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Marchlinski FE, Hanumanthu BKJ, Rodriguez-Queralto O. Identifying the Method Preceding the Madness: Can it Advance Treatment Strategies? JACC Clin Electrophysiol 2024:S2405-500X(24)00484-5. [PMID: 39093278 DOI: 10.1016/j.jacep.2024.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 06/08/2024] [Indexed: 08/04/2024]
Affiliation(s)
- Francis E Marchlinski
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Balaram Krishna J Hanumanthu
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Oriol Rodriguez-Queralto
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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2
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Do DH, Shivkumar K. Idiopathic Ventricular Fibrillation: Truly Idiopathic or Are We Missing Occult Pathology? JACC Clin Electrophysiol 2024:S2405-500X(24)00483-3. [PMID: 39066780 DOI: 10.1016/j.jacep.2024.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 06/11/2024] [Indexed: 07/30/2024]
Affiliation(s)
- Duc H Do
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, Los Angeles, California, USA.
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, Los Angeles, California, USA
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3
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Haïssaguerre M, Sellal JM, Benali K, de Becker B, Defaye P, Pascale P, Martins R, Mabo P, Xhaet O, Extramiana F, Surget E, Lavergne T, Marijon E, Adragao P, Carvalho MS, Milliez PU, Laredo M, Gandjbakhch E, Giustetto C, Gaita F, Tilz R, Jesel-Morel L, Steinfurt J, Arentz T, Knecht S, Duytschaever M, Roten L, Reichlin T, Fatemi M, Mansourati J, Kouakam C, Bessière F, Chevalier P, Tadros R, Macle L, Gallego F, Hadjis A, Sacher F, Pereira D, Hourdain J, Deharo JC, Eschalier R, Massoulié G, Maury P, Latcu DG, Anselme F, Duchateau J, Tixier R, Nademanee K, Nogami A, de Groot N, Vigmond E, Bernus O, Strik M, Bordachar P, Cathala A, Bouteiller X, Dubois R, Ploux S. Distinct Substrates of Idiopathic Ventricular Fibrillation Revealed by Arrhythmia Characteristics on Implantable Cardioverter-Defibrillator. JACC Clin Electrophysiol 2024:S2405-500X(24)00356-6. [PMID: 38970599 DOI: 10.1016/j.jacep.2024.04.028] [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: 01/12/2024] [Revised: 04/25/2024] [Accepted: 04/27/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Idiopathic ventricular fibrillation (IVF) can be associated with undetected distinct conditions such as microstructural cardiomyopathic alterations (MiCM) or Purkinje (Purk) activities with structurally normal hearts. OBJECTIVE This study sought to evaluate the characteristics of recurrent VF recorded on implantable defibrillator electrograms, associated with these substrates. METHODS This was a multicenter collaboration study. At 32 centers, we selected patients with an initial diagnosis of IVF and recurrent arrhythmia at follow-up without antiarrhythmic drugs, in whom mapping demonstrated Purk or MiCM substrate. We analyzed variables related to previous ectopy, sinus rate preceding VF, trigger, and initial VF cycle lengths. Logistic regression with cross validation was used to evaluate the performance of criteria to discriminate Purk or MiCM substrates. RESULTS Among 95 patients (35 women, age 35 ± 11 years) meeting the inclusion criteria, IVF was associated with MiCM in 41 and Purk in 54 patients. A total of 117 arrhythmia recurrences including 91% VF were recorded on defibrillator. Three variables were mostly discriminant. Sinus tachycardia (≤570 ms) was more frequent in MiCM (35.9% vs 13.4%, P = 0.014) whereas short-coupled (<350 ms) triggers were most frequent in Purk-related VF (95.5% vs 23.1%, P = 0.001), which also had shorter VFCLs (182 ± 15 ms vs 215 ± 24 ms, P < 0.001).The multivariable combination provided the highest prediction (accuracy = 0.93 ± 0.05, range 0.833-1.000), discriminating 81% of IVF substrates with a high probability (>80%). Ectopy were inconsistently present before VF. CONCLUSIONS Characteristics of arrhythmia recurrences on implantable cardioverter- defibrillator provide phenotypic markers of the distinct and hidden substrates underlying IVF. These findings have significant clinical and genetic implications.
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Affiliation(s)
- Michel Haïssaguerre
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Cardiac electrophysiology and stimulation, Cardiology Department, Bordeaux University Hospital (CHU), Pessac, France.
| | - Jean-Marc Sellal
- Cardiology Department, Nancy University Hospital (CHRU), Nancy, France
| | - Karim Benali
- Cardiac electrophysiology and stimulation, Cardiology Department, Bordeaux University Hospital (CHU), Pessac, France; Department of Cardiac Electrophysiology, Saint-Etienne University Hospital Center, Jean-Monnet University, Saint-Etienne, France
| | | | - Pascal Defaye
- Rhythmology and Cardiac stimulation Unit, Grenoble University Hospital (CHU), Grenoble, France
| | - Patrizio Pascale
- Cardiology Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Raphael Martins
- Cardiology Department, Rennes University Hospital (CHU), Rennes, France
| | - Philippe Mabo
- Cardiology Departement, Namur University Hospital (CHU UCL Namur), Yvoir, Belgium
| | - Olivier Xhaet
- Cardiology Department, APHP Hôpital Bichat, Paris, France
| | - Fabrice Extramiana
- Cardiology Department, Rhythmology Unit, Hôpital Européen Georges Pompidou, Paris, France
| | - Elodie Surget
- Heart Rhythm Centre, Hospital da Luz, Lisbon, Portugal
| | - Thomas Lavergne
- Cardiology Department, Caen Normandie University Hospital (CHU), Caen, France
| | - Eloi Marijon
- Pitié-Salpêtrière University Hospital, Institute of Cardiology, Paris, France
| | - Pedro Adragao
- Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Paul-Ursmar Milliez
- Cardiology Department, Caen Normandie University Hospital (CHU), Caen, France
| | - Mickael Laredo
- Pitié-Salpêtrière University Hospital, Institute of Cardiology, Paris, France
| | - Estelle Gandjbakhch
- Pitié-Salpêtrière University Hospital, Institute of Cardiology, Paris, France
| | - Carla Giustetto
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Fiorenzo Gaita
- Universitätsklinikum Schleswig-Holstein (UKSH), Klinik für Rhythmologie, Lübeck, Germany
| | - Roland Tilz
- Cardiology Department, Strasbourg University Hospital (CHRU), Strasbourg, France
| | - Laurence Jesel-Morel
- Cardiology Department, Strasbourg University Hospital (CHRU), Strasbourg, France
| | - Johannes Steinfurt
- Department of Cardiology, Universitäts-Herzzentrum Freiburg - Bad Krozingen, Freiburg, Germany
| | - Thomas Arentz
- Department of Cardiology, Universitäts-Herzzentrum Freiburg - Bad Krozingen, Freiburg, Germany
| | | | | | - Laurent Roten
- Inselspital, Bern University Hospital, University Clinic for Cardiology, Bern, Switzerland
| | - Tobias Reichlin
- Inselspital, Bern University Hospital, University Clinic for Cardiology, Bern, Switzerland
| | - Marjaneh Fatemi
- Cardiology Department, Brest University Hospital(CHU), Brest, France
| | | | - Claude Kouakam
- Cardiology Department, Lille University Hospital (CHRU), Lille, France
| | - Francis Bessière
- Cardiac Rhythmology Department, Hôpital cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Philippe Chevalier
- Cardiac Rhythmology Department, Hôpital cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Rafik Tadros
- Montreal Heart Institute (ICM), Montréal, Canada
| | | | | | - Alexios Hadjis
- Electrophysiology Unit, Cardiology Department, Sacré-Coeur Hospital of Montréal (HSCM), Montréal, Canada
| | - Frederic Sacher
- Cardiac electrophysiology and stimulation, Cardiology Department, Bordeaux University Hospital (CHU), Pessac, France; Reference Center for Hereditary Rhythmic Diseases and Sudden Death Prevention (CMARY), Cardiology Department, Bordeaux University Hospital (CHU), Pessac, France
| | - Dylan Pereira
- Cardiology Department, Tours University Hospital (CHU), Tours, France
| | - Jerome Hourdain
- Cardiology Department, Tours University Hospital (CHU), Tours, France
| | - Jean-Claude Deharo
- Cardiology Department, Marseille University Hospital La Timone (AP-HM), Marseille, France
| | - Romain Eschalier
- Cardiology Department, Marseille University Hospital La Timone (AP-HM), Marseille, France; Cardiology Department, Clermont-Ferrand University Hospital, (CHU), Clermont-Ferrand, France
| | - Grégoire Massoulié
- Cardiology Department, Clermont-Ferrand University Hospital, (CHU), Clermont-Ferrand, France
| | - Philippe Maury
- Cardiology Department, Rangueil University Hospital (CHU), Toulouse, France
| | | | - Frederic Anselme
- Cardiology Department, Rouen-Normandie University Hospital (CHU), Rouen, France
| | - Josselin Duchateau
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Cardiac electrophysiology and stimulation, Cardiology Department, Bordeaux University Hospital (CHU), Pessac, France
| | - Romain Tixier
- Cardiac electrophysiology and stimulation, Cardiology Department, Bordeaux University Hospital (CHU), Pessac, France
| | - Koonlawee Nademanee
- Pacific Rim Electrophysiology Research Institute at Bumrungrad Hospital, Bangkok, Thailand
| | | | | | - Edward Vigmond
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Olivier Bernus
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Marc Strik
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Cardiac electrophysiology and stimulation, Cardiology Department, Bordeaux University Hospital (CHU), Pessac, France
| | - Pierre Bordachar
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Cardiac electrophysiology and stimulation, Cardiology Department, Bordeaux University Hospital (CHU), Pessac, France
| | - Aude Cathala
- Cardiac electrophysiology and stimulation, Cardiology Department, Bordeaux University Hospital (CHU), Pessac, France
| | - Xavier Bouteiller
- Cardiac electrophysiology and stimulation, Cardiology Department, Bordeaux University Hospital (CHU), Pessac, France
| | - Remi Dubois
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Sylvain Ploux
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Cardiac electrophysiology and stimulation, Cardiology Department, Bordeaux University Hospital (CHU), Pessac, France
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4
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Enriquez A, Muser D, Markman TM, Garcia F. Mapping and Ablation of Premature Ventricular Complexes: State of the Art. JACC Clin Electrophysiol 2024; 10:1206-1222. [PMID: 38639702 DOI: 10.1016/j.jacep.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 04/20/2024]
Abstract
Premature ventricular complexes (PVCs) are common arrhythmias in clinical practice. Although benign and asymptomatic in most cases, PVCs may result in disabling symptoms, left ventricular systolic dysfunction, or PVC-induced ventricular fibrillation. Catheter ablation has emerged as a first-line therapy in such cases, with high rates of efficacy and low risk of complications. Significant progress in mapping and ablation technology has been made in the past 2 decades, along with the development of a growing body of knowledge and accumulated experience regarding PVC sites of origin, anatomical relationships, electrocardiographic characterization, and mapping/ablation strategies. This paper provides an overview of the main indications for catheter ablation of PVCs, electrocardiographic features, PVC mapping techniques, and contemporary ablation approaches. The authors also review the most common sites of PVC origin and the main considerations and challenges with ablation in each location.
