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Clancy CE, Parkash R, Shah M, Tedrow U. Empowering Women in Electrophysiology: Insights on National Women's Heart Day. JACC Clin Electrophysiol 2024; 10:189-192. [PMID: 38310490 DOI: 10.1016/j.jacep.2024.01.012] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2024]
Affiliation(s)
| | - Ratika Parkash
- Queen Elizabeth II Health Sciences Center, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Maully Shah
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Usha Tedrow
- Brigham and Womens' Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Enriquez A, Hanson M, Nazer B, Gibson DN, Cano O, Tokioka S, Fukamizu S, Sanchez Millan P, Hoyos C, Matos C, Sauer WH, Tedrow U, Romero J, Neira V, Futyma M, Futyma P. Bipolar ablation involving coronary venous system for refractory left ventricular summit arrhythmias. Heart Rhythm O2 2024; 5:24-33. [PMID: 38312200 PMCID: PMC10837170 DOI: 10.1016/j.hroo.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Background Catheter ablation of premature ventricular complexes (PVCs) and ventricular tachycardia (VT) from the left ventricular summit (LVS) may require advanced ablation techniques. Bipolar ablation from the coronary veins and adjacent endocardial structures can be effective for refractory LVS arrhythmias. Objective The aim of this study was to investigate the outcomes of bipolar ablation performed between the coronary venous system and adjacent endocardial left ventricular outflow tract (LVOT) or right ventricular outflow tract (RVOT). Methods This multicenter study included consecutive patients with LVS PVC/VT who underwent bipolar ablation between the anterior interventricular vein (AIV) or great cardiac vein (GCV) and the endocardial LVOT/RVOT after failed unipolar ablation. Ablation was started with powers of 10-20 W and uptitrated to achieve an impedance drop of at least 10%. Angiography was performed in all cases to confirm a safe distance (>5 mm) of the catheter from the major coronary arteries. Results Between 2013 and 2023, bipolar radiofrequency ablation between the AIV/GCV and the adjacent LVOT/RVOT was attempted in 20 patients (4 female; age 57 ± 16 years). Unipolar ablation from sites of early activation (AIV/GCV, LVOT, aortic cusps, RVOT) failed to effectively suppress the PVC/VT in all subjects. Bipolar ablation was delivered with a maximum power of 30 ± 8 W and total duration of 238 ± 217 s and led to acute PVC/VT elimination in all patients. No procedural-related complications occurred. Over a follow-up period of 30 ± 24 months, the freedom from arrhythmia recurrence was 85% (1 recurrence in the VT group and 2 in the PVC group). PVC burden was reduced from 22% ± 10% to 4% ± 8% (P <.001). Conclusion In cases of LVS PVC/VT refractory to unipolar ablation, bipolar ablation between the coronary venous system and adjacent endocardial LVOT/RVOT is safe and effective if careful titration of power and intraprocedural angiography are performed to ensure a safe distance from the coronary arteries.
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Affiliation(s)
- Andres Enriquez
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Matthew Hanson
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Babak Nazer
- Division of Cardiology, University of Washington, Seattle, Washington
| | | | - Oscar Cano
- Division of Cardiology, Hospital Universitari Politècnic La Fe, Valencia, Spain
| | - Sayuri Tokioka
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Seiji Fukamizu
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Pablo Sanchez Millan
- Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Carolina Hoyos
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carlos Matos
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - William H Sauer
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Usha Tedrow
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jorge Romero
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Victor Neira
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Marian Futyma
- Medical College, University of Rzeszów and St. Joseph's Heart Rhythm Center, Rzeszów, Poland
| | - Piotr Futyma
- Medical College, University of Rzeszów and St. Joseph's Heart Rhythm Center, Rzeszów, Poland
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Batnyam U, Zei PC, Romero JE, Kapur S, Steiger N, Tadros T, Sharma E, Tedrow U, Koplan BA, Sauer WH. Reduction and elimination of operator exposure to radiation during endocardial ventricular arrhythmia ablation procedures over time. Heart Rhythm O2 2023; 4:733-737. [PMID: 38034893 PMCID: PMC10685160 DOI: 10.1016/j.hroo.2023.09.011] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Affiliation(s)
- Uyanga Batnyam
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Paul C. Zei
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jorge E. Romero
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sunil Kapur
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nathaniel Steiger
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Thomas Tadros
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Esseim Sharma
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Usha Tedrow
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Bruce A. Koplan
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - William H. Sauer
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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John RM, Tedrow U, Tadros T, Richardson TD, Kanagasundram A, Hoffman RD, Kapp ME, Shah A, Michaud G, Stevenson W. Intramyocardial Hematoma During Catheter Ablation for Scar-Related Ventricular Tachycardia. JACC Clin Electrophysiol 2023; 9:2303-2314. [PMID: 37632506 DOI: 10.1016/j.jacep.2023.07.004] [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] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/20/2023] [Accepted: 07/05/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Intramural hematoma during ablation for scar-related ventricular tachycardia (VT) is a rare but life-threatening complication. OBJECTIVES The goal of this study was to describe the features and outcomes of intramural hematoma during ablation for scar-related VT. METHODS From 2010 to 2022, >3,514 ablations for ventricular arrhythmias were performed at 2 institutions. Four cases of intramural hematoma complicating VT ablation for scar-related VT were identified. Intraprocedural details, imaging data, and surgical notes were reviewed to create a recognizable pattern of events highlighting this complication. RESULTS In 3 of 4 cases, intramural hematoma occurred during catheter ablation with an open irrigated 3.5 mm tipped catheter using normal saline for irrigation. In one case, hematoma was noted after ablation using an investigational needle electrode catheter. The occurrence of a steam pop preceded detection of an expanding intramural hematoma in 3 cases. ST-segment elevation on electrocardiography was evident in 3 cases; intracardiac echocardiographic imaging detected the hematoma in all cases. Epicardial rupture and pericardial effusion requiring drainage occurred in 3 cases, whereas 1 hematoma was self-contained and did not require intervention. Surgical intervention was performed in 2 cases, with successful outcomes. One patient who was deemed not a surgical candidate died of progressive cardiogenic shock. CONCLUSIONS Intramural hematoma during ablation for scar-related VT is a rare but potentially catastrophic complication that requires prompt recognition. Steam pops during ablation frequently precede the hematoma formation. Surgical intervention may be life-saving, although contained hematomas can occasionally be managed conservatively.
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Affiliation(s)
- Roy M John
- Stanford University, Palo Alto, California, USA.
| | - Usha Tedrow
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Thomas Tadros
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | | | - Meghan E Kapp
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ashish Shah
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Abstract
Ventricular tachycardia (VT) describes rapid heart rhythms originating from the ventricles. Accurate diagnosis of VT is important to allow prompt referral to specialist services for ongoing management. The diagnosis of VT is usually made based on electrocardiographic data, most commonly 12-lead echocardiography (ECG), as well as supportive cardiac telemetric monitoring. Distinguishing between VT and supraventricular arrhythmias on ECG can be difficult. However, the VT diagnosis frequently needs to be made rapidly in the acute setting. In this review, we discuss the definition of VT, review features of wide-complex tachycardia (WCT) on ECG that might be helpful in diagnosing VT, discuss the different substrates in which VT can occur and offer brief comments on management considerations for patients found to have VT.
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Affiliation(s)
- John Whitaker
- School of Biomedical Engineering and Imaging Sciences at King's College, London, UK and Cardiovascular Directorate Guy's and St Thomas's NHS Foundation Trust, London, UK
| | - Matthew J Wright
- School of Biomedical Engineering and Imaging Sciences at King's College, London, UK and Cardiovascular Directorate Guy's and St Thomas's NHS Foundation Trust, London, UK
| | - Usha Tedrow
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Daubert JP, Tedrow U. Heart Rhythm Society Education Council Update. Heart Rhythm 2023; 20:1216-1218. [PMID: 37517863 DOI: 10.1016/j.hrthm.2023.05.033] [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: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 08/01/2023]
Affiliation(s)
- James P Daubert
- Cardiology Division, Department of Medicine, Duke University, Durham, North Carolina.
| | - Usha Tedrow
- Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Whitaker J, Baum TE, Qian P, Prassl AJ, Plank G, Blankstein R, Cochet H, Sauer WH, Bishop MJ, Tedrow U. Frequency Domain Analysis of Endocardial Electrograms for Detection of Nontransmural Myocardial Fibrosis in Nonischemic Cardiomyopathy. JACC Clin Electrophysiol 2023; 9:923-935. [PMID: 36669900 DOI: 10.1016/j.jacep.2022.11.019] [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: 06/28/2022] [Revised: 11/18/2022] [Accepted: 11/18/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Voltage mapping in nonischemic cardiomyopathy can fail to identify midmyocardial substrate for ventricular arrhythmias, an important cause of ablation failure. OBJECTIVES The aim of this study was to assess whether frequency domain analysis of endocardial left ventricular electrograms (EGMs) can better predict the presence of midmyocardial fibrosis (MMF) compared with voltage amplitude. METHODS Nonischemic cardiomyopathy patients undergoing ventricular tachycardia ablation with registered preprocedural cardiac computed tomography and late iodine enhancement were included. Presence of fibrosis at each EGM site was assessed. Bipolar and unipolar EGMs were transformed to the frequency domain using multitaper spectral analysis. Singular value decomposition of the EGM frequency spectrum was used within a supervised machine learning process to select features to predict the presence of MMF and compare against predictions using voltage amplitude. RESULTS Thirteen patients were included (median age 57 years [IQR: 28-73 years], median ejection fraction 40% [IQR: 15%-57%]). A total of 6,015 EGM pairs were processed: 2,459 EGM pairs in MMF areas and 3,556 EGM pairs in non-MMF areas. Supervised classifiers were trained with stratified k-fold cross-validation within patients. The distribution of mean area under the curve metrics using frequency features, f, was significantly greater than voltage feature area under the curve metrics, v, (mean f = 0.841 [95% CI: 0.789-0.884] vs mean v = 0.591 [95% CI: 0.530-0.658]; P < 0.001), indicating that frequency-trained classifiers better predicted the presence of MMF. CONCLUSIONS These data indicate the promising discriminatory value of endocardial EGM frequency content in the assessment of concealed myocardial substrate. Further studies are needed to investigate the importance of the specific frequency features identified.
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Affiliation(s)
- John Whitaker
- Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Taylor E Baum
- Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | | | - Anton J Prassl
- Gottfried Schatz Research Center, Division of Biophysics, Medical University of Graz, Graz, Austria
| | - Gernot Plank
- Gottfried Schatz Research Center, Division of Biophysics, Medical University of Graz, Graz, Austria
| | - Ron Blankstein
- Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Hubert Cochet
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Université de Bordeaux, Pessac, France
| | - William H Sauer
- Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | | | - Usha Tedrow
- Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
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John LA, Divakaran S, Tedrow U. Phase of Disease Matters. JACC Clin Electrophysiol 2023; 9:327-329. [PMID: 36990595 DOI: 10.1016/j.jacep.2022.11.013] [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] [Received: 10/30/2022] [Accepted: 11/02/2022] [Indexed: 03/29/2023]
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Whitaker J, Bredfeldt J, Williams SE, Qian P, Chang D, Mak RH, Cochet H, Sauer W, Zei PC, Tedrow U. Ventricular Conduction Velocity Following Multimodal Ablation Including Stereotactic Body Radiation Therapy for Refractory Ventricular Tachycardia. JACC Clin Electrophysiol 2023; 9:119-121. [PMID: 36697191 DOI: 10.1016/j.jacep.2022.08.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/16/2022] [Indexed: 11/05/2022]
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10
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Sharma E, Wang W, Tadros TM, Koplan BA, Zei PC, Maytin M, Romero J, Tedrow U, Sauer W, Kapur S. Effect of Extracellular Matrix Envelopes on Shock Impedance in Patients With Subcutaneous Implantable Cardiac Defibrillators. JACC Clin Electrophysiol 2022; 9:701-703. [DOI: 10.1016/j.jacep.2022.10.008] [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] [Received: 07/27/2022] [Revised: 09/29/2022] [Accepted: 10/05/2022] [Indexed: 12/05/2022]
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11
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Wei C, Boeck M, Qian PC, Vivenzio T, Elizee Z, Bredfeldt JS, Kaplan RS, Tedrow U, Mak R, Zei PC. Cost of cardiac stereotactic body radioablation therapy versus catheter ablation for treatment of ventricular tachycardia. Pacing Clin Electrophysiol 2022; 45:1124-1131. [PMID: 35621224 DOI: 10.1111/pace.14512] [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: 12/10/2021] [Revised: 04/02/2022] [Accepted: 04/08/2022] [Indexed: 11/29/2022]
Abstract
AIMS To compare the cost of cardiac stereotactic body radiotherapy (SBRT) vs catheter ablation for treating ventricular tachycardia (VT). BACKGROUND Cardiac SBRT is a novel way of treating refractory VT that may be less costly than catheter ablation, owing to its non-invasive, outpatient nature. However, the true costs of either procedure are not well described, which could help inform a more appropriate reimbursement for cardiac SBRT than simply cross-indexing existing procedural rates. METHODS Process maps were derived for the full patient care cycle of both procedures using time-driven activity-based costing. Step-by-step timestamps were collected prospectively from a 10-patient SBRT cohort and retrospectively from a 59-patient catheter ablation cohort. Individual costs were estimated by multiplying timestamps with capacity cost rates (CCRs) for personnel, space, equipment, consumable, and indirect resources. These were summed into total cost, which for cardiac SBRT was compared with current catheter ablation and single-fraction lung SBRT reimbursements, both potential reference rates for cardiac SBRT. RESULTS The direct and total procedural costs of cardiac SBRT ($7,549 and $10,621) were 49% and 54% less than those of VT ablation ($14,707 and $23,225). These costs were significantly different from current reimbursement for catheter ablation ($22,692) and lung SBRT ($6,329). After including hospitalization expenses (≥$15,000), VT ablation cost at least $27,604 more to furnish than cardiac SBRT. CONCLUSIONS TDABC can be a helpful tool for assessing healthcare costs, including novel treatment approaches. In addition to its clinical benefits, cardiac SBRT may provide significant cost reduction opportunities for treatment of VT. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Chen Wei
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.,Department of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Michelle Boeck
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA, USA
| | - Pierre C Qian
- Department of Cardiology, Westmead Hospital, Sydney, Australia.,Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, Australia
| | - Todd Vivenzio
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA, USA
| | - Zoe Elizee
- Department of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jeremy S Bredfeldt
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Usha Tedrow
- Department of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Raymond Mak
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA, USA
| | - Paul C Zei
- Department of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Cochet H, Tedrow U, Maury P, Whitaker J, Woods C, Gandjbakhch E, Khalifa J, Bredfeldt J, Mak R, Sauer W, Sermesant M, Sacher F, Bogun F, Jais P, Zei P. Multimodality planning of stereotactic radio-ablation for ventricular tachycardia. Results from the international MUSIC consortium. Europace 2022. [DOI: 10.1093/europace/euac053.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Research Council
Background
Optimal SBRT planning methods for VT ablation are yet to be defined.
