1
|
Park J, Seol SH, Kim DK, Kim S, Song YJ, Kim DI, Kim KH. Safety concern with electrical cardioversion of persistent atrial fibrillation with slow ventricular response. Pacing Clin Electrophysiol 2022; 45:963-967. [PMID: 35276015 DOI: 10.1111/pace.14483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 11/23/2021] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
Rhythm control strategies in patients with atrial fibrillation (AF) can bring many clinical benefits. However, there is still uncertainty regarding selection of the optimal rhythm control strategy for persistent AF. Chronicity, substrate alteration, and underlying bradyarrhythmias could influence the clinical outcomes. Current guidelines do not provide a distinct recommendation for electrical cardioversion (ECV) in patients with AF with a slow ventricular response (SVR). We present two cases of sudden cardiac arrest due to sustained ventricular tachycardia/fibrillation after ECV of persistent AF with SVR. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Jino Park
- Division of Cardiology, Department of Internal Medicine, Haeundae Paik Hospital, University of Inje College of Medicine, Busan, Korea
| | - Sang-Hoon Seol
- Division of Cardiology, Department of Internal Medicine, Haeundae Paik Hospital, University of Inje College of Medicine, Busan, Korea
| | - Dong-Kie Kim
- Division of Cardiology, Department of Internal Medicine, Haeundae Paik Hospital, University of Inje College of Medicine, Busan, Korea
| | - Seunghwan Kim
- Division of Cardiology, Department of Internal Medicine, Haeundae Paik Hospital, University of Inje College of Medicine, Busan, Korea
| | - Yeo-Jeong Song
- Division of Cardiology, Department of Internal Medicine, Haeundae Paik Hospital, University of Inje College of Medicine, Busan, Korea
| | - Doo-Il Kim
- Division of Cardiology, Department of Internal Medicine, Haeundae Paik Hospital, University of Inje College of Medicine, Busan, Korea
| | - Ki-Hun Kim
- Division of Cardiology, Department of Internal Medicine, Haeundae Paik Hospital, University of Inje College of Medicine, Busan, Korea
| |
Collapse
|
2
|
Zada M, Tanous D, Thomas SP, Kumar S, Kizana E. Bradycardia-induced polymorphic ventricular tachycardia after radiofrequency catheter ablation for right atrial flutter. HeartRhythm Case Rep 2019; 5:414-418. [PMID: 31453092 PMCID: PMC6702133 DOI: 10.1016/j.hrcr.2019.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Matthew Zada
- Department of Cardiology, Westmead Hospital, Westmead, Australia
| | - David Tanous
- Department of Cardiology, Westmead Hospital, Westmead, Australia.,Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Stuart P Thomas
- Department of Cardiology, Westmead Hospital, Westmead, Australia.,Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Westmead, Australia.,Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Eddy Kizana
- Department of Cardiology, Westmead Hospital, Westmead, Australia.,Sydney Medical School, The University of Sydney, Sydney, Australia.,Centre for Heart Research, The Westmead Institute for Medical Research, Westmead, Australia
| |
Collapse
|
3
|
Mustafa U, Atkins J, Mina G, Dawson D, Vanchiere C, Duddyala N, Jones R, Reddy P, Dominic P. Outcomes of cardiac resynchronisation therapy in patients with heart failure with atrial fibrillation: a systematic review and meta-analysis of observational studies. Open Heart 2019; 6:e000937. [PMID: 31217991 PMCID: PMC6546263 DOI: 10.1136/openhrt-2018-000937] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/22/2018] [Accepted: 01/20/2019] [Indexed: 01/02/2023] Open
Abstract
Background Cardiac resynchronisation therapy (CRT) is beneficial in selected patients with heart failure (HF) in normal sinus rhythm (NSR). We sought to evaluate the impact of CRT with or without atrioventricular junction (AVJ) ablation in patients with HF with concomitant atrial fibrillation (AF). Methods and results Literature was searched (inception through 30 August 2017) for observational studies that reported outcomes in patients with HF with CRT and AF that reported all-cause and cardiovascular mortality. Thirty-one studies with 83, 571 patients were included. CRT did not decrease mortality compared with internal cardioverter defibrillator or medical therapy alone in patients with HF and AF with indications for CRT (OR: 0.851, 95% CI 0.616 to 1.176, p=0.328, I2=86.954). CRT-AF patients had significantly higher all-cause and cardiovascular mortality than CRT-NSR patients ([OR: 1.472, 95% CI 1.301 to 1.664, p=0.000] and [OR: 1.857, 95% CI 1.350 to 2.554, p=0.000] respectively). Change in left ventricular ejection fraction was not different between CRT patients with and without AF (p=0.705). AVJ ablation, however, improved all-cause mortality in CRT-AF patients when compared with CRT-AF patients without AVJ ablation (OR: 0.485, 95% CI 0.247 to 0.952, p=0.035). With AVJ ablation, there was no difference in all-cause mortality in CRT-AF patients compared with CRT-NSR patients (OR: 1.245, 95% CI 0.914 to 1.696, p=0.165). Conclusion The results of our meta-analysis suggest that AF was associated with decreased CRT benefits in patients with HF. CRT, however, benefits patients with AF with AVJ ablation.
