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Mistrulli R, Ferrera A, Salerno L, Vannini F, Guida L, Corradetti S, Addeo L, Valcher S, Di Gioia G, Spera FR, Tocci G, Barbato E. Cardiomyopathy and Sudden Cardiac Death: Bridging Clinical Practice with Cutting-Edge Research. Biomedicines 2024; 12:1602. [PMID: 39062175 PMCID: PMC11275154 DOI: 10.3390/biomedicines12071602] [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: 06/17/2024] [Revised: 07/10/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
Sudden cardiac death (SCD) prevention in cardiomyopathies such as hypertrophic (HCM), dilated (DCM), non-dilated left ventricular (NDLCM), and arrhythmogenic right ventricular cardiomyopathy (ARVC) remains a crucial but complex clinical challenge, especially among younger populations. Accurate risk stratification is hampered by the variability in phenotypic expression and genetic heterogeneity inherent in these conditions. This article explores the multifaceted strategies for preventing SCD across a spectrum of cardiomyopathies and emphasizes the integration of clinical evaluations, genetic insights, and advanced imaging techniques such as cardiac magnetic resonance (CMR) in assessing SCD risks. Advanced imaging, particularly CMR, not only enhances our understanding of myocardial architecture but also serves as a cornerstone for identifying at-risk patients. The integration of new research findings with current practices is essential for advancing patient care and improving survival rates among those at the highest risk of SCD. This review calls for ongoing research to refine risk stratification models and enhance the predictive accuracy of both clinical and imaging techniques in the management of cardiomyopathies.
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Affiliation(s)
- Raffaella Mistrulli
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (A.F.); (L.S.); (F.V.); (L.G.); (S.C.); (F.R.S.); (G.T.); (E.B.)
- OLV Hospital Aalst, 9300 Aalst, Belgium; (L.A.); (S.V.)
| | - Armando Ferrera
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (A.F.); (L.S.); (F.V.); (L.G.); (S.C.); (F.R.S.); (G.T.); (E.B.)
| | - Luigi Salerno
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (A.F.); (L.S.); (F.V.); (L.G.); (S.C.); (F.R.S.); (G.T.); (E.B.)
| | - Federico Vannini
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (A.F.); (L.S.); (F.V.); (L.G.); (S.C.); (F.R.S.); (G.T.); (E.B.)
| | - Leonardo Guida
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (A.F.); (L.S.); (F.V.); (L.G.); (S.C.); (F.R.S.); (G.T.); (E.B.)
| | - Sara Corradetti
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (A.F.); (L.S.); (F.V.); (L.G.); (S.C.); (F.R.S.); (G.T.); (E.B.)
- OLV Hospital Aalst, 9300 Aalst, Belgium; (L.A.); (S.V.)
| | - Lucio Addeo
- OLV Hospital Aalst, 9300 Aalst, Belgium; (L.A.); (S.V.)
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Corso Umberto I, 40, 80138 Naples, Italy
| | - Stefano Valcher
- OLV Hospital Aalst, 9300 Aalst, Belgium; (L.A.); (S.V.)
- Cardiovascular Department, Humanitas University, Via Alessandro Manzoni, 56, 20089 Rozzano, Italy
| | - Giuseppe Di Gioia
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197 Rome, Italy;
| | - Francesco Raffaele Spera
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (A.F.); (L.S.); (F.V.); (L.G.); (S.C.); (F.R.S.); (G.T.); (E.B.)
| | - Giuliano Tocci
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (A.F.); (L.S.); (F.V.); (L.G.); (S.C.); (F.R.S.); (G.T.); (E.B.)
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (A.F.); (L.S.); (F.V.); (L.G.); (S.C.); (F.R.S.); (G.T.); (E.B.)
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Tonet E, Vitali F, Amantea V, Azzolini G, Balla C, Micillo M, Lapolla D, Canovi L, Bertini M. Prognostic Electrocardiographic Signs in Arrhythmogenic Cardiomyopathy. BIOLOGY 2024; 13:265. [PMID: 38666877 PMCID: PMC11048689 DOI: 10.3390/biology13040265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 04/09/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024]
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a rare cardiac disease, characterized by the progressive replacement of myocardial tissue with fibrous and fatty deposits. It can involve both the right and left ventricles. It is associated with the development of life-threatening arrhythmias and culminates in sudden cardiac death. Electrocardiography (ECG) has emerged as a pivotal tool, offering diagnostic insights and prognostic information. The specific ECG abnormalities observed in ACM not only contribute to early detection but also hold the key to the prediction of the likelihood of severe complications. The recognition of these nuanced ECG manifestations has become imperative for clinicians as it guides them in the formulation of tailored therapeutic strategies that address both the present symptoms and the potential future risks.
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Affiliation(s)
| | - Francesco Vitali
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria of Ferrara, 44124 Cona, Italy; (E.T.); (V.A.); (G.A.); (C.B.); (M.M.); (D.L.); (L.C.); (M.B.)
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Shen L, Liu S, Zhang Z, Xiong Y, Lai Z, Hu F, Zheng L, Yao Y. Catheter ablation of ventricular tachycardia in patients with arrhythmogenic right ventricular cardiomyopathy and biventricular involvement. Europace 2024; 26:euae059. [PMID: 38417843 PMCID: PMC10946245 DOI: 10.1093/europace/euae059] [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: 11/12/2023] [Revised: 01/09/2024] [Accepted: 02/26/2024] [Indexed: 03/01/2024] Open
Abstract
AIMS Catheter ablation of ventricular tachycardia (VT) improves VT-free survival in 'classic' arrhythmogenic right ventricular cardiomyopathy (ARVC). This study aims to investigate electrophysiological features and ablation outcomes in patients with ARVC and biventricular (BiV) involvement. METHODS AND RESULTS We assembled a retrospective cohort of definite ARVC cases with sustained VTs. Patients were divided into the BiV (BiV involvement) group and the right ventricular (RV) (isolated RV involvement) group based on the left ventricular systolic function detected by cardiac magnetic resonance. All patients underwent electrophysiological mapping and VT ablation. Acute complete success was non-inducibility of any sustained VT, and the primary endpoint was VT recurrence. Ninety-eight patients (36 ± 14 years; 87% male) were enrolled, including 50 in the BiV group and 48 in the RV group. Biventricular involvement was associated with faster clinical VTs, a higher VT inducibility, and more extensive arrhythmogenic substrates (all P < 0.05). Left-sided VTs were observed in 20% of the BiV group cases and correlated with significantly reduced left ventricular systolic function. Catheter ablation achieved similar acute efficacy between these two groups, whereas the presence of left-sided VTs increased acute ablation failure (40 vs. 5%, P = 0.012). Over 51 ± 34 months [median, 48 (22-83) months] of follow-up, cumulative VT-free survival was 52% in the BiV group and 58% in the RV group (P = 0.353). A multivariate analysis showed that younger age, lower RV ejection fraction (RVEF), and non-acute complete ablation success were associated with VT recurrence in the BiV group. CONCLUSION Biventricular involvement implied a worse arrhythmic phenotype and increased the risk of left-sided VTs, while catheter ablation maintained its efficacy for VT control in this population. Younger age, lower RVEF, and non-acute complete success predicted VT recurrence after ablation.
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Affiliation(s)
- Lishui Shen
- Arrhythmia Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No. 167 North Lishi Road, Xicheng District, Beijing 100037, China
- Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University, Shanghai 200072, China
| | - Shangyu Liu
- Arrhythmia Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No. 167 North Lishi Road, Xicheng District, Beijing 100037, China
- Department of Cardiology, The First Hospital of Hebei Medical University, Shijiazhuang 050031, China
| | - Zhenhao Zhang
- Arrhythmia Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No. 167 North Lishi Road, Xicheng District, Beijing 100037, China
| | - Yulong Xiong
- Arrhythmia Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No. 167 North Lishi Road, Xicheng District, Beijing 100037, China
| | - Zihao Lai
- Arrhythmia Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No. 167 North Lishi Road, Xicheng District, Beijing 100037, China
| | - Feng Hu
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Lihui Zheng
- Arrhythmia Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No. 167 North Lishi Road, Xicheng District, Beijing 100037, China
| | - Yan Yao
- Arrhythmia Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No. 167 North Lishi Road, Xicheng District, Beijing 100037, China
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Iqbal M, Kamarullah W, Achmad C, Karwiky G, Akbar MR. The pivotal role of compelling high-risk electrocardiographic markers in prediction of ventricular arrhythmic risk in arrhythmogenic right ventricular cardiomyopathy: A systematic review and meta-analysis. Curr Probl Cardiol 2024; 49:102241. [PMID: 38040211 DOI: 10.1016/j.cpcardiol.2023.102241] [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: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 12/03/2023]
Abstract
INTRODUCTION Several investigations have shown that existing risk stratification processes remain insufficient for stratifying sudden cardiac death risk in arrhythmogenic right ventricular cardiomyopathy (ARVC). Multiple auxiliary parameters are investigated to offer a more precise prognostic model. Our aim was to assess the association between several ECG markers (epsilon waves, prolonged terminal activation duration (TAD) of QRS, fragmented QRS (fQRS), late potentials on signal-averaged electrocardiogram (SA-ECG), T-wave inversion (TWI) in right precordial leads, and extension of TWI in inferior leads) with the risk of developing poor outcomes in ARVC. METHODS A systematic literature search from several databases was conducted until September 9th, 2023. Studies were eligible if it investigated the relationship between the ECG markers with the risk of developing ventricular arrhythmic events. RESULTS This meta-analysis encompassed 25 studies with a total of 3767 participants. Our study disclosed that epsilon waves, prolonged TAD of QRS, fQRS, late potentials on SA-ECG, TWI in right precordial leads, and extension of TWI in inferior leads were associated with the incremental risk of ventricular arrhythmias, implantable cardioverter-defibrillator shock, and sudden cardiac death, with the risk ratios ranging from 1.46 to 2.11. In addition, diagnostic test accuracy meta-analysis stipulated that the extension of TWI in inferior leads had the uppermost overall area under curve (AUC) value amidst other ECG markers apropos of our outcomes of interest. CONCLUSION A multivariable risk assessment strategy based on the previously stated ECG markers potentially enhances the current risk stratification models in ARVC patients, especially extension of TWI in inferior leads.
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Affiliation(s)
- Mohammad Iqbal
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Padjadjaran University, Jl. Pasteur No.38, Pasteur, Kec. Sukajadi, Bandung, Jawa Barat, Indonesia.
| | - William Kamarullah
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Padjadjaran University, Jl. Pasteur No.38, Pasteur, Kec. Sukajadi, Bandung, Jawa Barat, Indonesia
| | - Chaerul Achmad
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Padjadjaran University, Jl. Pasteur No.38, Pasteur, Kec. Sukajadi, Bandung, Jawa Barat, Indonesia
| | - Giky Karwiky
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Padjadjaran University, Jl. Pasteur No.38, Pasteur, Kec. Sukajadi, Bandung, Jawa Barat, Indonesia
| | - Mohammad Rizki Akbar
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Padjadjaran University, Jl. Pasteur No.38, Pasteur, Kec. Sukajadi, Bandung, Jawa Barat, Indonesia
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Polovina M, Tschöpe C, Rosano G, Metra M, Crea F, Mullens W, Bauersachs J, Sliwa K, de Boer RA, Farmakis D, Thum T, Corrado D, Bayes-Genis A, Bozkurt B, Filippatos G, Keren A, Skouri H, Moura B, Volterrani M, Abdelhamid M, Ašanin M, Krljanac G, Tomić M, Savarese G, Adamo M, Lopatin Y, Chioncel O, Coats AJS, Seferović PM. Incidence, risk assessment and prevention of sudden cardiac death in cardiomyopathies. Eur J Heart Fail 2023; 25:2144-2163. [PMID: 37905371 DOI: 10.1002/ejhf.3076] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/17/2023] [Accepted: 10/22/2023] [Indexed: 11/02/2023] Open
Abstract
Cardiomyopathies are a significant contributor to cardiovascular morbidity and mortality, mainly due to the development of heart failure and increased risk of sudden cardiac death (SCD). Despite improvement in survival with contemporary treatment, SCD remains an important cause of mortality in cardiomyopathies. It occurs at a rate ranging between 0.15% and 0.7% per year (depending on the cardiomyopathy), which significantly surpasses SCD incidence in the age- and sex-matched general population. The risk of SCD is affected by multiple factors including the aetiology, genetic basis, age, sex, physical exertion, the extent of myocardial disease severity, conduction system abnormalities, and electrical instability, as measured by various metrics. Over the past decades, the knowledge on the mechanisms and risk factors for SCD has substantially improved, allowing for a better-informed risk stratification. However, unresolved issues still challenge the guidance of SCD prevention in patients with cardiomyopathies. In this review, we aim to provide an in-depth discussion of the contemporary concepts pertinent to understanding the burden, risk assessment and prevention of SCD in cardiomyopathies (dilated, non-dilated left ventricular, hypertrophic, arrhythmogenic right ventricular, and restrictive). The review first focuses on SCD incidence in cardiomyopathies and then summarizes established and emerging risk factors for life-threatening arrhythmias/SCD. Finally, it discusses validated approaches to the risk assessment and evidence-based measures for SCD prevention in cardiomyopathies, pointing to the gaps in evidence and areas of uncertainties that merit future clarification.
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Affiliation(s)
- Marija Polovina
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Carsten Tschöpe
- Berlin Institute of Health (BIH), Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Centre for Cardiovascular Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Marco Metra
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Filippo Crea
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Wilfried Mullens
- Hasselt University, Hasselt, Belgium
- Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Karen Sliwa
- Cape Heart Institute. Division of Cardiology, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Rudolf A de Boer
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover, Germany
- Fraunhofer Cluster of Excellence Immune-Mediated Diseases (CIMD), Hannover, Germany
- Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Hannover, Germany
| | - Domenico Corrado
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Antoni Bayes-Genis
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, CIBERCV, Universidad Autónoma de Barcelona, Badalona, Spain
| | - Biykem Bozkurt
- Section of Cardiology, Winters Center for Heart Failure, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens, School of Medicine, Department of Cardiology, Attikon University Hospital, Athens, Greece
| | - Andre Keren
- Hadassah-Hebrew University Medical Center Jerusalem, Clalit Services District of Jerusalem, Jerusalem, Israel
| | - Hadi Skouri
- Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Brenda Moura
- Armed Forces Hospital, Porto, & Faculty of Medicine, University of Porto, Porto, Portugal
| | - Maurizio Volterrani
- IRCCS San Raffaele Pisana, Rome, Italy
- Department of Human Science and Promotion of Quality of Life, San Raffaele Open University of Rome, Rome, Italy
| | - Magdy Abdelhamid
- Department of Cardiovascular Medicine, Faculty of Medicine, Kasr Al Ainy, Cairo University, Giza, Egypt
| | - Milika Ašanin
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Gordana Krljanac
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Milenko Tomić
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Marianna Adamo
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Yuri Lopatin
- Volgograd Medical University, Cardiology Centre, Volgograd, Russian Federation
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. Dr. C.C. Iliescu', Bucharest, Romania
- University for Medicine and Pharmacy 'Carol Davila', Bucharest, Romania
| | | | - Petar M Seferović
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Serbian Academy of Sciences and Arts, Belgrade, Serbia
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Gasperetti A, James CA, Carrick RT, Protonotarios A, te Riele ASJM, Cadrin-Tourigny J, Compagnucci P, Duru F, van Tintelen P, Elliot PM, Calkins H. Arrhythmic risk stratification in arrhythmogenic right ventricular cardiomyopathy. Europace 2023; 25:euad312. [PMID: 37935403 PMCID: PMC10674106 DOI: 10.1093/europace/euad312] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 10/19/2023] [Indexed: 11/09/2023] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a heritable cardiomyopathy characterized by a predominantly arrhythmic presentation. It represents the leading cause of sudden cardiac death (SCD) among athletes and poses a significant morbidity threat in the general population. As a causative treatment for ARVC is still not available, the placement of an implantable cardioverter defibrillator represents the current cornerstone for SCD prevention in this setting. Thanks to international ARVC-dedicated efforts, significant steps have been achieved in recent years towards an individualized, patient-centred risk stratification approach. A novel risk calculator algorithm estimating the 5-year risk of arrhythmias of patients with ARVC has been introduced in clinical practice and subsequently validated. The purpose of this article is to summarize the body of evidence that has allowed the development of this tool and to discuss the best way to implement its use in the care of an individual patient.
