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Vidal Margenat A, Zedan A, Schubert S, Gopani S, Hariharan R. Patients with a high defibrillation threshold: Approaches to management. Pacing Clin Electrophysiol 2024; 47:222-232. [PMID: 38291870 DOI: 10.1111/pace.14936] [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: 10/06/2023] [Revised: 12/30/2023] [Accepted: 01/11/2024] [Indexed: 02/01/2024]
Abstract
Implantable cardioverter-defibrillators (ICDs) have revolutionized the prognosis for patients at elevated risk of ventricular tachyarrhythmias. For safety, defibrillation should be effective with a minimum of 10 J below the device's maximum energy. While modern ICDs rarely deliver ineffective shocks in primary prevention, the surge in managing severe heart failure patients has led to an increased number of patients with high defibrillation thresholds (DFTs). This article elucidates the potential causes of high DFT, including clinical factors, lead and device placement, the presence of a Left Ventricular Assist Device (LVAD), prolonged ventricular arrhythmias, shock vectors, waveform tilt, medications, and manufacturer-specific options. We also detail management strategies, highlighting alternative shock coil placements, practical recommendations, and case studies from our institution. Our management algorithm suggests addressing preventable causes, re-evaluating coil positions, considering non-invasive system modifications, upgrading to a higher-capacity device, and adding extra coil(s).
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Affiliation(s)
| | - Ahmed Zedan
- EP Heart, University of Texas, Houston, Texas, USA
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Younis A, Aktas MK, Rosero S, Kutyifa V, Polonsky B, McNitt S, Sotoodehnia N, Kudenchuk P, Rea TD, Arking DE, Goldenberg I, Zareba W. Outcome by Sex in Patients With Long QT Syndrome With an Implantable Cardioverter Defibrillator. J Am Heart Assoc 2020; 9:e016398. [PMID: 33021160 PMCID: PMC7792399 DOI: 10.1161/jaha.120.016398] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Sex differences in outcome have been reported in patients with congenital long QT syndrome. We aimed to report on the incidence of time‐dependent life‐threatening events in male and female patients with long QT syndrome with an implantable cardioverter defibrillator (ICD). Methods and Results A total of 60 patients with long QT syndrome received an ICD for primary or secondary prevention indications. Life‐threatening events were evaluated from the date of ICD implant and included ICD shocks for ventricular tachycardia, ventricular fibrillation, or death. ICDs were implanted in 219 women (mean age 38±13 years), 46 girls (12±5 years), 55 men (43±17 years), and 40 boys (11±4 years). Mean follow‐up post‐ICD implantation was 14±6 years for females and 12±6 years for males. At 15 years of follow‐up, the cumulative probability of life‐threatening events was 27% in females and 34% in males (log‐rank P=0.26 for the overall difference). In the multivariable Cox model, sex was not associated with significant differences in risk first appropriate ICD shock (hazard ratio, 0.83 female versus male; 95% CI, 0.52–1.34; P=0.47). Results were similar when stratified by age and by genotype: long QT syndrome type 1 (LQT1), long QT syndrome type 2 (LQT2), and long QT syndrome type 3 (LQT3). Incidence of inappropriate ICD shocks was higher in males versus females (4.2 versus 2.7 episodes per 100 patient‐years; P=0.018), predominantly attributed to atrial fibrillation. The first shock did not terminate ventricular tachycardia/ventricular fibrillation in 48% of females and 62% of males (P=0.25). Conclusions In patients with long QT syndrome with an ICD, the risk and rate of life‐threatening events did not significantly differ between males and females regardless of ICD indications or genotype. In a substantial proportion of patients with long QT syndrome, first shock did not terminate ventricular tachycardia/ventricular fibrillation.
