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Saleh K, Varnava A, Shun-Shin MJ, Ali N, Mohal J, Chiew K, Hanif MA, Merzah AJ, Howard JP, Jurak P, Leinveber P, Kanagaratnam P, Francis DP, Whinnett ZI, Arnold A. Ultra-high-frequency ECG assessment of QRS fragmentation predicts sudden cardiac death risk in inherited arrhythmia syndromes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Fragmentation of the QRS complex, as a surrogate for scar or functionally disrupted ventricular activation, has been postulated as a risk factor for malignant ventricular arrhythmias across a range of cardiac diagnoses including cardiomyopathies, channelopathies and myocardial infarction. Fragmentation is subtle on the conventionally filtered 12-lead ECG and can easily be missed or over-diagnosed. Isolation of high-frequency (HF) QRS components could overcome this to demonstrate easily identifiable fragmentation but this has previously been limited by technological constraints resulting in a limited range of measured frequencies (150–300Hz). Ultra-high-frequency ECG (UHF-ECG) is a novel technology that utilises amplification and signal-averaging techniques to reliably measure frequencies up to 1000Hz.
Purpose
We explored the use of UHF-ECG in arrhythmia risk stratification.
Methods
We recruited 60 participants to undergo UHF-ECG recordings, including 23 healthy volunteers and 37 patients with inherited arrhythmia syndromes: 25 hypertrophic cardiomyopathy (HCM), 5 Brugada syndrome, 4 arrhythmogenic cardiomyopathy, 3 idiopathic ventricular fibrillation, 2 long QT syndrome and 1 non-ischaemic dilated cardiomyopathy.
The arrhythmia risk status of patients with inherited disease was classified, by two independent researchers, into high or low risk based on their history of cardiac arrest, sustained ventricular arrhythmia, appropriate therapy, syncope and programmed ventricular stimulation result. A third researcher adjudicated disagreement. Two further researchers, blinded to aforementioned risk status, independently assessed the UHF-ECG recordings of all participants.
Results
40 patients were classified as low risk, and 20 as high. Healthy volunteer UHF-ECGs showed uniform ventricular activation with single HF peaks in each lead. High-risk patients' UHF-ECGs showed multiple HF peaks, representing QRS fragmentation. The maximum number of HF peaks in any lead was used to measure severity of fragmentation. Example UHF-ECGs are shown in Figure 1. Fragmentation severity (number of peaks) correlated with arrhythmia risk status (chi-square statistic = 8.95, p-value = 0.03) across all participants (Figure 2) and when comparing high to low risk patients with inherited disease.
UHF-ECG fragmentation could be observed even when the 12-lead ECG did not show any observable fragmentation. Among patients with inherited disease, patients with HCM showed the largest difference in UHF-ECG fragmentation between high and low risk. UHF-ECG fragmentation analysis showed excellent reproducibility with no difference in number of peaks identified between two independent assessors.
Conclusion
We demonstrate proof-of-concept that a novel ultra-high-frequency tool for measuring a broad range of high frequency QRS components can be used for sudden death risk stratification in patients with inherited cardiac conditions.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K Saleh
- National Heart and Lung Institute Imperial College , London , United Kingdom
| | - A Varnava
- National Heart and Lung Institute Imperial College , London , United Kingdom
| | - M J Shun-Shin
- National Heart and Lung Institute Imperial College , London , United Kingdom
| | - N Ali
- National Heart and Lung Institute Imperial College , London , United Kingdom
| | - J Mohal
- National Heart and Lung Institute Imperial College , London , United Kingdom
| | - K Chiew
- National Heart and Lung Institute Imperial College , London , United Kingdom
| | - M A Hanif
- National Heart and Lung Institute Imperial College , London , United Kingdom
| | - A J Merzah
- National Heart and Lung Institute Imperial College , London , United Kingdom
| | - J P Howard
- National Heart and Lung Institute Imperial College , London , United Kingdom
| | - P Jurak
- Institute of Scientific Instruments of the Czech Academy of Sciences , Brno , Czechia
| | - P Leinveber
- International Clinical Research Center, St. Anne's University Hospital , Brno , Czechia
| | - P Kanagaratnam
- National Heart and Lung Institute Imperial College , London , United Kingdom
| | - D P Francis
- National Heart and Lung Institute Imperial College , London , United Kingdom
| | - Z I Whinnett
- National Heart and Lung Institute Imperial College , London , United Kingdom
| | - A Arnold
- National Heart and Lung Institute Imperial College , London , United Kingdom
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Bhatia R, Malhotra A, MacLachlan H, Gati S, Kasiakogias A, Marwaha S, Chatrath N, Fyyaz S, Cooper R, Rakhit D, Varnava A, Esteban M, Finocchiaro G, Papadakis M, Sharma S. Prevalence and diagnostic significance of novel 12-lead ECG patterns following COVID-19 infection in elite soccer players. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Identification of athletes with cardiac inflammation following COVID-19 can prevent exercise fatalities. The efficacy of pre and post COVID-19 infection electrocardiograms (ECGs) for detecting athletes with myopericarditis has never been reported. We aimed to assess the prevalence and diagnostic significance of novel 12-lead ECG patterns following COVID-19 infection in elite soccer players.
