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Zhang Y, Zhang Z, Qu Z. Curvature-mediated source and sink effects on the genesis of premature ventricular complexes in long QT syndrome. Am J Physiol Heart Circ Physiol 2024; 326:H1350-H1365. [PMID: 38551483 DOI: 10.1152/ajpheart.00004.2024] [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: 01/02/2024] [Revised: 03/13/2024] [Accepted: 03/25/2024] [Indexed: 05/08/2024]
Abstract
Premature ventricular complexes (PVCs) are spontaneous excitations occurring in the ventricles of the heart that are associated with ventricular arrhythmias and sudden cardiac death. Under long QT conditions, PVCs can be mediated by repolarization gradient (RG) and early afterdepolarizations (EADs), yet the effects of heterogeneities or geometry of the RG or EAD regions on PVC genesis remain incompletely understood. In this study, we use computer simulation to systematically investigate the effects of the curvature of the RG border region on PVC genesis under long QT conditions. We show that PVCs can be either promoted or suppressed by negative or positive RG border curvature depending on the source and sink conditions. When the origin of oscillation is in the source region and the source is too strong, a positive RG border curvature can promote PVCs by causing the source area to oscillate. When the origin of oscillation is in the sink region, a negative RG border curvature can promote PVCs by causing the sink area to oscillate. Furthermore, EAD-mediated PVCs are also promoted by negative border curvature. We also investigate the effects of wavefront curvature and show that PVCs are promoted by convex but suppressed by concave wavefronts; however, the effect of wavefront curvature is much smaller than that of RG border curvature. In conclusion, besides the increase of RG and occurrence of EADs caused by QT prolongation, the geometry of the RG border plays important roles in PVC genesis, which can greatly increase the risk of arrhythmias in cardiac diseases.NEW & NOTEWORTHY The effects of the curvature or geometry of the repolarization gradient region and wavefront curvature on the genesis of premature ventricular complexes are systematically investigated using computer modeling and simulation. Premature ventricular complexes can be promoted by either positive or negative curvature of the gradient region depending on the source and sink conditions. The underlying mechanisms of the curvature effects are revealed, which provides mechanistic insights into arrhythmogenesis in cardiac diseases.
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Affiliation(s)
- Yuhao Zhang
- Department of Physics, School of Physical Science and Technology, Ningbo University, Ningbo, People's Republic of China
| | - Zhaoyang Zhang
- Department of Physics, School of Physical Science and Technology, Ningbo University, Ningbo, People's Republic of China
| | - Zhilin Qu
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, United States
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2
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Guenzler V, Arzt M, Grimm M, Ebert A, Zeman F, Linz D, Woehrle H, Tamisier R, Cowie M, Fisser C. Temporal association of ventricular arrhythmias and respiratory events in heart failure patients with central sleep apnoea. Sleep Med 2024; 118:59-62. [PMID: 38608416 DOI: 10.1016/j.sleep.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024]
Abstract
In contrast to obstructive sleep apnoea, the peak of sympathetic tone in central sleep apnoea occurs during the hyperventilation phase. To explore the temporal association of premature ventricular complex (PVC) burden in the context of the apnoea/hypopnoea-hyperpnoea cycle, the duration of apnoea/hypopnoea was defined as 100 %. We assessed the PVC burden throughout the apnoea/hypopnoea-hyperpnoea cycle during the periods of ±150 % in 50 % increments before and after the apnoea/hypopnoea phase. In this subanalysis of 54 SERVE-HF patients, PVC burden was 32 % higher in the late hyperventilation period (50-100 % after apnoea/hypopnoea) compared to the apnoea/hypopnoea phase.
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Affiliation(s)
- Valentin Guenzler
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
| | - Michael Arzt
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Marjorie Grimm
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Amelie Ebert
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands; Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Centre for Heart Rhythm Disorders, Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia
| | - Holger Woehrle
- Sleep and Ventilation Centre Blaubeuren, Lung Centre Ulm, Ulm, Germany
| | - Renaud Tamisier
- Grenoble Alpes University, HP2 Laboratory, INSERM, Grenoble Alps University Hospital, U1300, Grenoble, France
| | - Martin Cowie
- Faculty of Medicine, National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Christoph Fisser
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
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Shinoda Y, Shatz NA, Tung R. Successful ablation of premature ventricular contractions from "late" activation site in cardiac sarcoidosis: Evidence suggestive of a reentrant mechanism. Heart Rhythm 2024; 21:670-673. [PMID: 38280619 DOI: 10.1016/j.hrthm.2024.01.035] [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: 10/28/2023] [Revised: 12/25/2023] [Accepted: 01/05/2024] [Indexed: 01/29/2024]
Affiliation(s)
- Yasutoshi Shinoda
- The University of Arizona College of Medicine-Phoenix, Banner University Medical Center, Phoenix, Arizona
| | | | - Roderick Tung
- The University of Arizona College of Medicine-Phoenix, Banner University Medical Center, Phoenix, Arizona.
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Fink T, Sciacca V, Sommer P. Catheter ablation of premature ventricular contractions with multiple morphologies in tachycardia-induced cardiomyopathy: all or nothing? Europace 2023; 25:euad064. [PMID: 36942441 PMCID: PMC10227652 DOI: 10.1093/europace/euad064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Affiliation(s)
- Thomas Fink
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, Bad Oeynhausen 32545, Germany
| | - Vanessa Sciacca
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, Bad Oeynhausen 32545, Germany
| | - Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, Bad Oeynhausen 32545, Germany
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Zhang Z, Zhang Z, Zou C, Pei Z, Yang Z, Wu J, Sun S, Gu F. ECGNet: An Efficient Network for Detecting Premature Ventricular Complexes Based on ECG Images. IEEE Trans Biomed Eng 2023; 70:446-458. [PMID: 35881595 DOI: 10.1109/tbme.2022.3193906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Preoperative prediction of the origin site of premature ventricular complexes (PVCs) is critical for the success of operations. However, current methods are not efficient or accurate enough. In addition, among the proposed strategies, there are few good prediction methods for electrocardiogram (ECG) images combined with deep learning aspects. METHODS We propose ECGNet, a new neural network for the classification of 12-lead ECG images. In ECGNet, 609 ECG images from 310 patients who had undergone successful surgery in the Division of Cardiology, the First Affiliated Hospital of Soochow University, are utilized to construct the dataset. We adopt dense blocks, special convolution kernels and divergent paths to improve the performance of ECGNet. In addition, a new loss function is designed to address the sample imbalance situation, whose cause is the uneven distribution of cases themselves, which often occurs in the medical field. We also conduct extensive experiments in terms of network prediction accuracy to compare ECGNet with other networks, such as ResNet and DarkNet. RESULTS Our ECGNet achieves extremely high prediction accuracy (91.74%) and efficiency with very small datasets. Our newly proposed loss function can solve the problem of sample imbalance during the training process. CONCLUSION The proposed ECGNet can quickly and accurately realize the multiclassification of PVCs after training with little data. Our network has the potential to be helpful to doctors with a preoperative diagnosis of PVCs. We will continue to collect similar cases and perfect our network structure to further improve the accuracy of our network's prediction.
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Dailey-Schwartz AL, Dyal JA, Mahle WT, Oster ME. Implementation of a practice plan for the outpatient cardiac evaluation of children after acute SARS-CoV-2 infection and a report of outcomes. Am Heart J 2021; 241:83-86. [PMID: 34302751 PMCID: PMC8295496 DOI: 10.1016/j.ahj.2021.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/25/2021] [Indexed: 11/18/2022]
Abstract
SARS-CoV-2 infection has been associated with cardiovascular disease in children, but which children need cardiac evaluation is unclear. We describe our experience evaluating 206 children for cardiac disease following SARS-CoV-2 infection (one of whom had ventricular ectopy) and propose a new guideline for management of these children. Routine cardiac screening after SARS-CoV-2 infection in children without any cardiac signs or symptoms does not appear to be high yield.
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Affiliation(s)
- Andrew L Dailey-Schwartz
- Emory University School of Medicine, Department of Pediatrics, Atlanta, GA; Children's Healthcare of Atlanta, Sibley Heart Center Cardiology, Atlanta, GA
| | - Jameson A Dyal
- Emory University School of Medicine, Department of Pediatrics, Atlanta, GA; Children's Healthcare of Atlanta, Sibley Heart Center Cardiology, Atlanta, GA
| | - William T Mahle
- Emory University School of Medicine, Department of Pediatrics, Atlanta, GA; Children's Healthcare of Atlanta, Sibley Heart Center Cardiology, Atlanta, GA
| | - Matthew E Oster
- Emory University School of Medicine, Department of Pediatrics, Atlanta, GA; Children's Healthcare of Atlanta, Sibley Heart Center Cardiology, Atlanta, GA.
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Huizar JF, Tan AY, Kaszala K, Ellenbogen KA. Clinical and translational insights on premature ventricular contractions and PVC-induced cardiomyopathy. Prog Cardiovasc Dis 2021; 66:17-27. [PMID: 33857575 PMCID: PMC9192164 DOI: 10.1016/j.pcad.2021.04.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 04/06/2021] [Indexed: 12/29/2022]
Abstract
The medical community's understanding of the consequences of premature ventricular contractions (PVCs) and PVC-induced cardiomyopathy has been derived mostly from observational and large population-based studies. Due to the difficulty of predicting the development of PVC-cardiomyopathy, the acute and chronic cardiac effects of PVCs and the mechanism of PVC-cardiomyopathy have been derived from pre-clinical studies with large animal models. Recently, these studies have described myocardial substrates that could potentially increase morbidity and mortality in patients with frequent PVCs and PVC-cardiomyopathy. In this paper, we provide an up-to-date comprehensive review of these pre-clinical and clinical studies.
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Affiliation(s)
- Jose F Huizar
- Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States of America; Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, United States of America.
| | - Alex Y Tan
- Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States of America; Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, United States of America
| | - Karoly Kaszala
- Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States of America; Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, United States of America
| | - Kenneth A Ellenbogen
- Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States of America
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Zhang Z, Hou X, Qian Z, Guo J, Zou J. Target Characteristics and Voltage Mapping of the Matrix in Idiopathic Premature Ventricular Contractions Originating from the Right Ventricular Outflow Tract. Biomed Res Int 2021; 2021:5551325. [PMID: 33997005 PMCID: PMC8099527 DOI: 10.1155/2021/5551325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/30/2021] [Accepted: 04/21/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The study was aimed at exploring the electrophysiological characteristics (EPS) of the optimal ablation site and its relationship with electroanatomic voltage mapping (EVM) in idiopathic premature ventricular contractions (PVCs) originating from the right ventricular outflow tract (RVOT). METHODS A total of 28 patients with idiopathic RVOT PVCs underwent successful ablation and EVM using a 3D electroanatomical mapping (CARTO) system. RESULTS Both bipolar and unipolar EVM showed a similar band-like lower-voltage area (LVA) under the pulmonary valve in all the patients; 21.4% of the targets were located in the band-like LVA. 42.9% of the targets were at the border of the band-like LVA on the bipolar voltage map, but unipolar mapping showed that 53.6% of the targets were located in the band-like LVA, and 35.7% of the targets at the border of the band-like LVA. A significant difference was found in both unipolar and bipolar voltage values between the regions within 0-5 mm above the optimal ablation site and the other regions. A similar difference was observed only in unipolar voltage values below the optimal ablation site. At the ablation site, there were frequent occurrences of a fragmented wave and voltage reversion in the bipolar electrograms, frustrated falling limbs, W bottom, and a QS configuration width > 150 ms in the unipolar electrograms. CONCLUSIONS EVM showed that the band-like LVA was an interesting area for the search of the optimal ablation sites of idiopathic RVOT-PVCs, especially the border area. There was focal microscarring around the ablation targets; some characteristics of EPS proved significant for successful ablation.
