1
|
Zupan Mežnar A, Mrak M, Mullens W, Štublar J, Ivanovski M, Žižek D. AV-optimized conduction system pacing for treatment of AV dromotropathy: A randomized, cross-over study. J Cardiovasc Electrophysiol 2024. [PMID: 38686618 DOI: 10.1111/jce.16268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 02/04/2024] [Accepted: 03/19/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Severe first-degree atrioventricular (AV) block may produce symptoms similar to heart failure due to AV dyssynchrony, a syndrome termed AV dromotropathy. According to guidelines, it should be considered for permanent pacemaker implantation, yet evidence supporting this treatment is scarce. OBJECTIVES This study aimed to determine the impact of AV-optimized conduction system pacing (CSP) in patients with symptomatic severe first-degree AV block and echocardiographic signs of AV dyssynchrony. METHODS Patients with symptomatic first-degree AV block (PR > 250 ms), preserved left ventricular ejection fraction, narrow QRS, and AV dyssynchrony were included in the study. In a single-blind cross-over design, patients were randomized to AV sequential CSP or backup VVI pacing with a base rate of 40 bpm. We compared exercise capacity, echocardiographic parameters, and symptom occurrence at the end of 3 months of each period. RESULTS Fourteen patients completed the study. During the AV-optimized CSP compared to the backup pacing period, patients achieved a higher workload on exercise test (147.2 ± 50.9 vs. 140.7 ± 55.8 W; p = .032), with a trend towards higher peak VO2 (23.3 ± 7.1 vs. 22.8 ± 7.1 mL/min/kg; p = .224), and higher left ventricular stroke volume (LVSV 74.5 ± 13.8 vs. 66.4 ± 12.5 mL; p < .001). Symptomatic improvement was recorded, with fewer patients reporting general tiredness and 71% of patients preferring the AV-optimized CSP (p = .008). CONCLUSIONS AV-optimized CSP could improve symptoms, exercise capacity and LVSV in patients with severe first-degree AV block.
Collapse
Affiliation(s)
- Anja Zupan Mežnar
- Department of Cardiology, University Medical Center Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Miha Mrak
- Department of Cardiology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Faculty of Medicine and Life Sciences, University Hasselt, Hasselt, Belgium
| | - Jernej Štublar
- Department of Cardiology, University Medical Center Ljubljana, Ljubljana, Slovenia
- Department of Cardiovascular Surgery, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Maja Ivanovski
- Department of Cardiology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - David Žižek
- Department of Cardiology, University Medical Center Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
2
|
Žižek D, Mrak M, Jan M, Zupan Mežnar A, Ivanovski M, Žlahtič T, Kajdič N, Antolič B, Klemen L, Skale R, Avramovič Gregorič J, Štublar J, Pernat A, Šinkovec M. Impact of preventive substrate catheter ablation on implantable cardioverter-defibrillator interventions in patients with ischaemic cardiomyopathy and infarct-related coronary chronic total occlusion. Europace 2024:euae109. [PMID: 38657209 DOI: 10.1093/europace/euae109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/20/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Primary prevention patients with ischemic cardiomyopathy and chronic total occlusion of an infarct-related coronary artery (IRA-CTO) are at a particularly high risk of implantable cardioverter-defibrillator (ICD) therapy occurrence. AIM To evaluate the efficacy of preventive CTO-related substrate ablation strategy in ischaemic cardiomyopathy patients undergoing primary prevention ICD implantation. METHODS The PREVENTIVE VT study was a prospective, multicenter, randomized trial including ischaemic patients with ejection fraction ≤40%, no documented VAs, and evidence of scar related to the coronary CTO. Patients were randomly assigned 1:1 to a preventive substrate ablation before ICD implantation or standard therapy with ICD implantation only. The primary outcome was a composite of appropriate ICD therapy or unplanned hospitalization for VAs. Secondary outcomes included the primary outcome's components, the incidence of appropriate ICD therapies, cardiac hospitalization, electrical storm, and cardiovascular (CV) mortality. RESULTS Sixty patients were included in the study. During the mean follow-up of 44.7± 20.7 months, the primary outcome occurred in 5 (16.7%) patients undergoing preventive substrate ablation and in 13 (43.3%) patients receiving only ICD (hazard ratio [HR]: 0.33; 95% confidence interval [CI]: 0.12-0.94; P=0.037). Patients in the preventive ablation group also had fewer appropriate ICD therapies (P=0.039) and the electrical storms (Log rank: P=0.01). While preventive ablation also reduced cardiac hospitalizations (P=0.006), it had no significant impact on CV mortality (P=0.151). CONCLUSIONS Preventive ablation of the coronary CTO-related substrate in patients undergoing primary ICD implantation is associated with the reduced risk of appropriate ICD therapy or unplanned hospitalization due to VAs.
