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Leo M, Sharp AJ, Gala ABE, Pope MTB, Betts TR. Transvenous or subcutaneous implantable cardioverter defibrillator: a review to aid decision-making. J Interv Card Electrophysiol 2022:10.1007/s10840-022-01299-6. [PMID: 35835888 DOI: 10.1007/s10840-022-01299-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/06/2022] [Indexed: 01/08/2023]
Abstract
The implantable cardioverter-defibrillator (ICD) is a proven treatment for preventing sudden cardiac death. Transvenous leads are associated with significant mortality and morbidity, and the subcutaneous ICD (S-ICD) addresses this. However, it is not without limitations, in particular the absence of anti-tachycardia pacing. The decision of which device is most suitable for an individual patient is often complex. Here, we review the relative merits and weaknesses of both the transvenous and S-ICD. We summarise the available evidence for each device in particular patient cohorts, namely: ischaemic and non-ischaemic cardiomyopathy, idiopathic ventricular fibrillation, Brugada syndrome, long QT syndrome, arrhythmogenic right ventricular cardiomyopathy, and hypertrophic cardiomyopathy.
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Affiliation(s)
- Milena Leo
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alexander J Sharp
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - Andre Briosa E Gala
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Michael T B Pope
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Timothy R Betts
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Antzelevitch C, Di Diego JM. J wave syndromes: What's new? Trends Cardiovasc Med 2021; 32:350-363. [PMID: 34256120 PMCID: PMC8743304 DOI: 10.1016/j.tcm.2021.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/03/2021] [Accepted: 07/04/2021] [Indexed: 12/19/2022]
Abstract
Among the inherited ion channelopathies associated with potentially life-threatening ventricular arrhythmia syndromes in nominally structurally normal hearts are the J wave syndromes, which include the Brugada (BrS) and early repolarization (ERS) syndromes. These ion channelopathies are responsible for sudden cardiac death (SCD), most often in young adults in the third and fourth decade of life. Our principal goal in this review is to briefly outline the clinical characteristics, as well as the molecular, ionic, cellular, and genetic mechanisms underlying these primary electrical diseases that have challenged the cardiology community over the past two decades. In addition, we discuss our recently developed whole-heart experimental model of BrS, providing compelling evidence in support of the repolarization hypothesis for the BrS phenotype as well as novel findings demonstrating that voltage-gated sodium and transient outward current channels can modulate each other's function via trafficking and gating mechanisms with implications for improved understanding of the genetics of both cardiac and neuronal syndromes.
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Affiliation(s)
- Charles Antzelevitch
- Distinguished Professor Emeritus and Executive Director, Cardiovascular Research, Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA; Lankenau Institute for Medical Research, Wynnwoddm PA USA; Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia PA, USA.
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3
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Sapp JA, Gillis AM, AbdelWahab A, Nault I, Nery PB, Healey JS, Raj SR, Lockwood E, Sterns LD, Sears SF, Wells GA, Yee R, Philippon F, Tang A, Parkash R. Remote-only monitoring for patients with cardiac implantable electronic devices: a before-and-after pilot study. CMAJ Open 2021; 9:E53-E61. [PMID: 33495385 PMCID: PMC7843075 DOI: 10.9778/cmajo.20200041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Outcomes for patients with cardiac implantable electronic devices are better when follow-up incorporates remote monitoring technology in addition to in-clinic visits. For patients with implantable devices, we sought to determine the feasibility, safety and associated health care utilization of remote-only follow-up, along with its effects on patients' quality of life and costs. METHODS This multicentre before-and-after pilot study involved patients with new or existing pacemakers or implantable cardioverter defibrillators. The "before" phase of the study spanned the period October 2015 to February 2017; the "after" phase spanned the period October 2016 to February 2018. The exposure was remote-only follow-up in combination with Remote View, a service that facilitates access to device data, allowing device settings to be viewed remotely to facilitate remote programming. Outcomes at 12 months were feasibility (adherence to remote monitoring), safety (rate of adverse events) and health care utilization (remote and in-clinic appointments). We also assessed quality of life, using 3 validated scales, and costs, taking into account both health care system and patient costs. RESULTS A total of 176 patients were enrolled. Adherence (defined as at least 1 successful remote transmission during follow-up) was 87% over a mean follow-up of 11.7 (standard deviation 2.2) months. There was a reduction in in-clinic visits at specialized sites among patients with both implantable defibrillators (26 v. 5, p < 0.001, n = 48) and pacemakers (42 v. 10, p < 0.001, n = 51). There was no significant change in visits to community sites for patients with defibrillators (13 v. 17, p = 0.3, n = 48). The composite rate of death, stroke, cardiovascular hospitalization and device-related hospitalization was 7% (n = 164). No adverse events were linked to the intervention. There was no change in quality-of-life scales between baseline and 12 months. Health care costs were reduced by 31% for patients with defibrillators and by 44% for those with pacemakers. INTERPRETATION This pilot study showed the feasibility of remote-only follow-up, with no increase in adverse clinical outcomes and no effect on quality of life, but with reductions in costs and health care utilization. These results support progression to a larger-scale study of whether superior effectiveness and reduced cost can be achieved, with preservation of safety, through use of remote-only follow-up. TRIAL REGISTRATION ClinicalTrials.gov, no. NCT02585817.
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Affiliation(s)
- John A Sapp
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Anne M Gillis
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Amir AbdelWahab
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Isabelle Nault
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Pablo B Nery
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Jeff S Healey
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Satish R Raj
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Evan Lockwood
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Laurence D Sterns
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Samuel F Sears
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - George A Wells
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Raymond Yee
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - François Philippon
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Anthony Tang
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Ratika Parkash
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont.