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Affiliation(s)
- Arwa Younis
- Clinical Cardiovascular Research Center University of Rochester Medical Center Rochester NY
| | - Mehmet K Aktas
- Clinical Cardiovascular Research Center University of Rochester Medical Center Rochester NY
| | - Spencer Rosero
- Clinical Cardiovascular Research Center University of Rochester Medical Center Rochester NY
| | - Valentina Kutyifa
- Clinical Cardiovascular Research Center University of Rochester Medical Center Rochester NY
| | - Bronislava Polonsky
- Clinical Cardiovascular Research Center University of Rochester Medical Center Rochester NY
| | - Scott McNitt
- Clinical Cardiovascular Research Center University of Rochester Medical Center Rochester NY
| | - Nona Sotoodehnia
- Cardiology Department and Cardiovascular Health Research Unit University of Washington Seattle WA
| | - Peter Kudenchuk
- Cardiology Department and Cardiovascular Health Research Unit University of Washington Seattle WA
| | - Thomas D Rea
- Center for Progression in Resuscitation University of Washington Seattle WA
| | - Dan E Arking
- Department of Genetic Medicine McKusick-Nathans Institute John Hopkins University School of Medicine Baltimore MD
| | - Ilan Goldenberg
- Clinical Cardiovascular Research Center University of Rochester Medical Center Rochester NY
| | - Wojciech Zareba
- Clinical Cardiovascular Research Center University of Rochester Medical Center Rochester NY
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Rudic B, Tülümen E, Berlin V, Röger S, Stach K, Liebe V, El-Battrawy I, Dösch C, Papavassiliu T, Akin I, Borggrefe M, Kuschyk J. Low Prevalence of Inappropriate Shocks in Patients With Inherited Arrhythmia Syndromes With the Subcutaneous Implantable Defibrillator Single Center Experience and Long-Term Follow-Up. J Am Heart Assoc 2017; 6:e006265. [PMID: 29042423 PMCID: PMC5721842 DOI: 10.1161/jaha.117.006265] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 08/16/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Up to 40% of patients with transvenous implantable cardioverter-defibrillator (ICD) experience lead-associated complications and may suffer from high complication rates when lead extraction is indicated. Subcutaneous ICD may represent a feasible alternative; however, the efficacy of the subcutaneous ICD in the detection and treatment of ventricular arrhythmias in patients with hereditary arrhythmia syndromes has not been fully evaluated. METHODS AND RESULTS Patients with primary hereditary arrhythmia syndromes who fulfilled indication for defibrillator placement were eligible for enrollment. Between 2010 and 2016, 62 consecutive patients with primary hereditary arrhythmia syndromes, without indication for antibradycardia therapy, were enrolled in the study. Mean follow-up was 31.0±14.2 months. The study cohort comprised of 24 patients with Brugada syndrome, 17 with idiopathic ventricular fibrillation, 6 with long-QT syndrome, 1 with short-QT syndrome, 3 with catecholaminergic polymorphic ventricular tachycardia, 8 with hypertrophic cardiomyopathy, and 3 with arrhythmogenic right ventricular cardiomyopathy. Thirty-nine patients were implanted for secondary prevention. Twenty-two patients had a previous transvenous ICD implanted, but required revision because of infection or lead defects. A total of 20 spontaneous ventricular tachyarrhythmias requiring shock intervention occurred in 10 patients during follow-up. All episodes were terminated within the first ICD shock delivery with 80 J. Two patients had inappropriate therapies caused by oversensing following an uneventful implantation. No pocket-site infections and no premature revisions have occurred during follow-up. CONCLUSIONS Our study supports the use of the subcutaneous ICD for both secondary and primary prevention of sudden cardiac death as a reliable alternative to the conventional transvenous ICD.
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Affiliation(s)
- Boris Rudic
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Erol Tülümen
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Veronika Berlin
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Susanne Röger
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Ksenija Stach
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Volker Liebe
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Ibrahim El-Battrawy
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Christina Dösch
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Theano Papavassiliu
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Martin Borggrefe
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Jürgen Kuschyk
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
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Aizawa Y. Brugada Syndrome:Risk Stratification And Management. J Atr Fibrillation 2017; 9:1507. [PMID: 28496938 DOI: 10.4022/jafib.1507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 06/06/2016] [Accepted: 06/06/2016] [Indexed: 12/19/2022]
Abstract
The Brugada syndrome (BrS) is an arrhythmogenic disease associated with an increased risk of ventricular fibrillation and sudden cardiac death. The risk stratification and management of BrS patients, particularly of asymptomatic ones, still remains challenging. A previous history of aborted sudden cardiac death or arrhythmic syncope in the presence of spontaneous type 1 ECG pattern of BrS phenotype appear to be the most reliable predictors of future arrhythmic events. Several other ECG parameters have been proposed for risk stratification. Among these ECG markers, QRS-fragmentation appears very promising. Although the value of electrophysiological study still remains controversial, it appears to add important information on risk stratification, particularly when incorporated in multiparametric scores in combination with other known risk factors. The present review article provides an update on the pathophysiology, risk stratification and management of patients with BrS.
