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Haïssaguerre M, Hocini M, Cheniti G, Duchateau J, Sacher F, Puyo S, Cochet H, Takigawa M, Denis A, Martin R, Derval N, Bordachar P, Ritter P, Ploux S, Pambrun T, Klotz N, Massoullié G, Pillois X, Dallet C, Schott JJ, Scouarnec S, Ackerman MJ, Tester D, Piot O, Pasquié JL, Leclerc C, Hermida JS, Gandjbakhch E, Maury P, Labrousse L, Coronel R, Jais P, Benoist D, Vigmond E, Potse M, Walton R, Nademanee K, Bernus O, Dubois R. Localized Structural Alterations Underlying a Subset of Unexplained Sudden Cardiac Death. Circ Arrhythm Electrophysiol 2019; 11:e006120. [PMID: 30002064 PMCID: PMC7661047 DOI: 10.1161/circep.117.006120] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 05/08/2018] [Indexed: 01/17/2023]
Abstract
Supplemental Digital Content is available in the text. Background: Sudden cardiac death because of ventricular fibrillation (VF) is commonly unexplained in younger victims. Detailed electrophysiological mapping in such patients has not been reported. Methods: We evaluated 24 patients (29±13 years) who survived idiopathic VF. First, we used multielectrode body surface recordings to identify the drivers maintaining VF. Then, we analyzed electrograms in the driver regions using endocardial and epicardial catheter mapping during sinus rhythm. Established electrogram criteria were used to identify the presence of structural alterations. Results: VF occurred spontaneously in 3 patients and was induced in 16, whereas VF was noninducible in 5. VF mapping demonstrated reentrant and focal activities (87% versus 13%, respectively) in all. The activities were dominant in one ventricle in 9 patients, whereas they had biventricular distribution in others. During sinus rhythm areas of abnormal electrograms were identified in 15/24 patients (62.5%) revealing localized structural alterations: in the right ventricle in 11, the left ventricle in 1, and both in 3. They covered a limited surface (13±6 cm2) representing 5±3% of the total surface and were recorded predominantly on the epicardium. Seventy-six percent of these areas were colocated with VF drivers (P<0.001). In the 9 patients without structural alteration, we observed a high incidence of Purkinje triggers (7/9 versus 4/15, P=0.033). Catheter ablation resulted in arrhythmia-free outcome in 15/18 patients at 17±11 months follow-up. Conclusions: This study shows that localized structural alterations underlie a significant subset of previously unexplained sudden cardiac death. In the other subset, Purkinje electrical pathology seems as a dominant mechanism.
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Affiliation(s)
- Michel Haïssaguerre
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.). .,Univ. Bordeaux (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, France (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., L.L., P.J.)
| | - Mélèze Hocini
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Univ. Bordeaux (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, France (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., L.L., P.J.)
| | - Ghassen Cheniti
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., L.L., P.J.)
| | - Josselin Duchateau
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Univ. Bordeaux (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, France (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., L.L., P.J.)
| | - Frédéric Sacher
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Univ. Bordeaux (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, France (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., L.L., P.J.)
| | - Stéphane Puyo
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Univ. Bordeaux (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, France (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., L.L., P.J.)
| | - Hubert Cochet
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Univ. Bordeaux (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, France (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., L.L., P.J.)
| | - Masateru Takigawa
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., L.L., P.J.)
| | - Arnaud Denis
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Univ. Bordeaux (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, France (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., L.L., P.J.)
| | - Ruairidh Martin
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.)
| | - Nicolas Derval
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Univ. Bordeaux (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, France (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., L.L., P.J.)
| | - Pierre Bordachar
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Univ. Bordeaux (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, France (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., L.L., P.J.)
| | - Philippe Ritter
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Univ. Bordeaux (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, France (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., L.L., P.J.)
| | - Sylvain Ploux
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Univ. Bordeaux (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, France (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., L.L., P.J.)
