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Gula LJ, Khan HR, Skanes AC. Implantable Cardioverter-Defibrillators in Octogenarians: An Appeal for a Randomized Clinical Trial. Can J Cardiol 2024; 40:399-401. [PMID: 38176538 DOI: 10.1016/j.cjca.2023.12.031] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/06/2024] Open
Affiliation(s)
- Lorne J Gula
- London Heart Rhythm Program, Division of Cardiology, Western University, London, Ontario, Canada
| | - Habib R Khan
- London Heart Rhythm Program, Division of Cardiology, Western University, London, Ontario, Canada
| | - Allan C Skanes
- London Heart Rhythm Program, Division of Cardiology, Western University, London, Ontario, Canada.
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Antiperovitch P, Mokhtar AT, Yee R, Manlucu J, Gula LJ, Leong-Sit P, Skanes AC, Tang ASL, Khan HR. Efficacy and safety of supraclavicular and pectoralis nerve blocks as primary peri-procedural analgesia for cardiac electronic device implantation: A pilot study. Pacing Clin Electrophysiol 2023; 46:1447-1454. [PMID: 37997450 DOI: 10.1111/pace.14843] [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: 06/02/2023] [Revised: 09/28/2023] [Accepted: 10/03/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Cardiac implantable electronic devices (CIEDs) are routinely implanted using intravenous drugs for sedation. However, some patients are poor candidates for intravenous sedation. OBJECTIVE We present a case series demonstrating the safety and efficacy of a novel, ultrasound-guided nerve block technique that allows for pre-pectoral CIED implantation. The targets are the supraclavicular nerve (SCN) and pectoral nerve (PECS1). METHODS We enrolled 20 patients who were planned for new CIED implantation. Following US-localization of the SCN and PECS1, local anesthetic (LA) was instilled at least 30-60 min pre-procedure. Successful nerve block was determined if < 5 mL of intraprocedural LA was used, along with lack of sensation with skin and deep tissue pinprick. Optional sedation was offered to patients' pre-procedure if discomfort was reported. RESULTS Seventeen patients (85%) had a successful periprocedural nerve block, with only three patients exceeding 5 mL of LA. SCN and PECS1 success occurred in 19 (95%) and 18 (90%) patients, respectively. The overall success of nerve block by fulfilling all the criteria was demonstrated in 17 out of 20 patients (85%). Patients who reported no pain (VAS score = 0) were distributed as follows: 13 patients (65%) in the immediate post-procedure interval, 18 patients (90%) at the 1 h post-implant interval, and 14 patients (70%) at the 24 h post- implant interval. The median cumulative VAS score was 0 (IQR = 0 - 1). There were no reported significant adverse effects. CONCLUSION SCN and PECS1 nerve blocks are safe and effective for patients undergoing CIED implantation to minimize or eliminate the use of intravenous sedation.
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Affiliation(s)
- Pavel Antiperovitch
- London Health Sciences Center, University of Western Ontario, London, Ontario, Canada
| | - Ahmed T Mokhtar
- London Health Sciences Center, University of Western Ontario, London, Ontario, Canada
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Raymond Yee
- London Health Sciences Center, University of Western Ontario, London, Ontario, Canada
| | - Jaimie Manlucu
- London Health Sciences Center, University of Western Ontario, London, Ontario, Canada
| | - Lorne J Gula
- London Health Sciences Center, University of Western Ontario, London, Ontario, Canada
| | - Peter Leong-Sit
- London Health Sciences Center, University of Western Ontario, London, Ontario, Canada
| | - Allan C Skanes
- London Health Sciences Center, University of Western Ontario, London, Ontario, Canada
| | - Anthony S L Tang
- London Health Sciences Center, University of Western Ontario, London, Ontario, Canada
| | - Habib Rehman Khan
- London Health Sciences Center, University of Western Ontario, London, Ontario, Canada
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Khan HR, Moustafa AT, Triemstra S, Mokhtar AT, Saravu S, Mtwesi V, Gula LJ, Leong-Sit P, Manlucu J, Skanes AC, Yee R, Tang A. Vascular and Cardiac Ultrasound as the Primary Imaging Tool to safely deliver pacing leads while implanting Single Chamber Permanent Pacemakers: A single operator experience in a tertiary cardiac centre. Heart Rhythm 2023:S1547-5271(23)02323-8. [PMID: 37271353 DOI: 10.1016/j.hrthm.2023.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/23/2023] [Accepted: 05/30/2023] [Indexed: 06/06/2023]
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Klein GJ, Gula LJ. A Sensible Decision: Evidence Should Guide Management Decisions for Asymptomatic WPW Pattern in Any Patient. JACC Case Rep 2023; 9:101605. [PMID: 36909275 PMCID: PMC9998717 DOI: 10.1016/j.jaccas.2022.08.021] [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] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Gula LJ, Frydman A, Khan HR, Klein GJ, Leong-Sit P, Manlucu J, Roberts JD, Tang AS, Yee R, Skanes AC. Hemodynamically tolerated ventricular tachycardia with mildly impaired ejection fraction – Do these patients have VT/VF recurrence and ICD therapies? Can J Cardiol 2022; 38:1271-1276. [DOI: 10.1016/j.cjca.2022.03.015] [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: 12/13/2021] [Revised: 03/01/2022] [Accepted: 03/12/2022] [Indexed: 11/02/2022] Open
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Gula LJ, Skanes AC. Insufficient Use of Anticoagulation for Frail Patients With Atrial Fibrillation: Still Stuck in the "Early Majority" Phase. Can J Cardiol 2022; 38:9-10. [DOI: 10.1016/j.cjca.2021.10.010] [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] [Received: 10/12/2021] [Revised: 10/16/2021] [Accepted: 10/17/2021] [Indexed: 11/02/2022] Open
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Lazarte J, Laksman ZW, Wang J, Robinson JF, Dron JS, Leach E, Liew J, McIntyre AD, Skanes AC, Gula LJ, Leong-Sit P, Cao H, Trost B, Scherer SW, Hegele RA, Roberts JD. Enrichment of loss-of-function and copy number variants in ventricular cardiomyopathy genes in 'lone' atrial fibrillation. Europace 2021; 23:844-850. [PMID: 33682005 DOI: 10.1093/europace/euaa421] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/22/2020] [Indexed: 12/31/2022] Open
Abstract
AIMS Atrial fibrillation (AF) is a complex heritable disease whose genetic underpinnings remain largely unexplained, though recent work has suggested that the arrhythmia may develop secondary to an underlying atrial cardiomyopathy. We sought to evaluate for enrichment of loss-of-function (LOF) and copy number variants (CNVs) in genes implicated in ventricular cardiomyopathy in 'lone' AF. METHODS AND RESULTS Whole-exome sequencing was performed in 255 early onset 'lone' AF cases, defined as arrhythmia onset prior to 60 years of age in the absence of known clinical risk factors. Subsequent evaluations were restricted to 195 cases of European genetic ancestry, as defined by principal component analysis, and focused on a pre-defined set of 43 genes previously implicated in ventricular cardiomyopathy. Bioinformatic analysis identified 6 LOF variants (3.1%), including 3 within the TTN gene, among cases in comparison with 4 of 503 (0.80%) controls [odds ratio: 3.96; 95% confidence interval (CI): 1.11-14.2; P = 0.033]. Further, two AF cases possessed a novel heterozygous 8521 base pair TTN deletion, confirmed with Sanger sequencing and breakpoint validation, which was absent from 4958 controls (P = 0.0014). Subsequent cascade screening in two families revealed evidence of co-segregation of a LOF variant with 'lone' AF. CONCLUSION 'Lone' AF cases are enriched in rare LOF variants from cardiomyopathy genes, findings primarily driven by TTN, and a novel TTN deletion, providing additional evidence to implicate atrial cardiomyopathy as an AF genetic sub-phenotype. Our results also highlight that AF may develop in the context of these variants in the absence of a discernable ventricular cardiomyopathy.
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Affiliation(s)
- Julieta Lazarte
- Department of Medicine, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Zachary W Laksman
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jian Wang
- Department of Medicine, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - John F Robinson
- Department of Medicine, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Jacqueline S Dron
- Department of Medicine, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Emma Leach
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Janet Liew
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Adam D McIntyre
- Department of Medicine, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Allan C Skanes
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, ON, Canada
| | - Lorne J Gula
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, ON, Canada
| | - Peter Leong-Sit
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, ON, Canada
| | - Henian Cao
- Department of Medicine, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Brett Trost
- The Centre for Applied Genomics, Hospital for Sick Children, Toronto, ON, Canada
| | - Stephen W Scherer
- The Centre for Applied Genomics, Hospital for Sick Children, Toronto, ON, Canada.,Department of Molecular Genetics, McLaughlin Centre, University of Toronto, Toronto, ON, Canada
| | - Robert A Hegele
- Department of Medicine, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Jason D Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, ON, Canada
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Lazarte J, Dron JS, McIntyre AD, Skanes AC, Gula LJ, Tang AS, Tadros R, Laksman ZW, Hegele RA, Roberts JD. Evaluating Polygenic Risk Scores in "Lone" Atrial Fibrillation. CJC Open 2021; 3:751-757. [PMID: 34169254 PMCID: PMC8209371 DOI: 10.1016/j.cjco.2021.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 02/01/2021] [Indexed: 12/31/2022] Open
Abstract
Background Polygenic scores incorporating varying numbers of single nucleotide polymorphisms (SNPs) have been demonstrated to exert a prominent role in atrial fibrillation (AF). We sought to compare the relative discriminatory capacities of 2 previously validated polygenic scores in "lone" AF. Methods A total of 186 lone AF cases of European ancestry underwent SNP genotyping. A genome-wide polygenic score (GPS) and polygenic risk score (PRS) involving 6,730,541 and 1168 SNPs, respectively, were calculated for 186 cases and 423 controls of European ancestry from the 1000 Genomes (1KG) Project. The distribution of the polygenic scores was compared between the cases and controls and their discriminatory capacities were evaluated using receiver operating characteristic (ROC) curves. Results A total of 34.4% of patients with lone AF had GPS scores greater than the top 10th percentile of 1KG controls, corresponding to a 4.64-fold increased odds (95% confidence interval [CI], 2.99-7.18; P < 0.001) for AF. A PRS score in the top 10th percentile of 1KG controls was observed in 26.3% of cases, which equated to a 3.16-fold increased odds (95% CI, 2.01-4.98; P < 0.001) for AF. Comparison of C-statistics from ROC curves indicated improved discriminatory capacity of the GPS (0.76) relative to the PRS (0.70) (P = 0.002). Conclusions Our study evaluating 2 polygenic scores for AF suggests that the GPS, containing more than 6.7 million SNPs, exhibits an improved discriminatory capacity in lone AF compared with a PRS possessing 1168 SNPs. Our findings suggest that genetic risk scores for AF that maximally leverage genomic data may provide improved predictive power.
