1
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Haïssaguerre M, Sellal JM, Benali K, de Becker B, Defaye P, Pascale P, Martins R, Mabo P, Xhaet O, Extramiana F, Surget E, Lavergne T, Marijon E, Adragao P, Carvalho MS, Milliez PU, Laredo M, Gandjbakhch E, Giustetto C, Gaita F, Tilz R, Jesel-Morel L, Steinfurt J, Arentz T, Knecht S, Duytschaever M, Roten L, Reichlin T, Fatemi M, Mansourati J, Kouakam C, Bessière F, Chevalier P, Tadros R, Macle L, Gallego F, Hadjis A, Sacher F, Pereira D, Hourdain J, Deharo JC, Eschalier R, Massoulié G, Maury P, Latcu DG, Anselme F, Duchateau J, Tixier R, Nademanee K, Nogami A, de Groot N, Vigmond E, Bernus O, Strik M, Bordachar P, Cathala A, Bouteiller X, Dubois R, Ploux S. Distinct Substrates of Idiopathic Ventricular Fibrillation Revealed by Arrhythmia Characteristics on Implantable Cardioverter-Defibrillator. JACC Clin Electrophysiol 2024:S2405-500X(24)00356-6. [PMID: 38970599 DOI: 10.1016/j.jacep.2024.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 04/25/2024] [Accepted: 04/27/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Idiopathic ventricular fibrillation (IVF) can be associated with undetected distinct conditions such as microstructural cardiomyopathic alterations (MiCM) or Purkinje (Purk) activities with structurally normal hearts. OBJECTIVE This study sought to evaluate the characteristics of recurrent VF recorded on implantable defibrillator electrograms, associated with these substrates. METHODS This was a multicenter collaboration study. At 32 centers, we selected patients with an initial diagnosis of IVF and recurrent arrhythmia at follow-up without antiarrhythmic drugs, in whom mapping demonstrated Purk or MiCM substrate. We analyzed variables related to previous ectopy, sinus rate preceding VF, trigger, and initial VF cycle lengths. Logistic regression with cross validation was used to evaluate the performance of criteria to discriminate Purk or MiCM substrates. RESULTS Among 95 patients (35 women, age 35 ± 11 years) meeting the inclusion criteria, IVF was associated with MiCM in 41 and Purk in 54 patients. A total of 117 arrhythmia recurrences including 91% VF were recorded on defibrillator. Three variables were mostly discriminant. Sinus tachycardia (≤570 ms) was more frequent in MiCM (35.9% vs 13.4%, P = 0.014) whereas short-coupled (<350 ms) triggers were most frequent in Purk-related VF (95.5% vs 23.1%, P = 0.001), which also had shorter VFCLs (182 ± 15 ms vs 215 ± 24 ms, P < 0.001).The multivariable combination provided the highest prediction (accuracy = 0.93 ± 0.05, range 0.833-1.000), discriminating 81% of IVF substrates with a high probability (>80%). Ectopy were inconsistently present before VF. CONCLUSIONS Characteristics of arrhythmia recurrences on implantable cardioverter- defibrillator provide phenotypic markers of the distinct and hidden substrates underlying IVF. These findings have significant clinical and genetic implications.
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Affiliation(s)
- Michel Haïssaguerre
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Cardiac electrophysiology and stimulation, Cardiology Department, Bordeaux University Hospital (CHU), Pessac, France.
| | - Jean-Marc Sellal
- Cardiology Department, Nancy University Hospital (CHRU), Nancy, France
| | - Karim Benali
- Cardiac electrophysiology and stimulation, Cardiology Department, Bordeaux University Hospital (CHU), Pessac, France; Department of Cardiac Electrophysiology, Saint-Etienne University Hospital Center, Jean-Monnet University, Saint-Etienne, France
| | | | - Pascal Defaye
- Rhythmology and Cardiac stimulation Unit, Grenoble University Hospital (CHU), Grenoble, France
| | - Patrizio Pascale
- Cardiology Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Raphael Martins
- Cardiology Department, Rennes University Hospital (CHU), Rennes, France
| | - Philippe Mabo
- Cardiology Departement, Namur University Hospital (CHU UCL Namur), Yvoir, Belgium
| | - Olivier Xhaet
- Cardiology Department, APHP Hôpital Bichat, Paris, France
| | - Fabrice Extramiana
- Cardiology Department, Rhythmology Unit, Hôpital Européen Georges Pompidou, Paris, France
| | - Elodie Surget
- Heart Rhythm Centre, Hospital da Luz, Lisbon, Portugal
| | - Thomas Lavergne
- Cardiology Department, Caen Normandie University Hospital (CHU), Caen, France
| | - Eloi Marijon
- Pitié-Salpêtrière University Hospital, Institute of Cardiology, Paris, France
| | - Pedro Adragao
- Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Paul-Ursmar Milliez
- Cardiology Department, Caen Normandie University Hospital (CHU), Caen, France
| | - Mickael Laredo
- Pitié-Salpêtrière University Hospital, Institute of Cardiology, Paris, France
| | - Estelle Gandjbakhch
- Pitié-Salpêtrière University Hospital, Institute of Cardiology, Paris, France
| | - Carla Giustetto
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Fiorenzo Gaita
- Universitätsklinikum Schleswig-Holstein (UKSH), Klinik für Rhythmologie, Lübeck, Germany
| | - Roland Tilz
- Cardiology Department, Strasbourg University Hospital (CHRU), Strasbourg, France
| | - Laurence Jesel-Morel
- Cardiology Department, Strasbourg University Hospital (CHRU), Strasbourg, France
| | - Johannes Steinfurt
- Department of Cardiology, Universitäts-Herzzentrum Freiburg - Bad Krozingen, Freiburg, Germany
| | - Thomas Arentz
- Department of Cardiology, Universitäts-Herzzentrum Freiburg - Bad Krozingen, Freiburg, Germany
| | | | | | - Laurent Roten
- Inselspital, Bern University Hospital, University Clinic for Cardiology, Bern, Switzerland
| | - Tobias Reichlin
- Inselspital, Bern University Hospital, University Clinic for Cardiology, Bern, Switzerland
| | - Marjaneh Fatemi
- Cardiology Department, Brest University Hospital(CHU), Brest, France
| | | | - Claude Kouakam
- Cardiology Department, Lille University Hospital (CHRU), Lille, France
| | - Francis Bessière
- Cardiac Rhythmology Department, Hôpital cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Philippe Chevalier
- Cardiac Rhythmology Department, Hôpital cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Rafik Tadros
- Montreal Heart Institute (ICM), Montréal, Canada
| | | | | | - Alexios Hadjis
- Electrophysiology Unit, Cardiology Department, Sacré-Coeur Hospital of Montréal (HSCM), Montréal, Canada
| | - Frederic Sacher
- Cardiac electrophysiology and stimulation, Cardiology Department, Bordeaux University Hospital (CHU), Pessac, France; Reference Center for Hereditary Rhythmic Diseases and Sudden Death Prevention (CMARY), Cardiology Department, Bordeaux University Hospital (CHU), Pessac, France
| | - Dylan Pereira
- Cardiology Department, Tours University Hospital (CHU), Tours, France
| | - Jerome Hourdain
- Cardiology Department, Tours University Hospital (CHU), Tours, France
| | - Jean-Claude Deharo
- Cardiology Department, Marseille University Hospital La Timone (AP-HM), Marseille, France
| | - Romain Eschalier
- Cardiology Department, Marseille University Hospital La Timone (AP-HM), Marseille, France; Cardiology Department, Clermont-Ferrand University Hospital, (CHU), Clermont-Ferrand, France
| | - Grégoire Massoulié
- Cardiology Department, Clermont-Ferrand University Hospital, (CHU), Clermont-Ferrand, France
| | - Philippe Maury
- Cardiology Department, Rangueil University Hospital (CHU), Toulouse, France
| | | | - Frederic Anselme
- Cardiology Department, Rouen-Normandie University Hospital (CHU), Rouen, France
| | - Josselin Duchateau
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Cardiac electrophysiology and stimulation, Cardiology Department, Bordeaux University Hospital (CHU), Pessac, France
| | - Romain Tixier
- Cardiac electrophysiology and stimulation, Cardiology Department, Bordeaux University Hospital (CHU), Pessac, France
| | - Koonlawee Nademanee
- Pacific Rim Electrophysiology Research Institute at Bumrungrad Hospital, Bangkok, Thailand
| | | | | | - Edward Vigmond
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Olivier Bernus
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Marc Strik
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Cardiac electrophysiology and stimulation, Cardiology Department, Bordeaux University Hospital (CHU), Pessac, France
| | - Pierre Bordachar
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Cardiac electrophysiology and stimulation, Cardiology Department, Bordeaux University Hospital (CHU), Pessac, France
| | - Aude Cathala
- Cardiac electrophysiology and stimulation, Cardiology Department, Bordeaux University Hospital (CHU), Pessac, France
| | - Xavier Bouteiller
- Cardiac electrophysiology and stimulation, Cardiology Department, Bordeaux University Hospital (CHU), Pessac, France
| | - Remi Dubois
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Sylvain Ploux
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Cardiac electrophysiology and stimulation, Cardiology Department, Bordeaux University Hospital (CHU), Pessac, France
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2
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Marrakchi S, Badenco N, Schumacher S, Bennour E, Livarek B, Gandjbakhch E, Hidden-Lucet F. Focus on malignant ventricular premature contractions. Ann Cardiol Angeiol (Paris) 2023; 72:101662. [PMID: 37742408 DOI: 10.1016/j.ancard.2023.101662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023]
Abstract
Premature ventricular contractions (PVCs) are common. Although often benign, they can also be associated with increased morbidity and mortality. The aim of this review was to assess the risk evaluation of PVCs in patients with or without structural heart disease and discuss the management of this arrhythmia. Reports published in English were searched in PubMed with the following search terms: premature ventricular contraction, ectopic ventricular beat, ventricular extrasystole, antiarrhythmic drugs, ablation, ventricular arrhythmia, ventricular tachycardia, ventricular fibrillation and torsade de pointe. This analysis suggests that all patients with frequent PVCs should be assessed for PVC burden, symptom status and the presence of structural heart disease. PVCs in patients with structurally normal hearts was once considered a benign phenomenon. Uncommonly, PVCs may provoke life-threatening arrhythmias. Ventricular fibrillation is the initial mode of malignant rapid ventricular arrhythmias (MRVAs). Patients with malignant PVC and PVC burden >10% are at increased risk of MRVA in case of myocardial infarction and heart failure. MRVA is the primary cause of sudden cardiac death in patients with and without structural heart disease. Therapeutic options include medical therapy and catheter ablation, the latter more effective and potentially curable, particularly in patients with left ventricular dysfunction. The timely recognition and effective treatment of malignant PVCs in symptomatic patients with underling cardiomyopathy are mandatory to initiate early therapies before the occurrence of adverse clinical outcomes and to improve the long-term prognosis.
