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Zhao S, Ching CK, Huang D, Liu YB, Rodriguez-Guerrero DA, Hussin A, Kim YH, Van Dorn B, Zhou X, Singh B, Zhang S. Regional disparities and risk factors of mortality among patients at high risk of sudden cardiac death in emerging countries: a nonrandomized controlled trial. BMC Med 2024; 22:130. [PMID: 38519982 PMCID: PMC10960430 DOI: 10.1186/s12916-024-03310-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 02/20/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Comprehensive data on patients at high risk of sudden cardiac death (SCD) in emerging countries are lacking. The aim was to deepen our understanding of the SCD phenotype and identify risk factors for death among patients at high risk of SCD in emerging countries. METHODS Patients who met the class I indication for implantable cardioverter-defibrillator (ICD) implantation according to guideline recommendations in 17 countries and regions underrepresented in previous trials were enrolled. Countries were stratified by the WHO regional classification. Patients were or were not implanted with an ICD at their discretion. The outcomes were all-cause mortality and SCD. RESULTS We enrolled 4222 patients, and 3889 patients were included in the analysis. The mean follow-up period was 21.6 ± 10.2 months. There were 433 (11.1%) instances of all-cause mortality and 117 (3.0%) cases of SCD. All-cause mortality was highest in primary prevention (PP) patients from Southeast Asia and secondary prevention (SP) patients from the Middle East and Africa. The SCD rates among PP and SP patients were both highest in South Asia. Multivariate Cox regression modelling demonstrated that in addition to the independent predictors identified in previous studies, both geographic region and ICD use were associated with all-cause mortality in patients with high SCD risk. Primary prophylactic ICD implantation was associated with a 36% (HR = 0.64, 95% CI 0.531-0.802, p < 0.0001) lower all-cause mortality risk and an 80% (HR = 0.20, 95% CI = 0.116-0.343, p < 0.0001) lower SCD risk. CONCLUSIONS There was significant heterogeneity among patients with high SCD risk in emerging countries. The influences of geographic regions on patient characteristics and outcomes were significant. Improvement in increasing ICD utilization and uptake of guideline-directed medical therapy in emerging countries is urgent. TRIAL REGISTRATION ClinicalTrials.gov, NCT02099721.
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Affiliation(s)
- Shuang Zhao
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Rd, Xicheng District, Beijing, 100037, China
| | - Chi-Keong Ching
- National Heart Centre Singapore, Outram District, Singapore, Singapore
| | | | - Yen-Bin Liu
- National Taiwan University Hospital, Taipei City, Taiwan, China
| | - Diego A Rodriguez-Guerrero
- Instituto de Cardiología Fundación Cardioinfantil, Centro Internacional de Arritmias, Bogotá, Colombia
- Universidad de La Sabana, Bogota, Colombia
| | | | - Young-Hoon Kim
- Korea University Medical Center, Seoul, Republic of Korea
| | | | | | - Balbir Singh
- Pan Max Hospital, Delhi, India
- Max Super Speciality Hospital, Delhi, India
| | - Shu Zhang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Rd, Xicheng District, Beijing, 100037, China.
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Yan Y, Tang L, Wang X, Zhou K, Hu F, Duan H, Liu X, Hua Y, Wang C. Clinical and genetic profiles of chinese pediatric patients with catecholaminergic polymorphic ventricular tachycardia. Orphanet J Rare Dis 2023; 18:380. [PMID: 38053087 PMCID: PMC10696677 DOI: 10.1186/s13023-023-02991-0] [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: 12/12/2022] [Accepted: 11/18/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUNDS Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare but lethal cardiac ion channelopathy. Delayed diagnosis and misdiagnosis remain a matter of concern due to its rarity and insufficient recognition of this disorder, particularly in developing countries like China. AIMS AND METHODS We reported six catecholaminergic polymorphic ventricular tachycardia (CPVT) children diagnosed in our center along with a comprehensive review of Chinese pediatric CPVT patients reported in domestic and overseas literature between January 2013 and December 2021 to provide an essential reference for physicians to deepen their understanding of pediatric CPVT. RESULTS A total of 95 children with CPVT, including our six patients from 21 medical centers were identified. The median age of symptom onset is 8.7 ± 3.0 years. Diagnosis occurred at a median age of 12.9 ± 6.8 years with a delay of 4.3 ± 6.6 years. Selective beta-blockers (Metoprolol and Bisoprolol) were prescribed for 38 patients (56.7%) and 29 (43.3%) patients received non-selective beta-blocker (Propranolol and Nadolol) treatment. Six patients accepted LCSD and seven received ICD implantation at the subsequent therapy. A total of 13 patients died during the disease course. Of the 67 patients with positive gene test results, variants in RYR2 were 47 (70.1%), CASQ2 were 11 (16.4%), and RYR2 accompanied SCN5A were 7 (10.4%). Patients with CASQ2 gene mutations presented with younger symptom onset age, higher positive family history rate and better prognosis than those with RYR2 mutations. CONCLUSION Chinese pediatric patients with CPVT had a poorer prognosis than other cohorts, probably due to delayed/missed diagnosis, non-standard usage of beta-blockers, unavailability of flecainide, and a lower rate of LCSD and ICD implantation.
