1
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Lynch PT, Maloof A, Badjatiya A, Safavi-Naeini P, Segar MW, Kim JA, Marashly Q, Molina-Razavi JE, Simpson L, Oberton SB, Xie LX, Civitello A, Mathuria N, Cheng J, Rasekh A, Saeed M, Razavi M, Nair A, Chelu MG. Mortality in Recipients of Durable Left Ventricular Assist Devices Undergoing Ventricular Tachycardia Ablation. JACC Clin Electrophysiol 2024:S2405-500X(24)00457-2. [PMID: 39023485 DOI: 10.1016/j.jacep.2024.04.037] [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: 12/11/2023] [Revised: 04/25/2024] [Accepted: 04/27/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Left ventricular assist device (LVAD) recipients have a higher incidence of ventricular tachycardia (VT). However, the role of VT ablation in this population is not well-established. OBJECTIVES This single-center retrospective cohort study sought to examine the impact of post-LVAD implant VT ablation on survival. METHODS This retrospective study examined a cohort of patients that underwent LVAD implantation at Baylor St. Luke's Medical Center and Texas Heart Institute between January 2011 and January 2021. All-cause estimated mortality was compared across LVAD recipients based on the incidence of VT, timing of VT onset, and the occurrence and timing of VT ablation utilizing Kaplan-Meier survival analysis and Cox proportional hazards models. RESULTS Post-implant VT occurred in 53% of 575 LVAD recipients. Higher mortality was seen among patients with post-implant VT within a year of implantation (HR: 1.62 [95% CI: 1.15-2.27]). Among this cohort, patients who were treated with a catheter ablation had superior survival compared with patients treated with medical therapy alone for the 45 months following VT onset (HR: 0.48 [95% CI: 0.26-0.89]). Moreover, performance of an ablation in this population aligned mortality rates with those who did not experience post-implant VT (HR: 1.18 [95% CI: 0.71-1.98]). CONCLUSIONS VT occurrence within 1 year of LVAD implantation was associated with worse survival. However, performance of VT ablation in this population was correlated with improved survival compared with medical management alone. Among patients with refractory VT, catheter ablation aligned survival with other LVAD participants without post-implant VT. Catheter ablation of VT is associated with improved survival in LVAD recipients, but further prospective randomized studies are needed to compare VT ablation to medical management in LVAD recipients.
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Affiliation(s)
- Patrick T Lynch
- Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA.
| | - Alexandra Maloof
- Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Anish Badjatiya
- Department of Medicine (Division of Cardiology), Baylor College of Medicine, Houston, Texas, USA
| | - Payam Safavi-Naeini
- Department of Medicine (Division of Cardiology), Baylor College of Medicine, Houston, Texas, USA
| | - Matthew W Segar
- Department of Medicine (Division of Cardiology), Baylor College of Medicine, Houston, Texas, USA; Texas Heart Institute, Houston, Texas, USA
| | - Jitae A Kim
- Division of Cardiovascular Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Qussay Marashly
- Department of Cardiology, Montefiore Medical Center, New York, New York, USA
| | - Joanna E Molina-Razavi
- Department of Medicine (Division of Cardiology), Baylor College of Medicine, Houston, Texas, USA; Texas Heart Institute, Houston, Texas, USA
| | - Leo Simpson
- Department of Medicine (Division of Cardiology), Baylor College of Medicine, Houston, Texas, USA; Texas Heart Institute, Houston, Texas, USA
| | - Selby B Oberton
- Department of Medicine (Division of Cardiology), Baylor College of Medicine, Houston, Texas, USA; Texas Heart Institute, Houston, Texas, USA
| | - Lola X Xie
- Department of Medicine (Division of Cardiology), Baylor College of Medicine, Houston, Texas, USA; Texas Heart Institute, Houston, Texas, USA
| | - Andrew Civitello
- Department of Medicine (Division of Cardiology), Baylor College of Medicine, Houston, Texas, USA; Texas Heart Institute, Houston, Texas, USA; Cardiovascular Research Institute, Baylor College of Medicine, Houston, Texas, USA
| | - Nilesh Mathuria
- Department of Medicine (Division of Cardiology), Baylor College of Medicine, Houston, Texas, USA
| | - Jie Cheng
- Department of Medicine (Division of Cardiology), Baylor College of Medicine, Houston, Texas, USA; Texas Heart Institute, Houston, Texas, USA
| | - Abdi Rasekh
- Department of Medicine (Division of Cardiology), Baylor College of Medicine, Houston, Texas, USA; Texas Heart Institute, Houston, Texas, USA; Cardiovascular Research Institute, Baylor College of Medicine, Houston, Texas, USA
| | - Mohammad Saeed
- Department of Medicine (Division of Cardiology), Baylor College of Medicine, Houston, Texas, USA; Texas Heart Institute, Houston, Texas, USA; Cardiovascular Research Institute, Baylor College of Medicine, Houston, Texas, USA
| | - Mehdi Razavi
- Department of Medicine (Division of Cardiology), Baylor College of Medicine, Houston, Texas, USA; Texas Heart Institute, Houston, Texas, USA; Cardiovascular Research Institute, Baylor College of Medicine, Houston, Texas, USA
| | - Ajith Nair
- Department of Medicine (Division of Cardiology), Baylor College of Medicine, Houston, Texas, USA; Texas Heart Institute, Houston, Texas, USA; Cardiovascular Research Institute, Baylor College of Medicine, Houston, Texas, USA
| | - Mihail G Chelu
- Department of Medicine (Division of Cardiology), Baylor College of Medicine, Houston, Texas, USA; Texas Heart Institute, Houston, Texas, USA; Cardiovascular Research Institute, Baylor College of Medicine, Houston, Texas, USA.
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2
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Soni B, Gopinathannair R. Managing ventricular arrhythmias and implantable cardiac defibrillator shocks after left ventricular assist device implantation. J Cardiovasc Electrophysiol 2024; 35:592-600. [PMID: 38013210 DOI: 10.1111/jce.16142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023]
Abstract
Continuous flow left ventricular assist devices (CF-LVADs) have been shown to reduce mortality and morbidity in patients with advanced heart failure with reduced ejection fraction. However, ventricular arrhythmias (VA) are common, are mostly secondary to underlying myocardial scar, and have a higher incidence in patients with pre-LVAD VA. Sustained VA is well tolerated in the LVAD patient but can result in implantable defibrillator (ICD) shocks, right ventricular failure, hospitalizations, and reduced quality of life. There is limited data regarding best practices for the medical management of VA as well as the role for procedural interventions in patients with uncontrolled VA and/or ICD shocks. Vast majority of CF-LVAD patients have a preexisting cardiovascular implantable electronic device (CIED) and ICD and/or cardiac resynchronization therapies are continued in many. Several questions, however, remain regarding the efficacy of ICD and CRT following CF-LVAD. Moreover, optimal CIED programming after CF-LVAD implantation. Therefore, the primary objective of this review article is to provide the most up-to-date evidence and to provide guidance on the clinical significance, pathogenesis, predictors, and management strategies for VA and ICD therapies in the CF-LVAD population. We also discuss knowledge gaps as well as areas for future research.
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Affiliation(s)
- Bosky Soni
- Department of Medicine, University of Pittsburgh School of Medicine, Harrisburg, Pennsylvania, USA
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3
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Benali K, Lloyd MS, Petrosyan A, Rigal L, Quivrin M, Bessieres I, Vlachos K, Hammache N, Bellec J, Simon A, Laurent G, Higgins K, Garnier F, de Crevoisier R, Martins R, Da Costa A, Guenancia C. Cardiac stereotactic radiation therapy for refractory ventricular arrhythmias in patients with left ventricular assist devices. J Cardiovasc Electrophysiol 2024; 35:206-213. [PMID: 38018417 DOI: 10.1111/jce.16139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 11/30/2023]
Abstract
Left ventricular assist device (LVAD) implantation is an established treatment for patients with advanced heart failure refractory to medical therapy. However, the incidence of ventricular arrhythmias (VAs) is high in this population, both in the acute and delayed phases after implantation. About one-third of patients implanted with an LVAD will experience sustained VAs, predisposing these patients to worse outcomes and complicating patient management. The combination of pre-existing myocardial substrate and complex electrical remodeling after LVAD implantation account for the high incidence of VAs observed in this population. LVAD patients presenting VAs refractory to antiarrhythmic therapy and catheter ablation procedures are not rare. In such patients, treatment options are extremely limited. Stereotactic body radiation therapy (SBRT) is a technique that delivers precise and high doses of radiation to highly defined targets, reducing exposure to adjacent normal tissue. Cardiac SBRT has recently emerged as a promising alternative with a growing number of case series reporting the effectiveness of the technique in reducing the VA burden in patients with arrhythmias refractory to conventional therapies. The safety profile of cardiac SBRT also appears favorable, even though the current clinical experience remains limited. The use of cardiac SBRT for the treatment of refractory VAs in patients implanted with an LVAD are even more scarce. This review summarizes the clinical experience of cardiac SBRT in LVAD patients and describes technical considerations related to the implementation of the SBRT procedure in the presence of an LVAD.
