1
|
Bacharova L, Chevalier P, Gorenek B, Jons C, Li Y, Locati ET, Maanja M, Pérez‐Riera AR, Platonov PG, Ribeiro ALP, Schocken D, Soliman EZ, Svehlikova J, Tereshchenko LG, Ugander M, Varma N, Elena Z, Ikeda T. ISE/ISHNE expert consensus statement on the ECG diagnosis of left ventricular hypertrophy: The change of the paradigm. Ann Noninvasive Electrocardiol 2024; 29:e13097. [PMID: 37997698 PMCID: PMC10770819 DOI: 10.1111/anec.13097] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/30/2023] [Accepted: 11/01/2023] [Indexed: 11/25/2023] Open
Abstract
The ECG diagnosis of LVH is predominantly based on the QRS voltage criteria. The classical paradigm postulates that the increased left ventricular mass generates a stronger electrical field, increasing the leftward and posterior QRS forces, reflected in the augmented QRS amplitude. However, the low sensitivity of voltage criteria has been repeatedly documented. We discuss possible reasons for this shortcoming and proposal of a new paradigm. The theoretical background for voltage measured at the body surface is defined by the solid angle theorem, which relates the measured voltage to spatial and non-spatial determinants. The spatial determinants are represented by the extent of the activation front and the distance of the recording electrodes. The non-spatial determinants comprise electrical characteristics of the myocardium, which are comparatively neglected in the interpretation of the QRS patterns. Various clinical conditions are associated with LVH. These conditions produce considerable diversity of electrical properties alterations thereby modifying the resultant QRS patterns. The spectrum of QRS patterns observed in LVH patients is quite broad, including also left axis deviation, left anterior fascicular block, incomplete and complete left bundle branch blocks, Q waves, and fragmented QRS. Importantly, the QRS complex can be within normal limits. The new paradigm stresses the electrophysiological background in interpreting QRS changes, i.e., the effect of the non-spatial determinants. This postulates that the role of ECG is not to estimate LV size in LVH, but to understand and decode the underlying electrical processes, which are crucial in relation to cardiovascular risk assessment.
Collapse
Affiliation(s)
| | - Philippe Chevalier
- Neuromyogene InstituteClaude Bernard UniversityVilleurbanneFrance
- Service de RythmologieHospices Civils de LyonLyonFrance
| | - Bulent Gorenek
- Eskisehir Osmangazi University Cardiology DepartmentEskisehirTurkey
| | - Christian Jons
- Department of CardiologyRigshospitalet, Copenhagen University HospitalCopenhagenDenmark
| | - Yi‐Gang Li
- Department of Cardiology, Xinhua HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Emanuela T. Locati
- Department of Arrhythmology and ElectrophysiologyIRCCS Policlinico San DonatoMilanoItaly
| | - Maren Maanja
- Department of Clinical PhysiologyKarolinska University Hospital, and Karolinska InstitutetStockholmSweden
| | | | - Pyotr G. Platonov
- Department of Cardiology, Clinical SciencesLund UniversityLundSweden
| | - Antonio Luiz Pinho Ribeiro
- Internal Medicine, Faculdade de Medicina da Universidade Federal de Minas GeraisBelo HorizonteBrazil
- Telehealth Center, Hospital das Clínicas da Universidade Federal de Minas GeraisBelo HorizonteBrazil
| | - Douglas Schocken
- Division of Cardiology, Department of MedicineDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Elsayed Z. Soliman
- Section on Cardiovascular Medicine, Department of Medicine, Epidemiological Cardiology Research CenterWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Jana Svehlikova
- Institute of Measurement Sciences, Slovak Academy of SciencesBratislavaSlovak Republic
| | - Larisa G. Tereshchenko
- Department of Quantitative Health SciencesLerner Research Institute, Cleveland ClinicClevelandOhioUSA
| | - Martin Ugander
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Department of Clinical PhysiologyKarolinska InstituteStockholmSweden
| | - Niraj Varma
- Cardiac Pacing & ElectrophysiologyHeart and Vascular Institute, Cleveland ClinicClevelandOhioUSA
| | - Zaklyazminskaya Elena
- Medical Genetics LaboratoryPetrovsky National Research Centre of SurgeryMoscowRussia
| | | |
Collapse
|
2
|
Santinelli V, Ciconte G, Manguso F, Anastasia L, Micaglio E, Calovic Z, Vicedomini G, Mazza B, Vecchi M, Mecarocci V, Locati ET, Boccellino A, Negro G, Napolano A, Giannelli L, Pappone C. High-risk Brugada syndrome: factors associated with arrhythmia recurrence and benefits of epicardial ablation in addition to implantable cardioverter defibrillator implantation. Europace 2023; 26:euae019. [PMID: 38252933 PMCID: PMC10824473 DOI: 10.1093/europace/euae019] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 11/30/2023] [Accepted: 12/28/2023] [Indexed: 01/24/2024] Open
Abstract
AIMS This study aims to evaluate the prognostic impact of the arrhythmogenic substrate size in symptomatic Brugada syndrome (BrS) as well as to validate the long-term safety and effectiveness of epicardial radiofrequency ablation (RFA) compared with no-RFA group. METHODS AND RESULTS In this prospective investigational long-term registry study, 257 selected symptomatic BrS patients with implantable cardioverter defibrillator (ICD) implantation were included. Among them, 206 patients underwent epicardial RFA and were monitored for over 5 years post-ablation (RFA group), while 51 patients received only ICD implantation declining RFA. Primary endpoints included risk factors for ventricular fibrillation (VF) events pre-ablation and freedom from VF events post-ablation. In the RFA group, BrS substrates were identified in the epicardial surface of the right ventricle. During the pre-RFA follow-up period (median 27 months), VF episodes and VF storms were experienced by 53 patients. Independent risk factors included substrate size [hazard ratio (HR), 1.13; 95% confidence interval (CI), 1.08-1.18; P < 0.001], aborted cardiac arrest (HR, 2.98; 95% CI, 1.68-5.28; P < 0.001), and SCN5A variants (HR, 2.22; 95% CI, 1.15-4.27; P = 0.017). In the post-RFA follow-up (median 40 months), the RFA group demonstrated superior outcomes compared with no-RFA (P < 0.001) without major procedure-related complications. CONCLUSION Our study underscores the role of BrS substrate extent as a crucial prognostic factor for recurrent VF and validates the safety and efficacy of RFA when compared with a no-RFA group. Our findings highlight the importance of ajmaline in guiding epicardial mapping/ablation in symptomatic BrS patients, laying the groundwork for further exploration of non-invasive methods to guide informed clinical decision-making.
Collapse
Affiliation(s)
- Vincenzo Santinelli
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Giuseppe Ciconte
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Francesco Manguso
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Luigi Anastasia
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Emanuele Micaglio
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Zarko Calovic
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Gabriele Vicedomini
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Beniamino Mazza
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Mattia Vecchi
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Valerio Mecarocci
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Emanuela T Locati
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Antonio Boccellino
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Gabriele Negro
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Antonio Napolano
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Luigi Giannelli
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Carlo Pappone
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
- University Vita-Salute San Raffaele, Via Olgettina 58, 20132 Milan, Italy
| |
Collapse
|
3
|
Locati ET, Van Dam PM, Ciconte G, Heilbron F, Boonstra M, Vicedomini G, Micaglio E, Ćalović Ž, Anastasia L, Santinelli V, Pappone C. Electrocardiographic temporo-spatial assessment of depolarization and repolarization changes after epicardial arrhythmogenic substrate ablation in Brugada syndrome. Eur Heart J Digit Health 2023; 4:473-487. [PMID: 38045442 PMCID: PMC10689926 DOI: 10.1093/ehjdh/ztad050] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/16/2023] [Accepted: 08/25/2023] [Indexed: 12/05/2023]
Abstract
Aims In Brugada syndrome (BrS), with spontaneous or ajmaline-induced coved ST elevation, epicardial electro-anatomic potential duration maps (epi-PDMs) were detected on a right ventricle (RV) outflow tract (RVOT), an arrhythmogenic substrate area (AS area), abolished by epicardial-radiofrequency ablation (EPI-AS-RFA). Novel CineECG, projecting 12-lead electrocardiogram (ECG) waveforms on a 3D heart model, previously localized depolarization forces in RV/RVOT in BrS patients. We evaluate 12-lead ECG and CineECG depolarization/repolarization changes in spontaneous type-1 BrS patients before/after EPI-AS-RFA, compared with normal controls. Methods and results In 30 high-risk BrS patients (93% males, age 37 + 9 years), 12-lead ECGs and epi-PDMs were obtained at baseline, early after EPI-AS-RFA, and late follow-up (FU) (2.7-16.1 months). CineECG estimates temporo-spatial localization during depolarization (Early-QRS and Terminal-QRS) and repolarization (ST-Tpeak, Tpeak-Tend). Differences within BrS patients (baseline vs. early after EPI-AS-RFA vs. late FU) were analysed by Wilcoxon signed-rank test, while differences between BrS patients and 60 age-sex-matched normal controls were analysed by the Mann-Whitney test. In BrS patients, baseline QRS and QTc durations were longer and normalized after EPI-AS-ATC (151 ± 15 vs. 102 ± 13 ms, P < 0.001; 454 ± 40 vs. 421 ± 27 ms, P < 0.000). Baseline QRS amplitude was lower and increased at late FU (0.63 ± 0.26 vs. 0.84 ± 13 ms, P < 0.000), while Terminal-QRS amplitude decreased (0.24 ± 0.07 vs. 0.08 ± 0.03 ms, P < 0.000). At baseline, CineECG depolarization/repolarization wavefront prevalently localized in RV/RVOT (Terminal-QRS, 57%; ST-Tpeak, 100%; and Tpeak-Tend, 61%), congruent with the AS area on epi-PDM. Early after EPI-AS-RFA, RV/RVOT localization during depolarization disappeared, as Terminal-QRS prevalently localized in the left ventricle (LV, 76%), while repolarization still localized on RV/RVOT [ST-Tpeak (44%) and Tpeak-Tend (98%)]. At late FU, depolarization/repolarization forces prevalently localized in the LV (Terminal-QRS, 94%; ST-Tpeak, 63%; Tpeak-Tend, 86%), like normal controls. Conclusion CineECG and 12-lead ECG showed a complex temporo-spatial perturbation of both depolarization and repolarization in BrS patients, prevalently localized in RV/RVOT, progressively normalizing after epicardial ablation.
