1
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Nguyen DSN, Lin CY, Chung FP, Chang TY, Lo LW, Lin YJ, Chang SL, Hu YF, Tuan TC, Chao TF, Liao JN, Kuo L, Liu CM, Liu SH, Wu CI, Kuo MJ, Li GY, Huang YS, Wu SJ, Siow YK, Bautista JAL, Cao DT, Chen SA. Signal-averaged electrocardiography as a noninvasive tool for evaluating the ventricular substrate in patients with nonischemic cardiomyopathy: reassessment of an old tool. Front Cardiovasc Med 2024; 11:1306055. [PMID: 38689859 PMCID: PMC11058987 DOI: 10.3389/fcvm.2024.1306055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 04/03/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction Signal-averaged electrocardiography (SAECG) provides diagnostic and prognostic information regarding cardiac diseases. However, its value in other nonischemic cardiomyopathies (NICMs) remains unclear. This study aimed to investigate the role of SAECG in patients with NICM. Methods and results This retrospective study included consecutive patients with NICM who underwent SAECG, biventricular substrate mapping, and ablation for ventricular arrhythmia (VA). Patients with baseline ventricular conduction disturbances were excluded. Patients who fulfilled at least one SAECG criterion were categorized into Group 1, and the other patients were categorized into Group 2. Baseline and ventricular substrate characteristics were compared between the two groups. The study included 58 patients (39 men, mean age 50.4 ± 15.5 years), with 34 and 24 patients in Groups 1 and 2, respectively. Epicardial mapping was performed in eight (23.5%) and six patients (25.0%) in Groups 1 and 2 (p = 0.897), respectively. Patients in Group 1 had a more extensive right ventricular (RV) low-voltage zone (LVZ) and scar area than those in Group 2. Group 1 had a larger epicardial LVZ than Group 2. Epicardial late potentials were more frequent in Group 1 than in Group 2. There were more arrhythmogenic foci within the RV outflow tract in Group 1 than in Group 2. There was no significant difference in long-term VA recurrence. Conclusion In our NICM population, a positive SAECG was associated with a larger RV endocardial scar, epicardial scar/late potentials, and a higher incidence of arrhythmogenic foci in the RV outflow tract.
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Affiliation(s)
- Dinh Son Ngoc Nguyen
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Cardiology Department, University Medical Center, Ho Chi Minh City, Vietnam
| | - Chin-Yu Lin
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Fa-Po Chung
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ting-Yung Chang
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Li-Wei Lo
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Lin Chang
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Feng Hu
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ta-Chuan Tuan
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jo-Nan Liao
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ling Kuo
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Min Liu
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shin-Huei Liu
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-I Wu
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ming-Jen Kuo
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Guan-Yi Li
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Yu-Shan Huang
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Shang-Ju Wu
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Department of Cardiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yoon Kee Siow
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Department of Cardiology, Serdang Hospital, Selangor, Malaysia
| | - Jose Antonio L. Bautista
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Section of Clinical Cardiac Electrophysiology, Heart Institute, St. Luke’s Medical Center – Global City, Taguig City, Philippines
| | - Dat Tran Cao
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Arrhythmia Treatment Department, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Cardiology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medicine, National Chung Hsing University, Taichung, Taiwan
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Silvetti E, Lanza O, Romeo F, Martino A, Fedele E, Lanzillo C, Crescenzi C, Fanisio F, Calò L. The pivotal role of ECG in cardiomyopathies. Front Cardiovasc Med 2023; 10:1178163. [PMID: 37404739 PMCID: PMC10315483 DOI: 10.3389/fcvm.2023.1178163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/15/2023] [Indexed: 07/06/2023] Open