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Affiliation(s)
- Julieta Lazarte
- Department of Medicine and Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jacqueline S Dron
- Department of Medicine and Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Adam D McIntyre
- Department of Medicine and Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Allan C Skanes
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
| | - Lorne J Gula
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
| | - Anthony S Tang
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
| | - Rafik Tadros
- Division of Cardiology, Montréal Heart Institute, University of Montréal, Montréal, Québec, Canada
| | - Zachary W Laksman
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert A Hegele
- Department of Medicine and Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jason D Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
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Lazarte J, Dron JS, McIntyre AD, Skanes AC, Gula LJ, Tang AS, Tadros R, Laksman ZW, Hegele RA, Roberts JD. Role of Common Genetic Variation in Lone Atrial Fibrillation. Circ Genom Precis Med 2021; 14:e003179. [PMID: 33517663 DOI: 10.1161/circgen.120.003179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Julieta Lazarte
- Department of Medicine and Robarts Research Institute, Schulich School of Medicine and Dentistry (J.L., J.S.D., A.D.M., R.A.H.), Western University, London, Ontario, Canada
| | - Jacqueline S Dron
- Department of Medicine and Robarts Research Institute, Schulich School of Medicine and Dentistry (J.L., J.S.D., A.D.M., R.A.H.), Western University, London, Ontario, Canada
| | - Adam D McIntyre
- Department of Medicine and Robarts Research Institute, Schulich School of Medicine and Dentistry (J.L., J.S.D., A.D.M., R.A.H.), Western University, London, Ontario, Canada
| | - Allan C Skanes
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine (A.C.S., L.J.G., A.S.T., J.D.R.), Western University, London, Ontario, Canada
| | - Lorne J Gula
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine (A.C.S., L.J.G., A.S.T., J.D.R.), Western University, London, Ontario, Canada
| | - Anthony S Tang
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine (A.C.S., L.J.G., A.S.T., J.D.R.), Western University, London, Ontario, Canada
| | - Rafik Tadros
- Division of Cardiology, Montreal Heart Institute, University of Montreal, Quebec, Canada (R.T.)
| | - Zachary W Laksman
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada (Z.W.L.)
| | - Robert A Hegele
- Department of Medicine and Robarts Research Institute, Schulich School of Medicine and Dentistry (J.L., J.S.D., A.D.M., R.A.H.), Western University, London, Ontario, Canada
| | - Jason D Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine (A.C.S., L.J.G., A.S.T., J.D.R.), Western University, London, Ontario, Canada
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Kanawati J, Roberts JD, Rowe MK, Khan H, Chan WK, Leong-Sit P, Manlucu J, Yee R, Tang AS, Gula LJ, Skanes AC, Klein GJ. A simple maneuver to determine if septal accessory pathway ablation requires a left atrial approach. J Cardiovasc Electrophysiol 2020; 31:3207-3214. [PMID: 32936492 DOI: 10.1111/jce.14745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/04/2020] [Accepted: 09/11/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Septal accessory pathway (AP) ablation can be challenging due to the complex anatomy of the septal region. The decision to access the left atrium (LA) is often made after failure of ablation from the right. We sought to establish whether the difference between ventriculo-atrial (VA) time during right ventricular (RV) apical pacing versus the VA during tachycardia would help establish the successful site for ablation of septal APs. METHODS Intracardiac electrograms of patients with orthodromic reciprocating tachycardia (ORT) using a septal AP with successful catheter ablation were reviewed. The ∆VA was the difference between the VA interval during RV apical pacing and the VA interval during ORT. The difference in the VA interval during right ventricular entrainment and ORT (StimA-VA) was also measured. RESULTS The median ∆VA time was significantly less in patients with a septal AP ablated on the right side compared with patients with a septal AP ablated on the left side (12 ± 19 vs. 56 ± 10 ms, p < .001). The StimA-VA was significantly different between the two groups (22 ± 14 vs. 53 ± 9 ms, p < .001). The ∆VA and StimA-VA were always ≤ 40 ms in patients with non-decremental septal APs ablated from the right side and always greater than 40 ms in those with septal APs ablated from the left. CONCLUSION ΔVA and StimA-VA values identified with RV apical pacing in the setting of ORT involving a septal AP predict when left atrial access will be necessary for successful ablation.
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Affiliation(s)
- Juliana Kanawati
- Division of Cardiology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Cardiology, Concord Repatriation General Hospital, Sydney, New South Wale, Australia
| | - Jason D Roberts
- Division of Cardiology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Matthew K Rowe
- Division of Cardiology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Habib Khan
- Division of Cardiology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - William K Chan
- Division of Cardiology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Peter Leong-Sit
- Division of Cardiology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jaimie Manlucu
- Division of Cardiology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Raymond Yee
- Division of Cardiology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Anthony S Tang
- Division of Cardiology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Lorne J Gula
- Division of Cardiology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Allan C Skanes
- Division of Cardiology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - George J Klein
- Division of Cardiology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Deyell MW, AbdelWahab A, Angaran P, Essebag V, Glover B, Gula LJ, Khoo C, Lane C, Nault I, Nery PB, Rivard L, Slawnych MP, Tulloch HL, Sapp JL. 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Position Statement on the Management of Ventricular Tachycardia and Fibrillation in Patients With Structural Heart Disease. Can J Cardiol 2020; 36:822-836. [DOI: 10.1016/j.cjca.2020.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/29/2020] [Accepted: 04/05/2020] [Indexed: 10/24/2022] Open
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Roberts JD, Asaki SY, Mazzanti A, Bos JM, Tuleta I, Muir AR, Crotti L, Krahn AD, Kutyifa V, Shoemaker MB, Johnsrude CL, Aiba T, Marcondes L, Baban A, Udupa S, Dechert B, Fischbach P, Knight LM, Vittinghoff E, Kukavica D, Stallmeyer B, Giudicessi JR, Spazzolini C, Shimamoto K, Tadros R, Cadrin-Tourigny J, Duff HJ, Simpson CS, Roston TM, Wijeyeratne YD, El Hajjaji I, Yousif MD, Gula LJ, Leong-Sit P, Chavali N, Landstrom AP, Marcus GM, Dittmann S, Wilde AAM, Behr ER, Tfelt-Hansen J, Scheinman MM, Perez MV, Kaski JP, Gow RM, Drago F, Aziz PF, Abrams DJ, Gollob MH, Skinner JR, Shimizu W, Kaufman ES, Roden DM, Zareba W, Schwartz PJ, Schulze-Bahr E, Etheridge SP, Priori SG, Ackerman MJ. An International Multicenter Evaluation of Type 5 Long QT Syndrome: A Low Penetrant Primary Arrhythmic Condition. Circulation 2020; 141:429-439. [PMID: 31941373 DOI: 10.1161/circulationaha.119.043114] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Insight into type 5 long QT syndrome (LQT5) has been limited to case reports and small family series. Improved understanding of the clinical phenotype and genetic features associated with rare KCNE1 variants implicated in LQT5 was sought through an international multicenter collaboration. METHODS Patients with either presumed autosomal dominant LQT5 (N = 229) or the recessive Type 2 Jervell and Lange-Nielsen syndrome (N = 19) were enrolled from 22 genetic arrhythmia clinics and 4 registries from 9 countries. KCNE1 variants were evaluated for ECG penetrance (defined as QTc >460 ms on presenting ECG) and genotype-phenotype segregation. Multivariable Cox regression was used to compare the associations between clinical and genetic variables with a composite primary outcome of definite arrhythmic events, including appropriate implantable cardioverter-defibrillator shocks, aborted cardiac arrest, and sudden cardiac death. RESULTS A total of 32 distinct KCNE1 rare variants were identified in 89 probands and 140 genotype positive family members with presumed LQT5 and an additional 19 Type 2 Jervell and Lange-Nielsen syndrome patients. Among presumed LQT5 patients, the mean QTc on presenting ECG was significantly longer in probands (476.9±38.6 ms) compared with genotype positive family members (441.8±30.9 ms, P<0.001). ECG penetrance for heterozygous genotype positive family members was 20.7% (29/140). A definite arrhythmic event was experienced in 16.9% (15/89) of heterozygous probands in comparison with 1.4% (2/140) of family members (adjusted hazard ratio [HR] 11.6 [95% CI, 2.6-52.2]; P=0.001). Event incidence did not differ significantly for Type 2 Jervell and Lange-Nielsen syndrome patients relative to the overall heterozygous cohort (10.5% [2/19]; HR 1.7 [95% CI, 0.3-10.8], P=0.590). The cumulative prevalence of the 32 KCNE1 variants in the Genome Aggregation Database, which is a human database of exome and genome sequencing data from now over 140 000 individuals, was 238-fold greater than the anticipated prevalence of all LQT5 combined (0.238% vs 0.001%). CONCLUSIONS The present study suggests that putative/confirmed loss-of-function KCNE1 variants predispose to QT prolongation, however, the low ECG penetrance observed suggests they do not manifest clinically in the majority of individuals, aligning with the mild phenotype observed for Type 2 Jervell and Lange-Nielsen syndrome patients.
