1
|
Grubb A, Aleong R, Rosenberg MA, Chang S, Padalia K, Ashur C, Adewumi J, Saqi B, Varela D, Sandhu A, Cerbin L, Barrett C, Tumolo AZ, Varosy P, Zipse MM, Tzou WS, Garg L, Sabzwari SRA. Development and Validation of the Atri-Risk Conduction Index Risk Score to Predict Risk of Atrial Fibrillation After Typical Atrial Flutter Ablation. Heart Rhythm 2024:S1547-5271(24)02526-8. [PMID: 38762137 DOI: 10.1016/j.hrthm.2024.04.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 04/24/2024] [Accepted: 04/26/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Identification of patients at risk for atrial fibrillation (AF) after typical atrial flutter ablation (tAFl) is important to guide monitoring and treatment. OBJECTIVE To create and validate a risk score to predict AF after tAFl ablation METHODS: We identified patients who underwent tAFL ablation with no AF history between 2017-2022 and randomly allocated to derivation and validation cohorts. We collected clinical variables and measured conduction parameters in sinus rhythm on an electrophysiology recording system (CardioLab, GE Healthcare). Univariate and multivariate logistic regressions (LogR) were used to evaluate association with AF development. RESULTS 242 consecutive patients (81% males, mean age 66+/-11) were divided into derivation and validation cohorts, (n=142 and n=100). 42% developed AF over a median follow up of 330 days. In multivariate LogR (derivation cohort) , proximal to distal coronary sinus time (pCS-dCS) ≥70ms (OR 16.7 CI 5.6-49), pCS time≥36ms (OR 4.5 CI 1.5-13), and CHADS2VASc≥3 (OR 4.3 CI 1.6-11.8) were independently associated with new AF in follow-up. The Atri-Risk Conduction Index (ARCI) score was created with 0 as minimal and 4 as high-risk using pCS-dCS ≥70ms =2 points, pCS≥36ms=1 point, and CHADS2VASC≥3=1point. In the validation cohort, 0% of patients with ARCI score of 0 developed AF while 89% of patients with ARCI score of 4 developed AF. CONCLUSION We developed and validated a risk-score using atrial conduction parameters and clinical risk factors to predict AF after tAFl ablation. It stratifies low, moderate, and high-risk patients and may be helpful in individualizing approaches to AF monitoring and anticoagulation.
Collapse
Affiliation(s)
- Alex Grubb
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Ryan Aleong
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Michael A Rosenberg
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Shu Chang
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kishan Padalia
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Carmel Ashur
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Joseph Adewumi
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Bilal Saqi
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Daniel Varela
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Amneet Sandhu
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; Cardiac Electrophysiology Section, Division of Cardiology, Rocky Mountain VA Medical Center, Aurora, Colorado, USA
| | - Lukasz Cerbin
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Christopher Barrett
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; Cardiac Electrophysiology Section, Division of Cardiology, Denver Health Medical Center, Denver, Colorado, USA
| | - Alexis Z Tumolo
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Paul Varosy
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; Cardiac Electrophysiology Section, Division of Cardiology, Rocky Mountain VA Medical Center, Aurora, Colorado, USA
| | - Matthew M Zipse
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Wendy S Tzou
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Lohit Garg
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Syed Rafay A Sabzwari
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
| |
Collapse
|
2
|
Ashur C, Zirille F, Aleong RG, Varosy PD, West JJ, Sandhu A, Tumolo AZ, Rosenberg MA, Sabzwari SRA, Barrett C, Cerbin L, Saqi B, Varela D, Zipse MM, Tzou WS, Garg L. Right versus left-sided implantation of left bundle branch area pacemaker insertion. J Interv Card Electrophysiol 2024; 67:257-258. [PMID: 37731143 DOI: 10.1007/s10840-023-01649-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/14/2023] [Indexed: 09/22/2023]
Affiliation(s)
- Carmel Ashur
- Division of Cardiovascular Medicine, Electrophysiology Section, University of Colorado Anschutz Medical Campus, 12505 E. 16Th Avenue, Aurora, CO, 80045, USA.
| | - Francis Zirille
- Division of Cardiovascular Medicine, Electrophysiology Section, University of Colorado Anschutz Medical Campus, 12505 E. 16Th Avenue, Aurora, CO, 80045, USA
| | - Ryan G Aleong
- Division of Cardiovascular Medicine, Electrophysiology Section, University of Colorado Anschutz Medical Campus, 12505 E. 16Th Avenue, Aurora, CO, 80045, USA
| | - Paul D Varosy
- Division of Cardiovascular Medicine, Veterans Affairs Eastern Colorado Health Care System, Aurora, CO, USA
| | - J Jason West
- Division of Cardiovascular Medicine, Denver Health, Denver, CO, USA
| | - Amneet Sandhu
- Division of Cardiovascular Medicine, Veterans Affairs Eastern Colorado Health Care System, Aurora, CO, USA
| | - Alexis Z Tumolo
- Division of Cardiovascular Medicine, Electrophysiology Section, University of Colorado Anschutz Medical Campus, 12505 E. 16Th Avenue, Aurora, CO, 80045, USA
| | - Michael A Rosenberg
- Division of Cardiovascular Medicine, Electrophysiology Section, University of Colorado Anschutz Medical Campus, 12505 E. 16Th Avenue, Aurora, CO, 80045, USA
| | - Syed Rafay Ali Sabzwari
- Division of Cardiovascular Medicine, Electrophysiology Section, University of Colorado Anschutz Medical Campus, 12505 E. 16Th Avenue, Aurora, CO, 80045, USA
| | - Christopher Barrett
- Division of Cardiovascular Medicine, Electrophysiology Section, University of Colorado Anschutz Medical Campus, 12505 E. 16Th Avenue, Aurora, CO, 80045, USA
| | - Lukasz Cerbin
- Division of Cardiovascular Medicine, Electrophysiology Section, University of Colorado Anschutz Medical Campus, 12505 E. 16Th Avenue, Aurora, CO, 80045, USA
| | - Bilal Saqi
- Division of Cardiovascular Medicine, Electrophysiology Section, University of Colorado Anschutz Medical Campus, 12505 E. 16Th Avenue, Aurora, CO, 80045, USA
| | - Daniel Varela
- Division of Cardiovascular Medicine, Electrophysiology Section, University of Colorado Anschutz Medical Campus, 12505 E. 16Th Avenue, Aurora, CO, 80045, USA
| | - Matthew M Zipse
- Division of Cardiovascular Medicine, Electrophysiology Section, University of Colorado Anschutz Medical Campus, 12505 E. 16Th Avenue, Aurora, CO, 80045, USA
| | - Wendy S Tzou
- Division of Cardiovascular Medicine, Electrophysiology Section, University of Colorado Anschutz Medical Campus, 12505 E. 16Th Avenue, Aurora, CO, 80045, USA
| | - Lohit Garg
- Division of Cardiovascular Medicine, Electrophysiology Section, University of Colorado Anschutz Medical Campus, 12505 E. 16Th Avenue, Aurora, CO, 80045, USA
| |
Collapse
|
3
|
Sundaram S, Alyesh D, Walker L, Zipse MM. The 1 st implantation of an atrial only leadless pacemaker in right atrial appendage. J Interv Card Electrophysiol 2023; 66:1955-1958. [PMID: 37773557 DOI: 10.1007/s10840-023-01644-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/10/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Sri Sundaram
- Electrophysiology Section, South Denver Cardiology Associates, 1000 SouthPark Drive, Littleton, 80120, CO, USA.
| | - Daniel Alyesh
- Electrophysiology Section, South Denver Cardiology Associates, 1000 SouthPark Drive, Littleton, 80120, CO, USA
| | - Lisa Walker
- Department of Radiology, University of Colorado, Aurora, CO, USA
| | - Matthew M Zipse
- Division of Cardiology, University of Colorado, Aurora, CO, USA
| |
Collapse
|
4
|
Myadam R, Crawford TC, Bogun FM, Gu X, Ellenbogen KA, Jasti S, Chicos AB, Roukoz H, Zimetbaum PJ, Kalbfleisch SJ, Murgatroyd FD, Steckman DA, Rosenfeld LE, Garlitski AC, Soejima K, Bhan AK, Vedantham V, Dickfeld TML, De Lurgio DB, Platonov PG, Zipse MM, Nishiuchi S, Ortman ML, Narasimhan C, Patton KK, Rosenthal DG, Mukerji SS, Hoogendoorn JC, Zeppenfeld K, Sauer WH, Kron J. Reply: Association of Adverse Events With the Different Diagnostic Schemes of Cardiac Sarcoidosis. JACC Clin Electrophysiol 2023; 9:2662-2663. [PMID: 38151306 DOI: 10.1016/j.jacep.2023.07.011] [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: 07/03/2023] [Accepted: 07/10/2023] [Indexed: 12/29/2023]
Affiliation(s)
- Rahul Myadam
- Virginia Commonwealth University, Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Richmond, Virginia, USA
| | - Thomas C Crawford
- Department of Cardiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Frank M Bogun
- Department of Cardiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Xiaokui Gu
- Department of Cardiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Kenneth A Ellenbogen
- Virginia Commonwealth University, Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Richmond, Virginia, USA
| | - Shilpa Jasti
- Virginia Commonwealth University, Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Richmond, Virginia, USA
| | - Alexandru B Chicos
- Division of Cardiology, Department of Medicine, and the Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Northwestern University, Chicago, Illinois, USA
| | - Henri Roukoz
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | | | - Steven J Kalbfleisch
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Francis D Murgatroyd
- Department of Cardiology King's College Hospital NHS Foundation Trust London, United Kingdom
| | - David A Steckman
- Division of Cardiology, Albany Medical Center, Albany, New York, USA
| | - Lynda E Rosenfeld
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Ann C Garlitski
- The New England Cardiac Arrhythmia Center, Tufts Medical Center, Tufts University, School of Medicine, Boston, Massachusetts, USA
| | | | - Adarsh K Bhan
- Advocate Christ Medical Center, Oak Lawn, Illinois, USA
| | - Vasanth Vedantham
- University of California-San Francisco, San Francisco, California, USA
| | | | | | - Pyotr G Platonov
- Department of Cardiology, Institution for Clinical Sciences, Lund University, Lund, Sweden
| | - Matthew M Zipse
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | - Matthew L Ortman
- Division of Cardiology, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | | | - Kristen K Patton
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - David G Rosenthal
- University of California-San Francisco, San Francisco, California, USA
| | | | - Jarieke C Hoogendoorn
- Department of Cardiology, Willem Einthoven Center of Arrhythmia research and Management, Leiden University Medical Center, Leiden, the Netherlands
| | - Katja Zeppenfeld
- Department of Cardiology, Willem Einthoven Center of Arrhythmia research and Management, Leiden University Medical Center, Leiden, the Netherlands
| | - William H Sauer
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jordana Kron
- Virginia Commonwealth University, Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Richmond, Virginia, USA.
