during long-term device support, according to previous registries. Atrial arrhythmias, primarily atrial fibrillation, generally exhibit good hemodynamic tolerance; therefore, catheter ablation cannot be easily recommended due to the risk of a residual iatrogenic atrial septal defect that may lead to a right-to-left shunt under durable LVAD supports. The clinical impacts of ventricular arrhythmias, mainly ventricular tachycardia, may vary depending on the time periods following the index implantation. Early occurrence after the operation affects the hospitalization period and mortality; however, the late onset of ventricular tachycardia causes varying prognostic impacts on a case-by-case basis. In cases of hemodynamic instability, catheter ablation utilizing a trans-septal approach is necessary to stabilize hemodynamics. Nonetheless, in some cases originating from the intramural region or the epicardium, procedural failure may occur with the endocardial ablation. Specialized complications associated with the state of LVAD support should be carefully considered when conducting procedures. In LVAD patients, electrophysiologists, circulatory support specialists, and surgeons should collaborate as an integrated team to address the multifaceted issues related to arrhythmia management.
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Affiliation(s)
| | - Teruhiko Imamura
- Second Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan;
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Huang DT, Gosev I, Wood KL, Vidula H, Stevenson W, Marchlinski F, Supple G, Zalawadiya SK, Weiss JP, Tung R, Tzou WS, Moss JD, Kancharla K, Chaudhry S, Patel PJ, Khan AM, Schuger C, Rozen G, Kiernan MS, Couper GS, Leacche M, Molina EJ, Shah AD, Lloyd M, Sroubek J, Soltesz E, Shivkumar K, White C, Tankut S, Johnson BA, McNitt S, Kutyifa V, Zareba W, Goldenberg I. Design and characteristics of the prophylactic intra-operative ventricular arrhythmia ablation in high-risk LVAD candidates (PIVATAL) trial. Ann Noninvasive Electrocardiol 2023; 28:e13073. [PMID: 37515396 PMCID: PMC10475893 DOI: 10.1111/anec.13073] [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: 02/27/2023] [Revised: 04/25/2023] [Accepted: 06/27/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The use of a Left Ventricular Assist Device (LVAD) in patients with advanced heart failure refractory to optimal medical management has progressed steadily over the past two decades. Data have demonstrated reduced LVAD efficacy, worse clinical outcome, and higher mortality for patients who experience significant ventricular tachyarrhythmia (VTA). We hypothesize that a novel prophylactic intra-operative VTA ablation protocol at the time of LVAD implantation may reduce the recurrent VTA and adverse events postimplant. METHODS We designed a prospective, multicenter, open-label, randomized-controlled clinical trial enrolling 100 patients who are LVAD candidates with a history of VTA in the previous 5 years. Enrolled patients will be randomized in a 1:1 fashion to intra-operative VTA ablation (n = 50) versus conventional medical management (n = 50) with LVAD implant. Arrhythmia outcomes data will be captured by an implantable cardioverter defibrillator (ICD) to monitor VTA events, with a uniform ICD programming protocol. Patients will be followed prospectively over a mean of 18 months (with a minimum of 9 months) after LVAD implantation to evaluate recurrent VTA, adverse events, and procedural outcomes. Secondary endpoints include right heart function/hemodynamics, healthcare utilization, and quality of life. CONCLUSION The primary aim of this first-ever randomized trial is to assess the efficacy of intra-operative ablation during LVAD surgery in reducing VTA recurrence and improving clinical outcomes for patients with a history of VTA.
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Affiliation(s)
- David T. Huang
- Division of CardiologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Igor Gosev
- Division of Cardiothoracic SurgeryUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Katherine L. Wood
- Division of Cardiothoracic SurgeryUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Hima Vidula
- Division of CardiologyUniversity of Pennsylvania Medical CenterPhiladelphiaPennsylvaniaUSA
| | - William Stevenson
- Division of Cardiovascular MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Frank Marchlinski
- Division of CardiologyUniversity of Pennsylvania Medical CenterPhiladelphiaPennsylvaniaUSA
| | - Gregory Supple
- Division of CardiologyUniversity of Pennsylvania Medical CenterPhiladelphiaPennsylvaniaUSA
| | - Sandip K. Zalawadiya
- Division of Cardiovascular MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - J. Peter Weiss
- The University of Arizona College of Medicine‐Phoenix, Banner University Medical CenterPhoenixArizonaUSA
| | - Roderick Tung
- The University of Arizona College of Medicine‐Phoenix, Banner University Medical CenterPhoenixArizonaUSA
| | - Wendy S. Tzou
- Division of CardiologyUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Joshua D. Moss
- Division of CardiologyUniversity of California‐San FranciscoSan FranciscoCaliforniaUSA
| | - Krishna Kancharla
- Department of MedicineHeart and Vascular Institute, University of Pittsburgh Medical Center and School of MedicinePittsburghPennsylvaniaUSA
| | - Sunit‐Preet Chaudhry
- Division of CardiologyAscension St. Vincent Heart CenterIndianapolisIndianaUSA
- Ascension St. Vincent Cardiovascular Research InstituteIndianapolisIndianaUSA
| | - Parin J. Patel
- Division of CardiologyAscension St. Vincent Heart CenterIndianapolisIndianaUSA
- Ascension St. Vincent Cardiovascular Research InstituteIndianapolisIndianaUSA
| | - Arfaat M. Khan
- Henry Ford Heart and Vascular Institute, Henry Ford HospitalDetroitMichiganUSA
| | - Claudio Schuger
- Henry Ford Heart and Vascular Institute, Henry Ford HospitalDetroitMichiganUSA
| | - Guy Rozen
- Cardiovascular Center, Tufts Medical CenterBostonMassachusettsUSA
| | | | | | - Marzia Leacche
- Department of Cardiothoracic SurgerySpectrum HealthGrand RapidsMichiganUSA
| | - Ezequiel J. Molina
- Department of Cardiothoracic SurgeryPiedmont Heart InstituteAtlantaGeorgiaUSA
| | - Anand D. Shah
- Section of Cardiac ElectrophysiologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Michael Lloyd
- Section of Cardiac ElectrophysiologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Jakub Sroubek
- Heart Vascular and Thoracic Institute, Cleveland ClinicClevelandOhioUSA
| | - Edward Soltesz
- Department of Thoracic and Cardiovascular SurgeryCleveland ClinicClevelandOhioUSA
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Casey White
- Division of CardiologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Sinan Tankut
- Division of CardiologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Brent A. Johnson
- Department of Biostatistics and Computational BiologyUniversity of RochesterRochesterNew YorkUSA
| | - Scott McNitt
- Clinical Cardiovascular Research CenterUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Valentina Kutyifa
- Clinical Cardiovascular Research CenterUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Wojciech Zareba
- Clinical Cardiovascular Research CenterUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Ilan Goldenberg
- Clinical Cardiovascular Research CenterUniversity of Rochester Medical CenterRochesterNew YorkUSA
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Izumida T, Kataoka N, Imamura T, Uchida K, Koi T, Nakagaito M, Nakamura M, Komatsu Y, Nogami A, Kinugawa K. Bail-out Ablation of Ventricular Tachycardia Electrical Storm in a Patient with a Durable Left Ventricular Assist Device. Intern Med 2023; 62:2201-2204. [PMID: 36476550 PMCID: PMC10465274 DOI: 10.2169/internalmedicine.0796-22] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 10/25/2022] [Indexed: 12/12/2022] Open
Abstract
The therapeutic strategy for sustained ventricular tachycardia (VT) during left ventricular assist device usage remains unclear. We encountered a patient with durable left ventricular assist device who presented sustained VT. Electrophysiological mapping was able to be established appropriately owing to the robust mechanical hemodynamics support despite inter-device interference. The three-dimensional activation map of clinically documented VT demonstrated that the propagation exited from the right ventricular apex through the critical isthmus located at the epicardium or interventricular septum, which was successfully treated by catheter ablation at the exit site. Further experiences like ours should be accumulated to establish a therapeutic strategy.
