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Zhou S, AbdelWahab A, Wang R, Dang H, Warren JW, Sapp JL. Optimization of a 12-Lead Electrocardiography Subset for Automated Early Left Ventricular Activation Localization Approach Based on Pace-Mapping Technology. Can J Cardiol 2023; 39:1410-1416. [PMID: 37270167 DOI: 10.1016/j.cjca.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/15/2023] [Accepted: 05/25/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND We previously developed an automated approach based on pace mapping to localise early left ventricular (LV) activation origin. To avoid a singular system, we require pacing from at least 2 more known sites than the number of electrocardiography (ECG) leads used. Fewer leads used means fewer pacing sites required. We sought to identify an optimal minimal ECG lead set for the automated approach. METHODS We used 1715 LV endocardial pacing sites to create derivation and testing data sets. The derivation data set, consisting of 1012 known pacing sites pooled from 38 patients, was used to identify an optimal 3-lead set by means of random forest regression (RFR), and a second 3-lead set by means of exhaustive search. The performance of these sets and the calculated Frank leads was compared within the testing data set with 703 pacing sites pooled from 25 patients. RESULTS The RFR yielded III, V1, and V4, whereas the exhaustive search identified leads II, V2 and V6. Comparison of these sets and the calculated Frank leads demonstrated similar performance when using 5 or more known pacing sites. Accuracy improved with additional pacing sites, achieving mean accuracy of < 5 mm, after including up to 9 pacing sites when they were focused on a suspected area of ventricular activation origin (radius < 10 mm). CONCLUSIONS The RFR identified the quasi-orthogonal leads set to localise the source of LV activation, minimizing the training set of pacing sites. Localization accuracy was high with the use of these leads and was not significantly different from using leads identified by exhaustive search or empiric use of Frank leads.
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Affiliation(s)
- Shijie Zhou
- Department of Chemical, Paper, and Biomedical Engineering, College of Engineering and Computing, Miami University, Oxford, Ohio, USA; Department of Electrical and Computer Engineering, College of Engineering and Computing, Miami University, Oxford, Ohio, USA.
| | - Amir AbdelWahab
- Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | | | - Huan Dang
- Department of Electrical and Computer Engineering, College of Engineering and Computing, Miami University, Oxford, Ohio, USA
| | - James W Warren
- Department of Physiology and Biophysics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - John L Sapp
- Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
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Damaty AE, Yahya D, El-Mowafy M, Rizk H, Sapp J, Parkash R, Gardner M, Gray C, AbdelWahab A. Paced P-wave morphology templates to guide atrial tachycardia localization: A derivation and validation study. Pacing Clin Electrophysiol 2023; 46:1019-1031. [PMID: 37402219 DOI: 10.1111/pace.14774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/15/2023] [Accepted: 06/20/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Surface ECG is a useful tool to guide mapping of focal atrial tachycardia (AT). OBJECTIVES We aimed to construct 12-lead ECG templates for P-wave morphology (PWM) during endocardial pacing from different sites in both atria in patients with no apparent structural heart disease (derivation cohort), with the goal of creating a localization algorithm, which could subsequently be validated in a cohort of patients undergoing catheter ablation of focal AT (validation cohort). METHODS We prospectively enrolled consecutive patients who underwent electrophysiology study, had no structural heart disease and no atrial enlargement. Atrial pacing, at twice diastolic threshold, was carried out at different anatomical sites in both atria. Paced PWM and duration were assessed. An algorithm was generated from the constructed templates of each pacing site. The algorithm was applied on a retrospective series of successfully ablated AT patients. Overall and site-specific accuracy were determined. RESULTS Derivation cohort included 65 patients (25 men, age 37 ± 13 years). Atrial pacing was performed in 1025 sites in 61 patients (95%) in RA and in 15 patients (23%) in LA. The validation cohort included 71 patients (28 men, age 52 ± 19 years). AT were right atrial in 66.2%. The algorithm successfully predicted AT origin in 91.5% of patients (100% in LA and 87.2% in RA). It was off by one adjacent segment in the remaining 8.5%. CONCLUSIONS A simple ECG algorithm based on paced PWM templates was highly accurate in localizing site of origin of focal AT in patients with structurally normal hearts.
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Affiliation(s)
- Ahmed El Damaty
- Department of Cardiovascular Medicine, Electrophysiology and Pacing Service, Cairo University, Cairo, Egypt
| | - Dhaifallah Yahya
- Department of Cardiovascular Medicine, Electrophysiology and Pacing Service, Cairo University, Cairo, Egypt
| | - Mahmoud El-Mowafy
- Department of Cardiovascular Medicine, Electrophysiology and Pacing Service, Cairo University, Cairo, Egypt
| | - Hussien Rizk
- Department of Cardiovascular Medicine, Electrophysiology and Pacing Service, Cairo University, Cairo, Egypt
| | - John Sapp
- QE II Health Sciences Center, Division of Cardiology, Heart Rhythm Service, Halifax, Nova Scotia, Canada
| | - Ratika Parkash
- QE II Health Sciences Center, Division of Cardiology, Heart Rhythm Service, Halifax, Nova Scotia, Canada
| | - Martin Gardner
- QE II Health Sciences Center, Division of Cardiology, Heart Rhythm Service, Halifax, Nova Scotia, Canada
| | - Chris Gray
- QE II Health Sciences Center, Division of Cardiology, Heart Rhythm Service, Halifax, Nova Scotia, Canada
| | - Amir AbdelWahab
- Department of Cardiovascular Medicine, Electrophysiology and Pacing Service, Cairo University, Cairo, Egypt
- QE II Health Sciences Center, Division of Cardiology, Heart Rhythm Service, Halifax, Nova Scotia, Canada
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Roberts H, Matheson K, Sapp J, Gardner M, Gray C, AbdelWahab A, Lee D, MacIntyre C, Parkash R. Prevalence and management of electrical lead abnormalities in cardiac implantable electronic device leads. Heart Rhythm O2 2023; 4:417-426. [PMID: 37520017 PMCID: PMC10373148 DOI: 10.1016/j.hroo.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
Background Electrical lead abnormalities (ELAs) can result in device malfunction, leading to significant morbidity in patients with cardiac implantable electronic devices (CIEDs). Objective We sought to determine the prevalence and management of ELAs in patients with CIEDs. Methods This was a retrospective cohort study of patients implanted with a CIED between 2012 and 2019 at a tertiary care center. The primary outcome was ELA defined as increased capture threshold (≥2× implantation value), decreased sensing (≤0.5 implantation value), change in impedance (>50% over 3 months), or nonphysiologic potentials. A secondary outcome of device clinic utilization was also collected. Results There were 2996 unique patients (35% female) included with 4600 leads (57% Abbott, 43% Medtronic). ELAs were observed in 135 (3%) leads, including 124 (92%) Abbott and 10 (7%) Medtronic leads (hazard ratio 9.25, P < .001). Mean follow-up was 4.5 ± 2.2 years. ELAs were associated smaller lead French size, atrial location, and Abbott leads. Lead revision was required in 28% of cases. Patients with lead abnormalities had 38% more in-clinic visits per patient year of follow-up compared with those without (P < .001). Conclusion ELAs were more frequent in certain models, which increased rates of revision and follow-up. Identification of factors that mitigate these abnormalities to improve lead performance are required to improve care for these devices and provide efficient healthcare.