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Affiliation(s)
- Yoshifusa Aizawa
- Research and Development, Tachikawa Medical Center. Nagaoka, Japan
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Long-time “real-life” performance of the subcutaneous ICD in patients with electrical heart disease or idiopathic ventricular fibrillation. J Interv Card Electrophysiol 2016; 47:185-188. [DOI: 10.1007/s10840-016-0143-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 05/16/2016] [Indexed: 12/31/2022]
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Lee WS, Kim J, Kwon CH, Choi JH, Jo U, Kim YR, Nam GB, Choi KJ, Kim YH. Tachyarrhythmia Cycle Length in Appropriate versus Inappropriate Defibrillator Shocks in Brugada Syndrome, Early Repolarization Syndrome, or Idiopathic Ventricular Fibrillation. Korean Circ J 2016; 46:179-85. [PMID: 27014348 PMCID: PMC4805562 DOI: 10.4070/kcj.2016.46.2.179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 10/08/2015] [Accepted: 11/05/2015] [Indexed: 11/11/2022] Open
Abstract
Background and Objectives Implantable cardioverter–defibrillators (ICDs) are indicated in patients with Brugada syndrome (BS), early repolarization syndrome (ERS), or idiopathic ventricular fibrillation (IVF) who are at high risk for sudden cardiac death. The optimal ICD programming for reducing inappropriate shocks in these patients remains to be determined. We investigated the difference in the mean cycle length of tachyarrhythmias that activated either appropriate or inappropriate ICD shocks in these three patient groups to determine the optimal ventricular fibrillation (VF) zone for minimizing inappropriate ICD shocks. Subjects and Methods We selected 41 patients (35 men) (mean age±standard deviation=42.6±13.0 year) who received ICD shocks between April 1996 and April 2014 to treat BS (n=24), ERS (n=9), or IVF (n=8). Clinical and ICD interrogation data were retrospectively collected and analyzed for all events with ICD shocks. Results Of the 244 episodes, 180 (73.8%) shocks were appropriate and 64 (26.2%) were inappropriate. The mean cycle lengths of the tachyarrhythmias that activated appropriate and inappropriate shocks were 178.9±28.7 ms and 284.8±24.4 ms, respectively (p<0.001). The cutoff value with the highest sensitivity and specificity for discriminating between appropriate and inappropriate shocks was 235 ms (sensitivity, 98.4%; specificity, 95.6%). When we programmed a single VF zone of ≤270 ms, inappropriate ICD shocks were reduced by 70.5% and appropriate shocks were missed in 1.7% of these patients. Conclusion Programming of a single VF zone of ≤270 ms in patients with BS, ERS, or IVF could reduce inappropriate ICD shocks, with a low risk of missing appropriate shocks.
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Affiliation(s)
- Woo Seok Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang-Hee Kwon
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Hee Choi
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Uk Jo
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yoo Ri Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi-Byoung Nam
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee-Joon Choi
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - You-Ho Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Catanzaro JN, Makaryus JN, Makaryus AN, Sison C, Vavasis C, Fan D, Jadonath R. Echocardiographic predictors of ventricular tachycardia. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2015; 8:37-42. [PMID: 25861227 PMCID: PMC4360853 DOI: 10.4137/cmc.s18499] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 11/03/2014] [Accepted: 11/09/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Patients with structural heart disease are prone to ventricular tachycardia (VT) and ventricular fibrillation (VF), which account for the majority of sudden cardiac deaths (SCDs). We sought to examine echocardiographic parameters that can predict VT as documented by implantable cardioverter-defibrillator (ICD) appropriate discharge. We examine echocardiographic parameters other than ejection fraction that may predict VT as recorded via rates of ICD discharge. METHODS Analysis of 586 patients (469 males; mean age = 68 ± 3 years; mean follow-up time of 11 ± 14 months) was undertaken. Echo parameters assessed included left ventricular (LV) internal end diastolic/systolic dimension (LVIDd, LVIDs), relative wall thickness (RWT), and left atrial (LA) size. RESULTS The incidence of VT was 0.22 (114 VT episodes per 528 person-years of follow-up time). Median time-to-first VT was 3.8 years. VT was documented in 79 patients (59 first VT incidence, 20 multiple). The echocardiographic parameter associated with first VT was LVIDs >4 cm (P = 0.02). CONCLUSION The main echocardiographic predictor associated with the first occurrence of VT was LVIDs >4 cm. Patients with an LVIDs >4 cm were 2.5 times more likely to have an episode of VT. Changes in these echocardiographic parameters may warrant aggressive pharmacologic therapy and implantation of an ICD.
