1
|
Luna-Alcala S, Garcia-Cardenas M, Guerra EC, Martinez-Dominguez P, Cabello-Ganem A, Proaño-Bernal L, Chava-Ponte CA, Hernandez-Pacherres A, Espinola-Zavaleta N. Ventricular predominance in biventricular arrhythmogenic cardiomyopathy: Should new subtype criteria be recognized? Radiol Case Rep 2024; 19:2457-2463. [PMID: 38585407 PMCID: PMC10998062 DOI: 10.1016/j.radcr.2024.03.014] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
Arrhythmogenic cardiomyopathy is a biventricular disease in which the effect on the left ventricle can be either equivalent to or more severe than that on the right ventricle. It is a rare disease due to its low reported prevalence and typically becomes clinically evident during the second to fourth decade of life. It represents 4% of sudden cardiac death cases referred for autopsy and 10% of cases of unexplained cardiac arrest. We present a challenging case report of a 68-year-old man who arrived at the emergency room with chest discomfort, palpitations, and light-headedness before a syncopal episode with urinary incontinence. During monitoring, ventricular tachycardia was detected and was treated with cardioversion. However, a follow-up electrocardiogram revealed low QRS voltages in limb leads and T-wave inversion in the left precordial leads. The patient underwent a transthoracic echocardiogram and a gadolinium-based magnetic resonance imaging study to evaluate the possibility of acute decompensated heart failure. Both imaging studies revealed low ejection fraction and systolic dysfunction in both right and left ventricles. Furthermore, in the late gadolinium enhancement study, extensive left ventricular subepicardial enhancement with septal predominance in a ring pattern and an irregular morphology of the right ventricular free wall were observed. A diagnosis of biventricular arrhythmogenic cardiomyopathy was established based on the 2020 Padua Criteria. Although there is not a recognized classification within these criteria to establish its subtype, in our case there was a left ventricular predominance due to the presence of additional left ventricular categories.
Collapse
Affiliation(s)
- Santiago Luna-Alcala
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | | | - Enrique C. Guerra
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
- MD–PhD (PECEM) Program, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Pavel Martinez-Dominguez
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Aldo Cabello-Ganem
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Leonardo Proaño-Bernal
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | | | | | - Nilda Espinola-Zavaleta
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| |
Collapse
|
2
|
Paratz ED, Stub D, Sutherland N, Gutman S, La Gerche A, Mariani J, Taylor A, Ellims A. Response to: Regard to assessing agreement between two raters with kappa statistics. Int J Cardiol 2024; 404:131978. [PMID: 38513734 DOI: 10.1016/j.ijcard.2024.131978] [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: 02/21/2024] [Accepted: 03/15/2024] [Indexed: 03/23/2024]
Affiliation(s)
- Elizabeth D Paratz
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia; Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia; St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC 3065, Australia; Ambulance Victoria, 375 Manningham Rd, Doncaster, VIC 3108, Australia.
| | - Dion Stub
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia; Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia; Ambulance Victoria, 375 Manningham Rd, Doncaster, VIC 3108, Australia; Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Australia
| | | | - Sarah Gutman
- Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia
| | - Andre La Gerche
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia; Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia; St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC 3065, Australia
| | - Justin Mariani
- Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia
| | - Andrew Taylor
- Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia
| | - Andris Ellims
- Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia
| |
Collapse
|
3
|
Mactaggart S, Ahmed R. The role of ICDs in patients with sarcoidosis-A comprehensive review. Curr Probl Cardiol 2024; 49:102483. [PMID: 38401822 DOI: 10.1016/j.cpcardiol.2024.102483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 02/21/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Implantable cardioverter defibrillator (ICD) use in cardiac sarcoidosis (CS) to prevent sudden cardiac death (SCD) is a potentially life-saving intervention. However, the factors that determine outcome in this cohort remains largely unknown. This review analyses CS patients with an ICD and highlights determinants of poor outcome. OUTCOMES Analysis of studies which used the 2014 HRS Consensus, 2017 AHA/ACC/HRS Guideline and 2022 ESC Guidelines showed that those with class I recommendations have higher incidences of ventricular arrhythmia (VA) than those with class II recommendations. Additionally, even those with normal left ventricular ejection fraction (LVEF) and CS are at high risk of VA and SCD. SUMMARY Compounding research emphasises the importance of cardiac imaging in those with sarcoidosis, with evidence to suggest a possible need for revision of the guidelines. Other variables such as demographics and ventricular characteristics may prove useful in predicting those to benefit most from ICD insertion.
Collapse
Affiliation(s)
| | - Raheel Ahmed
- Royal Brompton Hospital, London, United Kingdom; National Heart and Lung Institute, Imperial College London, United Kingdom
| |
Collapse
|
4
|
van der Lingen ALCJ, Verstraelen TE, van Erven L, Meeder JG, Theuns DA, Vernooy K, Wilde AAM, Maass AH, Allaart CP. Assessment of ICD eligibility in non-ischaemic cardiomyopathy patients: a position statement by the Task Force of the Dutch Society of Cardiology. Neth Heart J 2024; 32:190-197. [PMID: 38634993 DOI: 10.1007/s12471-024-01859-7] [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] [Accepted: 01/30/2024] [Indexed: 04/19/2024] Open
Abstract
International guidelines recommend implantation of an implantable cardioverter-defibrillator (ICD) in non-ischaemic cardiomyopathy (NICM) patients with a left ventricular ejection fraction (LVEF) below 35% despite optimal medical therapy and a life expectancy of more than 1 year with good functional status. We propose refinement of these recommendations in patients with NICM, with careful consideration of additional risk parameters for both arrhythmic and non-arrhythmic death. These additional parameters include late gadolinium enhancement on cardiac magnetic resonance imaging and genetic testing for high-risk genetic variants to further assess arrhythmic risk, and age, comorbidities and sex for assessment of non-arrhythmic mortality risk. Moreover, several risk modifiers should be taken into account, such as concomitant arrhythmias that may affect LVEF (atrial fibrillation, premature ventricular beats) and resynchronisation therapy. Even though currently no valid cut-off values have been established, the proposed approach provides a more careful consideration of risks that may result in withholding ICD implantation in patients with low arrhythmic risk and substantial non-arrhythmic mortality risk.
Collapse
Affiliation(s)
- Anne-Lotte C J van der Lingen
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Tom E Verstraelen
- Department of Cardiology, Heart Centre, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Lieselot van Erven
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Joan G Meeder
- Department of Cardiology, VieCuri Medical Centre Noord-Limburg, Venlo, The Netherlands
| | - Dominic A Theuns
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Arthur A M Wilde
- Department of Cardiology, Heart Centre, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Alexander H Maass
- Department of Cardiology, University Medical Centre Groningen, Heart Centre, University of Groningen, Groningen, The Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| |
Collapse
|
5
|
Zha F, Li X, Yin H, Huang D, Du Y, Zhou C. Case report: A 56-year-old woman presenting with torsades de pointes and cardiac arrest associated with levosimendan administration and underlying congenital long QT syndrome type 1. Heliyon 2024; 10:e29300. [PMID: 38644859 PMCID: PMC11033119 DOI: 10.1016/j.heliyon.2024.e29300] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 03/30/2024] [Accepted: 04/04/2024] [Indexed: 04/23/2024] Open
Abstract
Torsades de Pointes (TdP) is a malignant polymorphic ventricular tachycardia with heart rate corrected QT interval (QTc) prolongation, which may be attributed to congenital and acquired factors. Although various acquired factors for TdP have been summarized, levosimendan administration in complex postoperative settings is relatively uncommon. Timely identification of potential causes and appropriate management may improve the outcome. Herein, we describe the postoperative case of a 56-year-old female with initial normal QTc who accepted the administration of levosimendan for heart failure, suffered TdP, cardiac arrest, and possible Takotsubo cardiomyopathy, further genetically confirmed as long QT syndrome type 1 (LQT1). The patient was successfully treated with magnesium sulfate, atenolol, and implantable cardioverter defibrillator implantation. There should be a careful evaluation of the at-risk populations and close monitoring of the electrocardiograms, particularly the QT interval, to reduce the risk of near-fatal arrhythmias during the use of levosimendan.
Collapse
Affiliation(s)
- Fengyan Zha
- Department of Surgical Intensive Care Unit, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, SZ, China
| | - Xing Li
- Department of Surgical Intensive Care Unit, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, SZ, China
| | - Hui Yin
- Department of Surgical Intensive Care Unit, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, SZ, China
| | - Di Huang
- Department of Surgical Intensive Care Unit, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, SZ, China
| | - Yu Du
- Department of Surgical Intensive Care Unit, Fuwai Hospital Chinese Academy of Medical Sciences, Beijing, BJ, China
| | - Chuzhi Zhou
- Department of Surgical Intensive Care Unit, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, SZ, China
| |
Collapse
|
6
|
Enomoto Y, Ikeda T, Nakamura K, Noro M, Sugi K, Moroi M, Nakamura M, Kusano K, Schwartz T, Kayser T, Aonuma K. Impact of High-Voltage Device Implantation in Elderly Japanese Patients With Heart Failure as Primary Prevention - Post Hoc Analysis of HINODE. Circ J 2024:CJ-23-0801. [PMID: 38616125 DOI: 10.1253/circj.cj-23-0801] [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] [Indexed: 04/16/2024]
Abstract
BACKGROUND Despite an increased incidence of chronic heart failure (HF) and sudden cardiac death (SCD), the use of implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) is much lower in Japan than in Western countries. The HF Indication and SCD Prevention Trial Japan (HINODE) prospectively assessed the mortality rate, appropriately treated ventricular arrhythmias (VA), and HF in Japanese patients with a higher risk of HF.Methods and Results: HINODE consisted of ICD, CRT-defibrillator (CRT-D), pacing, and non-device treatment cohorts. This subanalysis evaluated the impact of the implantation of high-voltage devices (HVD; ICD and CRT-D) in 171 Japanese patients. We compared all-cause mortality, VA, and HF events between elderly (age >70 years at study enrollment) and non-elderly HVD recipients. The estimated survival rate through 24 months in the HVD cohort was 85.8% (97.5% lower control limit 77.6%). The risk of all-cause mortality was increased for the elderly vs. non-elderly (hazard ratio [HR] 2.82; 95% confidence interval [CI] 1.01-7.91; P=0.039), but did not differ after excluding ICD patients with CRT-D indication (HR 2.32; 95% CI 0.79-6.78; P=0.11). There were no differences in VA and HF event-free rates between elderly and non-elderly HVD recipients (P=0.73 and P=0.55, respectively). CONCLUSIONS Although elderly patients may have a higher risk of mortality in general, the benefit of HVD therapy in this group is comparable to that in non-elderly patients.
Collapse
Affiliation(s)
- Yoshinari Enomoto
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
- Division of Cardiology, National Center for Global Health and Medicine Hospital
| | - Takanori Ikeda
- Division of Cardiovascular Medicine, Toho University Faculty of Medicine
| | - Keijiro Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Mahito Noro
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
- Division of Cardiology, Odawara Cardiovascular Hospital
| | - Kaoru Sugi
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
- Division of Cardiology, Odawara Cardiovascular Hospital
| | - Masao Moroi
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | | | | |
Collapse
|
7
|
Maris MT, Koçar A, Willems DL, Pols J, Tan HL, Lindinger GL, Bak MAR. Ethical use of artificial intelligence to prevent sudden cardiac death: an interview study of patient perspectives. BMC Med Ethics 2024; 25:42. [PMID: 38575931 PMCID: PMC10996273 DOI: 10.1186/s12910-024-01042-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/27/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND The emergence of artificial intelligence (AI) in medicine has prompted the development of numerous ethical guidelines, while the involvement of patients in the creation of these documents lags behind. As part of the European PROFID project we explore patient perspectives on the ethical implications of AI in care for patients at increased risk of sudden cardiac death (SCD). AIM Explore perspectives of patients on the ethical use of AI, particularly in clinical decision-making regarding the implantation of an implantable cardioverter-defibrillator (ICD). METHODS Semi-structured, future scenario-based interviews were conducted among patients who had either an ICD and/or a heart condition with increased risk of SCD in Germany (n = 9) and the Netherlands (n = 15). We used the principles of the European Commission's Ethics Guidelines for Trustworthy AI to structure the interviews. RESULTS Six themes arose from the interviews: the ability of AI to rectify human doctors' limitations; the objectivity of data; whether AI can serve as second opinion; AI explainability and patient trust; the importance of the 'human touch'; and the personalization of care. Overall, our results reveal a strong desire among patients for more personalized and patient-centered care in the context of ICD implantation. Participants in our study express significant concerns about the further loss of the 'human touch' in healthcare when AI is introduced in clinical settings. They believe that this aspect of care is currently inadequately recognized in clinical practice. Participants attribute to doctors the responsibility of evaluating AI recommendations for clinical relevance and aligning them with patients' individual contexts and values, in consultation with the patient. CONCLUSION The 'human touch' patients exclusively ascribe to human medical practitioners extends beyond sympathy and kindness, and has clinical relevance in medical decision-making. Because this cannot be replaced by AI, we suggest that normative research into the 'right to a human doctor' is needed. Furthermore, policies on patient-centered AI integration in clinical practice should encompass the ethics of everyday practice rather than only principle-based ethics. We suggest that an empirical ethics approach grounded in ethnographic research is exceptionally well-suited to pave the way forward.
Collapse
Affiliation(s)
- Menno T Maris
- Department of Ethics, Law and Humanities, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Ayca Koçar
- Institute for Healthcare Management and Health Sciences, University of Bayreuth, Bayreuth, Germany
| | - Dick L Willems
- Department of Ethics, Law and Humanities, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jeannette Pols
- Department of Ethics, Law and Humanities, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands
| | - Hanno L Tan
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Georg L Lindinger
- Institute for Healthcare Management and Health Sciences, University of Bayreuth, Bayreuth, Germany
| | - Marieke A R Bak
- Department of Ethics, Law and Humanities, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Institute of History and Ethics in Medicine, TUM School of Medicine, Technical University of Munich, Munich, Germany
| |
Collapse
|
8
|
Liu CF, Hurwitz JL, Krahn AD, Ellenbogen KA, Slotwiner DJ, Schoenfeld MH, Pelosi F, Mainigi SK, Berman AE, Rashba EJ, Hao S, Sachdev M, Larsen TR, Tsai S, Miller L, Smith AM, Shanker AJ. Heart Rhythm Society's survey assessing same-day discharge after electrophysiology procedures and implementation in ambulatory surgical centers. Heart Rhythm 2024:S1547-5271(24)02307-5. [PMID: 38574785 DOI: 10.1016/j.hrthm.2024.03.1812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 03/26/2024] [Accepted: 03/29/2024] [Indexed: 04/06/2024]
Affiliation(s)
| | | | - Andrew D Krahn
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Frank Pelosi
- University of Michigan School of Medicine, Ann Arbor, Michigan
| | | | | | - Eric J Rashba
- Stony Brook University Medical Center, Stony Brook, New York
| | - Steven Hao
- Sutter Health, San Francisco, California
| | - Molly Sachdev
- Washington University School of Medicine, St Louis, Missouri
| | | | - Shane Tsai
- University of Nebraska Medical Center, Omaha, Nebraska
| | | | | | | |
Collapse
|
9
|
Imburgio S, Johal A, Akhlaq H, Klei L, Arcidiacono AM, Udongwo N, Mararenko A, Ajam F, Heaton J, Hansalia R, Zagha D. Fatal ventricular arrhythmias in myocarditis: A review of current indications for defibrillator devices. J Cardiol 2024:S0914-5087(24)00054-6. [PMID: 38552838 DOI: 10.1016/j.jjcc.2024.03.007] [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: 11/14/2023] [Revised: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 04/12/2024]
Abstract
Historically, patients with myocarditis were considered for implantable cardioverter defibrillator (ICD) utilization only in the chronic phase of the disease following the development of persistent cardiomyopathy refractory to medical therapy or occurrence of a major ventricular arrhythmic event. However, recent literature has indicated that ventricular arrhythmias are frequently reported even in the acute phase of the disease, challenging the long-standing perception that this disease process was largely reversible. Given this changing environment of information, the latest US and European guidelines were recently updated in 2022 to now consider ICD implantation during the acute phase which has significantly increased the number of individuals eligible for these devices. Additionally, several studies with small subgroups of patients have demonstrated a possible benefit of wearable cardioverter defibrillators (WCDs) in this patient demographic. Assuming that larger studies confirm their utility, it is possible that WCDs can assist in detection of ventricular arrhythmias and selection of high-risk candidates for ICD implantation, while providing temporary protection for a small percentage of patients before the development of a major arrhythmic event. This review ultimately serves as a comprehensive review of the most recent guidelines for defibrillator use in acute and chronic myocarditis. OPINION STATEMENT: The latest US and European guidelines support ICD use for myocarditis patients following the development of persistent cardiomyopathy refractory to medical therapy or occurrence of a major ventricular arrhythmic event. Previously, patients in the acute phase were excluded from ICD utilization even after experiencing malignant ventricular tachycardia or ventricular fibrillation due to the long-standing perception that this disease process was largely reversible. However, recent literature has indicated that ventricular arrhythmias are frequently reported even in the acute phase of the disease. Additionally, we found that the myocardial damage that is inflicted persists many years after the initial episode. Given this changing environment of information, guidelines were recently updated in 2022 to now consider ICD implantation during the acute phase which has significantly increased the number of individuals eligible for these devices. We support possible ICD utilization for secondary prevention during the acute phase of myocarditis given the elevated risk of arrhythmia recurrence and the fact that any ventricular arrhythmia can induce sudden cardiac death. Future prospective studies are needed to assess which patients may benefit most from early ICD implantation. WCDs have improved survival in patient populations at high-risk for sudden cardiac death who are not candidates for ICD implantation. After analyzing several recent studies with small subgroups of patients, WCDs appear to demonstrate similar efficacy for myocarditis patients as well. Assuming that larger studies confirm their utility, we believe that WCDs can assist in detection of ventricular arrhythmias and selection of high-risk candidates for ICD implantation. Furthermore, WCDs have the additional benefit of acting as primary prevention by providing temporary protection for a small percentage of myocarditis patients before they develop a major arrhythmic event.
