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Kovacs B, Lehmann HI, Manninger M, Saguner AM, Futyma P, Duncker D, Chun J. Stereotactic arrhythmia radioablation and its implications for modern cardiac electrophysiology: results of an EHRA survey. Europace 2024; 26:euae110. [PMID: 38666444 PMCID: PMC11086561 DOI: 10.1093/europace/euae110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 04/23/2024] [Indexed: 05/12/2024] Open
Abstract
Stereotactic arrhythmia radioablation (STAR) is a treatment option for recurrent ventricular tachycardia/fibrillation (VT/VF) in patients with structural heart disease (SHD). The current and future role of STAR as viewed by cardiologists is unknown. The study aimed to assess the current role, barriers to application, and expected future role of STAR. An online survey consisting of 20 questions on baseline demographics, awareness/access, current use, and the future role of STAR was conducted. A total of 129 international participants completed the survey [mean age 43 ± 11 years, 25 (16.4%) female]. Ninety-one (59.9%) participants were electrophysiologists. Nine participants (7%) were unaware of STAR as a therapeutic option. Sixty-four (49.6%) had access to STAR, while 62 (48.1%) had treated/referred a patient for treatment. Common primary indications for STAR were recurrent VT/VF in SHD (45%), recurrent VT/VF without SHD (7.8%), or premature ventricular contraction (3.9%). Reported main advantages of STAR were efficacy in the treatment of arrhythmias not amenable to conventional treatment (49%) and non-invasive treatment approach with overall low expected acute and short-term procedural risk (23%). Most respondents have foreseen a future clinical role of STAR in the treatment of VT/VF with or without underlying SHD (72% and 75%, respectively), although only a minority expected a first-line indication for it (7% and 5%, respectively). Stereotactic arrhythmia radioablation as a novel treatment option of recurrent VT appears to gain acceptance within the cardiology community. Further trials are critical to further define efficacy, patient populations, as well as the appropriate clinical use for the treatment of VT.
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Affiliation(s)
- Boldizsar Kovacs
- Department of Cardiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, 48109 MI, USA
- Department of Cardiology, University Heart Center Zurich, Raemistrasse 100, Zurich 8091, Switzerland
| | - Helge Immo Lehmann
- Department of Cardiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, 48109 MI, USA
- Corrigan Minehan Heart Center, Massachusetts General Hospital, 55 Fruit St, Boston, 02114 MA, USA
| | - Martin Manninger
- Division of Cardiology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Ardan Muammer Saguner
- Department of Cardiology, University Heart Center Zurich, Raemistrasse 100, Zurich 8091, Switzerland
| | - Piotr Futyma
- Medical College, University of Rzeszów and St. Joseph’s Heart Rhythm Center, Rzeszów, Poland
| | - David Duncker
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Julian Chun
- Cardioangiologisches Centrum Bethanien, Agaplesion Bethanien Krankenhaus, Frankfurt, Germany
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Ghannam M, Kovacs B, Liang J, Attili A, Cochet H, Latchamsetty R, Jongnarangsin K, Morady F, Bogun F. Ventricular arrhythmias in patients with bicuspid aortic valves. J Cardiovasc Electrophysiol 2024. [PMID: 38509335 DOI: 10.1111/jce.16235] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/08/2024] [Accepted: 02/22/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION Bicuspid aortic valves (BAV) are the most common congenital heart defects and the extent of ventricular arrhythmias (VA) in patients with BAV is unclear. The objective of this study is to describe VAs and late gadolinium enhancement cardiac magnetic resonance imaging (LGE-CMR) in patients with BAV. METHODS A total of 19 patients with BAV (18 males, age: 58 ± 13 years) were referred for VA ablation procedures. Ten patients had BAVs at the time of ablation, nine patients had prior aortic valve replacement for a BAV. All but one patient had LGE-CMR and all patients underwent programmed ventricular stimulation at the time of the ablation. RESULTS Frequent PVCs were the targeted VAs in 17/19 patients and VT in 2/19 patients. Monomorphic ventricular tachycardia (VT) was inducible in 6 patients. A total of 15 VTs were inducible (2.5 ± 1.0 VTs per patient with a mean cycle length of 322 ± 83 msec). LGE was present in 13 patients. Patients with inducible VT had larger borderzone and core scar compared to non-inducible patients (7.8 ± 2.1 cm3 vs. 2.5 ± 3.1 cm3 and 5.1 ± 2.6 cm3 vs. 1.9 ± 3.0 cm3, p-value < .05 for both). PVCs and VTs were mapped to the periaortic valve area in 12 patients and 4 patients, respectively. The PVC burden was reduced from 27 ± 13 to 3 ± 6 (p < .001) and the ejection fraction improved from 49 ± 13% to 55 ± 9% (p = .005). CONCLUSIONS VAs in patients with BAV often originate from the perivalvular area and patients often have LGE and inducible VT. LGE may be due to ventricular remodeling secondary to the presence of BAV and harbors the arrhythmogenic substrate for VT.
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Affiliation(s)
- Michael Ghannam
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Boldizsar Kovacs
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Jackson Liang
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Anil Attili
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Rakesh Latchamsetty
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Krit Jongnarangsin
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Fred Morady
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Frank Bogun
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Kovacs B, Giannopoulos AA, Bogun F, Pazhenkottil AP, Bonetti NR, Manka R, Medeiros-Domingo A, Gruner C, Schmidt D, Flammer AJ, Ruschitzka F, Duru F, Kaufmann PA, Buechel RR, Saguner AM. Sustained Ventricular Tachyarrhythmias are Associated With Increased 18F-Fluorodeoxyglucose Uptake Mimicking Cardiac Sarcoidosis. Circ Cardiovasc Imaging 2024; 17:e016316. [PMID: 38456290 DOI: 10.1161/circimaging.123.016316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Affiliation(s)
- Boldizsar Kovacs
- Department of Cardiology, University Heart Center (B.K., N.R.B., R.M., C.G., D.S., A.J.F., F.R., F.D., A.M.S.), University Hospital Zurich, Switzerland
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor (B.K., F.B.)
- Center for Translational and Experimental Cardiology (CTEC) (B.K., N.R.B., C.G., D.S., A.J.F., F.R., F.D., A.M.S.), University Zurich, Switzerland
| | - Andreas A Giannopoulos
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland (A.A.G., A.P.P., P.A.K., R.R.B.)
| | - Frank Bogun
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor (B.K., F.B.)
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland (A.A.G., A.P.P., P.A.K., R.R.B.)
| | - Nicole R Bonetti
- Department of Cardiology, University Heart Center (B.K., N.R.B., R.M., C.G., D.S., A.J.F., F.R., F.D., A.M.S.), University Hospital Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC) (B.K., N.R.B., C.G., D.S., A.J.F., F.R., F.D., A.M.S.), University Zurich, Switzerland
| | - Robert Manka
- Department of Cardiology, University Heart Center (B.K., N.R.B., R.M., C.G., D.S., A.J.F., F.R., F.D., A.M.S.), University Hospital Zurich, Switzerland
- Institute of Diagnostic and Interventional Radiology (R.M.), University Hospital Zurich, Switzerland
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland (R.M.)
| | - Argelia Medeiros-Domingo
- Center for Translational and Experimental Cardiology (CTEC) (B.K., N.R.B., C.G., D.S., A.J.F., F.R., F.D., A.M.S.), University Zurich, Switzerland
- Swiss DNAlysis, Dübendorf, Switzerland (A.M.-D.)
| | - Christiane Gruner
- Department of Cardiology, University Heart Center (B.K., N.R.B., R.M., C.G., D.S., A.J.F., F.R., F.D., A.M.S.), University Hospital Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC) (B.K., N.R.B., C.G., D.S., A.J.F., F.R., F.D., A.M.S.), University Zurich, Switzerland
| | - Dörthe Schmidt
- Department of Cardiology, University Heart Center (B.K., N.R.B., R.M., C.G., D.S., A.J.F., F.R., F.D., A.M.S.), University Hospital Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC) (B.K., N.R.B., C.G., D.S., A.J.F., F.R., F.D., A.M.S.), University Zurich, Switzerland
| | - Andreas J Flammer
- Department of Cardiology, University Heart Center (B.K., N.R.B., R.M., C.G., D.S., A.J.F., F.R., F.D., A.M.S.), University Hospital Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC) (B.K., N.R.B., C.G., D.S., A.J.F., F.R., F.D., A.M.S.), University Zurich, Switzerland
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center (B.K., N.R.B., R.M., C.G., D.S., A.J.F., F.R., F.D., A.M.S.), University Hospital Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC) (B.K., N.R.B., C.G., D.S., A.J.F., F.R., F.D., A.M.S.), University Zurich, Switzerland
- Center for Integrative Human Physiology (F.R., F.D.), University Zurich, Switzerland
| | - Firat Duru
- Department of Cardiology, University Heart Center (B.K., N.R.B., R.M., C.G., D.S., A.J.F., F.R., F.D., A.M.S.), University Hospital Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC) (B.K., N.R.B., C.G., D.S., A.J.F., F.R., F.D., A.M.S.), University Zurich, Switzerland
- Center for Integrative Human Physiology (F.R., F.D.), University Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland (A.A.G., A.P.P., P.A.K., R.R.B.)
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland (A.A.G., A.P.P., P.A.K., R.R.B.)
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center (B.K., N.R.B., R.M., C.G., D.S., A.J.F., F.R., F.D., A.M.S.), University Hospital Zurich, Switzerland
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Huntrakul A, Yokokawa M, Kovacs B, Ghannam M, Liang JJ, Cochet H, Latchamsetty R, Jongnarangsin K, Morady F, Bogun F. Pleomorphism of premature ventricular complexes originating from papillary muscles and their myocardial connections. Heart Rhythm 2024; 21:36-44. [PMID: 37852565 DOI: 10.1016/j.hrthm.2023.10.012] [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: 08/14/2023] [Revised: 09/29/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Patients with arrhythmias originating from papillary muscles (PAPs) often have pleomorphic ventricular arrhythmias (PVAs) that can result in failed ablations. The mechanism of PVAs is unknown. OBJECTIVE The purpose of this study was to assess the prevalence and mechanisms of PVAs and the impact on outcomes in patients with focal left ventricular PAP ventricular arrhythmias (VAs). METHODS The sites of origin (SOOs) of VAs in 43 consecutive patients referred for ablation of focal left ventricular PAP VAs were determined by activation and pacemapping. SOOs were classified as (1) unifocal generating a single VA morphology; (2) unifocal from a deeper-seated origin generating multiple VA morphologies; (3) unifocal located on a PAP branching site; (4) multifocal from a single or multiple PAPs generating multiple VA morphologies; and (5) multifocal from a PAP and a different anatomic source. RESULTS Most patients had multiple morphologies (n = 34 [79%]) and multiple mechanisms (79%) generating the different VA morphologies. Most of the patients with PVAs had multiple SOOs from a single or different PAPs (n = 23 [68%]), followed by patients with SOOs from PAP and non-PAP sites (n = 19 [56%]). In 13 patients (38%), single SOOs accounted for the observed PVAs. The frequent observation (n = 20) of changing QRS morphologies after radiofrequency energy delivery targeting a single VA suggests the presence of a deeper focus with changing sites of preferential conduction. CONCLUSION VA pleomorphism in patients with PAP arrhythmias is most often due to premature ventricular complexes originating from different SOOs. The second most common cause is preferential conduction from a single SOO via PAP branching sites.
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Affiliation(s)
- Anurut Huntrakul
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan; Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Cardiac Center, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Miki Yokokawa
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Boldizsar Kovacs
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Michael Ghannam
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Jackson J Liang
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Hubert Cochet
- Department of Radiology, University of Bordeaux, Bordeaux, France
| | - Rakesh Latchamsetty
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Krit Jongnarangsin
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Fred Morady
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Frank Bogun
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.
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Kovacs B, Mayinger M, Ehrbar S, Fesslmeier D, Ahmadsei M, Sazgary L, Manka R, Alkadhi H, Ruschitzka F, Duru F, Papachristofilou A, Sticherling C, Blamek S, Gołba KS, Guckenberger M, Saguner AM, Andratschke N. Dose escalation for stereotactic arrhythmia radioablation of recurrent ventricular tachyarrhythmia - a phase II clinical trial. Radiat Oncol 2023; 18:185. [PMID: 37941012 PMCID: PMC10634182 DOI: 10.1186/s13014-023-02361-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/08/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Stereotactic arrhythmia radioablation (STAR) is delivered with a planning target volume (PTV) prescription dose of 25 Gy, mostly to the surrounding 75-85% isodose line. This means that the average and maximum dose received by the target is less than 35 Gy, which is the minimum threshold required to create a homogenous transmural fibrosis. Similar to catheter ablation, the primary objective of STAR should be transmural fibrosis to prevent heterogenous intracardiac conduction velocities and the occurrence of sustained ventricular arrhythmias (sVA) caused by reentry. We hypothesize that the current dose prescription used in STAR is inadequate for the long-term prevention of sVA and that a significant increase in dose is necessary to induce transmural scar formation. OBJECTIVE A single arm, multi-center, phase II, dose escalation prospective clinical trial employing the i3 + 3 design is being conducted to examine the safety of a radiation dose-escalation strategy aimed at inducing transmural scar formation. The ultimate objective of this trial is to decrease the likelihood of sVA recurrence in patients at risk. METHODS Patients with ischemic or non-ischemic cardiomyopathy and recurrent sVA, with an ICD and history of ≥ 1 catheter ablation for sVA will be included. This is a prospective, multicenter, one-arm, dose-escalation trial utilizing the i3 + 3 design, a modified 3 + 3 specifically created to overcome limitations in traditional dose-finding studies. A total of 15 patients will be recruited. The trial aims to escalate the ITV dose from 27.0 Gy to an ITV prescription dose-equivalent level of maximum 35.1 Gy by keeping the PTV prescription dose constant at 25 Gy while increasing the dose to the target (i.e. the VT substrate without PTV margin) by step-wise reduction of the prescribing isodose line (85% down to 65%). The primary outcome of this trial is safety measured by registered radiation associated adverse events (AE) up to 90 days after study intervention including radiation associated serious adverse events graded as at least 4 or 5 according to CTCAE v5, radiation pneumonitis or pericarditis requiring hospitalization and decrease in LVEF ≥ 10% as assessed by echocardiography or cardiac MRI at 90 days after STAR. The sample size was determined assuming an acceptable primary outcome event rate of 20%. Secondary outcomes include sVA burden at 6 months after STAR, time to first sVA recurrence, reduction in appropriate ICD therapies, the need for escalation of antiarrhythmic drugs, non-radiation associated safety and patient reported outcome measures such as SF-36 and EQ5D. DISCUSSION DEFT-STAR is an innovative prospective phase II trial that aims to evaluate the optimal radiation dose for STAR in patients with therapy-refractory sVA. The trial has obtained IRB approval and focuses on determining the safe and effective radiation dose to be employed in the STAR procedure. TRIAL REGISTRATION NCT05594368.
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Affiliation(s)
- Boldizsar Kovacs
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, USA
- Center for Translational and Experimental Cardiology (CTEC), University of Zurich, Zurich, Switzerland
| | - Michael Mayinger
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Stefanie Ehrbar
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Debra Fesslmeier
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Maiwand Ahmadsei
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Lorraine Sazgary
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), University of Zurich, Zurich, Switzerland
| | - Robert Manka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), University of Zurich, Zurich, Switzerland
- Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Hatem Alkadhi
- Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), University of Zurich, Zurich, Switzerland
- Center for Integrative Human Physiology, University Zurich, Zurich, Switzerland
| | - Firat Duru
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), University of Zurich, Zurich, Switzerland
- Center for Integrative Human Physiology, University Zurich, Zurich, Switzerland
| | | | | | - Slawomir Blamek
- Department of Radiotherapy, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | - Krzysztof S Gołba
- Department of Electrocardiology, Upper Silesian Heart Center, Medical University of Silesia, Katowice, Poland
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| | | | - Ardan M Saguner
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), University of Zurich, Zurich, Switzerland
- Center for Integrative Human Physiology, University Zurich, Zurich, Switzerland
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland.