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Affiliation(s)
- S Marrakchi
- Université de Sorbonne, AP-HP, Centre Hospitalo-universitaire Pitié-Salpêtrière, Institut de Cardiology, ICAN, Paris, France; Département de Cardiologie, Hospital André Mignot, Versailles, France; University El Manar, Tunis, Tunisie.
| | - N Badenco
- Université de Sorbonne, AP-HP, Centre Hospitalo-universitaire Pitié-Salpêtrière, Institut de Cardiology, ICAN, Paris, France
| | - S Schumacher
- Université de Sorbonne, AP-HP, Centre Hospitalo-universitaire Pitié-Salpêtrière, Institut de Cardiology, ICAN, Paris, France; Département de Cardiologie, Hospital André Mignot, Versailles, France
| | - E Bennour
- University El Manar, Tunis, Tunisie; Département de Cardiologie, Hospital Abderrahmane Mami Hospital, Tunis, Tunisie
| | - B Livarek
- Département de Cardiologie, Hospital André Mignot, Versailles, France
| | - E Gandjbakhch
- Université de Sorbonne, AP-HP, Centre Hospitalo-universitaire Pitié-Salpêtrière, Institut de Cardiology, ICAN, Paris, France
| | - F Hidden-Lucet
- Université de Sorbonne, AP-HP, Centre Hospitalo-universitaire Pitié-Salpêtrière, Institut de Cardiology, ICAN, Paris, France
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3
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Steinberg C. Short-Coupled Ventricular Fibrillation. Card Electrophysiol Clin 2023; 15:331-341. [PMID: 37558303 DOI: 10.1016/j.ccep.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Short-coupled ventricular fibrillation (SCVF) is a distinct phenotype among individuals with unexplained cardiac arrest accounting for 7% to 14% of cases of idiopathic ventricular fibrillation (IVF). VF is typically initiated by a trigger premature ventricular contraction with a short-coupling interval of less than 350 milliseconds. In the absence of specific electrocardiographic features or provocative tests, the diagnosis remains challenging and requires documentation of VF onset. Most cases are diagnosed during follow-up at the time of VF recurrence. SCVF is characterized by a high risk of VF recurrence. Insertion of an implantable cardioverter-defibrillator and quinidine are the keystones of SCVF management.
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Affiliation(s)
- Christian Steinberg
- Institut universitaire de cardiologie et pneumologie de Québec (IUCPQ-UL), Laval University, 2725 Chemin Ste-Foy, Quebec, QC, G1V 4G5, Canada.
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4
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Suba S, Hoffmann TJ, Fleischmann KE, Schell-Chaple H, Marcus GM, Prasad P, Hu X, Badilini F, Pelter MM. Evaluation of premature ventricular complexes during in-hospital ECG monitoring as a predictor of ventricular tachycardia in an intensive care unit cohort. Res Nurs Health 2023. [PMID: 37127543 DOI: 10.1002/nur.22314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/17/2023] [Accepted: 04/15/2023] [Indexed: 05/03/2023]
Abstract
In-hospital electrocardiographic (ECG) monitors are typically configured to alarm for premature ventricular complexes (PVCs) due to the potential association of PVCs with ventricular tachycardia (VT). However, no contemporary hospital-based studies have examined the association of PVCs with VT. Hence, the benefit of PVC monitoring in hospitalized patients is largely unknown. This secondary analysis used a large PVC alarm data set to determine whether PVCs identified during continuous ECG monitoring were associated with VT, in-hospital cardiac arrest (IHCA), and/or death in a cohort of adult intensive care unit patients. Six PVC types were examined (i.e., isolated, bigeminy, trigeminy, couplets, R-on-T, and run PVCs) and were compared between patients with and without VT, IHCA, and/or death. Of 445 patients, 48 (10.8%) had VT; 11 (2.5%) had IHCA; and 49 (11%) died. Isolated and run PVC counts were higher in the VT group (p = 0.03 both), but group differences were not seen for the other four PVC types. The regression models showed no significant associations between any of the six PVC types and VT or death, although confidence intervals were wide. Due to the small number of cases, we were unable to test for associations between PVCs and IHCA. Our findings suggest that we should question the clinical relevance of activating PVC alarms as a forewarning of VT, and more work should be done with larger sample sizes. A more precise characterization of clinically relevant PVCs that might be associated with VT is warranted.
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Affiliation(s)
- Sukardi Suba
- School of Nursing, University of Rochester, Rochester, New York, USA
| | - Thomas J Hoffmann
- Department of Epidemiology and Biostatistics, School of Medicine, and Office of Research, School of Nursing, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Kirsten E Fleischmann
- Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Hildy Schell-Chaple
- Center for Nursing Excellence & Innovation, UCSF Medical Center, San Francisco, California, USA
| | - Gregory M Marcus
- Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Priya Prasad
- Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Xiao Hu
- Nell Hodgson Woodruff School of Nursing, Biomedical Informatics, School of Medicine, and Computer Science, College of Arts and Sciences, Emory University, Atlanta, Georgia, USA
| | - Fabio Badilini
- Department of Physiological Nursing, Center for Physiologic Research, School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Michele M Pelter
- Department of Physiological Nursing, Center for Physiologic Research, School of Nursing, University of California, San Francisco, San Francisco, California, USA
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5
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Surget E, Duchateau J, Marchant J, Maury P, Walton R, Lavergne T, Gandjbakhch E, Leenhardt A, Extramiana F, Haïssaguerre M. Idiopathic ventricular fibrillation associated with long-coupled Purkinje ectopy. J Cardiovasc Electrophysiol 2023; 34:615-623. [PMID: 36748854 DOI: 10.1111/jce.15833] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/07/2023] [Accepted: 01/14/2023] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Idiopathic ventricular fibrillation (IVF) is mainly associated with and triggered by short-coupled (R-on-T) ventricular ectopics. However, little is known about the risk of VF associated with long-coupled premature ventricular complexes (LCPVCs). OBJECTIVE To examine the prevalence and characteristics of IVF patients presenting with LCPVCs. METHODS Consecutive patients with IVF and PVCs from five arrhythmia referral centers were reviewed. We included patients presenting LCPVCs, defined as PVCs falling after the end of the T wave, with a normal QTc interval. We evaluated demographics, medical history, and clinical circumstances associated with PVCs and VF episodes. The origin of PVCs was determined by invasive mapping. RESULTS Seventy-nine patients with IVF were reviewed. Among them, 12 (15.2%) met the inclusion criteria (8 women, age 36 ± 14 years). Eleven patients had documented LCPVCs initiating repetitive PVCs or sustained VF, whereas 1 had only documented isolated PVCs. In 10 of 12 patients, PVCs were recorded showing both long and short coupling intervals of 418 ± 46 and 304 ± 33 ms, respectively. Mapping showed that PVCs originated from the left Purkinje in 10 patients, from the right Purkinje in 1 patient, and both in 1 patient. Compared to other patients from the initial cohort, IVF with LCPVCs was associated with a left-sided origin of PVCs (92% in long-coupled IVF vs. 46% of left Purkinje PVCs in short-coupled IVF, p = .004). CONCLUSION Long-coupled fascicular PVCs, traditionally recognized as benign, can be associated with IVF in a subset of patients. They can induce IVF by themselves or in association with short-coupled PVCs.
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Affiliation(s)
- Elodie Surget
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Josselin Duchateau
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - James Marchant
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Philippe Maury
- Cardiology Department, Rangueil University Hospital, Toulouse, France
| | - Richard Walton
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Thomas Lavergne
- Cardiology Department, Rhythmology Unit, Hôpital Européen Georges Pompidou, Paris, France
| | - Estelle Gandjbakhch
- Institute of Cardiology, Pitié-Salpêtrière University Hospital, Paris, France
| | - Antoine Leenhardt
- Université de Paris Cité, CNMR, Maladies Cardiaques Héréditaires Rares, APHP Hôpital Bichat, Paris, France
| | - Fabrice Extramiana
- Université de Paris Cité, CNMR, Maladies Cardiaques Héréditaires Rares, APHP Hôpital Bichat, Paris, France
| | - Michel Haïssaguerre
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
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6
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Surget E, Faye NR, Marchant J, Cheniti G, Hocini M, Haissaguerre M. Burden of Purkinje ectopies associated with sex hormone levels. HeartRhythm Case Rep 2023. [DOI: 10.1016/j.hrcr.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
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7
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Belhassen B, Tovia-Brodie O. Short or long-coupled idiopathic ventricular fibrillation: Does the coupling interval really matter? J Cardiovasc Electrophysiol 2023; 34:624-626. [PMID: 36709472 DOI: 10.1111/jce.15832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 01/22/2023] [Indexed: 01/30/2023]
Affiliation(s)
- Bernard Belhassen
- Hadassah Medical Center, Heart Institute, Jerusalem, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Oholi Tovia-Brodie
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
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8
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Qu Z, Liu MB, Olcese R, Karagueuzian H, Garfinkel A, Chen PS, Weiss JN. R-on-T and the initiation of reentry revisited: Integrating old and new concepts. Heart Rhythm 2022; 19:1369-1383. [PMID: 35364332 DOI: 10.1016/j.hrthm.2022.03.1224] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/11/2022] [Accepted: 03/23/2022] [Indexed: 12/29/2022]
Abstract
Initiation of reentry requires 2 factors: (1) a triggering event, most commonly focal excitations such as premature ventricular complexes (PVCs); and (2) a vulnerable substrate with regional dispersion of refractoriness and/or excitability, such as occurs during the T wave of the electrocardiogram when some areas of the ventricle have repolarized and recovered excitability but others have not. When the R wave of a PVC coincides in time with the T wave of the previous beat, this timing can lead to unidirectional block and initiation of reentry, known as the R-on-T phenomenon. Classically, the PVC triggering reentry has been viewed as arising focally from 1 region and propagating into another region whose recovery is delayed, resulting in unidirectional conduction block and reentry initiation. However, more recent evidence indicates that PVCs also can arise from the T wave itself. In the latter case, the PVC initiating reentry is not a separate event from the T wave but rather is causally generated from the repolarization gradient that manifests as the T wave. We call the former an "R-to-T" mechanism and the latter an "R-from-T" mechanism, which are initiation mechanisms distinct from each other. Both are important components of the R-on-T phenomenon and need to be taken into account when designing antiarrhythmic strategies. Strategies targeting suppression of triggers alone or vulnerable substrate alone may be appropriate in some instances but not in others. Preventing R-from-T arrhythmias requires suppressing the underlying dynamic tissue instabilities responsible for producing both triggers and substrate vulnerability simultaneously. The same principles are likely to apply to supraventricular arrhythmias.
