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Kalantarian S, Åström Aneq M, Svetlichnaya J, Sharma S, Vittinghoff E, Klein L, Scheinman MM. Long-Term Electrocardiographic and Echocardiographic Progression of Arrhythmogenic Right Ventricular Cardiomyopathy and Their Correlation With Ventricular Tachyarrhythmias. Circ Heart Fail 2021; 14:e008121. [PMID: 34550004 DOI: 10.1161/circheartfailure.120.008121] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Prior studies of structural and electrocardiographic changes in arrhythmogenic right ventricular (RV) cardiomyopathy and their role in predicting ventricular arrhythmias (ventricular tachycardia) have shown conflicting results. METHODS We reviewed 405 ECGs, 315 transthoracic echocardiographies, and 441 implantable cardioverter defibrillator interrogations in 64 arrhythmogenic RV cardiomyopathy patients (56% men, mean age [SD], 44.2 [14.6] years) over a mean follow-up of 10 (range, 2.3-19) years. Generalized estimating equations were used to identify the association between ECG abnormalities, clinical variables, and transthoracic echocardiographic measurements (>mild degree of tricuspid regurgitation, RV outflow tract diameter in parasternal long axis and short axis, RV end-diastolic area, fractional area change). RESULTS There was a 4.65 (95% CI, 0.51%-8.8%) increase in RV end-diastolic area, a 3.75 (95% CI, 1.17%-6.34%) decrease in fractional area change, and 1.9 (95% CI, 1.3-2.8) higher odds (odds ratio) of RV wall motion abnormality with every 5-year increase in age after patients' first transthoracic echocardiography. >Mild tricuspid regurgitation was an independent predictor of RV enlargement and dysfunction (hazard ratio of >10% drop in fractional area change from baseline [95% CI], 3.51 [1.77-6.95] and hazard ratio of >10% increase in RV end-diastolic area from baseline [95% CI], 4.90 [2.52-9.52]). Patients with implantable cardioverter defibrillator were more likely to develop >mild tricuspid regurgitation and larger structural and functional disease progression. More pronounced increase in RV end-diastolic area was translated into higher rates of any ventricular tachycardia. Inferior T-wave inversions and sum of R waves (mm) in V1 to V3 were predictors of RV enlargement and dysfunction with the former also predicting risk of any ventricular tachycardia. CONCLUSIONS Arrhythmogenic RV cardiomyopathy is a progressive disease. Tricuspid regurgitation is an independent predictor of structural disease progression, which may be exacerbated by use of a transvenous implantable cardioverter defibrillator lead.
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Affiliation(s)
- Shadi Kalantarian
- University of California San Francisco (S.K., S.S., E.V., L.K., M.M.S.)
| | - Meriam Åström Aneq
- Department of Clinical Physiology and Department of Health, Medicine and Caring Sciences, Linköping University, Sweden (M.A.A.)
| | | | - Shikha Sharma
- University of California San Francisco (S.K., S.S., E.V., L.K., M.M.S.)
| | - Eric Vittinghoff
- University of California San Francisco (S.K., S.S., E.V., L.K., M.M.S.)
| | - Liviu Klein
- University of California San Francisco (S.K., S.S., E.V., L.K., M.M.S.)
