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Brignoli M, Mattera A, Chianese R, Simonetti A, Vittoria D, Viscusi M. Real-world use of a novel ventricular tachyarrhythmia detection algorithm: A case report. HeartRhythm Case Rep 2023; 9:929-934. [PMID: 38204833 PMCID: PMC10774585 DOI: 10.1016/j.hrcr.2023.10.002] [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: 01/12/2024] Open
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Müller J, Behnes M, Schupp T, Reiser L, Taton G, Reichelt T, Ellguth D, Borggrefe M, Engelke N, Bollow A, Kim SH, Weidner K, Ansari U, Mashayekhi K, Akin M, Halbfass P, Meininghaus DG, Akin I, Rusnak J. Clinical outcome of out-of-hospital vs. in-hospital cardiac arrest survivors presenting with ventricular tachyarrhythmias. Heart Vessels 2021; 37:828-839. [PMID: 34783873 PMCID: PMC8986738 DOI: 10.1007/s00380-021-01976-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 10/22/2021] [Indexed: 11/28/2022]
Abstract
Limited data regarding the prognostic impact of ventricular tachyarrhythmias related to out-of-hospital (OHCA) compared to in-hospital cardiac arrest (IHCA) is available. A large retrospective single-center observational registry with all patients admitted due to ventricular tachyarrhythmias was used including all consecutive patients with ventricular tachycardia (VT) and fibrillation (VF) on admission from 2002 to 2016. Survivors discharged after OHCA were compared to those after IHCA using multivariable Cox regression models and propensity-score matching for evaluation of the primary endpoint of long-term all-cause mortality at 2.5 years. Secondary endpoints were all-cause mortality at 6 months and cardiac rehospitalization at 2.5 years. From 2.422 consecutive patients with ventricular tachyarrhythmias, a total of 524 patients survived cardiac arrest and were discharged from hospital (OHCA 62%; IHCA 38%). In about 50% of all cases, acute myocardial infarction was the underlying disease leading to ventricular tachyarrhythmias with consecutive aborted cardiac arrest. Survivors of IHCA were associated with increased long-term all-cause mortality compared to OHCA even after multivariable adjustment (28% vs. 16%; log rank p = 0.001; HR 1.623; 95% CI 1.002-2.629; p = 0.049) and after propensity-score matching (28% vs. 19%; log rank p = 0.045). Rates of cardiac rehospitalization rates at 2.5 years were equally distributed between OHCA and IHCA survivors. In patients presenting with ventricular tachyarrhythmias, survivors of IHCA were associated with increased risk for all-cause mortality at 2.5 years compared to OHCA survivors.
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Affiliation(s)
- Julian Müller
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Michael Behnes
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Tobias Schupp
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Linda Reiser
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Gabriel Taton
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Thomas Reichelt
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Dominik Ellguth
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Niko Engelke
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Armin Bollow
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Seung-Hyun Kim
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Kathrin Weidner
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Uzair Ansari
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Kambis Mashayekhi
- Department of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Germany
| | - Muharrem Akin
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Philipp Halbfass
- Department of Interventional Electrophysiology, Heart Centre Bad, Neustadt, Germany
| | | | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Jonas Rusnak
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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Santobuono VE, Guaricci AI, Carulli E, Bozza N, Pepe M, Ranauro A, Ranieri C, Carella MC, Loizzi F, Resta N, Favale S, Forleo C. Importance of clinical suspicion and multidisciplinary management for early diagnosis of a cardiac laminopathy patient: A case report. World J Clin Cases 2021; 9:7472-7477. [PMID: 34616814 PMCID: PMC8464441 DOI: 10.12998/wjcc.v9.i25.7472] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/06/2021] [Accepted: 07/14/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Laminopathies are rare diseases, whose cardiac manifestations are heterogeneous and, especially in their initial stage, similar to those of more common conditions, such as ischemic heart disease. Early diagnosis is essential, as these conditions can first manifest themselves with sudden cardiac death. Electrical complications usually appear before structural complications; therefore, it is important to take into consideration these rare genetic disorders for the differential diagnosis of brady and tachyarrhythmias, even when left ventricle systolic function is still preserved.
CASE SUMMARY A 60-year-old man, without history of previous disorders, presented in September 2019 to the emergency department because of the onset of syncope associated with hypotension. The patient was diagnosed with a high-grade atrioventricular block. A dual chamber pacemaker was implanted, but after the onset of a sustained ventricular tachycardia during physical exertion, a drug eluting stent was implanted on an intermediate stenosis on the left anterior descending artery, which had previously been considered non-haemodynamically significant. During the follow-up, the treating cardiologist, suspicious of the overall clinical picture, recommended a genetic test for the diagnosis of cardiomyopathies, which tested positive for a pathogenetic mutation of the lamin A/C gene. While awaiting the result of the genetic test and, later, the pacemaker to be upgraded to a biventricular defibrillator, a remote monitoring device was given to the patient in order to minimize in-person clinical evaluations during the coronavirus disease 2019-related lockdown.
CONCLUSION This case aims to raise awareness of the cardiological manifestations of laminopathies, which can be dangerously misdiagnosed as other, more common conditions.
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Affiliation(s)
- Vincenzo Ezio Santobuono
- Department of Emergency and Organ Transplantation, Cardiology Unit of Policlinic University of Bari, Bari 70124, BA, Italy
| | - Andrea Igoren Guaricci
- Department of Emergency and Organ Transplantation, Cardiology Unit of Policlinic University of Bari, Bari 70124, BA, Italy
| | - Eugenio Carulli
- Department of Emergency and Organ Transplantation, Cardiology Unit of Policlinic University of Bari, Bari 70124, BA, Italy
| | - Nicola Bozza
- Department of Emergency and Organ Transplantation, Cardiology Unit of Policlinic University of Bari, Bari 70124, BA, Italy
| | - Martino Pepe
- Department of Emergency and Organ Transplantation, Cardiology Unit of Policlinic University of Bari, Bari 70124, BA, Italy
| | - Alfredo Ranauro
- Department of Emergency and Organ Transplantation, Cardiology Unit of Policlinic University of Bari, Bari 70124, BA, Italy
| | - Carlotta Ranieri
- Division of Medical Genetics, Department of Biomedical Sciences and Human Oncology, Policlinic University of Bari, Bari 70124, BA, Italy
| | - Maria Cristina Carella
- Department of Emergency and Organ Transplantation, Cardiology Unit of Policlinic University of Bari, Bari 70124, BA, Italy
| | - Francesco Loizzi
- Department of Emergency and Organ Transplantation, Cardiology Unit of Policlinic University of Bari, Bari 70124, BA, Italy
| | - Nicoletta Resta
- Division of Medical Genetics, Department of Biomedical Sciences and Human Oncology, Policlinic University of Bari, Bari 70124, BA, Italy
| | - Stefano Favale
- Department of Emergency and Organ Transplantation, Cardiology Unit of Policlinic University of Bari, Bari 70124, BA, Italy
| | - Cinzia Forleo
- Department of Emergency and Organ Transplantation, Cardiology Unit of Policlinic University of Bari, Bari 70124, BA, Italy
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Shen MJ. The cardiac autonomic nervous system: an introduction. Herzschrittmacherther Elektrophysiol 2021; 32:295-301. [PMID: 34389873 DOI: 10.1007/s00399-021-00776-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/01/2021] [Indexed: 10/20/2022]
Abstract
In recent decades, numerous anatomical and physiological studies of the cardiac autonomic nervous system (ANS) have investigated the complex relationships between the brain and the heart. Autonomic activation not only alters heart rate, conduction, and hemodynamics, but also cellular and subcellular properties of individual myocytes. Moreover, the cardiac ANS plays an essential role in cardiac arrhythmogenesis. There is mounting evidence that neural modulation either by ablation or stimulation can effectively control a wide spectrum of cardiac arrhythmias. This article discusses anatomic aspects of the cardiac ANS, focusing on how autonomic activities influence cardiac electrophysiology. Specific autonomic triggers of various cardiac arrhythmias, in particular atrial fibrillation (AF) and ventricular arrhythmias, are also briefly discussed. Studies with heart-rate variability analysis indicate that, rather than being triggered by either vagal or sympathetic activity, the onset of AF can be associated with simultaneous discharge of both limbs, leading to an imbalance between these two arms of the cardiac ANS. At the same time, sudden cardiac death resulting from ventricular arrhythmias continues to be a significant health and societal burden. These nerve activities of the cardiac ANS can be targeted for the treatment for cardiac arrhythmias, in particular AF and ventricular tachyarrhythmias.
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Zhong X, Guo W, Wei J, Tang Y, Liu Y, Zhang JZ, Tan VH, Zhang L, Wang R, Jones PP, Napolitano C, Priori SG, Chen SRW. Identification of loss-of-function RyR2 mutations associated with idiopathic ventricular fibrillation and sudden death. Biosci Rep 2021; 41:BSR20210209. [PMID: 33825858 DOI: 10.1042/BSR20210209] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/24/2021] [Accepted: 04/06/2021] [Indexed: 11/23/2022] Open
Abstract
Mutations in cardiac ryanodine receptor (RyR2) are linked to catecholaminergic polymorphic ventricular tachycardia (CPVT). Most CPVT RyR2 mutations characterized are gain-of-function (GOF), indicating enhanced RyR2 function as a major cause of CPVT. Loss-of-function (LOF) RyR2 mutations have also been identified and are linked to a distinct entity of cardiac arrhythmia termed RyR2 Ca2+ release deficiency syndrome (CRDS). Exercise stress testing (EST) is routinely used to diagnose CPVT, but it is ineffective for CRDS. There is currently no effective diagnostic tool for CRDS in humans. An alternative strategy to assess the risk for CRDS is to directly determine the functional impact of the associated RyR2 mutations. To this end, we have functionally screened 18 RyR2 mutations that are associated with idiopathic ventricular fibrillation (IVF) or sudden death. We found two additional RyR2 LOF mutations E4146K and G4935R. The E4146K mutation markedly suppressed caffeine activation of RyR2 and abolished store overload induced Ca2+ release (SOICR) in human embryonic kidney 293 (HEK293) cells. E4146K also severely reduced cytosolic Ca2+ activation and abolished luminal Ca2+ activation of single RyR2 channels. The G4935R mutation completely abolished caffeine activation of and [3H]ryanodine binding to RyR2. Co-expression studies showed that the G4935R mutation exerted dominant negative impact on the RyR2 wildtype (WT) channel. Interestingly, the RyR2-G4935R mutant carrier had a negative EST, and the E4146K carrier had a family history of sudden death during sleep, which are different from phenotypes of typical CPVT. Thus, our data further support the link between RyR2 LOF and a new entity of cardiac arrhythmias distinct from CPVT.