Methods
We conducted a multicentre study over a 2-year period involving 5 centres and 34 clubs and compared pre COVID and post COVID ECG changes in 455 consecutive athletes. ECGs were reported in accordance with the International recommendations for ECG interpretation in athletes. The following patterns were considered abnormal if they were not detected on the pre COVID-19 infection ECG: (a) biphasic T-waves; (b) reduction in T-wave amplitude by 50% in contiguous leads; (c) ST-segment depression; (d) J-point and ST-segment elevation >0.2 mV in the precordial leads and >0.1 mV in the limb leads; (e) tall T-waves ≥1.0 mV (f) low QRS-amplitude in >3 limb leads and (g) complete right bundle branch block. Athletes exhibiting novel ECG changes underwent cardiovascular magnetic resonance (CMR) scans. One club mandated CMR scans for all 28 (6%) athletes, despite the absence of cardiac symptoms or ECG changes.
Results
Athletes were aged 22±5 years (89% male and 57% white). 65 (14%) athletes reported cardiac symptoms. The mean duration of illness was 3±4 days. The post COVID ECG was performed 14±16 days following a positive PCR. 440 (97%) athletes had an unchanged post COVID-19 ECG. Of these, 3 (0.6%) had cardiac symptoms and CMRs resulted in a diagnosis of pericarditis. 15 (3%) athletes demonstrated novel ECG changes following COVID-19 infection. Among athletes who demonstrated novel ECG changes, 10 (67%) reported cardiac symptoms. 13 (87%) athletes with novel ECG changes were diagnosed with inflammatory cardiac sequelae; pericarditis (n=6), healed myocarditis (n=3), definitive myocarditis (n=2), and possible/probable myocarditis (n=2). The overall prevalence of inflammatory cardiac sequelae based on novel ECG changes was 2.8%. None of the 28 (6%) athletes, who underwent a CMR, in the absence of cardiac symptoms or novel ECG changes revealed any abnormalities. Athletes revealing novel ECG changes, had a higher prevalence of cardiac symptoms (67% v 12% p<0.0001) and longer symptom duration (8±8 days v 2±4 days; p<0.0001) compared with athletes without novel ECG changes. Among athletes without cardiac symptoms, the additional yield of novel ECG changes to detect cardiac inflammation was 20% (n=3).
Conclusions
3% of elite soccer players demonstrated novel ECG changes post COVID-19 infection, of which almost 90% were diagnosed with cardiac inflammation during subsequent investigation. Most athletes with novel ECG changes exhibited cardiac symptoms. Novel ECGs changes contributed to a diagnosis of cardiac inflammation in 20% of athletes without cardiac symptoms.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R Bhatia
- St George's University of London , London , United Kingdom
| | - A Malhotra
- Manchester University NHS Foundation Trust , Manchester , United Kingdom
| | - H MacLachlan
- St George's University of London , London , United Kingdom
| | - S Gati
- Royal Brompton and Harefield NHS Foundation Trust , London , United Kingdom
| | - A Kasiakogias
- Royal Brompton and Harefield NHS Foundation Trust , London , United Kingdom
| | - S Marwaha
- St George's University of London , London , United Kingdom
| | - N Chatrath
- St George's University of London , London , United Kingdom
| | - S Fyyaz
- St George's University of London , London , United Kingdom
| | - R Cooper
- Liverpool Heart and Chest Hospital , Liverpool , United Kingdom
| | - D Rakhit
- University Hospital Southampton NHS Foundation Trust , Southampton , United Kingdom
| | - A Varnava
- Imperial College Healthcare NHS Trust , London , United Kingdom
| | - M Esteban
- St George's University of London , London , United Kingdom
| | - G Finocchiaro
- St George's University of London , London , United Kingdom
| | - M Papadakis
- St George's University of London , London , United Kingdom
| | - S Sharma
- St George's University of London , London , United Kingdom
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Cheng TC, Arnold ADA, Chow JC, Shun-Shin MJSS, Howard JPH, Keene DK, Ali NA, Miyazawa AM, Varnava AV, Kanagaratnam PK, Ng FSN, Peters NSP, Francis DPF, Whinnett ZIW. His resynchronization therapy produces more physiological ventricular repolarisation compared with biventricular pacing. Europace 2021. [DOI: 10.1093/europace/euab116.441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): British Heart Foundation
BACKGROUND
Biventricular pacing (BVP) is known to shorten activation time in patients with heart failure and left bundle branch block (LBBB) but its effects on repolarisation are not well studied. His bundle pacing (HBP) can correct LBBB to deliver cardiac resynchronization therapy (HBP-CRT), producing more physiological ventricular activation time and pattern than BVP. It is not known whether this translates to more physiological repolarisation, and if so whether the effect is mediated through its effects on activation.