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Affiliation(s)
- Jason D Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada (J.D.R., I.E.H., M.D.Y., L.J.G., P.L.-S.)
| | - S Yukiko Asaki
- Department of Pediatrics, University of Utah, and Primary Children's Hospital, Salt Lake City (S.Y.A., S.P.E.)
| | - Andrea Mazzanti
- Molecular Cardiology, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico and Department of Molecular Medicine, University of Pavia, Italy (A.M., D.K., S.G.P.).,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (A.M., I.T., L.C., A.B., D.K., B.S., C.S., Y.D.W., S.D., A.A.M.W., E.R.B., J.T.-H., J.P.K., F.D., P.J.S., E.S.-B., S.G.P.)
| | | | - Izabela Tuleta
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (A.M., I.T., L.C., A.B., D.K., B.S., C.S., Y.D.W., S.D., A.A.M.W., E.R.B., J.T.-H., J.P.K., F.D., P.J.S., E.S.-B., S.G.P.).,Department of Cardiology I (I.T.), University Hospital Muenster, Germany
| | - Alison R Muir
- Northern Ireland Inherited Cardiac Conditions Service, Belfast City Hospital, United Kingdom (A.R.M.)
| | - Lia Crotti
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (A.M., I.T., L.C., A.B., D.K., B.S., C.S., Y.D.W., S.D., A.A.M.W., E.R.B., J.T.-H., J.P.K., F.D., P.J.S., E.S.-B., S.G.P.).,Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, Milan, Italy (L.C., C.S., P.J.S.).,Department of Medicine and Surgery, University of Milano-Bicocca, Italy (L.C.).,Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy (L.C.)
| | - Andrew D Krahn
- Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, Canada (A.D.K., T.M.R.)
| | - Valentina Kutyifa
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, NY (V.K., W.Z.)
| | - M Benjamin Shoemaker
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Department of Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN (M.B., J.R.G., M.J.A.).,Departments of Medicine (M.B.S., N.C., D.M.R.), Vanderbilt University Medical Center, Nashville, TN
| | - Christopher L Johnsrude
- Division of Pediatric Cardiology, Department of Pediatrics, University of Louisville, KY (C.L.J.)
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (T.A., K.S., W.S.)
| | - Luciana Marcondes
- Cardiac Inherited Disease Group New Zealand, Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland (L.M., J.R.S.)
| | - Anwar Baban
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (A.M., I.T., L.C., A.B., D.K., B.S., C.S., Y.D.W., S.D., A.A.M.W., E.R.B., J.T.-H., J.P.K., F.D., P.J.S., E.S.-B., S.G.P.).,Pediatric Cardiology and Cardiac Arrhythmias Complex Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy (A.B., F.D.)
| | - Sharmila Udupa
- Children's Hospital of Eastern Ontario, Department of Pediatrics, University of Ottawa, Canada (S.U., R.M.G.)
| | - Brynn Dechert
- Division of Cardiology, Department of Pediatrics, University of Michigan Children's Hospital, University of Michigan, Ann Arbor (B.D.)
| | - Peter Fischbach
- Children's Healthcare of Atlanta, Sibley Heart Center Cardiology, GA (P.F., L.M.K.)
| | - Linda M Knight
- Children's Healthcare of Atlanta, Sibley Heart Center Cardiology, GA (P.F., L.M.K.)
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics (E.V.), University of California San Francisco
| | - Deni Kukavica
- Molecular Cardiology, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico and Department of Molecular Medicine, University of Pavia, Italy (A.M., D.K., S.G.P.).,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (A.M., I.T., L.C., A.B., D.K., B.S., C.S., Y.D.W., S.D., A.A.M.W., E.R.B., J.T.-H., J.P.K., F.D., P.J.S., E.S.-B., S.G.P.)
| | - Birgit Stallmeyer
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (A.M., I.T., L.C., A.B., D.K., B.S., C.S., Y.D.W., S.D., A.A.M.W., E.R.B., J.T.-H., J.P.K., F.D., P.J.S., E.S.-B., S.G.P.).,Institute for Genetics of Heart Disease (B.S., S.D., E.S.-B.), University Hospital Muenster, Germany
| | - John R Giudicessi
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Department of Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN (M.B., J.R.G., M.J.A.)
| | - Carla Spazzolini
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (A.M., I.T., L.C., A.B., D.K., B.S., C.S., Y.D.W., S.D., A.A.M.W., E.R.B., J.T.-H., J.P.K., F.D., P.J.S., E.S.-B., S.G.P.).,Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, Milan, Italy (L.C., C.S., P.J.S.)
| | - Keiko Shimamoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (T.A., K.S., W.S.)
| | - Rafik Tadros
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, Quebec, Canada (R.T., J., C.-T.)
| | - Julia Cadrin-Tourigny
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, Quebec, Canada (R.T., J., C.-T.)
| | - Henry J Duff
- Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Canada (H.J.D.)
| | | | - Thomas M Roston
- Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, Canada (A.D.K., T.M.R.)
| | - Yanushi D Wijeyeratne
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (A.M., I.T., L.C., A.B., D.K., B.S., C.S., Y.D.W., S.D., A.A.M.W., E.R.B., J.T.-H., J.P.K., F.D., P.J.S., E.S.-B., S.G.P.).,Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George's University of London, and St. George's University Hospitals NHS Foundation Trust, United Kingdom (Y.D.W., E.R.B.)
| | - Imane El Hajjaji
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada (J.D.R., I.E.H., M.D.Y., L.J.G., P.L.-S.)
| | - Maisoon D Yousif
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada (J.D.R., I.E.H., M.D.Y., L.J.G., P.L.-S.)
| | - Lorne J Gula
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada (J.D.R., I.E.H., M.D.Y., L.J.G., P.L.-S.)
| | - Peter Leong-Sit
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada (J.D.R., I.E.H., M.D.Y., L.J.G., P.L.-S.)
| | - Nikhil Chavali
- Departments of Medicine (M.B.S., N.C., D.M.R.), Vanderbilt University Medical Center, Nashville, TN
| | - Andrew P Landstrom
- Department of Pediatrics, Division of Pediatric Cardiology, and Department of Cell Biology, Duke University School of Medicine, Durham, NC (A.P.L.)
| | - Gregory M Marcus
- Amsterdam University Medical Centre, location AMC, Heart Center, Department of Clinical and Experimental Cardiology, The Netherlands (G.M.M., A.A.M.W.)
| | - Sven Dittmann
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (A.M., I.T., L.C., A.B., D.K., B.S., C.S., Y.D.W., S.D., A.A.M.W., E.R.B., J.T.-H., J.P.K., F.D., P.J.S., E.S.-B., S.G.P.).,Institute for Genetics of Heart Disease (B.S., S.D., E.S.-B.), University Hospital Muenster, Germany
| | - Arthur A M Wilde
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (A.M., I.T., L.C., A.B., D.K., B.S., C.S., Y.D.W., S.D., A.A.M.W., E.R.B., J.T.-H., J.P.K., F.D., P.J.S., E.S.-B., S.G.P.).,Amsterdam University Medical Centre, location AMC, Heart Center, Department of Clinical and Experimental Cardiology, The Netherlands (G.M.M., A.A.M.W.)
| | - Elijah R Behr
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (A.M., I.T., L.C., A.B., D.K., B.S., C.S., Y.D.W., S.D., A.A.M.W., E.R.B., J.T.-H., J.P.K., F.D., P.J.S., E.S.-B., S.G.P.).,Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George's University of London, and St. George's University Hospitals NHS Foundation Trust, United Kingdom (Y.D.W., E.R.B.)
| | - Jacob Tfelt-Hansen
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (A.M., I.T., L.C., A.B., D.K., B.S., C.S., Y.D.W., S.D., A.A.M.W., E.R.B., J.T.-H., J.P.K., F.D., P.J.S., E.S.-B., S.G.P.).,The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Denmark (J.T.-H.)
| | - Melvin M Scheinman
- Department of Medicine, Division of Cardiology, Section of Cardiac Electrophysiology M.M.S.), University of California San Francisco
| | - Marco V Perez
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (M.V.P.)
| | - Juan Pablo Kaski
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (A.M., I.T., L.C., A.B., D.K., B.S., C.S., Y.D.W., S.D., A.A.M.W., E.R.B., J.T.-H., J.P.K., F.D., P.J.S., E.S.-B., S.G.P.).,Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital and UCL Institute of Cardiovascular Science, London, United Kingdom (J.P.K.)
| | - Robert M Gow
- Children's Hospital of Eastern Ontario, Department of Pediatrics, University of Ottawa, Canada (S.U., R.M.G.)
| | - Fabrizio Drago
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (A.M., I.T., L.C., A.B., D.K., B.S., C.S., Y.D.W., S.D., A.A.M.W., E.R.B., J.T.-H., J.P.K., F.D., P.J.S., E.S.-B., S.G.P.).,Pediatric Cardiology and Cardiac Arrhythmias Complex Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy (A.B., F.D.)
| | - Peter F Aziz
- Department of Pediatric Cardiology, Cleveland Clinic, OH (P.F.A.)
| | - Dominic J Abrams
- Inherited Cardiac Arrhythmia Program, Boston Children's Hospital, Harvard Medical School, MA (D.J.A.)
| | - Michael H Gollob
- Department of Physiology and Department of Medicine, Toronto General Hospital, University of Toronto, Ontario, Canada (M.H.G.)
| | - Jonathan R Skinner
- Cardiac Inherited Disease Group New Zealand, Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland (L.M., J.R.S.)