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Affiliation(s)
- Zhilin Qu
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California; Department of Computational Medicine, David Geffen School of Medicine, University of California, Los Angeles, California.
| | - Michael B Liu
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Riccardo Olcese
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles, California; Department of Physiology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Hrayr Karagueuzian
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Alan Garfinkel
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California; Department of Integrative Biology and Physiology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Peng-Sheng Chen
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - James N Weiss
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California; Department of Physiology, David Geffen School of Medicine, University of California, Los Angeles, California
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9
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Krahn AD, Tfelt-Hansen J, Tadros R, Steinberg C, Semsarian C, Han HC. Latent Causes of Sudden Cardiac Arrest. JACC Clin Electrophysiol 2022; 8:806-821. [PMID: 35738861 DOI: 10.1016/j.jacep.2021.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/09/2021] [Accepted: 12/29/2021] [Indexed: 11/30/2022]
Abstract
Inherited arrhythmia syndromes are a common cause of apparently unexplained cardiac arrest or sudden cardiac death. These include long QT syndrome and Brugada syndrome, with a well-recognized phenotype in most patients with sufficiently severe disease to lead to cardiac arrest. Less common and typically less apparent conditions that may not be readily evident include catecholaminergic polymorphic ventricular tachycardia, short QT syndrome and early repolarization syndrome. In cardiac arrest patients whose extensive testing does not reveal an underlying etiology, a diagnosis of idiopathic ventricular fibrillation or short-coupled ventricular fibrillation is assigned. This review summarizes our current understanding of the less common inherited arrhythmia syndromes and provides clinicians with a practical approach to diagnosis and management.
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Affiliation(s)
- Andrew D Krahn
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Jacob Tfelt-Hansen
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rafik Tadros
- Cardiovascular Genetics Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Québec, Canada
| | - Christian Steinberg
- Institut universitaire de cardiologie et pneumologie de Québec (IUCPQ-UL), Laval University, Inherited Arrhythmia Services, Départment of Cardiology and Cardiac Surgery, Québec, Canada
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Hui-Chen Han
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada; Victorian Heart Institute, Monash University, Clayton, Victoria, Australia
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10
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Belhassen B, Tovia-Brodie O. Short-Coupled Idiopathic Ventricular Fibrillation: A Literature Review With Extended Follow-Up. JACC Clin Electrophysiol 2022; 8:918-936. [PMID: 35597766 DOI: 10.1016/j.jacep.2022.04.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/25/2022] [Accepted: 04/18/2022] [Indexed: 01/07/2023]
Abstract
Idiopathic ventricular fibrillation is responsible for approximately 10% of cases of aborted cardiac arrest. Recent studies have shown that short-coupled ventricular premature complexes are present at the onset of idiopathic ventricular fibrillation in 6.6%-17% of patients. The present review provided information on 86 patients with short-coupled malignant ventricular arrhythmias that were reported as case reports or small patient series during the last 70 years. In 75% of the 81 cases published during the last 40 years, extended information and follow-up (from 2.63 ± 4.5 to 10.67 ± 7.8 years; P < 0.001, between the original publication to the latest update) could be obtained from the authors. The review shows that short-coupled malignant ventricular arrhythmias occurred almost equally in males and females, at the mean age of 40 years. A tendency for later occurrence of the arrhythmia by 4 years was observed in females. A prior history of syncope was noted in 45.3% of the patients, whereas arrhythmic storm occurred in 42% at presentation. The most common mode of revelation of short-coupled malignant ventricular arrhythmias was syncope (53.5%), followed by aborted cardiac arrest (26.7%) and recurrent arrhythmic event after prior implantable-cardioverter defibrillator implantation for idiopathic ventricular fibrillation (17.4%). For the first time, short-coupled malignant arrhythmias exhibiting "not-so-short" coupling intervals (≥350 ms) were found in a significant proportion of patients (17.4%). During long-term follow-up, quinidine yielded a slightly higher success rate in arrhythmia control than ablation. Larger studies are necessary to assess the best strategy for the management of this potentially lethal arrhythmia.
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Affiliation(s)
- Bernard Belhassen
- Heart Institute, Hadassah Medical Center, Jerusalem, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Oholi Tovia-Brodie
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel; Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
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11
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Surget E, Duchateau J, Lavergne T, Ramirez FD, Cheniti G, Haissaguerre M. Long-term freedom from ventricular fibrillation despite persistent Purkinje ectopy after catheter ablation. HeartRhythm Case Rep 2022; 8:259-263. [PMID: 35497479 PMCID: PMC9039102 DOI: 10.1016/j.hrcr.2022.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Elodie Surget
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Josselin Duchateau
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Thomas Lavergne
- Cardiology Department, European Georges Pompidou Hospital, Paris, France
| | - F Daniel Ramirez
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Ghassen Cheniti
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Michel Haissaguerre
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
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12
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Diagnostic and prognostic significance of premature ventricular complexes in community and hospital-based participants: A scoping review. PLoS One 2021; 16:e0261712. [PMID: 34941955 PMCID: PMC8699640 DOI: 10.1371/journal.pone.0261712] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 12/07/2021] [Indexed: 11/21/2022] Open
Abstract
Background While there are published studies that have examined premature ventricular complexes (PVCs) among patients with and without cardiac disease, there has not been a comprehensive review of the literature examining the diagnostic and prognostic significance of PVCs. This could help guide both community and hospital-based research and clinical practice. Methods Scoping review frameworks by Arksey and O’Malley and the Joanna Briggs Institute (JBI) were used. A systematic search of the literature using four databases (CINAHL, Embase, PubMed, and Web of Science) was conducted. The review was prepared adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Review (PRISMA-ScR). Results A total of 71 relevant articles were identified, 66 (93%) were observational, and five (7%) were secondary analyses from randomized clinical trials. Three studies (4%) examined the diagnostic importance of PVC origin (left/right ventricle) and QRS morphology in the diagnosis of acute myocardial ischemia (MI). The majority of the studies examined prognostic outcomes including left ventricular dysfunction, heart failure, arrhythmias, ischemic heart diseases, and mortality by PVCs frequency, burden, and QRS morphology. Conclusions Very few studies have evaluated the diagnostic significance of PVCs and all are decades old. No hospital setting only studies were identified. Community-based longitudinal studies, which make up most of the literature, show that PVCs are associated with structural and coronary heart disease, lethal arrhythmias, atrial fibrillation, stroke, all-cause and cardiac mortality. However, a causal association between PVCs and these outcomes cannot be established due to the purely observational study designs employed.
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13
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Belhassen B. Quinidine vs. ICD in patients with short-coupled idiopathic ventricular fibrillation: a call for a multicenter randomized trial. Eur Heart J 2021; 42:3992. [PMID: 34480537 DOI: 10.1093/eurheartj/ehab549] [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: 11/12/2022] Open
Affiliation(s)
- Bernard Belhassen
- Heart Institute, Hadassah University Hospital, Kalman Ya'akov Man St, Jerusalem 9112001, Israel
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14
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Rabah H, Khalaf Z, Rabah A. Dopamine in Idiopathic Polymorphic Ventricular Tachycardia/Ventricular Fibrillation. J Innov Card Rhythm Manag 2021; 12:4699-4703. [PMID: 34595055 PMCID: PMC8476091 DOI: 10.19102/icrm.2021.120908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/12/2021] [Indexed: 11/13/2022] Open
Abstract
The role of medical therapy in the treatment of idiopathic polymorphic ventricular tachycardia (IPMVT) and idiopathic ventricular fibrillation (IVF) is not well established. Current medications in use include amiodarone, lidocaine, isoproterenol, verapamil, and quinidine. However, the use of dopamine for controlling such arrhythmias has never been described. We present an interesting case of IPMVT/IVF storm induced by short-coupled premature ventricular contractions. The arrhythmia was terminated acutely using dopamine infusion and was suppressed chronically using verapamil.
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Affiliation(s)
- Hussein Rabah
- Department of Internal Medicine, Staten Island University Hospital, New York, NY, USA
| | - Zaynab Khalaf
- Department of Internal Medicine, Faculty of Medical Sciences, Lebanese University, Al Hadath, Lebanon
| | - Ali Rabah
- Division of Electrophysiology, Beirut Cardiac Institute (BCI), Beirut, Lebanon
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15
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Viskin S, Chorin E, Viskin D, Hochstadt A, Schwartz AL, Rosso R. Polymorphic Ventricular Tachycardia: Terminology, Mechanism, Diagnosis, and Emergency Therapy. Circulation 2021; 144:823-839. [PMID: 34491774 DOI: 10.1161/circulationaha.121.055783] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Polymorphic ventricular tachyarrhythmias are highly lethal arrhythmias. Several types of polymorphic ventricular tachycardia have similar electrocardiographic characteristics but have different modes of therapy. In fact, medications considered the treatment of choice for one form of polymorphic ventricular tachycardia, are contraindicated for the other. Yet confusion about terminology, and thus diagnosis and therapy, continues. We present an in-depth review of the different forms of polymorphic ventricular tachycardia and propose a practical step-by-step approach for distinguishing these malignant arrhythmias.
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Affiliation(s)
- Sami Viskin
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Israel
| | - Ehud Chorin
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Israel
| | - Dana Viskin
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Israel
| | - Aviram Hochstadt
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Israel
| | - Arie Lorin Schwartz
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Israel
| | - Raphael Rosso
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Israel
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16
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Steinberg C, Davies B, Mellor G, Tadros R, Laksman ZW, Roberts JD, Green M, Alqarawi W, Angaran P, Healey J, Sanatani S, Leather R, Seifer C, Fournier A, Duff H, Gardner M, McIntyre C, Hamilton R, Simpson CS, Krahn AD. Short-coupled ventricular fibrillation represents a distinct phenotype among latent causes of unexplained cardiac arrest: a report from the CASPER registry. Eur Heart J 2021; 42:2827-2838. [PMID: 34010395 DOI: 10.1093/eurheartj/ehab275] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 02/14/2021] [Accepted: 04/27/2021] [Indexed: 12/25/2022] Open
Abstract
AIMS The term idiopathic ventricular fibrillation (IVF) describes survivors of unexplained cardiac arrest (UCA) without a specific diagnosis after clinical and genetic testing. Previous reports have described a subset of IVF individuals with ventricular arrhythmia initiated by short-coupled trigger premature ventricular contractions (PVCs) for which the term short-coupled ventricular fibrillation (SCVF) has been proposed. The aim of this article is to establish the phenotype and frequency of SCVF in a large cohort of UCA survivors. METHODS AND RESULTS We performed a multicentre study including consecutive UCA survivors from the CASPER registry. Short-coupled ventricular fibrillation was defined as otherwise unexplained ventricular fibrillation initiated by a trigger PVC with a coupling interval of <350 ms. Among 364 UCA survivors, 24/364 (6.6%) met diagnostic criteria for SCVF. The diagnosis of SCVF was obtained in 19/24 (79%) individuals by documented ventricular fibrillation during follow-up. Ventricular arrhythmia was initiated by a mean PVC coupling interval of 274 ± 32 ms. Electrical storm occurred in 21% of SCVF probands but not in any UCA proband (P < 0.001). The median time to recurrent ventricular arrhythmia in SCVF was 31 months. Recurrent ventricular fibrillation resulted in quinidine administration in 12/24 SCVF (50%) with excellent arrhythmia control. CONCLUSION Short-coupled ventricular fibrillation is a distinct primary arrhythmia syndrome accounting for at least 6.6% of UCA. As documentation of ventricular fibrillation onset is necessary for the diagnosis, most cases are diagnosed at the time of recurrent arrhythmia, thus the true prevalence of SCVF remains still unknown. Quinidine is effective in SCVF and should be considered as first-line treatment for patients with recurrent episodes.
