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Tompkins JD, Hoover DB, Havton LA, Patel JC, Cho Y, Smith EH, Biscola NP, Ajijola OA, Shivkumar K, Ardell JL. Comparative specialization of intrinsic cardiac neurons in humans, mice, and pigs. bioRxiv 2024:2024.04.04.588174. [PMID: 38645175 PMCID: PMC11030249 DOI: 10.1101/2024.04.04.588174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Intrinsic cardiac neurons (ICNs) play a crucial role in the proper functioning of the heart; yet a paucity of data pertaining to human ICNs exists. We took a multidisciplinary approach to complete a detailed cellular comparison of the structure and function of ICNs from mice, pigs, and humans. Immunohistochemistry of whole and sectioned ganglia, transmission electron microscopy, intracellular microelectrode recording and dye filling for quantitative morphometry were used to define the neurophysiology, histochemistry, and ultrastructure of these cells across species. The densely packed, smaller ICNs of mouse lacked dendrites, formed axosomatic connections, and had high synaptic efficacy constituting an obligatory synapse. At Pig ICNs, a convergence of subthreshold cholinergic inputs onto extensive dendritic arbors supported greater summation and integration of synaptic input. Human ICNs were tonically firing, with synaptic stimulation evoking large suprathreshold excitatory postsynaptic potentials like mouse, and subthreshold potentials like pig. Ultrastructural examination of synaptic terminals revealed conserved architecture, yet small clear vesicles (SCVs) were larger in pigs and humans. The presence and localization of ganglionic neuropeptides was distinct, with abundant VIP observed in human but not pig or mouse ganglia, and little SP or CGRP in pig ganglia. Action potential waveforms were similar, but human ICNs had larger after-hyperpolarizations. Intrinsic excitability differed; 93% of human cells were tonic, all pig neurons were phasic, and both phasic and tonic phenotypes were observed in mouse. In combination, this publicly accessible, multimodal atlas of ICNs from mice, pigs, and humans identifies similarities and differences in the evolution of ICNs.
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Affiliation(s)
- John D. Tompkins
- UCLA Cardiac Arrhythmia Center and Neurocardiology Research Program of Excellence, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Donald B. Hoover
- Department of Biomedical Sciences, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Leif A. Havton
- Departments of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Janaki C. Patel
- UCLA Cardiac Arrhythmia Center and Neurocardiology Research Program of Excellence, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Youngjin Cho
- UCLA Cardiac Arrhythmia Center and Neurocardiology Research Program of Excellence, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Elizabeth H. Smith
- Department of Biomedical Sciences, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Natalia P. Biscola
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Olujimi A. Ajijola
- UCLA Cardiac Arrhythmia Center and Neurocardiology Research Program of Excellence, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center and Neurocardiology Research Program of Excellence, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jeffrey L. Ardell
- UCLA Cardiac Arrhythmia Center and Neurocardiology Research Program of Excellence, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Sato T, Bradfield JS, Shivkumar K, Mori S. Understanding Cardiac Anatomy and Imaging to Improve Safety of Procedures: The Interleaflet Triangle. JACC Clin Electrophysiol 2024; 10:801-807. [PMID: 38430089 DOI: 10.1016/j.jacep.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 03/03/2024]
Affiliation(s)
- Takanori Sato
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, Cardiovascular & Interventional Programs, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jason S Bradfield
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, Cardiovascular & Interventional Programs, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Kalyanam Shivkumar
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, Cardiovascular & Interventional Programs, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Shumpei Mori
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, Cardiovascular & Interventional Programs, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
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Shivkumar K. JACC: Clinical Electrophysiology 2023 Young Author Achievement Award Winner. JACC Clin Electrophysiol 2024; 10:808-809. [PMID: 38658065 DOI: 10.1016/j.jacep.2024.02.002] [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] [Indexed: 04/26/2024]
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Aksu T, Tung R, De Potter T, Markman TM, Santangeli P, du Fay de Lavallaz J, Winterfield JR, Baykaner T, Alyesh D, Joza JE, Gopinathannair R, Badertscher P, Do DH, Hussein A, Osorio J, Dewland T, Perino A, Rodgers AJ, DeSimone C, Alfie A, Atwater BD, Singh D, Kumar K, Salcedo J, Bradfield JS, Upadhyay G, Sood N, Sharma PS, Gautam S, Kumar V, Forno ARJD, Woods CE, Rav-Acha M, Valeriano C, Kapur S, Enriquez A, Sundaram S, Glikson M, Gerstenfeld E, Piccini J, Tzou WS, Sauer W, d'Avila A, Shivkumar K, Huang HD. Cardioneuroablation for the management of patients with recurrent vasovagal syncope and symptomatic bradyarrhythmias: the CNA-FWRD Registry. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01789-9. [PMID: 38499825 DOI: 10.1007/s10840-024-01789-9] [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: 12/08/2023] [Accepted: 03/13/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Cardioneuroablation has been emerging as a potential treatment alternative in appropriately selected patients with cardioinhibitory vasovagal syncope (VVS) and functional AV block (AVB). However the majority of available evidence has been derived from retrospective cohort studies performed by experienced operators. METHODS The Cardioneuroablation for the Management of Patients with Recurrent Vasovagal Syncope and Symptomatic Bradyarrhythmias (CNA-FWRD) Registry is a multicenter prospective registry with cross-over design evaluating acute and long-term outcomes of VVS and AVB patients treated by conservative therapy and CNA. RESULTS The study is a prospective observational registry with cross-over design for analysis of outcomes between a control group (i.e., behavioral and medical therapy only) and intervention group (Cardioneuroablation). Primary and secondary outcomes will only be assessed after enrollment in the registry. The follow-up period will be 3 years after enrollment. CONCLUSIONS There remains a lack of prospective multicentered data for long-term outcomes comparing conservative therapy to radiofrequency CNA procedures particularly for key outcomes including recurrence of syncope, AV block, durable impact of disruption of the autonomic nervous system, and long-term complications after CNA. The CNA-FWRD registry has the potential to help fill this information gap.
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Yeditepe University Hospital, 34100, Istanbul, Turkey
| | - Roderick Tung
- The University of Arizona College of Medicine, Banner-University Medical Center, 755 E McDowell Road, Phoenix, AZ, 85006, USA
| | - Tom De Potter
- Department of Cardiology, OLV Hospital, Aalst, Belgium
| | - Timothy M Markman
- Division of Cardiology, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Pasquale Santangeli
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | | | - Tina Baykaner
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | - Daniel Alyesh
- South Denver Cardiology Associates, 1000 SouthPark Drive, Littleton, CO, 80120, USA
| | | | | | | | - Duc H Do
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Ayman Hussein
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Jose Osorio
- Arrhythmia Institute at Grandview, Birmingham, AL, USA
- Heart Rhythm Clinical Research Solutions, Birmingham, AL, USA
| | - Thomas Dewland
- Electrophysiology Section, Division of Cardiology, Department of Internal Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Alexander Perino
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | - Albert J Rodgers
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | | | - Alberto Alfie
- Electrophysiology Section, Cardiology Division, Hospital Nacional Profesor Alejandro Posadas, Av. Illia y Marconi S/N 1684, El Palomar, Moron, Province of Buenos Aires, Argentina
| | | | - David Singh
- The Queens Medical Center, Honolulu, HI, USA
| | | | | | - Jason S Bradfield
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Gaurav Upadhyay
- Center for Arrhythmia Care, Section of Cardiology, Pritzker School of Medicine, The University of Chicago Medicine, 5841 S. Maryland Avenue, MC 9024, Chicago, IL, 60637, USA
| | - Nitesh Sood
- Arrhythmia Services, Southcoast Health, Fall River, MA, USA
| | - Parikshit S Sharma
- Department of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Sandeep Gautam
- Department of Cardiac Electrophysiology, University of Missouri-Columbia, Columbia, MO, USA
| | - Vineet Kumar
- Inova Heart and Vascular Institute, Falls Church, VA, USA
| | | | - Christopher E Woods
- Department of Cardiology, California Pacific Medical Center, San Francisco, CA, USA
| | - Moshe Rav-Acha
- Jesselson Integrated Heart Center, Shaare Zedek Hospital, 9112102, Jerusalem, Israel
| | | | - Sunil Kapur
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Andres Enriquez
- Division of Cardiology, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Sri Sundaram
- South Denver Cardiology Associates, 1000 SouthPark Drive, Littleton, CO, 80120, USA
| | - Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Hospital, 9112102, Jerusalem, Israel
| | - Edward Gerstenfeld
- Electrophysiology Section, Division of Cardiology, Department of Internal Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Jonathan Piccini
- Duke Clinical Research Institute, Duke University Hospital, Durham, USA
| | - Wendy S Tzou
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - William Sauer
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Kalyanam Shivkumar
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Henry D Huang
- Department of Cardiology, Rush University Medical Center, Chicago, IL, USA.
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Rajendran PS, Hadaya J, Khalsa SS, Yu C, Chang R, Shivkumar K. The vagus nerve in cardiovascular physiology and pathophysiology: From evolutionary insights to clinical medicine. Semin Cell Dev Biol 2024; 156:190-200. [PMID: 36641366 PMCID: PMC10336178 DOI: 10.1016/j.semcdb.2023.01.001] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/01/2023] [Accepted: 01/03/2023] [Indexed: 01/13/2023]
Abstract
The parasympathetic nervous system via the vagus nerve exerts profound influence over the heart. Together with the sympathetic nervous system, the parasympathetic nervous system is responsible for fine-tuned regulation of all aspects of cardiovascular function, including heart rate, rhythm, contractility, and blood pressure. In this review, we highlight vagal efferent and afferent innervation of the heart, with a focus on insights from comparative biology and advances in understanding the molecular and genetic diversity of vagal neurons, as well as interoception, parasympathetic dysfunction in heart disease, and the therapeutic potential of targeting the parasympathetic nervous system in cardiovascular disease.
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Affiliation(s)
| | - Joseph Hadaya
- University of California, Los Angeles (UCLA) Cardiac Arrhythmia Center and Neurocardiology Research Program of Excellence, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; UCLA Molecular, Cellular, and Integrative Physiology Program, Los Angeles, CA, USA
| | - Sahib S Khalsa
- Laureate Institute for Brain Research, Tulsa, Ok, USA; Oxley College of Health Sciences, University of Tulsa, Tulsa, Ok, USA
| | - Chuyue Yu
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA; Department of Cellular and Molecular Physiology, Yale University School of Medicine, New Haven, CT, USA
| | - Rui Chang
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA; Department of Cellular and Molecular Physiology, Yale University School of Medicine, New Haven, CT, USA
| | - Kalyanam Shivkumar
- University of California, Los Angeles (UCLA) Cardiac Arrhythmia Center and Neurocardiology Research Program of Excellence, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; UCLA Molecular, Cellular, and Integrative Physiology Program, Los Angeles, CA, USA.