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Affiliation(s)
- Karim Benali
- Department of Cardiac Electrophysiology, Saint-Etienne University Hospital Center, Saint-Etienne, France
- Department of Signal Analysis, IHU LIRYC, Electrophysiology and Heart Modelling Institute, Bordeaux University, Bordeaux, France
- LTSI-UMR 1099, Rennes, France
| | - Michael S Lloyd
- Department of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Andranik Petrosyan
- Department of Cardiac Surgery, Saint-Etienne University Hospital Center, Saint-Etienne, France
| | - Louis Rigal
- Department of Signal Analysis, IHU LIRYC, Electrophysiology and Heart Modelling Institute, Bordeaux University, Bordeaux, France
| | - Magali Quivrin
- Department of Radiation Oncology, Centre Georges Francois Leclerc, Dijon, France
| | - Igor Bessieres
- Department of Radiation Oncology, Centre Georges Francois Leclerc, Dijon, France
| | | | - Nefissa Hammache
- Department of Cardiac Electrophysiology, Nancy University Hospital Center, Nancy, France
| | - Julien Bellec
- Department of Radiation Oncology, Centre Eugene Marquis, Rennes, France
| | - Antoine Simon
- Department of Signal Analysis, IHU LIRYC, Electrophysiology and Heart Modelling Institute, Bordeaux University, Bordeaux, France
| | - Gabriel Laurent
- Department of Cardiac Electrophysiology, Dijon University Hospital Center, Dijon, France
| | - Kristin Higgins
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Fabien Garnier
- Department of Cardiac Electrophysiology, Dijon University Hospital Center, Dijon, France
| | | | - Raphaël Martins
- Department of Signal Analysis, IHU LIRYC, Electrophysiology and Heart Modelling Institute, Bordeaux University, Bordeaux, France
- Department of Cardiac Electrophysiology, Rennes University Hospital Center, Rennes, France
| | - Antoine Da Costa
- Department of Cardiac Electrophysiology, Saint-Etienne University Hospital Center, Saint-Etienne, France
| | - Charles Guenancia
- Department of Radiation Oncology, Centre Eugene Marquis, Rennes, France
- PEC 2 EA 7460, University of Burgundy and Franche-Comté, Dijon, France
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4
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Huang DT, Gosev I, Wood KL, Vidula H, Stevenson W, Marchlinski F, Supple G, Zalawadiya SK, Weiss JP, Tung R, Tzou WS, Moss JD, Kancharla K, Chaudhry S, Patel PJ, Khan AM, Schuger C, Rozen G, Kiernan MS, Couper GS, Leacche M, Molina EJ, Shah AD, Lloyd M, Sroubek J, Soltesz E, Shivkumar K, White C, Tankut S, Johnson BA, McNitt S, Kutyifa V, Zareba W, Goldenberg I. Design and characteristics of the prophylactic intra-operative ventricular arrhythmia ablation in high-risk LVAD candidates (PIVATAL) trial. Ann Noninvasive Electrocardiol 2023; 28:e13073. [PMID: 37515396 PMCID: PMC10475893 DOI: 10.1111/anec.13073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/25/2023] [Accepted: 06/27/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The use of a Left Ventricular Assist Device (LVAD) in patients with advanced heart failure refractory to optimal medical management has progressed steadily over the past two decades. Data have demonstrated reduced LVAD efficacy, worse clinical outcome, and higher mortality for patients who experience significant ventricular tachyarrhythmia (VTA). We hypothesize that a novel prophylactic intra-operative VTA ablation protocol at the time of LVAD implantation may reduce the recurrent VTA and adverse events postimplant. METHODS We designed a prospective, multicenter, open-label, randomized-controlled clinical trial enrolling 100 patients who are LVAD candidates with a history of VTA in the previous 5 years. Enrolled patients will be randomized in a 1:1 fashion to intra-operative VTA ablation (n = 50) versus conventional medical management (n = 50) with LVAD implant. Arrhythmia outcomes data will be captured by an implantable cardioverter defibrillator (ICD) to monitor VTA events, with a uniform ICD programming protocol. Patients will be followed prospectively over a mean of 18 months (with a minimum of 9 months) after LVAD implantation to evaluate recurrent VTA, adverse events, and procedural outcomes. Secondary endpoints include right heart function/hemodynamics, healthcare utilization, and quality of life. CONCLUSION The primary aim of this first-ever randomized trial is to assess the efficacy of intra-operative ablation during LVAD surgery in reducing VTA recurrence and improving clinical outcomes for patients with a history of VTA.
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Affiliation(s)
- David T. Huang
- Division of CardiologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Igor Gosev
- Division of Cardiothoracic SurgeryUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Katherine L. Wood
- Division of Cardiothoracic SurgeryUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Hima Vidula
- Division of CardiologyUniversity of Pennsylvania Medical CenterPhiladelphiaPennsylvaniaUSA
| | - William Stevenson
- Division of Cardiovascular MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Frank Marchlinski
- Division of CardiologyUniversity of Pennsylvania Medical CenterPhiladelphiaPennsylvaniaUSA
| | - Gregory Supple
- Division of CardiologyUniversity of Pennsylvania Medical CenterPhiladelphiaPennsylvaniaUSA
| | - Sandip K. Zalawadiya
- Division of Cardiovascular MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - J. Peter Weiss
- The University of Arizona College of Medicine‐Phoenix, Banner University Medical CenterPhoenixArizonaUSA
| | - Roderick Tung
- The University of Arizona College of Medicine‐Phoenix, Banner University Medical CenterPhoenixArizonaUSA
| | - Wendy S. Tzou
- Division of CardiologyUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Joshua D. Moss
- Division of CardiologyUniversity of California‐San FranciscoSan FranciscoCaliforniaUSA
| | - Krishna Kancharla
- Department of MedicineHeart and Vascular Institute, University of Pittsburgh Medical Center and School of MedicinePittsburghPennsylvaniaUSA
| | - Sunit‐Preet Chaudhry
- Division of CardiologyAscension St. Vincent Heart CenterIndianapolisIndianaUSA
- Ascension St. Vincent Cardiovascular Research InstituteIndianapolisIndianaUSA
| | - Parin J. Patel
- Division of CardiologyAscension St. Vincent Heart CenterIndianapolisIndianaUSA
- Ascension St. Vincent Cardiovascular Research InstituteIndianapolisIndianaUSA
| | - Arfaat M. Khan
- Henry Ford Heart and Vascular Institute, Henry Ford HospitalDetroitMichiganUSA
| | - Claudio Schuger
- Henry Ford Heart and Vascular Institute, Henry Ford HospitalDetroitMichiganUSA
| | - Guy Rozen
- Cardiovascular Center, Tufts Medical CenterBostonMassachusettsUSA
| | | | | | - Marzia Leacche
- Department of Cardiothoracic SurgerySpectrum HealthGrand RapidsMichiganUSA
| | - Ezequiel J. Molina
- Department of Cardiothoracic SurgeryPiedmont Heart InstituteAtlantaGeorgiaUSA
| | - Anand D. Shah
- Section of Cardiac ElectrophysiologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Michael Lloyd
- Section of Cardiac ElectrophysiologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Jakub Sroubek
- Heart Vascular and Thoracic Institute, Cleveland ClinicClevelandOhioUSA
| | - Edward Soltesz
- Department of Thoracic and Cardiovascular SurgeryCleveland ClinicClevelandOhioUSA
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Casey White
- Division of CardiologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Sinan Tankut
- Division of CardiologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Brent A. Johnson
- Department of Biostatistics and Computational BiologyUniversity of RochesterRochesterNew YorkUSA
| | - Scott McNitt
- Clinical Cardiovascular Research CenterUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Valentina Kutyifa
- Clinical Cardiovascular Research CenterUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Wojciech Zareba
- Clinical Cardiovascular Research CenterUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Ilan Goldenberg
- Clinical Cardiovascular Research CenterUniversity of Rochester Medical CenterRochesterNew YorkUSA
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5
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Wang R, Mainville DJ, Vacaru A, Pasca I. Iatrogenic Hypoxemia and Atrial Septal Defect Due to Electrical Storm Ablation After Left Ventricular Assist Device: A Case Report. Cureus 2023; 15:e39418. [PMID: 37362482 PMCID: PMC10287845 DOI: 10.7759/cureus.39418] [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] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
A 59-year-old male with an implantable cardiac defibrillator, left ventricular assist device, and refractory ventricular tachycardia presented with hypoxemia due to a post-ablation iatrogenic atrial septal defect. Left ventricular assist devices generate pressure gradients that may exacerbate intracardiac shunts and can precipitate significant hypoxemia.
