1
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Verheul LM, Hoeksema WF, Groeneveld SA, Mulder BA, Bootsma M, Alings M, Evertz R, Blank AC, Kammeraad JAE, Clur SAB, Yap SC, Postema PG, Wilde AAM, Volders PGA, Hassink RJ. Comparing adolescent- and adult-onset unexplained cardiac arrest: Results from the Dutch Idiopathic VF Registry. Heart Rhythm 2024:S1547-5271(24)00276-5. [PMID: 38493994 DOI: 10.1016/j.hrthm.2024.03.031] [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] [Received: 12/12/2023] [Revised: 02/22/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Current cohorts of patients with idiopathic ventricular fibrillation (IVF) primarily include adult-onset patients. Underlying causes of sudden cardiac arrest vary with age; therefore, underlying causes and disease course may differ for adolescent-onset vs adult-onset patients. OBJECTIVE The purpose of this study was to compare adolescent-onset with adult-onset patients having an initially unexplained cause of VF. METHODS The study included 39 patients with an index event aged ≤19 years (adolescent-onset) and 417 adult-onset patients from the Dutch Idiopathic VF Registry. Data on event circumstances, clinical characteristics, change in diagnosis, and arrhythmia recurrences were collected and compared between the 2 groups. RESULTS In total, 42 patients received an underlying diagnosis during follow-up (median 7 [2-12] years), with similar yields (15% adolescent-onset vs 9% adult-onset; P = .16). Among the remaining unexplained patients, adolescent-onset patients (n = 33) had their index event at a median age of 17 [16-18] years, and 72% were male. The youngest patient was aged 13 years. In comparison with adults (n = 381), adolescent-onset patients more often had their index event during exercise (P <.01). Adolescent-onset patients experienced more appropriate implantable cardioverter-defibrillator (ICD) therapy during follow-up compared with adults (44% vs 26%; P = .03). Inappropriate ICD therapy (26% vs 17%; P = .19), ICD complications (19% vs 14%; P = .41), and deaths (3% vs 4%; P = 1) did not significantly differ between adolescent-onset and adult-onset patients. CONCLUSION IVF may occur during adolescence. Adolescent-onset patients more often present during exercise compared with adults. Furthermore, they are more vulnerable to ventricular arrhythmias as reflected by a higher incidence of appropriate ICD therapy.
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Affiliation(s)
- Lisa M Verheul
- University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Wiert F Hoeksema
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Heart Failure and Arrhythmias, Amsterdam, The Netherlands, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands
| | | | - Bart A Mulder
- University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Reinder Evertz
- Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Janneke A E Kammeraad
- Erasmus MC-Sophia Children's Hospital, Cardiovascular Institute, Department of Pediatric Cardiology, Rotterdam, The Netherlands
| | - Sally-Ann B Clur
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Heart Failure and Arrhythmias, Amsterdam, The Netherlands, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands; Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart,"
| | - Sing-Chien Yap
- Cardiovascular Institute, Thorax Center, Erasmus MC, Rotterdam, The Netherlands
| | - Pieter G Postema
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Heart Failure and Arrhythmias, Amsterdam, The Netherlands, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands; Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart,"
| | - Arthur A M Wilde
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Heart Failure and Arrhythmias, Amsterdam, The Netherlands, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands; Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart,"
| | - Paul G A Volders
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart,"; Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rutger J Hassink
- University Medical Center Utrecht, Utrecht, The Netherlands; Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart,"
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2
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Pupaza A, Cinteza E, Vasile CM, Nicolescu A, Vatasescu R. Assessment of Sudden Cardiac Death Risk in Pediatric Primary Electrical Disorders: A Comprehensive Overview. Diagnostics (Basel) 2023; 13:3551. [PMID: 38066791 PMCID: PMC10706572 DOI: 10.3390/diagnostics13233551] [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: 11/05/2023] [Revised: 11/22/2023] [Accepted: 11/24/2023] [Indexed: 06/30/2024] Open
Abstract
Sudden cardiac death (SCD) in children is a devastating event, often linked to primary electrical diseases (PED) of the heart. PEDs, often referred to as channelopathies, are a group of genetic disorders that disrupt the normal ion channel function in cardiac cells, leading to arrhythmias and sudden cardiac death. This paper investigates the unique challenges of risk assessment and stratification for channelopathy-related SCD in pediatric patients-Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, idiopathic ventricular fibrillation, long QT syndrome, Anderson-Tawil syndrome, short QT syndrome, and early repolarization syndrome. We explore the intricate interplay of genetic, clinical, and electrophysiological factors that contribute to the complex nature of these conditions. Recognizing the significance of early identification and tailored management, this paper underscores the need for a comprehensive risk stratification approach specifically designed for pediatric populations. By integrating genetic testing, family history, and advanced electrophysiological evaluation, clinicians can enhance their ability to identify children at the highest risk for SCD, ultimately paving the way for more effective preventive strategies and improved outcomes in this vulnerable patient group.