Collapse
Affiliation(s)
- Usman Mustafa
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Heatlh Sciences Center, Shreveport, Louisiana, USA
| | - Jessica Atkins
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Heatlh Sciences Center, Shreveport, Louisiana, USA
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - George Mina
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Heatlh Sciences Center, Shreveport, Louisiana, USA
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Desiree Dawson
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Heatlh Sciences Center, Shreveport, Louisiana, USA
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Catherine Vanchiere
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Heatlh Sciences Center, Shreveport, Louisiana, USA
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Narendra Duddyala
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Heatlh Sciences Center, Shreveport, Louisiana, USA
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Ryan Jones
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Heatlh Sciences Center, Shreveport, Louisiana, USA
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Pratap Reddy
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Heatlh Sciences Center, Shreveport, Louisiana, USA
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Paari Dominic
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Heatlh Sciences Center, Shreveport, Louisiana, USA
- Department of Medicine/Division of Cardiology and Center for Cardiovascular Disease & Sciences, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| |
Collapse
|
4
|
Martínez-Sande JL, Rodríguez-Mañero M, García-Seara J, Lago R, González-Melchor L, Kreidieh B, Iacopino S, De Regibus V, De Greef Y, Bruno S, Curnis A, Sieira J, Chierchia GB, Brugada P, González-Juanatey JR, de Asmundis C. Acute and long-term outcomes of simultaneous atrioventricular node ablation and leadless pacemaker implantation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1484-1490. [PMID: 30221378 DOI: 10.1111/pace.13496] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/21/2018] [Accepted: 08/07/2018] [Indexed: 11/30/2022]
Abstract
AIMS Leadless pacemaker (LDP) allows implantation using a femoral approach. This access could be utilized for conventional atrioventricular nodal ablation (AVNA). It could facilitate unifying the two procedural components. Data regarding its feasibility and long-term outcomes remain lacking. We aim to evaluate the feasibility and long-term outcomes of sequential LDP and AVNA. METHODS Prospective, observational multicenter study including consecutive patients with indication for single-chamber pacemaker placement. In those with additional indication for AVNA, ablation was performed immediately after the LPD through the same sheath. RESULTS A total of 137 patients were included. Mean age was 77.9 ± 10.5 years; 74 (54%) were men. Immediately following LDP implantation, 27 patients (19.7%) underwent concurrent AVNA. There were six (5.5%) complications in patients referred for LDP procedures and three (11%) in those who underwent a combined approach. None of these complications were solely attributable to the added AVNA component. No mechanical dislodgement, electrical damage to any device, or electromagnetic interference ever took place. During a mean follow-up period of 123 ± 48 days, three patients (3.6%) died of noncardiovascular causes. The remaining population stayed alive without significant arrhythmias. There were no relevant differences with regard to sensing and pacing thresholds between patients in the two groups. CONCLUSIONS AVNA can safely be performed immediately following LDP. A combined approach obviates the need for additional vascular access and optimizes feasibility and comfort for patients and healthcare providers. It offers an acceptable safety and efficacy profile, both acutely and upon intermediate-term follow-up.
Collapse
Affiliation(s)
- José Luis Martínez-Sande
- Electrophysiology Unit, Hospital Clínico Universitario de Santiago de Compostela, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Moisés Rodríguez-Mañero
- Electrophysiology Unit, Hospital Clínico Universitario de Santiago de Compostela, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Javier García-Seara
- Electrophysiology Unit, Hospital Clínico Universitario de Santiago de Compostela, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Ramón Lago
- Electrophysiology Unit, Hospital Clínico Universitario de Santiago de Compostela, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Laila González-Melchor
- Electrophysiology Unit, Hospital Clínico Universitario de Santiago de Compostela, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Bahij Kreidieh
- Electrophysiology Unit, Hospital Clínico Universitario de Santiago de Compostela, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Saverio Iacopino
- Cardiac Electrophysiology Unit, Villa Maria Cecilia Hospital, GVM, Cotignola, Italy
| | - Valentina De Regibus
- Cardiac Electrophysiology Unit, Villa Maria Cecilia Hospital, GVM, Cotignola, Italy
| | - Yves De Greef
- Electrophysiology Unit, ZNA Middelheim, Antwerp, Belgium
| | | | - Antonio Curnis
- Division of Cardiology, Spedali Civili Hospital Università degli Studi di Brescia, Brescia, Italy
| | - Juan Sieira
- Heart Rhythm Management Center, Universitair Ziekenhuis Brussel, Postgraduate Program Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium
| | - Gian Battista Chierchia
- Heart Rhythm Management Center, Universitair Ziekenhuis Brussel, Postgraduate Program Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Center, Universitair Ziekenhuis Brussel, Postgraduate Program Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium
| | - José Ramón González-Juanatey
- Electrophysiology Unit, Hospital Clínico Universitario de Santiago de Compostela, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Carlo de Asmundis
- Heart Rhythm Management Center, Universitair Ziekenhuis Brussel, Postgraduate Program Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium
| |
Collapse
|
5
|
Waldmann V, Marijon E, Combes N. Holter-monitored sudden cardiac arrest after atrioventricular junction ablation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 41:422-424. [PMID: 28617967 DOI: 10.1111/pace.13140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 05/09/2017] [Accepted: 05/26/2017] [Indexed: 11/29/2022]
Abstract
We present a case of sudden cardiac arrest 7 hours after radiofrequency ablation of the atrioventricular junction for symptomatic permanent atrial fibrillation unresponsive to medical therapy. The Holter monitoring revealed a progressive increasing of QT interval after the procedure, highlighting the repolarization instability after acute changes in heart rates associated with modification of ventricular activation, leading to occurrence of short coupling interval ventricular extra beats and finally to a "torsade de pointes." This illustration underlines the need to program a relatively rapid ventricular rate first weeks after junction ablation, especially in case of rapid ventricular rate prior to the procedure, as well as the role of continuous ECG and QT interval monitoring during hospital stay.
