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Davtyan K, Chugunov I, Topchyan A, Mareev Y, Mironova N, Rimskaya E, Golitsyn S, Mikhaylov E, Lebedev D, Vander M, Lyasnikova E, Sitnikova M, Minjia K, Glembo S, Sukhorukov O. HF Etiology and cardiac contractility modulation therapy. BMC Cardiovasc Disord 2024; 24:279. [PMID: 38811946 PMCID: PMC11134617 DOI: 10.1186/s12872-024-03950-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 05/20/2024] [Indexed: 05/31/2024] Open
Abstract
OBJECTIVES Our study aimed to assess the safety and efficacy of cardiac contractility modulation (CCM) therapy in patients with heart failure with reduced ejection fraction (HFrEF) depending on HF etiology. METHODS We enrolled 166 patients with optimal medical therapy-resistant HFrEF (median age 59 years, 83.7% males, median NYHA class - 2, median left ventricular ejection fraction (LVEF) - 29.0%) who underwent CCM therapy device implantation from 2013 to 2019 in four medical centers in Russia. The HF etiology was determined based on invasive coronary angiography or cardiac MRI data. Transthoracic echocardiography (TTE), 6-minute walking test (6MWT), and NTproBNP-tests were performed at a baseline and 12 months after the implantation. RESULTS The ischemic etiology of HF was revealed in 100 patients (61.5%) (ICM group); the non-ischemic group (NICM) evolved 66 patients (38.5%). Patients in the ICM group were significantly older (61[57-69] vs. 55 [42.8-61], p < 0.001), more frequently had hypertension (79% vs. 42.4%, p < 0.001) and chronic kidney disease (43% vs. 22.7%, p = 0.012). Patients in the NICM group had significantly more often atrial fibrillation (AF) (58% vs. 74%, p = 0.048), larger end-diastolic volume (EDV) (249 [208-309] vs. 220 [192-271], p = 0.019) and end-systolic volume (ESV) (183 [147-230] vs. 154 [128-199], p = 0.003). There were no significant differences in mortality between ICM and NICM groups (14.4 vs. 10.8%, p = 0.51). In 12 months, there was a significant increase in LVEF in the NICM group (+ 2.0 [2-6] vs. +7.7 [2-12], p < 0.001), while the improvement in the 6MWT (+ 75 [22-108] vs. +80 [10-160], p = 0.851) and NYHA class did not reach the level of significance. The subanalysis between patients with improved NYHA class and those without improvement revealed that patients without improvement more frequently had AF (56% vs. 89%; p < 0.01), chronic obstructive lung disease (18% vs. 35% p = 0.047), higher blood pressure (110 [105-120] vs. 120[110-129]; p = 0.032). CONCLUSION In this multicenter retrospective study, patients with non-ischemic HFrEF showed a significantly higher improvement in LVEF and LV reverse remodeling following CCM therapy device implantation. There was no significant association between HF etiology and survival in drug-resistant HFrEF patients following CCM therapy.
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Affiliation(s)
- Karapet Davtyan
- National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russia
| | - Ivan Chugunov
- National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russia
| | - Arpi Topchyan
- National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russia.
| | - Yury Mareev
- National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russia
| | - Natalia Mironova
- National Medical Research Centre of Cardiology after E.I. Chazov, Moscow, Russia
| | - Elena Rimskaya
- National Medical Research Centre of Cardiology after E.I. Chazov, Moscow, Russia
| | - Sergey Golitsyn
- National Medical Research Centre of Cardiology after E.I. Chazov, Moscow, Russia
| | - Evgeny Mikhaylov
- Almazov National Medical Research Centre, Saint-Petersburg, Russia
| | - Dmitry Lebedev
- Almazov National Medical Research Centre, Saint-Petersburg, Russia
| | - Marianna Vander
- Almazov National Medical Research Centre, Saint-Petersburg, Russia
| | - Elena Lyasnikova
- Almazov National Medical Research Centre, Saint-Petersburg, Russia
| | - Maria Sitnikova
- Almazov National Medical Research Centre, Saint-Petersburg, Russia
| | - Khatuna Minjia
- Research and Practical Center of Interventional Cardioangiology of Sechenov University, Moscow, Russia
| | - Svetlana Glembo
- Research and Practical Center of Interventional Cardioangiology of Sechenov University, Moscow, Russia
| | - Oleg Sukhorukov
- Research and Practical Center of Interventional Cardioangiology of Sechenov University, Moscow, Russia
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2
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Ueda N, Ishibashi K, Noda T, Oka S, Miyazaki Y, Shimamoto K, Wakamiya A, Nakajima K, Kamakura T, Wada M, Inoue Y, Miyamoto K, Nagase S, Aiba T, Kanzaki H, Izumi C, Noguchi T, Kusano K. Implications of ventricular arrhythmia after cardiac resynchronization therapy. Heart Rhythm 2024; 21:163-171. [PMID: 37739199 DOI: 10.1016/j.hrthm.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/02/2023] [Accepted: 09/16/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Conflicting data are available on whether ventricular arrhythmia (VA) or shock therapy increases mortality. Although cardiac resynchronization therapy (CRT) reduces the risk of VA, little is known about the prognostic value of VA among patients with CRT devices. OBJECTIVES The purpose of this study was to evaluate the implications of VA as a prognostic marker for CRT. METHODS We investigated 330 CRT patients within 1 year after CRT device implantation. The primary endpoint was the composite endpoint of all-cause death or hospitalization for heart failure. RESULTS Forty-three patients had VA events. These patients had a significantly higher risk of the primary endpoint, even among CRT responders (P = .009). Fast VA compared to slow VA was associated with an increased risk of the primary endpoint (hazard ratio [HR] 2.14; 95% confidence interval [CI] 1.06-4.34; P = .035). Shock therapy was not associated with a primary endpoint (shock therapy vs antitachycardia pacing: HR 1.49; 95% CI 0.73-3.03; P = .269). The patients with VA had a lower prevalence of response to CRT (23 [53%] vs 202 [70%]; P = .031) and longer left ventricular paced conduction time (174 ± 23 ms vs 143 ± 36 ms; P = .003) than the patients without VA. CONCLUSION VA occurrence within 1 year was related to paced electrical delay and poor response to CRT. VA could be associated with poor prognosis among CRT patients.
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Affiliation(s)
- Nobuhiko Ueda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
| | - Kohei Ishibashi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoshi Oka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yuichiro Miyazaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Keiko Shimamoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Akinori Wakamiya
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kenzaburo Nakajima
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tsukasa Kamakura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Mitsuru Wada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yuko Inoue
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Koji Miyamoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoshi Nagase
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hideaki Kanzaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
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3
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Herweg B, Sharma PS, Cano Ó, Ponnusamy SS, Zanon F, Jastrzebski M, Zou J, Chelu MG, Vernooy K, Whinnett ZI, Nair GM, Molina-Lerma M, Curila K, Zalavadia D, Dye C, Vipparthy SC, Brunetti R, Mumtaz M, Moskal P, Leong AM, van Stipdonk A, George J, Qadeer YK, Kolominsky J, Golian M, Morcos R, Marcantoni L, Subzposh FA, Ellenbogen KA, Vijayaraman P. Arrhythmic Risk in Biventricular Pacing Compared With Left Bundle Branch Area Pacing: Results From the I-CLAS Study. Circulation 2024; 149:379-390. [PMID: 37950738 DOI: 10.1161/circulationaha.123.067465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/02/2023] [Indexed: 11/13/2023]
Abstract
BACKGROUND Left bundle branch area pacing (LBBAP) may be associated with greater improvement in left ventricular ejection fraction and reduction in death or heart failure hospitalization compared with biventricular pacing (BVP) in patients requiring cardiac resynchronization therapy. We sought to compare the occurrence of sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) and new-onset atrial fibrillation (AF) in patients undergoing BVP and LBBAP. METHODS The I-CLAS study (International Collaborative LBBAP Study) included patients with left ventricular ejection fraction ≤35% who underwent BVP or LBBAP for cardiac resynchronization therapy between January 2018 and June 2022 at 15 centers. We performed propensity score-matched analysis of LBBAP and BVP in a 1:1 ratio. We assessed the incidence of VT/VF and new-onset AF among patients with no history of AF. Time to sustained VT/VF and time to new-onset AF was analyzed using the Cox proportional hazards survival model. RESULTS Among 1778 patients undergoing cardiac resynchronization therapy (BVP, 981; LBBAP, 797), there were 1414 propensity score-matched patients (propensity score-matched BVP, 707; propensity score-matched LBBAP, 707). The occurrence of VT/VF was significantly lower with LBBAP compared with BVP (4.2% versus 9.3%; hazard ratio, 0.46 [95% CI, 0.29-0.74]; P<0.001). The incidence of VT storm (>3 episodes in 24 hours) was also significantly lower with LBBAP compared with BVP (0.8% versus 2.5%; P=0.013). Among 299 patients with cardiac resynchronization therapy pacemakers (BVP, 111; LBBAP, 188), VT/VF occurred in 8 patients in the BVP group versus none in the LBBAP group (7.2% versus 0%; P<0.001). In 1194 patients with no history of VT/VF or antiarrhythmic therapy (BVP, 591; LBBAP, 603), the occurrence of VT/VF was significantly lower with LBBAP than with BVP (3.2% versus 7.3%; hazard ratio, 0.46 [95% CI, 0.26-0.81]; P=0.007). Among patients with no history of AF (n=890), the occurrence of new-onset AF >30 s was significantly lower with LBBAP than with BVP (2.8% versus 6.6%; hazard ratio, 0.34 [95% CI, 0.16-0.73]; P=0.008). The incidence of AF lasting >24 hours was also significantly lower with LBBAP than with BVP (0.7% versus 2.9%; P=0.015). CONCLUSIONS LBBAP was associated with a lower incidence of sustained VT/VF and new-onset AF compared with BVP. This difference remained significant after adjustment for differences in baseline characteristics between patients with BVP and LBBAP. Physiological resynchronization by LBBAP may be associated with lower risk of arrhythmias compared with BVP.
