1
|
Pothineni NVK, Cherian T, Patel N, Smietana J, Frankel DS, Deo R, Epstein AE, Marchlinski FE, Schaller RD. Subcutaneous Implantable Cardioverter-defibrillator Explantation-A Single Tertiary Center Experience. J Innov Card Rhythm Manag 2022; 13:4947-4953. [PMID: 35474857 PMCID: PMC9023024 DOI: 10.19102/icrm.2022.130407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/14/2021] [Indexed: 11/29/2022] Open
Abstract
The subcutaneous implantable cardioverter-defibrillator (S-ICD) is an appealing alternative to transvenous ICD systems. However, data on indications for S-ICD explantations are sparse. The objective of this study was to assess the incidence and indications for S-ICD explantation at a large tertiary referral center. We conducted a retrospective study of all S-ICD explantations performed from 2014–2020. Data on demographics, comorbidities, implantation characteristics, and indications for explantation were collected. A total of 64 patients underwent S-ICD explantation during the study period. During that time, there were 410 S-ICD implantations at our institution, of which 53 (12.9%) were explanted with a mean duration from implant to explant of 19.7 ± 20.1 months. The mean age of the patients at explantation was 44.8 ± 15.3 years, and 42% (n = 27) were women. The indication for S-ICD implantation was primary prevention in 58% and secondary prevention in 42% of patients, respectively. The most common reason for explantation was infection (32.8%), followed by abnormal sensing (25%) and the need for pacing (18.8%). Those who underwent S-ICD explantation for pacing indications were significantly older (55.7 ± 13.6 vs. 42.3 ± 14.6 years, P = 0.005) with a wider QRS duration (111 ± 19 vs. 98 ± 19 ms, P = 0.03) at device implantation compared to patients who underwent explantation for other indications. The incidence of S-ICD explantation in a large tertiary practice was 12.9%. While infection was the indication for one-third of the explantations, a significant number of explantations were due to sensing abnormalities and the need for pacing. These data may have implications for patient selection for S-ICD implantation.
Collapse
Affiliation(s)
- Naga Venkata K Pothineni
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tharian Cherian
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Neel Patel
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeffrey Smietana
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David S Frankel
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Rajat Deo
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew E Epstein
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Francis E Marchlinski
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert D Schaller
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
2
|
Markman TM, Pothineni NVK, Zghaib T, Smietana J, McBride D, Amankwah NA, Linn KA, Kumareswaran R, Hyman M, Arkles J, Santangeli P, Schaller RD, Supple GE, Frankel DS, Deo R, Lin D, Riley MP, Epstein AE, Callans DJ, Marchlinski FE, Hamilton R, Nazarian S. Effect of Transcutaneous Magnetic Stimulation in Patients With Ventricular Tachycardia Storm: A Randomized Clinical Trial. JAMA Cardiol 2022; 7:445-449. [PMID: 35171197 PMCID: PMC8851364 DOI: 10.1001/jamacardio.2021.6000] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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: 12/20/2022]
Abstract
IMPORTANCE Autonomic neuromodulation provides therapeutic benefit in ventricular tachycardia (VT) storm. Transcutaneous magnetic stimulation (TcMS) can noninvasively and nondestructively modulate a patient's nervous system activity and may reduce VT burden in patients with VT storm. OBJECTIVE To evaluate the safety and efficacy of TcMS of the left stellate ganglion for patients with VT storm. DESIGN, SETTING, AND PARTICIPANTS This double-blind, sham-controlled randomized clinical trial took place at a single tertiary referral center between August 2019 and July 2021. The study included 26 adult patients with 3 or more episodes of VT in 24 hours. INTERVENTIONS Patients were randomly assigned to receive a single session of either TcMS that targeted the left stellate ganglion (n = 14) or sham stimulation (n = 12). MAIN OUTCOMES AND MEASURES The primary outcome was freedom from VT in the 24-hour period following randomization. Key secondary outcomes included safety of TcMS on cardiac implantable electronic devices, as well as burden of VT in the 72-hour period following randomization. RESULTS Among 26 patients (mean [SD] age, 64 [13] years; 20 [77%] male), a mean (SD) of 12.7 (10.3) episodes of VT occurred within the 24 hours preceding randomization. Patients had recurrent VT despite taking a mean (SD) of 2.0 (0.6) antiarrhythmic drugs (AADs), and 11 patients (42%) required mechanical hemodynamic support at the time of randomization. In the 24-hour period after randomization, VT recurred in 4 of 14 patients (29% [SD 47%]) in the TcMS group vs 7 of 12 patients (58% [SD 51%]) in the sham group (P = .20). In the 72-hour period after randomization, patients in the TcMS group had a mean (SD) of 4.5 (7.2) episodes of VT vs 10.7 (13.8) in the sham group (incidence rate ratio, 0.42; P < .001). Patients in the TcMS group were taking fewer AADs 24 hours after randomization compared with baseline (mean [SD], 0.9 [0.8] vs 1.8 [0.4]; P = .001), whereas there was no difference in the number of AADs taken for the sham group (mean [SD], 2.3 [0.8] vs 1.9 [0.5]; P = .20). None of the 7 patients in the TcMS group with a cardiac implantable electronic device had clinically significant effects on device function. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, findings support the potential for TcMS to safely reduce the burden of VT in the setting of VT storm in patients with and without cardiac implantable electronic devices and inform the design of future trials to further investigate this novel treatment approach. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04043312.
Collapse
Affiliation(s)
- Timothy M. Markman
- Division of Cardiology, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia,Penn Brain Science, Translation, Innovation, and Modulation Center, University of Pennsylvania, Philadelphia
| | - Naga Venkata K. Pothineni
- Division of Cardiology, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia
| | - Tarek Zghaib
- Division of Cardiology, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia
| | - Jeffrey Smietana
- Division of Cardiology, Temple University, Temple University Hospital, Philadelphia, Pennsylvania
| | - Daniel McBride
- Division of Cardiology, University of Michigan, Ann Arbor
| | - Nigel A. Amankwah
- Division of Cardiology, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia
| | - Kristin A. Linn
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia
| | - Ramanan Kumareswaran
- Division of Cardiology, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia
| | - Matthew Hyman
- Division of Cardiology, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia
| | - Jeffrey Arkles
- Division of Cardiology, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia
| | - Pasquale Santangeli
- Division of Cardiology, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia
| | - Robert D. Schaller
- Division of Cardiology, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia
| | - Gregory E. Supple
- Division of Cardiology, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia
| | - David S. Frankel
- Division of Cardiology, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia
| | - Rajat Deo
- Division of Cardiology, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia
| | - David Lin
- Division of Cardiology, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia
| | - Michael P. Riley
- Division of Cardiology, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia
| | - Andrew E. Epstein
- Division of Cardiology, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia,Cardiology Division, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - David J. Callans
- Division of Cardiology, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia
| | - Francis E. Marchlinski
- Division of Cardiology, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia
| | - Roy Hamilton
- Penn Brain Science, Translation, Innovation, and Modulation Center, University of Pennsylvania, Philadelphia,Department of Neurology, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia
| | - Saman Nazarian
- Division of Cardiology, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia
| |
Collapse
|
3
|
Smietana J. Supraventricular Tachycardia: In Search of an Underlying Mechanism. JACC Case Rep 2021; 3:1354-1356. [PMID: 34505068 PMCID: PMC8414424 DOI: 10.1016/j.jaccas.2021.04.044] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/21/2021] [Accepted: 04/27/2021] [Indexed: 06/13/2023]
Abstract
A 12-lead electrocardiogram of a regular narrow complex tachycardia with electrocardiographic characteristics used to help elucidate the arrhythmia mechanism. (Level of Difficulty: Intermediate.).
