1
|
Centner AM, Shiel EA, Farra W, Cannon EN, Landim-Vieira M, Salazar G, Chelko SP. High-Fat Diet Augments Myocardial Inflammation and Cardiac Dysfunction in Arrhythmogenic Cardiomyopathy. Nutrients 2024; 16:2087. [PMID: 38999835 PMCID: PMC11243382 DOI: 10.3390/nu16132087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 06/25/2024] [Accepted: 06/26/2024] [Indexed: 07/14/2024] Open
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a familial heart disease characterized by cardiac dysfunction, arrhythmias, and myocardial inflammation. Exercise and stress can influence the disease's progression. Thus, an investigation of whether a high-fat diet (HFD) contributes to ACM pathogenesis is warranted. In a robust ACM mouse model, 8-week-old Desmoglein-2 mutant (Dsg2mut/mut) mice were fed either an HFD or rodent chow for 8 weeks. Chow-fed wildtype (WT) mice served as controls. Echo- and electrocardiography images pre- and post-dietary intervention were obtained, and the lipid burden, inflammatory markers, and myocardial fibrosis were assessed at the study endpoint. HFD-fed Dsg2mut/mut mice showed numerous P-wave perturbations, reduced R-amplitude, left ventricle (LV) remodeling, and reduced ejection fraction (%LVEF). Notable elevations in plasma high-density lipoprotein (HDL) were observed, which correlated with the %LVEF. The myocardial inflammatory adipokines, adiponectin (AdipoQ) and fibroblast growth factor-1, were substantially elevated in HFD-fed Dsg2mut/mut mice, albeit no compounding effect was observed in cardiac fibrosis. The HFD not only potentiated cardiac dysfunction but additionally promoted adverse cardiac remodeling. Further investigation is warranted, particularly given elevated AdipoQ levels and the positive correlation of HDL with the %LVEF, which may suggest a protective effect. Altogether, the HFD worsened some, but not all, disease phenotypes in Dsg2mut/mut mice. Notwithstanding, diet may be a modifiable environmental factor in ACM disease progression.
Collapse
Affiliation(s)
- Ann M Centner
- Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, FL 32306, USA
| | - Emily A Shiel
- Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, FL 32306, USA
| | - Waleed Farra
- Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, FL 32306, USA
| | - Elisa N Cannon
- Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, FL 32306, USA
| | - Maicon Landim-Vieira
- Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, FL 32306, USA
| | - Gloria Salazar
- Department of Health, Nutrition, and Food Sciences, College of Education, Health, and Human Science, Florida State University, Center for Advancing Exercise and Nutrition Research on Aging (CAENRA), Tallahassee, FL 32306, USA
| | - Stephen P Chelko
- Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, FL 32306, USA
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21218, USA
| |
Collapse
|
2
|
van Pottelberghe S, Heine F, Van Dooren S, Hes F, Kupper N. Barriers and facilitators for the implementation of patient-centered care in cardiogenetics: a Delphi study among ERN GUARD-heart members. Eur J Hum Genet 2023; 31:1371-1380. [PMID: 36543931 PMCID: PMC9768771 DOI: 10.1038/s41431-022-01268-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 10/24/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
Current clinical practice regarding inherited cardiac conditions has a biomedical focus, while psychological and social expertize and capacity are often lacking. As patient-centered care entails a multidisciplinary approach, the present study (a) explores barriers and facilitators of implementing patient-centered care in cardiogenetics and (b) contrasts various stakeholder viewpoints and perceived influence. We performed a three-round modified Delphi study using the input of a virtual expert panel comprising 25 medical professionals, 9 psychosocial professionals working in cardiogenetics, and 6 patient representatives. In round 1, the brainstorming phase and workshop breakout sessions were transcribed verbatim, coded and processed into unique statements listed as barriers and facilitators. In round 2, we asked the expert panel to validate, add or revise the list of barriers and facilitators. In round 3, the most relevant barriers and facilitators were ranked in importance. The experts identified 6 barriers dispersed across various levels of implementation. Having a blind spot for the patient perspective was of the highest importance, while the lack of multidisciplinary communication was ranked the lowest. We selected 9 facilitators: 2 were workflow related, 5 advocated various aspects of increased multidisciplinarity, and 2 suggested improvements in patient communication. This study revealed health system and organizational barriers and facilitators predominantly in implementing patient-centered care and only some patient-level factors. Some barriers and facilitators may be addressed easily (e.g., improving communication), while others may prove more complicated (e.g., biomedical thinking). Close interdisciplinary collaboration seems to be needed to implement PCC in cardiogenetics successfully.
Collapse
Affiliation(s)
- Saar van Pottelberghe
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Clinical Sciences, research group Reproduction and Genetics, Centre for Medical Genetics, Laarbeeklaan 101, 1090, Brussels, Belgium.
- Member of the European Reference Network for rare, low prevalence and/or complex diseases of the heart: ERN GUARD-Heart, Amsterdam, the Netherlands.
| | - Fenja Heine
- Center of Research on Psychological disorders and Somatic diseases; Department of Medical & Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Sonia Van Dooren
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Clinical Sciences, research group Reproduction and Genetics, Centre for Medical Genetics, Laarbeeklaan 101, 1090, Brussels, Belgium
- Member of the European Reference Network for rare, low prevalence and/or complex diseases of the heart: ERN GUARD-Heart, Amsterdam, the Netherlands
| | - Frederik Hes
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Clinical Sciences, research group Reproduction and Genetics, Centre for Medical Genetics, Laarbeeklaan 101, 1090, Brussels, Belgium
- Member of the European Reference Network for rare, low prevalence and/or complex diseases of the heart: ERN GUARD-Heart, Amsterdam, the Netherlands
| | - Nina Kupper
- Center of Research on Psychological disorders and Somatic diseases; Department of Medical & Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| |
Collapse
|
3
|
Arbelo E, Protonotarios A, Gimeno JR, Arbustini E, Barriales-Villa R, Basso C, Bezzina CR, Biagini E, Blom NA, de Boer RA, De Winter T, Elliott PM, Flather M, Garcia-Pavia P, Haugaa KH, Ingles J, Jurcut RO, Klaassen S, Limongelli G, Loeys B, Mogensen J, Olivotto I, Pantazis A, Sharma S, Van Tintelen JP, Ware JS, Kaski JP. 2023 ESC Guidelines for the management of cardiomyopathies. Eur Heart J 2023; 44:3503-3626. [PMID: 37622657 DOI: 10.1093/eurheartj/ehad194] [Citation(s) in RCA: 279] [Impact Index Per Article: 279.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
|
4
|
Muller SA, Gasperetti A, Bosman LP, Schmidt AF, Baas AF, Amin AS, Houweling AC, Wilde AAM, Compagnucci P, Targetti M, Casella M, Calò L, Tondo C, van der Harst P, Asselbergs FW, van Tintelen JP, Oerlemans MIFJ, Te Riele ASJM. Individualized Family Screening for Arrhythmogenic Right Ventricular Cardiomyopathy. J Am Coll Cardiol 2023; 82:214-225. [PMID: 37210036 DOI: 10.1016/j.jacc.2023.05.005] [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: 12/19/2022] [Revised: 03/30/2023] [Accepted: 05/05/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Clinical guidelines recommend regular screening for arrhythmogenic right ventricular cardiomyopathy (ARVC) to monitor at-risk relatives, resulting in a significant burden on clinical resources. Prioritizing relatives on their probability of developing definite ARVC may provide more efficient patient care. OBJECTIVES The aim of this study was to determine the predictors and probability of ARVC development over time among at-risk relatives. METHODS A total of 136 relatives (46% men, median age 25.5 years [IQR: 15.8-44.4 years]) from the Netherlands Arrhythmogenic Cardiomyopathy Registry without definite ARVC by 2010 task force criteria were included. Phenotype was ascertained using electrocardiography, Holter monitoring, and cardiac imaging. Subjects were divided into groups with "possible ARVC" (only genetic or familial predisposition) and "borderline ARVC" (1 minor task force criterion plus genetic or familial predisposition). Cox regression was performed to determine predictors and multistate modeling to assess the probability of ARVC development. Results were replicated in an unrelated Italian cohort (57% men, median age 37.0 years [IQR: 25.4-50.4 years]). RESULTS At baseline, 93 subjects (68%) had possible ARVC, and 43 (32%) had borderline ARVC. Follow-up was available for 123 relatives (90%). After 8.1 years (IQR: 4.2-11.4 years), 41 (33%) had developed definite ARVC. Independent of baseline phenotype, symptomatic subjects (P = 0.014) and those 20 to 30 years of age (P = 0.002) had a higher hazard of developing definite ARVC. Furthermore, patients with borderline ARVC had a higher probability of developing definite ARVC compared with those with possible ARVC (1-year probability 13% vs 0.6%, 3-year probability 35% vs 5%; P < 0.01). External replication showed comparable results (P > 0.05). CONCLUSIONS Symptomatic relatives, those 20 to 30 years of age, and those with borderline ARVC have a higher probability of developing definite ARVC. These patients may benefit from more frequent follow-up, while others may be monitored less often.
Collapse
Affiliation(s)
- Steven A Muller
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands
| | - Alessio Gasperetti
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands; Division of Medicine, Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA; Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Laurens P Bosman
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Amand F Schmidt
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, United Kingdom; Amsterdam University Medical Centers, Department of Cardiology, University of Amsterdam, Amsterdam, the Netherlands
| | - Annette F Baas
- Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ahmad S Amin
- Amsterdam University Medical Centers, Department of Cardiology, University of Amsterdam, Amsterdam, the Netherlands
| | - Arjan C Houweling
- Amsterdam University Medical Centers, Department of Human Genetics, University of Amsterdam, Amsterdam, the Netherlands
| | - Arthur A M Wilde
- Amsterdam University Medical Centers, Department of Cardiology, University of Amsterdam, Amsterdam, the Netherlands
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti," Ancona, Italy
| | - Mattia Targetti
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti," Ancona, Italy
| | - Leonardo Calò
- Department of Cardiology, Policlinico Casilino, Rome, Italy
| | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Pim van der Harst
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Folkert W Asselbergs
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, United Kingdom; Amsterdam University Medical Centers, Department of Cardiology, University of Amsterdam, Amsterdam, the Netherlands; Health Data Research UK and Institute of Health Informatics, University College London, London, United Kingdom
| | - J Peter van Tintelen
- Netherlands Heart Institute, Utrecht, the Netherlands; Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - Anneline S J M Te Riele
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands.
| |
Collapse
|
5
|
Welkie R. Understanding arrhythmogenic right ventricular cardiomyopathy. JAAPA 2023; 36:1-6. [PMID: 37097786 DOI: 10.1097/01.jaa.0000918764.35264.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
ABSTRACT Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiac disease characterized by fibrofatty replacement of myocardial tissue and is an important cause of ventricular dysrhythmias, ventricular dysfunction, and sudden cardiac death. The clinical course and genetics of this condition are highly variable, and definitive diagnosis can be challenging, despite published diagnostic criteria. Recognizing symptoms and risk factors for ventricular dysrhythmias is key to managing affected patients and family members. High-intensity and endurance exercise is widely known to increase disease expression and progression; however, a safe exercise regimen remains uncertain, and a personalized approach to management should be considered. This article reviews the incidence, pathophysiology, diagnostic criteria, and treatment considerations for ARVC.
