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Chen L, Li H, Liu X, Zhang N, Wang K, Shi A, Gao H, Akdis D, Saguner AM, Xu X, Osto E, Van de Veen W, Li G, Bayés-Genís A, Duru F, Song J, Li X, Hu S. PBX/Knotted 1 homeobox-2 (PKNOX2) is a novel regulator of myocardial fibrosis. Signal Transduct Target Ther 2024; 9:94. [PMID: 38644381 PMCID: PMC11033280 DOI: 10.1038/s41392-024-01804-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 02/08/2024] [Accepted: 03/13/2024] [Indexed: 04/23/2024] Open
Abstract
Much effort has been made to uncover the cellular heterogeneities of human hearts by single-nucleus RNA sequencing. However, the cardiac transcriptional regulation networks have not been systematically described because of the limitations in detecting transcription factors. In this study, we optimized a pipeline for isolating nuclei and conducting single-nucleus RNA sequencing targeted to detect a higher number of cell signal genes and an optimal number of transcription factors. With this unbiased protocol, we characterized the cellular composition of healthy human hearts and investigated the transcriptional regulation networks involved in determining the cellular identities and functions of the main cardiac cell subtypes. Particularly in fibroblasts, a novel regulator, PKNOX2, was identified as being associated with physiological fibroblast activation in healthy hearts. To validate the roles of these transcription factors in maintaining homeostasis, we used single-nucleus RNA-sequencing analysis of transplanted failing hearts focusing on fibroblast remodelling. The trajectory analysis suggested that PKNOX2 was abnormally decreased from fibroblast activation to pathological myofibroblast formation. Both gain- and loss-of-function in vitro experiments demonstrated the inhibitory role of PKNOX2 in pathological fibrosis remodelling. Moreover, fibroblast-specific overexpression and knockout of PKNOX2 in a heart failure mouse model induced by transverse aortic constriction surgery significantly improved and aggravated myocardial fibrosis, respectively. In summary, this study established a high-quality pipeline for single-nucleus RNA-sequencing analysis of heart muscle. With this optimized protocol, we described the transcriptional regulation networks of the main cardiac cell subtypes and identified PKNOX2 as a novel regulator in suppressing fibrosis and a potential therapeutic target for future translational studies.
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Affiliation(s)
- Liang Chen
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
| | - Haotong Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
| | - Xiaorui Liu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
| | - Ningning Zhang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
| | - Kui Wang
- School of Statistics and Data Science, Nankai University, Tianjin, China
| | - Anteng Shi
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
| | - Hang Gao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
| | - Deniz Akdis
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Xinjie Xu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
| | - Elena Osto
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Institute for Clinical Chemistry, University Hospital Zurich and University of Zürich, Zurich, Switzerland
| | - Willem Van de Veen
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Guangyu Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
| | - Antoni Bayés-Genís
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, CIBERCV, Spain
| | - Firat Duru
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Jiangping Song
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China.
| | - Xiangjie Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China.
| | - Shengshou Hu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China.
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Schlatzer C, Berg J, Duru F, Brunckhorst C, Saguner AM, Haegeli LM. Real World Data from Catheter Ablation of Ventricular Tachycardias and Premature Ventricular Complexes in a Tertiary Care Center. J Clin Med 2024; 13:2310. [PMID: 38673583 DOI: 10.3390/jcm13082310] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/01/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Catheter ablation in patients with ventricular arrhythmias (VA), such as ventricular tachycardias (VT) or frequent premature ventricular complexes (PVC), is increasingly considered an effective and safe therapy when performed in experienced centers. This study sought to determine acute success rates and complication rates of ablation procedures for patients with VA in a Swiss tertiary care center. Methods: All patients who underwent ablation therapy for VT and PVC at the University Heart Center in Zurich, Switzerland, between March 2012 and April 2017 were included in this analysis. Results: A total of 120 patients underwent catheter ablation for VT and PVC (69 and 51, respectively). Seventy percent of patients were male, and the mean age was 55.3 years. The most common indication for ablation was high PVC burden (47.5%), followed by paroxysmal VT (38.3%), ICD shocks (23.3%), incessant VT (12.5%), electrical storm (7.5%), and syncope (3.3%). Acute success rates for VT and PVC ablations were 94.2% and 92.2%, respectively. Rates for complications (including major and minor) for VT and PVC were 10.1% and 7.8%, respectively. Complications occurred only in patients with structural heart disease; no complications were noted in structurally normal hearts. Conclusions: Our results suggest that catheter ablation for VT and PVC has high acute success rates with a reasonable risk for complications in the setting of tertiary care centers, comparable to those reported in other studies.
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Affiliation(s)
| | - Jan Berg
- University Hospital of Zurich, 8091 Zurich, Switzerland
- Department of Cardiology, Medical University Department, Kantonsspital Aarau Tellstrasse 25, 5001 Aarau, Switzerland
| | - Firat Duru
- University Hospital of Zurich, 8091 Zurich, Switzerland
| | | | | | - Laurent M Haegeli
- University Hospital of Zurich, 8091 Zurich, Switzerland
- Department of Cardiology, Medical University Department, Kantonsspital Aarau Tellstrasse 25, 5001 Aarau, Switzerland
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3
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Sazgary L, Samara ET, Stüssi A, Saltybaeva N, Guckenberger M, Ruschitzka F, Wolber T, Molitor N, Hofer D, Guan F, Suna G, Hermes-Laufer J, Breitenstein A, Brunckhorst CB, Duru F, Saguner AM. The Impact of Clinical Radiation Audits on Patient Radiation Exposure in Cardiac Implantable Electronic Device Procedures. Heart Rhythm 2024:S1547-5271(24)02387-7. [PMID: 38636928 DOI: 10.1016/j.hrthm.2024.04.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 04/20/2024]
Affiliation(s)
- Lorraine Sazgary
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Anja Stüssi
- Radiation Protection Unit, University Hospital Zurich, Zurich, Switzerland
| | - Natalia Saltybaeva
- Radiation Protection Unit, University Hospital Zurich, Zurich, Switzerland
| | | | - Frank Ruschitzka
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Wolber
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Nadine Molitor
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Daniel Hofer
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Fu Guan
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Gonca Suna
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | | | | | | | - Firat Duru
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland; Center for Translational and Experimental Cardiology (CTEC), University of Zurich, Zurich, Switzerland; Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland; Center for Translational and Experimental Cardiology (CTEC), University of Zurich, Zurich, Switzerland.
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Pouymayou B, Perez-Haas Y, Allemann F, Saguner AM, Andratschke N, Guckenberger M, Tanadini-Lang S, Wilke L. Characterization of spatial integrity with active and passive implants in a low-field magnetic resonance linear accelerator scanner. Phys Imaging Radiat Oncol 2024; 30:100576. [PMID: 38644933 PMCID: PMC11031795 DOI: 10.1016/j.phro.2024.100576] [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: 12/04/2023] [Revised: 04/02/2024] [Accepted: 04/05/2024] [Indexed: 04/23/2024] Open
Abstract
Background and Purpose Standard imaging protocols can guarantee the spatial integrity of magnetic resonance (MR) images utilized in radiotherapy. However, the presence of metallic implants can significantly compromise this integrity. Our proposed method aims at characterizing the geometric distortions induced by both passive and active implants commonly encountered in planning images obtained from a low-field 0.35 T MR-linear accelerator (LINAC). Materials and Methods We designed a spatial integrity phantom defining 1276 control points and covering a field of view of 20x20x20 cm3. This phantom was scanned in a water tank with and without different implants used in hip and shoulder arthroplasty procedures as well as with active cardiac stimulators. The images were acquired with the clinical planning sequence (balanced steady-state free-precession, resolution 1.5x1.5x1.5 mm3). Spatial integrity was assessed by the Euclidian distance between the control point detected on the image and their theoretical locations. A first plane free of artefact (FPFA) was defined to evaluate the spatial integrity beyond the larger banding artefact. Results In the region extending up to 20 mm from the largest banding artefacts, the tested passive and active implants could cause distortions up to 2 mm and 3 mm, respectively. Beyond this region the spatial integrity was recovered and the image could be considered as unaffected by the implants. Conclusions We characterized the impact of common implants on a low field MR-LINAC planning sequence. These measurements could support the creation of extra margin while contouring organs at risk and target volumes in the vicinity of implants.
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Affiliation(s)
- Bertrand Pouymayou
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Yoel Perez-Haas
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Florin Allemann
- Department of Traumatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Ardan M. Saguner
- Department of Cardiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Lotte Wilke
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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5
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Schiavone M, Gasperetti A, Compagnucci P, Vogler J, Laredo M, Montemerlo E, Gulletta S, Breitenstein A, Ziacchi M, Martinek M, Casella M, Palmisano P, Kaiser L, Lavalle C, Calò L, Seidl S, Saguner AM, Rovaris G, Kuschyk J, Biffi M, Di Biase L, Dello Russo A, Tondo C, Della Bella P, Tilz R, Forleo GB. Impact of ventricular tachycardia ablation in subcutaneous implantable cardioverter defibrillator carriers: a multicentre, international analysis from the iSUSI project. Europace 2024; 26:euae066. [PMID: 38584394 PMCID: PMC10999646 DOI: 10.1093/europace/euae066] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 02/14/2024] [Indexed: 04/09/2024] Open
Abstract
AIMS Catheter ablation (CA) of ventricular tachycardia (VT) has become an important tool to improve clinical outcomes in patients with appropriate transvenous implantable cardioverter defibrillator (ICD) shocks. The aim of our analysis was to test whether VT ablation (VTA) impacts long-term clinical outcomes even in subcutaneous ICD (S-ICD) carriers. METHODS AND RESULTS International Subcutaneous Implantable Cardioverter Defibrillator (iSUSI) registry patients who experienced either an ICD shock or a hospitalization for monomorphic VT were included in this analysis. Based on an eventual VTA after the index event, patients were divided into VTA+ vs. VTA- cohorts. Primary outcome of the study was the occurrence of a combination of device-related appropriate shocks, monomorphic VTs, and cardiovascular mortality. Secondary outcomes were addressed individually. Among n = 1661 iSUSI patients, n = 211 were included: n = 177 experiencing ICD shocks and n = 34 hospitalized for VT. No significant differences in baseline characteristics were observed. Both the crude and the yearly event rate of the primary outcome (5/59 and 3.8% yearly event rate VTA+ vs. 41/152 and 16.4% yearly event rate in the VTA-; log-rank: P value = 0.0013) and the cardiovascular mortality (1/59 and 0.7% yearly event rate VTA+ vs. 13/152 and 4.7% yearly event rate VTA-; log-rank P = 0.043) were significantly lower in the VTA + cohort. At multivariate analysis, VTA was the only variable remaining associated with a lower incidence of the primary outcome [adjusted hazard ratio 0.262 (0.100-0.681), P = 0.006]. CONCLUSION In a real-world registry of S-ICD carriers, the combined study endpoint of arrhythmic events and cardiovascular mortality was lower in the patient cohort undergoing VTA at long-term follow-up. CLINICALTRIALS.GOV IDENTIFIER NCT0473876.
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Affiliation(s)
- Marco Schiavone
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Alessio Gasperetti
- Cardiology Unit, Luigi Sacco University Hospital, Via Giovanni Battista Grassi, 74, Milan 20157, Italy
- Department of Cardiology, Johns Hopkins University, 1800 Orleans Street, Baltimore, MD 21218, USA
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital ‘Ospedali Riuniti’, Ancona, Italy
| | - Julia Vogler
- Department of Rhythmology, University Heart Center Lübeck, Lubeck, Germany
| | - Mikael Laredo
- Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière and Sorbonne Université, Paris, France
| | | | - Simone Gulletta
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy
| | | | - Matteo Ziacchi
- Cardiology Unit, IRCCS, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Martin Martinek
- Internal Medicine 2 with Cardiology, Angiology, and Intensive Care Medicine, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital ‘Ospedali Riuniti’, Ancona, Italy
| | | | - Lukas Kaiser
- Department of Cardiology and Critical Care Medicine, St. George Klinik Asklepios, Hamburg, Germany
| | - Carlo Lavalle
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Leonardo Calò
- Department of Cardiology, Policlinico Casilino, Rome, Italy
| | - Sebastian Seidl
- Internal Medicine 2 with Cardiology, Angiology, and Intensive Care Medicine, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Ardan M Saguner
- Cardiology Clinic, University Hospital Zurich, Zurich, Switzerland
| | | | - Jürgen Kuschyk
- Cardiology Unit, University Medical Centre Mannheim, Manheim, Germany
| | - Mauro Biffi
- Cardiology Unit, IRCCS, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Luigi Di Biase
- Cardiac Arrhythmia Center, Division of Cardiology, Montefiore-Einstein Center, Bronx, NY, USA
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital ‘Ospedali Riuniti’, Ancona, Italy
| | - Claudio Tondo
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Paolo Della Bella
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Roland Tilz
- Department of Rhythmology, University Heart Center Lübeck, Lubeck, Germany
| | - Giovanni B Forleo
- Cardiology Unit, Luigi Sacco University Hospital, Via Giovanni Battista Grassi, 74, Milan 20157, Italy
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Kovacs B, Giannopoulos AA, Bogun F, Pazhenkottil AP, Bonetti NR, Manka R, Medeiros-Domingo A, Gruner C, Schmidt D, Flammer AJ, Ruschitzka F, Duru F, Kaufmann PA, Buechel RR, Saguner AM. Sustained Ventricular Tachyarrhythmias are Associated With Increased 18F-Fluorodeoxyglucose Uptake Mimicking Cardiac Sarcoidosis. Circ Cardiovasc Imaging 2024; 17:e016316. [PMID: 38456290 DOI: 10.1161/circimaging.123.016316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Affiliation(s)
- Boldizsar Kovacs
- Department of Cardiology, University Heart Center (B.K., N.R.B., R.M., C.G., D.S., A.J.F., F.R., F.D., A.M.S.), University Hospital Zurich, Switzerland
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor (B.K., F.B.)
- Center for Translational and Experimental Cardiology (CTEC) (B.K., N.R.B., C.G., D.S., A.J.F., F.R., F.D., A.M.S.), University Zurich, Switzerland
| | - Andreas A Giannopoulos
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland (A.A.G., A.P.P., P.A.K., R.R.B.)
| | - Frank Bogun
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor (B.K., F.B.)
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland (A.A.G., A.P.P., P.A.K., R.R.B.)
| | - Nicole R Bonetti
- Department of Cardiology, University Heart Center (B.K., N.R.B., R.M., C.G., D.S., A.J.F., F.R., F.D., A.M.S.), University Hospital Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC) (B.K., N.R.B., C.G., D.S., A.J.F., F.R., F.D., A.M.S.), University Zurich, Switzerland
| | - Robert Manka
- Department of Cardiology, University Heart Center (B.K., N.R.B., R.M., C.G., D.S., A.J.F., F.R., F.D., A.M.S.), University Hospital Zurich, Switzerland
- Institute of Diagnostic and Interventional Radiology (R.M.), University Hospital Zurich, Switzerland
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland (R.M.)
| | - Argelia Medeiros-Domingo
- Center for Translational and Experimental Cardiology (CTEC) (B.K., N.R.B., C.G., D.S., A.J.F., F.R., F.D., A.M.S.), University Zurich, Switzerland
- Swiss DNAlysis, Dübendorf, Switzerland (A.M.-D.)
| | - Christiane Gruner
- Department of Cardiology, University Heart Center (B.K., N.R.B., R.M., C.G., D.S., A.J.F., F.R., F.D., A.M.S.), University Hospital Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC) (B.K., N.R.B., C.G., D.S., A.J.F., F.R., F.D., A.M.S.), University Zurich, Switzerland
| | - Dörthe Schmidt
- Department of Cardiology, University Heart Center (B.K., N.R.B., R.M., C.G., D.S., A.J.F., F.R., F.D., A.M.S.), University Hospital Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC) (B.K., N.R.B., C.G., D.S., A.J.F., F.R., F.D., A.M.S.), University Zurich, Switzerland
| | - Andreas J Flammer
- Department of Cardiology, University Heart Center (B.K., N.R.B., R.M., C.G., D.S., A.J.F., F.R., F.D., A.M.S.), University Hospital Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC) (B.K., N.R.B., C.G., D.S., A.J.F., F.R., F.D., A.M.S.), University Zurich, Switzerland
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center (B.K., N.R.B., R.M., C.G., D.S., A.J.F., F.R., F.D., A.M.S.), University Hospital Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC) (B.K., N.R.B., C.G., D.S., A.J.F., F.R., F.D., A.M.S.), University Zurich, Switzerland
- Center for Integrative Human Physiology (F.R., F.D.), University Zurich, Switzerland
| | - Firat Duru
- Department of Cardiology, University Heart Center (B.K., N.R.B., R.M., C.G., D.S., A.J.F., F.R., F.D., A.M.S.), University Hospital Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC) (B.K., N.R.B., C.G., D.S., A.J.F., F.R., F.D., A.M.S.), University Zurich, Switzerland
- Center for Integrative Human Physiology (F.R., F.D.), University Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland (A.A.G., A.P.P., P.A.K., R.R.B.)
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland (A.A.G., A.P.P., P.A.K., R.R.B.)
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center (B.K., N.R.B., R.M., C.G., D.S., A.J.F., F.R., F.D., A.M.S.), University Hospital Zurich, Switzerland
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7
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Hofer D, Perucchini F, Blessberger H, Steinwender C, Zehetleitner S, Molitor N, Saguner AM, El-Chami MF, Black G, Schiavone M, Forleo G, Gasperetti A, Steffel J, Noti F, Haeberlin A, Breitenstein A. Electrocardiographic predictors of atrial mechanical sensing in leadless pacemakers. Heart Rhythm 2024:S1547-5271(24)00233-9. [PMID: 38432424 DOI: 10.1016/j.hrthm.2024.02.061] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Leadless pacemakers (LPs) capable of VDD pacing allow for atrioventricular synchrony through mechanical sensing of atrial contraction. However, mechanical sensing is less reliable and less predictable than electrical sensing. OBJECTIVE The purpose of this study was to evaluate P-wave amplitude during sinus rhythm from preoperative 12-lead electrocardiograms (ECGs) as a predictor for atrial mechanical sensing in patients undergoing VDD LP implantation. METHODS Consecutive patients undergoing VDD LP implantation were included in this 2-center prospective cohort study. ECG parameters were evaluated separately and in combination for association with the signal amplitude of atrial mechanical contraction (A4). RESULTS Eighty patients (median age 82 years; female 55%; mean body mass index [BMI] 25.8 kg/m2) were included in the study and 61 patients in the A4 signal analysis (19 patients in VVI mode during follow-up). Absolute (aVL, aVF, V1, V2) and BMI-adjusted (I, II, aVL, aVF, aVR, V1, V2) P-wave amplitudes from baseline ECGs demonstrated a statistically significant positive correlation with A4 signal amplitude (all P <.05). A combined P-wave signal amplitude of at least 0.2 mV in V1 and aVL was predictive, with specificity of 83% (95% confidence interval 67%-100%) for A4 signal ≥1 m/s2. We found a significant correlation of A4 signal amplitude and overall atrioventricular synchrony (P = .013). CONCLUSION P-wave amplitudes in ECG leads aVL and V1 can predict A4 signal amplitude in patients with VDD LP and therefore the probability of successful AV synchronous pacing.