Collapse
Affiliation(s)
- David Žižek
- Cardiology Department, University Medical Centre Ljubljana, Ljubljana, Slovenia
- University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
| | - Miha Mrak
- Cardiology Department, University Medical Centre Ljubljana, Ljubljana, Slovenia
- University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
| | - Matevž Jan
- Cardiovascular Surgery Department, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Anja Zupan Mežnar
- Cardiology Department, University Medical Centre Ljubljana, Ljubljana, Slovenia
- University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
| | - Maja Ivanovski
- Cardiology Department, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Tadej Žlahtič
- Cardiology Department, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Nina Kajdič
- Cardiology Department, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Bor Antolič
- Cardiology Department, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Luka Klemen
- Cardiology Department, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Rafael Skale
- Cardiology Division, General Hospital Celje, Celje, Slovenia
| | | | - Jernej Štublar
- Cardiology Department, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Andrej Pernat
- Cardiology Department, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Matjaž Šinkovec
- Cardiology Department, University Medical Centre Ljubljana, Ljubljana, Slovenia
- University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
| |
Collapse
|
3
|
Fauvel C, Bonnet G, Mullens W, Giraldo CIS, Mežnar AZ, Barasa A, Tokmakova M, Shchendrygina A, Costa FM, Mapelli M, Zemrak F, Tops LF, Jakus N, Sultan A, Bahouth F, Hadjseyd CE, Salvat M, Anselmino M, Messroghli D, Weberndörfer V, Giverts I, Bochaton T, Courand PY, Berthelot E, Legallois D, Beauvais F, Bauer F, Lamblin N, Damy T, Girerd N, Sebbag L, Pezel T, Cohen-Solal A, Rosano G, Roubille F, Mewton N. Sequencing and titrating approach of therapy in heart failure with reduced ejection fraction following the 2021 European Society of Cardiology guidelines: an international cardiology survey. Eur J Heart Fail 2023; 25:213-222. [PMID: 36404398 DOI: 10.1002/ejhf.2743] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/26/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022] Open
Abstract
AIMS In symptomatic patients with heart failure and reduced ejection fraction (HFrEF), recent international guidelines recommend initiating four major therapeutic classes rather than sequential initiation. It remains unclear how this change in guidelines is perceived by practicing cardiologists versus heart failure (HF) specialists. METHODS AND RESULTS An independent academic web-based survey was designed by a group of HF specialists and posted by email and through various social networks to a broad community of cardiologists worldwide 1 year after the publication of the latest European HF guidelines. Overall, 615 cardiologists (38 [32-47] years old, 63% male) completed the survey, of which 58% were working in a university hospital and 26% were HF specialists. The threshold to define HFrEF was ≤40% for 61% of the physicians. Preferred drug prescription for the sequential approach was angiotensin-converting enzyme inhibitors or angiotensin receptor-neprilysin inhibitors first (74%), beta-blockers second (55%), mineralocorticoid receptor antagonists third (52%), and sodium-glucose cotransporter 2 inhibitors (53%) fourth. Eighty-four percent of participants felt that starting all four classes was feasible within the initial hospitalization, and 58% felt that titration is less important than introducing a new class. Age, status in training, and specialization in HF field were the principal characteristics that significantly impacted the answers. CONCLUSION In a broad international cardiology community, the 'historical approach' to HFrEF therapies remains the preferred sequencing approach. However, accelerated introduction and uptitration are also major treatment goals. Strategy trials in treatment guidance are needed to further change practices.