Collapse
Affiliation(s)
- Victor Waldmann
- Cardiology Department, European Georges Pompidou Hospital, Paris, France.,Paris Descartes University, Paris, France
| | - Eloi Marijon
- Cardiology Department, European Georges Pompidou Hospital, Paris, France.,Paris Descartes University, Paris, France
| | - Nicolas Combes
- Cardiology Department, Clinique Pasteur, Toulouse, France
| |
Collapse
|
6
|
Squara F, Theodore G, Scarlatti D, Ferrari E. Ventricular fibrillation occurring after atrioventricular node ablation despite minimal difference between pre- and post-ablation heart rates. Ann Cardiol Angeiol (Paris) 2017; 66:48-51. [PMID: 28088306 DOI: 10.1016/j.ancard.2016.09.036] [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] [Received: 04/28/2016] [Accepted: 09/08/2016] [Indexed: 11/16/2022]
Abstract
We report the case of an 82-year-old man presenting with ventricular fibrillation (VF) occurring acutely after atrioventricular node (AVN) ablation. This patient had severe valvular cardiomyopathy, chronic atrial fibrillation (AF), and underwent prior to the AVN ablation a biventricular implantable cardiac defibrillator positioning. The VF was successfully cardioverted with one external electrical shock. What makes this presentation original is that the pre-ablation spontaneous heart rate in AF was slow (84 bpm), and that VF occurred after ablation despite a minimal heart rate drop of only 14 bpm. VF is the most feared complication of AVN ablation, but it had previously only been described in case of acute heart rate drop after ablation of at least 30 bpm (and more frequently>50 bpm). This case report highlights the fact that VF may occur after AVN ablation regardless of the heart rate drop, rendering temporary fast ventricular pacing mandatory whatever the pre-ablation heart rate.
Collapse
Affiliation(s)
- F Squara
- Cardiology department, Pasteur university hospital, Nice, France.
| | - G Theodore
- Cardiology department, Pasteur university hospital, Nice, France
| | - D Scarlatti
- Cardiology department, Pasteur university hospital, Nice, France
| | - E Ferrari
- Cardiology department, Pasteur university hospital, Nice, France
| |
Collapse
|
7
|
Sriwattanakomen R, Mukamal KJ, Shvilkin A. A novel algorithm to predict the QT interval during intrinsic atrioventricular conduction from an electrocardiogram obtained during ventricular pacing. Heart Rhythm 2016; 13:2076-82. [DOI: 10.1016/j.hrthm.2016.06.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Indexed: 01/08/2023]
|
8
|
Wilkoff BL, Fauchier L, Stiles MK, Morillo CA, Al-Khatib SM, Almendral J, Aguinaga L, Berger RD, Cuesta A, Daubert JP, Dubner S, Ellenbogen KA, Estes NAM, Fenelon G, Garcia FC, Gasparini M, Haines DE, Healey JS, Hurtwitz JL, Keegan R, Kolb C, Kuck KH, Marinskis G, Martinelli M, McGuire M, Molina LG, Okumura K, Proclemer A, Russo AM, Singh JP, Swerdlow CD, Teo WS, Uribe W, Viskin S, Wang CC, Zhang S. 2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing. J Arrhythm 2016; 32:1-28. [PMID: 26949427 PMCID: PMC4759125 DOI: 10.1016/j.joa.2015.12.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Key Words
- AF, atrial fibrillation
- ATP, antitachycardia pacing
- Bradycardia mode and rate
- CI, confidence interval
- CL, cycle length
- CRT, cardiac resynchronization therapy
- CRT-D, cardiac resynchronization therapy–defibrillator
- DT, defibrillation testing
- Defibrillation testing
- EEG, electroencephalography
- EGM, electrogram
- HF, heart failure
- HR, hazard ratio
- ICD, implantable cardioverter-defibrillator
- Implantable cardioverter-defibrillator
- LV, left ventricle
- LVEF, left ventricular ejection fraction
- MI, myocardial infarction
- MVP, managed ventricular pacing
- NCDR, National Cardiovascular Data Registry
- NYHA, New York Heart Association
- OR, odds ratio
- PEA, peak endocardial acceleration
- PVC, premature ventricular contraction
- Programming
- RCT, randomized clinical trial
- RV, right ventricle
- S-ICD, subcutaneous implantable cardioverter-defibrillator
- SCD, sudden cardiac death
- SVT, supraventricular tachycardia
- TIA, transient ischemic attack
- Tachycardia detection
- Tachycardia therapy
- VF, ventricular fibrillation
- VT, ventricular tachycardia (Heart Rhythm 2015;0:1–37)
- aCRT, adaptive cardiac resynchronization therapy
Collapse
Affiliation(s)
| | | | | | - Carlos A Morillo
- Department of Medicine, Cardiology Division, McMaster University-Population Health Research Institute, Hamilton, Canada
| | | | - Jesœs Almendral
- Grupo HM Hospitales, Universidad CEU San Pablo, Madrid, Spain
| | | | | | - Alejandro Cuesta
- Servicio de Arritmias, Instituto de Cardiologia Infantil, Montevideo, Uruguay
| | | | - Sergio Dubner
- Clinica y Maternidad Suizo Argentina; De Los Arcos Sanatorio, Buenos Aires, Argentina
| | | | | | | | - Fermin C Garcia
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - David E Haines
- William Beaumont Hospital Division of Cardiology, Royal Oak, Michigan
| | - Jeff S Healey
- Department of Medicine, Cardiology Division, McMaster University-Population Health Research Institute, Hamilton, Canada
| | | | | | | | | | | | | | | | - Luis G Molina
- Mexico's National University, Mexico's General Hospital, Mexico City, Mexico
| | - Ken Okumura
- Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Alessandro Proclemer
- Azienda Ospedaliero Universitaria S. Maria della Misericordia- Udine, Udine, Italy
| | | | - Jagmeet P Singh
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Wee Siong Teo
- National Heart Centre Singapore, Singapore, Singapore
| | - William Uribe
- CES Cardiología and Centros Especializados San Vicente Fundación, Medellín y Rionegro, Colombia
| | - Sami Viskin
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Shu Zhang
- National Center for Cardiovascular Disease and Beijing Fu Wai Hospital, Peking Union Medical College and China Academy of Medical Sciences, Beijing, China
| |
Collapse
|
9
|
2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing. Heart Rhythm 2015; 13:e50-86. [PMID: 26607062 DOI: 10.1016/j.hrthm.2015.11.018] [Citation(s) in RCA: 179] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Indexed: 12/12/2022]
|
10
|
Wilkoff BL, Fauchier L, Stiles MK, Morillo CA, Al-Khatib SM, Almendral J, Aguinaga L, Berger RD, Cuesta A, Daubert JP, Dubner S, Ellenbogen KA, Estes NAM, Fenelon G, Garcia FC, Gasparini M, Haines DE, Healey JS, Hurtwitz JL, Keegan R, Kolb C, Kuck KH, Marinskis G, Martinelli M, Mcguire M, Molina LG, Okumura K, Proclemer A, Russo AM, Singh JP, Swerdlow CD, Teo WS, Uribe W, Viskin S, Wang CC, Zhang S. 2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing. Europace 2015; 18:159-83. [PMID: 26585598 DOI: 10.1093/europace/euv411] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
|
11
|
Shurrab M, Singarajah T, Wijeysundera HC, Haj-Yahia S, Newman D, Crystal E, Lashevsky I. Is lower base rate detrimental to transcatheter aortic valve implantation patients requiring pacemakers? Expert Rev Med Devices 2015; 12:675-8. [PMID: 26414946 DOI: 10.1586/17434440.2015.1093414] [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: 11/08/2022]
Abstract
Sudden cardiac death related to polymorphic ventricular tachycardia/ventricular fibrillation has been well reported post atrioventricular junction ablation. The practice of faster pacing rate immediately after atrioventricular junction ablation is well recognized to decrease the risk of sudden cardiac death. We propose that this practice (faster pacing rate) be implemented in patients who need permanent pacemakers secondary to transcatheter aortic valve implantation (or even surgical aortic valve interventions).