PURPOSE
We measured the effects of HBP-CRT and BVP on left ventricular repolarisation using non-invasive epicardial mapping (ECGI).
METHODS
Patients were recruited in two groups. 1) Patients scheduled for clinically indicated BVP procedures for heart failure with LBBB, 2) Individuals with narrow QRS, normal ventricular function and intact conduction systems. Using non-invasive electrocardiographic imaging, we identified patients with LBBB in whom HBP shortened ECGI-derived left ventricular (LV) activation time by >10ms. We compared the effects of HBP and BVP on ECGI-derived dispersion of LV repolarisation times and activation-recovery intervals (a surrogate for action potential duration).
RESULTS
21 patients in whom HBP shortened LV activation time by >10ms and an equal number of individuals with narrow intrinsic QRS were recruited. LV repolarisation dispersion was reduced by HBP-CRT (-42.0 ms, 95% confidence interval (CI): -52.3 to -31.7 ms, p <0.001) but not by BVP (11.9 ms, 95% CI: -6.24 to 30.1 ms, p = 0.182). The mean within-patient change in LV repolarisation dispersion from BVP to HBP-CRT was -56.5 ms (95% CI: -70.5 to -42.5 ms, p < 0.001). LV repolarisation dispersion with HBP-CRT was not different from individuals with narrow intrinsic QRS (2.75 ms, 95% CI: -16.2 to 21.7 ms, p = 0.981). The magnitude of reduction in LV repolarisation dispersion with HBP-CRT from intrinsic LBBB appeared similar to the magnitude of LV activation time shortening (-54.9 ms, 95% CI: -68.2 to -41.6 ms, p < 0.001). However, LV activation-recovery interval dispersion was also reduced by HBP-CRT (-44.3 ms, 95% CI: -69.2 to -19.3 ms, p < 0.001). Repolarisation mapping demonstrated normalisation of repolarisation pattern by HBP-CRT.
CONCLUSIONS
HBP-CRT can normalise repolarisation dispersion, producing more physiological repolarisation compared with BVP, which does not resolve the repolarisation abnormality of LBBB. HBP-CRT improves repolarisation through both activation resynchronization and modulation of action-potential duration. If these acute results translate to longer term outcomes, HBP-CRT may reduce the risk of ventricular arrhythmias in heart failure with LBBB to a greater extent than BVP. Abstract Figure. Epicardial Repolarisation Maps
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Affiliation(s)
- TC Cheng
- National Heart and Lung Institute Imperial College, London, United Kingdom of Great Britain & Northern Ireland
| | - ADA Arnold
- National Heart and Lung Institute Imperial College, London, United Kingdom of Great Britain & Northern Ireland
| | - JC Chow
- National Heart and Lung Institute Imperial College, London, United Kingdom of Great Britain & Northern Ireland
| | - MJS-S Shun-Shin
- National Heart and Lung Institute Imperial College, London, United Kingdom of Great Britain & Northern Ireland
| | - JPH Howard
- National Heart and Lung Institute Imperial College, London, United Kingdom of Great Britain & Northern Ireland
| | - DK Keene
- National Heart and Lung Institute Imperial College, London, United Kingdom of Great Britain & Northern Ireland
| | - NA Ali
- National Heart and Lung Institute Imperial College, London, United Kingdom of Great Britain & Northern Ireland
| | - AM Miyazawa
- National Heart and Lung Institute Imperial College, London, United Kingdom of Great Britain & Northern Ireland
| | - AV Varnava
- National Heart and Lung Institute Imperial College, London, United Kingdom of Great Britain & Northern Ireland
| | - PK Kanagaratnam
- National Heart and Lung Institute Imperial College, London, United Kingdom of Great Britain & Northern Ireland
| | - FSN Ng
- National Heart and Lung Institute Imperial College, London, United Kingdom of Great Britain & Northern Ireland
| | - NSP Peters
- National Heart and Lung Institute Imperial College, London, United Kingdom of Great Britain & Northern Ireland
| | - DPF Francis
- National Heart and Lung Institute Imperial College, London, United Kingdom of Great Britain & Northern Ireland
| | - ZIW Whinnett
- National Heart and Lung Institute Imperial College, London, United Kingdom of Great Britain & Northern Ireland
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Arnold AD, Shun-Shin MJ, Sohaib A, Chiew K, Howard JP, Keene D, Leong K, Ahmad Y, Cole G, Lefroy D, Kanagaratnam P, Varnava A, Francis DP, Whinnett ZI. P3553Automated, high-precision echocardiographic and haemodynamic assessment of the effect of atrioventricular interval during right ventricular pacing in obstructed hypertrophic cardiomyopathy. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A D Arnold
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - M J Shun-Shin
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - A Sohaib