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Ahmadsei M, Thaler K, Gasser E, Pouymayou B, Dal Bello R, Christ SM, Willmann J, Kovacs B, Balermpas P, Tanadini-Lang S, Saguner AM, Mayinger M, Andratschke N, Guckenberger M. Dosimetric analysis of 17 cardiac Sub-structures, Toxicity, and survival in ultra central lung tumor patients treated with SBRT. Clin Transl Radiat Oncol 2023; 43:100675. [PMID: 37744054 PMCID: PMC10511337 DOI: 10.1016/j.ctro.2023.100675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/04/2023] [Accepted: 09/07/2023] [Indexed: 09/26/2023] Open
Abstract
•Data on cardiac toxicity after SBRT for ultra-central lung tumors remains limited.•We analyzed the dose to 18 cardiac sub-structures and cardiovascular toxicity.•A SBRT regimen of 45 Gy in 8-10 fractions yields good local control and low toxicity.•The highest cardiac doses were observed in the pulmonary artery and left atrium.•Higher doses to the base of the heart seem to be associated with non-cancer deaths.
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Affiliation(s)
- Maiwand Ahmadsei
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Kai Thaler
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Elena Gasser
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Bertrand Pouymayou
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Riccardo Dal Bello
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Sebastian M. Christ
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Jonas Willmann
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Boldizsar Kovacs
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Panagiotis Balermpas
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Ardan M. Saguner
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, Zurich University Hospital, University of Zurich, 8952 Schlieren, Switzerland
| | - Michael Mayinger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
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7
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Herrera Siklody C, Schiappacasse L, Jumeau R, Reichlin T, Saguner AM, Andratschke N, Elicin O, Schreiner F, Kovacs B, Mayinger M, Huber A, Verhoeff JJC, Pascale P, Solana Muñoz J, Luca A, Domenichini G, Moeckli R, Bourhis J, Ozsahin EM, Pruvot E. Recurrences of ventricular tachycardia after stereotactic arrhythmia radioablation arise outside the treated volume: analysis of the Swiss cohort. Europace 2023; 25:euad268. [PMID: 37695314 PMCID: PMC10551232 DOI: 10.1093/europace/euad268] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/16/2023] [Indexed: 09/12/2023] Open
Abstract
AIMS Stereotactic arrhythmia radioablation (STAR) has been recently introduced for the management of therapy-refractory ventricular tachycardia (VT). VT recurrences have been reported after STAR but the mechanisms remain largely unknown. We analysed recurrences in our patients after STAR. METHODS AND RESULTS From 09.2017 to 01.2020, 20 patients (68 ± 8 y, LVEF 37 ± 15%) suffering from refractory VT were enrolled, 16/20 with a history of at least one electrical storm. Before STAR, an invasive electroanatomical mapping (Carto3) of the VT substrate was performed. A mean dose of 23 ± 2 Gy was delivered to the planning target volume (PTV). The median ablation volume was 26 mL (range 14-115) and involved the interventricular septum in 75% of patients. During the first 6 months after STAR, VT burden decreased by 92% (median value, from 108 to 10 VT/semester). After a median follow-up of 25 months, 12/20 (60%) developed a recurrence and underwent a redo ablation. VT recurrence was located in the proximity of the treated substrate in nine cases, remote from the PTV in three cases and involved a larger substrate over ≥3 LV segments in two cases. No recurrences occurred inside the PTV. Voltage measurements showed a significant decrease in both bipolar and unipolar signal amplitude after STAR. CONCLUSION STAR is a new tool available for the treatment of VT, allowing for a significant reduction of VT burden. VT recurrences are common during follow-up, but no recurrences were observed inside the PTV. Local efficacy was supported by a significant decrease in both bipolar and unipolar signal amplitude.
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Affiliation(s)
| | - Luis Schiappacasse
- Department of Radiation Oncology, CHUV, Lausanne University Hospital, Lausanne, Switzerland
| | - Raphaël Jumeau
- Department of Radiation Oncology, CHUV, Lausanne University Hospital, Lausanne, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, Universitätsspital Zürich, University Hospital Zürich, Zurich, Switzerland
| | - Nicolaus Andratschke
- Department of Radiation Oncology, Universitätsspital Zürich, University Hospital Zürich, Zurich, Switzerland
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | | | - Boldizsar Kovacs
- Department of Cardiology, Universitätsspital Zürich, University Hospital Zürich, Zurich, Switzerland
| | - Michael Mayinger
- Department of Radiation Oncology, Universitätsspital Zürich, University Hospital Zürich, Zurich, Switzerland
| | - Adrian Huber
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Joost J C Verhoeff
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Patrizio Pascale
- Department of Cardiology, CHUV, Lausanne University Hospital, Lausanne, Switzerland
| | - Jorge Solana Muñoz
- Department of Cardiology, CHUV, Lausanne University Hospital, Lausanne, Switzerland
| | - Adrian Luca
- Department of Cardiology, CHUV, Lausanne University Hospital, Lausanne, Switzerland
| | - Giulia Domenichini
- Department of Cardiology, CHUV, Lausanne University Hospital, Lausanne, Switzerland
| | - Raphael Moeckli
- Department of Radiation Oncology, CHUV, Lausanne University Hospital, Lausanne, Switzerland
| | - Jean Bourhis
- Department of Radiation Oncology, CHUV, Lausanne University Hospital, Lausanne, Switzerland
| | - Esat M Ozsahin
- Department of Radiation Oncology, CHUV, Lausanne University Hospital, Lausanne, Switzerland
| | - Etienne Pruvot
- Department of Cardiology, CHUV, Lausanne University Hospital, Lausanne, Switzerland
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8
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El‐Battrawy I, Koepsel K, Tenbrink D, Kovacs B, Dreher TC, Blockhaus C, Gotzmann M, Klein N, Kuntz T, Shin D, Lapp H, Rosenkaimer S, Abumayyaleh M, Hamdani N, Saguner AM, Kowitz J, Erath JW, Duru F, Mügge A, Akin I, Aweimer A, Beiert T. Use of the Wearable Cardioverter-Defibrillator Among Patients With Myocarditis and Reduced Ejection Fraction or Ventricular Tachyarrhythmia: Data From a Multicenter Registry. J Am Heart Assoc 2023; 12:e030615. [PMID: 37681569 PMCID: PMC10547297 DOI: 10.1161/jaha.123.030615] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 08/18/2023] [Indexed: 09/09/2023]
Abstract
Background Data on the use of the wearable cardioverter-defibrillator (WCD) among patients with myocarditis remain sparse. Consequently, evidence for guideline recommendations in this patient population is lacking. Methods and Results In total, 1596 consecutive patients were included in a multicenter registry from 8 European centers, with 124 patients (8%) having received the WCD due to myocarditis and reduced left ventricular ejection fraction or prior ventricular tachyarrhythmia. The mean age was 51.6±16.3 years, with 74% being male. Patients were discharged after index hospitalization on heart failure medication: Angiotensin-converting enzyme inhibitors (62.5%), angiotensin-receptor-neprilysin inhibitor (22.9%), aldosterone-antagonists (51%), or beta blockers (91.4%). The initial median left ventricular ejection fraction was 30% (22%-45%) and increased to 48% (39%-55%) over long-term follow-up (P<0.001). The median BNP (brain natriuretic peptide) level at baseline was 1702 pg/mL (565-3748) and decreased to 188 pg/mL (26-348) over long-term follow-up (P=0.022). The mean wear time was 79.7±52.1 days and 21.0±4.9 hours per day. Arrhythmic event rates documented by the WCD were 9.7% for nonsustained ventricular tachycardia, 6.5% for sustained ventricular tachycardia, and 0% for ventricular fibrillation. Subsequently, 2.4% of patients experienced an appropriate WCD shock. The rate of inappropriate WCD shocks was 0.8%. All 3 patients with appropriate WCD shock had experienced ventricular tachycardia/ventricular fibrillation before WCD prescription, with only 1 patient showing a left ventricular ejection fraction <35%. Conclusions Patients with myocarditis and risk for occurrence of ventricular tachyarrhythmia may benefit from WCD use. Prior ventricular arrhythmia might appear as a better risk predictor than a reduced left ventricular ejection fraction <35% in this population.
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Affiliation(s)
- Ibrahim El‐Battrawy
- Department of Cardiology and AngiologyBergmannsheil University Hospital, Ruhr University of BochumBochumGermany
- Department of Molecular and Experimental CardiologyInstitut für Forschung und Lehre (IFL), Ruhr University BochumBochumGermany
| | - Katharina Koepsel
- Department of Cardiology and AngiologyBergmannsheil University Hospital, Ruhr University of BochumBochumGermany
| | - David Tenbrink
- Department of Cardiology and AngiologyBergmannsheil University Hospital, Ruhr University of BochumBochumGermany
| | - Boldizsar Kovacs
- Department of CardiologyUniversity Heart Center, University Hospital ZurichZürichSwitzerland
| | - Tobias C. Dreher
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive CareUniversity Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg UniversityMannheimGermany
| | - Christian Blockhaus
- Department of CardiologyHeart Centre Niederrhein, Helios Clinic KrefeldKrefeldGermany
- Faculty of Health, School of MedicineUniversity Witten/HerdeckeWittenGermany
| | - Michael Gotzmann
- Cardiology and RhythmologyUniversity Hospital St. Josef‐Hospital Bochum, Ruhr University BochumBochumGermany
| | - Norbert Klein
- Department of Cardiology, Angiology and Internal Intensive‐Care MedicineKlinikum St. Georg gGmbH LeipzigLeipzigGermany
| | - Thomas Kuntz
- Department of Cardiology, Angiology and Internal Intensive‐Care MedicineKlinikum St. Georg gGmbH LeipzigLeipzigGermany
| | - Dong‐In Shin
- Department of CardiologyHeart Centre Niederrhein, Helios Clinic KrefeldKrefeldGermany
- Faculty of Health, School of MedicineUniversity Witten/HerdeckeWittenGermany
| | - Hendrik Lapp
- Department of Internal Medicine II, Heart Center BonnUniversity Hospital BonnBonnGermany
| | - Stephanie Rosenkaimer
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive CareUniversity Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg UniversityMannheimGermany
| | - Mohammad Abumayyaleh
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive CareUniversity Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg UniversityMannheimGermany
- German Center for Cardiovascular Research (DZHK)Partner Site Heidelberg‐MannheimMannheimGermany
| | - Nazha Hamdani
- Department of Molecular and Experimental CardiologyInstitut für Forschung und Lehre (IFL), Ruhr University BochumBochumGermany
| | - Ardan Muammer Saguner
- Department of CardiologyUniversity Heart Center, University Hospital ZurichZürichSwitzerland
| | - Jacqueline Kowitz
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive CareUniversity Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg UniversityMannheimGermany
| | - Julia W. Erath
- Department of Cardiology, Frankfurt University HospitalGoethe UniversityFrankfurt am MainGermany
| | - Firat Duru
- Department of CardiologyUniversity Heart Center, University Hospital ZurichZürichSwitzerland
| | - Andreas Mügge
- Department of Cardiology and AngiologyBergmannsheil University Hospital, Ruhr University of BochumBochumGermany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive CareUniversity Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg UniversityMannheimGermany
- German Center for Cardiovascular Research (DZHK)Partner Site Heidelberg‐MannheimMannheimGermany
| | - Assem Aweimer
- Department of Cardiology and AngiologyBergmannsheil University Hospital, Ruhr University of BochumBochumGermany
| | - Thomas Beiert
- Department of Internal Medicine II, Heart Center BonnUniversity Hospital BonnBonnGermany
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9
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Kovacs B, Ghannam M, Liang J, Moccoro E, Attili A, Cochet H, Helms A, Latchamsetty R, Jongnarangsin K, Morady F, Bogun F. Value of genotyping and scar-phenotyping for VT ablation procedures in patients with nonischemic left ventricular cardiomyopathies. J Cardiovasc Electrophysiol 2023; 34:1835-1842. [PMID: 37579221 DOI: 10.1111/jce.16039] [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: 05/08/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Variants of cardiomyopathy genes in patients with nonischemic cardiomyopathy (NICM) generate various phenotypes of cardiac scar and delayed enhancement cardiac magnetic resonance (DE-CMR) imaging which may impact ventricular tachycardia (VT) management. METHODS The objective was to compare the findings of cardiomyopathy genetic testing on DE-CMR imaging and long-term outcomes among patients with NICM undergoing VT ablation procedures. Image phenotyping and genotyping were performed in a consecutive series of patients referred for VT ablation and correlated to survival free of VT. Scar depth index (SDI) (% of scar at 0-3 mm, 3-5 mm and >5 mm projected on the closest endocardial surface) was determined. RESULTS Forty-three patients were included (11 women, 55 ± 14 years, ejection fraction (EF) 45 ± 16%) and were followed for 3.4 ± 2.9 years. Pathogenic variants (PV) were identified in 16 patients (37%) in the following genes: LMNA (n = 5), TTN (n = 5), DSP (n = 2), AMLS1 (n = 1), MYBPC3 (n = 1), PLN (n = 1), and SCN5A (n = 1). A ring-like septal scar (RLSS) pattern was more often seen in patients with pathogenic variants (66% vs 15%, p = .001). RLSS was associated with deeper seated scars (SDI >5 mm 30.6 ± 22.6% vs 12.4 ± 16.2%, p = .005), and increased VT recurrence (HR 5.7 95% CI[1.8-18.4], p = .003). After adjustment for age, sex, EF, and total scar burden, the presence of a PV remained independently associated with worse outcomes (HR 4.7 95% CI[1.22-18.0], p = .02). CONCLUSIONS Preprocedural genotyping and scar phenotyping is beneficial to identify patients with a favorable procedural outcome. Some PVs are associated with an intramural, deeper seated scar phenotype and have an increase of VT recurrence after ablation.