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Affiliation(s)
- Zhiyong Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
- Department of Cardiology, Suqian First People's Hospital, Suqian, Jiangsu 223800, China
| | - Xiaofeng Hou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Zhiyong Qian
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Jianghong Guo
- Department of Cardiology, Rugao First People's Hospital, Rugao, Jiangsu 226500, China
| | - Jiangang Zou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
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El-Eshmawi A, Pandis D, Miller MA, Boateng P, Dukkipati SR, Reddy VY, Adams DH. Surgical Cryoablation of Papillary Muscle PVCs During Mitral Valve Surgery: Therapeutic Consideration for Malignant MVP. J Am Coll Cardiol 2021; 76:3061-3062. [PMID: 33334428 DOI: 10.1016/j.jacc.2020.10.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/15/2020] [Accepted: 10/05/2020] [Indexed: 11/16/2022]
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10
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Zou S, Cen Z, Jia R, Lu S, Hao Y, Cui K. Electrophysiological study and radiofrequency ablation of hemodynamically-instable ventricular arrhythmias in a patient with pulmonary hypertension: A case report. Medicine (Baltimore) 2021; 100:e24896. [PMID: 33663121 PMCID: PMC7909233 DOI: 10.1097/md.0000000000024896] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 02/04/2021] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Hemodynamically-instable ventricular arrhythmias (VAs) are rare in patients with pulmonary hypertension (PH). To the best of our knowledge, only 1 case has been reported so far. Moreover, the pathogenesis of this kind of arrhythmia remains obscured and its treatment is challenging. Here we report another case and presented the substrate for VAs initiation and therapeutic effect of radiofrequency ablation. PATIENT CONCERNS This is a 57-year-old man who presented paroxysmal palpitation associated with presyncope at rest. Surface electrocardiogram (ECG) revealed frequent ventricular premature contractions and non-sustained ventricular tachycardia when symptoms occurred. He also had a history of severe PH which was secondary to atrial septal defect and partial anomalous pulmonary venous drainage and suffered from obvious dyspnea when climbing stairs World Health Organization Class III (WHO Class III). DIAGNOSIS Hemodynamically-instable VAs associated with severe PH. INTERVENTION Echocardiography revealed enlargement of right ventricle (right ventricle [RV]: 43 mm). Electrophysiological examination showed the origin of VAs is next to a small low-voltage zone of RV. Radiofrequency delivery at the origin successfully terminated VAs without occurrence of complication. OUTCOME The patient was free from arrhythmias and got an improvement of exercise tolerance, just with mild dyspnea when climbing stairs World Health Organization Class II (WHO class II), during six-month follow up. LESSONS This case suggests the low-voltage zone of remodeled RV, which may be secondary to increased pulmonary artery pressure, serves as the substrate for VAs initiation in patient with PH. Radiofrequency ablation can successfully terminate VAs and the termination of VAs can significantly improve the patient's impaired exercise tolerance.
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Affiliation(s)
- Song Zou
- Department of Cardiology, West China Hospital
| | - Zhifu Cen
- Department of Cardiology, West China Hospital
| | - Ruikun Jia
- Department of Cardiology, West China Hospital
| | - Sijie Lu
- Department of Cardiology, West China Hospital
| | - Yan Hao
- State Key Laboratory of Biotherapy, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Kaijun Cui
- Department of Cardiology, West China Hospital
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Hsia BC, Greige N, Patel SK, Clark RM, Ferrick KJ, Fisher JD, Gross J, Di Biase L, Krumerman A. Determining the optimal duration for premature ventricular contraction monitoring. Heart Rhythm 2020; 17:2119-2125. [PMID: 32679267 DOI: 10.1016/j.hrthm.2020.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 05/05/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Premature ventricular contractions (VPC) have hour-to-hour and day-to-day variation. High VPC burden correlates with cardiomyopathy. OBJECTIVE To determine the optimal duration for ambulatory electrocardiogram monitoring for accurate assessment of VPC burden. METHODS Our group performed a retrospective analysis on patch monitors used for any indication with overall VPC burden ≥5.0% between February 1, 2016, and February 1, 2020. We generated cumulative daily VPC averages for each day of wear and performed linear regression analysis between each cumulative daily average and overall burden. Patients were divided into groups based on low or high VPC frequency, and the analysis was repeated. Split-sample validation was used to internally validate the overall prediction model. RESULTS A total of 116 patches representing 107 patients (mean age: 64.5; female: 48%) were analyzed. Mean overall VPC burden was 13.4% ± 7.5% (range: 5.0%-42.0%). Day 1 R2 was 60%, P < .001, and continued to increase to R2 88%, P < .001 at day 14. Median percent and absolute error decreased from 22.70% (interquartile range [IQR]: 9.73-34.39) and 2.58% (IQR: 1.24-4.59) at day 1 to 5.62% (IQR: 2.82-8.39) and 0.55% (IQR: 0.28-1.05) at day 14. Patients with higher overall VPC frequencies achieved a more rapid rise in R2 relative to those with lower frequencies. Split-sample validation supported the internal validity of our linear regression prediction model. CONCLUSION Mobile telemetry for a period of ∼7 days accurately reflects overall VPC burden. Measurement of VPC burden for only 24-48 hours may not accurately reflect total burden. Monitoring for 2 weeks or longer adds little additional VPC information.
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Affiliation(s)
- Brian C Hsia
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, New York
| | - Nicolas Greige
- Harold and Muriel Block Institute for Clinical and Translational Research, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, New York
| | - Shreyans K Patel
- Department of Medicine, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, New York
| | - Rachel M Clark
- Department of Medicine, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, New York
| | - Kevin J Ferrick
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, New York
| | - John D Fisher
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, New York
| | - Jay Gross
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, New York
| | - Luigi Di Biase
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, New York
| | - Andrew Krumerman
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, New York.
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Keir DA, Duffin J, Badrov MB, Alba AC, Floras JS. Hypercapnia During Wakefulness Attenuates Ventricular Ectopy: Observations in a Young Man With Heart Failure With Reduced Ejection Fraction. Circ Heart Fail 2020; 13:e006837. [PMID: 32493059 DOI: 10.1161/circheartfailure.119.006837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Daniel A Keir
- University Health Network and Mount Sinai Hospital Division of Cardiology and Department of Medicine, University of Toronto, and the Toronto General Research Institute, Toronto, ON, Canada (D.A.K., M.B.B., A.C.A., J.S.F)
| | - James Duffin
- Departments of Anaesthesia and Physiology (J.D.), University of Toronto, ON, Canada
- Thornhill Research, Inc, Toronto, ON, Canada (J.D.)
| | - Mark B Badrov
- University Health Network and Mount Sinai Hospital Division of Cardiology and Department of Medicine, University of Toronto, and the Toronto General Research Institute, Toronto, ON, Canada (D.A.K., M.B.B., A.C.A., J.S.F)
| | - Ana Carolina Alba
- University Health Network and Mount Sinai Hospital Division of Cardiology and Department of Medicine, University of Toronto, and the Toronto General Research Institute, Toronto, ON, Canada (D.A.K., M.B.B., A.C.A., J.S.F)
| | - John S Floras
- University Health Network and Mount Sinai Hospital Division of Cardiology and Department of Medicine, University of Toronto, and the Toronto General Research Institute, Toronto, ON, Canada (D.A.K., M.B.B., A.C.A., J.S.F)
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Wang Y, He K, Wang O, Lin X, Chen S, Jiang Y, Li M, Xia W, Xing X. Manifestations of left ventricular dysfunction and arrhythmia in patients with chronic hypoparathyroidism and pseudohypoparathyroidism: a preliminary study. BMC Endocr Disord 2020; 20:61. [PMID: 32393234 PMCID: PMC7216721 DOI: 10.1186/s12902-020-0541-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 04/28/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Cardiac damage triggered by severe hypocalcemia is well known. However, the role of chronic hypoparathyroidism (HP) and pseudohypoparathyroidism (PHP) in cardiac health is still unclear. We investigated the effect of chronic HP and PHP on cardiac structure and conductive function in patients compiling with treatment. METHODS The study included 18 patients with HP and eight with PHP aged 45.4 ± 15.4 and 22.1 ± 6.4 years, respectively with a previously regular follow-up. In addition, 26 age- and sex-matched healthy controls were included. General characteristics and biochemical indices were recorded. Cardiac function and structure were assessed by estimation of myocardial enzymes, B-type natriuretic peptide (BNP), and echocardiography. The 12-lead electrocardiogram and 24-h Holter electrocardiography were performed to evaluate the conductive function. RESULTS Levels of serum calcium in HP and PHP were 2.05 ± 0.16 mmol/L and 2.25 ± 0.19 mmol/L, respectively. The levels of myocardial enzyme and BNP were within the normal range. Adjusting for age at evaluation and body mass index, all M-mode measurements, left ventricular mass (LVM), LVM index (LVMI) and relative wall thickness (RWT) were comparable between patients and controls. Prolongation of corrected QT (QTc) intervals occurred in 52.6% (10/19) of patients, and 6.7% (1/15) of patients manifested more than 100 episodes of supraventricular and ventricular extrasystoles, as well as supraventricular tachycardia. None of the above arrhythmias was related to a severe clinical event. CONCLUSIONS From this pilot study, patients diagnosed with HP and PHP and well-controlled serum calcium levels manifested normal cardiac morphology and ventricular function, except for prolonged QTc intervals, and a small percentage of mild arrhythmias needing further investigation.
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MESH Headings
- Adolescent
- Adult
- Arrhythmias, Cardiac/etiology
- Arrhythmias, Cardiac/metabolism
- Arrhythmias, Cardiac/physiopathology
- Atrial Premature Complexes/etiology
- Atrial Premature Complexes/metabolism
- Atrial Premature Complexes/physiopathology
- Calcium/metabolism
- Case-Control Studies
- Chronic Disease
- Echocardiography
- Electrocardiography
- Electrocardiography, Ambulatory
- Female
- Humans
- Hypoparathyroidism/complications
- Hypoparathyroidism/metabolism
- Hypoparathyroidism/physiopathology
- Long QT Syndrome/etiology
- Long QT Syndrome/metabolism
- Long QT Syndrome/physiopathology
- Male
- Middle Aged
- Natriuretic Peptide, Brain/metabolism
- Pilot Projects
- Pseudohypoparathyroidism/complications
- Pseudohypoparathyroidism/metabolism
- Pseudohypoparathyroidism/physiopathology
- Tachycardia, Supraventricular/etiology
- Tachycardia, Supraventricular/metabolism
- Tachycardia, Supraventricular/physiopathology
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/metabolism
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Premature Complexes/etiology
- Ventricular Premature Complexes/metabolism
- Ventricular Premature Complexes/physiopathology
- Young Adult
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Affiliation(s)
- Yabing Wang
- Department of Endocrinology, Key Laboratory of Endocrinology of the Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Dongcheng District, Shuaifuyuan No.1, Beijing, 100730 China
| | - Kun He
- Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Dongcheng District, Shuaifuyuan No.1, Beijing, 100730 China
| | - Ou Wang
- Department of Endocrinology, Key Laboratory of Endocrinology of the Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Dongcheng District, Shuaifuyuan No.1, Beijing, 100730 China
| | - Xue Lin
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Dongcheng District, Shuaifuyuan No.1, Beijing, 100730 China
| | - Sixing Chen
- Department of Endocrinology, Key Laboratory of Endocrinology of the Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Dongcheng District, Shuaifuyuan No.1, Beijing, 100730 China
| | - Yan Jiang
- Department of Endocrinology, Key Laboratory of Endocrinology of the Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Dongcheng District, Shuaifuyuan No.1, Beijing, 100730 China
| | - Mei Li
- Department of Endocrinology, Key Laboratory of Endocrinology of the Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Dongcheng District, Shuaifuyuan No.1, Beijing, 100730 China
| | - Weibo Xia
- Department of Endocrinology, Key Laboratory of Endocrinology of the Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Dongcheng District, Shuaifuyuan No.1, Beijing, 100730 China
| | - Xiaoping Xing
- Department of Endocrinology, Key Laboratory of Endocrinology of the Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Dongcheng District, Shuaifuyuan No.1, Beijing, 100730 China
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Im SI, Lee SH, Gwag HB, Park Y, Park SJ, Kim JS, On YK, Park KM. Electrocardiographic characteristics for successful radiofrequency ablation of right coronary cusp premature ventricular contractions. Medicine (Baltimore) 2020; 99:e19398. [PMID: 32176065 PMCID: PMC7220497 DOI: 10.1097/md.0000000000019398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Electrocardiographic (ECG) criteria identifying right- and left-sided outflow tract origins have been established. The purpose of this study was to define the criteria for premature ventricular contractions (PVCs) originating from the right coronary cusp (RCC) adequately.We analyzed ECG and electrophysiologic study data from patients who underwent successful ablation of PVCs originating from the RCC and right ventricular outflow tract (RVOT). Eighteen RCC and 28 septal RVOT PVCs were studied. Among these 18 successful RCC PVCs, a predominantly positive QRS in lead I in 18/18 (100%), longer V1-2 R-wave duration (81.4 ± 31.1 vs 44.8 ± 7.0 ms, P = .02), V1-2 R wave duration index (RWDI) (51.3 ± 22.0 vs 31.2 ± 7.5%, P = .06) were observed compared to those with posteroseptal RVOT. Local ventricular activation time preceding QRS onset was significantly earlier (-38 ± 12 ms) at the successful RCC ablation site compared to the failed ablation site of the septal RVOT (-22 ± 8 ms), even without good pace mapping at the RVOT (P < .001). The receiver operating characteristic curve showed that a pre-QRS time of ≥-31 ms predicted successful RCC ablation with 67% sensitivity and 94% specificity. A predominantly positive QRS in lead I, longer R-wave duration and RWDI in lead V1 or V2 with a local ventricular activation preceding QRS onset by an average of -31 ms suggests an effective RCC ablation site.