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - K Chiew
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - J P Howard
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - D Keene
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - K Leong
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - Y Ahmad
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - G Cole
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - D Lefroy
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - P Kanagaratnam
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - A Varnava
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - D P Francis
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - Z I Whinnett
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
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Arnold AD, Howard JP, Ahmad Y, Chiew K, Kerrigan W, De Vere F, Keene D, Shun-Shin MJ, Cole G, Sohaib A, Varnava A, Francis DP, Whinnett ZI. P3551Right ventricular pacing for LVOT gradient reduction in hypertrophic obstructive cardiomyopathy: a meta-analysis and meta-regression of clinical trials. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A D Arnold
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - J P Howard
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - Y Ahmad
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - K Chiew
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - W Kerrigan
- Imperial College Healthcare NHS Trust, Cardiology, London, United Kingdom
| | - F De Vere
- Royal Free Hospital, Intensive Care Unit, London, United Kingdom
| | - D Keene
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - M J Shun-Shin
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - G Cole
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - A Sohaib
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - A Varnava
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - D P Francis
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - Z I Whinnett
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
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Champney F, Maddock L, Welford J, Kemp J, Allan V, Persidskikh Y, Orini M, Ang R, Workman A, Wong L, Honarbakhsh S, Leong K, Silberbauer J, O'Nunain S, Gomes J, McCready J, Bostock J, Shaw K, McKenna C, Bailey J, Honarbakhsh S, Casas J, Wallace J, Hunter R, Schilling R, Perel P, Morley K, Banerjee A, Hemingway H, Mrochak A, Ilyina T, Goncharik D, Chasnoits A, Plashinskaya L, Taggart P, Hayward M, Lambiase P, Hosford P, Kasparov S, Lambiase P, Tinker A, Gourine A, Kettlewell S, Dempster J, Colman M, Rankin A, Myles R, Smith G, Tester D, Jaye A, FitzPatrick D, Evans M, Fleming P, Jeffrey I, Cohen M, Simpson M, Ackerman M, Behr E, Srinivasan N, Kirkby C, Firman E, Tobin L, Murphy C, Lowe M, Hunter RJ, Finlay M, Schilling RJ, Lambiase PD, Ng F, Tomlinson L, Nuthoo S, Cajilog E, Lefroy D, Qureshi N, Koa-Wing M, Whinnett Z, Linton N, Davies D, Lim P, Peters N, Kanagaratnam P, Varnava A. ORAL ABSTRACTS (1)Allied Professionals7CRYOABLATION FOR PAROXYSMAL ATRIAL FIBRILLATION - IS AN EP LAB REQUIRED?8A PATHWAY TO SAFETY - ANTICOAGULATION COMPLIANCE IN CIED PATIENTS WITH AF9UNDERSTANDING THE WAYS IN WHICH OCCUPATION IS AFFECTED BY POSTURAL TACHYCARDIA SYNDROME: A UK OCCUPATIONAL THERAPY PERSPECTIVE10DEVELOPMENT OF AN INTERGRATED SUPPORT PATHWAY FOR PATIENTS FULFILLING NICE CRITERIA FOR AN INTERNAL CARDIOVASCULAR DEBRIBRILLATOR (ICD) IN A DISTRICT GENERAL HOSPITAL11ARE CARDIOVASCULAR RISK FACTORS ALSO ASSOCIATED WITH THE INCIDENCE OF ATRIAL FIBRILLATION? A SYSTEMATIC REVIEW AND FIELD SYNOPSIS OF 23 FACTORS IN 32 INITIALLY HEALTHY COHORTS OF 20 MILLION PARTICIPANTS12BRAIN MRI FINDINGS IN PATIENTS WITH ATRIAL FIBRILLATION UNDERGOING CARDIOVERSIONBasic Science/Sudden Cardiac Death13PRELIMINARY ASSESSMENT OF THE “RE-ENTRY VULNERABILITY INDEX” AS A MARKER OF CARDIAC INSTABILITY IN THE HUMAN HEART USING WHOLE-HEART CONTACT EPICARDIAL MAPPING14OPTOGENETIC STIMULATION OF BRAINSTEM'S VAGAL PREGANGLIONIC NEURONES IS ASSOCIATED WITH NEURONAL NITRIC OXIDE SYNTHASE-DEPENDENT PROLONGATION OF VENTRICULAR EFFECTIVE REFRACTORY PERIOD15A DYNAMIC-CLAMP STUDY OF L-TYPE Ca2+ CURRENT IN RABBIT AND HUMAN ATRIAL MYOCYTES: THE CONTRIBUTION OF WINDOW ICaL TO EARLY AFTERDEPOLARISATIONS16WHOLE EXOME SEQUENCING IN SUDDEN INFANT DEATH SYNDROME17MEDIUM TERM SURVIVAL AND FAMILY SCREENING OUTCOMES IN AN IDIOPATHIC VENTRICULAR FIBRILLATION COHORT - A MULTICENTRE EXPERIENCE18CLINICAL CHARACTERISTICS OF SCD SURVIVORS WITH BRUGADA SYNDROME:- ARE SPONSANEOUS TYPE I ECG AND PREVIOUS SYNCOPE REALLY ASSOCIATED WITH HIGH RISK? Europace 2016. [DOI: 10.1093/europace/euw270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Leong