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Tsiachris D, Argyriou N, Tsioufis P, Antoniou CK, Laina A, Oikonomou G, Doundoulakis I, Kordalis A, Dimitriadis K, Gatzoulis K, Tsioufis K. Aggressive Rhythm Control Strategy in Atrial Fibrillation Patients Presenting at the Emergency Department: The HEROMEDICUS Study Design and Initial Results. J Cardiovasc Dev Dis 2024; 11:109. [PMID: 38667727 PMCID: PMC11049958 DOI: 10.3390/jcdd11040109] [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: 01/07/2024] [Revised: 03/26/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Atrial fibrillation has progressively become a more common reason for emergency department visits, representing 0.5% of presenting reasons. Registry data have indicated that about 60% of atrial fibrillation patients who present to the emergency department are admitted, emphasizing the need for more efficient management of atrial fibrillation in the acute phase. Management of atrial fibrillation in the setting of the emergency department varies between countries and healthcare systems. The most plausible reason to justify a conservative rather than an aggressive strategy in the management of atrial fibrillation is the absence of specific guidelines from diverse societies. Several trials of atrial fibrillation treatment strategies, including cardioversion, have demonstrated that atrial fibrillation in the emergency department can be treated safely and effectively, avoiding admission. In the present study, we present the epidemiology and characteristics of atrial fibrillation patients presenting to the emergency department, as well as the impact of diverse management strategies on atrial-fibrillation-related hospital admissions. Lastly, the design and initial data of the HEROMEDICUS protocol will be presented, which constitutes an electrophysiology-based aggressive rhythm control strategy in patients with atrial fibrillation in the emergency department setting.
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Affiliation(s)
- Dimitrios Tsiachris
- First Department of Cardiology, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (N.A.); (P.T.); (C.K.A.); (A.L.); (G.O.); (A.K.); (K.D.); (K.G.); (K.T.)
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2
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Milaras N, Kordalis A, Tsiachris D, Sakalidis A, Ntalakouras I, Pamporis K, Dourvas P, Apostolos A, Sotiriou Z, Arsenos P, Archontakis S, Tsioufis K, Gatzoulis K, Sideris S. Ischemia testing and revascularization in patients with monomorphic ventricular tachycardia: A relic of the past? Curr Probl Cardiol 2024; 49:102358. [PMID: 38169203 DOI: 10.1016/j.cpcardiol.2023.102358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024]
Abstract
Testing for myocardial ischemia in patients presenting with sustained monomorphic Ventricular Tachycardia(VT) even without evidence of acute myocardial infarction is a tempting strategy that is frequently utilized in clinical practice. Monomorphic VT is mainly caused by re-entry around chronic myocardial scar and active ischemia has no role in its pathogenesis, thus making testing for ischemia futile, at least in theory. This systematic literature review sought to address the usefulness of ischemia testing (mainly coronary angiography) in patients presenting with monomorphic VT through 8 selected studies after evaluating a total of 130 published manuscripts. Particularly, we sought to unveil whether coronary angiography and possibly concomitant revascularization leads to lesser tachycardia recurrence. Our conclusion can be summarized as follows: this approach whether combined with revascularization or not, does not seem to reduce VT recurrence nor does it affect mortality in such patients. Even though most of the published literature points at this direction, validation from randomized controlled trials is imperative.
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Affiliation(s)
- Nikias Milaras
- State Department of Cardiology, "Hippokration" General Hospital of Athens, Greece; School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Vasilissis Sofias 114, Athens 11527, Greece.
