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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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2
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Benali K, Lloyd MS, Petrosyan A, Rigal L, Quivrin M, Bessieres I, Vlachos K, Hammache N, Bellec J, Simon A, Laurent G, Higgins K, Garnier F, de Crevoisier R, Martins R, Da Costa A, Guenancia C. Cardiac stereotactic radiation therapy for refractory ventricular arrhythmias in patients with left ventricular assist devices. J Cardiovasc Electrophysiol 2024; 35:206-213. [PMID: 38018417 DOI: 10.1111/jce.16139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 11/30/2023]
Abstract
Left ventricular assist device (LVAD) implantation is an established treatment for patients with advanced heart failure refractory to medical therapy. However, the incidence of ventricular arrhythmias (VAs) is high in this population, both in the acute and delayed phases after implantation. About one-third of patients implanted with an LVAD will experience sustained VAs, predisposing these patients to worse outcomes and complicating patient management. The combination of pre-existing myocardial substrate and complex electrical remodeling after LVAD implantation account for the high incidence of VAs observed in this population. LVAD patients presenting VAs refractory to antiarrhythmic therapy and catheter ablation procedures are not rare. In such patients, treatment options are extremely limited. Stereotactic body radiation therapy (SBRT) is a technique that delivers precise and high doses of radiation to highly defined targets, reducing exposure to adjacent normal tissue. Cardiac SBRT has recently emerged as a promising alternative with a growing number of case series reporting the effectiveness of the technique in reducing the VA burden in patients with arrhythmias refractory to conventional therapies. The safety profile of cardiac SBRT also appears favorable, even though the current clinical experience remains limited. The use of cardiac SBRT for the treatment of refractory VAs in patients implanted with an LVAD are even more scarce. This review summarizes the clinical experience of cardiac SBRT in LVAD patients and describes technical considerations related to the implementation of the SBRT procedure in the presence of an LVAD.
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Affiliation(s)
- Karim Benali
- Department of Cardiac Electrophysiology, Saint-Etienne University Hospital Center, Saint-Etienne, France
- Department of Signal Analysis, IHU LIRYC, Electrophysiology and Heart Modelling Institute, Bordeaux University, Bordeaux, France
- LTSI-UMR 1099, Rennes, France
| | - Michael S Lloyd
- Department of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Andranik Petrosyan
- Department of Cardiac Surgery, Saint-Etienne University Hospital Center, Saint-Etienne, France
| | - Louis Rigal
- Department of Signal Analysis, IHU LIRYC, Electrophysiology and Heart Modelling Institute, Bordeaux University, Bordeaux, France
| | - Magali Quivrin
- Department of Radiation Oncology, Centre Georges Francois Leclerc, Dijon, France
| | - Igor Bessieres
- Department of Radiation Oncology, Centre Georges Francois Leclerc, Dijon, France
| | | | - Nefissa Hammache
- Department of Cardiac Electrophysiology, Nancy University Hospital Center, Nancy, France
| | - Julien Bellec
- Department of Radiation Oncology, Centre Eugene Marquis, Rennes, France
| | - Antoine Simon
- Department of Signal Analysis, IHU LIRYC, Electrophysiology and Heart Modelling Institute, Bordeaux University, Bordeaux, France
| | - Gabriel Laurent
- Department of Cardiac Electrophysiology, Dijon University Hospital Center, Dijon, France
| | - Kristin Higgins
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Fabien Garnier
- Department of Cardiac Electrophysiology, Dijon University Hospital Center, Dijon, France
| | | | - Raphaël Martins
- Department of Signal Analysis, IHU LIRYC, Electrophysiology and Heart Modelling Institute, Bordeaux University, Bordeaux, France
- Department of Cardiac Electrophysiology, Rennes University Hospital Center, Rennes, France
| | - Antoine Da Costa
- Department of Cardiac Electrophysiology, Saint-Etienne University Hospital Center, Saint-Etienne, France
| | - Charles Guenancia
- Department of Radiation Oncology, Centre Eugene Marquis, Rennes, France
- PEC 2 EA 7460, University of Burgundy and Franche-Comté, Dijon, France
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3
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Moeller CM, Valledor AF, Oren D, Rubinstein G, Sayer GT, Uriel N. Evolution of Mechanical Circulatory Support for advanced heart failure. Prog Cardiovasc Dis 2024; 82:135-146. [PMID: 38242192 DOI: 10.1016/j.pcad.2024.01.018] [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: 01/15/2024] [Accepted: 01/15/2024] [Indexed: 01/21/2024]
Abstract
This comprehensive review highlights the significant advancements in Left Ventricular Assist Device (LVAD) therapy, emphasizing its evolution from the early pulsatile flow systems to the cutting-edge continuous-flow devices, particularly the HeartMate 3 (HM3) LVAD. These advancements have notably improved survival rates, reduced complications, and enhanced the quality of life (QoL) for patients with advanced heart failure. The dual role of LVADs, as a bridge-to-transplantation and destination therapy is discussed, highlighting the changing trends and policies in their application. The marked reduction in hemocompatibility-related adverse events (HRAE) with the HM3 LVAD, compared to previous models signifies ongoing progress in the field. Challenges such as managing major infections are discussed, including innovative solutions like energy transfer systems aimed at eliminating external drivelines. It explores various LVAD-associated complications, including HRAE, infections, hemodynamic-related adverse events, and cardiac arrhythmias, and underscores emerging strategies for predicting post-implantation outcomes, fostering a more individualized patient care approach. Tools such as the HM3 risk score are introduced for predicting survival based on pre-implant factors, along with advanced imaging techniques for improved complication prediction. Additionally, the review highlights potential new technologies and therapies in LVAD management, such as hemodynamic ramp tests for optimal speed adjustment and advanced remote monitoring systems. The goal is to automate LVAD speed adjustments based on real-time hemodynamic measurements, indicating a shift towards more effective, patient-centered therapy. The review concludes optimistically that ongoing research and potential future innovations hold the promise of revolutionizing heart failure management, paving the way for more effective and personalized treatment modalities.
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Affiliation(s)
- Cathrine M Moeller
- Division of Cardiology, Department of Medicine, Advanced Cardiac Care, Columbia University Irving Medical Center, NY, USA
| | - Andrea Fernandez Valledor
- Division of Cardiology, Department of Medicine, Advanced Cardiac Care, Columbia University Irving Medical Center, NY, USA
| | - Daniel Oren
- Division of Cardiology, Department of Medicine, Advanced Cardiac Care, Columbia University Irving Medical Center, NY, USA
| | - Gal Rubinstein
- Division of Cardiology, Department of Medicine, Advanced Cardiac Care, Columbia University Irving Medical Center, NY, USA
| | - Gabriel T Sayer
- Division of Cardiology, Department of Medicine, Advanced Cardiac Care, Columbia University Irving Medical Center, NY, USA
| | - Nir Uriel
- Division of Cardiology, Department of Medicine, Advanced Cardiac Care, Columbia University Irving Medical Center, NY, USA.
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Vázquez-Calvo S, Roca-Luque I, Althoff TF. Management of Ventricular Arrhythmias in Heart Failure. Curr Heart Fail Rep 2023; 20:237-253. [PMID: 37227669 DOI: 10.1007/s11897-023-00608-y] [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] [Accepted: 05/08/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE OF REVIEW Despite substantial progress in medical and device-based heart failure (HF) therapy, ventricular arrhythmias (VA) and sudden cardiac death (SCD) remain a major challenge. Here we review contemporary management of VA in the context of HF with one particular focus on recent advances in imaging and catheter ablation. RECENT FINDINGS Besides limited efficacy of antiarrhythmic drugs (AADs), their potentially life-threatening side effects are increasingly acknowledged. On the other hand, with tremendous advances in catheter technology, electroanatomical mapping, imaging, and understanding of arrhythmia mechanisms, catheter ablation has evolved into a safe, efficacious therapy. In fact, recent randomized trials support early catheter ablation, demonstrating superiority over AAD. Importantly, CMR imaging with gadolinium contrast has emerged as a central tool for the management of VA complicating HF: CMR is not only essential for an accurate diagnosis of the underlying entity and subsequent treatment decisions, but also improves risk stratification for SCD prevention and patient selection for ICD therapy. Finally, 3-dimensional characterization of arrhythmogenic substrate by CMR and imaging-guided ablation approaches substantially enhance procedural safety and efficacy. VA management in HF patients is highly complex and should be addressed in a multidisciplinary approach, preferably at specialized centers. While recent evidence supports early catheter ablation of VA, an impact on mortality remains to be demonstrated. Moreover, risk stratification for ICD therapy may have to be reconsidered, taking into account imaging, genetic testing, and other parameters beyond left ventricular function.
