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Markman TM, Marchlinski FE, Callans DJ, Frankel DS. Programmed Ventricular Stimulation: Risk Stratification and Guiding Antiarrhythmic Therapies. JACC Clin Electrophysiol 2024; 10:1489-1507. [PMID: 38661601 DOI: 10.1016/j.jacep.2024.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 02/13/2024] [Indexed: 04/26/2024]
Abstract
Electrophysiologic testing with programmed ventricular stimulation (PVS) has been utilized to induce ventricular tachycardia (VT), thereby improving risk stratification for patients with ischemic and nonischemic cardiomyopathies and determining the effectiveness of antiarrhythmic therapies, especially catheter ablation. A variety of procedural aspects can be modified during PVS in order to alter the sensitivity and specificity of the test including the addition of multiple baseline pacing cycle lengths, extrastimuli, and pacing locations. The definition of a positive result is also critically important, which has varied from exclusively sustained monomorphic VT (>30 seconds) to any ventricular arrhythmia regardless of morphology. In this review, we discuss the history of PVS and evaluate its role in sudden cardiac death risk stratification in a variety of patient populations. We propose an approach to future investigations that will capitalize on the unique ability to vary the sensitivity and specificity of this test. We then discuss the application of PVS during and following catheter ablation. The strategies that have been utilized to improve the efficacy of intraprocedural PVS are highlighted during a discussion of the limitations of this probabilistic strategy. The role of noninvasive programmed stimulation is also reviewed in predicting recurrent VT and informing management decisions including repeat ablations, modifications in antiarrhythmic drugs, and implantable cardioverter-defibrillator programming. Based on the available evidence and guidelines, we propose an approach to future investigations that will allow clinicians to optimize the use of PVS for risk stratification and assessment of therapeutic efficacy.
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Affiliation(s)
- Timothy M Markman
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Francis E Marchlinski
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David J Callans
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David S Frankel
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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2
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Bellicini MG, Cersosimo A, Cerini M, Bontempi L, Curnis A, Arabia G. ICD early after myocardial infarction: it is really necessary to wait 40 days before implantation? J Interv Card Electrophysiol 2024; 67:439-441. [PMID: 38099975 DOI: 10.1007/s10840-023-01711-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 11/26/2023] [Indexed: 04/14/2024]
Abstract
ESC Guidelines don't recommend ICD implantation within 40 days after MI, on the basis of old evidence with several limitations. However, a significant number of patients remain at high risk of arrhythmic death also in the early period after ACS, in these patients early ICD implantation or LifeVest may be use with benefit on survival.
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Affiliation(s)
- Maria Giulia Bellicini
- Cardiology Department, Department of Molecular and Translational Medicine, Spedali Civili Hospital, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Angelica Cersosimo
- Cardiology Department, Department of Molecular and Translational Medicine, Spedali Civili Hospital, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Manuel Cerini
- Cardiology Department, Department of Molecular and Translational Medicine, Spedali Civili Hospital, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Luca Bontempi
- Unit of Cardiology, Cardiac Electrophysiology and, Electrostimulation Laboratory, Bolognini" Hospital of Seriate - ASST Bergamo Est, Bergamo, Italy
| | - Antonio Curnis
- Cardiology Department, Department of Molecular and Translational Medicine, Spedali Civili Hospital, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
- Department of Molecular and Translational Medicine, University of Brescia, 25123, Brescia, Italy
| | - Gianmarco Arabia
- Cardiology Department, Department of Molecular and Translational Medicine, Spedali Civili Hospital, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy.
- Department of Molecular and Translational Medicine, University of Brescia, 25123, Brescia, Italy.
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3
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Deshmukh T, Kovoor JG, Byth K, Chow CK, Zaman S, Chong JJH, Figtree GA, Thiagalingam A, Kovoor P. Influence of standard modifiable risk factors on ventricular tachycardia after myocardial infarction. Front Cardiovasc Med 2023; 10:1283382. [PMID: 37942068 PMCID: PMC10628449 DOI: 10.3389/fcvm.2023.1283382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/27/2023] [Indexed: 11/10/2023] Open
Abstract
Background Inducible ventricular tachycardia (VT) at electrophysiology study (EPS) predicts sudden cardiac death because of ventricular tachyarrhythmia, the single greatest cause of death within 2 years after myocardial infarction (MI). Objectives We aimed to assess the association between standard modifiable risk factors (SMuRFs) and inducible VT at EPS early after MI. Methods Consecutive patients with left ventricle ejection fraction ≤40% on days 3-5 after ST elevation MI (STEMI) who underwent EPS were prospectively recruited. Positive EPS was defined as induced sustained monomorphic VT cycle length ≥200 ms for ≥10 s or shorter if hemodynamically compromised. The primary outcome was inducibility of VT at EPS, and the secondary outcome was all-cause mortality on follow-up. Results In 410 eligible patients undergoing EPS soon (median of 9 days) after STEMI, 126 had inducible VT. Ex-smokers experienced an increased risk of inducible VT [multivariable logistic regression adjusted odds ratio (OR) 2.0, p = 0.033] compared with current or never-smokers, with comparable risk. The presence of any SMuRFs apart from being a current smoker conferred an increased risk of inducible VT (adjusted OR 1.9, p = 0.043). Neither the number of SMuRFs nor the presence of any SMuRFs was associated with mortality at a median follow-up of 5.4 years. Conclusions In patients with recent STEMI and impaired left ventricular function, the presence of any SMuRFs, apart from being a current smoker, conferred an increased risk of inducible VT at EPS. These results highlight the need to modify SMuRFs in this high-risk subset of patients.
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Affiliation(s)
- Tejas Deshmukh
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
- Centre for Heart Research, Westmead Institute for Medical Research, University of Sydney, Westmead, Sydney, NSW, Australia
| | - Joshua G. Kovoor
- University of Adelaide, The Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - Karen Byth
- Research and Education Network, Western Sydney Local Health District, Westmead Hospital, Sydney, NSW, Australia
| | - Clara K. Chow
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
- Research and Education Network, Western Sydney Local Health District, Westmead Hospital, Sydney, NSW, Australia
| | - Sarah Zaman
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
- Research and Education Network, Western Sydney Local Health District, Westmead Hospital, Sydney, NSW, Australia
| | - James J. H. Chong
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
- Centre for Heart Research, Westmead Institute for Medical Research, University of Sydney, Westmead, Sydney, NSW, Australia
| | - Gemma A. Figtree
- Kolling Institute, Royal North Shore Hospital, Sydney, NSW, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Aravinda Thiagalingam
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
- Research and Education Network, Western Sydney Local Health District, Westmead Hospital, Sydney, NSW, Australia
| | - Pramesh Kovoor
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
- Research and Education Network, Western Sydney Local Health District, Westmead Hospital, Sydney, NSW, Australia
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4
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Romano LR, Spaccarotella CAM, Indolfi C, Curcio A. Revascularization and Left Ventricular Dysfunction for ICD Eligibility. Life (Basel) 2023; 13:1940. [PMID: 37763344 PMCID: PMC10533106 DOI: 10.3390/life13091940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/17/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
Common triggers for sudden cardiac death (SCD) are transient ischemia, hemodynamic fluctuations, neurocardiovascular influences, and environmental factors. SCD occurs rapidly when sinus rhythm degenerates into ventricular tachycardia (VT) and/or ventricular fibrillation (VF), followed by asystole. Such progressive worsening of the cardiac rhythm is in most cases observed in the setting of ischemic heart disease and often associated with advanced left ventricular (LV) impairment. Revascularization prevents negative outcomes including SCD and heart failure (HF) due to LV dysfunction (LVD). The implantable cardioverter-defibrillator (ICD) on top of medical therapy is superior to antiarrhythmic drugs for patients with LVD and VT/VF. The beneficial effects of ICD have been demonstrated in primary prevention of SCD as well. However, yet debated is the temporal management for patients with LVD who are eligible to ICD prior to revascularization, either through percutaneous or surgical approach. Restoration of coronary blood flow has a dramatic impact on adverse LV remodeling, while it requires aggressive long-term antiplatelet therapy, which might increase complication for eventual ICD procedure when percutaneous strategy is pursued; on the other hand, when LV and/or multiorgan dysfunction is present and coronary artery bypass grafting is chosen, the overall risk is augmented, mostly in HF patients. The aims of this review are to describe the pathophysiologic benefits of revascularization, the studies addressing percutaneous, surgical or no revascularization and ICD implantation, as well as emerging defibrillation strategies for patients deemed at transient risk of SCD and/or at higher risk for transvenous ICD implantation.
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Affiliation(s)
- Letizia Rosa Romano
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy
| | | | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy
| | - Antonio Curcio
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy
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5
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Kovoor JG, Deshmukh T, von Huben A, Marschner SL, Byth K, Chow CK, Zaman S, Chong JJH, Thiagalingam A, Kovoor P. Optimizing electrophysiology studies to prevent sudden cardiac death after myocardial infarction. Europace 2023; 25:euad219. [PMID: 37470454 PMCID: PMC10374980 DOI: 10.1093/europace/euad219] [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: 04/17/2023] [Revised: 06/06/2023] [Accepted: 07/03/2023] [Indexed: 07/21/2023] Open
Abstract
AIMS This study assessed associations of minimum final extrastimulus coupling interval utilized within electrophysiology study (EPS) after myocardial infarction (MI) and possible site of origin of induced ventricular tachycardia (VT) with long-term occurrence of spontaneous ventricular tachyarrhythmia and long-term survival. METHODS AND RESULTS This prospective study recruited consecutive patients with left ventricular ejection fraction (LVEF) ≤ 40% who underwent EPS days 3-5 after MI between 2004 and 2017. Positive EPS was defined as sustained monomorphic VT cycle length ≥200 ms for ≥10 s or shorter duration if haemodynamic compromise occurred. Each of the four extrastimuli was shortened by 10 ms at a time, until it failed to capture the ventricle (ventricular refractoriness) or induced ventricular tachyarrhythmia. Outcomes included spontaneous ventricular tachyarrhythmia occurrence and all-cause mortality. Shorter coupling interval length of final extrastimulus that induced VT was associated with higher risk of spontaneous ventricular tachyarrhythmia (P < 0.001). Significantly higher rates of spontaneous ventricular tachyarrhythmia (65.2% vs. 23.2%; P < 0.001) were observed for final coupling interval at EPS <200 ms vs. >200 ms. Right bundle branch block (RBBB) morphology of induced VT, with possible site of origin from the left ventricle, was associated with all-cause mortality [hazard ratio (HR) 3.2, P = 0.044] and a composite of spontaneous ventricular tachyarrhythmia recurrence or mortality (HR 1.8, P = 0.043). CONCLUSION Ventricular tachycardia induced with shorter coupling intervals was associated with higher risk of spontaneous ventricular tachyarrhythymia on follow-up, indicating that the final extrastimulus coupling interval at EPS early after MI should be determined by ventricular refractoriness. Induced VT with possible origin from left ventricle was associated with increased risk of spontaneous ventricular tachyarrhythmia recurrence or death.
