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Kotake Y, Huang K, Bennett R, De Silva K, Bhaskaran A, Kanawati J, Turnbull S, Zhou J, Campbell T, Kumar S. Efficacy and safety of catheter ablation as first-line therapy for the management of ventricular tachycardia. J Interv Card Electrophysiol 2023; 66:1701-1711. [PMID: 36754908 PMCID: PMC10547804 DOI: 10.1007/s10840-023-01483-2] [Citation(s) in RCA: 1] [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: 10/10/2022] [Accepted: 01/17/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Ventricular tachycardia (VT) is associated with significantly increased morbidity and mortality. Catheter ablation (CA) in line with an implantable cardioverter-defibrillator (ICD) is highly effective in VT management; however, it is unknown if CA should be considered as first-line therapy. The aim of this study is to verify the efficacy and safety of CA as first-line therapy for the first VT presentation (as adjunctive to ICD insertion), compared to initial ICD insertion and anti-arrhythmic drug (AAD) therapy. METHODS Data from patients with the first presentation for VT from January 2017 to January 2021 was reviewed. Patients were classified as "ablation first" vs "ICD first" groups and compared the clinical outcomes between groups. RESULTS One hundred and eighty-four consecutive patients presented with VT; 34 underwent CA as first-line therapy prior to ICD insertion, and 150 had ICD insertion/AAD therapy as first-line. During the median follow-up of 625 days, patients who underwent CA as first-line therapy had significantly higher ventricular arrhythmia (VA)-free survival (91% vs 59%, log-rank P = 0.002) and composite of VA recurrence, cardiovascular hospitalization, transplant, and death (84% vs 54%, log-rank P = 0.01) compared to those who did not undergo CA. Multivariate analysis revealed that first-line CA was the only protective predictor of VA recurrence (hazard ratio (HR) 0.20, P = 0.003). There were 3 (9%) peri-procedural complications with no peri-procedural deaths. CONCLUSION Real-world data supports the efficacy and safety of CA as first-line therapy at the time of the first VT hospitalization, compared to the initial ICD implant and AAD therapy.
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Affiliation(s)
- Yasuhito Kotake
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
- Westmead Applied Research Centre, University of Sydney, Corner Hawkesbury and Darcy Roads, Westmead, Sydney, NSW, 2145, Australia
| | - Kaimin Huang
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
- Westmead Applied Research Centre, University of Sydney, Corner Hawkesbury and Darcy Roads, Westmead, Sydney, NSW, 2145, Australia
| | - Richard Bennett
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
- Westmead Applied Research Centre, University of Sydney, Corner Hawkesbury and Darcy Roads, Westmead, Sydney, NSW, 2145, Australia
| | - Kasun De Silva
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
- Westmead Applied Research Centre, University of Sydney, Corner Hawkesbury and Darcy Roads, Westmead, Sydney, NSW, 2145, Australia
| | - Ashwin Bhaskaran
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
- Westmead Applied Research Centre, University of Sydney, Corner Hawkesbury and Darcy Roads, Westmead, Sydney, NSW, 2145, Australia
| | - Juliana Kanawati
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
- Westmead Applied Research Centre, University of Sydney, Corner Hawkesbury and Darcy Roads, Westmead, Sydney, NSW, 2145, Australia
| | - Samual Turnbull
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
- Westmead Applied Research Centre, University of Sydney, Corner Hawkesbury and Darcy Roads, Westmead, Sydney, NSW, 2145, Australia
| | - Julia Zhou
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
- Westmead Applied Research Centre, University of Sydney, Corner Hawkesbury and Darcy Roads, Westmead, Sydney, NSW, 2145, Australia
| | - Timothy Campbell
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
- Westmead Applied Research Centre, University of Sydney, Corner Hawkesbury and Darcy Roads, Westmead, Sydney, NSW, 2145, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia.
- Westmead Applied Research Centre, University of Sydney, Corner Hawkesbury and Darcy Roads, Westmead, Sydney, NSW, 2145, Australia.