Collapse
Affiliation(s)
- Mohammed Shurrab
- a 1 Arrhythmia Services, Cardiology Department, An-Najah National University Hospital, Faculty of Medicine and Health Sciences, An-Najah National University , Nablus, Palestine.,b 2 Arrhythmia Services, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto , Toronto, Ontario, Canada
| | - Theepana Singarajah
- b 2 Arrhythmia Services, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto , Toronto, Ontario, Canada
| | - Harindra C Wijeysundera
- c 3 Sunnybrook Research Institute and Institute for Clinical Evaluative Sciences, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto , Toronto, Ontario, Canada
| | - Saleem Haj-Yahia
- a 1 Arrhythmia Services, Cardiology Department, An-Najah National University Hospital, Faculty of Medicine and Health Sciences, An-Najah National University , Nablus, Palestine.,d 4 Institute of Cardiovascular and Medical Sciences, The University of Glasgow , Scotland, UK
| | - David Newman
- b 2 Arrhythmia Services, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto , Toronto, Ontario, Canada
| | - Eugene Crystal
- b 2 Arrhythmia Services, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto , Toronto, Ontario, Canada
| | - Ilan Lashevsky
- b 2 Arrhythmia Services, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto , Toronto, Ontario, Canada
| |
Collapse
|
12
|
Akerström F, Mañero MR, Pachón M, Puchol A, López XAF, Sande LM, Valderrábano M, Arias MA. Atrioventricular Junction Ablation In Atrial Fibrillation: Choosing The Right Patient And Pacing Device. J Atr Fibrillation 2015; 8:1253. [PMID: 27957188 DOI: 10.4022/jafib.1253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 07/14/2015] [Accepted: 07/19/2015] [Indexed: 11/10/2022]
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia and despite advancements in rhythm control through direct catheter ablation, maintaining sinus rhythm is not possible in a large proportion of AF patients, who therefore are subject to a rate control strategy only. Nonetheless, in some of these patients pharmacological rate control may be ineffective, often leaving the patient highly symptomatic and at risk of developing tachycardia-induced cardiomyopathy and heart failure (HF). Catheter ablation of the atrioventricular junction (AVJ) with subsequent permanent pacemaker implantation provides definite rate control and represents an attractive therapeutic option when pharmacological rate control is not achieved. In patients with reduced ventricular function, cardiac resynchronization therapy (CRT) should be considered over right ventricular apical (RVA) pacing in order to avoid the deleterious effects associated with a high amount of chronic RVA pacing. Another group of patients that may also benefit from AVJ ablation are HF patients with concomitant AF receiving CRT. In this patient cohort AVJ ablation ensures near 100% biventricular pacing, thus allowing optimization of the therapeutic effects of CRT.
Collapse
Affiliation(s)
- Finn Akerström
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain
| | - Moisés Rodríguez Mañero
- Cardiac Electrophysiology, Department of Cardiology. Methodist DeBakey Heart and Vascular Center and Methodist Hospital Research Institute, The Methodist Hospital, Houston, Texas
| | - Marta Pachón
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain
| | - Alberto Puchol
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain
| | - Xesús Alberte Fernández López
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Universitario Santiago de Compostela, Spain
| | - Luis Martínez Sande
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Universitario Santiago de Compostela, Spain
| | - Miguel Valderrábano
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain
| | - Miguel A Arias
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain
| |
Collapse
|
13
|
Chain ASY, Dieleman JP, van Noord C, Hofman A, Stricker BHC, Danhof M, Sturkenboom MCJM, Della Pasqua O. Not-in-trial simulation I: Bridging cardiovascular risk from clinical trials to real-life conditions. Br J Clin Pharmacol 2014; 76:964-72. [PMID: 23617533 DOI: 10.1111/bcp.12151] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Accepted: 04/04/2013] [Indexed: 01/08/2023] Open
Abstract
AIMS The assessment of heart rate-corrected QT (QTc) interval prolongation relies on the evidence of drug effects in healthy subjects. This study demonstrates the relevance of pharmacokinetic-pharmacodynamic (PKPD) relationships to characterize drug-induced QTc interval prolongation and explore the discrepancies between clinical trials and real-life conditions. METHODS d,l-Sotalol data from healthy subjects and from the Rotterdam Study cohort were used to assess treatment response in a phase I setting and in a real-life conditions, respectively. Using modelling and simulation, drug effects at therapeutic doses were predicted in both populations. RESULTS Inclusion criteria were shown to restrict the representativeness of the trial population in comparison to real-life conditions. A significant part of the typical patient population was excluded from trials due to weight and baseline QTc interval criteria. Relative risk was significantly different between sotalol users with and without heart failure, hypertension, diabetes and myocardial infarction (P < 0.01). Although drug effects do cause an increase in the relative risk of QTc interval prolongation, the presence of diabetes represented an increase from 4.0 [95% confidence interval (CI) 2.7-5.8] to 6.5 (95% CI 1.6-27.1), whilst for myocardial infarction it increased from 3.4 (95% CI 2.3-5.13) to 15.5 (95% CI 4.9-49.3). CONCLUSIONS Our findings show that drug effects on QTc interval do not explain the observed QTc values in the population. The prevalence of high QTc values in the real-life population can be assigned to co-morbidities and concomitant medications. These findings substantiate the need to account for these factors when evaluating the cardiovascular risk of medicinal products.