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Affiliation(s)
- Andres Enriquez
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Daniele Muser
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Timothy M Markman
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Fermin Garcia
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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5
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Kataoka N, Imamura T, Uchida K, Koi T, Kinugawa K. Catheter ablation in a geriatric case presenting idiopathic ventricular fibrillation initiated by Purkinje-related premature ventricular contractions. HeartRhythm Case Rep 2024; 10:346-350. [PMID: 38799590 PMCID: PMC11116959 DOI: 10.1016/j.hrcr.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Affiliation(s)
- Naoya Kataoka
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Teruhiko Imamura
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Keisuke Uchida
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Takahisa Koi
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Koichiro Kinugawa
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
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6
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Tsuji Y, Yamazaki M, Shimojo M, Yanagisawa S, Inden Y, Murohara T. Mechanisms of torsades de pointes: an update. Front Cardiovasc Med 2024; 11:1363848. [PMID: 38504714 PMCID: PMC10948600 DOI: 10.3389/fcvm.2024.1363848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 02/19/2024] [Indexed: 03/21/2024] Open
Abstract
Torsades de Pointes (TdP) refers to a polymorphic ventricular tachycardia (VT) with undulating QRS axis that occurs in long QT syndrome (LQTS), although the term has been used to describe polymorphic ventricular tachyarrhythmias in which QT intervals are not prolonged, such as short-coupled variant of TdP currently known as short-coupled ventricular fibrillation (VF) and Brugada syndrome. Extensive works on LQTS-related TdP over more than 50 years since it was first recognized by Dessertennes who coined the French term meaning "twisting of the points", have led to current understanding of the electrophysiological mechanism that TdP is initiated by triggered activity due to early afterdepolarization (EAD) and maintained by reentry within a substrate of inhomogeneous repolarization. While a recently emerging notion that steep voltage gradients rather than EADs are crucial to generate premature ventricular contractions provides additions to the initiation mode, the research to elucidate the maintenance mechanism hasn't made much progress. The reentrant activity that produces the specific form of VT is not well characterized. We have conducted optical mapping in a rabbit model of electrical storm by electrical remodeling (QT prolongation) due to chronic complete atrioventricular block and demonstrated that a tissue-island with prolonged refractoriness due to enhanced late Na+ current (INa-L) contributes to the generation of drifting rotors in a unique manner, which may explain the ECG characteristic of TdP. Moreover, we have proposed that the neural Na+ channel NaV1.8-mediated INa-L may be a new player to form the substrate for TdP. Here we discuss TdP mechanisms by comparing the findings in electrical storm rabbits with recently published studies by others in simulation models and human and animal models of LQTS.
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Affiliation(s)
- Yukiomi Tsuji
- Departments of Cardiovascular Research and Innovation, Cardiology and Advanced Cardiovascular Therapeutics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masatoshi Yamazaki
- Department of Cardiology, Nagano Hospital, Soja and Medical Device Development and Regulation Research Center and Department of Precision Engineering, The University of Tokyo, Tokyo, Japan
| | - Masafumi Shimojo
- Departments of Cardiovascular Research and Innovation, Cardiology and Advanced Cardiovascular Therapeutics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Yanagisawa
- Departments of Cardiovascular Research and Innovation, Cardiology and Advanced Cardiovascular Therapeutics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuya Inden
- Departments of Cardiovascular Research and Innovation, Cardiology and Advanced Cardiovascular Therapeutics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Departments of Cardiovascular Research and Innovation, Cardiology and Advanced Cardiovascular Therapeutics, Nagoya University Graduate School of Medicine, Nagoya, Japan
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7
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Ranganathan D, Gonzalez ES, Terricabras M, Cheung CC. Surviving the Shocks: A Contemporary of Short-coupled Ventricular Fibrillation. J Innov Card Rhythm Manag 2024; 15:5805-5809. [PMID: 38584752 PMCID: PMC10994154 DOI: 10.19102/icrm.2024.15033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 10/29/2023] [Indexed: 04/09/2024] Open
Abstract
A young man presented following successful cardiac resuscitation after an out-of-hospital cardiac arrest. During his admission, he had multiple runs of short-coupled ventricular fibrillation with a similar morphology premature ventricular complex (PVC) trigger. He was brought to the electrophysiology laboratory, and, with a high dose of isoprenaline, the PVC was localised to the moderator band. Ablation induced short runs of ventricular tachycardia before elimination of the PVC. He subsequently underwent subcutaneous implantable cardiac defibrillator implantation before his discharge.
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Affiliation(s)
- Deepti Ranganathan
- Division of Cardiology, Sunnybrook Health Science Centre, Toronto, Ontario, Canada
| | | | - Maria Terricabras
- Division of Cardiology, Sunnybrook Health Science Centre, Toronto, Ontario, Canada
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8
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Gao Y, Wu HY, Cao YW. Recurrent Ventricular Fibrillation in an Apparently Healthy Patient. JAMA Intern Med 2024; 184:205-206. [PMID: 38079158 DOI: 10.1001/jamainternmed.2023.5244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
This case report describes a patient in their 50s who collapsed, received chest compressions, and recovered consciousness at home.
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Affiliation(s)
- Yan Gao
- Department of Electrocardiology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Hao-Yu Wu
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Yi-Wei Cao
- Department of Electrocardiology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
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9
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Khalaph M, Costard-Jäckle A, Braun M, El Hamriti M. Successful ablation of Purkinje ectopy-triggered ventricular fibrillation storm in a patient with orthotopic heart transplantation and severe SARS-CoV-2 pneumonia: a case report. Eur Heart J Case Rep 2024; 8:ytae057. [PMID: 38348056 PMCID: PMC10859305 DOI: 10.1093/ehjcr/ytae057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 01/21/2024] [Accepted: 01/25/2024] [Indexed: 02/15/2024]
Abstract
Background Catheter ablation is one of the most effective treatment options for patients with drug-refractory, scar-related monomorphic ventricular tachycardia (VT). In selected cases, catheter ablation also plays an important role in treatment of polymorphic VT (PMVT) and/or ventricular fibrillation (VF). Rarely, premature ventricular contractions (PVCs) originating from the Purkinje network can induce PMVT/VF. Ablation and elimination of these PVCs can prevent VF recurrences. Case summary A 41-year-old patient with a history of orthotopic heart transplantation (HTX) 8 years before admission and newly diagnosed SARS-CoV-2 pneumonia was referred to our centre after experiencing several episodes of drug-refractory VF. An electrophysiological study showed ectopy-triggered VF originating from the anterior and posterior fascicles of the left bundle branch (LBB). Ablation of these PVCs from the LBB led to complete elimination of VF. A subcutaneous implantable cardioverter defibrillator was implanted as secondary prophylaxis. During the observation period of 6 months, no VF recurrence was observed. Conclusion Identifying and eliminating the trigger (PVCs) can be life-saving and prevent VF in the specific cohort of HTX patients. High-density mapping using multipolar catheters with microelectrodes contributes significantly to our understanding of tachycardia mechanisms.
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Affiliation(s)
- Moneeb Khalaph
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany
| | - Angelika Costard-Jäckle
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany
| | - Martin Braun
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany
| | - Mustapha El Hamriti
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany
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10
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Komatsu Y, Nogami A, Hocini M, Morita H, Sato N, Marijon E, Arentz T, Yli-Mäyry S, Onishi Y, Kowase S, Duchateau J, Benali K, Takase T, Hosaka Y, Takei A, Nakajima I, Kawamura M, Inden Y, Ieda M, Aonuma K, Haïssaguerre M. Triggers of Ventricular Fibrillation in Patients With Inferolateral J-Wave Syndrome. JACC Clin Electrophysiol 2024; 10:1-12. [PMID: 37855774 DOI: 10.1016/j.jacep.2023.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/13/2023] [Accepted: 09/16/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND There are few data on ventricular fibrillation (VF) initiation in patients with inferolateral J waves. OBJECTIVES This multicenter study investigated the characteristics of triggers initiating spontaneous VF in inferolateral J-wave syndrome. METHODS A total of 31 patients (age 37 ± 14 years, 24 male) with spontaneous VF episodes associated with inferolateral J waves were evaluated to determine the origin and characteristics of triggers. The J-wave pattern was recorded in inferior leads in 11 patients, lateral leads in 3, and inferolateral leads in 17. RESULTS The VF triggers (n = 37) exhibited varying QRS durations (176 ± 21 milliseconds, range 119-219 milliseconds) and coupling intervals (339 ± 46 milliseconds, range 250-508 milliseconds) with a right (70%) or left (30%) bundle branch block (BBB) pattern. Trigger patterns were associated with J-wave location: left BBB triggers with inferior J waves and right BBB triggers with lateral J waves. Electrophysiologic study was performed for 22 VF triggers in 19 patients. They originated from the left or right Purkinje system in 6 and from the ventricular myocardium in 10 and were undetermined in 6. Purkinje vs myocardial triggers showed distinct electrocardiographic characteristics in coupling interval and QRS-complex duration and morphology. Abnormal epicardial substrate associated with fragmented electrograms was identified in 9 patients, with triggers originating from the same region in 7 patients. Catheter ablation resulted in VF suppression in 15 patients (79%). CONCLUSIONS VF initiation in inferolateral J-wave syndrome is associated with significant individual heterogeneity in trigger characteristics. Myocardial triggers have electrocardiographic features distinct from Purkinje triggers, and their origin often colocalizes with an abnormal epicardial substrate.
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Affiliation(s)
- Yuki Komatsu
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Akihiko Nogami
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Mélèze Hocini
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Hiroshi Morita
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Nobuyuki Sato
- Department of Cardiology, Asahikawa Medical University, Asahikawa, Japan
| | - Eloi Marijon
- Cardiology Department, Rhythmology Unit, Hôpital Européen Georges Pompidou, Paris, France
| | - Thomas Arentz
- Arrhythmia Division, Clinic for Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Sinikka Yli-Mäyry
- Heart Hospital, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Yoshimi Onishi
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Shinya Kowase
- Department of Heart Rhythm Management, Yokohama Rosai Hospital, Yokohama, Japan
| | - Josselin Duchateau
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Karim Benali
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Tetsuro Takase
- Department of Cardiology, Ayase Heart Hospital, Tokyo, Japan
| | - Yukio Hosaka
- Department of Cardiovascular Medicine, Niigata City General Hospital, Niigata, Japan
| | - Asumi Takei
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ikutaro Nakajima
- Division of Cardiology, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Japan
| | - Mitsuharu Kawamura
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaki Ieda
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kazutaka Aonuma
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Michel Haïssaguerre
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
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11
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Suna G, Mellor GJ. Explaining the Unexplained: A Practical Approach to Investigating the Cardiac Arrest Survivor. Arrhythm Electrophysiol Rev 2023; 12:e27. [PMID: 38124802 PMCID: PMC10731537 DOI: 10.15420/aer.2023.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 10/12/2023] [Indexed: 12/23/2023] Open
Abstract
Sudden cardiac arrest (SCA) is a common cause of death. The majority of SCA is caused by ventricular arrhythmia due to underlying CHD. Aborted SCA with no apparent diagnosis after initial assessment with ECG, echocardiography and coronary assessment is referred to as unexplained cardiac arrest (UCA). Systematic evaluation of such patients may reveal a specific diagnosis in up to half of patients before a diagnosis of idiopathic VF is assigned. Specific diagnoses include inherited cardiac conditions, such as latent cardiomyopathies or inherited primary electrical disease. Identifying the cause of UCA is therefore not only critical for appropriate management of the SCA survivors to prevent recurrence, but also for their family members who may be at risk of the same condition. This review provides a tiered, systematic approach for the investigation of UCA.
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Affiliation(s)
- Gonca Suna
- Cardiology Department, Royal Papworth Hospital NHS Foundation Trust Cambridge, UK
| | - Greg J Mellor
- Cardiology Department, Royal Papworth Hospital NHS Foundation Trust Cambridge, UK
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12
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Steinberg C. Short-Coupled Ventricular Fibrillation. Card Electrophysiol Clin 2023; 15:331-341. [PMID: 37558303 DOI: 10.1016/j.ccep.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Short-coupled ventricular fibrillation (SCVF) is a distinct phenotype among individuals with unexplained cardiac arrest accounting for 7% to 14% of cases of idiopathic ventricular fibrillation (IVF). VF is typically initiated by a trigger premature ventricular contraction with a short-coupling interval of less than 350 milliseconds. In the absence of specific electrocardiographic features or provocative tests, the diagnosis remains challenging and requires documentation of VF onset. Most cases are diagnosed during follow-up at the time of VF recurrence. SCVF is characterized by a high risk of VF recurrence. Insertion of an implantable cardioverter-defibrillator and quinidine are the keystones of SCVF management.