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2
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Rao K, Danaila V, Bennett RG, Turnbull S, Campbell T, Kumar S. Correlation of exit sites of inducible ventricular tachycardia post-ST elevation myocardial infarction on electrophysiology study, with region of infarct. Intern Med J 2023; 53:1570-1580. [PMID: 36053941 DOI: 10.1111/imj.15891] [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: 03/30/2022] [Accepted: 07/18/2022] [Indexed: 09/26/2023]
Abstract
BACKGROUND Ventricular arrhythmia (VA) is the most common cause of sudden cardiac death post-ST elevation myocardial infarction (STEMI). Ventricular tachycardia (VT) may be inducible in electrophysiology studies (EPS) early (<40 days) post-STEMI. Whether it originates from the infarct site remains unknown. We examined the correlation between inducible VT and infarct location post-STEMI. AIMS To investigate the correlation between inducible VT and infarct location post-STEMI. METHODS We retrospectively analysed 46 patients from 2005 to 2017 with STEMI who underwent early programmed ventricular stimulation through EPS (>48 h post-STEMI and <40 days from admission). Gated heart pool scans were used to visualise infarct scar regions, and VT exit sites were derived from induction 12-lead electrocardiography. Patients were followed up for primary outcomes of recurrent VA and all-cause mortality. RESULTS Forty-six patients were included for analysis, with 50 uniquely induced VT exit sites. Mean left ventricular ejection fraction was 30 ± 8.7% and 22% had impaired right ventricular ejection fraction. Mean time from presentation to EPS was 16 ± 31.3 days. Of the induced VT, 44 (88%) were from within scar and scar-border regions, whereas 6 (12%) of the induced VT were found to be remote to imaging-derived scar. Over a median follow-up period of 75 months, 6 (13%) patients died, and 7 (15%) patients had recurrent VA. No deaths occurred in patients with remote VT. CONCLUSION The majority of early inducible post-infarct VT arises from acute myocardial scar; however, a small portion arises from sites remote from scars with a possible focal aetiology.
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Affiliation(s)
- Karan Rao
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
- Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Vlad Danaila
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Richard G Bennett
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
- Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Samual Turnbull
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
- Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Timothy Campbell
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
- Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
- Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
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3
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Morellato J, Chik W, Barry MA, Lu J, Thiagalingam A, Kovoor P, Pouliopoulos J. Quantitative spectral assessment of intracardiac electrogram characteristics associated with post infarct fibrosis and ventricular tachycardia. PLoS One 2018; 13:e0204997. [PMID: 30289934 PMCID: PMC6173422 DOI: 10.1371/journal.pone.0204997] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 09/18/2018] [Indexed: 12/15/2022] Open
Abstract
Background Post-myocardial infarction (MI) remodeling contributes to increased electrophysiological and structural heterogeneity and arrhythmogenesis. Utilising the post-infarct ovine model our aim was to determine unipolar electrogram frequency characteristics consequent to this remodeling and the development of Ventricular Tachycardia (VT). Methods and results Mapping studies were performed on 14 sheep at >1 month post-MI induction. Sheep were divided into VT inducible (n = 7) and non-inducible (n = 7) groups. Multielectrode needles (n = 20) were deployed within and surrounding ventricular scar for electrophysiological assessment of electrogram amplitude and width. Spectral analysis of electrograms was undertaken using wavelet and fast fourier transformations (WFFT) to calculate root mean square (RMS) power intervals spanning 0-300Hz in 20Hz intervals. Quantitative assessment between electrophysiological and histological parameters including collagen density, and structural organization of the myocardium was performed. Increasing myocardial scar density resulted in attenuation of electrogram amplitude and RMS values. (all p<0.01). Between groups there were no differences in electrogram amplitude (p = 0.37), however WFFT analysis revealed significantly higher RMS values in the VT group (p<0.05) in association with high frequency fractional components of the electrogram. As scar density increased, greater between-group differences in RMS were observed spanning this high frequency (200-280Hz) spectrum and which were proportionally dependent on the degree of structural disorganisation of the myocardium (p<0.001) and number of extrastimuli required to induce VT (p<0.05). Conclusion High frequency unipolar electrogram spectral characteristics were quantitatively co-influenced by the presence of fibrosis and degree of myocardial structural dissorganisation and were associated with the propensity for development of VT.
