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Amoako-Mensah E, Achempim-Ansong G, Gbordzoe NI, Adofo CE, Sarfo JO. Perceptions of nurses regarding quality of adult cardiopulmonary resuscitation in Ghana: a qualitative study. BMC Nurs 2023; 22:220. [PMID: 37370085 DOI: 10.1186/s12912-023-01388-5] [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: 04/21/2023] [Accepted: 06/19/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVES Cardiopulmonary resuscitation (CPR) is a necessary life-saving emergency intervention for patients with cardiac arrest and other medical conditions. The study's primary objective was to qualitatively explore nurses' perceptions of the quality of adult cardiopulmonary resuscitation in Ghana. METHODS An exploratory descriptive qualitative study was conducted among 13 purposively sampled nurses in Ghana. We collected thirteen face-to-face and telephone interviews using a semi-structured interview guide. Data were transcribed verbatim and analysed using the thematic analysis approach recommended by Braun and Clarke. RESULTS Data analysis revealed that nurses were filled with positive emotions when patients regained consciousness following resuscitation. When the otherwise happens, they tend to become tortured psychologically and filled with negative emotions. Besides, environmental factors such as the time of initiating CPR following a cardiac arrest, the availability and appropriateness of equipment and medications, workplace ergonomics, and institutional regulations affected the quality of resuscitation practices of nurses. Participants perceived that attitudes of condemnation, prejudice, apathy and skills deficiency also impacted the quality of resuscitation practices. Significant aspects of self-reported behavioural competence that affected resuscitation were knowledge and skills of CPR, confidence in initiating CPR, and the need for effort maximisation. CONCLUSION This study revealed several non-medical factors that influenced the resuscitation practices of nurses from their perspective. Nurses need to maximise their effort toward seeking further education in speciality areas such as emergency nursing and critical care nursing to guide their CPR practices and other newly emerging evidence-based protocols.
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Precision medicine for long QT syndrome: patient-specific iPSCs take the lead. Expert Rev Mol Med 2023; 25:e5. [PMID: 36597672 DOI: 10.1017/erm.2022.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Long QT syndrome (LQTS) is a detrimental arrhythmia syndrome mainly caused by dysregulated expression or aberrant function of ion channels. The major clinical symptoms of ventricular arrhythmia, palpitations and syncope vary among LQTS subtypes. Susceptibility to malignant arrhythmia is a result of delayed repolarisation of the cardiomyocyte action potential (AP). There are 17 distinct subtypes of LQTS linked to 15 autosomal dominant genes with monogenic mutations. However, due to the presence of modifier genes, the identical mutation may result in completely different clinical manifestations in different carriers. In this review, we describe the roles of various ion channels in orchestrating APs and discuss molecular aetiologies of various types of LQTS. We highlight the usage of patient-specific induced pluripotent stem cell (iPSC) models in characterising fundamental mechanisms associated with LQTS. To mitigate the outcomes of LQTS, treatment strategies are initially focused on small molecules targeting ion channel activities. Next-generation treatments will reap the benefits from development of LQTS patient-specific iPSC platform, which is bolstered by the state-of-the-art technologies including whole-genome sequencing, CRISPR genome editing and machine learning. Deep phenotyping and high-throughput drug testing using LQTS patient-specific cardiomyocytes herald the upcoming precision medicine in LQTS.
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Lou J, Chen H, Huang S, Chen P, Yu Y, Chen F. Update on risk factors and biomarkers of sudden unexplained cardiac death. J Forensic Leg Med 2022; 87:102332. [DOI: 10.1016/j.jflm.2022.102332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/21/2022] [Accepted: 03/02/2022] [Indexed: 02/01/2023]
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Cardiac Channelopathies Masquerading as Seizures. Indian Pediatr 2021. [DOI: 10.1007/s13312-021-2315-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Loppini A, Barone A, Gizzi A, Cherubini C, Fenton FH, Filippi S. Thermal effects on cardiac alternans onset and development: A spatiotemporal correlation analysis. Phys Rev E 2021; 103:L040201. [PMID: 34005953 PMCID: PMC8202768 DOI: 10.1103/physreve.103.l040201] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/09/2021] [Indexed: 01/08/2023]
Abstract
Alternans of cardiac action potential duration represent critical precursors for the development of life-threatening arrhythmias and sudden cardiac death. The system's thermal state affects these electrical disorders requiring additional theoretical and experimental efforts to improve a patient-specific clinical understanding. In such a scenario, we generalize a recent work from Loppini et al. [Phys. Rev. E 100, 020201(R) (2019)PREHBM2470-004510.1103/PhysRevE.100.020201] by performing an extended spatiotemporal correlation study. We consider high-resolution optical mapping recordings of canine ventricular wedges' electrical activity at different temperatures and pacing frequencies. We aim to recommend the extracted characteristic length as a potential predictive index of cardiac alternans onset and evolution within a wide range of system states. In particular, we show that a reduction of temperature results in a drop of the characteristic length, confirming the impact of thermal instabilities on cardiac dynamics. Moreover, we theoretically investigate the use of such an index to identify and predict different alternans regimes. Finally, we propose a constitutive phenomenological law linking conduction velocity, characteristic length, and temperature in view of future numerical investigations.
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Affiliation(s)
- Alessandro Loppini
- Department of Engineering, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Alessandro Barone
- Department of Engineering, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Alessio Gizzi
- Department of Engineering, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Christian Cherubini
- Department of Science and Technology for Humans and the Environment and ICRA, Campus Bio-Medico University of Rome, 00128 Rome, Italy and International Center for Relativistic Astrophysics Network-ICRANet, 65122 Pescara, Italy
| | - Flavio H. Fenton
- School of Physics, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Simonetta Filippi
- Department of Engineering and ICRA, Campus Bio-Medico University of Rome, 00128 Rome, Italy and International Center for Relativistic Astrophysics Network-ICRANet, 65122 Pescara, Italy
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Rashid U, Virk A, Nawaz R, Mahmood T, Fatima Z. Overt long QT syndrome in children presenting with seizure disorders in Pakistan. Ann Pediatr Cardiol 2021; 14:485-489. [PMID: 35527745 PMCID: PMC9075568 DOI: 10.4103/apc.apc_10_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 05/23/2021] [Accepted: 05/28/2021] [Indexed: 11/04/2022] Open
Abstract
Background and Objective: Materials and Methods: Results: Conclusions:
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Takembo CN, Fouda HPE. Effect of temperature fluctuation on the localized pattern of action potential in cardiac tissue. Sci Rep 2020; 10:15087. [PMID: 32934327 PMCID: PMC7493951 DOI: 10.1038/s41598-020-72188-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 08/17/2020] [Indexed: 02/02/2023] Open
Abstract
Based on the improved FitzHugh-Nagumo myocardial model driven by a constant external current, the effect of temperature fluctuation in a network of electrically coupled myocardial cells are investigated through analytical and numerical computations. Through the technique of multiple scale expansion, we successfully reduced the complex nonlinear system of equations to a more tractable and solvable nonlinear amplitude equation on which the analysis of linear stability is performed. Interestingly from this analysis, a plot of critical amplitude of action potential versus wave number revealed the growth rate of modulational instability (MI) is an increasing function of the thermoelectric couplings; [Formula: see text] and [Formula: see text], under fixed conditions of nonlinear electrical couplings. In order to verify our analytical predictions through the study the long-time evolution of the modulated cardiac impulses, numerical computation is finally carried out. Numerical experiment revealed the existence of localized coherent structures with some recognized features of synchronization. Through the mechanism of MI, changes in thermoelectrical couplings promote wave localization and mode transition in electrical activities in the cell lattice. Results could provide new insights in understanding the underlying mechanism of the manifestation of sudden heart disorder subjected to heavily temperature fluctuation.