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Malik V, Shivkumar K. Stellate ganglion blockade for the management of ventricular arrhythmia storm. Eur Heart J 2024; 45:834-836. [PMID: 38366239 PMCID: PMC10919926 DOI: 10.1093/eurheartj/ehae083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2024] Open
Affiliation(s)
- Varun Malik
- Cardiac Arrhythmia Center, University of California, Los Angeles (UCLA), 100 UCLA Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Kalyanam Shivkumar
- Cardiac Arrhythmia Center, University of California, Los Angeles (UCLA), 100 UCLA Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
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Thompson N, Ravagli E, Mastitskaya S, Challita R, Hadaya J, Iacoviello F, Shah Idil A, Shearing PR, Ajijola OA, Ardell JL, Shivkumar K, Holder D, Aristovich K. Anatomical and functional organization of cardiac fibers in the porcine cervical vagus nerve allows spatially selective efferent neuromodulation. bioRxiv 2024:2024.01.09.574861. [PMID: 38260584 PMCID: PMC10802425 DOI: 10.1101/2024.01.09.574861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Cardiac disease progression reflects the dynamic interaction between adversely remodeled neurohumoral control systems and an abnormal cardiac substrate. Vagal nerve stimulation (VNS) is an attractive neuromodulatory option to dampen this dynamic interaction; however, it is limited by off-target effects. Spatially-selective VNS (sVNS) offers a promising solution to induce cardioprotection while mitigating off-target effects by specifically targeting pre-ganglionic parasympathetic efferent cardiac fibers. This approach also has the potential to enhance therapeutic outcomes by eliminating time-consuming titration required for optimal VNS. Recent studies have demonstrated the independent modulation of breathing rate, heart rate, and laryngeal contraction through sVNS. However, the spatial organization of afferent and efferent cardiac-related fibers within the vagus nerve remains unexplored. By using trial-and-error sVNS in vivo in combination with ex vivo micro-computed tomography fascicle tracing, we show the significant spatial separation of cardiac afferent and efferent fibers (179±55° SD microCT, p<0.05 and 200±137° SD, p<0.05 sVNS - degrees of separation across a cross-section of nerve) at the mid-cervical level. We also show that cardiac afferent fibers are located in proximity to pulmonary fibers consistent with recent findings of cardiopulmonary convergent neurons and circuits. We demonstrate the ability of sVNS to selectively elicit desired scalable heart rate decrease without stimulating afferent-related reflexes. By elucidating the spatial organization of cardiac-related fibers within the vagus nerve, our findings pave the way for more targeted neuromodulation, thereby reducing off-target effects and eliminating the need for titration. This, in turn, will enhance the precision and efficacy of VNS therapy in treating cardiac pathology, allowing for improved therapeutic efficacy.
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Affiliation(s)
- Nicole Thompson
- EIT and Neurophysiology Research Group, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Enrico Ravagli
- EIT and Neurophysiology Research Group, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Svetlana Mastitskaya
- EIT and Neurophysiology Research Group, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Ronald Challita
- UCLA Cardiac Arrhythmia Center and Neurocardiology Research Program of Excellence, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Joseph Hadaya
- UCLA Cardiac Arrhythmia Center and Neurocardiology Research Program of Excellence, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Francesco Iacoviello
- Electrochemical Innovation Lab, Department of Chemical Engineering, University College London, London, United Kingdom
| | - Ahmad Shah Idil
- EIT and Neurophysiology Research Group, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Paul R. Shearing
- Electrochemical Innovation Lab, Department of Chemical Engineering, University College London, London, United Kingdom
| | - Olujimi A. Ajijola
- UCLA Cardiac Arrhythmia Center and Neurocardiology Research Program of Excellence, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jeffrey L. Ardell
- UCLA Cardiac Arrhythmia Center and Neurocardiology Research Program of Excellence, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center and Neurocardiology Research Program of Excellence, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - David Holder
- EIT and Neurophysiology Research Group, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Kirill Aristovich
- EIT and Neurophysiology Research Group, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
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Ramdat Misier NL, Moore JP, Nguyen HH, Lloyd MS, Dubin AM, Mah DY, Czosek RJ, Khairy P, Chang PM, Nielsen JC, Aydin A, Pilcher TA, O'Leary ET, Shivkumar K, de Groot NMS. Long-Term Outcomes of Cardiac Resynchronization Therapy in Patients With Repaired Tetralogy of Fallot: A Multicenter Study. Circ Arrhythm Electrophysiol 2024; 17:e012363. [PMID: 38344811 DOI: 10.1161/circep.123.012363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 01/17/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND A growing number of patients with tetralogy of Fallot develop left ventricular systolic dysfunction and heart failure, in addition to right ventricular dysfunction. Although cardiac resynchronization therapy (CRT) is an established treatment option, the effect of CRT in this population is still not well defined. This study aimed to investigate the early and late efficacy, survival, and safety of CRT in patients with tetralogy of Fallot. METHODS Data were analyzed from an observational, retrospective, multicenter cohort, initiated jointly by the Pediatric and Congenital Electrophysiology Society and the International Society of Adult Congenital Heart Disease. Twelve centers contributed baseline and longitudinal data, including vital status, left ventricular ejection fraction (LVEF), QRS duration, and NYHA functional class. Outcomes were analyzed at early (3 months), intermediate (1 year), and late follow-up (≥2 years) after CRT implantation. RESULTS A total of 44 patients (40.3±19.2 years) with tetralogy of Fallot and CRT were enrolled. Twenty-nine (65.9%) patients had right ventricular pacing before CRT upgrade. The left ventricular ejection fraction improved from 32% [24%-44%] at baseline to 42% [32%-50%] at early follow-up (P<0.001) and remained improved from baseline thereafter (P≤0.002). The QRS duration decreased from 180 [160-205] ms at baseline to 152 [133-182] ms at early follow-up (P<0.001) and remained decreased at intermediate and late follow-up (P≤0.001). Patients with upgraded CRT had consistent improvement in left ventricular ejection fraction and QRS duration at each time point (P≤0.004). Patients had a significantly improved New York Heart Association functional class after CRT implantation at each time point compared with baseline (P≤0.002). The transplant-free survival rates at 3, 5, and 8 years after CRT implantation were 85%, 79%, and 73%. CONCLUSIONS In patients with tetralogy of Fallot treated with CRT consistent improvement in QRS duration, left ventricular ejection fraction, New York Heart Association functional class, and reasonable long-term survival were observed. The findings from this multicenter study support the consideration of CRT in this unique population.
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Affiliation(s)
- Nawin L Ramdat Misier
- Department of Cardiology, Erasmus Medical Center, Rotterdam , The Netherlands (N.L.R.M., N.M.S.d.G.)
| | - Jeremy P Moore
- Ahmanson/University of California Los Angeles Adult Congenital Heart Disease Center, Los Angeles, CA (J.P.M., K.S.)
| | - Hoang H Nguyen
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX (H.H.N.)
| | - Michael S Lloyd
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (M.S.L.)
| | - Anne M Dubin
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto CA (A.M.D.)
| | - Douglas Y Mah
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston MA (D.Y.M., E.T.O.)
| | - Richard J Czosek
- Division of Pediatric Cardiology, Department of Pediatrics, The Heart Institute at Cincinnati Children's Hospital Medical Center, Cincinnati OH (R.J.C.)
| | - Paul Khairy
- Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal Quebec, Canada (P.K.)
| | - Philip M Chang
- Congenital Heart Center, University of Florida Health, Gainesville, FL (P.M.C.)
| | - Jens C Nielsen
- Department of Clinical Medicine, Aarhus University, Aarhus Denmark (J.C.N.)
- Department of Cardiology, Aarhus University Hospital, Aarhus Denmark (J.C.N.)
| | - Alper Aydin
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario Canada (A.A.)
| | - Thomas A Pilcher
- Division of Pediatric Cardiology, Department of Internal Medicine, University of Utah, Salt Lake City UT (T.A.P.)
| | - Edward T O'Leary
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston MA (D.Y.M., E.T.O.)
| | - Kalyanam Shivkumar
- Ahmanson/University of California Los Angeles Adult Congenital Heart Disease Center, Los Angeles, CA (J.P.M., K.S.)
| | - Natasja M S de Groot
- Department of Cardiology, Erasmus Medical Center, Rotterdam , The Netherlands (N.L.R.M., N.M.S.d.G.)
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Moore JP, Su J, Shannon KM, Perens GS, Newlon C, Bradfield JS, Shivkumar K. Multidetector Computed Tomography Assessment of Anatomical Ventricular Tachycardia Isthmuses in Repaired Tetralogy of Fallot. JACC Clin Electrophysiol 2024:S2405-500X(24)00089-6. [PMID: 38456860 DOI: 10.1016/j.jacep.2024.102333] [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: 11/01/2023] [Revised: 01/19/2024] [Accepted: 01/30/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Tetralogy of Fallot (TOF) is associated with risk for sustained monomorphic ventricular tachycardia (VT). Preemptive electrophysiology study before transcatheter pulmonary valve placement is increasing, but the value of MDCT for anatomical VT isthmus assessment is unknown. OBJECTIVES The purpose of this study was to determine the impact of multidetector computed tomography (MDCT) in the evaluation of sustained monomorphic VT for repaired TOF. METHODS Consecutive pre-transcatheter pulmonary valve MDCT studies were identified, and anatomical isthmus dimensions were measured. For a subset of patients with preemptive electrophysiology study, MDCT features were compared with electroanatomical maps. RESULTS A total of 61 repaired TOFs with MDCT were identified (mean 35 ± 14 years, 58% men) with MDCT electroanatomical map pairs in 35 (57%). Calcification corresponding to patch material was present in 46 (75%) and was used to measure anatomical VT isthmuses. MDCT wall thickness correlated positively with number of ablation lesions and varied with functional isthmus properties (blocked isthmus 2.6 mm [Q1, Q3: 2.1, 4.0 mm], slow conduction 4.8 mm [Q1, Q3: 3.3, 6.0 mm], and normal conduction 5.6 mm [Q1, Q3: 3.9, 8.3 mm]; P < 0.001). A large conal branch was present in 6 (10%) and a major coronary anomaly was discovered in 3 (5%). Median ablation lesion distance was closer to the right vs the left coronary artery (10 mm vs 15 mm; P = 0.01) with lesion-to-coronary distance <5 mm in 3 patients. CONCLUSIONS MDCT identifies anatomical structures relevant to catheter ablation for repaired TOF. Wall thickness at commonly targeted anatomical VT isthmuses is associated with functional isthmus properties and increased thermal energy delivery.
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Affiliation(s)
- Jeremy P Moore
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, Los Angeles, California, USA; Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California, USA; Division of Pediatric Cardiology, Department of Pediatrics, David Geffen School of Medicine, UCLA Health System, Los Angeles, California, USA.
| | - Jonathan Su
- Division of Pediatric Cardiology, Department of Pediatrics, David Geffen School of Medicine, UCLA Health System, Los Angeles, California, USA
| | - Kevin M Shannon
- Division of Pediatric Cardiology, Department of Pediatrics, David Geffen School of Medicine, UCLA Health System, Los Angeles, California, USA
| | - Gregory S Perens
- Division of Pediatric Cardiology, Department of Pediatrics, David Geffen School of Medicine, UCLA Health System, Los Angeles, California, USA
| | - Claire Newlon
- Division of Pediatric Cardiology, Department of Pediatrics, David Geffen School of Medicine, UCLA Health System, Los Angeles, California, USA
| | - Jason S Bradfield
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, Los Angeles, California, USA
| | - Kalyanam Shivkumar
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, Los Angeles, California, USA
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Chen J, Bendowski KT, Bizanti A, Zhang Y, Ma J, Hoover DB, Gozal D, Shivkumar K, Cheng ZJ. Distribution and morphology of calcitonin gene-related peptide (CGRP) innervation in flat mounts of whole rat atria and ventricles. Auton Neurosci 2024; 251:103127. [PMID: 38211380 DOI: 10.1016/j.autneu.2023.103127] [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: 09/18/2023] [Revised: 10/10/2023] [Accepted: 10/19/2023] [Indexed: 01/13/2024]
Abstract
Calcitonin gene-related peptide (CGRP) is widely used as a marker for nociceptive afferent axons. However, the distribution of CGRP-IR axons has not been fully determined in the whole rat heart. Immunohistochemically labeled flat-mounts of the right and left atria and ventricles, and the interventricular septum (IVS) in rats for CGRP were assessed with a Zeiss imager to generate complete montages of the entire atria, ventricles, and septum, and a confocal microscope was used to acquire detailed images of selected regions. We found that 1) CGRP-IR axons extensively innervated all regions of the atrial walls including the sinoatrial node region, auricles, atrioventricular node region, superior/inferior vena cava, left pre-caval vein, and pulmonary veins. 2) CGRP-IR axons formed varicose terminals around individual neurons in some cardiac ganglia but passed through other ganglia without making appositions with cardiac neurons. 3) Varicose CGRP-IR axons innervated the walls of blood vessels. 4) CGRP-IR axons extensively innervated the right/left ventricular walls and IVS. Our data shows the rather ubiquitous distribution of CGRP-IR axons in the whole rat heart at single-cell/axon/varicosity resolution for the first time. This study lays the foundation for future studies to quantify the differences in CGRP-IR axon innervation between sexes, disease models, and species.