Collapse
Affiliation(s)
- Steven Imburgio
- Jersey Shore University Medical Center, Department of Medicine, Neptune City, NJ, USA
| | - Anmol Johal
- Jersey Shore University Medical Center, Department of Medicine, Neptune City, NJ, USA
| | - Hira Akhlaq
- Jersey Shore University Medical Center, Department of Medicine, Neptune City, NJ, USA
| | - Lauren Klei
- Jersey Shore University Medical Center, Department of Medicine, Neptune City, NJ, USA
| | | | - Ndausung Udongwo
- Jersey Shore University Medical Center, Department of Medicine, Neptune City, NJ, USA
| | - Anton Mararenko
- Jersey Shore University Medical Center, Department of Cardiology, Neptune City, NJ, USA
| | - Firas Ajam
- Jersey Shore University Medical Center, Department of Cardiology, Neptune City, NJ, USA
| | - Joseph Heaton
- Jersey Shore University Medical Center, Department of Medicine, Neptune City, NJ, USA
| | - Riple Hansalia
- Jersey Shore University Medical Center, Department of Cardiology, Neptune City, NJ, USA
| | - David Zagha
- Jersey Shore University Medical Center, Department of Cardiology, Neptune City, NJ, USA
| |
Collapse
|
10
|
Kanneganti V, Bahl A, Rohit MK, Mehrotra S. Implantable cardioverter defibrillators for primary prevention in cardiomyopathies. Indian Heart J 2024:S0019-4832(24)00050-6. [PMID: 38521121 DOI: 10.1016/j.ihj.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 12/06/2023] [Accepted: 03/19/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Implantable cardioverter defibrillators (ICD) are often used as primary prevention strategy for sudden cardiac death (SCD) in young individuals. This study analyzed appropriate therapies, complications and inappropriate shocks in the real-world Indian population. METHODS All patients in the cardiomyopathy cohort under follow up who had ICD implanted as a primary prevention strategy were studied. The objective was to assess the incidence of appropriate ICD therapies, inappropriate therapies and complications. ICD was interrogated and stored electrograms analyzed. Underlying arrhythmia or conditions resulting in appropriate or inappropriate ICD therapy were studied. Correlation and regression studies was done to assess for the predictors of appropriate therapy. RESULTS Fifty patients were followed up for a mean follow-up duration of 4.4 ± 3.1 years with total follow up of 220.2 patient years. Appropriate ICD therapy was delivered in 16 out of 50 (32%) patients, with 65 appropriate therapies (median 2 per patient, range: 0-20). Inappropriate therapy delivered in 7 of the 50 (14%) patients, with 44 inappropriate therapies (median 5 per patient, range: 0-20). Complications occurred in 8 of the 50 (16%) patients. Overall, the rate of appropriate therapy was 29.5 per 100 patient years, that of inappropriate therapy was 19.9 per 100 patient years and the rate of complications was 3.6 per 100 patient years. CONCLUSIONS When implanted for primary prevention in patients with cardiomyopathies over a mean period of 4.4 ± 3.1 years, appropriate ICD therapy was delivered in 32% patients. However, inappropriate therapy (14% patients) and complications (16% patients) were also common.
Collapse
Affiliation(s)
- Vineetha Kanneganti
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Bahl
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Manoj Kumar Rohit
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Saurabh Mehrotra
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
11
|
Kay B, Lampert R. Devices and Athletics: Decision-Making Around Return to Play. Card Electrophysiol Clin 2024; 16:81-92. [PMID: 38280816 DOI: 10.1016/j.ccep.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
Until recently, implantable cardioverter defibrillators (ICDs) were considered a contraindication to competitive athletics. Recent prospective observational registry data in athletes with ICDs who participated in sports against the societal recommendations at the time have demonstrated the safety of sports participation. While athletes did receive both appropriate and inappropriate shocks, these were not more frequent during sports participation than other activity, and there were no sports-related deaths or need for external resuscitation in the 440 athlete cohort (median followup 44 months). Optimization of medical therapies, device settings and having an emergency action plan allow many athletes to safely continue athletic activity.
Collapse
Affiliation(s)
- Bradley Kay
- Section of Cardiovascular Medicine, Yale School of Medicine, 789 Howard Avenue, Dana 319, New Haven, CT 06520, USA
| | - Rachel Lampert
- Section of Cardiovascular Medicine, Yale School of Medicine, 789 Howard Avenue, Dana 319, New Haven, CT 06520, USA.
| |
Collapse
|
12
|
Sticherling C, Ellenbogen KA, Burri H. Stepping back for good reasons: a reappraisal of the DF-1 connector for defibrillator leads. Europace 2024; 26:euae057. [PMID: 38412340 PMCID: PMC10919383 DOI: 10.1093/europace/euae057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/22/2024] [Indexed: 02/29/2024] Open
Abstract
The DF-4 defibrillator standard has been rapidly adopted due to its convenience at implantation. There are however trade-offs compared to the traditional DF-1 standard that are underappreciated. This viewpoint outlines the advantages and limitations of current defibrillator lead standards that should be kept in mind, as they impact the options that are available to deal with issues that may arise.
Collapse
Affiliation(s)
- Christian Sticherling
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, CH-4059 Basel, Switzerland
| | - Kenneth A Ellenbogen
- Department of Electrophysiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Haran Burri
- Department of Cardiology, University Hospital Geneva, Geneva, Switzerland
| |
Collapse
|
13
|
Kloppe A, Winter J, Prull M, Aweimer A, El-Battrawy I, Hanefeld C, O'Connor S, Mügge A, Schiedat F. Subcutaneous cardioverter defibrillator implanted intermuscularly in patients with end-stage renal disease requiring hemodialysis: 5-year follow-up. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01767-1. [PMID: 38383674 DOI: 10.1007/s10840-024-01767-1] [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: 11/15/2023] [Accepted: 02/01/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND The aim of the present study was to evaluate the long-term safety and effectiveness of the subcutaneous implantable cardioverter defibrillator (S-ICD) when implanted intermuscularly in patients with end-stage renal disease and hemodialysis. METHODS This study is a retrospective analysis of 21 consecutive patients implanted with S-ICDs at three experienced centers in Germany with comorbid renal insufficiency requiring hemodialysis, as well as being at risk of sudden cardiac death. The S-ICD was placed intermuscularly in all patients. Follow-ups (FUs) were performed every 6 months. RESULTS The mean ± standard deviation FU duration was 60.0 ± 11.4 months, with a range of 39 to 78 months. There were no deaths due to arrhythmia, or device-associated infections and complications. Four patients (19.1%) died during FU due to respiratory insufficiency during dialysis, systolic heart failure, septic infection of the urogenital tract, and colorectal cancer, respectively. There were six non-device-related hospitalizations with a duration of 12.7 ± 5.1 days and a hospitalization rate of 4.1 per 100 patient years. CONCLUSIONS In the long-term FU of this small population of seriously compromised hemodialysis patients at risk of sudden cardiac death, the intermuscularly implanted S-ICD system was safe and effective. No arrhythmic complications, device-associated infections, or complications compromised survival. These data are encouraging and support testing in a larger group of similarly compromised patients.
Collapse
Affiliation(s)
- Axel Kloppe
- Department of Cardiology, Intensive Medicine and Angiology, Marienhospital Gelsenkirchen, Academic Hospital of the Ruhr University Bochum, Virchowstraße 122, 45886, Gelsenkirchen, Germany
- Department of Cardiology and Angiology, University Hospital Bergmannsheil Bochum, Ruhr University Bochum, Bochum, Germany
| | - Joachim Winter
- Department of Cardiovascular Surgery, Heinrich Heine University, Dusseldorf, Germany
| | - Magnus Prull
- Department of Cardiology, Augusta Hospital Bochum, Bochum, Germany
| | - Assem Aweimer
- Department of Cardiology and Angiology, University Hospital Bergmannsheil Bochum, Ruhr University Bochum, Bochum, Germany
| | - Ibrahim El-Battrawy
- Department of Cardiology and Angiology, University Hospital Bergmannsheil Bochum, Ruhr University Bochum, Bochum, Germany
- Department of Molecular and Experimental Cardiology, Institut Für Forschung Und Lehre (IFL), Ruhr University Bochum, Bochum, Germany
| | - Christoph Hanefeld
- Department of Cardiology, Katholische Kliniken Bochum, Ruhr University Bochum, Bochum, Germany
| | - Stephen O'Connor
- Department of Biomedical Engineering, City, University of London, London, UK
| | - Andreas Mügge
- Department of Cardiology and Angiology, University Hospital Bergmannsheil Bochum, Ruhr University Bochum, Bochum, Germany
- Department of Cardiology, Katholische Kliniken Bochum, Ruhr University Bochum, Bochum, Germany
| | - Fabian Schiedat
- Department of Cardiology, Intensive Medicine and Angiology, Marienhospital Gelsenkirchen, Academic Hospital of the Ruhr University Bochum, Virchowstraße 122, 45886, Gelsenkirchen, Germany.
- Department of Cardiology and Angiology, University Hospital Bergmannsheil Bochum, Ruhr University Bochum, Bochum, Germany.
| |
Collapse
|
14
|
Zylla MM, Wolfes J, Schleberger R, Lawin D, Kieser M, Reinke F, Eckardt L, Rillig A, Stellbrink C, Thomas D, Frey N, Lugenbiel P. Use of class IC antiarrhythmic drugs in patients with structural heart disease and implantable cardioverter defibrillator. Clin Res Cardiol 2024:10.1007/s00392-024-02394-6. [PMID: 38372753 DOI: 10.1007/s00392-024-02394-6] [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: 08/31/2023] [Accepted: 02/02/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Due to suspected pro-arrhythmic effects and increased mortality associated with class-IC antiarrhythmic drugs (AADs) in previous trials, AAD therapy in structural heart disease (SHD) is mainly restricted to amiodarone. In the presence of diagnostic and therapeutic advancements in cardiovascular medicine, it remains unclear if previous studies adequately reflect contemporary patients. In clinical practice, class-IC-AADs are occasionally used in individual cases, particularly in patients with an implantable cardioverter defibrillator (ICD). METHODS This study retrospectively investigated outcome in ICD-carriers with SHD in whom class-IC-AADs were used as an individualized therapy due to failure, side effects, or unacceptable risk of alternative therapeutic options. RESULTS Fifty patients from four tertiary centers were included (median age 48.5 years; 52% female). The most common underlying SHD were dilated (42%) or ischemic cardiomyopathy (26%) (median LVEF = 45%). Indications for AAD were sustained ventricular arrhythmias (VA) (58%), symptomatic premature ventricular contractions (26%), or atrial arrhythmias (16%). Median follow-up was 27.8 months. Freedom from sustained VA was 72%, and freedom from ICD therapy was 80%. In 19 patients (38%), AAD therapy was terminated. The most common reason was insufficient efficacy (n = 8). Pro-arrhythmia was suspected in three patients. Five patients died during follow-up (10.0%), two of cardiovascular cause (4.0%). CONCLUSION In a multicenter cohort of ICD-carriers with SHD, class-IC-AADs were associated with a low rate of pro-arrhythmic effects or cardiovascular mortality. The majority of patients remained free from sustained VA during a follow-up of > 2 years. Further efforts should be made to evaluate the safety of class-IC-AADs in SHD patients receiving contemporary cardiovascular therapy.
Collapse
Affiliation(s)
- Maura M Zylla
- Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
- HCR (Heidelberg Center for Heart Rhythm Disorders), Medical University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
- DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | - Julian Wolfes
- Department of Cardiology II (Electrophysiology), University Hospital Münster, Albert-Schweitzer-Straße 33, 48149, Münster, Germany
| | - Ruben Schleberger
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Lübeck/Kiel, Martinistr. 52, 20251, Hamburg, Germany
- Department of Cardiology, Albertinen Heart and Vascular Center, Albertinen Hospital, Süntelstr. 11a, 22457, Hamburg, Germany
| | - Dennis Lawin
- Department of Cardiology and Intensive Care Medicine, University Hospital OWL of Bielefeld University, Campus Klinikum Bielefeld, Teutoburger Str. 50, 33604, Bielefeld, Germany
| | - Meinhard Kieser
- Institute of Medical Biometry, Heidelberg University Hospital, Im Neuenheimer Feld 310, 69120, Heidelberg, Germany
| | - Florian Reinke
- Department of Cardiology II (Electrophysiology), University Hospital Münster, Albert-Schweitzer-Straße 33, 48149, Münster, Germany
| | - Lars Eckardt
- Department of Cardiology II (Electrophysiology), University Hospital Münster, Albert-Schweitzer-Straße 33, 48149, Münster, Germany
| | - Andreas Rillig
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Lübeck/Kiel, Martinistr. 52, 20251, Hamburg, Germany
| | - Christoph Stellbrink
- Department of Cardiology and Intensive Care Medicine, University Hospital OWL of Bielefeld University, Campus Klinikum Bielefeld, Teutoburger Str. 50, 33604, Bielefeld, Germany
| | - Dierk Thomas
- Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- HCR (Heidelberg Center for Heart Rhythm Disorders), Medical University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Norbert Frey
- Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- HCR (Heidelberg Center for Heart Rhythm Disorders), Medical University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Patrick Lugenbiel
- Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- HCR (Heidelberg Center for Heart Rhythm Disorders), Medical University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| |
Collapse
|
15
|
Yang S, Zhao J, Liu X, Wang J, Gu M, Cai C, Niu H, Chen L, Hua W. Metabolomics Profiling Predicts Ventricular Arrhythmia in Patients with an Implantable Cardioverter Defibrillator. J Cardiovasc Transl Res 2024; 17:91-101. [PMID: 37556036 DOI: 10.1007/s12265-023-10413-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/04/2023] [Indexed: 08/10/2023]
Abstract
Implantable cardioverter defibrillators (ICDs) reduce sudden cardiac death (SCD) when patients experience life-threatening ventricular arrhythmias (LTVA). However, current strategies determining ICD patient selection and risk stratification are inefficient. We used metabolomics to assess whether dysregulated metabolites are associated with LTVA and identify potential biomarkers. Baseline plasma samples were collected from 72 patients receiving ICDs. Over a median follow-up of 524.0 days (range 239.0-705.5), LTVA occurred in 23 (31.9%) patients (22 effective ICD treatments and 1 SCD). After confounding risk factors adjustment for age, smoking, secondary prevention, and creatine kinase MB, 23 metabolites were significantly associated with LTVA. Pathway analysis revealed LTVA associations with disrupted metabolism of glycine, serine, threonine, and branched chain amino acids. Pathway enrichment analysis identified a panel of 6 metabolites that potentially predicted LTVA, with an area under the receiver operating characteristic curve of 0.8. Future studies are necessary on biological mechanisms and potential clinical use.