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (T.A., K.S., W.S.).,Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.)
| | - Elizabeth S Kaufman
- The Heart and Vascular Research Center, Metro-Health Campus, Case Western Reserve University, Cleveland, OH (E.S.K.)
| | - Dan M Roden
- Departments of Medicine (M.B.S., N.C., D.M.R.), Vanderbilt University Medical Center, Nashville, TN.,Pharmacology (D.M.R.), Vanderbilt University Medical Center, Nashville, TN.,Biomedical Informatics (D.M.R.), Vanderbilt University Medical Center, Nashville, TN
| | - Wojciech Zareba
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, NY (V.K., W.Z.)
| | - Peter J Schwartz
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (A.M., I.T., L.C., A.B., D.K., B.S., C.S., Y.D.W., S.D., A.A.M.W., E.R.B., J.T.-H., J.P.K., F.D., P.J.S., E.S.-B., S.G.P.).,Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, Milan, Italy (L.C., C.S., P.J.S.)
| | - Eric Schulze-Bahr
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (A.M., I.T., L.C., A.B., D.K., B.S., C.S., Y.D.W., S.D., A.A.M.W., E.R.B., J.T.-H., J.P.K., F.D., P.J.S., E.S.-B., S.G.P.).,Institute for Genetics of Heart Disease (B.S., S.D., E.S.-B.), University Hospital Muenster, Germany
| | - Susan P Etheridge
- Department of Pediatrics, University of Utah, and Primary Children's Hospital, Salt Lake City (S.Y.A., S.P.E.)
| | - Silvia G Priori
- Molecular Cardiology, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico and Department of Molecular Medicine, University of Pavia, Italy (A.M., D.K., S.G.P.).,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (A.M., I.T., L.C., A.B., D.K., B.S., C.S., Y.D.W., S.D., A.A.M.W., E.R.B., J.T.-H., J.P.K., F.D., P.J.S., E.S.-B., S.G.P.)
| | - Michael J Ackerman
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Department of Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN (M.B., J.R.G., M.J.A.)
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13
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Gula LJ. Is atrial flutter ablation a stop along the road to atrial fibrillation? Int J Cardiol 2020; 298:52-53. [PMID: 31604659 DOI: 10.1016/j.ijcard.2019.09.002] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 09/04/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Lorne J Gula
- London Heart Rhythm Program, Western University, London, Ontario, Canada.
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14
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Manlucu J, Sharma V, Koehler J, Warman EN, Wells GA, Gula LJ, Yee R, Tang AS. Incremental Value of Implantable Cardiac Device Diagnostic Variables Over Clinical Parameters to Predict Mortality in Patients With Mild to Moderate Heart Failure. J Am Heart Assoc 2019; 8:e010998. [PMID: 31291801 PMCID: PMC6662119 DOI: 10.1161/jaha.118.010998] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Heart failure remains a leading cause of morbidity and mortality. Clinical prediction models provide suboptimal estimates of mortality in this population. We sought to determine the incremental value of implantable device diagnostics over clinical prediction models for mortality. Methods and Results RAFT (Resynchronization/Defibrillation for Ambulatory Heart Failure Trial) patients with implanted devices capable of device diagnostic monitoring were included, and demographic and clinical parameters were used to compute Meta‐Analysis Global Group in Chronic Heart Failure (MAGGIC) heart failure risk scores. Patients were classified according to MAGGIC score into low (0–16), intermediate (17–24), or high (>24) risk groups. Mortality was evaluated from 6 months postimplant in accordance with the RAFT protocol. In a subset of 1036 patients, multivariable analysis revealed that intermediate and high MAGGIC scores, fluid index, atrial fibrillation, and low activity flags were independent predictors of mortality. A device‐integrated diagnostic parameter that included a fluid index flag and either a positive atrial fibrillation flag or a positive activity flag was able to significantly differentiate higher from lower risk for mortality in the intermediate MAGGIC cohort. The effect was more pronounced in the high‐risk MAGGIC cohort, in which device‐integrated diagnostic–positive patients had a shorter time to death than those who were device‐integrated diagnostic negative. Conclusions Device diagnostics using a combination of fluid index trends, atrial fibrillation burden, and patient activity provide significant incremental prognostic value over clinical heart failure prediction scores in higher‐risk patients. This suggests that combining clinical and device diagnostic parameters may lead to models with better predictive power. Whether this risk is modifiable with early medical intervention would warrant further studies. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00251251.
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Affiliation(s)
| | | | | | | | - George A Wells
- 3 University of Ottawa Heart Institute Ottawa Ontario Canada
| | | | | | - Anthony S Tang
- 1 Western University London Ontario Canada.,3 University of Ottawa Heart Institute Ottawa Ontario Canada
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15
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Roberts JD, Gula LJ. QT-Interval Assessment in Left Bundle Branch Block: Deciphering Normal Within Abnormal. Can J Cardiol 2019; 35:802-804. [PMID: 31292074 DOI: 10.1016/j.cjca.2019.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 03/05/2019] [Accepted: 03/05/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- Jason D Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada.
| | - Lorne J Gula
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
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16
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Gula LJ, Leong-Sit P, Skanes AC. Measuring the Impact of Guideline Concordance: The More Things Change, the More They Stay the Same. Circ Arrhythm Electrophysiol 2019; 10:CIRCEP.117.005838. [PMID: 29141845 DOI: 10.1161/circep.117.005838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 11/16/2022]
Affiliation(s)
- Lorne J Gula
- From the London Heart Rhythm Program, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
| | - Peter Leong-Sit
- From the London Heart Rhythm Program, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
| | - Allan C Skanes
- From the London Heart Rhythm Program, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada.
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17
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Malhi N, Cheung CC, Deif B, Roberts JD, Gula LJ, Green MS, Pang B, Sultan O, Konieczny KM, Angaran P, Dorian P, Lashevsky I, Healey JS, Alak A, Tadros R, Andorin A, Steinberg C, Ayala-Paredes F, Simpson CS, Atallah J, Krahn AD. Challenge and Impact of Quinidine Access in Sudden Death Syndromes. JACC Clin Electrophysiol 2019; 5:376-382. [DOI: 10.1016/j.jacep.2018.10.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 10/11/2018] [Accepted: 10/15/2018] [Indexed: 11/24/2022]
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18
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Gula LJ, Roberts JD. Early Repolarization in Long QT Syndrome. JACC Clin Electrophysiol 2018; 4:1245-1247. [DOI: 10.1016/j.jacep.2018.07.003] [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] [Received: 06/26/2018] [Accepted: 07/06/2018] [Indexed: 10/28/2022]
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19
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Gula LJ, Redfearn DP, Jenkyn KB, Allen B, Skanes AC, Leong-Sit P, Shariff SZ. Elevated Incidence of Atrial Fibrillation and Stroke in Patients With Atrial Flutter—A Population-Based Study. Can J Cardiol 2018; 34:774-783. [DOI: 10.1016/j.cjca.2018.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 01/03/2018] [Accepted: 01/03/2018] [Indexed: 10/18/2022] Open
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20
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Gula LJ, Doucette S, Leong-Sit P, Tang AS, Parkash R, Sarrazin JF, Thibault B, Essebag V, Tung SK, Deyell MW, Raymond JM, Lane C, Nery PB, Veenhuyzen GD, Redfearn DP, Healey JS, Roux JF, Giddens K, Sapp JL. Quality of life with ablation or medical therapy for ventricular arrhythmias: A substudy of VANISH. J Cardiovasc Electrophysiol 2018; 29:421-434. [DOI: 10.1111/jce.13419] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 12/11/2017] [Accepted: 12/18/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Lorne J. Gula
- Heart Rhythm Service, University Hospital; Western University; London Ontario Canada
| | - Steve Doucette
- Department of Medicine; QEII Health Sciences Centre and Dalhousie University; Halifax Nova Scotia Canada
| | - Peter Leong-Sit
- Heart Rhythm Service, University Hospital; Western University; London Ontario Canada
| | - Anthony S.L. Tang
- Heart Rhythm Service, University Hospital; Western University; London Ontario Canada
| | - Ratika Parkash
- Department of Medicine; QEII Health Sciences Centre and Dalhousie University; Halifax Nova Scotia Canada
| | - Jean-Francois Sarrazin
- Institut Universitaire de Cardiologie et de Pneumologie de Québec; Québec City Québec Canada
| | | | - Vidal Essebag
- McGill University Health Centre and Hôpital Sacré-Coeur de Montréal; Montréal Québec Canada
| | - Stanley K. Tung
- Royal Columbian Hospital; New Westminster British Columbia Canada
| | - Marc W. Deyell
- University of British Columbia; Vancouver British Columbia Canada
| | - Jean-Marc Raymond
- Centre Hospitalier de L'Universite de Montréal; Montréal Québec Canada
| | - Chris Lane
- Royal Jubilee Hospital; Victoria British Columbia Canada
| | - Pablo B. Nery
- University of Ottawa Heart Institute; Ottawa Ontario Canada
| | | | | | | | - Jean-Francois Roux
- Centre Hospitalier Universitaire de Sherbrooke; Sherbrooke Québec Canada
| | - Karen Giddens
- Department of Medicine; QEII Health Sciences Centre and Dalhousie University; Halifax Nova Scotia Canada
| | - John L. Sapp
- Department of Medicine; QEII Health Sciences Centre and Dalhousie University; Halifax Nova Scotia Canada
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21
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Roberts JD, Krahn AD, Ackerman MJ, Rohatgi RK, Moss AJ, Nazer B, Tadros R, Gerull B, Sanatani S, Wijeyeratne YD, Baruteau AE, Muir AR, Pang B, Cadrin-Tourigny J, Talajic M, Rivard L, Tester DJ, Liu T, Whitman IR, Wojciak J, Conacher S, Gula LJ, Leong-Sit P, Manlucu J, Green MS, Hamilton R, Healey JS, Lopes CM, Behr ER, Wilde AA, Gollob MH, Scheinman MM. Loss-of-Function
KCNE2
Variants. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.117.005282. [DOI: 10.1161/circep.117.005282] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 06/29/2017] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | | | | | - Babak Nazer
- For author affiliations, please see the Appendix
| | - Rafik Tadros
- For author affiliations, please see the Appendix
| | | | | | | | | | | | | | | | | | - Lena Rivard
- For author affiliations, please see the Appendix
| | | | - Taylor Liu
- For author affiliations, please see the Appendix
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22
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Modi S, Yee R, Scholl D, Stirrat J, Wong JA, Lydell C, Kotha V, Gula LJ, Skanes AC, Leong-Sit P, McCarty D, Drangova M, White JA. Ventricular pacing site separation by cardiac computed tomography: validation for the prediction of clinical response to cardiac resynchronization therapy. Int J Cardiovasc Imaging 2017; 33:1433-1442. [DOI: 10.1007/s10554-017-1120-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 03/20/2017] [Indexed: 12/01/2022]
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23
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Inoue J, Skanes AC, Gula LJ, Drangova M. Effect of Left Atrial Wall Thickness on Radiofrequency Ablation Success. J Cardiovasc Electrophysiol 2016; 27:1298-1303. [PMID: 27510229 DOI: 10.1111/jce.13065] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 06/29/2016] [Accepted: 08/09/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Radiofrequency (RF) ablation in thicker regions of the left atrium (LA) may require increased ablation energy in order to achieve effective transmural lesions. Consequently, many cases of recurrent atrial fibrillation (AF) postablation may be due to thicker-than-normal atrial tissue. The aim of this study was to test the hypotheses that patients with recurrent AF have thicker tissue overall and that electrical reconnection is more likely in regions of thicker tissue. METHODS AND RESULTS Retrospective analysis was performed on 86 CT images acquired preoperatively from a cohort of 119 patients who had undergone RF ablation for AF. Of these, 33 patients experienced recurrence of AF within 1 year of initial treatment and 29 returned for a repeat ablation. For each patient, LA wall thickness (LAWT) was measured from the images in 12 anatomical regions using custom software. Patients with recurrent AF had larger LAWT compared to successfully treated patients (1.6 ± 0.6 mm vs. 1.5 ± 0.5 mm, P < 0.001) and reconnection was found to be at regions of thicker tissue (1.6 ± 0.6 mm, P = 0.038) compared to nonreconnected regions (1.5 ± 0.5 mm). The superior right posterior wall of the LA was significantly related to both recurrence (P = 0.048) and reconnection (P = 0.014). CONCLUSION Increased LAWT has a small but significant effect on postablation recurrence and reconnection. Measures of LAWT may facilitate appropriate dosing of RF energy, but other factors will be critical in transmural lesion formation and ablation success.