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Affiliation(s)
- John N Catanzaro
- Columbia St. Mary's Community Physicians Cardiac Rhythm Specialists, Oshkosh, WI, USA
| | - John N Makaryus
- North Shore-LIJ Health System, Hofstra NSLIJ School of Medicine, Manhasset, NY, USA
| | - Amgad N Makaryus
- North Shore-LIJ Health System, Hofstra NSLIJ School of Medicine, Manhasset, NY, USA ; NuHealth, Nassau University Medical Center, East Meadow, NY, USA
| | - Cristina Sison
- Biostatistics Unit, Feinstein Institute for Medical Research at the North Shore-LIJ Health System, Hofstra NSLIJ School of Medicine, Manhasset, NY, USA
| | - Christos Vavasis
- North Shore-LIJ Health System, Hofstra NSLIJ School of Medicine, Manhasset, NY, USA
| | - Dali Fan
- North Shore-LIJ Health System, Hofstra NSLIJ School of Medicine, Manhasset, NY, USA
| | - Ram Jadonath
- North Shore-LIJ Health System, Hofstra NSLIJ School of Medicine, Manhasset, NY, USA
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8
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Iijima K, Chinushi M, Saitoh O, Hasegawa K, Sonoda K, Yagihara N, Sato A, Izumi D, Watanabe H, Furushima H, Aizawa Y, Minamino T. Frequency characteristics and associations with the defibrillation threshold of ventricular fibrillation in patients with implantable cardioverter defibrillators. Intern Med 2015; 54:1175-82. [PMID: 25986253 DOI: 10.2169/internalmedicine.54.3113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The dominant frequency (DF) in frequency analyses is considered to represent the objective cycle length and complexity of activation under conditions of ventricular fibrillation (VF). However, knowledge regarding the mechanisms determining the DF in human VF is limited. We studied the characteristics of the DF of human VF and relationship between DF and the defibrillation threshold. METHODS Seventy-two implantable cardioverter-defibrillator patients and 211 VF were studied. Using defibrillation tests, we performed a frequency analysis with fast Fourier transformation. The correlations between DF and clinical characteristics, including the defibrillation threshold, were assessed. RESULTS The mean DF of all induced VFs was 5.2±0.8 Hz. The patients were divided into two groups according to DF: the low-DF (DF <5.2 Hz, n=32) and high-DF (DF ≥5.2 Hz, n=40) groups. The frequency of structural heart disease was significantly higher in the low-DF group. In addition, the QRS duration, QT interval and effective refractory period of the right ventricle (RV-ERP) were significantly longer in the low-DF group. A multivariate analysis showed RV-ERP to be the only independent predictor of DF. Excluding patients receiving group III anti-arrhythmic drugs, which are known to have potent defibrillation threshold effects, the defibrillation threshold was significantly lower in the low-DF group (p=0.026). CONCLUSION We found that the DF of human VF is associated with underlying heart disease, the cardiac function, cardiac conduction, ventricular refractoriness and defibrillation threshold. Our findings may be useful for identifying and managing patients with a high defibrillation threshold.
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Affiliation(s)
- Kenichi Iijima
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Japan
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Mizukami K, Yokoshiki H, Mitsuyama H, Watanabe M, Tenma T, Matsui Y, Tsutsui H. Predictors of high defibrillation threshold in patients with implantable cardioverter-defibillator using a transvenous dual-coil lead. Circ J 2014; 79:77-84. [PMID: 25391259 DOI: 10.1253/circj.cj-14-0860] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Defibrillation testing (DT) is considered a standard procedure during implantable cardioverter-defibrillator (ICD) implantation. However, little is known about the factors that are significantly related to patients with high defibrillation threshold (DFT) using the present triad system. METHODS AND RESULTS We examined 286 consecutive patients who underwent ICD implantation with a transvenous dual-coil lead and DT from December 2000 to December 2011. We defined patients who required 25 J or more by the implanted device as the high DFT group, and those who required less than 25 J as the normal DFT group. For each patient, assessment parameters included underlying disease, comorbidities, NYHA functional class, drugs, and echocardiographic measures. The high DFT group consisted of 12 patients (4.2%). Multivariate analysis identified 3 independent predictors for high DFT: atrial fibrillation (odds ratio (OR) 4.85, 95% confidence interval (CI) 1.24-22.33, P=0.023), hypertension (OR 4.01, 95% CI 1.08-15.96, P=0.039), thickness of interventricular septum (IVS) >12 mm (OR 4.82, 95% CI 1.17-20.31, P=0.030). CONCLUSIONS Atrial fibrillation, hypertension and IVS hypertrophy were significantly associated with high DFT. Identification of such patients could help to lower the risk of complications with DT.