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Chen L, Song J, Chen X, Chen K, Ren J, Zhang N, Rao M, Hu Z, Zhang Y, Gu M, Zhao H, Tang H, Yang Z, Hu S. A novel genotype-based clinicopathology classification of arrhythmogenic cardiomyopathy provides novel insights into disease progression. Eur Heart J 2020; 40:1690-1703. [PMID: 30945739 DOI: 10.1093/eurheartj/ehz172] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/23/2018] [Accepted: 03/17/2019] [Indexed: 11/13/2022] Open
Abstract
AIMS Arrhythmogenic cardiomyopathy (AC) shows large heterogeneity in its clinical, genetic, and pathological presentation. This study aims to provide a comprehensive atlas of end-stage AC and illustrate the relationships among clinical characteristics, genotype, and pathological profiles of patients with this disease. METHODS AND RESULTS We collected 60 explanted AC hearts and performed standard pathology examinations. The clinical characteristics of patients, their genotype and cardiac magnetic resonance imaging findings were assessed along with pathological characteristics. Masson staining of six representative sections of each heart were performed. Digital pathology combined with image segmentation was developed to calculate distribution of myocardium, fibrosis, and adipose tissue. An unsupervised clustering based on fibrofatty distribution containing four subtypes was constructed. Patients in Cluster 1 mainly carried desmosomal mutations (except for desmoplakin) and were subjected to transplantation at early age; this group was consistent with classical 'desmosomal cardiomyopathy'. Cluster 2 mostly had non-desmosomal mutations and showed regional fibrofatty replacement in right ventricle. Patients in Cluster 3 showed parallel progression, and included patients with desmoplakin mutations. Cluster 4 is typical left-dominant AC, although the genetic background of these patients is not yet clear. Multivariate regression analysis revealed precordial QRS voltage as an independent indicator of the residual myocardium of right ventricle, which was validated in predicting death and transplant events in the validation cohort (n = 92). CONCLUSION This study provides a novel classification of AC with distinct genetic backgrounds indicating different potential pathogenesis. Cluster 1 is distinct in genotype and clinicopathology and can be defined as 'desmosomal cardiomyopathy'. Precordial QRS amplitude is an independent indicator reflecting the right ventricular remodelling, which may be able to predict transplant/death events for AC patients.
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Affiliation(s)
- Liang Chen
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167A Beilishi Road, Xi Cheng District, Beijing, China
| | - Jiangping Song
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167A Beilishi Road, Xi Cheng District, Beijing, China
| | - Xiao Chen
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167A Beilishi Road, Xi Cheng District, Beijing, China.,Department of Pathology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kai Chen
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167A Beilishi Road, Xi Cheng District, Beijing, China
| | - Jie Ren
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167A Beilishi Road, Xi Cheng District, Beijing, China
| | - Ningning Zhang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167A Beilishi Road, Xi Cheng District, Beijing, China
| | - Man Rao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167A Beilishi Road, Xi Cheng District, Beijing, China
| | - Zhenliang Hu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167A Beilishi Road, Xi Cheng District, Beijing, China
| | - Yan Zhang
- Department of Radiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min Gu
- The Cardiac Arrhythmia Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong Zhao
- Department of Pathology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hanwei Tang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167A Beilishi Road, Xi Cheng District, Beijing, China
| | - Zhongfa Yang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167A Beilishi Road, Xi Cheng District, Beijing, China
| | - Shengshou Hu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167A Beilishi Road, Xi Cheng District, Beijing, China
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3
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Chung FP, Wu CI, Lin YJ, Chang SL, Lo LW, Hu YF, Lin CY, Chang TY, Chao TF, Liao JN, Tuan TC, Kuo L, Liu CM, Chin CG, Liao YC, Chen SA. Precordial T-Wave Inversions in Patients with Arrhythmogenic Right Ventricular Cardiomyopathy Who Present with the Initial Features of Right Ventricular Outflow Tract Arrhythmia. ACTA CARDIOLOGICA SINICA 2020; 36:464-474. [PMID: 32952356 PMCID: PMC7490609 DOI: 10.6515/acs.202009_36(5).20200621a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Precordial T-wave inversion (TWI) is an important diagnostic criterion for arrhythmogenic right ventricular cardiomyopathy (ARVC). OBJECTIVE This study aimed to characterize the initial repolarization features of definite ARVC in patients who first presented with right ventricular outflow tract ventricular arrhythmia (RVOT-VA) and TWI. METHODS Patients who presented with RVOT-VA and TWI ≥ V2 were retrospectively assessed. The initial characteristics of repolarization between patients with and without a final diagnosis of definite ARVC during follow-up were compared. RESULTS TWI ≥ V2 was observed in 61 of 553 patients (mean age: 44.1 ± 14.7 years; 14 men) with RVOT-VAs. After an average follow-up time of 54.9 ± 33.7 months, 31 (50.8%) patients were classified into the definite ARVC group and 30 (49.2%) into the non-definite ARVC group. The disappearance of precordial TWI ≥ V2 was observed in eight (13.1%) patients after the elimination of RVOT-VAs. In a multivariate analysis of the initial electrocardiogram features, only fragmented QRS [odds ratio (OR): 15.45, 95% confidence interval (CI): 1.61-148.26, p = 0.02] and precordial V2 TpTe interval (OR: 1.03, 95% CI: 1.01-1.06, p = 0.02) could independently predict definite ARVC during longitudinal follow-up. An initial V2 TpTe cutoff value > 88.5 ms could predict the final diagnosis of definite ARVC, with a sensitivity and specificity of 74.2% and 78.6%, respectively. CONCLUSIONS Despite the high risk of ARVC in RVOT-VAs and TWI ≥ V2, "normalization" of TWI was observed after ventricular arrhythmia elimination in 13.1% of the patients. Fragmented QRS and longer V2 TpTe interval were associated with definite ARVC during longitudinal follow-up.
