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Kidess GG, Brennan MT, Basit J, Alraies MC. Interventional Cardiac Electrophysiology for the Management of Adults With Congenital Heart Disease. Cardiol Rev 2025:00045415-990000000-00403. [PMID: 39807895 DOI: 10.1097/crd.0000000000000855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2025]
Abstract
Congenital heart disease (CHD) is the most common congenital anomaly in newborns. Advances in catheter and surgical techniques led to the majority of these patients surviving into adulthood, leading to evolving challenges due to the emergence of long-term complications such as arrhythmias. Interventional electrophysiology (EP) has had remarkable advances over the last few decades, and various techniques and devices have been explored to treat adult patients with CHD. This comprehensive review aims to summarize findings from recent studies exploring advances in the use of interventional electrophysiology to manage adult patients with CHD. While pacemaker therapy has some indications in adults with CHD, various long-term consequences include pacing-induced cardiomyopathy and complications requiring reintervention. Cardiac resynchronization therapy has shown promising results in some studies to treat CHD patients with heart failure, although further research to clarify guidelines is encouraged. Implantable cardiac defibrillators have demonstrated clear benefits in CHD patients and are indicated for primary prevention of sudden cardiac death, although selection criteria for secondary prevention of sudden cardiac death are uncertain. Catheter ablation has also been used for various atrial and ventricular arrhythmias in patients with CHD with high success rates, although the likelihood of success depends on patient characteristics and the type of arrhythmia, and multidisciplinary assessment is encouraged to improve the chance of successful therapy.
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Affiliation(s)
- George G Kidess
- From the Department of Medicine, Wayne State School of Medicine, Detroit, MI
| | - Matthew T Brennan
- From the Department of Medicine, Wayne State School of Medicine, Detroit, MI
| | - Jawad Basit
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - M Chadi Alraies
- Department of Cardiology, Detroit Medical Center, Detroit, MI
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2
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Thawkar VN, Taksande K. A Comprehensive Review on Stereotactic Arrhythmia Radioablation (STAR): Pioneering a New Era in Arrhythmia Management. Cureus 2024; 16:e70601. [PMID: 39483583 PMCID: PMC11525945 DOI: 10.7759/cureus.70601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Accepted: 10/01/2024] [Indexed: 11/03/2024] Open
Abstract
Stereotactic arrhythmia radioablation (STAR) is an innovative treatment modality that leverages advanced imaging techniques and focused radiation to target arrhythmogenic foci within the heart, offering a non-invasive alternative to traditional catheter ablation methods. Arrhythmias, characterized by irregular heartbeats, pose significant health risks, including heart failure and stroke, particularly among older adults. Traditional management approaches, such as pharmacological therapies and catheter ablation, often face efficacy, safety, and recurrence limitations. STAR addresses these challenges by utilizing high-precision stereotactic technology to deliver targeted radiation, minimizing damage to surrounding tissues while maximizing therapeutic effects. This review explores the mechanisms, clinical indications, procedural techniques, and outcomes associated with STAR. Recent clinical studies demonstrate that STAR provides comparable efficacy to catheter ablation, with a favorable safety profile, making it a promising option for patients who have not responded to conventional treatments. Integrating STAR into arrhythmia management protocols may enhance patient outcomes and reduce the burden of recurrent arrhythmias. As research in this field advances, STAR holds the potential to reshape the landscape of arrhythmia treatment, providing new hope for patients suffering from these complex conditions. This review aims to elucidate the significance of STAR in modern arrhythmia management and to encourage further exploration and clinical application of this pioneering technique.
