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Zhang Y, Zhang Z, Qu Z. Curvature-mediated source and sink effects on the genesis of premature ventricular complexes in long QT syndrome. Am J Physiol Heart Circ Physiol 2024; 326:H1350-H1365. [PMID: 38551483 DOI: 10.1152/ajpheart.00004.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/13/2024] [Accepted: 03/25/2024] [Indexed: 05/08/2024]
Abstract
Premature ventricular complexes (PVCs) are spontaneous excitations occurring in the ventricles of the heart that are associated with ventricular arrhythmias and sudden cardiac death. Under long QT conditions, PVCs can be mediated by repolarization gradient (RG) and early afterdepolarizations (EADs), yet the effects of heterogeneities or geometry of the RG or EAD regions on PVC genesis remain incompletely understood. In this study, we use computer simulation to systematically investigate the effects of the curvature of the RG border region on PVC genesis under long QT conditions. We show that PVCs can be either promoted or suppressed by negative or positive RG border curvature depending on the source and sink conditions. When the origin of oscillation is in the source region and the source is too strong, a positive RG border curvature can promote PVCs by causing the source area to oscillate. When the origin of oscillation is in the sink region, a negative RG border curvature can promote PVCs by causing the sink area to oscillate. Furthermore, EAD-mediated PVCs are also promoted by negative border curvature. We also investigate the effects of wavefront curvature and show that PVCs are promoted by convex but suppressed by concave wavefronts; however, the effect of wavefront curvature is much smaller than that of RG border curvature. In conclusion, besides the increase of RG and occurrence of EADs caused by QT prolongation, the geometry of the RG border plays important roles in PVC genesis, which can greatly increase the risk of arrhythmias in cardiac diseases.NEW & NOTEWORTHY The effects of the curvature or geometry of the repolarization gradient region and wavefront curvature on the genesis of premature ventricular complexes are systematically investigated using computer modeling and simulation. Premature ventricular complexes can be promoted by either positive or negative curvature of the gradient region depending on the source and sink conditions. The underlying mechanisms of the curvature effects are revealed, which provides mechanistic insights into arrhythmogenesis in cardiac diseases.
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Affiliation(s)
- Yuhao Zhang
- Department of Physics, School of Physical Science and Technology, Ningbo University, Ningbo, People's Republic of China
| | - Zhaoyang Zhang
- Department of Physics, School of Physical Science and Technology, Ningbo University, Ningbo, People's Republic of China
| | - Zhilin Qu
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, United States
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Álvarez-Ortega C, Gómez-Martínez JD, Cardona-Gallardo MA, Torres-España NF, Pava-Molano LF, Sánchez-Ortiz ÁI, Velásquez-Galvis M. Cardiac Sympathetic Denervation as a Treatment for Ventricular Arrhythmias Refractory to Conventional Treatment: A Case Series. Interv Cardiol 2024; 19:e06. [PMID: 38808282 PMCID: PMC11131149 DOI: 10.15420/icr.2023.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/01/2023] [Indexed: 05/30/2024] Open
Abstract
Background Ventricular arrhythmias are a leading cause of sudden death. The objective of this study was to characterise the results of patients with ventricular arrhythmias refractory to standard medical management, undergoing Video-assisted thoracoscopic cardiac sympathetic denervation (VAT-CSD) during 2012-2022 in Cali, Colombia. Methods This was an observational retrospective study, using the Institutional General Thoracic Surgery Database for patient identification and retrospectively reviewing the clinical charts for data description and analysis. Results Clinical records of 19 patients who underwent VAT-CSD for ventricular arrhythmia were analysed. The patients were predominantly male (73.7%) with an mean age of 62 years. Ischaemic heart disease was the main underlying condition (52.6%); all individuals had a diagnosis of heart failure, with comorbidities such as hypertension (63.1%), acute MI (57.8%) and diabetes (26.3%) also present. The procedure was performed bilaterally in 89.4% of cases and was successful with minimal perioperative complications. Postoperative follow-up showed improvement in symptoms, including a significant reduction in the number of ICD shocks and emergency department visits. Conclusion VAT-CSD is a viable, safe and palliative therapeutic option for patients with ventricular arrhythmias who have not responded to conventional treatments, achieving a significant decrease in symptoms with low mortality and perioperative complications.
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Ahn HJ, Choi EK, Lee SR, Kwon S, Song HS, Lee YS, Oh S. Three-Day Monitoring of Adhesive Single-Lead Electrocardiogram Patch for Premature Ventricular Complex: Prospective Study for Diagnosis Validation and Evaluation of Burden Fluctuation. J Med Internet Res 2024; 26:e46098. [PMID: 38512332 PMCID: PMC10995782 DOI: 10.2196/46098] [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: 01/30/2023] [Revised: 08/13/2023] [Accepted: 02/12/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Wearable electrocardiogram (ECG) monitoring devices are used worldwide. However, data on the diagnostic yield of an adhesive single-lead ECG patch (SEP) to detect premature ventricular complex (PVC) and the optimal duration of wearing an SEP for PVC burden assessment are limited. OBJECTIVE We aimed to validate the diagnostic yield of an SEP (mobiCARE MC-100, Seers Technology) for PVC detection and evaluate the PVC burden variation recorded by the SEP over a 3-day monitoring period. METHODS This is a prospective study of patients with documented PVC on a 12-lead ECG. Patients underwent simultaneous ECG monitoring with the 24-hour Holter monitor and SEP on the first day. On the subsequent second and third days, ECG monitoring was continued using only SEP, and a 3-day extended monitoring was completed. The diagnostic yield of SEP for PVC detection was evaluated by comparison with the results obtained on the first day of Holter monitoring. The PVC burden monitored by SEP for 3 days was used to assess the daily and 6-hour PVC burden variations. The number of patients additionally identified to reach PVC thresholds of 10%, 15%, and 20% during the 3-day extended monitoring by SEP and the clinical factors associated with the higher PVC burden variations were explored. RESULTS The recruited data of 134 monitored patients (mean age, 54.6 years; males, 45/134, 33.6%) were analyzed. The median daily PVC burden of these patients was 2.4% (IQR 0.2%-10.9%), as measured by the Holter monitor, and 3.3% (IQR 0.3%-11.7%), as measured in the 3-day monitoring by SEP. The daily PVC burden detected on the first day of SEP was in agreement with that of the Holter monitor: the mean difference was -0.07%, with 95% limits of agreement of -1.44% to 1.30%. A higher PVC burden on the first day was correlated with a higher daily (R2=0.34) and 6-hour burden variation (R2=0.48). Three-day monitoring by SEP identified 29% (12/42), 18% (10/56), and 7% (4/60) more patients reaching 10%, 15%, and 20% of daily PVC burden, respectively. Younger age was additionally associated with the identification of clinically significant PVC burden during the extended monitoring period (P=.02). CONCLUSIONS We found that the mobiCARE MC-100 SEP accurately detects PVC with comparable diagnostic yield to the 24-hour Holter monitor. Performing 3-day PVC monitoring with SEP, especially among younger patients, may offer a pragmatic alternative for identifying more individuals exceeding the clinically significant PVC burden threshold.
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Affiliation(s)
- Hyo-Jeong Ahn
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - So-Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Soonil Kwon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hee-Seok Song
- Seers Technology Co, Ltd, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Young-Shin Lee
- Seers Technology Co, Ltd, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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4
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Gonska BD. [Development and clinical value of programmed ventricular stimulation in coronary artery disease and dilated cardiomyopathy]. Herzschrittmacherther Elektrophysiol 2024; 35:83-87. [PMID: 38421398 PMCID: PMC10923973 DOI: 10.1007/s00399-024-01003-3] [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] [Accepted: 02/06/2024] [Indexed: 03/02/2024]
Abstract
Programmed ventricular stimulation (PVS), a clinical tool introduced in the early 1980s, aims to prove the electrical vulnerability of the heart and, independent of spontaneous arrhythmia variability, to trigger arrhythmias under controlled conditions. A specific response is the inducibility of monomorphic sustained ventricular tachycardia. This depends on the underlying heart disease, e.g., only for coronary artery disease but not for nonischemic diseases. The value of pharmacologic arrhythmia control as serial electrical testing is uncertain. Up to now there seems to be no prognostic value of PVS concerning sudden cardiac death. PVS is used as a tool to monitor the results of ventricular tachycardia (VT)-catheter ablation in patients who were primarily inducible.
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Cai C, Wu N, Yang G, Yang S, Liu W, Chen M, Po SS. Transcutaneous electrical vagus nerve stimulation to suppress premature ventricular complexes (TREAT PVC): study protocol for a multi-center, double-blind, randomized controlled trial. Trials 2023; 24:683. [PMID: 37872628 PMCID: PMC10591365 DOI: 10.1186/s13063-023-07713-2] [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: 08/06/2022] [Accepted: 10/07/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND The autonomic nervous system can be responsible for the initiation and maintenance of arrhythmias. Low-level tragus stimulation (LLTS), a noninvasive form of autonomic neuromodulation, has been shown to be effective in treating atrial fibrillation. We intended to treat frequent premature ventricular complexes (PVCs) with LLTS. METHODS AND DESIGN The present study will be a prospective multicenter, double-blind, randomized, controlled trial to assess the antiarrhythmic effects of LLTS on frequent PVCs in patients without structured heart disease (SHD). A total of 100 patients with PVC burden > 10% will be randomly assigned to the active or sham LLTS in 1:1 fashion and receive the proposed intervention for 6 months. The primary outcome is PVC burden at 6 months as assessed by 10 days of continuous ambulatory electrocardiographic monitoring. Secondary outcomes include heart rate variability (HRV), quality of life, skin sympathetic nerve activity, and inflammatory markers. Adverse events will also be recorded. DISCUSSION The present trial will be the first to evaluate the effect of LLTS on frequent PVCs on patients without SHD. LLTS may serve as a low-cost, minimal-risk, and non-invasive alternative to conventional antiarrhythmic therapy. TRIAL REGISTRATION ClinicalTrial.gov NCT04909528. Registered on 17 June 2021. World health organization trial registration data set was shown in Supplementary Table 1.
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Affiliation(s)
- Cheng Cai
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Nan Wu
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Gang Yang
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Shu Yang
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Wenjie Liu
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Minglong Chen
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
| | - Sunny S Po
- Heart Rhythm Institute, Section of Cardiovascular Diseases, The University of Oklahoma Health Sciences Center, Oklahoma, USA.
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Tsiachris D, Botis M, Doundoulakis I, Bartsioka LI, Tsioufis P, Kordalis A, Antoniou CK, Tsioufis K, Gatzoulis KA. Electrocardiographic Characteristics, Identification, and Management of Frequent Premature Ventricular Contractions. Diagnostics (Basel) 2023; 13:3094. [PMID: 37835837 PMCID: PMC10572222 DOI: 10.3390/diagnostics13193094] [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: 08/17/2023] [Revised: 09/09/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
Premature ventricular complexes (PVCs) are frequently encountered in clinical practice. The association of PVCs with adverse cardiovascular outcomes is well established in the context of structural heart disease, yet not so much in the absence of structural heart disease. However, cardiac magnetic resonance (CMR) seems to contribute prognostically in the latter subgroup. PVC-induced myocardial dysfunction refers to the impairment of ventricular function due to PVCs and is mostly associated with a PVC burden > 10%. Surface 12-lead ECG has long been used to localize the anatomic site of origin and multiple algorithms have been developed to differentiate between right ventricular and left ventricular outflow tract (RVOT and LVOT, respectively) origin. Novel algorithms include alternative ECG lead configurations and, lately, sophisticated artificial intelligence methods have been utilized to determine the origins of outflow tract arrhythmias. The decision to therapeutically address PVCs should be made upon the presence of symptoms or the development of PVC-induced myocardial dysfunction. Therapeutic modalities include pharmacological therapy (I-C antiarrhythmic drugs and beta blockers), as well as catheter ablation, which has demonstrated superior efficacy and safety.
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Affiliation(s)
- Dimitris Tsiachris
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, “Hippokration” Hospital, 11527 Athens, Greece; (M.B.); (I.D.); (L.I.B.); (P.T.); (A.K.); (C.-K.A.); (K.T.); (K.A.G.)
- Athens Heart Center, Athens Medical Center, 15125 Athens, Greece
| | - Michail Botis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, “Hippokration” Hospital, 11527 Athens, Greece; (M.B.); (I.D.); (L.I.B.); (P.T.); (A.K.); (C.-K.A.); (K.T.); (K.A.G.)
| | - Ioannis Doundoulakis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, “Hippokration” Hospital, 11527 Athens, Greece; (M.B.); (I.D.); (L.I.B.); (P.T.); (A.K.); (C.-K.A.); (K.T.); (K.A.G.)
| | - Lamprini Iro Bartsioka
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, “Hippokration” Hospital, 11527 Athens, Greece; (M.B.); (I.D.); (L.I.B.); (P.T.); (A.K.); (C.-K.A.); (K.T.); (K.A.G.)
| | - Panagiotis Tsioufis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, “Hippokration” Hospital, 11527 Athens, Greece; (M.B.); (I.D.); (L.I.B.); (P.T.); (A.K.); (C.-K.A.); (K.T.); (K.A.G.)
| | - Athanasios Kordalis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, “Hippokration” Hospital, 11527 Athens, Greece; (M.B.); (I.D.); (L.I.B.); (P.T.); (A.K.); (C.-K.A.); (K.T.); (K.A.G.)
| | - Christos-Konstantinos Antoniou
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, “Hippokration” Hospital, 11527 Athens, Greece; (M.B.); (I.D.); (L.I.B.); (P.T.); (A.K.); (C.-K.A.); (K.T.); (K.A.G.)
