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Cycle length of nonsustanied ventricular tachycardias among ICD patients: implications on subsequent appropriate therapies. BMC Cardiovasc Disord 2021; 21:268. [PMID: 34058991 PMCID: PMC8167949 DOI: 10.1186/s12872-021-02087-2] [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: 11/23/2020] [Accepted: 05/26/2021] [Indexed: 11/12/2022] Open
Abstract
Background ICD patients with episodes of nonsustained ventricular tachycardias (NSVT) are at risk of appropriate therapies. However, the relationship between the cycle length (CL) of such NSVTs and the subsequent incidence of appropriate interventions is unknown. Methods 416 ICD patients with LVEF < 45% were studied. ICD programming was standardized. NSVT was defined as any VT of 5 or more beats at ≥ 150 bpm occurred in the first 6 months after implantation that terminated spontaneously and was not preceded by any appropriate therapy. The mean follow-up was 41 ± 27 months. Results We analyzed 2201 NSVTs (mean CL = 323 ms) that occurred in 250 patients; 111 of such episodes were fast (CL ≤ 300 ms). Secondary prevention (HR = 1.7; p < 0.001), number of NSVT episodes (HR = 1.05; 95% CI 1.04–1.07; p < 0.001) and beta-blocker treatment (HR = 0.7; p = 0.04) were independent predictors of appropriate interventions; however, the mean CL of NSVTs was not (p = 0.6). There was a correlation between the mean CL of NSVTs and the CL of the first monomorphic VT: r = 0.88; p < 0.001. This correlation was especially robust in individuals with > 5 NSVTs (r = 0.97; p < 0.001), with an agreement between both values greater than 95%. Patients with any fast NSVT experienced a higher incidence of VF episodes (26%) compared to those without NVSTs (3%) or with only slow NSVTs (7%); p < 0.001. Conclusions Unlike the burden, the CL of NSVTs is not a predictor of subsequent appropriate interventions. However, there is a close relationship between the CL of NSVTs and that of arrhythmias that will later lead to appropriate therapies.
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Xie E, Mayer K, Capps MF, Barth AS, Love CJ, Coronel R, Ashikaga H. Mechanism of spontaneous initiation of ventricular fibrillation in patients with implantable defibrillators. J Cardiovasc Electrophysiol 2020; 31:2415-2424. [PMID: 32618399 DOI: 10.1111/jce.14648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/15/2020] [Accepted: 06/29/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION To improve the mechanistic understanding of spontaneous initiation of ventricular fibrillation (VF), we characterized the patterns of premature ventricular complex (PVC) preceding spontaneous VF in primary and secondary implantable cardioverter-defibrillator (ICD) recipients. METHODS AND RESULTS A single-center, cross-sectional analysis of 1209 patients with primary and secondary prevention ICD identified 190 patients who received ICD therapy (firing or antitachycardia pacing) for VF or monomorphic ventricular tachycardia (MMVT). Initiation was quantified by the coupling interval (CI), the cycle length immediately preceding the CI (CL(-1)), the CI corrected by CL(-1) using Fridericia's formula (CIc), and the prematurity index (PI). In both VF (n = 44; 23%) and MMVT (n = 134; 71%), the most common pattern of initiation was late-coupled PVC, followed by the short-long-short pattern. The parameters such as pre-initiation median CL, CL(-1), CI, and PI were not significantly different between VF and MMVT for any patterns. At least some events (45% of VF and 63% of MMVT) had extremely long CIs beyond the QTc cut-off estimated from the CL(-1), suggestive of initiation by a train of multiple PVCs or nonsustained VT instead of a single PVC. CONCLUSION Some spontaneous VF events in ICD recipients appear to be initiated by a train of multiple PVC or nonsustained VT rather than a single PVC. This finding indicates that patterns of a single PVC are not an important determinant of VF initiation and thus account for conflicting results in previous studies.