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Affiliation(s)
- Jin Chen
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, FL 32816, USA.
| | - Kohlton T Bendowski
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, FL 32816, USA.
| | - Ariege Bizanti
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, FL 32816, USA
| | - Yuanyuan Zhang
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, FL 32816, USA
| | - Jichao Ma
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, FL 32816, USA
| | - Donald B Hoover
- Department of Biomedical Sciences, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, USA
| | - David Gozal
- Office of the Dean, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25701, USA
| | - Kalyanam Shivkumar
- Department of Medicine, Cardiac Arrhythmia Center and Neurocardiology Research Program of Excellence, University of California, Los Angeles, CA 90095, USA
| | - Zixi Jack Cheng
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, FL 32816, USA.
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11
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Mori S, Bradfield JS, Fukuzawa K, Shivkumar K. Comprehensive Anatomy of the Summit of the Left Ventricle. JACC Clin Electrophysiol 2024; 10:168-184. [PMID: 37999670 DOI: 10.1016/j.jacep.2023.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/07/2023] [Accepted: 09/19/2023] [Indexed: 11/25/2023]
Affiliation(s)
- Shumpei Mori
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA; UCLA Cardiovascular Interventional Programs, Department of Medicine, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
| | - Jason S Bradfield
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA; UCLA Cardiovascular Interventional Programs, Department of Medicine, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Koji Fukuzawa
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA; UCLA Cardiovascular Interventional Programs, Department of Medicine, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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12
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Esrailian DL, Mori S, Shivkumar K. Understanding Cardiac Anatomy and Imaging to Improve Safety of Procedures: The Sinus Node Artery. JACC Case Rep 2023; 28:102124. [PMID: 38204525 PMCID: PMC10774828 DOI: 10.1016/j.jaccas.2023.102124] [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: 08/20/2023] [Revised: 10/11/2023] [Accepted: 10/17/2023] [Indexed: 01/12/2024]
Abstract
The sinus node artery can originate from either the right or the left coronary arteries, or even both, and follows a variable course. Being aware of these important variations is of clinical significance during open heart surgery and catheter ablation procedures to avoid injury to the artery.
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Affiliation(s)
- Derek L. Esrailian
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California USA
| | - Shumpei Mori
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California USA
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California USA
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13
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Paterson DJ, Shivkumar K. Bioelectronics for neurocardiology: diagnosis and therapeutics. Eur Heart J 2023; 44:4822-4825. [PMID: 37949823 DOI: 10.1093/eurheartj/ehad624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Affiliation(s)
- David J Paterson
- Burdon Sanderson Cardiac Science Centre, Sherrington Building, Department of Physiology, Anatomy & Genetics, University of Oxford, Parks Road, Oxford OX1 3PT, UK
| | - Kalyanam Shivkumar
- Department of Medicine, UCLA Cardiac Arrhythmia Center University of California, Los Angeles, 100 UCLA Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
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14
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Chung WH, Hayase J, Davies MJ, Do DH, Sorg JM, Ajijola OA, Buch EF, Boyle NG, Shivkumar K, Bradfield JS. Cryothermal energy demonstrates shorter ablation time and lower complication rates compared with radiofrequency in surgical hybrid ablation for recurrent ventricular tachycardia. Heart Rhythm 2023; 20:1708-1717. [PMID: 37659454 DOI: 10.1016/j.hrthm.2023.08.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 08/08/2023] [Accepted: 08/28/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Recurrent ventricular tachycardia (VT) after prior endocardial catheter ablation(s) presents challenges in the setting of prior cardiac surgery where percutaneous epicardial access may not be feasible. OBJECTIVE The purpose of this study was to compare the outcomes of cryothermal vs radiofrequency ablation in direct surgical epicardial access procedures. METHODS We performed a retrospective study of consecutive surgical epicardial VT ablation cases. Surgical cases using cryothermal vs radiofrequency ablation were analyzed and outcomes were compared. RESULTS Between 2009 and 2022, 43 patients underwent either a cryothermal (n = 17) or a radiofrequency (n = 26) hybrid epicardial ablation procedure with direct surgical access. Both groups were similarly matched for age, sex, etiology of VT, and comorbidities with a high burden of refractory VT despite previous endocardial and/or percutaneous epicardial ablation procedures. The surgical access site was lateral thoracotomy (76.5%) in the cryothermal ablation group compared with lateral thoracotomy (42.3%) and subxiphoid approach (38.5%) in the radiofrequency group, with the remainder in both groups performed via median sternotomy. The ablation time was significantly shorter in those undergoing cryothermal ablation vs radiofrequency ablation (11.54 ± 15.5 minutes vs 48.48 ± 23.6 minutes; P < .001). There were no complications in the cryothermal ablation group compared with 6 patients with complications in the radiofrequency group. Recurrent VT episodes and all-cause mortality were similar in both groups. CONCLUSION Hybrid surgical VT ablation with cryothermal or radiofrequency energy demonstrated similar efficacy outcomes. Cryothermal ablation was more efficient and safer than radiofrequency in a surgical setting and should be considered when surgical access is required.
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Affiliation(s)
- Wei-Hsin Chung
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California; Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Justin Hayase
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California; Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Mark J Davies
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California; Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Duc H Do
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Julie M Sorg
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Olujimi A Ajijola
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Eric F Buch
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Noel G Boyle
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Jason S Bradfield
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California.
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15
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Moore JP, Shannon KM, Khairy P, Waldmann V, Bessière F, Burrows A, Su J, Shivkumar K. Sinus rhythm QRS morphology reflects right ventricular activation and anatomical ventricular tachycardia isthmus conduction in repaired tetralogy of Fallot. Heart Rhythm 2023; 20:1689-1696. [PMID: 37598989 DOI: 10.1016/j.hrthm.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/08/2023] [Accepted: 08/12/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Patients with repaired tetralogy of Fallot (TOF) are at risk for ventricular tachycardia (VT) related to well-described anatomical isthmuses. OBJECTIVE The purpose of this study was to explore QRS morphology as an indicator of anatomical isthmus conduction. METHODS Patients with repaired TOF and complete right bundle branch block referred for transcatheter pulmonary valve replacement (PVR) or presenting with sustained VT underwent comprehensive 3-dimensional mapping in sinus rhythm. Electrocardiographic characteristics were compared to right ventricular (RV) activation and anatomical isthmus conduction properties. RESULTS Twenty-two patients (19 pre-pulmonary valve replacement and 3 clinical VT) underwent comprehensive 3-dimensional mapping (median 39 years; interquartile range [IQR] 27-48 years; 12 [55%] male). Septal RV activation (median 40 ms; IQR 34-46 ms) corresponded to the nadir in lead V1 and free wall activation (median 71 ms; IQR 64-81 ms) to the transition point in the upstroke of the R' wave. Patients with isthmus block between the pulmonary annulus and the ventricular septal defect patch and between the ventricular septal defect patch and the tricuspid annulus (when present), were more likely to demonstrate lower amplitude R' waves in lead V1 (5.8 mV vs 9.4 mV; P = .005), QRS fragmentation in lead V1 (15 [94%] vs 2 [13%]; P < .001), and terminal S waves in lead aVF (15 [94%] vs 6 [40%]; P < .001) than those with intact conduction. During catheter ablation, these QRS changes developed during isthmus block. CONCLUSION For patients with repaired TOF, the status of septal isthmus conduction was evident from sinus rhythm QRS morphology. Low-amplitude, fragmented R' waves in lead V1 and terminal S waves in the inferior leads were related to septal isthmus conduction abnormalities, providing a mechanistic link between RV activation and common electrocardiographic findings.
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Affiliation(s)
- Jeremy P Moore
- Division of Cardiology, Department of Medicine, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California; UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California; Division of Cardiology, Department of Pediatrics, UCLA Health System, Los Angeles, California.
| | - Kevin M Shannon
- Division of Cardiology, Department of Medicine, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California; UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California; Division of Cardiology, Department of Pediatrics, UCLA Health System, Los Angeles, California
| | - Paul Khairy
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Victor Waldmann
- Université Paris Cité, Inserm, PARCC, Paris, France; Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France; M3C-Necker, Hôpital Universitaire Necker-Enfants malades, APHP, Paris, France
| | - Francis Bessière
- Cardiac Electrophysiology Unit, European Georges Pompidou Hospital, Paris, France; Louis Pradel Hospital, Hospices Civils de Lyon, Université Lyon 1 Claude Bernard, Lyon, France
| | - Austin Burrows
- David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Jonathan Su
- Division of Cardiology, Department of Pediatrics, UCLA Health System, Los Angeles, California
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California
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16
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Chung WH, Masuyama K, Challita R, Hayase J, Mori S, Cha S, Bradfield JS, Ardell JL, Shivkumar K, Ajijola OA. Ischemia-induced ventricular proarrhythmia and cardiovascular autonomic dysreflexia after cardioneuroablation. Heart Rhythm 2023; 20:1534-1545. [PMID: 37562487 DOI: 10.1016/j.hrthm.2023.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Cardioneuroablation (CNA) is an attractive treatment of vasovagal syncope. Its long-term efficacy and safety remain unknown. OBJECTIVE The purpose of this study was to develop a chronic porcine model of CNA to examine the susceptibility to ventricular tachyarrhythmia (ventricular tachycardia/ventricular fibrillation [VT/VF]) and cardiac autonomic function after CNA. METHODS A percutaneous CNA model was developed by ablation of left- and right-sided ganglionated plexi (n = 5), confirmed by histology. Reproducible bilateral vagal denervation was confirmed after CNA by extracardiac vagal nerve stimulation (VNS) and histology. Chronic studies included 16 pigs randomized to CNA (n = 8) and sham ablation (n = 8, Control). After 6 weeks, animals underwent hemodynamic studies, assessment of cardiac sympathetic and parasympathetic function using sympathetic chain stimulation and direct VNS, respectively, and proarrhythmic potential after left anterior descending (LAD) coronary artery ligation. RESULTS After CNA, extracardiac VNS responses remained abolished for 6 weeks despite ganglia remaining in ablated ganglionated plexi. In the CNA group, direct VNS resulted in paradoxical increases in blood pressure, but not in sham-ablated animals (CNA group vs sham group: 8.36% ± 7.0% vs -4.83% ± 8.7%, respectively; P = .009). Left sympathetic chain stimulation (8 Hz) induced significant corrected QT interval prolongation in the CNA group vs the sham group (11.23% ± 4.0% vs 1.49% ± 4.0%, respectively; P < .001). VT/VF after LAD ligation was more prevalent and occurred earlier in the CNA group than in the control group (61.44 ± 73.7 seconds vs 245.11 ± 104.0 seconds, respectively; P = .002). CONCLUSION Cardiac vagal denervation is maintained long-term after CNA in a porcine model. However, chronic CNA was associated with cardiovascular dysreflexia, diminished cardioprotective effects of cardiac vagal tone, and increased susceptibility to VT/VF in ischemia. These potential long-term negative effects of CNA suggest the need for rigorous clinical studies on CNA.
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Affiliation(s)
- Wei-Hsin Chung
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California; China Medical University Hospital, Taichung, Taiwan
| | - Kiyoshi Masuyama
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Ronald Challita
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Justin Hayase
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Shumpei Mori
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Steven Cha
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Jason S Bradfield
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Jeffery L Ardell
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Olujimi A Ajijola
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California.