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Affiliation(s)
- Bengt Herweg
- University of South Florida Morsani College of Medicine, Tampa (B.H., R.B., M.M.)
| | | | - Óscar Cano
- Hospital Universitari i Politècnic La Fe and Centro de Investigaciones Biomédicas en RED en Enfermedades Cardiovasculares, Valencia, Spain (O.C.)
| | | | - Francesco Zanon
- Santa Maria Della Misericordia Hospital, Rovigo, Italy (F.Z., L.M.)
| | - Marek Jastrzebski
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland (M.J., P.M.)
| | - Jiangang Zou
- The First Affiliated Hospital of Nanjing Medical University, Cardiology, Jiangsu, China (J.Z.)
| | - Mihail G Chelu
- The First Affiliated Hospital of Nanjing Medical University, Cardiology, Jiangsu, China (J.Z.)
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Netherlands (K.V., A.v.S.)
| | - Zachary I Whinnett
- National Heart and Lung Institute, Imperial College London, United Kingdom (Z.I.W., A.M.L.)
| | - Girish M Nair
- University of Ottawa Heart Institute, ON, Canada (G.M.N., M.G.)
| | | | - Karol Curila
- Cardiocenter, Third Faculty of Medicine, Charles University, Prague, Czech Republic (K.C.)
| | | | - Cicely Dye
- Rush University Medical Center, Chicago, IL (P.S.S., C.D., S.C.V.)
| | | | - Ryan Brunetti
- University of South Florida Morsani College of Medicine, Tampa (B.H., R.B., M.M.)
| | - Mishal Mumtaz
- University of South Florida Morsani College of Medicine, Tampa (B.H., R.B., M.M.)
| | - Pawel Moskal
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland (M.J., P.M.)
| | - Andrew M Leong
- National Heart and Lung Institute, Imperial College London, United Kingdom (Z.I.W., A.M.L.)
| | - Antonius van Stipdonk
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Netherlands (K.V., A.v.S.)
| | - Jerin George
- Baylor College of Medicine and Texas Heart Institute, Houston (M.G.C., J.G., Y.K.Q.)
| | - Yusuf K Qadeer
- Baylor College of Medicine and Texas Heart Institute, Houston (M.G.C., J.G., Y.K.Q.)
| | - Jeffrey Kolominsky
- Virginia Commonwealth University Medical Center, Richmond (J.K., K.A.E.)
| | - Mehrdad Golian
- University of Ottawa Heart Institute, ON, Canada (G.M.N., M.G.)
| | - Ramez Morcos
- Geisinger Heart Institute, Wilkes Barre, PA (R.M., F.A.S., P.V.)
| | - Lina Marcantoni
- Santa Maria Della Misericordia Hospital, Rovigo, Italy (F.Z., L.M.)
| | - Faiz A Subzposh
- Geisinger Heart Institute, Wilkes Barre, PA (R.M., F.A.S., P.V.)
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4
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Sapp JL, Sivakumaran S, Redpath CJ, Khan H, Parkash R, Exner DV, Healey JS, Thibault B, Sterns LD, Lam NHN, Manlucu J, Mokhtar A, Sumner G, McKinlay S, Kimber S, Mondesert B, Talajic M, Rouleau J, McCarron CE, Wells G, Tang ASL. Long-Term Outcomes of Resynchronization-Defibrillation for Heart Failure. N Engl J Med 2024; 390:212-220. [PMID: 38231622 DOI: 10.1056/nejmoa2304542] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
BACKGROUND The Resynchronization-Defibrillation for Ambulatory Heart Failure Trial (RAFT) showed a greater benefit with respect to mortality at 5 years among patients who received cardiac-resynchronization therapy (CRT) than among those who received implantable cardioverter-defibrillators (ICDs). However, the effect of CRT on long-term survival is not known. METHODS We randomly assigned patients with New York Heart Association (NYHA) class II or III heart failure, a left ventricular ejection fraction of 30% or less, and an intrinsic QRS duration of 120 msec or more (or a paced QRS duration of 200 msec or more) to receive either an ICD alone or a CRT defibrillator (CRT-D). We assessed long-term outcomes among patients at the eight highest-enrolling participating sites. The primary outcome was death from any cause; the secondary outcome was a composite of death from any cause, heart transplantation, or implantation of a ventricular assist device. RESULTS The trial enrolled 1798 patients, of whom 1050 were included in the long-term survival trial; the median duration of follow-up for the 1050 patients was 7.7 years (interquartile range, 3.9 to 12.8), and the median duration of follow-up for those who survived was 13.9 years (interquartile range, 12.8 to 15.7). Death occurred in 405 of 530 patients (76.4%) assigned to the ICD group and in 370 of 520 patients (71.2%) assigned to the CRT-D group. The time until death appeared to be longer for those assigned to receive a CRT-D than for those assigned to receive an ICD (acceleration factor, 0.80; 95% confidence interval, 0.69 to 0.92; P = 0.002). A secondary-outcome event occurred in 412 patients (77.7%) in the ICD group and in 392 (75.4%) in the CRT-D group. CONCLUSIONS Among patients with a reduced ejection fraction, a widened QRS complex, and NYHA class II or III heart failure, the survival benefit associated with receipt of a CRT-D as compared with ICD appeared to be sustained during a median of nearly 14 years of follow-up. (RAFT ClinicalTrials.gov number, NCT00251251.).
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Affiliation(s)
- John L Sapp
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Soori Sivakumaran
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Calum J Redpath
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Habib Khan
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Ratika Parkash
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Derek V Exner
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Jeff S Healey
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Bernard Thibault
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Laurence D Sterns
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Nhat Hung N Lam
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Jaimie Manlucu
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Ahmed Mokhtar
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Glen Sumner
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Stuart McKinlay
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Shane Kimber
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Blandine Mondesert
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Mario Talajic
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Jean Rouleau
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - C Elizabeth McCarron
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - George Wells
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Anthony S L Tang
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
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5
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Li Y, Lu W, Hu Q, Cheng C, Lin J, Zhou Y, Chen R, Dai Y, Chen K, Zhang S. Comparison of immediate changes of repolarization parameters after left bundle branch area pacing and traditional biventricular pacing in heart failure patients. Chin Med J (Engl) 2023; 136:868-870. [PMID: 36921113 PMCID: PMC10150851 DOI: 10.1097/cm9.0000000000002357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Indexed: 03/17/2023] Open
Affiliation(s)
- Yao Li
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
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6
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Guarracini F, Bonvicini E, Zanon S, Martin M, Casagranda G, Mochen M, Coser A, Quintarelli S, Branzoli S, Mazzone P, Bonmassari R, Marini M. Emergency Management of Electrical Storm: A Practical Overview. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020405. [PMID: 36837606 PMCID: PMC9963509 DOI: 10.3390/medicina59020405] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 02/08/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023]
Abstract
Electrical storm is a medical emergency characterized by ventricular arrythmia recurrence that can lead to hemodynamic instability. The incidence of this clinical condition is rising, mainly in implantable cardioverter defibrillator patients, and its prognosis is often poor. Early acknowledgment, management and treatment have a key role in reducing mortality in the acute phase and improving the quality of life of these patients. In an emergency setting, several measures can be employed. Anti-arrhythmic drugs, based on the underlying disease, are often the first step to control the arrhythmic burden; besides that, new therapeutic strategies have been developed with high efficacy, such as deep sedation, early catheter ablation, neuraxial modulation and mechanical hemodynamic support. The aim of this review is to provide practical indications for the management of electrical storm in acute settings.