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Affiliation(s)
- Christian Steinberg
- Cardiac Electrophysiology Service, Department of Cardiology and Cardiac Surgery, Institut universitaire de cardiologie et pneumologie de Québec, Laval University, 2725, Chemin Ste-Foy, Quebec, QC G1V 4G5, Canada
| | - Brianna Davies
- Heart Rhythm Services, Department of Medicine, St-Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Greg Mellor
- Cardiac Electrophysiology Service, Royal Papworth Hospital, Cambridge, UK
| | - Rafik Tadros
- Section of Cardiac Electrophysiology, Montreal Heart Institute, University of Montreal, Montreal, QC, Canada
| | - Zachary W Laksman
- Heart Rhythm Services, Department of Medicine, St-Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Jason D Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, ON, Canada
| | - Martin Green
- Cardiac Electrophysiology Service, Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada
| | - Wael Alqarawi
- Cardiac Electrophysiology Service, Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada
| | - Paul Angaran
- Cardiac Arrhythmia Service, St-Michael's Hospital, Toronto, ON, Canada
| | - Jeffrey Healey
- Arrhythmia Services Hamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | | | - Richard Leather
- Cardiac Electrophysiology Service, Royal Jubilee Hospital, Victoria, BC, Canada
| | - Colette Seifer
- St-Boniface Hospital, University of Manitoba, Winnipeg, MB, Canada
| | - Anne Fournier
- Division of Pediatric Cardiology, Department of Pediatrics, Centre Hospitalier Universitaire de Sainte-Justine, Montreal, QC, Canada
| | - Henry Duff
- Division of Cardiology, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
| | - Martin Gardner
- Cardiac Electrophysiology Service, QEII Health Sciences Center, Dalhousie University, Halifax, NS, Canada
| | - Ciorsti McIntyre
- Cardiac Electrophysiology Service, QEII Health Sciences Center, Dalhousie University, Halifax, NS, Canada
| | - Robert Hamilton
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | - Andrew D Krahn
- Heart Rhythm Services, Department of Medicine, St-Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
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17
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Conte G, Giudicessi JR, Ackerman MJ. Idiopathic ventricular fibrillation: the ongoing quest for diagnostic refinement. Europace 2021; 23:4-10. [PMID: 33038214 DOI: 10.1093/europace/euaa211] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/03/2020] [Indexed: 11/13/2022] Open
Abstract
Prior to the recognition of distinct clinical entities, such as Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, and long QT syndrome, all sudden cardiac arrest (SCA) survivors with ventricular fibrillation (VF) and apparently structurally normal hearts were labelled as idiopathic ventricular fibrillation (IVF). Over the last three decades, the definition of IVF has changed substantially, mostly as result of the identification of the spectrum of SCA-predisposing genetic heart diseases (GHDs), and the molecular evidence, by post-mortem genetic analysis (aka, the molecular autopsy), of cardiac channelopathies as the pathogenic basis for up to 35% of unexplained cases of sudden cardiac death (SCD) in the young. The evolution of the definition of IVF over time has led to a progressively greater awareness of the need for an extensive diagnostic assessment in unexplained SCA survivors. Nevertheless, GHDs are still underdiagnosed among SCA survivors, due to the underuse of pharmacological challenges (i.e. sodium channel blocker test), misrecognition of electrocardiogram (ECG) abnormalities/patterns (i.e. early repolarization pattern or exercise-induced ventricular bigeminy) or errors in the measurement of ECG parameters (e.g. the heart-rate corrected QT interval). In this review, we discuss the epidemiology, diagnostic approaches, and the controversies related to role of the genetic background in unexplained SCA survivors with a default diagnosis of IVF.
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Affiliation(s)
- Giulio Conte
- Division of Cardiology, Cardiocentro Ticino, via Tesserete 48, 6900, Lugano, Switzerland.,Faculty of Biomedical Sciences, USI, Lugano, Switzerland.,Centre for Computational Medicine in Cardiology, Faculty of Informatics, Università della Svizzera Italiana, Lugano, Switzerland
| | - John R Giudicessi
- Department of Cardiovascular Medicine (Clinician-Investigator Training Program), Mayo Clinic, Rochester, MN, USA.,Division of Heart Rhythm Services, Department of Cardiovascular Medicine, Windland Smith Rice Genetic Heart Rhythm Clinic, Mayo Clinic, Rochester, MN, USA.,Division of Pediatric Cardiology, Department of Pediatric & Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Molecular Pharmacology and Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Michael J Ackerman
- Department of Cardiovascular Medicine (Clinician-Investigator Training Program), Mayo Clinic, Rochester, MN, USA.,Division of Heart Rhythm Services, Department of Cardiovascular Medicine, Windland Smith Rice Genetic Heart Rhythm Clinic, Mayo Clinic, Rochester, MN, USA.,Division of Pediatric Cardiology, Department of Pediatric & Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Molecular Pharmacology and Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN, USA
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18
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Surget E, Cheniti G, Ramirez FD, Leenhardt A, Nogami A, Gandjbakhch E, Extramiana F, Hidden-Lucet F, Pillois X, Benoist D, Krisai P, Nakatani Y, Nakashima T, Takagi T, Kamakura T, André C, Welte N, Chauvel R, Tixier R, Duchateau J, Pambrun T, Derval N, Jaïs P, Sacher F, Bernus O, Hocini M, Haïssaguerre M. Sex differences in the origin of Purkinje ectopy-initiated idiopathic ventricular fibrillation. Heart Rhythm 2021; 18:1647-1654. [PMID: 34260987 DOI: 10.1016/j.hrthm.2021.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/02/2021] [Accepted: 07/07/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Purkinje ectopics (PurkEs) are major triggers of idiopathic ventricular fibrillation (VF). Identifying clinical factors associated with specific PurkE characteristics could yield insights into the mechanisms of Purkinje-mediated arrhythmogenicity. OBJECTIVE The purpose of this study was to examine the associations of clinical, environmental, and genetic factors with PurkE origin in patients with PurkE-initiated idiopathic VF. METHODS Consecutive patients with PurkE-initiated idiopathic VF from 4 arrhythmia referral centers were included. We evaluated demographic characteristics, medical history, clinical circumstances associated with index VF events, and electrophysiological characteristics of PurkEs. An electrophysiology study was performed in most patients to confirm the Purkinje origin. RESULTS Eighty-three patients were included (mean age 38 ± 14 years; 44 [53%] women), of whom 32 had a history of syncope. Forty-four patients had VF at rest. PurkEs originated from the right ventricle (RV) in 41 patients (49%), from the left ventricle (LV) in 36 (44%), and from both ventricles in 6 (7%). Seasonal and circadian distributions of VF episodes were similar according to PurkE origin. The clinical characteristics of patients with RV vs LV PurkE origins were similar, except for sex. RV PurkEs were more frequent in men than in women (76% vs 24%), whereas LV and biventricular PurkEs were more frequent in women (81% vs 19% and 83% vs 17%, respectively) (P < .0001). CONCLUSION PurkEs triggering idiopathic VF originate dominantly from the RV in men and from the LV or both ventricles in women, adding to other sex-related arrhythmias such as Brugada syndrome or long QT syndrome. Sex-based factors influencing Purkinje arrhythmogenicity warrant investigation.
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Affiliation(s)
- Elodie Surget
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.
| | - Ghassen Cheniti
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - F Daniel Ramirez
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Antoine Leenhardt
- Université de Paris, CNMR, Maladies Cardiaques Héréditaires Rares, Hôpital Bichat, INSERMU1166, Paris, France
| | - Akihiko Nogami
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Estelle Gandjbakhch
- Département de Cardiologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Fabrice Extramiana
- Université de Paris, CNMR, Maladies Cardiaques Héréditaires Rares, Hôpital Bichat, INSERMU1166, Paris, France
| | - Françoise Hidden-Lucet
- Département de Cardiologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Xavier Pillois
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - David Benoist
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Philipp Krisai
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Yosuke Nakatani
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Takashi Nakashima
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Takamitsu Takagi
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Tsukasa Kamakura
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Clémentine André
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Nicolas Welte
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Rémi Chauvel
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Romain Tixier
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Josselin Duchateau
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Thomas Pambrun
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Nicolas Derval
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Pierre Jaïs
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Frédéric Sacher
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Olivier Bernus
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Mélèze Hocini
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Michel Haïssaguerre
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
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19
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Viskin S, Marai I, Rosso R. Long QT Syndrome and Torsade de Pointes Ultimately Treated With Quinidine: Introducing the Concept of Pseudo-Torsade de Pointes. Circulation 2021; 144:85-89. [PMID: 34228481 DOI: 10.1161/circulationaha.121.054991] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sami Viskin
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Israel (S.V., R.R.)
| | - Ibrahim Marai
- Baruch Padeh Medical Center, Poriya and Faculty of Medicine in the Galilee, Bar Ilan University, Israel (I.M.)
| | - Raphael Rosso
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Israel (S.V., R.R.)
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20
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Noheria A, Anderson J. Advances in Mapping and Ablation of Ventricular Fibrillation. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-021-00899-1] [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: 11/24/2022]
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21
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Rosso R, Hochstadt A, Viskin D, Chorin E, Schwartz AL, Tovia-Brodie O, Laish-Farkash A, Havakuk O, Gepstein L, Banai S, Viskin S. Polymorphic ventricular tachycardia, ischaemic ventricular fibrillation, and torsade de pointes: importance of the QT and the coupling interval in the differential diagnosis. Eur Heart J 2021; 42:3965-3975. [PMID: 33693589 DOI: 10.1093/eurheartj/ehab138] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/13/2021] [Accepted: 02/18/2021] [Indexed: 12/20/2022] Open
Abstract
AIMS Distinctive types of polymorphic ventricular tachycardia (VT) respond differently to different forms of therapy. We therefore performed the present study to define the electrocardiographic characteristics of different forms of polymorphic VT. METHODS AND RESULTS We studied 190 patients for whom the onset of 305 polymorphic VT events was available. The study group included 87 patients with coronary artery disease who had spontaneous polymorphic VT triggered by short-coupled extrasystoles in the absence of myocardial ischaemia. This group included 32 patients who had a long QT interval but nevertheless had their polymorphic VT triggered by ectopic beats with short coupling interval, a subcategory termed 'pseudo-torsade de pointes] (TdP). For comparison, we included 50 patients who had ventricular fibrillation (VF) during acute myocardial infarction ('ischaemic VF' group) and 53 patients with drug-induced TdP ('true TdP' group). The QT of patients with pseudo-TdP was (by definition) longer than that of patients with polymorphic VT and normal QT (QTc 491.4 ± 25.2 ms vs. 447.3 ± 55.6 ms, P < 0.001). However, their QT was significantly shorter than that of patients with true TdP (QTc 564.6 ± 75.6 ms, P < 0.001). Importantly, the coupling interval of the ectopic beat triggering the arrhythmia was just as short during pseudo-TdP as during polymorphic VT with normal QT (359.1 ± 38.1 ms vs. 356.6 ± 39.4 ms, P = 0.467) but was much shorter than during true TdP (581.2 ± 95.3 ms, P < 0.001). CONCLUSIONS The coupling interval helps discriminate between polymorphic VT that occurs despite a long QT interval (pseudo-TdP) and polymorphic arrhythmias striking because of a long QT (true TdP).