| |
Collapse
|
5
|
Zipse MM. Editorial commentary: Cardiac sarcoidosis in contemporary practice: Forward progress, but clinical quandaries persist. Trends Cardiovasc Med 2023; 33:456-457. [PMID: 35798173 DOI: 10.1016/j.tcm.2022.06.012] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 06/30/2022] [Indexed: 10/17/2022]
Affiliation(s)
- Matthew M Zipse
- From the Division of Cardiology, Section of Cardiac Electrophysiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| |
Collapse
|
6
|
Myadam R, Crawford TC, Bogun FM, Gu X, Ellenbogen KA, Jasti S, Chicos AB, Roukoz H, Zimetbaum PJ, Kalbfleisch SJ, Murgatroyd FD, Steckman DA, Rosenfeld LE, Garlitski AC, Soejima K, Bhan AK, Vedantham V, Dickfeld TML, De Lurgio DB, Platonov PG, Zipse MM, Nishiuchi S, Ortman ML, Narasimhan C, Patton KK, Rosenthal DG, Mukerji SS, Hoogendoorn JC, Zeppenfeld K, Sauer WH, Kron J. Risk of Adverse Outcomes Associated With Cardiac Sarcoidosis Diagnostic Schemes. JACC Clin Electrophysiol 2023; 9:1719-1729. [PMID: 37227359 DOI: 10.1016/j.jacep.2023.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/28/2023] [Accepted: 04/10/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Multiple cardiac sarcoidosis (CS) diagnostic schemes have been published. OBJECTIVES This study aims to evaluate the association of different CS diagnostic schemes with adverse outcomes. The diagnostic schemes evaluated were 1993, 2006, and 2017 Japanese criteria and the 2014 Heart Rhythm Society criteria. METHODS Data were collected from the Cardiac Sarcoidosis Consortium, an international registry of CS patients. Outcome events were any of the following: all-cause mortality, left ventricular assist device placement, heart transplantation, and appropriate implantable cardioverter-defibrillator therapy. Logistic regression analysis evaluated the association of outcomes with each CS diagnostic scheme. RESULTS A total of 587 subjects met the following criteria: 1993 Japanese (n = 310, 52.8%), 2006 Japanese (n = 312, 53.2%), 2014 Heart Rhythm Society (n = 480, 81.8%), and 2017 Japanese (n = 112, 19.1%). Patients who met the 1993 criteria were more likely to experience an event than patients who did not (n = 109 of 310, 35.2% vs n = 59 of 277, 21.3%; OR: 2.00; 95% CI: 1.38-2.90; P < 0.001). Similarly, patients who met the 2006 criteria were more likely to have an event than patients who did not (n = 116 of 312, 37.2% vs n = 52 of 275, 18.9%; OR: 2.54; 95% CI: 1.74-3.71; P < 0.001). There was no statistically significant association between the occurrence of an event and whether a patient met the 2014 or the 2017 criteria (OR: 1.39; 95% CI: 0.85-2.27; P = 0.18 or OR: 1.51; 95% CI: 0.97-2.33; P = 0.067, respectively). CONCLUSIONS CS patients who met the 1993 and the 2006 criteria had higher odds of adverse clinical outcomes. Future research is needed to prospectively evaluate existing diagnostic schemes and develop new risk models for this complex disease.
Collapse
Affiliation(s)
- Rahul Myadam
- Virginia Commonwealth University, Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Richmond, Virginia, USA
| | - Thomas C Crawford
- Department of Cardiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Frank M Bogun
- Department of Cardiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Xiaokui Gu
- Department of Cardiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Kenneth A Ellenbogen
- Virginia Commonwealth University, Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Richmond, Virginia, USA
| | - Shilpa Jasti
- Virginia Commonwealth University, Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Richmond, Virginia, USA
| | - Alexandru B Chicos
- Division of Cardiology, Department of Medicine, and the Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Northwestern University, Chicago, Illinois, USA
| | - Henri Roukoz
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | | | - Steven J Kalbfleisch
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Francis D Murgatroyd
- Department of Cardiology King's College Hospital NHS Foundation Trust London, London, UK
| | - David A Steckman
- Division of Cardiology, Albany Medical Center, Albany, New York, USA
| | - Lynda E Rosenfeld
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Ann C Garlitski
- The New England Cardiac Arrhythmia Center, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | | | - Adarsh K Bhan
- Advocate Christ Medical Center, Oak Lawn, Illinois, USA
| | - Vasanth Vedantham
- University of California-San Francisco, San Francisco, California, USA
| | | | | | - Pyotr G Platonov
- Department of Cardiology, Institution for Clinical Sciences, Lund University, Lund, Sweden
| | - Matthew M Zipse
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | - Matthew L Ortman
- Division of Cardiology, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | | | - Kristen K Patton
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - David G Rosenthal
- University of California-San Francisco, San Francisco, California, USA
| | | | - Jarieke C Hoogendoorn
- Department of Cardiology, Willem Einthoven Center of Arrhythmia Research and Management, Leiden University Medical Center, the Netherlands
| | - Katja Zeppenfeld
- Department of Cardiology, Willem Einthoven Center of Arrhythmia Research and Management, Leiden University Medical Center, the Netherlands
| | - William H Sauer
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jordana Kron
- Virginia Commonwealth University, Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Richmond, Virginia, USA.
| |
Collapse
|
7
|
Sandhu A, Holman B, Lammers S, Cerbin L, Barrett C, Sabzwari R, Garg L, Zipse MM, Tumolo AZ, Aleong RG, Von Alvensleben J, Rosenberg M, West JJ, Varosy P, Nguyen DT, Sauer WH, Tzou WS. Evaluating temperature gradients across the posterior left atrium with radiofrequency ablation. J Cardiovasc Electrophysiol 2023; 34:880-887. [PMID: 36682068 DOI: 10.1111/jce.15826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/13/2023] [Accepted: 01/15/2023] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Esophageal injury is a well-known complication associated with catheter ablation. Though novel methods to mitigate esophageal injury have been developed, few studies have evaluated temperature gradients with catheter ablation across the posterior wall of the left atrium, interstitium, and esophagus. METHODS To investigate temperature gradients across the tissue, we developed a porcine heart-esophageal model to perform ex vivo catheter ablation on the posterior wall of the left atrium (LA), with juxtaposed interstitial tissue and esophagus. Circulating saline (5 L/min) was used to mimic blood flow along the LA and alteration of ionic content to modulate impedance. Thermistors along the region of interest were used to analyze temperature gradients. Varying time and power, radiofrequency (RF) ablation lesions were applied with an externally irrigated ablation catheter. Ablation strategies were divided into standard approaches (SAs, 10-15 g, 25-35 W, 30 s) or high-power short duration (HPSD, 10-15 g, 40-50 W, 10 s). Temperature gradients, time to the maximum measured temperature, and the relationship between measured temperature as a function of distance from the site of ablation was analyzed. RESULTS In total, five experiments were conducted each utilizing new porcine posterior LA wall-esophageal specimens for RF ablation (n = 60 lesions each for SA and HPSD). For both SA and HPSD, maximum temperature rise from baseline was markedly higher at the anterior wall (AW) of the esophagus compared to the esophageal lumen (SA: 4.29°C vs. 0.41°C, p < .0001 and HPSD: 3.13°C vs. 0.28°C, p < .0001). Across ablation strategies, the average temperature rise at the AW of the esophagus was significantly higher with SA relative to HPSD ablation (4.29°C vs. 3.13°C, p = .01). From the start of ablation, the average time to reach a maximum temperature as measured at the AW of the esophagus with SA was 36.49 ± 12.12 s, compared to 16.57 ± 4.54 s with HPSD ablation, p < .0001. Fit to a linear scale, a 0.37°C drop in temperature was seen for every 1 cm increase in distance from the site of ablation and thermistor location at the AW of the esophagus. CONCLUSION Both SA and HPSD ablation strategies resulted in markedly higher temperatures measured at the AW of the esophagus compared to the esophageal lumen, raising concern about the value of clinical intraluminal temperature monitoring. The temperature rise at the AW was lower with HPSD. A significant time delay was seen to reach the maximum measured temperature and a modest increase in distance between the site of ablation and thermistor location impacted the accuracy of monitored temperatures.
Collapse
Affiliation(s)
- Amneet Sandhu
- Division of Cardiology, Section of Electrophysiology, University of Colorado Hospital, University of Colorado, Aurora, Colorado, USA.,Denver VA Medical Center, Section of Cardiology, Aurora, Colorado, USA
| | - Blair Holman
- Division of Bioengineering, University of Colorado, Boulder, Colorado, USA
| | - Steven Lammers
- Division of Bioengineering, University of Colorado, Boulder, Colorado, USA
| | - Lukasz Cerbin
- Division of Cardiology, Section of Electrophysiology, University of Colorado Hospital, University of Colorado, Aurora, Colorado, USA
| | - Christopher Barrett
- Division of Cardiology, Section of Electrophysiology, University of Colorado Hospital, University of Colorado, Aurora, Colorado, USA
| | - Rafay Sabzwari
- Division of Cardiology, Section of Electrophysiology, University of Colorado Hospital, University of Colorado, Aurora, Colorado, USA
| | - Lohit Garg
- Division of Cardiology, Section of Electrophysiology, University of Colorado Hospital, University of Colorado, Aurora, Colorado, USA
| | - Matthew M Zipse
- Division of Cardiology, Section of Electrophysiology, University of Colorado Hospital, University of Colorado, Aurora, Colorado, USA
| | - Alexis Z Tumolo
- Division of Cardiology, Section of Electrophysiology, University of Colorado Hospital, University of Colorado, Aurora, Colorado, USA
| | - Ryan G Aleong
- Division of Cardiology, Section of Electrophysiology, University of Colorado Hospital, University of Colorado, Aurora, Colorado, USA
| | - Johannes Von Alvensleben
- Division of Cardiology, Section of Electrophysiology, University of Colorado Hospital, University of Colorado, Aurora, Colorado, USA
| | - Michael Rosenberg
- Division of Cardiology, Section of Electrophysiology, University of Colorado Hospital, University of Colorado, Aurora, Colorado, USA
| | - John J West
- Division of Cardiology, Section of Electrophysiology, University of Colorado Hospital, University of Colorado, Aurora, Colorado, USA
| | - Paul Varosy
- Division of Cardiology, Section of Electrophysiology, University of Colorado Hospital, University of Colorado, Aurora, Colorado, USA.,Denver VA Medical Center, Section of Cardiology, Aurora, Colorado, USA
| | - Duy T Nguyen
- Mayo Clinic Foundation, Section of Electrophysiology, Rochester, Minnesota, USA
| | - William H Sauer
- Division of Cardiology, Section of Electrophysiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Wendy S Tzou
- Division of Cardiology, Section of Electrophysiology, University of Colorado Hospital, University of Colorado, Aurora, Colorado, USA
| |
Collapse
|
8
|
Bressi E, Crawford TC, Bogun FM, Gu X, Ellenbogen KA, Chicos AB, Roukoz H, Zimetbaum PJ, Kalbfleisch SJ, Murgatroyd FD, Steckman DA, Rosenfeld LE, Garlitski AC, Soejima K, Bhan AK, Vedantham V, Dickfeld TM, De Lurgio DB, Platonov PG, Zipse MM, Nishiuchi S, Ortman ML, Narasimhan C, Patton KK, Rosenthal DG, Mukerji SS, Hoogendoorn JC, Zeppenfeld K, Sauer WH, Kron J. Arrhythmia Monitoring and Outcomes in Patients With Cardiac Sarcoidosis: Insights From the Cardiac Sarcoidosis Consortium. J Am Heart Assoc 2022; 11:e024924. [PMID: 35730638 PMCID: PMC9333370 DOI: 10.1161/jaha.121.024924] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Edoardo Bressi