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Affiliation(s)
- Hilary Roberts
- Department of Medicine, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Kara Matheson
- Research Methods Unit, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - John Sapp
- Division of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Martin Gardner
- Division of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Chris Gray
- Division of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Amir AbdelWahab
- Division of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - David Lee
- 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
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Zhou S, Wang R, Seagren A, Emmert N, Warren JW, MacInnis PJ, AbdelWahab A, Sapp JL. Improving localization accuracy for non-invasive automated early left ventricular origin localization approach. Front Physiol 2023; 14:1183280. [PMID: 37435305 PMCID: PMC10330701 DOI: 10.3389/fphys.2023.1183280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/02/2023] [Indexed: 07/13/2023] Open
Abstract
Background: We previously developed a non-invasive approach to localize the site of early left ventricular activation origin in real time using 12-lead ECG, and to project the predicted site onto a generic LV endocardial surface using the smallest angle between two vectors algorithm (SA). Objectives: To improve the localization accuracy of the non-invasive approach by utilizing the K-nearest neighbors algorithm (KNN) to reduce projection errors. Methods: Two datasets were used. Dataset #1 had 1012 LV endocardial pacing sites with known coordinates on the generic LV surface and corresponding ECGs, while dataset #2 included 25 clinically-identified VT exit sites and corresponding ECGs. The non-invasive approach used "population" regression coefficients to predict the target coordinates of a pacing site or VT exit site from the initial 120-m QRS integrals of the pacing site/VT ECG. The predicted site coordinates were then projected onto the generic LV surface using either the KNN or SA projection algorithm. Results: The non-invasive approach using the KNN had a significantly lower mean localization error than the SA in both dataset #1 (9.4 vs. 12.5 mm, p < 0.05) and dataset #2 (7.2 vs. 9.5 mm, p < 0.05). The bootstrap method with 1,000 trials confirmed that using KNN had significantly higher predictive accuracy than using the SA in the bootstrap assessment with the left-out sample (p < 0.05). Conclusion: The KNN significantly reduces the projection error and improves the localization accuracy of the non-invasive approach, which shows promise as a tool to identify the site of origin of ventricular arrhythmia in non-invasive clinical modalities.
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Affiliation(s)
- Shijie Zhou
- The Department of Chemical, Paper and Biomedical Engineering, Miami University, Oxford, OH, United States
- The Department of Computer Science and Software Engineering, Miami University, Oxford, OH, United States
| | | | - Avery Seagren
- The Department of Chemical, Paper and Biomedical Engineering, Miami University, Oxford, OH, United States
| | - Noah Emmert
- The Department of Computer Science and Software Engineering, Miami University, Oxford, OH, United States
| | - James W. Warren
- The Department of Physiology and Biophysics, Dalhousie University, Halifax, NS, Canada
| | - Paul J. MacInnis
- The Department of Physiology and Biophysics, Dalhousie University, Halifax, NS, Canada
| | - Amir AbdelWahab
- Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - John L. Sapp
- Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
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Zhou S, AbdelWahab A, Sapp JL, Sung E, Aronis KN, Warren JW, MacInnis PJ, Shah R, Horáček BM, Berger R, Tandri H, Trayanova NA, Chrispin J. Assessment of an ECG-Based System for Localizing Ventricular Arrhythmias in Patients With Structural Heart Disease. J Am Heart Assoc 2021; 10:e022217. [PMID: 34612085 PMCID: PMC8751877 DOI: 10.1161/jaha.121.022217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background We have previously developed an intraprocedural automatic arrhythmia‐origin localization (AAOL) system to identify idiopathic ventricular arrhythmia origins in real time using a 3‐lead ECG. The objective was to assess the localization accuracy of ventricular tachycardia (VT) exit and premature ventricular contraction (PVC) origin sites in patients with structural heart disease using the AAOL system. Methods and Results In retrospective and prospective case series studies, a total of 42 patients who underwent VT/PVC ablation in the setting of structural heart disease were recruited at 2 different centers. The AAOL system combines 120‐ms QRS integrals of 3 leads (III, V2, V6) with pace mapping to predict VT exit/PVC origin site and projects that site onto the patient‐specific electroanatomic mapping surface. VT exit/PVC origin sites were clinically identified by activation mapping and/or pace mapping. The localization error of the VT exit/PVC origin site was assessed by the distance between the clinically identified site and the estimated site. In the retrospective study of 19 patients with structural heart disease, the AAOL system achieved a mean localization accuracy of 6.5±2.6 mm for 25 induced VTs. In the prospective study with 23 patients, mean localization accuracy was 5.9±2.6 mm for 26 VT exit and PVC origin sites. There was no difference in mean localization error in epicardial sites compared with endocardial sites using the AAOL system (6.0 versus 5.8 mm, P=0.895). Conclusions The AAOL system achieved accurate localization of VT exit/PVC origin sites in patients with structural heart disease; its performance is superior to current systems, and thus, it promises to have potential clinical utility.