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Affiliation(s)
- Clovis Ntahkie Takembo
- Department of Electrical and Electronic Engineering, College of Technology, University of Buéa, P.O. Box 63, Buéa, Cameroon.
| | - Henri Paul Ekobena Fouda
- Laboratory of Biophysics, Department of Physics, Faculty of Science, University of Yaoundé I, P.O. Box 812, Yaoundé, Cameroon
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Abstract
BACKGROUND Cardiac arrest is a tragic event that causes 1 death roughly every 90 seconds worldwide. Survivors generally undergo a workup to identify the cause of arrest. However, 5% to 10% of cardiac arrests remain unexplained. Because cardiac arrhythmias underlie most cardiac arrests and increasing evidence strongly supports the involvement of autoantibodies in arrhythmogenesis, a large-panel autoantibody screening was performed in patients with cardiac arrest. METHODS This is an observational, cross-sectional study of patients from the Montreal Heart Institute hospital cohort, a single-center registry of participants. A peptide microarray was designed to screen for immunoglobulin G targeting epitopes from all known cardiac ion channels with extracellular domains. Plasma samples from 23 patients with unexplained cardiac arrest were compared with those from 22 patients with cardiac arrest cases of ischemic origin and a group of 29 age-, sex-, and body mass index-matched healthy subjects. The false discovery rate, least absolute shrinkage and selection operator logistic regression, and random forest methods were carried out jointly to find significant differential immunoglobulin G responses. RESULTS The autoantibody against the pore domain of the L-type voltage-gated calcium channel was consistently identified as a biomarker of idiopathic cardiac arrest (P=0.002; false discovery rate, 0.007; classification accuracies ≥0.83). Functional studies on human induced pluripotent stem cell-derived cardiomyocytes demonstrated that the anti-L-type voltage-gated calcium channel immunoglobulin G purified from patients with idiopathic cardiac arrest is proarrhythmogenic by reducing the action potential duration through calcium channel inhibition. CONCLUSIONS The present report addresses the concept of autoimmunity and cardiac arrest. Hitherto unknown autoantibodies targeting extracellular sequences of cardiac ion channels were detected. Moreover, the study identified an autoantibody signature specific to patients with cardiac arrest.
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Affiliation(s)
- Ange Maguy
- Institute of Physiology (A.M.), University of Bern, Switzerland
| | - Jean-Claude Tardif
- Montreal Heart Institute, Université de Montréal, QC, Canada (J.C.T., D.B.)
| | - David Busseuil
- Montreal Heart Institute, Université de Montréal, QC, Canada (J.C.T., D.B.)
| | - Camillo Ribi
- Division of Immunology and Allergy (C.R.), Lausanne University Hospital, Switzerland
| | - Jin Li
- Institute of Biochemistry and Molecular Medicine (J.L.), University of Bern, Switzerland.,Department of Cardiology (J.L.), Lausanne University Hospital, Switzerland
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Abstract
Out of hospital cardiac arrest (OHCA) is a major cause of morbidity and mortality worldwide. Clinical decision making is extremely difficult in this understudied patient population with high prevalence of neurological injury and inexorable shock states. As such, there are uncertain benefits from therapies available in the cardiac catheterization laboratory. Fear of futility and public reporting often affects decision making and can result in risk aversion. This review focuses on invasive management in OHCA care, with particular focus on coronary angiography, coronary revascularization, and mechanical support. Guidelines recommend emergency coronary angiography in patients with ST-segment elevations on ECG after OHCA, while the role of coronary angiography in patients without ST-segment elevations is less clear. Similar uncertainty remains in the appropriate revascularization strategy in these patients. As in other areas of cardiology, there is a growing interest in the role of mechanical circulatory support after OHCA, though the available literature shows mixed results. The many uncertainties associated with treating the patient with OHCA highlight the importance of clinical decision support tools and treatment algorithms in the care of this population. This review focuses on invasive management in OHCA care, with particular focus on coronary angiography, coronary revascularization, and mechanical support.
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Affiliation(s)
- Erik M Kelly
- The Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Duane S Pinto
- The Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Laksman Z, Barichello S, Roston TM, Deyell MW, Krahn AD. Acute Management of Ventricular Arrhythmia in Patients With Suspected Inherited Heart Rhythm Disorders. JACC Clin Electrophysiol 2019; 5:267-283. [DOI: 10.1016/j.jacep.2019.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/02/2019] [Accepted: 02/03/2019] [Indexed: 02/08/2023]
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Wallace E, Howard L, Liu M, O'Brien T, Ward D, Shen S, Prendiville T. Long QT Syndrome: Genetics and Future Perspective. Pediatr Cardiol 2019; 40:1419-1430. [PMID: 31440766 PMCID: PMC6785594 DOI: 10.1007/s00246-019-02151-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 07/10/2019] [Indexed: 01/19/2023]
Abstract
Long QT syndrome (LQTS) is an inherited primary arrhythmia syndrome that may present with malignant arrhythmia and, rarely, risk of sudden death. The clinical symptoms include palpitations, syncope, and anoxic seizures secondary to ventricular arrhythmia, classically torsade de pointes. This predisposition to malignant arrhythmia is from a cardiac ion channelopathy that results in delayed repolarization of the cardiomyocyte action potential. The QT interval on the surface electrocardiogram is a summation of the individual cellular ventricular action potential durations, and hence is a surrogate marker of the abnormal cellular membrane repolarization. Severely affected phenotypes administered current standard of care therapies may not be fully protected from the occurrence of cardiac arrhythmias. There are 17 different subtypes of LQTS associated with monogenic mutations of 15 autosomal dominant genes. It is now possible to model the various LQTS phenotypes through the generation of patient-specific induced pluripotent stem cell-derived cardiomyocytes. RNA interference can silence or suppress the expression of mutant genes. Thus, RNA interference can be a potential therapeutic intervention that may be employed in LQTS to knock out mutant mRNAs which code for the defective proteins. CRISPR/Cas9 is a genome editing technology that offers great potential in elucidating gene function and a potential therapeutic strategy for monogenic disease. Further studies are required to determine whether CRISPR/Cas9 can be employed as an efficacious and safe rescue of the LQTS phenotype. Current progress has raised opportunities to generate in vitro human cardiomyocyte models for drug screening and to explore gene therapy through genome editing.