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Affiliation(s)
| | - Naoya Kataoka
- Second Department of Medicine, University of Toyama, Japan
| | | | - Keisuke Uchida
- Second Department of Medicine, University of Toyama, Japan
| | - Takahisa Koi
- Second Department of Medicine, University of Toyama, Japan
| | | | | | - Yuki Komatsu
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Japan
| | - Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Japan
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9
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Rocchi M, Gross C, Moscato F, Schlöglhofer T, Meyns B, Fresiello L. An in vitro model to study suction events by a ventricular assist device: validation with clinical data. Front Physiol 2023; 14:1155032. [PMID: 37560156 PMCID: PMC10407082 DOI: 10.3389/fphys.2023.1155032] [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: 01/31/2023] [Accepted: 07/11/2023] [Indexed: 08/11/2023] Open
Abstract
Introduction: Ventricular assist devices (LVADs) are a valuable therapy for end-stage heart failure patients. However, some adverse events still persist, such as suction that can trigger thrombus formation and cardiac rhythm disorders. The aim of this study is to validate a suction module (SM) as a test bench for LVAD suction detection and speed control algorithms. Methods: The SM consists of a latex tube, mimicking the ventricular apex, connected to a LVAD. The SM was implemented into a hybrid in vitro-in silico cardiovascular simulator. Suction was induced simulating hypovolemia in a profile of a dilated cardiomyopathy and of a restrictive cardiomyopathy for pump speeds ranging between 2,500 and 3,200 rpm. Clinical data collected in 38 LVAD patients were used for the validation. Clinical and simulated LVAD flow waveforms were visually compared. For a more quantitative validation, a binary classifier was used to classify simulated suction and non-suction beats. The obtained classification was then compared to that generated by the simulator to evaluate the specificity and sensitivity of the simulator. Finally, a statistical analysis was run on specific suction features (e.g., minimum impeller speed pulsatility, minimum slope of the estimated flow, and timing of the maximum slope of the estimated flow). Results: The simulator could reproduce most of the pump waveforms observed in vivo. The simulator showed a sensitivity and specificity and of 90.0% and 97.5%, respectively. Simulated suction features were in the interquartile range of clinical ones. Conclusions: The SM can be used to investigate suction in different pathophysiological conditions and to support the development of LVAD physiological controllers.
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Affiliation(s)
- Maria Rocchi
- Unit of Cardiac Surgery, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Christoph Gross
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Francesco Moscato
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Thomas Schlöglhofer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria
| | - Bart Meyns
- Unit of Cardiac Surgery, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Libera Fresiello
- Unit of Cardiac Surgery, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
- Cardiovascular and Respiratory Physiology, University of Twente, Enschede, Netherlands
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10
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Single center experience of intraoperative ventricular tachycardia ablation at time of ventricular assist device placement. HeartRhythm Case Rep 2023; 9:253-254. [PMID: 37101680 PMCID: PMC10123935 DOI: 10.1016/j.hrcr.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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11
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Nogami A, Phanthawimol W, Haruna T. Catheter Ablation for Ventricular Tachycardia Involving the His-Purkinje System: Fascicular and Bundle Branch Reentrant Ventricular Tachycardia. Card Electrophysiol Clin 2022; 14:633-656. [PMID: 36396182 DOI: 10.1016/j.ccep.2022.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The Purkinje system has been found to mediate several monomorphic ventricular tachycardias (VTs). These include fascicular VTs and bundle branch reentrant (BBR) VTs. Previous studies have revealed that VTs involving the His-Purkinje system are composed of multiple discrete subtypes that are best differentiated by their mechanism, drug effect, VT morphology, and successful ablation site. Recognition of the heterogeneity of these VTs and their unique characteristics should facilitate the appropriate diagnosis and therapy and help guide catheter ablation therapy. In this article, we focus on the latest updates of the mechanisms underlying left ventricle fascicular VTs and BBR-VTs as well as the latest catheter ablation techniques.
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Affiliation(s)
- Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan.
| | - Wipat Phanthawimol
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Tetsuya Haruna
- Department of Cardiology, Kitano Hospital, 2-4-20 Ohgimachi, Kita-ku, Osaka 530-8480, Japan
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12
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Rocchi M, Fresiello L, Jacobs S, Dauwe D, Droogne W, Meyns B. Potential of Medical Management to Mitigate Suction Events in Ventricular Assist Device Patients. ASAIO J 2022; 68:814-821. [PMID: 34524148 DOI: 10.1097/mat.0000000000001573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Ventricular suction is a common adverse event in ventricular assist device (VAD) patients and can be due to multiple underlying causes. The aim of this study is to analyze the potential of different therapeutic interventions to mitigate suction events induced by different pathophysiological conditions. To do so, a suction module was embedded in a cardiovascular hybrid (hydraulic-computational) simulator reproducing the entire cardiovascular system. An HVAD system (Medtronic) was connected between a compliant ventricular apex and a simulated aorta. Starting from a patient profile with severe dilated cardiomyopathy, four different pathophysiological conditions leading to suction were simulated: hypovolemia (blood volume: -900 ml), right ventricular failure (contractility -70%), hypotension (systemic vascular resistance: 8.3 Wood Units), and tachycardia (heart rate:185 bpm). Different therapeutic interventions such as volume infusion, ventricular contractility increase, vasoconstriction, heart rate increase, and pump speed reduction were simulated. Their effects were compared in terms of general hemodynamics and suction mitigation. Each intervention elicited a different effect on the hemodynamics for every pathophysiological condition. Pump speed reduction mitigated suction but did not ameliorate the hemodynamics. Administering volume and inducing a systemic vasoconstriction were the most efficient interventions in both improving the hemodynamics and mitigating suction. When simulating volume infusion, the cardiac powers increased, respectively, by 38%, 25%, 42%, and 43% in the case of hypovolemia, right ventricular failure, hypotension, and tachycardia. Finally, a management algorithm is proposed to identify a therapeutic intervention suited for the underlying physiologic condition causing suction.
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Affiliation(s)
- Maria Rocchi
- From the Department of Cardiovascular Sciences, Cardiac Surgery, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Libera Fresiello
- From the Department of Cardiovascular Sciences, Cardiac Surgery, Katholieke Universiteit Leuven, Leuven, Belgium
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Steven Jacobs
- From the Department of Cardiovascular Sciences, Cardiac Surgery, Katholieke Universiteit Leuven, Leuven, Belgium
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Dieter Dauwe
- From the Department of Cardiovascular Sciences, Cardiac Surgery, Katholieke Universiteit Leuven, Leuven, Belgium
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Walter Droogne
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Bart Meyns
- From the Department of Cardiovascular Sciences, Cardiac Surgery, Katholieke Universiteit Leuven, Leuven, Belgium
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
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13
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Gopinathannair R. Another Strike Against Continuing Cardiac Resynchronization Therapy in Left Ventricular Assist Device recipients? J Cardiovasc Electrophysiol 2022; 33:1032-1033. [PMID: 35245412 DOI: 10.1111/jce.15439] [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: 02/26/2022] [Accepted: 02/28/2022] [Indexed: 11/28/2022]
Abstract
Continuous flow left ventricular assist devices (LVAD) are an important therapeutic strategy, either as a bridge to transplant, bridge to recovery or as destination therapy, in patients with end-stage heart failure. This article is protected by copyright. All rights reserved.