Collapse
Affiliation(s)
- Anne S Y Chain
- Leiden/Amsterdam Center for Drug Research, Division of Pharmacology, Leiden University, 2300 RA, Leiden, The Netherlands; Department of Medical Informatics, Erasmus Medical Centre, 3015 GE, Rotterdam, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Bergfeldt L. Confirmative studies essential part of science--as is doing the homework properly. Heart Rhythm 2013; 10:e75. [PMID: 23851062 DOI: 10.1016/j.hrthm.2013.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Indexed: 10/26/2022]
|
15
|
Shen WK, Wang RX. Confirmative studies essential part of science--as is doing the homework properly. Heart Rhythm 2013; 10:e75-6. [PMID: 23851065 DOI: 10.1016/j.hrthm.2013.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Indexed: 10/26/2022]
|
16
|
Kim JJ, Němec J, Papp R, Strongin R, Abramson JJ, Salama G. Bradycardia alters Ca(2+) dynamics enhancing dispersion of repolarization and arrhythmia risk. Am J Physiol Heart Circ Physiol 2013; 304:H848-60. [PMID: 23316064 DOI: 10.1152/ajpheart.00787.2012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Bradycardia prolongs action potential (AP) durations (APD adaptation), enhances dispersion of repolarization (DOR), and promotes tachyarrhythmias. Yet, the mechanisms responsible for enhanced DOR and tachyarrhythmias remain largely unexplored. Ca(2+) transients and APs were measured optically from Langendorff rabbit hearts at high (150 × 150 μm(2)) or low (1.5 × 1.5 cm(2)) magnification while pacing at a physiological (120 beats/min) or a slow heart rate (SHR = 50 beats/min). Western blots and pharmacological interventions were used to elucidate the regional effects of bradycardia. As a result, bradycardia (SHR 50 beats/min) increased APDs gradually (time constant τf→s = 48 ± 9.2 s) and caused a secondary Ca(2+) release (SCR) from the sarcoplasmic reticulum during AP plateaus, occurring at the base on average of 184.4 ± 9.7 ms after the Ca(2+) transient upstroke. In subcellular imaging, SCRs were temporally synchronous and spatially homogeneous within myocytes. In diastole, SHR elicited variable asynchronous sarcoplasmic reticulum Ca(2+) release events leading to subcellular Ca(2+) waves, detectable only at high magnification. SCR was regionally heterogeneous, correlated with APD prolongation (P < 0.01, n = 5), enhanced DOR (r = 0.9277 ± 0.03, n = 7), and was gradually reversed by pacing at 120 beats/min along with APD shortening (P < 0.05, n = 5). A stabilizer of leaky ryanodine receptors (RyR2), 3-(4-benzylcyclohexyl)-1-(7-methoxy-2,3-dihydrobenzo[f][1,4]thiazepin-4(5H)-yl)propan-1-one (K201; 1 μM), suppressed SCR and reduced APD at the base, thereby reducing DOR (P < 0.02, n = 5). Ventricular ectopy induced by bradycardia (n = 5/15) was suppressed by K201. Western blot analysis revealed spatial differences of voltage-gated L-type Ca(2+) channel protein (Cav1.2α), Na(+)-Ca(2+) exchange (NCX1), voltage-gated Na(+) channel (Nav1.5), and rabbit ether-a-go-go-related (rERG) protein [but not RyR2 or sarcoplasmic reticulum Ca(2+) ATPase 2a] that correlate with the SCR distribution and explain the molecular basis for SCR heterogeneities. In conclusion, acute bradycardia elicits synchronized subcellular SCRs of sufficient magnitude to overcome the source-sink mismatch and to promote afterdepolarizations.
Collapse
Affiliation(s)
- Jong J Kim
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | | | | | | | | | | |
Collapse
|
17
|
Hoffmayer KS, Scheinman M. Current role of atrioventricular junction (AVJ) ablation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 36:257-65. [PMID: 23078186 DOI: 10.1111/pace.12022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 07/29/2012] [Accepted: 08/27/2012] [Indexed: 11/28/2022]
Abstract
Atrioventricular junction ablation with permanent pacemaker insertion is a highly effective treatment approach in patients with atrial fibrillation that is resistant to other treatment modalities, especially in the elderly or those with severe comorbidities. This effect likely reflects reversal of rapid ventricular rates and regularizing ventricular rates. There is increasing evidence that cardiac resynchronization therapy devices may be beneficial in selected populations after atrioventricular node ablation. The limitations of this approach include continued need for anticoagulation and lifelong pacemaker therapy.