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Affiliation(s)
- Eimear Wallace
- Regenerative Medicine Institute, School of Medicine, National University of Ireland (NUI) Galway, Galway, Ireland
| | - Linda Howard
- Regenerative Medicine Institute, School of Medicine, National University of Ireland (NUI) Galway, Galway, Ireland
| | - Min Liu
- Regenerative Medicine Institute, School of Medicine, National University of Ireland (NUI) Galway, Galway, Ireland
| | - Timothy O'Brien
- Regenerative Medicine Institute, School of Medicine, National University of Ireland (NUI) Galway, Galway, Ireland
| | - Deirdre Ward
- Department of Cardiology, Tallaght University Hospital, Dublin, Ireland
| | - Sanbing Shen
- Regenerative Medicine Institute, School of Medicine, National University of Ireland (NUI) Galway, Galway, Ireland
| | - Terence Prendiville
- Department of Paediatric Cardiology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland.
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Abstract
The discovery of the human genome has ushered in a new era of molecular testing, advancing our knowledge and ability to identify cardiac channelopathies. Genetic variations can affect the opening and closing of the potassium, sodium, and calcium channels, resulting in arrhythmias and sudden death. Cardiac arrhythmias caused by disorders of ion channels are known as cardiac channelopathies. Nurses are important members of many interdisciplinary teams and must have a general understanding of the pathophysiology of the most commonly encountered cardiac channelopathies, electrocardiogram characteristics, approaches to treatment, and care for patients and their families. This article provides an overview of cardiac channelopathies that nurses might encounter in an array of clinical and research settings, focusing on the clinically relevant features of long QT syndrome, short QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, and arrhythmogenic right ventricular dysplasia/cardiomyopathy.
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Affiliation(s)
- Kathleen T Hickey
- Kathleen T. Hickey is Professor of Nursing, Columbia University Medical Center, 622 W 168th St, New York, NY 10032 . Amir Elzomor is a premedical student at the Albert Dorman Honors College at the New Jersey Institute of Technology, Newark, New Jersey
| | - Amir Elzomor
- Kathleen T. Hickey is Professor of Nursing, Columbia University Medical Center, 622 W 168th St, New York, NY 10032 . Amir Elzomor is a premedical student at the Albert Dorman Honors College at the New Jersey Institute of Technology, Newark, New Jersey
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Müllertz KM, Christiansen MK, Broendberg AK, Pedersen LN, Jensen HK. Outcome of clinical management in relatives of sudden cardiac death victims. Int J Cardiol 2018; 262:45-50. [DOI: 10.1016/j.ijcard.2018.03.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 02/24/2018] [Accepted: 03/06/2018] [Indexed: 10/17/2022]
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Sueda S, Kohno H. Optimal Medications and Appropriate Implantable Cardioverter-defibrillator Shocks in Aborted Sudden Cardiac Death Due to Coronary Spasm. Intern Med 2018; 57:1361-1369. [PMID: 29321418 PMCID: PMC5995710 DOI: 10.2169/internalmedicine.8796-17] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective Life-threatening ventricular arrhythmias are recognized in patients with coronary spastic angina. Implantable cardioverter-defibrillators (ICDs) are effective in patients with structural heart disease and ventricular fibrillation. However, the optimal medication for patients with aborted sudden cardiac death (SCD) due to coronary artery spasm after the implantation of ICD remains controversial. Methods We investigated the medications and the numbers of appropriate ICD shocks in 137 patients with a history of aborted SCD due to coronary spasm. Results Appropriate ICD shocks were observed in 24.1% (33/137) of patients with aborted SCD due to coronary spasm during 41 months of follow-up. Only 15 (15.6%) of the 96 patients with ICDs received aggressive medical therapy, including two or three calcium-channel antagonists. The rate of appropriate ICD shocks was significantly higher in Western countries than in Asian countries (42.9% vs. 19.3%, p<0.01), whereas the medications did not differ between the two regions. Appropriate ICD shocks successfully resuscitated 33 patients. Three patients died due to second serious fatal arrhythmias. Conclusion Appropriate ICD shocks were recognized in a quarter of patients with aborted SCD due to coronary spasm and ICD implantation was effective for suppressing the next serious fatal arrhythmia in these patients. We should reconsider prescribing more medications after ICD implantation in patients with aborted SCD due to coronary artery spasm.
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Affiliation(s)
- Shozo Sueda
- Department of Cardiology, Ehime Prefectural Niihama Hospital, Japan
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15
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Rodrigues P, Joshi A, Williams H, Westwood M, Petersen SE, Zemrak F, Schilling RJ, Kirkby C, Wragg A, Manisty C, Mohiddin S. Diagnosis and Prognosis in Sudden Cardiac Arrest Survivors Without Coronary Artery Disease: Utility of a Clinical Approach Using Cardiac Magnetic Resonance Imaging. Circ Cardiovasc Imaging 2017; 10:e006709. [PMID: 29237609 DOI: 10.1161/circimaging.117.006709] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 11/01/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND Determining the pathogenesis of sudden cardiac arrest or periarrest without significant coronary artery disease is crucial for management and prognosis. Cardiovascular magnetic resonance (CMR) can detect morphological, functional, or tissue abnormalities, and we sought to evaluate the role of CMR in determining sudden cardiac arrest pathogenesis and prognosis in survivors. METHODS AND RESULTS We retrospectively reviewed cardiac investigations and clinical outcomes in consecutive survivors of potentially fatal arrhythmias without coronary artery disease admitted to our institutions from 2008 to 2014. After coronary angiography and echocardiography, all underwent CMR and, when indicated, electrophysiology studies. Major adverse cardiac events (MACE), comprising significant nonfatal ventricular arrhythmia or death, was the primary outcome. Of 164 included subjects (65% men; mean age 48 [18-80] years), CMR contributed to the diagnosis in 80 (49%) and was decisive in 50 cases (30%). Dilated cardiomyopathy (n=27), myocarditis or sarcoidosis (n=22), occult myocardial infarction (n=13), and hypertrophic cardiomyopathy (n=9) were most frequent. Arrhythmic causes were found in 14% while no cause was identified in 36%. MACE occurred in 31% of subjects during a median follow-up of 32 months. MACE associated with presence of a CMR diagnosis, extent of late gadolinium enhancement, and left and right ventricular ejection fractions. Right ventricular ejection fraction was an independent predictor of MACE. CONCLUSIONS CMR identified a likely pathogenesis for sudden cardiac arrest in nearly half of survivors in whom coronary artery disease had been excluded. One in 3 subjects had MACE; risk doubled in those with a CMR diagnosis and some CMR parameters-late gadolinium enhancement, left ventricular ejection fraction, and especially right ventricular ejection fraction-associated with prognosis.