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Affiliation(s)
- Adelina Pupaza
- Department of Cardiology, Clinic Emergency Hospital Bucharest, 050098 Bucharest, Romania;
| | - Eliza Cinteza
- Department of Pediatrics, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Pediatric Cardiology, “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania;
| | - Corina Maria Vasile
- Pediatric and Adult Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, 33600 Bordeaux, France;
| | - Alin Nicolescu
- Department of Pediatric Cardiology, “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania;
| | - Radu Vatasescu
- Department of Cardiology, Clinic Emergency Hospital Bucharest, 050098 Bucharest, Romania;
- Cardio-Thoracic Department, “Carol Davila” University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania
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3
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Ezzeddine FM, Darlington AM, DeSimone CV, Asirvatham SJ. Catheter Ablation of Ventricular Fibrillation. Card Electrophysiol Clin 2022; 14:729-742. [PMID: 36396189 DOI: 10.1016/j.ccep.2022.06.002] [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: 06/16/2023]
Abstract
Ventricular fibrillation (VF) is a common cause of sudden cardiac death (SCD) and is unfortunately without a cure. Current therapies focus on prevention of SCD, such as implantable cardioverter-defibrillator (ICD) implantation and anti-arrhythmic agents. Significant progress has been made in improving our understanding and ability to target the triggers of VF, via advanced mapping and ablation techniques, as well as with autonomic modulation. However, the critical substrate for VF maintenance remains incompletely defined. In this review, we discuss the evidence behind the basic mechanisms of VF and review the current role of catheter ablation in patients with VF.
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Affiliation(s)
- Fatima M Ezzeddine
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN, USA
| | - Ashley M Darlington
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN, USA
| | - Christopher V DeSimone
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN, USA
| | - Samuel J Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN, USA.
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4
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State-of-the-Art Multimodality Imaging in Sudden Cardiac Arrest with Focus on Idiopathic Ventricular Fibrillation: A Review. J Clin Med 2022; 11:jcm11164680. [PMID: 36012918 PMCID: PMC9410297 DOI: 10.3390/jcm11164680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022] Open
Abstract
Idiopathic ventricular fibrillation is a rare cause of sudden cardiac arrest and a diagnosis by exclusion. Unraveling the mechanism of ventricular fibrillation is important for targeted management, and potentially for initiating family screening. Sudden cardiac arrest survivors undergo extensive clinical testing, with a growing role for multimodality imaging, before diagnosing “idiopathic” ventricular fibrillation. Multimodality imaging, considered as using multiple imaging modalities as diagnostics, is important for revealing structural myocardial abnormalities in patients with cardiac arrest. This review focuses on combining imaging modalities (echocardiography, cardiac magnetic resonance and computed tomography) and the electrocardiographic characterization of sudden cardiac arrest survivors and discusses the surplus value of multimodality imaging in the diagnostic routing of these patients. We focus on novel insights obtained through electrostructural and/or electromechanical imaging in apparently idiopathic ventricular fibrillation patients, with special attention to non-invasive electrocardiographic imaging.