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Affiliation(s)
- Daniel Hofer
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.
| | - Fabrizio Perucchini
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Hermann Blessberger
- Department of Cardiology, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - Clemens Steinwender
- Department of Cardiology, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - Samantha Zehetleitner
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Nadine Molitor
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Mikhael F El-Chami
- Division of Cardiology, Section of Electrophysiology, Emory University, Atlanta, Georgia
| | - George Black
- Division of Cardiology, Section of Electrophysiology, Emory University, Atlanta, Georgia
| | - Marco Schiavone
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Giovanni Forleo
- Cardiology Unit, Luigi Sacco University Hospital, Milan, Italy
| | | | - Jan Steffel
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Alexander Breitenstein
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
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8
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Carrick RT, De Marco C, Gasperetti A, Bosman LP, Gourraud JB, Trancuccio A, Mazzanti A, Murray B, Pendleton C, Tichnell C, Tandri H, Zeppenfeld K, Wilde AAM, Davies B, Seifer C, Roberts JD, Healey JS, MacIntyre C, Alqarawi W, Tadros R, Cutler MJ, Targetti M, Calò L, Vitali F, Bertini M, Compagnucci P, Casella M, Dello Russo A, Cappelletto C, De Luca A, Stolfo D, Duru F, Jensen HK, Svensson A, Dahlberg P, Hasselberg NE, Di Marco A, Jordà P, Arbelo E, Moreno Weidmann Z, Borowiec K, Delinière A, Biernacka EK, van Tintelen JP, Platonov PG, Olivotto I, Saguner AM, Haugaa KH, Cox M, Tondo C, Merlo M, Krahn AD, te Riele ASJM, Wu KC, Calkins H, James CA, Cadrin-Tourigny J. Implantable cardioverter defibrillator use in arrhythmogenic right ventricular cardiomyopathy in North America and Europe. Eur Heart J 2024; 45:538-548. [PMID: 38195003 PMCID: PMC11024811 DOI: 10.1093/eurheartj/ehad799] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 09/14/2023] [Accepted: 11/21/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND AND AIMS Implantable cardioverter-defibrillators (ICDs) are critical for preventing sudden cardiac death (SCD) in arrhythmogenic right ventricular cardiomyopathy (ARVC). This study aims to identify cross-continental differences in utilization of primary prevention ICDs and survival free from sustained ventricular arrhythmia (VA) in ARVC. METHODS This was a retrospective analysis of ARVC patients without prior VA enrolled in clinical registries from 11 countries throughout Europe and North America. Patients were classified according to whether they received treatment in North America or Europe and were further stratified by baseline predicted VA risk into low- (<10%/5 years), intermediate- (10%-25%/5 years), and high-risk (>25%/5 years) groups. Differences in ICD implantation and survival free from sustained VA events (including appropriate ICD therapy) were assessed. RESULTS One thousand ninety-eight patients were followed for a median of 5.1 years; 554 (50.5%) received a primary prevention ICD, and 286 (26.0%) experienced a first VA event. After adjusting for baseline risk factors, North Americans were more than three times as likely to receive ICDs {hazard ratio (HR) 3.1 [95% confidence interval (CI) 2.5, 3.8]} but had only mildly increased risk for incident sustained VA [HR 1.4 (95% CI 1.1, 1.8)]. North Americans without ICDs were at higher risk for incident sustained VA [HR 2.1 (95% CI 1.3, 3.4)] than Europeans. CONCLUSIONS North American ARVC patients were substantially more likely than Europeans to receive primary prevention ICDs across all arrhythmic risk strata. A lower rate of ICD implantation in Europe was not associated with a higher rate of VA events in those without ICDs.
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MESH Headings
- Humans
- Defibrillators, Implantable/adverse effects
- Arrhythmogenic Right Ventricular Dysplasia/complications
- Arrhythmogenic Right Ventricular Dysplasia/epidemiology
- Arrhythmogenic Right Ventricular Dysplasia/therapy
- Retrospective Studies
- Arrhythmias, Cardiac/epidemiology
- Arrhythmias, Cardiac/therapy
- Arrhythmias, Cardiac/etiology
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/prevention & control
- Death, Sudden, Cardiac/etiology
- Risk Factors
- North America/epidemiology
- Europe/epidemiology
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Affiliation(s)
- Richard T Carrick
- Heart and Vascular Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Corrado De Marco
- Cardiovascular Genetics Centre, Montreal Heart Institute, Université de Montréal, 5000 rue Bélanger, Montréal, Québec H1T 1C8, Canada
| | - Alessio Gasperetti
- Heart and Vascular Institute, Johns Hopkins University, Baltimore, MD, USA
- Division of Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Laurens P Bosman
- Division of Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
| | - Jean-Baptiste Gourraud
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
- Department of Cardiology, Centre Hospitalier Universitaire Nantes, Nantes, France
| | | | - Andrea Mazzanti
- Molecular Cardiology, Istituti Clinici Scientifici Maugeri (IRCCS), Pavia, Italy
| | - Brittney Murray
- Heart and Vascular Institute, Johns Hopkins University, Baltimore, MD, USA
| | | | - Crystal Tichnell
- Heart and Vascular Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Harikrishna Tandri
- Heart and Vascular Institute, Johns Hopkins University, Baltimore, MD, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Arthur A M Wilde
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
- Amsterdam UMC, Heart Center Department of Cardiology, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, University of Amsterdam, Amsterdam, The Netherlands
| | - Brianna Davies
- Center for Cardiac Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Colette Seifer
- St.Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jason D Roberts
- Hamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
| | - Jeff S Healey
- Hamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Ciorsti MacIntyre
- Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Wael Alqarawi
- Department of Cardiac Sciences, College of Medicine, King Saudi University, Riyadh, Saudi Arabia
- Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Canada
| | - Rafik Tadros
- Cardiovascular Genetics Centre, Montreal Heart Institute, Université de Montréal, 5000 rue Bélanger, Montréal, Québec H1T 1C8, Canada
| | - Michael J Cutler
- Intermountain Medical Center, Intermountain Medical Center Heart Institute, Murray, UT, USA
| | - Mattia Targetti
- Cardiomyopathy Unit, Careggi Hospital and Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Leonardo Calò
- Division of Cardiology, Policlinico Casilino, Rome, Italy
| | - Francesco Vitali
- Cardiology Unit, Sant’Anna University Hospital, University of Ferrara, Ferrara, Italy
| | - Matteo Bertini
- Cardiology Unit, Sant’Anna University Hospital, University of Ferrara, Ferrara, Italy
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti, Ancona, Italy
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti, Ancona, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti, Ancona, Italy
| | - Chiara Cappelletto
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Antonio De Luca
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
| | - Davide Stolfo
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Firat Duru
- Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland
| | - Henrik K Jensen
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Aarhus N, Denmark
| | - Anneli Svensson
- Department of Cardiology, Linköping University Hospital, Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Pia Dahlberg
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Nina E Hasselberg
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Oslo, Norway
| | - Andrea Di Marco
- Arrhythmia Unit, Department ofCardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
- BioHeartCardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Paloma Jordà
- Cardiovascular Genetics Centre, Montreal Heart Institute, Université de Montréal, 5000 rue Bélanger, Montréal, Québec H1T 1C8, Canada
- Arrhythmia Section, Department of Cardiology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Elena Arbelo
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
- Arrhythmia Section, Department of Cardiology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | - Karolina Borowiec
- Department of Congenital Heart Diseases, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
- Outpatient Department of Genetic Arrhythmias, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Antoine Delinière
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
- Department of Cardiology, National Reference Center for Inherited Arrhythmias of Lyon, Louis Pradel Cardiovascular Hospital, Hospices Civils de Lyon, Lyon, France
- University of Lyon, Claude Bernard Lyon 1 University, MeLiS, CNRS UMR 5284, INSERM U1314, Institut NeuroMyoGène, Lyon, France
| | - Elżbieta K Biernacka
- Department of Congenital Heart Diseases, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
- Outpatient Department of Genetic Arrhythmias, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - J Peter van Tintelen
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
- Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Pyotr G Platonov
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi Hospital and Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland
| | - Kristina H Haugaa
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Oslo, Norway
| | - Moniek Cox
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, University of Milan, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Marco Merlo
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
| | - Andrew D Krahn
- Center for Cardiac Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anneline S J M te Riele
- Division of Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
| | - Katherine C Wu
- Heart and Vascular Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Hugh Calkins
- Heart and Vascular Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Cynthia A James
- Heart and Vascular Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Julia Cadrin-Tourigny
- Cardiovascular Genetics Centre, Montreal Heart Institute, Université de Montréal, 5000 rue Bélanger, Montréal, Québec H1T 1C8, Canada
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9
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Jelisejevas J, Regoli F, Hofer D, Conte G, Oezkartal T, Saguner AM, Caputo ML, Grazioli L, Steffel J, Auricchio A, Breitenstein A. Leadless Pacemaker Implantation, Focusing on Patients With Conduction System Disorders Post-Transcatheter Aortic Valve Replacement: A Retrospective Analysis. CJC Open 2024; 6:96-103. [PMID: 38585679 PMCID: PMC10994977 DOI: 10.1016/j.cjco.2023.10.009] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 10/09/2023] [Indexed: 04/09/2024] Open
Abstract
Background Impairment of the conduction system is a common complication of transcatheter aortic valve replacement (TAVR), which is typically performed in elderly patients. A leadless pacemaker (LP) may be a suitable option in this frail population, but the available scientific data concerning the efficacy and safety of leadless pacing after TAVR are sparse. The purpose of this analysis was to evaluate the efficacy and safety of LP implantation in patients with relevant bradycardias after TAVR, compared to other indications. Methods Consecutive patients were retrospectively enrolled. Demographics, background heart diseases, interventional parameters, and follow-up data were collected. Results A total of 257 consecutive patients who underwent LP implantation were included. In 26 patients, the device was implanted due to bradycardias after TAVR (TAVR group), whereas the remaining 231 patients were in the population without previous TAVR (non-TAVR group). The mean implantation duration (56 ± 22 minutes in the TAVR group vs 48 ± 20 minutes in the non-TAVR group; P = not significant [NS]) and the implantation success rate (100% in the TAVR group vs 98.7% in the non-TAVR group; P = NS) were similar in the 2 cohorts. No significant differences occurred in pacing parameters (sensing, impedance, and threshold, respectively) between the 2 groups, either at implantation or during follow-up. A total of 8 major periprocedural complications (3.1% of patients in total; 3.8% in the TAVR group vs 3.0% in the non-TAVR group; P = NS) occurred within 30 days, without significant difference between the 2 groups. Conclusions LP implantation appears to be safe and effective in patients after TAVR, and therefore, this procedure is a suitable option for this often old and frail population.
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Affiliation(s)
- Julius Jelisejevas
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - François Regoli
- Fondazione Cardiocentro Ticino, Lugano, Switzerland
- Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Daniel Hofer
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Giulio Conte
- Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | | | - Ardan M. Saguner
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | | | | | - Jan Steffel
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
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10
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Jurisic S, Medeiros-Domingo A, Berger F, Balmer C, Brunckhorst C, Ruschitzka F, Saguner AM, Duru F. Catecholaminergic Polymorphic Ventricular Tachycardia: Multiple Clinical Presentations of a Genetically Determined Disease. J Clin Med 2023; 13:47. [PMID: 38202054 PMCID: PMC10779837 DOI: 10.3390/jcm13010047] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/17/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare, inherited heart rhythm disorder that is caused by variants in genes responsible for cardiac calcium homeostasis. The aim of this study was to analyze different genotype-specific clinical manifestations of this disease. METHODS AND RESULTS We analyzed five CPVT cases from our institution in the context of specific patient characteristics and genotype-phenotype correlations. In this cohort, three of the index patients were male. The median age at diagnosis was 11 (11-30) years, and median age at disease onset was 12 (12-33) years. Four index patients suffered from syncope, while one female index patient suffered from out-of-hospital cardiac arrest. Two index patients experienced concomitant atrial flutter and atrial fibrillation. Three patients received an implantable cardioverter defibrillator and one patient received an event recorder. All index patients had causative genetic variants in the RYR2-gene. CONCLUSIONS This study presents various phenotypic presentations of patients with CPVT harboring different pathogenic variants in the RYR2 gene, some of which have not previously been described in published studies. Syncope was the most prevalent symptom on admission. Adjustment of beta-blocker therapy may be necessary due to side effects. Moreover, our work further highlights the common occurrence of atrial tachyarrhythmias in these patients.
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Affiliation(s)
- Stjepan Jurisic
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Argelia Medeiros-Domingo
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, 8091 Zurich, Switzerland
- Cardiogenetics—Swiss DNAlysis, 8600 Dubendorf, Switzerland
| | - Florian Berger
- Divison of Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
| | - Christian Balmer
- Divison of Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
| | - Corinna Brunckhorst
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, 8091 Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Ardan M. Saguner
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, 8091 Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Firat Duru
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, 8091 Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
- Center for Integrative Human Physiology, University of Zurich, 8091 Zurich, Switzerland
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11
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Gasperetti A, Peretto G, Muller SA, Hasegawa K, Compagnucci P, Casella M, Murray B, Tichnell C, Carrick RT, Cadrin-Tourigny J, Schiavone M, James C, Amin AS, Saguner AM, Dello Russo A, Tondo C, Stevenson W, Della Bella P, Calkins H, Tandri H. Catheter Ablation for Ventricular Tachycardia in Patients With Desmoplakin Cardiomyopathy. JACC Clin Electrophysiol 2023:S2405-500X(23)00897-6. [PMID: 38206263 DOI: 10.1016/j.jacep.2023.11.017] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Desmoplakin (DSP) pathogenic/likely pathogenic (P/LP) variants are associated with malignant phenotypes of arrhythmogenic cardiomyopathy (DSP-ACM). Reports of outcomes after ventricular tachycardia (VT) ablation in DSP-ACM are scarce. OBJECTIVES In this study, the authors sought to report on long-term outcomes of VT ablation in DSP-ACM. METHODS Patients with P/LP DSP variants at 9 institutions undergoing VT ablation were included. Demographic, clinical, and instrumental data as well as all ventricular arrhythmia (VA) events were collected. Sustained VAs after the index procedure were the primary outcome. A per-patient before and after ablation comparison of rates of VA episodes per year was performed as well. RESULTS Twenty-four DSP-ACM patients (39.3 ± 12.1 years of age, 62.5% male, median 6,116 [Q1-Q3: 3,362-7,760] premature ventricular complexes [PVCs] per 24 hours, median 4 [Q1-Q3: 2-11] previous VA episodes per patient at ablation) were included. Index procedure was most commonly endocardial/epicardial (19/24) The endocardium of the right ventricle (RV), the left ventricle (LV), or both ventricles were mapped in 8 (33.3%), 9 (37.5%), and 7 (29.2%) cases, respectively. Low voltage potentials were found in 10 of 15 patients in the RV and 11 of 16 in the LV. Endocardial ablation was performed in 18 patients (75.0%). Epicardial mapping in 19 patients (79.2%) identified low voltage potentials in 17, and 16 received epicardial ablation. Over the following 2.9 years (Q1-Q3: 1.8-5.5 years), 13 patients (54.2%) experienced VA recurrences. A significant reduction in per-patient event/year before and after ablation was observed (1.4 [Q1-Q3: 0.5-2.4] to 0.1 [Q1-Q3: 0.0-0.4]; P = 0.009). 2 patients needed heart transplantation, and 4 died (3 of heart failure and 1 noncardiac death). CONCLUSIONS VT ablation in DSP-ACM is effective in reducing the VA burden of the disease, but recurrences are common. Most VT circuits are epicardial, with both LV and RV low voltage abnormalities. Heart failure complicates clinical course and is an important cause of mortality.
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Affiliation(s)
- Alessio Gasperetti
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy; Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Giovanni Peretto
- Department of Cardiac Electrophysiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Steven A Muller
- Department of Cardiology, Division Heart and Lungs, Utrecht University Medical Centre, Utrecht, the Netherlands
| | - Kanae Hasegawa
- Department of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Paolo Compagnucci
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy; Cardiology and Arrhythmology Clinic, University Hospital "Azienda Ospedaliero-Universitaria delle Marche," Ancona, Italy
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital "Azienda Ospedaliero-Universitaria delle Marche," Ancona, Italy; Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy
| | - Brittney Murray
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Crystal Tichnell
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Richard T Carrick
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Julia Cadrin-Tourigny
- Cardiovascular Genetics Center and Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Marco Schiavone
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Cardiology, Luigi Sacco University Hospital, Milan, Italy
| | - Cynthia James
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ahmad S Amin
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam, the Netherlands
| | - Ardan M Saguner
- Department of Cardiology, University Hospital of Zurich, Zurich, Switzerland; Center for Translational and Experimental Cardiology, Department of Cardiology, Zurich University Hospital, University of Zurich, Schlieren, Switzerland
| | - Antonio Dello Russo
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy; Cardiology and Arrhythmology Clinic, University Hospital "Azienda Ospedaliero-Universitaria delle Marche," Ancona, Italy
| | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Milan, Italy
| | - William Stevenson
- Department of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Paolo Della Bella
- Department of Cardiac Electrophysiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Hugh Calkins
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Harikrishna Tandri
- Department of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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12
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Nagyova E, Hoorntje ET, Te Rijdt WP, Bosman LP, Syrris P, Protonotarios A, Elliott PM, Tsatsopoulou A, Mestroni L, Taylor MRG, Sinagra G, Merlo M, Wada Y, Horie M, Mogensen J, Christensen AH, Gerull B, Song L, Yao Y, Fan S, Saguner AM, Duru F, Koskenvuo JW, Cruz Marino T, Tichnell C, Judge DP, Dooijes D, Lekanne Deprez RH, Basso C, Pilichou K, Bauce B, Wilde AAM, Charron P, Fressart V, van der Heijden JF, van den Berg MP, Asselbergs FW, James CA, Jongbloed JDH, Harakalova M, van Tintelen JP. A Systematic Analysis of the Clinical Outcome Associated with Multiple Reclassified Desmosomal Gene Variants in Arrhythmogenic Right Ventricular Cardiomyopathy Patients. J Cardiovasc Transl Res 2023; 16:1276-1286. [PMID: 37418234 PMCID: PMC10721666 DOI: 10.1007/s12265-023-10403-8] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 06/07/2023] [Indexed: 07/08/2023]
Abstract
The presence of multiple pathogenic variants in desmosomal genes (DSC2, DSG2, DSP, JUP, and PKP2) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) has been linked to a severe phenotype. However, the pathogenicity of variants is reclassified frequently, which may result in a changed clinical risk prediction. Here, we present the collection, reclassification, and clinical outcome correlation for the largest series of ARVC patients carrying multiple desmosomal pathogenic variants to date (n = 331). After reclassification, only 29% of patients remained carriers of two (likely) pathogenic variants. They reached the composite endpoint (ventricular arrhythmias, heart failure, and death) significantly earlier than patients with one or no remaining reclassified variant (hazard ratios of 1.9 and 1.8, respectively). Periodic reclassification of variants contributes to more accurate risk stratification and subsequent clinical management strategy. Graphical Abstract.
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Affiliation(s)
- Emilia Nagyova
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- Department of Molecular Biology, Faculty of Natural Sciences, Comenius University in Bratislava, Bratislava, Slovakia
| | - Edgar T Hoorntje
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Wouter P Te Rijdt
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Laurens P Bosman
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Petros Syrris
- Center for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, London, UK
| | - Alexandros Protonotarios
- Center for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, London, UK
- Nikos Protonotarios Medical Center, 84300, Naxos, Greece
| | - Perry M Elliott
- Center for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, London, UK
| | | | - Luisa Mestroni
- Cardiovascular Institute, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Matthew R G Taylor
- Cardiovascular Institute, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria-Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
| | - Marco Merlo
- Cardiothoracovascular Department, Azienda Sanitaria-Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
| | - Yuko Wada
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Minoru Horie
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Jens Mogensen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Alex H Christensen
- Department of Cardiology, Herlev-Gentofte and Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Brenda Gerull
- Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Comprehensive Heart Failure Center (CHFC) and Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Lei Song
- Arrhythmia Center and Clinical EP Laboratory, State Key Laboratory of Cardiovascular Diseases, National Center for Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College-Chinese Academy of Medical Sciences, Beijing, China
| | - Yan Yao
- Arrhythmia Center and Clinical EP Laboratory, State Key Laboratory of Cardiovascular Diseases, National Center for Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College-Chinese Academy of Medical Sciences, Beijing, China
| | - Siyang Fan
- Arrhythmia Center and Clinical EP Laboratory, State Key Laboratory of Cardiovascular Diseases, National Center for Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College-Chinese Academy of Medical Sciences, Beijing, China
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center, Zurich, Switzerland
| | - Firat Duru
- Department of Cardiology, University Heart Center, Zurich, Switzerland
| | | | - Tania Cruz Marino
- Department of Medical Biology, CIUSSS Saguenay Lac-St-Jean, Chicoutimi, QC, Canada
| | - Crystal Tichnell
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Daniel P Judge
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, USA
| | - Dennis Dooijes
- Department of Genetics, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Ronald H Lekanne Deprez
- Department of Human Genetics, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Cristina Basso
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Kalliopi Pilichou
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Barbara Bauce
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Arthur A M Wilde
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Philippe Charron
- APHP, Referral Center for Cardiac Hereditary Diseases, Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France
| | - Véronique Fressart
- APHP, Referral Center for Cardiac Hereditary Diseases, Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France
| | - Jeroen F van der Heijden
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Maarten P van den Berg
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- Institute of Cardiovascular Science, Faculty of Population Health Science, University College London, London, UK
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - Cynthia A James
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Jan D H Jongbloed
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Magdalena Harakalova
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
- Netherlands Heart Institute, Utrecht, The Netherlands.