Abstract
Cardiomyopathies are a heterogeneous group of pathologies characterized by structural and functional alterations of the heart. Recent technological advances in cardiovascular imaging offer an opportunity for deep phenotypic and etiological definition. Electrocardiogram (ECG) is the first-line diagnostic tool in the evaluation of both asymptomatic and symptomatic individuals. Some electrocardiographic signs are pathognomonic or fall within validated diagnostic criteria of individual cardiomyopathy such as the inverted T waves in right precordial leads (V1-V3) or beyond in individuals with complete pubertal development in the absence of complete right bundle branch block for the diagnosis of arrhythmogenic cardiomyopathy of the right ventricle (ARVC) or the presence of low voltages typically seen in more than 60% of patients with amyloidosis. Most other electrocardiographic findings such as the presence of depolarization changes including QRS fragmentation, the presence of epsilon wave, the presence of reduced or increased voltages as well as alterations in the repolarization phase including the negative T waves in the lateral leads, or the profound inversion of the T waves or downsloping of the ST tract are more non-specific signs which can however raise the clinical suspicion of cardiomyopathy in order to initiate a diagnostic procedure especially using imaging techniques for diagnostic confirmation. Such electrocardiographic alterations not only have a counterpart in imaging investigations such as evidence of late gadolinium enhancement on magnetic resonance imaging, but may also have an important prognostic value once a definite diagnosis has been made. In addition, the presence of electrical stimulus conduction disturbances or advanced atrioventricular blocks that can be seen especially in conditions such as cardiac amyloidosis or sarcoidosis, or the presence of left bundle branch block or posterior fascicular block in dilated or arrhythmogenic left ventricular cardiomyopathies are recognized as a possible expression of advanced pathology. Similarly, the presence of ventricular arrhythmias with typical patterns such as non-sustained or sustained ventricular tachycardia of LBBB morphology in ARVC or non-sustained or sustained ventricular tachycardia with an RBBB morphology (excluding the "fascicular pattern") in arrhythmogenic left ventricle cardiomyopathy could have a significant impact on the course of each disease. It is therefore clear that a learned and careful interpretation of ECG features can raise suspicion of the presence of a cardiomyopathy, identify diagnostic "red flags" useful for orienting the diagnosis toward specific forms, and provide useful tools for risk stratification. The purpose of this review is to emphasize the important role of the ECG in the diagnostic workup, describing the main ECG findings of different cardiomyopathies.
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3
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Concealed Substrates in Brugada Syndrome: Isolated Channelopathy or Associated Cardiomyopathy? Genes (Basel) 2022; 13:genes13101755. [DOI: 10.3390/genes13101755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/20/2022] [Accepted: 09/23/2022] [Indexed: 11/17/2022] Open
Abstract
Brugada syndrome (BrS) is an inherited autosomal dominant genetic disorder responsible for sudden cardiac death from malignant ventricular arrhythmia. The term “channelopathy” is nowadays used to classify BrS as a purely electrical disease, mainly occurring secondarily to loss-of-function mutations in the α subunit of the cardiac sodium channel protein Nav1.5. In this setting, arrhythmic manifestations of the disease have been reported in the absence of any apparent structural heart disease or cardiomyopathy. Over the last few years, however, a consistent amount of evidence has grown in support of myocardial structural and functional abnormalities in patients with BrS. In detail, abnormal ventricular dimensions, either systolic or diastolic dysfunctions, regional wall motion abnormalities, myocardial fibrosis, and active inflammatory foci have been frequently described, pointing to alternative mechanisms of arrhythmogenesis which challenge the definition of channelopathy. The present review aims to depict the status of the art of concealed arrhythmogenic substrates in BrS, often resulting from an advanced and multimodal diagnostic workup, to foster future preclinical and clinical research in support of the cardiomyopathic nature of the disease.