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MESH Headings
- Humans
- Risk Factors
- Arrhythmogenic Right Ventricular Dysplasia/complications
- Arrhythmogenic Right Ventricular Dysplasia/diagnosis
- Arrhythmogenic Right Ventricular Dysplasia/therapy
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Death, Sudden, Cardiac/epidemiology
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/therapy
- Arrhythmias, Cardiac/complications
- Defibrillators, Implantable/adverse effects
- Risk Assessment
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Affiliation(s)
- Alessio Gasperetti
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Blalock 545, 600 N. Wolfe St., Baltimore, MD 21287, USA
- Department of Genetics, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, Utrecht, The Netherlands
- Department of Medicine, Division of Cardiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, Utrecht, The Netherlands
| | - Cynthia A James
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Blalock 545, 600 N. Wolfe St., Baltimore, MD 21287, USA
| | - Richard T Carrick
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Blalock 545, 600 N. Wolfe St., Baltimore, MD 21287, USA
| | | | - Anneline S J M te Riele
- Department of Medicine, Division of Cardiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, Utrecht, The Netherlands
| | - Julia Cadrin-Tourigny
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, Montréal, QC, Canada
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy
| | - Firat Duru
- Department of Cardiology, Arrhythmia Unit, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Peter van Tintelen
- Department of Genetics, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, Utrecht, The Netherlands
| | - Perry M Elliot
- Department of Cardiology, UCL Institute of Cardiovascular Science, London, UK
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Blalock 545, 600 N. Wolfe St., Baltimore, MD 21287, USA
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Arbelo E, Protonotarios A, Gimeno JR, Arbustini E, Barriales-Villa R, Basso C, Bezzina CR, Biagini E, Blom NA, de Boer RA, De Winter T, Elliott PM, Flather M, Garcia-Pavia P, Haugaa KH, Ingles J, Jurcut RO, Klaassen S, Limongelli G, Loeys B, Mogensen J, Olivotto I, Pantazis A, Sharma S, Van Tintelen JP, Ware JS, Kaski JP. 2023 ESC Guidelines for the management of cardiomyopathies. Eur Heart J 2023; 44:3503-3626. [PMID: 37622657 DOI: 10.1093/eurheartj/ehad194] [Citation(s) in RCA: 318] [Impact Index Per Article: 318.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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8
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Trancuccio A, Kukavica D, Sugamiele A, Mazzanti A, Priori SG. Prevention of Sudden Death and Management of Ventricular Arrhythmias in Arrhythmogenic Cardiomyopathy. Card Electrophysiol Clin 2023; 15:349-365. [PMID: 37558305 DOI: 10.1016/j.ccep.2023.04.004] [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] [Indexed: 08/11/2023]
Abstract
Arrhythmogenic cardiomyopathy is an umbrella term for a group of inherited diseases of the cardiac muscle characterized by progressive fibro-fatty replacement of the myocardium. As suggested by the name, the disease confers electrical instability to the heart and increases the risk of the development of life-threatening arrhythmias, representing one of the leading causes of sudden cardiac death (SCD), especially in young athletes. In this review, the authors review the current knowledge of the disease, highlighting the state-of-the-art approaches to the prevention of the occurrence of SCD.
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Affiliation(s)
- Alessandro Trancuccio
- Department of Molecular Medicine, University of Pavia, Pavia, Italy; Molecular Cardiology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Deni Kukavica
- Department of Molecular Medicine, University of Pavia, Pavia, Italy; Molecular Cardiology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Andrea Sugamiele
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Andrea Mazzanti
- Department of Molecular Medicine, University of Pavia, Pavia, Italy; Molecular Cardiology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Silvia G Priori
- Department of Molecular Medicine, University of Pavia, Pavia, Italy; Molecular Cardiology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy.
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de la Guía-Galipienso F, Ugedo-Alzaga K, Grazioli G, Quesada-Ocete FJ, Feliu-Rey E, Perez MV, Quesada-Dorador A, Sanchis-Gomar F. Arrhythmogenic Cardiomyopathy and Athletes - A Dangerous Relationship. Curr Probl Cardiol 2023:101799. [PMID: 37172878 DOI: 10.1016/j.cpcardiol.2023.101799] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/07/2023] [Indexed: 05/15/2023]
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a disease characterized by a progressive replacement of myocardium by fibro-adipose material, predisposing to ventricular arrhythmias (VA) and sudden cardiac death (SCD). Its prevalence is estimated at 1:2000 to 1:5000, with a higher incidence in males, and clinical onset is usually between the 2nd and 4th decade of life. The prevalence of ACM in SCD victims is relatively high, making it one of the most common etiologies in young patients with SCD, especially if they are athletes. Cardiac events occur more frequently in individuals with ACM who participate in competitive sports and/or high-intensity training. In effect, exercise activity can worsen RV function in cases of hereditary ACM. Estimating the incidence of SCD caused by ACM in athletes remains challenging, being reported frequency ranging from 3-20%. Here, we review the potential implications of exercising on the clinical course of the classical genetic form of ACM, as well as the diagnostic tools, risk stratification, and the different therapeutic tools available for managing ACM.
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Affiliation(s)
- Fernando de la Guía-Galipienso
- From the Glorieta Policlinic, Denia, Alicante, Spain; REMA-Sports Cardiology Clinic, Denia, Alicante, Spain; Cardiology Service, Hospital HCB Benidorm, Alicante, Spain; School of Medicine, Catholic University of Valencia San Vicente Mártir, Valencia, Spain.
| | | | | | - Francisco Javier Quesada-Ocete
- School of Medicine, Catholic University of Valencia San Vicente Mártir, Valencia, Spain; Arrhythmia Unit, Cardiology Service, General University Hospital Consortium of Valencia, Valencia, Spain
| | - Eloísa Feliu-Rey
- Magnetic Resonance Unit, Inscanner, General University Hospital of Alicante, Alicante, Spain
| | - Marco V Perez
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA
| | - Aurelio Quesada-Dorador
- School of Medicine, Catholic University of Valencia San Vicente Mártir, Valencia, Spain; Arrhythmia Unit, Cardiology Service, General University Hospital Consortium of Valencia, Valencia, Spain
| | - Fabian Sanchis-Gomar
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA..
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10
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Migliore F, Pittorru R, De Lazzari M, Cipriani A, Bauce B, Marra MP, Giacomin E, Dall'Aglio P, Accinelli S, Iliceto S, Corrado D. Third-generation subcutaneous implantable cardioverter defibrillator and intermuscular two-incision implantation technique in patients with Arrhythmogenic cardiomyopathy: 3-year follow-up. Int J Cardiol 2023; 382:33-39. [PMID: 37059308 DOI: 10.1016/j.ijcard.2023.04.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/07/2023] [Accepted: 04/11/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND Long-term data on the potential advantages of combining the third-generation subcutaneous implantable cardioverter defibrillator (S-ICD) with modern software upgrade including the "SMART Pass", modern programming strategies and the intermuscular (IM) two-incision implantation technique in arrhythmogenic cardiomyopathy (ACM) with different phenotypic variants are lacking. In this study we evaluated the long-term outcome of patients with ACM who underwent third-generation S-ICD (Emblem, Boston Scientific) and IM two-incision technique. METHODS The study population included 23 consecutive patients [70% male, median age 31 (24-46) years] diagnosed with ACM with different phenotypic variants who received third-generation S-ICD implantation with the IM two-incision technique. RESULTS During a median follow-up of 45.5 months [16-65], 4 patients (17.4%) received a at least one inappropriate shock (IS), with median annual event rate of 4.5%. Extra-cardiac oversensing (myopotential) during effort represented the only cause of IS. No IS due to T-wave oversensing (TWOS) were recorded. Only one patient (4.3%) experienced device-related complication consisting of premature cell battery depletion requiring device replacement. No device explantation because of need for anti-tachycardia pacing or ineffective therapy occurred. There was no significant difference between patients who did and did not experienced IS with regard to baseline clinical, ECG and technical characteristics. Five patients (21.7%) received appropriate shock on ventricular arrythmias. CONCLUSIONS According to our finding, although the third-generation S-ICD implanted with the IM two-incision technique appears to be associated with a low risk of complications and IS due to cardiac oversensing, the risk of IS due to myopotential mainly during effort should be considered.
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Affiliation(s)
- Federico Migliore
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
| | - Raimondo Pittorru
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Manuel De Lazzari
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Alberto Cipriani
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Barbara Bauce
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Martina Perazzolo Marra
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Enrico Giacomin
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Pietro Dall'Aglio
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Stefano Accinelli
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Sabino Iliceto
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Domenico Corrado
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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11
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Quintella Sangiorgi Olivetti N, Sacilotto L, Wulkan F, D'Arezzo Pessente G, Lombardi Peres de Carvalho M, Moleta D, Tessariol Hachul D, Veronese P, Hardy C, Pisani C, Wu TC, Vieira MLC, de França LA, de Souza Freitas M, Rochitte CE, Bueno SC, Bastos Lovisi V, Krieger JE, Scanavacca M, da Costa Pereira A, da Costa Darrieux F. Clinical Features, Genetic Findings, and Risk Stratification in Arrhythmogenic Right Ventricular Cardiomyopathy: Data From a Brazilian Cohort. Circ Arrhythm Electrophysiol 2023; 16:e011391. [PMID: 36720007 DOI: 10.1161/circep.122.011391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Arrhythmogenic right ventricular cardiomyopathy (ARVC), a rare inherited disease, causes ventricular tachycardia, sudden cardiac death, and heart failure (HF). We investigated ARVC clinical features, genetic findings, natural history, and the occurrence of life-threatening arrhythmic events (LTAEs), HF death, or heart transplantation (HF-death/HTx) to identify risk factors. METHODS The clinical course of 111 consecutive patients with definite ARVC, predictors of LTAE, HF-death/HTx, and combined events were analyzed in the entire cohort and in a subgroup of 40 patients without sustained ventricular arrhythmia before diagnosis. RESULTS The 5-year cumulative probability of LTAE was 30% and HF-death/HTx was 10%. Predictors of HF-death/HTx were reduced right ventricle ejection fraction (HR: 0.93; P=0.010), HF symptoms (HR: 4.37; P=0.010), epsilon wave (HR: 4.99; P=0.015), and number of leads with low QRS voltage (HR: 1.28; P=0.001). Each additional lead with low QRS voltage increased the risk of HF-death/HTx by 28%. Predictors of LTAE were prior syncope (HR: 1.81; P=0.040), number of leads with T wave inversion (HR: 1.17; P=0.039), low QRS voltage (HR: 1.12; P=0.021), younger age (HR: 0.97; P=0.006), and prior ventricular arrhythmia/ventricular fibrillation (HR: 2.45; P=0.012). Each additional lead with low QRS voltage increased the risk of LTAE by 17%. In patients without ventricular arrhythmia before clinical diagnosis of ARVC, the number of leads with low QRS voltage (HR: 1.68; P=0.023) was independently associated with HF-death/HTx. CONCLUSIONS Our study demonstrated the characteristics of a specific cohort with a high prevalence of arrhythmic burden at presentation, male predominance, younger age and HF severe outcomes. Our main results suggest that the presence and extension of low QRS voltage can be a risk predictor for HF-death/HTx in ARVC patients, regardless of the arrhythmic risk. This study can contribute to the global ARVC risk stratification, adding new insights to the international current scientific knowledge.
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Affiliation(s)
- Natália Quintella Sangiorgi Olivetti
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.).,Laboratory of Genetics and Molecular Cardiology (LGMC) (N.Q.S.O., F.W., M.L.P.d.C., J.E.K., A.d.C.P.)
| | - Luciana Sacilotto
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
| | - Fanny Wulkan
- Laboratory of Genetics and Molecular Cardiology (LGMC) (N.Q.S.O., F.W., M.L.P.d.C., J.E.K., A.d.C.P.)
| | - Gabrielle D'Arezzo Pessente
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
| | | | - Danilo Moleta
- Echocardiogram Imaging Unit (D.B.M., M.L.C.V.).,Echocardiogram Imaging Unit, Hospital Israelita Albert Einstein. São Paulo, Brazil (D.B.M., M.L.C.V., L.A.d.F.)
| | - Denise Tessariol Hachul
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
| | - Pedro Veronese
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
| | - Carina Hardy
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
| | - Cristiano Pisani
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
| | - Tan Chen Wu
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
| | - Marcelo Luiz Campos Vieira
- Echocardiogram Imaging Unit (D.B.M., M.L.C.V.).,Echocardiogram Imaging Unit, Hospital Israelita Albert Einstein. São Paulo, Brazil (D.B.M., M.L.C.V., L.A.d.F.)
| | - Lucas Arraes de França
- Echocardiogram Imaging Unit, Hospital Israelita Albert Einstein. São Paulo, Brazil (D.B.M., M.L.C.V., L.A.d.F.)
| | - Matheus de Souza Freitas
- Division of Cardiovascular Magnetic Ressonance Imaging, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil (M.d.S.F., C.E.R.)
| | - Carlos Eduardo Rochitte
- Division of Cardiovascular Magnetic Ressonance Imaging, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil (M.d.S.F., C.E.R.)
| | - Sávia Christina Bueno
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
| | - Vitor Bastos Lovisi
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
| | - José Eduardo Krieger
- Laboratory of Genetics and Molecular Cardiology (LGMC) (N.Q.S.O., F.W., M.L.P.d.C., J.E.K., A.d.C.P.)
| | - Maurício Scanavacca
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
| | | | - Francisco da Costa Darrieux
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
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12
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Gasperetti A, Carrick RT, Costa S, Compagnucci P, Bosman LP, Chivulescu M, Tichnell C, Murray B, Tandri H, Tadros R, Rivard L, van den Berg MP, Zeppenfeld K, Wilde AA, Pompilio G, Carbucicchio C, Dello Russo A, Casella M, Svensson A, Brunckhorst CB, van Tintelen JP, Platonov PG, Haugaa KH, Duru F, te Riele AS, Khairy P, Tondo C, Calkins H, James CA, Saguner AM, Cadrin-Tourigny J. Programmed Ventricular Stimulation as an Additional Primary Prevention Risk Stratification Tool in Arrhythmogenic Right Ventricular Cardiomyopathy: A Multinational Study. Circulation 2022; 146:1434-1443. [PMID: 36205131 PMCID: PMC9640278 DOI: 10.1161/circulationaha.122.060866] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND A novel risk calculator based on clinical characteristics and noninvasive tests that predicts the onset of clinical sustained ventricular arrhythmias (VA) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) has been proposed and validated by recent studies. It remains unknown whether programmed ventricular stimulation (PVS) provides additional prognostic value. METHODS All patients with a definite ARVC diagnosis, no history of sustained VAs at diagnosis, and PVS performed at baseline were extracted from 6 international ARVC registries. The calculator-predicted risk for sustained VA (sustained or implantable cardioverter defibrillator treated ventricular tachycardia [VT] or fibrillation, [aborted] sudden cardiac arrest) was assessed in all patients. Independent and combined performance of the risk calculator and PVS on sustained VA were assessed during a 5-year follow-up period. RESULTS Two hundred eighty-eight patients (41.0±14.5 years, 55.9% male, right ventricular ejection fraction 42.5±11.1%) were enrolled. At PVS, 137 (47.6%) patients had inducible ventricular tachycardia. During a median of 5.31 [2.89-10.17] years of follow-up, 83 (60.6%) patients with a positive PVS and 37 (24.5%) with a negative PVS experienced sustained VA (P<0.001). Inducible ventricular tachycardia predicted clinical sustained VA during the 5-year follow-up and remained an independent predictor after accounting for the calculator-predicted risk (HR, 2.52 [1.58-4.02]; P<0.001). Compared with ARVC risk calculator predictions in isolation (C-statistic 0.72), addition of PVS inducibility showed improved prediction of VA events (C-statistic 0.75; log-likelihood ratio for nested models, P<0.001). PVS inducibility had a 76% [67-84] sensitivity and 68% [61-74] specificity, corresponding to log-likelihood ratios of 2.3 and 0.36 for inducible (likelihood ratio+) and noninducible (likelihood ratio-) patients, respectively. In patients with a ARVC risk calculator-predicted risk of clinical VA events <25% during 5 years (ie, low/intermediate subgroup), PVS had a 92.6% negative predictive value. CONCLUSIONS PVS significantly improved risk stratification above and beyond the calculator-predicted risk of VA in a primary prevention cohort of patients with ARVC, mainly for patients considered to be at low and intermediate risk by the clinical risk calculator.