Collapse
Affiliation(s)
- Charles Fauvel
- CHU ROUEN, Department of Cardiology, FHU Carnaval, Rouen University Hospital, Rouen, France
- Internal Medicine Department, Cardiovascular Medicine Section, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Guillaume Bonnet
- Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Unité Médico-Chirurgical de Valvulopathies et Cardiomyopathies, Pessac, France
| | - Wilfried Mullens
- Ziekenhuis Oost-Limburg A.V, Genk, Belgium
- Hasselt University, Hasselt, Belgium
| | | | | | - Anders Barasa
- Department of Cardiology, Glostrup Hospital, Copenhagen, Denmark
| | - Mariya Tokmakova
- Cardiology Department, UMHAT 'Sv. Georgi' EAD Plovdi, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Anastasia Shchendrygina
- Cardiology Department, Department of Hospital Therapy No.2, Sechenov University, Moscow, Russia
| | | | - Massimo Mapelli
- Heart Failure Unit, Centro Cardiologico Monzino IRCCs, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Filip Zemrak
- Department of Cardiac Imaging, Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Laurens F Tops
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nina Jakus
- Department of Cardiology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Arian Sultan
- Department of Electrophysiology, Cologne, University Heart Center Cologne, Köln, Germany
| | - Fadel Bahouth
- Cardiology Department, Bnai Zion Hospital, Haifa, Israel
| | - Chahr-Eddine Hadjseyd
- Heart Failure Department and Clinical Investigation Center Inserm 1407, Louis Pradel Cardiovascular Hospital, Hospices Civils de Lyon, Claude Bernard University, Lyon, France
| | | | - Matteo Anselmino
- Città della Salute e della Scienza di Torino, Hospital Department of Medical Sciences, University of Turin, Turin, Italy
| | - Daniel Messroghli
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Vanessa Weberndörfer
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, The Netherlands
| | - Ilya Giverts
- Cardiopulmonary Exercise Core Laboratory, Massachusetts General Hospital, Boston, MA, USA
| | - Thomas Bochaton
- Heart Failure Department and Clinical Investigation Center Inserm 1407, Louis Pradel Cardiovascular Hospital, Hospices Civils de Lyon, Claude Bernard University, Lyon, France
| | - Pierre Yves Courand
- Fédération de cardiologie, Hôpital de la Croix-Rousse et Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon
- France; Université de Lyon, CREATIS; CNRS UMR5220; INSERM U1044; INSA-Lyon; Université Claude Bernard Lyon 1, France
| | | | - Damien Legallois
- Service de Cardiologie et de Pathologie Vasculaire, Caen, France
| | - Florence Beauvais
- Inserm UMRS 942, Department of Cardiology, University of Paris, Paris, France
| | - Fabrice Bauer
- Service de Chirurgie Cardiaque, Clinique d'Insuffisance Cardiaque Avancée, Centre de Compétence en Hypertension Pulmonaire 27/76, Centre Hospitalier Universitaire Charles Nicolle, Rouen, France
| | - Nicolas Lamblin
- Université de Lille, Service de Cardiologie, CHU Lille, Institut Pasteur de Lille, Lille, France
| | - Thibaud Damy
- Réseau Cardiogen, Department of Cardiology, Centre Français de Référence de l'Amylose Cardiaque (CRAC), CHU d'Henri-Mondor, Créteil, France
| | - Nicolas Girerd
- Centre d'Investigation Clinique-Plurithématique Inserm CIC-P 1433, Inserm U1116, CHRU Nancy Brabois, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Université de Lorraine, Nancy, France
| | - Laurent Sebbag
- Heart Failure Department and Clinical Investigation Center Inserm 1407, Louis Pradel Cardiovascular Hospital, Hospices Civils de Lyon, Claude Bernard University, Lyon, France
| | - Théo Pezel
- Inserm UMRS 942, Department of Cardiology, University of Paris, Paris, France
| | - Alain Cohen-Solal