KMW, Chow JJ, Ng FS, Yates S, Ian W, Lefroy D, Qureshi N, Koa-Wing M, Whinnett Z, Linton N, Davies W, Lim PB, Peters NS, Kanagaratnam P, Varnava A. 131-07: European Society of Cardiology Risk Scores in Hypertrophic Cardiomyopathy Patients with Implantable Defibrillators for Primary and Secondary Prevention. Europace 2016. [DOI: 10.1093/europace/18.suppl_1.i88c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Wilson D, Hyde E, Wilson D, Claridge S, Leong K, Salciccioli J, Conroy R, Ganesha Babu G, Scott P, Manupati S, Lazdam M, Leventogiannis G, Barr C, Morgan J, Plank G, Rinaldi C, Niederer S, Zeljko H, Leventopoulos G, Ahmed N, Thomas G, Duncan E, Rodderick P, Morgan J, Chen Z, Jackson T, Behar J, Ali M, Bostock J, Lumley M, Williams R, Assress K, De Silva K, Gill J, Perera D, Rinaldi C, Ng F, Kanapeckaite L, Hu M, Roney C, Lim P, Harding S, Peters N, Varnava A, Kanagaratnam P, Marshall D, Sykes M, Lim P, Lee S, Rotheram N, Macedo A, Cobb V, Providencia R, Srinivasan N, Ahsan S, Chow A, Murgatroyd F, Silberbauer J, Hooper J, Zaman M, Yao Z, Zaidi A, Ahmed F, Virdee M, Heck P, Agarwal S, Lee J, Grace A, Begley D, Fynn S. Posters 2. Europace 2015; 17:v22-v25. [PMCID: PMC4892099 DOI: 10.1093/europace/euv330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
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Behar J, Behar J, Providência R, Cronbach P, Siddiqui S, Brough C, Ara F, Newham W, Ng F, Ayala-Paredes F, Withers K, Hayward C, Chin H, Fearn S, Omerod J, Gamble J, Foley P, Bostock J, Claridge S, Jackson T, Sohal M, Razavi R, Betts T, Herring N, Rinaldi C, Pourmorteza A, McVeigh E, Niederer S, Claridge S, Jackson T, Sohal M, Preston R, Carr-White G, Razavi R, Rajani R, Rinaldi C, Boveda S, Defaye P, Barra S, Babu G, Ang R, Algalarrondo V, Bouzeman A, Ahsan S, Deharo JC, Sporton S, Segal O, Klug D, Lambiase P, Sadoul N, Agarwal S, Piot O, Chow A, Périer M, Fauchier L, Babuty D, Lowe M, Leclercq C, Bordachar P, Marijon E, Wilson D, Panfilo D, Greenhut S, Stegemann B, Morgan J, Nicolson W, Li A, Behr E, Ng G, Raman G, Belchambers S, Rao A, Wright D, John I, Crockford C, Kaba R, Begg G, Tayebjee M, Leong K, Hu M, Kanapeckaite L, Roney C, Lim P, Harding S, Peters N, Varnava A, Kanagaratnam P, Roux JF, Badra M, White J, Lencioni M, Carolan-Rees G, Patrick H, Griffith M, Patel H, Spiesshoefer J, Morley-Smith A, Patel K, Rosen S, DiMario C, Lyon A, Cowie M. Devices & Sudden death. Europace 2015; 17:v10-v13. [PMCID: PMC4892105 DOI: 10.1093/europace/euv331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
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Wynne-Jones G, Buck R, Varnava A, Phillips CJ, Main CJ. Impacts on work performance; what matters 6 months on? Occup Med (Lond) 2011; 61:205-8. [DOI: 10.1093/occmed/kqr005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Wynne-Jones G, Buck R, Varnava A, Phillips C, Main CJ. Impacts on work absence and performance: what really matters? Occup Med (Lond) 2009; 59:556-62. [DOI: 10.1093/occmed/kqp125] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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13
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Thaman R, Varnava A, Hamid MS, Firoozi S, Sachdev B, Condon M, Gimeno JR, Murphy R, Elliott PM, McKenna WJ. Pregnancy related complications in women with hypertrophic cardiomyopathy. Heart 2003; 89:752-6. [PMID: 12807849 PMCID: PMC1767741 DOI: 10.1136/heart.89.7.752] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To determine whether pregnancy is well tolerated in hypertrophic cardiomyopathy. SETTING Referral clinic. DESIGN The study cohort comprised 127 consecutively referred women with hypertrophic cardiomyopathy. Forty (31.5%) underwent clinical evaluation before pregnancy. The remaining 87 (68.5%) were referred after their first pregnancy. All underwent history, examination, electrocardiography, and echocardiography. Pregnancy related symptoms and complications were determined by questionnaire and review of medical and obstetric records where available. RESULTS There were 271 pregnancies in total. Thirty six (28.3%) women reported cardiac symptoms in pregnancy. Over 90% of these women had been symptomatic before pregnancy. Symptoms deteriorated during pregnancy in fewer than 10%. Of the 36 women with symptoms during pregnancy, 30 had further pregnancies. Symptoms reoccurred in 18 (60%); symptomatic deterioration was not reported. Heart failure occurred postnatally in two women (1.6%). No complications were reported in 19 (15%) women who underwent general anaesthesia and in 22 (17.4%) women who received epidural anaesthesia, three of whom had a significant left ventricular outflow tract gradient at diagnosis after pregnancy. Three unexplained intrauterine deaths occurred in women taking cardiac medication throughout pregnancy. No echocardiographic or clinical feature was a useful indicator of pregnancy related complications. CONCLUSIONS Most women with hypertrophic cardiomyopathy tolerate pregnancy well. However, rare complications can occur and therefore planned delivery and fetal monitoring are still required for some patients.