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Affiliation(s)
- Boldizsar Kovacs
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael Ghannam
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Jackson Liang
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Emmeline Moccoro
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Anil Attili
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Hubert Cochet
- Department of Radiology, University of Bordeaux, Bordeaux, France
| | - Adam Helms
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Rakesh Latchamsetty
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Krit Jongnarangsin
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Fred Morady
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Frank Bogun
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
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10
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Abumayyaleh M, Koepsel K, Aweimer A, Ewers A, Erath JW, Kuntz T, Klein N, Kovacs B, Duru F, Saguner AM, Blockhaus C, Shin DI, Gotzmann M, Lapp H, Beiert T, Mügge A, El-Battrawy I, Akin I. Characteristics and outcome of wearable cardioverter-defibrillator therapy stratified by gender: Insights from a multicenter international registry. J Cardiovasc Electrophysiol 2023; 34:1502-1505. [PMID: 37051873 DOI: 10.1111/jce.15905] [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: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/14/2023]
Affiliation(s)
- Mohammad Abumayyaleh
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research (DZHK)), Partner Site, Heidelberg/Mannheim, Heidelberg University, Mannheim, Germany
| | - Katharina Koepsel
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
| | - Assem Aweimer
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
| | - Aydan Ewers
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
| | - Julia W Erath
- Department of Cardiology/Division of Clinical Electrophysiology, University Hospital Frankfurt, Goethe University, Frankfurt, Hessen, Germany
| | - Thomas Kuntz
- Department of Arrhythmias & Invasive Cardiology, St. Georg Hospital, Leipzig, Germany
| | - Norbert Klein
- Department of Arrhythmias & Invasive Cardiology, St. Georg Hospital, Leipzig, Germany
| | - Boldizsar Kovacs
- Department of Cardiology, University Hospital Zurich, University Heart Center, Zurich, Switzerland
| | - Firat Duru
- Department of Cardiology, University Hospital Zurich, University Heart Center, Zurich, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Hospital Zurich, University Heart Center, Zurich, Switzerland
| | - Christian Blockhaus
- Department of Cardiology Heart Centre Niederrhein Helios Clinic Krefeld Germany, Krefeld, Germany
- School of Medicine, Faculty of Health, University Witten/Herdecke, Witten, Germany
| | - Dong-In Shin
- Department of Cardiology Heart Centre Niederrhein Helios Clinic Krefeld Germany, Krefeld, Germany
- School of Medicine, Faculty of Health, University Witten/Herdecke, Witten, Germany
| | - Michael Gotzmann
- University Hospital St. Josef-Hospital Bochum, Cardiology and Rhythmology, Ruhr University Bochum, Bochum, Germany
| | - Hendrik Lapp
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Thomas Beiert
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Andreas Mügge
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
- Department of Molecular and Experimental Cardiology, Institut für Forschung und Lehre (IFL), Ruhr-University Bochum, Bochum, Germany
| | - Ibrahim El-Battrawy
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
- Department of Molecular and Experimental Cardiology, Institut für Forschung und Lehre (IFL), Ruhr-University Bochum, Bochum, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research (DZHK)), Partner Site, Heidelberg/Mannheim, Heidelberg University, Mannheim, Germany
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11
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Ghannam M, Kovacs B, Liang JJ, Mocorro-Ma EN, Attili AK, Helms A, Latchamsetty R, Jongnarangsin K, Morady F, Bogun FM. VALUE OF GENOTYPING AND SCAR-PHENOTYPING FOR VT ABLATION PROCEDURESIN PATIENTS WITH NONISCHEMIC LEFT VENTRICULAR CARDIOMYOPATHIES. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00510-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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12
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El-Battrawy I, Tenbrink D, Kovacs B, Dreher TC, Blockhaus C, Klein N, Shin DI, Hijazi M, Rosenkaimer S, Beiert T, Abumayyaleh M, Saguner AM, Kowitz J, Erath JW, Duru F, Mügge A, Aweimer A, Akin I. Age differences of patients treated with wearable cardioverter defibrillator: Data from a multicentre registry. Eur J Clin Invest 2023:e13977. [PMID: 36852491 DOI: 10.1111/eci.13977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/17/2023] [Accepted: 02/19/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Wearable cardioverter defibrillators (WCD) are used as a 'bridging' technology in patients, who are temporarily at high risk for sudden cardiac death (SCD). Several factors should be taken into consideration, for example patient selection, compliance and optimal drug treatment, when WCD is prescribed. We aimed to present real-world data from seven centres from Germany and Switzerland according to age differences regarding the outcome, prognosis, WCD data and compliance. MATERIALS AND METHODS Between 04/2012 and 03/2021, 1105 patients were included in this registry. Outcome data according to age differences (old ≥45 years compared to young <45 years) were analysed. At young age, WCDs were more often prescribed due to congenital heart disease and myocarditis. On the other hand, ischaemic cardiomyopathy (ICM) was more present in older patients. Wear days of WCD were similar between both groups (p = .115). In addition, during the WCD use, documented arrhythmic life-threatening events were comparable [sustained ventricular tachycardia: 5.8% vs. 7.7%, ventricular fibrillation (VF) .5% vs. .6%] and consequently the rate of appropriate shocks was similar between both groups. Left ventricular ejection fraction improvement was documented over follow-up with a better improvement in younger patients as compared to older patients (77% vs. 63%, p = .002). In addition, at baseline, the rate of atrial fibrillation was significantly higher in the older age group (23% vs. 8%; p = .001). The rate of permanent cardiac implantable electronic device implantation (CiED) was lower in the younger group (25% vs. 36%, p = .05). The compliance rate defined as wearing WCD at least 20 h per day was significantly lower in young patients compared to old patients (68.9% vs. 80.9%, p < .001). During the follow-up, no significant difference regarding all-cause mortality or arrhythmic death was documented in both groups. A low compliance rate of wearing WCD is predicted by young patients and patients suffering from non-ischaemic cardiomyopathies. CONCLUSION Although the compliance rate in different age groups is high, the average wear hours tended to be lower in young patients compared to older patients. The clinical events were similar in younger patients compared to older patients.
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Affiliation(s)
- Ibrahim El-Battrawy
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany.,Department of Molecular and Experimental Cardiology, Institut für Forschung und Lehre (IFL), Ruhr University Bochum, Bochum, Germany.,Institute of Physiology, Ruhr University Bochum, Bochum, Germany
| | - David Tenbrink
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
| | - Boldizsar Kovacs
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zürich, Switzerland
| | - Tobias C Dreher
- Faculty Medicine of Heidelberg, University Mannheim, University Heidelberg, Mannheim, Germany
| | - Christian Blockhaus
- Department of Cardiology, Heart Centre Niederrhein, Helios Clinic Krefeld, Krefeld, Germany.,Faculty of Health, School of Medicine, University Witten/Herdecke, Witten, Germany
| | - Norbert Klein
- Department of Cardiology, Angiology and Internal Intensive-Care Medicine, Klinikum St. Georg gGmbH Leipzig, Leipzig, Germany.,Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Dong-In Shin
- Department of Cardiology, Heart Centre Niederrhein, Helios Clinic Krefeld, Krefeld, Germany.,Faculty of Health, School of Medicine, University Witten/Herdecke, Witten, Germany
| | - Mido Hijazi
- Department of Neurosurgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Stephanie Rosenkaimer
- Faculty Medicine of Heidelberg, University Mannheim, University Heidelberg, Mannheim, Germany
| | - Thomas Beiert
- Faculty Medicine of Heidelberg, University Mannheim, University Heidelberg, Mannheim, Germany
| | - Mohammad Abumayyaleh
- Faculty Medicine of Heidelberg, University Mannheim, University Heidelberg, Mannheim, Germany
| | - Ardan Muammer Saguner
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zürich, Switzerland
| | - Jacqueline Kowitz
- Faculty Medicine of Heidelberg, University Mannheim, University Heidelberg, Mannheim, Germany
| | - Julia W Erath
- Department of Cardiology, Frankfurt University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Firat Duru
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zürich, Switzerland
| | - Andreas Mügge
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany.,Department of Molecular and Experimental Cardiology, Institut für Forschung und Lehre (IFL), Ruhr University Bochum, Bochum, Germany.,Institute of Physiology, Ruhr University Bochum, Bochum, Germany
| | - Assem Aweimer
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
| | - Ibrahim Akin
- Faculty Medicine of Heidelberg, University Mannheim, University Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg-Mannheim, Mannheim, Germany
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13
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Kovacs B, Yakupoglu HY, Eriksson U, Krasniqi N, Duru F. Medical therapy with flecainide and propafenone in atrial fibrillation: Long-term clinical experience in the tertiary care setting. Cardiol J 2023; 30:82-90. [PMID: 36510792 PMCID: PMC9987554 DOI: 10.5603/cj.a2022.0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 05/21/2022] [Accepted: 05/23/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Flecainide and propafenone are Class Ic antiarrhythmic drugs that block the cardiac fast inwards Na+ current and are used for rhythm control in patients with atrial fibrillation (AF). However, data on long-term clinical efficacy and safety of these drugs in a real-world setting are scarce. METHODS Patients with AF who received chronic flecainide or propafenone therapy were retrospectively studied from the database of a tertiary care center. The primary outcome of the study was clinical efficacy of Class Ic antiarrhythmics, which was assessed based on the improvement of arrhythmia-related symptoms at the time of last follow-up. RESULTS Among the 361 patients (261 males, 72.3%) with a mean age of 56 ± 12 years, 287 (79.5%) were using long-term flecainide, and 74 (20.5%) patients propafenone. The majority of the patients had paroxysmal AF (n = 331, 91.7%) and had an atrioventricular-nodal blocking co-medication (n = 287, 79.5%). A total of 117 (32%) patients discontinued therapy after a median of 210 days (interquartile range 62-855 days). Clinical efficacy was observed in 188 (52%) patients. The most common reason for therapy discontinuation was adverse drug effects, particularly proarrhythmic effects (48% for flecainide and 33% for propafenone). Patients who did not clinically benefit from Class Ic antiarrhythmics more often underwent pulmonary vein isolation (p = 0.02). CONCLUSIONS Long-term therapy with Class Ic antiarrhythmics showed clinical efficacy in approximately half of the patients with paroxysmal or persistent AF. However, these drugs were also associated with a relatively high rate of adverse events, and in particular proarrhythmic effects, which often resulted in therapy discontinuation rendering appropriate patient selection and therapy surveillance essential.
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Affiliation(s)
- Boldizsar Kovacs
- Department of Cardiology, University Heart Center, Zurich, Switzerland.,Division of Cardiology, GZO - R egional Health Center, Wetzikon, Switzerland
| | - Haci Yakup Yakupoglu
- Department of Cardiology, University Heart Center, Zurich, Switzerland.,Division of Cardiology, GZO - R egional Health Center, Wetzikon, Switzerland.,Division of Cardiology, Medical University Department, Kantonsspital Aarau, Switzerland
| | - Urs Eriksson
- Department of Cardiology, University Heart Center, Zurich, Switzerland.,Division of Cardiology, GZO - R egional Health Center, Wetzikon, Switzerland.,Center for Integrative Human Physiology, University of Zurich, Switzerland
| | - Nazmi Krasniqi
- Department of Cardiology, University Heart Center, Zurich, Switzerland.,Division of Cardiology, GZO - R egional Health Center, Wetzikon, Switzerland
| | - Firat Duru
- Department of Cardiology, University Heart Center, Zurich, Switzerland. .,Division of Cardiology, GZO - R egional Health Center, Wetzikon, Switzerland. .,Center for Integrative Human Physiology, University of Zurich, Switzerland.
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14
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Mayinger M, Boda-Heggemann J, Mehrhof F, Krug D, Hohmann S, Xie J, Ehrbar S, Kovacs B, Merten R, Grehn M, Zaman A, Fleckenstein J, Kaestner L, Buergy D, Rudic B, Kluge A, Boldt LH, Dunst J, Bonnemeier H, Saguner AM, Andratschke N, Blanck O, Schweikard A. Quality assurance process within the RAdiosurgery for VENtricular TAchycardia (RAVENTA) trial for the fusion of electroanatomical mapping and radiotherapy planning imaging data in cardiac radioablation. Phys Imaging Radiat Oncol 2022; 25:100406. [PMID: 36655216 PMCID: PMC9841340 DOI: 10.1016/j.phro.2022.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 12/27/2022] Open
Abstract
A novel quality assurance process for electroanatomical mapping (EAM)-to-radiotherapy planning imaging (RTPI) target transport was assessed within the multi-center multi-platform framework of the RAdiosurgery for VENtricular TAchycardia (RAVENTA) trial. A stand-alone software (CARDIO-RT) was developed to enable platform independent registration of EAM and RTPI of the left ventricle (LV), based on pre-generated radiotherapy contours (RTC). LV-RTC were automatically segmented into the American-Heart-Association 17-segment-model and a manual 3D-3D method based on EAM 3D-geometry data and a semi-automated 2D-3D method based on EAM screenshot projections were developed. The quality of substrate transfer was evaluated in five clinical cases and the structural analyses showed substantial differences between manual target transfer and target transport using CARDIO-RT.
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Affiliation(s)
- Michael Mayinger
- Department of Radiation Oncology, University Hospital Zürich, University of Zürich, Zürich, Switzerland,Corresponding author.
| | - Judit Boda-Heggemann
- Department of Radiation Oncology, University Medicine Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Felix Mehrhof
- Department of Radiation Oncology, Charité University Medicine Berlin, Berlin, Germany
| | - David Krug
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Stephan Hohmann
- Department of Cardiology and Angiology, Hannover Heart Rhythm Center, Hannover Medical School, Hannover, Germany
| | - Jingyang Xie
- Institute for Robotics and Cognitive Systems, Univesity of Lübeck, Lübeck, Germany
| | - Stefanie Ehrbar
- Department of Radiation Oncology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Boldizsar Kovacs
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Switzerland
| | - Roland Merten
- Department of Radiotherapy, Hannover Medical School, Hannover, Germany
| | - Melanie Grehn
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Adrian Zaman
- Department of Internal Medicine III, Section for Electrophysiology und Rhythmology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Jens Fleckenstein
- Department of Radiation Oncology, University Medicine Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Lena Kaestner
- Department of Radiation Oncology, University Medicine Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Daniel Buergy
- Department of Radiation Oncology, University Medicine Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Boris Rudic
- Medizinische Klinik I, Abteilung für Elektrophysiologie und Rhythmologie, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Anne Kluge
- Department of Radiation Oncology, Charité University Medicine Berlin, Berlin, Germany
| | - Leif-Hendrik Boldt
- Department of Cardiology, University Medicine Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Jürgen Dunst
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Hendrik Bonnemeier
- Department of Internal Medicine III, Section for Electrophysiology und Rhythmology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Ardan M. Saguner
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Switzerland
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Oliver Blanck
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Achim Schweikard
- Institute for Robotics and Cognitive Systems, Univesity of Lübeck, Lübeck, Germany
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15
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Kovacs B, Mayinger M, Andratschke N, Saguner AM. Stereotactic arrhythmia radioablation: competitor or adjunct to catheter ablation? Eur Heart J 2022; 43:3279-3281. [PMID: 35947872 DOI: 10.1093/eurheartj/ehac435] [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: 11/13/2022] Open
Affiliation(s)
- Boldizsar Kovacs
- Arrhythmia Unit, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Michael Mayinger
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Ardan M Saguner
- Arrhythmia Unit, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
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Abumayyaleh M, Dreher TC, Rosenkaimer S, Röger S, Erath JW, Klein N, Kovacs B, Duru F, Saguner AM, El-Battrawy I, Akin I. Sex differences and adherence of patients treated with wearable cardioverter-defibrillator: insights from an international multicenter register. J Cardiovasc Electrophysiol 2022; 33:2243-2249. [PMID: 35930623 DOI: 10.1111/jce.15648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 07/13/2022] [Accepted: 07/24/2022] [Indexed: 11/28/2022]
Abstract
AIMS Treatment with the wearable cardioverter defibrillator (WCD) may protect against sudden cardiac death (SCD) as a bridging therapy until a cardioverter-defibrillator may be implanted. We analyzed in a multicenter setting a consecutive patient cohort wearing WCD to explore sex differences. METHODS AND RESULTS We analyzed 708 consecutive patients, 579 (81.8%) from whom were males and 129 (18.2%) females (age, 60.5±14 vs. 61.6±17 years old; p=0.44). While the rate of ischemic cardiomyopathy (ICM) as a cause of prescription of WCD was significantly higher in males as compared to females (42.7% vs. 26.4%; p=0.001), females received it more frequently due to non-ischemic cardiomyopathy (NICM) (55.8% vs. 42.7%); p=0.009). The wear time of WCD was equivalent in both groups (21.1±4.3 hours/days in males vs. 21.5±4.4 hours/days in females; p=0.27; and 62.6±44.3 days in males vs. 56.5±39 days in females; p=0.15). Mortality was comparable in both groups at 2-year-follow-up (6.8% in males vs. 9.7% in females; p=0.55). Appropriate WCD shocks and the incidence of ICD implantations were similar in both groups (2.4% in males vs. 3.9% in females; p=0.07) (35.1% in males vs. 31.8% in females; p=0.37), respectively. In age tertile analysis, compliance was observed more in 73-91 years old group as compared to 14-51 years old group (87.8% vs. 68.3%; p<0.001). CONCLUSION Compliance for wearing WCD was excellent regardless of sex. Furthermore, mortality and the incidence of ICD implantations were comparable in both sexes. Appropriate WCD shocks were similar in both sexes. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Mohammad Abumayyaleh
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Tobias C Dreher
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Stephanie Rosenkaimer
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Susanne Röger
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Julia W Erath
- Department of Cardiology/Division of Clinical Electrophysiology, University Hospital Frankfurt, Goethe University, Frankfurt a. M., Germany
| | - Norbert Klein
- Department of Arrhythmias & Invasive Cardiology, St. Georg Hospital, Leipzig, Germany
| | - Boldizsar Kovacs
- Department of Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | - Firat Duru
- Department of Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | - Ibrahim El-Battrawy
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
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17
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Kluge A, Ehrbar S, Grehn M, Fleckenstein J, Baus WW, Siebert FA, Schweikard A, Andratschke N, Mayinger MC, Boda-Heggemann J, Buergy D, Celik E, Krug D, Kovacs B, Saguner AM, Rudic B, Bergengruen P, Boldt LH, Stauber A, Zaman A, Bonnemeier H, Dunst J, Budach V, Blanck O, Mehrhof F. Treatment Planning for Cardiac Radioablation: Multicenter Multiplatform Benchmarking for the XXX Trial. Int J Radiat Oncol Biol Phys 2022; 114:360-372. [PMID: 35716847 DOI: 10.1016/j.ijrobp.2022.06.056] [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] [Received: 01/03/2022] [Revised: 05/15/2022] [Accepted: 06/05/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Cardiac radioablation is a novel treatment option for patients with refractory ventricular tachycardia (VT) unsuitable for catheter ablation. The quality of treatment planning depends on dose specifications, platform capabilities, and experience of the treating staff. To harmonize the treatment planning, benchmarking of this process is necessary for multicenter clinical studies such as the XXX trial. METHODS AND MATERIALS Planning computed tomography data and consensus structures from three patients were sent to five academic centers for independent plan development using a variety of platforms and techniques with the XXX study protocol serving as guideline. Three-dimensional dose distributions and treatment plan details were collected and analyzed. In addition, an objective relative plan quality ranking system for VT treatments was established. RESULTS For each case, three coplanar volumetric modulated arc (VMAT) plans for C-arm linear accelerators (LINAC) and three non-coplanar treatment plans for robotic arm LINAC were generated. All plans were suitable for clinical applications with minor deviations from study guidelines in most centers. Eleven of 18 treatment plans showed maximal one minor deviation each for target and cardiac substructures. However, dose-volume histograms showed substantial differences: in one case, the PTV≥30Gy ranged from 0.0% to 79.9% and the RIVA V14Gy ranged from 4.0% to 45.4%. Overall, the VMAT plans had steeper dose gradients in the high dose region, while the plans for the robotic arm LINAC had smaller low dose regions. Thereby, VMAT plans required only about half as many monitor units, resulting in shorter delivery times, possibly an important factor in treatment outcome. CONCLUSIONS Cardiac radioablation is feasible with robotic arm and C-arm LINAC systems with comparable plan quality. Although cross-center training and best practice guidelines have been provided, further recommendations, especially for cardiac substructures, and ranking of dose guidelines will be helpful to optimize cardiac radioablation outcomes.