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Affiliation(s)
- Sara Vázquez-Calvo
- Arrhythmia Section, Cardiovascular Institute (ICCV), CLÍNIC Barcelona University Hospital, C/Villarroel N° 170, 08036, Barcelona, Catalonia, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Ivo Roca-Luque
- Arrhythmia Section, Cardiovascular Institute (ICCV), CLÍNIC Barcelona University Hospital, C/Villarroel N° 170, 08036, Barcelona, Catalonia, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Till F Althoff
- Arrhythmia Section, Cardiovascular Institute (ICCV), CLÍNIC Barcelona University Hospital, C/Villarroel N° 170, 08036, Barcelona, Catalonia, Spain.
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.
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Fukuzawa K, Hisamatsu E, Nakai H, Okada K. Open-chest epicardial ablation of ventricular tachycardia during a left ventricular assist device implantation: a case report. Eur Heart J Case Rep 2023; 7:ytad277. [PMID: 37425660 PMCID: PMC10325002 DOI: 10.1093/ehjcr/ytad277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/02/2022] [Accepted: 06/22/2023] [Indexed: 07/11/2023]
Abstract
Background Ventricular arrhythmias (VAs) are common after a left ventricular assist device (LVAD) implantation. Further, the majority of post-LVAD ventricular tachycardias (VTs) are secondary to a preexisting cardiomyopathy substrate. Intraoperative ablation of patients with recurrent preoperative VTs may reduce post-LVAD VTs. Case summary A 59-year-old female with advanced heart failure due to non-ischaemic cardiomyopathy (LV ejection fraction = 24%) and recurrent VTs was referred for an LVAD implantation as a bridge to a heart transplant (INTERMACS Profile-5A). The previous endocardial ablation failed due to an epicardial arrhythmogenic substrate. Therefore, open-chest epicardial mapping during the LVAD implantation was indicated and three target areas of the arrhythmogenic substrate were found, which were ablated by radiofrequency applications. To minimize the cardiopulmonary bypass time, cardiopulmonary bypass was initiated after ablation, and then, an LVAD was implanted. An additional 68 min was required for mapping and ablation. All procedures were performed without any complications, and the post-operative course was uneventful. Thereafter, no VT episodes were observed without any anti-arrhythmic drugs during a 15-month follow-up with LVAD support. Discussion Intraoperative epicardial mapping and ablation during an LVAD implantation can play an important role in the management of LVAD recipients with recurrent VAs.
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Affiliation(s)
| | - Eriko Hisamatsu
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine Japan, 7-5-2 Kusunoki-Cho, Chuoh-Ku, Kobe 650-0017, Japan
| | - Hidekazu Nakai
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuoh-Ku, Kobe 650-0017, Japan
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Nitta T. Surgical Ablation of Ventricular Tachycardia. Card Electrophysiol Clin 2022; 14:793-799. [PMID: 36396194 DOI: 10.1016/j.ccep.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Surgery for ventricular tachycardia (VT) is indicated in patients in whom pharmacotherapy or catheter ablation is ineffective or frequent VT attacks are not suppressed or with frequent activation of implantable cardioverter defibrillator. In ischemic VT, resection of fibrous endocardium combined with encircling cryothermia at the border between the infarcted and normal myocardium is performed. In surgery for VT associated with cardiomyopathy, close collaboration between the physician and surgeon is important and intraoperative mapping using electro-anatomic mapping system is helpful. In VT associated with cardiac tumors, cryothermia of the thinned subepicardial myocardium at the edge of the tumor is recommended in addition to resection of tumors.
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Affiliation(s)
- Takashi Nitta
- Hanyu General Hospital, Shimo-iwase 446, Hanyu City, Saitama 348-8505 Japan; Nippon Medical School, Tokyo, Japan.
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Tankut S, Gosev I, Yoruk A, Younis A, McNitt S, Bjelic M, Vidula H, Wu I, Aktas MK, Goldenberg I, Huang DT. Intraoperative Ventricular Tachycardia Ablation During Left Ventricular Assist Device Implantation in High-Risk Heart Failure Patients. Circ Arrhythm Electrophysiol 2022; 15:e010660. [PMID: 35617273 DOI: 10.1161/circep.121.010660] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sinan Tankut
- Department of Cardiology (S.T., H.V., M.K.A., D.T.H.), University of Rochester, NY
| | - Igor Gosev
- Clinical Cardiovascular Research Center (I.Goldenberg, S.M., M.B., I.G.), University of Rochester, NY.,Department of Cardiac Surgery (I.Gosev), University of Rochester, NY
| | - Ayhan Yoruk
- Department of Electrophysiology, University of California San Francisco (A.Y.)
| | - Arwa Younis
- Department of Electrophysiology, University of California San Francisco (A.Y.)
| | - Scott McNitt
- Clinical Cardiovascular Research Center (I.Goldenberg, S.M., M.B., I.G.), University of Rochester, NY
| | - Milica Bjelic
- Clinical Cardiovascular Research Center (I.Goldenberg, S.M., M.B., I.G.), University of Rochester, NY
| | - Himabindu Vidula
- Department of Cardiology (S.T., H.V., M.K.A., D.T.H.), University of Rochester, NY
| | - Isaac Wu
- Department of Cardiac Anesthesia (I.W.), University of Rochester, NY
| | - Mehmet K Aktas
- Department of Cardiology (S.T., H.V., M.K.A., D.T.H.), University of Rochester, NY
| | - Ilan Goldenberg
- Clinical Cardiovascular Research Center (I.Goldenberg, S.M., M.B., I.G.), University of Rochester, NY
| | - David T Huang
- Department of Cardiology (S.T., H.V., M.K.A., D.T.H.), University of Rochester, NY
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8
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto S, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias. J Arrhythm 2021; 37:709-870. [PMID: 34386109 PMCID: PMC8339126 DOI: 10.1002/joa3.12491] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto SI, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 Guideline on Non-Pharmacotherapy of Cardiac Arrhythmias. Circ J 2021; 85:1104-1244. [PMID: 34078838 DOI: 10.1253/circj.cj-20-0637] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Haruhiko Abe
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital
| | - Toshiyuki Ishikawa
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University
| | - Katsuhiko Imai
- Department of Cardiovascular Surgery, Kure Medical Center and Chugoku Cancer Center
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kaoru Okishige
- Department of Cardiology, Yokohama City Minato Red Cross Hospital
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Yoshihiro Seo
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | | | - Yuji Nakazato
- Department of Cardiovascular Medicine, Juntendo University Urayasu Hospital
| | - Takashi Nishimura
- Department of Cardiac Surgery, Tokyo Metropolitan Geriatric Hospital
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | | | - Yuji Murakawa
- Fourth Department of Internal Medicine, Teikyo University Hospital Mizonokuchi
| | - Teiichi Yamane
- Department of Cardiology, Jikei University School of Medicine
| | - Takeshi Aiba
- Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Koichi Inoue
- Division of Arrhythmia, Cardiovascular Center, Sakurabashi Watanabe Hospital
| | - Yuki Iwasaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kikuya Uno
- Arrhythmia Center, Chiba Nishi General Hospital
| | - Michio Ogano
- Department of Cardiovascular Medicine, Shizuoka Medical Center
| | - Masaomi Kimura
- Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine
| | | | - Shingo Sasaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | | | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University
| | - Tsugutoshi Suzuki
- Departments of Pediatric Electrophysiology, Osaka City General Hospital
| | - Yukio Sekiguchi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Kyoko Soejima
- Arrhythmia Center, Second Department of Internal Medicine, Kyorin University Hospital
| | - Masahiko Takagi
- Division of Cardiac Arrhythmia, Department of Internal Medicine II, Kansai Medical University
| | - Masaomi Chinushi
- School of Health Sciences, Faculty of Medicine, Niigata University
| | - Nobuhiro Nishi
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hitoshi Hachiya
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | | | | | - Yasushi Miyauchi
- Department of Cardiovascular Medicine, Nippon Medical School Chiba-Hokusoh Hospital
| | - Aya Miyazaki
- Department of Pediatric Cardiology, Congenital Heart Disease Center, Tenri Hospital
| | - Tomoshige Morimoto
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Hiro Yamasaki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | | | - Takeshi Kimura
- Department of Cardiology, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
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10
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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: 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: 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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11
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Kunkel M, Rothstein P, Sauer P, Zipse MM, Sandhu A, Tumolo AZ, Borne RT, Aleong RG, Cleveland JC, Fullerton D, Pal JD, Davies AS, Lane C, Nguyen DT, Sauer WH, Tzou WS. Open surgical ablation of ventricular tachycardia: Utility and feasibility of contemporary mapping and ablation tools. Heart Rhythm O2 2021; 2:271-279. [PMID: 34337578 PMCID: PMC8322924 DOI: 10.1016/j.hroo.2021.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Ventricular tachycardia (VT) catheter ablation success may be limited when transcutaneous epicardial access is contraindicated. Surgical ablation (SurgAbl) is an option, but ablation guidance is limited without simultaneously acquired electrophysiological data. Objective We describe our SurgAbl experience utilizing contemporary electroanatomic mapping (EAM) among patients with refractory VT storm. Methods Consecutive patients with recurrent VT despite antiarrhythmic drugs (AADs) and prior ablation, for whom percutaneous epicardial access was contraindicated, underwent open SurgAbl using intraoperative EAM guidance. Results Eight patients were included, among whom mean age was 63 ± 5 years, all were male, mean left ventricular ejection fraction was 39% ± 12%, and 2 (25%) had ischemic cardiomyopathy. Reasons for surgical epicardial access included dense adhesions owing to prior cardiac surgery, hemopericardium, or pericarditis (n = 6); or planned left ventricular assist device (LVAD) implantation at time of SurgAbl (n = 2). Cryoablation guided by real-time EAM was performed in all. Goals of clinical VT noninducibility or core isolation were achieved in 100%. VT burden was significantly reduced, from median 15 to 0 events in the month pre- and post-SurgAbl (P = .01). One patient underwent orthotopic heart transplantation for recurrent VT storm 2 weeks post-SurgAbl. Over mean follow-up of 3.4 ± 1.7 years, VT storm–free survival was achieved in 6 (75%); all continued AADs, although at lower dose. Conclusion Surgical mapping and ablation of refractory VT with use of contemporary EAM is feasible and effective, particularly among patients with contraindication to percutaneous epicardial access or with another indication for cardiac surgery.