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Affiliation(s)
- Patricia Rodrigues
- From the St Bartholomew's Hospital, Barts Heart Centre, London, United Kingdom (P.R., A.J., H.W., M.W., S.E.P., F.Z., R.J.S., C.K., A.W., C.M., S.M.); Centro Hospitalar do Porto, Portugal (P.R.); Institute of Cardiovascular Science, University College London, United Kingdom (C.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (S.E.P., F.Z., R.J.S., S.M.).
| | - Abhishek Joshi
- From the St Bartholomew's Hospital, Barts Heart Centre, London, United Kingdom (P.R., A.J., H.W., M.W., S.E.P., F.Z., R.J.S., C.K., A.W., C.M., S.M.); Centro Hospitalar do Porto, Portugal (P.R.); Institute of Cardiovascular Science, University College London, United Kingdom (C.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (S.E.P., F.Z., R.J.S., S.M.)
| | - Howell Williams
- From the St Bartholomew's Hospital, Barts Heart Centre, London, United Kingdom (P.R., A.J., H.W., M.W., S.E.P., F.Z., R.J.S., C.K., A.W., C.M., S.M.); Centro Hospitalar do Porto, Portugal (P.R.); Institute of Cardiovascular Science, University College London, United Kingdom (C.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (S.E.P., F.Z., R.J.S., S.M.)
| | - Mark Westwood
- From the St Bartholomew's Hospital, Barts Heart Centre, London, United Kingdom (P.R., A.J., H.W., M.W., S.E.P., F.Z., R.J.S., C.K., A.W., C.M., S.M.); Centro Hospitalar do Porto, Portugal (P.R.); Institute of Cardiovascular Science, University College London, United Kingdom (C.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (S.E.P., F.Z., R.J.S., S.M.)
| | - Steffen E Petersen
- From the St Bartholomew's Hospital, Barts Heart Centre, London, United Kingdom (P.R., A.J., H.W., M.W., S.E.P., F.Z., R.J.S., C.K., A.W., C.M., S.M.); Centro Hospitalar do Porto, Portugal (P.R.); Institute of Cardiovascular Science, University College London, United Kingdom (C.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (S.E.P., F.Z., R.J.S., S.M.)
| | - Filip Zemrak
- From the St Bartholomew's Hospital, Barts Heart Centre, London, United Kingdom (P.R., A.J., H.W., M.W., S.E.P., F.Z., R.J.S., C.K., A.W., C.M., S.M.); Centro Hospitalar do Porto, Portugal (P.R.); Institute of Cardiovascular Science, University College London, United Kingdom (C.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (S.E.P., F.Z., R.J.S., S.M.)
| | - Richard J Schilling
- From the St Bartholomew's Hospital, Barts Heart Centre, London, United Kingdom (P.R., A.J., H.W., M.W., S.E.P., F.Z., R.J.S., C.K., A.W., C.M., S.M.); Centro Hospitalar do Porto, Portugal (P.R.); Institute of Cardiovascular Science, University College London, United Kingdom (C.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (S.E.P., F.Z., R.J.S., S.M.)
| | - Claire Kirkby
- From the St Bartholomew's Hospital, Barts Heart Centre, London, United Kingdom (P.R., A.J., H.W., M.W., S.E.P., F.Z., R.J.S., C.K., A.W., C.M., S.M.); Centro Hospitalar do Porto, Portugal (P.R.); Institute of Cardiovascular Science, University College London, United Kingdom (C.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (S.E.P., F.Z., R.J.S., S.M.)
| | - Andrew Wragg
- From the St Bartholomew's Hospital, Barts Heart Centre, London, United Kingdom (P.R., A.J., H.W., M.W., S.E.P., F.Z., R.J.S., C.K., A.W., C.M., S.M.); Centro Hospitalar do Porto, Portugal (P.R.); Institute of Cardiovascular Science, University College London, United Kingdom (C.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (S.E.P., F.Z., R.J.S., S.M.)
| | - Charlotte Manisty
- From the St Bartholomew's Hospital, Barts Heart Centre, London, United Kingdom (P.R., A.J., H.W., M.W., S.E.P., F.Z., R.J.S., C.K., A.W., C.M., S.M.); Centro Hospitalar do Porto, Portugal (P.R.); Institute of Cardiovascular Science, University College London, United Kingdom (C.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (S.E.P., F.Z., R.J.S., S.M.)
| | - Saidi Mohiddin
- From the St Bartholomew's Hospital, Barts Heart Centre, London, United Kingdom (P.R., A.J., H.W., M.W., S.E.P., F.Z., R.J.S., C.K., A.W., C.M., S.M.); Centro Hospitalar do Porto, Portugal (P.R.); Institute of Cardiovascular Science, University College London, United Kingdom (C.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (S.E.P., F.Z., R.J.S., S.M.).
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Abstract
Sudden cardiac death (SCD) remains a major public health burden despite revolutionary progress in the last three decades in the treatment of ventricular tachyarrhythmia with the use of implantable cardioverter defibrillator (ICD) therapy. Survivors of sudden cardiac arrest are at high risk for recurrent tachyarrhythmia events. Early recognition of low left ventricular ejection fractions (≤35%) as a strong predictor of mortality and the causal association between ventricular tachyarrhythmia and SCD has led to a significant development of not only pharmacological antiarrhythmic therapy but also device-based prevention of SCD. The ICD therapy is nowadays routinely used for primary prevention of SCD in patients with significant structural cardiomyopathy and primary electrical arrhythmia syndromes, which are associated with high a risk and secondary prevention in survivors of sudden cardiac arrest. Additionally, effective approaches exist to significantly reduce the recurrence rate of ventricular tachyarrhythmia of various origins by complex electrophysiological endocardial and epicardial catheter ablation procedures.
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17
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The genetics underlying idiopathic ventricular fibrillation: A special role for catecholaminergic polymorphic ventricular tachycardia? Int J Cardiol 2017; 250:139-145. [PMID: 29032884 DOI: 10.1016/j.ijcard.2017.10.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/03/2017] [Accepted: 10/03/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Ventricular fibrillation (VF) is a major cause of sudden cardiac death. In some cases clinical investigations fail to identify the underlying cause and the event is classified as idiopathic (IVF). Since mutations in arrhythmia-associated genes frequently determine arrhythmia susceptibility, screening for disease-predisposing variants could improve IVF diagnostics. METHODS AND RESULTS The study included 76 Finnish and Italian patients with a mean age of 31.2years at the time of the VF event, collected between the years 1996-2016 and diagnosed with idiopathic, out-of-hospital VF. Using whole-exome sequencing (WES) and next-generation sequencing (NGS) approaches, we aimed to identify genetic variants potentially contributing to the life-threatening arrhythmias of these patients. Combining the results from the two study populations, we identified pathogenic or likely pathogenic variants residing in the RYR2, CACNA1C and DSP genes in 7 patients (9%). Most of them (5, 71%) were found in the RYR2 gene, associated with catecholaminergic polymorphic ventricular tachycardia (CPVT). These genetic findings prompted clinical investigations leading to disease reclassification. Additionally, in 9 patients (11.8%) we detected 10 novel or extremely rare (MAF<0.005%) variants that were classified as of unknown significance (VUS). CONCLUSION The results of our study suggest that a subset of patients originally diagnosed with IVF may carry clinically-relevant variants in genes associated with cardiac channelopathies and cardiomyopathies. Although misclassification of other cardiac channelopathies as IVF appears rare, our findings indicate that the possibility of CPVT as the underlying disease entity should be carefully evaluated in IVF patients.