Collapse
Affiliation(s)
- Shengwen Yang
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Junhan Zhao
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xi Liu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, China National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Jing Wang
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min Gu
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chi Cai
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongxia Niu
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liang Chen
- Department of Cardiac surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Hua
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| |
Collapse
|
16
|
Gao W, Liu Y, Li T. Recurrent cardiac arrest and complete atrioventricular block due to idiopathic coronary vasospasm: A case report. Heliyon 2024; 10:e23766. [PMID: 38205299 PMCID: PMC10777016 DOI: 10.1016/j.heliyon.2023.e23766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 01/12/2024] Open
Abstract
Recurrent complete atrioventricular block induced by coronary spasm is rare. We present a case of a 47-year-old woman who suffered from two episodes of out-of-hospital cardiac arrest within one year due to complete atrioventricular block caused by coronary vasospasm. No implantable cardioverter defibrillator was implanted after her first episode. As for the second episode, permanent brain injury was left behind despite successful cardiopulmonary resuscitation. She underwent a challenging rehabilitation process and an implantable cardioverter defibrillator was implanted before discharge. We captured the dynamic changes of the electrocardiogram during the episode with high temporal resolution. This case illustrates the importance of recognizing coronary spasm as a potential cause of complete atrioventricular block and highlights the need for implantable cardioverter defibrillator in such patients to improve survival and quality of life.
Collapse
Affiliation(s)
- Wei Gao
- Department of Heart Center, The Third Central Hospital of Tianjin, 83 Jintang Road, Hedong District, Tianjin, 300170, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, China
- Artificial Cell Engineering Technology Research Center, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Yingwu Liu
- Department of Heart Center, The Third Central Hospital of Tianjin, 83 Jintang Road, Hedong District, Tianjin, 300170, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, China
- Artificial Cell Engineering Technology Research Center, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Tong Li
- Department of Heart Center, The Third Central Hospital of Tianjin, 83 Jintang Road, Hedong District, Tianjin, 300170, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, China
- Artificial Cell Engineering Technology Research Center, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| |
Collapse
|
17
|
Paratz ED, Stub D, Sutherland N, Gutman S, La Gerche A, Mariani J, Taylor A, Ellims A. The challenge of risk stratification in hypertrophic cardiomyopathy: Clinical, genetic and imaging insights from a quaternary referral centre. Int J Cardiol 2024; 395:131416. [PMID: 37802298 DOI: 10.1016/j.ijcard.2023.131416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/27/2023] [Accepted: 10/02/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is the commonest genetic cardiomyopathy and may result in sudden cardiac death (SCD). Clinical risk stratification scores are utilised to estimate SCD risk and determine potential utility of a primary prevention implantable cardioverter defibrillator (ICD). METHODS Patients with a confirmed diagnosis of HCM from a quaternary HCM service were defined according to clinical characteristics, genetic profiles and cardiac imaging results. European Risk-SCD score and American Heart Association / American College of Cardiology (AHA/ACC) Score were calculated. The primary outcome was cardiac arrest. RESULTS 380 patients with HCM were followed up for a median of 6.4 years. 18 patients (4.7%) experienced cardiac arrest, with predictive factors being younger age (37.2 vs 54.4 years, p = 0.0041), unexplained syncope (33.3% vs 9.4%, p = 0.007), non-sustained ventricular tachycardia (50.0% vs 12.7%, p < 0.0001), increased septal thickness (21.5 vs 17.5 mm, p = 0.0003), and presence of a sarcomeric gene mutation (100.0% vs 65.8%, p = 0.038). The Risk-SCD and AHA/ACC scores had poor agreement (kappa coefficient 0.38). Risk-SCD score had poor sensitivity (44.4%), classifying 55.6% of patients with cardiac arrest as low-risk but was highly specific (93.7%). AHA/ACC risk score did not discriminate between groups significantly. 20 patients (5.3%) died, with most >60-year-olds having a non-cardiac cause of death (p = 0.0223). CONCLUSION This study highlights limited (38%) agreement between the Risk-SCD and AHA/ACC scores. Most cardiac arrests occurred in ostensibly low or medium-risk patients under both scores. Appropriate ICD selection remains challenging. Incorporating newer risk markers such as HCM genotyping and myocardial fibrosis quantification by cardiac MRI may assist future risk refinement.
Collapse
Affiliation(s)
- Elizabeth D Paratz
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia; Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia; St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC 3065, Australia; Ambulance Victoria, 375 Manningham Rd, Doncaster, VIC 3108, Australia.
| | - Dion Stub
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia; Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia; Ambulance Victoria, 375 Manningham Rd, Doncaster, VIC 3108, Australia; Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Australia
| | | | - Sarah Gutman
- Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia
| | - Andre La Gerche
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia; Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia; St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC 3065, Australia
| | - Justin Mariani
- Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia
| | - Andrew Taylor
- Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia
| | - Andris Ellims
- Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia
| |
Collapse
|
18
|
Wang CN, Lu Z, Simpson CS, Lee DS, Tranmer JE. Predicting long-term survival after de novo cardioverter-defibrillator implantation for primary prevention: A population based study. Heliyon 2024; 10:e23355. [PMID: 38223713 PMCID: PMC10784147 DOI: 10.1016/j.heliyon.2023.e23355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/22/2023] [Accepted: 12/01/2023] [Indexed: 01/16/2024] Open
Abstract
Background Implantable cardioverter-defibrillators (ICDs) reduce the risk of sudden cardiac death in patients with left ventricular dysfunction. While short-term mortality benefit of ICD insertion has been established in landmark randomized controlled trials, little is known about the long-term outcomes of patients with ICDs in clinical practice. In this paper, we describe the long-term survival of patients following de novo ICD implantation for primary prevention in clinical practice and determine the factors which help predict survival after ICD implant. Methods Retrospective population-based study of all patients receiving a de novo ICD for primary prevention in Ontario, Canada from 2007 to 2011 using the Ontario ICD Database housed within ICES. Simple random selection was used to split the population into a derivation and internal validation cohort in a ratio of 2:1. Cox proportional hazards regression was used to determine predictors of interest and predict 10-year survival, model performance was assessed using calibration and validation. Results In the derivation cohort (n = 3399), mean age was 65.3 years (standard deviation [SD] = 11.0), 664 patients were female (19.5 %) and 2344 patients (69.0 %) had ischemic cardiomyopathy. Ten year survival was 45.7 % (95 % confidence interval [CI] 44.0 %-47.4 %). The final prediction model included age, sex, disease factors (ischemic vs nonischemic cardiomyopathy, left ventricular ejection fraction) and patient factors (symptoms, comorbidities), and biomarkers at the time of ICD assessment. This model had good discrimination and calibration in derivation (0.79, 95 % CI 0.77, 0.81) and validation samples (0.78, 95 % CI 0.76, 0.79). Conclusions A combination of demographic and clinical factors determined at baseline can be used to predict 10-year survival in patients with implantable cardioverter-defibrillators with good accuracy. Our findings help to identify individuals at risk of long-term mortality and may be useful in targeting future prevention strategies to enhance longevity in this high-risk population.
Collapse
Affiliation(s)
- Chang Nancy Wang
- Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
- ICES Central, Toronto, Ontario, Canada
| | - Zihang Lu
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Christopher S. Simpson
- Division of Cardiology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
- ICES Queen's, Kingston, Ontario, Canada
- Ontario Health, Toronto, Ontario, Canada
| | - Douglas S. Lee
- ICES Central, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Peter Munk Cardiac Center, University Health Network, Toronto, Ontario, Canada
- Ted Rogers Center for Heart Research, Toronto, Ontario, Canada
| | - Joan E. Tranmer
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
- ICES Queen's, Kingston, Ontario, Canada
- School of Nursing, Queen's University, Kingston, Ontario, Canada
| |
Collapse
|
19
|
Misra S, Swayampakala K, Rajwani A, Davenport E, Fedor J, Saxonhouse S, Holshouser J, Patel N, Thompson J, Beaty E, Jain M, Powell B, Mehta R. Outcomes of an expedited same-day discharge protocol following cardiac implantable electronic device (CIED) implantation. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01734-w. [PMID: 38194120 DOI: 10.1007/s10840-024-01734-w] [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: 07/31/2023] [Accepted: 01/01/2024] [Indexed: 01/10/2024]
Abstract
BACKGROUND With increasing constraints on healthcare resources, greater attention is being focused on improved resource utilization. Prior studies have demonstrated safety of same-day discharge following CIED implantation but are limited by vague protocols with long observation periods. In this study, we evaluate the safety of an expedited 2 hour same-day discharge protocol following CIED implantation. METHODS Patients undergoing CIED implantation at three centers between 2015 and 2021 were included. Procedural, demographic, and adverse event data were abstracted from the electronic health record. Patients were divided into same-day discharge (SDD) and delayed discharge (DD) cohorts. The primary outcome was complications including lead malfunction requiring revision, pneumothorax, hemothorax, lead dislodgement, lead perforation with tamponade, and mortality within 30 days of procedure. Outcomes were compared between the two cohorts using the χ2 test. RESULTS A total of 4543 CIED implantation procedures were included with 1557 patients (34%) in the SDD cohort. SDD patients were comparatively younger, were more likely to be male, and had fewer comorbidities than DD patients. Among SDD patients, the mean time to post-operative chest X-ray was 2.6 h. SDD had lower rates of complications (1.3% vs 2.1%, p = 0.0487) and acute care utilization post-discharge (9.6% vs 14.0%, p < 0.0001). There was no difference in the 90-day infection rate between the cohorts. CONCLUSIONS An expedited 2 hour same-day discharge protocol is safe and effective with low rates of complications, infection, and post-operative acute care utilization.
Collapse
Affiliation(s)
- Satish Misra
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA.
| | - Kamala Swayampakala
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - Aparna Rajwani
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - Elizabeth Davenport
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - John Fedor
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - Sherry Saxonhouse
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - John Holshouser
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - Neel Patel
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - Joseph Thompson
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - Elijah Beaty
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - Manish Jain
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - Brian Powell
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - Rohit Mehta
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| |
Collapse
|
20
|
Rautio E, Gadler F, Gudbjörnsdottir S, Franzén S, Rydén L, Savarese G, Svensson AM, Mellbin LG. Implantable cardioverter defibrillator and cardiac resynchronization treatment in people with type 2 diabetes: a comparison with age- and sex matched controls from the general population. Cardiovasc Diabetol 2024; 23:18. [PMID: 38184588 PMCID: PMC10771698 DOI: 10.1186/s12933-023-02084-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/01/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Increased risk of severe tachyarrhythmias is reported in patients with type 2 diabetes mellitus (T2DM). The aim of this study was to explore if treatment with cardiac implantable electronic device (CIED) such as implantable cardioverter defibrillator (ICD), cardiac resynchronization therapy- pacemaker and -defibrillator (CRT-P/CRT-D) differed in patients with vs. without T2DM. A secondary aim was to identify patient characteristics indicating an increased CIED treatment. METHOD 416 162 adult patients with T2DM from the Swedish National Diabetes Registry and 2 081 087 controls from the Swedish population, matched for age, sex and living area, were included between 1/1/1998 and 31/12/2012 and followed until 31/12/2013. They were compared regarding prevalence of ventricular tachycardia (VT) at baseline and the risk of receiving a CIED during follow-up. Multivariable Cox regression analysis was performed to estimate the risk of CIED-treatment and factors identifying patients with such risk. RESULTS Ventricular fibrillation (VF) (0.1% vs 0.0004%) and (VT) (0.2% vs. 0.1%) were more frequent among patients with T2DM compared to controls. CIED-treatment was significantly increased in patients with T2DM both in unadjusted and adjusted analyses. HR and 95% CI, after adjustment for sex, age, marital status, income, education, country of birth, coronary artery disease and congestive heart failure, were 1.32 [1.21-1.45] for ICD, 1.74 [1.55-1.95] for CRT-P and 1.69 [1.43-1.99] for CRT-D. Blood-pressure and lipid lowering therapies were independent risk factors associated to receiving CIED, while female sex was protective. CONCLUSIONS Although the proportion of VT/VF was low, patients with T2DM had a higher prevalence of these conditions and increased risk for treatment with CIED compared to controls. This underlines the importance of recognizing that T2DM patients have an increased need of CIED.
Collapse
Affiliation(s)
- Elina Rautio
- Cardiology Research Unit, Department of Medicine, Solna Karolinska Institutet, 171 76, Stockholm, Sweden.
| | - Fredrik Gadler
- Cardiology Research Unit, Department of Medicine, Solna Karolinska Institutet, 171 76, Stockholm, Sweden
- Department of Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden
- Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Soffia Gudbjörnsdottir
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
- Centre of Registers in Region Västra Götaland, Gothenburg, Sweden
| | - Stefan Franzén
- Centre of Registers in Region Västra Götaland, Gothenburg, Sweden
- Health Metrics Unit, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lars Rydén
- Cardiology Research Unit, Department of Medicine, Solna Karolinska Institutet, 171 76, Stockholm, Sweden
- Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Gianluigi Savarese
- Cardiology Research Unit, Department of Medicine, Solna Karolinska Institutet, 171 76, Stockholm, Sweden
| | - Ann-Marie Svensson
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
- Centre of Registers in Region Västra Götaland, Gothenburg, Sweden
| | - Linda G Mellbin
- Cardiology Research Unit, Department of Medicine, Solna Karolinska Institutet, 171 76, Stockholm, Sweden
- Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
21
|
Kurozumi A, Enomoto Y, Hara H, Kato N, Hiroi Y. A Case of Ventricular Fibrillation in Masked Long-QT Syndrome Coexisting with Coronary Vasospasm. Int Heart J 2024; 65:354-358. [PMID: 38556343 DOI: 10.1536/ihj.23-397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Although long-QT syndrome (LQTS) with a normal range QT interval at rest leads to fatal ventricular arrhythmias, it is difficult to diagnose. In this article, we present a rare case of a patient who suffered a cardiac arrest and was recently diagnosed with LQTS and coronary vasospasm. A 62-year-old man with no syncopal episodes had a cardiopulmonary arrest while running. During coronary angiography, vasospasm was induced and we prescribed coronary vasodilators, including calcium channel blockers. An exercise stress test was performed to evaluate the effect of medications and accidentally unveiled exercise-induced QT prolongation. He was diagnosed with LQTS based on diagnostic criteria. Pharmacotherapy and an implantable cardioverter defibrillator were used for his medical management. It is extremely rare for LQTS and coronary vasospasm to coexist. In cases of exercise-induced arrhythmic events, the exercise stress test might be helpful to diagnose underlying disease.