Purpose
To evaluate a multimodal approach for SBRT planning.
Methods
30 pts (age 70±10, 90% men, LVEF 26±9%, 67% ICM, 47% NICM or mixed, 1.7±1.2 prior catheter ablations) with drug-refractory VT underwent imaging prior to SBRT. The inHEART technology was used to create image-based 3D models of substrate, cardiac anatomy, and organs at risk (coronaries, phrenic nerve, GI tract, AV node). In MUSIC software (IHU Liryc-Inria), 3D models were fused with prior EP maps, and SBRT targets were interactively drawn in 3D by the referring EP cardiologist. Transmural target volumes and organs at risk were fused with a 4D planning CT and used to plan SBRT in Eclipse (Varian).
Results
SBRT was delivered on median PTVs of 96[63-149] mL (total dose 25 Gy) with either Truebeam or Edge systems (Varian). Over a median FU of 4[2-8] months, death occurred in 11(37%) pts, due to arrhythmia recurrence in 4(13%). FU at 6 months was available in 14 pts. In these, the median numbers of VT episodes and ICD shocks over the 6 months preceding SBRT were 20[9-27] and 8[5-15], respectively. In the 6 months following SBRT, these decreased to 0[0-30] and 0[0-0], respectively (P<0.001 for both). 8/14(57%) pts were free from any VT recurrence, and 11/14(79%) were free from any ICD shock. In the total cohort, complications attributed to SBRT were observed in 2/30 (7%), none of which were fatal (heart failure and pneumonitis, both managed with steroids).
Conclusion
In patients with severe drug- and catheter ablation-refractory VT, SBRT planning based on 3D image-based models fused with prior EP maps is feasible, and associated with favorable efficacy and safety profiles.
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Affiliation(s)
- H Cochet
- IHU Liryc, CHU Bordeaux, Univ. Bordeaux, Bordeaux, France
| | - U Tedrow
- Brigham And Women’S Hospital, Harvard Medical School, Boston, United States of America
| | - P Maury
- University Hospital of Toulouse, Toulouse, France
| | - J Whitaker
- Brigham And Women’S Hospital, Harvard Medical School, Boston, United States of America
| | - C Woods
- Palo Alto Medical Foundation Research Institute, Palo Alto, United States of America
| | | | - J Khalifa
- University Hospital of Toulouse, Toulouse, France
| | - J Bredfeldt
- Brigham And Women’S Hospital, Harvard Medical School, Boston, United States of America
| | - R Mak
- Brigham And Women’S Hospital, Harvard Medical School, Boston, United States of America
| | - W Sauer
- Brigham And Women’S Hospital, Harvard Medical School, Boston, United States of America
| | | | - F Sacher
- IHU Liryc, CHU Bordeaux, Univ. Bordeaux, Bordeaux, France
| | - F Bogun
- University of Michigan, Ann Arbor, United States of America
| | - P Jais
- IHU Liryc, CHU Bordeaux, Univ. Bordeaux, Bordeaux, France
| | - P Zei
- Brigham And Women’S Hospital, Harvard Medical School, Boston, United States of America
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Zeppenfeld K, Wijnmaalen AP, Ebert M, Baldinger SH, Vaseghi M, De Riva Silva M, Gaspar T, Tedrow U, Deneke T, Soejima K, Shivkumar K, Carbucicchio C, Berruezo A, Hindricks G, Stevenson WG. The outcome spectrum for Dilated Cardiomyopathy and Ventricular Tachycardia: results from the prospective, multicenter, DCM-VT ablation study. Europace 2022. [DOI: 10.1093/europace/euac053.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): The study was partially supported by an investigator initiated grant from Biosense Webster (a Johnson & Johnson company)
Background
Recurrent sustained ventricular tachycardia (VT) due to nonischemic dilated cardiomyopathy (DCM) is difficult to treat and long-term outcome data are limited.
Objective
We aimed to identify predictors for mortality or heart transplantation (MHT) and VT recurrence.
Methods
Consecutive DCM patients accepted for VT catheter ablation (RFCA) in 9 centers were prospectively enrolled and followed.
Results
Of 281 consecutive patients (age 60±13yrs, 85% men, LVEF 36±12%) 35% had VT storm, 20% incessant VT, and 68% failed amiodarone. During a median follow-up of 21 (IQR 6-30) months after RFCA (epicardial in 58%, no RFCA due to inaccessible target in 6.4%), 67(24%) patients died/underwent HT and 138(49%) had VT recurrence (45 within 30 days defined as early); the cumulative 4-year rate of VT or MHT was 70% and of MHT 38%.
In multivariable analysis predictors of MHT were early VT recurrence (HR 2.92 (CI1.37-6.21), p<0.01), amiodarone at discharge (HR 3.23 (CI1.43-7.33, p<0.01), renal dysfunction (HR 1.92 (CI1.01-3.64), p=0.046), and LVEF (HR 1.36 (CI 1.0-1.84), p=0.052). A LVEF ≤32% was the optimal threshold to identify patients at risk for MHT (AUC 0.75).
MHT per 100 person-years was 40.4 after early VT recurrence and significantly higher, compared to 14.2 after later VT recurrence and to 8.5 after RFCA with no VT recurrence (both p<0.01). Mortality rates for patients with VT recurrence after 30 days were not significantly higher than for patients with no VT recurrences
Patients with early recurrence and LVEF≤32% had a 1-year MHT rate of 55% (figure). VT recurrence was predicted by prior ICD shocks, basal antero-septal VT origin, and procedural failure but not LVEF.
Conclusion
DCM patients needing RFCA for VT are a high-risk group. Following RFCA half remain free of VT recurrences. Early VT recurrence with LVEF<0.32 identifies those with a very high risk and screening for mechanical support/ HT should be considered. Late VT recurrence after RFCA does not predict worse outcome.
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Affiliation(s)
- K Zeppenfeld
- Leiden University Medical Centre, Leiden, Netherlands (The)
| | - AP Wijnmaalen
- Leiden University Medical Centre, Leiden, Netherlands (The)
| | - M Ebert
- Heart Center of Leipzig, Leipzig, Germany
| | - SH Baldinger
- Inselspital - University of Bern, Bern, Switzerland
| | - M Vaseghi
- University of California San Francisco, San Francisco, United States of America
| | | | - T Gaspar
- Dresden University Heart Center, Dresden, Germany
| | - U Tedrow
- Brigham and Women’s Hospital, Boston, United States of America
| | - T Deneke
- Heart Center Bad Neustadt, Bad Neustadt a. d. Saale, Germany
| | - K Soejima
- Kyorin University Hospital, Tokyo, Japan
| | - K Shivkumar
- University of California San Francisco, San Francisco, United States of America
| | | | | | | | - WG Stevenson
- Vanderbilt University Medical Center, Nashville, United States of America
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Choi MY, Weber B, Stevens E, Guan H, Ellrodt J, Oakes E, Di Carli M, Tedrow U, Sauer W, Costenbader KH. Prevalence of ECG testing and characteristics among new hydroxychloroquine and chloroquine users within a multi-center tertiary care center. Rheumatol Int 2022; 42:1767-1774. [PMID: 35430712 PMCID: PMC9013275 DOI: 10.1007/s00296-022-05125-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/21/2022] [Indexed: 11/27/2022]
Abstract
COVID-19 raised concern regarding cardiotoxicity and QTc prolongation of hydroxychloroquine (HCQ) and chloroquine (CQ). We examined the frequency and patient factors associated with ECG testing and the detection of prolonged QTc among new HCQ/CQ users in a large academic medical system. 10,248 subjects with a first HCQ/CQ prescription (1/2015–3/2020) were included. We assessed baseline (1 year prior to and including day of initiation of HCQ/CQ through 2 months after initial HCQ/CQ prescription) and follow-up (10 months after the baseline period) patient characteristics and ECGs obtained from electronic health records. Among 8384 female HCQ/CQ new users, ECGs were obtained for 22.3%, 14.3%, and 7.6%, at baseline, follow, and both periods, respectively. Among 1864 male HCQ/CQ new users, ECGs were obtained more frequently at baseline (29.7%), follow-up (18.0%), and both periods (11.3%). Female HCQ/CQ users with a normal QTc at baseline but prolonged QTc (> 470 ms) at follow-up (13.1%) were older at HCQ/CQ initiation [mean 64.7 (SD 16.5) vs. 58.7 (SD 16.9) years, p = 0.004] and more likely to have history of myocardial infarction (41.0% vs. 21.6%, p = 0.0003) compared to those who had normal baseline and follow-up QTc. The frequency of prolonged QTc development was similar (12.4%) among male HCQ/CQ new users (> 450 ms). Prior to COVID-19, ECG testing before and after HCQ/CQ prescription was infrequent, particularly for females who are disproportionately affected by rheumatic diseases and were just as likely to develop prolonged QTc (> 1/10 new users). Prospective studies are needed to guide future management of HCQ/CQ therapy in rheumatic populations.
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Affiliation(s)
- May Y Choi
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, 3230 Hospital Drive NW, Calgary, AB, T2N 4Z6, USA.
| | - Brittany Weber
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Emma Stevens
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Hongshu Guan
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jack Ellrodt
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Emily Oakes
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Marcelo Di Carli
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Usha Tedrow
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - William Sauer
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Karen H Costenbader
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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15
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Whitaker J, Batnyam U, Kapur S, Sauer WH, Tedrow U. Safety and Efficacy of Cryoablation for Right Ventricular Moderator Band–Papillary Muscle Complex Ventricular Arrhythmias. JACC Clin Electrophysiol 2022; 8:857-868. [DOI: 10.1016/j.jacep.2022.03.011] [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] [Received: 02/04/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 10/18/2022]
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16
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Tedrow U, Stevenson W. Conversations With Legends in Cardiac Electrophysiology. JACC Clin Electrophysiol 2021; 7:277-277.e7. [PMID: 33602414 DOI: 10.1016/j.jacep.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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17
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Narui R, Tanigawa S, Nakajima I, Tokutake K, Nakamura T, Richardson T, Salloum J, Sapp J, Kanagasundram A, Tedrow U, Stevenson W. Irrigated Needle Ablation Compared With Other Advanced Ablation Techniques for Failed Endocardial Ventricular Arrhythmia Ablation. Circ Arrhythm Electrophysiol 2021; 14:e009817. [PMID: 34133194 DOI: 10.1161/circep.121.009817] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Ryohsuke Narui
- Cardiovascular Division, Department of Medicine, Vanderbilt University, Medical Center, Nashville, TN
| | - Shinichi Tanigawa
- Cardiovascular Division, Department of Medicine, Vanderbilt University, Medical Center, Nashville, TN
| | - Ikutaro Nakajima
- Cardiovascular Division, Department of Medicine, Vanderbilt University, Medical Center, Nashville, TN
| | - Kenichi Tokutake
- Cardiovascular Division, Department of Medicine, Vanderbilt University, Medical Center, Nashville, TN
| | - Tomofumi Nakamura
- Cardiovascular Division, Department of Medicine, Vanderbilt University, Medical Center, Nashville, TN
| | - Travis Richardson
- Cardiovascular Division, Department of Medicine, Vanderbilt University, Medical Center, Nashville, TN
| | - Joseph Salloum
- Cardiovascular Division, Department of Medicine, Vanderbilt University, Medical Center, Nashville, TN
| | - John Sapp
- Cardiovascular Division, Department of Medicine, Vanderbilt University, Medical Center, Nashville, TN
| | - Arvindh Kanagasundram
- Cardiovascular Division, Department of Medicine, Vanderbilt University, Medical Center, Nashville, TN
| | - Usha Tedrow
- Cardiovascular Division, Department of Medicine, Vanderbilt University, Medical Center, Nashville, TN
| | - William Stevenson
- Cardiovascular Division, Department of Medicine, Vanderbilt University, Medical Center, Nashville, TN
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Hoogendoorn J, Venlet J, Man S, Kumar S, Sramko M, Dechering DG, Nakajima I, Siontis KC, Watanabe M, Tedrow U, Bogun F, Eckardt L, Peichl P, Stevenson WG, Zeppenfeld K. The precordial R-prime wave: a novel discriminator between cardiac sarcoidosis and arrhythmogenic right ventricular cardiomyopathy in patients presenting with ventricular tachycardia. Europace 2021. [DOI: 10.1093/europace/euab116.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): The department of cardiology from Leiden University Medical Center receives unrestricted grants from Edwards Lifesciences, Biotronik, Medtronik, Boston Scientific and BioSense Webster. MS was supported by the Research Fellowship of the European Society of Cardiology 2017/2018.