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Kamioka M, Hijioka N, Nodera M, Yamada S, Kaneshiro T, Takeishi Y. Electrophysiological properties and involvement of anatomical factors for the prediction of intramural origin in patients with ventricular tachyarrhythmia arising from the left ventricular outflow tract. J Interv Card Electrophysiol 2021; 63:115-123. [PMID: 33564988 DOI: 10.1007/s10840-021-00959-3] [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: 10/22/2020] [Accepted: 02/04/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To elucidate the electrophysiological predictors of the intramural origins of left ventricular outflow tract-ventricular tachyarrhythmias (LVOT-VAs), and to clarify the involvement of anatomical factors. METHODS Twenty-nine successfully ablated LVOT-VAs patients with origins in the aortomitral continuity (AMC) (n = 8), aortic sinus of valsalva (ASV) (n = 9), great cardiac vein (GCV) (n = 5), and intramural myocardium (n = 7) were enrolled. Intramural origins were defined as when effective ablation from AMC and epicardium (ASV and/or GCV) was needed. The local activation time difference (LATD) was calculated as follows: (earliest AMC activation) - (earliest epicardial activation), and was presented as an absolute value. Electrophysiological parameters and anatomical factors predisposing the intramural origins were investigated. RESULTS LATD of intramural origins was significantly shorter than that of AMC and GCV (4.5 ± 2.6 vs. 12.1 ± 7.4 vs. 17.4 ± 4.7, P < 0.05), respectively. In multivariate logistic regression analysis, LATD was associated with intramural origins (odds ratio: 0.711, confidence interval: 0.514-0.985, P = 0.040). ROC analysis revealed LATD of 7 ms as cut-off value. In computed tomography analysis, some patients who had thick fat tissue below the GCV, and an unusual GCV running pattern might be misdiagnosed as intramural origins. CONCLUSION LATD ≤ 7 ms was associated with intramural origins, but with some anatomical limitations.
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Affiliation(s)
- Masashi Kamioka
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan.
| | - Naoko Hijioka
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Minoru Nodera
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Shinya Yamada
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takashi Kaneshiro
- Department of Arrhythmia and Cardiac Pacing, Fukushima Medical University, Fukushima, Japan
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
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Kutyifa V, Brown MW, Beck CA, McNitt S, Miller C, Cox K, Zareba W, Rosero SZ, Gleva MJ, Poole JE. AnaLysIs of Both sex and device specific factoRs on outcomes in pAtients with non-ischemic cardiomyopathy (BIO-LIBRA): Design and clinical protocol. Heart Rhythm O2 2020; 1:376-384. [PMID: 34113895 PMCID: PMC8183973 DOI: 10.1016/j.hroo.2020.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Background Outcomes of patients with nonischemic cardiomyopathy and low ejection fraction implanted with an implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy with a defibrillator (CRT-D), especially in contemporary, real-life cohorts, are not fully understood. Objective We aimed to better characterize outcomes of death and ventricular tachyarrhythmias in patients with nonischemic cardiomyopathy, implanted with an ICD or CRT-D, and specifically assess differences by sex. Methods The AnaLysIs of Both Sex and Device Specific FactoRs on Outcomes in PAtients with Non-Ischemic Cardiomyopathy (BIO-LIBRA) study was designed to prospectively assess outcomes of device-treated ventricular tachyarrhythmias and all-cause mortality events in nonischemic cardiomyopathy patients, indicated for an ICD or CRT-D implantation for the primary prevention of sudden cardiac death (SCD), with a specific focus on sex differences. We will enroll a total of 1000 subjects across 50 U.S. sites and follow patients for up to 3 years. Results The primary objective of BIO-LIBRA is to evaluate the combined risk of all-cause mortality and treated ventricular tachycardia (VT) or ventricular fibrillation (VF) events by subject sex and by implanted device type. We will also assess all-cause mortality, VT or VF alone, cardiac death, and SCD in the total cohort, as well as by subject sex and by the implanted device type. In addition, the previously validated Seattle Proportional Risk Model (SPRM) will be used to compare the SPRM predicted incidence of SCD to the observed incidence. Conclusions The BIO-LIBRA study will provide novel and contemporary information regarding outcomes in patients with a NICM who receive a defibrillator.
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Affiliation(s)
- Valentina Kutyifa
- Clinical Cardiovascular Research Center, Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Mary W Brown
- Clinical Cardiovascular Research Center, Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Christopher A Beck
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York
| | - Scott McNitt
- Clinical Cardiovascular Research Center, Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | | | | | - Wojciech Zareba
- Clinical Cardiovascular Research Center, Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Spencer Z Rosero
- Clinical Cardiovascular Research Center, Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Marye J Gleva
- Washington University in St Louis School of Medicine, St. Louis, Missouri
| | - Jeanne E Poole
- Department of Cardiology, University of Washington, Seattle, Washington
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Behnes M, Mashayekhi K, Kuche P, Kim SH, Schupp T, von Zworowsky M, Reiser L, Bollow A, Taton G, Reichelt T, Borggrefe M, Ellguth D, Engelke N, Weidner K, Lindner S, Müller J, Ansari U, Meininghaus DG, Bertsch T, Lang S, Akin I. Prognostic impact of coronary chronic total occlusion on recurrences of ventricular tachyarrhythmias and ICD therapies. Clin Res Cardiol 2021; 110:281-91. [PMID: 33150467 DOI: 10.1007/s00392-020-01758-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 10/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Despite a few studies evaluating the prognostic impact of coronary chronic total occlusion (CTO) in implantable cardioverter defibrillator (ICD) recipients, the impact of CTO on different types of recurrences of ventricular tachyarrhythmias, as well as their predictors has not yet been investigated in CTO patients. METHODS A large retrospective registry was used including all consecutive patients with ventricular tachyarrhythmias undergoing coronary angiography at index from 2002 to 2016. Only ICD recipients with CTO were compared to patients without (non-CTO). Kaplan-Meier and Cox regression analyses were applied for the primary end point of first recurrence of ventricular tachyarrhythmias at 5 years. Secondary end points comprised of the different types of recurrences, first appropriate ICD therapy and all-cause mortality at 5 years. RESULTS From a total of 422 consecutive ICD recipients with ventricular tachyarrhythmias at index, at least one CTO was present in 25%. CTO was associated with the primary end point of first recurrence of ventricular tachyarrhythmias at 5 years (55% vs. 39%; log rank p = 0.001; HR = 1.665; 95% CI 1.221-2.271; p = 0.001), as well as increased risk of first appropriate ICD therapy (40% vs. 31%; log rank p = 0.039; HR = 1.454; 95% CI 1.016-2.079; p = 0.041) and all-cause mortality at 5 years (26% vs. 16%; log rank p = 0.011; HR = 1.797; 95% CI 1.133-2.850; p = 0.013). Less developed collaterals (i.e., either ipsi- or contralateral compared to bilateral) and a J-CTO score ≥ 3 were strongest predictors of recurrences in CTO patients at 5 years. CONCLUSION A coronary CTO even in the presence of less developed collaterals and more complex CTO category is associated with increasing risk of recurrent ventricular tachyarrhythmias at 5 years in consecutive ICD recipients.
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Adhyapak SM, Parachuri VR. Is programmed electrical stimulation mandatory for recognition of ventricular arrhythmogenicity in heart failure? Indian J Thorac Cardiovasc Surg 2020; 36:52-55. [PMID: 33061094 DOI: 10.1007/s12055-019-00839-6] [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] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 11/28/2022] Open
Abstract
Ischemic cardiomyopathy often presents with advanced heart failure necessitating an intensive multidisciplinary approach to management. These patients constitute a very difficult population presenting with angina and ventricular tachyarrhythmias sometimes presenting as sudden cardiac death. In those patients presenting with spontaneous ventricular tachyarrhythmias, treatment with automated intracardiac defibrillator implantation has a significant mortality benefit. In patients with significant left ventricular (LV) dilatation and a left ventricular ejection fraction ≤ 30%, guidelines state that device implantation should be preceded by programmed electrical stimulation, which demonstrates inducible ventricular tachyarrhythmia. The treatment options for patients with moderate LV dilatation and ejection fraction ≥ 30% is individualized. Devices have their associated problems. Radiofrequency ablation has mixed results. Surgical cryoablation when performed concomitantly with surgical ventricular restoration has shown promising results. But, this option remains isolated to patients eligible for surgical ventricular restoration. Programmed electrical stimulation for inducibility of ventricular tachyarrhythmias in these patients also has a questionable role. The need for programmed electrical stimulation prior to cryoablation also seems highly individualized. In this review, we discuss the mechanisms of ischemic ventricular tachyarrhythmias and treatment options in heart failure. The mechanisms of ventricular arrhythmogenesis in ischemic cardiomyopathy help in formulating novel technical modifications for cryoablation when performed concomitantly with surgical ventricular restoration.