| | - Athanasios Kordalis
- School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Vasilissis Sofias 114, Athens 11527, Greece
| | - Dimitrios Tsiachris
- School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Vasilissis Sofias 114, Athens 11527, Greece
| | - Athanasios Sakalidis
- School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Vasilissis Sofias 114, Athens 11527, Greece
| | - Ioannis Ntalakouras
- State Department of Cardiology, "Hippokration" General Hospital of Athens, Greece
| | | | - Panagiotis Dourvas
- State Department of Cardiology, "Hippokration" General Hospital of Athens, Greece
| | - Anastasios Apostolos
- School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Vasilissis Sofias 114, Athens 11527, Greece
| | - Zoi Sotiriou
- School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Vasilissis Sofias 114, Athens 11527, Greece
| | - Petros Arsenos
- School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Vasilissis Sofias 114, Athens 11527, Greece
| | - Stefanos Archontakis
- State Department of Cardiology, "Hippokration" General Hospital of Athens, Greece
| | - Konstantinos Tsioufis
- School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Vasilissis Sofias 114, Athens 11527, Greece
| | - Konstantinos Gatzoulis
- School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Vasilissis Sofias 114, Athens 11527, Greece
| | - Skevos Sideris
- State Department of Cardiology, "Hippokration" General Hospital of Athens, Greece
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Vouliotis AI, Roberts PR, Dilaveris P, Gatzoulis K, Yue A, Tsioufis K. Leadless Pacemakers: Current Achievements and Future Perspectives. Eur Cardiol 2023; 18:e49. [PMID: 37655133 PMCID: PMC10466270 DOI: 10.15420/ecr.2022.32] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/18/2022] [Indexed: 09/02/2023] Open
Abstract
Despite the technological advances in pacemaker technology, the transvenous implanted leads are still considered the Achilles' heel of this rhythm-control therapy. The leadless permanent pacemaker system was developed as an option to bypass the weakness of the transvenous approach. Advances in battery technology and deep miniaturisation of electronics now offer the opportunity to implant the whole pacemaker system into the right ventricle. This review aims to provide a comprehensive report on the advent of leadless pacemakers, their clinical usefulness and the future perspectives of this disruptive and promising technology. Further research is required before some of these technologies are safely and routinely used in clinical practice.
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Affiliation(s)
- Apostolos Ilias Vouliotis
- Cardiology Department, University Hospital SouthamptonSouthampton, UK
- First University Department of Cardiology, School of Medicine, National and Kapodistrian University of AthensAthens, Greece
| | - Paul R Roberts
- Cardiology Department, University Hospital SouthamptonSouthampton, UK
| | - Polychronis Dilaveris
- First University Department of Cardiology, School of Medicine, National and Kapodistrian University of AthensAthens, Greece
| | - Konstantinos Gatzoulis
- First University Department of Cardiology, School of Medicine, National and Kapodistrian University of AthensAthens, Greece
| | - Arthur Yue
- Cardiology Department, University Hospital SouthamptonSouthampton, UK
| | - Konstantinos Tsioufis
- First University Department of Cardiology, School of Medicine, National and Kapodistrian University of AthensAthens, Greece
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4
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Milaras N, Dourvas P, Doundoulakis I, Sotiriou Z, Nevras V, Xintarakou A, Laina A, Soulaidopoulos S, Zachos P, Kordalis A, Arsenos P, Archontakis S, Antoniou CK, Tsiachris D, Dilaveris P, Tsioufis K, Sideris S, Gatzoulis K. Noninvasive electrocardiographic risk factors for sudden cardiac death in dilated ca rdiomyopathy: is ambulatory electrocardiography still relevant? Heart Fail Rev 2023:10.1007/s10741-023-10300-x. [PMID: 36872393 DOI: 10.1007/s10741-023-10300-x] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 03/07/2023]
Abstract
Risk stratification for sudden cardiac death in dilated cardiomyopathy is a field of constant debate, and the currently proposed criteria have been widely questioned due to their low positive and negative predictive value. In this study, we conducted a systematic review of the literature utilizing the PubMed and Cochrane library platforms, in order to gain insight about dilated cardiomyopathy and its arrhythmic risk stratification utilizing noninvasive risk markers derived mainly from 24 h electrocardiographic monitoring. The obtained articles were reviewed in order to register the various electrocardiographic noninvasive risk factors used, their prevalence, and their prognostic significance in dilated cardiomyopathy. Premature ventricular complexes, nonsustained ventricular tachycardia, late potentials on Signal averaged electrocardiography, T wave alternans, heart rate variability and deceleration capacity of the heart rate, all have both some positive and negative predictive value to identify patients in higher likelihood for ventricular arrhythmias and sudden cardiac death. Corrected QT, QT dispersion, and turbulence slope-turbulence onset of heart rate have yet to establish a predictive correlation in the literature. Although ambulatory electrocardiographic monitoring is frequently used in clinical practice in DCM patients, no single risk marker can be used for the selection of patients at high-risk for malignant ventricular arrhythmic events and sudden cardiac death who could benefit from the implantation of a defibrillator. More studies are needed in order to establish a risk score or a combination of risk factors with the purpose of selecting high-risk patients for ICD implantation in the context of primary prevention.