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Affiliation(s)
- Christian Steinberg
- Institut universitaire de cardiologie et pneumologie de Québec (IUCPQ-UL), Laval University, 2725 Chemin Ste-Foy, Quebec, QC, G1V 4G5, Canada.
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13
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Alsaeed AH, Alqarawi W. Investigation of Unexplained Cardiac Arrest: Phenotyping and Genetic Testing. Card Electrophysiol Clin 2023; 15:307-318. [PMID: 37558301 DOI: 10.1016/j.ccep.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Unexplained cardiac arrest (UCA) is a working diagnosis that should be replaced by a final diagnosis once evaluation is completed. Complete evaluation of UCA should include high-yield tests like cardiac magnetic resonance imaging, exercise treadmill test, and sodium-channel blocker challenge to identify latent causes of UCA. If no clear etiology is revealed after complete evaluation, idiopathic ventricular fibrillation may be diagnosed, and the strength of its diagnosis can be divided into definitive, probable, and possible based on the number of high-yield tests performed. Care should be provided by a multidisciplinary team with expertise in this area.
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Affiliation(s)
- Abdulelah H Alsaeed
- Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Wael Alqarawi
- Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia; University of Ottawa Heart Institute, University of Ottawa, Ottawa, Canada.
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14
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Haissaguerre M, Duchateau J, Laredo M, Lavergne T, Winum PF, Cheniti G, Waintraub X, Samson S, Surget E, Tixier R, Sacher F, Marijon E, Bernus O, Gandjbakhch E. Inducibility of Short-Coupled Purkinje Ectopy by Pharmacological Tests in Patients With Spontaneous Short-Coupled Idiopathic Ventricular Fibrillation. Circulation 2023; 148:70-72. [PMID: 37399260 DOI: 10.1161/circulationaha.122.063578] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Affiliation(s)
- Michel Haissaguerre
- Université de Bordeaux, CRCTB U1045, Inserm, France (M.H., J.D., G.C., E.S., F.S., O.B.)
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France (M.H., F.S., O.B.)
- Cardiac Electrophysiology and Stimulation Department, Bordeaux University Hospital, France (M.H., R.T., F.S., O.B.)
| | - Josselin Duchateau
- Université de Bordeaux, CRCTB U1045, Inserm, France (M.H., J.D., G.C., E.S., F.S., O.B.)
| | - Mikael Laredo
- Cardiology Institute, Pitié-Salpetriere, AP-HP, Sorbonne Université, Paris, France (M.L., X.W., E.G.)
| | - Thomas Lavergne
- Cardiology Department, European Hospital Georges Pompidou, AP-HP, Paris University, France (T.L., E.M.)
| | - Pierre F Winum
- Cardiology Department, University Hospital, CHU Nimes, France (P.F.W.)
| | - Ghassen Cheniti
- Université de Bordeaux, CRCTB U1045, Inserm, France (M.H., J.D., G.C., E.S., F.S., O.B.)
| | - Xavier Waintraub
- Cardiology Institute, Pitié-Salpetriere, AP-HP, Sorbonne Université, Paris, France (M.L., X.W., E.G.)
| | | | - Elodie Surget
- Université de Bordeaux, CRCTB U1045, Inserm, France (M.H., J.D., G.C., E.S., F.S., O.B.)
| | - Romain Tixier
- Cardiac Electrophysiology and Stimulation Department, Bordeaux University Hospital, France (M.H., R.T., F.S., O.B.)
| | - Frederic Sacher
- Université de Bordeaux, CRCTB U1045, Inserm, France (M.H., J.D., G.C., E.S., F.S., O.B.)
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France (M.H., F.S., O.B.)
- Cardiac Electrophysiology and Stimulation Department, Bordeaux University Hospital, France (M.H., R.T., F.S., O.B.)
- Inherited Arrhythmic Disease Center, Haut-Leveque Hospital, CHU Bordeaux, France (F.S.)
| | - Eloi Marijon
- Cardiology Department, European Hospital Georges Pompidou, AP-HP, Paris University, France (T.L., E.M.)
| | - Olivier Bernus
- Université de Bordeaux, CRCTB U1045, Inserm, France (M.H., J.D., G.C., E.S., F.S., O.B.)
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France (M.H., F.S., O.B.)
- Cardiac Electrophysiology and Stimulation Department, Bordeaux University Hospital, France (M.H., R.T., F.S., O.B.)
| | - Estelle Gandjbakhch
- Cardiology Institute, Pitié-Salpetriere, AP-HP, Sorbonne Université, Paris, France (M.L., X.W., E.G.)
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15
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Tseng AS, Kowlgi GN, DeSimone CV. Management of Premature Ventricular Complexes in the Outpatient Setting. Mayo Clin Proc 2023; 98:1042-1053. [PMID: 37419573 DOI: 10.1016/j.mayocp.2023.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/18/2023] [Accepted: 01/30/2023] [Indexed: 07/09/2023]
Abstract
With an aging population and an explosion in ambulatory electrocardiographic monitoring, primary care clinicians will undoubtedly see an increase in patients presenting with premature ventricular complexes (PVCs), especially given how common they are in the general population. A sizable number of patients with PVCs are asymptomatic, and these PVCs have no significant clinical implications. In contrast, PVCs can predispose patients to or are a clinical marker of an underlying cardiomyopathy, heart failure, or sudden cardiac death. Such a dichotomy can create fear in dealing with PVCs in the outpatient setting, both in immediate situations and for surveillance and follow-up. In this review, we provide a comprehensive overview of the pathophysiologic basis of PVCs, appropriate diagnostic testing, management, and prognostic considerations necessary when faced with PVCs in the outpatient clinic. We also provide a simplistic approach to help guide the initial work-up of PVCs, basic treatment strategies, and indications of when to refer for cardiovascular specialty consultation to improve physician comfort and to enhance patient care.
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Affiliation(s)
- Andrew S Tseng
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
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16
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Jentzer JC, Noseworthy PA, Kashou AH, May AM, Chrispin J, Kabra R, Arps K, Blumer V, Tisdale JE, Solomon MA. Multidisciplinary Critical Care Management of Electrical Storm: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 81:2189-2206. [PMID: 37257955 PMCID: PMC10683004 DOI: 10.1016/j.jacc.2023.03.424] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/14/2023] [Indexed: 06/02/2023]
Abstract
Electrical storm (ES) reflects life-threatening cardiac electrical instability with 3 or more ventricular arrhythmia episodes within 24 hours. Identification of underlying arrhythmogenic cardiac substrate and reversible triggers is essential, as is interrogation and programming of an implantable cardioverter-defibrillator, if present. Medical management includes antiarrhythmic drugs, beta-adrenergic blockade, sedation, and hemodynamic support. The initial intensity of these interventions should be matched to the severity of ES using a stepped-care algorithm involving escalating treatments for higher-risk presentations or recurrent ventricular arrhythmias. Many patients with ES are considered for catheter ablation, which may require the use of temporary mechanical circulatory support. Outcomes after ES are poor, including frequent ES recurrences and deaths caused by progressive heart failure and other cardiac causes. A multidisciplinary collaborative approach to the management of ES is crucial, and evaluation for heart transplantation or palliative care is often appropriate, even for patients who survive the initial episode.
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Affiliation(s)
- Jacob C Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | - Peter A Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Anthony H Kashou
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Adam M May
- Cardiovascular Division, Washington University School of Medicine, St Louis, Missouri, USA
| | - Jonathan Chrispin
- Clinical Cardiac Electrophysiology, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rajesh Kabra
- Kansas City Heart Rhythm Institute, Overland Park, Kansas, USA
| | - Kelly Arps
- Cardiac Electrophysiology Section, Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Vanessa Blumer
- Department of Cardiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - James E Tisdale
- College of Pharmacy, Purdue University, West Lafayette, Indiana, USA; School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Michael A Solomon
- Critical Care Medicine Department, National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, Maryland, USA; Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
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17
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Christie S, Idris S, Bennett RG, Deyell MW, Roston T, Laksman Z. Trigger and Substrate Mapping and Ablation for Ventricular Fibrillation in the Structurally Normal Heart. J Cardiovasc Dev Dis 2023; 10:jcdd10050200. [PMID: 37233167 DOI: 10.3390/jcdd10050200] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 04/28/2023] [Accepted: 04/29/2023] [Indexed: 05/27/2023] Open
Abstract
Sudden cardiac death (SCD) represents approximately 50% of all cardiovascular mortality in the United States. The majority of SCD occurs in individuals with structural heart disease; however, around 5% of individuals have no identifiable cause on autopsy. This proportion is even higher in those <40 years old, where SCD is particularly devastating. Ventricular fibrillation (VF) is often the terminal rhythm leading to SCD. Catheter ablation for VF has emerged as an effective tool to alter the natural history of this disease among high-risk individuals. Important advances have been made in the identification of several mechanisms involved in the initiation and maintenance of VF. Targeting the triggers of VF as well as the underlying substrate that perpetuates these lethal arrhythmias has the potential to eliminate further episodes. Although important gaps remain in our understanding of VF, catheter ablation has become an important option for individuals with refractory arrhythmias. This review outlines a contemporary approach to the mapping and ablation of VF in the structurally normal heart, specifically focusing on the following major conditions: idiopathic ventricular fibrillation, short-coupled ventricular fibrillation, and the J-wave syndromes-Brugada syndrome and early-repolarization syndrome.
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Affiliation(s)
- Simon Christie
- Faculty of Medicine, Division of Cardiology, University of British Columbia, Gordon & Leslie Diamond Health Care Centre, 2775 Laurel St., 9th Floor, Vancouver, BC V5Z 1M9, Canada
| | - Sami Idris
- Faculty of Medicine, Division of Cardiology, University of British Columbia, Gordon & Leslie Diamond Health Care Centre, 2775 Laurel St., 9th Floor, Vancouver, BC V5Z 1M9, Canada
| | - Richard G Bennett
- Faculty of Medicine, Division of Cardiology, University of British Columbia, Gordon & Leslie Diamond Health Care Centre, 2775 Laurel St., 9th Floor, Vancouver, BC V5Z 1M9, Canada
| | - Marc W Deyell
- Faculty of Medicine, Division of Cardiology, University of British Columbia, Gordon & Leslie Diamond Health Care Centre, 2775 Laurel St., 9th Floor, Vancouver, BC V5Z 1M9, Canada
| | - Thomas Roston
- Faculty of Medicine, Division of Cardiology, University of British Columbia, Gordon & Leslie Diamond Health Care Centre, 2775 Laurel St., 9th Floor, Vancouver, BC V5Z 1M9, Canada
| | - Zachary Laksman
- Faculty of Medicine, Division of Cardiology, University of British Columbia, Gordon & Leslie Diamond Health Care Centre, 2775 Laurel St., 9th Floor, Vancouver, BC V5Z 1M9, Canada
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18
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Bergeman AT, Postema PG, Wilde AAM, van der Werf C. Pharmacological treatment of short-coupled idiopathic ventricular fibrillation: A review. Indian Pacing Electrophysiol J 2023; 23:77-83. [PMID: 36933619 PMCID: PMC10160784 DOI: 10.1016/j.ipej.2023.03.004] [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: 01/21/2023] [Revised: 03/11/2023] [Accepted: 03/15/2023] [Indexed: 03/18/2023] Open
Abstract
Short-coupled idiopathic ventricular fibrillation (IVF) is a subtype of IVF in which episodes of polymorphic ventricular tachycardia or ventricular fibrillation are initiated by short-coupled premature ventricular contractions (PVCs). Our understanding of the pathophysiology is evolving, with evidence suggesting that these malignant PVCs originate from the Purkinje system. In most cases, the genetic underpinning has not been identified. Whereas the implantation of an implantable cardioverter-defibrillator is uncontroversial, the choice of pharmacological treatment is the subject of discussion. In this review, we summarize the available knowledge on pharmacological therapy in short-coupled IVF and provide our recommendations for management of patients with this syndrome.
