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Ciaccio EJ, Coromilas J, Saluja DS, Hsia HH, Peters NS, Yarmohammadi H. Sinus Rhythm Activation Signature Indicates Reentrant Ventricular Tachycardia Inducibility and Approximate Isthmus Location. Heart Rhythm 2024:S1547-5271(24)02517-7. [PMID: 38677360 DOI: 10.1016/j.hrthm.2024.04.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 04/18/2024] [Accepted: 04/20/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Sinus rhythm activation time is useful to assess infarct border zone substrate. OBJECTIVE To further investigate sinus activation in ventricular tachycardia (VT). METHODS Canine postinfarction data was analyzed retrospectively. In each experiment, an infarct was created in the left ventricular wall by LAD coronary artery ligation. Three-to-five days following ligation, 196-312 bipolar electrograms were recorded from the anterior left ventricular epicardium overlapping the infarct border zone. Sustained monomorphic VT was induced via premature electrical stimulation in 50 experiments and was non-inducible in 43 experiments. Acquired sinus rhythm and VT electrograms were marked for electrical activation time, and activation maps of representative sinus rhythm and VT cycles were constructed. The sinus rhythm activation signature was defined as the cumulative number of multielectrode recording sites that had activated per time epoch, and its derivative was used to predict VT inducibility, and to define the sinus rhythm slow/late activation sequence. RESULTS Plotting mean activation signature derivative, a best cutoff value was useful to separate experiments with reentrant VT inducibility (sensitivity: 42/50) versus non-inducibility (specificity: 39/43), with an accuracy of 81/93. For the 50 experiments with inducible VT, recording sites overlying a segment of isochrone encompassing the sinus rhythm slow/late activation sequence, spanned the VT isthmus location in 32 cases (64%), partially spanned it in 15 cases (30%), but did not span in 3 cases (6%). CONCLUSION The sinus rhythm activation signature derivative is assistive to differentiate substrate supporting reentrant VT inducibility versus non-inducibility, and to identify slow/late activation for targeting isthmus location.
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Affiliation(s)
- Edward J Ciaccio
- Department of Medicine - Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY, USA; ElectroCardioMaths Programme, Imperial Centre for Cardiac Engineering, Imperial College London, London, UK.
| | - James Coromilas
- Department of Medicine - Division of Cardiovascular Disease and Hypertension, Rutgers University, New Brunswick, NJ, USA
| | - Deepak S Saluja
- Department of Medicine - Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Henry H Hsia
- Department of Medicine, Cardiac Electrophysiology and Arrhythmia Service, University of California, San Francisco, CA, USA
| | - Nicholas S Peters
- ElectroCardioMaths Programme, Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
| | - Hirad Yarmohammadi
- Department of Medicine - Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Ciaccio EJ, Coromilas J, Wan EY, Yarmohammadi H, Saluja DS, Peters NS, Garan H, Biviano AB. Correlation relationships of the reentrant ventricular tachycardia circuit. Comput Methods Programs Biomed 2023; 241:107764. [PMID: 37597351 DOI: 10.1016/j.cmpb.2023.107764] [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] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 07/01/2023] [Accepted: 08/12/2023] [Indexed: 08/21/2023]
Abstract
INTRODUCTION A quantitative analysis of the components of reentrant ventricular tachycardia (VT) circuitry could improve understanding of its onset and perpetuation. METHOD In 19 canine experiments, the left anterior descending coronary artery was ligated to generate a subepicardial infarct. The border zone resided at the epicardial surface of the anterior left ventricle and was mapped 3-5 days postinfarction with a 196-312 bipolar multielectrode array. Monomorphic VT was inducible by extrastimulation. Activation maps revealed an epicardial double-loop reentrant circuit and isthmus, causing VT. Several circuit parameters were analyzed: the coupling interval for VT induction, VT cycle length, the lateral isthmus boundary (LIB) lengths, and isthmus width and angle. RESULTS The extrastimulus interval for VT induction and the VT cycle length were strongly correlated (p < 0.001). Both the extrastimulus interval and VT cycle length were correlated to the shortest LIB (p < 0.005). A derivation was developed to suggest that when conduction block at the shorter LIB is functional, the VT cycle length may depend on the local refractory period and the delay from wavefront pivot around the LIB. Isthmus width and angle were uncorrelated to other parameters. CONCLUSIONS The shorter LIB is correlated to VT cycle length, hence its circuit loop may drive reentrant VT. The extrastimulation interval, VT cycle length, and shorter LIB are intertwined, and may depend upon the local refractory period. Isthmus width and angle are less correlated, perhaps being more related to electrical discontinuity caused by alterations in infarct shape at depth.
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Affiliation(s)
- Edward J Ciaccio
- Department of Medicine - Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY, USA; ElectroCardioMaths Programme, Imperial Centre for Cardiac Engineering, Imperial College London, London, UK.
| | - James Coromilas
- Department of Medicine - Division of Cardiovascular Disease and Hypertension, Rutgers University, New Brunswick, NJ, USA
| | - Elaine Y Wan
- Department of Medicine - Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Hirad Yarmohammadi
- Department of Medicine - Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Deepak S Saluja
- Department of Medicine - Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Nicholas S Peters
- ElectroCardioMaths Programme, Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
| | - Hasan Garan
- Department of Medicine - Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Angelo B Biviano
- Department of Medicine - Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Ciaccio EJ, Coromilas J, Wan EY, Yarmohammadi H, Saluja DS, Peters NS, Garan H, Biviano AB. Lateral Boundaries of the Ventricular Tachycardia Circuit Align With Sinus Rhythm Discontinuities. JACC Clin Electrophysiol 2023; 9:851-861. [PMID: 37227361 DOI: 10.1016/j.jacep.2022.11.037] [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: 09/09/2022] [Revised: 11/08/2022] [Accepted: 11/20/2022] [Indexed: 05/26/2023]
Abstract
BACKGROUND Sinus rhythm electrical activation mapping can provide information regarding the ischemic re-entrant ventricular tachycardia (VT) circuit. The information gleaned may include the localization of sinus rhythm electrical discontinuities, which can be defined as arcs of disrupted electrical conduction with large activation time differences across the arc. OBJECTIVES This study sought to detect and localize sinus rhythm electrical discontinuities that might be present in activation maps constructed from infarct border zone electrograms. METHODS Monomorphic re-entrant VT with a double-loop circuit and central isthmus was repeatedly inducible by programmed electrical stimulation in the epicardial border zone of 23 postinfarction canine hearts. Sinus rhythm and VT activation maps were constructed from 196 to 312 bipolar electrograms acquired surgically at the epicardial surface and analyzed computationally. A complete re-entrant circuit was mappable from the epicardial electrograms of VT, and isthmus lateral boundary (ILB) locations were ascertained. The difference in sinus rhythm activation time across ILB locations, vs the central isthmus and vs the circuit periphery, was determined. RESULTS Sinus rhythm activation time differences averaged 14.4 milliseconds across the ILB vs 6.5 milliseconds at the central isthmus and 6.4 milliseconds at the periphery (ie, the outer circuit loop) (P ≤ 0.001). Locations with large sinus rhythm activation difference tended to overlap ILB (60.3% ± 23.2%) compared with their overlap with the entire grid (27.5% ± 18.5%) (P < 0.001). CONCLUSIONS Disrupted electrical conduction is evident as discontinuity in sinus rhythm activation maps, particularly at ILB locations. These areas may represent permanent fixtures relating to spatial differences in border zone electrical properties, caused in part by alterations in underlying infarct depth. The tissue properties producing sinus rhythm discontinuity at ILB may contribute to functional conduction block formation at VT onset.
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Affiliation(s)
- Edward J Ciaccio
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York, USA; ElectroCardioMaths Programme, Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom.
| | - James Coromilas
- Department of Medicine, Division of Cardiovascular Disease and Hypertension, Rutgers University, New Brunswick, New Jersey, USA
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Hirad Yarmohammadi
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Deepak S Saluja
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Nicholas S Peters
- ElectroCardioMaths Programme, Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom
| | - Hasan Garan
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Angelo B Biviano
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York, USA
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Dalsania R, Aboyme A, Coromilas J, Kassotis J. An Unusual Cause of AV Dyssynchrony. JACC: Case Reports 2023; 13:101812. [PMID: 37077755 PMCID: PMC10107086 DOI: 10.1016/j.jaccas.2023.101812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 02/06/2023] [Accepted: 03/01/2023] [Indexed: 04/03/2023]
Abstract
A 71-year-old male with persistent atrial fibrillation and a dual chamber permanent pacemaker presented complaining of dyspnea on exertion, easy fatiguability, and intermittent cough. A 12-lead electrocardiogram revealed ventricular paced complexes, native QRS complexes, and irregular atrial activity. Herein we present an unusual mechanism of atrioventricular dyssynchrony. (Level of Difficulty: Intermediate.).
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Kranick S, Mishra N, Theertham A, Vo H, Hiltner E, Coromilas J, Kassotis J. A Survey of Antibiotic Use During Insertion of Cardiovascular Implantable Devices Among United States Implanters. Angiology 2023; 74:351-356. [PMID: 35816293 DOI: 10.1177/00033197221114689] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Antibiotic use for cardiovascular implantable devices (CIED) prophylaxis is well-accepted despite a paucity of data. Pre-procedural prophylaxis lowers the rate of CIED infections; however, data is lacking for intra- or post-procedural antibiotic use. Antibiotic-eluting envelopes (ENVELOPE) [TYRX®TM] have been shown to reduce post-procedural infections. Understanding implanter practices may provide insight as to the need for antibiotic stewardship. The purpose of this survey was to assess the practices of implanters nationally. A survey was completed by 150 implanters across the US. Participants were board certificated, implanters of CIEDs, with varying experience (1-25 years), in various hospital settings. Of the respondents, 97% reported routine use of systemic antibiotics pre-operatively. About two-thirds of implanters continue systemic antibiotics post-operatively, with half continuing antibiotics for >24 h; 83% of implanters add antibiotic to saline for the purpose of irrigating the wound; 55% routinely use ENVELOPE on approximately 38% of patients. Common reasons cited for ENVELOPE use were infection concerns, significant risk factors, prior device infection, and immunosuppressed status. Two-thirds of respondents use systemic antibiotics during generator changes, with >50% continuing antibiotics for >24 h. This study suggests wide variations in practice among implanters. Additional attention to existing guidelines and evidence regarding appropriate use of ENVELOPE is still needed.
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Affiliation(s)
- Stephen Kranick
- Department of Medicine, 12287Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Nikita Mishra
- Department of Medicine, 12287Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Arjun Theertham
- Department of Medicine, Division of Cardiology Rutgers, 12287Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Hung Vo
- Department of Medicine, Division of Cardiology Rutgers, 12287Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Emily Hiltner
- Department of Medicine, Division of Cardiology Rutgers, 12287Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - James Coromilas
- Department of Medicine, Division of Cardiology Rutgers, 12287Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - John Kassotis
- Department of Medicine, Division of Cardiology Rutgers, 12287Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Bodempudi S, Wus L, Kloo J, Zeniecki P, Coromilas J, West FM, Lev Y. Improving Time to Defibrillation Following Ventricular Tachycardia (VTach) and Ventricular Fibrillation (VFib) Cardiac Arrest: A Multicenter Retrospective and Prospective Quality Improvement Study. Am J Med Qual 2023; 38:73-80. [PMID: 36519966 DOI: 10.1097/jmq.0000000000000102] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The goal of this study was to identify how often 2 independent centers defibrillated patients within the American Heart Association recommended 2-minute time interval following ventricular fibrillation/ventricular tachycardia arrest. A retrospective chart review revealed significant delays in defibrillation. Simulation sessions and modules were implemented to train nursing staff in a single nursing unit at a Philadelphia teaching hospital. Recruited nurses completed a code blue simulation session to establish a baseline time to defibrillation. They were then given 2 weeks to complete an online educational module. Upon completion, they participated in a second set of simulation sessions to assess improvement. First round simulations resulted in 33% with delayed defibrillation and 27% no defibrillation. Following the module, 77% of the second round of simulations ended in timely defibrillation, a statistically significant improvement ( P < 0.00001). Next steps involve prospective collection of the code blue data to analyze improvement in real code blue events.