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Fumimoto T, Ueyama T, Shimizu A, Yoshiga Y, Ono M, Kato T, Ishiguchi H, Okamura T, Yamada J, Yano M. Inferior J waves in patients with vasospastic angina might be a risk factor for ventricular fibrillation. J Cardiol 2017; 70:271-277. [DOI: 10.1016/j.jjcc.2016.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 12/08/2016] [Accepted: 12/12/2016] [Indexed: 10/20/2022]
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Abstract
INTRODUCTION Sudden cardiac arrest continues to be the leading cause of death in the industrialized world. SOURCES OF DATA Original papers, reviews and guidelines. AREAS OF AGREEMENT Community programs for lay bystander cardiopulmonary resuscitation (CPR) and automatic external defibrillation improve outcomes. Post-arrest care, including targeted temperature management (TTM) combined with early coronary angiography and percutaneous coronary intervention, is helpful for those suffering cardiac arrest during an ST-segment elevation myocardial infarction. AREAS OF CONTROVERSY (1) The optimal approach to encourage lay bystanders to assist with resuscitation efforts. (2) Whether TTM combined with early coronary angiography is cost effective for those without ST elevation on their post-arrest ECG is unknown. GROWING POINTS Increasing data show that chest compression-only CPR is preferred by lay rescuers and improves local survival rates. AREAS TIMELY FOR DEVELOPING RESEARCH Randomized clinical trials are underway to examine the utility of early coronary angiography in the treatment of post-arrest patients without ST-segment elevation.
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Affiliation(s)
- Jagdesh Kandala
- Sarver Heart Center, University of Arizona, 1501 N. Campbell Avenue, Tucson, AZ 85724, USA
| | - Clint Oommen
- Sarver Heart Center, University of Arizona, 1501 N. Campbell Avenue, Tucson, AZ 85724, USA
| | - Karl B Kern
- Sarver Heart Center, University of Arizona, 1501 N. Campbell Avenue, Tucson, AZ 85724, USA
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Maheshwari A, Norby FL, Soliman EZ, Adabag S, Whitsel EA, Alonso A, Chen LY. Low Heart Rate Variability in a 2-Minute Electrocardiogram Recording Is Associated with an Increased Risk of Sudden Cardiac Death in the General Population: The Atherosclerosis Risk in Communities Study. PLoS One 2016; 11:e0161648. [PMID: 27551828 PMCID: PMC4995012 DOI: 10.1371/journal.pone.0161648] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/09/2016] [Indexed: 12/19/2022] Open
Abstract
Low heart rate variability (HRV) has been linked to increased total mortality in the general population; however, the relationship between low HRV and sudden cardiac death (SCD) is less well-characterized. The goal of this study was to evaluate the relationship between low HRV and SCD in a community-based cohort. Our cohort consisted of 12,543 participants from the Atherosclerosis Risk in Communities (ARIC) study. HRV measures were derived from 2-minute electrocardiogram recordings obtained during the baseline exam (1987-89). Time domain measurements included the standard deviation of all normal RR intervals (SDNN) and the root mean squared successive difference (r-MSSD). Frequency domain measurements included low frequency power (LF) and high frequency (HF) power. During a median follow-up of 13 years, 215 SCDs were identified from physician adjudication of all coronary heart disease deaths through 2001. In multivariable adjusted Cox proportional hazards models, each standard deviation decrement in SDNN, LF, and HF were associated with 24%, 27% and 16% increase in SCD risk, respectively. Low HRV is independently associated with increased risk of SCD in the general population.
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Affiliation(s)
- Ankit Maheshwari
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
| | - Faye L. Norby
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Elsayed Z. Soliman
- Epidemiological Cardiology Research Center (EPICARE), Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Selcuk Adabag
- Division of Cardiology, Veteran Affairs Medical Center, Minneapolis, Minnesota, United States of America
| | - Eric A. Whitsel
- Departments of Epidemiology and Medicine, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Lin Y. Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
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Abstract
Alcohol intoxication is a potentially under-recognised precipitant of Brugada syndrome. Higher pre-cordial electrocardiogram lead placement increases sensitivity of detecting the Brugada pattern.
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Affiliation(s)
- Andrew Achaiah
- Cardiology Department, Queen Alexandra Hospital, Portsmouth, Hampshire PO63LY, UK
| | - Neil Andrews
- Cardiology Department, Queen Alexandra Hospital, Portsmouth, Hampshire PO63LY, UK
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Abstract
Sudden cardiac death (SCD) is defined by the World Health Organization (WHO) as death within 1 h of symptom onset (witnessed) or within 24 h of being observed alive and symptom free (unwitnessed). It affects more than 3 million people annually worldwide and affects approximately 1/1000 people each year in the USA. Familial studies of syndromes with Mendelian inheritance, candidate genes analyses, and genome-wide association studies (GWAS) have helped our understanding of the genetics of SCD. We will review the genetics of arrhythmogenic hereditary syndromes with Mendelian inheritance from familial studies with structural heart disease (hypertrophic cardiomyopathy, dilated cardiomyopathy, and arrhythmogenic cardiomyopathy) as well as primary electrical causes (long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, and short QT syndrome). In addition, we will review the genetics of intermediate phenotypes for SCD such as coronary artery disease and electrocardiographic variables (QT interval, QRS duration, and RR interval). Finally, we will review rare and common variants that are associated with SCD in the general population and were identified from candidate gene analyses and GWAS. Our understanding of the genetics of SCD will improve by the use of next-generation sequencing/whole-exome sequencing as well as whole-genome sequencing which have the potential to discover unsuspected common and rare genetic variants that might be associated with SCD.
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Katritsis DG, Gersh BJ, Camm AJ. A Clinical Perspective on Sudden Cardiac Death. Arrhythm Electrophysiol Rev 2016; 5:177-182. [PMID: 28116082 PMCID: PMC5248660 DOI: 10.15420/aer.2016:11:2] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 10/28/2016] [Indexed: 11/04/2022] Open
Abstract
This article presents the epidemiology, aetiology and pathophysiology of sudden cardiac death. The modern management of survivors as well as of family members of victims is discussed, as are the relevant recommendations of guidelines prepared by learned societies.
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Affiliation(s)
- Demosthenes G Katritsis
- Athens Euroclinic, Greece, and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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24
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Abstract
Despite the revolutionary advancements in the past 3 decades in the treatment of ventricular tachyarrhythmias with device-based therapy, sudden cardiac death (SCD) remains an enormous public health burden. Survivors of SCD are generally at high risk for recurrent events. The clinical management of such patients requires a multidisciplinary approach from postresuscitative care to a thorough cardiovascular investigation in an attempt to identify the underlying substrate, with potential to eliminate or modify the triggers through catheter ablation and ultimately an implantable cardioverter-defibrillator (ICD) for prompt treatment of recurrences in those at risk. Early recognition of low left ventricular ejection fraction as a strong predictor of death and association of ventricular arrhythmias with sudden death led to significant investigation with antiarrhythmic drugs. The lack of efficacy and the proarrhythmic effects of drugs catalyzed the development and investigation of the ICD through several major clinical trials that proved the efficacy of ICD as a bedrock tool to detect and promptly treat life-threatening arrhythmias. The ICD therapy is routinely used for primary prevention of SCD in patients with cardiomyopathy and high risk inherited arrhythmic conditions and secondary prevention in survivors of sudden cardiac arrest. This compendium will review the clinical management of those surviving SCD and discuss landmark studies of antiarrhythmic drugs, ICD, and cardiac resynchronization therapy in the primary and secondary prevention of SCD.