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5
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Neves R, Tester DJ, Simpson MA, Behr ER, Ackerman MJ, Giudicessi JR. Exome Sequencing Highlights a Potential Role for Concealed Cardiomyopathies in Youthful Sudden Cardiac Death. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2022; 15:e003497. [PMID: 34949102 DOI: 10.1161/circgen.121.003497] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sudden cardiac arrest (SCA) and sudden unexplained death (SUD) are feared sequelae of many genetic heart diseases. In rare circumstances, pathogenic variants in cardiomyopathy-susceptibility genes may result in electrical instability leading to SCA/SUD before any structural manifestations of underlying cardiomyopathy are evident. METHODS Collectively, 38 unexplained SCA survivors (21 males; mean age at SCA 26.4±13.1 years), 68 autopsy-inconclusive SUD cases (46 males; mean age at death 20.4±9.0 years) without disease-causative variants in the channelopathy genes, and 973 ostensibly healthy controls were included. Following exome sequencing, ultrarare (minor allele frequency ≤0.00005 in any ethnic group within Genome Aggregation Database [gnomAD, N=141 456 individuals]) nonsynonymous variants identified in 24 Clinical Genome Resource adjudicated definitive/strong evidence cardiomyopathy-susceptibility genes were analyzed. Eligible variants were adjudicated as pathogenic, likely pathogenic, or variant of uncertain significance in accordance with current American College of Medical Genetics and Genomics guidelines. RESULTS Overall, 7 out of 38 (18.4%) SCA survivors and 14 out of 68 (20.5%) autopsy-inconclusive, channelopathic-negative SUD cases had at least one pathogenic/likely pathogenic or a variant of uncertain significance nonsynonymous variant within a strong evidence, cardiomyopathy-susceptibility gene. Following American College of Medical Genetics and Genomics criterion variant adjudication, a pathogenic or likely pathogenic variant was identified in 3 out of 38 (7.9%; P=0.05) SCA survivors and 8 out of 68 (11.8%; P=0.0002) autopsy-inconclusive SUD cases compared to 20 out of 973 (2.1%) European controls. Interestingly, the yield of pathogenic/likely pathogenic variants was significantly greater in autopsy-inconclusive SUD cases with documented interstitial fibrosis (4/11, 36%) compared with only 4 out of 57 (7%, P<0.02) SUD cases without ventricular fibrosis. CONCLUSIONS Our data further supports the inclusion of strong evidence cardiomyopathy-susceptibility genes on the genetic testing panels used to evaluate unexplained SCA survivors and autopsy-inconclusive/negative SUD decedents. However, to avoid diagnostic miscues, the careful interpretation of genetic test results in patients without overt phenotypes is vital.
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Affiliation(s)
- Raquel Neves
- Division of Heart Rhythm Services, Departments of Cardiovascular Medicine (R.N., D.J.T., M.J.A.), Mayo Clinic, Rochester, MN.,Division of Pediatric Cardiology, Pediatric and Adolescent Medicine (R.N., D.J.T., M.J.A.), Mayo Clinic, Rochester, MN.,Windland Smith Rice Sudden Death Genomics Laboratory, Molecular Pharmacology & Experimental Therapeutics (R.N., D.J.T., M.J.A.), Mayo Clinic, Rochester, MN
| | - David J Tester
- Division of Heart Rhythm Services, Departments of Cardiovascular Medicine (R.N., D.J.T., M.J.A.), Mayo Clinic, Rochester, MN.,Division of Pediatric Cardiology, Pediatric and Adolescent Medicine (R.N., D.J.T., M.J.A.), Mayo Clinic, Rochester, MN.,Windland Smith Rice Sudden Death Genomics Laboratory, Molecular Pharmacology & Experimental Therapeutics (R.N., D.J.T., M.J.A.), Mayo Clinic, Rochester, MN
| | | | - Elijah R Behr
- St George's University of London and St George's University Hospitals' NHS Foundation Trust, United Kingdom (E.R.B.)