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Affiliation(s)
| | - William Chik
- University of Sydney, Sydney, Australia
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - M. A. Barry
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Juntang Lu
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Aravinda Thiagalingam
- University of Sydney, Sydney, Australia
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Pramesh Kovoor
- University of Sydney, Sydney, Australia
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Jim Pouliopoulos
- University of Sydney, Sydney, Australia
- Department of Cardiology, Westmead Hospital, Sydney, Australia
- * E-mail: ,
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4
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Influence of BMI on inducible ventricular tachycardia and mortality in patients with myocardial infarction and left ventricular dysfunction: The obesity paradox. Int J Cardiol 2018; 265:148-154. [DOI: 10.1016/j.ijcard.2018.03.055] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/05/2018] [Accepted: 03/12/2018] [Indexed: 12/28/2022]
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5
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Romero J, Di Biase L, Diaz JC, Quispe R, Du X, Briceno D, Avendano R, Tedrow U, John RM, Michaud GF, Natale A, Stevenson WG, Kumar S. Early Versus Late Referral for Catheter Ablation of Ventricular Tachycardia in Patients With Structural Heart Disease: A Systematic Review and Meta-Analysis of Clinical Outcomes. JACC Clin Electrophysiol 2018; 4:374-382. [PMID: 30089564 DOI: 10.1016/j.jacep.2017.12.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 11/30/2017] [Accepted: 12/04/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVES This was a meta-analysis of published studies to examine the impact of early referral on outcomes after catheter ablation for ventricular tachycardia (VT) in patients with structural heart disease. BACKGROUND Patients are frequently referred for VT ablation after failure of antiarrhythmic drugs to control VT. Some studies have suggested that early referral might confer better outcomes. METHODS An electronic search was performed using major databases. The primary outcomes were long-term VT recurrence and total mortality. Secondary outcomes were acute procedural success and acute complications. RESULTS Three studies were included with a total of 980 patients (mean age 64 ± 12 years, 71% males). Mean follow-up was 29 ± 27 months. Early referral for VT ablation was associated with decreased VT recurrence and acute complications compared with late referral (relative risk: 0.69 [95% confidence interval: 0.58 to 0.82], p < 0.0001 and relative risk: 0.50 [95% confidence interval: 0.27 to 0.93], p = 0.03, respectively). There was no significant difference between early and late referral for total mortality and acute success. CONCLUSIONS Late referral for VT ablation was associated with worse outcomes (VT recurrence and acute complications) in patients with structural heart disease, which suggests that early referral for VT ablation might be a reasonable consideration in this patient population.
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Affiliation(s)
- Jorge Romero
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Luigi Di Biase
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Juan Carlos Diaz
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Renato Quispe
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Xianfeng Du
- Department of Cardiology, Ningbo First Hospital, Zhejiang Sheng, China
| | - David Briceno
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Ricardo Avendano
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Usha Tedrow
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Roy M John
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gregory F Michaud
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Andrea Natale
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - William G Stevenson
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts; Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Saurabh Kumar
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts; Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Westmead, New South Wales, Australia.
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6
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Penela D, Acosta J, Andreu D, Ortiz-Perez JT, Bosch X, Perea RJ, de Caralt TM, Fernández-Armenta J, Soto-Iglesias D, Prat-Gonzalez S, Borràs R, Mont L, Hervas V, Morales-Ruiz M, Jiménez W, Mira A, Donnelly J, Ekinci O, Lasalvia L, Berruezo A. Identification of the potentially arrhythmogenic substrate in the acute phase of ST-segment elevation myocardial infarction. Heart Rhythm 2017; 14:592-598. [DOI: 10.1016/j.hrthm.2017.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Indexed: 10/20/2022]
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7
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Yang LC, Zhang PP, Chen XM, Li CY, Sun J, Hou JW, Chen RH, Wang YP, Li YG. Semaphorin 3a transfection into the left stellate ganglion reduces susceptibility to ventricular arrhythmias after myocardial infarction in rats. Europace 2015; 18:1886-1896. [PMID: 26541708 DOI: 10.1093/europace/euv276] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 07/06/2015] [Indexed: 02/01/2023] Open