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Affiliation(s)
- Sairamya Bodempudi
- Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Lisa Wus
- Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Juergen Kloo
- Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Patrick Zeniecki
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - James Coromilas
- Robert Wood Johnson Medical School, Division of Cardiovascular Diseases and Hypertension, Rutgers University, Newark, NJ
| | - Frances Mae West
- Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Yair Lev
- Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA
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7
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Dalsania R, Lindsay DA, Maglione T, Coromilas J. FUNCTIONAL ATRIOVENTRICULAR BLOCK DUE TO QT INTERVAL PROLONGATION IN WILSON DISEASE. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)03469-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Dalsania R, Lindsay DA, Maglione T, Kostis W, Coromilas J. A RARE PRESENTATION OF ELECTRICAL ALTERNANS IN A PATIENT WITH TAKOTSUBO CARDIOMYOPATHY. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)03501-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ciaccio EJ, Anter E, Coromilas J, Wan EY, Yarmohammadi H, Wit AL, Peters NS, Garan H. Structure and function of the ventricular tachycardia isthmus. Heart Rhythm 2022; 19:137-153. [PMID: 34371192 DOI: 10.1016/j.hrthm.2021.08.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/22/2021] [Accepted: 08/01/2021] [Indexed: 12/24/2022]
Abstract
Catheter ablation of postinfarction reentrant ventricular tachycardia (VT) has received renewed interest owing to the increased availability of high-resolution electroanatomic mapping systems that can describe the VT circuits in greater detail, and the emergence and need to target noninvasive external beam radioablation. These recent advancements provide optimism for improving the clinical outcome of VT ablation in patients with postinfarction and potentially other scar-related VTs. The combination of analyses gleaned from studies in swine and canine models of postinfarction reentrant VT, and in human studies, suggests the existence of common electroanatomic properties for reentrant VT circuits. Characterizing these properties may be useful for increasing the specificity of substrate mapping techniques and for noninvasive identification to guide ablation. Herein, we describe properties of reentrant VT circuits that may assist in elucidating the mechanisms of onset and maintenance, as well as a means to localize and delineate optimal catheter ablation targets.
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Affiliation(s)
- Edward J Ciaccio
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York; ElectroCardioMaths Programme, Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom.
| | - Elad Anter
- Department of Cardiovascular Medicine, Cardiac Electrophysiology, Cleveland Clinic, Cleveland, Ohio
| | - James Coromilas
- Department of Medicine, Division of Cardiovascular Disease and Hypertension, Rutgers University, New Brunswick, New Jersey
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Hirad Yarmohammadi
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Andrew L Wit
- Department of Pharmacology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Nicholas S Peters
- ElectroCardioMaths Programme, Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom
| | - Hasan Garan
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York
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10
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Aboyme A, Coromilas J, Scheinman M, Kassotis J. Exercise Induced Brugada Syndrome Type I Pattern. HeartRhythm Case Rep 2022; 8:288-291. [PMID: 35497475 PMCID: PMC9039088 DOI: 10.1016/j.hrcr.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
| | | | | | - John Kassotis
- Address reprint requests and correspondence: Dr John Kassotis, Rutgers, Robert Wood Johnson Medical School, 125 Paterson St, Medical Education Building 5 Floor, Room 582, New Brunswick, NJ 08901.
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Muntané-Carol G, Okoh AK, Chen C, Nault I, Kassotis J, Mohammadi S, Coromilas J, Lee LY, Alperi A, Philippon F, Russo MJ, Rodés-Cabau J. Ambulatory Electrocardiographic Monitoring Following Minimalist Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2021; 14:2711-2722. [PMID: 34949396 DOI: 10.1016/j.jcin.2021.08.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/27/2021] [Accepted: 08/17/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVES The aim of this study was to determine the impact of delayed high-degree atrioventricular block (HAVB) or complete heart block (CHB) after transcatheter aortic valve replacement (TAVR) using a minimalist approach followed by ambulatory electrocardiographic (AECG) monitoring. BACKGROUND Little is known regarding the clinical impact of HAVB or CHB in the early period after discharge following TAVR. METHODS A prospective, multicenter study was conducted, including 459 consecutive TAVR patients without permanent pacemaker who underwent continuous AECG monitoring for 14 days (median length of hospital stay 2 days; IQR: 1-3 days), using 2 devices (CardioSTAT and Zio AT). The primary endpoint was the occurrence of HAVB or CHB. Patients were divided into 3 groups: 1) no right bundle branch block (RBBB) and no electrocardiographic (ECG) changes; 2) baseline RBBB with no further changes; and 3) new-onset ECG conduction disturbances. RESULTS Delayed HAVB or CHB episodes occurred in 21 patients (4.6%) (median 5 days postprocedure; IQR: 4-6 days), leading to PPM in 17 (81.0%). HAVB or CHB events were rare in group 1 (7 of 315 [2.2%]), and the incidence increased in group 2 (5 of 38 [13.2%]; P < 0.001 vs group 1) and group 3 (9 of 106 [8.5%]; P = 0.007 vs group 1; P = 0.523 vs group 2). No episodes of sudden or all-cause death occurred at 30-day follow-up. CONCLUSIONS Systematic 2-week AECG monitoring following minimalist TAVR detected HAVB and CHB episodes in about 5% of cases, with no mortality at 1 month. Whereas HAVB or CHB was rare in patients without ECG changes post-TAVR, baseline RBBB and new-onset conduction disturbances determined an increased risk. These results would support tailored management using AECG monitoring and the possibility of longer hospitalization periods in patients at higher risk for delayed HAVB or CHB.
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Affiliation(s)
- Guillem Muntané-Carol
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Alexis K Okoh
- Department of Surgery, Division of Cardiac Surgery, Robert Wood Johnson University Medical School, New Brunswick, New Jersey, USA
| | - Chunguang Chen
- Department of Surgery, Division of Cardiac Surgery, Robert Wood Johnson University Medical School, New Brunswick, New Jersey, USA
| | - Isabelle Nault
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - John Kassotis
- Department of Medicine, Division of Cardiology, Robert Wood Johnson University Medical School, New Brunswick, New Jersey, USA
| | - Siamak Mohammadi
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - James Coromilas
- Department of Medicine, Division of Cardiology, Robert Wood Johnson University Medical School, New Brunswick, New Jersey, USA
| | - Leonard Y Lee
- Department of Surgery, Division of Cardiac Surgery, Robert Wood Johnson University Medical School, New Brunswick, New Jersey, USA
| | - Alberto Alperi
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - François Philippon
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Mark J Russo
- Department of Surgery, Division of Cardiac Surgery, Robert Wood Johnson University Medical School, New Brunswick, New Jersey, USA
| | - Josep Rodés-Cabau
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Hospital Clínic of Barcelona, Barcelona, Spain.
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12
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Okoh AK, Chen C, Kassotis J, Soliman F, Patel K, Sohitliv A, Loi A, Smith M, Pineda-Salazar J, Chaudhary A, Ghosh BD, Hakeem A, Lee LY, Coromilas J, Russo MJ. Utilizing ambulatory electrocardiogram monitoring to reduce conduction related death after transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2021; 99:1243-1250. [PMID: 34851550 DOI: 10.1002/ccd.30027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/18/2021] [Accepted: 11/17/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The purpose of this study is to assess the utility of ambulatory cardiac monitoring (ACM) in detecting delayed advanced conduction abnormalities (DACA) and associated 30-day mortality. BACKGROUND DACA are well-known complications of TAVR and may be associated with post-discharge mortality within 30-days. METHODS Between October 2019 and October 2020, TAVR patients who were discharged home without a permanent pacemaker (PPM) were monitored with an ACM device for 14-days. The incidence of DACA at follow up, mortality and readmission within 30-days were investigated. The risk of DACA was assessed in three patient categories based on a composite of their 12-lead electrocardiogram (ECG) data. Group I: Normal pre-TAVR, periprocedural, and discharge ECGs. Group II: Normal pre-TAVR and abnormal subsequent ECGs. Group III. Abnormal baseline and abnormal subsequent ECGs. RESULTS Among 340 TAVR patients, 248 were discharged home with an ACM device. The overall incidence of DACA was 7% (n = 17), of whom 4% (n = 10) required a PPM. Mortality and readmission between discharge and 30 days was 0% and 8.3%, respectively. Stratification of patients identified 96 (38.7%) patients in Group I: 50 (20%) in Group II, and 102 (41%) in Group III. The incidence of DACA requiring a PPM was 0% in Group I, 4% (n = 2) in Group II, and 8.5% (n = 8) in Group III (p < 0.004). CONCLUSIONS In TAVR patients who were discharged home with ACM, none died between discharge and 30-days. For those with normal baseline, perioperative and discharge ECG, there were no events of DACA at 14-days.
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Affiliation(s)
- Alexis K Okoh
- Department of Surgery, Division of Cardiac Surgery, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA.,Rutgers Robert Wood Johnson University Medical School, New Brunswick, New Jersey, USA
| | - Chunguang Chen
- Department of Surgery, Division of Cardiac Surgery, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - John Kassotis
- Rutgers Robert Wood Johnson University Medical School, New Brunswick, New Jersey, USA.,Department of Medicine, Division of Cardiology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Fady Soliman
- Rutgers Robert Wood Johnson University Medical School, New Brunswick, New Jersey, USA
| | - Kush Patel
- Department of Medicine, Division of Cardiology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Amy Sohitliv
- Department of Medicine, Division of Cardiology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Amandeep Loi
- Department of Surgery, Division of Cardiac Surgery, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Meghan Smith
- Department of Surgery, Division of Cardiac Surgery, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA.,Rutgers Robert Wood Johnson University Medical School, New Brunswick, New Jersey, USA
| | - Jennifer Pineda-Salazar
- Department of Surgery, Division of Cardiac Surgery, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA.,Rutgers Robert Wood Johnson University Medical School, New Brunswick, New Jersey, USA
| | - Ashok Chaudhary
- Rutgers Robert Wood Johnson University Medical School, New Brunswick, New Jersey, USA.,Department of Medicine, Division of Cardiology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Bobby D Ghosh
- Rutgers Robert Wood Johnson University Medical School, New Brunswick, New Jersey, USA.,Department of Medicine, Division of Cardiology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Abdul Hakeem
- Rutgers Robert Wood Johnson University Medical School, New Brunswick, New Jersey, USA.,Department of Medicine, Division of Cardiology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Leonard Y Lee
- Department of Surgery, Division of Cardiac Surgery, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA.,Rutgers Robert Wood Johnson University Medical School, New Brunswick, New Jersey, USA
| | - James Coromilas
- Rutgers Robert Wood Johnson University Medical School, New Brunswick, New Jersey, USA.,Department of Medicine, Division of Cardiology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Mark J Russo
- Department of Surgery, Division of Cardiac Surgery, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA.,Rutgers Robert Wood Johnson University Medical School, New Brunswick, New Jersey, USA
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13
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Aboyme A, Nehass M, Coromilas J. ARRHYTHMIA AND MYOCARDIAL INFARCTION INCIDENCE IN 904 PATIENTS DIAGNOSED WITH NOVEL CORONAVIRUS AT AN ACADEMIC CENTER. J Am Coll Cardiol 2021. [PMCID: PMC8091354 DOI: 10.1016/s0735-1097(21)04502-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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14
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Coromilas EJ, Kochav S, Goldenthal I, Biviano A, Garan H, Goldbarg S, Kim JH, Yeo I, Tracy C, Ayanian S, Akar J, Singh A, Jain S, Zimerman L, Pimentel M, Osswald S, Twerenbold R, Schaerli N, Crotti L, Fabbri D, Parati G, Li Y, Atienza F, Zatarain E, Tse G, Leung KSK, Guevara-Valdivia ME, Rivera-Santiago CA, Soejima K, De Filippo P, Ferrari P, Malanchini G, Kanagaratnam P, Khawaja S, Mikhail GW, Scanavacca M, Abrahão Hajjar L, Rizerio B, Sacilotto L, Mollazadeh R, Eslami M, Laleh Far V, Mattioli AV, Boriani G, Migliore F, Cipriani A, Donato F, Compagnucci P, Casella M, Dello Russo A, Coromilas J, Aboyme A, O'Brien CG, Rodriguez F, Wang PJ, Naniwadekar A, Moey M, Kow CS, Cheah WK, Auricchio A, Conte G, Hwang J, Han S, Lazzerini PE, Franchi F, Santoro A, Capecchi PL, Joglar JA, Rosenblatt AG, Zardini M, Bricoli S, Bonura R, Echarte-Morales J, Benito-González T, Minguito-Carazo C, Fernández-Vázquez F, Wan EY. Worldwide Survey of COVID-19-Associated Arrhythmias. Circ Arrhythm Electrophysiol 2021; 14:e009458. [PMID: 33554620 PMCID: PMC7982128 DOI: 10.1161/circep.120.009458] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Supplemental Digital Content is available in the text. Coronavirus disease 2019 (COVID-19) has led to over 1 million deaths worldwide and has been associated with cardiac complications including cardiac arrhythmias. The incidence and pathophysiology of these manifestations remain elusive. In this worldwide survey of patients hospitalized with COVID-19 who developed cardiac arrhythmias, we describe clinical characteristics associated with various arrhythmias, as well as global differences in modulations of routine electrophysiology practice during the pandemic.