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MESH Headings
- Humans
- Stroke Volume/physiology
- Ventricular Function, Left
- Prospective Studies
- Defibrillators, Implantable/adverse effects
- Myocardial Infarction/complications
- Myocardial Infarction/diagnosis
- Cardiac Electrophysiology
- Tachycardia, Ventricular/diagnosis
- Tachycardia, Ventricular/etiology
- Tachycardia, Ventricular/prevention & control
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Death, Sudden, Cardiac/epidemiology
- Follow-Up Studies
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Affiliation(s)
- Joshua G Kovoor
- University of Adelaide, North Terrace, Adelaide, South Australia, 5005, Australia
- Queen Elizabeth Hospital, 28 Woodville Road, Adelaide, South Australia, 5011, Australia
| | - Tejas Deshmukh
- Centre for Heart Research, The Westmead Institute for Medical Research, The University of Sydney, 176 Hawkesbury Road, Westmead, Sydney, NSW, 2145, Australia
- Department of Cardiology, Westmead Hospital, Corner Darcy and Hawkesbury Roads, Sydney, New South Wales 2145Australia
| | - Amy von Huben
- Centre for Heart Research, The Westmead Institute for Medical Research, The University of Sydney, 176 Hawkesbury Road, Westmead, Sydney, NSW, 2145, Australia
- Department of Cardiology, Westmead Hospital, Corner Darcy and Hawkesbury Roads, Sydney, New South Wales 2145Australia
| | - Simone L Marschner
- Centre for Heart Research, The Westmead Institute for Medical Research, The University of Sydney, 176 Hawkesbury Road, Westmead, Sydney, NSW, 2145, Australia
- Department of Cardiology, Westmead Hospital, Corner Darcy and Hawkesbury Roads, Sydney, New South Wales 2145Australia
| | - Karen Byth
- Centre for Heart Research, The Westmead Institute for Medical Research, The University of Sydney, 176 Hawkesbury Road, Westmead, Sydney, NSW, 2145, Australia
- Department of Cardiology, Westmead Hospital, Corner Darcy and Hawkesbury Roads, Sydney, New South Wales 2145Australia
| | - Clara K Chow
- Centre for Heart Research, The Westmead Institute for Medical Research, The University of Sydney, 176 Hawkesbury Road, Westmead, Sydney, NSW, 2145, Australia
- Department of Cardiology, Westmead Hospital, Corner Darcy and Hawkesbury Roads, Sydney, New South Wales 2145Australia
| | - Sarah Zaman
- Centre for Heart Research, The Westmead Institute for Medical Research, The University of Sydney, 176 Hawkesbury Road, Westmead, Sydney, NSW, 2145, Australia
- Department of Cardiology, Westmead Hospital, Corner Darcy and Hawkesbury Roads, Sydney, New South Wales 2145Australia
| | - James J H Chong
- Centre for Heart Research, The Westmead Institute for Medical Research, The University of Sydney, 176 Hawkesbury Road, Westmead, Sydney, NSW, 2145, Australia
- Department of Cardiology, Westmead Hospital, Corner Darcy and Hawkesbury Roads, Sydney, New South Wales 2145Australia
| | - Aravinda Thiagalingam
- Centre for Heart Research, The Westmead Institute for Medical Research, The University of Sydney, 176 Hawkesbury Road, Westmead, Sydney, NSW, 2145, Australia
- Department of Cardiology, Westmead Hospital, Corner Darcy and Hawkesbury Roads, Sydney, New South Wales 2145Australia
| | - Pramesh Kovoor
- Centre for Heart Research, The Westmead Institute for Medical Research, The University of Sydney, 176 Hawkesbury Road, Westmead, Sydney, NSW, 2145, Australia
- Department of Cardiology, Westmead Hospital, Corner Darcy and Hawkesbury Roads, Sydney, New South Wales 2145Australia
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6
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Arsenos P, Gatzoulis KA, Tsiachris D, Dilaveris P, Sideris S, Sotiropoulos I, Archontakis S, Antoniou CK, Kordalis A, Skiadas I, Toutouzas K, Vlachopoulos C, Tousoulis D, Tsioufis K. Arrhythmic risk stratification in ischemic, non-ischemic and hypertrophic cardiomyopathy: A two-step multifactorial, electrophysiology study inclusive approach. World J Cardiol 2022; 14:139-151. [PMID: 35432775 PMCID: PMC8968455 DOI: 10.4330/wjc.v14.i3.139] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 10/28/2021] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
Annual arrhythmic sudden cardiac death ranges from 0.6% to 4% in ischemic cardiomyopathy (ICM), 1% to 2% in non-ischemic cardiomyopathy (NICM), and 1% in hypertrophic cardiomyopathy (HCM). Towards a more effective arrhythmic risk stratification (ARS) we hereby present a two-step ARS with the usage of seven non-invasive risk factors: Late potentials presence (≥ 2/3 positive criteria), premature ventricular contractions (≥ 30/h), non-sustained ventricular tachycardia (≥ 1episode/24 h), abnormal heart rate turbulence (onset ≥ 0% and slope ≤ 2.5 ms) and reduced deceleration capacity (≤ 4.5 ms), abnormal T wave alternans (≥ 65μV), decreased heart rate variability (SDNN < 70ms), and prolonged QTc interval (> 440 ms in males and > 450 ms in females) which reflect the arrhythmogenic mechanisms for the selection of the intermediate arrhythmic risk patients in the first step. In the second step, these intermediate-risk patients undergo a programmed ventricular stimulation (PVS) for the detection of inducible, truly high-risk ICM and NICM patients, who will benefit from an implantable cardioverter defibrillator. For HCM patients, we also suggest the incorporation of the PVS either for the low HCM Risk-score patients or for the patients with one traditional risk factor in order to improve the inadequate sensitivity of the former and the low specificity of the latter.
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Affiliation(s)
- Petros Arsenos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, Athens 11527, Attika, Greece
| | - Konstantinos A Gatzoulis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, Athens 11527, Attika, Greece
| | | | - Polychronis Dilaveris
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, Athens 11527, Attika, Greece
| | - Skevos Sideris
- Department of Cardiology, Hippokration Hospital, Athens 11527, Attika, Greece
| | - Ilias Sotiropoulos
- Department of Cardiology, Hippokration Hospital, Athens 11527, Attika, Greece
| | | | | | - Athanasios Kordalis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, Athens 11527, Attika, Greece
| | - Ioannis Skiadas
- Fifth Department of Cardiology, Hygeia Hospital, Marousi 15123, Attika, Greece
| | - Konstantinos Toutouzas
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, Athens 11527, Attika, Greece
| | - Charalambos Vlachopoulos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, Athens 11527, Attika, Greece
| | - Dimitrios Tousoulis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, Athens 11527, Attika, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, Athens 11527, Attika, Greece
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7
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Thavapalachandran S, Grieve SM, Hume RD, Le TYL, Raguram K, Hudson JE, Pouliopoulos J, Figtree GA, Dye RP, Barry AM, Brown P, Lu J, Coffey S, Kesteven SH, Mills RJ, Rashid FN, Taran E, Kovoor P, Thomas L, Denniss AR, Kizana E, Asli NS, Xaymardan M, Feneley MP, Graham RM, Harvey RP, Chong JJH. Platelet-derived growth factor-AB improves scar mechanics and vascularity after myocardial infarction. Sci Transl Med 2021; 12:12/524/eaay2140. [PMID: 31894101 DOI: 10.1126/scitranslmed.aay2140] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 11/06/2019] [Indexed: 12/13/2022]
Abstract
Therapies that target scar formation after myocardial infarction (MI) could prevent ensuing heart failure or death from ventricular arrhythmias. We have previously shown that recombinant human platelet-derived growth factor-AB (rhPDGF-AB) improves cardiac function in a rodent model of MI. To progress clinical translation, we evaluated rhPDGF-AB treatment in a clinically relevant porcine model of myocardial ischemia-reperfusion. Thirty-six pigs were randomized to sham procedure or balloon occlusion of the proximal left anterior descending coronary artery with 7-day intravenous infusion of rhPDGF-AB or vehicle. One month after MI, rhPDGF-AB improved survival by 40% compared with vehicle, and cardiac magnetic resonance imaging showed left ventricular (LV) ejection fraction improved by 11.5%, driven by reduced LV end-systolic volumes. Pressure volume loop analyses revealed improved myocardial contractility and energetics after rhPDGF-AB treatment with minimal effect on ventricular compliance. rhPDGF-AB enhanced angiogenesis and increased scar anisotropy (high fiber alignment) without affecting overall scar size or stiffness. rhPDGF-AB reduced inducible ventricular tachycardia by decreasing heterogeneity of the ventricular scar that provides a substrate for reentrant circuits. In summary, we demonstrated that rhPDGF-AB promotes post-MI cardiac wound repair by altering the mechanics of the infarct scar, resulting in robust cardiac functional improvement, decreased ventricular arrhythmias, and improved survival. Our findings suggest a strong translational potential for rhPDGF-AB as an adjunct to current MI treatment and possibly to modulate scar in other organs.
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Affiliation(s)
- Sujitha Thavapalachandran
- Centre for Heart Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, NSW 2145, Australia.,Department of Cardiology, Westmead Hospital, Westmead, NSW 2145, Australia
| | - Stuart M Grieve
- Sydney Translational Imaging Laboratory, Heart Research Institute, Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
| | - Robert D Hume
- Centre for Heart Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, NSW 2145, Australia
| | - Thi Yen Loan Le
- Centre for Heart Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, NSW 2145, Australia
| | - Kalyan Raguram
- Centre for Heart Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, NSW 2145, Australia
| | - James E Hudson
- QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia
| | - Jim Pouliopoulos
- Department of Cardiology, Westmead Hospital, Westmead, NSW 2145, Australia
| | - Gemma A Figtree
- Kolling Institute of Medical Research, The University of Sydney, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Rafael P Dye
- Kolling Institute of Medical Research, The University of Sydney, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Anthony M Barry
- Department of Cardiology, Westmead Hospital, Westmead, NSW 2145, Australia
| | - Paula Brown
- Department of Cardiology, Westmead Hospital, Westmead, NSW 2145, Australia
| | - Juntang Lu
- Department of Cardiology, Westmead Hospital, Westmead, NSW 2145, Australia
| | - Sean Coffey
- Kolling Institute of Medical Research, The University of Sydney, Royal North Shore Hospital, St Leonards, NSW 2065, Australia.,Department of Medicine, Dunedin School of Medicine, Dunedin Hospital, Dunedin 9016, New Zealand
| | - Scott H Kesteven
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW 2010, Australia
| | - Richard J Mills
- QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia
| | - Fairooj N Rashid
- Centre for Heart Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, NSW 2145, Australia
| | - Elena Taran
- Australian National Fabrication Facility-Queensland Node, The University of Queensland, St. Lucia, QLD 4072, Australia.,School of Chemical Engineering, University of Melbourne, VIC 3010, Australia
| | - Pramesh Kovoor
- Department of Cardiology, Westmead Hospital, Westmead, NSW 2145, Australia
| | - Liza Thomas
- Department of Cardiology, Westmead Hospital, Westmead, NSW 2145, Australia
| | | | - Eddy Kizana
- Centre for Heart Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, NSW 2145, Australia.,Department of Cardiology, Westmead Hospital, Westmead, NSW 2145, Australia
| | - Naisana S Asli
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW 2010, Australia.,Faculty of Medicine and Health, University of Sydney, Westmead Hospital, Westmead, NSW 2145, Australia.,Centre for Cancer Research, The Westmead Institute for Medical Research, Sydney, NSW 2145, Australia
| | - Munira Xaymardan
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW 2010, Australia
| | - Michael P Feneley
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW 2010, Australia.,St. Vincent's Clinical School, UNSW Sydney, Kensington, NSW 2052, Australia
| | - Robert M Graham
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW 2010, Australia.,St. Vincent's Clinical School, UNSW Sydney, Kensington, NSW 2052, Australia
| | - Richard P Harvey
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW 2010, Australia.,St. Vincent's Clinical School, UNSW Sydney, Kensington, NSW 2052, Australia.,School of Biotechnology and Biomolecular Science, UNSW Sydney, Kensington, NSW 2052, Australia
| | - James J H Chong
- Centre for Heart Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, NSW 2145, Australia. .,Department of Cardiology, Westmead Hospital, Westmead, NSW 2145, Australia
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8
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Haanschoten DM, Elvan A, Ramdat Misier AR, Delnoy PPH, Smit JJJ, Adiyaman A, Demirel F, Wellens HJ, Verheugt FW, Ottervanger JP, Schalij M, Zijlstra F, Wever E, de Boer M, Boersma E, Robbe H. Long-Term Outcome of the Randomized DAPA Trial. Circ Arrhythm Electrophysiol 2020; 13:e008484. [DOI: 10.1161/circep.120.008484] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The randomized DAPA trial (Defibrillator After Primary Angioplasty) aimed to evaluate the survival benefit of prophylactic implantable cardioverter defibrillator (ICD) implantation in early selected high-risk patients after primary percutaneous coronary intervention for ST-segment–elevation myocardial infarction.
Methods:
A randomized, multicenter, controlled trial compared ICD versus conventional medical therapy in high-risk patients with primary percutaneous coronary intervention, based on one of the following factors: left ventricular ejection fraction <30% within 4 days after ST-segment–elevation myocardial infarction, primary ventricular fibrillation, Killip class ≥2 or TIMI (Thrombolysis in Myocardial Infarction) flow <3 after percutaneous coronary intervention. ICD was implanted 30 to 60 days after MI. Primary end point was all-cause mortality at 3 years follow-up. The trial prematurely ended after inclusion of 266 patients (38% of the calculated sample size). Additional survival assessment was performed in February 2019 for the primary end point.
