1
|
Paymard M, Deyell MW, Laksman ZW, Yeung-Lai-Wah JA, Chakrabarti S. Correlation of unipolar electrogram modification with ablation index during pulmonary vein isolation: A pilot study. Pacing Clin Electrophysiol 2023; 46:138-143. [PMID: 36514201 DOI: 10.1111/pace.14642] [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: 12/07/2021] [Revised: 07/21/2022] [Accepted: 11/21/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Pulmonary vein isolation (PVI) using radiofrequency catheter ablation is a widely accepted therapy for drug-refractory atrial fibrillation patients. Elimination of the negative component of the local unipolar electrogram (UEGM) during PVI is a marker of transmural lesion formation. The ablation index (AI) can predict the quality of ablation lesion. Combining these two parameters could make PVI safer and efficient. The purpose of this pilot study was to examine the correlation between UEGM modification characteristics of the different target areas of left atrium and the associated AI values during PVI. METHODS We analyzed 10 patients who underwent PVI using radiofrequency energy. The local electrophysiological properties and ablation parameters of 15 designated areas of interest in the left atria targeted by radiofrequency catheter ablation were collected. RESULTS Out of the 10 patients, six were men (mean age 66 years) and 80% had paroxysmal AF. The mean time to achieve the UEGM modification in the posterior wall was shorter than that of the anterior wall (8.9 seconds vs. 11.1 s, respectively). The UEGM modification for every lesion was achieved at significantly lower AI values than conventional AIs (p < .001). CONCLUSION During PVI, the AIs deduced according to the local UEGM modification are markedly shorter than those generally recommended AIs in contemporary practice. This indicates that conventionally recommended AIs could be safely reduced while ensuring the efficacy and quality of radiofrequency ablation during PVI. This approach would probably reduce to risk of collateral thermal injuries.
Collapse
Affiliation(s)
- Mohammad Paymard
- Heart Rhythm services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marc W Deyell
- Heart Rhythm services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Zachary W Laksman
- Heart Rhythm services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - John A Yeung-Lai-Wah
- Heart Rhythm services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Santabhanu Chakrabarti
- Heart Rhythm services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
2
|
Deyell MW, Hoskin K, Forman J, Laksman ZW, Hawkins NM, Bennett MT, Yeung-Lai-Wah JA, Chakrabarti S, Krahn AD, Andrade JG. Same-day discharge for atrial fibrillation ablation: outcomes and impact of ablation modality. Europace 2022; 25:400-407. [PMID: 36164922 PMCID: PMC9935052 DOI: 10.1093/europace/euac170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/18/2022] [Indexed: 11/12/2022] Open
Abstract
AIMS Same-day discharge is increasingly common after catheter ablation for atrial fibrillation (AF). However, the impact of same-day discharge on healthcare utilization after ablation and whether this differs by ablation modality remains uncertain. We examined the safety, efficacy, and subsequent healthcare utilization of a same-day discharge protocol for AF ablation, including radiofrequency (RF) and cryoballoon ablation, in a contemporary cohort. METHODS AND RESULTS All consecutive patients for whom full healthcare utilization data were available at two centres and who underwent AF ablation from 2018 to 2019 were included. Same-day discharge was the default strategy for all patients. The efficacy and safety outcomes were proportions of same-day discharge and readmission/emergency room (ER) visits, and post-discharge complications, respectively. Of the 421 patients who underwent AF ablation (mean 63.3 ± 10.2 years, 33% female), 90.5% (381/421) achieved same-day discharge with no difference between RF and cryoballoon ablation (89.8 vs. 95.1%, adjusted P = 0.327). Readmission ≤30 days occurred in 4.8%, with ER visits ≤30 days seen in 26.1% with no difference between ablation modalities (P = 0.634). Patients admitted overnight were more likely to present to the ER (40.0 vs. 24.7% with same-day discharge, P = 0.036). The overall post-discharge complication rate was low at 4/421 (1.0%), with no difference between ablation modality (P = 0.324) and admission/same-day discharge (P = 0.485). CONCLUSION Same-day discharge can be achieved in a majority of patients undergoing RF or cryoballoon ablation for AF. Healthcare utilization, particularly ER visits, remains high after AF ablation, regardless of ablation modality or same-day discharge.
Collapse
Affiliation(s)
- Marc W Deyell
- Corresponding author. Tel: +1 605 806 8256. E-mail address:
| | - Kurt Hoskin
- Division of Cardiology, Department of Medicine, University of British Columbia, #200-1033 Davie Street, Vancouver, BC, Canada V6E 1M7
| | - Jacqueline Forman
- St. Paul's Hospital, Providence Health Care, 1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
| | - Zachary W Laksman
- Division of Cardiology, Department of Medicine, University of British Columbia, #200-1033 Davie Street, Vancouver, BC, Canada V6E 1M7,Centre for Cardiovascular Innovation, University of British Columbia, 2775 Laurel Street, 9th Floor, Vancouver, BC, Canada V5Z 1M9
| | - Nathaniel M Hawkins
- Division of Cardiology, Department of Medicine, University of British Columbia, #200-1033 Davie Street, Vancouver, BC, Canada V6E 1M7,Centre for Cardiovascular Innovation, University of British Columbia, 2775 Laurel Street, 9th Floor, Vancouver, BC, Canada V5Z 1M9
| | - Matthew T Bennett
- Division of Cardiology, Department of Medicine, University of British Columbia, #200-1033 Davie Street, Vancouver, BC, Canada V6E 1M7,Centre for Cardiovascular Innovation, University of British Columbia, 2775 Laurel Street, 9th Floor, Vancouver, BC, Canada V5Z 1M9
| | - John A Yeung-Lai-Wah
- Division of Cardiology, Department of Medicine, University of British Columbia, #200-1033 Davie Street, Vancouver, BC, Canada V6E 1M7
| | - Santabhanu Chakrabarti
- Division of Cardiology, Department of Medicine, University of British Columbia, #200-1033 Davie Street, Vancouver, BC, Canada V6E 1M7
| | - Andrew D Krahn
- Division of Cardiology, Department of Medicine, University of British Columbia, #200-1033 Davie Street, Vancouver, BC, Canada V6E 1M7,Centre for Cardiovascular Innovation, University of British Columbia, 2775 Laurel Street, 9th Floor, Vancouver, BC, Canada V5Z 1M9
| | - Jason G Andrade
- Division of Cardiology, Department of Medicine, University of British Columbia, #200-1033 Davie Street, Vancouver, BC, Canada V6E 1M7,Centre for Cardiovascular Innovation, University of British Columbia, 2775 Laurel Street, 9th Floor, Vancouver, BC, Canada V5Z 1M9
| |
Collapse
|
3
|
Hosseini F, Thibert MJ, Gulsin GS, Murphy D, Alexander G, Andrade JG, Hawkins NM, Laksman ZW, Yeung-Lai-Wah JA, Chakrabarti S, Bennett MT, Krahn AD, Deyell MW. Cardiac Magnetic Resonance in the Evaluation of Patients With Frequent Premature Ventricular Complexes. JACC Clin Electrophysiol 2022; 8:1122-1132. [PMID: 36137717 DOI: 10.1016/j.jacep.2022.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/23/2022] [Accepted: 06/25/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND The role of cardiac magnetic resonance (CMR) in the evaluation and management of patients with frequent premature ventricular complexes (PVCs) of unknown etiology remains unclear. OBJECTIVES This study evaluated the prevalence and prognostic significance of myocardial abnormalities detected with CMR among patients with frequent PVCs and no known structural heart disease. METHODS This prospective cohort study included consecutive patients with frequent PVCs and a negative initial diagnostic work-up who underwent CMR with late gadolinium enhancement imaging. The clinical outcome was a composite of mortality, ventricular fibrillation, sustained ventricular tachycardia, or reduction in left ventricular ejection fraction of ≥10%. RESULTS A total of 255 patients were included, of whom 35 (13.7%) had evidence of myocardial abnormality on CMR. Age ≥60 years (odds ratio [OR]: 6.96; 95% CI: 1.30-37.18), multifocal PVCs (OR: 10.90; 95% CI: 3.21-36.97), and non-outflow tract left ventricular PVC origin (OR: 3.00; 95% CI: 1.00-8.95) were independently associated with the presence of a myocardial abnormality on CMR. After a median follow-up of 36 months, the composite outcome occurred in 15 (5.9%) patients. The presence of a myocardial abnormality on CMR was independently associated with the composite outcome (HR: 4.35; 95% CI: 1.34-14.15; P = 0.014). CONCLUSIONS One in 7 patients with frequent PVCs with no known structural heart disease had myocardial abnormality detected on CMR, and these abnormalities were associated with adverse clinical outcomes. These findings highlight the important role of CMR in the evaluation of patients with frequent PVCs.