Abstract
AIMS Myocardial infarction (MI) induces neural remodelling of the left stellate ganglion (LSG), which may contribute to ischaemia-induced arrhythmias. The neural chemorepellent Semaphorin 3a (Sema3a) has been identified as a negative regulator of sympathetic innervation in the LSG and heart. We previously reported that overexpression of Sema3a in the border zone could reduce the arrhythmogenic effects of cardiac sympathetic hyperinnervation post-MI. This study investigated whether Sema3a overexpression within the LSG confers an antiarrhythmic effect after MI through decreasing extra- and intra-cardiac neural remodelling. METHODS AND RESULTS Sprague-Dawley rats were subjected to MI, and randomly allocated to intra-LSG microinjection of either phosphate-buffered saline (PBS), adenovirus encoding green fluorescent protein (AdGFP), or adenovirus encoding Sema3a (AdSema3a). Sham-operated rats served as controls. Two weeks after infarction, MI-induced nerve sprouting and sympathetic hyperinnervation in the LSG and myocardium were significantly attenuated by intra-LSG injection with AdSema3a, as assessed by immunohistochemistry and western blot analysis of growth-associated protein 43 and tyrosine hydroxylase. This was also confirmed by sympathetic nerve function changes assessed by cardiac norepinephrine content. Additionally, intra-LSG injection with AdSema3a alleviated MI-induced accumulation of dephosphorylated connexin 43 in the infarct border zone. Furthermore, Sema3a overexpression in the LSG reduced the incidence of inducible ventricular tachyarrhythmia by programmed electrical stimulation post-MI, and arrhythmia scores were significantly lower in the AdSema3a group than in the PBS and AdGFP groups. CONCLUSION Semaphorin 3a overexpression in the LSG ameliorates the inducibility of ventricular arrhythmias after MI, mainly through attenuation of neural remodelling within the cardiac-neuraxis.
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Affiliation(s)
- Ling-Chao Yang
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Peng-Pai Zhang
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Xiao-Meng Chen
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Chang-Yi Li
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Jian Sun
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Jian-Wen Hou
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Ren-Hua Chen
- Department of Cardiology, Ganzhou People Hospital, Ganzhou Hospital Affiliated to Nanchang University, Ganzhou, Jiangxi 341000, China
| | - Yue-Peng Wang
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Yi-Gang Li
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
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8
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Alex A, Li A, Tanzi RE, Zhou C. Optogenetic pacing in Drosophila melanogaster. SCIENCE ADVANCES 2015; 1:e1500639. [PMID: 26601299 PMCID: PMC4646813 DOI: 10.1126/sciadv.1500639] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 08/12/2015] [Indexed: 05/19/2023]
Abstract
Electrical stimulation is currently the gold standard for cardiac pacing. However, it is invasive and nonspecific for cardiac tissues. We recently developed a noninvasive cardiac pacing technique using optogenetic tools, which are widely used in neuroscience. Optogenetic pacing of the heart provides high spatial and temporal precisions, is specific for cardiac tissues, avoids artifacts associated with electrical stimulation, and therefore promises to be a powerful tool in basic cardiac research. We demonstrated optogenetic control of heart rhythm in a well-established model organism, Drosophila melanogaster. We developed transgenic flies expressing a light-gated cation channel, channelrhodopsin-2 (ChR2), specifically in their hearts and demonstrated successful optogenetic pacing of ChR2-expressing Drosophila at different developmental stages, including the larva, pupa, and adult stages. A high-speed and ultrahigh-resolution optical coherence microscopy imaging system that is capable of providing images at a rate of 130 frames/s with axial and transverse resolutions of 1.5 and 3.9 μm, respectively, was used to noninvasively monitor Drosophila cardiac function and its response to pacing stimulation. The development of a noninvasive integrated optical pacing and imaging system provides a novel platform for performing research studies in developmental cardiology.
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Affiliation(s)
- Aneesh Alex
- Department of Electrical and Computer Engineering, Lehigh University, Bethlehem, PA 18015, USA
- Center for Photonics and Nanoelectronics, Lehigh University, Bethlehem, PA 18015, USA
| | - Airong Li
- Genetics and Aging Research Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02129, USA
| | - Rudolph E. Tanzi
- Genetics and Aging Research Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02129, USA
- Corresponding author. E-mail: (R.E.T.); (C.Z.)
| | - Chao Zhou
- Department of Electrical and Computer Engineering, Lehigh University, Bethlehem, PA 18015, USA
- Center for Photonics and Nanoelectronics, Lehigh University, Bethlehem, PA 18015, USA
- Bioengineering Program, Lehigh University, Bethlehem, PA 18015, USA
- Corresponding author. E-mail: (R.E.T.); (C.Z.)