Results:
A total of 266 patients, 78.2% males, with a mean age of 60.8±11.3 years, were enrolled. One hundred thirty-one patients were randomized to the ICD arm and 135 patients to the control arm. All-cause mortality was significant lower in the ICD group (5% versus 13%, hazard ratio, 0.37 [95% CI, 0.15–0.95]) after 3 years follow-up. Appropriate ICD therapy occurred in 9 patients at 3 years follow-up (5 within the first 8 months after implantation). After a median long-term follow-up of 9 years (interquartile range, 3–11), total mortality (18% versus 38%; hazard ratio, 0.58 [95% CI, 0.37–0.91]), and cardiac mortality (hazard ratio, 0.52 [95% CI, 0.28–0.99]) was significant lower in the ICD group. Noncardiac death was not significantly different between groups. Left ventricular ejection fraction increased ≥10% in 46.5% of the patients during follow-up, and the extent of improvement was similar in both study groups.
Conclusions:
In this prematurely terminated and thus underpowered randomized trial, early prophylactic ICD implantation demonstrated lower total and cardiac mortality in patients with high-risk ST-segment–elevation myocardial infarction treated with primary percutaneous coronary intervention.
Registration:
URL:
https://www.trialregister.nl
; Unique identifier: Trial NL74 (NTR105).
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Affiliation(s)
- Danielle M. Haanschoten
- Department of Cardiology, Isala Heart Center, Zwolle, the Netherlands (D.M.H., A.E., A.R.R.M., P.P.H.M.D., J.J.J.S., A.A., F.D., J.P.O.)
| | - Arif Elvan
- Department of Cardiology, Isala Heart Center, Zwolle, the Netherlands (D.M.H., A.E., A.R.R.M., P.P.H.M.D., J.J.J.S., A.A., F.D., J.P.O.)
| | - Anand R. Ramdat Misier
- Department of Cardiology, Isala Heart Center, Zwolle, the Netherlands (D.M.H., A.E., A.R.R.M., P.P.H.M.D., J.J.J.S., A.A., F.D., J.P.O.)
| | - Peter Paul H.M. Delnoy
- Department of Cardiology, Isala Heart Center, Zwolle, the Netherlands (D.M.H., A.E., A.R.R.M., P.P.H.M.D., J.J.J.S., A.A., F.D., J.P.O.)
| | - Jaap Jan J. Smit
- Department of Cardiology, Isala Heart Center, Zwolle, the Netherlands (D.M.H., A.E., A.R.R.M., P.P.H.M.D., J.J.J.S., A.A., F.D., J.P.O.)
| | - Ahmet Adiyaman
- Department of Cardiology, Isala Heart Center, Zwolle, the Netherlands (D.M.H., A.E., A.R.R.M., P.P.H.M.D., J.J.J.S., A.A., F.D., J.P.O.)
| | - Fatma Demirel
- Department of Cardiology, Isala Heart Center, Zwolle, the Netherlands (D.M.H., A.E., A.R.R.M., P.P.H.M.D., J.J.J.S., A.A., F.D., J.P.O.)
| | - Hein J.J. Wellens
- Cardiovascular Research Centre Maastricht, the Netherlands (H.J.J.W.)
| | - Freek W.A. Verheugt
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, the Netherlands (F.W.A.V.)
| | - Jan Paul Ottervanger
- Department of Cardiology, Isala Heart Center, Zwolle, the Netherlands (D.M.H., A.E., A.R.R.M., P.P.H.M.D., J.J.J.S., A.A., F.D., J.P.O.)
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9
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Kalarus Z, Svendsen JH, Capodanno D, Dan GA, De Maria E, Gorenek B, Jędrzejczyk-Patej E, Mazurek M, Podolecki T, Sticherling C, Tfelt-Hansen J, Traykov V, Lip GYH, Fauchier L, Boriani G, Mansourati J, Blomström-Lundqvist C, Mairesse GH, Rubboli A, Deneke T, Dagres N, Steen T, Ahrens I, Kunadian V, Berti S. Cardiac arrhythmias in the emergency settings of acute coronary syndrome and revascularization: an European Heart Rhythm Association (EHRA) consensus document, endorsed by the European Association of Percutaneous Cardiovascular Interventions (EAPCI), and European Acute Cardiovascular Care Association (ACCA). Europace 2020; 21:1603-1604. [PMID: 31353412 DOI: 10.1093/europace/euz163] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/14/2019] [Indexed: 12/22/2022] Open
Abstract
Despite major therapeutic advances over the last decades, complex supraventricular and ventricular arrhythmias (VAs), particularly in the emergency setting or during revascularization for acute myocardial infarction (AMI), remain an important clinical problem. Although the incidence of VAs has declined in the hospital phase of acute coronary syndromes (ACS), mainly due to prompt revascularization and optimal medical therapy, still up to 6% patients with ACS develop ventricular tachycardia and/or ventricular fibrillation within the first hours of ACS symptoms. Despite sustained VAs being perceived predictors of worse in-hospital outcomes, specific associations between the type of VAs, arrhythmia timing, applied treatment strategies and long-term prognosis in AMI are vague. Atrial fibrillation (AF) is the most common supraventricular tachyarrhythmia that may be asymptomatic and/or may be associated with rapid haemodynamic deterioration requiring immediate treatment. It is estimated that over 20% AMI patients may have a history of AF, whereas the new-onset arrhythmia may occur in 5% patients with ST elevation myocardial infarction. Importantly, patients who were treated with primary percutaneous coronary intervention for AMI and developed AF have higher rates of adverse events and mortality compared with subjects free of arrhythmia. The scope of this position document is to cover the clinical implications and pharmacological/non-pharmacological management of arrhythmias in emergency presentations and during revascularization. Current evidence for clinical relevance of specific types of VAs complicating AMI in relation to arrhythmia timing has been discussed.
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Affiliation(s)
- Zbigniew Kalarus
- SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland.,Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Jesper Hastrup Svendsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Davide Capodanno
- Division of Cardiology, CAST, P.O. "Rodolico", Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Gheorghe-Andrei Dan
- "Carol Davila" University of Medicine, Colentina University Hospital, Bucharest, Romania
| | - Elia De Maria
- Ramazzini Hospital, Cardiology Unit, Carpi (Modena), Italy
| | | | - Ewa Jędrzejczyk-Patej
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Michał Mazurek
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Tomasz Podolecki
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jacob Tfelt-Hansen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Vassil Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Clinic of Cardiology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Université de Tours, Faculté de Médecine., Tours, France
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | | | | | - Georges H Mairesse
- Department of Cardiology - Electrophysiology, Cliniques du Sud Luxembourg - Vivalia, Arlon, Belgium
| | - Andrea Rubboli
- Department of Cardiovascular Diseases - AUSL Romagna, Division of Cardiology, Ospedale S. Maria delle Croci, Ravenna, Italy
| | - Thomas Deneke
- Clinic for Electrophysiology, Rhoen-Clinic Campus Bad Neustadt, Germany
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Torkel Steen
- Department of Cardiology, Pacemaker- & ICD-Centre, Oslo University Hospital Ullevaal, Oslo, Norway
| | - Ingo Ahrens
- Department of Cardiology & Intensive Care, Augustinerinnen Hospital, Cologne, Germany
| | - Vijay Kunadian
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sergio Berti
- Department of Cardiology, Fondazione C.N.R. Reg. Toscana G. Monasterio, Heart Hospital, Massa, Italy
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10
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Deshmukh T, Zaman S, Narayan A, Kovoor P. Duration of Inducible Ventricular Tachycardia Early After ST-Segment-Elevation Myocardial Infarction and Its Impact on Mortality and Ventricular Tachycardia Recurrence. J Am Heart Assoc 2020; 9:e015204. [PMID: 32573328 PMCID: PMC7670508 DOI: 10.1161/jaha.119.015204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background The clinical significance of the duration of inducible ventricular tachycardia (VT) at electrophysiology study (EPS) in patients soon after ST‐segment–elevation myocardial infarction and its predictive utility for VT recurrence are not known. Methods and Results Consecutive ST‐segment–elevation myocardial infarction patients with day 3 to 5 left ventricular ejection fraction ≤40% underwent EPS. A positive EPS was defined as sustained monomorphic VT with cycle length ≥200 ms. The induced VT was terminated by overdrive pacing or direct current shock at 30 s or earlier if hemodynamic decompensation occurred. Patients with inducible VT duration 2 to 10 s were compared with patients with inducible VT >10 s. The primary end point was survival free of VT or cardiac mortality. From 384 consecutive ST‐segment–elevation myocardial infarction patients who underwent EPS, 29% had inducible VT (n=112, 87% men). After mean follow‐up of 5.9±3.9 years, primary end point occurred in 35% of patients with induced VT 2 to 10 s duration (n=68) and in 22% of patients with induced VT >10 s (n=41) (P=0.61). This was significantly different from the noninducible VT group, in which primary end point occurred in 3% of patients (n=272) (P=0.001). Conclusions This study is the first to show that in patients who undergo EPS early after myocardial infarction, inducible VT of short duration (2–10 s) has similar predictive utility for ventricular tachyarrhythmia as longer duration (>10 s) inducible VT, which was significantly different to those without inducible VT. It is possible that immediate cardioversion of rapid VT might have contributed to some of the short durations of inducible VT.
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Affiliation(s)
- Tejas Deshmukh
- Department of Cardiology Westmead Hospital Sydney Australia.,University of Sydney Australia
| | - Sarah Zaman
- Monash University Melbourne Australia.,Monash Cardiovascular Research Centre Monash Heart Melbourne Australia
| | - Arun Narayan
- Department of Cardiology Westmead Hospital Sydney Australia
| | - Pramesh Kovoor
- Department of Cardiology Westmead Hospital Sydney Australia.,University of Sydney Australia
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11
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Zaman S, Deshmukh T, Aslam A, Martin C, Kovoor P. Sex Differences in Electrophysiology, Ventricular Tachyarrhythmia, Cardiac Arrest and Sudden Cardiac Death Following Acute Myocardial Infarction. Heart Lung Circ 2019; 29:1025-1031. [PMID: 31558356 DOI: 10.1016/j.hlc.2019.07.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 06/27/2019] [Accepted: 07/23/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Women experience less appropriate implantable cardioverter-defibrillator (ICD) interventions and are underrepresented in randomised ICD trials. Sex-differences in inducible and spontaneous ventricular tachycardia/fibrillation (VT/VF), cardiac arrest and sudden cardiac death (SCD) early post-myocardial infarction (MI) require further study. METHODS Consecutive ST-elevation MI patients with left ventricular ejection fraction (LVEF)≤40% underwent electrophysiology study (EPS) to target early prevention of SCD. An ICD was implanted for a positive (inducible monomorphic VT) but not a negative (no arrhythmia or inducible VF) EPS. The combined primary endpoint of VT/VF (spontaneous or ICD-treated), cardiac arrest or SCD was assessed using competing risk survival analysis in women versus men with adjustment for confounders. Logistic regression was used to determine independent predictors of inducible VT at EPS. RESULTS A total of 403 patients (16.9% female) underwent EPS. Women were significantly older than men but with similar LVEF (31.5 ± 6.3 versus 31.6 ± 6.4%, p = 0.91). Electrophysiology study was positive for inducible VT in 22.1% and 33.4% (p = 0.066) and an ICD implanted in 25.0% and 33.4% (p = 0.356) of women versus men. Appropriate ICD activations (VT/VF) occurred in 5.9% of women and 36.6% of men (p = 0.012). The adjusted cumulative primary endpoint incidence was significantly lower in women than men (1.6% versus 26.5%, p = 0.03). Female sex was not an independent predictor of inducible VT at EPS (HR 0.63, 95% CI 0.33-1.23, p = 0.178). CONCLUSIONS Women with early post-MI cardiomyopathy had lower VT/VF, cardiac arrest and SCD, compared to men. In ICD recipients the rate of appropriate activations was six-fold less in women compared to men.