Collapse
Affiliation(s)
- Farshad Hosseini
- Division of Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael J Thibert
- Heart Rhythm Services and Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Gaurav S Gulsin
- Department of Radiology, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Darra Murphy
- Department of Radiology, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - George Alexander
- Heart Rhythm Services and Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason G Andrade
- Heart Rhythm Services and Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathaniel M Hawkins
- Heart Rhythm Services and Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Zachary W Laksman
- Heart Rhythm Services and Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - John A Yeung-Lai-Wah
- Heart Rhythm Services and Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Santabhanu Chakrabarti
- Heart Rhythm Services and Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Matthew T Bennett
- Heart Rhythm Services and Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew D Krahn
- Heart Rhythm Services and Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marc W Deyell
- Heart Rhythm Services and Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
| |
Collapse
|
4
|
Steinberg C, Dognin N, Sodhi A, Champagne C, Staples JA, Champagne J, Laksman ZW, Sarrazin JF, Bennett MT, Plourde B, Deyell MW, Andrade JG, Roy K, Yeung-Lai-Wah JA, Hawkins NM, Mondésert B, Blier L, Nault I, O'Hara G, Krahn AD, Philippon F, Chakrabarti S. DREAM-ICD-II Study. Circulation 2022; 145:742-753. [PMID: 34913361 DOI: 10.1161/circulationaha.121.056471] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Regulatory authorities of most industrialized countries recommend 6 months of private driving restriction after implantation of a secondary prevention implantable cardioverter-defibrillator (ICD). These driving restrictions result in significant inconvenience and social implications. This study aimed to assess the incidence rate of appropriate device therapies in contemporary recipients of a secondary prevention ICD. METHODS This retrospective study at 3 Canadian tertiary care centers enrolled consecutive patients with new secondary prevention ICD implants between 2016 and 2020. RESULTS For a median of 760 days (324, 1190 days), 721 patients were followed up. The risk of recurrent ventricular arrhythmia was highest during the first 3 months after device insertion (34.4%) and decreased over time (10.6% between 3 and 6 months, 11.7% between 6 and 12 months). The corresponding incidence rate per 100 patient-days was 0.48 (95% CI, 0.35-0.64) at 90 days, 0.28 (95% CI, 0.17-0.45) at 180 days, and 0.21 (95% CI, 0.13-0.33) between 181 and 365 days after ICD insertion (P<0.001). The cumulative incidence of arrhythmic syncope resulting in sudden cardiac incapacitation was 1.8% within the first 90 days and subsequently dropped to 0.4% between 91 and 180 days (P<0.001) after ICD insertion. CONCLUSIONS The incidence rate of appropriate therapies resulting in sudden cardiac incapacitation in contemporary recipients of a secondary prevention ICD is much lower than previously reported and declines significantly after the first 3 months. Lowering driving restrictions to 3 months after the index cardiac event seems safe, and revision of existing guidelines should be considered in countries still adhering to a 6-month period. Existing restrictions for private driving after implantation of a secondary prevention ICD should be reconsidered.
Collapse
Affiliation(s)
- Christian Steinberg
- Institut universitaire de cardiologie et pneumologie de Québec, Quebec, Canada (C.S., N.D., C.C., J.C., J.-F.S., B.P., K.R., L.B., I.N., G.O., F.P.)
| | - Nicolas Dognin
- Institut universitaire de cardiologie et pneumologie de Québec, Quebec, Canada (C.S., N.D., C.C., J.C., J.-F.S., B.P., K.R., L.B., I.N., G.O., F.P.)
| | - Amit Sodhi
- Centre for Cardiovascular Innovation, Division of Cardiology (A.S., Z.L., M.B., M.W.D., J.G.A., J.A.Y.-L.-W., N.M.H., A.D.K., S.C.), University of British Columbia, Vancouver, Canada
- Department of Medicine (A.S., J.A.S., Z.L., M.B., M.W.D., J.G.A., J.A.Y.-L.W., N.M.H., A.D.K., S.C.), University of British Columbia, Vancouver, Canada
| | - Catherine Champagne
- Institut universitaire de cardiologie et pneumologie de Québec, Quebec, Canada (C.S., N.D., C.C., J.C., J.-F.S., B.P., K.R., L.B., I.N., G.O., F.P.)
| | - John A Staples
- Department of Medicine (A.S., J.A.S., Z.L., M.B., M.W.D., J.G.A., J.A.Y.-L.W., N.M.H., A.D.K., S.C.), University of British Columbia, Vancouver, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver, British Columbia, Canada (J.A.S.)
| | - Jean Champagne
- Institut universitaire de cardiologie et pneumologie de Québec, Quebec, Canada (C.S., N.D., C.C., J.C., J.-F.S., B.P., K.R., L.B., I.N., G.O., F.P.)
| | - Zachary W Laksman
- Centre for Cardiovascular Innovation, Division of Cardiology (A.S., Z.L., M.B., M.W.D., J.G.A., J.A.Y.-L.-W., N.M.H., A.D.K., S.C.), University of British Columbia, Vancouver, Canada
- Department of Medicine (A.S., J.A.S., Z.L., M.B., M.W.D., J.G.A., J.A.Y.-L.W., N.M.H., A.D.K., S.C.), University of British Columbia, Vancouver, Canada
| | - Jean-François Sarrazin
- Institut universitaire de cardiologie et pneumologie de Québec, Quebec, Canada (C.S., N.D., C.C., J.C., J.-F.S., B.P., K.R., L.B., I.N., G.O., F.P.)
| | - Matthew T Bennett
- Centre for Cardiovascular Innovation, Division of Cardiology (A.S., Z.L., M.B., M.W.D., J.G.A., J.A.Y.-L.-W., N.M.H., A.D.K., S.C.), University of British Columbia, Vancouver, Canada
- Department of Medicine (A.S., J.A.S., Z.L., M.B., M.W.D., J.G.A., J.A.Y.-L.W., N.M.H., A.D.K., S.C.), University of British Columbia, Vancouver, Canada
| | - Benoit Plourde
- Institut universitaire de cardiologie et pneumologie de Québec, Quebec, Canada (C.S., N.D., C.C., J.C., J.-F.S., B.P., K.R., L.B., I.N., G.O., F.P.)
| | - Marc W Deyell
- Centre for Cardiovascular Innovation, Division of Cardiology (A.S., Z.L., M.B., M.W.D., J.G.A., J.A.Y.-L.-W., N.M.H., A.D.K., S.C.), University of British Columbia, Vancouver, Canada
- Department of Medicine (A.S., J.A.S., Z.L., M.B., M.W.D., J.G.A., J.A.Y.-L.W., N.M.H., A.D.K., S.C.), University of British Columbia, Vancouver, Canada
| | - Jason G Andrade
- Centre for Cardiovascular Innovation, Division of Cardiology (A.S., Z.L., M.B., M.W.D., J.G.A., J.A.Y.-L.-W., N.M.H., A.D.K., S.C.), University of British Columbia, Vancouver, Canada
- Department of Medicine (A.S., J.A.S., Z.L., M.B., M.W.D., J.G.A., J.A.Y.-L.W., N.M.H., A.D.K., S.C.), University of British Columbia, Vancouver, Canada
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada (J.G.A., B.M.)
| | - Karine Roy
- Institut universitaire de cardiologie et pneumologie de Québec, Quebec, Canada (C.S., N.D., C.C., J.C., J.-F.S., B.P., K.R., L.B., I.N., G.O., F.P.)