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Affiliation(s)
- Eric Xie
- Cardiac Arrhythmia Service, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Katarina Mayer
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Melissa F Capps
- Cardiac Arrhythmia Service, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andreas S Barth
- Cardiac Arrhythmia Service, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Charles J Love
- Cardiac Arrhythmia Service, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ruben Coronel
- Department of Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands.,IHU Liryc (L'institut de rythmologie et modélisation cardiaque), Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - Hiroshi Ashikaga
- Cardiac Arrhythmia Service, Johns Hopkins University School of Medicine, Baltimore, Maryland.,IHU Liryc (L'institut de rythmologie et modélisation cardiaque), Fondation Bordeaux Université, Pessac-Bordeaux, France
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Zhang S, Ching CK, Huang D, Liu YB, Rodriguez-Guerrero DA, Hussin A, Kim YH, Chasnoits AR, Cerkvenik J, Lexcen DR, Muckala K, Brown ML, Cheng A, Singh B. Utilization of implantable cardioverter-defibrillators for the prevention of sudden cardiac death in emerging countries: Improve SCA clinical trial. Heart Rhythm 2019; 17:468-475. [PMID: 31561030 DOI: 10.1016/j.hrthm.2019.09.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Implantable cardioverter-defibrillators (ICDs) are underutilized in Asia, Latin America, Eastern Europe, the Middle East, and Africa. The Improve SCA Study is the largest prospective study to evaluate the benefit of ICD therapy in underrepresented geographies. This analysis reports the primary objective of the study. OBJECTIVES The objectives of this study was to determine whether patients with primary prevention (PP) indications with specific risk factors (1.5PP: syncope, nonsustained ventricular tachycardia, premature ventricular contractions >10/h, and low ventricular ejection fraction <25%) are at a similar risk of life-threatening arrhythmias as patients with secondary prevention (SP) indications and to evaluate all-cause mortality rates in 1.5PP patients with and without devices. METHODS A total of 3889 patients were included in the analysis to evaluate ventricular tachycardia or fibrillation therapy and mortality rates. Patients were stratified as SP (n = 1193) and patients with PP indications. The PP cohort was divided into 1.5PP patients (n = 1913) and those without any 1.5PP criteria (n = 783). The decision to undergo ICD implantation was left to the patient and/or physician. The Cox proportional hazards model was used to compute hazard ratios. RESULTS Patients had predominantly nonischemic cardiomyopathy. The rate of ventricular tachycardia or fibrillation in 1.5PP patients was not equivalent (within 30%) to that in patients with SP indications (hazard ratio 0.47; 95% confidence interval 0.38-0.57) but was higher than that in PP patients without any 1.5PP criteria (hazard ratio 0.67; 95% confidence interval 0.46-0.97) (P = .03). There was a 49% relative risk reduction in all-cause mortality in ICD implanted 1.5PP patients. In addition, the number needed to treat to save 1 life over 3 years was 10.0 in the 1.5PP cohort vs 40.0 in PP patients without any 1.5PP criteria. CONCLUSION These data corroborate the mortality benefit of ICD therapy and support extension to a selected PP population from underrepresented geographies.
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Affiliation(s)
- Shu Zhang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Chi-Keong Ching
- National Heart Centre of Singapore, Outram District, Singapore
| | | | - Yen-Bin Liu
- National Taiwan University Hospital, Taipei City, Taiwan
| | - Diego A Rodriguez-Guerrero
- Instituto de Cardiología Fundación Cardio infantil, Centro Internacional de Arritmias, Bogotá, Colombia; Universidad de La Sabana, Bogota, Colombia
| | | | | | | | | | | | | | | | | | - Balbir Singh
- Medanta, The Medicity Hospital, Gurugram, Haryana, India
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Singh B, Zhang S, Ching CK, Huang D, Liu YB, Rodriguez DA, Hussin A, Kim YH, Chasnoits AR, Cerkvenik J, Muckala KA, Cheng A. Improving the utilization of implantable cardioverter defibrillators for sudden cardiac arrest prevention (Improve SCA) in developing countries: Clinical characteristics and reasons for implantation refusal. Pacing Clin Electrophysiol 2018; 41:1619-1626. [PMID: 30320410 DOI: 10.1111/pace.13526] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 08/11/2018] [Accepted: 08/13/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Despite available evidence that implantable cardioverter defibrillators (ICDs) reduce all-cause mortality among patients at risk for sudden cardiac death, utilization of ICDs is low especially in developing countries. OBJECTIVE To summarize reasons for ICD or cardiac resynchronization therapy defibrillator implant refusal by patients at risk for sudden cardiac arrest (Improve SCA) in developing countries. METHODS Primary prevention (PP) and secondary prevention (SP) patients from countries where ICD use is low were enrolled. PP patients with additional risk factors (syncope, ejection fraction < 25%, nonsustained ventricular tachycardia [NSVT], or frequent premature ventricular complexes) were further categorized as "1.5 PP patients." Candidates who declined implantation were asked for reasons for refusal. Baseline factors that may have influenced the implant decision were examined using logistic regression. RESULTS Among 3892 patients, the implant refusal rate was 46.5% among PP patients (n = 2700), and 10.3% among SP patients (n = 1192). The most common refusal reason was inability to pay for the device (53.8%), followed by not believing in the benefits of the ICD (19.4%). Among PP ICD candidates, those with no syncope, no NSVT, no premature ventricular contractions, shorter QRS duration, no atrial arrhythmias, and no left bundle branch block were more likely to refuse implant. Among SP candidates, a history of cardiovascular surgery and no sinus node dysfunction were significant predictors of ICD refusal. Additionally, countries had significant differences in patient refusal rates among PP and SP groups. CONCLUSION Implant refusal among PP patients is high in many countries. Increased reimbursement and better awareness of the benefits of an ICD could increase their utilization.