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Affiliation(s)
- Varun N Thawkar
- Anaesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Karuna Taksande
- Anaesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Pennoyer J, Bykhovsky M, Sohinki D, Mallard R, Berman AE. Successful Catheter Ablation of Two Macro-reentrant Atrial Tachycardias in a Patient with Congenitally Corrected Transposition of the Great Arteries: A Case Report. J Innov Card Rhythm Manag 2020; 11:4273-4280. [PMID: 33123416 PMCID: PMC7588239 DOI: 10.19102/icrm.2020.111005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/27/2020] [Indexed: 01/23/2023] Open
Abstract
Adults with congenital heart disease represent a complex and growing patient population. By virtue of their variant anatomy and the complex surgical repair often required in infancy, these patients are at risk of developing unique atrial and ventricular arrhythmias throughout their lifetimes. Electrophysiologists involved in the care of these patients should have a detailed understanding of their underlying anatomy and any prior surgical procedures to guide procedural planning and should have knowledge of the range of possible arrhythmia mechanisms that may differ from patients without structural heart disease. Despite this complexity, standard mapping techniques and electrophysiologic maneuvers may still be used to elucidate arrhythmia mechanisms, map tachycardia circuits, and guide catheter ablation. We report a case of two different macroreentrant right atrial tachycardias that were successfully ablated in a patient with congenitally-corrected transposition of the great arteries.
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Affiliation(s)
- James Pennoyer
- Division of Adult Cardiology, Medical College of Georgia, Augusta, GA, USA
| | - Michael Bykhovsky
- Division of Pediatric Cardiology, Medical College of Georgia, Augusta, GA, USA
| | - Daniel Sohinki
- Division of Adult Cardiology, Medical College of Georgia, Augusta, GA, USA
| | - Rachel Mallard
- Division of Adult Cardiology, Medical College of Georgia, Augusta, GA, USA
| | - Adam E Berman
- Division of Adult Cardiology, Medical College of Georgia, Augusta, GA, USA.,Division of Pediatric Cardiology, Medical College of Georgia, Augusta, GA, USA
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Hernández-Madrid A, Paul T, Abrams D, Aziz PF, Blom NA, Chen J, Chessa M, Combes N, Dagres N, Diller G, Ernst S, Giamberti A, Hebe J, Janousek J, Kriebel T, Moltedo J, Moreno J, Peinado R, Pison L, Rosenthal E, Skinner JR, Zeppenfeld K, Sticherling C, Kautzner J, Wissner E, Sommer P, Gupta D, Szili-Torok T, Tateno S, Alfaro A, Budts W, Gallego P, Schwerzmann M, Milanesi O, Sarquella-Brugada G, Kornyei L, Sreeram N, Drago F, Dubin A. Arrhythmias in congenital heart disease: a position paper of the European Heart Rhythm Association (EHRA), Association for European Paediatric and Congenital Cardiology (AEPC), and the European Society of Cardiology (ESC) Working Group on Grown-up Congenital heart disease, endorsed by HRS, PACES, APHRS, and SOLAECE. Europace 2018; 20:1719-1753. [DOI: 10.1093/europace/eux380] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Antonio Hernández-Madrid
- Department of Cardiology, Arrhythmia Unit, Ramón y Cajal Hospital, Alcalá University, Carretera Colmenar Viejo, km 9, 100, Madrid, Spain
| | - Thomas Paul
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Robert-Koch-Str. 40, Göttingen, Germany
| | - Dominic Abrams
- PACES (Pediatric and Congenital Electrophysiology Society) Representative, Department of Cardiology, Boston Childreńs Hospital, Boston, MA, USA
| | - Peter F Aziz
- HRS Representative, Pediatric Electrophysiology, Cleveland Clinic Children's, Cleveland, OH, USA
| | - Nico A Blom
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Academical Medical Center, Amsterdam, The Netherlands
| | - Jian Chen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Massimo Chessa
- Pediatric and Adult Congenital Heart Centre-University Hospital, IRCCS Policlinico San Donato, Milan, Italy
| | - Nicolas Combes
- Arrhythmia Unit, Department of Pediatric and Adult Congenital Heart Disease, Clinique Pasteur, Toulouse, France
| | - Nikolaos Dagres
- Department of Electrophysiology, University Leipzig Heart Center, Leipzig, Germany
| | | | - Sabine Ernst
- Royal Brompton and Harefield Hospital, London, UK