| | - John A Yeung-Lai-Wah
- Centre for Cardiovascular Innovation, Division of Cardiology (A.S., Z.L., M.B., M.W.D., J.G.A., J.A.Y.-L.-W., N.M.H., A.D.K., S.C.), University of British Columbia, Vancouver, Canada
- Department of Medicine (A.S., J.A.S., Z.L., M.B., M.W.D., J.G.A., J.A.Y.-L.W., N.M.H., A.D.K., S.C.), University of British Columbia, Vancouver, Canada
| | - Nathaniel M Hawkins
- Centre for Cardiovascular Innovation, Division of Cardiology (A.S., Z.L., M.B., M.W.D., J.G.A., J.A.Y.-L.-W., N.M.H., A.D.K., S.C.), University of British Columbia, Vancouver, Canada
- Department of Medicine (A.S., J.A.S., Z.L., M.B., M.W.D., J.G.A., J.A.Y.-L.W., N.M.H., A.D.K., S.C.), University of British Columbia, Vancouver, Canada
| | - Blandine Mondésert
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada (J.G.A., B.M.)
| | - Louis Blier
- Institut universitaire de cardiologie et pneumologie de Québec, Quebec, Canada (C.S., N.D., C.C., J.C., J.-F.S., B.P., K.R., L.B., I.N., G.O., F.P.)
| | - Isabelle Nault
- Institut universitaire de cardiologie et pneumologie de Québec, Quebec, Canada (C.S., N.D., C.C., J.C., J.-F.S., B.P., K.R., L.B., I.N., G.O., F.P.)
| | - Gilles O'Hara
- Institut universitaire de cardiologie et pneumologie de Québec, Quebec, Canada (C.S., N.D., C.C., J.C., J.-F.S., B.P., K.R., L.B., I.N., G.O., F.P.)
| | - Andrew D Krahn
- Centre for Cardiovascular Innovation, Division of Cardiology (A.S., Z.L., M.B., M.W.D., J.G.A., J.A.Y.-L.-W., N.M.H., A.D.K., S.C.), University of British Columbia, Vancouver, Canada
- Department of Medicine (A.S., J.A.S., Z.L., M.B., M.W.D., J.G.A., J.A.Y.-L.W., N.M.H., A.D.K., S.C.), University of British Columbia, Vancouver, Canada
| | - François Philippon
- Institut universitaire de cardiologie et pneumologie de Québec, Quebec, Canada (C.S., N.D., C.C., J.C., J.-F.S., B.P., K.R., L.B., I.N., G.O., F.P.)
| | - Santabhanu Chakrabarti
- Centre for Cardiovascular Innovation, Division of Cardiology (A.S., Z.L., M.B., M.W.D., J.G.A., J.A.Y.-L.-W., N.M.H., A.D.K., S.C.), University of British Columbia, Vancouver, Canada
- Department of Medicine (A.S., J.A.S., Z.L., M.B., M.W.D., J.G.A., J.A.Y.-L.W., N.M.H., A.D.K., S.C.), University of British Columbia, Vancouver, Canada
| |
Collapse
|
5
|
Grondin S, Davies B, Cadrin-Tourigny J, Steinberg C, Cheung CC, Jorda P, Healey JS, Green MS, Sanatani S, Alqarawi W, Angaran P, Arbour L, Antiperovitch P, Khan H, Leather R, Guerra PG, Rivard L, Simpson CS, Gardner M, MacIntyre C, Seifer C, Fournier A, Joza J, Gollob MH, Lettre G, Talajic M, Laksman ZW, Roberts JD, Krahn AD, Tadros R. OUP accepted manuscript. Eur Heart J 2022; 43:3071-3081. [PMID: 35352813 PMCID: PMC9392649 DOI: 10.1093/eurheartj/ehac145] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/25/2022] [Accepted: 03/07/2022] [Indexed: 12/04/2022] Open
Abstract
Aims Genetic testing is recommended in specific inherited heart diseases but its role remains unclear and it is not currently recommended in unexplained cardiac arrest (UCA). We sought to assess the yield and clinical utility of genetic testing in UCA using whole-exome sequencing (WES). Methods and results Survivors of UCA requiring external defibrillation were included from the Cardiac Arrest Survivor with Preserved Ejection fraction Registry. Whole-exome sequencing was performed, followed by assessment of rare variants in previously reported cardiovascular disease genes. A total of 228 UCA survivors (mean age at arrest 39 ± 13 years) were included. The majority were males (66%) and of European ancestry (81%). Following advanced clinical testing at baseline, the likely aetiology of cardiac arrest was determined in 21/228 (9%) cases. Whole-exome sequencing identified a pathogenic or likely pathogenic (P/LP) variant in 23/228 (10%) of UCA survivors overall, increasing the proportion of ‘explained’ cases from 9% only following phenotyping to 18% when combining phenotyping with WES. Notably, 13 (57%) of the 23 P/LP variants identified were located in genes associated with cardiomyopathy, in the absence of a diagnosis of cardiomyopathy at the time of arrest. Conclusions Genetic testing identifies a disease-causing variant in 10% of apparent UCA survivors. The majority of disease-causing variants was located in cardiomyopathy-associated genes, highlighting the arrhythmogenic potential of such variants in the absence of an overt cardiomyopathy diagnosis. The present study supports the use of genetic testing including assessment of arrhythmia and cardiomyopathy genes in survivors of UCA.
Collapse
Affiliation(s)
- Steffany Grondin
- Cardiovascular Genetics Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger, Montreal, QC, Canada H1T 1C8
| | - Brianna Davies
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Julia Cadrin-Tourigny
- Cardiovascular Genetics Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger, Montreal, QC, Canada H1T 1C8
| | - Christian Steinberg
- Institut universitaire de cardiologie et pneumologie de Québec, Université Laval, Québec City, QC, Canada
| | - Christopher C Cheung
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Paloma Jorda
- Cardiovascular Genetics Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger, Montreal, QC, Canada H1T 1C8
| | - Jeffrey S Healey
- Population Health Research Institute, McMaster University, and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Martin S Green
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Shubhayan Sanatani
- Division of Pediatric Cardiology, British Columbia Children’s Hospital, Vancouver, BC, Canada
| | - Wael Alqarawi
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
- Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Paul Angaran
- Cardiac Arrhythmia Service, St Michael’s Hospital, Toronto, ON, Canada
| | - Laura Arbour
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Pavel Antiperovitch
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, ON, Canada
| | - Habib Khan
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, ON, Canada
| | - Richard Leather
- Division of Cardiology, Royal Jubilee Hospital, Victoria, BC, Canada
| | - Peter G Guerra
- Cardiovascular Genetics Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger, Montreal, QC, Canada H1T 1C8
| | - Lena Rivard
- Cardiovascular Genetics Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger, Montreal, QC, Canada H1T 1C8
| | | | - Martin Gardner
- Queen Elizabeth II Health Sciences Center, Halifax, NS, Canada
| | | | - Colette Seifer
- St Boniface Hospital, University of Manitoba, Winnipeg, MB, Canada
| | - Anne Fournier
- Ste-Justine Hospital, Université de Montréal, Montreal, QC, Canada
| | - Jacqueline Joza
- Department of Medicine, McGill University Health Center, Montreal, QC, Canada
| | - Michael H Gollob
- Division of Cardiology, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - Guillaume Lettre
- Cardiovascular Genetics Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger, Montreal, QC, Canada H1T 1C8
| | - Mario Talajic
- Cardiovascular Genetics Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger, Montreal, QC, Canada H1T 1C8
| | - Zachary W Laksman
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jason D Roberts
- Population Health Research Institute, McMaster University, and Hamilton Health Sciences, Hamilton, ON, Canada
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, ON, Canada
| | - Andrew D Krahn
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Rafik Tadros
- Corresponding author. Tel: +1 514 376 3330, Fax: +1 514 593 2158, , Twitter: @rafik_tadros
| |
Collapse
|
6
|
Roston TM, Islam S, Hawkins NM, Laksman ZW, Sanatani S, Krahn AD, Sandhu R, Kaul P. A Population-Based Study of Unexplained/Lone Atrial Fibrillation: Temporal Trends, Management, and Outcomes. CJC Open 2022; 4:65-74. [PMID: 35072029 PMCID: PMC8767123 DOI: 10.1016/j.cjco.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/06/2021] [Indexed: 11/28/2022] Open
Abstract
Background Previous studies on lone/unexplained atrial fibrillation and atrial flutter (AF) did not exclude patients with contemporary secondary AF triggers. We characterized unexplained AF using a strict definition, and compared it to secondary AF. Methods In this population-based study, unexplained AF was defined by the lack of any identifiable triggering medical/surgical diagnosis. Comparisons by AF type (unexplained vs secondary), age-of-onset (≤ / > 65 years), and sex were undertaken. Data were acquired by linking 6 population databases maintained by the Alberta Ministry of Health over a 9-year period (April 2006 to March 2015). The primary composite outcome of stroke, transient ischemic attack, thromboembolism, and/or death was assessed. Results There were 33,150 incident AF diagnoses identified, including 1145 patients (3.5%) with unexplained AF, 931 (81.2%) of whom were aged ≤ 65 years (2.8% of diagnoses, and 79% male). Patients with unexplained AF less often received rate/rhythm-control drugs (P < 0.0001), but they more often underwent electrical cardioversion (P < 0.0001) vs secondary AF patients. Men were younger at unexplained AF diagnosis (45 [interquartile range: 34-59] vs 58 [interquartile range: 40-69] years; P < 0.001). After adjusting for age at diagnosis, there were no sex-based differences in the primary outcome. Event-free survival in young unexplained AF (age ≤ 65 years) was 99.4% at 1 year and 98.3% at 3 years. At 3 years, hospitalization(s)/emergency visit(s) for noncardiovascular reasons and for AF occurred in 56.6% and 23.8% of these patients, respectively. Conclusions Using a strict contemporary definition of unexplained AF, this study shows that the condition is rare, predominantly male, and has excellent event-free survival. However, the high rate of acute hospital utilization after diagnosis is concerning.