- Athens Heart Center, Athens Medical Center, 15125 Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, “Hippokration” Hospital, 11527 Athens, Greece; (M.B.); (I.D.); (L.I.B.); (P.T.); (A.K.); (C.-K.A.); (K.T.); (K.A.G.)
| | - Konstantinos A. Gatzoulis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, “Hippokration” Hospital, 11527 Athens, Greece; (M.B.); (I.D.); (L.I.B.); (P.T.); (A.K.); (C.-K.A.); (K.T.); (K.A.G.)
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Spaulding C. Peut-ton prédire la mort subite d’origine cardiaque? BULLETIN DE L'ACADÉMIE NATIONALE DE MÉDECINE 2023. [DOI: 10.1016/j.banm.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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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 PMCID: PMC11334931 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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Leikas AJ, Hassinen I, Kivelä A, Hedman A, Mussalo H, Ylä-Herttuala S, Hartikainen JEK. Intramyocardial adenoviral vascular endothelial growth factor-D ∆N∆C gene therapy does not induce ventricular arrhythmias. J Gene Med 2022; 24:e3437. [PMID: 35750637 DOI: 10.1002/jgm.3437] [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: 05/01/2022] [Revised: 06/13/2022] [Accepted: 06/19/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Phase I KAT301 trial investigated the use of intramyocardial adenoviral vascular endothelial growth factor -DΔNΔC (AdVEGF-D) gene therapy (GT) to alleviate symptoms in refractory angina (RA) patients. In KAT301, 30 patients with RA were randomized to AdVEGF-D or control group in 4:1 ratio. The treatment was found feasible, increased myocardial perfusion, and reduced angina symptoms at 1-year follow-up. However, there is some evidence suggesting that intramyocardial delivery route and overexpression of VEGFs might induce ventricular arrhythmias. Thus, we investigated whether intramyocardial AdVEGF-D GT increases the risk of ventricular arrhythmias in patients treated for RA. METHODS We analyzed non-invasive risk predictors of ventricular arrhythmias from 12-lead electrocardiography (ECG) as well as heart rate variability (HRV) and the incidence of arrhythmias from 24 h ambulatory ECG at baseline and 3 and 12 months after the GT. In addition, we analyzed the incidence of new-onset arrhythmias and pacemaker implantations during 8.2-year (range 6.3 - 10.4 years) follow-up. RESULTS We found no significant increase in arrhythmias, including supraventricular and ventricular ectopic beats, atrial fibrillation, non-sustained ventricular tachycardias, and life-threatening tachycardias, nor changes in the non-invasive risk predictors of ventricular arrhythmias in the AdVEGF-D treated patients. Instead, we found a significant improvement in the very low and high-frequency bands of HRV suggestive of improved cardiac autonomic regulation after GT. CONCLUSIONS In conclusion, our results suggest that AdVEGF-D GT does not predispose to arrhythmias and might improve HRV metrics.
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Affiliation(s)
- Aleksi J Leikas
- Heart Center, Kuopio University Hospital, Kuopio, Finland.,A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland.,Gene Therapy Unit, Kuopio University Hospital, Kuopio, Finland
| | - Iiro Hassinen
- Heart Center, Kuopio University Hospital, Kuopio, Finland.,Mikkeli Central Hospital, Mikkeli, Finland
| | - Antti Kivelä
- Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Antti Hedman
- Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Hanna Mussalo
- Center of Diagnostic Imaging, Kuopio University Hospital, Kuopio, Finland
| | - Seppo Ylä-Herttuala
- Heart Center, Kuopio University Hospital, Kuopio, Finland.,A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland.,Gene Therapy Unit, Kuopio University Hospital, Kuopio, Finland
| | - Juha E K Hartikainen
- Heart Center, Kuopio University Hospital, Kuopio, Finland.,Gene Therapy Unit, Kuopio University Hospital, Kuopio, Finland
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10
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Prognostic implications of structural heart disease and premature ventricular contractions in recovery of exercise. Sci Rep 2022; 12:10265. [PMID: 35715698 PMCID: PMC9205997 DOI: 10.1038/s41598-022-14535-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/08/2022] [Indexed: 11/11/2022] Open
Abstract
Premature ventricular contractions (PVCs) during recovery of exercise stress testing are associated with increased cardiovascular mortality, but the cause remains unknown. We aimed to evaluate the association of PVCs during recovery with echocardiographic abnormalities, and their combined prognostic performance. Echocardiographic abnormalities [reduced left ventricular (LV) ejection fraction, valvular heart disease, LV dilatation, LV hypertrophy, or increased filling pressures] and PVCs during recovery were identified among patients having undergone both echocardiography and exercise stress test. Among included patients (n = 3106, age 59 ± 16 years, 55% males), PVCs during recovery were found in 1327 (43%) patients, among which the prevalence of echocardiographic abnormalities was increased (58% vs. 43%, p < 0.001). Overall, PVCs during recovery were associated with increased cardiovascular mortality (219 total events, 7.9 [5.4–11.1] years follow-up; adjusted hazard ratio (HR [95% confidence interval]) 1.6 [1.2–2.1], p < 0.001). When analyzed in combination with either presence or absence of echocardiographic abnormalities, PVCs during recovery were associated with increased risk when such were present (HR 3.3 [1.9–5.5], p < 0.001) but not when absent (HR 1.5 [0.8–2.8], p = 0.22), in reference to those with neither. Our findings provide mechanistic insights to the increased CV risk reported in patients with PVCs during recovery.
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11
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Zacharia EM, Istvanic F, Mulukutla S, Thoma F, Aronis KN, Bhonsale A, Kancharla K, Voigt A, Shalaby A, Estes NAM, Jain SK, Saba S. Predictors of Hospital Admissions for Ventricular Arrhythmia or Cardiac Arrest in Patients With Cardiomyopathy. Am J Cardiol 2022; 171:127-131. [PMID: 35292146 DOI: 10.1016/j.amjcard.2022.01.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 11/19/2022]
Abstract
Although ventricular dysfunction is associated with the occurrence of ventricular arrhythmia (VA), most patients with cardiomyopathy do not experience VA. We therefore investigated other predictors of VA in a large contemporary cohort of patients with cardiomyopathy. All patients at a large academic medical system with left ventricular ejection fraction (LVEF) ≤50% were enrolled at the time of first documented low LVEF. Predictors of hospital admission for VA were examined using multivariable Cox models. The incidence of implantable defibrillator (ICD) placement was also examined. A total of 18,003 patients were enrolled. Over a median follow-up of 3.35 years, 389 patients (2.2%) were admitted for VA (304 of 12,037 [2.5%] among patients with LVEF ≤35% vs 85 of 5,966 [1.4%] among those with LVEF 36% to 50%). Predictors of VA hospitalization included lower LVEF (hazard ratio (HR) = 1.43 per 10% decrease, p <0.001), the presence of an ICD at baseline (HR = 1.63, p = 0.010), higher blood glucose (HR = 1.02 per 10 mg/100 ml increase, p = 0.050), the presence of end-stage renal disease (HR = 3.59, p <0.001), and the presence of liver cirrhosis (HR = 1.93, p = 0.013). During follow-up, 626 patients were implanted with a new ICD. In addition to being admitted with VA, a lower LVEF and a history of coronary artery disease or heart failure were the main predictors of ICD therapy in this population. In conclusion, in addition to more severe cardiomyopathy and the presence of an implanted ICD, metabolic derangements on initial contact are independent predictors of hospital admissions for VA in patients with cardiomyopathy. Noncardiac co-morbidities play an important role in stratifying patients with cardiomyopathy for their risk of VA or cardiac arrest.
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Affiliation(s)
- Effimia M Zacharia
- Cardiology Division of the Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Filip Istvanic
- Cardiology Division of the Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Suresh Mulukutla
- Cardiology Division of the Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Floyd Thoma
- Cardiology Division of the Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Konstantinos N Aronis
- Cardiology Division of the Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Aditya Bhonsale
- Cardiology Division of the Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Krishna Kancharla
- Cardiology Division of the Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Andrew Voigt
- Cardiology Division of the Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Alaa Shalaby
- Cardiology Division of the Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - N A Mark Estes
- Cardiology Division of the Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sandeep K Jain
- Cardiology Division of the Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Samir Saba
- Cardiology Division of the Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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Graham AJ, Orini M, Zacur E, Dhillon G, Jones D, Prabhu S, Pugliese F, Lowe M, Ahsan S, Earley MJ, Chow A, Sporton S, Dhinoja M, Hunter RJ, Schilling RJ, Lambiase PD. Assessing Noninvasive Delineation of Low-Voltage Zones Using ECG Imaging in Patients With Structural Heart Disease. JACC Clin Electrophysiol 2022; 8:426-436. [PMID: 35450597 DOI: 10.1016/j.jacep.2021.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 11/12/2021] [Accepted: 11/16/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study sought to assess the association between electrocardiographic imaging (ECGI) parameters and voltage from simultaneous electroanatomic mapping (EAM). BACKGROUND ECGI offers noninvasive assessment of electrophysiologic features relevant for mapping ventricular arrhythmia and its substrate, but the accuracy of ECGI in the delineation of scar is unclear. METHODS Sixteen patients with structural heart disease underwent simultaneous ECGI (CardioInsight, Medtronic) and contact EAM (CARTO, Biosense-Webster) during ventricular tachycardia catheter ablation, with 7 mapped epicardially. ECGI and EAM geometries were coregistered using anatomic landmarks. ECGI points were paired to the closest site on the EAM within 10 mm. The association between EAM voltage and ECGI features from reconstructed epicardial unipolar electrograms was assessed by mixed-effects regression models. The classification of low-voltage regions was performed using receiver-operating characteristic analysis. RESULTS A total of 9,541 ECGI points (median: 596; interquartile range: 377-737 across patients) were paired to an EAM site. Epicardial EAM voltage was associated with ECGI features of signal fractionation and local repolarization dispersion (N = 7; P < 0.05), but they poorly classified sites with bipolar voltage of <1.5 mV or <0.5 mV thresholds (median area under the curve across patients: 0.50-0.62). No association was found between bipolar EAM voltage and low-amplitude reconstructed epicardial unipolar electrograms or ECGI-derived bipolar electrograms. Similar results were found in the combined cohort (n = 16), including endocardial EAM voltage compared to epicardial ECGI features (n = 9). CONCLUSIONS Despite a statistically significant association between ECGI features and EAM voltage, the accuracy of the delineation of low-voltage zones was modest. This may limit ECGI use for pr-procedural substrate analysis in ventricular tachycardia ablation, but it could provide value in risk assessment for ventricular arrhythmias.
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Affiliation(s)
- Adam J Graham
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Michele Orini
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Ernesto Zacur
- Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | - Gurpreet Dhillon
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Daniel Jones
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Sandeep Prabhu
- Department of Cardiology, The Alfred Hospital, Melbourne, Australia
| | - Francesca Pugliese
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Martin Lowe
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Syed Ahsan
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Mark J Earley
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Anthony Chow
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Simon Sporton
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Mehul Dhinoja
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Ross J Hunter
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Richard J Schilling
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Pier D Lambiase
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom.
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13
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Zhao G, Feng Y, Xue L, Cui M, Zhang Q, Xu F, Peng N, Jiang Z, Gao D, Zhang X. Anisotropic conductive reduced graphene oxide/silk matrices promote post-infarction myocardial function by restoring electrical integrity. Acta Biomater 2022; 139:190-203. [PMID: 33836222 DOI: 10.1016/j.actbio.2021.03.073] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 02/07/2023]
Abstract
Myocardial infarction (MI) remains the leading cause of death globally, often leading to impaired cardiac function and pathological myocardial microenvironment. Electrical conduction abnormalities of the infarcted myocardium not only induce adverse myocardial remodeling but also prevent tissue repair. Restoring the myocardial electrical integrity, particularly the anisotropic electrical signal propagation within the injured area after infarction is crucial for an effective function recovery. Herein, optimized reduced graphene oxide (rGO) functionalized electrospun silk fibroin (rGO/silk) biomaterials presenting anisotropic conductivity and enhanced suturablity were developed and investigated as cardiac patches for their potential in improving the post-MI myocardial function of rat models. The results show that the anisotropic conductive rGO/silk patches exhibit remarkable therapeutic effect on repairing the infarcted myocardium compared to the nonconductive silk and isotropic conductive rGO/silk patches as determined by the enhanced pumping function, reduced susceptibility to arrhythmias, thickened left ventricular walls and improved survival of functional cardiomyocytes. Their notable effect on promoting the angiogenesis of capillaries in the infarcted myocardium has also been demonstrated. This study highlights an effective and biomimetic reconstruction of the electrical myocardial microenvironment based on the anisotropic conductive rGO/silk biomaterials as a promising option for promoting the repair of infarcted myocardium. STATEMENT OF SIGNIFICANCE: The dysfunctional electrical microenvironment in the infarcted myocardium not only aggravates the adverse myocardial remodeling but also limits the effect of cardiac regenerative medicine. Although various conductive biomaterials have been employed to restore the electrical network in the infarcted myocardium in vivo, the anisotropic nature of the myocardial electrical microenvironment which enables directional electrical signal propagation were neglected. In this study, an anisotropic conductive rGO/silk biomaterial system is developed to improve the myocardial function post infarction by restoring the anisotropic electrical microenvironment in the infarcted myocardium. The promoted effects of anisotropic conductive grafts on repairing infarcted hearts are demonstrated with improved pumping function, cardiomyocyte survival, resistance to ventricular fibrillation, and angiogenesis of capillary network.