- Division of Cardiology Department of Internal Medicine Virginia Commonwealth University, Pauley Heart Center Richmond VA.,Department of Cardiovascular Sciences Policlinico Casilino of Rome Italy
| | - Thomas C Crawford
- Department of Cardiology University of Michigan Health System Ann Arbor MI
| | - Frank M Bogun
- Department of Cardiology University of Michigan Health System Ann Arbor MI
| | - Xiaokui Gu
- Department of Cardiology University of Michigan Health System Ann Arbor MI
| | - Kenneth A Ellenbogen
- Division of Cardiology Department of Internal Medicine Virginia Commonwealth University, Pauley Heart Center Richmond VA
| | - Alexandra B Chicos
- Division of Cardiology Department of Medicine, and the Bluhm Cardiovascular Institute Northwestern Memorial Hospital Northwestern University Chicago IL
| | - Henri Roukoz
- Cardiovascular Division Department of Medicine University of Minnesota Medical School Minneapolis MN
| | | | - Steven J Kalbfleisch
- Division of Cardiovascular Medicine The Ohio State University Wexner Medical Center Columbus OH
| | | | | | - Lynda E Rosenfeld
- Section of Cardiovascular Medicine Yale University School of Medicine New Haven CT
| | - Ann C Garlitski
- The New England Cardiac Arrhythmia Center Tufts Medical Center Tufts University School of Medicine Boston MA
| | | | | | | | | | | | - Pyotr G Platonov
- Department of Cardiology Institution for Clinical Sciences Lund University Lund Sweden
| | - Matthew M Zipse
- Division of Cardiology University of Colorado Anschutz Medical Campus Aurora CO
| | | | - Matthew L Ortman
- Division of Cardiology Cooper Medical School of Rowan University Camden NJ
| | | | - Kris K Patton
- Department of Medicine University of Washington Seattle WA
| | | | | | - Jarieke C Hoogendoorn
- Department of Cardiology Willem Einthoven Center of Arrhythmia Research and Management Leiden University Medical Center Leiden The Netherlands
| | - Katja Zeppenfeld
- Department of Cardiology Willem Einthoven Center of Arrhythmia Research and Management Leiden University Medical Center Leiden The Netherlands
| | - William H Sauer
- Division of Cardiovascular Medicine Brigham and Women's Hospital Boston MA
| | - Jordana Kron
- Division of Cardiology Department of Internal Medicine Virginia Commonwealth University, Pauley Heart Center Richmond VA
| | | |
Collapse
|
9
|
Sabzwari SRA, Rosenberg MA, Mann J, Cerbin L, Barrett C, Garg L, Aleong RG, Sandhu A, West J, Tumolo AZ, Varosy PD, Sauer WH, Zipse MM, Tzou WS. Limitations of Unipolar Signals in Guiding Successful Outflow Tract Premature Ventricular Contraction Ablation. JACC Clin Electrophysiol 2022; 8:843-853. [PMID: 35643806 DOI: 10.1016/j.jacep.2022.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/25/2022] [Accepted: 03/23/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The authors sought to compare bipolar electrograms (BiEGMs) vs unipolar electrograms (UniEGMs) in guiding successful ablation of right ventricular outflow tract (RVOT) vs intramural outflow tract (OT) premature ventricular contractions (PVCs). The authors hypothesized that: 1) earliest bipolar local activation time (LATBi) would better guide mapping and ablation, vs UniEGM dV/dt (LATUni) or QS morphology; and 2) LAT differences using bipolar vs unipolar EGMs (ΔLATBi-Uni) would be greater for intramural OT than RVOT PVCs. BACKGROUND UniEGMs are commonly used to annotate earliest local activation of focal arrhythmias. However, their utility in guiding PVC ablation may be limited when the PVC source is less superficial. METHODS Consecutive patients undergoing successful PVC ablation 2017 to2020 requiring only RVOT or RVOT+left ventricular OT (RVOT+LVOT) ablation were retrospectively analyzed. BiEGMs and UniEGMs at successful ablation sites were compared. RESULTS Of 70 patients, 50 required RVOT-only, and 20 required RVOT+LVOT ablation for acute and long-term PVC suppression. Mean ΔLATBi-Uni was lower for RVOT vs RVOT+LVOT groups (9.3 ± 6.4 ms vs 17.4 ± 9.9 ms; P < 0.01). QS UniEGM was seen in 78% of RVOT, compared with 53% of RVOT+LVOT patients (P < 0.016). RVOT+LVOT sites most frequently included the posteroseptal RVOT and adjacent LVOT (73%), and 43% lacked a QS unipolar EGM. ΔLATBi-Uni ≥15 ms best distinguished sites in which RVOT-only vs RVOT+LVOT ablation achieved acute PVC suppression (area under the curve: 0.77). CONCLUSIONS Earliest BiEGM activation guides successful ablation of OT PVCs better than UniEGM-guided analysis, especially when an intramural PVC source is present.
Collapse
Affiliation(s)
- Syed Rafay Ali Sabzwari
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Michael A Rosenberg
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - James Mann
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Lukasz Cerbin
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Christopher Barrett
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Lohit Garg
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Ryan G Aleong
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Amneet Sandhu
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jason West
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Alexis Z Tumolo
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Paul D Varosy
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - William H Sauer
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Matthew M Zipse
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Wendy S Tzou
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
| |
Collapse
|
10
|
Mann JA, Ali Sabzwari SR, Barrett C, Cerbin L, Garg L, Rosenberg MA, Tumolo AZ, Sandhu A, West JJ, Varosy PD, Aleong RG, Zipse MM, Tzou WS, von Alvensleben JC. PO-708-04 HIGH DENSITY ELECTROANATOMICAL MAPPING FOR TARGETED PACING LEAD PLACEMENT IN PATIENTS WITH ATRIAL MYOPATHY. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.1102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
11
|
Crawford TC, Kron J, Gu X, Afzal MR, Chicos AB, Roukoz H, Zimetbaum PJ, Murgatroyd FD, Martin K, Torosoff M, Steckman DA, Platonov PG, Bhan AK, Rosenfeld LE, De Lurgio DB, Garlitski AC, Vedantham V, Soejima K, Appelbaum J, Dickfeld TM, Ortman ML, Kaitani K, Nishiuchi S, Narasimhan C, Patton KK, Rosenthal D, Nour K, Mukerji SS, Zeppenfeld K, Zipse MM, Judson M, Judson M, Sauer WH, Ellenbogen KA, Froehlich J, Eagle KA, Bogun FM. CE-522-04 MORTALITY AND MORBIDITY OF CARDIAC SARCOIDOSIS: AN INTERNATIONAL REGISTRY. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.609] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
12
|
Park D, Ali Sabzwari SR, Mann JA, Cerbin L, Barrett C, West JJ, Sandhu A, Varosy PD, Tumolo AZ, Aleong RG, Rosenberg MA, Garg L, Zipse MM, Tzou WS. PO-714-07 ELECTROCARDIOGRAPHIC DISCORDANCE TO PREDICT LEFT VENTRICULAR SUMMIT VENTRICULAR ARRHYTHMIA ORIGIN. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.1157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
13
|
Holman B, Barrett C, Cerbin L, Mann JA, Tumolo AZ, Zipse MM, Garg L, von Alvensleben JC, Aleong RG, Rosenberg MA, Varosy PD, Tzou WS, Sandhu A. CA-528-04 ANTERIOR WALL TEMPERATURE OF ESOPHAGUS DURING CATHETER ABLATION OF THE LA POSTERIOR WALL IS MARKEDLY HIGHER COMPARED TO LUMINAL TEMPERATURE. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
14
|
Barrett C, Tumolo AZ, Tzou WS, Zipse MM, Rosenberg MA, Varosy PD, Sandhu A, West J, Ali Sabzwari SR, Mann JA, Cerbin L, von Alvensleben JC, Garg L. PO-651-06 OUTCOMES OF ATRIAL FIBRILLATION ABLATION IN PATIENTS WITH TRANSTHYRETIN CARDIAC AMYLOIDOSIS. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
15
|
Edward J, Chang SC, Gill E, Zipse MM, Rosenberg MA, Tumolo AZ, Mann JA, Ali Sabzwari SR, Cerbin L, Barrett C, Sandhu A, Varosy PD, West J, Garg L, Tzou WS, Aleong RG. PO-642-01 ESOPHAGO-PERICARDIAL FISTULA AS A RARE AND LIFE-THREATENING COMPLICATION OF EPICARDIAL VENTRICULAR TACHYCARDIA ABLATION. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.154] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
16
|
von Alvensleben JC, Sandhu A, Tzou WS, Tumolo AZ, Zipse MM, Garg L, Turan O, Collins KK. PO-704-06 CLINICAL PREDICTORS OF INDUCIBLE VENTRICULAR ARRHYTHMIAS AND ABLATION EFFECTIVENESS IN TETRALOGY OF FALLOT PATIENTS UNDERGOING PERCUTANEOUS PULMONARY VALVE REPLACEMENT. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.1069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
17
|
Zirille F, Barrett C, Tzou WS, Zipse MM, Tumolo AZ, Rosenberg MA, Varosy PD, Sandhu A, West J, Mann JA, Ali Sabzwari SR, Cerbin L, Garg L. PO-696-05 RISK OF VENOUS THROMBOSIS AND THROMBOEMBOLISM IN PATIENTS UNDERGOING RIGHT SIDED ABLATION PROCEDURES WITH OR WITHOUT SYSTEMIC ANTICOAGULATION. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
18
|
Adewumi J, Mann JA, Ali Sabzwari SR, Cerbin L, Barrett C, Garg L, Sandhu A, Tumolo AZ, von Alvensleben JC, Rosenberg MA, West J, Aleong RG, Varosy PD, Aftab M, Rochon-Duck MJ, Zipse MM, Tzou WS. PO-702-03 THE GHOSTS OF LEADS PAST: LEAD CASTS AND RECURRENT BACTEREMIA. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.1048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
19
|
Siontis KC, Santangeli P, Muser D, Marchlinski FE, Zeppenfeld K, Hoogendoorn JC, Narasimhan C, Sauer WH, Zipse MM, Kapa S, Vedantham V, Rosenthal DG, Robinson MR, Patton KK, Murgatroyd F, Chicos AB, Soejima K, Roukoz H, Sacher F, Bhan A, Appelbaum J, Dickfeld T, Mankad P, Ellenbogen KA, Kron J, Kim HM, Froehlich J, Eagle KA, Bogun FM, Crawford TC. Outcomes Associated With Catheter Ablation of Ventricular Tachycardia in Patients With Cardiac Sarcoidosis. JAMA Cardiol 2021; 7:175-183. [PMID: 34787643 DOI: 10.1001/jamacardio.2021.4738] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Ventricular tachycardia (VT) is associated with high mortality in patients with cardiac sarcoidosis (CS), and medical management of CS-associated VT is limited by high failure rates. The role of catheter ablation has been investigated in small, single-center studies. Objective To investigate outcomes associated with VT ablation in patients with CS. Design, Setting, and Participants This cohort study from the Cardiac Sarcoidosis Consortium registry (2003-2019) included 16 tertiary referral centers in the US, Europe, and Asia. A total of 158 consecutive patients with CS and VT were included (33% female; mean [SD] age, 52 [11] years; 53% with ejection fraction [EF] <50%). Exposures Catheter ablation of CS-associated VT and, as appropriate, medical treatment. Main Outcomes and Measures Immediate and short-term outcomes included procedural success, elimination of VT storm, and reduction in defibrillator shocks. The primary long-term outcome was the composite of VT recurrence, heart transplant (HT), or death. Results Complete procedural success (no inducible VT postablation) was achieved in 85 patients (54%). Sixty-five patients (41%) had preablation VT storm that did not recur postablation in 53 (82%). Defibrillator shocks were significantly reduced from a median (IQR) of 2 (1-5) to 0 (0-0) in the 30 days before and after ablation (P < .001). During median (IQR) follow-up of 2.5 (1.1-4.9) years, 73 patients (46%) experienced VT recurrence and 81 (51%) experienced the composite primary outcome. One- and 2-year rates of survival free of VT recurrence, HT, or death were 60% and 52%, respectively. EF less than 50% and myocardial inflammation on preprocedural 18F-fluorodeoxyglucose positron emission tomography were significantly associated with adverse prognosis in multivariable analysis for the primary outcome (HR, 2.24; 95% CI, 1.37-3.64; P = .001 and HR, 2.93; 95% CI, 1.31-6.55; P = .009, respectively). History of hypertension was associated with a favorable long-term outcome (adjusted HR, 0.51; 95% CI, 0.28-0.92; P = .02). Conclusions and Relevance In this observational study of selected patients with CS and VT, catheter ablation was associated with reductions in defibrillator shocks and recurrent VT storm. Preablation LV dysfunction and myocardial inflammation were associated with adverse long-term prognosis. These data support the role of catheter ablation in conjunction with medical therapy in the management of CS-associated VT.