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Affiliation(s)
- Anne Kluge
- Klinik für Radioonkologie und Strahlentherapie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Stefanie Ehrbar
- Klinik für Radio-Onkologie, UniversitätsSpital Zürich, University of Zurich, Zürich, CH
| | - Melanie Grehn
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Jens Fleckenstein
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Wolfgang W Baus
- Department of Radiation Oncology and Cyberknife Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Frank-Andre Siebert
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Achim Schweikard
- University of Lübeck, Institute for Robotic and Cognitive Systems, Lübeck, Germany
| | - Nicolaus Andratschke
- Klinik für Radio-Onkologie, UniversitätsSpital Zürich, University of Zurich, Zürich, CH
| | - Michael C Mayinger
- Klinik für Radio-Onkologie, UniversitätsSpital Zürich, University of Zurich, Zürich, CH
| | - Judit Boda-Heggemann
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Daniel Buergy
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Eren Celik
- Department of Radiation Oncology and Cyberknife Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - David Krug
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Boldizsar Kovacs
- Universitäres Herzzentrum, Klinik für Kardiologie, UniversitätsSpital Zürich, University of Zurich, Zürich, CH
| | - Ardan M Saguner
- Universitäres Herzzentrum, Klinik für Kardiologie, UniversitätsSpital Zürich, University of Zurich, Zürich, CH
| | - Boris Rudic
- Medizinische Klinik, Universitätsmedizin Mannheim and German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Paula Bergengruen
- Klinik für Radioonkologie und Strahlentherapie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Leif-Hendrik Boldt
- Med. Klinik m.S. Kardiologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Annina Stauber
- Department of Radiation Oncology and Cyberknife Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Adrian Zaman
- Klinik für Innere Medizin III, Abteilung für Elektrophysiologie und Rhythmologie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Hendrik Bonnemeier
- Klinik für Innere Medizin III, Abteilung für Elektrophysiologie und Rhythmologie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Jürgen Dunst
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Volker Budach
- Klinik für Radioonkologie und Strahlentherapie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Oliver Blanck
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Felix Mehrhof
- Klinik für Radioonkologie und Strahlentherapie, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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18
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Kovacs B. AP-517-03 WHOLE EXOME SEQUENCING IDENTIFIES TWO NOVEL EXTREMELY RARE CANDIDATE VARIANTS ASSOCIATED WITH THE SHORT QT SYNDROME IN TWO LARGE PEDIGREES. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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19
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El-Battrawy I, Kovacs B, Dreher TC, Klein N, Rosenkaimer S, Röger S, Kuschyk J, Saguner AM, Kowitz J, Erath JW, Duru F, Akin I. Real life experience with the wearable cardioverter-defibrillator in an international multicenter Registry. Sci Rep 2022; 12:3203. [PMID: 35217697 PMCID: PMC8881447 DOI: 10.1038/s41598-022-06007-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 12/20/2021] [Indexed: 01/10/2023] Open
Abstract
Patients at high risk for sudden cardiac death (SCD) may benefit from wearable cardioverter defibrillators (WCD) by avoiding immediate implantable cardioverter defibrillator (ICD) implantation. Different factors play an important role including patient selection, compliance and optimal drug treatment. We aimed to present real world data from 4 centers from Germany and Switzerland. Between 04/2012 and 03/2019, 708 patients were included in this registry. Patients were followed up over a mean time of 28 ± 35.5 months. Outcome data including gender differences and different etiologies of cardiomyopathy were analyzed. Out of 708 patients (81.8% males, mean age 61.0 ± 14.6), 44.6% of patients had non-ischemic cardiomyopathy, 39.8% ischemic cardiomyopathy, 7.9% myocarditis, 5.4% prior need for ICD explantation and 2.1% channelopathy. The mean wear time of WCD was 21.2 ± 4.3 h per day. In 46% of patients, left ventricular ejection fraction (LVEF) was > 35% during follow-up. The younger the patient was, the higher the LVEF and the lower the wear hours per day were. The total shock rate during follow-up was 2.7%. Whereas an appropriate WCD shock was documented in 16 patients (2.2%), 3 patients received an inappropriate ICD shock (0.5%). During follow-up, implantation of a cardiac implantable electronic device was carried out in 34.5% of patients. When comparing German patients (n = 516) to Swiss patients (n = 192), Swiss patients presented with longer wear days (70.72 ± 49.47 days versus 58.06 ± 40.45 days; p = 0.001) and a higher ICD implantation rate compared to German patients (48.4% versus 29.3%; p = 0.001), although LVEF at follow-up was similar between both groups. Young age is a negative independent predictor for the compliance in this large registry. The most common indication for WCD was non-ischemic cardiomyopathy followed by ischemic cardiomyopathy. The compliance rate was generally high with a decrease of wear hours per day at younger age. Slight differences were found between Swiss and German patients, which might be related to differences in mentality for ICD implantation.
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Affiliation(s)
- Ibrahim El-Battrawy
- grid.5570.70000 0004 0490 981XBergmannsheil University Medical Center, Ruhr University Bochum, Bochum, Germany ,grid.5570.70000 0004 0490 981XDepartment of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
| | - Boldizsar Kovacs
- grid.412004.30000 0004 0478 9977Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Tobias C. Dreher
- grid.5601.20000 0001 0943 599XUniversity of Mannheim, Mannheim, Germany
| | - Norbert Klein
- grid.470221.20000 0001 0690 7373Department of Cardiology, Angiology and Internal Intensive-Care Medicine, Klinikum St. Georg gGmbH Leipzig, Delitzscher Straße 141, 04129 Leipzig, Germany
| | | | - Susanne Röger
- grid.5601.20000 0001 0943 599XUniversity of Mannheim, Mannheim, Germany
| | - Jürgen Kuschyk
- grid.5601.20000 0001 0943 599XUniversity of Mannheim, Mannheim, Germany
| | - Ardan Muammer Saguner
- grid.412004.30000 0004 0478 9977Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Jacqueline Kowitz
- grid.5601.20000 0001 0943 599XUniversity of Mannheim, Mannheim, Germany
| | - Julia W. Erath
- grid.7839.50000 0004 1936 9721Department of Cardiology, Frankfurt University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Firat Duru
- grid.412004.30000 0004 0478 9977Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Ibrahim Akin
- grid.5601.20000 0001 0943 599XUniversity of Mannheim, Mannheim, Germany
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20
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Neubauer J, Kissel CK, Bolliger SA, Barbon D, Thali MJ, Kloiber D, Bode PK, Kovacs B, Graf U, Maspoli A, Berger W, Saguner AM, Haas C. Benefits and outcomes of a new multidisciplinary approach for the management and financing of sudden unexplained death cases in a forensic setting in Switzerland. Forensic Sci Int 2022; 334:111240. [DOI: 10.1016/j.forsciint.2022.111240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/01/2022] [Accepted: 02/22/2022] [Indexed: 12/29/2022]
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21
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El‐Battrawy I, Lan H, Cyganek L, Maywald L, Zhong R, Zhang F, Xu Q, Lee J, Duperrex E, Hierlemann A, Saguner AM, Duru F, Kovacs B, Huang M, Liao Z, Albers S, Müller J, Dinkel H, Rose L, Hohn A, Yang Z, Qiao L, Li Y, Lang S, Kleinsorge M, Mügge A, Aweimer A, Fan X, Diecke S, Akin I, Li G, Zhou X. Deciphering the pathogenic role of a variant with uncertain significance for short QT and Brugada syndromes using gene-edited human-induced pluripotent stem cell-derived cardiomyocytes and preclinical drug screening. Clin Transl Med 2021; 11:e646. [PMID: 34954893 PMCID: PMC8710296 DOI: 10.1002/ctm2.646] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/24/2021] [Accepted: 10/30/2021] [Indexed: 12/22/2022] Open
Affiliation(s)
- Ibrahim El‐Battrawy
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM), University of HeidelbergMannheimGermany
- DZHK (German Center for Cardiovascular Research)Partner Site Heidelberg‐Mannheim and GöttingenMannheimGermany
- Department of Cardiology and AngiologyBergmannsheil Bochum, Medical Clinic IIRuhr UniversityBochumGermany
| | - Huan Lan
- Key Laboratory of Medical Electrophysiology of Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan ProvinceInstitute of Cardiovascular Research, Southwest Medical UniversityLuzhouChina
| | - Lukas Cyganek
- Stem Cell Unit, Clinic for Cardiology and PneumologyUniversity Medical Center GöttingenGöttingenGermany
- DZHK (German Center for Cardiovascular Research)Partner Site Heidelberg‐Mannheim and GöttingenMannheimGermany
| | - Lasse Maywald
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM), University of HeidelbergMannheimGermany
- DZHK (German Center for Cardiovascular Research)Partner Site Heidelberg‐Mannheim and GöttingenMannheimGermany
| | - Rujia Zhong
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM), University of HeidelbergMannheimGermany
| | - Feng Zhang
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM), University of HeidelbergMannheimGermany
| | - Qiang Xu
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM), University of HeidelbergMannheimGermany
| | - Jihyun Lee
- Department of Biosystems Science and EngineeringBioengineering LaboratoryBaselSwitzerland
| | - Eliane Duperrex
- Department of Biosystems Science and EngineeringBioengineering LaboratoryBaselSwitzerland
| | - Andreas Hierlemann
- Department of Biosystems Science and EngineeringBioengineering LaboratoryBaselSwitzerland
| | - Ardan M. Saguner
- Department of CardiologyElectrophysiology DivisionUniversity Heart Center ZurichZurichSwitzerland
| | - Firat Duru
- Department of CardiologyElectrophysiology DivisionUniversity Heart Center ZurichZurichSwitzerland
| | - Boldizsar Kovacs
- Department of CardiologyElectrophysiology DivisionUniversity Heart Center ZurichZurichSwitzerland
| | - Mengying Huang
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM), University of HeidelbergMannheimGermany
| | - Zhenxing Liao
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM), University of HeidelbergMannheimGermany
| | - Sebastian Albers
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM), University of HeidelbergMannheimGermany
- DZHK (German Center for Cardiovascular Research)Partner Site Heidelberg‐Mannheim and GöttingenMannheimGermany
| | - Jonas Müller
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM), University of HeidelbergMannheimGermany
- DZHK (German Center for Cardiovascular Research)Partner Site Heidelberg‐Mannheim and GöttingenMannheimGermany
| | - Hendrik Dinkel
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM), University of HeidelbergMannheimGermany
- DZHK (German Center for Cardiovascular Research)Partner Site Heidelberg‐Mannheim and GöttingenMannheimGermany
| | - Lena Rose
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM), University of HeidelbergMannheimGermany
| | - Alyssa Hohn
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM), University of HeidelbergMannheimGermany
| | - Zhen Yang
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM), University of HeidelbergMannheimGermany
| | - Lin Qiao
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM), University of HeidelbergMannheimGermany
| | - Yingrui Li
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM), University of HeidelbergMannheimGermany
| | - Siegfried Lang
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM), University of HeidelbergMannheimGermany
- DZHK (German Center for Cardiovascular Research)Partner Site Heidelberg‐Mannheim and GöttingenMannheimGermany
| | - Mandy Kleinsorge
- Stem Cell Unit, Clinic for Cardiology and PneumologyUniversity Medical Center GöttingenGöttingenGermany
- Department of CardiologyElectrophysiology DivisionUniversity Heart Center ZurichZurichSwitzerland
| | - Andreas Mügge
- Department of Cardiology and AngiologyBergmannsheil Bochum, Medical Clinic IIRuhr UniversityBochumGermany
| | - Assem Aweimer
- Department of Cardiology and AngiologyBergmannsheil Bochum, Medical Clinic IIRuhr UniversityBochumGermany
| | - Xuehui Fan
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM), University of HeidelbergMannheimGermany
| | | | - Ibrahim Akin
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM), University of HeidelbergMannheimGermany
- DZHK (German Center for Cardiovascular Research)Partner Site Heidelberg‐Mannheim and GöttingenMannheimGermany
| | - Guang Li
- Key Laboratory of Medical Electrophysiology of Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan ProvinceInstitute of Cardiovascular Research, Southwest Medical UniversityLuzhouChina
| | - Xiaobo Zhou
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM), University of HeidelbergMannheimGermany
- Key Laboratory of Medical Electrophysiology of Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan ProvinceInstitute of Cardiovascular Research, Southwest Medical UniversityLuzhouChina
- DZHK (German Center for Cardiovascular Research)Partner Site Heidelberg‐Mannheim and GöttingenMannheimGermany
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22
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Kovacs B, Winnik S, Medeiros-Domingo A, Costa S, Fu G, Biskup S, Ruschitzka F, Flammer AJ, Tanner FC, Duru F, Saguner AM. The novel TRPM4 c.448G>T variant is associated with familial conduction disorders, cardiomyopathy, and sudden cardiac death. Cardiol J 2021; 29:514-516. [PMID: 34897640 PMCID: PMC9170332 DOI: 10.5603/cj.a2021.0157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 10/14/2021] [Accepted: 11/20/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Boldizsar Kovacs
- Department of Cardiology, Division of Electrophysiology and Pacing, University Heart Center Zurich, Switzerland
| | - Stephan Winnik
- Department of Cardiology, Division of Electrophysiology and Pacing, University Heart Center Zurich, Switzerland
| | | | - Sarah Costa
- Department of Cardiology, Division of Electrophysiology and Pacing, University Heart Center Zurich, Switzerland
| | - Guan Fu
- Department of Cardiology, Division of Electrophysiology and Pacing, University Heart Center Zurich, Switzerland
| | - Saskia Biskup
- Praxis für Humangenetik, Tübingen, Germany & CeGaT GmbH, Tübingen, Germany
| | | | | | - Felix C Tanner
- Department of Cardiology, University Heart Center, Switzerland
| | - Firat Duru
- Department of Cardiology, Division of Electrophysiology and Pacing, University Heart Center Zurich, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, Division of Electrophysiology and Pacing, University Heart Center Zurich, Switzerland.