| | - Michael J Ackerman
- Division of Heart Rhythm Services, Departments of Cardiovascular Medicine (R.N., D.J.T., M.J.A.), Mayo Clinic, Rochester, MN.,Division of Pediatric Cardiology, Pediatric and Adolescent Medicine (R.N., D.J.T., M.J.A.), Mayo Clinic, Rochester, MN.,Windland Smith Rice Sudden Death Genomics Laboratory, Molecular Pharmacology & Experimental Therapeutics (R.N., D.J.T., M.J.A.), Mayo Clinic, Rochester, MN
| | - John R Giudicessi
- Divisions of Heart Rhythm Services and Circulatory Failure, Department of Cardiovascular Medicine (J.R.G.), Mayo Clinic, Rochester, MN
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6
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Baban A, Lodato V, Parlapiano G, Drago F. Genetics in Congenital Heart Diseases: Unraveling the Link Between Cardiac Morphogenesis, Heart Muscle Disease, and Electrical Disorders. Heart Fail Clin 2021; 18:139-153. [PMID: 34776075 DOI: 10.1016/j.hfc.2021.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The genetic background of congenital heart diseases (CHDs) is extremely complex, heterogenous, and still majorly to be determined. CHDs can be sporadic or familial. In this article we discuss in detail the phenotypic spectrum of selected genes including MYH7, GATA4, NKX2-5, TBX5, and TBX20. Our goal is to offer the clinician a general overview of the clinical spectrum of the analyzed topics that are traditionally known as causative for CHDs but we underline in this review the possible progressive functional (cardiomyopathy) and electric aspects (arrhythmias) caused by the genetic background.
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Affiliation(s)
- Anwar Baban
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children Hospital and Research Institute, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Valentina Lodato
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children Hospital and Research Institute, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Giovanni Parlapiano
- Laboratory of Medical Genetics, Bambino Gesù Children Hospital and Research Institute, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Fabrizio Drago
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children Hospital and Research Institute, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy
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7
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Conte G, Giudicessi JR, Ackerman MJ. Idiopathic ventricular fibrillation: the ongoing quest for diagnostic refinement. Europace 2021; 23:4-10. [PMID: 33038214 DOI: 10.1093/europace/euaa211] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/03/2020] [Indexed: 11/13/2022] Open
Abstract
Prior to the recognition of distinct clinical entities, such as Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, and long QT syndrome, all sudden cardiac arrest (SCA) survivors with ventricular fibrillation (VF) and apparently structurally normal hearts were labelled as idiopathic ventricular fibrillation (IVF). Over the last three decades, the definition of IVF has changed substantially, mostly as result of the identification of the spectrum of SCA-predisposing genetic heart diseases (GHDs), and the molecular evidence, by post-mortem genetic analysis (aka, the molecular autopsy), of cardiac channelopathies as the pathogenic basis for up to 35% of unexplained cases of sudden cardiac death (SCD) in the young. The evolution of the definition of IVF over time has led to a progressively greater awareness of the need for an extensive diagnostic assessment in unexplained SCA survivors. Nevertheless, GHDs are still underdiagnosed among SCA survivors, due to the underuse of pharmacological challenges (i.e. sodium channel blocker test), misrecognition of electrocardiogram (ECG) abnormalities/patterns (i.e. early repolarization pattern or exercise-induced ventricular bigeminy) or errors in the measurement of ECG parameters (e.g. the heart-rate corrected QT interval). In this review, we discuss the epidemiology, diagnostic approaches, and the controversies related to role of the genetic background in unexplained SCA survivors with a default diagnosis of IVF.
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Affiliation(s)
- Giulio Conte
- Division of Cardiology, Cardiocentro Ticino, via Tesserete 48, 6900, Lugano, Switzerland.,Faculty of Biomedical Sciences, USI, Lugano, Switzerland.,Centre for Computational Medicine in Cardiology, Faculty of Informatics, Università della Svizzera Italiana, Lugano, Switzerland
| | - John R Giudicessi
- Department of Cardiovascular Medicine (Clinician-Investigator Training Program), Mayo Clinic, Rochester, MN, USA.,Division of Heart Rhythm Services, Department of Cardiovascular Medicine, Windland Smith Rice Genetic Heart Rhythm Clinic, Mayo Clinic, Rochester, MN, USA.,Division of Pediatric Cardiology, Department of Pediatric & Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Molecular Pharmacology and Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Michael J Ackerman
- Department of Cardiovascular Medicine (Clinician-Investigator Training Program), Mayo Clinic, Rochester, MN, USA.,Division of Heart Rhythm Services, Department of Cardiovascular Medicine, Windland Smith Rice Genetic Heart Rhythm Clinic, Mayo Clinic, Rochester, MN, USA.,Division of Pediatric Cardiology, Department of Pediatric & Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Molecular Pharmacology and Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN, USA
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9
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Abstract
In this section of the European Resuscitation Council Guidelines 2021, key information on the epidemiology and outcome of in and out of hospital cardiac arrest are presented. Key contributions from the European Registry of Cardiac Arrest (EuReCa) collaboration are highlighted. Recommendations are presented to enable health systems to develop registries as a platform for quality improvement and to inform health system planning and responses to cardiac arrest.