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Affiliation(s)
- Guoxu Zhao
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Center for Mitochondrial Biology and Medicine, School of Life Science and Technology, International Joint Laboratory for Micro/Nano Manufacturing and Measurement Technology, Xi'an Key Laboratory for Biomedical Testing and High-end Equipment, Xi'an Jiaotong University, Xi'an 710049, Shannxi, PR China; School of Material Science and Chemical Engineering, Xi'an Technological University, Xi'an 710021, Shaanxi, PR China
| | - Yanjing Feng
- Department of Cardiology, The Second Affiliated Hospital, School of Medical, Xi'an Jiaotong University, Xi'an 710004, Shaanxi, PR China
| | - Li Xue
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Center for Mitochondrial Biology and Medicine, School of Life Science and Technology, International Joint Laboratory for Micro/Nano Manufacturing and Measurement Technology, Xi'an Key Laboratory for Biomedical Testing and High-end Equipment, Xi'an Jiaotong University, Xi'an 710049, Shannxi, PR China
| | - Mengjie Cui
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Center for Mitochondrial Biology and Medicine, School of Life Science and Technology, International Joint Laboratory for Micro/Nano Manufacturing and Measurement Technology, Xi'an Key Laboratory for Biomedical Testing and High-end Equipment, Xi'an Jiaotong University, Xi'an 710049, Shannxi, PR China
| | - Qi Zhang
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Center for Mitochondrial Biology and Medicine, School of Life Science and Technology, International Joint Laboratory for Micro/Nano Manufacturing and Measurement Technology, Xi'an Key Laboratory for Biomedical Testing and High-end Equipment, Xi'an Jiaotong University, Xi'an 710049, Shannxi, PR China
| | - Feng Xu
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Bioinspired Engineering and Biomechanics Center (BEBC), School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710049, Shaanxi, PR China
| | - Niancai Peng
- International Joint Laboratory for Micro/Nano Manufacturing and Measurement Technology, State Key Laboratory for Manufacturing Systems Engineering, Xi'an Key Laboratory for Biomedical Testing and High-end Equipment, Xi'an Jiaotong University, Xi'an 710049, Shaanxi, PR China
| | - Zhuangde Jiang
- International Joint Laboratory for Micro/Nano Manufacturing and Measurement Technology, State Key Laboratory for Manufacturing Systems Engineering, Xi'an Key Laboratory for Biomedical Testing and High-end Equipment, Xi'an Jiaotong University, Xi'an 710049, Shaanxi, PR China
| | - Dengfeng Gao
- Department of Cardiology, The Second Affiliated Hospital, School of Medical, Xi'an Jiaotong University, Xi'an 710004, Shaanxi, PR China.
| | - Xiaohui Zhang
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Center for Mitochondrial Biology and Medicine, School of Life Science and Technology, International Joint Laboratory for Micro/Nano Manufacturing and Measurement Technology, Xi'an Key Laboratory for Biomedical Testing and High-end Equipment, Xi'an Jiaotong University, Xi'an 710049, Shannxi, PR China.
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14
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Carvalho GDD, Armaganijan LV, Lopes RD, Olandoski M, Galvão BMDA, Pessoa CC, Erbano BO, Luz RSBD, Demarchi AV, Medeiros BGD, Moreira DAR. Relationship between ventricular repolarization parameters and the inducibility of ventricular arrhythmias during electrophysiological study in patients with coronary artery disease. REVISTA DA ASSOCIAÇÃO MÉDICA BRASILEIRA 2022; 68:61-66. [DOI: 10.1590/1806-9282.20210806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/08/2021] [Indexed: 11/21/2022]
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15
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Marijon E, Garcia R, Narayanan K, Karam N, Jouven X. OUP accepted manuscript. Eur Heart J 2022; 43:1457-1464. [PMID: 35139183 PMCID: PMC9009402 DOI: 10.1093/eurheartj/ehab903] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 12/16/2021] [Accepted: 12/21/2021] [Indexed: 11/24/2022] Open
Abstract
More than 40 years after the first implantable cardioverter-defibrillator (ICD) implantation, sudden cardiac death (SCD) still accounts for more than five million deaths worldwide every year. Huge efforts in the field notwithstanding, it is now increasingly evident that the current strategy of long-term prevention based on left ventricular ejection fraction as the key selection criterion is actually of very limited impact, also because the largest absolute numbers of SCD are encountered in the general population not known to be at risk. It has been recently reemphasized that SCD is often not so sudden, with almost half of the victims experiencing typical warning symptoms preceding the event. Importantly, heeded and prompt medical attention can dramatically improve survival. Essentially, such timely action increases the chances of the SCD event being witnessed by emergency medical services and provides the opportunity for early intervention. In addition, newer technologies incorporating digital data acquisition, transfer between interconnected devices, and artificial intelligence, should allow dynamic, real-time monitoring of diverse parameters and therefore better identification of subjects at short-term SCD risk. Along with warning symptoms, these developments allow a new approach of near-term prevention based on the hours and minutes preceding SCD. In the present review, we challenge the current paradigm of mid- and long-term prevention using ICD in patients at the highest risk of SCD, and introduce a complementary concept applicable to the entire population that would aim to pre-empt SCD by timely detection and intervention within the minutes or hours prior to the event.
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Affiliation(s)
- Eloi Marijon
- Corresponding author. Tel: +33 6 62 83 38 48, Fax: +33 1 56 09 30 47,
| | | | - Kumar Narayanan
- Université de Paris, PARCC, INSERM, F-75015 Paris, France
- Paris-Sudden Death Expertise Center (SDEC), Paris, France
- Cardiology Department, Medicover Hospitals, Hyderabad, India
| | - Nicole Karam
- Université de Paris, PARCC, INSERM, F-75015 Paris, France
- Cardiology Department, European Georges Pompidou Hospital, Paris, France
- Paris-Sudden Death Expertise Center (SDEC), Paris, France
| | - Xavier Jouven
- Université de Paris, PARCC, INSERM, F-75015 Paris, France
- Cardiology Department, European Georges Pompidou Hospital, Paris, France
- Paris-Sudden Death Expertise Center (SDEC), Paris, France
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16
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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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17
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Trachanas K, Sideris S, Arsenos P, Tsiachris D, Antoniou CK, Dilaveris P, Triantafyllou K, Xenogiannis I, Tsimos K, Efremidis M, Kanoupakis E, Flevari P, Vassilikos V, Sideris A, Korantzopoulos P, Tousoulis D, Tsioufis K, Gatzoulis K. Noninvasive risk factors for the prediction of inducibility on programmed ventricular stimulation in post-myocardial infarction patients with an ejection fraction ≥40% at risk for sudden cardiac arrest: Insights from the PRESERVE-EF study. Ann Noninvasive Electrocardiol 2021; 27:e12908. [PMID: 34873786 PMCID: PMC8916556 DOI: 10.1111/anec.12908] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/05/2021] [Accepted: 10/11/2021] [Indexed: 11/29/2022] Open
Abstract
Background In the PRESERVE‐EF study, a two‐step sudden cardiac death (SCD) risk stratification approach to detect post‐myocardial infarction (MI) patients with left ventricle ejection fraction (LVEF) ≥40% at risk for major arrhythmic events (MAEs) was used. Seven noninvasive risk factors (NIRFs) were extracted from a 24‐h ambulatory electrocardiography (AECG) and a 45‐min resting recording. Patients with at least one NIRF present were referred for invasive programmed ventricular stimulation (PVS) and inducible patients received an Implantable Cardioverter ‐ Defibrillator (ICD). Methods In the present study, we evaluated the performance of the NIRFs, as they were described in the PRESERVE‐EF study protocol, in predicting a positive PVS. In the PRESERVE‐EF study, 152 out of 575 patients underwent PVS and 41 of them were inducible. For the present analysis, data from these 152 patients were analyzed. Results Among the NIRFs examined, the presence of signal averaged ECG‐late potentials (SAECG‐LPs) ≥ 2/3 and non‐sustained ventricular tachycardia (NSVT) ≥1 eposode/24 h cutoff points were important predictors of a positive PVS study, demonstrating in the logistic regression analysis odds ratios 2.285 (p = .027) and 2.867 (p = .006), respectively. A simple risk score based on the above cutoff points in combination with LVEF < 50% presented high sensitivity but low specificity for a positive PVS. Conclusion Cutoff points of NSVT ≥ 1 episode/24 h and SAECG‐LPs ≥ 2/3 in combination with a LVEF < 50% were important predictors of inducibility. However, the final decision for an ICD implantation should be based on a positive PVS, which is irreplaceable in risk stratification.
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Affiliation(s)
| | - Skevos Sideris
- State Department of Cardiology, Hippokrateion General Hospital, Athens, Greece
| | - Petros Arsenos
- First Department of Cardiology, Hippokrateion General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Dimitrios Tsiachris
- First Department of Cardiology, Hippokrateion General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Christos-Konstantinos Antoniou
- First Department of Cardiology, Hippokrateion General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Polychronis Dilaveris
- First Department of Cardiology, Hippokrateion General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | | | - Iosif Xenogiannis
- Second Department of Cardiology, Attikon General Hospital, National and Kapodistrian University of Athens School of Medicine, Chaidari, Greece
| | - Konstantinos Tsimos
- Department of Cardiology, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Michalis Efremidis
- Second State Department of Cardiology, Evangelismos Athens General Hospital, Athens, Greece
| | - Emmanuel Kanoupakis
- Department of Cardiology, Heraklion University Hospital, University of Crete, School of Medicine, Heraklion, Greece
| | - Panagiota Flevari
- Second Department of Cardiology, Attikon General Hospital, National and Kapodistrian University of Athens School of Medicine, Chaidari, Greece
| | - Vassilios Vassilikos
- Third Department of Cardiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Sideris
- Second State Department of Cardiology, Evangelismos Athens General Hospital, Athens, Greece
| | | | - Dimitrios Tousoulis
- First Department of Cardiology, Hippokrateion General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, Hippokrateion General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Konstantinos Gatzoulis
- First Department of Cardiology, Hippokrateion General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
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18
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Transcription factor Meis1 act as a new regulator of ischemic arrhythmias in mice. J Adv Res 2021; 39:275-289. [PMID: 35777912 PMCID: PMC9263651 DOI: 10.1016/j.jare.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/25/2021] [Accepted: 11/10/2021] [Indexed: 11/20/2022] Open
Abstract
The reduction of Meis1 after MI leads to an increased susceptibility to arrhythmia. Meis1 deficiency is related to ubiquitination proteasome pathway mediated by CDC20. Meis1 acts as a new transcription activator for SCN5A in cardiomyocytes. After Meis1 recovery, the electrophysiological function in cardiomyocytes are improved. Meis1 is a new target for the treatment of arrhythmia after myocardial infarction.