Collapse
Affiliation(s)
- Regina Welkie
- At the time this article was written, Regina Welkie was an assistant professor and clinical coordinator in the PA program at DeSales University in Center Valley, Pa. She now practices at Eastern Pennsylvania Gastroenterology and Liver Specialists, affiliated with Lehigh Valley Health Network in Allentown, Pa. The author has disclosed no potential conflicts of interest, financial or otherwise
| |
Collapse
|
6
|
Hutchens J, Frawley J, Sullivan EA. Quality of life and mental health of women who had cardiac disease in pregnancy and postpartum. BMC Pregnancy Childbirth 2022; 22:797. [PMID: 36307772 PMCID: PMC9617394 DOI: 10.1186/s12884-022-05123-x] [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: 07/11/2022] [Revised: 09/25/2022] [Accepted: 10/12/2022] [Indexed: 11/10/2022] Open
Abstract
Purpose Cardiac disease is a leading cause of maternal morbidity and mortality yet there is limited research on women’s experiences and quality of life (QoL) outcomes. The aim of this study is to explore the general and health-related QoL (HRQoL) and mental health outcomes for women who have experienced cardiac disease in pregnancy and the first 12 months postpartum (CDPP). Methods This exploratory descriptive study recruited 43 women with acquired, genetic and congenital CDPP. Patient reported outcomes measures (PROMs) used were: WHOQoL-Bref, a Kansas City Cardiac Questionnaire (KCCQ), the Depression, Anxiety and Stress Scales-21 (DASS-21), the Cardiac Anxiety Questionnaire (CAQ) plus newly developed questions. Results Women reported low health satisfaction (51.7/100), physical health (55.2/100) and low HRQoL (63.1/100). Women had clinically significant scores for depression (24%), anxiety (22%) and stress (19.5%) (DASS-21) and 44.5% scored at least moderate anxiety on the CAQ. Most women (83.7%) were advised to avoid pregnancy which 88.9% found “upsetting” to “devastating”; 10.0% were offered counselling. Most women were concerned about reduced longevity (88.1%), offspring developing a cardiac condition (73.8%), and the limitations on enjoyment of life (57.1%). Women missed medical appointments due to cost (25.03%) and difficulty arranging childcare (45.5%). Conclusion The majority of women reported inadequate information and counselling support, with women with CDPP having sustained impaired QoL and mental health outcomes. The new and modified questions relating to mothering and children reflected the primacy of mothering to women’s identity and needs. Supplementary information The online version contains supplementary material available at 10.1186/s12884-022-05123-x.
Collapse
|
7
|
Bosman LP, Nielsen Gerlach CL, Cadrin-Tourigny J, Orgeron G, Tichnell C, Murray B, Bourfiss M, van der Heijden JF, Yap SC, Zeppenfeld K, van den Berg MP, Wilde AAM, Asselbergs FW, Tandri H, Calkins H, van Tintelen JP, James CA, te Riele ASJM. Comparing clinical performance of current implantable cardioverter-defibrillator implantation recommendations in arrhythmogenic right ventricular cardiomyopathy. Europace 2022; 24:296-305. [PMID: 34468736 PMCID: PMC8824519 DOI: 10.1093/europace/euab162] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 06/14/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Arrhythmogenic right ventricular cardiomyopathy (ARVC) patients have an increased risk of ventricular arrhythmias (VA). Four implantable cardioverter-defibrillator (ICD) recommendation algorithms are available The International Task Force Consensus ('ITFC'), an ITFC modification by Orgeron et al. ('mITFC'), the AHA/HRS/ACC guideline for VA management ('AHA'), and the HRS expert consensus statement ('HRS'). This study aims to validate and compare the performance of these algorithms in ARVC. METHODS AND RESULTS We classified 617 definite ARVC patients (38.5 ± 15.1 years, 52.4% male, 39.2% prior sustained VA) according to four algorithms. Clinical performance was evaluated by sensitivity, specificity, ROC-analysis, and decision curve analysis for any sustained VA and for fast VA (>250 b.p.m.). During 6.4 [2.8-11.5] years follow-up, 282 (45.7%) patients experienced any sustained VA, and 63 (10.2%) fast VA. For any sustained VA, ITFC and mITFC provide higher sensitivity than AHA and HRS (94.0-97.8% vs. 76.7-83.5%), but lower specificity (15.9-32.0% vs. 42.7%-60.1%). Similarly, for fast VA, ITFC and mITFC provide higher sensitivity than AHA and HRS (95.2-97.1% vs. 76.7-78.4%) but lower specificity (42.7-43.1 vs. 76.7-78.4%). Decision curve analysis showed ITFC and mITFC to be superior for a 5-year sustained VA risk ICD indication threshold between 5-25% or 2-9% for fast VA. CONCLUSION The ITFC and mITFC provide the highest protection rates, whereas AHA and HRS decrease unnecessary ICD placements. ITFC or mITFC should be used if we consider the 5-year threshold for ICD indication to lie within 5-25% for sustained VA or 2-9% for fast VA. These data will inform decision-making for ICD placement in ARVC.
Collapse
Affiliation(s)
- Laurens P Bosman
- Netherlands Heart Institute, PO Box 19258, 3501 DG, Utrecht, The Netherlands
- Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - Claire L Nielsen Gerlach
- Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - Julia Cadrin-Tourigny
- Cardiovascular Genetics Center, Montreal Heart Institute, University of Montreal, 5000 Belanger St, Montreal H1T 1C8, Canada
| | - Gabriela Orgeron
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21287, USA
| | - Crystal Tichnell
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21287, USA
| | - Brittney Murray
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21287, USA
| | - Mimount Bourfiss
- Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - Jeroen F van der Heijden
- Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - Sing-Chien Yap
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Dr Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - Maarten P van den Berg
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
| | - Arthur A M Wilde
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Folkert W Asselbergs
- Netherlands Heart Institute, PO Box 19258, 3501 DG, Utrecht, The Netherlands
- Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - Hariskrishna Tandri
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21287, USA
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21287, USA
| | - J Peter van Tintelen
- Netherlands Heart Institute, PO Box 19258, 3501 DG, Utrecht, The Netherlands
- Department of Genetics, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - Cynthia A James
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21287, USA
| | - Anneline S J M te Riele
- Netherlands Heart Institute, PO Box 19258, 3501 DG, Utrecht, The Netherlands
- Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| |
Collapse
|
8
|
van den Heuvel LM, Sarina T, Sweeting J, Yeates L, Bates K, Spinks C, O’Donnell C, Sears SF, McGeechan K, Semsarian C, Ingles J. A Prospective Longitudinal Study of Health-Related Quality of Life and Psychological Wellbeing after an Implantable Cardioverter Defibrillator in Patients with Genetic Heart Diseases. Heart Rhythm O2 2022; 3:143-151. [PMID: 35496461 PMCID: PMC9043389 DOI: 10.1016/j.hroo.2022.02.003] [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] [Indexed: 11/09/2022] Open
Abstract
Background Genetic heart diseases (GHDs) can be clinically heterogeneous and pose an increased risk of sudden cardiac death (SCD). The implantable cardioverter-defibrillator (ICD) is a lifesaving therapy. Impacts on prospective and long-term psychological and health-related quality of life (HR-QoL) after ICD implant in patients with GHDs are unknown. Objectives Investigate the psychological functioning and HR-QoL over time in patients with GHDs who receive an ICD, and identify risk factors for poor psychological functioning and HR-QoL. Methods A longitudinal, prospective study design was used. Patients attending a specialized clinic, diagnosed with a GHD for which they received an ICD between May 2012 and January 2015, were eligible. Baseline surveys were completed prior to ICD implantation with 5-year follow-up after ICD implant. We measured psychological functioning (Hospital Anxiety Depression Scale, Florida Shock Anxiety Scale), HR-QoL (Short-Form 36v2), and device acceptance (Florida Patient Acceptance Scale). Results Forty patients were included (mean age 46.3 ± 14.2 years; 65.0% male). Mean psychological and HR-QoL measures were within normative ranges during follow-up. After 12 months, 33.3% and 19.4% of participants showed clinically elevated levels of anxiety and depression, respectively. Longitudinal mixed-effect analysis showed significant improvements from baseline to first follow-up for the overall cohort, with variability increasing after 36 months. Nontertiary education and female sex predicted worse mental HR-QoL and anxiety over time, while comorbidities predicted depression and worse physical HR-QoL. Conclusion While the majority of patients with a GHD adjust well to their ICD implant, a subset of patients experience poor psychological and HR-QoL outcomes.
Collapse
|
9
|
Finocchiaro G, Magavern EF, Georgioupoulos G, Maurizi N, Sinagra G, Carr-White G, Pantazis A, Olivotto I. Sudden cardiac death in cardiomyopathies: acting upon "acceptable" risk in the personalized medicine era. Heart Fail Rev 2022; 27:1749-1759. [PMID: 35083629 DOI: 10.1007/s10741-021-10198-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 11/04/2022]
Abstract
Patients with cardiomyopathies are confronted with the risk of sudden cardiac death (SCD) throughout their lifetime. Despite the fact that SCD is relatively rare, prognostic stratification is an integral part of physician-patient discussion, with the goal of risk modification and prevention. The current approach is based on a concept of "acceptable risk." However, there are intrinsic problems with an algorithm-based approach to risk management, magnified by the absence of robust evidence underlying clinical decision support tools, which can make high- versus low-risk classifications arbitrary. Strategies aimed at risk reduction range from selecting patients for an implantable cardioverter defibrillator (ICD) to disqualification from competitive sports. These clinical options, especially when implying the use of finite financial resources, are often delivered from the physician's perspective citing decision-making algorithms. When the burden of intervention-related risks or financial costs is deemed higher than an "acceptable risk" of SCD, the patient's perspective may not be appropriately considered. Designating a numeric threshold of "acceptable risk" has ethical implications. One could reasonably ask "acceptable to whom?" In an era when individual choice and autonomy are pillars of the physician-patient relationship, the subjective aspects of perceived risk should be acknowledged and be part of shared decision-making. This is particularly true when the lack of a strong scientific evidence base makes a dichotomous algorithm-driven approach suboptimal for unmitigated translation to clinical practice.