| | - Alessandro Giamberti
- Congenital Cardiac Surgery Unit, Policlinico San Donato, University and Research Hospital, Milan, Italy
| | - Joachim Hebe
- Center for Electrophysiology at Heart Center Bremen, Bremen, Germany
| | - Jan Janousek
- 2nd Faculty of Medicine, Children's Heart Centre, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Thomas Kriebel
- Westpfalz-Klinikum Kaiserslautern, Children’s Hospital, Kaiserslautern, Germany
| | - Jose Moltedo
- SOLAECE Representative, Head Pediatric Electrophysiology, Section of Pediatric Cardiology Clinica y Maternidad Suizo Argentina, Buenos Aires, Argentina
| | - Javier Moreno
- Department of Cardiology, Arrhythmia Unit, Ramón y Cajal Hospital, Alcalá University, Carretera Colmenar Viejo, km 9, 100, Madrid, Spain
| | - Rafael Peinado
- Department of Cardiology, Arrhythmia Unit, Hospital la Paz, Madrid, Spain
| | - Laurent Pison
- Department of Cardiology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Eric Rosenthal
- Consultant Paediatric and Adult Congenital Cardiologist, Evelina London Children's Hospital, Guy's and St Thomas' Hospital Trust, London, UK
| | - Jonathan R Skinner
- APHRS Representative, Paediatric and Congenital Cardiac Services Starship Childreńs Hospital, Grafton, Auckland, New Zealand
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Joseph Kautzner
- Institute For Clinical and Experimental Medicine, Prague, Czech Republic
| | - Erik Wissner
- University of Illinois at Chicago, 840 S. Wood St., 905 S (MC715), Chicago, IL, USA
| | - Philipp Sommer
- Heart Center Leipzig, Struempellstr. 39, Leipzig, Germany
| | - Dhiraj Gupta
- Consultant Electrophysiologist Liverpool Heart and Chest Hospital, Honorary Senior Lecturer Imperial College London and University of Liverpool, Liverpool, UK
| | | | - Shigeru Tateno
- Chiba Cerebral and Cardiovascular Center, Tsurumai, Ichihara, Chiba, Japan
| | | | - Werner Budts
- UZ Leuven, Campus Gasthuisberg, Herestraat 49, Leuven, Belgium
| | | | - Markus Schwerzmann
- INSELSPITAL, Universitätsspital Bern, Universitätsklinik für Kardiologie, Zentrum für angeborene Herzfehler ZAH, Bern, Switzerland
| | - Ornella Milanesi
- Department of Woman and Child's Health, University of Padua, Padua Italy
| | - Georgia Sarquella-Brugada
- Pediatric Arrhythmias, Electrophysiology and Sudden Death Unit, Department of Cardiology, Hospital Sant Joan de Déu, Barcelona - Universitat de Barcelona, Passeig Sant Joan de Déu, 2, Esplugues, Barcelona, Catalunya, Spain
| | - Laszlo Kornyei
- Gottsegen Gyorgy Orszagos Kardiologiai, Pediatric, Haller U. 29, Budapest, Hungary
| | - Narayanswami Sreeram
- Department of Pediatric Cardiology, University Hospital Of Cologne, Kerpenerstrasse 62, Cologne, Germany
| | - Fabrizio Drago
- IRCCS Ospedale Pediatrico Bambino Gesù, Piazza Sant'Onofrio 4, Roma
| | - Anne Dubin
- Division of Pediatric Cardiology, 750 Welch Rd, Suite 321, Palo Alto, CA, USA
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Acena M, Anguera I, Dallaglio PD, Rodriguez M, Sabaté X. Atrial Fibrillation Ablation in Adults With Repaired Congenital Heart Disease. J Atr Fibrillation 2016; 8:1363. [PMID: 27909479 DOI: 10.4022/jafib.1363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 02/08/2016] [Accepted: 02/14/2016] [Indexed: 11/10/2022]
Abstract
The incidence of atrial fibrillation (AF) in congenital heart disease (CHD) adults has increased in the past decades due to a longer life expectancy of this population where the subjects are exposed to cardiac overflow, overpressure and structural changes for years. The literature regarding AF ablation in repaired CHD adults emphasizes the importance of intracardiac echocardiography (ICE) to perform the transseptal puncture and the ablation procedure in the left atrium (LA), both effectively and safely. In small case control studies, where the predominant congenital cardiomyopathy was the atrial septal defect, the most common strategy for ablation was antral isolation of the pulmonary veins showing results, at one year follow-up, similar to those in the general population. The positive results of AF ablation so far, in this specific population, widen the range of therapeutic options for a group of patients whose only chance has been pharmacological treatment, which has proved to be inefficacious in most of the cases and not free from adverse events.
