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Awad SS, Azeez EF, Taha MO, El-Naggar WM, El-Damaty A. Arrhythmogenicity of anti-tachycardia pacing in patients with implantable cardioverter defibrillator. Egypt Heart J 2023; 75:44. [PMID: 37266828 DOI: 10.1186/s43044-023-00369-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 05/16/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Anti-tachycardia pacing therapy (ATP) has shown comparable efficacy to shock therapy in ventricular tachycardia (VT) termination with better quality of life. However, some ATPs may lead to VT acceleration or degeneration to ventricular fibrillation (VF), which will result in more ICD shocks. The aim of this study was to investigate the predictors of VT acceleration by ATP therapy in a real-life patient cohort. RESULTS We retrospectively reviewed 448 monomorphic VT episodes that required ATP therapy in 60 patients with structural heart diseases implanted with ICD or CRTD. The clinical data of the patients and the episodes' details were evaluated. We found that patients with a higher ejection fraction (EF) were more likely to be cardioverted by ATP therapy (P: 0.024). VT acceleration was more frequent in patients with lower EF (mean 31.24 ± 4.08) compared with the non-accelerated patients with higher EF (mean 37.00 ± 9.4, P: 0.016). The percentage of accelerated episodes was 8.5%. VT episodes with a mean cycle length (CL) < 310 ms are more likely to accelerate (sensitivity 76.3%, specificity 67.7%, PPV value 45%, NPV 86%, and AUC 0.790). There was a statistically significant difference in the accelerated VT episodes as compared to non-accelerated episodes regarding the number of ATP bursts (mean 3.66 ± 2.22 vs. 1.76 ± 1.35, P: < 0.001), ramp (23.7% vs. 4.2%, P: < 0.001), scanning (55.3% vs. 31.3%, P: 0.003) and burst adaptive cycle length (mean 83.55 ± 2.92 vs. 84.64 ± 2.61, P: 0.016). In a multivariate analysis, the VT CL, number of ATP bursts and ramp pacing predicted VT acceleration by ATP therapy. CONCLUSIONS Ventricular tachycardia in patients with low LV EF and fast VTs with a CL less than 310 ms were more likely to accelerate with ATP therapy. The number of ATP bursts and the use of ramp had a significant effect on VT acceleration. To avoid VT acceleration by ATP therapy, ramp pacing better be avoided, especially in fast VTs, and lesser number of bursts should be delivered.
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Affiliation(s)
- Sherien Samy Awad
- Egyptian Ministry of Health, Al Kasr Al Aini Street, Old Cairo, 11562, Cairo Governorate, Egypt.
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2
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Qian S, Connolly A, Mendonca-Costa C, Campos F, Rodero C, Whitaker J, Rinaldi CA, Bishop MJ. Optimization of anti-tachycardia pacing efficacy through scar-specific delivery and minimization of re-initiation: a virtual study on a cohort of infarcted porcine hearts. Europace 2023; 25:716-725. [PMID: 36197749 PMCID: PMC9935023 DOI: 10.1093/europace/euac165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/31/2022] [Indexed: 11/15/2022] Open
Abstract
AIMS Anti-tachycardia pacing (ATP) is a reliable electrotherapy to painlessly terminate ventricular tachycardia (VT). However, ATP is often ineffective, particularly for fast VTs. The efficacy may be enhanced by optimized delivery closer to the re-entrant circuit driving the VT. This study aims to compare ATP efficacy for different delivery locations with respect to the re-entrant circuit, and further optimize ATP by minimizing failure through re-initiation. METHODS AND RESULTS Seventy-three sustained VTs were induced in a cohort of seven infarcted porcine ventricular computational models, largely dominated by a single re-entrant pathway. The efficacy of burst ATP delivered from three locations proximal to the re-entrant circuit (septum) and three distal locations (lateral/posterior left ventricle) was compared. Re-initiation episodes were used to develop an algorithm utilizing correlations between successive sensed electrogram morphologies to automatically truncate ATP pulse delivery. Anti-tachycardia pacing was more efficacious at terminating slow compared with fast VTs (65 vs. 46%, P = 0.000039). A separate analysis of slow VTs showed that the efficacy was significantly higher when delivered from distal compared with proximal locations (distal 72%, proximal 59%), being reversed for fast VTs (distal 41%, proximal 51%). Application of our early termination detection algorithm (ETDA) accurately detected VT termination in 79% of re-initiated cases, improving the overall efficacy for proximal delivery with delivery inside the critical isthmus (CI) itself being overall most effective. CONCLUSION Anti-tachycardia pacing delivery proximal to the re-entrant circuit is more effective at terminating fast VTs, but less so slow VTs, due to frequent re-initiation. Attenuating re-initiation, through ETDA, increases the efficacy of delivery within the CI for all VTs.
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Affiliation(s)
- Shuang Qian
- Department of Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, London, UK
| | | | - Caroline Mendonca-Costa
- Department of Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, London, UK
| | - Fernando Campos
- Department of Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, London, UK
| | - Cristobal Rodero
- Department of Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, London, UK
| | - John Whitaker
- Department of Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, London, UK
- Department of Cardiology, Guy’s and St Thomas’ Hospital, London, UK
| | - Christopher A Rinaldi
- Department of Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, London, UK
- Department of Cardiology, Guy’s and St Thomas’ Hospital, London, UK
| | - Martin J Bishop
- Department of Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, London, UK
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3
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Das TS, Wilson D. Optimal entrainment for removal of pinned spiral waves. Phys Rev E 2022; 105:064213. [PMID: 35854563 DOI: 10.1103/physreve.105.064213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Abstract
Cardiac fibrillation is caused by self-sustaining spiral waves that occur in the myocardium, some of which can be pinned to anatomical obstacles, making them more difficult to eliminate. A small electrical stimulation is often sufficient to unpin these spirals but only if it is applied during the vulnerable unpinning window. Even if these unpinning windows can be inferred from data, when multiple pinned spirals exist, their unpinning windows will not generally overlap. Using phase-based reduction techniques, we formulate and solve an optimal control problem to yield a time-varying external voltage gradient that can synchronize a collection of spiral waves that are pinned to a collection of heterogeneous obstacles. Upon synchronization, the unpinning windows overlap so that they can be simultaneously unpinned by applying an external voltage gradient pulse at an appropriate moment. Numerical validation is presented in bidomain model simulations. Results represent a proof-of-concept illustration of the proposed unpinning strategy which explicitly incorporates heterogeneity in the problem formulation and requires no real-time feedback about the system state.
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Affiliation(s)
- Tuhin Subhra Das
- Department of Electrical Engineering and Computer Science, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - Dan Wilson
- Department of Electrical Engineering and Computer Science, University of Tennessee, Knoxville, Tennessee 37996, USA
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4
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Qian S, Connolly A, Mendonca-Costa C, Campos F, Williams SE, Whitaker J, Rinaldi CA, Bishop MJ. An in-silico assessment of efficacy of two novel intra-cardiac electrode configurations versus traditional anti-tachycardia pacing therapy for terminating sustained ventricular tachycardia. Comput Biol Med 2021; 139:104987. [PMID: 34741904 PMCID: PMC8669079 DOI: 10.1016/j.compbiomed.2021.104987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/24/2021] [Accepted: 10/24/2021] [Indexed: 11/06/2022]
Abstract
The implanted cardioverter defibrillator (ICD) is an effective direct therapy for the treatment of cardiac arrhythmias, including ventricular tachycardia (VT). Anti-tachycardia pacing (ATP) is often applied by the ICD as the first mode of therapy, but is often found to be ineffective, particularly for fast VTs. In such cases, strong, painful and damaging backup defibrillation shocks are applied by the device. Here, we propose two novel electrode configurations: "bipolar" and "transmural" which both combine the concept of targeted shock delivery with the advantage of reduced energy required for VT termination. We perform an in silico study to evaluate the efficacy of VT termination by applying one single (low-energy) monophasic shock from each novel configuration, comparing with conventional ATP therapy. Both bipolar and transmural configurations are able to achieve a higher efficacy (93% and 85%) than ATP (45%), with energy delivered similar to and two orders of magnitudes smaller than conventional ICD defibrillation shocks, respectively. Specifically, the transmural configuration (which applies the shock vector directly across the scar substrate sustaining the VT) is most efficient, requiring typically less than 1 J shock energy to achieve a high efficacy. The efficacy of both bipolar and transmural configurations are higher when applied to slow VTs (100% and 97%) compared to fast VTs (57% and 29%). Both novel electrode configurations introduced are able to improve electrotherapy efficacy while reducing the overall number of required therapies and need for strong backup shocks.