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van Veldhuisen DJ, van Woerden G, Gorter TM, van Empel VP, Manintveld OC, Tieleman RG, Maass AH, Vernooy K, Westenbrink BD, van Gelder IC, Rienstra M. Ventricular tachyarrhythmia detection by implantable loop recording in patients with heart failure and preserved ejection fraction: the VIP-HF study. Eur J Heart Fail 2020; 22:1923-1929. [PMID: 32683763 PMCID: PMC7693069 DOI: 10.1002/ejhf.1970] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 12/28/2022] Open
Abstract
AIMS The primary aim of the VIP-HF study was to examine the incidence of sustained ventricular tachyarrhythmias (VTs) in heart failure (HF) with mid-range (HFmrEF) or preserved ejection fraction (HFpEF). Secondary aims were to examine the incidence of non-sustained VTs, bradyarrhythmias, HF hospitalizations and mortality. METHODS AND RESULTS This was an investigator-initiated, prospective, multicentre, observational study of patients with HF and left ventricular ejection fraction (LVEF) >40%. Patients underwent extensive phenotyping, after which an implantable loop recorder was implanted. We enrolled 113 of the planned 250 patients [mean age 73 ± 8 years, 51% women, New York Heart Association class II/III 54%/46%, median N-terminal pro B-type natriuretic peptide 1367 (710-2452) pg/mL and mean LVEF 54 ± 6%; 75% had LVEF >50%]. Eighteen percent had non-sustained VTs and 37% had atrial fibrillation on Holter monitoring. During a median follow-up of 657 (219-748) days, the primary endpoint of sustained VT was observed in one patient. The incidence of the primary endpoint was 0.6 (95% confidence interval 0.2-3.5) per 100 person-years. The incidence of the secondary endpoint of non-sustained VT was 11.5 (7.1-18.7) per 100 person-years. Five patients developed bradyarrhythmias [3.2 (1.4-7.5) per 100 person-years], three were implanted with a pacemaker. In total, 23 patients (20%) were hospitalized for HF [16.3 (10.9-24.4) per 100 person-years]. Fourteen patients (12%) died [8.7 (5.2-14.7) per 100 person-years]; 10 due to cardiovascular causes, and four sudden deaths, one with implantable loop recorder-confirmed bradyarrhythmias as terminal event, three others undetermined. CONCLUSION Despite the lower than expected number of included patients, the incidence of sustained VTs in HFmrEF/HFpEF was low. Clinically relevant bradyarrhythmias were more often observed than expected.
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Affiliation(s)
- Dirk J. van Veldhuisen
- Department of CardiologyUniversity of Groningen, University Medical Centre GroningenGroningenThe Netherlands
| | - Gijs van Woerden
- Department of CardiologyUniversity of Groningen, University Medical Centre GroningenGroningenThe Netherlands
| | - Thomas M. Gorter
- Department of CardiologyUniversity of Groningen, University Medical Centre GroningenGroningenThe Netherlands
| | - Vanessa P.M. van Empel
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM)Medical University Centre MaastrichtMaastrichtThe Netherlands
| | | | - Robert G. Tieleman
- Department of CardiologyUniversity of Groningen, University Medical Centre GroningenGroningenThe Netherlands
- Department of CardiologyMartini Hospital GroningenGroningenThe Netherlands
| | - Alexander H. Maass
- Department of CardiologyUniversity of Groningen, University Medical Centre GroningenGroningenThe Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM)Medical University Centre MaastrichtMaastrichtThe Netherlands
| | - B. Daan Westenbrink
- Department of CardiologyUniversity of Groningen, University Medical Centre GroningenGroningenThe Netherlands
| | - Isabelle C. van Gelder
- Department of CardiologyUniversity of Groningen, University Medical Centre GroningenGroningenThe Netherlands
| | - Michiel Rienstra
- Department of CardiologyUniversity of Groningen, University Medical Centre GroningenGroningenThe Netherlands
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Hashimoto K, Harada N, Kasamaki Y. Reference values for a novel ambulatory-based frequency domain T-wave alternans in subjects without structural heart disease. J Cardiol 2020; 76:506-513. [PMID: 32624298 DOI: 10.1016/j.jjcc.2020.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 04/12/2020] [Accepted: 05/17/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Conventional frequency domain T wave alternans (FD-TWA) is a noninvasive risk stratification marker for identifying arrhythmic sudden cardiac death, but the conventional FD-TWA device that was considered the gold standard device has been discontinued commercially. Recently, a newly developed ambulatory electrocardiogram (AECG) device that can detect FD-TWA continuously for 24 hours is available in clinical settings. However, information on the normal values using the novel AECG-based frequency domain TWA (FD-TWA) is lacking. METHODS FD-TWA for AECG was examined in 312 subjects without heart disease (Sb-wHD) (range 20-89 years, 146 men) and 30 heart disease patients (HD-P) (mean age 57±17 years, 24 men). The maximum FD-TWA amplitude over 24 hours was measured with manual editing. The upper limit of local noise levels for measurement of FD-TWA was set to both <10 μV and <20 μV (acceptable noise level <10 μV and <20 μV). RESULTS The reference values (95th percentiles) of FD-TWA in Sb-wHD were 19.9 μV for the acceptable noise level <10 μV and 23.6 μV for the acceptable noise level <20 μV. The 75th percentile of FD-TWA amplitude in HD-P was 19.5 µV at an acceptable noise level <10 µV and 21.5 µV at an acceptable noise level <20 µV. FD-TWA amplitude without heart disease was significantly affected by heart rate when the maximum FD-TWA was measured (β = 0.274 p < 0.001 for the acceptable noise level <10 μV; β = 0.263, p < 0.001 for the acceptable noise level <20 μV) and age (β = 0.204, p = 0.004 for the acceptable noise level <10 μV; β = 0.149, p = 0.034 for the acceptable noise level <20 μV). CONCLUSIONS In the present study, the reference values for a novel FD-TWA in Sb-wHD and the distribution of TWA values in HD-P were established. In future research, the cut-off values of FD-TWA in HD-P will need to be examined.
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Affiliation(s)
- Kenichi Hashimoto
- Department of General Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan.
| | - Naomi Harada
- Division of General Medicine, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yuji Kasamaki
- Department of Community Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi, Toyama, Japan
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12
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Schupp T, Bertsch T, von Zworowsky M, Kim SH, Weidner K, Rusnak J, Barth C, Reiser L, Taton G, Reichelt T, Ellguth D, Engelke N, Bollow A, Akin M, Mashayekhi K, Große Meininghaus D, Borggrefe M, Akin I, Behnes M. Prognostic impact of potassium levels in patients with ventricular tachyarrhythmias. Clin Res Cardiol 2020; 109:1292-1306. [PMID: 32236716 DOI: 10.1007/s00392-020-01624-x] [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: 11/04/2019] [Accepted: 02/24/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The study sought to assess the prognostic impact of potassium levels (K) in patients with ventricular tachyarrhythmias. METHODS A large retrospective registry was used including all consecutive patients presenting with ventricular tachyarrhythmias on admission from 2002 to 2016. Patients with hypokalemia (i.e., K < 3.3 mmol/L), normokalemia (i.e., K 3.3-4.5 mmol/L), and hyperkalemia (i.e., K > 4.5 mmol/L) were compared applying multi-variable Cox regression models and propensity-score matching for evaluation of the primary endpoint of all-cause mortality at 3 years. Secondary endpoints were early cardiac death at 24 h, in-hospital death, death at 30 days, as well as the composite endpoint of early cardiac death at 24 h, recurrences of ventricular tachyarrhythmias, and appropriate ICD therapies at 3 years. RESULTS In 1990 consecutive patients with ventricular tachyarrhythmias, 63% of the patients presented with normokalemia, 30% with hyperkalemia, and 7% with hypokalemia. After propensity matching, both hypokalemic (HR = 1.545; 95% CI 0.970-2.459; p = 0.067) and hyperkalemic patients (HR = 1.371; 95% CI 1.094-1.718; p = 0.006) were associated with the primary endpoint of all-cause mortality at 3 years compared to normokalemic patients. Hyperkalemia was associated with even worse prognosis directly compared to hypokalemia (HR = 1.496; 95% CI 1.002-2.233; p = 0.049). In contrast, potassium measurements were not associated with the composite endpoint at 3 years. CONCLUSION In patients presenting with ventricular tachyarrhythmias, normokalemia was associated with best short- and long-term survival, whereas hyperkalemia and hypokalemia were associated with increased mortality at 30 days and at 3 years.
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Affiliation(s)
- Tobias Schupp
- Department of Medicine, Faculty of Medicine Mannheim, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site, University Medical Centre Mannheim (UMM), University of Heidelberg, Heidelberg/Mannheim, Mannheim, Germany
| | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, General Hospital Nuremberg, Paracelsus Medical University, Nuremberg, Germany
| | - Max von Zworowsky
- Department of Medicine, Faculty of Medicine Mannheim, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site, University Medical Centre Mannheim (UMM), University of Heidelberg, Heidelberg/Mannheim, Mannheim, Germany
| | - Seung-Hyun Kim
- Department of Medicine, Faculty of Medicine Mannheim, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site, University Medical Centre Mannheim (UMM), University of Heidelberg, Heidelberg/Mannheim, Mannheim, Germany
| | - Kathrin Weidner
- Department of Medicine, Faculty of Medicine Mannheim, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site, University Medical Centre Mannheim (UMM), University of Heidelberg, Heidelberg/Mannheim, Mannheim, Germany
| | - Jonas Rusnak
- Department of Medicine, Faculty of Medicine Mannheim, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site, University Medical Centre Mannheim (UMM), University of Heidelberg, Heidelberg/Mannheim, Mannheim, Germany
| | - Christian Barth
- Department of Medicine, Faculty of Medicine Mannheim, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site, University Medical Centre Mannheim (UMM), University of Heidelberg, Heidelberg/Mannheim, Mannheim, Germany
| | - Linda Reiser
- Department of Medicine, Faculty of Medicine Mannheim, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site, University Medical Centre Mannheim (UMM), University of Heidelberg, Heidelberg/Mannheim, Mannheim, Germany
| | - Gabriel Taton
- Department of Medicine, Faculty of Medicine Mannheim, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site, University Medical Centre Mannheim (UMM), University of Heidelberg, Heidelberg/Mannheim, Mannheim, Germany
| | - Thomas Reichelt
- Department of Medicine, Faculty of Medicine Mannheim, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site, University Medical Centre Mannheim (UMM), University of Heidelberg, Heidelberg/Mannheim, Mannheim, Germany
| | - Dominik Ellguth
- Department of Medicine, Faculty of Medicine Mannheim, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site, University Medical Centre Mannheim (UMM), University of Heidelberg, Heidelberg/Mannheim, Mannheim, Germany
| | - Niko Engelke
- Department of Medicine, Faculty of Medicine Mannheim, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site, University Medical Centre Mannheim (UMM), University of Heidelberg, Heidelberg/Mannheim, Mannheim, Germany
| | - Armin Bollow
- Department of Medicine, Faculty of Medicine Mannheim, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site, University Medical Centre Mannheim (UMM), University of Heidelberg, Heidelberg/Mannheim, Mannheim, Germany
| | - Muharrem Akin
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Kambis Mashayekhi
- Department of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Germany
| | | | - Martin Borggrefe
- Department of Medicine, Faculty of Medicine Mannheim, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site, University Medical Centre Mannheim (UMM), University of Heidelberg, Heidelberg/Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- Department of Medicine, Faculty of Medicine Mannheim, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site, University Medical Centre Mannheim (UMM), University of Heidelberg, Heidelberg/Mannheim, Mannheim, Germany.