Collapse
Affiliation(s)
- Kurt S Hoffmayer
- Division of Cardiac Electrophysiology, San Francisco, California, USA
| | | |
Collapse
|
18
|
Chatterjee NA, Upadhyay GA, Ellenbogen KA, McAlister FA, Choudhry NK, Singh JP. Atrioventricular Nodal Ablation in Atrial Fibrillation. Circ Arrhythm Electrophysiol 2012; 5:68-76. [DOI: 10.1161/circep.111.967810] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Neal A. Chatterjee
- From the Department of Medicine and the Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA (N.A.C., G.A.U., J.P.S.); the Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA (K.A.E.); the Division of Internal Medicine, University of Alberta Hospital, Edmonton, Canada (F.A.M.); and the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (N.K.C.)
| | - Gaurav A. Upadhyay
- From the Department of Medicine and the Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA (N.A.C., G.A.U., J.P.S.); the Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA (K.A.E.); the Division of Internal Medicine, University of Alberta Hospital, Edmonton, Canada (F.A.M.); and the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (N.K.C.)
| | - Kenneth A. Ellenbogen
- From the Department of Medicine and the Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA (N.A.C., G.A.U., J.P.S.); the Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA (K.A.E.); the Division of Internal Medicine, University of Alberta Hospital, Edmonton, Canada (F.A.M.); and the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (N.K.C.)
| | - Finlay A. McAlister
- From the Department of Medicine and the Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA (N.A.C., G.A.U., J.P.S.); the Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA (K.A.E.); the Division of Internal Medicine, University of Alberta Hospital, Edmonton, Canada (F.A.M.); and the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (N.K.C.)
| | - Niteesh K. Choudhry
- From the Department of Medicine and the Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA (N.A.C., G.A.U., J.P.S.); the Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA (K.A.E.); the Division of Internal Medicine, University of Alberta Hospital, Edmonton, Canada (F.A.M.); and the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (N.K.C.)
| | - Jagmeet P. Singh
- From the Department of Medicine and the Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA (N.A.C., G.A.U., J.P.S.); the Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA (K.A.E.); the Division of Internal Medicine, University of Alberta Hospital, Edmonton, Canada (F.A.M.); and the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (N.K.C.)
| |
Collapse
|
19
|
Vahedi F, Haney MF, Jensen SM, Näslund U, Bergfeldt L. Effect of heart rate on ventricular repolarization in healthy individuals applying vectorcardiographic T vector and T vector loop analysis. Ann Noninvasive Electrocardiol 2011; 16:287-94. [PMID: 21762257 DOI: 10.1111/j.1542-474x.2011.00444.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Ventricular repolarization (VR) is strongly influenced by heart rate (HR) and autonomic nervous activity, both of which also are important for arrhythmogenesis. Their relative influence on VR is difficult to separate, but might be crucial for understanding while some but not other individuals are at risk for life-threatening arrhythmias at a certain HR. This study was therefore designed to assess the "pure" effect of HR increase by atrial pacing on the ventricular gradient (VG) and other vectorcardiographically (VCG) derived VR parameters during an otherwise unchanged condition. METHODS In 19 patients with structurally normal hearts, a protocol with stepwise increased atrial pacing was performed after successful arrhythmia ablation. Conduction intervals were measured on averaged three-dimensional (3D) QRST complexes. In addition, various VCG parameters were measured from the QRS and T vectors as well as from the T loop. All measurements were performed after at least 3 minutes of rate adaptation of VR. RESULTS VR changes at HR from 80 to 120 bpm were assessed. The QRS and QT intervals, VG, QRSarea, Tarea, and Tamplitude were markedly rate dependent. In contrast, the Tp-e/QT ratio was rate independent as well as the T-loop morphology parameters Tavplan and Teigenvalue describing the bulginess and circularity of the loop. CONCLUSIONS In healthy individuals, the response to increased HR within the specified range suggests a decreased heterogeneity of depolarization instants, action potential morphology, and consequently of the global VR.
Collapse
Affiliation(s)
- Farzad Vahedi
- Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | | | | | | |
Collapse
|
20
|
Wecke L, van Deursen CJ, Bergfeldt L, Prinzen FW. Repolarization changes in patients with heart failure receiving cardiac resynchronization therapy—signs of cardiac memory. J Electrocardiol 2011; 44:590-8. [DOI: 10.1016/j.jelectrocard.2011.06.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Indexed: 11/28/2022]
|
21
|
Braunschweig F, Pfizenmayer H, Rubulis A, Schoels W, Linde C, Bergfeldt L. Transient repolarization instability following the initiation of cardiac resynchronization therapy. Europace 2011; 13:1327-34. [DOI: 10.1093/europace/eur103] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
|
22
|
Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Kay GN, Le Huezey JY, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann LS. 2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation. Circulation 2011; 123:e269-367. [PMID: 21382897 DOI: 10.1161/cir.0b013e318214876d] [Citation(s) in RCA: 595] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
23
|
Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Kay GN, Le Huezey JY, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann LS. 2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation. J Am Coll Cardiol 2011; 57:e101-98. [PMID: 21392637 DOI: 10.1016/j.jacc.2010.09.013] [Citation(s) in RCA: 642] [Impact Index Per Article: 49.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
24
|
Mantziari AA, Vassilikos VP, Chatzizisis YS, Dakos G, Stavropoulos G, Paraskevaidis S, Styliadis IH. Cardiac Arrest Caused by Torsades de Pointes Tachycardia after Successful Atrial Flutter Radiofrequency Catheter Ablation. Open Cardiovasc Med J 2011; 5:1-3. [PMID: 21660252 PMCID: PMC3109644 DOI: 10.2174/1874192401105010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Revised: 11/17/2010] [Accepted: 11/20/2010] [Indexed: 11/22/2022] Open
Abstract
A 66-year-old woman underwent successful radiofrequency catheter ablation for long-lasting, drug refractory fast atrial flutter. Two days later she had a cardiac arrest due to torsades de pointes (TdP) tachycardia attributed to relative sinus bradycardia and QT interval prolongation. After successful resuscitation further episodes of TdP occurred, which were treated with temporary pacing. Because of concomitant systolic dysfunction due to ischemic and valvular heart disease she was finally treated with an implantable defibrillator. In conclusion we strongly advise prolonged monitoring for 2 or more days for patients with structural heart disease following successful catheter ablation for long lasting tachyarrhythmias.