Collapse
Affiliation(s)
- Atsumasa Kurozumi
- Department of Cardiology, National Center for Global Health and Medicine
| | - Yoshinari Enomoto
- Department of Cardiology, National Center for Global Health and Medicine
| | - Hisao Hara
- Department of Cardiology, National Center for Global Health and Medicine
| | - Norihiro Kato
- Department of Cardiology, National Center for Global Health and Medicine
- Medical Genomics Center, National Center for Global Health and Medicine
| | - Yukio Hiroi
- Department of Cardiology, National Center for Global Health and Medicine
| |
Collapse
|
22
|
Lee SR, Lee JH, Choi EK, Jung EK, You SJ, Oh S, Lip GY. Risk of Atrial Fibrillation and Adverse Outcomes in Patients With Cardiac Implantable Electronic Devices. Korean Circ J 2024; 54:13-27. [PMID: 37973974 PMCID: PMC10784609 DOI: 10.4070/kcj.2023.0084] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/02/2023] [Accepted: 08/23/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Comprehensive epidemiological data are lacking on the incident atrial fibrillation (AF) in patients with cardiac implantable electronic devices (CIEDs). This study aimed to examine the incidence, risk factors, and AF-related adverse outcomes of patients with CIEDs. METHODS This was an observational cohort study that analyzed patients without prevalent AF who underwent CIED implantation in 2009-2018 using a Korean nationwide claims database. The subjects were divided into three groups by CIED type and indication: pacemaker (n=21,438), implantable cardioverter defibrillator (ICD)/cardiac resynchronization therapy (CRT) with heart failure (HF) (n=3,450), and ICD for secondary prevention without HF (n=2,146). The incidence of AF, AF-associated predictors, and adverse outcomes were evaluated. RESULTS During follow-up, the incidence of AF was 4.3, 7.3, and 5.1 per 100 person-years in the pacemaker, ICD/CRT with HF, and ICD without HF cohorts, respectively. Across the three cohorts, older age and valvular heart disease were commonly associated with incident AF. Incident AF was consistently associated with an increased risk of ischemic stroke (3.8-11.4-fold), admission for HF (2.6-10.5-fold), hospitalization for any cause (2.4-2.7-fold), all-cause death (4.1-5.0-fold), and composite outcomes (3.4-5.7-fold). Oral anticoagulation rates were suboptimal in patients with incident AF (pacemaker, 51.3%; ICD/CRT with HF, 51.7%; and ICD without HF, 33.8%, respectively). CONCLUSIONS A substantial proportion of patients implanted CIED developed newly diagnosed AF. Incident AF was associated with a higher risk of adverse events. The importance of awareness, early detection, and appropriate management of AF in patients with CIED should be emphasized.
Collapse
Affiliation(s)
- So-Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Hyun Lee
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
| | | | | | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Gregory Yh Lip
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Chest and Heart Hospital, Liverpool, United Kingdom
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| |
Collapse
|
23
|
Sun H, Liu X, Fu J, Song Y, Qin X, Wang H. Cost effectiveness of implantable cardioverter defibrillators for 1.5 primary prevention of sudden cardiac arrest in China: an analysis from the Improve SCA study. J Med Econ 2024; 27:575-581. [PMID: 38566556 DOI: 10.1080/13696998.2024.2333187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/18/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES Implantable cardioverter defibrillator (ICDs) for primary prevention (PP) of sudden cardiac arrest (SCA) is underutilized in developing countries. The Improve SCA study has identified a subset of 1.5 primary prevention (1.5PP) patients with a higher risk of SCA and a significant mortality benefit from ICD therapy. From the perspective of China's healthcare system, we evaluated the cost-effectiveness of ICD therapy vs. no ICD therapy among 1.5PP patients with a view to informing clinical and policy decisions. METHODS A published Markov model was adjusted and verified to simulate the course of the disease and describe different health states of 1.5PP patients. The patient characteristics, mortality, utility and complication estimates were obtained from the Improve SCA study and other literature. Cost inputs were sourced from government tender prices, medical service prices and clinical experts' surveys in 9 Chinese public hospitals. For both ICD and no ICD therapy, the total medical costs and quality-adjusted life-years (QALYs) were modelled over a lifetime horizon and the incremental cost-effectiveness ratio (ICER) was calculated. Deterministic and probabilistic sensitivity analyses were performed to assess the uncertainty of the model parameters. We used the willingness-to-pay (WTP) threshold recommended by China Guidelines for Pharmacoeconomic Evaluations, one to three times China's GDP per capita (CNY85,698-CNY257,094) in 2022 Chinese Yuan. RESULTS The incremental cost effectiveness ratio (ICER) of ICD therapy compared to no ICD therapy is 139,652 CNY/QALY, which is about 1-2 times China's GDP per capita. The probability that ICD therapy is cost effective was 92.1%. Results from sensitivity analysis supported the findings of the base case. CONCLUSIONS ICD therapy compared to no ICD therapy is cost-effective for the 1.5PP patients in China.
Collapse
Affiliation(s)
- Hui Sun
- Shanghai Medical Information Center, Shanghai Health Development Research Center, Shanghai, China
| | - Xin Liu
- Shanghai Medical Information Center, Shanghai Health Development Research Center, Shanghai, China
| | - Jin Fu
- Medtronic, Shanghai, China
| | | | - Xiaoxiao Qin
- Shanghai Medical Information Center, Shanghai Health Development Research Center, Shanghai, China
| | - Haiyin Wang
- Shanghai Medical Information Center, Shanghai Health Development Research Center, Shanghai, China
| |
Collapse
|
24
|
Sau A, Ahmed A, Chen JY, Pastika L, Wright I, Li X, Handa B, Qureshi N, Koa-Wing M, Keene D, Malcolme-Lawes L, Varnava A, Linton NWF, Lim PB, Lefroy D, Kanagaratnam P, Peters NS, Whinnett Z, Ng FS. Machine learning-derived cycle length variability metrics predict spontaneously terminating ventricular tachycardia in implantable cardioverter defibrillator recipients. Eur Heart J Digit Health 2024; 5:50-59. [PMID: 38264702 PMCID: PMC10802825 DOI: 10.1093/ehjdh/ztad064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/06/2023] [Accepted: 10/16/2023] [Indexed: 01/25/2024]
Abstract
Aims Implantable cardioverter defibrillator (ICD) therapies have been associated with increased mortality and should be minimized when safe to do so. We hypothesized that machine learning-derived ventricular tachycardia (VT) cycle length (CL) variability metrics could be used to discriminate between sustained and spontaneously terminating VT. Methods and results In this single-centre retrospective study, we analysed data from 69 VT episodes stored on ICDs from 27 patients (36 spontaneously terminating VT, 33 sustained VT). Several VT CL parameters including heart rate variability metrics were calculated. Additionally, a first order auto-regression model was fitted using the first 10 CLs. Using features derived from the first 10 CLs, a random forest classifier was used to predict VT termination. Sustained VT episodes had more stable CLs. Using data from the first 10 CLs only, there was greater CL variability in the spontaneously terminating episodes (mean of standard deviation of first 10 CLs: 20.1 ± 8.9 vs. 11.5 ± 7.8 ms, P < 0.0001). The auto-regression coefficient was significantly greater in spontaneously terminating episodes (mean auto-regression coefficient 0.39 ± 0.32 vs. 0.14 ± 0.39, P < 0.005). A random forest classifier with six features yielded an accuracy of 0.77 (95% confidence interval 0.67 to 0.87) for prediction of VT termination. Conclusion Ventricular tachycardia CL variability and instability are associated with spontaneously terminating VT and can be used to predict spontaneous VT termination. Given the harmful effects of unnecessary ICD shocks, this machine learning model could be incorporated into ICD algorithms to defer therapies for episodes of VT that are likely to self-terminate.
Collapse
Affiliation(s)
- Arunashis Sau
- National Heart and Lung Institute, Hammersmith Campus, Imperial College London, 72 Du Cane Road, W12 0HS, London, UK
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, 72 Du Cane Road, W12 0HS, London, UK
| | - Amar Ahmed
- National Heart and Lung Institute, Hammersmith Campus, Imperial College London, 72 Du Cane Road, W12 0HS, London, UK
| | - Jun Yu Chen
- National Heart and Lung Institute, Hammersmith Campus, Imperial College London, 72 Du Cane Road, W12 0HS, London, UK
| | - Libor Pastika
- National Heart and Lung Institute, Hammersmith Campus, Imperial College London, 72 Du Cane Road, W12 0HS, London, UK
| | - Ian Wright
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, 72 Du Cane Road, W12 0HS, London, UK
| | - Xinyang Li
- National Heart and Lung Institute, Hammersmith Campus, Imperial College London, 72 Du Cane Road, W12 0HS, London, UK
| | - Balvinder Handa
- National Heart and Lung Institute, Hammersmith Campus, Imperial College London, 72 Du Cane Road, W12 0HS, London, UK
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, 72 Du Cane Road, W12 0HS, London, UK
| | - Norman Qureshi
- National Heart and Lung Institute, Hammersmith Campus, Imperial College London, 72 Du Cane Road, W12 0HS, London, UK
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, 72 Du Cane Road, W12 0HS, London, UK
| | - Michael Koa-Wing
- National Heart and Lung Institute, Hammersmith Campus, Imperial College London, 72 Du Cane Road, W12 0HS, London, UK
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, 72 Du Cane Road, W12 0HS, London, UK
| | - Daniel Keene
- National Heart and Lung Institute, Hammersmith Campus, Imperial College London, 72 Du Cane Road, W12 0HS, London, UK
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, 72 Du Cane Road, W12 0HS, London, UK
| | - Louisa Malcolme-Lawes
- National Heart and Lung Institute, Hammersmith Campus, Imperial College London, 72 Du Cane Road, W12 0HS, London, UK
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, 72 Du Cane Road, W12 0HS, London, UK
| | - Amanda Varnava
- National Heart and Lung Institute, Hammersmith Campus, Imperial College London, 72 Du Cane Road, W12 0HS, London, UK
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, 72 Du Cane Road, W12 0HS, London, UK
| | - Nicholas W F Linton
- National Heart and Lung Institute, Hammersmith Campus, Imperial College London, 72 Du Cane Road, W12 0HS, London, UK
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, 72 Du Cane Road, W12 0HS, London, UK
| | - Phang Boon Lim
- National Heart and Lung Institute, Hammersmith Campus, Imperial College London, 72 Du Cane Road, W12 0HS, London, UK
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, 72 Du Cane Road, W12 0HS, London, UK
| | - David Lefroy
- National Heart and Lung Institute, Hammersmith Campus, Imperial College London, 72 Du Cane Road, W12 0HS, London, UK
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, 72 Du Cane Road, W12 0HS, London, UK
| | - Prapa Kanagaratnam
- National Heart and Lung Institute, Hammersmith Campus, Imperial College London, 72 Du Cane Road, W12 0HS, London, UK
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, 72 Du Cane Road, W12 0HS, London, UK
| | - Nicholas S Peters
- National Heart and Lung Institute, Hammersmith Campus, Imperial College London, 72 Du Cane Road, W12 0HS, London, UK
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, 72 Du Cane Road, W12 0HS, London, UK
| | - Zachary Whinnett
- National Heart and Lung Institute, Hammersmith Campus, Imperial College London, 72 Du Cane Road, W12 0HS, London, UK
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, 72 Du Cane Road, W12 0HS, London, UK
| | - Fu Siong Ng
- National Heart and Lung Institute, Hammersmith Campus, Imperial College London, 72 Du Cane Road, W12 0HS, London, UK
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, 72 Du Cane Road, W12 0HS, London, UK
- Department of Cardiology, Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, SW10 9NH, London, UK
| |
Collapse
|
25
|
Li L, Ding L, Zhou L, Wu L, Zheng L, Zhang Z, Xiong Y, Zhang Z, Yao Y. Outcomes of catheter ablation in high-risk patients with Brugada syndrome refusing an implantable cardioverter defibrillator implantation. Europace 2023; 26:euad318. [PMID: 37889958 PMCID: PMC10754161 DOI: 10.1093/europace/euad318] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/14/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
AIMS The aim of this study was to investigate the outcomes of catheter ablation (CA) in preventing arrhythmic events among patients with symptomatic Brugada syndrome (BrS) who declined implantable cardioverter defibrillator (ICD) implantation. METHODS AND RESULTS A total of 40 patients with symptomatic BrS were included in the study, of which 18 refused ICD implantation and underwent CA, while 22 patients received ICD implantation. The study employed substrate modification (including endocardial and epicardial approaches) and ventricular fibrillation (VF)-triggering pre-mature ventricular contraction (PVC) ablation strategies. The primary outcomes were a composite endpoint consisting of episodes of VF and sudden cardiac death during the follow-up period. The study population had a mean age of 43.8 ± 9.6 years, with 36 (90.0%) of them being male. All patients exhibited the typical Type 1 BrS electrocardiogram pattern, and 16 (40.0%) were carriers of an SCN5A mutation. The Shanghai risk scores were comparable between the CA and the ICD groups (7.05 ± 0.80 vs. 6.71 ± 0.86, P = 0.351). Ventricular fibrillation-triggering PVCs were ablated in 3 patients (16.7%), while VF substrates were ablated in 15 patients (83.3%). Epicardial ablation was performed in 12 patients (66.7%). During a median follow-up of 46.2 (17.5-73.7) months, the primary outcomes occurred more frequently in the ICD group than in the CA group (5.6 vs. 54.5%, Log-rank P = 0.012). CONCLUSION Catheter ablation is an effective alternative therapy for improving arrhythmic outcomes in patients with symptomatic BrS who decline ICD implantation. Our findings support the consideration of CA as an alternative treatment option in this population.
Collapse
Affiliation(s)
- Le Li
- Chinese Academy of Medical Sciences, Peking Union Medical College, National Center for Cardiovascular Diseases, Fuwai Hospital, Beilishi Road 167#, Xicheng District, Beijing 100037, China
| | - Ligang Ding
- Chinese Academy of Medical Sciences, Peking Union Medical College, National Center for Cardiovascular Diseases, Fuwai Hospital, Beilishi Road 167#, Xicheng District, Beijing 100037, China
| | - Likun Zhou
- Chinese Academy of Medical Sciences, Peking Union Medical College, National Center for Cardiovascular Diseases, Fuwai Hospital, Beilishi Road 167#, Xicheng District, Beijing 100037, China
| | - Lingmin Wu
- Chinese Academy of Medical Sciences, Peking Union Medical College, National Center for Cardiovascular Diseases, Fuwai Hospital, Beilishi Road 167#, Xicheng District, Beijing 100037, China
| | - Lihui Zheng
- Chinese Academy of Medical Sciences, Peking Union Medical College, National Center for Cardiovascular Diseases, Fuwai Hospital, Beilishi Road 167#, Xicheng District, Beijing 100037, China
| | - Zhenhao Zhang
- Chinese Academy of Medical Sciences, Peking Union Medical College, National Center for Cardiovascular Diseases, Fuwai Hospital, Beilishi Road 167#, Xicheng District, Beijing 100037, China
| | - Yulong Xiong
- Chinese Academy of Medical Sciences, Peking Union Medical College, National Center for Cardiovascular Diseases, Fuwai Hospital, Beilishi Road 167#, Xicheng District, Beijing 100037, China
| | - Zhuxin Zhang
- Chinese Academy of Medical Sciences, Peking Union Medical College, National Center for Cardiovascular Diseases, Fuwai Hospital, Beilishi Road 167#, Xicheng District, Beijing 100037, China
| | - Yan Yao
- Chinese Academy of Medical Sciences, Peking Union Medical College, National Center for Cardiovascular Diseases, Fuwai Hospital, Beilishi Road 167#, Xicheng District, Beijing 100037, China
| |
Collapse
|
26
|
Skov O, Johansen JB, Nielsen JC, Larroudé CE, Riahi S, Melchior TM, Vinther M, Skovbakke SJ, Rottmann N, Wiil UK, Brandt CJ, Smolderen KG, Spertus JA, Pedersen SS. Efficacy of a web-based healthcare innovation to advance the quality of life and care of patients with an implantable cardioverter defibrillator (ACQUIRE-ICD): a randomized controlled trial. Europace 2023; 25:euad253. [PMID: 38055845 PMCID: PMC10700011 DOI: 10.1093/europace/euad253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/08/2023] [Indexed: 12/08/2023] Open
Abstract
AIMS Modern clinical management of patients with an implantable cardioverter defibrillator (ICD) largely consists of remote device monitoring, although a subset is at risk of mental health issues post-implantation. We compared a 12-month web-based intervention consisting of goal setting, monitoring of patients' mental health-with a psychological intervention if needed-psychoeducational support from a nurse, and an online patient forum, with usual care on participants' device acceptance 12 months after implantation. METHODS AND RESULTS This national, multi-site, two-arm, non-blinded, randomized, controlled, superiority trial enrolled 478 first-time ICD recipients from all 6 implantation centres in Denmark. The primary endpoint was patient device acceptance measured by the Florida Patient Acceptance Survey (FPAS; general score range = 0-100, with higher scores indicating higher device acceptance) 12 months after implantation. Secondary endpoints included symptoms of depression and anxiety. The primary endpoint of device acceptance was not different between groups at 12 months [B = -2.67, 95% confidence interval (CI) (-5.62, 0.29), P = 0.08]. Furthermore, the secondary endpoint analyses showed no significant treatment effect on either depressive [B = -0.49, 95% CI (-1.19; 0.21), P = 0.17] or anxiety symptoms [B = -0.39, 95% CI (-0.96; 0.18), P = 0.18]. CONCLUSION The web-based intervention as supplement to usual care did not improve patient device acceptance nor symptoms of anxiety and depression compared with usual care. This specific web-based intervention thus cannot be recommended as a standardized intervention in ICD patients.