| | - Michael Behnes
- Department of Medicine, Faculty of Medicine Mannheim, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site, University Medical Centre Mannheim (UMM), University of Heidelberg, Heidelberg/Mannheim, Mannheim, Germany
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13
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Beinart R, Kutyifa V, McNitt S, Huang D, Aktas M, Rosero S, Goldenberg I, Nof E. Relation between resting heart rate and the risk of ventricular tachyarrhythmias in MADIT-RIT. Europace 2020; 22:281-287. [PMID: 31942613 DOI: 10.1093/europace/euz353] [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: 07/21/2019] [Accepted: 12/06/2019] [Indexed: 11/13/2022] Open
Abstract
AIMS To explore the association between resting heart rate (RHR) and ventricular tachyarrhythmias (VTA) events among patients who were enrolled in MADIT-RIT. METHODS AND RESULTS Multivariate Cox proportional hazards regression modelling was employed to evaluate the association between baseline RHR [dichotomized at the lower quartile (≤63 b.p.m.) and further assessed as a continuous measure] and the risk for any VTA, fast VTA (>200 b.p.m.), and appropriate implantable cardioverter-defibrillator (ICD) therapy, among 1500 patients who were enrolled in MADIT-RIT. Kaplan-Meier survival analysis showed that at 2 years of follow-up the rate of any VTA was significantly lower among patients with low baseline RHR (≤63 b.p.m.) as compared with faster RHR (11% vs. 19%, respectively; P = 0.001 for the overall difference during follow-up). Similar results were shown for the association with the rate of fast VTA (8% vs. 14%, respectively; P = 0.016), and appropriate ICD therapy (10% vs. 18%, respectively; P = 0.004). Multivariate analysis, after adjustment for medical therapy, showed that low baseline RHR was associated with a significant 45% (P = 0.002) reduction in the VTA risk as compared with faster baseline RHRs. When assessed as a continuous measure, each 10 b.p.m. decrement in RHR was associated with a corresponding 13% (P = 0.014) reduction in the VTA risk. CONCLUSION In MADIT-RIT, low RHR was independently associated with a lower risk for life-threatening arrhythmic events. These findings suggest a possible role for RHR for improved selection of candidates for ICD therapy.
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Affiliation(s)
- Roy Beinart
- Leviev Heart Institute, Sheba Medical Center, Ramat Gan and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Valentina Kutyifa
- Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY, USA
| | - Scott McNitt
- Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY, USA
| | - David Huang
- Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY, USA
| | - Mehmet Aktas
- Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY, USA
| | - Spencer Rosero
- Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY, USA
| | - Ilan Goldenberg
- Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY, USA
| | - Eyal Nof
- Leviev Heart Institute, Sheba Medical Center, Ramat Gan and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Lekkas P, Kontonika M, Georgiou ES, La Rocca V, Mouchtouri ET, Mourouzis I, Pantos C, Kolettis TM. Endothelin receptors in the brain modulate autonomic responses and arrhythmogenesis during acute myocardial infarction in rats. Life Sci 2019; 239:117062. [PMID: 31734261 DOI: 10.1016/j.lfs.2019.117062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/31/2019] [Accepted: 11/09/2019] [Indexed: 10/25/2022]
Abstract
AIMS Endothelin has been implicated in various processes in the brain, including the modulation of sympathetic responses. The present study examined the pathophysiologic role of brain endothelin-receptors in the setting of acute myocardial infarction, characterized by high incidence of ventricular tachyarrhythmias. MAIN METHODS We investigated the effects of intracerebroventricular administration of antagonists of endothelin-receptors ETA, ETB, or both, during a 24 h-observation period post-coronary ligation in (n = 70) rats. Continuous recording was performed via implanted telemetry transmitters, followed by arrhythmia-analysis and calculation of autonomic indices derived from heart rate variability. The regional myocardial electrophysiologic properties were assessed by monophasic action potentials and multi-electrode recordings. KEY FINDINGS Sympathetic-activity was decreased and vagal-activity was enhanced after intracerebroventricular ETA-receptor blockade, thus attenuating regional myocardial repolarization inhomogeneity. As a result, the incidence of ventricular tachyarrhythmias was markedly lower in this group. Such effects were also observed after intracerebroventricular blockade of ETB-, or both, ETA- and ETB-receptors, although to a lesser extent. SIGNIFICANCE ETA-receptors in the brain modulate sympathetic and vagal responses and alter arrhythmogenesis during evolving myocardial necrosis in rats. These findings provide insights into arrhythmogenic mechanisms during acute myocardial infarction and call for further investigation on the role of endothelin in the central autonomic network.
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Affiliation(s)
- Panagiotis Lekkas
- Cardiovascular Research Institute, Ioannina and Athens, Greece; Department of Physiology, Medical School, University of Ioannina, Greece
| | | | | | | | - Eleni-Taxiarchia Mouchtouri
- Cardiovascular Research Institute, Ioannina and Athens, Greece; Department of Cardiology, Medical School, University of Ioannina, Greece
| | - Iordanis Mourouzis
- Department of Pharmacology, Medical School, National & Kapodistrian University of Athens, Greece
| | - Constantinos Pantos
- Department of Pharmacology, Medical School, National & Kapodistrian University of Athens, Greece
| | - Theofilos M Kolettis
- Cardiovascular Research Institute, Ioannina and Athens, Greece; Department of Cardiology, Medical School, University of Ioannina, Greece.
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15
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Weidner K, Behnes M, Weiß C, Nienaber C, Schupp T, Reiser L, Bollow A, Taton G, Reichelt T, Ellguth D, Engelke N, Rusnak J, Kim SH, Barth C, Akin M, Mashayekhi K, Borggrefe M, Akin I. Increasing age is associated with recurrent ventricular tachyarrhythmias and appropriate ICD therapies secondary to documented index ventricular tachyarrhythmias. Eur Geriatr Med 2019; 10:567-576. [PMID: 34652729 DOI: 10.1007/s41999-019-00178-0] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 02/22/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Data regarding the prognostic impact of age in implantable cardioverter defibrillator (ICD) recipients is limited. OBJECTIVE The study sought to assess the impact of age on recurrences of ventricular tachyarrhythmias in ICD recipients. METHODS This "secondary prevention" study is based on a large retrospective registry including consecutive ICD recipients with documented ventricular tachyarrhythmias from 2002 to 2016. Patients < 75 years of age were compared to patients ≥ 75 years. The primary endpoint was first recurrence of ventricular tachyarrhythmias at 5 years. Secondary endpoints were ICD-related therapies, rehospitalization, and all-cause mortality at 5 years. Statistics comprised Kaplan-Meier survival curves, multivariable Cox regression analyses, and propensity-score matching. RESULTS A total of 592 consecutive ICD recipients with index ventricular tachyarrhythmias was included (< 75 years: 78%; ≥ 75 years 22%). Age ≥ 75 years was associated with the primary endpoint of first recurrence of ventricular tachyarrhythmias (49% vs. 43%, log-rank p = 0.015; HR 1.418; 95% CI 1.070-1.881; p = 0.015), and with the secondary endpoint of first appropriate ICD therapy (78% vs. 22%, log-rank p = 0.011) even within multivariable Cox regression analyses. After propensity-score matching, age ≥ 75 years was still associated with the primary endpoint of first recurrence of ventricular tachyarrhythmias (49% vs. 42%, log-rank p = 0.045; HR 1.482; 95% CI 1.007-2.182; p = 0.046). CONCLUSION Elderly ICD recipients aged ≥ 75 years are at increased risk of recurrent ventricular tachyarrhythmias, appropriate ICD therapies, and all-cause mortality at 5 years.
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Affiliation(s)
- Kathrin Weidner
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Michael Behnes
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Christel Weiß
- Institute of Biomathematics and Medical Statistics, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Tobias Schupp
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Linda Reiser
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Armin Bollow
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Gabriel Taton
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Thomas Reichelt
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Dominik Ellguth
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Niko Engelke
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Jonas Rusnak
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Seung-Hyun Kim
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Christian Barth
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Muharrem Akin
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Kambis Mashayekhi
- Clinic for Cardiology and Angiology II, Universitaetszentrum Freiburg Bad Krozingen, University of Freiburg, Bad Krozingen, Germany
| | - Martin Borggrefe
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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Rusnak J, Behnes M, Schupp T, Lang S, Reiser L, Taton G, Bollow A, Reichelt T, Ellguth D, Engelke N, Ansari U, El-Battrawy I, Bertsch T, Nienaber CA, Akin M, Mashayekhi K, Weiß C, Borggrefe M, Akin I. Statin therapy is associated with improved survival in patients with ventricular tachyarrhythmias. Lipids Health Dis 2019; 18:119. [PMID: 31122256 PMCID: PMC6533673 DOI: 10.1186/s12944-019-1011-x] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 03/08/2019] [Indexed: 11/22/2022] Open
Abstract
Objectives The study sought to assess the impact of statin therapy on survival in patients presenting with ventricular tachyarrhythmias. Background Data regarding the outcome of patients with statin therapy presenting with ventricular tachyarrhythmias is limited. Methods A large retrospective registry was used including all consecutive patients presenting with ventricular tachycardia (VT) or fibrillation (VF) from 2002 to 2016. Patients with statin were compared to patients without statin therapy (non-statin). The primary prognostic endpoint was long-term all-cause death at 3 years. Uni- and multivariable Cox regression analyses were applied in propensity-score matched cohorts. Results A total of 424 matched patients was included. The rates of VT and VF were similar in both groups (VT: statin 71% vs. non-statin 68%; VF: statin 29% vs. 32%; p = 0.460). Statin therapy was associated with lower all-cause mortality at long-term follow-up (mortality rates 16% versus 33%; log rank, p = 0.001; HR = 0.438; 95% CI 0.290–0.663; p = 0.001), irrespective of the underlying type of ventricular tachyarrhythmia (VT/VF), left ventricular ejection fraction (LVEF) > 35%, presence of an activated implantable cardioverter defibrillator (ICD), cardiogenic shock or cardiopulmonary resuscitation (CPR). Conclusion Statin therapy is independently associated with lower long-term mortality in patients presenting with ventricular tachyarrhythmias on admission. Trial registration Clinicaltrials.gov, NCT02982473, 11/29/2016, Retrospectively registered.