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14
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Chou A, Larson J, Deshmukh A, Cascino TM, Ghannam M, Latchamsetty R, Jongnarangsin K, Oral H, Morady F, Bogun F, Aaronson KD, Pagani FD, Liang JJ. Association Between Biventricular Pacing and Incidence of Ventricular Arrhythmias in the Early Post-Operative Period after Left Ventricular Assist Device Implantation. J Cardiovasc Electrophysiol 2022; 33:1024-1031. [PMID: 35245401 DOI: 10.1111/jce.15437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/13/2022] [Accepted: 02/07/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cardiac resynchronization therapy (CRT) and left ventricular assist devices (LVAD) improve outcomes in heart failure patients. Early ventricular arrhythmias (VA) are common after LVAD and are associated with increased mortality. The association between left ventricular pacing (LVP) with CRT and VAs in the early post-LVAD period remains unclear. METHODS This was a retrospective study of all patients undergoing LVAD implantation from 1/2016 - 12/2019. Patients were divided into those with CRT and active LVP (CRT-LVP) immediately post-LVAD implant versus those without CRT-LVP. ICD electrograms were reviewed and early VAs were defined as sustained VT/VF occurring within 30 days of LVAD implantation. RESULTS Of 186 included patients (mean age 53 years, 75% male, mean BMI 28), 72 had CRT devices, 63 of whom had LV pacing enabled after LVAD implant (CRT-LVP group). Patients with CRT-LVP were more likely to have VA in the early post-operative period (21% vs 4%; p=0.0001). All 9 patients with CRT in whom LVP was disabled had no early VA. Among those with early VA, patients with CRT-LVP were more likely to have monomorphic VT (77% vs 40%; p=0.07). In multiple logistic regression, CRT-LVP pacing remained an independent predictor of early VA after adjustment for history of VA and AF. CONCLUSIONS Patients with CRT-LVP after LVAD implant had a higher incidence of early VA (specifically monomorphic VT). Epicardial LV pacing may be proarrhythmic in the early post-operative period after LVAD. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Francis D Pagani
- Division of Cardiac Surgery, University of Michigan, Ann Arbor, MI
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15
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Nof E, Peichl P, Stojadinovic P, Arceluz M, Maury P, Katz M, Tedrow UB, Singh RM, Narui R, John RM, Stevenson WG, Beinart R, Grupper A, Sternik L, Lavee J, Sacher F, Kautzner J, Sabbag A. HeartMate 3: new challenges in ventricular tachycardia ablation. Europace 2021; 24:598-605. [PMID: 34791165 DOI: 10.1093/europace/euab272] [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: 01/09/2021] [Accepted: 10/27/2021] [Indexed: 11/14/2022] Open
Abstract
AIM To describe clinical characteristics, procedural details, specific challenges, and outcomes in patients with HeartMate3™ (HM3), a left ventricular assist device system with a magnetically levitated pump, undergoing ventricular tachycardia ablation (VTA). METHODS AND RESULTS Data were collected from patients with an HM3 system who underwent VTA in seven tertiary centres. Data included baseline patient characteristics, procedural data, mortality, and arrhythmia-free survival. The study cohort included 19 patients with cardiomyopathy presenting with ventricular tachycardia (VT) (53% with VT storm). Ventricular tachycardias were induced in 89% of patients and a total of 41 VTs were observed. Severe electromagnetic interference was present on the surface electrocardiogram. Hence, VT localization required analysis of intra-cardiac signals or the use of filter in the 40-20 Hz range. The large house pump HM3 design obscured the cannula inflow and therefore multi imaging modalities were necessary to avoid catheter entrapment in the cannula. A total of 32 VTs were mapped and were successfully ablated (31% to the anterior wall, 38% to the septum and only 9% to the inflow cannula region). Non-inducibility of any VT was reached in 11 patients (58%). Over a follow-up of 429 (interquartile range 101-692) days, 5 (26%) patients underwent a redo VT ablation due to recurrent VTA and 2 (11%) patients died. CONCLUSIONS Ventricular tachycardia ablation in patients with HM3 is feasible and safe when done in the appropriate setup. Long-term arrhythmia-free survival is acceptable but not well predicted by non-inducibility at the end of the procedure.
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Affiliation(s)
- Eyal Nof
- Davidai Arrhythmia Center, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Petr Peichl
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Predrag Stojadinovic
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Martin Arceluz
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Philippe Maury
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Moshe Katz
- Davidai Arrhythmia Center, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Usha B Tedrow
- Cardiovascular Division, Brigham and Women's Hospital, 75, Boston, MA, USA
| | - Robin M Singh
- Cardiovascular Division, Brigham and Women's Hospital, 75, Boston, MA, USA
| | - Ryohsuke Narui
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Roy M John
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - William G Stevenson
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Roy Beinart
- Davidai Arrhythmia Center, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avishay Grupper
- Davidai Arrhythmia Center, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Leonid Sternik
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Cardiac Surgery, Sheba Medical Center, Ramat Gan, Israel
| | - Jacob Lavee
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Cardiac Surgery, Sheba Medical Center, Ramat Gan, Israel
| | - Frédéric Sacher
- LIRYC Institute, Bordeaux University Hospital, Pessac, France; Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital, Pessac, France
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Avi Sabbag
- Davidai Arrhythmia Center, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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16
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Uribarri A, Sandín M, San Román JA, Datino T. [Taquicardia ventricular en un paciente con asistencia ventricular izquierda de larga duración: un reto terapéutico]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2021; 91:539-541. [PMID: 33328686 PMCID: PMC8641455 DOI: 10.24875/acm.20000215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Aitor Uribarri
- Departamento de Cardiología, Hospital Clínico Universitario, Valladolid; Centro de Investigación Biomédica en Red, Madrid, España
| | - Ma Sandín
- Departamento de Cardiología, Hospital Clínico Universitario, Valladolid, España
| | - José A San Román
- Departamento de Cardiología, Hospital Clínico Universitario, Valladolid; Centro de Investigación Biomédica en Red, Madrid, España
| | - Tomás Datino
- Departamento de Cardiología, Instituto de Investigación Sanitaria del Hospital General Universitario Gregorio Marañón, Madrid; Centro de Investigación Biomédica en Red, Madrid, España
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17
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Lessons learned from catheter ablation of ventricular arrhythmias in patients with a fully magnetically levitated left ventricular assist device. Clin Res Cardiol 2021; 111:574-582. [PMID: 34709450 PMCID: PMC9054875 DOI: 10.1007/s00392-021-01958-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 10/19/2021] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Data on catheter ablation of ventricular arrhythmias (VA) are scarce in patients with left ventricular assist devices (LVADs) and current evidence predominantly consists of case reports with outdated LVAD. This prospective observational study reports our experience in terms of catheter ablation of VAs in patients with novel 3rd generation LVADs. METHODS AND RESULTS Between 2018 and 2020, nine consecutive patients undergoing a total number of ten ablation procedures for VAs were analyzed. The mean duration between LVAD implantation and catheter ablation was 23 ± 16 months. Acute procedural success was achieved in all patients. VA substrates were not related to the LVAD scarring (cannula) site in the majority of patients. All procedures were conducted without any relevant procedure-related complications. In terms of follow-up, only one patient presented with a repeat episode of electrical storm requiring ICD-shocks 16 months after the initial ablation procedure. Four patients suffered of singular VA effectively treated with antitachycardia pacing via their ICD. The remainder were free of any VA relapse (n = 4). Two non-procedure-related deaths occurred during follow-up. CONCLUSIONS Catheter ablation of VAs in patients with 3rd generation LVAD is feasible and leads to satisfying clinical results in terms of freedom from VA recurrence and quality of life. The majority of arrhythmia substrates in these patients are not directly related to the LVAD cannulation site and may represent a progress of heart failure.
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18
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Tsuji M, Amiya E, Bujo C, Hara T, Saito A, Minatsuki S, Maki H, Ishida J, Hosoya Y, Hatano M, Imai H, Nemoto M, Kagami Y, Endo M, Kimura M, Ando M, Shimada S, Kinoshita O, Ono M, Komuro I. Carbon Monoxide Diffusing Capacity Predicts Cardiac Readmission in Patients Undergoing Left Ventricular Assist Device Implantation in Japan. ASAIO J 2021; 67:1111-1118. [PMID: 33470633 DOI: 10.1097/mat.0000000000001363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Carbon monoxide diffusion capacity (DLCO) is impaired in heart failure patients; however, its clinical impact has not been well investigated in the left ventricular assist device (LVAD) population. We explored the predictive value of preoperative DLCO in the survival and cardiac readmission rates after LVAD implantation. Seventy-six patients who received continuous-flow LVAD as bridge-to-transplant therapy from November 2007 to September 2018 and underwent pulmonary function test before LVAD implantation were included. The primary study endpoints were death and readmission for heart failure or arrhythmia (cardiac readmission). Patients were stratified into two groups according to the percent of predicted DLCO (%DLCO). Pulmonary vascular resistance (PVR) was equivocal between the groups preoperatively, whereas the low DLCO group (%DLCO < 80%) showed significantly high PVR postoperatively. The mortality rate was not different between the groups. The 2 year cardiac readmission rate was 33.5% in the low DLCO group and 8.7% in the high DLCO group (%DLCO ≥ 80%) (P = 0.028). The %DLCO was associated with cardiac readmission in univariate and multivariate analyses (hazard ratio: 4.32; 95% CI: 1.50-15.9; P = 0.005). Low %DLCO was associated with high PVR postoperatively and was a risk factor for cardiac readmission after LVAD implantation.