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Affiliation(s)
- Alessio Gasperetti
- Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (A.G., R.T.C., C. Tichnell, B.M., H.T., H.C., C.A.J.)
| | - Richard T. Carrick
- Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (A.G., R.T.C., C. Tichnell, B.M., H.T., H.C., C.A.J.)
| | - Sarah Costa
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich‚ Switzerland (S.C., C.B.B., F.D., A.M.S.)
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital Umberto-I-Salesi-Lancisi, Ancona, Italy (P.C., A.D.R., M. Casella)
| | - Laurens P. Bosman
- Department of Cardiology (L.P.B., A.S.J.M.t.R.), University Medical Center Utrecht, University of Utrecht, The Netherlands
| | - Monica Chivulescu
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway and University of Oslo (M. Chivulescu, K.H.H.)
| | - Crystal Tichnell
- Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (A.G., R.T.C., C. Tichnell, B.M., H.T., H.C., C.A.J.)
| | - Brittney Murray
- Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (A.G., R.T.C., C. Tichnell, B.M., H.T., H.C., C.A.J.)
| | - Harikrishna Tandri
- Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (A.G., R.T.C., C. Tichnell, B.M., H.T., H.C., C.A.J.)
| | - Rafik Tadros
- Cardiovascular Genetics Center and Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Canada (R.T., L.R., P.K., J.C.-T.)
| | - Lena Rivard
- Cardiovascular Genetics Center and Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Canada (R.T., L.R., P.K., J.C.-T.)
| | - Maarten P. van den Berg
- Department of Cardiology, University Medical Center Groningen, University of Groningen‚ The Netherlands (M.P.v.d.B.)
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, The Netherlands (K.Z.)
| | - Arthur A.M. Wilde
- Amsterdam UMC location University of Amsterdam‚ Department of Cardiology‚ Amsterdam‚ The Netherlands (A.A.M.W.)
| | | | - Corrado Carbucicchio
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Department of Clinical Electrophisiology and Cardiac Pacing, Milan, Italy (C.C., C. Tondo)
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital Umberto-I-Salesi-Lancisi, Ancona, Italy (P.C., A.D.R., M. Casella)
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital Umberto-I-Salesi-Lancisi, Ancona, Italy (P.C., A.D.R., M. Casella)
| | - Anneli Svensson
- Department of Cardiology and Department of Health‚ Medicine and Caring Sciences‚ Linköping University‚ Sweden (A.S.)
| | - Corinna B. Brunckhorst
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich‚ Switzerland (S.C., C.B.B., F.D., A.M.S.)
| | - J. Peter van Tintelen
- Department of Genetics (J.P.v.T.), University Medical Center Utrecht, University of Utrecht, The Netherlands
| | - Pyotr G. Platonov
- Department of Cardiology, Clinical Sciences, Lund University, Sweden (P.G.P.)
| | - Kristina H. Haugaa
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway and University of Oslo (M. Chivulescu, K.H.H.)
| | - Firat Duru
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich‚ Switzerland (S.C., C.B.B., F.D., A.M.S.)
| | - Anneline S.J.M. te Riele
- Department of Cardiology (L.P.B., A.S.J.M.t.R.), University Medical Center Utrecht, University of Utrecht, The Netherlands
| | - Paul Khairy
- Cardiovascular Genetics Center and Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Canada (R.T., L.R., P.K., J.C.-T.)
| | - Claudio Tondo
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Department of Clinical Electrophisiology and Cardiac Pacing, Milan, Italy (C.C., C. Tondo).,Department Biomedical, Surgical and Dental Sciences, University of Milan, Italy (C. Tondo)
| | - Hugh Calkins
- Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (A.G., R.T.C., C. Tichnell, B.M., H.T., H.C., C.A.J.)
| | - Cynthia A. James
- Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (A.G., R.T.C., C. Tichnell, B.M., H.T., H.C., C.A.J.)
| | - Ardan M. Saguner
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich‚ Switzerland (S.C., C.B.B., F.D., A.M.S.)
| | - Julia Cadrin-Tourigny
- Cardiovascular Genetics Center and Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Canada (R.T., L.R., P.K., J.C.-T.)
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13
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Carrick RT, Te Riele ASJM, Gasperetti A, Bosman L, Muller SA, Pendleton C, Tichnell C, Murray B, Yap SC, van den Berg MP, Wilde A, Zeppenfeld K, Hays A, Zimmerman SL, Tandri H, Cadrin-Tourigny J, van Tintelen P, Calkins H, James CA, Wu KC. Longitudinal Prediction of Ventricular Arrhythmic Risk in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy. Circ Arrhythm Electrophysiol 2022; 15:e011207. [PMID: 36315818 PMCID: PMC9669260 DOI: 10.1161/circep.122.011207] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/30/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The arrhythmogenic right ventricular cardiomyopathy (ARVC) risk calculator stratifies risk for incident sustained ventricular arrhythmias (VA) at the time of ARVC diagnosis. However, included risk factors change over time, and how well the ARVC risk calculator performs at follow-up is unknown. METHODS This was a retrospective analysis of patients with definite ARVC and without prior sustained VA. Risk factors for VA including age, nonsustained ventricular tachycardia, premature ventricular complex burden, T-wave inversions on electrocardiogram, cardiac syncope, right ventricular function, therapeutic medication use, and exercise intensity were assessed at the time of 2010 Task Force Criteria based ARVC diagnosis and upon repeat evaluations. Changes in these risk factors were analyzed over 5-year follow-up. The 5-year risk of VA was predicted longitudinally using (1) the baseline ARVC risk calculator prediction, (2) the ARVC risk prediction calculated using updated risk factors, and (3) time-varying Cox regression. Discrimination and calibration were assessed in comparison to observed VA event rates. RESULTS Four hundred eight patients with ARVC experiencing 132 primary VA events were included. Matched comparison of risk factors at baseline versus at 5 years of follow-up revealed decreased burdens of premature ventricular complexes (-1200/day) and nonsustained ventricular tachycardia (-14%). Presence of significant right ventricular dysfunction and number of T-wave inversions on electrocardiogram were unchanged. Observed risk for VA decreased by 13% by 5 years follow-up. The baseline ARVC risk calculator's ability to predict 5-year VA risk worsened during follow-up (C statistics, 0.83 at diagnosis versus 0.68 at 5 years). Both the updated ARVC risk calculator (C statistics of 0.77) and time-varying Cox regression model (C statistics, 0.77) had strong discrimination. The updated ARVC risk calculator overestimated 5-year VA risk by an average of +6%. CONCLUSIONS Risk factors for VA in ARVC are dynamic, and overall risk for incident sustained VA decreases during follow-up. Up-to-date risk factor assessment improves VA risk stratification.
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Affiliation(s)
- Richard T Carrick
- Division of Cardiology, Johns Hopkins Medical Institute, Baltimore, MD (R.T.C., A.G., C.P., C.T., B.M., A.H., S.L.Z., H.T., H.C., C.A.J., K.C.W.)
| | - Anneline S J M Te Riele
- Division of Cardiology, Department of Heart & Lungs (A.G., A.S.J.M.t.R., L.B., S.A.M.), University Medical Center Utrecht, the Netherlands
- Member of the European Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart' Academic Medical Center' Amsterdam' the Netherlands (A.S.J.M.t.R., S.-C.Y.)
| | - Alessio Gasperetti
- Division of Cardiology, Johns Hopkins Medical Institute, Baltimore, MD (R.T.C., A.G., C.P., C.T., B.M., A.H., S.L.Z., H.T., H.C., C.A.J., K.C.W.)
- Division of Cardiology, Department of Heart & Lungs (A.G., A.S.J.M.t.R., L.B., S.A.M.), University Medical Center Utrecht, the Netherlands
| | - Laurens Bosman
- Division of Cardiology, Department of Heart & Lungs (A.G., A.S.J.M.t.R., L.B., S.A.M.), University Medical Center Utrecht, the Netherlands
| | - Steven A Muller
- Division of Cardiology, Department of Heart & Lungs (A.G., A.S.J.M.t.R., L.B., S.A.M.), University Medical Center Utrecht, the Netherlands
| | - Catherine Pendleton
- Division of Cardiology, Johns Hopkins Medical Institute, Baltimore, MD (R.T.C., A.G., C.P., C.T., B.M., A.H., S.L.Z., H.T., H.C., C.A.J., K.C.W.)
| | - Crystal Tichnell
- Division of Cardiology, Johns Hopkins Medical Institute, Baltimore, MD (R.T.C., A.G., C.P., C.T., B.M., A.H., S.L.Z., H.T., H.C., C.A.J., K.C.W.)
| | - Brittney Murray
- Division of Cardiology, Johns Hopkins Medical Institute, Baltimore, MD (R.T.C., A.G., C.P., C.T., B.M., A.H., S.L.Z., H.T., H.C., C.A.J., K.C.W.)
| | - Sing-Chien Yap
- Member of the European Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart' Academic Medical Center' Amsterdam' the Netherlands (A.S.J.M.t.R., S.-C.Y.)
- Erasmus MC, University Medical Center Rotterdam, the Netherlands (S.C.Y., A.W., P.v.T.)
| | - Maarten P van den Berg
- Department of Cardiology, University Medical Center Groningen, University of Groningen, the Netherlands (M.P.v.d.B.)
| | - Arthur Wilde
- Erasmus MC, University Medical Center Rotterdam, the Netherlands (S.C.Y., A.W., P.v.T.)
- Amsterdam University Medical Center, Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, the Netherlands (A.W.)
| | | | - Allison Hays
- Division of Cardiology, Johns Hopkins Medical Institute, Baltimore, MD (R.T.C., A.G., C.P., C.T., B.M., A.H., S.L.Z., H.T., H.C., C.A.J., K.C.W.)
| | - Stefan L Zimmerman
- Division of Cardiology, Johns Hopkins Medical Institute, Baltimore, MD (R.T.C., A.G., C.P., C.T., B.M., A.H., S.L.Z., H.T., H.C., C.A.J., K.C.W.)
| | - Harikrishna Tandri
- Division of Cardiology, Johns Hopkins Medical Institute, Baltimore, MD (R.T.C., A.G., C.P., C.T., B.M., A.H., S.L.Z., H.T., H.C., C.A.J., K.C.W.)
| | | | - Peter van Tintelen
- Department of Clinical Genetics (P.v.T.), University Medical Center Utrecht, the Netherlands
- Erasmus MC, University Medical Center Rotterdam, the Netherlands (S.C.Y., A.W., P.v.T.)
| | - Hugh Calkins
- Division of Cardiology, Johns Hopkins Medical Institute, Baltimore, MD (R.T.C., A.G., C.P., C.T., B.M., A.H., S.L.Z., H.T., H.C., C.A.J., K.C.W.)
| | - Cynthia A James
- Division of Cardiology, Johns Hopkins Medical Institute, Baltimore, MD (R.T.C., A.G., C.P., C.T., B.M., A.H., S.L.Z., H.T., H.C., C.A.J., K.C.W.)
| | - Katherine C Wu
- Division of Cardiology, Johns Hopkins Medical Institute, Baltimore, MD (R.T.C., A.G., C.P., C.T., B.M., A.H., S.L.Z., H.T., H.C., C.A.J., K.C.W.)
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14
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Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA, Charron P, Corrado D, Dagres N, de Chillou C, Eckardt L, Friede T, Haugaa KH, Hocini M, Lambiase PD, Marijon E, Merino JL, Peichl P, Priori SG, Reichlin T, Schulz-Menger J, Sticherling C, Tzeis S, Verstrael A, Volterrani M. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J 2022; 43:3997-4126. [PMID: 36017572 DOI: 10.1093/eurheartj/ehac262] [Citation(s) in RCA: 829] [Impact Index Per Article: 414.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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15
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Spadotto A, Morabito D, Carecci A, Massaro G, Statuto G, Angeletti A, Graziosi M, Biagini E, Martignani C, Ziacchi M, Diemberger I, Biffi M. The Challenges of Diagnosis and Treatment of Arrhythmogenic Cardiomyopathy: Are We there yet? Rev Cardiovasc Med 2022; 23:283. [PMID: 39076647 PMCID: PMC11266951 DOI: 10.31083/j.rcm2308283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/15/2022] [Accepted: 07/04/2022] [Indexed: 07/31/2024] Open
Abstract
Background we sought to review the evolution in the diagnosis and treatment of Arrhythmogenic Cardiomyopathy (ACM), a clinically multifaceted entity beyond the observation of ventricular arrhythmias, and the outcome of therapies aiming at sudden death prevention in a single center experience. Methods retrospective analysis of the data of consecutive patients with an implanted cardioverter-defibrillator (ICD) and a confirmed diagnosis of ACM according to the proposed Padua Criteria, who were referred to our center from January 1992 to October 2021. Results we enrolled 72 patients (66% males, mean age at implant 46 ± 16 years), 63.9% implanted for primary prevention. At the time of ICD implant, 29 (40.3%) patients had a right ventricular involvement, 24 (33.3%) had a dominant LV involvement and 19 (26.4%) had a biventricular involvement. After a median follow-up of 6,1 years [IQR: 2.5-9.9], 34 patients (47.2%) had 919 sustained episodes of ventricular arrhythmias (VA). 27 patients (37.5%) had 314 episodes of life-threatening arrhythmias (LT-VA), defined as sustained ventricular tachycardia ≥ 200 beats/min. Considering only the patients with an ICD capable of delivering ATP, 80.4% of VA and 65% of LT-VA were successfully terminated with ATP. 16 (22.2%) patients had an inappropriate ICD activation, mostly caused by atrial fibrillation, while in 9 patients (12.5%) there was a complication needing reintervention (in 3 cases there was a loss of ventricular sensing dictating lead revision). During the follow-up 11 (15.3%) patients died, most of them due to heart failure, and 8 (11.1%) underwent heart transplantation. Conclusions ACM is increasingly diagnosed owing to heightened suspicion at ECG examination and to improved imaging technology and availability, though the diagnostic workflow is particularly challenging in the earliest disease stages. ICD therapy is the cornerstone of sudden death prevention, albeit its efficacy is not based on controlled studies, and VT ablation/medical therapy are complementary to this strategy. The high burden of ATP-terminated VA makes shock-only devices debatable. The progressive nature of ACM leads to severe biventricular enlargement and refractory heart failure, which pose significant treatment issues when a predominant RV dysfunction occurs owing to the reduced possibility for mechanical circulatory assistance.
