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Miyagawa M, Nakajima Y, Murata N, Okumura Y. Potential Benefits of Non-Gated Computed Tomography for an Early Invasive Strategy in Ventricular Fibrillation. Circ J 2024; 88:614. [PMID: 38382973 DOI: 10.1253/circj.cj-23-0855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Affiliation(s)
- Masatsugu Miyagawa
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Yuki Nakajima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Nobuhiro Murata
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
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Elgamal HR, Trottenberg H, Glaser A, Billion M, Balzer S, Ritter F. Transesophageal Echocardiography for Recognition of an Unusual Cause of Refractory Ventricular Fibrillation. J Cardiothorac Vasc Anesth 2023; 37:2401-2402. [PMID: 37635038 DOI: 10.1053/j.jvca.2023.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/12/2023] [Accepted: 07/17/2023] [Indexed: 08/29/2023]
Affiliation(s)
- Hany R Elgamal
- Schüchtermann Klink, Heart Center, Bad Rothenfelde, Germany.
| | | | - Andre Glaser
- Schüchtermann Klink, Heart Center, Bad Rothenfelde, Germany
| | | | - Stefan Balzer
- Schüchtermann Klink, Heart Center, Bad Rothenfelde, Germany
| | - Frank Ritter
- Schüchtermann Klink, Heart Center, Bad Rothenfelde, Germany
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Affiliation(s)
- Shuichi Kegai
- Department of Cardiology, Iida Municipal Hospital, Japan
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4
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Leyva F, Zegard A, Okafor O, Foley P, Umar F, Taylor RJ, Marshall H, Stegemann B, Moody W, Steeds RP, Halliday BP, Hammersley DJ, Jones RE, Prasad SK, Qiu T. Myocardial Fibrosis Predicts Ventricular Arrhythmias and Sudden Death After Cardiac Electronic Device Implantation. J Am Coll Cardiol 2022; 79:665-678. [PMID: 35177196 DOI: 10.1016/j.jacc.2021.11.050] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Increasing evidence supports a link between myocardial fibrosis (MF) and ventricular arrhythmias. OBJECTIVES The purpose of this study was to determine whether presence of myocardial fibrosis on visual assessment (MFVA) and gray zone fibrosis (GZF) mass predicts sudden cardiac death (SCD) and ventricular fibrillation/sustained ventricular tachycardia after cardiac implantable electronic device (CIED) implantation. METHODS In this prospective study, total fibrosis and GZF mass, quantified using cardiovascular magnetic resonance, was assessed in relation to the primary endpoint of SCD and the secondary, arrhythmic endpoint of SCD or ventricular arrhythmias after CIED implantation. RESULTS Among 700 patients (age 68.0 ± 12.0 years), 27 (3.85%) experienced a SCD and 121 (17.3%) met the arrhythmic endpoint over median 6.93 years (IQR: 5.82-9.32 years). MFVA predicted SCD (HR: 26.3; 95% CI: 3.7-3,337; negative predictive value: 100%). In competing risk analyses, MFVA also predicted the arrhythmic endpoint (subdistribution HR: 19.9; 95% CI: 6.4-61.9; negative predictive value: 98.6%). Compared with no MFVA, a GZF mass measured with the 5SD method (GZF5SD) >17 g was associated with highest risk of SCD (HR: 44.6; 95% CI: 6.12-5,685) and the arrhythmic endpoint (subdistribution HR: 30.3; 95% CI: 9.6-95.8). Adding GZF5SD mass to MFVA led to reclassification of 39% for SCD and 50.2% for the arrhythmic endpoint. In contrast, LVEF did not predict either endpoint. CONCLUSIONS In CIED recipients, MFVA excluded patients at risk of SCD and virtually excluded ventricular arrhythmias. Quantified GZF5SD mass added predictive value in relation to SCD and the arrhythmic endpoint.
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MESH Headings
- Aged
- Aged, 80 and over
- Cardiac Resynchronization Therapy/mortality
- Cardiac Resynchronization Therapy/trends
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/pathology
- Death, Sudden, Cardiac/prevention & control
- Defibrillators, Implantable/trends
- Female
- Fibrosis
- Follow-Up Studies
- Humans
- Magnetic Resonance Imaging, Cine/mortality
- Magnetic Resonance Imaging, Cine/trends
- Male
- Middle Aged
- Myocardium/pathology
- Predictive Value of Tests
- Prospective Studies
- Ventricular Fibrillation/diagnostic imaging
- Ventricular Fibrillation/mortality
- Ventricular Fibrillation/therapy
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Affiliation(s)
- Francisco Leyva
- Aston Medical School, Aston University, Birmingham, United Kingdom.
| | - Abbasin Zegard
- Aston Medical School, Aston University, Birmingham, United Kingdom; University Hospitals Birmingham, Queen Elizabeth, Birmingham, United Kingdom
| | - Osita Okafor
- Aston Medical School, Aston University, Birmingham, United Kingdom; University Hospitals Birmingham, Queen Elizabeth, Birmingham, United Kingdom
| | - Paul Foley
- The Great Western Hospital, Swindon, United Kingdom
| | - Fraz Umar
- The Ottawa Hospital, Ottawa Cardiovascular Centre, Ottawa, Ontario, Canada
| | - Robin J Taylor
- Worcestershire Acute Hospitals NHS Trust, Alexandra Hospital, Worcestershire, United Kingdom
| | - Howard Marshall
- University Hospitals Birmingham, Queen Elizabeth, Birmingham, United Kingdom
| | | | - William Moody
- University Hospitals Birmingham, Queen Elizabeth, Birmingham, United Kingdom
| | - Richard P Steeds
- University Hospitals Birmingham, Queen Elizabeth, Birmingham, United Kingdom
| | - Brian P Halliday
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Daniel J Hammersley
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Richard E Jones
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Sanjay K Prasad
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Tian Qiu
- University Hospitals Birmingham, Queen Elizabeth, Birmingham, United Kingdom
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Meddeb M, Chaudhry K, Timilsina S, Mahat J, Vunnam R, Acharya A, Restrepo AJ, See V, Shorofsky S, Dickfeld T. Dominant vector changes during early wavebreak/spiral wave (Wiggers stage 1) in ventricular fibrillation: insights from the analysis of 100 electrophysiology studies. J Interv Card Electrophysiol 2021; 63:153-164. [PMID: 33591458 DOI: 10.1007/s10840-021-00945-9] [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: 08/26/2020] [Accepted: 01/11/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe electrocardiographic vector patterns during early VF transition (Wiggers stage 1). METHODS In 100 electrophysiology studies with VF induction, the first 3 beats of VF were analyzed in lead I for left/right axis (LA/RA), V1 for left/right bundle (LB/RB), and aVF for superior/inferior axis (SA/IA). Correlation with demographic/clinical factors was performed using regression analyses and mixed effect modeling. RESULTS VF initiated more likely with LA than RA (P < 0.001) and LB than RB (P = 0.04) suggesting original wavebreak in the right ventricle. The 3-dimensional morphology changed in 69% of VF during the first 3 beats, with predominant increase in RB, suggesting a transition of QRS-originating vector to septum/left ventricle. Conservation of morphology (31%) was favored by initial RB (P = 0.002) and LA morphology (P = 0.01). Initiation of VF with LA vs RA was more likely in African-Americans (P = 0.016) and increasing age (P = 0.032). Ischemic cardiomyopathy favored VF initiation with RB 6.7-fold (P = 0.025), possibly linking LV myocardial scar to initial VF wavebreak location. Male gender and ischemic cardiomyopathy prolonged time-to-loss of predominant vector by 119% (P = 0.002) and 71% (P = 0.017), respectively, suggesting more preserved anatomic/functional reentry. CONCLUSION The predominant QRS vectors during early Wiggers stage 1 VF are not random and suggest an initial wavebreak more commonly in the right ventricle, followed by a transitional shift to the septum/left ventricle. Ethnicity, male gender, age, and co-morbidities result in directional preservation of initiating VF vectors possibly due to myocardial mass/fibrosis. Findings may allow new treatment/ablation approaches.
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Affiliation(s)
- Mariam Meddeb
- University of Maryland Medical Center, 22 S Greene St, Baltimore, MD, 21201, USA.
| | - Kashif Chaudhry
- University of Maryland Medical Center, 22 S Greene St, Baltimore, MD, 21201, USA
| | - Saroj Timilsina
- University of Maryland Medical Center, 22 S Greene St, Baltimore, MD, 21201, USA
| | - Jagat Mahat
- University of Maryland Medical Center, 22 S Greene St, Baltimore, MD, 21201, USA
| | - Ramarao Vunnam
- University of Maryland Medical Center, 22 S Greene St, Baltimore, MD, 21201, USA
| | - Aashish Acharya
- University of Maryland Medical Center, 22 S Greene St, Baltimore, MD, 21201, USA
| | | | - Vincent See
- University of Maryland Medical Center, 22 S Greene St, Baltimore, MD, 21201, USA
| | - Stephen Shorofsky
- University of Maryland Medical Center, 22 S Greene St, Baltimore, MD, 21201, USA
| | - Timm Dickfeld
- University of Maryland Medical Center, 22 S Greene St, Baltimore, MD, 21201, USA
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Todica A, Siebermair J, Schiller J, Zacherl MJ, Fendler WP, Massberg S, Bartenstein P, Cyran CC, Kääb S, Hacker M, Wakili R, Lehner S. Assessment of right ventricular sympathetic dysfunction in patients with arrhythmogenic right ventricular cardiomyopathy: An 123I-metaiodobenzylguanidine SPECT/CT study. J Nucl Cardiol 2020; 27:2402-2409. [PMID: 30560521 PMCID: PMC7749057 DOI: 10.1007/s12350-018-01545-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 09/21/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of the study was to evaluate a novel approach for the quantification of right ventricular sympathetic dysfunction in patients diagnosed with ARVC/D through state-of-the-art functional SPECT/CT hybrid imaging. METHODS Sympathetic innervation of the heart was assessed using 123I-MIBG-SPECT/CT in 17 patients diagnosed with ARVC according to the modified task force criteria, and in 10 patients diagnosed with idiopathic ventricular fibrillation (IVF). The 123I-MIBG-uptake in the left (LV) and right ventricle (RV) was evaluated separately based on anatomic information derived from the CT scan, and compared to the uptake in the mediastinum (M). RESULTS There was a significant difference in the LV/M ratio between the ARVC/D and the IVF groups (3.2 ± 0.5 vs. 3.9 ± 0.8, P = 0.014), with a cut-off value of 3.41 (77% sensitivity, 80% specificity, AUC 0.78). There was a highly significant difference in the mean RV/M ratios between both groups (1.6 ± 0.3 vs. 2.0 ± 0.2, P = 0.001), with optimal cut-off for discrimination at 1.86 (88% sensitivity, 90% specificity, AUC 0.93). CONCLUSION Employing state-of-the-art functional SPECT/CT hybrid imaging, we could reliably assess and quantify right and left ventricular sympathetic innervation. The RV/M ratio was significantly lower in patients diagnosed with ARVC/D and provided sensitive and specific discrimination between patients with ARVC/D and IVF patients.