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Affiliation(s)
- Masaki Tsuji
- From the Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Eisuke Amiya
- From the Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Therapeutic Strategy for Heart Failure, The University of Tokyo, Tokyo, Japan
| | - Chie Bujo
- From the Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toru Hara
- From the Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akihito Saito
- From the Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shun Minatsuki
- From the Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hisataka Maki
- From the Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Junichi Ishida
- From the Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yumiko Hosoya
- From the Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Therapeutic Strategy for Heart Failure, The University of Tokyo, Tokyo, Japan
| | - Masaru Hatano
- From the Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Therapeutic Strategy for Heart Failure, The University of Tokyo, Tokyo, Japan
| | - Hiroko Imai
- Department of Organ Transplantation, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mariko Nemoto
- Department of Organ Transplantation, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukie Kagami
- Department of Organ Transplantation, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Miyoko Endo
- Department of Organ Transplantation, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mitsutoshi Kimura
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masahiko Ando
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shogo Shimada
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Osamu Kinoshita
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Issei Komuro
- From the Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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A Compliant Model of the Ventricular Apex to Study Suction in Ventricular Assist Devices. ASAIO J 2021; 67:1125-1133. [PMID: 34570727 DOI: 10.1097/mat.0000000000001370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Ventricular suction is a frequent adverse event in patients with a ventricular assist device (VAD). This study presents a suction module (SM) embedded in a hybrid (hydraulic-computational) cardiovascular simulator suitable for the testing of VADs and related suction events. The SM consists of a compliant latex tube reproducing a simplified ventricular apex. The SM is connected on one side to a hydraulic chamber of the simulator reproducing the left ventricle, and on the other side to a HeartWare HVAD system. The SM is immersed in a hydraulic chamber with a controllable pressure to occlude the compliant tube and activate suction. Two patient profiles were simulated (dilated cardiomyopathy and heart failure with preserved ejection fraction), and the circulating blood volume was reduced stepwise to obtain different preload levels. For each simulated step, the following data were collected: HVAD flow, ventricular pressure and volume, and pressure at the inflow cannula. Data collected for the two profiles and for decreasing preload levels evidenced suction profiles differing in terms of frequency (intermittent vs. every heart beat), amplitude (partial or complete stoppage of the HVAD flow), and shape. Indeed different HVAD flow patterns were observed for the two patient profiles because of the different mechanical properties of the simulated ventricles. Overall, the HVAD flow patterns showed typical indicators of suctions observed in clinics. Results confirmed that the SM can reproduce suction phenomena with VAD under different pathophysiological conditions. As such, the SM can be used in the future to test VADs and control algorithms aimed at preventing suction phenomena.
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20
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Association between early ventricular arrhythmias and mortality in destination vs. bridge patients on continuous flow LVAD support. Sci Rep 2021; 11:19196. [PMID: 34584108 PMCID: PMC8479086 DOI: 10.1038/s41598-021-98109-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 08/10/2021] [Indexed: 12/01/2022] Open
Abstract
The association between ventricular arrhythmias (VAs) and mortality in patients supported by continuous flow left ventricular assist devices (LVAD) remains controversial. To evaluate the association between pre-implantation, early (≤ 30 day) post-implantation VAs and mortality in bridge to transplant (BTT) and destination therapy (DT) LVAD patients, separately. The risk factors for post LVAD VAs were also investigated. In this observational cohort study, we included 341 patients who received a first time, continuous flow LVAD between January 1st 2010 and July 30th 2018. We used Kaplan–Meier curves and multivariable cox regression analyses to study the association between VAs and mortality in the BTT and DT populations. The mean age of the cohort was 58 ± 14 years, with 82% males, 53% had ischemic cardiomyopathy, and 45% were DT. The mean follow-up was 2.2 ± 2.1 years. In both BTT and DT cohorts, pre LVAD VAs were not associated with mortality after LVAD implantation (log-rank p = 0.95 and p = 0.089, respectively). In the BTT population, early post-LVAD VAs were not statistically associated with increased mortality (log rank p = 0.072). In the DT patients, early post LVAD VAs were associated with a 67% increase in the hazards rate of mortality on LVAD support (HR 1.67 [1.05–2.65], p = 0.029). The final model was adjusted for type of cardiomyopathy, INTERMACS profile, glomerular filtration rate, post LVAD atrial fibrillation, age and cerebrovascular events. Early post-LVAD VA is common after LVAD implantation and is an independent predictor of mortality in the DT LVAD population.
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21
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Jakstaite AM, Luedike P, Wakili R, Kochhäuser S, Ruhparwar A, Rassaf T, Papathanasiou M. Case report: incessant ventricular fibrillation in a conscious left ventricular assist device patient. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab337. [PMID: 34557636 PMCID: PMC8453423 DOI: 10.1093/ehjcr/ytab337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/10/2021] [Accepted: 08/05/2021] [Indexed: 12/05/2022]
Abstract
Background Ventricular arrhythmia in left ventricular assist device (LVAD) recipients represents a challenging clinical scenario and the optimal treatment strategy in this unique patient population still needs to be defined. Case summary We report on a 61-year-old LVAD patient with incessant ventricular fibrillation (VF) despite multiple unsuccessful attempts to restore normal rhythm with external defibrillation and antiarrhythmic medication. He remained initially stable as an outpatient and subsequently developed secondary organ failure. Discussion This case demonstrates that under LVAD support long-term haemodynamic stability is possible even in case of VF, a situation that resembles Fontan circulation. However, ventricular arrhythmias are associated with a high risk of secondary organ damage due to right heart failure if left untreated. In case of refractory ventricular tachycardia or electrical storm listing for heart transplantation with high priority status should be pursued when possible. Alternatively, catheter ablation may be considered in selected cases and be performed in experienced centres in close collaboration with all involved specialists.
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Affiliation(s)
- Aiste Monika Jakstaite
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Peter Luedike
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Reza Wakili
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Simon Kochhäuser
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Maria Papathanasiou
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
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22
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Moss JD, Yoruk A. Open Chest Epicardial VT Ablation After LVAD: Ounce of Prevention or Pound of Cure? JACC Case Rep 2021; 3:1061-1063. [PMID: 34317684 PMCID: PMC8311373 DOI: 10.1016/j.jaccas.2021.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Joshua D. Moss
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California-San Francisco, San Francisco, California, USA
| | - Ayhan Yoruk
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California-San Francisco, San Francisco, California, USA
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23
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Sisti N, Santoro A, Carreras G, Valente S, Donzelli S, Mandoli GE, Sciaccaluga C, Cameli M. Ablation therapy for ventricular arrhythmias in patients with LVAD: Multiple faces of an electrophysiological challenge. J Arrhythm 2021; 37:535-543. [PMID: 34141004 PMCID: PMC8207352 DOI: 10.1002/joa3.12542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 03/12/2021] [Accepted: 04/04/2021] [Indexed: 12/15/2022] Open
Abstract
Left ventricular assist device implantation is a recognized treatment option for patients with advanced heart failure refractory to medical therapy and can be used both as bridge to transplantation and as destination therapy. The risk of ventricular arrhythmias is common after left ventricular assist device implantation and is influenced by pre-, peri and post-operative determinants. The management of ventricular arrhythmias can be a challenge when they become refractory to medication or to device therapy and their impact on prognosis can be detrimental despite the mechanical support. In this setting, catheter ablation is being increasingly recognized as a feasible option for patients in which standard therapeutic strategies fail, but also with preventive purpose. Catheter ablation is being increasingly considered for the management of ventricular arrhythmias in patients with left ventricular assist device despite complex clinical and technical peculiarities due to the characteristics of the mechanical support. Much conflicting data exist regarding the predictors of success of the procedure and the rate of recurrence. In this review we discuss the latest evidences regarding catheter ablation of ventricular arrhythmias in this subset of patients, focusing on clinical characteristics, arrhythmia etiology, technical aspects and postprocedural features which must be considered by the electrophysiologist.