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17
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Vijayaraman P, Chelu MG, Curila K, Dandamudi G, Herweg B, Mori S, Jastrzebski M, Sharma PS, Shivkumar K, Tung R, Upadhyay G, Vernooy K, Welter-Frost A, Whinnett Z, Zanon F, Ellenbogen KA. Cardiac Conduction System Pacing: A Comprehensive Update. JACC Clin Electrophysiol 2023; 9:2358-2387. [PMID: 37589646 DOI: 10.1016/j.jacep.2023.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 04/04/2023] [Revised: 05/10/2023] [Accepted: 06/02/2023] [Indexed: 08/18/2023]
Abstract
The field of cardiac pacing has changed rapidly in the last several years. Since the initial description of His bundle pacing targeting the conduction system, recent advances in pacing the left bundle branch and its fascicles have evolved. The field and investigators' knowledge of conduction system pacing including relevant anatomy and physiology has advanced significantly. The aim of this review is to provide a comprehensive update on recent advances in conduction system pacing.
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Affiliation(s)
- Pugazhendhi Vijayaraman
- Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, Wilkes-Barre, Pennsylvania, USA.
| | - Mihal G Chelu
- Division of Cardiology, Baylor College of Medicine and Baylor St. Luke's Medical Center and Texas Heart Institute, Houston, Texas, USA
| | - Karol Curila
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Gopi Dandamudi
- Virginia Mason Franciscan Health, Seattle, Washington, USA
| | - Bengt Herweg
- University of South Florida Morsani College of Medicine, Department of Cardiovascular Sciences, Tampa, Florida, USA
| | - Shumpei Mori
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Marek Jastrzebski
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland
| | - Parikshit S Sharma
- Department of Cardiology, Rush University School of Medicine, Chicago, Illinois, USA
| | - Kalyanam Shivkumar
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Roderick Tung
- Division of Cardiology, University of Arizona College of Medicine-Phoenix, Banner-University Medical Center, Phoenix, Arizona, USA
| | - Gaurav Upadhyay
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Kevin Vernooy
- Center for Arrhythmia Care, Heart and Vascular Center, University of Chicago, Chicago, Illinois, USA
| | - Allan Welter-Frost
- Cleveland Clinic Indian River Hospital, Heart Vascular and Thoracic Institute, Vero Beach, Florida, USA
| | - Zachary Whinnett
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | | | - Kenneth A Ellenbogen
- Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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18
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Mori S, Beyer RS, Bernardes de Souza B, Sorg JM, Hoover DB, Sacks HS, Fishbein MC, Chang G, Peacock WJ, St. John MA, Law J, Symonds ME, Ajijola OA, Shivkumar K, Srikanthan P. Sympathetic innervation of the supraclavicular brown adipose tissue: A detailed anatomical study. PLoS One 2023; 18:e0290455. [PMID: 37792692 PMCID: PMC10550181 DOI: 10.1371/journal.pone.0290455] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 08/08/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND The supraclavicular fossa is the dominant location for human brown adipose tissue (BAT). Activation of BAT promotes non-shivering thermogenesis by utilization of glucose and free fatty acids and has been the focus of pharmacological and non-pharmacological approaches for modulation in order to improve body weight and glucose homeostasis. Sympathetic neural control of supraclavicular BAT has received much attention, but its innervation has not been extensively investigated in humans. METHODS Dissection of the cervical region in human cadavers was performed to find the distribution of sympathetic nerve branches to supraclavicular fat pad. Furthermore, proximal segments of the 4th cervical nerve were evaluated histologically to assess its sympathetic components. RESULTS Nerve branches terminating in supraclavicular fat pad were identified in all dissections, including those from the 3rd and 4th cervical nerves and from the cervical sympathetic plexus. Histology of the proximal segments of the 4th cervical nerves confirmed tyrosine hydroxylase positive thin nerve fibers in all fascicles with either a scattered or clustered distribution pattern. The scattered pattern was more predominant than the clustered pattern (80% vs. 20%) across cadavers. These sympathetic nerve fibers occupied only 2.48% of the nerve cross sectional area on average. CONCLUSIONS Human sympathetic nerves use multiple pathways to innervate the supraclavicular fat pad. The present finding serves as a framework for future clinical approaches to activate human BAT in the supraclavicular region.
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Affiliation(s)
- Shumpei Mori
- David Geffen School of Medicine at UCLA, UCLA Health System, University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, Los Angeles, CA, United States of America
| | - Ryan S. Beyer
- David Geffen School of Medicine at UCLA, UCLA Health System, University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, Los Angeles, CA, United States of America
| | - Breno Bernardes de Souza
- David Geffen School of Medicine at UCLA, UCLA Health System, University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, Los Angeles, CA, United States of America
| | - Julie M. Sorg
- David Geffen School of Medicine at UCLA, UCLA Health System, University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, Los Angeles, CA, United States of America
| | - Donald B. Hoover
- Department of Biomedical Sciences, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States of America
- Center of Excellence in Inflammation, Infectious Disease and Immunity, East Tennessee State University, Johnson City, TN, United States of America
| | - Harold S. Sacks
- VA Endocrinology and Diabetes Division, Department of Medicine, UCLA, Los Angeles, CA, United States of America
| | - Michael C. Fishbein
- Department of Pathology and Laboratory Medicine, UCLA, Los Angeles, CA, United States of America
| | - Grace Chang
- Department of Surgery, UCLA, Los Angeles, CA, United States of America
| | | | - Maie A. St. John
- Department of Head and Neck Surgery, UCLA, Los Angeles, CA, United States of America
| | - James Law
- Academic Unit of Population and Lifespan Sciences, Centre for Perinatal Research, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Nottingham Children’s Hospital, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Micheal E. Symonds
- Academic Unit of Population and Lifespan Sciences, Centre for Perinatal Research, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Olujimi A. Ajijola
- David Geffen School of Medicine at UCLA, UCLA Health System, University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, Los Angeles, CA, United States of America
| | - Kalyanam Shivkumar
- David Geffen School of Medicine at UCLA, UCLA Health System, University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, Los Angeles, CA, United States of America
| | - Preethi Srikanthan
- Division of Endocrinology UCLA, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
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19
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Sato T, Moussa ID, Hanna P, Shivkumar K, Mori S. Intermediate Accessory Papillary Muscle: An Anatomic Variant of Interest for Transcatheter Edge-to-Edge Mitral Valve Repair. Circ Cardiovasc Imaging 2023; 16:e015151. [PMID: 37847764 PMCID: PMC10584364 DOI: 10.1161/circimaging.122.015151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Affiliation(s)
- Takanori Sato
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Issam D. Moussa
- Carle Illinois College of Medicine, University of Illinois; Carle Heart and Vascular Institute, Champaign, IL, USA
| | - Peter Hanna
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Kalyanam Shivkumar
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Shumpei Mori
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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20
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Sato T, Adlaka K, Moussa ID, Hanna P, Do DH, Fishbein MC, Shivkumar K, Mori S. Understanding Cardiac Anatomy and Imaging to Improve Safety of Procedures: The Right Ventricle. JACC Cardiovasc Imaging 2023; 16:1348-1352. [PMID: 37656118 DOI: 10.1016/j.jcmg.2023.06.026] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/30/2023] [Accepted: 06/28/2023] [Indexed: 09/02/2023]
Abstract
Right ventricular perforation is a catastrophic complication of catheter-based intracardiac interventions. In this context, appreciation of 5 attachments of the right ventricle to the aortoventricular unit is essential to recognize extent of right ventricular free wall. We herein present progressive dissection and virtual and photographic endoscopic images of the hearts without distortion. Real dissection images show us how and where to avoid this complication by indicating the true muscular component of the ventricular septum. Both virtual and photographic endoscopic images, when combined with transillumination, beautifully shows the thin wall regions and trabeculations with unprecedented clarity. We believe recognition of these anatomical nuances can reduce the likelihood of right ventricular perforation.
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Affiliation(s)
- Takanori Sato
- Cardiac Arrhythmia Center, University of California-Los Angeles, Los Angeles, California, USA; Cardiovascular & Interventional Programs, University of California-Los Angeles Health System, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California, USA
| | - Kyle Adlaka
- Cardiac Arrhythmia Center, University of California-Los Angeles, Los Angeles, California, USA; Cardiovascular & Interventional Programs, University of California-Los Angeles Health System, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California, USA; Postbaccalaureate Premedical Program, University of Southern California, Los Angeles, California, USA
| | - Issam D Moussa
- Carle Illinois College of Medicine, University of Illinois, Carle Heart and Vascular Institute, Champaign, Illinois, USA
| | - Peter Hanna
- Cardiac Arrhythmia Center, University of California-Los Angeles, Los Angeles, California, USA; Cardiovascular & Interventional Programs, University of California-Los Angeles Health System, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California, USA
| | - Duc H Do
- Cardiac Arrhythmia Center, University of California-Los Angeles, Los Angeles, California, USA; Cardiovascular & Interventional Programs, University of California-Los Angeles Health System, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California, USA
| | - Michael C Fishbein
- Department of Pathology and Laboratory Medicine, University of California-Los Angeles, Los Angeles, California USA
| | - Kalyanam Shivkumar
- Cardiac Arrhythmia Center, University of California-Los Angeles, Los Angeles, California, USA; Cardiovascular & Interventional Programs, University of California-Los Angeles Health System, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California, USA
| | - Shumpei Mori
- Cardiac Arrhythmia Center, University of California-Los Angeles, Los Angeles, California, USA; Cardiovascular & Interventional Programs, University of California-Los Angeles Health System, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California, USA.
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21
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Moore JP, Aboulhosn JA, Zeppenfeld K, Waldmann V, Bessière F, Blom NA, Combes N, Fish FA, McLeod CJ, Kanter RJ, Tan W, Patel N, von Alvensleben JC, Kamp A, Lloyd MS, Anderson CC, Tan RB, Mariucci E, Levi DS, Salem M, Shivkumar K, Khairy P. Rationale and Design of the Multicenter Catheter Ablation of Ventricular Tachycardia Before Transcatheter Pulmonary Valve Replacement in Repaired Tetralogy of Fallot Study. Am J Cardiol 2023; 204:14-21. [PMID: 37536198 DOI: 10.1016/j.amjcard.2023.07.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/08/2023] [Accepted: 07/13/2023] [Indexed: 08/05/2023]
Abstract
Patients with repaired tetralogy of Fallot are at elevated risk for ventricular arrhythmia and sudden cardiac death. Over the past decade, the pathogenesis and natural history of ventricular tachycardia has become increasingly understood, and catheter ablation has emerged as an effective treatment modality. Concurrently, there has been great progress in the development of a versatile array of transcatheter valves that can be placed in the native right ventricular outflow tract for the treatment of long-standing pulmonary regurgitation. Although such valve platforms may eliminate the need for repeat cardiac operations, they may also impede catheter access to the myocardial substrates responsible for sustained macro-reentrant ventricular tachycardia. This manuscript provides the rationale and design of a recently devised multicenter study that will examine the clinical outcomes of a uniform, preemptive strategy to eliminate ventricular tachycardia substrates before transcatheter pulmonary valve implantation in patients with tetralogy of Fallot.