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Affiliation(s)
- R Thaman
- Department of Cardiological Sciences, St George's Hospital Medical School, London, UK
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Abstract
The direction of attentional bias in forty normal adults was assessed using a computer generated line bisection task. A 4 (viewing distance)x4 (line length)x2 (cursor starting position) repeated measures factorial design was employed. As predicted, differences in bisection performance as a function of viewing distance were observed. The findings confirmed that scanning direction (contingent upon the starting position of the cursor), but not line length, significantly modulated this effect. The direction of bias across near and far space was further clarified yielding a progressive shift from a leftward bias in near space to a rightward bias in far space. A significant interaction of distance, line length and starting position revealed differential effects for left and right starting positions as a function of viewing distance and line length. More specifically, a leftward start witnessed deviations shifting progressively from left-to-right as distance and line length increased though no comparable pattern was observed for rightward starts. The results provide important behavioural support for the suggestion that dissociated neural systems may be responsible for attending and acting in near and far space and that other lateralised functions (such as scanning strategies) can influence hemispheric activation. The findings have relevant theoretical implications as well as important implications for the clinical assessment of unilateral neglect using a standard line bisection task, both of which are discussed.
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Affiliation(s)
- A Varnava
- School of Psychology, Cardiff University, Cardiff, UK
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15
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Elliott PM, Poloniecki J, Dickie S, Sharma S, Monserrat L, Varnava A, Mahon NG, McKenna WJ. Sudden death in hypertrophic cardiomyopathy: identification of high risk patients. J Am Coll Cardiol 2000; 36:2212-8. [PMID: 11127463 DOI: 10.1016/s0735-1097(00)01003-2] [Citation(s) in RCA: 586] [Impact Index Per Article: 24.4] [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: 11/18/2022]
Abstract
OBJECTIVES We sought to identify patients with hypertrophic cardiomyopathy (HCM) at high risk of sudden death (SD). BACKGROUND Relatively low mortality rates in HCM make conventional analysis of multiple clinical risk markers for SD problematic. This study used a referral center registry to investigate a smaller number of generally accepted noninvasive risk markers. METHODS We studied 368 patients (14 to 65 years old, 239 males) with HCM. There were five variables: nonsustained ventricular tachycardia (NSVT), syncope, exercise blood pressure response (BPR), family history of sudden death (FHSD) and left ventricular wall thickness (LVWT). RESULTS During follow-up (3.6+/-2.5 years [range 2 days to 9.6 years]), 36 patients (9.8%) died, 22 of them suddenly. Two patients received heart transplants. The six-year SD-free survival rate was 91% (95% confidence interval [CI] 87% to 95%). In the Cox model, there was a significant pairwise interaction between FHSD and syncope (p = 0.01), and these were subsequently considered together. The multivariate SD risk ratios (with 95% CIs) were 1.8 for BPR (0.7 to 4.4) (p = 0.22); 5.3 for FHSD and syncope (1.9 to 14.9) (p = 0.002); 1.9 for NSVT (0.7 to 5.0) (p = 0.18) and 2.9 for LVWT (1.1 to 7.1) (p = 0.03). Patients with no risk factors (n = 203) had an estimated six-year SD-free survival rate of 95% (95% CI 91% to 99%). The corresponding six-year estimates (with 95% CIs) for one (n = 122), two (n = 36) and three (n = 7) risk factors were 93% (87% to 99%), 82% (67% to 96%) and 36% (0% to 75%), respectively. Patients with two or more risk factors had a lower six-year SD survival rate (95% CI) compared with patients with one or no risk factors (72% [56% to 88%] vs. 94% [91% to 98%]) (p = 0.0001). CONCLUSIONS This study demonstrates that patients with multiple risk factors have a substantially increased risk of SD sufficient to warrant consideration for prophylactic therapy.