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Affiliation(s)
- Fabrizio Guarracini
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy
- Correspondence: ; Tel.: +39-(0)461-903121; Fax: +39-(0)461-903122
| | - Eleonora Bonvicini
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy
- Department of Cardiology, University of Verona, 37126 Verona, Italy
| | - Sofia Zanon
- Department of Cardiology, University of Verona, 37126 Verona, Italy
| | - Marta Martin
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy
| | | | - Marianna Mochen
- Department of Radiology, Santa Chiara Hospital, 38122 Trento, Italy
| | - Alessio Coser
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy
| | | | - Stefano Branzoli
- Cardiac Surgery Unit, Santa Chiara Hospital, 38122 Trento, Italy
- Department of Cardiac Surgery, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Patrizio Mazzone
- Cardiothoracovascular Department, Electrophysiology Unit, Niguarda Hospital, 20162 Milan, Italy
| | | | - Massimiliano Marini
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, 1090 Brussel, Belgium
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7
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Yilmaz D, Egorova AD, Schalij MJ, Spierenburg HAM, Verbunt RAM, van Erven L. The development of a decision aid for shared decision making in the Dutch implantable cardioverter defibrillator patient population: A novel approach to patient education. Front Cardiovasc Med 2022; 9:946404. [PMID: 36312281 PMCID: PMC9606344 DOI: 10.3389/fcvm.2022.946404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Counseling of Implantable Cardioverter-defibrillator (ICD) patients with regard to individual risks and benefits is challenging. An evidence-based decision aid tailored to the needs of Dutch ICD patients is not yet available. The objective of this pilot project was to structurally evaluate the current clinical practice in The Netherlands and the ICD patient experience, in order to develop an online decision aid to facilitate shared decision making in ICD procedures. Methods Between June 2016 and December 2017, a Dutch web-based decision aid was developed according to the Patient Decision Aid Standards (IPDAS) using the RAND-UCLA/multi-stepped Delphi model. Development process consisted of 5 stages in which the Dutch clinical practice was reviewed (stage 1), patients’ needs and their history of decision making was structurally assessed (stages 2A and B) and a modified Delphi consensus process was performed with an expert panel consisting of representatives from different medical fields (stage 3). Results from stages 1–3 were used to design and structure the content of an online-based decision aid (stage 4) which was finally evaluated in a usability testing by patients in stage 5. Results and conclusion This study describes the evidence-based approach to the development of the Dutch ICD decision aid. In our population, levels of shared decision-making experience were low. The ICD decision aid was structurally developed for the Dutch ICD patient population. Our upcoming multicenter stepped wedge clustered randomized trial will further evaluate the ICD decision aid in clinical practice.
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Affiliation(s)
- Dilek Yilmaz
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Martin J. Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | | | | | - Lieselot van Erven
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands,*Correspondence: Lieselot van Erven,
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8
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Sapp JL. Myocardial Scar and Clustered Ventricular Arrhythmias: Imaging Is Part of the Picture. JACC Clin Electrophysiol 2022; 8:967-969. [PMID: 35981801 DOI: 10.1016/j.jacep.2022.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 06/29/2022] [Indexed: 10/15/2022]
Affiliation(s)
- John L Sapp
- Department of Medicine, Dalhousie University and QEII Health Sciences Centre, Halifax, Nova Scotia, Canada.
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9
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Sammani A, van de Leur RR, Henkens MTHM, Meine M, Loh P, Hassink RJ, Oberski DL, Heymans SRB, Doevendans PA, Asselbergs FW, Te Riele ASJM, van Es R. Life-threatening ventricular arrhythmia prediction in patients with dilated cardiomyopathy using explainable electrocardiogram-based deep neural networks. Europace 2022; 24:1645-1654. [PMID: 35762524 PMCID: PMC9559909 DOI: 10.1093/europace/euac054] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 04/10/2022] [Indexed: 11/17/2022] Open
Abstract
Aims While electrocardiogram (ECG) characteristics have been associated with life-threatening ventricular arrhythmias (LTVA) in dilated cardiomyopathy (DCM), they typically rely on human-derived parameters. Deep neural networks (DNNs) can discover complex ECG patterns, but the interpretation is hampered by their ‘black-box’ characteristics. We aimed to detect DCM patients at risk of LTVA using an inherently explainable DNN. Methods and results In this two-phase study, we first developed a variational autoencoder DNN on more than 1 million 12-lead median beat ECGs, compressing the ECG into 21 different factors (F): FactorECG. Next, we used two cohorts with a combined total of 695 DCM patients and entered these factors in a Cox regression for the composite LTVA outcome, which was defined as sudden cardiac arrest, spontaneous sustained ventricular tachycardia, or implantable cardioverter-defibrillator treated ventricular arrhythmia. Most patients were male (n = 442, 64%) with a median age of 54 years [interquartile range (IQR) 44–62], and median left ventricular ejection fraction of 30% (IQR 23–39). A total of 115 patients (16.5%) reached the study outcome. Factors F8 (prolonged PR-interval and P-wave duration, P < 0.005), F15 (reduced P-wave height, P = 0.04), F25 (increased right bundle branch delay, P = 0.02), F27 (P-wave axis P < 0.005), and F32 (reduced QRS-T voltages P = 0.03) were significantly associated with LTVA. Conclusion Inherently explainable DNNs can detect patients at risk of LTVA which is mainly driven by P-wave abnormalities.
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Affiliation(s)
- Arjan Sammani
- Department of Cardiology, University Medical Centre Utrecht, University of Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Rutger R van de Leur
- Department of Cardiology, University Medical Centre Utrecht, University of Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Michiel T H M Henkens
- Department of Cardiology, CARIM, Maastricht University Medical Centre, Maastricht, The Netherlands.,Netherlands Heart Institute (NLHI), Utrecht, The Netherlands
| | - Mathias Meine
- Department of Cardiology, University Medical Centre Utrecht, University of Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Peter Loh
- Department of Cardiology, University Medical Centre Utrecht, University of Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Rutger J Hassink
- Department of Cardiology, University Medical Centre Utrecht, University of Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Daniel L Oberski
- Department of Cardiology, University Medical Centre Utrecht, University of Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.,Department of Methodology and Statistics, Faculty of Social Sciences, Utrecht University and University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Stephane R B Heymans
- Department of Cardiology, CARIM, Maastricht University Medical Centre, Maastricht, The Netherlands.,Netherlands Heart Institute (NLHI), Utrecht, The Netherlands.,Department of Cardiovascular Research, University of Leuven, Leuven, Belgium
| | - Pieter A Doevendans
- Department of Cardiology, University Medical Centre Utrecht, University of Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.,Netherlands Heart Institute (NLHI), Utrecht, The Netherlands.,Central Military Hospital, Utrecht, The Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, University Medical Centre Utrecht, University of Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.,Institute of Cardiovascular Science and Institute of Health Informatics, Faculty of Population Health Sciences, University College London, London, UK
| | - Anneline S J M Te Riele
- Department of Cardiology, University Medical Centre Utrecht, University of Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - René van Es
- Department of Cardiology, University Medical Centre Utrecht, University of Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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10
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2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Translation of the document prepared by the Czech Society of Cardiology. COR ET VASA 2022. [DOI: 10.33678/cor.2022.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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11
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Implantable Cardioverter Defibrillator in Primary and Secondary Prevention of SCD-What We Still Don't Know. J Cardiovasc Dev Dis 2022; 9:jcdd9040120. [PMID: 35448096 PMCID: PMC9028370 DOI: 10.3390/jcdd9040120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/04/2022] [Accepted: 04/14/2022] [Indexed: 12/07/2022] Open
Abstract
Implantable cardioverter defibrillators (ICDs) are the cornerstone of primary and secondary prevention of sudden cardiac death (SCD) all around the globe. In almost 40 years of technological advances and multiple clinical trials, there has been a continuous increase in the implantation rate. The purpose of this review is to highlight the grey areas related to actual ICD recommendations, focusing specifically on the primary prevention of SCD. We will discuss the still-existing controversies strongly reflected in the differences between the international guidelines regarding ICD indication class in non-ischemic cardiomyopathy, and also address the question of early implantation after myocardial infarction in the absence of clear protocols for patients at high risk of life-threatening arrhythmias. Correlating the insufficient data in the literature for 40-day waiting times with the increased risk of SCD in the first month after myocardial infarction, we review the pros and cons of early ICD implantation.