Collapse
Affiliation(s)
- Emanuela T Locati
- Arrhythmology-Electrophysiology Department, IRCCS Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Peter M Van Dam
- Cardiology Department, Utrecht University Medical Center, Heidelberglaan 100, 3584 CX, Utrecht, Netherlands
- Center for Digital Medicine and Robotics, Jagiellonian University Medical College, Kopernika 7e, 31-034 Kraków, Poland
| | - Giuseppe Ciconte
- Arrhythmology-Electrophysiology Department, IRCCS Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Francesca Heilbron
- Milano Bicocca University, Istituto Auxologico, Via Thomas Mann 8, 20162 Milan, Italy
| | - Machteld Boonstra
- Cardiology Department, Utrecht University Medical Center, Heidelberglaan 100, 3584 CX, Utrecht, Netherlands
| | - Gabriele Vicedomini
- Arrhythmology-Electrophysiology Department, IRCCS Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Emanuele Micaglio
- Arrhythmology-Electrophysiology Department, IRCCS Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Žarko Ćalović
- Arrhythmology-Electrophysiology Department, IRCCS Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Luigi Anastasia
- Arrhythmology-Electrophysiology Department, IRCCS Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
- Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
| | - Vincenzo Santinelli
- Arrhythmology-Electrophysiology Department, IRCCS Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Carlo Pappone
- Arrhythmology-Electrophysiology Department, IRCCS Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
- Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
| |
Collapse
|
4
|
Bacharova L, Chevalier P, Gorenek B, Jons C, Li YG, Locati ET, Maanja M, Pérez-Riera AR, Platonov PG, Ribeiro ALP, Schocken D, Soliman EZ, Svehlikova J, Tereshchenko LG, Ugander M, Varma N, Zaklyazminskaya E, Ikeda T. ISE/ISHNE Expert Consensus Statement on ECG Diagnosis of Left Ventricular Hypertrophy: The Change of the Paradigm. The joint paper of the International Society of Electrocardiology and the International Society for Holter Monitoring and Noninvasive Electrocardiology. J Electrocardiol 2023; 81:85-93. [PMID: 37647776 DOI: 10.1016/j.jelectrocard.2023.08.005] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 09/01/2023]
Abstract
The ECG diagnosis of LVH is predominantly based on the QRS voltage criteria, i.e. the increased QRS complex amplitude in defined leads. The classical ECG diagnostic paradigm postulates that the increased left ventricular mass generates a stronger electrical field, increasing the leftward and posterior QRS forces. These increased forces are reflected in the augmented QRS amplitude in the corresponding leads. However, the clinical observations document increased QRS amplitude only in the minority of patients with LVH. The low sensitivity of voltage criteria has been repeatedly documented. We discuss possible reasons for this shortcoming and proposal of a new paradigm.
Collapse
Affiliation(s)
- Ljuba Bacharova
- International Laser Center CVTI, Ilkovicova 3, 841 04 Bratislava, Slovak Republic.
| | - Philippe Chevalier
- Neuromyogene Institute, Claude Bernard University, Lyon 1, Villeurbanne, France; Service de Rythmologie, Hospices Civils de Lyon, Lyon, France.
| | - Bulent Gorenek
- Eskisehir Osmangazi University, Cardiology Department, Eskisehir, Turkiye.
| | - Christian Jons
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Yi-Gang Li
- Department of Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 200092 Shanghai, PR China.
| | - Emanuela T Locati
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, Piazza E. Malan 2, 20097 San Donato Milanese, Milano, Italy.
| | - Maren Maanja
- Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
| | | | - Pyotr G Platonov
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
| | - Antonio Luiz P Ribeiro
- Internal Medicine, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Telehealth Center, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Douglas Schocken
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center, Section on Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Jana Svehlikova
- Institute of Measurement Sciences, Slovak Academy of Sciences, Bratislava, Slovak Republic.
| | - Larisa G Tereshchenko
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave JJN3-01, Cleveland, OH 44195, USA.
| | - Martin Ugander
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Clinical Physiology, Karolinska Institute, Stockholm, Stockholm, Sweden
| | - Niraj Varma
- Cardiac Pacing & Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH 44195, USA.
| | - Elena Zaklyazminskaya
- Medical Genetics Laboratory, Petrovsky National Research Centre of Surgery, Moscow 119991, Russia
| | | |
Collapse
|
5
|
Pappone C, Ciconte G, Anastasia L, Gaita F, Grant E, Micaglio E, Locati ET, Calovic Z, Vicedomini G, Santinelli V. Right ventricular epicardial arrhythmogenic substrate in long-QT syndrome patients at risk of sudden death. Europace 2023; 25:948-955. [PMID: 36610790 PMCID: PMC10062343 DOI: 10.1093/europace/euac264] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/16/2022] [Indexed: 01/09/2023] Open
Abstract
AIMS The long-QT syndrome (LQTS) represents a leading cause of sudden cardiac death (SCD). The aim of this study was to assess the presence of an underlying electroanatomical arrhythmogenic substrate in high-risk LQTS patients. METHODS AND RESULTS The present study enrolled 11 consecutive LQTS patients who had experienced frequent implantable cardioverter-defibrillator (ICD discharges triggered by ventricular fibrillation (VF). We acquired electroanatomical biventricular maps of both endo and epicardial regions for all patients and analyzed electrograms sampled from several myocardial regions. Abnormal electrical activities were targeted and eliminated by the means of radiofrequency catheter ablation. VF episodes caused a median of four ICD discharges in eleven patients (6 male, 54.5%; mean age 44.0 ± 7.8 years, range 22-53) prior to our mapping and ablation procedures. The average QTc interval was 500.0 ± 30.2 ms. Endo-epicardial biventricular maps displayed abnormally fragmented, low-voltage (0.9 ± 0.2 mV) and prolonged electrograms (89.9 ± 24.1 ms) exclusively localized in the right ventricular epicardium. We found electrical abnormalities extending over a mean epicardial area of 15.7 ± 3.1 cm2. Catheter ablation of the abnormal epicardial area completely suppressed malignant arrhythmias over a mean 12 months of follow-up (median VF episodes before vs. after ablation, 4 vs. 0; P = 0.003). After the procedure, the QTc interval measured in a 12-lead ECG analysis shortened to a mean of 461.8 ± 23.6 ms (P = 0.004). CONCLUSION This study reveals that, among high-risk LQTS patients, regions localized in the epicardium of the right ventricle harbour structural electrophysiological abnormalities. Elimination of these abnormal electrical activities successfully prevented malignant ventricular arrhythmia recurrences.
Collapse
Affiliation(s)
- Carlo Pappone
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, piazza Malan 2, 20097 San Donato Milanese, Milano, Italy
- Vita-Salute San Raffaele University, via Olgettina 58, 20132 Milano, Italy
- Institute of Molecular and Translational Cardiology (IMTC), piazza Malan 2, 20097, San Donato Milanese, Milan, Italy
| | - Giuseppe Ciconte
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, piazza Malan 2, 20097 San Donato Milanese, Milano, Italy
- Institute of Molecular and Translational Cardiology (IMTC), piazza Malan 2, 20097, San Donato Milanese, Milan, Italy
| | - Luigi Anastasia
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, piazza Malan 2, 20097 San Donato Milanese, Milano, Italy
- Vita-Salute San Raffaele University, via Olgettina 58, 20132 Milano, Italy
- Institute of Molecular and Translational Cardiology (IMTC), piazza Malan 2, 20097, San Donato Milanese, Milan, Italy
| | - Fiorenzo Gaita
- Department of Medical Sciences, Città della Salute e Della Scienza, University of Torino, Corso Bramante 88, 10126 Torino, Italy
| | - Edward Grant
- Institute of Molecular and Translational Cardiology (IMTC), piazza Malan 2, 20097, San Donato Milanese, Milan, Italy
- Department of Chemistry and Department of Physics & Astronomy, The University of British Columbia, 2036 Main Mall, Vancouver, BC V6T1Z1, Canada
| | - Emanuele Micaglio
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, piazza Malan 2, 20097 San Donato Milanese, Milano, Italy
- Institute of Molecular and Translational Cardiology (IMTC), piazza Malan 2, 20097, San Donato Milanese, Milan, Italy
| | - Emanuela T Locati
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, piazza Malan 2, 20097 San Donato Milanese, Milano, Italy
| | - Zarko Calovic
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, piazza Malan 2, 20097 San Donato Milanese, Milano, Italy
| | - Gabriele Vicedomini
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, piazza Malan 2, 20097 San Donato Milanese, Milano, Italy
- Institute of Molecular and Translational Cardiology (IMTC), piazza Malan 2, 20097, San Donato Milanese, Milan, Italy
| | - Vincenzo Santinelli
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, piazza Malan 2, 20097 San Donato Milanese, Milano, Italy
| |
Collapse
|
6
|
Locati ET, Pappone C, Heilbron F, van Dam PM. CineECG provides a novel anatomical view on the normal atrial P-wave. Eur Heart J Digit Health 2022; 3:169-180. [PMID: 36713023 PMCID: PMC9708036 DOI: 10.1093/ehjdh/ztac007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/09/2022] [Accepted: 02/03/2022] [Indexed: 02/01/2023]
Abstract
Aims Novel CineECG computed from standard 12-lead electrocardiogram (ECG) correlated the ventricular electric activity to ventricular anatomy. CineECG was never applied to reconstruct the spatial distribution of normal atrial electric activity into an atrial anatomic model. Methods and results From 6409 normal ECGs from PTB-XL database, we computed a median beat with fiducial points for P-and Q-onset. To determine the temporo-spatial location of atrial activity during PQ-interval, CineECG was computed on a normal 58-year-old male atrial/torso model. CineECG was projected to three major cardiac axes: posterior-anterior, right-left, base-roof, and to the standard cardiac four-chamber, left anterior oblique, and right anterior oblique (RAO) views. In 6409 normal subjects, during P-wave, CineECG moved homogeneously from right atrial roof towards left atrial base (-54 ± 14° in four-chamber view, 95 ± 24° RAO view). During terminal PQ-interval, the CineECG direction was opposite, moving towards left atrial roof (62 ± 27° in four-chamber view, 78 ± 27° RAO view). We identified the deflection point, where the atrial CineECG changes in direction. The time from P-onset to deflection point was similar to P-wave duration. Conclusion CineECG provided a novel three-dimensional visualization of atrial electrical activity during the PQ-interval, relating atrial electrical activity to the atrial anatomy. CineECG location during P-wave and terminal PQ-interval were homogeneous within normal controls. CineECG and its deflection point may enable the early detection of atrial conduction disorders predisposing to atrial arrhythmias.