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Affiliation(s)
- Ellie J Coromilas
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians & Surgeons (E.J.C., S. Kochav, I.G., A.B., H.G., E.Y.W.)
| | - Stephanie Kochav
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians & Surgeons (E.J.C., S. Kochav, I.G., A.B., H.G., E.Y.W.)
| | - Isaac Goldenthal
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians & Surgeons (E.J.C., S. Kochav, I.G., A.B., H.G., E.Y.W.)
| | - Angelo Biviano
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians & Surgeons (E.J.C., S. Kochav, I.G., A.B., H.G., E.Y.W.)
| | - Hasan Garan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians & Surgeons (E.J.C., S. Kochav, I.G., A.B., H.G., E.Y.W.)
| | - Seth Goldbarg
- New York Presbyterian Queens, Weill Medical College (S.G., J.-H.K., I.Y.)
| | - Joon-Hyuk Kim
- New York Presbyterian Queens, Weill Medical College (S.G., J.-H.K., I.Y.)
| | - Ilhwan Yeo
- New York Presbyterian Queens, Weill Medical College (S.G., J.-H.K., I.Y.)
| | - Cynthia Tracy
- The George Washington University School of Medicine & Health Sciences, The GW Medical Faculty Associates, Washington, DC (C.T., S.A.)
| | - Shant Ayanian
- The George Washington University School of Medicine & Health Sciences, The GW Medical Faculty Associates, Washington, DC (C.T., S.A.)
| | - Joseph Akar
- Section of Cardiovascular Disease, Yale University School of Medicine, New Haven, CT (J.A., A. Singh, S.J.)
| | - Avinainder Singh
- Section of Cardiovascular Disease, Yale University School of Medicine, New Haven, CT (J.A., A. Singh, S.J.)
| | - Shashank Jain
- Section of Cardiovascular Disease, Yale University School of Medicine, New Haven, CT (J.A., A. Singh, S.J.)
| | - Leandro Zimerman
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil (L.Z., M.P.)
| | - Maurício Pimentel
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil (L.Z., M.P.)
| | - Stefan Osswald
- Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland (S.O., R.T., N.S.)
| | - Raphael Twerenbold
- Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland (S.O., R.T., N.S.)
| | - Nicolas Schaerli
- Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland (S.O., R.T., N.S.)
| | - Lia Crotti
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural & Metabolic Sciences, San Luca Hospital, Milan, Italy (L.C., D.F., G.P.).,Department of Medicine & Surgery, University of Milano-Bicocca, Milan, Italy (L.C., D.F., G.P.)
| | - Daniele Fabbri
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural & Metabolic Sciences, San Luca Hospital, Milan, Italy (L.C., D.F., G.P.).,Department of Medicine & Surgery, University of Milano-Bicocca, Milan, Italy (L.C., D.F., G.P.)
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural & Metabolic Sciences, San Luca Hospital, Milan, Italy (L.C., D.F., G.P.).,Department of Medicine & Surgery, University of Milano-Bicocca, Milan, Italy (L.C., D.F., G.P.)
| | - Yi Li
- Wuhan Asia General Hospital, China (Y.L.)
| | - Felipe Atienza
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) (F.A., E.Z.).,CIBERCV, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain (F.A., E.Z.)
| | - Eduardo Zatarain
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) (F.A., E.Z.).,CIBERCV, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain (F.A., E.Z.)
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, China (G.T.).,School of Life Sciences. The Hospital Authority of Hong Kong, Hong Kong, China (G.T.).,Laboratory of Cardiovascular Physiology, Li Ka Shing Institute of Health Sciences, Hong Kong, China (G.T.)
| | - Keith Sai Kit Leung
- Aston Medical School, Aston University, Birmingham, United Kingdom (K.C.K.L.)
| | - Milton E Guevara-Valdivia
- UMAE Hospital de Especialidades Dr. Antonio Fraga Mouret CMN La Raza IMSS, CDMX, Mexico (M.E.G.-V., C.A.R.-S.)
| | - Carlos A Rivera-Santiago
- UMAE Hospital de Especialidades Dr. Antonio Fraga Mouret CMN La Raza IMSS, CDMX, Mexico (M.E.G.-V., C.A.R.-S.)
| | - Kyoko Soejima
- Kyorin University School of Medicine, Tokyo, Japan (K.S.)
| | - Paolo De Filippo
- Electrophysiology & Cardiac Pacing Unit, Cardiology Department, ASST Papa Giovanni XXIII, Bergamo, Italy (P.D.F., P.F., G.M.)
| | - Paola Ferrari
- Electrophysiology & Cardiac Pacing Unit, Cardiology Department, ASST Papa Giovanni XXIII, Bergamo, Italy (P.D.F., P.F., G.M.)
| | - Giovanni Malanchini
- Electrophysiology & Cardiac Pacing Unit, Cardiology Department, ASST Papa Giovanni XXIII, Bergamo, Italy (P.D.F., P.F., G.M.)
| | - Prapa Kanagaratnam
- Imperial College Healthcare NHS Trust, London, United Kingdom (P.K., S. Khawaja, G.W.M.)
| | - Saud Khawaja
- Imperial College Healthcare NHS Trust, London, United Kingdom (P.K., S. Khawaja, G.W.M.)
| | - Ghada W Mikhail
- Imperial College Healthcare NHS Trust, London, United Kingdom (P.K., S. Khawaja, G.W.M.)
| | - Mauricio Scanavacca
- Heart Institute (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Brazil (M.S., A.H., B.R., L.S.)
| | - Ludhmila Abrahão Hajjar
- Heart Institute (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Brazil (M.S., A.H., B.R., L.S.)
| | - Brenno Rizerio
- Heart Institute (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Brazil (M.S., A.H., B.R., L.S.)
| | - Luciana Sacilotto
- Heart Institute (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Brazil (M.S., A.H., B.R., L.S.)
| | - Reza Mollazadeh
- Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Iran (R.M., M.E., V.L.f.)
| | - Masoud Eslami
- Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Iran (R.M., M.E., V.L.f.)
| | - Vahideh Laleh Far
- Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Iran (R.M., M.E., V.L.f.)
| | | | - Giuseppe Boriani
- University of Modena & Reggio Emilia, Modena, Italy (V.M., G.B.)
| | - Federico Migliore
- Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy (F.M., A.C., F.D.)
| | - Alberto Cipriani
- Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy (F.M., A.C., F.D.)
| | - Filippo Donato
- Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy (F.M., A.C., F.D.)
| | - Paolo Compagnucci
- Cardiology & Arrhythmology Clinic, University Hospital "Ospedali Riuniti," Marche Polytechnic University, Ancona, Italy (P.C., M.C., A.D.R.)
| | - Michela Casella
- Cardiology & Arrhythmology Clinic, University Hospital "Ospedali Riuniti," Marche Polytechnic University, Ancona, Italy (P.C., M.C., A.D.R.)
| | - Antonio Dello Russo
- Cardiology & Arrhythmology Clinic, University Hospital "Ospedali Riuniti," Marche Polytechnic University, Ancona, Italy (P.C., M.C., A.D.R.)
| | - James Coromilas
- Division of Cardiovascular Disease & Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (J.C., A. Aboyme)
| | - Andrew Aboyme
- Division of Cardiovascular Disease & Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (J.C., A. Aboyme)
| | - Connor Galen O'Brien
- Department of Medicine, Division of Cardiology, University of California San Francisco School of Medicine (C.G.O.)
| | | | - Paul J Wang
- Division of Cardiology, Stanford University, CA (F.R., P.J.W.)
| | | | - Melissa Moey
- East Carolina University, Greenville, NC (A.N., M.M.)
| | - Chia Siang Kow
- School of Postgraduate Studies, International Medical University, Kuala Lumpur (C.S.K.)
| | - Wee Kooi Cheah
- Department of Medicine & Clinical Research Center, Taiping Hospital, Perak, Malaysia (W.K.C.)
| | - Angelo Auricchio
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A. Auricchio, G.C.)
| | - Giulio Conte
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A. Auricchio, G.C.)
| | - Jongmin Hwang
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea (J.H., S.H.)
| | - Seongwook Han
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea (J.H., S.H.)
| | - Pietro Enea Lazzerini
- Department of Medical Sciences, Surgery & Neurosciences, University of Siena, Italy (P.E.L., F.F., A. Santoro, P.L.C.).,Azienda Ospedaliera Universitaria Senese (AOUS), Siena, Italy (P.E.L., F.F., A. Santoro, P.L.C.)
| | - Federico Franchi
- Department of Medical Sciences, Surgery & Neurosciences, University of Siena, Italy (P.E.L., F.F., A. Santoro, P.L.C.).,Azienda Ospedaliera Universitaria Senese (AOUS), Siena, Italy (P.E.L., F.F., A. Santoro, P.L.C.)
| | - Amato Santoro
- Department of Medical Sciences, Surgery & Neurosciences, University of Siena, Italy (P.E.L., F.F., A. Santoro, P.L.C.).,Azienda Ospedaliera Universitaria Senese (AOUS), Siena, Italy (P.E.L., F.F., A. Santoro, P.L.C.)
| | - Pier Leopoldo Capecchi
- Department of Medical Sciences, Surgery & Neurosciences, University of Siena, Italy (P.E.L., F.F., A. Santoro, P.L.C.).,Azienda Ospedaliera Universitaria Senese (AOUS), Siena, Italy (P.E.L., F.F., A. Santoro, P.L.C.)
| | - Jose A Joglar
- University of Texas Southwestern Medical Center, Dallas (J.A.G., A.G.R.)
| | - Anna G Rosenblatt
- University of Texas Southwestern Medical Center, Dallas (J.A.G., A.G.R.)
| | - Marco Zardini
- Division of Cardiology, University Hospital "Ospedale Maggiore," Parma, Italy (M.Z., S.B., R.B.)
| | - Serena Bricoli
- Division of Cardiology, University Hospital "Ospedale Maggiore," Parma, Italy (M.Z., S.B., R.B.)
| | - Rosario Bonura
- Division of Cardiology, University Hospital "Ospedale Maggiore," Parma, Italy (M.Z., S.B., R.B.)
| | - Julio Echarte-Morales
- Department of Cardiology, University Hospital of Leon, Spain (J.E.-M., T.B.-G., C.M.-C., F.F.-V.)
| | - Tomás Benito-González
- Department of Cardiology, University Hospital of Leon, Spain (J.E.-M., T.B.-G., C.M.-C., F.F.-V.)
| | - Carlos Minguito-Carazo
- Department of Cardiology, University Hospital of Leon, Spain (J.E.-M., T.B.-G., C.M.-C., F.F.-V.)
| | - Felipe Fernández-Vázquez
- Department of Cardiology, University Hospital of Leon, Spain (J.E.-M., T.B.-G., C.M.-C., F.F.-V.)
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians & Surgeons (E.J.C., S. Kochav, I.G., A.B., H.G., E.Y.W.)
