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Marrakchi S, Badenco N, Schumacher S, Bennour E, Livarek B, Gandjbakhch E, Hidden-Lucet F. Focus on malignant ventricular premature contractions. Ann Cardiol Angeiol (Paris) 2023; 72:101662. [PMID: 37742408 DOI: 10.1016/j.ancard.2023.101662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023]
Abstract
Premature ventricular contractions (PVCs) are common. Although often benign, they can also be associated with increased morbidity and mortality. The aim of this review was to assess the risk evaluation of PVCs in patients with or without structural heart disease and discuss the management of this arrhythmia. Reports published in English were searched in PubMed with the following search terms: premature ventricular contraction, ectopic ventricular beat, ventricular extrasystole, antiarrhythmic drugs, ablation, ventricular arrhythmia, ventricular tachycardia, ventricular fibrillation and torsade de pointe. This analysis suggests that all patients with frequent PVCs should be assessed for PVC burden, symptom status and the presence of structural heart disease. PVCs in patients with structurally normal hearts was once considered a benign phenomenon. Uncommonly, PVCs may provoke life-threatening arrhythmias. Ventricular fibrillation is the initial mode of malignant rapid ventricular arrhythmias (MRVAs). Patients with malignant PVC and PVC burden >10% are at increased risk of MRVA in case of myocardial infarction and heart failure. MRVA is the primary cause of sudden cardiac death in patients with and without structural heart disease. Therapeutic options include medical therapy and catheter ablation, the latter more effective and potentially curable, particularly in patients with left ventricular dysfunction. The timely recognition and effective treatment of malignant PVCs in symptomatic patients with underling cardiomyopathy are mandatory to initiate early therapies before the occurrence of adverse clinical outcomes and to improve the long-term prognosis.
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Affiliation(s)
- S Marrakchi
- Université de Sorbonne, AP-HP, Centre Hospitalo-universitaire Pitié-Salpêtrière, Institut de Cardiology, ICAN, Paris, France; Département de Cardiologie, Hospital André Mignot, Versailles, France; University El Manar, Tunis, Tunisie.
| | - N Badenco
- Université de Sorbonne, AP-HP, Centre Hospitalo-universitaire Pitié-Salpêtrière, Institut de Cardiology, ICAN, Paris, France
| | - S Schumacher
- Université de Sorbonne, AP-HP, Centre Hospitalo-universitaire Pitié-Salpêtrière, Institut de Cardiology, ICAN, Paris, France; Département de Cardiologie, Hospital André Mignot, Versailles, France
| | - E Bennour
- University El Manar, Tunis, Tunisie; Département de Cardiologie, Hospital Abderrahmane Mami Hospital, Tunis, Tunisie
| | - B Livarek
- Département de Cardiologie, Hospital André Mignot, Versailles, France
| | - E Gandjbakhch
- Université de Sorbonne, AP-HP, Centre Hospitalo-universitaire Pitié-Salpêtrière, Institut de Cardiology, ICAN, Paris, France
| | - F Hidden-Lucet
- Université de Sorbonne, AP-HP, Centre Hospitalo-universitaire Pitié-Salpêtrière, Institut de Cardiology, ICAN, Paris, France
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CMR-Based Risk Stratification of Sudden Cardiac Death and Use of Implantable Cardioverter-Defibrillator in Non-Ischemic Cardiomyopathy. Int J Mol Sci 2021; 22:ijms22137115. [PMID: 34281168 PMCID: PMC8268120 DOI: 10.3390/ijms22137115] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/27/2021] [Accepted: 06/29/2021] [Indexed: 01/04/2023] Open
Abstract
Non-ischemic cardiomyopathy (NICM) is one of the most important entities for arrhythmias and sudden cardiac death (SCD). Previous studies suggest a lower benefit of implantable cardioverter–defibrillator (ICD) therapy in patients with NICM as compared to ischemic cardiomyopathy (ICM). Nevertheless, current guidelines do not differentiate between the two subgroups in recommending ICD implantation. Hence, risk stratification is required to determine the subgroup of patients with NICM who will likely benefit from ICD therapy. Various predictors have been proposed, among others genetic mutations, left-ventricular ejection fraction (LVEF), left-ventricular end-diastolic volume (LVEDD), and T-wave alternans (TWA). In addition to these parameters, cardiovascular magnetic resonance imaging (CMR) has the potential to further improve risk stratification. CMR allows the comprehensive analysis of cardiac function and myocardial tissue composition. A range of CMR parameters have been associated with SCD. Applicable examples include late gadolinium enhancement (LGE), T1 relaxation times, and myocardial strain. This review evaluates the epidemiological aspects of SCD in NICM, the role of CMR for risk stratification, and resulting indications for ICD implantation.
