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Kamakura T, Chishaki S, Nakamura T, Kusano K. Efficacy of quinidine for suppressing Purkinje-related ventricular fibrillation in a patient with hypertrophic cardiomyopathy associated with midventricular obstruction. Heart Rhythm 2024:S1547-5271(24)02816-9. [PMID: 38936450 DOI: 10.1016/j.hrthm.2024.06.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/15/2024] [Accepted: 06/21/2024] [Indexed: 06/29/2024]
Affiliation(s)
- Tsukasa Kamakura
- From the Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
| | - Shoko Chishaki
- From the Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Toshihiro Nakamura
- From the Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kengo Kusano
- From the Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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2
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Shauer A, Horowitz-Cederboim S, Mor-Shaked H, Durst R, Zwas DR, Belhassen B. Calmodulinopathy Associated Long QT Syndrome, Hypertrophic Cardiomyopathy With Excessive Trabeculation in a 14-Year-Old Girl Presenting With Ventricular Fibrillation. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2024; 17:e004163. [PMID: 38258601 DOI: 10.1161/circgen.123.004163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Affiliation(s)
- Ayelet Shauer
- Heart Institute (A.S., S.H.-C., R.D., D.R.Z., B.B.), Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Israel (A.S., H.M.-S., R.D., D.R.Z.)
| | | | - Hagar Mor-Shaked
- Department of Genetics (H.M.-S.), Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Israel (A.S., H.M.-S., R.D., D.R.Z.)
| | - Ronen Durst
- Heart Institute (A.S., S.H.-C., R.D., D.R.Z., B.B.), Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Israel (A.S., H.M.-S., R.D., D.R.Z.)
| | - Donna R Zwas
- Heart Institute (A.S., S.H.-C., R.D., D.R.Z., B.B.), Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Israel (A.S., H.M.-S., R.D., D.R.Z.)
| | - Bernard Belhassen
- Heart Institute (A.S., S.H.-C., R.D., D.R.Z., B.B.), Hadassah Medical Center, Jerusalem, Israel
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3
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Çetin N, Soylu MÖ, Özbaş B, Bayturan Ö, Tezcan UK. Substrate-Based Ablation of Purkinje-Related Ventricular Fibrillation in an Elderly Patient with Ischemic Cardiomyopathy. Arq Bras Cardiol 2023; 120:e20220774. [PMID: 37820171 PMCID: PMC10519349 DOI: 10.36660/abc.20220774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 04/17/2023] [Accepted: 06/14/2023] [Indexed: 10/13/2023] Open
Affiliation(s)
- Nurullah Çetin
- Departamento de CardiologiaManisa Celal Bayar UniversityFaculty of MedicineManisaTurquiaDepartamento de Cardiologia - Manisa Celal Bayar University, Faculty of Medicine, Manisa – Turquia
| | - Mustafa Özcan Soylu
- Departamento de CardiologiaManisa Celal Bayar UniversityFaculty of MedicineManisaTurquiaDepartamento de Cardiologia - Manisa Celal Bayar University, Faculty of Medicine, Manisa – Turquia
| | - Batuhan Özbaş
- Departamento de CardiologiaManisa Celal Bayar UniversityFaculty of MedicineManisaTurquiaDepartamento de Cardiologia - Manisa Celal Bayar University, Faculty of Medicine, Manisa – Turquia
| | - Özgür Bayturan
- Departamento de CardiologiaManisa Celal Bayar UniversityFaculty of MedicineManisaTurquiaDepartamento de Cardiologia - Manisa Celal Bayar University, Faculty of Medicine, Manisa – Turquia
| | - Uğur Kemal Tezcan
- Departamento de CardiologiaManisa Celal Bayar UniversityFaculty of MedicineManisaTurquiaDepartamento de Cardiologia - Manisa Celal Bayar University, Faculty of Medicine, Manisa – Turquia
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4
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Duchateau J, Krisai P, Charton J, Benali K, Cheniti G, Surget E, Sacher F, Hocini M, Haïssaguerre M. How to perform Purkinje tissue ablation for the treatment of idiopathic VF. Heart Rhythm 2023; 20:1408-1413. [PMID: 37468026 DOI: 10.1016/j.hrthm.2023.07.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 07/21/2023]
Affiliation(s)
- Josselin Duchateau
- Hôpital Cardiologique du Haut Lévêque, CHU de Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France.