- Regenerative Medicine Utrecht (RMU), University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands.
| | - J Peter van Tintelen
- Netherlands Heart Institute, Utrecht, The Netherlands
- Department of Human Genetics, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Department of Genetics, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
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13
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Rossi VA, Saguner AM. A silent interweaving: interatrial block and laminopathy. Eur Heart J Case Rep 2023; 7:ytad616. [PMID: 38130858 PMCID: PMC10733588 DOI: 10.1093/ehjcr/ytad616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Affiliation(s)
- Valentina A Rossi
- University Heart Centre, University Hospital of Zurich, Rämistrasse 100, Zurich 8091, Switzerland
| | - Ardan M Saguner
- University Heart Centre, University Hospital of Zurich, Rämistrasse 100, Zurich 8091, Switzerland
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14
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Saguner AM, Lunk D, Mohsen M, Knecht S, Akdis D, Costa S, Gasperetti A, Duru F, Rossi VA, Brunckhorst CB. Electroanatomical voltage mapping with contact force sensing for diagnosis of arrhythmogenic right ventricular cardiomyopathy. Int J Cardiol 2023; 392:131289. [PMID: 37619879 DOI: 10.1016/j.ijcard.2023.131289] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/17/2023] [Accepted: 08/20/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Three-dimensional electroanatomical mapping (EAM) can be helpful to diagnose arrhythmogenic right ventricular cardiomyopathy (ARVC). Yet, previous studies utilizing EAM have not systematically used contact-force sensing catheters (CFSC) to characterize the substrate in ARVC, which is the current gold standard to assure adequate tissue contact. OBJECTIVE To investigate reference values for endocardial right ventricular (RV) EAM as well as substrate characterization in patients with ARVC by using CFSC. METHODS Endocardial RV EAM during sinus rhythm was performed with CFSC in 12 patients with definite ARVC and 5 matched controls without structural heart disease. A subanalysis for the RV outflow tract (RVOT), septum, free-wall, subtricuspid region, and apex was performed. Endocardial bipolar and unipolar voltage amplitudes (BVA, UVA), signal characteristics and duration as well as the impact of catheter orientation on endocardial signals were also investigated. RESULTS ARVC patients showed lower BVA vs. controls (p = 0.018), particularly in the subtricuspid region (1.4, IQR:0.5-3.1 vs. 3.8, IQR:2.5-5 mV, p = 0.037) and RV apex (2.5, IQR:1.5-4 vs. 4.3,IQR:2.9-6.1 mV, p = 0.019). BVA in all RV regions yielded a high sensitivity and specificity for ARVC diagnosis (AUC 59-78%, p < 0.05 for all), with the highest performance for the subtricuspid region (AUC 78%, 95% CI:0.75-0.81, p < 0.001, negative predictive value 100%). A positive correlation between BVA and an orthogonal catheter orientation (46°-90°:r = 0.106, p < 0.001), and a negative correlation between BVA and EGM duration (r = -0.370, p < 0.001) was found. CONCLUSIONS EAM using CFSC validates previous bipolar cut-off values for normal endocardial RV voltage amplitudes. RV voltages are generally lower in ARVC as compared to controls, with the subtricuspid area being commonly affected and having the highest discriminatory power to differentiate between ARVC and healthy controls. Therefore, EAM using CFSC constitutes a promising tool for diagnosis of ARVC.
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Affiliation(s)
- A M Saguner
- Arrhythmia Division, Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland; Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, Zurich University Hospital, University of Zurich, 8952 Schlieren, Switzerland.
| | - D Lunk
- Arrhythmia Division, Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland
| | - M Mohsen
- Arrhythmia Division, Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland; Department of Cardiology, Qatar Heart Hospital 7GR5+RW4, Doha, Qatar
| | - Sven Knecht
- Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Deniz Akdis
- Arrhythmia Division, Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland
| | - S Costa
- Arrhythmia Division, Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland
| | - A Gasperetti
- Arrhythmia Division, Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland; Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St., Baltimore, MD 21287, USA
| | - F Duru
- Arrhythmia Division, Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland; Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, Zurich University Hospital, University of Zurich, 8952 Schlieren, Switzerland
| | - V A Rossi
- Arrhythmia Division, Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland
| | - C B Brunckhorst
- Arrhythmia Division, Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland
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15
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Kovacs B, Mayinger M, Ehrbar S, Fesslmeier D, Ahmadsei M, Sazgary L, Manka R, Alkadhi H, Ruschitzka F, Duru F, Papachristofilou A, Sticherling C, Blamek S, Gołba KS, Guckenberger M, Saguner AM, Andratschke N. Dose escalation for stereotactic arrhythmia radioablation of recurrent ventricular tachyarrhythmia - a phase II clinical trial. Radiat Oncol 2023; 18:185. [PMID: 37941012 PMCID: PMC10634182 DOI: 10.1186/s13014-023-02361-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/08/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Stereotactic arrhythmia radioablation (STAR) is delivered with a planning target volume (PTV) prescription dose of 25 Gy, mostly to the surrounding 75-85% isodose line. This means that the average and maximum dose received by the target is less than 35 Gy, which is the minimum threshold required to create a homogenous transmural fibrosis. Similar to catheter ablation, the primary objective of STAR should be transmural fibrosis to prevent heterogenous intracardiac conduction velocities and the occurrence of sustained ventricular arrhythmias (sVA) caused by reentry. We hypothesize that the current dose prescription used in STAR is inadequate for the long-term prevention of sVA and that a significant increase in dose is necessary to induce transmural scar formation. OBJECTIVE A single arm, multi-center, phase II, dose escalation prospective clinical trial employing the i3 + 3 design is being conducted to examine the safety of a radiation dose-escalation strategy aimed at inducing transmural scar formation. The ultimate objective of this trial is to decrease the likelihood of sVA recurrence in patients at risk. METHODS Patients with ischemic or non-ischemic cardiomyopathy and recurrent sVA, with an ICD and history of ≥ 1 catheter ablation for sVA will be included. This is a prospective, multicenter, one-arm, dose-escalation trial utilizing the i3 + 3 design, a modified 3 + 3 specifically created to overcome limitations in traditional dose-finding studies. A total of 15 patients will be recruited. The trial aims to escalate the ITV dose from 27.0 Gy to an ITV prescription dose-equivalent level of maximum 35.1 Gy by keeping the PTV prescription dose constant at 25 Gy while increasing the dose to the target (i.e. the VT substrate without PTV margin) by step-wise reduction of the prescribing isodose line (85% down to 65%). The primary outcome of this trial is safety measured by registered radiation associated adverse events (AE) up to 90 days after study intervention including radiation associated serious adverse events graded as at least 4 or 5 according to CTCAE v5, radiation pneumonitis or pericarditis requiring hospitalization and decrease in LVEF ≥ 10% as assessed by echocardiography or cardiac MRI at 90 days after STAR. The sample size was determined assuming an acceptable primary outcome event rate of 20%. Secondary outcomes include sVA burden at 6 months after STAR, time to first sVA recurrence, reduction in appropriate ICD therapies, the need for escalation of antiarrhythmic drugs, non-radiation associated safety and patient reported outcome measures such as SF-36 and EQ5D. DISCUSSION DEFT-STAR is an innovative prospective phase II trial that aims to evaluate the optimal radiation dose for STAR in patients with therapy-refractory sVA. The trial has obtained IRB approval and focuses on determining the safe and effective radiation dose to be employed in the STAR procedure. TRIAL REGISTRATION NCT05594368.
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Affiliation(s)
- Boldizsar Kovacs
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, USA
- Center for Translational and Experimental Cardiology (CTEC), University of Zurich, Zurich, Switzerland
| | - Michael Mayinger
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Stefanie Ehrbar
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Debra Fesslmeier
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Maiwand Ahmadsei
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Lorraine Sazgary
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), University of Zurich, Zurich, Switzerland
| | - Robert Manka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), University of Zurich, Zurich, Switzerland
- Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Hatem Alkadhi
- Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), University of Zurich, Zurich, Switzerland
- Center for Integrative Human Physiology, University Zurich, Zurich, Switzerland
| | - Firat Duru
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), University of Zurich, Zurich, Switzerland
- Center for Integrative Human Physiology, University Zurich, Zurich, Switzerland
| | | | | | - Slawomir Blamek
- Department of Radiotherapy, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | - Krzysztof S Gołba
- Department of Electrocardiology, Upper Silesian Heart Center, Medical University of Silesia, Katowice, Poland
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| | | | - Ardan M Saguner
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), University of Zurich, Zurich, Switzerland
- Center for Integrative Human Physiology, University Zurich, Zurich, Switzerland
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland.
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van der Voorn SM, van Drie E, Proost V, Dimitrova K, Ernst RF, James CA, Tichnell C, Murray B, Calkins H, Saguner AM, Duru F, Ellinor PT, Bezzina CR, Jurgens SJ, van Tintelen JP, van Veen TAB. Lack of Evidence for the Role of the p.(Ser96Ala) Polymorphism in Histidine-Rich Calcium Binding Protein as a Secondary Hit in Cardiomyopathies. Int J Mol Sci 2023; 24:15931. [PMID: 37958923 PMCID: PMC10648441 DOI: 10.3390/ijms242115931] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/17/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023] Open
Abstract
Inherited forms of arrhythmogenic and dilated cardiomyopathy (ACM and DCM) are characterized by variable disease expression and age-related penetrance. Calcium (Ca2+) is crucially important for proper cardiac function, and dysregulation of Ca2+ homeostasis seems to underly cardiomyopathy etiology. A polymorphism, c.286T>G p.(Ser96Ala), in the gene encoding the histidine-rich Ca2+ binding (HRC) protein, relevant for sarcoplasmic reticulum Ca2+ cycling, has previously been associated with a marked increased risk of life-threatening arrhythmias among idiopathic DCM patients. Following this finding, we investigated whether p.(Ser96Ala) affects major cardiac disease manifestations in carriers of the phospholamban (PLN) c.40_42delAGA; p.(Arg14del) pathogenic variant (cohort 1); patients diagnosed with, or predisposed to, ACM (cohort 2); and DCM patients (cohort 3). We found that the allele frequency of the p.(Ser96Ala) polymorphism was similar across the general European-American population (control cohort, 40.3-42.2%) and the different cardiomyopathy cohorts (cohorts 1-3, 40.9-43.9%). Furthermore, the p.(Ser96Ala) polymorphism was not associated with life-threatening arrhythmias or heart failure-related events across various patient cohorts. We therefore conclude that there is a lack of evidence supporting the important role of the HRC p.(Ser96Ala) polymorphism as a modifier in cardiomyopathy, refuting previous findings. Further research is required to identify bona fide genomic predictors for the stratification of cardiomyopathy patients and their risk for life-threatening outcomes.
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Affiliation(s)
- Stephanie M. van der Voorn
- Department of Medical Physiology, Division Heart & Lungs, University Medical Center Utrecht, 3584 CM Utrecht, The Netherlands (K.D.)
| | - Esmée van Drie
- Department of Genetics, Division Heart & Lungs, University Medical Center Utrecht, 3584 CM Utrecht, The Netherlands
- Netherlands Heart Institute, 3511 EP Utrecht, The Netherlands
| | - Virginnio Proost
- Departments of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers Location Academic Medical Center, 1105 AZ Amsterdam, The Netherlands (C.R.B.)
| | - Kristina Dimitrova
- Department of Medical Physiology, Division Heart & Lungs, University Medical Center Utrecht, 3584 CM Utrecht, The Netherlands (K.D.)
| | | | - Robert F. Ernst
- Department of Genetics, Division Heart & Lungs, University Medical Center Utrecht, 3584 CM Utrecht, The Netherlands
| | - Cynthia A. James
- Department of Medicine, Division Cardiology, Johns Hopkins University, Baltimore, MD 21218, USA (C.T.)
| | - Crystal Tichnell
- Department of Medicine, Division Cardiology, Johns Hopkins University, Baltimore, MD 21218, USA (C.T.)
| | - Brittney Murray
- Department of Medicine, Division Cardiology, Johns Hopkins University, Baltimore, MD 21218, USA (C.T.)
| | - Hugh Calkins
- Department of Medicine, Division Cardiology, Johns Hopkins University, Baltimore, MD 21218, USA (C.T.)
| | - Ardan M. Saguner
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Firat Duru
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, 8091 Zurich, Switzerland
- Center for Integrative Human Physiology (ZIHP), University of Zurich, 8091 Zurich, Switzerland
| | - Patrick T. Ellinor
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Connie R. Bezzina
- Departments of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers Location Academic Medical Center, 1105 AZ Amsterdam, The Netherlands (C.R.B.)
| | - Sean J. Jurgens
- Departments of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers Location Academic Medical Center, 1105 AZ Amsterdam, The Netherlands (C.R.B.)
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - J. Peter van Tintelen
- Department of Genetics, Division Heart & Lungs, University Medical Center Utrecht, 3584 CM Utrecht, The Netherlands
- Netherlands Heart Institute, 3511 EP Utrecht, The Netherlands
| | - Toon A. B. van Veen
- Department of Medical Physiology, Division Heart & Lungs, University Medical Center Utrecht, 3584 CM Utrecht, The Netherlands (K.D.)
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17
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Ahmadsei M, Thaler K, Gasser E, Pouymayou B, Dal Bello R, Christ SM, Willmann J, Kovacs B, Balermpas P, Tanadini-Lang S, Saguner AM, Mayinger M, Andratschke N, Guckenberger M. Dosimetric analysis of 17 cardiac Sub-structures, Toxicity, and survival in ultra central lung tumor patients treated with SBRT. Clin Transl Radiat Oncol 2023; 43:100675. [PMID: 37744054 PMCID: PMC10511337 DOI: 10.1016/j.ctro.2023.100675] [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: 05/22/2023] [Revised: 08/04/2023] [Accepted: 09/07/2023] [Indexed: 09/26/2023] Open
Abstract
•Data on cardiac toxicity after SBRT for ultra-central lung tumors remains limited.•We analyzed the dose to 18 cardiac sub-structures and cardiovascular toxicity.•A SBRT regimen of 45 Gy in 8-10 fractions yields good local control and low toxicity.•The highest cardiac doses were observed in the pulmonary artery and left atrium.•Higher doses to the base of the heart seem to be associated with non-cancer deaths.
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Affiliation(s)
- Maiwand Ahmadsei
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Kai Thaler
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Elena Gasser
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Bertrand Pouymayou
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Riccardo Dal Bello
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Sebastian M. Christ
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Jonas Willmann
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Boldizsar Kovacs
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Panagiotis Balermpas
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Ardan M. Saguner
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, Zurich University Hospital, University of Zurich, 8952 Schlieren, Switzerland
| | - Michael Mayinger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
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18
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Herrera Siklody C, Schiappacasse L, Jumeau R, Reichlin T, Saguner AM, Andratschke N, Elicin O, Schreiner F, Kovacs B, Mayinger M, Huber A, Verhoeff JJC, Pascale P, Solana Muñoz J, Luca A, Domenichini G, Moeckli R, Bourhis J, Ozsahin EM, Pruvot E. Recurrences of ventricular tachycardia after stereotactic arrhythmia radioablation arise outside the treated volume: analysis of the Swiss cohort. Europace 2023; 25:euad268. [PMID: 37695314 PMCID: PMC10551232 DOI: 10.1093/europace/euad268] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/16/2023] [Indexed: 09/12/2023] Open
Abstract
AIMS Stereotactic arrhythmia radioablation (STAR) has been recently introduced for the management of therapy-refractory ventricular tachycardia (VT). VT recurrences have been reported after STAR but the mechanisms remain largely unknown. We analysed recurrences in our patients after STAR. METHODS AND RESULTS From 09.2017 to 01.2020, 20 patients (68 ± 8 y, LVEF 37 ± 15%) suffering from refractory VT were enrolled, 16/20 with a history of at least one electrical storm. Before STAR, an invasive electroanatomical mapping (Carto3) of the VT substrate was performed. A mean dose of 23 ± 2 Gy was delivered to the planning target volume (PTV). The median ablation volume was 26 mL (range 14-115) and involved the interventricular septum in 75% of patients. During the first 6 months after STAR, VT burden decreased by 92% (median value, from 108 to 10 VT/semester). After a median follow-up of 25 months, 12/20 (60%) developed a recurrence and underwent a redo ablation. VT recurrence was located in the proximity of the treated substrate in nine cases, remote from the PTV in three cases and involved a larger substrate over ≥3 LV segments in two cases. No recurrences occurred inside the PTV. Voltage measurements showed a significant decrease in both bipolar and unipolar signal amplitude after STAR. CONCLUSION STAR is a new tool available for the treatment of VT, allowing for a significant reduction of VT burden. VT recurrences are common during follow-up, but no recurrences were observed inside the PTV. Local efficacy was supported by a significant decrease in both bipolar and unipolar signal amplitude.
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Affiliation(s)
| | - Luis Schiappacasse
- Department of Radiation Oncology, CHUV, Lausanne University Hospital, Lausanne, Switzerland
| | - Raphaël Jumeau
- Department of Radiation Oncology, CHUV, Lausanne University Hospital, Lausanne, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, Universitätsspital Zürich, University Hospital Zürich, Zurich, Switzerland
| | - Nicolaus Andratschke
- Department of Radiation Oncology, Universitätsspital Zürich, University Hospital Zürich, Zurich, Switzerland
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | | | - Boldizsar Kovacs
- Department of Cardiology, Universitätsspital Zürich, University Hospital Zürich, Zurich, Switzerland
| | - Michael Mayinger
- Department of Radiation Oncology, Universitätsspital Zürich, University Hospital Zürich, Zurich, Switzerland
| | - Adrian Huber
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Joost J C Verhoeff
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Patrizio Pascale
- Department of Cardiology, CHUV, Lausanne University Hospital, Lausanne, Switzerland
| | - Jorge Solana Muñoz
- Department of Cardiology, CHUV, Lausanne University Hospital, Lausanne, Switzerland
| | - Adrian Luca
- Department of Cardiology, CHUV, Lausanne University Hospital, Lausanne, Switzerland
| | - Giulia Domenichini
- Department of Cardiology, CHUV, Lausanne University Hospital, Lausanne, Switzerland
| | - Raphael Moeckli
- Department of Radiation Oncology, CHUV, Lausanne University Hospital, Lausanne, Switzerland
| | - Jean Bourhis
- Department of Radiation Oncology, CHUV, Lausanne University Hospital, Lausanne, Switzerland
| | - Esat M Ozsahin
- Department of Radiation Oncology, CHUV, Lausanne University Hospital, Lausanne, Switzerland
| | - Etienne Pruvot
- Department of Cardiology, CHUV, Lausanne University Hospital, Lausanne, Switzerland
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19
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Mitacchione G, Schiavone M, Gasperetti A, Arabia G, Tundo F, Breitenstein A, Montemerlo E, Monaco C, Gulletta S, Palmisano P, Hofer D, Rovaris G, Dello Russo A, Biffi M, Pisanò ECL, Della Bella P, Di Biase L, Chierchia GB, Saguner AM, Tondo C, Curnis A, Forleo GB. Sex differences in leadless pacemaker implantation: A propensity-matched analysis from the i-LEAPER registry. Heart Rhythm 2023; 20:1429-1435. [PMID: 37481220 DOI: 10.1016/j.hrthm.2023.07.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 05/15/2023] [Revised: 07/13/2023] [Accepted: 07/17/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND The impact of sex in clinical and procedural outcomes in leadless pacemaker (LPM) patients has not yet been investigated. OBJECTIVE The purpose of this study was to investigate sex-related differences in patients undergoing LPM implantation. METHODS Consecutive patients enrolled in the i-LEAPER registry were analyzed. Comparisons between sexes were performed within the overall cohort using an adjusted analysis with 1:1 propensity matching for age and comorbidities. The primary outcome was the comparison of major complication rates. Sex-related differences regarding electrical performance and all-cause mortality during follow-up were deemed secondary outcomes. RESULTS In the overall population (n = 1179 patients; median age 80 years), 64.3% were men. After propensity matching, 738 patients with no significant baseline differences among groups were identified. During median follow-up of 25 [interquartile range 24-39] months, female sex was not associated with LPM-related major complications (hazard ratio [HR] 2.03; 95% confidence interval [CI] 0.70-5.84; P = .190) or all-cause mortality (HR 0.98; 95% CI 0.40-2.42; P = .960). LPM electrical performance results were comparable between groups, except for a higher pacing impedance in women at implant and during follow-up (24 months: 670 [550-800] Ω vs 616 [530-770] Ω; P = .014) that remained within normal limits. CONCLUSION In a real-world setting, we found differences in sex-related referral patterns for LPM implantation with an underrepresentation of women, although major complication rate and LPM performance were comparable between sexes. Female patients showed higher impedance values, which had no impact on overall device performance. Electrical parameters remained within normal limits in both groups during the entire follow-up.