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Affiliation(s)
- Jiro Inoue
- Robarts Research Institute, The University of Western Ontario, London, Ontario, Canada
| | - Allan C Skanes
- Division of Cardiology, Department of Medicine, The University of Western Ontario, London, Ontario, Canada
| | - Lorne J Gula
- Division of Cardiology, Department of Medicine, The University of Western Ontario, London, Ontario, Canada
| | - Maria Drangova
- Robarts Research Institute, The University of Western Ontario, London, Ontario, Canada.,Department of Medical Biophysics, The University of Western Ontario, London, Ontario, Canada
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Manian U, Gula LJ. Arrhythmia Management in the Elderly—Implanted Cardioverter Defibrillators and Prevention of Sudden Death. Can J Cardiol 2016; 32:1117-23. [DOI: 10.1016/j.cjca.2016.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 03/17/2016] [Accepted: 03/21/2016] [Indexed: 11/16/2022] Open
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Qirjazi E, McArthur E, Nash DM, Dixon SN, Weir MA, Vasudev A, Jandoc R, Gula LJ, Oliver MJ, Wald R, Garg AX. Risk of Ventricular Arrhythmia with Citalopram and Escitalopram: A Population-Based Study. PLoS One 2016; 11:e0160768. [PMID: 27513855 PMCID: PMC4981428 DOI: 10.1371/journal.pone.0160768] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 06/14/2016] [Indexed: 01/17/2023] Open
Abstract
Background The risk of ventricular arrhythmia with citalopram and escitalopram is controversial. In this study we investigated the association between these two drugs and the risk of ventricular arrhythmia. Methods We conducted a population-based retrospective cohort study of older adults (mean age 76 years) from 2002 to 2012 in Ontario, Canada, newly prescribed citalopram (n = 137 701) or escitalopram (n = 38 436), compared to those prescribed referent antidepressants sertraline or paroxetine (n = 96 620). After inverse probability of treatment weighting using a propensity score, the baseline characteristics of the comparison groups were similar. The primary outcome was a hospital encounter with ventricular arrhythmia within 90 days of a new prescription, assessed using hospital diagnostic codes. The secondary outcome was all-cause mortality within 90 days. Results Citalopram was associated with a higher risk of a hospital encounter with ventricular arrhythmia compared with referent antidepressants (0.06% vs. 0.04%, relative risk [RR] 1.53, 95% confidence intervals [CI]1.03 to 2.29), and a higher risk of mortality (3.49% vs. 3.12%, RR 1.12, 95% CI 1.06 to 1.18). Escitalopram was not associated with a higher risk of ventricular arrhythmia compared with the referent antidepressants (0.03% vs. 0.04%, RR 0.84, 95% CI 0.42 to 1.68), but was associated with a higher risk of mortality (2.86% vs. 2.63%, RR 1.09, 95% CI 1.01 to 1.18). Conclusion Among older adults, initiation of citalopram compared to two referent antidepressants was associated with a small but statistically significant increase in the 90-day risk of a hospital encounter for ventricular arrhythmia.
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Affiliation(s)
- Elena Qirjazi
- Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada
| | - Eric McArthur
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Danielle M. Nash
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Stephanie N. Dixon
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| | - Matthew A. Weir
- Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada
- Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| | - Akshya Vasudev
- Division of Geriatric Psychiatry, Department of Psychiatry, Western University, London, Ontario, Canada
- Division of Clinical Pharmacology, Department of Medicine, Western University, London, Ontario, Canada
| | - Racquel Jandoc
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Lorne J. Gula
- Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
| | - Matthew J. Oliver
- Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ron Wald
- Keenan Research Centre in the Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Amit X. Garg
- Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada
- * E-mail:
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Gula LJ, Skanes AC, Klein GJ, Jenkyn KB, Redfearn DP, Manlucu J, Roberts JD, Yee R, Tang AS, Leong-Sit P. Atrial flutter and atrial fibrillation ablation – sequential or combined? A cost-benefit and risk analysis of primary prevention pulmonary vein ablation. Heart Rhythm 2016; 13:1441-8. [DOI: 10.1016/j.hrthm.2016.02.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Indexed: 10/22/2022]
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Abstract
Studies suggest clinically manifest cardiac involvement occurs in 5% of patients with pulmonary/systemic sarcoidosis. The principal manifestations of cardiac sarcoidosis (CS) are conduction abnormalities, ventricular arrhythmias, and heart failure. Data indicate that an 20% to 25% of patients with pulmonary/systemic sarcoidosis have asymptomatic (clinically silent) cardiac involvement. An international guideline for the diagnosis and management of CS recommends that patients be screened for cardiac involvement. Most studies suggest a benign prognosis for patients with clinically silent CS. Immunosuppression therapy is advocated for clinically manifest CS. Device therapy, with implantable cardioverter defibrillators, is recommended for some patients.
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Affiliation(s)
- David Birnie
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4 W7, Canada.
| | - Andrew C T Ha
- Department of Medicine, Peter Munk Cardiac Centre, University Health Network, University of Toronto, GW 3-558A, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada
| | - Lorne J Gula
- Division of Cardiology, London Health Sciences Centre, 339 Windermere Road, c6-110, London, Ontario N6A 5A5, Canada
| | - Santabhanu Chakrabarti
- Division of Cardiology, Department of Medicine, University of British Columbia, 211 1033, Davie Street, Vancouver, British Columbia V6E 1M7, Canada
| | - Rob S B Beanlands
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4 W7, Canada
| | - Pablo Nery
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4 W7, Canada
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Laksman Z, Momciu B, Seong YW, Burrows P, Conacher S, Manlucu J, Leong-Sit P, Gula LJ, Skanes AC, Yee R, Klein GJ, Krahn AD. A detailed description and assessment of outcomes of patients with hospital recorded QTc prolongation. Am J Cardiol 2015; 115:907-11. [PMID: 25665761 DOI: 10.1016/j.amjcard.2015.01.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 01/05/2015] [Accepted: 01/05/2015] [Indexed: 11/24/2022]
Abstract
Corrected QT (QTc) interval prolongation has been shown to be an independent predictor of mortality in many clinical settings and is a common finding in hospitalized patients. The causes and outcomes of patients with extreme QTc interval prolongation during a hospital admission are poorly described. The aim of this study was to prospectively identify patients with automated readings of QTc intervals >550 ms at 1 academic tertiary hospital. One hundred seventy-two patients with dramatic QTc interval prolongation (574 ± 53 ms) were identified (mean age 67.6 ± 15.1 years, 48% women). Most patients had underlying heart disease (60%), predominantly ischemic cardiomyopathy (43%). At lease 1 credible and presumed reversible cause associated with QTc interval prolongation was identified in 98% of patients. The most common culprits were QTc interval-prolonging medications, which were deemed most responsible in 48% of patients, with 25% of these patients taking ≥2 offending drugs. Two patients were diagnosed with congenital long-QT syndrome. Patients with electrocardiograms available before and after hospital admission demonstrated significantly lower preadmission and postdischarge QTc intervals compared with the QTc intervals recorded in the hospital. In conclusion, in-hospital mortality was high in the study population (29%), with only 4% of patients experiencing arrhythmic deaths, all of which were attributed to secondary causes.
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Affiliation(s)
- Lorne J Gula
- Arrhythmia Service, University Hospital, Western University, London, Ontario, Canada
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Hanninen M, Klein GJ, Laksman Z, Conacher SS, Skanes AC, Yee R, Gula LJ, Leong-Sit P, Manlucu J, Krahn AD. Reduced Uptake of Family Screening in Genotype-Negative Versus Genotype-Positive Long QT Syndrome. J Genet Couns 2014; 24:558-64. [PMID: 25273952 DOI: 10.1007/s10897-014-9776-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 09/12/2014] [Indexed: 01/08/2023]
Abstract
The acceptance and yield of family screening in genotype-negative long QT syndrome (LQTS) remains incompletely characterized. In this study of family screening for phenotype-definite Long QT Syndrome (LQTS, Schwartz score ≥3.5), probands at a regional Inherited Cardiac Arrhythmia clinic were reviewed. All LQTS patients were offered education by a qualified genetic counselor, along with materials for family screening including electronic and paper correspondence to provide to family members. Thirty-eight qualifying probands were identified and 20 of these had family members who participated in cascade screening. The acceptance of screening was found to be lower among families without a known pathogenic mutation (33 vs. 77 %, p = 0.02). A total of 52 relatives were screened; fewer relatives were screened per index case when the proband was genotype-negative (1.7 vs. 3.1, p = 0.02). The clinical yield of screening appeared to be similar irrespective of gene testing results (38 vs. 33 %, p = 0.69). Additional efforts to promote family screening among gene-negative long QT families may be warranted.