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Affiliation(s)
- Nikias Milaras
- National and Kapodistrian University of Athens, Athens, Greece.
- State Department of Cardiology, "Hippokration" Hospital, Vasilisis Sofias 14, 11256, Athens, Greece.
| | - Panagiotis Dourvas
- State Department of Cardiology, "Hippokration" Hospital, Vasilisis Sofias 14, 11256, Athens, Greece
| | - Ioannis Doundoulakis
- First Department of Cardiology, National and Kapodistrian University, Hippokration" Hospital, Athens, Greece
| | - Zoi Sotiriou
- Department of Cardiology, General Hospital of Karditsa, Karditsa, Greece
| | - Vasileios Nevras
- Department of Cardiology, General Hospital of Thessaloniki Gennimatas, Thessaloniki, Greece
| | - Anastasia Xintarakou
- First Department of Cardiology, National and Kapodistrian University, Hippokration" Hospital, Athens, Greece
| | - Aggeliki Laina
- First Department of Cardiology, National and Kapodistrian University, Hippokration" Hospital, Athens, Greece
| | - Stergios Soulaidopoulos
- First Department of Cardiology, National and Kapodistrian University, Hippokration" Hospital, Athens, Greece
| | - Panagiotis Zachos
- Department of Cardiology, General Hospital of Karditsa, Karditsa, Greece
| | - Athanasios Kordalis
- First Department of Cardiology, National and Kapodistrian University, Hippokration" Hospital, Athens, Greece
| | - Petros Arsenos
- First Department of Cardiology, National and Kapodistrian University, Hippokration" Hospital, Athens, Greece
| | - Stefanos Archontakis
- State Department of Cardiology, "Hippokration" Hospital, Vasilisis Sofias 14, 11256, Athens, Greece
| | | | | | - Polychronis Dilaveris
- First Department of Cardiology, National and Kapodistrian University, Hippokration" Hospital, Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, National and Kapodistrian University, Hippokration" Hospital, Athens, Greece
| | - Skevos Sideris
- State Department of Cardiology, "Hippokration" Hospital, Vasilisis Sofias 14, 11256, Athens, Greece
| | - Konstantinos Gatzoulis
- First Department of Cardiology, National and Kapodistrian University, Hippokration" Hospital, Athens, Greece
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Archontakis S, Oikonomou E, Sideris K, Laina A, Tirovola D, Paraskevopoulou D, Kostakis P, Doundoulakis I, Arsenos P, Ntalakouras I, Charitakis E, Gatzoulis K, Tsioufis K, Sideris S. Safety of same-day discharge versus overnight stay strategy following cardiac device implantations: a high-volume single-centre experience. J Interv Card Electrophysiol 2023; 66:471-481. [PMID: 36063282 PMCID: PMC9442569 DOI: 10.1007/s10840-022-01319-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/21/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The strategy of cardiac implantable electronic device (CIED) implantations performed as day-case admissions has gained a wider acceptance overtime; however, data on safety are still limited. This study aims to investigate the safety of a same-day discharge protocol introduced in our hospital for the postprocedural management of patients undergoing CIED implantation. METHODS Α prospective, non-interventional, non-randomised study performed in a single high-volume implanting centre for a 16-month period (March 2020 to June 2021). At total of 821 of 965 (85.1%) patients scheduled for elective CIED implantation were considered to be eligible for inclusion in the Short-stay Device Management Protocol. These patients were compared with a historical group of 932 patients, meeting the same inclusion criteria. RESULTS Procedure was successful in 812 patients (98.9%), committed to same-day discharge versus 921 of 932 patients (98.8%) admitted for overnight stay (p = 0.87). Overall, 90-day complication rate was comparable in both groups (4.14% vs 4.07%, p = 0.95), as was major (1.46% vs. 1.82%, p = 0.55) and minor (2.67% vs. 2.25%, p = 0.64) complication rates. The composite early post-procedural complication rates and late post-procedural complication rates were comparable among groups (0.97 vs 1.18%, p = 0.70 and 0.73% vs 0.64%, p = 0.83, respectively). Six hundred sixty-seven patients (84%) preferred the same-day discharge strategy. Finally, a reduction of 792 bed-days was recorded, resulting in possible financial Health System benefits. CONCLUSIONS Same-day discharge is feasible and safe in the majority of patients referred for CIED implantation. Additionally, same-day discharge is preferred by patients and may reduce procedure-related costs due to significant bed-day reductions.