Collapse
Affiliation(s)
- Gherardo Finocchiaro
- Cardiothoracic Centre, Guy's and St Thomas' Hospital, London, UK. .,King's College London, London, UK. .,Royal Brompton Hospital, Sydney St, London, SW3 6NP, UK. .,Cardiovascular Clinical Academic Group, St George's, University of London, London, UK.
| | - Emma F Magavern
- The London School of Medicine and Dentistry, William Harvey Research Institute, Barts, London, UK.,Department of Clinical Pharmacology, Cardiovascular Medicine, Barts Health NHS Trust, London, UK
| | | | - Niccolo' Maurizi
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Gerald Carr-White
- Cardiothoracic Centre, Guy's and St Thomas' Hospital, London, UK.,King's College London, London, UK
| | | | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| |
Collapse
|
10
|
Sandhu U, Kovacs AH, Nazer B. Psychosocial symptoms of ventricular arrhythmias: Integrating patient-reported outcomes into clinical care. Heart Rhythm O2 2021; 2:832-839. [PMID: 34988534 PMCID: PMC8710626 DOI: 10.1016/j.hroo.2021.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Patient-reported outcome measures (PROMs) are a valuable metric for assessing the quality of life and overall well-being in patients with ventricular arrhythmias (VAs) and/or implantable cardioverter-defibrillators (ICDs). The incorporation of PROMs into the workflow of a VA clinic not only allows for more patient-centered care but also may improve detection and treatment of clinically relevant anxiety or depression symptoms. Awareness of the factors known to correlate with adverse PROM scores may guide PROM administration and subsequent referral to mental health services. Further, change or stability in PROM scores can be used as a gauge to guide the effectiveness of cardiac and psychological treatment in certain populations that are the focus of this manuscript: patients with ICDs (with and without shocks), cardiac arrest survivors, and those with inherited arrhythmia syndromes.
Collapse
Affiliation(s)
- Uday Sandhu
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Adrienne H. Kovacs
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Babak Nazer
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| |
Collapse
|
11
|
Murray B, Tichnell C, Burch AE, Calkins H, James CA. Strength of the genetic counselor: patient relationship is associated with extent of increased empowerment in patients with arrhythmogenic cardiomyopathy. J Genet Couns 2021; 31:388-397. [PMID: 34672408 DOI: 10.1002/jgc4.1499] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 08/05/2021] [Accepted: 08/11/2021] [Indexed: 11/09/2022]
Abstract
Genetic testing and genetic counseling (GC) are increasingly recommended in the cardiovascular setting, with multiple guidelines recommending GC for patients with or at risk for inherited cardiovascular conditions. There are scant data, however, describing patient outcomes to guide evidence-based care. No studies have quantified the influence of the strength of the genetic counselor:patient relationship on outcomes. Individuals referred for first time GC at the Johns Hopkins Arrhythmogenic Cardiomyopathy (ACM) center were surveyed prior to their visit and immediately after, before any genetic test results ordered at the session had been returned. Outcomes and measures were selected based on the Reciprocal Engagement Model of GC and include empowerment assessed by the Genetic Counseling Outcome Scale (GCOS), anxiety assessed by the Cardiac Anxiety Questionnaire (CAQ), and genetic counselor:patient therapeutic alliance assessed by the Working Alliance Inventory (WAI-SR). Response rate was 59% (120/203). 54 (45%) of patients had genetic testing ordered prior to their GC visit. There was a significant increase in GCOS score (mean 15.7 points) within 4 weeks post-GC session (p<.0001) with no significant difference in GCOS change between patients who had genetic testing ordered previously and those attending pre-test counseling (17.4 ± 18.2 versus. 14.1 ± 16 [p=.35]). Average CAQ score was high at baseline (1.67 ± 0.68), and there was a significant inverse relationship between pre-GC CAQ score and extent of increase in GCOS score (p=.008) post-GC. Controlling for baseline anxiety, there was a strong positive relationship between the WAI-SR score and GCOS change (B = 0.80, 95% CI: 0.43, 1.17, p<.001). These results demonstrate a significant increase in empowerment after GC in ACM patients and that this outcome is not reliant on the ordering of a genetic test but instead sensitive to the quality of the genetic counselor:patient relationship. Genetic counselors can strive to further improve empowerment by focusing on reducing pre-visit anxiety and alliance building with the patient.
Collapse
Affiliation(s)
- Brittney Murray
- Department of Medicine, Division of Cardiology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Crystal Tichnell
- Department of Medicine, Division of Cardiology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ashley E Burch
- Department of Health Services and Information Management, East Carolina University, Greenville, NC, USA
| | - Hugh Calkins
- Department of Medicine, Division of Cardiology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Cynthia A James
- Department of Medicine, Division of Cardiology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
12
|
Singh SM, Murray B, Tichnell C, McClellan R, James CA, Barth AS. Anxiety and depression in inherited channelopathy patients with implantable cardioverter-defibrillators. Heart Rhythm O2 2021; 2:388-393. [PMID: 34430944 PMCID: PMC8369306 DOI: 10.1016/j.hroo.2021.06.001] [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] [Indexed: 10/27/2022] Open
Abstract
Background Implantable cardioverter-defibrillators (ICDs) are an effective treatment in some patients with inherited heart disease, including inherited channelopathies, yet they have also been shown to impact patients' psychological health. Objective We sought to improve understanding of the level of anxiety and depression as well as device acceptance among inherited channelopathy patients with an ICD. Methods Eligible patients seen at Johns Hopkins Hospital were sent a survey, which included the Hospital Anxiety and Depression Scale (HADS), Cardiac Anxiety Questionnaire (CAQ), and the Florida Patient Acceptance Survey (FPAS). Student t tests and χ2 tests were used to identify associations with abnormal anxiety and depression scores. Results Among eligible patients (n = 65), 32 individuals (49%) completed the survey. The rate of device-related complications was 34%, and 41% of patients experienced 1 or more ICD shocks. Twelve patients (38%) had an abnormal HADS anxiety subscore and 5 patients (16%) had an abnormal HADS depression subscore (score ≥ 8). Secondary-prevention ICDs were associated with an abnormal HADS anxiety subscore (P = .03). Experiencing ICD shock(s), device complications, age, sex, and family history of sudden cardiac death were not statistically associated with anxiety or depression. Overall, respondents demonstrated high device acceptance by FPAS (79.9 ± 2.9, maximum total score 100) and moderately high cardiac-specific anxiety by CAQ total score (1.53 ± 0.12). Conclusion A high prevalence of generalized anxiety was identified among inherited channelopathy patients with ICDs. High device acceptance and lack of association with ICD shocks or complications indicate that further research is necessary to understand this increased incidence.
Collapse
Affiliation(s)
- Sajya M Singh
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brittney Murray
- Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Crystal Tichnell
- Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rebecca McClellan
- Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Cynthia A James
- Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andreas S Barth
- Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
13
|
Abstract
Arrhythmogenic right ventricular cardiomyopathy, formerly called "arrhythmogenic right ventricular dysplasia," is an under-recognized clinical entity characterized by ventricular arrhythmias and a characteristic ventricular pathology. Diagnosis is often difficult due to the nonspecific nature of the disease and the broad spectrum of phenotypic variations. Therefore, consensus diagnostic criteria have been developed which combine electrocardiographic, echocardiographic, cardiac magnetic resonance imaging and histologic criteria. In 1994, an international task force first proposed the major and minor diagnostic criteria of arrhythmogenic right ventricular cardiomyopathy based on family history, arrhythmias, electrocardiographic abnormalities, tissue characterization, and structural and functional right ventricular abnormalities. In 2010, the task force criteria were revised to include quantitative abnormalities. These diagnostic modalities and the most recent task force criteria are discussed in this review.
Collapse
|
14
|
Zhang N, Song Y, Hua W, Hu Y, Chen L, Cai M, Niu H, Cai C, Gu M, Zhao S, Zhang S. Left ventricular involvement assessed by LGE-CMR in predicting the risk of adverse outcomes of arrhythmogenic cardiomyopathy with ICDs. Int J Cardiol 2021; 337:79-85. [PMID: 33839174 DOI: 10.1016/j.ijcard.2021.04.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/23/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Arrhythmogenic cardiomyopathy (ACM) is characterized by a high incidence of ventricular tachyarrhythmia and sudden death. Implantable cardioverter-defibrillator (ICD) implantation is the cornerstone of management. OBJECTIVE This study aims to reveal the prognostic value of the contrast-enhanced cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) amount in predicting varying lethal outcomes among ACM patients with ICDs. METHODS The 88 patients with definite ACM who were all referred for contrast-enhanced CMR received an ICD and were followed up for a median of 4.0 years. RESULTS Fifty-four patients had no left ventricular (LV) involvement and sixteen had an LV LGE amount > 15%. During the follow-up time, appropriate ICD therapy was seen in 57, electrical storm (ES) in 19, and cardiac death in 9 patients. Compared with those without LV involvement, patients with LV LGE amount > 15% had a higher risk of cardiac death (log-rank P = 0.021). LV LGE amount was associated with an increased risk of ICD therapy [adjusted hazard ratio (HR) 1.035, 95% confidence interval (CI) 1.008-1.062, P = 0.010], and cardiac death (adjusted HR 1.082, 95% 1.006-1.164, P = 0.034), independently of LV ejection fraction. LV LGE mass of >15% demonstrated an over 2-fold increase in ICD therapy (adjusted HR 2.180, 95%CI 1.058-4.488, P = 0.035) and an over 7-fold increase in cardiac death (unadjusted HR 7.198, 95%CI 1.399-37.043, P = 0.018) than those without LV involvement, respectively. CONCLUSIONS The LV LGE-CMR in ACM shows a dose-dependent association with ICD therapy and cardiac death. And LV LGE amount of >15% is a strong predictor.