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Affiliation(s)
- Ryan Wang
- Anesthesiology, Loma Linda University Health, Loma Linda, USA
| | - Darcy J Mainville
- Critical Care Medicine, Loma Linda University Health, Loma Linda, USA
| | | | - Ioana Pasca
- Anesthesiology, Riverside University Health System, Moreno Valley, USA
- Critical Care Medicine, Loma Linda University Health, Loma Linda, USA
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6
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Nof E, Peichl P, Stojadinovic P, Arceluz M, Maury P, Katz M, Tedrow UB, Singh RM, Narui R, John RM, Stevenson WG, Beinart R, Grupper A, Sternik L, Lavee J, Sacher F, Kautzner J, Sabbag A. HeartMate 3: new challenges in ventricular tachycardia ablation. Europace 2021; 24:598-605. [PMID: 34791165 DOI: 10.1093/europace/euab272] [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: 01/09/2021] [Accepted: 10/27/2021] [Indexed: 11/14/2022] Open
Abstract
AIM To describe clinical characteristics, procedural details, specific challenges, and outcomes in patients with HeartMate3™ (HM3), a left ventricular assist device system with a magnetically levitated pump, undergoing ventricular tachycardia ablation (VTA). METHODS AND RESULTS Data were collected from patients with an HM3 system who underwent VTA in seven tertiary centres. Data included baseline patient characteristics, procedural data, mortality, and arrhythmia-free survival. The study cohort included 19 patients with cardiomyopathy presenting with ventricular tachycardia (VT) (53% with VT storm). Ventricular tachycardias were induced in 89% of patients and a total of 41 VTs were observed. Severe electromagnetic interference was present on the surface electrocardiogram. Hence, VT localization required analysis of intra-cardiac signals or the use of filter in the 40-20 Hz range. The large house pump HM3 design obscured the cannula inflow and therefore multi imaging modalities were necessary to avoid catheter entrapment in the cannula. A total of 32 VTs were mapped and were successfully ablated (31% to the anterior wall, 38% to the septum and only 9% to the inflow cannula region). Non-inducibility of any VT was reached in 11 patients (58%). Over a follow-up of 429 (interquartile range 101-692) days, 5 (26%) patients underwent a redo VT ablation due to recurrent VTA and 2 (11%) patients died. CONCLUSIONS Ventricular tachycardia ablation in patients with HM3 is feasible and safe when done in the appropriate setup. Long-term arrhythmia-free survival is acceptable but not well predicted by non-inducibility at the end of the procedure.
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Affiliation(s)
- Eyal Nof
- Davidai Arrhythmia Center, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Petr Peichl
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Predrag Stojadinovic
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Martin Arceluz
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Philippe Maury
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Moshe Katz
- Davidai Arrhythmia Center, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Usha B Tedrow
- Cardiovascular Division, Brigham and Women's Hospital, 75, Boston, MA, USA
| | - Robin M Singh
- Cardiovascular Division, Brigham and Women's Hospital, 75, Boston, MA, USA
| | - Ryohsuke Narui
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Roy M John
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - William G Stevenson
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Roy Beinart
- Davidai Arrhythmia Center, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avishay Grupper
- Davidai Arrhythmia Center, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Leonid Sternik
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Cardiac Surgery, Sheba Medical Center, Ramat Gan, Israel
| | - Jacob Lavee
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Cardiac Surgery, Sheba Medical Center, Ramat Gan, Israel
| | - Frédéric Sacher
- LIRYC Institute, Bordeaux University Hospital, Pessac, France; Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital, Pessac, France
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Avi Sabbag
- Davidai Arrhythmia Center, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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7
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Tsuji M, Amiya E, Bujo C, Hara T, Saito A, Minatsuki S, Maki H, Ishida J, Hosoya Y, Hatano M, Imai H, Nemoto M, Kagami Y, Endo M, Kimura M, Ando M, Shimada S, Kinoshita O, Ono M, Komuro I. Carbon Monoxide Diffusing Capacity Predicts Cardiac Readmission in Patients Undergoing Left Ventricular Assist Device Implantation in Japan. ASAIO J 2021; 67:1111-1118. [PMID: 33470633 DOI: 10.1097/mat.0000000000001363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Carbon monoxide diffusion capacity (DLCO) is impaired in heart failure patients; however, its clinical impact has not been well investigated in the left ventricular assist device (LVAD) population. We explored the predictive value of preoperative DLCO in the survival and cardiac readmission rates after LVAD implantation. Seventy-six patients who received continuous-flow LVAD as bridge-to-transplant therapy from November 2007 to September 2018 and underwent pulmonary function test before LVAD implantation were included. The primary study endpoints were death and readmission for heart failure or arrhythmia (cardiac readmission). Patients were stratified into two groups according to the percent of predicted DLCO (%DLCO). Pulmonary vascular resistance (PVR) was equivocal between the groups preoperatively, whereas the low DLCO group (%DLCO < 80%) showed significantly high PVR postoperatively. The mortality rate was not different between the groups. The 2 year cardiac readmission rate was 33.5% in the low DLCO group and 8.7% in the high DLCO group (%DLCO ≥ 80%) (P = 0.028). The %DLCO was associated with cardiac readmission in univariate and multivariate analyses (hazard ratio: 4.32; 95% CI: 1.50-15.9; P = 0.005). Low %DLCO was associated with high PVR postoperatively and was a risk factor for cardiac readmission after LVAD implantation.
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Affiliation(s)
- Masaki Tsuji
- From the Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Eisuke Amiya
- From the Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Therapeutic Strategy for Heart Failure, The University of Tokyo, Tokyo, Japan
| | - Chie Bujo
- From the Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toru Hara
- From the Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akihito Saito
- From the Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shun Minatsuki
- From the Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hisataka Maki
- From the Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Junichi Ishida
- From the Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yumiko Hosoya
- From the Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Therapeutic Strategy for Heart Failure, The University of Tokyo, Tokyo, Japan
| | - Masaru Hatano
- From the Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Therapeutic Strategy for Heart Failure, The University of Tokyo, Tokyo, Japan
| | - Hiroko Imai
- Department of Organ Transplantation, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mariko Nemoto
- Department of Organ Transplantation, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukie Kagami
- Department of Organ Transplantation, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Miyoko Endo
- Department of Organ Transplantation, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mitsutoshi Kimura
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masahiko Ando
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shogo Shimada
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Osamu Kinoshita
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Issei Komuro
- From the Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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8
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Sisti N, Santoro A, Carreras G, Valente S, Donzelli S, Mandoli GE, Sciaccaluga C, Cameli M. Ablation therapy for ventricular arrhythmias in patients with LVAD: Multiple faces of an electrophysiological challenge. J Arrhythm 2021; 37:535-543. [PMID: 34141004 PMCID: PMC8207352 DOI: 10.1002/joa3.12542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 03/12/2021] [Accepted: 04/04/2021] [Indexed: 12/15/2022] Open
Abstract
Left ventricular assist device implantation is a recognized treatment option for patients with advanced heart failure refractory to medical therapy and can be used both as bridge to transplantation and as destination therapy. The risk of ventricular arrhythmias is common after left ventricular assist device implantation and is influenced by pre-, peri and post-operative determinants. The management of ventricular arrhythmias can be a challenge when they become refractory to medication or to device therapy and their impact on prognosis can be detrimental despite the mechanical support. In this setting, catheter ablation is being increasingly recognized as a feasible option for patients in which standard therapeutic strategies fail, but also with preventive purpose. Catheter ablation is being increasingly considered for the management of ventricular arrhythmias in patients with left ventricular assist device despite complex clinical and technical peculiarities due to the characteristics of the mechanical support. Much conflicting data exist regarding the predictors of success of the procedure and the rate of recurrence. In this review we discuss the latest evidences regarding catheter ablation of ventricular arrhythmias in this subset of patients, focusing on clinical characteristics, arrhythmia etiology, technical aspects and postprocedural features which must be considered by the electrophysiologist.