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Affiliation(s)
| | - Marco Schiavone
- Department of Cardiology, Luigi Sacco University Hospital, Milan, Italy; Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Alessio Gasperetti
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Gianmarco Arabia
- Department of Cardiology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Fabrizio Tundo
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | | | - Cinzia Monaco
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium
| | - Simone Gulletta
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy
| | | | - Daniel Hofer
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Giovanni Rovaris
- Department of Cardiology, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Salesi-Lancisi", Ancona, Italy
| | - Mauro Biffi
- Department of Cardiology, IRCCS, Azienda Ospedaliero Universitaria Di Bologna, Policlinico S. Orsola, Bologna, Italy
| | - Ennio C L Pisanò
- U.O.S.V.D. Elettrofisiologia Cardiologica-Ospedale "V. Fazzi", Lecce, Italy
| | - Paolo Della Bella
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Luigi Di Biase
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Hospital, New York
| | - Gian Battista Chierchia
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ardan M Saguner
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Claudio Tondo
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Antonio Curnis
- Department of Cardiology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Giovanni B Forleo
- Department of Cardiology, Luigi Sacco University Hospital, Milan, Italy
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20
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Reiner MF, Schmidt D, Frischknecht L, Ruschitzka F, Duru F, Saguner AM. Case report of long-term postural tachycardia syndrome in a patient after messenger RNA coronavirus disease-19 vaccination with mRNA-1273. Eur Heart J Case Rep 2023; 7:ytad390. [PMID: 37650075 PMCID: PMC10464593 DOI: 10.1093/ehjcr/ytad390] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/27/2023] [Accepted: 08/08/2023] [Indexed: 09/01/2023]
Abstract
Background Postural tachycardia syndrome (POTS) is characterized by orthostatic intolerance and heart rate increase in an upright position without orthostatic hypotension. It has been described after coronavirus disease-19 (COVID-19) as well as after COVID-19 vaccination. Case summary A 54-year-old female patient presented with a 9-months history of severe orthostatic intolerance since COVID-19 vaccination with messenger RNA (mRNA)-1273 (Spikevax, Moderna). Except for diet-controlled coeliac disease, the patient was healthy, had no allergies, and did not take regular medication. Tilt table testing revealed a significant heart rate increase to 168 bpm without orthostatic hypotension accompanied by light-headedness, nausea, and syncope, findings consistent with POTS. Potential underlying causes including anaemia, thyroid dysfunction, adrenal insufficiency, pheochromocytoma, (auto)-immune disease, chronic inflammation as well as neurological causes were ruled out. Echocardiography and cardiac stress magnetic resonance imaging (MRI) did not detect structural or functional heart disease or myocardial ischaemia. Forty-eight-hour-electrocardiogram (ECG) showed no tachycardias other than sinus tachycardia. Finally, genomic analysis did not detect an inherited arrhythmia syndrome. Serologic analysis revealed adequate immune response to mRNA-1273 vaccination without signs of previous severe acute respiratory syndrome-coronavirus-2 infection. While ivabradine was not tolerated and metoprolol extended release only slightly improved symptoms, physical exercise reduced orthostatic intolerance moderately. At a 5-months follow-up, the patient remained dependant on assistance for activities of daily living. Discussion The temporal association of POTS with the COVID-19 vaccination in a previously healthy patient and the lack of evidence of an alternative aetiology suggests COVID-19 vaccination is the potential cause of POTS in this patient. To our knowledge, this is the first case reporting severe, long-term, and treatment-refractory POTS following COVID-19 vaccination with mRNA1273.
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Affiliation(s)
- Martin F Reiner
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Dörthe Schmidt
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Lukas Frischknecht
- Department of Immunology, University Hospital Zurich, Zurich, Switzerland
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Firat Duru
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
- Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
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21
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Hofer D, Regoli F, Saguner AM, Conte G, Jelisejevas J, Luce Caputo M, Graup V, Grazioli Gauthier L, Gasperetti A, Steffel J, Auricchio A, Breitenstein A. Efficacy and Safety of Leadless Pacemaker Implantation in Octogenarians. Cardiology 2023; 148:441-447. [PMID: 37487479 DOI: 10.1159/000532075] [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: 04/23/2023] [Accepted: 07/04/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION Long-term complication rates in standard transvenous pacemakers are reported around 4-12% with a higher incidence in the elderly population. We report our experience in octogenarians undergoing leadless pacemaker implantation in two large-volume centers in Switzerland. METHODS Consecutive patients undergoing leadless pacemaker implantation at two Swiss large volume centers (University Hospital Zurich, Zurich and Cardiocentro Ticino Institute, Lugano) between October 2015 and March 2020 were included in this retrospective analysis. Demographic information, clinical data, and procedural characteristics were recorded at the day of implantation and during follow-up. RESULTS Two hundred and twenty patients (mean age 80.6 ± 7.7 years, male 66%) were included. The main indication for pacemaker implantation was slow ventricular rate atrial fibrillation (111 of 220 patients, 50.4%). Out of the 220 patients, 124 (56.3%) were ≥80 years. Overall successful implantation rate was 98.6%. In the octogenarian population, the median procedure time (45 ± 20.2 min vs. 40 ± 19.6 min, p = 0.03) and radiation duration (6.1 ± 8.2 min vs. 5.0 ± 7.2 min, p = 0.03) were longer compared to patients <80 years. Major complications (2.7%, n = 6) and device measurements during follow-up were similar between patients ≥80 and <80 years. CONCLUSION Implantation of a leadless pacemaker device in octogenarians is safe and effective with a similarly low complication rate compared to non-octogenarians.
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Affiliation(s)
- Daniel Hofer
- Electrophysiology, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - François Regoli
- Cardiocentro Ticino Institute, Lugano, Switzerland
- Cardiology, San Giovanni Hospital, Bellinzona, Switzerland
| | - Ardan M Saguner
- Electrophysiology, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Giulio Conte
- Cardiocentro Ticino Institute, Lugano, Switzerland
| | - Julius Jelisejevas
- Electrophysiology, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Vera Graup
- Department of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Alessio Gasperetti
- Electrophysiology, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Jan Steffel
- Electrophysiology, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Alexander Breitenstein
- Electrophysiology, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
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22
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Regoli FD, Saguner AM, Auricchio A, Demarchi A, Pasotti E, Conte G, Caputo ML, Özkartal T, Breitenstein A. Peri-Procedural Management of Direct-Acting Oral Anticoagulants (DOACs) in Transcatheter Miniaturized Leadless Pacemaker Implantation. J Clin Med 2023; 12:4814. [PMID: 37510929 PMCID: PMC10381618 DOI: 10.3390/jcm12144814] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/07/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION Data on peri-operative management of direct-acting oral anticoagulants (DOACs) during transcatheter pacing leadless system (TPS) implantations remain limited. This study aimed to evaluate a standardized DOAC management regime consisting of interruption of a single dose prior to implantation and reinitiation within 6-24 h; also, patient clinical characteristics associated with this approach were identified. METHOD Consecutive patients undergoing standard TPS implantation procedures from two Swiss tertiary centers were included. DOAC peri-operative management included the standardized approach (Group 1A) or other approaches (Group 1B). RESULTS Three hundred and ninety-two pts (mean age 81.4 ± 7.3 years, 66.3% male, left ventricular ejection fraction 55.5 ± 9.6%) underwent TPS implantation. Two hundred and eighty-two pts (71.9%) were under anticoagulation therapy; 192 pts were treated with DOAC; 90 pts were under vitamin-K antagonist. Patients treated with DOAC less often had structural heart disease, diabetes mellitus, and advanced renal failure. The rate of major peri-procedural complications did not differ between groups 1A (n = 115) and 1B (n = 77) (2.6% and 3.8%, p = 0.685). Compared to 1B, 1A patients were implanted with TPS for slow ventricular rate atrial fibrillation (AF) (p = 0.002), in a better overall clinical status, and implanted electively (<0.001). CONCLUSIONS Standardized peri-procedural DOAC management was more often implemented for elective TPS procedures and did not seem to increase bleeding or thromboembolic adverse events.
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Affiliation(s)
- François Diederik Regoli
- Service of Cardiology, Hospital of San Giovanni, Cardiocentro Ticino Institute, 6500 Bellinzona, Switzerland
- Cardiology Department, Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
| | - Ardan M Saguner
- University Heart Center Zurich, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Angelo Auricchio
- Cardiology Department, Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
| | - Andrea Demarchi
- Cardiology Department, Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
| | - Elena Pasotti
- Cardiology Department, Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
| | - Giulio Conte
- Cardiology Department, Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
| | - Maria Luce Caputo
- Cardiology Department, Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
| | - Tardu Özkartal
- Cardiology Department, Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
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23
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Kornienko J, Rodríguez-Martínez M, Fenzl K, Hinze F, Schraivogel D, Grosch M, Tunaj B, Lindenhofer D, Schraft L, Kueblbeck M, Smith E, Mao C, Brown E, Owens A, Saguner AM, Meder B, Parikh V, Gotthardt M, Steinmetz LM. Mislocalization of pathogenic RBM20 variants in dilated cardiomyopathy is caused by loss-of-interaction with Transportin-3. Nat Commun 2023; 14:4312. [PMID: 37463913 DOI: 10.1038/s41467-023-39965-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 07/05/2023] [Indexed: 07/20/2023] Open
Abstract
Severe forms of dilated cardiomyopathy (DCM) are associated with point mutations in the alternative splicing regulator RBM20 that are frequently located in the arginine/serine-rich domain (RS-domain). Such mutations can cause defective splicing and cytoplasmic mislocalization, which leads to the formation of detrimental cytoplasmic granules. Successful development of personalized therapies requires identifying the direct mechanisms of pathogenic RBM20 variants. Here, we decipher the molecular mechanism of RBM20 mislocalization and its specific role in DCM pathogenesis. We demonstrate that mislocalized RBM20 RS-domain variants retain their splice regulatory activity, which reveals that aberrant cellular localization is the main driver of their pathological phenotype. A genome-wide CRISPR knockout screen combined with image-enabled cell sorting identified Transportin-3 (TNPO3) as the main nuclear importer of RBM20. We show that the direct RBM20-TNPO3 interaction involves the RS-domain, and is disrupted by pathogenic variants. Relocalization of pathogenic RBM20 variants to the nucleus restores alternative splicing and dissolves cytoplasmic granules in cell culture and animal models. These findings provide proof-of-principle for developing therapeutic strategies to restore RBM20's nuclear localization in RBM20-DCM patients.
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Affiliation(s)
- Julia Kornienko
- Genome Biology Unit, European Molecular Biology Laboratory (EMBL), Heidelberg, Germany
- Faculty of Biosciences, Heidelberg University, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
| | | | - Kai Fenzl
- Genome Biology Unit, European Molecular Biology Laboratory (EMBL), Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Florian Hinze
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Daniel Schraivogel
- Genome Biology Unit, European Molecular Biology Laboratory (EMBL), Heidelberg, Germany
| | - Markus Grosch
- Genome Biology Unit, European Molecular Biology Laboratory (EMBL), Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Brigit Tunaj
- Genome Biology Unit, European Molecular Biology Laboratory (EMBL), Heidelberg, Germany
| | - Dominik Lindenhofer
- Genome Biology Unit, European Molecular Biology Laboratory (EMBL), Heidelberg, Germany
| | - Laura Schraft
- Genome Biology Unit, European Molecular Biology Laboratory (EMBL), Heidelberg, Germany
| | - Moritz Kueblbeck
- Genome Biology Unit, European Molecular Biology Laboratory (EMBL), Heidelberg, Germany
| | - Eric Smith
- University of Michigan, Ann Arbor, MI, USA
| | - Chad Mao
- Children's Healthcare of Atlanta & Emory University, Atlanta, GA, USA
| | | | - Anjali Owens
- University of Pennsylvania, Philadelphia, PA, USA
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Benjamin Meder
- Cardiogenetics Center Heidelberg, Department of Cardiology, Angiology and Pulmology, University Hospital Heidelberg, Heidelberg, Germany
| | - Victoria Parikh
- Stanford Center for Inherited Cardiovascular Disease, Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael Gotthardt
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Lars M Steinmetz
- Genome Biology Unit, European Molecular Biology Laboratory (EMBL), Heidelberg, Germany.
- DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany.
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA.
- Stanford Genome Technology Center, Palo Alto, CA, USA.
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24
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Guan F, Saguner AM, Breitenstein A, Wang M, Molitor N, Brunckhorst C, Wolber T, Duru F. The effect of first step right atrial mapping (FRAM) on ablation duration and fluoroscopy exposure during cavotricuspid isthmus ablation of atrial flutter. Front Cardiovasc Med 2023; 10:1205966. [PMID: 37346289 PMCID: PMC10279846 DOI: 10.3389/fcvm.2023.1205966] [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: 04/14/2023] [Accepted: 05/22/2023] [Indexed: 06/23/2023] Open
Abstract
Aim To investigate the clinical significance of right atrial mapping prior to cavotricuspid isthmus (CTI) ablation in patients with typical atrial flutter (AFL). Methods Clinical and ablation parameters were retrospectively assessed and compared in patients undergoing CTI ablation with or without a first-step right atrial mapping (FRAM) by using the CARTO 3D mapping system. Results CTI block by radiofrequency ablation (RFA) was achieved in all 143 patients. In the FRAM group there was a shorter ablation duration and fluoroscopy exposure compared with the non-FRAM group. CHA2DS2-VASc score was associated with higher ablation durations, more ablation applications and increased fluoroscopy exposure. Body mass index (BMI) was associated with longer ablation duration and more ablation applications. Furthermore, patients with reduced left ventricular ejection fraction (LVEF) had longer ablation durations and more fluoroscopy exposure. One patient in the non-FRAM group developed cardiac effusion after ablation. None of the patients had recurrence after 6 months of follow-up. Conclusions Patients with high BMI, high CHA2DS2-VASc score and reduced LVEF may benefit from the FRAM approach by reducing ablation duration, number of ablation applications and fluoroscopy exposure.
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Affiliation(s)
- Fu Guan
- Cardiac Arrhythmia and Electrophysiology Division, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Ardan M. Saguner
- Cardiac Arrhythmia and Electrophysiology Division, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), University of Zurich, Schlieren, Switzerland
| | - Alexander Breitenstein
- Cardiac Arrhythmia and Electrophysiology Division, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Mia Wang
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States
| | - Nadine Molitor
- Cardiac Arrhythmia and Electrophysiology Division, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Corinna Brunckhorst
- Cardiac Arrhythmia and Electrophysiology Division, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Wolber
- Cardiac Arrhythmia and Electrophysiology Division, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
- Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Firat Duru
- Cardiac Arrhythmia and Electrophysiology Division, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), University of Zurich, Schlieren, Switzerland
- Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
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25
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Abumayyaleh M, Koepsel K, Aweimer A, Ewers A, Erath JW, Kuntz T, Klein N, Kovacs B, Duru F, Saguner AM, Blockhaus C, Shin DI, Gotzmann M, Lapp H, Beiert T, Mügge A, El-Battrawy I, Akin I. Characteristics and outcome of wearable cardioverter-defibrillator therapy stratified by gender: Insights from a multicenter international registry. J Cardiovasc Electrophysiol 2023; 34:1502-1505. [PMID: 37051873 DOI: 10.1111/jce.15905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/14/2023]
Affiliation(s)
- Mohammad Abumayyaleh
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research (DZHK)), Partner Site, Heidelberg/Mannheim, Heidelberg University, Mannheim, Germany
| | - Katharina Koepsel
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
| | - Assem Aweimer
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
| | - Aydan Ewers
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
| | - Julia W Erath
- Department of Cardiology/Division of Clinical Electrophysiology, University Hospital Frankfurt, Goethe University, Frankfurt, Hessen, Germany
| | - Thomas Kuntz
- Department of Arrhythmias & Invasive Cardiology, St. Georg Hospital, Leipzig, Germany
| | - Norbert Klein
- Department of Arrhythmias & Invasive Cardiology, St. Georg Hospital, Leipzig, Germany
| | - Boldizsar Kovacs
- Department of Cardiology, University Hospital Zurich, University Heart Center, Zurich, Switzerland
| | - Firat Duru
- Department of Cardiology, University Hospital Zurich, University Heart Center, Zurich, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Hospital Zurich, University Heart Center, Zurich, Switzerland
| | - Christian Blockhaus
- Department of Cardiology Heart Centre Niederrhein Helios Clinic Krefeld Germany, Krefeld, Germany
- School of Medicine, Faculty of Health, University Witten/Herdecke, Witten, Germany
| | - Dong-In Shin
- Department of Cardiology Heart Centre Niederrhein Helios Clinic Krefeld Germany, Krefeld, Germany
- School of Medicine, Faculty of Health, University Witten/Herdecke, Witten, Germany
| | - Michael Gotzmann
- University Hospital St. Josef-Hospital Bochum, Cardiology and Rhythmology, Ruhr University Bochum, Bochum, Germany
| | - Hendrik Lapp
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Thomas Beiert
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Andreas Mügge
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
- Department of Molecular and Experimental Cardiology, Institut für Forschung und Lehre (IFL), Ruhr-University Bochum, Bochum, Germany
| | - Ibrahim El-Battrawy
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
- Department of Molecular and Experimental Cardiology, Institut für Forschung und Lehre (IFL), Ruhr-University Bochum, Bochum, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research (DZHK)), Partner Site, Heidelberg/Mannheim, Heidelberg University, Mannheim, Germany
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26
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Krizanovic-Grgic I, Anwer S, Steffel J, Hofer D, Saguner AM, Spengler CM, Breitenstein A, Tanner FC. 3D Atrial Strain for Predicting Recurrence of Atrial Fibrillation after Pulmonary Vein Isolation. J Clin Med 2023; 12:jcm12113696. [PMID: 37297892 DOI: 10.3390/jcm12113696] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/12/2023] [Accepted: 05/18/2023] [Indexed: 06/12/2023] Open
Abstract
AIMS Association of two-(2D) and three-dimensional (3D) left atrial strain (LAS) and low-voltage area (LVA) with recurrence of atrial fibrillation (AF) after pulmonary vein isolation (PVI) was assessed. METHODS AND RESULTS 3D LAS, 2D LAS, and LVA were obtained in 93 consecutive patients undergoing PVI and recurrence of AF was analyzed prospectively. AF recurred in 12 patients (13%). The 3D left atrial reservoir strain (LARS) and pump strain (LAPS) were lower in patients with recurrent AF than without (p = 0.008 and p = 0.009, respectively). In univariable Cox regression, 3D LARS or LAPS were associated with recurrent AF (LARS: HR = 0.89 (0.81-0.99), p = 0.025; LAPS: HR = 1.40 (1.02-1.92), p = 0.040), while other values were not. Association of 3D LARS or LAPS with recurrent AF was independent of age, body mass index, arterial hypertension, left ventricular ejection fraction, and end-diastolic volume index and left atrial volume index in multivariable models. Kaplan-Meier curves revealed that patients with 3D LAPS < -5.9% did not exhibit recurrent AF, while those >-5.9% had a significant risk of recurrent AF. CONCLUSIONS 3D LARS and LAPS were associated with recurrent AF after PVI. Association of 3D LAS was independent of relevant clinical and echocardiographic parameters and improved their predictive value. Hence, they may be applied for outcome prediction in patients undergoing PVI.