Collapse
|
25
|
Abstract
Atrial fibrillation (AF) and heart failure (HF) are common and interrelated conditions, each promoting the other, and both associated with increased mortality. HF leads to structural and electrical atrial remodeling, thus creating the basis for the development and perpetuation of AF; and AF may lead to hemodynamic deterioration and the development of tachycardia-mediated cardiomyopathy. Stroke prevention by antithrombotic therapy is crucial in patients with AF and HF. Of the 2 principal therapeutic strategies to treat AF, rate control and rhythm control, neither has been shown to be superior to the other in terms of survival, despite better survival in patients with sinus rhythm compared with those in AF. Antiarrhythmic drug toxicity and poor efficacy are concerns. Catheter ablation of AF can establish sinus rhythm without the risks of antiarrhythmic drug therapy, but has important procedural risks, and data from randomized trials showing a survival benefit of this treatment strategy are still lacking. In intractable cases, ablation of the atrioventricular junction and placement of a permanent pacemaker is a treatment alternative; and biventricular pacing may prevent or reduce the negative consequences of chronic right ventricular pacing.
Collapse
|
26
|
McLeod CJ, Gersh BJ. A practical approach to the management of patients with atrial fibrillation. HEART ASIA 2010; 2:95-103. [PMID: 27325953 DOI: 10.1136/ha.2009.000596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 10/20/2009] [Indexed: 11/03/2022]
Abstract
Atrial fibrillation is the most commonly encountered clinical arrhythmia and continues to grow in incidence. Current management involves highly individualised therapies based on underlying concomitant disease processes and symptoms. Moreover, there are numerous therapeutic permutations involving anticoagulation, rate-limitation and antiarrhythmic strategies. This review serves to update the clinician with a practical approach to each patient population and on current advances in management.
Collapse
Affiliation(s)
| | - Bernard J Gersh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
27
|
Stevenson WG, Tedrow UB, Seiler J. Atrial Fibrillation and Heart Failure. J Atr Fibrillation 2008; 1:101. [PMID: 28496583 DOI: 10.4022/jafib.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 07/11/2008] [Accepted: 07/14/2008] [Indexed: 02/02/2023]
Abstract
Atrial fibrillation is common in heart failure patients and is associated with increased mortality. Pharmacologic trials have not shown any survival benefit for a rhythm control over a rate control strategy. It has been suggested that sinus rhythm is associated with a survival benefit, but that the risks of anti-arrhythmic drug treatment and poor efficacy offset the beneficial effect. Catheter ablation for atrial fibrillation can establish sinus rhythm without the risks of anti-arrhythmic drug therapy. Data from randomized trials demonstrating a survival benefit for patients undergoing an ablation procedure for atrial fibrillation are still lacking. Ablation of the AV junction and permanent pacing remain a treatment alternative in otherwise refractory cases. Placement of a biventricular system may prevent or reduce negative consequences of chronic right ventricular pacing. Current objectives and options for treatment of atrial fibrillation in heart failure patients are reviewed.
Collapse
Affiliation(s)
- William G Stevenson
- The Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital,Harvard Medical School, Boston, Massachusetts
| | - Usha B Tedrow
- The Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital,Harvard Medical School, Boston, Massachusetts
| | - Jens Seiler
- The Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital,Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
28
|
Betts TR. Atrioventricular junction ablation and pacemaker implant for atrial fibrillation: still a valid treatment in appropriately selected patients. Europace 2008; 10:425-32. [DOI: 10.1093/europace/eun063] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
29
|
Darbar D, Kimbrough J, Jawaid A, McCray R, Ritchie MD, Roden DM. Persistent atrial fibrillation is associated with reduced risk of torsades de pointes in patients with drug-induced long QT syndrome. J Am Coll Cardiol 2008; 51:836-42. [PMID: 18294569 DOI: 10.1016/j.jacc.2007.09.066] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Revised: 09/14/2007] [Accepted: 09/19/2007] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The goal of this study was to identify markers of torsades de pointes (TdP) in patients with drug-associated long QT syndrome (LQTS). BACKGROUND Drug-induced LQTS includes individuals developing marked prolongation of ventricular repolarization on exposure to an offending drug. Under these conditions, TdP develops in some but not all patients. METHODS This was a case-control study of 123 adults with drug-associated LQTS. Patients were divided into LQTS only (LQTS; n = 40, QT >500 ms on drug) and LQTS + TdP (TdP; n = 83). RESULTS Baseline QT intervals were similar in the 2 groups (381 +/- 38 ms [LQTS] vs. 388 +/- 43 ms [TdP]). Clinical variables associated with risk of TdP included hypokalemia and female gender; by contrast, persistent atrial fibrillation (AF) at the time of drug discontinuation for QT prolongation was protective despite similar heart rates in AF and sinus rhythm (n = 20, 71 +/- 13 beats/min vs. 69 +/- 13 beats/min). Electrocardiographic variables that significantly increased the risk for TdP included absolute and rate-corrected QT intervals (QTc) on drug therapy, the magnitude of QT and QTc interval prolongation, and the change in T(peak) to T(end) (DeltaT(p)-T(e)), a relatively new index of transmural dispersion of repolarization and potential arrhythmogenicity. Multivariable logistic regression analysis revealed that only gender was predictive for TdP, whereas persistent AF at the time of drug discontinuation for QT prolongation (odds ratio 0.14, 95% confidence interval 0.03 to 0.63, p = 0.01) was negatively associated with the arrhythmia. CONCLUSIONS This study strongly suggests that despite ongoing rate irregularity, AF reduces the likelihood of developing TdP after the administration of drugs that prolong cardiac repolarization.