Collapse
Affiliation(s)
| | - Pasquale Santangeli
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia
| | - Daniele Muser
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia
| | - Francis E Marchlinski
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia
| | - Katja Zeppenfeld
- Department of Cardiology, Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Leiden University Medical Center, Leiden, the Netherlands
| | - Jarieke C Hoogendoorn
- Department of Cardiology, Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Leiden University Medical Center, Leiden, the Netherlands
| | | | - William H Sauer
- Section of Cardiac Electrophysiology, Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Matthew M Zipse
- Section of Cardiac Electrophysiology, University of Colorado, Aurora
| | - Suraj Kapa
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | | | | | | | - Francis Murgatroyd
- Department of Cardiology, King's College Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Alexandru B Chicos
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kyoko Soejima
- Department of Cardiovascular Medicine, Kyorin University Hospital, Tokyo, Japan
| | - Henri Roukoz
- Division of Cardiology, University of Minnesota, Minneapolis
| | - Frederic Sacher
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Adarsh Bhan
- Heart Vascular Institute, Advocate Christ Medical Center, Oak Lawn, Illinois
| | - Jason Appelbaum
- Division of Cardiology, University of Maryland School of Medicine, Baltimore
| | - Timm Dickfeld
- Division of Cardiology, University of Maryland School of Medicine, Baltimore
| | - Pranav Mankad
- Division of Cardiology, Virginia Commonwealth University, Richmond
| | | | - Jordana Kron
- Division of Cardiology, Virginia Commonwealth University, Richmond
| | - Hyungjin Myra Kim
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor
| | - James Froehlich
- Division of Cardiovascular Medicine, Cardiovascular Center, University of Michigan, Ann Arbor
| | - Kim A Eagle
- Division of Cardiovascular Medicine, Cardiovascular Center, University of Michigan, Ann Arbor
| | - Frank M Bogun
- Division of Cardiovascular Medicine, Cardiovascular Center, University of Michigan, Ann Arbor
| | - Thomas C Crawford
- Division of Cardiovascular Medicine, Cardiovascular Center, University of Michigan, Ann Arbor
| |
Collapse
|
20
|
Ali Sabzwari SR, Chang SC, Mann JA, Barrett C, Cerbin L, Borne RT, Sandhu A, Varosy PD, Sanchez JM, West J, Tumolo AZ, Zipse MM, Tzou WS, Rosenberg MA, Aleong RG. B-PO03-132 ARE WE USING THE CORRECT ABLATION INDEX FOR THE CORRECT CHAMBER: CORRELATING ABLATION INDEX TO EFFECTIVE LESION IN VENTRICULAR TACHYCARDIA ABLATION. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
21
|
Mann JA, Ali Sabzwari SR, Chang SC, von Alvensleben JC, Runciman M, Max Mitchell, Turan O, Tzou WS, Collins KK, Zipse MM. B-PO01-032 TRANSHEPATIC ACCESS TO FACILITATE LEAD EXTRACTION IN A PATIENT WITH INTERRUPTED INFERIOR VENA CAVA. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
22
|
Mann JA, Chang SC, Ali Sabzwari SR, Tumolo AZ, Sanchez JM, Zipse MM, Tzou WS, Sandhu A, Borne RT, Rosenberg MA, Varosy PD, West J, Aleong RG. B-PO03-051 REVERSE TELESCOPING SHEATHS TO FACILITATE CORONARY SINUS LEAD DELIVERY AND BYPASS A CORONARY SINUS DISSECTION. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
23
|
Kunkel M, Rothstein P, Sauer P, Zipse MM, Sandhu A, Tumolo AZ, Borne RT, Aleong RG, Cleveland JC, Fullerton D, Pal JD, Davies AS, Lane C, Nguyen DT, Sauer WH, Tzou WS. Open surgical ablation of ventricular tachycardia: Utility and feasibility of contemporary mapping and ablation tools. Heart Rhythm O2 2021; 2:271-279. [PMID: 34337578 PMCID: PMC8322924 DOI: 10.1016/j.hroo.2021.05.004] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Ventricular tachycardia (VT) catheter ablation success may be limited when transcutaneous epicardial access is contraindicated. Surgical ablation (SurgAbl) is an option, but ablation guidance is limited without simultaneously acquired electrophysiological data. Objective We describe our SurgAbl experience utilizing contemporary electroanatomic mapping (EAM) among patients with refractory VT storm. Methods Consecutive patients with recurrent VT despite antiarrhythmic drugs (AADs) and prior ablation, for whom percutaneous epicardial access was contraindicated, underwent open SurgAbl using intraoperative EAM guidance. Results Eight patients were included, among whom mean age was 63 ± 5 years, all were male, mean left ventricular ejection fraction was 39% ± 12%, and 2 (25%) had ischemic cardiomyopathy. Reasons for surgical epicardial access included dense adhesions owing to prior cardiac surgery, hemopericardium, or pericarditis (n = 6); or planned left ventricular assist device (LVAD) implantation at time of SurgAbl (n = 2). Cryoablation guided by real-time EAM was performed in all. Goals of clinical VT noninducibility or core isolation were achieved in 100%. VT burden was significantly reduced, from median 15 to 0 events in the month pre- and post-SurgAbl (P = .01). One patient underwent orthotopic heart transplantation for recurrent VT storm 2 weeks post-SurgAbl. Over mean follow-up of 3.4 ± 1.7 years, VT storm–free survival was achieved in 6 (75%); all continued AADs, although at lower dose. Conclusion Surgical mapping and ablation of refractory VT with use of contemporary EAM is feasible and effective, particularly among patients with contraindication to percutaneous epicardial access or with another indication for cardiac surgery.
Collapse
Affiliation(s)
- Megan Kunkel
- University of Colorado School of Medicine, Division of Cardiology, Section of Cardiac Electrophysiologist, Aurora, Colorado
| | - Peter Rothstein
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
| | - Peter Sauer
- Brigham and Women's Hospital, Cardiac Arrhythmia Service, Boston, Massachusetts
| | - Matthew M. Zipse
- University of Colorado School of Medicine, Division of Cardiology, Section of Cardiac Electrophysiologist, Aurora, Colorado
| | - Amneet Sandhu
- University of Colorado School of Medicine, Division of Cardiology, Section of Cardiac Electrophysiologist, Aurora, Colorado
- VA Eastern Colorado Health Care System, Aurora, Colorado
| | - Alexis Z. Tumolo
- University of Colorado School of Medicine, Division of Cardiology, Section of Cardiac Electrophysiologist, Aurora, Colorado
| | - Ryan T. Borne
- University of Colorado School of Medicine, Division of Cardiology, Section of Cardiac Electrophysiologist, Aurora, Colorado
| | - Ryan G. Aleong
- University of Colorado School of Medicine, Division of Cardiology, Section of Cardiac Electrophysiologist, Aurora, Colorado
| | - Joseph C. Cleveland
- University of Colorado School of Medicine, Division of Cardiology, Section of Cardiac Electrophysiologist, Aurora, Colorado
| | - David Fullerton
- University of Colorado School of Medicine, Division of Cardiology, Section of Cardiac Electrophysiologist, Aurora, Colorado
| | - Jay D. Pal
- University of Colorado School of Medicine, Division of Cardiology, Section of Cardiac Electrophysiologist, Aurora, Colorado
| | | | | | - Duy T. Nguyen
- Stanford University, Section of Electrophysiology, Division of Cardiology, Palo Alto, California
| | - William H. Sauer
- Brigham and Women's Hospital, Cardiac Arrhythmia Service, Boston, Massachusetts
| | - Wendy S. Tzou
- University of Colorado School of Medicine, Division of Cardiology, Section of Cardiac Electrophysiologist, Aurora, Colorado
- Address reprint requests and correspondence: Dr Wendy S. Tzou, University of Colorado School of Medicine Anschutz Medical Campus, Division of Cardiology, Cardiac Electrophysiology Section, 12401 E 17th Ave, MS B-136, Aurora, CO 80045.
| |
Collapse
|
24
|
Borne RT, Masoudi FA, Curtis JP, Zipse MM, Sandhu A, Hsu JC, Peterson PN. Use and Outcomes of Dual Chamber or Cardiac Resynchronization Therapy Defibrillators Among Older Patients Requiring Ventricular Pacing in the National Cardiovascular Data Registry Implantable Cardioverter Defibrillator Registry. JAMA Netw Open 2021; 4:e2035470. [PMID: 33496796 PMCID: PMC7838925 DOI: 10.1001/jamanetworkopen.2020.35470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Frequent right ventricular (RV) pacing can cause and exacerbate heart failure. Cardiac resynchronization therapy (CRT) has been shown to be associated with improved outcomes among patients with reduced left ventricular ejection fraction who need frequent RV pacing, but the patterns of use of CRT vs dual chamber (DC) devices and the associated outcomes among these patients in clinical practice is not known. OBJECTIVE To assess outcomes, variability in use of device type, and trends in use of device type over time among patients undergoing implantable cardioverter defibrillator (ICD) implantation who were likely to require frequent RV pacing but who did not have a class I indication for CRT. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used the National Cardiovascular Data Registry (NCDR) ICD Registry. A total of 3100 Medicare beneficiaries undergoing first-time implantation of CRT defibrillator (CRT-D) or DC-ICD from 2010 to 2016 who had a class I or II guideline ventricular bradycardia pacing indication but not a class I indication for CRT were included. Data were analyzed from August 2018 to October 2019. EXPOSURES Implantation of a CRT-D or DC-ICD. MAIN OUTCOMES AND MEASURES All-cause mortality, heart failure hospitalization, and complications were ascertained from Medicare claims data. Multivariable Cox proportional hazards models and Fine-Gray models were used to evaluate 1-year mortality and heart failure hospitalization, respectively. Multivariable logistic regression was used to evaluate 30-day and 90-day complications. All models accounted for clustering. The median odds ratio (MOR) was used to assess variability and represents the odds that a randomly selected patient receiving CRT-D at a hospital with high implant rates would receive CRT-D if they had been treated at a hospital with low CRT-D implant rates. RESULTS A total of 3100 individuals were included. The mean (SD) age was 76.3 (6.4) years, and 2500 (80.6%) were men. The 1698 patients (54.7%) receiving CRT-D were more likely than those receiving DC-ICD to have third-degree atrioventricular block (828 [48.8%] vs 432 [30.8%]; P < .001), nonischemic cardiomyopathy (508 [29.9%] vs 255 [18.2%]; P < .001), and prior heart failure hospitalizations (703 [41.4%] vs 421 [30.0%]; P < .001). Following adjustment, CRT-D was associated with lower 1-year mortality (hazard ratio [HR], 0.70; 95% CI, 0.57-0.87; P = .001) and heart failure hospitalization (subdistribution HR, 0.77; 95% CI, 0.61-0.97; P = .02) and no difference in complications compared with DC-ICD. Hospital variation in use of CRT was present (MOR, 2.00), and the use of CRT in this cohort was higher over time (654 of 1351 [48.4%] in 2010 vs 362 of 594 [60.9%] in 2016; P < .001). CONCLUSIONS AND RELEVANCE In this cohort study of older patients in contemporary practice undergoing ICD implantation with a bradycardia pacing indication but without a class I indication for CRT, CRT-D was associated with better outcomes compared with DC devices. Variability in use of device type was observed, and the rate of CRT implantation increased over time.