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Affiliation(s)
- A T Bergeman
- Heart Centre, Department of Cardiology, Amsterdam UMC Location AMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, the Netherlands
| | - P G Postema
- Heart Centre, Department of Cardiology, Amsterdam UMC Location AMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, the Netherlands
| | - A A M Wilde
- Heart Centre, Department of Cardiology, Amsterdam UMC Location AMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, the Netherlands
| | - C van der Werf
- Heart Centre, Department of Cardiology, Amsterdam UMC Location AMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, the Netherlands.
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19
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Arceluz MR, Thind M, Garcia FC, Guandalini GS, Santangeli P, Hyman M, Deo R, Frankel DS, Supple GE, Schaller RD, Callans DJ, Nazarian S, Dixit S, Kumareswaran R, Zado ES, Marchlinski FE. Sinus Rhythm Electrocardiographic Abnormalities, Sites of Origin, and Ablation Outcomes of Ventricular Premature Depolarizations Initiating Ventricular Fibrillation. Heart Rhythm 2023; 20:844-852. [PMID: 36958413 DOI: 10.1016/j.hrthm.2023.03.019] [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: 09/26/2022] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Ventricular fibrillation (VF) can be initiated by ventricular premature depolarizations (VPDs) in the absence of obvious structural abnormalities. OBJECTIVE To determine the prevalence of 12-lead ECG sinus rhythm reduced QRS amplitude, QRS fractionation (QRSf) and early repolarization (ER) pattern, and the outcome of catheter ablation and VPD anatomic distribution in patients with VPDs initiating VF. METHODS We compared a cohort with no apparent structural heart disease and VPDs initiating VF (Group 1, n=42) to a reference cohort (Group 2, n=61) of patients with no structural heart disease and symptomatic unifocal VPDs. RESULTS A reduced QRS amplitude (<.55 mV) in aVF (59 % vs 10%, p<0.001), QRSf in ≥2 contiguous leads (50% vs 16%, p<0.001) and early repolarization pattern (21.4% vs 1.6%, p=0.01) were more common in Group 1 vs Group 2. At least one abnormal ECG finding was present in 34 (81%) Group 1 vs 17 (28%) Group 2 patients, (p<0.001). VPD origin included RV and LV distal Purkinje system and moderator band/ papillary muscles, in 83% Group 1 vs 18% Group 2 patients, p<0.001. VF was eliminated with single ablation procedure in 77% of Group 1 patients with at least 2 years of follow-up. CONCLUSIONS A reduced QRS amplitude (<.55 mV) in aVF, QRS fractionation in ≥2 contiguous leads and/or an early repolarization pattern are frequently observed in patients with VPDs initiating VF. VPDs initiating VF typically originate from the distal Purkinje system and papillary muscles and can be successfully eliminated with catheter ablation.
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Affiliation(s)
- Martín R Arceluz
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Munveer Thind
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Fermin C Garcia
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gustavo S Guandalini
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pasquale Santangeli
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew Hyman
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rajat Deo
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David S Frankel
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gregory E Supple
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert D Schaller
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David J Callans
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Saman Nazarian
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sanjay Dixit
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ramanan Kumareswaran
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Erica S Zado
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Francis E Marchlinski
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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20
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Steinberg C, Krahn AD. Seeking Certainty About the Uncertain. JACC Clin Electrophysiol 2023; 9:356-358. [PMID: 36990597 DOI: 10.1016/j.jacep.2022.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 03/29/2023]
Affiliation(s)
- Christian Steinberg
- Institut Universitaire de Cardiologie, et Pneumologie, de Québec, Laval University, Quebec City, Quebec, Canada
| | - Andrew D Krahn
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
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21
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Surget E, Duchateau J, Marchant J, Maury P, Walton R, Lavergne T, Gandjbakhch E, Leenhardt A, Extramiana F, Haïssaguerre M. Idiopathic ventricular fibrillation associated with long-coupled Purkinje ectopy. J Cardiovasc Electrophysiol 2023; 34:615-623. [PMID: 36748854 DOI: 10.1111/jce.15833] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/07/2023] [Accepted: 01/14/2023] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Idiopathic ventricular fibrillation (IVF) is mainly associated with and triggered by short-coupled (R-on-T) ventricular ectopics. However, little is known about the risk of VF associated with long-coupled premature ventricular complexes (LCPVCs). OBJECTIVE To examine the prevalence and characteristics of IVF patients presenting with LCPVCs. METHODS Consecutive patients with IVF and PVCs from five arrhythmia referral centers were reviewed. We included patients presenting LCPVCs, defined as PVCs falling after the end of the T wave, with a normal QTc interval. We evaluated demographics, medical history, and clinical circumstances associated with PVCs and VF episodes. The origin of PVCs was determined by invasive mapping. RESULTS Seventy-nine patients with IVF were reviewed. Among them, 12 (15.2%) met the inclusion criteria (8 women, age 36 ± 14 years). Eleven patients had documented LCPVCs initiating repetitive PVCs or sustained VF, whereas 1 had only documented isolated PVCs. In 10 of 12 patients, PVCs were recorded showing both long and short coupling intervals of 418 ± 46 and 304 ± 33 ms, respectively. Mapping showed that PVCs originated from the left Purkinje in 10 patients, from the right Purkinje in 1 patient, and both in 1 patient. Compared to other patients from the initial cohort, IVF with LCPVCs was associated with a left-sided origin of PVCs (92% in long-coupled IVF vs. 46% of left Purkinje PVCs in short-coupled IVF, p = .004). CONCLUSION Long-coupled fascicular PVCs, traditionally recognized as benign, can be associated with IVF in a subset of patients. They can induce IVF by themselves or in association with short-coupled PVCs.
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Affiliation(s)
- Elodie Surget
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Josselin Duchateau
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - James Marchant
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Philippe Maury
- Cardiology Department, Rangueil University Hospital, Toulouse, France
| | - Richard Walton
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Thomas Lavergne
- Cardiology Department, Rhythmology Unit, Hôpital Européen Georges Pompidou, Paris, France
| | - Estelle Gandjbakhch
- Institute of Cardiology, Pitié-Salpêtrière University Hospital, Paris, France
| | - Antoine Leenhardt
- Université de Paris Cité, CNMR, Maladies Cardiaques Héréditaires Rares, APHP Hôpital Bichat, Paris, France
| | - Fabrice Extramiana
- Université de Paris Cité, CNMR, Maladies Cardiaques Héréditaires Rares, APHP Hôpital Bichat, Paris, France
| | - Michel Haïssaguerre
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
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22
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Belhassen B, Tovia-Brodie O. Short or long-coupled idiopathic ventricular fibrillation: Does the coupling interval really matter? J Cardiovasc Electrophysiol 2023; 34:624-626. [PMID: 36709472 DOI: 10.1111/jce.15832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 01/22/2023] [Indexed: 01/30/2023]
Affiliation(s)
- Bernard Belhassen
- Hadassah Medical Center, Heart Institute, Jerusalem, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Oholi Tovia-Brodie
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
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23
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Guarracini F, Bonvicini E, Zanon S, Martin M, Casagranda G, Mochen M, Coser A, Quintarelli S, Branzoli S, Mazzone P, Bonmassari R, Marini M. Emergency Management of Electrical Storm: A Practical Overview. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020405. [PMID: 36837606 PMCID: PMC9963509 DOI: 10.3390/medicina59020405] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 02/08/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023]
Abstract
Electrical storm is a medical emergency characterized by ventricular arrythmia recurrence that can lead to hemodynamic instability. The incidence of this clinical condition is rising, mainly in implantable cardioverter defibrillator patients, and its prognosis is often poor. Early acknowledgment, management and treatment have a key role in reducing mortality in the acute phase and improving the quality of life of these patients. In an emergency setting, several measures can be employed. Anti-arrhythmic drugs, based on the underlying disease, are often the first step to control the arrhythmic burden; besides that, new therapeutic strategies have been developed with high efficacy, such as deep sedation, early catheter ablation, neuraxial modulation and mechanical hemodynamic support. The aim of this review is to provide practical indications for the management of electrical storm in acute settings.
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Affiliation(s)
- Fabrizio Guarracini
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy
- Correspondence: ; Tel.: +39-(0)461-903121; Fax: +39-(0)461-903122
| | - Eleonora Bonvicini
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy
- Department of Cardiology, University of Verona, 37126 Verona, Italy
| | - Sofia Zanon
- Department of Cardiology, University of Verona, 37126 Verona, Italy
| | - Marta Martin
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy
| | | | - Marianna Mochen
- Department of Radiology, Santa Chiara Hospital, 38122 Trento, Italy
| | - Alessio Coser
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy
| | | | - Stefano Branzoli
- Cardiac Surgery Unit, Santa Chiara Hospital, 38122 Trento, Italy
- Department of Cardiac Surgery, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Patrizio Mazzone
- Cardiothoracovascular Department, Electrophysiology Unit, Niguarda Hospital, 20162 Milan, Italy
| | | | - Massimiliano Marini
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, 1090 Brussel, Belgium
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24
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Janzen ML, Davies B, Laksman ZW, Roberts JD, Sanatani S, Steinberg C, Tadros R, Cadrin-Tourigny J, MacIntyre C, Atallah J, Fournier A, Green MS, Hamilton R, Khan HR, Kimber S, White S, Joza J, Makanjee B, Ilhan E, Lee D, Hansom S, Hadjis A, Arbour L, Leather R, Seifer C, Angaran P, Simpson CS, Healey JS, Gardner M, Talajic M, Krahn AD. Management of Inherited Arrhythmia Syndromes: a HiRO Consensus Handbook on Process of Care. CJC Open 2023; 5:268-284. [PMID: 37124966 PMCID: PMC10140751 DOI: 10.1016/j.cjco.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 02/14/2023] [Indexed: 02/27/2023] Open
Abstract
Inherited arrhythmia syndromes are rare genetic conditions that predispose seemingly healthy individuals to sudden cardiac arrest and death. The Hearts in Rhythm Organization is a multidisciplinary Canadian network of clinicians, researchers, patients, and families that aims to improve care for patients and families with inherited cardiac conditions, focused on those that confer predisposition to arrhythmia and sudden cardiac arrest and/or death. The field is rapidly evolving as research discoveries increase. A streamlined, practical guide for providers to diagnose and follow pediatric and adult patients with inherited cardiac conditions represents a useful tool to improve health system utilization, clinical management, and research related to these conditions. This review provides consensus care pathways for 7 conditions, including the 4 most common inherited cardiac conditions that confer predisposition to arrhythmia, with scenarios to guide investigation, diagnosis, risk stratification, and management. These conditions include Brugada syndrome, long QT syndrome, arrhythmogenic right ventricular cardiomyopathy and related arrhythmogenic cardiomyopathies, and catecholaminergic polymorphic ventricular tachycardia. In addition, an approach to investigating and managing sudden cardiac arrest, sudden unexpected death, and first-degree family members of affected individuals is provided. Referral to specialized cardiogenetic clinics should be considered in most cases. The intention of this review is to offer a framework for the process of care that is useful for both experts and nonexperts, and related allied disciplines such as hospital management, diagnostic services, coroners, and pathologists, in order to provide high-quality, multidisciplinary, standardized care.