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Affiliation(s)
- Megan Kunkel
- University of Colorado School of Medicine, Division of Cardiology, Section of Cardiac Electrophysiologist, Aurora, Colorado
| | - Peter Rothstein
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
| | - Peter Sauer
- Brigham and Women's Hospital, Cardiac Arrhythmia Service, Boston, Massachusetts
| | - Matthew M. Zipse
- University of Colorado School of Medicine, Division of Cardiology, Section of Cardiac Electrophysiologist, Aurora, Colorado
| | - Amneet Sandhu
- University of Colorado School of Medicine, Division of Cardiology, Section of Cardiac Electrophysiologist, Aurora, Colorado
- VA Eastern Colorado Health Care System, Aurora, Colorado
| | - Alexis Z. Tumolo
- University of Colorado School of Medicine, Division of Cardiology, Section of Cardiac Electrophysiologist, Aurora, Colorado
| | - Ryan T. Borne
- University of Colorado School of Medicine, Division of Cardiology, Section of Cardiac Electrophysiologist, Aurora, Colorado
| | - Ryan G. Aleong
- University of Colorado School of Medicine, Division of Cardiology, Section of Cardiac Electrophysiologist, Aurora, Colorado
| | - Joseph C. Cleveland
- University of Colorado School of Medicine, Division of Cardiology, Section of Cardiac Electrophysiologist, Aurora, Colorado
| | - David Fullerton
- University of Colorado School of Medicine, Division of Cardiology, Section of Cardiac Electrophysiologist, Aurora, Colorado
| | - Jay D. Pal
- University of Colorado School of Medicine, Division of Cardiology, Section of Cardiac Electrophysiologist, Aurora, Colorado
| | | | | | - Duy T. Nguyen
- Stanford University, Section of Electrophysiology, Division of Cardiology, Palo Alto, California
| | - William H. Sauer
- Brigham and Women's Hospital, Cardiac Arrhythmia Service, Boston, Massachusetts
| | - Wendy S. Tzou
- University of Colorado School of Medicine, Division of Cardiology, Section of Cardiac Electrophysiologist, Aurora, Colorado
- Address reprint requests and correspondence: Dr Wendy S. Tzou, University of Colorado School of Medicine Anschutz Medical Campus, Division of Cardiology, Cardiac Electrophysiology Section, 12401 E 17th Ave, MS B-136, Aurora, CO 80045.
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12
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McNamara N, Narroway H, Williams M, Brookes J, Farag J, Cistulli D, Bannon P, Marasco S, Potapov E, Loforte A. Contemporary outcomes of continuous-flow left ventricular assist devices-a systematic review. Ann Cardiothorac Surg 2021; 10:186-208. [PMID: 33842214 DOI: 10.21037/acs-2021-cfmcs-35] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background End stage heart failure is a major cause of morbidity and mortality, and its prevalence is expected to rise with the ageing population. For suitable patients, orthotopic heart transplantation remains the gold standard therapy, however, a paucity of donor organs has led to the development of left ventricular assist devices (LVAD). These devices can be utilized as either a bridge-to-transplant (BTT) or as an alternative to heart transplantation. While these devices can prolong life and improve quality of life, they are associated with a significant number of adverse events. We aim to systematically review the literature to quantify survival and the incidence of adverse events following implantation of continuous-flow LVADs (cf-LVAD). Methods A systematic review was performed to determine outcomes following implantation of a cf-LVAD. Primary outcomes were survival and frequency of adverse events (such as bleeding, infection, thrombosis, stroke and right ventricular failure). Secondary outcomes included quality of life and assessment of functional status. Results Sixty-three studies reported clinical outcomes of 9,280 patients. Survival after cf-LVAD varied between studies. Industry-funded trials generally reported better overall survival than the single- and multi-center case series, which showed significant variation. The largest registry report documented twelve, twenty-four and forty-eight-month survival rates of 82%, 72% and 57% respectively. The most commonly reported adverse events were gastrointestinal bleeding (GIB), device-related infection, neurological events and right heart failure (RHF). Bleeding, RHF and infection were the most frequent complications experienced by those supported with cf-LVAD, occurring in up to 35%, 40% and 55% of patients, respectively. Quality of life as measured using the Kansas City Cardiomyopathy Questionnaire (KCCQ) and functional status as measured with the 6-minute walk test (6MWT) improved after cf-LVAD implantation with no decline evident two years after implantation. Conclusions The paucity of donor hearts has led to the development of left-ventricular assist devices as a BTT or as a destination therapy (DT). Outcomes after cf-LVAD implantation are excellent, with short-term survival comparable to heart transplantation, but long-term survival remains limited due to the incidence of post-implantation adverse events. Despite these complications, quality of life and functional status improve significantly post-implantation and remain improved over the long-term. This study demonstrates the potential benefits of cf-LVAD therapy whilst also identifying adverse events as an area of increased morbidity and mortality.
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Affiliation(s)
- Nicholas McNamara
- Cardiothoracic Surgical Department, Royal Prince Alfred Hospital, Sydney, Australia.,Faculty of Health and Medicine, University of Sydney, Sydney, Australia.,Baird Institute of Applied Heart and Lung Research, Sydney, Australia
| | - Harry Narroway
- Department of Vascular Surgery, Gosford Hospital, Gosford, Australia
| | - Michael Williams
- Cardiothoracic Surgical Department, Royal Prince Alfred Hospital, Sydney, Australia.,Faculty of Health and Medicine, University of Sydney, Sydney, Australia
| | - John Brookes
- Cardiothoracic Surgical Department, Royal Prince Alfred Hospital, Sydney, Australia
| | - James Farag
- Cardiothoracic Surgical Department, Royal Prince Alfred Hospital, Sydney, Australia.,Baird Institute of Applied Heart and Lung Research, Sydney, Australia
| | - David Cistulli
- Cardiothoracic Surgical Department, Royal Prince Alfred Hospital, Sydney, Australia
| | - Paul Bannon
- Cardiothoracic Surgical Department, Royal Prince Alfred Hospital, Sydney, Australia.,Baird Institute of Applied Heart and Lung Research, Sydney, Australia
| | - Silvana Marasco
- Cardiothoracic Surgical Department, The Alfred, Melbourne, Australia.,Department of Medicine and Surgery, Monash University, Melbourne, Australia
| | - Evgenij Potapov
- Deutsches Zentrum für Herz Kreislauf Forschung (DZHK) - Standort Berlin/Charité, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin (DHZB), Berlin, Germany
| | - Antonio Loforte
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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13
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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: 230] [Impact Index Per Article: 57.5] [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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14
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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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15
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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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16
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Rao SD, Chahal CAA, Atluri P, Mather P, Santangeli P, Arkles J. Massive myocardial edema and inflow cannula obstruction due to epicardial surgical ventricular tachycardia cryoablation at time of left ventricular assist device implantation. HeartRhythm Case Rep 2020; 6:523-527. [PMID: 32817833 PMCID: PMC7424293 DOI: 10.1016/j.hrcr.2020.05.014] [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: 11/19/2022] Open
Affiliation(s)
- Sriram D. Rao
- Advanced Heart Failure/Transplantation Program, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- Address reprint requests and correspondence: Dr Sriram D. Rao, Advanced Heart Failure/Cardiac Transplantation, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman Center for Advanced Medicine, South Pavilion, 11th Floor, Suite 11-162, 3400 Civic Center Boulevard, Philadelphia, PA 19104.
| | - C. Anwar A. Chahal
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Pavan Atluri
- Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Paul Mather
- Advanced Heart Failure/Transplantation Program, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Pasquale Santangeli
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeffrey Arkles
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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17
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Abstract
Hybrid surgical ventricular tachycardia (VT) ablation combines surgical epicardial access/exposure with contemporary mapping and ablation techniques adapted from percutaneous catheter ablation procedures. Patients considered for a hybrid surgical approach for VT are those who have had prior cardiac surgery or failed percutaneous epicardial access due to pericardial adhesions. They often represent the most challenging end of the spectrum of patients and usually have undergone multiple unsuccessful ablations. In this review, the indications, preprocedure work-up, ablation techniques, and outcomes from hybrid surgical access VT ablations are discussed as well as key technical details that present unique challenges to its success.