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Affiliation(s)
- Sung Il Im
- Division of Cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan
| | - Sung Ho Lee
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital
| | - Hye Bin Gwag
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan university School of Medicine, Seoul, Republic of Korea
| | - Youngjun Park
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan university School of Medicine, Seoul, Republic of Korea
| | - Seung-Jung Park
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan university School of Medicine, Seoul, Republic of Korea
| | - June Soo Kim
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan university School of Medicine, Seoul, Republic of Korea
| | - Young Keun On
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan university School of Medicine, Seoul, Republic of Korea
| | - Kyoung-Min Park
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan university School of Medicine, Seoul, Republic of Korea
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15
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Zhao Z, Liu X, Gao L, Xi Y, Chen Q, Chang D, Xiao X, Cheng J, Yang Y, Xia Y, Yin X. Benefit of Contact Force-Guided Catheter Ablation for Treating Premature Ventricular Contractions. Tex Heart Inst J 2020; 47:3-9. [PMID: 32148445 DOI: 10.14503/thij-17-6441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We evaluated whether an irrigated contact force-sensing catheter would improve the safety and effectiveness of radiofrequency ablation of premature ventricular contractions originating from the right ventricular outflow tract. We retrospectively reviewed the charts of patients with symptomatic premature ventricular contractions who underwent ablation with a contact force-sensing catheter (56 patients, SmartTouch) or conventional catheter (59 patients, ThermoCool) at our hospital from August 2013 through December 2015. During a mean follow-up of 16 ± 5 months, 3 patients in the conventional group had recurrences, compared with none in the contact force group. Complications occurred only in the conventional group (one steam pop; 2 ablations suspended because of significantly increasing impedance). In the contact force group, the median contact force during ablation was 10 g (interquartile range, 7-14 g). Times for overall procedure (36.9 ± 5 min), fluoroscopy (86.3 ± 22.7 s), and ablation (60.3 ± 21.4 s) were significantly shorter in the contact force group than in the conventional group (46.2 ± 6.2 min, 107.7 ± 30 s, and 88.7 ± 32.3 s, respectively; P <0.001). In the contact force group, cases with a force-time integral <560 gram-seconds (g-s) had significantly longer procedure and fluoroscopy times (both P <0.001) than did those with a force-time integral ≥560 g-s. These findings suggest that ablation of premature ventricular contractions originating from the right ventricular outflow tract with an irrigated contact force-sensing catheter instead of a conventional catheter shortens overall procedure, fluoroscopy, and ablation times without increasing risk of recurrence or complications.
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16
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Tan AY, Elharrif K, Cardona-Guarache R, Mankad P, Ayers O, Joslyn M, Das A, Kaszala K, Lin SF, Ellenbogen KA, Minisi AJ, Huizar JF. Persistent Proarrhythmic Neural Remodeling Despite Recovery From Premature Ventricular Contraction-Induced Cardiomyopathy. J Am Coll Cardiol 2020; 75:1-13. [PMID: 31918815 PMCID: PMC7006705 DOI: 10.1016/j.jacc.2019.10.046] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 07/11/2019] [Revised: 09/30/2019] [Accepted: 10/21/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND The presence and significance of neural remodeling in premature ventricular contraction-induced cardiomyopathy (PVC-CM) remain unknown. OBJECTIVES This study aimed to characterize cardiac sympathovagal balance and proarrhythmia in a canine model of PVC-CM. METHODS In 12 canines, the investigators implanted epicardial pacemakers and radiotelemetry units to record cardiac rhythm and nerve activity (NA) from the left stellate ganglion (SNA), left cardiac vagus (VNA), and arterial blood pressure. Bigeminal PVCs (200 ms coupling) were applied for 12 weeks to induce PVC-CM in 7 animals then disabled for 4 weeks to allow complete recovery of left ventricular ejection fraction (LVEF), versus 5 sham controls. RESULTS After 12 weeks of PVCs, LVEF (p = 0.006) and dP/dT (p = 0.007) decreased. Resting SNA (p = 0.002) and VNA (p = 0.04), exercise SNA (p = 0.01), SNA response to evoked PVCs (p = 0.005), heart rate (HR) at rest (p = 0.003), and exercise (p < 0.04) increased, whereas HR variability (HRV) decreased (p = 0.009). There was increased spontaneous atrial (p = 0.02) and ventricular arrhythmias (p = 0.03) in PVC-CM. Increased SNA preceded both atrial (p = 0.0003) and ventricular (p = 0.009) arrhythmia onset. Clonidine suppressed SNA and abolished all arrhythmias. After disabling PVC for 4 weeks, LVEF (p = 0.01), dP/dT (p = 0.047), and resting VNA (p = 0.03) recovered to baseline levels. However, SNA, resting HR, HRV, and atrial (p = 0.03) and ventricular (p = 0.03) proarrhythmia persisted. There was sympathetic hyperinnervation in stellate ganglia (p = 0.02) but not ventricles (p = 0.2) of PVC-CM and recovered animals versus sham controls. CONCLUSIONS Neural remodeling in PVC-CM is characterized by extracardiac sympathetic hyperinnervation and sympathetic neural hyperactivity that persists despite normalization of LVEF. The altered cardiac sympathovagal balance is an important trigger and substrate for atrial and ventricular proarrhythmia.
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Affiliation(s)
- Alex Y Tan
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; Electrophysiology Section, Division of Cardiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia.
| | - Khalid Elharrif
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; Electrophysiology Section, Division of Cardiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Ricardo Cardona-Guarache
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; Electrophysiology Section, Division of Cardiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Pranav Mankad
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; Electrophysiology Section, Division of Cardiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Owen Ayers
- Electrophysiology Section, Division of Cardiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Martha Joslyn
- Electrophysiology Section, Division of Cardiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Anindita Das
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Karoly Kaszala
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; Electrophysiology Section, Division of Cardiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Shien-Fong Lin
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Kenneth A Ellenbogen
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; Electrophysiology Section, Division of Cardiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Anthony J Minisi
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; Electrophysiology Section, Division of Cardiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Jose F Huizar
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; Electrophysiology Section, Division of Cardiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
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17
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Boässon MP, Rienks R, van der Ven A, van Hulst RA. Arrhythmogenicity of scuba diving: Holter monitoring in a hyperbaric environment. Undersea Hyperb Med 2019; 46:421-427. [PMID: 31509898] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION About 26% of diving-related fatalities are caused by cardiac disease, part of which might be associated with fatal arrhythmias. This raises the question as to whether fatal arrhythmias are being provoked by hyperbaric conditions themselves or if exercise or stress provokes the fatal arrhythmias in cases of underlying (ischemic) cardiac disease. OBJECTIVE To measure the influence of hyperbaric conditions (50 msw) on cardiac conduction and arrhythmias in professional divers by means of ECG. METHODS This is a prospective study on military divers in a hyperbaric chamber with continuous ECG monitoring using Holter registrations. Supraventricular and ventricular ectopy was registered during hyperbaric conditions. RR, PR, QRS, QT and QTc intervals were calculated at 50 msw and compared with ECGs at rest. RESULTS Included were 17 male military divers who made 20 dives. A total of 10 PVCs, 45 PACs, four atrial runs and four atrial pairs were seen. Significant prolongation of the PR interval was seen and a decrease of in QRS duration at 50 msw. There was no significant change in the RR, QT and QTc intervals. CONCLUSION In these divers, no clinically relevant arrhythmias were observed during wet dives in a recompression chamber at 50 msw. We observed a small prolongation of PR interval that is probably not clinically relevant in divers without any known conduction disorders.
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Affiliation(s)
- M P Boässon
- Department of Cardiology, Meander Medical Center, Amersfoort, The Netherlands
| | - R Rienks
- Department of Cardiology, Central Military Hospital, Utrecht, The Netherlands
| | - A van der Ven
- Diving Medical Center, Royal Netherlands Navy, Den Helder, The Netherlands
- Military Rehabilitation Center, Doorn, The Netherlands
| | - R A van Hulst
- Diving Medical Center, Royal Netherlands Navy, Den Helder, The Netherlands
- Department Hyperbaric and Diving Medicine, Anesthesiology, AMC, Amsterdam, The Netherlands
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Kanat S, Mutluer FO, Tütüncü A, Karaduman BD, Bozkaya VO, Keskin M, Uslu A, Çay S, Tenekecioglu E. Left Atrial Function Is Improved in Short-Term Follow-Up after Catheter Ablation of Outflow Tract Premature Ventricular Complexes. ACTA ACUST UNITED AC 2019; 55:medicina55060241. [PMID: 31163695 PMCID: PMC6630603 DOI: 10.3390/medicina55060241] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 04/04/2019] [Accepted: 05/27/2019] [Indexed: 12/13/2022]
Abstract
Background: Association of premature ventricular complexes (PVC) with left ventricular systolic dysfunction (LVSD) and efficacy of catheter ablation treatment have been demonstrated in studies. The role of left atrial (LA) mechanics in the etiopathogenesis of PVC-induced cardiomyopathy (PVC-CMP) as well as changes in LA mechanics with catheter ablation have not been studied before. Methods: A total number of 61 patients (Mean Age 43 ± 3) with idiopathic outflow tract (OT) PVCs undergoing radiofrequency catheter ablation (RFCA) were enrolled. ECG, 24 h Holter, and echocardiographic evaluation with left ventricular (LV) diastolic functions and LA volumetric assessments were performed before and three months after RFCA. Results: Along with a marginal increase in left ventricle ejection fraction (LVEF), improvement in diastolic functions and left atrial mechanics were observed in the study (LVEF 53 ± 7 versus 57 ± 6, p < 0.01) in short-term follow-up. The frequency of LV diastolic dysfunction (LVDD) decreased with catheter ablation (n = 5 to 0, p = 0.02). The overall LA function improved. Left atrium passive and overall emptying fraction (LAEF) increased significantly (0.32 ± 0.04 to 0.41 ± 0.04, p < 0.05 and 0.62 ± 0.04 to 0.65 ± 0.004, p < 0.05, respectively). Active LAEF decreased significantly (0.29 ± 0.005 to 0.24 ± 0.006, p < 0.05). Conclusions: The results of this study are indicative of “PVC-induced atriomyopathy” which responds to RFCA in short-term follow-up. Atrial dysfunction might play a role in symptoms and etiopathogenesis of LVSD.