Collapse
Affiliation(s)
- Thomas M. Roston
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Centre for Cardiovascular Innovation, Division of Cardiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Sunjidatul Islam
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Nathaniel M. Hawkins
- Centre for Cardiovascular Innovation, Division of Cardiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Zachary W. Laksman
- Centre for Cardiovascular Innovation, Division of Cardiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Shubhayan Sanatani
- Division of Cardiology, Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew D. Krahn
- Centre for Cardiovascular Innovation, Division of Cardiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Roopinder Sandhu
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Department of Medicine and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Padma Kaul
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
- Department of Medicine and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
- Corresponding author: Dr Padma Kaul, 4-120 Katz Group Centre for Pharmacy and Health Research, University of Alberta, Edmonton, Alberta T6G 2E1, Canada. Tel.: +1-780-492-1140 ; fax: +1-780-492-0613.
| |
Collapse
|
7
|
Steinberg C, Davies B, Mellor G, Tadros R, Laksman ZW, Roberts JD, Green M, Alqarawi W, Angaran P, Healey J, Sanatani S, Leather R, Seifer C, Fournier A, Duff H, Gardner M, McIntyre C, Hamilton R, Simpson CS, Krahn AD. Short-coupled ventricular fibrillation represents a distinct phenotype among latent causes of unexplained cardiac arrest: a report from the CASPER registry. Eur Heart J 2021; 42:2827-2838. [PMID: 34010395 DOI: 10.1093/eurheartj/ehab275] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [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: 11/08/2020] [Revised: 02/14/2021] [Accepted: 04/27/2021] [Indexed: 12/25/2022] Open
Abstract
AIMS The term idiopathic ventricular fibrillation (IVF) describes survivors of unexplained cardiac arrest (UCA) without a specific diagnosis after clinical and genetic testing. Previous reports have described a subset of IVF individuals with ventricular arrhythmia initiated by short-coupled trigger premature ventricular contractions (PVCs) for which the term short-coupled ventricular fibrillation (SCVF) has been proposed. The aim of this article is to establish the phenotype and frequency of SCVF in a large cohort of UCA survivors. METHODS AND RESULTS We performed a multicentre study including consecutive UCA survivors from the CASPER registry. Short-coupled ventricular fibrillation was defined as otherwise unexplained ventricular fibrillation initiated by a trigger PVC with a coupling interval of <350 ms. Among 364 UCA survivors, 24/364 (6.6%) met diagnostic criteria for SCVF. The diagnosis of SCVF was obtained in 19/24 (79%) individuals by documented ventricular fibrillation during follow-up. Ventricular arrhythmia was initiated by a mean PVC coupling interval of 274 ± 32 ms. Electrical storm occurred in 21% of SCVF probands but not in any UCA proband (P < 0.001). The median time to recurrent ventricular arrhythmia in SCVF was 31 months. Recurrent ventricular fibrillation resulted in quinidine administration in 12/24 SCVF (50%) with excellent arrhythmia control. CONCLUSION Short-coupled ventricular fibrillation is a distinct primary arrhythmia syndrome accounting for at least 6.6% of UCA. As documentation of ventricular fibrillation onset is necessary for the diagnosis, most cases are diagnosed at the time of recurrent arrhythmia, thus the true prevalence of SCVF remains still unknown. Quinidine is effective in SCVF and should be considered as first-line treatment for patients with recurrent episodes.
Collapse
Affiliation(s)
- Christian Steinberg
- Cardiac Electrophysiology Service, Department of Cardiology and Cardiac Surgery, Institut universitaire de cardiologie et pneumologie de Québec, Laval University, 2725, Chemin Ste-Foy, Quebec, QC G1V 4G5, Canada
| | - Brianna Davies
- Heart Rhythm Services, Department of Medicine, St-Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Greg Mellor
- Cardiac Electrophysiology Service, Royal Papworth Hospital, Cambridge, UK
| | - Rafik Tadros
- Section of Cardiac Electrophysiology, Montreal Heart Institute, University of Montreal, Montreal, QC, Canada
| | - Zachary W Laksman
- Heart Rhythm Services, Department of Medicine, St-Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Jason D Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, ON, Canada
| | - Martin Green
- Cardiac Electrophysiology Service, Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada
| | - Wael Alqarawi
- Cardiac Electrophysiology Service, Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada
| | - Paul Angaran
- Cardiac Arrhythmia Service, St-Michael's Hospital, Toronto, ON, Canada
| | - Jeffrey Healey
- Arrhythmia Services Hamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | | | - Richard Leather
- Cardiac Electrophysiology Service, Royal Jubilee Hospital, Victoria, BC, Canada
| | - Colette Seifer
- St-Boniface Hospital, University of Manitoba, Winnipeg, MB, Canada
| | - Anne Fournier
- Division of Pediatric Cardiology, Department of Pediatrics, Centre Hospitalier Universitaire de Sainte-Justine, Montreal, QC, Canada
| | - Henry Duff
- Division of Cardiology, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
| | - Martin Gardner
- Cardiac Electrophysiology Service, QEII Health Sciences Center, Dalhousie University, Halifax, NS, Canada
| | - Ciorsti McIntyre
- Cardiac Electrophysiology Service, QEII Health Sciences Center, Dalhousie University, Halifax, NS, Canada
| | - Robert Hamilton
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | - Andrew D Krahn
- Heart Rhythm Services, Department of Medicine, St-Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
8
|
Lazarte J, Laksman ZW, Wang J, Robinson JF, Dron JS, Leach E, Liew J, McIntyre AD, Skanes AC, Gula LJ, Leong-Sit P, Cao H, Trost B, Scherer SW, Hegele RA, Roberts JD. Enrichment of loss-of-function and copy number variants in ventricular cardiomyopathy genes in 'lone' atrial fibrillation. Europace 2021; 23:844-850. [PMID: 33682005 DOI: 10.1093/europace/euaa421] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/22/2020] [Indexed: 12/31/2022] Open
Abstract
AIMS Atrial fibrillation (AF) is a complex heritable disease whose genetic underpinnings remain largely unexplained, though recent work has suggested that the arrhythmia may develop secondary to an underlying atrial cardiomyopathy. We sought to evaluate for enrichment of loss-of-function (LOF) and copy number variants (CNVs) in genes implicated in ventricular cardiomyopathy in 'lone' AF. METHODS AND RESULTS Whole-exome sequencing was performed in 255 early onset 'lone' AF cases, defined as arrhythmia onset prior to 60 years of age in the absence of known clinical risk factors. Subsequent evaluations were restricted to 195 cases of European genetic ancestry, as defined by principal component analysis, and focused on a pre-defined set of 43 genes previously implicated in ventricular cardiomyopathy. Bioinformatic analysis identified 6 LOF variants (3.1%), including 3 within the TTN gene, among cases in comparison with 4 of 503 (0.80%) controls [odds ratio: 3.96; 95% confidence interval (CI): 1.11-14.2; P = 0.033]. Further, two AF cases possessed a novel heterozygous 8521 base pair TTN deletion, confirmed with Sanger sequencing and breakpoint validation, which was absent from 4958 controls (P = 0.0014). Subsequent cascade screening in two families revealed evidence of co-segregation of a LOF variant with 'lone' AF. CONCLUSION 'Lone' AF cases are enriched in rare LOF variants from cardiomyopathy genes, findings primarily driven by TTN, and a novel TTN deletion, providing additional evidence to implicate atrial cardiomyopathy as an AF genetic sub-phenotype. Our results also highlight that AF may develop in the context of these variants in the absence of a discernable ventricular cardiomyopathy.