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Affiliation(s)
- Andrei Todica
- Department of Nuclear Medicine, University of Munich, Munich, Germany
| | - Johannes Siebermair
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany
- Department of Cardiology, University of Munich, Munich, Germany
| | - Julia Schiller
- Department of Nuclear Medicine, University of Munich, Munich, Germany
| | - Mathias J Zacherl
- Department of Nuclear Medicine, University of Munich, Munich, Germany
| | | | | | - Peter Bartenstein
- Department of Nuclear Medicine, University of Munich, Munich, Germany
| | - Clemens C Cyran
- Department of Clinical Radiology, University of Munich, Munich, Germany
| | - Stefan Kääb
- Department of Cardiology, University of Munich, Munich, Germany
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Reza Wakili
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany
- Department of Cardiology, University of Munich, Munich, Germany
| | - Sebastian Lehner
- Department of Nuclear Medicine, University of Munich, Munich, Germany
- Ambulatory Healthcare Center Dr. Neumaier & Colleagues, Radiology, Nuclear Medicine, Radiation Therapy, Regensburg, Germany
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7
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Marano PJ, Lim LJ, Sanchez JM, Alvi R, Nah G, Badhwar N, Gerstenfeld EP, Tseng ZH, Marcus GM, Delling FN. Long-term outcomes of ablation for ventricular arrhythmias in mitral valve prolapse. J Interv Card Electrophysiol 2020; 61:145-154. [PMID: 32506159 DOI: 10.1007/s10840-020-00775-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 05/04/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Prior studies reporting efficacy of radiofrequency catheter ablation for complex ventricular ectopy in mitral valve prolapse (MVP) are limited by selective inclusion of bileaflet MVP, papillary muscle only ablation, or short-term follow-up. We sought to evaluate the long-term incidence of hemodynamically significant ventricular tachycardia (VT) or fibrillation (VF) in patients with MVP after initial ablation. METHODS We studied consecutive patients with MVP undergoing ablation for complex ventricular ectopy between 2013 and 2017 at our institution. Of 580 patients with MVP, we included 15 (2.6%, 10 women; mean age 50 ± 14 years, 53% bileaflet) with complex ventricular ectopy treated with initial ablation. RESULTS Over a median follow-up of 3406 (1875-6551) days or 9 years, 5 of 15 (33%) patients developed hemodynamically significant VT/VF after their initial ablation and underwent placement of an implantable cardioverter defibrillator (ICD). Three of 5 also underwent repeat ablations. Sustained VT was inducible prior to index ablation in all 5 who developed VT/VF, compared to none of the 10 patients who did not develop VT/VF after index ablation (p = 0.002). Complex ventricular ectopy at index ablation was multifocal in all 5 patients who underwent repeat intervention versus 4 of 10 patients (40%) who did not (p = 0.04). All 3 patients with subsequent VT/VF who underwent repeat ablation had a new clinically dominant focus of ventricular arrhythmia and 3 of the patients with ICD had appropriate VT/VF therapies. CONCLUSIONS In the long term, a subset of MVP patients treated with ablation for ventricular arrhythmias, all with multifocal ectopy on initial EP study, develop hemodynamically significant VT/VF. Our findings suggest the progressive nature of ventricular arrhythmias in patients with MVP and multifocal ectopy.
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Affiliation(s)
- Paul J Marano
- Division of Cardiovascular Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Lisa J Lim
- Division of Cardiovascular Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Jose M Sanchez
- Division of Cardiovascular Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Raza Alvi
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gregory Nah
- Division of Cardiovascular Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Nitish Badhwar
- Division of Cardiovascular Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Edward P Gerstenfeld
- Division of Cardiovascular Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Zian H Tseng
- Division of Cardiovascular Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Gregory M Marcus
- Division of Cardiovascular Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Francesca N Delling
- Division of Cardiovascular Medicine, University of California, San Francisco, San Francisco, CA, USA.
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Haïssaguerre M, Nademanee W, Hocini M, Duchateau J, André C, Lavergne T, Takigawa M, Sacher F, Derval N, Pambrun T, Jais P, Walton R, Potse M, Vigmond E, Dubois R, Bernus O. The Spectrum of Idiopathic Ventricular Fibrillation and J-Wave Syndromes: Novel Mapping Insights. Card Electrophysiol Clin 2019; 11:699-709. [PMID: 31706476 DOI: 10.1016/j.ccep.2019.08.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Idiopathic ventricular fibrillation and J-wave syndromes are causes of sudden cardiac death (SCD) without any identified structural cardiac disease after extensive investigations. Recent data show that high-density electrophysiological mapping may ultimately offer diagnoses of subclinical diseases in most patients including those termed "unexplained" SCD. Three major conditions can underlie the occurrence of SCD: (1) localized depolarization abnormalities (due to microstructural myocardial alteration), (2) Purkinje abnormalities manifesting as triggering ectopy and inducible reentry; or (3) repolarization heterogeneities. Each condition may result from a spectrum of pathophysiologic processes with implications for individual therapy.
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Affiliation(s)
- Michel Haïssaguerre
- Electrophysiology and Cardiac Stimulation, Bordeaux University Hospital, 311 President Wilson Boulevard, Bordeaux 33200, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France; Univ Bordeaux, CRCTB, U1045, Bordeaux, France.
| | | | - Mélèze Hocini
- Electrophysiology and Cardiac Stimulation, Bordeaux University Hospital, 311 President Wilson Boulevard, Bordeaux 33200, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France; Univ Bordeaux, CRCTB, U1045, Bordeaux, France
| | - Josselin Duchateau
- Electrophysiology and Cardiac Stimulation, Bordeaux University Hospital, 311 President Wilson Boulevard, Bordeaux 33200, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Clementine André
- Electrophysiology and Cardiac Stimulation, Bordeaux University Hospital, 311 President Wilson Boulevard, Bordeaux 33200, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Thomas Lavergne
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Masa Takigawa
- Electrophysiology and Cardiac Stimulation, Bordeaux University Hospital, 311 President Wilson Boulevard, Bordeaux 33200, France
| | - Frederic Sacher
- Electrophysiology and Cardiac Stimulation, Bordeaux University Hospital, 311 President Wilson Boulevard, Bordeaux 33200, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Nicolas Derval
- Electrophysiology and Cardiac Stimulation, Bordeaux University Hospital, 311 President Wilson Boulevard, Bordeaux 33200, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Thomas Pambrun
- Electrophysiology and Cardiac Stimulation, Bordeaux University Hospital, 311 President Wilson Boulevard, Bordeaux 33200, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Pierre Jais
- Electrophysiology and Cardiac Stimulation, Bordeaux University Hospital, 311 President Wilson Boulevard, Bordeaux 33200, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Rick Walton
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Mark Potse
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Ed Vigmond
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Remi Dubois
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France
| | - Olivier Bernus
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Avenue du Haut Leveque, Bordeaux 33604, Passes Cedex, France; Univ Bordeaux, CRCTB, U1045, Bordeaux, France
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Hernández-Romero I, Guillem MS, Figuera C, Atienza F, Fernández-Avilés F, M. Climent A. Optical imaging of voltage and calcium in isolated hearts: Linking spatiotemporal heterogeneities and ventricular fibrillation initiation. PLoS One 2019; 14:e0215951. [PMID: 31086382 PMCID: PMC6516663 DOI: 10.1371/journal.pone.0215951] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 04/11/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Alternans have been associated with the development of ventricular fibrillation and its control has been proposed as antiarrhythmic strategy. However, cardiac arrhythmias are a spatiotemporal phenomenon in which multiple factors are involved (e.g. calcium and voltage spatial alternans or heterogeneous conduction velocity) and how an antiarrhythmic drug modifies these factors is poorly understood. OBJECTIVE The objective of the present study is to evaluate the relation between spatial electrophysiological properties (i.e. spatial discordant alternans and conduction velocity) and the induction of ventricular fibrillation (VF) when a calcium blocker is applied. METHODS The mechanisms of initiation of VF were studied by simultaneous epicardial voltage and calcium optical mapping in isolated rabbit hearts using an incremental fast pacing protocol. The additional value of analyzing spatial phenomena in the generation of unidirectional blocks and reentries as precursors of VF was depicted. Specifically, the role of action potential duration (APD), calcium transients (CaT), spatial alternans and conduction velocity in the initiation of VF was evaluated during basal conditions and after the administration of verapamil. RESULTS Our results enhance the relation between (1) calcium spatial alternans and (2) slow conduction velocities with the dynamic creation of unidirectional blocks that allowed the induction of VF. In fact, the administration of verapamil demonstrated that calcium and not voltage spatial alternans were the main responsible for VF induction. CONCLUSIONS VF induction at high activation rates was linked with the concurrence of a low conduction velocity and high magnitude of calcium alternans, but not necessarily related with increases of APD. Verapamil can postpone the development of cardiac alternans and the apparition of ventricular arrhythmias.
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Affiliation(s)
- Ismael Hernández-Romero
- Department of Signal Theory and Communications, Universidad Rey Juan Carlos, Madrid, Spain
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain
| | | | - Carlos Figuera
- Department of Signal Theory and Communications, Universidad Rey Juan Carlos, Madrid, Spain
| | - Felipe Atienza
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain
- CIBERCV, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
- Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Francisco Fernández-Avilés
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain
- CIBERCV, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
- Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Andreu M. Climent
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain
- CIBERCV, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
- * E-mail:
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10
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Quast AFBE, Baalman SWE, Brouwer TF, Smeding L, Wilde AAM, Burke MC, Knops RE. A novel tool to evaluate the implant position and predict defibrillation success of the subcutaneous implantable cardioverter-defibrillator: The PRAETORIAN score. Heart Rhythm 2019; 16:403-410. [PMID: 30292861 DOI: 10.1016/j.hrthm.2018.09.029] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [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: 06/27/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Suboptimal positioning of the subcutaneous implantable cardioverter-defibrillator (S-ICD) increases the defibrillation threshold and risk of conversion failure. OBJECTIVE Our objective is to develop a tool to evaluate the implant position and predict defibrillation success of the S-ICD: the PRAETORIAN score. METHODS The PRAETORIAN score is based on clinical and computer modeling knowledge of determinants affecting the defibrillation threshold: subcoil fat, subgenerator fat, and anterior positioning of the S-ICD generator. The score evaluates these determinants on the postoperative anterior-posterior and lateral chest radiographs and has 3 categories: 30-<90 points representing a low risk, 90-<150 points representing an intermediate risk, and ≥150 points representing a high risk of conversion failure. The score was developed using 2 separate S-ICD data sets for derivation and validation. The performance metrics are the positive and negative predictive values. RESULTS The development data set consisted of 181 patients with S-ICD, and the validation cohort consisted of 321 patients from the S-ICD Investigational Device Exemption trial. The distribution of scores was 93%-98% low risk (<90 points), 2%-5% intermediate risk (90-<150 points), and 1% high risk (≥150 points). The positive predictive value for an intermediate or high PRAETORIAN score for a failed conversion test was 51%, while a low PRAETORIAN score predicted a successful conversion in 99.8% of patients. CONCLUSION The PRAETORIAN score allows the identification of patients with high defibrillation thresholds by using the routine chest radiograph and provides feedback to implanters on S-ICD positioning. The PRAETORIAN-DFT trial will prospectively validate the score by randomizing to standard conversion testing vs using the score without conversion testing.