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15
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Ciaccio EJ, Coromilas J, Wan EY, Yarmohammadi H, Saluja DS, Biviano AB, Wit AL, Peters NS, Garan H. Slow uniform electrical activation during sinus rhythm is an indicator of reentrant VT isthmus location and orientation in an experimental model of myocardial infarction. Comput Methods Programs Biomed 2020; 196:105666. [PMID: 32717622 DOI: 10.1016/j.cmpb.2020.105666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 07/12/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND To validate the predictability of reentrant circuit isthmus locations without ventricular tachycardia (VT) induction during high-definition mapping, we used computer methods to analyse sinus rhythm activation in experiments where isthmus location was subsequently verified by mapping reentrant VT circuits. METHOD In 21 experiments using a canine postinfarction model, bipolar electrograms were obtained from 196-312 recordings with 4mm spacing in the epicardial border zone during sinus rhythm and during VT. From computerized electrical activation maps of the reentrant circuit, areas of conduction block were determined and the isthmus was localized. A linear regression was computed at three different locations about the reentry isthmus using sinus rhythm electrogram activation data. From the regression analysis, the uniformity, a measure of the constancy at which the wavefront propagates, and the activation gradient, a measure that may approximate wavefront speed, were computed. The purpose was to test the hypothesis that the isthmus locates in a region of slow uniform activation bounded by areas of electrical discontinuity. RESULTS Based on the regression parameters, sinus rhythm activation along the isthmus near its exit proceeded uniformly (mean r2= 0.95±0.05) and with a low magnitude gradient (mean 0.37±0.10mm/ms). Perpendicular to the isthmus long-axis across its boundaries, the activation wavefront propagated much less uniformly (mean r2= 0.76±0.24) although of similar gradient (mean 0.38±0.23mm/ms). In the opposite direction from the exit, at the isthmus entrance, there was also less uniformity (mean r2= 0.80±0.22) but a larger magnitude gradient (mean 0.50±0.25mm/ms). A theoretical ablation line drawn perpendicular to the last sinus rhythm activation site along the isthmus long-axis was predicted to prevent VT reinduction. Anatomical conduction block occurred in 7/21 experiments, but comprised only small portions of the isthmus lateral boundaries; thus detection of sinus rhythm conduction block alone was insufficient to entirely define the VT isthmus. CONCLUSIONS Uniform activation with a low magnitude gradient during sinus rhythm is present at the VT isthmus exit location but there is less uniformity across the isthmus lateral boundaries and at isthmus entrance locations. These factors may be useful to verify any proposed VT isthmus location, reducing the need for VT induction to ablate the isthmus. Measured computerized values similar to those determined herein could therefore be assistive to sharpen specificity when applying sinus rhythm mapping to localize EP catheter ablation sites.
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Affiliation(s)
- Edward J Ciaccio
- Department of Medicine - Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA; ElectroCardioMaths Programme, Imperial Centre for Cardiac Engineering, Imperial College London, London, UK.
| | - James Coromilas
- Department of Medicine - Division of Cardiovascular Disease and Hypertension, Rutgers University, New Brunswick, NJ, USA
| | - Elaine Y Wan
- Department of Medicine - Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
| | - Hirad Yarmohammadi
- Department of Medicine - Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
| | - Deepak S Saluja
- Department of Medicine - Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
| | - Angelo B Biviano
- Department of Medicine - Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
| | - Andrew L Wit
- Department of Pharmacology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Nicholas S Peters
- ElectroCardioMaths Programme, Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
| | - Hasan Garan
- Department of Medicine - Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
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16
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Saluja D, Bar-On T, Hayam G, Kassotis J, Kostis WJ, Coromilas J. The Rapid Prediction of Focal Wavefront Origins: Integration With a 3-Dimensional Mapping System. JACC Clin Electrophysiol 2020; 6:1478-1487. [PMID: 33213807 DOI: 10.1016/j.jacep.2020.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/20/2020] [Accepted: 05/20/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This study assessed the accuracy of an algorithm that predicts the origin of focal arrhythmias using a limited number of data points. BACKGROUND Despite advances in technology, ablations can be time-consuming, and activation mapping continues to have inherent limitations. The authors developed an algorithm that can predict the origin of a focal wavefront using the location and activation timing information in 2 pairs of sampled points. This algorithm was incorporated into an electroanatomic mapping (EAM) system to assess its accuracy in a 3-dimensional clinical environment. METHODS EAM data from patients who underwent successful ablation of a focal wavefront using the CARTO3 system were loaded onto an offline version of the software modified to contain the algorithm. Prediction curves were retrospectively generated. Predictive accuracy, defined as the distance between true and predicted origin wavefront origins, was measured. RESULTS Seventeen wavefronts in as many patients (2 with atrial tachycardia, 3 with orthodromic re-entrant tachycardia, 8 with premature ventricular complex and/or ventricular tachycardia, 4 with focal pulmonary vein isolation breakthroughs) were studied. Thirty-three origin predictions were attempted (1.9 ± 0.4 per patient) using 132 points. Predictions were successfully calculated in 31 of 33 (93.9%) attempts and were accurate to within 5.7 ± 6.9 mm. Individual prediction curves were accurate to within 3.0 ± 4.7 mm. CONCLUSIONS Focal wavefront origins may be accurately predicted in 3 dimensions using a novel algorithm incorporated into an EAM system.
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Affiliation(s)
- Deepak Saluja
- Department of Medicine, Columbia University, New York, New York, USA.
| | | | | | - John Kassotis
- Department of Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - William J Kostis
- Department of Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - James Coromilas
- Department of Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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Siroky GP, Niazi K, Ghaly A, Kahaleh M, Tyberg A, Langenfeld J, Kostis WJ, Kassotis J, Coromilas J, Saluja D. Surgical and endoscopic management of a pericardioesophageal fistula after radiofrequency pulmonary vein isolation. Pacing Clin Electrophysiol 2020; 43:1408-1411. [PMID: 32543768 DOI: 10.1111/pace.13988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/26/2020] [Accepted: 06/14/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The most feared complication of pulmonary vein isolation (PVI) is an atrioesophageal fistula (AEF). While rare (0.1-0.25%), primary surgical closure (as opposed to esophageal stenting) is associated with lower mortality. Pericardioesophageal fistula (PEF) may present prior to fistulization into the atrium. Unfortunately, data on the optimal management of PEFs are lacking. CASE REPORT Seventy-one-year-old male with AF presented with chest pain 3 weeks after radiofrequency PVI. Computed tomography angiography (CTA) chest and echocardiogram showed pneumopericardium. Barium esophagram showed extravasation from esophagus into the pericardium without connection to the left atrium. Sternotomy with mediastinal exploration exposed the pericardial defect, over which a CorMatrix patch was placed. The fistula was then stented endoscopically with endosuture fixation. Poststent esophagram did not show barium leak, and the patient was discharged home. One week later, the patient returned with enterococcal and candida bacteremia and an acute right parietal/occipital lobe infarct. Barium esophagram showed contrast extravasation into the pericardium. The patient rapidly succumbed to his illness and died. Autopsy revealed pericardial abscess posterior to the LA in communication with the esophagus. Extension to the LA was not seen. CONCLUSION While the surgical treatment of AEF is relatively well established, there is no consensus in the management of PEF. While prior small series have suggested PEF may be managed with esophageal stenting, our case illustrates the limitations of this approach.
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Affiliation(s)
- Gregory P Siroky
- Division of Cardiology, Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Kareem Niazi
- Division of Cardiology, Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Aziz Ghaly
- Division of Cardiothoracic Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Michel Kahaleh
- Division of Gastroenterology, Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Amy Tyberg
- Division of Gastroenterology, Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - John Langenfeld
- Division of Thoracic Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - William J Kostis
- Division of Cardiology, Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - John Kassotis
- Division of Cardiology, Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - James Coromilas
- Division of Cardiology, Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Deepak Saluja
- Division of Cardiology, Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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18
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Sethi A, Kodumuri V, Prasad V, Chaudhary A, Coromilas J, Kassotis J. Does the Presence of Significant Mitral Regurgitation prior to Transcatheter Aortic Valve Implantation for Aortic Stenosis Impact Mortality? – Meta-Analysis and Systematic Review. Cardiology 2020; 145:428-438. [DOI: 10.1159/000506624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/06/2020] [Indexed: 11/19/2022]
Abstract
Background: Mitral regurgitation (MR) is commonly encountered in patients with severe aortic stenosis (AS). However, its independent impact on mortality in patients undergoing transcatheter aortic valve implantation (TAVI) has not been established. Methods: We performed a systematic search for studies reporting characteristics and outcome of patients with and without significant MR and/or adjusted mortality associated with MR post-TAVI. We conducted a meta-analysis of quantitative data. Results: Seventeen studies with 20,717 patients compared outcomes and group characteristics. Twenty-one studies with 32,257 patients reported adjusted odds of mortality associated with MR. Patients with MR were older, had a higher Society of Thoracic Surgeons score, lower left ventricular ejection fraction, a higher incidence of prior myocardial infarction, atrial fibrillation, and a trend towards higher NYHA class III/IV, but had similar mean gradient, gender, and chronic kidney disease. The MR patients had a higher unadjusted short-term (RR = 1.46, 95% CI 1.30–1.65) and long-term mortality (RR = 1.40, 95% CI 1.18–1.65). However, 16 of 21 studies with 27,777 patients found no association between MR and mortality after adjusting for baseline variables. In greater than half of the patients (0.56, 95% CI 0.45–0.66) MR improved by at least one grade following TAVI. Conclusion: The patients with MR undergoing TAVI have a higher burden of risk factors which can independently impact mortality. There is a lack of robust evidence supporting an increased mortality in MR patients, after adjusting for other compounding variables. MR tends to improve in the majority of patients post-TAVI.
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Siroky G, Coromilas J, Maulion C. TAKOTSUBO CARDIOMYOPATHY-INDUCED TORSADE DE POINTES: ICD OR NO ICD? J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)33449-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Saluja D, Pagan E, Maglione T, Kassotis J, Kostis WJ, Coromilas J. Pulmonary vein antral isolation causes depolarization of vein sleeves: Implications for the assessment of isolation. Pacing Clin Electrophysiol 2019; 43:181-188. [PMID: 31853981 DOI: 10.1111/pace.13860] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/10/2019] [Accepted: 12/13/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Pulmonary vein isolation (PVI) for atrial fibrillation has been shown to result in inexcitability of a large fraction of pulmonary veins (PVs), but the mechanism is unknown. We investigated the mechanism of PV inexcitability by assessing the effects of PVI on the electrophysiology of PV sleeves. METHODS Patients undergoing first-time radiofrequency PVI were studied. Capture threshold, effective refractory period (ERP), and excitability were measured in PVs and the left atrial appendage (LAA) before and after ablation. Adenosine was used to assess both transient reconnection and transient venous re-excitability. RESULTS We assessed 248 veins among 67 patients. Mean PV ERP (249.7 ± 54.0 ms) and capture threshold (1.4 ± 1.6 mA) increased to 300.5 ± 67.1 and 5.7 ± 5.6 mA, respectively (P < .0001 for both) in the 26.9% PVs that remained excitable, but no change was noted in either measure in the LAA. In 16.3% of the 73.1% inexcitable veins, transient PV re-excitability (as opposed to reconnection) was seen with adenosine administration. CONCLUSIONS Antral PVI causes inexcitability in a majority of the PVs, which can transiently be restored in some with adenosine. Among PVs that remain excitable, ERP and capture threshold increase significantly. These data imply resting membrane potential depolarization of the of PV myocardial sleeves. As PV inexcitability hampers the assessment of entrance and exit block, demonstrating transient PV re-excitability during adenosine administration helps ensure true isolation.