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Affiliation(s)
- Stefanos Archontakis
- Department of Cardiology, Hippokration General Hospital, 114 VasilisisSofias str, Athens, Greece
| | - Evangelos Oikonomou
- First Cardiology Division, Medical School, Hippokration General Hospital, University of Athens, 114 VasilisisSofias str, Athens, Greece
| | - Konstantinos Sideris
- Department of Cardiology, Hippokration General Hospital, 114 VasilisisSofias str, Athens, Greece
| | - Ageliki Laina
- First Cardiology Division, Medical School, Hippokration General Hospital, University of Athens, 114 VasilisisSofias str, Athens, Greece
| | - Dimitra Tirovola
- Department of Cardiology, Hippokration General Hospital, 114 VasilisisSofias str, Athens, Greece
| | - Dimitra Paraskevopoulou
- Department of Cardiology, Hippokration General Hospital, 114 VasilisisSofias str, Athens, Greece
| | - Panagiotis Kostakis
- Department of Cardiology, Hippokration General Hospital, 114 VasilisisSofias str, Athens, Greece
| | - Ioannis Doundoulakis
- First Cardiology Division, Medical School, Hippokration General Hospital, University of Athens, 114 VasilisisSofias str, Athens, Greece
| | - Petros Arsenos
- First Cardiology Division, Medical School, Hippokration General Hospital, University of Athens, 114 VasilisisSofias str, Athens, Greece
| | - Ioannis Ntalakouras
- First Cardiology Division, Medical School, Hippokration General Hospital, University of Athens, 114 VasilisisSofias str, Athens, Greece
| | - Emmanouil Charitakis
- Department of Cardiology, Hippokration General Hospital, 114 VasilisisSofias str, Athens, Greece
| | - Konstantinos Gatzoulis
- First Cardiology Division, Medical School, Hippokration General Hospital, University of Athens, 114 VasilisisSofias str, Athens, Greece
| | - Konstantinos Tsioufis
- First Cardiology Division, Medical School, Hippokration General Hospital, University of Athens, 114 VasilisisSofias str, Athens, Greece
| | - Skevos Sideris
- Department of Cardiology, Hippokration General Hospital, 114 VasilisisSofias str, Athens, Greece.
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6
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Archontakis S, Oikonomou E, Sideris K, Laina A, Tirovola D, Paraskevopoulou D, Kostakis P, Doundoulakis I, Arsenos P, Ntalakouras I, Charitakis E, Gatzoulis K, Tsioufis K, Sideris S. Correction to: Safety of same-day discharge versus overnight stay strategy following cardiac device implantations: a high-volume single-centre experience. J Interv Card Electrophysiol 2023; 66:483. [PMID: 36542314 PMCID: PMC10074511 DOI: 10.1007/s10840-022-01458-9] [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: 12/24/2022]
Affiliation(s)
- Stefanos Archontakis
- Department of Cardiology, Hippokration General Hospital, 114 VasilisisSofias str, Athens, Greece
| | - Evangelos Oikonomou
- First Cardiology Division, Medical School, Hippokration General Hospital, University of Athens, 114 VasilisisSofias str, Athens, Greece
| | - Konstantinos Sideris
- Department of Cardiology, Hippokration General Hospital, 114 VasilisisSofias str, Athens, Greece
| | - Ageliki Laina
- First Cardiology Division, Medical School, Hippokration General Hospital, University of Athens, 114 VasilisisSofias str, Athens, Greece
| | - Dimitra Tirovola
- Department of Cardiology, Hippokration General Hospital, 114 VasilisisSofias str, Athens, Greece
| | - Dimitra Paraskevopoulou
- Department of Cardiology, Hippokration General Hospital, 114 VasilisisSofias str, Athens, Greece
| | - Panagiotis Kostakis
- Department of Cardiology, Hippokration General Hospital, 114 VasilisisSofias str, Athens, Greece
| | - Ioannis Doundoulakis
- First Cardiology Division, Medical School, Hippokration General Hospital, University of Athens, 114 VasilisisSofias str, Athens, Greece
| | - Petros Arsenos
- First Cardiology Division, Medical School, Hippokration General Hospital, University of Athens, 114 VasilisisSofias str, Athens, Greece
| | - Ioannis Ntalakouras
- First Cardiology Division, Medical School, Hippokration General Hospital, University of Athens, 114 VasilisisSofias str, Athens, Greece
| | - Emmanouil Charitakis
- Department of Cardiology, Hippokration General Hospital, 114 VasilisisSofias str, Athens, Greece
| | - Konstantinos Gatzoulis
- First Cardiology Division, Medical School, Hippokration General Hospital, University of Athens, 114 VasilisisSofias str, Athens, Greece
| | - Konstantinos Tsioufis
- First Cardiology Division, Medical School, Hippokration General Hospital, University of Athens, 114 VasilisisSofias str, Athens, Greece
| | - Skevos Sideris
- Department of Cardiology, Hippokration General Hospital, 114 VasilisisSofias str, Athens, Greece.