- Inserm UMRS 942, Department of Cardiology, University of Paris, Paris, France
| | - Giuseppe Rosano
- Department of Cardiology, IRCCS San Raffaele Pisana, Rome, Italy
| | - François Roubille
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology Department, Montpellier, France
| | - Nathan Mewton
- Heart Failure Department and Clinical Investigation Center Inserm 1407, Louis Pradel Cardiovascular Hospital, Hospices Civils de Lyon, Claude Bernard University, Lyon, France
| |
Collapse
|
4
|
Žižek D, Antolič B, Mežnar AZ, Zavrl-Džananović D, Jan M, Štublar J, Pernat A. Biventricular versus His bundle pacing after atrioventricular node ablation in heart failure patients with narrow QRS. Acta Cardiol 2022; 77:222-230. [PMID: 34078244 DOI: 10.1080/00015385.2021.1903196] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: His bundle pacing (HBP) is a physiological alternative to biventricular (BiV) pacing. We compared short-term results of both pacing approaches in symptomatic atrial fibrillation (AF) patients with moderately reduced left ventricular (LV) ejection fraction (EF ≥35% and <50%) and narrow QRS (≤120 ms) who underwent atrioventricular node ablation (AVNA).Methods: Thirty consecutive AF patients who received BiV pacing or HBP in conjunction with AVNA between May 2015 and January 2020 were retrospectively assessed. Electrocardiographic, echocardiographic, and clinical data at baseline and 6 months after the procedure were assessed.Results: Twenty-four patients (age 68.8 ± 6.5 years, 50% female, EF 39.6 ± 4%, QRS 95 ± 10 ms) met the inclusion criteria, 12 received BiV pacing and 12 HBP. Both groups had similar acute procedure-related success and complication rates. HBP was superior to BiV pacing in terms of post-implant QRS duration, implantation fluoroscopy times, reduction of indexed LV volumes (EDVi 63.8 (49.6-81) mL/m2 vs. 79.9 (66-100) mL/m2, p = 0.055; ESVi 32.7 (25.6-42.6) mL/m2 vs. 46.4 (42.9-68.1) mL/m2, p = 0.009) and increase in LVEF (46 (41-55) % vs. 38 (35-42) %, p = 0.005). However, the improvement of the NYHA class was similar in both groups.Conclusions: In symptomatic AF patients with moderately reduced EF and narrow QRS undergoing AVNA, HBP could be a conceivable alternative to BiV pacing. Further prospective studies are warranted to address the outcomes between both 'ablate and pace' strategies.
Collapse
Affiliation(s)
- David Žižek
- Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Bor Antolič
- Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Anja Zupan Mežnar
- Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Matevž Jan
- Cardiovascular Surgery Department, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Jernej Štublar
- Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Andrej Pernat
- Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
5
|
Zupan Mežnar A, Žižek D, Mewton N. Atrioventricular dromotropathy: an important substrate for complete resynchronization therapy. Europace 2022; 24:868. [PMID: 35352812 DOI: 10.1093/europace/euac036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Anja Zupan Mežnar
- Cardiology Department, University Medical Centre Ljubljana, Zaloška Cesta 7, 1000Ljubljana, Slovenia
| | - David Žižek
- Cardiology Department, University Medical Centre Ljubljana, Zaloška Cesta 7, 1000Ljubljana, Slovenia
| | - Nathan Mewton
- Heart Failure Department, Hôpital Cardio-Vasculaire Louis Pradel, Clinical Investigation Center Inserm 1407, CarMeN Inserm 1060, Hospices Civils de Lyon, Claude Barnard University Lyon 1, Lyon, France
| |
Collapse
|
6
|