Collapse
Affiliation(s)
- Emanuela T Locati
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, Milano, Italy
| | - Carlo Pappone
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, Milano, Italy,University San Raffaele Vita & Salute, Milano, Italy
| | | | | |
Collapse
|
7
|
Van Dam PM, Locati ET, Ciconte G, Borrelli V, Santinelli V, Vicedomini G, Monasky MM, Micaglio E, Giannelli L, Mecarocci V, Calovic Z, Pappone C. The electro-anatomical pathway for normal and bundle branch block ECGs. J Electrocardiol 2021. [DOI: 10.1016/j.jelectrocard.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
8
|
Boonstra MJ, Hilderink BN, Locati ET, Asselbergs FW, Loh P, van Dam PM. Novel CineECG enables anatomical 3D localization and classification of bundle branch blocks. Europace 2021; 23:i80-i87. [PMID: 33751077 DOI: 10.1093/europace/euaa396] [Citation(s) in RCA: 6] [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] [Received: 11/21/2020] [Accepted: 12/03/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS Ventricular conduction disorders can induce arrhythmias and impair cardiac function. Bundle branch blocks (BBBs) are diagnosed by 12-lead electrocardiogram (ECG), but discrimination between BBBs and normal tracings can be challenging. CineECG computes the temporo-spatial trajectory of activation waveforms in a 3D heart model from 12-lead ECGs. Recently, in Brugada patients, CineECG has localized the terminal components of ventricular depolarization to right ventricle outflow tract (RVOT), coincident with arrhythmogenic substrate localization detected by epicardial electro-anatomical maps. This abnormality was not found in normal or right BBB (RBBB) patients. This study aimed at exploring whether CineECG can improve the discrimination between left BBB (LBBB)/RBBB, and incomplete RBBB (iRBBB). METHODS AND RESULTS We utilized 500 12-lead ECGs from the online Physionet-XL-PTB-Diagnostic ECG Database with a certified ECG diagnosis. The mean temporo-spatial isochrone trajectory was calculated and projected into the anatomical 3D heart model. We established five CineECG classes: 'Normal', 'iRBBB', 'RBBB', 'LBBB', and 'Undetermined', to which each tracing was allocated. We determined the accuracy of CineECG classification with the gold standard diagnosis. A total of 391 ECGs were analysed (9 ECGs were excluded for noise) and 240/266 were correctly classified as 'normal', 14/17 as 'iRBBB', 55/55 as 'RBBB', 51/51 as 'LBBB', and 31 as 'undetermined'. The terminal mean temporal spatial isochrone contained most information about the BBB localization. CONCLUSION CineECG provided the anatomical localization of different BBBs and accurately differentiated between normal, LBBB and RBBB, and iRBBB. CineECG may aid clinical diagnostic work-up, potentially contributing to the difficult discrimination between normal, iRBBB, and Brugada patients.
Collapse
Affiliation(s)
- Machteld J Boonstra
- Division Heart & Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht 3508 GA, Heidelberglaan 100, Utrecht, The Netherlands
| | - Bashar N Hilderink
- Division Heart & Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht 3508 GA, Heidelberglaan 100, Utrecht, The Netherlands
| | - Emanuela T Locati
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, Milano, Italy
| | - Folkert W Asselbergs
- Division Heart & Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht 3508 GA, Heidelberglaan 100, Utrecht, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands.,Institute of Cardiovascular Science, Institute of Health Informatics, Faculty of Population Health Sciences, University College London, London, UK
| | - Peter Loh
- Division Heart & Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht 3508 GA, Heidelberglaan 100, Utrecht, The Netherlands
| | - Peter M van Dam
- Division Heart & Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht 3508 GA, Heidelberglaan 100, Utrecht, The Netherlands.,ECG Excellence BV, Nieuwerbrug aan den Rijn, The Netherlands
| |
Collapse
|
9
|
van Dam PM, Boonstra M, Locati ET, Loh P. The relation of 12 lead ECG to the cardiac anatomy: The normal CineECG. J Electrocardiol 2021; 69S:67-74. [PMID: 34325899 DOI: 10.1016/j.jelectrocard.2021.07.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/02/2021] [Accepted: 07/17/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The interpretation of the 12‑lead ECG is notoriously difficult and requires experts to distinguish normal from abnormal ECG waveforms. ECG waveforms depend on body build and electrode positions, both often different in males and females. To relate the ECG waveforms to cardiac anatomical structures is even more difficult. The novel CineECG algorithm enables a direct projection of the 12‑lead ECG to the cardiac anatomy by computing the mean location of cardiac activity over time. The aim of this study is to investigate the cardiac locations of the CineECG derived from standard 12‑lead ECGs of normal subjects. METHODS In this study we used 6525 12‑lead ECG tracings labelled as normal obtained from the certified Physionet PTB XL Diagnostic ECG Database to construct the CineECG. All 12 lead ECGs were analyzed, and then divided by age groups (18-29,30-39,40-49,50-59,60-69,70-100 years) and by gender (male/female). For each ECG, we computed the CineECG within a generic 3D heart/torso model. Based on these CineECG's, the average normal cardiac location and direction for QRS, STpeak, and TpeakTend segments were determined. RESULTS The CineECG direction for the QRS segment showed large variation towards the left free wall, whereas the STT segments were homogeneously directed towards the septal/apical region. The differences in the CineECG location for the QRS, STpeak, and TpeakTend between the age and gender groups were relatively small (maximally 10 mm at end T-wave), although between the gender groups minor differences were found in the 4 chamber direction angles (QRS 4°, STpeak 5°, and TpeakTend 8°) and LAO (QRS 1°, STpeak 13°, and TpeakTend 30°). CONCLUSION CineECG demonstrated to be a feasible and pragmatic solution for ECG waveform interpretation, relating the ECG directly to the cardiac anatomy. The variations in depolarization and repolarization CineECG were small within this group of normal healthy controls, both in cardiac location as well as in direction. CineECG may enable an easier discrimination between normal and abnormal QRS and T-wave morphologies, reducing the amount of expert training. Further studies are needed to prove whether novel CineECG can significantly contribute to the discrimination of normal versus abnormal ECG tracings.
Collapse
Affiliation(s)
- Peter M van Dam
- Department of Cardiology, University Medical Center Utrecht, the Netherlands; ECG Excellence BV, Nieuwerbrug aan den Rijn, Netherlands.