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18
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Orozco-Hernandez EJ, Argueta-Sosa EE, Joly JM, Pamboukian SV, Tallaj JA, Hoopes CW. Cryoablation during left ventricular assist device implantation: A case report. JTCVS Tech 2020; 1:55-57. [PMID: 34317713 PMCID: PMC8288615 DOI: 10.1016/j.xjtc.2020.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 11/25/2019] [Accepted: 01/03/2020] [Indexed: 10/25/2022] Open
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19
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Altshuler PJ, Atluri P. Commentary: Intraoperative cryoblation during HeartMate 3 left ventricular assist device implantation for refractory ventricular arrhythmias: Ipsa scientia potestas est. JTCVS Tech 2020; 1:58-59. [PMID: 34317714 PMCID: PMC8288620 DOI: 10.1016/j.xjtc.2020.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 12/29/2019] [Accepted: 01/03/2020] [Indexed: 11/06/2022] Open
Affiliation(s)
- Peter J Altshuler
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Pavan Atluri
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa
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20
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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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21
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Galand V, Flécher E, Auffret V, Pichard C, Boulé S, Vincentelli A, Rollin A, Mondoly P, Barandon L, Pernot M, Kindo M, Cardi T, Gaudard P, Rouvière P, Sénage T, Jacob N, Defaye P, Chavanon O, Verdonk C, Ghodbane W, Pelcé E, Gariboldi V, Pozzi M, Obadia JF, Savouré A, Anselme F, Babatasi G, Belin A, Garnier F, Bielefeld M, Hamon D, Lellouche N, Pierre B, Bourguignon T, Eschalier R, D'Ostrevy N, Bories MC, Marijon E, Vanhuyse F, Blangy H, Verhoye JP, Leclercq C, Martins RP. Early Ventricular Arrhythmias After LVAD Implantation Is the Strongest Predictor of 30-Day Post-Operative Mortality. JACC Clin Electrophysiol 2019; 5:944-954. [PMID: 31439296 DOI: 10.1016/j.jacep.2019.05.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 05/22/2019] [Accepted: 05/30/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This study aimed to evaluate incidence, clinical significance, and predictors of early ventricular arrhythmias (VAs) in left ventricular assist device (LVAD) recipients. BACKGROUND LVAD implantation is increasingly used in patients with end-stage heart failure. Early VAs may occur during the 30-day post-operative period, but many questions remain unanswered regarding their incidence and clinical impact. METHODS This observational study was conducted in 19 centers between 2006 and 2016. Early VAs were defined as sustained ventricular tachycardia and/or ventricular fibrillation occurring <30 days post-LVAD implantation and requiring appropriate implantable cardioverter-defibrillator therapy, external electrical shock, or medical therapy. RESULTS A total of 652 patients (median age: 59.8 years; left ventricular ejection fraction: 20.7 ± 7.4%; HeartMate 2: 72.8%; HeartWare: 19.5%; Jarvik 2000: 7.7%) were included in the analysis. Early VAs occurred in 162 patients (24.8%), most frequently during the first week after LVAD implantation. Multivariable analysis identified history of VAs prior to LVAD and any combined surgery with LVAD as 2 predictors of early VAs. The occurrence of early VAs with electrical storm was the strongest predictor of 30-day post-operative mortality, associated with a 7-fold increase of 30-day mortality. However, in patients discharged alive from hospital, occurrence of early VAs did not influence long-term survival. CONCLUSIONS Early VAs are common after LVAD implantation and increase 30-day post-operative mortality, without affecting long-term survival. Further studies will be needed to analyze whether pre- or pre-operative ablation of VAs may improve post-operative outcomes. (Determination of Risk Factors of Ventricular Arrhythmias After Implantation of Continuous Flow Left Ventricular Assist Device With Continuous Flow Left Ventricular Assist Device [ASSIST-ICD]; NCT02873169).
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Affiliation(s)
- Vincent Galand
- Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France
| | - Erwan Flécher
- Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France
| | - Vincent Auffret
- Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France
| | - Camille Pichard
- Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France
| | - Stéphane Boulé
- Department of Cardiology and Cardiac Surgery, CHU Lille, Institut Coeur-Poumons, Lille, France
| | - André Vincentelli
- Department of Cardiology and Cardiac Surgery, CHU Lille, Institut Coeur-Poumons, Lille, France
| | - Anne Rollin
- Department of Cardiology, Department of Cardiac Surgery, CHU de Toulouse, Toulouse, France
| | - Pierre Mondoly
- Department of Cardiology, Department of Cardiac Surgery, CHU de Toulouse, Toulouse, France
| | - Laurent Barandon
- Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, Bordeaux, France
| | - Mathieu Pernot
- Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, Bordeaux, France
| | - Michel Kindo
- Department of Cardiovascular Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Thomas Cardi
- Department of Cardiovascular Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Philippe Gaudard
- Department of Anesthesiology and Critical Care Medicine, PhyMedExp, University of Montpellier, INSERM, CNRS, Department of Cardiac Surgery, University of Montpellier, CHU Montpellier, Montpellier, France
| | - Philippe Rouvière
- Department of Anesthesiology and Critical Care Medicine, PhyMedExp, University of Montpellier, INSERM, CNRS, Department of Cardiac Surgery, University of Montpellier, CHU Montpellier, Montpellier, France
| | - Thomas Sénage
- Department of Cardiology and Heart Transplantation Unit, CHU Nantes, France
| | - Nicolas Jacob
- Department of Cardiology and Heart Transplantation Unit, CHU Nantes, France
| | - Pascal Defaye
- Department of Cardiology and Cardiovascular Surgery, CHU Michallon, Grenoble, France
| | - Olivier Chavanon
- Department of Cardiology and Cardiovascular Surgery, CHU Michallon, Grenoble, France
| | - Constance Verdonk
- Department of Cardiology and Cardiac Surgery, Bichat-Hospital, Paris, France
| | - Walid Ghodbane
- Department of Cardiology and Cardiac Surgery, Bichat-Hospital, Paris, France
| | - Edeline Pelcé
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Vlad Gariboldi
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Matteo Pozzi
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Lyon, France
| | - Jean-François Obadia
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Lyon, France
| | - Arnaud Savouré
- Department of Cardiology and Cardiovascular Surgery, Hospital Charles Nicolle, Rouen, France
| | - Frédéric Anselme
- Department of Cardiology and Cardiovascular Surgery, Hospital Charles Nicolle, Rouen, France
| | - Gerard Babatasi
- Department of Cardiology and Cardiac Surgery, University Hospital of Caen, University of Caen, Caen, France
| | - Annette Belin
- Department of Cardiology and Cardiac Surgery, University Hospital of Caen, University of Caen, Caen, France
| | - Fabien Garnier
- Department of Cardiology and Cardiac Surgery, University Hospital, Dijon, France
| | - Marie Bielefeld
- Department of Cardiology and Cardiac Surgery, University Hospital, Dijon, France
| | - David Hamon
- Department of Cardiology and Cardiac Surgery, Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, Créteil, France
| | - Nicolas Lellouche
- Department of Cardiology and Cardiac Surgery, Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, Créteil, France
| | - Bertrand Pierre
- Department of Cardiology and Cardiac Surgery, Tours University Hospital, Tours, France
| | - Thierry Bourguignon
- Department of Cardiology and Cardiac Surgery, Tours University Hospital, Tours, France
| | - Romain Eschalier
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Nicolas D'Ostrevy
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Eloi Marijon
- Cardiology Department, European Georges Pompidou Hospital, Paris, France
| | - Fabrice Vanhuyse
- Department of Cardiology and Cardiac Surgery, CHU de Nancy, Hopital de Brabois, Nancy, France
| | - Hugues Blangy
- Department of Cardiology and Cardiac Surgery, CHU de Nancy, Hopital de Brabois, Nancy, France
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22
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Potapov EV, Antonides C, Crespo-Leiro MG, Combes A, Färber G, Hannan MM, Kukucka M, de Jonge N, Loforte A, Lund LH, Mohacsi P, Morshuis M, Netuka I, Özbaran M, Pappalardo F, Scandroglio AM, Schweiger M, Tsui S, Zimpfer D, Gustafsson F. 2019 EACTS Expert Consensus on long-term mechanical circulatory support. Eur J Cardiothorac Surg 2019; 56:230-270. [PMID: 31100109 PMCID: PMC6640909 DOI: 10.1093/ejcts/ezz098] [Citation(s) in RCA: 240] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Long-term mechanical circulatory support (LT-MCS) is an important treatment modality for patients with severe heart failure. Different devices are available, and many-sometimes contradictory-observations regarding patient selection, surgical techniques, perioperative management and follow-up have been published. With the growing expertise in this field, the European Association for Cardio-Thoracic Surgery (EACTS) recognized a need for a structured multidisciplinary consensus about the approach to patients with LT-MCS. However, the evidence published so far is insufficient to allow for generation of meaningful guidelines complying with EACTS requirements. Instead, the EACTS presents an expert opinion in the LT-MCS field. This expert opinion addresses patient evaluation and preoperative optimization as well as management of cardiac and non-cardiac comorbidities. Further, extensive operative implantation techniques are summarized and evaluated by leading experts, depending on both patient characteristics and device selection. The faculty recognized that postoperative management is multidisciplinary and includes aspects of intensive care unit stay, rehabilitation, ambulatory care, myocardial recovery and end-of-life care and mirrored this fact in this paper. Additionally, the opinions of experts on diagnosis and management of adverse events including bleeding, cerebrovascular accidents and device malfunction are presented. In this expert consensus, the evidence for the complete management from patient selection to end-of-life care is carefully reviewed with the aim of guiding clinicians in optimizing management of patients considered for or supported by an LT-MCS device.