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Barbosa AR, Dias Ferreira N, Martins O’Neill C, Ruivo C, Cruz I, Rocha Lopes L. Deformación miocárdica basada en resonancia magnética cardiaca y riesgo arrítmico en la miocardiopatía hipertrófica. Rev Esp Cardiol (Engl Ed) 2020. [DOI: 10.1016/j.recesp.2020.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mavrogeni S, Gargani L, Pepe A, Monti L, Markousis-Mavrogenis G, De Santis M, De Marchi D, Koutsogeorgopoulou L, Karabela G, Stavropoulos E, Katsifis G, Bratis K, Bellando-Randone S, Guiducci S, Bruni C, Moggi-Pignone A, Dimitroulas T, Kolovou G, Bournia VK, Sfikakis PP, Matucci-Cerinic M. Cardiac magnetic resonance predicts ventricular arrhythmias in scleroderma: the Scleroderma Arrhythmia Clinical Utility Study (SAnCtUS). Rheumatology (Oxford) 2020; 59:1938-1948. [PMID: 31764972 PMCID: PMC7382593 DOI: 10.1093/rheumatology/kez494] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/28/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Cardiac rhythm disturbances constitute the most frequent cardiovascular cause of death in SSc. However, electrocardiographic findings are not a part of risk stratification in SSc. We aimed to translate 24 h Holter findings into a tangible risk prediction score using cardiovascular magnetic resonance. METHODS The Scleroderma Arrhythmia Clinical Utility Study (SAnCtUS) was a prospective multicentre study including 150 consecutive SSc patients from eight European centres, assessed with 24 h Holter and cardiovascular magnetic resonance, including ventricular function, oedema (T2 ratio) and late gadolinium enhancement (%LGE). Laboratory/clinical parameters were included in multivariable corrections. A combined endpoint of sustained ventricular tachycardia requiring hospitalization and sudden cardiac death at a median (interquartile range) follow-up of 1 (1.0-1.4) year was generated. RESULTS Only T2 ratio and %LGE were significant predictors of ventricular rhythm disturbances, but not of supraventricular rhythm disturbances, after multivariable correction and adjustment for multiple comparisons. Using decision-tree analysis, we created the SAnCtUS score, a four-category scoring system based on T2 ratio and %LGE, for identifying SSc patients at high risk of experiencing ventricular rhythm disturbance at baseline. Increasing SAnCtUS scores were associated with a greater disease and arrhythmic burden. All cases of non-sustained ventricular tachycardia (n = 7) occurred in patients with the highest SAnCtUS score (=4). Having a score of 4 conveyed a higher risk of reaching the combined endpoint in multivariable Cox regression compared with scores 1/2/3 [hazard ratio (95% CI): 3.86 (1.14, 13.04), P = 0.029] independently of left ventricular ejection fraction and baseline ventricular tachycardia occurrence. CONCLUSION T2 ratio and %LGE had the greatest utility as independent predictors of rhythm disturbances in SSc patients.
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Affiliation(s)
- Sophie Mavrogeni
- Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Luna Gargani
- Institute of Clinical Physiology, National Research Council, Pisa
| | - Alessia Pepe
- Magnetic Resonance Imaging Unit, Fondazione G. Monasterio C.N.R, Pisa
| | - Lorenzo Monti
- Department of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | | | - Maria De Santis
- Department of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Daniele De Marchi
- Magnetic Resonance Imaging Unit, Fondazione G. Monasterio C.N.R, Pisa
| | | | | | | | - Gikas Katsifis
- Department of Internal Medicine, Navy Hospital, Athens, Greece
| | | | - Silvia Bellando-Randone
- Department of Experimental and Clinical Medicine, Divisions of Internal Medicine and Rheumatology AOUC, University of Florence, Florence, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, Divisions of Internal Medicine and Rheumatology AOUC, University of Florence, Florence, Italy
| | - Cosimo Bruni
- Department of Experimental and Clinical Medicine, Divisions of Internal Medicine and Rheumatology AOUC, University of Florence, Florence, Italy
| | - Alberto Moggi-Pignone
- Department of Experimental and Clinical Medicine, Divisions of Internal Medicine and Rheumatology AOUC, University of Florence, Florence, Italy
| | | | - Genovefa Kolovou
- Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Vasiliki-Kalliopi Bournia
- First Department of Propaedeutic and Internal Medicine, Laikon Hospital, Athens University Medical School, Athens, Greece
| | - Petros P Sfikakis
- First Department of Propaedeutic and Internal Medicine, Laikon Hospital, Athens University Medical School, Athens, Greece
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Divisions of Internal Medicine and Rheumatology AOUC, University of Florence, Florence, Italy
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Barbosa AR, Dias Ferreira N, Martins O'Neill C, Ruivo C, Cruz I, Rocha Lopes L. Impaired myocardial deformation assessed by cardiac magnetic resonance is associated with increased arrhythmic risk in hypertrophic cardiomyopathy. ACTA ACUST UNITED AC 2020; 73:849-851. [PMID: 32201275 DOI: 10.1016/j.rec.2020.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 02/06/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Ana Raquel Barbosa
- Cardiology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Porto, Portugal.