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Affiliation(s)
- Mikael Hanninen
- Division of Cardiology, Grey Nuns Hospital, Edmonton, AB, Canada
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Laksman Z, Yee R, Stirrat J, Gula LJ, Skanes AC, Leong-Sit P, Manlucu J, McCarty D, Turkistani Y, Scholl D, Rajchl M, Goela A, Islam A, Thompson RT, Drangova M, White JA. Model-based navigation of left and right ventricular leads to optimal targets for cardiac resynchronization therapy: a single-center feasibility study. Circ Arrhythm Electrophysiol 2014; 7:1040-7. [PMID: 25221334 DOI: 10.1161/circep.114.001729] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Left ventricular (LV) and right ventricular pacing site characteristics have been shown to influence response to cardiac resynchronization therapy (CRT). This study aimed to determine the clinical feasibility of image-guided lead delivery using a 3-dimensional navigational model displaying both LV and right ventricular (RV) pacing targets. Serial echocardiographic measures of clinical response and procedural metrics were evaluated. METHODS AND RESULTS Thirty-one consecutive patients underwent preimplant cardiac MRI with the generation of a 3-dimensional navigational model depicting optimal segmental targets for LV and RV leads. Lead delivery was guided by the model in matched views to intraprocedural fluoroscopy. Blinded assessment of final lead tip location was performed from postprocedural cardiac computed tomography. Clinical and LV remodeling response criteria were assessed at baseline, 3 months, and 6 months using a 6-minute hall walk, quality of life questionnaire, and echocardiography. Mean age and LV ejection fraction was 66 ± 8 years and 26 ± 8%, respectively. LV leads were successfully delivered to a target or adjacent segment in 30 of 31 patients (97%), 68% being nonposterolateral. RV leads were delivered to a target or adjacent segment in 30 of 31 patients (97%), 26% being nonapical. Twenty-three patients (74%) met standard criteria for response (LV end-systolic volume reduction ≥ 15%), 18 patients (58%) for super-response (LV end-systolic volume reduction ≥ 30%). LV ejection fraction improved at 6 months (31 ± 8 versus 26 ± 8%, P=0.04). CONCLUSIONS This study demonstrates clinical feasibility of dual cardiac resynchronization therapy lead delivery to optimal targets using a 3-dimensional navigational model. High procedural success, acceptable procedural times, and a low rate of early procedural complications were observed. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT01640769.
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Affiliation(s)
- Zachary Laksman
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - Raymond Yee
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - John Stirrat
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - Lorne J Gula
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - Allan C Skanes
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - Peter Leong-Sit
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - Jamie Manlucu
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - David McCarty
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - Yosra Turkistani
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - David Scholl
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - Martin Rajchl
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - Aashish Goela
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - Ali Islam
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - R Terry Thompson
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - Maria Drangova
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - James A White
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.).
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Gula LJ, Skanes AC. Dissociated pulmonary vein potentials: let sleeping dogs lie. J Cardiovasc Electrophysiol 2014; 26:14-5. [PMID: 25201590 DOI: 10.1111/jce.12537] [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: 08/29/2014] [Accepted: 09/02/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Lorne J Gula
- Arrhythmia Service, University Hospital, Western University, London, Ontario, Canada
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Gula LJ, Wells GA, Yee R, Koehler J, Sarkar S, Sharma V, Skanes AC, Sapp JL, Redfearn DP, Manlucu J, Tang ASL. A novel algorithm to assess risk of heart failure exacerbation using ICD diagnostics: validation from RAFT. Heart Rhythm 2014; 11:1626-31. [PMID: 24846373 DOI: 10.1016/j.hrthm.2014.05.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND The integrated diagnostics (ID) algorithm is an implantable device-based tool that collates data pertaining to heart rhythm, heart rate, intrathoracic fluid status, and activity, producing a risk score that correlates with 30-day risk of heart failure (HF) hospitalization. OBJECTIVE We sought to validate the ID algorithm using the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial. METHODS Diagnostic measures of the algorithm include OptiVol fluid index, nighttime heart rate, minutes of patient activity, heart rate variability, and combined measure of cardiac rhythm and biventricular pacing. Monthly evaluations of ID parameters were assessed for the development of HF symptoms and hospitalization for HF. RESULTS A total of 1224 patients were included: 741 (61%) with cardiac resynchronization therapy with defibrillator devices and 483 (39%) with implanted cardioverter-defibrillator only. The mean age was 66 ± 9 years, and 1013 (83%) were men. A total of 37,861 months of follow-up data were available, with 258 HF hospitalizations (event rate 0.68% per month). There were 33 HF hospitalizations during low-risk months (0.21% per month), 123 during medium-risk months (0.66% per month), and 102 during high-risk months (2.61% per month). Compared with low-risk months, and 95% confidence intervals) of HF hospitalizations during medium-risk months was 2.9 (2.0-4.4) and during high-risk months was 10.7 (6.9-16.6). Multivariable analysis demonstrated that each ID variable had independent association with HF hospitalization. CONCLUSION The risk of HF as determined by the ID algorithm correlated with HF hospitalization and several HF signs and symptoms among patients in the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial. This may present a useful adjunct to detect early signs of HF and adjust therapy to reduce morbidity and costs involved with hospital admission.
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Affiliation(s)
| | - George A Wells
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | | | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia
| | | | | | - Anthony S L Tang
- Western University, London, Ontario, Canada; University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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Bennett MT, Gula LJ, Klein GJ, Skanes AC, Yee R, Leong-Sit P, Chattha I, Sy R, Jones DL, Krahn AD. Effect of beta-blockers on QT dynamics in the long QT syndrome: measuring the benefit. ACTA ACUST UNITED AC 2014; 16:1847-51. [DOI: 10.1093/europace/euu086] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Subbiah R, Chia PL, Gula LJ, Klein GJ, Skanes AC, Yee R, Krahn AD. Cardiac monitoring in patients with syncope: making that elusive diagnosis. Curr Cardiol Rev 2014; 9:299-307. [PMID: 23228074 PMCID: PMC3941093 DOI: 10.2174/1573403x10666140214120056] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 11/27/2012] [Accepted: 11/28/2012] [Indexed: 11/25/2022] Open
Abstract
Elucidating the cause of syncope is often a diagnostic challenge. At present, there is a myriad of ambulatory
cardiac monitoring modalities available for recording cardiac rhythm during spontaneous symptoms. We provide a comprehensive
review of these devices and discuss strategies on how to reach the elusive diagnosis based on current evidencebased
recommendations.
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Affiliation(s)
| | | | | | | | | | | | - Andrew D Krahn
- London Health Sciences Centre, University Campus, C6-113, 339 Windermere Road, London, Ontario, Canada, N6A 5A5.
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Leather RA, Gardner M, Green MS, Kavanagh K, Macle L, Ahmad K, Gray C, Ayala-Paredes F, Guerra PG, O'Hara G, Essebag V, Sturmer M, Baranchuk A, Hruczkowski T, Lahevsky I, Novak P, Chakrabarti S, Harris L, Gula LJ, Morillo C, Sanatani S, Hamilton RM, Gow RM, Krahn AD. Charting a course for cardiac electrophysiology training in Canada: the vital role of fellows in advanced cardiovascular care. Can J Cardiol 2014; 29:1527-30. [PMID: 24182759 DOI: 10.1016/j.cjca.2013.08.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 08/30/2013] [Accepted: 08/30/2013] [Indexed: 11/18/2022] Open
Abstract
Canadian electrophysiology (EP) fellowship programs have evolved in an ad hoc fashion over 30 years. This evolution has occurred in many fields in medicine and is natural when innovators and pioneers attract research fellows who help change the status quo from predominantly research to a predominantly clinical application and focus. Fellows not only push their supervisors and their centres into new areas of inquiry but also function at the most advanced level to encourage and teach junior trainees and to provide examples of excellence to residents, medical students, and other health professionals. Funding for fellows has never been provided in the traditional way through the Ministry of Health or the Ministry of Advanced Education. Each Canadian centre has over the years found novel ways to fund fellowship programs, and many centres have used value-adds from procurement programs. These sources of funding are eroding as provincial government agencies are beginning to assume procurement responsibilities and local flexibility to fund fellowships is lost. In particular, provincial government agencies feel that valuable financial resources should be restricted to Canadian trainees only, despite the international consensus that fellowship is an essential time for advanced trainees to travel abroad to acquire a broad a range of experience, learn new techniques and approaches, make lifelong research connections, and hopefully return home with these skills and expertise. This article summarizes the long history of EP fellowship training in Canada, as well as EP fellowship experiences at home and abroad by Canadian electrophysiologists, in an attempt to contextualize these new realities.