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Affiliation(s)
- Iva Krizanovic-Grgic
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
- Exercise Physiology Laboratory, Institute of Human Movement Sciences and Sport, Swiss Federal Institute of Technology in Zurich (ETH Zürich), 8092 Zurich, Switzerland
| | - Shehab Anwer
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Jan Steffel
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Daniel Hofer
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Christina M Spengler
- Exercise Physiology Laboratory, Institute of Human Movement Sciences and Sport, Swiss Federal Institute of Technology in Zurich (ETH Zürich), 8092 Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, 8006 Zurich, Switzerland
| | - Alexander Breitenstein
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Felix C Tanner
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, 8006 Zurich, Switzerland
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Pohl GM, Göz M, Gaertner A, Brodehl A, Cimen T, Saguner AM, Schulze-Bahr E, Walhorn V, Anselmetti D, Milting H. Cardiomyopathy related desmocollin-2 prodomain variants affect the intracellular cadherin transport and processing. Front Cardiovasc Med 2023; 10:1127261. [PMID: 37273868 PMCID: PMC10235514 DOI: 10.3389/fcvm.2023.1127261] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 05/02/2023] [Indexed: 06/06/2023] Open
Abstract
Background Arrhythmogenic cardiomyopathy can be caused by genetic variants in desmosomal cadherins. Since cardiac desmosomal cadherins are crucial for cell-cell-adhesion, their correct localization at the plasma membrane is essential. Methods Nine desmocollin-2 variants at five positions from various public genetic databases (p.D30N, p.V52A/I, p.G77V/D/S, p.V79G, p.I96V/T) and three additional conserved positions (p.C32, p.C57, p.F71) within the prodomain were investigated in vitro using confocal microscopy. Model variants (p.C32A/S, p.V52G/L, p.C57A/S, p.F71Y/A/S, p.V79A/I/L, p.I96l/A) were generated to investigate the impact of specific amino acids. Results We revealed that all analyzed positions in the prodomain are critical for the intracellular transport. However, the variants p.D30N, p.V52A/I and p.I96V listed in genetic databases do not disturb the intracellular transport revealing that the loss of these canonical sequences may be compensated. Conclusion As disease-related homozygous truncating desmocollin-2 variants lacking the transmembrane domain are not localized at the plasma membrane, we predict that some of the investigated prodomain variants may be relevant in the context of arrhythmogenic cardiomyopathy due to disturbed intracellular transport.
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Affiliation(s)
- Greta Marie Pohl
- Erich & Hanna Klessmann-Institute for Cardiovascular Research and Development & Clinic for Thoracic and Cardiovascular Surgery, Heart- and Diabetes Center NRW, D-32545 Bad Oeynhausen, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Manuel Göz
- Experimental Biophysics and Applied Nanoscience, Faculty of Physics, University of Bielefeld, NRW, Bielefeld, Germany
| | - Anna Gaertner
- Erich & Hanna Klessmann-Institute for Cardiovascular Research and Development & Clinic for Thoracic and Cardiovascular Surgery, Heart- and Diabetes Center NRW, D-32545 Bad Oeynhausen, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Andreas Brodehl
- Erich & Hanna Klessmann-Institute for Cardiovascular Research and Development & Clinic for Thoracic and Cardiovascular Surgery, Heart- and Diabetes Center NRW, D-32545 Bad Oeynhausen, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Tolga Cimen
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Zürich, Switzerland
| | - Ardan M. Saguner
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Zürich, Switzerland
| | - Eric Schulze-Bahr
- Department of Cardiovascular Medicine, Institute for Genetics of Heart Diseases (IfGH), University Hospital Münster, Münster, Germany
| | - Volker Walhorn
- Experimental Biophysics and Applied Nanoscience, Faculty of Physics, University of Bielefeld, NRW, Bielefeld, Germany
| | - Dario Anselmetti
- Experimental Biophysics and Applied Nanoscience, Faculty of Physics, University of Bielefeld, NRW, Bielefeld, Germany
| | - Hendrik Milting
- Erich & Hanna Klessmann-Institute for Cardiovascular Research and Development & Clinic for Thoracic and Cardiovascular Surgery, Heart- and Diabetes Center NRW, D-32545 Bad Oeynhausen, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany
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28
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Tilz RR, Schmidt V, Pürerfellner H, Maury P, Chun KJ, Martinek M, Sohns C, Schmidt B, Mandel F, Gandjbakhch E, Laredo M, Gunawardene MA, Willems S, Beiert T, Borlich M, Iden L, Füting A, Spittler R, Gaspar T, Richter S, Schade A, Kuniss M, Neumann T, Francke A, Wunderlich C, Shin DI, Grosse Meininghaus D, Foresti M, Bonsels M, Reek D, Wiegand U, Bauer A, Metzner A, Eckardt L, Popescu SȘ, Krahnefeld O, Sticherling C, Kühne M, Nguyen DQ, Roten L, Saguner AM, Linz D, van der Voort P, Mulder BA, Vijgen J, Almorad A, Guenancia C, Fauchier L, Boveda S, De Greef Y, Da Costa A, Jais P, Derval N, Milhem A, Jesel L, Garcia R, Poty H, Khoueiry Z, Seitz J, Laborderie J, Mechulan A, Brigadeau F, Zhao A, Saludas Y, Piot O, Ahluwalia N, Martin C, Chen J, Antolic B, Leventopoulos G, Özcan EE, Yorgun H, Cay S, Yalin K, Botros MS, Mahmoud AT, Jędrzejczyk-Patej E, Inaba O, Okumura K, Ejima K, Khakpour H, Boyle N, Catanzaro JN, Reddy V, Mohanty S, Natale A, Blessberger H, Yang B, Stevens I, Sommer P, Veltmann C, Steven D, Vogler J, Kuck KH, Merino JL, Keelani A, Heeger CH. A worldwide survey on incidence, management and prognosis of oesophageal fistula formation following atrial fibrillation catheter ablation: The POTTER-AF study. Eur Heart J 2023:7123667. [PMID: 37062040 DOI: 10.1093/eurheartj/ehad250] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/25/2023] [Accepted: 04/14/2023] [Indexed: 04/17/2023] Open
Abstract
AIMS Oesophageal fistula represents a rare but dreadful complication of atrial fibrillation catheter ablation. Data on its incidence, management and outcome are sparse. METHODS AND RESULTS This international multicenter registry investigates the characteristics of oesophageal fistulae after treatment of atrial fibrillation by catheter ablation. A total of 553,729 catheter ablation procedures (radiofrequency: 62.9%, cryoballoon: 36.2%, other modalities: 0.9%) were performed at 214 centers in 35 countries. In 78 centers 138 patients (0.025%, radiofrequency: 0.038%, cryoballoon: 0.0015% (p<0.0001)) were diagnosed with an oesophageal fistula. Periprocedural data were available for 118 patients (85.5%). Following catheter ablation, the median time to symptoms and the median time to diagnosis were 18 (7.75, 25; range: 0-60) days and 21 (15, 29.5; range: 2-63) days, respectively. The median time from symptom onset to oesophageal fistula diagnosis was 3 (1, 9; range: 0-42) days. The most common initial symptom was fever (59.3%). The diagnosis was established by chest computed tomography in 80.2% of patients. Oesophageal surgery was performed in 47.4% and direct endoscopic treatment in 19.8%, and conservative treatment in 32.8% of patients. The overall mortality was 65.8%. Mortality following surgical (51.9%) or endoscopic treatment (56.5%) was significantly lower as compared to conservative management (89.5%) (odds ratio 7.463 (2.414, 23.072) p<0.001). CONCLUSIONS Oesophageal fistula after catheter ablation of atrial fibrillation is rare and occurs mostly with the use of radiofrequency energy rather than cryoenergy. Mortality without surgical or endoscopic intervention is exceedingly high.
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Affiliation(s)
- Roland Richard Tilz
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Vanessa Schmidt
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Germany
| | | | - Philippe Maury
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Kr Julian Chun
- MVZ CCB am Agaplesion Markus Krankenhaus, Frankfurt a.M., Germany
| | | | - Christian Sohns
- Kliniken für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum NRW, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Boris Schmidt
- MVZ CCB am Agaplesion Markus Krankenhaus, Frankfurt a.M., Germany
| | - Franck Mandel
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Estelle Gandjbakhch
- Sorbonne Université, APHP, Pitié Salpêtrière University Hospital, Cardiology Institute, Paris, France
| | - Mikael Laredo
- APHP, Pitié Salpêtrière University Hospital, Cardiology Institute, Paris, France
| | | | - Stephan Willems
- Klinik für Kardiologie und Internistische Intensivmedizin, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Thomas Beiert
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Martin Borlich
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg), Bad Segeberg, Schleswig-Holstein, Germany
| | - Leon Iden
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg), Bad Segeberg, Schleswig-Holstein, Germany
| | - Anna Füting
- Dept. of Electrophysiology, Alfred Krupp Hospital, EssenGermany
- Dept. Of Medicine, Witten/Herdecke University, Witten, Germany
| | - Raphael Spittler
- Department of Cardiology II/Electrophysiology, Center for Cardiology, University Hospital Mainz, Germany
| | - Thomas Gaspar
- Department of Internal and Cardiovascular Medicine, Herzzentrum Dresden, University Clinic, Technische Universität Dresden, Germany
| | - Sergio Richter
- Department of Internal and Cardiovascular Medicine, Herzzentrum Dresden, University Clinic, Technische Universität Dresden, Germany
| | - Anja Schade
- Department of Interventional Electrophysiology, Helios Hospital Erfurt, Erfurt, Germany
| | - Malte Kuniss
- Dept. of Cardiology Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Thomas Neumann
- Dept. of Cardiology Kerckhoff Heart Center, Bad Nauheim, Germany
| | | | | | - Dong-In Shin
- Department of Cardiology, Heart Centre Niederrhein, Helios Clinic Krefeld, Krefeld, Germany
- Faculty of Health, School of Medicine, University Witten/Herdecke, Witten, Germany
| | | | - Mike Foresti
- Kliniken Maria Hilf GmbH, Mönchengladbach, Germany
| | - Marc Bonsels
- Kliniken Maria Hilf GmbH, Mönchengladbach, Germany
| | - David Reek
- University Hospital Augsburg, Department of Cardiology, Augsburg, Germany
| | - Uwe Wiegand
- Sana-Klinikum Remscheid GmbH, Akademisches Lehrkrankenhaus der Universität zu Köln, Remscheid, Germany
| | - Alexander Bauer
- Diak-Klinikum Schwäbisch Hall und Klinikum Crailsheim, Schwäbisch Hall, Germany
| | - Andreas Metzner
- Universitäres Herz- und Gefäßzentrum, Klinik für Kardiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Lars Eckardt
- Department of Cardiology II (Electrophysiology), University Hospital Münster, Germany
| | - Sorin Ștefan Popescu
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Germany
| | | | | | - Michael Kühne
- Deaprtment of Cardiology, University Hospital Basel, Switzerland
| | | | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | | | - Bart A Mulder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Johan Vijgen
- Heart Center Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Alexandre Almorad
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | | | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Serge Boveda
- Cardiology - Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Y De Greef
- Department of Cardiology, ZNA Heart Centre, Antwerp, Belgium
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Antoine Da Costa
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
| | - Pierre Jais
- CHU Bordeaux, Univ. Bordeaux, IHU LIRYC ANR-10-IAHU-04, France
| | - Nicolas Derval
- CHU Bordeaux, Univ. Bordeaux, IHU LIRYC ANR-10-IAHU-04, France
| | | | | | | | | | | | | | | | | | | | | | | | | | - Nikhil Ahluwalia
- Barts Heart Centre, Barts Health NHS Trust, London, UK
- Wiliam Harvey Heart Centre, Queen Mary University of London, UK
| | | | - Jian Chen
- Department of Heart Disease, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Bor Antolic
- Department of Cardiology, University Medical Center Ljubljana, Slovenia
| | | | - Emin Evren Özcan
- Heart Rhythm Management Center, Dokuz Eylul University, Izmir, Turkey
| | - Hikmet Yorgun
- Hacettepe University, Department of Cardiology, Ankara, Turkey
| | - Serkan Cay
- Department of Cardiology, Division of Arrhythmia and Electrophysiology, University of Health Sciences, Yuksek Ihtisas Cardiovascular Building, Ankara City Hospital, Ankara, Turkey
| | - Kivanc Yalin
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Maichel Sobhy Botros
- Department of critical care medicine, Faculty of medicine, Cairo University, Cairo, Egypt
| | - Ahmed Taher Mahmoud
- Department of critical care medicine, Faculty of medicine, Cairo University, Cairo, Egypt
| | - Ewa Jędrzejczyk-Patej
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Osamu Inaba
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Japan
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Koichiro Ejima
- Department of Cardiology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | | | - Noel Boyle
- UCLA Cardiac Arrhythmia Center, Los Angeles, USA
| | - J N Catanzaro
- University of Florida Health, Jacksonville, Florida, USA
| | - Vivek Reddy
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
- International Electrophysiology, Scripps Clinic, San Diego, CA, USA
- Metro Health Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Bing Yang
- Department of Cardiology, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Irene Stevens
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Germany
| | - Philipp Sommer
- Kliniken für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum NRW, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | | | - Daniel Steven
- Department for Electrophysiology, Heart Center University Cologne, Cologne, Germany
| | - Julia Vogler
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Germany
| | - Karl-Heinz Kuck
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Germany
| | - José Luis Merino
- La Paz University Hospital, Universidad Autónoma de Madrid, Idipaz, Madrid, Spain
| | - Ahmad Keelani
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Germany
| | - Christian-H Heeger
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
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29
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Molitor N, Hofer D, Çimen T, Gasperetti A, Akdis D, Costa S, Jenni R, Breitenstein A, Wolber T, Winnik S, Fokstuen S, Fu G, Medeiros-Domingo A, Ruschitzka F, Brunckhorst C, Duru F, Saguner AM. Evolution and triggers of defibrillator shocks in patients with arrhythmogenic right ventricular cardiomyopathy. Heart 2023:heartjnl-2022-321739. [PMID: 36889907 DOI: 10.1136/heartjnl-2022-321739] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 02/13/2023] [Indexed: 03/10/2023] Open
Abstract
INTRODUCTION Implantable cardioverter-defibrillators (ICDs) can prevent sudden cardiac death due to ventricular arrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). The aim of our study was to assess the cumulative burden, evolution and potential triggers of appropriate ICD shocks during long-term follow-up, which may help to reduce and further refine individual arrhythmic risk in this challenging disease. METHODS This retrospective cohort study included 53 patients with definite ARVC according to the 2010 Task Force Criteria from the multicentre Swiss ARVC Registry with an implanted ICD for primary or secondary prevention. Follow-up was conducted by assessing all available patient records from patient visits, hospitalisations, blood samples, genetic analysis, as well as device interrogation and tracings. RESULTS Fifty-three patients (male 71.7%, mean age 43±2.2 years, genotype positive 58.5%) were analysed during a median follow-up of 7.9 (IQR 10) years. In 29 (54.7%) patients, 177 appropriate ICD shocks associated with 71 shock episodes occurred. Median time to first appropriate ICD shock was 2.8 (IQR 3.6) years. Long-term risk of shocks remained high throughout long-term follow-up. Shock episodes occurred mainly during daytime (91.5%, n=65) and without seasonal preference. We identified potentially reversible triggers in 56 of 71 (78.9%) appropriate shock episodes, the main triggers representing physical activity, inflammation and hypokalaemia. CONCLUSION The long-term risk of appropriate ICD shocks in patients with ARVC remains high during long-term follow-up. Ventricular arrhythmias occur more often during daytime, without seasonal preference. Reversible triggers are frequent with the most common triggers for appropriate ICD shocks being physical activity, inflammation and hypokalaemia in this patient population.
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Affiliation(s)
- Nadine Molitor
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Daniel Hofer
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Tolga Çimen
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Alessio Gasperetti
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.,Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, US
| | - Deniz Akdis
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.,Division of Cardiology, GZO - Regional Health Center, Wetzikon, Switzerland
| | - Sarah Costa
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Rolf Jenni
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Alexander Breitenstein
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Wolber
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.,Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
| | - Stephan Winnik
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Siv Fokstuen
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.,Genetic Medicine division, Diagnostic Department, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - Guan Fu
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | | | - Frank Ruschitzka
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Corinna Brunckhorst
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Firat Duru
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.,Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
| | - Ardan M Saguner
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
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30
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van der Voorn SM, Bourfiss M, Muller SA, Çimen T, Saguner AM, Duru F, te Riele ASJM, Remme CA, van Veen TAB. Circulating Biomarkers of Fibrosis Formation in Patients with Arrhythmogenic Cardiomyopathy. Biomedicines 2023; 11:biomedicines11030813. [PMID: 36979791 PMCID: PMC10045011 DOI: 10.3390/biomedicines11030813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/02/2023] [Accepted: 03/04/2023] [Indexed: 03/11/2023] Open
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a progressive inheritable disease which is characterized by a gradual fibro-(fatty) replacement of the myocardium. Visualization of diffuse and patchy fibrosis patterns is challenging using clinically applied cardiac imaging modalities (e.g., late gadolinium enhancement, LGE). During collagen synthesis and breakdown, carboxy–peptides are released into the bloodstream, specifically procollagen type-I carboxy-terminal propeptides (PICP) and collagen type-I carboxy-terminal telopeptides (ICTP). We collected the serum and EDTA blood samples and clinical data of 45 ACM patients (age 50.11 ± 15.53 years, 44% female), divided into 35 diagnosed ACM patients with a 2010 ARVC Task Force Criteria score (TFC) ≥ 4, and 10 preclinical variant carriers with a TFC < 4. PICP levels were measured using an enzyme-linked immune sorbent assay and ICTP levels with a radio immunoassay. Increased PICP/ICTP ratios suggest a higher collagen deposition. We found significantly higher PICP and PICP/ICTP levels in diagnosed patients compared to preclinical variant carriers (p < 0.036 and p < 0.027). A moderate negative correlation existed between right ventricular ejection fractions (RVEF) and the PICP/ICTP ratio (r = −0.46, p = 0.06). In addition, significant correlations with left ventricular function (LVEF r = −0.53, p = 0.03 and end-systolic volume r = 0.63, p = 0.02) were found. These findings indicate impaired contractile performance due to pro-fibrotic remodeling. Follow-up studies including a larger number of patients should be performed to substantiate our findings and the validity of those levels as potential promising biomarkers in ACM.
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Affiliation(s)
- Stephanie M. van der Voorn
- Department of Medical Physiology, Division Heart & Lungs, University Medical Center Utrecht, 3584 CM Utrecht, The Netherlands
| | - Mimount Bourfiss
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Steven A. Muller
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Tolga Çimen
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, CH-8091 Zurich, Switzerland
| | - Ardan M. Saguner
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, CH-8091 Zurich, Switzerland
| | - Firat Duru
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, CH-8091 Zurich, Switzerland
- Center for Integrative Human Physiology (ZIHP), University of Zurich, CH-8091 Zurich, Switzerland
| | - Anneline S. J. M. te Riele
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Carol Ann Remme
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Toon A. B. van Veen
- Department of Medical Physiology, Division Heart & Lungs, University Medical Center Utrecht, 3584 CM Utrecht, The Netherlands
- Correspondence: ; Tel.: +31-(0)88-75-589-08
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31
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Grehn M, Mandija S, Miszczyk M, Krug D, Tomasik B, Stickney KE, Alcantara P, Alongi F, Anselmino M, Aranda RS, Balgobind BV, Boda-Heggemann J, Boldt LH, Bottoni N, Cvek J, Elicin O, De Ferrari GM, Hassink RJ, Hazelaar C, Hindricks G, Hurkmans C, Iotti C, Jadczyk T, Jiravsky O, Jumeau R, Buus Kristiansen S, Levis M, López MA, Martí-Almor J, Mehrhof F, Møller DS, Molon G, Ouss A, Peichl P, Plasek J, Postema PG, Quesada A, Reichlin T, Rordorf R, Rudic B, Saguner AM, Ter Bekke RMA, Torrecilla JL, Troost EGC, Vitolo V, Andratschke N, Zeppenfeld K, Blamek S, Fast M, de Panfilis L, Blanck O, Pruvot E, Verhoeff JJC. STereotactic Arrhythmia Radioablation (STAR): the Standardized Treatment and Outcome Platform for Stereotactic Therapy Of Re-entrant tachycardia by a Multidisciplinary consortium (STOPSTORM.eu) and review of current patterns of STAR practice in Europe. Europace 2023; 25:1284-1295. [PMID: 36879464 PMCID: PMC10105846 DOI: 10.1093/europace/euac238] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/18/2022] [Indexed: 03/08/2023] Open
Abstract
The EU Horizon 2020 Framework-funded Standardized Treatment and Outcome Platform for Stereotactic Therapy Of Re-entrant tachycardia by a Multidisciplinary (STOPSTORM) consortium has been established as a large research network for investigating STereotactic Arrhythmia Radioablation (STAR) for ventricular tachycardia (VT). The aim is to provide a pooled treatment database to evaluate patterns of practice and outcomes of STAR and finally to harmonize STAR within Europe. The consortium comprises 31 clinical and research institutions. The project is divided into nine work packages (WPs): (i) observational cohort; (ii) standardization and harmonization of target delineation; (iii) harmonized prospective cohort; (iv) quality assurance (QA); (v) analysis and evaluation; (vi, ix) ethics and regulations; and (vii, viii) project coordination and dissemination. To provide a review of current clinical STAR practice in Europe, a comprehensive questionnaire was performed at project start. The STOPSTORM Institutions' experience in VT catheter ablation (83% ≥ 20 ann.) and stereotactic body radiotherapy (59% > 200 ann.) was adequate, and 84 STAR treatments were performed until project launch, while 8/22 centres already recruited VT patients in national clinical trials. The majority currently base their target definition on mapping during VT (96%) and/or pace mapping (75%), reduced voltage areas (63%), or late ventricular potentials (75%) during sinus rhythm. The majority currently apply a single-fraction dose of 25 Gy while planning techniques and dose prescription methods vary greatly. The current clinical STAR practice in the STOPSTORM consortium highlights potential areas of optimization and harmonization for substrate mapping, target delineation, motion management, dosimetry, and QA, which will be addressed in the various WPs.