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Affiliation(s)
- Sarah Zaman
- Monash University, Melbourne, Vic, Australia; Monash Cardiovascular Research Centre, Monash Heart, Melbourne, Vic, Australia.
| | - Tejas Deshmukh
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
| | - Anum Aslam
- Monash University, Melbourne, Vic, Australia
| | | | - Pramesh Kovoor
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; University of Sydney, Sydney, NSW, Australia
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12
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Samanta R, Narayan A, Pouliopoulos J, Kovoor P, Thiagalingam A. Influence of Body Mass Index on Recurrence of Ventricular Arrhythmia, Mortality in Defibrillator Recipients With Ischaemic Cardiomyopathy. Heart Lung Circ 2019; 29:254-261. [PMID: 30922553 DOI: 10.1016/j.hlc.2018.12.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 10/15/2018] [Accepted: 12/31/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Obesity is associated with increased risk of cardiovascular disease. There is little known, however, about the influence of body mass index (BMI) on spontaneously occurring ventricular arrhythmias in patients with ischaemic heart disease. We sought to examine the effect of BMI on the ventricular arrhythmia (VA) recurrence and mortality in defibrillator recipients with ischaemic cardiomyopathy. METHODS Consecutive patients (n = 123) with ischaemic cardiomyopathy (left ventricular ejection fraction (LVEF) ≤ 40%) and a primary or secondary prevention defibrillator were included. Patients were classified according to their BMI as being normal (18.5-24.99, n = 54/ 43.9%), overweight (2 -29.99, n = 43/ 35%) or obese (>30, n = 26/20.3%). RESULTS The primary combined endpoint of VA recurrence and mortality occurred in 36%, 5.4% and 11.5% of patients with normal, overweight and obese BMI (p = 0.001). When adjusting for risk factors such as ejection fraction, age and triple vessel disease, on multivariable analysis, normal BMI remained a significant predictor for the primary outcome (Hazard Ratio, Normal vs Overweight = 7.1, 95% CI 1.8-25, p = 0.002: Hazard Ratio, Normal vs Obese = 5.5, 95% CI 1.11-25, p = 0.033). There was a non-significant trend towards reduced survival in patients with normal weight in comparison to overweight and obese patients (p = 0.08). CONCLUSION In defibrillator recipients with ischaemic cardiomyopathy, BMI appears to be a significant predictor for the combined primary outcome of spontaneously occurring ventricular arrhythmias and mortality. Normal BMI, compared to overweight and obese patients had worse outcomes, suggesting the presence of the obesity paradox in ventricular arrhythmogenesis late post infarction.
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Affiliation(s)
- Rahul Samanta
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia.
| | - Arun Narayan
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
| | - Jim Pouliopoulos
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia
| | - Pramesh Kovoor
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia
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13
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Current Device Therapies for Sudden Cardiac Death Prevention – the ICD, Subcutaneous ICD and Wearable ICD. Heart Lung Circ 2019; 28:65-75. [DOI: 10.1016/j.hlc.2018.09.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 09/23/2018] [Indexed: 02/06/2023]
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14
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2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Heart Rhythm 2018; 15:e73-e189. [DOI: 10.1016/j.hrthm.2017.10.036] [Citation(s) in RCA: 177] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Indexed: 02/07/2023]
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15
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Muresan L, Cismaru G, Martins RP, Bataglia A, Rosu R, Puiu M, Gusetu G, Mada RO, Muresan C, Ispas DR, Le Bouar R, Diene LL, Rugina E, Levy J, Klein C, Sellal JM, Poull IM, Laurent G, de Chillou C. Recommendations for the use of electrophysiological study: Update 2018. Hellenic J Cardiol 2018; 60:82-100. [PMID: 30278230 DOI: 10.1016/j.hjc.2018.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 08/31/2018] [Accepted: 09/24/2018] [Indexed: 12/16/2022] Open
Abstract
The field of cardiac electrophysiology has greatly developed during the past decades. Consequently, the use of electrophysiological studies (EPSs) in clinical practice has also significantly augmented, with a progressively increasing number of certified electrophysiology centers and specialists. Since Zipes et al published the Guidelines for Clinical Intracardiac Electrophysiology and Catheter Ablation Procedures in 1995, no official document summarizing current EPS indications has been published. The current paper focuses on summarizing all relevant data of the role of EPS in patients with different types of cardiac pathologies and provides up-to-date recommendations on this topic. For this purpose, the PubMed database was screened for relevant articles in English up to December 2018 and ESC and ACC/AHA Clinical Practice Guidelines, and EHRA/HRS/APHRS position statements related to the current topic were analyzed. Current recommendations for the use of EPS in clinical practice are discussed and presented in 17 distinct cardiac pathologies. A short rationale, evidence, and indications are provided for each cardiac disease/group of diseases. In conclusion, because of its capability to establish a diagnosis in patients with a variety of cardiac pathologies, the EPS remains a useful tool in the evaluation of patients with cardiac arrhythmias and conduction disorders and is capable of establishing indications for cardiac device implantation and guide catheter ablation procedures.
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Affiliation(s)
- Lucian Muresan
- "Emile Muller" Hospital, Cardiology Department, 68100 Mulhouse, France.
| | - Gabriel Cismaru
- Rehabilitation Hospital, Cardiology Department, 400347 Cluj-Napoca, Romania
| | - Raphaël Pedro Martins
- Centre Hospitalier Universitaire de Rennes, Cardiology Department, 35000 Rennes, France
| | - Alberto Bataglia
- Institut Lorrain du Coeur et des Vaisseaux « Louis Mathieu », Cardiology Department, Electrophysiology Department, 54000 Vandoeuvre-les-Nancy, France
| | - Radu Rosu
- Rehabilitation Hospital, Cardiology Department, 400347 Cluj-Napoca, Romania
| | - Mihai Puiu
- Rehabilitation Hospital, Cardiology Department, 400347 Cluj-Napoca, Romania
| | - Gabriel Gusetu
- Rehabilitation Hospital, Cardiology Department, 400347 Cluj-Napoca, Romania
| | - Razvan Olimpiu Mada
- "Niculae Stancioiu" Heart Institute, Cardiology Department, 400005 Cluj-Napoca, Romania
| | - Crina Muresan
- "Emile Muller" Hospital, Cardiology Department, 68100 Mulhouse, France
| | - Daniel Radu Ispas
- Rehabilitation Hospital, Cardiology Department, 400347 Cluj-Napoca, Romania
| | - Ronan Le Bouar
- "Emile Muller" Hospital, Cardiology Department, 68100 Mulhouse, France
| | | | - Elena Rugina
- "Emile Muller" Hospital, Cardiology Department, 68100 Mulhouse, France
| | - Jacques Levy
- "Emile Muller" Hospital, Cardiology Department, 68100 Mulhouse, France
| | - Cedric Klein
- Centre Hospitalier Universitaire de Lille, Cardiology Department, 59000 Lille, France
| | - Jean Marc Sellal
- Institut Lorrain du Coeur et des Vaisseaux « Louis Mathieu », Cardiology Department, Electrophysiology Department, 54000 Vandoeuvre-les-Nancy, France
| | - Isabelle Magnin Poull
- Institut Lorrain du Coeur et des Vaisseaux « Louis Mathieu », Cardiology Department, Electrophysiology Department, 54000 Vandoeuvre-les-Nancy, France
| | - Gabriel Laurent
- Centre Hospitalier Universitaire de Dijon, Cardiology Department, 21000 Dijon, France
| | - Christian de Chillou
- Institut Lorrain du Coeur et des Vaisseaux « Louis Mathieu », Cardiology Department, Electrophysiology Department, 54000 Vandoeuvre-les-Nancy, France
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16
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Zaman S, Goldberger JJ, Kovoor P. Sudden Death Risk-Stratification in 2018-2019: The Old and the New. Heart Lung Circ 2018; 28:57-64. [PMID: 30482684 DOI: 10.1016/j.hlc.2018.08.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 08/10/2018] [Accepted: 08/15/2018] [Indexed: 12/12/2022]
Abstract
Sudden Cardiac Death (SCD) is a major public health issue, accounting for half of all cardiovascular deaths world-wide. The implantable cardioverter-defibrillator (ICD) has been solidified as the cornerstone therapy in primary prevention of SCD in ischaemic and non-ischaemic cardiomyopathy. However, what has become increasingly clear is that the left ventricular ejection fraction (LVEF) is an inadequate tool to select patients for a prophylactic ICD, despite its widespread use for this purpose. Use of LVEF alone has poor specificity for arrhythmic versus non-arrhythmic death. In addition, the vast majority of sudden deaths occur in patients with more preserved cardiac function. Alternate predictors of sudden death include electrophysiology study, non-invasive markers of electrical instability, myocardial fibrosis, genetic and bio-markers. The challenge for the future is finding a risk stratification test, or combination of tests, that adequately select patients at high risk of SCD with low competing risk of non-sudden death.
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Affiliation(s)
- Sarah Zaman
- Monash Cardiovascular Research Centre, Monash University, Melbourne, Vic, Australia; MonashHEART, Monash Medical Centre, Melbourne, Vic, Australia
| | - Jeffrey J Goldberger
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Pramesh Kovoor
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia.
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17
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Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2018; 138:e272-e391. [PMID: 29084731 DOI: 10.1161/cir.0000000000000549] [Citation(s) in RCA: 264] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | - William G Stevenson
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Michael J Ackerman
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - William J Bryant
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - David J Callans
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Anne B Curtis
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Barbara J Deal
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Timm Dickfeld
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Michael E Field
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Gregg C Fonarow
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Anne M Gillis
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Christopher B Granger
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Stephen C Hammill
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Mark A Hlatky
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - José A Joglar
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - G Neal Kay
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Daniel D Matlock
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Robert J Myerburg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Richard L Page
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
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Katritsis DG, Zografos T, Hindricks G. Electrophysiology testing for risk stratification of patients with ischaemic cardiomyopathy: a call for action. Europace 2018; 20:f148-f152. [PMID: 29236981 DOI: 10.1093/europace/eux305] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 12/05/2017] [Indexed: 01/05/2023] Open
Abstract
Current guidelines recommendations, based on the results of primary sudden cardiac death prevention trials, use the left ventricular ejection fraction (LVEF) as a sole criterion for the indication of implantable cardioverter defibrillator therapy for primary prevention purposes. In this article, we review the sensitivity and specificity of LVEF for predicting arrhythmic vs. non-arrhythmic cardiac death and examine existing evidence on the use of electrophysiology testing for risk stratification of ischaemic patients with reduced left ventricular function.
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Affiliation(s)
| | - Theodoros Zografos
- Department of Cardiology, Athens Euroclinic, 9 Athanassiadou Street, Athens, Greece
| | - Gerhard Hindricks
- Department of Electrophysiology, University Leipzig-Heart Center, Strümpellstr. Leipzig, Germany
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19
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Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2018; 72:e91-e220. [PMID: 29097296 DOI: 10.1016/j.jacc.2017.10.054] [Citation(s) in RCA: 717] [Impact Index Per Article: 119.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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20
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Influence of BMI on inducible ventricular tachycardia and mortality in patients with myocardial infarction and left ventricular dysfunction: The obesity paradox. Int J Cardiol 2018; 265:148-154. [DOI: 10.1016/j.ijcard.2018.03.055] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/05/2018] [Accepted: 03/12/2018] [Indexed: 12/28/2022]
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21
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Bergau L, Willems R, Sprenkeler DJ, Fischer TH, Flevari P, Hasenfuß G, Katsaras D, Kirova A, Lehnart SE, Lüthje L, Röver C, Seegers J, Sossalla S, Dunnink A, Sritharan R, Tuinenburg AE, Vandenberk B, Vos MA, Wijers SC, Friede T, Zabel M. Differential multivariable risk prediction of appropriate shock versus competing mortality - A prospective cohort study to estimate benefits from ICD therapy. Int J Cardiol 2018; 272:102-107. [PMID: 29983251 DOI: 10.1016/j.ijcard.2018.06.103] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/18/2018] [Accepted: 06/27/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND OBJECTIVE We prospectively investigated combinations of risk stratifiers including multiple EP diagnostics in a cohort study of ICD patients. METHODS For 672 enrolled patients, we collected history, LVEF, EP study and T-wave alternans testing, 24-h Holter, NT-proBNP, and the eGFR. All-cause mortality and first appropriate ICD shock were predefined endpoints. RESULTS The 635 patients included in the final analyses were 63 ± 13 years old, 81% were male, LVEF averaged 40 ± 14%, 20% were inducible at EP study, 63% had a primary prophylactic ICD. During follow-up over 4.3 ± 1.5 years, 108 patients died (4.0% per year), and appropriate shock therapy occurred in n = 96 (3.9% per year). In multivariate regression, age (p < 0.001), LVEF (p < 0.001), NYHA functional class (p = 0.007), eGFR (p = 0.024), a history of atrial fibrillation (p = 0.011), and NT-pro-BNP (p = 0.002) were predictors of mortality. LVEF (p = 0.002), inducibility at EP study (p = 0.007), and secondary prophylaxis (p = 0.002) were identified as independent predictors of appropriate shocks. A high annualized risk of shocks of about 10% per year was prevalent in the upper quintile of the shock score. In contrast, a low annual risk of shocks (1.8% per year) was found in the lower two quintiles of the shock score. The lower two quintiles of the mortality score featured an annual mortality <0.6%. CONCLUSIONS In a prospective ICD patient cohort, a very good approximation of mortality versus arrhythmic risk was possible using a multivariable diagnostic strategy. EP stimulation is the best test to assess risk of arrhythmias resulting in ICD shocks.