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10
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Conte G, Belhassen B, Lambiase P, Ciconte G, de Asmundis C, Arbelo E, Schaer B, Frontera A, Burri H, Calo' L, Letsas KP, Leyva F, Porter B, Saenen J, Zacà V, Berne P, Ammann P, Zardini M, Luani B, Rordorf R, Sarquella Brugada G, Medeiros-Domingo A, Geller JC, de Potter T, Stokke MK, Márquez MF, Michowitz Y, Honarbakhsh S, Conti M, Sticherling C, Martino A, Zegard A, Özkartal T, Caputo ML, Regoli F, Braun-Dullaeus RC, Notarangelo F, Moccetti T, Casu G, Rinaldi CA, Levinstein M, Haugaa KH, Derval N, Klersy C, Curti M, Pappone C, Heidbuchel H, Brugada J, Haïssaguerre M, Brugada P, Auricchio A. Out-of-hospital cardiac arrest due to idiopathic ventricular fibrillation in patients with normal electrocardiograms: results from a multicentre long-term registry. Europace 2020; 21:1670-1677. [PMID: 31504477 PMCID: PMC6826207 DOI: 10.1093/europace/euz221] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 07/18/2019] [Indexed: 11/12/2022] Open
Abstract
AIMS To define the clinical characteristics and long-term clinical outcomes of a large cohort of patients with idiopathic ventricular fibrillation (IVF) and normal 12-lead electrocardiograms (ECGs). METHODS AND RESULTS Patients with ventricular fibrillation as the presenting rhythm, normal baseline, and follow-up ECGs with no signs of cardiac channelopathy including early repolarization or atrioventricular conduction abnormalities, and without structural heart disease were included in a registry. A total of 245 patients (median age: 38 years; males 59%) were recruited from 25 centres. An implantable cardioverter-defibrillator (ICD) was implanted in 226 patients (92%), while 18 patients (8%) were treated with drug therapy only. Over a median follow-up of 63 months (interquartile range: 25-110 months), 12 patients died (5%); in four of them (1.6%) the lethal event was of cardiac origin. Patients treated with antiarrhythmic drugs only had a higher rate of cardiovascular death compared to patients who received an ICD (16% vs. 0.4%, P = 0.001). Fifty-two patients (21%) experienced an arrhythmic recurrence. Age ≤16 years at the time of the first ventricular arrhythmia was the only predictor of arrhythmic recurrence on multivariable analysis [hazard ratio (HR) 0.41, 95% confidence interval (CI) 0.18-0.92; P = 0.03]. CONCLUSION Patients with IVF and persistently normal ECGs frequently have arrhythmic recurrences, but a good prognosis when treated with an ICD. Children are a category of IVF patients at higher risk of arrhythmic recurrences.