Collapse
Affiliation(s)
- Ryan T. Borne
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora
| | | | - Jeptha P. Curtis
- Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Matthew M. Zipse
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora
| | - Amneet Sandhu
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora
| | - Jonathan C. Hsu
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Diego, La Jolla
| | - Pamela N. Peterson
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora
- Division of Cardiology, Denver Health Hospital, Denver, Colorado
| |
Collapse
|
25
|
Sandhu A, Tzou WS, Borne RT, Zipse MM, Nguyen DT, Sauer WH. Uncovering a unique path: Antidromic AVRT utilizing a left anteroseptal Mahaim-like accessory pathway. Pacing Clin Electrophysiol 2020; 44:185-188. [PMID: 32794265 DOI: 10.1111/pace.14024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/17/2020] [Accepted: 07/26/2020] [Indexed: 11/27/2022]
Abstract
A 40-year-old man presented to our emergency department 2 hours after onset of shortness of breath, palpitations, and presyncope secondary to an adenosine-responsive wide complex tachycardia. Electrophysiology study was diagnostic for antidromic atrioventricular (AV) reentrant tachycardia utilizing a muscular connection from the anterior interventricular vein to the left ventricle with Mahaim-like properties, successfully treated with ablation in the distal coronary sinus (CS) system. This case highlights accessory pathways (a) with unique features (i.e., Mahaim-like characteristics) and (b) involving musculature from the distal CS system, thereby limiting the value of endocardial ablation for durable treatment. Importantly, the coronary venous system is an accessible vascular network for evaluation and catheter ablation of such arrhythmias.
Collapse
Affiliation(s)
- Amneet Sandhu
- Section of Electrophysiology, The University of Colorado, Aurora, Colorado.,Section of Electrophysiology, Rocky Mountain Regional VA Medical Center, Aurora, Colorado
| | - Wendy S Tzou
- Section of Electrophysiology, The University of Colorado, Aurora, Colorado
| | - Ryan T Borne
- Section of Electrophysiology, The University of Colorado, Aurora, Colorado
| | - Matthew M Zipse
- Section of Electrophysiology, The University of Colorado, Aurora, Colorado
| | - Duy T Nguyen
- Section of Electrophysiology, Stanford University, Palo Alto, California
| | - William H Sauer
- Section of Electrophysiology, Brigham and Women's Hospital, Boston, Massachusetts
| |
Collapse
|
26
|
Abstract
Background Patients undergoing lead extraction for infected devices have worse outcomes compared with those with noninfected devices. We assessed predictors of in-hospital mortality and procedure-related major adverse events (MAEs) in a large cohort undergoing lead extraction. Methods and Results Deidentified hospital records procedure from 7 states between 1994 and 2013 were aggregated and International Classification of Disease, Ninth Revision (ICD-9) procedure codes were used to identify hospital records reporting lead extraction. MAEs included death, cardiac tamponade, hemothorax, and need for emergent cardiac surgery. Predictors of in-hospital MAEs for infected compared with noninfected leads were identified using multivariate regression. Associations between outcomes and specific microbe were also assessed. In total, 57 220 discharges specified lead extraction. Infected leads accounted for the minority of total lead extractions compared with fractured leads (16.1 versus 59.8%, 25.7% not reported). There were 3298 MAEs (5.8%) including 980 deaths (1.7%). Multivariate predictors of MAE included black race, atrial fibrillation, anemia, heart failure, and admission via either hospital transfer or emergency department versus home (all P<0.001). Infected leads were associated with an increased risk of death (4.6% versus 0.9%, P<0.001) compared with leads with fracture only. Among patients with microbial data, staphylococcal infection was most common, whereas streptococcal infection was associated with the worst outcomes. Conclusions Patients undergoing extraction of infected leads have higher in-hospital mortality and adverse events compared with noninfected leads. Streptococcus, anemia, and heart failure are predictors of adverse outcomes.
Collapse
Affiliation(s)
- Ryan G Aleong
- Section of Cardiac Electrophysiology University of Colorado Hospital Aurora CO
| | - Matthew M Zipse
- Section of Cardiac Electrophysiology University of Colorado Hospital Aurora CO
| | - Christine Tompkins
- Section of Cardiac Electrophysiology University of Colorado Hospital Aurora CO
| | - Muhammad Aftab
- Department of Surgery Division of Cardiothoracic Surgery University of Colorado Denver CO
| | - Paul Varosy
- Section of Cardiac Electrophysiology University of Colorado Hospital Aurora CO
| | - William Sauer
- Section of Cardiac Electrophysiology University of Colorado Hospital Aurora CO
| | - David Kao
- Section of Cardiac Electrophysiology University of Colorado Hospital Aurora CO
| |
Collapse
|
27
|
Zipse MM, Edward JA, Zheng L, Tzou WS, Borne RT, Sauer WH, Nguyen DT. Impact of epicardial adipose tissue and catheter ablation strategy on biophysical parameters and ablation lesion characteristics. J Cardiovasc Electrophysiol 2020; 31:1114-1124. [PMID: 32031304 DOI: 10.1111/jce.14383] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 07/19/2018] [Revised: 11/29/2019] [Accepted: 12/15/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Epicardial adipose (EA) tissue may limit effective radiofrequency ablation (RFA). OBJECTIVES We sought to evaluate the lesion formation of different ablation strategies on ventricular myocardium with overlying EA. METHODS Bovine myocardium with EA was placed in a circulating saline bath in an ex vivo model. Open-irrigated (OI) RFA was performed, parallel to the myocardium, over fat at 50 W for variable RF durations, variable contact force, catheter configurations (unipolar RF vs bipolar RF), and catheter irrigants (normal saline vs half-normal saline). Ablation was also performed with a needle-tipped ablation catheter (NTAC), perpendicular to the myocardium. RESULTS Increasingly thick EA attenuated lesion size regardless of ablation strategy. RF applied with longer durations and increasing CF produced larger lesion volumes and deeper lesions with ablation over EA more than 3 mm but was unable to produce measurable lesions when EA less than 3 mm. Similarly, ablation with half normal saline irrigant created slightly deeper lesions than bipolar RF and unipolar RF with normal saline as EA thickness increased, but was unable to produce measurable lesions when EA more than 3 mm. Of all ablation strategies, only NTAC produced effective lesion volumes when ablating over thick (>3 mm) EA. CONCLUSIONS While EA attenuates lesion depth and size, relatively larger, and deeper lesions can be achieved with longer RFA duration, higher CF, half normal saline irrigant, and, to a greater extent, by utilizing bipolar RF or NTAC, but only over thin adipose (<3 mm). Of those catheters/strategies tested, only NTAC was able to effectively deliver RF over thick (>3 mm) EA with this model.
Collapse
Affiliation(s)
- Matthew M Zipse
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora, Colorado
| | - Justin A Edward
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora, Colorado
| | - Lijun Zheng
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora, Colorado
| | - Wendy S Tzou
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora, Colorado
| | - Ryan T Borne
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora, Colorado
| | - William H Sauer
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora, Colorado
| | - Duy T Nguyen
- Section of Cardiac Electrophysiology, Division of Cardiology, Stanford University, Palo Alto, California
| |
Collapse
|
28
|
Zipse MM, Messenger JC, Carroll JD, Seres T. Percutaneous repair of right ventricular perforation with Amplatzer septal defect occlusion device. Eur Heart J 2019; 39:817. [PMID: 28025192 DOI: 10.1093/eurheartj/ehw514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 08/25/2016] [Indexed: 11/12/2022] Open
Affiliation(s)
- Matthew M Zipse
- Section of Cardiac Electrophysiology, Section of Interventional Cardiology, and Department of Anesthesiology, University of Colorado, Denver, 12605 E. 16th Ave., Mailstop B136, Aurora, CO 80045, USA
| | - John C Messenger
- Section of Cardiac Electrophysiology, Section of Interventional Cardiology, and Department of Anesthesiology, University of Colorado, Denver, 12605 E. 16th Ave., Mailstop B136, Aurora, CO 80045, USA
| | - John D Carroll
- Section of Cardiac Electrophysiology, Section of Interventional Cardiology, and Department of Anesthesiology, University of Colorado, Denver, 12605 E. 16th Ave., Mailstop B136, Aurora, CO 80045, USA
| | - Tamas Seres
- Section of Cardiac Electrophysiology, Section of Interventional Cardiology, and Department of Anesthesiology, University of Colorado, Denver, 12605 E. 16th Ave., Mailstop B136, Aurora, CO 80045, USA
| |
Collapse
|
29
|
Nguyen DT, Zheng L, Zipse MM, Borne RT, Tzou WS, Fleeman B, Sauer WH. Bipolar radiofrequency ablation creates different lesion characteristics compared to simultaneous unipolar ablation. J Cardiovasc Electrophysiol 2019; 30:2960-2967. [DOI: 10.1111/jce.14213] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 07/03/2019] [Revised: 09/21/2019] [Accepted: 09/28/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Duy T. Nguyen
- Section of Cardiac Electrophysiology, Division of CardiologyStanford UniversityPalo Alto California
| | - Lijun Zheng
- Section of Cardiac Electrophysiology, Division of CardiologyUniversity of ColoradoAurora Colorado
| | - Matthew M. Zipse
- Section of Cardiac Electrophysiology, Division of CardiologyUniversity of ColoradoAurora Colorado
| | - Ryan T. Borne
- Section of Cardiac Electrophysiology, Division of CardiologyUniversity of ColoradoAurora Colorado
| | - Wendy S. Tzou
- Section of Cardiac Electrophysiology, Division of CardiologyUniversity of ColoradoAurora Colorado
| | - Blake Fleeman
- Section of Cardiac Electrophysiology, Division of CardiologyUniversity of ColoradoAurora Colorado
| | - William H. Sauer
- Section of Cardiac Electrophysiology, Division of CardiologyBrigham and Women's HospitalBoston Massachusetts
| |
Collapse
|
30
|
Borne RT, Randolph T, Wang Y, Curtis JP, Peterson PN, Masoudi FA, Sandhu A, Zipse MM, Thomas K, Kutyifa V, Desai NR, Cha YM, Hsu JC, Russo AM. Analysis of Temporal Trends and Variation in the Use of Defibrillation Testing in Contemporary Practice. JAMA Netw Open 2019; 2:e1913553. [PMID: 31626314 PMCID: PMC6813586 DOI: 10.1001/jamanetworkopen.2019.13553] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
IMPORTANCE Defibrillation testing (DFT) is performed during implantable cardioverter-defibrillator (ICD) implantation to assess the capacity of the device to detect and terminate ventricular arrhythmias. However, DFT can result in complications and omission of its use has been shown to be safe. OBJECTIVE To describe temporal trends and variation in the use of DFT in contemporary practice in the United States. DESIGN, SETTING, AND PARTICIPANTS This multicenter cross-sectional study used data from the National Cardiovascular Data Registry ICD Registry. A total of 499 211 patients from 1794 different facilities undergoing first-time ICD implantation from April 2010 to December 2015 were included. Data analysis was performed from May 20, 2015, to August 15, 2019. EXPOSURE Defibrillation testing was assessed using the National Cardiovascular Data Registry ICD Registry. MAIN OUTCOMES AND MEASURES Defibrillation testing rates and median odds ratios (MORs) were assessed over time. The MOR represents the odds that a randomly selected patient receiving testing at a hospital with high testing rates would be tested compared with if he or she had received care at a hospital with low testing rates. RESULTS Of the 499 211 patients from 1794 different facilities included in this analysis, the mean (SD) age of the population was 65.5 (13.4) years and 356 681 patients (71.4%) were men. The use of DFT declined from 71.6% in the first calendar quarter of 2010 to 36.4% in the fourth quarter of 2015 (P < .001). Patients undergoing DFT were more likely than those without testing to have ischemic heart disease (170 569 [58.1%] vs 116 295 [56.6%]), ventricular tachycardia (91 500 [31.2%] vs 58 949 [28.7%]), and less advanced heart failure (New York Heart Association class I and II, 153 188 [52.2%] vs 91 215 [44.4%]) (P < .001 for all). The MOR for the use of defibrillation testing was 3.78 (95% CI, 3.54-4.03) in 2010, increasing to 6.05 (95% CI, 5.61-6.52) in 2015, indicating that by 2015 a randomly selected patient receiving testing at a hospital with high testing rates would have a 6-fold higher odds of being tested than if they had received care at a hospital with low testing rates. CONCLUSIONS AND RELEVANCE Defibrillation testing at the time of ICD placement in the United States may have declined over time; however, institutional variation in its use appears to be marked and increased. This variability in the reduced use of defibrillation testing could reflect differences in individual or institutional cultures of practice.