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Affiliation(s)
- Leonard Bergau
- University Medical Center Göttingen, Dept. of Cardiology and Pneumology, Göttingen, Germany
| | - Rik Willems
- University Hospitals of Leuven, Leuven, Belgium
| | - David J Sprenkeler
- University Medical Center Utrecht, Dept. of Medical Physiology, Utrecht, Netherlands
| | - Thomas H Fischer
- University Medical Center Göttingen, Dept. of Cardiology and Pneumology, Göttingen, Germany
| | - Panayota Flevari
- Attikon University Hospital, Dept. of Cardiology, Athens, Greece
| | - Gerd Hasenfuß
- University Medical Center Göttingen, Dept. of Cardiology and Pneumology, Göttingen, Germany; DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | | | - Aleksandra Kirova
- University Medical Center Göttingen, Dept. of Cardiology and Pneumology, Göttingen, Germany
| | - Stephan E Lehnart
- University Medical Center Göttingen, Dept. of Cardiology and Pneumology, Göttingen, Germany; DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Lars Lüthje
- University Medical Center Göttingen, Dept. of Cardiology and Pneumology, Göttingen, Germany
| | - Christian Röver
- University Medical Center Göttingen, Dept. of Medical Statistics, Göttingen, Germany
| | - Joachim Seegers
- University Medical Center Göttingen, Dept. of Cardiology and Pneumology, Göttingen, Germany; Division of Cardiology, Dept. of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Samuel Sossalla
- University Medical Center Göttingen, Dept. of Cardiology and Pneumology, Göttingen, Germany; Division of Cardiology, Dept. of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Albert Dunnink
- University Medical Center Utrecht, Dept. of Medical Physiology, Utrecht, Netherlands
| | - Rajevaa Sritharan
- University Medical Center Göttingen, Dept. of Cardiology and Pneumology, Göttingen, Germany
| | - Anton E Tuinenburg
- University Medical Center Utrecht, Dept. of Cardiology, Utrecht, Netherlands
| | | | - Marc A Vos
- University Medical Center Utrecht, Dept. of Medical Physiology, Utrecht, Netherlands
| | - Sofieke C Wijers
- University Medical Center Utrecht, Dept. of Medical Physiology, Utrecht, Netherlands; University Medical Center Utrecht, Dept. of Cardiology, Utrecht, Netherlands
| | - Tim Friede
- DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany; University Medical Center Göttingen, Dept. of Medical Statistics, Göttingen, Germany
| | - Markus Zabel
- University Medical Center Göttingen, Dept. of Cardiology and Pneumology, Göttingen, Germany; DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany.
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22
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Cho JH, Zhang R, Kilfoil PJ, Gallet R, de Couto G, Bresee C, Goldhaber JI, Marbán E, Cingolani E. Delayed Repolarization Underlies Ventricular Arrhythmias in Rats With Heart Failure and Preserved Ejection Fraction. Circulation 2017; 136:2037-2050. [PMID: 28974519 DOI: 10.1161/circulationaha.117.028202] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 09/07/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Heart failure with preserved ejection fraction (HFpEF) represents approximately half of heart failure, and its incidence continues to increase. The leading cause of mortality in HFpEF is sudden death, but little is known about the underlying mechanisms. METHODS Dahl salt-sensitive rats were fed a high-salt diet (8% NaCl) from 7 weeks of age to induce HFpEF (n=38). Rats fed a normal-salt diet (0.3% NaCl) served as controls (n=13). Echocardiograms were performed to assess systolic and diastolic function from 14 weeks of age. HFpEF-verified and control rats underwent programmed electrical stimulation. Corrected QT interval was measured by surface ECG. The mechanisms of ventricular arrhythmias (VA) were probed by optical mapping, whole-cell patch clamp to measure action potential duration and ionic currents, and quantitative polymerase chain reaction and Western blotting to investigate changes in ion channel expression. RESULTS After 7 weeks of a high-salt diet, 31 of 38 rats showed diastolic dysfunction and preserved ejection fraction along with signs of heart failure and hence were diagnosed with HFpEF. Programmed electric stimulation demonstrated increased susceptibility to VA in HFpEF rats (P<0.001 versus controls). The arrhythmogenicity index was increased (P<0.001) and the corrected QT interval on ECG was prolonged (P<0.001) in HFpEF rats. Optical mapping of HFpEF hearts demonstrated prolonged action potentials (P<0.05) and multiple reentry circuits during induced VA. Single-cell recordings of cardiomyocytes isolated from HFpEF rats confirmed a delay of repolarization (P=0.001) and revealed downregulation of transient outward potassium current (Ito; P<0.05). The rapid components of the delayed rectifier potassium current (IKr) and the inward rectifier potassium current (IK1) were also downregulated (P<0.05), but the current densities were much lower than for Ito. In accordance with the reduction of Ito, both Kcnd3 transcript and Kv4.3 protein levels were decreased in HFpEF rat hearts. CONCLUSIONS Susceptibility to VA was markedly increased in rats with HFpEF. Underlying abnormalities include QT prolongation, delayed repolarization from downregulation of potassium currents, and multiple reentry circuits during VA. Our findings are consistent with the hypothesis that potassium current downregulation leads to abnormal repolarization in HFpEF, which in turn predisposes to VA and sudden cardiac death.
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Affiliation(s)
- Jae Hyung Cho
- Cedars-Sinai Heart Institute, Los Angeles, CA (J.H.C., R.Z., P.J.K., G.d.C., J.I.G., E.M., E.C.)
| | - Rui Zhang
- Cedars-Sinai Heart Institute, Los Angeles, CA (J.H.C., R.Z., P.J.K., G.d.C., J.I.G., E.M., E.C.)
| | - Peter J Kilfoil
- Cedars-Sinai Heart Institute, Los Angeles, CA (J.H.C., R.Z., P.J.K., G.d.C., J.I.G., E.M., E.C.)
| | - Romain Gallet
- Henri Mondor University Hospital, Créteil, France (R.G.)
| | - Geoffrey de Couto
- Cedars-Sinai Heart Institute, Los Angeles, CA (J.H.C., R.Z., P.J.K., G.d.C., J.I.G., E.M., E.C.)
| | - Catherine Bresee
- Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, CA (C.B.)
| | - Joshua I Goldhaber
- Cedars-Sinai Heart Institute, Los Angeles, CA (J.H.C., R.Z., P.J.K., G.d.C., J.I.G., E.M., E.C.)
| | - Eduardo Marbán
- Cedars-Sinai Heart Institute, Los Angeles, CA (J.H.C., R.Z., P.J.K., G.d.C., J.I.G., E.M., E.C.)
| | - Eugenio Cingolani
- Cedars-Sinai Heart Institute, Los Angeles, CA (J.H.C., R.Z., P.J.K., G.d.C., J.I.G., E.M., E.C.)
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23
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Nguyen TL, Phan J, Hogan J, Hee L, Moses D, Otton J, Premawardhana U, Rajaratnam R, Juergens CP, Dimitri H, French JK, Richards D, Thomas L. Adverse diastolic remodeling after reperfused ST-elevation myocardial infarction: An important prognostic indicator. Am Heart J 2016; 180:117-27. [PMID: 27659890 DOI: 10.1016/j.ahj.2016.05.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 05/09/2016] [Indexed: 01/29/2023]
Abstract
OBJECTIVES We sought to determine the relationship of adverse diastolic remodeling (ie, worsening diastolic or persistent restrictive filling) with infarct scar characteristics, and to evaluate its prognostic value after ST-segment elevation myocardial infarction (STEMI). BACKGROUND Severe diastolic dysfunction (restrictive filling) has known prognostic value post STEMI. However, ongoing left ventricular (LV) remodeling post STEMI may alter diastolic function even if less severe. METHODS AND RESULTS There were 218 prospectively recruited STEMI patients with serial echocardiograms (transthoracic echocardiography) and cardiac magnetic resonance imaging (CMR) performed, at a median of 4 days (early) and 55 days (follow-up). LV ejection fraction and infarct characteristics were assessed by CMR, and comprehensive diastolic function assessment including a diastolic grade was evaluated on transthoracic echocardiography. 'Adverse diastolic remodeling' occurred if diastolic function grade either worsened (≥1 grade) between early and follow-up imaging, or remained as persistent restrictive filling at follow-up. Follow-up infarct scar size (IS) predicted adverse diastolic remodeling (area under the curve 0.86) and persistent restrictive filling (area under the curve 0.89). The primary endpoint of major adverse cardiovascular events (MACE) occurred in 48 patients during follow-up (mean, 710±79 days). Kaplan-Meier analysis showed that adverse diastolic remodeling (n=50) and persistent restrictive filling alone (n=33) were significant predictors of MACE (both P<.001). Multivariate Cox analysis, when adjusted for TIMI risk score and CMR IS, microvascular obstruction, and LV ejection fraction, showed adverse diastolic remodeling (HR 3.79, P<.001) was an independent predictor of MACE, as was persistent restrictive filling alone (HR 2.61, P=.019). CONCLUSIONS Larger IS is associated with adverse diastolic remodeling. Following STEMI, adverse diastolic remodeling is a powerful prognostic marker, and identifies a larger group of 'at-risk' patients, than does persistent restrictive filling alone.
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Dind A, Allahwala U, Asrress KN, Jolly SS, Bhindi R. Contemporary Management of ST-Elevation Myocardial Infarction. Heart Lung Circ 2016; 26:114-121. [PMID: 27617370 DOI: 10.1016/j.hlc.2016.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 05/11/2016] [Accepted: 07/22/2016] [Indexed: 02/07/2023]
Abstract
Recent advances have caused a major shift in the way ST-elevation myocardial infarctions are managed. This review explores the pharmacological and interventional techniques that have evidence for improving outcomes and the landmark trials that have sparked change. The new P2Y12 inhibitors, ticagrelor and prasugrel, have been shown to be superior to clopidogrel in STEMI patients undergoing primary percutaneous coronary intervention. Concurrently, many technical aspects of percutaneous coronary intervention have been further clarified by trial data, with bare-metal stents, routine thrombus aspiration and femoral access showing evidence of inferiority. Ongoing trials will provide more information on the role of non-culprit lesion PCI, bioresorbable vascular scaffolds, mechanical devices in persistent ischaemia and early automatic implantable cardioverter-defibrillators for inducible ventricular tachycardia.
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Affiliation(s)
- Ashleigh Dind
- Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Usaid Allahwala
- Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Kaleab N Asrress
- Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Sanjit S Jolly
- Department of Medicine, Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Ravinay Bhindi
- Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia.