Collapse
Affiliation(s)
- Nixiao Zhang
- Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China; Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Yanyan Song
- Departments of CMR, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Wei Hua
- Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
| | - Yiran Hu
- Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Liang Chen
- Department of Cardiac Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Minsi Cai
- Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Hongxia Niu
- Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Chi Cai
- Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Min Gu
- Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Shihua Zhao
- Departments of CMR, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Shu Zhang
- Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| |
Collapse
|
15
|
Psychosocial Stress Hastens Disease Progression and Sudden Death in Mice with Arrhythmogenic Cardiomyopathy. J Clin Med 2020; 9:jcm9123804. [PMID: 33255451 PMCID: PMC7761318 DOI: 10.3390/jcm9123804] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 02/06/2023] Open
Abstract
Physiological stressors, such as exercise, can precipitate sudden cardiac death or heart failure progression in patients with arrhythmogenic cardiomyopathy (ACM). Yet, whether and to what extent a highly prevalent and more elusive environmental factor, such as psychosocial stress (PSS), can also increase ACM disease progression is unexplored. Here, we first quantified perceived stress levels in patients with ACM and found these levels correlated with the extent of arrhythmias and cardiac dysfunction. To determine whether the observed correlation is due to causation, we inflicted PSS-via the resident-intruder (RI) paradigm—upon Desmoglein-2 mutant mice, a vigorously used mammalian model of ACM. We found that ACM mice succumbed to abnormally high in-trial, PSS mortality. Conversely, no sudden deaths occurred in wildtype (WT) counterparts. Desmoglein-2 mice that survived RI challenge manifested markedly worse cardiac dysfunction and remodeling, namely apoptosis and fibrosis. Furthermore, WT and ACM mice displayed similar behavior at baseline, but Desmoglein-2 mice exhibited heightened anxiety following RI-induced PSS. This outcome correlated with the worsening of cardiac phenotypes. Our mouse model demonstrates that in ACM-like subjects, PSS is incisive enough to deteriorate cardiac structure and function per se, i.e., in the absence of any pre-existing anxious behavior. Hence, PSS may represent a previously underappreciated risk factor in ACM disease penetrance.
Collapse
|
16
|
O'Donovan CE, Skinner JR, Broadbent E. The trajectory of anxiety and depression in people presenting to a cardiac inherited disease service: a longitudinal study. Psychol Health 2020; 36:1260-1274. [PMID: 33090029 DOI: 10.1080/08870446.2020.1836181] [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: 10/23/2022]
Abstract
OBJECTIVE Little is known about the psychological experiences of individuals being investigated for cardiac inherited diseases (CID). This study aimed to assess the prevalence, trajectory and associated variables of anxiety and depression in this population. DESIGN This was a longitudinal study with 116 individuals being investigated for a CID; 85 (73%) completed follow-up. MAIN OUTCOME MEASURES Questionnaires were administered at the first appointment, post-disclosure of genetic results, and six-months later. Questionnaires measured demographic and psychological variables. The NZCID Registry provided clinical and genetic information. RESULTS Thirty-seven (43%) individuals reported clinical and subclinical levels of anxiety and/or depression at least once. Anxiety and depression at follow up were associated with anxiety (p < .001) and depression (p < .001) at baseline. Elevated anxiety and depression scores at any point were also associated with more reporting of somatic symptoms (p < .001), poorer social support (p < .01) and greater intolerance for uncertainty (p < .001). There were five different trajectories of anxiety and depression: stable-low, stable-high, increasing, decreasing and fluctuating. CONCLUSION A significant minority of individuals being investigated for a CID experience anxiety and depression. Ongoing screening for anxiety, depression, social support and somatic symptoms could help identify those individuals.
Collapse
Affiliation(s)
- Claire E O'Donovan
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Jonathan R Skinner
- Green Lane Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland, New Zealand.,Department of Paediatrics Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Elizabeth Broadbent
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
17
|
Ingles J. Psychological Issues in Managing Families with Inherited Cardiovascular Diseases. Cold Spring Harb Perspect Med 2020; 10:cshperspect.a036558. [PMID: 31548222 DOI: 10.1101/cshperspect.a036558] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The field of cardiovascular genetic counseling has evolved dramatically in recent years largely to manage the unique psychological needs of the inherited cardiovascular disease patient population. For many, there can be difficulty in coming to terms with a diagnosis, whether it be adjusting to lifestyle recommendations such as exclusion from competitive sports or living with a small but remarkable risk of sudden cardiac death. For those considered at risk of life-threatening ventricular arrhythmias, the decision to have an implantable cardioverter defibrillator can be difficult. Living with the device, especially for those who are young and those who receive multiple shocks, can precipitate psychological distress and poor adaptation to the device. Family members who experience a sudden cardiac death of a young relative have a significant risk of poor psychological outcomes. The roles of the cardiac genetic counselor in facilitating patients' adaptation to their diagnoses and management and recognizing when additional support from a clinical psychologist is needed are key to ensuring families receive the best possible care.
Collapse
Affiliation(s)
- Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Newtown, New South Wales NSW 2042, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales NSW 2000, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales NSW 2050, Australia
| |
Collapse
|
18
|
Mathew S, Saguner AM, Schenker N, Kaiser L, Zhang P, Yashuiro Y, Lemes C, Fink T, Maurer T, Santoro F, Wohlmuth P, Reißmann B, Heeger CH, Tilz R, Wissner E, Rillig A, Metzner A, Kuck KH, Ouyang F. Catheter Ablation of Ventricular Tachycardia in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia: A Sequential Approach. J Am Heart Assoc 2020; 8:e010365. [PMID: 30813830 PMCID: PMC6474920 DOI: 10.1161/jaha.118.010365] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background It has been suggested that endocardial and epicardial ablation of ventricular tachycardia (VT) improves outcome in arrhythmogenic right ventricular cardiomyopathy/dysplasia. We investigated our sequential approach for VT ablation in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia in a single center. Methods and Results We included 47 patients (44±16 years) with definite (81%) or borderline (19%) arrhythmogenic right ventricular cardiomyopathy/dysplasia between 1998 and 2016. Our ablation strategy was to target the endocardial substrate. Epicardial ablation was performed in case of acute ablation failure or lack of an endocardial substrate. Single and multiple procedural 1‐ and 5‐year outcome data for the first occurrence of the study end points (sustained VT/ventricular fibrillation, heart transplant, and death after the index procedure, and sustained VT/ventricular fibrillation for multiple procedures) are reported. Eighty‐one radiofrequency ablation procedures were performed (mean 1.7 per patient, range 1–4). Forty‐five (56%) ablation procedures were performed via an endocardial, 11 (13%) via an epicardial, and 25 (31%) via a combined endo‐ and epicardial approach. Complete acute success was achieved in 65 (80%) procedures, and partial success in 13 (16%). After a median follow‐up of 50.8 (interquartile range, [18.6; 99.2]) months after the index procedure, 17 (36%) patients were free from the primary end point. After multiple procedures, freedom from sustained VT/ventricular fibrillation was 63% (95% CI, 52–75) at 1 year, and 45% (95% CI, 34–61) at 5 years, with 36% of patients receiving only endocardial radiofrequency ablation. A trend (log rank P=0.058) towards an improved outcome using a combined endo‐/epicardial approach was observed after multiple procedures. Conclusion Endocardial ablation can be effective in a considerable number of arrhythmogenic right ventricular cardiomyopathy/dysplasia patients with VT, potentially obviating the need for an epicardial approach.
Collapse
Affiliation(s)
- Shibu Mathew
- 1 Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
| | - Ardan M Saguner
- 1 Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany.,2 Department of Cardiology University Heart Center Zurich Switzerland
| | - Niklas Schenker
- 1 Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
| | - Lukas Kaiser
- 1 Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
| | - Pengpai Zhang
- 1 Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
| | - Yoshiga Yashuiro
- 1 Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
| | - Christine Lemes
- 1 Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
| | - Thomas Fink
- 1 Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
| | - Tilman Maurer
- 1 Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
| | - Francesco Santoro
- 1 Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
| | - Peter Wohlmuth
- 1 Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
| | - Bruno Reißmann
- 1 Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
| | - Christian H Heeger
- 3 University Heart Center Lübeck Medical Clinic II University Hospital Schleswig Holstein Lübeck Germany
| | - Roland Tilz
- 3 University Heart Center Lübeck Medical Clinic II University Hospital Schleswig Holstein Lübeck Germany
| | - Erik Wissner
- 4 University of Illinois Chicago, College of Medicine Chicago IL
| | - Andreas Rillig
- 1 Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
| | - Andreas Metzner
- 1 Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
| | - Karl-Heinz Kuck
- 1 Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
| | - Feifan Ouyang
- 1 Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
| |
Collapse
|
19
|
Ng J, Sears SF, Exner DV, Reyes L, Cravetchi X, Cassidy P, Morton J, Lohrenz C, Low A, Sandhu RK, Sheldon RS, Raj SR. Age, Sex, and Remote Monitoring Differences in Device Acceptance for Patients With Implanted Cardioverter Defibrillators in Canada. CJC Open 2020; 2:483-489. [PMID: 33305207 PMCID: PMC7710939 DOI: 10.1016/j.cjco.2020.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 10/29/2022] Open
Abstract
Background Implantable cardioverter defibrillator (ICD) acceptance and shock anxiety are issues that clinicians should address to improve quality of life among device recipients. Previous findings have indicated that younger patients experience poorer device adjustment. The purpose of this study was to examine age and ICD-specific quality-of-life outcomes in a large sample of Canadian ICD patients. We tested the hypothesis that patient age is related to device acceptance and shock anxiety in an Alberta (Canada) ICD population. Methods The Florida Patient Acceptance Survey (FPAS) and Florida Shock Acceptance Survey (FSAS) were completed by ICD patients attending the Cardiac Implantable Electrical Device Clinics in Alberta. The population was dichotomized into those aged ≤ 65 years (younger) and those aged > 65 years (older). Sex, ICD shock history, and remote monitoring use were also examined. Results Surveys were completed by 126 younger (53 ± 11 years; 79% male) and 216 older (74 ± 6 years; 85% male) patients. Younger, compared with older, patients had greater device-related distress (P < 0.001) and more body-image concerns (P < 0.001), but no differences in return to function or positive appraisal. Younger patients reported lower total device acceptance (P = 0.001) and greater total shock anxiety (P < 0.001) compared with older patients. Conclusions ICD patients aged ≤ 65 years reported poorer device acceptance and greater shock anxiety than older patients. Younger patients may require targeted interventions addressing adjustment to the ICD, and impact of the ICD on body image. Moreover, education about the relatively low probability of shocks may alleviate shock anxiety in younger patients.
Collapse
Affiliation(s)
- Jessica Ng
- Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Samuel F Sears
- Departments of Psychology and Cardiovascular Sciences, East Carolina University, Greenville, North Carolina, USA
| | - Derek V Exner
- Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Lucy Reyes
- Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Xenia Cravetchi
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | | | - James Morton
- Alberta Health Services, Red Deer, Alberta, Canada
| | | | - Aaron Low
- Alberta Health Services, Lethbridge, Alberta, Canada
| | - Roopinder K Sandhu
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Robert S Sheldon
- Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Satish R Raj
- Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
20
|
O'Donovan C, Ingles J, Broadbent E, Skinner JR, Kasparian NA. How Patient Perceptions Shape Responses and Outcomes in Inherited Cardiac Conditions. Heart Lung Circ 2020; 29:641-652. [PMID: 31974024 DOI: 10.1016/j.hlc.2019.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 11/04/2019] [Accepted: 11/07/2019] [Indexed: 02/05/2023]
Abstract
At least one-third of adults living with an inherited cardiac condition report clinically-significant levels of psychological distress. Poorer health-related quality of life compared with population norms is also consistently reported. These outcomes are associated with younger patient age, having an implantable cardioverter defibrillator, and receipt of uncertain clinical test results, and can influence self-management behaviours, such as adherence to potentially critical life-preserving medications. According to the Common Sense Model of Illness, people use information from multiple sources to 'make sense' of their health condition, and how they conceptualise the condition can strongly influence adaptation and coping responses. Previous studies with people with inherited cardiac conditions show that illness perceptions, such as greater perceived consequences and a poorer understanding of the condition, are associated with greater psychological distress and poorer adherence to medication. The Common Sense Model provides one potential framework for identifying patients who may be more vulnerable to adverse health outcomes, and for developing early interventions to reduce the physical and psychosocial burden of these conditions. Interventions based on the Common Sense Model have successfully improved physical and psychosocial outcomes associated with other cardiac conditions, and could be tailored for use with patients with an inherited cardiac condition (ICC).