Collapse
Affiliation(s)
- Ole Skov
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense, Denmark
| | | | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Thomas M Melchior
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Michael Vinther
- Department of Cardiology B, Rigshospitalet, Copenhagen, Denmark
| | - Søren Jensen Skovbakke
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense, Denmark
| | - Nina Rottmann
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense, Denmark
| | - Uffe Kock Wiil
- SDU Health Informatics and Technology, The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
| | - Carl Joakim Brandt
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Kim G Smolderen
- Department of Internal Medicine, Vascular Medicine Outcomes Program, Yale School of Medicine, New Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - John A Spertus
- Kansas City’s Healthcare Institute for Innovations in Quality and Saint Luke’s Mid America Heart Institute, University of Missouri, Kansas City, MO, USA
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| |
Collapse
|
27
|
Tan RB, Stephenson EA, Bulic A. Epicardial Devices in Pediatrics and Congenital Heart Disease. Card Electrophysiol Clin 2023; 15:467-480. [PMID: 37865520 DOI: 10.1016/j.ccep.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Epicardial cardiac implantable electronic device implant remains a common option in pediatric patients and certain patients with congenital heart disease due to patient size, complex anatomy, residual intracardiac shunts, and prior surgery precluding transvenous implant. Advantages include the lack of thromboembolic and vascular risks and ability to implant during concomitant surgery. Significant disadvantages include the occurrence of lead dysfunction that can result in bradycardia events in pacemaker patients, inappropriate shocks in implantable cardiac defibrillator patients, and overall a more invasive procedure.
Collapse
Affiliation(s)
- Reina Bianca Tan
- Division of Cardiology, Department of Pediatrics, NYU Langone Health and Hassenfeld Children's Hospital, 403 East 34th Street, Level 4, New York, NY 10017, USA.
| | - Elizabeth A Stephenson
- University of Toronto, The Hospital for Sick Children, Labatt Family Heart Centre, 555 University Avenue, Room 1725, Toronto, Ontario M5G1X8, Canada
| | - Anica Bulic
- University of Toronto, The Hospital for Sick Children, Labatt Family Heart Centre, 555 University Avenue, Room 1725, Toronto, Ontario M5G1X8, Canada
| |
Collapse
|
28
|
Howard TS, Vinocur JM. Translation of Tools and Techniques from the Adult Electrophysiology World to Pediatric Cardiac Implantable Electronic Devices. Card Electrophysiol Clin 2023; 15:515-525. [PMID: 37865524 DOI: 10.1016/j.ccep.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
This article reviews various opportunities to translate established and novel tools and techniques used in adult electrophysiology to pediatrics and the adult congenital heart disease population. There is a specific focus on preoperative management of special population, implantation techniques, and postoperative programming of devices.
Collapse
Affiliation(s)
- Taylor S Howard
- Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, 6651 Main Street, E1920, Houston, TX 77030, USA.
| | - Jeffrey M Vinocur
- Department of Pediatrics, Division of Pediatric Cardiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
| |
Collapse
|
29
|
Clark BC, Berul CI. Emerging Technologies for the Smallest Patients. Card Electrophysiol Clin 2023; 15:505-513. [PMID: 37865523 DOI: 10.1016/j.ccep.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Pediatric and congenital heart disease patients may require cardiac implantable electronic device implantation, inclusive of pacemaker, ICD, and implantable cardiac monitor, for a variety of etiologies. While leads, generators, and monitors have decreased in size over the years, they remain less ideal for the smallest patients. The potential for a miniature pacemaker, fetal micropacemaker, improving leadless technology, and rechargeable devices creates hope that the development of pediatric-focused devices will increase. Further, alternative approaches that avoid the need for a transvenous or surgical approach may add more options to the toolbox for the pediatric and congenital electrophysiologist.
Collapse
Affiliation(s)
- Bradley C Clark
- Division of Pediatric Cardiology, Department of Pediatrics, Masonic Children's Hospital, University of Minnesota Medical School, 2450 Riverside Avenue South, AO-405, Minneapolis, MN 55454, USA.
| | - Charles I Berul
- Division of Cardiology, Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, 111 Michigan Avenue, NW, Washington, DC 20010, USA
| |
Collapse
|
30
|
Helmark C, Egholm CL, Rottmann N, Skovbakke SJ, Andersen CM, Johansen JB, Nielsen JC, Larroudé CE, Riahi S, Brandt CJ, Pedersen SS. A web-based intervention for patients with an implantable cardioverter defibrillator - A qualitative study of nurses' experiences (Data from the ACQUIRE-ICD study). PEC Innov 2023; 2:100110. [PMID: 37214535 PMCID: PMC10194258 DOI: 10.1016/j.pecinn.2022.100110] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 11/08/2022] [Accepted: 11/26/2022] [Indexed: 05/24/2023]
Abstract
Objective The aim of this study was to explore cardiac nurses' experiences with a comprehensive web-based intervention for patients with an implantable cardioverter defibrillator. Methods We conducted an explorative qualitative study based on individual semi-structured interviews with 9 cardiac nurses from 5 Danish university hospitals. Results We found one overall theme: "Between traditional nursing and modern eHealth". This theme was derived from the following six categories: (1) comprehensive content in the intervention, (2) patient-related differences in engagement, (3) following the protocol is a balancing act, (4) online communication challenges patient contact, (5) professional collaboration varies, and (6) an intervention with potential. Cardiac nurses were positive towards the web-based intervention and believe it holds a large potential. However, they felt challenged by not having in-person and face-to-face contact with patients, which they found valuable for assessing patients' wellbeing and psychological distress. Conclusion Specific training in eHealth communication seems necessary as web-based care entails a shift in the nursing role and requires a different way of communication.InnovationFocusing on the user experience in web-based care from the perspective of cardiac nurses is innovative, and by applying implementation science this leads to new knowledge to consider when developing and implementing web-based care.
Collapse
Affiliation(s)
- Charlotte Helmark
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Cecilie L. Egholm
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Nina Rottmann
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Søren J. Skovbakke
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Christina M. Andersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense, Denmark
| | - Jens B. Johansen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Jens C. Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
- Denmark and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Charlotte E. Larroudé
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Carl J. Brandt
- Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - Susanne S. Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| |
Collapse
|
31
|
Staal DP, Maarse M, Aarnink E, Huijboom MFM, Abeln BGS, Rensing BJMW, Swaans MJ, Van Dijk VF, Boersma LVA. Percutaneous left atrial appendage occlusion in patients with a cardiac implantable electronic device. J Interv Card Electrophysiol 2023; 66:1971-1978. [PMID: 36856972 PMCID: PMC10694092 DOI: 10.1007/s10840-023-01512-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/14/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Left atrial appendage occlusion (LAAO) may be a viable option for stroke prevention in patients with non-valvular atrial fibrillation and a contraindication for oral anticoagulation. No evidence evaluating the safety of this procedure in patients with a cardiac implantable electronic device (CIED) exists. The aim of this study was to evaluate whether CIED function is affected by LAAO and to explore LAAO procedural characteristics and complications in patients with a CIED. METHODS This single-center cohort study included consecutive patients scheduled for percutaneous LAAO. Patients with a CIED prior to LAAO were selected and compared to the patients without CIED, concerning procedural characteristics and peri-procedural complications. In the group of patients with CIEDs, essential pacemaker integrity parameters were compared before and after the procedure to detect possible micro and macro lead displacements. RESULTS Thirty-one patients with CIED were scheduled for LAAO (age 73.7 ± 5.4 years, 65% males, CHA2DS2-VASc 4.3 ± 1.5, and HAS-BLED 3.3 ± 1.0). The 245 patients without CIED were younger, and HAS-BLED-score was slightly lower (69.4 ± 8.2 years, p < 0.001; 2.8 ± 1.0, p = 0.022). Patients without CIED more frequently underwent LAAO combined with catheter ablation (p = 0.002). All other procedural characteristics were comparable between both groups. No visible lead displacement was observed on chest X-ray after LAAO. Additionally, no differences in impedance, threshold, or intracardiac sensing in various CIED lead locations were found prior versus post LAAO. CONCLUSION This study supports the feasibility and safety of LAAO in patients with a CIED.
Collapse
Affiliation(s)
- D P Staal
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands.
| | - M Maarse
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
- Department of Cardiology, AMC Amsterdam, Amsterdam, the Netherlands
| | - E Aarnink
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
- Department of Cardiology, AMC Amsterdam, Amsterdam, the Netherlands
| | - M F M Huijboom
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
- Department of Cardiology, AMC Amsterdam, Amsterdam, the Netherlands
| | - B G S Abeln
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
- Department of Cardiology, AMC Amsterdam, Amsterdam, the Netherlands
| | - B J M W Rensing
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - M J Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - V F Van Dijk
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - L V A Boersma
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
- Department of Cardiology, AMC Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
32
|
Chaudry HA, Maskoun W. An intuitive method to reduce the defibrillation threshold: a case report. Eur Heart J Case Rep 2023; 7:ytad577. [PMID: 38046647 PMCID: PMC10691872 DOI: 10.1093/ehjcr/ytad577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 11/06/2023] [Accepted: 11/16/2023] [Indexed: 12/05/2023]
Abstract
Background Defibrillation threshold (DFT) testing is done to assess whether proper sensing of ventricular fibrillation and adequate safety margin for defibrillation are present in an implantable cardioverter defibrillator (ICD). This case report presents an intuitive method for lowering the DFT. It may be used on a larger scale in other patients with high DFTs when other methods for lowering the DFT (changing medications, adjusting the device, and adding coils) are not feasible or preferable to use. Case summary A 64-year-old male presented to the emergency room with failed appropriate shocks from his ICD. Device interrogation revealed that he failed his first maximum output shock before subsequent shock at the same polarity and output succeeded, suggesting a high DFT. Therefore, the DFT needs to be lowered in our patient. After considering the potential efficacy and risk of a number of traditional options, we used an intuitive method whereby the right ventricular (RV) coils of two separate leads were combined via a y-adapter. This method successfully lowered the patient's DFT, and he received successful shocks from his ICD over the next 9 months before reaching end-stage heart failure. He received a transplant, and the device and transvenous leads, except for the superior vena cava coil, were successfully removed. Discussion Combining two RV coils from different locations may lower the DFT. This method may be considered in the larger population in cases where using traditional methods are not safe or possible for certain patients. This method may work by lowering shock impedance and increasing the shock tissue surface area.
Collapse
Affiliation(s)
- Hayyan Asim Chaudry
- Division of Electrophysiology, Department of Cardiovascular Medicine, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202, USA
| | - Waddah Maskoun
- Division of Electrophysiology, Department of Cardiovascular Medicine, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202, USA
| |
Collapse
|
33
|
Malik J, Awais M, Shabbir M, Rauf A, Zaffar S, Hayat A, Mehmoodi A. Tachycardia Therapy Outcomes of Ischemic Versus Nonischemic Cardiomyopathy on Cardiac Resynchronization Therapy: A Propensity Score-matched Analysis. J Community Hosp Intern Med Perspect 2023; 13:83-89. [PMID: 38596550 PMCID: PMC11000856 DOI: 10.55729/2000-9666.1268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/23/2023] [Accepted: 09/07/2023] [Indexed: 04/11/2024] Open
Abstract
Objective This investigation aimed to investigate differences between dilated cardiomyopathy (DCM) and ischemic cardiomyopathy (ICM) patients treated with cardiac resynchronization therapy with defibrillator (CRT-D) for tachycardia therapy-related outcomes as well as mortality during follow-up of at least 1 year. Methods Seventy-eight patients with DCM (n = 42) and ICM (n = 36) with implantation or upgradation to CRT-D were included in this study and analyzed for incidence of non-sustained ventricular tachycardia (NSVT), non-sustained ventricular fibrillation (NSVF), defibrillator therapies, anti-tachycardia pacing (ATP), and mortality. Results DCM was the underlying etiology in 42 (53.84%) and ICM in 36 (46.15%). Time to first therapy was numerically longer in DCM than in ICM (9.5 ± 2.4 vs. 7.1 ± 3.2; P-value = 0.088). DCM patients had significantly higher therapy-free survival and mortality compared with ICM patients (OR (95%CI): 0.238 (0.155-0.424); log-rank P = 0.017) and (OR (95% CI): 0.612 (0.254-0.924); log-rank P = 0.029). ICM (HR (95%CI): 0.529 (0.243-0.925); P-value = 0.014) CAD (HR (95%CI): 0.326 (0.122-0.691): P-value = 0.003), and NSVT (HR (95%CI): 0.703 (0.513-0.849): P-value = 0.005) were demonstrated as independent predictors of the primary endpoint of appropriate therapy in CRT-D and ICM (HR (95%CI): 0.421 (0.321-0.524); P-value = 0.037), chronic kidney disease (CKD; HR (95%CI): 0.289 (0.198-0.380); P-value = 0.013), and CAD (HR (95%CI): 0.786 (0.531-0.967); P-value = 0.003) were predictors of mortality. Conclusion The clinical course of ICM and DCM cohorts who were treated with CRT-D differs significantly during follow-up, with increased tachycardia therapy and increased incidence of mortality in ICM patients.