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Affiliation(s)
- Balbir Singh
- Department of Cardiology, Medanta, The Medicity Hospital, Gurgaon, Haryana, India
| | - Shu Zhang
- The Cardiac Arrhythmia Center, Fuwai Cardiovascular Hospital, Beijing, China
| | - Chi-Keong Ching
- Department of Cardiology, National Heart Centre of Singapore, Singapore
| | - Dejia Huang
- Department of Cardiology, West China Hospital, Chengdu, China
| | - Yen-Bin Liu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Diego A Rodriguez
- Instituto de Cardiología, Fundación Cardio infantil, Centro Internacional de Arritmias, Bogota, Colombia and Universidad de la Sabana, Chía, Colombia
| | - Azlan Hussin
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Young-Hoon Kim
- Cardiology Division, Korea University Medical Center, Seoul, South Korea
| | | | - Jeffrey Cerkvenik
- Department of Cardiac Rhythm Management, Medtronic, Mounds View, Minnesota
| | - Katy A Muckala
- Department of Cardiac Rhythm Management, Medtronic, Mounds View, Minnesota
| | - Alan Cheng
- Department of Cardiac Rhythm Management, Medtronic, Mounds View, Minnesota
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Li Z, Zhao S, Chen K, Su Y, Hua W, Chen S, Liang Z, Xu W, Dai Y, Fan X, Chen R, Zhang S. Prognostic significance of frequent premature ventricular complex early after implantation among patients with implantable cardioverter defibrillator. J Electrocardiol 2018; 51:898-905. [PMID: 30177337 DOI: 10.1016/j.jelectrocard.2018.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 05/31/2018] [Accepted: 06/04/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Premature ventricular complex (PVC) was mainly studied by 24-hour Holter in previous studies. However, the value of long-term Home Monitoring of PVC burden early after ICD implantation is unknown. METHODS The data of 416 patients with ICD were analyzed. The percentage of days with frequent PVC (≥10/h) within 30th-90th days was calculated as the continuous frequent PVC (CfPVC) percentage. ROC curve of CfPVC percentages was plotted. Kaplan-Meier survival and Cox regression were used to assess the cumulative risks. RESULTS Based on ROC curves, the cut-off value for the CfPVC percentage was 40%. According to Kaplan-Meier analysis and multivariate Cox regression analysis, CfPVC percentage ≥40% was an independent predictor of higher incidences of VAEs, appropriate ATP, appropriate shocks, and cardiac death. CONCLUSION A long-term continuous burden of frequent PVC with CfPVC percentage ≥40% can be a predictor of future VAEs, appropriate ATP, appropriate shocks and cardiac death in ICD recipients.