Introduction Objectives Methods Results Conclusion
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19
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Perino AC, Gummidipundi SE, Lee J, Hedlin H, Garcia A, Ferris T, Balasubramanian V, Gardner RM, Cheung L, Hung G, Granger CB, Kowey P, Rumsfeld JS, Russo AM, True Hills M, Talati N, Nag D, Tsay D, Desai S, Desai M, Mahaffey KW, Turakhia MP, Perez MV. Arrhythmias Other Than Atrial Fibrillation in Those With an Irregular Pulse Detected With a Smartwatch: Findings From the Apple Heart Study. Circ Arrhythm Electrophysiol 2021; 14:e010063. [PMID: 34565178 DOI: 10.1161/circep.121.010063] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Alexander C Perino
- Department of Medicine (A.C.P., M.P.T., M.V.P.), Stanford University School of Medicine, CA.,Center for Digital Health (A.C.P., M.P.T.), Stanford University School of Medicine, CA
| | - Santosh E Gummidipundi
- Quantitative Sciences Unit (S.E.G., J.L., H.H., A.G., V.B., R.M.G., M.D.), Stanford University School of Medicine, CA
| | - Justin Lee
- Quantitative Sciences Unit (S.E.G., J.L., H.H., A.G., V.B., R.M.G., M.D.), Stanford University School of Medicine, CA
| | - Haley Hedlin
- Quantitative Sciences Unit (S.E.G., J.L., H.H., A.G., V.B., R.M.G., M.D.), Stanford University School of Medicine, CA
| | - Ariadna Garcia
- Quantitative Sciences Unit (S.E.G., J.L., H.H., A.G., V.B., R.M.G., M.D.), Stanford University School of Medicine, CA
| | - Todd Ferris
- Information Resources and Technology (T.F., G.H.), Stanford University School of Medicine, CA
| | - Vidhya Balasubramanian
- Quantitative Sciences Unit (S.E.G., J.L., H.H., A.G., V.B., R.M.G., M.D.), Stanford University School of Medicine, CA
| | - Rebecca M Gardner
- Quantitative Sciences Unit (S.E.G., J.L., H.H., A.G., V.B., R.M.G., M.D.), Stanford University School of Medicine, CA
| | | | - Grace Hung
- Information Resources and Technology (T.F., G.H.), Stanford University School of Medicine, CA
| | | | - Peter Kowey
- Lankenau Heart Institute and Jefferson Medical College, Philadelphia, PA (P.K.)
| | - John S Rumsfeld
- Department of Medicine, University of Colorado School of Medicine, Aurora (J.S.R.)
| | - Andrea M Russo
- Department of Medicine, Cooper Medical School of Rowan University, Camden, NJ (A.M.R.)
| | | | - Nisha Talati
- Stanford Center for Clinical Research (N.T., K.W.M.), Stanford University School of Medicine, CA
| | - Divya Nag
- Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G., D.N.)
| | - David Tsay
- Apple, Inc, Cupertino, CA (L.C., D.T., S.D.)
| | | | - Manisha Desai
- Quantitative Sciences Unit (S.E.G., J.L., H.H., A.G., V.B., R.M.G., M.D.), Stanford University School of Medicine, CA
| | - Kenneth W Mahaffey
- Stanford Center for Clinical Research (N.T., K.W.M.), Stanford University School of Medicine, CA
| | - Mintu P Turakhia
- Department of Medicine (A.C.P., M.P.T., M.V.P.), Stanford University School of Medicine, CA.,Center for Digital Health (A.C.P., M.P.T.), Stanford University School of Medicine, CA
| | - Marco V Perez
- Department of Medicine (A.C.P., M.P.T., M.V.P.), Stanford University School of Medicine, CA
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20
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Affiliation(s)
- Koji Higuchi
- Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
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21
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Sudden Cardiac Death in Patients with Heart Disease and Preserved Systolic Function: Current Options for Risk Stratification. J Clin Med 2021; 10:jcm10091823. [PMID: 33922111 PMCID: PMC8122448 DOI: 10.3390/jcm10091823] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/17/2021] [Accepted: 04/20/2021] [Indexed: 12/26/2022] Open
Abstract
Sudden cardiac death (SCD) is the leading cause of cardiovascular mortality in patients with coronary artery disease without severe systolic dysfunction and in heart failure with preserved ejection fraction. From a global health perspective, while risk may be lower, the absolute number of SCDs in patients with left ventricle ejection fraction >35% is higher than in those with severely reduced left ventricle ejection fraction (defined as ≤35%). Despite these observations and the high amount of available data, to date there are no clear recommendations to reduce the sudden cardiac death burden in the population with mid-range or preserved left ventricle ejection fraction. Ongoing improvements in risk stratification based on electrophysiological and imaging techniques point towards a more precise identification of patients who would benefit from ICD implantation, which is still an unmet need in this subset of patients. The aim of this review is to provide a state-of-the-art approach in sudden cardiac death risk stratification of patients with mid-range and preserved left ventricular ejection fraction and one of the following etiologies: ischemic cardiomyopathy, heart failure, atrial fibrillation or myocarditis.
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22
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Wong JA, Roberts JD, Healey JS. The Optimal Timing of Primary Prevention Implantable Cardioverter-Defibrillator Referral in the Rapidly Changing Medical Landscape. Can J Cardiol 2021; 37:644-654. [PMID: 33549824 DOI: 10.1016/j.cjca.2021.01.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/28/2021] [Accepted: 01/28/2021] [Indexed: 12/28/2022] Open
Abstract
The use of implantable cardioverter-defibrillators (ICDs) significantly reduces the risk of mortality in patients with heart failure with reduced ejection fraction (HFrEF). Current guidelines, which are based on seminal clinical trials published nearly 2 decades ago, recommend that patients be on optimal medical therapy for HF for a minimum of 3 months before referral for prophylactic ICD. This waiting period allows for left ventricular reverse remodelling and improvement in HF symptoms, which may render primary prevention ICD implantation unnecessary. However, medical therapy for HFrEF has significantly evolved since the publication of these landmark trials. Given the plethora of medical therapy options now available for HFrEF, it is appropriate to reassess the duration of this waiting period. In the present review, we examine the landmark randomised trials in primary prevention of sudden cardiac death in patients with HFrEF, summarise the novel medical therapies (sacubitril-valsartan, sodium-glucose cotransporter 2 inhibitors, ivabradine, vericiguat, and omecamtiv mecarbil) that have emerged since the publication of those trials, discuss the optimal timing of ICD referral, and review subtypes of nonischemic cardiomyopathy where timing of ICD insertion is guided by alternative criteria. With the steps now needed to optimise medical therapy for HFrEF, in terms of both classes of drugs and doses of each agent, it can easily take up to 6 months to achieve optimisation. Following that, waiting periods of 3 months for ischemic cardiomyopathy and 6 months for nonischemic cardiomyopathy may be required to allow adequate reverse remodelling before reevaluating for ICD implantation.
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Affiliation(s)
- Jorge A Wong
- Population Health Research Institute, Hamilton, Ontario, Canada; Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jason D Roberts
- Population Health Research Institute, Hamilton, Ontario, Canada; Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jeff S Healey
- Population Health Research Institute, Hamilton, Ontario, Canada; Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Anan R, Watanabe H, Takahama H, Mori W. Ventricular tachycardia in patients undergoing 24-h Holter monitoring as preoperative evaluation for noncardiac surgery. Heart Vessels 2021; 36:1047-1055. [PMID: 33475765 DOI: 10.1007/s00380-021-01779-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/08/2021] [Indexed: 11/29/2022]
Abstract
The incidence of ventricular tachycardia (VT) in preoperative evaluation for noncardiac surgery in general hospitals has not been established. The aim of this study was to determine the incidence of VT, characteristics of patients with VT, characteristics of VT, and significance of VT in patients undergoing 24-h Holter monitoring as preoperative evaluation for noncardiac surgery. In 601 patients, VT was detected in 46 patients (7.7%). In patients with VT, left ventricular ejection fraction (LVEF) was lower (62.6 ± 9.3% vs. 66.6 ± 8.9%, p = 0.003), and B-type natriuretic peptide (BNP) was higher compared with patients without VT (median, 52.5 pg/mL vs. 32.8 pg/mL, p = 0.02). The maximum number of consecutive beats of VT was more frequent in the patients with LVEF < 50% than in the patients with LVEF ≥ 50% (median, 11.5 beats vs. 3.0 beats, p = 0.01). Forty patients (87%) underwent scheduled surgery without major complications.
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Affiliation(s)
- Ryuichiro Anan
- Department of Cardiology, National Hospital Organization Miyakonojo Medical Center, 5033-1 Iwayoshi-cho, Miyakonojo, 885-0014, Japan. .,Institute for Clinical Research, National Hospital Organization Miyakonojo Medical Center, 5033-1 Iwayoshi-cho, Miyakonojo, 885-0014, Japan.
| | - Hideaki Watanabe
- Clinical Laboratory Department, National Hospital Organization Miyakonojo Medical Center, 5033-1 Iwayoshi-cho, Miyakonojo, 885-0014, Japan
| | - Hitomi Takahama
- Clinical Laboratory Department, National Hospital Organization Miyakonojo Medical Center, 5033-1 Iwayoshi-cho, Miyakonojo, 885-0014, Japan
| | - Wakako Mori
- Clinical Laboratory Department, National Hospital Organization Miyakonojo Medical Center, 5033-1 Iwayoshi-cho, Miyakonojo, 885-0014, Japan
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24
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Mulder BA, Rienstra M, Blaauw Y. Evaluation and treatment of premature ventricular contractions in heart failure with reduced ejection fraction. Heart 2020; 107:10-17. [PMID: 33077503 DOI: 10.1136/heartjnl-2020-317491] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/10/2020] [Accepted: 09/12/2020] [Indexed: 12/27/2022] Open
Abstract
Premature ventricular complexes (PVCs) are often observed in patients presenting with heart failure with a reduced ejection fraction (HFrEF). PVCs may in some patients be considered to be the cause of heart failure, while in others it may be the consequence of heart failure. PVCs are important prognostic markers in HFrEF. The uncertainty whether PVCs are the cause or effect in HFrEF impacts clinical decision making. In this review, we discuss the complexity of the cause-effect relationship between PVCs and HFrEF. We demonstrate a workflow with the use of a trial period of amiodarone that may discover whether the reduced LVEF is reversible, the symptoms are due to PVCs and whether biventricular pacing can be increased by the reduction of PVCs. The use of non-invasive and invasive (high-density) mapping techniques may help to improve accuracy and efficacy in the treatment of PVC, which will be demonstrated. With these results in mind, we conclude this review highlighting the future directions for PVC research and treatment.
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Affiliation(s)
- Bart A Mulder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michiel Rienstra
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Yuri Blaauw
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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25
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Arsenos P, Gatzoulis KA, Doundoulakis I, Dilaveris P, Antoniou C, Stergios S, Sideris S, Ilias S, Tousoulis D. Arrhythmic risk stratification in heart failure mid-range ejection fraction patients with a non-invasive guiding to programmed ventricular stimulation two-step approach. J Arrhythm 2020; 36:890-898. [PMID: 33024466 PMCID: PMC7532265 DOI: 10.1002/joa3.12416] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/15/2020] [Accepted: 07/10/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Although some post myocardial infarction (post-MI) and dilated cardiomyopathy (DCM) patients with mid-range ejection fraction heart failure (HFmrEF/40%-49%) face an increased risk for arrhythmic sudden cardiac death (SCD), current guidelines do not recommend an implantable cardiac defibrilator (ICD). We risk stratified hospitalized HFmrEF patients for SCD with a combined non-invasive risk factors (NIRFs) guiding to programmed ventricular stimulation (PVS) two-step approach. METHODS Forty-eight patients (male = 83%, age = 64 ± 14 years, LVEF = 45 ± 5%, CAD = 69%, DCM = 31%) underwent a NIRFs screening first-step with electrocardiogram (ECG), SAECG, Echocardiography and 24-hour ambulatory ECG (AECG). Thirty-two patients with presence of one of three NIRFs (SAECG ≥ 2 positive criteria for late potentials, ventricular premature beats ≥ 240/24 hours, and non-sustained ventricular tachycardia [VT] episode ≥ 1/24 hours) were further investigated with PVS. Patients were classified as either low risk (Group 1, n = 16, NIRFs-), moderate risk (Group 2, n = 18, NIRFs+/PVS-), and high risk (Group 3, n = 14, NIRFs+/PVS+). All in Group 3 received an ICD. RESULTS After 41 ± 18 months, 9 of 48 patients, experienced the major arrhythmic event (MAE) endpoint (clinical VT/fibrillation = 3, appropriate ICD activation = 6). The endpoint occurred more frequently in Group 3 (7/14, 50%) than in Groups 1 and 2 (2/34, 5.8%). Logistic regression model adjusted for PVS, age, and LVEF revealed that PVS was an independent MAE predictor (OR: 21.152, 95% CI: 2.618-170.887, P = .004). Kaplan-Meier curves diverged significantly (log rank, P < .001) while PVS negative predictive value was 94%. CONCLUSIONS In hospitalized HFmrEF post-MI and DCM patients, a NIRFs guiding to PVS two-step approach efficiently detected the subgroup at increased risk for MAE.