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7
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Xintarakou A, Arsenos P, Gatzoulis K, Manis G, Trachanas K, Soulaidopoulos S, Dilaveris P, Doundoulakis I, Kordalis A, Laina A, Xydis P, Tsimos K, Korantzopoulos P, Kolettis T, Tsioufis K. Prediction of programmed ventricular stimulation inducibility using machine learning in post-myocardial infarction patients at risk for sudden cardiac arrest with preserved ejection fraction ≥40%. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Sudden cardiac death (SCD) in post myocardial infarction (post-MI) patients with a relatively preserved left ventricular ejection fraction (LVEF ≥40%) has 1% annual incidence. In the PRESERVE-EF study, we used a two-step SCD risk stratification approach to detect patients with a relatively preserved left ventricular ejection fraction ≥40% at risk for major arrhythmic events. Seven noninvasive risk factors (NIRFs) were extracted from ambulatory electrocardiography. Patients with at least one NIRF present were referred for invasive programmed ventricular stimulation (PVS). Inducible patients received an ICD.
Purpose
The present study examines the performance of machine learning technology for the prediction of the inducible patients in PRESERVE-EF study.
Methods
After first step screening with NIRFs, 152 out of 575 patients underwent PVS and 41 of them were inducible. For the present analysis, data from these 152 patients were analysed. We used machine learning of NIRFs to predict these inducible high risk patients. We selected as classification method the Nearest Neighbour (NN) algorithm, after experimentation with several classifiers. NN classifies each subject according to the class of the N nearest neighbours. For each subject, we created a vector with the following 7 features: SAECG Late Potentials, Ventricular Premature beats ≥30/hour, Non-sustained Ventricular Tachycardia ≥1 episode (s)/24 hours, Fredericia corrected QT interval ≥45 0ms, SDNN/HRV ≤75 ms, T Wave Alternans ≥65 μV, Combined Deceleration capacity (DC) ≤4.5 ms and Heart Rate Turbulence Onset (To) ≥0% and Heart Rate Turbulence Slope (Ts) ≤2.5 ms.
Results
The achieved accuracy reached up to 72.2% when N was set to 7. We had totally 144 samples, 41 of which were inducible high risk patients. Results were similar for other values of N. To ensure independence of train and test sets, we employed 10-fold cross validation.
Conclusions
Inducible on PVS patients in PRESERVE-EF study were predicted with machine learning classification of NIRFs.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Xintarakou
- Hippokration General Hospital, First Department of Cardiology, National and Kapodistrian University of Athens , Athens , Greece
| | - P Arsenos
- Hippokration General Hospital, First Department of Cardiology, National and Kapodistrian University of Athens , Athens , Greece
| | - K Gatzoulis
- Hippokration General Hospital, First Department of Cardiology, National and Kapodistrian University of Athens , Athens , Greece
| | - G Manis
- University of Ioannina, Department of Computer Science and Engineering, School of Engineering , Ioannina , Greece
| | - K Trachanas
- Hippokration General Hospital, First Department of Cardiology, National and Kapodistrian University of Athens , Athens , Greece
| | - S Soulaidopoulos
- Hippokration General Hospital, First Department of Cardiology, National and Kapodistrian University of Athens , Athens , Greece
| | - P Dilaveris
- Hippokration General Hospital, First Department of Cardiology, National and Kapodistrian University of Athens , Athens , Greece
| | - I Doundoulakis
- Hippokration General Hospital, First Department of Cardiology, National and Kapodistrian University of Athens , Athens , Greece
| | - A Kordalis
- Hippokration General Hospital, First Department of Cardiology, National and Kapodistrian University of Athens , Athens , Greece
| | - A Laina
- Hippokration General Hospital, First Department of Cardiology, National and Kapodistrian University of Athens , Athens , Greece
| | - P Xydis
- Hippokration General Hospital, First Department of Cardiology, National and Kapodistrian University of Athens , Athens , Greece
| | - K Tsimos
- University Hospital of Ioannina, First Cardiology Division , Ioannina , Greece
| | - P Korantzopoulos
- University Hospital of Ioannina, First Cardiology Division , Ioannina , Greece
| | - T Kolettis
- University Hospital of Ioannina, First Cardiology Division , Ioannina , Greece
| | - K Tsioufis
- Hippokration General Hospital, First Department of Cardiology, National and Kapodistrian University of Athens , Athens , Greece
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8
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Patsourakos D, Aggeli C, Gatzoulis K, Delicou S, Xydaki A, Koukos M, Gialleli F, Dimitroglou Y, Tsioufis K. Right ventricular mechanics among beta-thalassemia major patients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.040] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
Right ventricular function among β-thalassemia (β-TM) patients is affected by both pulmonary circulation pressure and primary iron deposition on right ventricular myocardium.