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Affiliation(s)
- Zeyi Li
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Shuang Zhao
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Keping Chen
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yangang Su
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Wei Hua
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Silin Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangzhou 510080, China
| | - Zhaoguang Liang
- Department of Cardiology, First Affiliated Hospital of Harbin Medical University, Harbin 150081, China
| | - Wei Xu
- Department of Cardiology, Nanjing Drum Tower Hospital, Nanjing 210008, China
| | - Yan Dai
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xiaohan Fan
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Ruohan Chen
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Shu Zhang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
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Aune D, Schlesinger S, Norat T, Riboli E. Body mass index, abdominal fatness, and the risk of sudden cardiac death: a systematic review and dose-response meta-analysis of prospective studies. Eur J Epidemiol 2018; 33:711-722. [PMID: 29417316 PMCID: PMC6061127 DOI: 10.1007/s10654-017-0353-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 12/26/2017] [Indexed: 12/11/2022]
Abstract
Although overweight and obesity are established risk factors for some types of heart disease including ischemic heart disease, heart failure and atrial fibrillation, less is known about the association between adiposity and sudden cardiac death. We conducted a systematic review and meta-analysis of prospective studies to clarify the association between adiposity and risk of sudden cardiac death. PubMed and Embase databases were searched up to July 20th 2017. Summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated using random effects models. The summary RR was 1.16 (95% CI 1.05-1.28, I2 = 68%, n = 14) per 5 unit increment in BMI, and 1.82 (95% CI 1.61-2.07, I2 = 0%, n = 3) per 0.1 unit increase in waist-to-hip ratio, and 1.03 (95% CI 0.93-1.15, I2 = 0%, n = 2) per 10 cm increase in waist circumference. The heterogeneity in the analysis of BMI and sudden cardiac death persisted across most subgroup analyses. The association was stronger among studies with longer follow-up compared to short follow-up and was observed in the European and American studies, but not in the Asian studies. There was a J-shaped association between BMI and sudden cardiac death and the lowest risk was observed in the normal weight range, however, the increased risk with a low BMI was attenuated among studies with a longer duration of follow-up. This meta-analysis suggest an increased risk of sudden cardiac death with increasing BMI and waist-to-hip ratio, however, further studies with stratification for smoking status are needed of waist circumference, weight changes and adiposity at younger ages.
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Affiliation(s)
- Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, Paddington, London, W2 1PG, UK.
- Bjørknes University College, Oslo, Norway.
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.
| | - Sabrina Schlesinger
- Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Teresa Norat
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, Paddington, London, W2 1PG, UK
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, Paddington, London, W2 1PG, UK
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7
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Sutherland GR. Sudden cardiac death: the pro-arrhythmic interaction of an acute loading with an underlying substrate. Eur Heart J 2017; 38:2986-2994. [DOI: 10.1093/eurheartj/ehw449] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 08/29/2016] [Indexed: 11/14/2022] Open
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8
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Shi B, Harding S, Larsen P. Analysis of ECG Measures of Cardiac Repolarization in Relation to Arrhythmic Events in an Implantable Cardioverter Defibrillator Population. Ann Noninvasive Electrocardiol 2016; 22. [PMID: 27292910 DOI: 10.1111/anec.12390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND ECG-derived measures of cardiac repolarization may have utility in risk prediction of future ventricular arrhythmia, and a range of different measures have been proposed. We compared time-based, vectorcardiographic, and singular value decomposition (SVD) derived measures of repolarization to determine which was most predictive of appropriate therapy in an ICD population. METHODS We examined the independent prognostic value of a range of repolarization measures derived from 60 second 12-lead ECG recordings in 150 patients receiving new ICD implants in relation to the occurrence of appropriate therapy during follow-up. RESULTS Over an average follow-up of 2.15 ± 0.87 years, male gender, presence of premature ventricular complex (PVC), relative T wave residuum (TWR-rel, measures regional repolarization heterogeneity), and TCRT (the total cosine R-to-T, describes the global angle between repolarization and depolarization wavefronts) were the only independent predictors of appropriate therapy. With every 0.01% increase in TWR-rel, there was 2% increased risk of appropriate therapy (HR = 1.02, 95% CI 1.006-1.034, P < 0.001). With every 1° decrease in TCRT, there was an increase in arrhythmic risk of 0.9% (HR 1.009, 95% CI 1.003-1.015, P = 0.003). CONCLUSIONS The use of advanced analytic ECG techniques to derive measures of repolarization abnormality might shave utility in risk stratification in an ICD population.