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Affiliation(s)
- Melanie Grehn
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel 24105, Germany
| | - Stefano Mandija
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Marcin Miszczyk
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Ul. Wybrzeze Armii Krajowej, Gliwice 44102, Poland
| | - David Krug
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel 24105, Germany
| | - Bartłomiej Tomasik
- Department of Radiotherapy, Maria Skłodowska-Curie National Research Institute of Oncology, Ul. Wybrzeze Armii Krajowej, Gliwice 44102, Poland.,Department of Oncology and Radiotherapy, Faculty of Medicine, Medical University of Gdansk, M. Sklodowskiel-Curie 3a, Gdansk 80210, Poland
| | - Kristine E Stickney
- Research Support Office, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Pino Alcantara
- Department of Radiation Oncology, Hospital Clínico San Carlos, Faculty of Medicine, University Complutense of Madrid, Profesor Martin Lagos, Madrid 28040, Spain
| | - Filippo Alongi
- Department of Advanced Radiation Oncology, IRCCS Sacro Cuore Don Calabria Hospital, University of Brescia, Via San Zeno in Monte 23, Verona 37129, Italy
| | - Matteo Anselmino
- Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital, Via Giuseppe Verdi 8, Torino 10124, Italy.,Department of Medical Sciences, University of Turin, Via Verdi 8, Torino 10124, Italy
| | - Ricardo Salgado Aranda
- Electrophysiology Unit, Department of Cardiology, Hospital Clínico San Carlos Madrid, Professor Martin Lagos, Madrid 28040, Spain
| | - Brian V Balgobind
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Meibergdreef 15, Amsterdam 1105AZ, The Netherlands
| | - Judit Boda-Heggemann
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim 68167, Germany
| | - Leif-Hendrik Boldt
- Department of Rhythmology, Charité-University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Nicola Bottoni
- Cardiology Arrhythmology Center, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, Reggio Emilia 42100, Italy
| | - Jakub Cvek
- Department of Oncology, University Hospital and Faculty of Medicine, Listopadu 1790, Ostrava Poruba 70852, Czech Republic
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, Bern 3010, Switzerland
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital, Via Giuseppe Verdi 8, Torino 10124, Italy
| | - Rutger J Hassink
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Colien Hazelaar
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, P. Debyelaan 25, Maastricht 6229 HX, The Netherlands
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany
| | - Coen Hurkmans
- Department of Radiation Oncology, Catharina Hospital, Michelangelolaan 2, Eindhoven 5623 EJ, The Netherlands
| | - Cinzia Iotti
- Radiation Oncology Unit, Clinical Cancer Centre, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, Reggio Emilia 42100, Italy
| | - Tomasz Jadczyk
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ul. Poniatowskiego 15, Katowice 40055, Poland.,Interventional Cardiac Electrophysiology Group, International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Otakar Jiravsky
- Cardiocenter, Hospital Agel Trinec Podlesi and Masaryk University, Konska 453, Trinec 73961, Czech Republic
| | - Raphaël Jumeau
- Department of Radio-Oncology, Lausanne University Hospital, Rue du Bugnon 21, Lausanne 1011, Switzerland
| | - Steen Buus Kristiansen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus 8200, Denmark
| | - Mario Levis
- Department of Oncology, University of Torino, Via Giuseppe Verdi 8, Torino 10124, Italy
| | - Manuel Algara López
- Department of Radiation Oncology, Hospital del Mar, Universitat Pompeu Fabra, Institut Hospital del Mar d'Investigacions Mèdiques, Paseo Maritim 25-29, Barcelona 08003, Spain
| | - Julio Martí-Almor
- Department of Cardiology, Hospital del Mar, Universitat Pompeu Fabra, Institut Hospital del Mar d'Investigacions Mèdiques, Paseo Maritim 25-29, Barcelona 08003, Spain
| | - Felix Mehrhof
- Department for Radiation Oncology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Ditte Sloth Møller
- Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus 8200, Denmark
| | - Giulio Molon
- Department of Cardiology, IRCCS Sacro Cuore Don Calabria Hospital, Via San Zeno in Monte 23, Verona 37129, Italy
| | - Alexandre Ouss
- Department of Cardiology, Catharina Hospital, Michelangelolaan 2, Eindhoven 5623 EJ, The Netherlands
| | - Petr Peichl
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Videnska 9, Prague 14000, Czech Republic
| | - Jiri Plasek
- Department of Cardiovascular Medicine, University Hospital Ostrava, Listopadu 1790. Ostrava Poruba 70852, Czech Republic
| | - Pieter G Postema
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 15, Amsterdam 1105AZ, The Netherlands
| | - Aurelio Quesada
- Arrhythmia Unit, Department of Cardiology, Consorcio Hospital General Universitario de Valencia, Av Tres Cruces 2, Valencia 46014, Spain
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, Bern 3010, Switzerland
| | - Roberto Rordorf
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Camillo Golgi Avenue 5, Pavia 27100, Italy
| | - Boris Rudic
- Department of Medicine I, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim 68167, Germany
| | - Ardan M Saguner
- Arrhythmia Unit, Department of Cardiology, University Hospital Zurich, Ramistrasse 71, Zurich 8006, Switzerland
| | - Rachel M A Ter Bekke
- Department of Cardiology, Maastricht University Medical Center, P. Debyelaan 25, Maastricht 6229 HX, The Netherlands
| | - José López Torrecilla
- Department of Radiation Oncology, Hospital General Valencia, Av Tres Cruces 2, Valencia 46014, Spain
| | - Esther G C Troost
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, Dresden 01307, Germany.,OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus. Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstrasse 74, Dresden 01307, Germany.,Institute of Radiooncology - OncoRay, Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstr. 400, Dresden 01328, Germany
| | - Viviana Vitolo
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Strada Campeggi 53, Pavia PV27100, Italy
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital of Zurich, Ramistrasse 71, Zurich 8006, Switzerland
| | - Katja Zeppenfeld
- Unit of Clinical Electrophysiology, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, The Netherlands
| | - Slawomir Blamek
- Department of Radiotherapy, Maria Skłodowska-Curie National Research Institute of Oncology, Ul. Wybrzeze Armii Krajowej, Gliwice 44102, Poland
| | - Martin Fast
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Ludovica de Panfilis
- Bioethics Unit, Azienda Unità Sanitaria Locale-IRCCS, Via Amendola 2, Reggio Emilia 42100, Italy
| | - Oliver Blanck
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel 24105, Germany
| | - Etienne Pruvot
- Heart and Vessel Department, Service of Cardiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 21, Lausanne 1011, Switzerland
| | - Joost J C Verhoeff
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
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Guan F, Wolber T, Saguner AM, Medeiros A, Müggler O, Berger F, Gass M, Molitor N, Ruschitzka F, Brunckhorst C, Duru F. A Desmoplakin Variant Associated with Isolated Arrhythmogenic Left Ventricular Cardiomyopathy with Rapid Monomorphic Ventricular Tachycardia at First Presentation. HeartRhythm Case Rep 2023. [DOI: 10.1016/j.hrcr.2023.03.017] [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: 03/30/2023] Open
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33
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Mitacchione G, Schiavone M, Gasperetti A, Arabia G, Breitenstein A, Cerini M, Palmisano P, Montemerlo E, Ziacchi M, Gulletta S, Salghetti F, Russo G, Monaco C, Mazzone P, Hofer D, Tundo F, Rovaris G, Russo AD, Biffi M, Pisanò ECL, Chierchia GB, Della Bella P, de Asmundis C, Saguner AM, Tondo C, Forleo GB, Curnis A. Outcomes of leadless pacemaker implantation following transvenous lead extraction in high-volume referral centers: Real-world data from a large international registry. Heart Rhythm 2023; 20:395-404. [PMID: 36496135 DOI: 10.1016/j.hrthm.2022.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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: 10/10/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Limited data on the real-world safety and efficacy of leadless pacemakers (LPMs) post-transvenous lead extraction (TLE) are available. OBJECTIVE The purpose of this study was to assess the long-term safety and effectiveness of LPMs following TLE in comparison with LPMs de novo implantation. METHODS Consecutive patients who underwent LPM implantation in 12 European centers joining the International LEAdless PacemakEr Registry were enrolled. The primary end point was the comparison of LPM-related complication rate at implantation and during follow-up (FU) between groups. Differences in electrical performance were deemed secondary outcomes. RESULTS Of the 1179 patients enrolled, 15.6% underwent a previous TLE. During a median FU of 33 (interquartile range 24-47) months, LPM-related major complications and all-cause mortality did not differ between groups (TLE group: 1.6% and 5.4% vs de novo group: 2.2% and 7.8%; P = .785 and P = .288, respectively). Pacing threshold (PT) was higher in the TLE group at implantation and during FU, with very high PT (>2 V@0.24 ms) patients being more represented than in the de novo implantation group (5.4% vs 1.6 %; P = .004). When the LPM was deployed at a different right ventricular (RV) location than the one where the previous transvenous RV lead was extracted, a lower proportion of high PT (>1-2 V@0.24 ms) patients at implantation, 1-month FU, and 12-month FU (5.9% vs 18.2%, P = .012; 3.4% vs 12.9%, P = .026; and 4.3% vs 14.5%, P = .037, respectively) was found. CONCLUSION LPMs showed a satisfactory safety and efficacy profile after TLE. Better electrical parameters were obtained when LPMs were implanted at a different RV location than the one where the previous transvenous RV lead was extracted.
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Affiliation(s)
- Gianfranco Mitacchione
- Department of Cardiology, Spedali Civili Hospital, University of Brescia, Brescia, Italy; Department of Cardiology, Luigi Sacco University Hospital, Milan, Italy.
| | - Marco Schiavone
- Department of Cardiology, Luigi Sacco University Hospital, Milan, Italy; Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | - Gianmarco Arabia
- Department of Cardiology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | | | - Manuel Cerini
- Department of Cardiology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | | | | | - Matteo Ziacchi
- Department of Cardiology, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Simone Gulletta
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Francesca Salghetti
- Department of Cardiology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Giulia Russo
- U.O.S.V.D. Elettrofisiologia Cardiologica - Ospedale "V. Fazzi," Lecce, Italy
| | - Cinzia Monaco
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Patrizio Mazzone
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Daniel Hofer
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Fabrizio Tundo
- Heart Rhythm Center, IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - Giovanni Rovaris
- Department of Cardiology, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Salesi-Lancisi," Ancona, Italy
| | - Mauro Biffi
- Department of Cardiology, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Ennio C L Pisanò
- U.O.S.V.D. Elettrofisiologia Cardiologica - Ospedale "V. Fazzi," Lecce, Italy
| | - Gian Battista Chierchia
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Paolo Della Bella
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ardan M Saguner
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Claudio Tondo
- Heart Rhythm Center, IRCCS Centro Cardiologico Monzino, Milan, Italy; Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Salesi-Lancisi," Ancona, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Giovanni B Forleo
- Department of Cardiology, Luigi Sacco University Hospital, Milan, Italy
| | - Antonio Curnis
- Department of Cardiology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
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Çimen T, Medeiros-Domingo A, Kolios A, Akdiş D, Anwer S, Tanner FC, Brunckhorst C, Duru F, Saguner AM. A Novel Heterozygous Desmoplakin Variant Causes Cardiocutaneous Syndrome with Arrhythmogenic Cardiomyopathy and Palmoplantar Keratosis. J Clin Med 2023; 12:jcm12030913. [PMID: 36769561 PMCID: PMC9917917 DOI: 10.3390/jcm12030913] [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: 12/16/2022] [Revised: 01/16/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
Cardiocutaneous syndrome (CCS) is often caused by genetic variants in desmoplakin (DSP) in the presence of thick calluses on the hands and soles of the feet (palmoplantar keratoderma) in combination with arrhythmogenic cardiomyopathy. In this case report, we describe a 58-year-old man presenting with a history of cardiomyopathy with recurrent sustained ventricular tachycardia and palmoplantar keratosis. The cardiological evaluation showed biventricular cardiomyopathy, and repeated genetic testing identified a novel DSP variant. Repeated genetic testingis clinically meaningful in patients with a high probability of a specific inherited cardiac disease, such as CCS, particularly if molecular screening has been performed in the pre-NGS era with an incomplete NGS panel or outdated technology as presented in this case report.
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Affiliation(s)
- Tolga Çimen
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
| | | | - Antonios Kolios
- Department of Dermatology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Deniz Akdiş
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Shehab Anwer
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Felix C. Tanner
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Corinna Brunckhorst
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Firat Duru
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
- Center for Integrative Human Physiology (ZIHP), University of Zurich, 8057 Zurich, Switzerland
| | - Ardan M. Saguner
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
- Correspondence: ; Tel.: +41-(0)44-255-2111
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Gulletta S, Schiavone M, Gasperetti A, Breitenstein A, Palmisano P, Mitacchione G, Chierchia GB, Montemerlo E, Statuto G, Russo G, Casella M, Vitali F, Mazzone P, Hofer D, Arabia G, Moltrasio M, Lipartiti F, Fierro N, Bertini M, Dello Russo A, Pisanò ECL, Biffi M, Rovaris G, de Asmundis C, Tondo C, Curnis A, Della Bella P, Saguner AM, Forleo GB. Peri-procedural and mid-term follow-up age-related differences in leadless pacemaker implantation: Insights from a multicenter European registry. Int J Cardiol 2023; 371:197-203. [PMID: 36115442 DOI: 10.1016/j.ijcard.2022.09.026] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/08/2022] [Accepted: 09/12/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Age-related differences on leadless pacemaker (LP) are poorly described. Aim of this study was to compare clinical indications, periprocedural and mid-term device-associated outcomes in a large real-world cohort of LP patients, stratified by age at implantation. METHODS Two cohorts of younger and older patients (≤50 and > 50 years old) were retrieved from the iLEAPER registry. The primary outcome was to compare the underlying indication why a LP was preferred over a transvenous PM across the two cohorts. Rates of peri-procedural and mid-term follow-up major complications as well as LP electrical performance were deemed secondary outcomes. RESULTS 1154 patients were enrolled, with younger patients representing 6.2% of the entire cohort. Infective and vascular concerns were the most frequent characteristics that led to a LP implantation in the older cohort (45.8% vs 67.7%, p < 0.001; 4.2% vs 16.4%, p = 0.006), while patient preference was the leading cause to choose a LP in the younger (47.2% vs 5.6%, p < 0.001). Median overall procedural (52 [40-70] vs 50 [40-65] mins) and fluoroscopy time were similar in both groups. 4.3% of patients experienced periprocedural complications, without differences among groups. Threshold values were higher in the younger, both at discharge and at last follow-up (0.63 [0.5-0.9] vs 0.5 [0.38-0-7] V, p = 0.004). CONCLUSION When considering LP indications, patient preference was more common in younger, while infective and vascular concerns were more frequent in the older cohort. Rates of device-related complications did not differ significantly. Younger patients tended to have a slightly higher pacing threshold at mid-term follow-up.
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Affiliation(s)
- Simone Gulletta
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, IT, Italy
| | - Marco Schiavone
- Cardiology Unit, Luigi Sacco University Hospital, Milan, IT, Italy; Department of Systems Medicine, University of Rome Tor Vergata, Rome, IT, Italy
| | - Alessio Gasperetti
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCSS, Milan, IT, Italy.
| | | | | | - Gianfranco Mitacchione
- Department of Cardiology, Spedali Civili Hospital, University of Brescia, Brescia, IT, Italy
| | - Gian Battista Chierchia
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, BE, Belgium
| | | | - Giovanni Statuto
- Department of Cardiology, IRCCS, Azienda Ospedaliero Universitaria Di Bologna, Policlinico Di S.Orsola, Bologna, IT, Italy
| | - Giulia Russo
- U.O.S.V.D. Elettrofisiologia Cardiologica - Ospedale "V. Fazzi", Lecce, IT, Italy
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Salesi-Lancisi", Ancona, IT, Italy
| | - Francesco Vitali
- Cardiology Unit, Sant'Anna University Hospital, University of Ferrara, Ferrara, IT, Italy
| | - Patrizio Mazzone
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, IT, Italy
| | - Daniel Hofer
- University Hospital Zurich, Zurich, CH, Switzerland
| | - Gianmarco Arabia
- Department of Cardiology, Spedali Civili Hospital, University of Brescia, Brescia, IT, Italy
| | - Massimo Moltrasio
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCSS, Milan, IT, Italy
| | - Felicia Lipartiti
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, BE, Belgium
| | - Nicolai Fierro
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, IT, Italy
| | - Matteo Bertini
- Cardiology Unit, Sant'Anna University Hospital, University of Ferrara, Ferrara, IT, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Salesi-Lancisi", Ancona, IT, Italy
| | - Ennio C L Pisanò
- U.O.S.V.D. Elettrofisiologia Cardiologica - Ospedale "V. Fazzi", Lecce, IT, Italy
| | - Mauro Biffi
- Department of Cardiology, IRCCS, Azienda Ospedaliero Universitaria Di Bologna, Policlinico Di S.Orsola, Bologna, IT, Italy
| | - Giovanni Rovaris
- Department of Cardiology, ASST Monza, San Gerardo Hospital, Monza, IT, Italy
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, BE, Belgium
| | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCSS, Milan, IT, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, IT, Italy
| | | | - Paolo Della Bella
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, IT, Italy
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Mayinger M, Boda-Heggemann J, Mehrhof F, Krug D, Hohmann S, Xie J, Ehrbar S, Kovacs B, Merten R, Grehn M, Zaman A, Fleckenstein J, Kaestner L, Buergy D, Rudic B, Kluge A, Boldt LH, Dunst J, Bonnemeier H, Saguner AM, Andratschke N, Blanck O, Schweikard A. Quality assurance process within the RAdiosurgery for VENtricular TAchycardia (RAVENTA) trial for the fusion of electroanatomical mapping and radiotherapy planning imaging data in cardiac radioablation. Phys Imaging Radiat Oncol 2022; 25:100406. [PMID: 36655216 PMCID: PMC9841340 DOI: 10.1016/j.phro.2022.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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] [Received: 10/09/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 12/27/2022] Open
Abstract
A novel quality assurance process for electroanatomical mapping (EAM)-to-radiotherapy planning imaging (RTPI) target transport was assessed within the multi-center multi-platform framework of the RAdiosurgery for VENtricular TAchycardia (RAVENTA) trial. A stand-alone software (CARDIO-RT) was developed to enable platform independent registration of EAM and RTPI of the left ventricle (LV), based on pre-generated radiotherapy contours (RTC). LV-RTC were automatically segmented into the American-Heart-Association 17-segment-model and a manual 3D-3D method based on EAM 3D-geometry data and a semi-automated 2D-3D method based on EAM screenshot projections were developed. The quality of substrate transfer was evaluated in five clinical cases and the structural analyses showed substantial differences between manual target transfer and target transport using CARDIO-RT.