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Affiliation(s)
- Kazuya Mizukami
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
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Ghosh J, McGuire MA, Kilborn MJ, Singarayar S, Medi C, Sy RW. Shock-resistant ventricular fibrillation. Int J Cardiol 2014; 174:e26-8. [PMID: 24726354 DOI: 10.1016/j.ijcard.2014.03.151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 03/22/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Justin Ghosh
- Department of Cardiology, Royal Prince Alfred Hospital, NSW, Australia
| | - Mark A McGuire
- Department of Cardiology, Royal Prince Alfred Hospital, NSW, Australia; University of Sydney, NSW, Australia
| | - Michael J Kilborn
- Department of Cardiology, Royal Prince Alfred Hospital, NSW, Australia; University of Sydney, NSW, Australia
| | - Suresh Singarayar
- Department of Cardiology, Royal Prince Alfred Hospital, NSW, Australia; University of Sydney, NSW, Australia
| | - Caroline Medi
- Department of Cardiology, Royal Prince Alfred Hospital, NSW, Australia; University of Sydney, NSW, Australia
| | - Raymond W Sy
- Department of Cardiology, Royal Prince Alfred Hospital, NSW, Australia; University of Sydney, NSW, Australia.
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11
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Shimizu A. Indication of ICD in Brugada syndrome. J Arrhythm 2013. [DOI: 10.1016/j.joa.2012.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Aydin A, Hartel F, Schlüter M, Butter C, Köbe J, Seifert M, Gosau N, Hoffmann B, Hoffmann M, Vettorazzi E, Wilke I, Wegscheider K, Reichenspurner H, Eckardt L, Steven D, Willems S. Shock efficacy of subcutaneous implantable cardioverter-defibrillator for prevention of sudden cardiac death: initial multicenter experience. Circ Arrhythm Electrophysiol 2012; 5:913-9. [PMID: 22923274 DOI: 10.1161/circep.112.973339] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Recently, subcutaneous implantable cardioverter-defibrillator (S-ICD) has become available. The aim of our study was to assess the efficacy of S-ICD in a clinical setting. METHODS AND RESULTS Between June 2010 and July 2011, 40 consecutive patients (42 ± 15 years; body mass index, 27 ± 6 kg/m(2); left ventricular ejection fraction, 47 ± 15%; 28 men) received an S-ICD for primary (n=17) or secondary prevention (n=23 [58%]) at 3 institutions in Germany. Intraoperative defibrillation efficacy testing failed in 1 patient with severely reduced left ventricular ejection fraction; testing was effective in all other patients. All episodes stored in the S-ICD were analyzed for appropriate and inappropriate detection, as well as effective shock delivery to convert ventricular tachyarrhythmia into sinus rhythm. During a median follow-up of 229 (interquartile range, 116-305) days, 4 patients experienced 21 episodes, with correct detection of ventricular tachyarrhythmia and subsequent shock therapy. A total of 28 shocks were delivered in these 4 patients. Mixed logistic regression modeling revealed a shock efficacy of 96.4% (95% CI, 12.8%-100%). The efficacy of first shocks, however, was only 57.9% (95% CI, 35.6%-77.4%). Four episodes were incorrectly classified as ventricular tachyarrhythmia, which led to inappropriate shock delivery in 2 patients. CONCLUSIONS Ineffective shock delivery may occur in patients with S-ICD, even after successful intraoperative testing. Multicenter trials are required with close monitoring of safety and efficacy end points to identify patients who may be at risk for shock failure.
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Affiliation(s)
- Ali Aydin
- Department of Electrophysiology, University Heart Center, Hamburg, Germany.