| | - Machteld Boonstra
- Department of Cardiology, University Medical Center Utrecht, the Netherlands
| | - Emanuela T Locati
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, Milano, Italy
| | - Peter Loh
- Department of Cardiology, University Medical Center Utrecht, the Netherlands
| |
Collapse
|
10
|
Ciconte G, Monasky MM, Santinelli V, Micaglio E, Vicedomini G, Anastasia L, Negro G, Borrelli V, Giannelli L, Santini F, de Innocentiis C, Rondine R, Locati ET, Bernardini A, Mazza BC, Mecarocci V, Ćalović Ž, Ghiroldi A, D'Imperio S, Benedetti S, Di Resta C, Rivolta I, Casari G, Petretto E, Pappone C. Brugada syndrome genetics is associated with phenotype severity. Eur Heart J 2021; 42:1082-1090. [PMID: 33221895 PMCID: PMC7955973 DOI: 10.1093/eurheartj/ehaa942] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/02/2020] [Accepted: 11/02/2020] [Indexed: 12/14/2022] Open
Abstract
Aims Brugada syndrome (BrS) is associated with an increased risk of sudden cardiac death due to ventricular tachycardia/fibrillation (VT/VF) in young, otherwise healthy individuals. Despite SCN5A being the most commonly known mutated gene to date, the genotype–phenotype relationship is poorly understood and remains uncertain. This study aimed to elucidate the genotype–phenotype correlation in BrS. Methods and results Brugada syndrome probands deemed at high risk of future arrhythmic events underwent genetic testing and phenotype characterization by the means of epicardial arrhythmogenic substrate (AS) mapping, and were divided into two groups according to the presence or absence of SCN5A mutation. Two-hundred probands (160 males, 80%; mean age 42.6 ± 12.2 years) were included in this study. Patients harbouring SCN5A mutations exhibited a spontaneous type 1 pattern and experienced aborted cardiac arrest or spontaneous VT/VF more frequently than the other subjects. SCN5A-positive patients exhibited a larger epicardial AS area, more prolonged electrograms and more frequently observed non-invasive late potentials. The presence of an SCN5A mutation explained >26% of the variation in the epicardial AS area and was the strongest predictor of a large epicardial area. Conclusion In BrS, the genetic background is the main determinant for the extent of the electrophysiological abnormalities. SCN5A mutation carriers exhibit more pronounced epicardial electrical abnormalities and a more aggressive clinical presentation. These results contribute to the understanding of the genetic determinants of the BrS phenotypic expression and provide possible explanations for the varying degrees of disease expression. ![]()
Collapse
Affiliation(s)
- Giuseppe Ciconte
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Michelle M Monasky
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Vincenzo Santinelli
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Emanuele Micaglio
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Gabriele Vicedomini
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Luigi Anastasia
- Stem Cells for Tissue Engineering Laboratory, IRCCS Policlinico San Donato, piazza Malan 2, 20097 San Donato Milanese, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Gabriele Negro
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Valeria Borrelli
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Luigi Giannelli
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Francesca Santini
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Carlo de Innocentiis
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Roberto Rondine
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Emanuela T Locati
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Andrea Bernardini
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Beniamino C Mazza
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Valerio Mecarocci
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Žarko Ćalović
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy
| | - Andrea Ghiroldi
- Stem Cells for Tissue Engineering Laboratory, IRCCS Policlinico San Donato, piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Sara D'Imperio
- Stem Cells for Tissue Engineering Laboratory, IRCCS Policlinico San Donato, piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Sara Benedetti
- Clinical Genomics - SMEL, IRCCS San Raffaele Hospital, Milan, Italy
| | - Chiara Di Resta
- Vita-Salute San Raffaele University, Milan, Italy.,Clinical Genomics - SMEL, IRCCS San Raffaele Hospital, Milan, Italy
| | - Ilaria Rivolta
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Giorgio Casari
- Vita-Salute San Raffaele University, Milan, Italy.,Clinical Genomics - SMEL, IRCCS San Raffaele Hospital, Milan, Italy
| | - Enrico Petretto
- Programme in Cardiovascular and Metabolic Disorders and Centre for Computational Biology, Duke-NUS Medical School Singapore, Republic of Singapore
| | - Carlo Pappone
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
11
|
Micaglio E, Locati ET, Monasky MM, Romani F, Heilbron F, Pappone C. Role of Pharmacogenetics in Adverse Drug Reactions: An Update towards Personalized Medicine. Front Pharmacol 2021; 12:651720. [PMID: 33995067 PMCID: PMC8120428 DOI: 10.3389/fphar.2021.651720] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/29/2021] [Indexed: 12/28/2022] Open
Abstract
Adverse drug reactions (ADRs) are an important and frequent cause of morbidity and mortality. ADR can be related to a variety of drugs, including anticonvulsants, anaesthetics, antibiotics, antiretroviral, anticancer, and antiarrhythmics, and can involve every organ or apparatus. The causes of ADRs are still poorly understood due to their clinical heterogeneity and complexity. In this scenario, genetic predisposition toward ADRs is an emerging issue, not only in anticancer chemotherapy, but also in many other fields of medicine, including hemolytic anemia due to glucose-6-phosphate dehydrogenase (G6PD) deficiency, aplastic anemia, porphyria, malignant hyperthermia, epidermal tissue necrosis (Lyell's Syndrome and Stevens-Johnson Syndrome), epilepsy, thyroid diseases, diabetes, Long QT and Brugada Syndromes. The role of genetic mutations in the ADRs pathogenesis has been shown either for dose-dependent or for dose-independent reactions. In this review, we present an update of the genetic background of ADRs, with phenotypic manifestations involving blood, muscles, heart, thyroid, liver, and skin disorders. This review aims to illustrate the growing usefulness of genetics both to prevent ADRs and to optimize the safe therapeutic use of many common drugs. In this prospective, ADRs could become an untoward "stress test," leading to new diagnosis of genetic-determined diseases. Thus, the wider use of pharmacogenetic testing in the work-up of ADRs will lead to new clinical diagnosis of previously unsuspected diseases and to improved safety and efficacy of therapies. Improving the genotype-phenotype correlation through new lab techniques and implementation of artificial intelligence in the future may lead to personalized medicine, able to predict ADR and consequently to choose the appropriate compound and dosage for each patient.
Collapse
Affiliation(s)
- Emanuele Micaglio
- Arrhythmology and Electrophysiology Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Emanuela T Locati
- Arrhythmology and Electrophysiology Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Michelle M Monasky
- Arrhythmology and Electrophysiology Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Federico Romani
- Arrhythmology and Electrophysiology Department, IRCCS Policlinico San Donato, Milan, Italy.,Vita-Salute San Raffaele University, (Vita-Salute University) for Federico Romani, Milan, Italy
| | | | - Carlo Pappone
- Arrhythmology and Electrophysiology Department, IRCCS Policlinico San Donato, Milan, Italy.,Vita-Salute San Raffaele University, (Vita-Salute University) for Federico Romani, Milan, Italy
| |
Collapse
|
12
|
Monasky MM, Micaglio E, Locati ET, Pappone C. Evaluating the Use of Genetics in Brugada Syndrome Risk Stratification. Front Cardiovasc Med 2021; 8:652027. [PMID: 33969014 PMCID: PMC8096997 DOI: 10.3389/fcvm.2021.652027] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/24/2021] [Indexed: 12/19/2022] Open
Abstract
The evolution of the current dogma surrounding Brugada syndrome (BrS) has led to a significant debate about the real usefulness of genetic testing in this syndrome. Since BrS is defined by a particular electrocardiogram (ECG) pattern, after ruling out certain possible causes, this disease has come to be defined more for what it is not than for what it is. Extensive research is required to understand the effects of specific individual variants, including modifiers, rather than necessarily grouping together, for example, “all SCN5A variants” when trying to determine genotype-phenotype relationships, because not all variants within a particular gene act similarly. Genetic testing, including whole exome or whole genome testing, and family segregation analysis should always be performed when possible, as this is necessary to advance our understanding of the genetics of this condition. All considered, BrS should no longer be considered a pure autosomal dominant disorder, but an oligogenic condition. Less common patterns of inheritance, such as recessive, X–linked, or mitochondrial may exist. Genetic testing, in our opinion, should not be used for diagnostic purposes. However, variants in SCN5A can have a prognostic value. Patients should be diagnosed and treated per the current guidelines, after an arrhythmologic examination, based on the presence of the specific BrS ECG pattern. The genotype characterization should come in a second stage, particularly in order to guide the familial diagnostic work-up. In families in which an SCN5A pathogenic variant is found, genetic testing could possibly contribute to the prognostic risk stratification.
Collapse
Affiliation(s)
| | - Emanuele Micaglio
- Arrhythmology Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Emanuela T Locati
- Arrhythmology Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Carlo Pappone
- Arrhythmology Department, IRCCS Policlinico San Donato, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
13
|
Micaglio E, Monasky MM, Bernardini A, Mecarocci V, Borrelli V, Ciconte G, Locati ET, Piccoli M, Ghiroldi A, Anastasia L, Pappone C. Clinical Considerations for a Family with Dilated Cardiomyopathy, Sudden Cardiac Death, and a Novel TTN Frameshift Mutation. Int J Mol Sci 2021; 22:ijms22020670. [PMID: 33445410 PMCID: PMC7826882 DOI: 10.3390/ijms22020670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/31/2020] [Accepted: 01/05/2021] [Indexed: 12/15/2022] Open
Abstract
Dilated cardiomyopathy (DCM) is the leading indication for heart transplantation. TTN gene truncating mutations account for about 25% of familial DCM cases and for 18% of sporadic DCM cases. The clinical relevance of specific variants in TTN has been difficult to determine because of the sheer size of the protein for which TTN encodes, as well as existing extensive genetic variation. Clinicians should communicate novel clinically-relevant variants and genotype–phenotype associations, so that animal studies evaluating the molecular mechanisms are always conducted with a focus on clinical significance. In the present study, we report for the first time the novel truncating heterozygous variant NM_001256850.1:c.72777_72783del (p.Phe24259Leufs*51) in the TTN gene and its association with DCM in a family with sudden death. This variant occurs in the A-band region of the sarcomere, in a known mutational hotspot of the gene. Truncating titin variants that occur in this region are the most common cause of DCM and have been rarely reported in asymptomatic individuals, differently from other pathogenic TTN gene variants. Further studies are warranted to better understand this particular clinically-relevant variant.
Collapse
Affiliation(s)
- Emanuele Micaglio
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza Edmondo Malan 1, San Donato Milanese, 20097 Milan, Italy; (E.M.); (M.M.M.); (A.B.); (V.M.); (V.B.); (G.C.); (E.T.L.)
| | - Michelle M. Monasky
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza Edmondo Malan 1, San Donato Milanese, 20097 Milan, Italy; (E.M.); (M.M.M.); (A.B.); (V.M.); (V.B.); (G.C.); (E.T.L.)
| | - Andrea Bernardini
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza Edmondo Malan 1, San Donato Milanese, 20097 Milan, Italy; (E.M.); (M.M.M.); (A.B.); (V.M.); (V.B.); (G.C.); (E.T.L.)
| | - Valerio Mecarocci
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza Edmondo Malan 1, San Donato Milanese, 20097 Milan, Italy; (E.M.); (M.M.M.); (A.B.); (V.M.); (V.B.); (G.C.); (E.T.L.)
| | - Valeria Borrelli
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza Edmondo Malan 1, San Donato Milanese, 20097 Milan, Italy; (E.M.); (M.M.M.); (A.B.); (V.M.); (V.B.); (G.C.); (E.T.L.)
| | - Giuseppe Ciconte
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza Edmondo Malan 1, San Donato Milanese, 20097 Milan, Italy; (E.M.); (M.M.M.); (A.B.); (V.M.); (V.B.); (G.C.); (E.T.L.)
| | - Emanuela T. Locati
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza Edmondo Malan 1, San Donato Milanese, 20097 Milan, Italy; (E.M.); (M.M.M.); (A.B.); (V.M.); (V.B.); (G.C.); (E.T.L.)
| | - Marco Piccoli
- Laboratory of Stem Cells for Tissue Engineering, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy; (M.P.); (A.G.); (L.A.)
| | - Andrea Ghiroldi
- Laboratory of Stem Cells for Tissue Engineering, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy; (M.P.); (A.G.); (L.A.)
| | - Luigi Anastasia
- Laboratory of Stem Cells for Tissue Engineering, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy; (M.P.); (A.G.); (L.A.)
- Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Carlo Pappone
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza Edmondo Malan 1, San Donato Milanese, 20097 Milan, Italy; (E.M.); (M.M.M.); (A.B.); (V.M.); (V.B.); (G.C.); (E.T.L.)
- Vita-Salute San Raffaele University, 20132 Milan, Italy
- Correspondence: ; Tel.: +39-0252774260; Fax: +39-0252774306
| |
Collapse
|
14
|
Abstract
Sudden cardiac death results from arrhythmias commonly caused by channelopathies and cardiomyopathies, often due to several genetic factors. An emerging concept is that these disease states may in fact overlap, with variants in traditionally classified ‘cardiomyopathy genes’ resulting in ‘channelopathies phenotypes’. Another important concept is the influence of both genetic and non-genetic factors in disease expression, leading to the utilization of systems biology approaches, such as genomics/epigenomics, transcriptomics, proteomics, metabolomics, lipidomics, and glycomics, to understand the disease severity and progression and to determine the prognosis and the best course of treatment. In fact, our group has discovered significant differences in metabolites, proteins, and lipids between controls and Brugada syndrome patients. Omics approaches are useful in overcoming the dogma that both channelopathies and cardiomyopathies exist as Mendelian disorders (caused by a mutation in a single gene). This shift in understanding could lead to new diagnostic and therapeutic approaches.
Collapse
Affiliation(s)
- Carlo Pappone
- Arrhythmology and Electrophysiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Emanuele Micaglio
- Arrhythmology and Electrophysiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Emanuela T Locati
- Arrhythmology and Electrophysiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Michelle M Monasky
- Arrhythmology and Electrophysiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| |
Collapse
|
15
|
Monasky MM, Micaglio E, Vicedomini G, Locati ET, Ciconte G, Giannelli L, Giordano F, Crisà S, Vecchi M, Borrelli V, Ghiroldi A, D'Imperio S, Di Resta C, Benedetti S, Ferrari M, Santinelli V, Anastasia L, Pappone C. Comparable clinical characteristics in Brugada syndrome patients harboring SCN5A or novel SCN10A variants. Europace 2020; 21:1550-1558. [PMID: 31292628 DOI: 10.1093/europace/euz186] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 03/25/2019] [Accepted: 06/10/2019] [Indexed: 12/19/2022] Open
Abstract
AIMS The Brugada syndrome (BrS) is an inherited disease associated with an increased risk of sudden cardiac death. Often, the genetic cause remains undetected. Perhaps due at least in part because the NaV1.8 protein is expressed more in both the central and peripheral nervous systems than in the heart, the SCN10A gene is not included in diagnostic arrhythmia/sudden death panels in the vast majority of cardiogenetics centres. METHODS AND RESULTS Clinical characteristics were assessed in patients harboring either SCN5A or novel SCN10A variants. Genetic testing was performed using Next Generation Sequencing on genomic DNA. Clinical characteristics, including the arrhythmogenic substrate, in BrS patients harboring novel SCN10A variants and SCN5A variants are comparable. Clinical characteristics, including gender, age, personal history of cardiac arrest/syncope, spontaneous BrS electrocardiogram pattern, family history of sudden death, and arrhythmic substrate are not significantly different between probands harboring SCN10A or SCN5A variants. CONCLUSION Future studies are warranted to further characterize the role of these specific SCN10A variants.
Collapse
Affiliation(s)
- Michelle M Monasky
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy
| | - Emanuele Micaglio
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy
| | - Gabriele Vicedomini
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy
| | - Emanuela T Locati
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy
| | - Giuseppe Ciconte
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy
| | - Luigi Giannelli
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy
| | - Federica Giordano
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy
| | - Simonetta Crisà
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy
| | - Mattia Vecchi
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy
| | - Valeria Borrelli
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy
| | - Andrea Ghiroldi
- Stem Cells for Tissue Engineering Laboratory, IRCCS Policlinico San Donato, Piazza Malan 2, San Donato Milanese, Milan, Italy
| | - Sara D'Imperio
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy.,Stem Cells for Tissue Engineering Laboratory, IRCCS Policlinico San Donato, Piazza Malan 2, San Donato Milanese, Milan, Italy
| | - Chiara Di Resta
- Genomic Unit for the Diagnosis of Human Pathologies, Division of Genetics and Cellular Biology, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Sara Benedetti
- Laboratory of Clinical Molecular Biology and Cytogenetics, IRCCS San Raffaele Hospital, Milan, Italy
| | - Maurizio Ferrari
- Genomic Unit for the Diagnosis of Human Pathologies, Division of Genetics and Cellular Biology, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy.,Laboratory of Clinical Molecular Biology and Cytogenetics, IRCCS San Raffaele Hospital, Milan, Italy
| | - Vincenzo Santinelli
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy
| | - Luigi Anastasia
- Stem Cells for Tissue Engineering Laboratory, IRCCS Policlinico San Donato, Piazza Malan 2, San Donato Milanese, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Via Luigi Mangiagalli 31, Milan, Italy
| | - Carlo Pappone
- Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, Milano, Italy
| |
Collapse
|
16
|
van Dam PM, Locati ET, Ciconte G, Borrelli V, Heilbron F, Santinelli V, Vicedomini G, Monasky MM, Micaglio E, Giannelli L, Mecarocci V, Ćalović Ž, Anastasia L, Pappone C. Novel CineECG Derived From Standard 12-Lead ECG Enables Right Ventricle Outflow Tract Localization of Electrical Substrate in Patients With Brugada Syndrome. Circ Arrhythm Electrophysiol 2020; 13:e008524. [DOI: 10.1161/circep.120.008524] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
In Brugada syndrome (BrS), diagnosed in presence of a spontaneous or ajmaline-induced type-1 pattern, ventricular arrhythmias originate from the right ventricle outflow tract (RVOT). We developed a novel CineECG method, obtained by inverse electrocardiogram (ECG) from standard 12-lead ECG, to localize the electrical activity pathway in patients with BrS.
Methods:
The CineECG enabled the temporospatial localization of the ECG waveforms, deriving the mean temporospatial isochrone from standard 12-lead ECG. The study sample included (1) 15 patients with spontaneous type-1 Brugada pattern, and (2) 18 patients with ajmaline-induced BrS (at baseline and after ajmaline), in whom epicardial potential duration maps were available; (3) 17 type-3 BrS pattern patients not showing type-1 BrS pattern after ajmaline (ajmaline-negative); (4) 47 normal subjects; (5) 18 patients with right bundle branch block (RBBB). According to CineECG algorithm, each ECG was classified as Normal, Brugada, RBBB, or Undetermined.
Results:
In patients with spontaneous or ajmaline-induced BrS, CineECG localized the terminal mean temporospatial isochrone forces in the RVOT, congruent with the arrhythmogenic substrate location detected by epicardial potential duration maps. The RVOT location was never observed in normal, RBBB, or ajmaline-negative patients. In most patients with ajmaline-induced BrS (78%), the RVOT location was already evident at baseline. The CineECG classified all normal subjects and ajmaline-negative patients at baseline as Normal or Undetermined, all patients with RBBB as RBBB, whereas all patients with spontaneous and ajmaline-induced BrS as Brugada. Compared with standard 12-lead ECG, CineECG at baseline had a 100% positive predictive value and 81% negative predictive value in predicting ajmaline test results.
Conclusions:
In patients with spontaneous and ajmaline-induced BrS, the CineECG localized the late QRS activity in the RVOT, a phenomenon never observed in normal, RBBB, or ajmaline-negative patients. The possibility to identify the RVOT as the location of the arrhythmogenic substrate by the noninvasive CineECG, based on the standard 12-lead ECG, opens new prospective for diagnosing patients with BrS.
Collapse
Affiliation(s)
- Peter M. van Dam
- Department of Cardiology, University Medical Center Utrecht, the Netherlands (P.M.v.D.)
- ECG Excellence BV, Nieuwerbrug aan den Rijn, the Netherlands (P.M.v.D.)
| | - Emanuela T. Locati
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (E.T.L., G.C., V.B., V.S., G.V., M.M.M., E.M., L.G., V.M., Z.C., L.A, C.P.)
| | - Giuseppe Ciconte
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (E.T.L., G.C., V.B., V.S., G.V., M.M.M., E.M., L.G., V.M., Z.C., L.A, C.P.)
| | - Valeria Borrelli
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (E.T.L., G.C., V.B., V.S., G.V., M.M.M., E.M., L.G., V.M., Z.C., L.A, C.P.)
| | - Francesca Heilbron
- Milano Bicocca University, Istituto Auxologico Italiano San Luca, Milan, Italy (F.H.)
| | - Vincenzo Santinelli
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (E.T.L., G.C., V.B., V.S., G.V., M.M.M., E.M., L.G., V.M., Z.C., L.A, C.P.)
| | - Gabriele Vicedomini
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (E.T.L., G.C., V.B., V.S., G.V., M.M.M., E.M., L.G., V.M., Z.C., L.A, C.P.)
| | - Michelle M. Monasky
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (E.T.L., G.C., V.B., V.S., G.V., M.M.M., E.M., L.G., V.M., Z.C., L.A, C.P.)
| | - Emanuele Micaglio
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (E.T.L., G.C., V.B., V.S., G.V., M.M.M., E.M., L.G., V.M., Z.C., L.A, C.P.)
| | - Luigi Giannelli
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (E.T.L., G.C., V.B., V.S., G.V., M.M.M., E.M., L.G., V.M., Z.C., L.A, C.P.)
| | - Valerio Mecarocci
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (E.T.L., G.C., V.B., V.S., G.V., M.M.M., E.M., L.G., V.M., Z.C., L.A, C.P.)
| | - Žarko Ćalović
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (E.T.L., G.C., V.B., V.S., G.V., M.M.M., E.M., L.G., V.M., Z.C., L.A, C.P.)
| | - Luigi Anastasia
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (E.T.L., G.C., V.B., V.S., G.V., M.M.M., E.M., L.G., V.M., Z.C., L.A, C.P.)