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Affiliation(s)
- Yu Yan
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
- The Cardiac development and early intervention unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Liting Tang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
- The Cardiac development and early intervention unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Xiaoqin Wang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
- Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road, Chengdu, Sichuan, 610041, China
- West China Medical School of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Kaiyu Zhou
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
- Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road, Chengdu, Sichuan, 610041, China
- West China Medical School of Sichuan University, Chengdu, Sichuan, 610041, China
- Key Laboratory of Birth Defects and Related Disease of Women and Children (Sichuan University), Ministry of Education Chengdu, Chengdu, Sichuan, 610041, China
| | - Fan Hu
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
- Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road, Chengdu, Sichuan, 610041, China
- West China Medical School of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Hongyu Duan
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
- Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road, Chengdu, Sichuan, 610041, China
- West China Medical School of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Xiaoliang Liu
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
- Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road, Chengdu, Sichuan, 610041, China.
- West China Medical School of Sichuan University, Chengdu, Sichuan, 610041, China.
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
| | - Yimin Hua
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
- Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road, Chengdu, Sichuan, 610041, China.
- West China Medical School of Sichuan University, Chengdu, Sichuan, 610041, China.
- Key Laboratory of Birth Defects and Related Disease of Women and Children (Sichuan University), Ministry of Education Chengdu, Chengdu, Sichuan, 610041, China.
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
| | - Chuan Wang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
- Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road, Chengdu, Sichuan, 610041, China.
- West China Medical School of Sichuan University, Chengdu, Sichuan, 610041, China.
- Key Laboratory of Birth Defects and Related Disease of Women and Children (Sichuan University), Ministry of Education Chengdu, Chengdu, Sichuan, 610041, China.
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
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Kohli U, von Alvensleben J, Srinivasan C. Subcutaneous Implantable Cardioverter Defibrillators in Pediatrics and Congenital Heart Disease. Card Electrophysiol Clin 2023; 15:e1-e16. [PMID: 38030336 DOI: 10.1016/j.ccep.2023.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Subcutaneous implantable cardioverter defibrillators (S-ICDs) are being used with increased frequency in children and patients with congenital heart disease. Vascular access complexities, intracardiac shunts, and specific anatomies make these devices particularly appealing for some of these patients. Alternative screening, implantation, and programming techniques should be considered based on patient size, body habitus, anatomy, procedural history, and preference. Appropriate and inappropriate shock rates are generally comparable to those seen with transvenous devices. Complications such as infection can occur, although their severity is likely to be less than that seen with transvenous devices. Technical advances are likely to further broaden S-ICD applicability.
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Affiliation(s)
- Utkarsh Kohli
- Division of Pediatric Cardiology, Department of Pediatrics, West Virginia University School of Medicine and West Virginia University Children's Heart Center, 64 Medical Center Drive, Robert C. Byrd Health Science Center, PO Box 9214, Morgantown, WV 26506-9214, USA.