Collapse
Affiliation(s)
- Julieta Lazarte
- Department of Medicine, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Zachary W Laksman
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jian Wang
- Department of Medicine, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - John F Robinson
- Department of Medicine, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Jacqueline S Dron
- Department of Medicine, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Emma Leach
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Janet Liew
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Adam D McIntyre
- Department of Medicine, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Allan C Skanes
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, ON, Canada
| | - Lorne J Gula
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, ON, Canada
| | - Peter Leong-Sit
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, ON, Canada
| | - Henian Cao
- Department of Medicine, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Brett Trost
- The Centre for Applied Genomics, Hospital for Sick Children, Toronto, ON, Canada
| | - Stephen W Scherer
- The Centre for Applied Genomics, Hospital for Sick Children, Toronto, ON, Canada.,Department of Molecular Genetics, McLaughlin Centre, University of Toronto, Toronto, ON, Canada
| | - Robert A Hegele
- Department of Medicine, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Jason D Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, ON, Canada
| |
Collapse
|
9
|
Tang JKK, Andrade JG, Hawkins NM, Laksman ZW, Krahn AD, Bennett MT, Heilbron B, Chakrabarti S, Yeung-Lai-Wah JA, Deyell MW. Effectiveness of medical therapy for treatment of idiopathic frequent premature ventricular complexes. J Cardiovasc Electrophysiol 2021; 32:2246-2253. [PMID: 34216056 DOI: 10.1111/jce.15150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/20/2021] [Accepted: 06/21/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The relative effectiveness of medical therapy compared with a conservative approach of monitoring in patients with idiopathic frequent premature ventricular complexes (PVCs) is uncertain. We evaluated the effectiveness of medical versus conservative therapy for frequent PVCs. METHODS Patients with frequent PVCs (≥5%) were prospectively enrolled in this cohort study between 2016 and 2020. In patients with normal cardiac function and no structural heart disease, those receiving medical therapy were compared with controls without therapy. Patients were followed longitudinally for change in PVC burden and with serial echocardiography. RESULTS Overall, 120 patients met inclusion criteria (mean: 56.5 ± 14.6 years, 54.2% female) with 53 on beta-blockers or calcium channel blockers (BBs/CCBs), 27 on Class I or III antiarrhythmic drugs (AADs), and 40 patients treated conservatively. Median initial PVC burden ranged from 15.5% to 20.6%. The median relative reduction of PVCs was 32.7%, 30.5%, and 81.3%, in the conservative therapy, BBs/CCBs, and AADs cohorts, respectively. AADs had greater PVC reduction compared with BBs/CCBs (p = 0.017) and conservative therapy (p = 0.045). PVC reduction to <1% was comparable across groups at 35.0%, 17.0%, 33.3%, respectively. Four patients (4/120, 3.3%) developed left ventricular dysfunction. Rates of adverse drug reactions and medication discontinuation were similar between groups, with no serious adverse events noted. CONCLUSION In patients with idiopathic frequent PVCs, BB, and CCB have limited effectiveness in PVC reduction. Class I and III AADs have superior effectiveness for medical therapy in symptomatic patients, but only achieved complete PVC resolution suppression in one-third of patients.
Collapse
Affiliation(s)
- Jacky K K Tang
- Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason G Andrade
- Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathaniel M Hawkins
- Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Zachary W Laksman
- Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew D Krahn
- Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Matthew T Bennett
- Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brett Heilbron
- Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Santabhanu Chakrabarti
- Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - John A Yeung-Lai-Wah
- Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marc W Deyell
- Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
10
|
Paymard M, Deyell MW, Chakrabarti S, Laksman ZW, Larsen J, Yeung-Lai-Wah JA. Use of 3D mapping system for ablating an accessory pathway associated with coronary sinus diverticulum. Int J Arrhythm 2021. [DOI: 10.1186/s42444-021-00037-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
This is a rare and challenging case of Wolff–Parkinson–White syndrome due to a posteroseptal accessory pathway located in the coronary sinus diverticulum. It is often difficult to precisely locate this type of accessory pathway, and the ablation procedure could be associated with collateral damage to the neighbouring coronary arteries.
Case Presentation
The patient was a 49-year-old female with Wolff–Parkinson–White syndrome who was referred for catheter ablation. She had had a previous unsuccessful attempt at ablation and had remained symptomatic despite drug therapy. The pre-procedural cardiac computed tomography scan revealed the presence of a diverticulum in the proximal coronary sinus. Using an advanced three-dimensional cardiac mapping system, the electroanatomic map of the diverticulum was created. The accessory pathway potential was identified within the diverticulum preceding the ventricular insertion. The accessory pathway was then successfully ablated using radiofrequency energy.
Conclusion
We have demonstrated that the advanced three-dimensional cardiac mapping system plays a very important role in guiding clinicians in order to precisely locate and safely ablate this type of challenging accessory pathway.
Collapse
|
11
|
Lazarte J, Dron JS, McIntyre AD, Skanes AC, Gula LJ, Tang AS, Tadros R, Laksman ZW, Hegele RA, Roberts JD. Evaluating Polygenic Risk Scores in "Lone" Atrial Fibrillation. CJC Open 2021; 3:751-757. [PMID: 34169254 PMCID: PMC8209371 DOI: 10.1016/j.cjco.2021.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 02/01/2021] [Indexed: 12/31/2022] Open
Abstract
Background Polygenic scores incorporating varying numbers of single nucleotide polymorphisms (SNPs) have been demonstrated to exert a prominent role in atrial fibrillation (AF). We sought to compare the relative discriminatory capacities of 2 previously validated polygenic scores in "lone" AF. Methods A total of 186 lone AF cases of European ancestry underwent SNP genotyping. A genome-wide polygenic score (GPS) and polygenic risk score (PRS) involving 6,730,541 and 1168 SNPs, respectively, were calculated for 186 cases and 423 controls of European ancestry from the 1000 Genomes (1KG) Project. The distribution of the polygenic scores was compared between the cases and controls and their discriminatory capacities were evaluated using receiver operating characteristic (ROC) curves. Results A total of 34.4% of patients with lone AF had GPS scores greater than the top 10th percentile of 1KG controls, corresponding to a 4.64-fold increased odds (95% confidence interval [CI], 2.99-7.18; P < 0.001) for AF. A PRS score in the top 10th percentile of 1KG controls was observed in 26.3% of cases, which equated to a 3.16-fold increased odds (95% CI, 2.01-4.98; P < 0.001) for AF. Comparison of C-statistics from ROC curves indicated improved discriminatory capacity of the GPS (0.76) relative to the PRS (0.70) (P = 0.002). Conclusions Our study evaluating 2 polygenic scores for AF suggests that the GPS, containing more than 6.7 million SNPs, exhibits an improved discriminatory capacity in lone AF compared with a PRS possessing 1168 SNPs. Our findings suggest that genetic risk scores for AF that maximally leverage genomic data may provide improved predictive power.