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Kovacs B, Müller F, Niederseer D, Krasniqi N, Saguner AM, Duru F, Hermann M. Wearable Cardioverter-Defibrillator-Measured Step Count for the Surveillance of Physical Fitness during Cardiac Rehabilitation. Sensors (Basel) 2021; 21:s21217054. [PMID: 34770361 PMCID: PMC8588232 DOI: 10.3390/s21217054] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/13/2021] [Accepted: 10/21/2021] [Indexed: 11/25/2022]
Abstract
Background: The wearable cardioverter–defibrillator (WCD) has a built-in accelerometer, which allows tracking of patients’ physical activity by remote monitoring. It is unclear whether WCD-measured physical activity, step count, and heart rate correlate with established tools for the assessment of cardiopulmonary fitness such as the 6-min walk test (6MWT). Objective: To correlate measurements of patient physical activity through the WCD with a supervised 6MWT during in-patient cardiac rehabilitation (CR) and to allow their use as surrogate parameters of cardiopulmonary fitness in an out-patient setting. Methods: Consecutive patients with a history of WCD use treated at our center and an in-patient CR following an index hospitalization were included. Baseline characteristics, measurements of WCD accelerometer (median daily step count, median daily activity level), median daily heart rate, and clinically supervised 6MWT at admission and discharge of CR were obtained. Results: Forty-one patients with a mean age of 55.5 (±11.5) years were included. Thirty-five patients (85.4%) were male and 28 patients (68%) had a primary prophylactic WCD-indication. The most common underlying heart diseases were ischemic heart disease (24 patients 58.6%) and dilated cardiomyopathy (13 patients, 31.7%). Median CR duration was 20 (IQR 19.75–26.25) days. 6MWT distance increased from a mean of 329 m (±107) to 470 m (±116) during CR (p < 0.0001). The median daily step count and activity level increased significantly, from 5542 steps (IQR 3718–7055) to 8778 (IQR 6229–12,920, p < 0.0001) and median 117 × 106 (IQR 96 × 106–142 × 106) threshold value exceedance (TVE) to 146 × 106 TVE (IQR 110 × 106–169 × 106, p < 0.0001), respectively. The median heart rate was 74.9 bpm (IQR 65.8–84.5) and 70.2 (IQR 64.1–77.3, p = 0.09) at admission and discharge, respectively. Of all three parameters, median daily step count showed the best correlation to the results of the 6MWT at admission and discharge (r = 0.32, p = 0.04 and 0.37, p = 0.02, respectively). Conclusions: Remote monitoring of median daily step count as assessed by the WCD’s accelerometer showed positive correlation with the 6MWT and could serve as a surrogate for cardiopulmonary exercise capacity. Assessment of daily step count and activity level measured remotely by the WCD could help to tailor optimal exercise instruction for patients not attending CR.
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Affiliation(s)
- Boldizsar Kovacs
- Department of Cardiology, University Heart Center Zurich, 8091 Zurich, Switzerland; (B.K.); (F.M.); (A.M.S.); (F.D.); (M.H.)
| | - Flavia Müller
- Department of Cardiology, University Heart Center Zurich, 8091 Zurich, Switzerland; (B.K.); (F.M.); (A.M.S.); (F.D.); (M.H.)
| | - David Niederseer
- Department of Cardiology, University Heart Center Zurich, 8091 Zurich, Switzerland; (B.K.); (F.M.); (A.M.S.); (F.D.); (M.H.)
- Correspondence: ; Tel.: +41-44-2551111
| | - Nazmi Krasniqi
- GZO Regional Healthcare Center, 8620 Zurich, Switzerland;
| | - Ardan M. Saguner
- Department of Cardiology, University Heart Center Zurich, 8091 Zurich, Switzerland; (B.K.); (F.M.); (A.M.S.); (F.D.); (M.H.)
| | - Firat Duru
- Department of Cardiology, University Heart Center Zurich, 8091 Zurich, Switzerland; (B.K.); (F.M.); (A.M.S.); (F.D.); (M.H.)
- Center for Integrative Human Physiology, University of Zurich, 8006 Zurich, Switzerland
| | - Matthias Hermann
- Department of Cardiology, University Heart Center Zurich, 8091 Zurich, Switzerland; (B.K.); (F.M.); (A.M.S.); (F.D.); (M.H.)
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Kovacs B, Burri H, Reek S, Sticherling C, Linka A, Ammann P, Mueller A, Kobza R, Haegeli L, Mayer K, Eriksson U, Reichlin T, Steffel J, Saguner A, Duru F. High incidence of inappropriate alarms in patients with wearable cardioverter-defibrillators: findings from the swiss WCD registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0668] [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
Introduction
The wearable cardioverter defibrillator (WCD) uses surface electrodes built into the vest to detect underlying arrhythmia before initiating a treatment sequence. However, it is also prone to inappropriate detection due to artefacts.
Purpose
The aim of this study was to assess the alarm burden in patients and its possible impact on clinical outcomes.
Methods
The Swiss WCD Registry is a nationwide, retrospective, observational registry. Patients were included from December 2011 until February 2018. Clinical characteristics and data from the WCDs, including alarm burden were analysed. Recordings ≥30 seconds of length were analysed and categorized as VT/VF, atrial fibrillation (AF), supraventricular tachycardia or artefact.
Results
A total of 10'653 device alarms were documented in 324 of 456 patients (71.1%) over a mean WCD wear-time of 2.0±1.6 months. Among these, the episode duration was 30 seconds or more in 2996 (28.2%). One hundred and eleven (3.7%) were VT/VF episodes. The remaining recordings were inappropriate arrhythmia detections (2736 (91%) due to artefacts; 117 (3.7%) AF; 48 (1.6%) supraventricular tachycardia). Two-hundred and seven patients (45.0%) had 3 or more alarms per month, whereas 49 patients (10.7%) had 1 or more alarms per day. Body mass index (BMI) was significantly higher in patients with 3 or more alarms per month (p=0.002, 25.6 vs. 27.3 kg/m2) High alarm burden was not associated with a lower average daily wear time (20.8 hours vs 20.7 hours, p=0.785) or a decreased implantable cardioverter defibrillator implantation rate after stopping WCD use (48% vs 47.3%, p=0.156).
Conclusions
In patients using WCDs, alarms emitted by the device and impending inappropriate shocks were frequent and most commonly caused by artefacts. A high alarm burden did not lead to a decreased adherence, as determined by average daily wear-times. Obesity was significantly associated with a higher alarm burden.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- B Kovacs
- University Hospital Zurich, Cardiology, Zurich, Switzerland
| | - H Burri
- University Hospital of Geneva, Cardiology, Geneva, Switzerland
| | - S Reek
- Hirslanden Medical Center, Cardiology, Aarau, Switzerland
| | - C Sticherling
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - A Linka
- Cantonal Hospital Winterthur, Cardiology, Winterthur, Switzerland
| | - P Ammann
- Cantonal Hospital St. Gallen, Cardiology, St. Gallen, Switzerland
| | - A.S Mueller
- Triemli Hospital, Cardiology, Zurich, Switzerland
| | - R Kobza
- Lucerne Cantonal Hospital, Cardiology, Lucerne, Switzerland
| | - L Haegeli
- Cantonal Hospital Aarau, Cardiology, Aarau, Switzerland
| | - K Mayer
- Cantonal Hospital Grison, Cardiology, Chur, Switzerland
| | - U Eriksson
- GZO Zurich Regional Health Center, Cardiology, Wetzikon, Switzerland
| | - T Reichlin
- Bern University Hospital, Inselspital, Cardiology, Bern, Switzerland
| | - J Steffel
- University Hospital Zurich, Cardiology, Zurich, Switzerland
| | - A.M Saguner
- University Hospital Zurich, Cardiology, Zurich, Switzerland
| | - F Duru
- University Hospital Zurich, Cardiology, Zurich, Switzerland
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Kovacs B, Burri H, Buehler A, Reek S, Sticherling C, Linka A, Ammann P, Mueller AS, Dzemali O, Kobza R, Schindler M, Haegeli LM, Mayer K, Eriksson U, Schlaepfer J, Reichlin T, Steffel J, Saguner AM, Duru F. B-PO02-180 HIGH BURDEN OF INAPPROPRIATE ALARMS BY THE WEARABLE CARDIOVERTER-DEFIBRILLATOR IN OBESE PATIENTS - FINDINGS FROM THE SWISS WCD REGISTRY. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kovacs B, Mayinger M, Schindler M, Steffel J, Andratschke N, Saguner AM. Stereotactic radioablation of ventricular arrhythmias in patients with structural heart disease - A systematic review. Radiother Oncol 2021; 162:132-139. [PMID: 34233215 DOI: 10.1016/j.radonc.2021.06.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/28/2021] [Accepted: 06/28/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE Several studies have suggested stereotactic arrhythmia radioablation (STAR) as a treatment option for patients suffering from therapy-refractory ventricular tachycardia or fibrillation (VT/VF). MATERIAL AND METHODS We performed a systematic review of human reports of STAR for structural VT/VF to assess its effectivity and safety. All identified publications were assessed for inclusion. This study adheres to the PRISMA guidelines and was registered on PROSPERO (CRD42020183044). RESULTS Thirteen studies were included resulting in a population of 57 patients. Median age was 64 (range 34-83), 31 patients (54%) had ischemic cardiomyopathy and 50 patients (88%) had prior catheter ablation (CA) for VT/VF. A mean planned target volume of 64.4 cc (range 3.5-238) with a mean safety margin of 3.3 mm (0-5) was treated with 25 Gy. Immediately following STAR, four patients (7%) experienced an electrical storm. During a mean follow-up duration of 410 days, all patients suffering from sustained VT/VF prior to STAR (n = 55) had a reduction of their sustained VT/VF-burden after STAR, but recurrence occurred in 41 patients (75%) during follow-up. Forty-six patients (81%) had an adverse effect from therapy, but no treatment-related death occurred. Evidence of scar-formation after STAR either by imaging, invasive mapping or histopathology was found in six of nine examined patients (67%). CONCLUSION From the still very limited experience, STAR appears effective and safe in patients with structural heart disease and therapy-refractory sustained VT/VF. It is associated with a significant short-term reduction of sustained VT/VF-burden, but recurrences are common.
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Affiliation(s)
- Boldizsar Kovacs
- Department of Cardiology, University Hospital Zurich, Switzerland
| | - Michael Mayinger
- Department of Radiation Oncology, University Hospital Zurich, Switzerland
| | | | - Jan Steffel
- Department of Cardiology, University Hospital Zurich, Switzerland
| | | | - Ardan M Saguner
- Department of Cardiology, University Hospital Zurich, Switzerland.
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Kovacs B, Siegrist P, Stähli B, Buechel R. Convenient timing by “accident” – Resting ischemia detected by resting myocardial perfusion imaging. Imaging 2021. [DOI: 10.1556/1647.2020.00012] [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] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- B. Kovacs
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - P.T. Siegrist
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - B.E. Stähli
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - R.R. Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
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Kovacs B, Graf U, Magyar I, Baehr L, Maspoli A, Duru F, Berger W, Saguner AM. A novel variant in the SLC4A3 gene with high penetrance in a family with short QT Syndrome. Europace 2021. [DOI: 10.1093/europace/euab116.327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Short QT syndrome (SQTS) is a rare, autosomal dominant disease causing sudden cardiac death (SCD). Current guidelines recommend genetic testing. Associated variants in KCNQ1, KCNH2, KCNJ2 and SLC4A3 genes have been reported.
Purpose
We report a family with a variant in the SLC4A3 gene with several presentations of SCD and high clinical penetrance of SQTS.
Methods
We performed a post-mortem genetic testing in the index patient in whom prior ECG was available. Subsequently, clinical and electrophysiological work-up and cascade screening (CS) of the detected suspected variant was carried out in available relatives.
Results
The index patient had suffered a SCD at the age of 17 (figure, upper panel, arrow). A previously registered ECG showed a shortened QTc of 340ms (figure, lower panel). Autopsy revealed no structural heart disease. Post-mortem genetic testing revealed variants in the LDB3, MYH7 and a novel heterozygous missense variant, p.(Ser1039Arg) also in the SLC4A3 gene. Although predictive bioinformatic algorithms (AlignGVGD, SIFT, MutationTaster, Polyphen2) showed conflicting classifications, family history was notable for SCD without post-mortem genetic work-up in three second degree relatives (figure, upper panel, patients 207, 208 and 305, age of death 33, 25 and 33 years respectively). CS was performed in first and second degree relatives of the index patient and was highly suggestive for disease association of the variant in the SLC4A3 gene with co-segregation in all clinically affected family members. Only one patient with the variant had a normal QTc (figure, upper panel, patient 202) of 407ms, however this patient was on regular QT-prolonging medication (risperidone and loperamide).
Conclusion
Genetic testing revealed a novel in the SLC4A3 gene, which was recently implicated in the pathogenesis of the SQTS. Although predictive bioinformatic algorithms yielded conflicting results, CS of family members suggests a likely pathogenicity (class IV) of the variant. Further CS or functional tests are necessary to establish causality. Abstract Figure. ECG of index patient and family tree
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Affiliation(s)
- B Kovacs
- University Hospital Zurich, Department of Cardiology, Zurich, Switzerland
| | - U Graf
- University of Zurich, Institute of Medical Molecular Genetics, Zurich, Switzerland
| | - I Magyar
- University of Zurich, Institute of Medical Molecular Genetics, Zurich, Switzerland
| | - L Baehr
- University of Zurich, Institute of Medical Molecular Genetics, Zurich, Switzerland
| | - A Maspoli
- University of Zurich, Institute of Medical Molecular Genetics, Zurich, Switzerland
| | - F Duru
- University Hospital Zurich, Department of Cardiology, Zurich, Switzerland
| | - W Berger
- University of Zurich, Institute of Medical Molecular Genetics, Zurich, Switzerland
| | - AM Saguner
- University Hospital Zurich, Department of Cardiology, Zurich, Switzerland
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Rossi VA, Niederseer D, Sokolska JM, Kovacs B, Costa S, Gasperetti A, Brunckhorst CB, Akdis D, Tanner FC, Duru F, Schmied CM, Saguner AM. A novel diagnostic score to differentiate between athlete"s heart and ARVC. Europace 2021. [DOI: 10.1093/europace/euab116.504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The 2010 Task Force Criteria (TFC), although representing the current gold standard to diagnose arrhythmogenic right ventricular cardiomyopathy (ARVC), have not been tested to differentiate ARVC from the athlete’s heart. Furthermore, not all 6 diagnostic categories are easy to obtain.