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Affiliation(s)
- Giulio Conte
- Electrophysiology Unit, Department of Cardiology, Fondazione Cardiocentro Ticino, via Tesserete 48, Lugano, Switzerland
| | - Bernard Belhassen
- Department of Cardiology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pier Lambiase
- Electrophysiology Department, Barts Heart Centre, Barts Health NHS trust, London, UK
| | - Giuseppe Ciconte
- Cardiology Department, Arrhythmia and Electrophysiology Center IRCCS, Policlinico San Donato, Italy
| | - Carlo de Asmundis
- Cardiovascular Department, Heart Rhythm Management Centre, UZ-VUB, Jette, Brussels
| | - Elena Arbelo
- Cardiology Department, Arrhythmias Unit, Hospital Clinic, Barcelona, Spain
| | - Beat Schaer
- Kardiologie/Elektrophysiologie Universitätsspital, Basel, Switzerland
| | - Antonio Frontera
- LIRYC Institute, INSERM 1045, Bordeaux University Hospital, Bordeaux, France
| | - Haran Burri
- Cardiology Department, University Hospital of Geneva, Switzerland
| | - Leonardo Calo'
- Division of Cardiology, Policlinico Casilino, Roma, Italy
| | - Kostantinos P Letsas
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Francisco Leyva
- Aston Medical Research Institute, Aston University, Birmingham, UK
| | | | | | - Valerio Zacà
- Arrhythmology Unit, Cardiovascular and Thoracic Department, AOU Senese, Siena, Italy
| | - Paola Berne
- Cardiology Department, Ospedale San Francesco, Nuoro, Italy
| | - Peter Ammann
- Kardiologie, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Marco Zardini
- Cardiology Department, Parma University Hospital, Parma, Italy
| | - Blerim Luani
- Division of Cardiology and Angiology, Department of Internal Medicine, Magdeburg University, Magdeburg, Germany
| | - Roberto Rordorf
- Elettrofisiologia ed Elettrostimolazione, Divisione di Cardiologia, IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Georgia Sarquella Brugada
- Arrhythmia and Inherited Cardiac Diseases Unit, Hospital Sant Joan de Déu, University of Barcelona, Spain.,Medical Sciences Department, Medical School, University of Girona, Girona, Spain
| | - Argelia Medeiros-Domingo
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Johann-Christoph Geller
- Cardiology Department, Rhythmologie und invasive Elektrophysiologie, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Tom de Potter
- Electrophysiology Section, Department of Cardiology, OLV Hospital, Aalst, Belgium
| | - Mathis K Stokke
- Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway
| | - Manlio F Márquez
- Electrocardiology Department, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Yoav Michowitz
- Department of Cardiology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shohreh Honarbakhsh
- Electrophysiology Department, Barts Heart Centre, Barts Health NHS trust, London, UK
| | - Manuel Conti
- Cardiology Department, Arrhythmia and Electrophysiology Center IRCCS, Policlinico San Donato, Italy
| | | | | | - Abbasin Zegard
- Aston Medical Research Institute, Aston University, Birmingham, UK
| | - Tardu Özkartal
- Electrophysiology Unit, Department of Cardiology, Fondazione Cardiocentro Ticino, via Tesserete 48, Lugano, Switzerland
| | - Maria Luce Caputo
- Electrophysiology Unit, Department of Cardiology, Fondazione Cardiocentro Ticino, via Tesserete 48, Lugano, Switzerland
| | - François Regoli
- Electrophysiology Unit, Department of Cardiology, Fondazione Cardiocentro Ticino, via Tesserete 48, Lugano, Switzerland
| | - Rüdiger C Braun-Dullaeus
- Division of Cardiology and Angiology, Department of Internal Medicine, Magdeburg University, Magdeburg, Germany
| | | | - Tiziano Moccetti
- Electrophysiology Unit, Department of Cardiology, Fondazione Cardiocentro Ticino, via Tesserete 48, Lugano, Switzerland
| | - Gavino Casu
- Cardiology Department, Ospedale San Francesco, Nuoro, Italy
| | | | - Moises Levinstein
- Cardiology Department, Cardiovascular Center, American British Cowdray Medical Center, Mexico City, Mexico
| | - Kristina H Haugaa
- Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway
| | - Nicolas Derval
- LIRYC Institute, INSERM 1045, Bordeaux University Hospital, Bordeaux, France
| | - Catherine Klersy
- Service of Biometry and Clinical Epidemiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Moreno Curti
- Service of Biometry and Clinical Epidemiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carlo Pappone
- Cardiology Department, Arrhythmia and Electrophysiology Center IRCCS, Policlinico San Donato, Italy
| | | | - Josép Brugada
- Cardiology Department, Arrhythmias Unit, Hospital Clinic, Barcelona, Spain