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Affiliation(s)
- Omair Yousuf
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Jonathan Chrispin
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Gordon F Tomaselli
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ronald D Berger
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
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Sallam K, Li Y, Sager PT, Houser SR, Wu JC. Finding the rhythm of sudden cardiac death: new opportunities using induced pluripotent stem cell-derived cardiomyocytes. Circ Res 2015; 116:1989-2004. [PMID: 26044252 DOI: 10.1161/circresaha.116.304494] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Sudden cardiac death is a common cause of death in patients with structural heart disease, genetic mutations, or acquired disorders affecting cardiac ion channels. A wide range of platforms exist to model and study disorders associated with sudden cardiac death. Human clinical studies are cumbersome and are thwarted by the extent of investigation that can be performed on human subjects. Animal models are limited by their degree of homology to human cardiac electrophysiology, including ion channel expression. Most commonly used cellular models are cellular transfection models, which are able to mimic the expression of a single-ion channel offering incomplete insight into changes of the action potential profile. Induced pluripotent stem cell-derived cardiomyocytes resemble, but are not identical, adult human cardiomyocytes and provide a new platform for studying arrhythmic disorders leading to sudden cardiac death. A variety of platforms exist to phenotype cellular models, including conventional and automated patch clamp, multielectrode array, and computational modeling. Induced pluripotent stem cell-derived cardiomyocytes have been used to study long QT syndrome, catecholaminergic polymorphic ventricular tachycardia, hypertrophic cardiomyopathy, and other hereditary cardiac disorders. Although induced pluripotent stem cell-derived cardiomyocytes are distinct from adult cardiomyocytes, they provide a robust platform to advance the science and clinical care of sudden cardiac death.
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Affiliation(s)
- Karim Sallam
- From the Division of Cardiology, Department of Medicine, Stanford Cardiovascular Institute (K.S., Y.L., P.T.S., J.C.W.), Institute of Stem Cell Biology and Regenerative Medicine (K.S., Y.L., J.C.W.), Stanford University School of Medicine, CA; and Cardiovascular Research Center and Department of Physiology, Temple University School of Medicine, Philadelphia, PA (S.R.H.)
| | - Yingxin Li
- From the Division of Cardiology, Department of Medicine, Stanford Cardiovascular Institute (K.S., Y.L., P.T.S., J.C.W.), Institute of Stem Cell Biology and Regenerative Medicine (K.S., Y.L., J.C.W.), Stanford University School of Medicine, CA; and Cardiovascular Research Center and Department of Physiology, Temple University School of Medicine, Philadelphia, PA (S.R.H.)
| | - Philip T Sager
- From the Division of Cardiology, Department of Medicine, Stanford Cardiovascular Institute (K.S., Y.L., P.T.S., J.C.W.), Institute of Stem Cell Biology and Regenerative Medicine (K.S., Y.L., J.C.W.), Stanford University School of Medicine, CA; and Cardiovascular Research Center and Department of Physiology, Temple University School of Medicine, Philadelphia, PA (S.R.H.)
| | - Steven R Houser
- From the Division of Cardiology, Department of Medicine, Stanford Cardiovascular Institute (K.S., Y.L., P.T.S., J.C.W.), Institute of Stem Cell Biology and Regenerative Medicine (K.S., Y.L., J.C.W.), Stanford University School of Medicine, CA; and Cardiovascular Research Center and Department of Physiology, Temple University School of Medicine, Philadelphia, PA (S.R.H.).
| | - Joseph C Wu
- From the Division of Cardiology, Department of Medicine, Stanford Cardiovascular Institute (K.S., Y.L., P.T.S., J.C.W.), Institute of Stem Cell Biology and Regenerative Medicine (K.S., Y.L., J.C.W.), Stanford University School of Medicine, CA; and Cardiovascular Research Center and Department of Physiology, Temple University School of Medicine, Philadelphia, PA (S.R.H.).
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Poterucha JT, Bos JM, Cannon BC, Ackerman MJ. Frequency and severity of hypoglycemia in children with beta-blocker-treated long QT syndrome. Heart Rhythm 2015; 12:1815-9. [PMID: 25929701 DOI: 10.1016/j.hrthm.2015.04.034] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Hypoglycemia is a potential side effect of beta-blockers; however, no cases have been reported in children with long QT syndrome (LQTS). OBJECTIVE The purpose of this study was to determine the frequency and severity of hypoglycemia among children with beta-blocker-treated LQTS. METHODS A retrospective study was performed to identify children with LQTS evaluated from 2000 to 2014 who developed symptomatic hypoglycemia while being treated with a beta-blocker. RESULTS Nine children (3%; 7 boys; average corrected QT interval 486 ± 35 ms) developed 13 episodes (0.005 events per 100 treatment years) of beta-blocker-associated hypoglycemia (mean initial glucose 21 ± 7 mg/dL), including 3 of 157 patients with LQTS type 1 (LQT1; 1.9%) and 6 of 105 with LQTS type 2 (LQT2; 5.7%). The mean age at hypoglycemic event was 3.5 ± 2 years (range 7 months to 9 years), involving nadolol in 6 cases (mean dose 1.4 ± 0.2 mg/kg/d) and propranolol in 3 (mean dose 2.7±1 mg/kg/d). Hypoglycemic events were more frequent in patients with LQT2 than in those with LQT1 (10 vs. 3 events; P = .02). Hypoglycemia-triggered seizures were observed in 6 patients, fasting ketoacidosis in 5, and 7 patients required hospitalization (mean of 3 ± 2 days). Decreased caloric intake before the event was identified in all patients and a concomitant viral infection in 3. CONCLUSION This is the largest single-center case series of beta-blocker-induced hypoglycemia. Clinicians should be cognizant of hypoglycemia symptoms in younger children during periods of poor appetite and during viral illness, and parents of these children should be educated about the signs and symptoms of hypoglycemia. A potential LQT2-hypoglycemia genotype-phenotype relationship warrants further investigation.
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Affiliation(s)
- Joseph T Poterucha
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - J Martijn Bos
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota; Department of Molecular Pharmacology and Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Bryan C Cannon
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Michael J Ackerman
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota; Department of Molecular Pharmacology and Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, Minnesota; Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
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Choong H, Hanna I, Beran R. Importance of cardiological evaluation for first seizures. World J Clin Cases 2015; 3:381-384. [PMID: 25879012 PMCID: PMC4391010 DOI: 10.12998/wjcc.v3.i4.381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 07/16/2014] [Accepted: 02/09/2015] [Indexed: 02/05/2023] Open
Abstract
This paper reports two cases of long QT syndrome (LQTS) which presented with seizures as their initial feature. Case 1, AB was seen in emergency department with post-partum seizure, discharged and re-presented following cardiac arrest associated with LQTS. Case 2, CD presented initially with tonic-clonic seizure and because of experience with AB, CD was assessed for LQTS which was subsequently confirmed. The legal medicine experience re Dobler v Halverson, which involved a young boy with LQTS, who suffered cardiac arrest without prior diagnosis of LQTS, has reinforced the requirement to seriously consider LQTS as an aetiological factor in first seizure presentations.