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Affiliation(s)
- Nicolò Sisti
- Department of Cardiovascular DiseasesUniversity of SienaSienaItaly
| | - Amato Santoro
- Department of Cardiovascular DiseasesUniversity of SienaSienaItaly
| | | | - Serafina Valente
- Department of Cardiovascular DiseasesUniversity of SienaSienaItaly
| | | | | | | | - Matteo Cameli
- Department of Cardiovascular DiseasesUniversity of SienaSienaItaly
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9
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Grinstein J, Garan AR, Oesterle A, Fried J, Imamura T, Mai X, Kalantari S, Sayer G, Kim GH, Sarswat N, Raikhelkar J, Adatya S, Jeevanandam V, Flatley E, Moss J, Uriel N. Increased Rate of Pump Thrombosis and Cardioembolic Events Following Ventricular Tachycardia Ablation in Patients Supported With Left Ventricular Assist Devices. ASAIO J 2021; 66:1127-1136. [PMID: 33136600 PMCID: PMC10024475 DOI: 10.1097/mat.0000000000001155] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Ventricular arrhythmias are common following left ventricular assist device implantation (LVAD), and the effects of ventricular tachycardia (VT) ablation on thrombosis and embolic events are unknown. We aimed to assess LVAD thrombosis, stroke, and embolic event rates after VT ablation. Left ventricular assist device implantation patients from two academic centers who underwent endocardial VT ablation between 2009 and 2016 were compared to a control group with VT who were not ablated and followed for one year. The primary composite outcome was confirmed or suspected LVAD thrombosis, stroke, or other embolic event. Survival analysis was conducted with Kaplan-Meier curves, log-rank tests, and Cox regression. Forty-three LVAD patients underwent VT ablation, and 73 LVAD patients had VT but were not ablated. Patients who were ablated were more likely have VT prior to LVAD (p = 0.04), monomorphic VT (p < 0.01), and to be on antiarrhythmics (p < 0.01). Fifty-eight percent of the patients in the ablation group experienced the primary composite outcome (11% had confirmed device thrombosis [DT], 41% suspected DT, 39% had a stroke or embolic event) compared to 30% in the control group (12% with confirmed DT, 11% with suspected DT, 14% with stroke or embolic event) (p = 0.002). In multivariable regression, ablation was an independent predictor of the primary composite outcome (hazard ratios, 2.24; 95% confidence interval, 1.09-4.61; p = 0.03). Patients with LVADs referred for endocardial VT ablation had elevated rates of DT and embolic events.
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Affiliation(s)
| | | | | | - Justin Fried
- Division of Cardiology, Columbia University, New York, NY
| | | | - Xingchen Mai
- Division of Cardiology, Columbia University, New York, NY
| | - Sara Kalantari
- Department of Medicine, University of Chicago, Chicago, IL
| | - Gabriel Sayer
- Division of Cardiology, Columbia University, New York, NY
| | - Gene H. Kim
- Department of Medicine, University of Chicago, Chicago, IL
| | | | | | - Sirtaz Adatya
- Kaiser Permanente Advanced Heart Failure, Santa Clara, CA
| | - Valluvan Jeevanandam
- Department of Surgery, University of Chicago Medical Center, University of Chicago, Chicago, IL
| | - Erin Flatley
- Division of Cardiology, University of California San Francisco, San Francisco, CA
| | - Joshua Moss
- Division of Cardiology, University of California San Francisco, San Francisco, CA
| | - Nir Uriel
- Division of Cardiology, Columbia University, New York, NY
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10
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Sáenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Europace 2020; 21:1143-1144. [PMID: 31075787 DOI: 10.1093/europace/euz132] [Citation(s) in RCA: 220] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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11
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Bella PD, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. J Interv Card Electrophysiol 2020; 59:145-298. [PMID: 31984466 PMCID: PMC7223859 DOI: 10.1007/s10840-019-00663-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, IN, USA
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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12
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Khalil F, Siontis K, Bagameri G, Killu AM. Hybrid Catheter-Based and Surgical Techniques for Ablation of Ventricular Arrhythmias. Arrhythm Electrophysiol Rev 2020; 9:97-103. [PMID: 32983531 PMCID: PMC7491053 DOI: 10.15420/aer.2020.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Catheter ablation is a rapidly expanding and evolving field. The advent of interventional techniques and advances in technology have allowed catheter ablation to supplant antiarrhythmic surgery for ventricular arrhythmia treatment. However, issues related to access and energy delivery limit the use of catheter ablation in some cases. Hybrid catheter-based and surgical techniques represent a novel approach to overcome these limitations. The hybrid technique combines the strengths and minimises the limitations of either catheter or surgical ablation alone. There is a growing body of evidence in the literature supporting the safety and efficacy of the hybrid surgical technique. This review aims to provide an overview of hybrid surgical-catheter ablation for ventricular arrhythmia.
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Affiliation(s)
- Fouad Khalil
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, US
| | - Konstantinos Siontis
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, US
| | - Gabor Bagameri
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, US
| | - Ammar M Killu
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, US
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13
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Ventricular arrhythmias in patients with biventricular assist devices. J Interv Card Electrophysiol 2019; 58:243-252. [PMID: 31838665 PMCID: PMC7293581 DOI: 10.1007/s10840-019-00682-0] [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: 09/05/2019] [Accepted: 12/02/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Ventricular arrhythmias (VAs) are common in patients after left ventricular assist device (LVAD) implant and are associated with worse outcomes. However, the prevalence and impact of VA in patients with durable biventricular assist device (BIVAD) is unknown. We performed a retrospective cohort study of patients with BIVADs to evaluate the prevalence of VA and their clinical outcomes. METHODS Consecutive patients who received a BIVAD between June 2014 and July 2017 at our medical center were included. The prevalence of VA, defined as sustained ventricular tachycardia or fibrillation requiring defibrillation or ICD therapy, was compared between BIVAD patients and a propensity-matched population of patients with LVAD from our center. The occurrence of adverse clinical events was compared between BIVAD patients with and without VA. RESULTS Of the 13 patients with BIVADs, 6 patients (46%) experienced clinically significant VA, similar to a propensity-matched LVAD population (38%, p = 1.00). There were no differences in baseline characteristics between the two cohorts, except patients in the non-VA group who had worse hemodynamics (mitral regurgitation and right-sided indices), had less history of VA, and were younger. BIVAD patients with VA had a higher incidence of major bleeding (MR 3.05 (1.07-8.66), p = 0.036) and worse composite outcomes (log-rank test, p = 0.046). The presence of VA was associated with worse outcomes in both LVAD and BIVAD groups. CONCLUSIONS Ventricular arrhythmias are common in patients with BIVADs and are associated with worse outcomes. Future work should assess whether therapies such as ablation improve the outcome of BIVAD patients with VA.