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25
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Tomas N, Kachekele ZA. Nurses' Knowledge, Attitudes, and Practice of Cardiopulmonary Resuscitation at a Selected Training Hospital in Namibia: A Cross-Sectional Survey. SAGE Open Nurs 2023; 9:23779608231216809. [PMID: 38020323 PMCID: PMC10676069 DOI: 10.1177/23779608231216809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 11/05/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023] Open
Abstract
Background Nurses play a key role in cases of cardiopulmonary arrest by promptly attending to and initiating cardiopulmonary resuscitation. Effective cardiopulmonary resuscitation thus requires nurses to possess appropriate attitudes, competencies, and adherence to the best nursing practice. Cardiac arrests are a prevalent cause of fatalities, being responsible for approximately 30% of deaths worldwide. Despite this statistic, however, research in this specific field is lacking in Namibia. Objective The objective of this research was to examine registered nurses' knowledge, attitudes toward, and practice with regard to cardiopulmonary resuscitation at a selected teaching hospital in Namibia. Methods A cross-sectional survey design using a self-administered questionnaire was utilized to purposively recruit 158 registered nurses from the inpatient and outpatient departments of a teaching hospital in Namibia. Descriptive and chi-square tests were performed using SPSSv26. Results The results of the study indicate that a significant percentage of nurses have limited knowledge (14.7 ± 1.50), negative attitudes (36.2 ± 4.8), and poor practice (11.16 ± 1.18) when it comes to cardiopulmonary resuscitation. Their poor knowledge is strongly associated with poor practice (χ2 = 9.162, P = .002). The study further revealed a significant correlation between the departments in which the nurses worked and their practice of cardiopulmonary resuscitation, suggesting that the work environment is a crucial factor in determining a nurse's approach to emergency care. Conclusion The findings of study indicate that the cardiopulmonary resuscitation practice in the selected hospital is unsafe due to the registered nurses' poor knowledge and negative attitudes. It is strongly recommended that hospital managers and policy-makers take steps to formulate guidelines that mandate regular cardiopulmonary resuscitation training at predetermined times.
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Affiliation(s)
- Nestor Tomas
- Department of General Nursing Science, Faculty of Health Sciences and Veterinary Medicine, School of Nursing and Public Health, University of Namibia (UNAM), Rundu, Namibia
| | - Zuze A. Kachekele
- Department of General Nursing Science, Faculty of Health Sciences and Veterinary Medicine, School of Nursing and Public Health, University of Namibia (UNAM), Rundu, Namibia
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26
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Sabbag A, Essayagh B, Barrera JDR, Basso C, Berni A, Cosyns B, Deharo JC, Deneke T, Di Biase L, Enriquez-Sarano M, Donal E, Imai K, Lim HS, Marsan NA, Turagam MK, Peichl P, Po SS, Haugaa KH, Shah D, de Riva Silva M, Bertrand P, Saba M, Dweck M, Townsend SN, Ngarmukos T, Fenelon G, Santangeli P, Sade LE, Corrado D, Lambiase P, Sanders P, Delacrétaz E, Jahangir A, Kaufman ES, Saggu DK, Pierard L, Delgado V, Lancellotti P. EHRA expert consensus statement on arrhythmic mitral valve prolapse and mitral annular disjunction complex in collaboration with the ESC Council on valvular heart disease and the European Association of Cardiovascular Imaging endorsed cby the Heart Rhythm Society, by the Asia Pacific Heart Rhythm Society, and by the Latin American Heart Rhythm Society. Europace 2022; 24:1981-2003. [PMID: 35951656 DOI: 10.1093/europace/euac125] [Citation(s) in RCA: 78] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/04/2022] [Indexed: 12/14/2022] Open
Affiliation(s)
- Avi Sabbag
- The Davidai Center for Rhythm Disturbances and Pacing, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel
| | - Benjamin Essayagh
- Department of Cardiovascular Medicine, Simone Veil Hospital, Cannes 06400, France.,Department of Cardiovascular Medicine, Mayo Clinic, Rochester 55905, Minnesota
| | | | - Cristina Basso
- Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, Università degli Studi di Padova, Padova 35128, Italy
| | - Ana Berni
- Cardiology and Cardiac Electrophysiology, EP Lab. Hospital Angeles Pedregal. Mexico City 10700, Board member, Mexican Society of Cardiology
| | - Bernard Cosyns
- Cardiology Department, Centrum voor hart en vaatziekten, Universitair Ziekenhuis Brussel, Free University of Brussels, Brussels 1090, Belgium
| | - Jean-Claude Deharo
- Department of Cardiology, L'hôpital de la Timone, Marseille, 13005, France
| | - Thomas Deneke
- Clinic for Interventional Electrophysiology, Heart Center RHÖN-KLINIKUM Campus Bad Neustadt, 97616, Germany
| | - Luigi Di Biase
- Albert Einstein College of Medicine at Montefiore Hospital, New York, NY 10467, USA
| | | | - Erwan Donal
- Service de Cardiologie, CCP-CHU Pontchaillou, Rennes 35033, France
| | - Katsuhiko Imai
- Department of Cardiovascular Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Hiroshima 737-0023, Japan
| | - Han S Lim
- Department of Cardiology, Austin and Northern Health, University of Melbourne, Melbourne 3010, Australia
| | | | - Mohit K Turagam
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Petr Peichl
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague 73117, Czech Republic
| | - Sunny S Po
- Heart Rhythm Institute and Section of Cardiovascular Diseases, University of Oklahoma Health Sciences Center, Oklahoma City, OK 0372, USA
| | - Kristina Hermann Haugaa
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Dipen Shah
- Cantonal Hospital, Cardiology Department, CH-1211 Geneva, Switzerland
| | - Marta de Riva Silva
- Department of Cardiology, Leiden University Medical Center, Leiden 2333, The Netherlands
| | - Philippe Bertrand
- Ziekenhuis Oost-Limburg, Hasselt University, Genk, Hasselt 3600, Belgium
| | - Magdi Saba
- Consultant and Reader in Cardiac Electrophysiology, Director, Advanced Ventricular Arrhythmia Training and Research Program, St. George's Hospital NHS Foundation Trust, St. George's, University of London, SW17 0QT, UK
| | - Marc Dweck
- Centre for cardiovascular science, University of Edinburgh, EH16 4TJ, UK
| | - Santiago Nava Townsend
- Instituto Nacional De Cardiologia Ich, Electrophysiology Department, Mexico Df 14080, Mexico
| | - Tachapong Ngarmukos
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 73170, Thailand
| | - Guilherme Fenelon
- Coordenador - Centro de Arritmia, Hospital Israelita Albert Einstein, São Paulo - SP, 05652-900, Brazil
| | | | - Leyla Elif Sade
- University of Pittsburgh, UPMC, Heart and Vascular Institute, ittsburgh, PA 15219, USA.,C.H.U. du Sart-Tilman, Universite de Liege, Liege 4000, Belgium
| | - Domenico Corrado
- Full Professor of Cardiovascular Medicine, Director, Inherited Arrhythmogenic Cardiomyopathies and Sports Cardiology Unit, Dept. of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padova 35122, Italy
| | - Pier Lambiase
- UCL & Barts Heart Centre, Co-Director of Cardiovascular Research Barts NHS Trust, Inherited Arrhythmia Clinical Lead, UCL MRC DTP Theme Lead, BHRS Committee Research Lead, Institute of Cardiovascular Science, UCL, Department of Cardiology, Barts Heart Centre E1 1BB, UK
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide, South Australia 5000, Australia
| | - Etienne Delacrétaz
- Clinique Cecil Hirslanden Lausanne & University Hospital Fribourg, Cardiology 1003, Switzerland
| | - Arshad Jahangir
- University of Wisconsin School of Medicine and Public Health, Milwaukee, MI 53705, USA
| | - Elizabeth S Kaufman
- Clinical Electrophysiologist, MetroHealth Medical Center, Professor, Case Western Reserve University 44106, USA
| | - Daljeet Kaur Saggu
- Consultant Cardiologist and Electrophysiologist, AIG HOSPITAL, Hyderabad 500032, India
| | - Luc Pierard
- C.H.U. du Sart-Tilman, Universite de Liege, Liege 4000, Belgium
| | - Victoria Delgado
- Heart Institute, Hospital University Germans Trias i Pujol, Badalona 08916, Spain
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27
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Crea F. Physical exercise, inflammation, and hypertension: how to improve cardiovascular prevention. Eur Heart J 2022; 43:4763-4766. [PMID: 36473697 DOI: 10.1093/eurheartj/ehac695] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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28
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Ensam B, Cheung CC, Almehmadi F, Gregers Winkel B, Scrocco C, Brennan P, Leong K, Muir A, Vanarva A, Tfelt-Hansen J, Roberts JD, Krahn AD, Behr ER. The Utility of Sodium Channel Provocation in Unexplained Cardiac Arrest Survivors and Electrocardiographic Predictors of Ventricular Fibrillation Recurrence. Circ Arrhythm Electrophysiol 2022; 15:e011263. [PMID: 36441561 PMCID: PMC10289235 DOI: 10.1161/circep.122.011263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 11/10/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The implications of a drug-induced type 1 Brugada ECG pattern following sodium channel blocker provocation (SCBP) are not fully understood. METHODS Baseline clinical and ECG data were obtained from consecutive unexplained cardiac arrest survivors undergoing SCBP at 3 centers. A further 15 SCBP positive (SCBP+) unexplained cardiac arrest survivors were recruited from 3 additional centers to explore ventricular fibrillation recurrence. RESULTS A total of 121 consecutive unexplained cardiac arrest survivors underwent SCBP. The yield of the drug-induced type 1 Brugada ECG pattern was 17%. A baseline type 2/3 Brugada pattern (T2/3BP) (adjusted odds ratio, 19.36 [2.74-136.61]; P=0.003) and PR interval (odds ratio, 1.03 [1.01-1.05] per ms; P=0.017) were independent predictors of SCBP+ response. A pathogenic SCN5A variant was identified in 36% of the SCBP+ group versus 0% in the SCBP- group (P<0.001). Amongst SCBP+ patients, a spontaneous type 1 Brugada pattern was identified in 19% during follow up and in 24% a type 1 Brugada pattern was identified in a relative. Prior syncope (adjusted hazard ratio, 3.83 [1.36-10.78]; P=0.011) and the presence of global early repolarization (hazard ratio, 7.91 [3.22-19.44]; P<0.001) were independent predictors of 5-year ventricular fibrillation recurrence. There was a nonsignificant trend toward greater 5-year ventricular fibrillation recurrence in the SCBP- group (23/95 [24%] versus 3/34 [9%]; P=0.055). CONCLUSIONS The yield of the drug-induced type 1 Brugada ECG pattern in consecutive unexplained cardiac arrest survivors undergoing SCBP is 17%. A baseline T2/3BP and PR interval were independent predictors of the drug-induced type 1 Brugada ECG pattern. Greater heritability of BrS phenotype in this group was evidenced by a greater prevalence of pathogenic SCN5A variants and relatives with a type 1 Brugada pattern. A history of prior syncope and the presence of global early repolarization were independent predictors of ventricular fibrillation recurrence.
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Affiliation(s)
- Bode Ensam
- Cardiology Clinical Academic Group, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom (B.E., C.S., E.R.B.)
- Institute of Molecular and Clinical Sciences, St George’s University of London, United Kingdom (B.E., C.S., E.R.B.)
| | - Christopher C. Cheung
- Center for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver (C.C.C., A.D.K.)
| | - Fahad Almehmadi
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada (F.A., J.D.R.)
| | - Bo Gregers Winkel
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (B.G.W., J.T.-H.)
| | - Chiara Scrocco
- Cardiology Clinical Academic Group, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom (B.E., C.S., E.R.B.)