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Vohra J. Sudden Cardiac Death in the Young: What We Know, What We Don’t Know and What We Need To Do. Heart Lung Circ 2014; 23:1097-9. [DOI: 10.1016/j.hlc.2014.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 09/23/2014] [Accepted: 09/23/2014] [Indexed: 10/24/2022]
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Filippi S, Gizzi A, Cherubini C, Luther S, Fenton FH. Mechanistic insights into hypothermic ventricular fibrillation: the role of temperature and tissue size. Europace 2014; 16:424-34. [PMID: 24569897 PMCID: PMC3934849 DOI: 10.1093/europace/euu031] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 01/27/2014] [Indexed: 12/26/2022] Open
Abstract
AIMS Hypothermia is well known to be pro-arrhythmic, yet it has beneficial effects as a resuscitation therapy and valuable during intracardiac surgeries. Therefore, we aim to study the mechanisms that induce fibrillation during hypothermia. A better understanding of the complex spatiotemporal dynamics of heart tissue as a function of temperature will be useful in managing the benefits and risks of hypothermia. METHODS AND RESULTS We perform two-dimensional numerical simulations by using a minimal model of cardiac action potential propagation fine-tuned on experimental measurements. The model includes thermal factors acting on the ionic currents and the gating variables to correctly reproduce experimentally recorded restitution curves at different temperatures. Simulations are implemented using WebGL, which allows long simulations to be performed as they run close to real time. We describe (i) why fibrillation is easier to induce at low temperatures, (ii) that there is a minimum size required for fibrillation that depends on temperature, (iii) why the frequency of fibrillation decreases with decreasing temperature, and (iv) that regional cooling may be an anti-arrhythmic therapy for small tissue sizes however it may be pro-arrhythmic for large tissue sizes. CONCLUSION Using a mathematical cardiac cell model, we are able to reproduce experimental observations, quantitative experimental results, and discuss possible mechanisms and implications of electrophysiological changes during hypothermia.
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Affiliation(s)
- Simonetta Filippi
- Nonlinear Physics and Mathematical Modeling Laboratory, University Campus Bio-Medico of Rome, Via A. del Portillo 21, I-00128 Rome, Italy
- International Center for Relativistic Astrophysics—I.C.R.A, University Campus Bio-Medico of Rome, Via A. del Portillo 21, I-00128 Rome, Italy
| | - Alessio Gizzi
- Nonlinear Physics and Mathematical Modeling Laboratory, University Campus Bio-Medico of Rome, Via A. del Portillo 21, I-00128 Rome, Italy
- International Center for Relativistic Astrophysics—I.C.R.A, University Campus Bio-Medico of Rome, Via A. del Portillo 21, I-00128 Rome, Italy
| | - Christian Cherubini
- Nonlinear Physics and Mathematical Modeling Laboratory, University Campus Bio-Medico of Rome, Via A. del Portillo 21, I-00128 Rome, Italy
- International Center for Relativistic Astrophysics—I.C.R.A, University Campus Bio-Medico of Rome, Via A. del Portillo 21, I-00128 Rome, Italy
| | - Stefan Luther
- Max Planck Institute for Dynamics and Self-Organization, Am Fassberg 17, D-37077 Göttingen, Germany
| | - Flavio H. Fenton
- School of Physics, Georgia Institute of Technology, 837 State Street Atlanta, Atlanta, GA 30332, USA
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Prevalence and spectrum of electroencephalogram-identified epileptiform activity among patients with long QT syndrome. Heart Rhythm 2014; 11:53-7. [DOI: 10.1016/j.hrthm.2013.10.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Indexed: 11/21/2022]
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Vittoria Matassini M, Krahn AD, Gardner M, Champagne J, Sanatani S, Birnie DH, Gollob MH, Chauhan V, Simpson CS, Hamilton RM, Talajic M, Ahmad K, Gerull B, Chakrabarti S, Healey JS. Evolution of clinical diagnosis in patients presenting with unexplained cardiac arrest or syncope due to polymorphic ventricular tachycardia. Heart Rhythm 2013; 11:274-81. [PMID: 24239842 DOI: 10.1016/j.hrthm.2013.11.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND A systematic evaluation of patients with unexplained cardiac arrest (UCA) yields a diagnosis in 50% of the cases. However, evolution of clinical phenotype, identification of new disease-causing mutations, and description of new syndromes may revise the diagnosis. OBJECTIVE To assess the evolution in diagnosis among patients with initially UCA. METHODS Diagnoses were reviewed for all patients with UCA recruited from the Cardiac Arrest Survivors with Preserved Ejection Fraction Registry with at least 1 year of follow-up. RESULTS After comprehensive investigation of 68 patients (age 45.2 ± 14.9 years; 63% men), the initial diagnosis was as follows: idiopathic ventricular fibrillation (n = 34 [50%]), a primary arrhythmic disorder (n = 21 [31%]), and an occult structural cause (n = 13 [19%]). Patients were followed for 30 ± 17 months, during which time the diagnosis changed in 12 (18%) patients. A specific diagnosis emerged for 7 patients (21%) with an initial diagnosis of idiopathic ventricular fibrillation. A structural cardiomyopathy evolved in 2 patients with an initial diagnosis of primary electrical disorder, while the specific structural cardiomyopathy was revised for 1 patient. Two patients with an initial diagnosis of a primary arrhythmic disorder were subsequently considered to have a different primary arrhythmic disorder. A follow-up resting electrocardiogram was the test that most frequently changed the diagnosis (67% of the cases), followed by genetic testing (17%). CONCLUSIONS The reevaluation of patients presenting with UCA may lead to a change in diagnosis in up to 20%. This emphasizes the need to actively monitor the phenotype and also has implications for the treatment of these patients and the screening of their relatives.
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Affiliation(s)
- Maria Vittoria Matassini
- Population Health Research Institute, McMaster University, Hamilton, Canada; Polytechnic University of Marche, Ancona, Italy
| | - Andrew D Krahn
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Shubhayan Sanatani
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | | | | | - Vijay Chauhan
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Kam Ahmad
- St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Jeff S Healey
- Population Health Research Institute, McMaster University, Hamilton, Canada.
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Fenton FH, Gizzi A, Cherubini C, Pomella N, Filippi S. Role of temperature on nonlinear cardiac dynamics. PHYSICAL REVIEW. E, STATISTICAL, NONLINEAR, AND SOFT MATTER PHYSICS 2013; 87:042717. [PMID: 23679459 DOI: 10.1103/physreve.87.042717] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 12/19/2012] [Indexed: 06/02/2023]
Abstract
Thermal effects affecting spatiotemporal behavior of cardiac tissue are discussed by relating temperature variations to proarrhythmic dynamics in the heart. By introducing a thermoelectric coupling in a minimal model of cardiac tissue, we are able to reproduce experimentally measured dynamics obtained simultaneously from epicardial and endocardial canine right ventricles at different temperatures. A quantitative description of emergent proarrhythmic properties of restitution, conduction velocity, and alternans regimes as a function of temperature is presented. Complex discordant alternans patterns that enhance tissue dispersion consisting of one wave front and three wave backs are described in both simulations and experiments. Possible implications for model generalization are finally discussed.