Cameli M, Miglioranza MH, Magne J, Mandoli GE, Benfari G, Ancona R, Sibilio G, Reskovic Luksic V, Dejan D, Griseli L, Van De Heyning CM, Mortelmans P, Michalski B, Kupczynska K, Di Giannuario G, Devito F, Dulgheru R, Ilardi F, Salustri A, Abushahba G, Morrone D, Fabiani I, Penicka M, Katbeh A, Sammarco G, Esposito R, Santoro C, Pastore MC, Comenale Pinto S, Kalinin A, Pičkure Ž, Ažman Juvan K, Zupan Mežnar A, Coisne A, Coppin A, Opris MM, Nistor DO, Paakkanen R, Biering-Sørensen T, Olsen FJ, Lapinskas T, Vaškelyté JJ, Galian-Gay L, Casas G, Motoc AI, Papadopoulos CH, Loizos S, Ágoston G, Szabó I, Hristova K, Tsonev SN, Galli E, Vinereanu D, Mihaila Baldea S, Muraru D, Mondillo S, Donal E, Galderisi M, Cosyns B, Edvardsen T, Popescu BA. Multicentric Atrial Strain COmparison between Two Different Modalities: MASCOT HIT Study. Diagnostics (Basel) 2020; 10:diagnostics10110946. [PMID: 33202837 PMCID: PMC7696899 DOI: 10.3390/diagnostics10110946] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/07/2020] [Accepted: 11/10/2020] [Indexed: 12/18/2022] Open
Abstract
Two methods are currently available for left atrial (LA) strain measurement by speckle tracking echocardiography, with two different reference timings for starting the analysis: QRS (QRS-LASr) and P wave (P-LASr). The aim of MASCOT HIT study was to define which of the two was more reproducible, more feasible, and less time consuming. In 26 expert centers, LA strain was analyzed by two different echocardiographers (young vs senior) in a blinded fashion. The study population included: healthy subjects, patients with arterial hypertension or aortic stenosis (LA pressure overload, group 2) and patients with mitral regurgitation or heart failure (LA volume–pressure overload, group 3). Difference between the inter-correlation coefficient (ICC) by the two echocardiographers using the two techniques, feasibility and analysis time of both methods were analyzed. A total of 938 subjects were included: 309 controls, 333 patients in group 2, and 296 patients in group 3. The ICC was comparable between QRS-LASr (0.93) and P-LASr (0.90). The young echocardiographers calculated QRS-LASr in 90% of cases, the expert ones in 95%. The feasibility of P-LASr was 85% by young echocardiographers and 88% by senior ones. QRS-LASr young median time was 110 s (interquartile range, IR, 78-149) vs senior 110 s (IR 78-155); for P-LASr, 120 s (IR 80-165) and 120 s (IR 90-161), respectively. LA strain was feasible in the majority of patients with similar reproducibility for both methods. QRS complex guaranteed a slightly higher feasibility and a lower time wasting compared to the use of P wave as the reference.
Collapse
Affiliation(s)
- Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy; (G.E.M.); (M.C.P.); (S.M.)
- Correspondence: ; Tel.: +39-0577585377
| | - Marcelo Haertel Miglioranza
- Institute of Cardiology, University Foundation of Cardiology, Porto Alegre 90620-000, Brazil; (M.H.M.); (L.G.)
| | - Julien Magne
- CHU Limoges, Hôpital Dupuytren, Service Cardiologie, F-87042, 87042 Limoges, France;
- Cardiology Department, INSERM U1094, Faculté de médecine de Limoges, 2, rue Marcland, 87000 Limoges, France
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy; (G.E.M.); (M.C.P.); (S.M.)
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy;
| | - Roberta Ancona
- UOC Cardiologia/UTIC—“Santa Maria delle Grazie” Hospital Pozzuoli, 80078 Pozzuoli, Italy; (R.A.); @gmail.it (G.S.); (S.C.P.)
| | - Gerolamo Sibilio
- UOC Cardiologia/UTIC—“Santa Maria delle Grazie” Hospital Pozzuoli, 80078 Pozzuoli, Italy; (R.A.); @gmail.it (G.S.); (S.C.P.)
| | - Vlatka Reskovic Luksic
- Department of Cardiovascular Diseases, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (V.R.L.); (D.D.)
| | - Dosen Dejan
- Department of Cardiovascular Diseases, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (V.R.L.); (D.D.)
| | - Leonardo Griseli
- Institute of Cardiology, University Foundation of Cardiology, Porto Alegre 90620-000, Brazil; (M.H.M.); (L.G.)