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12
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Chou A, Larson J, Deshmukh A, Cascino TM, Ghannam M, Latchamsetty R, Jongnarangsin K, Oral H, Morady F, Bogun F, Aaronson KD, Pagani FD, Liang JJ. Association Between Biventricular Pacing and Incidence of Ventricular Arrhythmias in the Early Post-Operative Period after Left Ventricular Assist Device Implantation. J Cardiovasc Electrophysiol 2022; 33:1024-1031. [PMID: 35245401 DOI: 10.1111/jce.15437] [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: 11/11/2021] [Revised: 01/13/2022] [Accepted: 02/07/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cardiac resynchronization therapy (CRT) and left ventricular assist devices (LVAD) improve outcomes in heart failure patients. Early ventricular arrhythmias (VA) are common after LVAD and are associated with increased mortality. The association between left ventricular pacing (LVP) with CRT and VAs in the early post-LVAD period remains unclear. METHODS This was a retrospective study of all patients undergoing LVAD implantation from 1/2016 - 12/2019. Patients were divided into those with CRT and active LVP (CRT-LVP) immediately post-LVAD implant versus those without CRT-LVP. ICD electrograms were reviewed and early VAs were defined as sustained VT/VF occurring within 30 days of LVAD implantation. RESULTS Of 186 included patients (mean age 53 years, 75% male, mean BMI 28), 72 had CRT devices, 63 of whom had LV pacing enabled after LVAD implant (CRT-LVP group). Patients with CRT-LVP were more likely to have VA in the early post-operative period (21% vs 4%; p=0.0001). All 9 patients with CRT in whom LVP was disabled had no early VA. Among those with early VA, patients with CRT-LVP were more likely to have monomorphic VT (77% vs 40%; p=0.07). In multiple logistic regression, CRT-LVP pacing remained an independent predictor of early VA after adjustment for history of VA and AF. CONCLUSIONS Patients with CRT-LVP after LVAD implant had a higher incidence of early VA (specifically monomorphic VT). Epicardial LV pacing may be proarrhythmic in the early post-operative period after LVAD. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Francis D Pagani
- Division of Cardiac Surgery, University of Michigan, Ann Arbor, MI
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13
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJ, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM. Grupo de trabajo sobre estimulación cardiaca y terapia de resincronización cardiaca de la Sociedad Europea de Cardiología (ESC). Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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14
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Peichl P, Rafaj A, Kautzner J. Management of ventricular arrhythmias in heart failure: Current perspectives. Heart Rhythm O2 2022; 2:796-806. [PMID: 34988531 PMCID: PMC8710622 DOI: 10.1016/j.hroo.2021.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Congestive heart failure (HF) is a progressive affliction defined as the inability of the heart to sufficiently maintain blood flow. Ventricular arrhythmias (VAs) are common in patients with HF, and conversely, advanced HF promotes the risk of VAs. Management of VA in HF requires a systematic, multimodality approach that comprises optimization of medical therapy and use of implantable cardioverter-defibrillator and/or device combined with cardiac resynchronization therapy. Catheter ablation is one of the most important strategies with the potential to abolish or decrease the number of recurrences of VA in this population. It can be a curative strategy in arrhythmia-induced cardiomyopathy and may even save lives in cases of an electrical storm. Additionally, modulation of the autonomic nervous system and stereotactic radiotherapy have been introduced as novel methods to control refractory VAs. In patients with end-stage HF and refractory VAs, an institution of the mechanical circulatory support device and cardiac transplant may be considered. This review aims to provide an overview of current evidence regarding management strategies of VAs in HF with an emphasis on interventional treatment.
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Affiliation(s)
- Petr Peichl
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Adam Rafaj
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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15
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJS, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM, Leyva F, Linde C, Abdelhamid M, Aboyans V, Arbelo E, Asteggiano R, Barón-Esquivias G, Bauersachs J, Biffi M, Birgersdotter-Green U, Bongiorni MG, Borger MA, Čelutkienė J, Cikes M, Daubert JC, Drossart I, Ellenbogen K, Elliott PM, Fabritz L, Falk V, Fauchier L, Fernández-Avilés F, Foldager D, Gadler F, De Vinuesa PGG, Gorenek B, Guerra JM, Hermann Haugaa K, Hendriks J, Kahan T, Katus HA, Konradi A, Koskinas KC, Law H, Lewis BS, Linker NJ, Løchen ML, Lumens J, Mascherbauer J, Mullens W, Nagy KV, Prescott E, Raatikainen P, Rakisheva A, Reichlin T, Ricci RP, Shlyakhto E, Sitges M, Sousa-Uva M, Sutton R, Suwalski P, Svendsen JH, Touyz RM, Van Gelder IC, Vernooy K, Waltenberger J, Whinnett Z, Witte KK. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Europace 2022; 24:71-164. [PMID: 34455427 DOI: 10.1093/europace/euab232] [Citation(s) in RCA: 111] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Elsokkari I, Tsuji Y, Sapp JL, Nattel S. Recent insights into mechanisms and clinical approaches to electrical storm. Can J Cardiol 2021; 38:439-453. [PMID: 34979281 DOI: 10.1016/j.cjca.2021.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/21/2021] [Accepted: 12/30/2021] [Indexed: 12/14/2022] Open
Abstract
Electrical storm, characterized by repetitive ventricular tachycardia/fibrillation (VT/VF) over a short period, is becoming commoner with widespread use of implantable cardioverter-defibrillator (ICD) therapy. Electrical storm, sometimes called "arrhythmic storm" or "VT-storm", is usually a medical emergency requiring hospitalization and expert management, and significantly affects short- and long-term outcomes. This syndrome typically occurs in patients with underlying structural heart disease (ischemic or non-ischemic cardiomyopathy) or inherited channelopathies. Triggers for electrical storm should be sought but are often unidentifiable. Initial management is dictated by the hemodynamic status, while subsequent management typically involves ICD interrogation and reprogramming to reduce recurrent shocks, identification/management of triggers like electrolyte abnormalities, myocardial ischemia, or decompensated heart failure, and antiarrhythmic-drug therapy or catheter ablation. Sympathetic nervous system activation is central to the initiation and maintenance of arrhythmic storm, so autonomic modulation is a cornerstone of management. Sympathetic inhibition can be achieved with medications (particularly beta-adrenoreceptor blockers), deep sedation, or cardiac sympathetic denervation. More definitive management targets the underlying ventricular arrhythmia substrate to terminate and prevent recurrent arrhythmia. Arrhythmia targeting can be achieved with antiarrhythmic medications, catheter ablation or more novel therapies such as stereotactic radiation therapy that targets the arrhythmic substrate. Mechanistic studies point to adrenergic activation and other direct consequences of ICD-shocks in promoting further arrhythmogenesis and hypocontractility. Here, we review the pathophysiologic mechanisms, clinical features, prognosis, and therapeutic options for electrical storm. We also outline a clinical approach to this challenging and complex condition, along with its mechanistic basis.
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Affiliation(s)
- Ihab Elsokkari
- University of Sydney, Nepean Blue Mountains local health district, Australia
| | - Yukiomi Tsuji
- Department of Physiology of Visceral Function, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - John L Sapp
- Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada.
| | - Stanley Nattel
- Departments of Medicine and Research Center, Montreal Heart Institute and Université de Montréal and Pharmacology and Therapeutics McGill University, Montreal, Quebec, Canada; Institute of Pharmacology, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany; IHU LIYRC Institute, Bordeaux, France.