| | - Philipp Krisai
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jan Charton
- Hôpital Cardiologique du Haut Lévêque, CHU de Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Karim Benali
- Hôpital Cardiologique du Haut Lévêque, CHU de Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Ghassen Cheniti
- Hôpital Cardiologique du Haut Lévêque, CHU de Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Elodie Surget
- Hôpital Cardiologique du Haut Lévêque, CHU de Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Frédéric Sacher
- Hôpital Cardiologique du Haut Lévêque, CHU de Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Mélèze Hocini
- Hôpital Cardiologique du Haut Lévêque, CHU de Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Michel Haïssaguerre
- Hôpital Cardiologique du Haut Lévêque, CHU de Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
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5
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Siontis KC, Ommen SR, Geske JB. Art and science of risk stratification of sudden cardiac death in hypertrophic cardiomyopathy: Current state, unknowns, and future directions. Prog Cardiovasc Dis 2023; 80:25-31. [PMID: 37586655 DOI: 10.1016/j.pcad.2023.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 08/12/2023] [Indexed: 08/18/2023]
Abstract
The progress in the management of hypertrophic cardiomyopathy (HCM) over the last several decades has resulted in great improvements in quality of life and overall survival for HCM patients. Yet, sudden cardiac death (SCD) due to ventricular tachyarrhythmias is among the common causes of HCM-related mortality. SCD risk stratification is a central and often challenging domain in the care of the HCM patient. Distinguishing the individuals most likely to benefit from a primary prevention implantable-cardioverter defibrillator (ICD) from those truly at a low risk of SCD in whom an ICD is not necessary is a nuanced process. Clinicians need to carefully balance the potential benefit and risks of ICDs, particularly in young patients. Because of intense investigations in diverse HCM cohorts globally, two main approaches to SCD risk stratification in HCM have emerged, one based on major SCD risk factors and one based on a mathematically derived risk score. In this overview, we discuss the current state, latest advances and remaining unknowns about established and novel markers of risk of SCD in HCM. We also review how the risk factor- and risk score-based assessments can and should be used in conjunction to enhance rather than contradict each other in facilitating informed ICD decision-making in contemporary clinical practice.
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Affiliation(s)
- Konstantinos C Siontis
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Steve R Ommen
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Jeffrey B Geske
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America.
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6
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Garg J, Kewcharoen J, Shah K, Turagam M, Bhardwaj R, Contractor T, Mandapati R, Lakkireddy D. Clinical outcomes of radiofrequency catheter ablation of ventricular tachycardia in patients with hypertrophic cardiomyopathy. J Cardiovasc Electrophysiol 2023; 34:219-224. [PMID: 36335616 PMCID: PMC10100142 DOI: 10.1111/jce.15739] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/27/2022] [Accepted: 11/01/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Monomorphic ventricular tachycardia (VT) is rare in patients with hypertrophic cardiomyopathy (HCM), management of which is challenging. Limited data exists on the utility of catheter ablation for the treatment of VT in this population. OBJECTIVES We aimed to assess clinical outcomes of catheter ablation for VT in HCM patients. METHODS A systematic search, without language restriction, using PubMed, EMBASE, SCOPUS, Google Scholar, and ClinicalTrials.gov was performed. The meta-analysis was performed using a meta-package for R version 4.0/RStudio version 1.2 and Freeman Tukey double arcsine method to establish the variance of raw proportions. Outcomes measured included (1) acute procedure success (defined as noninducible for clinical VT), (2) freedom from VT at follow-up, (3) mortality. RESULTS This systematic review of six studies (three from the United States and three from Japan) incorporated a total of 68 drug-refractory HCM patients who underwent VT radiofrequency catheter ablation (mean age 57.6 ± 13.3 years, mean LVEF 45.8 ± 15.4%, 85% men, maximum septal wall thickness 17.4 ± 4.6 mm, and 32.3% with an apical aneurysm). Acute procedural success was achieved in 84.5% patients (95% confidence interval [CI]: 70.6%-95.2%) with 27.9% patients had recurrent VT requiring multiple ablations (median 1, IQR 1-3). During the follow-up period (18.3 ± 11.7 months), the pooled incidence of freedom from recurrent VT after index procedure was 70.2% (95% CI: 51.9%-86.2%), while after the last ablation was 82.8% (95% CI: 57%-99.2%). There were two deaths during follow-up, one from heart failure and one from SCD 0.8% (95% CI: 0%-5.8%). CONCLUSION The results of our pooled analysis demonstrated that catheter ablation for VT in HCM patients was associated with high acute procedural success, and reduced VT recurrence-findings comparable to previously published reports in other disease substrates.