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Affiliation(s)
- Shuang Qian
- School of Biomedical Engineering and Imaging Sciences, Rayne Institute, King's College London, 4th Floor, Lambeth Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom.
| | - Adam Connolly
- Invicro, Burlington Danes Building, Du Cane Rd, London, W12 0N, United Kingdom
| | - Caroline Mendonca-Costa
- School of Biomedical Engineering and Imaging Sciences, Rayne Institute, King's College London, 4th Floor, Lambeth Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom
| | - Fernando Campos
- School of Biomedical Engineering and Imaging Sciences, Rayne Institute, King's College London, 4th Floor, Lambeth Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom
| | - Steven E Williams
- School of Biomedical Engineering and Imaging Sciences, Rayne Institute, King's College London, 4th Floor, Lambeth Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom
| | - John Whitaker
- School of Biomedical Engineering and Imaging Sciences, Rayne Institute, King's College London, 4th Floor, Lambeth Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom; Department of Cardiology, Guy's and St Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, Rayne Institute, King's College London, 4th Floor, Lambeth Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom; Department of Cardiology, Guy's and St Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - Martin J Bishop
- School of Biomedical Engineering and Imaging Sciences, Rayne Institute, King's College London, 4th Floor, Lambeth Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom
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5
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Guarracini F, Casella M, Muser D, Barbato G, Notarstefano P, Sgarito G, Marini M, Grandinetti G, Mariani MV, Boriani G, Ricci RP, De Ponti R, Lavalle C. Clinical management of electrical storm: a current overview. J Cardiovasc Med (Hagerstown) 2021; 22:669-679. [PMID: 32925390 DOI: 10.2459/jcm.0000000000001107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The number of patients affected by electrical storm has been continuously increasing in emergency departments. Patients are often affected by multiple comorbidities requiring multidisciplinary interventions to achieve a clinical stability. Careful reprogramming of cardiac devices, correction of electrolyte imbalance, knowledge of underlying heart disease and antiarrhythmic drugs in the acute phase play a crucial role. The aim of this review is to provide a comprehensive overview of pharmacological treatment, latest transcatheter ablation techniques and advanced management of patients with electrical storm.
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Affiliation(s)
| | - Michela Casella
- Heart Rhythm Center, Centro Cardiologico Monzino, Milan.,Department of Clinical, Special and Dental Sciences, Cardiology and Arrhythmology Clinic, University Hospital 'UmbertoI-Lancisi-Salesi', Marche Polytechnic University, Ancona
| | - Daniele Muser
- Cardiothoracic Department, University Hospital of Udine, Udine
| | | | | | - Giuseppe Sgarito
- Cardiology Division, ARNAS Ospedale Civico e Benfratelli, Palermo
| | | | | | - Marco V Mariani
- Department of Cardiology, Policlinico Universitario Umberto I, Roma
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena
| | | | - Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo & Macchi Foundation, University of Insubria, Varese, Italy
| | - Carlo Lavalle
- Department of Cardiology, Policlinico Universitario Umberto I, Roma
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6
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Trohman RG, Huang HD, Larsen T, Krishnan K, Sharma PS. Sensors for rate-adaptive pacing: How they work, strengths, and limitations. J Cardiovasc Electrophysiol 2020; 31:3009-3027. [PMID: 32877004 DOI: 10.1111/jce.14733] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/19/2020] [Accepted: 08/19/2020] [Indexed: 12/21/2022]
Abstract
Chronotropic incompetence is the inability of the sinus node to increase heart rate commensurate with increased metabolic demand. Cardiac pacing alone may be insufficient to address exercise intolerance, fatigue, dyspnea on exertion, and other symptoms of chronotropic incompetence. Rate-responsive (adaptive) pacing employs sensors to detect physical or physiological indices and mimic the response of the normal sinus node. This review describes the development, strengths, and limitations of a variety of sensors that have been employed to address chronotropic incompetence. A mini-tutorial on programming rate-adaptive parameters is included along with emphasis that patients' lifestyles and underlying medical conditions require careful consideration. In addition, special sensor applications used to respond prophylactically to physiologic signals are detailed and an in-depth discussion of sensors as a potential aid in heart failure management is provided.
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Affiliation(s)
- Richard G Trohman
- Department of Medicine, Section of Electrophysiology, Arrhythmia and Pacemaker Services, Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Henry D Huang
- Department of Medicine, Section of Electrophysiology, Arrhythmia and Pacemaker Services, Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Timothy Larsen
- Department of Medicine, Section of Electrophysiology, Arrhythmia and Pacemaker Services, Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Kousik Krishnan
- Department of Medicine, Section of Electrophysiology, Arrhythmia and Pacemaker Services, Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Parikshit S Sharma
- Department of Medicine, Section of Electrophysiology, Arrhythmia and Pacemaker Services, Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
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7
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Gould J, Porter B, Sidhu BS, Claridge S, Chen Z, Sieniewicz BJ, Elliott M, Mehta V, Campos FO, Bishop MJ, Costa CM, Niederer S, Ganeshan B, Razavi R, Chiribiri A, Rinaldi CA. High mean entropy calculated from cardiac MRI texture analysis is associated with antitachycardia pacing failure. Pacing Clin Electrophysiol 2020; 43:737-745. [PMID: 32469085 DOI: 10.1111/pace.13969] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 04/22/2020] [Accepted: 05/20/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Antitachycardia pacing (ATP), which may avoid unnecessary implantable cardioverter-defibrillator (ICD) shocks, does not always terminate ventricular arrhythmias (VAs). Mean entropy calculated using cardiac magnetic resonance texture analysis (CMR-TA) has been shown to predict appropriate ICD therapy. We examined whether scar heterogeneity, quantified by mean entropy, is associated with ATP failure and explore potential mechanisms using computer modeling. METHODS A subanalysis of 114 patients undergoing CMR-TA where the primary endpoint was delivery of appropriate ICD therapy (ATP or shock therapy) was performed. Patients receiving appropriate ICD therapy (n = 33) were dichotomized into "successful ATP" versus "shock therapy" groups. In silico computer modeling was used to explore underlying mechanisms. RESULTS A total of 16 of 33 (48.5%) patients had successful ATP to terminate VA, and 17 of 33 (51.5%) patients required shock therapy. Mean entropy was significantly higher in the shock versus successful ATP group (6.1 ± 0.5 vs 5.5 ± 0.7, P = .037). Analysis of patients receiving ATP (n = 22) showed significantly higher mean entropy in the six of 22 patients that failed ATP (followed by rescue ICD shock) compared to 16 of 22 that had successful ATP (6.3 ± 0.7 vs 5.5 ± 0.7, P = .048). Computer modeling suggested inability of the paced wavefront in ATP to successfully propagate from the electrode site through patchy fibrosis as a possible mechanism of failed ATP. CONCLUSIONS Our findings suggest lower scar heterogeneity (mean entropy) is associated with successful ATP, whereas higher scar heterogeneity is associated with more aggressive VAs unresponsive to ATP requiring shock therapy that may be due to inability of the paced wavefront to propagate through scar and terminate the VA circuit.