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Affiliation(s)
- Evgenij V Potapov
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
| | - Christiaan Antonides
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Maria G Crespo-Leiro
- Complexo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), CIBERCV, UDC, La Coruña, Spain
| | - Alain Combes
- Sorbonne Université, INSERM, Institute of Cardiometabolism and Nutrition, Paris, France
- Service de médecine intensive-réanimation, Institut de Cardiologie, APHP, Hôpital Pitié–Salpêtrière, Paris, France
| | - Gloria Färber
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Margaret M Hannan
- Department of Medical Microbiology, University College of Dublin, Dublin, Ireland
| | - Marian Kukucka
- Department of Anaesthesiology, German Heart Center Berlin, Berlin, Germany
| | - Nicolaas de Jonge
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Antonio Loforte
- Department of Cardiothoracic, S. Orsola Hospital, Transplantation and Vascular Surgery, University of Bologna, Bologna, Italy
| | - Lars H Lund
- Department of Medicine Karolinska Institute, Heart and Vascular Theme, Karolinska University Hospital, Solna, Sweden
| | - Paul Mohacsi
- Department of Cardiovascular Surgery Swiss Cardiovascular Center, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Michiel Morshuis
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany
| | - Ivan Netuka
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Mustafa Özbaran
- Department of Cardiovascular Surgery, Ege University, Izmir, Turkey
| | - Federico Pappalardo
- Advanced Heart Failure and Mechanical Circulatory Support Program, Cardiac Intensive Care, San Raffaele Hospital, Vita Salute University, Milan, Italy
| | - Anna Mara Scandroglio
- Department of Anesthesia and Intensive Care, San Raffaele Hospital, Vita Salute University, Milan, Italy
| | - Martin Schweiger
- Department of Congenital Pediatric Surgery, Zurich Children's Hospital, Zurich, Switzerland
| | - Steven Tsui
- Royal Papworth Hospital, Cambridge, United Kingdom
| | - Daniel Zimpfer
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
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23
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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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24
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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: 186] [Impact Index Per Article: 37.2] [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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25
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Arkles JS, Marchlinski F. When Should the Electrophysiologist Be Involved in Managing Patients with Ventricular Assist Devices and Ventricular Arrhythmias? J Innov Card Rhythm Manag 2019; 10:3605-3610. [PMID: 32494416 PMCID: PMC7252896 DOI: 10.19102/icrm.2019.100407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 10/18/2018] [Indexed: 11/06/2022] Open
Abstract
The successful management of ventricular arrhythmias (VAs) in people with left ventricular assist devices (LVADs) is often complex. The need for and the role of defibrillator therapy is continually evolving in this group. VAs occur frequently and significantly impact the clinical course of patients with LVADs. The management of VAs begins prior to LVAD implantation and typically involves appropriate implantable cardioverter-defibrillator use and programming after the fact. Surgical ablation during LVAD implantation and supplementary catheter ablation performed as needed are attractive options for the management of VAs in this population. The performance of catheter ablation is generally safe and feasible after LVAD implantation with a team approach.
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Affiliation(s)
- Jeffrey S Arkles
- Electrophysiology Section, Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Francis Marchlinski
- Electrophysiology Section, Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA, USA
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26
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Moss JD, Oesterle A, Raiman M, Flatley EE, Beaser AD, Jeevanandam V, Klein L, Ota T, Wieselthaler G, Uriel N, Tung R. Feasibility and utility of intraoperative epicardial scar characterization during left ventricular assist device implantation. J Cardiovasc Electrophysiol 2018; 30:183-192. [PMID: 30516301 DOI: 10.1111/jce.13803] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 10/29/2018] [Accepted: 11/06/2018] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Ventricular arrhythmias (VA) after left ventricular assist device (LVAD) placement are associated with increased morbidity and mortality. We sought to assess epicardial voltage characteristics at the time of LVAD implantation and investigate relationships between scar burden and postimplant VA. METHODS AND RESULTS Consecutive patients underwent open chest epicardial electroanatomic mapping immediately before LVAD implantation. Areas of low voltage and sites with local abnormal potentials were identified. Patients were followed prospectively for postimplant VA and clinical outcomes. Between 2015 and 2017, 36 patients underwent high-density intraoperative epicardial voltage mapping; 15 had complete maps suitable for analysis. Mapping required a median of 11.8 (interquartile range [IQR], 8.5-12.7) minutes, with a median of 2650 (IQR, 2139-3191) points sampled per patient. Over a median follow-up of 311 (IQR, 168-469) postoperative days, four patients (27%) experienced sustained VA. Patients with postimplant VA were more likely to have had preimplant implantable cardioverter defibrillator shocks (100% vs 27%; P = 0.03), ventricular tachycardia storm (75% vs 9%; P = 0.03), and lower ejection fraction (13.5 vs 19.0%, P = 0.05). Patients with postimplant VA also had a significantly higher burden of epicardial low bipolar voltage points: 55.4% vs 24.9% of points were less than 0.5 mV (P = 0.01), and 88.9% vs 63.7% of points less than 1.5 mV (P = 0.004). CONCLUSIONS Intraoperative high-density epicardial mapping during LVAD implantation is safe and efficient, facilitating characterization of a potentially arrhythmogenic substrate. An increased burden of the epicardial scar may be associated with a higher incidence of postimplant VA. The role of empiric intraoperative epicardial ablation to mitigate risk of postimplant VA requires further study.
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Affiliation(s)
- Joshua D Moss
- Department of Medicine, Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Francisco, San Francisco, California
| | - Adam Oesterle
- Department of Medicine, Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Francisco, San Francisco, California
| | | | - Erin E Flatley
- Department of Medicine, Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Francisco, San Francisco, California
| | - Andrew D Beaser
- Department of Medicine, Section of Cardiology, Center for Arrhythmia Care, University of Chicago Medicine, Chicago, Illinois
| | - Valluvan Jeevanandam
- Department of Surgery, Section of Cardiac and Thoracic Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Liviu Klein
- Department of Medicine, Division of Cardiology, Section of Heart Failure, University of California San Francisco, San Francisco, California
| | - Takeyoshi Ota
- Department of Surgery, Section of Cardiac and Thoracic Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Georg Wieselthaler
- Department of Surgery, Division of Adult Cardiothoracic Surgery, University of California San Francisco, San Francisco, California
| | - Nir Uriel
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, Chicago, IL
| | - Roderick Tung
- Department of Medicine, Section of Cardiology, Center for Arrhythmia Care, University of Chicago Medicine, Chicago, Illinois
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27
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2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Heart Rhythm 2018; 15:e73-e189. [DOI: 10.1016/j.hrthm.2017.10.036] [Citation(s) in RCA: 177] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Indexed: 02/07/2023]
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28
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Catheter Ablation of Ventricular Tachycardia in Patients With a Ventricular Assist Device: A Systematic Review of Procedural Characteristics and Outcomes. JACC Clin Electrophysiol 2018; 5:39-51. [PMID: 30678785 DOI: 10.1016/j.jacep.2018.08.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/07/2018] [Accepted: 08/17/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVES This is a systematic review summarizing the procedural characteristics and outcomes of ventricular assist device (VAD)-related ventricular tachycardia (VT) ablation. BACKGROUND Drug-refractory VT refractory commonly develops post-VAD implantation. Procedural and outcome data come from small series or case reports. METHODS An electronic search was performed using major databases. Primary outcomes were VT recurrence, mortality, and cardiac transplantation. Secondary endpoints were acute procedural success and procedural complications. RESULTS Eighteen studies were included, with a total of 110 patients (mean age 59.6 ± 11 years, 89% men; VT storm 34%). Scar-related re-entry was the predominant mechanism of VT (90.3%) and cannula-related VT in 19.3% cases. Electroanatomical mapping interference occurred in 1.8% of cases; there were no reports of catheter entrapment. Noninducibility of clinical VT was achieved in 77.9%; procedural complications occurred in 9.4%. At a mean follow-up of 263.5 ± 267.0 days, VT recurred in 43.6%, 23.4% underwent cardiac transplant, and 48.1% died. There were no procedural-related deaths and no death was directly related to ventricular arrhythmia. In follow-up, there was a significant reduction in implantable cardioverter-defibrillator therapies or shocks (57.1% vs. 23.8%). Ablation allowed VT storm termination in 90% of patients. CONCLUSIONS VAD-related VT is predominantly related to pre-existing intrinsic myocardial scar rather than inflow cannula site insertion. Catheter ablation is a reasonable treatment strategy, albeit with expectedly high rate of recurrence, transplantation, and mortality related to severe underlying disease.