| | - Thomas Pambrun
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., L.L., P.J.)
| | - Nicolas Klotz
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., L.L., P.J.)
| | - Gregoire Massoullié
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., L.L., P.J.)
| | - Xavier Pillois
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., L.L., P.J.)
| | - Corentin Dallet
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.)
| | - Jean-Jacques Schott
- Inserm UMR 915 l'institut du thorax IRT, Nantes Cedex, France (J.-J.S., S.L.S.)
| | | | - Michael J Ackerman
- Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN (M.J.A., D.T.)
| | - David Tester
- Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN (M.J.A., D.T.)
| | | | | | | | | | | | | | - Louis Labrousse
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., L.L., P.J.)
| | - Ruben Coronel
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.)
| | - Pierre Jais
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Univ. Bordeaux (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, France (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., L.L., P.J.)
| | - David Benoist
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Univ. Bordeaux (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, France (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.)
| | - Edward Vigmond
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Univ. Bordeaux, IMB UMR 5251, CNRS (E.V.).,CNRS, IMB, UMR5251, Talence (E.V.)
| | - Mark Potse
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.)
| | - Richard Walton
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Univ. Bordeaux (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, France (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.)
| | - Koonlawee Nademanee
- Pacific Rim Electrophysiology Research Institute, White Memorial Medical Center, Los Angeles, CA (K.N.)
| | - Olivier Bernus
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Univ. Bordeaux (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, France (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.)
| | - Remi Dubois
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (M. Haïssaguerre, M. Hocini, G.C., J.D., F.S., S.P., H.C., M.T., A.D., R.M., N.D., P.B., P.R., S.P., T.P., N.K., G.M., X.P., C.D., L.L., R.C., P.J., D.B., E.V., M.P., R.W., O.B., R.D.).,Univ. Bordeaux (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, France (M. Haïssaguerre, M. Hocini, J.D., F.S., S.P., H.C., A.D., N.D., P.B., P.R., S.P., P.J., D.B., R.W., O.B., R.D.)
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Yin D, Hsieh YC, Tsai WC, Wu AZY, Jiang Z, Chan YH, Xu D, Yang N, Shen C, Chen Z, Lin SF, Chen PS, Everett TH. Role of Apamin-Sensitive Calcium-Activated Small-Conductance Potassium Currents on the Mechanisms of Ventricular Fibrillation in Pacing-Induced Failing Rabbit Hearts. Circ Arrhythm Electrophysiol 2017; 10:e004434. [PMID: 28213506 DOI: 10.1161/circep.116.004434] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 01/05/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ventricular fibrillation (VF) during heart failure is characterized by stable reentrant spiral waves (rotors). Apamin-sensitive small-conductance calcium-activated potassium currents (IKAS) are heterogeneously upregulated in failing hearts. We hypothesized that IKAS influences the location and stability of rotors during VF. METHODS AND RESULTS Optical mapping was performed on 9 rabbit hearts with pacing-induced heart failure. The epicardial right ventricular and left ventricular surfaces were simultaneously mapped in a Langendorff preparation. At baseline and after apamin (100 nmol/L) infusion, the action potential duration (APD80) was determined, and VF was induced. Areas with a >50% increase in the maximum action potential duration (ΔAPD) after apamin infusion were considered to have a high IKAS distribution. At baseline, the distribution density of phase singularities during VF in high IKAS distribution areas was higher than in other areas (0.0035±0.0011 versus 0.0014±0.0010 phase singularities/pixel; P=0.004). In addition, high dominant frequencies also colocalized to high IKAS distribution areas (26.0 versus 17.9 Hz; P=0.003). These correlations were eliminated during VF after apamin infusion, as the number of phase singularities (17.2 versus 11.0; P=0.009) and dominant frequencies (22.1 versus 16.2 Hz; P=0.022) were all significantly decreased. In addition, reentrant spiral waves became unstable after apamin infusion, and the duration of VF decreased. CONCLUSIONS The IKAS current influences the mechanism of VF in failing hearts as phase singularities, high dominant frequencies, and reentrant spiral waves all correlated to areas of high IKAS. Apamin eliminated this relationship and reduced VF vulnerability.