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Affiliation(s)
- Bijia Shi
- Wellington Cardiovascular Research Group, Wellington, New Zealand.,Department of Surgery and Anaesthesia, University of Otago, Wellington, New Zealand
| | - Scott Harding
- Wellington Cardiovascular Research Group, Wellington, New Zealand.,Department of Cardiology, Wellington Regional Hospital, Wellington, New Zealand
| | - Peter Larsen
- Wellington Cardiovascular Research Group, Wellington, New Zealand.,Department of Surgery and Anaesthesia, University of Otago, Wellington, New Zealand
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9
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Zhang S, Singh B, Rodriguez DA, Chasnoits AR, Hussin A, Ching CK, Huang D, Liu YB, Cerkvenik J, Willey S, Kim YH. Improve the prevention of sudden cardiac arrest in emerging countries: the Improve SCA clinical study design. Europace 2015; 17:1720-6. [PMID: 26037794 PMCID: PMC4654425 DOI: 10.1093/europace/euv103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 03/23/2015] [Indexed: 02/05/2023] Open
Abstract
AIMS This study aims to demonstrate that primary prevention (PP) patients with one or more additional risk factors are at a similar risk of life-threatening ventricular arrhythmias when compared with secondary prevention (SP) patients, and would receive similar benefit from an implantable cardioverter defibrillator (ICD), or cardiac resynchronization therapy-defibrillator (CRT-D) implant. The study evaluates the benefits of therapy for high-risk patients in countries where defibrillation therapy for PP of SCA is underutilized. METHODS Enrolment will consist of 4800 ICD-eligible patients from Asia, Latin America, Eastern Europe, the Middle East, and Africa. Upon enrolment, patients will be categorized as SP or PP. Primary prevention patients will be assessed for additional risk factors: syncope/pre-syncope, non-sustained ventricular tachycardia, frequent premature ventricular contractions, and low left ventricular ejection fraction. Those PP patients with one or more risk factors will be categorized as '1.5' patients. Implant of an ICD/CRT-D will be left to the patient and/or physician's discretion. The primary endpoint will compare the appropriate ICD therapy rate between SP and 1.5 patients. The secondary endpoint compares mortality between 1.5 implanted and non-implanted patients. CONCLUSION The Improve SCA study will investigate a subset of PP patients, believed to be at similar risk of life-threatening ventricular arrhythmias as SP patients. Results may help clinicians identify and refer the highest risk PP patients for ICDs, help local societies expand guidelines to include PP of SCA utilizing ICDs, and provide additional geographical-relevant evidence to allow patients to make an informed decision whether to receive an ICD. TRIAL REGISTRATION NCT02099721.
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Affiliation(s)
- Shu Zhang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 North Lishi Road, Beijing 100037, China
| | - Balbir Singh
- Medanta, The Medicity Hospital, Sector 38, Gurgaon, Haryana 122041, India
| | - Diego A Rodriguez
- Instituto de Cardiologia - Fundacion Cardioinfantil, Centro Internacional de Arritmias Calle 163 A #13B- 60, Bogota, Colombia
| | | | - Azlan Hussin
- Institut Jantung Negara, 145 Jalan Tun Razak, Kuala Lumpur 50400, Malaysia
| | - Chi-Keong Ching
- National Heart Centre Singapore, 5 Hospital Avenue, Singapore 169609, Singapore
| | - Dejia Huang
- West China Hospital, Sichuan University, No. 37 Guo Xue St., Chengdu 610041, China
| | - Yen-Bin Liu
- Cardiovascular Center, 5/F, National Taiwan University Hospital, No. 7, Chung Shan S. Rd, Zhong Zheng District, Taipei City 10002, Taiwan
| | - Jeffrey Cerkvenik
- Medtronic, CRHF Clinical Research, 8200 Coral Sea Street NE, Mounds View, Minneapolis, MN 55112, USA
| | - Sarah Willey
- Medtronic, CRHF Clinical Research, 8200 Coral Sea Street NE, Mounds View, Minneapolis, MN 55112, USA
| | - Young-Hoon Kim
- Korea University Medical Center, A126-1 5th St. Anam-dong Sungbuk-ku, Seoul 136-705, Korea
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10
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Pansani AP, Sonoda EY, Scorza FA, Colugnati DB. Premature ventricular complexes: How benign are they in epilepsy? Epilepsy Behav 2015; 52:74-5. [PMID: 26409133 DOI: 10.1016/j.yebeh.2015.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 08/13/2015] [Indexed: 01/08/2023]
Affiliation(s)
- Aline P Pansani
- Laboratório Integrado de Fisiopatologia Cardiovascular e Neurológica/Departamento de Ciências Fisiológicas, ICB/Universidade Federal de Goiás, GO, Brazil
| | - Eliza Y Sonoda
- Disciplina de Neurologia Experimental, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
| | - Fulvio A Scorza
- Disciplina de Neurologia Experimental, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
| | - Diego B Colugnati
- Laboratório Integrado de Fisiopatologia Cardiovascular e Neurológica/Departamento de Ciências Fisiológicas, ICB/Universidade Federal de Goiás, GO, Brazil.