- Institute of Molecular and Clinical Sciences, St George’s University of London, United Kingdom (B.E., C.S., E.R.B.)
| | - Paul Brennan
- Royal Victoria Hospital, Belfast, United Kingdom (P.B., A.M.)
| | - Kevin Leong
- Imperial College Healthcare NHS Trust, London, United Kingdom (K.L., A.V.)
| | - Alison Muir
- Royal Victoria Hospital, Belfast, United Kingdom (P.B., A.M.)
| | - Amanda Vanarva
- Imperial College Healthcare NHS Trust, London, United Kingdom (K.L., A.V.)
| | - Jacob Tfelt-Hansen
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (B.G.W., J.T.-H.)
- Section of Forensic Genetics, Department of Forensic Medicine, Copenhagen University, Denmark (J.T.-H.)
| | - Jason D. Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada (F.A., J.D.R.)
| | - Andrew D. Krahn
- Center for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver (C.C.C., A.D.K.)
| | - Elijah R. Behr
- Cardiology Clinical Academic Group, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom (B.E., C.S., E.R.B.)
- Institute of Molecular and Clinical Sciences, St George’s University of London, United Kingdom (B.E., C.S., E.R.B.)
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29
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Belhassen B, Tovia-Brodie O. Red Flags in Syncope: Clues for the Diagnosis of Idiopathic Ventricular Fibrillation. Am J Med 2022; 135:1434-1436. [PMID: 35878689 DOI: 10.1016/j.amjmed.2022.06.020] [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: 06/17/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 11/01/2022]
Abstract
Idiopathic ventricular fibrillation is responsible for ≈5%-7% of aborted cardiac arrest, mainly striking subjects in their forties. Syncope caused by short-coupled rapid polymorphic ventricular tachycardia is frequently noted in a patient's past history. However, a diagnosis of neurally mediated syncope, the most frequent cause of syncope in the young, is often erroneously made. Clinical clues suggest that syncope has an arrhythmic rather than a neurally mediated origin. In addition, the presence of premature ventricular contractions on an electrocardiogram recorded shortly after a syncopal event has utmost importance in establishing the cause of syncope. Although such extrasystoles are frequently benign, especially when associated with a long coupling interval, they also may suggest a malignant origin when closely coupled to the preceding complex with short coupling intervals (usually <350 ms). These arrhythmias mainly originate from the Purkinje system (usually the right ventricle in men and the left ventricle in women) and favorably respond to quinidine as well as to ablation therapy targeting Purkinje-fibers ectopic activity.
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Affiliation(s)
- Bernard Belhassen
- Heart Institute, Hadassah Medical Center, Jerusalem and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Oholi Tovia-Brodie
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
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30
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The Importance of Systematic Diagnostic Testing in Idiopathic Ventricular Fibrillation: Results From the Dutch iVF-Registry. JACC Clin Electrophysiol 2022; 9:345-355. [PMID: 36752476 DOI: 10.1016/j.jacep.2022.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/27/2022] [Accepted: 10/03/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Idiopathic ventricular fibrillation (iVF) is a diagnosis of exclusion. Systematic diagnostic testing is important to exclude alternative causes for VF. The early use of "high yield" testing, including cardiac magnetic resonance (CMR), exercise testing, and sodium channel blocker provocation, has been increasingly recognized. OBJECTIVES The purpose of this study was to investigate the importance and consistency of systematic diagnostic testing in iVF. METHODS This study included 423 iVF patients from 11 large secondary and tertiary hospitals in the Netherlands. Clinical characteristics and diagnostic testing data were ascertained. RESULTS IVF patients experienced the index event at a median age of 40 years (IQR: 28-52 years), and 61% were men. The median follow-up time was 6 years (IQR: 2-12 years). Over the years, "high yield" diagnostic tests were increasingly performed (mean 68% in 2000-2010 vs 75% in 2011-2021; P < 0.001). During follow-up, 38 patients (9%) originally labeled as iVF received an alternative diagnosis. Patients in whom "high-yield" diagnostic tests were consistently performed during the initial work-up received an alternative diagnosis less frequently during follow-up (HR: 0.439; 95% CI: 0.219-0.878; P = 0.020). Patients who received an alternative diagnosis during follow-up had a worse prognosis in terms of cardiac death (P = 0.012) with a trend toward more implantable cardioverter-defibrillator therapy (P = 0.055). CONCLUSIONS Although adherence to (near) complete diagnostic testing in this population of iVF patients increased over the years, patients with iVF still undergo varying levels of diagnostic evaluation. The latter leads to initial underdiagnosis of alternative conditions and is associated with a worse prognosis. Our results underscore the importance of early systematic diagnostic assessment in patients with apparent iVF.
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31
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Belhassen B, Tovia-Brodie O. To the Editor-Give to Caesar what belongs to Caesar. Heart Rhythm 2022; 19:1920. [PMID: 36002108 DOI: 10.1016/j.hrthm.2022.08.016] [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: 07/27/2022] [Accepted: 08/03/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Bernard Belhassen
- Heart Institute, Hadassah Medical Center, Jerusalem, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Oholi Tovia-Brodie
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
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32
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Steinberg C, Chakrabarti S. Response by Steinberg and Chakrabarti to Letter Regarding Article, "DREAM-ICD-II Study". Circulation 2022; 146:e91-e92. [PMID: 35994561 DOI: 10.1161/circulationaha.122.060915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Christian Steinberg
- Institut universitaire de cardiologie et pneumologie de Québec (IUCPQ-UL), Laval University, Quebec, Canada (C.S.)
| | - Santabhanu Chakrabarti
- Heart Rhythm Services and Center for Cardiovascular Innovation, Division of Cardiology, St-Paul's Hospital, University of British Columbia, Vancouver, Canada (S.C.)
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33
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Malignant Purkinje Ectopy induced by Sodium-channel Blocker. Heart Rhythm 2022; 19:1595-1603. [PMID: 35835363 DOI: 10.1016/j.hrthm.2022.06.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Sodium-Channel Blocker (SCB) infusion is used to unmask the ECG pattern of Brugada syndrome. The test may also induce premature ventricular complexes (PVCs) in individuals without Brugada pattern, the clinical relevance of which is little known. OBJECTIVE To describe the prevalence of short-coupled (Sc) PVCs induced by ajmaline or flecainide in patients with suspected or documented severe ventricular arrhythmias. METHODS We reviewed the SCB tests performed in 335 patients with suspected ventricular arrhythmias and structurally normal hearts in 9 centers. ScPVCs were defined as frequent and repetitive PVCs with an R-on-T pattern on SCB tests. Repeated SCB tests were performed in seven patients and electrophysiological mapping of ScPVCs in nine. RESULTS Sixteen patients (8 males, 36±11 years) showed ScPVCs and were included. ScPVCs appeared 229±118 sec after the start of the infusion and displayed coupling intervals of 288±28 ms. ScPVC patterns were monomorphic in 10 and polymorphic in 5 patients, originating from the Purkinje system in mapped patients. Repetitive PVCs were induced in 15 (94%) patients including polymorphic ventricular tachycardias in 9 (56%). SCB was repeated 45 (IQR 0.6-46) months later and induced identical ScPVC in all. SCB test was the only mean to reveal the malignant arrhythmia in six patients. Catheter ablation was performed in 9 patients, resulting in arrhythmia elimination in 8 with a follow-up of 6 (IQR 2-9) years. CONCLUSION SCB can induce ScPVC, mostly from Purkinje tissue, in a small subset of patients with idiopathic ventricular arrhythmias. Its high reproducibility suggests a distinct individual mechanism.
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Sarcoplasmic Reticulum Ca2+ Dysregulation in the Pathophysiology of Inherited Arrhythmia: An Update. Biochem Pharmacol 2022; 200:115059. [DOI: 10.1016/j.bcp.2022.115059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 11/19/2022]
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35
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Krahn AD, Tfelt-Hansen J, Tadros R, Steinberg C, Semsarian C, Han HC. Latent Causes of Sudden Cardiac Arrest. JACC Clin Electrophysiol 2022; 8:806-821. [PMID: 35738861 DOI: 10.1016/j.jacep.2021.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/09/2021] [Accepted: 12/29/2021] [Indexed: 11/30/2022]
Abstract
Inherited arrhythmia syndromes are a common cause of apparently unexplained cardiac arrest or sudden cardiac death. These include long QT syndrome and Brugada syndrome, with a well-recognized phenotype in most patients with sufficiently severe disease to lead to cardiac arrest. Less common and typically less apparent conditions that may not be readily evident include catecholaminergic polymorphic ventricular tachycardia, short QT syndrome and early repolarization syndrome. In cardiac arrest patients whose extensive testing does not reveal an underlying etiology, a diagnosis of idiopathic ventricular fibrillation or short-coupled ventricular fibrillation is assigned. This review summarizes our current understanding of the less common inherited arrhythmia syndromes and provides clinicians with a practical approach to diagnosis and management.
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Affiliation(s)
- Andrew D Krahn
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Jacob Tfelt-Hansen
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rafik Tadros
- Cardiovascular Genetics Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Québec, Canada
| | - Christian Steinberg
- Institut universitaire de cardiologie et pneumologie de Québec (IUCPQ-UL), Laval University, Inherited Arrhythmia Services, Départment of Cardiology and Cardiac Surgery, Québec, Canada
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Hui-Chen Han
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada; Victorian Heart Institute, Monash University, Clayton, Victoria, Australia
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Groeneveld SA, van der Ree MH, Mulder BA, Balt J, Wilde AAM, Postema PG, Hassink RJ. Prevalence of Short-Coupled Ventricular Fibrillation in a Large Cohort of Dutch Patients With Idiopathic Ventricular Fibrillation. Circulation 2022; 145:1437-1439. [PMID: 35500051 DOI: 10.1161/circulationaha.121.057878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sanne A Groeneveld
- Department of Cardiology, University Medical Center Utrecht, The Netherlands (S.A.G., R.J.H.)
| | - Martijn H van der Ree
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, The Netherlands (M.H.v.d.R., A.A.M.W., P.G.P.)
| | - Bart A Mulder
- Department of Cardiology, University Medical Center Groningen, The Netherlands (B.A.M.)
| | - Jippe Balt
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands (J.B.)
| | - Arthur A M Wilde
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, The Netherlands (M.H.v.d.R., A.A.M.W., P.G.P.)
| | - Pieter G Postema
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, The Netherlands (M.H.v.d.R., A.A.M.W., P.G.P.)
| | - Rutger J Hassink
- Department of Cardiology, University Medical Center Utrecht, The Netherlands (S.A.G., R.J.H.)
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Hashmath Z, Naniwadekar A. Idiopathic Ventricular Fibrillation Triggered by Premature Ventricular Complexes Originating from the False Tendon of the Left Ventricle. HeartRhythm Case Rep 2022; 8:515-519. [PMID: 35860782 PMCID: PMC9289068 DOI: 10.1016/j.hrcr.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Garmany R, Neves R, Ali Ahmed F, Tester DJ, Cannon BC, Giudicessi JR, Ackerman MJ. Red herring pathogenic variants: a case report of premature ventricular contraction-triggered ventricular fibrillation with an incidental pathogenic LMNA variant. Eur Heart J Case Rep 2022; 6:ytac115. [PMID: 35528128 PMCID: PMC9071339 DOI: 10.1093/ehjcr/ytac115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/18/2021] [Accepted: 03/08/2022] [Indexed: 12/04/2022]
Abstract
Background Pathogenic variants in the lamin A/C gene (LMNA) can lead to a wide range of phenotypes from dilated and arrhythmogenic cardiomyopathies and conduction abnormalities to partial lipodystrophies. This case highlights a coincidental pathogenic LMNA variant identified in a patient with sudden cardiac arrest (SCA). We demonstrate the need for careful interpretation of pathogenic variants identified in cardiomyopathy genes by highlighting a case in which a coincidental pathogenic LMNA variant was found in a patient with premature ventricular complex (PVC)-induced ventricular fibrillation (VF). Case summary We present the case of a 16-year-old male with SCA secondary to VF. Genetic testing identified a maternally inherited pathogenic variant in LMNA annotated c.1961dup; p.T655Nfs*49. The patient received an implantable cardiac defibrillator and was discharged on nadolol. The patient's two brothers were also variant-positive. However, the patient and both brothers had normal chamber dimensions on echocardiogram and no late gadolinium enhancement on cardiac magnetic resonance imaging. The family members with the variant were recommended to have prophylactic implantable cardiac defibrillators and thus sought a second opinion. The patient received an appropriate shock and device interrogation identified PVCs. Electrophysiology study identified PVC-induced VF which was ablated with no recurrent ventricular arrhythmias/implantable cardioverter defibrillator therapies over 8 months of follow-up. Although the variant in LMNA could lead to cardiac arrest, the clinical phenotype was consistent with a non-genetic aetiology. The family members were told to have periodic cardiac evaluation. Discussion This case demonstrates the identification of a coincidental pathogenic variant in a cardiomyopathy gene in a patient with cardiac arrest. Although this variant could lead to cardiomyopathy, it appears the cardiac arrest was not due to the pathogenic variant. This highlights the need to consider the clinical phenotype when interpreting genetic test results for cardiomyopathies even in the presence of a positive genetic test result.