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Affiliation(s)
- Jeremy P Moore
- Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California.
| | - Jamil A Aboulhosn
- Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California
| | - Katja Zeppenfeld
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands
| | - Victor Waldmann
- Paris Cardiovascular Research Center (PARCC), Institut national de la santé et de la recherche médicale (Inserm), Université Paris Cité, Paris, France; Adult Congenital Heart Disease Medico-Surgical Unit; M3C-Necker, Hôpital Universitaire Necker-Enfants malades, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - Francis Bessière
- Cardiac Electrophysiology Unit, European Georges Pompidou Hospital, Paris, France; Louis Pradel Hospital, Hospices Civils de Lyon, Université Lyon 1 Claude Bernard, Lyon, France
| | - Nico A Blom
- Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Nicolas Combes
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, Paris, France; University of Versailles Saint-Quentin-en-Yvelines (UVSQ), Institut national de la santé et de la recherche médicale (Inserm), CESP U1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Frank A Fish
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Ronald J Kanter
- Nicklaus Children's Hospital, Miami, Florida; Duke University School of Medicine, Durham, North Carolina
| | - Weiyi Tan
- Adult Congenital Heart Disease, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Nimesh Patel
- Adult Congenital Heart Disease, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Anna Kamp
- The Heart Center, Nationwide Children's Hospital, the Ohio State University, Columbus, Ohio
| | - Michael S Lloyd
- Department of Cardiac Electrophysiology, Emory University, Atlanta, Georgia
| | - Charles C Anderson
- Center for Congenital Heart Disease, Providence Sacred Heart Children's Hospital, Spokane, Washington
| | - Reina B Tan
- Division of Cardiology, Hassenfeld Children's Hospital, NYU Langone Health, New York, New York
| | - Elisabetta Mariucci
- Pediatric Cardiology and Adult Congenital Heart Disease Program, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Daniel S Levi
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Morris Salem
- Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California; Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Paul Khairy
- Montreal Heart Institute, Université de Montréal, Montreal, Que, Canada
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22
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Sato T, Hanna P, Ajijola OA, Shivkumar K, Mori S. Photogrammetry of Perfusion-Fixed Heart: Innovative Approach to Study 3-Dimensional Cardiac Anatomy. JACC Clin Electrophysiol 2023; 9:2197-2216. [PMID: 37516938 DOI: 10.1016/j.jacep.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 05/04/2023] [Accepted: 05/23/2023] [Indexed: 07/31/2023]
Affiliation(s)
- Takanori Sato
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Peter Hanna
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Olujimi A Ajijola
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Kalyanam Shivkumar
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Shumpei Mori
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
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23
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Sato T, Moussa ID, Hanna P, Shivkumar K, Mori S. Insights Into Interaction Between Clip Device and the Mitral Valve Apparatus in the Human Heart. JACC Case Rep 2023; 22:101999. [PMID: 37790766 PMCID: PMC10544422 DOI: 10.1016/j.jaccas.2023.101999] [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: 01/16/2023] [Revised: 05/03/2023] [Accepted: 06/06/2023] [Indexed: 10/05/2023]
Abstract
Precise appreciation of the 3-dimensional relationship between the edge-to-edge clips and mitral valve apparatus remains clinically challenging. We demonstrate the images of clips observed in situ 4 years after implantation. Detailed observation from this case helps improve our understanding of 3-dimensional clinical cardiac anatomy related to transcatheter edge-to-edge mitral valve repair. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Takanori Sato
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, Cardiovascular & Interventional Programs, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Issam D. Moussa
- Carle Illinois College of Medicine, University of Illinois, Carle Heart and Vascular Institute, Champaign, Illinois, USA
| | - Peter Hanna
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, Cardiovascular & Interventional Programs, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Kalyanam Shivkumar
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, Cardiovascular & Interventional Programs, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Shumpei Mori
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, Cardiovascular & Interventional Programs, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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24
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Sato T, Hanna P, Ajijola OA, Shivkumar K, Mori S. Photogrammetry of Perfusion-Fixed Heart: Innovative Approach to Study 3-Dimensional Cardiac Anatomy. JACC Case Rep 2023; 21:101937. [PMID: 37719294 PMCID: PMC10500340 DOI: 10.1016/j.jaccas.2023.101937] [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: 12/26/2022] [Revised: 05/04/2023] [Accepted: 05/23/2023] [Indexed: 09/19/2023]
Abstract
Photogrammetry generates a 3-dimensional high-resolution model from multiple 2-dimensional photographs. Herein, we demonstrate a photogrammetry of a perfusion-fixed cardiac sample around the left ventricular summit. The single photogrammetric model can be observed from almost all directions and illustrates important anatomical features for the general cardiologist. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Takanori Sato
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Peter Hanna
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Olujimi A. Ajijola
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Kalyanam Shivkumar
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Shumpei Mori
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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25
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Huang DT, Gosev I, Wood KL, Vidula H, Stevenson W, Marchlinski F, Supple G, Zalawadiya SK, Weiss JP, Tung R, Tzou WS, Moss JD, Kancharla K, Chaudhry S, Patel PJ, Khan AM, Schuger C, Rozen G, Kiernan MS, Couper GS, Leacche M, Molina EJ, Shah AD, Lloyd M, Sroubek J, Soltesz E, Shivkumar K, White C, Tankut S, Johnson BA, McNitt S, Kutyifa V, Zareba W, Goldenberg I. Design and characteristics of the prophylactic intra-operative ventricular arrhythmia ablation in high-risk LVAD candidates (PIVATAL) trial. Ann Noninvasive Electrocardiol 2023; 28:e13073. [PMID: 37515396 PMCID: PMC10475893 DOI: 10.1111/anec.13073] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/25/2023] [Accepted: 06/27/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The use of a Left Ventricular Assist Device (LVAD) in patients with advanced heart failure refractory to optimal medical management has progressed steadily over the past two decades. Data have demonstrated reduced LVAD efficacy, worse clinical outcome, and higher mortality for patients who experience significant ventricular tachyarrhythmia (VTA). We hypothesize that a novel prophylactic intra-operative VTA ablation protocol at the time of LVAD implantation may reduce the recurrent VTA and adverse events postimplant. METHODS We designed a prospective, multicenter, open-label, randomized-controlled clinical trial enrolling 100 patients who are LVAD candidates with a history of VTA in the previous 5 years. Enrolled patients will be randomized in a 1:1 fashion to intra-operative VTA ablation (n = 50) versus conventional medical management (n = 50) with LVAD implant. Arrhythmia outcomes data will be captured by an implantable cardioverter defibrillator (ICD) to monitor VTA events, with a uniform ICD programming protocol. Patients will be followed prospectively over a mean of 18 months (with a minimum of 9 months) after LVAD implantation to evaluate recurrent VTA, adverse events, and procedural outcomes. Secondary endpoints include right heart function/hemodynamics, healthcare utilization, and quality of life. CONCLUSION The primary aim of this first-ever randomized trial is to assess the efficacy of intra-operative ablation during LVAD surgery in reducing VTA recurrence and improving clinical outcomes for patients with a history of VTA.
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Affiliation(s)
- David T. Huang
- Division of CardiologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Igor Gosev
- Division of Cardiothoracic SurgeryUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Katherine L. Wood
- Division of Cardiothoracic SurgeryUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Hima Vidula
- Division of CardiologyUniversity of Pennsylvania Medical CenterPhiladelphiaPennsylvaniaUSA
| | - William Stevenson
- Division of Cardiovascular MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Frank Marchlinski
- Division of CardiologyUniversity of Pennsylvania Medical CenterPhiladelphiaPennsylvaniaUSA
| | - Gregory Supple
- Division of CardiologyUniversity of Pennsylvania Medical CenterPhiladelphiaPennsylvaniaUSA
| | - Sandip K. Zalawadiya
- Division of Cardiovascular MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - J. Peter Weiss
- The University of Arizona College of Medicine‐Phoenix, Banner University Medical CenterPhoenixArizonaUSA
| | - Roderick Tung
- The University of Arizona College of Medicine‐Phoenix, Banner University Medical CenterPhoenixArizonaUSA
| | - Wendy S. Tzou
- Division of CardiologyUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Joshua D. Moss
- Division of CardiologyUniversity of California‐San FranciscoSan FranciscoCaliforniaUSA
| | - Krishna Kancharla
- Department of MedicineHeart and Vascular Institute, University of Pittsburgh Medical Center and School of MedicinePittsburghPennsylvaniaUSA
| | - Sunit‐Preet Chaudhry
- Division of CardiologyAscension St. Vincent Heart CenterIndianapolisIndianaUSA
- Ascension St. Vincent Cardiovascular Research InstituteIndianapolisIndianaUSA
| | - Parin J. Patel
- Division of CardiologyAscension St. Vincent Heart CenterIndianapolisIndianaUSA
- Ascension St. Vincent Cardiovascular Research InstituteIndianapolisIndianaUSA
| | - Arfaat M. Khan
- Henry Ford Heart and Vascular Institute, Henry Ford HospitalDetroitMichiganUSA
| | - Claudio Schuger
- Henry Ford Heart and Vascular Institute, Henry Ford HospitalDetroitMichiganUSA
| | - Guy Rozen
- Cardiovascular Center, Tufts Medical CenterBostonMassachusettsUSA
| | | | | | - Marzia Leacche
- Department of Cardiothoracic SurgerySpectrum HealthGrand RapidsMichiganUSA
| | - Ezequiel J. Molina
- Department of Cardiothoracic SurgeryPiedmont Heart InstituteAtlantaGeorgiaUSA
| | - Anand D. Shah
- Section of Cardiac ElectrophysiologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Michael Lloyd
- Section of Cardiac ElectrophysiologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Jakub Sroubek
- Heart Vascular and Thoracic Institute, Cleveland ClinicClevelandOhioUSA
| | - Edward Soltesz
- Department of Thoracic and Cardiovascular SurgeryCleveland ClinicClevelandOhioUSA
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Casey White
- Division of CardiologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Sinan Tankut
- Division of CardiologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Brent A. Johnson
- Department of Biostatistics and Computational BiologyUniversity of RochesterRochesterNew YorkUSA
| | - Scott McNitt
- Clinical Cardiovascular Research CenterUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Valentina Kutyifa
- Clinical Cardiovascular Research CenterUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Wojciech Zareba
- Clinical Cardiovascular Research CenterUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Ilan Goldenberg
- Clinical Cardiovascular Research CenterUniversity of Rochester Medical CenterRochesterNew YorkUSA
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26
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Hadaya J, Dajani AH, Cha S, Hanna P, Challita R, Hoover DB, Ajijola OA, Shivkumar K, Ardell JL. Vagal Nerve Stimulation Reduces Ventricular Arrhythmias and Mitigates Adverse Neural Cardiac Remodeling Post-Myocardial Infarction. JACC Basic Transl Sci 2023; 8:1100-1118. [PMID: 37791302 PMCID: PMC10543930 DOI: 10.1016/j.jacbts.2023.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/29/2023] [Accepted: 03/29/2023] [Indexed: 10/05/2023]
Abstract
This study sought to evaluate the impact of chronic vagal nerve stimulation (cVNS) on cardiac and extracardiac neural structure/function after myocardial infarction (MI). Groups were control, MI, and MI + cVNS; cVNS was started 2 days post-MI. Terminal experiments were performed 6 weeks post-MI. MI impaired left ventricular mechanical function, evoked anisotropic electrical conduction, increased susceptibility to ventricular tachycardia and fibrillation, and altered neuronal and glial phenotypes in the stellate and dorsal root ganglia, including glial activation. cVNS improved cardiac mechanical function and reduced ventricular tachycardia/ventricular fibrillation post-MI, partly by stabilizing activation/repolarization in the border zone. MI-associated extracardiac neural remodeling, particularly glial activation, was mitigated with cVNS.