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Ursaru AM, Petris AO, Costache II, Dan Tesloianu N. Comparable Efficacy in Ischemic and Non-Ischemic ICD Recipients for the Primary Prevention of Sudden Cardiac Death. Biomedicines 2021; 9:biomedicines9111595. [PMID: 34829824 PMCID: PMC8615246 DOI: 10.3390/biomedicines9111595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/27/2021] [Accepted: 10/30/2021] [Indexed: 12/31/2022] Open
Abstract
(1) Background: In patients suffering from heart failure, the main causes of death are either hemodynamic failure, or ventricular arrhythmias. The only tool to significantly reduce arrhythmic sudden death is the implantable cardioverter defibrillator (ICD), but not all patients benefit to the same extent from these devices. (2) Methods: The primary outcome of this single-center study was defined as cardiovascular death in patients with ischemic and non-ischemic heart failure who have benefited from ICD therapy. The secondary outcomes were death from any cause, sudden cardiac death, ICD-related therapies (appropriate antitachycardia pacing or shock therapy for ventricular tachycardia or fibrillation) and recurrences of ventricular tachyarrhythmias. (3) Results: A total of 403 consecutive ICD recipients—symptomatic heart failure patients with ICD for the primary prevention of sudden cardiac death—were included retrospectively: 59% ischemic cardiomyopathy (ICMP) and 41% non-ischemic cardiomyopathy (NICMP) patients. Within a median follow-up period of 36 months, the incidence of cardiovascular mortality was not significantly different in patients with NICMP and ICMP: the primary outcome had occurred in 9 patients (5.4%) in the NICMP group and in 14 patients (5.9%) in the ICMP group (hazard ratio 1; 95% confidence interval (CI) 0.45 to 2.28; p = 0.97). All-cause mortality occurred in 14 of 166 patients (8.4%) in the NICMP group and 18 of 237 patients (7.6%) in the ICMP group. Sudden cardiac death occurred in two patients (1.2%) in the NICMP group and in four patients (1.7%) in the ICMP group (hazard ratio 0.71; 95% CI, 0.13 to 3.88; p = 0.69). The rate of appropriate device therapies was comparable in both groups. (4) Conclusions: In this study, ICD implantation for primary prevention of sudden cardiac death in patients with symptomatic systolic heart failure was associated with similar rates of cardiovascular and all-cause mortality in patients with ischemic heart disease, and in patients with heart failure from other causes. NICMP and ICMP showed comparable rates of recurrent ventricular tachyarrhythmias and appropriate ICD therapies.
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Affiliation(s)
- Andreea Maria Ursaru
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, 700111 Iași, Romania; (A.M.U.); (A.O.P.); (N.D.T.)
| | - Antoniu Octavian Petris
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, 700111 Iași, Romania; (A.M.U.); (A.O.P.); (N.D.T.)
- Department of Cardiology, “Grigore. T. Popa” University of Medicine and Pharmacy, 700111 Iași, Romania
| | - Irina Iuliana Costache
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, 700111 Iași, Romania; (A.M.U.); (A.O.P.); (N.D.T.)
- Department of Cardiology, “Grigore. T. Popa” University of Medicine and Pharmacy, 700111 Iași, Romania
- Correspondence:
| | - Nicolae Dan Tesloianu
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, 700111 Iași, Romania; (A.M.U.); (A.O.P.); (N.D.T.)
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Guckel D, Niemann S, Ditzhaus M, Molatta S, Bergau L, Fink T, Sciacca V, El Hamriti M, Imnadze G, Steinhauer P, Braun M, Khalaph M, Nölker G, Sommer P, Sohns C. Long-Term Efficacy and Impact on Mortality of Remote Magnetic Navigation Guided Catheter Ablation of Ventricular Arrhythmias. J Clin Med 2021; 10:jcm10204695. [PMID: 34682822 PMCID: PMC8540658 DOI: 10.3390/jcm10204695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/06/2021] [Accepted: 10/11/2021] [Indexed: 01/01/2023] Open
Abstract
Remote magnetic navigation (RMN) facilitates ventricular arrhythmia (VA) ablation. This study aimed to evaluate the long-term efficacy of RMN-guided ablation for ventricular tachycardia (VT) and premature ventricular contractions (PVC). A total of 176 consecutive patients (mean age 53.23 ± 17.55 years, 37% female) underwent VA ablation for PVC (132 patients, 75%) or VT (44 patients, 25%). The cohort consisted of 119 patients (68%) with idiopathic VA, 31 (18%) with ischemic (ICM), and 26 (15%) with dilated cardiomyopathy (DCM). VA recurrence was observed in 69 patients (39%, mean age 51.71 ± 19.91 years, 23% female) during a follow-up period of 5.48 years (first quartile 770.50 days, second quartile 1101.50 days, third quartile 1615.50 days). Left ventricular ejection fraction <40% lead to a significantly increased risk for VA (p = 0.031*). Multivariate analyses found DCM to be an independent predictor (IP) for VA recurrence (p < 0.001*, hazard ratio (HR) 3.74, confidence interval (CI) 1.58-8.88). ICM resulted in a lower increase in VA recurrence (p = 0.221, HR 1.49, CI 0.79-2.81). Class I/III/IV antiarrhythmic drug therapy (AADs) was also identified as IP for recurrence (p = 0.030*, HR 2.48, CI 1.11-5.68). A total of 16 patients (9%) died within the observational period. RMN-guided ablation of VA lead to acceptable long-term results. An impaired LV function, DCM, and AADs were associated with a significant risk for VA recurrence. Personalized paths are needed to improve efficacy and outcome.
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Affiliation(s)
- Denise Guckel
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany; (D.G.); (S.N.); (S.M.); (L.B.); (T.F.); (V.S.); (M.E.H.); (G.I.); (M.B.); (M.K.); (G.N.); (P.S.)
| | - Sarah Niemann
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany; (D.G.); (S.N.); (S.M.); (L.B.); (T.F.); (V.S.); (M.E.H.); (G.I.); (M.B.); (M.K.); (G.N.); (P.S.)
| | - Marc Ditzhaus
- Fakultät Statistik, Technische Universität Dortmund, 44227 Dortmund, Germany; (M.D.); (P.S.)
| | - Stephan Molatta
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany; (D.G.); (S.N.); (S.M.); (L.B.); (T.F.); (V.S.); (M.E.H.); (G.I.); (M.B.); (M.K.); (G.N.); (P.S.)
| | - Leonard Bergau
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany; (D.G.); (S.N.); (S.M.); (L.B.); (T.F.); (V.S.); (M.E.H.); (G.I.); (M.B.); (M.K.); (G.N.); (P.S.)
| | - Thomas Fink
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany; (D.G.); (S.N.); (S.M.); (L.B.); (T.F.); (V.S.); (M.E.H.); (G.I.); (M.B.); (M.K.); (G.N.); (P.S.)
| | - Vanessa Sciacca
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany; (D.G.); (S.N.); (S.M.); (L.B.); (T.F.); (V.S.); (M.E.H.); (G.I.); (M.B.); (M.K.); (G.N.); (P.S.)
| | - Mustapha El Hamriti
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany; (D.G.); (S.N.); (S.M.); (L.B.); (T.F.); (V.S.); (M.E.H.); (G.I.); (M.B.); (M.K.); (G.N.); (P.S.)
| | - Guram Imnadze
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany; (D.G.); (S.N.); (S.M.); (L.B.); (T.F.); (V.S.); (M.E.H.); (G.I.); (M.B.); (M.K.); (G.N.); (P.S.)
| | - Philipp Steinhauer
- Fakultät Statistik, Technische Universität Dortmund, 44227 Dortmund, Germany; (M.D.); (P.S.)
| | - Martin Braun
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany; (D.G.); (S.N.); (S.M.); (L.B.); (T.F.); (V.S.); (M.E.H.); (G.I.); (M.B.); (M.K.); (G.N.); (P.S.)
| | - Moneeb Khalaph
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany; (D.G.); (S.N.); (S.M.); (L.B.); (T.F.); (V.S.); (M.E.H.); (G.I.); (M.B.); (M.K.); (G.N.); (P.S.)
| | - Georg Nölker
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany; (D.G.); (S.N.); (S.M.); (L.B.); (T.F.); (V.S.); (M.E.H.); (G.I.); (M.B.); (M.K.); (G.N.); (P.S.)
- Clinic for Internal Medicine II/Cardiology, Christliches Klinikum Unna Mitte, 59423 Unna, Germany
| | - Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany; (D.G.); (S.N.); (S.M.); (L.B.); (T.F.); (V.S.); (M.E.H.); (G.I.); (M.B.); (M.K.); (G.N.); (P.S.)
| | - Christian Sohns
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany; (D.G.); (S.N.); (S.M.); (L.B.); (T.F.); (V.S.); (M.E.H.); (G.I.); (M.B.); (M.K.); (G.N.); (P.S.)
- Correspondence:
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJS, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J 2021; 42:3427-3520. [PMID: 34455430 DOI: 10.1093/eurheartj/ehab364] [Citation(s) in RCA: 778] [Impact Index Per Article: 259.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Abstract
Electrical storm is present when a cluster of ventricular arrhythmias (VAs) occurs within a short time frame. The most widely accepted definition is 3 or more episodes of VA within a 24-h period, although prognostic risk begins to rise when 2 or more events occur within 3months. Electrical storm often presents as a medical emergency in the form of recurrent implantable cardiac defibrillator (ICD) shocks, recurrent syncope in patients with no ICD or low cardiac output symptoms. Management often requires a multimodality approach including ICD management, pharmacologic therapy, catheter ablation and modulations of the autonomic nervous system. In this article, we review the definition, prognosis and management of electrical storm.