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Affiliation(s)
- Jonas Rusnak
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Michael Behnes
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Tobias Schupp
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Siegfried Lang
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Linda Reiser
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Gabriel Taton
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Armin Bollow
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Thomas Reichelt
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Dominik Ellguth
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Niko Engelke
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Uzair Ansari
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Ibrahim El-Battrawy
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, General Hospital Nuremberg, Paracelsus Medical University, Nuremberg, Germany
| | | | - Muharrem Akin
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Kambis Mashayekhi
- Clinic for Cardiology and Angiology II, Universitaetszentrum Freiburg Bad Krozingen, University of Freiburg, Bad Krozingen, Germany
| | - Christel Weiß
- Institute of Biomathematics and Medical Statistics, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, Heidelberg University, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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Xu S, Yang L, Hong D, Chen L, Wang X. The Prognostic Value of Early Repolarization Pattern for the Ventricular Tachyarrhythmias of Acute Myocardial Infarction Patients: A Meta-Analysis. Cardiology 2019; 144:69-75. [PMID: 31434097 DOI: 10.1159/000501474] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 06/08/2019] [Indexed: 02/05/2023]
Abstract
Several studies have indicated that early repolarization (ER) is a risk factor for ventricular tachyarrhythmias (VTAs) in acute myocardial infarction (AMI) patients. The prognostic values of ER detail characteristics except J-point morphology, and inferior leads ER location for VTAs are still unclear. We searched PubMed, Embase, and the Cochrane Library for eligible studies up to March 4, 2019. Studies to investigate the relationship between ER and the incidence of VTAs in AMI patients were extracted. A total of 10 studies with 2,672 participants were included in the analysis. ER significantly predicted the incidence of VTAs (odds ratio [OR] 3.62, 95% confidence intervals [CI] 2.77-4.73), regardless of the type of AMI. The presence of ER before AMI (OR 5.58, 95% CI 3.41 to 9.12) and after AMI (OR 3.02, 95% CI 2.19-4.15) increased the risk of VTAs. The prognostic value of ER for VTAs in the long follow-up (≥30 days) (OR 2.39, 95% CI 1.59-3.59) fell by half compared to the short follow-up duration (<30 days) (OR 4.97, 95% CI 3.48-7.09). Patients with ER displayed a higher risk of developing ventricular fibrillation (VF) (OR 6.94, 95% CI 3.87-12.43) than those without ER. However, neither J-point elevation with OR = 2.48 nor lateral leads' ER location with OR = 3.83 remarkably increased the risk of VTAs in patients with AMI. ER is significantly associated with increasing risk of VTAs, particularly VF, in AMI patients. This relationship is weaker in the 30-day follow-up and is not reinforced by J-point elevation and lateral leads' ER location.
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Affiliation(s)
- Shangbo Xu
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Shantou University Medical College, Shantou, China
| | - Lihua Yang
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Danhua Hong
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Lan Chen
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Xin Wang
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, China,
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18
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Duncker D, Veltmann C. [Wearable defibrillator : Current evidence]. Herzschrittmacherther Elektrophysiol 2018; 29:362-8. [PMID: 30357452 DOI: 10.1007/s00399-018-0601-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 10/04/2018] [Indexed: 10/28/2022]
Abstract
The wearable cardioverter/defibrillator (WCD) is safe and effective in the prevention of sudden cardiac death, and has found its way into international guidelines and clinical practice. Nearly 40,000 patients with a WCD have been published in clinical registries and one randomized study has recently been presented. Especially patients with newly diagnosed cardiomyopathy with severely reduced left ventricular function show an increased risk for ventricular tachyarrhythmias and may benefit from a WCD. In these patients without an indication for an implantable cardioverter-defibrillator (ICD), the WCD offers protection from sudden cardiac death during initiation and optimization of heart failure medication. Critical patient selection and structured patient management is crucial for successful WCD prescription. This review gives an overview of the current data and recommendations on WCD.
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19
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Weidner K, Behnes M, Schupp T, Rusnak J, Reiser L, Bollow A, Taton G, Reichelt T, Ellguth D, Engelke N, Hoppner J, El-Battrawy I, Mashayekhi K, Weiß C, Borggrefe M, Akin I. Type 2 diabetes is independently associated with all-cause mortality secondary to ventricular tachyarrhythmias. Cardiovasc Diabetol 2018; 17:125. [PMID: 30200967 PMCID: PMC6130079 DOI: 10.1186/s12933-018-0768-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 08/25/2018] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES The study sought to assess the prognostic impact of type 2 diabetes in patients presenting with ventricular tachyarrhythmias on admission. BACKGROUND Data regarding the prognostic outcome of diabetics presenting with ventricular tachyarrhythmias is limited. METHODS A large retrospective registry was used including all consecutive patients presenting with ventricular tachycardia (VT) and fibrillation (VF) on admission from 2002 to 2016. Patients with type 2 diabetes (diabetics) were compared to non-diabetics applying multivariable Cox regression models and propensity-score matching for evaluation of the primary prognostic endpoint of long-term all-cause mortality at 2 years. Secondary prognostic endpoints were cardiac death at 24 h, in-hospital death at index, all-cause mortality at 30 days, all-cause mortality in patients surviving index hospitalization at 2 years (i.e. "after discharge") and rehospitalization due to recurrent ventricular tachyarrhythmias at 2 years. RESULTS In 2411 unmatched high-risk patients with ventricular tachyarrhythmias, diabetes was present in 25% compared to non-diabetics (75%). Rates of VT (57% vs. 56%) and VF (43% vs. 44%) were comparable in both groups. Multivariable Cox regression models revealed diabetics associated with the primary endpoint of long-term all-cause mortality at 2 years (HR = 1.513; p = 0.001), which was still proven after propensity score matching (46% vs. 33%, log rank p = 0.001; HR = 1.525; p = 0.001). The rates of secondary endpoints were higher for in-hospital death at index, all-cause mortality at 30 days, as well as after discharge, but not for cardiac death at 24 h or rehospitalization due to recurrent ventricular tachyarrhythmias. CONCLUSION Presence of type 2 diabetes is independently associated with an increase of all-cause mortality in patients presenting with ventricular tachyarrhythmias on admission.
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Affiliation(s)
- Kathrin Weidner
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Michael Behnes
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Tobias Schupp
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Jonas Rusnak
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Linda Reiser
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Armin Bollow
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Gabriel Taton
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Thomas Reichelt
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Dominik Ellguth
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Niko Engelke
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Jorge Hoppner
- Department of Diagnostic and Interventional Radiology, University Heidelberg, Heidelberg, Germany
| | - Ibrahim El-Battrawy
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Kambis Mashayekhi
- Department of Cardiology and Angiology II, University Heart Center Freiburg Bad Krozingen, Bad Krozingen, Germany
| | - Christel Weiß
- Institute of Biomathematics and Medical Statistics, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, Heidelberg University, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
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20
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Kolettis TM. Autonomic function and ventricular tachyarrhythmias during acute myocardial infarction. World J Exp Med 2018; 8:8-11. [PMID: 30191139 PMCID: PMC6125141 DOI: 10.5493/wjem.v8.i1.8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/05/2018] [Accepted: 08/21/2018] [Indexed: 02/07/2023] Open
Abstract
Most cases of sudden cardiac death are attributed to sustained ventricular tachyarrhythmias (VTs), triggered by acute coronary occlusion. Autonomic dysfunction, an important arrhythmogenic mechanism in this setting, is being actively investigated, aiming at the advent of preventive strategies. Recent experimental studies have shown vagal withdrawal after anterior myocardial infarction, coinciding with high incidence of VTs, followed by more gradual sympathetic activation coinciding with a second arrhythmia peak. This article summarizes recent knowledge on this intriguing topic, generating hypotheses that can be investigated in future experimental and clinical studies.
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Affiliation(s)
- Theofilos M Kolettis
- Department of Cardiology, Cardiovascular Research Institute and University of Ioannina Medical School, Ioannina 45500, Greece
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21
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Abstract
The population incidence of sudden cardiac arrest (SCA) and sudden cardiac death have not changed appreciably during the decades of improvement in general outcomes from cardiovascular diseases, but the age, clinical circumstances, and pathophysiologic mechanisms have. The epidemiology and pathophysiology of SCA are linked, in that mechanisms of SCA can be modeled based on substrate and expression characteristics. The goal for the future is to expand pathophysiologic and epidemiologic interactions to achieve strong individual risk prediction, to complement the limits of application of population risk data to individuals.
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Affiliation(s)
- Robert J Myerburg
- Division of Cardiology, University of Miami Miller School of Medicine, D-39, PO Box 016960, Miami, FL 33101, USA
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22
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Vander MA, Fedotov PA, Lyubimtseva TA, Bortsova MA, Sitnikova MY, Lebedev DS, Mikhaylov EN. Renal artery denervation suppresses intractable ventricular arrhythmia in patients with left heart thrombosis. J Geriatr Cardiol 2017; 14:587-589. [PMID: 29056958 PMCID: PMC5641647 DOI: 10.11909/j.issn.1671-5411.2017.09.005] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Affiliation(s)
- Marianna A Vander
- Neuromodulation Unit, Almazov National Medical Research Centre, Saint-Petersburg, Russia
- Arrhythmia Department, Almazov National Medical Research Centre, Saint-Petersburg, Russia
| | - Petr A Fedotov
- Heart Failure Department, Almazov National Medical Research Centre, Saint-Petersburg, Russia
| | - Tamara A Lyubimtseva
- Arrhythmia Department, Almazov National Medical Research Centre, Saint-Petersburg, Russia
| | - Maria A Bortsova
- Heart Failure Department, Almazov National Medical Research Centre, Saint-Petersburg, Russia
| | - Maria Yu Sitnikova
- Heart Failure Department, Almazov National Medical Research Centre, Saint-Petersburg, Russia
| | - Dmitry S Lebedev
- Arrhythmia Department, Almazov National Medical Research Centre, Saint-Petersburg, Russia
| | - Evgeny N Mikhaylov
- Neuromodulation Unit, Almazov National Medical Research Centre, Saint-Petersburg, Russia
- Arrhythmia Department, Almazov National Medical Research Centre, Saint-Petersburg, Russia
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23
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Chin A, Ntsekhe M, Viljoen C, Rossouw J, Pennel T, Schwartz PJ. Rationale and design of a prospective study to assess the effect of left cardiac sympathetic denervation in chronic heart failure. Int J Cardiol 2017; 248:227-231. [PMID: 28864134 DOI: 10.1016/j.ijcard.2017.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 08/04/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The main causes of mortality in patients with chronic heart failure include sudden cardiac death (SCD) and progressive heart failure. Autonomic dysfunction plays a detrimental role in the progression of chronic heart failure. Left cardiac sympathetic denervation (LCSD) is an inexpensive and safe procedure which modifies autonomic innervation of the heart and is associated with a significant antifibrillatory effect. Whether LCSD reduces the risk of SCD, delays progression of heart failure and improves quality of life in patients with heart failure with reduced ejection fraction (HFrEF) is not known. METHODS AND DESIGN This is a 2-phased prospective, randomized trial to test the efficacy and safety of LCSD as an adjunct to guideline recommended medical therapy for patients with HFrEF. Once the safety and feasibility of conducting a large LCSD study have been demonstrated in the pilot phase, a phase III efficacy trial to assess the impact on ventricular arrhythmias, heart failure outcomes, and mortality will be completed. Outcome data from the pilot study will remain blinded and added to the results of phase III study for analysis. RESULTS To date the study has received approval from local and national ethics and regulatory bodies and recruitment has commenced, and 4 patients have been randomized so far. CONCLUSION If LCSD is proven to be safe, feasible and effective in this first ever study using this novel approach in patients with HFrEF it may be a cost-effective alternative to the implantable cardioverter defibrillator therapy especially in regions where ICDs and cardiac transplantation are unavailable.