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Affiliation(s)
- Joseph Hadaya
- UCLA Cardiac Arrhythmia Center and Neurocardiology Research Program of Excellence, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Molecular, Cellular, and Integrative Physiology Program, University of California, Los Angeles, Los Angeles, California, USA
| | - Al-Hassan Dajani
- UCLA Cardiac Arrhythmia Center and Neurocardiology Research Program of Excellence, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Steven Cha
- UCLA Cardiac Arrhythmia Center and Neurocardiology Research Program of Excellence, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Peter Hanna
- UCLA Cardiac Arrhythmia Center and Neurocardiology Research Program of Excellence, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Molecular, Cellular, and Integrative Physiology Program, University of California, Los Angeles, Los Angeles, California, USA
| | - Ronald Challita
- UCLA Cardiac Arrhythmia Center and Neurocardiology Research Program of Excellence, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Donald B. Hoover
- Department of Biomedical Sciences, Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee, USA
- Center of Excellence in Inflammation, Infectious Disease and Immunity, East Tennessee State University, Johnson City, Tennessee, USA
| | - Olujimi A. Ajijola
- UCLA Cardiac Arrhythmia Center and Neurocardiology Research Program of Excellence, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Molecular, Cellular, and Integrative Physiology Program, University of California, Los Angeles, Los Angeles, California, USA
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center and Neurocardiology Research Program of Excellence, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Molecular, Cellular, and Integrative Physiology Program, University of California, Los Angeles, Los Angeles, California, USA
| | - Jeffrey L. Ardell
- UCLA Cardiac Arrhythmia Center and Neurocardiology Research Program of Excellence, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Molecular, Cellular, and Integrative Physiology Program, University of California, Los Angeles, Los Angeles, California, USA
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27
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Hayase J, Fishbein G, Rerkpichaisuth V, Chung WH, Ajijola O, Shivkumar K, Bradfield JS. Linear epicardial cryoablation effects in a porcine model: Lesion characteristics and vascular risk. J Cardiovasc Electrophysiol 2023; 34:1878-1884. [PMID: 37473428 DOI: 10.1111/jce.16014] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 03/19/2023] [Accepted: 07/11/2023] [Indexed: 07/22/2023]
Abstract
INTRODUCTION Cryoablation in open-chest surgical interventions for ventricular arrhythmias has been reported with reasonable procedural outcomes. However, the characteristics of cryoablation lesions on the ventricular myocardium are not well defined. The purpose of the present study was to determine the tissue and vascular effects of a linear epicardial cryoablation probe in a porcine animal model. METHODS Five adult Yorkshire swine underwent median sternotomy and application of linear cryoablation lesions using a malleable aluminum linear cryoablation probe of varying duration (2, 3, 4, and 5 min), including one lesion placed intentionally over the left anterior descending coronary (LAD) artery. Histological analysis was performed. RESULTS Maximum lesion depth was approximately 1.0 cm with 3 min freezes, with no significant increase in depth achieved with longer lesions. No transmural lesions were achieved. No large vessel epicardial coronary artery injuries were seen to the LAD; however, surprisingly, remote isolated interventricular septal injury was seen in all animals, suggestive of possible compromise of smaller coronary arterial vessels. CONCLUSION Single application freezes with an aluminum linear cryoablation probe can create homogeneous ablative lesions over the ventricular myocardium with a maximum depth of approximately 1.0 cm. No large vessel injury occurred with direct lesion application of the LAD; however, small coronary vessels may be at risk.
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Affiliation(s)
- Justin Hayase
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - Gregory Fishbein
- UCLA Department of Pathology, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - Vilasinee Rerkpichaisuth
- UCLA Department of Pathology, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
- Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Kanchanaburi, Thailand
| | - Wei-Hsin Chung
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
- Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Olujimi Ajijola
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - Jason S Bradfield
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
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28
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Do DH, Bailey KL, Beyer R, Neubuerger S, Bradfield J, Shivkumar K, Nsair A, Boyle NG. Outcomes in orthotopic heart transplantation following pacemaker implantation. Pacing Clin Electrophysiol 2023; 46:583-591. [PMID: 37221975 PMCID: PMC10524466 DOI: 10.1111/pace.14716] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 04/25/2023] [Accepted: 05/06/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Bradyarrhythmias including sinus node dysfunction (SND) and atrioventricular block (AVB) can necessitate pacemaker (PPM) implantation in orthotopic heart transplant (OHT) recipients. Prior studies have shown conflicting findings regarding the effect of PPM implantation on survival. We evaluated the effect of PPM indication on long-term re-transplant-free survival in OHT patients. METHODS We conducted a retrospective cohort study of OHT patients at UCLA Medical Center from 1985 to 2018. Indication for PPM (SND, AVB) was identified. Cox proportional hazards model with pacemaker implantation as a time-varying covariate was used to evaluate its effect on the primary endpoint of retransplant or death. We included 1609 OHTs in 1511 adult patients with median follow-up of 12 years. RESULTS At transplant, patients were aged 53 ± 13 years and 1125 (74.5%) were male. Pacemakers were implanted in 109 (7.2%) patients; 65 for SND (4.3%) and 43 for AVB (2.8%). Repeat OHT was performed in 103 (6.4%) cases and 798 (52.8%) patients died during the follow-up period. The risk of the primary endpoint was significantly higher in patients requiring PPM for AVB (HR 3.0, 95% CI 2.1-4.2, p < .01) after controlling for age at OHT, gender, hypertension, diabetes, renal disease, history of repeat OHT, acute rejection, transplant coronary vasculopathy, and atrial fibrillation, but not PPM for SND (HR 1.0, 95% CI 0.70-1.4, p = 1.0). CONCLUSIONS Patients who required PPM for AVB, but not SND, were at significantly higher risk of death or retransplant compared to patients who did not require PPM.
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Affiliation(s)
- Duc H Do
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Katherine L Bailey
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Ryan Beyer
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Samuel Neubuerger
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Jason Bradfield
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Ali Nsair
- UCLA Heart Transplant Program, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Noel G Boyle
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
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Mori S, Aksoy O, Do DH, Dave RH, Shivkumar K. Transcatheter Aortic Valve Replacement Guided by Preprocedural Simulation of Fluoroscopic Location of the Membranous Septum. JACC Case Rep 2023; 16:101888. [PMID: 37396330 PMCID: PMC10313484 DOI: 10.1016/j.jaccas.2023.101888] [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: 10/19/2022] [Revised: 02/15/2023] [Accepted: 03/01/2023] [Indexed: 07/04/2023]
Abstract
We show the virtual simulation of the fluoroscopic location of the membranous septum using preprocedural cardiac computed tomographic data sets. Recognizing the risk distance before the procedure can help individualize implantation strategy to reduce the risk of atrioventricular conduction axis damage during transcatheter aortic valve replacement. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Shumpei Mori
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Olcay Aksoy
- UCLA Cardiovascular Interventional Programs, David Geffen School of Medicine at UCLA and UCLA Health System, Los Angeles, California, USA
| | - Duc H. Do
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Ravi H. Dave
- UCLA Cardiovascular Interventional Programs, David Geffen School of Medicine at UCLA and UCLA Health System, Los Angeles, California, USA
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- UCLA Cardiovascular Interventional Programs, David Geffen School of Medicine at UCLA and UCLA Health System, Los Angeles, California, USA
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Fuster V, Bozkurt B, Chandrashekhar Y, Grapsa J, Ky B, Mann DL, Moliterno DJ, Shivkumar K, Silversides CK, Turco JV, Wang J. JACC Journals' Pathway Forward With AI Tools: The Future Is Now. JACC Case Rep 2023; 13:101806. [PMID: 37153478 PMCID: PMC10157143 DOI: 10.1016/j.jaccas.2023.101806] [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: 05/09/2023]
Affiliation(s)
- Valentin Fuster
- Address for correspondence: Dr Valentin Fuster, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, New York 10029, USA.
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Fuster V, Bozkurt B, Chandrashekhar Y, Grapsa J, Ky B, Mann DL, Moliterno DJ, Shivkumar K, Silversides CK, Turco JV, Wang J. JACC Journals' Pathway Forward With AI Tools: The Future Is Now. JACC Basic Transl Sci 2023; 8:596-598. [PMID: 37325406 PMCID: PMC10264704 DOI: 10.1016/j.jacbts.2023.03.005] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- Valentin Fuster
- Address for correspondence: Dr Valentin Fuster, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, New York 10029, USA.
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Zhang Y, Bizanti A, Harden SW, Chen J, Bendowski K, Hoover DB, Gozal D, Shivkumar K, Heal M, Tappan S, Cheng ZJ. Topographical mapping of catecholaminergic axon innervation in the flat-mounts of the mouse atria: a quantitative analysis. Sci Rep 2023; 13:4850. [PMID: 37029119 PMCID: PMC10082215 DOI: 10.1038/s41598-023-27727-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/06/2023] [Indexed: 04/09/2023] Open
Abstract
The sympathetic nervous system is crucial for controlling multiple cardiac functions. However, a comprehensive, detailed neuroanatomical map of the sympathetic innervation of the heart is unavailable. Here, we used a combination of state-of-the-art techniques, including flat-mount tissue processing, immunohistochemistry for tyrosine hydroxylase (TH, a sympathetic marker), confocal microscopy and Neurolucida 360 software to trace, digitize, and quantitatively map the topographical distribution of the sympathetic postganglionic innervation in whole atria of C57Bl/6 J mice. We found that (1) 4-5 major extrinsic TH-IR nerve bundles entered the atria at the superior vena cava, right atrium (RA), left precaval vein and the root of the pulmonary veins (PVs) in the left atrium (LA). Although these bundles projected to different areas of the atria, their projection fields partially overlapped. (2) TH-IR axon and terminal density varied considerably between different sites of the atria with the greatest density of innervation near the sinoatrial node region (P < 0.05, n = 6). (3) TH-IR axons also innervated blood vessels and adipocytes. (4) Many principal neurons in intrinsic cardiac ganglia and small intensely fluorescent cells were also strongly TH-IR. Our work provides a comprehensive topographical map of the catecholaminergic efferent axon morphology, innervation, and distribution in the whole atria at single cell/axon/varicosity scale that may be used in future studies to create a cardiac sympathetic-brain atlas.
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Affiliation(s)
- Yuanyuan Zhang
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, BMS Building 20, Room 230, 4110 Libra Drive, Orlando, FL, 32816, USA
| | - Ariege Bizanti
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, BMS Building 20, Room 230, 4110 Libra Drive, Orlando, FL, 32816, USA
| | - Scott W Harden
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, BMS Building 20, Room 230, 4110 Libra Drive, Orlando, FL, 32816, USA
| | - Jin Chen
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, BMS Building 20, Room 230, 4110 Libra Drive, Orlando, FL, 32816, USA
| | - Kohlton Bendowski
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, BMS Building 20, Room 230, 4110 Libra Drive, Orlando, FL, 32816, USA
| | - Donald B Hoover
- Department of Biomedical Sciences, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, 37614, USA
| | - David Gozal
- Department of Child Health and Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO, 65201, USA
- Department of Medical Pharmacology and Physiology, University of Missouri School of Medicine, Columbia, MO, 65201, USA
| | - Kalyanam Shivkumar
- Department of Medicine, Cardiac Arrhythmia Center and Neurocardiology Research Program of Excellence, University of California, Los Angeles, CA, 90095, USA
| | - Maci Heal
- MBF Bioscience, Williston, VT, 05495, USA
| | | | - Zixi Jack Cheng
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, BMS Building 20, Room 230, 4110 Libra Drive, Orlando, FL, 32816, USA.
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Bizanti A, Zhang Y, Harden SW, Chen J, Hoover DB, Gozal D, Shivkumar K, Cheng ZJ. Cover Image, Volume 531, Issue 5. J Comp Neurol 2023. [DOI: 10.1002/cne.25464] [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: 02/11/2023]
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Fuster V, Bozkurt B, Chandrashekhar Y, Grapsa J, Ky B, Mann DL, Moliterno DJ, Shivkumar K, Silversides CK, Turco JV, Wang J. JACC Journals' Pathway Forward With AI Tools: The Future Is Now. JACC Asia 2023; 3:317-319. [PMID: 37181383 PMCID: PMC10167500 DOI: 10.1016/j.jacasi.2023.03.002] [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] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- Valentin Fuster
- Address for correspondence: Dr Valentin Fuster, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, New York 10029, USA.