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21
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Cardiac resynchronization therapy and ventricular tachyarrhythmia burden. Heart Rhythm 2021; 18:762-769. [PMID: 33440249 DOI: 10.1016/j.hrthm.2020.12.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/17/2020] [Accepted: 12/31/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy-defibrillator (CRT-D) may reduce the incidence of first ventricular tachyarrhythmia (VTA) in patients with heart failure (HF) and left bundle branch block (LBBB). OBJECTIVE The purpose of this study was to assess the effect of CRT-D on VTA burden in LBBB patients. METHODS We included 1281 patients with LBBB from MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy). VTA was defined as any treated or monitored sustained ventricular tachycardia (VT ≥180 bpm) or ventricular fibrillation (VF). Life-threatening VTA was defined as VT ≥200 bpm or VF. VTA recurrence was assessed using the Andersen-Gill model. RESULTS During a mean follow-up of 2.5 years, 964 VTA episodes occurred in 264 patients (21%). The VTA rate per 100 person-years was significantly lower in the CRT-D group compared with the implantable cardioverter-defibrillator (ICD) group (20 vs 34; P <.01). Multivariate analysis demonstrated that CRT-D treatment was associated with a 32% risk reduction for VTA recurrence (hazard ratio 0.68; 95% confidence interval 0.57-0.82; P <.001), 57% risk reduction for recurrent life-threatening VTA, 54% risk reduction for recurrent appropriate ICD shocks, and 25% risk reduction for the combined endpoint of VTA and death. The effect of CRT-D on VTA burden was consistent among all tested subgroups but was more pronounced among patients in New York Heart Association functional class I. Landmark analysis showed that at 2 years, the cumulative probability of death subsequent to year one was highest (16%) among patients who had ≥2 VTA events during their first year. CONCLUSION In patients with LBBB and HF, early intervention with CRT-D reduces mortality, VTA burden, and frequency of multiple appropriate ICD shocks. VTA burden is a powerful predictor of subsequent mortality.
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Quesada A, Arteaga F, Romero-Villafranca R, Perez-Alvarez L, Martinez-Ferrer J, Alzueta-Rodriguez J, Fernández de la Concha J, Martinez JG, Viñolas X, Porres JM, Anguera I, Porro-Fernández R, Quesada-Ocete B, de la Guía-Galipienso F, Palanca V, Jimenez J, Quesada-Ocete J, Sanchis-Gomar F. Sex-Specific Ventricular Arrhythmias and Mortality in Cardiac Resynchronization Therapy Recipients. JACC Clin Electrophysiol 2020; 7:705-715. [PMID: 33358670 DOI: 10.1016/j.jacep.2020.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The study goal was to examine whether there are sex-related differences in the incidence of ventricular arrhythmias and mortality in CRT-defibrillator (CRT-D) recipients. BACKGROUND Few studies have evaluated sex-related benefits of cardiac resynchronization therapy (CRT). Moreover, data on sex-related differences in the occurrence of ventricular tachyarrhythmias in this population are limited. METHODS A multicenter retrospective study was conducted in 460 patients (355 male subjects and 105 female subjects) from the UMBRELLA (Incidence of Arrhythmia in Spanish Population With a Medtronic Implantable Cardiac Defibrillator Implant) national registry. Patients were followed up through remote monitoring after the first implantation of a CRT-D during a median follow-up of 2.2 ± 1.0 years. Sex differences were analyzed in terms of ventricular arrhythmia-treated incidence and death during the follow-up period, with a particular focus on primary prevention patients. RESULTS Baseline New York Heart Association functional class was worse in women compared with that in men (67.0% of women in New York Heart Association functional class III vs. 49.7% of men; p = 0.003), whereas women had less ischemic cardiac disease (20.8% vs. 41.7%; p < 0.001). Female sex was an independent predictor of ventricular arrhythmias (hazard ratio: 0.40; 95% confidence interval: 0.19 to 0.86; p = 0.020), as well as left ventricular ejection fraction and nonischemic cardiomyopathy. Mortality in women was one-half that of men, although events were scarce and without significant differences (2.9% vs. 5.6%; p = 0.25). CONCLUSIONS Women with left bundle branch block and implanted CRT have a lower rate of ventricular tachyarrhythmias than men. All-cause mortality in patients is, at least, similar between female and male subjects.
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Affiliation(s)
- Aurelio Quesada
- Arrhythmia Unit, Cardiology Service, General University Hospital Consortium of Valencia, Valencia, Spain; School of Medicine, Catholic University of Valencia San Vicente Mártir, Valencia, Spain.
| | - Francisco Arteaga
- School of Medicine, Catholic University of Valencia San Vicente Mártir, Valencia, Spain
| | | | - Luisa Perez-Alvarez
- Arrhythmia Unit, Cardiology Service, University Hospital Complex A Coruña, A Coruña, Spain
| | - José Martinez-Ferrer
- Arrhythmia Unit, Cardiology Service, University Hospital of Araba, Vitoria, Álava, Spain
| | | | | | - Juan G Martinez
- Arrhythmia Unit, Cardiology Service, General University Hospital of Alicante, Alicante, Spain
| | - Xavier Viñolas
- Arrhythmia Unit, Cardiology Service, Santa Creu and Sant Pau Hospital, Barcelona, Spain
| | - Jose M Porres
- Arrhythmia Unit, Intensive Care Service, University Hospital of Donostia, San Sebastian, Spain
| | - Ignasi Anguera
- Arrhythmia Unit, Cardiology Service, Bellvitge Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Rosa Porro-Fernández
- Arrhythmia Unit, Cardiology Service, San Pedro de Alcántara Hospital, Cáceres, Spain
| | - Blanca Quesada-Ocete
- Department of Cardiology II/Electrophysiology, Center of Cardiology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | | | - Victor Palanca
- Arrhythmia Unit, Cardiology Service, General University Hospital Consortium of Valencia, Valencia, Spain
| | - Javier Jimenez
- Arrhythmia Unit, Cardiology Service, General University Hospital Consortium of Valencia, Valencia, Spain
| | - Javier Quesada-Ocete
- Arrhythmia Unit, Cardiology Service, General University Hospital Consortium of Valencia, Valencia, Spain; School of Medicine, Catholic University of Valencia San Vicente Mártir, Valencia, Spain
| | - Fabian Sanchis-Gomar
- Department of Physiology, Faculty of Medicine, University of Valencia and INCLIVA Biomedical Research Institute, Valencia, Spain; Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA.
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Elsokkari I, Parkash R, Tang A, Wells G, Doucette S, Yetisir E, Gardner M, Healey JS, Thibault B, Sterns L, Birnie D, Nery P, Sivakumaran S, Essebag V, Dorian P, Sapp J. Mortality Risk Increases With Clustered Ventricular Arrhythmias in Patients With Implantable Cardioverter-Defibrillators. JACC Clin Electrophysiol 2020; 6:327-337. [PMID: 32192684 DOI: 10.1016/j.jacep.2019.11.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/12/2019] [Accepted: 11/14/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study sought to examine the adverse prognosis associated with ventricular arrhythmia clusters that falls outside the current electrical storm definition. BACKGROUND Electrical storm is most frequently defined as a cluster of ≥3 episodes of ventricular arrhythmia (VA) in a 24-h period. This definition has been associated with adverse cardiovascular outcomes and mortality, but the effect of lesser and greater clustering of arrhythmias has not been described. METHODS Among all patients in the Resynchronization in Ambulatory Heart Failure trial, 14,515 implantable cardioverter-defibrillator-detected events with data available were rigorously adjudicated in blinded fashion. Arrhythmia incidence was examined for clustering, defined as 2 or more VA events occurring within 3 months. The prognostic importance of clustering was analyzed by varying the cluster length and number of events used to define a cluster. Mortality rates of groups with clustered arrhythmias were compared to patients with no arrhythmia or with unclustered arrhythmia. RESULTS The trial included 1,764 patients, among whom 465 patients had two or more VA episodes within 3 months, whereas 406 had unclustered arrhythmias. Compared to patients with no arrhythmia, patients experiencing unclustered VA had increased risk of death (hazard ratio [HR]: 1.45; 95% confidence interval [CI]: 1.09 to 1.93; p = 0.011), whereas the risk was even higher in patients with clustered arrhythmia (HR: 2.68; 95% CI: 2.13 to 3.36; p < 0.0001). Mortality risk increased with higher VA burden (number of VAs in a cluster) and shorter cluster length. This was observed in all groups tested, including the cluster with the least VA burden in the longest cluster length tested (2 VA episodes occurring within 3 months) (mortality HR: 2.85; 95% CI: 1.95 to 4.17; p < 0.0001). Although clustered arrhythmias terminated with antitachycardia pacing were associated with increased mortality, clusters terminated with implantable cardioverter-defibrillator shocks were associated with still higher mortality risk. CONCLUSIONS Significant adverse prognostic association of clustered VAs is observable with even 2 VA events within 3 months and increases with higher cluster density.
