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Tereshchenko LG, Waks JW, Tompkins C, Rogers AJ, Ehdaie A, Henrikson CA, Dalouk K, Raitt M, Kewalramani S, Kattan MW, Santangeli P, Wilkoff BW, Kapadia SR, Narayan SM, Chugh SS. Competing risks of monomorphic vs. non-monomorphic ventricular arrhythmias in primary prevention implantable cardioverter-defibrillator recipients: Global Electrical Heterogeneity and Clinical Outcomes (GEHCO) study. Europace 2024; 26:euae127. [PMID: 38703375 PMCID: PMC11167666 DOI: 10.1093/europace/euae127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/09/2024] [Accepted: 03/29/2024] [Indexed: 05/06/2024] Open
Abstract
AIMS Ablation of monomorphic ventricular tachycardia (MMVT) has been shown to reduce shock frequency and improve survival. We aimed to compare cause-specific risk factors for MMVT and polymorphic ventricular tachycardia (PVT)/ventricular fibrillation (VF) and to develop predictive models. METHODS AND RESULTS The multicentre retrospective cohort study included 2668 patients (age 63.1 ± 13.0 years; 23% female; 78% white; 43% non-ischaemic cardiomyopathy; left ventricular ejection fraction 28.2 ± 11.1%). Cox models were adjusted for demographic characteristics, heart failure severity and treatment, device programming, and electrocardiogram metrics. Global electrical heterogeneity was measured by spatial QRS-T angle (QRSTa), spatial ventricular gradient elevation (SVGel), azimuth, magnitude (SVGmag), and sum absolute QRST integral (SAIQRST). We compared the out-of-sample performance of the lasso and elastic net for Cox proportional hazards and the Fine-Gray competing risk model. During a median follow-up of 4 years, 359 patients experienced their first sustained MMVT with appropriate implantable cardioverter-defibrillator (ICD) therapy, and 129 patients had their first PVT/VF with appropriate ICD shock. The risk of MMVT was associated with wider QRSTa [hazard ratio (HR) 1.16; 95% confidence interval (CI) 1.01-1.34], larger SVGel (HR 1.17; 95% CI 1.05-1.30), and smaller SVGmag (HR 0.74; 95% CI 0.63-0.86) and SAIQRST (HR 0.84; 95% CI 0.71-0.99). The best-performing 3-year competing risk Fine-Gray model for MMVT [time-dependent area under the receiver operating characteristic curve (ROC(t)AUC) 0.728; 95% CI 0.668-0.788] identified high-risk (> 50%) patients with 75% sensitivity and 65% specificity, and PVT/VF prediction model had ROC(t)AUC 0.915 (95% CI 0.868-0.962), both satisfactory calibration. CONCLUSION We developed and validated models to predict the competing risks of MMVT or PVT/VF that could inform procedural planning and future randomized controlled trials of prophylactic ventricular tachycardia ablation. CLINICAL TRIAL REGISTRATION URL:www.clinicaltrials.gov Unique identifier:NCT03210883.
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Affiliation(s)
- Larisa G Tereshchenko
- Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave, JJN3-01, Cleveland, OH, USA
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jonathan W Waks
- Department of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Christine Tompkins
- Department of Cardiovascular Medicine, University of Colorado, Aurora, CO, USA
| | - Albert J Rogers
- Department of Cardiovascular Medicine, Stanford University, Palo Alto, CA, USA
| | - Ashkan Ehdaie
- Department of Cardiovascular Medicine, Cedars-Sinai Health System, Los Angeles, CA, USA
| | - Charles A Henrikson
- Department of Cardiovascular Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Khidir Dalouk
- Department of Cardiovascular Medicine, VA Portland Health Care System, OR, USA
| | - Merritt Raitt
- Department of Cardiovascular Medicine, VA Portland Health Care System, OR, USA
| | - Shivangi Kewalramani
- Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave, JJN3-01, Cleveland, OH, USA
| | - Michael W Kattan
- Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave, JJN3-01, Cleveland, OH, USA
| | - Pasquale Santangeli
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bruce W Wilkoff
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sanjiv M Narayan
- Department of Cardiovascular Medicine, Stanford University, Palo Alto, CA, USA
| | - Sumeet S Chugh
- Department of Cardiovascular Medicine, Cedars-Sinai Health System, Los Angeles, CA, USA
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Kataoka N, Imamura T, Uchida K, Koi T, Kinugawa K. Catheter ablation in a geriatric case presenting idiopathic ventricular fibrillation initiated by Purkinje-related premature ventricular contractions. HeartRhythm Case Rep 2024; 10:346-350. [PMID: 38799590 PMCID: PMC11116959 DOI: 10.1016/j.hrcr.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Affiliation(s)
- Naoya Kataoka
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Teruhiko Imamura
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Keisuke Uchida
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Takahisa Koi
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Koichiro Kinugawa
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
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Fujita S, Kabata E, Nishiyama M, Sakai T, Takeda Y, Yachi Y, Hatasaki K, Chikata A, Usuda K. Efficacy of High-Density Three-Dimensional Mapping for Verapamil-Sensitive Left Posterior Fascicular Ventricular Tachycardia in Pediatric Patients. Pediatr Cardiol 2024; 45:368-376. [PMID: 38071252 DOI: 10.1007/s00246-023-03352-1] [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: 09/15/2023] [Accepted: 11/09/2023] [Indexed: 01/28/2024]