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Fuster V, Bozkurt B, Chandrashekhar Y, Grapsa J, Ky B, Mann DL, Moliterno DJ, Shivkumar K, Silversides CK, Turco JV, Wang J. JACC Journals' Pathway Forward With AI Tools: The Future Is Now. JACC Cardiovasc Imaging 2023; 16:572-574. [PMID: 36939663 DOI: 10.1016/j.jcmg.2023.03.001] [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: 03/21/2023]
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Bizanti A, Zhang Y, Harden SW, Chen J, Hoover DB, Gozal D, Shivkumar K, Cheng ZJ. Catecholaminergic axon innervation and morphology in flat-mounts of atria and ventricles of mice. J Comp Neurol 2023; 531:596-617. [PMID: 36591925 PMCID: PMC10499115 DOI: 10.1002/cne.25444] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 09/03/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 01/03/2023]
Abstract
Sympathetic efferent axons regulate cardiac functions. However, the topographical distribution and morphology of cardiac sympathetic efferent axons remain insufficiently characterized due to the technical challenges involved in immunohistochemical labeling of the thick walls of the whole heart. In this study, flat-mounts of the left and right atria and ventricles of FVB mice were immunolabeled for tyrosine hydroxylase (TH), a marker of sympathetic nerves. Atrial and ventricular flat-mounts were scanned using a confocal microscope to construct montages. We found (1) In the atria: A few large TH-immunoreactive (IR) axon bundles entered both atria, branched into small bundles and then single axons that eventually formed very dense terminal networks in the epicardium, myocardium and inlet regions of great vessels to the atria. Varicose TH-IR axons formed close contact with cardiomyocytes, vessels, and adipocytes. Multiple intrinsic cardiac ganglia (ICG) were identified in the epicardium of both atria, and a subpopulation of the neurons in the ICG were TH-IR. Most TH-IR axons in bundles traveled through ICG before forming dense varicose terminal networks in cardiomyocytes. We did not observe varicose TH-IR terminals encircling ICG neurons. (2) In the left and right ventricles and interventricular septum: TH-IR axons formed dense terminal networks in the epicardium, myocardium, and vasculature. Collectively, TH labeling is achievable in flat-mounts of thick cardiac walls, enabling detailed mapping of catecholaminergic axons and terminal structures in the whole heart at single-cell/axon/varicosity scale. This approach provides a foundation for future quantification of the topographical organization of the cardiac sympathetic innervation in different pathological conditions.
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Affiliation(s)
- Ariege Bizanti
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida, USA
| | - Yuanyuan Zhang
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida, USA
| | - Scott W Harden
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida, USA
| | - Jin Chen
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida, USA
| | - Donald B Hoover
- Department of Biomedical Sciences, Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee, USA
| | - David Gozal
- Department of Child Health and Child Health Research Institute, and Department of Medical Pharmacology and Physiology, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Kalyanam Shivkumar
- Department of Medicine, Cardiac Arrhythmia Center and Neurocardiology Research Program of Excellence, University of California, Los Angeles, California, USA
| | - Zixi Jack Cheng
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida, USA
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Fuster V, Bozkurt B, Chandrashekhar Y, Grapsa J, Ky B, Mann DL, Moliterno DJ, Shivkumar K, Silversides CK, Turco JV, Wang J. JACC Journals' Pathway Forward With AI Tools: The Future Is Now. JACC Cardiovasc Interv 2023; 16:881-883. [PMID: 36935255 DOI: 10.1016/j.jcin.2023.03.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
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Fuster V, Bozkurt B, Chandrashekhar Y, Grapsa J, Ky B, Mann DL, Moliterno DJ, Shivkumar K, Silversides CK, Turco JV, Wang J. JACC Journals' Pathway Forward With AI Tools: The Future Is Now. JACC Heart Fail 2023; 11:487-489. [PMID: 36939659 DOI: 10.1016/j.jchf.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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Fuster V, Bozkurt B, Chandrashekhar YS, Grapsa J, Ky B, Mann DL, Moliterno DJ, Shivkumar K, Silversides CK, Turco JV, Wang J. JACC Journals' Pathway Forward With AI Tools: The Future Is Now. J Am Coll Cardiol 2023; 81:1543-1545. [PMID: 36935264 DOI: 10.1016/j.jacc.2023.02.030] [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: 03/21/2023]
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40
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Mori S, Moussa ID, Hanna P, Shivkumar K. Veiled Anatomy of the Tricuspid Valve Perimeter: What the Interventionalist Must Know…But Cannot See! JACC Cardiovasc Interv 2023; 16:614-616. [PMID: 36764916 DOI: 10.1016/j.jcin.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 10/14/2022] [Accepted: 11/07/2022] [Indexed: 02/11/2023]
Affiliation(s)
- Shumpei Mori
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
| | - Issam D Moussa
- Carle Illinois College of Medicine, University of Illinois, Carle Heart and Vascular Institute, Champaign, Illinois, USA
| | - Peter Hanna
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Kalyanam Shivkumar
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Fuster V, Bozkurt B, Chandrashekhar Y, Grapsa J, Ky B, Mann DL, Moliterno DJ, Shivkumar K, Silversides CK, Turco JV, Wang J. JACC Journals’ Pathway Forward With AI Tools. JACC: CardioOncology 2023; 5:275-277. [PMID: 37144104 PMCID: PMC10152189 DOI: 10.1016/j.jaccao.2023.03.001] [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] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Affiliation(s)
- Valentin Fuster
- Address for correspondence: Dr Valentin Fuster, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, New York 10029, USA.
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Shivkumar K. JACC: Clinical Electrophysiology 2022 Young Author Award Winner. JACC Clin Electrophysiol 2023; 9:453-454. [PMID: 36990602 DOI: 10.1016/j.jacep.2023.02.001] [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: 03/29/2023]
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43
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Mori S, Hayase J, Sridharan A, Fukuzawa K, Shivkumar K, Bradfield JS. Revisiting the Anatomy of the Left Ventricular Summit. Card Electrophysiol Clin 2023; 15:1-8. [PMID: 36774131 DOI: 10.1016/j.ccep.2022.04.003] [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] [Indexed: 12/15/2022]
Abstract
The left ventricular summit corresponds to the epicardial side of the basal superior free wall, extending from the base of the left coronary aortic sinus. The summit composes the floor of the compartment surrounded by the aortic root, infundibulum, pulmonary root, and left atrial appendage. The compartment is filled with thick adipose tissue, carrying the coronary vessels. Thus, the treatment of ventricular tachycardia originating from the summit is challenging, and three-dimensional understanding of this complicated region is fundamental. We revisit the clinical anatomy of the left ventricular summit with original images from the Wallace A. McAlpine collection.
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Affiliation(s)
- Shumpei Mori
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; UCLA Cardiovascular Interventional Programs, Department of Medicine, David Geffen School of Medicine at UCLA & UCLA Health System, Los Angeles, CA, USA.
| | - Justin Hayase
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; UCLA Cardiovascular Interventional Programs, Department of Medicine, David Geffen School of Medicine at UCLA & UCLA Health System, Los Angeles, CA, USA
| | - Aadhavi Sridharan
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; UCLA Cardiovascular Interventional Programs, Department of Medicine, David Geffen School of Medicine at UCLA & UCLA Health System, Los Angeles, CA, USA
| | - Koji Fukuzawa
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; UCLA Cardiovascular Interventional Programs, Department of Medicine, David Geffen School of Medicine at UCLA & UCLA Health System, Los Angeles, CA, USA
| | - Jason S Bradfield
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; UCLA Cardiovascular Interventional Programs, Department of Medicine, David Geffen School of Medicine at UCLA & UCLA Health System, Los Angeles, CA, USA
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Temma T, Lux RL, Yoshie K, Hayase J, Bradfield JS, Shivkumar K, Ajijola OA. The derivative of tissue activation as a marker of arrhythmogenic myocardium. Heart Rhythm 2023; 20:261-271. [PMID: 36270579 DOI: 10.1016/j.hrthm.2022.10.013] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 10/06/2022] [Accepted: 10/12/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Mapping techniques to identify diseased myocardial substrate during ventricular tachycardia ablation procedures remain limited. OBJECTIVE We hypothesized that tissue derivative of the voltage with respect to time (dV/dt), the slope of the unipolar ventricular electrogram registered by local ventricular activation, represents a unique parameter for identifying potential arrhythmogenic tissue in the ischemic scar border zone. METHODS Using high-resolution electrical mapping, we examined dV/dt characteristics in the border zone of animals after chronic myocardial infarction (MI). RESULTS Minimum dV/dt (dV/dtmin) in MI animals was less than that in control animals (-344.7 ± 68.7 in controls vs -174.2 ± 104.5 in MI; P < .001) and related to ventricular fibrosis. In MI animals, dV/dtmin values were divided into high (≤-200 μV/ms) and low (>-200 μV/ms) dV/dtmin. Low dV/dtmin regions harbored arrhythmogenic substrates that were characterized by (1) high responsiveness to sympathetic stimulation, (2) presence of late potentials, and (3) lower unipolar and bipolar voltage amplitudes. CONCLUSION Our data indicate that dV/dtmin is a unique parameter for identifying arrhythmogenic myocardium and may add a useful metric to conventional mapping strategies.
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Affiliation(s)
- Taro Temma
- UCLA Cardiac Arrhythmia Center, UCLA Neurocardiology Research Program of Excellence, University of California, Los Angeles, California
| | - Robert L Lux
- Cardiovascular Research and Training Institute, University of Utah, Salt Lake, Utah
| | - Koji Yoshie
- UCLA Cardiac Arrhythmia Center, UCLA Neurocardiology Research Program of Excellence, University of California, Los Angeles, California; Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Justin Hayase
- UCLA Cardiac Arrhythmia Center, UCLA Neurocardiology Research Program of Excellence, University of California, Los Angeles, California
| | - Jason S Bradfield
- UCLA Cardiac Arrhythmia Center, UCLA Neurocardiology Research Program of Excellence, University of California, Los Angeles, California
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, UCLA Neurocardiology Research Program of Excellence, University of California, Los Angeles, California
| | - Olujimi A Ajijola
- UCLA Cardiac Arrhythmia Center, UCLA Neurocardiology Research Program of Excellence, University of California, Los Angeles, California.
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Do DH, O’Meara K, Lee J, Meyer S, Hanna P, Mori S, Fishbein MC, Boyle NG, Elizari MV, Bradfield JS, Shivkumar K. Ventricular Parasystole in Cardiomyopathy Patients. JACC Clin Electrophysiol 2023. [DOI: 10.1016/j.jacep.2022.11.014] [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: 02/24/2023]
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Shivkumar K, Qu Z, Harvey R. Cardiac fibrosis in three dimensions - mechanistic insights into arrhythmic risk due to hypertrophy. J Physiol 2023; 601:249-250. [PMID: 36511350 PMCID: PMC9846953 DOI: 10.1113/jp283710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, Department of Medicine, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Zhilin Qu
- UCLA Cardiac Arrhythmia Center, Department of Medicine, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Qian K, Tol MJ, Wu J, Uchiyama LF, Xiao X, Cui L, Bedard AH, Weston TA, Rajendran PS, Vergnes L, Shimanaka Y, Yin Y, Jami-Alahmadi Y, Cohn W, Bajar BT, Lin CH, Jin B, DeNardo LA, Black DL, Whitelegge JP, Wohlschlegel JA, Reue K, Shivkumar K, Chen FJ, Young SG, Li P, Tontonoz P. CLSTN3β enforces adipocyte multilocularity to facilitate lipid utilization. Nature 2023; 613:160-168. [PMID: 36477540 PMCID: PMC9995219 DOI: 10.1038/s41586-022-05507-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 11/01/2022] [Indexed: 12/12/2022]
Abstract
Multilocular adipocytes are a hallmark of thermogenic adipose tissue1,2, but the factors that enforce this cellular phenotype are largely unknown. Here, we show that an adipocyte-selective product of the Clstn3 locus (CLSTN3β) present in only placental mammals facilitates the efficient use of stored triglyceride by limiting lipid droplet (LD) expansion. CLSTN3β is an integral endoplasmic reticulum (ER) membrane protein that localizes to ER-LD contact sites through a conserved hairpin-like domain. Mice lacking CLSTN3β have abnormal LD morphology and altered substrate use in brown adipose tissue, and are more susceptible to cold-induced hypothermia despite having no defect in adrenergic signalling. Conversely, forced expression of CLSTN3β is sufficient to enforce a multilocular LD phenotype in cultured cells and adipose tissue. CLSTN3β associates with cell death-inducing DFFA-like effector proteins and impairs their ability to transfer lipid between LDs, thereby restricting LD fusion and expansion. Functionally, increased LD surface area in CLSTN3β-expressing adipocytes promotes engagement of the lipolytic machinery and facilitates fatty acid oxidation. In human fat, CLSTN3B is a selective marker of multilocular adipocytes. These findings define a molecular mechanism that regulates LD form and function to facilitate lipid utilization in thermogenic adipocytes.