Collapse
Affiliation(s)
- Jeffrey Smietana
- Address for correspondence: Dr. Jeffrey Smietana, Electrophysiology Section, Division of Cardiovascular Medicine, The Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, Pennsylvania 19104, USA. @Dr_Smietana
| |
Collapse
|
4
|
Smietana J, Schell A, Pothineni NVK, Walsh K, Lin D. A left ventricular assist device interfering with leadless pacemaker implantation. Pacing Clin Electrophysiol 2021; 44:1949-1951. [PMID: 34346519 DOI: 10.1111/pace.14332] [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] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/03/2021] [Accepted: 08/01/2021] [Indexed: 11/30/2022]
Abstract
Left ventricular assist devices (LVAD) produce electromagnetic interference (EMI) which can have implications when patients require cardiac implantable electronic devices. Leadless pacemakers have been successfully implanted in patients with Heartmate 2 and Heartmate 3 LVADs without evidence of EMI or device-to-device interaction. Here we report a case of a Heartmate 3 LVAD and Micra VR transcatheter pacing system interaction requiring device repositioning.
Collapse
Affiliation(s)
- Jeffrey Smietana
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrea Schell
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Naga Venkata K Pothineni
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Katie Walsh
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David Lin
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
5
|
Krishna Chand Pothineni NV, Cherian TS, Patel NA, Smietana J, Luebbert JJ, Santangeli P, Supple GE, Frankel DS, Marchlinski FE, Schaller RD. B-PO05-052 INDICATIONS FOR SUBCUTANEOUS ICD EXTRACTIONS - A SINGLE TERTIARY CENTER EXPERIENCE. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.972] [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]
|
6
|
Smietana J, Krishna Chand Pothineni NV, Cherian TS, Deo R, Serletti JM, Arkles J, Frankel DS, Marchlinski FE, Schaller RD. B-PO02-064 SUB-SERRATUS IMPLANTATION OF THE SUBCUTANEOUS IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR: A SINGLE-CENTER EXPERIENCE. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.320] [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: 10/20/2022]
|
7
|
Musikantow DR, Smietana J, Christia P, Aaron Vigdor NP, Chu EW, Gandhi J, Moss N, Koruth JS, Whang W, Turagam MK, Frankel DS, Miller MA, Dukkipati SR, Reddy VY. B-PO02-059 MULTICENTER ANALYSIS OF RIGHT VENTRICULAR LEAD DYSFUNCTION AFTER LEFT VENTRICULAR ASSIST DEVICE IMPLANTATION: A COMPARISON OF CENTRIFUGAL-FLOW VS AXIAL-FLOW DEVICES. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.315] [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: 10/20/2022]
|
8
|
Enriquez A, Liang J, Smietana J, Muser D, Salazar P, Shah R, Badhwar N, Bogun F, Marchlinski FE, Garcia F, Baranchuk A, Tung R, Redfearn D, Santangeli P. Substrate Characterization and Outcomes of Ventricular Tachycardia Ablation in Titin Cardiomyopathy: A Multicenter Study. Circ Arrhythm Electrophysiol 2021; 14:e010006. [PMID: 34315225 DOI: 10.1161/circep.121.010006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Indexed: 11/16/2022]
Abstract
Background - Truncating variants of the titin gene (TTNtv) are a leading cause of dilated cardiomyopathy (DCM) and have been associated with an increased risk of ventricular arrhythmias. This study evaluated the substrate distribution and the acute and long-term outcomes of patients with TTN-related cardiomyopathy undergoing ventricular tachycardia (VT) ablation. Methods - This multicenter registry included 15 patients with DCM (age 59±11 years, 93% male, ejection fraction 30±12%) and genotypically confirmed TTNtvs who underwent VT ablation between July 2014 and July 2020. Results - All patients presented with sustained monomorphic VT, including electrical storm in 4 of them. A median of 2 VTs per patient were induced during the procedure (cycle-length 318±68 ms) and the predominant morphologies were left bundle branch block with inferior axis (39%) and right bundle branch block with inferior axis (29%). A complete map of the left ventricle (LV) was created in 12 patients and showed voltage abnormalities mainly at the periaortic (92%) and basal septal region (58%). A preprocedural cardiac magnetic resonance imaging was available in 13 patients and in 11 there was evidence of LV delayed gadolinium enhancement, with predominantly midmyocardial distribution. Sequential ablation from both sides of the septum was required in 47% of patients to target septal intramural substrate and epicardial ablation was performed in 20%. At the end of the procedure, the clinical VT was noninducible in all patients, while in 3 cases a non-clinical VT was still inducible. After a follow-up of 26.5±23.0 months, 53% of patients experienced VT recurrence, 20% received transplant or mechanical circulatory support and 7% died. Conclusion - The arrhythmogenic substrate in TTN-related cardiomyopathy involves the basal septal and perivalvular regions. Long-term outcomes of catheter ablation are modest, with high recurrence rate, likely related to an intramural location of VT circuits.