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Affiliation(s)
- Alberto Spadotto
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, 40138 Bologna, Italy
| | - Domenico Morabito
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, 40138 Bologna, Italy
| | - Alessandro Carecci
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, 40138 Bologna, Italy
| | - Giulia Massaro
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, 40138 Bologna, Italy
| | - Giovanni Statuto
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, 40138 Bologna, Italy
| | - Andrea Angeletti
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Maddalena Graziosi
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Elena Biagini
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | | | - Matteo Ziacchi
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Igor Diemberger
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, 40138 Bologna, Italy
| | - Mauro Biffi
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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16
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Zhang N, Wang C, Gasperetti A, Song Y, Niu H, Gu M, Duru F, Chen L, Zhang S, Hua W. Validation of an Arrhythmogenic Right Ventricular Cardiomyopathy Risk-Prediction Model in a Chinese Cohort. J Clin Med 2022; 11:jcm11071973. [PMID: 35407585 PMCID: PMC8999693 DOI: 10.3390/jcm11071973] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 03/23/2022] [Accepted: 03/29/2022] [Indexed: 02/07/2023] Open
Abstract
Background: The novel arrhythmogenic right ventricular cardiomyopathy (ARVC)-associated ventricular arrhythmias (VAs) risk-prediction model endorsed by Cadrin-Tourigny et al. was recently developed to estimate visual VA risk and was identified to be more effective for predicting ventricular events than the International Task Force Consensus (ITFC) criteria, and the Heart Rhythm Society (HRS) criteria. Data regarding its application in Asians are lacking. Objectives: We aimed to perform an external validation of this algorithm in the Chinese ARVC population. Methods: The study enrolled 88 ARVC patients who received implantable cardioverter-defibrillator (ICD) from January 2005 to January 2020. The primary endpoint was appropriate ICD therapies. The novel prediction model was used to calculate a priori predicted VA risk that was compared with the observed rates. Results: During a median follow-up of 3.9 years, 57 (64.8%) patients received the ICD therapy. Patients with implanted ICDs for primary prevention had non-significantly lower rates of ICD therapy than secondary prevention (5-year event rate: 0.46 (0.13–0.66) and 0.80 (0.64–0.89); log-rank p = 0.098). The validation study revealed the C-statistic of 0.833 (95% confidence interval (CI) 0.615–1.000), and the predicted and the observed patterns were similar in primary prevention patients (mean predicted–observed risk: −0.07 (95% CI −0.21, 0.09)). However, in secondary prevention patients, the C-statistic was 0.640 (95% CI 0.510–0.770) and the predicted risk was significantly underestimated (mean predicted–observed risk: −0.32 (95% CI −0.39, −0.24)). The recalibration analysis showed that the performance of the prediction model in secondary prevention patients was improved, with the mean predicted–observed risk of −0.04 (95% CI −0.10, 0.03). Conclusions: The novel risk-prediction model had a good fitness to predict arrhythmic risk in Asian ARVC patients for primary prevention, and for secondary prevention patients after recalibration of the baseline risk.
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Affiliation(s)
- Nixiao Zhang
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China;
- Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China; (H.N.); (M.G.); (S.Z.)
| | - Chuangshi Wang
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 102300, China;
| | - Alessio Gasperetti
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, 8091 Zurich, Switzerland; (A.G.); (F.D.)
| | - Yanyan Song
- Department of CMR, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China;
| | - Hongxia Niu
- Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China; (H.N.); (M.G.); (S.Z.)
| | - Min Gu
- Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China; (H.N.); (M.G.); (S.Z.)
| | - Firat Duru
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, 8091 Zurich, Switzerland; (A.G.); (F.D.)
| | - Liang Chen
- Department of Cardiac Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
- Correspondence: (L.C.); (W.H.); Fax: +86-10-8839-8026 (L.C.); +86-10-8839-8290 (W.H.)
| | - Shu Zhang
- Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China; (H.N.); (M.G.); (S.Z.)
| | - Wei Hua
- Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China; (H.N.); (M.G.); (S.Z.)
- Correspondence: (L.C.); (W.H.); Fax: +86-10-8839-8026 (L.C.); +86-10-8839-8290 (W.H.)
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17
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Agbaedeng TA, Roberts KA, Colley L, Noubiap JJ, Oxborough D. Incidence and predictors of sudden cardiac death in arrhythmogenic right ventricular cardiomyopathy: a pooled analysis. Europace 2022; 24:1665-1674. [PMID: 35298614 PMCID: PMC9559905 DOI: 10.1093/europace/euac014] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 02/14/2022] [Indexed: 11/12/2022] Open
Abstract
AIMS Arrhythmogenic right ventricular cardiomyopathy (ARVC), an inherited heart muscle abnormality, is a major cause of sudden cardiac death (SCD). However, the burden of SCD and risk factors in ARVC are not clearly described. Thus, we estimated the rates and predictors of SCD in ARVC in a meta-analysis. METHODS AND RESULTS PubMed, Embase, and Web of Science were searched through 7 April 2021. Prospective studies reporting SCD from ARVC cohorts were included. Data were independently extracted by two reviewers and pooled in a random-effects meta-analysis. Fifty-two studies (n = 5485 patients) with moderate-to-low risk of bias were included. The pooled annualized rates of SCD were 0.65 per 1000 [95% confidence interval 0.00-6.43, I2 0.00%] in those with an implantable cardioverter-defibrillator (ICD) and 7.21 (2.38-13.79, I2 0.0%) in non-ICD cohorts: 7.14 in probands and 8.44 for 2010 Task Force Criteria (TFC). Multivariable predictors of life-threatening arrhythmic events including SCD were: age at presentation [adjusted hazard ratio 0.98 (0.97-0.99)], male sex [2.08 (1.29-3.36)], right ventricular (RV) dysfunction [6.99 (2.17-22.49)], QRS fragmentation [6.55 (3.33-12.90)], T-wave inversion [1.12 (1.02-1.24)], syncope at presentation [2.83 (2.40-4.08)], previous non-sustained ventricular tachyarrhythmia [2.53 (1.44-4.45)], and the TFC score [1.96 (1.02-3.76)], (P < 0.05). Predictors of appropriate ICD therapy were RV dysfunction, syncope, and inducible ventricular arrhythmia (P < 0.01). CONCLUSION This meta-analysis demonstrates a high burden of SCD in ARVC patients, especially among probands and ARVC defined by the modified TFC. Better strategies are required to improve patient management and prevent SCD in ARVC. PROSPERO ID: CRD42020211761.
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Affiliation(s)
- Thomas A Agbaedeng
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia.,Centre for Heart Rhythm Disorders, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Kirsty A Roberts
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Liam Colley
- HMGBiotech srl, Milan, Italy.,School of Medicine and Surgery, The University of Milano-Bicocca, Milano, Italy
| | - Jean Jacques Noubiap
- Centre for Heart Rhythm Disorders, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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18
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Chen V, Knight BP, McNally EM. Case report: DSP truncation variant p. R1951X leads to arrhythmogenic left ventricular cardiomyopathy. Eur Heart J Case Rep 2022; 6:ytac105. [PMID: 35474678 PMCID: PMC9026210 DOI: 10.1093/ehjcr/ytac105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/21/2021] [Accepted: 02/02/2022] [Indexed: 11/30/2022]
Abstract
Background Standardized diagnostic criteria for arrhythmogenic left ventricular cardiomyopathy (ALVC) have been recently proposed. The criteria emphasize structural left ventricle (LV) myocardial change on contrast-enhanced imaging and require the identification of gene variants associated with arrhythmogenic cardiomyopathy. Case summary A 21-year-old man presented for evaluation of exertional syncope and was found to have monomorphic ventricular tachycardia (VT) and an episode of polymorphic VT that degenerated to ventricular fibrillatory cardiac arrest. Documented premature ventricular contractions were of left bundle branch block, inferior axis morphology. Ventricular arrhythmias were successfully suppressed with β-blockade, amiodarone, and lidocaine, and a subcutaneous implantable cardioverter-defibrillator was implanted. Cardiac magnetic resonance imaging demonstrated normal-appearing right ventricle, reduced LV ejection fraction, and sub-epicardial scarring of basal-anterior and anterolateral LV segments. Endomyocardial biopsy showed lymphocytic myocarditis, and genetic testing revealed a pathogenic truncating mutation in the DSP gene, which encodes desmoplakin; this variant was also identified in the patient’s mother who carried a diagnosis of non-ischaemic cardiomyopathy. These findings are consistent with a diagnosis of ALVC. Discussion The clinical presentation of ALVC can be very dramatic. The differential for sub-epicardial LV myocardial fibrosis includes myocarditis, sarcoidosis, and in those with a suspicious family history or characteristic electrocardiogram findings, genetic cardiomyopathy. Prompt referral to a genetic counsellor can be lifesaving to patients and their family members.
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Affiliation(s)
- Vincent Chen
- Division of Cardiology, Bluhm Cardiovascular Institute, Department of Medicine , Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bradley P Knight
- Division of Cardiology, Bluhm Cardiovascular Institute, Department of Medicine , Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elizabeth M McNally
- Division of Cardiology, Bluhm Cardiovascular Institute, Department of Medicine , Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine , 303 E. Superior St. SQ6-516, Chicago, IL 60611, USA
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19
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Bosman LP, Nielsen Gerlach CL, Cadrin-Tourigny J, Orgeron G, Tichnell C, Murray B, Bourfiss M, van der Heijden JF, Yap SC, Zeppenfeld K, van den Berg MP, Wilde AAM, Asselbergs FW, Tandri H, Calkins H, van Tintelen JP, James CA, te Riele ASJM. Comparing clinical performance of current implantable cardioverter-defibrillator implantation recommendations in arrhythmogenic right ventricular cardiomyopathy. Europace 2022; 24:296-305. [PMID: 34468736 PMCID: PMC8824519 DOI: 10.1093/europace/euab162] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 06/14/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Arrhythmogenic right ventricular cardiomyopathy (ARVC) patients have an increased risk of ventricular arrhythmias (VA). Four implantable cardioverter-defibrillator (ICD) recommendation algorithms are available The International Task Force Consensus ('ITFC'), an ITFC modification by Orgeron et al. ('mITFC'), the AHA/HRS/ACC guideline for VA management ('AHA'), and the HRS expert consensus statement ('HRS'). This study aims to validate and compare the performance of these algorithms in ARVC. METHODS AND RESULTS We classified 617 definite ARVC patients (38.5 ± 15.1 years, 52.4% male, 39.2% prior sustained VA) according to four algorithms. Clinical performance was evaluated by sensitivity, specificity, ROC-analysis, and decision curve analysis for any sustained VA and for fast VA (>250 b.p.m.). During 6.4 [2.8-11.5] years follow-up, 282 (45.7%) patients experienced any sustained VA, and 63 (10.2%) fast VA. For any sustained VA, ITFC and mITFC provide higher sensitivity than AHA and HRS (94.0-97.8% vs. 76.7-83.5%), but lower specificity (15.9-32.0% vs. 42.7%-60.1%). Similarly, for fast VA, ITFC and mITFC provide higher sensitivity than AHA and HRS (95.2-97.1% vs. 76.7-78.4%) but lower specificity (42.7-43.1 vs. 76.7-78.4%). Decision curve analysis showed ITFC and mITFC to be superior for a 5-year sustained VA risk ICD indication threshold between 5-25% or 2-9% for fast VA. CONCLUSION The ITFC and mITFC provide the highest protection rates, whereas AHA and HRS decrease unnecessary ICD placements. ITFC or mITFC should be used if we consider the 5-year threshold for ICD indication to lie within 5-25% for sustained VA or 2-9% for fast VA. These data will inform decision-making for ICD placement in ARVC.
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Affiliation(s)
- Laurens P Bosman
- Netherlands Heart Institute, PO Box 19258, 3501 DG, Utrecht, The Netherlands
- Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - Claire L Nielsen Gerlach
- Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - Julia Cadrin-Tourigny
- Cardiovascular Genetics Center, Montreal Heart Institute, University of Montreal, 5000 Belanger St, Montreal H1T 1C8, Canada
| | - Gabriela Orgeron
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21287, USA
| | - Crystal Tichnell
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21287, USA
| | - Brittney Murray
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21287, USA
| | - Mimount Bourfiss
- Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - Jeroen F van der Heijden
- Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - Sing-Chien Yap
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Dr Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - Maarten P van den Berg
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
| | - Arthur A M Wilde
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Folkert W Asselbergs
- Netherlands Heart Institute, PO Box 19258, 3501 DG, Utrecht, The Netherlands
- Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - Hariskrishna Tandri
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21287, USA
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21287, USA
| | - J Peter van Tintelen
- Netherlands Heart Institute, PO Box 19258, 3501 DG, Utrecht, The Netherlands
- Department of Genetics, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - Cynthia A James
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21287, USA
| | - Anneline S J M te Riele
- Netherlands Heart Institute, PO Box 19258, 3501 DG, Utrecht, The Netherlands
- Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
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20
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Eberly L, Garg L, Vidula M, Reza N, Krishnan S. Running the Risk: Exercise and Arrhythmogenic Cardiomyopathy. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2022; 23. [PMID: 35082480 DOI: 10.1007/s11936-021-00943-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Purpose of review The purpose of this review is to summarize what is known about the relationship between exercise and arrhythmogenic right ventricular cardiomyopathy (ARVC) with regard to disease onset, diagnosis, progression, and clinical severity. This relationship forms the basis of the management recommendations for restricting physical activity in individuals with and at risk for ARVC. Recent findings While ARVC can be challenging to diagnose, there are several diagnostic testing and imaging modalities that may help distinguish athletic heart remodeling from ARVC. There is an increased risk of adverse clinical outcomes in ARVC from endurance and competitive sports participation, including a dose-dependent relationship between exercise intensity and risk of disease penetrance and progression. Summary High-intensity exercise can lead to earlier disease onset, increased penetrance, and clinical progression among individuals with and at risk for ARVC. Both amount and intensity of exercise are correlated with adverse outcomes, including ventricular arrhythmias and worsening biventricular function. All individuals with and at risk for ARVC should undergo detailed clinical phenotyping and risk stratification to reduce the risk of such outcomes, including sudden cardiac death. Consensus guidelines recommend against participation in competitive or high-intensity and endurance exercise for individuals with and at risk for ARVC.
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Affiliation(s)
- Lauren Eberly
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia, PA, USA.,Penn Cardiovascular Center for Health Equity and Justice, University of Pennsylvania, Philadelphia, PA, USA
| | - Lohit Garg
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Mahesh Vidula
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Nosheen Reza
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Sheela Krishnan
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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21
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Finocchiaro G, Magavern EF, Georgioupoulos G, Maurizi N, Sinagra G, Carr-White G, Pantazis A, Olivotto I. Sudden cardiac death in cardiomyopathies: acting upon "acceptable" risk in the personalized medicine era. Heart Fail Rev 2022; 27:1749-1759. [PMID: 35083629 DOI: 10.1007/s10741-021-10198-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 11/04/2022]
Abstract
Patients with cardiomyopathies are confronted with the risk of sudden cardiac death (SCD) throughout their lifetime. Despite the fact that SCD is relatively rare, prognostic stratification is an integral part of physician-patient discussion, with the goal of risk modification and prevention. The current approach is based on a concept of "acceptable risk." However, there are intrinsic problems with an algorithm-based approach to risk management, magnified by the absence of robust evidence underlying clinical decision support tools, which can make high- versus low-risk classifications arbitrary. Strategies aimed at risk reduction range from selecting patients for an implantable cardioverter defibrillator (ICD) to disqualification from competitive sports. These clinical options, especially when implying the use of finite financial resources, are often delivered from the physician's perspective citing decision-making algorithms. When the burden of intervention-related risks or financial costs is deemed higher than an "acceptable risk" of SCD, the patient's perspective may not be appropriately considered. Designating a numeric threshold of "acceptable risk" has ethical implications. One could reasonably ask "acceptable to whom?" In an era when individual choice and autonomy are pillars of the physician-patient relationship, the subjective aspects of perceived risk should be acknowledged and be part of shared decision-making. This is particularly true when the lack of a strong scientific evidence base makes a dichotomous algorithm-driven approach suboptimal for unmitigated translation to clinical practice.