Background Cardiac sarcoidosis (CS) with right ventricular (RV) involvement may mimic ARVC. Histopathological differences may result in disease specific RV activation patterns, detectable on the 12-lead electrocardiogram (ECG). Scar in ARVC progresses from epicardium to endocardium and may lead to delayed activation of areas with reduced voltages, translating into terminal activation delay and occasionally an (epsilon) wave with small amplitude on the ECG. On the contrary, patchy transmural RV scar in CS may lead to conduction block, and therefore late activated areas with preserved voltages, reflected as preserved R’-waves in the right precordial leads.
Purpose To determine whether the terminal activation patterns in precordial leads V1-V3 distinguish CS with RV involvement from ARVC.
Methods This is a multicenter retrospective study including patients with either 1) CS with RV involvement or 2) gene-positive ARVC referred for VT ablation. A non-ventricular paced 12-lead surface ECG prior to ablation was obtained (25mm/s and 10mm/mV). For detailed analysis, Leiden ECG Analysis and Decomposition Software (LEADS) was used. After detection of QRST complexes in the spatial velocity signal, LEADS generates a representative and low-noise averaged beat. Then, measurements per lead were performed using the measurement tool in Adobe Pro DC. Based on the hypothesis that conduction block in CS will lead to late activated areas with preserved voltages, we measured the surface area (SA) of the R’-wave in V1-V3. An R’-wave was defined as any positive deflection from baseline after an S-wave.
Results 13 CS patients with RV involvement (54 ± 8years, 62% male) and 23 ARVC patients (37 ± 15years, 78% male) were included. A R’-wave in V1-V3 was present in all CS patients, compared to 11 (48%) of ARVC patients (p = 0.002). The maximum R’-wave SA in lead V1-V3 was 3.55 (IQR:2.18-5.81) mm2 in CS vs. 0.00 (IQR:0.00-0.43) mm2 in ARVC (p < 0.001; Figure A). By ROC-analysis, the maximum R’-wave SA in lead V1-V3 was an excellent discriminator (area under the curve 0.980 [95%CI: 0.945-1.000]). A cutoff of ≥1.65mm2 had a sensitivity of 85% and specificity of 96% for diagnosing CS. An algorithm was created including the presence of an R’-wave in V1-V3 and the SA of this R’-wave (Figure B). This was validated in a second cohort (18 CS and 40 ARVC) with 72% sensitivity and 88% specificity.
Conclusion Transmural RV scars in CS may cause localized conduction block, leading to late activated areas with preserved voltages, reflected as large R’-wave on the 12-lead surface ECG. An easily applicable algorithm including the surface area of the largest R’-wave in lead V1-V3 ≥1.65mm2 distinguishes CS from ARVC with good sensitivity and specificity. The QRS terminal activation in precordial leads V1-V2 may reflect disease specific scar patterns (for examples: Figure C). Abstract Figure
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Affiliation(s)
- J Hoogendoorn
- Leiden University Medical Center, Cardiology, Leiden, Netherlands (The)
| | - J Venlet
- Leiden University Medical Center, Cardiology, Leiden, Netherlands (The)
| | - S Man
- Leiden University Medical Center, Cardiology, Leiden, Netherlands (The)
| | - S Kumar
- Brigham and Women"s Hospital, Cardiology, Boston, United States of America
| | - M Sramko
- Institute of Clinical and Experimental Medicine, Cardiology, Prague, Czechia
| | - DG Dechering
- University Hospital Munster, Cardiology, Munster, Germany
| | - I Nakajima
- Vanderbilt University Medical Center, Cardiology, Nashville, United States of America
| | - KC Siontis
- University of Michigan, Cardiology, Michigan, United States of America
| | - M Watanabe
- Hokkaido University Hospital, Cardiology, Hokkaido, Japan
| | - U Tedrow
- Brigham and Women"s Hospital, Cardiology, Boston, United States of America
| | - F Bogun
- University of Michigan, Cardiology, Michigan, United States of America
| | - L Eckardt
- University Hospital Munster, Cardiology, Munster, Germany
| | - P Peichl
- Institute of Clinical and Experimental Medicine, Cardiology, Prague, Czechia
| | - WG Stevenson
- Vanderbilt University Medical Center, Cardiology, Nashville, United States of America
| | - K Zeppenfeld
- Leiden University Medical Center, Cardiology, Leiden, Netherlands (The)
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19
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Weber B, Choi M, Stevens E, Guan H, Ellrodt J, Di Carli M, Tedrow U, Sauer W, Costenbader K. PREVALENCE OF ECG TESTING AND CHARACTERISTICS AMONG NEW HYDROXYCHLOROQUINE AND CHLOROQUINE PRESCRIPTIONS WITHIN A LARGE MULTI-CENTER TERTIARY CARE CENTER. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01601-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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20
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Bains K, Janfaza D, Flaherty D, Zeballos J, Halawa A, Tedrow U, Vlassakov K. Sympathetic Blockade for the Management of Refractory Ventricular Tachycardia: A Case Report. A A Pract 2021; 15:e01456. [PMID: 33882033 DOI: 10.1213/xaa.0000000000001456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 64-year-old man with a history of nonischemic cardiomyopathy (NICM) presented with electrical storm (ES). Episodes of ventricular tachycardia (VT) persisted despite endocardial catheter ablations and exhaustive pharmacotherapy. We used alternating regional anesthesia techniques, left stellate ganglion block, and proximal intercostal block to reduce sympathetic input to the heart, resulting in a significant decrease in VT burden. By using alternating catheter locations, we were able to maintain continuous sympathetic blockade for 31 days and bridge the patient to a successful orthotopic heart transplant.
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Affiliation(s)
- Kavin Bains
- From the Department of Anesthesiology, Perioperative and Pain Medicine
| | - David Janfaza
- From the Department of Anesthesiology, Perioperative and Pain Medicine
| | - Devon Flaherty
- From the Department of Anesthesiology, Perioperative and Pain Medicine
| | - Jose Zeballos
- From the Department of Anesthesiology, Perioperative and Pain Medicine
| | - Ahmad Halawa
- Department of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Usha Tedrow
- Department of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kamen Vlassakov
- From the Department of Anesthesiology, Perioperative and Pain Medicine
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21
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Siontis KC, Kim HM, Vergara P, Peretto G, Do DH, de Riva M, Lam A, Qian P, Yokokawa M, Jongnarangsin K, Latchamsetty R, Jais P, Sacher F, Tedrow U, Shivkumar K, Zeppenfeld K, Della Bella P, Stevenson WG, Morady F, Bogun FM. Arrhythmia exacerbation after post-infarction ventricular tachycardia ablation: prevalence and prognostic significance. Europace 2020; 22:1680-1687. [PMID: 32830247 DOI: 10.1093/europace/euaa169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 08/08/2020] [Indexed: 01/03/2023] Open
Abstract
AIMS Catheter ablation is an effective treatment for post-infarction ventricular tachycardia (VT). However, some patients may experience a worsened arrhythmia phenotype after ablation. We aimed to determine the prevalence and prognostic impact of arrhythmia exacerbation (AE) after post-infarction VT ablation. METHODS AND RESULTS A total of 1187 consecutive patients (93% men, median age 68 years, median ejection fraction 30%) who underwent post-infarction VT ablation at six centres were included. Arrhythmia exacerbation was defined as post-ablation VT storm or incessant VT in patients without prior similar events. During follow-up (median 717 days), 426 (36%) patients experienced VT recurrence. Events qualifying as AE occurred in 67 patients (6%). Median times to VT recurrence with and without AE were 238 [interquartile range (IQR) 35-640] days and 135 (IQR 22-521) days, respectively (P = 0.25). Almost half of the patients (46%) who experienced AE experienced it within 6 months of the index procedure. Patients with AE had had longer ablation times during the ablation procedures compared to the rest of the patients (median 42 vs. 34 min, P = 0.02). Among patients with VT recurrence, the risk of death or heart transplantation was significantly higher in patients with than without AE (hazard ratio 1.99, 95% CI 1.28-3.10; P = 0.002) after adjusting for age, gender, ejection fraction, cardiac resynchronization therapy, post-ablation non-inducibility, and post-ablation amiodarone use. CONCLUSION Arrhythmia exacerbation after ablation of infarct-related VT is infrequent but is independently associated with an adverse long-term outcome among patients who experience a VT recurrence. The mechanisms and mitigation strategies of AE after catheter ablation require further investigation.
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Affiliation(s)
| | - Hyungjin M Kim
- Biostatistics Department, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Pasquale Vergara
- Department of Arrhythmology, San Raffaele University Hospital, Milan, Italy
| | - Giovanni Peretto
- Department of Arrhythmology, San Raffaele University Hospital, Milan, Italy
| | - Duc H Do
- Cardiac Arrhythmia Center, University of California-Los Angeles, Los Angeles, CA, USA
| | - Marta de Riva
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Anna Lam
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Pierre Qian
- Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Miki Yokokawa
- Division of Cardiovascular Medicine, University of Michigan, 1500 East Medical Center Drive SPC 5853, Ann Arbor, MI 48109-5853, USA
| | - Krit Jongnarangsin
- Division of Cardiovascular Medicine, University of Michigan, 1500 East Medical Center Drive SPC 5853, Ann Arbor, MI 48109-5853, USA
| | - Rakesh Latchamsetty
- Division of Cardiovascular Medicine, University of Michigan, 1500 East Medical Center Drive SPC 5853, Ann Arbor, MI 48109-5853, USA
| | - Pierre Jais
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Fred Sacher
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Usha Tedrow
- Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Kalyanam Shivkumar
- Cardiac Arrhythmia Center, University of California-Los Angeles, Los Angeles, CA, USA
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Paolo Della Bella
- Department of Arrhythmology, San Raffaele University Hospital, Milan, Italy
| | - William G Stevenson
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Fred Morady
- Division of Cardiovascular Medicine, University of Michigan, 1500 East Medical Center Drive SPC 5853, Ann Arbor, MI 48109-5853, USA
| | - Frank M Bogun
- Division of Cardiovascular Medicine, University of Michigan, 1500 East Medical Center Drive SPC 5853, Ann Arbor, MI 48109-5853, USA
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22
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Dherange P, Sauer WH, Halawa A, Qian P, Kapur S, Zei PC, Cochet H, Blankstein R, Tedrow U. Intracardiac Impedance. JACC Clin Electrophysiol 2020; 6:1465-1466. [DOI: 10.1016/j.jacep.2020.06.005] [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] [Received: 04/20/2020] [Revised: 05/21/2020] [Accepted: 06/04/2020] [Indexed: 10/23/2022]
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23
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Dherange P, Lang J, Qian P, Oberfeld B, Sauer WH, Koplan B, Tedrow U. Arrhythmias and COVID-19: A Review. JACC Clin Electrophysiol 2020; 6:1193-1204. [PMID: 32972561 PMCID: PMC7417167 DOI: 10.1016/j.jacep.2020.08.002] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 12/15/2022]
Abstract
Current understanding of the impact of coronavirus disease-2019 (COVID-19) on arrhythmias continues to evolve as new data emerge. Cardiac arrhythmias are more common in critically ill COVID-19 patients. The potential mechanisms that could result in arrhythmogenesis among COVID-19 patients include hypoxia caused by direct viral tissue involvement of lungs, myocarditis, abnormal host immune response, myocardial ischemia, myocardial strain, electrolyte derangements, intravascular volume imbalances, and drug sides effects. To manage these arrhythmias, it is imperative to increase the awareness of potential drug-drug interactions, to monitor QTc prolongation while receiving COVID therapy and provide special considerations for patients with inherited arrhythmia syndromes. It is also crucial to minimize exposure to COVID-19 infection by stratifying the need for intervention and using telemedicine. As COVID-19 infection continues to prevail with a potential for future surges, more data are required to better understand pathophysiology and to validate management strategies.
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Affiliation(s)
- Parinita Dherange
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Joshua Lang
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Pierre Qian
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Blake Oberfeld
- Division of Cardiovascular Medicine, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - William H Sauer
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bruce Koplan
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Usha Tedrow
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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24
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Schaeffer B, Tanigawa S, Nakamura T, Muthalaly RG, Sapp J, John R, Ghidoli D, Pellegrini C, Tedrow U, Stevenson WG. Characteristics of myocardial tissue staining and lesion creation with an infusion-needle ablation catheter for the treatment of ventricular tachycardia in humans. Heart Rhythm 2020; 17:398-405. [DOI: 10.1016/j.hrthm.2019.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Indexed: 01/09/2023]
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Abstract
Ventricular tachycardia (VT) is associated with significant morbidity and mortality. Radiofrequency catheter ablation can be effective for the treatment of VT but it carries a high rate of recurrence often attributable to insufficient depth of penetration for reaching critical arrhythmogenic substrates. Stereotactic body radioablation (SBRT) is a commonly used technology developed for the non-invasive treatment of solid tumours. Recent evidence suggests that it can also be effective for the treatment of VT. It is a non-invasive procedure and it has the unique advantage of delivering ablative energy to any desired volume within the body to reach sites that are inaccessible with catheter ablation. This article summarises the pre-clinical studies that have formed the evidence base for SBRT in the heart, describes the clinical approaches for SBRT VT ablation and provides perspective on next steps for this new treatment modality.