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Affiliation(s)
- Nicolò Sisti
- Department of Cardiovascular DiseasesUniversity of SienaSienaItaly
| | - Amato Santoro
- Department of Cardiovascular DiseasesUniversity of SienaSienaItaly
| | | | - Serafina Valente
- Department of Cardiovascular DiseasesUniversity of SienaSienaItaly
| | | | | | | | - Matteo Cameli
- Department of Cardiovascular DiseasesUniversity of SienaSienaItaly
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24
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Corona S, Naliato M, Tondo C, Casella M, Apostolo A, Agostoni P, Salvi L, Alamanni F. Successful Open Chest Epicardial Ablation for Refractory Ventricular Tachycardia in an LVAD Recipient. JACC Case Rep 2021; 3:1055-1060. [PMID: 34317683 PMCID: PMC8311376 DOI: 10.1016/j.jaccas.2021.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 01/26/2021] [Accepted: 02/08/2021] [Indexed: 11/19/2022]
Abstract
A patient with history of dilated cardiomyopathy, a cardiac resynchronization therapy defibrillator, and endocardial ablation presented for refractory ventricular tachycardia 3 years after implantation of a Jarvik 2000 left ventricular assist device (Jarvik Heart, Inc., New York, New York). Open-chest epicardial ablation safely and effectively terminated the arrhythmia, without ventricular tachycardia recurrence at 9-month follow-up and in the absence of complications during the hospital stay. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Silvia Corona
- Department of Cardiac Surgery, Centro Cardiologico Monzino, Scientific Institute for Research, Hospitalization, and Healthcare (IRCCS), Milan, Italy
- Address for correspondence: Dr Silvia Corona, IRCCS Centro Cardiologico Monzino, Via Parea 4, 20138 Milan, Italy. @SilviaCorona89
| | - Moreno Naliato
- Department of Cardiac Surgery, Centro Cardiologico Monzino, Scientific Institute for Research, Hospitalization, and Healthcare (IRCCS), Milan, Italy
| | - Claudio Tondo
- Department of Electrophysiology, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Cardiovascular Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Michela Casella
- Department of Electrophysiology, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Anna Apostolo
- Department of Heart Failure and Clinical Cardiology, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Piergiuseppe Agostoni
- Department of Heart Failure and Clinical Cardiology, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Anaesthesia and Intensive Care, Monzino Cardiology Center, IRCCS, Milan, Italy
| | - Luca Salvi
- Department of Anaesthesia and Intensive Care, Monzino Cardiology Center, IRCCS, Milan, Italy
| | - Francesco Alamanni
- Department of Cardiac Surgery, Centro Cardiologico Monzino, Scientific Institute for Research, Hospitalization, and Healthcare (IRCCS), Milan, Italy
- Department of Cardiovascular Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
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25
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Vlismas PP, Rochlani YM, Romero J, Scheinin S, Shin JJ, Goldstein D, Jorde UP. Cardiac Sympathetic Denervation for Refractory Ventricular Arrhythmia in Continuous-Flow Left Ventricular Assist Device. JACC Case Rep 2021; 3:443-446. [PMID: 34317554 PMCID: PMC8311031 DOI: 10.1016/j.jaccas.2020.12.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 12/21/2020] [Accepted: 12/24/2020] [Indexed: 11/30/2022]
Abstract
Cardiac sympathetic denervation has been shown to reduce sustained ventricular arrhythmias and implantable cardioverter-defibrillator shocks by inhibiting sympathetic outflow to the heart. We describe the first case to our knowledge of cardiac sympathetic denervation in the left ventricular assist device population. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Peter P Vlismas
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
| | - Yogita M Rochlani
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
| | - Jorge Romero
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
| | - Scott Scheinin
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - Jooyoung J Shin
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
| | - Daniel Goldstein
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - Ulrich P Jorde
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
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26
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Grinstein J, Garan AR, Oesterle A, Fried J, Imamura T, Mai X, Kalantari S, Sayer G, Kim GH, Sarswat N, Raikhelkar J, Adatya S, Jeevanandam V, Flatley E, Moss J, Uriel N. Increased Rate of Pump Thrombosis and Cardioembolic Events Following Ventricular Tachycardia Ablation in Patients Supported With Left Ventricular Assist Devices. ASAIO J 2021; 66:1127-1136. [PMID: 33136600 PMCID: PMC10024475 DOI: 10.1097/mat.0000000000001155] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Ventricular arrhythmias are common following left ventricular assist device implantation (LVAD), and the effects of ventricular tachycardia (VT) ablation on thrombosis and embolic events are unknown. We aimed to assess LVAD thrombosis, stroke, and embolic event rates after VT ablation. Left ventricular assist device implantation patients from two academic centers who underwent endocardial VT ablation between 2009 and 2016 were compared to a control group with VT who were not ablated and followed for one year. The primary composite outcome was confirmed or suspected LVAD thrombosis, stroke, or other embolic event. Survival analysis was conducted with Kaplan-Meier curves, log-rank tests, and Cox regression. Forty-three LVAD patients underwent VT ablation, and 73 LVAD patients had VT but were not ablated. Patients who were ablated were more likely have VT prior to LVAD (p = 0.04), monomorphic VT (p < 0.01), and to be on antiarrhythmics (p < 0.01). Fifty-eight percent of the patients in the ablation group experienced the primary composite outcome (11% had confirmed device thrombosis [DT], 41% suspected DT, 39% had a stroke or embolic event) compared to 30% in the control group (12% with confirmed DT, 11% with suspected DT, 14% with stroke or embolic event) (p = 0.002). In multivariable regression, ablation was an independent predictor of the primary composite outcome (hazard ratios, 2.24; 95% confidence interval, 1.09-4.61; p = 0.03). Patients with LVADs referred for endocardial VT ablation had elevated rates of DT and embolic events.
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Affiliation(s)
| | | | | | - Justin Fried
- Division of Cardiology, Columbia University, New York, NY
| | | | - Xingchen Mai
- Division of Cardiology, Columbia University, New York, NY
| | - Sara Kalantari
- Department of Medicine, University of Chicago, Chicago, IL
| | - Gabriel Sayer
- Division of Cardiology, Columbia University, New York, NY
| | - Gene H. Kim
- Department of Medicine, University of Chicago, Chicago, IL
| | | | | | - Sirtaz Adatya
- Kaiser Permanente Advanced Heart Failure, Santa Clara, CA
| | - Valluvan Jeevanandam
- Department of Surgery, University of Chicago Medical Center, University of Chicago, Chicago, IL
| | - Erin Flatley
- Division of Cardiology, University of California San Francisco, San Francisco, CA
| | - Joshua Moss
- Division of Cardiology, University of California San Francisco, San Francisco, CA
| | - Nir Uriel
- Division of Cardiology, Columbia University, New York, NY
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27
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Hanna P, Bradfield JS. Ventricular Arrhythmia in the Left Ventricular Assist Device Patient: When You Can't Ablate, Denervate. JACC Case Rep 2021; 3:447-449. [PMID: 34317555 PMCID: PMC8311010 DOI: 10.1016/j.jaccas.2021.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Peter Hanna
- Cardiac Arrhythmia Center, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, California, USA
- Neurocardiology Research Program of Excellence, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, California, USA
- Molecular, Cellular & Integrative Physiology Program, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, California, USA
| | - Jason S. Bradfield
- Cardiac Arrhythmia Center, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, California, USA
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28
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Sáenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Europace 2020; 21:1143-1144. [PMID: 31075787 DOI: 10.1093/europace/euz132] [Citation(s) in RCA: 220] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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29
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Nandkeolyar S, Contractor T, Bhardwaj R, Mandapati R, Sakr A, Abudayyeh I, Razzouk A, Bharadwaj AS. A Multidisciplinary Approach to Electrical Instability and Cardiogenic Shock in Acute Myocardial Infarction. JACC Case Rep 2020; 2:2053-2059. [PMID: 34317107 PMCID: PMC8299773 DOI: 10.1016/j.jaccas.2020.07.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/10/2020] [Accepted: 07/22/2020] [Indexed: 11/26/2022]
Abstract
New cardiogenic shock classifications allow prompt recognition and management of complications of acute coronary syndrome. A 59-year-old man presented after a delayed left anterior descending coronary artery ST-segment elevation myocardial infarction in Society of Cardiovascular Angiography and Interventions stage E cardiogenic shock and ventricular tachycardia storm. He underwent revascularization of the left anterior descending artery, percutaneous left ventricular assist device bridged to permanent assist device placement, epicardial and endocardial ventricular tachycardia ablation, and iatrogenic closure of an atrial septal defect. (Level of Difficulty: Beginner.)