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Lopes MACQ, Oliveira GMMD, Ribeiro ALP, Pinto FJ, Rey HCV, Zimerman LI, Rochitte CE, Bacal F, Polanczyk CA, Halperin C, Araújo EC, Mesquita ET, Arruda JA, Rohde LEP, Grinberg M, Moretti M, Caramori PRA, Botelho RV, Brandão AA, Hajjar LA, Santos AF, Colafranceschi AS, Etges APBDS, Marino BCA, Zanotto BS, Nascimento BR, Medeiros CR, Santos DVDV, Cook DMA, Antoniolli E, Souza Filho EMD, Fernandes F, Gandour F, Fernandez F, Souza GEC, Weigert GDS, Castro I, Cade JR, Figueiredo Neto JAD, Fernandes JDL, Hadlich MS, Oliveira MAP, Alkmim MB, Paixão MCD, Prudente ML, Aguiar Netto MAS, Marcolino MS, Oliveira MAD, Simonelli O, Lemos Neto PA, Rosa PRD, Figueira RM, Cury RC, Almeida RC, Lima SRF, Barberato SH, Constancio TI, Rezende WFD. Guideline of the Brazilian Society of Cardiology on Telemedicine in Cardiology - 2019. Arq Bras Cardiol 2020; 113:1006-1056. [PMID: 31800728 PMCID: PMC7020958 DOI: 10.5935/abc.20190205] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Carlos Eduardo Rochitte
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | - Fernando Bacal
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | - Carisi Anne Polanczyk
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brazil.,Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brazil.,Instituto de Avaliação de Tecnologias em Saúde (IATS), Porto Alegre, RS - Brazil
| | | | | | | | | | | | - Max Grinberg
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | - Miguel Moretti
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | | | - Roberto Vieira Botelho
- Instituto do Coração do Triângulo (ICT), Uberlândia, MG - Brazil.,International Telemedical Systems do Brasil (ITMS), Uberlândia, MG - Brazil
| | | | - Ludhmila Abrahão Hajjar
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | | | | | | | - Bárbara Campos Abreu Marino
- Hospital Madre Teresa, Belo Horizonte, MG - Brazil.,Pontifícia Universidade Católica de Minas Gerais (PUCMG), Belo Horizonte, MG - Brazil
| | - Bruna Stella Zanotto
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brazil.,Instituto de Avaliação de Tecnologias em Saúde (IATS), Porto Alegre, RS - Brazil
| | - Bruno Ramos Nascimento
- Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brazil
| | | | | | - Daniela Matos Arrowsmith Cook
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brazil.,Hospital Copa Star, Rio de Janeiro, RJ - Brazil.,Hospital dos Servidores do Estado do Rio de Janeiro, Rio de Janeiro, RJ - Brazil
| | | | - Erito Marques de Souza Filho
- Universidade Federal Fluminense (UFF), Rio de Janeiro, RJ - Brazil.,Universidade Federal Rural do Rio de Janeiro, Seropédica, RJ - Brazil
| | | | - Fabio Gandour
- Universidade de Brasília (UnB), Brasília, DF - Brazil
| | | | | | | | - Iran Castro
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS - Brazil.,Fundação Universitária de Cardiologia, Porto Alegre, RS - Brazil
| | | | | | | | - Marcelo Souza Hadlich
- Fleury Medicina e Saúde, Rio de Janeiro, RJ - Brazil.,Rede D'Or, Rio de Janeiro, RJ - Brazil.,Unimed-Rio, Rio de Janeiro, RJ - Brazil
| | | | - Maria Beatriz Alkmim
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brazil.,Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brazil
| | | | | | | | | | | | - Osvaldo Simonelli
- Conselho Regional de Medicina do Estado de São Paulo, São Paulo, SP - Brazil.,Instituto Paulista de Direito Médico e da Saúde (IPDMS), Ribeirão Preto, SP - Brazil
| | | | - Priscila Raupp da Rosa
- Hospital Israelita Albert Einstein, São Paulo, SP - Brazil.,Hospital Sírio Libanês, São Paulo, SP - Brazil
| | | | | | | | | | - Silvio Henrique Barberato
- CardioEco-Centro de Diagnóstico Cardiovascular, Curitiba, PR - Brazil.,Quanta Diagnóstico e Terapia, Curitiba, PR - Brazil
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Vlachos K, Mascia G, Martin CA, Bazoukis G, Frontera A, Cheniti G, Letsas KP, Efremidis M, Georgopoulos S, Gkalapis C, Duchateau J, Parmbrun T, Derval N, Hocini M, Haissaguerre M, Jais P, Sacher F. Atrial fibrillation in Brugada syndrome: Current perspectives. J Cardiovasc Electrophysiol 2020; 31:975-984. [DOI: 10.1111/jce.14361] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/10/2020] [Accepted: 01/15/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Konstantinos Vlachos
- Hôpital Cardiologique du Haut LévèqueCHU de Bordeaux and IHU‐LIRYC Pessac France
| | - Giuseppe Mascia
- Cardiology and Electrophysiology UnitAzienda USL Toscana Florence Italy
| | - Claire A. Martin
- Hôpital Cardiologique du Haut LévèqueCHU de Bordeaux and IHU‐LIRYC Pessac France
- Department of Electrophysiology‐CardiologyRoyal Papworth Hospital Cambridge UK
| | - George Bazoukis
- Laboratory of Electrophysiology, Second Department of CardiologyGeneral Hospital of Athens “Evangelismos" Athens Greece
| | - Antonio Frontera
- Hôpital Cardiologique du Haut LévèqueCHU de Bordeaux and IHU‐LIRYC Pessac France
| | - Ghassen Cheniti
- Hôpital Cardiologique du Haut LévèqueCHU de Bordeaux and IHU‐LIRYC Pessac France
| | - Konstantinos P. Letsas
- Laboratory of Electrophysiology, Second Department of CardiologyGeneral Hospital of Athens “Evangelismos" Athens Greece
| | - Micheal Efremidis
- Laboratory of Electrophysiology, Second Department of CardiologyGeneral Hospital of Athens “Evangelismos" Athens Greece
| | - Stamatis Georgopoulos
- Laboratory of Electrophysiology, Second Department of CardiologyGeneral Hospital of Athens “Evangelismos" Athens Greece