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14
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Ahmed A, Amin M, Boilson BA, Killu AM, Madhavan M. Ventricular Arrhythmias in Patients With Left Ventricular Assist Device (LVAD). CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:75. [PMID: 31773322 DOI: 10.1007/s11936-019-0783-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Left ventricular assist device (LVAD) implantation is a well-known treatment option for patients with advanced heart failure refractory to medical therapy and is recognized both as bridge to transplant and a destination therapy. The risk of ventricular arrhythmias (VAs) is common after LVAD implantation. We review the pathophysiology and recent advances in the management of VA in LVAD patients. RECENT FINDINGS VAs are most likely to occur in the early post-operative periods after LVAD implantation and a prior history of VA is the most important risk factor. Post-LVAD VAs are usually well tolerated with less morbidity and decreased risk of sudden cardiac death. However, risk of right heart failure in the setting of persistent VAs is being increasingly recognized. The mechanisms of post-LVAD VAs may vary depending on the time from LVAD implantation. Electrical remodeling may play an important role in the immediate post-implant phase. Preexisting myocardial scar and to a lesser extent mechanical irritation from the LVAD cannula are important in the later phases. Most LVAD patients have a previously placed implantable cardioverter-defibrillator (ICD). The benefit of implanting a new ICD in LVAD patients is unknown and should be individualized. For ICD programming, a conservative strategy with higher detection zones and prolonged time to detection is usually recommended aiming to minimize ICD shocks. More aggressive programming is appropriate if the VA results in hemodynamic instability. Antiarrhythmic drugs including amiodarone, mexiletine, and beta blockers are usually the first-line therapy for VAs. Catheter ablation has been shown to be safe and effective in LVAD recipients with recurrent VAs not responsive to antiarrhythmic drugs. LVAD-related VA is most frequently reentrant secondary to myocardial scar and usually well tolerated. Management options include antiarrhythmic drugs and catheter ablation.
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Affiliation(s)
- Azza Ahmed
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Mustapha Amin
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Barry A Boilson
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Ammar M Killu
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Malini Madhavan
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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15
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Gopinathannair R, Cornwell WK, Dukes JW, Ellis CR, Hickey KT, Joglar JA, Pagani FD, Roukoz H, Slaughter MS, Patton KK. Device Therapy and Arrhythmia Management in Left Ventricular Assist Device Recipients: A Scientific Statement From the American Heart Association. Circulation 2019; 139:e967-e989. [DOI: 10.1161/cir.0000000000000673] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Left ventricular assist devices (LVADs) are an increasingly used strategy for the management of patients with advanced heart failure with reduced ejection fraction. Although these devices effectively improve survival, atrial and ventricular arrhythmias are common, predispose these patients to additional risk, and complicate patient management. However, there is no consensus on best practices for the medical management of these arrhythmias or on the optimal timing for procedural interventions in patients with refractory arrhythmias. Although the vast majority of these patients have preexisting cardiovascular implantable electronic devices or cardiac resynchronization therapy, given the natural history of heart failure, it is common practice to maintain cardiovascular implantable electronic device detection and therapies after LVAD implantation. Available data, however, are conflicting on the efficacy of and optimal device programming after LVAD implantation. Therefore, the primary objective of this scientific statement is to review the available evidence and to provide guidance on the management of atrial and ventricular arrhythmias in this unique patient population, as well as procedural interventions and cardiovascular implantable electronic device and cardiac resynchronization therapy programming strategies, on the basis of a comprehensive literature review by electrophysiologists, heart failure cardiologists, cardiac surgeons, and cardiovascular nurse specialists with expertise in managing these patients. The structure and design of commercially available LVADs are briefly reviewed, as well as clinical indications for device implantation. The relevant physiological effects of long-term exposure to continuous-flow circulatory support are highlighted, as well as the mechanisms and clinical significance of arrhythmias in the setting of LVAD support.
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16
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Heart Rhythm 2019; 17:e2-e154. [PMID: 31085023 PMCID: PMC8453449 DOI: 10.1016/j.hrthm.2019.03.002] [Citation(s) in RCA: 179] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Indexed: 01/10/2023]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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17
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Moss JD, Oesterle A, Raiman M, Flatley EE, Beaser AD, Jeevanandam V, Klein L, Ota T, Wieselthaler G, Uriel N, Tung R. Feasibility and utility of intraoperative epicardial scar characterization during left ventricular assist device implantation. J Cardiovasc Electrophysiol 2018; 30:183-192. [PMID: 30516301 DOI: 10.1111/jce.13803] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 10/29/2018] [Accepted: 11/06/2018] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Ventricular arrhythmias (VA) after left ventricular assist device (LVAD) placement are associated with increased morbidity and mortality. We sought to assess epicardial voltage characteristics at the time of LVAD implantation and investigate relationships between scar burden and postimplant VA. METHODS AND RESULTS Consecutive patients underwent open chest epicardial electroanatomic mapping immediately before LVAD implantation. Areas of low voltage and sites with local abnormal potentials were identified. Patients were followed prospectively for postimplant VA and clinical outcomes. Between 2015 and 2017, 36 patients underwent high-density intraoperative epicardial voltage mapping; 15 had complete maps suitable for analysis. Mapping required a median of 11.8 (interquartile range [IQR], 8.5-12.7) minutes, with a median of 2650 (IQR, 2139-3191) points sampled per patient. Over a median follow-up of 311 (IQR, 168-469) postoperative days, four patients (27%) experienced sustained VA. Patients with postimplant VA were more likely to have had preimplant implantable cardioverter defibrillator shocks (100% vs 27%; P = 0.03), ventricular tachycardia storm (75% vs 9%; P = 0.03), and lower ejection fraction (13.5 vs 19.0%, P = 0.05). Patients with postimplant VA also had a significantly higher burden of epicardial low bipolar voltage points: 55.4% vs 24.9% of points were less than 0.5 mV (P = 0.01), and 88.9% vs 63.7% of points less than 1.5 mV (P = 0.004). CONCLUSIONS Intraoperative high-density epicardial mapping during LVAD implantation is safe and efficient, facilitating characterization of a potentially arrhythmogenic substrate. An increased burden of the epicardial scar may be associated with a higher incidence of postimplant VA. The role of empiric intraoperative epicardial ablation to mitigate risk of postimplant VA requires further study.
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Affiliation(s)
- Joshua D Moss
- Department of Medicine, Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Francisco, San Francisco, California
| | - Adam Oesterle
- Department of Medicine, Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Francisco, San Francisco, California
| | | | - Erin E Flatley
- Department of Medicine, Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Francisco, San Francisco, California
| | - Andrew D Beaser
- Department of Medicine, Section of Cardiology, Center for Arrhythmia Care, University of Chicago Medicine, Chicago, Illinois
| | - Valluvan Jeevanandam
- Department of Surgery, Section of Cardiac and Thoracic Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Liviu Klein
- Department of Medicine, Division of Cardiology, Section of Heart Failure, University of California San Francisco, San Francisco, California
| | - Takeyoshi Ota
- Department of Surgery, Section of Cardiac and Thoracic Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Georg Wieselthaler
- Department of Surgery, Division of Adult Cardiothoracic Surgery, University of California San Francisco, San Francisco, California
| | - Nir Uriel
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, Chicago, IL
| | - Roderick Tung
- Department of Medicine, Section of Cardiology, Center for Arrhythmia Care, University of Chicago Medicine, Chicago, Illinois
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18
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Ambulatory Ventricular Assist Device Patient Management. Cardiol Clin 2018; 36:571-581. [PMID: 30297074 DOI: 10.1016/j.ccl.2018.06.014] [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: 11/24/2022]
Abstract
Understanding the ventricular assist device (VAD) patient pump interface and developing expertise in monitoring patients with a VAD are the goals of care in the ambulatory setting. The objective is to improve long-term outcomes. The purpose of expert, focused, routine outpatient surveillance is to facilitate the integration of pulseless, electrically dependent VAD patients into the community. Other goals of outpatient care include maximizing quality of life, maintaining equipment integrity, treating heart failure symptoms, monitoring for common VAD-related complications, ensuring viability as a heart transplant candidate, consideration for patients implanted to become transplantable, and monitoring for possible cardiac recovery.