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Affiliation(s)
- Raphael Rosso
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Weizmann St 6, Tel Aviv-Yafo 6423906, Israel
| | - Aviram Hochstadt
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Weizmann St 6, Tel Aviv-Yafo 6423906, Israel
| | - Dana Viskin
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Weizmann St 6, Tel Aviv-Yafo 6423906, Israel
| | - Ehud Chorin
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Weizmann St 6, Tel Aviv-Yafo 6423906, Israel
| | - Arie Lorin Schwartz
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Weizmann St 6, Tel Aviv-Yafo 6423906, Israel
| | - Oholi Tovia-Brodie
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Weizmann St 6, Tel Aviv-Yafo 6423906, Israel
| | - Avishag Laish-Farkash
- Department of Cardiology, Assuta Ashdod University Hospital, Ha-Refu'a St 7, Ashdod 7747629, Israel
| | - Ofer Havakuk
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Weizmann St 6, Tel Aviv-Yafo 6423906, Israel
| | - Lior Gepstein
- Department of Cardiology, Rambam Health Care Campus and Rappaport Faculty of Medicine, Technion-Israel institute of Technology, HaAliya HaShniya St 8, Haifa 3109601, Israel
| | - Shmuel Banai
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Weizmann St 6, Tel Aviv-Yafo 6423906, Israel
| | - Sami Viskin
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Weizmann St 6, Tel Aviv-Yafo 6423906, Israel
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22
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Stawiarski K, Clarke JRD, Pollack A, Winslow R, Majumdar S. Ventricular fibrillation in Graves disease reveals a rare SCN5A mutation with W1191X variant associated with Brugada syndrome. HeartRhythm Case Rep 2021; 7:95-99. [PMID: 33665110 PMCID: PMC7897746 DOI: 10.1016/j.hrcr.2020.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Kristin Stawiarski
- Yale New Haven Health Heart and Vascular Center, Bridgeport Hospital, Bridgeport, Connecticut
| | - John-Ross D Clarke
- Yale New Haven Health Heart and Vascular Center, Bridgeport Hospital, Bridgeport, Connecticut
| | - Ari Pollack
- Yale New Haven Health Heart and Vascular Center, Bridgeport Hospital, Bridgeport, Connecticut
| | - Robert Winslow
- Yale New Haven Health Heart and Vascular Center, Bridgeport Hospital, Bridgeport, Connecticut
| | - Sachin Majumdar
- Yale New Haven Health Heart and Vascular Center, Bridgeport Hospital, Bridgeport, Connecticut
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23
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Krummen DE, Ho G, Hoffmayer KS, Schweis FN, Baykaner T, Rogers AJ, Han FT, Hsu JC, Viswanathan MN, Wang PJ, Rappel WJ, Narayan SM. Electrical Substrate Ablation for Refractory Ventricular Fibrillation: Results of the AVATAR Study. Circ Arrhythm Electrophysiol 2021; 14:e008868. [PMID: 33550811 DOI: 10.1161/circep.120.008868] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- David E Krummen
- University of California, San Diego (D.E.K., G.H., K.S.H., F.N.S., F.T.H., J.C.H., W.-J.R.).,Veterans Affairs San Diego Healthcare System, CA (D.E.K., G.H., K.S.H., F.T.H.)
| | - Gordon Ho
- University of California, San Diego (D.E.K., G.H., K.S.H., F.N.S., F.T.H., J.C.H., W.-J.R.).,Veterans Affairs San Diego Healthcare System, CA (D.E.K., G.H., K.S.H., F.T.H.)
| | - Kurt S Hoffmayer
- University of California, San Diego (D.E.K., G.H., K.S.H., F.N.S., F.T.H., J.C.H., W.-J.R.).,Veterans Affairs San Diego Healthcare System, CA (D.E.K., G.H., K.S.H., F.T.H.)
| | - Franz N Schweis
- University of California, San Diego (D.E.K., G.H., K.S.H., F.N.S., F.T.H., J.C.H., W.-J.R.)
| | - Tina Baykaner
- Stanford University, Palo Alto, CA (T.B., A.J.R., M.N.V., P.J.W., S.M.N.)
| | - A J Rogers
- Stanford University, Palo Alto, CA (T.B., A.J.R., M.N.V., P.J.W., S.M.N.)
| | - Frederick T Han
- University of California, San Diego (D.E.K., G.H., K.S.H., F.N.S., F.T.H., J.C.H., W.-J.R.).,Veterans Affairs San Diego Healthcare System, CA (D.E.K., G.H., K.S.H., F.T.H.)
| | - Jonathan C Hsu
- University of California, San Diego (D.E.K., G.H., K.S.H., F.N.S., F.T.H., J.C.H., W.-J.R.)
| | | | - Paul J Wang
- Stanford University, Palo Alto, CA (T.B., A.J.R., M.N.V., P.J.W., S.M.N.)
| | - Wouter-Jan Rappel
- University of California, San Diego (D.E.K., G.H., K.S.H., F.N.S., F.T.H., J.C.H., W.-J.R.)
| | - Sanjiv M Narayan
- Stanford University, Palo Alto, CA (T.B., A.J.R., M.N.V., P.J.W., S.M.N.)
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24
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Pinnelas R, Friedman J, Gidea C, Yuriditsky E, Chinitz L, Cerrone M, Jankelson L. The case for quinidine: Management of electrical storm in refractory ventricular fibrillation. HeartRhythm Case Rep 2020; 6:375-377. [PMID: 32695580 PMCID: PMC7360984 DOI: 10.1016/j.hrcr.2020.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Rebecca Pinnelas
- Leon H. Charney Division of Cardiology, NYU School of Medicine, New York, New York
| | - Julie Friedman
- Leon H. Charney Division of Cardiology, NYU School of Medicine, New York, New York
| | - Claudia Gidea
- Leon H. Charney Division of Cardiology, NYU School of Medicine, New York, New York
| | - Eugene Yuriditsky
- Leon H. Charney Division of Cardiology, NYU School of Medicine, New York, New York
| | - Larry Chinitz
- Heart Rhythm Center, Leon H. Charney Division of Cardiology, NYU School of Medicine, New York, New York
| | - Marina Cerrone
- Heart Rhythm Center, Leon H. Charney Division of Cardiology, NYU School of Medicine, New York, New York
| | - Lior Jankelson
- Heart Rhythm Center, Leon H. Charney Division of Cardiology, NYU School of Medicine, New York, New York
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25
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Sonoda K, Ohno S, Shimizu Y, Kaitani K, Makiyama T, Nakagawa Y, Horie M. SCN5A
mutation identified in a patient with short‐coupled variant of torsades de pointes. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:456-461. [DOI: 10.1111/pace.13924] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/27/2020] [Accepted: 04/19/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Keiko Sonoda
- Department of Bioscience and GeneticsNational Cerebral and Cardiovascular Center Suita Japan
- Department of Cardiovascular MedicineShiga University of Medical Science Shiga Japan
- Department of Cardiovascular Biology and MedicineNiigata University Graduate School of Medical and Dental Sciences Niigata Japan
| | - Seiko Ohno
- Department of Bioscience and GeneticsNational Cerebral and Cardiovascular Center Suita Japan
- Department of Cardiovascular MedicineShiga University of Medical Science Shiga Japan
- Center for Epidemiologic Research in AsiaShiga University of Medical Science Shiga Japan
| | - Yukiko Shimizu
- Department of Cardiovascular MedicineHyogo Prefectural Amagasaki General Medical Center Amagasaki Japan
| | - Kazuaki Kaitani
- Department of Cardiovascular MedicineJapanese Red Cross Otsu Hospital Otsu Japan
| | - Takeru Makiyama
- Department of Cardiovascular MedicineKyoto University Graduate School of Medicine Kyoto Japan
| | - Yoshihisa Nakagawa
- Department of Cardiovascular MedicineShiga University of Medical Science Shiga Japan
| | - Minoru Horie
- Department of Cardiovascular MedicineShiga University of Medical Science Shiga Japan
- Center for Epidemiologic Research in AsiaShiga University of Medical Science Shiga Japan
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26
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Haïssaguerre M, Nademanee W, Hocini M, Duchateau J, André C, Lavergne T, Takigawa M, Sacher F, Derval N, Pambrun T, Jais P, Walton R, Potse M, Vigmond E, Dubois R, Bernus O. The Spectrum of Idiopathic Ventricular Fibrillation and J-Wave Syndromes: Novel Mapping Insights. Card Electrophysiol Clin 2019; 11:699-709. [PMID: 31706476 DOI: 10.1016/j.ccep.2019.08.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Idiopathic ventricular fibrillation and J-wave syndromes are causes of sudden cardiac death (SCD) without any identified structural cardiac disease after extensive investigations. Recent data show that high-density electrophysiological mapping may ultimately offer diagnoses of subclinical diseases in most patients including those termed "unexplained" SCD. Three major conditions can underlie the occurrence of SCD: (1) localized depolarization abnormalities (due to microstructural myocardial alteration), (2) Purkinje abnormalities manifesting as triggering ectopy and inducible reentry; or (3) repolarization heterogeneities. Each condition may result from a spectrum of pathophysiologic processes with implications for individual therapy.
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Affiliation(s)
- Michel Haïssaguerre
- Electrophysiology and Cardiac Stimulation, Bordeaux University Hospital, 311 President Wilson Boulevard, Bordeaux 33200, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France; Univ Bordeaux, CRCTB, U1045, Bordeaux, France.
| | | | - Mélèze Hocini
- Electrophysiology and Cardiac Stimulation, Bordeaux University Hospital, 311 President Wilson Boulevard, Bordeaux 33200, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France; Univ Bordeaux, CRCTB, U1045, Bordeaux, France
| | - Josselin Duchateau
- Electrophysiology and Cardiac Stimulation, Bordeaux University Hospital, 311 President Wilson Boulevard, Bordeaux 33200, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Clementine André
- Electrophysiology and Cardiac Stimulation, Bordeaux University Hospital, 311 President Wilson Boulevard, Bordeaux 33200, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Thomas Lavergne
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Masa Takigawa
- Electrophysiology and Cardiac Stimulation, Bordeaux University Hospital, 311 President Wilson Boulevard, Bordeaux 33200, France
| | - Frederic Sacher
- Electrophysiology and Cardiac Stimulation, Bordeaux University Hospital, 311 President Wilson Boulevard, Bordeaux 33200, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Nicolas Derval
- Electrophysiology and Cardiac Stimulation, Bordeaux University Hospital, 311 President Wilson Boulevard, Bordeaux 33200, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Thomas Pambrun
- Electrophysiology and Cardiac Stimulation, Bordeaux University Hospital, 311 President Wilson Boulevard, Bordeaux 33200, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Pierre Jais
- Electrophysiology and Cardiac Stimulation, Bordeaux University Hospital, 311 President Wilson Boulevard, Bordeaux 33200, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Rick Walton
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Mark Potse
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Ed Vigmond
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Remi Dubois
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Olivier Bernus
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France; Univ Bordeaux, CRCTB, U1045, Bordeaux, France
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27
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Viskin S, Hochstadt A, Chorin E, Viskin D, Havakuk O, Khoury S, Lee JK, Belhassen B, Rosso R. Quinidine-responsive out-of-hospital polymorphic ventricular tachycardia in patients with coronary heart disease. Europace 2019; 22:265-273. [DOI: 10.1093/europace/euz290] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 10/01/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
We recently reported that patients with coronary artery disease (CAD) who develop polymorphic ventricular tachycardia (VT) during the healing phase of an acute coronary event, generally fail to respond to revascularization or standard antiarrhythmic therapy but respond immediately to quinidine therapy. Here, we describe that CAD patients presenting with out-of-hospital polymorphic VT without a recent coronary event or an obvious precipitating factor, also respond uniquely to quinidine therapy.