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Affiliation(s)
- Anne-Floor B E Quast
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Sarah W E Baalman
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Tom F Brouwer
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Lonneke Smeding
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Arthur A M Wilde
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Martin C Burke
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; CorVita Science Foundation, Chicago, Illinois
| | - Reinoud E Knops
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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11
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Yamanoglu A, Celebi Yamanoglu NG, Evran T, Sogut O. How much can synthetic cannabinoid damage the heart? A case of cardiogenic shock following resistant ventricular fibrillation after synthetic cannabinoid use. J Clin Ultrasound 2018; 46:605-609. [PMID: 29479764 DOI: 10.1002/jcu.22581] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 02/06/2018] [Accepted: 02/10/2018] [Indexed: 06/08/2023]
Abstract
New substances are constantly being added to the content of synthetic cannabinoids (SCs). SCs can affect the cardiovascular system and cause hypotension and bradycardia, myocardial infarction, atrial fibrillation, prolonged QTc, and Mobitz type II atrioventricular block. However, no cases associated with ventricular fibrillation (VF) have been reported to date. We report a case of a 26-year-old male patient admitted to the emergency department due to altered consciousness after SC use and requiring prolonged cardiopulmonary resuscitation due to resistant VF and cardiogenic shock.
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Affiliation(s)
- Adnan Yamanoglu
- Department of Emergency Medicine, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | | | - Tugba Evran
- Department of Emergency Medicine, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Ozgur Sogut
- Department of Emergency Medicine, Haseki Training and Research Hospital, Istanbul, Turkey
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12
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Handa BS, Roney CH, Houston C, Qureshi NA, Li X, Pitcher DS, Chowdhury RA, Lim PB, Dupont E, Niederer SA, Cantwell CD, Peters NS, Ng FS. Analytical approaches for myocardial fibrillation signals. Comput Biol Med 2018; 102:315-326. [PMID: 30025847 PMCID: PMC6215772 DOI: 10.1016/j.compbiomed.2018.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 07/11/2018] [Accepted: 07/11/2018] [Indexed: 12/11/2022]
Abstract
Atrial and ventricular fibrillation are complex arrhythmias, and their underlying mechanisms remain widely debated and incompletely understood. This is partly because the electrical signals recorded during myocardial fibrillation are themselves complex and difficult to interpret with simple analytical tools. There are currently a number of analytical approaches to handle fibrillation data. Some of these techniques focus on mapping putative drivers of myocardial fibrillation, such as dominant frequency, organizational index, Shannon entropy and phase mapping. Other techniques focus on mapping the underlying myocardial substrate sustaining fibrillation, such as voltage mapping and complex fractionated electrogram mapping. In this review, we discuss these techniques, their application and their limitations, with reference to our experimental and clinical data. We also describe novel tools including a new algorithm to map microreentrant circuits sustaining fibrillation.
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Affiliation(s)
- Balvinder S Handa
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Caroline H Roney
- Division of Imaging Sciences and Bioengineering, King's College London, United Kingdom
| | - Charles Houston
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Norman A Qureshi
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Xinyang Li
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - David S Pitcher
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Rasheda A Chowdhury
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Phang Boon Lim
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Emmanuel Dupont
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Steven A Niederer
- Division of Imaging Sciences and Bioengineering, King's College London, United Kingdom
| | - Chris D Cantwell
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom; Department of Aeronautics, Imperial College London, United Kingdom
| | - Nicholas S Peters
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Fu Siong Ng
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom.
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13
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Hennig A, Salel M, Sacher F, Camaioni C, Sridi S, Denis A, Montaudon M, Laurent F, Jais P, Cochet H. High-resolution three-dimensional late gadolinium-enhanced cardiac magnetic resonance imaging to identify the underlying substrate of ventricular arrhythmia. Europace 2018; 20:f179-f191. [PMID: 29069369 PMCID: PMC6140447 DOI: 10.1093/europace/eux278] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [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] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 09/06/2017] [Indexed: 01/05/2023] Open
Abstract
Aims Cardiac magnetic resonance (CMR) is recommended as a second-line method to diagnose ventricular arrhythmia (VA) substrate. We assessed the diagnostic yield of CMR including high-resolution late gadolinium-enhanced (LGE) imaging. Methods and results Consecutive patients with sustained ventricular tachycardia (VT), non-sustained VT (NSVT), or ventricular fibrillation/aborted sudden death (VF/SCD) underwent a non-CMR diagnostic workup according to current guidelines, and CMR including LGE imaging with both a conventional breath-held and a free-breathing method enabling higher spatial resolution (HR-LGE). The diagnostic yield of CMR was compared with the non-CMR workup, including the incremental value of HR-LGE. A total of 157 patients were enrolled [age 54 ± 17 years; 75% males; 88 (56%) sustained VT, 52 (33%) NSVT, 17 (11%) VF/SCD]. Of these, 112 (71%) patients had no history of structural heart disease (SHD). All patients underwent electrocardiography and echocardiography, 72% coronary angiography, and 51% exercise testing. Pre-CMR diagnoses were 84 (54%) no SHD, 39 (25%) ischaemic cardiomyopathy (ICM), 11 (7%) non-ischaemic cardiomyopathy (NICM), 3 (2%) arrhythmogenic right ventricular cardiomyopathy (ARVC), 2 (1%) hypertrophic cardiomyopathy (HCM), and 18 (11%) other. CMR modified these diagnoses in 48 patients (31% of all and 43% of those with no SHD history). New diagnoses were 9 ICM, 28 NICM, 8 ARVC, 1 HCM, and 2 other. CMR modified therapy in 19 (12%) patients. In patients with no SHD after non-CMR tests, SHD was found in 32 of 84 (38%) patients. Eighteen of these patients showed positive HR-LGE and negative conventional LGE. Thus, HR-LGE significantly increased the CMR detection of SHD (17-38%, P < 0.001). Conclusion CMR including HR-LGE imaging has high diagnostic value in patients with VAs. This has major prognostic and therapeutic implications, particularly in patients with negative pre-CMR workup.
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Affiliation(s)
- Alexia Hennig
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, Unité d’Imagerie Thoracique et Cardiovasculaire, CHU de Bordeaux, Avenue de Magellan, Pessac, France
| | - Marjorie Salel
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, Unité d’Imagerie Thoracique et Cardiovasculaire, CHU de Bordeaux, Avenue de Magellan, Pessac, France
| | - Frederic Sacher
- Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, Pessac, France
- IHU LIRYC, Université de Bordeaux—INSERM U1045, Avenue du Haut Lévêque, Pessac, France
| | - Claudia Camaioni
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, Unité d’Imagerie Thoracique et Cardiovasculaire, CHU de Bordeaux, Avenue de Magellan, Pessac, France
| | - Soumaya Sridi
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, Unité d’Imagerie Thoracique et Cardiovasculaire, CHU de Bordeaux, Avenue de Magellan, Pessac, France
| | - Arnaud Denis
- Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, Pessac, France
- IHU LIRYC, Université de Bordeaux—INSERM U1045, Avenue du Haut Lévêque, Pessac, France
| | - Michel Montaudon
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, Unité d’Imagerie Thoracique et Cardiovasculaire, CHU de Bordeaux, Avenue de Magellan, Pessac, France
- IHU LIRYC, Université de Bordeaux—INSERM U1045, Avenue du Haut Lévêque, Pessac, France
| | - François Laurent
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, Unité d’Imagerie Thoracique et Cardiovasculaire, CHU de Bordeaux, Avenue de Magellan, Pessac, France
- IHU LIRYC, Université de Bordeaux—INSERM U1045, Avenue du Haut Lévêque, Pessac, France
| | - Pierre Jais
- Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, Pessac, France
- IHU LIRYC, Université de Bordeaux—INSERM U1045, Avenue du Haut Lévêque, Pessac, France
| | - Hubert Cochet
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, Unité d’Imagerie Thoracique et Cardiovasculaire, CHU de Bordeaux, Avenue de Magellan, Pessac, France
- IHU LIRYC, Université de Bordeaux—INSERM U1045, Avenue du Haut Lévêque, Pessac, France
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14
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Tse G, Gong M, Wong CW, Chan C, Georgopoulos S, Chan YS, Yan BP, Li G, Whittaker P, Ciobanu A, Ali‐Hasan‐Al‐Saegh S, Wong SH, Wu WKK, Bazoukis G, Lampropoulos K, Wong WT, Tse LA, Baranchuk AM, Letsas KP, Liu T. Total cosine R-to-T for predicting ventricular arrhythmic and mortality outcomes: A systematic review and meta-analysis. Ann Noninvasive Electrocardiol 2018; 23:e12495. [PMID: 28901628 PMCID: PMC6931891 DOI: 10.1111/anec.12495] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 07/27/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The total cosine R-to-T (TCRT), a vectorcardiographic marker reflecting the spatial difference between the depolarization and repolarization wavefronts, has been used to predict ventricular tachycardia/fibrillation (VT/VF) and sudden cardiac death (SCD) in different clinical settings. However, its prognostic value has been controversial. OBJECTIVE This systematic review and meta-analysis evaluated the significance of TRCT in predicting arrhythmic and/or mortality endpoints. METHODS PubMed and Embase databases were searched through December 31, 2016. RESULTS Of the 890 studies identified initially, 13 observational studies were included in our meta-analysis. A total of 11,528 patients, mean age 47 years old, 72% male, were followed for 43 ± 6 months. Data from five studies demonstrated lower TCRT values in myocardial infarction patients with adverse events (syncope, ventricular arrhythmias, or sudden cardiac death) compared to those without these events (mean difference = -0.36 ± 0.05, p < .001; I2 = 48%). By contrast, only two studies analyzed outcomes in heart failure, and pooled meta-analysis did not demonstrate significant difference in TCRT between event-positive and event-negative patients (mean difference = -0.01 ± 0.10, p > .05; I2 = 80%). CONCLUSION TCRT is lower in MI patients at high risk of adverse events when compared to those free from such events. It can provide additional risk stratification beyond the use of clinical parameters and traditional electrocardiogram markers. Its value in other diseases such as heart failure requires further studies.