| | | | - Philippe Mortelmans
- Department of Cardiology, Antwerp University Hospital, 2650 Edegem, Belgium; (C.M.V.D.H.); (P.M.)
| | - Blazej Michalski
- Department of Cardiology, Medical University of Lodz, 91347 Lodz, Poland; (B.M.); (K.K.)
| | - Karolina Kupczynska
- Department of Cardiology, Medical University of Lodz, 91347 Lodz, Poland; (B.M.); (K.K.)
| | | | | | - Raluca Dulgheru
- Cardiology Department—Heart Valve Clinic—University Hospital Liege, B-4000 Liege, Belgium; (R.D.); (F.I.)
| | - Federica Ilardi
- Cardiology Department—Heart Valve Clinic—University Hospital Liege, B-4000 Liege, Belgium; (R.D.); (F.I.)
- Department of Advanced Biomedical Sciences, Federico II, University Hospital, 80131 Naples, Italy; (R.E.); (C.S.); (M.G.)
| | - Alessandro Salustri
- Non-Invasive Department, Heart Hospital—Hamad Medical Corporation, Doha 3050, Qatar; (A.S.); (G.A.)
| | - Galal Abushahba
- Non-Invasive Department, Heart Hospital—Hamad Medical Corporation, Doha 3050, Qatar; (A.S.); (G.A.)
| | - Doralisa Morrone
- Cardiothoracic and Vascular Department, Pisa University, 56126 Pisa, Italy; (D.M.); (I.F.)
| | - Iacopo Fabiani
- Cardiothoracic and Vascular Department, Pisa University, 56126 Pisa, Italy; (D.M.); (I.F.)
- Cardiologia e Medicina Cardiovascolare—Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
| | - Martin Penicka
- Cardiovascular Research Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (M.P.); (A.K.)
| | - Asim Katbeh
- Cardiovascular Research Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (M.P.); (A.K.)
| | - Giuseppe Sammarco
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35122 Padua, Italy; (G.S.); (D.M.)
| | - Roberta Esposito
- Department of Advanced Biomedical Sciences, Federico II, University Hospital, 80131 Naples, Italy; (R.E.); (C.S.); (M.G.)
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, Federico II, University Hospital, 80131 Naples, Italy; (R.E.); (C.S.); (M.G.)
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy; (G.E.M.); (M.C.P.); (S.M.)
| | - Salvatore Comenale Pinto
- UOC Cardiologia/UTIC—“Santa Maria delle Grazie” Hospital Pozzuoli, 80078 Pozzuoli, Italy; (R.A.); @gmail.it (G.S.); (S.C.P.)
| | - Artem Kalinin
- Department “Gailezers”, Riga East Clinical University Hospital, LV-1038 Riga, Latvia; (A.K.); (Z.P.)
| | - Žanna Pičkure
- Department “Gailezers”, Riga East Clinical University Hospital, LV-1038 Riga, Latvia; (A.K.); (Z.P.)
| | - Katja Ažman Juvan
- Department of Cardiovascular Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia;
| | - Anja Zupan Mežnar
- Cardiology Department, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia;
| | - Augustine Coisne
- Department of Clinical Physiology and Echocardiography—Heart Valve Clinic, Lille University Hospital, 59800 Lille, France; (A.C.); (A.C.)
| | - Amandine Coppin
- Department of Clinical Physiology and Echocardiography—Heart Valve Clinic, Lille University Hospital, 59800 Lille, France; (A.C.); (A.C.)
| | - Mihaela Maria Opris
- Institute for Emergency Cardiovascular Diseases and Transplant of Targu Mures, 540136 Targu Mures, Romania; (M.M.O.); (D.O.N.)
| | - Dan Octavian Nistor
- Institute for Emergency Cardiovascular Diseases and Transplant of Targu Mures, 540136 Targu Mures, Romania; (M.M.O.); (D.O.N.)
| | - Riitta Paakkanen
- Heart and Lung Center, Helsinki University Hospital and Helsinki University, 00100 Helsinki, Finland;
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Copenhagen, Denmark; (T.B.-S.); (F.J.O.)