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Priori SG, Gasparini M, Napolitano C, Della Bella P, Ottonelli AG, Sassone B, Giordano U, Pappone C, Mascioli G, Rossetti G, De Nardis R, Colombo M. Risk stratification in Brugada syndrome: results of the PRELUDE (PRogrammed ELectrical stimUlation preDictive valuE) registry. J Am Coll Cardiol 2012; 59:37-45. [PMID: 22192666 DOI: 10.1016/j.jacc.2011.08.064] [Citation(s) in RCA: 428] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 07/29/2011] [Accepted: 08/16/2011] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The PRELUDE (PRogrammed ELectrical stimUlation preDictive valuE) prospective registry was designed to assess the predictive accuracy of sustained ventricular tachycardia/ventricular fibrillation (VTs/VF) inducibility and to identify additional predictors of arrhythmic events in Brugada syndrome patients without history of VT/VF. BACKGROUND Brugada syndrome is a genetic disease associated with increased risk of sudden cardiac death. Even though its value has been questioned, inducibility of VTs/VF is widely used to select candidates to receive a prophylactic implantable defibrillator, and its accuracy has never been addressed in prospective studies with homogeneous enrolling criteria. METHODS Patients with a spontaneous or drug-induced type I electrocardiogram (ECG) and without history of cardiac arrest were enrolled. The registry included 308 consecutive individuals (247 men, 80%; median age 44 years, range 18 to 72 years). Programmed electrical stimulation was performed at enrollment, and patients were followed-up every 6 months. RESULTS During a median follow-up of 34 months, 14 arrhythmic events (4.5%) occurred (13 appropriate shocks of the implantable defibrillator, and 1 cardiac arrest). Programmed electrical stimulation performed with a uniform and pre-specified protocol induced ventricular tachyarrhythmias in 40% of patients: arrhythmia inducibility was not a predictor of events at follow-up (9 of 14 events occurred in noninducible patients). History of syncope and spontaneous type I ECG (hazard ratio [HR]: 4.20), ventricular refractory period <200 ms (HR: 3.91), and QRS fragmentation (HR: 4.94) were significant predictors of arrhythmias. CONCLUSIONS Our data show that VT/VF inducibility is unable to identify high-risk patients, whereas the presence of a spontaneous type I ECG, history of syncope, ventricular effective refractory period <200 ms, and QRS fragmentation seem useful to identify candidates for prophylactic implantable cardioverter defibrillator.
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Affiliation(s)
- Silvia G Priori
- Cardiologia Molecolare, IRCCS Fondazione Salvatore Maugeri, Via Maugeri 10/10a, Pavia, Italy.
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Sato A, Chinushi M, Iijima K, Watanabe H, Izumi D, Furushima H, Sonoda K, Hasegawa K, Yagihara N, Aizawa Y. An appropriate defibrillation threshold obtained by the combined connection between two shock leads and ICD generator. Intern Med 2011; 50:2815-8. [PMID: 22082895 DOI: 10.2169/internalmedicine.50.5792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 60-year-old man with arrhythmogenic right ventricular cardiomyopathy was readmitted for the battery exchange of his implantable cardioverter-defibrillator (ICD). Since (i) he had been treated with a dual-coil shock lead (Sprint Fidelis, Medtronic) and (ii) pre-operative venography showed mild collateral flow to the left subclavian vein, a single-coil lead was additionally implanted. However, the single-coil defibrillation system was unable to terminate the induced ventricular fibrillation (VF), thus dual defibrillation shock pathways were created using the connection to the superior vena cava coil of the Fidelis lead. The combined connections of the two shock leads provided an appropriate margin of the defibrillation threshold.
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Affiliation(s)
- Akinori Sato
- Division of Cardiology, Niigata University Graduate School of Medical and Dental Sciences, Japan
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Hadano Y, Ogawa H, Wakeyama T, Takaki A, Iwami T, Kimura M, Miyazaki Y, Okada H, Shimizu A, Matsuzaki M. Defibrillation efficacy of a subcutaneous array lead: A case report. J Cardiol Cases 2009; 1:e21-e24. [PMID: 30615746 DOI: 10.1016/j.jccase.2009.06.004] [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: 04/12/2009] [Revised: 05/31/2009] [Accepted: 06/11/2009] [Indexed: 10/20/2022] Open
Abstract
We report a case of Brugada syndrome with a high defibrillation threshold (DFT) in whom a subcutaneous array lead was used to lower the DFT in combination with a transvenous right ventricular defibrillation lead. The patient had previously received pacemaker implantation due to sick sinus syndrome. An implantable cardioverter defibrillator (ICD) with a transvenous right ventricular defibrillation lead alone required a high DFT. A subcutaneous array lead improved defibrillation efficacy in combination with a right ventricular lead. These data suggest that a subcutaneous array lead facilitates implantation of an effective ICD lead system in patients requiring a high DFT.