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Affiliation(s)
- Marta Acena
- Heart Disease Institute, Bellvitge Biomedical Research Institute-IDIBELL, Bellvitge University Hospital
| | - Ignasi Anguera
- Heart Disease Institute, Bellvitge Biomedical Research Institute-IDIBELL, Bellvitge University Hospital
| | - Paolo D Dallaglio
- Heart Disease Institute, Bellvitge Biomedical Research Institute-IDIBELL, Bellvitge University Hospital
| | - Marcos Rodriguez
- Heart Disease Institute, Bellvitge Biomedical Research Institute-IDIBELL, Bellvitge University Hospital
| | - Xavier Sabaté
- Heart Disease Institute, Bellvitge Biomedical Research Institute-IDIBELL, Bellvitge University Hospital
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Truszewski Z, Szarpak L, Kurowski A, Evrin T, Zasko P, Bogdanski L, Czyzewski L. Randomized trial of the chest compressions effectiveness comparing 3 feedback CPR devices and standard basic life support by nurses. Am J Emerg Med 2015; 34:381-5. [PMID: 26612703 DOI: 10.1016/j.ajem.2015.11.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/23/2015] [Accepted: 11/01/2015] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Out-of-hospital cardiac arrest is a leading cause of mortality and serious neurological morbidity in Europe. We aim to investigate the effect of 3 cardiopulmonary resuscitation (CPR) feedback devices on effectiveness of chest compression during CPR. METHODS This was prospective, randomized, crossover, controlled trial. Following a brief didactic session, 140 volunteer nurses inexperienced with feedback CPR devices attempted chest compression on a manikin using 3 CPR feedback devices (TrueCPR, CPR-Ezy, and iCPR) and standard basic life support (BLS) without feedback. RESULTS Comparison of standard BLS, TrueCPR, CPR-Ezy, and iCPR showed differences in the effectiveness of chest compression (compressions with correct pressure point, correct depth, and sufficient decompression), which are, respectively, 37.5%, 85.6%, 39.5%, and 33.4%; compression depth (44.6 vs 54.5 vs 45.6 vs 39.6 mm); and compression rate (129.4 vs 110.2 vs 101.5 vs 103.5 min(-1)). CONCLUSIONS During the simulated resuscitation scenario, only TrueCPR significantly affected the increased effectiveness compression compared with standard BLS, CPR-Ezy, and iCPR. Further studies are required to confirm the results in clinical practice.
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Affiliation(s)
- Zenon Truszewski
- Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Lukasz Szarpak
- Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland.
| | - Andrzej Kurowski
- Department of Anesthesiology, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Togay Evrin
- Department of Emergency Medicine, UFuK University Medical Faculty, Dr Ridvan Ege Education and Research Hospital, Ankara, Turkey
| | - Piotr Zasko
- Department of Anesthesiology, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Lukasz Bogdanski
- Department of Anesthesiology, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Lukasz Czyzewski
- Department of Nephrologic Nursing, Medical University of Warsaw, Warsaw, Poland
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