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Affiliation(s)
- Ashley Chin
- Division of Cardiology, Department of Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Mpiko Ntsekhe
- Division of Cardiology, Department of Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Charle Viljoen
- Division of Cardiology, Department of Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Johan Rossouw
- Christiaan Barnard Division of Cardiothoracic Surgery, Faculty of Health Sciences, University of Cape Town, 7925, Observatory, Cape Town, South Africa
| | - Tim Pennel
- Christiaan Barnard Division of Cardiothoracic Surgery, Faculty of Health Sciences, University of Cape Town, 7925, Observatory, Cape Town, South Africa
| | - Peter J Schwartz
- Division of Cardiology, Department of Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa; IRCCS Istituto Auxologico Italiano, Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, Milan, Italy.
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24
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Sideris S, Archontakis S, Gatzoulis KA, Anastasakis A, Sotiropoulos I, Arsenos P, Kasiakogias A, Terentes D, Trachanas K, Paschalidis E, Tousoulis D, Kallikazaros I. The subcutaneous ICD as an alternative to the conventional ICD system: Initial experience in Greece and a review of the literature. Hellenic J Cardiol 2017; 58:4-16. [PMID: 28163146 DOI: 10.1016/j.hjc.2017.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 08/31/2016] [Indexed: 01/11/2023] Open
Abstract
The introduction of an implantable cardioverter defibrillator (ICD) in clinical practice has revolutionized our therapeutic approach for both primary and secondary prevention of sudden cardiac death (SCD), as it has proven to be superior to medical therapy in treating potentially life-threatening ventricular arrhythmias and has resulted in reduced mortality rates. However, implantation of a conventional ICD carries a non-negligible risk of periprocedural and long-term complications associated with the transvenous ICD leads. The entirely subcutaneous implantable cardioverter defibrillator (S-ICD) has recently emerged as a therapeutic alternative to the conventional ICD for patients with various cardiopathies and who are at high risk of SCD. The main advantage is the avoidance of vascular access and thus avoidance of complications associated with transvenous leads. Patients without pacing indications, such as bradycardia, a need for antitachycardia pacing or cardiac resynchronization, as well as those at higher risk of complications from transvenous lead implantation are perfect candidates for this novel technology. The subcutaneous ICD has proven to be equally safe and effective compared to transvenous ICD systems in early clinical trials. Further technical improvements of the system will likely lead to the expansion of indications and widespread use of this technology. In the present review, we discuss the indications for this system, summarize early clinical experiences and highlight the advantages and disadvantages of this novel technology. In addition, we present the first two cases of subcutaneous cardioverter defibrillator system implantation in Greece.
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25
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Wang X, Tang H, Wei EQ, Wang Z, Yang J, Yang R, Wang S, Zhang Y, Pitt GS, Zhang H, Wang C. Conditional knockout of Fgf13 in murine hearts increases arrhythmia susceptibility and reveals novel ion channel modulatory roles. J Mol Cell Cardiol 2017; 104:63-74. [PMID: 28119060 DOI: 10.1016/j.yjmcc.2017.01.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 01/13/2017] [Accepted: 01/17/2017] [Indexed: 01/06/2023]
Abstract
The intracellular fibroblast growth factors (iFGF/FHFs) bind directly to cardiac voltage gated Na+ channels, and modulate their function. Mutations that affect iFGF/FHF-Na+ channel interaction are associated with arrhythmia syndromes. Although suspected to modulate other ionic currents, such as Ca2+ channels based on acute knockdown experiments in isolated cardiomyocytes, the in vivo consequences of iFGF/FHF gene ablation on cardiac electrical activity are still unknown. We generated inducible, cardiomyocyte-restricted Fgf13 knockout mice to determine the resultant effects of Fgf13 gene ablation. Patch clamp recordings from ventricular myocytes isolated from Fgf13 knockout mice showed a ~25% reduction in peak Na+ channel current density and a hyperpolarizing shift in steady-state inactivation. Electrocardiograms on Fgf13 knockout mice showed a prolonged QRS duration. The Na+ channel blocker flecainide further prolonged QRS duration and triggered ventricular tachyarrhythmias only in Fgf13 knockout mice, suggesting that arrhythmia vulnerability resulted, at least in part, from a loss of functioning Na+ channels. Consistent with these effects on Na+ channels, action potentials in Fgf13 knockout mice, compared to Cre control mice, exhibited slower upstrokes and reduced amplitude, but unexpectedly had longer durations. We investigated candidate sources of the prolonged action potential durations in myocytes from Fgf13 knockout mice and found a reduction of the transient outward K+ current (Ito). Fgf13 knockout did not alter whole-cell protein levels of Kv4.2 and Kv4.3, the Ito pore-forming subunits, but did decrease Kv4.2 and Kv4.3 at the sarcolemma. No changes were seen in the sustained outward K+ current or voltage-gated Ca2+ current, other candidate contributors to the increased action potential duration. These results implicate that FGF13 is a critical cardiac Na+ channel modulator and Fgf13 knockout mice have increased arrhythmia susceptibility in the setting of Na+ channel blockade. The unanticipated effect on Ito revealed new FGF13 properties and the unexpected lack of an effect on voltage-gated Ca2+ channels highlight potential compensatory changes in vivo not readily revealed with acute Fgf13 knockdown in cultured cardiomyocytes.
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Affiliation(s)
- Xiangchong Wang
- Department of Pharmacology, Hebei Medical University, Shijiazhuang 050017, China; The Key Laboratory of Neural and Vascular Biology, Ministry of Education, China, Shijiazhuang, 050017, China; The Key Laboratory of New Drug Pharmacology and Toxicology, Hebei Province, Shijiazhuang 050017, China
| | - He Tang
- Department of Pharmacology, Hebei Medical University, Shijiazhuang 050017, China; The Key Laboratory of Neural and Vascular Biology, Ministry of Education, China, Shijiazhuang, 050017, China; The Key Laboratory of New Drug Pharmacology and Toxicology, Hebei Province, Shijiazhuang 050017, China
| | - Eric Q Wei
- Ion Channel Research Unit, Department of Medicine/Cardiology and Pharmacology, Duke University Medical Center, Durham, NC 27710, USA
| | - Zhihua Wang
- Department of Pharmacology, Hebei Medical University, Shijiazhuang 050017, China; The Key Laboratory of Neural and Vascular Biology, Ministry of Education, China, Shijiazhuang, 050017, China; The Key Laboratory of New Drug Pharmacology and Toxicology, Hebei Province, Shijiazhuang 050017, China
| | - Jing Yang
- Department of Physiology, Hebei Medical University, Shijiazhuang 050017, China
| | - Rong Yang
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Sheng Wang
- Department of Physiology, Hebei Medical University, Shijiazhuang 050017, China
| | - Yongjian Zhang
- Department of Pharmacology, Hebei Medical University, Shijiazhuang 050017, China; The Key Laboratory of Neural and Vascular Biology, Ministry of Education, China, Shijiazhuang, 050017, China; The Key Laboratory of New Drug Pharmacology and Toxicology, Hebei Province, Shijiazhuang 050017, China
| | - Geoffrey S Pitt
- Ion Channel Research Unit, Department of Medicine/Cardiology and Pharmacology, Duke University Medical Center, Durham, NC 27710, USA
| | - Hailin Zhang
- Department of Pharmacology, Hebei Medical University, Shijiazhuang 050017, China; The Key Laboratory of Neural and Vascular Biology, Ministry of Education, China, Shijiazhuang, 050017, China; The Key Laboratory of New Drug Pharmacology and Toxicology, Hebei Province, Shijiazhuang 050017, China.
| | - Chuan Wang
- Department of Pharmacology, Hebei Medical University, Shijiazhuang 050017, China; The Key Laboratory of Neural and Vascular Biology, Ministry of Education, China, Shijiazhuang, 050017, China; The Key Laboratory of New Drug Pharmacology and Toxicology, Hebei Province, Shijiazhuang 050017, China.