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Affiliation(s)
- Shijie Zhou
- Alliance for Cardiovascular Diagnostic and Treatment Innovation Johns Hopkins University Baltimore MD
| | - Amir AbdelWahab
- Department of Medicine Queen Elizabeth II Health Sciences Centre Halifax NS Canada
| | - John L Sapp
- Department of Medicine Queen Elizabeth II Health Sciences Centre Halifax NS Canada.,Department of Physiology and Biophysics Dalhousie University Halifax NS Canada
| | - Eric Sung
- Alliance for Cardiovascular Diagnostic and Treatment Innovation Johns Hopkins University Baltimore MD.,Department of Biomedical Engineering Johns Hopkins University Baltimore MD
| | - Konstantinos N Aronis
- Division of Cardiology Department of Medicine Section of Cardiac Electrophysiology Johns Hopkins Hospital Baltimore MD.,Department of Biomedical Engineering Johns Hopkins University Baltimore MD
| | - James W Warren
- Department of Physiology and Biophysics Dalhousie University Halifax NS Canada
| | - Paul J MacInnis
- Department of Physiology and Biophysics Dalhousie University Halifax NS Canada
| | - Rushil Shah
- Division of Cardiology Department of Medicine Section of Cardiac Electrophysiology Johns Hopkins Hospital Baltimore MD
| | - B Milan Horáček
- School of Biomedical Engineering Dalhousie University Halifax NS Canada
| | - Ronald Berger
- Alliance for Cardiovascular Diagnostic and Treatment Innovation Johns Hopkins University Baltimore MD.,Division of Cardiology Department of Medicine Section of Cardiac Electrophysiology Johns Hopkins Hospital Baltimore MD
| | - Harikrishna Tandri
- Alliance for Cardiovascular Diagnostic and Treatment Innovation Johns Hopkins University Baltimore MD.,Division of Cardiology Department of Medicine Section of Cardiac Electrophysiology Johns Hopkins Hospital Baltimore MD
| | - Natalia A Trayanova
- Alliance for Cardiovascular Diagnostic and Treatment Innovation Johns Hopkins University Baltimore MD.,Department of Biomedical Engineering Johns Hopkins University Baltimore MD
| | - Jonathan Chrispin
- Alliance for Cardiovascular Diagnostic and Treatment Innovation Johns Hopkins University Baltimore MD.,Division of Cardiology Department of Medicine Section of Cardiac Electrophysiology Johns Hopkins Hospital Baltimore MD
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Zhou S, Sung E, Prakosa A, Aronis KN, Chrispin J, Tandri H, AbdelWahab A, Horáček BM, Sapp JL, Trayanova NA. Feasibility study shows concordance between image-based virtual-heart ablation targets and predicted ECG-based arrhythmia exit-sites. Pacing Clin Electrophysiol 2021; 44:432-441. [PMID: 33527422 DOI: 10.1111/pace.14181] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/05/2021] [Accepted: 01/24/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION We recently developed two noninvasive methodologies to help guide VT ablation: population-derived automated VT exit localization (PAVEL) and virtual-heart arrhythmia ablation targeting (VAAT). We hypothesized that while very different in their nature, limitations, and type of ablation targets (substrate-based vs. clinical VT), the image-based VAAT and the ECG-based PAVEL technologies would be spatially concordant in their predictions. OBJECTIVE The objective is to test this hypothesis in ischemic cardiomyopathy patients in a retrospective feasibility study. METHODS Four post-infarct patients who underwent LV VT ablation and had pre-procedural LGE-CMRs were enrolled. Virtual hearts with patient-specific scar and border zone identified potential VTs and ablation targets. Patient-specific PAVEL based on a population-derived statistical method localized VT exit sites onto a patient-specific 238-triangle LV endocardial surface. RESULTS Ten induced VTs were analyzed and 9-exit sites were localized by PAVEL onto the patient-specific LV endocardial surface. All nine predicted VT exit sites were in the scar border zone defined by voltage mapping and spatially correlated with successful clinical lesions. There were 2.3 ± 1.9 VTs per patient in the models. All five VAAT lesions fell within regions ablated clinically. VAAT targets correlated well with 6 PAVEL-predicted VT exit sites. The distance between the center of the predicted VT-exit-site triangle and nearest corresponding VAAT ablation lesion was 10.7 ± 7.3 mm. CONCLUSIONS VAAT targets are concordant with the patient-specific PAVEL-predicted VT exit sites. These findings support investigation into combining these two complementary technologies as a noninvasive, clinical tool for targeting clinically induced VTs and regions likely to harbor potential VTs.
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Affiliation(s)
- Shijie Zhou
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA.,Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland, USA
| | - Eric Sung
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA.,Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland, USA
| | - Adityo Prakosa
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA.,Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland, USA
| | - Konstantinos N Aronis
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA.,Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jonathan Chrispin
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA.,Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland, USA
| | - Harikrishna Tandri
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA.,Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland, USA
| | - Amir AbdelWahab
- Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - B Milan Horáček
- School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada
| | - John L Sapp
- Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Natalia A Trayanova
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA.,Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland, USA
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Weng W, Blanchard C, Reed JL, Matheson K, McIntyre C, Gray C, Sapp JL, Gardner M, AbdelWahab A, Yung J, Parkash R. A virtual platform to deliver ambulatory care for patients with atrial fibrillation. Cardiovascular Digital Health Journal 2021; 2:63-70. [PMID: 35265891 PMCID: PMC8890105 DOI: 10.1016/j.cvdhj.2020.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background There are little data on the use of virtual care for patients with arrhythmia. We evaluated a virtual clinic platform, in conjunction with specialist care, for patients with symptomatic atrial fibrillation (AF). Methods This was a prospective, observational cohort study evaluating an online educational and treatment platform, with a randomized sub-study examining the use of an ambulatory single-lead electrocardiogram heart monitor (AHM). Follow-up was 6 months. The main outcome was patients’ platform use; success was defined as 90% of patients using the platform at least once, and 75% using it at least twice. The primary outcome in the AHM sub-study was Atrial Fibrillation Symptom Severity (AFSS) score. Other outcomes included patient satisfaction questionnaires, quality of life, emergency department visits, and hospitalizations for AF. Results We enrolled 94 patients between July 2018 and May 2019; 83% of patients logged in at least once and 54.3% more than once. Patients who were older, were male, or had new-onset AF were more likely to log in to the platform. Satisfaction scores were high; 70%–94% of patients responded favorably. Quality-of-life scores improved at 3 and 6 months. In the AHM sub-study (n = 71), those who received an AHM had lower AFSS scores (least square mean difference -2.52, 95% CI -4.48 to -0.25, P = .03). There was no difference in emergency department visits or hospitalizations. Conclusion The online platform did not reach our feasibility target but was well received. Allocation of an AHM was associated with improved quality of life. Virtual AF care shows promise and should be evaluated in further research.