Collapse
Affiliation(s)
- Andres Enriquez
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Jackson Liang
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI
| | - Jeffrey Smietana
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Daniele Muser
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Pablo Salazar
- University of Chicago Pritzker School of Medicine, Center for Arrhythmia Care at the University of Chicago Medicine, Chicago, IL
| | - Rajan Shah
- Section of Cardiac Electrophysiology, Stanford Health Care, Palo Alto, CA
| | - Nitish Badhwar
- Section of Cardiac Electrophysiology, Stanford Health Care, Palo Alto, CA
| | - Frank Bogun
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI
| | - Francis E Marchlinski
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Fermin Garcia
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Adrian Baranchuk
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Roderick Tung
- University of Chicago Pritzker School of Medicine, Center for Arrhythmia Care at the University of Chicago Medicine, Chicago, IL
| | - Damian Redfearn
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Pasquale Santangeli
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
9
|
Cherian TS, Supple G, Smietana J, Santangeli P, Nazarian S, Lin D, Hyman MC, Walsh K, Marchlinski F, Arkles J. Idiopathic Atypical Atrial Flutter Is Associated With a Distinct Atriopathy. JACC Clin Electrophysiol 2021; 7:1193-1195. [PMID: 34332868 DOI: 10.1016/j.jacep.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 11/15/2022]
|
10
|
Smietana J, Frankel DS, Serletti JM, Arkles J, Pothineni NVK, Marchlinski FE, Schaller RD. Subserratus implantation of the subcutaneous implantable cardioverter-defibrillator. Heart Rhythm 2021; 18:1799-1804. [PMID: 34119694 DOI: 10.1016/j.hrthm.2021.06.1169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/20/2021] [Revised: 06/02/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Jeffrey Smietana
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David S Frankel
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph M Serletti
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeffrey Arkles
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Naga Venkata K Pothineni
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Francis E Marchlinski
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert D Schaller
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
| |
Collapse
|
11
|
Smietana J, Santangeli P. Long-standing Persistent Atrial Fibrillation Ablation: How do You Perform it? J Cardiac Arrhtythmias 2020. [DOI: 10.24207/jca.v33i2.3399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Catheter ablation of long-standing persistent atrial fibrillation (LSPAF) presents unique challenges and the lack of large body of evidence surrounding management makes for disagreement and different approaches for treatment. Outlined is a case example that offers a comprehensive approach to ablation in patients with LSPAF that consists of risk factor management, an ablation strategy, a rigorous trigger protocol and follow-up rhythm monitoring. The case presented highlights management of this difficult population as best guided by current evidence and our experience. Ablation treatment and management strategies will continue to evolve with further randomized data and the advent of improved ablation technologies.