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4
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Peretto G, Mazzone P. Arrhythmogenic Cardiomyopathy: One, None and a Hundred Thousand Diseases. J Pers Med 2022; 12:jpm12081256. [PMID: 36013207 PMCID: PMC9409808 DOI: 10.3390/jpm12081256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Giovanni Peretto
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
- Correspondence: ; Tel.: +39-02-2643-7484; Fax: +39-02-2643-7326
| | - Patrizio Mazzone
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
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5
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Continuous Electrical Monitoring in Patients with Arrhythmic Myocarditis: Insights from a Referral Center. J Clin Med 2021; 10:jcm10215142. [PMID: 34768662 PMCID: PMC8584651 DOI: 10.3390/jcm10215142] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 12/15/2022] Open
Abstract
Background. The incidence and burden of arrhythmias in myocarditis are under-reported. Objective. We aimed to assess the diagnostic yield and clinical impact of continuous arrhythmia monitoring (CAM) in patients with arrhythmic myocarditis. Methods. We enrolled consecutive adult patients (n = 104; 71% males, age 47 ± 11 year, mean LVEF 50 ± 13%) with biopsy-proven active myocarditis and de novo ventricular arrhythmias (VAs). All patients underwent prospective monitoring by both sequential 24-h Holter ECGs and CAM, including either ICD (n = 62; 60%) or loop recorder (n = 42; 40%). Results. By 3.7 ± 1.6 year follow up, 45 patients (43%) had VT, 67 (64%) NSVT and 102 (98%) premature ventricular complexes (PVC). As compared to the Holter ECG (average 9.5 exams per patient), CAM identified more patients with VA (VT: 45 vs. 4; NSVT: 64 vs. 45; both p < 0.001), more VA episodes (VT: 100 vs. 4%; NSVT: 91 vs. 12%) and earlier NSVT timing (median 6 vs. 24 months, p < 0.001). The extensive ICD implantation strategy was proven beneficial in 80% of the population. Histological signs of chronically active myocarditis (n = 73, 70%) and anteroseptal late gadolinium enhancement (n = 26, 25%) were significantly associated with the occurrence of VTs during follow up, even in the primary prevention subgroup. Conclusion. In patients with arrhythmic myocarditis, CAM allowed accurate arrhythmia detection and showed a considerable clinical impact.
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6
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Peretto G, Villatore A, Rizzo S, Esposito A, De Luca G, Palmisano A, Vignale D, Cappelletti AM, Tresoldi M, Campochiaro C, Sartorelli S, Ripa M, De Gaspari M, Busnardo E, Ferro P, Calabrò MG, Fominskiy E, Monaco F, Cavalli G, Gianolli L, De Cobelli F, Margonato A, Dagna L, Scandroglio M, Camici PG, Mazzone P, Della Bella P, Basso C, Sala S. The Spectrum of COVID-19-Associated Myocarditis: A Patient-Tailored Multidisciplinary Approach. J Clin Med 2021; 10:jcm10091974. [PMID: 34064463 PMCID: PMC8124580 DOI: 10.3390/jcm10091974] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/08/2021] [Accepted: 04/22/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Myocarditis lacks systematic characterization in COVID-19 patients. METHODS We enrolled consecutive patients with newly diagnosed myocarditis in the context of COVID-19 infection. Diagnostic and treatment strategies were driven by a dedicated multidisciplinary disease unit for myocarditis. Multimodal outcomes were assessed during prospective follow-up. RESULTS Seven consecutive patients (57% males, age 51 ± 9 y) with acute COVID-19 infection received a de novo diagnosis of myocarditis. Endomyocardial biopsy was of choice in hemodynamically unstable patients (n = 4, mean left ventricular ejection fraction (LVEF) 25 ± 9%), whereas cardiac magnetic resonance constituted the first exam in stable patients (n = 3, mean LVEF 48 ± 10%). Polymerase chain reaction (PCR) analysis revealed an intra-myocardial SARS-CoV-2 genome in one of the six cases undergoing biopsy: in the remaining patients, myocarditis was either due to other viruses (n = 2) or virus-negative (n = 3). Hemodynamic support was needed for four unstable patients (57%), whereas a cardiac device implant was chosen in two of four cases showing ventricular arrhythmias. Medical treatment included immunosuppression (43%) and biological therapy (29%). By the 6-month median follow-up, no patient died or experienced malignant arrhythmias. However, two cases (29%) were screened for heart transplantation. CONCLUSIONS Myocarditis associated with acute COVID-19 infection is a spectrum of clinical manifestations and underlying etiologies. A multidisciplinary approach is the cornerstone for tailored management.
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Affiliation(s)
- Giovanni Peretto
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (P.M.); (P.D.B.); (S.S.)
- Myocarditis Disease Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (A.E.); (G.D.L.); (A.P.); (D.V.); (C.C.); (S.S.); (E.B.)
- School of Medicine, San Raffaele Vita-Salute University, 20132 Milan, Italy; (A.V.); (F.D.C.); (L.D.); (P.G.C.)
- Correspondence: ; Tel./Fax: +39-02-2643-7484-7326
| | - Andrea Villatore
- School of Medicine, San Raffaele Vita-Salute University, 20132 Milan, Italy; (A.V.); (F.D.C.); (L.D.); (P.G.C.)
| | - Stefania Rizzo
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Cardiovascular Pathology, Padua University, 35128 Padua, Italy; (S.R.); (M.D.G.); (C.B.)
| | - Antonio Esposito
- Myocarditis Disease Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (A.E.); (G.D.L.); (A.P.); (D.V.); (C.C.); (S.S.); (E.B.)