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Affiliation(s)
- Chen Wei
- Harvard Medical School, Boston, MA, US.,Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, US
| | - Pierre Qian
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, US
| | - Usha Tedrow
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, US
| | - Raymond Mak
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA, US
| | - Paul C Zei
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, US
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26
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AbdelWahab A, Stevenson W, Tedrow U, Pellegrini C, MacIntyre C, Parkash R, Gray C, Gardner M, Sapp J. INFUSION NEEDLE RADIOFREQUENCY ABLATION FOR TREATMENT OF REFRACTORY VENTRICULAR ARRHYTHMIAS IN NON-ISCHEMIC CARDIOMYOPATHY PATIENTS: A CASE-CONTROL STUDY. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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27
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Qian P, Tedrow U. Scar Anisotropy: What Can Varying Wavefronts of Ventricular Activation Tell Us About the Physiology of Reentry Circuits? Circ Arrhythm Electrophysiol 2019; 12:e007457. [PMID: 31122053 DOI: 10.1161/circep.119.007457] [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] [Indexed: 11/16/2022]
Affiliation(s)
- Pierre Qian
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA
| | - Usha Tedrow
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA
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28
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Romero J, Cerrud-Rodriguez RC, Di Biase L, Diaz JC, Alviz I, Grupposo V, Cerna L, Avendano R, Tedrow U, Natale A, Tung R, Kumar S. Combined Endocardial-Epicardial Versus Endocardial Catheter Ablation Alone for Ventricular Tachycardia in Structural Heart Disease. JACC Clin Electrophysiol 2019; 5:13-24. [DOI: 10.1016/j.jacep.2018.08.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/13/2018] [Accepted: 08/15/2018] [Indexed: 01/06/2023]
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Vergara P, Tzou WS, Tung R, Brombin C, Nonis A, Vaseghi M, Frankel D, Biase LD, Tedrow U, Mathuria N, Nakahara S, Tholakanahalli V, Bunch TJ, Weiss JP, Dickfeld T, Lakireddy D, Burkhardt JD, Santangeli P, Callans D, Natale A, Marchlinski F, Stevenson WG, Shivkumar K, Sauer WH, Bella PD. Predictive Score for Identifying Survival and Recurrence Risk Profiles in Patients Undergoing Ventricular Tachycardia Ablation: The I-VT Score. Circ Arrhythm Electrophysiol 2018; 11:e006730. [PMID: 30562104 PMCID: PMC6301075 DOI: 10.1161/circep.118.006730] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [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] [Indexed: 01/30/2023]
Abstract
BACKGROUND Several distinct risk factors for arrhythmia recurrence and mortality following ventricular tachycardia (VT) ablation have been described. The effect of concurrent risk factors has not been assessed so far; thus, it is not yet possible to estimate these risks for a patient with several comorbidities. The aim of the study was to identify specific risk groups for mortality and VT recurrence using the Survival Tree (ST) analysis method. METHODS In 1251 patients 16 demographic, clinical and procedure-related variables were evaluated as potential prognostic factors using ST analysis using a recursive partitioning algorithm that searches for relationships among variables. Survival time and time to VT recurrence in groups derived from ST analysis were compared by a log-rank test. A random forest analysis was then run to extract a variable importance index and internally validate the ST models. RESULTS Left ventricular ejection fraction, implantable cardioverter defibrillator/cardiac resynchronization device, previous ablation were, in hierarchical order, identified by ST analysis as best predictors of VT recurrence, while left ventricular ejection fraction, previous ablation, Electrical storm were identified as best predictors of mortality. Three groups with significantly different survival rates were identified. Among the high-risk group, 65.0% patients were survived and 52.1% patients were free from VT recurrence; within the medium- and low-risk groups, 84.0% and 97.2% patients survived, 72.4% and 88.4% were free from VT recurrence, respectively. CONCLUSIONS Our study is the first to derive and validate a decisional model that provides estimates of VT recurrence and mortality with an effective classification tree. Preprocedure risk stratification could help optimize periprocedural and postprocedural care.
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Affiliation(s)
| | | | - Roderick Tung
- University of Chicago Medical Center, Chicago, Illinois
| | - Chiara Brombin
- University Centre for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milano, Italy
| | - Alessandro Nonis
- University Centre for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milano, Italy
| | - Marmar Vaseghi
- UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, CA
| | - David Frankel
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Luigi Di Biase
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, NY
| | | | - Nilesh Mathuria
- Baylor St. Luke’s Medical Center/Texas Heart Institute, Houston, Texas
| | - Shiro Nakahara
- Dokkyo Medical University Koshigaya Hospital, Saitama, Japan
| | - Venkat Tholakanahalli
- University of Minnesota Medical Center, Minneapolis VA Medical Center, Minneapolis, MN
| | - T. Jared Bunch
- Intermountain Heart Institute, Intermountain Medical Center, Murray, UT
| | - J. Peter Weiss
- Intermountain Heart Institute, Intermountain Medical Center, Murray, UT
| | - Timm Dickfeld
- University of Maryland Medical Center, Baltimore, MD
| | | | - J. David Burkhardt
- Texas Cardiac Arrhythmia Institute, St. David’ s Medical Center, Austin, TX
| | - Pasquale Santangeli
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - David Callans
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’ s Medical Center, Austin, TX
| | - Francis Marchlinski
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Sarkozy A, De Potter T, Heidbuchel H, Ernst S, Kosiuk J, Vano E, Picano E, Arbelo E, Tedrow U. Occupational radiation exposure in the electrophysiology laboratory with a focus on personnel with reproductive potential and during pregnancy: A European Heart Rhythm Association (EHRA) consensus document endorsed by the Heart Rhythm Society (HRS). Europace 2018; 19:1909-1922. [PMID: 29126278 DOI: 10.1093/europace/eux252] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 07/07/2017] [Indexed: 12/21/2022] Open
Affiliation(s)
- Andrea Sarkozy
- University Antwerp and University Hospital of Antwerp, Cardiology department, Antwerp, Belgium
| | - Tom De Potter
- Cardiology Department, OLV Hospital, Moorselbaan, 164 Aalst B-9300, Belgium
| | - Hein Heidbuchel
- University Antwerp and University Hospital of Antwerp, Cardiology department, Antwerp, Belgium
| | - Sabine Ernst
- Cardiology Department, Royal Brompton And Harefield Hospital Sydney Street Chelsea Wing, Level 4 London, SW3 6NP, UK
| | - Jedrzej Kosiuk
- Cardiology Department, University Hospital of Leipzig, Leipzig, Germany
| | - Eliseo Vano
- Department Radiology, Medical School and San Carlos University Hosp Radiology, Madrid 28040, Spain
| | | | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona. IDIBAPS, Institut d'Investigació August Pi i Sunyer, Hospital Clínic de Barcelona Villarroel, 17008036 Barcelona, Spain
| | - Usha Tedrow
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street Boston, MA 02115, USA
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31
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Tedrow U. Assembling the Pieces of the Puzzle. JACC Clin Electrophysiol 2018; 4:304-306. [DOI: 10.1016/j.jacep.2018.01.018] [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] [Received: 01/10/2018] [Accepted: 01/16/2018] [Indexed: 10/17/2022]
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Romero J, Di Biase L, Diaz JC, Quispe R, Du X, Briceno D, Avendano R, Tedrow U, John RM, Michaud GF, Natale A, Stevenson WG, Kumar S. Early Versus Late Referral for Catheter Ablation of Ventricular Tachycardia in Patients With Structural Heart Disease: A Systematic Review and Meta-Analysis of Clinical Outcomes. JACC Clin Electrophysiol 2018; 4:374-382. [PMID: 30089564 DOI: 10.1016/j.jacep.2017.12.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 11/30/2017] [Accepted: 12/04/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVES This was a meta-analysis of published studies to examine the impact of early referral on outcomes after catheter ablation for ventricular tachycardia (VT) in patients with structural heart disease. BACKGROUND Patients are frequently referred for VT ablation after failure of antiarrhythmic drugs to control VT. Some studies have suggested that early referral might confer better outcomes. METHODS An electronic search was performed using major databases. The primary outcomes were long-term VT recurrence and total mortality. Secondary outcomes were acute procedural success and acute complications. RESULTS Three studies were included with a total of 980 patients (mean age 64 ± 12 years, 71% males). Mean follow-up was 29 ± 27 months. Early referral for VT ablation was associated with decreased VT recurrence and acute complications compared with late referral (relative risk: 0.69 [95% confidence interval: 0.58 to 0.82], p < 0.0001 and relative risk: 0.50 [95% confidence interval: 0.27 to 0.93], p = 0.03, respectively). There was no significant difference between early and late referral for total mortality and acute success. CONCLUSIONS Late referral for VT ablation was associated with worse outcomes (VT recurrence and acute complications) in patients with structural heart disease, which suggests that early referral for VT ablation might be a reasonable consideration in this patient population.
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Affiliation(s)
- Jorge Romero
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Luigi Di Biase
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Juan Carlos Diaz
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Renato Quispe
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Xianfeng Du
- Department of Cardiology, Ningbo First Hospital, Zhejiang Sheng, China
| | - David Briceno
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Ricardo Avendano
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Usha Tedrow
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Roy M John
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gregory F Michaud
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Andrea Natale
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - William G Stevenson
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts; Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Saurabh Kumar
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts; Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Westmead, New South Wales, Australia.
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Vakil K, Garcia S, Tung R, Vaseghi M, Tedrow U, Della Bella P, Frankel DS, Vergara P, Di Biase L, Nagashima K, Nakahara S, Tzou WS, Burkhardt JD, Dickfeld T, Weiss JP, Bunch J, Callans D, Lakkireddy D, Natale A, Sauer WH, Stevenson WG, Marchlinski F, Shivkumar K, Tholakanahalli VN. Ventricular Tachycardia Ablation in the Elderly: An International Ventricular Tachycardia Center Collaborative Group Analysis. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.117.005332. [PMID: 29254946 DOI: 10.1161/circep.117.005332] [Citation(s) in RCA: 7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 09/20/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Successful ventricular tachycardia (VT) ablation is associated with improved survival in patients with heart failure. However, the safety and efficacy of VT ablation in the elderly, a population with higher competing nonsudden death risk and comorbidities, have not been well defined. METHODS AND RESULTS The International Ventricular Tachycardia Center Collaborative Study Group registry of 2061 patients who underwent VT ablation at 12 international centers was analyzed. Kaplan-Meier analysis was used to estimate survival of patients ≥70 years with and without VT recurrence. Of the 2049 patients who met inclusion criteria, 681 (33%) patients were ≥70 years of age (mean age, 75±4 years). Among these, 92% were men, 71% had ischemic VT, and 42% had VT storm at presentation. Mean (±SD) left ventricular ejection fraction was 30±11%. Compared with patients <70 years, patients ≥70 years had higher in-hospital (4.4% versus 2.3%; P=0.01) and 1-year mortality (15% versus 11%; P=0.002) but a similar incidence of VT recurrence at 1 year (26% versus 25%; P=0.74) and time to VT recurrence (280 versus 289 days; P=0.20). Absence of VT recurrence during follow-up was strongly associated with improved survival in patients ≥70 years. CONCLUSION VT ablation in the elderly is feasible and reasonably safe with a modestly higher in-hospital and 1-year mortality, with similar rates of VT recurrence at 1 year compared with younger patients. Successful VT ablation, that is, lack of VT recurrence, is strongly associated with improved survival even in this elderly subgroup.