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Affiliation(s)
- Gary Tse
- Department of Medicine and TherapeuticsFaculty of MedicineChinese University of Hong KongHong Kong SARChina
- Faculty of MedicineLi Ka Shing Institute of Health SciencesChinese University of Hong KongHong Kong SARChina
| | - Mengqi Gong
- Department of CardiologyTianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular diseaseTianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina
| | - Cheuk Wai Wong
- Li Ka Shing Faculty of MedicineUniversity of Hong KongHong Kong SARChina
| | - Cynthia Chan
- Li Ka Shing Faculty of MedicineUniversity of Hong KongHong Kong SARChina
| | - Stamatis Georgopoulos
- Second Department of CardiologyLaboratory of Cardiac Electrophysiology“Evangelismos” General Hospital of AthensAthensGreece
| | - Yat Sun Chan
- Department of Medicine and TherapeuticsFaculty of MedicineChinese University of Hong KongHong Kong SARChina
| | - Bryan P. Yan
- Department of Medicine and TherapeuticsFaculty of MedicineChinese University of Hong KongHong Kong SARChina
| | - Guangping Li
- Department of CardiologyTianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular diseaseTianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina
| | - Paula Whittaker
- Division of Population HealthHealth Services Research and Primary CareSchool of Health SciencesUniversity of ManchesterManchesterUnited Kingdom
| | - Ana Ciobanu
- Department of CardiologyTheodor Burghele Clinical HospitalCarol Davila University of Medicine and PharmacyBucharestRomania
| | | | - Sunny H. Wong
- Department of Medicine and TherapeuticsFaculty of MedicineChinese University of Hong KongHong Kong SARChina
- Faculty of MedicineLi Ka Shing Institute of Health SciencesChinese University of Hong KongHong Kong SARChina
| | - William K. K. Wu
- Faculty of MedicineLi Ka Shing Institute of Health SciencesChinese University of Hong KongHong Kong SARChina
- Department of Anesthesia and Intensive CareState Key Laboratory of Digestive DiseaseThe Chinese University of Hong KongHong KongChina
| | - George Bazoukis
- Second Department of CardiologyLaboratory of Cardiac Electrophysiology“Evangelismos” General Hospital of AthensAthensGreece
| | - Konstantinos Lampropoulos
- Second Department of CardiologyLaboratory of Cardiac Electrophysiology“Evangelismos” General Hospital of AthensAthensGreece
| | - Wing Tak Wong
- School of Life SciencesThe Chinese University of Hong KongHong KongChina
| | - Lap Ah Tse
- Division of Occupational and Environmental HealthJC School of Public Health and Primary CareThe Chinese University of Hong KongHong KongChina
| | - Adrian M. Baranchuk
- Department of MedicineKingston General HospitalQueen's UniversityKingstonONCanada
| | - Konstantinos P. Letsas
- Second Department of CardiologyLaboratory of Cardiac Electrophysiology“Evangelismos” General Hospital of AthensAthensGreece
| | - Tong Liu
- Department of CardiologyTianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular diseaseTianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina
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15
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Hanna EB, LeLorier PA, Tadin DM, Ortiz RO, Glancy DL. Malignant Early Repolarization. Am J Cardiol 2018; 121:520-522. [PMID: 29273208 DOI: 10.1016/j.amjcard.2017.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 11/06/2017] [Indexed: 11/19/2022]
Abstract
A 27-year-old man presents with successfully resuscitated ventricular fibrillation. Structural and electrical causes of ventricular fibrillation in the young are presented along with a diagnostic strategy. Electrocardiographic features of malignant early repolarization are discussed.
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Affiliation(s)
- Elias B Hanna
- Section of Cardiology, Department of Medicine, Louisiana State University Health Sciences Center and University Medical Center New Orleans, New Orleans, Louisiana
| | - Paul A LeLorier
- Section of Cardiology, Department of Medicine, Louisiana State University Health Sciences Center and University Medical Center New Orleans, New Orleans, Louisiana
| | - David M Tadin
- Section of Cardiology, Department of Medicine, Louisiana State University Health Sciences Center and University Medical Center New Orleans, New Orleans, Louisiana
| | - Ronnie O Ortiz
- Section of Cardiology, Department of Medicine, Louisiana State University Health Sciences Center and University Medical Center New Orleans, New Orleans, Louisiana
| | - D Luke Glancy
- Section of Cardiology, Department of Medicine, Louisiana State University Health Sciences Center and University Medical Center New Orleans, New Orleans, Louisiana.
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16
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Chiang KF, Hung GU, Tsai SC, Cheng CM, Chang YC, Lin WY, Hsieh YC, Wu TJ, Chen SA, Huang JL, Liao YC, Chen J. Impact of cardiac reverse remodeling after cardiac resynchronization therapy assessed by myocardial perfusion imaging on ventricular arrhythmia. J Nucl Cardiol 2017; 24:1282-1288. [PMID: 26979308 DOI: 10.1007/s12350-016-0447-x] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 02/02/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although cardiac resynchronization therapy (CRT) has been a useful treatment of heart failure, patients with CRT are still in risk of sudden cardiac death due to ventricular arrhythmia. The aim of this study was to investigate the impact of cardiac reverse remodeling after CRT on the prevalence of ventricular tachycardia or fibrillation (VT/VF). METHODS AND RESULTS Forty-one heart failure patients (26 men, age 66 ± 10 years), who were implanted with CRT for at least 12 months, were enrolled. All patients received myocardial perfusion imaging (MPI) under CRT pacing to evaluate left ventricle (LV) function, dyssynchrony, and scar. VT/VF episodes during the follow-up period after MPI were recorded by the CRT devices. Sixteen patients (N = 16/41, 39%) were found to have VT/VF. Multivariate Cox regression analysis and receiver operating characteristic curve analysis showed that five risk factors were significant predictors of VT/VF, including increased left ventricle ejection fraction (LVEF) by ≤7% after CRT, low LVEF after CRT (≤30%), change of intrinsic QRS duration (iQRSd) by ≤7 ms, wide iQRSd after CRT (≥121 ms), and high systolic dyssynchrony after CRT (phase standard deviation ≥45.6°). For those patients with all of the 5 risk factors, 85.7% or more developed VT/VF. CONCLUSIONS The characteristics of cardiac reverse remodeling after CRT as assessed by MPI are associated with the prevalence of ventricular arrhythmia.
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Affiliation(s)
- Kuo-Feng Chiang
- Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
| | - Guang-Uei Hung
- Department of Nuclear Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
- Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan
| | - Shih-Chung Tsai
- Department of Nuclear Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chien-Ming Cheng
- Division of Cardiology, Department of Medicine, Department of Health of Executive Yuan, Fong Yuan Hospital, Taichung, Taiwan
| | - Yu-Cheng Chang
- Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
| | - Wan-Yu Lin
- Department of Nuclear Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Cheng Hsieh
- Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tsu-Juey Wu
- Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Ann Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Divisions of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Jin-Long Huang
- Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan.
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Ying-Chieh Liao
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.
- Division of Cardiology, Department of Medicine, Buddhist Tzu-Chi General Hospital, Taichung Branch, 6688, Fung Hing Rd Sect 1, Tanzi District, Taichung, 427, Taiwan.
| | - Ji Chen
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
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17
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Butterfield M, Derr C, Keffeler J, Jelic T. Organized cardiac activity in an awake LVAD patient during ventricular fibrillation. Am J Emerg Med 2017; 35:1041.e1-1041.e3. [PMID: 28291704 DOI: 10.1016/j.ajem.2017.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 03/01/2017] [Indexed: 11/18/2022] Open
Affiliation(s)
- Mike Butterfield
- Tampa General Hospital, University of South Florida, Emergency Medicine Residency Program, Tampa, FL, United States.
| | - Charlotte Derr
- Tampa General Hospital, University of South Florida, Emergency Medicine Residency Program, Tampa, FL, United States
| | - Jotham Keffeler
- Aeromed Transport, Tampa General Hospital, Tampa, FL, United States
| | - Tom Jelic
- Tampa General Hospital, University of South Florida, Emergency Medicine Residency Program, Tampa, FL, United States
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18
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McKeag N. Radiofrequency ablation of ventricular fibrillation: correlation between electroanatomical mapping and gross pathology. QJM 2016; 109:821. [PMID: 27634972 DOI: 10.1093/qjmed/hcw153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lau E, Kossidas K, Kim TY, Kunitomo Y, Ziv O, Zhen S, Taylor C, Schofield L, Yammine J, Liu G, Peng X, Qu Z, Koren G, Choi BR. Spatially Discordant Alternans and Arrhythmias in Tachypacing-Induced Cardiac Myopathy in Transgenic LQT1 Rabbits: The Importance of IKs and Ca2+ Cycling. PLoS One 2015; 10:e0122754. [PMID: 25970695 PMCID: PMC4430457 DOI: 10.1371/journal.pone.0122754] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 02/12/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Remodeling of cardiac repolarizing currents, such as the downregulation of slowly activating K+ channels (IKs), could underlie ventricular fibrillation (VF) in heart failure (HF). We evaluated the role of Iks remodeling in VF susceptibility using a tachypacing HF model of transgenic rabbits with Long QT Type 1 (LQT1) syndrome. METHODS AND RESULTS LQT1 and littermate control (LMC) rabbits underwent three weeks of tachypacing to induce cardiac myopathy (TICM). In vivo telemetry demonstrated steepening of the QT/RR slope in LQT1 with TICM (LQT1-TICM; pre: 0.26±0.04, post: 0.52±0.01, P<0.05). In vivo electrophysiology showed that LQT1-TICM had higher incidence of VF than LMC-TICM (6 of 11 vs. 3 of 11, respectively). Optical mapping revealed larger APD dispersion (16±4 vs. 38±6 ms, p<0.05) and steep APD restitution in LQT1-TICM compared to LQT1-sham (0.53±0.12 vs. 1.17±0.13, p<0.05). LQT1-TICM developed spatially discordant alternans (DA), which caused conduction block and higher-frequency VF (15±1 Hz in LQT1-TICM vs. 13±1 Hz in LMC-TICM, p<0.05). Ca2+ DA was highly dynamic and preceded voltage DA in LQT1-TICM. Ryanodine abolished DA in 5 out of 8 LQT1-TICM rabbits, demonstrating the importance of Ca2+ in complex DA formation. Computer simulations suggested that HF remodeling caused Ca2+-driven alternans, which was further potentiated in LQT1-TICM due to the lack of IKs. CONCLUSIONS Compared with LMC-TICM, LQT1-TICM rabbits exhibit steepened APD restitution and complex DA modulated by Ca2+. Our results strongly support the contention that the downregulation of IKs in HF increases Ca2+ dependent alternans and thereby the risk of VF.