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26
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Chung FP, Raharjo SB, Lin YJ, Chang SL, Lo LW, Hu YF, Tuan TC, Chao TF, Liao JN, Lin CY, Chang YT, Hung Y, Te A, Yamada S, Tasaka H, Wang CT, Chen SA. A novel method to enhance phenotype, epicardial functional substrates, and ventricular tachyarrhythmias in Brugada syndrome. Heart Rhythm 2017; 14:508-517. [PMID: 28065832 DOI: 10.1016/j.hrthm.2017.01.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Fever is associated with the manifestation of Brugada phenotype and ventricular tachycardia/ventricular fibrillation (VT/VF) in patients with Brugada syndrome (BrS). The thermal effect on the pathogenesis of functional substrates in BrS remains unknown. OBJECTIVE This study aimed to elucidate the thermal effect on BrS phenotype, VT/VF, and electrophysiological characteristics of epicardial functional substrates in BrS. METHODS We consecutively studied 15 patients with BrS receiving radiofrequency catheter ablation for drug-refractory ventricular tachyarrhythmias. Baseline characteristics, electrocardiographic features, and changes in epicardial functional substrates before and after epicardial warm water instillation (n = 6) were recorded and analyzed. RESULTS A total of 15 male patients (mean age 41.3 ± 10.3 years) with type 1 BrS presenting with ventricular tachyarrhythmias were consecutively enrolled. Epicardial mapping in 11 patients demonstrated a significantly larger epicardial scar/low-voltage zone (LVZ) area within the right ventricular outflow tract and anterior right ventricular free wall than within the endocardium (6.32 ± 12.74 cm2 vs 52.91 ± 45.25 cm2; P = .007). Epicardial warm water instillation in 6 patients led to a significant enlargement of the functional scar/LVZ area (123.83 ± 35.26 cm2 vs 63.53 ± 40.57 cm2; P = .03), accelerated conduction velocity of the endocardium and epicardium without scar/LVZ area, and increased VT/VF inducibility (16.7% vs 100%; P = .02). Ablation by targeting premature ventricular complexes and/or epicardial abnormal substrates rendered noninducibility of VT/VF and prevented the recurrences of VT/VF. CONCLUSION Epicardial warm water instillation enhanced functional epicardial substrates, which contributed to the increased inducibility of ventricular tachyarrhythmias in BrS. Ablation by targeting the triggers and abnormal epicardial substrates provided an effective strategy for preventing ventricular tachyarrhythmia recurrences in BrS.
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Affiliation(s)
- Fa-Po Chung
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Sunu Budhi Raharjo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Lin Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Li-Wei Lo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Feng Hu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ta-Chuan Tuan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jo-Nan Liao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chin-Yu Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yao-Ting Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yuan Hung
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Abigail Te
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shinya Yamada
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hiroshi Tasaka
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chin-Tien Wang
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University, Taipei, Taiwan.
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27
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Kolettis TM, Kontonika M, La Rocca V, Vlahos AP, Baltogiannis GG, Kyriakides ZS. Local conduction during acute myocardial infarction in rats: Interplay between central sympathetic activation and endothelin. J Arrhythm 2016; 33:144-146. [PMID: 28416983 PMCID: PMC5388042 DOI: 10.1016/j.joa.2016.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 06/23/2016] [Accepted: 07/19/2016] [Indexed: 01/01/2023] Open
Abstract
We investigated the effects of autonomic dysfunction and endothelin on local conduction and arrhythmogenesis during myocardial infarction. We recorded ventricular tachyarrhythmias, monophasic action potentials, and activation sequences in wild-type and ETB-deficient rats displaying high endothelin levels. Central sympathetic inputs were examined after clonidine administration. Clonidine mitigated early and delayed arrhythmogenesis in ETB-deficient and wild-type rats, respectively. The right ventricular activation delay increased in clonidine-treated ETB-deficient rats and slightly decreased in wild-type rats. The left ventricular voltage rise decreased in all groups, whereas the activation delay increased mainly in clonidine-treated ETB-deficient rats. Central sympathetic activation and endothelin modulate ischemia-induced arrhythmogenesis. Ischemia alters excitability, whereas endothelin impairs local conduction, an action partly counterbalanced by central sympathetic activity.
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Affiliation(s)
- Theofilos M Kolettis
- Cardiovascular Research Institute, 1 Stavrou Niarxou Ave., 45500 Ioannina, Greece
| | - Marianthi Kontonika
- Cardiovascular Research Institute, 1 Stavrou Niarxou Ave., 45500 Ioannina, Greece
| | - Vassilios La Rocca
- Cardiovascular Research Institute, 1 Stavrou Niarxou Ave., 45500 Ioannina, Greece
| | - Antonios P Vlahos
- Cardiovascular Research Institute, 1 Stavrou Niarxou Ave., 45500 Ioannina, Greece
| | | | - Zenon S Kyriakides
- Cardiovascular Research Institute, 1 Stavrou Niarxou Ave., 45500 Ioannina, Greece
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28
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Szepietowska B, Polonsky B, Sherazi S, Biton Y, Kutyifa V, McNitt S, Aktas M, Moss AJ, Zareba W. Effect of obesity on the effectiveness of cardiac resynchronization to reduce the risk of first and recurrent ventricular tachyarrhythmia events. Cardiovasc Diabetol 2016; 15:93. [PMID: 27388610 PMCID: PMC4936234 DOI: 10.1186/s12933-016-0401-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 04/15/2016] [Accepted: 05/24/2016] [Indexed: 01/08/2023] Open
Abstract
Background Obesity is associated with multiple adverse cardiovascular conditions and may increase the risk of ventricular tachyarrhythmias (VT/VF). There is limited data on the association between obesity and risk of VT/VF requiring appropriate implantable cardioverter-defibrillator (ICD) therapies and the effectiveness of cardiac resynchronization therapy (CRT) to reduce risk for VT/VF. The multicenter automatic defibrillator implantation trial with cardiac resynchronization therapy (MADIT-CRT) was design to investigate effectiveness of CRT therapy to reduce cardiovascular outcome for patients with heart failure (HF) and reduced ejection fraction. Methods and results We identified patients enrolled in the MADIT CRT trial as obese (n = 433) and non-obese (n = 845) and analyzed their risk for appropriate device therapy for VT/VF, repeated VT/VF events, fast VT/VF, as well as events after first VT/VF episodes. Obesity was defined as body mass index (BMI) ≥30 kg/m2. Among ICD patients, the risk of first appropriate ICD therapy for VT/VF at 3 years was similar between obese and non-obese patients (23 vs. 21 %, p = 0.76). CRT-D treatment reduced the risk of first appropriate ICD therapy both in non-obese ([HR]; 0.58 [CI]: 0.42–0.79; p < 0.001) and obese patients (HR 0.75, 95 % CI 0.5–1.38; p = 0.179) (interaction p value 0.323). Similarly, a significant reduction in the risk of fast VT/VF was observed in non-obese patients ([HR]; 0.49 [CI]: 0.33–0.73; p < 0.001) and obese ([HR]; 0.49 [CI]: 0.29–0.81; p < 0.01), (interaction p value 0.984). Conclusion Obese and non-obese patients with mild heart failure have a similar risk of ventricular tachyarrhythmias. Obesity in mild heart failure did not diminish the clinical benefit of cardiac resynchronization therapy to reduce risk for appropriate ICD therapy. Clinical trial registrationhttp://clinicaltrials.gov/ct2/show/NCT00180271 Electronic supplementary material The online version of this article (doi:10.1186/s12933-016-0401-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Barbara Szepietowska
- Heart Research Follow-up Program, Cardiology Division, University of Rochester Medical Center, 265 Crittenden Blvd., PO Box 653, Rochester, NY, 14642, USA.
| | - Bronislava Polonsky
- Heart Research Follow-up Program, Cardiology Division, University of Rochester Medical Center, 265 Crittenden Blvd., PO Box 653, Rochester, NY, 14642, USA
| | - Saadia Sherazi
- Heart Research Follow-up Program, Cardiology Division, University of Rochester Medical Center, 265 Crittenden Blvd., PO Box 653, Rochester, NY, 14642, USA
| | - Yitschak Biton
- Heart Research Follow-up Program, Cardiology Division, University of Rochester Medical Center, 265 Crittenden Blvd., PO Box 653, Rochester, NY, 14642, USA
| | - Valentina Kutyifa
- Heart Research Follow-up Program, Cardiology Division, University of Rochester Medical Center, 265 Crittenden Blvd., PO Box 653, Rochester, NY, 14642, USA
| | - Scott McNitt
- Heart Research Follow-up Program, Cardiology Division, University of Rochester Medical Center, 265 Crittenden Blvd., PO Box 653, Rochester, NY, 14642, USA
| | - Mehmet Aktas
- Heart Research Follow-up Program, Cardiology Division, University of Rochester Medical Center, 265 Crittenden Blvd., PO Box 653, Rochester, NY, 14642, USA
| | - Arthur J Moss
- Heart Research Follow-up Program, Cardiology Division, University of Rochester Medical Center, 265 Crittenden Blvd., PO Box 653, Rochester, NY, 14642, USA
| | - Wojciech Zareba
- Heart Research Follow-up Program, Cardiology Division, University of Rochester Medical Center, 265 Crittenden Blvd., PO Box 653, Rochester, NY, 14642, USA
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Abstract
Based on prospective population-based cohort studies from the Netherlands approximately 120,000 sudden cardiac deaths (SCD) have to be assumed in 2014 in Germany for persons older than 55 years of age without an implantable cardioverter defibrillator (ICD). In contrast in 2014 only 30,000 ICD were implanted in Germany. Due to the fact that victims of SCD are difficult to predict many more implantations are actually necessary because only approximately one third of the patients use their ICD during battery running time. Also according to the largest ICD study on ischemic cardiomyopathy at least six patients must be treated with an ICD to save one life after 8 years. Guidelines for ICD implantation are based on 12 randomized studies with more than 9000 patients. In 2014 in Germany 94 % of ICD implantations were carried out in accordance with the guidelines. The most important studies for primary prophylaxis of SCD (MADIT 2 and SCD-HeFT) finished recruitment of patients in 2001 but propensity score-matched ICD patients from a large national data base showed identical survival curves in 2005 and 2006. New ICD developments in recent years, such as suppression of inappropriate ICD therapy by improved programming, cardiac resynchronization, and telemonitoring showed promise for current ICD patients of improved survival in comparison to the original randomized patients from the studies, which led to the indications in the guidelines.
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Affiliation(s)
- M Block
- Innere Medizin - Kardiologie und Intensivmedizin, Klinik Augustinum München, Wolkerweg 16, 81375, München, Deutschland.