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Key Words
- ASD closure
- CPO, cardiac power output
- CRT-D, cardiac resynchronization therapy defibrillator
- LAD, left anterior descending (coronary artery)
- LV, left ventricular
- LVAD, left ventricular assist device
- PCI, percutaneous coronary intervention
- RV, right ventricular
- STEMI, ST-segment elevation myocardial infarction
- TIMI, Thrombolysis In Myocardial Infarction
- VT, ventricular tachycardia
- cardiogenic shock
- delayed STEMI presentation
- mechanical assist devices
- ventricular tachycardia storm
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Affiliation(s)
- Shuktika Nandkeolyar
- Division of Cardiology, Department of Internal Medicine, Loma Linda University Medical Center, Loma Linda, California
| | - Tahmeed Contractor
- Division of Cardiology, Department of Internal Medicine, Loma Linda University Medical Center, Loma Linda, California
| | - Rahul Bhardwaj
- Division of Cardiology, Department of Internal Medicine, Loma Linda University Medical Center, Loma Linda, California
| | - Ravi Mandapati
- Division of Cardiology, Department of Internal Medicine, Loma Linda University Medical Center, Loma Linda, California
| | - Antoine Sakr
- Division of Cardiology, Department of Internal Medicine, Loma Linda University Medical Center, Loma Linda, California
| | - Islam Abudayyeh
- Division of Cardiology, Department of Internal Medicine, Loma Linda University Medical Center, Loma Linda, California
| | - Anees Razzouk
- Department of Cardiothoracic Surgery, Loma Linda University Medical Center, Loma Linda, California
| | - Aditya Satish Bharadwaj
- Division of Cardiology, Department of Internal Medicine, Loma Linda University Medical Center, Loma Linda, California
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30
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National Landscape of Hospitalizations in Patients with Left Ventricular Assist Device. Insights from the National Readmission Database 2010-2015. ASAIO J 2020; 66:1087-1094. [PMID: 33136594 DOI: 10.1097/mat.0000000000001138] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The number of patients with left ventricular assist devices (LVAD) has increased over the years and it is important to identify the etiologies for hospital admission, as well as the costs, length of stay and in-hospital complications in this patient group. Using the National Readmission Database from 2010 to 2015, we identified patients with a history of LVAD placement using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code V43.21. We aimed to identify the etiologies for hospital admission, patient characteristics, and in-hospital outcomes. We identified a total of 15,996 patients with an LVAD, the mean age was 58 years and 76% were males. The most common cause of hospital readmission after LVAD was heart failure (HF, 13%), followed by gastrointestinal (GI) bleed (11.8%), device complication (11.5%), and ventricular tachycardia/fibrillation (4.2%). The median length of stay was 6 days (3-11 days) and the median hospital costs was $12,723 USD. The in-hospital mortality was 3.9%, blood transfusion was required in 26.8% of patients, 20.5% had acute kidney injury, 2.8% required hemodialysis, and 6.2% of patients underwent heart transplantation. Interestingly, the most common cause of readmission was the same as the diagnosis for the preceding admission. One in every four LVAD patients experiences a readmission within 30 days of a prior admission, most commonly due to HF and GI bleeding. Interventions to reduce HF readmissions, such as speed optimization, may be one means of improving LVAD outcomes and resource utilization.
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31
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Bella PD, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. J Interv Card Electrophysiol 2020; 59:145-298. [PMID: 31984466 PMCID: PMC7223859 DOI: 10.1007/s10840-019-00663-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, IN, USA
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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32
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Abstract
PURPOSE OF REVIEW Left ventricular assist devices (LVADs) have extended the life expectancy of patients with heart failure. The hemodynamic support afforded by LVADs in this population has also resulted in patients having prolonged ventricular arrhythmias. The purpose of this article is to review the mechanisms of ventricular arrhythmias in LVADs and the available management strategies. RECENT FINDINGS Recent evidence suggests that prolonged ventricular arrhythmias may result in increased mortality in patients with LVADs. SUMMARY Successful management of ventricular arrhythmias in patients with LVAD requires interdisciplinary collaboration between electrophysiology and heart failure specialists. Medical management, including changes to LVAD changes, heart failure medication management, and antiarrhythmics constitute the initial treatment for ventricular arrhythmias. Surgical or endocardial ablation are reasonable options if VAs are refractory.
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33
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Bohonos CJ, Bechtum EL, Luckhardt AJ, Clavell AL, Stulak JM, Boilson BA. Ventricular tachycardia and preload deficiency post LVAD - The importance of integrated assessment. Heart Lung 2020; 49:481-487. [DOI: 10.1016/j.hrtlng.2020.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 10/24/2022]
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34
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Rehorn MR, Koontz J, Barnett AS, Black-Maier E, Piccini JP, Loring Z, Schroder J, Sun AY. Noninvasive electrocardiographic mapping of ventricular tachycardia in a patient with a left ventricular assist device. HeartRhythm Case Rep 2020; 6:398-401. [PMID: 32695586 PMCID: PMC7361129 DOI: 10.1016/j.hrcr.2020.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Michael R. Rehorn
- Section of Cardiac Electrophysiology, Division of Cardiovascular Disease, Duke University Medical Center, Durham, North Carolina
- Address reprint requests and correspondence: Dr Michael R. Rehorn, Box 3154-Cardiac Electrophysiology, Duke University Medical Center, Durham, NC 27710.
| | - Jason Koontz
- Section of Cardiac Electrophysiology, Division of Cardiovascular Disease, Duke University Medical Center, Durham, North Carolina
- Durham VA Medical Center, Durham, North Carolina
| | - Adam S. Barnett
- Section of Cardiac Electrophysiology, Division of Cardiovascular Disease, Duke University Medical Center, Durham, North Carolina
| | - Eric Black-Maier
- Section of Cardiac Electrophysiology, Division of Cardiovascular Disease, Duke University Medical Center, Durham, North Carolina
| | - Jonathan P. Piccini
- Section of Cardiac Electrophysiology, Division of Cardiovascular Disease, Duke University Medical Center, Durham, North Carolina
| | - Zak Loring
- Section of Cardiac Electrophysiology, Division of Cardiovascular Disease, Duke University Medical Center, Durham, North Carolina
| | - Jacob Schroder
- Section of Cardiac Electrophysiology, Division of Cardiovascular Disease, Duke University Medical Center, Durham, North Carolina
- Durham VA Medical Center, Durham, North Carolina
| | - Albert Y. Sun
- Section of Cardiac Electrophysiology, Division of Cardiovascular Disease, Duke University Medical Center, Durham, North Carolina
- Durham VA Medical Center, Durham, North Carolina
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35
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Gordon JS, Maynes EJ, Choi JH, Wood CT, Weber MP, Morris RJ, Massey HT, Tchantchaleishvili V. Ventricular arrhythmias following continuous-flow left ventricular assist device implantation: A systematic review. Artif Organs 2020; 44:E313-E325. [PMID: 32043582 DOI: 10.1111/aor.13665] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/05/2020] [Accepted: 02/07/2020] [Indexed: 12/16/2022]
Abstract
Ventricular arrhythmias (VA) are not uncommon after continuous-flow left ventricular assist device (CF-LVAD) implantation. In this systematic review, we sought to identify the patterns of VA that occurred following CF-LVAD implantation and evaluate their outcomes. An electronic search was performed to identify all articles reporting the development of VA following CF-LVAD implantation. VA was defined as any episode of ventricular fibrillation (VF) or sustained (>30 seconds) ventricular tachycardia (VT). Eleven studies were pooled for the analysis that included 393 CF-LVAD patients with VA. The mean patient age was 57 years [95%CI: 54; 61] and 82% [95%CI: 73; 88] were male. Overall, 37% [95%CI: 19; 60] of patients experienced a new onset VA after CF-LVAD implantation, while 60% [95%CI: 51; 69] of patients had a prior history of VA. Overall, 88% of patients [95%CI: 78; 94] were supported on HeartMate II CF-LVAD, 6% [95%CI: 3; 14] on HeartWare HVAD, and 6% [95%CI: 2; 13] on other CF-LVADs. VA was symptomatic in 47% [95%CI: 28; 68] of patients and in 50% [95%CI: 37; 52], early VA (<30 days from CF-LVAD) was observed. The 30-day mortality rate was 7% [95%CI: 5; 11]. Mean follow-up was 22.9 months [95%CI: 4.8; 40.8], during which 27% [95%CI: 17; 39] of patients underwent heart transplantation. In conclusion, approximately a third of patients had new VA following CF-LVAD placement. VA in CF-LVAD patients is often symptomatic, necessitates treatment, and carries a worse prognosis.
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Affiliation(s)
- Jonathan S Gordon
- Division of Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Elizabeth J Maynes
- Division of Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Jae Hwan Choi
- Division of Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Chelsey T Wood
- Division of Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Matthew P Weber
- Division of Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Rohinton J Morris
- Division of Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - H Todd Massey
- Division of Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Gross C, Schima H, Schlöglhofer T, Dimitrov K, Maw M, Riebandt J, Wiedemann D, Zimpfer D, Moscato F. Continuous LVAD monitoring reveals high suction rates in clinically stable outpatients. Artif Organs 2020; 44:E251-E262. [PMID: 31945201 PMCID: PMC7318142 DOI: 10.1111/aor.13638] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 01/08/2020] [Accepted: 01/08/2020] [Indexed: 12/17/2022]
Abstract
Suction of the left ventricle can lead to potentially life‐threatening events in left ventricular assist device (LVAD) patients. With the resolution of currently available clinical LVAD monitoring healthcare professionals are unable to evaluate patients’ suction occurrences in detail. This study investigates occurrences and durations of suction events and their associations with tachycardia in stable outpatients. Continuous high‐resolution LVAD data from HVAD patients were analyzed in the early outpatient period for 15 days. A validated suction detection from LVAD signals was used. Suction events were evaluated as suction rates, bursts of consecutive suction beats, and clusters of suction beats. The occurrence of tachycardia was analyzed before, during, and after suction clusters. Furthermore, blood work, implant strategy, LVAD speed setting, inflow cannula position, left ventricular diameters, and adverse events were evaluated in these patients. LVAD data of 10 patients was analyzed starting at 78 ± 22 postoperative days. Individuals’ highest suction rates per hour resulted in a median of 11% (range 3%‐61%). Bursts categorized as consecutive suction beats with n = 2, n = 3‐5, n = 6‐15, and n > 15 beats were homogenously distributed with 10.3 ± 0.8% among all suction beats. Larger suction bursts were followed by shorter suction‐free periods. Tachycardia during suction occurred in 12% of all suction clusters. Significant differences in clinical parameters between individuals with high and low suction rates were only observed in left ventricular end‐diastolic and end‐systolic diameters (P < .02). Continuous high‐resolution LVAD monitoring sheds light on outpatient suction occurrences. Interindividual and intraindividual characteristics of longitudinal suction rates were observed. Longer suction clusters have higher probabilities of tachycardia within the cluster and more severe types of suction waveforms. This work shows the necessity of improved LVAD monitoring and the implementation of an LVAD speed control to reduce suction rates and their concomitant burden on the cardiovascular system.