| | - Johannes von Alvensleben
- Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, Aurora, CO 80045 720-777-1234, USA
| | - Chandra Srinivasan
- The Children's Hospital of Philadelphia; University of Perelman School of Medicine, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
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Mascia G, Brugada J, Arbelo E, Porto I. Athletes and suspected catecholaminergic polymorphic ventricular tachycardia: Awareness and current knowledge. J Cardiovasc Electrophysiol 2023; 34:2095-2101. [PMID: 37655865 DOI: 10.1111/jce.16045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 08/01/2023] [Accepted: 08/17/2023] [Indexed: 09/02/2023]
Abstract
INTRODUCTION Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a cardiac inherited arrhythmogenic disease potentially leading to sudden cardiac death that is determined by electrical instability exacerbated by acute adrenergic tone. METHODS AND RESULTS Despite its life-threatening nature, CPVT remains potentially unnoticed since diagnosis may be difficult especially in apparently healthy athletes. This review summarizes current knowledge and shortcomings of CPVT, focusing on genetics, arrhythmic mechanisms, sport preparticipation screening, and current recommendations. CONCLUSIONS The paper captures the importance of CPVT athletes regarding the necessity of risk stratification, as well as the importance of maintaining a healthy lifestyle.
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Affiliation(s)
- Giuseppe Mascia
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Josep Brugada
- Arrhythmia, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Deu, Universitat de Barcelona, Barcelona, Spain
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of The Heart-ERN GUARD-Heart
| | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of The Heart-ERN GUARD-Heart
| | - Italo Porto
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine, University of Genoa, Genoa, Italy
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Regoli FD, Cattaneo M, Kola F, Thartori A, Bytyci H, Saccarello L, Amoruso M, Di Valentino M, Menafoglio A. Management of hemodynamically stable wide QRS complex tachycardia in patients with implantable cardioverter defibrillators. Front Cardiovasc Med 2023; 9:1011619. [PMID: 36684577 PMCID: PMC9846131 DOI: 10.3389/fcvm.2022.1011619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023] Open
Abstract
Management of hemodynamically stable, incessant wide QRS complex tachycardia (WCT) in patients who already have an implantable cardioverter defibrillator (ICD) is challenging. First-line treatment is performed by medical staff who have no knowledge on programmed ICD therapy settings and there is always some concern for unexpected ICD shock. In these patients, a structured approach is necessary from presentation to therapy. The present review provides a systematic approach in four distinct phases to guide any physician involved in the management of these patients: PHASE I: assessment of hemodynamic status and use of the magnet to temporarily suspend ICD therapies, especially shocks; identification of possible arrhythmia triggers; risk stratification in case of electrical storm (ES). PHASE II The preparation phase includes reversal of potential arrhythmia "triggers", mild patient sedation, and patient monitoring for therapy delivery. Based on resource availability and competences, the most adequate therapeutic approach is chosen. This choice depends on whether a device specialist is readily available or not. In the case of ES in a "high-risk" patient an accelerated patient management protocol is advocated, which considers urgent ventricular tachycardia transcatheter ablation with or without mechanical cardiocirculatory support. PHASE III Therapeutic phase is based on the use of intravenous anti-arrhythmic drugs mostly indicated in this clinical context are presented. Device interrogation is very important in this phase when sustained monomorphic VT diagnosis is confirmed, then ICD ATP algorithms, based on underlying VT cycle length, are proposed. In high-risk patients with intractable ES, intensive patient management considers MCS and transcatheter ablation. PHASE IV The patient is hospitalized for further diagnostics and management aimed at preventing arrhythmia recurrences.
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Affiliation(s)
- François D. Regoli
- Cardiology Service, Ospedale San Giovanni, Cardiocentro Institute, Ente Ospedaliero Cantonale, Bellinzona, Switzerland,Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland,*Correspondence: François D. Regoli,
| | - Mattia Cattaneo
- Cardiology Service, Ospedale San Giovanni, Cardiocentro Institute, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Florenc Kola
- Department of Internal Medicine, Ospedale San Giovanni, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Albana Thartori
- Department of Internal Medicine, Ospedale San Giovanni, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Hekuran Bytyci
- Department of Internal Medicine, Ospedale San Giovanni, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Luca Saccarello
- Department of Internal Medicine, Ospedale San Giovanni, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Marco Amoruso
- Cardiology Service, Ospedale San Giovanni, Cardiocentro Institute, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Marcello Di Valentino
- Cardiology Service, Ospedale San Giovanni, Cardiocentro Institute, Ente Ospedaliero Cantonale, Bellinzona, Switzerland,Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Andrea Menafoglio
- Cardiology Service, Ospedale San Giovanni, Cardiocentro Institute, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
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