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Affiliation(s)
- Kairav Vakil
- From the Section of Cardiology, Minneapolis VA Health Care System, University of Minnesota (K.V., S.G., V.N.T.); Department of Cardiology, University of Colorado, Aurora (W.S.T., W.H.S.); Division of Cardiology, University of Chicago Medical Center, IL (R.T.); UCLA Cardiac Arrhythmia Center, Division of Cardiology, UCLA Health System (M.V., K.S.); Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia (D.S.F., D.C., F.M.); Division of Cardiology, Hospital San Raffaele, Milan, Italy (P.D.B., P.V.); Division of Cardiology, Texas Cardiac Arrhythmia Institute; Division of Cardiology, St. David's Medical Center, Austin (L.D.B., J.D.B., A.N.); Division of Cardiology, Brigham and Women's Hospital, Boston, MA (U.T., W.G.S.); Division of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan (K.N., S.N.); Division of Cardiology, University of Maryland Medical Center, Baltimore (T.D.); Division of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (J.P.W., J.B.); and Division of Cardiology, University of Kansas Medical Center, Kansas City (D.L.).
| | - Santiago Garcia
- From the Section of Cardiology, Minneapolis VA Health Care System, University of Minnesota (K.V., S.G., V.N.T.); Department of Cardiology, University of Colorado, Aurora (W.S.T., W.H.S.); Division of Cardiology, University of Chicago Medical Center, IL (R.T.); UCLA Cardiac Arrhythmia Center, Division of Cardiology, UCLA Health System (M.V., K.S.); Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia (D.S.F., D.C., F.M.); Division of Cardiology, Hospital San Raffaele, Milan, Italy (P.D.B., P.V.); Division of Cardiology, Texas Cardiac Arrhythmia Institute; Division of Cardiology, St. David's Medical Center, Austin (L.D.B., J.D.B., A.N.); Division of Cardiology, Brigham and Women's Hospital, Boston, MA (U.T., W.G.S.); Division of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan (K.N., S.N.); Division of Cardiology, University of Maryland Medical Center, Baltimore (T.D.); Division of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (J.P.W., J.B.); and Division of Cardiology, University of Kansas Medical Center, Kansas City (D.L.)
| | - Roderick Tung
- From the Section of Cardiology, Minneapolis VA Health Care System, University of Minnesota (K.V., S.G., V.N.T.); Department of Cardiology, University of Colorado, Aurora (W.S.T., W.H.S.); Division of Cardiology, University of Chicago Medical Center, IL (R.T.); UCLA Cardiac Arrhythmia Center, Division of Cardiology, UCLA Health System (M.V., K.S.); Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia (D.S.F., D.C., F.M.); Division of Cardiology, Hospital San Raffaele, Milan, Italy (P.D.B., P.V.); Division of Cardiology, Texas Cardiac Arrhythmia Institute; Division of Cardiology, St. David's Medical Center, Austin (L.D.B., J.D.B., A.N.); Division of Cardiology, Brigham and Women's Hospital, Boston, MA (U.T., W.G.S.); Division of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan (K.N., S.N.); Division of Cardiology, University of Maryland Medical Center, Baltimore (T.D.); Division of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (J.P.W., J.B.); and Division of Cardiology, University of Kansas Medical Center, Kansas City (D.L.)
| | - Marmar Vaseghi
- From the Section of Cardiology, Minneapolis VA Health Care System, University of Minnesota (K.V., S.G., V.N.T.); Department of Cardiology, University of Colorado, Aurora (W.S.T., W.H.S.); Division of Cardiology, University of Chicago Medical Center, IL (R.T.); UCLA Cardiac Arrhythmia Center, Division of Cardiology, UCLA Health System (M.V., K.S.); Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia (D.S.F., D.C., F.M.); Division of Cardiology, Hospital San Raffaele, Milan, Italy (P.D.B., P.V.); Division of Cardiology, Texas Cardiac Arrhythmia Institute; Division of Cardiology, St. David's Medical Center, Austin (L.D.B., J.D.B., A.N.); Division of Cardiology, Brigham and Women's Hospital, Boston, MA (U.T., W.G.S.); Division of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan (K.N., S.N.); Division of Cardiology, University of Maryland Medical Center, Baltimore (T.D.); Division of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (J.P.W., J.B.); and Division of Cardiology, University of Kansas Medical Center, Kansas City (D.L.)
| | - Usha Tedrow
- From the Section of Cardiology, Minneapolis VA Health Care System, University of Minnesota (K.V., S.G., V.N.T.); Department of Cardiology, University of Colorado, Aurora (W.S.T., W.H.S.); Division of Cardiology, University of Chicago Medical Center, IL (R.T.); UCLA Cardiac Arrhythmia Center, Division of Cardiology, UCLA Health System (M.V., K.S.); Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia (D.S.F., D.C., F.M.); Division of Cardiology, Hospital San Raffaele, Milan, Italy (P.D.B., P.V.); Division of Cardiology, Texas Cardiac Arrhythmia Institute; Division of Cardiology, St. David's Medical Center, Austin (L.D.B., J.D.B., A.N.); Division of Cardiology, Brigham and Women's Hospital, Boston, MA (U.T., W.G.S.); Division of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan (K.N., S.N.); Division of Cardiology, University of Maryland Medical Center, Baltimore (T.D.); Division of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (J.P.W., J.B.); and Division of Cardiology, University of Kansas Medical Center, Kansas City (D.L.)
| | - Paolo Della Bella
- From the Section of Cardiology, Minneapolis VA Health Care System, University of Minnesota (K.V., S.G., V.N.T.); Department of Cardiology, University of Colorado, Aurora (W.S.T., W.H.S.); Division of Cardiology, University of Chicago Medical Center, IL (R.T.); UCLA Cardiac Arrhythmia Center, Division of Cardiology, UCLA Health System (M.V., K.S.); Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia (D.S.F., D.C., F.M.); Division of Cardiology, Hospital San Raffaele, Milan, Italy (P.D.B., P.V.); Division of Cardiology, Texas Cardiac Arrhythmia Institute; Division of Cardiology, St. David's Medical Center, Austin (L.D.B., J.D.B., A.N.); Division of Cardiology, Brigham and Women's Hospital, Boston, MA (U.T., W.G.S.); Division of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan (K.N., S.N.); Division of Cardiology, University of Maryland Medical Center, Baltimore (T.D.); Division of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (J.P.W., J.B.); and Division of Cardiology, University of Kansas Medical Center, Kansas City (D.L.)
| | - David S Frankel
- From the Section of Cardiology, Minneapolis VA Health Care System, University of Minnesota (K.V., S.G., V.N.T.); Department of Cardiology, University of Colorado, Aurora (W.S.T., W.H.S.); Division of Cardiology, University of Chicago Medical Center, IL (R.T.); UCLA Cardiac Arrhythmia Center, Division of Cardiology, UCLA Health System (M.V., K.S.); Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia (D.S.F., D.C., F.M.); Division of Cardiology, Hospital San Raffaele, Milan, Italy (P.D.B., P.V.); Division of Cardiology, Texas Cardiac Arrhythmia Institute; Division of Cardiology, St. David's Medical Center, Austin (L.D.B., J.D.B., A.N.); Division of Cardiology, Brigham and Women's Hospital, Boston, MA (U.T., W.G.S.); Division of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan (K.N., S.N.); Division of Cardiology, University of Maryland Medical Center, Baltimore (T.D.); Division of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (J.P.W., J.B.); and Division of Cardiology, University of Kansas Medical Center, Kansas City (D.L.)
| | - Pasquale Vergara
- From the Section of Cardiology, Minneapolis VA Health Care System, University of Minnesota (K.V., S.G., V.N.T.); Department of Cardiology, University of Colorado, Aurora (W.S.T., W.H.S.); Division of Cardiology, University of Chicago Medical Center, IL (R.T.); UCLA Cardiac Arrhythmia Center, Division of Cardiology, UCLA Health System (M.V., K.S.); Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia (D.S.F., D.C., F.M.); Division of Cardiology, Hospital San Raffaele, Milan, Italy (P.D.B., P.V.); Division of Cardiology, Texas Cardiac Arrhythmia Institute; Division of Cardiology, St. David's Medical Center, Austin (L.D.B., J.D.B., A.N.); Division of Cardiology, Brigham and Women's Hospital, Boston, MA (U.T., W.G.S.); Division of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan (K.N., S.N.); Division of Cardiology, University of Maryland Medical Center, Baltimore (T.D.); Division of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (J.P.W., J.B.); and Division of Cardiology, University of Kansas Medical Center, Kansas City (D.L.)
| | - Luigi Di Biase
- From the Section of Cardiology, Minneapolis VA Health Care System, University of Minnesota (K.V., S.G., V.N.T.); Department of Cardiology, University of Colorado, Aurora (W.S.T., W.H.S.); Division of Cardiology, University of Chicago Medical Center, IL (R.T.); UCLA Cardiac Arrhythmia Center, Division of Cardiology, UCLA Health System (M.V., K.S.); Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia (D.S.F., D.C., F.M.); Division of Cardiology, Hospital San Raffaele, Milan, Italy (P.D.B., P.V.); Division of Cardiology, Texas Cardiac Arrhythmia Institute; Division of Cardiology, St. David's Medical Center, Austin (L.D.B., J.D.B., A.N.); Division of Cardiology, Brigham and Women's Hospital, Boston, MA (U.T., W.G.S.); Division of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan (K.N., S.N.); Division of Cardiology, University of Maryland Medical Center, Baltimore (T.D.); Division of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (J.P.W., J.B.); and Division of Cardiology, University of Kansas Medical Center, Kansas City (D.L.)
| | - Koichi Nagashima
- From the Section of Cardiology, Minneapolis VA Health Care System, University of Minnesota (K.V., S.G., V.N.T.); Department of Cardiology, University of Colorado, Aurora (W.S.T., W.H.S.); Division of Cardiology, University of Chicago Medical Center, IL (R.T.); UCLA Cardiac Arrhythmia Center, Division of Cardiology, UCLA Health System (M.V., K.S.); Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia (D.S.F., D.C., F.M.); Division of Cardiology, Hospital San Raffaele, Milan, Italy (P.D.B., P.V.); Division of Cardiology, Texas Cardiac Arrhythmia Institute; Division of Cardiology, St. David's Medical Center, Austin (L.D.B., J.D.B., A.N.); Division of Cardiology, Brigham and Women's Hospital, Boston, MA (U.T., W.G.S.); Division of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan (K.N., S.N.); Division of Cardiology, University of Maryland Medical Center, Baltimore (T.D.); Division of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (J.P.W., J.B.); and Division of Cardiology, University of Kansas Medical Center, Kansas City (D.L.)
| | - Shiro Nakahara
- From the Section of Cardiology, Minneapolis VA Health Care System, University of Minnesota (K.V., S.G., V.N.T.); Department of Cardiology, University of Colorado, Aurora (W.S.T., W.H.S.); Division of Cardiology, University of Chicago Medical Center, IL (R.T.); UCLA Cardiac Arrhythmia Center, Division of Cardiology, UCLA Health System (M.V., K.S.); Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia (D.S.F., D.C., F.M.); Division of Cardiology, Hospital San Raffaele, Milan, Italy (P.D.B., P.V.); Division of Cardiology, Texas Cardiac Arrhythmia Institute; Division of Cardiology, St. David's Medical Center, Austin (L.D.B., J.D.B., A.N.); Division of Cardiology, Brigham and Women's Hospital, Boston, MA (U.T., W.G.S.); Division of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan (K.N., S.N.); Division of Cardiology, University of Maryland Medical Center, Baltimore (T.D.); Division of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (J.P.W., J.B.); and Division of Cardiology, University of Kansas Medical Center, Kansas City (D.L.)
| | - Wendy S Tzou
- From the Section of Cardiology, Minneapolis VA Health Care System, University of Minnesota (K.V., S.G., V.N.T.); Department of Cardiology, University of Colorado, Aurora (W.S.T., W.H.S.); Division of Cardiology, University of Chicago Medical Center, IL (R.T.); UCLA Cardiac Arrhythmia Center, Division of Cardiology, UCLA Health System (M.V., K.S.); Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia (D.S.F., D.C., F.M.); Division of Cardiology, Hospital San Raffaele, Milan, Italy (P.D.B., P.V.); Division of Cardiology, Texas Cardiac Arrhythmia Institute; Division of Cardiology, St. David's Medical Center, Austin (L.D.B., J.D.B., A.N.); Division of Cardiology, Brigham and Women's Hospital, Boston, MA (U.T., W.G.S.); Division of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan (K.N., S.N.); Division of Cardiology, University of Maryland Medical Center, Baltimore (T.D.); Division of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (J.P.W., J.B.); and Division of Cardiology, University of Kansas Medical Center, Kansas City (D.L.)
| | - J David Burkhardt
- From the Section of Cardiology, Minneapolis VA Health Care System, University of Minnesota (K.V., S.G., V.N.T.); Department of Cardiology, University of Colorado, Aurora (W.S.T., W.H.S.); Division of Cardiology, University of Chicago Medical Center, IL (R.T.); UCLA Cardiac Arrhythmia Center, Division of Cardiology, UCLA Health System (M.V., K.S.); Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia (D.S.F., D.C., F.M.); Division of Cardiology, Hospital San Raffaele, Milan, Italy (P.D.B., P.V.); Division of Cardiology, Texas Cardiac Arrhythmia Institute; Division of Cardiology, St. David's Medical Center, Austin (L.D.B., J.D.B., A.N.); Division of Cardiology, Brigham and Women's Hospital, Boston, MA (U.T., W.G.S.); Division of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan (K.N., S.N.); Division of Cardiology, University of Maryland Medical Center, Baltimore (T.D.); Division of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (J.P.W., J.B.); and Division of Cardiology, University of Kansas Medical Center, Kansas City (D.L.)
| | - Timm Dickfeld
- From the Section of Cardiology, Minneapolis VA Health Care System, University of Minnesota (K.V., S.G., V.N.T.); Department of Cardiology, University of Colorado, Aurora (W.S.T., W.H.S.); Division of Cardiology, University of Chicago Medical Center, IL (R.T.); UCLA Cardiac Arrhythmia Center, Division of Cardiology, UCLA Health System (M.V., K.S.); Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia (D.S.F., D.C., F.M.); Division of Cardiology, Hospital San Raffaele, Milan, Italy (P.D.B., P.V.); Division of Cardiology, Texas Cardiac Arrhythmia Institute; Division of Cardiology, St. David's Medical Center, Austin (L.D.B., J.D.B., A.N.); Division of Cardiology, Brigham and Women's Hospital, Boston, MA (U.T., W.G.S.); Division of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan (K.N., S.N.); Division of Cardiology, University of Maryland Medical Center, Baltimore (T.D.); Division of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (J.P.W., J.B.); and Division of Cardiology, University of Kansas Medical Center, Kansas City (D.L.)