Purpose
We hypothesized that atrial dimensions are useful to differentiate between both entities. Therefore, we developed a new diagnostic score based upon readily available clinical parameters including atrial dimensions on TTE to help distinguishing the athlete’s heart from ARVC in daily clinical practice.
Methods
In this observational study, 37 patients with definite ARVC (from the Zurich ARVC Program) were compared to 68 athletes. Base on ROC analysis, the following echocardiographic, laboratory and electrocardiographic parameters were included in the final score: indexed right/left atrial volumes (RAVI/LAVI ratio), NT-proBNP, RVOT measurements (PLAX and PSAX adjusted for BSA) on TTE, tricuspid annular motion velocity (TAM) on TTE, precordial electrocardiographic T-wave inversions and depolarization abnormalities according to the TFC.
Results
ARVC patients had a higher RAVI/LAVI ratio (1.78 ± 1.6vs0.95 ± 0.3,p < 0.001), lower right-ventricular function (fac:28 ± 9.7vs42.1 ± 4.8%,p < 0.001; TAM:17.9 ± 5.6vs23.3 ± 3.7mm,p < 0.001) and higher serum NT-proBNP levels (491 ± 771vs44.8 ± 50.6ng/l,p < 0.001). Our novel score outperformed the performance of the 2010 TFC using those parameters, which are available in routine clinical practice (AUC95%,p < 0.001(95%CI.91-.99)vs.AUC90%,p < 0.001(95%CI.84-.97). A score value of 7/12 points yielded a specificity of 98% and a sensitivity of 61% for a diagnosis of ARVC.
Conclusions
ARVC patients present with significantly larger RA as compared to athletes, resulting in a greater RAVI/LAVI ratio. Our novel diagnostic score includes readily available clinical parameters and has a high diagnostic accuracy to differentiate between ARVC and the athlete´s heart. Abstract Figure. Novel clinical score
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Affiliation(s)
- VA Rossi
- University Hospital Zurich, Zurich, Switzerland
| | | | - JM Sokolska
- Wroclaw Medical University, Department of Heart Diseases, Wroclaw, Poland
| | - B Kovacs
- University Hospital Zurich, Zurich, Switzerland
| | - S Costa
- University Hospital Zurich, Zurich, Switzerland
| | | | | | - D Akdis
- University Hospital Zurich, Zurich, Switzerland
| | - FC Tanner
- University Hospital Zurich, Zurich, Switzerland
| | - F Duru
- University Hospital Zurich, Zurich, Switzerland
| | - CM Schmied
- University Hospital Zurich, Zurich, Switzerland
| | - AM Saguner
- University Hospital Zurich, Zurich, Switzerland
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Rossi VA, Kovacs B, Saguner AM. Atrial fibrillation and dementia: an unresolved 'Folie à Deux'. Open Heart 2020; 7:openhrt-2019-001087. [PMID: 33361279 PMCID: PMC7768951 DOI: 10.1136/openhrt-2019-001087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2019] [Indexed: 12/02/2022] Open
Affiliation(s)
- Valentina A Rossi
- Department of Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | - Boldizsar Kovacs
- Department of Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Hospital of Zurich, Zurich, Switzerland
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Kovacs B, Graf U, Magyar I, Baehr L, Maspoli A, Duru F, Berger W, Saguner A. Two novel variants in the SLC4A3 gene in two families with Short QT Syndrome: the role of cascade screening. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0741] [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
Short QT syndrome (SQTS) is a rare, autosomal dominant disease causing sudden cardiac death (SCD). Genetic testing is recommended according to current guidelines. Variants in KCNQ1, KCNH2, KCNJ2 and SLC4A3 genes have been reported in SQTS.
Purpose
We report implications of genetic testing and cascade screening (CS) in two families with phenotypical presentation of SQTS and novel genetic variants of unknown significance.
Methods
We performed a thorough clinical and electrophysiological work-up of the index patients of both families. In addition, genetic screening was conducted. Subsequently, segregation analysis of potentially pathogenic variants was carried out in available relatives.
Results
Index patient 1 presented with a history of recurrent syncope. His ECG showed a shortened QTc of 340ms. Family history was unremarkable. Structural heart disease was excluded by cardiac MRI and coronary angiography. Genetic testing detected a rare heterozygous missense variant in the KCNH2 gene (p.(Arg328Cys), frequency 0.053%), predicted to be pathogenic according to various prediction algorithms (Polyphen, SIFT, Align GVGD, mutation taster). CS of relatives did not confirm this variant as the causative mutation. Reanalysis of whole-exome sequencing data revealed a novel heterozygous missense variant, p.(Arg370Cys) in the recently identified SLC4A3 gene. A variant at the same position has previously been associated with SQTS. CS suggested disease association. The second index patient had a SCD at the age of 17. A previously registered ECG showed a shortened QTc of 340ms. Autopsy revealed no structural heart disease. Post-mortem genetic testing revealed variants in the LDB3, MYH7 and a novel heterozygous missense variant, p.(Ser1039Arg) also in the SLC4A3 gene. Family history was positive for SCD in three 2° relatives. The index patient's father had a positive phenotype with a QTc of 365ms. CS again suggested disease association of the variant in the SLC4A3 gene only.
Conclusion
Genetic testing revealed two novel variants in the SLC4A3 gene, which was recently implicated in the pathogenesis of the SQTS. Predictive bioinformatic algorithms to assess the pathogenicity of missense variants are of limited relevance, but genetic analysis of additional unaffected and affected family members may be instrumental to identify pathogenic DNA sequence variations.
Family tree index patients 1 and 2
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- B Kovacs
- University Hospital Zurich, Department of Cardiology, Zurich, Switzerland
| | - U Graf
- University of Zurich, Institute of Medical Molecular Genetics, Zurich, Switzerland
| | - I Magyar
- University of Zurich, Institute of Medical Molecular Genetics, Zurich, Switzerland
| | - L Baehr
- University of Zurich, Institute of Medical Molecular Genetics, Zurich, Switzerland
| | - A Maspoli
- University of Zurich, Institute of Medical Molecular Genetics, Zurich, Switzerland
| | - F Duru
- University Hospital Zurich, Department of Cardiology, Zurich, Switzerland
| | - W Berger
- University of Zurich, Institute of Medical Molecular Genetics, Zurich, Switzerland
| | - A.M Saguner
- University Hospital Zurich, Department of Cardiology, Zurich, Switzerland
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Kovacs B, Mayinger M, Tanadini-Lang S, Ehrbar S, Wilke L, Chamberlain M, Duru F, Steffel J, Garcia Schueler H, Manka R, Ruschitzka F, Guckenberger M, Andratschke N, Saguner A. First two MRI guided stereotactic body radiation therapy of recurrent sustained ventricular tachycardia. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 11/13/2022] Open
Abstract
Abstract
Background
Stereotactic body radiation therapy (SBRT) is emerging as a bail-out treatment in patients suffering from therapy resistant ventricular tachyarrhythmias (VT).
Purpose
We report the worldwide first cases of real-time magnetic resonance image guided SBRT (MR-SBRT) in recurrent sustained VT and electrical storm (ES) due to dilated cardiomyopathy (DCM).
Methods
The patients were male, 71- (patient A) and 74-year-old (patients B) suffering from recurrent VT and ES with ICD shocks, despite guideline-directed medical therapy including maximal antiarrhythmic therapy. Patient A had two endocardial radiofrequency catheter ablation (RFA) and one epicardial surgical RFA and patient B had one endocardial RFA prior. An interdisciplinary decision was made to perform MR-SBRT in palliative intent to minimize repetitive ICD shocks.
Results
Areas of VT-substrate were identified to build a volumetric target using the performed EP studies as well as cardiac MRI and CT. A single fraction of 25Gy at isodose 80% was delivered to a planned target volume of 115.1ml and 73ml in the anterior/anteroseptal basal regions in patients A and B, respectively on a dedicated MR linac using real-time MRI tracking. Patient A developed a prolonged ES interpreted as acute radiation-induced inflammation following the treatment, which ceased two days after administration of high-dose dexamethasone. Patient B had no immediate adverse effects from the treatment. Left-ventricular ejection fraction remained stable in both patients at 25%. Both patients had significant improvement of their quality of life. Patient A died 222 days after MR-SBRT due to recurrent ES at another hospital. Patient B is free from VT over six months after treatment.
Conclusion
In these first two cases, we demonstrate feasibility, safety and short-term efficacy of MR-SBRT.
ICD therapies before and after MR-SBRT
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- B Kovacs
- University Hospital Zurich, Department of Cardiology, Zurich, Switzerland
| | - M Mayinger
- University Hospital Zurich, Department of Radiation Oncology, Zurich, Switzerland
| | - S Tanadini-Lang
- University Hospital Zurich, Department of Radiation Oncology, Zurich, Switzerland
| | - S Ehrbar
- University Hospital Zurich, Department of Radiation Oncology, Zurich, Switzerland
| | - L Wilke
- University Hospital Zurich, Department of Radiation Oncology, Zurich, Switzerland
| | - M Chamberlain
- University Hospital Zurich, Department of Radiation Oncology, Zurich, Switzerland
| | - F Duru
- University Hospital Zurich, Department of Cardiology, Zurich, Switzerland
| | - J Steffel
- University Hospital Zurich, Department of Cardiology, Zurich, Switzerland
| | - H.I Garcia Schueler
- University Hospital Zurich, Department of Radiation Oncology, Zurich, Switzerland
| | - R Manka
- University Hospital Zurich, Department of Cardiology, Zurich, Switzerland
| | - F Ruschitzka
- University Hospital Zurich, Department of Cardiology, Zurich, Switzerland
| | - M Guckenberger
- University Hospital Zurich, Department of Radiation Oncology, Zurich, Switzerland
| | - N Andratschke
- University Hospital Zurich, Department of Radiation Oncology, Zurich, Switzerland
| | - A.M Saguner
- University Hospital Zurich, Department of Cardiology, Zurich, Switzerland
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Mayinger M, Kovacs B, Tanadini-Lang S, Ehrbar S, Wilke L, Chamberlain M, Moreira A, Weitkamp N, Brunckhorst C, Duru F, Steffel J, Breitenstein A, Alkadhi H, Garcia Schueler HI, Manka R, Ruschitzka F, Guckenberger M, Saguner AM, Andratschke N. First magnetic resonance imaging-guided cardiac radioablation of sustained ventricular tachycardia. Radiother Oncol 2020; 152:203-207. [DOI: 10.1016/j.radonc.2020.01.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/16/2019] [Accepted: 01/09/2020] [Indexed: 12/26/2022]
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Kovacs B, Reek S, Sticherling C, Schaer B, Linka A, Ammann P, Brenner R, Krasniqi N, Müller AS, Dzemali O, Kobza R, Grebmer C, Haegeli L, Berg J, Mayer K, Schläpfer J, Domenichini G, Reichlin T, Roten L, Burri H, Eriksson U, Saguner AM, Steffel J, Duru F, Swiss Wcd Registry. Use of the wearable cardioverter-defibrillator - the Swiss experience. Swiss Med Wkly 2020; 150:w20343. [PMID: 33035354 DOI: 10.4414/smw.2020.20343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Sudden cardiac death caused by malignant arrhythmia can be prevented by the use of defibrillators. Although the wearable cardioverter defibrillator (WCD) can prevent such an event, its role in clinical practice is ill defined. We investigated the use of the WCD in Switzerland with emphasis on prescription rate, therapy adherence and treatment rate. MATERIALS AND METHODS The Swiss WCD Registry is a retrospective observational registry including patients using a WCD. Patients were included from the first WCD use in Switzerland until February 2018. Baseline characteristics and data on WCD usage were examined for the total study population, and separately for each hospital. RESULTS From 1 December 2011 to 18 February 2018, a total of 456 patients (67.1% of all WCDs prescribed in Switzerland and 81.1% of all prescribed in the participating hospitals) were included in the registry. Up to 2017 there was a yearly increase in the number of prescribed WCDs to a maximum of 271 prescriptions per year. The mean age of patients was 57 years (± 14), 81 (17.8%) were female and mean left ventricular ejection fraction (EF) was 32% (± 13). The most common indications for WCD use were new-onset ischaemic cardiomyopathy (ICM) with EF ≤35% (206 patients, 45.2%), new-onset nonischaemic cardiomyopathy (NICM) with EF ≤35% (115 patients, 25.2%), unknown arrhythmic risk (83 patients, 18.2%), bridging to implantable cardioverter-defibrillator implantation or heart transplant (37 patients, 8.1%) and congenital/inherited heart disease (15 patients, 3.3%). Median wear duration was 58 days (interquartile range [IQR] 31–94) with a median average daily wear time of 22.6 hours (IQR 20–23.2). Seventeen appropriate therapies from the WCD were delivered in the whole population (treatment rate: 3.7%) to a total of 12 patients (2.6% of all patients). The most common underlying heart disease in patients with a treatment was ICM (13/17, 76.5%). There were no inappropriate treatments. CONCLUSION The use of WCDs has increased in Switzerland over the years for a variety of indications. There is high therapy adherence to the WCD, and a treatment rate comparable to previously published registry data.  .
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Affiliation(s)
- Boldizsar Kovacs
- Division of Cardiology, University Heart Centre Zurich, Switzerland / Division of Cardiology, GZO Regional Healthcare Centre Wetzikon, Switzerland
| | - Sven Reek
- Hirslanden Klinik Aarau, Switzerland
| | | | - Beat Schaer
- Division of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - André Linka
- Division of Cardiology, Kantonsspital Winterthur, Switzerland
| | - Peter Ammann
- Division of Cardiology, Kantonsspital St Gallen, Switzerland
| | - Roman Brenner
- Division of Cardiology, Kantonsspital St Gallen, Switzerland
| | - Nazmi Krasniqi
- Division of Cardiology, GZO Regional Healthcare Centre Wetzikon, Switzerland
| | | | - Omer Dzemali
- Division of Cardiac Surgery, Triemli Hospital Zurich, Switzerland
| | - Richard Kobza
- Division of Cardiology, Luzerner Kantonsspital, Switzerland
| | | | - Laurent Haegeli
- Division of Cardiology, University Heart Centre Zurich, Switzerland / Division of Cardiology, Kantonsspital Aarau, Switzerland
| | - Jan Berg
- Division of Cardiology, Kantonsspital Aarau, Switzerland
| | - Kurt Mayer
- Division of Cardiology, Kantonsspital Graubünden, Switzerland
| | - Jürg Schläpfer
- Service of Cardiology, University Hospital Lausanne, Switzerland
| | | | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Harran Burri
- Division of Cardiology, University Hospital of Geneva, Switzerland
| | - Urs Eriksson
- Division of Cardiology, GZO Regional Healthcare Centre Wetzikon, Switzerland
| | - Ardan M Saguner
- Division of Cardiology, University Heart Centre Zurich, Switzerland
| | - Jan Steffel
- Division of Cardiology, University Heart Centre Zurich, Switzerland
| | - Firat Duru
- Division of Cardiology, University Heart Centre Zurich, Switzerland
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Kovacs B, Reek S, Linka A, Ammann P, Mueller AS, Reichlin T, Haegeli L, Steffel J, Saguner AM, Burri H, Duru F. 911Which patients are most likely to benefit from the wearable cardioverter-defibrillator? Findings from the Swiss WCD registry. Europace 2020. [DOI: 10.1093/europace/euaa162.296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
OnBehalf
Swiss WCD Registry
Introduction
The wearable cardioverter-defibrillator (WCD) has established itself as a temporary protection from sudden arrhythmogenic death in selected patients at risk. However, it is still of debate which patients and for what duration benefit from its use. Therefore, appropriate patient selection is key. Purpose: This study reports the results of the Swiss WCD registry with an emphasis on implantable cardioverter-defibrillator (ICD) implantation rate and ICD therapies.