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9
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Nchimi A, Davin L, Georgiopoulos A, Lancellotti P. Value of cardiac MRI to evaluate ischemia-related ventricular arrhythmia substrates. Expert Rev Cardiovasc Ther 2015; 13:565-76. [DOI: 10.1586/14779072.2015.1030394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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10
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Dinov B, Arya A, Bertagnolli L, Schirripa V, Schoene K, Sommer P, Bollmann A, Rolf S, Hindricks G. Early Referral for Ablation of Scar-Related Ventricular Tachycardia Is Associated With Improved Acute and Long-Term Outcomes. Circ Arrhythm Electrophysiol 2014; 7:1144-51. [DOI: 10.1161/circep.114.001953] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
The effects of time to referral for catheter ablation (CA) of scar-related ventricular tachycardia (VT) on acute success, VT recurrence, and cardiac mortality are unclear.
Methods and Results—
We investigated 300 patients after CA of sustained VT. CA was performed within 30 days after the first documented VT in 75 (25%) patients (group 1), between 1 month and 1 year in 84 (28%) patients (group 2), and >1 year after the first VT occurrence in 141 (47%) patients (group 3). The end points were noninducibility of any VT after CA (acute success), VT recurrence and cardiac mortality after 2 years. Acute success was achieved in 66 (88%) patients in group 1, 68 (81%) in group 2, and in 99 (70.2%) in group 3 (
P
=0.008). During the 2-year follow-up period, VT recurred in 28 (37.3%) patients in group 1, 52 (61.9%) patients in group 2, and 91 (64.5%) patients in group 3 (
P
<0.0001). Recurrence-free survival was higher in group 1, as compared with group 2 (hazard ratio [HR], 1.85;
P
=0.009) and group 3 (HR, 2.04;
P
=0.001). No survival difference was observed between groups 1 and 2 (HR, 0.85;
P
=0.68) and groups 1 and 3 (HR, 1.13;
P
=0.73). β-blocker therapy, VT of ischemic origin, and complete success were associated with VT-free survival. VT recurrence (HR, 1.91;
P
=0.037) predicted cardiac mortality.
Conclusions—
CA of scar-related VT performed within 30 days after the first documented VT was associated with improved acute and long-term success. VT recurrence, but not the early referral for CA, was associated with cardiovascular mortality.
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Affiliation(s)
- Borislav Dinov
- From the Department of Cardiac Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Arash Arya
- From the Department of Cardiac Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Livio Bertagnolli
- From the Department of Cardiac Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Valentina Schirripa
- From the Department of Cardiac Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Katharina Schoene
- From the Department of Cardiac Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Philipp Sommer
- From the Department of Cardiac Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Andreas Bollmann
- From the Department of Cardiac Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Sascha Rolf
- From the Department of Cardiac Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Gerhard Hindricks
- From the Department of Cardiac Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
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11
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Zaman S, Kovoor P. Sudden cardiac death early after myocardial infarction: pathogenesis, risk stratification, and primary prevention. Circulation 2014; 129:2426-35. [PMID: 24914016 DOI: 10.1161/circulationaha.113.007497] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Sarah Zaman
- From the Westmead Hospital, Sydney, and University of Sydney, Sydney, Australia
| | - Pramesh Kovoor
- From the Westmead Hospital, Sydney, and University of Sydney, Sydney, Australia.