- Vita-Salute San Raffaele University (L.A., C.P.)
| | - Carlo Pappone
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (E.T.L., G.C., V.B., V.S., G.V., M.M.M., E.M., L.G., V.M., Z.C., L.A, C.P.)
- Vita-Salute San Raffaele University (L.A., C.P.)
| |
Collapse
|
17
|
Monasky MM, Micaglio E, Giachino D, Ciconte G, Giannelli L, Locati ET, Ramondini E, Cotugno R, Vicedomini G, Borrelli V, Ghiroldi A, Anastasia L, Pappone C. Genotype-Phenotype Correlation in a Family with Brugada Syndrome Harboring the Novel p.Gln371* Nonsense Variant in the SCN5A Gene. Int J Mol Sci 2019; 20:ijms20225522. [PMID: 31698696 PMCID: PMC6888117 DOI: 10.3390/ijms20225522] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 10/31/2019] [Accepted: 11/03/2019] [Indexed: 12/30/2022] Open
Abstract
Brugada syndrome (BrS) is marked by coved ST-segment elevation and increased risk of sudden cardiac death. The genetics of this syndrome are elusive in over half of the cases. Variants in the SCN5A gene are the single most common known genetic unifier, accounting for about a third of cases. Research models, such as animal models and cell lines, are limited. In the present study, we report the novel NM_198056.2:c.1111C>T (p.Gln371*) heterozygous variant in the SCN5A gene, as well as its segregation with BrS in a large family. The results herein suggest a pathogenic effect of this variant. Functional studies are certainly warranted to characterize the molecular effects of this variant.
Collapse
Affiliation(s)
- Michelle M. Monasky
- Arrhythmology Department, IRCCS Policlinico San Donato, 20097 San Donato Milanese (MI), Italy; (M.M.M.); (E.M.); (G.C.); (L.G.); (E.T.L.); (E.R.); (R.C.); (G.V.); (V.B.)
| | - Emanuele Micaglio
- Arrhythmology Department, IRCCS Policlinico San Donato, 20097 San Donato Milanese (MI), Italy; (M.M.M.); (E.M.); (G.C.); (L.G.); (E.T.L.); (E.R.); (R.C.); (G.V.); (V.B.)
| | - Daniela Giachino
- Department of Clinical and Biological Sciences, University of Turin, 10043 Orbassano (TO), Italy;
| | - Giuseppe Ciconte
- Arrhythmology Department, IRCCS Policlinico San Donato, 20097 San Donato Milanese (MI), Italy; (M.M.M.); (E.M.); (G.C.); (L.G.); (E.T.L.); (E.R.); (R.C.); (G.V.); (V.B.)
| | - Luigi Giannelli
- Arrhythmology Department, IRCCS Policlinico San Donato, 20097 San Donato Milanese (MI), Italy; (M.M.M.); (E.M.); (G.C.); (L.G.); (E.T.L.); (E.R.); (R.C.); (G.V.); (V.B.)
| | - Emanuela T. Locati
- Arrhythmology Department, IRCCS Policlinico San Donato, 20097 San Donato Milanese (MI), Italy; (M.M.M.); (E.M.); (G.C.); (L.G.); (E.T.L.); (E.R.); (R.C.); (G.V.); (V.B.)
| | - Elisa Ramondini
- Arrhythmology Department, IRCCS Policlinico San Donato, 20097 San Donato Milanese (MI), Italy; (M.M.M.); (E.M.); (G.C.); (L.G.); (E.T.L.); (E.R.); (R.C.); (G.V.); (V.B.)
| | - Roberta Cotugno
- Arrhythmology Department, IRCCS Policlinico San Donato, 20097 San Donato Milanese (MI), Italy; (M.M.M.); (E.M.); (G.C.); (L.G.); (E.T.L.); (E.R.); (R.C.); (G.V.); (V.B.)
| | - Gabriele Vicedomini
- Arrhythmology Department, IRCCS Policlinico San Donato, 20097 San Donato Milanese (MI), Italy; (M.M.M.); (E.M.); (G.C.); (L.G.); (E.T.L.); (E.R.); (R.C.); (G.V.); (V.B.)
| | - Valeria Borrelli
- Arrhythmology Department, IRCCS Policlinico San Donato, 20097 San Donato Milanese (MI), Italy; (M.M.M.); (E.M.); (G.C.); (L.G.); (E.T.L.); (E.R.); (R.C.); (G.V.); (V.B.)
| | - Andrea Ghiroldi
- Stem Cells for Tissue Engineering Laboratory, IRCCS Policlinico San Donato, 20097 San Donato Milanese (MI), Italy; (A.G.); (L.A.)
| | - Luigi Anastasia
- Stem Cells for Tissue Engineering Laboratory, IRCCS Policlinico San Donato, 20097 San Donato Milanese (MI), Italy; (A.G.); (L.A.)
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | - Carlo Pappone
- Arrhythmology Department, IRCCS Policlinico San Donato, 20097 San Donato Milanese (MI), Italy; (M.M.M.); (E.M.); (G.C.); (L.G.); (E.T.L.); (E.R.); (R.C.); (G.V.); (V.B.)
- Correspondence: ; Tel./Fax: +39-0252774260/4306
| |
Collapse
|
18
|
Micaglio E, Monasky MM, Resta N, Bagnulo R, Ciconte G, Gianelli L, Locati ET, Vicedomini G, Borrelli V, Ghiroldi A, Anastasia L, Benedetti S, Di Resta C, Ferrari M, Pappone C. Novel SCN5A p.W697X Nonsense Mutation Segregation in a Family with Brugada Syndrome. Int J Mol Sci 2019; 20:ijms20194920. [PMID: 31590245 PMCID: PMC6801452 DOI: 10.3390/ijms20194920] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 01/05/2023] Open
Abstract
Brugada syndrome (BrS) is marked by an elevated ST-segment elevation and increased risk of sudden cardiac death. Variants in the SCN5A gene are considered to be molecular confirmation of the syndrome in about one third of cases, while the genetics remain a mystery in about half of the cases, with the remaining cases being attributed to variants in any of a number of genes. Before research models can be developed, it is imperative to understand the genetics in patients. Even data from humans is complicated, since variants in the most common gene in BrS, SCN5A, are associated with a number of pathologies, or could even be considered benign, depending on the variant. Here, we provide crucial human data on a novel NM_198056.2:c.2091G>A (p.Trp697X) point-nonsense heterozygous variant in the SCN5A gene, as well as its segregation with BrS. The results herein suggest a pathogenic effect of this variant. These results could be used as a stepping stone for functional studies to better understand the molecular effects of this variant in BrS.
Collapse
Affiliation(s)
- Emanuele Micaglio
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy (M.M.M.); (G.C.); (L.G.); (E.T.L.); (G.V.); (V.B.)
| | - Michelle M. Monasky
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy (M.M.M.); (G.C.); (L.G.); (E.T.L.); (G.V.); (V.B.)
| | - Nicoletta Resta
- Medical Genetics Unit, Department of Biomedical Sciences and Human Oncology, “Aldo Moro” University of Bari, Policlinico Hospital, 70121 Bari, Italy; (N.R.); (R.B.)
| | - Rosanna Bagnulo
- Medical Genetics Unit, Department of Biomedical Sciences and Human Oncology, “Aldo Moro” University of Bari, Policlinico Hospital, 70121 Bari, Italy; (N.R.); (R.B.)
| | - Giuseppe Ciconte
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy (M.M.M.); (G.C.); (L.G.); (E.T.L.); (G.V.); (V.B.)
| | - Luigi Gianelli
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy (M.M.M.); (G.C.); (L.G.); (E.T.L.); (G.V.); (V.B.)
| | - Emanuela T. Locati
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy (M.M.M.); (G.C.); (L.G.); (E.T.L.); (G.V.); (V.B.)
| | - Gabriele Vicedomini
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy (M.M.M.); (G.C.); (L.G.); (E.T.L.); (G.V.); (V.B.)
| | - Valeria Borrelli
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy (M.M.M.); (G.C.); (L.G.); (E.T.L.); (G.V.); (V.B.)
| | - Andrea Ghiroldi
- Stem Cells for Tissue Engineering Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy; (A.G.); (L.A.)
| | - Luigi Anastasia
- Stem Cells for Tissue Engineering Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy; (A.G.); (L.A.)
- Department of Biomedical Sciences for Health, University of Milan, 20122 Milan, Italy
| | - Sara Benedetti
- Laboratory of Clinical Molecular Biology and Cytogenetics, Division of Genetics and Cellular Biology, IRCCS San Raffaele Hospital, 20132 Milan, Italy; (S.B.); (M.F.)
| | - Chiara Di Resta
- Genomic Unit for the Diagnosis of Human Pathologies, Division of Genetics and Cellular Biology, IRCCS San Raffaele Hospital, 20132 Milan, Italy;
- Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Maurizio Ferrari
- Laboratory of Clinical Molecular Biology and Cytogenetics, Division of Genetics and Cellular Biology, IRCCS San Raffaele Hospital, 20132 Milan, Italy; (S.B.); (M.F.)
- Genomic Unit for the Diagnosis of Human Pathologies, Division of Genetics and Cellular Biology, IRCCS San Raffaele Hospital, 20132 Milan, Italy;
- Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Carlo Pappone
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy (M.M.M.); (G.C.); (L.G.); (E.T.L.); (G.V.); (V.B.)
- Correspondence: ; Tel.: +39-0252774260
| |
Collapse
|
19
|
Padeletti M, Bagliani G, De Ponti R, Leonelli FM, Locati ET. Surface Electrocardiogram Recording: Baseline 12-lead and Ambulatory Electrocardiogram Monitoring. Card Electrophysiol Clin 2019; 11:189-201. [PMID: 31084846 DOI: 10.1016/j.ccep.2019.01.004] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The 12-lead standard electrocardiogram (ECG) is a 10 second recording of human myocytes electrical activity. Filters and oversampling are necessary in order to acquire a smooth signal without distortion. ECG recordings may display ongoing arrhythmias, and some leads may be helpful in formulating the diagnosis. Advanced modalities of baseline ECG recording can be used to extract additional information with significant prognostic value. Ambulatory ECG (AECG) recording is a long-term and low-cost external recording obtained with 1 to 12 leads lasting from 24 to 30 days. For patient comfort, longer AECG recordings use fewer leads.