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Affiliation(s)
- Christoph Gross
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute Cardiovascular Research, Vienna, Austria
| | - Heinrich Schima
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute Cardiovascular Research, Vienna, Austria.,Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Thomas Schlöglhofer
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute Cardiovascular Research, Vienna, Austria.,Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Kamen Dimitrov
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Martin Maw
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute Cardiovascular Research, Vienna, Austria.,Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Julia Riebandt
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Dominik Wiedemann
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Daniel Zimpfer
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Francesco Moscato
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute Cardiovascular Research, Vienna, Austria
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Double bundle branch reentrant ventricular tachycardia ablation in a patient on ventricular assist device support. HeartRhythm Case Rep 2020; 5:452-456. [PMID: 31934539 PMCID: PMC6951302 DOI: 10.1016/j.hrcr.2019.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Ventricular arrhythmias in patients with biventricular assist devices. J Interv Card Electrophysiol 2019; 58:243-252. [PMID: 31838665 PMCID: PMC7293581 DOI: 10.1007/s10840-019-00682-0] [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: 09/05/2019] [Accepted: 12/02/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Ventricular arrhythmias (VAs) are common in patients after left ventricular assist device (LVAD) implant and are associated with worse outcomes. However, the prevalence and impact of VA in patients with durable biventricular assist device (BIVAD) is unknown. We performed a retrospective cohort study of patients with BIVADs to evaluate the prevalence of VA and their clinical outcomes. METHODS Consecutive patients who received a BIVAD between June 2014 and July 2017 at our medical center were included. The prevalence of VA, defined as sustained ventricular tachycardia or fibrillation requiring defibrillation or ICD therapy, was compared between BIVAD patients and a propensity-matched population of patients with LVAD from our center. The occurrence of adverse clinical events was compared between BIVAD patients with and without VA. RESULTS Of the 13 patients with BIVADs, 6 patients (46%) experienced clinically significant VA, similar to a propensity-matched LVAD population (38%, p = 1.00). There were no differences in baseline characteristics between the two cohorts, except patients in the non-VA group who had worse hemodynamics (mitral regurgitation and right-sided indices), had less history of VA, and were younger. BIVAD patients with VA had a higher incidence of major bleeding (MR 3.05 (1.07-8.66), p = 0.036) and worse composite outcomes (log-rank test, p = 0.046). The presence of VA was associated with worse outcomes in both LVAD and BIVAD groups. CONCLUSIONS Ventricular arrhythmias are common in patients with BIVADs and are associated with worse outcomes. Future work should assess whether therapies such as ablation improve the outcome of BIVAD patients with VA.
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Ahmed A, Amin M, Boilson BA, Killu AM, Madhavan M. Ventricular Arrhythmias in Patients With Left Ventricular Assist Device (LVAD). CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:75. [PMID: 31773322 DOI: 10.1007/s11936-019-0783-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Left ventricular assist device (LVAD) implantation is a well-known treatment option for patients with advanced heart failure refractory to medical therapy and is recognized both as bridge to transplant and a destination therapy. The risk of ventricular arrhythmias (VAs) is common after LVAD implantation. We review the pathophysiology and recent advances in the management of VA in LVAD patients. RECENT FINDINGS VAs are most likely to occur in the early post-operative periods after LVAD implantation and a prior history of VA is the most important risk factor. Post-LVAD VAs are usually well tolerated with less morbidity and decreased risk of sudden cardiac death. However, risk of right heart failure in the setting of persistent VAs is being increasingly recognized. The mechanisms of post-LVAD VAs may vary depending on the time from LVAD implantation. Electrical remodeling may play an important role in the immediate post-implant phase. Preexisting myocardial scar and to a lesser extent mechanical irritation from the LVAD cannula are important in the later phases. Most LVAD patients have a previously placed implantable cardioverter-defibrillator (ICD). The benefit of implanting a new ICD in LVAD patients is unknown and should be individualized. For ICD programming, a conservative strategy with higher detection zones and prolonged time to detection is usually recommended aiming to minimize ICD shocks. More aggressive programming is appropriate if the VA results in hemodynamic instability. Antiarrhythmic drugs including amiodarone, mexiletine, and beta blockers are usually the first-line therapy for VAs. Catheter ablation has been shown to be safe and effective in LVAD recipients with recurrent VAs not responsive to antiarrhythmic drugs. LVAD-related VA is most frequently reentrant secondary to myocardial scar and usually well tolerated. Management options include antiarrhythmic drugs and catheter ablation.
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Affiliation(s)
- Azza Ahmed
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Mustapha Amin
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Barry A Boilson
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Ammar M Killu
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Malini Madhavan
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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Alvarez CK, Cronin E, Baker WL, Kluger J. Heart failure as a substrate and trigger for ventricular tachycardia. J Interv Card Electrophysiol 2019; 56:229-247. [PMID: 31598875 DOI: 10.1007/s10840-019-00623-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 09/06/2019] [Indexed: 02/06/2023]
Abstract
Heart failure (HF) is a major cause of morbidity and mortality with more than 5.1 million individuals affected in the USA. Ventricular tachyarrhythmias (VAs) including ventricular tachycardia and ventricular fibrillation are common in patients with heart failure. The pathophysiology of these mechanisms as well as the contribution of heart failure to the genesis of these arrhythmias is complex and multifaceted. Myocardial hypertrophy and stretch with increased preload and afterload lead to shortening of the action potential at early repolarization and lengthening of the action potential at final repolarization which can result in re-entrant ventricular tachycardia. Myocardial fibrosis and scar can create the substrate for re-entrant ventricular tachycardia. Altered calcium handling in the failing heart can lead to the development of proarrhythmic early and delayed after depolarizations. Various medications used in the treatment of HF such as loop diuretics and angiotensin converting enzyme inhibitors have not demonstrated a reduction in sudden cardiac death (SCD); however, beta-blockers (BB) are effective in reducing mortality and SCD. Amongst patients who have HF with reduced ejection fraction, the angiotensin receptor-neprilysin inhibitor (sacubitril/valsartan) has been shown to reduce cardiovascular mortality, specifically by reducing SCD, as well as death due to worsening HF. Implantable cardioverter-defibrillator (ICD) implantation in HF patients reduces the risk of SCD; however, subsequent mortality is increased in those who receive ICD shocks. Prophylactic ICD implantation reduces death from arrhythmia but does not reduce overall mortality during the acute post-myocardial infarction (MI) period (less than 40 days), for those with reduced ejection fraction and impaired autonomic dysfunction. Furthermore, although death from arrhythmias is reduced, this is offset by an increase in the mortality from non-arrhythmic causes. This article provides a review of the aforementioned mechanisms of arrhythmogenesis in heart failure; the role and impact of HF therapy such as cardiac resynchronization therapy (CRT), including the role, if any, of CRT-P and CRT-D in preventing VAs; the utility of both non-invasive parameters as well as multiple implant-based parameters for telemonitoring in HF; and the effect of left ventricular assist device implantation on VAs.
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Affiliation(s)
- Chikezie K Alvarez
- Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA.
| | - Edmond Cronin
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - William L Baker
- University of Connecticut School of Pharmacy, Storrs, CT, USA
| | - Jeffrey Kluger
- Hartford Healthcare Heart and Vascular Institute, Hartford Hospital, Hartford, CT, USA
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Devabhaktuni SR, Shirazi JT, Miller JM. Mapping and Ablation of Ventricle Arrhythmia in Patients with Left Ventricular Assist Devices. Card Electrophysiol Clin 2019; 11:689-697. [PMID: 31706475 DOI: 10.1016/j.ccep.2019.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Ventricular arrhythmias (VA) constitute well-known problems in patients with left ventricular assist devices (LVADs), with incidence ranging from 18% to as high as 52%. Catheter ablation has become a common therapeutic intervention to treat drug-refractory VA, particularly with the increase and more widespread use of durable LVADs to bridge patients to transplantation or as destination therapy. In this article, we focus on etiology, mechanisms, periprocedural management, and mapping and ablation techniques in patients with LVADs and VA.