Collapse
Affiliation(s)
- Dawood Darbar
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee 37323-6602, USA.
| | | | | | | | | | | |
Collapse
|
30
|
Right ventricular pacing-induced electrophysiological remodeling in the human heart and its relationship to cardiac memory. Heart Rhythm 2007; 4:1477-86. [PMID: 17997360 DOI: 10.1016/j.hrthm.2007.08.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2007] [Accepted: 08/01/2007] [Indexed: 11/20/2022]
Abstract
BACKGROUND Right ventricular apical (RVA) pacing induces electrophysiological and structural remodeling. Cardiac memory (CM) evolves during the course of pacing and is readily apparent on electrocardiography (ECG) or vectorcardiography (VCG) when normal ventricular activation resumes. OBJECTIVE This study sought to assess ventricular repolarization (VR) changes during pacing and intermittent normal ventricular conduction by ECG and VCG and to determine the temporal and conformational evolution of CM. METHODS Twenty sick sinus patients received a dual-chamber rate-adaptive (DDD-R) pacemaker and were paced from the RVA endocardium. The pacemakers were programmed to a short AV delay to maximize ventricular preexcitation. The ECG and VCG were recorded before and 1 day after implantation, and then daily for the first week (n=6) or weekly for 5 to 8 weeks (n=14), with the pacemakers temporarily programmed to AAI (normal ventricular activation). RESULTS The first parameters to change were T-vector amplitude, T(area), and T(peak)-T(end) (T(p-e)), which decreased within 1 day after initiating pacing. CM became apparent between day 1 and day 3, was fully established after 1 week, and then remained stable. Signs of increased VR heterogeneity were observed as the T loop became more circular (decreased T(egenv)) and distorted (increased T(avplan)), which have previously been observed in conditions with increased risk for arrhythmias. Over weeks, VR duration was prolonged (increased QTc). In contrast, during ventricular pacing, a gradual shortening of the repolarization time was observed, suggesting a stabilizing adaptive process. CONCLUSION In sick sinus syndrome patients in whom ventricular pacing is indicated, switching between normal AV conduction and ventricular pacing should be minimized to avoid periods of repolarization instability.
Collapse
|
31
|
Darbar D, Hardin B, Harris P, Roden DM. A rate-independent method of assessing QT-RR slope following conversion of atrial fibrillation. J Cardiovasc Electrophysiol 2007; 18:636-41. [PMID: 17488270 DOI: 10.1111/j.1540-8167.2007.00817.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Following conversion of atrial fibrillation (AF), QT interval transiently and variably prolongs and can trigger torsades de pointes (TdP). However, quantitative analysis of risk in this setting is difficult because cycle length variability during AF makes rate-corrected QT impossible to calculate. In this study, a newly developed method to study heart rate dependence of the QT interval during AF was applied to assess the QT-RR relationships prior to and following cardioversion in patients with AF. METHODS AND RESULTS Cardiac rhythm was digitized for > or = 30 minutes prior to and following elective cardioversion to sinus rhythm (SR) in 12 patients. Each QT interval was placed in a "bin" (50 ms), according to the preceding RR interval. All QT intervals within a bin were averaged and RR bin-specific QT values were derived. The slope of the QT-RR relationship was much flatter in AF (0.058 +/- 0.02) compared with that predicted by conventionally used QT rate corrections (0.130 [Bazett], 0.096 [Fridericia]) and much steeper after cardioversion (0.238 +/- 0.14, P < 0.01 compared with AF). The method also allowed us to establish that QT at any given RR interval prolonged when SR was restored (e.g., at RR interval 800 ms: QT = 0.38 +/- 0.03 second [AF] vs 0.46 +/- 0.05 second [SR], P < 0.01). The longest QT values were in patients receiving sotalol or quinidine. CONCLUSIONS The results of this study demonstrate that QT interval can be reliably measured in AF using a method that is independent of heart rate. We also showed that cardioversion of AF acutely increases the QT interval and the steepness of the QT-RR slope.
Collapse
Affiliation(s)
- Dawood Darbar
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tenneessee 37323-6602, USA.
| | | | | | | |
Collapse
|
32
|
Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Le Heuzey JY, Kay GN, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann S, Smith SC, Jacobs AK, Adams CD, Anderson JL, Antman EM, Halperin JL, Hunt SA, Nishimura R, Ornato JP, Page RL, Riegel B, Priori SG, Blanc JJ, Budaj A, Camm AJ, Dean V, Deckers JW, Despres C, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo JL, Zamorano JL. ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 2006; 114:e257-354. [PMID: 16908781 DOI: 10.1161/circulationaha.106.177292] [Citation(s) in RCA: 1381] [Impact Index Per Article: 76.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
33
|
|
34
|
Nowinski K, Wecke L, Gadler F, Linde C, Bergfeldt L. Pacing-induced electrophysiological remodeling in hypertrophic obstructive cardiomyopathy--observations on cardiac memory. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2006; 28:561-7. [PMID: 15955190 DOI: 10.1111/j.1540-8159.2005.09469.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hypertrophic cardiomyopathy carries an increased risk for sudden cardiac death. While pacing therapy reduces the left ventricular outflow tract gradient and improves symptoms in a subgroup of hypertrophic obstructive cardiomyopathy (HOCM) patients, its electrophysiological consequences are unknown and were therefore assessed in this prospective study. METHODS AND RESULTS Fifteen consecutive HOCM patients were studied and compared with 14 patients without HOCM paced because of sinus bradycardia. ECG intervals were measured before pacemaker implantation and after > or =3 months of DDD pacing in HOCM patients and > or =5 weeks in controls. Both groups showed similar ECG signs of cardiac memory development. In HOCM patients, with baseline QTc 447 +/- 33 ms, cardiac memory development was not associated with any significant changes in ECG intervals. In contrast, baseline repolarization in control patients was significantly prolonged by 6% (QTc 429 +/- 33 vs 454 +/- 46 ms; P < 0.05). Furthermore, in HOCM patients repolarization was 7% shorter during DDD pacing compared to sinus rhythm (JTc 329 +/- 25 vs 353 +/- 21 ms; P < 0.05), despite a significantly prolonged ventricular activation time (QRS duration 155 +/- 16 vs 91 +/- 9 ms; P < 0.01). CONCLUSIONS Importantly, the development of cardiac memory-induced different repolarization responses depending on baseline structure and electrophysiology. In HOCM patients repolarization was shorter during right ventricular apical pacing than during normal activation despite prolonged activation time.
Collapse
Affiliation(s)
- Karolina Nowinski
- Department of Cardiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | | |
Collapse
|
35
|
Affiliation(s)
- Dan M Roden
- Division of Clinical Pharmacology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
| |
Collapse
|