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Affiliation(s)
- Dechun Yin
- From the Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis (D.Y., Y.-C.H., W.-C.T., A.Z.-Y.W., Z.J., Y.-H.C., D.X., N.Y., Z.C., S.-F.L., P.-S.C., T.H.E.); Department of Cardiology (D.Y.) and Department of Gynecological and Obstetric Ultrasound (N.Y.), First Affiliated Hospital of Harbin Medical University, China; Cardiovascular Center, Taichung Veterans General Hospital and Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei (Y.-C.H.); Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan (W.-C.T.); Institute of Biomedical Engineering, National Chiao-Tung University, Hsin-Chu, Taiwan (A.Z.-Y.W., S.-F.L.); Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China (Z.J.); Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, Taoyuan, Taiwan (Y.-H.C.); Department of Cardiology, Faculty of Medicine, University of Tsukuba, Japan (D.X.); and Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.S.)
| | - Yu-Cheng Hsieh
- From the Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis (D.Y., Y.-C.H., W.-C.T., A.Z.-Y.W., Z.J., Y.-H.C., D.X., N.Y., Z.C., S.-F.L., P.-S.C., T.H.E.); Department of Cardiology (D.Y.) and Department of Gynecological and Obstetric Ultrasound (N.Y.), First Affiliated Hospital of Harbin Medical University, China; Cardiovascular Center, Taichung Veterans General Hospital and Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei (Y.-C.H.); Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan (W.-C.T.); Institute of Biomedical Engineering, National Chiao-Tung University, Hsin-Chu, Taiwan (A.Z.-Y.W., S.-F.L.); Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China (Z.J.); Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, Taoyuan, Taiwan (Y.-H.C.); Department of Cardiology, Faculty of Medicine, University of Tsukuba, Japan (D.X.); and Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.S.)
| | - Wei-Chung Tsai
- From the Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis (D.Y., Y.-C.H., W.-C.T., A.Z.-Y.W., Z.J., Y.-H.C., D.X., N.Y., Z.C., S.-F.L., P.-S.C., T.H.E.); Department of Cardiology (D.Y.) and Department of Gynecological and Obstetric Ultrasound (N.Y.), First Affiliated Hospital of Harbin Medical University, China; Cardiovascular Center, Taichung Veterans General Hospital and Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei (Y.-C.H.); Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan (W.-C.T.); Institute of Biomedical Engineering, National Chiao-Tung University, Hsin-Chu, Taiwan (A.Z.-Y.W., S.-F.L.); Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China (Z.J.); Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, Taoyuan, Taiwan (Y.-H.C.); Department of Cardiology, Faculty of Medicine, University of Tsukuba, Japan (D.X.); and Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.S.)
| | - Adonis Zhi-Yang Wu
- From the Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis (D.Y., Y.-C.H., W.-C.T., A.Z.-Y.W., Z.J., Y.-H.C., D.X., N.Y., Z.C., S.-F.L., P.-S.C., T.H.E.); Department of Cardiology (D.Y.) and Department of Gynecological and Obstetric Ultrasound (N.Y.), First Affiliated Hospital of Harbin Medical University, China; Cardiovascular Center, Taichung Veterans General Hospital and Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei (Y.-C.H.); Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan (W.-C.T.); Institute of Biomedical Engineering, National Chiao-Tung University, Hsin-Chu, Taiwan (A.Z.-Y.W., S.-F.L.); Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China (Z.J.); Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, Taoyuan, Taiwan (Y.-H.C.); Department of Cardiology, Faculty of Medicine, University of Tsukuba, Japan (D.X.); and Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.S.)