Collapse
Affiliation(s)
- Ryan T. Borne
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | - Yongfei Wang
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
- Center of Outcomes and Research Evaluation, Yale-New Haven Health, New Haven, Connecticut
| | - Jeptha P. Curtis
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
- Center of Outcomes and Research Evaluation, Yale-New Haven Health, New Haven, Connecticut
| | - Pamela N. Peterson
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Department of Medicine, Denver Health Hospital, Denver, Colorado
| | - Frederick A. Masoudi
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Amneet Sandhu
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Matthew M. Zipse
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kevin Thomas
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | | | - Nihar R. Desai
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
- Center of Outcomes and Research Evaluation, Yale-New Haven Health, New Haven, Connecticut
| | - Yong-Mei Cha
- Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jonathan C. Hsu
- Department of Medicine, University of California, San Diego, La Jolla
| | - Andrea M. Russo
- Department of Medicine, Cooper Medical School of Rowan University, Camden, New Jersey
| |
Collapse
|
31
|
Edward JA, Zipse MM, Tompkins C, Varosy PD, Sandhu A, Rosenberg M, Aleong R, Tzou WS, Borne RT, Sauer WH, Nguyen DT. Follow-Up After Catheter Ablation of Papillary Muscles and Valve Cusps. JACC Clin Electrophysiol 2019; 5:1185-1196. [DOI: 10.1016/j.jacep.2019.07.004] [Citation(s) in RCA: 6] [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: 01/30/2019] [Revised: 07/08/2019] [Accepted: 07/08/2019] [Indexed: 11/24/2022]
|
32
|
Zipse MM, Tzou WS, Schuller JL, Aleong RG, Varosy PD, Tompkins C, Borne RT, Tumolo AZ, Sandhu A, Kim D, Freeman AM, Weinberger HD, Maier LA, Sung RK, Nguyen DT, Sauer WH. Electrophysiologic testing for diagnostic evaluation and risk stratification in patients with suspected cardiac sarcoidosis with preserved left and right ventricular systolic function. J Cardiovasc Electrophysiol 2019; 30:1939-1948. [DOI: 10.1111/jce.14058] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 04/07/2019] [Revised: 06/18/2019] [Accepted: 06/19/2019] [Indexed: 01/01/2023]
Affiliation(s)
- Matthew M. Zipse
- Division of Cardiology, Section of Cardiac ElectrophysiologyUniversity of ColoradoAurora Colorado
| | - Wendy S. Tzou
- Division of Cardiology, Section of Cardiac ElectrophysiologyUniversity of ColoradoAurora Colorado
| | - Joseph L. Schuller
- Division of Cardiology, Section of Cardiac ElectrophysiologyUniversity of ColoradoAurora Colorado
| | - Ryan G. Aleong
- Division of Cardiology, Section of Cardiac ElectrophysiologyUniversity of ColoradoAurora Colorado
| | - Paul D. Varosy
- Division of Cardiology, Section of Cardiac ElectrophysiologyUniversity of ColoradoAurora Colorado
- Division of Cardiology, Section of Cardiac ElectrophysiologyEastern Colorado VA Medical CenterAurora Colorado
| | - Christine Tompkins
- Division of Cardiology, Section of Cardiac ElectrophysiologyUniversity of ColoradoAurora Colorado
| | - Ryan T. Borne
- Division of Cardiology, Section of Cardiac ElectrophysiologyUniversity of ColoradoAurora Colorado
| | - Alexis Z. Tumolo
- Division of Cardiology, Section of Cardiac ElectrophysiologyUniversity of ColoradoAurora Colorado
| | - Amneet Sandhu
- Division of Cardiology, Section of Cardiac ElectrophysiologyUniversity of ColoradoAurora Colorado
- Division of Cardiology, Section of Cardiac ElectrophysiologyEastern Colorado VA Medical CenterAurora Colorado
| | - Darlene Kim
- The Divisions of Cardiology and Pulmonary MedicineNational Jewish HealthDenver Colorado
| | - Andrew M. Freeman
- The Divisions of Cardiology and Pulmonary MedicineNational Jewish HealthDenver Colorado
| | - Howard D. Weinberger
- The Divisions of Cardiology and Pulmonary MedicineNational Jewish HealthDenver Colorado
| | - Lisa A. Maier
- The Divisions of Cardiology and Pulmonary MedicineNational Jewish HealthDenver Colorado
| | - Raphael K. Sung
- The Divisions of Cardiology and Pulmonary MedicineNational Jewish HealthDenver Colorado
| | - Duy T. Nguyen
- Division of Cardiology, Section of Cardiac ElectrophysiologyUniversity of ColoradoAurora Colorado
| | - William H. Sauer
- Division of Cardiology, Section of Cardiac ElectrophysiologyUniversity of ColoradoAurora Colorado
| |
Collapse
|
33
|
Ream K, Sandhu A, Valle J, Weber R, Kaizer A, Wiktor DM, Borne RT, Tumolo AZ, Kunkel M, Zipse MM, Schuller J, Tompkins C, Rosenberg M, Nguyen DT, Cleveland JC, Fullerton D, Carroll JD, Messenger J, Sauer WH, Aleong RG, Tzou WS. Ambulatory Rhythm Monitoring to Detect Late High-Grade Atrioventricular Block Following Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2019; 73:2538-2547. [DOI: 10.1016/j.jacc.2019.02.068] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/17/2019] [Accepted: 02/26/2019] [Indexed: 12/31/2022]
|
34
|
Sandhu A, Zipse MM, Borne RT, Aleong RG, Tompkins C, Schuller J, Rosenberg M, Varosy PD, Tzou WS, Nguyen DT, Sauer WH. Esophageal position, measured luminal temperatures, and risk of atrioesophageal fistula with atrial fibrillation ablation. Pacing Clin Electrophysiol 2019; 42:458-463. [DOI: 10.1111/pace.13639] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/06/2019] [Accepted: 02/10/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Amneet Sandhu
- Section of ElectrophysiologyThe University of Colorado Aurora Colorado
- Section of ElectrophysiologyRocky Mountain Regional VA Medical Center Aurora Colorado
| | - Matthew M. Zipse
- Section of ElectrophysiologyThe University of Colorado Aurora Colorado
| | - Ryan T. Borne
- Section of ElectrophysiologyThe University of Colorado Aurora Colorado
| | - Ryan G. Aleong
- Section of ElectrophysiologyThe University of Colorado Aurora Colorado
| | | | - Joseph Schuller
- Section of ElectrophysiologyThe University of Colorado Aurora Colorado
| | - Michael Rosenberg
- Section of ElectrophysiologyThe University of Colorado Aurora Colorado
| | - Paul D. Varosy
- Section of ElectrophysiologyThe University of Colorado Aurora Colorado
- Section of ElectrophysiologyRocky Mountain Regional VA Medical Center Aurora Colorado
| | - Wendy S. Tzou
- Section of ElectrophysiologyThe University of Colorado Aurora Colorado
| | - Duy T. Nguyen
- Section of ElectrophysiologyThe University of Colorado Aurora Colorado
| | - William H. Sauer
- Section of ElectrophysiologyThe University of Colorado Aurora Colorado
| |
Collapse
|
35
|
Tzou WS, Rothstein PA, Cowherd M, Zipse MM, Tompkins C, Marzec L, Aleong RG, Schuller JL, Varosy PD, Borne RT, Mathew J, Tumolo A, Sandhu A, Nguyen DT, Sauer WH. Repeat ablation of refractory ventricular arrhythmias in patients with nonischemic cardiomyopathy: Impact of midmyocardial substrate and role of adjunctive ablation techniques. J Cardiovasc Electrophysiol 2018; 29:1403-1412. [PMID: 30033528 DOI: 10.1111/jce.13663] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 05/18/2018] [Accepted: 06/06/2018] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Multiple ablations are often necessary to manage ventricular arrhythmias (VAs) in nonischemic cardiomyopathy (NICM) patients. We assessed characteristics and outcomes and role of adjunctive, nonstandard ablation in repeat VA ablation (RAbl) in NICM. METHODS AND RESULTS Consecutive NICM patients undergoing RAbl were analyzed, with characteristics of the last VA ablations compared between those undergoing 1 versus multiple-repeat ablations (1-RAbl vs. >1RAbl), and between those with or without midmyocardial substrate (MMS). VA-free survival was compared. Eighty-eight patients underwent 124 RAbl, 26 with > 1RAbl, and 26 with MMS. 1-RAbl and > 1-RAbl groups were similar in age (57 ± 16 vs. 57 ± 17 years; P = 0.92), males (76% vs. 69%; P = 0.60), LVEF (40 ± 17% vs. 40 ± 18%; P = 0.96), and amiodarone use (31% vs. 46%, P = 0.22). One-year VA freedom between 1-RAbl vs. > 1RAbl was similar (82% vs. 80%; P = 0.81); adjunctive ablation was utilized more in >1RAbl (31% vs. 11%, P = 0.02), and complication rates were higher (27% vs. 7%, P = 0.01), most due to septal substrate and anticipated heart block. >1-RAbl patients had more MMS (62% vs. 16%, P < 0.01). Although MMS was associated with worse VA-free survival after 1-RAbl (43% vs. 69%, P = 0.01), when >1RAbl was performed, more often with nonstandard ablation, VA-free survival was comparable to non-MMS patients (85% vs. 81%; P = 0.69). More RAbls were required in MMS versus non-MMS patients (2.00 ± 0.98 vs. 1.16 ± 0.37; P < 0.001). CONCLUSION For NICM patients with recurrent, refractory VAs despite previous ablation, effective arrhythmia control can safely be achieved with subsequent ablation, although >1 repeat procedure with adjunctive ablation is often required, especially with MMS.