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12
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Thakkar JB, Zaman S, Byth K, Narayan A, Thiagalingam A, Chow C, Thomas SP, Sivagangabalan G, Farlow D, Barnett R, Kovoor P. Right ventricular dysfunction predisposes to inducible ventricular tachycardia at electrophysiology studies in patients with acute ST-segment-elevation myocardial infarction and reduced left ventricular ejection fraction. Circ Arrhythm Electrophysiol 2014; 7:898-905. [PMID: 25108742 DOI: 10.1161/circep.113.001594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Inducible ventricular tachycardia (VT) is a strong predictor of spontaneous ventricular tachyarrhythmia following ST-segment-elevation myocardial infarction. Reduced left ventricular ejection fraction (EF) predisposes patients to inducible VT after ST-segment-elevation myocardial infarction. However, the role of right ventricular (RV) dysfunction in predisposing to inducible VT has not been described previously. METHODS AND RESULTS Consecutive patients with ST-segment-elevation myocardial infarction treated with primary percutaneous coronary intervention underwent predischarge radionuclide gated heart pool scan to assess ventricular EF. The study cohort included patients with reduced left ventricular EF (left ventricular EF ≤40%) who underwent electrophysiology study (n=220) in an attempt to induce VT. We defined RV dysfunction as RVEF ≤35%. The end point was sustained monomorphic VT (cycle length ≥200 ms). This was considered a positive study. No inducible arrhythmia, ventricular fibrillation, or flutter (cycle length <200 ms) was considered a negative study. Infarct region, infarct-related artery, male sex, and RVEF ≤35% were univariable predictors of positive test. After multivariable analysis, RVEF ≤35% had the strongest association as an independent predictor of inducible VT at electrophysiology study (P<0.001; odds ratio, 5.8; 95% confidence interval, 3.005-11.262). CONCLUSIONS RV dysfunction (RVEF ≤35%) predisposed to inducible VT at electrophysiology study in patients with impaired left ventricular EF (≤40%) after acute ST-segment-elevation myocardial infarction treated with primary percutaneous coronary intervention.
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Affiliation(s)
- Jay B Thakkar
- From the Westmead Hospital, Westmead, Australia (J.B.T., S.Z., K.B., A.N., A.T., C.C., S.P.T., G.S., D.F., R.B., P.K.) and Sydney Medical School, University of Sydney, Sydney, Australia (J.B.T., A.T., C.C., S.P.T., G.S., P.K.)
| | - Sarah Zaman
- From the Westmead Hospital, Westmead, Australia (J.B.T., S.Z., K.B., A.N., A.T., C.C., S.P.T., G.S., D.F., R.B., P.K.) and Sydney Medical School, University of Sydney, Sydney, Australia (J.B.T., A.T., C.C., S.P.T., G.S., P.K.)
| | - Karen Byth
- From the Westmead Hospital, Westmead, Australia (J.B.T., S.Z., K.B., A.N., A.T., C.C., S.P.T., G.S., D.F., R.B., P.K.) and Sydney Medical School, University of Sydney, Sydney, Australia (J.B.T., A.T., C.C., S.P.T., G.S., P.K.)
| | - Arun Narayan
- From the Westmead Hospital, Westmead, Australia (J.B.T., S.Z., K.B., A.N., A.T., C.C., S.P.T., G.S., D.F., R.B., P.K.) and Sydney Medical School, University of Sydney, Sydney, Australia (J.B.T., A.T., C.C., S.P.T., G.S., P.K.)
| | - Aravinda Thiagalingam
- From the Westmead Hospital, Westmead, Australia (J.B.T., S.Z., K.B., A.N., A.T., C.C., S.P.T., G.S., D.F., R.B., P.K.) and Sydney Medical School, University of Sydney, Sydney, Australia (J.B.T., A.T., C.C., S.P.T., G.S., P.K.)
| | - Clara Chow
- From the Westmead Hospital, Westmead, Australia (J.B.T., S.Z., K.B., A.N., A.T., C.C., S.P.T., G.S., D.F., R.B., P.K.) and Sydney Medical School, University of Sydney, Sydney, Australia (J.B.T., A.T., C.C., S.P.T., G.S., P.K.)
| | - Stuart P Thomas
- From the Westmead Hospital, Westmead, Australia (J.B.T., S.Z., K.B., A.N., A.T., C.C., S.P.T., G.S., D.F., R.B., P.K.) and Sydney Medical School, University of Sydney, Sydney, Australia (J.B.T., A.T., C.C., S.P.T., G.S., P.K.)
| | - Gopal Sivagangabalan
- From the Westmead Hospital, Westmead, Australia (J.B.T., S.Z., K.B., A.N., A.T., C.C., S.P.T., G.S., D.F., R.B., P.K.) and Sydney Medical School, University of Sydney, Sydney, Australia (J.B.T., A.T., C.C., S.P.T., G.S., P.K.)