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Affiliation(s)
- Gherardo Finocchiaro
- Cardiothoracic Centre, Guy's and St Thomas' Hospital, London, UK. .,King's College London, London, UK. .,Royal Brompton Hospital, Sydney St, London, SW3 6NP, UK. .,Cardiovascular Clinical Academic Group, St George's, University of London, London, UK.
| | - Emma F Magavern
- The London School of Medicine and Dentistry, William Harvey Research Institute, Barts, London, UK.,Department of Clinical Pharmacology, Cardiovascular Medicine, Barts Health NHS Trust, London, UK
| | | | - Niccolo' Maurizi
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Gerald Carr-White
- Cardiothoracic Centre, Guy's and St Thomas' Hospital, London, UK.,King's College London, London, UK
| | | | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
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22
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Khan Z, Abumedian M, Yousif Y, Gupta A, Myo SL, Mlawa G. Arrhythmogenic Right Ventricular Cardiomyopathy in a Patient Experiencing Out-of-Hospital Ventricular Fibrillation Arrest Twice: Case Report and Review of the Literature. Cureus 2022; 14:e21457. [PMID: 35223241 PMCID: PMC8857986 DOI: 10.7759/cureus.21457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2022] [Indexed: 11/13/2022] Open
Abstract
We present a case of a 62-year-old male who was admitted to the hospital with out-of-hospital ventricular fibrillation (VF) arrest. He had a VF arrest in 2011 and was admitted to another hospital. He had several investigations excluding cardiac magnetic resonance imaging, all of which were normal. He was playing tennis on both occasions when he experienced the VF arrest. His electrocardiogram on admission showed AF with partial right bundle branch block, inverted T waves in V1-V2, low voltage QRS complexes, ventricular ectopic in lead V1-V2, and prolonged QTc. His echocardiogram showed normal left ventricular function and a dilated right ventricle. Cardiac magnetic resonance imaging showed a dilated RV cavity size with impaired systolic function and dyskinetic region in the mid-ventricular free wall proximal to the insertion of the moderator band and late gadolinium enhancement in both right and left ventricles insertion points and mid-wall late gadolinium enhancement in the basal inferolateral wall suggestive of arrhythmogenic right ventricular cardiomyopathy. He had a single chamber VVI implantable cardioverter-defibrillator fitted for primary prevention and was discharged home. He had outpatient follow-up and showed good improvement and his implantable cardioverter-defibrillator checks were satisfactory and did not experience any shocks.
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23
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Pathogenesis, Diagnosis and Risk Stratification in Arrhythmogenic Cardiomyopathy. CARDIOGENETICS 2021. [DOI: 10.3390/cardiogenetics11040025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a genetically determined myocardial disease associated with sudden cardiac death (SCD). It is most frequently caused by mutations in genes encoding desmosomal proteins. However, there is growing evidence that ACM is not exclusively a desmosome disease but rather appears to be a disease of the connexoma. Fibroadipose replacement of the right ventricle (RV) had long been the hallmark of ACM, although biventricular involvement or predominant involvement of the left ventricle (LD-ACM) is increasingly found, raising the challenge of differential diagnosis with arrhythmogenic dilated cardiomyopathy (a-DCM). A-DCM, ACM, and LD-ACM are increasingly acknowledged as a single nosological entity, the hallmark of which is electrical instability. Our aim was to analyze the complex molecular mechanisms underlying arrhythmogenic cardiomyopathies, outlining the role of inflammation and autoimmunity in disease pathophysiology. Secondly, we present the clinical tools used in the clinical diagnosis of ACM. Focusing on the challenge of defining the risk of sudden death in this clinical setting, we present available risk stratification strategies. Lastly, we summarize the role of genetics and imaging in risk stratification, guiding through the appropriate patient selection for ICD implantation.
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24
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Przybylski R, Abrams DJ. Clinical and genetic features of arrhythmogenic cardiomyopathy: the electrophysiology perspective. PROGRESS IN PEDIATRIC CARDIOLOGY 2021. [DOI: 10.1016/j.ppedcard.2021.101463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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25
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Siskin M, Cerrone M, Shokr M, Aizer A, Barbhaiya C, Dai M, Bernstein S, Holmes D, Knotts R, Park DS, Spinelli M, Chinitz LA, Jankelson L. ICD shocks and complications in patients with inherited arrhythmia syndromes. IJC HEART & VASCULATURE 2021; 37:100908. [PMID: 34765721 PMCID: PMC8569698 DOI: 10.1016/j.ijcha.2021.100908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/25/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is limited information on the long-term outcomes of ICDs in patients with inherited arrhythmia syndromes. METHODS Prospective registry study of inherited arrhythmia patients with an ICD. Incidence of therapies and complications were measured as 5-year cumulative incidence proportions and analyzed with the Kaplan-Meier method. Incidence was compared by device indication, diagnosis type and device type. Cox-regression analysis was used to identify predictors of appropriate shock and device complication. RESULTS 123 patients with a mean follow up of 6.4 ± 4.8 years were included. The incidence of first appropriate shock was 56.52% vs 24.44%, p < 0.05 for cardiomyopathy and channelopathy patients, despite similar ejection fraction (61% vs 60%, p = 0.6). The incidence of first inappropriate shock was 13.46% vs 56.25%, p < 0.01 for single vs. multi-lead devices. The incidence of first lead complication was higher for multi-lead vs. single lead devices, 43.75% vs. 17.31%, p = 0.04. Patients with an ICD for secondary prevention were more likely to receive an appropriate shock than those with primary prevention indication (HR 2.21, CI 1.07-4.56, p = 0.03). Multi-lead devices were associated with higher risk of inappropriate shock (HR 3.99, CI 1.27-12.52, p = 0.02), with similar appropriate shock risk compared to single lead devices. In 26.5% of patients with dual chamber devices, atrial sensing or pacing was not utilized. CONCLUSION The rate of appropriate therapies and ICD complications in patients with inherited arrhythmia is high, particularly in cardiomyopathies with multi-lead devices. Risk-benefit ratio should be carefully considered when assessing the indication and type of device in this population.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Lior Jankelson
- Corresponding author at: Leon H. Charney Division of Cardiology New York University Langone Health 516 1st Avenue, New York 10016, USA.
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26
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Shah MJ, Silka MJ, Avari Silva JN, Balaji S, Beach CM, Benjamin MN, Berul CI, Cannon B, Cecchin F, Cohen MI, Dalal AS, Dechert BE, Foster A, Gebauer R, Gonzalez Corcia MC, Kannankeril PJ, Karpawich PP, Kim JJ, Krishna MR, Kubuš P, LaPage MJ, Mah DY, Malloy-Walton L, Miyazaki A, Motonaga KS, Niu MC, Olen M, Paul T, Rosenthal E, Saarel EV, Silvetti MS, Stephenson EA, Tan RB, Triedman J, Von Bergen NH, Wackel PL. 2021 PACES expert consensus statement on the indications and management of cardiovascular implantable electronic devices in pediatric patients. Indian Pacing Electrophysiol J 2021; 21:367-393. [PMID: 34333141 PMCID: PMC8577100 DOI: 10.1016/j.ipej.2021.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
In view of the increasing complexity of both cardiovascular implantable electronic devices (CIEDs) and patients in the current era, practice guidelines, by necessity, have become increasingly specific. This document is an expert consensus statement that has been developed to update and further delineate indications and management of CIEDs in pediatric patients, defined as ≤21 years of age, and is intended to focus primarily on the indications for CIEDs in the setting of specific disease categories. The document also highlights variations between previously published adult and pediatric CIED recommendations and provides rationale for underlying important differences. The document addresses some of the deterrents to CIED access in low- and middle-income countries and strategies to circumvent them. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by class of recommendation and level of evidence. Several questions addressed in this document either do not lend themselves to clinical trials or are rare disease entities, and in these instances recommendations are based on consensus expert opinion. Furthermore, specific recommendations, even when supported by substantial data, do not replace the need for clinical judgment and patient-specific decision-making. The recommendations were opened for public comment to Pediatric and Congenital Electrophysiology Society (PACES) members and underwent external review by the scientific and clinical document committee of the Heart Rhythm Society (HRS), the science advisory and coordinating committee of the American Heart Association (AHA), the American College of Cardiology (ACC), and the Association for European Paediatric and Congenital Cardiology (AEPC). The document received endorsement by all the collaborators and the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS). This document is expected to provide support for clinicians and patients to allow for appropriate CIED use, appropriate CIED management, and appropriate CIED follow-up in pediatric patients.
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Affiliation(s)
- Maully J Shah
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Michael J Silka
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
| | | | | | | | - Monica N Benjamin
- Hospital de Pediatría Juan P. Garrahan, Hospital El Cruce, Hospital Británico de Buenos Aires, Instituto Cardiovascular ICBA, Buenos Aires, Argentina
| | | | | | - Frank Cecchin
- New York University Grossman School of Medicine, New York, NY, USA
| | | | - Aarti S Dalal
- Washington University in St. Louis, St. Louis, Missouri, USA
| | | | - Anne Foster
- Advocate Children's Heart Institute, Chicago, IL, USA
| | - Roman Gebauer
- Heart Centre Leipzig, University of Leipzig, Leipzig, Germany
| | | | | | - Peter P Karpawich
- University Pediatricians, Children's Hospital of Michigan, Detroit, MI, USA
| | | | | | - Peter Kubuš
- Children's Heart Center, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | | | | | | | - Aya Miyazaki
- Shizuoka General Hospital and Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | | | - Mary C Niu
- University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | | | - Thomas Paul
- Georg-August-University Medical Center, Göttingen, Germany
| | - Eric Rosenthal
- Evelina London Children's Hospital and St Thomas' Hospital, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | | | | | - Reina B Tan
- New York University Langone Health, New York, NY, USA
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27
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2021 PACES expert consensus statement on the indications and management of cardiovascular implantable electronic devices in pediatric patients. Cardiol Young 2021; 31:1738-1769. [PMID: 34338183 DOI: 10.1017/s1047951121003413] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
In view of the increasing complexity of both cardiovascular implantable electronic devices (CIEDs) and patients in the current era, practice guidelines, by necessity, have become increasingly specific. This document is an expert consensus statement that has been developed to update and further delineate indications and management of CIEDs in pediatric patients, defined as ≤21 years of age, and is intended to focus primarily on the indications for CIEDs in the setting of specific disease categories. The document also highlights variations between previously published adult and pediatric CIED recommendations and provides rationale for underlying important differences. The document addresses some of the deterrents to CIED access in low- and middle-income countries and strategies to circumvent them. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by class of recommendation and level of evidence. Several questions addressed in this document either do not lend themselves to clinical trials or are rare disease entities, and in these instances recommendations are based on consensus expert opinion. Furthermore, specific recommendations, even when supported by substantial data, do not replace the need for clinical judgment and patient-specific decision-making. The recommendations were opened for public comment to Pediatric and Congenital Electrophysiology Society (PACES) members and underwent external review by the scientific and clinical document committee of the Heart Rhythm Society (HRS), the science advisory and coordinating committee of the American Heart Association (AHA), the American College of Cardiology (ACC), and the Association for European Paediatric and Congenital Cardiology (AEPC). The document received endorsement by all the collaborators and the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS). This document is expected to provide support for clinicians and patients to allow for appropriate CIED use, appropriate CIED management, and appropriate CIED follow-up in pediatric patients.
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28
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Heart Failure in Patients with Arrhythmogenic Cardiomyopathy. J Clin Med 2021; 10:jcm10204782. [PMID: 34682905 PMCID: PMC8540844 DOI: 10.3390/jcm10204782] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/10/2021] [Accepted: 10/14/2021] [Indexed: 02/07/2023] Open
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a rare inherited cardiomyopathy characterized as fibro-fatty replacement, and a common cause for sudden cardiac death in young athletes. Development of heart failure (HF) has been an under-recognized complication of ACM for a long time. The current clinical management guidelines for HF in ACM progression have nowadays been updated. Thus, a comprehensive review for this great achievement in our understanding of HF in ACM is necessary. In this review, we aim to describe the research progress on epidemiology, clinical characteristics, risk stratification and therapeutics of HF in ACM.
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29
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Shah MJ, Silka MJ, Silva JA, Balaji S, Beach C, Benjamin M, Berul C, Cannon B, Cecchin F, Cohen M, Dalal A, Dechert B, Foster A, Gebauer R, Gonzalez Corcia MC, Kannankeril P, Karpawich P, Kim J, Krishna MR, Kubuš P, Malloy-Walton L, LaPage M, Mah D, Miyazaki A, Motonaga K, Niu M, Olen M, Paul T, Rosenthal E, Saarel E, Silvetti MS, Stephenson E, Tan R, Triedman J, Von Bergen N, Wackel P. 2021 PACES Expert Consensus Statement on the Indications and Management of Cardiovascular Implantable Electronic Devices in Pediatric Patients. Heart Rhythm 2021; 18:1888-1924. [PMID: 34363988 DOI: 10.1016/j.hrthm.2021.07.038] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 07/15/2021] [Indexed: 01/10/2023]
Abstract
In view of the increasing complexity of both cardiovascular implantable electronic devices (CIEDs) and patients in the current era, practice guidelines, by necessity, have become increasingly specific. This document is an expert consensus statement that has been developed to update and further delineate indications and management of CIEDs in pediatric patients, defined as ≤21 years of age, and is intended to focus primarily on the indications for CIEDs in the setting of specific disease categories. The document also highlights variations between previously published adult and pediatric CIED recommendations and provides rationale for underlying important differences. The document addresses some of the deterrents to CIED access in low- and middle-income countries and strategies to circumvent them. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by class of recommendation and level of evidence. Several questions addressed in this document either do not lend themselves to clinical trials or are rare disease entities, and in these instances recommendations are based on consenus expert opinion. Furthermore, specific recommendations, even when supported by substantial data, do not replace the need for clinical judgment and patient-specific decision-making. The recommendations were opened for public comment to Pediatric and Congenital Electrophysiology Society (PACES) members and underwent external review by the scientific and clinical document committee of the Heart Rhythm Society (HRS), the science advisory and coordinating committee of the American Heart Association (AHA), the American College of Cardiology, (ACC) and the Association for European Paediatric and Congenital Cardiology (AEPC). The document received endorsement by all the collaborators and the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS). This document is expected to provide support for clinicians and patients to allow for appropriate CIED use, appropriate CIED management, and appropriate follow-up in pediatric patients.
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Affiliation(s)
- Maully J Shah
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
| | - Michael J Silka
- University of Southern California Keck School of Medicine, Los Angeles, California.
| | | | | | - Cheyenne Beach
- Yale University School of Medicine, New Haven, Connecticut
| | - Monica Benjamin
- Hospital de Pediatría Juan P. Garrahan, Hospital El Cruce, Hospital Británico de Buenos Aires, Instituto Cardiovascular ICBA, Buenos Aires, Argentina
| | | | | | - Frank Cecchin
- New York Univeristy Grossman School of Medicine, New York, New York
| | | | - Aarti Dalal
- Washington University in St. Louis, St. Louis, Missouri
| | | | - Anne Foster
- Advocate Children's Heart Institute, Chicago, Illinois
| | - Roman Gebauer
- Heart Centre Leipzig, University of Leipzig, Leipzig, Germany
| | | | | | - Peter Karpawich
- University Pediatricians, Children's Hospital of Michigan, Detroit, Michigan
| | | | | | - Peter Kubuš
- Children's Heart Center, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | | | | | - Doug Mah
- Harvard Medical School, Boston, Massachussetts
| | - Aya Miyazaki
- Shizuoka General Hospital and Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | | | - Mary Niu
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | | | - Thomas Paul
- Georg-August-University Medical Center, Göttingen, Germany
| | - Eric Rosenthal
- Evelina London Children's Hospital and St Thomas' Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | | | | | | | - Reina Tan
- New York University Langone Health, New York, New York
| | - John Triedman
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Nicholas Von Bergen
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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30
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Christensen AH, Platonov PG, Svensson A, Jensen HK, Rootwelt-Norberg C, Dahlberg P, Madsen T, Frederiksen TC, Heliö T, Haugaa KH, Bundgaard H, Svendsen JH. Complications of implantable cardioverter-defibrillator treatment in arrhythmogenic right ventricular cardiomyopathy. Europace 2021; 24:306-312. [PMID: 34279601 DOI: 10.1093/europace/euab112] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/08/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Treatment with implantable cardioverter-defibrillators (ICD) is a cornerstone for prevention of sudden cardiac death in arrhythmogenic right ventricular cardiomyopathy (ARVC). We aimed at describing the complications associated with ICD treatment in a multinational cohort with long-term follow-up. METHODS AND RESULTS The Nordic ARVC registry was established in 2010 and encompasses a large multinational cohort of ARVC patients, including their clinical characteristics, treatment, and events during follow-up. We included 299 patients (66% males, median age 41 years). During a median follow-up of 10.6 years, 124 (41%) patients experienced appropriate ICD shock therapy, 28 (9%) experienced inappropriate shocks, 82 (27%) had a complication requiring surgery (mainly lead-related, n = 75), and 99 (33%) patients experienced the combined endpoint of either an inappropriate shock or a surgical complication. The crude rate of first inappropriate shock was 3.4% during the first year after implantation but decreased after the first year and plateaued over time. Contrary, the risk of a complication requiring surgery was 5.5% the first year and remained high throughout the study period. The combined risk of any complication was 7.9% the first year. In multivariate cox regression, presence of atrial fibrillation/flutter was a risk factor for inappropriate shock (P < 0.05), whereas sex, age at implant, and device type were not (all P > 0.05). CONCLUSION Forty-one percent of ARVC patients treated with ICD experienced potentially life-saving ICD therapy during long-term follow-up. A third of the patients experienced a complication during follow-up with lead-related complications constituting the vast majority.