Collapse
Affiliation(s)
- Claire O'Donovan
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Elizabeth Broadbent
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Jonathan R Skinner
- Green Lane Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland, New Zealand; Department of Paediatrics Child and Youth Health, The University of Auckland, Auckland, New Zealand.
| | - Nadine A Kasparian
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia; Department of Cardiology, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| |
Collapse
|
21
|
Jalloul Y, Refaat MM. The utility of the Florida Shock Anxiety Scale: What have we learned? Pacing Clin Electrophysiol 2019; 42:1302-1303. [DOI: 10.1111/pace.13794] [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: 08/26/2019] [Accepted: 08/26/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Youssef Jalloul
- Department of Internal MedicineDivision of CardiologyAmerican University of Beirut Medical Center Beirut Lebanon
| | - Marwan M. Refaat
- Department of Internal MedicineDivision of CardiologyAmerican University of Beirut Medical Center Beirut Lebanon
| |
Collapse
|
22
|
Haggerty CM, Murray B, Tichnell C, Judge DP, Tandri H, Schwartz M, Sturm AC, Matsumura ME, Murray MF, Calkins H, Fornwalt BK, James CA. Managing Secondary Genomic Findings Associated With Arrhythmogenic Right Ventricular Cardiomyopathy: Case Studies and Proposal for Clinical Surveillance. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2019; 11:e002237. [PMID: 29997227 DOI: 10.1161/circgen.118.002237] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
| | - Brittney Murray
- Geisinger, Danville, PA (C.M.H., M.S., A.C.S., M.E.M., M.F.M., B.K.F.).,Johns Hopkins Medical Center, Baltimore, MD (B.M., C.T., D.P.J., H.T., H.C., C.A.J.)
| | - Crystal Tichnell
- Johns Hopkins Medical Center, Baltimore, MD (B.M., C.T., D.P.J., H.T., H.C., C.A.J.)
| | - Daniel P Judge
- Johns Hopkins Medical Center, Baltimore, MD (B.M., C.T., D.P.J., H.T., H.C., C.A.J.).,Medical University of South Carolina, Charleston, SC (D.P.J.)
| | - Harikrishna Tandri
- Johns Hopkins Medical Center, Baltimore, MD (B.M., C.T., D.P.J., H.T., H.C., C.A.J.)
| | - Marci Schwartz
- Geisinger, Danville, PA (C.M.H., M.S., A.C.S., M.E.M., M.F.M., B.K.F.)
| | - Amy C Sturm
- Geisinger, Danville, PA (C.M.H., M.S., A.C.S., M.E.M., M.F.M., B.K.F.)
| | | | - Michael F Murray
- Geisinger, Danville, PA (C.M.H., M.S., A.C.S., M.E.M., M.F.M., B.K.F.).,Yale School of Medicine, New Haven, CT (M.F.M.)
| | - Hugh Calkins
- Johns Hopkins Medical Center, Baltimore, MD (B.M., C.T., D.P.J., H.T., H.C., C.A.J.)
| | | | - Cynthia A James
- Johns Hopkins Medical Center, Baltimore, MD (B.M., C.T., D.P.J., H.T., H.C., C.A.J.)
| |
Collapse
|
23
|
Tripp C, Huber NL, Kuhl EA, Sears SF. Measuring ICD shock anxiety: Status update on the Florida Shock Anxiety Scale after over a decade of use. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1294-1301. [DOI: 10.1111/pace.13793] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/14/2019] [Accepted: 07/30/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Connor Tripp
- Department of PsychologyEast Carolina University Greenville North Carolina
| | - Nichelle L. Huber
- Department of PsychologyEast Carolina University Greenville North Carolina
| | | | - Samuel F. Sears
- Department of PsychologyEast Carolina University Greenville North Carolina
- Department of Cardiovascular SciencesEast Carolina University Greenville North Carolina
| |
Collapse
|
24
|
Ablation compared with drug therapy for recurrent ventricular tachycardia in arrhythmogenic right ventricular cardiomyopathy: Results from a multicenter study. Heart Rhythm 2019; 16:536-543. [DOI: 10.1016/j.hrthm.2018.10.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Indexed: 01/20/2023]
|
25
|
James CA, Calkins H. Arrhythmogenic Right Ventricular Cardiomyopathy: Progress Toward Personalized Management. Annu Rev Med 2019; 70:1-18. [DOI: 10.1146/annurev-med-041217-010932] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited heart disease characterized by fibrofatty replacement of the ventricular myocardium, a high risk of ventricular arrhythmias, and progressive ventricular dysfunction. The clinical course is highly variable, and optimal approaches to management remain undefined. ARVC is associated with pathogenic variants in genes encoding the cardiac desmosome. Genetic testing facilitates identification of at-risk family members, but penetrance of ARVC in pathogenic variant carriers is difficult to predict. Participation in endurance exercise is a known key risk factor. However, there remains significant uncertainty about which family member will develop disease and how best to approach longitudinal screening. Our clinically focused review describes how new insights gained from natural history studies, improved understanding of pathogenic mechanisms, and appreciation of genetic and environmental modifiers have set the stage for developing personalized approaches to managing both ARVC patients and their at-risk family members.
Collapse
Affiliation(s)
- Cynthia A. James
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA;,
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA;,
| |
Collapse
|
26
|
Frydensberg VS, Skovbakke SJ, Pedersen SS, Kok RN. Body image concerns in patients with an implantable cardioverter defibrillator: A scoping review. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1235-1260. [DOI: 10.1111/pace.13421] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/14/2018] [Accepted: 06/10/2018] [Indexed: 12/13/2022]
Affiliation(s)
| | - Søren J. Skovbakke
- Department of Psychology; University of Southern Denmark; Odense Denmark
| | - Susanne S. Pedersen
- Department of Cardiology; Odense University Hospital; Odense Denmark
- Department of Psychology; University of Southern Denmark; Odense Denmark
| | - Robin N. Kok
- Department of Psychology; University of Southern Denmark; Odense Denmark
- Centre for Innovative Medical Technology; Odense University Hospital; Odense Denmark
| |
Collapse
|
27
|
Psychosocial Impact of a Positive Gene Result for Asymptomatic Relatives at Risk of Hypertrophic Cardiomyopathy. J Genet Couns 2018; 27:1040-1048. [DOI: 10.1007/s10897-018-0218-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 01/16/2018] [Indexed: 12/14/2022]
|
28
|
Orgeron GM, Te Riele A, Tichnell C, Wang W, Murray B, Bhonsale A, Judge DP, Kamel IR, Zimmerman SL, Tandri H, Calkins H, James CA. Performance of the 2015 International Task Force Consensus Statement Risk Stratification Algorithm for Implantable Cardioverter-Defibrillator Placement in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy. Circ Arrhythm Electrophysiol 2018; 11:e005593. [PMID: 29453325 DOI: 10.1161/circep.117.005593] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 12/15/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ventricular arrhythmias are a feared complication of arrhythmogenic right ventricular dysplasia/cardiomyopathy. In 2015, an International Task Force Consensus Statement proposed a risk stratification algorithm for implantable cardioverter-defibrillator placement in arrhythmogenic right ventricular dysplasia/cardiomyopathy. METHODS AND RESULTS To evaluate performance of the algorithm, 365 arrhythmogenic right ventricular dysplasia/cardiomyopathy patients were classified as having a Class I, IIa, IIb, or III indication per the algorithm at baseline. Survival free from sustained ventricular arrhythmia (VT/VF) in follow-up was the primary outcome. Incidence of ventricular fibrillation/flutter cycle length <240 ms was also assessed. Two hundred twenty-four (61%) patients had a Class I implantable cardioverter-defibrillator indication; 80 (22%), Class IIa; 54 (15%), Class IIb; and 7 (2%), Class III. During a median 4.2 (interquartile range, 1.7-8.4)-year follow-up, 190 (52%) patients had VT/VF and 60 (16%) had ventricular fibrillation/flutter. Although the algorithm appropriately differentiated risk of VT/VF, incidence of VT/VF was underestimated (observed versus expected: 29.6 [95% confidence interval, 25.2-34.0] versus >10%/year Class I; 15.5 [confidence interval 11.1-21.6] versus 1% to 10%/year Class IIa). In addition, the algorithm did not differentiate survival free from ventricular fibrillation/flutter between Class I and IIa patients (P=0.97) or for VT/VF in Class I and IIa primary prevention patients (P=0.22). Adding Holter results (<1000 premature ventricular contractions/24 hours) to International Task Force Consensus classification differentiated risks. CONCLUSIONS While the algorithm differentiates arrhythmic risk well overall, it did not distinguish ventricular fibrillation/flutter risks of patients with Class I and IIa implantable cardioverter-defibrillator indications. Limited differentiation was seen for primary prevention cases. As these are vital uncertainties in clinical decision-making, refinements to the algorithm are suggested prior to implementation.