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Affiliation(s)
- Jalaj Garg
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California, USA
| | - Jakrin Kewcharoen
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California, USA
| | - Kuldeep Shah
- Department of Cardiovascular Medicine, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Mohit Turagam
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rahul Bhardwaj
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California, USA
| | - Tahmeed Contractor
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California, USA
| | - Ravi Mandapati
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California, USA
| | - Dhanunjaya Lakkireddy
- Kansas City Heart Rhythm Institute and Research Foundation, Kansas City, Kansas, USA
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7
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Waldmann V, Iserin F, Vigmond E, Marijon E, Bonnet D, Lavergne T, Haissaguerre M. Two-to-one Purkinje-to-myocardium activation during ventricular fibrillation associated with hypertrophic cardiomyopathy. HeartRhythm Case Rep 2022; 9:113-117. [PMID: 36860756 PMCID: PMC9968904 DOI: 10.1016/j.hrcr.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Victor Waldmann
- M3C-Necker, Hôpital Universitaire Necker-Enfants malades, APHP, Paris, France,Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France,Université de Paris Cité, Paris, France,Electrophysiology Unit, Cardiology Department, European Georges Pompidou Hospital, Paris, France,Address reprint requests and correspondence: Dr Victor Waldmann, M3C-Necker, Hôpital Universitaire Necker-Enfants malades, APHP, 149 rue de Sèvres, 75015 Paris, France.
| | - Franck Iserin
- M3C-Necker, Hôpital Universitaire Necker-Enfants malades, APHP, Paris, France
| | - Edward Vigmond
- IHU LIRYC, Electrophysiology and Heart Modeling Institute; Inserm CRCTB U1045; Bordeaux University Hospital, Bordeaux, France
| | - Eloi Marijon
- Université de Paris Cité, Paris, France,Electrophysiology Unit, Cardiology Department, European Georges Pompidou Hospital, Paris, France
| | - Damien Bonnet
- M3C-Necker, Hôpital Universitaire Necker-Enfants malades, APHP, Paris, France,Université de Paris Cité, Paris, France
| | - Thomas Lavergne
- Université de Paris Cité, Paris, France,Electrophysiology Unit, Cardiology Department, European Georges Pompidou Hospital, Paris, France
| | - Michel Haissaguerre
- IHU LIRYC, Electrophysiology and Heart Modeling Institute; Inserm CRCTB U1045; Bordeaux University Hospital, Bordeaux, France
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8
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Lukas Laws J, Lancaster MC, Ben Shoemaker M, Stevenson WG, Hung RR, Wells Q, Marshall Brinkley D, Hughes S, Anderson K, Roden D, Stevenson LW. Arrhythmias as Presentation of Genetic Cardiomyopathy. Circ Res 2022; 130:1698-1722. [PMID: 35617362 PMCID: PMC9205615 DOI: 10.1161/circresaha.122.319835] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
There is increasing evidence regarding the prevalence of genetic cardiomyopathies, for which arrhythmias may be the first presentation. Ventricular and atrial arrhythmias presenting in the absence of known myocardial disease are often labelled as idiopathic, or lone. While ventricular arrhythmias are well-recognized as presentation for arrhythmogenic cardiomyopathy in the right ventricle, the scope of arrhythmogenic cardiomyopathy has broadened to include those with dominant left ventricular involvement, usually with a phenotype of dilated cardiomyopathy. In addition, careful evaluation for genetic cardiomyopathy is also warranted for patients presenting with frequent premature ventricular contractions, conduction system disease, and early onset atrial fibrillation, in which most detected genes are in the cardiomyopathy panels. Sudden death can occur early in the course of these genetic cardiomyopathies, for which risk is not adequately tracked by left ventricular ejection fraction. Only a few of the cardiomyopathy genotypes implicated in early sudden death are recognized in current indications for implantable cardioverter defibrillators which otherwise rely upon a left ventricular ejection fraction ≤0.35 in dilated cardiomyopathy. The genetic diagnoses impact other aspects of clinical management such as exercise prescription and pharmacological therapy of arrhythmias, and new therapies are coming into clinical investigation for specific genetic cardiomyopathies. The expansion of available genetic information and implications raises new challenges for genetic counseling, particularly with the family member who has no evidence of a cardiomyopathy phenotype and may face a potentially negative impact of a genetic diagnosis. Discussions of risk for both probands and relatives need to be tailored to their numeric literacy during shared decision-making. For patients presenting with arrhythmias or cardiomyopathy, extension of genetic testing and its implications will enable cascade screening, intervention to change the trajectory for specific genotype-phenotype profiles, and enable further development and evaluation of emerging targeted therapies.