Collapse
Affiliation(s)
- Jahanzeb Malik
- Department of Electrophysiology, Armed Forces Institute of Cardiology/National Institute of Heart Disease, Rawalpindi,
Pakistan
- Cardiovascular Analytics Group, Canterbury,
UK
| | - Muhammad Awais
- Department of Electrophysiology, Armed Forces Institute of Cardiology/National Institute of Heart Disease, Rawalpindi,
Pakistan
| | - Muhammad Shabbir
- Department of Electrophysiology, Armed Forces Institute of Cardiology/National Institute of Heart Disease, Rawalpindi,
Pakistan
| | - Amer Rauf
- Department of Electrophysiology, Armed Forces Institute of Cardiology/National Institute of Heart Disease, Rawalpindi,
Pakistan
| | - Shehzad Zaffar
- Department of Electrophysiology, Armed Forces Institute of Cardiology/National Institute of Heart Disease, Rawalpindi,
Pakistan
| | - Azmat Hayat
- Department of Electrophysiology, Armed Forces Institute of Cardiology/National Institute of Heart Disease, Rawalpindi,
Pakistan
| | - Amin Mehmoodi
- Department of Medicine, Ibn e Seena Hospital, Kabul,
Afghanistan
| |
Collapse
|
34
|
Mlayeh D, Hamdi S, Abdou V, Monsel F, Amara W. [Electrical storm in patients with Automatic Implantable Defibrillator : A single Center study]. Ann Cardiol Angeiol (Paris) 2023; 72:101642. [PMID: 37738754 DOI: 10.1016/j.ancard.2023.101642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Electrical storms (ES) are serious cardiac emergencies associated with increased short-term mortality. The true incidence of ES in patients with an implantable cardioverter defibrillator (ICD) is still difficult to estimate because of the heterogeneous definition. The clinical presentation is variable and its management is multidisciplinary. OBJECTIVE The aim of the study was to analyze the epidemiological profile and evolution of a group of patients implanted with an ICD who had electrical storms detected by a home monitoring system. METHODS This is a single-center retrospective observational study, which included 14 patients who were implanted with ICDs, for primary or secondary prevention between 2008 and 2021. All of them were followed by home monitoring. All these patients had an ES detected by home monitoring and authenticated by ECG. RESULTS The mean age of the patients at the time of onset of the electrical storm was 75.4 ± 14.5 years, with extremes ranging from 49 to 101 years. Most of patients (n = 11) were male. The majority of them had underlying ischaemic cardiomyopathy (n = 12). In a third of cases (n = 5) patients were implanted for secondary prevention. The electrical storm was related to recurrent episodes of VT. No cases of VF were detected. Syncope was the most frequent clinical presentation (four patients). Nine patients received internal shocks, with an average of four shocks per patient. The triggering factor was myocardial ischaemia in four cases. Majority of patients were managed in the cardiac intensive care unit. Two patients were admitted to the intensive care unit. In addition to anti-arrhythmic treatment with amiodarone and beta blockers. Nine patients underwent ablation of ventricular tachycardia focus. Mortality was high (in half of the cases) mainly due to a cardiogenic shock. CONCLUSION This study shows that OR remain rare, but are still associated with high mortality. Home monitoring makes it possible to manage them earlier.
Collapse
|
35
|
Friedman DJ, Qin L, Freeman JV, Singh JP, Curtis JP, Piccini JP, Al-Khatib SM, Jackson KP. Left ventricular lead implantation failure in an unselected nationwide cohort. Heart Rhythm 2023; 20:1420-1428. [PMID: 37406870 DOI: 10.1016/j.hrthm.2023.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Left ventricular (LV) lead implantation is often the most challenging aspect of cardiac resynchronization therapy (CRT) procedures; early studies reported implant failure rates in ∼10% of cases. OBJECTIVE The purpose of this study was to define rates, reasons for, and factors independently associated with LV lead implant failure. METHODS We studied patients with left bundle branch block and ejection fraction ≤ 35% who underwent planned de novo transvenous CRT implantation (2010-2016) and were reported to the National Cardiovascular Data Registry ICD Registry. Independent predictors of LV lead implant failure were determined using logistic regression; age, sex, and variables with a univariable P value of <.15 were considered for inclusion in the model. RESULTS Of the 111,802 patients who underwent a planned CRT procedure, 3.6% of patients (n = 3979) had LV lead implant failure. Reasons for implant failure included venous access (7.5%), coronary sinus access (64.3%), tributary vein access (13.5%), coronary sinus dissection (7.6%), unacceptable threshold (4.4%), and diaphragmatic stimulation (1.7%). Significant independent predictors of LV lead implant failure included younger age (odds ratio [OR] 1.01; 95% confidence interval [CI] 0.1.01-1.02), female sex (OR 1.38; 95% CI 1.29-1.47), black race (vs white, OR 1.44; 95% CI 1.32-1.57), Hispanic ethnicity (OR 1.23; 95% CI 1.08-1.40), QRS duration (OR 1.055 per 10 ms; 95% CI 1.038-1.072 per 10 ms), obstructive sleep apnea (OR 1.14; 95% CI 1.04-1.24), and implantation by a physician without specialized training (vs electrophysiology trained, OR 1.53; 95% CI 1.34-1.76). CONCLUSION LV lead implant failure is uncommon in the current era and is most commonly due to coronary sinus access failure. Predictors of LV lead implant failure included younger age, female sex, black race, Hispanic ethnicity, increased QRS duration, sleep apnea, and absence of electrophysiology training.
Collapse
Affiliation(s)
- Daniel J Friedman
- Electrophysiology Section, Duke University Hospital, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
| | - Li Qin
- Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut
| | - James V Freeman
- Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut
| | - Jagmeet P Singh
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts
| | - Jeptha P Curtis
- Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut
| | - Jonathan P Piccini
- Electrophysiology Section, Duke University Hospital, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Sana M Al-Khatib
- Electrophysiology Section, Duke University Hospital, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Kevin P Jackson
- Electrophysiology Section, Duke University Hospital, Durham, North Carolina
| |
Collapse
|
36
|
Oesterle A, Dhruva SS, Pellegrini CN, Liem B, Raitt MH. Ventricular arrhythmia detection for contemporary Biotronik and Abbott implantable cardioverter defibrillators with markedly prolonged detection in Biotronik devices. J Interv Card Electrophysiol 2023; 66:1679-1691. [PMID: 36737506 DOI: 10.1007/s10840-023-01498-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/27/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Implantable cardioverter defibrillators (ICDs) are typically programed with both ventricular tachycardia (VT) and ventricular fibrillation (VF) treatment zones. Biotronik and Abbott ICDs do not increment the VT counter when the tachycardia accelerates to the VF zone, which could result in a prolonged delay in tachycardia detection. METHODS Patients with Biotronik and Abbott ICDs receiving care at Veterans Affairs facilities in Northern California were identified. Patient information and device tracings for patients with any ICD therapies were examined to assess for possible delayed tachycardia detection. RESULTS Among 52 patients with Biotronik ICDs, 8 (15%) experienced appropriate ICD therapy over a median follow-up of 29 months. Among 68 patients with Abbott ICDs, 26 (38%) experienced appropriate ICD therapy over a median follow-up of 83 months. Three of the patients with Biotronik ICDs who received appropriate therapy experienced a delay in VT/VF detection due to the tachycardia rate oscillating between the VT and VF treatment zones (longest 31.2 s on detection), compared with four of the patients with Abbott ICDs (longest 4.1 s on the detection and 8 s on redetect). One of the patients with a Biotronik ICD experienced recurrent syncope associated with delayed detection and another died on the day of delayed detection. One of the patients with an Abbott ICD experienced syncope. CONCLUSIONS Because contemporary Biotronik and Abbott ICDs freeze the VT counters when tachycardia is in the VF zone, ICD therapies can be markedly delayed when the tachycardia oscillates between the VT and VF zone.
Collapse
Affiliation(s)
- Adam Oesterle
- Division of Cardiology, Department of Medicine, University of California San Francisco - Veterans Affairs San Francisco Health Care System, 4150 Clement Street, Building 203, Room 2A-25, San Francisco, CA, 94121, USA.
| | - Sanket S Dhruva
- Division of Cardiology, Department of Medicine, University of California San Francisco - Veterans Affairs San Francisco Health Care System, 4150 Clement Street, Building 203, Room 2A-25, San Francisco, CA, 94121, USA
| | - Cara N Pellegrini
- Division of Cardiology, Department of Medicine, University of California San Francisco - Veterans Affairs San Francisco Health Care System, 4150 Clement Street, Building 203, Room 2A-25, San Francisco, CA, 94121, USA
| | - Bing Liem
- Division of Cardiology, Department of Medicine, University of California San Francisco - Veterans Affairs San Francisco Health Care System, 4150 Clement Street, Building 203, Room 2A-25, San Francisco, CA, 94121, USA
| | - Merritt H Raitt
- Division of Cardiology, Veterans Affairs Portland Health Care System, Portland, OR, USA
| |
Collapse
|
37
|
Arbelo E, Protonotarios A, Gimeno JR, Arbustini E, Barriales-Villa R, Basso C, Bezzina CR, Biagini E, Blom NA, de Boer RA, De Winter T, Elliott PM, Flather M, Garcia-Pavia P, Haugaa KH, Ingles J, Jurcut RO, Klaassen S, Limongelli G, Loeys B, Mogensen J, Olivotto I, Pantazis A, Sharma S, Van Tintelen JP, Ware JS, Kaski JP. 2023 ESC Guidelines for the management of cardiomyopathies. Eur Heart J 2023; 44:3503-3626. [PMID: 37622657 DOI: 10.1093/eurheartj/ehad194] [Citation(s) in RCA: 138] [Impact Index Per Article: 138.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
|
38
|
Martens E, Sommer P, Johnson V, Tilz RR, Althoff T, Jansen H, Steven D, Steger A, Iden L, Estner H, Rillig A, Duncker D. [Venous access routes for cardiac implantable electronic devices]. Herzschrittmacherther Elektrophysiol 2023; 34:250-255. [PMID: 37460626 DOI: 10.1007/s00399-023-00954-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 06/19/2023] [Indexed: 08/29/2023]
Abstract
Various venous access routes in the region of the clavicle are available for cardiac device treatment. After many years of choosing access via the subclavian vein, current data explicitly show that lateral approaches such as preparation of the cephalic vein or puncture of the axillary vein are clearly superior in terms of probe durability and risk of complications. This article describes the preparation and performance of the various access techniques and is intended to provide a practical guide for the work in cardiac pacemaker operations. This work continues a series of articles designed for advanced training in specialized rhythmology.
Collapse
Affiliation(s)
- Eimo Martens
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar der technischen Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
| | - Philipp Sommer
- Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
| | - Victoria Johnson
- Klinik für Kardiologie und Angiologie, Universitätsklinikum Giessen, Giessen, Deutschland
| | - Roland R Tilz
- Sektion für Elektrophysiologie, Medizinische Klinik II, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Lübeck, Deutschland
| | - Till Althoff
- Cardiovascular Institute (ICCV), Arrhythmia Section, CLINIC Barcelona University Hospital, Carrer de Villarroel 170, 08036, Barcelona, Spanien
| | | | - Daniel Steven
- Sektion Elektrophysiologie, Klinik III für Innere Medizin, Universitätsklinikum Köln, Köln, Deutschland
| | - Alexander Steger
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar der technischen Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - Leon Iden
- Klinik für Kardiologie, Herz- und Gefäßzentrum Bad Segeberg, Bad Segeberg, Deutschland
| | - Heidi Estner
- Klinik und Poliklinik für Innere Medizin I, Klinikum der Universität München, München, Deutschland
| | - Andreas Rillig
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - David Duncker
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| |
Collapse
|
39
|
Rajjoub K, Vila-Olives R, Francisco-Pascual J. A wobble tachycardia… supraventricular, ventricular or both? J Electrocardiol 2023; 80:174-177. [PMID: 37562269 DOI: 10.1016/j.jelectrocard.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/11/2023] [Accepted: 07/31/2023] [Indexed: 08/12/2023]
Abstract
We present the case of a 77-year-old man with ischemic heart disease and baseline right bundle branch block having a well-tolerated and regular wide complex tachycardia with right bundle branch block morphology. A wide complex tachycardia (WCT) could be of supraventricular or ventricular origin. In this setting, we discuss the differential diagnosis of WCT, the usefulness and limitations of the diagnostic criteria for ventricular tachycardia.
Collapse
Affiliation(s)
- Kinán Rajjoub
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
| | - Rosa Vila-Olives
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Jaume Francisco-Pascual
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| |
Collapse
|
40
|
Teerawongsakul P, Ananwattanasuk T, Chokesuwattanaskul R, Shah M, Lathkar-Pradhan S, Barham W, Oral H, Thakur RK, Jongnarangsin K, Tanawuttiwat T. Programming of implantable cardioverter defibrillators for primary prevention: outcomes at centers with high vs. low concordance with guidelines. J Interv Card Electrophysiol 2023; 66:1359-1366. [PMID: 36422768 DOI: 10.1007/s10840-022-01431-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/15/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND While ICD therapy reduction programming strategies are recommended in current multi-society guidelines, concerns remain about a possible trade-off between the benefits of ICD therapy reduction and failure to treat episodes of ventricular arrhythmias. The study is to evaluate the outcomes of primary prevention patients followed in centers with high and low concordance with the 2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement and 2019 focused update on optimal ICD programming and testing guidelines. METHODS Consecutive patients with primary prevention ICD implantation from two centers between 2014 and 2016 were included. One center was classified as high guideline concordance center (HGC) with 47% (146/310) of patients with initial ICD concordant with the guidelines, and the other center was classified as low guideline concordance center (LGC) with only 1% (2/178) of patients with guideline-concordant initial ICD programming. Cox proportional hazard models were used to assess risk of first ICD therapy (ATP or shock), first ICD shock, and mortality. RESULTS A total of 488 patients were included (mean age, 66 ± 13 years). During a mean follow-up of 1.9 ± 0.9 years, patients followed at HGC were 63% less likely to receive any ICD therapy (adjusted HR [aHR] 0.37, 95% CI 0.42-0.99). There were no significant differences in the rate of first ICD shock (aHR 0.72, 95% CI 0.34-1.52) or mortality (aHR 1.19, 95% CI, 0.47-3.05). CONCLUSIONS Compared to primary prevention patients followed at LGC, primary prevention ICD patients followed at HGC received a significantly lower rate of ICD therapy, mainly from ATP reduction, without a difference in mortality during follow-up.
Collapse
Affiliation(s)
- Padoemwut Teerawongsakul
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
- Division of Cardiac Electrophysiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Teetouch Ananwattanasuk
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
- Division of Cardiac Electrophysiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Ronpichai Chokesuwattanaskul
- Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Cardiac Center, Bangkok, Thailand
| | - Muazzum Shah
- Division of Cardiac Electrophysiology, University of Michigan Health System, Ann Arbor, MI, USA
| | | | - Waseem Barham
- Division of Cardiac Electrophysiology, Michigan State University, and Sparrow Thoracic and Cardiovascular Institute, Lansing, MI, USA
| | - Hakan Oral
- Division of Cardiac Electrophysiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Ranjan K Thakur
- Division of Cardiac Electrophysiology, Michigan State University, and Sparrow Thoracic and Cardiovascular Institute, Lansing, MI, USA
| | - Krit Jongnarangsin
- Division of Cardiac Electrophysiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Tanyanan Tanawuttiwat
- Division of Cardiovascular Medicine, Indiana University School of Medicine, 1800 N Capitol Ave, Room E300B, Indianapolis, IN, 46202, USA.
| |
Collapse
|
41
|
Pay L, Yumurtaş AÇ, Tezen O, Çetin T, Eren S, Çinier G, Hayıroğlu Mİ, Tekkeşin Aİ. Efficiency of MVP ECG Risk Score for Prediction of Long-Term Atrial Fibrillation in Patients With ICD for Heart Failure With Reduced Ejection Fraction. Korean Circ J 2023; 53:621-631. [PMID: 37525494 PMCID: PMC10475693 DOI: 10.4070/kcj.2022.0353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/03/2023] [Accepted: 05/09/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The morphology-voltage-P-wave duration (MVP) electrocardiography (ECG) risk score is a newly defined scoring system that has recently been used for atrial fibrillation (AF) prediction. The aim of this study was to evaluate the ability of the MVP ECG risk score to predict AF in patients with an implantable cardioverter defibrillator (ICD) and heart failure with reduced ejection fraction in long-term follow-up. METHODS The study used a single-center, and retrospective design. The study included 328 patients who underwent ICD implantation in our hospital between January 2010 and April 2021, diagnosed with heart failure. The patients were divided into low, intermediate and high-risk categories according to the MVP ECG risk scores. The long-term development of atrial fibrillation was compared among these 3 groups. RESULTS The low-risk group included 191 patients, the intermediate-risk group 114 patients, and the high-risk group 23 patients. The long-term AF development rate was 12.0% in the low-risk group, 21.9% in the intermediate risk group, and 78.3% in the high-risk group. Patients in the high-risk group were found to have 5.2 times higher rates of long-term AF occurrence compared to low-risk group. CONCLUSIONS The MVP ECG risk score, which is an inexpensive, simple and easily accessible tool, was found to be a significant predictor of the development of AF in the long-term follow-up of patients with an ICD with heart failure with reduced ejection fraction. This risk score may be used to identify patients who require close follow-up for development and management of AF.