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Affiliation(s)
- Deepak Saluja
- Department of Medicine, Robert Wood Johnson School of Medicine, New Brunswick, New Jersey.,Present address: Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Eric Pagan
- Department of Medicine, Robert Wood Johnson School of Medicine, New Brunswick, New Jersey
| | - Theodore Maglione
- Department of Medicine, Robert Wood Johnson School of Medicine, New Brunswick, New Jersey
| | - John Kassotis
- Department of Medicine, Robert Wood Johnson School of Medicine, New Brunswick, New Jersey
| | - William J Kostis
- Department of Medicine, Robert Wood Johnson School of Medicine, New Brunswick, New Jersey
| | - James Coromilas
- Department of Medicine, Robert Wood Johnson School of Medicine, New Brunswick, New Jersey
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Coromilas J. Quantitative cardiology comes of age. Comput Biol Med 2019; 106:31-32. [DOI: 10.1016/j.compbiomed.2019.01.005] [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: 11/16/2022]
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Saluja D, Kassotis J, Kostis WJ, Coromilas J. A novel method for the prediction of focal wavefront origins in cardiac arrhythmias. Comput Biol Med 2018; 102:421-425. [DOI: 10.1016/j.compbiomed.2018.08.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/17/2018] [Accepted: 08/18/2018] [Indexed: 11/25/2022]
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Ciaccio EJ, Coromilas J, Wit AL, Peters NS, Garan H. Formation of Functional Conduction Block During the Onset of Reentrant Ventricular Tachycardia. Circ Arrhythm Electrophysiol 2018; 9:CIRCEP.116.004462. [PMID: 27879278 DOI: 10.1161/circep.116.004462] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 10/14/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Edward J Ciaccio
- From the Department of Medicine, Division of Cardiology (E.J.C., H.G.) and Department of Pharmacology (A.L.W.), Columbia University College of Physicians and Surgeons, New York, NY; Department of Medicine, Division of Cardiovascular Disease and Hypertension, Rutgers University New Brunswick, NJ (J.C.); and Department of Medicine, Cardiovascular Sciences, Imperial College London, United Kingdom (N.S.P.).
| | - James Coromilas
- From the Department of Medicine, Division of Cardiology (E.J.C., H.G.) and Department of Pharmacology (A.L.W.), Columbia University College of Physicians and Surgeons, New York, NY; Department of Medicine, Division of Cardiovascular Disease and Hypertension, Rutgers University New Brunswick, NJ (J.C.); and Department of Medicine, Cardiovascular Sciences, Imperial College London, United Kingdom (N.S.P.)
| | - Andrew L Wit
- From the Department of Medicine, Division of Cardiology (E.J.C., H.G.) and Department of Pharmacology (A.L.W.), Columbia University College of Physicians and Surgeons, New York, NY; Department of Medicine, Division of Cardiovascular Disease and Hypertension, Rutgers University New Brunswick, NJ (J.C.); and Department of Medicine, Cardiovascular Sciences, Imperial College London, United Kingdom (N.S.P.)
| | - Nicholas S Peters
- From the Department of Medicine, Division of Cardiology (E.J.C., H.G.) and Department of Pharmacology (A.L.W.), Columbia University College of Physicians and Surgeons, New York, NY; Department of Medicine, Division of Cardiovascular Disease and Hypertension, Rutgers University New Brunswick, NJ (J.C.); and Department of Medicine, Cardiovascular Sciences, Imperial College London, United Kingdom (N.S.P.)
| | - Hasan Garan
- From the Department of Medicine, Division of Cardiology (E.J.C., H.G.) and Department of Pharmacology (A.L.W.), Columbia University College of Physicians and Surgeons, New York, NY; Department of Medicine, Division of Cardiovascular Disease and Hypertension, Rutgers University New Brunswick, NJ (J.C.); and Department of Medicine, Cardiovascular Sciences, Imperial College London, United Kingdom (N.S.P.)
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Ciaccio EJ, Coromilas J, Wit AL, Peters NS, Garan H. Source-Sink Mismatch Causing Functional Conduction Block in Re-Entrant Ventricular Tachycardia. JACC Clin Electrophysiol 2017; 4:1-16. [PMID: 29600773 PMCID: PMC5874259 DOI: 10.1016/j.jacep.2017.08.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/14/2017] [Accepted: 08/31/2017] [Indexed: 12/04/2022]
Abstract
Ventricular tachycardia (VT) caused by a re-entrant circuit is a life-threatening arrhythmia that at present cannot always be treated adequately. A realistic model of re-entry would be helpful to accurately guide catheter ablation for interruption of the circuit. In this review, models of electrical activation wavefront propagation during onset and maintenance of re-entrant VT are discussed. In particular, the relationship between activation mapping and maps of transition in infarct border zone thickness, which results in source-sink mismatch, is considered in detail and supplemented with additional data. Based on source-sink mismatch, the re-entry isthmus can be modeled from its boundary properties. Isthmus boundary segments with large transitions in infarct border zone thickness have large source-sink mismatch, and functional block forms there during VT. These alternate with segments having lesser thickness change and therefore lesser source-sink mismatch, which act as gaps, or entrance and exit points, to the isthmus during VT. Besides post-infarction substrates, the source-sink model is likely applicable to other types of volumetric changes in the myocardial conducting medium, such as when there is presence of fibrosis or dissociation of muscle fibers.
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Affiliation(s)
- Edward J Ciaccio
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York; ElectroCardioMaths Programme, Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom.
| | - James Coromilas
- Department of Medicine, Division of Cardiovascular Disease and Hypertension, Rutgers University, New Brunswick, New Jersey
| | - Andrew L Wit
- Department of Pharmacology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Nicholas S Peters
- ElectroCardioMaths Programme, Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom
| | - Hasan Garan
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York
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Tang D, Feliberti J, Coromilas J, Saluja A. SEARCHING FOR A TRIGGER IN RESISTANT VENTRICULAR TACHYCARDIA IN POST ACUTE MYOCARDIAL INFARCTION. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35706-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mann DM, Fernandez S, Mondal Z, Laskow D, Osband A, Debroy M, Lebowitz J, Coromilas J, Vagaonescu T, Moreyra A, Melita EA, Mann RA. Role of Coronary Angiography in the Assessment of Cardiovascular Risk in Kidney Transplant Candidates. Am J Cardiol 2016; 118:679-83. [PMID: 27392506 DOI: 10.1016/j.amjcard.2016.06.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 06/03/2016] [Accepted: 06/03/2016] [Indexed: 11/27/2022]
Abstract
Cardiovascular disease is the leading cause of death among those with renal insufficiency, those requiring dialysis, and in recipients of kidney transplants reflecting the greatly increased cardiovascular burden that these patients carry. The best method by which to assess cardiovascular risk in such patients is not well established. In the present study, 1,225 patients seeking a kidney transplant, over a 30-month period, underwent cardiovascular evaluation. Two hundred twenty-five patients, who met selected criteria, underwent coronary angiography that revealed significant coronary artery disease (CAD) in 47%. Those found to have significant disease underwent revascularization. Among the patients found to have significant CAD, 74% had undergone a nuclear stress test before angiography and 65% of these stress tests were negative for ischemia. The positive predictive value of a nuclear stress test in this patient population was 0.43 and the negative predictive value was 0.47. During a 30-month period, 28 patients who underwent coronary angiography received an allograft. None of these patients died, experienced a myocardial infarction, or lost their allograft. The annual mortality rate of those who remained on the waiting list was well below the national average. In conclusion, our results indicate that, in renal failure patients, noninvasive testing fails to detect the majority of significant CAD, that selected criteria may identify patients with a high likelihood of CAD, and that revascularization reduces mortality both for those on the waiting list and for those who receive an allograft.
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Ciaccio EJ, Coromilas J, Wit AL, Peters NS, Garan H. Formation of reentrant circuits in the mid-myocardial infarct border zone. Comput Biol Med 2016; 71:205-13. [DOI: 10.1016/j.compbiomed.2016.02.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 01/19/2016] [Accepted: 02/08/2016] [Indexed: 11/28/2022]
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Ciaccio EJ, Coromilas J, Ashikaga H, Cervantes DO, Wit AL, Peters NS, McVeigh ER, Garan H. Reprint of 'Model of unidirectional block formation leading to reentrant ventricular tachycardia in the infarct border zone of postinfarction canine hearts'. Comput Biol Med 2015; 65:256-66. [PMID: 26372420 PMCID: PMC4593299 DOI: 10.1016/j.compbiomed.2015.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 04/14/2015] [Indexed: 12/04/2022]
Abstract
BACKGROUND When the infarct border zone is stimulated prematurely, a unidirectional block line (UBL) can form and lead to double-loop (figure-of-eight) reentrant ventricular tachycardia (VT) with a central isthmus. The isthmus is composed of an entrance, center, and exit. It was hypothesized that for certain stimulus site locations and coupling intervals, the UBL would coincide with the isthmus entrance boundary, where infarct border zone thickness changes from thin-to-thick in the travel direction of the premature stimulus wavefront. METHOD A quantitative model was developed to describe how thin-to-thick changes in the border zone result in critically convex wavefront curvature leading to conduction block, which is dependent upon coupling interval. The model was tested in 12 retrospectively analyzed postinfarction canine experiments. Electrical activation was mapped for premature stimulation and for the first reentrant VT cycle. The relationship of functional conduction block forming during premature stimulation to functional block during reentrant VT was quantified. RESULTS For an appropriately placed stimulus, in accord with model predictions: 1. The UBL and reentrant VT isthmus lateral boundaries overlapped (error: 4.8±5.7mm). 2. The UBL leading edge coincided with the distal isthmus where the center-entrance boundary would be expected to occur. 3. The mean coupling interval was 164.6±11.0ms during premature stimulation and 190.7±20.4ms during the first reentrant VT cycle, in accord with model calculations, which resulted in critically convex wavefront curvature and functional conduction block, respectively, at the location of the isthmus entrance boundary and at the lateral isthmus edges. DISCUSSION Reentrant VT onset following premature stimulation can be explained by the presence of critically convex wavefront curvature and unidirectional block at the isthmus entrance boundary when the premature stimulation interval is sufficiently short. The double-loop reentrant circuit pattern is a consequence of wavefront bifurcation around this UBL followed by coalescence, and then impulse propagation through the isthmus. The wavefront is blocked from propagating laterally away from the isthmus by sharp increases in border zone thickness, which results in critically convex wavefront curvature at VT cycle lengths.
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Affiliation(s)
- Edward J Ciaccio
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, United States.
| | - James Coromilas
- Division of Cardiovascular Diseases & Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Hiroshi Ashikaga
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States
| | | | - Andrew L Wit
- Division of Cardiology, Department of Pharmacology, Columbia University Medical Center, New York, United States
| | - Nicholas S Peters
- Myocardial Function Section, Imperial College and Imperial NHS Trust, London, United Kingdom
| | - Elliot R McVeigh
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Hasan Garan
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, United States
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Ciaccio EJ, Coromilas J, Ashikaga H, Cervantes DO, Wit AL, Peters NS, McVeigh ER, Garan H. Model of unidirectional block formation leading to reentrant ventricular tachycardia in the infarct border zone of postinfarction canine hearts. Comput Biol Med 2015; 62:254-63. [PMID: 25966920 PMCID: PMC4533242 DOI: 10.1016/j.compbiomed.2015.04.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 03/09/2015] [Accepted: 04/14/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND When the infarct border zone is stimulated prematurely, a unidirectional block line (UBL) can form and lead to double-loop (figure-of-eight) reentrant ventricular tachycardia (VT) with a central isthmus. The isthmus is composed of an entrance, center, and exit. It was hypothesized that for certain stimulus site locations and coupling intervals, the UBL would coincide with the isthmus entrance boundary, where infarct border zone thickness changes from thin-to-thick in the travel direction of the premature stimulus wavefront. METHOD A quantitative model was developed to describe how thin-to-thick changes in the border zone result in critically convex wavefront curvature leading to conduction block, which is dependent upon coupling interval. The model was tested in 12 retrospectively analyzed postinfarction canine experiments. Electrical activation was mapped for premature stimulation and for the first reentrant VT cycle. The relationship of functional conduction block forming during premature stimulation to functional block during reentrant VT was quantified. RESULTS For an appropriately placed stimulus, in accord with model predictions: (1) The UBL and reentrant VT isthmus lateral boundaries overlapped (error: 4.8±5.7mm). (2) The UBL leading edge coincided with the distal isthmus where the center-entrance boundary would be expected to occur. (3) The mean coupling interval was 164.6±11.0ms during premature stimulation and 190.7±20.4ms during the first reentrant VT cycle, in accord with model calculations, which resulted in critically convex wavefront curvature with functional conduction block, respectively, at the location of the isthmus entrance boundary and at the lateral isthmus edges. DISCUSSION Reentrant VT onset following premature stimulation can be explained by the presence of critically convex wavefront curvature and unidirectional block at the isthmus entrance boundary when the premature stimulation interval is sufficiently short. The double-loop reentrant circuit pattern is a consequence of wavefront bifurcation around this UBL followed by coalescence, and then impulse propagation through the isthmus. The wavefront is blocked from propagating laterally away from the isthmus by sharp increases in border zone thickness, which results in critically convex wavefront curvature at VT cycle lengths.