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Affiliation(s)
- Justin Gould
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Bradley Porter
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Baldeep S Sidhu
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Simon Claridge
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Zhong Chen
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Benjamin J Sieniewicz
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Mark Elliott
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Vishal Mehta
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Fernando O Campos
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Martin J Bishop
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | | | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Balaji Ganeshan
- Institute of Nuclear Medicine, University College London, London, UK
| | - Reza Razavi
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Amedeo Chiribiri
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Christopher A Rinaldi
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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8
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Jiménez-Candil J, Durán O, Núñez J, Bravo L, Hernández J, Martín-García A, Morínigo J, Sánchez PL. Effectiveness of first versus successive antitachycardia pacing attempts: predictors and clinical consequences. J Interv Card Electrophysiol 2019; 56:349-357. [DOI: 10.1007/s10840-019-00624-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 09/06/2019] [Indexed: 11/30/2022]
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9
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Plancke AM, Connolly A, Gemmell PM, Neic A, McSpadden LC, Whitaker J, O'Neill M, Rinaldi CA, Rajani R, Niederer SA, Plank G, Bishop MJ. Generation of a cohort of whole-torso cardiac models for assessing the utility of a novel computed shock vector efficiency metric for ICD optimisation. Comput Biol Med 2019; 112:103368. [PMID: 31352217 PMCID: PMC6873640 DOI: 10.1016/j.compbiomed.2019.103368] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/22/2019] [Accepted: 07/22/2019] [Indexed: 11/29/2022]
Abstract
Implanted cardiac defibrillators (ICDs) seek to automatically detect and terminate potentially lethal ventricular arrhythmias by applying strong internal electric shocks across the heart. However, the optimisation of the specific electrode design and configurations represents an intensive area of research in the pursuit of reduced shock strengths and fewer device complications and risks. Computational whole-torso simulations play an important role in this endeavour, although knowing which specific metric should be used to assess configuration efficacy and assessing the impact of different patient anatomies and pathologies, and the corresponding effect this may have on different metrics has not been investigated. We constructed a cohort of CT-derived high-resolution whole torso-cardiac computational models, including variants of cardiomyopathies and patients with differing torso dimensions. Simulations of electric shock application between electrode configurations corresponding to transveneous (TV-ICD) and subcutaneous (S-ICD) ICDs were modelled and conventional metrics such as defibrillation threshold (DFT) and impedance computed. In addition, we computed a novel metric termed the shock vector efficiency (η), which quantifies the fraction of electrical energy dissipated in the heart relative to the rest of the torso. Across the cohort, S-ICD configurations showed higher DFTs and impedances than TV-ICDs, as expected, although little consistent difference was seen between healthy and cardiomyopathy variants. η was consistently <2% for S-ICD configurations, becoming as high as 13% for TV-ICD setups. Simulations also suggested that a total torso height of approximately 20 cm is required for convergence in η. Overall, η was seen to be approximately negatively correlated with both DFT and impedance. However, important scenarios were identified in which certain values of DFT (or impedance) were associated with a range of η values, and vice-versa, highlighting the heterogeneity introduced by the different torsos and pathologies modelled. In conclusion, the shock vector efficiency represents a useful additional metric to be considered alongside DFT and impedance in the optimisation of ICD electrode configurations, particularly in the context of differing torso anatomies and cardiac pathologies, which can induce significant heterogeneity in conventional metrics of ICD efficacy.
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Affiliation(s)
- Anne-Marie Plancke
- Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Adam Connolly
- Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Philip M Gemmell
- Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Aurel Neic
- Institute of Biophysics, Medical University of Graz, Austria
| | | | - John Whitaker
- Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; Department of Cardiology, Guy's and St Thomas' Hospitals, London, UK
| | - Mark O'Neill
- Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; Department of Cardiology, Guy's and St Thomas' Hospitals, London, UK
| | - Christopher A Rinaldi
- Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; Department of Cardiology, Guy's and St Thomas' Hospitals, London, UK
| | - Ronak Rajani
- Cardiovascular Imaging Department, St Thomas' Hospital, London, UK
| | - Steven A Niederer
- Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Gernot Plank
- Institute of Biophysics, Medical University of Graz, Austria
| | - Martin J Bishop
- Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.
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10
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Harrison JW, Manola A, Kalluri LK, Duvall WL, Giedrimiene D, Kluger JW. Clinical predictors of antitachycardia pacing response in implantable cardioverter defibrillator patients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1219-1225. [PMID: 31322287 DOI: 10.1111/pace.13760] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/24/2019] [Accepted: 05/14/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Antitachycardia pacing (ATP) provides safe and painless termination of reentrant ventricular arrhythmias in patients with implantable cardioverter defibrillator (ICDs), improving their quality of life. Established predictors of ATP responsiveness are not well known; only longer ventricular tachycardia (VT) cycle length and higher ejection fraction have been found to predict ATP success. OBJECTIVE To investigate clinical and ECG predictors of ATP response in ICD patients with monomorphic VT. METHODS The ICD clinic database was searched for monomorphic VT events requiring ICD therapy in patients with ischemic or non-ischemic cardiomyopathy. Each patient's first ICD encounter for VT was assessed. Patient demographics, clinical characteristics, VT rate, and ATP responsiveness (always, sometimes, and never successful) were recorded. An ECG was analyzed for QRS morphology and duration. Data was assessed for predictors of ATP responsiveness. RESULTS In 527 patients, characteristics associated with always successful ATP included ACE-I/ARB therapy and slower VT rate (never successful ATP 197 ± 28 bpm, sometimes successful ATP 190 ± 27 bpm, always successful ATP 183 ± 22 bpm, P < .0001). Secondary prevention indication, amiodarone therapy, and longer QRS duration were associated with ATP failure. After multivariate analysis, only faster VT rate and amiodarone therapy were predictive of ATP failure. CONCLUSIONS Neither QRS morphology nor duration was predictive of ATP success. Slower VT rate was predictive of repeated ATP responsiveness. Amiodarone therapy, which is known to increase VT cycle length, interestingly was associated with ATP failure for unclear reasons. More individualized and possibly more aggressive ATP programming may be warranted in patients on amiodarone.
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Affiliation(s)
- Joshua W Harrison
- Division of Cardiology Hartford Hospital, Hartford, CT.,Departemnt of Medicine, University of Connecticut, Farmington, CT
| | - Akrivi Manola
- Division of Cardiology Hartford Hospital, Hartford, CT.,Departemnt of Medicine, University of Connecticut, Farmington, CT
| | | | - W Lane Duvall
- Division of Cardiology Hartford Hospital, Hartford, CT
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11
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Regoli F, Graf D, Schaer B, Duru F, Ammann P, Stefano LMDS, Naegli B, Burri H, Zbinden R, Krasniqi N, Fromer M. Arrhythmic episodes in patients implanted with a cardioverter-defibrillator - results from the Prospective Study on Predictive Quality with Preferencing PainFree ATP therapies (4P). BMC Cardiovasc Disord 2019; 19:146. [PMID: 31208342 PMCID: PMC6580638 DOI: 10.1186/s12872-019-1121-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 05/27/2019] [Indexed: 11/20/2022] Open
Abstract
Background Little is known about the ICD performance using enhanced detection algorithms in unselected, non-trial patients. Performance of recent generation ICD equipped with SmartShock™ technology (SST) for detection and conversion of ventricular tachyarrhythmias (VTA) was investigated. Methods 4P was a prospective, multicenter, observational study conducted in 10 Swiss implanting centers. Patients with a Class I indication according to international guidelines were included and received an ICD with SST. ICD discrimination capability was assessed by evaluating SST performance; therapy efficacy was assessed by rate of VTA conversions by ATP and by rescue shocks. Results Overall, 196 patients were included in the analysis with a mean duration of follow-up of 27.7 months (452 patient-years of observation). Patient-specific rather than recommended programming was preferred. Device-detected episodes were frequent (5147 episodes in 146 patients, 74.5%). In 44 patients (22.4%), 1274 episodes were categorized as VTA; only 215 episodes were symptomatic. ATP was the first-line therapy and highly effective (99.9% success rate at the episode level, 100.0% at the patient level). Rescue shocks were rare (66 episodes in 28 patients); 7 shocks in 5 patients (2.6%) were inappropriate. Death and hospitalization rates were low. Conclusions In a cohort of non-trial, unselected ICD patients, VTA episodes were frequent. The 4P results confirm the robustness of VTA detection by SST and the effectiveness of ATP treatment, hence limiting overall ICD shock burden.