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Affiliation(s)
- Selçuk Kanat
- Department of Cardiology, Bursa Education and Research Hospital, Health Sciences University Bursa, 16310 Bursa, Turkey.
| | - Ferit Onur Mutluer
- Department of Cardiology, Erasmus MC, Erasmus University, 3000 CA Rotterdam, The Netherlands.
| | - Ahmet Tütüncü
- Department of Cardiology, Bursa Education and Research Hospital, Health Sciences University Bursa, 16310 Bursa, Turkey.
| | - Bilge Duran Karaduman
- Department of Cardiology, Atatürk Education and Research Hospital, Yildirim Bayezit University, 06760 Ankara, Turkey.
| | - Veciha Ozlem Bozkaya
- Department of Cardiology, Zekai Tahir Burak Education and Research Hospital, 06230 Ankara, Turkey.
| | - Muhammed Keskin
- Department of Cardiology, Istanbul Sultan Abdulhamid Han Education and Research Hospital, 34668 Istanbul, Turkey.
| | - Abdulkadir Uslu
- Department of Cardiology, Kosuyolu Education and Research Hospital, 34865 Istanbul, Turkey.
| | - Serkan Çay
- Department of Cardiology, Ankara Yüksek İhtisas Education and Research Hospital, 06100 Ankara, Turkey.
| | - Erhan Tenekecioglu
- Department of Cardiology, Bursa Education and Research Hospital, Health Sciences University Bursa, 16310 Bursa, Turkey.
- Department of Cardiology, Erasmus MC, Erasmus University, 3000 CA Rotterdam, The Netherlands.
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Popescu I, Yin G, Velmurugan S, Erickson JR, Despa F, Despa S. Lower sarcoplasmic reticulum Ca 2+ threshold for triggering afterdepolarizations in diabetic rat hearts. Heart Rhythm 2019; 16:765-772. [PMID: 30414461 PMCID: PMC6491240 DOI: 10.1016/j.hrthm.2018.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 03/14/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND Type 2 diabetes (T2D) increases arrhythmia risk through incompletely elucidated mechanisms. Ventricular arrhythmias could be initiated by delayed afterdepolarizations (DADs) resulting from elevated spontaneous sarcoplasmic reticulum (SR) Ca2+ release (SR Ca2+ leak). OBJECTIVE The purpose of this study was to test the role of DADs and SR Ca2+ leak in triggering arrhythmias in T2D hearts. METHODS We compared rats with late-onset T2D that display pancreatic and cardiac phenotypes similar to those in humans with T2D (HIP rats) and their nondiabetic littermates (wild type [WT]). RESULTS HIP rats showed higher propensity for premature ventricular complexes and ventricular tachyarrhythmias, whereas HIP myocytes displayed more frequent DADs and had lower SR Ca2+ content than WT. However, the threshold SR Ca2+ at which depolarizing transient inward currents (Itis) are generated was also significantly decreased in HIP myocytes and was below the actual SR Ca2+ load, which explains the increased DAD incidence despite reduced Ca2+ in SR. In agreement with these findings, Ca2+ spark frequency was augmented in myocytes from HIP vs WT rats, which suggests activation of ryanodine receptors (RyRs) in HIP hearts. Indeed, RyR phosphorylation (by CaMKII and protein kinase A) and oxidation are enhanced in HIP hearts, whereas there is no RyR O-GlcNAcylation in either HIP or control hearts. CaMKII inhibition dissipated the difference in Ca2+ spark frequency between HIP and WT myocytes. CONCLUSION The threshold SR Ca2+ for generating depolarizing Itis is lower in T2D because of RyR activation after hyperphosphorylation and oxidation, which favors the occurrence of DADs despite low SR Ca2+ loads.
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Affiliation(s)
- Iuliana Popescu
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, Kentucky
| | - Guo Yin
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, Kentucky
| | - Sathya Velmurugan
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, Kentucky
| | - Jeffrey R Erickson
- Department of Physiology and HeartOtago, University of Otago, Dunedin, New Zealand
| | - Florin Despa
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, Kentucky
| | - Sanda Despa
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, Kentucky.
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Alawad M, Wang L. Learning Domain Shift in Simulated and Clinical Data: Localizing the Origin of Ventricular Activation From 12-Lead Electrocardiograms. IEEE Trans Med Imaging 2019; 38:1172-1184. [PMID: 30418900 PMCID: PMC6601334 DOI: 10.1109/tmi.2018.2880092] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Building a data-driven model to localize the origin of ventricular activation from 12-lead electrocardiograms (ECG) requires addressing the challenge of large anatomical and physiological variations across individuals. The alternative of a patient-specific model is, however, difficult to implement in clinical practice because the training data must be obtained through invasive procedures. In this paper, we present a novel approach that overcomes this problem of the scarcity of clinical data by transferring the knowledge from a large set of patient-specific simulation data while utilizing domain adaptation to address the discrepancy between the simulation and clinical data. The method that we have developed quantifies non-uniformly distributed simulation errors, which are then incorporated into the process of domain adaptation in the context of both classification and regression. This yields a quantitative model that, with the addition of 12-lead ECG data from each patient, provides progressively improved patient-specific localizations of the origin of ventricular activation. We evaluated the performance of the presented method in localizing 75 pacing sites on three in-vivo premature ventricular contraction (PVC) patients. We found that the presented model showed an improvement in localization accuracy relative to a model trained on clinical ECG data alone or a model trained on combined simulation and clinical data without considering domain shift. Furthermore, we demonstrated the ability of the presented model to improve the real-time prediction of the origin of ventricular activation with each added clinical ECG data, progressively guiding the clinician towards the target site.
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21
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Parreira L, Marinheiro R, Carmo P, Amador P, Mesquita D, Farinha J, Cavaco D, Jeronimo R, Costa F, Adragão P. Isolated diastolic potentials as predictors of success in ablation of right ventricular outflow tract idiopathic premature ventricular contractions. PLoS One 2019; 14:e0211232. [PMID: 30726274 PMCID: PMC6364967 DOI: 10.1371/journal.pone.0211232] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 01/09/2019] [Indexed: 11/19/2022] Open
Abstract
Background and aims Discrete potentials, low voltage and fragmented electrograms, have been previously reported at ablation site, in patients with premature ventricular contractions (PVCs) originating in the right ventricular outflow tract (RVOT). The aim of this study was to review the electrograms at ablation site and assess the presence of diastolic potentials and their association with success. Methods We retrospectively reviewed the electrograms obtained at the radiofrequency (RF) delivery sites of 48 patients subjected to ablation of RVOT frequent PVCs. We assessed the duration and amplitude of local electrogram, local activation time, and presence of diastolic potentials and fragmented electrograms. Results We reviewed 134 electrograms, median 2 (1–4) per patient. Success was achieved in 40 patients (83%). At successful sites the local activation time was earlier– 54 (-35 to -77) ms vs -26 (-12 to -35) ms, p<0.0001; the local electrogram had lower amplitude 1 (0.45–1.15) vs 1.5 (0.5–2.1) mV, p = 0.006, and longer duration 106 (80–154) vs 74 (60–90) ms, p<0.0001. Diastolic potentials and fragmented electrograms were more frequently present, respectively 76% vs 9%, p <0.0001 and 54% vs 11%, p<0.0001. In univariable analysis these variables were all associated with success. In multivariable analysis only the presence of diastolic potentials [OR 15.5 (95% CI: 3.92–61.2; p<0.0001)], and the value of local activation time [OR 1.11 (95% CI: 1.049–1.172 p<0.0001)], were significantly associated with success. Conclusion In this group of patients the presence of diastolic potentials at the ablation site was associated with success.
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Affiliation(s)
- Leonor Parreira
- Arrhythmology Department, Hospital da Luz, Lisboa, Portugal
- Cardiology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
- * E-mail:
| | - Rita Marinheiro
- Cardiology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Pedro Carmo
- Arrhythmology Department, Hospital da Luz, Lisboa, Portugal
| | - Pedro Amador
- Cardiology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Dinis Mesquita
- Cardiology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - José Farinha
- Cardiology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Diogo Cavaco
- Arrhythmology Department, Hospital da Luz, Lisboa, Portugal
| | | | | | - Pedro Adragão
- Arrhythmology Department, Hospital da Luz, Lisboa, Portugal
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22
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Fang L, Xu J, Hu H, Chen Y, Shi P, Wang L, Liu H. Noninvasive Imaging of Epicardial and Endocardial Potentials With Low Rank and Sparsity Constraints. IEEE Trans Biomed Eng 2019; 66:2651-2662. [PMID: 30668450 DOI: 10.1109/tbme.2019.2894286] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
In this study, we explore the use of low rank and sparse constraints for the noninvasive estimation of epicardial and endocardial extracellular potentials from body-surface electrocardiographic data to locate the focus of premature ventricular contractions (PVCs). The proposed strategy formulates the dynamic spatiotemporal distribution of cardiac potentials by means of low rank and sparse decomposition, where the low rank term represents the smooth background and the anomalous potentials are extracted in the sparse matrix. Compared to the most previous potential-based approaches, the proposed low rank and sparse constraints are batch spatiotemporal constraints that capture the underlying relationship of dynamic potentials. The resulting optimization problem is solved using alternating direction method of multipliers. Three sets of simulation experiments with eight different ventricular pacing sites demonstrate that the proposed model outperforms the existing Tikhonov regularization (zero-order, second-order) and L1-norm based method at accurately reconstructing the potentials and locating the ventricular pacing sites. Experiments on a total of 39 cases of real PVC data also validate the ability of the proposed method to correctly locate ectopic pacing sites.
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23
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Gordon M, Williams C. PVC Detection Using a Convolutional Autoencoder and Random Forest Classifier. Pac Symp Biocomput 2019; 24:42-53. [PMID: 30864309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The accurate detection of premature ventricular contractions (PVCs) in patients is an important task in cardiac care for some patients. In some cases, the usefulness to physicians in detecting PVCs stems from their long-term correlations with dangerous heart conditions. In other cases their potential as a precursor to serious cardiac events may make their detection a useful early warning mechanism. In many of these applications, the long-term nature of the monitoring required and the infrequency of PVCs make manual observation for PVCs impractical. Existing methods of automated PVC detection suffer from drawbacks such as the need to use difficult to extract morphological features, domain-specific features, or large numbers of estimated parameters. In particular, systems using large numbers of trained parameters have the potential to require large amounts of training data and computation and may have issues generalizing due to their potential to overfit. To address some of these drawbacks, we developed a novel PVC detection algorithm based around a convolutional autoencoder to address these weaknesses and validated our method using the MIT-BIH arrhythmia database.
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Affiliation(s)
- Max Gordon
- Department of Electrical and Computer Engineering, North Carolina State University, Raleigh, North Carolina 27607, USA www.ncsu.edu,
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Hourdain J, Clavel MA, Deharo JC, Asirvatham S, Avierinos JF, Habib G, Franceschi F, Probst V, Sadoul N, Martins R, Leclercq C, Chauvin M, Pasquie JL, Maury P, Laurent G, Ackerman M, Hodge DO, Enriquez-Sarano M. Common Phenotype in Patients With Mitral Valve Prolapse Who Experienced Sudden Cardiac Death. Circulation 2018; 138:1067-1069. [PMID: 30354542 DOI: 10.1161/circulationaha.118.033488] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jérôme Hourdain
- Centre Hospitalier Universitaire la Timone, Marseille, France (J.H., J.-C.D., J.F.A., G.H., F.F.)
| | | | - Jean-Claude Deharo
- Centre Hospitalier Universitaire la Timone, Marseille, France (J.H., J.-C.D., J.F.A., G.H., F.F.)
| | | | - Jean François Avierinos
- Centre Hospitalier Universitaire la Timone, Marseille, France (J.H., J.-C.D., J.F.A., G.H., F.F.)
| | - Gilbert Habib
- Centre Hospitalier Universitaire la Timone, Marseille, France (J.H., J.-C.D., J.F.A., G.H., F.F.)
| | - Frederic Franceschi
- Centre Hospitalier Universitaire la Timone, Marseille, France (J.H., J.-C.D., J.F.A., G.H., F.F.)
| | - Vincent Probst
- Centre Hospitalier Universitaire Nord-Laennec, Nantes, France (V.P.)
| | - Nicolas Sadoul
- Centre Hospitalier Universitaire Brabois, Vandoeuve-lès-Nancy, France (N.S.)
| | - Raphael Martins
- Centre Hospitalier Universitaire Pontchaillou, Rennes, France (R.M., C.L.)
| | | | | | - Jean Luc Pasquie
- Centre Hospitalier Universitaire Arnaud de Villeneuve, Montpellier, France (J.L.P.)
| | - Philippe Maury
- Centre Hospitalier Universitaire Rangueil, Toulouse, France (P.M.)
| | - Gabriel Laurent
- Centre Hospitalier Universitaire Bocage, Dijon, France (G.L.)
| | - Michael Ackerman
- Mayo Clinic, Rochester, MN (M.A.C., S.A., M.A., D.O.H., M.E.-S.)
| | - David O Hodge
- Mayo Clinic, Rochester, MN (M.A.C., S.A., M.A., D.O.H., M.E.-S.)