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Affiliation(s)
- Alex Hørby Christensen
- Department of Cardiology, Copenhagen University Hospital-Herlev-Gentofte, Borgmester Ib Juuls Vej 1, DK-2730 Herlev, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
| | - Pyotr G Platonov
- Department of Cardiology, Lund University, Lund, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Anneli Svensson
- Department of Cardiology, Linköping University, Linköping, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Henrik K Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Christine Rootwelt-Norberg
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway.,Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Pia Dahlberg
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Trine Madsen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Tanja Charlotte Frederiksen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Tiina Heliö
- Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.,University of Helsinki, Helsinki, Finland
| | - Kristina H Haugaa
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway.,Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Henning Bundgaard
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
| | - Jesper H Svendsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
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31
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Lutokhina YA, Blagova OV, Nedostup AV, Alexandrova SA, Evseeva EV, Shestak AG, Zaklyazminskaya EV. Contribution of concomitant myocarditis to the development of various clinical types of arrhythmogenic right ventricular cardiomyopathy. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2021. [DOI: 10.15829/1728-8800-2021-2781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aim. To assess the contribution of genetic and inflammatory factors to the development of arrhythmogenic right ventricular cardiomyopathy (ARVC).Material and methods. The study involved 54 patients with ARVC (age, 38,7±14,1 years; men, 42,6%; mean follow-up period, 21 [6; 60] months). All patients underwent electrocardiography (ECG), 24-hour ECG monitoring, echocardiography, determination of anticardiac antibodies and DNA of cardiotropic viruses in the blood, molecular genetic ARVC testing, as well as cardiac magnetic resonance imaging (n=49), high-resolution ECG (n=18), right ventricular endomyocardial biopsy (n=2), and autopsy (n=2).Results. Following four clinical types of ARVC were identified: I. Latent arrhythmic form: characterized by frequent premature ventricular contractions and/or nonsustained ventricular tachycardia (VT). II. Manifested arrhythmic form (n=11) — SVT/ventricular fibrillation (VF). III. ARVC with progressive heart failure (HF, n=8). IV. Combination of ARVC with left ventricular noncompaction (LVNC, n=8). Superimposed myocarditis was identified in 74%, 36%, 87,5% and 85,7% of patients in forms I-IV, respectively. Mutations were detected in 11%, 46%, 50%, and 38% of patients in forms I-IV, respectively. Clinical forms were stable: there was no transition from one clinical form to another during follow-up period.Conclusion. The contribution of genetic and inflammatory mechanisms to the clinical picture is different: in the latent arrhythmic form, the leading role belongs to inflammation; in the manifested arrhythmic form, the contribution of pathogenic mutations prevails, and in ARVC with progressive HF and in combination with LVNC, the contribution of genetic and inflammatory factors is equally important.
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Affiliation(s)
| | | | | | - S. A. Alexandrova
- A.N. Bakulev National Medical Research Center of Cardiovascular Surgery
| | | | - A. G Shestak
- B.V. Petrovsky Russian Research Center of Surgery
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32
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Pelliccia A, Sharma S, Gati S, Bäck M, Börjesson M, Caselli S, Collet JP, Corrado D, Drezner JA, Halle M, Hansen D, Heidbuchel H, Myers J, Niebauer J, Papadakis M, Piepoli MF, Prescott E, Roos-Hesselink JW, Graham Stuart A, Taylor RS, Thompson PD, Tiberi M, Vanhees L, Wilhelm M. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. Eur Heart J 2021; 42:17-96. [PMID: 32860412 DOI: 10.1093/eurheartj/ehaa605] [Citation(s) in RCA: 728] [Impact Index Per Article: 242.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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33
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Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC), also called arrhythmogenic right ventricular dysplasia or arrhythmogenic cardiomyopathy, is a genetic disease characterised by progressive myocyte loss with replacement by fibrofatty tissue. This structural change leads to the prominent features of ARVC of ventricular arrhythmia and increased risk for sudden cardiac death (SCD). Emphasis should be placed on determining and stratifying the patient’s risk of ventricular arrhythmia and SCD. ICDs should be used to treat the former and prevent the latter, but ICDs are not benign interventions. ICDs come with their own complications in this overall young population of patients. This article reviews the literature regarding the factors that contribute to the assessment of risk stratification in ARVC patients.
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Affiliation(s)
- Ryan Wallace
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institute, Baltimore, MD, US
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institute, Baltimore, MD, US
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34
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Woźniak O, Borowiec K, Konka M, Cicha-Mikołajczyk A, Przybylski A, Szumowski Ł, Hoffman P, Poślednik K, Biernacka EK. Implantable cardiac defibrillator events in patients with arrhythmogenic right ventricular cardiomyopathy. Heart 2021; 108:22-28. [PMID: 33674353 DOI: 10.1136/heartjnl-2020-318415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 02/09/2021] [Accepted: 02/16/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Arrhythmogenic right ventricular cardiomyopathy (ARVC) is associated with a risk of sudden cardiac death. Optimal risk stratification is still under debate. The main purpose of this long-term, single-centre observation was to analyse predictors of appropriate and inappropriate implantable cardioverter-defibrillator (ICD) interventions in the population of patients with ARVC with a high risk of life-threatening arrhythmias. METHODS The study comprised 65 adult patients (median age 40 years, 48 men) with a definite diagnosis of ARVC who received ICD over a time span of 20 years in primary (40%) or secondary (60%) prevention of sudden cardiac death. The study endpoints were first appropriate and inappropriate ICD interventions (shock or antitachycardia pacing) after device implantation. RESULTS During a median follow-up of 7.75 years after ICD implantation, nine patients died and six individuals underwent heart transplantation. Appropriate ICD interventions occurred in 43 patients (66.2%) and inappropriate ICD interventions in 18 patients (27.7%). Multivariable analysis using cause-specific hazard model identified three predictors of appropriate ICD interventions: right ventricle dysfunction (cause-specific HR 2.85, 95% CI 1.56 to 5.21, p<0.001), age <40 years at ICD implantation (cause-specific HR 2.37, 95% CI 1.13 to 4.94, p=0.022) and a history of sustained ventricular tachycardia (cause-specific HR 2.55, 95% CI 1.16 to 5.63, p=0.020). Predictors of inappropriate ICD therapy were not found. Complications related to ICD implantation occurred in 12 patients. CONCLUSIONS Right ventricle dysfunction, age <40 years and a history of sustained ventricular tachycardia were predictors of appropriate ICD interventions in patients with ARVC. The results may be used to improve risk stratification before ICD implantation.
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Affiliation(s)
- Olgierd Woźniak
- Department of Congenital Heart Diseases, National Institute of Cardiology, Warsaw, Poland
| | - Karolina Borowiec
- Department of Congenital Heart Diseases, National Institute of Cardiology, Warsaw, Poland
| | - Marek Konka
- Department of Congenital Heart Diseases, National Institute of Cardiology, Warsaw, Poland
| | - Alicja Cicha-Mikołajczyk
- Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, National Institute of Cardiology, Warsaw, Poland
| | | | - Łukasz Szumowski
- Arrhythmia Department, National Institute of Cardiology, Warsaw, Poland
| | - Piotr Hoffman
- Department of Congenital Heart Diseases, National Institute of Cardiology, Warsaw, Poland
| | - Krzysztof Poślednik
- Department of Congenital Heart Diseases, National Institute of Cardiology, Warsaw, Poland
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Keen J, Prisco SZ, Prins KW. Sex Differences in Right Ventricular Dysfunction: Insights From the Bench to Bedside. Front Physiol 2021; 11:623129. [PMID: 33536939 PMCID: PMC7848185 DOI: 10.3389/fphys.2020.623129] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/17/2020] [Indexed: 12/04/2022] Open
Abstract
There are inherent distinctions in right ventricular (RV) performance based on sex as females have better RV function than males. These differences are magnified and have very important prognostic implications in two RV-centric diseases, pulmonary hypertension (PH), and arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D). In both PH and ARVC/D, RV dysfunction results in poor patient outcomes. However, there are no currently approved therapies specifically targeting the failing RV, an important unmet need for these two life-threatening disorders. In this review, we highlight human data demonstrating divergent RV phenotypes in healthy, PH, and ARVC/D patients based on sex. Furthermore, we discuss the links between estrogen (the female predominant sex hormone), testosterone (the male predominant sex hormone), and dehydroepiandrosterone (a precursor hormone for multiple sex hormones in males and females) and RV function in both disorders. To provide potential mechanistic insights into sex differences in RV function, we review data that investigate how sex hormones combat or contribute to pathophysiological changes in the RV. Finally, we highlight the ongoing clinical trials in pulmonary arterial hypertension targeting estrogen and dehydroepiandrosterone signaling. Hopefully, a greater understanding of the factors that promote superior RV function in females will lead to novel therapeutic approaches to combat RV dysfunction in PH and ARVC/D.
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Affiliation(s)
- Jennifer Keen
- Pulmonary and Critical Care, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Sasha Z Prisco
- Cardiovascular Division, Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis, MN, United States
| | - Kurt W Prins
- Cardiovascular Division, Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis, MN, United States
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36
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Briongos-Figuero S, García-Alberola A, Rubio J, Segura JM, Rodríguez A, Peinado R, Alzueta J, Martínez-Ferrer JB, Viñolas X, Fernández de la Concha J, Anguera I, Martín M, Cerdá L, Pérez L. Long-Term Outcomes Among a Nationwide Cohort of Patients Using an Implantable Cardioverter-Defibrillator: UMBRELLA Study Final Results. J Am Heart Assoc 2020; 10:e018108. [PMID: 33356406 PMCID: PMC7955463 DOI: 10.1161/jaha.120.018108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Large‐scale studies describing modern populations using an implantable cardioverter‐defibrillator (ICD) are lacking. We aimed to analyze the incidence of arrhythmia, device interventions, and mortality in a broad spectrum of real‐world ICD patients with different heart disorders. Methods and Results The UMBRELLA study is a prospective, multicenter, nationwide study of contemporary patients using an ICD followed up by remote monitoring, with a blinded review of arrhythmic episodes. From November 2005 to November 2017, 4296 patients were followed up. After 46.6±27.3 months, 16 067 episodes of sustained ventricular arrhythmia occurred in 1344 patients (31.3%). Appropriate ICD therapy occurred in 27.3% of study population. Patients with ischemic cardiomyopathy (hazard ratio [HR], 1.51; 95% CI, 1.29–1.78), dilated cardiomyopathy (HR, 1.28; 95% CI, 1.07–1.53), and valvular heart disease (HR, 1.94; 95% CI, 1.43–2.62) exhibited a higher risk of appropriate ICD therapies, whereas patients with hypertrophic cardiomyopathy (HR, 0.72; 95% CI, 0.54–0.96) and Brugada syndrome (HR, 0.25; 95% CI, 0.14–0.45) showed a lower risk. All‐cause death was 13.4% at follow‐up. Ischemic cardiomyopathy (HR, 3.09; 95% CI, 2.58–5.90), dilated cardiomyopathy (HR, 3.33; 95% CI, 2.18–5.10), and valvular heart disease (HR, 3.97; 95% CI, 2.25–6.99) had the worst prognoses. Delayed high‐rate detection was enabled in 39.7% of patients, and single‐zone programming occurred in 52.6% of primary prevention patients. Both parameters correlated with lower risk of first appropriate ICD therapy, with no excess risk of mortality. The rate of inappropriate shocks at follow‐up was low (6%) and did not differ among type of ICD but was lower in SmartShock‐capable devices. Conclusions Irrespective of the cause, contemporary ICD patients with heart failure–related disorders had a similar risk of ICD life‐saving interventions and death. Current ICD programming recommendations still need to be implemented. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NTC01561144.
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Affiliation(s)
- Sem Briongos-Figuero
- Hospital Universitario Infanta Leonor Madrid Spain.,Universidad Complutense de Madrid Madrid Spain
| | | | - Jerónimo Rubio
- Hospital Clínico Universitario de Valladolid Valladolid Spain
| | | | | | | | - Javier Alzueta
- Hospital Universitario Virgen de la Victoria Málaga Spain
| | | | | | | | | | | | | | - Luisa Pérez
- Complexo Hospitalario Universitario de A Coruña A Coruña Spain
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37
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Cadrin-Tourigny J, Bosman LP, Wang W, Tadros R, Bhonsale A, Bourfiss M, Lie ØH, Saguner AM, Svensson A, Andorin A, Tichnell C, Murray B, Zeppenfeld K, van den Berg MP, Asselbergs FW, Wilde AAM, Krahn AD, Talajic M, Rivard L, Chelko S, Zimmerman SL, Kamel IR, Crosson JE, Judge DP, Yap SC, Van der Heijden JF, Tandri H, Jongbloed JDH, van Tintelen JP, Platonov PG, Duru F, Haugaa KH, Khairy P, Hauer RNW, Calkins H, Te Riele ASJM, James CA. Sudden Cardiac Death Prediction in Arrhythmogenic Right Ventricular Cardiomyopathy: A Multinational Collaboration. Circ Arrhythm Electrophysiol 2020; 14:e008509. [PMID: 33296238 PMCID: PMC7834666 DOI: 10.1161/circep.120.008509] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Supplemental Digital Content is available in the text. Arrhythmogenic right ventricular cardiomyopathy (ARVC) is associated with ventricular arrhythmias (VA) and sudden cardiac death (SCD). A model was recently developed to predict incident sustained VA in patients with ARVC. However, since this outcome may overestimate the risk for SCD, we aimed to specifically predict life-threatening VA (LTVA) as a closer surrogate for SCD.
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Affiliation(s)
- Julia Cadrin-Tourigny
- Department of Medicine, Division of Cardiology (J.C.-T., W.W., A.B., C.T., B.M., S.C., J.E.C., D.P.J., H.T., H.C., C.A.J.), Johns Hopkins Hospital, Baltimore, MD.,Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, Canada (J.C.-T., R.T., A.A., M.T., L.R., P.K.)
| | - Laurens P Bosman
- Netherlands Heart Institute (L.P.B., F.W.A., J.P.v.T., R.N.W.H., A.S.J.M.t.R.).,Department of Cardiology (L.P.B., M.B., F.W.A., J.F.V.d.H., A.S.J.M.t.R.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Weijia Wang
- Department of Medicine, Division of Cardiology (J.C.-T., W.W., A.B., C.T., B.M., S.C., J.E.C., D.P.J., H.T., H.C., C.A.J.), Johns Hopkins Hospital, Baltimore, MD
| | - Rafik Tadros
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, Canada (J.C.-T., R.T., A.A., M.T., L.R., P.K.)
| | - Aditya Bhonsale
- Department of Medicine, Division of Cardiology (J.C.-T., W.W., A.B., C.T., B.M., S.C., J.E.C., D.P.J., H.T., H.C., C.A.J.), Johns Hopkins Hospital, Baltimore, MD
| | - Mimount Bourfiss
- Department of Cardiology (L.P.B., M.B., F.W.A., J.F.V.d.H., A.S.J.M.t.R.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Øyvind H Lie
- Department of Cardiology and Research group for Cardiogenetics and Sudden Cardiac Death, Oslo University Hospital, Rikshospitalet, Norway (Ø.H.L., K.H.H.)