| | - Michel Haïssaguerre
- LIRYC Institute, INSERM 1045, Bordeaux University Hospital, Bordeaux, France
| | - Pedro Brugada
- Cardiovascular Department, Heart Rhythm Management Centre, UZ-VUB, Jette, Brussels
| | - Angelo Auricchio
- Electrophysiology Unit, Department of Cardiology, Fondazione Cardiocentro Ticino, via Tesserete 48, Lugano, Switzerland
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11
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von Alvensleben JC, Etheridge SP, Viskin S, Collins KK. Short-coupled premature ventricular beats leading to ventricular fibrillation in a young patient: A Sudden Arrhythmia Death Syndrome case report and literature review. HeartRhythm Case Rep 2020; 6:815-818. [PMID: 33204612 PMCID: PMC7653467 DOI: 10.1016/j.hrcr.2020.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
| | - Susan P Etheridge
- Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City, Utah
| | - Sami Viskin
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Kathryn K Collins
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
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Frontera A, Vlachos K, Kitamura T, Mahida S, Pillois X, Fahy G, Marquie C, Cappato R, Stuart G, Defaye P, Kaski JP, Ector J, Maltret A, Scanu P, Pasquie JL, Deisenhofer I, Blankoff I, Scherr D, Manninger M, Aizawa Y, Koutbi L, Denis A, Pambrun T, Ritter P, Sacher F, Hocini M, Maury P, Jaïs P, Bordachar P, Haïssaguerre M, Derval N. Long-Term Follow-Up of Idiopathic Ventricular Fibrillation in a Pediatric Population: Clinical Characteristics, Management, and Complications. J Am Heart Assoc 2020; 8:e011172. [PMID: 31057083 PMCID: PMC6512137 DOI: 10.1161/jaha.118.011172] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background The natural history and long‐term outcome in pediatric patients with idiopathic ventricular fibrillation (IVF) are poorly characterized. We sought to define the clinical characteristics and long‐term outcomes of a pediatric cohort with an initial diagnosis of IVF. Methods and Results Patients were included from an International Registry of IVF (consisting of 496 patients). Inclusion criteria were: (1) VF with no identifiable cause following comprehensive analysis for ischemic, electrical or structural heart disease and (2) age ≤16 years. These included 54 pediatric IVF cases (age 12.7±3.7 years, 59% male) among whom 28 (52%) had a previous history of syncope (median 2 syncopal episodes [interquartile range 1]). Thirty‐six (67%) had VF in situations associated with high adrenergic tone. During a median 109±12 months of follow‐up, 31 patients (57%) had recurrence of ventricular arrhythmias, mainly VF. Two patients developed phenotypic expression of an inherited arrhythmia syndrome during follow‐up (hypertrophic cardiomyopathy and long QT syndrome, respectively). A total of 15 patients had positive genetic testing for inherited arrhythmia syndromes. Ten patients (18%) experienced device‐related complications. Three patients (6%) died, 2 due to VF storm. Conclusions In pediatric patients with IVF, a minority develop a definite clinical phenotype during long‐term follow‐up. Recurrent VF is common in this patient group.
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Affiliation(s)
- Antonio Frontera
- 1 Electrophysiology Department, Hopital Haut Lévêque Bordeaux France.,2 Liryc Institute Bordeaux France
| | | | - Takeshi Kitamura
- 1 Electrophysiology Department, Hopital Haut Lévêque Bordeaux France
| | - Saagar Mahida
- 3 Department of Cardiac Electrophysiology and Inherited Cardiac Diseases Liverpool Heart and Chest Hospital Liverpool United Kingdom
| | - Xavier Pillois
- 1 Electrophysiology Department, Hopital Haut Lévêque Bordeaux France.,2 Liryc Institute Bordeaux France
| | | | | | - Riccardo Cappato
- 6 Humanitas Clinical and Research Center Rozzano, Milan, Italy and Humanitas University, Department of Biomedical Sciences Milan Italy
| | | | | | - Juan Pablo Kaski
- 9 Centre for Inherited Cardiovascular Diseases Great Ormond Street Hospital London United Kingdom.,10 UCL Institute of Cardiovascular Science London United Kingdom
| | - Joris Ector
- 11 University Hospital Gasthuisberg Leuven Belgium
| | - Alice Maltret
- 12 Hôpital Necker Enfants Malades Service de Cardiologie Pédiatrique et Centre de Référence des Maladies Cardiaques Héréditaires Université Paris Descartes Paris France
| | | | | | | | - Ivan Blankoff
- 16 Centre Hospitalier University of Charleroi Belgium
| | - Daniel Scherr
- 17 Division of Cardiology Department of Medicine Medical University of Graz Austria