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Affiliation(s)
- Fa-Po Chung
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital;
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Department of Medicine, National Yang-Ming University School of Medicine
| | - Cheng-I Wu
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital;
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Department of Medicine, National Yang-Ming University School of Medicine
| | - Yenn-Jiang Lin
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital;
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Department of Medicine, National Yang-Ming University School of Medicine
| | - Shih-Lin Chang
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital;
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Department of Medicine, National Yang-Ming University School of Medicine
| | - Li-Wei Lo
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital;
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Department of Medicine, National Yang-Ming University School of Medicine
| | - Yu-Feng Hu
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital;
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Department of Medicine, National Yang-Ming University School of Medicine
| | - Chin-Yu Lin
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital;
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Department of Medicine, National Yang-Ming University School of Medicine
| | - Ting-Yung Chang
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
| | - Tze-Fan Chao
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital;
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Department of Medicine, National Yang-Ming University School of Medicine
| | - Jo-Nan Liao
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital;
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Department of Medicine, National Yang-Ming University School of Medicine
| | - Ta-Chuan Tuan
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital;
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Department of Medicine, National Yang-Ming University School of Medicine
| | - Ling Kuo
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital;
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Department of Medicine, National Yang-Ming University School of Medicine
| | - Chih-Min Liu
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital;
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Department of Medicine, National Yang-Ming University School of Medicine
| | - Chye-Gen Chin
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei
| | | | - Shih-Ann Chen
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital;
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Department of Medicine, National Yang-Ming University School of Medicine
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4
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Calò L, Martino A, Goanta E, Okumura Y, de Ruvo E. Right bundle branch block and conduction disturbances in Brugada syndrome and arrhythmogenic right ventricular cardiomyopathy. J Interv Card Electrophysiol 2018; 52:307-313. [DOI: 10.1007/s10840-018-0386-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 05/16/2018] [Indexed: 10/16/2022]
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5
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Peters S. Value of epsilon wave in lead aVR in an 83-year old male patient with arrhythmogenic cardiomyopathy. Int J Cardiol 2015; 199:401-2. [DOI: 10.1016/j.ijcard.2015.07.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 07/18/2015] [Indexed: 11/30/2022]
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6
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Peters S. Electrocardiographic characteristics of arrhythmogenic right ventricular dysplasia, cardiac sarcoidosis and arrhythmogenic biventricular cardiomyopathy. Int J Cardiol 2015; 196:38-41. [PMID: 26070184 DOI: 10.1016/j.ijcard.2015.05.176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 05/27/2015] [Indexed: 11/16/2022]
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7
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Peters S. Prognostic value of epsilon waves in lead aVR in arrhythmogenic cardiomyopathy. Int J Cardiol 2015; 191:77-8. [DOI: 10.1016/j.ijcard.2015.04.261] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 04/30/2015] [Indexed: 11/29/2022]
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8