Collapse
Affiliation(s)
- Margherita Padeletti
- Cardiology Unit, Mugello Hospital, Viale della Resistenza, 60, Borgo San Lorenzo, Florence 50032, Italy.
| | - Giuseppe Bagliani
- Arrhythmology Unit, Cardiology Department, Foligno General Hospital, Via Massimo Arcamone, Foligno, Perugia 06034, Italy; Cardiovascular Disease Department, University of Perugia, Piazza Menghini 1, Perugia 06129, Italy
| | - Roberto De Ponti
- Department of Cardiology, School of Medicine, University of Insubria, Viale Borri, 57, Varese 21100, Italy
| | - Fabio M Leonelli
- Cardiology Department, James A. Haley Veterans' Hospital, University South Florida, Tampa, FL, USA
| | - Emanuela T Locati
- Electrophysiology Unit, Cardiovascular Department, Niguarda Hospital, Milan, Italy
| |
Collapse
|
20
|
Locati ET, Bagliani G, Cecchi F, Johny H, Lunati M, Pappone C. Arrhythmias due to Inherited and Acquired Abnormalities of Ventricular Repolarization. Card Electrophysiol Clin 2019; 11:345-362. [PMID: 31084855 DOI: 10.1016/j.ccep.2019.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Several acquired and congenital disease conditions and many cardiac and noncardiac drugs affect ventricular repolarization and increase susceptibility to ventricular arrhythmias. Abnormal ventricular repolarization can be reflected on the surface ECG by prolonged or shortened QT interval, early repolarization, and abnormal T-wave configuration. Reduced outward K+ currents and abnormal or increased sodium or calcium currents increase the vulnerability to ventricular arrhythmias. Multiple mechanisms give rise to ventricular arrhythmias in conditions of congenital or acquired abnormal ventricular repolarization. Ventricular arrhythmias associated with abnormalities of ventricular repolarization typically are rapid, usually polymorphic, ventricular tachycardia or torsades de pointes, often degenerating into ventricular fibrillation.
Collapse
Affiliation(s)
- Emanuela T Locati
- Department of Arryhmology, IRCCS San Donato Hospital, Piazza Edmondo Malan 2, 20097 San Donato Milanese, Milano, Italy; Studio Cardiologico Locati, Viale Beatrice d'Este, 20, Milano 20122, Italy.
| | - Giuseppe Bagliani
- Cardiology Department, Arrhythmology Unit, Foligno General Hospital, Via Massimo Arcamore 5, Foligno 06034, Italy; Cardiovascular Diseases Department, University of Perugia, Piazza Universita 1, Perugia 06123, Italy
| | - Franco Cecchi
- Studio Cardiologico Locati, Viale Beatrice d'Este, 20, Milano 20122, Italy; Heart and Vessels Department, University of Florence, Piazza San Marco 4, 50121 Florence, Italy; IRCCS Auxologico, Milano, Cardiovascular San Luca Hospital, Piazzale Brescia 1, 20100 Milan, Italy
| | - Helou Johny
- Cardiology Department, Arrhythmology Unit, Foligno General Hospital, Via Massimo Arcamore 5, Foligno 06034, Italy
| | - Maurizio Lunati
- Cardiothoracovascular Department, Electrophysiology Unit, Niguarda Hospital, Piazza Ospedale Maggiore 1, 20162 Milano, Italy
| | - Carlo Pappone
- Department of Arryhmology, IRCCS San Donato Hospital, Piazza Edmondo Malan 2, 20097 San Donato Milanese, Milano, Italy
| |
Collapse
|
21
|
Locati ET, Bagliani G, Testoni A, Lunati M, Padeletti L. Role of Surface Electrocardiograms in Patients with Cardiac Implantable Electronic Devices. Card Electrophysiol Clin 2018; 10:233-255. [PMID: 29784482 DOI: 10.1016/j.ccep.2018.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Surface electrocardiograms, both resting 12-lead electrocardiographs and ambulatory electrocardiograph monitoring, play an essential role in establishing indications for cardiac implantable electronic devices (pacemakers, cardiac implantable defibrillators, and cardiac resynchronization therapies), and in the evaluation of patients already implanted. Current devices have prolonged memory capabilities (defined as Holter functions) and remote monitoring functions, to evaluate the electrical properties and the automatic detection of arrhythmias. Nonetheless, surface electrocardiography remains the critical tool to detect device malfunction, evaluate programming and function, verify the automatic arrhythmia analysis and the delivered electric therapy, and prevent inappropriate intervention.
Collapse
Affiliation(s)
- Emanuela T Locati
- Electrophysiology Unit, Cardiovascular Department, Niguarda Hospital, Piazza Ospedale Maggiore, 3, Milano 20162, Italy.
| | - Giuseppe Bagliani
- Cardiology Department, Arrhythmia Unit, Foligno General Hospital, Via Massimo Arcamone, 06034 Foligno (PG), Italy
| | - Alessio Testoni
- Electrophysiology Unit, Cardiovascular Department, Niguarda Hospital, Piazza Ospedale Maggiore, 3, Milano 20162, Italy
| | - Maurizio Lunati
- Electrophysiology Unit, Cardiovascular Department, Niguarda Hospital, Piazza Ospedale Maggiore, 3, Milano 20162, Italy
| | - Luigi Padeletti
- Heart and Vessels Department, University of Florence, Largo Brambilla, 3, Florence 50134, Italy; Cardiovascular Department, IRCCS, Multimedica, Via Milanese 300, 20099 Sesto San Giovanni, Italy
| |
Collapse
|
22
|
|
23
|
Abstract
The QT interval on surface electrocardiogram represents the sum of depolarization and repolarization process of the ventricles. The ventricular recovery process, reflected by ST segment and T wave, mainly depends on the transmembrane outward transport of potassium ions to reestablish the endocellular electronegativity. Outward potassium channels represent a heterogeneous family of ionic carriers, whose global kinetics is modulated by heart rate and autonomic nervous activity. Several cardiac and noncardiac drugs and disease conditions, and several mutations of genes encoding ionic channels, generating distinct genetic channellopathies, may affect the ventricular repolarization, provoke QT interval prolongation and shortening, and increase the susceptibility to ventricular arrhythmias.
Collapse
Affiliation(s)
- Emanuela T Locati
- Electrophysiology Unit, Cardiology Division, Cardiovascular Department, ASST GOM Niguarda Hospital, Piazza Ospedale Maggiore, 3, 20162 Milano, Italy.
| | - Giuseppe Bagliani
- Arrhythmology Unit, Cardiology Department, Foligno General Hospital, Via Massimo Arcamone, 06034 Foligno (PG), Italy; Cardiovascular Diseases Department, University of Perugia, Piazza Menghini 1, 06129 Perugia Italy
| | - Luigi Padeletti
- Heart and Vessels Department, University of Florence, Largo Brambilla, 3, 50134 Florence, Italy; IRCCS Multimedica, Cardiology Department, Via Milanese, 300, 20099 Sesto San Giovanni, Italy
| |
Collapse
|
24
|
Steinberg JS, Varma N, Cygankiewicz I, Aziz P, Balsam P, Baranchuk A, Cantillon DJ, Dilaveris P, Dubner SJ, El-Sherif N, Krol J, Kurpesa M, La Rovere MT, Lobodzinski SS, Locati ET, Mittal S, Olshansky B, Piotrowicz E, Saxon L, Stone PH, Tereshchenko L, Turitto G, Wimmer NJ, Verrier RL, Zareba W, Piotrowicz R. 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry. Heart Rhythm 2017; 14:e55-e96. [DOI: 10.1016/j.hrthm.2017.03.038] [Citation(s) in RCA: 159] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Indexed: 12/18/2022]
|
25
|
Steinberg JS, Varma N, Cygankiewicz I, Aziz P, Balsam P, Baranchuk A, Cantillon DJ, Dilaveris P, Dubner SJ, El‐Sherif N, Krol J, Kurpesa M, La Rovere MT, Lobodzinski SS, Locati ET, Mittal S, Olshansky B, Piotrowicz E, Saxon L, Stone PH, Tereshchenko L, Turitto G, Wimmer NJ, Verrier RL, Zareba W, Piotrowicz R. 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry. Ann Noninvasive Electrocardiol 2017; 22:e12447. [PMID: 28480632 PMCID: PMC6931745 DOI: 10.1111/anec.12447] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [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: 02/03/2017] [Accepted: 02/06/2017] [Indexed: 02/06/2023] Open
Abstract
Ambulatory ECG (AECG) is very commonly employed in a variety of clinical contexts to detect cardiac arrhythmias and/or arrhythmia patterns which are not readily obtained from the standard ECG. Accurate and timely characterization of arrhythmias is crucial to direct therapies that can have an important impact on diagnosis, prognosis or patient symptom status. The rhythm information derived from the large variety of AECG recording systems can often lead to appropriate and patient-specific medical and interventional management. The details in this document provide background and framework from which to apply AECG techniques in clinical practice, as well as clinical research.