| | - J Peter Weiss
- From the Section of Cardiology, Minneapolis VA Health Care System, University of Minnesota (K.V., S.G., V.N.T.); Department of Cardiology, University of Colorado, Aurora (W.S.T., W.H.S.); Division of Cardiology, University of Chicago Medical Center, IL (R.T.); UCLA Cardiac Arrhythmia Center, Division of Cardiology, UCLA Health System (M.V., K.S.); Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia (D.S.F., D.C., F.M.); Division of Cardiology, Hospital San Raffaele, Milan, Italy (P.D.B., P.V.); Division of Cardiology, Texas Cardiac Arrhythmia Institute; Division of Cardiology, St. David's Medical Center, Austin (L.D.B., J.D.B., A.N.); Division of Cardiology, Brigham and Women's Hospital, Boston, MA (U.T., W.G.S.); Division of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan (K.N., S.N.); Division of Cardiology, University of Maryland Medical Center, Baltimore (T.D.); Division of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (J.P.W., J.B.); and Division of Cardiology, University of Kansas Medical Center, Kansas City (D.L.)
| | - Jared Bunch
- From the Section of Cardiology, Minneapolis VA Health Care System, University of Minnesota (K.V., S.G., V.N.T.); Department of Cardiology, University of Colorado, Aurora (W.S.T., W.H.S.); Division of Cardiology, University of Chicago Medical Center, IL (R.T.); UCLA Cardiac Arrhythmia Center, Division of Cardiology, UCLA Health System (M.V., K.S.); Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia (D.S.F., D.C., F.M.); Division of Cardiology, Hospital San Raffaele, Milan, Italy (P.D.B., P.V.); Division of Cardiology, Texas Cardiac Arrhythmia Institute; Division of Cardiology, St. David's Medical Center, Austin (L.D.B., J.D.B., A.N.); Division of Cardiology, Brigham and Women's Hospital, Boston, MA (U.T., W.G.S.); Division of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan (K.N., S.N.); Division of Cardiology, University of Maryland Medical Center, Baltimore (T.D.); Division of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (J.P.W., J.B.); and Division of Cardiology, University of Kansas Medical Center, Kansas City (D.L.)
| | - David Callans
- From the Section of Cardiology, Minneapolis VA Health Care System, University of Minnesota (K.V., S.G., V.N.T.); Department of Cardiology, University of Colorado, Aurora (W.S.T., W.H.S.); Division of Cardiology, University of Chicago Medical Center, IL (R.T.); UCLA Cardiac Arrhythmia Center, Division of Cardiology, UCLA Health System (M.V., K.S.); Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia (D.S.F., D.C., F.M.); Division of Cardiology, Hospital San Raffaele, Milan, Italy (P.D.B., P.V.); Division of Cardiology, Texas Cardiac Arrhythmia Institute; Division of Cardiology, St. David's Medical Center, Austin (L.D.B., J.D.B., A.N.); Division of Cardiology, Brigham and Women's Hospital, Boston, MA (U.T., W.G.S.); Division of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan (K.N., S.N.); Division of Cardiology, University of Maryland Medical Center, Baltimore (T.D.); Division of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (J.P.W., J.B.); and Division of Cardiology, University of Kansas Medical Center, Kansas City (D.L.)
| | - Dhanunjaya Lakkireddy
- From the Section of Cardiology, Minneapolis VA Health Care System, University of Minnesota (K.V., S.G., V.N.T.); Department of Cardiology, University of Colorado, Aurora (W.S.T., W.H.S.); Division of Cardiology, University of Chicago Medical Center, IL (R.T.); UCLA Cardiac Arrhythmia Center, Division of Cardiology, UCLA Health System (M.V., K.S.); Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia (D.S.F., D.C., F.M.); Division of Cardiology, Hospital San Raffaele, Milan, Italy (P.D.B., P.V.); Division of Cardiology, Texas Cardiac Arrhythmia Institute; Division of Cardiology, St. David's Medical Center, Austin (L.D.B., J.D.B., A.N.); Division of Cardiology, Brigham and Women's Hospital, Boston, MA (U.T., W.G.S.); Division of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan (K.N., S.N.); Division of Cardiology, University of Maryland Medical Center, Baltimore (T.D.); Division of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (J.P.W., J.B.); and Division of Cardiology, University of Kansas Medical Center, Kansas City (D.L.)
| | - Andrea Natale
- From the Section of Cardiology, Minneapolis VA Health Care System, University of Minnesota (K.V., S.G., V.N.T.); Department of Cardiology, University of Colorado, Aurora (W.S.T., W.H.S.); Division of Cardiology, University of Chicago Medical Center, IL (R.T.); UCLA Cardiac Arrhythmia Center, Division of Cardiology, UCLA Health System (M.V., K.S.); Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia (D.S.F., D.C., F.M.); Division of Cardiology, Hospital San Raffaele, Milan, Italy (P.D.B., P.V.); Division of Cardiology, Texas Cardiac Arrhythmia Institute; Division of Cardiology, St. David's Medical Center, Austin (L.D.B., J.D.B., A.N.); Division of Cardiology, Brigham and Women's Hospital, Boston, MA (U.T., W.G.S.); Division of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan (K.N., S.N.); Division of Cardiology, University of Maryland Medical Center, Baltimore (T.D.); Division of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (J.P.W., J.B.); and Division of Cardiology, University of Kansas Medical Center, Kansas City (D.L.)
| | - William H Sauer
- From the Section of Cardiology, Minneapolis VA Health Care System, University of Minnesota (K.V., S.G., V.N.T.); Department of Cardiology, University of Colorado, Aurora (W.S.T., W.H.S.); Division of Cardiology, University of Chicago Medical Center, IL (R.T.); UCLA Cardiac Arrhythmia Center, Division of Cardiology, UCLA Health System (M.V., K.S.); Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia (D.S.F., D.C., F.M.); Division of Cardiology, Hospital San Raffaele, Milan, Italy (P.D.B., P.V.); Division of Cardiology, Texas Cardiac Arrhythmia Institute; Division of Cardiology, St. David's Medical Center, Austin (L.D.B., J.D.B., A.N.); Division of Cardiology, Brigham and Women's Hospital, Boston, MA (U.T., W.G.S.); Division of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan (K.N., S.N.); Division of Cardiology, University of Maryland Medical Center, Baltimore (T.D.); Division of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (J.P.W., J.B.); and Division of Cardiology, University of Kansas Medical Center, Kansas City (D.L.)
| | - William G Stevenson
- From the Section of Cardiology, Minneapolis VA Health Care System, University of Minnesota (K.V., S.G., V.N.T.); Department of Cardiology, University of Colorado, Aurora (W.S.T., W.H.S.); Division of Cardiology, University of Chicago Medical Center, IL (R.T.); UCLA Cardiac Arrhythmia Center, Division of Cardiology, UCLA Health System (M.V., K.S.); Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia (D.S.F., D.C., F.M.); Division of Cardiology, Hospital San Raffaele, Milan, Italy (P.D.B., P.V.); Division of Cardiology, Texas Cardiac Arrhythmia Institute; Division of Cardiology, St. David's Medical Center, Austin (L.D.B., J.D.B., A.N.); Division of Cardiology, Brigham and Women's Hospital, Boston, MA (U.T., W.G.S.); Division of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan (K.N., S.N.); Division of Cardiology, University of Maryland Medical Center, Baltimore (T.D.); Division of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (J.P.W., J.B.); and Division of Cardiology, University of Kansas Medical Center, Kansas City (D.L.)
| | - Francis Marchlinski
- From the Section of Cardiology, Minneapolis VA Health Care System, University of Minnesota (K.V., S.G., V.N.T.); Department of Cardiology, University of Colorado, Aurora (W.S.T., W.H.S.); Division of Cardiology, University of Chicago Medical Center, IL (R.T.); UCLA Cardiac Arrhythmia Center, Division of Cardiology, UCLA Health System (M.V., K.S.); Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia (D.S.F., D.C., F.M.); Division of Cardiology, Hospital San Raffaele, Milan, Italy (P.D.B., P.V.); Division of Cardiology, Texas Cardiac Arrhythmia Institute; Division of Cardiology, St. David's Medical Center, Austin (L.D.B., J.D.B., A.N.); Division of Cardiology, Brigham and Women's Hospital, Boston, MA (U.T., W.G.S.); Division of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan (K.N., S.N.); Division of Cardiology, University of Maryland Medical Center, Baltimore (T.D.); Division of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (J.P.W., J.B.); and Division of Cardiology, University of Kansas Medical Center, Kansas City (D.L.)
| | - Kalyanam Shivkumar
- From the Section of Cardiology, Minneapolis VA Health Care System, University of Minnesota (K.V., S.G., V.N.T.); Department of Cardiology, University of Colorado, Aurora (W.S.T., W.H.S.); Division of Cardiology, University of Chicago Medical Center, IL (R.T.); UCLA Cardiac Arrhythmia Center, Division of Cardiology, UCLA Health System (M.V., K.S.); Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia (D.S.F., D.C., F.M.); Division of Cardiology, Hospital San Raffaele, Milan, Italy (P.D.B., P.V.); Division of Cardiology, Texas Cardiac Arrhythmia Institute; Division of Cardiology, St. David's Medical Center, Austin (L.D.B., J.D.B., A.N.); Division of Cardiology, Brigham and Women's Hospital, Boston, MA (U.T., W.G.S.); Division of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan (K.N., S.N.); Division of Cardiology, University of Maryland Medical Center, Baltimore (T.D.); Division of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (J.P.W., J.B.); and Division of Cardiology, University of Kansas Medical Center, Kansas City (D.L.)
| | - Venkatakrishna N Tholakanahalli
- From the Section of Cardiology, Minneapolis VA Health Care System, University of Minnesota (K.V., S.G., V.N.T.); Department of Cardiology, University of Colorado, Aurora (W.S.T., W.H.S.); Division of Cardiology, University of Chicago Medical Center, IL (R.T.); UCLA Cardiac Arrhythmia Center, Division of Cardiology, UCLA Health System (M.V., K.S.); Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia (D.S.F., D.C., F.M.); Division of Cardiology, Hospital San Raffaele, Milan, Italy (P.D.B., P.V.); Division of Cardiology, Texas Cardiac Arrhythmia Institute; Division of Cardiology, St. David's Medical Center, Austin (L.D.B., J.D.B., A.N.); Division of Cardiology, Brigham and Women's Hospital, Boston, MA (U.T., W.G.S.); Division of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan (K.N., S.N.); Division of Cardiology, University of Maryland Medical Center, Baltimore (T.D.); Division of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT (J.P.W., J.B.); and Division of Cardiology, University of Kansas Medical Center, Kansas City (D.L.)
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Vergara P, Tung R, Vaseghi M, Brombin C, Frankel DS, Di Biase L, Nagashima K, Tedrow U, Tzou WS, Sauer WH, Mathuria N, Nakahara S, Vakil K, Tholakanahalli V, Bunch TJ, Weiss JP, Dickfeld T, Vunnam R, Lakireddy D, Burkhardt JD, Correra A, Santangeli P, Callans D, Natale A, Marchlinski F, Stevenson WG, Shivkumar K, Della Bella P. Successful ventricular tachycardia ablation in patients with electrical storm reduces recurrences and improves survival. Heart Rhythm 2017; 15:48-55. [PMID: 28843418 DOI: 10.1016/j.hrthm.2017.08.022] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [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: 04/28/2017] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the characteristics and outcome of patients undergoing ablation after electrical storm (ES). METHODS Clinical and procedural characteristics, ventricular tachycardia (VT) recurrence, and mortality rates from 1940 patients undergoing VT ablation were compared between patients with and without ES. RESULTS The group of 677 patients with ES (34.9%) were older, were more frequently men, and had a lower ejection fraction, more advanced heart failure, and a higher prevalence of cardiovascular comorbidities as compared with those without ES (86.1% patients with ES had ≥2 comorbidities vs 71.4%; P < .001). Patients with ES had more inducible VTs (2.5 ± 1.8 vs 1.9 ± 1.9; P < .001), required longer procedures (296.1 ± 119.1 minutes vs 265.7 ± 110.3 minutes; P < .001), and had a higher in-hospital mortality (42 deaths [6.2%] vs 18 deaths [1.4%]; P < .001). At 1-year follow-up, patients with ES experienced a higher risk of VT recurrence and mortality (32.1% vs 22.6% and 20.1% vs 8.5%; long-rank, P < .001 for both). Among patients with ES, those without any inducible VT after ablation had a higher survival rate (86.3%) than did those with nonclinical VTs only (72.9%), those with clinical VTs inducible at programmed electrical stimulation (51.2%), and not-tested patients (65.0%) (long-rank, P < .001 for all). In multivariate analysis, ES remained an independent predictor of in-hospital mortality, VT recurrence, and 1-year mortality (P < .001). CONCLUSION Patients with ES have a high risk of VT recurrence and mortality. Patient and procedure characteristics are consistent with advanced cardiac disease and longer and more complex procedures. In patients with ES, acute procedural success is associated with a significant reduction in VT recurrence and improved 1-year survival.