Methods and results
Retrospective study of patients with unheralded, mainly out-of-hospital, polymorphic VT related to CAD but without evidence of acute myocardial ischaemia. We identified 20 patients who developed polymorphic VT without precipitating factors. The polymorphic VT events were triggered by extrasystoles with short (376 ± 49 ms) coupling interval. Arrhythmic storms occurred in 70% patients. These arrhythmic storms were generally refractory to conventional antiarrhythmic therapy but invariably responded to quinidine therapy. Revascularization was antiarrhythmic in 3 patients despite the absent clinical or ECG signs of ischaemia. During long-term follow-up (range 2 months to 11 years), 3 (15%) of patients not receiving quinidine developed recurrent polymorphic VT. There were no recurrent arrhythmias during long-term quinidine therapy.
Conclusions
Patients with CAD may develop polymorphic VT in the absence of obvious acute ischaemia or apparent precipitating factors, presenting as out-of-hospital polymorphic VT with high risk of arrhythmic storms that respond uniquely to quinidine therapy.
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Affiliation(s)
- Sami Viskin
- Department of Cardiology, Tel Aviv Sourasky Medical Center, and Sackler School of Medicine, Tel Aviv University, Weizman 6, Tel Aviv 64239, Israel
| | - Aviram Hochstadt
- Department of Cardiology, Tel Aviv Sourasky Medical Center, and Sackler School of Medicine, Tel Aviv University, Weizman 6, Tel Aviv 64239, Israel
| | - Ehud Chorin
- Department of Cardiology, Tel Aviv Sourasky Medical Center, and Sackler School of Medicine, Tel Aviv University, Weizman 6, Tel Aviv 64239, Israel
| | - Dana Viskin
- Department of Cardiology, Tel Aviv Sourasky Medical Center, and Sackler School of Medicine, Tel Aviv University, Weizman 6, Tel Aviv 64239, Israel
| | - Ofer Havakuk
- Department of Cardiology, Tel Aviv Sourasky Medical Center, and Sackler School of Medicine, Tel Aviv University, Weizman 6, Tel Aviv 64239, Israel
| | - Shafik Khoury
- Department of Cardiology, Tel Aviv Sourasky Medical Center, and Sackler School of Medicine, Tel Aviv University, Weizman 6, Tel Aviv 64239, Israel
| | - John K Lee
- St Luke’s Hospital Mid America Heart Institute, Kansas City, MI, USA
| | - Bernard Belhassen
- Department of Cardiology, Tel Aviv Sourasky Medical Center, and Sackler School of Medicine, Tel Aviv University, Weizman 6, Tel Aviv 64239, Israel
| | - Raphael Rosso
- Department of Cardiology, Tel Aviv Sourasky Medical Center, and Sackler School of Medicine, Tel Aviv University, Weizman 6, Tel Aviv 64239, Israel
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28
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Haissaguerre M, Cheniti G, Escande W, Zhao A, Hocini M, Bernus O. Idiopathic ventricular fibrillation with repetitive activity inducible within the distal Purkinje system. Heart Rhythm 2019; 16:1268-1272. [PMID: 30980946 PMCID: PMC6659587 DOI: 10.1016/j.hrthm.2019.04.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Michel Haissaguerre
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM U1045, Bordeaux, France; Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux, France.
| | - Ghassen Cheniti
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux, France
| | - William Escande
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux, France
| | - Alexandre Zhao
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Mélèze Hocini
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM U1045, Bordeaux, France; Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux, France
| | - Olivier Bernus
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France; Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM U1045, Bordeaux, France
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29
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30
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Gray B, Behr ER. New Insights Into the Genetic Basis of Inherited Arrhythmia Syndromes. ACTA ACUST UNITED AC 2018; 9:569-577. [PMID: 27998945 DOI: 10.1161/circgenetics.116.001571] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Belinda Gray
- From the Department of Cardiology, Royal Prince Alfred Hospital, New South Wales, Australia (B.G.); Sydney Medical School, University of Sydney, Australia (B.G.), Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, New South Wales, Australia (B.G.); Cardiology Clinical Academic Group, St George's University of London, United Kingdom (E.R.B.); and St George's University Hospitals NHS Foundation Trust, London, United Kingdom (E.R.B.)
| | - Elijah R Behr
- From the Department of Cardiology, Royal Prince Alfred Hospital, New South Wales, Australia (B.G.); Sydney Medical School, University of Sydney, Australia (B.G.), Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, New South Wales, Australia (B.G.); Cardiology Clinical Academic Group, St George's University of London, United Kingdom (E.R.B.); and St George's University Hospitals NHS Foundation Trust, London, United Kingdom (E.R.B.).
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31
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Ip JE, Lerman BB. Idiopathic malignant premature ventricular contractions. Trends Cardiovasc Med 2018; 28:295-302. [DOI: 10.1016/j.tcm.2017.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 11/01/2017] [Accepted: 11/20/2017] [Indexed: 10/18/2022]
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32
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33
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Antzelevitch C, Viskin S. Should theophylline be added to the J wave syndrome therapeutic armamentarium? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 41:439-440. [PMID: 29148067 DOI: 10.1111/pace.13237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 10/18/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Charles Antzelevitch
- Lankenau Institute for Medical Research, Wynnewood, PA, USA.,Lankenau Heart Institute, Main Line Health System, Wynnewood, PA, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sami Viskin
- Tel Aviv Medical Center and Sackler School of Medicine, Tel Aviv University, Israel
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34
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Viskin S, Havakuk O, Antzelevitch C, Rosso R. Theophylline: The forgotten antiarrhythmic drug… now for malignant early repolarization. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 41:441-443. [PMID: 29148055 DOI: 10.1111/pace.13239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 10/22/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Sami Viskin
- Tel Aviv Medical Center and Sackler School of Medicine, Tel Aviv University, Israel
| | - Ofer Havakuk
- Tel Aviv Medical Center and Sackler School of Medicine, Tel Aviv University, Israel
| | | | - Raphael Rosso
- Tel Aviv Medical Center and Sackler School of Medicine, Tel Aviv University, Israel
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35
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Wolpert C, Vogel M, Nagel C, Herrera-Siklody C, Rüb N. [Ventricular arrhythmias in ion channel diseases]. Herzschrittmacherther Elektrophysiol 2017; 28:169-176. [PMID: 28534204 DOI: 10.1007/s00399-017-0510-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 04/13/2017] [Indexed: 06/07/2023]
Abstract
In patients with ion channel disease the predominant arrhythmias are polymorphic ventricular tachycardias (VT), torsade de pointes tachycardia and ventricular fibrillation (VF). In only extremely rare cases is very rapid monomorphic ventricular tachycardia observed. This is why implantable cardioverter-defibrillators (ICDs) should always be programmed for treatment of VF only with high detection rates to avoid inappropriate discharges. In idiopathic VF and catecholaminergic polymorphic ventricular tachycardia (CPVT), no baseline electrocardiographic abnormalities can be detected, whereas in Brugada syndrome, long QT syndrome, early repolarisation syndrome and Anderson-Tawil syndrome alterations of the baseline ECG are very important to identify patients at risk.
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Affiliation(s)
- Christian Wolpert
- Medizinische Klinik für Kardiologie, Nephrologie und Internistische Intensivmedizin, Klinikum Ludwigsburg, Posilipostrasse 4, 71640, Ludwigsburg, Deutschland.
| | - Mara Vogel
- Medizinische Klinik für Kardiologie, Nephrologie und Internistische Intensivmedizin, Klinikum Ludwigsburg, Posilipostrasse 4, 71640, Ludwigsburg, Deutschland
| | - Christian Nagel
- Medizinische Klinik für Kardiologie, Nephrologie und Internistische Intensivmedizin, Klinikum Ludwigsburg, Posilipostrasse 4, 71640, Ludwigsburg, Deutschland
| | - Claudia Herrera-Siklody
- Medizinische Klinik für Kardiologie, Nephrologie und Internistische Intensivmedizin, Klinikum Ludwigsburg, Posilipostrasse 4, 71640, Ludwigsburg, Deutschland
| | - Norman Rüb
- Medizinische Klinik für Kardiologie, Nephrologie und Internistische Intensivmedizin, Klinikum Ludwigsburg, Posilipostrasse 4, 71640, Ludwigsburg, Deutschland
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Viskin S. Idiopathic Polymorphic Ventricular Tachycardia: a "Benign Disease" with a Touch of Bad Luck? Korean Circ J 2017; 47:299-306. [PMID: 28567077 PMCID: PMC5449521 DOI: 10.4070/kcj.2016.0303] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 10/24/2016] [Accepted: 11/11/2016] [Indexed: 11/22/2022] Open
Abstract
Ventricular extrasystole originating from the right ventricular outflow tract or the left ventricular outflow tract are the most commonly encountered ventricular arrhythmias recorded in ostensibly healthy individuals with no evidence of heart disease. These ventricular arrhythmias have a distinctive electrocardiographic morphology. The morphology is so distinctive that it is common practice to accept the diagnosis of “idiopathic benign ventricular arrhythmias from the outflow tract” based on this unique morphology when the electrocardiogram during sinus rhythm and the echocardiogram are normal, sometimes removing the need to perform invasive tests in patients. Even if the outflow ventricular extrasystole ultimately triggers sustained ventricular arrhythmia, the resulting ventricular tachycardia (VT) will be a monomorphic VT originating from the outflow tract, which is known to be hemodynamically well tolerated. Thus, idiopathic ventricular arrhythmias originating from outflow tracts are universally considered benign. In 2005, we described a rare form of malignant polymorphic VT resulting in syncope or cardiac arrest. Here, we review the literature on this topic since the emergence of initial descriptions of this intriguing phenomenon.