- School of Medicine, San Raffaele Vita-Salute University, 20132 Milan, Italy; (A.V.); (F.D.C.); (L.D.); (P.G.C.)
- Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Giacomo De Luca
- Myocarditis Disease Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (A.E.); (G.D.L.); (A.P.); (D.V.); (C.C.); (S.S.); (E.B.)
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Anna Palmisano
- Myocarditis Disease Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (A.E.); (G.D.L.); (A.P.); (D.V.); (C.C.); (S.S.); (E.B.)
- Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Davide Vignale
- Myocarditis Disease Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (A.E.); (G.D.L.); (A.P.); (D.V.); (C.C.); (S.S.); (E.B.)
- Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Alberto Maria Cappelletti
- Department of Clinical Cardiology and Intensive Care Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (A.M.C.); (A.M.)
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
- COVID-19 Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Corrado Campochiaro
- Myocarditis Disease Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (A.E.); (G.D.L.); (A.P.); (D.V.); (C.C.); (S.S.); (E.B.)
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Silvia Sartorelli
- Myocarditis Disease Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (A.E.); (G.D.L.); (A.P.); (D.V.); (C.C.); (S.S.); (E.B.)
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Marco Ripa
- COVID-19 Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
- Department of Infectious Diseases, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Monica De Gaspari
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Cardiovascular Pathology, Padua University, 35128 Padua, Italy; (S.R.); (M.D.G.); (C.B.)
| | - Elena Busnardo
- Myocarditis Disease Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (A.E.); (G.D.L.); (A.P.); (D.V.); (C.C.); (S.S.); (E.B.)
- Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (P.F.); (L.G.)
| | - Paola Ferro
- Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (P.F.); (L.G.)
| | - Maria Grazia Calabrò
- Cardiac Surgery Intensive Care Unit, Division of Anesthesiology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (M.G.C.); (E.F.); (F.M.); (M.S.)
| | - Evgeny Fominskiy
- Cardiac Surgery Intensive Care Unit, Division of Anesthesiology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (M.G.C.); (E.F.); (F.M.); (M.S.)
| | - Fabrizio Monaco
- Cardiac Surgery Intensive Care Unit, Division of Anesthesiology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (M.G.C.); (E.F.); (F.M.); (M.S.)
| | - Giulio Cavalli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Luigi Gianolli
- Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (P.F.); (L.G.)
| | - Francesco De Cobelli
- School of Medicine, San Raffaele Vita-Salute University, 20132 Milan, Italy; (A.V.); (F.D.C.); (L.D.); (P.G.C.)
- Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Alberto Margonato
- Department of Clinical Cardiology and Intensive Care Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (A.M.C.); (A.M.)
| | - Lorenzo Dagna
- School of Medicine, San Raffaele Vita-Salute University, 20132 Milan, Italy; (A.V.); (F.D.C.); (L.D.); (P.G.C.)
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Mara Scandroglio
- Cardiac Surgery Intensive Care Unit, Division of Anesthesiology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (M.G.C.); (E.F.); (F.M.); (M.S.)
| | - Paolo Guido Camici
- School of Medicine, San Raffaele Vita-Salute University, 20132 Milan, Italy; (A.V.); (F.D.C.); (L.D.); (P.G.C.)
| | - Patrizio Mazzone
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (P.M.); (P.D.B.); (S.S.)
| | - Paolo Della Bella
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (P.M.); (P.D.B.); (S.S.)
| | - Cristina Basso
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Cardiovascular Pathology, Padua University, 35128 Padua, Italy; (S.R.); (M.D.G.); (C.B.)
| | - Simone Sala
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (P.M.); (P.D.B.); (S.S.)
- Myocarditis Disease Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (A.E.); (G.D.L.); (A.P.); (D.V.); (C.C.); (S.S.); (E.B.)