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Affiliation(s)
- P M Elliott
- Department of Cardiological Sciences, St. George's Hospital Medical School, London, United Kingdom.
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16
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D'Cruz LG, Baboonian C, Phillimore HE, Taylor R, Elliott PM, Varnava A, Davison F, McKenna WJ, Carter ND. Cytosine methylation confers instability on the cardiac troponin T gene in hypertrophic cardiomyopathy. J Med Genet 2000; 37:E18. [PMID: 10978365 PMCID: PMC1734704 DOI: 10.1136/jmg.37.9.e18] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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17
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Varnava A, Baboonian C, Davison F, de Cruz L, Elliott PM, Davies MJ, McKenna WJ. A new mutation of the cardiac troponin T gene causing familial hypertrophic cardiomyopathy without left ventricular hypertrophy. Heart 1999; 82:621-4. [PMID: 10525521 PMCID: PMC1760789 DOI: 10.1136/hrt.82.5.621] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.2] [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] [Indexed: 11/04/2022] Open
Abstract
AIM To screen for a mutation of the cardiac troponin T gene in two families where there had been sudden deaths without an increase in left ventricular mass but with myocardial disarray suggesting hypertrophic cardiomyopathy. METHODS DNA from affected individuals from both families was used to screen the cardiac troponin T gene on an exon by exon basis. Mutation screening was achieved by polymerase chain reaction and direct sequencing. Where appropriate, a mutation was confirmed by restriction digest. RESULTS A novel missense mutation of exon 9 was found in the affected individuals of one of the families. This mutation at amino acid 94 resulted in the substitution of arginine for leucine and was not found in 100 normal control samples. A mutation of the cardiac troponin T gene was excluded in the second family. CONCLUSIONS A mutation of the gene for the sarcomeric protein cardiac troponin T can cause familial hypertrophic cardiomyopathy with marked myocyte disarray and frequent premature sudden death in the absence of myocardial hypertrophy at clinical or macroscopic level.
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Affiliation(s)
- A Varnava
- Department of Cardiological Sciences, St George's Hospital Medical School, Cranmer Terrace, London SW17 ORE, UK
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18
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Elliott PM, Sharma S, Varnava A, Poloniecki J, Rowland E, McKenna WJ. Survival after cardiac arrest or sustained ventricular tachycardia in patients with hypertrophic cardiomyopathy. J Am Coll Cardiol 1999; 33:1596-601. [PMID: 10334430 DOI: 10.1016/s0735-1097(99)00056-x] [Citation(s) in RCA: 148] [Impact Index Per Article: 5.9] [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: 02/08/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the survival of patients with hypertrophic cardiomyopathy (HCM) after resuscitated ventricular fibrillation or syncopal sustained ventricular tachycardia (VT/VF) when treated with low dose amiodarone or implantable cardioverter defibrillators (ICDs). BACKGROUND Prospective data on clinical outcome in patients with HCM who survive a cardiac arrest are limited, but studies conducted before the widespread use of amiodarone and/or ICD therapy suggest that over a third die within seven years from sudden cardiac death or progressive heart failure. METHODS Sixteen HCM patients with a history of VT/VF (nine male, age at VT/VF 19 +/- 8 years [range 10 to 36]) were studied. Syncopal sustained ventricular tachycardia/ventricular fibrillation occurred during or immediately after exertion in eight patients and was the initial presentation in eight. One patient had disabling neurologic deficit after VT/VF. Before VT/VF, two patients had angina, four had syncope and six had a family history of premature sudden cardiac death. After VT/VF all patients were in New York Heart Association class I or II, three had nonsustained VT during ambulatory electrocardiography and 11 had an abnormal exercise blood pressure response. After VT/VF eight patients were treated with low dose amiodarone and six received an ICD. Prophylactic therapy was declined by two patients. RESULTS Mean follow-up was 6.1 +/- 4.0 years (range 0.5 to 14.5). Cumulative survival (death or ICD discharge) for the entire cohort was 59% at five years (95% confidence interval: 33% to 84%). Thirteen (81%) patients were alive at last follow-up. Two patients died suddenly while taking low dose amiodarone, and one died due to neurologic complications of his initial cardiac arrest. Three patients had one or more appropriate ICD discharges during follow-up; the times to first shock after ICD implantation were 23, 197 and 1,124 days. CONCLUSIONS This study shows that patients with HCM who survive an episode of VT/VF remain at risk for a recurrent event. Implantable cardioverter defibrillator therapy appears to offer the best potential benefit regarding outcome.