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Affiliation(s)
- Sami Viskin
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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37
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Differences in the onset mode of ventricular tachyarrhythmia between patients with J wave in anterior leads and those with J wave in inferolateral leads. Heart Rhythm 2017; 14:553-561. [DOI: 10.1016/j.hrthm.2016.11.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Indexed: 11/20/2022]
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38
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Abdin A, Eitel C, Thiele H, Tilz RR. Nightmares in cardiology: Sudden cardiac death in a patient with apparently healthy heart and "benign" outflow tract extrasystoles. Int J Cardiol 2016; 222:101-103. [PMID: 27487424 DOI: 10.1016/j.ijcard.2016.06.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 06/27/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Amr Abdin
- University Heart Centre Luebeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Luebeck, Germany.
| | - Charlotte Eitel
- University Heart Centre Luebeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Luebeck, Germany
| | - Holger Thiele
- University Heart Centre Luebeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Luebeck, Germany
| | - Roland Richard Tilz
- University Heart Centre Luebeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Luebeck, Germany
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39
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Fujii Y, Itoh H, Ohno S, Murayama T, Kurebayashi N, Aoki H, Blancard M, Nakagawa Y, Yamamoto S, Matsui Y, Ichikawa M, Sonoda K, Ozawa T, Ohkubo K, Watanabe I, Guicheney P, Horie M. A type 2 ryanodine receptor variant associated with reduced Ca 2+ release and short-coupled torsades de pointes ventricular arrhythmia. Heart Rhythm 2016; 14:98-107. [PMID: 27756708 DOI: 10.1016/j.hrthm.2016.10.015] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ventricular fibrillation may be caused by premature ventricular contractions (PVCs) whose coupling intervals are <300 ms, a characteristic of the short-coupled variant of torsades de pointes (scTdP). OBJECTIVE The purpose of this study was to analyze the underlying cardiac ryanodine receptor (RyR2) variants in patients with scTdP. METHODS Seven patients with scTdP (mean age 34 ± 12 years; 4 men and 3 women) were enrolled in this study. The RyR2 gene was screened by targeted gene sequencing methods; variant minor allele frequency was confirmed in 3 databases; and the pathogenicity was investigated in silico analysis using multiple tools. The activity of wild-type and mutant RyR2 channels was evaluated by monitoring Ca2+ signals of HEK293 cells with a [3H]ryanodine binding assay. RESULTS The mean coupling interval of PVCs was 282 ± 13 ms. The 12-lead electrocardiogram had no specific findings except PVCs with an extremely short-coupling interval. Genetic analysis revealed 3 novel RyR2 variants and 1 polymorphism, all located in the cytoplasmic region. p.Ser4938Phe was not detected in 3 databases, and in silico analysis indicated its pathogenicity. In functional analysis, p.Ser4938Phe demonstrated loss of function and impaired RyR2 channel Ca2+ release, while 2 other variants, p.Val1024Ile and p.Ala2673Val, had mild gain-of-function effects but were similar to the polymorphism p.Asn1551Ser. CONCLUSION We identified an RyR2 variant associated with reduced Ca2+ release and short-coupled torsades de pointes ventricular arrhythmia. The mechanisms of arrhythmogenesis remain unclear.
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Affiliation(s)
- Yusuke Fujii
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Hideki Itoh
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Seiko Ohno
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Takashi Murayama
- Department of Cellular and Molecular Pharmacology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Nagomi Kurebayashi
- Department of Cellular and Molecular Pharmacology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hisaaki Aoki
- Department of Pediatric Cardiology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Malorie Blancard
- INSERM, UMR U1166, ICAN, Paris, France; Sorbonne Universites, UPMC Univ Paris 06, UMR S1166, Paris, France
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Tenriyorozu Hospital, Nara, Japan
| | - Satoshi Yamamoto
- Department of Cardiovascular Medicine, Saiseikai Izumio Hospital, Osaka, Japan
| | - Yumie Matsui
- Department of Cardiovascular Medicine, Saiseikai Izumio Hospital, Osaka, Japan
| | - Mari Ichikawa
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Keiko Sonoda
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Tomoya Ozawa
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Kimie Ohkubo
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Ichiro Watanabe
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Pascale Guicheney
- INSERM, UMR U1166, ICAN, Paris, France; Sorbonne Universites, UPMC Univ Paris 06, UMR S1166, Paris, France
| | - Minoru Horie
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan.
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40
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Syed FF, Ackerman MJ, McLeod CJ, Kapa S, Mulpuru SK, Sriram CS, Cannon BC, Asirvatham SJ, Noseworthy PA. Sites of Successful Ventricular Fibrillation Ablation in Bileaflet Mitral Valve Prolapse Syndrome. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.116.004005. [PMID: 27103091 DOI: 10.1161/circep.116.004005] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 03/22/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Although the vast majority of mitral valve prolapse (MVP) is benign, a small subset of patients, predominantly women, with bileaflet prolapse, complex ventricular ectopy (VE), and abnormal T waves comprise the recently described bileaflet MVP syndrome. We compared findings on electrophysiological study in bileaflet MVP syndrome patients with and without cardiac arrest to identify factors that may predispose to malignant ventricular arrhythmia. METHODS AND RESULTS Fourteen consecutive bileaflet MVP syndrome patients (n=13 women; median [limits], age at index ablation, 33.8 [21.0-58.7] years; ejection fraction, 60% [45%-67%]; all ≤ moderate mitral regurgitation; n=6 with previous cardiac arrest and implantable cardioverter defibrillator shocks for ventricular fibrillation; and n=8 without implantable cardioverter defibrillator although with symptomatic complex VE) were included. The 2 groups had similar baseline echocardiographic and electrocardiographic characteristics. All patients had at least 1 left ventricular papillary or fascicular VE focus. Purkinje origin VE was identified as the ventricular fibrillation trigger in 6 of 6 cardiac arrest patients (4 from papillary muscle) and Purkinje origin of dominant VE was seen in 5 of 8 (3 from papillary muscle) nonarrest patients. Acute success was seen in 17 of 19 procedures, and a ventricular fibrillation storm occurred within 24 hours of ablation in a single patient. Repeat ablation for recurrent symptomatic arrhythmia was performed in 6 patients. At 478 (39-2099) days of follow-up, 2 cardiac arrest patients received appropriate shocks. Symptoms from VE were reduced in 12 of 14. CONCLUSIONS Bileaflet MVP syndrome is characterized by fascicular and papillary muscle VE that triggers ventricular fibrillation. Ablation of clinically dominant VE foci improves symptoms and reduces appropriate implantable cardioverter defibrillator shocks.
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Affiliation(s)
- Faisal F Syed
- From the Division of Cardiovascular Diseases/Department of Medicine (F.F.S., M.J.A., C.J.M., S.K., S.K.M., C.S.S., B.C.C., S.J.A., P.A.N.), Windland Smith Rice Sudden Death Genomics Laboratory/Department of Molecular Pharmacology & Experimental Therapeutics (M.J.A.), and Division of Pediatric Cardiology/Department of Pediatrics (B.C.C., S.J.A.), Mayo Clinic, Rochester, MN
| | - Michael J Ackerman
- From the Division of Cardiovascular Diseases/Department of Medicine (F.F.S., M.J.A., C.J.M., S.K., S.K.M., C.S.S., B.C.C., S.J.A., P.A.N.), Windland Smith Rice Sudden Death Genomics Laboratory/Department of Molecular Pharmacology & Experimental Therapeutics (M.J.A.), and Division of Pediatric Cardiology/Department of Pediatrics (B.C.C., S.J.A.), Mayo Clinic, Rochester, MN.
| | - Christopher J McLeod
- From the Division of Cardiovascular Diseases/Department of Medicine (F.F.S., M.J.A., C.J.M., S.K., S.K.M., C.S.S., B.C.C., S.J.A., P.A.N.), Windland Smith Rice Sudden Death Genomics Laboratory/Department of Molecular Pharmacology & Experimental Therapeutics (M.J.A.), and Division of Pediatric Cardiology/Department of Pediatrics (B.C.C., S.J.A.), Mayo Clinic, Rochester, MN
| | - Suraj Kapa
- From the Division of Cardiovascular Diseases/Department of Medicine (F.F.S., M.J.A., C.J.M., S.K., S.K.M., C.S.S., B.C.C., S.J.A., P.A.N.), Windland Smith Rice Sudden Death Genomics Laboratory/Department of Molecular Pharmacology & Experimental Therapeutics (M.J.A.), and Division of Pediatric Cardiology/Department of Pediatrics (B.C.C., S.J.A.), Mayo Clinic, Rochester, MN
| | - Siva K Mulpuru
- From the Division of Cardiovascular Diseases/Department of Medicine (F.F.S., M.J.A., C.J.M., S.K., S.K.M., C.S.S., B.C.C., S.J.A., P.A.N.), Windland Smith Rice Sudden Death Genomics Laboratory/Department of Molecular Pharmacology & Experimental Therapeutics (M.J.A.), and Division of Pediatric Cardiology/Department of Pediatrics (B.C.C., S.J.A.), Mayo Clinic, Rochester, MN
| | - Chenni S Sriram
- From the Division of Cardiovascular Diseases/Department of Medicine (F.F.S., M.J.A., C.J.M., S.K., S.K.M., C.S.S., B.C.C., S.J.A., P.A.N.), Windland Smith Rice Sudden Death Genomics Laboratory/Department of Molecular Pharmacology & Experimental Therapeutics (M.J.A.), and Division of Pediatric Cardiology/Department of Pediatrics (B.C.C., S.J.A.), Mayo Clinic, Rochester, MN
| | - Bryan C Cannon
- From the Division of Cardiovascular Diseases/Department of Medicine (F.F.S., M.J.A., C.J.M., S.K., S.K.M., C.S.S., B.C.C., S.J.A., P.A.N.), Windland Smith Rice Sudden Death Genomics Laboratory/Department of Molecular Pharmacology & Experimental Therapeutics (M.J.A.), and Division of Pediatric Cardiology/Department of Pediatrics (B.C.C., S.J.A.), Mayo Clinic, Rochester, MN
| | - Samuel J Asirvatham
- From the Division of Cardiovascular Diseases/Department of Medicine (F.F.S., M.J.A., C.J.M., S.K., S.K.M., C.S.S., B.C.C., S.J.A., P.A.N.), Windland Smith Rice Sudden Death Genomics Laboratory/Department of Molecular Pharmacology & Experimental Therapeutics (M.J.A.), and Division of Pediatric Cardiology/Department of Pediatrics (B.C.C., S.J.A.), Mayo Clinic, Rochester, MN
| | - Peter A Noseworthy
- From the Division of Cardiovascular Diseases/Department of Medicine (F.F.S., M.J.A., C.J.M., S.K., S.K.M., C.S.S., B.C.C., S.J.A., P.A.N.), Windland Smith Rice Sudden Death Genomics Laboratory/Department of Molecular Pharmacology & Experimental Therapeutics (M.J.A.), and Division of Pediatric Cardiology/Department of Pediatrics (B.C.C., S.J.A.), Mayo Clinic, Rochester, MN
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Herman ARM, Cheung C, Gerull B, Simpson CS, Birnie DH, Klein GJ, Champagne J, Healey JS, Gibbs K, Talajic M, Gardner M, Bennett MT, Steinberg C, Janzen M, Gollob MH, Angaran P, Yee R, Leather R, Chakrabarti S, Sanatani S, Chauhan VS, Krahn AD. Outcome of Apparently Unexplained Cardiac Arrest: Results From Investigation and Follow-Up of the Prospective Cardiac Arrest Survivors With Preserved Ejection Fraction Registry. Circ Arrhythm Electrophysiol 2016; 9:e003619. [PMID: 26783233 DOI: 10.1161/circep.115.003619] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Cardiac Arrest Survivors with Preserved Ejection Fraction Registry (CASPER) enrolls patients with apparently unexplained cardiac arrest and no evident cardiac disease to identify the pathogenesis of cardiac arrest through systematic clinical testing. Exercise testing, drug provocation, advanced cardiac imaging, and genetic testing may be useful when a cause is not apparent. METHODS AND RESULTS The first 200 survivors of unexplained cardiac arrest from 14 centers across Canada were evaluated to determine the results of investigation and follow-up (age, 48.6±14.7 years, 41% female). Patients were free of evidence of coronary artery disease, left ventricular dysfunction, or evident repolarization syndromes. Advanced testing determined a diagnosis in 34% of patients at baseline, with a diagnosis emerging during follow-up in 7% of patients. Of those who were diagnosed, 28 (35%) had an underlying structural condition and 53 (65%) had a primary electric disease. During a mean follow-up of 3.15±2.34 years, 23% of patients had either a shock or an appropriate antitachycardia pacing from their implantable cardioverter defibrillator, or both. The implantable cardioverter defibrillator appropriate intervention rate was 8.4% at 1 year and 18.1% at 3 years, with no clear difference between diagnosed and undiagnosed subjects, or between those diagnosed with a primary electric versus structural pathogenesis. CONCLUSIONS Obtaining a diagnosis in previously unexplained cardiac arrest patients requires systematic clinical testing and regular follow-up to unmask the cause. Nearly half of apparently unexplained cardiac arrest patients ultimately received a diagnosis, allowing for improved treatment and family screening. A substantial proportion of patients received appropriate implantable cardioverter defibrillator therapy during medium-term follow-up. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00292032.