Purpose
In our study we aimed to detect the presence of impaired right ventricular function and right ventricle to pulmonary circulation (RV-PC) coupling by applying novel echocardiographic techniques among these patients.
Methods
47 β-TM patients (mean age 39.02±8.76 years, 48.9% male sex) and 24, age and sex matched, healthy controls were examined by transthoracic echocardiography. Conventional echocardiographic parameters were estimated (LVEF, E/e' ratio, left atrial volume index (LAVI), right ventricular systolic pressure (RVSP), S' wave of tricuspid annulus), alongside with deformation indices (left atrial strain at reservoir phase (LASr), right ventricular free wall (RVfw) and 4 chamber (RV4c) strain), as well as RV-PC coupling expressed as S'/RVSP, RVfw/RVSP and RV4c/RVSP. T2* was calculated by cardiac magnetic resonance imaging in β-TM patient group.
Results
E/e' ratio, LVEF, LAVI, RVSP, LASr, RVfw, RV4c, S'/RVSP, RVfw/RVSP and RV4c/RVSP differed significantly between patients and controls (Table 1). T2* did not correlate with either right ventricular deformation indices or RV-PC coupling indices. A correlation was found regarding LASr with both S'/RVSP (r=0.383, p=0.008) and RV4c/RVSP (r=−0.388, p=0.007) but not with RVfw/PVSP (Table 2).
Conclusions
Right ventricular deformation indices were found to be impaired in β-TM patients compared to controls, but they do not seem to be associated with myocardial iron load (T2* index). RV-PC coupling was also found to be impaired among patients and a correlation was found between RV-PC indices and left atrial strain. The latter suggests that the presence of atrial cardiomyopathy in β-TM patients could be associated with the impaired RV-PC coupling.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - C Aggeli
- Hippokration General Hospital , Athens , Greece
| | - K Gatzoulis
- Hippokration General Hospital , Athens , Greece
| | - S Delicou
- Hippokration General Hospital , Athens , Greece
| | - A Xydaki
- Hippokration General Hospital , Athens , Greece
| | - M Koukos
- Hippokration General Hospital , Athens , Greece
| | - F Gialleli
- Hippokration General Hospital , Athens , Greece
| | | | - K Tsioufis
- Hippokration General Hospital , Athens , Greece
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9
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Tsiachris D, Antoniou C, Doundoulakis I, Manolakou P, Kordalis A, Konstantinou D, Gatzoulis K, Tsioufis K, Stefanadis C. Three‐dimensional electroanatomically guided slow pathway elimination is associated with procedural improvements and clinical benefit in atrioventricular node reentrant tachycardia patients. J Arrhythm 2022; 38:1035-1041. [DOI: 10.1002/joa3.12778] [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] [Received: 05/26/2022] [Revised: 08/28/2022] [Accepted: 09/02/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Dimitrios Tsiachris
- Athens Heart Center Athens Medical Center Athens Greece
- First Department of Cardiology National and Kapodistrian University, “Hippokration” Hospital Athens Greece
| | | | - Ioannis Doundoulakis
- Athens Heart Center Athens Medical Center Athens Greece
- First Department of Cardiology National and Kapodistrian University, “Hippokration” Hospital Athens Greece
| | | | - Athanasios Kordalis
- First Department of Cardiology National and Kapodistrian University, “Hippokration” Hospital Athens Greece
| | | | - Konstantinos Gatzoulis
- First Department of Cardiology National and Kapodistrian University, “Hippokration” Hospital Athens Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology National and Kapodistrian University, “Hippokration” Hospital Athens Greece
| | - Christodoulos Stefanadis
- Athens Heart Center Athens Medical Center Athens Greece
- Section of Cardiovascular Medicine Yale University School of Medicine New Haven Connecticut USA
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10