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Sapp JA, Gillis AM, AbdelWahab A, Nault I, Nery PB, Healey JS, Raj SR, Lockwood E, Sterns LD, Sears SF, Wells GA, Yee R, Philippon F, Tang A, Parkash R. Remote-only monitoring for patients with cardiac implantable electronic devices: a before-and-after pilot study. CMAJ Open 2021; 9:E53-E61. [PMID: 33495385 PMCID: PMC7843075 DOI: 10.9778/cmajo.20200041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Outcomes for patients with cardiac implantable electronic devices are better when follow-up incorporates remote monitoring technology in addition to in-clinic visits. For patients with implantable devices, we sought to determine the feasibility, safety and associated health care utilization of remote-only follow-up, along with its effects on patients' quality of life and costs. METHODS This multicentre before-and-after pilot study involved patients with new or existing pacemakers or implantable cardioverter defibrillators. The "before" phase of the study spanned the period October 2015 to February 2017; the "after" phase spanned the period October 2016 to February 2018. The exposure was remote-only follow-up in combination with Remote View, a service that facilitates access to device data, allowing device settings to be viewed remotely to facilitate remote programming. Outcomes at 12 months were feasibility (adherence to remote monitoring), safety (rate of adverse events) and health care utilization (remote and in-clinic appointments). We also assessed quality of life, using 3 validated scales, and costs, taking into account both health care system and patient costs. RESULTS A total of 176 patients were enrolled. Adherence (defined as at least 1 successful remote transmission during follow-up) was 87% over a mean follow-up of 11.7 (standard deviation 2.2) months. There was a reduction in in-clinic visits at specialized sites among patients with both implantable defibrillators (26 v. 5, p < 0.001, n = 48) and pacemakers (42 v. 10, p < 0.001, n = 51). There was no significant change in visits to community sites for patients with defibrillators (13 v. 17, p = 0.3, n = 48). The composite rate of death, stroke, cardiovascular hospitalization and device-related hospitalization was 7% (n = 164). No adverse events were linked to the intervention. There was no change in quality-of-life scales between baseline and 12 months. Health care costs were reduced by 31% for patients with defibrillators and by 44% for those with pacemakers. INTERPRETATION This pilot study showed the feasibility of remote-only follow-up, with no increase in adverse clinical outcomes and no effect on quality of life, but with reductions in costs and health care utilization. These results support progression to a larger-scale study of whether superior effectiveness and reduced cost can be achieved, with preservation of safety, through use of remote-only follow-up. TRIAL REGISTRATION ClinicalTrials.gov, no. NCT02585817.
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Affiliation(s)
- John A Sapp
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Anne M Gillis
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Amir AbdelWahab
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Isabelle Nault
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Pablo B Nery
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Jeff S Healey
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Satish R Raj
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Evan Lockwood
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Laurence D Sterns
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Samuel F Sears
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - George A Wells
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Raymond Yee
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - François Philippon
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Anthony Tang
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Ratika Parkash
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont.
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9
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Weng W, Blanchard C, McIntyre C, Gray C, Sapp J, Gardner M, AbdelWahab A, Yung J, Parkash R. AN ONLINE VIRTUAL PLATFORM TO DELIVER OUTPATIENT CARE FOR PATIENTS WITH ATRIAL FIBRILLATION: A PILOT STUDY. Can J Cardiol 2020. [DOI: 10.1016/j.cjca.2020.07.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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10
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Zhou S, AbdelWahab A, Horáček BM, MacInnis PJ, Warren JW, Davis JS, Elsokkari I, Lee DC, MacIntyre CJ, Parkash R, Gray CJ, Gardner MJ, Marcoux C, Choudhury R, Trayanova NA, Sapp JL. Prospective Assessment of an Automated Intraprocedural 12-Lead ECG-Based System for Localization of Early Left Ventricular Activation. Circ Arrhythm Electrophysiol 2020; 13:e008262. [PMID: 32538133 DOI: 10.1161/circep.119.008262] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND To facilitate ablation of ventricular tachycardia (VT), an automated localization system to identify the site of origin of left ventricular activation in real time using the 12-lead ECG was developed. The objective of this study was to prospectively assess its accuracy. METHODS The automated site of origin localization system consists of 3 steps: (1) localization of ventricular segment based on population templates, (2) population-based localization within a segment, and (3) patient-specific site localization. Localization error was assessed by the distance between the known reference site and the estimated site. RESULTS In 19 patients undergoing 21 catheter ablation procedures of scar-related VT, site of origin localization accuracy was estimated using 552 left ventricular endocardial pacing sites pooled together and 25 VT-exit sites identified by contact mapping. For the 25 VT-exit sites, localization error of the population-based localization steps was within 10 mm. Patient-specific site localization achieved accuracy of within 3.5 mm after including up to 11 pacing (training) sites. Using 3 remotes (67.8±17.0 mm from the reference VT-exit site), and then 5 close pacing sites, resulted in localization error of 7.2±4.1 mm for the 25 identified VT-exit sites. In 2 emulated clinical procedure with 2 induced VTs, the site of origin localization system achieved accuracy within 4 mm. CONCLUSIONS In this prospective validation study, the automated localization system achieved estimated accuracy within 10 mm and could thus provide clinical utility.
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Affiliation(s)
- Shijie Zhou
- Department of Biomedical Engineering (S.Z., N.A.T.), Johns Hopkins University, Baltimore, MD.,Alliance for Cardiovascular Diagnostic and Treatment Innovation (S.Z., N.A.T.), Johns Hopkins University, Baltimore, MD.,Heart Rhythm Service, Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S.Z., A.A., J.S.D., I.E., D.C.L., C.J.M., R.P., C.J.G., M.J.G., C.M., R.C., J.L.S.)
| | - Amir AbdelWahab
- Heart Rhythm Service, Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S.Z., A.A., J.S.D., I.E., D.C.L., C.J.M., R.P., C.J.G., M.J.G., C.M., R.C., J.L.S.)
| | - B Milan Horáček
- School of Biomedical Engineering (B.M.H.), Dalhousie University, Halifax, NS, Canada
| | - Paul J MacInnis
- Departments of Physiology and Biophysics (P.J.M., J.W.W., J.L.S.), Dalhousie University, Halifax, NS, Canada
| | - James W Warren
- Departments of Physiology and Biophysics (P.J.M., J.W.W., J.L.S.), Dalhousie University, Halifax, NS, Canada
| | - Jason S Davis
- Heart Rhythm Service, Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S.Z., A.A., J.S.D., I.E., D.C.L., C.J.M., R.P., C.J.G., M.J.G., C.M., R.C., J.L.S.)