Collapse
Affiliation(s)
- Wendy S Tzou
- University of Colorado,, Cardiac Electrophysiology Section, Aurora, Colorado
| | - Peter A Rothstein
- University of Colorado,, Cardiac Electrophysiology Section, Aurora, Colorado
| | - Michael Cowherd
- University of Colorado,, Cardiac Electrophysiology Section, Aurora, Colorado
| | - Matthew M Zipse
- University of Colorado,, Cardiac Electrophysiology Section, Aurora, Colorado
| | - Christine Tompkins
- University of Colorado,, Cardiac Electrophysiology Section, Aurora, Colorado
| | - Lucas Marzec
- University of Colorado,, Cardiac Electrophysiology Section, Aurora, Colorado
| | - Ryan G Aleong
- University of Colorado,, Cardiac Electrophysiology Section, Aurora, Colorado
| | - Joseph L Schuller
- University of Colorado,, Cardiac Electrophysiology Section, Aurora, Colorado
| | - Paul D Varosy
- University of Colorado,, Cardiac Electrophysiology Section, Aurora, Colorado
| | - Ryan T Borne
- University of Colorado,, Cardiac Electrophysiology Section, Aurora, Colorado
| | - Jehu Mathew
- University of Colorado,, Cardiac Electrophysiology Section, Aurora, Colorado
| | - Alexis Tumolo
- University of Colorado,, Cardiac Electrophysiology Section, Aurora, Colorado
| | - Amneet Sandhu
- University of Colorado,, Cardiac Electrophysiology Section, Aurora, Colorado
| | - Duy T Nguyen
- University of Colorado,, Cardiac Electrophysiology Section, Aurora, Colorado
| | - William H Sauer
- University of Colorado,, Cardiac Electrophysiology Section, Aurora, Colorado
| |
Collapse
|
36
|
Borne RT, Sauer WH, Zipse MM, Zheng L, Tzou W, Nguyen DT. Longer Duration Versus Increasing Power During Radiofrequency Ablation Yields Different Ablation Lesion Characteristics. JACC Clin Electrophysiol 2018; 4:902-908. [PMID: 30025690 DOI: 10.1016/j.jacep.2018.03.020] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/12/2018] [Accepted: 03/26/2018] [Indexed: 10/16/2022]
Abstract
OBJECTIVES The goal of this study was to characterize differences in ablation lesions with varying radiofrequency ablation (RFA) power and time. BACKGROUND Increasing power delivery or prolonging duration can improve the efficacy of RFA. However, the extent to which ablation lesion characteristics change, based on varying degrees of power and duration, is unknown. METHODS An ex vivo model consisting of viable bovine myocardium in a circulating warmed saline bath was used. An open irrigated RFA catheter was positioned with 10 g of force in the perpendicular position, and RFA was delivered at powers of 20, 30, 40, and 50 W and for various time intervals, up to a total of 90 s, at each power. An in vivo porcine thigh preparation model was used to perform RFA at 50 W for 5 s and 20 W for 30 s. Lesion volumes were analyzed. RESULTS Greater power delivery and longer radiofrequency time increased ablation lesion size. However, compared with a proportional change in radiofrequency duration, the same proportional increase in power produced a significantly larger lesion volume (p < 0.01). For in vivo models, 50 W/5 s ablation lesions yielded similar volumes but significantly less depth than 20 W/30 s ablation lesions. Peak temperatures were not significantly different at 2 and 4 mm with 50 W/5 s versus 20 W/30 s. CONCLUSIONS Varying power and duration will confer different ablation lesion characteristics that can be tailored according to the substrate/anatomy that is being ablated. This phenomenon has important implications during catheter ablation.
Collapse
Affiliation(s)
- Ryan T Borne
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora, Colorado
| | - William H Sauer
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora, Colorado
| | - Matthew M Zipse
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora, Colorado
| | - Lijun Zheng
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora, Colorado
| | - Wendy Tzou
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora, Colorado
| | - Duy T Nguyen
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora, Colorado.
| |
Collapse
|
37
|
Affiliation(s)
- Matthew M Zipse
- From the Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora
| | - Duy T Nguyen
- From the Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora.
| |
Collapse
|
38
|
Zipse MM, Tzou WS. Sudden cardiac death in nonischemic cardiomyopathy: Refining risk assessment. J Cardiovasc Electrophysiol 2017; 28:1361-1366. [PMID: 28670752 DOI: 10.1111/jce.13284] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 06/17/2017] [Accepted: 06/23/2017] [Indexed: 12/12/2022]
Abstract
Sudden cardiac death (SCD) risk assessment among patients with nonischemic cardiomyopathy (NICM) has been has been less straightforward than for patients with ischemic cardiomyopathy. The common surrogate that has been associated with highest SCD risk for all cardiomyopathies, and which has been universally used to guide implantation of primary-prevention implantable cardioverter-defibrillators (ICDs), is left ventricular ejection fraction (LVEF) ≤35%. However, this practice has been called into question, especially in light of recent trials suggesting that ICD treatment may not be of additional survival benefit among those with NICM treated with optimal medical therapy. This Clinical Review attempts to offer refinements to the current practice of SCD risk assessment among patients with NICM, with specific focus on importance of NICM etiology and efforts to identify myocardial scarring and arrhythmogenic substrate, both of which may provide greater information about SCD risk than the LVEF alone. These concepts are illustrated further as they apply to hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, and cardiac sarcoidosis, all of which are increasingly recognized NICM substrates associated with SCD and for which refinements for assessing risk are lacking in conventional guidelines.
Collapse
Affiliation(s)
- Matthew M Zipse
- University of Colorado, Section of Cardiac Electrophysiology, Aurora, CO, USA
| | - Wendy S Tzou
- University of Colorado, Section of Cardiac Electrophysiology, Aurora, CO, USA
| |
Collapse
|
39
|
Moss TJ, Zipse MM, Krantz MJ, Sauer WH, Salcedo EE, Schuller JL. Incidence of Atrial Fibrillation following Alcohol Septal Ablation for Hypertrophic Cardiomyopathy. Ann Noninvasive Electrocardiol 2016; 21:443-9. [PMID: 26970562 DOI: 10.1111/anec.12335] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Patients with hypertrophic cardiomyopathy (HCM) are at a fourfold to sixfold higher risk of developing atrial fibrillation (AF) compared to the general population, though incidence rates among patients undergoing alcohol septal ablation (ASA) are not well characterized. The purpose of this study was to evaluate atrial fibrillation incidence following ASA. METHODS We studied 132 consecutive HCM patients without comorbid AF that underwent 154 ASA procedures. The incidence of AF in follow-up was assessed through chart abstraction including electrocardiography. Survival free of AF was estimated using Kaplan-Meier methodology. RESULTS Over a mean follow-up of 3.6 ± 2.7 years (maximum 11.3 years), 10 (7.6%) patients developed new-onset AF. Of those who developed AF, both resting and provoked left ventricular outflow tract (LVOT) gradients had improved significantly (difference -79.78 mm Hg, P ≤ 0.005). Severity of mitral regurgitation improved in 7 (70%) patients. Survival free of AF was estimated to be 99.1%, 93.7%, and 91.7% at 1, 3, and 5 years. CONCLUSIONS Despite relieving LVOT obstruction and improving mitral regurgitation severity via ASA, new-onset AF remained a common complication of hypertrophic cardiomyopathy.
Collapse
Affiliation(s)
- Travis J Moss
- Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, VA
| | - Matthew M Zipse
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Mori J Krantz
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO.,Cardiovascular Division, Denver Health Medical Center, Denver, CO
| | - William H Sauer
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Ernesto E Salcedo
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Joseph L Schuller
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO.,Cardiovascular Division, Denver Health Medical Center, Denver, CO
| |
Collapse
|
40
|
Gonzalez JE, Zipse MM, Nguyen DT, Sauer WH. Antidromic Atrioventricular Reciprocating Tachycardia Using a Concealed Retrograde Conducting Left Lateral Accessory Pathway. Card Electrophysiol Clin 2016; 8:37-43. [PMID: 26920167 DOI: 10.1016/j.ccep.2015.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Atrioventricular reciprocating tachycardia is a common cause of undifferentiated supraventricular tachycardia. In patients with manifest or concealed accessory pathways, it is imperative to assess for the presence of other accessory pathways. Multiple accessory pathways are present in 4% to 10% of patients and are more common in patients with structural heart disease. In rare cases, multiple accessory pathways can act as the anterograde and retrograde limbs of the tachycardia.
Collapse
Affiliation(s)
- Jaime E Gonzalez
- Cardiac Electrophysiology, Cardiology Division, University of Colorado, Denver, Anschutz Medical Campus, 12401 East 17th Avenue, B-132, Aurora, CO 80045, USA
| | - Matthew M Zipse
- Cardiac Electrophysiology, Cardiology Division, University of Colorado, Denver, Anschutz Medical Campus, 12401 East 17th Avenue, B-132, Aurora, CO 80045, USA
| | - Duy T Nguyen
- Cardiac Electrophysiology, Cardiology Division, University of Colorado, Denver, Anschutz Medical Campus, 12401 East 17th Avenue, B-132, Aurora, CO 80045, USA
| | - William H Sauer
- Cardiac Electrophysiology, Cardiology Division, University of Colorado, Denver, Anschutz Medical Campus, 12401 East 17th Avenue, B-132, Aurora, CO 80045, USA.
| |
Collapse
|
41
|
Zipse MM, Groves DW, Khanna AD, Nguyen DT. An Approach to Endovascular Ventricular Pacing in a Patient with Ebstein Anomaly and a Mechanical Tricuspid Valve. Card Electrophysiol Clin 2016; 8:169-71. [PMID: 26920188 DOI: 10.1016/j.ccep.2015.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In the presence of a mechanical tricuspid valve, endocardial right ventricular pacing is contraindicated, and permanent pacing is usually achieved via a surgically implanted epicardial lead. In a patient with Ebstein anomaly, a mechanical tricuspid valve, and complete heart block, transvenous pacing was achieved by implantation of a pace-sense lead in a coronary sinus ventricular branch. Noninvasive cardiac imaging can provide information regarding anatomic variation in patients with congenital heart disease or when there are challenges to lead placement. With careful planning and execution, endovascular pacing in patients with a mechanical tricuspid valve is feasible and can safely be performed.