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Affiliation(s)
- Ramin Garmany
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic Alix School of Medicine and the Mayo Clinic Medical Scientist Training Program, Rochester, MN 55905, USA
- Department of Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN 55905, USA
| | - Raquel Neves
- Department of Cardiovascular Medicine/Division of Heart Rhythm Services, Windland Smith Rice Genetic Heart Rhythm Clinic, Mayo Clinic, Guggenheim 501, 200 First Street SW, Rochester, MN 55905, USA
| | - Fatima Ali Ahmed
- Department of Cardiovascular Medicine/Division of Heart Rhythm Services, Windland Smith Rice Genetic Heart Rhythm Clinic, Mayo Clinic, Guggenheim 501, 200 First Street SW, Rochester, MN 55905, USA
| | - David J. Tester
- Department of Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN 55905, USA
| | - Bryan C. Cannon
- Department of Pediatric and Adolescent Medicine/Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN 55905, USA
| | - John R. Giudicessi
- Department of Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN 55905, USA
- Department of Cardiovascular Medicine/Division of Heart Rhythm Services, Windland Smith Rice Genetic Heart Rhythm Clinic, Mayo Clinic, Guggenheim 501, 200 First Street SW, Rochester, MN 55905, USA
- Department of Pediatric and Adolescent Medicine/Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Michael J. Ackerman
- Department of Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN 55905, USA
- Department of Cardiovascular Medicine/Division of Heart Rhythm Services, Windland Smith Rice Genetic Heart Rhythm Clinic, Mayo Clinic, Guggenheim 501, 200 First Street SW, Rochester, MN 55905, USA
- Department of Pediatric and Adolescent Medicine/Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN 55905, USA
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39
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Belhassen B, Tovia-Brodie O. Short-Coupled Idiopathic Ventricular Fibrillation: A Literature Review With Extended Follow-Up. JACC Clin Electrophysiol 2022; 8:918-936. [PMID: 35597766 DOI: 10.1016/j.jacep.2022.04.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/25/2022] [Accepted: 04/18/2022] [Indexed: 01/07/2023]
Abstract
Idiopathic ventricular fibrillation is responsible for approximately 10% of cases of aborted cardiac arrest. Recent studies have shown that short-coupled ventricular premature complexes are present at the onset of idiopathic ventricular fibrillation in 6.6%-17% of patients. The present review provided information on 86 patients with short-coupled malignant ventricular arrhythmias that were reported as case reports or small patient series during the last 70 years. In 75% of the 81 cases published during the last 40 years, extended information and follow-up (from 2.63 ± 4.5 to 10.67 ± 7.8 years; P < 0.001, between the original publication to the latest update) could be obtained from the authors. The review shows that short-coupled malignant ventricular arrhythmias occurred almost equally in males and females, at the mean age of 40 years. A tendency for later occurrence of the arrhythmia by 4 years was observed in females. A prior history of syncope was noted in 45.3% of the patients, whereas arrhythmic storm occurred in 42% at presentation. The most common mode of revelation of short-coupled malignant ventricular arrhythmias was syncope (53.5%), followed by aborted cardiac arrest (26.7%) and recurrent arrhythmic event after prior implantable-cardioverter defibrillator implantation for idiopathic ventricular fibrillation (17.4%). For the first time, short-coupled malignant arrhythmias exhibiting "not-so-short" coupling intervals (≥350 ms) were found in a significant proportion of patients (17.4%). During long-term follow-up, quinidine yielded a slightly higher success rate in arrhythmia control than ablation. Larger studies are necessary to assess the best strategy for the management of this potentially lethal arrhythmia.
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Affiliation(s)
- Bernard Belhassen
- Heart Institute, Hadassah Medical Center, Jerusalem, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Oholi Tovia-Brodie
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel; Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
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40
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Franciosi S, Abrams DJ, Ingles J, Sanatani S. Sudden Cardiac Arrest in the Paediatric Population. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2022; 1:45-59. [PMID: 37969243 PMCID: PMC10642157 DOI: 10.1016/j.cjcpc.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/03/2022] [Indexed: 11/17/2023]
Abstract
Sudden cardiac arrest in the young is a rare event with a range of potential causes including cardiomyopathies, ion channelopathies, and autonomic nervous system dysfunction. Investigations into the cause involve a multidisciplinary team, including cardiologists, geneticists, and psychologists. In addition to a detailed medical history, family history and circumstances surrounding the event are important in determining the cause. Clinical investigations including an electrocardiogram are fundamental in diagnosis and should be interpreted cautiously because some children may have atypical presentations and an evolving phenotype. The potential for misdiagnosis exists that could lead to incorrect long-term management strategies. If an inherited condition is suspected, genetic testing of the patient and cascade screening of family members is recommended with genetic counselling and psychological support. Medical management is left to the treating physician acknowledging that a clear diagnosis cannot be made in approximately half of cases. Secondary prevention implantable defibrillators are widely deployed but can be associated with complications in young patients. A plan for safe return to activity is recommended along with a proper transition of care into adulthood. Broad screening of the general population for arrhythmia syndromes is not recommended; preventative measures include screening paediatric patients for risk factors by their primary care physician. Several milestone events or activities that take place in youth could be used as opportunities to promote safety. Further work into risk stratification of this paediatric population through patient registries and greater awareness of cardiopulmonary resuscitation and automated external defibrillator use in saving lives is warranted.
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Affiliation(s)
- Sonia Franciosi
- BC Children’s Hospital Heart Centre, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dominic J. Abrams
- Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jodie Ingles
- Centre for Population Genomics, Garvan Institute of Medical Research, and UNSW Sydney, Sydney, New South Wales, Australia
- Centre for Population Genomics, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Shubhayan Sanatani
- BC Children’s Hospital Heart Centre, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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41
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Christensen AH, Vissing CR, Pietersen A, Tfelt-Hansen J, Hartvig Lindkær Jensen T, Pehrson S, Henriksen FL, Sandgaard NCF, Iversen KK, Jensen HK, Olesen MS, Bundgaard H. Electrocardiographic Findings, Arrhythmias, and Left Ventricular Involvement in Familial ST-Depression Syndrome. Circ Arrhythm Electrophysiol 2022; 15:e010688. [PMID: 35357203 DOI: 10.1161/circep.121.010688] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Familial ST-depression syndrome is an inherited disease characterized by persistent, nonischemic ST-deviations, and risk of arrhythmias and heart failure. We aimed at further characterizing the ECG, arrhythmias, and structural characteristics associated with this novel syndrome. METHODS Retrospective analysis of data from consecutive families with familial ST-depression Syndrome in Denmark. ECG features, prevalence and type of arrhythmias, occurrence of systolic dysfunction, and medium-term outcome were analyzed. RESULTS Forty affected individuals (43% men; mean age at diagnosis 49.1 years) from 14 apparently unrelated families with ≥2 affected members were included. Autosomal dominant inheritance was observed in all families. The ECG phenotype seemed to develop in prepuberty and the ST-deviations were persistent and most pronounced in leads V4/V5/II, respectively. Serial ECG analyses showed stable to slow progression of the ECG phenotype. Exercise accentuated the ST-deviations with a maximum difference between rest/stress (mean) of -117 μV in lead V5. During a mean follow-up of 9.3±7.1 years 5 (13%) patients developed sustained ventricular arrhythmias or (aborted) sudden cardiac death, 10 (25%) developed atrial fibrillation, 2 (5%) other supraventricular arrhythmias, and 10 (25%) were diagnosed with left ventricular ejection fraction ≤50%. The ventricular arrhythmias were polymorphic with relatively short-coupled premature ventricular contractions at onset (300-360 ms); no QT prolongation was observed. Seven patients had at least one catheter ablation; 5 for supraventricular arrhythmias and 2 for ventricular arrhythmias. Males experienced more arrhythmic end points than females (P<0.01). CONCLUSIONS The familial ST-depression ECG phenotype is stable to slowly progressive after medium-term follow-up. Clinically, both supra- and ventricular arrhythmias are common; as are some degree of left ventricular systolic dysfunction. Familial ST-depression represent a novel inherited cause of polymorphic ventricular tachycardia.
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Affiliation(s)
- Alex Hørby Christensen
- The Unit for Inherited Cardiac Diseases, Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark & Department of Clinical Medicine (A.H.C., C.R.V., J.T.-H., S.P., H.B.), The Heart Centre, Rigshospitalet, University of Copenhagen.,Department of Cardiology, Herlev-Gentofte Hospital (A.H.C., A.P., K.K.I.), Copenhagen University Hospital
| | - Christoffer Rasmus Vissing
- The Unit for Inherited Cardiac Diseases, Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark & Department of Clinical Medicine (A.H.C., C.R.V., J.T.-H., S.P., H.B.), The Heart Centre, Rigshospitalet, University of Copenhagen
| | - Adrian Pietersen
- Department of Cardiology, Herlev-Gentofte Hospital (A.H.C., A.P., K.K.I.), Copenhagen University Hospital
| | - Jacob Tfelt-Hansen
- The Unit for Inherited Cardiac Diseases, Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark & Department of Clinical Medicine (A.H.C., C.R.V., J.T.-H., S.P., H.B.), The Heart Centre, Rigshospitalet, University of Copenhagen.,Department of Forensic Medicine, Faculty of Medical Sciences (J.T.-H.), The Heart Centre, Rigshospitalet, University of Copenhagen
| | | | - Steen Pehrson
- The Unit for Inherited Cardiac Diseases, Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark & Department of Clinical Medicine (A.H.C., C.R.V., J.T.-H., S.P., H.B.), The Heart Centre, Rigshospitalet, University of Copenhagen
| | | | | | - Kasper Karmark Iversen
- Department of Cardiology, Herlev-Gentofte Hospital (A.H.C., A.P., K.K.I.), Copenhagen University Hospital
| | - Henrik Kjærulf Jensen
- Department of Cardiology, Aarhus University Hospital (H.K.J.).,Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark (H.K.J.)