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Affiliation(s)
- Ihab Elsokkari
- Division of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada.
| | - Ratika Parkash
- Division of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Anthony Tang
- Division of Cardiology, Western University, Ontario, Canada
| | - George Wells
- Cardiovascular Methods Centre, University of Ottawa Heart Institute, Cardiovascular Methods Center, Ottawa, Ontario, Canada
| | - Steve Doucette
- Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Elizabeth Yetisir
- Cardiovascular Methods Centre, University of Ottawa Cardiovascular Methods Centre, Ottawa, Ontario, Canada
| | - Martin Gardner
- Division of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Jeffrey S Healey
- Department of Medicine, Division of Cardiology, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Bernard Thibault
- Department of Medicine, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Laurence Sterns
- Department of Medicine, Division of Cardiology, Royal Jubilee Hospital, Victoria, British Columbia, Canada
| | - David Birnie
- Department of Medicine, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Pablo Nery
- Department of Medicine, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Soori Sivakumaran
- Department of Medicine, Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
| | - Vidal Essebag
- Department of Medicine, Division of Cardiology, McGill University Health Centre and Hopital Sacre Coeur de Montreal, Montreal, Quebec, Canada
| | - Paul Dorian
- Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
| | - John Sapp
- Division of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
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24
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de Waard D, Manlucu J, Gillis AM, Sapp J, Bernick J, Doucette S, Tang A, Wells G, Parkash R. Cardiac Resynchronization in Women: A Substudy of the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial. JACC Clin Electrophysiol 2019; 5:1036-1044. [PMID: 31537332 DOI: 10.1016/j.jacep.2019.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/10/2019] [Accepted: 06/10/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This study sought to evaluate the effect of cardiac resynchronization therapy with defibrillator (CRT-D) as compared with implantable cardioverter-defibrillator (ICD) on mortality, heart failure (HF) hospitalization, and ventricular arrhythmia in women versus men. BACKGROUND CRT-D has demonstrated reduced mortality and HF hospitalizations with greater benefit observed in women compared with men. However, whether CRT-D prevented ventricular arrhythmias in women compared with men was unclear. METHODS The RAFT (Resynchronization-Defibrillation for Ambulatory Heart Failure Trial) study randomized 1,798 patients to an ICD or CRT-D. In this post hoc analysis, women and men were compared by randomized group. By using a multivariable model, the outcomes of death and HF hospitalization and incidence of ventricular arrhythmia were compared between men and women. RESULTS There were 1,490 (83%) men (732, ICD; 758, CRT-D) and 308 (17%) women (172, ICD; 136, CRT-D) included in the analysis. Women with CRT-D had a significantly reduced incidence of death and HF hospitalization compared with men with CRT-D (hazard ratio: 0.52; 95% confidence interval: 0.33 to 0.81; p < 0.001) on multivariable analysis. Women with a primary prevention indication and CRT-D had the lowest rate of ventricular arrhythmia compared with men (hazard ratio: 0.59; 95% confidence interval: 0.39 to 0.91; p = 0.016). CONCLUSIONS Women have improved rates of death and HF hospitalization with CRT-D and were less likely to experience ventricular arrhythmia when compared with men, after adjusting for differences in baseline characteristics over a prolonged follow-up. Whether these improved outcomes reflect inherent sex differences in the underlying myocardial substrate resulting in an enhanced response to CRT-D requires further research.
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Affiliation(s)
| | - Jaimie Manlucu
- London Health Sciences Center, University of Western Ontario, London, Ontario, Canada
| | - Anne M Gillis
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - John Sapp
- Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada
| | - Jordan Bernick
- Ottawa Cardiovascular Research Methods Center, Ottawa, Ontario, Canada
| | | | - Anthony Tang
- London Health Sciences Center, University of Western Ontario, London, Ontario, Canada
| | - George Wells
- Ottawa Cardiovascular Research Methods Center, Ottawa, Ontario, Canada
| | - Ratika Parkash
- Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada.
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Su H, Bao P, Chen KY, Yan J, Xu J, Yu F, Yang DM. Influence of the Right Ventricular Lead Location on Ventricular Arrhythmias in Cardiac Resynchronization Therapy. Chin Med J (Engl) 2018; 131:2402-2409. [PMID: 30334524 PMCID: PMC6202593 DOI: 10.4103/0366-6999.243560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The influence of different right ventricular lead locations on ventricular arrhythmias (VTA) in patients with a cardiac resynchronization therapy (CRT) is not clear. This study aimed to evaluate the influence on VTA in patients with a CRT when right ventricular lead was positioned at the right ventricular middle septum (RVMS) and the right ventricular apical (RVA). Methods: A total of 352 patients implanted with a CRT-defibrillator (CRT-D) between May 2012 and July 2016 in the Department of Cardiology of Anhui Provincial Hospital were included. Two-year clinical and pacemaker follow-up data were collected to evaluate the influence of the right ventricular lead location on VTA. Patients were divided into the RVMS group (n = 155) and the RVA group (n = 197) based on the right ventricular lead position. The VTA were compared between these two groups using a Kaplan-Meier curve and Cox multivariate analysis. Results: When the left ventricular lead location was not considered, RVMS and RVA locations did not affect VTA. However, the subgroup analysis results showed that when the left ventricular lead was positioned at the anterolateral cardiac vein (ALCV), the RVMS group had an increased risk of ventricular arrhythmias and appropriate defibrillation (hazard ratio [HR] = 3.29, P = 0.01 and HR = 4.33, P < 0.01, respectively); when the left ventricular lead was at the posterolateral cardiac vein (PLCV), these risks in the RVMS group decreased (HR = 0.45, P = 0.02 and HR = 0.33, P < 0.01, respectively), and when the left ventricular lead was at the lateral cardiac vein, there was no difference between the two groups. In regard to inappropriate defibrillation, there was no significant difference among all these groups. Conclusions: When the left ventricular lead was positioned at ALCV or PLCV, the right ventricular lead location was associated with VTA and appropriate defibrillation after CRT. Greater distances between leads not only improved cardiac function but also may reduce the risk of VTA.
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Deif B, Ballantyne B, Almehmadi F, Mikhail M, McIntyre WF, Manlucu J, Yee R, Sapp JL, Roberts JD, Healey JS, Leong-Sit P, Tang AS. Cardiac resynchronization is pro-arrhythmic in the absence of reverse ventricular remodelling: a systematic review and meta-analysis. Cardiovasc Res 2018; 114:1435-1444. [PMID: 30010807 DOI: 10.1093/cvr/cvy182] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 09/27/2018] [Indexed: 11/14/2022] Open
Abstract
Aims Cardiac resynchronization therapy (CRT) has been shown to reduce mortality and heart failure (HF) hospitalization but its effects on the rate of ventricular arrhythmias (VAs) appears to be neutral. We hypothesize that CRT with LV epicardial stimulation is inherently pro-arrhythmic and increases VA rates in the absence of reverse ventricular remodelling while conferring an anti-arrhythmic effect in mechanical responders. Methods and results In this systematic review and meta-analysis, we considered retrospective cohort, prospective cohort, and randomized controlled trials comparing VA rates between cardiac resynchronization therapy-defibrillator (CRT-D) non-responders, CRT-D responders and those with implantable cardioverter-defibrillator (ICD) only. Studies were eligible if they defined CRT-D responders using a discrete left ventricular volumetric value as assessed by any imaging modality. Studies were identified through searching electronic databases from their inception to July 2017. We identified 2579 citations, of which 23 full-text articles were eligible for final analysis. Our results demonstrated that CRT-D responders were less likely to experience VA than CRT-D non-responders, relative risk (RR) 0.49 [95% confidence interval (CI) 0.41-0.58, P < 0.01] and also less than patients with ICD only: RR 0.59 (95% CI 0.50-0.69, P < 0.01). However, CRT-D mechanical non-responders had a greater likelihood of VA compared with ICD only, RR 0.76 (95% CI 0.63-0.92, P = 0.004). Conclusion CRT-D non-responders experienced more VA than CRT-D responders and also more than those with ICD only, suggesting that CRT with LV epicardial stimulation may be inherently pro-arrhythmic in the absence of reverse remodelling.