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Muñoz LM, Gelzer ARM, Fenton FH, Qian W, Lin W, Gilmour RF, Otani NF. Discordant Alternans as a Mechanism for Initiation of Ventricular Fibrillation In Vitro. J Am Heart Assoc 2018; 7:e007898. [PMID: 30371176 PMCID: PMC6201417 DOI: 10.1161/jaha.117.007898] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 06/19/2018] [Indexed: 11/16/2022]
Abstract
Background Ventricular tachyarrhythmias are often preceded by short sequences of premature ventricular complexes. In a previous study, a restitution-based computational model predicted which sequences of stimulated premature complexes were most likely to induce ventricular fibrillation in canines in vivo. However, the underlying mechanism, based on discordant-alternans dynamics, could not be verified in that study. The current study seeks to elucidate the mechanism by determining whether the spatiotemporal evolution of action potentials and initiation of ventricular fibrillation in in vitro experiments are consistent with model predictions. Methods and Results Optical mapping voltage signals from canine right-ventricular tissue (n=9) were obtained simultaneously from the entire epicardium and endocardium during and after premature stimulus sequences. Model predictions of action potential propagation along a 1-dimensional cable were developed using action potential duration versus diastolic interval data. The model predicted sign-change patterns in action potential duration and diastolic interval spatial gradients with posterior probabilities of 91.1%, and 82.1%, respectively. The model predicted conduction block with 64% sensitivity and 100% specificity. A generalized estimating equation logistic-regression approach showed that model-prediction effects were significant for both conduction block ( P<1×10-15, coefficient 44.36) and sustained ventricular fibrillation ( P=0.0046, coefficient, 1.63) events. Conclusions The observed sign-change patterns favored discordant alternans, and the model successfully identified sequences of premature stimuli that induced conduction block. This suggests that the relatively simple discordant-alternans-based process that led to block in the model may often be responsible for ventricular fibrillation onset when preceded by premature beats. These observations may aid in developing improved methods for anticipating block and ventricular fibrillation.
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Affiliation(s)
- Laura M. Muñoz
- School of Mathematical SciencesRochester Institute of TechnologyRochesterNY
| | | | | | | | | | - Robert F. Gilmour
- University of Prince Edward IslandCharlottetownPrince Edward IslandCanada
| | - Niels F. Otani
- School of Mathematical SciencesRochester Institute of TechnologyRochesterNY
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Vyas A, Lokhandwala Y. Coronary sinus as a site for stable temporary atrial pacing to tide over premature ventricular complex-triggered recurrent ventricular fibrillation in a patient with severe left ventricular dysfunction after coronary bypass surgery. Indian Heart J 2018; 70 Suppl 3:S483-S485. [PMID: 30595312 PMCID: PMC6309571 DOI: 10.1016/j.ihj.2018.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 07/24/2018] [Accepted: 07/25/2018] [Indexed: 12/13/2022] Open
Abstract
Use of atrial pacing has been known, yet underutilized tool for effective temporary pacing whenever needed early after cardiac surgery. The reasons may be frequent failures of epicardial wires (fixed over atria intra-operative) leading to loss of capture. Endocardial atrial pacing sites for temporary pacing are unstable and hence continuous pacing with acceptable thresholds is impossible. We describe a case of ischemic cardiomyopathy and severe left ventricle systolic dysfunction who required atrial pacing post coronary artery bypass grafting (CABG) surgery for around 48–72 hours starting 4th day post operation when he had multiple episodes of ventricular fibrillation (VF) needing many defibrillation shocks. VF episodes were triggered by premature ventricular complexes (PVC) falling on as R on T. Episodes were refractory to anti-arrhythmic drugs and general anesthesia. These PVC were successfully overdriven by atrial pacing by fluoroscopically placing pacing lead in coronary sinus. This led to complete suppression of PVC induced VF for next 48–72 hours while the antiarrhythmic drugs were continued. Subsequently the patient was discharged in stable state. Atrial pacing, though quite valuable during the post-operative period after cardiac surgery, is underutilized, especially when pacing through surgically placed epicardial wire fails. This report is helpful in drawing attention towards coronary sinus (CS) as an alternate site for achieving stable, temporary atrial pacing during the post-operative period. This site can also be utilized for short term dual chamber pacing if required in post-operative state using transvenous CS site for atrial pacing and intraoperatively placed epicardial wire for ventricular pacing.
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Affiliation(s)
| | - Yash Lokhandwala
- Cardiologist, Holy Family Hospital & Research Center, Mumbai, India.
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27
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Abstract
To study the possible role of autonomic influences on the occurrence of frequent premature ventricular beats (VPBs) in subjects without structural heart disease.24-hour Holter ECG recordings (≥1500 VPBs/d, sinus rhythm) of 20 symptomatic patients (9 women, 11 men, mean age 58.9 years) without structural heart disease were used for the study. The circadian distribution pattern of VPBs was studied (paired t test) by dividing the day into 3 periods (16:00-22:00-06:00-16:00), and correlations were analyzed between the absolute (ln transformed) and relative (% of total beats) average hourly numbers of VPBs and the hourly mean values of global and vagal time domain parameters of heart rate variability (Pearson correlation).No significant (P > .3 for every comparison) tendency for circadian distribution of VPBs was found. However, VPBs showed a significant correlation with rMSSD (r = 0.51 and P = .02 for the relative number), which became even stronger if VPBs were > 8000/d (r = 0.65 and P = .04 for both numbers).The significant correlation between the number of VPBs and a vagally mediated parameter underlines the triggering/permitting effect of parasympathetic tone on ventricular ectopy. This fact suggests that initiation of beta-blocker therapy could not be recommended routinely in these patients.
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Affiliation(s)
- Attila Frigy
- Department of Internal Medicine IV, University of Medicine and Pharmacy of Tirgu Mures
| | - Endre Csiki
- Department of Gastroenterology, Clinical County Hospital Mures
| | - Cosmin Caraşca
- Department of Forensic Medicine, University of Medicine and Pharmacy of Tirgu Mures, Tirgu Mures
| | - István Adorján Szabó
- Department of Internal Medicine IV, University of Medicine and Pharmacy of Tirgu Mures
| | - Victor-Dan Moga
- Department of Cardiology I, Victor Babes University of Medicine and Pharmacy Timisoara, Timisioara, Romania
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28
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Yang T, Yu L, Jin Q, Wu L, He B. Localization of Origins of Premature Ventricular Contraction by Means of Convolutional Neural Network From 12-Lead ECG. IEEE Trans Biomed Eng 2018; 65:1662-1671. [PMID: 28952932 PMCID: PMC6089373 DOI: 10.1109/tbme.2017.2756869] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This paper proposes a novel method to localize origins of premature ventricular contractions (PVCs) from 12-lead electrocardiography (ECG) using convolutional neural network (CNN) and a realistic computer heart model. METHODS The proposed method consists of two CNNs (Segment CNN and Epi-Endo CNN) to classify among ventricular sources from 25 segments and from epicardium (Epi) or endocardium (Endo). The inputs are the full time courses and the first half of QRS complexes of 12-lead ECG, respectively. After registering the ventricle computer model with an individual patient's heart, the training datasets were generated by multiplying ventricular current dipoles derived from single pacing at various locations with patient-specific lead field. The origins of PVC are localized by calculating the weighted center of gravity of classification returned by the CNNs. A number of computer simulations were conducted to evaluate the proposed method under a variety of noise levels and heart registration errors. Furthermore, the proposed method was evaluated on 90 PVC beats from nine human patients with PVCs and compared against ablation outcome in the same patients. RESULTS The computer simulation evaluation returned relatively high accuracies for Segment CNN (∼78%) and Epi-Endo CNN (∼90%). Clinical testing in nine PVC patients resulted an averaged localization error of 11 mm. CONCLUSION Our simulation and clinical evaluation results demonstrate the capability and merits of the proposed CNN-based method for localization of PVC. SIGNIFICANCE This paper suggests a new approach for cardiac source localization of origin of arrhythmias using only the 12-lead ECG by means of CNN, and may have important applications for future real-time monitoring and localizing origins of cardiac arrhythmias guiding ablation treatment.
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29
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Abstract
Dispersion of ventricular repolarization due to abnormal activation contributes to the susceptibility to cardiac arrhythmias. However, the global pattern of repolarization is difficult to assess clinically. Activation recovery interval (ARI) has been used to understand the properties of ventricular repolarization. In this study, we developed an ARI imaging technique to noninvasively reconstruct three-dimensional (3D) ARI maps in 10 premature ventricular contraction (PVC) patients and evaluated the results with the endocardial ARI maps recorded by a clinical navigation system (CARTO). From the analysis results of a total of 100 PVC beats in 10 patients, the average correlation coefficient is 0.86±0.05 and the average relative error is 0.06±0.03. The average localization error is 4.5±2.3 mm between the longest ARI sites in 3D ARI maps and those in CARTO endocardial ARI maps. The present results suggest that ARI imaging could serve as an alternative of evaluating global pattern of ventricular repolarization noninvasively and could assist in the future investigation of the relationship between global repolarization dispersion and the susceptibility to cardiac arrhythmias.
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Affiliation(s)
- Ting Yang
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, United States of America
| | - Long Yu
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, United States of America
| | - Qi Jin
- Department of Cardiology, Shanghai Ruijin Hospital, Shanghai, China
| | - Liqun Wu
- Department of Cardiology, Shanghai Ruijin Hospital, Shanghai, China
| | - Bin He
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, United States of America
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, United States of America
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30
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Karaman K, Karayakali M, Arisoy A, Akar I, Ozturk M, Yanik A, Yilmaz S, Celik A. Is There any Relationship Between Myocardial Repolarization Parameters and the Frequency of Ventricular Premature Contractions? Arq Bras Cardiol 2018; 110:534-541. [PMID: 30226912 PMCID: PMC6023631 DOI: 10.5935/abc.20180079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 10/18/2017] [Accepted: 10/18/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Ventricular premature contractions (VPCs) may trigger lethal ventricular arrhythmias in patients with structural heart disease. However, this role of VPCs in healthy people remains controversial once that not enough clinical trials are available. Recently, some myocardial repolarization markers, such as Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios, have been reported to be useful for predicting lethal ventricular arrhythmias in various clinical disorders without structural heart disease. OBJECTIVE In this study, we aimed to investigate the relation between VPC frequent and myocardial repolarization markers in individuals without structural heart disease. METHODS This study included 100 patients who had complaints of dizziness and palpitations. Twelve-lead electrocardiography and 24-hour ambulatory Holter recordings were obtained from all patients. VPC burden was calculated as the total number of VPCs divided by the number of all QRS complexes in the total recording time. P-values < 0.05 were considered significant. RESULTS Tp-e interval and Tp-e/QTc ratio were significantly higher in patients with higher VPC burden than in patients with lower VPC burden, and a positive correlation was found between these markers and VPC burden. Tp-e (β = 1.318, p = 0.043) and Tp-e/QTc (β = -405.136, p = 0.024) in the lead V5 were identified as independent predictors of increased VPC burden. CONCLUSIONS Tp-e interval and Tp-e/QTc ratio increased in patients with high VPC number. Our study showed that VPCs may have a negative effect on myocardial repolarization. This interaction may lead to an increased risk of malignant arrhythmias.