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26
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Zaman S, Taylor AJ, Stiles M, Chow C, Kovoor P. Programmed Ventricular Stimulation to Risk Stratify for Early Cardioverter-Defibrillator Implantation to Prevent Tachyarrhythmias following Acute Myocardial Infarction (PROTECT-ICD): Trial Protocol, Background and Significance. Heart Lung Circ 2016; 25:1055-1062. [PMID: 27522511 DOI: 10.1016/j.hlc.2016.04.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 03/09/2016] [Accepted: 04/08/2016] [Indexed: 12/29/2022]
Abstract
The 'Programmed Ventricular Stimulation to Risk Stratify for Early Cardioverter-Defibrillator Implantation to Prevent Tachyarrhythmias following Acute Myocardial Infarction' (PROTECT-ICD) trial is an Australian-led multicentre randomised controlled trial targeting prevention of sudden cardiac death in patients who have at least moderately reduced cardiac function following a myocardial infarct (MI). The primary objective of the trial is to assess whether electrophysiological study to guide prophylactic implantation of an implantable cardioverter-defibrillator (ICD) early following MI (first 40 days) will lead to a significant reduction in sudden cardiac death and non-fatal arrhythmia. The secondary objective is to assess the utility of cardiac MRI (CMR) in assessing early myocardial characteristics, and its predictive value for both inducible ventricular tachycardia (VT) at EPS and SCD/ non-fatal arrhythmia at follow-up.
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Affiliation(s)
- Sarah Zaman
- MonashHEART, Monash Medical Centre, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
| | - Andrew J Taylor
- Department of Cardiology, The Alfred Hospital, Melbourne, Vic, Australia; Baker IDI Heart and Diabetes Institute, Melbourne, Vic, Australia
| | | | - Clara Chow
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia; The George Institute for Global Health, Sydney, NSW, Australia
| | - Pramesh Kovoor
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia.
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27
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Nguyen TL, French JK, Hogan J, Hee L, Moses D, Mussap CJ, Rajaratnam R, Juergens CP, Dimitri HR, Richards DAB, Thomas L. Prognostic value of high sensitivity troponin T after ST-segment elevation myocardial infarction in the era of cardiac magnetic resonance imaging. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2015; 2:164-171. [PMID: 29474609 DOI: 10.1093/ehjqcco/qcv033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Indexed: 02/01/2023]
Abstract
Aims To determine if high sensitivity troponin T (hs-TnT) measurements performed during the 'plateau phase' of troponin release (≥48 h) following ST-segment elevation myocardial infarction (STEMI) can predict major adverse cardiovascular endpoints (MACE), and to evaluate its prognostic value compared with cardiac magnetic resonance imaging (CMRI) parameters. Methods and results We prospectively recruited 201 first presentation STEMI patients. Serial hs-TnT levels were measured at admission, peak (highest), 24, 48 and 72 h. CMRI and transthoracic echocardiography were performed (4 days median) post-STEMI, evaluating infarct scar characteristics and left ventricular ejection fraction (LVEF). Associations were determined between hs-TnT levels and CMRI parameters early after STEMI with MACE (comprising mortality, re-infarction, new or worsening of heart failure, cerebrovascular accident, and sustained ventricular arrhythmias) at medium-term follow-up. After 602 days (median), 33 (17%) patients had MACE. Upper tertile hs-TnT levels at 48 and 72 h were associated with MACE (Kaplan-Meier P = 0.002 and P = 0.012, respectively). Multivariate Cox analyses, incorporating diabetes, CMRI scar size, LVEF and hs-TnT levels (applied at a single hs-TnT time point) showed that 48 and 72 h hs-TnT levels were independent predictors for MACE (HR = 1.20, P = 0.002, and HR = 1.21, P = 0.035 respectively). Conclusion Measurement of hs-TnT in the plateau phase after STEMI is an inexpensive method of prognostic risk assessment.
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Affiliation(s)
- Tuan L Nguyen
- Cardiology Department, Liverpool Hospital, Elizabeth Street, Sydney, NSW 2170, Australia.,South Western Sydney Clinical School, The University of NSW, Sydney, NSW, Australia
| | - John K French
- Cardiology Department, Liverpool Hospital, Elizabeth Street, Sydney, NSW 2170, Australia.,South Western Sydney Clinical School, The University of NSW, Sydney, NSW, Australia
| | - Jarred Hogan
- South Western Sydney Clinical School, The University of NSW, Sydney, NSW, Australia
| | - Leia Hee
- Cardiology Department, Liverpool Hospital, Elizabeth Street, Sydney, NSW 2170, Australia.,South Western Sydney Clinical School, The University of NSW, Sydney, NSW, Australia
| | - Daniel Moses
- South Western Sydney Clinical School, The University of NSW, Sydney, NSW, Australia.,Radiology Department, Liverpool Hospital, Sydney, NSW, Australia
| | - Christian J Mussap
- Cardiology Department, Liverpool Hospital, Elizabeth Street, Sydney, NSW 2170, Australia.,South Western Sydney Clinical School, The University of NSW, Sydney, NSW, Australia
| | - Rohan Rajaratnam
- Cardiology Department, Liverpool Hospital, Elizabeth Street, Sydney, NSW 2170, Australia.,South Western Sydney Clinical School, The University of NSW, Sydney, NSW, Australia.,School of Medicine, University of Western Sydney, Campbelltown, NSW, Australia
| | - Craig P Juergens
- Cardiology Department, Liverpool Hospital, Elizabeth Street, Sydney, NSW 2170, Australia.,South Western Sydney Clinical School, The University of NSW, Sydney, NSW, Australia
| | - Hany R Dimitri
- Cardiology Department, Liverpool Hospital, Elizabeth Street, Sydney, NSW 2170, Australia.,South Western Sydney Clinical School, The University of NSW, Sydney, NSW, Australia
| | - David A B Richards
- Cardiology Department, Liverpool Hospital, Elizabeth Street, Sydney, NSW 2170, Australia.,South Western Sydney Clinical School, The University of NSW, Sydney, NSW, Australia
| | - Liza Thomas
- Cardiology Department, Liverpool Hospital, Elizabeth Street, Sydney, NSW 2170, Australia.,South Western Sydney Clinical School, The University of NSW, Sydney, NSW, Australia
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28
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Nguyen TL, Phan JAK, Hee L, Moses DA, Otton J, Terreblanche OD, Xiong J, Premawardhana U, Rajaratnam R, Juergens CP, Dimitri HR, French JK, Richards DAB, Thomas L. High-sensitivity troponin T predicts infarct scar characteristics and adverse left ventricular function by cardiac magnetic resonance imaging early after reperfused acute myocardial infarction. Am Heart J 2015; 170:715-725.e2. [PMID: 26386795 DOI: 10.1016/j.ahj.2015.06.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 06/22/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Late gadolinium enhancement cardiac magnetic resonance imaging (CMRI) is the current standard for evaluation of myocardial infarct scar size and characteristics. Because post-ST-segment elevation myocardial infarction (STEMI) troponin levels correlate with clinical outcomes, we sought to determine the sampling period for high-sensitivity troponin T (hs-TnT) that would best predict CMRI-measured infarct scar characteristics and left ventricular (LV) function. METHODS AND RESULTS Among 201 patients with first presentation with STEMI who were prospectively recruited, we measured serial hs-TnT levels at admission, peak, 24 hours, 48 hours, and 72 hours after STEMI. Indexed LV volumes, LV ejection fraction (LVEF) and infarct scar characteristics (scar size, scar heterogeneity, myocardial salvage index, and microvascular obstruction) were evaluated by CMRI at a median of 4 days post-STEMI. Peak and serial hs-TnT levels correlated positively with early indexed LV volumes and infarct scar characteristics, and negatively correlated with myocardial salvage index and LVEF. Both 48- and 72-hour hs-TnT levels similarly predicted "large" total infarct scar size (odds ratios [ORs] 3.08 and 3.53, both P < .001), myocardial salvage index (ORs 1.68 and 2.30, both P < .001), and LVEF <40% (ORs 2.16 and 2.17, both P < .001) on univariate analyses. On multivariate analyses, 48- and 72-hour hs-TnT levels independently predicted large infarct scar size (ORs 2.05 and 2.31, both P < .001), reduced myocardial salvage index (OR 1.39 [P = .031] and OR 1.55 [P = .009]), and LVEF <40% (OR 1.47 [P = .018] and OR 1.43 [P = .026]). All measured hs-TnT levels had a modest association and similar capacity to predict microvascular obstruction. CONCLUSIONS Levels of hs-TnT at 48 and 72 hours, measured during the "plateau phase" post-STEMI, predicted infarct scar size, poor myocardial salvage, and LVEF. These levels also correlated with scar heterogeneity and microvascular obstruction post-STEMI. Since ascertaining peak levels after STEMI is challenging in routine practice, based on the biphasic kinetics of hs-TnT, a measurement at 48 to 72 hours (during the plateau phase) provides a useful and simple method for early evaluation of LV function and infarct scar characteristics.
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Affiliation(s)
- Tuan L Nguyen
- Cardiology Department, Liverpool Hospital, Sydney, New South Wales, Australia; South Western Sydney Clinical School, The University of NSW, Sydney, New South Wales, Australia.
| | - Justin A K Phan
- Cardiology Department, Liverpool Hospital, Sydney, New South Wales, Australia; South Western Sydney Clinical School, The University of NSW, Sydney, New South Wales, Australia
| | - Leia Hee
- Cardiology Department, Liverpool Hospital, Sydney, New South Wales, Australia; South Western Sydney Clinical School, The University of NSW, Sydney, New South Wales, Australia
| | - Daniel A Moses
- South Western Sydney Clinical School, The University of NSW, Sydney, New South Wales, Australia; Radiology Department, Liverpool Hospital, Sydney, New South Wales, Australia
| | - James Otton
- Cardiology Department, Liverpool Hospital, Sydney, New South Wales, Australia; South Western Sydney Clinical School, The University of NSW, Sydney, New South Wales, Australia
| | - Owen D Terreblanche
- Radiology Department, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Jessica Xiong
- South Western Sydney Clinical School, The University of NSW, Sydney, New South Wales, Australia
| | - Upul Premawardhana
- Cardiology Department, Liverpool Hospital, Sydney, New South Wales, Australia; South Western Sydney Clinical School, The University of NSW, Sydney, New South Wales, Australia; School of Medicine, University of Western Sydney, Campbelltown, New South Wales, Australia
| | - Rohan Rajaratnam
- Cardiology Department, Liverpool Hospital, Sydney, New South Wales, Australia; South Western Sydney Clinical School, The University of NSW, Sydney, New South Wales, Australia; School of Medicine, University of Western Sydney, Campbelltown, New South Wales, Australia
| | - Craig P Juergens
- Cardiology Department, Liverpool Hospital, Sydney, New South Wales, Australia; South Western Sydney Clinical School, The University of NSW, Sydney, New South Wales, Australia
| | - Hany R Dimitri
- Cardiology Department, Liverpool Hospital, Sydney, New South Wales, Australia; South Western Sydney Clinical School, The University of NSW, Sydney, New South Wales, Australia
| | - John K French
- Cardiology Department, Liverpool Hospital, Sydney, New South Wales, Australia; South Western Sydney Clinical School, The University of NSW, Sydney, New South Wales, Australia
| | - David A B Richards
- Cardiology Department, Liverpool Hospital, Sydney, New South Wales, Australia; South Western Sydney Clinical School, The University of NSW, Sydney, New South Wales, Australia
| | - Liza Thomas
- Cardiology Department, Liverpool Hospital, Sydney, New South Wales, Australia; South Western Sydney Clinical School, The University of NSW, Sydney, New South Wales, Australia
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Lip GYH, Heinzel FR, Gaita F, Juanatey JRG, Le Heuzey JY, Potpara T, Svendsen JH, Vos MA, Anker SD, Coats AJ, Haverkamp W, Manolis AS, Chung MK, Sanders P, Pieske B. European Heart Rhythm Association/Heart Failure Association joint consensus document on arrhythmias in heart failure, endorsed by the Heart Rhythm Society and the Asia Pacific Heart Rhythm Society. Eur J Heart Fail 2015; 17:848-74. [PMID: 26293171 DOI: 10.1002/ejhf.338] [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] [Indexed: 11/07/2022] Open
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30
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Lip GYH, Heinzel FR, Gaita F, Juanatey JRG, Le Heuzey JY, Potpara T, Svendsen JH, Vos MA, Anker SD, Coats AJ, Haverkamp W, Manolis AS, Chung MK, Sanders P, Pieske B, Gorenek B, Lane D, Boriani G, Linde C, Hindricks G, Tsutsui H, Homma S, Brownstein S, Nielsen JC, Lainscak M, Crespo-Leiro M, Piepoli M, Seferovic P, Savelieva I. European Heart Rhythm Association/Heart Failure Association joint consensus document on arrhythmias in heart failure, endorsed by the Heart Rhythm Society and the Asia Pacific Heart Rhythm Society. Europace 2015; 18:12-36. [PMID: 26297713 DOI: 10.1093/europace/euv191] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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31
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Manolis AS. The clinical challenge of preventing sudden cardiac death immediately after acute ST-elevation myocardial infarction. Expert Rev Cardiovasc Ther 2014; 12:1427-37. [PMID: 25382137 DOI: 10.1586/14779072.2014.981159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Unfortunately, of all patients experiencing acute myocardial infarction (MI), usually in the form of ST-elevation MI, 25-35% will die of sudden cardiac death (SCD) before receiving medical attention, most often from ventricular fibrillation. For patients who reach the hospital, prognosis is considerably better and has improved over the years. Reperfusion therapy, best attained with primary percutaneous coronary intervention compared to thrombolysis, has made a big difference in reducing the risk of SCD early and late after ST-elevation MI. In-hospital SCD due to ventricular tachyarrhythmias is manageable, with either preventive measures or drugs or electrical cardioversion. There is general agreement for secondary prevention of SCD post-MI with implantation of a cardioverter defibrillator (ICD) when malignant ventricular arrhythmias occur late (>48 h) after an MI, and are not due to reversible or correctable causes. The major challenge remains that of primary prevention, that is, how to prevent SCD during the first 1-3 months after ST-elevation MI for patients who have low left ventricular ejection fraction and are not candidates for an ICD according to current guidelines, due to the results of two studies, which did not show any benefits of early (<40 days after an MI) ICD implantation. Two recent documents may provide direction as to how to bridge the gap for this early post-MI period. Both recommend an electrophysiology study to guide implantation of an ICD, at least for those developing syncope or non-sustained ventricular tachycardia, who have an inducible sustained ventricular tachycardia at the electrophysiology study. An ICD is also recommended for patients with indication for a permanent pacemaker due to bradyarrhythmias, who also meet primary prevention criteria for SCD.