Collapse
Affiliation(s)
- Jeffrey Smietana
- Hospital of University of Pennsylvania – Cardiovascular Division – Electrophysiology Section – Philadelphia/Pennsylvania – United States of America
| | - Pasquale Santangeli
- Hospital of University of Pennsylvania – Cardiovascular Division – Electrophysiology Section – Philadelphia/Pennsylvania – United States of America
| |
Collapse
|
12
|
Harari R, Smietana J, Madias JE. Progression of electrocardiographic changes in a patient with apical hypertrophic cardiomyopathy. J Electrocardiol 2019; 57:132-134. [PMID: 31654969 DOI: 10.1016/j.jelectrocard.2019.09.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 09/14/2019] [Accepted: 09/25/2019] [Indexed: 11/29/2022]
Abstract
A 58-year-old man asymptomatic from the cardiovascular point of view and with no known relevant family history was found by transthoracic echocardiography to have apical hypertrophic cardiomyopathy (AHCM). His electrocardiogram (ECG) revealed prominent precordial R-waves, particularly in V3-V4 leads, and "giant" (>1.0 mV), inverted T-waves, previously associated with AHCM. ECGs recorded 17 and 13 years previously, did not disclose such abnormalities, as the ones of his current ECG. The presented case illustrates a potential role of serial ECGs (along with serial imaging testing) in detecting the development and progression of regional left ventricular hypertrophy in patients with AHCM, and probably in other hypertrophic cardiomyopathy phenotypes.
Collapse
Affiliation(s)
- Rafael Harari
- Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Division of Cardiology, Elmhurst Hospital Center, Elmhurst, NY, United States of America
| | - Jeffrey Smietana
- Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Division of Cardiology, Elmhurst Hospital Center, Elmhurst, NY, United States of America
| | - John E Madias
- Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Division of Cardiology, Elmhurst Hospital Center, Elmhurst, NY, United States of America.
| |
Collapse
|
13
|
Abstract
Atrial fibrillation (AF) is associated with thrombus formation in the left atrial appendage and systemic embolic events including ischemic stroke. Cardiogenic thromboembolism can also occur in the absence of clinical AF as a result of various pathological conditions affecting the endocardium. The inconsistent temporal relation between AF and ischemic events has stimulated exploration for factors other than clinical AF that contribute to thromboembolism. These include subclinical AF, a thrombogenic atrial cardiomyopathy, and left atrial appendage dysfunction and embolism from other sources. In conclusion, thromboembolism during normal sinus rhythm is likely multifactorial, involving intertwined pathologic processes. Patients at risk, if accurately identified, could theoretically benefit from anticoagulation.
Collapse
Affiliation(s)
- Jeffrey Smietana
- The Cardiovascular Institute, Mount Sinai Medical Center, New York, New York
| | - Anna Plitt
- The Cardiovascular Institute, Mount Sinai Medical Center, New York, New York
| | - Jonathan L Halperin
- The Cardiovascular Institute, Mount Sinai Medical Center, New York, New York.
| |
Collapse
|
14
|
Tran VN, Kusa S, Smietana J, Tsai WC, Bhasin K, Teh A, Syros G, Singh A, Choudry S, Miller MA, Koruth J, D'Avila A, Dukkipati SD, Reddy VY. The relationship between oesophageal heating during left atrial posterior wall ablation and the durability of pulmonary vein isolation. Europace 2017; 19:1664-1669. [DOI: 10.1093/europace/euw232] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 06/27/2016] [Indexed: 11/13/2022] Open
|
15
|
Calenda BW, Smietana J, Casagrande L. Long-Term Hemodialysis via Arteriovenous Fistula in Patients With Continuous-Flow Left Ventricular Assist Devices. Artif Organs 2017; 40:712. [PMID: 27378615 DOI: 10.1111/aor.12684] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 11/10/2015] [Accepted: 12/03/2015] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Lisette Casagrande
- Samuel Bronfman Department of Medicine, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| |
Collapse
|