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Abstract
For individuals and the society as a whole, the increased risk of sudden cardiac death in obese patients is becoming a major challenge, especially since obesity prevalence has been increasing steadily around the globe. Traditional risk factors and obesity often coexist. Hypertension, diabetes, obstructive sleep apnea and metabolic syndrome are well-known risk factors for CV disease and are often present in the obese patient. Although the bulk of evidence is circumstantial, sudden cardiac death and obesity share common traditional CV risk factors. Structural, functional and metabolic factors modulate and influence the risk of sudden cardiac death in the obese population. Other risk factors such as left ventricular hypertrophy, increased number of premature ventricular complexes, altered QT interval and reduced heart rate variability are all documented in both obese and sudden cardiac death populations. The present review focuses on out-of-hospital sudden cardiac death and potential mechanisms leading to sudden cardiac death in this population.
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Affiliation(s)
- Benoit Plourde
- Department of Medicine, Faculty of Medicine, Quebec City, QC, Canada
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12
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Stoupel E, Kusniec J, Golovchiner G, Abramson E, Kadmon U, Strasberg B. Association of time of occurrence of electrical heart storms with environmental physical activity. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 37:1067-70. [PMID: 24645938 DOI: 10.1111/pace.12383] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 01/03/2014] [Accepted: 01/17/2014] [Indexed: 01/29/2023]
Abstract
AIM Many publications in recent decades have reported a temporal link between medical events and environmental physical activity. The aim of this study was to analyze the time of occurrence of electrical heart storms against levels of cosmological parameters. METHODS The sample included 82 patients (71 male) with ischemic cardiomyopathy treated with an implantable cardioverter defibrillator at a tertiary medical center in 1999-2012 (5,114 days). The time of occurrence of all electrical heart storms, defined as three or more events of ventricular tachycardia or ventricular fibrillation daily, was recorded from the defibrillator devices. Findings were analyzed against data on solar, geomagnetic, and cosmic ray (neutron) activity for the same time period obtained from space institutions in the United States and Russia. RESULTS Electrical storms occurred in all months of the year, with a slight decrease in July, August, and September. Most events took place on days with lower-than-average levels of solar and geomagnetic activity and higher-than-average levels of cosmic ray (neutron) activity. There was a significant difference in mean daily cosmic ray activity between the whole observation period and the days of electrical storm activity (P = 0.0001). CONCLUSION These data extend earlier findings on the association of the timing of cardiac events and space weather parameters to the most dangerous form of cardiac arrhythmia-electric storms. Further studies are needed to delineate the pathogenetic mechanism underlying this association.
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Affiliation(s)
- Eliiyahu Stoupel
- Division of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Ulus T, Kudaiberdieva G, Gorenek B. The onset mechanisms of ventricular tachycardia. Int J Cardiol 2013; 167:619-23. [DOI: 10.1016/j.ijcard.2012.09.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Accepted: 09/15/2012] [Indexed: 10/27/2022]
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KIRUBAKARAN SENTHIL, GILL JASWINDER, RINALDI CHRISTOPHERA. Successful Catheter Ablation of Focal Ventricular Fibrillation in a Patient with Nonischemic Dilated Cardiomyopathy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:e38-42. [DOI: 10.1111/j.1540-8159.2010.02750.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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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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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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Gorenek B, Cengiz O, Kudaiberdieva G, Durak I, Dogan V, Yasar B, Birdane A, Cavusoglu Y, Ata N. Mode of onset of polymorphic ventricular tachycardia in acute myocardial infarction. Can J Cardiol 2010; 26:e254-7. [PMID: 20847973 DOI: 10.1016/s0828-282x(10)70421-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Polymorphic ventricular tachycardia (PVT) can occur during acute myocardial infarction (MI). In the past, studies investigated the initiation pattern of ventricular tachycardias in different patient populations; however, the mode of onset of PVT in acute MI patients has not been investigated previously. OBJECTIVE To retrospectively investigate the electrophysiological features of PVT with different initiation patterns in acute MI patients to assess whether there is a relationship of