Collapse
Affiliation(s)
- Gabriela M Orgeron
- From the Department of Medicine, Division of Cardiology (G.M.O., C.T., W.W., B.M., A.B., D.P.J., H.T., H.C., C.A.J.) and Department of Radiology (I.R.K., S.L.Z.), Johns Hopkins Hospital, Baltimore, MD; and Department of Heart and Lungs, Division of Cardiology, University Medical Center Utrecht, and Netherlands Heart Institute (A.t.R.)
| | - Anneline Te Riele
- From the Department of Medicine, Division of Cardiology (G.M.O., C.T., W.W., B.M., A.B., D.P.J., H.T., H.C., C.A.J.) and Department of Radiology (I.R.K., S.L.Z.), Johns Hopkins Hospital, Baltimore, MD; and Department of Heart and Lungs, Division of Cardiology, University Medical Center Utrecht, and Netherlands Heart Institute (A.t.R.)
| | - Crystal Tichnell
- From the Department of Medicine, Division of Cardiology (G.M.O., C.T., W.W., B.M., A.B., D.P.J., H.T., H.C., C.A.J.) and Department of Radiology (I.R.K., S.L.Z.), Johns Hopkins Hospital, Baltimore, MD; and Department of Heart and Lungs, Division of Cardiology, University Medical Center Utrecht, and Netherlands Heart Institute (A.t.R.)
| | - Weijia Wang
- From the Department of Medicine, Division of Cardiology (G.M.O., C.T., W.W., B.M., A.B., D.P.J., H.T., H.C., C.A.J.) and Department of Radiology (I.R.K., S.L.Z.), Johns Hopkins Hospital, Baltimore, MD; and Department of Heart and Lungs, Division of Cardiology, University Medical Center Utrecht, and Netherlands Heart Institute (A.t.R.)
| | - Brittney Murray
- From the Department of Medicine, Division of Cardiology (G.M.O., C.T., W.W., B.M., A.B., D.P.J., H.T., H.C., C.A.J.) and Department of Radiology (I.R.K., S.L.Z.), Johns Hopkins Hospital, Baltimore, MD; and Department of Heart and Lungs, Division of Cardiology, University Medical Center Utrecht, and Netherlands Heart Institute (A.t.R.)
| | - Aditya Bhonsale
- From the Department of Medicine, Division of Cardiology (G.M.O., C.T., W.W., B.M., A.B., D.P.J., H.T., H.C., C.A.J.) and Department of Radiology (I.R.K., S.L.Z.), Johns Hopkins Hospital, Baltimore, MD; and Department of Heart and Lungs, Division of Cardiology, University Medical Center Utrecht, and Netherlands Heart Institute (A.t.R.)
| | - Daniel P Judge
- From the Department of Medicine, Division of Cardiology (G.M.O., C.T., W.W., B.M., A.B., D.P.J., H.T., H.C., C.A.J.) and Department of Radiology (I.R.K., S.L.Z.), Johns Hopkins Hospital, Baltimore, MD; and Department of Heart and Lungs, Division of Cardiology, University Medical Center Utrecht, and Netherlands Heart Institute (A.t.R.)
| | - Ihab R Kamel
- From the Department of Medicine, Division of Cardiology (G.M.O., C.T., W.W., B.M., A.B., D.P.J., H.T., H.C., C.A.J.) and Department of Radiology (I.R.K., S.L.Z.), Johns Hopkins Hospital, Baltimore, MD; and Department of Heart and Lungs, Division of Cardiology, University Medical Center Utrecht, and Netherlands Heart Institute (A.t.R.)
| | - Stephan L Zimmerman
- From the Department of Medicine, Division of Cardiology (G.M.O., C.T., W.W., B.M., A.B., D.P.J., H.T., H.C., C.A.J.) and Department of Radiology (I.R.K., S.L.Z.), Johns Hopkins Hospital, Baltimore, MD; and Department of Heart and Lungs, Division of Cardiology, University Medical Center Utrecht, and Netherlands Heart Institute (A.t.R.)
| | - Harikrishna Tandri
- From the Department of Medicine, Division of Cardiology (G.M.O., C.T., W.W., B.M., A.B., D.P.J., H.T., H.C., C.A.J.) and Department of Radiology (I.R.K., S.L.Z.), Johns Hopkins Hospital, Baltimore, MD; and Department of Heart and Lungs, Division of Cardiology, University Medical Center Utrecht, and Netherlands Heart Institute (A.t.R.)
| | - Hugh Calkins
- From the Department of Medicine, Division of Cardiology (G.M.O., C.T., W.W., B.M., A.B., D.P.J., H.T., H.C., C.A.J.) and Department of Radiology (I.R.K., S.L.Z.), Johns Hopkins Hospital, Baltimore, MD; and Department of Heart and Lungs, Division of Cardiology, University Medical Center Utrecht, and Netherlands Heart Institute (A.t.R.)
| | - Cynthia A James
- From the Department of Medicine, Division of Cardiology (G.M.O., C.T., W.W., B.M., A.B., D.P.J., H.T., H.C., C.A.J.) and Department of Radiology (I.R.K., S.L.Z.), Johns Hopkins Hospital, Baltimore, MD; and Department of Heart and Lungs, Division of Cardiology, University Medical Center Utrecht, and Netherlands Heart Institute (A.t.R.).
| |
Collapse
|
29
|
Wang M, Szepietowska B, Polonsky B, McNitt S, Moss AJ, Zareba W, Auerbach DS. Risk of Cardiac Events Associated With Antidepressant Therapy in Patients With Long QT Syndrome. Am J Cardiol 2018; 121:182-187. [PMID: 29174490 DOI: 10.1016/j.amjcard.2017.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/26/2017] [Accepted: 10/04/2017] [Indexed: 12/14/2022]
Abstract
Patients with long QT syndrome (LQTS) are at a high risk of cardiac events. Many patients with LQTS are treated with antidepressant drugs (ADs). We investigated the LQTS genotype-specific risk of recurrent cardiac arrhythmic events (CAEs) associated with AD therapy. The study included 59 LQT1 and 72 LQT2 patients from the Rochester-based LQTS Registry with corrected QT (QTc) prolongation and a history of AD therapy. Using multivariate Anderson-Gill models, we estimated the LQTS genotype-specific risk of recurrent CAEs (ventricular tachyarrhythmias, aborted cardiac arrest, or sudden cardiac death) associated with time-dependent ADs. Specifically, we examined the risk associated with all ADs, selective serotonin reuptake inhibitor (SSRI), and ADs classified on the CredibleMeds list (www.CredibleMeds.org) as "Conditional" or "Known risk of Torsades de pointes (TdP)." After adjusting for baseline QTc duration, sex, and time-dependent beta-blocker usage, there was an increased risk of recurrent CAEs associated with ADs in LQT1 patients (hazard ratio = 3.67, 95% confidence interval 1.98-6.82, p < 0.001) but not in LQT2 patients (hazard ratio = 0.89, 95% confidence interval 0.49-1.64, p = 0.716; LQT1 vs LQT2 interaction, p < 0.001). Similarly, LQT1 patients who were on SSRIs or ADs with "Known risk of TdP" had a higher risk of recurrent CAEs than those patients off all ADs, whereas there was no association in LQT2 patients. ADs with "Conditional risk of TdP" were not associated with the risk of recurrent CAEs in any of the groups. In conclusion, the risk of recurrent CAEs associated with time-dependent ADs is higher in LQT1 patients but not in LQT2 patients. Results suggest a LQTS genotype-specific effect of ADs on the risk of arrhythmic events.
Collapse
Affiliation(s)
- Meng Wang
- Department of Medicine, Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, New York; Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York
| | - Barbara Szepietowska
- Department of Medicine, Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, New York
| | - Bronislava Polonsky
- Department of Medicine, Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, New York
| | - Scott McNitt
- Department of Medicine, Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, New York
| | - Arthur J Moss
- Department of Medicine, Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, New York
| | - Wojciech Zareba
- Department of Medicine, Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, New York
| | - David S Auerbach
- Department of Medicine, Aab Cardiovascular Research Institute, University of Rochester Medical Center, Rochester, New York; Department of Pharmacology & Physiology, University of Rochester Medical Center, Rochester, New York.
| |
Collapse
|
30
|
Quality of life metrics in arrhythmogenic right ventricular cardiomyopathy patients: The impact of age, shock and sex. Int J Cardiol 2017; 248:216-220. [DOI: 10.1016/j.ijcard.2017.08.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 07/18/2017] [Accepted: 08/09/2017] [Indexed: 11/24/2022]
|
31
|
Richardson E, Spinks C, Davis A, Turner C, Atherton J, McGaughran J, Semsarian C, Ingles J. Psychosocial Implications of Living with Catecholaminergic Polymorphic Ventricular Tachycardia in Adulthood. J Genet Couns 2017; 27:549-557. [DOI: 10.1007/s10897-017-0152-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 08/31/2017] [Indexed: 02/08/2023]
|
32
|
Manuel A, Brunger F. Embodying a New Meaning of Being At Risk: Living With an Implantable Cardioverter Defibrillator for Arrhythmogenic Right Ventricular Cardiomyopathy. Glob Qual Nurs Res 2017; 3:2333393616674810. [PMID: 28462346 PMCID: PMC5342860 DOI: 10.1177/2333393616674810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/20/2016] [Accepted: 09/27/2016] [Indexed: 11/16/2022] Open
Abstract
Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia (ARVC/D) is a genetic condition that can cause fatal arrhythmias. The implantable cardioverter defibrillation (ICD) is a primary treatment for ARVC/D. Using a grounded theory approach, this study examines the experiences of 15 individuals living with an ICD. The ability to cope with and adjust to having an ICD is influenced by the acceptance of the ICD as something needed to survive, an understanding of the ICD's function, existing support networks, and ones' ability to manage everyday challenges. Coping well requires reshaping ideas about the meaning of being at risk and understanding how the ICD fits into that changing personal risk narrative. A thorough understanding of the unique needs of individuals with ARVC/D and of the specific factors contributing to the psychosocial distress related to having an ICD (vs. having the disease itself) is needed. Nurses must be prepared to provide ongoing support and education to this population.
Collapse
Affiliation(s)
- April Manuel
- Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Fern Brunger
- Memorial University, St. John's, Newfoundland and Labrador, Canada
| |
Collapse
|
33
|
Etchegary H, Pullman D, Connors SP, Simmonds C, Young TL, Hodgkinson KA. “There are days I wish it wasn’t there, and there’s days I realize I’m lucky”: A qualitative study of psychological sequelae to the implantable cardioverter defibrillator as a treatment for the prevention of sudden cardiac death in arrhythmogenic right ventricular cardiomyopathy. JRSM Cardiovasc Dis 2017; 6:2048004017698614. [PMID: 35186284 PMCID: PMC8851103 DOI: 10.1177/2048004017698614] [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: 11/08/2016] [Revised: 01/06/2017] [Accepted: 02/07/2017] [Indexed: 11/17/2022] Open
Abstract
Objectives Arrhythmogenic right ventricular cardiomyopathy caused by a TMEM43 p.S358L mutation is a fully penetrant autosomal dominant cause of sudden cardiac death where prophylactic implantable cardioverter defibrillator therapy significantly reduces mortality by returning lethal cardiac rhythms to normal. This qualitative study assessed the psychological ramifications of the implantable cardioverter defibrillator on recipients, their spouses and their mutation negative siblings. Design Qualitative interview study. Participants Twenty-one individuals (nine mutation positive, eight mutation negative and four spouses) from 15 families completed semi-structured interviews. Results No theoretical assumptions about the data were made: inductive sub-coding was accomplished with the constant comparison method and cohesive themes across all respondent interviews were determined. All interviewees had a family history of sudden cardiac death and appropriate implantable cardioverter defibrillator therapy in themselves or family members. Average length of time with an implantable cardioverter defibrillator was 10 years. Major themes included: (1) acceptance and gratitude, (2) grudging acceptance, (3) psychological effects (on emotional and psychological well-being; functioning of the broader family unit; and relationships), and (4) practical concerns (on clothes, travel, loss of driving licence and the effects of an implantable cardioverter defibrillator discharge). These affected all family members, regardless of mutation status. Conclusions Despite the survival advantage of implantable cardioverter defibrillator therapy, the intervention carries psychological and practical burdens for family members from kindreds manifesting p.S358L TMEM43 ARVC that does not appear to dissipate with time. A move towards integrating psychology services with the cardiac genetics clinic for the extended family may provide benefit.