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Affiliation(s)
| | - Roderick Tung
- University of Chicago Medical Center, Chicago, Illinois
| | - Marmar Vaseghi
- UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California
| | - Chiara Brombin
- University Centre for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | - David S Frankel
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Luigi Di Biase
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York
| | | | - Usha Tedrow
- Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | - Nilesh Mathuria
- Baylor St. Luke's Medical Center/Texas Heart Institute, Houston, Texas
| | - Shiro Nakahara
- Dokkyo Medical University Koshigaya Hospital, Saitama, Japan
| | - Kairav Vakil
- University of Minnesota Medical Center, Minneapolis VA Medical Center, Minneapolis, Minnesota
| | - Venkat Tholakanahalli
- University of Minnesota Medical Center, Minneapolis VA Medical Center, Minneapolis, Minnesota
| | - T Jared Bunch
- Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah
| | - J Peter Weiss
- Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah
| | - Timm Dickfeld
- University of Maryland Medical Center, Baltimore, Maryland
| | - Rama Vunnam
- University of Maryland Medical Center, Baltimore, Maryland
| | | | - J David Burkhardt
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | | | - Pasquale Santangeli
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Callans
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Francis Marchlinski
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California
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Tzou WS, Tung R, Frankel DS, Vaseghi M, Bunch TJ, Di Biase L, Tholakanahalli VN, Lakkireddy D, Dickfeld T, Saliaris A, Weiss JP, Mathuria N, Tedrow U, Afzal MR, Vergara P, Nagashima K, Patel M, Nakahara S, Vakil K, Burkhardt JD, Tseng CH, Natale A, Shivkumar K, Callans DJ, Stevenson WG, Della Bella P, Marchlinski FE, Sauer WH. Ventricular Tachycardia Ablation in Severe Heart Failure: An International Ventricular Tachycardia Ablation Center Collaboration Analysis. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.116.004494. [PMID: 28082527 DOI: 10.1161/circep.116.004494] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 07/15/2016] [Accepted: 11/30/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ventricular tachycardia (VT) radiofrequency ablation has been associated with reduced VT recurrence and mortality, although it is typically not considered among New York Heart Association class IV (NYHA IV) heart failure patients. We compared characteristics and VT radiofrequency ablation outcomes of those with and without NYHA IV in the International VT Ablation Center Collaboration. METHODS AND RESULTS NYHA II-IV patients undergoing VT radiofrequency ablation at 12 international centers were included. Clinical variables, VT recurrence, and mortality were analyzed by NYHA IV status using Kaplan-Meier analysis and Cox proportional hazard models. There were significant differences between NYHA IV (n=111) and NYHA II and III (n=1254) patients: NYHA IV had lower left ventricular ejection fraction; more had diabetes mellitus, kidney disease, cardiac resynchronization implantable cardioverter-defibrillator, and VT storm despite greater antiarrhythmic drug use (P<0.01). NYHA IV subjects required more hemodynamic support, were inducible for more and slower VTs, and were less likely to undergo final programmed stimulation. There was no significant difference in acute complications. In-hospital deaths, recurrent VT, and 1-year mortality were higher in the NYHA IV group, in the context of greater baseline comorbidities. Importantly, NYHA IV patients without recurrent VT had similar survival compared with NYHA II and III patients with recurrent VT (68% versus 73%). Early VT recurrence (≤30 days) was significantly associated with mortality, especially in NYHA IV patients. CONCLUSIONS Despite greater baseline comorbidities, VT radiofrequency ablation can be safely performed among NYHA IV patients. Early VT recurrence is significantly associated with subsequent mortality regardless of NYHA status. Elimination of recurrent VT in NYHA IV patients may reduce mortality to a level comparable to NYHA II and III with arrhythmia recurrence.
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Affiliation(s)
- Wendy S Tzou
- For the author affiliations, please see the Appendix.
| | - Roderick Tung
- For the author affiliations, please see the Appendix
| | | | | | - T Jared Bunch
- For the author affiliations, please see the Appendix
| | | | | | | | - Timm Dickfeld
- For the author affiliations, please see the Appendix
| | | | - J Peter Weiss
- For the author affiliations, please see the Appendix
| | | | - Usha Tedrow
- For the author affiliations, please see the Appendix
| | | | | | | | - Mehul Patel
- For the author affiliations, please see the Appendix
| | | | - Kairav Vakil
- For the author affiliations, please see the Appendix
| | | | | | - Andrea Natale
- For the author affiliations, please see the Appendix
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Mehta N, Bapat A, Tedrow U, Stevenson WG, Koplan B. Inappropriate sinus tachycardia in a heart transplant successfully treated with ivabradine. Europace 2017; 19:1100. [DOI: 10.1093/europace/eux038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Frankel DS, Tung R, Santangeli P, Tzou WS, Vaseghi M, Di Biase L, Nagashima K, Tedrow U, Bunch TJ, Tholakanahalli VN, Dendi R, Reddy M, Lakkireddy D, Dickfeld T, Weiss JP, Mathuria N, Vergara P, Patel M, Nakahara S, Vakil K, Sauer WH, Callans DJ, Natale A, Stevenson WG, Della Bella P, Shivkumar K, Marchlinski FE. Sex and Catheter Ablation for Ventricular Tachycardia. JAMA Cardiol 2016; 1:938-944. [DOI: 10.1001/jamacardio.2016.2361] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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: 11/14/2022]
Affiliation(s)
- David S. Frankel
- Electrophysiology Section, Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Roderick Tung
- University of Chicago Medical Center, Chicago, Illinois
| | - Pasquale Santangeli
- Electrophysiology Section, Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Wendy S. Tzou
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora
| | - Marmar Vaseghi
- University of California Los Angeles Cardiac Arrhythmia Center, University of California Los Angeles Health System
| | - Luigi Di Biase
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York
| | | | - Usha Tedrow
- Brigham and Women’s Hospital, Boston, Massachusetts
| | - T. Jared Bunch
- Intermountain Medical Center Heart Institute, Murray, Utah
| | | | | | - Madhu Reddy
- University of Kansas Medical Center, Kansas City
| | | | | | - J. Peter Weiss
- Intermountain Medical Center Heart Institute, Murray, Utah
| | - Nilesh Mathuria
- Baylor St Luke’s Medical Center/Texas Heart Institute, Houston
| | | | - Mehul Patel
- Baylor St Luke’s Medical Center/Texas Heart Institute, Houston
| | - Shiro Nakahara
- Dokkyo Medical University Koshigaya Hospital, Saitama, Japan
| | - Kairav Vakil
- Veteran’s Affairs Medical Center, University of Minnesota, Minneapolis
| | - William H. Sauer
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora
| | - David J. Callans
- Electrophysiology Section, Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St David’s Medical Center, Austin
| | | | | | - Kalyanam Shivkumar
- University of California Los Angeles Cardiac Arrhythmia Center, University of California Los Angeles Health System
| | - Francis E. Marchlinski
- Electrophysiology Section, Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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Chiuve SE, Sun Q, Sandhu RK, Tedrow U, Cook NR, Manson JE, Albert CM. Adiposity throughout adulthood and risk of sudden cardiac death in women. JACC Clin Electrophysiol 2015; 1:520-528. [PMID: 26824079 DOI: 10.1016/j.jacep.2015.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Sudden cardiac death (SCD) is often the first manifestation of coronary heart disease (CHD) among women. Data regarding BMI and risk of SCD are limited and conflicting. OBJECTIVES We examined the association of BMI repeatedly measured over 32 years and BMI during early and mid-adulthood with risk of SCD in the Nurses' Health Study. METHODS We prospectively followed 72,484 women free of chronic disease from 1980-2012. We ascertained adult height, current weight, and weight at age 18 at baseline and updated weight biennially. The primary endpoint was SCD (n=445). RESULTS When updated biennially, higher BMI was associated with greater SCD risk after adjusting for confounders (p, linear trend: <0.001). Compared to a BMI of 21.0-22.9, the multivariate RR (95%CI) of SCD was 1.46 (1.05, 2.04) for BMI 25.0-29.9, 1.46 (1.00, 2.13) for BMI 30.0-34.9 and 2.18 (1.44, 3.28) for BMI ≥35.0. Among women with a BMI ≥35.0, SCD remained elevated even after adjustment for interim development of CHD and other mediators (RR: 1.72; 95%CI: 1.13, 2.60). In contrast, the association between BMI and fatal CHD risk was completely attenuated after adjustment for mediators. The magnitude of the association between BMI and SCD was greater when BMI was assessed at baseline or at age 18, at which time SCD risk remained significantly elevated at BMI≥30 after adjustment for mediators. CONCLUSIONS Higher BMI was associated with greater risk of SCD, particularly when assessed earlier in adulthood. Strategies to maintain a healthy weight throughout adulthood may minimize SCD incidence.
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Affiliation(s)
- Stephanie E Chiuve
- Center for Arrhythmia Prevention, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; The Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Qi Sun
- The Channing Division for Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Roopinder K Sandhu
- The Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
| | - Usha Tedrow
- Center for Arrhythmia Prevention, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; The Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Nancy R Cook
- The Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - JoAnn E Manson
- The Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Christine M Albert
- Center for Arrhythmia Prevention, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; The Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; The Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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Latchamsetty R, Yokokawa M, Morady F, Kim HM, Mathew S, Tilz R, Kuck KH, Nagashima K, Tedrow U, Stevenson WG, Yu R, Tung R, Shivkumar K, Sarrazin JF, Arya A, Hindricks G, Vunnam R, Dickfeld T, Daoud EG, Oza NM, Bogun F. Multicenter Outcomes for Catheter Ablation of Idiopathic Premature Ventricular Complexes. JACC Clin Electrophysiol 2015; 1:116-123. [DOI: 10.1016/j.jacep.2015.04.005] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 04/09/2015] [Indexed: 10/23/2022]
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40
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Tung R, Vaseghi M, Frankel DS, Vergara P, Di Biase L, Nagashima K, Yu R, Vangala S, Tseng CH, Choi EK, Khurshid S, Patel M, Mathuria N, Nakahara S, Tzou WS, Sauer WH, Vakil K, Tedrow U, Burkhardt JD, Tholakanahalli VN, Saliaris A, Dickfeld T, Weiss JP, Bunch TJ, Reddy M, Kanmanthareddy A, Callans DJ, Lakkireddy D, Natale A, Marchlinski F, Stevenson WG, Della Bella P, Shivkumar K. Freedom from recurrent ventricular tachycardia after catheter ablation is associated with improved survival in patients with structural heart disease: An International VT Ablation Center Collaborative Group study. Heart Rhythm 2015; 12:1997-2007. [PMID: 26031376 DOI: 10.1016/j.hrthm.2015.05.036] [Citation(s) in RCA: 348] [Impact Index Per Article: 38.7] [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: 04/02/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND The impact of catheter ablation of ventricular tachycardia (VT) on all-cause mortality remains unknown. OBJECTIVE The purpose of this study was to examine the association between VT recurrence after ablation and survival in patients with scar-related VT. METHODS Analysis of 2061 patients with structural heart disease referred for catheter ablation of scar-related VT from 12 international centers was performed. Data on clinical and procedural variables, VT recurrence, and mortality were analyzed. Kaplan-Meier analysis was used to estimate freedom from recurrent VT, transplant, and death. Cox proportional hazards frailty models were used to analyze the effect of risk factors on VT recurrence and mortality. RESULTS One-year freedom from VT recurrence was 70% (72% in ischemic and 68% in nonischemic cardiomyopathy). Fifty-seven patients (3%) underwent cardiac transplantation, and 216 (10%) died during follow-up. At 1 year, the estimated rate of transplant and/or mortality was 15% (same for ischemic and nonischemic cardiomyopathy). Transplant-free survival was significantly higher in patients without VT recurrence than in those with recurrence (90% vs 71%, P<.001). In multivariable analysis, recurrence of VT after ablation showed the highest risk for transplant and/or mortality [hazard ratio 6.9 (95% CI 5.3-9.0), P<.001]. In patients with ejection fraction <30% and across all New York Heart Association functional classes, improved transplant-free survival was seen in those without VT recurrence. CONCLUSION Catheter ablation of VT in patients with structural heart disease results in 70% freedom from VT recurrence, with an overall transplant and/or mortality rate of 15% at 1 year. Freedom from VT recurrence is associated with improved transplant-free survival, independent of heart failure severity.
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Affiliation(s)
- Roderick Tung
- UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California
| | - Marmar Vaseghi
- UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California
| | - David S Frankel
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | | | - Ricky Yu
- UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California
| | - Sitaram Vangala
- UCLA Department of Medicine Statistics Core, Los Angeles, California
| | - Chi-Hong Tseng
- UCLA Department of Medicine Statistics Core, Los Angeles, California
| | | | - Shaan Khurshid
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mehul Patel
- Baylor St. Luke's Medical Center/Texas Heart Institute, Houston, Texas
| | - Nilesh Mathuria
- Baylor St. Luke's Medical Center/Texas Heart Institute, Houston, Texas
| | - Shiro Nakahara
- Dokkyo Medical University Koshigaya Hospital, Saitama, Japan
| | | | | | - Kairav Vakil
- University of Minnesota Medical Center, Minneapolis VA Medical Center, Minneapolis, Minnesota
| | - Usha Tedrow
- Brigham and Women's Hospital, Boston, Massachusetts
| | - J David Burkhardt
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | | | | | - Timm Dickfeld
- University of Maryland Medical Center, Baltimore, Maryland
| | - J Peter Weiss
- Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah
| | - T Jared Bunch
- Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah
| | - Madhu Reddy
- University of Kansas Medical Center, Kansas City, Kansas
| | | | - David J Callans
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | | | | | | | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California.