| | - Flemming Javier Olsen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Copenhagen, Denmark; (T.B.-S.); (F.J.O.)
| | - Tomas Lapinskas
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (T.L.); (J.J.V.)
| | - Jolanta Justina Vaškelyté
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (T.L.); (J.J.V.)
| | - Laura Galian-Gay
- Department of Cardiology, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (L.G.-G.); (G.C.)
| | - Guillem Casas
- Department of Cardiology, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (L.G.-G.); (G.C.)
| | - Andreea Iulia Motoc
- Centre for Cardiovascular Diseases, University Hospital of Brussels, B-1090 Brussels, Belgium; (A.I.M.); (B.C.)
| | | | - Savvas Loizos
- Korgialenio Benakio—Red Cross Hospital, 115 26 Athens, Greece; (C.H.P.); (S.L.)
| | - Gergely Ágoston
- Department of Family Medicine, University of Szeged, H-6725 Szeged, Hungary; (G.A.); (I.S.)
| | - Istvan Szabó
- Department of Family Medicine, University of Szeged, H-6725 Szeged, Hungary; (G.A.); (I.S.)
| | - Krasimira Hristova
- Department of Noninvasive Functional Diagnostic and Imaging, National Heart Hospital, 1309 Sofia, Bulgaria; (K.H.); (S.N.T.)
| | - Svetlin Netkov Tsonev
- Department of Noninvasive Functional Diagnostic and Imaging, National Heart Hospital, 1309 Sofia, Bulgaria; (K.H.); (S.N.T.)
| | - Elena Galli
- Centre Hospitalier Universitaire de Rennes, Inserm, University of Rennes, LTSI—UMR 1099, F-35000 Rennes, France; (E.G.); (E.D.)
| | - Dragos Vinereanu
- Department of Cardiology, University of Medicine and Pharmacy Carol Davila—Emergency and University Hospital, 050474 Bucharest, Romania; (D.V.); (S.M.B.)
| | - Sorina Mihaila Baldea
- Department of Cardiology, University of Medicine and Pharmacy Carol Davila—Emergency and University Hospital, 050474 Bucharest, Romania; (D.V.); (S.M.B.)
| | - Denisa Muraru
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35122 Padua, Italy; (G.S.); (D.M.)
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy; (G.E.M.); (M.C.P.); (S.M.)
| | - Erwan Donal
- Centre Hospitalier Universitaire de Rennes, Inserm, University of Rennes, LTSI—UMR 1099, F-35000 Rennes, France; (E.G.); (E.D.)
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II, University Hospital, 80131 Naples, Italy; (R.E.); (C.S.); (M.G.)
| | - Bernard Cosyns
- Centre for Cardiovascular Diseases, University Hospital of Brussels, B-1090 Brussels, Belgium; (A.I.M.); (B.C.)
| | - Thor Edvardsen
- Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, 0372 Oslo, Norway;
- Faculty of Medicine, University of Oslo, 0315 Oslo, Norway
| | - Bogdan A. Popescu
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila”—Euroecolab, Emergency Institute for Cardiovascular Diseases “Prof. Dr. C. C. Iliescu”, Sos. Fundeni 258, 022328 Bucharest, Romania;
| |
Collapse
|
7
|
Kajdič N, Zupan Mežnar A, Šinkovec M, Žižek D. Diagnostic yield of implantable loop recorders in patients with unexplained syncope: single-center experience. Minerva Cardiol Angiol 2020. [PMID: 32989968 DOI: 10.23736/s0026-4725.20.05247-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND A significant proportion of patients have syncope of uncertain etiology. While implantable loop recorder (ILR) has become an important diagnostic tool in diagnosing syncope, its contemporary role in accordance with the recently updated syncope guidelines is not well established. The purpose of this single-center retrospective study was to determine the diagnostic yield of ILR in patients with unexplained syncope following initial diagnostic work-up as recommended by the guidelines. METHODS Medical records of 100 consecutive patients with syncope or presyncope who received ILR following the recently updated recommended diagnostic work-up were retrospectively evaluated. RESULTS Seven patients were lost to follow-up (7%). During a median follow-up of 12 months (IQR 6.5-27.5), syncope or presyncope recurred in 61 patients (65.6%). In 37 (37/61, 60.7%), correlation between abnormal heart rhythm and symptoms was confirmed by ILR. Syncope was predominantly caused by bradyarrhythmia (33/37, 89.2%). Of the remaining four patients, three (8.1%) had ventricular tachycardia and one had atrial fibrillation with rapid ventricular response. Arrhythmogenic cause of syncope or presyncope was excluded in 24 patients (24/61, 39.3%) as no arrhythmia was recorded at the time of reported symptoms. Median time to establishing diagnosis was 354 days (171-783). CONCLUSIONS The diagnostic yield of ILR after initial inconclusive recommended diagnostic work-up in accordance with the relevant guidelines was high. The findings affirm ILR as an important diagnostic tool in contemporary management of syncope.