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Affiliation(s)
- François Regoli
- Department of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, 6900, Lugano, Switzerland.
| | - Denis Graf
- Cantonal Hospital of Fribourg (HFR), Fribourg, Switzerland
| | - Beat Schaer
- University Hospital of Basel (KSB), Basel, Switzerland
| | - Firat Duru
- University Hospital of Zurich (USZ), Zürich, Switzerland
| | - Peter Ammann
- Cantonal Hospital of St. Gallen (KSSG), St. Gallen, Switzerland
| | | | | | - Haran Burri
- University Hospital of Geneva (HUG), Geneva, Switzerland
| | | | | | - Martin Fromer
- University Hospital of Lausanne (CHUV), Lausanne, Switzerland
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12
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Geraghty L, Santangeli P, Tedrow UB, Shivkumar K, Kumar S. Contemporary Management of Electrical Storm. Heart Lung Circ 2019; 28:123-133. [DOI: 10.1016/j.hlc.2018.10.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/02/2018] [Indexed: 01/10/2023]
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13
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Fang Y, Gu K, Yang B, Ju W, Chen H, Li M, Liu H, Wang J, Yang G, Chen M. What factors lead to the acceleration of ventricular tachycardia during antitachycardia pacing?-Results from over 1000 episodes. J Arrhythm 2017; 34:36-45. [PMID: 29721112 PMCID: PMC5828264 DOI: 10.1002/joa3.12010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 10/04/2017] [Indexed: 11/25/2022] Open
Abstract
Introduction Ventricular tachycardia (VT) acceleration due to antitachycardia pacing (ATP) therapy could be often observed in patients with implantable cardioverter defibrillator (ICD), which usually results in additional shock. However, few studies focused on the risk factors for VT acceleration caused by ATP therapy. The purpose of this study was to investigate risk factors for VT acceleration due to ATP delivery. Methods We retrospectively reviewed 1056 ATP episodes in 33 patients with structural heart diseases, of whom clinical characteristics and episodes details were evaluated. Results At individual patient level, number of VT morphologies recorded in electrograms during follow‐up was a risk factor with cutoff point of 1 (AUC 0.79, sensitivity 72.7%, specificity 77.3%, P < .001) to predict ATP acceleration (OR 3.50, P = .008). From episode‐based analysis, VT cycle length (VTCL) and mean variation in VTCL were risk factors to predict ATP acceleration (OR 0.98, P < 0.001 vs OR 1.06, P < .001, respectively), with cutoff points of 347 ms (AUC 0.67, sensitivity 82.5%, specificity 47.6%, P < .001) and 7.3 ms (AUC 0.66, sensitivity 77.5%, specificity 56.7%, P < .001), respectively. In addition, VTs with cycle length less than 347 ms were more likely to be accelerated by burst stimulation with more pulse numbers (OR 3.31, P < .001). Conclusions Number of VT morphologies, VTCL, and mean variation in VTCL are risk factors predicting ATP acceleration. Burst stimulation with less pulse numbers should be performed in VTs with cycle length less than 347 ms.
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Affiliation(s)
- Yin Fang
- Department of Anesthesiology The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Kai Gu
- Department of Cardiology The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Bing Yang
- Department of Cardiology The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Weizhu Ju
- Department of Cardiology The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Hongwu Chen
- Department of Cardiology The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Mingfang Li
- Department of Cardiology The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Hailei Liu
- Department of Cardiology The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Jiaxian Wang
- Department of Cardiology The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Gang Yang
- Department of Cardiology The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Minglong Chen
- Department of Cardiology The First Affiliated Hospital of Nanjing Medical University Nanjing China
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Vargas N, Tibullo L, Landi CA, Carifi G, Landi E, Salsano E, Di Grezia F, Candelmo F. Slow ventricular tachycardia in a 91-year-old man with implantable cardioverter-defibrillator and acute respiratory failure. Am J Emerg Med 2017; 35:1213.e5-1213.e8. [DOI: 10.1016/j.ajem.2017.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 05/06/2017] [Accepted: 05/10/2017] [Indexed: 10/19/2022] Open
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15
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Magnetic resonance imaging in patients with cardiac implantable electronic devices: a single-center prospective study. J Interv Card Electrophysiol 2017; 50:95-104. [DOI: 10.1007/s10840-017-0262-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 06/01/2017] [Indexed: 10/19/2022]
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16
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Muser D, Santangeli P, Liang JJ. Management of ventricular tachycardia storm in patients with structural heart disease. World J Cardiol 2017; 9:521-530. [PMID: 28706587 PMCID: PMC5491469 DOI: 10.4330/wjc.v9.i6.521] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/24/2017] [Accepted: 05/15/2017] [Indexed: 02/06/2023] Open
Abstract
Electrical storm (ES) is a medical emergency characterized by repetitive episodes of sustained ventricular arrhythmias (VAs) in a limited amount of time (at least 3 within a 24-h period) leading to repeated appropriate implantable cardioverter defibrillator therapies. The occurrence of ES represents a major turning point in the natural history of patients with structural heart disease being associated with poor short- and long-term survival particularly in those with compromised left ventricular ejection fraction (LVEF) that can develop hemodynamic decompensation and multi-organ failure. Management of ES is challenging with limited available evidence coming from small retrospective series and a substantial lack of randomized-controlled trials. In general, a multidisciplinary approach including medical therapies such as anti-arrhythmic drugs, sedation, as well as interventional approaches like catheter ablation, may be required. Accurate patient risk stratification at admission for ES is pivotal and should take into account hemodynamic tolerability of VAs as well as comorbidities like low LVEF, advanced NYHA class and chronic pulmonary disease. In high risk patients, prophylactic mechanical circulatory support with left ventricular assistance devices or extracorporeal membrane oxygenation should be considered as bridge to ablation and recovery. In the present manuscript we review the available strategies for management of ES and the evidence supporting them.
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17
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Malagù M, Ferri A, Mancuso O, Trevisan F, Nardozza M, Bertini M. Implantable cardioverter defibrillator management: an update. Future Cardiol 2016; 12:673-688. [PMID: 27762625 DOI: 10.2217/fca-2016-0031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Implantable cardioverter defibrillator (ICD) is the cornerstone of primary and secondary prevention of sudden cardiac death. In 35 years of technologic improvement and clinical trials, there has been a continuous increase in implantation rate. Purpose of this review is to point out and discuss every aspect related to actual ICD management, investigating implantation procedure and predischarge care, office and remote monitoring follow-up, diagnostic evaluations, management of patients with suspected therapies or malfunctions, heart failure, surgery, radiotherapy and endoscopic procedures. Also, ICD backface such as infections and other complications will be discussed. Finally, we will focus on interesting future perspectives for this setting of patients.
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Affiliation(s)
- Michele Malagù
- Department of Cardiology, University of Ferrara, S Anna Hospital, Ferrara, Italy
| | - Alessandra Ferri
- Department of Cardiology, University of Ferrara, S Anna Hospital, Ferrara, Italy
| | - Ottavia Mancuso
- Department of Cardiology, University of Ferrara, S Anna Hospital, Ferrara, Italy
| | - Filippo Trevisan
- Department of Cardiology, University of Ferrara, S Anna Hospital, Ferrara, Italy
| | - Marianna Nardozza
- Department of Cardiology, University of Ferrara, S Anna Hospital, Ferrara, Italy
| | - Matteo Bertini
- Department of Cardiology, University of Ferrara, S Anna Hospital, Ferrara, Italy
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18
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Wilson D, Moehlis J. Toward a More Efficient Implementation of Antifibrillation Pacing. PLoS One 2016; 11:e0158239. [PMID: 27391010 PMCID: PMC4938213 DOI: 10.1371/journal.pone.0158239] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 06/12/2016] [Indexed: 11/18/2022] Open
Abstract
We devise a methodology to determine an optimal pattern of inputs to synchronize firing patterns of cardiac cells which only requires the ability to measure action potential durations in individual cells. In numerical bidomain simulations, the resulting synchronizing inputs are shown to terminate spiral waves with a higher probability than comparable inputs that do not synchronize the cells as strongly. These results suggest that designing stimuli which promote synchronization in cardiac tissue could improve the success rate of defibrillation, and point towards novel strategies for optimizing antifibrillation pacing.