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Affiliation(s)
- Petros Arsenos
- First Department of Cardiology and Electrophysiology LaboratoryHippokration General HospitalNational and Kapodistrian University of Athens School of MedicineAthensGreece
- Arsenos Heart and Biosignals LabAvlonasGreece
| | - Konstantinos A. Gatzoulis
- First Department of Cardiology and Electrophysiology LaboratoryHippokration General HospitalNational and Kapodistrian University of Athens School of MedicineAthensGreece
| | - Ioannis Doundoulakis
- First Department of Cardiology and Electrophysiology LaboratoryHippokration General HospitalNational and Kapodistrian University of Athens School of MedicineAthensGreece
| | - Polychronis Dilaveris
- First Department of Cardiology and Electrophysiology LaboratoryHippokration General HospitalNational and Kapodistrian University of Athens School of MedicineAthensGreece
| | - Christos‐Konstantinos Antoniou
- First Department of Cardiology and Electrophysiology LaboratoryHippokration General HospitalNational and Kapodistrian University of Athens School of MedicineAthensGreece
| | - Soulaidopoulos Stergios
- First Department of Cardiology and Electrophysiology LaboratoryHippokration General HospitalNational and Kapodistrian University of Athens School of MedicineAthensGreece
| | - Skevos Sideris
- State Department of CardiologyHippokration General HospitalAthensGreece
| | | | - Dimitrios Tousoulis
- First Department of Cardiology and Electrophysiology LaboratoryHippokration General HospitalNational and Kapodistrian University of Athens School of MedicineAthensGreece
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26
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Nielsen JC, Lin YJ, de Oliveira Figueiredo MJ, Sepehri Shamloo A, Alfie A, Boveda S, Dagres N, Di Toro D, Eckhardt LL, Ellenbogen K, Hardy C, Ikeda T, Jaswal A, Kaufman E, Krahn A, Kusano K, Kutyifa V, Lim HS, Lip GYH, Nava-Townsend S, Pak HN, Rodríguez Diez G, Sauer W, Saxena A, Svendsen JH, Vanegas D, Vaseghi M, Wilde A, Bunch TJ, Buxton AE, Calvimontes G, Chao TF, Eckardt L, Estner H, Gillis AM, Isa R, Kautzner J, Maury P, Moss JD, Nam GB, Olshansky B, Pava Molano LF, Pimentel M, Prabhu M, Tzou WS, Sommer P, Swampillai J, Vidal A, Deneke T, Hindricks G, Leclercq C. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on risk assessment in cardiac arrhythmias: use the right tool for the right outcome, in the right population. Europace 2020; 22:1147-1148. [PMID: 32538434 PMCID: PMC7400488 DOI: 10.1093/europace/euaa065] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Alireza Sepehri Shamloo
- Department of Electrophysiology, Leipzig Heart Center at University of Leipzig, Leipzig, Germany
| | - Alberto Alfie
- Division of Electrophysiology, Instituto Cardiovascular Adventista, Clinica Bazterrica, Buenos Aires, Argentina
| | - Serge Boveda
- Department of Cardiology, Clinique Pasteur, Toulouse, France
| | - Nikolaos Dagres
- Department of Electrophysiology, Leipzig Heart Center at University of Leipzig, Leipzig, Germany
| | - Dario Di Toro
- Department of Cardiology, Division of Electrophysiology, Argerich Hospital and CEMIC, Buenos Aires, Argentina
| | - Lee L Eckhardt
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Kenneth Ellenbogen
- Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, USA
| | - Carina Hardy
- Arrhythmia Unit, Heart Institute, University of São, Paulo Medical School, Instituto do Coração -InCor- Faculdade de Medicina de São Paulo-São Paulo, Brazil
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Faculty of Medicine, Toho University, Japan
| | - Aparna Jaswal
- Department of Cardiac Electrophysiology, Fortis Escorts Heart Institute, Okhla Road, New Delhi, India
| | - Elizabeth Kaufman
- The Heart and Vascular Research Center, Metrohealth Campus of Case Western Reserve University, Cleveland, OH, USA
| | - Andrew Krahn
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Kengo Kusano
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Valentina Kutyifa
- University of Rochester, Medical Center, Rochester, USA
- Semmelweis University, Heart and Vascular Center, Budapest, Hungary
| | - Han S Lim
- Department of Cardiology, Austin Health, Melbourne, VIC, Australia
- University of Melbourne, Melbourne, VIC, Australia
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Santiago Nava-Townsend
- Department of Electrocardiology, National Institute of Cardiology “Ignacio Chavez,” Mexico City, Mexico
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Republic of Korea
| | - Gerardo Rodríguez Diez
- Department of Electrophysiology and Hemodynamic, Arrhytmias Unity, CMN 20 de Noviembre, ISSSTE, Mexico City, Mexico
| | - William Sauer
- Cardiovascular Division, Brigham and Women s Hospital and Harvard Medical School, Boston, USA
| | - Anil Saxena
- Department of Cardiac Electrophysiology, Fortis Escorts Heart Institute, Okhla Road, New Delhi, India
| | - Jesper Hastrup Svendsen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Diego Vanegas
- Hospital Militar Central, Fundarritmia, Bogotá, Colombia
| | - Marmar Vaseghi
- Los Angeles UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine, at UCLA, USA
| | - Arthur Wilde
- Amsterdam UMC, University of Amsterdam, Heart Center; Department of Clinical and Experimental Cardiology, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - T Jared Bunch
- Department of Medicine, Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, USA
| | | | - Alfred E Buxton
- Department of Medicine, The Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Lars Eckardt
- Department for Cardiology, Electrophysiology, University Hospital Münster, Münster, Germany
| | - Heidi Estner
- Department of Medicine, I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany
| | - Anne M Gillis
- University of Calgary - Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Rodrigo Isa
- Clínica RedSalud Vitacura and Hospital el Carmen de Maipú, Santiago, Chile
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | | | - Joshua D Moss
- Department of Cardiac Electrophysiology, University of California San Francisco, San Francisco, USA
| | - Gi-Byung Nam
- Division of Cardiology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
| | - Brian Olshansky
- University of Iowa Carver College of Medicine, Iowa City, USA
| | | | - Mauricio Pimentel
- Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Mukund Prabhu
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Wendy S Tzou
- Department of Cardiology/Cardiac Electrophysiology, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum, Clinic for Electrophysiology, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | | | - Alejandro Vidal
- Division of Cardiology, McGill University Health Center, Montreal, Canada
| | - Thomas Deneke
- Clinic for Cardiology II (Interventional Electrophysiology), Heart Center Bad Neustadt, Bad Neustadt a.d. Saale, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Leipzig Heart Center at University of Leipzig, Leipzig, Germany
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27
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Nielsen JC, Lin YJ, de Oliveira Figueiredo MJ, Sepehri Shamloo A, Alfie A, Boveda S, Dagres N, Di Toro D, Eckhardt LL, Ellenbogen K, Hardy C, Ikeda T, Jaswal A, Kaufman E, Krahn A, Kusano K, Kutyifa V, Lim HS, Lip GYH, Nava-Townsend S, Pak HN, Diez GR, Sauer W, Saxena A, Svendsen JH, Vanegas D, Vaseghi M, Wilde A, Bunch TJ, Buxton AE, Calvimontes G, Chao TF, Eckardt L, Estner H, Gillis AM, Isa R, Kautzner J, Maury P, Moss JD, Nam GB, Olshansky B, Pava Molano LF, Pimentel M, Prabhu M, Tzou WS, Sommer P, Swampillai J, Vidal A, Deneke T, Hindricks G, Leclercq C. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on risk assessment in cardiac arrhythmias: use the right tool for the right outcome, in the right population. Heart Rhythm 2020; 17:e269-e316. [PMID: 32553607 DOI: 10.1016/j.hrthm.2020.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/05/2020] [Indexed: 02/07/2023]
Affiliation(s)
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Alireza Sepehri Shamloo
- Department of Electrophysiology, Leipzig Heart Center at University of Leipzig, Leipzig, Germany
| | - Alberto Alfie
- Division of Electrophysiology, Instituto Cardiovascular Adventista, Clinica Bazterrica, Buenos Aires, Argentina
| | - Serge Boveda
- Department of Cardiology, Clinique Pasteur, Toulouse, France
| | - Nikolaos Dagres
- Department of Electrophysiology, Leipzig Heart Center at University of Leipzig, Leipzig, Germany
| | - Dario Di Toro
- Department of Cardiology, Division of Electrophysiology, Argerich Hospital and CEMIC, Buenos Aires, Argentina
| | - Lee L Eckhardt
- Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Kenneth Ellenbogen
- Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Carina Hardy
- Arrhythmia Unit, Heart Institute, University of São Paulo Medical School, Instituto do Coração -InCor- Faculdade de Medicina de São Paulo, São Paulo, Brazil
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Aparna Jaswal
- Department of Cardiac Electrophysiology, Fortis Escorts Heart Institute, Okhla Road, New Delhi, India
| | - Elizabeth Kaufman
- The Heart and Vascular Research Center, Metrohealth Campus of Case Western Reserve University, Cleveland, Ohio, USA
| | - Andrew Krahn
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Kengo Kusano
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Valentina Kutyifa
- University of Rochester, Medical Center, Rochester, New York, USA; Semmelweis University, Heart and Vascular Center, Budapest, Hungary
| | - Han S Lim
- Department of Cardiology, Austin Health, Melbourne, VIC, Australia; University of Melbourne, Melbourne, VIC, Australia
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Santiago Nava-Townsend
- Department of Electrocardiology, National Institute of Cardiology "Ignacio Chavez," Mexico City, Mexico
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Republic of Korea
| | - Gerardo Rodríguez Diez
- Department of Electrophysiology and Hemodynamic, Arrhytmias Unity, CMN 20 de Noviembre, ISSSTE, Mexico City, Mexico
| | - William Sauer
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Anil Saxena
- Department of Cardiac Electrophysiology, Fortis Escorts Heart Institute, Okhla Road, New Delhi, India
| | - Jesper Hastrup Svendsen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Diego Vanegas
- Hospital Militar Central, Fundarritmia, Bogotá, Colombia
| | - Marmar Vaseghi
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Arthur Wilde
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam, the Netherlands
| | - T Jared Bunch
- Department of Medicine, Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah, USA
| | | | - Alfred E Buxton
- Department of Medicine, The Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Lars Eckardt
- Department for Cardiology, Electrophysiology, University Hospital Münster, Münster, Germany
| | - Heidi Estner
- Department of Medicine, I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany
| | - Anne M Gillis
- University of Calgary - Libin Cardiovascular Institute of Alberta, Calgary, Canada
| | - Rodrigo Isa
- Clínica RedSalud Vitacura and Hospital el Carmen de Maipú, Santiago, Chile
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | | | - Joshua D Moss
- Department of Cardiac Electrophysiology, University of California San Francisco, San Francisco, California, USA
| | - Gi-Byung Nam
- Division of Cardiology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
| | - Brian Olshansky
- University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | | | - Mauricio Pimentel
- Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Mukund Prabhu
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Wendy S Tzou
- Department of Cardiology/Cardiac Electrophysiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum, Clinic for Electrophysiology, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | | | - Alejandro Vidal
- Division of Cardiology, McGill University Health Center, Montreal, Canada
| | - Thomas Deneke
- Clinic for Cardiology II (Interventional Electrophysiology), Heart Center Bad Neustadt, Bad Neustadt a.d. Saale, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Leipzig Heart Center at University of Leipzig, Leipzig, Germany
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28
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Nielsen JC, Lin YJ, de Oliveira Figueiredo MJ, Sepehri Shamloo A, Alfie A, Boveda S, Dagres N, Di Toro D, Eckhardt LL, Ellenbogen K, Hardy C, Ikeda T, Jaswal A, Kaufman E, Krahn A, Kusano K, Kutyifa V, S Lim H, Lip GYH, Nava-Townsend S, Pak HN, Rodríguez Diez G, Sauer W, Saxena A, Svendsen JH, Vanegas D, Vaseghi M, Wilde A, Bunch TJ, Buxton AE, Calvimontes G, Chao TF, Eckardt L, Estner H, Gillis AM, Isa R, Kautzner J, Maury P, Moss JD, Nam GB, Olshansky B, Molano LFP, Pimentel M, Prabhu M, Tzou WS, Sommer P, Swampillai J, Vidal A, Deneke T, Hindricks G, Leclercq C. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on risk assessment in cardiac arrhythmias: use the right tool for the right outcome, in the right population. J Arrhythm 2020; 36:553-607. [PMID: 32782627 PMCID: PMC7411224 DOI: 10.1002/joa3.12338] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
| | - Yenn-Jiang Lin
- Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan
| | | | - Alireza Sepehri Shamloo
- Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany
| | - Alberto Alfie
- Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina
| | - Serge Boveda
- Department of Cardiology Clinique Pasteur Toulouse France
| | - Nikolaos Dagres
- Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany
| | - Dario Di Toro
- Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina
| | - Lee L Eckhardt
- Department of Medicine University of Wisconsin-Madison Madison WI USA
| | - Kenneth Ellenbogen
- Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA
| | - Carina Hardy
- Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil
| | - Takanori Ikeda
- Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan
| | - Aparna Jaswal
- Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India
| | - Elizabeth Kaufman
- The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA
| | - Andrew Krahn
- Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada
| | - Kengo Kusano
- Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan
| | - Valentina Kutyifa
- University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary
| | - Han S Lim
- Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark
| | - Santiago Nava-Townsend
- Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico
| | - Hui-Nam Pak
- Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea
| | - Gerardo Rodríguez Diez
- Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico
| | - William Sauer
- Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA
| | - Anil Saxena
- Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India
| | - Jesper Hastrup Svendsen
- Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands
| | | | - Marmar Vaseghi
- UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA
| | - Arthur Wilde
- Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | - T Jared Bunch
- Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Alfred E Buxton
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Gonzalo Calvimontes
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Tze-Fan Chao
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Lars Eckardt
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Heidi Estner
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Anne M Gillis
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Rodrigo Isa
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Josef Kautzner
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Philippe Maury
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Joshua D Moss
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Gi-Byung Nam
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Brian Olshansky
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Luis Fernando Pava Molano
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Mauricio Pimentel
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Mukund Prabhu
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Wendy S Tzou
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Philipp Sommer
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Janice Swampillai
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Alejandro Vidal
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Thomas Deneke
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Gerhard Hindricks
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
| | - Christophe Leclercq
- Department of Cardiology Aarhus University Hospital Skejby Denmark.,Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,Electrophysiology Service Department of Internal Medicine University of Campinas Hospital Campinas Brazil.,Department of Electrophysiology Leipzig Heart Center at University of Leipzig Leipzig Germany.,Division of Electrophysiology Instituto Cardiovascular Adventista Clinica Bazterrica Buenos Aires Argentina.,Department of Cardiology Clinique Pasteur Toulouse France.,Division of Electrophysiology Department of Cardiology Argerich Hospital and CEMIC Buenos Aires Argentina.,Department of Medicine University of Wisconsin-Madison Madison WI USA.,Division of Cardiology Virginia Commonwealth University School of Medicine Richmond USA.,Heart Institute University of São Paulo Medical School Arrhythmia Unit Instituto do Coração -InCor- Faculdade de Medicina de São Paulo São Paulo Brazil.,Faculty of Medicine Department of Cardiovascular Medicine Toho University Japan.,Department of Cardiac Electrophysiology Fortis Escorts Heart Institute New Delhi India.,The Heart and Vascular Research Center Metrohealth Campus of Case Western Reserve University Cleveland OH USA.,Division of Cardiology Department of Medicine University of British Columbia Vancouver Canada.,Division of Arrthythmia and Electrophysiology Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.,University of Rochester Medical Center Rochester USA.,Heart and Vascular Center Semmelweis University Budapest Hungary.,Department of Cardiology Austin Health Melbourne VIC Australia.,Cardiovascular Medicine University of Melbourne Melbourne VIC Australia.,Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Department of Electrocardiology National Institute of Cardiology "Ignacio Chavez" Mexico City Mexico.,Division of Cardiology Department of Internal Medicine Yonsei University Health System Seoul Republic of Korea.,Department of Electrophysiology and Hemodynamic Arrhytmias Unity CMN 20 de Noviembre ISSSTE Mexico City Mexico.,Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston USA.,Department of Cardio Electrophysiology Fortis Escorts Heart Institute New Delhi India.,Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Amsterdam UMC University of Amsterdam Heart Center Department of Clinical and Experimental Cardiology Amsterdam The Netherlands.,Hospital Militar Central Bogotá Colombia.,UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine, at UCLA Los Angeles USA.,Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.,Department of Medicine Intermountain Heart Institute Intermountain Medical Center Salt Lake City USA
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Abstract
Premature ventricular complexes (PVCs) are extremely common, found in the majority of individuals undergoing long-term ambulatory monitoring. Increasing age, a taller height, a higher blood pressure, a history of heart disease, performance of less physical activity, and smoking each predict a greater PVC frequency. Although the fundamental causes of PVCs remain largely unknown, potential mechanisms for any given PVC include triggered activity, automaticity, and reentry. PVCs are commonly asymptomatic but can also result in palpitations, dyspnea, presyncope, and fatigue. The history, physical examination, and 12-lead ECG are each critical to the diagnosis and evaluation of a PVC. An echocardiogram is indicated in the presence of symptoms or particularly frequent PVCs, and cardiac magnetic resonance imaging is helpful when the evaluation suggests the presence of associated structural heart disease. Ambulatory monitoring is required to assess PVC frequency. The prognosis of those with PVCs is variable, with ongoing uncertainty regarding the most informative predictors of adverse outcomes. An increased PVC frequency may be a risk factor for heart failure and death, and the resolution of systolic dysfunction after successful catheter ablation of PVCs demonstrates that a causal relationship can be present. Patients with no or mild symptoms, a low PVC burden, and normal ventricular function may be best served with simple reassurance. Either medical treatment or catheter ablation are considered first-line therapies in most patients with PVCs associated with symptoms or a reduced left ventricular ejection fraction, and patient preference plays a role in determining which to try first. If medical treatment is selected, either β-blockers or nondihydropyridine calcium channel blockers are reasonable drugs in patients with normal ventricular systolic function. Other antiarrhythmic drugs should be considered if those initial drugs fail and ablation has been declined, has been unsuccessful, or has been deemed inappropriate. Catheter ablation is the most efficacious approach to eradicate PVCs but may confer increased upfront risks. Original research remains necessary to identify individuals at risk for PVC-induced cardiomyopathy and to identify preventative and therapeutic approaches targeting the root causes of PVCs to maximize effectiveness while minimizing risk.