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Affiliation(s)
- Emily Lau
- Cardiovascular Research Center, Division of Cardiology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Konstantinos Kossidas
- Cardiovascular Research Center, Division of Cardiology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Tae Yun Kim
- Cardiovascular Research Center, Division of Cardiology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Yukiko Kunitomo
- Cardiovascular Research Center, Division of Cardiology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Ohad Ziv
- Cardiovascular Research Center, Division of Cardiology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Song Zhen
- Department of Medicine (Cardiology), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Chantel Taylor
- Cardiovascular Research Center, Division of Cardiology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Lorraine Schofield
- Cardiovascular Research Center, Division of Cardiology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Joe Yammine
- Cardiovascular Research Center, Division of Cardiology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Gongxin Liu
- Cardiovascular Research Center, Division of Cardiology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Xuwen Peng
- Department of Comparative Medicine, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, United States of America
| | - Zhilin Qu
- Department of Medicine (Cardiology), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Gideon Koren
- Cardiovascular Research Center, Division of Cardiology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Bum-Rak Choi
- Cardiovascular Research Center, Division of Cardiology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
- * E-mail:
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Lubanda JC, Kudlicka J, Mlcek M, Chochola M, Neuzil P, Linhart A, Kittnar O. Renal denervation decreases effective refractory period but not inducibility of ventricular fibrillation in a healthy porcine biomodel: a case control study. J Transl Med 2015; 13:4. [PMID: 25591755 PMCID: PMC4300561 DOI: 10.1186/s12967-014-0367-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 12/16/2014] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Ventricular arrhythmias play an important role in cardiovascular mortality especially in patients with impaired cardiac and autonomic function. The aim of this experimental study was to determine, if renal denervation (RDN) could decrease the inducibility of ventricular fibrillation (VF) in a healthy porcine biomodel. METHODS Controlled electrophysiological study was performed in 6 biomodels 40 days after RDN (RDN group) and in 6 healthy animals (control group). The inducibility of VF was tested by programmed ventricular stimulation from the apex of right ventricle (8 basal stimuli coupled with up to 4 extrastimuli) always three times in each biomodel using peripheral extracorporeal oxygenation for hemodynamic support. Further, basal heart rate (HR), PQ and QT intervals and effective refractory period of ventricles (ERP) were measured. Technical success of RDN was evaluated by histological examination. RESULTS According to histological findings, RDN procedure was successfully performed in all biomodels. Comparing the groups, basal HR was lower in RDN group: 79 (IQR 58; 88) vs. 93 (72; 95) beats per minute (p = 0.003); PQ interval was longer in RDN group: 145 (133; 153) vs. 115 (113; 120) ms (p < 0.0001) and QTc intervals were comparable: 402 (382; 422) ms in RDN vs. 386 (356; 437) ms in control group (p = 0.1). ERP was prolonged significantly in RDN group: 159 (150; 169) vs. 140 (133; 150) ms (p = 0.001), but VF inducibility was the same (18/18 vs. 18/18 attempts). CONCLUSIONS RDN decreased the influence of sympathetic nerve system on the heart conduction system in healthy porcine biomodel. However, the electrophysiological study was not associated with a decrease of VF inducibility after RDN.
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Affiliation(s)
- Jean-Claude Lubanda
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, Prague 2, 128 00, Czech Republic.
| | - Jaroslav Kudlicka
- Institute of Physiology, First Faculty of Medicine, Charles University in Prague, Albertov 5, Prague 2, 128 00, Czech Republic.
- 3rd Department of Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, U Nemocnice 2, Prague 2, 128 00, Czech Republic.
| | - Mikulas Mlcek
- Institute of Physiology, First Faculty of Medicine, Charles University in Prague, Albertov 5, Prague 2, 128 00, Czech Republic.
| | - Miroslav Chochola
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, Prague 2, 128 00, Czech Republic.
| | - Petr Neuzil
- Department of Cardiology, Na Homolce Hospital, Roentgenova 2/37, Prague 5, 150 30, Czech Republic.
| | - Ales Linhart
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, Prague 2, 128 00, Czech Republic.
| | - Otomar Kittnar
- Institute of Physiology, First Faculty of Medicine, Charles University in Prague, Albertov 5, Prague 2, 128 00, Czech Republic.
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Stiefelhagen P. [Finally the roentgen image reveals the cause of syncope]. MMW Fortschr Med 2014; 156:33. [PMID: 25417464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Petretta M, Pellegrino T, Cuocolo A. The "gray zone" for the heart to mediastinum MIBG uptake ratio. J Nucl Cardiol 2014; 21:921-4. [PMID: 24810428 DOI: 10.1007/s12350-014-9894-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 03/15/2014] [Indexed: 01/26/2023]
Affiliation(s)
- Mario Petretta
- Department of Translational Medicine, University Federico II, Naples, Italy
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Zhou Y, Zhou W, Folks RD, Manatunga DN, Jacobson AF, Bax JJ, Garcia EV, Chen J. I-123 mIBG and Tc-99m myocardial SPECT imaging to predict inducibility of ventricular arrhythmia on electrophysiology testing: a retrospective analysis. J Nucl Cardiol 2014; 21:913-20. [PMID: 24858625 DOI: 10.1007/s12350-014-9911-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 03/31/2014] [Indexed: 01/31/2023]
Abstract
OBJECTIVES The purpose of this study is to assess mIBG uptake in scar border zone and its relation with ventricular arrhythmia (VA) inducibility on electrophysiology (EP) testing using I-123 mIBG SPECT and resting Tc-99m SPECT myocardial perfusion imaging (MPI). METHODS Forty-seven patients from a previous clinical trial were retrospectively analyzed. These patients underwent I-123 mIBG and resting Tc-99m tetrofosmin SPECT, and EP testing. Twenty-eight patients were positive (EP+) and 19 patients were negative (EP-) for inducibility of sustained (>30 seconds) VA on EP testing. MPI scar extent, border zone extent, and mIBG uptake in border zone were used to predict VA inducibility on EP testing, respectively. RESULTS There was no significant difference in scar extent between the EP+ and EP- groups. The EP+ group had significantly larger border zone and lower mIBG uptake ratio in the border zone than the EP- group. Receiver operating characteristic (ROC) curve analysis showed that the prediction accuracy for border zone extent (area under ROC = 0.75) was better than scar extent (area under ROC = 0.66). The prediction accuracy was further improved (area under ROC = 0.78), when assessing mIBG uptake in the border zone. CONCLUSION A new tool has been developed to measure scar and border zone and to assess mIBG uptake in scar and border zone from combined I-123 MIBG SPECT and resting Tc-99m SPECT MPI. The mIBG uptake in the border zone predicted VA inducibility on EP testing with a promising accuracy.
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Affiliation(s)
- Yanli Zhou
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA, 30322, USA
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Imam MH, Karmakar CK, Khandoker AH, Palaniswami M. Effect of premature activation in analyzing QT dynamics instability using QT-RR model for ventricular fibrillation and healthy subjects. Annu Int Conf IEEE Eng Med Biol Soc 2013; 2013:2559-62. [PMID: 24110249 DOI: 10.1109/embc.2013.6610062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Perturbations in the normal heart rate are generally represented by the presence of premature activation (PA) beats in the surface electrocardiogram (ECG). The presence of PA is one of the main reasons of instability in QT dynamics which could initiate arrhythmia. Analyzing Boundary-Input Boundary-Output (BIBO) stability of the short term linear autoregressive QT-RR model is a way of detecting instability in QT dynamics from the ECG. The aim of this paper is to investigate if PA is the only reason for instability in the ventricular repolarisation process, which is denoted by QT interval of surface ECG. Ten healthy subjects with normal sinus rhythm and seven patients with sustained ventricular tachycardia (VT) were analyzed in this study. 10 min long ECG data were collected from each subject of the healthy group and 10 min ECG before the start of VT were taken for each subject of the VT group. Autoregressive QT-RR model was derived for each non-overlapping 1 min long ECG segment of the 10 min long ECG data. Instability in QT dynamics was quantified by measuring the numbers of unstable segments in ECG data for each subject ( ). Results of this study revealed that like the VT group subjects, QT instability detected by QT-RR model is also found in healthy subjects whose ECG segments are mostly free from PA beats. This finding indicates that BIBO unstable QT characteristics might arise from other inherent factors of cardiovascular system in addition to PA.
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Shiozaki AA, Senra T, Arteaga E, Martinelli Filho M, Pita CG, Ávila LFR, Parga Filho JR, Mady C, Kalil-Filho R, Bluemke DA, Rochitte CE. Myocardial fibrosis detected by cardiac CT predicts ventricular fibrillation/ventricular tachycardia events in patients with hypertrophic cardiomyopathy. J Cardiovasc Comput Tomogr 2013; 7:173-81. [PMID: 23849490 DOI: 10.1016/j.jcct.2013.04.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 04/21/2013] [Accepted: 04/23/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Myocardial fibrosis (MF) occurs in up to 80% of subjects with asymptomatic or mildly symptomatic hypertrophic cardiomyopathy (HCM) and can constitute an arrhythmogenic substrate for re-entrant, life-threatening ventricular arrhythmias in predisposed persons. OBJECTIVE The aim was to investigate whether MF detected by delayed enhancement cardiac CT is predictive of ventricular tachycardia (VT) and fibrillation (VF) that require appropriate therapy by an implantable cardioverter defibrillator (ICD) in patients with HCM. METHODS Twenty-six patients with HCM with previously (for at least 1 year) implanted ICD underwent MF evaluation by cardiac CT. MF was quantified by myocardial delayed enhanced cardiac CT. Data on ICD firing were recorded every 3 months after ICD implantation. Risk factors for sudden cardiac death in patients with HCM were evaluated in all patients. RESULTS MF was present in 25 of 26 patients (96%) with mean fibrosis mass of 20.5 ± 15.8 g. Patients with appropriate ICD shocks for VF/VT had significantly greater MF mass than patients without (29.10 ± 19.13 g vs 13.57 ± 8.31 g; P = .01). For a MF mass of at least 18 g, sensitivity and specificity for appropriate ICD firing were 73% (95% CI, 49%-88%) and 71% (95% CI, 56%-81%), respectively. Kaplan-Meier curves indicated a significantly greater VF/VT event rate in patients with MF mass ≥18 g than in patients with MF <18 g (P = .02). In the Cox regression analysis, the amount of MF was independently associated with VF/VT in ICD-stored electrograms. CONCLUSION The mass of MF detected by cardiac CT in patients with HCM at high risk of sudden death was associated with appropriate ICD firings.
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Affiliation(s)
- Afonso Akio Shiozaki
- Cardiovascular Magnetic Resonance and Computed Tomography Sector, Heart Institute, InCor, University of São Paulo Medical School, São Paulo, Brazil
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Rasooli M, Foomany FH, Balasundaram K, Masse S, Zamiri N, Ramadeen A, Hu X, Dorian P, Nanthakumar K, Beheshti S, Umapathy K. Blind source separation in characterizing ECG pre-shock waveforms during Ventricular Fibrillation. Annu Int Conf IEEE Eng Med Biol Soc 2013; 2013:5833-5836. [PMID: 24111065 DOI: 10.1109/embc.2013.6610878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Ventricular Fibrillation (VF) is a cardiac arrhythmia for which the only available treatment option is defibrillation by electrical shock. Existing literature indicates that VF could be the manifestation of different sources controlling the heart with different degrees of organization. In this work we test the hypothesis that the pre-shock waveforms of successful and unsuccessful shock outcomes could be related to the number of independent sources present in these waveforms. The proposed method uses Blind Source Separation (BSS) to extract independent components in frequency direction from a pig database consisting of 20 pre-shock waveforms. The slope of the energy capture curve was used as an indicator to demonstrate the number of independent sources required to model the pre-shock waveforms. The results were also quantified by performing a linear discriminant analysis based classification achieving an overall classification accuracy of 75%. The results indicate that successful cases can be modeled with less number of independent sources compared to unsuccessful cases.