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Derval N, Skanes AC, Gula LJ, Gray C, Denis A, Lim HS, Krahn AD, Yee R, Sacher F, Haïssaguerre M, Klein GJ. Differential sequential septal pacing: A simple maneuver to differentiate nodal versus extranodal ventriculoatrial conduction. Heart Rhythm 2013; 10:1785-91. [DOI: 10.1016/j.hrthm.2013.09.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Indexed: 10/26/2022]
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Affiliation(s)
- Lorne J Gula
- Division of Cardiology, Western University, London, Ontario, Canada
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Hanninen M, Laksman Z, Conacher SS, Skanes AC, Yee R, Gula LJ, Klein GJ, Leong-Sit P, Manlucu J, Krahn AD. Yield of Family Screening Is Similar in Gene-Negative and Gene-Positive Long-QT Syndrome. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Laksman Z, Saklani P, Cassagneau R, Moxey L, Conacher S, Yee R, Skanes A, Leong-Sit P, Manlucu J, Gula LJ, Klein G, Krahn AD. Early Repolarization Is a Cofactor Predicting Risk of Symptoms in Patients With Long QT Syndrome. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Thomas K, Wright GA, Gula LJ, Skanes AC. The Use of Ibutelide to Improve Atrial Fibrillation Ablation Outcomes. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Wong JA, Yee R, Stirrat J, Scholl D, Krahn AD, Gula LJ, Skanes AC, Leong-Sit P, Klein GJ, McCarty D, Fine N, Goela A, Islam A, Thompson T, Drangova M, White JA. Influence of pacing site characteristics on response to cardiac resynchronization therapy. Circ Cardiovasc Imaging 2013; 6:542-50. [PMID: 23741053 DOI: 10.1161/circimaging.111.000146] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Transmural scar occupying left ventricular (LV) pacing regions has been associated with reduced response to cardiac resynchronization therapy (CRT). However, spatial influences of lead tip delivery relative to scar at both pacing sites remain poorly explored. This study evaluated scar distribution relative to LV and right ventricular (RV) lead tip placement through coregistration of late gadolinium enhancement MRI and cardiac computed tomographic (CT) findings. Influences on CRT response were assessed by serial echocardiography. METHODS AND RESULTS Sixty patients receiving CRT underwent preimplant late gadolinium enhancement MRI, postimplant cardiac CT, and serial echocardiography. Blinded segmental evaluations of mechanical delay, percentage scar burden, and lead tip location were performed. Response to CRT was defined as a reduction in LV end-systolic volume ≥15% at 6 months. The mean age and LV ejection fraction were 64±9 years and 25±7%, respectively. Mean scar volume was higher among CRT nonresponders for both the LV (23±23% versus 8±14% [P=0.01]) and RV pacing regions (40±32% versus 24±30% [P=0.04]). Significant pacing region scar was identified in 13% of LV pacing regions and 37% of RV pacing regions. Absence of scar in both regions was associated with an 81% response rate compared with 55%, 25%, and 0%, respectively, when the RV, LV, or both pacing regions contained scar. LV pacing region dyssynchrony was not predictive of response. CONCLUSIONS Myocardial scar occupying the LV pacing region is associated with nonresponse to CRT. Scar occupying the RV pacing region is encountered at higher frequency and seems to provide a more intermediate influence on CRT response.
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Affiliation(s)
- Jorge A Wong
- Division of Cardiology, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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Manian U, Yee R, Nevis I, McCarty D, Stirrat J, Scholl D, Gula LJ, Leong-Sit P, Drangova M, White JA. Predictors of response to cardiac resynchronization therapy on pre-implantation cardiovascular magnetic resonance imaging. J Cardiovasc Magn Reson 2013. [PMCID: PMC3559369 DOI: 10.1186/1532-429x-15-s1-e40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Kathirgamanathan K, Angaran P, Lazo-Langner A, Gula LJ. Cardiac Conduction Block at Multiple Levels Caused by Arsenic Trioxide Therapy. Can J Cardiol 2013; 29:130.e5-6. [DOI: 10.1016/j.cjca.2012.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 04/05/2012] [Accepted: 04/05/2012] [Indexed: 10/28/2022] Open
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Haley CL, Gula LJ, Miranda R, Michael KA, Baranchuk AM, Simpson CS, Abdollah H, West AJ, Akl SG, Redfearn DP. Validation of a novel algorithm for quantification of the percentage of signal fractionation in atrial fibrillation. ACTA ACUST UNITED AC 2012; 15:447-52. [DOI: 10.1093/europace/eus361] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Krahn AD, Healey JS, Chauhan VS, Birnie DH, Champagne J, Sanatani S, Ahmad K, Ballantyne E, Gerull B, Yee R, Skanes AC, Gula LJ, Leong-Sit P, Klein GJ, Gollob MH, Simpson CS, Talajic M, Gardner M. Epinephrine Infusion in the Evaluation of Unexplained Cardiac Arrest and Familial Sudden Death. Circ Arrhythm Electrophysiol 2012; 5:933-40. [DOI: 10.1161/circep.112.973230] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Epinephrine infusion may unmask latent genetic conditions associated with cardiac arrest, including long-QT syndrome and catecholaminergic polymorphic ventricular tachycardia (VT).
Methods and Results—
Patients with unexplained cardiac arrest (normal left ventricular function and QT interval) and selected family members from the Cardiac Arrest Survivors with Preserved Ejection Fraction Registry (CASPER) registry underwent epinephrine challenge at doses of 0.05, 0.10, and 0.20 μg/kg per minute. A test was considered positive for long-QT syndrome if the absolute QT interval prolonged by ≥30 ms at 0.10 μg/kg per minute and borderline if QT prolongation was 1 to 29 ms. Catecholaminergic polymorphic VT was diagnosed if epinephrine provoked ≥3 beats of polymorphic or bidirectional VT and borderline if polymorphic couplets, premature ventricular contractions, or nonsustained monomorphic VT was induced. Epinephrine infusion was performed in 170 patients (age, 42±16 years; 49% men), including 98 patients with unexplained cardiac arrest. Testing was positive for long-QT syndrome in 31 patients (18%) and borderline in 24 patients (14%). Exercise testing provoked an abnormal QT response in 42% of tested patients with a positive epinephrine response. Testing for catecholaminergic polymorphic VT was positive in 7% and borderline in 5%. Targeted genetic testing of abnormal patients was positive in 17% of long-QT syndrome patients and 13% of catecholaminergic polymorphic VT patients.
Conclusions—
Epinephrine challenge provoked abnormalities in a substantial proportion of patients, most commonly a prolonged QT interval. Exercise and genetic testing replicated the diagnosis suggested by the epinephrine response in a small proportion of patients. Epinephrine infusion combined with exercise testing and targeted genetic testing is recommended in the workup of suspected familial sudden death syndromes.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00292032.
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Affiliation(s)
- Andrew D. Krahn
- From the University of British Columbia (A.D.K.), Vancouver, BC; Population Health Research Institute, McMaster University (J.S.H.), Hamilton, ON; University Health Network (V.S.C.), Toronto, Canada; University of Ottawa Heart Institute (D.H.B., M.H.G.), Ottawa, ON; Quebec Heart Institute (J.C.), Laval Hospital, Quebec City, PQ; BC Children’s Hospital (S.S.), Vancouver, British Columbia, Vancouver, BC; St Michael’s Hospital (K.A.), Toronto, Canada; University of Western Ontario (E.B., R.Y., A.C.S.,
| | - Jeffrey S. Healey
- From the University of British Columbia (A.D.K.), Vancouver, BC; Population Health Research Institute, McMaster University (J.S.H.), Hamilton, ON; University Health Network (V.S.C.), Toronto, Canada; University of Ottawa Heart Institute (D.H.B., M.H.G.), Ottawa, ON; Quebec Heart Institute (J.C.), Laval Hospital, Quebec City, PQ; BC Children’s Hospital (S.S.), Vancouver, British Columbia, Vancouver, BC; St Michael’s Hospital (K.A.), Toronto, Canada; University of Western Ontario (E.B., R.Y., A.C.S.,
| | - Vijay S. Chauhan
- From the University of British Columbia (A.D.K.), Vancouver, BC; Population Health Research Institute, McMaster University (J.S.H.), Hamilton, ON; University Health Network (V.S.C.), Toronto, Canada; University of Ottawa Heart Institute (D.H.B., M.H.G.), Ottawa, ON; Quebec Heart Institute (J.C.), Laval Hospital, Quebec City, PQ; BC Children’s Hospital (S.S.), Vancouver, British Columbia, Vancouver, BC; St Michael’s Hospital (K.A.), Toronto, Canada; University of Western Ontario (E.B., R.Y., A.C.S.,
| | - David H. Birnie
- From the University of British Columbia (A.D.K.), Vancouver, BC; Population Health Research Institute, McMaster University (J.S.H.), Hamilton, ON; University Health Network (V.S.C.), Toronto, Canada; University of Ottawa Heart Institute (D.H.B., M.H.G.), Ottawa, ON; Quebec Heart Institute (J.C.), Laval Hospital, Quebec City, PQ; BC Children’s Hospital (S.S.), Vancouver, British Columbia, Vancouver, BC; St Michael’s Hospital (K.A.), Toronto, Canada; University of Western Ontario (E.B., R.Y., A.C.S.,
| | - Jean Champagne
- From the University of British Columbia (A.D.K.), Vancouver, BC; Population Health Research Institute, McMaster University (J.S.H.), Hamilton, ON; University Health Network (V.S.C.), Toronto, Canada; University of Ottawa Heart Institute (D.H.B., M.H.G.), Ottawa, ON; Quebec Heart Institute (J.C.), Laval Hospital, Quebec City, PQ; BC Children’s Hospital (S.S.), Vancouver, British Columbia, Vancouver, BC; St Michael’s Hospital (K.A.), Toronto, Canada; University of Western Ontario (E.B., R.Y., A.C.S.,