| | - Zhaolei Jiang
- From the Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis (D.Y., Y.-C.H., W.-C.T., A.Z.-Y.W., Z.J., Y.-H.C., D.X., N.Y., Z.C., S.-F.L., P.-S.C., T.H.E.); Department of Cardiology (D.Y.) and Department of Gynecological and Obstetric Ultrasound (N.Y.), First Affiliated Hospital of Harbin Medical University, China; Cardiovascular Center, Taichung Veterans General Hospital and Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei (Y.-C.H.); Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan (W.-C.T.); Institute of Biomedical Engineering, National Chiao-Tung University, Hsin-Chu, Taiwan (A.Z.-Y.W., S.-F.L.); Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China (Z.J.); Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, Taoyuan, Taiwan (Y.-H.C.); Department of Cardiology, Faculty of Medicine, University of Tsukuba, Japan (D.X.); and Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.S.)
| | - Yi-Hsin Chan
- From the Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis (D.Y., Y.-C.H., W.-C.T., A.Z.-Y.W., Z.J., Y.-H.C., D.X., N.Y., Z.C., S.-F.L., P.-S.C., T.H.E.); Department of Cardiology (D.Y.) and Department of Gynecological and Obstetric Ultrasound (N.Y.), First Affiliated Hospital of Harbin Medical University, China; Cardiovascular Center, Taichung Veterans General Hospital and Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei (Y.-C.H.); Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan (W.-C.T.); Institute of Biomedical Engineering, National Chiao-Tung University, Hsin-Chu, Taiwan (A.Z.-Y.W., S.-F.L.); Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China (Z.J.); Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, Taoyuan, Taiwan (Y.-H.C.); Department of Cardiology, Faculty of Medicine, University of Tsukuba, Japan (D.X.); and Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.S.)
| | - Dongzhu Xu
- From the Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis (D.Y., Y.-C.H., W.-C.T., A.Z.-Y.W., Z.J., Y.-H.C., D.X., N.Y., Z.C., S.-F.L., P.-S.C., T.H.E.); Department of Cardiology (D.Y.) and Department of Gynecological and Obstetric Ultrasound (N.Y.), First Affiliated Hospital of Harbin Medical University, China; Cardiovascular Center, Taichung Veterans General Hospital and Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei (Y.-C.H.); Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan (W.-C.T.); Institute of Biomedical Engineering, National Chiao-Tung University, Hsin-Chu, Taiwan (A.Z.-Y.W., S.-F.L.); Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China (Z.J.); Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, Taoyuan, Taiwan (Y.-H.C.); Department of Cardiology, Faculty of Medicine, University of Tsukuba, Japan (D.X.); and Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.S.)
| | - Na Yang
- From the Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis (D.Y., Y.-C.H., W.-C.T., A.Z.-Y.W., Z.J., Y.-H.C., D.X., N.Y., Z.C., S.-F.L., P.-S.C., T.H.E.); Department of Cardiology (D.Y.) and Department of Gynecological and Obstetric Ultrasound (N.Y.), First Affiliated Hospital of Harbin Medical University, China; Cardiovascular Center, Taichung Veterans General Hospital and Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei (Y.-C.H.); Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan (W.-C.T.); Institute of Biomedical Engineering, National Chiao-Tung University, Hsin-Chu, Taiwan (A.Z.-Y.W., S.-F.L.); Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China (Z.J.); Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, Taoyuan, Taiwan (Y.-H.C.); Department of Cardiology, Faculty of Medicine, University of Tsukuba, Japan (D.X.); and Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.S.)
| | - Changyu Shen
- From the Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis (D.Y., Y.-C.H., W.-C.T., A.Z.-Y.W., Z.J., Y.-H.C., D.X., N.Y., Z.C., S.-F.L., P.-S.C., T.H.E.); Department of Cardiology (D.Y.) and Department of Gynecological and Obstetric Ultrasound (N.Y.), First Affiliated Hospital of Harbin Medical University, China; Cardiovascular Center, Taichung Veterans General Hospital and Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei (Y.-C.H.); Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan (W.-C.T.); Institute of Biomedical Engineering, National Chiao-Tung University, Hsin-Chu, Taiwan (A.Z.-Y.W., S.-F.L.); Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China (Z.J.); Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, Taoyuan, Taiwan (Y.-H.C.); Department of Cardiology, Faculty of Medicine, University of Tsukuba, Japan (D.X.); and Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.S.)