| | - Ihab Elsokkari
- Heart Rhythm Service, Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S.Z., A.A., J.S.D., I.E., D.C.L., C.J.M., R.P., C.J.G., M.J.G., C.M., R.C., J.L.S.)
| | - David C Lee
- Heart Rhythm Service, Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S.Z., A.A., J.S.D., I.E., D.C.L., C.J.M., R.P., C.J.G., M.J.G., C.M., R.C., J.L.S.)
| | - Ciorsti J MacIntyre
- Heart Rhythm Service, Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S.Z., A.A., J.S.D., I.E., D.C.L., C.J.M., R.P., C.J.G., M.J.G., C.M., R.C., J.L.S.)
| | - Ratika Parkash
- Heart Rhythm Service, Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S.Z., A.A., J.S.D., I.E., D.C.L., C.J.M., R.P., C.J.G., M.J.G., C.M., R.C., J.L.S.)
| | - Chris J Gray
- Heart Rhythm Service, Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S.Z., A.A., J.S.D., I.E., D.C.L., C.J.M., R.P., C.J.G., M.J.G., C.M., R.C., J.L.S.)
| | - Martin J Gardner
- Heart Rhythm Service, Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S.Z., A.A., J.S.D., I.E., D.C.L., C.J.M., R.P., C.J.G., M.J.G., C.M., R.C., J.L.S.)
| | - Curtis Marcoux
- Heart Rhythm Service, Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S.Z., A.A., J.S.D., I.E., D.C.L., C.J.M., R.P., C.J.G., M.J.G., C.M., R.C., J.L.S.)
| | - Rajin Choudhury
- Heart Rhythm Service, Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S.Z., A.A., J.S.D., I.E., D.C.L., C.J.M., R.P., C.J.G., M.J.G., C.M., R.C., J.L.S.)
| | - Natalia A Trayanova
- Department of Biomedical Engineering (S.Z., N.A.T.), Johns Hopkins University, Baltimore, MD.,Alliance for Cardiovascular Diagnostic and Treatment Innovation (S.Z., N.A.T.), Johns Hopkins University, Baltimore, MD
| | - John L Sapp
- Heart Rhythm Service, Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S.Z., A.A., J.S.D., I.E., D.C.L., C.J.M., R.P., C.J.G., M.J.G., C.M., R.C., J.L.S.).,Departments of Physiology and Biophysics (P.J.M., J.W.W., J.L.S.), Dalhousie University, Halifax, NS, Canada.,Medicine (J.L.S.), Dalhousie University, Halifax, NS, Canada
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Deyell MW, AbdelWahab A, Angaran P, Essebag V, Glover B, Gula LJ, Khoo C, Lane C, Nault I, Nery PB, Rivard L, Slawnych MP, Tulloch HL, Sapp JL. 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Position Statement on the Management of Ventricular Tachycardia and Fibrillation in Patients With Structural Heart Disease. Can J Cardiol 2020; 36:822-836. [DOI: 10.1016/j.cjca.2020.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/29/2020] [Accepted: 04/05/2020] [Indexed: 10/24/2022] Open
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Beca B, Sapp JL, Gardner MJ, Gray C, AbdelWahab A, MacIntyre C, Doucette S, Parkash R. Mortality and Heart Failure After Upgrade to Cardiac Resynchronization Therapy. CJC Open 2020; 1:93-99. [PMID: 32159089 PMCID: PMC7063653 DOI: 10.1016/j.cjco.2019.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 02/13/2019] [Indexed: 11/03/2022] Open
Abstract
Background Cardiac resynchronization therapy (CRT) is effective in treating advanced heart failure (HF), but data describing benefits and long-term outcomes for upgrades from a preexisting device are limited. This study sought to compare long-term outcomes in de novo CRT implants with those eligible for CRT with a prior device. Methods This is a retrospective cohort study using data from a provincial registry (2002-2015). Patients were included if they had mild-moderate HF, left ventricular ejection fraction ≤ 35%, and QRS duration ≥ 130 ms. Patients were classified as de novo CRT or upgraded to CRT from a prior device. Outcomes were mortality and composite mortality and HF hospitalization. Results There were 342 patients included in the study. In a multivariate model, patients in the upgraded cohort (n = 233) had a higher 5-year mortality rate (adjusted hazard ratio, 2.86; 95% confidence interval, 1.59-5.15; P = 0.0005) compared with the de novo cohort (n = 109) and higher composite mortality and HF hospitalization (adjusted hazard ratio, 2.60; 95% confidence interval, 1.54-4.37; P = 0.0003). Conclusions Implantation of de novo CRTs was associated with lower mortality and HF hospitalization compared with upgraded CRTs from preexisting devices. It is unknown whether these differences are due to the timing of CRT implementation or other clinical factors. Further work in this area may be helpful to determine how to improve outcomes for these patients.
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Affiliation(s)
- Bogdan Beca
- Division of Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada
| | - John L Sapp
- Division of Cardiology, Department of Medicine, Queen Elizabeth II Health Centre, Halifax, Nova Scotia, Canada
| | - Martin J Gardner
- Division of Cardiology, Department of Medicine, Queen Elizabeth II Health Centre, Halifax, Nova Scotia, Canada
| | - Christopher Gray
- Division of Cardiology, Department of Medicine, Queen Elizabeth II Health Centre, Halifax, Nova Scotia, Canada
| | - Amir AbdelWahab
- Division of Cardiology, Department of Medicine, Queen Elizabeth II Health Centre, Halifax, Nova Scotia, Canada
| | - Ciorsti MacIntyre
- Division of Cardiology, Department of Medicine, Queen Elizabeth II Health Centre, Halifax, Nova Scotia, Canada
| | - Steve Doucette
- Research Methods Unit, Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ratika Parkash
- Division of Cardiology, Department of Medicine, Queen Elizabeth II Health Centre, Halifax, Nova Scotia, Canada
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Affiliation(s)
| | - Ihab Elsokkari
- Queen Elizabeth II Health Sciences Centre, Heart Rhythm Service, Division of Cardiology, Halifax, Canada (I.E., A.A.)
| | - Amir AbdelWahab
- Queen Elizabeth II Health Sciences Centre, Heart Rhythm Service, Division of Cardiology, Halifax, Canada (I.E., A.A.)