| | - Shubhayan Sanatani
- From the University of British Columbia (A.D.K.), Vancouver, BC; Population Health Research Institute, McMaster University (J.S.H.), Hamilton, ON; University Health Network (V.S.C.), Toronto, Canada; University of Ottawa Heart Institute (D.H.B., M.H.G.), Ottawa, ON; Quebec Heart Institute (J.C.), Laval Hospital, Quebec City, PQ; BC Children’s Hospital (S.S.), Vancouver, British Columbia, Vancouver, BC; St Michael’s Hospital (K.A.), Toronto, Canada; University of Western Ontario (E.B., R.Y., A.C.S.,
| | - Kamran Ahmad
- From the University of British Columbia (A.D.K.), Vancouver, BC; Population Health Research Institute, McMaster University (J.S.H.), Hamilton, ON; University Health Network (V.S.C.), Toronto, Canada; University of Ottawa Heart Institute (D.H.B., M.H.G.), Ottawa, ON; Quebec Heart Institute (J.C.), Laval Hospital, Quebec City, PQ; BC Children’s Hospital (S.S.), Vancouver, British Columbia, Vancouver, BC; St Michael’s Hospital (K.A.), Toronto, Canada; University of Western Ontario (E.B., R.Y., A.C.S.,
| | - Emily Ballantyne
- From the University of British Columbia (A.D.K.), Vancouver, BC; Population Health Research Institute, McMaster University (J.S.H.), Hamilton, ON; University Health Network (V.S.C.), Toronto, Canada; University of Ottawa Heart Institute (D.H.B., M.H.G.), Ottawa, ON; Quebec Heart Institute (J.C.), Laval Hospital, Quebec City, PQ; BC Children’s Hospital (S.S.), Vancouver, British Columbia, Vancouver, BC; St Michael’s Hospital (K.A.), Toronto, Canada; University of Western Ontario (E.B., R.Y., A.C.S.,
| | - Brenda Gerull
- From the University of British Columbia (A.D.K.), Vancouver, BC; Population Health Research Institute, McMaster University (J.S.H.), Hamilton, ON; University Health Network (V.S.C.), Toronto, Canada; University of Ottawa Heart Institute (D.H.B., M.H.G.), Ottawa, ON; Quebec Heart Institute (J.C.), Laval Hospital, Quebec City, PQ; BC Children’s Hospital (S.S.), Vancouver, British Columbia, Vancouver, BC; St Michael’s Hospital (K.A.), Toronto, Canada; University of Western Ontario (E.B., R.Y., A.C.S.,
| | - Raymond Yee
- From the University of British Columbia (A.D.K.), Vancouver, BC; Population Health Research Institute, McMaster University (J.S.H.), Hamilton, ON; University Health Network (V.S.C.), Toronto, Canada; University of Ottawa Heart Institute (D.H.B., M.H.G.), Ottawa, ON; Quebec Heart Institute (J.C.), Laval Hospital, Quebec City, PQ; BC Children’s Hospital (S.S.), Vancouver, British Columbia, Vancouver, BC; St Michael’s Hospital (K.A.), Toronto, Canada; University of Western Ontario (E.B., R.Y., A.C.S.,
| | - Allan C. Skanes
- From the University of British Columbia (A.D.K.), Vancouver, BC; Population Health Research Institute, McMaster University (J.S.H.), Hamilton, ON; University Health Network (V.S.C.), Toronto, Canada; University of Ottawa Heart Institute (D.H.B., M.H.G.), Ottawa, ON; Quebec Heart Institute (J.C.), Laval Hospital, Quebec City, PQ; BC Children’s Hospital (S.S.), Vancouver, British Columbia, Vancouver, BC; St Michael’s Hospital (K.A.), Toronto, Canada; University of Western Ontario (E.B., R.Y., A.C.S.,
| | - Lorne J. Gula
- From the University of British Columbia (A.D.K.), Vancouver, BC; Population Health Research Institute, McMaster University (J.S.H.), Hamilton, ON; University Health Network (V.S.C.), Toronto, Canada; University of Ottawa Heart Institute (D.H.B., M.H.G.), Ottawa, ON; Quebec Heart Institute (J.C.), Laval Hospital, Quebec City, PQ; BC Children’s Hospital (S.S.), Vancouver, British Columbia, Vancouver, BC; St Michael’s Hospital (K.A.), Toronto, Canada; University of Western Ontario (E.B., R.Y., A.C.S.,
| | - Peter Leong-Sit
- From the University of British Columbia (A.D.K.), Vancouver, BC; Population Health Research Institute, McMaster University (J.S.H.), Hamilton, ON; University Health Network (V.S.C.), Toronto, Canada; University of Ottawa Heart Institute (D.H.B., M.H.G.), Ottawa, ON; Quebec Heart Institute (J.C.), Laval Hospital, Quebec City, PQ; BC Children’s Hospital (S.S.), Vancouver, British Columbia, Vancouver, BC; St Michael’s Hospital (K.A.), Toronto, Canada; University of Western Ontario (E.B., R.Y., A.C.S.,
| | - George J. Klein
- From the University of British Columbia (A.D.K.), Vancouver, BC; Population Health Research Institute, McMaster University (J.S.H.), Hamilton, ON; University Health Network (V.S.C.), Toronto, Canada; University of Ottawa Heart Institute (D.H.B., M.H.G.), Ottawa, ON; Quebec Heart Institute (J.C.), Laval Hospital, Quebec City, PQ; BC Children’s Hospital (S.S.), Vancouver, British Columbia, Vancouver, BC; St Michael’s Hospital (K.A.), Toronto, Canada; University of Western Ontario (E.B., R.Y., A.C.S.,
| | - Michael H. Gollob
- From the University of British Columbia (A.D.K.), Vancouver, BC; Population Health Research Institute, McMaster University (J.S.H.), Hamilton, ON; University Health Network (V.S.C.), Toronto, Canada; University of Ottawa Heart Institute (D.H.B., M.H.G.), Ottawa, ON; Quebec Heart Institute (J.C.), Laval Hospital, Quebec City, PQ; BC Children’s Hospital (S.S.), Vancouver, British Columbia, Vancouver, BC; St Michael’s Hospital (K.A.), Toronto, Canada; University of Western Ontario (E.B., R.Y., A.C.S.,
| | - Christopher S. Simpson
- From the University of British Columbia (A.D.K.), Vancouver, BC; Population Health Research Institute, McMaster University (J.S.H.), Hamilton, ON; University Health Network (V.S.C.), Toronto, Canada; University of Ottawa Heart Institute (D.H.B., M.H.G.), Ottawa, ON; Quebec Heart Institute (J.C.), Laval Hospital, Quebec City, PQ; BC Children’s Hospital (S.S.), Vancouver, British Columbia, Vancouver, BC; St Michael’s Hospital (K.A.), Toronto, Canada; University of Western Ontario (E.B., R.Y., A.C.S.,
| | - Mario Talajic
- From the University of British Columbia (A.D.K.), Vancouver, BC; Population Health Research Institute, McMaster University (J.S.H.), Hamilton, ON; University Health Network (V.S.C.), Toronto, Canada; University of Ottawa Heart Institute (D.H.B., M.H.G.), Ottawa, ON; Quebec Heart Institute (J.C.), Laval Hospital, Quebec City, PQ; BC Children’s Hospital (S.S.), Vancouver, British Columbia, Vancouver, BC; St Michael’s Hospital (K.A.), Toronto, Canada; University of Western Ontario (E.B., R.Y., A.C.S.,
| | - Martin Gardner
- From the University of British Columbia (A.D.K.), Vancouver, BC; Population Health Research Institute, McMaster University (J.S.H.), Hamilton, ON; University Health Network (V.S.C.), Toronto, Canada; University of Ottawa Heart Institute (D.H.B., M.H.G.), Ottawa, ON; Quebec Heart Institute (J.C.), Laval Hospital, Quebec City, PQ; BC Children’s Hospital (S.S.), Vancouver, British Columbia, Vancouver, BC; St Michael’s Hospital (K.A.), Toronto, Canada; University of Western Ontario (E.B., R.Y., A.C.S.,
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Obeyesekere MN, Leong-Sit P, Krahn AD, Gula LJ, Yee R, Skanes AC, Klein GJ. Asymptomatic Wolff-Parkinson-White Syndrome: Who Should Be Treated? Card Electrophysiol Clin 2012; 4:273-280. [PMID: 26939946 DOI: 10.1016/j.ccep.2012.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This article discusses the merits of electrophysiology study (EPS) and/or ablation for asymptomatic preexcitation Wolff-Parkinson-White (WPW) ECG pattern. Sudden deaths in asymptomatic patients are too few to merit broad screening and aggressive intervention. It also discusses the risks of ablation and the low predictive accuracy of EPS. When WPW is an incidental finding, the decision to proceed with investigation and ablation can be made considering patients' situations and preferences. An invasive strategy is targeted at patients concerned about the low risk of life-threatening arrhythmia as a first presentation after a discussion of the risks and benefits.
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Affiliation(s)
- Manoj N Obeyesekere
- Division of Cardiology, Western University, 339 Windermere Road, C6-110, London, Ontario N6A 5A5, Canada
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Obeyesekere MN, Leong-Sit P, Massel D, Manlucu J, Krahn AD, Skanes AC, Yee R, Gula LJ, Klein GJ. Incidence of atrial fibrillation and prevalence of intermittent pre-excitation in asymptomatic Wolff–Parkinson–White patients: A meta-analysis. Int J Cardiol 2012; 160:75-7. [DOI: 10.1016/j.ijcard.2012.05.078] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 05/25/2012] [Accepted: 05/27/2012] [Indexed: 11/15/2022]
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Obeyesekere MN, Leong-Sit P, Gula LJ, Yee R, Skanes AC, Klein GJ, Krahn AD. The Evaluation of a Borderline Long QT Interval in an Asymptomatic Patient. Card Electrophysiol Clin 2012; 4:227-238. [PMID: 26939820 DOI: 10.1016/j.ccep.2012.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
QT prolongation on resting electrocardiography (ECG) is common, and the clinician is often challenged by the dilemma of excluding acquired causes and recognizing potential congenital long QT syndrome (LQTS). The hallmark of LQTS is an abnormally long QT interval. However, a normal or borderline long QT interval may be observed in up to 50% of patients with LQTS because of the intermittent nature of QT prolongation. This review presents an approach to evaluating the asymptomatic patient with a borderline long QT interval, which incorporates a comprehensive clinical assessment, rest and provocative ECG testing, and genetic testing when appropriate.
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Affiliation(s)
- Manoj N Obeyesekere
- Division of Cardiology, The University of Western Ontario, 339 Windermere Road, London, Ontario N6A 5A5, Canada
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