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41
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Sacher F, Reichlin T, Zado ES, Field ME, Viles-Gonzalez JF, Peichl P, Ellenbogen KA, Maury P, Dukkipati SR, Picard F, Kautzner J, Barandon L, Koneru JN, Ritter P, Mahida S, Calderon J, Derval N, Denis A, Cochet H, Shepard RK, Corre J, Coffey JO, Garcia F, Hocini M, Tedrow U, Haissaguerre M, d'Avila A, Stevenson WG, Marchlinski FE, Jais P. Characteristics of ventricular tachycardia ablation in patients with continuous flow left ventricular assist devices. Circ Arrhythm Electrophysiol 2015; 8:592-7. [PMID: 25870335 DOI: 10.1161/circep.114.002394] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [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: 10/10/2014] [Accepted: 03/30/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Left ventricular assist devices (LVADs) are increasingly used as a bridge to cardiac transplantation or as destination therapy. Patients with LVADs are at high risk for ventricular arrhythmias. This study describes ventricular arrhythmia characteristics and ablation in patients implanted with a Heart Mate II device. METHODS AND RESULTS All patients with a Heart Mate II device who underwent ventricular arrhythmia catheter ablation at 9 tertiary centers were included. Thirty-four patients (30 male, age 58±10 years) underwent 39 ablation procedures. The underlying cardiomyopathy pathogenesis was ischemic in 21 and nonischemic in 13 patients with a mean left ventricular ejection fraction of 17%±5% before LVAD implantation. One hundred and ten ventricular tachycardias (VTs; cycle lengths, 230-740 ms, arrhythmic storm n=28) and 2 ventricular fibrillation triggers were targeted (25 transseptal, 14 retrograde aortic approaches). Nine patients required VT ablation <1 month after LVAD implantation because of intractable VT. Only 10/110 (9%) of the targeted VTs were related to the Heart Mate II cannula. During follow-up, 7 patients were transplanted and 10 died. Of the remaining 17 patients, 13 were arrhythmia-free at 25±15 months. In 1 patient with VT recurrence, change of turbine speed from 9400 to 9000 rpm extinguished VT. CONCLUSIONS Catheter ablation of VT among LVAD recipients is feasible and reasonably safe even soon after LVAD implantation. Intrinsic myocardial scar, rather than the apical cannula, seems to be the dominant substrate.
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Affiliation(s)
- Frederic Sacher
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.).
| | - Tobias Reichlin
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Erica S Zado
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Michael E Field
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Juan F Viles-Gonzalez
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Petr Peichl
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Kenneth A Ellenbogen
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Philippe Maury
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Srinivas R Dukkipati
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Francois Picard
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Josef Kautzner
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Laurent Barandon
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Jayanthi N Koneru
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Philippe Ritter
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Saagar Mahida
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Joachim Calderon
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Nicolas Derval
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Arnaud Denis
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Hubert Cochet
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Richard K Shepard
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Jerome Corre
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - James O Coffey
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Fermin Garcia
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Meleze Hocini
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Usha Tedrow
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Michel Haissaguerre
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Andre d'Avila
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - William G Stevenson
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Francis E Marchlinski
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
| | - Pierre Jais
- From the Bordeaux University Hospital/LIRYC institute/INSERM 1045/Bordeaux University, Bordeaux, France (F.S., F.P., L.B., P.R., J.C., N.D., A.D., H.C., J.C., M.H., M.H., P.J.); Brigham and Women Hospital, Boston, MA (T.R., S.M., U.T., W.G.S.); Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (E.S.Z., F.G., F.E.M.); Division of Cardiovascular Medicine, University of Wisconsin Hospital, Madison (M.E.F.); Department of Cardiac Electrophysiology, University of Miami Medical Center, FL (J.F.V.-G., J.O.C.); Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.P., J.K.); Division of Cardiology, Department of Medicine, Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond (K.A.E., J.N.K., R.K.S.); CHU de Toulouse, Toulouse, France (P.M.); and Mount Sinai Hospital, New York, NY (S.R.D., A.d'A.)
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Abstract
Women have a similar lifetime prevalence of non-valvular atrial fibrillation (NVAF) compared with that of men. Given the significant morbidity and potential mortality associated with NVAF, it is crucial to understand gender differences with NVAF. Women can be more symptomatic than men. Despite a higher baseline stroke risk, they are less likely to be on anticoagulation. Women have a greater risk of thromboembolism and a similar rate of bleeding risk compared with men on anticoagulation. Initial experience suggests that novel oral anticoagulants have similar safety and efficacy profile in men and women. Although women can have more adverse reactions from antiarrhythmic therapies, they are often referred later than men for ablation. As a group, a mitigating factor in ablation referral is that women also have a higher incidence of procedural complications from catheter ablation. This review summarizes the available literature highlighting significant gender-based differences and also highlights areas for research to improve NVAF outcomes in women.
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Affiliation(s)
- Nishaki Mehta Oza
- The Ohio State University - Cardiovascular Medicine, Columbus, OH 43210, USA
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Abstract
Dyssynchronous ventricular contraction, often associated with delayed electrical activation, contributes to worsened clinical status in patients with chronic dilated heart failure. There are three levels of impaired electromechanical synchrony that can be recognized and potentially improved with pacing methods. Prolonged atrioventricular (AV) delay can promote presystolic mitral regurgitation and impaired left ventricular (LV) filling. Interventricular conduction delay with right ventricular (RV) activation preceding LV activation often occurs in the setting of left bundle branch block or RV apical pacing, and can result in impeded LV filling and ejection. Activation delays within the LV itself (intraventricular dyssynchrony) can cause decreased efficiency of contraction, increased mitral regurgitation, and abnormal ventricular remodeling. Cardiac resynchronization therapy (CRT) can improve ventricular performance in two thirds of patients selected based on QRS duration alone. Improved understanding of the pathophysiology of cardiac dyssynchrony will aid in patient selection and in assessment and optimization of response to CRT.
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Affiliation(s)
- Usha Tedrow
- Tower 3-B, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
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Affiliation(s)
- Usha Tedrow
- From Arrhythmia Service of the Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - William G. Stevenson
- From Arrhythmia Service of the Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
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Ujeyl A, Inada K, Hillmann K, Wohlmuth P, Kato M, Tedrow U, Stevenson LW, Stevenson WG. Right heart function prediction of outcome in heart failure patients after catheter ablation for recurrent ventricular tachycardia. JACC Heart Fail 2013; 1:281-289. [PMID: 24621931 DOI: 10.1016/j.jchf.2013.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 04/23/2013] [Accepted: 05/03/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVES This study sought to determine the relevance of echocardiographic assessment focusing on right ventricular (RV) function to estimate prognosis in patients with heart failure (HF) and low left ventricular ejection fraction (LVEF) after ablation of ventricular tachycardia (VT). BACKGROUND Recurrent VT is a marker of increased mortality in HF. Decision making remains challenging as some patients have a poor outcome despite successful catheter ablation of VT due to progressive biventricular HF. METHODS Retrospective analysis was performed on data from 320 consecutive patients with HF and LVEF ≤40% who underwent ablation for recurrent VT between 1999 and 2008. Baseline clinical and echocardiographic data were analyzed in relation to survival. RESULTS Among the 320 patients included, the mean age was 63 years, and 86% were male. During follow-up (median: 36 months) 127 patients (40%) died. RV dysfunction (hazard ratio [HR]: 1.4) and tricuspid regurgitation (TR) (HR: 1.7), together with age, New York Heart Association (NYHA) class, and serum creatinine, were independent predictors of death in a Cox regression model. Mortality was more than 2-fold higher in patients with at least moderate RV dysfunction and TR (HR: 2.6; p < 0.001). In patients with at least moderate RV dysfunction, TR, and estimated pulmonary arterial pressure ≥45 mm Hg, mortality was 61% at 2 years, compared with 16% in patients with good RV function without pulmonary hypertension (p < 0.0001). CONCLUSIONS Despite low LVEF, patients with recurrent VT who had good RV function without elevated pulmonary pressures had a good prognosis after VT ablation. RV dysfunction, TR, and elevated pulmonary pressures identified a high-risk group of VT survivors in whom additional interventions may be necessary to improve survival.
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Affiliation(s)
- Amaar Ujeyl
- Cardiovascular Division and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Keiichi Inada
- Cardiovascular Division and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Katja Hillmann
- Department of Economics, University of Hamburg, Hamburg, Germany
| | | | - Mahoto Kato
- Cardiovascular Division and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Usha Tedrow
- Cardiovascular Division and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lynne W Stevenson
- Cardiovascular Division and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - William G Stevenson
- Cardiovascular Division and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Neilan TG, Coelho-Filho O, Danik S, Verdini DJ, Michifumi T, Shah R, Tedrow U, Stevenson W, Jerosch-Herold M, Ghoshhajra B, Kwong R. THE IMPACT OF MYOCARDIAL SCAR BY CARDIAC MAGNETIC RESONANCE IN PATIENTS WITH NONISCHEMIC DILATED CARDIOMYOPATHY REFERRED FOR AN IMPLANTABLE CARDIOVERTER DEFIBRILLATOR FOR PRIMARY PREVENTION OF SUDDEN CARDIAC DEATH. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)60867-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Miller AL, Kramer DB, Lewis EF, Koplan B, Epstein LM, Tedrow U. Event-free survival following CRT with surgically implanted LV leads versus standard transvenous approach. Pacing Clin Electrophysiol 2011; 34:490-500. [PMID: 21463344 PMCID: PMC3079428 DOI: 10.1111/j.1540-8159.2010.03014.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [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] [Indexed: 11/29/2022]
Abstract
BACKGROUND While surgical epicardial lead placement is performed in a subset of cardiac resynchronization therapy patients, data comparing survival following surgical versus transvenous lead placement are limited. We hypothesized that surgical procedures would be associated with increased mortality risk. METHODS Long-term event-free survival was assessed for 480 consecutive patients undergoing surgical (48) or percutaneous (432) left ventricle (LV) lead placement at our institution from January 2000 to September 2008. RESULTS Baseline clinical and demographic characteristics were similar between groups. While there was no statistically significant difference in overall event-free survival (P = 0.13), when analysis was restricted to surgical patients with isolated surgical lead placement (n = 28), event-free survival was significantly lower in surgical patients (P = 0.015). There appeared to be an early risk (first approximately 3 months postimplantation) with surgical lead placement, primarily in LV lead-only patients. Event rates were significantly higher in LV lead-only surgical patients than in transvenous patients in the first 3 months (P = 0.006). In proportional hazards analysis comparing isolated surgical LV lead placement to transvenous lead placement, adjusted hazard ratios were 1.8 ([1.1,2.7] P = 0.02) and 1.3 ([1.0,1.7] P = 0.07) for the first 3 months and for the full duration of follow-up, respectively. CONCLUSIONS Isolated surgical LV lead placement appears to carry a small but significant upfront mortality cost, with risk extending beyond the immediate postoperative period. Long-term survival is similar, suggesting those surviving beyond this period of early risk derive the same benefit as coronary sinus lead recipients. Further work is needed to identify risk factors associated with early mortality following surgical lead placement.
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Affiliation(s)
- Amy L Miller
- Department of Medicine, Cardiovascular Division, Brigham & Women's Hospital, Boston, Massachusetts, USA.
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Tokuda M, Stevenson W, Tedrow U. Radiofrequency Catheter Ablation for Ventricular Tachycardia in a Patient with Peripartum Cardiomyopathy. J Arrhythm 2011. [DOI: 10.4020/jhrs.27.op66_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Ujeyl A, Inada K, Hillman K, Kato M, Seiler J, Tedrow U, Stevenson LW, Stevenson WG. Preserved Right Ventricular Function Despite Low Left Ventricular Ejection Fraction Predicts Good Survival after Ablation for Recurrent Ventricular Tachycardia. J Card Fail 2010. [DOI: 10.1016/j.cardfail.2010.06.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Sacher F, Roberts-Thomson K, Maury P, Tedrow U, Nault I, Steven D, Hocini M, Koplan B, Leroux L, Derval N, Seiler J, Wright MJ, Epstein L, Haissaguerre M, Jais P, Stevenson WG. Epicardial ventricular tachycardia ablation a multicenter safety study. J Am Coll Cardiol 2010; 55:2366-72. [PMID: 20488308 DOI: 10.1016/j.jacc.2009.10.084] [Citation(s) in RCA: 299] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2009] [Revised: 10/02/2009] [Accepted: 10/18/2009] [Indexed: 01/30/2023]
Abstract
OBJECTIVES The aim of this study was to perform a systematic evaluation of safety and midterm complications after epicardial ventricular tachycardia (VT) ablation. BACKGROUND Epicardial VT ablation is increasingly performed, but there is limited information about its safety and midterm complications. METHODS All patients undergoing VT ablation at 3 tertiary care centers between 2001 and 2007 were included in this study. Of 913 VT ablations, 156 procedures (17%) involved epicardial mapping and/or ablation. These were performed in 134 patients (109 men; mean age 56 +/- 15 years) after a previous VT ablation in 115 (86%). The underlying substrates were ischemic cardiomyopathy in 51 patients, nonischemic cardiomyopathy in 39 patients, arrhythmogenic right ventricular cardiomyopathy in 14 patients, and other types of cardiomyopathy in 30 patients. RESULTS Epicardial access was obtained via percutaneous subxiphoid puncture in 136 procedures, by a surgical subxiphoid approach in 14, and during open-heart surgery in 6. Epicardial ablation (mean radiofrequency duration: 13 +/- 12 min; median: 10 min) was performed in 121 of 156 procedures (78%). Twenty patients subsequently required repeat procedures, and the epicardium could be reaccessed in all but 1 patient. A total of 8 (5%) major complications related to pericardial access were observed acutely: 7 epicardial bleeding (>80 cm(3)) and 1 coronary stenosis. After a mean follow-up period of 23 +/- 21 months, 3 delayed complications related to pericardial access were noted: 1 major pericardial inflammatory reaction, 1 delayed tamponade, and 1 coronary occlusion 2 weeks after the procedure. CONCLUSIONS VT ablation required epicardial ablation in 121 of 913 procedures (13%), with a risk of 5% and 2% of acute and delayed major complications related to epicardial access.
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Affiliation(s)
- Frédéric Sacher
- Université Bordeaux II, Hôpital Cardiologique du Haut-Lévêque, Bordeaux-Pessac, France.
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