| | - Martin Manninger
- 17 Division of Cardiology Department of Medicine Medical University of Graz Austria
| | - Yoshifusa Aizawa
- 18 Niigata University Graduate School of Medical and Dental Science Niigata Japan
| | | | - Arnaud Denis
- 1 Electrophysiology Department, Hopital Haut Lévêque Bordeaux France
| | - Thomas Pambrun
- 1 Electrophysiology Department, Hopital Haut Lévêque Bordeaux France
| | - Philippe Ritter
- 1 Electrophysiology Department, Hopital Haut Lévêque Bordeaux France
| | - Frederic Sacher
- 1 Electrophysiology Department, Hopital Haut Lévêque Bordeaux France
| | - Meleze Hocini
- 1 Electrophysiology Department, Hopital Haut Lévêque Bordeaux France.,2 Liryc Institute Bordeaux France
| | | | - Pierre Jaïs
- 1 Electrophysiology Department, Hopital Haut Lévêque Bordeaux France.,2 Liryc Institute Bordeaux France
| | - Pierre Bordachar
- 1 Electrophysiology Department, Hopital Haut Lévêque Bordeaux France.,2 Liryc Institute Bordeaux France
| | - Michel Haïssaguerre
- 1 Electrophysiology Department, Hopital Haut Lévêque Bordeaux France.,2 Liryc Institute Bordeaux France
| | - Nicolas Derval
- 1 Electrophysiology Department, Hopital Haut Lévêque Bordeaux France
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Cunningham T, Roston TM, Franciosi S, Liu MC, Atallah J, Escudero CA, Udupa S, Roberts JD, Dhillon S, Dallaire F, Fournier A, Fatah M, Hamilton R, Sanatani S. Initially unexplained cardiac arrest in children and adolescents: A national experience from the Canadian Pediatric Heart Rhythm Network. Heart Rhythm 2020; 17:975-981. [DOI: 10.1016/j.hrthm.2020.01.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 01/29/2020] [Indexed: 02/01/2023]
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Manolis AA, Manolis TA, Apostolopoulos EJ, Apostolaki NE, Melita H, Manolis AS. The role of the autonomic nervous system in cardiac arrhythmias: The neuro-cardiac axis, more foe than friend? Trends Cardiovasc Med 2020; 31:290-302. [PMID: 32434043 DOI: 10.1016/j.tcm.2020.04.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/24/2020] [Accepted: 04/30/2020] [Indexed: 02/07/2023]
Abstract
The autonomic nervous system (ANS) with its two limbs, the sympathetic (SNS) and parasympathetic nervous system (PSNS), plays a critical role in the modulation of cardiac arrhythmogenesis. It can be both pro- and/or anti-arrhythmic at both the atrial and ventricular level of the myocardium. Intricate mechanisms, different for specific cardiac arrhythmias, are involved in this modulatory process. More data are available for the arrhythmogenic effects of the SNS, which, when overactive, can trigger atrial and/or ventricular "adrenergic" arrhythmias in susceptible individuals (e.g. in patients with paroxysmal atrial fibrillation-PAF, ventricular pre-excitation, specific channelopathies, ischemic heart disease or cardiomyopathies), while it can also negate the protective anti-arrhythmic drug effects. However, there is also evidence that PSNS overactivity may be responsible for triggering "vagotonic" arrhythmias (e.g. PAF, Brugada syndrome, idiopathic ventricular fibrillation). Thus, a fine balance is necessary to attain in these two limbs of the ANS in order to maintain eurhythmia, which is a difficult task to accomplish. Over the years, in addition to classical drug therapies, where beta-blockers prevail, several ANS-modulating interventions have been developed aiming at prevention and management of arrhythmias. Among them, techniques of cardiac sympathetic denervation, renal denervation, vagal stimulation, ganglionated plexi ablation and the newer experimental method of optogenetics have been employed. However, in many arrhythmogenic diseases, ANS modulation is still an investigative tool. Initial data are encouraging; however, further studies are needed to explore the efficacy of such interventions. These issues are herein reviewed and old and recent literature data are discussed, tabulated and pictorially illustrated.
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Silka MJ, Hill AC. Pediatric unexplained cardiac arrest: When no answer is also an answer. Heart Rhythm 2020; 17:982-983. [PMID: 32105773 DOI: 10.1016/j.hrthm.2020.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 02/13/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Michael J Silka
- Division of Cardiology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California.
| | - Allison C Hill
- Division of Cardiology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
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