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Affiliation(s)
- Adam R M Herman
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Christopher Cheung
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Brenda Gerull
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Christopher S Simpson
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - David H Birnie
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - George J Klein
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Jean Champagne
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Jeffrey S Healey
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Karen Gibbs
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Mario Talajic
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Martin Gardner
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Matthew T Bennett
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Christian Steinberg
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Mikyla Janzen
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Michael H Gollob
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Paul Angaran
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Raymond Yee
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Richard Leather
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Santabhanu Chakrabarti
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Shubhayan Sanatani
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Vijay S Chauhan
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Andrew D Krahn
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.).
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Lerma C, Glass L. Predicting the risk of sudden cardiac death. J Physiol 2016; 594:2445-58. [PMID: 26660287 DOI: 10.1113/jp270535] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 12/07/2015] [Indexed: 12/18/2022] Open
Abstract
Sudden cardiac death (SCD) is the result of a change of cardiac activity from normal (typically sinus) rhythm to a rhythm that does not pump adequate blood to the brain. The most common rhythms leading to SCD are ventricular tachycardia (VT) or ventricular fibrillation (VF). These result from an accelerated ventricular pacemaker or ventricular reentrant waves. Despite significant efforts to develop accurate predictors for the risk of SCD, current methods for risk stratification still need to be improved. In this article we briefly review current approaches to risk stratification. Then we discuss the mathematical basis for dynamical transitions (called bifurcations) that may lead to VT and VF. One mechanism for transition to VT or VF involves a perturbation by a premature ventricular complex (PVC) during sinus rhythm. We describe the main mechanisms of PVCs (reentry, independent pacemakers and abnormal depolarizations). An emerging approach to risk stratification for SCD involves the development of individualized dynamical models of a patient based on measured anatomy and physiology. Careful analysis and modelling of dynamics of ventricular arrhythmia on an individual basis will be essential in order to improve risk stratification for SCD and to lay a foundation for personalized (precision) medicine in cardiology.
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Affiliation(s)
- Claudia Lerma
- Departamento de Instrumentación Electromecánica, Instituto Nacional de Cardiología Ignacio Chávez, México, Distrito Federal, México, 14080
| | - Leon Glass
- Department of Physiology, McGill University, Montreal, Quebec, Canada, H3G 1Y6
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Latchamsetty R, Bogun F. Premature Ventricular Complexes and Premature Ventricular Complex Induced Cardiomyopathy. Curr Probl Cardiol 2015; 40:379-422. [DOI: 10.1016/j.cpcardiol.2015.03.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wilde AAM, Viskin S. From whole exome sequencing to patient-specific therapy: another example of how basic research pays off in patient care. J Am Heart Assoc 2015; 4:JAHA.115.002085. [PMID: 26015323 PMCID: PMC4599431 DOI: 10.1161/jaha.115.002085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Arthur A M Wilde
- Heart Center, Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands (A.M.W.) Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, Jeddah, Saudi Arabia (A.M.W.)
| | - Sami Viskin
- Department of Cardiology, Tel-Aviv Sourasky Medical Center and Sackler School of Medicine, Tel-Aviv University, Israel (S.V.)
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Tikkanen J, Huikuri H. Characteristics of “malignant” vs. “benign” electrocardiographic patterns of early repolarization. J Electrocardiol 2015; 48:390-4. [DOI: 10.1016/j.jelectrocard.2014.12.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Indexed: 12/19/2022]
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Ichikawa T, Sobue Y, Kasai A, Kiyono K, Hayano J, Yamamoto M, Okuda K, Watanabe E, Ozaki Y. Beat-to-beat T-wave amplitude variability in the risk stratification of right ventricular outflow tract-premature ventricular complex patients. Europace 2015; 18:138-45. [DOI: 10.1093/europace/euu404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 12/22/2014] [Indexed: 12/30/2022] Open
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Kim YR, Nam GB, Kwon CH, Lee WS, Kim YG, Hwang KW, Kim J, Choi KJ, Kim YH. Second coupling interval of nonsustained ventricular tachycardia to distinguish malignant from benign outflow tract ventricular tachycardias. Heart Rhythm 2014; 11:2222-30. [DOI: 10.1016/j.hrthm.2014.08.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Indexed: 10/24/2022]
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Miyake CY, Davis AM, Motonaga KS, Dubin AM, Berul CI, Cecchin F. Infant Ventricular Fibrillation After ST-Segment Changes and QRS Widening. Circ Arrhythm Electrophysiol 2013; 6:712-8. [DOI: 10.1161/circep.113.000444] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Christina Y. Miyake
- From the Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, CA (C.Y.M., K.S.M., A.M.Du.); Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia (A.M.Da.); Murdoch Children’s Research Institute, Parkville, Victoria, Australia (A.M.Da.); Department of Pediatrics, Melbourne University, Melbourne, Victoria, Australia (A.M.Da.); Department of Pediatrics, Children’s National Medical Center, Washington, DC (C.I.B.); Department of Cardiology, Boston
| | - Andrew M. Davis
- From the Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, CA (C.Y.M., K.S.M., A.M.Du.); Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia (A.M.Da.); Murdoch Children’s Research Institute, Parkville, Victoria, Australia (A.M.Da.); Department of Pediatrics, Melbourne University, Melbourne, Victoria, Australia (A.M.Da.); Department of Pediatrics, Children’s National Medical Center, Washington, DC (C.I.B.); Department of Cardiology, Boston
| | - Kara S. Motonaga
- From the Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, CA (C.Y.M., K.S.M., A.M.Du.); Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia (A.M.Da.); Murdoch Children’s Research Institute, Parkville, Victoria, Australia (A.M.Da.); Department of Pediatrics, Melbourne University, Melbourne, Victoria, Australia (A.M.Da.); Department of Pediatrics, Children’s National Medical Center, Washington, DC (C.I.B.); Department of Cardiology, Boston
| | - Anne M. Dubin
- From the Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, CA (C.Y.M., K.S.M., A.M.Du.); Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia (A.M.Da.); Murdoch Children’s Research Institute, Parkville, Victoria, Australia (A.M.Da.); Department of Pediatrics, Melbourne University, Melbourne, Victoria, Australia (A.M.Da.); Department of Pediatrics, Children’s National Medical Center, Washington, DC (C.I.B.); Department of Cardiology, Boston
| | - Charles I. Berul
- From the Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, CA (C.Y.M., K.S.M., A.M.Du.); Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia (A.M.Da.); Murdoch Children’s Research Institute, Parkville, Victoria, Australia (A.M.Da.); Department of Pediatrics, Melbourne University, Melbourne, Victoria, Australia (A.M.Da.); Department of Pediatrics, Children’s National Medical Center, Washington, DC (C.I.B.); Department of Cardiology, Boston
| | - Frank Cecchin
- From the Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, CA (C.Y.M., K.S.M., A.M.Du.); Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia (A.M.Da.); Murdoch Children’s Research Institute, Parkville, Victoria, Australia (A.M.Da.); Department of Pediatrics, Melbourne University, Melbourne, Victoria, Australia (A.M.Da.); Department of Pediatrics, Children’s National Medical Center, Washington, DC (C.I.B.); Department of Cardiology, Boston
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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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Aizawa Y, Chinushi M, Hasegawa K, Naiki N, Horie M, Kaneko Y, Kurabayashi M, Ito S, Imaizumi T, Aizawa Y, Takatsuki S, Joo K, Sato M, Ebe K, Hosaka Y, Haissaguerre M, Fukuda K. Electrical storm in idiopathic ventricular fibrillation is associated with early repolarization. J Am Coll Cardiol 2013; 62:1015-9. [PMID: 23747791 DOI: 10.1016/j.jacc.2013.05.030] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 04/24/2013] [Accepted: 05/14/2013] [Indexed: 01/02/2023]
Abstract
OBJECTIVES This study sought to characterize patients with idiopathic ventricular fibrillation (IVF) who develop electrical storms. BACKGROUND Some IVF patients develop ventricular fibrillation (VF) storms, but the characteristics of these patients are poorly known. METHODS Ninety-one IVF patients (86% male) were selected after the exclusion of structural heart diseases, primary electrical diseases, and coronary spasm. Electrocardiogram features were compared between the patients with and without electrical storms. A VF storm was defined as VF occurring ≥3 times in 24 h and J waves >0.1 mV above the isoelectric line in contiguous leads. RESULTS Fourteen (15.4%) patients had VF storms occurring out-of-hospital at night or in the early morning. J waves were more closely associated with VF storms compared to patients without VF storms: 92.9% versus 36.4% (p < 0.0001). VF storms were controlled by intravenous isoproterenol, which attenuated the J-wave amplitude. After the subsidence of VF storms, the J waves decreased to the nondiagnostic level during the entire follow-up period. Implantable cardioverter-defibrillator therapy was administered to all patients during follow-up. Quinidine therapy was limited, but the patients on disopyramide (n = 3), bepridil (n = 1), or isoprenaline (n = 1) were free from VF recurrence, while VF recurred in 5 of the 9 patients who were not given antiarrhythmic drugs. CONCLUSIONS The VF storms in the IVF patients were highly associated with J waves that showed augmentation prior to the VF onset. Isoproterenol was effective in controlling VF and attenuated the J waves, which diminished to below the diagnostic level during follow-up. VF recurred in patients followed up without antiarrhythmic agents.
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