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Müssigbrodt A, Dinov B, Bertagnoli L, Sommer P, Richter S, Breithardt OA, Rolf S, Bollmann A, Hindricks G, Arya A. Precordial QRS amplitude ratio predicts long-term outcome after catheter ablation of electrical storm due to ventricular tachycardias in patients with arrhythmogenic right ventricular cardiomyopathy. J Electrocardiol 2015; 48:86-92. [DOI: 10.1016/j.jelectrocard.2014.10.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Indexed: 12/23/2022]
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Sabate Rotes A, Connolly HM, Warnes CA, Ammash NM, Phillips SD, Dearani JA, Schaff HV, Burkhart HM, Hodge DO, Asirvatham SJ, McLeod CJ. Ventricular arrhythmia risk stratification in patients with tetralogy of Fallot at the time of pulmonary valve replacement. Circ Arrhythm Electrophysiol 2014; 8:110-6. [PMID: 25416756 DOI: 10.1161/circep.114.001975] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Most patients with repaired tetralogy of Fallot require pulmonary valve replacement (PVR), but the evaluation for and management of ventricular arrhythmia remain unclear. This study is aimed at clarifying the optimal approach to this potentially life-threatening issue at the time of PVR. METHODS AND RESULTS A retrospective analysis was performed on 205 patients with repaired tetralogy of Fallot undergoing PVR at our institution between 1988 and 2010. Median age was 32.9 (range, 25.6) years. Previous ventricular tachycardia occurred in 16 patients (8%) and 37 (16%) had left ventricular dysfunction, defined as left ventricular ejection fraction <50%. Surgical right ventricular outflow tract cryoablation was performed in 22 patients (10.7%). The primary outcome was a combined event including ventricular tachycardia, out-of-hospital cardiac arrest, appropriate implantable cardioverter defibrillator therapy, and sudden cardiac death. Freedom from the combined event at 5, 10, and 15 years was 95%, 90%, and 79%, respectively. In the first year after PVR, 2 events occurred. Conversely, in the 22 patients who underwent surgical cryoablation, a single event occurred 7 years after PVR. A history of ventricular tachycardia and left ventricular dysfunction was associated with higher risk for the combined event (hazard ratio, 4.7; P=0.004 and hazard ratio, 0.8; P=0.02, respectively). CONCLUSIONS Patients with repaired tetralogy of Fallot undergoing PVR with history of ventricular tachycardia or left ventricular dysfunction appear to be associated with a higher risk of arrhythmic events after operation. Events in the first year after PVR are rare, and in select high-risk patients, surgical cryoablation does not seem to increase arrhythmic events and may be protective.
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Affiliation(s)
- Anna Sabate Rotes
- From the Division of Cardiovascular Disease (A.S.R., H.M.C., C.A.W., N.M.A., S.D.P., S.J.A., C.J.M.), Division of Cardiovascular Surgery (J.A.D., H.V.S., H.M.B.), and Division of Biomedical Statistics and Informatics (D.O.H.), Mayo Clinic, Rochester, MN; and Pediatric Cardiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.S.R.)
| | - Heidi M Connolly
- From the Division of Cardiovascular Disease (A.S.R., H.M.C., C.A.W., N.M.A., S.D.P., S.J.A., C.J.M.), Division of Cardiovascular Surgery (J.A.D., H.V.S., H.M.B.), and Division of Biomedical Statistics and Informatics (D.O.H.), Mayo Clinic, Rochester, MN; and Pediatric Cardiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.S.R.)
| | - Carole A Warnes
- From the Division of Cardiovascular Disease (A.S.R., H.M.C., C.A.W., N.M.A., S.D.P., S.J.A., C.J.M.), Division of Cardiovascular Surgery (J.A.D., H.V.S., H.M.B.), and Division of Biomedical Statistics and Informatics (D.O.H.), Mayo Clinic, Rochester, MN; and Pediatric Cardiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.S.R.)
| | - Naser M Ammash
- From the Division of Cardiovascular Disease (A.S.R., H.M.C., C.A.W., N.M.A., S.D.P., S.J.A., C.J.M.), Division of Cardiovascular Surgery (J.A.D., H.V.S., H.M.B.), and Division of Biomedical Statistics and Informatics (D.O.H.), Mayo Clinic, Rochester, MN; and Pediatric Cardiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.S.R.)
| | - Sabrina D Phillips
- From the Division of Cardiovascular Disease (A.S.R., H.M.C., C.A.W., N.M.A., S.D.P., S.J.A., C.J.M.), Division of Cardiovascular Surgery (J.A.D., H.V.S., H.M.B.), and Division of Biomedical Statistics and Informatics (D.O.H.), Mayo Clinic, Rochester, MN; and Pediatric Cardiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.S.R.)
| | - Joseph A Dearani
- From the Division of Cardiovascular Disease (A.S.R., H.M.C., C.A.W., N.M.A., S.D.P., S.J.A., C.J.M.), Division of Cardiovascular Surgery (J.A.D., H.V.S., H.M.B.), and Division of Biomedical Statistics and Informatics (D.O.H.), Mayo Clinic, Rochester, MN; and Pediatric Cardiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.S.R.)