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Affiliation(s)
- Dan Wilson
- Department of Mechanical Engineering, University of California Santa Barbara, Santa Barbara, CA 93106, United States of America
- * E-mail:
| | - Jeff Moehlis
- Department of Mechanical Engineering, University of California Santa Barbara, Santa Barbara, CA 93106, United States of America
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19
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Aguilar M, Nattel S. The pioneering work of George Mines on cardiac arrhythmias: groundbreaking ideas that remain influential in contemporary cardiac electrophysiology. J Physiol 2016; 594:2377-86. [PMID: 26607760 PMCID: PMC4850190 DOI: 10.1113/jp270506] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 09/09/2015] [Indexed: 11/08/2022] Open
Abstract
George Mines was a pioneering physiologist who, despite an extremely short period of professional activity and only primitive experimental methodology, succeeded in formulating concepts that continue to be of great influence today. Here, we review some of his most important discoveries and their impact on contemporary concepts and clinical practice. Mines' greatest contribution was his conceptualization and characterization of circus movement reentry. His observations and ideas about the basis for cardiac reentrant activity underlie how we understand and manage a wide range of important clinical rhythm disturbances today. The notions he introduced regarding the influence of premature extrastimuli on reentry (termination, resetting and entrainment) are central to contemporary assessment of arrhythmia mechanisms in clinical electrophysiology laboratories and modern device therapy of cardiac tachyarrhythmias. Refinements of his model of reentry have led to sophisticated biophysical theories of the mechanisms underlying cardiac fibrillation. His seminal observations on the influence of electrolyte derangements and autonomic tone on the heart are relevant to our understanding of the physiology and pharmacology of arrhythmias caused by cardiac pathology. In this era of advanced technology, it is important to appreciate that ideas of lasting impact come from great minds and do not necessarily require great tools.
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Affiliation(s)
- Martin Aguilar
- Research Center, Montreal Heart Institute, Montreal, Canada
- Department of Physiology, Université de Montréal, Montreal, Canada
- Department of Medicine, Université de Montréal, Montreal, Canada
| | - Stanley Nattel
- Research Center, Montreal Heart Institute, Montreal, Canada
- Department of Medicine, Université de Montréal, Montreal, Canada
- Department of Medicine, McGill University, Montreal, Canada
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Canada
- Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
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20
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Pokorney SD, Friedman DJ, Calkins H, Callans DJ, Daoud EG, Della-Bella P, Jackson KP, Shivkumar K, Saba S, Sapp J, Stevenson WG, Al-Khatib SM. Catheter ablation of ventricular tachycardia: Lessons learned from past clinical trials and implications for future clinical trials. Heart Rhythm 2016; 13:1748-54. [PMID: 27050910 DOI: 10.1016/j.hrthm.2016.04.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Indexed: 11/17/2022]
Abstract
Catheter ablation of ventricular tachycardia (VT) has evolved in recent years, especially in patients with ischemic heart disease. Data from prospective studies show that VT catheter ablation reduces the risk of recurrent VT; however, there is a paucity of data on the effect of VT catheter ablation on mortality and patient-centered outcomes such as quality of life. Performing randomized clinical trials of VT catheter ablation can be fraught with challenges, and, as a result, several prior trials of VT catheter ablation had to be stopped prematurely. The main challenges are inability to blind the patient to therapy to obtain a traditional control group, high crossover rates between the 2 arms of the study, patient refusal to participate in trials in which they have an equal chance of receiving a "pill" vs an invasive procedure, heterogeneity of mapping and ablation techniques as well as catheters and equipment, rapid evolution of technology that may make findings of any long trial less relevant to clinical practice, lack of consensus on what constitutes acute procedural and long-term success, and presentation of patients to electrophysiologists late in the course of their disease. In this article, a panel of experts on VT catheter ablation and/or clinical trials of VT catheter ablation review challenges faced in conducting prior trials of VT catheter ablation and offer potential solutions for those challenges. It is hoped that the proposed solutions will enhance the feasibility of randomized clinical trials of VT catheter ablation.
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Affiliation(s)
| | | | - Hugh Calkins
- The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | | | | | - Samir Saba
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - John Sapp
- QEII Health Sciences Centre, Halifax, NS, Canada
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21
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Jiménez-Candil J, Hernández J, Martín A, Moríñigo J, Perdiguero P, Bravo L, Ruiz S, Sánchez PL. Differences in ventricular tachyarrythmias and antitachycardia pacing effectiveness according to the ICD indication (primary versus secondary prevention): an analysis based on the stored electrograms. J Interv Card Electrophysiol 2015; 44:187-95. [DOI: 10.1007/s10840-015-0050-0] [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: 05/17/2015] [Accepted: 08/14/2015] [Indexed: 12/22/2022]
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22
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Pokorney SD, Al-Khatib SM. Management of pace-terminated ventricular arrhythmias. Card Electrophysiol Clin 2015; 7:497-513. [PMID: 26304530 DOI: 10.1016/j.ccep.2015.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
An implantable-cardioverter defibrillator (ICD) can terminate ventricular arrhythmias by delivering a shock or by antitachycardia pacing (ATP). The ATP works by capturing the excitable gap and disrupting re-entrant ventricular arrhythmias. Multiple studies have demonstrated that ATP is successful at terminating ventricular tachycardia (VT). Shocks from the ICD are associated with higher mortality. The data are conflicting about whether appropriate ATP is associated with higher mortality. In a patient with VT that is treated by ATP, the patient's guideline-based heart failure medications should be maximized. The use of VT ablation after appropriate and successful ATP requires additional studies.
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Affiliation(s)
- Sean D Pokorney
- Electrophysiology Section, Duke University Medical Center, Durham, NC, USA
| | - Sana M Al-Khatib
- Electrophysiology Section, Duke University Medical Center, Durham, NC, USA.
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23
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Anguera I, Dallaglio P, Martínez-Ferrer J, Rodríguez A, Alzueta J, Pérez-Villacastín J, Porres JM, Viñolas X, Fontenla A, Fernández-Lozano I, García-Alberola A, Sabaté X. Shock Reduction With Multiple Bursts of Antitachycardia Pacing Therapies to Treat Fast Ventricular Tachyarrhythmias in Patients With Implantable Cardioverter Defibrillators: A Multicenter Study. J Cardiovasc Electrophysiol 2015; 26:774-82. [PMID: 25916814 DOI: 10.1111/jce.12699] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 03/17/2015] [Accepted: 03/27/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION An empirical sequence of burst antitachycardia pacing (ATP) is effective in terminating fast ventricular tachycardias (FVT) in patients with implantable cardioverter-defibrillators (ICDs). We aimed to determine whether multiple ATP bursts for termination of FVT results in shock reduction compared to a single ATP burst. METHODS AND RESULTS We analyzed data from the Umbrella trial, a multicenter prospective observational study of ICD patients followed by the CareLink Monitoring System. We compared the safety and effectiveness of a single ATP burst (Group 1) with a strategy of successive ATP sequences (Group 2) for termination of FVT episodes (cycle lengths 250-320 milliseconds) before shock therapy. Over a mean follow-up of 35 months, a total of 650 FVT episodes were detected in 154 patients (mean cycle length: 299 ± 18 milliseconds). Effectiveness of the first burst ATP in Group 1 was 73% and shocks were required in 27% of episodes. Effectiveness of the first burst ATP in Group 2 was 77%, and this increased to 91% with the third or successive ATP bursts. Shocks were required in 9% of episodes in group 2, representing a 67% reduction in the need of high-energy shocks. Median duration of FVT episodes and mortality in both groups were similar. Multivariate analysis indicated that programming multiple ATP bursts (OR 3.4, 95%CI 1.7-6.8, P = 0.001) was an independent predictor of ATP effectiveness. CONCLUSION This study provides first evidence that a strategy of multiple burst ATP sequences for termination of FVT episodes leads to a clinically meaningful reduction in the need for shocks.
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Affiliation(s)
- Ignasi Anguera
- Cardiology Department, Heart Disease Institute, Bellvitge Biomedical Research Institute IDIBELL, Bellvitge University Hospital, Barcelona, Spain
| | - Paolo Dallaglio
- Cardiology Department, Heart Disease Institute, Bellvitge Biomedical Research Institute IDIBELL, Bellvitge University Hospital, Barcelona, Spain
| | | | - Aníbal Rodríguez
- Cardiology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Javier Alzueta
- Cardiology Department, Hospital Vírgen de la Victoria, Málaga, Spain
| | | | - José Manuel Porres
- Cardiology Department, Hospital Universitario Donostia, San Sebastian, Spain
| | - Xavier Viñolas
- Cardiology Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Adolfo Fontenla
- Cardiology Department, Hospital 12 de Octubre, Madrid, Spain
| | | | | | - Xavier Sabaté
- Cardiology Department, Heart Disease Institute, Bellvitge Biomedical Research Institute IDIBELL, Bellvitge University Hospital, Barcelona, Spain
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Cantillon DJ, Wilkoff BL. Antitachycardia pacing for reduction of implantable cardioverter-defibrillator shocks. Heart Rhythm 2015; 12:1370-5. [PMID: 25708880 DOI: 10.1016/j.hrthm.2015.02.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Indexed: 12/11/2022]
Abstract
Antitachycardia pacing (ATP) strategies represent safe, effective, and painless therapy for ventricular tachyarrhythmias, with a large body of clinical evidence supporting their routine use in both primary and secondary implantable cardioverter-defibrillator recipients. This article details the evidence supporting the use of standardized and validated ATP strategies for primary prevention patients and the conceptual framework to design effective ATP strategy for secondary prevention patients.