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Affiliation(s)
- Kayihan Karaman
- Gaziosmanpasa University Faculty of Medicine, Department
of Cardiology, Tokat - Turkey
| | - Metin Karayakali
- Gaziosmanpasa University Faculty of Medicine, Department
of Cardiology, Tokat - Turkey
| | - Arif Arisoy
- Gaziosmanpasa University Faculty of Medicine, Department
of Cardiology, Tokat - Turkey
| | - Ilker Akar
- Gaziosmanpasa University Faculty of Medicine, Department
of Cardiovascular Surgery, Tokat - Turkey
| | - Mustafa Ozturk
- Erzurum Territorial Training and Research Hospital,
Cardiology Clinic, Erzurum - Turkey
| | - Ahmet Yanik
- Samsun Training and Research Hospital, Cardiology Clinic,
Samsun - Turkey
| | - Samet Yilmaz
- Gaziosmanpasa University Faculty of Medicine, Department
of Cardiology, Tokat - Turkey
| | - Atac Celik
- Gaziosmanpasa University Faculty of Medicine, Department
of Cardiology, Tokat - Turkey
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31
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He Z, Liu M, Yu M, Lu N, Li J, Xu T, Zhu J, O'Gara MC, O'Meara M, Ye H, Tan X. An electrocardiographic diagnostic model for differentiating left from right ventricular outflow tract tachycardia origin. J Cardiovasc Electrophysiol 2018; 29:908-915. [PMID: 29608235 DOI: 10.1111/jce.13493] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 01/09/2018] [Revised: 03/12/2018] [Accepted: 03/21/2018] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Although several electrocardiographic (ECG) algorithms have been proposed for differentiating the origins of outflow tract ventricular arrhythmias, the most optimal one has not been agreed on. The purpose of this study was to establish an ECG diagnostic model based on the previous ECG algorithms. METHODS AND RESULTS The following ECG diagnostic model, Y=-1.15×( TZ )-0.494×(V2S/V3R), was developed by standard 12-lead ECG algorithms in 488 patients with idiopathic premature ventricular contractions or ventricular tachycardia with a left bundle branch block pattern and inferior axis QRS morphology. Binary logistic regression analysis was performed to establish the ECG diagnostic model. The ECG diagnostic model consisted of two ECG algorithms-the transition zone (TZ) index and V2S/V3R index. The area under the curve by receiver operating characteristic curve analysis for the ECG diagnostic model was 0.88, with a cut-off value of ≥ -0.76 predicting a left ventricular outflow tract (LVOT) origin with a sensitivity of 82% and a specificity of 86%, which was higher than other ECG algorithms in this study. The predictive accuracy of the ECG diagnostic model was also the best among all ECG algorithms in patients with a lead V3 precordial transition. This model was tested prospectively in 207 patients with a sensitivity of 90%, a specificity of 87%, and Youden index of 0.77. CONCLUSIONS A highly accurate ECG diagnostic model for correctly differentiating LVOT origin from right ventricular outflow tract origin was developed.
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Affiliation(s)
- Zhuoqiao He
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Ming Liu
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Cardio-Pulmonary Function Department, Wuhan Asia Heart Hospital, Wuhan, Hubei, China
| | - Min Yu
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Nan Lu
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Jia Li
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, Hubei, China
| | - Tan Xu
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Jinxiu Zhu
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Mary Clare O'Gara
- Department of Nursing, Shantou University Medical College, Shantou, Guangdong, China
| | - Michael O'Meara
- Department of Information Technology, Shantou University Medical College, Shantou, Guangdong, China
| | - Hong Ye
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, Hubei, China
| | - Xuerui Tan
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
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Javidanpour S, Dianat M, Badavi M, Mard SA. The inhibitory effect of rosmarinic acid on overexpression of NCX1 and stretch- induced arrhythmias after acute myocardial infarction in rats. Biomed Pharmacother 2018; 102:884-893. [PMID: 29710544 DOI: 10.1016/j.biopha.2018.03.103] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 01/24/2018] [Revised: 03/10/2018] [Accepted: 03/17/2018] [Indexed: 11/19/2022] Open
Abstract
The incidence of arrhythmias is the main cause of high mortality after myocardial infarction (AMI). The aim of the present study was to determine whether the rosmarinic acid (RA) could reduce the stretch-induced arrhythmias (SIAs) related to overexpression of NCX1 after AMI. Adult male Sprague-Dawley rats were randomly allocated into six groups: Sham, MI (100 mg/kg of isoproterenol (Iso), subcutaneously, on two consecutive days), RA (30 mg/kg, orally, 14 days), and RA (10, 15 and 30 mg/kg, 14 days) + I. MI induction was performed on the 13th and 14th days of the study period. Forty-eight hours after the first injection of Iso, the parameters of hypertrophy, plasma levels of malondialdehyde (MDA) and lipid profile were evaluated. Using Langendorff apparatus, the isolated hearts were transiently stretched for 5 s with three different end-diastolic volumes (ΔV1to3 = 0.05, 0.1 and 0.2 mL). Cardiac function parameters were measured for 30 s, and ventricular arrhythmias were recorded for 3 min after each stretch. Finally, the levels of cardiac troponin-I and NCX1 mRNA expression were examined. The rats of MI group showed a significant increase in hypertrophy index, MDA, triglyceride and cholesterol (P < 0.001). Additionally, a marked impairment in cardiac parameters, an increase in the rates of SIAs and NCX1 expression, and a decrease in troponin-I (P < 0.001) were observed. RA at three doses especially 15 mg/kg strongly improved almost all the mentioned factors (P < 0.001). Our results confirm that RA pretreatment could prevent hypertrophia, arrhythmia and cardiac dysfunction following AMI which is associated with inhibition of lipid peroxidation and overexpression of NCX1.
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MESH Headings
- Animals
- Arrhythmias, Cardiac/blood
- Arrhythmias, Cardiac/complications
- Arrhythmias, Cardiac/drug therapy
- Arrhythmias, Cardiac/physiopathology
- Blood Pressure/drug effects
- Cardiomegaly/blood
- Cardiomegaly/complications
- Cardiomegaly/drug therapy
- Cardiomegaly/physiopathology
- Cholesterol, HDL/blood
- Cholesterol, LDL/blood
- Cinnamates/pharmacology
- Cinnamates/therapeutic use
- Depsides/pharmacology
- Depsides/therapeutic use
- Diastole/drug effects
- Electrocardiography
- Gene Expression Regulation/drug effects
- Heart Ventricles/drug effects
- Heart Ventricles/pathology
- Heart Ventricles/physiopathology
- Male
- Malondialdehyde/blood
- Myocardial Infarction/blood
- Myocardial Infarction/complications
- Myocardial Infarction/drug therapy
- Myocardial Infarction/physiopathology
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- Rats, Sprague-Dawley
- Sodium-Calcium Exchanger/genetics
- Sodium-Calcium Exchanger/metabolism
- Stress, Mechanical
- Tachycardia/blood
- Tachycardia/complications
- Tachycardia/drug therapy
- Tachycardia/physiopathology
- Triglycerides/blood
- Troponin I/metabolism
- Ventricular Premature Complexes/blood
- Ventricular Premature Complexes/complications
- Ventricular Premature Complexes/physiopathology
- Rosmarinic Acid
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Affiliation(s)
- Somayeh Javidanpour
- Department of Physiology, Physiology Research Center, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahin Dianat
- Department of Physiology, Physiology Research Center, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Mohammad Badavi
- Department of Physiology, Physiology Research Center, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyyed Ali Mard
- Department of Physiology, Physiology Research Center, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Abstract
The purpose of this study was to explore the modes of initiation and clinical significance of malignant rapid ventricular arrhythmias (MRVAs).The surface 12-lead electrocardiogram (ECG) or sustained electrocardiomonitor graph was analyzed in 79 patients. All patients had at least 1 MRVA after being admitted to the hospital.According to the length of coupling interval of the initial premature ventricular contraction of MRVA, the modes of initiation of MRVA were divided into the following types: those initiated by premature ventricular contraction with short coupling intervals in patients with normal Q-T interval, and for which short-long-short sequences before MRVA precipitation were not observed; those initiated following short-long-short sequences, which were divided into 2 types according to the length of Q-T interval: a normal Q-T interval and a long Q-T interval. On the basis of the different modes of onset, treatments of MRVA were different.MRVAs have different modes of onset depending on the patients' underlying condition. Prompt recognition of the mode of onset is necessary to facilitate appropriate management. These findings could have important pathophysiologic and clinical implications.
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Affiliation(s)
- Li-Hong Luo
- Department of Cardiology, Xixi Hospital of Hangzhou, Hangzhou
| | | | - Xin Chen
- Department of ICU, Hangzhou Cancer Hospital, Hangzhou
| | - Jiafeng Lin
- Department of Cardiology, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ming Zhang
- Department of ICU, Hangzhou Cancer Hospital, Hangzhou
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Abstract
RATIONALE Coronary artery lesion is the most prominent cardiac manifestation in Kawasaki disease. However, few cases of life-threatening cardiac arrhythmia were reported in the acute phase of Kawasaki disease. PATIENT CONCERNS A 1-year-old girl presented in the hospital with ventricular premature beats and ventricular tachycardia after 2 days of fever. DIAGNOSIS On the fifth day of fever, the diagnosis of Kawasaki disease was achieved. INTERVENTIONS Immunoglobulin was administered. OUTCOME The temperature became normal and ventricular arrhythmia disappeared. LESSONS This case suggests that Kawasaki disease has various clinical manifestations besides typical features, and it can cause life-threatening cardiac arrhythmia in the acute phase with normal coronary artery and normal cardiac function.
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Affiliation(s)
- Fan Hu
- Department of Pediatrics, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defect and Related Diseases of Women and Children (Sichuan University), Ministry of Education
- Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases of Sichuan Province, Chengdu, Sichuan, China
| | - Xiaoqing Shi
- Department of Pediatrics, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defect and Related Diseases of Women and Children (Sichuan University), Ministry of Education
- Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases of Sichuan Province, Chengdu, Sichuan, China
| | - Yifei Li
- Department of Pediatrics, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defect and Related Diseases of Women and Children (Sichuan University), Ministry of Education
- Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases of Sichuan Province, Chengdu, Sichuan, China
| | - Yimin Hua
- Department of Pediatrics, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defect and Related Diseases of Women and Children (Sichuan University), Ministry of Education
- Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases of Sichuan Province, Chengdu, Sichuan, China
| | - Kaiyu Zhou
- Department of Pediatrics, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defect and Related Diseases of Women and Children (Sichuan University), Ministry of Education
- Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases of Sichuan Province, Chengdu, Sichuan, China
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35
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Hansen PR, Juhl CR, Isaksen JL, Jemec GB, Ellervik C, Kanters JK. Frequency of Electrocardiographic Abnormalities in Patients With Psoriasis. Am J Cardiol 2018; 121:1004-1007. [PMID: 29454476 DOI: 10.1016/j.amjcard.2017.12.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 12/20/2017] [Accepted: 12/29/2017] [Indexed: 01/21/2023]
Abstract
Psoriasis is a chronic inflammatory disease associated with cardiovascular disease, for example, myocardial infarction, stroke, cardiovascular death, and arrhythmias. The resting electrocardiogram may carry prognostic information, but limited evidence is available of electrocardiographic findings in subjects with psoriasis. The electrocardiographic results were compared between 1,131 subjects with self-reported psoriasis and 18,397 controls participating in the Danish General Suburban Population Study (GESUS). The mean heart rate was marginally increased in patients with psoriasis (66 ± 11 vs 65 ± 11 beats/min, p = 0.007), but not after adjustment for smoking and body mass index. All other examined electrocardiographic variables, including QT interval corrected for heart rate with the Fridericia formula, PR interval, QRS duration, R axis, P-wave duration in lead V1, P-terminal force, J point elevation in lead V1, electrocardiographic criteria for left ventricular hypertrophy, electrocardiographic signs of previous myocardial infarction, and premature ventricular or supraventricular complexes, respectively, were comparable between the 2 groups. In conclusion, psoriasis was associated with a marginal increase in resting heart rate, which was driven by smoking and increased body mass index. All other examined electrocardiographic variables were similar between the 2 groups. The results suggest that psoriasis per se is not associated with significant abnormalities of the electrocardiogram.