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14
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Zhou S, Sapp JL, Horáček BM, Warren JW, MacInnis PJ, Davis J, Elsokkari I, Choudhury R, Parkash R, Gray C, Gardner M, MacIntyre CJ, AbdelWahab A. Automated intraprocedural localization of origin of ventricular activation using patient-specific computed tomographic imaging. Heart Rhythm 2019; 17:567-575. [PMID: 31669770 DOI: 10.1016/j.hrthm.2019.10.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND To facilitate catheter ablation of ventricular tachycardia (VT), we previously developed an automated method to identify sources of left ventricular (LV) activation in real time using 12-lead electrocardiography (ECG), the accuracy of which depends on acquisition of a complete electroanatomic (EA) map. OBJECTIVE The purpose of this study was to assess the feasibility of using a registered cardiac computed tomogram (CT) rather than an EA map to permit real-time localization and avoid errors introduced by incomplete maps. METHODS Before LV VT ablation, 10 patients underwent CT imaging and 3-dimensional reconstruction of the cardiac surface to create a triangle mesh surface, which was registered to the EA map during the procedure and imported into custom localization software. The software uses QRS integrals from leads III, V2, and V6; derives personalized regression coefficients from pacing at ≥5 sites with known locations; and estimates the location of unknown activation sites on the 3-dimensional patient-specific LV endocardial surface. Localization accuracy was quantified for VT exit sites in millimeters by comparing the calculated against the known locations. RESULTS The VT exit site was identified for 20 VTs using activation and entrainment mapping, supplemented by pace-mapping at the scar margin. The automated localization software achieved incremental accuracy with additional pacing sites and had a mean localization error of 6.9 ± 5.7 mm for the 20 VTs. CONCLUSION Patient-specific CT geometry is feasible for use in real-time automated localization of ventricular activation and may avoid reliance on a complete EA map.
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Affiliation(s)
- Shijie Zhou
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Institute of Computational Medicine, Johns Hopkins University, Baltimore, Maryland
| | - John L Sapp
- Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Canada; Department of Physiology and Biophysics, Dalhousie University, Halifax, Canada.
| | - B Milan Horáček
- School of Biomedical Engineering, Dalhousie University, Halifax, Canada
| | - James W Warren
- Department of Physiology and Biophysics, Dalhousie University, Halifax, Canada
| | - Paul J MacInnis
- Department of Physiology and Biophysics, Dalhousie University, Halifax, Canada
| | - Jason Davis
- Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Ihab Elsokkari
- Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Rajin Choudhury
- Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Ratika Parkash
- Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Chris Gray
- Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Martin Gardner
- Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Ciorsti J MacIntyre
- Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Amir AbdelWahab
- Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Canada
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Zhou S, Sapp J, Horacek B, Davis J, Parkash R, Gray C, Gardner M, MacIntyre C, AbdelWahab A. AUTOMATED LOCALIZATION SYSTEM FOR LOCALIZATION OF VENTRICULAR ACTIVATION ORIGIN BASED PATIENT-SPECIFIC CT IMAGING. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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16
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AbdelWahab A, Stevenson W, Tedrow U, Pellegrini C, MacIntyre C, Parkash R, Gray C, Gardner M, Sapp J. INFUSION NEEDLE RADIOFREQUENCY ABLATION FOR TREATMENT OF REFRACTORY VENTRICULAR ARRHYTHMIAS IN NON-ISCHEMIC CARDIOMYOPATHY PATIENTS: A CASE-CONTROL STUDY. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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17
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MacIntyre C, Gray C, AbdelWahab A, Parkash R, Sapp J, Gardner M. IMPLANTABLE CARDIOVERTER DEFIBRILLATOR USE IN INHERITED HEART DISEASES: PROPHYLACTIC VERSUS SECONDARY INDICATIONS. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Stevenson WG, Tedrow UB, Reddy V, AbdelWahab A, Dukkipati S, John RM, Fujii A, Schaeffer B, Tanigawa S, Elsokkari I, Koruth J, Nakamura T, Naniwadekar A, Ghidoli D, Pellegrini C, Sapp JL. Infusion Needle Radiofrequency Ablation for Treatment of Refractory Ventricular Arrhythmias. J Am Coll Cardiol 2019; 73:1413-1425. [DOI: 10.1016/j.jacc.2018.12.070] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 12/11/2018] [Accepted: 12/13/2018] [Indexed: 10/27/2022]
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Zhou S, AbdelWahab A, Sapp JL, Warren JW, Horáček BM. Localization of Ventricular Activation Origin from the 12-Lead ECG: A Comparison of Linear Regression with Non-Linear Methods of Machine Learning. Ann Biomed Eng 2018; 47:403-412. [PMID: 30465152 DOI: 10.1007/s10439-018-02168-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/15/2018] [Indexed: 10/27/2022]
Abstract
We have previously developed an automated localization method based on multiple linear regression (MLR) model to estimate the activation origin on a generic left-ventricular (LV) endocardial surface in real time from the 12-lead ECG. The present study sought to investigate whether machine learning-namely, random-forest regression (RFR) and support-vector regression (SVR)-can improve the localization accuracy compared to MLR. For 38 patients the 12-lead ECG was acquired during LV endocardial pacing at 1012 sites with known coordinates exported from an electroanatomic mapping system; each pacing site was then registered to a generic LV endocardial surface subdivided into 16 segments tessellated into 238 triangles. ECGs were reduced to one variable per lead, consisting of 120-ms time integral of the QRS. To compare three regression models, the entire dataset ([Formula: see text]) was partitioned at random into a design set with 80% and a test set with the remaining 20% of the entire set, and the localization error-measured as geodesic distance on the generic LV surface-was assessed. Bootstrap method with replacement, using 1000 resampling trials, estimated each model's error distribution for the left-out sample ([Formula: see text]). In the design set ([Formula: see text]), the mean accuracy was 8.8, 12.1, and 12.9 mm, respectively for SVR, RVR and MLR. In the test set ([Formula: see text]), the mean value of the localization error in the SVR model was consistently lower than the other two models, both in comparison with the MLR (11.4 vs. 12.5 mm), and with the RFR (11.4 vs. 12.0 mm); the RFR model was also better than the MLR model for estimating localization accuracy (12.0 vs. 12.5 mm). The bootstrap method with 1,000 trials confirmed that the SVR and RFR models had significantly higher predictive accurate than the MLR in the bootstrap assessment with the left-out sample (SVR vs. MLR ([Formula: see text]), RFR vs. MLR ([Formula: see text])). The performance comparison of regression models showed that a modest improvement in localization accuracy can be achieved by SVR and RFR models, in comparison with MLR. The "population" coefficients generated by the optimized SVR model from our dataset are superior to the previously-derived "population" coefficients generated by the MLR model and can supersede them to improve the localization of ventricular activation on the generic LV endocardial surface.