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29
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Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2018; 138:e272-e391. [PMID: 29084731 DOI: 10.1161/cir.0000000000000549] [Citation(s) in RCA: 249] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | - William G Stevenson
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Michael J Ackerman
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - William J Bryant
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - David J Callans
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Anne B Curtis
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Barbara J Deal
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Timm Dickfeld
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Michael E Field
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Gregg C Fonarow
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Anne M Gillis
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Christopher B Granger
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Stephen C Hammill
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Mark A Hlatky
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - José A Joglar
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - G Neal Kay
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Daniel D Matlock
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Robert J Myerburg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Richard L Page
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
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30
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Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2018; 138:e210-e271. [PMID: 29084733 DOI: 10.1161/cir.0000000000000548] [Citation(s) in RCA: 153] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | - William G Stevenson
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Michael J Ackerman
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - William J Bryant
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - David J Callans
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Anne B Curtis
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Barbara J Deal
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Timm Dickfeld
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Michael E Field
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Gregg C Fonarow
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Anne M Gillis
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Christopher B Granger
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Stephen C Hammill
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Mark A Hlatky
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - José A Joglar
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - G Neal Kay
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Daniel D Matlock
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Robert J Myerburg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Richard L Page
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
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Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2018; 72:e91-e220. [PMID: 29097296 DOI: 10.1016/j.jacc.2017.10.054] [Citation(s) in RCA: 707] [Impact Index Per Article: 117.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Management of Arrhythmias and Cardiac Implantable Electronic Devices in Patients With Left Ventricular Assist Devices. JACC Clin Electrophysiol 2018; 4:847-859. [DOI: 10.1016/j.jacep.2018.04.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/28/2018] [Accepted: 04/30/2018] [Indexed: 11/21/2022]
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Controversies and Challenges of Ventricular Assist Device Therapy. Am J Cardiol 2018; 121:1219-1224. [PMID: 29576232 DOI: 10.1016/j.amjcard.2018.01.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/16/2018] [Accepted: 01/22/2018] [Indexed: 11/23/2022]
Abstract
Left ventricular assist device (LVAD) therapy has emerged as an increasingly vital facet of the treatment algorithm for advanced heart failure. Growing experience with LVAD support has led to substantial improvements in outcomes, with 1-year survival rates approaching that of cardiac transplantation. These therapeutic refinements have engendered growing interests in the potential for expanding the clinical indications for LVAD therapy to patients with less advanced heart failure. The primary obstacles to this evolution of care center largely on the prevention and/or management of the adverse events associated with LVAD therapy along with patient preference. Many programs also face the mounting difficulty of balancing quality outcomes with the increased volume of implants. During the recently assembled Users Meeting organized by St. Jude Medical, heart failure clinicians from nearly 50 LVAD implanting centers discussed these and other challenges and controversies impacting the field. The present review summarizes the key insights gleaned from this meeting.
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Corre J, Picard F, Garcia R, Zemmoura A, Derval N, Denis A, Romen A, Nubret K, Jais P, Haissaguerre M, Dos Santos P, Barandon L, Sacher F. Electrical storm in the early phase of HeartMate ® II device implantation: Incidence, risk factors and prognosis. Arch Cardiovasc Dis 2017; 111:332-339. [PMID: 29217463 DOI: 10.1016/j.acvd.2017.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 07/31/2017] [Accepted: 07/31/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Ventricular arrhythmia is common after left ventricular assist device (LVAD) implantation, especially in the early postoperative phase (<30 days). AIM To identify the incidence of and risk factors for electrical storm (ES) occurring within 30 days of HeartMate® II implantation. METHODS We reviewed data from all consecutive patients undergoing HeartMate® II device implantation at our institution from January 2008 to December 2014. Patient demographic data, pharmacotherapies and outcomes were collected. The primary endpoint was occurrence of early ES (within 30 days of surgery), defined as three or more separate episodes of sustained ventricular arrhythmia within a 24-hour interval, requiring appropriate therapy. RESULTS Forty-three patients (mean age 56.7±11.2 years; 39 men) were included. At HeartMate® II implantation, mean left ventricular ejection fraction was 20±5%, 32 (74.4%) patients had ischaemic cardiomyopathy and 31 (72.1%) were implanted with an indication of bridge to cardiac transplantation. During follow-up, 12 (27.9%) patients experienced early ES after HeartMate® II implantation (median delay 9.1±7.8 days). Early ES was more frequent in larger patients (body surface area 1.99 vs 1.81 m2; P<0.01), tended to be associated with previous sustained ventricular tachycardia (50.0% vs 22.6%; P=0.08), previous implantable cardioverter-defibrillator implantation (66.7% vs 38.7%; P=0.09), discontinuation of long-term beta-blocker therapy (75.0% vs 45.2%; P=0.08), weaning of adrenergic drugs after the third day (66.7% vs 35.5%; P=0.06) and the use of extracorporeal life support (50% vs 22.6%; P=0.079), but was not associated with the cardiomyopathy aetiology or the indication for assistance. Catheter ventricular tachycardia ablation was performed in six (14.0%) patients. Early ES was associated with a significantly higher all-cause mortality rate at the 30th day (33.3% vs 6.5%; P=0.02). CONCLUSION ES is a common and pejorative feature in the early postoperative period.
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Affiliation(s)
- Jerome Corre
- Service de rythmologie, hôpital cardiologique du Haut-Lévêque, 1, avenue Magellan, 33600 Pessac, France.
| | - François Picard
- Service d'insuffisance cardiaque, hôpital cardiologique du Haut-Lévêque, 33600 Pessac, France
| | - Rodrigue Garcia
- Service de rythmologie, hôpital cardiologique du Haut-Lévêque, 1, avenue Magellan, 33600 Pessac, France
| | - Adlane Zemmoura
- Service de rythmologie, hôpital cardiologique du Haut-Lévêque, 1, avenue Magellan, 33600 Pessac, France
| | - Nicolas Derval
- Service de rythmologie, hôpital cardiologique du Haut-Lévêque, 1, avenue Magellan, 33600 Pessac, France
| | - Arnaud Denis
- Service de rythmologie, hôpital cardiologique du Haut-Lévêque, 1, avenue Magellan, 33600 Pessac, France; LIRYC Institute, Inserm 1045, University of Bordeaux, Bordeaux, France
| | - Antoine Romen
- Service d'insuffisance cardiaque, hôpital cardiologique du Haut-Lévêque, 33600 Pessac, France
| | - Karine Nubret
- Service d'insuffisance cardiaque, hôpital cardiologique du Haut-Lévêque, 33600 Pessac, France
| | - Pierre Jais
- Service de rythmologie, hôpital cardiologique du Haut-Lévêque, 1, avenue Magellan, 33600 Pessac, France; LIRYC Institute, Inserm 1045, University of Bordeaux, Bordeaux, France
| | - Michel Haissaguerre
- Service de rythmologie, hôpital cardiologique du Haut-Lévêque, 1, avenue Magellan, 33600 Pessac, France; LIRYC Institute, Inserm 1045, University of Bordeaux, Bordeaux, France
| | - Pierre Dos Santos
- Service de rythmologie, hôpital cardiologique du Haut-Lévêque, 1, avenue Magellan, 33600 Pessac, France
| | - Laurent Barandon
- Service de chirurgie cardiaque, hôpital cardiologique du Haut-Lévêque, Pessac, France
| | - Frederic Sacher
- Service de rythmologie, hôpital cardiologique du Haut-Lévêque, 1, avenue Magellan, 33600 Pessac, France; LIRYC Institute, Inserm 1045, University of Bordeaux, Bordeaux, France
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Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2017; 72:1677-1749. [PMID: 29097294 DOI: 10.1016/j.jacc.2017.10.053] [Citation(s) in RCA: 249] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: Executive summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm 2017; 15:e190-e252. [PMID: 29097320 DOI: 10.1016/j.hrthm.2017.10.035] [Citation(s) in RCA: 391] [Impact Index Per Article: 55.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Indexed: 12/23/2022]
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Abstract
PURPOSE OF REVIEW Ventricular tachycardia occurrence in implantable cardioverter defibrillator (ICD) patients may result in shock delivery and is associated with increased morbidity and mortality. In addition, shocks may have deleterious mechanical and psychological effects. Prevention of ventricular tachycardia (VT) recurrence with the use of antiarrhythmic drugs or catheter ablation may be warranted. Antiarrhythmic drugs are limited by incomplete efficacy and an unfavorable adverse effect profile. Catheter ablation can be effective but acute complications and long-term VT recurrence risk necessitating repeat ablation should be recognized. A shared clinical decision process accounting for patients' cardiac status, comorbidities, and goals of care is often required. RECENT FINDINGS There are four published randomized trials of catheter ablation for sustained monomorphic VT (SMVT) in the setting of ischemic heart disease; there are no randomized studies for non-ischemic ventricular substrates. The most recent trial is the VANISH trial which randomly allocated patients with ICD, prior infarction, and SMVT despite first-line antiarrhythmic drug therapy to catheter ablation or more aggressive antiarrhythmic drug therapy. During 28 months of follow-up, catheter ablation resulted in a 28% relative risk reduction in the composite endpoint of death, VT storm, and appropriate ICD shock (p = 0.04). In a subgroup analysis, patients having VT despite amiodarone had better outcomes with ablation as compared to increasing amiodarone dose or adding mexiletine. There is evidence for the effectiveness of both catheter ablation and antiarrhythmic drug therapy for patients with myocardial infarction, an implantable defibrillator, and VT. If sotalol is ineffective in suppressing VT, either catheter ablation or initiation of amiodarone is a reasonable option. If VT occurs despite amiodarone therapy, there is evidence that catheter ablation is superior to administration of more aggressive antiarrhythmic drug therapy. Early catheter ablation may be appropriate in some clinical situations such as patients presenting with relatively slow VT below ICD detection, electrical storms, hemodynamically stable VT, or in very selected patients with left ventricular assist devices. The optimal first-line suppressive therapy for VT, after ICD implantation and appropriate programming, remains to be determined. Thus far, there has not been a randomized controlled trial to compare catheter ablation to antiarrhythmic drug therapy as a first-line treatment; the VANISH-2 study has been initiated as a pilot to examine this question.