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Ikeda A, Inagaki M, Fukuzawa S, Sugioka J, Okino S, Maekawa J, Maekawa S, Ichikawa S, Uchiyama T, Kamioka N, Kuroiwa N. Contrast media injection into right coronary artery caused thrombus extraction to aorta that may have resulted in left main trunk thrombosis. Cardiovasc Interv Ther 2012; 27:37-42. [PMID: 24122640 DOI: 10.1007/s12928-011-0082-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 08/01/2011] [Indexed: 11/26/2022]
Abstract
A 59-year-old man with inferior acute myocardial infarction underwent an urgent coronary angiography and as a result a total occlusion of the ostial right coronary artery (RCA) was observed. Interestingly, the thrombus in the RCA clearly shortened within 2.3 s during the contrast media injection. While we prepared for percutaneous coronary intervention (PCI) of the RCA, ventricular fibrillation occurred and pulseless electrical activity continued in spite of repeated cardioversion. Despite no stenosis in the left main trunk (LMT) in the initial coronary angiography, the LMT was totally occluded. Following aspiration therapy on the LMT with percutaneous cardiopulmonary support, PCI of the RCA was performed. A coronary angiography should be carefully performed if a lot of thrombi exist in the coronary ostium because LMT embolism may have been caused by thrombus extraction from the RCA by contrast media injection.
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Affiliation(s)
- Atsushi Ikeda
- Division of Cardiology, Heart and Vascular Institute, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Funabashi, 273-8588, Chiba, Japan,
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Kitazawa H, Matsushita H, Nakayama M, Saito A, Fuse K, Fujita S, Ikeda Y, Takahashi M, Sato M, Aizawa Y. Unmasking of J waves during right coronary angiography in patients with spontaneous coronary spasms and ventricular fibrillation. Intern Med 2012; 51:185-8. [PMID: 22246488 DOI: 10.2169/internalmedicine.51.6343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We encountered two consecutive cases with spontaneous ST elevation due to right coronary spasms and subsequent ventricular fibrillation (VF). Their 12-lead ECGs on anterior chest pain showed elevation of ST-segments in the inferior leads, but coronary angiography (CAG) revealed no significant stenosis. Both cases showed dramatically evolving J waves in the inferior leads during the right CAG, but it was not observed during angiography of the left CAG. Neither Brugada-type ECG nor long-QT was evident. In summary, J waves can be produced without ST-segment elevation, and contrast media-induced J waves might be related to the arrhythmogenesis of subsequent VF evoked by right coronary spasms.
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Abstract
AIM The aim of this study was to identify echocardiographic LV systolic and diastolic measurements that predict clinical events post-coronary artery bypass graft (CABG) surgery. METHODS We collected data from 27 patients (age 70 +/- 7 years) who underwent elective CABG, before and within 6 weeks after surgery. LV systolic function was assessed by conventional echocardiographic parameters. A number of LV filling measurements were also made, which included total isovolumic time (t-IVT), Tei index, and restrictive filling pattern. Postoperative cardiac events were death or hospitalization for chest pain, breathlessness, or arrhythmia. RESULTS Patient's follow-up period was 17 +/- 10 months. Of the 27 patients (age 70 +/- 7 years, 22 male), 10 had postoperative cardiac events. LV ejection fraction (EF) and fractional shortening (FS) were lower (P = 0.01, and P = 0.007, respectively), t-IVT longer (P < 0.001), and Tei index was higher (P < 0.001) preoperatively in patients with events compared to those without. The same differences between groups remained after surgery; EF (P = 0.002), FS (P = 0.002), t-IVT (P < 0.001), and Tei index (P < 0.001). T-IVT was the only preoperative predictor of events (P = 0.038) but its postoperative value as well as that of FS predicted events (P = 0.034, and P = 0.042, respectively). T-IVT of 12.2 s/min and FS of 26% were 80% sensitive and 88% specific for predicting postoperative events. CONCLUSION Despite successful surgical revascularization residual impairment of LV systolic function and persistent asynchrony in the form of prolonged t-IVT are associated with postoperative events. Since these abnormalities remained despite full medical therapy, they may thus suggest a need for electrical resynchronization therapy.
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Affiliation(s)
- Gani Bajraktari
- Second Division of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo
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Baker GH, Hlavacek AM, Chessa KS, Fleming DM, Shirali GS. Left Ventricular Dysfunction is Associated with Intraventricular Dyssynchrony by 3-Dimensional Echocardiography in Children. J Am Soc Echocardiogr 2008; 21:230-3. [PMID: 17904813 DOI: 10.1016/j.echo.2007.08.046] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Indexed: 11/25/2022]
Abstract
INTRODUCTION We used 3-dimensional (3D) echocardiography to identify and quantify left ventricular (LV) dyssynchrony in children with LV dysfunction compared with control subjects. METHODS The 3D echocardiography LV full volumes were acquired in 18 children, 9 with LV dysfunction and 9 control subjects. The LV was subdivided into 16 segments (apex excluded). Time from end diastole to the minimal systolic volume for each segment was expressed as a percent of the R-R interval. The SD of these times provided a 16-segment dyssynchrony index (16-SDI). The second index (12-SDI) was similarly calculated using 6 basal and 6 mid segments. The third index consisted of 6 basal segments (6-SDI). RESULTS The dysfunction group exhibited significantly increased 16-SDI (P = .008) and 12-SDI (P = .01). The 16-SDI was negatively correlated with 3D ejection fraction and 2-dimensional fractional shortening. CONCLUSIONS Children with LV dysfunction demonstrate increased intraventricular LV dyssynchrony by 3D echocardiography, in a pattern that is negatively correlated with LV systolic function.
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Affiliation(s)
- G Hamilton Baker
- South Carolina Children's Heart Program, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
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Abstract
BACKGROUND An electromuscular incapacitating device (EMD) delivers pulses of high-voltage electricity, causing strong muscle contraction. Data from a pig model suggest that an EMD dart tip placed within 17 mm of the epicardial surface can cause ventricular fibrillation. The current study estimates minimum skin-to-heart distance in the adult, to determine whether individuals might be at risk for ventricular fibrillation from an EMD. METHODS We performed 2-dimensional echocardiograms in 150 standing adults in the parasternal, apical, and subcostal views. From each view, the shortest linear skin-to-heart distance was measured. RESULTS Average skin-to-heart distances were: parasternal 32.1 +/- 7.9 mm; apical 31.3 +/- 11.3 mm; and subcostal 70.8 +/- 22.3 mm. There were 9 (6%) individuals with a skin-to-heart distance less than or equal to 17 mm. The skin-to-heart distance was significantly correlated with body mass index: parasternal r = 0.57, apical r = 0.55 (P < .0001). CONCLUSIONS An EMD dart penetrating the skin directly over the heart might put individuals at risk for ventricular fibrillation.
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Affiliation(s)
- Peter S Rahko
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53792, USA.
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Jiamsripong P, Honda T, McCully R, Khandheria BK, Mookadam F. Ventricular Fibrillation in Late Recovery After Dobutamine Stress Echocardiography. J Am Soc Echocardiogr 2007; 20:1220.e7-10. [PMID: 17681730 DOI: 10.1016/j.echo.2007.02.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2006] [Indexed: 11/27/2022]
Abstract
A 62-year-old man with multiple cardiac risk factors, including diabetes mellitus type II, treated hypertension, and hyperlipidemia, had a dobutamine stress echocardiogram performed as part of a preoperative evaluation. At peak stress the patient developed an apical regional wall motion abnormality. Approximately 12 minutes into the recovery period, the patient developed ventricular tachycardia that degenerated into ventricular fibrillation. He was successfully resuscitated and underwent emergency coronary angiography that showed a 95% distal left anterior descending coronary artery stenosis.
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Affiliation(s)
- Panupong Jiamsripong
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Scottsdale, Arizona, USA
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Jacon P, Benhalima A, Thony F, Defaye P. [Significance of the contralateral approach combined with venous deocclusion in a case of biventricular defibrillator implantation]. Arch Mal Coeur Vaiss 2007; 100:883-886. [PMID: 18033021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The authors report the case of a patient in whom a biventricular defibrillator was successfully implanted from the right, following a failed approach from the left. The patient had chronic thrombosis of the subclavian vein, and this procedure was only possible after venous deocclusion and the positioning of an endoprosthesis. The authors underline the significance of the contralateral approach in case of difficulties in inserting pacing devices, as well as the complementary benefits of interventional radiological procedures in order to allow vascular access in cases of chronic venous thrombosis.
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Affiliation(s)
- P Jacon
- Service de cardiologie et urgences cardiologiques, CHU Albert-Michalon, Grenoble cedex 9.
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Mörtberg E, Cumming P, Wiklund L, Wall A, Rubertsson S. A PET study of regional cerebral blood flow after experimental cardiopulmonary resuscitation. Resuscitation 2007; 75:98-104. [PMID: 17499906 DOI: 10.1016/j.resuscitation.2007.03.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Revised: 03/26/2007] [Accepted: 03/30/2007] [Indexed: 10/23/2022]
Abstract
Cerebral blood flow (CBF) during cardiopulmonary resuscitation and after restoration of spontaneous circulation (ROSC) from cardiac arrest has previously been measured with the microspheres and laser Doppler techniques. We used positron emission tomography (PET) with [15O]--water to map the haemodynamic changes after ROSC in nine young pigs. After the baseline PET recording, ventricular fibrillation of 5 min duration was induced, followed by closed-chest cardiopulmonary resuscitation (CPR) in conjunction with IV administration of three bolus doses of adrenaline (epinephrine). After CPR, external defibrillatory shocks were applied to achieve ROSC. CBF was measured at intervals during 4h after ROSC. Relative to the mean global CBF at baseline (32+/-5 ml hg(-1)min(-1)), there was a substantial global increase in CBF at 10 min, especially in the diencephalon. This was followed by an interval of cortical hypoperfusion and a subsequent gradual return to baseline values.
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Affiliation(s)
- Erik Mörtberg
- Department of Surgical Sciences-Anesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden.