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Affiliation(s)
- Daniel J Cantillon
- Cleveland Clinic, Heart and Vascular Institute, Cardiac Electrophysiology and Pacing, Cleveland, Ohio.
| | - Bruce L Wilkoff
- Cleveland Clinic, Heart and Vascular Institute, Cardiac Electrophysiology and Pacing, Cleveland, Ohio
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25
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Incidence and relevance of nonreentrant monomorphic ventricular tachycardia in patients with frequent implantable cardioverter defibrillator interventions. J Interv Card Electrophysiol 2015; 42:151-60. [DOI: 10.1007/s10840-015-9973-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 01/13/2015] [Indexed: 11/27/2022]
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Qian Z, Guo J, Zhang Z, Wang Y, Hou X, Zou J. Optimal programming management of ventricular tachycardia storm in ICD patients. J Biomed Res 2015; 29:35-43. [PMID: 25745473 PMCID: PMC4342433 DOI: 10.7555/jbr.29.20140146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 12/12/2014] [Indexed: 11/08/2022] Open
Abstract
Ventricular tachycardia storm (VTS) is defined as a life-threatening syndrome of three or more separate episodes of ventricular tachycardia (VT) leading to implantable cardioverter defibrillator (ICD) therapy within 24 hours. Patients with VTS have poor outcomes and require immediate medical attention. ICD shocks have been shown to be associated with increased mortality in several studies. Optimal programming in minimization of ICD shocks may decrease mortality. Large controlled trials showed that long detection time and high heart rate detection threshold reduced ICD shock burden without an increase in syncope or death. As a fundamental therapy of ICD, antitachycardia pacing (ATP) can terminate most slow VT with a low risk of acceleration. For fast VT, burst pacing is more effective and less likely to result in acceleration than ramp pacing. One algorithm of optimal programming management during a VTS is presented in the review.
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Affiliation(s)
| | | | | | | | | | - Jiangang Zou
- Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China.
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Abstract
In a normal human life span, the heart beats about 2 to 3 billion times. Under diseased conditions, a heart may lose its normal rhythm and degenerate suddenly into much faster and irregular rhythms, called arrhythmias, which may lead to sudden death. The transition from a normal rhythm to an arrhythmia is a transition from regular electrical wave conduction to irregular or turbulent wave conduction in the heart, and thus this medical problem is also a problem of physics and mathematics. In the last century, clinical, experimental, and theoretical studies have shown that dynamical theories play fundamental roles in understanding the mechanisms of the genesis of the normal heart rhythm as well as lethal arrhythmias. In this article, we summarize in detail the nonlinear and stochastic dynamics occurring in the heart and their links to normal cardiac functions and arrhythmias, providing a holistic view through integrating dynamics from the molecular (microscopic) scale, to the organelle (mesoscopic) scale, to the cellular, tissue, and organ (macroscopic) scales. We discuss what existing problems and challenges are waiting to be solved and how multi-scale mathematical modeling and nonlinear dynamics may be helpful for solving these problems.
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Affiliation(s)
- Zhilin Qu
- Department of Medicine (Cardiology), David Geffen School of Medicine, University of California, Los Angeles, California 90095, USA
- Correspondence to: Zhilin Qu, PhD, Department of Medicine, Division of Cardiology, David Geffen School of Medicine at UCLA, A2-237 CHS, 650 Charles E. Young Drive South, Los Angeles, CA 90095, Tel: 310-794-6050, Fax: 310-206-9133,
| | - Gang Hu
- Department of Physics, Beijing Normal University, Beijing 100875, China
| | - Alan Garfinkel
- Department of Medicine (Cardiology), David Geffen School of Medicine, University of California, Los Angeles, California 90095, USA
- Department of Integrative Biology and Physiology, University of California, Los Angeles, California 90095, USA
| | - James N. Weiss
- Department of Medicine (Cardiology), David Geffen School of Medicine, University of California, Los Angeles, California 90095, USA
- Department of Physiology, David Geffen School of Medicine, University of California, Los Angeles, California 90095, USA
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Jiménez-Candil J, Moríñigo JL, Hernández J, Martín A, Durán O, Carlos Rama J, Ledesma C, Sánchez PL. Fragmentation of the paced QRS complex: a marker of antitachycardia pacing effectiveness among ICD patients. J Cardiovasc Electrophysiol 2014; 25:1100-8. [PMID: 24816219 DOI: 10.1111/jce.12451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 04/25/2014] [Accepted: 05/02/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The presence of notches in the paced QRS complex (P-QRS) from the right ventricular apex (RVA) reflects delays in the activation of the left ventricle and may therefore be associated with longer times of stimulus conduction. Our objective was to determine prospectively the relationship between the duration of a notch ≥0.1 mV in the P-QRS (DN) and the effectiveness of antitachycardia pacing (ATP). METHODS AND RESULTS We followed 286 implantable cardioverter-defibrillator (ICD) patients with left ventricular dysfunction (pacing site: RVA) for 41 ± 27 months. ICD programming was standardized. P-QRS (100 bpm) was obtained at implant (50 mm/s). A total of 955 monomorphic ventricular tachycardias (VTs) with a cycle length of 335 ± 32 milliseconds occurred consecutively in 108 patients. ATP was successful in 84% of VTs. DN correlated with the probability of ineffective ATP (C = 0.67; P < 0.001), the cutoff point with the best sensitivity and specificity being 50 milliseconds. The adjusted mean ATP effectiveness per patient was 76% (95% CI: 72-85). Patients with a DN ≥ 50 milliseconds had a lower ATP efficiency: 67% (56-77) versus 92% (87-97) and a higher proportion of VTs terminated with shocks (SH): 31% (21-42) versus 8% (2-14); P < 0.001 for both. Although the occurrence of VT was similar (41% vs. 40%), the incidence of VT-related SH was higher in patients with a DN ≥ 50 (25% vs. 14%; P = 0.01) in the overall study population (n = 286). CONCLUSIONS When ATP is applied to the RVA, a DN ≥ 50 milliseconds is associated with a lower ATP effectiveness and a higher risk of SH due to VT.