| | - David Farlow
- From the Westmead Hospital, Westmead, Australia (J.B.T., S.Z., K.B., A.N., A.T., C.C., S.P.T., G.S., D.F., R.B., P.K.) and Sydney Medical School, University of Sydney, Sydney, Australia (J.B.T., A.T., C.C., S.P.T., G.S., P.K.)
| | - Robert Barnett
- From the Westmead Hospital, Westmead, Australia (J.B.T., S.Z., K.B., A.N., A.T., C.C., S.P.T., G.S., D.F., R.B., P.K.) and Sydney Medical School, University of Sydney, Sydney, Australia (J.B.T., A.T., C.C., S.P.T., G.S., P.K.)
| | - Pramesh Kovoor
- From the Westmead Hospital, Westmead, Australia (J.B.T., S.Z., K.B., A.N., A.T., C.C., S.P.T., G.S., D.F., R.B., P.K.) and Sydney Medical School, University of Sydney, Sydney, Australia (J.B.T., A.T., C.C., S.P.T., G.S., P.K.).
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13
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Zaman S, Narayan A, Thiagalingam A, Sivagangabalan G, Thomas S, Ross DL, Kovoor P. What is the optimal left ventricular ejection fraction cut-off for risk stratification for primary prevention of sudden cardiac death early after myocardial infarction? Europace 2014; 16:1315-21. [DOI: 10.1093/europace/euu026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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14
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Hsieh CH, Chia EM, Huang K, Lu J, Barry M, Pouliopoulos J, Ross DL, Thomas SP, Kovoor P. Primary Radiofrequency Ablation of Ventricular Tachycardia Early After Myocardial Infarction. Circ Arrhythm Electrophysiol 2013; 6:1215-21. [DOI: 10.1161/circep.113.000447] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Ventricular tachycardia (VT) is a significant complication of myocardial infarction. Radiofrequency ablation for postinfarct VT is reserved for drug refractory VT or VT storms. Our hypothesis is that radiofrequency ablation in the early postinfarct period could abolish or diminish late recurrences of VT.
Methods and Results—
Myocardial infarct was induced by balloon occlusion of the left anterior descending artery in 35 sheep. The 25 survivors underwent programmed ventricular stimulation and electroanatomical mapping 8 days postinfarct. Animals with inducible VT (12 out of 25 animals) underwent immediate radiofrequency ablation. Further VT inductions were performed 100 and 200 days postinfarct. At day 8, 3.0±0.9 VT morphologies per animal were inducible. All were successfully ablated with 24±6 applications of radiofrequency energy. All had ablations on the left ventricular endocardium, and 67% had ablations on the right ventricular aspect of the interventricular septum. All targeted arrhythmias were successfully ablated acutely. One animal was euthanized because of hypotension from a serious pericardial effusion. The other 11 survived and remained arrhythmia free on subsequent inductions on the 100th and 200th days (
P
<0.001). The 13 animals without inducible VT remained noninducible at the subsequent studies. A historical control arm of 9 animals with inducible VT at day 8 remained inducible at day 100.
Conclusions—
Radiofrequency ablation on the eighth day after infarction abolished inducibility of VT at late induction studies ≤200 days in an ovine model. Early identification and ablation of VT after infarction may prevent or reduce late ventricular arrhythmias but needs to be validated in clinical studies.
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Affiliation(s)
- Calvin H.C. Hsieh
- From the Westmead Hospital and the University of Sydney, Sydney, Australia
| | - Ee-May Chia
- From the Westmead Hospital and the University of Sydney, Sydney, Australia
| | - Kaimin Huang
- From the Westmead Hospital and the University of Sydney, Sydney, Australia
| | - Juntang Lu
- From the Westmead Hospital and the University of Sydney, Sydney, Australia
| | - Michael Barry
- From the Westmead Hospital and the University of Sydney, Sydney, Australia
| | - Jim Pouliopoulos
- From the Westmead Hospital and the University of Sydney, Sydney, Australia
| | - David L. Ross
- From the Westmead Hospital and the University of Sydney, Sydney, Australia
| | - Stuart P. Thomas
- From the Westmead Hospital and the University of Sydney, Sydney, Australia
| | - Pramesh Kovoor
- From the Westmead Hospital and the University of Sydney, Sydney, Australia
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