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Affiliation(s)
- Peter Riis Hansen
- Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
| | - Christian Rimer Juhl
- Laboratory of Experimental Cardiology, Department of Biomedical Sciences, Panum Institute, Copenhagen N, Denmark
| | - Jonas Lynggaard Isaksen
- Laboratory of Experimental Cardiology, Department of Biomedical Sciences, Panum Institute, Copenhagen N, Denmark; Department of Health Science and Technology, Aalborg University, Aalborg Oest, Denmark
| | - Gregor Borut Jemec
- Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Christina Ellervik
- Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Laboratory Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Production, Research and Innovation, Region Zealand, Sorø, Denmark
| | - Jørgen Kim Kanters
- Laboratory of Experimental Cardiology, Department of Biomedical Sciences, Panum Institute, Copenhagen N, Denmark
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Santangeli P. April 2nd Question. Circ Arrhythm Electrophysiol 2018; 11:e006298. [PMID: 29610218 DOI: 10.1161/circep.118.006298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Martin-Yebra A, Monasterio V, Cygankiewicz I, Bayes-de-Luna A, Caiani EG, Laguna P, Martinez JP. Post-Ventricular Premature Contraction Phase Correction Improves the Predictive Value of Average T-Wave Alternans in Ambulatory ECG Recordings. IEEE Trans Biomed Eng 2018; 65:635-644. [PMID: 29461965 DOI: 10.1109/tbme.2017.2711645] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We proposed and evaluated a method for correcting possible phase shifts provoked by the presence of ventricular premature contractions (VPCs) for a better assessment of T-wave alternans (TWA). Methods: First, we synthesized ECG signals with artificial TWA in the presence of different noise sources. Then, we assessed the prognostic value for sudden cardiac death (SCD) of the long-term average of TWA amplitude (the index of average alternans, ) in ambulatory ECG signals from congestive heart failure (CHF) and evaluated whether it is sensitive to the presence of VPCs. RESULTS The inclusion of the phase correction after VPC in the processing always improved estimation accuracy of the under different noisy conditions and regardless of the number of the VPCs included in the sequence. It also presented a positive impact on the prognostic value of with increased hazard ratios (from 17% to 29%, depending of the scenario) in comparison to the noninclusion of this step. CONCLUSION The proposed methodology for estimation, which corrects for the possible phase reversal on TWA after the presence of VPCs, represents a robust TWA estimation approach with a significant impact on the prognostic value of for SCD stratification in CHF patients. SIGNIFICANCE An accurate TWA estimation has a potential direct clinical impact on noninvasive SCD stratification, allowing better identification of patients at higher risk and helping clinicians in adopting the most appropriate therapeutic strategy.
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Noheria A. February 5th Question. Circ Arrhythm Electrophysiol 2018; 11:e006208. [PMID: 29431633 DOI: 10.1161/circep.118.006208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Killu AM, Sugrue A, Munger TM, Hodge DO, Mulpuru SK, McLeod CJ, Packer DL, Asirvatham SJ, Friedman PA. Impact of sedation vs. general anaesthesia on percutaneous epicardial access safety and procedural outcomes. Europace 2018; 20:329-336. [PMID: 28339558 DOI: 10.1093/europace/euw313] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 04/04/2016] [Accepted: 09/06/2016] [Indexed: 11/14/2022] Open
Abstract
Aims Patient movement while under moderate/deep sedation may complicate percutaneous epicardial access (EpiAcc), mapping and ablation. We sought to compare procedural outcomes in patients undergoing EpiAcc under sedation vs. general anaesthesia (GA) for ablation. Methods and results Patients undergoing EpiAcc between January 2004 and July 2014 were included. Safety, procedural, and clinical outcomes were compared between patients undergoing EpiAcc under sedation or GA for ventricular tachycardia or premature ventricular complex ablation. Between January 2004 and July 2014, 170 patients underwent EpiAcc (mean age, 53.2 ± 15.8 years; average ejection fraction, 44.3 ± 15.3%). The majority (122 [72%] patients) were male. GA was used in 69 (40.6%). There was no difference in route of access (more often anterior, 53.0%) or the rate of successful access (96% overall) between groups. Similarly, the site of ablation (endocardial vs. epicardial vs. combined endocardial/epicardial) was similar between groups. Complications were equally seen between groups-the most frequent event/complication was pericardial effusion, occurring in 10.6% of patients. Finally, procedural and clinical success rates between GA and sedation groups were comparable (93 vs. 91% and 44 vs. 51%, respectively, P > 0.05). Conclusions Choice of anaesthesia for EpiAcc does not appear to significantly affect safety and procedural or clinical outcomes. For patients in whom anaesthesia may pose increased risk, it is reasonable to obtain epicardial access under sedation.
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Affiliation(s)
- Ammar M Killu
- Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Alan Sugrue
- Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Thomas M Munger
- Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - David O Hodge
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - Siva K Mulpuru
- Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Christopher J McLeod
- Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Douglas L Packer
- Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Samuel J Asirvatham
- Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
- Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Paul A Friedman
- Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
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Zhao X, Cai R, Sun L, He L, Sun W, Ma X, Song L. A correlative study of myocardial infarction scar characteristics by DE-MR and the Lown's classification of ventricular premature beats. J Xray Sci Technol 2018; 26:987-996. [PMID: 30223422 DOI: 10.3233/xst-180398] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Correlation between myocardial infarction (MI) scar by cardiac magnetic resonance and the Lown's classification of ventricular premature beats (VPBs) is poorly understood. This study aims to investigate the correlation between the MI scar characteristics by delayed-enhancement magnetic resonance imaging (DE-MRI) and the Lown's classification of VPBs. METHODS Sixty-five patients, in the convalescence stage and consolidation phase of MI, were included in this retrospective study. All patient were divided into VPBs group (n = 39) and non-VPBs group (n = 26 patients) according to the clinical diagnostic criteria of Universal Definition of MI scar. VPBs patients were assigned to Lown's I-II group and Lown's III-IV subgroup in accordance with the Lown classification criteria. Cardiac function parameters and MI scar characteristics were detected by cardiac magnetic resonance (CMR) and DE-MRI, respectively. RESULTS Lown's classification was negatively correlated with left ventricular ejection fraction (LVEF), peak ejection rate (PER) and peak filling rate (PFR) (-0.724, -0.628, -0.559), and positively correlated with MI area, MI integral, MI segments number and left ventricular end systolic volume (LVESV) (0.673, 0.655, 0.586, and 0.514), respectively.CONCLUSIONSThe study indicated that MI area and MI integral were strongly associated with Lown's classification.
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Affiliation(s)
- Xinxiang Zhao
- Department of Radiology, The Second Affiliated Hospital of Kunming Medical University, China
| | - Renhui Cai
- Department of Radiology, Wuhan Asian Heart Hospital, China
| | - Lin Sun
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, China
| | - Liping He
- Department of Epidemiology and Biostatistics, School of Public Health of Kunming Medical University, China
| | - Wenjing Sun
- Biomedical Engineering Research Center, Kunming Medical University, China
| | - Xiaohai Ma
- Department of Radiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Linsheng Song
- Department of Radiology, The Second Affiliated Hospital of Kunming Medical University, China
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Yu M, Chen T, Hu S, Zou S, Wang C, Zeng C, Chen W, Tan X. R-Wave Peak Time at Lead II in Adults With Ventricular Premature Beats, Bundle Branch Block and Left Anterior Fascicular Block. Am J Med Sci 2018; 355:44-47. [PMID: 29289261 DOI: 10.1016/j.amjms.2017.08.017] [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: 03/26/2017] [Revised: 08/11/2017] [Accepted: 08/28/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Recently, the R-wave peak time (RWPT) at lead II was reported to be a helpful and simple tool for differentiating wide QRS complex tachycardias with a RWPT ≥ 50ms for ventricular tachycardia diagnosis. Our previous study showed that the duration of RWPT at lead II in adults was ≈29ms. However, the effects of ventricular premature beats (VPBs), bundle branch block (BBB) or left anterior fascicular block (LAFB) on RWPT at lead II remain unknown. METHODS The study was conducted in the First Affiliated Hospital of Shantou University Medical College in Southern China. Adults with VPBs, BBB or LAFB were included. RWPT at lead II was determined. RESULTS Compared with the control groups, the right BBB, LAFB, RWPT were longer in groups with left BBB and VPBs. Compared with the group with left BBB, the group with VPBs had a significantly longer RWPT at lead II (54.20 ± 18.52 versus 84.76 ± 16.38ms, P < 0.01). CONCLUSION Our study showed that there is a significant difference in the RWPT at lead II between groups with left BBB, ventricular premature beat, right BBB and LAFB. A RWPT of 50ms may be optimal to differentiate between ventricular tachycardia and supraventricular tachycardia with right left BBB and LAFB, but not with left BBB.
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Affiliation(s)
- Min Yu
- Department of Cardiology, The First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China
| | - Tingting Chen
- Department of Cardiology, The First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China
| | - Shuang Hu
- Department of Cardiology, The First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China
| | - Shan Zou
- Department of Cardiology, The First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China
| | - Cantian Wang
- Department of Cardiology, The First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China
| | - Chujuan Zeng
- Department of Cardiology, The First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China
| | - Weijie Chen
- Department of Cardiology, The First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China
| | - Xuerui Tan
- Department of Cardiology, The First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China.
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Laeeq R, Pollet M, Faza N, Birnbaum Y. Varying Morphology of QRS Complexes: A Possible Explanation. Tex Heart Inst J 2017; 44:429-430. [PMID: 29276447 DOI: 10.14503/thij-17-6442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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43
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Chen CF, Liu XH, Gao XF, Chen B, Xu YZ. Catheter ablation of premature ventricular contractions originating from aortic sinus cusps in a patient with dextrocardia and situs solitus: A case report. Medicine (Baltimore) 2017; 96:e8947. [PMID: 29310391 PMCID: PMC5728792 DOI: 10.1097/md.0000000000008947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Premature ventricular contractions (PVCs) originating from aortic sinus cusps is not infrequent and can be eliminated effectively by radiofrequency ablation with rare complications. However, after a review of the medical literature, and to our knowledge, this is the first case of successful idiopathic aortic sinus cusps-PVC-ablation using a 3-dimensional (3D) mapping system in an adult with dextrocardia. METHODS A 62-year-old male with dextrocardia and situs inversus underwent catheter ablation of frequent PVCs. The electrocardiograms (ECG) were recorded by placement of the electrodes in reversed positions. The PVCs exhibited left bundle branch block and inferior axis QRS morphology with transition at leads V2-V3. The activation mapping indicated the earliest site of ventricular activation between the left and right aortic sinus cusps, highlighting that catheter ablation was successful at this point. RESULTS The catheter ablation was successful between the left and right aortic sinus cusps, and the PVCs were not detected for the subsequent 30 min following the procedure as well as for the rest of the hospital stay. CONCLUSION Combined with ECG electrodes in reversed positions and 3D electroanatomical mapping system, catheter ablation of PVCs originating from aortic sinus cusps in patients with dextrocardia can be safely and effectively performed.
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Campos FO, Shiferaw Y, Vigmond EJ, Plank G. Stochastic spontaneous calcium release events and sodium channelopathies promote ventricular arrhythmias. Chaos 2017; 27:093910. [PMID: 28964108 PMCID: PMC5568869 DOI: 10.1063/1.4999612] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Premature ventricular complexes (PVCs), the first initiating beats of a variety of cardiac arrhythmias, have been associated with spontaneous calcium release (SCR) events at the cell level. However, the mechanisms underlying the degeneration of such PVCs into arrhythmias are not fully understood. The objective of this study was to investigate the conditions under which SCR-mediated PVCs can lead to ventricular arrhythmias. In particular, we sought to determine whether sodium (Na+) current loss-of-function in the structurally normal ventricles provides a substrate for unidirectional conduction block and reentry initiated by SCR-mediated PVCs. To achieve this goal, a stochastic model of SCR was incorporated into an anatomically accurate compute model of the rabbit ventricles with the His-Purkinje system (HPS). Simulations with reduced Na+ current due to a negative-shift in the steady-state channel inactivation showed that SCR-mediated delayed afterdepolarizations led to PVC formation in the HPS, where the electrotonic load was lower, conduction block, and reentry in the 3D myocardium. Moreover, arrhythmia initiation was only possible when intrinsic electrophysiological heterogeneity in action potential within the ventricles was present. In conclusion, while benign in healthy individuals SCR-mediated PVCs can lead to life-threatening ventricular arrhythmias when combined with Na+ channelopathies.