| | - Charis Gkalapis
- Department of Electrophysiology‐CardiologyKlinikum Vest Recklinghausen Germany
- Department of Cardiology, Akademisches LehrkrankenhausRuhr‐Universität Bochum Bochum Germany
| | - Josselin Duchateau
- Hôpital Cardiologique du Haut LévèqueCHU de Bordeaux and IHU‐LIRYC Pessac France
| | - Thomas Parmbrun
- Hôpital Cardiologique du Haut LévèqueCHU de Bordeaux and IHU‐LIRYC Pessac France
| | - Nicholas Derval
- Hôpital Cardiologique du Haut LévèqueCHU de Bordeaux and IHU‐LIRYC Pessac France
| | - Mélèze Hocini
- Hôpital Cardiologique du Haut LévèqueCHU de Bordeaux and IHU‐LIRYC Pessac France
| | - Michel Haissaguerre
- Hôpital Cardiologique du Haut LévèqueCHU de Bordeaux and IHU‐LIRYC Pessac France
| | - Pierre Jais
- Hôpital Cardiologique du Haut LévèqueCHU de Bordeaux and IHU‐LIRYC Pessac France
| | - Frédéric Sacher
- Hôpital Cardiologique du Haut LévèqueCHU de Bordeaux and IHU‐LIRYC Pessac France
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Di Diego JM, Antzelevitch C. J wave syndromes as a cause of malignant cardiac arrhythmias. Pacing Clin Electrophysiol 2018; 41:684-699. [PMID: 29870068 PMCID: PMC6281786 DOI: 10.1111/pace.13408] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 05/05/2018] [Indexed: 12/19/2022]
Abstract
The J wave syndromes, including the Brugada (BrS) and early repolarization (ERS) syndromes, are characterized by the manifestation of prominent J waves in the electrocardiogram appearing as an ST segment elevation and the development of life-threatening cardiac arrhythmias. BrS and ERS differ with respect to the magnitude and lead location of abnormal J waves and are thought to represent a continuous spectrum of phenotypic expression termed J wave syndromes. Despite over 25 years of intensive research, risk stratification and the approach to therapy of these two inherited cardiac arrhythmia syndromes are still rapidly evolving. Our objective in this review is to provide an integrated synopsis of the clinical characteristics, risk stratifiers, as well as the molecular, ionic, cellular, and genetic mechanisms underlying these two syndromes that have captured the interest and attention of the cardiology community over the past two decades.
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Affiliation(s)
| | - Charles Antzelevitch
- Lankenau Institute for Medical Research, Wynnewood PA
- Lankenau Heart Institute, Wynnewood, PA
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia PA
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Abstract
INTRODUCTION Brugada syndrome (BrS) is an inherited cardiac arrhythmia syndrome characterized by ST-segment elevation in right precordial ECG leads and associated with sudden cardiac death in young adults. The ECG manifestations of BrS are often concealed but can be unmasked by sodium channel blockers and fever. Areas covered: Implantation of a cardioverter defibrillator (ICD) is first-line therapy for BrS patients presenting with prior cardiac arrest or documented VT. A pharmacological approach to therapy is recommended in cases of electrical storm, as an adjunct to ICD and as preventative therapy. The goal of pharmacological therapy is to produce an inward shift to counter the genetically-induced outward shift of ion channel current flowing during the early phases of the ventricular epicardial action potential. This is accomplished by augmentation of ICa using □□adrenergic agents or phosphodiesterase III inhibitors or via inhibition of Ito. Radiofrequency ablation of the right ventricular outward flow tract epicardium is effective in suppressing arrhythmogenesis in BrS patients experiencing frequent appropriate ICD-shocks. Expert commentary: Understanding of the pathophysiology and approach to therapy of BrS has advanced considerably in recent years, but there remains an urgent need for development of cardio-selective and ion-channel-specific Ito blockers for treatment of BrS.
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Affiliation(s)
- Mariana Argenziano
- a Cardiovascular Research , Lankenau Institute for Medical Research , Wynnewood , PA , USA
| | - Charles Antzelevitch
- a Cardiovascular Research , Lankenau Institute for Medical Research , Wynnewood , PA , USA.,b Cardiovascular Research , Lankenau Heart Institute , Wynnewood , PA , USA.,c Department of Medicine and Pharmacology and Experimental Therapeutics , Sidney Kimmel Medical College of Thomas Jefferson University , Philadelphia , PA , USA
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8
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Abstract
Brugada syndrome (BrS) is a cardiac disease caused by an inherited ion channelopathy associated with a propensity to develop ventricular fibrillation. Implantable cardioverter defibrillator implantation is recommended in BrS, based on the clinical presentation in the presence of diagnostic ECG criteria. Implantable cardioverter defibrillator implantation is not always indicated or sufficient in BrS, and is associated with a high device complication rate. Pharmacological therapy aimed at rebalancing the membrane action potential can prevent arrhythmogenesis in BrS. Quinidine, a class 1A antiarrhythmic drug with significant Ito blocking properties, is the most extensively used drug for the prevention of arrhythmias in BrS. The present review provides contemporary data gathered on all drugs effective in the therapy of BrS, and on ineffective or contraindicated antiarrhythmic drugs.