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center Zurich, Switzerland (A.M.S., F.D.)
| | - Anneli Svensson
- Department of Cardiology and Department of Medical & Health Sciences, Linköping University, Swede (A.S.)
| | - Antoine Andorin
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, Canada (J.C.-T., R.T., A.A., M.T., L.R., P.K.)
| | - Crystal Tichnell
- Department of Medicine, Division of Cardiology (J.C.-T., W.W., A.B., C.T., B.M., S.C., J.E.C., D.P.J., H.T., H.C., C.A.J.), Johns Hopkins Hospital, Baltimore, MD
| | - Brittney Murray
- Department of Medicine, Division of Cardiology (J.C.-T., W.W., A.B., C.T., B.M., S.C., J.E.C., D.P.J., H.T., H.C., C.A.J.), Johns Hopkins Hospital, Baltimore, MD
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center (K.Z.)
| | - Maarten P van den Berg
- Department of Cardiology (M.P.v.d.B.), University Medical Center Groningen, University of Groningen, the Netherlands
| | - Folkert W Asselbergs
- Netherlands Heart Institute (L.P.B., F.W.A., J.P.v.T., R.N.W.H., A.S.J.M.t.R.).,Department of Cardiology (L.P.B., M.B., F.W.A., J.F.V.d.H., A.S.J.M.t.R.), University Medical Center Utrecht, Utrecht University, the Netherlands.,Institute of Cardiovascular Science & Institute of Health Informatics, Faculty of Population Health Sciences, University College London, United Kingdom (F.W.A.)
| | - Arthur A M Wilde
- Amsterdam UMC, University of Amsterdam, Heart Center (A.A.M.W.).,Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, the Netherlands (A.A.M.W.)
| | - Andrew D Krahn
- Division of Cardiology, University of British Columbia, Vancouver, Canada (A.D.K.)
| | - Mario Talajic
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, Canada (J.C.-T., R.T., A.A., M.T., L.R., P.K.)
| | - Lena Rivard
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, Canada (J.C.-T., R.T., A.A., M.T., L.R., P.K.)
| | - Stephen Chelko
- Department of Medicine, Division of Cardiology (J.C.-T., W.W., A.B., C.T., B.M., S.C., J.E.C., D.P.J., H.T., H.C., C.A.J.), Johns Hopkins Hospital, Baltimore, MD.,Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee (S.C.)
| | - Stefan L Zimmerman
- The Russell H. Morgan Department of Radiology and Radiological Science (S.L.Z., I.R.K.), Johns Hopkins Hospital, Baltimore, MD
| | - Ihab R Kamel
- The Russell H. Morgan Department of Radiology and Radiological Science (S.L.Z., I.R.K.), Johns Hopkins Hospital, Baltimore, MD
| | - Jane E Crosson
- Department of Medicine, Division of Cardiology (J.C.-T., W.W., A.B., C.T., B.M., S.C., J.E.C., D.P.J., H.T., H.C., C.A.J.), Johns Hopkins Hospital, Baltimore, MD
| | - Daniel P Judge
- Department of Medicine, Division of Cardiology (J.C.-T., W.W., A.B., C.T., B.M., S.C., J.E.C., D.P.J., H.T., H.C., C.A.J.), Johns Hopkins Hospital, Baltimore, MD
| | - Sing-Chien Yap
- Department of Cardiology, Erasmus Medical Center, Rotterdam (S.-C.Y.)
| | - Jeroen F Van der Heijden
- Department of Cardiology (L.P.B., M.B., F.W.A., J.F.V.d.H., A.S.J.M.t.R.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Harikrishna Tandri
- Department of Medicine, Division of Cardiology (J.C.-T., W.W., A.B., C.T., B.M., S.C., J.E.C., D.P.J., H.T., H.C., C.A.J.), Johns Hopkins Hospital, Baltimore, MD
| | - Jan D H Jongbloed
- Department of Genetics (J.D.H.J.), University Medical Center Groningen, University of Groningen, the Netherlands
| | - J Peter van Tintelen
- Netherlands Heart Institute (L.P.B., F.W.A., J.P.v.T., R.N.W.H., A.S.J.M.t.R.).,Department of Genetics (J.P.v.T.), University Medical Center Utrecht, Utrecht University, the Netherlands.,Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, the Netherlands (J.P.v.T.)
| | - Pyotr G Platonov
- Department of Medicine, Division of Cardiology (J.C.-T., W.W., A.B., C.T., B.M., S.C., J.E.C., D.P.J., H.T., H.C., C.A.J.), Johns Hopkins Hospital, Baltimore, MD
| | - Firat Duru
- Department of Medicine, Division of Cardiology (J.C.-T., W.W., A.B., C.T., B.M., S.C., J.E.C., D.P.J., H.T., H.C., C.A.J.), Johns Hopkins Hospital, Baltimore, MD
| | - Kristina H Haugaa
- Department of Medicine, Division of Cardiology (J.C.-T., W.W., A.B., C.T., B.M., S.C., J.E.C., D.P.J., H.T., H.C., C.A.J.), Johns Hopkins Hospital, Baltimore, MD
| | - Paul Khairy
- Department of Medicine, Division of Cardiology (J.C.-T., W.W., A.B., C.T., B.M., S.C., J.E.C., D.P.J., H.T., H.C., C.A.J.), Johns Hopkins Hospital, Baltimore, MD
| | - Richard N W Hauer
- Department of Medicine, Division of Cardiology (J.C.-T., W.W., A.B., C.T., B.M., S.C., J.E.C., D.P.J., H.T., H.C., C.A.J.), Johns Hopkins Hospital, Baltimore, MD
| | - Hugh Calkins
- Department of Medicine, Division of Cardiology (J.C.-T., W.W., A.B., C.T., B.M., S.C., J.E.C., D.P.J., H.T., H.C., C.A.J.), Johns Hopkins Hospital, Baltimore, MD
| | - Anneline S J M Te Riele
- Department of Medicine, Division of Cardiology (J.C.-T., W.W., A.B., C.T., B.M., S.C., J.E.C., D.P.J., H.T., H.C., C.A.J.), Johns Hopkins Hospital, Baltimore, MD
| | - Cynthia A James
- Department of Medicine, Division of Cardiology (J.C.-T., W.W., A.B., C.T., B.M., S.C., J.E.C., D.P.J., H.T., H.C., C.A.J.), Johns Hopkins Hospital, Baltimore, MD
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Towbin JA, McKenna WJ, Abrams DJ, Ackerman MJ, Calkins H, Darrieux FCC, Daubert JP, de Chillou C, DePasquale EC, Desai MY, Estes NAM, Hua W, Indik JH, Ingles J, James CA, John RM, Judge DP, Keegan R, Krahn AD, Link MS, Marcus FI, McLeod CJ, Mestroni L, Priori SG, Saffitz JE, Sanatani S, Shimizu W, van Tintelen JP, Wilde AAM, Zareba W. 2019 HRS expert consensus statement on evaluation, risk stratification, and management of arrhythmogenic cardiomyopathy: Executive summary. Heart Rhythm 2020; 16:e373-e407. [PMID: 31676023 DOI: 10.1016/j.hrthm.2019.09.019] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Indexed: 01/14/2023]
Abstract
Arrhythmogenic cardiomyopathy (ACM) is an arrhythmogenic disorder of the myocardium not secondary to ischemic, hypertensive, or valvular heart disease. ACM incorporates a broad spectrum of genetic, systemic, infectious, and inflammatory disorders. This designation includes, but is not limited to, arrhythmogenic right/left ventricular cardiomyopathy, cardiac amyloidosis, sarcoidosis, Chagas disease, and left ventricular noncompaction. The ACM phenotype overlaps with other cardiomyopathies, particularly dilated cardiomyopathy with arrhythmia presentation that may be associated with ventricular dilatation and/or impaired systolic function. This expert consensus statement provides the clinician with guidance on evaluation and management of ACM and includes clinically relevant information on genetics and disease mechanisms. PICO questions were utilized to evaluate contemporary evidence and provide clinical guidance related to exercise in arrhythmogenic right ventricular cardiomyopathy. Recommendations were developed and approved by an expert writing group, after a systematic literature search with evidence tables, and discussion of their own clinical experience, to present the current knowledge in the field. Each recommendation is presented using the Class of Recommendation and Level of Evidence system formulated by the American College of Cardiology and the American Heart Association and is accompanied by references and explanatory text to provide essential context. The ongoing recognition of the genetic basis of ACM provides the opportunity to examine the diverse triggers and potential common pathway for the development of disease and arrhythmia.
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Affiliation(s)
- Jeffrey A Towbin
- Le Bonheur Children's Hospital, Memphis, Tennessee; University of Tennessee Health Science Center, Memphis, Tennessee
| | - William J McKenna
- University College London, Institute of Cardiovascular Science, London, United Kingdom
| | | | | | | | | | | | | | | | | | - N A Mark Estes
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Wei Hua
- Fu Wai Hospital, Beijing, China
| | - Julia H Indik
- University of Arizona, Sarver Heart Center, Tucson, Arizona
| | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, Australia
| | | | - Roy M John
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Daniel P Judge
- Medical University of South Carolina, Charleston, South Carolina
| | - Roberto Keegan
- Hospital Privado Del Sur, Buenos Aires, Argentina; Hospital Español, Bahia Blanca, Argentina
| | | | - Mark S Link
- UT Southwestern Medical Center, Dallas, Texas
| | - Frank I Marcus
- University of Arizona, Sarver Heart Center, Tucson, Arizona
| | | | - Luisa Mestroni
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Silvia G Priori
- University of Pavia, Pavia, Italy; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart); ICS Maugeri, IRCCS, Pavia, Italy
| | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - J Peter van Tintelen
- University of Amsterdam, Academic Medical Center, Amsterdam, the Netherlands; Utrecht University Medical Center Utrecht, University of Utrecht, Department of Genetics, Utrecht, the Netherlands
| | - Arthur A M Wilde
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart); University of Amsterdam, Academic Medical Center, Amsterdam, the Netherlands; Department of Medicine, Columbia University Irving Medical Center, New York, New York
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Sáenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Europace 2020; 21:1143-1144. [PMID: 31075787 DOI: 10.1093/europace/euz132] [Citation(s) in RCA: 222] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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40
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Leopoulou M, Mattsson G, LeQuang JA, Pergolizzi JV, Varrassi G, Wallhagen M, Magnusson P. Naxos disease - a narrative review. Expert Rev Cardiovasc Ther 2020; 18:801-808. [PMID: 32966140 DOI: 10.1080/14779072.2020.1828064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Naxos disease is a rare entity that manifests with woolly hair, keratosis of extremities, and cardiac manifestations that resemble arrhythmogenic right ventricular cardiomyopathy. It is inherited in an autosomal recessive pattern and mutations affecting plakoglobin and desmoplakin have been identified. There is an increased risk of arrhythmias, including sudden cardiac death at a young age. Right ventricular systolic dysfunction often progresses and left ventricular involvement may also occur. AREAS COVERED This article reviews historic background, epidemiology, clinical characteristics, genetics, and pathogenesis as well as therapeutic management and future perspectives. EXPERT OPINION The principles of evaluation and treatment are based on arrhythmogenic right ventricular cardiomyopathy (ARVC) and general heart failure guidelines, because specific data on Naxos disease are limited. Therefore, larger registries on Naxos disease are welcome in order to gain more knowledge about clinical course and risk stratification. Translational research on pathophysiological mechanisms has evolved, including promising approaches using stem cells for novel targets.
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Affiliation(s)
| | - Gustav Mattsson
- Centre for Research and Development, Uppsala University/Region Gävleborg , Gävle, Sweden
| | | | - Joseph V Pergolizzi
- NEMA Research, Inc , Naples, Florida, USA.,Native Cardio, Inc , Naples, Florida, USA
| | - Giustino Varrassi
- Paolo Procacci Foundation , Rome, Italy.,President, World Institute of Pain , California, USA
| | - Marita Wallhagen
- Faculty of Engineering and Sustainable Development, University of Gävle , Gävle, Sweden
| | - Peter Magnusson
- Centre for Research and Development, Uppsala University/Region Gävleborg , Gävle, Sweden.,Cardiology Research Unit, Department of Medicine, Karolinska Institutet , Stockholm, Sweden
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41
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Bella PD, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. J Interv Card Electrophysiol 2020; 59:145-298. [PMID: 31984466 PMCID: PMC7223859 DOI: 10.1007/s10840-019-00663-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, IN, USA
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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42
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Aquaro GD, De Luca A, Cappelletto C, Raimondi F, Bianco F, Botto N, Barison A, Romani S, Lesizza P, Fabris E, Todiere G, Grigoratos C, Pingitore A, Stolfo D, Dal Ferro M, Merlo M, Di Bella G, Sinagra G. Comparison of different prediction models for the indication of implanted cardioverter defibrillator in patients with arrhythmogenic right ventricular cardiomyopathy. ESC Heart Fail 2020; 7:4080-4088. [PMID: 32965795 PMCID: PMC7755004 DOI: 10.1002/ehf2.13019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/25/2020] [Accepted: 09/02/2020] [Indexed: 01/07/2023] Open
Abstract
Aims Arrhythmogenic right ventricular cardiomyopathy (ARVC) is associated with a high risk of sudden cardiac death. Three different prediction models for the indication of implanted cardioverter defibrillator (ICD) are now available: the 5 year ARVC risk score, the International Task Force Consensus (ITFC) criteria, and the Heart Rhythm Society (HRS) criteria. We compared these three prediction models in a validation cohort of patients with definite ARVC. Methods and results In a cohort of 140 patients with definite ARVC, the 5 year ARVC risk score and the ITFC and HRS criteria were compared for the prediction of a major combined endpoint of sudden cardiac death, appropriate ICD intervention, resuscitated cardiac arrest, and sustained ventricular tachycardia. During the follow‐up, 65 major events occurred. The 5 year ARVC risk score with a threshold >10%, derived from the maximally selected rank statistic, predicted 62 (95%) events [odds ratio (OR) 9.1, 95% confidence interval (CI) 2.6–32, P = 0.0006], the ITFC criteria 53 (81%, OR 4.8, 95% CI 2.2–10.3, P = 0.0001), and the HRS criteria 29 (45%, OR 4.2, 95% CI 1.9–9.3, P = 0.0003). At the analysis of decision curve for ICD implantation, a 5 year ARVC risk score >10% showed a greater net benefit than the ITFC and HRS criteria over a wide range of threshold probability of events. Finally, at multivariate analysis, the 5 year ARVC risk score >10% was the only independent predictor of major events. Conclusions The 5 year score with a threshold of >10% was more effective for predicting events than the ITFC and HRS criteria.