| | - Nuno Dias Ferreira
- Cardiology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Porto, Portugal
| | | | - Catarina Ruivo
- Cardiology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Inês Cruz
- Cardiology Department, Hospital Garcia de Orta, Lisbon, Portugal
| | - Luís Rocha Lopes
- Barts Heart Centre, Barts Health NHS Trust; Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, London, United Kingdom
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Dimos A, Xanthopoulos A, Papamichalis M, Bourazana A, Tavoularis D, Skoularigis J, Triposkiadis F. Sudden Arrhythmic Death at the Higher End of the Heart Failure Spectrum. Angiology 2019; 71:389-396. [DOI: 10.1177/0003319719896475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The risk of sudden cardiac death (SCD) is high in heart failure (HF) patients. Sudden arrhythmic death (SAD) is a frequent cause of exit in HF patients at the lower end of the HF spectrum, and implantable cardioverter–defibrillators have been recommended to prevent these life-threatening rhythm disturbances in select patients. However, less is known regarding the cause of SCD in patients at the upper end of the HF spectrum, despite the fact that the majority of out-of-hospital SCD victims have unknown or near-normal/normal left ventricular ejection fraction (LVEF). In this review, we report the epidemiology, summarize the mechanisms, discuss the diagnostic challenges, and propose a stepwise approach for the prevention of SAD in HF with near-normal/normal LVEF.
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Affiliation(s)
- Apostolos Dimos
- Department of Cardiology, University General Hospital of Larissa, Larisa, Greece
| | - Andrew Xanthopoulos
- Department of Cardiology, University General Hospital of Larissa, Larisa, Greece
| | - Michail Papamichalis
- Department of Cardiology, University General Hospital of Larissa, Larisa, Greece
| | - Angeliki Bourazana
- Department of Cardiology, University General Hospital of Larissa, Larisa, Greece
| | - Dimitrios Tavoularis
- Department of Cardiology, University General Hospital of Larissa, Larisa, Greece
| | - John Skoularigis
- Department of Cardiology, University General Hospital of Larissa, Larisa, Greece
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van der Bijl P, Delgado V, Bax JJ. Imaging for sudden cardiac death risk stratification: Current perspective and future directions. Prog Cardiovasc Dis 2019; 62:205-211. [PMID: 31054859 DOI: 10.1016/j.pcad.2019.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 04/25/2019] [Indexed: 12/31/2022]
Abstract
Sudden cardiac death (SCD) accounts for one fifth of global deaths, and occurs when a trigger (e.g. myocardial ischemia, premature ventricular contraction) interacts with an arrhythmic substrate (e.g. myocardial scar, dilated cardiomyopathy). Multimodality imaging (echocardiographic, cardiac magnetic resonance and nuclear techniques) can potentially visualize many predisposing substrates and triggers. Implantable cardioverter-defibrillator (ICD) is the most effective approach to primary prevention of SCD, and current guidelines regarding ICD implantation are based on a left ventricular ejection fraction (LVEF) ≤35%. This practice is limited by a low sensitivity and specificity, and has limited value when applied to different etiologies. In this review, the role of multimodality imaging in SCD risk-stratification and the limitations of an LVEF-based approach, are discussed. Additional randomized, prospective data are eagerly awaited to inform on the role of imaging in SCD risk-stratification, and ongoing/ planned trials are subsequently discussed.
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Affiliation(s)
- Pieter van der Bijl
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center
| | - Victoria Delgado
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center.
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