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Affiliation(s)
- Amir AbdelWahab
- QEII Health Sciences Centre, Room 2501 B/F Halifax Infirmary 1796 Summer Street, Halifax, NS, B3H 3A7, Canada
| | - John Sapp
- QEII Health Sciences Centre, Room 2501 B/F Halifax Infirmary 1796 Summer Street, Halifax, NS, B3H 3A7, Canada.
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Moss JD, Flatley EE, Beaser AD, Shin JH, Nayak HM, Upadhyay GA, Burke MC, Jeevanandam V, Uriel N, Tung R. Characterization of Ventricular Tachycardia After Left Ventricular Assist Device Implantation as Destination Therapy: A Single-Center Ablation Experience. JACC Clin Electrophysiol 2017; 3:1412-1424. [PMID: 29759673 DOI: 10.1016/j.jacep.2017.05.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/30/2017] [Accepted: 05/31/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study sought to report mechanisms of ventricular tachycardia (VT) and outcomes of VT ablation in patients with a left ventricular assist device (LVAD) as destination therapy. BACKGROUND Continuous flow LVAD implantation plays a growing role in the management of end-stage heart failure, and VT is common. There are limited reports of VT ablation in patients with a destination LVAD. METHODS Patients with a continuous-flow LVAD referred for VT ablation from 2010 to 2016 were analyzed retrospectively. Baseline patient characteristics, procedural data, and clinical follow-up were evaluated. Arrhythmia-free survival was assessed. RESULTS Twenty-one patients (90% male, 62 ± 10 years) underwent catheter ablation of VT at a median of 191 days (interquartile range: 55 to 403 days) after LVAD implantation (15 HeartMate II, 6 HeartWare HVAD). Five patients (24%) had termination (n = 4) or slowing (n = 1) of VT with ablation near the apical inflow cannula, and 3 (14%) had bundle-branch re-entry. Freedom from recurrent VT among surviving patients was 64% at 1 year, with overall survival 67% at 1 year for patients without arrhythmia recurrence and 29% for patients with recurrence (p = 0.049). One patient had suspected pump thrombosis within 30 days of the ablation procedure, with no other major acute complications. CONCLUSIONS In this relatively large, single-center experience of VT ablation in destination LVAD, freedom from recurrent VT and implantable cardioverter-defibrillator shocks was associated with improved 1-year survival. Bundle branch re-entry was more prevalent than anticipated, and cannula-adjacent VT was less common. This challenging population remains at risk for late pump thrombosis and mortality.
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Affiliation(s)
- Joshua D Moss
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California-San Francisco, San Francisco, California.
| | - Erin E Flatley
- Heart and Vascular Center, University of Chicago Medicine, Chicago, Illinois
| | - Andrew D Beaser
- Heart and Vascular Center, University of Chicago Medicine, Chicago, Illinois
| | - John H Shin
- Mid-Atlantic Permanente Medical Group, Rockville, Maryland
| | - Hemal M Nayak
- Heart and Vascular Center, University of Chicago Medicine, Chicago, Illinois
| | - Gaurav A Upadhyay
- Heart and Vascular Center, University of Chicago Medicine, Chicago, Illinois
| | | | | | - Nir Uriel
- Heart and Vascular Center, University of Chicago Medicine, Chicago, Illinois
| | - Roderick Tung
- Heart and Vascular Center, University of Chicago Medicine, Chicago, Illinois
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Gianni C, Mohanty S, Trivedi C, Di Biase L, Al-Ahmad A, Natale A, David Burkhardt J. Alternative Approaches for Ablation of Resistant Ventricular Tachycardia. Card Electrophysiol Clin 2017; 9:93-98. [PMID: 28167089 DOI: 10.1016/j.ccep.2016.10.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Ventricular tachycardia (VT) ablation is usually performed with an ablation catheter that delivers unipolar radiofrequency (RF) energy to eliminate the re-entry circuit responsible for VT. However, there are some instances when unipolar RF ablation fails, notably in VTs with a deep intramural origin, or cases in which epicardial access is not attainable due to prior cardiac surgery. To overcome these limitations, several alternative approaches have been used in clinical practice, including alcohol ablation or coil embolization, simultaneous unipolar or bipolar RF ablation, surgical ablation, or noninvasive ablation with stereotactic radiosurgery. This review article describes some of these alternative techniques.
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Affiliation(s)
- Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; Department of Internal Medicine, Dell Medical School, University of Texas, Austin, TX, USA
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas, Austin, TX, USA; Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; Department of Internal Medicine, Dell Medical School, University of Texas, Austin, TX, USA; Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas, Austin, TX, USA; Interventional Electrophysiology, Scripps Clinic, La Jolla, CA, USA; Department of Cardiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Division of Cardiology, Stanford University, Stanford, CA, USA; Atrial Fibrillation and Arrhythmia Center, California Pacific Medical Center, San Francisco, CA, USA
| | - J David Burkhardt
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA.
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Ikegami H, Kurlansky P, Takeda K, Naka Y. Challenges faced in long term ventricular assist device support. Expert Rev Med Devices 2016; 13:727-40. [PMID: 27376168 DOI: 10.1080/17434440.2016.1208557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The development of ventricular assist device (VAD) has been one of the revolutionary advancements in end-stage heart failure management. Although the device has developed and improved significantly over the last few decades, we still face multiple challenges. AREAS COVERED This review will discuss quality of life, survival, and clinically encountered complications in patients with VAD support. The literature was extensively reviewed for studies describing the above topic area. We describe the impact of major challenges faced in VAD support and discuss their future and expectations. Expert commentary: The technological advancement of VADs has contributed to major improvement of overall survival, enhancement of quality of life and decrease of incidence of complications. It is expected that technologies will continue to evolve. At the same time, the indications for and timing of device implantation, and selection of device type are continuously important in clinical practice setting.
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Affiliation(s)
- Hirohisa Ikegami
- a Department of Surgery, Division of Cardiothoracic Surgery , Columbia University Medical Center , New York , NY , USA
| | - Paul Kurlansky
- a Department of Surgery, Division of Cardiothoracic Surgery , Columbia University Medical Center , New York , NY , USA
| | - Koji Takeda
- a Department of Surgery, Division of Cardiothoracic Surgery , Columbia University Medical Center , New York , NY , USA
| | - Yoshifumi Naka
- a Department of Surgery, Division of Cardiothoracic Surgery , Columbia University Medical Center , New York , NY , USA
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McIlvennan CK, Babu AN, Brieke A, Ambardekar AV. Concomitant surgical cryoablation for refractory ventricular tachycardia and left ventricular assist device placement: a dual remedy but a recipe for thrombosis? J Cardiothorac Surg 2016; 11:53. [PMID: 27067868 PMCID: PMC4827214 DOI: 10.1186/s13019-016-0451-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 04/04/2016] [Indexed: 11/10/2022] Open
Abstract
Background Ventricular tachycardia (VT) can persist following placement of a left ventricular assist device (LVAD). The optimal management strategy for VT during the peri-LVAD period is unknown. Case Presentations Two case reports are presented that describe epicardial and endocardial VT ablation performed during LVAD placement. Subsequently, both patients developed LVAD thrombosis, a known and dreaded complication of LVADs, requiring re-operation. Conclusions While LVAD thrombosis is likely multifactorial and remains an area of active research, these two cases should increase awareness of the possible risks of VT ablation—especially endocardial ablation—during LVAD placement. Further research is needed to understand the effects of VT ablation during the peri-LVAD period.