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Affiliation(s)
| | - Antonio De Luca
- Cardio-thoraco-vascular Department, University of Trieste, Trieste, Italy
| | - Chiara Cappelletto
- Cardio-thoraco-vascular Department, University of Trieste, Trieste, Italy
| | | | - Francesco Bianco
- Institute of Cardiology, 'G. d'Annunzio' University, Chieti, Italy
| | - Nicoletta Botto
- Fondazione Toscana G. Monasterio, Via Giuseppe Moruzzi, 1, Pisa, 56124, Italy
| | - Andrea Barison
- Fondazione Toscana G. Monasterio, Via Giuseppe Moruzzi, 1, Pisa, 56124, Italy
| | - Simona Romani
- Cardio-thoraco-vascular Department, University of Trieste, Trieste, Italy
| | - Pierluigi Lesizza
- Cardio-thoraco-vascular Department, University of Trieste, Trieste, Italy
| | - Enrico Fabris
- Cardio-thoraco-vascular Department, University of Trieste, Trieste, Italy
| | - Giancarlo Todiere
- Fondazione Toscana G. Monasterio, Via Giuseppe Moruzzi, 1, Pisa, 56124, Italy
| | | | | | - Davide Stolfo
- Cardio-thoraco-vascular Department, University of Trieste, Trieste, Italy
| | - Matteo Dal Ferro
- Cardio-thoraco-vascular Department, University of Trieste, Trieste, Italy
| | - Marco Merlo
- Cardio-thoraco-vascular Department, University of Trieste, Trieste, Italy
| | | | - Gianfranco Sinagra
- Cardio-thoraco-vascular Department, University of Trieste, Trieste, Italy
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43
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Romero J, Patel K, Briceno D, Alviz I, Gabr M, Diaz JC, Trivedi C, Mohanty S, Della Rocca D, Al-Ahmad A, Yang R, Rios S, Cerna L, Du X, Tarantino N, Zhang XD, Lakkireddy D, Natale A, Di Biase L. Endo-epicardial ablation vs endocardial ablation for the management of ventricular tachycardia in arrhythmogenic right ventricular cardiomyopathy: A systematic review and meta-analysis. J Cardiovasc Electrophysiol 2020; 31:2022-2031. [PMID: 32478430 DOI: 10.1111/jce.14593] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/28/2020] [Accepted: 05/25/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND The pathologic process of ARVC (arrhythmogenic right ventricular cardiomyopathy) typically originates in the epicardium or subepicardial layers with progression toward endocardium. However, in the most recent ARVC international task force consensus statement, epicardial ventricular tachycardia (VT) ablation is recommended as a Class I indication only in patients with at least one failed endocardial VT ablation attempt. OBJECTIVE The aim of this meta-analysis is to assess the outcomes of ARVC patients undergoing combined endo-epicardial VT ablation, as compared to endocardial ablation alone. METHODS A systematic review of PubMed, Embase, and Cochrane was performed for studies reporting clinical outcomes of endo-epicardial VT ablation vs endocardial-only VT ablation in patients with ARVC. Fixed-Effect model was used if I2 < 25 and the Random-Effects Model was used if I2 ≥ 25%. RESULTS Nine studies consisting of 452 patients were included (mean age 42.3 ± 5.7 years; 70% male). After a mean follow-up of 48.1 ± 21.5 months, endo-epicardial ablation was associated with 42% relative risk reduction in VA recurrence as opposed to endocardial ablation alone (risk ratio [RR], 0.58; 95% confidence interval [CI], 0.45-0.75; P < .0001). No significant differences were noted between endo-epicardial and endocardial VT ablation groups in terms of all-cause mortality (RR, 1.19; 95% CI, 0.03-47.08; P = .93) and acute procedural complications (RR, 5.39; 95% CI, 0.60-48.74; P = .13). CONCLUSIONS Our findings suggest that in patients with ARVC, endo-epicardial VT ablation is associated with a significant reduction in VA recurrence as opposed to endocardial ablation alone, without a significant difference in all-cause mortality or acute procedural complications.
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Affiliation(s)
- Jorge Romero
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Kavisha Patel
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - David Briceno
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Isabella Alviz
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Mohamed Gabr
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Juan Carlos Diaz
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | | | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Ruike Yang
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.,Division of Cardiology, Department of Medicine, Henan Provincial People's Hospital, Zhengzhou, China
| | - Saul Rios
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Luis Cerna
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Xianfeng Du
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Nicola Tarantino
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Xiao-Dong Zhang
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Luigi Di Biase
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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44
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AlTurki A, Alotaibi B, Joza J, Proietti R. Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia: Mechanisms and Management . RESEARCH REPORTS IN CLINICAL CARDIOLOGY 2020. [DOI: 10.2147/rrcc.s198185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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45
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Gerçek C, Kourtiche D, Nadi M, Magne I, Schmitt P, Roth P, Souques M. Phantom Model Testing of Active Implantable Cardiac Devices at 50/60 Hz Electric Field. Bioelectromagnetics 2020; 41:136-147. [PMID: 31903644 DOI: 10.1002/bem.22245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 12/18/2019] [Indexed: 11/11/2022]
Abstract
Exposure to external extremely low-frequency (ELF) electric and magnetic fields induces the development of electric fields inside the human body, with their nature depending on multiple factors including the human body characteristics and frequency, amplitude, and wave shape of the field. The objective of this study was to determine whether active implanted cardiac devices may be perturbed by a 50 or 60 Hz electric field and at which level. A numerical method was used to design the experimental setup. Several configurations including disadvantageous scenarios, 11 implantable cardioverter-defibrillators, and 43 cardiac pacemakers were tested in vitro by an experimental bench test up to 100 kV/m at 50 Hz and 83 kV/m at 60 Hz. No failure was observed for ICNIRP public exposure levels for most configurations (in more than 99% of the clinical cases), except for six pacemakers tested in unipolar mode with maximum sensitivity and atrial sensing. The implants configured with a nominal sensitivity in the bipolar mode were found to be resistant to electric fields exceeding the low action levels, even for the highest action levels, as defined by the Directive 2013/35/EU. Bioelectromagnetics. 2020;41:136-147. © 2020 Bioelectromagnetics Society.
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Affiliation(s)
- Cihan Gerçek
- Institut Jean Lamour (UMR 7198), Universite de Lorraine-CNRS, Nancy, France.,Department of Design, Production and Management, University of Twente, Enschede, the Netherlands
| | - Djilali Kourtiche
- Institut Jean Lamour (UMR 7198), Universite de Lorraine-CNRS, Nancy, France
| | - Mustapha Nadi
- Institut Jean Lamour (UMR 7198), Universite de Lorraine-CNRS, Nancy, France
| | | | - Pierre Schmitt
- Institut Jean Lamour (UMR 7198), Universite de Lorraine-CNRS, Nancy, France
| | - Patrice Roth
- Institut Jean Lamour (UMR 7198), Universite de Lorraine-CNRS, Nancy, France
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46
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Laredo M, Oliveira Da Silva L, Extramiana F, Lellouche N, Varlet É, Amet D, Algalarrondo V, Waintraub X, Duthoit G, Badenco N, Maupain C, Hidden-Lucet F, Maury P, Gandjbakhch E. Catheter ablation of electrical storm in patients with arrhythmogenic right ventricular cardiomyopathy. Heart Rhythm 2020; 17:41-48. [DOI: 10.1016/j.hrthm.2019.06.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Indexed: 10/26/2022]
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47
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Orgeron GM, Bhonsale A, Migliore F, James CA, Tichnell C, Murray B, Bertaglia E, Cadrin-Tourigny J, De Franceschi P, Crosson J, Tandri H, Corrado D, Calkins H. Subcutaneous Implantable Cardioverter-Defibrillator in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia: A Transatlantic Experience. J Am Heart Assoc 2019; 7:e008782. [PMID: 30608223 PMCID: PMC6404172 DOI: 10.1161/jaha.118.008782] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Despite growing use of the subcutaneous implantable cardioverter-defibrillator (S- ICD ), its clinical role in arrhythmogenic right ventricular cardiomyopathy/dysplasia ( ARVC /D) patients remains undefined. We aim to elucidate the cardiac phenotype, implant characteristics, and long-term efficacy regarding appropriate therapy and complications in ARVC /D patients with an S- ICD implant. Methods and Results A transatlantic cohort of ARVC /D patients who underwent S- ICD implantation was analyzed for clinical characteristics, S- ICD therapy, and long-term outcome including device-related complications. The cohort included 29 patients (52% male, 76% probands, 59% with ARVC /D-associated mutation, 59% primary prevention [no prior sustained ventricular arrhythmias], and 45% first-generation S- ICD devices). At implant, all inducible patients (27/29) had conversion of induced ventricular fibrillation. Two patients (7%) had superficial infections of the incision site that were treated conservatively. Over a median follow-up of 3.16 years (interquartile range: 2.21-4.51 years), all episodes (6 patients, 4% per year) of sustained ventricular arrhythmias were appropriately detected and treated. Six patients (21%) experienced 39 inappropriate shocks, with 3 requiring device explantation. Oversensing of noncardiac signal (n=4; especially myopotentials) and cardiac signal (n=4) was the most frequent etiology. No lead or device dislodgement, infection, skin erosion, or explantation related to need for antitachycardia pacing was noted. Conclusions S- ICD can effectively treat both induced and spontaneous ventricular arrhythmias in patients with ARVC /D. The rate of inappropriate shocks, although considerable, is comparable to that in ARVC /D patients treated with transvenous ICD s. When they occurred, inappropriate shocks were primarily due to cardiac and, uniquely, noncardiac oversensing. We suggest potential strategies for minimizing inappropriate therapy.
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Affiliation(s)
- Gabriela M Orgeron
- 1 Division of Cardiology Department of Medicine Johns Hopkins Hospital Baltimore MD
| | - Aditya Bhonsale
- 1 Division of Cardiology Department of Medicine Johns Hopkins Hospital Baltimore MD
| | - Federico Migliore
- 2 Division of Cardiology Department of Cardiac Thoracic and Vascular Sciences University of Padova Italy
| | - Cynthia A James
- 1 Division of Cardiology Department of Medicine Johns Hopkins Hospital Baltimore MD
| | - Crystal Tichnell
- 1 Division of Cardiology Department of Medicine Johns Hopkins Hospital Baltimore MD
| | - Brittney Murray
- 1 Division of Cardiology Department of Medicine Johns Hopkins Hospital Baltimore MD
| | - Emanuele Bertaglia
- 2 Division of Cardiology Department of Cardiac Thoracic and Vascular Sciences University of Padova Italy
| | | | - Pietro De Franceschi
- 2 Division of Cardiology Department of Cardiac Thoracic and Vascular Sciences University of Padova Italy
| | - Jane Crosson
- 1 Division of Cardiology Department of Medicine Johns Hopkins Hospital Baltimore MD
| | - Harikrishna Tandri
- 1 Division of Cardiology Department of Medicine Johns Hopkins Hospital Baltimore MD
| | - Domenico Corrado
- 2 Division of Cardiology Department of Cardiac Thoracic and Vascular Sciences University of Padova Italy
| | - Hugh Calkins
- 1 Division of Cardiology Department of Medicine Johns Hopkins Hospital Baltimore MD
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48
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Left Ventricular Involvement in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy Predicts Adverse Clinical Outcomes: A Cardiovascular Magnetic Resonance Feature Tracking Study. Sci Rep 2019; 9:14235. [PMID: 31578430 PMCID: PMC6775112 DOI: 10.1038/s41598-019-50535-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 09/12/2019] [Indexed: 02/05/2023] Open
Abstract
The aim of this study was to investigate left ventricular (LV) global myocardial strain and LV involvement characteristics in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) and to evaluate their predictive value of adverse cardiac events. Sixty consecutive ARVD/C patients with a definite diagnosis of ARVD/C who underwent CMR examination and thirty-four healthy controls were enrolled retrospectively. The CMR images were analyzed for LV myocardial strain and the presence of LV involvement. The endpoint was defined as a composite of sustained ventricular tachycardia or fibrillation, cardiac death, resuscitated cardiac arrest, heart transplantation, and appropriate implantable cardioverter-defibrillator shock. LV global longitudinal (GLS), circumferential (GCS), and radial strain (GRS) were significantly impaired in ARVC/D patients compared to healthy controls (GLS: −13.89 ± 3.26% vs. −16.68 ± 2.74%, GCS: −15.65 ± 3.40% vs. −19.20 ± 2.23%, GRS: 34.57 ± 11.98% vs. 49.92 ± 12.59%; P < 0.001 for all). Even in ARVC/D patients with preserved LVEF, LV GLS, GCS and GRS were also significantly reduced than in controls. During a mean follow-up period of 4.10 ± 1.77 years, the endpoint was reached in 17 patients. LV GLS >−12.65% (HR, 3.58; 95%CI, 1.14 to 11.25; p = 0.029) and history of syncope (HR, 4.99; 95%CI, 1.88 to 13.24; p = 0.001) were the only independent predictors of cardiac outcomes. The LV myocardial deformation derived from FT CMR was significantly impaired in ARVD/C patients, and this alteration can occur before the impairment of LVEF. LV GLS >−12.65% and history of syncope were the only independent prognostic markers of adverse cardiac outcomes.
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49
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Cadrin-Tourigny J, Bosman LP, Tadros R, Talajic M, Rivard L, James CA, Khairy P. Risk stratification for ventricular arrhythmias and sudden cardiac death in arrhythmogenic right ventricular cardiomyopathy: an update. Expert Rev Cardiovasc Ther 2019; 17:645-651. [PMID: 31422711 DOI: 10.1080/14779072.2019.1657831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetically determined disease associated with a significant risk of ventricular arrhythmias and sudden cardiac death (SCD). Implantable cardioverter-defibrillators (ICDs) are the only effective preventive measure. Over the past 30 years, much effort has been invested in determining predictors of adverse arrhythmic events in these patients. Areas covered: This review summarizes available evidence on risk stratification for ARVC, with an emphasis on recent research findings. While efforts are ongoing to define risk predictors, several recent publications have synthetized and built on this knowledge base. A recently published meta-analysis has clarified the strongest predictors of ventricular arrhythmias in ARVC, which vary depending on the population included. Three management guidelines/expert consensus documents have integrated the previously described risk predictors into proposed ICD recommendations. Furthermore, a risk prediction model has allowed the integration of multiple risk factors to provide individualized risk prediction and to inform shared-decision making regarding ICD implantation. Expert opinion: Over the past few years, knowledge of risk prediction in ARVC has been consolidated and refined. Further improvements may be made by the considering additional predictors such as exercise and by targeting more specific surrogate outcomes for SCD.
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Affiliation(s)
| | - Laurens P Bosman
- Department of Cardiology, University Medical Center Utrecht , Utrecht , The Netherlands
| | - Rafik Tadros
- Department of Medicine, Montreal Heart Institute , Montreal , Quebec , Canada
| | - Mario Talajic
- Department of Medicine, Montreal Heart Institute , Montreal , Quebec , Canada
| | - Lena Rivard
- Department of Medicine, Montreal Heart Institute , Montreal , Quebec , Canada
| | - Cynthia A James
- Division of Cardiology, Johns Hopkins University , Baltimore , MD , USA
| | - Paul Khairy
- Department of Medicine, Montreal Heart Institute , Montreal , Quebec , Canada
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50
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Morimoto Y, Nishii N, Tsukuda S, Kawada S, Miyamoto M, Miyoshi A, Nakagawa K, Watanabe A, Nakamura K, Morita H, Ito H. A Low Critical Event Rate Despite a High Abnormal Event Rate in Patients with Cardiac Implantable Electric Devices Followed Up by Remote Monitoring. Intern Med 2019; 58:2333-2340. [PMID: 31118368 PMCID: PMC6746648 DOI: 10.2169/internalmedicine.1905-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objective Remote monitoring (RM) of cardiac implantable electric devices (CIEDs) has been advocated as a healthcare standard. However, expert consensus statements suggest that all patients require annual face-to-face follow-up consultations at outpatient clinics even if RM reveals no episodes. The objective of this study was to determine the critical event rate after CIED implantation through RM. Methods This multicenter, retrospective, cohort study evaluated patients with pacemakers (PMs), implantable cardioverter defibrillators (ICDs), or cardiac resynchronization therapy defibrillator (CRT-Ds) and analyzed whether or not the data drawn from RM included abnormal or critical events. Patients A total of 1,849 CIED patients in 12 hospitals who were followed up by the RM center in Okayama University Hospital were included in this study. Results During the mean follow-up period of 774.9 days, 16,560 transmissions were analyzed, of which 11,040 (66.7%) were abnormal events and only 676 (4.1%) were critical events. The critical event rate in the PM group was significantly lower than that in the ICD or CRT-D groups (0.9% vs. 5.0% or 5.9%, p<0.001). A multivariate analysis revealed that ICD, CRT-D, and a low ejection fraction were independently associated with critical events. In patients with ICD, the independent risk factors for a critical event were old age, low ejection fraction, Brugada syndrome, dilated phase hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy. Conclusion Although abnormal events were observed in two-thirds of the transmitted RM data, the critical event rate was <1% in patients with a PM, which was lower in comparison to the rates in patients with ICDs or CRT-Ds. A low ejection fraction was an independent predictor of critical events.
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Affiliation(s)
- Yoshimasa Morimoto
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Nobuhiro Nishii
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Saori Tsukuda
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Satoshi Kawada
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Masakazu Miyamoto
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Akihito Miyoshi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Koji Nakagawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Atsuyuki Watanabe
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Hiroshi Morita
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
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