Collapse
Affiliation(s)
- Levent Pay
- Department of Cardiac, Ardahan State Hospital, Ardahan, Turkey.
| | - Ahmet Çağdaş Yumurtaş
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training Hospital, İstanbul, Turkey
| | - Ozan Tezen
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training Hospital, İstanbul, Turkey
| | - Tuğba Çetin
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training Hospital, İstanbul, Turkey
| | - Semih Eren
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training Hospital, İstanbul, Turkey
| | - Göksel Çinier
- Department of Cardiac Electrophysiology, Başakşehir Çam ve Sakura City Hospital, Istanbul, Turkey
| | - Mert İlker Hayıroğlu
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training Hospital, İstanbul, Turkey
| | - Ahmet İlker Tekkeşin
- Department of Cardiac Electrophysiology, Başakşehir Çam ve Sakura City Hospital, Istanbul, Turkey
| |
Collapse
|
42
|
Whearty L, Lever N, Martin A. Transvenous Lead Extraction: Outcomes From a Single Centre Providing a National Service for New Zealand. Heart Lung Circ 2023; 32:1115-1121. [PMID: 37271619 DOI: 10.1016/j.hlc.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 04/27/2023] [Accepted: 05/14/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND With increasing demand for cardiac implantable electronic devices there is a parallel increase in the need for transvenous lead extraction (TLE). Due to its small population, all TLE procedures in New Zealand are currently performed in a single centre, Auckland City Hospital. We analysed the clinical characteristics and outcomes of those undergoing TLE since this service was established. METHODS We performed a retrospective, single-centre cohort study of all TLE procedures between October 2015 and December 2021. Definitions from the European Lead Extraction Controlled study, Heart Rhythm Society, European Heart Rhythm Association consensus documents were used. RESULTS A total of 247 patients had 480 leads extracted, averaging 40 TLE procedures annually. Patients had a median lead dwell time of 6 (interquartile range [IQR] 3-11) years, 60 (13%) of leads had been in-situ >15 years, median age 61 (IQR 48-70) years, 73 (30%) female, 28 (11%) Māori, 23 (9%) Pasifika. Lead dysfunction (115 patients, 47%) and infection (90 patients, 37%) were the most common indications for TLE. Complete clinical and radiological success was achieved for 96% and 95%, respectively. Procedure-related complications occurred in 16 (7%) patients. Major intra-procedure complications occurred in 5 patients (2%), including 2 (1%) deaths. Death within one year of TLE occurred in 13 (26%) with systemic infection, 5 (3%) with local infection, and 5 (3%) with non-infection indications for TLE, p <0.01. CONCLUSIONS TLE is associated with high radiographic and clinical success, low complication, and low mortality rate. At our single centre providing a national service, TLE outcomes are comparable with those achieved internationally.
Collapse
Affiliation(s)
- Lauren Whearty
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Nigel Lever
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Green Lane Cardiovascular Services, Auckland City Hospital, Te Whatu Ora | Te Toka Tumai-Health New Zealand, Auckland, New Zealand
| | - Andrew Martin
- Green Lane Cardiovascular Services, Auckland City Hospital, Te Whatu Ora | Te Toka Tumai-Health New Zealand, Auckland, New Zealand.
| |
Collapse
|
43
|
Trancuccio A, Kukavica D, Sugamiele A, Mazzanti A, Priori SG. Prevention of Sudden Death and Management of Ventricular Arrhythmias in Arrhythmogenic Cardiomyopathy. Card Electrophysiol Clin 2023; 15:349-365. [PMID: 37558305 DOI: 10.1016/j.ccep.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Arrhythmogenic cardiomyopathy is an umbrella term for a group of inherited diseases of the cardiac muscle characterized by progressive fibro-fatty replacement of the myocardium. As suggested by the name, the disease confers electrical instability to the heart and increases the risk of the development of life-threatening arrhythmias, representing one of the leading causes of sudden cardiac death (SCD), especially in young athletes. In this review, the authors review the current knowledge of the disease, highlighting the state-of-the-art approaches to the prevention of the occurrence of SCD.
Collapse
Affiliation(s)
- Alessandro Trancuccio
- Department of Molecular Medicine, University of Pavia, Pavia, Italy; Molecular Cardiology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Deni Kukavica
- Department of Molecular Medicine, University of Pavia, Pavia, Italy; Molecular Cardiology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Andrea Sugamiele
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Andrea Mazzanti
- Department of Molecular Medicine, University of Pavia, Pavia, Italy; Molecular Cardiology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Silvia G Priori
- Department of Molecular Medicine, University of Pavia, Pavia, Italy; Molecular Cardiology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy.
| |
Collapse
|
44
|
Gómez-Mesa JE, Márquez-Murillo M, Figueiredo M, Berni A, Jerez AM, Núñez-Ayala E, Pow-Chon F, Sáenz-Morales LC, Pava-Molano LF, Montes MC, Garillo R, Galindo-Coral S, Reyes-Caorsi W, Speranza M, Romero A. Inter-American Society of Cardiology (CIFACAH-ELECTROSIAC) and Latin-American Heart Rhythm Society (LAHRS): multidisciplinary review on the appropriate use of implantable cardiodefibrillator in heart failure with reduced ejection fraction. J Interv Card Electrophysiol 2023; 66:1211-1229. [PMID: 36469237 PMCID: PMC10333140 DOI: 10.1007/s10840-022-01425-4] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/10/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND Our main objective was to present a multidisciplinary review on the epidemiology of sudden cardiac death (SCD) and the tools that could be used to identify malignant ventricular arrhythmias (VAs) and to perform risk stratification. In addition, indications and contraindications for the use of implantable cardioverter defibrillator (ICD) in general and in special populations including the elderly and patients with chronic kidney disease (CKD) are also given. METHODS An expert group from the Inter American Society of Cardiology (IASC), through their HF Council (CIFACAH) and Electrocardiology Council (ElectroSIAC), together with the Latin American Heart Rhythm Society (LAHRS), reviewed and discussed the literature regarding the appropriate use of an ICD in people with heart failure (HF) with reduced ejection fraction (HFpEF). Indications and contraindications for the use of ICD are presented in this multidisciplinary review. RESULTS Numerous clinical studies have demonstrated the usefulness of ICD in both primary and secondary prevention of SCD in HFpEF. There are currently precise indications and contraindications for the use of these devices. CONCLUSIONS In some Latin American countries, a low rate of implantation is correlated with low incomes, but this is not the case for all Latin America. Determinants of the low rates of ICD implantation in many Latin American countries are still a matter of research. VA remains one of the most common causes of cardiovascular death associated with HFrEF and different tools are available for stratifying the risk of SCD in this population.
Collapse
Affiliation(s)
- Juan Esteban Gómez-Mesa
- Cardiology Department, Fundación Valle del Lili, Cali, Colombia.
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia.
- Inter-American Council of Heart Failure and Pulmonary Hypertension/CIFACAH, Mexico City, Mexico.
- Inter-American Society of Cardiology/IASC, Mexico City, Mexico.
| | - Manlio Márquez-Murillo
- Inter-American Society of Cardiology/IASC, Mexico City, Mexico
- Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
- Inter-American Council of Electrocardiography and Arrhythmias/ELECTROSIAC, Mexico City, Mexico
| | - Marcio Figueiredo
- University of Campinas (UNICAMP) Hospital, Campinas, Brazil
- Latin American Heart Rhythm Society/LAHRS, Montevideo, Uruguay
| | - Ana Berni
- Inter-American Society of Cardiology/IASC, Mexico City, Mexico
- Inter-American Council of Electrocardiography and Arrhythmias/ELECTROSIAC, Mexico City, Mexico
- Hospital Angeles Pedregal, Mexico City, Mexico
| | - Ana Margarita Jerez
- Inter-American Council of Heart Failure and Pulmonary Hypertension/CIFACAH, Mexico City, Mexico
- Inter-American Society of Cardiology/IASC, Mexico City, Mexico
- Instituto de Cardiología Y Cirugía Cardiovascular, La Habana, Cuba
| | - Elaine Núñez-Ayala
- Inter-American Council of Heart Failure and Pulmonary Hypertension/CIFACAH, Mexico City, Mexico
- Inter-American Society of Cardiology/IASC, Mexico City, Mexico
- Electrophysiology, Arrhythmias and Pacemaker Unit, CEDIMAT, Centro Cardiovascular, Santo Domingo, Dominican Republic
| | - Freddy Pow-Chon
- Inter-American Council of Heart Failure and Pulmonary Hypertension/CIFACAH, Mexico City, Mexico
- Inter-American Society of Cardiology/IASC, Mexico City, Mexico
- Hospital Luis Vernaza, Guayaquil, Ecuador
| | - Luis Carlos Sáenz-Morales
- Latin American Heart Rhythm Society/LAHRS, Montevideo, Uruguay
- Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
| | - Luis Fernando Pava-Molano
- Cardiology Department, Fundación Valle del Lili, Cali, Colombia
- Latin American Heart Rhythm Society/LAHRS, Montevideo, Uruguay
| | - María Claudia Montes
- Cardiology Department, Fundación Valle del Lili, Cali, Colombia
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
| | - Raúl Garillo
- Inter-American Society of Cardiology/IASC, Mexico City, Mexico
- Inter-American Council of Electrocardiography and Arrhythmias/ELECTROSIAC, Mexico City, Mexico
- Facultad de Ciencias Médicas, Pontificia Universidad Católica Argentina, Buenos Aires, Argentina
| | - Stephania Galindo-Coral
- Cardiology Department, Fundación Valle del Lili, Cali, Colombia
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
| | - Walter Reyes-Caorsi
- Inter-American Council of Electrocardiography and Arrhythmias/ELECTROSIAC, Mexico City, Mexico
- Latin American Heart Rhythm Society/LAHRS, Montevideo, Uruguay
- Comisión Honoraria Para La Salud Cardiovascular, Montevideo, Uruguay
| | - Mario Speranza
- Inter-American Council of Heart Failure and Pulmonary Hypertension/CIFACAH, Mexico City, Mexico
- Inter-American Society of Cardiology/IASC, Mexico City, Mexico
- Hospital Clínica Bíblica, Ciudad de Costa Rica, Costa Rica
| | - Alexander Romero
- Inter-American Council of Heart Failure and Pulmonary Hypertension/CIFACAH, Mexico City, Mexico
- Inter-American Society of Cardiology/IASC, Mexico City, Mexico
- Hospital Santo Tomas, Ciudad de Panama, Panama
| |
Collapse
|
45
|
Kazawa S, Satomi K, Murakami H, Tanaka N. Case report: successful termination of ventricular tachycardia by intrinsic anti-tachycardia pacing beyond conventional anti-tachycardia pacing. Eur Heart J Case Rep 2023; 7:ytad285. [PMID: 37425658 PMCID: PMC10328381 DOI: 10.1093/ehjcr/ytad285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 06/22/2023] [Indexed: 07/11/2023]
Abstract
Background Anti-tachycardia pacing (ATP) is a pain-free alternative to defibrillation shock for monomorphic ventricular tachycardia (VT). Intrinsic ATP (iATP) is a novel algorithm of auto-programmed ATP. However, the advantage of iATP over conventional ATP in clinical cases is still unknown. Case summary A 49-year-old man with no significant past medical history was transferred to our institution with sudden-onset fatigue from working on a farm. A 12-lead electrocardiogram showed monomorphic sustained wide QRS tachycardia with a right bundle branch block pattern and superior axis deviation with a cycle length (CL) of 300 ms. Sustained monomorphic VT originating from the left ventricle due to underlying vasospastic angina was diagnosed by contrast-enhanced cardiac magnetic resonance imaging, coronary angiography, and the acetylcholine stress test, and implantable cardioverter defibrillator implantation was performed. Nine months later, a clinical VT episode with a CL of 300 ms was observed, which could not be terminated by three sequences of conventional burst pacing. Ventricular tachycardia was finally terminated by a third iATP sequence without any acceleration. Discussion Although standard burst pacing by conventional ATP reached the VT circuit, it failed to terminate the VT. Using the post-pacing interval, iATP automatically calculated the appropriate number of S1 pulses required to reach the VT circuit. In iATP, the S2 pulses are delivered with a calculated coupling interval based on the estimated effective refractory period during tachycardia. In this case, iATP might have led to less aggressive S1 stimulation, followed by aggressive S2 stimulation, which probably helped terminate the VT without any acceleration.
Collapse
Affiliation(s)
| | - Kazuhiro Satomi
- Department of Cardiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Hidetaka Murakami
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo 193-0998, Japan
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo 193-0998, Japan
| |
Collapse
|
46
|
Kataoka S, Yagishita D, Yazaki K, Kanai M, Hasegawa S, Shoda M, Yamaguchi J. Prolonged T-peak to T-end Interval Predicts Implantable Cardioverter Defibrillator Therapy in Patients With Cardiac Sarcoidosis. Circ J 2023:CJ-23-0058. [PMID: 37344406 DOI: 10.1253/circj.cj-23-0058] [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] [Indexed: 06/23/2023]
Abstract
BACKGROUND The association between the T-peak to T-end interval (Tp-e) and ventricular arrhythmia (VA) events in cardiac sarcoidosis (CS) is unknown. The purpose of this study was to investigate whether Tp-e was associated with VA events in CS patients with implantable cardioverter defibrillators (ICDs) or cardiac resynchronization therapy defibrillators (CRT-Ds).Methods and Results: We retrospectively studied 50 patients (16 men; mean [±SD] age 56.3±10.5 years) with CS and ICD/CRT-D. The maximum Tp-e in the precordial leads recorded by a 12-lead electrocardiogram after ICD/CRT-D implantation was evaluated. The clinical endpoint was defined as appropriate ICD therapy. During a median follow-up period of 85.0 months, 22 patients underwent appropriate therapy and 10 patients died. Kaplan-Meier analysis revealed that the probability of the clinical endpoint was 28.3% at 2 years and 35.3% at 4 years. The optimal cut-off value of the Tp-e for the prediction of the clinical endpoint was 91 ms, with a sensitivity of 72.7% and a specificity of 87.0% (area under the curve=0.81). Multivariate Cox regression analysis showed that Tp-e ≥91 ms (hazard ratio [HR] 5.10; 95% confidence interval [CI] 1.99-13.1; P<0.001) and a histological diagnosis of CS (HR 3.84; 95% CI 1.28-11.5; P=0.016) were significantly associated with the clinical endpoint. CONCLUSIONS Tp-e ≥91 ms was a significant predictor of VA events in patients with CS and ICD/CRT-D.