Collapse
Affiliation(s)
- Nina Kajdič
- Department of Cardiology, University Medical Center of Ljubljana, Ljubljana, Slovenia
| | - Anja Zupan Mežnar
- Department of Cardiology, University Medical Center of Ljubljana, Ljubljana, Slovenia
| | - Matjaž Šinkovec
- Department of Cardiology, University Medical Center of Ljubljana, Ljubljana, Slovenia
| | - David Žižek
- Department of Cardiology, University Medical Center of Ljubljana, Ljubljana, Slovenia -
| |
Collapse
|
8
|
Kajdič N, Zupan Mežnar A, Šinkovec M, Žižek D. Diagnostic yield of implantable loop recorders in patients with unexplained syncope: single-center experience. Minerva Cardiol Angiol 2020; 69:419-425. [PMID: 32989968 DOI: 10.23736/s2724-5683.20.05247-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND A significant proportion of patients have syncope of uncertain etiology. While implantable loop recorder (ILR) has become an important diagnostic tool in diagnosing syncope, its contemporary role in accordance with the recently updated syncope guidelines is not well established. The purpose of this single-center retrospective study was to determine the diagnostic yield of ILR in patients with unexplained syncope following initial diagnostic work-up as recommended by the guidelines. METHODS Medical records of 100 consecutive patients with syncope or presyncope who received ILR following the recently updated recommended diagnostic work-up were retrospectively evaluated. RESULTS Seven patients were lost to follow-up (7%). During a median follow-up of 12 months (IQR 6.5-27.5), syncope or presyncope recurred in 61 patients (65.6%). In 37 (37/61, 60.7%), correlation between abnormal heart rhythm and symptoms was confirmed by ILR. Syncope was predominantly caused by bradyarrhythmia (33/37, 89.2%). Of the remaining four patients, three (8.1%) had ventricular tachycardia and one had atrial fibrillation with rapid ventricular response. Arrhythmogenic cause of syncope or presyncope was excluded in 24 patients (24/61, 39.3%) as no arrhythmia was recorded at the time of reported symptoms. Median time to establishing diagnosis was 354 days (171-783). CONCLUSIONS The diagnostic yield of ILR after initial inconclusive recommended diagnostic work-up in accordance with the relevant guidelines was high. The findings affirm ILR as an important diagnostic tool in contemporary management of syncope.
Collapse
Affiliation(s)
- Nina Kajdič
- Department of Cardiology, University Medical Center of Ljubljana, Ljubljana, Slovenia
| | - Anja Zupan Mežnar
- Department of Cardiology, University Medical Center of Ljubljana, Ljubljana, Slovenia
| | - Matjaž Šinkovec
- Department of Cardiology, University Medical Center of Ljubljana, Ljubljana, Slovenia
| | - David Žižek
- Department of Cardiology, University Medical Center of Ljubljana, Ljubljana, Slovenia -
| |
Collapse
|
9
|
Zupan Mežnar A, Berden P, Lainščak M. Left ventricular metastasis of soft tissue sarcoma causing heart failure: Presentation of two cases. Int J Cardiol 2016; 219:119-20. [DOI: 10.1016/j.ijcard.2016.06.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 06/12/2016] [Indexed: 02/06/2023]
|