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Affiliation(s)
- Michael Mayinger
- Department of Radiation Oncology, University Hospital Zürich, University of Zürich, Zürich, Switzerland,Corresponding author.
| | - Judit Boda-Heggemann
- Department of Radiation Oncology, University Medicine Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Felix Mehrhof
- Department of Radiation Oncology, Charité University Medicine Berlin, Berlin, Germany
| | - David Krug
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Stephan Hohmann
- Department of Cardiology and Angiology, Hannover Heart Rhythm Center, Hannover Medical School, Hannover, Germany
| | - Jingyang Xie
- Institute for Robotics and Cognitive Systems, Univesity of Lübeck, Lübeck, Germany
| | - Stefanie Ehrbar
- Department of Radiation Oncology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Boldizsar Kovacs
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Switzerland
| | - Roland Merten
- Department of Radiotherapy, Hannover Medical School, Hannover, Germany
| | - Melanie Grehn
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Adrian Zaman
- Department of Internal Medicine III, Section for Electrophysiology und Rhythmology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Jens Fleckenstein
- Department of Radiation Oncology, University Medicine Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Lena Kaestner
- Department of Radiation Oncology, University Medicine Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Daniel Buergy
- Department of Radiation Oncology, University Medicine Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Boris Rudic
- Medizinische Klinik I, Abteilung für Elektrophysiologie und Rhythmologie, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Anne Kluge
- Department of Radiation Oncology, Charité University Medicine Berlin, Berlin, Germany
| | - Leif-Hendrik Boldt
- Department of Cardiology, University Medicine Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Jürgen Dunst
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Hendrik Bonnemeier
- Department of Internal Medicine III, Section for Electrophysiology und Rhythmology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Ardan M. Saguner
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Switzerland
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Oliver Blanck
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Achim Schweikard
- Institute for Robotics and Cognitive Systems, Univesity of Lübeck, Lübeck, Germany
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Çimen T, Wilzeck VC, Montrasio G, Bonetti NR, Medeiros-Domingo A, Grebmer C, Matter CM, Tanner FC, Manka R, Brunckhorst CB, Duru F, Saguner AM. Biventricular Arrhythmogenic Cardiomyopathy Associated with a Novel Heterozygous Plakophilin-2 Early Truncating Variant. J Clin Med 2022; 11:jcm11247513. [PMID: 36556128 PMCID: PMC9782591 DOI: 10.3390/jcm11247513] [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: 11/22/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) is a hereditary condition that can cause sudden cardiac death in young, frequently athletic individuals under the age of 35 due to malignant arrhythmias. Competitive and endurance exercise may hasten the onset and progression of ARVC, leading to right ventricular dysfunction and potentially fatal ventricular arrhythmias earlier in life. In this article, we present a novel, pathogenic, early truncating heterozygous variant in the PKP2 gene that causes biventricular arrhythmogenic cardiomyopathy and affects a family, of which the only member with the positive phenotype is a competitive endurance athlete.
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Affiliation(s)
- Tolga Çimen
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Verena C. Wilzeck
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Giulia Montrasio
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Nicole R. Bonetti
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
| | | | - Christian Grebmer
- Department of Cardiology, Luzerner Kantonsspital, 6000 Lucerne, Switzerland
| | - Christian M. Matter
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Felix C. Tanner
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Robert Manka
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Corinna B. Brunckhorst
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Firat Duru
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
- Center for Integrative Human Physiology, University of Zurich, 8091 Zurich, Switzerland
| | - Ardan M. Saguner
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
- Correspondence: ; Tel.: +41-(0)44-255-2111
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Feher M, Saguner AM, Kirstein B, Vogler J, Eitel C, Phan HL, Keelani A, Cimen T, Hatahet S, Trajanoski D, Samara O, Kuck KH, Tilz RR, Heeger CH. Safety and Feasibility of Catheter Ablation Procedures in Patients with Bleeding Disorders. J Clin Med 2022; 11:jcm11236956. [PMID: 36498531 PMCID: PMC9739729 DOI: 10.3390/jcm11236956] [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: 10/14/2022] [Revised: 11/14/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Aims/Objectives: Patients with bleeding disorders are a rare and complex population in catheter ablation (CA) procedures. The most common types of bleeding disorders are von Willebrand disease (VWD) and hemophilia A (HA). Patients with VWD or HA tend to have a higher risk of bleeding complications compared to other patients. There is a lack of data concerning peri- and postinterventional coagulation treatment. We sought to assess the optimal management of patients with VWD and HA referred for catheter ablation procedures. Methods and Results: In this study, we analyzed patients with VWD or HA undergoing CA procedures at two centers in Germany and Switzerland between 2016 and 2021. Clotting factors were administered in conjunction with hemostaseological recommendations. CA was performed as per the institutional standard. During the procedure, unfractionated heparin (UFH) was given intravenously with respect to the activated clotting time (ACT). Primary endpoints included the feasibility of the procedure, bleeding complications, and thromboembolic events during the procedure. Secondary endpoints included bleeding complications and thromboembolic events up to one year after catheter ablation. A total of seven patients (three VWD Type I, one VWD Type IIa, three HA) underwent 10 catheter ablation procedures (pulmonary vein isolation (PVI): two × radiofrequency (RF), one × laser balloon (LB), one × cryoballoon (CB); PVI + cavotricuspid isthmus (CTI): one × RF; PVI + left atrial appendage isolation (LAAI): one × RF; Premature ventricular contraction (PVC): three × RF; Atrioventricular nodal reentrant tachycardia (AVNRT): one × RF). VWD patients received 2000−3000 IE Wilate i.v. 30 to 45 min prior to ablation. Patients with HA received 2000−3000 IE factor VIII before the procedure. All patients undergoing PVI received UFH (cumulative dose 9000−18,000 IE) with a target ACT of >300 s. All patients after PVI were started on oral anticoagulation (OAC) 12 h after ablation. Two patients received aspirin (acetylsalicylic acid; ASA) for 4 weeks after the ablation of left-sided PVCs. No anticoagulation was prescribed after slow pathway modulation in a case with AVNRT. No bleeding complications or thromboembolic events were reported. During a follow-up of one year, one case of gastrointestinal bleeding occurred following OAC withdrawal after LAA occlusion. Conclusions: After the substitution of clotting factors, catheter ablation in patients with VWD and HA seems to be safe and feasible.
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Affiliation(s)
- Marcel Feher
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Ardan M. Saguner
- Department of Cardiology, Universitätsspital Zurich, 8091 Zurich, Switzerland
| | - Bettina Kirstein
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Julia Vogler
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Charlotte Eitel
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Huong-Lan Phan
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Ahmad Keelani
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Tolga Cimen
- Department of Cardiology, Universitätsspital Zurich, 8091 Zurich, Switzerland
| | - Sascha Hatahet
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Darko Trajanoski
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Omar Samara
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Karl-Heinz Kuck
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
- LANS Cardio, 20354 Hamburg, Germany
| | - Roland R. Tilz
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
- LANS Cardio, 20354 Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Lübeck, 20246 Hamburg, Germany
| | - Christian-H. Heeger
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Lübeck, 20246 Hamburg, Germany
- Correspondence: ; Tel.: +49-451-500-75293
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Heeger CH, Popescu SȘ, Sohns C, Pott A, Metzner A, Inaba O, Straube F, Kuniss M, Aryana A, Miyazaki S, Cay S, Ehrlich JR, El-Battrawy I, Martinek M, Saguner AM, Tscholl V, Yalin K, Lyan E, Su W, Papiashvili G, Botros MSN, Gasperetti A, Proietti R, Wissner E, Scherr D, Kamioka M, Makimoto H, Urushida T, Aksu T, Chun JKR, Aytemir K, Jędrzejczyk-Patej E, Kuck KH, Dahme T, Steven D, Sommer P, Tilz RR. Impact of cryoballoon application abortion due to phrenic nerve injury on reconnection rates: a YETI subgroup analysis. Europace 2022; 25:374-381. [PMID: 36414239 PMCID: PMC9935004 DOI: 10.1093/europace/euac212] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Received: 06/25/2022] [Accepted: 09/30/2022] [Indexed: 11/24/2022] Open
Abstract
AIMS Cryoballoon (CB)-based pulmonary vein isolation (PVI) is an effective treatment for atrial fibrillation (AF). The most frequent complication during CB-based PVI is right-sided phrenic nerve injury (PNI) which is leading to premature abortion of the freeze cycle. Here, we analysed reconnection rates after CB-based PVI and PNI in a large-scale population during repeat procedures. METHODS AND RESULTS In the YETI registry, a total of 17 356 patients underwent CB-based PVI in 33 centres, and 731 (4.2%) patients experienced PNI. A total of 111/731 (15.2%) patients received a repeat procedure for treatment of recurrent AF. In 94/111 (84.7%) patients data on repeat procedures were available. A total of 89/94 (94.7%) index pulmonary veins (PVs) have been isolated during the initial PVI. During repeat procedures, 22 (24.7%) of initially isolated index PVs showed reconnection. The use of a double stop technique did non influence the PV reconnection rate (P = 0.464). The time to PNI was 140.5 ± 45.1 s in patients with persistent PVI and 133.5 ± 53.8 s in patients with reconnection (P = 0.559). No differences were noted between the two populations in terms of CB temperature at the time of PNI (P = 0.362). The only parameter associated with isolation durability was CB temperature after 30 s of freezing. The PV reconnection did not influence the time to AF recurrence. CONCLUSION In patients with cryoballon application abortion due to PNI, a high rate of persistent PVI rate was found at repeat procedures. Our data may help to identify the optimal dosing protocol in CB-based PVI procedures. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT03645577?term=YETI&cntry=DE&draw=2&rank=1 ClinicalTrials.gov Identifier: NCT03645577.
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Affiliation(s)
- Christian-H Heeger
- Corresponding author. Tel: +49 451 500 75293; Fax: +49 451 500 44585. E-mail address: ;
| | | | - Christian Sohns
- Klinik für Rhythmology, Herz- und Diabeteszentrum NRW, Bad Oeynhausen, Germany
| | | | - Andreas Metzner
- Asklepios Klinik St. Georg, Hamburg, Germany,Asklepios Klinik Harburg, Hamburg, Germany,University Heart Center Hamburg, Germany
| | - Osamu Inaba
- Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Florian Straube
- München Klinik Bogenhausen und Schwabing, Klinik für Kardiologie und Internistische Intensivmedizin, München, Germany,Faculty Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany
| | | | - Arash Aryana
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, CA, USA
| | | | - Serkan Cay
- Department of Cardiology, Division of Arrhythmia and Electrophysiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | | | - Ibrahim El-Battrawy
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
| | | | - Ardan M Saguner
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Switzerland
| | - Verena Tscholl
- Charité—Universitaetsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Kivanc Yalin
- Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | | | | | | | | | - Alessio Gasperetti
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, D-23538 Lübeck, Germany,Department of Cardiology, Johns Hopkins University, Baltimore, USA,Cardiology and Arrhythmology Clinic, Department of Biomedical Sciences and Public Health, University Hospital ‘Umberto I-Lancisi-Salesi’, Marche Polytechnic University, Ancona, IT, Italy
| | - Riccardo Proietti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Erik Wissner
- University of Illinois at Chicago Division of Cardiology, USA
| | | | - Masashi Kamioka
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
| | - Hisaki Makimoto
- Abteilung für Kardiologie, Universitätsklinik Düsseldorf, Germany
| | | | - Tolga Aksu
- Kocaeli Derince Training and Research, Turkey
| | - Julian K R Chun
- CCB/Med. Klinik III, Kardiologie, Markuskrankenhaus, Frankfurt am Main, Germany
| | - Kudret Aytemir
- Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hacettepe University, Ankara, Turkey
| | - Ewa Jędrzejczyk-Patej
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Zabrze, Poland
| | - Karl-Heinz Kuck
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, D-23538 Lübeck, Germany,Asklepios Klinik St. Georg, Hamburg, Germany,LANS Cardio, Hamburg, Germany
| | - Tillman Dahme
- Department of Cardiology, University of Ulm, Germany
| | - Daniel Steven
- Abteilung für Elektrophysiologie, Universität zu Köln, Köln, Germany
| | - Philipp Sommer
- Klinik für Rhythmology, Herz- und Diabeteszentrum NRW, Bad Oeynhausen, Germany
| | - Roland Richard Tilz
- Corresponding author. Tel: +49 451 500 75293; Fax: +49 451 500 44585. E-mail address: ;
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Gasperetti A, Carrick RT, Costa S, Compagnucci P, Bosman LP, Chivulescu M, Tichnell C, Murray B, Tandri H, Tadros R, Rivard L, van den Berg MP, Zeppenfeld K, Wilde AA, Pompilio G, Carbucicchio C, Dello Russo A, Casella M, Svensson A, Brunckhorst CB, van Tintelen JP, Platonov PG, Haugaa KH, Duru F, te Riele AS, Khairy P, Tondo C, Calkins H, James CA, Saguner AM, Cadrin-Tourigny J. Programmed Ventricular Stimulation as an Additional Primary Prevention Risk Stratification Tool in Arrhythmogenic Right Ventricular Cardiomyopathy: A Multinational Study. Circulation 2022; 146:1434-1443. [PMID: 36205131 PMCID: PMC9640278 DOI: 10.1161/circulationaha.122.060866] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND A novel risk calculator based on clinical characteristics and noninvasive tests that predicts the onset of clinical sustained ventricular arrhythmias (VA) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) has been proposed and validated by recent studies. It remains unknown whether programmed ventricular stimulation (PVS) provides additional prognostic value. METHODS All patients with a definite ARVC diagnosis, no history of sustained VAs at diagnosis, and PVS performed at baseline were extracted from 6 international ARVC registries. The calculator-predicted risk for sustained VA (sustained or implantable cardioverter defibrillator treated ventricular tachycardia [VT] or fibrillation, [aborted] sudden cardiac arrest) was assessed in all patients. Independent and combined performance of the risk calculator and PVS on sustained VA were assessed during a 5-year follow-up period. RESULTS Two hundred eighty-eight patients (41.0±14.5 years, 55.9% male, right ventricular ejection fraction 42.5±11.1%) were enrolled. At PVS, 137 (47.6%) patients had inducible ventricular tachycardia. During a median of 5.31 [2.89-10.17] years of follow-up, 83 (60.6%) patients with a positive PVS and 37 (24.5%) with a negative PVS experienced sustained VA (P<0.001). Inducible ventricular tachycardia predicted clinical sustained VA during the 5-year follow-up and remained an independent predictor after accounting for the calculator-predicted risk (HR, 2.52 [1.58-4.02]; P<0.001). Compared with ARVC risk calculator predictions in isolation (C-statistic 0.72), addition of PVS inducibility showed improved prediction of VA events (C-statistic 0.75; log-likelihood ratio for nested models, P<0.001). PVS inducibility had a 76% [67-84] sensitivity and 68% [61-74] specificity, corresponding to log-likelihood ratios of 2.3 and 0.36 for inducible (likelihood ratio+) and noninducible (likelihood ratio-) patients, respectively. In patients with a ARVC risk calculator-predicted risk of clinical VA events <25% during 5 years (ie, low/intermediate subgroup), PVS had a 92.6% negative predictive value. CONCLUSIONS PVS significantly improved risk stratification above and beyond the calculator-predicted risk of VA in a primary prevention cohort of patients with ARVC, mainly for patients considered to be at low and intermediate risk by the clinical risk calculator.
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Affiliation(s)
- Alessio Gasperetti
- Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (A.G., R.T.C., C. Tichnell, B.M., H.T., H.C., C.A.J.)
| | - Richard T. Carrick
- Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (A.G., R.T.C., C. Tichnell, B.M., H.T., H.C., C.A.J.)
| | - Sarah Costa
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich‚ Switzerland (S.C., C.B.B., F.D., A.M.S.)
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital Umberto-I-Salesi-Lancisi, Ancona, Italy (P.C., A.D.R., M. Casella)
| | - Laurens P. Bosman
- Department of Cardiology (L.P.B., A.S.J.M.t.R.), University Medical Center Utrecht, University of Utrecht, The Netherlands
| | - Monica Chivulescu
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway and University of Oslo (M. Chivulescu, K.H.H.)
| | - Crystal Tichnell
- Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (A.G., R.T.C., C. Tichnell, B.M., H.T., H.C., C.A.J.)
| | - Brittney Murray
- Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (A.G., R.T.C., C. Tichnell, B.M., H.T., H.C., C.A.J.)
| | - Harikrishna Tandri
- Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (A.G., R.T.C., C. Tichnell, B.M., H.T., H.C., C.A.J.)
| | - Rafik Tadros
- Cardiovascular Genetics Center and Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Canada (R.T., L.R., P.K., J.C.-T.)
| | - Lena Rivard
- Cardiovascular Genetics Center and Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Canada (R.T., L.R., P.K., J.C.-T.)
| | - Maarten P. van den Berg
- Department of Cardiology, University Medical Center Groningen, University of Groningen‚ The Netherlands (M.P.v.d.B.)
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, The Netherlands (K.Z.)
| | - Arthur A.M. Wilde
- Amsterdam UMC location University of Amsterdam‚ Department of Cardiology‚ Amsterdam‚ The Netherlands (A.A.M.W.)
| | | | - Corrado Carbucicchio
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Department of Clinical Electrophisiology and Cardiac Pacing, Milan, Italy (C.C., C. Tondo)
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital Umberto-I-Salesi-Lancisi, Ancona, Italy (P.C., A.D.R., M. Casella)
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital Umberto-I-Salesi-Lancisi, Ancona, Italy (P.C., A.D.R., M. Casella)
| | - Anneli Svensson
- Department of Cardiology and Department of Health‚ Medicine and Caring Sciences‚ Linköping University‚ Sweden (A.S.)
| | - Corinna B. Brunckhorst
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich‚ Switzerland (S.C., C.B.B., F.D., A.M.S.)
| | - J. Peter van Tintelen
- Department of Genetics (J.P.v.T.), University Medical Center Utrecht, University of Utrecht, The Netherlands
| | - Pyotr G. Platonov
- Department of Cardiology, Clinical Sciences, Lund University, Sweden (P.G.P.)
| | - Kristina H. Haugaa
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway and University of Oslo (M. Chivulescu, K.H.H.)
| | - Firat Duru
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich‚ Switzerland (S.C., C.B.B., F.D., A.M.S.)
| | - Anneline S.J.M. te Riele
- Department of Cardiology (L.P.B., A.S.J.M.t.R.), University Medical Center Utrecht, University of Utrecht, The Netherlands
| | - Paul Khairy
- Cardiovascular Genetics Center and Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Canada (R.T., L.R., P.K., J.C.-T.)
| | - Claudio Tondo
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Department of Clinical Electrophisiology and Cardiac Pacing, Milan, Italy (C.C., C. Tondo).,Department Biomedical, Surgical and Dental Sciences, University of Milan, Italy (C. Tondo)
| | - Hugh Calkins
- Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (A.G., R.T.C., C. Tichnell, B.M., H.T., H.C., C.A.J.)
| | - Cynthia A. James
- Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (A.G., R.T.C., C. Tichnell, B.M., H.T., H.C., C.A.J.)
| | - Ardan M. Saguner
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich‚ Switzerland (S.C., C.B.B., F.D., A.M.S.)
| | - Julia Cadrin-Tourigny
- Cardiovascular Genetics Center and Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Canada (R.T., L.R., P.K., J.C.-T.)
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Gülan U, Rossi VA, Gotschy A, Saguner AM, Manka R, Brunckhorst CB, Duru F, Schmied CM, Niederseer D. A comparative study on the analysis of hemodynamics in the athlete's heart. Sci Rep 2022; 12:16666. [PMID: 36198719 PMCID: PMC9534940 DOI: 10.1038/s41598-022-20839-8] [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: 02/06/2022] [Accepted: 09/19/2022] [Indexed: 12/02/2022] Open
Abstract
The pathophysiological mechanisms underlying the development of the athlete’s heart are still poorly understood. To characterize the intracavitary blood flows in the right ventricle (RV) and right-ventricular outflow tract (RVOT) in 2 healthy probands, patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) and 2 endurance athletes, we performed 4D-MRI flow measurements to assess differences in kinetic energy and shear stresses. Time evolution of velocity magnitude, mean kinetic energy (MKE), turbulent kinetic energy (TKE) and viscous shear stress (VSS) were measured both along the whole RV and in the RVOT. RVOT regions had higher kinetic energy values and higher shear stresses levels compared to the global averaging over RV among all subjects. Endurance athletes had relatively lower kinetic energy and shear stresses in the RVOT regions compared to both healthy probands and ARVC patients. The athlete’s heart is characterized by lower kinetic energy and shear stresses in the RVOT, which might be explained by a higher diastolic compliance of the RV.