| | - Zhenhui Chen
- From the Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis (D.Y., Y.-C.H., W.-C.T., A.Z.-Y.W., Z.J., Y.-H.C., D.X., N.Y., Z.C., S.-F.L., P.-S.C., T.H.E.); Department of Cardiology (D.Y.) and Department of Gynecological and Obstetric Ultrasound (N.Y.), First Affiliated Hospital of Harbin Medical University, China; Cardiovascular Center, Taichung Veterans General Hospital and Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei (Y.-C.H.); Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan (W.-C.T.); Institute of Biomedical Engineering, National Chiao-Tung University, Hsin-Chu, Taiwan (A.Z.-Y.W., S.-F.L.); Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China (Z.J.); Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, Taoyuan, Taiwan (Y.-H.C.); Department of Cardiology, Faculty of Medicine, University of Tsukuba, Japan (D.X.); and Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.S.)
| | - Shien-Fong Lin
- From the Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis (D.Y., Y.-C.H., W.-C.T., A.Z.-Y.W., Z.J., Y.-H.C., D.X., N.Y., Z.C., S.-F.L., P.-S.C., T.H.E.); Department of Cardiology (D.Y.) and Department of Gynecological and Obstetric Ultrasound (N.Y.), First Affiliated Hospital of Harbin Medical University, China; Cardiovascular Center, Taichung Veterans General Hospital and Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei (Y.-C.H.); Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan (W.-C.T.); Institute of Biomedical Engineering, National Chiao-Tung University, Hsin-Chu, Taiwan (A.Z.-Y.W., S.-F.L.); Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China (Z.J.); Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, Taoyuan, Taiwan (Y.-H.C.); Department of Cardiology, Faculty of Medicine, University of Tsukuba, Japan (D.X.); and Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.S.)
| | - Peng-Sheng Chen
- From the Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis (D.Y., Y.-C.H., W.-C.T., A.Z.-Y.W., Z.J., Y.-H.C., D.X., N.Y., Z.C., S.-F.L., P.-S.C., T.H.E.); Department of Cardiology (D.Y.) and Department of Gynecological and Obstetric Ultrasound (N.Y.), First Affiliated Hospital of Harbin Medical University, China; Cardiovascular Center, Taichung Veterans General Hospital and Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei (Y.-C.H.); Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan (W.-C.T.); Institute of Biomedical Engineering, National Chiao-Tung University, Hsin-Chu, Taiwan (A.Z.-Y.W., S.-F.L.); Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China (Z.J.); Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, Taoyuan, Taiwan (Y.-H.C.); Department of Cardiology, Faculty of Medicine, University of Tsukuba, Japan (D.X.); and Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.S.)
| | - Thomas H Everett
- From the Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis (D.Y., Y.-C.H., W.-C.T., A.Z.-Y.W., Z.J., Y.-H.C., D.X., N.Y., Z.C., S.-F.L., P.-S.C., T.H.E.); Department of Cardiology (D.Y.) and Department of Gynecological and Obstetric Ultrasound (N.Y.), First Affiliated Hospital of Harbin Medical University, China; Cardiovascular Center, Taichung Veterans General Hospital and Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei (Y.-C.H.); Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan (W.-C.T.); Institute of Biomedical Engineering, National Chiao-Tung University, Hsin-Chu, Taiwan (A.Z.-Y.W., S.-F.L.); Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China (Z.J.); Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, Taoyuan, Taiwan (Y.-H.C.); Department of Cardiology, Faculty of Medicine, University of Tsukuba, Japan (D.X.); and Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.S.).
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