Collapse
Affiliation(s)
- Matthew M Zipse
- Cardiac Electrophysiology, Cardiology Division, University of Colorado, Denver, Anschutz Medical Campus, 12401 East 17th Avenue, B-132, Aurora, CO 80045, USA.
| | - Daniel W Groves
- Cardiac Electrophysiology, Cardiology Division, University of Colorado, Denver, Anschutz Medical Campus, 12401 East 17th Avenue, B-132, Aurora, CO 80045, USA
| | - Amber D Khanna
- Cardiac Electrophysiology, Cardiology Division, University of Colorado, Denver, Anschutz Medical Campus, 12401 East 17th Avenue, B-132, Aurora, CO 80045, USA
| | - Duy Thai Nguyen
- Cardiac Electrophysiology, Cardiology Division, University of Colorado, Denver, Anschutz Medical Campus, 12401 East 17th Avenue, B-132, Aurora, CO 80045, USA.
| |
Collapse
|
42
|
Abstract
The electrophysiologic nature of atrial fibrillation (AF) and related atrial arrhythmias in Friedreich ataxia has not previously been characterized. In the presented case, dense atrial scar had progressed to the point of acquired pulmonary vein (PV) isolation before the delivery of a single radiofrequency lesion. AF was induced, and ultimately organized spontaneously into a microreentrant atrial tachycardia. Other atrial tachycardias were also identified near scar border zones; these potentially served as triggers for AF in this patient, independent of the PVs. This case emphasizes the need to address non-PV substrate in some patients undergoing catheter ablation of AF.
Collapse
Affiliation(s)
- Matthew M Zipse
- Cardiac Electrophysiology, Cardiology Division, University of Colorado, Denver, Anschutz Medical Campus, 12401 East 17th Avenue, B-132, Aurora, CO 80045, USA.
| | - Ryan G Aleong
- Cardiac Electrophysiology, Cardiology Division, University of Colorado, Denver, Anschutz Medical Campus, 12401 East 17th Avenue, B-132, Aurora, CO 80045, USA.
| |
Collapse
|
43
|
Oestreich BA, Ahlgren B, Seres T, Zipse MM, Tompkins C, Varosy PD, Aleong RG. Use of Transesophageal Echocardiography to Improve the Safety of Transvenous Lead Extraction. JACC Clin Electrophysiol 2015; 1:442-448. [DOI: 10.1016/j.jacep.2015.07.007] [Citation(s) in RCA: 11] [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: 05/21/2015] [Revised: 06/30/2015] [Accepted: 07/02/2015] [Indexed: 10/23/2022]
|
44
|
Abstract
Myocardial involvement in patients with sarcoidosis can be difficult to diagnose, and requires a high index of suspicion and low threshold for screening. The presentation of cardiac sarcoidosis is variable, and can range from asymptomatic electrocardiographic changes to sudden cardiac death. This review provides an overview of the arrhythmic consequences of cardiac sarcoidosis, with emphasis on the electrophysiologist's role in recognition, diagnostic testing, and management of this rare disease.
Collapse
Affiliation(s)
- Matthew M Zipse
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, 12401 East 17th Avenue, B132, Aurora, CO 80045, USA
| | - William H Sauer
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, 12401 East 17th Avenue, B132, Aurora, CO 80045, USA.
| |
Collapse
|
45
|
Katz DF, Turakhia MP, Sauer WH, Tzou WS, Heath RR, Zipse MM, Aleong RG, Varosy PD, Kao DP. Safety of ventricular tachycardia ablation in clinical practice: findings from 9699 hospital discharge records. Circ Arrhythm Electrophysiol 2015; 8:362-70. [PMID: 25688143 PMCID: PMC9893573 DOI: 10.1161/circep.114.002336] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [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: 08/25/2014] [Accepted: 02/03/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Outcomes of ventricular tachycardia (VT) ablation have been described in clinical trials and single-center studies. We assessed the safety of VT ablation in clinical practice. METHODS AND RESULTS Using administrative hospitalization data between 1994 and 2011, we identified hospitalizations with primary diagnosis of VT (International Classification of Diseases-9 Clinical Modification code: 427.1) and cardiac ablation (International Classification of Diseases-9 Clinical Modification code: 37.34). We quantified in-hospital adverse events (AEs), including death, stroke, intracerebral hemorrhage, pericardial complications, hematoma or hemorrhage, blood transfusion, or cardiogenic shock. Secondary outcomes included major AEs (stroke, tamponade, or death) and death. Multivariable mixed effects models identified patient and hospital characteristics associated with AEs. Of 9699 hospitalizations with VT ablations (age, 56.5 ± 17.6; 60.1% men), AEs were reported in 825 (8.5%), major AEs in 295 (3.0%), and death in 110 (1.1%). Heart failure had the strongest association with death (odds ratio, 5.52; 95% confidence interval, 2.97-10.3) and major AE (odds ratio, 2.99; 95% confidence interval, 2.15-4.16). Anemia (odds ratio, 4.84; 95% confidence interval, 3.79-6.19) and unscheduled admission (odds ratio, 1.64; 95% confidence interval, 1.37-1.97) were associated with AEs. During the study period, incidence of AEs increased from 9.2% to 12.8% as did the burden of AE risk factors (0.034 patient/y; P < 0.001). Hospital volume > 25 cases/y was associated with fewer AEs compared with lower volume centers (6.4% versus 8.8%; P = 0.008). CONCLUSIONS VT ablation-associated AE rates in clinical practice are similar to those reported in the literature. Over time rates have increased as have the number of AE risk factors per patient. Ablations done electively and at hospitals with higher procedural volume are associated with lower incidence of AEs.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Paul D. Varosy
- University of Colorado, Aurora, CO,Eastem Colorado VA Medical Center, Denver, CO
| | | |
Collapse
|
46
|
Zipse MM, Sauer WH, Varosy PD, Aleong RG, Nguyen DT. Inappropriate shocks due to subcutaneous air in a patient with a subcutaneous cardiac defibrillator. Circ Arrhythm Electrophysiol 2014; 7:768-70. [PMID: 25140025 DOI: 10.1161/circep.114.001614] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [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)
- Matthew M Zipse
- From the Department of Medicine, Division of Cardiology, Section of Cardiac Electrophysiology, University of Colorado-Denver, Aurora (M.M.Z., W.H.S., P.D.V., R.G.A., D.T.N.); and VA Eastern Colorado Health Care System, Denver (P.D.V.)
| | - William H Sauer
- From the Department of Medicine, Division of Cardiology, Section of Cardiac Electrophysiology, University of Colorado-Denver, Aurora (M.M.Z., W.H.S., P.D.V., R.G.A., D.T.N.); and VA Eastern Colorado Health Care System, Denver (P.D.V.)
| | - Paul D Varosy
- From the Department of Medicine, Division of Cardiology, Section of Cardiac Electrophysiology, University of Colorado-Denver, Aurora (M.M.Z., W.H.S., P.D.V., R.G.A., D.T.N.); and VA Eastern Colorado Health Care System, Denver (P.D.V.)
| | - Ryan G Aleong
- From the Department of Medicine, Division of Cardiology, Section of Cardiac Electrophysiology, University of Colorado-Denver, Aurora (M.M.Z., W.H.S., P.D.V., R.G.A., D.T.N.); and VA Eastern Colorado Health Care System, Denver (P.D.V.)
| | - Duy T Nguyen
- From the Department of Medicine, Division of Cardiology, Section of Cardiac Electrophysiology, University of Colorado-Denver, Aurora (M.M.Z., W.H.S., P.D.V., R.G.A., D.T.N.); and VA Eastern Colorado Health Care System, Denver (P.D.V.).
| |
Collapse
|
47
|
|
48
|
Moss TJ, Krantz MJ, Zipse MM, Quaife RA, Sauer WH, Messenger JC, Groves BM, Salcedo EE, Schuller JL. Left ventricular systolic function following alcohol septal ablation for symptomatic hypertrophic cardiomyopathy. Am J Cardiol 2014; 113:1401-4. [PMID: 24576545 DOI: 10.1016/j.amjcard.2014.01.417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 01/08/2014] [Accepted: 01/08/2014] [Indexed: 11/25/2022]
Abstract
Because alcohol septal ablation (ASA) for the treatment of symptomatic hypertrophic cardiomyopathy (HC) with left ventricular (LV) outflow tract (LVOT) obstruction results in a myocardial infarct of up to 10% of ventricular mass, LV systolic function could decline over time. We evaluated LV function during longitudinal follow-up in a cohort of patients who underwent ASA. We studied 145 consecutive patients with HC that underwent 167 ASA procedures from 2002 to 2011. Echocardiographic follow-up was available in 139 patients (96%). Echocardiographic indexes included LV ejection fraction (LVEF), mitral regurgitation severity, systolic anterior motion of the anterior mitral leaflet, and resting and provoked LVOT gradients. All patients had a baseline LVEF of >55%. LVEF was preserved in 97.1% of patients over a mean follow-up time of 3.1±2.3 years (maximum 9.7). Mild LV systolic dysfunction was observed (LVEF range 44% to 54%) in only 4 patients. Mitral regurgitation severity improved in 67% (n=112 of 138 with complete data). Resting LVOT gradient declined from a mean of 75 to 19 mm Hg (p<0.001), and provoked gradient declined from a mean of 101 to 33 mm Hg (p<0.001). New York Heart Association class improved from a mean of 2.9±0.4 to 1.3±0.5 (p<0.001). In conclusion, LV systolic function is only mildly reduced in a minority of patients after ASA for symptomatic HC; other echocardiographic and functional measures were significantly improved.
Collapse
|
49
|
Schuller JL, Olson MD, Zipse MM, Schneider PM, Aleong RG, Wienberger HD, Varosy PD, Sauer WH. Electrocardiographic characteristics in patients with pulmonary sarcoidosis indicating cardiac involvement. J Cardiovasc Electrophysiol 2011; 22:1243-8. [PMID: 21615816 DOI: 10.1111/j.1540-8167.2011.02099.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Sarcoidosis is a multisystem granulomatous disease that can affect the heart. Early identification of cardiac sarcoidosis (CS) is critical because sudden death can be the initial presentation. We sought to evaluate the potential role of the ECG for identification of cardiac involvement in a cohort of patients with biopsy-proven pulmonary sarcoidosis. METHODS Our cohort consisted of referred patients with biopsy-proven pulmonary sarcoidosis who demonstrated symptoms consistent with cardiac involvement. The ECG characteristics collected were PR, QRS duration, QT interval, rate, bundle branch block (BBB), fragmented QRS (fQRS). QRS fragmentation was defined as 2 anatomically contiguous leads demonstrating RSR' patterns in the absence of BBB. RESULTS There were 112 subjects included in the cohort. Of the 52 subjects eventually diagnosed with CS, 39 had an ECG demonstrating fQRS while 21 of the 60 of non-CS patients had fQRS (75% vs 33.9%, P < 0.01). A RBBB or LBBB pattern were both more prevalent in the CS population (RBBB: 23.1% vs 6.7%, P = 0.016; LBBB: 3.8% vs 1.7%, P = 0.6). QRS duration remained significantly associated with CS after exclusion of those with BBB (93.5 +/- 10.6 vs 88 +/- 11 ms; P = 0.04). When fQRS and bundle branch block were combined, 90.4% of CS patient's ECGs contained at least one of the features, compared to 36.7% of noncardiac CS (P < 0.01). CONCLUSIONS The presence of fQRS or BBB pattern in patients with pulmonary sarcoidosis is associated with cardiac involvement and therefore should prompt further evaluation.
Collapse
Affiliation(s)
- Joseph L Schuller
- Section of Cardiac Electrophysiology, University of Colorado, and Division of Cardiology, National Jewish Health, Denver, Colorado, USA
| | | | | | | | | | | | | | | |
Collapse
|