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Affiliation(s)
- J Lukas Laws
- Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN
| | - Megan C Lancaster
- Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN
| | - M Ben Shoemaker
- Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN
| | - William G Stevenson
- Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN
| | - Rebecca R Hung
- Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN
| | - Quinn Wells
- Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN
| | - D Marshall Brinkley
- Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN
| | - Sean Hughes
- Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN
| | - Katherine Anderson
- Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN
| | - Dan Roden
- Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN
| | - Lynne W Stevenson
- Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN
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9
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Belhassen B, Tovia-Brodie O. Short-Coupled Idiopathic Ventricular Fibrillation: A Literature Review With Extended Follow-Up. JACC Clin Electrophysiol 2022; 8:918-936. [PMID: 35597766 DOI: 10.1016/j.jacep.2022.04.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/25/2022] [Accepted: 04/18/2022] [Indexed: 01/07/2023]
Abstract
Idiopathic ventricular fibrillation is responsible for approximately 10% of cases of aborted cardiac arrest. Recent studies have shown that short-coupled ventricular premature complexes are present at the onset of idiopathic ventricular fibrillation in 6.6%-17% of patients. The present review provided information on 86 patients with short-coupled malignant ventricular arrhythmias that were reported as case reports or small patient series during the last 70 years. In 75% of the 81 cases published during the last 40 years, extended information and follow-up (from 2.63 ± 4.5 to 10.67 ± 7.8 years; P < 0.001, between the original publication to the latest update) could be obtained from the authors. The review shows that short-coupled malignant ventricular arrhythmias occurred almost equally in males and females, at the mean age of 40 years. A tendency for later occurrence of the arrhythmia by 4 years was observed in females. A prior history of syncope was noted in 45.3% of the patients, whereas arrhythmic storm occurred in 42% at presentation. The most common mode of revelation of short-coupled malignant ventricular arrhythmias was syncope (53.5%), followed by aborted cardiac arrest (26.7%) and recurrent arrhythmic event after prior implantable-cardioverter defibrillator implantation for idiopathic ventricular fibrillation (17.4%). For the first time, short-coupled malignant arrhythmias exhibiting "not-so-short" coupling intervals (≥350 ms) were found in a significant proportion of patients (17.4%). During long-term follow-up, quinidine yielded a slightly higher success rate in arrhythmia control than ablation. Larger studies are necessary to assess the best strategy for the management of this potentially lethal arrhythmia.
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Affiliation(s)
- Bernard Belhassen
- Heart Institute, Hadassah Medical Center, Jerusalem, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Oholi Tovia-Brodie
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel; Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
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10
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Anderson RD, Massé S, Asta J, Lai PFH, Chakraborty P, Azam MA, Downar E, Nanthakumar K. Role of Purkinje-Muscle Junction in Early Ventricular Fibrillation in a Porcine Model: Beyond the Trigger Concept. Pacing Clin Electrophysiol 2022; 45:742-751. [PMID: 35067947 DOI: 10.1111/pace.14453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/01/2022] [Accepted: 01/14/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The role of the Purkinje network in triggering ventricular fibrillation (VF) has been studied, however, its involvement after onset and in early maintenance of VF is controversial. AIM We studied the role of the Purkinje-muscle junctions (PMJ) on epicardial-endocardial activation gradients during early VF. METHODS In a healthy, porcine, beating-heart Langendorff model [control, n = 5; ablation, n = 5], simultaneous epicardial-endocardial dominant frequent mapping was used (224 unipolar electrograms) to calculate activation rate gradients during the onset and early phase of VF. Selective Purkinje ablation was performed using Lugol's solution, followed by VF re-induction and mapping and finally, histological evaluation. RESULTS Epicardial activation rates were faster than endocardial rates for both onset and early VF. After PMJ ablation, activation rates decreased epicardially and endocardially for both onset and early VF [Epi: 9.7±0.2 to 8.3±0.2 Hz (P<0.0001) and 10.9±0.4 to 8.8±0.3 Hz (P<0.0001), respectively; Endo: 8.2 ± 0.3 Hz to 7.4 ± 0.2 Hz (P<0.0001) and 7.0 ± 0.4 Hz to 6.6 ± 0.3 Hz (P = 0.0002), respectively]. In controls, epicardial-endocardial activation rate gradients during onset and early VF were 1.7±0.3 Hz and 4.5±0.4 Hz (P<0.001), respectively. After endocardial ablation of PMJs, these gradients were reduced to 0.9±0.3 Hz (onset VF, P<0.001) and to 2.2±0.3 Hz (early VF, P<0.001). Endocardial-epicardial Purkinje fibre arborization and selective Purkinje fibre extinction after only endocardial ablation (not with epicardial ablation) was confirmed on histological analysis. CONCLUSIONS Beyond the trigger paradigm, PMJs determine activation rate gradients during onset and during early maintenance of VF. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Robert D Anderson
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Canada
| | - Stéphane Massé
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Canada
| | - John Asta
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Canada
| | - Patrick F H Lai
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Canada
| | - Praloy Chakraborty
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Canada
| | - Mohammed Ali Azam
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Canada
| | - Eugene Downar
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Canada
| | - Kumaraswamy Nanthakumar
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Canada
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11
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Alsalem AB, Santangeli P. Catheter ablation of ventricular fibrillation in hypertrophic cardiomyopathy: Pushing the boundaries. J Cardiovasc Electrophysiol 2021; 32:2995-2996. [PMID: 34453382 DOI: 10.1111/jce.15228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 08/10/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Ahmed B Alsalem
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Cardiac Sciences, College of Medicine, King Saud bin-Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Pasquale Santangeli
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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