Methods
We retrospectively reviewed the indications, baseline characteristics and administered therapies in patients prescribed a WCD at 12 participating centers rom 2014 until 2018 in Switzerland. Further data on medical therapy, WCD therapy adherence, and ICD implantation rates were collected.
Results
456 patients were included in our study comprising of 66% of all Swiss patients prescribed a WCD in the examined time period. The mean age was 57 ±14 years, 18% were female and the mean ejection fraction (EF) was 32% ± 13. Indications for WCD use and appropriate shock rate are shown in the figure. Patients wore the WCD over a median of 58 days (range 1-455) with a median daily average wear-time of 22.6 hours (range 0.6-23.8). 17 appropriate therapies were administered by the WCD to a total of 12 patients leading to a therapy rate of 2.6% over a median wear-time of 16 days (range 2-79) and to a therapy rate of 3.9% in patients with ischemic cardiomyopathy (ICM) with an EF ≤35%. ICM with an EF ≤35% and bridging to ICD-implantation or heart transplantation as indication for WCD prescription were significantly associated with an appropriate therapy (p = 0.046 and 0.003, respectively). One patient with non-ischemic cardiomyopathy (NICM) received an appropriate therapy (0.8%). The mean EF in patients receiving an appropriate therapy by the WCD was also significantly lower (p = 0.04). No patient with wearing the WCD for congenital/inherited heart disease or risk stratification with an EF >35% had a therapy administered by the WCD. There were no inappropriate therapies during the investigated time period. After cessation of WCD use EF improved to 38% ±13; ultimately, 212 patients (46%) were implanted with an ICD. During a follow-up of 476 days (range 7-2347) 22 (9.8%) patients received an appropriate therapy by their ICD. Four of the 22 had prior appropriate therapy by the WCD.
Conclusions
ICM with severely reduced EF was the most common indication for WCD use leading to a high rate of appropriate therapy by the WCD. This, however, did not translate in a higher rate of appropriate ICD-therapies during follow-up in this subpopulation possibly due to significant improvements in their ejection fractions. Patients with NICM or congenital/inherited heart disease seldom had an appropriate therapy by the WCD.
Abstract Figure. Indications for WCD use and therapy rate
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Affiliation(s)
- B Kovacs
- University Hospital Zurich, Zurich, Switzerland
| | - S Reek
- Hirslanden Medical Center, Cardiology, Aarau, Switzerland
| | - A Linka
- Cantonal Hospital Winterthur, Cardiology, Winterthur, Switzerland
| | - P Ammann
- Cantonal Hospital St. Gallen, Cardiology, St Gallen, Switzerland
| | - A S Mueller
- Triemli Hospital, Cardiology, Zurich, Switzerland
| | - T Reichlin
- Bern University Hospital, Inselspital, Cardiology, Bern, Switzerland
| | - L Haegeli
- Cantonal Hospital Aarau, Cardiology, Aarau, Switzerland
| | - J Steffel
- University Hospital Zurich, Zurich, Switzerland
| | - A M Saguner
- University Hospital Zurich, Zurich, Switzerland
| | - H Burri
- University Hospital of Geneva, Cardiology, Geneva, Switzerland
| | - F Duru
- University Hospital Zurich, Zurich, Switzerland
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Kovacs B, Graf U, Magyar I, Baehr L, Maspoli A, Firat D, Berger W, Saguner AM. 1268A family with a novel variant in the SLC4A3 gene leading to short QT phenotype - the importance of whole-exome-sequencing and cascade screening. Europace 2020. [DOI: 10.1093/europace/euaa162.297] [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
none
Introduction
Short QT syndrome (SQTS) is a rare, autosomal dominant disease causing ventricular fibrillation and sudden cardiac death. Genetic testing is recommended according to current guidelines. Mutations in KCNQ1, KCNH2, KCNJ2 and more recently SLC4A3 genes have been implicated in SQTS. These genes encode potassium channel subunits and a bicarbonate transporter regulating intracellular pH. A dominant mutation in this transporter can lead to increased intracellular pH and shortened action potential.
Purpose
We present a family with a short QT phenotype and recurrent syncope in whom a novel genetic variant was detected by whole-exome sequencing (WES), confirmed by cascade screening.
Methods
We performed a thorough work-up of the index patient including medical history, physical examination, 12-lead ECG, echocardiography, stress testing, coronary angiography, flecainide challenge, and genetic testing with NGS. QTc was determined using Bazett’s formula. CS of all 1° and two 2° relatives was performed.
Results
The ECG of the index patient showed a QTc of 340ms and characteristics compatible with a SQTS (figure). Clinical work-up was unremarkable. A first genetic search with next generation sequencing focusing on genes that have been previously involved in the pathogenesis of channelopathies detected a rare known heterozygous missense variant in the KCNH2 gene (Arg328Cys, frequency 0.053%), which was predicted to be pathogenic according to various prediction algorithms (Polyphen, SIFT, Align GVGD, mutation taster). ECG screening of all asymptomatic first-degree family members identified a SQT phenotype in the mother (QTc 355ms), but not in the father (QTc 380ms) and sister (410ms). The KCNH2 variant was found in the father and sister but not the affected mother, which excludes this variant as the causative mutation in this family. Therefore, reanalysis of WES data was performed and revealed a novel heterozygous missense variant p.(Arg370Cys) in the SLC4A3 gene, recently associated with SQTS. A mutation in this gene at the same position has been previously reported in SQTS. The p.(Arg370Cys) mutation was found in the mother but not in the unaffected father or sister. Furthermore the mutation was present in two affected maternal uncles (QTc 319ms and 342ms) supporting the assumption that this was the causative mutation in this family.
Conclusions
A novel genetic variant in the SLC4A3 gene leading to sQT phenotype could be detected using WES and cascade screening. Predictive bioinformatic algorithms to assess the pathogenicity of missense variants are of limited relevance, but genetic analysis of additional unaffected and affected family members may be instrumental to identify pathogenic DNA sequence variations.
Abstract Figure. Pedigree and ECGs of the family
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Affiliation(s)
- B Kovacs
- University Hospital Zurich, Zurich, Switzerland
| | - U Graf
- University of Zurich, Institute of Medical Molecular Genetics, Zurich, Switzerland
| | - I Magyar
- University of Zurich, Institute of Medical Molecular Genetics, Zurich, Switzerland
| | - L Baehr
- University of Zurich, Institute of Medical Molecular Genetics, Zurich, Switzerland
| | - A Maspoli
- University of Zurich, Institute of Medical Molecular Genetics, Zurich, Switzerland
| | - D Firat
- University Hospital Zurich, Zurich, Switzerland
| | - W Berger
- University of Zurich, Institute of Medical Molecular Genetics, Zurich, Switzerland
| | - A M Saguner
- University Hospital Zurich, Zurich, Switzerland
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Kovacs B, Reek S, Saguner AM, Krasniqi N, Eriksson U, Duru F. Outcomes during and after the use of the wearable cardioverter-defibrillator in a tertiary-care and a regional hospital in Switzerland. Swiss Med Wkly 2019; 149:w20136. [PMID: 31707723 DOI: 10.4414/smw.2019.20136] [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: 11/18/2022] Open
Abstract
INTRODUCTION The wearable cardioverter-defibrillator (WCD) has established itself in treatment of potentially life-threatening ventricular arrhythmias, when implantation of an implantable cardioverter-defibrillator (ICD) is not warranted. Careful patient selection for this therapy is crucial, but unfortunately very little information from randomised controlled trials is available to guide clinical decision-making. Consequently, data from real-world patient registries play a more important role in this context. MATERIALS AND METHODS A retrospective observational study was conducted at the University Hospital of Zurich and the GZO Regional Healthcare Centre in Wetzikon. Clinical databases were screened for patients with a history of WCD use from the time of its approval in Switzerland in July 2014 until February 2018. Baseline characteristics, WCD data and outcome data, with an emphasis on ICD implantation and ICD therapies, were collected and analysed. RESULTS Two-hundred and seven patients were included in the primary analysis. Eighty-six percent were male and the mean age was 58 ± 13 years. The underlying heart disease was ischaemic cardiomyopathy (ICM), non-ischaemic cardiomyopathy (NICM) and congenital/inherited heart diseases in 60, 35 and 5%, respectively. The most common indication for WCD use was heart failure with an ejection fraction (EF) <35% due to ICM or NICM (43 and 27%, respectively). Three of the 207 patients received an appropriate shock over a median WCD wear-time of 62 days (interquartile range [IQR] 35–95). No inappropriate shocks were registered. Median average daily wear-time was 22.6 hours (IQR 19.9–23.2) and was significantly shorter for patients for whom WCD discontinuation was due to comfort issues (17 patients, p = 0.003). After the end of WCD therapy, 48% were implanted with an ICD. In those receiving an ICD, the rate of appropriate ICD therapies (either shock or antitachycardia pacing) was 8% during a median follow-up of 110 days (IQR 23–421). CONCLUSION The WCD is safe and effective in terminating malignant ventricular arrhythmias. A substantial subgroup of patients, however, discontinued WCD use prematurely because of comfort issues. This subset of patients deserves further attention in clinical practice to ensure therapy adherence.  .
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Affiliation(s)
- Boldizsar Kovacs
- Department of Cardiology, University Hospital of Zurich, Switzerland
| | | | | | - Nazmi Krasniqi
- Department of Cardiology, Department of Medicine, GZO - Regional Health Centre, Wetzikon, Switzerland
| | - Urs Eriksson
- Department of Cardiology, Department of Medicine, GZO - Regional Health Centre, Wetzikon, Switzerland / Centre for Integrative Human Physiology, University of Zurich, Switzerland
| | - Firat Duru
- Department of Cardiology, University Hospital of Zurich, Switzerland/ Centre for Integrative Human Physiology, University of Zurich, Switzerland
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Kovacs B, Reek S, Krasniqi N, Eriksson U, Duru F. Extended Use of the Wearable Cardioverter-Defibrillator: Which Patients Are Most Likely to Benefit? Cardiol Res Pract 2018; 2018:7373610. [PMID: 30622822 PMCID: PMC6304887 DOI: 10.1155/2018/7373610] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 09/18/2018] [Accepted: 10/28/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Wearable cardioverter-defibrillators (WCD, LifeVest, ZOLL) can protect from sudden cardiac death bridging a vulnerable period until a decision on implantable cardioverter-defibrillator (ICD) implantation can be reached. WCD is commonly used for 3 months or less. It is unknown, which patients use WCD longer and which patients are most likely to benefit from it. HYPOTHESIS Extended use of WCD is reasonable in selected cases based on underlying heart disease and overall patient risk profile. METHODS We conducted a systematic and comprehensive research of all published clinical studies on PubMed reporting on the use of the WCD. Only original articles reporting on wear times and time to appropriate shocks were included in our analysis. RESULTS The search resulted in 127 publications. 14 parameters were reported necessary for inclusion in our analysis. Median wear times ranged from 16 to 394 days. The median wear time was especially long for patients suffering from nonischemic cardiomyopathy (NICM) (range: 50-71 days) and specifically peripartum cardiomyopathy (PPCM) (120 days) and for heart transplant candidates. There was a large variation of appropriate shocks according to indication for WCD use. In contrast to NICM in general, the number of appropriate shocks was particularly high in patients with PPCM (0 in 254 patients and 5 in 49 patients, respectively). The median and maximal time periods to the first appropriate shock were longest in patients with PPCM (median time to the first appropriate shock: 68 days). CONCLUSIONS Prolonged use of WCD is not uncommon in available literature. Patients suffering from NICM and specifically PPCM seem most likely to have longer therapy duration with WCD with success. Careful patient selection for prolonged use may decrease the need for ICD implantation in the future; however, prospective data are needed to confirm this hypothesis.
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Affiliation(s)
- Boldizsar Kovacs
- Arrhythmias and Electrophysiology Unit, Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
- Department of Cardiology, Regional Hospital Wetzikon, Spitalstrasse 66, 8620 Wetzikon, Switzerland
| | | | - Nazmi Krasniqi
- Department of Cardiology, Regional Hospital Wetzikon, Spitalstrasse 66, 8620 Wetzikon, Switzerland
| | - Urs Eriksson
- Department of Cardiology, Regional Hospital Wetzikon, Spitalstrasse 66, 8620 Wetzikon, Switzerland
| | - Firat Duru
- Arrhythmias and Electrophysiology Unit, Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
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Masuda T, Mittal SK, Kovacs B, Smith M, Walia R, Huang J, Bremner RM. Thoracoabdominal pressure gradient and gastroesophageal reflux: insights from lung transplant candidates. Dis Esophagus 2018; 31:4958128. [PMID: 29617746 DOI: 10.1093/dote/doy025] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Indexed: 12/11/2022]
Abstract
Advanced lung disease is associated with gastroesophageal reflux disease (GERD). The thoracoabdominal pressure gradient (TAPG) facilitates gastroesophageal reflux, but the effects of TAPG on gastroesophageal reflux in patients with pulmonary disease have not been well defined. Patients diagnosed with end-stage lung disease are expected to have the most extreme derangement in respiratory mechanics. The aim of this study is to explore the relationship between TAPG and reflux in lung transplant (LTx) candidates. We reviewed LTx recipients who underwent pretransplant esophageal high-resolution manometry and a 24-hour pH study. Patients were excluded if they were undergoing redo LTx, had manometric hiatal hernia, or had previously undergone foregut surgery. TAPG was defined as the intra-abdominal pressure minus the intrathoracic pressure during inspiration. Adjusted TAPG was calculated by the TAPG minus the resting lower esophageal sphincter (LES) pressure (LESP). Twenty-two patients with normal esophageal function tests (i.e., normal esophageal motility with neither manometric hiatal hernia nor pathological reflux on 24-hour pH monitoring) were selected as the pulmonary disease-free control group. In total, 204 patients underwent LTx between January 2015 and December 2016. Of these, 77 patients met inclusion criteria. We compared patients with obstructive lung disease (OLD, n = 33; 42.9%) and those with restrictive lung disease (RLD, n = 42; 54.5%). 2/77 patients (2.6%) had pulmonary arterial hypertension. GERD was more common in the RLD group than in the OLD group (24.2% vs. 47.6%, P = 0.038). TAPG was similar between the OLD group and the controls (14.2 vs. 15.3 mmHg, P = 0.850); however, patients in the RLD group had significantly higher TAPG than the controls (24.4 vs. 15.3 mmHg, P = 0.002). Although TAPG was not correlated with GERD, the adjusted TAPG correlated with reflux in all 77 patients with end-stage lung disease (DeMeester score, rs = 0.256, P = 0.024; total reflux time, rs = 0.259, P = 0.023; total number of reflux episodes, rs = 0.268, P = 0.018). Additionally, pathological reflux was seen in 59.1% of lung transplant candidates with adjusted TAPG greater than 0 mmHg (i.e., TAPG exceeding LESP); GERD was seen in 30.9% of patients who had an adjusted TAPG ≤ 0 mmHg. In summary, TAPG varies based on the underlying cause of lung disease. Higher adjusted TAPG increases pathological reflux, even if patients have normal antireflux anatomy and physiology (i.e., no hiatal hernia and manometrically normal LES function). Adjusted TAPG may provide further insights into the pathophysiology of GERD.