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Affiliation(s)
- Edward J Ciaccio
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, United States.
| | - James Coromilas
- Division of Cardiovascular Diseases & Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Hiroshi Ashikaga
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States
| | | | - Andrew L Wit
- Department of Pharmacology, Columbia University Medical Center, New York, NY, United States
| | - Nicholas S Peters
- Myocardial Function Section, Imperial College and Imperial NHS Trust, London, United Kingdom
| | - Elliot R McVeigh
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Hasan Garan
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, United States
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Saluja D, Beauregard LA, Patel A, Coromilas J. The simultaneous presence of sustained atrial fibrillation and atrioventricular nodal reentrant tachycardia. Heart Rhythm 2015; 12:229-33. [DOI: 10.1016/j.hrthm.2014.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Indexed: 11/26/2022]
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Ciaccio EJ, Ashikaga H, Coromilas J, Hopenfeld B, Cervantes DO, Wit AL, Peters NS, McVeigh ER, Garan H. Model of Bipolar Electrogram Fractionation and Conduction Block Associated With Activation Wavefront Direction at Infarct Border Zone Lateral Isthmus Boundaries. Circ Arrhythm Electrophysiol 2014; 7:152-63. [DOI: 10.1161/circep.113.000840] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [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—
Improved understanding of the mechanisms underlying infarct border zone electrogram fractionation may be helpful to identify arrhythmogenic regions in the postinfarction heart. We describe the generation of electrogram fractionation from changes in activation wavefront curvature in experimental canine infarction.
Methods and Results—
A model was developed to estimate the extracellular signal shape that would be generated by wavefront propagation parallel to versus perpendicular to the lateral boundary (LB) of the reentrant ventricular tachycardia (VT) isthmus or diastolic pathway. LBs are defined as locations where functional block forms during VT, and elsewhere they have been shown to coincide with sharp thin-to-thick transitions in infarct border zone thickness. To test the model, bipolar electrograms were acquired from infarct border zone sites in 10 canine heart experiments 3 to 5 days after experimental infarction. Activation maps were constructed during sinus rhythm and during VT. The characteristics of model-generated versus actual electrograms were compared. Quantitatively expressed VT fractionation (7.6±1.2 deflections; 16.3±8.9-ms intervals) was similar to model-generated values with wavefront propagation perpendicular to the LB (9.4±2.4 deflections; 14.4±5.2-ms intervals). Fractionation during sinus rhythm (5.9±1.8 deflections; 9.2±4.4-ms intervals) was similar to model-generated fractionation with wavefront propagation parallel to the LB (6.7±3.1 deflections; 7.1±3.8-ms intervals). VT and sinus rhythm fractionation sites were adjacent to LBs ≈80% of the time.
Conclusions—
The results suggest that in a subacute canine infarct model, the LBs are a source of activation wavefront discontinuity and electrogram fractionation, with the degree of fractionation being dependent on activation rate and wavefront orientation with respect to the LB.
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Affiliation(s)
- Edward J. Ciaccio
- From the Division of Cardiology, Department of Medicine (E.J.C., H.G.) and Department of Pharmacology (D.O.C., A.L.W.), Columbia University Medical Center, New York; Division of Cardiology (H.A.) and Department of Biomedical Engineering (H.A., E.R.M.), Johns Hopkins University, Baltimore, MD; Angel Medical Systems, Inc, Shrewsbury, NJ (B.H.); Division of Cardiovascular Diseases & Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (J.C.); and Myocardial Function Section,
| | - Hiroshi Ashikaga
- From the Division of Cardiology, Department of Medicine (E.J.C., H.G.) and Department of Pharmacology (D.O.C., A.L.W.), Columbia University Medical Center, New York; Division of Cardiology (H.A.) and Department of Biomedical Engineering (H.A., E.R.M.), Johns Hopkins University, Baltimore, MD; Angel Medical Systems, Inc, Shrewsbury, NJ (B.H.); Division of Cardiovascular Diseases & Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (J.C.); and Myocardial Function Section,
| | - James Coromilas
- From the Division of Cardiology, Department of Medicine (E.J.C., H.G.) and Department of Pharmacology (D.O.C., A.L.W.), Columbia University Medical Center, New York; Division of Cardiology (H.A.) and Department of Biomedical Engineering (H.A., E.R.M.), Johns Hopkins University, Baltimore, MD; Angel Medical Systems, Inc, Shrewsbury, NJ (B.H.); Division of Cardiovascular Diseases & Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (J.C.); and Myocardial Function Section,
| | - Bruce Hopenfeld
- From the Division of Cardiology, Department of Medicine (E.J.C., H.G.) and Department of Pharmacology (D.O.C., A.L.W.), Columbia University Medical Center, New York; Division of Cardiology (H.A.) and Department of Biomedical Engineering (H.A., E.R.M.), Johns Hopkins University, Baltimore, MD; Angel Medical Systems, Inc, Shrewsbury, NJ (B.H.); Division of Cardiovascular Diseases & Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (J.C.); and Myocardial Function Section,
| | - Daniel O. Cervantes
- From the Division of Cardiology, Department of Medicine (E.J.C., H.G.) and Department of Pharmacology (D.O.C., A.L.W.), Columbia University Medical Center, New York; Division of Cardiology (H.A.) and Department of Biomedical Engineering (H.A., E.R.M.), Johns Hopkins University, Baltimore, MD; Angel Medical Systems, Inc, Shrewsbury, NJ (B.H.); Division of Cardiovascular Diseases & Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (J.C.); and Myocardial Function Section,
| | - Andrew L. Wit
- From the Division of Cardiology, Department of Medicine (E.J.C., H.G.) and Department of Pharmacology (D.O.C., A.L.W.), Columbia University Medical Center, New York; Division of Cardiology (H.A.) and Department of Biomedical Engineering (H.A., E.R.M.), Johns Hopkins University, Baltimore, MD; Angel Medical Systems, Inc, Shrewsbury, NJ (B.H.); Division of Cardiovascular Diseases & Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (J.C.); and Myocardial Function Section,
| | - Nicholas S. Peters
- From the Division of Cardiology, Department of Medicine (E.J.C., H.G.) and Department of Pharmacology (D.O.C., A.L.W.), Columbia University Medical Center, New York; Division of Cardiology (H.A.) and Department of Biomedical Engineering (H.A., E.R.M.), Johns Hopkins University, Baltimore, MD; Angel Medical Systems, Inc, Shrewsbury, NJ (B.H.); Division of Cardiovascular Diseases & Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (J.C.); and Myocardial Function Section,
| | - Elliot R. McVeigh
- From the Division of Cardiology, Department of Medicine (E.J.C., H.G.) and Department of Pharmacology (D.O.C., A.L.W.), Columbia University Medical Center, New York; Division of Cardiology (H.A.) and Department of Biomedical Engineering (H.A., E.R.M.), Johns Hopkins University, Baltimore, MD; Angel Medical Systems, Inc, Shrewsbury, NJ (B.H.); Division of Cardiovascular Diseases & Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (J.C.); and Myocardial Function Section,
| | - Hasan Garan
- From the Division of Cardiology, Department of Medicine (E.J.C., H.G.) and Department of Pharmacology (D.O.C., A.L.W.), Columbia University Medical Center, New York; Division of Cardiology (H.A.) and Department of Biomedical Engineering (H.A., E.R.M.), Johns Hopkins University, Baltimore, MD; Angel Medical Systems, Inc, Shrewsbury, NJ (B.H.); Division of Cardiovascular Diseases & Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (J.C.); and Myocardial Function Section,
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Ciaccio EJ, Biviano AB, Whang W, Coromilas J, Garan H. A new transform for the analysis of complex fractionated atrial electrograms. Biomed Eng Online 2011; 10:35. [PMID: 21569421 PMCID: PMC3125385 DOI: 10.1186/1475-925x-10-35] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Accepted: 05/12/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Representation of independent biophysical sources using Fourier analysis can be inefficient because the basis is sinusoidal and general. When complex fractionated atrial electrograms (CFAE) are acquired during atrial fibrillation (AF), the electrogram morphology depends on the mix of distinct nonsinusoidal generators. Identification of these generators using efficient methods of representation and comparison would be useful for targeting catheter ablation sites to prevent arrhythmia reinduction. METHOD A data-driven basis and transform is described which utilizes the ensemble average of signal segments to identify and distinguish CFAE morphologic components and frequencies. Calculation of the dominant frequency (DF) of actual CFAE, and identification of simulated independent generator frequencies and morphologies embedded in CFAE, is done using a total of 216 recordings from 10 paroxysmal and 10 persistent AF patients. The transform is tested versus Fourier analysis to detect spectral components in the presence of phase noise and interference. Correspondence is shown between ensemble basis vectors of highest power and corresponding synthetic drivers embedded in CFAE. RESULTS The ensemble basis is orthogonal, and efficient for representation of CFAE components as compared with Fourier analysis (p ≤ 0.002). When three synthetic drivers with additive phase noise and interference were decomposed, the top three peaks in the ensemble power spectrum corresponded to the driver frequencies more closely as compared with top Fourier power spectrum peaks (p ≤ 0.005). The synthesized drivers with phase noise and interference were extractable from their corresponding ensemble basis with a mean error of less than 10%. CONCLUSIONS The new transform is able to efficiently identify CFAE features using DF calculation and by discerning morphologic differences. Unlike the Fourier transform method, it does not distort CFAE signals prior to analysis, and is relatively robust to jitter in periodic events. Thus the ensemble method can provide a useful alternative for quantitative characterization of CFAE during clinical study.
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Affiliation(s)
- Edward J Ciaccio
- Department of Medicine, Division of Cardiology, Columbia University, USA
| | - Angelo B Biviano
- Department of Medicine, Division of Cardiology, Columbia University, USA
| | - William Whang
- Department of Medicine, Division of Cardiology, Columbia University, USA
| | - James Coromilas
- Department of Medicine, University of Medicine and Dentistry of New Jersey, USA
| | - Hasan Garan
- Department of Medicine, Division of Cardiology, Columbia University, USA
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Macia E, Dolmatova E, Cabo C, Sosinsky AZ, Dun W, Coromilas J, Ciaccio EJ, Boyden PA, Wit AL, Duffy HS. Characterization of gap junction remodeling in epicardial border zone of healing canine infarcts and electrophysiological effects of partial reversal by rotigaptide. Circ Arrhythm Electrophysiol 2011; 4:344-51. [PMID: 21493965 DOI: 10.1161/circep.110.959312] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [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: 12/13/2022]
Abstract
BACKGROUND The border zone of healing myocardial infarcts is an arrhythmogenic substrate, partly the result of structural and functional remodeling of the ventricular gap junction protein, Connexin43 (Cx43). Cx43 in arrhythmogenic substrates is a potential target for antiarrhythmic therapy. METHODS AND RESULTS We characterized Cx43 remodeling in the epicardial border zone (EBZ) of healing canine infarcts 5 days after coronary occlusion and examined whether the gap junction-specific agent rotigaptide could reverse it. Cx43 remodeling in the EBZ was characterized by a decrease in Cx43 protein, lateralization, and increased Cx43 phosphorylation at serine (S) 368. Rotigaptide partially reversed the loss of Cx43 but did not affect the increase in S368 phosphorylation, nor did it reverse Cx43 lateralization. Rotigaptide did not prevent conduction slowing in the EBZ, nor did it decrease the induction of sustained ventricular tachycardia by programmed stimulation, although it did decrease the EBZ effective refractory period. CONCLUSIONS We conclude that partial reversal of Cx43 remodeling in healing infarct border zone may not be sufficient to restore normal conduction or prevent arrhythmias.