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Affiliation(s)
- Shijie Zhou
- School of Biomedical Engineering, Dalhousie University, Dentistry Building, 5981 University Avenue, PO BOX 15000, Halifax, NS, B3H 4R2, Canada.
| | - Amir AbdelWahab
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - John L Sapp
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - James W Warren
- Department of Physiology and Biophysics, Dalhousie University, Halifax, NS, Canada
| | - B Milan Horáček
- School of Biomedical Engineering, Dalhousie University, Dentistry Building, 5981 University Avenue, PO BOX 15000, Halifax, NS, B3H 4R2, Canada
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Zhou S, Sapp JL, AbdelWahab A, Šťovíček P, Horáček BM. Localization of ventricular activation origin using patient-specific geometry: Preliminary results. J Cardiovasc Electrophysiol 2018; 29:979-986. [PMID: 29702740 DOI: 10.1111/jce.13622] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 04/13/2017] [Accepted: 04/17/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Catheter ablation of ventricular tachycardia (VT) may include induction of VT and localization of VT-exit site. Our aim was to assess localization performance of a novel statistical pace-mapping method and compare it with performance of an electrocardiographic inverse solution. METHODS Seven patients undergoing ablation of VT (4 with epicardial, 3 with endocardial exit) aided by electroanatomic mapping underwent intraprocedural 120-lead body-surface potential mapping (BSPM). Two approaches to localization of activation origin were tested: (1) A statistical method, based on multiple linear regression (MLR), which required only the conventional 12-lead ECG for a sufficient number of pacing sites with known origin together with patient-specific geometry of the endocardial/epicardial surface obtained by electroanatomic mapping; and (2) a classical deterministic inverse solution for recovering heart-surface potentials, which required BSPM and patient-specific geometry of the heart and torso obtained via computed tomography (CT). RESULTS For the MLR method, at least 10-15 pacing sites with known coordinates, together with their corresponding 12-lead ECGs, were required to derive reliable patient-specific regression equations, which then enabled accurate localization of ventricular activation with unknown origin. For 4 patients who underwent epicardial mapping, the median of localization error for the MLR was significantly lower than that for the inverse solution (10.6 vs. 27.3 mm, P = 0.034); a similar result held for 3 patients who underwent endocardial mapping (7.7 vs. 17.1 mm, P = 0.017). The pooled localization error for all epicardial and endocardial sites was also significantly smaller for the MLR compared with the inverse solution (P = 0.005). CONCLUSIONS The novel pace-mapping approach to localizing the origin of ventricular activation offers an easily implementable supplement and/or alternative to the preprocedure inverse solution; its simplicity makes it suitable for real-time applications during clinical catheter-ablation procedures.
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Affiliation(s)
- Shijie Zhou
- School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada
| | - John L Sapp
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Amir AbdelWahab
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Petr Šťovíček
- General University Hospital, Charles University, Prague, Czech Republic
| | - B Milan Horáček
- School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada
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Fadahunsi O, Elsokkari I, Choudhury R, AbdelWahab A. IRREGULAR NARROW COMPLEX TACHYCARDIA MISDIAGNOSED AS ATRIAL FIBRILLATION. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)33126-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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AbdelWahab A, Gardner M, Parkash R, Gray C, Sapp J. Ventricular tachycardia ablation in arrhythmogenic right ventricular cardiomyopathy patients with TMEM43 gene mutations. J Cardiovasc Electrophysiol 2017; 29:90-97. [PMID: 28960618 DOI: 10.1111/jce.13353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 09/05/2017] [Accepted: 09/18/2017] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Catheter ablation of VT in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) is often challenging, frequently requiring multiple or epicardial ablation procedures; TMEM43 gene mutations typically cause aggressive disease. We sought to compare VT ablation outcomes for ARVC patients with and without TMEM43 mutations. METHODS Patients with prior ablation for ARVC-related VT were reviewed. Demographic, procedural, and follow-up data were reviewed retrospectively. Patients with confirmed TMEM43 gene mutations were compared to those with other known mutations or who had no known mutations. RESULTS Thirteen patients (10 male, mean age 49 ± 14 years) underwent 29 ablation procedures (median 2 procedures/patient, range 1-6) with a median of 4 targeted VTs/patient (range 1-9). They were followed for a mean duration of 7.3 ± 4.2 years. Gene mutations included TMEM43 (n = 5), PKP2 (n = 2), DSG2 (n = 2), unidentifiable (n = 4). TMEM patients showed more biventricular involvement compared to non-TMEM patients (80% vs. 12.5%, P = 0.032), more inducible VTs during their ablation procedures (mean VTs/patient: 5.8 ± 3 vs. 2.6 ± 1, P = 0.021). Acute and long-term procedural outcomes did not show a significant difference between the two groups, however TMEM patients had worse composite endpoint of death or transplantation (60% vs. 0, P = 0.035; log-rank P = 0.013). CONCLUSIONS TMEM43 mutation patients were more likely to have biventricular arrhythmogenic substrate and more inducible VTs at EP study. Despite comparable acute VT ablation outcomes, long-term prognosis is unfavorable.