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Affiliation(s)
- Gregory M. Marcus
- Electrophysiology Section, Division of Cardiology, University of California, San Francisco
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30
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Premature ventricular contractions in patients with an implantable cardioverter defibrillator cardiac resynchronization therapy device: Results from the UMBRELLA registry. Indian Pacing Electrophysiol J 2020; 20:91-96. [PMID: 32165268 PMCID: PMC7244862 DOI: 10.1016/j.ipej.2020.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/02/2020] [Accepted: 03/04/2020] [Indexed: 12/04/2022] Open
Abstract
Background Premature ventricular contractions (PVC) are known to reduce the percentage of biventricular (BiV) pacing in patients with cardiac resynchronization (CRT), decreasing the clinical response. The aim of this study was to evaluate the prevalence of a high PVC burden, as well as therapeutic action (pharmacotherapy, catheter ablation or device programming), in a large CRT implantable-defibrillator (CRT-D) population. Methods Patients with a CRT-D device from the UMBRELLA multicenter prospective remote monitoring registry were included. The PVC count was collected from each remote monitoring transmission. Patients were divided into two high (≥1 transmission ≥200/≥400 PVC/h, respectively) and one low (all transmissions <200 PVC/h) PVC count groups. The PVC burden following a high PVC count transmission was calculated. Results Of 1268 patients, 135 (11%) and 43 (3.4%) presented high PVC count (≥200/≥400 PVC/h, respectively). The majority of patients in the high PVC groups were not treated (61 [79%] and 32 [74%], respectively. Considering the untreated patients in the high PVC groups, median PVC/h was 199 (interquartile range [IQR]: 196) and 271 (IQR: 330), respectively. The PVC burden (proportion of time with PVC/h ≥ 200/≥400) was 40% (IQR 70) and 29% (IQR 59), respectively. Conclusion A significant proportion of CRT-D patients presented a high PVC count, however, few received treatment. In the untreated patients with a high PVC count, the PVC burden during follow-up varied substantially. Several consecutive recordings of a high PVC count should be warranted before considering therapeutic action such as catheter ablation. This study shows that in a large CRT-D population (UMBRELLA registry) a significant proportion presented a high PVC burden. A minority received treatment aimed at reducing PVC, possibly since the high PVC count was missed during the remote transmission follow-up. In untreated patients with high PVC burden temporal trends varied substantially. Several consecutive recordings of a high PVC burden should be warranted before considering therapeutic action such as catheter ablation.
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31
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Santangeli P, Marchlinski FE. Ablation Therapy for Refractory Ventricular Arrhythmias. Annu Rev Med 2020; 71:177-190. [PMID: 31747356 DOI: 10.1146/annurev-med-041818-020033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Recurrent ventricular arrhythmias (VAs) are a leading cause of cardiovascular morbidity and mortality. In the last three decades, important advancements have occurred in the understanding of the mechanisms of recurrent VAs, their prognostic implications in different clinical contexts, and their treatment options. VAs occur in structurally normal hearts as well as in patients with underlying heart disease, but the latter group has a particularly high risk of recurrent VAs. Catheter ablation offers the possibility of cure for a substantial proportion of patients. Research has focused on identifying optimal targets for ablation, correlating the underlying structural abnormalities with the site of origin of VAs, and determining the optimal procedural approach. Ablation therapy can be life-saving in select patients with high burden of repetitive VAs or advanced heart failure syndromes. This article focuses on clinical aspects of catheter ablation of VAs, particularly the selection and clinical management of patients undergoing catheter ablation procedures and expected outcomes.
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Affiliation(s)
- Pasquale Santangeli
- Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA; ,
| | - Francis E Marchlinski
- Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA; ,
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32
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El Joueid N, Touma Boulos M, Abou Jaoude S, Daou L. Ventricular Tachycardia in an Infant Without Congenital Anomaly: A Case Report. Cardiol Res 2020; 11:61-65. [PMID: 32095198 PMCID: PMC7011923 DOI: 10.14740/cr1005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 01/08/2020] [Indexed: 11/30/2022] Open
Abstract
Ventricular tachycardia (VT) is a serious form of arrhythmia that can be life-threatening; that’s why diagnosis and treatment are very important in order to avoid serious complications. We are reporting this case of VT which is a rare entity, especially, in healthy infants. This infant, without cardiac pathology known from birth, presented with poor food intake and grunting with hepatomegaly on clinical examination, and a heartbeat at 200/ min. The electrocardiogram (ECG) showed wide QRS complex tachycardia, and the echocardiogram showed a dilated and hypokinetic cardiomyopathy. The clinical signs and chest X-ray changes were consistent with mild cardiac failure. This presentation makes the diagnosis challenging, therefore, it is important to take a good history of the case with a complete clinical exam to achieve the correct diagnosis, and to avoid potential complications. VT of an infant may be benign but should not be diagnosed as such before eliminating serious causes.
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Affiliation(s)
- Nouhad El Joueid
- Pediatric Department, Hotel-Dieu de France University Hospital, Saint Joseph University, Medical School, Alfred Naccache Boulevard, Achrafieh, Beirut, Lebanon
| | - Marianne Touma Boulos
- Pediatric Department, Hotel-Dieu de France University Hospital, Saint Joseph University, Medical School, Alfred Naccache Boulevard, Achrafieh, Beirut, Lebanon
| | - Simon Abou Jaoude
- Cardiology Department, Hotel-Dieu de France University Hospital, Saint Joseph University, Medical School, Alfred Naccache Boulevard, Achrafieh, Beirut, Lebanon
| | - Linda Daou
- Pediatric Cardiology Department, Hotel-Dieu de France University Hospital, Saint Joseph University, Medical School, Alfred Naccache Boulevard, Achrafieh, Beirut,Lebanon
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Li J, Xu C, Liu Y, Li Y, Du S, Zhang R, Sun Y, Zhang R, Wang Y, Xue H, Ni S, Asiya M, Xue G, Li Y, Shi L, Li D, Pan Z, Zhang Y, Wang Z, Cai B, Wang N, Yang B. Fibroblast growth factor 21 inhibited ischemic arrhythmias via targeting miR-143/EGR1 axis. Basic Res Cardiol 2020; 115:9. [PMID: 31900593 DOI: 10.1007/s00395-019-0768-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 12/16/2019] [Indexed: 12/26/2022]
Abstract
Ventricular arrhythmia is the most common cause of sudden cardiac death in patients with myocardial infarction (MI). Fibroblast growth factor 21 (FGF21) has been shown to play an important role in cardiovascular and metabolic diseases. However, the effects of FGF21 on ventricular arrhythmias following MI have not been addressed yet. The present study was conducted to investigate the pharmacological action of FGF21 on ventricular arrhythmias after MI. Adult male mice were administrated with or without recombinant human basic FGF21 (rhbFGF21), and the susceptibility to arrhythmias was assessed by programmed electrical stimulation and optical mapping techniques. Here, we found that rhbFGF21 administration reduced the occurrence of ventricular tachycardia (VT), improved epicardial conduction velocity and shorted action potential duration at 90% (APD90) in infarcted mouse hearts. Mechanistically, FGF21 may improve cardiac electrophysiological remodeling as characterized by the decrease of INa and IK1 current density in border zone of infarcted mouse hearts. Consistently, in vitro study also demonstrated that FGF21 may rescue oxidant stress-induced dysfunction of INa and IK1 currents in cultured ventricular myocytes. We further found that oxidant stress-induced down-regulation of early growth response protein 1 (EGR1) contributed to INa and IK1 reduction in post-infarcted hearts, and FGF21 may recruit EGR1 into the SCN5A and KCNJ2 promoter regions to up-regulate NaV1.5 and Kir2.1 expression at transcriptional level. Moreover, miR-143 was identified as upstream of EGR1 and mediated FGF21-induced EGR1 up-regulation in cardiomyocytes. Collectively, rhbFGF21 administration effectively suppressed ventricular arrhythmias in post-infarcted hearts by regulating miR-143-EGR1-NaV1.5/Kir2.1 axis, which provides novel therapeutic strategies for ischemic arrhythmias in clinics.
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Affiliation(s)
- Jiamin Li
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Medicine Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, 150081, China
| | - Chaoqian Xu
- Mudanjiang Medical University, Mudanjiang, 157000, China
| | - Yining Liu
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Medicine Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, 150081, China
| | - Yuanshi Li
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, 150086, China
| | - Sijia Du
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Medicine Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, 150081, China
| | - Ruijie Zhang
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Medicine Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, 150081, China
| | - Yuehang Sun
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Medicine Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, 150081, China
| | - Ronghao Zhang
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Medicine Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, 150081, China
| | - Ying Wang
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Medicine Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, 150081, China
| | - Hongru Xue
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Medicine Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, 150081, China
| | - Sha Ni
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Medicine Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, 150081, China
| | - Mavlikhanova Asiya
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Medicine Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, 150081, China
| | - Genlong Xue
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Medicine Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, 150081, China
| | - Yanyao Li
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Medicine Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, 150081, China
| | - Ling Shi
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Medicine Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, 150081, China
| | - Desheng Li
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Medicine Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, 150081, China
| | - Zhenwei Pan
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Medicine Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, 150081, China
| | - Yong Zhang
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Medicine Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, 150081, China
- Institute of Metabolic Disease, Heilongjiang Academy of Medical Science, Harbin, 150086, China
| | - Zhiguo Wang
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Medicine Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, 150081, China
| | - Benzhi Cai
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Medicine Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, 150081, China.
- Department of Pharmacy, The Second Affiliated Hospital of Harbin Medical University (Institute of Clinical Pharmacy, The University Key Laboratory of Drug Research, Heilongjiang Higher Education Institutions), Harbin, 150081, China.
| | - Ning Wang
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Medicine Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, 150081, China.
| | - Baofeng Yang
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Medicine Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, 150081, China.