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Key Words
- Brugada syndrome,
- arrhythmia,
- bepridil,
- cilostazol,
- denopamine,
- disopyramide,
- isoproterenol,
- orciprenaline,
- pharmacology,
- quinidine,
- quinine
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Affiliation(s)
- Oholi Tovia Brodie
- University of Miami Miller School of Medicine Miami, USA.,Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University Tel-Aviv, Israel
| | - Yoav Michowitz
- Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University Tel-Aviv, Israel
| | - Bernard Belhassen
- Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University Tel-Aviv, Israel
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9
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Antzelevitch C, Yan GX, Ackerman MJ, Borggrefe M, Corrado D, Guo J, Gussak I, Hasdemir C, Horie M, Huikuri H, Ma C, Morita H, Nam GB, Sacher F, Shimizu W, Viskin S, Wilde AA. J-Wave syndromes expert consensus conference report: Emerging concepts and gaps in knowledge. Europace 2017; 19:665-694. [PMID: 28431071 PMCID: PMC5834028 DOI: 10.1093/europace/euw235] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
| | - Gan-Xin Yan
- Lankenau Medical Center, Wynnewood, Pennsylvania
| | - Michael J. Ackerman
- Departments of Cardiovascular Diseases, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics, Divisions of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester,Minnesota
| | - Martin Borggrefe
- 1st Department of Medicine–Cardiology, University Medical Centre Mannheim, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Jihong Guo
- Division of Cardiology, Peking University of People's Hospital, Beijing, China
| | - Ihor Gussak
- Rutgers University, New Brunswick, New Jersey
| | - Can Hasdemir
- Department of Cardiology, Ege University School of Medicine, Izmir, Turkey
| | - Minoru Horie
- Shiga University of Medical Sciences, Ohtsu, Shiga, Japan
| | - Heikki Huikuri
- Research Unit of Internal Medicine, Medical Research Center, Oulu University Hospital, and University of Oulu, Oulu, Finland
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Hiroshi Morita
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Gi-Byoung Nam
- Heart Institute, Asan Medical Center, and Department of Internal Medicine, University of Ulsan College of Medicine Seoul, Seoul, Korea
| | - Frederic Sacher
- Bordeaux University Hospital, LIRYC Institute/INSERM 1045, Bordeaux, France
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Sami Viskin
- Tel-Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arthur A.M. Wilde
- Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands and Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, Jeddah, Kingdom of Saudi Arabia
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10
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Antzelevitch C, Yan GX, Ackerman MJ, Borggrefe M, Corrado D, Guo J, Gussak I, Hasdemir C, Horie M, Huikuri H, Ma C, Morita H, Nam GB, Sacher F, Shimizu W, Viskin S, Wilde AA. J-Wave syndromes expert consensus conference report: Emerging concepts and gaps in knowledge. J Arrhythm 2016; 32:315-339. [PMID: 27761155 PMCID: PMC5063270 DOI: 10.1016/j.joa.2016.07.002] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
| | - Gan-Xin Yan
- Lankenau Medical Center, Wynnewood, PA, United States
| | - Michael J. Ackerman
- Departments of Cardiovascular Diseases, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics, Divisions of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN, United States
| | - Martin Borggrefe
- 1st Department of Medicine–Cardiology, University Medical Centre Mannheim, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Jihong Guo
- Division of Cardiology, Peking University of People׳s Hospital, Beijing, China
| | - Ihor Gussak
- Rutgers University, New Brunswick, NJ, United States
| | - Can Hasdemir
- Department of Cardiology, Ege University School of Medicine, Izmir, Turkey
| | - Minoru Horie
- Shiga University of Medical Sciences, Ohtsu, Shiga, Japan
| | - Heikki Huikuri
- Research Unit of Internal Medicine, Medical Research Center, Oulu University Hospital, and University of Oulu, Oulu, Finland
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Hiroshi Morita
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Gi-Byoung Nam
- Heart Institute, Asian Medical Center, and Department of Internal Medicine, University of Ulsan College of Medicine Seoul, Seoul, South Korea
| | - Frederic Sacher
- Bordeaux University Hospital, LIRYC Institute/INSERM 1045, Bordeaux, France
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Sami Viskin
- Tel-Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arthur A.M. Wilde
- Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, The Netherlands
- Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, Jeddah, Saudi Arabia
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11
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Antzelevitch C, Yan GX, Ackerman MJ, Borggrefe M, Corrado D, Guo J, Gussak I, Hasdemir C, Horie M, Huikuri H, Ma C, Morita H, Nam GB, Sacher F, Shimizu W, Viskin S, Wilde AAM. J-Wave syndromes expert consensus conference report: Emerging concepts and gaps in knowledge. Heart Rhythm 2016; 13:e295-324. [PMID: 27423412 PMCID: PMC5035208 DOI: 10.1016/j.hrthm.2016.05.024] [Citation(s) in RCA: 222] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Indexed: 12/16/2022]
Affiliation(s)
| | - Gan-Xin Yan
- Lankenau Medical Center, Wynnewood, Pennsylvania
| | - Michael J Ackerman
- Departments of Cardiovascular Diseases, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics, Divisions of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester,Minnesota
| | - Martin Borggrefe
- 1st Department of Medicine-Cardiology, University Medical Centre Mannheim, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Jihong Guo
- Division of Cardiology, Peking University of People's Hospital, Beijing, China
| | - Ihor Gussak
- Rutgers University, New Brunswick, New Jersey
| | - Can Hasdemir
- Department of Cardiology, Ege University School of Medicine, Izmir, Turkey
| | - Minoru Horie
- Shiga University of Medical Sciences, Ohtsu, Shiga, Japan
| | - Heikki Huikuri
- Research Unit of Internal Medicine, Medical Research Center, Oulu University Hospital, and University of Oulu, Oulu, Finland
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Hiroshi Morita
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Gi-Byoung Nam
- Heart Institute, Asan Medical Center, and Department of Internal Medicine, University of Ulsan College of Medicine Seoul, Seoul, Korea
| | - Frederic Sacher
- Bordeaux University Hospital, LIRYC Institute/INSERM 1045, Bordeaux, France