Collapse
Affiliation(s)
- Shohei Kataoka
- Department of Cardiology, Tokyo Women's Medical University
| | - Daigo Yagishita
- Department of Cardiology, Tokyo Women's Medical University
- Clinical Research Division for Heart Rhythm Management, Department of Cardiology, Tokyo Women's Medical University
| | | | - Miwa Kanai
- Department of Cardiology, Tokyo Women's Medical University
| | - Shun Hasegawa
- Department of Cardiology, Tokyo Women's Medical University
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University
- Clinical Research Division for Heart Rhythm Management, Department of Cardiology, Tokyo Women's Medical University
| | | |
Collapse
|
47
|
Krug D, Zaman A, Eidinger L, Grehn M, Boda-Heggemann J, Rudic B, Mehrhof F, Boldt LH, Hohmann S, Merten R, Buergy D, Fleckenstein J, Kluge A, Rogge A, Both M, Rades D, Tilz RR, Olbrich D, König IR, Siebert FA, Schweikard A, Vonthein R, Bonnemeier H, Dunst J, Blanck O. Radiosurgery for ventricular tachycardia (RAVENTA): interim analysis of a multicenter multiplatform feasibility trial. Strahlenther Onkol 2023:10.1007/s00066-023-02091-9. [PMID: 37285038 DOI: 10.1007/s00066-023-02091-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/23/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Single-session cardiac stereotactic radiation therapy (SBRT) has demonstrated promising results for patients with refractory ventricular tachycardia (VT). However, the full safety profile of this novel treatment remains unknown and very limited data from prospective clinical multicenter trials are available. METHODS The prospective multicenter multiplatform RAVENTA (radiosurgery for ventricular tachycardia) study assesses high-precision image-guided cardiac SBRT with 25 Gy delivered to the VT substrate determined by high-definition endocardial and/or epicardial electrophysiological mapping in patients with refractory VT ineligible for catheter ablation and an implanted cardioverter defibrillator (ICD). Primary endpoint is the feasibility of full-dose application and procedural safety (defined as an incidence of serious [grade ≥ 3] treatment-related complications ≤ 5% within 30 days after therapy). Secondary endpoints comprise VT burden, ICD interventions, treatment-related toxicity, and quality of life. We present the results of a protocol-defined interim analysis. RESULTS Between 10/2019 and 12/2021, a total of five patients were included at three university medical centers. In all cases, the treatment was carried out without complications. There were no serious potentially treatment-related adverse events and no deterioration of left ventricular ejection fraction upon echocardiography. Three patients had a decrease in VT episodes during follow-up. One patient underwent subsequent catheter ablation for a new VT with different morphology. One patient with local VT recurrence died 6 weeks after treatment in cardiogenic shock. CONCLUSION The interim analysis of the RAVENTA trial demonstrates early initial feasibility of this new treatment without serious complications within 30 days after treatment in five patients. Recruitment will continue as planned and the study has been expanded to further university medical centers. TRIAL REGISTRATION NUMBER NCT03867747 (clinicaltrials.gov). Registered March 8, 2019. Study start: October 1, 2019.
Collapse
Affiliation(s)
- David Krug
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus L, 24105, Kiel, Germany.
| | - Adrian Zaman
- Klinik für Innere Medizin III, Kardiologie, Abteilung für Elektrophysiologie und Rhythmologie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Lina Eidinger
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus L, 24105, Kiel, Germany
- Klinik für Innere Medizin III, Kardiologie, Abteilung für Elektrophysiologie und Rhythmologie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Melanie Grehn
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus L, 24105, Kiel, Germany
| | - Judit Boda-Heggemann
- Universitätsmedizin Mannheim, Klinik für Strahlentherapie und Radioonkologie, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - Boris Rudic
- Universitätsmedizin Mannheim, Medizinische Klinik I, Abteilung für Elektrophysiologie und Rhythmologie, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - Felix Mehrhof
- Klinik für Radioonkologie und Strahlentherapie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Leif-Hendrik Boldt
- Medizinische Klinik mit Schwerpunkt Kardiologie (CVK), Abteilung für Elektrophysiologie und Rhythmologie, Charité Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Stephan Hohmann
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Roland Merten
- Klinik für Strahlentherapie und Spezielle Onkologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Daniel Buergy
- Universitätsmedizin Mannheim, Klinik für Strahlentherapie und Radioonkologie, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - Jens Fleckenstein
- Universitätsmedizin Mannheim, Klinik für Strahlentherapie und Radioonkologie, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - Anne Kluge
- Klinik für Radioonkologie und Strahlentherapie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Annette Rogge
- Klinisches Ethikkomitee, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Marcus Both
- Klinik für Radiologie und Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Dirk Rades
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Roland Richard Tilz
- Klinik für Rhythmologie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Denise Olbrich
- Zentrum für Klinische Studien, Universität zu Lübeck, Lübeck, Germany
| | - Inke R König
- Institut für Medizinische Biometrie und Statistik, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Frank-Andre Siebert
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus L, 24105, Kiel, Germany
| | - Achim Schweikard
- Institut für Robotik und Kognitive Systeme, Universität zu Lübeck, Lübeck, Germany
| | - Reinhard Vonthein
- Institut für Medizinische Biometrie und Statistik, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Hendrik Bonnemeier
- Klinik für Innere Medizin III, Kardiologie, Abteilung für Elektrophysiologie und Rhythmologie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
- Klinik für Kardiologie, Helios Klinik Cuxhaven, Cuxhaven, Germany
| | - Jürgen Dunst
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus L, 24105, Kiel, Germany
| | - Oliver Blanck
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus L, 24105, Kiel, Germany
| |
Collapse
|
48
|
Qian S, Monaci S, Mendonca-Costa C, Campos F, Gemmell P, Zaidi HA, Rajani R, Whitaker J, Rinaldi CA, Bishop MJ. Additional coils mitigate elevated defibrillation threshold in right-sided implantable cardioverter defibrillator generator placement: a simulation study. Europace 2023; 25:euad146. [PMID: 37314196 PMCID: PMC10265967 DOI: 10.1093/europace/euad146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/13/2023] [Indexed: 06/15/2023] Open
Abstract
AIMS The standard implantable cardioverter defibrillator (ICD) generator (can) is placed in the left pectoral area; however, in certain circumstances, right-sided cans may be required which may increase defibrillation threshold (DFT) due to suboptimal shock vectors. We aim to quantitatively assess whether the potential increase in DFT of right-sided can configurations may be mitigated by alternate positioning of the right ventricular (RV) shocking coil or adding coils in the superior vena cava (SVC) and coronary sinus (CS). METHODS AND RESULTS A cohort of CT-derived torso models was used to assess DFT of ICD configurations with right-sided cans and alternate positioning of RV shock coils. Efficacy changes with additional coils in the SVC and CS were evaluated. A right-sided can with an apical RV shock coil significantly increased DFT compared to a left-sided can [19.5 (16.4, 27.1) J vs. 13.3 (11.7, 19.9) J, P < 0.001]. Septal positioning of the RV coil led to a further DFT increase when using a right-sided can [26.7 (18.1, 36.1) J vs. 19.5 (16.4, 27.1) J, P < 0.001], but not a left-sided can [12.1 (8.1, 17.6) J vs. 13.3 (11.7, 19.9) J, P = 0.099). Defibrillation threshold of a right-sided can with apical or septal coil was reduced the most by adding both SVC and CS coils [19.5 (16.4, 27.1) J vs. 6.6 (3.9, 9.9) J, P < 0.001, and 26.7 (18.1, 36.1) J vs. 12.1 (5.7, 13.5) J, P < 0.001]. CONCLUSION Right-sided, compared to left-sided, can positioning results in a 50% increase in DFT. For right-sided cans, apical shock coil positioning produces a lower DFT than septal positions. Elevated right-sided can DFTs may be mitigated by utilizing additional coils in SVC and CS.
Collapse
Affiliation(s)
- Shuang Qian
- Department of Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, 4th North Wing, St Thomas’ Hospital, London SE1 7EH, UK
| | - Sofia Monaci
- Department of Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, 4th North Wing, St Thomas’ Hospital, London SE1 7EH, UK
| | - Caroline Mendonca-Costa
- Department of Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, 4th North Wing, St Thomas’ Hospital, London SE1 7EH, UK
| | - Fernando Campos
- Department of Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, 4th North Wing, St Thomas’ Hospital, London SE1 7EH, UK
| | - Philip Gemmell
- Department of Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, 4th North Wing, St Thomas’ Hospital, London SE1 7EH, UK
| | - Hassan A Zaidi
- Department of Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, 4th North Wing, St Thomas’ Hospital, London SE1 7EH, UK
| | - Ronak Rajani
- Department of Cardiology, Guy’s and St Thomas’ Hospital, Westminster Bridge Rd, London SE1 7EH, UK
| | - John Whitaker
- Department of Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, 4th North Wing, St Thomas’ Hospital, London SE1 7EH, UK
- Department of Cardiology, Guy’s and St Thomas’ Hospital, Westminster Bridge Rd, London SE1 7EH, UK
| | - Christopher A Rinaldi
- Department of Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, 4th North Wing, St Thomas’ Hospital, London SE1 7EH, UK
- Department of Cardiology, Guy’s and St Thomas’ Hospital, Westminster Bridge Rd, London SE1 7EH, UK
| | - Martin J Bishop
- Department of Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, 4th North Wing, St Thomas’ Hospital, London SE1 7EH, UK
| |
Collapse
|
49
|
Frausing MHJP, Johansen JB, Afonso D, Jørgensen OD, Olsen T, Gerdes C, Johansen ML, Wolff C, Mealing S, Nielsen JC, Kronborg MB. Cost-effectiveness of an antibacterial envelope for infection prevention in patients undergoing cardiac resynchronization therapy reoperations in Denmark. Europace 2023; 25:euad159. [PMID: 37345858 PMCID: PMC10286568 DOI: 10.1093/europace/euad159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 06/03/2023] [Indexed: 06/23/2023] Open
Abstract
AIMS Use of an absorbable antibacterial envelope during implantation prevents cardiac implantable electronic device infections in patients with a moderate-to-high infection risk. Previous studies demonstrated that an envelope is cost-effective in high-risk patients within German, Italian, and English healthcare systems, but these analyses were based on limited data and may not be generalizable to other healthcare settings. METHODS AND RESULTS A previously published decision-tree-based cost-effectiveness model was used to compare the costs per quality-adjusted life year (QALY) associated with adjunctive use of an antibacterial envelope for infection prevention compared to standard-of-care intravenous antibiotics. The model was adapted using data from a Danish observational two-centre cohort study that investigated infection-risk patients undergoing cardiac resynchronization therapy (CRT) reoperations with and without an antibacterial envelope (n = 1943). We assumed a cost-effectiveness threshold of €34 125/QALY gained, based on the upper threshold used by the National Institute for Health and Care Excellence (£30 000). An antibacterial envelope was associated with an incremental cost-effectiveness ratio (ICER) of €12 022 per QALY in patients undergoing CRT reoperations, thus indicating that the envelope is cost-effective when compared with standard of care. A separate analysis stratified by device type showed ICERS of €6227 (CRT defibrillator) and €29 177 (CRT pacemaker) per QALY gained. CONCLUSIONS Cost-effectiveness ratios were favourable for patients undergoing CRT reoperations in the Danish healthcare system, and thus are in line with previous studies. Results from this study can contribute to making the technology available to Danish patients and align preventive efforts in the pacemaker and ICD area.
Collapse
Affiliation(s)
- Maria Hee Jung Park Frausing
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Bvld. 99, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Bvld. 82, 8200 Aarhus, Denmark
| | - Jens Brock Johansen
- Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark
| | - Daniela Afonso
- York Health Economics Consortium, Enterprise House, Innovation Way, University of York, York Y0105NQ, United Kingdom
| | - Ole Dan Jørgensen
- Department of Cardiac-, Thoracic-, and Vascular Surgery, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark
| | - Thomas Olsen
- York Health Economics Consortium, Enterprise House, Innovation Way, University of York, York Y0105NQ, United Kingdom
| | - Christian Gerdes
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Bvld. 99, 8200 Aarhus, Denmark
| | | | - Claudia Wolff
- Medtronic International Trading Sarl, Route du Molliau 31, CH-1131 Tolochenaz, Switzerland
| | - Stuart Mealing
- York Health Economics Consortium, Enterprise House, Innovation Way, University of York, York Y0105NQ, United Kingdom
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Bvld. 99, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Bvld. 82, 8200 Aarhus, Denmark
| | - Mads Brix Kronborg
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Bvld. 99, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Bvld. 82, 8200 Aarhus, Denmark
| |
Collapse
|
50
|
Costa T, Bagnall A, Murray S, Bailey K, MacGowan G, Ng WF, McKinnon I, Watson S, McAllister-Williams RH. Role of autonomic dysregulation in quality of life and functional impairment in implantable cardioverter defibrillator patients. J Psychosom Res 2023; 171:111390. [PMID: 37270908 DOI: 10.1016/j.jpsychores.2023.111390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/26/2023] [Accepted: 05/27/2023] [Indexed: 06/06/2023]
Affiliation(s)
- Tiago Costa
- Translational and Clinical Research Institute, Faculty of Medical Sciences, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, United Kingdom; Northern Centre for Mood Disorders, Wolfson Research Centre, Newcastle University, Newcastle upon Tyne NE4 5PL, United Kingdom; Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, St. Nicholas Hospital, Jubilee Road, Gosforth, Newcastle upon Tyne NE3 3XT, United Kingdom.
| | - Alan Bagnall
- Newcastle Cardiovascular Trials and Research, Newcastle upon Tyne Hospitals NHS Foundation Trust, Cardiovascular Research, Room 122F, Education Centre, Freeman Hospital, Newcastle upon Tyne NE7 7DN, United Kingdom; Department of Cardiology, Freeman Hospital, Newcastle upon Tyne NE7 7DN, United Kingdom; Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Catherine Cookson Building, Newcastle upon Tyne NE2 4HH, United Kingdom
| | - Stephen Murray
- Newcastle Cardiovascular Trials and Research, Newcastle upon Tyne Hospitals NHS Foundation Trust, Cardiovascular Research, Room 122F, Education Centre, Freeman Hospital, Newcastle upon Tyne NE7 7DN, United Kingdom; Department of Cardiology, Freeman Hospital, Newcastle upon Tyne NE7 7DN, United Kingdom
| | - Kristian Bailey
- Newcastle Cardiovascular Trials and Research, Newcastle upon Tyne Hospitals NHS Foundation Trust, Cardiovascular Research, Room 122F, Education Centre, Freeman Hospital, Newcastle upon Tyne NE7 7DN, United Kingdom; Department of Cardiology, Freeman Hospital, Newcastle upon Tyne NE7 7DN, United Kingdom
| | - Guy MacGowan
- Newcastle Cardiovascular Trials and Research, Newcastle upon Tyne Hospitals NHS Foundation Trust, Cardiovascular Research, Room 122F, Education Centre, Freeman Hospital, Newcastle upon Tyne NE7 7DN, United Kingdom; Department of Cardiology, Freeman Hospital, Newcastle upon Tyne NE7 7DN, United Kingdom; Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Catherine Cookson Building, Newcastle upon Tyne NE2 4HH, United Kingdom
| | - Wan-Fai Ng
- Translational and Clinical Research Institute, Faculty of Medical Sciences, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, United Kingdom; Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Catherine Cookson Building, Newcastle upon Tyne NE2 4HH, United Kingdom; NIHR Newcastle Biomedical Research Centre and NIHR Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne NE4 5PL, United Kingdom
| | - Iain McKinnon
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, St. Nicholas Hospital, Jubilee Road, Gosforth, Newcastle upon Tyne NE3 3XT, United Kingdom; Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne NE2 4AX, United Kingdom
| | - Stuart Watson
- Translational and Clinical Research Institute, Faculty of Medical Sciences, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, United Kingdom; Northern Centre for Mood Disorders, Wolfson Research Centre, Newcastle University, Newcastle upon Tyne NE4 5PL, United Kingdom; Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, St. Nicholas Hospital, Jubilee Road, Gosforth, Newcastle upon Tyne NE3 3XT, United Kingdom
| | - R Hamish McAllister-Williams
- Translational and Clinical Research Institute, Faculty of Medical Sciences, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, United Kingdom; Northern Centre for Mood Disorders, Wolfson Research Centre, Newcastle University, Newcastle upon Tyne NE4 5PL, United Kingdom; Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, St. Nicholas Hospital, Jubilee Road, Gosforth, Newcastle upon Tyne NE3 3XT, United Kingdom
| |
Collapse
|