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Affiliation(s)
- Colleen K McIlvennan
- Division of Cardiology, University of Colorado, School of Medicine, 12631 East 17th Avenue, B130, Aurora, CO, 80045, Canada.
| | - Ashok N Babu
- Division of Cardiothoracic Surgery, University of Colorado, School of Medicine, Aurora, CO, USA
| | - Andreas Brieke
- Division of Cardiology, University of Colorado, School of Medicine, 12631 East 17th Avenue, B130, Aurora, CO, 80045, Canada
| | - Amrut V Ambardekar
- Division of Cardiology, University of Colorado, School of Medicine, 12631 East 17th Avenue, B130, Aurora, CO, 80045, Canada
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Smith LA, Yarboro LT, Kennedy JLW. Left ventricular assist device implantation strategies and outcomes. J Thorac Dis 2015; 7:2088-96. [PMID: 26793328 PMCID: PMC4703687 DOI: 10.3978/j.issn.2072-1439.2015.08.13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 07/30/2015] [Indexed: 11/14/2022]
Abstract
Over the past 15 years, the field of mechanical circulatory support has developed significantly. Currently, there are a multitude of options for both short and long term cardiac support. Choosing the appropriate device for each patient depends on the amount of support needed and the goals of care. This article focuses on long term, implantable devices for both bridge to transplantation and destination therapy indications. Implantation strategies, including the appropriate concomitant surgeries are discussed as well as expected long term outcomes. As device technology continues to improve, long term mechanical circulatory support may become a viable alternative to transplantation.
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Patel H, Madanieh R, Kosmas CE, Vatti SK, Vittorio TJ. Complications of Continuous-Flow Mechanical Circulatory Support Devices. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2015; 9:15-21. [PMID: 26052234 PMCID: PMC4441367 DOI: 10.4137/cmc.s19708] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 12/01/2014] [Accepted: 12/06/2014] [Indexed: 11/05/2022]
Abstract
Left ventricular assist devices (LVADs), more importantly the continuous-flow subclass, have revolutionized the medical field by improving New York Heart Association (NYHA) functional class status, quality of life, and survival rates in patients with advanced systolic heart failure. From the first pulsatile device to modern day continuous-flow devices, LVADs have continued to improve, but they are still associated with several complications. These complications include infection, bleeding, thrombosis, hemolysis, aortic valvular dysfunction, right heart failure, and ventricular arrhythmias. In this article, we aim to review these complications to understand the most appropriate approach for their prevention and to discuss the available therapeutic modalities.
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Affiliation(s)
- Harsh Patel
- Department of Internal Medicine, SUNY Downstate School of Medicine, Brooklyn, NY, USA
| | - Raef Madanieh
- St. Francis Hospital - The Heart Center , Center for Advanced Cardiac Therapeutics, Roslyn, NY, USA
| | - Constantine E Kosmas
- Icahn School of Medicine at Mount Sinai, Zena and Michael A. Wiener Cardiovascular Institute, New York, NY, USA
| | - Satya K Vatti
- St. Francis Hospital - The Heart Center , Center for Advanced Cardiac Therapeutics, Roslyn, NY, USA
| | - Timothy J Vittorio
- St. Francis Hospital - The Heart Center , Center for Advanced Cardiac Therapeutics, Roslyn, NY, USA
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Sacher F, Reichlin T, Zado ES, Field ME, Viles-Gonzalez JF, Peichl P, Ellenbogen KA, Maury P, Dukkipati SR, Picard F, Kautzner J, Barandon L, Koneru JN, Ritter P, Mahida S, Calderon J, Derval N, Denis A, Cochet H, Shepard RK, Corre J, Coffey JO, Garcia F, Hocini M, Tedrow U, Haissaguerre M, d'Avila A, Stevenson WG, Marchlinski FE, Jais P. Characteristics of ventricular tachycardia ablation in patients with continuous flow left ventricular assist devices. Circ Arrhythm Electrophysiol 2015; 8:592-7. [PMID: 25870335 DOI: 10.1161/circep.114.002394] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 03/30/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Left ventricular assist devices (LVADs) are increasingly used as a bridge to cardiac transplantation or as destination therapy. Patients with LVADs are at high risk for ventricular arrhythmias. This study describes ventricular arrhythmia characteristics and ablation in patients implanted with a Heart Mate II device. METHODS AND RESULTS All patients with a Heart Mate II device who underwent ventricular arrhythmia catheter ablation at 9 tertiary centers were included. Thirty-four patients (30 male, age 58±10 years) underwent 39 ablation procedures. The underlying cardiomyopathy pathogenesis was ischemic in 21 and nonischemic in 13 patients with a mean left ventricular ejection fraction of 17%±5% before LVAD implantation. One hundred and ten ventricular tachycardias (VTs; cycle lengths, 230-740 ms, arrhythmic storm n=28) and 2 ventricular fibrillation triggers were targeted (25 transseptal, 14 retrograde aortic approaches). Nine patients required VT ablation <1 month after LVAD implantation because of intractable VT. Only 10/110 (9%) of the targeted VTs were related to the Heart Mate II cannula. During follow-up, 7 patients were transplanted and 10 died. Of the remaining 17 patients, 13 were arrhythmia-free at 25±15 months. In 1 patient with VT recurrence, change of turbine speed from 9400 to 9000 rpm extinguished VT. CONCLUSIONS Catheter ablation of VT among LVAD recipients is feasible and reasonably safe even soon after LVAD implantation. Intrinsic myocardial scar, rather than the apical cannula, seems to be the dominant substrate.
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Affiliation(s)
- Frederic Sacher
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.).
| | - Tobias Reichlin
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Erica S Zado
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Michael E Field
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Juan F Viles-Gonzalez
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Petr Peichl
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Kenneth A Ellenbogen
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Philippe Maury
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Srinivas R Dukkipati
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Francois Picard
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Josef Kautzner
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Laurent Barandon
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Jayanthi N Koneru
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Philippe Ritter
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Saagar Mahida
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Joachim Calderon
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Nicolas Derval
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Arnaud Denis
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Hubert Cochet
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Richard K Shepard
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Jerome Corre
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - James O Coffey
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Fermin Garcia
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Meleze Hocini
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Usha Tedrow
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Michel Haissaguerre
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Andre d'Avila
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - William G Stevenson
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Francis E Marchlinski
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Pierre Jais
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
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Pedersen CT, Kay GN, Kalman J, Borggrefe M, Della-Bella P, Dickfeld T, Dorian P, Huikuri H, Kim YH, Knight B, Marchlinski F, Ross D, Sacher F, Sapp J, Shivkumar K, Soejima K, Tada H, Alexander ME, Triedman JK, Yamada T, Kirchhof P, Lip GY, Kuck KH, Mont L, Haines D, Indik J, Dimarco J, Exner D, Iesaka Y, Savelieva I. EHRA/HRS/APHRS expert consensus on ventricular arrhythmias. J Arrhythm 2014. [DOI: 10.1016/j.joa.2014.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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Pedersen CT, Kay GN, Kalman J, Borggrefe M, Della-Bella P, Dickfeld T, Dorian P, Huikuri H, Kim YH, Knight B, Marchlinski F, Ross D, Sacher F, Sapp J, Shivkumar K, Soejima K, Tada H, Alexander ME, Triedman JK, Yamada T, Kirchhof P, Lip GYH, Kuck KH, Mont L, Haines D, Indik J, Dimarco J, Exner D, Iesaka Y, Savelieva I. EHRA/HRS/APHRS expert consensus on ventricular arrhythmias. Europace 2014; 16:1257-83. [PMID: 25172618 DOI: 10.1093/europace/euu194] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Kumar S, Stevenson WG, John RM. Catheter ablation for premature ventricular contractions and ventricular tachycardia in patients with heart failure. Curr Cardiol Rep 2014; 16:522. [PMID: 25059465 DOI: 10.1007/s11886-014-0522-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Ventricular arrhythmias (VA) are a significant contributor to morbidity and mortality in patients with heart failure (HF). Implantable cardioverter defibrillators are effective in reducing mortality, but do not prevent arrhythmia recurrence. There is increasing recognition that frequent premature ventricular contractions or repetitive ventricular tachycardia may also lead to new onset ventricular dysfunction or deterioration of ventricular function in patients with pre-existing HF. Suppression of the arrhythmia may lead to recovery of ventricular function. Catheter ablation has emerged as a safe and effective treatment option for reducing arrhythmia recurrence and for suppression of PVCs but its efficacy is governed by the nature of the arrhythmias, the underlying HF substrate and the accessibility of the arrhythmia substrates to ablation.
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Affiliation(s)
- Saurabh Kumar
- Cardiac Arrhythmia Service, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
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