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TUAN TACHUAN, LO MENTZUNG, LIN YENNJIANG, HSIEH WANHSIN, LIN CHEN, HUANG NORDENE, LO LIWEI, CHAO TZEFAN, LIAO JONAN, HSIEH YUCHENG, WU TSUJUEY, CHEN SHIHANN. The Use of Signal Analyses of Ventricular Tachycardia Electrograms to Predict the Response of Antitachycardia Pacing in Patients with Implantable Cardioverter-Defibrillators. J Cardiovasc Electrophysiol 2014; 25:411-417. [DOI: 10.1111/jce.12340] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 11/11/2013] [Accepted: 11/26/2013] [Indexed: 11/29/2022]
Affiliation(s)
- TA-CHUAN TUAN
- Division of Cardiology; Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Faculty of Medicine and Institute of Clinical Medicine; National Yang-Ming University; School of Medicine; Taipei Taiwan
- Division of Cardiology, Taipei Municipal Gan-Dau Hospital; Taipei Taiwan
| | - MEN-TZUNG LO
- Research Center for Adaptive Data Analysis; Analysis and Center for Dynamical Biomarkers and Translational Medicine; National Central University; Jhongli Taiwan R.O.C
| | - YENN-JIANG LIN
- Division of Cardiology; Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Faculty of Medicine and Institute of Clinical Medicine; National Yang-Ming University; School of Medicine; Taipei Taiwan
| | - WAN-HSIN HSIEH
- Research Center for Adaptive Data Analysis; Analysis and Center for Dynamical Biomarkers and Translational Medicine; National Central University; Jhongli Taiwan R.O.C
- Medical Biodynamics Program; Division of Sleep Medicine; Brigham and Women's Hospital; Harvard Medical School; Boston Massachusetts USA
| | - CHEN LIN
- Research Center for Adaptive Data Analysis; Analysis and Center for Dynamical Biomarkers and Translational Medicine; National Central University; Jhongli Taiwan R.O.C
- Department of Psychiatry and Behavioral Sciences; Stanford University School of Medicine; Palo Alto California USA
| | - NORDEN E. HUANG
- Research Center for Adaptive Data Analysis; Analysis and Center for Dynamical Biomarkers and Translational Medicine; National Central University; Jhongli Taiwan R.O.C
| | - LI-WEI LO
- Division of Cardiology; Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Faculty of Medicine and Institute of Clinical Medicine; National Yang-Ming University; School of Medicine; Taipei Taiwan
| | - TZE-FAN CHAO
- Division of Cardiology; Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Faculty of Medicine and Institute of Clinical Medicine; National Yang-Ming University; School of Medicine; Taipei Taiwan
| | - JO-NAN LIAO
- Division of Cardiology; Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Faculty of Medicine and Institute of Clinical Medicine; National Yang-Ming University; School of Medicine; Taipei Taiwan
| | - YU-CHENG HSIEH
- Division of Cardiology; Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Cardiovascular Center; Taichung Veterans General Hospital; Taichung Taiwan
| | - TSU-JUEY WU
- Division of Cardiology; Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Cardiovascular Center; Taichung Veterans General Hospital; Taichung Taiwan
| | - SHIH-ANN CHEN
- Division of Cardiology; Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Faculty of Medicine and Institute of Clinical Medicine; National Yang-Ming University; School of Medicine; Taipei Taiwan
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30
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Schulman PM, Rozner MA, Sera V, Stecker EC. Patients with pacemaker or implantable cardioverter-defibrillator. Med Clin North Am 2013; 97:1051-75. [PMID: 24182719 DOI: 10.1016/j.mcna.2013.05.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The preparation of patients with a cardiac implantable electronic device (CIED) for the perioperative period necessitates familiarity with recommendations from the American Society of Anesthesiologists and Heart Rhythm Society. Even clinicians who are not CIED experts should understand the indications for implantation, as well as the basic functions, operations, and limitations of these devices. Before any scheduled procedure, proper CIED function should be verified and a specific CIED prescription obtained. Acquiring the requisite knowledge base and developing the systems to competently manage the CIED patient ensures safe and efficient perioperative care.
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Affiliation(s)
- Peter M Schulman
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Mail Code: UHS-2, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239, USA.
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31
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JIMÉNEZ-CANDIL JAVIER, ANGUERA IGNASI, LEDESMA CLAUDIO, FERNÁNDEZ-PORTALES JAVIER, MORÍÑIGO JOSÉLUIS, DALLAGLIO PAOLO, MARTÍN ANA, CANO TERESA, HERNÁNDEZ JESÚS, SABATÉ XAVIER, MARTÍN-LUENGO CÁNDIDO. Morphology of Far-Field Electrograms and Antitachycardia Pacing Effectiveness Among Fast Ventricular Tachycardias Occurring in ICD Patients: A Multicenter Study. J Cardiovasc Electrophysiol 2013; 24:1375-82. [DOI: 10.1111/jce.12228] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 06/20/2013] [Accepted: 06/26/2013] [Indexed: 11/28/2022]
Affiliation(s)
| | - IGNASI ANGUERA
- L'Hospitalet de Llobregat; Hospital Universitario de Bellvitge; Barcelona Spain
| | - CLAUDIO LEDESMA
- Cardiology Department; IBSAL-Hospital Universitario; Salamanca Spain
| | | | | | - PAOLO DALLAGLIO
- L'Hospitalet de Llobregat; Hospital Universitario de Bellvitge; Barcelona Spain
| | - ANA MARTÍN
- Cardiology Department; IBSAL-Hospital Universitario; Salamanca Spain
| | - TERESA CANO
- Cardiology Department; IBSAL-Hospital Universitario; Salamanca Spain
| | | | - XAVIER SABATÉ
- L'Hospitalet de Llobregat; Hospital Universitario de Bellvitge; Barcelona Spain
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32
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Jiménez-Candil J, Hernández J, Martín A, Moríñigo J, López R, Ledesma C, Martín-Luengo C. Influence of cycle length variations on antitachycardia pacing effectiveness among ICD patients. Heart Rhythm 2013; 10:207-13. [DOI: 10.1016/j.hrthm.2012.10.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Indexed: 10/27/2022]
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33
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John RM, Stevenson WG. Ventricular arrhythmias in patients with implanted cardioverter defibrillators. Trends Cardiovasc Med 2012; 22:169-73. [PMID: 22902094 DOI: 10.1016/j.tcm.2012.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Implantable cardioverter-defibrillators (ICDs) are highly effective in reducing mortality related to ventricular arrhythmias. However, there is considerable morbidity associated with their use, mostly related to ICD shocks. In addition, the occurrence of arrhythmias and ICD shocks in patients with heart failure is associated with an adverse prognosis. Strategies to reduce or prevent ventricular arrhythmias and shocks are a prime area of focus and development in patients with ICDs.
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Affiliation(s)
- Roy M John
- Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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34
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BOULÉ STÉPHANE, BRIGADEAU FRANÇOIS, MARQUIÉ CHRISTELLE, SALLERON JULIA, KLUG DIDIER, KOUAKAM CLAUDE, GUÉDON-MOREAU LAURENCE, DUHAMEL ALAIN, ACHERÉ CHARLES, WISSOCQUE LUDIVINE, LACROIX DOMINIQUE, KACET SALEM. Basal Exit Site of Clinical Ventricular Tachycardia is an Independent Predictor of Antitachycardia Pacing Failure in Implantable Cardioverter-Defibrillators Recipients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 35:1209-16. [DOI: 10.1111/j.1540-8159.2012.03478.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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35
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Martins RP, Blangy H, Muresan L, Freysz L, Groben L, Zinzius PY, Schwartz J, Sellal JM, Aliot E, Sadoul N. Safety and efficacy of programming a high number of antitachycardia pacing attempts for fast ventricular tachycardia: a prospective study. Europace 2012; 14:1457-64. [DOI: 10.1093/europace/eus107] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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36
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O'Mahony C, Lambiase PD, Rahman SM, Cardona M, Calcagnino M, Quarta G, Tsovolas K, Al-Shaikh S, McKenna W, Elliott P. The relation of ventricular arrhythmia electrophysiological characteristics to cardiac phenotype and circadian patterns in hypertrophic cardiomyopathy. ACTA ACUST UNITED AC 2011; 14:724-33. [DOI: 10.1093/europace/eur362] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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37
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Koneru JN, Swerdlow CD, Wood MA, Ellenbogen KA. Minimizing Inappropriate or “Unnecessary” Implantable Cardioverter-Defibrillator Shocks. Circ Arrhythm Electrophysiol 2011; 4:778-90. [DOI: 10.1161/circep.110.961243] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jayanthi N. Koneru
- From the Virginia Commonwealth University, Richmond, VA (J.N.K., M.A.W., K.A.E.), and Cedars Sinai Medical Center, Los Angeles, CA (C.D.S.)
| | - Charles D. Swerdlow
- From the Virginia Commonwealth University, Richmond, VA (J.N.K., M.A.W., K.A.E.), and Cedars Sinai Medical Center, Los Angeles, CA (C.D.S.)
| | - Mark A. Wood
- From the Virginia Commonwealth University, Richmond, VA (J.N.K., M.A.W., K.A.E.), and Cedars Sinai Medical Center, Los Angeles, CA (C.D.S.)
| | - Kenneth A. Ellenbogen
- From the Virginia Commonwealth University, Richmond, VA (J.N.K., M.A.W., K.A.E.), and Cedars Sinai Medical Center, Los Angeles, CA (C.D.S.)