the initiation patterns of PVT with clinical and electrophysiological characteristics. METHODS Sixty-two rhythm strips defined as PVT from 53 patients (mean [± SD] age 63±8 years) with acute ST elevation MI were analyzed. All patients were monitored while they were hospitalized in the coronary care unit, and the electrocardiogram strips were obtained from continuous monitoring. PVT was defined as sudden-onset tachycardia if it was not preceded by ventricular ectopic beats. PVT that was preceded by single or multiple ectopic beats was defined as nonsudden-onset tachycardia. RESULTS Nonsudden-onset episodes were more common than suddenonset episodes (40 episodes [64.5%] versus 22 episodes [35.5%]). In the nonsudden-onset group, 25 episodes (62.5%) were initiated after a single ectopic beat, while 15 episodes (37.5%) were initiated after multiple complexes. The mean (± SD) left ventricular ejection fraction of patients with nonsudden-onset PVT was decreased (53±6% versus 65±7%, P<0.01). Nonsudden-onset tachycardias had lower coupling intervals than suddenonset tachycardias. Similarly, the PVT cycle length was shorter in the presence of nonsudden-onset initiation. When nonsudden-onset PVT episodes were further subclassified based on the morphology of the first beat of tachycardia, 26 PVTs (65%) had a first beat of tachycardia similar to the subsequent PVT beats and 14 (35%) did not. CONCLUSIONS These results demonstrate that PVT is often preceded by ventricular ectopy in acute MI patients. Nonsudden-onset PVT is usually characterized by a lower coupling interval, shorter PVT cycle length and an associated lower ejection fraction.
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Affiliation(s)
- Bulent Gorenek
- Cardiology Department, Eskisehir Osmangazi University, Eskisehir, Turkey.
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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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Panfilov I, Lever NA, Smaill BH, Larsen PD. Ventricular fibrillation frequency from implanted cardioverter defibrillator devices. Europace 2009; 11:1052-6. [DOI: 10.1093/europace/eup159] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Israel CW. [Sandwiched between the single- and triple-chamber ICD: do we still need the dual-chamber ICD?]. Herzschrittmacherther Elektrophysiol 2008; 19 Suppl 1:14-24. [PMID: 19169731 DOI: 10.1007/s00399-008-0606-0] [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: 05/27/2023]
Abstract
Since it has been shown that adverse events are more frequent with dual-compared to single-chamber ICDs in patients with heart failure, and since the importance of prevention of unnecessary right ventricular pacing and the success of biventricular pacing have been demonstrated in numerous studies, the need for dual-chamber ICD systems has to be reassessed. The development of these systems was accompanied by expectations of improved hemodynamics in patients with bradycardia, a reduced incidence of atrial fibrillation, inappropriate therapies, and bradycardia-associated ventricular tachyarrhythmias. Single-chamber ICDs should be used restrictively and with great caution in patients with (sinus-) bradycardia and heart failure, since a relevant proportion of these patients is at risk of hemodynamic deterioration. Even if the proportion of patients with proven pacemaker syndrome is so small that it does not reach the level of statistical significance in large studies, a small percentage of patients with hemodynamic deterioration due to VVI pacing is still clinically (and economically) intolerable. Since the development of bradycardia or symptomatic chronotropic incompetence (e.g., due to amiodarone) is difficult to predict, it seems reasonable to use the indication for dualchamber systems liberally. However, the systematic prevention of unnecessary right ventricular pacing is crucial if dual-chamber ICDs are used. If advanced tachycardia discrimination algorithms and careful, individual programming are used, dual-chamber ICDs are superior in the prevention of inappropriate therapies. Additionally, dualchannel electrograms allow a more reliable interpretation of stored tachycardia episodes. In summary, dual-chamber systems represent a valuable improvement of ICD therapy but require thorough programming to convey their advantage.
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Affiliation(s)
- C W Israel
- Goethe-Universität Frankfurt a.M., Medizinische Klinik III - Kardiologie, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
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To the Response:. Pacing Clin Electrophysiol 2008. [DOI: 10.1111/j.1540-8159.2008.01218.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: 11/30/2022]
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Initiation of Serious Ventricular Arrhythmias in ICD Patients: A Letter on a Paper; Pacing Clin Electrophysiol 2008; 31:144-150. Pacing Clin Electrophysiol 2008; 31:1516-7; author reply 1517. [DOI: 10.1111/j.1540-8159.2008.01200.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: 11/27/2022]
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