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Affiliation(s)
- Flavio H Fenton
- School of Physics, Georgia Institute of Technology, Atlanta, Georgia 30332, USA
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Cleverley K, Mousavi N, Stronger L, Ann-Bordun K, Hall L, Tam JW, Tischenko A, Jassal DS, Philipp RK. The impact of telemetry on survival of in-hospital cardiac arrests in non-critical care patients. Resuscitation 2013; 84:878-82. [PMID: 23428352 DOI: 10.1016/j.resuscitation.2013.01.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 01/24/2013] [Accepted: 01/29/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Since the introduction of telemetry over a half century ago, it has expanded to various units and wards within health care institutions outside of the traditional critical care setting. Little is known on whether routine telemetry use is beneficial in this patient population. The aim of this study was to determine the impact of telemetry monitoring on survival of in-hospital cardiac arrests in patients admitted to non-critical care units. METHODS A retrospective study of cardiac arrests in patients admitted to non-critical care units within the Winnipeg Regional Health Authority from 2002 to 2006 inclusive was performed. Baseline demographic, cardiac arrest, and outcome data were collected. RESULTS Of the total 668 patients, the mean age was 70±14 years with 404 (61%) males. Patients presenting with asystole or pulseless electrical activity (PEA) demonstrated an increased mortality as compared to those presenting with ventricular tachycardia (VT) or ventricular fibrillation (VF). Overall, 268 of 668 patients (40%) survived their initial arrest, 66 (10%) survived to hospital discharge and 49 (7%) survived transfer to another facility. Patients on telemetry vs. no telemetry had higher survival rates immediately following cardiac arrest (66% vs. 34%, OR=3.67, p=0.02), as well as higher survival to hospital discharge (30% vs. 6%, OR=7.17, p=0.01). Finally, patients with cardiac arrest during the night and early morning benefited proportionally the greatest from telemetry use. CONCLUSION Regardless of whether cardiac arrest was witnessed or unwitnessed, telemetry use was an independent and strong predictor of survival to hospital discharge.
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Affiliation(s)
- Kelby Cleverley
- Institute of Cardiovascular Sciences, Cardiology Division, Department of Physiology, University of Manitoba, Winnipeg, Manitoba, Canada
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Abstract
Unexplained cardiac arrest is defined as a cardiac arrest in the absence of coronary artery disease and overt structural heart disease, present in 5%-10% of cardiac arrest survivors. A genetic contribution to cardiac arrest is more common in this population, most commonly attributed to an inherited ion channel abnormality leading to familial syncope and sudden death. The common causes are Long QT and Brugada syndrome, catecholaminergic ventricular tachycardia, idiopathic ventricular fibrillation, and early repolarization syndrome. Latent structural causes include inherited cardiomyopathy such as arrhythmogenic right ventricular cardiomyopathy. We review these causes in detail and a structured approach to the investigation of these patients, which provides a diagnosis in approximately half of these patients. This allows for the initiation of disease-specific treatments and enables family screening.
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Anderson JH, Bos JM, Meyer FB, Cascino GD, Ackerman MJ. Concealed long QT syndrome and intractable partial epilepsy: a case report. Mayo Clin Proc 2012; 87:1128-31. [PMID: 23058853 PMCID: PMC3532686 DOI: 10.1016/j.mayocp.2012.07.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 06/14/2012] [Accepted: 07/06/2012] [Indexed: 12/23/2022]
Abstract
Herein, we describe a patient with concealed type 2 long QT syndrome with concomitant electroencephalogram-documented epilepsy. Although syncope in patients with long QT syndrome is common and often secondary to cerebral hypoxia after a protracted ventricular arrhythmia, this article demonstrates the importance of avoiding "tunnel vision" as patients with long QT syndrome could also have a primary seizure disorder. Identification of the etiology underlying seizurelike activity is paramount in instituting effective therapy. Furthermore, we theorize that abnormal KCHN2-encoded potassium channel repolarization in the brain could result in epilepsy and arrhythmias in long QT syndrome.
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Affiliation(s)
| | - Johan Martijn Bos
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN
| | | | | | - Michael J. Ackerman
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
- Correspondence: Address to Michael J. Ackerman, MD, PhD, Mayo Clinic Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Guggenheim Building 501, 200 First St SW, Rochester, MN 55905
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Kumar S, Ewy GA. The hospital's role in improving survival of patients with out-of-hospital cardiac arrest. Clin Cardiol 2012; 35:462-6. [PMID: 22549822 DOI: 10.1002/clc.21992] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 03/05/2012] [Indexed: 01/22/2023] Open
Abstract
Out-of-hospital cardiac arrest (OHCA) is a major public health problem. Unfortunately, in spite of recurring updated guidelines, survival of patients with OHCA had been unchanged for decades. Recently, new approaches to patients with OHCA during the community and prehospital phases of therapy for cardiac arrest have resulted in a dramatic improvement in survival. Further improvement in survival has resulted from hospitals designated as Cardiac Receiving Centers. These centers are committed to the treatment of post-cardiac arrest syndrome by providing 24/7 therapeutic mild hypothermia, urgent cardiac catheterization and percutaneous coronary intervention, evidence-based termination of resuscitation protocols that limit premature withdrawal of care, protocol to address organ donation, commitment of cardiocerebral resuscitation training in their community, and a commitment and proven ability of data collection to assure that instituted changes result in improved survival. This newer aspect of hospital practice is an aspect that needs to be embraced by either becoming a Cardiac Receiving Center or partnering with other hospitals that can provide this critically important service.
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Affiliation(s)
- Sachin Kumar
- Cardiology and University of Arizona Sarver Heart Center Tucson, Arizona, USA
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Sörös P, Hachinski V. Cardiovascular and neurological causes of sudden death after ischaemic stroke. Lancet Neurol 2012; 11:179-88. [PMID: 22265213 DOI: 10.1016/s1474-4422(11)70291-5] [Citation(s) in RCA: 167] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Sudden death is an important but widely under-recognised consequence of stroke. Acute stroke can disturb central autonomic control, resulting in myocardial injury, electrocardiographic abnormalities, cardiac arrhythmias, and ultimately sudden death. Experimental and clinical evidence suggests that autonomic imbalance is more frequent after infarcts involving the insular cortex, a crucial region for the control of sympathetic and parasympathetic autonomic functions. Cardiovascular comorbidities increase the risk of cardiac morbidity and mortality after stroke. Thus, many sudden deaths and serious non-fatal cardiac events after stroke are probably due to an interaction between cardiovascular and neurological causes. The exact mechanisms leading to sudden death remain incompletely understood. Further research is needed to investigate the autonomic consequences of acute stroke and to identify patients at high risk of sudden death.
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Affiliation(s)
- Peter Sörös
- Department of Clinical Neurological Sciences, London Health Sciences Centre, University of Western Ontario, London, ON, Canada.
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Katritsis DG, Josephson ME. Sudden cardiac death and implantable cardioverter defibrillators: two modern epidemics? Europace 2012; 14:787-94. [DOI: 10.1093/europace/eus001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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