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Affiliation(s)
- T Masuda
- Norton Thoracic Institute; St. Joseph's Hospital and Medical Center Phoenix.,Creighton University School of Medicine-Phoenix Regional Campus Phoenix, Arizona, USA
| | - S K Mittal
- Norton Thoracic Institute; St. Joseph's Hospital and Medical Center Phoenix.,Creighton University School of Medicine-Phoenix Regional Campus Phoenix, Arizona, USA
| | - B Kovacs
- Norton Thoracic Institute; St. Joseph's Hospital and Medical Center Phoenix
| | - M Smith
- Norton Thoracic Institute; St. Joseph's Hospital and Medical Center Phoenix.,Creighton University School of Medicine-Phoenix Regional Campus Phoenix, Arizona, USA
| | - R Walia
- Norton Thoracic Institute; St. Joseph's Hospital and Medical Center Phoenix.,Creighton University School of Medicine-Phoenix Regional Campus Phoenix, Arizona, USA
| | - J Huang
- Norton Thoracic Institute; St. Joseph's Hospital and Medical Center Phoenix.,Creighton University School of Medicine-Phoenix Regional Campus Phoenix, Arizona, USA
| | - R M Bremner
- Norton Thoracic Institute; St. Joseph's Hospital and Medical Center Phoenix.,Creighton University School of Medicine-Phoenix Regional Campus Phoenix, Arizona, USA
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Szappanos A, Nagy Z, Kovacs B, Poor G, Toth M, Racz K, Kiss E, Patocs A. Tissue-specific Glucocorticoid Signaling May Determine the Resistance Against Glucocorticoids in Autoimmune Diseases. Curr Med Chem 2015. [DOI: 10.2174/0929867321666141216125012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Böckler D, Peters A, Pfeiffer S, Kovacs B, Geisbüsch P, Bischoff M, Müller-Eschner M, Hakimi M. Nellix® Endovascular Aneurysm Sealing (EVAS) – eine neue Technologie zur endovaskulären Ausschaltung infrarenaler Aortenaneurysmen. Zentralbl Chir 2014. [DOI: 10.1055/s-0034-1383254] [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] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- D. Böckler
- Klinik für Gefäßchirurgie und Endovasculäre Chirurgie, Universitätsklinik Heidelberg, Deutschland
| | - A. Peters
- Klinik für Gefäßchirurgie und Endovasculäre Chirurgie, Universitätsklinik Heidelberg, Deutschland
| | - S. Pfeiffer
- Klinik für Gefäßchirurgie und Endovasculäre Chirurgie, Universitätsklinik Heidelberg, Deutschland
| | - B. Kovacs
- Klinik für Gefäßchirurgie und Endovasculäre Chirurgie, Universitätsklinik Heidelberg, Deutschland
| | - P. Geisbüsch
- Klinik für Gefäßchirurgie und Endovasculäre Chirurgie, Universitätsklinik Heidelberg, Deutschland
| | - M. Bischoff
- Klinik für Gefäßchirurgie und Endovasculäre Chirurgie, Universitätsklinik Heidelberg, Deutschland
| | - M. Müller-Eschner
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinik, Heidelberg, Deutschland
| | - M. Hakimi
- Klinik für Gefäßchirurgie und Endovasculäre Chirurgie, Universitätsklinik Heidelberg, Deutschland
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Böckler D, Peters AS, Pfeiffer S, Kovacs B, Geisbüsch P, Bischoff MS, Müller-Eschner M, Hakimi M, Pfeiffer S. [Nellix® endovascular aneurysm sealing (EVAS) - a new technology for endovascular management of infrarenal aortic aneurysms]. Zentralbl Chir 2014; 139:562-8. [PMID: 25313891 DOI: 10.1055/s-0034-1383084] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Recently used endografts for envascular aneurysm repair (EVAR) exclude the pathology by fixation at both the proximal and distal landing zone. Due to endoleaks and migration EVAR is associated with a relevant rate of secondary interventions. The Nellix® system (Endologix Inc., CA, USA) was developed to seal the complete aneurysm using a polymer filling, therefore stabilising endograft-position and reducing the rate of endoleaks and reinterventions. The present contribution introduces the method, describes the technique of implantation and presents the first clinical results. Material und Methods: The Nellix system consists of two balloon-expandable stent grafts made of a cobalt-chromium composition, surrounded with ePTFE and the so-called endobags. During the implantation each endobag is filled with a non-biodegradable polymer, sealing the aneurysm lumina including the proximal and distal landing zone. Hence, lumbar arteries will be sealed to reduce the probability of a type II endoleak. RESULTS Longterm durability as well as the structural integrity of the Nellix system has been proven over 4 years in sheep experiments. The technical success in a multicentre, prospective registry was 94% without the appearance of severe adverse events (migration, occlusion, secondary endoleak). CONCLUSION EVAS is a new and different concept of endovascular AAA repair. Recent clinical data of the Nellix system are promising showing a high technical success rate while the need for secondary intervention is low. Further studies in larger cohorts are needed.
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Affiliation(s)
- D Böckler
- Klinik für Gefäßchirurgie und Endovasculäre Chirurgie, Universitätsklinik Heidelberg, Deutschland
| | - A S Peters
- Klinik für Gefäßchirurgie und Endovasculäre Chirurgie, Universitätsklinik Heidelberg, Deutschland
| | - S Pfeiffer
- Klinik für Gefäßchirurgie und Endovasculäre Chirurgie, Universitätsklinik Heidelberg, Deutschland
| | - B Kovacs
- Klinik für Gefäßchirurgie und Endovasculäre Chirurgie, Universitätsklinik Heidelberg, Deutschland
| | - P Geisbüsch
- Klinik für Gefäßchirurgie und Endovasculäre Chirurgie, Universitätsklinik Heidelberg, Deutschland
| | - M S Bischoff
- Klinik für Gefäßchirurgie und Endovasculäre Chirurgie, Universitätsklinik Heidelberg, Deutschland
| | - M Müller-Eschner
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinik, Heidelberg, Deutschland
| | | | - S Pfeiffer
- Klinik für Gefäßchirurgie und Endovasculäre Chirurgie, Universitätsklinik Heidelberg, Deutschland
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Balint OH, Siu SC, Mason J, Grewal J, Wald R, Oechslin EN, Kovacs B, Sermer M, Colman JM, Silversides CK. Cardiac outcomes after pregnancy in women with congenital heart disease. Heart 2010; 96:1656-61. [DOI: 10.1136/hrt.2010.202838] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Kasik I, Mrazek J, Podrazky O, Seidl M, Aubrecht J, Tobiska P, Matejec V, Kovacs B, Markovics A, Szili M, Vlckova K. Preparation and characterization of thin transducer layers sensitive to free chlorine in water. Materials Science and Engineering: C 2008. [DOI: 10.1016/j.msec.2007.10.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
PURPOSE To provide an overview of intraoperative and postoperative complications during phacoemulsification cataract surgery and to evaluate the visual results in patients having pars plana vitrectomy (PPV) with 10 years of follow-up. METHODS Retrospective evaluation of intraoperative and postoperative complications and postoperative visual results in 134 consecutive patients who underwent phacoemulsification after PPV. Of 11,498 eyes treated with phacoemulsification, 143 (1.2%) had previous PPV during the 10-year period were included in this study. RESULTS The phacoemulsification procedure seemed to be difficult where there was a deep or fluctuating anterior chamber (93%) and primary posterior capsule opacification (19%). The most frequent intraoperative complications were posterior capsule rupture (9%) and incomplete capsular rhexis (5%). Postoperative intraocular pressure elevation (7%), retinal detachment (6%), and posterior capsule opacification (8%) occurred most frequently during the mean follow-up period of 18.2 months (1.5-110 months). Best-corrected visual acuity (BCVA) increased two or more Snellen E lines in 55% of the cases or became better than or equal to 0.5 in 10% of the cases. CONCLUSIONS Despite the well-known difficulties encountered in vitrectomized eyes such as zonular damage, increased mobility of the lens-iris diaphragm, and altered intraocular fluid dynamics, phacoemulsification proved to be a safe procedure in the hands of experienced surgeons.
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Affiliation(s)
- Z Szijarto
- Department of Ophthalmology, University of Pecs, Ifjúság Street 13, 7624 Pecs, Hungary.
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Abstract
Prostate cancer incurs a substantial incidence and mortality burden, similarly to breast cancer, and it ranks among the top ten specific causes of death in the United States. It is inherent as we maximize the detection of early prostate cancer that we increase the detection of both nonaggressive (slow growing) and aggressive (faster growing) prostate cancers. The evidence clearly supports the use of PSA screening in conjunction with DRE as a means of early detection of prostate cancer. Widespread implementation of prostate cancer screening in the United States has led to the phenomenon of stage migration with more cancers being detected at a lower stage. Such a trend has decreased the incidence of metastatic disease at diagnosis and paralleled the decrease of the mortality rate from prostate cancer. Our understanding of the natural history of prostate cancer is progressing over time, but the question of its length is unanswerable. The relatively long doubling time (on average) of early prostate cancer of 3 to 4 years or more indicates a relatively good prognosis for many men with this disease, even without early detection and treatment. Unfortunately, the poor specificity of the PSA test in men with benign prostatic hyperplasia (BPH) leads to high rates of prostate biopsy and attendant illnesses and costs. Early detection is more apt to detect a slow-growing prostate cancer than a faster growing cancer that is associated with a more rapid course of progression to metastatic disease. Hence, the launching of mass screening programs for the early detection of prostate cancer is premature. However, in the absence of solid evidence of benefit, one reasonable approach to screening at the individual level is to involve the patient in decisions about whether or not to perform a PSA test. Thus, "offering" PSA testing must be accompanied by informed discussion within the context of an ongoing patient-physician relationship. This is to be distinguished from the use of PSA testing for the purpose of "mass screening." Concepts that must be explored with the patient include: 1. The long-term ramifications of screening 2. The relatively high probability of further evaluation and biopsy with positive results 3. Potentially difficult decisions that may arise about using treatments that are associated with considerable morbidity and uncertain benefits (at the time) if cancer is discovered We should identify a future path that is evidence-based, focused on the issues that make a difference to patients, and results in better and longer lives of those with the disease and those who are at risk of getting it. If that path leads to treating fewer patients in the future, even if sometimes more aggressively, we should pursue it definitely and consequently.
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Affiliation(s)
- P Tenke
- Department of Urology, Jahn Ferenc South-Pest Hospital, Budapest, Hungary
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Abstract
PURPOSE Cataract surgery is known to elicit postoperative macular oedema owing to its traumatic effect. The aim of the study was to measure the foveal and perifoveal thickness of the retina after uneventful phacoemulsification and posterior chamber intraocular lens (PC-IOL) implantation. METHODS Retinal thickness values of the foveal and perifoveal (fovea+3.0 mm, fovea+6.0 mm) sectors and the minimum values were measured in a prospective study using optical coherence tomography (OCT) in 71 eyes of 71 patients (34 men, 37 women, mean age: 68.8 years) who underwent cataract surgery. Phacoemulsification and 'in the bag' implantation of a foldable PC-IOL was performed under topical anaesthesia. Data were collected 1 day before the operation, and postoperatively at 1, 7, 30, and 60 days. Contralateral eyes of each patient served as controls. 'Student's t-test' was used for statistical analysis, and P<0.05 value was considered significant. RESULTS No significant change of the thickness values could be measured 1 day after surgery. However, a significant increase could be detected on the postoperative 7, 30, and 60 days in the perifoveal 3.0 and 6.0 mm sectors either calculated alone or averaged together with the foveal values. The initial (preoperative) average value of 234.1+/-2.6 microm (mean+/-SEM, n=536) in the 6.0 mm perifoveal region increased to 242.5+/-2.6 microm (mean+/-SEM, n=488, P<0.01) 1 week, to 247.7+/-4.6 microm (n=352, P<0.01) 1 month, and to 246.0+/-5.9 microm (n=208, P<0.05) 2 months after surgery, which proved to be significant. However, the relative change of macular thickness was moderate, 3.5, 5.6, and 5.3% at the above periods, respectively. In a subgroup of patients (n=34) minimum 6 months after cataract surgery, the 6.0 mm perifoveal values were found to be elevated at (237.8+/-3.9 microm, mean+/-SEM, n=272) as compared to the control eyes (233.9+/-3.8 microm, mean+/-SEM, n=272). The difference was 1.7% and proved not to be significant (P>0.05). CONCLUSIONS Mild subclinical perifoveal oedema following cataract surgery was detected using OCT at postoperative day 7 to 6 months. The minimal and the foveal values in itself are inadequate to describe the phenomenon. The macular thickness values of the perifoveal 3.0 and 6.0 mm sectors alone or averaged together with the foveal values provide more accurate description of the postoperative macular oedema.OCT enables the detection of minimal increases in perifoveal retinal thickness even 6 months after cataract surgery.
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Affiliation(s)
- Z Biro
- Department of Ophthalmology, University of Pecs, Faculty of Medicine, Pécs, Baranya, Hungary.
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Abstract
In the process of endourological development a great variety of foreign bodies have been invented besides urinary catheters on which biofilm can be formed. Bacteria in the biofilm are less sensible to antibiotics. An additional problem of medical biomaterials in the urinary tract environment is the development of encrustation and consecutive obstruction. In this review, we tried to sum up the conditions where biofilm formation has a great impact on the development or maintenance of urological infections and on treatment success. Modification of the biomaterial surface seems to be the most promising prevention strategy for bacterial biofilms. Easier methods for diagnosing and quantifying biofilm infection, to develop more specific antimicrobial agents and ideal device surfaces would surely help the fight against biofilm formation.
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Affiliation(s)
- P Tenke
- Department of Urology, Jahn Ferenc South-Pest Hospital, Köves utca 2-4, 1204 Budapest, Hungary.
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Kovacs B, Riley JL, Finkel TH. Ligation of CD28 Alone by its Natural Ligand, CD86, Induces Lipid Raft Polarization in Human CD4 T-cells. Retrovirology 2005. [DOI: 10.1186/1742-4690-2-s1-s114] [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: 11/10/2022] Open
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Feher J, Kovacs B, Kovacs I, Schveoller M, Papale A, Balacco Gabrieli C. Improvement of visual functions and fundus alterations in early age-related macular degeneration treated with a combination of acetyl-L-carnitine, n-3 fatty acids, and coenzyme Q10. Ophthalmologica 2005; 219:154-66. [PMID: 15947501 DOI: 10.1159/000085248] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2004] [Accepted: 10/22/2004] [Indexed: 11/19/2022]
Abstract
The aim of this randomized, double-blind, placebo-controlled clinical trial was to determine the efficacy of a combination of acetyl-L-carnitine, n-3 fatty acids, and coenzyme Q10 (Phototrop) on the visual functions and fundus alterations in early age-related macular degeneration (AMD). One hundred and six patients with a clinical diagnosis of early AMD were randomized to the treated or control groups. The primary efficacy variable was the change in the visual field mean defect (VFMD) from baseline to 12 months of treatment, with secondary efficacy parameters: visual acuity (Snellen chart and ETDRS chart), foveal sensitivity as measured by perimetry, and fundus alterations as evaluated according to the criteria of the International Classification and Grading System for AMD. The mean change in all four parameters of visual functions showed significant improvement in the treated group by the end of the study period. In addition, in the treated group only 1 out of 48 cases (2%) while in the placebo group 9 out of 53 (17%) showed clinically significant (>2.0 dB) worsening in VFMD (p = 0.006, odds ratio: 10.93). Decrease in drusen-covered area of treated eyes was also statistically significant as compared to placebo when either the most affected eyes (p = 0.045) or the less affected eyes (p = 0.017) were considered. These findings strongly suggested that an appropriate combination of compounds which affect mitochondrial lipid metabolism, may improve and subsequently stabilize visual functions, and it may also improve fundus alterations in patients affected by early AMD.
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Affiliation(s)
- J Feher
- Ophthalmic Neuroscience Program, Department of Ophthalmology, University of Rome 'La Sapienza', Rome, Italy.
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