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Affiliation(s)
- Amir AbdelWahab
- Heart Rhythm Service, Cardiology Division, QE II Health Sciences Centre, Nova Scotia Health Authority and Dalhousie University, Halifax, NS, Canada
| | - Martin Gardner
- Heart Rhythm Service, Cardiology Division, QE II Health Sciences Centre, Nova Scotia Health Authority and Dalhousie University, Halifax, NS, Canada
| | - Ratika Parkash
- Heart Rhythm Service, Cardiology Division, QE II Health Sciences Centre, Nova Scotia Health Authority and Dalhousie University, Halifax, NS, Canada
| | - Christopher Gray
- Heart Rhythm Service, Cardiology Division, QE II Health Sciences Centre, Nova Scotia Health Authority and Dalhousie University, Halifax, NS, Canada
| | - John Sapp
- Heart Rhythm Service, Cardiology Division, QE II Health Sciences Centre, Nova Scotia Health Authority and Dalhousie University, Halifax, NS, Canada
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AbdelWahab A, Yahya D, Sapp J, Rizk H, Parkash R, Gardner M, Gray C, El-Damaty A. VALIDATION OF PACED P-WAVE MORPHOLOGY TEMPLATES TO GUIDE ATRIAL TACHYCARDIA LOCALIZATION. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Elsokkari I, AbdelWahab A, Stevenson W, Parkash R, Gardner M, Gray C, Macintyre C, Sapp J. ENDOCARDIAL ELECTROGRAM MORPHOLOGY TO PREDICT INTRAMYOCARDIAL SUBSTRATE RESULTS FROM NEEDLE VT ABLATION. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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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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AbdelWahab A, Yahya D, Sapp J, Rizk H, Parkash R, Gardner M, Gray C, El-Damaty A. P476Validation of paced P-wave morphology templates to guide atrial tachycardia localization. Europace 2017. [DOI: 10.1093/ehjci/eux141.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Elsokkari I, AbdelWahab A, Stevenson W, Parkash R, Gardner M, Gray C, Macintyre C, Sapp J. Endocardial Electrogram Morphology to Predict Myocardial Substrate Results from Needle VT Ablation. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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MacIntyre C, Sapp J, AbdelWahab A, Brownell B, Gray C, Gardner M, Parkash R. THE EFFECT OF SHOCK BURDEN ON HEART FAILURE AND MORTALITY. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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AbdelWahab A, Stevenson W, Thompson K, Parkash R, Gray C, Gardner M, Sapp J. Intramural Ventricular Recording and Pacing in Patients With Refractory Ventricular Tachycardia. Circ Arrhythm Electrophysiol 2015; 8:1181-8. [DOI: 10.1161/circep.115.002940] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 06/26/2015] [Indexed: 01/09/2023]
Abstract
Background—
Ablation of ventricular arrhythmias (VA) can be limited by intramural substrate not amenable to endocardial or epicardial ablation. Feasibility of irrigated needle ablation has been shown, but optimal means of identifying targets is not clear. We analyzed intramural needle electrograms in relation to endocardial electrograms.
Methods and Results—
Eight sequential patients (mean age, 56 years) who had failed 1 to 4 prior ablations underwent irrigated needle ablation were included. At selected sites, the needle was advanced into the myocardium. Bipolar and unipolar electrograms from the needle and catheter tip were analyzed. The needle was deployed at 75 sites with suspected intramural substrate among 2309 mapping sites. Intramural bipolar electrogram amplitude and duration correlated closely with endocardial electrograms, but were greater in amplitude and duration (1.5±1.4 versus 0.6±0.5 mV and 131±66 versus 112±51 ms;
P
=0.001 for both). During sinus rhythm intramural late potentials tended to be more common than endocardial late potentials (53.6% versus 35.7%;
P
=0.12). Intramural electrograms during VA preceded endocardial electrograms (−29±34 versus −15±21 ms;
P
=0.001). Irrigated needle ablation terminated VA at 12 of 28 sites with ablation during VA. Termination site needle electrograms tended to be earlier than nontermination sites (−54±37 versus −36±33 ms pre-QRS;
P
=0.15). Pacemapping from the needle at 19 sites matched the VA at 18 and showed stimulus to QRS of 60±51 ms.
Conclusions—
Recordings from intramural needle may be useful for selecting ablation targets during ventricular tachycardia and for substrate mapping. Further study is needed to develop methods to guide selection of optimal sites for needle deployment and ablation.
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Affiliation(s)
- Amir AbdelWahab
- From the Heart Rhythm Service, Department of Medicine, Division of Cardiology, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada (A.A., R.P., C.G., M.G., J.S.); Electrophysiology and Pacing Service, Department of Cardiovascular Medicine, Cairo University, Cairo, Egypt (A.A.); Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (W.S.); and Research Methods Unit, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada (K.T.)
| | - William Stevenson
- From the Heart Rhythm Service, Department of Medicine, Division of Cardiology, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada (A.A., R.P., C.G., M.G., J.S.); Electrophysiology and Pacing Service, Department of Cardiovascular Medicine, Cairo University, Cairo, Egypt (A.A.); Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (W.S.); and Research Methods Unit, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada (K.T.)
| | - Kara Thompson
- From the Heart Rhythm Service, Department of Medicine, Division of Cardiology, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada (A.A., R.P., C.G., M.G., J.S.); Electrophysiology and Pacing Service, Department of Cardiovascular Medicine, Cairo University, Cairo, Egypt (A.A.); Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (W.S.); and Research Methods Unit, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada (K.T.)
| | - Ratika Parkash
- From the Heart Rhythm Service, Department of Medicine, Division of Cardiology, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada (A.A., R.P., C.G., M.G., J.S.); Electrophysiology and Pacing Service, Department of Cardiovascular Medicine, Cairo University, Cairo, Egypt (A.A.); Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (W.S.); and Research Methods Unit, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada (K.T.)
| | - Christopher Gray
- From the Heart Rhythm Service, Department of Medicine, Division of Cardiology, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada (A.A., R.P., C.G., M.G., J.S.); Electrophysiology and Pacing Service, Department of Cardiovascular Medicine, Cairo University, Cairo, Egypt (A.A.); Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (W.S.); and Research Methods Unit, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada (K.T.)
| | - Martin Gardner
- From the Heart Rhythm Service, Department of Medicine, Division of Cardiology, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada (A.A., R.P., C.G., M.G., J.S.); Electrophysiology and Pacing Service, Department of Cardiovascular Medicine, Cairo University, Cairo, Egypt (A.A.); Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (W.S.); and Research Methods Unit, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada (K.T.)
| | - John Sapp
- From the Heart Rhythm Service, Department of Medicine, Division of Cardiology, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada (A.A., R.P., C.G., M.G., J.S.); Electrophysiology and Pacing Service, Department of Cardiovascular Medicine, Cairo University, Cairo, Egypt (A.A.); Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (W.S.); and Research Methods Unit, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada (K.T.)
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Gouda S, AbdelWahab A, Salem M, AbdelHamid M. Discrepancy between MRI and echocardiography in assessing functional left ventricular parameters and scar characteristics in patients with chronic ischemic cardiomyopathy. Egypt Heart J 2015. [DOI: 10.1016/j.ehj.2014.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Ragab AM, AbdelWahab A, Yazeed Y, El Naggar W. CRT-305 ST Elevation Morphology and Site of Early Repolarization Pattern in Patients with False Tendons. JACC Cardiovasc Interv 2014. [DOI: 10.1016/j.jcin.2014.01.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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