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Sami Viskin
- Tel-Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arthur A M Wilde
- Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands and Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, Jeddah, Kingdom of Saudi Arabia
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12
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HRS Expert Consensus Statement on remote interrogation and monitoring for cardiovascular implantable electronic devices. Heart Rhythm 2015; 12:e69-100. [PMID: 25981148 DOI: 10.1016/j.hrthm.2015.05.008] [Citation(s) in RCA: 361] [Impact Index Per Article: 40.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Indexed: 11/23/2022]
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13
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Zhou ZW, Gou K, Luo ZY, Li W, Zhang WZ, Li YG. Feasibility and efficacy of a remote real-time wireless ECG monitoring and stimulation system for management of ventricular arrhythmia in rabbits with myocardial infarction. Exp Ther Med 2014; 8:201-206. [PMID: 24944622 PMCID: PMC4061215 DOI: 10.3892/etm.2014.1693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 04/03/2014] [Indexed: 11/21/2022] Open
Abstract
The purpose of this study was to explore the feasibility of continuous remote monitoring, and the induction and termination of malignant ventricular arrhythmias (VAs) by a novel implantable electronic cardiovascular device (IECD) system in rabbits with myocardial infarction (MI). The IECD was implanted and MI was induced by ligation of the left anterior descending coronary artery in 20 adult rabbits. Internet-based remote electrocardiogram (ECG) monitoring and ventricular stimulation were conducted in remote locations with internet access. The voltage amplitudes of the stimulation signals were recorded synchronously by remote and surface ECG. Programmed stimulation with regular stimuli and regular stimuli with an added extra stimulus were performed prior to and following the MI surgery to induce and terminate VAs. IECD implantation and MI surgery, as well as qualified remote and bidirectional signal communications between the implanted IECD and extracorporeal system, were successfully achieved in 18 rabbits. The voltage of the stimulation signals recorded by the remote and surface ECGs showed a good correlation with the stimulation current (remote ECG, r=0.972 and surface ECG, r=0.988; P<0.001). Sustained ventricular tachycardia (VT) was induced in five rabbits (5/20, 25%) prior to MI induction and in 12 rabbits (12/16, 75%) following MI induction. Of the 17 induced VTs, 16 were successfully terminated by remote ventricular stimulation. The novel IECD system provides qualified remote wireless ECG monitoring and possesses the potential to induce and terminate VAs by remote ventricular pacing in this rabbit model of MI. Thus, this model of MI may be used to test the efficacy of novel drugs and devices for the management of VAs.
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Affiliation(s)
- Zhi-Wen Zhou
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, P.R. China
| | - Kai Gou
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, P.R. China
| | - Zhang-Yuan Luo
- Genix Biotek Science Technology (Shanghai) Co., Ltd., Shanghai 200235, P.R. China
| | - Wei Li
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, P.R. China
| | - Wen-Zan Zhang
- Genix Biotek Science Technology (Shanghai) Co., Ltd., Shanghai 200235, P.R. China
| | - Yi-Gang Li
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, P.R. China
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14
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Dohadwala M, Link MS. Implantable Defibrillators in Long QT Syndrome, Brugada Syndrome, Hypertrophic Cardiomyopathy, and Arrhythmogenic Right Ventricular Cardiomyopathy. Cardiol Clin 2014; 32:305-18. [DOI: 10.1016/j.ccl.2013.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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15
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Sacher F, Probst V, Maury P, Babuty D, Mansourati J, Komatsu Y, Marquie C, Rosa A, Diallo A, Cassagneau R, Loizeau C, Martins R, Field ME, Derval N, Miyazaki S, Denis A, Nogami A, Ritter P, Gourraud JB, Ploux S, Rollin A, Zemmoura A, Lamaison D, Bordachar P, Pierre B, Jaïs P, Pasquié JL, Hocini M, Legal F, Defaye P, Boveda S, Iesaka Y, Mabo P, Haïssaguerre M. Outcome after implantation of a cardioverter-defibrillator in patients with Brugada syndrome: a multicenter study-part 2. Circulation 2013; 128:1739-47. [PMID: 23995538 DOI: 10.1161/circulationaha.113.001941] [Citation(s) in RCA: 181] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Implantable cardioverter-defibrillator indications in Brugada syndrome remain controversial, especially in asymptomatic patients. Previous outcome data are limited by relatively small numbers of patients or short follow-up durations. We report the outcome of patients with Brugada syndrome implanted with an implantable cardioverter-defibrillator in a large multicenter registry. METHODS AND RESULTS A total of 378 patients (310 male; age, 46±13 years) with a type 1 Brugada ECG pattern implanted with an implantable cardioverter-defibrillator (31 for aborted sudden cardiac arrest, 181 for syncope, and 166 asymptomatic) were included. Fifteen patients (4%) were lost to follow-up. During a mean follow-up of 77±42 months, 7 patients (2%) died (1 as a result of an inappropriate shock), and 46 patients (12%) had appropriate device therapy (5±5 shocks per patient). Appropriate device therapy rates at 10 years were 48% for patients whose implantable cardioverter-defibrillator indication was aborted sudden cardiac arrest, 19% for those whose indication was syncope, and 12% for the patients who were asymptomatic at implantation. At 10 years, rates of inappropriate shock and lead failure were 37% and 29%, respectively. Inappropriate shock occurred in 91 patients (24%; 4±4 shocks per patient) because of lead failure (n=38), supraventricular tachycardia (n=20), T-wave oversensing (n=14), or sinus tachycardia (n=12). Importantly, introduction of remote monitoring, programming a high single ventricular fibrillation zone (>210-220 bpm), and a long detection time were associated with a reduced risk of inappropriate shock. CONCLUSIONS Appropriate therapies are more prevalent in symptomatic Brugada syndrome patients but are not insignificant in asymptomatic patients (1%/y). Optimal implantable cardioverter-defibrillator programming and follow-up dramatically reduce inappropriate shock. However, lead failure remains a major problem in this population.