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Gemmell PM, Gillette K, Balaban G, Rajani R, Vigmond EJ, Plank G, Bishop MJ. A computational investigation into rate-dependant vectorcardiogram changes due to specific fibrosis patterns in non-ischæmic dilated cardiomyopathy. Comput Biol Med 2020; 123:103895. [PMID: 32741753 PMCID: PMC7429989 DOI: 10.1016/j.compbiomed.2020.103895] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/12/2020] [Accepted: 06/27/2020] [Indexed: 01/13/2023]
Abstract
Patients with scar-associated fibrotic tissue remodelling are at greater risk of ventricular arrhythmic events, but current methods to detect the presence of such remodelling require invasive procedures. We present here a potential method to detect the presence, location and dimensions of scar using pacing-dependent changes in the vectorcardiogram (VCG). Using a clinically-derived whole-torso computational model, simulations were conducted at both slow and rapid pacing for a variety of scar patterns within the myocardium, with various VCG-derived metrics being calculated, with changes in these metrics being assessed for their ability to discern the presence and size of scar. Our results indicate that differences in the dipole angle at the end of the QRS complex and differences in the QRS area and duration may be used to predict scar properties. Using machine learning techniques, we were also able to predict the location of the scar to high accuracy, using only these VCG-derived rate-dependent changes as input. Such a non-invasive predictive tool for the presence of scar represents a potentially useful clinical tool for identifying patients at arrhythmic risk.
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Affiliation(s)
- Philip M Gemmell
- King's College London, St. Thomas' Hospital North Wing, London, SE1 7EH, UK.
| | - Karli Gillette
- Medical University of Graz, Division of Biophysics, Neue Stiftingtalstraße 6(MC1.D.)/IV, 8010 Graz, Austria
| | - Gabriel Balaban
- University of Oslo, Research Group for Biomedical Infomatics, Gaustadalléen 23B 0373 Oslo, Norway
| | - Ronak Rajani
- King's College London, St. Thomas' Hospital North Wing, London, SE1 7EH, UK
| | - Edward J Vigmond
- University of Bordeaux, IHU Liryc, Site Hopital Xavier Arnozan, Avenue de Haut-Leveque, 33604 Pessac, France
| | - Gernot Plank
- Medical University of Graz, Division of Biophysics, Neue Stiftingtalstraße 6(MC1.D.)/IV, 8010 Graz, Austria
| | - Martin J Bishop
- King's College London, St. Thomas' Hospital North Wing, London, SE1 7EH, UK
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Higuchi S, Minami Y, Shoda M, Shirotani S, Saito C, Haruki S, Gotou M, Yagishita D, Ejima K, Hagiwara N. Prognostic Implication of First-Degree Atrioventricular Block in Patients With Hypertrophic Cardiomyopathy. J Am Heart Assoc 2020; 9:e015064. [PMID: 32146896 PMCID: PMC7335505 DOI: 10.1161/jaha.119.015064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background The association between first‐degree atrioventricular block (AVB) and life‐threatening cardiac events in patients with hypertrophic cardiomyopathy (HCM) remains unclear. This study sought to investigate whether presence of first‐degree AVB was associated with HCM‐related death in patients with HCM. Methods and Results We included 414 patients with HCM (mean age, 51±16 years; 64.5% men). The P‐R interval was measured at the time of the initial evaluation and patients were classified into those with and without first‐degree AVB, which was defined as a P‐R interval ≥200 ms. HCM‐related death was defined as a combined end point of sudden death or potentially lethal arrhythmic events, heart failure–related death, and stroke‐related death. First‐degree AVB was noted in 96 patients (23.2%) at time of enrollment. Over a median (interquartile range) follow‐up period of 8.8 (4.9–12.9) years, a total of 56 patients (13.5%) experienced HCM‐related deaths, including 47 (11.4%) with a combined end point of sudden death or potentially lethal arrhythmic events. In a multivariable analysis that included first‐degree AVB and risk factors for life‐threatening events, first‐degree AVB was independently associated with an HCM‐related death (adjusted hazard ratio, 2.41; 95% CI, 1.27–4.58; P=0.007), and this trend also persisted for the combined end point of sudden death or potentially lethal arrhythmic events (adjusted hazard ratio, 2.60; 95% CI, 1.28–5.27; P=0.008). Conclusions In this cohort of patients with HCM, first‐degree AVB may be associated with HCM‐related death, including the combined end point of sudden death or potentially lethal arrhythmic events.