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Ventricular tachyarrhythmia recurrence in primary versus secondary implantable cardioverter-defibrillator patients and role of electrophysiology study. J Interv Card Electrophysiol 2014; 41:195-202. [PMID: 25267274 DOI: 10.1007/s10840-014-9941-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 07/25/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE In recent years, there has been a shift away from performing electrophysiologic study (EPS) to guide implantable cardioverter-defibrillator (ICD) implantation with a reliance on left ventricular ejection fraction (LVEF) alone. METHODS ICD patients were prospectively recruited from the multicentre COMFORT (Concept of Optimal Management of ventricular Fibrillation Or Very fast ventricular Tachycardia) trial. Primary prevention ICD patients (n = 260, groups 1 and 2) were compared to secondary prevention ICD patients (n = 210, group 3). Primary prevention ICDs were implanted in patients with ischemic cardiomyopathy based on LVEF ≤ 40 % and inducible ventricular tachycardia (VT) at EPS (n = 123, group 1) or impaired LVEF alone (LVEF ≤ 30 % or LVEF ≤ 35 % with NYHA class II or III; n = 137, group 2). EPS was performed in 61 % of secondary prevention ICD patients (n = 129). Patients were followed up for >12 months with a primary endpoint of spontaneous VT/ventricular fibrillation (VF). RESULTS A significantly higher rate of spontaneous VT/VF occurred in secondary versus primary prevention ICD patients (P < 0.001) and in EPS-guided versus LVEF-guided primary prevention ICD patients (P = 0.029). At 2 years, the proportion of patients with ≥1 VT/VF episode was 24.6 ± 4.2 %, 19.9 ± 4.6 % and 37.1 ± 3.9 % for groups 1, 2 and 3, respectively. In the secondary prevention, patients who underwent EPS, VT/VF occurred in 44.4 ± 5.9 % and 14.1 ± 6.6 % with a positive versus negative result, respectively (P = 0.02). CONCLUSIONS Secondary prevention ICD patients have more spontaneous VT/VF than primary prevention ICD patients. Secondary and primary prevention ICD patients with inducible VT at EPS have more VT/VF than patients without inducible VT or impaired LVEF alone.
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Zaman S, Kovoor P. Sudden cardiac death early after myocardial infarction: pathogenesis, risk stratification, and primary prevention. Circulation 2014; 129:2426-35. [PMID: 24914016 DOI: 10.1161/circulationaha.113.007497] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Sarah Zaman
- From the Westmead Hospital, Sydney, and University of Sydney, Sydney, Australia
| | - Pramesh Kovoor
- From the Westmead Hospital, Sydney, and University of Sydney, Sydney, Australia.
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Thakkar JB, Zaman S, Byth K, Narayan A, Thiagalingam A, Chow C, Thomas SP, Sivagangabalan G, Farlow D, Barnett R, Kovoor P. Right ventricular dysfunction predisposes to inducible ventricular tachycardia at electrophysiology studies in patients with acute ST-segment-elevation myocardial infarction and reduced left ventricular ejection fraction. Circ Arrhythm Electrophysiol 2014; 7:898-905. [PMID: 25108742 DOI: 10.1161/circep.113.001594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Inducible ventricular tachycardia (VT) is a strong predictor of spontaneous ventricular tachyarrhythmia following ST-segment-elevation myocardial infarction. Reduced left ventricular ejection fraction (EF) predisposes patients to inducible VT after ST-segment-elevation myocardial infarction. However, the role of right ventricular (RV) dysfunction in predisposing to inducible VT has not been described previously. METHODS AND RESULTS Consecutive patients with ST-segment-elevation myocardial infarction treated with primary percutaneous coronary intervention underwent predischarge radionuclide gated heart pool scan to assess ventricular EF. The study cohort included patients with reduced left ventricular EF (left ventricular EF ≤40%) who underwent electrophysiology study (n=220) in an attempt to induce VT. We defined RV dysfunction as RVEF ≤35%. The end point was sustained monomorphic VT (cycle length ≥200 ms). This was considered a positive study. No inducible arrhythmia, ventricular fibrillation, or flutter (cycle length <200 ms) was considered a negative study. Infarct region, infarct-related artery, male sex, and RVEF ≤35% were univariable predictors of positive test. After multivariable analysis, RVEF ≤35% had the strongest association as an independent predictor of inducible VT at electrophysiology study (P<0.001; odds ratio, 5.8; 95% confidence interval, 3.005-11.262). CONCLUSIONS RV dysfunction (RVEF ≤35%) predisposed to inducible VT at electrophysiology study in patients with impaired left ventricular EF (≤40%) after acute ST-segment-elevation myocardial infarction treated with primary percutaneous coronary intervention.
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Affiliation(s)
- Jay B Thakkar
- From the Westmead Hospital, Westmead, Australia (J.B.T., S.Z., K.B., A.N., A.T., C.C., S.P.T., G.S., D.F., R.B., P.K.) and Sydney Medical School, University of Sydney, Sydney, Australia (J.B.T., A.T., C.C., S.P.T., G.S., P.K.)
| | - Sarah Zaman
- From the Westmead Hospital, Westmead, Australia (J.B.T., S.Z., K.B., A.N., A.T., C.C., S.P.T., G.S., D.F., R.B., P.K.) and Sydney Medical School, University of Sydney, Sydney, Australia (J.B.T., A.T., C.C., S.P.T., G.S., P.K.)
| | - Karen Byth
- From the Westmead Hospital, Westmead, Australia (J.B.T., S.Z., K.B., A.N., A.T., C.C., S.P.T., G.S., D.F., R.B., P.K.) and Sydney Medical School, University of Sydney, Sydney, Australia (J.B.T., A.T., C.C., S.P.T., G.S., P.K.)
| | - Arun Narayan
- From the Westmead Hospital, Westmead, Australia (J.B.T., S.Z., K.B., A.N., A.T., C.C., S.P.T., G.S., D.F., R.B., P.K.) and Sydney Medical School, University of Sydney, Sydney, Australia (J.B.T., A.T., C.C., S.P.T., G.S., P.K.)
| | - Aravinda Thiagalingam
- From the Westmead Hospital, Westmead, Australia (J.B.T., S.Z., K.B., A.N., A.T., C.C., S.P.T., G.S., D.F., R.B., P.K.) and Sydney Medical School, University of Sydney, Sydney, Australia (J.B.T., A.T., C.C., S.P.T., G.S., P.K.)
| | - Clara Chow
- From the Westmead Hospital, Westmead, Australia (J.B.T., S.Z., K.B., A.N., A.T., C.C., S.P.T., G.S., D.F., R.B., P.K.) and Sydney Medical School, University of Sydney, Sydney, Australia (J.B.T., A.T., C.C., S.P.T., G.S., P.K.)
| | - Stuart P Thomas
- From the Westmead Hospital, Westmead, Australia (J.B.T., S.Z., K.B., A.N., A.T., C.C., S.P.T., G.S., D.F., R.B., P.K.) and Sydney Medical School, University of Sydney, Sydney, Australia (J.B.T., A.T., C.C., S.P.T., G.S., P.K.)
| | - Gopal Sivagangabalan
- From the Westmead Hospital, Westmead, Australia (J.B.T., S.Z., K.B., A.N., A.T., C.C., S.P.T., G.S., D.F., R.B., P.K.) and Sydney Medical School, University of Sydney, Sydney, Australia (J.B.T., A.T., C.C., S.P.T., G.S., P.K.)
| | - David Farlow
- From the Westmead Hospital, Westmead, Australia (J.B.T., S.Z., K.B., A.N., A.T., C.C., S.P.T., G.S., D.F., R.B., P.K.) and Sydney Medical School, University of Sydney, Sydney, Australia (J.B.T., A.T., C.C., S.P.T., G.S., P.K.)
| | - Robert Barnett
- From the Westmead Hospital, Westmead, Australia (J.B.T., S.Z., K.B., A.N., A.T., C.C., S.P.T., G.S., D.F., R.B., P.K.) and Sydney Medical School, University of Sydney, Sydney, Australia (J.B.T., A.T., C.C., S.P.T., G.S., P.K.)
| | - Pramesh Kovoor
- From the Westmead Hospital, Westmead, Australia (J.B.T., S.Z., K.B., A.N., A.T., C.C., S.P.T., G.S., D.F., R.B., P.K.) and Sydney Medical School, University of Sydney, Sydney, Australia (J.B.T., A.T., C.C., S.P.T., G.S., P.K.).