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Affiliation(s)
- Kevin Qian
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Biological Chemistry, University of California, Los Angeles, Los Angeles, CA, USA
- Molecular Biology Institute, University of California, Los Angeles, Los Angeles, CA, USA
| | - Marcus J Tol
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Biological Chemistry, University of California, Los Angeles, Los Angeles, CA, USA
- Molecular Biology Institute, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jin Wu
- Institute of Metabolism and Integrative Biology, Fudan University, Shanghai, China
| | - Lauren F Uchiyama
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Biological Chemistry, University of California, Los Angeles, Los Angeles, CA, USA
- Molecular Biology Institute, University of California, Los Angeles, Los Angeles, CA, USA
| | - Xu Xiao
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Biological Chemistry, University of California, Los Angeles, Los Angeles, CA, USA
- Molecular Biology Institute, University of California, Los Angeles, Los Angeles, CA, USA
| | - Liujuan Cui
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Biological Chemistry, University of California, Los Angeles, Los Angeles, CA, USA
- Molecular Biology Institute, University of California, Los Angeles, Los Angeles, CA, USA
| | - Alexander H Bedard
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Biological Chemistry, University of California, Los Angeles, Los Angeles, CA, USA
- Molecular Biology Institute, University of California, Los Angeles, Los Angeles, CA, USA
| | - Thomas A Weston
- Department of Medicine, Division of Cardiology, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Human Genetics, University of California, Los Angeles, Los Angeles, CA, USA
| | - Pradeep S Rajendran
- Cardiac Arrhythmia Center and Neurocardiology Research Program of Excellence, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Laurent Vergnes
- Department of Human Genetics, University of California, Los Angeles, Los Angeles, CA, USA
| | - Yuta Shimanaka
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Biological Chemistry, University of California, Los Angeles, Los Angeles, CA, USA
- Molecular Biology Institute, University of California, Los Angeles, Los Angeles, CA, USA
| | - Yesheng Yin
- Institute of Metabolism and Integrative Biology, Fudan University, Shanghai, China
| | - Yasaman Jami-Alahmadi
- Department of Biological Chemistry, University of California, Los Angeles, Los Angeles, CA, USA
| | - Whitaker Cohn
- Pasarow Mass Spectrometry Laboratory, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Bryce T Bajar
- Department of Biological Chemistry, University of California, Los Angeles, Los Angeles, CA, USA
| | - Chia-Ho Lin
- Department of Microbiology, Immunology, and Molecular Genetics, University of California, Los Angeles, Los Angeles, CA, USA
| | - Benita Jin
- Department of Physiology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Laura A DeNardo
- Department of Physiology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Douglas L Black
- Department of Microbiology, Immunology, and Molecular Genetics, University of California, Los Angeles, Los Angeles, CA, USA
| | - Julian P Whitelegge
- Pasarow Mass Spectrometry Laboratory, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - James A Wohlschlegel
- Department of Biological Chemistry, University of California, Los Angeles, Los Angeles, CA, USA
| | - Karen Reue
- Department of Human Genetics, University of California, Los Angeles, Los Angeles, CA, USA
| | - Kalyanam Shivkumar
- Cardiac Arrhythmia Center and Neurocardiology Research Program of Excellence, University of California, Los Angeles, Los Angeles, CA, USA
| | - Feng-Jung Chen
- Institute of Metabolism and Integrative Biology, Fudan University, Shanghai, China
| | - Stephen G Young
- Department of Medicine, Division of Cardiology, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Human Genetics, University of California, Los Angeles, Los Angeles, CA, USA
| | - Peng Li
- Institute of Metabolism and Integrative Biology, Fudan University, Shanghai, China
- School of Life Sciences, Tsinghua University, Beijing, China
| | - Peter Tontonoz
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
- Department of Biological Chemistry, University of California, Los Angeles, Los Angeles, CA, USA.
- Molecular Biology Institute, University of California, Los Angeles, Los Angeles, CA, USA.
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48
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Chung WH, Hayase J, Do DH, Dixit N, Ajijola O, Buch E, Boyle N, Shivkumar K, Bradfield JS. Clinical predictors and implications of cardiac inflammation detected on positron emission tomography (PET) in patients referred for premature ventricular complex (PVC) ablation. J Interv Card Electrophysiol 2022:10.1007/s10840-022-01446-z. [PMID: 36510109 DOI: 10.1007/s10840-022-01446-z] [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: 09/28/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Positron emission tomography computed tomography (PET-CT) is not routinely used for premature ventricular complexes (PVCs). Whether specific clinical factors are associated with abnormal PET-CT results is not clear. METHODS The treatment courses and baseline characteristics of consecutive patients in a single center between 2012 and 2021, age > 18 years old, and who received 18F-fluorodeoxyglucose (FDG) PET-CT imaging for evaluation of PVCs were retrospectively analyzed. RESULTS A total of 102 patients was included. Of these, 27 patients (26.4%) had abnormal PET-CT and 61 (59.8%) had normal imaging. Abnormal PET-CT findings were associated with non-sustained ventricular tachycardia (NSVT) (95.2% vs. 52.6%, p = 0.001), higher number of PVC morphologies (2.29 ± 0.7 vs. 1.31 ± 0.6, p < 0.001), greater PVC coupling interval dispersion (72.47 ± 66.4 ms vs. 13.42 ± 17.9 ms, p < 0.001), and greater likelihood of fast heart rate dependent PVCs (78.5% vs. 38.2%, p = 0.017). Fourteen (51.8%) patients had an abnormal PET-CT and abnormal late gadolinium enhancement (LGE). Patients with abnormal PET-CT were more frequently treated with immunosuppression (81.4% vs. 3.2%, p < .0001) than with catheter ablation (11.1% vs. 45.9%, p = 0.002) compared to the normal PET-CT group. Over a median follow-up of 862 days (IQR 134, 1407), PVC burden decreased in both groups [from 23 ± 16% to 9 ± 10% (p < 0.001) in abnormal PET-CT group and from 21 ± 15% to 7 ± 10% (p < 0.001) in normal PET-CT group]. CONCLUSIONS Abnormal PET-CT findings were more commonly associated with NSVT, multiform PVCs, greater PVC coupling interval dispersion, and fast heart rate dependent PVCs. LGE was not sensitive for detecting inflammation. Immunosuppression was effective in managing PVCs with abnormal PET-CT.
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Affiliation(s)
- Wei-Hsin Chung
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA.
- Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, Taichung, Taiwan.
| | - Justin Hayase
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA
| | - Duc H Do
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA
| | - Neal Dixit
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA
| | - Olujimi Ajijola
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA
| | - Eric Buch
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA
| | - Noel Boyle
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA
| | - Jason S Bradfield
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA
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49
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Sridharan A, Bradfield JS, Shivkumar K, Ajijola OA. Autonomic nervous system and arrhythmias in structural heart disease. Auton Neurosci 2022; 243:103037. [DOI: 10.1016/j.autneu.2022.103037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/21/2022] [Accepted: 09/21/2022] [Indexed: 11/28/2022]
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50
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Kharbanda RK, Moore JP, Lloyd MS, Galotti R, Bogers AJJC, Taverne YJHJ, Madhavan M, McLeod CJ, Dubin AM, Mah DY, Chang PM, Kamp AN, Nielsen JC, Aydin A, Tanel RE, Shah MJ, Pilcher T, Evertz R, Khairy P, Tan RB, Czosek RJ, Shivkumar K, de Groot NMS. Cardiac Resynchronization Therapy for Adult Patients With a Failing Systemic Right Ventricle: A Multicenter Study. J Am Heart Assoc 2022; 11:e025121. [DOI: 10.1161/jaha.121.025121] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background
The objective of this international multicenter study was to investigate both early and late outcomes of cardiac resynchronization therapy (CRT) in patients with a systemic right ventricle (SRV) and to identify predictors for congestive heart failure readmissions and mortality.
Methods and Results
This retrospective international multicenter study included 13 centers. The study population comprised 80 adult patients with SRV (48.9% women) with a mean age of 45±14 (range, 18–77) years at initiation of CRT. Median follow‐up time was 4.1 (25th–75th percentile, 1.3–8.3) years. Underlying congenital heart disease consisted of congenitally corrected transposition of the great arteries and dextro‐transposition of the great arteries in 63 (78.8%) and 17 (21.3%) patients, respectively. CRT resulted in significant improvement in functional class (before CRT: III, 25th–75th percentile, II–III; after CRT: II, 25th–75th percentile, II–III;
P
=0.005) and QRS duration (before CRT: 176±27; after CRT: 150±24 milliseconds;
P
=0.003) in patients with pre‐CRT ventricular pacing who underwent an upgrade to a CRT device (n=49). These improvements persisted during long‐term follow‐up with a marginal but significant increase in SRV function (before CRT; 30%, 25th–75th percentile, 25–35; after CRT: 31%, 25th–75th percentile, 21–38;
P
=0.049). In contrast, no beneficial change in the above‐mentioned variables was observed in patients who underwent de novo CRT (n=31). A quarter of all patients were readmitted for heart failure during follow‐up, and mortality at latest follow‐up was 21.3%.
Conclusions
This international experience with CRT in patients with an SRV demonstrated that CRT in selected patients with SRV dysfunction and pacing‐induced dyssynchrony yielded consistent improvement in QRS duration and New York Heart Association functional status, with a marginal increase in SRV function.
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Affiliation(s)
- Rohit K. Kharbanda
- Department of Cardiology Erasmus MC, University Medical Center Rotterdam The Netherlands
- Department of Cardiothoracic Surgery Erasmus MC, University Medical Center Rotterdam The Netherlands
| | - Jeremy P. Moore
- Ahmanson/UCLA Adult Congenital Heart Disease Center Los Angeles CA
| | - Michael S. Lloyd
- Division of Cardiology, Department of Medicine Emory University School of Medicine Atlanta GA
| | - Robert Galotti
- Ahmanson/UCLA Adult Congenital Heart Disease Center Los Angeles CA
| | - Ad J. J. C. Bogers
- Department of Cardiothoracic Surgery Erasmus MC, University Medical Center Rotterdam The Netherlands
| | - Yannick J. H. J. Taverne
- Department of Cardiothoracic Surgery Erasmus MC, University Medical Center Rotterdam The Netherlands
| | - Malini Madhavan
- Department of Cardiovascular Diseases Mayo Clinic Rochester MN
| | | | - Anne M. Dubin
- Division of Pediatric Cardiology, Department of Pediatrics Stanford University School of Medicine Stanford CA
| | - Douglas Y. Mah
- Department of Cardiology Boston Children’s Hospital and Harvard Medical School Boston MA
| | - Philip M. Chang
- Congenital Heart Center University of Florida Health Gainesville FL
| | - Anna N. Kamp
- The Heart Center Nationwide Children’s Hospital Colombus OH
| | - Jens C. Nielsen
- Department of Clinical Medicine, Aarhus University and Department of Cardiology Aarhus University Hospital Aarhus Denmark
| | - Alper Aydin
- Division of Cardiology University of Ottawa Heart Institute Ottawa Canada
| | - Ronn E. Tanel
- Division of Pediatric Cardiology, UCSF Benioff Children’s Hospital University of California San Francisco CA
| | - Maully J. Shah
- Division of Cardiology Children’s Hospital of Philadelphia PA
| | - Thomas Pilcher
- Division of Pediatric Cardiology, Department of Internal Medicine University of Utah Salt Lake City UT
| | - Reinder Evertz
- Department of Cardiology Radboud University Medical Center Nijmegen The Netherlands
| | - Paul Khairy
- Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute Université de Montréal Montreal Quebec Canada
| | - Reina B. Tan
- Division of Pediatric Cardiology New York University Langone Medical Center New York NY
| | - Richard J. Czosek
- Division of Pediatric Cardiology Cincinnati Children’s Hospital Medical Center Cincinnati OH
| | | | - Natasja M. S. de Groot
- Department of Cardiology Erasmus MC, University Medical Center Rotterdam The Netherlands
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