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Affiliation(s)
- Frédéric Sacher
- Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, L'Institut de Rythmologie et de Modelisation Cardiaque, INSERM 1045, Bordeaux, France (F.S., A.D., C.L., M.E.F., N.D., A.D., P.R., S.P., A.Z., P.B., P.J., M.H., M.H.); Institut du Thorax, CHU de Nantes, Nantes, France (V.P., J.-B.G.); CHU de Toulouse, Toulouse, France (P. Maury, A. Rollin); CHU de Tours, Tours, France (D.B., B.P.); CHU de Brest, Brest, France (J.M., S.M.); Tsuchiura Kyodo Hospital, Tsuchiura, Japan (Y.K., Y.I.); CHU de Lille, Lille, France (C.M.); Clinique Pasteur, Toulouse, France (A. Rosa, S.B.); CHU de Grenoble, Grenoble, France (R.C., P.D.); CHU de Rennes, Rennes, France (R.M., P. Mabo); Yokohama Rosai Hospital, Yokohama, Japan (A.N.); CHU de Clermont-Ferrand, Clermont-Ferrand, France (D.L.); CHU de Montpellier, Montpellier, France (J.-L.P.); and CHU de Poitiers, Poiters, France (F.L.)
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16
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Papavasileiou LP, Forleo GB, Panattoni G, Schirripa V, Minni V, Magliano G, Bellos K, Santini L, Romeo F. Work burden with remote monitoring of implantable cardioverter defibrillator: is it time for reimbursement policies? J Cardiovasc Med (Hagerstown) 2013; 14:114-9. [PMID: 22644407 DOI: 10.2459/jcm.0b013e328354e3e1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The efficacy and accuracy, as well as patients' satisfaction, of device remote monitoring are well demonstrated. However, the workload of remote monitoring management has not been estimated and reimbursement schemes are currently unavailable in most European countries. This study evaluates the workload associated with remote monitoring systems. METHODS A total of 154 consecutive implantable cardioverter defibrillator patients (age 66±12 years; 86.5% men) with a remote monitoring system were enrolled. Data on the clinician's workload required for the management of the patients were analyzed. RESULTS A total of 1744 transmissions were received during a mean follow-up of 15.3±12.4 months. Median number of transmissions per patient was 11.3. There were 993 event-free transmissions, whereas 638 transmissions regarded one or more events (113 missed transmissions, 141 atrial events, 132 ventricular episodes, 299 heart failure-related transmissions, 14 transmissions regarding lead malfunction and 164 transmissions related to other events). In 402 cases telephonic contact was necessary, whereas in 68 cases an in-clinic visit was necessary and in 23 of them an in-clinic visit was prompted by the manufacturer due to technical issues of the transmitter. During follow-up, 316 work hours were required to manage the enrolled patients. Each month, a total of 14.9 h were spent on the remote monitoring of 154 patients (9.7 h for 100 patients monthly) with approximately 1.1±0.15 h per year for each patient. CONCLUSION The clinician's work burden is high in patients with remote monitoring. In order to expand remote monitoring in all patients, reimbursement policies should be considered.
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Affiliation(s)
- Lida P Papavasileiou
- Cardiology Department, University Hospital of Rome, Tor Vergata, Viale Oxford 81, Rome, Italy.
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17
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Canadian Cardiovascular Society/Canadian Heart Rhythm Society Joint Position Statement on the Use of Remote Monitoring for Cardiovascular Implantable Electronic Device Follow-up. Can J Cardiol 2013; 29:644-51. [DOI: 10.1016/j.cjca.2012.11.036] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 11/29/2012] [Accepted: 11/29/2012] [Indexed: 11/22/2022] Open
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de Asmundis C, Ricciardi D, Namdar M, Chierchia GB, Sarkozy A, Brugada P. Role of home monitoring in children with implantable cardioverter defibrillators for Brugada syndrome. ACTA ACUST UNITED AC 2013; 15 Suppl 1:i17-i25. [DOI: 10.1093/europace/eut112] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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19
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Postema PG, Tan HL, Wilde AAM. Ageing and Brugada syndrome: considerations and recommendations. J Geriatr Cardiol 2013; 10:75-81. [PMID: 23610577 PMCID: PMC3627719 DOI: 10.3969/j.issn.1671-5411.2013.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 01/12/2013] [Accepted: 01/19/2013] [Indexed: 12/05/2022] Open
Abstract
Brugada syndrome is an inherited disease associated with an increased risk of lethal ventricular arrhythmias. Such arrhythmias stem from innate disruptions in cardiac electrophysiology. Typically, such arrhythmias occur in the third or fourth decade of life. However, Brugada syndrome may also affect geriatric patients. In this paper, we focus on the ageing patient with Brugada syndrome, and specifically, on the interaction between Brugada syndrome and the more usually acquired clinical problems that may occur with increasing age, such as the use of cardiovascular and non-cardiovascular drugs, or the need for surgery. Such common conditions may also disrupt cardiac electrophysiology, thereby conferring added risk for Brugada syndrome patients. We present some considerations and recommendations that may serve as guidance to address these complexities.