Collapse
Affiliation(s)
- Julieta Lazarte
- Department of Medicine and Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jacqueline S Dron
- Department of Medicine and Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Adam D McIntyre
- Department of Medicine and Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Allan C Skanes
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
| | - Lorne J Gula
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
| | - Anthony S Tang
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
| | - Rafik Tadros
- Division of Cardiology, Montréal Heart Institute, University of Montréal, Montréal, Québec, Canada
| | - Zachary W Laksman
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert A Hegele
- Department of Medicine and Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jason D Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
| |
Collapse
|
12
|
Lazarte J, Dron JS, McIntyre AD, Skanes AC, Gula LJ, Tang AS, Tadros R, Laksman ZW, Hegele RA, Roberts JD. Role of Common Genetic Variation in Lone Atrial Fibrillation. Circ Genom Precis Med 2021; 14:e003179. [PMID: 33517663 DOI: 10.1161/circgen.120.003179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Julieta Lazarte
- Department of Medicine and Robarts Research Institute, Schulich School of Medicine and Dentistry (J.L., J.S.D., A.D.M., R.A.H.), Western University, London, Ontario, Canada
| | - Jacqueline S Dron
- Department of Medicine and Robarts Research Institute, Schulich School of Medicine and Dentistry (J.L., J.S.D., A.D.M., R.A.H.), Western University, London, Ontario, Canada
| | - Adam D McIntyre
- Department of Medicine and Robarts Research Institute, Schulich School of Medicine and Dentistry (J.L., J.S.D., A.D.M., R.A.H.), Western University, London, Ontario, Canada
| | - Allan C Skanes
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine (A.C.S., L.J.G., A.S.T., J.D.R.), Western University, London, Ontario, Canada
| | - Lorne J Gula
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine (A.C.S., L.J.G., A.S.T., J.D.R.), Western University, London, Ontario, Canada
| | - Anthony S Tang
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine (A.C.S., L.J.G., A.S.T., J.D.R.), Western University, London, Ontario, Canada
| | - Rafik Tadros
- Division of Cardiology, Montreal Heart Institute, University of Montreal, Quebec, Canada (R.T.)
| | - Zachary W Laksman
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada (Z.W.L.)
| | - Robert A Hegele
- Department of Medicine and Robarts Research Institute, Schulich School of Medicine and Dentistry (J.L., J.S.D., A.D.M., R.A.H.), Western University, London, Ontario, Canada
| | - Jason D Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine (A.C.S., L.J.G., A.S.T., J.D.R.), Western University, London, Ontario, Canada
| |
Collapse
|
13
|
Cheung CC, Davies B, Gibbs K, Laksman ZW, Krahn AD. Patch monitors for arrhythmia monitoring in patients for suspected inherited arrhythmia syndrome. J Cardiovasc Electrophysiol 2021; 32:856-859. [PMID: 33512057 DOI: 10.1111/jce.14917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Patients undergoing evaluation for an inherited arrhythmia syndrome undertake a series of ambulatory investigations including 24-h Holter monitor, exercise treadmill testing (ETT), and others. Patch monitors may simplify the evaluation, providing accurate arrhythmia evaluation and QT assessment. METHODS AND RESULTS Patients referred for evaluation of an inherited arrhythmia syndrome underwent standard investigations, including 12-lead electrocardiography (ECG), 24-h Holter monitoring, ETT, along with supplemental monitoring using a 7-day ECG patch monitor. Heart rates (HR), corrected QT intervals (QTc), and ectopic burden were compared across monitoring modalities. Among 35 patients that wore the patch monitor, the median age was 39 years (54% male). There was intermediate correlation between resting HR across modalities (r = .58-.66) and poor correlation of peak HR (r = .27-.39). There was intermediate correlation between resting QTc intervals across modalities (r = .72-.77) but negligible correlation between QTc intervals at peak HR across modalities (r = -.01 to -.06). There was good correlation in PAC and PVC ectopic burden across the Holter and patch monitor. CONCLUSION Patch monitors may simplify the evaluation of patients for an inherited arrhythmia syndrome and provide resting QT assessment over time. However, QTc interval comparison at peak HRs remains variable, and may be limited by the single-lead ECG vector when using the patch monitor. Apart from QTc intervals at peak HR, patch monitors demonstrated good correlation with the ECG and Holter monitor for other parameters.
Collapse
Affiliation(s)
- Christopher C Cheung
- Heart Rhythm Services, Division of Cardiology, Center for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brianna Davies
- Heart Rhythm Services, Division of Cardiology, Center for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Karen Gibbs
- Heart Rhythm Services, Division of Cardiology, Center for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Zachary W Laksman
- Heart Rhythm Services, Division of Cardiology, Center for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew D Krahn
- Heart Rhythm Services, Division of Cardiology, Center for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
14
|
Steinberg C, Pilote S, Philippon F, Laksman ZW, Champagne J, Simard C, Krahn AD, Drolet B. SCN5A-C683R exhibits combined gain-of-function and loss-of-function properties related to adrenaline-triggered ventricular arrhythmia. Exp Physiol 2021; 106:683-699. [PMID: 33480457 DOI: 10.1113/ep089088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/11/2021] [Indexed: 12/14/2022]
Abstract
NEW FINDINGS What is the role of SCN5A-C683R? SCN5A-C683R is a novel variant associated with an uncommon phenotype of adrenaline-triggered ventricular arrhythmia in the absence of a distinct ECG phenotype. What is the main finding and its importance? Functional studies demonstrated that NaV 1.5/C683R results in a mixed electrophysiological phenotype with gain-of-function (GOF) and loss-of-function (LOF) properties compared with NaV 1.5/wild type. Gain-of-function properties are characterized by a significant increase of the maximal current density and a hyperpolarizing shift of the steady-state activation. The LOF effect of NaV 1.5/C683R is characterized by increased closed-state inactivation. Electrophysiological properties and clinical manifestation of SCN5A-C683R are different from long-QT-3 or Brugada syndrome and might represent a distinct inherited arrhythmia syndrome. ABSTRACT Mutations of SCN5Ahave been identified as the genetic substrate of various inherited arrhythmia syndromes, including long-QT-3 and Brugada syndrome. We recently identified a novel SCN5A variant (C683R) in two genetically unrelated families. The index patients of both families experienced adrenaline-triggered ventricular arrhythmia with cardiac arrest but did not show a specific ECG phenotype, raising the hypothesis that SCN5A-C683R might be a susceptibility variant and the genetic substrate of distinct inherited arrhythmia. We conducted functional cellular studies to characterize the electrophysiological properties of NaV 1.5/C683R in order to explore the potential pathogenicity of this novel variant. The C683R variant was engineered by site-directed mutagenesis. NaV 1.5/wild type (WT) and NaV 1.5/C683R were expressed in tsA201 cells. Electrophysiological characterization of C683R was performed using the whole-cell patch-clamp technique. Adrenergic stimulation was mimicked by exposure to the protein kinase A activator 8-CPT-cAMP. The impact of β-blockers was tested by exposing NaV 1.5/WT and NaV 1.5/C683R currents to propranolol and nadolol. C683R resulted in a co-association of gain-of-function and loss-of-function properties of NaV 1.5. Gain-of-function properties were characterized by a significant increase of the maximal NaV 1.5 current density compared with NaV 1.5/WT (861 ± 309 vs. 627 ± 489 pA/pF; P < 0.05, n ≥ 9) that was potentiated in NaV 1.5/C683R with 8-CPT-cAMP stimulation (869 ± 287 vs. 607 ± 320 pA/pF; P < 0.05, n ≥ 12). C683R also resulted in a significant hyperpolarizing shift in the voltage of steady-state activation (-65.4 ± 3.0 vs. -57.2 ± 4.8 mV; P < 0.001), resulting in an increased window current compared with WT. The loss-of-function effect of NaV 1.5/C683R was characterized by significantly increased closed-state inactivation compared with NaV 1.5/WT (P < 0.05). C683R is a novel SCN5A variant resulting in a co-association of gain-of-function and loss-of-function properties of the cardiac sodium channel NaV 1.5. The phenotype is characterized by adrenaline-triggered ventricular arrhythmias. Electrophysiological properties and clinical manifestations are different from long-QT-3 or Brugada syndrome and might represent a distinct inherited arrhythmia syndrome.