| | - Hartzell V Schaff
- From the Division of Cardiovascular Disease (A.S.R., H.M.C., C.A.W., N.M.A., S.D.P., S.J.A., C.J.M.), Division of Cardiovascular Surgery (J.A.D., H.V.S., H.M.B.), and Division of Biomedical Statistics and Informatics (D.O.H.), Mayo Clinic, Rochester, MN; and Pediatric Cardiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.S.R.)
| | - Harold M Burkhart
- From the Division of Cardiovascular Disease (A.S.R., H.M.C., C.A.W., N.M.A., S.D.P., S.J.A., C.J.M.), Division of Cardiovascular Surgery (J.A.D., H.V.S., H.M.B.), and Division of Biomedical Statistics and Informatics (D.O.H.), Mayo Clinic, Rochester, MN; and Pediatric Cardiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.S.R.)
| | - David O Hodge
- From the Division of Cardiovascular Disease (A.S.R., H.M.C., C.A.W., N.M.A., S.D.P., S.J.A., C.J.M.), Division of Cardiovascular Surgery (J.A.D., H.V.S., H.M.B.), and Division of Biomedical Statistics and Informatics (D.O.H.), Mayo Clinic, Rochester, MN; and Pediatric Cardiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.S.R.)
| | - Samuel J Asirvatham
- From the Division of Cardiovascular Disease (A.S.R., H.M.C., C.A.W., N.M.A., S.D.P., S.J.A., C.J.M.), Division of Cardiovascular Surgery (J.A.D., H.V.S., H.M.B.), and Division of Biomedical Statistics and Informatics (D.O.H.), Mayo Clinic, Rochester, MN; and Pediatric Cardiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.S.R.)
| | - Christopher J McLeod
- From the Division of Cardiovascular Disease (A.S.R., H.M.C., C.A.W., N.M.A., S.D.P., S.J.A., C.J.M.), Division of Cardiovascular Surgery (J.A.D., H.V.S., H.M.B.), and Division of Biomedical Statistics and Informatics (D.O.H.), Mayo Clinic, Rochester, MN; and Pediatric Cardiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.S.R.).
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Yang XW, Hua W, Wang J, Liu ZM, Ding LG, Chen KP, Zhang S. Regression of fragmented QRS complex: a marker of electrical reverse remodeling in cardiac resynchronization therapy. Ann Noninvasive Electrocardiol 2014; 20:18-27. [PMID: 25040593 DOI: 10.1111/anec.12172] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Fragmented QRS (fQRS) marks inhomogeneous activation and asynchronous cardiac contraction. It has been proved that cardiac resynchronization therapy (CRT) could reverse geometrical remodeling as well as correct electrical dyssynchrony. We aimed to investigate whether fQRS changed corresponding to the therapeutic response to CRT. METHODS Patients who underwent de novo CRT implantation previously and had ≥1 follow-up between August 2012 and September 2013 in our hospital were investigated. Intrinsic electrocardiogram was recorded and fQRS in any lead was calculated. Response to CRT was defined as absolute improvement in left ventricular ejection fraction by ≥10% or by improvement >1 New York Heart Association class and without heart failure hospitalization. RESULTS A total of 75 patients (48 male, mean ages, 61 ± 9 years) were included in this study. At a median follow-up of 13 months, 57 patients had response to CRT. Responders had narrowed QRS (from 167 ± 23 ms to 158 ± 19 ms, P = 0.003) and reduced fQRS post-CRT. Nonresponders had QRS prolonging (from 151 ± 26 ms to 168 ± 16 ms, P = 0.033) and increase in fQRS. Eleven of 12 patients with reduced fQRS were responders and 8 of 12 with increased fQRS were nonresponders. Both changes in QRS and fQRS correlated strongly with CRT response (r = 0.389, P = 0.001 and r = 0.403, P = 0.000, respectively). Reduction of fQRS in ≥1 leads had high specificity (95%) in association to responders, though in low sensitivity (19%). CONCLUSIONS The changes in fQRS associated with therapeutic response to CRT. Regression of fQRS could be a maker of electrical reverse remodeling following CRT.
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Affiliation(s)
- Xin-wei Yang
- Center of Arrhythmia Diagnosis and Treatment, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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