Collapse
Affiliation(s)
- Jonathan S. Steinberg
- Heart Research Follow‐up ProgramUniversity of Rochester School of Medicine & DentistryRochesterNYUSA
- The Summit Medical GroupShort HillsNJUSA
| | - Niraj Varma
- Cardiac Pacing & ElectrophysiologyDepartment of Cardiovascular MedicineCleveland ClinicClevelandOHUSA
| | | | - Peter Aziz
- Cardiac Pacing & ElectrophysiologyDepartment of Cardiovascular MedicineCleveland ClinicClevelandOHUSA
| | - Paweł Balsam
- 1st Department of CardiologyMedical University of WarsawWarsawPoland
| | | | - Daniel J. Cantillon
- Cardiac Pacing & ElectrophysiologyDepartment of Cardiovascular MedicineCleveland ClinicClevelandOHUSA
| | - Polychronis Dilaveris
- 1st Department of CardiologyUniversity of Athens Medical SchoolHippokration HospitalAthensGreece
| | - Sergio J. Dubner
- Arrhythmias and Electrophysiology ServiceClinic and Maternity Suizo Argentina and De Los Arcos Private HospitalBuenos AiresArgentina
| | | | - Jaroslaw Krol
- Department of Cardiology, Hypertension and Internal Medicine2nd Medical Faculty Medical University of WarsawWarsawPoland
| | - Malgorzata Kurpesa
- Department of CardiologyMedical University of LodzBieganski HospitalLodzPoland
| | | | | | - Emanuela T. Locati
- Cardiovascular DepartmentCardiology, ElectrophysiologyOspedale NiguardaMilanoItaly
| | | | | | - Ewa Piotrowicz
- Telecardiology CenterInstitute of CardiologyWarsawPoland
| | - Leslie Saxon
- University of Southern CaliforniaLos AngelesCAUSA
| | - Peter H. Stone
- Vascular Profiling Research GroupCardiovascular DivisionHarvard Medical SchoolBrigham & Women's HospitalBostonMAUSA
| | - Larisa Tereshchenko
- Knight Cardiovascular InstituteOregon Health & Science UniversityPortlandORUSA
- Cardiovascular DivisionJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Gioia Turitto
- Weill Cornell Medical CollegeElectrophysiology ServicesNew York Methodist HospitalBrooklynNYUSA
| | - Neil J. Wimmer
- Vascular Profiling Research GroupCardiovascular DivisionHarvard Medical SchoolBrigham & Women's HospitalBostonMAUSA
| | - Richard L. Verrier
- Division of Cardiovascular MedicineBeth Israel Deaconess Medical CenterHarvard Medical SchoolHarvard‐Thorndike Electrophysiology InstituteBostonMAUSA
| | - Wojciech Zareba
- Heart Research Follow‐up ProgramUniversity of Rochester School of Medicine & DentistryRochesterNYUSA
| | - Ryszard Piotrowicz
- Department of Cardiac Rehabilitation and Noninvasive ElectrocardiologyNational Institute of CardiologyWarsawPoland
| |
Collapse
|
26
|
Locati ET, Moya A, Oliveira M, Tanner H, Willems R, Lunati M, Brignole M. External prolonged electrocardiogram monitoring in unexplained syncope and palpitations: results of the SYNARR-Flash study. Europace 2016; 18:1265-72. [PMID: 26519025 PMCID: PMC4974630 DOI: 10.1093/europace/euv311] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 08/18/2015] [Indexed: 12/15/2022] Open
Abstract
AIMS SYNARR-Flash study (Monitoring of SYNcopes and/or sustained palpitations of suspected ARRhythmic origin) is an international, multicentre, observational, prospective trial designed to evaluate the role of external 4-week electrocardiogram (ECG) monitoring in clinical work-up of unexplained syncope and/or sustained palpitations of suspected arrhythmic origin. METHODS AND RESULTS Consecutive patients were enrolled within 1 month after unexplained syncope or palpitations (index event) after being discharged from emergency room or hospitalization without a conclusive diagnosis. A 4-week ECG monitoring was obtained by external high-capacity loop recorder (SpiderFlash-T(®), Sorin) storing patient-activated and auto-triggered tracings. Diagnostic monitorings included (i) conclusive events with reoccurrence of syncope or palpitation with concomitant ECG recording (with/without arrhythmias) and (ii) events with asymptomatic predefined significant arrhythmias (sustained supraventricular or ventricular tachycardia, advanced atrio-ventricular block, sinus bradycardia <30 b.p.m., pauses >6 s). SYNARR-Flash study enrolled 395 patients (57.7% females, 56.9 ± 18.7 years, 28.1% with syncope, and 71.9% with palpitations) from 10 European centres. For syncope, the 4-week diagnostic yield was 24.5%, and predictors of diagnostic events were early start of recording (0-15 vs. >15 days after index event) (OR 6.2, 95% CI 1.3-29.6, P = 0.021) and previous history of supraventricular arrhythmias (OR 3.6, 95% CI 1.4-9.7, P = 0.018). For palpitations, the 4-week diagnostic yield was 71.6% and predictors of diagnostic events were history of recurrent palpitations (P < 0.001) and early start of recording (P = 0.001). CONCLUSION The 4-week external ECG monitoring can be considered as first-line tool in the diagnostic work-up of syncope and palpitation. Early recorder use, history of supraventricular arrhythmia, and frequent previous events increased the likelihood of diagnostic events during the 4-week external ECG monitoring.
Collapse
Affiliation(s)
- E T Locati
- Department of Cardiovascular-Cardiology 3, Electrophysiology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, Milano 20162, Italy
| | - A Moya
- Univeristy Hospital Vall d'Hebron, Barcelona, Spain University Hospital QuironDexeus, Barcelona, Spain
| | | | | | | | - M Lunati
- Department of Cardiovascular-Cardiology 3, Electrophysiology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, Milano 20162, Italy
| | - M Brignole
- Lavagna Hospital, Lavagna, Genova, Italy
| |
Collapse
|
27
|
Locati ET, Vecchi AM, Vargiu S, Cattafi G, Lunati M. Role of extended external loop recorders for the diagnosis of unexplained syncope, pre-syncope, and sustained palpitations. Europace 2013; 16:914-22. [PMID: 24158255 DOI: 10.1093/europace/eut337] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [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: 11/14/2022] Open
Abstract
AIMS To assess the diagnostic yield of new external loop recorders (ELRs) in patients with history of syncope, pre-syncope, and sustained palpitations. METHODS AND RESULTS Since 2005, we have established a registry including patients who consecutively received ELR monitoring for unexplained syncope or pre-syncope/palpitations. The registry included 307 patients (61% females, age 58 ± 19 years, range 8-94 years) monitored by high-capacity memory ELR of two subsequent generations: SpiderFlash-A(®) (SFA(®), Sorin CRM), storing two-lead electrocardiogram (ECG) patient-activated recordings by loop-recording technique (191 patients, 54 patients with syncope, years 2005-09), and SpiderFlash-T(®) (SFT(®)), adding auto-trigger detection for pauses, bradycardia, and supraventricular/ventricular arrhythmias (116 patients, 38 patients with syncope, years 2009-12). All the patients previously underwent routine workup for syncope or palpitation, including one or more 24 h Holter, not conclusive for diagnosis. Mean monitoring duration was 24.1 ± 8.9 days. Among 215 patients with palpitations, a conclusive diagnosis was obtained in 184 patients (86% diagnostic yield for palpitation). Among 92 patients with syncope, a conclusive diagnosis was obtained in 16 patients (17% clinical diagnostic yield for syncope), with recording during syncope of significant arrhythmias in 9 patients, and sinus rhythm in 7 patients. Furthermore, asymptomatic arrhythmias were de novo detected in 12 patients (13%), mainly by auto-trigger detection, suggesting an arrhythmic origin of the syncope. CONCLUSIONS The diagnostic yield of ELR in patients with syncope, pre-syncope, or palpitation of unknown origin after routine workup was similar to implantable loop recorder (ILR) within the same timeframe, therefore, ELR could be considered for patients candidate for long-term ECG monitoring, stepwise before ILR.
Collapse
Affiliation(s)
- Emanuela T Locati
- Department of Cardiovascular, Cardiology Unit 3 - Electrophysiology, Niguarda Hospital, Milan, Italy
| | - Anna Maria Vecchi
- Department of Cardiovascular, Cardiology Unit 3 - Electrophysiology, Niguarda Hospital, Milan, Italy
| | - Sara Vargiu
- Department of Cardiovascular, Cardiology Unit 3 - Electrophysiology, Niguarda Hospital, Milan, Italy
| | - Giuseppe Cattafi
- Department of Cardiovascular, Cardiology Unit 3 - Electrophysiology, Niguarda Hospital, Milan, Italy
| | - Maurizio Lunati
- Department of Cardiovascular, Cardiology Unit 3 - Electrophysiology, Niguarda Hospital, Milan, Italy
| |
Collapse
|
28
|
Proclemer A, Locati ET. [The MADIT-RIT study]. G Ital Cardiol (Rome) 2013; 14:241-245. [PMID: 23567763 DOI: 10.1714/1257.13877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Alessandro Proclemer
- S.O.C. di Cardiologia, Azienda Ospedaliera Universitaria S. Maria della Misericordia, Udine.
| | | |
Collapse
|
29
|
Locati ET, Vargiu S, Mulargia E, Ardito C, Schirru M, Pedretti S, Negrini F, Lunati M. [New implantable devices for patient management: role and perspectives of remote monitoring of implantable cardioverter-defibrillators]. G Ital Cardiol (Rome) 2012; 13:36S-40S. [PMID: 23096373 DOI: 10.1714/1167.12918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A large number of studies have demonstrated that remote control of implantable devices (home monitoring, HM) is beneficial for patients, as it allows strict and tailored controls with earlier identification of potential problems, by avoiding unnecessary visits. HM is also beneficial for hospitals, as it progressively reduces the resources necessary for routine controls and contributes to a better management of critical patients. According to current European and Italian guidelines, HM can replace standard ambulatory monitoring, thereby decreasing the number of outpatient visits for each individual patient (it is possible to schedule a comprehensive clinical evaluation at 1 year rather than every 6-8 months, while performing controls at 1 and 3 months by remote transmission). At present, however, reimbursement of HM services is not covered by the National Health System and, as a consequence, cannot be performed as an institutional activity within the hospital. In addition, many critical issues remain to be resolved before the HM system can be fully implemented into daily clinical management, particularly in patients with heart failure at higher risk for sudden cardiac death.
Collapse
Affiliation(s)
- Emanuela T Locati
- Dipartimento Cardiovascolare, A.O.Ospedale Niguarda Ca'Granda, Milano.
| | | | | | | | | | | | | | | |
Collapse
|
30
|
|