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Affiliation(s)
- Bishoy Deif
- Division of Cardiology, Department of Medicine, Western University, 339 Windermere Road, London, Ontario, Canada
| | - Brennan Ballantyne
- Division of Cardiology, Department of Medicine, Western University, 339 Windermere Road, London, Ontario, Canada
| | - Fahad Almehmadi
- Division of Cardiology, Department of Medicine, Western University, 339 Windermere Road, London, Ontario, Canada
| | - Michael Mikhail
- School of Biomedical Sciences, Department of Graduate Studies, Rowan University, Stratford, New Jersey, USA
| | - William F McIntyre
- Population Health Research Institute & Division of Cardiology, Department of Medicine McMaster University, Hamilton, Canada
| | - Jaimie Manlucu
- Division of Cardiology, Department of Medicine, Western University, 339 Windermere Road, London, Ontario, Canada
| | - Raymond Yee
- Division of Cardiology, Department of Medicine, Western University, 339 Windermere Road, London, Ontario, Canada
| | - John L Sapp
- Department of Medicine, QEII Health Sciences Centre, Dalhousie University, Halifax, Canada
| | - Jason D Roberts
- Division of Cardiology, Department of Medicine, Western University, 339 Windermere Road, London, Ontario, Canada
| | - Jeff S Healey
- Population Health Research Institute & Division of Cardiology, Department of Medicine McMaster University, Hamilton, Canada
| | - Peter Leong-Sit
- Division of Cardiology, Department of Medicine, Western University, 339 Windermere Road, London, Ontario, Canada
| | - Anthony S Tang
- Division of Cardiology, Department of Medicine, Western University, 339 Windermere Road, London, Ontario, Canada
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Nayyar S, Suszko A, Porta-Sanchez A, Dalvi R, Chauhan VS. Reduced T wave alternans in heart failure responders to cardiac resynchronization therapy: Evidence of electrical remodeling. PLoS One 2018; 13:e0199637. [PMID: 29953465 PMCID: PMC6023131 DOI: 10.1371/journal.pone.0199637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 06/11/2018] [Indexed: 01/25/2023] Open
Abstract
Background T-wave alternans (TWA), a marker of electrical instability, can be modulated by cardiac resynchronization therapy (CRT). The relationship between TWA and heart failure response to CRT has not been clearly defined. Methods and results In 40-patients (age 65±11 years, left ventricular ejection-fraction [LVEF] 23±7%), TWA was evaluated prospectively at median of 2 months (baseline) and 8 months (follow-up) post-CRT implant. TWA-magnitude (Valt >0μV, k≥3), its duration (d), and burden (Valt ·d) were quantified in moving 128-beat segments during incremental atrial (AAI, native-TWA) and atrio-biventricular (DDD-CRT) pacing. The immediate and long-term effect of CRT on TWA was examined. Clinical response to CRT was defined as an increase in LVEF of ≥5%. Native-TWA was clinically significant (Valt ≥1.9μV, k≥3) in 68% of subjects at baseline. Compared to native-TWA at baseline, DDD-CRT pacing at baseline and follow-up reduced the number of positive TWA segments, peak-magnitude, longest-duration and peak-burden of TWA (44±5 to 33±5 to 28±4%, p = 0.02 and 0.002; 5.9±0.8 to 4.1±0.7 to 3.8±0.7μV, p = 0.01 and 0.01; 97±9 to 76±8 to 67±8sec, p = 0.004 and <0.001; and 334±65 to 178±58 to 146±54μV.sec, p = 0.01 and 0.004). In addition, the number of positive segments and longest-duration of native-TWA diminished during follow-up (44±5 to 35±6%, p = 0.044; and 97±9 to 81±9sec, p = 0.02). Clinical response to CRT was observed in 71% of patients; the reduction in DDD-CRT paced TWA both at baseline and follow-up was present only in responders (interaction p-values <0.1). Conclusion Long-term CRT reduces the prevalence and magnitude of TWA. This CRT induced beneficial electrical remodeling is a marker of clinical response after CRT.
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Affiliation(s)
- Sachin Nayyar
- Peter Munk Cardiac Center, Division of Cardiology, University Health Network, Toronto, ON, Canada
| | - Adrian Suszko
- Peter Munk Cardiac Center, Division of Cardiology, University Health Network, Toronto, ON, Canada
| | - Andreu Porta-Sanchez
- Peter Munk Cardiac Center, Division of Cardiology, University Health Network, Toronto, ON, Canada
| | - Rupin Dalvi
- Peter Munk Cardiac Center, Division of Cardiology, University Health Network, Toronto, ON, Canada
| | - Vijay S. Chauhan
- Peter Munk Cardiac Center, Division of Cardiology, University Health Network, Toronto, ON, Canada
- * E-mail:
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Abstract
PURPOSE OF REVIEW Ventricular tachycardia occurrence in implantable cardioverter defibrillator (ICD) patients may result in shock delivery and is associated with increased morbidity and mortality. In addition, shocks may have deleterious mechanical and psychological effects. Prevention of ventricular tachycardia (VT) recurrence with the use of antiarrhythmic drugs or catheter ablation may be warranted. Antiarrhythmic drugs are limited by incomplete efficacy and an unfavorable adverse effect profile. Catheter ablation can be effective but acute complications and long-term VT recurrence risk necessitating repeat ablation should be recognized. A shared clinical decision process accounting for patients' cardiac status, comorbidities, and goals of care is often required. RECENT FINDINGS There are four published randomized trials of catheter ablation for sustained monomorphic VT (SMVT) in the setting of ischemic heart disease; there are no randomized studies for non-ischemic ventricular substrates. The most recent trial is the VANISH trial which randomly allocated patients with ICD, prior infarction, and SMVT despite first-line antiarrhythmic drug therapy to catheter ablation or more aggressive antiarrhythmic drug therapy. During 28 months of follow-up, catheter ablation resulted in a 28% relative risk reduction in the composite endpoint of death, VT storm, and appropriate ICD shock (p = 0.04). In a subgroup analysis, patients having VT despite amiodarone had better outcomes with ablation as compared to increasing amiodarone dose or adding mexiletine. There is evidence for the effectiveness of both catheter ablation and antiarrhythmic drug therapy for patients with myocardial infarction, an implantable defibrillator, and VT. If sotalol is ineffective in suppressing VT, either catheter ablation or initiation of amiodarone is a reasonable option. If VT occurs despite amiodarone therapy, there is evidence that catheter ablation is superior to administration of more aggressive antiarrhythmic drug therapy. Early catheter ablation may be appropriate in some clinical situations such as patients presenting with relatively slow VT below ICD detection, electrical storms, hemodynamically stable VT, or in very selected patients with left ventricular assist devices. The optimal first-line suppressive therapy for VT, after ICD implantation and appropriate programming, remains to be determined. Thus far, there has not been a randomized controlled trial to compare catheter ablation to antiarrhythmic drug therapy as a first-line treatment; the VANISH-2 study has been initiated as a pilot to examine this question.
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Affiliation(s)
- Amir AbdelWahab
- QEII Health Sciences Centre, Room 2501 B/F Halifax Infirmary 1796 Summer Street, Halifax, NS, B3H 3A7, Canada
| | - John Sapp
- QEII Health Sciences Centre, Room 2501 B/F Halifax Infirmary 1796 Summer Street, Halifax, NS, B3H 3A7, Canada.
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Abstract
Implantable cardioverter defibrillators (ICDs) reduce the mortality risk associated with recurrent ventricular tachycardia (VT) and can frequently terminate VT episodes painlessly, but do not prevent recurrent episodes. For patients with symptomatic recurrences, frequent asymptomatic recurrences, ICD shocks, or VT storm, most clinicians recommend strategies to suppress VT. The proarrhythmic mortality risk of antiarrhythmic drugs (AADs) may be mitigated by the presence of an ICD, but these medications are limited by high recurrence rates, and unfavorable side effect profiles. Catheter ablation is an alternative or adjunctive option, but is also limited by incomplete efficacy and procedural risk.
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Affiliation(s)
- Ciorsti J MacIntyre
- Dalhousie University, QEII Health Sciences Centre, Room 2501 F Halifax Infirmary, 1796 Summer Street, Halifax, Nova Scotia, Canada B3H 3A7
| | - John L Sapp
- Dalhousie University, QEII Health Sciences Centre, Room 2501 F Halifax Infirmary, 1796 Summer Street, Halifax, Nova Scotia, Canada B3H 3A7.
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