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Catheter Ablation of Ventricular Tachycardia in Patients With a Ventricular Assist Device: A Systematic Review of Procedural Characteristics and Outcomes. JACC Clin Electrophysiol 2018; 5:39-51. [PMID: 30678785 DOI: 10.1016/j.jacep.2018.08.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/07/2018] [Accepted: 08/17/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVES This is a systematic review summarizing the procedural characteristics and outcomes of ventricular assist device (VAD)-related ventricular tachycardia (VT) ablation. BACKGROUND Drug-refractory VT refractory commonly develops post-VAD implantation. Procedural and outcome data come from small series or case reports. METHODS An electronic search was performed using major databases. Primary outcomes were VT recurrence, mortality, and cardiac transplantation. Secondary endpoints were acute procedural success and procedural complications. RESULTS Eighteen studies were included, with a total of 110 patients (mean age 59.6 ± 11 years, 89% men; VT storm 34%). Scar-related re-entry was the predominant mechanism of VT (90.3%) and cannula-related VT in 19.3% cases. Electroanatomical mapping interference occurred in 1.8% of cases; there were no reports of catheter entrapment. Noninducibility of clinical VT was achieved in 77.9%; procedural complications occurred in 9.4%. At a mean follow-up of 263.5 ± 267.0 days, VT recurred in 43.6%, 23.4% underwent cardiac transplant, and 48.1% died. There were no procedural-related deaths and no death was directly related to ventricular arrhythmia. In follow-up, there was a significant reduction in implantable cardioverter-defibrillator therapies or shocks (57.1% vs. 23.8%). Ablation allowed VT storm termination in 90% of patients. CONCLUSIONS VAD-related VT is predominantly related to pre-existing intrinsic myocardial scar rather than inflow cannula site insertion. Catheter ablation is a reasonable treatment strategy, albeit with expectedly high rate of recurrence, transplantation, and mortality related to severe underlying disease.
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Ho G, Tran HA, Urey MA, Adler ED, Pretorius VG, Hsu JC. Successful ventricular tachycardia ablation in a patient with a biventricular ventricular assist device and heparin-induced thrombocytopenia using bivalirudin. HeartRhythm Case Rep 2018; 4:367-370. [PMID: 30116710 PMCID: PMC6092635 DOI: 10.1016/j.hrcr.2018.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/04/2018] [Accepted: 05/16/2018] [Indexed: 12/23/2022] Open
Affiliation(s)
- Gordon Ho
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, California
| | - Hao A. Tran
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, California
| | - Marcus A. Urey
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, California
| | - Eric D. Adler
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, California
| | - Victor G. Pretorius
- Department of Cardiothoracic Surgery, University of California San Diego, La Jolla, California
| | - Jonathan C. Hsu
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, California
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Management of Arrhythmias and Cardiac Implantable Electronic Devices in Patients With Left Ventricular Assist Devices. JACC Clin Electrophysiol 2018; 4:847-859. [DOI: 10.1016/j.jacep.2018.04.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/28/2018] [Accepted: 04/30/2018] [Indexed: 11/21/2022]
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Electromagnetic Interference Between Left Ventricular Assist Device and a Three-Dimensional Mapping System Overcome by "Hot Mapping". ASAIO J 2018; 64:e61-e63. [PMID: 29419535 DOI: 10.1097/mat.0000000000000757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The number of patients with implanted left ventricular assist devices is constantly increasing. Numerous patients suffer from drug-resistant ventricular tachycardias. Only a few studies and reports about ablation therapy in this cohort of patients are available. Electromagnetic interferences between the left ventricular assist device and the three-dimensional mapping system which is used for ablation has been described as disabling the investigator to create a proper map of the left ventricle. We observed that this interference is interrupted by "hot mapping" meaning that one pretends an ablation with only 5 W, permitting the creation of a clear map in areas of interference.
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Kadado AJ, Akar JG, Hummel JP. Arrhythmias after left ventricular assist device implantation: Incidence and management. Trends Cardiovasc Med 2018; 28:41-50. [DOI: 10.1016/j.tcm.2017.07.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 07/04/2017] [Accepted: 07/04/2017] [Indexed: 10/19/2022]
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Efimova E, Fischer J, Bertagnolli L, Dinov B, Kircher S, Rolf S, Sommer P, Bollmann A, Richter S, Meyer A, Garbade J, Hindricks G, Arya A. Predictors of ventricular arrhythmia after left ventricular assist device implantation: A large single-center observational study. Heart Rhythm 2017; 14:1812-1819. [DOI: 10.1016/j.hrthm.2017.07.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Indexed: 11/28/2022]
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25
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Moss JD, Flatley EE, Beaser AD, Shin JH, Nayak HM, Upadhyay GA, Burke MC, Jeevanandam V, Uriel N, Tung R. Characterization of Ventricular Tachycardia After Left Ventricular Assist Device Implantation as Destination Therapy: A Single-Center Ablation Experience. JACC Clin Electrophysiol 2017; 3:1412-1424. [PMID: 29759673 DOI: 10.1016/j.jacep.2017.05.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/30/2017] [Accepted: 05/31/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study sought to report mechanisms of ventricular tachycardia (VT) and outcomes of VT ablation in patients with a left ventricular assist device (LVAD) as destination therapy. BACKGROUND Continuous flow LVAD implantation plays a growing role in the management of end-stage heart failure, and VT is common. There are limited reports of VT ablation in patients with a destination LVAD. METHODS Patients with a continuous-flow LVAD referred for VT ablation from 2010 to 2016 were analyzed retrospectively. Baseline patient characteristics, procedural data, and clinical follow-up were evaluated. Arrhythmia-free survival was assessed. RESULTS Twenty-one patients (90% male, 62 ± 10 years) underwent catheter ablation of VT at a median of 191 days (interquartile range: 55 to 403 days) after LVAD implantation (15 HeartMate II, 6 HeartWare HVAD). Five patients (24%) had termination (n = 4) or slowing (n = 1) of VT with ablation near the apical inflow cannula, and 3 (14%) had bundle-branch re-entry. Freedom from recurrent VT among surviving patients was 64% at 1 year, with overall survival 67% at 1 year for patients without arrhythmia recurrence and 29% for patients with recurrence (p = 0.049). One patient had suspected pump thrombosis within 30 days of the ablation procedure, with no other major acute complications. CONCLUSIONS In this relatively large, single-center experience of VT ablation in destination LVAD, freedom from recurrent VT and implantable cardioverter-defibrillator shocks was associated with improved 1-year survival. Bundle branch re-entry was more prevalent than anticipated, and cannula-adjacent VT was less common. This challenging population remains at risk for late pump thrombosis and mortality.
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Affiliation(s)
- Joshua D Moss
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California-San Francisco, San Francisco, California.
| | - Erin E Flatley
- Heart and Vascular Center, University of Chicago Medicine, Chicago, Illinois
| | - Andrew D Beaser
- Heart and Vascular Center, University of Chicago Medicine, Chicago, Illinois
| | - John H Shin
- Mid-Atlantic Permanente Medical Group, Rockville, Maryland
| | - Hemal M Nayak
- Heart and Vascular Center, University of Chicago Medicine, Chicago, Illinois
| | - Gaurav A Upadhyay
- Heart and Vascular Center, University of Chicago Medicine, Chicago, Illinois
| | | | | | - Nir Uriel
- Heart and Vascular Center, University of Chicago Medicine, Chicago, Illinois
| | - Roderick Tung
- Heart and Vascular Center, University of Chicago Medicine, Chicago, Illinois
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Resolution of Intractable Ventricular Tachycardia after Surgical Repositioning of a Heartmate II Inflow Cannula. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016; 11:448-450. [DOI: 10.1097/imi.0000000000000317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ventricular arrhythmias are common after left ventricular assist device implantation. Malposition of the inflow cannula is one of the few etiologies with a mechanically correctable defect. We present a case of intractable ventricular tachycardia that resolved after surgical repositioning of a HeartMate II inflow cannula. The diagnosis and management of this case demonstrate the utility of imaging studies for detecting inflow cannula malposition and the efficacy of inflow cannula repositioning for treatment.
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Son AY, Reyentovich A, Pan S, DeAnda A, Balsam LB. Resolution of Intractable Ventricular Tachycardia after Surgical Repositioning of a Heartmate II Inflow Cannula. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016. [DOI: 10.1177/155698451601100615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andre Y. Son
- Department of Cardiothoracic Surgery, NYU-Langone Medical Center, New York, NY USA
| | - Alex Reyentovich
- Division of Cardiology, NYU-Langone Medical Center, New York, NY USA
| | - Stephen Pan
- Division of Cardiology, NYU-Langone Medical Center, New York, NY USA
| | - Abe DeAnda
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, TX USA
| | - Leora B. Balsam
- Department of Cardiothoracic Surgery, NYU-Langone Medical Center, New York, NY USA
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28
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Ventricular assist devices and sleep-disordered breathing. Sleep Med Rev 2016; 35:51-61. [PMID: 27641662 DOI: 10.1016/j.smrv.2016.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 08/16/2016] [Accepted: 08/17/2016] [Indexed: 11/22/2022]
Abstract
Congestive heart failure is one of the leading causes of morbidity and mortality in the United States, and left ventricular assist devices have revolutionized treatment of end-stage heart failure. Given that sleep apnea results in significant morbidity in these patients with advanced heart failure, practicing sleep physicians need to have an understanding of left ventricular assist devices. In this review, we summarize what is known about ventricular assist devices as they relate to sleep medicine.