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Ristagno G, Castillo C, Tang W, Sun S, Bisera J, Weil MH. Miniaturized mechanical chest compressor: a new option for cardiopulmonary resuscitation. Resuscitation 2007; 76:191-7. [PMID: 17728044 DOI: 10.1016/j.resuscitation.2007.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2006] [Revised: 06/27/2007] [Accepted: 07/02/2007] [Indexed: 11/25/2022]
Abstract
AIM OF STUDY After cardiac arrest, uninterrupted chest compressions with restoration of myocardial blood flow facilitates restoration of spontaneous circulation. We recognized that this may best be accomplished with a mechanical device and especially so during transport. We therefore sought to develop a lightweight, portable chest compressor which may be carried on the belt or attached to the oxygen tank typically carried on the back of the first response rescuer. A miniaturized pneumatic chest compressor (MCC) weighing less than 2 kg was developed and compared with a currently marketed "Michigan Thumper", which weighed 19 kg. We hypothesized that the 2 kg, low profile, portable device will be as effective as the standard pneumatic Thumper for restoring circulation during CPR. MATERIAL AND METHODS Ventricular fibrillation was electrically induced in 10 domestic male pigs weighing 39+/-2 kg, and untreated for 5 min. Animals were then randomized to receive chest compressions with either the MCC or the Thumper. After 5 min of mechanical chest compression, defibrillation was attempted with a 150 J biphasic shock. Coronary perfusion pressure (CPP) and end tidal PCO(2) (EtPCO(2)) were measured by conventional techniques together with right carotid artery blood flow (CBF). RESULTS Four of five animals compressed with the Thumper and each animal compressed with the MCC were successfully resuscitated. No significant differences in CPP, EtPCO(2), CBF and post-resuscitation myocardial function were observed between groups. Resuscitated animals survived for more than 72 h without neurological impairment. CONCLUSION The low profile, 2 kg miniaturized chest compressor is as effective as the conventional Thumper in an experimental model of CPR.
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Affiliation(s)
- Giuseppe Ristagno
- Weil Institute of Critical Care Medicine, Rancho Mirage, CA 92270, United States
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Xu T, Tang W, Ristagno G, Sun S, Weil MH. Myocardial performance index following electrically induced or ischemically induced cardiac arrest. Resuscitation 2007; 76:103-7. [PMID: 17644238 DOI: 10.1016/j.resuscitation.2007.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2007] [Revised: 05/25/2007] [Accepted: 06/04/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES We sought to investigate the echocardiographic myocardial performance index (MPI) to assess post-resuscitation myocardial function following electrically and ischemically induced ventricular fibrillation (VF). MATERIALS AND METHODS VF was induced in fourteen anesthetized pigs weighing 38+/-4 kg. VF was induced electrically in seven animals and ischemically, following transient occlusion of the left anterior descending coronary artery (LAD), in the remaining seven animals. VF was untreated for 7 min after which CPR, including precordial compression and mechanical ventilation was begun. Defibrillation was attempted after 5 min of CPR. MPI, ejection fraction (EF) and fractional area change (FAC) were measured hourly during the following 4 h interval post-resuscitation. RESULTS Five of seven animals were resuscitated in the electrically induced VF group, and four of seven animals in the ischemically induced VF group. No difference in EF and FAC were observed between the two groups. The MPI, however, was significantly greater at 60 min and 120 min post-resuscitation in animals after ischemically induced VF (p<0.05). CONCLUSION In this model, left ventricular (LV) MPI was a more sensitive and useful quantitative parameter to assess the LV function than the EF and FAC measurements used routinely. MPI measurements indicated that post-resuscitation myocardial dysfunction may be more severe after ischemically induced VF compared to the electrically induced VF.
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Affiliation(s)
- Tingyan Xu
- The Weil Institute of Critical Care Medicine, 35100 Bob Hope Drive, Rancho Mirage, CA 92270, United States
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Kempa M, Lubiński A, Wilczek R, Królak T, Pazdyga A, Raczak G. [Cardioverter-defibrillator implantation in a patient with persistent left superior vena cava--a case report]. Kardiol Pol 2006; 64:1281-3. [PMID: 17165164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
A case of a successful implantation of cardioverter-defibrilator using the persistent left superior vena cava is presented. After six month of follow-up pacing and sensing parameters remained constant.
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Affiliation(s)
- Maciej Kempa
- II Klinika Chorób Serca Akademii Medycznej, ul. Debinki 7, 80-952 Gdańsk.
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Kim H, Cho Y, Park Y, Lee H, Kang H, Nah DY, Park T, Yang DH, Park HS. Underlying cardiomyopathy in patients with ST-segment elevation in the right precordial leads. Circ J 2006; 70:719-25. [PMID: 16723793 DOI: 10.1253/circj.70.719] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Ventricular fibrillation (VF) and sudden death (SD) may occur in patients with ST-segment elevation in the right precordial leads. The mechanism of such events is unclear, so the aim of the present study was to assess whether there is an underlying morphological or pathological abnormality in these patients. METHODS AND RESULTS Fourteen consecutive patients (44+/-10 years old, all male) with ST-segment elevation of more than 2 mm in the right precordial leads underwent a cardiac evaluation, including right ventriculography and endomyocardial biopsy. The ST-segment changes after the administration of sodium-channel blockers were also evaluated. Two patients survived documented VF, 11 patients had chest pain or tightness, and another patient had a history of syncope. Only 1 patient had a family history of premature SD. The coronary angiograms were normal in all the patients. VF was induced in 5 patients (36%). Wall motion abnormalities of the right ventricle were detected in 4 patients (29%) and endomyocardial biopsy revealed features of cardiomyopathy in 7 patients (50%). In total, 9 (64%) of 14 patients exhibited wall motion abnormalities and/or pathologic findings. CONCLUSIONS Underlying cardiomyopathy was present in more than half of the present patients with ST-segment elevation in the right precordial leads.
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Affiliation(s)
- Hyungseop Kim
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University, Taegu, Korea
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Masuhara H, Watanabe Y, Shiono N, Kawasaki M, Yokomuro H, Fujii T, Koyama N. A case report of emergency off-pump CABG in an aged patient with ACS renewing ventricular fibrillation. Ann Thorac Cardiovasc Surg 2006; 12:219-22. [PMID: 16823341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
An emergency off-pump coronary artery bypass (OPCAB) was performed successfully in an aged patient with acute coronary syndrome (ACS). The patient, an 80-year-old woman residing in a nursing home, suddenly lost consciousness during lunch. The electrocardiogram (ECG) showed ventricular fibrillation (Vf) but defibrillation successfully recovered the sinus rhythm. The patient was brought to our hospital as an emergency. She underwent emergency cardiac catheterization. Coronary angiography demonstrated severe three vessel disease with left main coronary trunk (LMT) stenosis. Even during intra-aortic balloon pumping (IABP), the hemodynamic state was unstable, with repeated development of ventricular tachycardia and fibrillation. An emergency coronary artery bypass without a cardiopulmonary bypass was performed. Saving her life was of primary importance and revascularization of the left anterior descending artery (LAD) branch, was performed. Thanks to the advances made in various devices, safe and reliable anastomoses have become possible in OPCAB applied to ACS. OPCAB for ACS have become safe and reliable anastomoses following development of various devices. We think that OPCAB is an effective surgical technique for coronary revascularization for emergency or serious cases involving elderly patients.
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Affiliation(s)
- Hiroshi Masuhara
- Department of Surgery, Division of Cardiovascular Surgery, School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
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Abstract
The degree of ST-segment elevation and amplitude of J waves, which may change in patients with the Brugada-type electrocardiogram (ECG) over time, are influenced by autonomic nervous activity and the administration of antiarrhythmic drugs. In the present study, we evaluated whether the shape of ST-segment elevation in patients with a Brugada-type ECG might alter the parameters of an 123I-MIBG myocardial scintigraphy and body surface signal-averaged ECG (SAECG). The subjects consisted of 12 patients with a Brugada-type ECG and 15 healthy volunteers (N group). The patients with a Brugada-type ECG were classified into the following 2 groups based on the type of ST-segment elevation: 6 patients with the coved type ST-segment elevation (C group), and 6 patients with the saddle-back type ST-segment elevation (S group). Planar and SPECT images were obtained 15 minutes (early images) and 3 hours (delayed images) after the administration of 123I-MIBG, respectively. In addition, the washout rate (% WR) of 123I-MIBG was obtained in a bull's eye map of the SPECT image. There were no significant differences in the early H/M ratio between the C and S groups. In the C group, however, there were some patients who showed a decreased accumulation or defect of 123I-MIBG in the planar and SPECT images. Furthermore, in contrast to the N and S groups, the C group showed a decreased delayed H/M ratio and increased % WR. SAECG did not show any significant differences between the S and C groups. These results of the present study suggest that the shape of ST-segment elevation may be associated with myocardial autonomic nervous function. In addition, the electric heterogeneity of the action potential in the right ventricular epicardial myocardium, which is frequently influenced by autonomic nervous activity, is closely associated with the development of Brugada syndrome.
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Affiliation(s)
- Takashi Kawaguchi
- Department of Digestive and Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School, Japan
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Hamill JJ, Brunken RC, Bybel B, DiFilippo FP, Faul DD. A knowledge-based method for reducing attenuation artefacts caused by cardiac appliances in myocardial PET/CT. Phys Med Biol 2006; 51:2901-18. [PMID: 16723774 DOI: 10.1088/0031-9155/51/11/015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Attenuation artefacts due to implanted cardiac defibrillator leads have previously been shown to adversely impact cardiac PET/CT imaging. In this study, the severity of the problem is characterized, and an image-based method is described which reduces the resulting artefact in PET. Automatic implantable cardioverter defibrillator (AICD) leads cause a moving-metal artefact in the CT sections from which the PET attenuation correction factors (ACFs) are derived. Fluoroscopic cine images were measured to demonstrate that the defibrillator's highly attenuating distal shocking coil moves rhythmically across distances on the order of 1 cm. Rhythmic motion of this magnitude was created in a phantom with a moving defibrillator lead. A CT study of the phantom showed that the artefact contained regions of incorrect, very high CT values and adjacent regions of incorrect, very low CT values. The study also showed that motion made the artefact more severe. A knowledge-based metal artefact reduction method (MAR) is described that reduces the magnitude of the error in the CT images, without use of the corrupted sinograms. The method modifies the corrupted image through a sequence of artefact detection procedures, morphological operations, adjustments of CT values and three-dimensional filtering. The method treats bone the same as metal. The artefact reduction method is shown to run in a few seconds, and is validated by applying it to a series of phantom studies in which reconstructed PET tracer distribution values are wrong by as much as 60% in regions near the CT artefact when MAR is not applied, but the errors are reduced to about 10% of expected values when MAR is applied. MAR changes PET image values by a few per cent in regions not close to the artefact. The changes can be larger in the vicinity of bone. In patient studies, the PET reconstruction without MAR sometimes results in anomalously high values in the infero-septal wall. Clinical performance of MAR is assessed by two physicians' inspection of images generated in 30 patients with and without MAR. Noticeable image differences are judged in 14 of 28 (50%) observations with AICD leads, and significant clinical impact is judged in 2 of 28 (7%) of those observations. A polar map analysis shows significant differences in 10 of 14 (71%) studies with AICD leads, and 0 of 16 (0%) studies without AICD leads. These results show that the MAR method is successful in reducing the magnitude of the metal artefact without incorrectly altering cases without metal artefact. In spite of profound changes to the CT image from the moving metal, the PET ACF in that study was changed by no more than 20%.