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Affiliation(s)
- Satoshi Higuchi
- Department of Cardiology Tokyo Women's Medical University Tokyo Japan
| | - Yuichiro Minami
- Department of Cardiology Tokyo Women's Medical University Tokyo Japan
| | - Morio Shoda
- Department of Cardiology Tokyo Women's Medical University Tokyo Japan
| | - Shota Shirotani
- Department of Cardiology Tokyo Women's Medical University Tokyo Japan
| | - Chihiro Saito
- Department of Cardiology Tokyo Women's Medical University Tokyo Japan
| | - Shintaro Haruki
- Department of Cardiology Tokyo Women's Medical University Tokyo Japan
| | - Masayuki Gotou
- Department of Cardiology Tokyo Women's Medical University Tokyo Japan
| | - Daigo Yagishita
- Department of Cardiology Tokyo Women's Medical University Tokyo Japan
| | - Koichiro Ejima
- Department of Cardiology Tokyo Women's Medical University Tokyo Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology Tokyo Women's Medical University Tokyo Japan
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Bhaskaran A, De Silva K, Rao K, Campbell T, Trivic I, Bennett RG, Kizana E, Kumar S. Ventricular Tachycardia Ablation in Non-ischemic Cardiomyopathy. Korean Circ J 2019; 50:203-219. [PMID: 31845552 PMCID: PMC7043965 DOI: 10.4070/kcj.2019.0292] [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: 09/15/2019] [Accepted: 09/22/2019] [Indexed: 11/11/2022] Open
Abstract
Non-ischemic cardiomyopathies are a heterogeneous group of diseases of the myocardium that have a distinct proclivity to ventricular arrhythmias. Of these, ventricular tachycardias pose significant management challenges with the risk of sudden cardiac death and morbidity from multiple causes. Catheter ablation of ventricular tachycardias is becoming an increasingly utilised intervention that has been found to have significant benefits with improving symptoms, reducing anti-arrhythmic drug burden and debilitating device therapies, thereby improving quality of life. Nonetheless, the approach to the ablation of ventricular tachycardias in non-ischemic cardiomyopathies is governed heavily by the disease process, with several distinct differences from ischemic cardiomyopathy including a preponderance to epicardial and deep intramural substrate. This contemporary review aims to present the various disease processes within non-ischemic cardiomyopathies, catheter ablation techniques which have been developed to target ventricular tachycardia and more novel adjunctive therapeutic measures.
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Affiliation(s)
- Ashwin Bhaskaran
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
| | - Kasun De Silva
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
| | - Karan Rao
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
| | - Timothy Campbell
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia.,Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia
| | - Ivana Trivic
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia.,Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia
| | - Richard G Bennett
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia.,Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia
| | - Eddy Kizana
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia.,Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia.,Centre for Heart Research, The Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia.,Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia.
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10
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Okubo K, Gigli L, Della Bella P. Catheter ablation of ventricular tachycardia in nonischemic cardiomyopathy. J Arrhythm 2018; 34:347-355. [PMID: 30167005 PMCID: PMC6111485 DOI: 10.1002/joa3.12099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/23/2018] [Accepted: 07/09/2018] [Indexed: 01/19/2023] Open
Abstract
The number of patients with nonischemic cardiomyopathy (NICM) undergoing catheter ablation of ventricular tachycardia (VT) has increased by the years, however, there are no randomized studies of VT ablation in this population. Many studies have reported more mixed or inferior outcome after the ablation in patients with NICM as compared to in those with ischemic cardiomyopathy (ICM)-likely because of the heterogeneous VT substrates in each etiology. While, various ablation strategies for substrate modification in the setting of ICM, including low voltage area ablation, late potential abolition, and local abnormal ventricular activity elimination, have been well established, it is still unknown which ablation strategy is effective for prevention of recurrence VTs in NICM patients. Therefore, this review will highlight the recent progress made in VT ablation in patients with NICM.
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Affiliation(s)
- Kenji Okubo
- Arrhythmia Unit and Electrophysiology LaboratoriesOspedale San RaffaeleMilanoItaly
| | - Lorenzo Gigli
- Arrhythmia Unit and Electrophysiology LaboratoriesOspedale San RaffaeleMilanoItaly
| | - Paolo Della Bella
- Arrhythmia Unit and Electrophysiology LaboratoriesOspedale San RaffaeleMilanoItaly
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