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LIAN JIE, MUESSIG DIRK, LANG VOLKER. Risk Assessment of R-on-T Event Based on Modeled QT-RR Relationship. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:700-8. [DOI: 10.1111/j.1540-8159.2011.03058.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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39
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Haghjoo M, Hajahmadi M, Fazelifar AF, Sadr-Ameli MA. Efficacy and safety of different antitachycardia pacing sites in the termination of ventricular tachycardia in patients with biventricular implantable cardioverter-defibrillator. Europace 2011; 13:509-13. [PMID: 21296776 DOI: 10.1093/europace/euq513] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
AIMS We sought to evaluate the efficacy and safety of different antitachycardia pacing (ATP) sites in heart failure (HF) patients with a biventricular implantable cardioverter-defibrillator (ICD). METHODS AND RESULTS Between January 2003 and December 2008, 89 consecutive patients with biventricular (BiV) ICDs (Medtronic Inc., St Paul, Minnesota, USA) were enrolled. In these patients, stored electrograms of the true spontaneous ventricular tachycardia (VT) episodes with at least one ATP therapy were analysed. Out of the 89 patients, 46 experienced 259 VT episodes. When we considered all VT forms, both left ventricular (LV)-ATP (91%) and BiV-ATP (89%) were significantly better than right ventricular (RV)-ATP (72%) in terminating VTs (P = 0.03 and 0.04, respectively). In the fastVT zone, there was a trend for higher efficacy of BiV-ATP compared with RV-ATP and LV-ATP (75 vs. 60 vs. 60%, P = 0.10). Fast VT acceleration occurred to a similar extent in all ATP groups (20% in RV-ATP vs. 20% in LV-ATP vs. 20% in BiV-ATP, P = NS). In the slow VT zone, RV-ATP was significantly less effective than LV-ATP (74 vs. 100%, P = 0.001) and BiV-ATP (74 vs. 100%, P = 0.014). Incidence of acceleration was lower with LV-ATP and BiV-ATP than RV-ATP (0 vs. 0 vs. 9%, P = 0.03) in the slow VT zone. CONCLUSIONS In HF patients treated with BiV ICD, overall ATP efficacy is higher when delivered from LV or BiV than from RV. Biventricular-ATP and LV-ATP are also safer than RV-ATP in the slow VT zone.
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Affiliation(s)
- Majid Haghjoo
- Department of Pacemaker and Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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40
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SAEED MOHAMMAD, NEASON CURTISG, RAZAVI MEHDI, CHANDIRAMANI SHANKER, ALONSO JOSEPH, NATARAJAN SENTHIL, IP JOHNH, PERESS DARRENF, RAMADAS SUMATI, MASSUMI ALI. Programming Antitachycardia Pacing for Primary Prevention in Patients With Implantable Cardioverter Defibrillators: Results From the PROVE Trial. J Cardiovasc Electrophysiol 2010; 21:1349-54. [DOI: 10.1111/j.1540-8167.2010.01825.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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41
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LAWO THOMAS, SCHRADER JÜRGEN, BUDDENSIEK MICHAEL, SCHWEIKA OLIVER, MÜGGE ANDREAS, BÖSCHE LEIFI. Termination of Ventricular Tachycardia by Far-Field Stimulation in Humans: A Feasibility Study. Pacing Clin Electrophysiol 2010; 33:1540-7. [DOI: 10.1111/j.1540-8159.2010.02891.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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43
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Sánchez Muñoz JJ, García-Alberola A, Martínez-Sánchez J, Peñafiel-Verdú P, Caro-Martínez C, Manzano-Fernández S, Valdés Chávarri M. Premature ventricular complexes as a trigger for ventricular fibrillation. Rev Esp Cardiol 2010; 63:798-801. [PMID: 20609313 DOI: 10.1016/s1885-5857(10)70164-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES The mechanisms that trigger ventricular fibrillation (VF) are poorly understood. The aim of this study was to analyze the initiation of VF in electrograms stored in implantable cardioverter-defibrillators (ICDs). METHODS We analyzed ICD electrograms from patients who had suffered at least one episode of VF. RESULTS Of 250 patients with ICDs, 13 (10 male and 3 female, age 49+/-22 years) had at least one episode of VF. The diagnoses were Brugada syndrome (n=4), ischemic heart disease (n=3), dilated cardiomyopathy (n=2), hypertrophic cardiomyopathy (n=1), short-coupled variant of torsades de pointes (n=1), endocardial fibroelastosis (n=1) and idiopathic VF (n=1). In 7 patients, VF was the reason for ICD implantation. Overall, 31 episodes of VF were recorded, including three episodes of arrhythmic storm. In the 7 patients who had more than one episode of VF (within minutes or up to 3 years apart), all episodes started with premature ventricular complexes (PVCs) that had the same morphology and similar coupling intervals. A short-long-short cycle was observed in 2 patients. In 21 episodes, PVCs that did not trigger VF were observed during sinus rhythm. There was no significant difference between them and PVCs that did trigger VF in terms of morphology, coupling interval (409+/-121 ms vs. 411+/-123 ms) or the preceding sinus rhythm RR interval (801+/-233 ms vs. 793+/-230 ms). CONCLUSIONS Spontaneous VF in the form of an arrhythmic storm or an isolated episode were triggered by PVCs. On occasions, PVCs preceded VF without triggering it.
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Affiliation(s)
- Juan José Sánchez Muñoz
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.
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Muñoz JJS, García-Alberola A, Martínez-Sánchez J, Peñafiel-Verdú P, Caro-Martínez C, Manzano-Fernández S, Chávarri MV. Extrasistolia ventricular desencadenante de la fibrilación ventricular. Rev Esp Cardiol 2010. [DOI: 10.1016/s0300-8932(10)70182-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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45
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Jimenez-Candil J, Hernandez J, Martin A, Ruiz-Olgado M, Herrero J, Ledesma C, Morinigo J, Martin-Luengo C. Influence of beta-blocker therapy on antitachycardia pacing effectiveness for monomorphic ventricular tachycardias occurring in implantable cardioverter-defibrillator patients: a dose-dependent effect. Europace 2010; 12:1231-8. [DOI: 10.1093/europace/euq164] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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46
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Van Herendael H, Pinter A, Ahmad K, Korley V, Mangat I, Dorian P. Role of antiarrhythmic drugs in patients with implantable cardioverter defibrillators. Europace 2010; 12:618-25. [DOI: 10.1093/europace/euq073] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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47
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Bradfield J, Boyle NG. The paradox of ICD shocks: sudden cardiac death prevention--heart failure death acceleration. Heart Rhythm 2010; 7:361-2. [PMID: 20185110 DOI: 10.1016/j.hrthm.2009.12.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Indexed: 11/26/2022]
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48
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YEE RAYMOND, BIRGERSDOTTER-GREEN ULRIKA, BELK PAUL, JACKSON TROY, CHRISTENSEN JILL, WATHEN MARKS. The Relationship between Pacing Site and Induction or Termination of Sustained Monomorphic Ventricular Tachycardia by Antitachycardia Pacing. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:27-32. [DOI: 10.1111/j.1540-8159.2009.02591.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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49
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LIM HOONGSERN, LENCIONI MAURO, MARSHALL HOWARD. Local Activation Time Derived from Stored EGM is Associated with Failure of Antitachycardia Pacing in Patients with Implantable Defibrillator. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 33:549-52. [DOI: 10.1111/j.1540-8159.2009.02638.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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50
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Tanaka M, Isomura A, Hörning M, Kitahata H, Agladze K, Yoshikawa K. Unpinning of a spiral wave anchored around a circular obstacle by an external wave train: common aspects of a chemical reaction and cardiomyocyte tissue. CHAOS (WOODBURY, N.Y.) 2009; 19:043114. [PMID: 20059210 DOI: 10.1063/1.3263167] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
It is well known that spiral waves are often stabilized by anchoring to a local heterogeneity ("pinning") and that such pinned waves are rather difficult to eliminate. In the present report, we show that pinned spiral waves can be eliminated through collision with a wave train arriving from the outer region, as confirmed in experiments on the Belousov-Zhabotinsky (BZ) reaction as well as in cardiomyocyte tissue culture. A numerical simulation using the Oregonator, a mathematical model for the BZ reaction, provides the parameter area for successful unpinning. The scenario of unpinning is discussed in terms of the dispersion relation of the wave train by taking into account the curvature effect of the excitation wave.
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Affiliation(s)
- Masanobu Tanaka
- Department of Physics, Graduate School of Science, Kyoto University and Spatio-temporal Order Project, ICORP JST, Kyoto 606-8502, Japan
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