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Goldenberg I, Huang DT, Nielsen JC. The role of implantable cardioverter-defibrillators and sudden cardiac death prevention: indications, device selection, and outcome. Eur Heart J 2019; 41:2003-2011. [DOI: 10.1093/eurheartj/ehz788] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/09/2019] [Accepted: 10/26/2019] [Indexed: 12/31/2022] Open
Abstract
Abstract
Multiple randomized multicentre clinical trials have established the role of the implantable cardioverter-defibrillator (ICD) as the mainstay in the treatment of ventricular tachyarrhythmias and sudden cardiac death (SCD) prevention. These trials have focused mainly on heart failure patients with advanced left ventricular dysfunction and were mostly conducted two decades ago, whereas a more recent trial has provided conflicting results. Therefore, much remains to be determined on how best to balance the identification of patients at high risk of SCD together with who would benefit most from ICD implantation in a contemporary setting. Implantable cardioverter-defibrillators have also evolved from the simple, defibrillation-only devices implanted surgically to more advanced technologies of multi-chamber devices, with physiologic bradycardic pacing, including cardiac resynchronization therapy, atrial and ventricular therapeutic pacing algorithms, and subcutaneous ICDs. These multiple options necessitate individualized approach to device selection and programming. This review will focus on the current knowledge on selection of patients for ICD treatment, device selection and programming, and future directions of implantable device therapy for SCD prevention.
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Affiliation(s)
- Ilan Goldenberg
- Division of Cardiology, Department of Medicine, The Clinical Cardiovascular Research Center, University of Rochester Medical Center, 265 Crittenden Blvd CU 420653, Rochester, NY 14642, USA
| | - David T Huang
- Division of Cardiology, Department of Medicine, The Clinical Cardiovascular Research Center, University of Rochester Medical Center, 265 Crittenden Blvd CU 420653, Rochester, NY 14642, USA
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
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Notbohm J, Napiwocki B, deLange W, Stempien A, Saraswathibhatla A, Craven R, Salick M, Ralphe J, Crone W. Two-Dimensional Culture Systems to Enable Mechanics-Based Assays for Stem Cell-Derived Cardiomyocytes. EXPERIMENTAL MECHANICS 2019; 59:1235-1248. [PMID: 31680699 PMCID: PMC6824432 DOI: 10.1007/s11340-019-00473-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 01/09/2019] [Indexed: 06/10/2023]
Abstract
Well-controlled 2D cell culture systems advance basic investigations in cell biology and provide innovative platforms for drug development, toxicity testing, and diagnostic assays. These cell culture systems have become more advanced in order to provide and to quantify the appropriate biomechanical and biochemical cues that mimic the milieu of conditions present in vivo. Here we present an innovative 2D cell culture system to investigate human stem cell-derived cardiomyocytes, the muscle cells of the heart responsible for pumping blood throughout the body. We designed our 2D cell culture platform to control intracellular features to produce adult-like cardiomyocyte organization with connectivity and anisotropic conduction comparable to the native heart, and combined it with optical microscopy to quantify cell-cell and cell-substrate mechanical interactions. We show the measurement of forces and displacements that occur within individual cells, between neighboring cells, and between cells and their surrounding matrix. This system has broad potential to expand our understanding of tissue physiology, with particular advantages for the study of the mechanically active heart. Furthermore, this technique should prove valuable in screening potential drugs for efficacy and testing for toxicity.
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Affiliation(s)
- J. Notbohm
- Department of Engineering Physics, University of Wisconsin-Madison, Madison WI, USA
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison WI, USA
| | - B.N. Napiwocki
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison WI, USA
- Wisconsin Institute for Discovery, University of Wisconsin-Madison, Madison WI, USA
| | - W.J. deLange
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - A. Stempien
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison WI, USA
- Wisconsin Institute for Discovery, University of Wisconsin-Madison, Madison WI, USA
| | - A. Saraswathibhatla
- Department of Engineering Physics, University of Wisconsin-Madison, Madison WI, USA
| | - R.J. Craven
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison WI, USA
- Wisconsin Institute for Discovery, University of Wisconsin-Madison, Madison WI, USA
| | - M.R. Salick
- Wisconsin Institute for Discovery, University of Wisconsin-Madison, Madison WI, USA
- Department of Materials Science and Engineering, University of Wisconsin-Madison, Madison WI, USA
| | - J.C. Ralphe
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - W.C. Crone
- Department of Engineering Physics, University of Wisconsin-Madison, Madison WI, USA
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison WI, USA
- Wisconsin Institute for Discovery, University of Wisconsin-Madison, Madison WI, USA
- Department of Materials Science and Engineering, University of Wisconsin-Madison, Madison WI, USA
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Tosun V, Korucuk N, Güntekin Ü. Akut anterior ST segment miyokard infarktüsü sonrası GRACE risk skorunun sol ventrikül ejeksiyon fraksiyonundaki prediktif değeri. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.459500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Abstract
Sudden cardiac death (SCD) accounts for ∼50% of mortality after myocardial infarction (MI). Most SCDs result from ventricular tachyarrhythmias, and the tachycardias that precipitate cardiac arrest result from multiple mechanisms. As a result, it is highly unlikely that any single test will identify all patients at risk for SCD. Current guidelines for use of implantable cardioverter-defibrillators (ICDs) to prevent SCD are based primarily on measurement of left ventricular ejection fraction (LVEF). Although reduced LVEF is associated with increased total cardiac mortality after MI, the focus of current guidelines on LVEF omits ∼50% of patients who die suddenly. In addition, there is no evidence of a mechanistic link between reduced LVEF and arrhythmias. Thus, LVEF is neither sensitive nor specific as a tool for post-MI risk stratification. Newer tests to screen for predisposition to ventricular arrhythmias and SCD examine abnormalities of ventricular repolarization, autonomic nervous system function, and electrical heterogeneity. These tests, as well as older methods such as programmed stimulation, the signal-averaged electrocardiogram, and spontaneous ventricular ectopy, do not perform well in patients with LVEF ≤30%. Recent observational studies suggest, however, that these tests may have greater utility in patients with LVEF >30%. Because SCD results from multiple mechanisms, it is likely that combinations of risk factors will prove more precise for risk stratification. Prospective trials that evaluate the performance of risk stratification schema to determine ICD use are necessary for cost-effective reduction of the incidence of SCD after MI.
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Affiliation(s)
- Jonathan W Waks
- Department of Medicine, Harvard Medical School, Boston, Massachusetts 02115.,Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215; ;
| | - Alfred E Buxton
- Department of Medicine, Harvard Medical School, Boston, Massachusetts 02115.,Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215; ;
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Left Atrial Function and Sudden Cardiac Death. Can J Cardiol 2019; 35:1091-1093. [DOI: 10.1016/j.cjca.2019.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 05/21/2019] [Accepted: 05/21/2019] [Indexed: 11/20/2022] Open
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Reshetnik A, Puppe S, Bonnemeier H. Central Sleep Apnoea and Arrhythmogenesis After Myocardial Infarction-The CESAAR Study. Front Cardiovasc Med 2019; 6:108. [PMID: 31448290 PMCID: PMC6691753 DOI: 10.3389/fcvm.2019.00108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/19/2019] [Indexed: 12/26/2022] Open
Abstract
The prevalence of sleep disordered breathing (SDB) after acute myocardial infarction (AMI) is high. However, little is known about predominant SDB type and the impact of SDB severity on arrhythmogenesis. We conducted a prospective single-center observational study and performed an unattended sleep study and Holter monitoring within 10 days after AMI, and an unattended sleep study 11.3 months after AMI. All patients were included from the Department of Cardiology at the University Hospital Schleswig-Holstein, Lübeck, Germany. A total of 202 subjects with AMI (73.8% with ST-elevation; 59.8 years; 73.8% male) were included. The mean BMI was 27.8 kg/m2 and the mean neck/waist circumference was 41.7/103.3 cm. The mean left ventricular ejection fraction was 56.6%. The SDB prevalence defined as apnoea-hypopnea-index (AHI) ≥ 5/h was 66.7% with 44.9% having central (CSA), and 21.8% obstructive sleep apnoea (OSA). The mean AHI was 13.8 1/h. In 10.2% nsVT was detected in the Holter monitoring. AI >23/h was independently associated with higher risk of nsVT in the subacute AMI period. SDB is highly prevalent and CSA a predominant type of SDB in the subacute phase after uncomplicated AMI treated with modern revascularization procedures and evidence-based pharmacological therapy. Severe SDB is independently associated with higher risk for nsVT in the subacute AMI period and its course should be monitored as it can potentially have a negative impact on relevant outcomes of AMI patients. Further prospective studies are needed to assess long-term follow up of SDB after AMI and its impact on mortality and morbidity.
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Affiliation(s)
- Alexander Reshetnik
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Nephrology, Berlin, Germany
| | - Swetlana Puppe
- Department of Psychiatry, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany
| | - Hendrik Bonnemeier
- Department of Cardiology, Universitätsklinik Schleswig-Holstein, Kiel, Germany
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Relation of multicenter automatic defibrillator implantation trial implantable cardioverter-defibrillator score with long-term cardiovascular events in patients with implantable cardioverter-defibrillator. North Clin Istanb 2019; 6:40-47. [PMID: 31180377 PMCID: PMC6526984 DOI: 10.14744/nci.2018.69335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 02/01/2018] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To test the hypothesis that multicenter automatic defibrillator implantation trial (MADIT) - implantable cardioverter-defibrillator (ICD) scores predict replacement requirement and appropriate shock in a mixed population including both primary and secondary prevention and long-term adverse cardiovascular events. METHODS The study has a retrospective design. Patients who were implanted with ICD in the cardiology clinic of Atatürk University Faculty of Medicine between 2000 and 2013 were included in the study. For this purpose, 1394 patients who were implanted with a device in our clinic were reviewed. Then, those who were implanted with permanent pacemaker (n=1005), cardiac resynchronization treatment (CRT) (n=45) and CRT-ICD (n=198) were excluded. RESULTS A total of 146 patients (98 males, 67.1%) with a mean age of 61.1 (±14.8) years were recruited. The median follow-up time was 21.5 months (mean 30.6±25.9 months; minimum 4 months, and maximum 120 months). The median MADIT-ICD scores in the patients were 2. MADIT-ICD scores were categorized as low in 15.1%, intermediate in 57.5%, and high score in 27.4% of patients. Accordingly, MADIT-ICD scores (1.29 [1.00-1.68], p=0.050), hemoglobin (0.86 [0.75-0.99], p=0.047), and left ventricular ejection fraction (EF) (0.97 [0.94-0.99], p=0.023) were determined as independent predictors of major adverse cardiovascular events in the long-term follow-up of ICD-implanted population. CONCLUSION In this study, we showed that there was an independent association of long-term adverse cardiovascular events with MADIT-ICD score, hemoglobin, and EF in patients implanted with ICD.
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Maqsood MH, Rubab K. The Role of the Cardioversion Defibrillator in Post Myocardial Infarction Sudden Cardiac Death: A Systematic Review of Clinical Trials and Observational Studies. Cureus 2019; 11:e4314. [PMID: 31183294 PMCID: PMC6538101 DOI: 10.7759/cureus.4314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 03/25/2019] [Indexed: 11/17/2022] Open
Abstract
Sudden cardiac death (SCD) accounts for approximately half of all the deaths attributed to cardiovascular disease in the United States. Survivors of an acute myocardial infarction (AMI) are at high risk of SCD, largely due to cardiac arrhythmias and severe left ventricular (LV) systolic dysfunction. The implantable cardioverter defibrillator (ICD) or automated implantable cardioverter defibrillator (AICD) is a device that is implantable inside the body, able to perform cardioversion, defibrillation, and (in modern versions) pacing of the heart. According to a study included in our review, patients who received an ICD contributed to an adjusted 44% reduction (hazard ratio [HR] 0.56, 95% CI: 0.32-1.01; P = 0.053) of all-cause mortality compared to those with a comparable baseline. Patients with an ICD implant three months after a myocardial infarction (MI) demonstrated a non-significantly higher mortality than patients who did not receive an ICD. The factors favoring ICD implantation were multiple MIs, increased resting heart rate, occurrence of non-sustained ventricular tachycardia, QRS duration = 120 ms, syncope events, anti-arrhythmic drug treatment (mostly Class III), and an index MI of more than one year. The likelihood of receiving an ICD diminished with the patient's age. Increased periodic repolarization dynamics were a significant predictor of mortality. It can be concluded that cardioverter defibrillators help reduce not only all-cause mortality but also sudden cardiac death. It is important to note that ICDs are only significant if implanted after a sufficient time-gap post-MI.
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Affiliation(s)
| | - Kinza Rubab
- Internal Medicine, King Edward Medical University / Mayo Hospital, Lahore, PAK
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Blackman AO, Sobral Neto J, Lima ML, Rodrigues TMA, Gomes OM. Assessment and clinical relevance of the dynamic parameters of ventricular repolarization in patients with grade I left ventricular diastolic dysfunction 1. Can J Physiol Pharmacol 2019; 97:577-580. [PMID: 30676775 DOI: 10.1139/cjpp-2018-0507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Imbalance in ventricular repolarization parameters are related to increased risk of severe arrhythmia and sudden cardiac death. There is limited research regarding markers to detect patients at risk in this early stage. We aimed to assess the influence of grade I left ventricular diastolic dysfunction on repolarization parameters in asymptomatic patients. Ambulatory patients with grade I left ventricular diastolic dysfunction were studied and compared with a control group. We assessed the QT dispersion circadian variation, heart rate variability in the time and frequency domains, and dynamics of QT using a 12-lead Holter. In the diastolic dysfunction group, 8 (30%) patients had QT dispersion > 80 ms. One (3.8%) patient presented premature ventricular complex > 10/h. The comparison between the 2 groups showed that the difference between the standard deviation of normal-to-normal intervals and low frequency power in both groups was statistically significant. We therefore conclude that increased parameters of ventricular repolarization and depressed heart rate variability reflect an imbalance in autonomic responses in patients with grade I left ventricular diastolic dysfunction without cardiovascular symptoms, enabling the identification of patients that are at a higher risk for cardiovascular events.