| | - Morten Salling Olesen
- Laboratory for Molecular Cardiology (M.S.O.), The Heart Centre, Rigshospitalet, University of Copenhagen
| | - Henning Bundgaard
- The Unit for Inherited Cardiac Diseases, Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark & Department of Clinical Medicine (A.H.C., C.R.V., J.T.-H., S.P., H.B.), The Heart Centre, Rigshospitalet, University of Copenhagen
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42
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Crea F. Novel mechanistic insights into ventricular arrhythmias and sudden death. Eur Heart J 2022; 43:1177-1180. [DOI: 10.1093/eurheartj/ehac115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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43
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Nine Reasons for Performing an Electrophysiologic Study in Patients with Apparently Idiopathic Ventricular Fibrillation. Heart Rhythm 2022; 19:1212-1213. [DOI: 10.1016/j.hrthm.2022.03.010] [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: 02/07/2022] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 11/19/2022]
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Lador A, Giudicessi JR, Barake WM, Noseworthy PA, Kapa S, McLeod CJ, Cannon BC, Asirvatham SJ, Ackerman MJ. Premature Ventricular Contraction-Triggered Ventricular Fibrillation and Sudden Cardiac Arrest in the Young. JACC Clin Electrophysiol 2022; 8:380-382. [PMID: 35331434 DOI: 10.1016/j.jacep.2021.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/13/2021] [Accepted: 09/29/2021] [Indexed: 11/29/2022]
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45
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Kelley BP, Chaudry AM, Syed FF. Developing a Mechanistic Approach to Sudden Death Prevention in Mitral Valve Prolapse. J Clin Med 2022; 11:jcm11051285. [PMID: 35268384 PMCID: PMC8910972 DOI: 10.3390/jcm11051285] [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: 12/20/2021] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 11/30/2022] Open
Abstract
Sudden cardiac death (SCD) from ventricular fibrillation (VF) can occur in mitral valve prolapse (MVP) in the absence of other comorbidities including mitral regurgitation, heart failure or coronary disease. Although only a small proportion with MVP are at risk, it can affect young, otherwise healthy adults, most commonly premenopausal women, often as the first presentation of MVP. In this review, we discuss arrhythmic mechanisms in MVP and mechanistic approaches for sudden death risk assessment and prevention. We define arrhythmogenic or arrhythmic MVP (AMVP) as MVP associated with complex and frequent ventricular ectopy, and malignant MVP (MMVP) as MVP with high risk of SCD. Factors predisposing to AMVP are myxomatous, bileaflet MVP and mitral annular disjunction (MAD). Data from autopsy, cardiac imaging and electrophysiological studies suggest that ectopy in AMVP is due to inflammation, fibrosis and scarring within the left ventricular (LV) base, LV papillary muscles and Purkinje tissue. Postulated mechanisms include repetitive injury to these regions from systolic papillary muscle stretch and abrupt mitral annular dysmotility (excursion and curling) and diastolic endocardial interaction of redundant mitral leaflets and chordae. Whereas AMVP is seen relatively commonly (up to 30%) in those with MVP, MVP-related SCD is rare (2–4%). However, the proportion at risk (i.e., with MMVP) is unknown. The clustering of cardiac morphological and electrophysiological characteristics similar to AMVP in otherwise idiopathic SCD suggests that MMVP arises when specific arrhythmia modulators allow for VF initiation and perpetuation through action potential prolongation, repolarization heterogeneity and Purkinje triggering. Adequately powered prospective studies are needed to assess strategies for identifying MMVP and the primary prevention of SCD, including ICD implantation, sympathetic modulation and early surgical mitral valve repair. Given the low event rate, a collaborative multicenter approach is essential.
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Affiliation(s)
- Brian P. Kelley
- Division of Cardiology, University of North Carolina, Chapel Hill, NC 27599, USA;
| | | | - Faisal F. Syed
- Division of Cardiology, University of North Carolina, Chapel Hill, NC 27599, USA;
- Correspondence:
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46
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Neves R, Tester DJ, Simpson MA, Behr ER, Ackerman MJ, Giudicessi JR. Exome Sequencing Highlights a Potential Role for Concealed Cardiomyopathies in Youthful Sudden Cardiac Death. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2022; 15:e003497. [PMID: 34949102 DOI: 10.1161/circgen.121.003497] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sudden cardiac arrest (SCA) and sudden unexplained death (SUD) are feared sequelae of many genetic heart diseases. In rare circumstances, pathogenic variants in cardiomyopathy-susceptibility genes may result in electrical instability leading to SCA/SUD before any structural manifestations of underlying cardiomyopathy are evident. METHODS Collectively, 38 unexplained SCA survivors (21 males; mean age at SCA 26.4±13.1 years), 68 autopsy-inconclusive SUD cases (46 males; mean age at death 20.4±9.0 years) without disease-causative variants in the channelopathy genes, and 973 ostensibly healthy controls were included. Following exome sequencing, ultrarare (minor allele frequency ≤0.00005 in any ethnic group within Genome Aggregation Database [gnomAD, N=141 456 individuals]) nonsynonymous variants identified in 24 Clinical Genome Resource adjudicated definitive/strong evidence cardiomyopathy-susceptibility genes were analyzed. Eligible variants were adjudicated as pathogenic, likely pathogenic, or variant of uncertain significance in accordance with current American College of Medical Genetics and Genomics guidelines. RESULTS Overall, 7 out of 38 (18.4%) SCA survivors and 14 out of 68 (20.5%) autopsy-inconclusive, channelopathic-negative SUD cases had at least one pathogenic/likely pathogenic or a variant of uncertain significance nonsynonymous variant within a strong evidence, cardiomyopathy-susceptibility gene. Following American College of Medical Genetics and Genomics criterion variant adjudication, a pathogenic or likely pathogenic variant was identified in 3 out of 38 (7.9%; P=0.05) SCA survivors and 8 out of 68 (11.8%; P=0.0002) autopsy-inconclusive SUD cases compared to 20 out of 973 (2.1%) European controls. Interestingly, the yield of pathogenic/likely pathogenic variants was significantly greater in autopsy-inconclusive SUD cases with documented interstitial fibrosis (4/11, 36%) compared with only 4 out of 57 (7%, P<0.02) SUD cases without ventricular fibrosis. CONCLUSIONS Our data further supports the inclusion of strong evidence cardiomyopathy-susceptibility genes on the genetic testing panels used to evaluate unexplained SCA survivors and autopsy-inconclusive/negative SUD decedents. However, to avoid diagnostic miscues, the careful interpretation of genetic test results in patients without overt phenotypes is vital.
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Affiliation(s)
- Raquel Neves
- Division of Heart Rhythm Services, Departments of Cardiovascular Medicine (R.N., D.J.T., M.J.A.), Mayo Clinic, Rochester, MN.,Division of Pediatric Cardiology, Pediatric and Adolescent Medicine (R.N., D.J.T., M.J.A.), Mayo Clinic, Rochester, MN.,Windland Smith Rice Sudden Death Genomics Laboratory, Molecular Pharmacology & Experimental Therapeutics (R.N., D.J.T., M.J.A.), Mayo Clinic, Rochester, MN
| | - David J Tester
- Division of Heart Rhythm Services, Departments of Cardiovascular Medicine (R.N., D.J.T., M.J.A.), Mayo Clinic, Rochester, MN.,Division of Pediatric Cardiology, Pediatric and Adolescent Medicine (R.N., D.J.T., M.J.A.), Mayo Clinic, Rochester, MN.,Windland Smith Rice Sudden Death Genomics Laboratory, Molecular Pharmacology & Experimental Therapeutics (R.N., D.J.T., M.J.A.), Mayo Clinic, Rochester, MN
| | | | - Elijah R Behr
- St George's University of London and St George's University Hospitals' NHS Foundation Trust, United Kingdom (E.R.B.)
| | - Michael J Ackerman
- Division of Heart Rhythm Services, Departments of Cardiovascular Medicine (R.N., D.J.T., M.J.A.), Mayo Clinic, Rochester, MN.,Division of Pediatric Cardiology, Pediatric and Adolescent Medicine (R.N., D.J.T., M.J.A.), Mayo Clinic, Rochester, MN.,Windland Smith Rice Sudden Death Genomics Laboratory, Molecular Pharmacology & Experimental Therapeutics (R.N., D.J.T., M.J.A.), Mayo Clinic, Rochester, MN
| | - John R Giudicessi
- Divisions of Heart Rhythm Services and Circulatory Failure, Department of Cardiovascular Medicine (J.R.G.), Mayo Clinic, Rochester, MN
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47
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Crijns HJ, Sanders P, Albert CM, Lambiase PD. OUP accepted manuscript. Eur Heart J 2022; 43:1191-1197. [PMID: 35137041 PMCID: PMC9313516 DOI: 10.1093/eurheartj/ehac007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 12/22/2021] [Accepted: 01/06/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Prashantan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Christine M. Albert
- Department of Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center (CMA), Los Angeles, CA, USA
| | - Pier D. Lambiase
- Department of Cardiology, University College London and Barts Heart Centre, London, UK
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48
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Elsokkari I, Tsuji Y, Sapp JL, Nattel S. Recent insights into mechanisms and clinical approaches to electrical storm. Can J Cardiol 2021; 38:439-453. [PMID: 34979281 DOI: 10.1016/j.cjca.2021.12.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/21/2021] [Accepted: 12/30/2021] [Indexed: 12/14/2022] Open
Abstract
Electrical storm, characterized by repetitive ventricular tachycardia/fibrillation (VT/VF) over a short period, is becoming commoner with widespread use of implantable cardioverter-defibrillator (ICD) therapy. Electrical storm, sometimes called "arrhythmic storm" or "VT-storm", is usually a medical emergency requiring hospitalization and expert management, and significantly affects short- and long-term outcomes. This syndrome typically occurs in patients with underlying structural heart disease (ischemic or non-ischemic cardiomyopathy) or inherited channelopathies. Triggers for electrical storm should be sought but are often unidentifiable. Initial management is dictated by the hemodynamic status, while subsequent management typically involves ICD interrogation and reprogramming to reduce recurrent shocks, identification/management of triggers like electrolyte abnormalities, myocardial ischemia, or decompensated heart failure, and antiarrhythmic-drug therapy or catheter ablation. Sympathetic nervous system activation is central to the initiation and maintenance of arrhythmic storm, so autonomic modulation is a cornerstone of management. Sympathetic inhibition can be achieved with medications (particularly beta-adrenoreceptor blockers), deep sedation, or cardiac sympathetic denervation. More definitive management targets the underlying ventricular arrhythmia substrate to terminate and prevent recurrent arrhythmia. Arrhythmia targeting can be achieved with antiarrhythmic medications, catheter ablation or more novel therapies such as stereotactic radiation therapy that targets the arrhythmic substrate. Mechanistic studies point to adrenergic activation and other direct consequences of ICD-shocks in promoting further arrhythmogenesis and hypocontractility. Here, we review the pathophysiologic mechanisms, clinical features, prognosis, and therapeutic options for electrical storm. We also outline a clinical approach to this challenging and complex condition, along with its mechanistic basis.
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Affiliation(s)
- Ihab Elsokkari
- University of Sydney, Nepean Blue Mountains local health district, Australia
| | - Yukiomi Tsuji
- Department of Physiology of Visceral Function, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - John L Sapp
- Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada.
| | - Stanley Nattel
- Departments of Medicine and Research Center, Montreal Heart Institute and Université de Montréal and Pharmacology and Therapeutics McGill University, Montreal, Quebec, Canada; Institute of Pharmacology, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany; IHU LIYRC Institute, Bordeaux, France.
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Raymond-Paquin A, Lovejoy S, Ellenbogen KA, Padala SK. High-resolution mapping and successful ablation of Purkinje ectopy–triggered ventricular fibrillation storm. HeartRhythm Case Rep 2021; 8:217-221. [PMID: 35492838 PMCID: PMC9039689 DOI: 10.1016/j.hrcr.2021.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Alexandre Raymond-Paquin
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Québec, Canada
- Address reprint requests and correspondence: Dr Alexandre Raymond-Paquin, Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Gateway Building, 3rd floor, 3-216, 1200 East Marshall St, Richmond, VA.
| | | | - Kenneth A. Ellenbogen
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Santosh K. Padala
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
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Kataoka N, Nagase S, Okawa K, Aiba T, Kinugawa K, Kusano K. Multifocal Purkinje-related premature contractions and electrical storm suppressed by quinidine and verapamil in a case with short-coupled ventricular fibrillation. J Cardiol Cases 2021; 25:338-342. [DOI: 10.1016/j.jccase.2021.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 11/18/2021] [Accepted: 12/06/2021] [Indexed: 10/19/2022] Open
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