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JOSEPHSON MARKE. Programmed Stimulation for Risk Stratification for Postinfarction Sudden Cardiac Arrest: Why and How? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 37:791-4. [DOI: 10.1111/pace.12412] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 03/24/2014] [Indexed: 11/27/2022]
Affiliation(s)
- MARK E. JOSEPHSON
- Harvard Medical School; Harvard Thorndike Electrophysiology Institute; Beth Israel Deaconess Medical Center; Boston Massachusetts
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36
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ZAMAN SARAH, NARAYAN ARUN, THIAGALINGAM ARAVINDA, SIVAGANGABALAN GOPAL, THOMAS STUART, ROSS DAVIDL, KOVOOR PRAMESH. Significance of Repeat Programmed Ventricular Stimulation at Electrophysiology Study for Arrhythmia Prediction after Acute Myocardial Infarction. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 37:795-802. [DOI: 10.1111/pace.12391] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 01/12/2014] [Accepted: 01/28/2014] [Indexed: 11/28/2022]
Affiliation(s)
- SARAH ZAMAN
- Department of Cardiology, Westmead Hospital; Sydney Australia
- Department of Medicine; University of Sydney; Australia
| | - ARUN NARAYAN
- Department of Cardiology, Westmead Hospital; Sydney Australia
| | - ARAVINDA THIAGALINGAM
- Department of Cardiology, Westmead Hospital; Sydney Australia
- Department of Medicine; University of Sydney; Australia
| | | | - STUART THOMAS
- Department of Cardiology, Westmead Hospital; Sydney Australia
| | - DAVID L. ROSS
- Department of Cardiology, Westmead Hospital; Sydney Australia
| | - PRAMESH KOVOOR
- Department of Cardiology, Westmead Hospital; Sydney Australia
- Department of Medicine; University of Sydney; Australia
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Zaman S, Narayan A, Thiagalingam A, Sivagangabalan G, Thomas S, Ross DL, Kovoor P. What is the optimal left ventricular ejection fraction cut-off for risk stratification for primary prevention of sudden cardiac death early after myocardial infarction? Europace 2014; 16:1315-21. [DOI: 10.1093/europace/euu026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Wang TKM, Snow TAC, Chen Y, Rostom H, White JM, Stewart JT, Webster MWI, Ruygrok PN, Watson T, White HD. High-sensitivity troponin level pre-catheterization predicts adverse cardiovascular outcomes after primary angioplasty for ST-elevation myocardial infarction. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2014; 3:118-25. [DOI: 10.1177/2048872614527006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Tom Kai Ming Wang
- Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand
| | - Timothy AC Snow
- Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand
| | - Yang Chen
- Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand
| | - Hussam Rostom
- Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand
| | - Jonathon M White
- Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand
| | - James T Stewart
- Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand
| | - Mark WI Webster
- Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand
- Department of Medicine, University of Auckland, New Zealand
| | - Peter N Ruygrok
- Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand
- Department of Medicine, University of Auckland, New Zealand
| | - Timothy Watson
- Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand
- Department of Medicine, University of Auckland, New Zealand
| | - Harvey D White
- Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand
- Department of Medicine, University of Auckland, New Zealand
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Tedrow U, Stevenson WG. Sinus Rhythm Targeting of Channels for Ablation of Postinfarction Ventricular Tachycardia. Circ Arrhythm Electrophysiol 2014; 7:7-9. [DOI: 10.1161/circep.114.001422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Usha Tedrow
- From Arrhythmia Service of the Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - William G. Stevenson
- From Arrhythmia Service of the Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
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40
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Zaman S, Narayan A, Thiagalingam A, Sivagangabalan G, Thomas S, Ross DL, Kovoor P. Long-term arrhythmia-free survival in patients with severe left ventricular dysfunction and no inducible ventricular tachycardia after myocardial infarction. Circulation 2013; 129:848-54. [PMID: 24381209 DOI: 10.1161/circulationaha.113.005146] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND A negative electrophysiology study (EPS) may delineate a subgroup of patients with severely impaired left ventricular ejection fraction (LVEF) whose care can be safely managed long-term without an implantable cardioverter-defibrillator. METHODS AND RESULTS Consecutive patients treated with primary percutaneous coronary intervention for ST-segment-elevation myocardial infarction underwent early (median 4 days) LVEF assessment. Patients with LVEF ≤40% underwent EPS. A prophylactic implantable cardioverter-defibrillator was implanted for a positive (inducible monomorphic ventricular tachycardia) but not a negative (no inducible ventricular tachycardia or inducible ventricular fibrillation/flutter) EPS result. Patients who would have become eligible for a late primary prevention implantable cardioverter-defibrillator with LVEF ≤30% or ≤35% with New York Heart Association class II/III heart failure were included and analyzed according to EPS result. Patients with LVEF >40%, ineligible for EPS, were followed up as control subjects (n=1286). The primary end point was survival free of death or arrhythmia (resuscitated cardiac arrest or sustained ventricular tachycardia/ventricular fibrillation). EPS performed in 128 patients with LVEF ≤30% or with LVEF ≤35% and heart failure was negative in 63% (n=80) and positive in 37% (n=48). Implantable-cardioverter defibrillators were implanted in <0.1%, 4%, and 90% of control, EPS-negative, and EPS-positive patients, respectively. The distribution of time to death or arrhythmia was comparable in control patients and EPS-negative patients with LVEF ≤30% or with LVEF ≤35% and heart failure (P=0.738), who both differed significantly from EPS-positive patients (P<0.001). At 3 years, 91.8 ± 3.2%, 93.4 ± 1.0%, and 62.7 ± 7.5% of control, EPS-negative, and EPS-positive patients were free of death or arrhythmia, respectively. CONCLUSIONS Revascularized patients with ST-segment-elevation myocardial infarction with severely impaired left ventricular function but no inducible ventricular tachycardia have a favorable long-term prognosis without the protection of an implantable cardioverter-defibrillator.
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Affiliation(s)
- Sarah Zaman
- From Westmead Hospital, Sydney, Australia (S.Z., A.N., G.S., A.T., S.T., D.L.R., P.K.); and the Department of Medicine, University of Sydney, Sydney, Australia (S.Z., A.T., S.T., P.K.)
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41
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Affiliation(s)
- Alfred E Buxton
- From Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA
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42
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Hsieh CH, Chia EM, Huang K, Lu J, Barry M, Pouliopoulos J, Ross DL, Thomas SP, Kovoor P. Primary Radiofrequency Ablation of Ventricular Tachycardia Early After Myocardial Infarction. Circ Arrhythm Electrophysiol 2013; 6:1215-21. [DOI: 10.1161/circep.113.000447] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Ventricular tachycardia (VT) is a significant complication of myocardial infarction. Radiofrequency ablation for postinfarct VT is reserved for drug refractory VT or VT storms. Our hypothesis is that radiofrequency ablation in the early postinfarct period could abolish or diminish late recurrences of VT.
Methods and Results—
Myocardial infarct was induced by balloon occlusion of the left anterior descending artery in 35 sheep. The 25 survivors underwent programmed ventricular stimulation and electroanatomical mapping 8 days postinfarct. Animals with inducible VT (12 out of 25 animals) underwent immediate radiofrequency ablation. Further VT inductions were performed 100 and 200 days postinfarct. At day 8, 3.0±0.9 VT morphologies per animal were inducible. All were successfully ablated with 24±6 applications of radiofrequency energy. All had ablations on the left ventricular endocardium, and 67% had ablations on the right ventricular aspect of the interventricular septum. All targeted arrhythmias were successfully ablated acutely. One animal was euthanized because of hypotension from a serious pericardial effusion. The other 11 survived and remained arrhythmia free on subsequent inductions on the 100th and 200th days (
P
<0.001). The 13 animals without inducible VT remained noninducible at the subsequent studies. A historical control arm of 9 animals with inducible VT at day 8 remained inducible at day 100.
Conclusions—
Radiofrequency ablation on the eighth day after infarction abolished inducibility of VT at late induction studies ≤200 days in an ovine model. Early identification and ablation of VT after infarction may prevent or reduce late ventricular arrhythmias but needs to be validated in clinical studies.
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Affiliation(s)
- Calvin H.C. Hsieh
- From the Westmead Hospital and the University of Sydney, Sydney, Australia
| | - Ee-May Chia
- From the Westmead Hospital and the University of Sydney, Sydney, Australia
| | - Kaimin Huang
- From the Westmead Hospital and the University of Sydney, Sydney, Australia
| | - Juntang Lu
- From the Westmead Hospital and the University of Sydney, Sydney, Australia
| | - Michael Barry
- From the Westmead Hospital and the University of Sydney, Sydney, Australia
| | - Jim Pouliopoulos
- From the Westmead Hospital and the University of Sydney, Sydney, Australia
| | - David L. Ross
- From the Westmead Hospital and the University of Sydney, Sydney, Australia
| | - Stuart P. Thomas
- From the Westmead Hospital and the University of Sydney, Sydney, Australia
| | - Pramesh Kovoor
- From the Westmead Hospital and the University of Sydney, Sydney, Australia
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Denniss AR. Changes in Management of Acute Myocardial Infarction Over the Last 110 Years. Heart Lung Circ 2013; 22:883-4. [DOI: 10.1016/j.hlc.2013.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Nalliah CJ, Zaman S, Narayan A, Sullivan J, Kovoor P. Coronary artery reperfusion for ST elevation myocardial infarction is associated with shorter cycle length ventricular tachycardia and fewer spontaneous arrhythmias. Europace 2013; 16:1053-60. [DOI: 10.1093/europace/eut307] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Zaman S, Kumar S, Sullivan J, Narayan A, Thiagalingam A, Ross DL, Kovoor P. Significance of Inducible Very Fast Ventricular Tachycardia (Cycle Length 200–230 ms) After Early Reperfusion for ST-Segment–Elevation Myocardial Infarction. Circ Arrhythm Electrophysiol 2013; 6:884-90. [DOI: 10.1161/circep.113.000213] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sarah Zaman
- From the Department of Cardiology, Westmead Hospital, Sydney, Australia (S.Z., J.S., A.N., A.T., D.L.R., P.K.); Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia (S.K.); and Department of Medicine, University of Sydney, Sydney, Australia (S.Z., P.K.)
| | - Saurabh Kumar
- From the Department of Cardiology, Westmead Hospital, Sydney, Australia (S.Z., J.S., A.N., A.T., D.L.R., P.K.); Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia (S.K.); and Department of Medicine, University of Sydney, Sydney, Australia (S.Z., P.K.)
| | - Janice Sullivan
- From the Department of Cardiology, Westmead Hospital, Sydney, Australia (S.Z., J.S., A.N., A.T., D.L.R., P.K.); Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia (S.K.); and Department of Medicine, University of Sydney, Sydney, Australia (S.Z., P.K.)
| | - Arun Narayan
- From the Department of Cardiology, Westmead Hospital, Sydney, Australia (S.Z., J.S., A.N., A.T., D.L.R., P.K.); Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia (S.K.); and Department of Medicine, University of Sydney, Sydney, Australia (S.Z., P.K.)
| | - Aravinda Thiagalingam
- From the Department of Cardiology, Westmead Hospital, Sydney, Australia (S.Z., J.S., A.N., A.T., D.L.R., P.K.); Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia (S.K.); and Department of Medicine, University of Sydney, Sydney, Australia (S.Z., P.K.)
| | - David L. Ross
- From the Department of Cardiology, Westmead Hospital, Sydney, Australia (S.Z., J.S., A.N., A.T., D.L.R., P.K.); Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia (S.K.); and Department of Medicine, University of Sydney, Sydney, Australia (S.Z., P.K.)
| | - Pramesh Kovoor
- From the Department of Cardiology, Westmead Hospital, Sydney, Australia (S.Z., J.S., A.N., A.T., D.L.R., P.K.); Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia (S.K.); and Department of Medicine, University of Sydney, Sydney, Australia (S.Z., P.K.)
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Hsieh CH, Chia EM, Huang K, Lu J, Barry M, Pouliopoulos J, Ross DL, Thomas SP, Kovoor P. Evolution of Ventricular Tachycardia and Its Electrophysiological Substrate Early After Myocardial Infarction. Circ Arrhythm Electrophysiol 2013; 6:1010-7. [DOI: 10.1161/circep.113.000348] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Ee-May Chia
- From the Westmead Hospital, Sydney, Australia
| | | | - Juntang Lu
- From the Westmead Hospital, Sydney, Australia
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Zaman S, Kumar S, Narayan A, Sivagangabalan G, Thiagalingam A, Ross DL, Thomas SP, Kovoor P. Induction of ventricular tachycardia with the fourth extrastimulus and its relationship to risk of arrhythmic events in patients with post-myocardial infarct left ventricular dysfunction. Europace 2012; 14:1771-7. [DOI: 10.1093/europace/eus199] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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48
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Tan TC, Sindone AP, Denniss AR. Cardiac Electronic Implantable Devices in the Treatment of Heart Failure. Heart Lung Circ 2012; 21:338-51. [DOI: 10.1016/j.hlc.2012.03.124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 03/26/2012] [Accepted: 03/31/2012] [Indexed: 10/28/2022]
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Circulation: Arrhythmia and Electrophysiology
Editors' Picks. Circ Arrhythm Electrophysiol 2011. [DOI: 10.1161/circep.111.968941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The following articles are being highlighted as part of
Circulation: Arrhythmia and Electrophysiology's
Topic Review series. This series will summarize the most important manuscripts, as selected by the editors, published in
Circulation: Arrhythmia and Electrophysiology
and the rest of the
Circulation
portfolio. The studies included in this article represent the most read manuscripts published on the topic of atrial fibrillation in 2009 and 2010.
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Abstract
The following articles are being highlighted as part of
Circulation's
Topic Review series. This series will summarize the most important manuscripts, as selected by the editors, published in
Circulation
and the
Circulation
subspecialty journals. The studies included in this article represent the most read manuscripts published on the topic of arrhythmia and electrophysiology in 2009 and 2010.
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