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Affiliation(s)
- James J Hamill
- Siemens Medical Solutions, Molecular Imaging, 810 Innovation Dr., Knoxville, TN, USA
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Dohi K, Pinsky MR, Kanzaki H, Severyn D, Gorcsan J. Effects of Radial Left Ventricular Dyssynchrony on Cardiac Performance Using Quantitative Tissue Doppler Radial Strain Imaging. J Am Soc Echocardiogr 2006; 19:475-82. [PMID: 16644429 DOI: 10.1016/j.echo.2005.10.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2005] [Indexed: 10/24/2022]
Abstract
Our objective was to test the hypothesis that novel angle-corrected radial strain imaging can quantify left ventricular dyssynchrony associated with contractile impairment and improved with biventricular pacing. Eight open-chest dogs were studied by novel angle-corrected color-coded radial strain imaging and high-fidelity pressure-conductance catheters recording pressure-volume loops. Heart rate was controlled by right atrial pacing and all timing intervals were corrected by R-R interval (corrected interval = measured interval/(R-R interval)(1/2)). Left bundle branch block, simulated by right ventricular free wall pacing, resulted in marked radial dyssynchrony, which we defined as maximal time difference between peak segmental strain, from 39 +/- 17 to 354 +/- 49 milliseconds and stroke work decreased from 157 +/- 40 to 60 +/- 37 mJ, (P < .005 vs baseline). Depression of contractility by high-dose esmolol (end-systolic pressure-volume relationship from 5.7 +/- 2.4 to 3.6 +/- 1.0 mm Hg/mL) was associated with augmented dyssynchrony to 388 +/- 53 milliseconds (P < .05 vs baseline right ventricular pacing). Biventricular pacing improved dyssynchrony to 55 +/- 19 milliseconds and stroke work to 143 +/- 33 mJ (P < .05 vs right ventricular pacing). Changes in radial dyssynchrony correlated significantly with 6-site average regional strain (r = -0.93 +/- 0.05 individually, r = 0.80 overall) and stroke work (r = -0.88 +/- 0.12 individually, r = -0.82 overall). Angle-corrected radial strain imaging has clinical potential to quantify mechanical dyssynchrony and effects of biventricular pacing.
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Affiliation(s)
- Kaoru Dohi
- Division of Cardiovascular Disease, Critical Care Medicine Department, University of Pittsburgh, Pittsburgh, Pennsylvania 15213-2582, USA
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Paul M, Schäfers M, Kies P, Acil T, Schäfers K, Breithardt G, Schober O, Wichter T. Impact of sympathetic innervation on recurrent life-threatening arrhythmias in the follow-up of patients with idiopathic ventricular fibrillation. Eur J Nucl Med Mol Imaging 2006; 33:866-70. [PMID: 16612587 DOI: 10.1007/s00259-005-0061-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2005] [Accepted: 12/12/2005] [Indexed: 10/24/2022]
Abstract
PURPOSE Idiopathic ventricular fibrillation (IVF) is defined as VF in the absence of any identifiable structural or functional cardiac disease. The underlying pathophysiological mechanisms are unknown. This study was performed to investigate the potential impact of sympathetic dysfunction, assessed by (123)I-meta-iodo-benzylguanidine scintigraphy ((123)I-MIBG SPECT), on the long-term prognosis of patients with IVF. METHODS (123)I-MIBG SPECT was performed in 20 patients (mean age 37+/-13 years) with IVF. Mean follow-up of patients after study entry was 7.2+/-1.5 years (range 4.9-10.5 years). Ten patients (five men, five women; mean age 43+/-12 years; p=NS versus study group) with medullary carcinoma of the thyroid gland served as an age-matched control group. RESULTS Abnormal (123)I-MIBG uptake was observed in 13 patients (65%). During follow-up, 18 episodes of VF/fast polymorphic ventricular tachycardias occurred in four IVF patients with abnormal (123)I-MIBG uptake whereas only two episodes of monomorphic ventricular tachycardia (and no VF) occurred in a single IVF patient with normal (123)I-MIBG uptake. CONCLUSION Impairment of sympathetic innervation may indicate a higher risk of future recurrent episodes of life-threatening ventricular tachyarrhythmias in patients with IVF. Studies in larger cohorts are required to validate the significance of (123)I-MIBG SPECT during the long-term follow-up of these patients.
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Affiliation(s)
- Matthias Paul
- Department of Cardiology and Angiology, Hospital of the University of Münster, Münster, Germany.
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Ben-Dov IZ, Leibowitz D, Weiss AT. ST-segment elevation post cardioversion: a current of injury without injury. Int J Cardiol 2006; 106:255-6. [PMID: 16321699 DOI: 10.1016/j.ijcard.2004.12.058] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2004] [Accepted: 12/31/2004] [Indexed: 10/25/2022]
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Bloch Thomsen PE, Joergensen RM, Kanters JK, Jensen TJ, Haarbo J, Hagemann A, Vestergaard A, Saermark K. Phase 2 reentry in man. Heart Rhythm 2005; 2:797-803. [PMID: 16051112 DOI: 10.1016/j.hrthm.2005.04.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2004] [Accepted: 04/19/2005] [Indexed: 02/07/2023]
Abstract
BACKGROUND Ventricular extrasystoles are characterized by a fixed coupling interval to the last QRST complex preceding it. OBJECTIVES We hypothesized that this QRST complex differed from QRST complexes of other sinus beats not followed by ventricular extrasystoles. Further, we investigated whether phase 2 reentry, demonstrated in animal experiments to initiate ventricular extrasystoles, ventricular tachycardia, and ventricular fibrillation, also plays a role in humans. METHODS We examined 18 patients with ventricular extrasystoles and/or ventricular tachycardia by signal averaging of the ECG (group A) or by single-beat analysis of intracardiac electrograms (group B). Group A consisted of six patients without structural heart disease and one patient with the Brugada syndrome. Six of the seven patients had right ventricular outflow tract ventricular extrasystoles. Group B consisted of 11 patients undergoing radiofrequency ablation. Eight of the 11 patients had right ventricular outflow tract extrasystoles. RESULTS In six of the seven patients in group A, we demonstrated significant ST-elevation and/or T-wave changes in the sinus beat preceding ventricular extrasystoles compared with the second last sinus beat in one or more of the three orthogonal leads X, Y, and Z. In 9 of the 11 patients in group B, single-beat analysis of unipolar and bipolar electrograms recorded close to successful ablation sites demonstrated similar changes, that is, ST-elevation (median peak voltage gradient 150 muV, range 0-1,700) and T-wave changes in the sinus beat prior to ventricular ectopy. In addition, J-point elevation was demonstrated in several cases. In total, significant changes were demonstrated in 15 of the 18 patients studied (83%). CONCLUSION J-point elevation, ST-elevation, and T-wave changes documented in the last sinus beat prior to ventricular extrasystoles are in agreement with phase 2 reentry, suggesting that this may be the responsible mechanism for ventricular extrasystoles and ventricular tachycardia/fibrillation. The phenomenon has been demonstrated in only animal experiments to date.
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Arora V, Singh J, Kler TS. Implantable cardioverter defibrillatory implantation in a patient with persistent left superior vena cava and right superior vena cava atresia. Indian Heart J 2005; 57:717-9. [PMID: 16521645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Abstract
Persistence of a left superior vena cava has been observed in 0.3% of the general population as established by autopsy findings. In the adult population. it is an important anatomic finding if a left or right superior vena cava approach to the heart is considered for device implantation. We present a case with persistent left superior vena cava and right superior vena cava atresia in whom a dual chamber implantable cardioverter defibrillator was implanted and was technically challenging.
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Affiliation(s)
- Vanita Arora
- Escorts Heart Institute and Research Centre, New Delhi.
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Tada H, Kurosaki K, Ito S, Naito S, Yamada M, Miyaji K, Hashimoto T, Oshima S, Nogami A, Taniguchi K. Idiopathic premature ventricular contractions arising from the pulmonary artery: importance of mapping in the pulmonary artery in left bundle branch block-shaped ventricular arrhythmias. Circ J 2005; 69:865-9. [PMID: 15988115 DOI: 10.1253/circj.69.865] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A patient underwent radiofrequency (RF) catheter ablation of symptomatic idiopathic ventricular contractions (PVCs). RF energy applications at 2 sites in the right ventricular outflow tract (RVOT), where both the earliest ventricular activation and near-perfect pace mapping were obtained, did not abolish the PVC but resulted in changes in the QRS morphology of the PVC. Complete elimination of the PVC was achieved with RF energy application at a site within the pulmonary artery 13 mm above the pulmonary valve, which was greater than 20 mm away from the failed ablation sites within the RVOT.
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Affiliation(s)
- Hiroshi Tada
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan.
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Niendorff DF, Rassias AJ, Palac R, Beach ML, Costa S, Greenberg M. Rapid cardiac ultrasound of inpatients suffering PEA arrest performed by nonexpert sonographers. Resuscitation 2005; 67:81-7. [PMID: 16199290 DOI: 10.1016/j.resuscitation.2005.04.007] [Citation(s) in RCA: 108] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2005] [Revised: 04/07/2005] [Accepted: 04/07/2005] [Indexed: 11/15/2022]
Abstract
UNLABELLED Cardiac arrest presenting as pulseless electrical activity (PEA) currently has a very low survival rate. Many of the conditions underlying PEA (cardiac tamponade, hypovolemia, and pulmonary embolus) are associated with specific cardiac ultrasound findings. The aim of this study was to evaluate a rapid cardiac ultrasound assessment performed by trained nonexpert sonographers integrated into the ACLS response system at a major medical center. METHODS An emergency sonography system was created and deployed to each inpatient cardiac arrest occurring at Dartmouth Hitchcock Medical Center between November 1, 2003 and April 30, 2004. Thirteen internal medicine house officers received training to perform a limited subcostal cardiac ultrasound examination designed to diagnose cardiac tamponade, pulmonary embolus, severe hypovolemia, and lack of cardiac motion. Time from arrest alert to sonographic result, and correlation with over-reading by blinded echocardiography physicians were assessed. RESULTS A complete emergency ultrasound examination was performed in five PEA arrests. The average time from arrest alert to interpretation was 7.75 min. (95% CI 2.8-18.3 min). Three of these examinations (60%, 95% CI 14.7-94.7%) were adequate for interpretation. Agreement between the nonexpert sonographer and echocardiography physician occurred in four of five (kappa=0.706) cases. CONCLUSION Rapid cardiac sonography can be successfully integrated in the ACLS response. Nonexpert sonographers may be able to provide useful interpretive information when sufficiently trained.
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