Abstract
In verapamil-sensitive left posterior fascicular ventricular tachycardia (LPF-VT), radiofrequency catheter ablation (RFA) is performed targeting mid-to-late diastolic potential (P1) and presystolic potential (P2) during tachycardia. This study included four patients who had undergone electrophysiological study (EPS) and pediatric patients with verapamil-sensitive LPF-VT who had undergone RFA using high-density three-dimensional (3D) mapping. The included patients were 11-14 years old. During EPS, right bundle branch block and superior configuration VT were induced in all patients. VT mapping was performed via the transseptal approach. P1 and P2 during VT were recorded in three of the four patients. All patients initially underwent RFA via the transseptal approach. In three patients, P1 during VT was targeted, and VT was terminated. The lesion size indices in which VT was terminated were 4.6, 4.6, and 4.7. For one patient whose P1 could not be recorded, linear ablation was performed perpendicularly in the area where P2 was recorded during VT. Among the three patients in whom VT was terminated, linear ablation was performed in two to eliminate the ventricular echo beats. In all patients, VT became uninducible in the acute phase and had not recurred 8-24 months after RFA. High-density 3D mapping with an HD Grid Mapping Catheter allows recording of P1 and P2 during VT and may improve the success rate of RFA in pediatric patients with verapamil-sensitive LPF-VT.
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Affiliation(s)
- Shuhei Fujita
- Department of Pediatrics, Toyama Prefectural Central Hospital, 2-2-78 Nishinagae-Cho, Toyama-Shi, Toyama, 930-8550, Japan.
| | - Eriko Kabata
- Department of Pediatrics, Toyama Prefectural Central Hospital, 2-2-78 Nishinagae-Cho, Toyama-Shi, Toyama, 930-8550, Japan
| | - Mami Nishiyama
- Department of Pediatrics, Toyama Prefectural Central Hospital, 2-2-78 Nishinagae-Cho, Toyama-Shi, Toyama, 930-8550, Japan
| | - Tomohide Sakai
- Department of Pediatrics, Toyama Prefectural Central Hospital, 2-2-78 Nishinagae-Cho, Toyama-Shi, Toyama, 930-8550, Japan
| | - Yoshikatsu Takeda
- Department of Pediatrics, Toyama Prefectural Central Hospital, 2-2-78 Nishinagae-Cho, Toyama-Shi, Toyama, 930-8550, Japan
| | - Yusuke Yachi
- Department of Pediatrics, Toyama Prefectural Central Hospital, 2-2-78 Nishinagae-Cho, Toyama-Shi, Toyama, 930-8550, Japan
| | - Kiyoshi Hatasaki
- Department of Pediatrics, Toyama Prefectural Central Hospital, 2-2-78 Nishinagae-Cho, Toyama-Shi, Toyama, 930-8550, Japan
| | - Akio Chikata
- Department of Cardiology, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Kazuo Usuda
- Department of Cardiology, Toyama Prefectural Central Hospital, Toyama, Japan
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Stanciulescu LA, Vatasescu R. Ventricular Tachycardia Catheter Ablation: Retrospective Analysis and Prospective Outlooks-A Comprehensive Review. Biomedicines 2024; 12:266. [PMID: 38397868 PMCID: PMC10886924 DOI: 10.3390/biomedicines12020266] [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: 12/30/2023] [Revised: 01/16/2024] [Accepted: 01/23/2024] [Indexed: 02/25/2024] Open
Abstract
Ventricular tachycardia is a potentially life-threatening arrhythmia associated with an overall high morbi-mortality, particularly in patients with structural heart disease. Despite their pivotal role in preventing sudden cardiac death, implantable cardioverter-defibrillators, although a guideline-based class I recommendation, are unable to prevent arrhythmic episodes and significantly alter the quality of life by delivering recurrent therapies. From open-heart surgical ablation to the currently widely used percutaneous approach, catheter ablation is a safe and effective procedure able to target the responsible re-entry myocardial circuit from both the endocardium and the epicardium. There are four main mapping strategies, activation, entrainment, pace, and substrate mapping, each of them with their own advantages and limitations. The contemporary guideline-based recommendations for VT ablation primarily apply to patients experiencing antiarrhythmic drug ineffectiveness or those intolerant to the pharmacological treatment. Although highly effective in most cases of scar-related VTs, the traditional approach may sometimes be insufficient, especially in patients with nonischemic cardiomyopathies, where circuits may be unmappable using the classic techniques. Alternative methods have been proposed, such as stereotactic arrhythmia radioablation or radiotherapy ablation, surgical ablation, needle ablation, transarterial coronary ethanol ablation, and retrograde coronary venous ethanol ablation, with promising results. Further studies are needed in order to prove the overall efficacy of these methods in comparison to standard radiofrequency delivery. Nevertheless, as the field of cardiac electrophysiology continues to evolve, it is important to acknowledge the role of artificial intelligence in both the pre-procedural planning and the intervention itself.