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Affiliation(s)
- Utku Gülan
- Hi-D Imaging, 8406, Winterthur, Switzerland
| | - Valentina A Rossi
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Alexander Gotschy
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Robert Manka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Corinna B Brunckhorst
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Firat Duru
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.,Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Christian M Schmied
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - David Niederseer
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
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Krizanovic-Grgic I, Anwer S, Steffel J, Hofer D, Saguner AM, Spengler CM, Breitenstein A, Tanner FC. 3D atrial strain for prediction of atrial fibrillation recurrence. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.103] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Atrial fibrillation (AF) is one of the most common supraventricular arrhythmias. Treatment options apart from medication include interventional catheter-guided pulmonary vein isolation (PVI). However, there is limited knowledge about factors predicting arrhythmia recurrence after PVI.
Aim
To study the association of 3-dimensional (3D) left atrial (LA) strain (LAS) and 3D electro-anatomical voltage mapping (EAVM) with early recurrence of AF after PVI.
Methods
In this prospective single center study, 93 patients undergoing PVI were enrolled between December 2018 and October 2021. All patients underwent an echocardiographic examination within two weeks before PVI using the Canon Aplio i900 system to analyse LAS from 3D LA volume. A 3D EAVM was obtained using high-density mapping catheters during PVI. The CARTO 3 system (Version V6-V7) was used for determining LA scar area by low voltage mapping (local amplitude <0.5 mV) indicated as percentage (EAVM-%). Follow-up time points were set at 2, 3, 6 and 12 months to investigate recurrence of AF, with exclusion of events occurring during the first two months (blanking phase).
Results
During follow-up, 12 out of 93 patients experienced recurrence of AF (12.9%; AF-Group). Baseline characteristics did not differ between AF-Group and Non-AF-Group. In contrast, LAS was significantly impaired in the AF-Group (median −4.6, IQR [−5.6 to −3.6]) when compared to the Non-AF-Group (−6.2 [−8.3 to −4.5]; p=0.009). The EAVM-% did not differ between the groups (AF-Group: 5.0 [1.5 to 21.5]; Non-AF-Group: 4.4 [1.5 to 15.9]; p=0.710). No significant correlations were found between LAS and EAVM-% (r=0.03, p=0.812). A cut-off value of −5.89% for LAS had a sensitivity of 100% and a specificity of 57% for AF recurrence (AUC=70%; p<0.001). Kaplan Meier curves for event-free survival were generated based on the LAS cut-off demonstrating excellent differentiation of those with and without AF recurrence (p<0.001; see figure). Furthermore, LAS was associated with an increased risk of early AF recurrence (HR 1.40, IQR [1.02–1.92], p=0.040), while EAVM-% was not (HR 0.99 [0.95–1.04], p=0.787).
Conclusion
3D LAS was associated with an increased risk of early AF recurrence after PVI, while EAVM-% was not. 3D LAS might be used for identifying patients who would benefit from PVI.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - S Anwer
- University Hospital Zurich , Zurich , Switzerland
| | - J Steffel
- University Hospital Zurich , Zurich , Switzerland
| | - D Hofer
- University Hospital Zurich , Zurich , Switzerland
| | - A M Saguner
- University Hospital Zurich , Zurich , Switzerland
| | - C M Spengler
- Swiss Federal Institute of Technology Zurich (ETH Zurich) , Zurich , Switzerland
| | | | - F C Tanner
- University Hospital Zurich , Zurich , Switzerland
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Akdis D, Tan G, Wilzeck V, Costa S, Gasperetti A, Matter CM, Ruschitzka F, Brunckhorst C, Akdis CA, Saguner AM, Duru F. Identifying proteomic profiles as indicators of disease severity in arrhythmogenic cardiomyopathy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.359] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Arrhythmogenic cardiomyopathy (ACM) is an inherited heart muscle disease characterized by progressive fibrofatty replacement of the myocardium and ventricular arrhythmias. Biventricular (BiV) involvement may lead to heart failure. This study aimed to investigate characteristic proteomic patterns in plasma of ACM patients, and correlated them with clinical outcome as well as physical exercise, to assess if key soluble molecules may serve as specific biomarkers for ACM, and whether mechanical stress induced by physical exercise may alter proteomic patterns in ACM patients.
Methods
In 38 ACM patients clinical parameters and major adverse cardiovascular events (MACE defined as presence of sustained ventricular tachycardia, ventricular fibrillation, appropriate therapy from implantable cardioverter defibrillator, sudden cardiac death, death related to end-stage heart failure or cardiac transplant) were obtained prospectively during a mean follow-up period of 36 months. All patients received genetic testing using next generation DNA sequencing. Plasma protein expression was analysed using the Proximity Extension Assay (PEA) technology, where a pair of oligonucleotide-labelled antibody probe binds to each targeted protein. In a subgroup of 11 patients blood was drawn immediately before and 3 hours after standardised bicycle exercise testing, and plasma protein expression was compared.
Results
12 patients had ACM with BiV involvement, and 26 patients had isolated right ventricular (RV) involvement. During the follow-up period, 34 patients had a MACE (30% with RV and 14% with BiV). Over 360 proteins were assessed in all ACM patients and compared to 24 healthy controls. The proteomic signature of ACM patients differed significantly compared to controls, and 32 proteins were upregulated in ACM (Figure 1). The proteomic profiles of patients with RV involvement also differed from those with BiV involvement. Most importantly, after exercise, over 40 proteins were upregulated specifically in ACM patients compared to controls, including key pro-inflammatory, adipogenic molecules and also markers of cardiac fibrosis.
Conclusion
Our study shows that ACM patients with RV and BiV involvement have different plasma proteomic profiles compared to healthy controls. Furthermore we were able to demonstrate that, specifically in ACM patients, several pro-inflammatory pathways are upregulated after exercise compared to healthy controls, further elucidating the molecular pathways associated with arrhythmogenicity and disease progression and highlighting the key role of physical stress. Our results may enable the identification of potential future biomarkers for diagnosis and risk stratification and may pave the way for personalized patient specific treatments.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Baugarten Foundation ZurichSwiss National Foundation
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Affiliation(s)
- D Akdis
- University Heart Center, Cardiology , Zurich , Switzerland
| | - G Tan
- Swiss Institute of Allergy and Asthma Research , Davos , Switzerland
| | - V Wilzeck
- University Heart Center, Cardiology , Zurich , Switzerland
| | - S Costa
- University Heart Center, Cardiology , Zurich , Switzerland
| | - A Gasperetti
- Johns Hopkins University , Baltimore , United States of America
| | - C M Matter
- University Heart Center, Cardiology , Zurich , Switzerland
| | - F Ruschitzka
- University Heart Center, Cardiology , Zurich , Switzerland
| | - C Brunckhorst
- University Heart Center, Cardiology , Zurich , Switzerland
| | - C A Akdis
- Swiss Institute of Allergy and Asthma Research , Davos , Switzerland
| | - A M Saguner
- University Heart Center, Cardiology , Zurich , Switzerland
| | - F Duru
- University Heart Center, Cardiology , Zurich , Switzerland
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Lee J, Gänswein T, Ulusan H, Emmenegger V, Saguner AM, Duru F, Hierlemann A. Repeated and On-Demand Intracellular Recordings of Cardiomyocytes Derived from Human-Induced Pluripotent Stem Cells. ACS Sens 2022; 7:3181-3191. [PMID: 36166837 PMCID: PMC7613763 DOI: 10.1021/acssensors.2c01678] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 01/31/2023]
Abstract
Pharmaceutical compounds may have cardiotoxic properties, triggering potentially life-threatening arrhythmias. To investigate proarrhythmic effects of drugs, the patch clamp technique has been used as the gold standard for characterizing the electrophysiology of cardiomyocytes in vitro. However, the applicability of this technology for drug screening is limited, as it is complex to use and features low throughput. Recent studies have demonstrated that 3D-nanostructured electrodes enable to obtain intracellular signals from many cardiomyocytes in parallel; however, the tedious electrode fabrication and limited measurement duration still remain major issues for cardiotoxicity testing. Here, we demonstrate how porous Pt-black electrodes, arranged in high-density microelectrode arrays, can be used to record intracellular-like signals of cardiomyocytes at large scale repeatedly over an extended period of time. The developed technique, which yields highly parallelized electroporations using stimulation voltages around 1 V peak-to-peak amplitude, enabled intracellular-like recordings at high success rates without causing significant alteration in key electrophysiological features. In a proof-of-concept study, we investigated electrophysiological modulations induced by two clinically applied drugs, nifedipine and quinidine. As the obtained results were in good agreement with previously published data, we are confident that the developed technique has the potential to be routinely used in in vitro platforms for cardiotoxicity screening.
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Affiliation(s)
- Jihyun Lee
- Corresponding Authors Jihyun Lee — Bio Engineering Laboratory, ETH Zurich, 4058 Basel, Switzerland; ® Phone: +41 (0)61 387 31 28; jihyun.lee@ bsse.ethz.ch; Andreas Hierlemann — Bio Engineering Laboratory, ETH Zurich, 4058 Basel, Switzerland; Phone: +41 (0)61 387 31 50;
| | | | | | | | | | | | - Andreas Hierlemann
- Corresponding Authors Jihyun Lee — Bio Engineering Laboratory, ETH Zurich, 4058 Basel, Switzerland; ® Phone: +41 (0)61 387 31 28; jihyun.lee@ bsse.ethz.ch; Andreas Hierlemann — Bio Engineering Laboratory, ETH Zurich, 4058 Basel, Switzerland; Phone: +41 (0)61 387 31 50;
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45
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Çimen T, Saguner AM. What’s New in Arrhythmogenic Cardiomyopathies. J Clin Med 2022; 11:jcm11164764. [PMID: 36013003 PMCID: PMC9409703 DOI: 10.3390/jcm11164764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Ardan M. Saguner
- Correspondence: ; Tel.: +41-(0)44-255-2111; Fax: +41-(0)44-255-4004
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46
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Hosseini S, Erhart L, Anwer S, Heiniger PS, Winkler NE, Cimen T, Kuzo N, Hess R, Akdis D, Costa S, Gasperetti A, Brunckhorst C, Duru F, Saguner AM, Tanner FC. Tissue Doppler echocardiography and outcome in arrhythmogenic right ventricular cardiomyopathy. Int J Cardiol 2022; 368:86-93. [PMID: 35970442 DOI: 10.1016/j.ijcard.2022.08.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 04/15/2022] [Revised: 07/15/2022] [Accepted: 08/10/2022] [Indexed: 11/05/2022]
Abstract
AIMS This study aimed at investigating whether tissue Doppler imaging (TDI) is associated with adverse events in arrhythmogenic right ventricular cardiomyopathy (ARVC). METHODS AND RESULTS Transthoracic echocardiography was performed in 72 patients with definite (n = 63) or borderline (n = 9) ARVC diagnosed according to the 2010 Task Force Criteria and included in the prospective Zurich ARVC registry. Myocardial peak systolic tissue velocity (S') was measured by TDI at lateral tricuspid (tricuspid S'), medial mitral (septal S'), and lateral mitral annulus (lateral S'). Association of echocardiographic parameters with outcome was assessed by univariable Cox regression. During a median follow-up of 4.9 ± 2.6 years, 6 (8.3%) patients died of cardiovascular cause or received heart transplantation and 21 (29.2%) patients developed sustained ventricular arrhythmia. Tricuspid, septal, and lateral S' were lower in patients who died (p = 0.001; p < 0.001; p = 0.008; respectively), while tricuspid and septal S' were lower in those with ventricular arrhythmia (p = 0.001; p = 0.008; respectively). There was a significant association of tricuspid, septal, and lateral S' with mortality (HR = 1.61, p = 0.011; HR = 2.15, p = 0.007; HR = 1.67, p = 0.017; respectively), while tricuspid and septal S' were associated with ventricular arrhythmia (HR = 1.20, p = 0.022; HR = 1.37, p = 0.004; respectively). Kaplan-Meier analyses demonstrated a higher freedom from mortality with tricuspid S' >8 cm/s (p = 0.001) and from ventricular arrhythmia with S' >10.5 cm/s (p = 0.021). CONCLUSIONS This study demonstrates that TDI provides information on the ARVC phenotype, is associated with adverse events in ARVC patients, and differentiates between patients with and without adverse events.
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Affiliation(s)
- Sara Hosseini
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Ladina Erhart
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Shehab Anwer
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Pascal S Heiniger
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Neria E Winkler
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Tolga Cimen
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Nazar Kuzo
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Refael Hess
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Deniz Akdis
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Sarah Costa
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Alessio Gasperetti
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Corinna Brunckhorst
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Firat Duru
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Felix C Tanner
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.
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47
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Kovacs B, Mayinger M, Andratschke N, Saguner AM. Stereotactic arrhythmia radioablation: competitor or adjunct to catheter ablation? Eur Heart J 2022; 43:3279-3281. [PMID: 35947872 DOI: 10.1093/eurheartj/ehac435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Boldizsar Kovacs
- Arrhythmia Unit, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Michael Mayinger
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Ardan M Saguner
- Arrhythmia Unit, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
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48
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Abumayyaleh M, Dreher TC, Rosenkaimer S, Röger S, Erath JW, Klein N, Kovacs B, Duru F, Saguner AM, El-Battrawy I, Akin I. Sex differences and adherence of patients treated with wearable cardioverter-defibrillator: insights from an international multicenter register. J Cardiovasc Electrophysiol 2022; 33:2243-2249. [PMID: 35930623 DOI: 10.1111/jce.15648] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 07/13/2022] [Accepted: 07/24/2022] [Indexed: 11/28/2022]
Abstract
AIMS Treatment with the wearable cardioverter defibrillator (WCD) may protect against sudden cardiac death (SCD) as a bridging therapy until a cardioverter-defibrillator may be implanted. We analyzed in a multicenter setting a consecutive patient cohort wearing WCD to explore sex differences. METHODS AND RESULTS We analyzed 708 consecutive patients, 579 (81.8%) from whom were males and 129 (18.2%) females (age, 60.5±14 vs. 61.6±17 years old; p=0.44). While the rate of ischemic cardiomyopathy (ICM) as a cause of prescription of WCD was significantly higher in males as compared to females (42.7% vs. 26.4%; p=0.001), females received it more frequently due to non-ischemic cardiomyopathy (NICM) (55.8% vs. 42.7%); p=0.009). The wear time of WCD was equivalent in both groups (21.1±4.3 hours/days in males vs. 21.5±4.4 hours/days in females; p=0.27; and 62.6±44.3 days in males vs. 56.5±39 days in females; p=0.15). Mortality was comparable in both groups at 2-year-follow-up (6.8% in males vs. 9.7% in females; p=0.55). Appropriate WCD shocks and the incidence of ICD implantations were similar in both groups (2.4% in males vs. 3.9% in females; p=0.07) (35.1% in males vs. 31.8% in females; p=0.37), respectively. In age tertile analysis, compliance was observed more in 73-91 years old group as compared to 14-51 years old group (87.8% vs. 68.3%; p<0.001). CONCLUSION Compliance for wearing WCD was excellent regardless of sex. Furthermore, mortality and the incidence of ICD implantations were comparable in both sexes. Appropriate WCD shocks were similar in both sexes. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Mohammad Abumayyaleh
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Tobias C Dreher
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Stephanie Rosenkaimer
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Susanne Röger
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Julia W Erath
- Department of Cardiology/Division of Clinical Electrophysiology, University Hospital Frankfurt, Goethe University, Frankfurt a. M., Germany
| | - Norbert Klein
- Department of Arrhythmias & Invasive Cardiology, St. Georg Hospital, Leipzig, Germany
| | - Boldizsar Kovacs
- Department of Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | - Firat Duru
- Department of Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | - Ibrahim El-Battrawy
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
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49
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Li M, Ning Y, Tse G, Saguner AM, Wei M, Day JD, Luo G, Li G. Atrial cardiomyopathy: from cell to bedside. ESC Heart Fail 2022; 9:3768-3784. [PMID: 35920287 PMCID: PMC9773734 DOI: 10.1002/ehf2.14089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Received: 04/01/2022] [Revised: 06/09/2022] [Accepted: 07/10/2022] [Indexed: 01/19/2023] Open
Abstract
Atrial cardiomyopathy refers to structural and electrical remodelling of the atria, which can lead to impaired mechanical function. While historical studies have implicated atrial fibrillation as the leading cause of cardioembolic stroke, atrial cardiomyopathy may be an important, underestimated contributor. To date, the relationship between atrial cardiomyopathy, atrial fibrillation, and cardioembolic stroke remains obscure. This review summarizes the pathogenesis of atrial cardiomyopathy, with a special focus on neurohormonal and inflammatory mechanisms, as well as the role of adipose tissue, especially epicardial fat in atrial remodelling. It reviews the current evidence implicating atrial cardiomyopathy as a cause of embolic stroke, with atrial fibrillation as a lagging marker of an increased thrombogenic atrial substrate. Finally, it discusses the potential of antithrombotic therapy in embolic stroke with undetermined source and appraises the available diagnostic techniques for atrial cardiomyopathy, including imaging techniques such as echocardiography, computed tomography, and magnetic resonance imaging as well as electroanatomic mapping, electrocardiogram, biomarkers, and genetic testing. More prospective studies are needed to define the relationship between atrial cardiomyopathy, atrial fibrillation, and embolic stroke and to establish a prompt diagnosis and specific treatment strategies in these patients with atrial cardiomyopathy for the secondary and even primary prevention of embolic stroke.
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Affiliation(s)
- Mengmeng Li
- Stroke Centre and Department of NeurologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Yuye Ning
- Stroke Centre and Department of NeurologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina,Department of NeurologyShaanxi People's HospitalXi'anChina
| | - Gary Tse
- Kent and Medway Medical SchoolCanterburyUK,Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina
| | - Ardan M. Saguner
- Arrhythmia Division, Department of Cardiology, University Heart CentreUniversity Hospital ZurichZurichSwitzerland
| | - Meng Wei
- Stroke Centre and Department of NeurologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - John D. Day
- Department of CardiologySt. Mark's HospitalSalt Lake CityUTUSA
| | - Guogang Luo
- Stroke Centre and Department of NeurologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Guoliang Li
- Department of Cardiovascular MedicineThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
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50
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Chen S, Chen L, Saguner AM, Chen K, Akdis D, Gasperetti A, Brunckhorst C, Tang H, Guo G, Rao M, Li X, Song J, Duru F, Hu S. Novel Risk Prediction Model to Determine Adverse Heart Failure Outcomes in Arrhythmogenic Right Ventricular Cardiomyopathy. J Am Heart Assoc 2022; 11:e024634. [PMID: 35766284 PMCID: PMC9333366 DOI: 10.1161/jaha.121.024634] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Patients with arrhythmogenic right ventricular cardiomyopathy are at risk for life‐threatening ventricular tachyarrhythmias, but progressive heart failure (HF) may occur in later stages of disease. This study aimed to characterize potential risk predictors and develop a model for individualized assessment of adverse HF outcomes in arrhythmogenic right ventricular cardiomyopathy. Methods and Results Longitudinal and observational cohorts with 290 patients with arrhythmogenic right ventricular cardiomyopathy from the Fuwai Hospital in Beijing, China, and 99 patients from the University Heart Center in Zurich, Switzerland, with follow‐up data were studied. The primary end point of the study was heart transplantation or death attributable to HF. The model was developed by Cox regression analysis for predicting risk and was internally validated. During 4.92±3.03 years of follow‐up, 48 patients reached the primary end point. The determinants of the risk prediction model were left ventricular ejection fraction, serum creatinine levels, moderate‐to‐severe tricuspid regurgitation, and atrial fibrillation. Implantable cardioverter‐defibrillators did not reduce the occurrence of adverse HF outcomes. Conclusions A novel risk prediction model for arrhythmogenic right ventricular cardiomyopathy has been developed using 2 large and well‐established cohorts, incorporating common clinical parameters such as left ventricular ejection fraction, serum creatinine levels, tricuspid regurgitation, and atrial fibrillation, which can identify patients who are at risk for terminal HF events, and may guide physicians to assess individualized HF risk and to optimize management strategies.
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Affiliation(s)
- Shi Chen
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Liang Chen
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | | | - Kai Chen
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Deniz Akdis
- University Heart Center Zurich Zurich Switzerland
| | | | | | - Hanwei Tang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Guangran Guo
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Man Rao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Xiangjie Li
- School of Statistics and Data Science Nankai University Tianjin China
| | - Jiangping Song
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Firat Duru
- University Heart Center Zurich Zurich Switzerland.,Center for Integrative Human Physiology University of Zurich Zurich Switzerland
| | - Shengshou Hu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
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