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30
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Boriani G, Savelieva I, Dan GA, Deharo JC, Ferro C, Israel CW, Lane DA, La Manna G, Morton J, Mitjans AM, Vos MA, Turakhia MP, Lip GY. Chronic kidney disease in patients with cardiac rhythm disturbances or implantable electrical devices: clinical significance and implications for decision making-a position paper of the European Heart Rhythm Association endorsed by the Heart Rhythm Society and the Asia Pacific Heart Rhythm Society. Europace 2015; 17:1169-96. [PMID: 26108808 PMCID: PMC6281310 DOI: 10.1093/europace/euv202] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Giuseppe Boriani
- Corresponding author. Giuseppe Boriani, Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S.Orsola-Malpighi University Hospital, Via Massarenti 9, 40138 Bologna, Italy. Tel: +39 051 349858; fax: +39 051 344859. E-mail address:
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31
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Chung FP, Lin YJ, Chang SL, Lo LW, Hu YF, Tuan TC, Chao TF, Liao JN, Chiou CW, Chen SA. Current and state of the art on the electrophysiologic characteristics and catheter ablation of arrhythmogenic right ventricular dysplasia/cardiomyopathy. J Cardiol 2015; 65:441-50. [PMID: 25818480 DOI: 10.1016/j.jjcc.2014.12.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 12/15/2014] [Accepted: 12/26/2014] [Indexed: 01/27/2023]
Abstract
Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is an inherited genetic disease caused by defective desmosomal proteins, and it has typical histopathological features characterized by predominantly progressive fibro-fatty infiltration of the right ventricle. Clinical presentations of ARVD/C vary from syncope, progressive heart failure (HF), ventricular tachyarrhythmias, and sudden cardiac death (SCD). The 2010 modified Task Force criteria were established to facilitate the recognition and diagnosis of ARVD/C. An implantable cardiac defibrillator (ICD) remains to be the cornerstone in prevention of SCD in patients fulfilling the diagnosis of definite ARVD/C, especially among ARVD/C patients with syncope, hemodynamically unstable ventricular tachycardia (VT), ventricular fibrillation, and aborted SCD. Further risk stratification is clinically valuable in the management of patients with borderline or possible ARVD/C and mutation carriers of family members. However, given the entity of heterogeneous penetrance and non-uniform phenotypes, the standardization of clinical practice guidelines for at-risk individuals will be the next frontier to breakthrough. Antiarrhythmic drugs are prescribed frequently to patients experiencing frequent ventricular tachyarrhythmias and/or appropriate ICD shocks. Amiodarone is the recommended drug of choice. Radiofrequency catheter ablation (RFCA) has been demonstrated to effectively eliminate the drug-refractory VT in patients with ARVD/C. However, the efficacy and clinical prognosis of RFCA via endocardial approach alone was disappointing prior to the era of epicardial approach. In recent years, it has been proven that the integration of endocardial and epicardial ablation by targeting the critical isthmus or eliminating abnormal electrograms within the diseased substrates could yield higher acute success and lower recurrence of ventricular tachyarrhythmias during long-term follow-up. Heart transplantation is the final option for patients with extensive disease, biventricular HF with uncontrollable hemodynamic compromise, and refractory ventricular tachyarrhythmias despite aggressive medical and ablation therapies.
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32
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Chang PC, Wo HT, Lee HL, Wen MS, Chou CC. Paradoxical effects of KB-R7943 on arrhythmogenicity in a chronic myocardial infarction rabbit model. J Cardiol 2014; 66:80-7. [PMID: 25241015 DOI: 10.1016/j.jjcc.2014.08.002] [Citation(s) in RCA: 5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 07/22/2014] [Accepted: 08/05/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Na(+)/Ca(2+) exchanger blockade has been reported to be anti-arrhythmic in different models. The effects of KB-R7943, a Na(+)/Ca(2+) exchanger blocker, on arrhythmogenesis in hearts with chronic myocardial infarction (MI) remain unclear. METHODS Dual voltage and intracellular Ca(2+) (Cai) optical mapping was performed in nine rabbit hearts with chronic MI and four control hearts. Electrophysiology studies including inducibility of ventricular tachyarrhythmias, ventricular fibrillation dominant frequency, action potential, Cai alternans, Cai decay, and conduction velocity were performed. The same protocol was repeated in the presence of KB-R7943 (0.5, 1, and 5μM) after the baseline studies. RESULTS KB-R7943 was effective in suppressing afterdepolarizations and spontaneous ventricular tachyarrhythmias in hearts with chronic MI. Surprisingly, KB-R7943 increased the inducibility of ventricular tachyarrhythmias in a dose-dependent manner (11%, 11%, 22%, and 56% at baseline and with 0.5, 1, and 5μM KB-R7943, respectively, p=0.02). Optical mapping analysis revealed that the underlying mechanisms of the induced ventricular tachyarrhythmias were probably spatially discordant alternans with wave breaks and rotors. Further analysis showed that KB-R7943 significantly enhanced both action potential (p=0.033) and Cai (p=0.001) alternans, prolonged Cai decay (tau value) in a dose-dependent manner (p=0.004), and caused heterogeneous conduction delay especially at peri-infarct zones during rapid burst pacing. In contrast, KB-R7943 had insignificant effects in control hearts. CONCLUSIONS In this chronic MI rabbit model, KB-R7943 has contrasting effects on arrhythmogenesis, suppressing afterdepolarizations and spontaneous ventricular tachyarrhythmias, but enhancing the inducibility of tachyarrhythmias. The mechanism is probably the enhanced spatially discordant alternans because of prolonged Cai decay and heterogeneous conduction delay.
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Affiliation(s)
- Po-Cheng Chang
- Division of Cardiology, Department of Internal Medicine, Linko, Chang Gung Memorial Hospital, Taipei, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hung-Ta Wo
- Division of Cardiology, Department of Internal Medicine, Linko, Chang Gung Memorial Hospital, Taipei, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hui-Ling Lee
- Chang Gung University College of Medicine, Taoyuan, Taiwan; Department of Anesthesia, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Ming-Shien Wen
- Division of Cardiology, Department of Internal Medicine, Linko, Chang Gung Memorial Hospital, Taipei, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chung-Chuan Chou
- Division of Cardiology, Department of Internal Medicine, Linko, Chang Gung Memorial Hospital, Taipei, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan.
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Abstract
Worldwide, sudden cardiac death (SCD) is a major problem. It is most frequently caused by ventricular tachyarrhythmias: Monomorphic and polymorphic ventricular tachycardia (VT), torsade de pointes (TdP), and ventricular fibrillation (VF). Beta blockade, ACE inhibition, coronary reperfusion and other treatments have reduced the incidence of VT but pulseless electrical activity (PEA) is increasingly seen, particularly in patients with advanced chronic heart disease. From existing data, bradyarrhythmia in the form of asystole (usually complete heart block without escape rhythm) causes only a minor proportion (10-15%) of SCD. In patients aged 50 years and more, coronary artery disease plays a dominant role causing more than 75% of SCD cases, either by acute ischemia and ventricular fibrillation or by chronic scar formation and reentrant VT. In younger patients, SCD may occur in patients with structurally normal hearts. A number of arrhythmogenic disorders with an increased risk of SCD have been detected and better understood recently, such as long and short QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, and the early repolarization syndrome. Most importantly, ECG signs and clinical features indicating high risk for SCD have been identified. Knowledge of the exact electrophysiologic mechanisms of ventricular tachyarrhythmias at the cellular level has been improved and mechanisms such as phase 2 reentry and reflection proposed to better understand why and how SCD occurs.
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Affiliation(s)
- Carsten W Israel
- Assistant Professor, Dept. of Medicine, Div. of Cardiology, Evangelical Hospital Bielefeld, Burgsteig 13, 33617 Bielefeld, Germany.
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34
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Kolettis TM, Oikonomidis DL, Baibaki MEE, Barka E, Kontonika M, Tsalikakis DG, Papalois A, Kyriakides ZS. Endothelin B-receptors and sympathetic activation: impact on ventricular arrhythmogenesis during acute myocardial infarction. Life Sci 2014; 118:281-7. [PMID: 24503339 DOI: 10.1016/j.lfs.2014.01.069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 12/26/2013] [Accepted: 01/23/2014] [Indexed: 12/26/2022]
Abstract
AIMS We investigated the role of endothelin-B receptors on sympathetic activation originating from the adrenal gland or from the myocardium and its impact on arrhythmogenesis during acute myocardial infarction. MAIN METHODS We studied two groups of rats (n=120, 284±2 g), namely wild-type and ETB-deficient. Myocardial infarction was induced by permanent ligation of the left coronary artery and ventricular tachyarrhythmias were evaluated from continuous electrocardiographic recordings. Sympathetic activation, measured by indices of heart rate variability, was evaluated after adrenalectomy or catecholamine depletion induced by reserpine. Acute left ventricular failure was assessed by total animal activity. KEY FINDINGS Adrenalectomy decreased the total duration of tachyarrhythmias in ETB-deficient rats, but their incidence remained higher, compared to wild-type rats. After reserpine, heart rate variability indices and tachyarrhythmias were similar in the two groups during the initial, ischaemic phase. During evolving infarction, tachyarrhythmia duration was longer in ETB-deficient rats, despite lower sympathetic activation. Heart rate was lower in ETB-deficient rats throughout the 24-hour observation period, whereas activity was comparable in the two groups. SIGNIFICANCE Endothelin-B receptors modulate sympathetic activation during acute myocardial infarction not only in the ventricular myocardium, but also in the adrenal gland. Sympathetic activation markedly increases early-phase ventricular tachyarrhythmias, but other mechanisms involving the endothelin system underlie delayed arrhythmogenesis.
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Affiliation(s)
- Theofilos M Kolettis
- Department of Cardiology, University of Ioannina, Ioannina, Greece; Cardiovascular Research Institute, Ioannina and Athens, Greece.
| | | | - Maria-Eleni E Baibaki
- Department of Cardiology, University of Ioannina, Ioannina, Greece; Cardiovascular Research Institute, Ioannina and Athens, Greece; Experimental Research Center ELPEN, Pikermi, Athens, Greece
| | - Eleonora Barka
- Department of Materials Science and Engineering, University of Ioannina, Greece
| | - Marianthi Kontonika
- Department of Cardiology, University of Ioannina, Ioannina, Greece; Cardiovascular Research Institute, Ioannina and Athens, Greece
| | - Dimitrios G Tsalikakis
- Engineering Informatics and Telecommunications, University of Western Macedonia, Kozani, Greece
| | - Apostolos Papalois
- Cardiovascular Research Institute, Ioannina and Athens, Greece; Experimental Research Center ELPEN, Pikermi, Athens, Greece
| | - Zenon S Kyriakides
- Cardiovascular Research Institute, Ioannina and Athens, Greece; First Department of Cardiology, Red Cross Hospital, Athens, Greece
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