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Affiliation(s)
- Laura Adina Stanciulescu
- Cardio-Thoracic Department, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Cardiology Department, Clinical Emergency Hospital, 014461 Bucharest, Romania
| | - Radu Vatasescu
- Cardio-Thoracic Department, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Cardiology Department, Clinical Emergency Hospital, 014461 Bucharest, Romania
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Wei HQ, Chen W, Luo S, Liao Z, Fang X, Liao H, Sun Q, Guo XG, Yang JD, Liang JJ, Wu S, Xue Y, Ma J, Zhan X. Comparison of strategies for catheter ablation of left posterior fascicular ventricular tachycardia. Europace 2023; 25:euad339. [PMID: 37971899 PMCID: PMC10653165 DOI: 10.1093/europace/euad339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023] Open
Abstract
AIMS Traditional ablation strategies including targeting the earliest Purkinje potential (PP) during left posterior fascicular (LPF) ventricular tachycardia (VT) or linear ablation at the middle segment of LPF during sinus rhythm are commonly used for the treatment of LPF-VT. Catheter ablation for LPF-VT targeting fragmented antegrade Purkinje (FAP) potential during sinus rhythm is a novel approach. We aimed to compare safety and efficacy of different ablation strategies (FAP ablation vs. traditional ablation) for the treatment of LPF-VT. METHODS AND RESULTS Consecutive patients with electrocardiographically documented LPF-VT referred for catheter ablation received either FAP ablation approach or traditional ablation approach. Electrophysiological characteristics, procedural complications, and long-term clinical outcome were assessed. A total of 189 consecutive patients who underwent catheter ablation for LPF-VT were included. Fragmented antegrade Purkinje ablation was attempted in 95 patients, and traditional ablation was attempted in 94 patients. Acute ablation success with elimination of LPF-VT was achieved in all patients. Left posterior fascicular block occurred in 11 of 95 (11.6%) patients in the FAP group compared with 75 of 94 (79.8%) patients in the traditional group (P < 0.001). Fragmented antegrade Purkinje ablation was associated with significant shorter procedure time (94 ± 26 vs. 117 ± 23 min, P = 0.03) and fewer radiofrequency energy applications (4.1 ± 2.4 vs. 6.3 ± 3.5, P = 0.003) compared with the traditional group. One complete atrioventricular block and one left bundle branch block were seen in the traditional group. Over mean follow-up of 65 months, 89 (93.7%) patients in the FAP group and 81 (86.2%) patients in the traditional group remained free of recurrent VT off antiarrhythmic drugs (P = 0.157). CONCLUSION Left posterior fascicular-ventricular tachycardia ablation utilizing FAP and traditional ablation approaches resulted in similar acute and long-term procedural outcomes. Serious His-Purkinje injury did occur infrequently during traditional ablation. The use of FAP ablation approach was associated with shorter procedure time and fewer radiofrequency energy applications, especially for non-inducible patients.
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Affiliation(s)
- Hui-Qiang Wei
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 102 Zhongshan 2nd Rd, Yuexiu District, 510010 Guangzhou, China
| | - Wanwen Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 102 Zhongshan 2nd Rd, Yuexiu District, 510010 Guangzhou, China
| | - Sini Luo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 102 Zhongshan 2nd Rd, Yuexiu District, 510010 Guangzhou, China
| | - Zili Liao
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 102 Zhongshan 2nd Rd, Yuexiu District, 510010 Guangzhou, China
| | - Xianhong Fang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 102 Zhongshan 2nd Rd, Yuexiu District, 510010 Guangzhou, China
| | - Hongtao Liao
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 102 Zhongshan 2nd Rd, Yuexiu District, 510010 Guangzhou, China
| | - Qi Sun
- Arrhythmia Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No.167 Beilishi Rd. Xicheng District, 100037 Beijing, China
| | - Xiao-Gang Guo
- Arrhythmia Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No.167 Beilishi Rd. Xicheng District, 100037 Beijing, China
| | - Jian-Du Yang
- Arrhythmia Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No.167 Beilishi Rd. Xicheng District, 100037 Beijing, China
| | - Jackson J Liang
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Service, University of Michigan Health System, Ann Arbor, MI, USA
| | - Shulin Wu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 102 Zhongshan 2nd Rd, Yuexiu District, 510010 Guangzhou, China
| | - Yumei Xue
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 102 Zhongshan 2nd Rd, Yuexiu District, 510010 Guangzhou, China
| | - Jian Ma
- Arrhythmia Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No.167 Beilishi Rd. Xicheng District, 100037 Beijing, China
| | - Xianzhang Zhan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 102 Zhongshan 2nd Rd, Yuexiu District, 510010 Guangzhou, China
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