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Affiliation(s)
- Ester Macia
- Department of Pharmacology, Center for Molecular Therapeutics, Columbia University, New York, NY, USA
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Ciaccio EJ, Coromilas J, Wit AL, Garan H. Onset dynamics of ventricular tachyarrhythmias as measured by dominant frequency. Heart Rhythm 2011; 8:615-23. [DOI: 10.1016/j.hrthm.2010.11.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Accepted: 11/16/2010] [Indexed: 11/16/2022]
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Biviano AB, Coromilas J, Ciaccio EJ, Whang W, Hickey K, Garan H. Frequency domain and time complex analyses manifest low correlation and temporal variability when calculating activation rates in atrial fibrillation patients. Pacing Clin Electrophysiol 2011; 34:540-8. [PMID: 21208232 DOI: 10.1111/j.1540-8159.2010.02993.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) activation rates have been calculated using both frequency domain and time complex analyses. Direct comparisons of these methods are limited. We report: (1) their correlation when measuring AF activation rates, (2) comparisons of recording durations required to minimize variability, and (3) differences in the temporal reproducibility. METHODS AF activation rates were calculated using domain frequency (DF) (via fast Fourier transform) and time complex (TC) (via beat-to-beat activation measurements) analyses. We compared: (1) AF frequencies derived from each method; (2) successively longer subinterval durations to their 16-second reference intervals, and (3) the correlation between consecutively collected 8-second segments and segments collected 10 minutes apart. RESULTS There was low intraclass correlation coefficient (ICC = 0.234) when comparing AF activation rates derived using DF versus TC analysis. There was no difference in the frequencies between any of the subintervals compared to their 16-second reference intervals, but variability of measurements was higher for intervals <8 seconds (P < 0.01). Correlations between successive segments and segments taken 10 minutes apart were 0.92 and 0.75 using DF analysis (P < 0.001), and 0.72 and 0.49 using TC analysis (P < 0.001). CONCLUSIONS There is low correlation between the DF and TC methods of analyzing AF activation rates. While AF rates do not differ between subintervals and 16-second reference electrograms, the variability of measurements is dependent upon the subinterval duration, and increases for durations less than 8 seconds. AF rates were prone to change over a 10-minute time period. These results point out existing clinical limitations of measuring atrial activation rates in AF patients.
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Affiliation(s)
- Angelo B Biviano
- Cardiology Division, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA.
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Konofagou EE, Luo J, Saluja D, Cervantes DO, Coromilas J, Fujikura K. Noninvasive electromechanical wave imaging and conduction-relevant velocity estimation in vivo. Ultrasonics 2010; 50:208-15. [PMID: 19863987 PMCID: PMC4005418 DOI: 10.1016/j.ultras.2009.09.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Revised: 09/25/2009] [Accepted: 09/25/2009] [Indexed: 05/10/2023]
Abstract
Electromechanical wave imaging is a novel technique for the noninvasive mapping of conduction waves in the left ventricle through the combination of ECG gating, high frame rate ultrasound imaging and radio-frequency (RF)-based displacement estimation techniques. In this paper, we describe this new technique and characterize the origin and velocity of the wave under distinct pacing schemes. First, in vivo imaging (30 MHz) was performed on anesthetized, wild-type mice (n=12) at high frame rates in order to take advantage of the transient electromechanical coupling occurring in the myocardium. The RF signal acquisition in a long-axis echocardiographic view was gated between consecutive R-wave peaks of the mouse electrocardiogram (ECG) and yielded an ultra-high RF frame rate of 8000 frames/s (fps). The ultrasound RF signals in each frame were digitized at 160 MHz. Axial, frame-to-frame displacements were estimated using 1D cross-correlation (window size of 240 microm, overlap of 90%). Three pacing protocols were sequentially applied in each mouse: (1) sinus rhythm (SR), (2) right-atrial (RA) pacing and (3) right-ventricular (RV) pacing. Pacing was performed using an eight-electrode catheter placed into the right side of the heart with the capability of pacing from any adjacent bipole. During a cardiac cycle, several waves were depicted on the electromechanical wave images that propagated transmurally and/or from base to apex, or apex to base, depending on the type of pacing and the cardiac phase. Through comparison between the ciné-loops and their corresponding ECG obtained at different pacing protocols, we were able to identify and separate the electrically induced, or contraction, waves from the hemodynamic (or, blood-wall coupling) waves. In all cases, the contraction wave was best observed along the posterior wall starting at the S-wave of the ECG, which occurs after Purkinje fiber, and during myocardial, activation. The contraction wave was identified based on the fact that it changed direction only when the pacing origin changed, i.e., it propagated from the apex to the base at SR and RA pacing and from base to apex at RV pacing. This reversal in the wave propagation direction was found to be consistent in all mice scanned and the wave velocity values fell within the previously reported conduction wave range with statistically significant differences between SR/RA pacing (0.85+/-0.22 m/s and 0.84+/-0.20 m/s, respectively) and RV pacing (-0.52+/-0.31 m/s; p<0.0001). This study thus shows that imaging the electromechanical function of the heart noninvasively is feasible. It may therefore constitute a unique noninvasive method for conduction wave mapping of the entire left ventricle. Such a technology can be extended to 3D mapping and/or used for early detection of dyssynchrony, arrhythmias, left-bundle branch block, or other conduction abnormalities as well as diagnosis and treatment thereof.
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Affiliation(s)
- Elisa E Konofagou
- Department of Biomedical Engineering, Columbia University, New York, NY, USA.
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Ciaccio EJ, Biviano AB, Whang W, Wit AL, Coromilas J, Garan H. Optimized Measurement of Activation Rate at Left Atrial Sites with Complex Fractionated Electrograms During Atrial Fibrillation. J Cardiovasc Electrophysiol 2010; 21:133-43. [PMID: 19793138 DOI: 10.1111/j.1540-8167.2009.01595.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Edward J Ciaccio
- Department of Pharmacology, Columbia University, New York, NY 10032, USA.
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Ciaccio EJ, Biviano AB, Whang W, Wit AL, Garan H, Coromilas J. New methods for estimating local electrical activation rate during atrial fibrillation. Heart Rhythm 2009; 6:21-32. [PMID: 19121796 DOI: 10.1016/j.hrthm.2008.10.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Accepted: 10/08/2008] [Indexed: 10/21/2022]
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Ciaccio EJ, Ashikaga H, Kaba RA, Cervantes D, Hopenfeld B, Wit AL, Peters NS, McVeigh ER, Garan H, Coromilas J. Model of reentrant ventricular tachycardia based on infarct border zone geometry predicts reentrant circuit features as determined by activation mapping. Heart Rhythm 2007; 4:1034-45. [PMID: 17675078 PMCID: PMC2626544 DOI: 10.1016/j.hrthm.2007.04.015] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2007] [Accepted: 04/07/2007] [Indexed: 11/16/2022]
Abstract
BACKGROUND Infarct border zone (IBZ) geometry likely affects inducibility and characteristics of postinfarction reentrant ventricular tachycardia, but the connection has not been established. OBJECTIVE The purpose of this study was to determine characteristics of postinfarction ventricular tachycardia in the IBZ. METHODS A geometric model describing the relationship between IBZ geometry and wavefront propagation in reentrant circuits was developed. Based on the formulation, slow conduction and block were expected to coincide with areas where IBZ thickness (T) is minimal and the local spatial gradient in thickness (DeltaT) is maximal, so that the degree of wavefront curvature rho proportional, variant DeltaT/T is maximal. Regions of fastest conduction velocity were predicted to coincide with areas of minimum DeltaT. In seven arrhythmogenic postinfarction canine heart experiments, tachycardia was induced by programmed stimulation, and activation maps were constructed from multichannel recordings. IBZ thickness was measured in excised hearts from histologic analysis or magnetic resonance imaging. Reentrant circuit properties were predicted from IBZ geometry and compared with ventricular activation maps after tachycardia induction. RESULTS Mean IBZ thickness was 231 +/- 140 microm at the reentry isthmus and 1440 +/- 770 microm in the outer pathway (P <0.001). Mean curvature rho was 1.63 +/- 0.45 mm(-1) at functional block line locations, 0.71 +/- 0.18 mm(-1) at isthmus entrance-exit points, and 0.33 +/- 0.13 mm(-1) in the outer reentrant circuit pathway. The mean conduction velocity about the circuit during reentrant tachycardia was 0.32 +/- 0.04 mm/ms at entrance-exit points, 0.42 +/- 0.13 mm/ms for the entire outer pathway, and 0.64 +/- 0.16 mm/ms at outer pathway regions with minimum DeltaT. Model sensitivity and specificity to detect isthmus location was 75.0% and 97.2%. CONCLUSIONS Reentrant circuit features as determined by activation mapping can be predicted on the basis of IBZ geometrical relationships.
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Affiliation(s)
- Edward J Ciaccio
- Department of Pharmacology, Columbia University, New York, New York, USA
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Ciaccio E, Ashikaga H, Kaba R, Cervantes D, Hopenfeld B, Wit A, Garan H, Peters N, Coromilas J, McVeigh E. The location of the isthmus in reentrant ventricular tachycardia is correlated with the variation in infarct border zone thickness. J Electrocardiol 2006. [DOI: 10.1016/j.jelectrocard.2006.08.057] [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: 10/24/2022]
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Lehnart SE, Terrenoire C, Reiken S, Wehrens XHT, Song LS, Tillman EJ, Mancarella S, Coromilas J, Lederer WJ, Kass RS, Marks AR. Stabilization of cardiac ryanodine receptor prevents intracellular calcium leak and arrhythmias. Proc Natl Acad Sci U S A 2006; 103:7906-10. [PMID: 16672364 PMCID: PMC1472543 DOI: 10.1073/pnas.0602133103] [Citation(s) in RCA: 175] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Catecholaminergic polymorphic ventricular tachycardia is a form of exercise-induced sudden cardiac death that has been linked to mutations in the cardiac Ca2+ release channel/ryanodine receptor (RyR2) located on the sarcoplasmic reticulum (SR). We have shown that catecholaminergic polymorphic ventricular tachycardia-linked RyR2 mutations significantly decrease the binding affinity for calstabin-2 (FKBP12.6), a subunit that stabilizes the closed state of the channel. We have proposed that RyR2-mediated diastolic SR Ca2+ leak triggers ventricular tachycardia (VT) and sudden cardiac death. In calstabin-2-deficient mice, we have now documented diastolic SR Ca2+ leak, monophasic action potential alternans, and bidirectional VT. Calstabin-deficient cardiomyocytes exhibited SR Ca2+ leak-induced aberrant transient inward currents in diastole consistent with delayed after-depolarizations. The 1,4-benzothiazepine JTV519, which increases the binding affinity of calstabin-2 for RyR2, inhibited the diastolic SR Ca2+ leak, monophasic action potential alternans and triggered arrhythmias. Our data suggest that calstabin-2 deficiency is as a critical mediator of triggers that initiate cardiac arrhythmias.