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Ikegami H, Kurlansky P, Takeda K, Naka Y. Challenges faced in long term ventricular assist device support. Expert Rev Med Devices 2016; 13:727-40. [PMID: 27376168 DOI: 10.1080/17434440.2016.1208557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The development of ventricular assist device (VAD) has been one of the revolutionary advancements in end-stage heart failure management. Although the device has developed and improved significantly over the last few decades, we still face multiple challenges. AREAS COVERED This review will discuss quality of life, survival, and clinically encountered complications in patients with VAD support. The literature was extensively reviewed for studies describing the above topic area. We describe the impact of major challenges faced in VAD support and discuss their future and expectations. Expert commentary: The technological advancement of VADs has contributed to major improvement of overall survival, enhancement of quality of life and decrease of incidence of complications. It is expected that technologies will continue to evolve. At the same time, the indications for and timing of device implantation, and selection of device type are continuously important in clinical practice setting.
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Affiliation(s)
- Hirohisa Ikegami
- a Department of Surgery, Division of Cardiothoracic Surgery , Columbia University Medical Center , New York , NY , USA
| | - Paul Kurlansky
- a Department of Surgery, Division of Cardiothoracic Surgery , Columbia University Medical Center , New York , NY , USA
| | - Koji Takeda
- a Department of Surgery, Division of Cardiothoracic Surgery , Columbia University Medical Center , New York , NY , USA
| | - Yoshifumi Naka
- a Department of Surgery, Division of Cardiothoracic Surgery , Columbia University Medical Center , New York , NY , USA
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30
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Willemsen D, Cordes C, Bjarnason-Wehrens B, Knoglinger E, Langheim E, Marx R, Reiss N, Schmidt T, Workowski A, Bartsch P, Baumbach C, Bongarth C, Phillips H, Radke R, Riedel M, Schmidt S, Skobel E, Toussaint C, Glatz J. [Rehabilitation standards for follow-up treatment and rehabilitation of patients with ventricular assist device (VAD)]. Clin Res Cardiol Suppl 2016; 11 Suppl 1:2-49. [PMID: 26882905 DOI: 10.1007/s11789-015-0077-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The increasing use of ventricular assist devices (VADs) in terminal heart failure patients provides new challenges to cardiac rehabilitation physicians. Structured cardiac rehabilitation strategies are still poorly implemented for this special patient group. Clear guidance and more evidence for optimal modalities are needed. Thereby, attention has to be paid to specific aspects, such as psychological and social support and education (e.g., device management, INR self-management, drive-line care, and medication).In Germany, the post-implant treatment and rehabilitation of VAD Patients working group was founded in 2012. This working group has developed clear recommendations for the rehabilitation of VAD patients according to the available literature. All facets of VAD patients' rehabilitation are covered. The present paper is unique in Europe and represents a milestone to overcome the heterogeneity of VAD patient rehabilitation.
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Affiliation(s)
- Detlev Willemsen
- Schüchtermann-Klinik, Ulmenalle 5-11, 49214, Bad Rothenfelde, Deutschland.
| | - C Cordes
- Gollwitzer-Meier-Klinik, Bad Oeynhausen, Deutschland
| | - B Bjarnason-Wehrens
- Institut für Kreislaufforschung und Sportmedizin, Deutsche Sporthochschule Köln, Köln, Deutschland
| | | | - E Langheim
- Reha-Zentrum Seehof der DRV-Bund, Teltow, Deutschland
| | - R Marx
- MediClin Fachklinik Rhein/Ruhr, Essen, Deutschland
- Universität Witten/Herdecke, Witten, Deutschland
| | - N Reiss
- Schüchtermann-Klinik, Ulmenalle 5-11, 49214, Bad Rothenfelde, Deutschland
| | - T Schmidt
- Schüchtermann-Klinik, Ulmenalle 5-11, 49214, Bad Rothenfelde, Deutschland
| | - A Workowski
- Schüchtermann-Klinik, Ulmenalle 5-11, 49214, Bad Rothenfelde, Deutschland
| | - P Bartsch
- Schüchtermann-Klinik, Ulmenalle 5-11, 49214, Bad Rothenfelde, Deutschland
| | - C Baumbach
- Herz- und Gefäßzentrum Bad Bevensen, Bad Bevensen, Deutschland
| | - C Bongarth
- Klinik Höhenried, Bernried am Starnberger See, Deutschland
| | - H Phillips
- Reha Parcs Steinhof, Erkrath, Deutschland
| | - R Radke
- Christiaan-Barnard-Klinik, Dahlen-Schmannewitz, Dahlen, Deutschland
| | - M Riedel
- Klinik Fallingbostel, Bad Fallingbostel, Deutschland
| | - S Schmidt
- Gollwitzer-Meier-Klinik, Bad Oeynhausen, Deutschland
| | - E Skobel
- Rehaklinik "An der Rosenquelle", Aachen, Deutschland
| | - C Toussaint
- m&i Fachklinik Herzogenaurach, Herzogenaurach, Deutschland
| | - J Glatz
- Reha-Zentrum Seehof der DRV-Bund, Teltow, Deutschland
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Yoruk A, Sherazi S, Massey HT, Kutyifa V, McNitt S, Hallinan W, Huang DT, Chen L, Aktas MK. Predictors and clinical relevance of ventricular tachyarrhythmias in ambulatory patients with a continuous flow left ventricular assist device. Heart Rhythm 2016; 13:1052-1056. [PMID: 26829113 DOI: 10.1016/j.hrthm.2016.01.033] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Patients with a left ventricular assist device (LVAD) are at high risk for ventricular tachyarrhythmias (VTAs). OBJECTIVE We aimed to identify clinical predictors of VTAs and subsequent outcomes after VTA in ambulatory LVAD patients. METHODS A retrospective study of 149 patients with a continuous flow HeartMate II LVAD who survived to discharge from index hospitalization after LVAD implantation was performed from January 10, 2005, to September 3, 2013. A multivariate Cox model was used to assess clinical predictors of VTAs. RESULTS During a mean follow-up period of 2.1 ± 1.2 years, 41 patients (28%) experienced VTAs; 30 of these patients (71%) had ventricular tachycardia, and 11 (29%) had ventricular fibrillation. History of VTAs before LVAD (hazard ratio [HR] 3.06; 95% confidence interval [CI] 1.57-5.96; P = .001) and history of atrial fibrillation (AF) (HR 3.13; 95% CI 1.60-6.11; P = .008) were the most powerful predictors of VTAs after LVAD implantation. There were 19 deaths (46%) among patients with VTAs and 15 deaths (14%) among patients without VTAs (P < .001). In multivariate analysis, time-dependent VTAs after LVAD implantation were associated with a significantly higher risk of all-cause mortality when compared with those without VTAs (HR 7.28; 95% CI 3.50-15.15; P < .001). CONCLUSION In ambulatory LVAD patients, history of VTAs before LVAD implantation and history of AF predict VTAs after LVAD implantation. VTAs are associated with an increased risk of mortality. In such patients, aggressive measures to control VTAs and AF should be considered.
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Affiliation(s)
- Ayhan Yoruk
- University of Rochester Medical Center, Rochester, New York
| | - Saadia Sherazi
- University of Rochester Medical Center, Rochester, New York
| | - H Todd Massey
- University of Rochester Medical Center, Rochester, New York
| | | | - Scott McNitt
- University of Rochester Medical Center, Rochester, New York
| | | | - David T Huang
- University of Rochester Medical Center, Rochester, New York
| | - Leway Chen
- University of Rochester Medical Center, Rochester, New York
| | - Mehmet K Aktas
- University of Rochester Medical Center, Rochester, New York.