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Affiliation(s)
- Yasuyuki Hadano
- Division of Cardiology, Tokuyama Central Hospital, 1-1 Kodacho, Shunan, Japan
| | - Hiroshi Ogawa
- Division of Cardiology, Tokuyama Central Hospital, 1-1 Kodacho, Shunan, Japan
| | - Takatoshi Wakeyama
- Division of Cardiology, Tokuyama Central Hospital, 1-1 Kodacho, Shunan, Japan
| | - Akira Takaki
- Division of Cardiology, Tokuyama Central Hospital, 1-1 Kodacho, Shunan, Japan
| | - Takahiro Iwami
- Division of Cardiology, Tokuyama Central Hospital, 1-1 Kodacho, Shunan, Japan
| | - Masayasu Kimura
- Division of Cardiology, Tokuyama Central Hospital, 1-1 Kodacho, Shunan, Japan
| | - Yosuke Miyazaki
- Division of Cardiology, Tokuyama Central Hospital, 1-1 Kodacho, Shunan, Japan
| | - Haruhiko Okada
- Division of Cardiac Surgery, Tokuyama Central Hospital, Shunan, Japan
| | - Akihiko Shimizu
- Faculty of Health and Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Masunori Matsuzaki
- Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
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Chinushi M, Iijima K, Tagawa M, Komura S, Furushima H, Aizawa Y. Effects of verapamil on anterior ST segment and ventricular fibrillation cycle length in patients with Brugada syndrome. J Electrocardiol 2009; 42:367-73. [DOI: 10.1016/j.jelectrocard.2009.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Indexed: 11/27/2022]
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Scn3b knockout mice exhibit abnormal ventricular electrophysiological properties. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2009; 98:251-66. [PMID: 19351516 PMCID: PMC2764399 DOI: 10.1016/j.pbiomolbio.2009.01.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We report for the first time abnormalities in cardiac ventricular electrophysiology in a genetically modified murine model lacking the Scn3b gene (Scn3b−/−). Scn3b−/− mice were created by homologous recombination in embryonic stem (ES) cells. RT-PCR analysis confirmed that Scn3b mRNA was expressed in the ventricles of wild-type (WT) hearts but was absent in the Scn3b−/− hearts. These hearts also showed increased expression levels of Scn1b mRNA in both ventricles and Scn5a mRNA in the right ventricles compared to findings in WT hearts. Scn1b and Scn5a mRNA was expressed at higher levels in the left than in the right ventricles of both Scn3b−/− and WT hearts. Bipolar electrogram and monophasic action potential recordings from the ventricles of Langendorff-perfused Scn3b−/− hearts demonstrated significantly shorter ventricular effective refractory periods (VERPs), larger ratios of electrogram duration obtained at the shortest and longest S1–S2 intervals, and ventricular tachycardias (VTs) induced by programmed electrical stimulation. Such arrhythmogenesis took the form of either monomorphic or polymorphic VT. Despite shorter action potential durations (APDs) in both the endocardium and epicardium, Scn3b−/− hearts showed ΔAPD90 values that remained similar to those shown in WT hearts. The whole-cell patch-clamp technique applied to ventricular myocytes isolated from Scn3b−/− hearts demonstrated reduced peak Na+ current densities and inactivation curves that were shifted in the negative direction, relative to those shown in WT myocytes. Together, these findings associate the lack of the Scn3b gene with arrhythmic tendencies in intact perfused hearts and electrophysiological features similar to those in Scn5a+/− hearts.