Collapse
Affiliation(s)
- Holly Etchegary
- Faculty of Medicine, Genetics and Clinical Epidemiology, Memorial University, Canada
| | - Daryl Pullman
- Faculty of Medicine, Community Health and Humanities, Memorial University, Canada
| | - Sean P Connors
- Faculty of Medicine, Cardiology, Memorial University, Canada
| | - Charlene Simmonds
- Faculty of Medicine, Community Health and Humanities, Memorial University, Canada
| | | | - Kathy A Hodgkinson
- Faculty of Medicine, Genetics and Clinical Epidemiology, Memorial University, Canada
| |
Collapse
|
34
|
Caleshu C, Kasparian NA, Edwards KS, Yeates L, Semsarian C, Perez M, Ashley E, Turner CJ, Knowles JW, Ingles J. Interdisciplinary psychosocial care for families with inherited cardiovascular diseases. Trends Cardiovasc Med 2016; 26:647-53. [DOI: 10.1016/j.tcm.2016.04.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 04/23/2016] [Accepted: 04/23/2016] [Indexed: 12/21/2022]
|
35
|
Rhodes A, Rosman L, Cahill J, Ingles J, Murray B, Tichnell C, James CA, Sears SF. Minding the Genes: a Multidisciplinary Approach towards Genetic Assessment of Cardiovascular Disease. J Genet Couns 2016; 26:224-231. [PMID: 27695998 DOI: 10.1007/s10897-016-0017-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 09/05/2016] [Indexed: 02/04/2023]
Abstract
Genetic assessment for inherited cardiovascular disease (CVD) is increasingly available, due in part to rapid innovations in genetic sequencing technologies. While genetic testing is aimed at reducing uncertainty, it also produces awareness of potential medical conditions and can leave patients feeling uncertain about their risk, especially if there are ambiguous results. This uncertainty can produce psychological distress for patients and their families undergoing the assessment process. Additionally, patients may experience psychological distress related to living with inherited CVD. In order to more effectively manage the psychosocial challenges related to genetic assessment for CVD, a multidisciplinary model expanded to include psychologists and other allied health professionals is outlined. A case study is provided to illustrate how psychological distress can manifest in a patient living with inherited CVD, as well as proposed psychological management of this patient. Finally, a guide for genetic counselors is provided to aid in identifying and managing common psychological reactions to genetic assessment for CVD.
Collapse
Affiliation(s)
- Ashley Rhodes
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | - Lindsey Rosman
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | - John Cahill
- Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA
| | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Newtown, New South Wales, Australia.,Sydney Medical School, University of Sydney, Camperdown, Australia
| | - Brittney Murray
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Crystal Tichnell
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Cynthia A James
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Samuel F Sears
- Department of Psychology, East Carolina University, Greenville, NC, USA. .,Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA.
| |
Collapse
|
36
|
Murray B. Editorial Commentary: It is all in the family: Multidisciplinary care in inherited heart disease. Trends Cardiovasc Med 2016; 26:654-5. [PMID: 27296522 DOI: 10.1016/j.tcm.2016.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 05/06/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Brittney Murray
- Division of Cardiology, Johns Hopkins University, Baltimore, MD.
| |
Collapse
|
37
|
Sports in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy and desmosomal mutations. Herz 2016; 40:402-9. [PMID: 25963172 DOI: 10.1007/s00059-015-4223-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is a rare cardiomyopathy associated with life-threatening arrhythmias and an increased risk of sudden cardiac death. In addition to mutations in desmosomal genes, environmental factors such as exercise and sport have been implicated in the pathogenesis of the disease. Recent studies have shown that exercise may be associated with adverse outcomes in patients with ARVD/C. On the basis of current evidence, patients with ARVD/C are recommended to limit exercise irrespective of their mutation status. Some studies have suggested the presence of an entirely acquired form of the disease caused by exercise, which has been dubbed "exercise-induced ARVD/C."
Collapse
|
38
|
Sweeting J, Ingles J, Ball K, Semsarian C. Challenges of exercise recommendations and sports participation in genetic heart disease patients. ACTA ACUST UNITED AC 2015; 8:178-86. [PMID: 25691687 DOI: 10.1161/circgenetics.114.000784] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Joanna Sweeting
- From the Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Newtown, NSW, Australia (J.S., J.I., C.S.); Sydney Medical School, University of Sydney, Sydney, NSW, Australia (J.S., J.I., C.S.); Centre for Physical Activity and Nutrition Research, Deakin University, Melbourne, Australia (K.B.); and Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.S.)
| | - Jodie Ingles
- From the Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Newtown, NSW, Australia (J.S., J.I., C.S.); Sydney Medical School, University of Sydney, Sydney, NSW, Australia (J.S., J.I., C.S.); Centre for Physical Activity and Nutrition Research, Deakin University, Melbourne, Australia (K.B.); and Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.S.)
| | - Kylie Ball
- From the Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Newtown, NSW, Australia (J.S., J.I., C.S.); Sydney Medical School, University of Sydney, Sydney, NSW, Australia (J.S., J.I., C.S.); Centre for Physical Activity and Nutrition Research, Deakin University, Melbourne, Australia (K.B.); and Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.S.)
| | - Christopher Semsarian
- From the Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Newtown, NSW, Australia (J.S., J.I., C.S.); Sydney Medical School, University of Sydney, Sydney, NSW, Australia (J.S., J.I., C.S.); Centre for Physical Activity and Nutrition Research, Deakin University, Melbourne, Australia (K.B.); and Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.S.).
| |
Collapse
|
39
|
Perceived economic burden associated with an inherited cardiac condition: a qualitative inquiry with families affected by arrhythmogenic right ventricular cardiomyopathy. Genet Med 2015; 18:584-92. [PMID: 26513349 DOI: 10.1038/gim.2015.132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 08/18/2015] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Significant gaps remain in the literature on the economic burden of genetic illness. We explored perceived economic burden associated with one inherited cardiac condition, arrhythmogenic right ventricular cardiomyopathy (ARVC). METHODS Semistructured interviews were held with individuals from families affected by ARVC. Data on the perceived financial and economic impacts of ARVC were used to identify emerging categories and themes using the method of constant comparison. RESULTS Data analysis revealed four themes that described participants' perceptions of the economic impact ARVC had on them and their families: (i) economic impact during childhood, (ii) impact on current and future employment, (iii) impact on current and future financial well-being, and (iv) no perceived economic impact. CONCLUSIONS This study is the first to explore the economic burden of ARVC from the perspective of affected families. It revealed a number of perceived burdens, from employment and career choices to worry about insurance for self and children, decreased household spending, and the need for childhood employment. Findings highlight potential areas of discussion for genetic counseling sessions, as well as areas for future research.Genet Med 18 6, 584-592.
Collapse
|
40
|
Minto C, Bauce B, Calore C, Rigato I, Folino F, Soriani N, Hochdorn A, Iliceto S, Gregori D. Is Internet use associated with anxiety in patients with and at risk for cardiomyopathy? Am Heart J 2015; 170:87-95, 95.e1-4. [PMID: 26093868 DOI: 10.1016/j.ahj.2015.02.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 02/26/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of the study was to determine the relation between online health information seeking behavior and anxiety level among a sample of patients with manifested cardiomyopathy or at risk for cardiomyopathy. METHODS The research is a cross-sectional study conducted among 104 patients with cardiomyopathy diagnosis and patients at risk for cardiomyopathy. Patients completed 3 different questionnaires: Use of Internet Health Information questionnaire about the use of Internet, Short Form SF-12 items questionnaire on quality of life, and State-Trait Anxiety Inventory measuring general anxiety levels. RESULTS Forty-eight patients had a diagnosis of primary or secondary cardiomyopathy, and 56 patients, with conditions predisposing to cardiomyopathy. Eighty-five percent of the considered population is surfing the Internet to obtain nonspecific information about health in general, and the 65% use it to look specifically for heart disease. For both groups of patients with cardiomyopathy and at risk for cardiomyopathy, online health information seeking behavior is associated with substantially lower state anxiety levels (P = .041). CONCLUSION Web use, as a source of health information, has been shown to be associated with anxiety reduction in patients with or at risk for cardiomyopathy, suggesting that Internet technology can be a useful instrument due to its informational power and its potentially therapeutic value.
Collapse
|
41
|
Sawant AC, Calkins H. Relationship between arrhythmogenic right ventricular dysplasia and exercise. Card Electrophysiol Clin 2015; 7:195-206. [PMID: 26002386 DOI: 10.1016/j.ccep.2015.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is rare cardiomyopathy associated with life-threatening arrhythmias and increased risk of sudden cardiac death. In addition to mutations in desmosomal genes, environmental factors such as exercise have been implicated in the pathogenesis of the disease. Recent studies have shown that exercise may be associated with adverse outcomes in ARVD/C patients. Based on current evidence, ARVD/C patients are recommended to limit exercise irrespective of their mutation status. In addition, some studies have suggested the presence of an entirely acquired form of the disease caused by exercise that has been dubbed exercise-induced ARVD/C.