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MESH Headings
- Adolescent
- Adult
- Amiodarone/administration & dosage
- Anti-Arrhythmia Agents/administration & dosage
- Cardiomyopathy, Hypertrophic/genetics
- Cardiomyopathy, Hypertrophic/mortality
- Cardiomyopathy, Hypertrophic/therapy
- Child
- DNA Mutational Analysis
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/prevention & control
- Defibrillators, Implantable
- Dose-Response Relationship, Drug
- Female
- Follow-Up Studies
- Genetic Predisposition to Disease/genetics
- Genetic Testing
- Heart Arrest/genetics
- Heart Arrest/mortality
- Heart Arrest/prevention & control
- Humans
- Male
- Prospective Studies
- Resuscitation
- Sarcomeres/genetics
- Survival Rate
- Tachycardia, Ventricular/genetics
- Tachycardia, Ventricular/mortality
- Tachycardia, Ventricular/therapy
- Ventricular Fibrillation/genetics
- Ventricular Fibrillation/mortality
- Ventricular Fibrillation/therapy
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Affiliation(s)
- P M Elliott
- Department of Cardiological Sciences, St. George's Hospital Medical School, London, United Kingdom
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20
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Montgomery HE, Clarkson P, Dollery CM, Prasad K, Losi MA, Hemingway H, Statters D, Jubb M, Girvain M, Varnava A, World M, Deanfield J, Talmud P, McEwan JR, McKenna WJ, Humphries S. Association of angiotensin-converting enzyme gene I/D polymorphism with change in left ventricular mass in response to physical training. Circulation 1997; 96:741-7. [PMID: 9264477 DOI: 10.1161/01.cir.96.3.741] [Citation(s) in RCA: 243] [Impact Index Per Article: 9.0] [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] [Indexed: 02/05/2023]
Abstract
BACKGROUND The absence (deletion allele [D]) of a 287-base pair marker in the ACE gene is associated with higher ACE levels than its presence (insertion allele [I]). If renin-angiotensin systems regulate left ventricular (LV) growth, then individuals of DD genotype might show a greater hypertrophic response than those of II genotype. We tested this hypothesis by studying exercise-induced LV hypertrophy. METHODS AND RESULTS Echocardiographically determined LV dimensions and mass (n=140), electrocardiographically determined LV mass and frequency of LV hypertrophy (LVH) (n=121), and plasma brain natriuretic peptide (BNP) levels (n=49) were compared at the start and end of a 10-week physical training period in male Caucasian military recruits. Septal and posterior wall thicknesses increased with training, and LV mass increased by 18% (all P<.0001). Response magnitude was strongly associated with ACE genotype: mean LV mass altered by +2.0, +38.5, and +42.3 g in II, ID and DD, respectively (P<.0001). The prevalence of electrocardiographically defined LVH rose significantly only among those of DD genotype (from 6 of 24 before training to 11 of 24 after training, P<.01). Plasma brain natriuretic peptide levels rose by 56.0 and 11.5 pg/mL for DD and II, respectively (P<.001). CONCLUSIONS Exercise-induced LV growth in young males is strongly associated with the ACE I/D polymorphism.
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Affiliation(s)
- H E Montgomery
- The Hatter Institute for Cardiovascular Research University College, London Medical Schools, University College Hospital, UK
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Abstract
Venous ultrasound imaging was compared with ascending contrast venography for the diagnosis of suspected deep vein thrombosis (DVT) in the femoral, popliteal and calf vein segments of 44 limbs in 44 patients. One femoral and one calf vein segment could not be imaged (1.5% of the segments examined), but during the same period venography failed in six patients because of an inability to cannulate a swollen limb. Ultrasound imaging compared with venography as a means of diagnosing DVT showed an overall sensitivity of 95% and a specificity of 92%. The sensitivity and specificity of ultrasound imaging for the diagnosis of both femoral and popliteal vein thromboses were 100% and 97%, respectively, and for calf vein thrombosis were 85% and 83%, respectively. This study supports the recommendation that ultrasound imaging is now the investigation of choice for the diagnosis of DVT provided that the scan is performed by an experienced vascular technologist. Ultrasound imaging may also define other pathological conditions presenting in the differential diagnosis of DVT, such as superficial thrombophlebitis and Baker's cyst.
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