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Furushima H, Chinushi M, Iijima K, Izumi D, Hosaka Y, Aizawa Y. Significance of Early Onset and Progressive Increase of Activation Delay During Premature Stimulation in Brugada Syndrome. Circ J 2009; 73:1408-15. [DOI: 10.1253/circj.cj-08-1111] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hiroshi Furushima
- First Department of Internal Medicine, Niigata University School of Medicine
| | - Masaomi Chinushi
- First Department of Internal Medicine, Niigata University School of Medicine
| | - Kenichi Iijima
- First Department of Internal Medicine, Niigata University School of Medicine
| | - Daisuke Izumi
- First Department of Internal Medicine, Niigata University School of Medicine
| | - Yukio Hosaka
- First Department of Internal Medicine, Niigata University School of Medicine
| | - Yoshifusa Aizawa
- First Department of Internal Medicine, Niigata University School of Medicine
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Sarkozy A, Brugada P, Mont L, Brugada J. Optimizing the clinical use of implantable defibrillators in patients with Brugada syndrome. Eur Heart J Suppl 2007. [DOI: 10.1093/eurheartj/sum070] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sacher F, Probst V, Iesaka Y, Jacon P, Laborderie J, Mizon-Gérard F, Mabo P, Reuter S, Lamaison D, Takahashi Y, O'Neill MD, Garrigue S, Pierre B, Jaïs P, Pasquié JL, Hocini M, Salvador-Mazenq M, Nogami A, Amiel A, Defaye P, Bordachar P, Boveda S, Maury P, Klug D, Babuty D, Haïssaguerre M, Mansourati J, Clémenty J, Le Marec H. Outcome after implantation of a cardioverter-defibrillator in patients with Brugada syndrome: a multicenter study. Circulation 2006; 114:2317-24. [PMID: 17116772 DOI: 10.1161/circulationaha.106.628537] [Citation(s) in RCA: 209] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Brugada syndrome is an arrhythmogenic disease characterized by an increased risk of sudden cardiac death (SCD) by ventricular fibrillation. At present, an implantable cardioverter-defibrillator (ICD) is the recommended therapy in high-risk patients. This multicenter study reports the outcome of a large series of patients implanted with an ICD for Brugada syndrome. METHODS AND RESULTS All patients (n=220, 46+/-12 years, 183 male) with a type 1 Brugada ECG pattern implanted with an ICD in 14 centers between 1993 and 2005 were investigated. ICD indication was based on resuscitated SCD (18 patients, 8%), syncope (88 patients, 40%), or positive electrophysiological study in asymptomatic patients (99 patients, 45%). The remaining 15 patients received an ICD because of a family history of SCD or nonsustained ventricular arrhythmia. During a mean follow-up of 38+/-27 months, no patient died and 18 patients (8%) had appropriate device therapy (10+/-15 shocks/patient, 26+/-33 months after implantation). The complication rate was 28%, including inappropriate shocks, which occurred in 45 patients (20%, 4+/-3 shocks/patient, 21+/-20 months after implantation). The reasons for inappropriate therapy were lead failure (19 patients), T-wave oversensing (10 patients), sinus tachycardia (10 patients), and supraventricular tachycardia (9 patients). Among implantation parameters, high defibrillation threshold, high pacing threshold, and low R-wave amplitude occurred, respectively, in 12%, 27%, and 15% of cases. CONCLUSIONS In this large Brugada syndrome population, a low incidence of arrhythmic events was found, with an annual event rate of 2.6% during a follow-up of >3 years, in addition to a significant risk of device-related complications (8.9%/year). Inappropriate shocks were 2.5 times more frequent than appropriate ones.
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Affiliation(s)
- Frédéric Sacher
- Université Bordeaux II, Hôpital Cardiologique du Haut-Lévêque, 33604 Bordeaux-Pessac, France.
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Chinushi M, Tagawa M, Nakamura Y, Aizawa Y. Shortening of the ventricular fibrillatory intervals after administration of verapamil in a patient with Brugada syndrome and vasospastic angina. J Electrocardiol 2006; 39:331-5. [PMID: 16777521 DOI: 10.1016/j.jelectrocard.2005.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2005] [Indexed: 11/20/2022]
Abstract
A 43-year-old man presented with electrocardiographic findings consistent with Brugada syndrome. Though the baseline coronary angiogram was normal, intracoronary infusion of ergonovine maleate caused complete occlusion of the left anterior descending and a 99% occlusion of the proximal right coronary artery, each relieved by intracoronary isosorbide dinitrate. Double extrastimuli delivered at the right ventricular outflow tract induced ventricular fibrillation terminated by a 200-J shock. Verapamil, 10 mg IV, increased ST-segment elevation and programmed stimulation repeated after the drug induced ventricular fibrillation with shorter F-F intervals and lower amplitude signals, which was not terminated by 200 J and required an additional 360-J shock. Ca2+ antagonism may have been adverse in this patient with Brugada syndrome because the drug has the potential to increase the voltage gradient through the right ventricle and to slow intraventricular conduction at very fast heart rates.
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Affiliation(s)
- Masaomi Chinushi
- School of Health Science, Niigata University School of Medicine, Japan.
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Aizawa Y. Idiopathic ventricular fibrillation refractory to ICD therapy. Intern Med 2005; 44:777-8. [PMID: 16157969 DOI: 10.2169/internalmedicine.44.777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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