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Affiliation(s)
- Stephan E. Lehnart
- *Departments of Physiology and Cellular Biophysics, Clyde and Helen Wu Center for Molecular Cardiology, and Departments of
| | | | - Steven Reiken
- *Departments of Physiology and Cellular Biophysics, Clyde and Helen Wu Center for Molecular Cardiology, and Departments of
| | - Xander H. T. Wehrens
- *Departments of Physiology and Cellular Biophysics, Clyde and Helen Wu Center for Molecular Cardiology, and Departments of
| | - Long-Sheng Song
- Medical Biotechnology Center, University of Maryland Biotechnology Institute, 725 West Lombard Street, Baltimore, MD 21201; and
| | - Erik J. Tillman
- *Departments of Physiology and Cellular Biophysics, Clyde and Helen Wu Center for Molecular Cardiology, and Departments of
| | - Salvatore Mancarella
- *Departments of Physiology and Cellular Biophysics, Clyde and Helen Wu Center for Molecular Cardiology, and Departments of
| | - James Coromilas
- Medicine, College of Physicians and Surgeons, Columbia University, New York, NY 10032
| | - W. J. Lederer
- Medical Biotechnology Center, University of Maryland Biotechnology Institute, 725 West Lombard Street, Baltimore, MD 21201; and
- Department of Physiology, University of Maryland, Baltimore, MD 21201
| | | | - Andrew R. Marks
- *Departments of Physiology and Cellular Biophysics, Clyde and Helen Wu Center for Molecular Cardiology, and Departments of
- Medicine, College of Physicians and Surgeons, Columbia University, New York, NY 10032
- To whom correspondence should be addressed. E-mail:
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Ciaccio EJ, Saltman AE, Hernandez OM, Bornholdt RJ, Coromilas J. Multichannel data acquisition system for mapping the electrical activity of the heart. Pacing Clin Electrophysiol 2006; 28:826-38. [PMID: 16105011 DOI: 10.1111/j.1540-8159.2005.00167.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Details of the electrical conduction pattern of the heart are revealed to the electrophysiologist when multichannel data are used for activation mapping. Commercial electronic systems are available for simultaneous acquisition of many surface electrograms; however, the cost of these systems may be prohibitive and they can be mostly inflexible for adaptation to other research projects. Furthermore, the hardware and software design is often proprietary. In this article we describe the in-house design and implementation of a 320-multichannel acquisition system for animal electrophysiologic research. METHOD AND RESULTS Several modules comprise this system. The multichannel data are first preprocessed by amplification, filtering, and analog multiplexing. An algorithm for automatic adjustment of signal gains is implemented to maximize the voltage resolution and minimize noise pickup. Signals are then digitized, and sequenced to order the multichannel data and to add markers required for analysis. The digital data are streamed to archival storage media. Additionally, the electrocardiogram (ECG), blood pressure, and stimulus channel signals are stored simultaneously. Selected signals are then displayed in real-time for measurement and analysis and as a check of the system integrity. Examples of multielectrode arrays and surface recordings are provided. Costs for building such a system are estimated. CONCLUSIONS Multichannel data acquisition systems that are designed and constructed in-house have several advantages over turnkey commercial systems, including the potential for considerable cost savings, flexibility in acquiring data, and the ability to subsequently add additional components.
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Affiliation(s)
- Edward J Ciaccio
- Department of Pharmacology, Columbia University, New York, NY 10032, USA.
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Ciaccio EJ, Coromilas J, Costeas CA, Wit AL. Sinus Rhythm Electrogram Shape Measurements are Predictive of the Origins and Characteristics of Multiple Reentrant Ventricular Tachycardia Morphologies. J Cardiovasc Electrophysiol 2004; 15:1293-301. [PMID: 15574181 DOI: 10.1046/j.1540-8167.2004.03524.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION During clinical electrophysiologic study, multiple clinical tachycardia morphologies often can be induced in the infarct border zone, and all morphologies must be targeted for ablation therapy to be successful. Analysis of sinus rhythm electrogram shape for localizing figure-of-eight reentrant circuits in cases of multiple morphologies is proposed. METHODS AND RESULTS Sinus rhythm activation maps were constructed from bipolar electrograms acquired at 196 to 312 sites in the epicardial border zone in 10 postinfarction canine hearts. In each heart, at least two distinct figure-of-eight reentrant ventricular tachycardia morphologies were inducible by premature electrical stimulation, as determined by activation maps of sustained tachycardias. Sinus rhythm maps were used to predict the location of the isthmus (central common pathway [CCP]), which is the protected region of the circuit bounded by arcs of block (mean accuracy 76.7 +/- 4%). Although reentrant circuits differed, the positions of the entrance point of each CCP were common. The location of the line that would span the CCP at its narrowest width also was estimated (mean accuracy 91.3 +/- 5%). Ablation at this line is expected to prevent reentry recurrence. In one test experiment, ablation prevented recurrence of both sustained reentrant tachycardia morphologies. CONCLUSION Sinus rhythm electrogram analyses are useful for (1) localizing multiple reentrant circuits with differences in morphology that are inducible by premature stimulation in the infarct border zone, and (2) locating and orienting the position of a linear lesion for preventing recurrence of all morphologies with minimal damage to the heart.
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Affiliation(s)
- Edward J Ciaccio
- Department of Pharmacology, Columbia University, New York, New York 10032, USA.
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Wehrens XHT, Lehnart SE, Reiken SR, Deng SX, Vest JA, Cervantes D, Coromilas J, Landry DW, Marks AR. Protection from cardiac arrhythmia through ryanodine receptor-stabilizing protein calstabin2. Science 2004; 304:292-6. [PMID: 15073377 DOI: 10.1126/science.1094301] [Citation(s) in RCA: 343] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Ventricular arrhythmias can cause sudden cardiac death (SCD) in patients with normal hearts and in those with underlying disease such as heart failure. In animals with heart failure and in patients with inherited forms of exercise-induced SCD, depletion of the channel-stabilizing protein calstabin2 (FKBP12.6) from the ryanodine receptor-calcium release channel (RyR2) complex causes an intracellular Ca2+ leak that can trigger fatal cardiac arrhythmias. A derivative of 1,4-benzothiazepine (JTV519) increased the affinity of calstabin2 for RyR2, which stabilized the closed state of RyR2 and prevented the Ca2+ leak that triggers arrhythmias. Thus, enhancing the binding of calstabin2 to RyR2 may be a therapeutic strategy for common ventricular arrhythmias.
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Affiliation(s)
- Xander H T Wehrens
- Department of Physiology and Cellular Biophysics, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
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Kassotis J, Sauberman RB, Cabo C, Wit AL, Coromilas J. Beta receptor blockade potentiates the antiarrhythmic actions of d-sotalol on reentrant ventricular tachycardia in a canine model of myocardial infarction. J Cardiovasc Electrophysiol 2004; 14:1233-44. [PMID: 14678141 DOI: 10.1046/j.1540-8167.2003.02413.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The importance of beta receptor blockade for the antiarrhythmic action of sotalol has not been completely elucidated. We determined how beta receptor blockade interacts with the effects of potassium channel blockade on reentrant circuits. METHODS AND RESULTS Sustained ventricular tachycardia was induced by programmed stimulation in dogs 4 days after left anterior coronary artery occlusion and reentrant circuits in the epicardial border zone (EBZ) mapped. The effects of the beta receptor-blocking drug, esmolol, the potassium channel-blocking drug d-sotalol, which lacks beta receptor-blocking effects, and the combination of the two drugs on the reentrant circuits that cause tachycardia were determined. Esmolol did not alter the ability to induce tachycardia. Small changes in the location or extent of lines of block in reentrant circuits accounted for small decreases or increases in tachycardia cycle lengths. d-Sotalol prolonged the lines of block in reentrant circuits, slowed propagation around the circuits, and prolonged tachycardia cycle length, but it did not stop tachycardia or prevent the induction of tachycardia. The combination of esmolol and d-sotalol prevented the initiation of sustained tachycardia. The stimulated premature impulse either blocked before reentering or traversed the circuit several times prior to blocking in a region of fractionated electrograms. The addition of esmolol to d-sotalol abolished the reverse use-dependent effects of d-sotalol alone on effective refractory period (ERP) and significantly prolonged ERP in the area of the reentrant circuit. CONCLUSION Beta receptor blockade is important for the antiarrhythmic effects of d,l-sotalol on reentrant ventricular tachycardia in this model. The mechanism is speculative but may involve potentiation of d-sotalol actions to prolong ERP or effects on gap junctions.
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Affiliation(s)
- John Kassotis
- Department of Medicine, College of Physicians and Surgeons of Columbia University, 630 West 168th Street, New York, NY 10032, USA
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Cervantes D, Coromilas J, Wit A. P.1.8 Uncoupling myocardial gap junctions: A new antiarrhythmic drug mechanism. Europace 2003. [DOI: 10.1016/eupace/4.supplement_1.a35-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Affiliation(s)
- D. Cervantes
- Department of Pharmacology, Columbia University, New York, USA
| | - J. Coromilas
- Department of Pharmacology, Columbia University, New York, USA
| | - A. Wit
- Department of Pharmacology, Columbia University, New York, USA
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Klein RC, Raitt MH, Wilkoff BL, Beckman KJ, Coromilas J, Wyse DG, Friedman PL, Martins JB, Epstein AE, Hallstrom AP, Ledingham RB, Belco KM, Greene HL. Analysis of implantable cardioverter defibrillator therapy in the Antiarrhythmics Versus Implantable Defibrillators (AVID) Trial. J Cardiovasc Electrophysiol 2003; 14:940-8. [PMID: 12950538 DOI: 10.1046/j.1540-8167.2003.01554.x] [Citation(s) in RCA: 138] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The implantable cardioverter defibrillator (ICD) is commonly used to treat patients with documented sustained ventricular tachycardia (VT) or ventricular fibrillation (VF). Arrhythmia recurrence rates in these patients are high, but which patients will receive a therapy and the forms of arrhythmia recurrence (VT or VF) are poorly understood. METHODS AND RESULTS The therapy delivered by the ICD was examined in 449 patients randomized to ICD therapy in the Antiarrhythmics Versus Implantable Defibrillators (AVID) Trial. Events triggering ICD shocks or antitachycardia pacing (ATP) were reviewed for arrhythmia diagnosis, clinical symptoms, activity at the onset of the arrhythmia, and appropriateness and results of therapy. Both shock and ATP therapies were frequent by 2 years, with 68% of patients receiving some therapy or having an arrhythmic death. An appropriate shock was delivered in 53% of patients, and ATP was delivered in 68% of patients who had ATP activated. The first arrhythmia treated in follow-up was diagnosed as VT (63%), VF (13%), supraventricular tachycardia (18%), unknown arrhythmia (3%), or due to ICD malfunction or inappropriate sensing (3%). Acceleration of an arrhythmia by the ICD occurred in 8% of patients who received any therapy. No physical activity consistently preceded arrhythmias, nor did any single clinical factor predict the symptoms of the arrhythmia. CONCLUSION Delivery of ICD therapy in AVID patients was common, primarily due to VT. Inappropriate ICD therapy occurred frequently. Use of ICD therapy as a surrogate endpoint for death in clinical trials should be avoided.
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Affiliation(s)
- Richard C Klein
- Cardiology Division, University of Utah Health Sciences Center and VA Medical Center, 50 N. Medical Drive, Salt Lake City, UT 84132, USA.
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Raitt MH, Klein RC, Wyse DG, Wilkoff BL, Beckman K, Epstein AE, Coromilas J, Friedman PL, Martins J, Ledingham RB, Greene HL. Comparison of arrhythmia recurrence in patients presenting with ventricular fibrillation versus ventricular tachycardia in the Antiarrhythmics Versus Implantable Defibrillators (AVID) trial. Am J Cardiol 2003; 91:812-6. [PMID: 12667566 DOI: 10.1016/s0002-9149(03)00015-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Because many episodes of ventricular fibrillation (VF) are believed to be triggered by ventricular tachycardia (VT), patients who present with VT or VF are usually grouped together in discussions of natural history and treatment. However, there are significant differences in the clinical profiles of these 2 patient groups, and some studies have suggested differences in their response to therapy. We examined arrhythmias occurring spontaneously in 449 patients assigned to implantable cardioverter-defibrillator (ICD) therapy in the Antiarrhythmics Versus Implantable Defibrillators (AVID) trial to determine whether patients who receive an ICD after VT have arrhythmias during follow-up that are different from patients who present with VF. ICD printouts were analyzed both by a committee blinded to the patients' original presenting arrhythmia and by the local investigator. During 31 +/- 14 months of follow-up, 2,673 therapies were reported. Patients who were enrolled in the AVID trial after an episode of VT were more likely to have an episode of VT (73.5% vs 30.1%, p <0.001), and were less likely to have an episode of VF (18.3% vs 28.0%, p = 0.013) than patients enrolled after an episode of VF. Adjustment for differences in ejection fraction, previous infarction, and beta-blocker and antiarrhythmic therapy did not appreciably change the results. Ventricular arrhythmia recurrence during follow-up is different in patients who originally present with VT than in those who originally present with VF. These findings suggest there are important differences in the electrophysiologic characteristics of these 2 patient populations.
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Affiliation(s)
- Merritt H Raitt
- Portland VA Medical Center, Oregon Health and Science University, Portland, Oregon, USA.
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