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42
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Gopinathannair R, Cornwell WK, Dukes JW, Ellis CR, Hickey KT, Joglar JA, Pagani FD, Roukoz H, Slaughter MS, Patton KK. Device Therapy and Arrhythmia Management in Left Ventricular Assist Device Recipients: A Scientific Statement From the American Heart Association. Circulation 2019; 139:e967-e989. [DOI: 10.1161/cir.0000000000000673] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Left ventricular assist devices (LVADs) are an increasingly used strategy for the management of patients with advanced heart failure with reduced ejection fraction. Although these devices effectively improve survival, atrial and ventricular arrhythmias are common, predispose these patients to additional risk, and complicate patient management. However, there is no consensus on best practices for the medical management of these arrhythmias or on the optimal timing for procedural interventions in patients with refractory arrhythmias. Although the vast majority of these patients have preexisting cardiovascular implantable electronic devices or cardiac resynchronization therapy, given the natural history of heart failure, it is common practice to maintain cardiovascular implantable electronic device detection and therapies after LVAD implantation. Available data, however, are conflicting on the efficacy of and optimal device programming after LVAD implantation. Therefore, the primary objective of this scientific statement is to review the available evidence and to provide guidance on the management of atrial and ventricular arrhythmias in this unique patient population, as well as procedural interventions and cardiovascular implantable electronic device and cardiac resynchronization therapy programming strategies, on the basis of a comprehensive literature review by electrophysiologists, heart failure cardiologists, cardiac surgeons, and cardiovascular nurse specialists with expertise in managing these patients. The structure and design of commercially available LVADs are briefly reviewed, as well as clinical indications for device implantation. The relevant physiological effects of long-term exposure to continuous-flow circulatory support are highlighted, as well as the mechanisms and clinical significance of arrhythmias in the setting of LVAD support.
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Heart Rhythm 2019; 17:e2-e154. [PMID: 31085023 PMCID: PMC8453449 DOI: 10.1016/j.hrthm.2019.03.002] [Citation(s) in RCA: 179] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Indexed: 01/10/2023]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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Goette A, Auricchio A, Boriani G, Braunschweig F, Terradellas JB, Burri H, Camm AJ, Crijns H, Dagres N, Deharo JC, Dobrev D, Hatala R, Hindricks G, Hohnloser SH, Leclercq C, Lewalter T, Lip GYH, Merino JL, Mont L, Prinzen F, Proclemer A, Pürerfellner H, Savelieva I, Schilling R, Steffel J, van Gelder IC, Zeppenfeld K, Zupan I, Heidbüchel H, Boveda S, Defaye P, Brignole M, Chun J, Guerra Ramos JM, Fauchier L, Svendsen JH, Traykov VB, Heinzel FR. EHRA White Paper: knowledge gaps in arrhythmia management—status 2019. Europace 2019; 21:993-994. [DOI: 10.1093/europace/euz055] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/15/2019] [Indexed: 12/23/2022] Open
Abstract
Abstract
Clinicians accept that there are many unknowns when we make diagnostic and therapeutic decisions. Acceptance of uncertainty is essential for the pursuit of the profession: bedside decisions must often be made on the basis of incomplete evidence. Over the years, physicians sometimes even do not realize anymore which the fundamental gaps in our knowledge are. As clinical scientists, however, we have to halt and consider what we do not know yet, and how we can move forward addressing those unknowns. The European Heart Rhythm Association (EHRA) believes that scanning the field of arrhythmia / cardiac electrophysiology to identify knowledge gaps which are not yet the subject of organized research, should be undertaken on a regular basis. Such a review (White Paper) should concentrate on research which is feasible, realistic, and clinically relevant, and should not deal with futuristic aspirations. It fits with the EHRA mission that these White Papers should be shared on a global basis in order to foster collaborative and needed research which will ultimately lead to better care for our patients. The present EHRA White Paper summarizes knowledge gaps in the management of atrial fibrillation, ventricular tachycardia/sudden death and heart failure.
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Affiliation(s)
- Andreas Goette
- St. Vincenz-Krankenhaus GmbH, Cardiology and Intensive Care Medicine, Am Busdorf 2, Paderborn, Germany
- Working Group Molecular Electrophysiology, University Hospital Magdeburg, Magdeburg, Germany
| | - Angelo Auricchio
- Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano (Ticino), Switzerland
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | | | | | - Haran Burri
- Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland
| | - A John Camm
- St. George's, University of London, Molecular and Clinical Sciences Research Institute, London, UK
| | - Harry Crijns
- Department of Cardiology and Cardiovascular Research Institute Maastricht (CARIM), Maastricht UMC+, Maastricht, The Netherlands
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Jean-Claude Deharo
- Department of Cardiology, Aix Marseille Université, CHU la Timone, Marseille, France
| | - Dobromir Dobrev
- University Duisburg-Essen, Institute of Pharmacology, Essen, Germany
| | - Robert Hatala
- Department of Cardiology and Angiology, National Cardiovascular Institute, NUSCH, Bratislava, Slovak Republic
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Stefan H Hohnloser
- Division of Clinical Electrophysiology, Department of Cardiology, J.W. Goethe University, Frankfurt, Germany
| | | | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital for Internal Medicine Munich South, Munich, Germany
- Department of Cardiology, University of Bonn, Bonn, Germany
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jose Luis Merino
- Hospital Universitario La Paz, Arrhythmia and Robotic EP Unit, Madrid, Spain
| | - Lluis Mont
- Department of Cardiology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Frits Prinzen
- Department of Physiology, Maastricht University, Maastricht, Netherlands
| | | | - Helmut Pürerfellner
- Department of Cardiology, Ordensklinikum Linz Elisabethinen, Academic Teaching Hospital, Linz, Austria
| | - Irina Savelieva
- St. George's, University of London, Molecular and Clinical Sciences Research Institute, London, UK
| | | | - Jan Steffel
- University Heart Center Zurich, Zurich, Switzerland
| | - Isabelle C van Gelder
- Department Of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center (Lumc), Leiden, Netherlands
| | - Igor Zupan
- Department Of Cardiology, University Clinical Centre Ljubljana, Ljubljana, Slovenia
| | - Hein Heidbüchel
- Antwerp University and Antwerp University Hospital, Antwerp, Belgium
| | - Serge Boveda
- Cardiology Department, Clinique Pasteur, Toulouse, France
| | - Pascal Defaye
- CHU Hôpital Albert Michalon, Unité de Rythmologie Service De Cardiologie, FR-38043 Grenoble Cedex 09, France
| | - Michele Brignole
- Department of Cardiology, Ospedali Del Tigullio, Via Don Bobbio 25, IT-16033 Lavagna (GE), Italy
| | - Jongi Chun
- CCB, Cardiology Department, Med. Klinik Iii, Markuskrankenhaus, Wilhelm Epstein Str. 4, DE-60431 Frankfurt, Germany
| | | | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Université de Tours, Faculté de Médecine, Tours, France
| | - Jesper Hastrup Svendsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Vassil B Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Clinic of Cardiology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Frank R Heinzel
- Charité University Medicine, Campus Virchow-Klinikum, Berlin, Germany
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Ho G, Tran HA, Urey MA, Adler ED, Pretorius VG, Hsu JC. Successful ventricular tachycardia ablation in a patient with a biventricular ventricular assist device and heparin-induced thrombocytopenia using bivalirudin. HeartRhythm Case Rep 2018; 4:367-370. [PMID: 30116710 PMCID: PMC6092635 DOI: 10.1016/j.hrcr.2018.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/04/2018] [Accepted: 05/16/2018] [Indexed: 12/23/2022] Open
Affiliation(s)
- Gordon Ho
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, California
| | - Hao A. Tran
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, California
| | - Marcus A. Urey
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, California
| | - Eric D. Adler
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, California
| | - Victor G. Pretorius
- Department of Cardiothoracic Surgery, University of California San Diego, La Jolla, California
| | - Jonathan C. Hsu
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, California
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Fujii S, Zhou JR, Dhir A. Anesthesia for Cardiac Ablation. J Cardiothorac Vasc Anesth 2018; 32:1892-1910. [DOI: 10.1053/j.jvca.2017.12.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Indexed: 12/19/2022]
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