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Affiliation(s)
- Pieter G. Postema
- Department of Cardiology, Heart Center, Academic Medical Center, University of Amsterdam, P.O. box 22660, 1100 DD Amsterdam, The Netherlands
| | - Hanno L Tan
- Department of Cardiology, Heart Center, Academic Medical Center, University of Amsterdam, P.O. box 22660, 1100 DD Amsterdam, The Netherlands
| | - Arthur AM Wilde
- Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, Jeddah, Kingdom of Saudi Arabia
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20
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Guédon-Moreau L, Lacroix D, Sadoul N, Clémenty J, Kouakam C, Hermida JS, Aliot E, Boursier M, Bizeau O, Kacet S. A randomized study of remote follow-up of implantable cardioverter defibrillators: safety and efficacy report of the ECOST trial. Eur Heart J 2012; 34:605-14. [PMID: 23242192 PMCID: PMC3578267 DOI: 10.1093/eurheartj/ehs425] [Citation(s) in RCA: 216] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIMS The ECOST trial examined prospectively the long-term safety and effectiveness of home monitoring (HM) of implantable cardioverter defibrillators (ICD). METHODS AND RESULTS The trial's primary objective was to randomly compare the proportions of patients experiencing ≥ 1 major adverse event (MAE), including deaths from all causes, and cardiovascular, procedure-related, and device-related MAE associated with HM (active group) vs. ambulatory follow-ups (control group) in a sample of 433 patients. The 221 patients assigned to the active group were seen once a year, unless HM reported an ICD dysfunction or a clinical event requiring an ambulatory visit, while the 212 patients in the control group underwent ambulatory visits every 6 months. The characteristics of the study groups were similar. Over a follow-up of 24.2 months, 38.5% of patients in the active and 41.5% in the control group experienced ≥ 1 MAE (P < 0.05 for non-inferiority). The overall number of shocks delivered was significantly lower in the active (n = 193) than in the control (n = 657) group (P < 0.05) and the proportion of patients who received inappropriate shocks was 52% lower in the active (n = 11) than in the control (n = 22) group (P < 0.05). At the end of the follow-up, the battery longevity was longer in the active group because of a lower number of capacitor charges (499 vs. 2081). CONCLUSION Our observations indicate that long-term HM of ICD is at least as safe as standard ambulatory follow-ups with respect to a broad spectrum of MAE. It also lowered significantly the number of appropriate and inappropriate shocks delivered, and spared the device battery. Clinical trials registration NCT00989417.
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Sacher F, Arsac F, Wilton SB, Derval N, Denis A, de Guillebon M, Ramoul K, Bordachar P, Ritter P, Hocini M, Clémenty J, Jaïs P, Haïssaguerre M. Syncope in Brugada syndrome patients: Prevalence, characteristics, and outcome. Heart Rhythm 2012; 9:1272-9. [DOI: 10.1016/j.hrthm.2012.04.013] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Indexed: 10/28/2022]
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Kim AS, Huffer L. Atrial Fibrillation and Brugada Syndrome. Card Electrophysiol Clin 2012; 4:249-257. [PMID: 26939822 DOI: 10.1016/j.ccep.2012.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Since its first description in 1992, the Brugada syndrome (BrS) has attracted significant attention from the cardiology community because of its association with malignant ventricular arrhythmias and sudden cardiac death. Supraventricular tachyarrhythmias in BrS represent a unique and seemingly higher-risk clinical subgroup of patients with BrS. Atrial fibrillation represents the most common supraventricular arrhythmia in patients with BrS, with average ranges reported in the literature of 20% to 40%. This article summarizes the current literature regarding the patient with BrS with atrial fibrillation and discusses the management of these clinically challenging and potentially higher-risk individuals.
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Affiliation(s)
- Andrew S Kim
- Cardiology Service, Department of Medicine, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889, USA
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23
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BLANCK ZALMEN, AXTELL KATHI, BRODHAGEN KATHY, O'HEARN LAURA, ALBELO TAMMY, CERETTO CHERYL, DHALA ANWER, SRA JASBIR, AKHTAR MASOOD. Inappropriate Shocks in Patients With Fidelis® Lead Fractures: Impact of Remote Monitoring and the Lead Integrity Algorithm. J Cardiovasc Electrophysiol 2011; 22:1107-14. [DOI: 10.1111/j.1540-8167.2011.02077.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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24
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Perings C, Bauer WR, Bondke HJ, Mewis C, James M, Böcker D, Broadhurst P, Korte T, Toft E, Hintringer F, Clémenty J, Schwab JO. Remote monitoring of implantable-cardioverter defibrillators: results from the Reliability of IEGM Online Interpretation (RIONI) study. Europace 2011; 13:221-9. [PMID: 21252195 DOI: 10.1093/europace/euq447] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Intracardiac electrograms (IEGMs) recorded by implantable cardioverter-defibrillators (ICDs) are essential for arrhythmia diagnosis and ICD therapy assessment. Short IEGM snapshots showing 3-10 s before arrhythmia detection were added to the Biotronik Home Monitoring system in 2005 as the first-generation IEGM Online. The RIONI study tested the primary hypothesis that experts' ratings regarding the appropriateness of ICD therapy based on IEGM Online and on standard 30 s IEGM differ in <10% of arrhythmia events. METHODS AND RESULTS A total of 619 ICD patients were enrolled and followed for 1 year. According to a predefined procedure, 210 events recorded by the ICDs were selected for evaluation. Three expert board members rated the appropriateness of ICD therapy and classified the underlying arrhythmia using coded IEGM Online and standard IEGM to avoid bias. The average duration of IEGM Online was 4.4±1.5 s. According to standard IEGM, the underlying arrhythmia was ventricular in 135 episodes (64.3%), supraventricular in 53 episodes (25.2%), oversensing in 17 episodes (8.1%), and uncertain in 5 episodes (2.4%). The expert board's rating diverged between determinable IEGM Online tracings and standard IEGM in 4.6% of episodes regarding the appropriateness of ICD therapy (95% CI up to 8.0%) and in 6.6% of episodes regarding arrhythmia classification (95% CI up to 10.5%). CONCLUSION By enabling accurate evaluation of the appropriateness of ICD therapy and the underlying arrhythmia, the first-generation IEGM Online provided a clinically effective basis for timely interventions and for optimized patient management schemes, which was comparable with current IEGM recordings.