Collapse
Affiliation(s)
- Christian Steinberg
- Division of Cardiology, Electrophysiology Service, Institut universitaire de cardiologie et de pneumologie de Québec, IUCPQ-UL), Laval University, Québec, QC, Canada.,IUCPQ-UL Research Center, Laval University, Québec, QC, Canada
| | - Sylvie Pilote
- IUCPQ-UL Research Center, Laval University, Québec, QC, Canada.,Faculty of Pharmacy, Laval University, Québec, QC, Canada
| | - François Philippon
- Division of Cardiology, Electrophysiology Service, Institut universitaire de cardiologie et de pneumologie de Québec, IUCPQ-UL), Laval University, Québec, QC, Canada.,IUCPQ-UL Research Center, Laval University, Québec, QC, Canada
| | - Zachary W Laksman
- Heart Rhythm Services, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Jean Champagne
- Division of Cardiology, Electrophysiology Service, Institut universitaire de cardiologie et de pneumologie de Québec, IUCPQ-UL), Laval University, Québec, QC, Canada.,IUCPQ-UL Research Center, Laval University, Québec, QC, Canada
| | - Chantale Simard
- IUCPQ-UL Research Center, Laval University, Québec, QC, Canada.,Faculty of Pharmacy, Laval University, Québec, QC, Canada
| | - Andrew D Krahn
- Heart Rhythm Services, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Benoît Drolet
- IUCPQ-UL Research Center, Laval University, Québec, QC, Canada.,Faculty of Pharmacy, Laval University, Québec, QC, Canada
| |
Collapse
|
15
|
Huang K, Trinder M, Roston TM, Laksman ZW, Brunham LR. The Interplay Between Titin, Polygenic Risk, and Modifiable Cardiovascular Risk Factors in Atrial Fibrillation. Can J Cardiol 2020; 37:848-856. [PMID: 33373724 DOI: 10.1016/j.cjca.2020.12.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 12/03/2020] [Accepted: 12/06/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Common and rare variants, including those in the gene for the cardiac structural protein titin (TTN), have been implicated in the risk of developing atrial fibrillation (AF). However, the effect of genetic variants on risk of AF compared with established modifiable risk factors is unclear. The objective of this study was to evaluate the risk of AF and associated cardiovascular complications in TTN variant carriers and examine interactions between TTN variants or common variants and modifiable AF risk factors. METHODS We used whole exome sequencing data of 49,881 individuals and genotyping data of 408,572 individuals from the UK Biobank to examine the associations of TTN variants, polygenic risk, and 4 risk factors (hypertension, diabetes, obesity, and smoking) with AF. Adjusted hazard ratios (aHRs) were calculated with the use of Cox proportional hazards models. RESULTS TTN variant carrier status was associated with a higher risk of AF (aHR 2.10, 95% CI 1.59-2.79; P = 2.54 × 10-7) and higher risk of dilated cardiomyopathy in AF patients (aHR 10.39, 95% CI 5.31-20.33; P = 8.37 × 10-12). We identified additive effects between TTN variants and polygenic risk with hypertension, diabetes, obesity, and smoking on the risk of AF. CONCLUSIONS Genetic and modifiable cardiovascular risk factors contribute to the probability of developing AF. Our findings highlight the potential utility of incorporating data from targeted sequencing or genotyping of common variants to further inform AF risk stratification and aggressive management of modifiable cardiovascular risk factors.
Collapse
Affiliation(s)
- Kate Huang
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada; Experimental Medicine Program, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark Trinder
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada; Experimental Medicine Program, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas M Roston
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada; Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Zachary W Laksman
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada; Experimental Medicine Program, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Liam R Brunham
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada; Experimental Medicine Program, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| |
Collapse
|
16
|
Williams CB, Andrade JG, Hawkins NM, Cheung C, Krahn A, Laksman ZW, Bennett MT, Heilbron B, Chakrabarti S, Yeung-Lai-Wah JA, Deyell MW. Establishing reference ranges for ambulatory electrocardiography parameters: meta-analysis. Heart 2020; 106:1732-1739. [DOI: 10.1136/heartjnl-2020-316925] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/31/2020] [Accepted: 06/08/2020] [Indexed: 12/30/2022] Open
Abstract
ObjectiveDespite the widespread and increasing use of ambulatory electrocardiography (ECG), there is no consensus on reference ranges for ambulatory electrocardiogram parameters to guide interpretation. We sought to determine population distribution-based reference ranges for parameters measured during ambulatory electrocardiogram in healthy adults, based on existing literature.MethodsWe searched multiple databases from 1950 to 2020. Articles reporting original data from ≥24-hour ambulatory electrocardiogram monitoring in healthy adults were included. Data extraction and synthesis were performed according to Meta-analysis of Observational Studies in Epidemiology guidelines. The prevalence/mean and SD for common parameters (sinus pauses, conduction abnormalities and ectopy) were extracted by age group (18–39, 40–59, 60–79 and 80+ years).ResultsWe identified 33 studies involving 6466 patients. Sinus pauses of >3 s were rare (pooled prevalence <1%) across all ages. Supraventricular ectopy of >1000/24 hours increased with age, from 0% (95% CI 0% to 0%) in those aged 18–39 years to 6% (95% CI 0% to 17%) in those aged 60–79 years. Episodes of supraventricular tachycardia increased from 3% (95% CI 1% to 6%) in those aged 18–39 years to 28% (95% CI 9% to 52%) in those aged 60–79 years. Ventricular ectopy of >1000/24 hours also increased with age, from 1% (95% CI 0% to 2%) in those aged 18–39 years to 5% (95% CI 1% to 10%) in those aged 60–79 years. Episodes of non-sustained ventricular tachycardia ranged from 0% (95% CI 0% to 1%) in those aged 18–39 years to 2% (95% CI 0% to 5%) in those aged 60–79 years.ConclusionDespite the limitations of existing published data, this meta-analysis provides evidence-based reference ranges for ambulatory electrocardiogram parameters and highlights significant age-dependent differences that should be taken into account during interpretation.
Collapse
|
17
|
Cheung CC, Davies B, Gibbs K, Laksman ZW, Krahn AD. Multilead QT Screening Is Necessary for QT Measurement: Implications for Management of Patients in the COVID-19 Era. JACC Clin Electrophysiol 2020; 6:878-880. [PMID: 32703574 PMCID: PMC7141442 DOI: 10.1016/j.jacep.2020.04.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/03/2020] [Accepted: 04/03/2020] [Indexed: 12/27/2022]
|
18
|
Cheung CC, Larsen JM, Bashir J, Dorian P, Laksman ZW. The Potential Impact of Intrathoracic Impedance on Defibrillation Threshold Testing in S-ICDs. Can J Cardiol 2019; 35:1604.e13-1604.e16. [PMID: 31587933 DOI: 10.1016/j.cjca.2019.07.624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 07/21/2019] [Accepted: 07/22/2019] [Indexed: 11/17/2022] Open
Abstract
A man with an ischemic cardiomyopathy and chronic obstructive pulmonary disease underwent subcutaneous implantable cardioverter-defibrillator (S-ICD) placement under general anesthesia. Following induction of ventricular fibrillation (VF), defibrillation testing (65J) failed, requiring external rescue. Repeat shock testing with reversed polarity (65J) failed. A third shock and external defibrillation failed (80J and 200J), followed by a second external defibrillation (200J), which did not immediately terminate VF, and a device shock 2 seconds later (80J, successful). Repeat shock testing (80J) under conscious sedation without mechanical ventilation was successful. We discuss this case of failed defibrillation testing during S-ICD placement, potentially due to lung hyperinflation, requiring double sequential defibrillation.