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32
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Vega EA, Miko Enomoto T. Complications Following Left Ventricular Assist Device Implantation: Diagnosis and Management of Common Adverse Events. CURRENT ANESTHESIOLOGY REPORTS 2015. [DOI: 10.1007/s40140-015-0127-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Romano G, Raffa GM, Ruggieri A, Sgarito G, Falletta C, Sciacca S, Pilato M, Clemenza F. Recurrent ventricular tachycardia in a patient with continuous flow left ventricle assist device: Successful management with radiofrequency ablation and medical treatment. Int J Cardiol 2015; 190:198-200. [DOI: 10.1016/j.ijcard.2015.04.141] [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] [Received: 04/15/2015] [Accepted: 04/16/2015] [Indexed: 10/23/2022]
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Takeda K, Takayama H, Colombo PC, Yuzefpolskaya M, Fukuhara S, Han J, Kurlansky P, Mancini DM, Naka Y. Incidence and clinical significance of late right heart failure during continuous-flow left ventricular assist device support. J Heart Lung Transplant 2015; 34:1024-32. [PMID: 25935438 DOI: 10.1016/j.healun.2015.03.011] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 03/16/2015] [Accepted: 03/17/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Right heart failure (RHF) is an unresolved issue during continuous-flow left ventricular assist device (LVAD) support. Little is known about the incidence and clinical significance of late RHF during LVAD support. METHODS Between May 2004 and December 2013, 336 patients underwent continuous-flow LVAD implantation. Of these, 293 patients (87%) discharged with isolated LVAD support were included in this study. Late RHF was defined as HF requiring re-admission and medical or surgical intervention after initial surgery. RESULTS Late RHF occurred in 33 patients (11%) at a median of 99 days after discharge (range 19 to 1,357 days). Freedom from late RHF rates were 87%, 84% and 79% at 1, 2 and 3 years, respectively. RHF recurred in 15 patients. Three patients required right ventricular assist device insertion. Univariable Cox proportional hazards regression model showed diabetes mellitus (HR 2.05, 95% CI 1.03 to 4.06, p = 0.04), body mass index >29 (HR 2.47, 95% CI 1.24 to 4.94, p = 0.01) and blood urea nitrogen level >41 mg/dl (HR 2.19; 95% CI 1.10 to 4.36; p = 0.025) as significant predictors for late RHF. Estimated on-device survival rates at 2 years were 73% in the RHF group and 82% in the non-RHF group (p = 0.20). However, overall survival at 2 years was significantly worse in patients who developed late RHF (60% vs 85%, p = 0.016). This reduction was mostly attributed to worse overall outcomes in the bridge-to-transplant (BTT) population. CONCLUSIONS Late RHF is common after continuous-flow LVAD implantation, but does not affect survival during LVAD support. However, it is associated with worse overall outcomes in the BTT population.
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Affiliation(s)
- Koji Takeda
- Department of Surgery, Division of Cardiothoracic Surgery Columbia University Medical Center, New York, New York.
| | - Hiroo Takayama
- Department of Surgery, Division of Cardiothoracic Surgery Columbia University Medical Center, New York, New York
| | - Paolo C Colombo
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Melana Yuzefpolskaya
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Shinichi Fukuhara
- Department of Surgery, Division of Cardiothoracic Surgery Columbia University Medical Center, New York, New York
| | - Jiho Han
- Department of Surgery, Division of Cardiothoracic Surgery Columbia University Medical Center, New York, New York
| | - Paul Kurlansky
- Department of Surgery, Division of Cardiothoracic Surgery Columbia University Medical Center, New York, New York
| | - Donna M Mancini
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Yoshifumi Naka
- Department of Surgery, Division of Cardiothoracic Surgery Columbia University Medical Center, New York, New York
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36
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Griffin JM, Katz JN. The Burden of Ventricular Arrhythmias Following Left Ventricular Assist Device Implantation. Arrhythm Electrophysiol Rev 2014; 3:145-8. [PMID: 26835082 DOI: 10.15420/aer.2014.3.3.145] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 10/29/2014] [Indexed: 12/26/2022] Open
Abstract
Few innovations in medicine have so convincingly and expeditiously improved patient outcomes more than the development of the left ventricular assist device (LVAD). Where optimal pharmacotherapy once routinely failed those with end-stage disease, the LVAD now offers considerable hope for the growing advanced heart failure population. Despite improvements in mortality, however, mechanical circulatory support is not without its limitations. Those supported with an LVAD are at increased risk of several complications, including infection, bleeding, stroke and arrhythmic events. While once considered benign, ventricular arrhythmias in the LVAD patient are being increasingly recognised for their deleterious influence on patient morbidity and quality of life. In addition, the often multifactorial aetiology to these episodes makes treatment difficult and optimal therapeutic management controversial. Novel strategies are clearly needed to better predict, prevent, and eradicate these arrhythmias in order to allow future generations of heart failure patients to reap the full benefits of LVAD implantation.
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Affiliation(s)
- Jan M Griffin
- Department of Internal Medicine, University of North Carolina
| | - Jason N Katz
- Division of Cardiology, Center for Heart and Vascular Care, University of North Carolina, US
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Whang W, Patel MR, Iyer V, Gambhir A, Biviano AB, Garan AR, Takayama H, Bacchetta M, Naka Y, Jorde UP, Garan H. Epicardial catheter ablation through subxiphoid surgical approach in a patient with implanted left ventricular assist device and cannula-related ventricular tachycardia. Circ Heart Fail 2014; 7:868-9. [PMID: 25228322 DOI: 10.1161/circheartfailure.114.001487] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- William Whang
- From the Departments of Medicine (W.W., M.R.P, V.I, A.G., A.B.B., A.R.G, U.P. J., H.G.) and Surgery (H.T., M.B., Y.N.), Columbia University Medical Center, New York, NY.
| | - Minesh R Patel
- From the Departments of Medicine (W.W., M.R.P, V.I, A.G., A.B.B., A.R.G, U.P. J., H.G.) and Surgery (H.T., M.B., Y.N.), Columbia University Medical Center, New York, NY
| | - Vivek Iyer
- From the Departments of Medicine (W.W., M.R.P, V.I, A.G., A.B.B., A.R.G, U.P. J., H.G.) and Surgery (H.T., M.B., Y.N.), Columbia University Medical Center, New York, NY
| | - Alok Gambhir
- From the Departments of Medicine (W.W., M.R.P, V.I, A.G., A.B.B., A.R.G, U.P. J., H.G.) and Surgery (H.T., M.B., Y.N.), Columbia University Medical Center, New York, NY
| | - Angelo B Biviano
- From the Departments of Medicine (W.W., M.R.P, V.I, A.G., A.B.B., A.R.G, U.P. J., H.G.) and Surgery (H.T., M.B., Y.N.), Columbia University Medical Center, New York, NY
| | - Arthur R Garan
- From the Departments of Medicine (W.W., M.R.P, V.I, A.G., A.B.B., A.R.G, U.P. J., H.G.) and Surgery (H.T., M.B., Y.N.), Columbia University Medical Center, New York, NY
| | - Hiroo Takayama
- From the Departments of Medicine (W.W., M.R.P, V.I, A.G., A.B.B., A.R.G, U.P. J., H.G.) and Surgery (H.T., M.B., Y.N.), Columbia University Medical Center, New York, NY
| | - Matthew Bacchetta
- From the Departments of Medicine (W.W., M.R.P, V.I, A.G., A.B.B., A.R.G, U.P. J., H.G.) and Surgery (H.T., M.B., Y.N.), Columbia University Medical Center, New York, NY
| | - Yoshifumi Naka
- From the Departments of Medicine (W.W., M.R.P, V.I, A.G., A.B.B., A.R.G, U.P. J., H.G.) and Surgery (H.T., M.B., Y.N.), Columbia University Medical Center, New York, NY
| | - Ulrich P Jorde
- From the Departments of Medicine (W.W., M.R.P, V.I, A.G., A.B.B., A.R.G, U.P. J., H.G.) and Surgery (H.T., M.B., Y.N.), Columbia University Medical Center, New York, NY
| | - Hasan Garan
- From the Departments of Medicine (W.W., M.R.P, V.I, A.G., A.B.B., A.R.G, U.P. J., H.G.) and Surgery (H.T., M.B., Y.N.), Columbia University Medical Center, New York, NY
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