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Affiliation(s)
- Christian Perings
- Department of Cardiology and Angiology, Marienhospital Herne, University of Bochum, Bochum, Germany.
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Abstract
Three different types of implantable cardiac devices are now commonly used in clinical medicine: pacemakers (including cardiac resynchronization systems), cardiac defibrillators, and loop recorders. Although pacing specialists and electrophysiologists have traditionally been responsible for device follow-up, the newest generation of implanted devices stores a wealth of information that can be useful to the clinical cardiologist. Important information, in addition to device function, such as incidence and type of arrhythmias, general clinical condition of the patient, and hemodynamic status can now be stored on large databases that are available via web access to all physicians caring for an individual patient. The advent of the remote monitoring capability of implanted devices has initiated a rapidly accelerating paradigm shift in device follow-up that can potentially improve patient care at lower cost.
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Affiliation(s)
- Fred Kusumoto
- Electrophysiology and Pacing Service, Division of Cardiology, Department of Medicine, Mayo Clinic, Jacksonville, Florida, USA.
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Sancho-Tello de Carranza MJ, Martínez-Ferrer J, Pombo-Jiménez M, de Juan-Montiel J. [Progress in cardiac pacing]. Rev Esp Cardiol 2010; 63 Suppl 1:73-85. [PMID: 20223181 DOI: 10.1016/s0300-8932(10)70142-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This review discusses the utility and current status of remote monitoring in patients with cardiac devices in Spain, the different anticoagulation strategies used during device implantation, the surgical replacement and maintenance of pacemakers and defibrillators, and the present and future importance of impedance sensors in cardiac pacing and heart failure management. Finally, there is a summary of the most relevant scientific articles published in the last year.
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Prevention of inappropriate ICD shocks in patients with Brugada syndrome. Clin Res Cardiol 2009; 99:37-44. [PMID: 19760052 DOI: 10.1007/s00392-009-0075-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Accepted: 08/26/2009] [Indexed: 01/11/2023]
Abstract
BACKGROUND In Brugada syndrome implantable cardioverter defibrillator (ICD) therapy is associated with a high rate of inappropriate therapies, mainly due to supraventricular tachyarrhythmias (SVT) (2.7-14.1%/year). Aim of the present study was to evaluate a single ventricular fibrillation (VF) detection zone with a high cut-off rate with respect to prevention of inappropriate ICD shock due to SVT and safety of this programming. METHODS Sixty-one consecutive patients (mean age 42.6 +/- 12.9 years; 41 males) diagnosed with Brugada syndrome and implanted with an ICD were included. ICDs were prospectively programmed with a single VF detection zone and a cut-off rate of 222 beats/minute (bpm). A maximum of six shocks with the maximal shock energy were programmed. The minimal follow-up was 1 year. RESULTS During a follow-up of 47.6 +/- 23.1 months seven patients (2.91%/year) received appropriate ICD shocks. No patient suffered from syncope or died. Five patients (2.07%/year) received inappropriate ICD shocks: four patients due to T-wave oversensing and only one patient (0.4%/year) due to SVT (atrial fibrillation with a ventricular rate of >222 bpm). CONCLUSIONS Programming of a single, high-rate VF zone in patients with Brugada syndrome and an implanted defibrillator is safe. Such programming may be associated with reduced inappropriate defibrillator discharges. A single detection zone with a high VF cut-off rate can be recommended in patients with Brugada syndrome.
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Burri H, Senouf D. Remote monitoring and follow-up of pacemakers and implantable cardioverter defibrillators. Europace 2009; 11:701-9. [PMID: 19470595 PMCID: PMC2686319 DOI: 10.1093/europace/eup110] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
In the era of communication technology, new options are now available for following-up patients implanted with pacemakers (PMs) and defibrillators (ICDs). Most major companies offer devices with wireless capabilities that communicate automatically with home transmitters, which then relay data to the physician, thereby allowing remote patient follow-up and monitoring. These systems are being widely used in the USA for remote follow-up, and have been more recently introduced in Europe, where their adoption is increasing. In this article, we describe the currently existing systems, review the available evidence in the literature regarding remote follow-up and monitoring of PMs and ICDs, and finally discuss some unresolved issues.
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Affiliation(s)
- Haran Burri
- Cardiology service, University Hospital of Geneva, 23, rue Micheli-du-Crest, 1211 Geneva, Switzerland.
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