Collapse
Affiliation(s)
- Christopher C Cheung
- Heart Rhythm Services, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jacob M Larsen
- Heart Rhythm Services, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jamil Bashir
- Heart Rhythm Services, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Paul Dorian
- Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Zachary W Laksman
- Heart Rhythm Services, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
| |
Collapse
|
19
|
Lee AKY, Andrade J, Hawkins NM, Alexander G, Bennett MT, Chakrabarti S, Laksman ZW, Krahn A, Yeung-Lai-Wah JA, Deyell MW. Outcomes of untreated frequent premature ventricular complexes with normal left ventricular function. Heart 2019; 105:1408-1413. [DOI: 10.1136/heartjnl-2019-314922] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 04/05/2019] [Accepted: 04/26/2019] [Indexed: 11/04/2022] Open
Abstract
ObjectiveThe natural history of frequent premature ventricular complexes (PVCs) in association with preserved left ventricular ejection fraction (LVEF) is uncertain. The optimal management of this population is thus undefined. We studied the outcomes of untreated patients with frequent PVCs and preserved LVEF.MethodsThis cohort study prospectively evaluated consecutive patients from 2012 to 2017, with asymptomatic or minimally symptomatic frequent idiopathic PVCs (≥5% PVCs in 24 hours; normal LVEF; no cause identified on comprehensive evaluation). No suppressive therapy (ablation or antiarrhythmic drugs) were used and patients were followed with serial ambulatory ECG monitoring and echocardiography. The primary arrhythmic outcome was reduction in PVC burden to <1% on serial ambulatory monitoring. The primary echocardiographic outcome was a reduction of LVEF to <50%.ResultsOne hundred patients met inclusion criteria (mean age 51.8 years, 57% female) with a median PVC burden of 18.4%. Reduction to <1% PVCs occurred in 44 of 100 patients (44.0%) at a median of 15.4 months (range 2.6 to 64.3). Recurrence was uncommon (4/44, 9.1%). Four patients (4.3%) with a persistently elevated PVC burden developed left ventricular dysfunction (LVEF <50%) during the follow-up period at a range of 53–71 months. The initial PVC burden did not predict subsequent resolution (HR 1.00(0.97, 1.03); p=0.86).ConclusionsA strategy of active surveillance is appropriate for the majority of patients with frequent idiopathic PVCs in association with preserved LVEF, owing to the low risk of developing left ventricular systolic dysfunction and the high rate of spontaneous resolution.
Collapse
|
20
|
Cheung CC, Mellor G, Deyell MW, Ensam B, Batchvarov V, Papadakis M, Roberts JD, Leather R, Sanatani S, Healey JS, Chauhan VS, Birnie DH, Champagne J, Angaran P, Klein GJ, Yee R, Simpson CS, Talajic M, Gardner M, Yeung-Lai-Wah JA, Chakrabarti S, Laksman ZW, Sharma S, Behr ER, Krahn AD. Comparison of Ajmaline and Procainamide Provocation Tests in the Diagnosis of Brugada Syndrome. JACC Clin Electrophysiol 2019; 5:504-512. [DOI: 10.1016/j.jacep.2019.01.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/02/2019] [Accepted: 01/31/2019] [Indexed: 01/20/2023]
|
21
|
Cheung CC, Lieve KV, Roston TM, van der Ree MH, Deyell MW, Andrade JG, Laksman ZW, Nannenberg EA, Tadros R, Pang B, Rutberg J, Green MS, Conacher S, Seifer CM, Roberts JD, Steinberg C, Sanatani S, Wilde AA, Krahn AD. Pregnancy in Catecholaminergic Polymorphic Ventricular Tachycardia. JACC Clin Electrophysiol 2018; 5:387-394. [PMID: 30898243 DOI: 10.1016/j.jacep.2018.10.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 09/10/2018] [Revised: 10/31/2018] [Accepted: 10/31/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This investigation was a retrospective study of catecholaminergic polymorphic ventricular tachycardia (CPVT) patients in Canada and the Netherlands to compare pregnancy, postpartum, and nonpregnant event rates. BACKGROUND CPVT is characterized by life-threatening arrhythmias during exertion or emotional stress. The arrhythmic risk in CPVT patients during pregnancy is unknown. METHODS Baseline demographics, genetics, treatment, and pregnancy complications were reviewed. Event rate calculations assumed a 40-week pregnancy and 24-week postpartum period. RESULTS Ninety-six CPVT patients had 228 pregnancies (median 2 pregnancies per patient; range: 1 to 10; total: 175.4 pregnant patient-years). The median age of CPVT diagnosis was 40.7 years (range: 12 to 84 years), with a median follow-up of 2.9 years (range: 0 to 20 years; total 448.1 patient-years). Most patients had pregnancies before CPVT diagnosis (82%). Pregnancy and postpartum cardiac events included syncope (5%) and an aborted cardiac arrest (1%), which occurred in patients who were not taking beta-blockers. Other complications included miscarriages (13%) and intrauterine growth restriction (1 case). There were 6 cardiac events (6%) during the nonpregnant period. The pregnancy and postpartum event rates were 1.71 and 2.85 events per 100 patient-years, respectively, and the combined event rate during the pregnancy and postpartum period was 2.14 events per 100 patient-years. These rates were not different from the nonpregnant event rate (1.46 events per 100 patient-years). CONCLUSIONS The combined pregnancy and postpartum arrhythmic risk in CPVT patients was not elevated compared with the nonpregnant period. Most patients had pregnancies before diagnosis, and all patients with events were not taking beta-blockers at the time of the event.
Collapse
Affiliation(s)
- Christopher C Cheung
- Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Krystien V Lieve
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, the Netherlands
| | - Thomas M Roston
- Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martijn H van der Ree
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, the Netherlands
| | - Marc W Deyell
- Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason G Andrade
- Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Zachary W Laksman
- Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eline A Nannenberg
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, the Netherlands; Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Rafik Tadros
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, the Netherlands
| | - Benjamin Pang
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Julie Rutberg
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Martin S Green
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Susan Conacher
- Division of Cardiology, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Colette M Seifer
- Division of Cardiology, University of Manitoba, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Jason D Roberts
- Division of Cardiology, University of Manitoba, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Christian Steinberg
- Institut Universitaire de Cardiologie et Pneumologie de Québec, Université Laval, Québec City, Québec, Canada
| | - Shubhayan Sanatani
- Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Arthur A Wilde
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, the Netherlands
| | - Andrew D Krahn
- Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
| |
Collapse
|
22
|
Roston TM, Cunningham T, Lehman A, Laksman ZW, Krahn AD, Sanatani S. Beyond the Electrocardiogram: Mutations in Cardiac Ion Channel Genes Underlie Nonarrhythmic Phenotypes. Clin Med Insights Cardiol 2017; 11:1179546817698134. [PMID: 28469493 PMCID: PMC5392026 DOI: 10.1177/1179546817698134] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 02/01/2017] [Indexed: 12/19/2022]
Abstract
Cardiac ion channelopathies are an important cause of sudden death in the young and include long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, idiopathic ventricular fibrillation, and short QT syndrome. Genes that encode ion channels have been implicated in all of these conditions, leading to the widespread implementation of genetic testing for suspected channelopathies. Over the past half-century, researchers have also identified systemic pathologies that extend beyond the arrhythmic phenotype in patients with ion channel gene mutations, including deafness, epilepsy, cardiomyopathy, periodic paralysis, and congenital heart disease. A coexisting phenotype, such as cardiomyopathy, can influence evaluation and management. However, prior to recent molecular advances, our understanding and recognition of these overlapping phenotypes were poor. This review highlights the systemic and structural heart manifestations of the cardiac ion channelopathies, including their phenotypic spectrum and molecular basis.
Collapse
Affiliation(s)
- Thomas M Roston
- British Columbia Inherited Arrhythmia Program and University of British Columbia, Vancouver, BC, Canada
| | - Taylor Cunningham
- British Columbia Inherited Arrhythmia Program and University of British Columbia, Vancouver, BC, Canada
| | - Anna Lehman
- British Columbia Inherited Arrhythmia Program and University of British Columbia, Vancouver, BC, Canada
| | - Zachary W Laksman
- British Columbia Inherited Arrhythmia Program and University of British Columbia, Vancouver, BC, Canada
| | - Andrew D Krahn
- British Columbia Inherited Arrhythmia Program and University of British Columbia, Vancouver, BC, Canada
| | - Shubhayan Sanatani
- British Columbia Inherited Arrhythmia Program and University of British Columbia, Vancouver, BC, Canada.,Children's Heart Centre, BC Children's Hospital, Vancouver, BC, Canada
| |
Collapse
|