Collapse
Affiliation(s)
- Abhishek C Sawant
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA.
| |
Collapse
|
42
|
VERKERK AGNESJ, VERMEER ALEXAM, SMETS ELLENM, DEKKER LUKASR, WILDE ARTHURA, VAN LANGEN IRENEM, CHRISTIAANS IMKE, NIEUWKERK PYTHIAT. Quality of Life in Young Adult Patients with a Cardiogenetic Condition Receiving an ICD for Primary Prevention of Sudden Cardiac Death. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:870-7. [DOI: 10.1111/pace.12649] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 03/03/2015] [Accepted: 04/12/2015] [Indexed: 11/30/2022]
Affiliation(s)
- AGNES J. VERKERK
- Department of Clinical and Experimental Cardiology, Heart Centre AMC; Academic Medical Center; Amsterdam the Netherlands
| | - ALEXA M. VERMEER
- Department of Clinical Genetics; Academic Medical Center; Amsterdam the Netherlands
| | - ELLEN M. SMETS
- Department of Medical Psychology; Academic Medical Center; Amsterdam the Netherlands
| | - LUKAS R. DEKKER
- Department of Cardiology; Catharina Hospital; Eindhoven the Netherlands
| | - ARTHUR A. WILDE
- Department of Clinical and Experimental Cardiology, Heart Centre AMC; Academic Medical Center; Amsterdam the Netherlands
| | - IRENE M. VAN LANGEN
- Department of Clinical Genetics; University Medical Center Groningen; Groningen the Netherlands
| | - IMKE CHRISTIAANS
- Department of Clinical Genetics; Academic Medical Center; Amsterdam the Netherlands
| | - PYTHIA T. NIEUWKERK
- Department of Medical Psychology; Academic Medical Center; Amsterdam the Netherlands
| |
Collapse
|
43
|
Cadrin-Tourigny J, Tadros R, Talajic M, Rivard L, Abadir S, Khairy P. Risk stratification for sudden death in arrhythmogenic right ventricular cardiomyopathy. Expert Rev Cardiovasc Ther 2015; 13:653-64. [DOI: 10.1586/14779072.2015.1043891] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
44
|
Bedair R, Babu-Narayan SV, Dimopoulos K, Quyam S, Doyle AM, Swan L, Gatzoulis MA, Wong T. Acceptance and psychological impact of implantable defibrillators amongst adults with congenital heart disease. Int J Cardiol 2015; 181:218-24. [DOI: 10.1016/j.ijcard.2014.12.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 11/14/2014] [Accepted: 12/01/2014] [Indexed: 12/01/2022]
|
45
|
Tichnell C, James CA, Murray B, Tandri H, Sears SF, Calkins H. Cardiology patient page. Patient's guide to arrhythmogenic right ventricular dysplasia/cardiomyopathy: past to present. Circulation 2014; 130:e89-92. [PMID: 25210100 DOI: 10.1161/circulationaha.113.004845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Crystal Tichnell
- From the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (C.T., C.A.J., B.M., H.T., H.C.); and Departments of Psychology and Cardiovascular Sciences, East Carolina University, Greenville, NC (S.F.S.).
| | - Cynthia A James
- From the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (C.T., C.A.J., B.M., H.T., H.C.); and Departments of Psychology and Cardiovascular Sciences, East Carolina University, Greenville, NC (S.F.S.)
| | - Brittney Murray
- From the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (C.T., C.A.J., B.M., H.T., H.C.); and Departments of Psychology and Cardiovascular Sciences, East Carolina University, Greenville, NC (S.F.S.)
| | - Harikrishna Tandri
- From the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (C.T., C.A.J., B.M., H.T., H.C.); and Departments of Psychology and Cardiovascular Sciences, East Carolina University, Greenville, NC (S.F.S.)
| | - Samuel F Sears
- From the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (C.T., C.A.J., B.M., H.T., H.C.); and Departments of Psychology and Cardiovascular Sciences, East Carolina University, Greenville, NC (S.F.S.)
| | - Hugh Calkins
- From the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (C.T., C.A.J., B.M., H.T., H.C.); and Departments of Psychology and Cardiovascular Sciences, East Carolina University, Greenville, NC (S.F.S.)
| |
Collapse
|
46
|
Etchegary H, Pullman D, Simmonds C, Young TL, Hodgkinson K. ‘It had to be done’: genetic testing decisions for arrhythmogenic right ventricular cardiomyopathy. Clin Genet 2014; 88:344-51. [DOI: 10.1111/cge.12513] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 09/23/2014] [Accepted: 09/23/2014] [Indexed: 01/08/2023]
Affiliation(s)
- H. Etchegary
- Clinical Epidemiology; Eastern Health and Memorial University; St. John's NL Canada
| | - D. Pullman
- Community Health and Humanities; Memorial University; St. John's NL Canada
| | - C. Simmonds
- Health Research Unit, Community Health and Humanities; Memorial University; St. John's NL Canada
| | - T.-L. Young
- Discipline of Genetics; Memorial University; St. John's NL Canada
| | - K. Hodgkinson
- Clinical Epidemiology and Discipline of Genetics; Memorial University; St. John's NL Canada
| |
Collapse
|
47
|
te Riele ASJM, James CA, Rastegar N, Bhonsale A, Murray B, Tichnell C, Judge DP, Bluemke DA, Zimmerman SL, Kamel IR, Calkins H, Tandri H. Yield of serial evaluation in at-risk family members of patients with ARVD/C. J Am Coll Cardiol 2014; 64:293-301. [PMID: 25034067 DOI: 10.1016/j.jacc.2014.04.044] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 04/17/2014] [Accepted: 04/21/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Incomplete penetrance and variable expressivity of arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) complicate family screening. OBJECTIVES The objective of the present study was to determine the optimal approach to longitudinal follow-up regarding: 1) screening interval; and 2) testing strategy in at-risk relatives of ARVD/C patients. METHODS We included 117 relatives (45% male, age 33.3 ± 16.3 years) from 64 families who were at risk of developing ARVD/C by virtue of their familial predisposition (72% mutation carriers [92% plakophilin-2]; 28% first-degree relatives of a mutation-negative proband). Subjects were evaluated by electrocardiography (ECG), Holter monitoring, signal-averaged ECG, and cardiac magnetic resonance (CMR). Disease progression was defined as the development of a new criterion by the 2010 Task Force Criteria (not the "Hamid criteria") at last follow-up that was absent at enrollment. RESULTS At first evaluation, 43 subjects (37%) fulfilled an ARVD/C diagnosis according to the 2010 Task Force Criteria. Among the remaining 74 subjects (63%), 11 of 37 (30%) with complete re-evaluation experienced disease progression during 4.1 ± 2.3 years of follow-up. Electrical progression (n = 10 [27%], including by ECG [14%], Holter monitoring [11%], or signal-averaged ECG [14%]) was more frequently observed than structural progression (n = 1 [3%] on CMR). All 5 patients (14%) with clinical ARVD/C diagnosis at last follow-up had an abnormal ECG or Holter monitor recording, and the only patient with an abnormal CMR already had an abnormal ECG at enrollment. CONCLUSIONS Over a mean follow-up of 4 years, our study showed that: 1) almost one-third of at-risk relatives have electrical progression; 2) structural progression is rare; and 3) electrical abnormalities precede detectable structural changes. This information could be valuable in determining family screening protocols.
Collapse
Affiliation(s)
- Anneline S J M te Riele
- Department of Medicine, Division of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Cynthia A James
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Neda Rastegar
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aditya Bhonsale
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brittney Murray
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Crystal Tichnell
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel P Judge
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David A Bluemke
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Stefan L Zimmerman
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ihab R Kamel
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hugh Calkins
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Harikrishna Tandri
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| |
Collapse
|
48
|
Ingles J, Semsarian C. Conveying a probabilistic genetic test result to families with an inherited heart disease. Heart Rhythm 2014; 11:1073-8. [DOI: 10.1016/j.hrthm.2014.03.017] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Indexed: 12/16/2022]
|
49
|
STARRENBURG ANNEMIEKE, PEDERSEN SUSANNE, van den BROEK KRISTA, KRAAIER KARIN, SCHOLTEN MARCOEN, VAN DER PALEN JOB. Gender Differences in Psychological Distress and Quality of Life in Patients with an ICD 1-Year Postimplant. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 37:843-52. [DOI: 10.1111/pace.12357] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 12/19/2013] [Accepted: 12/29/2013] [Indexed: 11/27/2022]
Affiliation(s)
- ANNEMIEKE STARRENBURG
- Department of Clinical Psychology; Medisch Spectrum Twente; Enschede the Netherlands
| | - SUSANNE PEDERSEN
- CoRPS-Center of Research on Psychology in Somatic diseases; Tilburg University; Tilburg the Netherlands
- Department of Cardiology; Thoraxcentre; Erasmus Medical Centre; Rotterdam the Netherlands
| | - KRISTA van den BROEK
- CoRPS-Center of Research on Psychology in Somatic diseases; Tilburg University; Tilburg the Netherlands
| | - KARIN KRAAIER
- Department of Cardiology, Thorax Center Twente; Medisch Spectrum Twente; Enschede the Netherlands
| | - MARCOEN SCHOLTEN
- Department of Cardiology, Thorax Center Twente; Medisch Spectrum Twente; Enschede the Netherlands
| | - JOB VAN DER PALEN
- Department of Research Methodology; Measurement and Data Analyses; University of Twente; Enschede the Netherlands
- Medical School Twente; Medisch Spectrum Twente; Enschede the Netherlands
| |
Collapse
|
50
|
James CA, Calkins H. Update on Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C). CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2013; 15:476-87. [PMID: 23728845 DOI: 10.1007/s11936-013-0251-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OPINION STATEMENT Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is an inherited cardiomyopathy characterized by life-threatening ventricular arrhythmias and slowly progressive ventricular dysfunction. Treatment for families with ARVD/C is directed toward prevention of sudden cardiac death, prevention or delay of disease progression, and adjustment to life with a lifelong chronic genetic disease. As there have been no randomized trials of ARVD/C treatments or screening regimens, treatment decisions are based on clinical expertise, results of retrospective registry-based studies, and understanding of pathologic mechanisms of disease. The first step for treatment is securing an accurate diagnosis through careful application of the diagnostic Task Force criteria. Following diagnosis in an index case, family members are screened. We advise affected individuals and gene carriers to dramatically reduce exercise and strongly recommend that ARVD/C patients discontinue competitive athletics. We generally recommend implantable cardioverter defibrillator (ICD) placement in all probands who meet Task Force criteria, especially if they have a history of sustained ventricular tachycardia (VT), arrhythmogenic syncope, or frequent ventricular ectopy and/or nonsustained VT. We are more circumspect about recommending implantation of an ICD in a family member who has been diagnosed with ARVD/C through family screening, as these individuals are now being identified at a much earlier stage in their disease than was possible previously. Anti-arrhythmic medications and catheter ablation are used to decrease the frequency of ventricular tachycardia and associated implantable cardioverter defibrillator therapies. Epicardial ablation is offered if endocardial ablation fails or as part of an initial combined endocaridal/epicardial ablation strategy, depending on patient preference. We attempt to initiate beta-blocker therapy and therapy with angiotensin-converting enzyme inhibitors to limit structural progression and prevent ventricular arrhythmias. Unaffected family members are screened for disease onset regularly from adolescence through noninvasive cardiac testing. Support to families is provided through ongoing genetic counseling, patient-family web-based support, and in-person seminars for families.
Collapse
Affiliation(s)
- Cynthia A James
- Johns Hopkins Hospital, Johns Hopkins ARVD Program - Blalock 545, 600 N. Wolfe Street, Baltimore, MD, 21287, USA,
| | | |
Collapse
|