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Affiliation(s)
- Fernando O Campos
- Department of Congenital Heart Diseases and Pediatric Cardiology, German Heart Institute Berlin, Berlin, Germany
| | - Yohannes Shiferaw
- Department of Physics, California State University, Northridge, California 91330, USA
| | | | - Gernot Plank
- Institute of Biophysics, Medical University of Graz, Graz, Austria
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Sharma GK, Tripathi A, Jones PA. Premature Ventricular Contractions Producing Brockenbrough-Braunwald Sign in Obstructive Cardiomyopathy. J Invasive Cardiol 2017; 29:E83. [PMID: 28667811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Increased dynamic flow in hypertrophic obstructive cardiomyopathy depicts a classic sign on invasive pressure tracings of the aorta and left ventricle, simultaneously known as the Brockenbrough-Braunwald sign, which is demonstrated in the presented case.
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Affiliation(s)
- Gaurav K Sharma
- Department of Medicine, Mercy Hospital & Medical Center, 2525 South Michigan Ave, Chicago, IL 60616 USA.
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Vollmann D, Hansen C, Lüthje L, Breithardt OA. [Malignant bileaflet mitral valve prolapse syndrome in otherwise idiopathic ventricular fibrillation]. Herzschrittmacherther Elektrophysiol 2017; 28:232-235. [PMID: 28477226 DOI: 10.1007/s00399-017-0504-4] [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: 03/13/2017] [Accepted: 04/10/2017] [Indexed: 06/07/2023]
Abstract
A 32-year-old, otherwise healthy woman was admitted after successful out-of-hospital resuscitation due to ventricular fibrillation. Established cardiac, pulmonary, metabolic, and toxicological causes were excluded. However, persisting (biphasic) negative T waves in the inferior ECG leads and premature ventricular contractions (PVC) were noted. PVC morphology indicated a focus alternating between the posterior papillary muscle/the left posterior fascicle and the left ventricular outflow tract region/anterior papillary muscle. Echocardiography revealed a bileaflet mitral prolapse with mild mitral valve regurgitation. This case is a typical presentation of the recently described malignant bileaflet mitral valve prolapse syndrome. The patient was discharged without overt neurological deficit after implantation of a cardioverter-defibrillator.
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Affiliation(s)
- Dirk Vollmann
- Herz- & Gefäßzentrum Göttingen, Humboldtallee 6, 37073, Göttingen, Deutschland.
| | - Claudius Hansen
- Herz- & Gefäßzentrum Göttingen, Humboldtallee 6, 37073, Göttingen, Deutschland
| | - Lars Lüthje
- Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Ole A Breithardt
- Klinik für Kardiologie & Rhythmologie, Agaplesion Diakonie Kliniken Kassel, Kassel, Deutschland
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Abstract
Premature ventricular contractions (PVCs) are common arrhythmias noticed in the clinical setting because of premature depolarization of the ventricular myocytes. Although often thought to be reflective of underlying disease rather than intrinsically harmful, PVCs have recently been linked with worse outcomes in patients without significant cardiac disease. Long-term exposure to a high PVC burden can lead to the development of PVC-induced cardiomyopathy. The pathogenesis of this condition is poorly understood at the current time. Many studies have suggested that catheter ablation of these PVCs may result in reversal of the PVC-induced cardiomyopathy. This article will go over the natural history of PVCs and PVC-induced cardiomyopathy, as well as review the current literature on the role of catheter ablation in treating PVC-induced cardiomyopathy.
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Affiliation(s)
- Esseim Sharma
- From The Warren Alpert Medical School of Brown University, Providence, RI
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Wolpert C, Vogel M, Nagel C, Herrera-Siklody C, Rüb N. [Ventricular arrhythmias in ion channel diseases]. Herzschrittmacherther Elektrophysiol 2017; 28:169-176. [PMID: 28534204 DOI: 10.1007/s00399-017-0510-6] [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] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 04/13/2017] [Indexed: 06/07/2023]
Abstract
In patients with ion channel disease the predominant arrhythmias are polymorphic ventricular tachycardias (VT), torsade de pointes tachycardia and ventricular fibrillation (VF). In only extremely rare cases is very rapid monomorphic ventricular tachycardia observed. This is why implantable cardioverter-defibrillators (ICDs) should always be programmed for treatment of VF only with high detection rates to avoid inappropriate discharges. In idiopathic VF and catecholaminergic polymorphic ventricular tachycardia (CPVT), no baseline electrocardiographic abnormalities can be detected, whereas in Brugada syndrome, long QT syndrome, early repolarisation syndrome and Anderson-Tawil syndrome alterations of the baseline ECG are very important to identify patients at risk.
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Affiliation(s)
- Christian Wolpert
- Medizinische Klinik für Kardiologie, Nephrologie und Internistische Intensivmedizin, Klinikum Ludwigsburg, Posilipostrasse 4, 71640, Ludwigsburg, Deutschland.
| | - Mara Vogel
- Medizinische Klinik für Kardiologie, Nephrologie und Internistische Intensivmedizin, Klinikum Ludwigsburg, Posilipostrasse 4, 71640, Ludwigsburg, Deutschland
| | - Christian Nagel
- Medizinische Klinik für Kardiologie, Nephrologie und Internistische Intensivmedizin, Klinikum Ludwigsburg, Posilipostrasse 4, 71640, Ludwigsburg, Deutschland
| | - Claudia Herrera-Siklody
- Medizinische Klinik für Kardiologie, Nephrologie und Internistische Intensivmedizin, Klinikum Ludwigsburg, Posilipostrasse 4, 71640, Ludwigsburg, Deutschland
| | - Norman Rüb
- Medizinische Klinik für Kardiologie, Nephrologie und Internistische Intensivmedizin, Klinikum Ludwigsburg, Posilipostrasse 4, 71640, Ludwigsburg, Deutschland
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Li Y, Zhe-Wei S, Cheng Z, Guang-Yi C, De-Pu Z, Xiao-Wei L, Xueqiang G, Jiafeng L, Peng C. Clinical and electrocardiographic characteristics of infarctional ventricular ectopic beats: An observational study. Medicine (Baltimore) 2017; 96:e7007. [PMID: 28538417 PMCID: PMC5457897 DOI: 10.1097/md.0000000000007007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The purpose of this study was to explore the clinical and electrocardiographic characteristics of infarctional ventricular ectopic beats (IVEBs).Thirty-eight acute myocardial infarction (AMI) patients with IVEB and 109 AMI patients without IVEB were analyzed. The morphological changes of QRS complex, ST segment, and T wave were compared to IVEB with sinus rhythm from the same period and fully evolved phase.An IVEB QRS complex often revealed the right bundle branch block morphology, in addition to Q wave AMI; no-Q wave AMI also had IVEB. Single-factor analysis found that IVEB often appeared in early AMI (<6 hours), and they were more frequent in inferoposterior with/without right ventricular involvement, large area AMI and thrombolytic reperfusion than in anterior or anteroseptal myocardial infarction, small area AMI, and unthrombolytic nonreperfusion. Multifactors no conditional logistic regression analysis revealed a positive correlation between IVEB and early AMI, AMI size, Killip heart function degree, inferoposterior with/without right ventricular involvement, and thrombolytic reperfusion. The Q wave of IVEB was wider, and the ST segment elevation was higher than those of the same period in sinus rhythms. The infarctional morphological changes of IVEB could be found before the same period in sinus rhythm and elevated myocardial enzymes.IVEBs were not rare. They were useful for early diagnosis and location of AMI.
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Jhuo SJ, Lo LW, Chang SL, Lin YJ, Chung FP, Hu YF, Chao TF, Tuan TC, Liao JN, Lin CY, Chang YT, Lin CH, Walia R, Te ALD, Yamada S, Raharjo SB, Tang WH, Lee KT, Lai WT, Chen SA. Characteristics of diurnal ventricular premature complex variation in right ventricular outflow tract arrhythmias after catheter ablation. Medicine (Baltimore) 2017; 96:e6516. [PMID: 28403080 PMCID: PMC5403077 DOI: 10.1097/md.0000000000006516] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Diurnal variations in ventricular tachyarrhythmias (VAs) have been demonstrated in idiopathic arrhythmogenic heart disease. The electrophysiological characteristics of diurnal variations in idiopathic right ventricular outflow tract (RVOT) VA have not previously been elucidated. Sixty-two consecutive patients undergoing catheter ablation for idiopathic RVOT VA (mean age: 42.8 ± 12.3 years, 35 females) were enrolled. The diurnal variation type (group 1, n = 36) was defined as those patients who had most ventricular premature contractions (VPCs) during the night hours by preprocedure Holter recordings. Group 2 (n = 26) was defined as those patients who did not have significant VPC variations. The baseline characteristics and electrophysiological properties were collected and analyzed, and the rates of recurrence after catheter ablation were compared between the 2 groups. In this study, heart rate variability analysis demonstrated lower low frequency/high frequency ratios in group 1 than in group 2 (3.95 ± 3.08 vs 6.26 ± 5.33; P = 0.042). There were no significant differences in baseline characteristics, echocardiography and electrophysiological characteristics between the 2 groups. During a mean follow-up period of 13.5 ± 11.0 months, a total of 16 patients had VA recurrences, including 13 patients from group 1 and 3 patients from group 2 (36.1% vs 12.5%, P = 0.039). This study demonstrated the effect of the autonomic nervous system in idiopathic RVOT VAs and that the diurnal variation type leads to a higher recurrence rate after catheter ablation.
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Affiliation(s)
- Shih-Jie Jhuo
- Division of Cardiology, Kaohsiung Medical University Hospital
- Division of Cardiology, Taipei Veterans General Hospital
| | - Li-Wei Lo
- Division of Cardiology, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Center, Faculty of Medicine, College of Medicine, National Yang-Ming Medical University, Taipei
| | - Shih-Lin Chang
- Division of Cardiology, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Center, Faculty of Medicine, College of Medicine, National Yang-Ming Medical University, Taipei
| | - Yenn-Jiang Lin
- Division of Cardiology, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Center, Faculty of Medicine, College of Medicine, National Yang-Ming Medical University, Taipei
| | - Fa-Po Chung
- Division of Cardiology, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Center, Faculty of Medicine, College of Medicine, National Yang-Ming Medical University, Taipei
| | - Yu-Feng Hu
- Division of Cardiology, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Center, Faculty of Medicine, College of Medicine, National Yang-Ming Medical University, Taipei
| | - Tze-Fan Chao
- Division of Cardiology, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Center, Faculty of Medicine, College of Medicine, National Yang-Ming Medical University, Taipei
| | - Ta-Chuan Tuan
- Division of Cardiology, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Center, Faculty of Medicine, College of Medicine, National Yang-Ming Medical University, Taipei
| | - Jo-Nan Liao
- Division of Cardiology, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Center, Faculty of Medicine, College of Medicine, National Yang-Ming Medical University, Taipei
| | - Chin-Yu Lin
- Division of Cardiology, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Center, Faculty of Medicine, College of Medicine, National Yang-Ming Medical University, Taipei
| | - Yao-Ting Chang
- Division of Cardiology, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Center, Faculty of Medicine, College of Medicine, National Yang-Ming Medical University, Taipei
| | - Chung-Hsing Lin
- Division of Cardiology, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Center, Faculty of Medicine, College of Medicine, National Yang-Ming Medical University, Taipei
| | - Rohit Walia
- Division of Cardiology, Taipei Veterans General Hospital
| | | | - Shinya Yamada
- Division of Cardiology, Taipei Veterans General Hospital
| | | | - Wei-Hua Tang
- Division of Cardiology, Kaohsiung Medical University Hospital
| | - Kun-Tai Lee
- Division of Cardiology, Kaohsiung Medical University Hospital
- Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Ter Lai
- Division of Cardiology, Kaohsiung Medical University Hospital
- Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shih-Ann Chen
- Division of Cardiology, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Center, Faculty of Medicine, College of Medicine, National Yang-Ming Medical University, Taipei
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