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Affiliation(s)
- Antoinette Oliveira Blackman
- a Instituto Cardiovascular São Francisco de Assis - Hospital Servcor, Belo Horizonte, MG, Brazil.,b Centro de Avaliação Cardiológica de Brasília - Centrocard, Brasília, DF, Brazil.,c Faculdade de Medicina, Uniceub, Brasília, DF, Brazil
| | - José Sobral Neto
- b Centro de Avaliação Cardiológica de Brasília - Centrocard, Brasília, DF, Brazil
| | - Melchior Luiz Lima
- a Instituto Cardiovascular São Francisco de Assis - Hospital Servcor, Belo Horizonte, MG, Brazil
| | | | - Otoni Moreira Gomes
- a Instituto Cardiovascular São Francisco de Assis - Hospital Servcor, Belo Horizonte, MG, Brazil
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Lee A, Walters TE, Gerstenfeld EP, Haqqani HM. Frequent Ventricular Ectopy: Implications and Outcomes. Heart Lung Circ 2019; 28:178-190. [DOI: 10.1016/j.hlc.2018.09.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/19/2018] [Accepted: 09/20/2018] [Indexed: 11/29/2022]
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Abstract
Se presenta un estudio nomenclatural y taxonómico sobre Chrysanthemum italicum L., C. achilleae L., C. tanacetifolium Pourr., Pyrethrum cinereum Griseb., P. clusii Fisch. ex Rchb., P. clusii Tausch, P. daucifolium Pers. y P. tenuifolium Ten., táxones que pertenecen al grupo crítico de Tanacetum corymbosum. Se propone una nueva clasificación infraespecífica de Tanacetum corymbosum (L.) Sch. Bip. s. l. y se reconocen cinco subespecies sobre la base de un estudio morfológico del material tipo y otros especímenes. Se proporciona una clave de diagnóstico de los táxones estudiados. Se propone también un cambio nomenclatural, i.e. Tanacetum corymbosum subsp. daucifolium (Pers.) Iamonico comb. nov. Se designan lectotipos para los nombres Chrysanthemum cinereum (espécimen conservado en GOET), Chrysanthemum achilleae (imagen de Micheli), Chrysanthemum italicum (en LINN), Pyrethrum clusii de Rechenbach (ilustración de Clusius), Pyrethrum tenuifolium (en G) y Pyrethrum clusii de Tausch (imagen de Clusius). Se designa un neotipo para Chrysanthemum tanacetifolium (en P).
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Risk Stratification of Sudden Cardiac Death in Patients with Heart Failure: An update. J Clin Med 2018; 7:jcm7110436. [PMID: 30423853 PMCID: PMC6262425 DOI: 10.3390/jcm7110436] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 10/29/2018] [Accepted: 11/06/2018] [Indexed: 12/15/2022] Open
Abstract
Heart failure (HF) is a complex clinical syndrome in which structural/functional myocardial abnormalities result in symptoms and signs of hypoperfusion and/or pulmonary or systemic congestion at rest or during exercise. More than 80% of deaths in patients with HF recognize a cardiovascular cause, with most being either sudden cardiac death (SCD) or death caused by progressive pump failure. Risk stratification of SCD in patients with HF and preserved (HFpEF) or reduced ejection fraction (HFrEF) represents a clinical challenge. This review will give an update of current strategies for SCD risk stratification in both HFrEF and HFpEF.
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Osman M, Ahmed A, Alzubi H, Kheiri B, Osman K, Barbarawi M, Ríos-Bedoya CF, Bachuwa G, Hassan M. Association between changes in the intrathoracic impedance and ventricular arrhythmias in patients with heart failure. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1577-1582. [PMID: 30362185 DOI: 10.1111/pace.13535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/21/2018] [Accepted: 08/04/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ventricular arrhythmias (VAs) are independently related to mortality risk in patients with heart failure (HF). The wide availability of implantable cardioverter defibrillators and cardiac resynchronization therapy devices now offers an opportunity to clinically correlate the two disease processes. We hypothesized that there is an association between changes in the intrathoracic impedance and episodes of VA. METHODS Nonconcurrent prospective study of adults (age >20 years) with known HF with reduced ejection fraction (<35%). The OptiVol threshold was categorized as follows: 0-30 Ω-days, 31-60 Ω-days, 61-90 Ω-days, 91-120 Ω-days, and >120 Ω-days. Patients with OptiVol values at 0-30 Ω-days were used as the reference group. Receiver operating characteristic analysis was used to estimate the sensitivity and specificity at each threshold. RESULTS Of the 87 eligible patients, 65.5% were males. The mean age of the sample was 73.3 years (±12.7). Compared to patients in the 0-30 Ω-days category, those in the 31-60, 61-90, 91-120, and >120 Ω-days groups had, on average, 1.48, 1.64, 2.24, and 1.6 more VAs, respectively (P = 0.002, 0.009, 0.010 and 0.009, respectively). The sensitivity and specificity of each threshold were as follows: 82.6% and 61.7% at 31-60 Ω-days, 43.5% and 78.3% at 61-90 Ω-days, 30.4% and 85.0% at 91-120 Ω-days, and 21.7% and 88.3% at >121 Ω-days. CONCLUSION Our study found a significant positive relationship between changes in intrathoracic impedance and episodes of VAs in patients with HF.
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Affiliation(s)
- Mohammed Osman
- Internal Medicine Department, Hurley Medical Center/Michigan State University, Flint, MI, USA.,Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Azza Ahmed
- Internal Medicine Department, Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Hussam Alzubi
- Internal Medicine Department, Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Babikir Kheiri
- Internal Medicine Department, Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Khansa Osman
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Mahmoud Barbarawi
- Internal Medicine Department, Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Carlos F Ríos-Bedoya
- Internal Medicine Department, Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Ghassan Bachuwa
- Internal Medicine Department, Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Mustafa Hassan
- Internal Medicine Department, Hurley Medical Center/Michigan State University, Flint, MI, USA
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Sohinki DA, Mathew ST. Ventricular Arrhythmias in the Patient with a Structurally Normal Heart. J Innov Card Rhythm Manag 2018; 9:3338-3353. [PMID: 32477784 PMCID: PMC7252725 DOI: 10.19102/icrm.2018.091004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 02/04/2018] [Indexed: 11/24/2022] Open
Abstract
Ventricular arrhythmias (VAs) are among the most common cardiac rhythm disturbances encountered in clinical practice. Patients presenting with frequent ventricular ectopy or sustained ventricular tachycardia represent a challenging and worrisome clinical scenario for many practitioners because of concerning symptoms, frequent associated acute hemodynamic compromise, and the adverse prognostic implications inherent to these cases. While an underlying structural or functional cardiac abnormality, metabolic derangement, or medication toxicity is often readily apparent, many patients have no obvious underlying condition, despite a comprehensive diagnostic evaluation. Such patients are diagnosed as having an idiopathic VA, which is a label with specific implications regarding arrhythmia origin, prognosis, and potential for pharmacologic and invasive management. Further, a subset of patients with otherwise benign idiopathic ventricular ectopy can present with polymorphic ventricular tachycardia and ventricular fibrillation, adding a layer of complexity to a clinical syndrome previously felt to have a benign clinical course. Thus, this review seeks to highlight the most common types of idiopathic VAs with a focus on their prognostic implications, underlying electrophysiologic mechanisms, unique electrocardiographic signatures, and considerations for invasive electrophysiologic study and catheter ablation. We further address some of the data regarding idiopathic ventricular fibrillation with respect to the heterogeneous nature of this diagnosis.
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Affiliation(s)
- Daniel A Sohinki
- Department of Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Sunil T Mathew
- Department of Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Aune D, Schlesinger S, Norat T, Riboli E. Body mass index, abdominal fatness, and the risk of sudden cardiac death: a systematic review and dose-response meta-analysis of prospective studies. Eur J Epidemiol 2018; 33:711-722. [PMID: 29417316 PMCID: PMC6061127 DOI: 10.1007/s10654-017-0353-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 12/26/2017] [Indexed: 12/11/2022]
Abstract
Although overweight and obesity are established risk factors for some types of heart disease including ischemic heart disease, heart failure and atrial fibrillation, less is known about the association between adiposity and sudden cardiac death. We conducted a systematic review and meta-analysis of prospective studies to clarify the association between adiposity and risk of sudden cardiac death. PubMed and Embase databases were searched up to July 20th 2017. Summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated using random effects models. The summary RR was 1.16 (95% CI 1.05-1.28, I2 = 68%, n = 14) per 5 unit increment in BMI, and 1.82 (95% CI 1.61-2.07, I2 = 0%, n = 3) per 0.1 unit increase in waist-to-hip ratio, and 1.03 (95% CI 0.93-1.15, I2 = 0%, n = 2) per 10 cm increase in waist circumference. The heterogeneity in the analysis of BMI and sudden cardiac death persisted across most subgroup analyses. The association was stronger among studies with longer follow-up compared to short follow-up and was observed in the European and American studies, but not in the Asian studies. There was a J-shaped association between BMI and sudden cardiac death and the lowest risk was observed in the normal weight range, however, the increased risk with a low BMI was attenuated among studies with a longer duration of follow-up. This meta-analysis suggest an increased risk of sudden cardiac death with increasing BMI and waist-to-hip ratio, however, further studies with stratification for smoking status are needed of waist circumference, weight changes and adiposity at younger ages.
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Affiliation(s)
- Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, Paddington, London, W2 1PG, UK.
- Bjørknes University College, Oslo, Norway.
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.
| | - Sabrina Schlesinger
- Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Teresa Norat
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, Paddington, London, W2 1PG, UK
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, Paddington, London, W2 1PG, UK
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Arsenos P, Gatzoulis KA, Dilaveris P, Sideris S, Tousoulis D. T wave alternans extracted from 30-minute short resting Holter ECG recordings predicts mortality in heart failure. J Electrocardiol 2018; 51:588-591. [PMID: 29996995 DOI: 10.1016/j.jelectrocard.2018.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 03/12/2018] [Accepted: 03/24/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND We extracted T Wave Alternans (TWA) from a 30 minute Short Resting Holter ECG (SRH ECG) in the supine position, as a Total Mortality (TM) predictor in Heart Failure (HF). METHODS Signals from 146 HF patients (LVEF = 33 ± 10%), were analyzed with Modified Moving Average method. After 42.1 months, 26 patients died. RESULTS (Deceased vs Living group): TWA:31 ± 18 μV vs 25 ± 13 μV(p = 0.05), LVEF:32 ± 10% vs 34 ± 9% (p = 0.5), Heart Rate:73 ± 11 bpm vs 69 ± 12 bpm (p = 0.2), SDNN/HRV:45 ± 42 ms vs 41 ± 29 ms (p = 0.4), QRS:123 ± 26 ms vs 119 ± 29 ms (p = 0.5).Cox regression model adjusted for TWA, LVEF and QRS, revealed that the TWA was an independent TM predictor (H.R.: 1.022, 95% C.I.: 0.999-1.046, p = 0.05).The TWA ≥ 42 μV demonstrated HR: 2.521, (95% C.I.: 0.982-6.472, p = 0.05). CONCLUSIONS In severely affected HF patients, TWA from a SRH ECG may be present even during slow resting heart rates and proved to be an important and independent TM predictor. The SRH ECG recording is an efficient and fast method for mortality risk evaluation in HF patients.
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Affiliation(s)
- Petros Arsenos
- First Department of Cardiology and Electrophysiology Laboratory, Hippokration General Hospital, National and Kapodistrian, University of Athens School of Medicine, Athens, Greece; Arsenos Heart and Biosignals Lab., Avlonas, Attica, Greece.
| | - Konstantinos A Gatzoulis
- First Department of Cardiology and Electrophysiology Laboratory, Hippokration General Hospital, National and Kapodistrian, University of Athens School of Medicine, Athens, Greece
| | - Polychronis Dilaveris
- First Department of Cardiology and Electrophysiology Laboratory, Hippokration General Hospital, National and Kapodistrian, University of Athens School of Medicine, Athens, Greece
| | - Skevos Sideris
- State Department of Cardiology, Hippokration General Hospital, Athens, Greece
| | - Dimitrios Tousoulis
- First Department of Cardiology and Electrophysiology Laboratory, Hippokration General Hospital, National and Kapodistrian, University of Athens School of Medicine, Athens, Greece
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50
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Abi-Saleh B. Water is a good electrical conductor! Int J Cardiol 2018; 262:64-65. [DOI: 10.1016/j.ijcard.2018.03.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 03/15/2018] [Indexed: 10/17/2022]
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