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Vassilikos VP, Giannopoulos G, Billis A, Efremidis M, Andrikopoulos G, Katsivas A, Kossyvakis C, Kallergis E, Letsas K, Kanoupakis E, Ioannidis P, Tzeis S, Deftereos S, Tsiachris D, Theodorakis G, Maounis T, Lysitsas D, Chatzinikolaou E, Fragakis N, Paraskevaidis S, Mezilis N, Kourouklis S, Pastromas S, Apostolopoulos T, Avramidis D, Chatzidou S, Papagiannis I, Kostopoulou A, Symeonidou E, Rassias I, Mantziari L, Leventopoulos G, Kourgiannidis G, Stavropoulos G, Katritsis D, Chiladakis I, Xydonas S, Ginos C, Kotsakis A, Baltogiannis G, Manolis AS, Sideris S, Gatzoulis K. Effect of the COVID-19 pandemic on cardiac electrophysiological ablation procedures in Greece - data from the Hellenic Society of Cardiology Ablation Registry. Hellenic J Cardiol 2022; 67:76-78. [PMID: 35811060 PMCID: PMC9263686 DOI: 10.1016/j.hjc.2022.07.002] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/03/2022] [Accepted: 07/03/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Vassilios P Vassilikos
- Third Department of Cardiology, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki
| | - Georgios Giannopoulos
- Third Department of Cardiology, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki.
| | - Antonis Billis
- Lab of Medical Physics, Aristotle University of Thessaloniki, Thessaloniki
| | - Michalis Efremidis
- Onassis Cardiothoracic Center, Department of Electrophysiology and Pacing, Athens
| | | | | | | | - Eleftherios Kallergis
- Department of Cardiology, University Hospital of Heraklion, University of Crete, Heraklion
| | - Konstantinos Letsas
- Onassis Cardiothoracic Center, Department of Electrophysiology and Pacing, Athens
| | - Emmanouel Kanoupakis
- Department of Cardiology, University Hospital of Heraklion, University of Crete, Heraklion
| | | | | | - Spyridon Deftereos
- Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens
| | | | | | - Themistoklis Maounis
- Onassis Cardiothoracic Center, Department of Electrophysiology and Pacing, Athens
| | | | | | - Nikolaos Fragakis
- Third Department of Cardiology, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki
| | - Stylianos Paraskevaidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki
| | | | | | | | | | | | - Sophia Chatzidou
- Alexandra University Hospital, National and Kapodistrian University of Athens, Athens
| | | | - Anna Kostopoulou
- Onassis Cardiothoracic Center, Department of Electrophysiology and Pacing, Athens
| | - Eftychia Symeonidou
- Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens
| | | | | | | | | | - George Stavropoulos
- Second Department of Cardiology, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki
| | | | - Ioannis Chiladakis
- Department of Cardiology, Rio University Hospital, University of Patras, Patras
| | | | | | | | - Giannis Baltogiannis
- Department of Cardiology, University Hospital of Ioannina, University of Ioannina, Ioannina
| | - Antonis S Manolis
- First Department of Cardiology, Hippokration University Hospital, National and Kapodistrian University of Athens, Athens
| | - Skevos Sideris
- First Department of Cardiology, Hippokration University Hospital, National and Kapodistrian University of Athens, Athens
| | - Konstantinos Gatzoulis
- First Department of Cardiology, Hippokration University Hospital, National and Kapodistrian University of Athens, Athens
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11
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Karanasos A, Tyrovolas K, Tsiachris D, Efremidis M, Kordalis A, Karmpalioti M, Prappa E, Karagiannis S, Aggeli C, Gatzoulis K, Tousoulis D, Tsioufis C, Toutouzas KP. Left Atrial Function Post Radiofrequency and Cryoballoon Ablation Assessed by Volume-Pressure Loops. Front Cardiovasc Med 2022; 9:830055. [PMID: 35355975 PMCID: PMC8959489 DOI: 10.3389/fcvm.2022.830055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/28/2022] [Indexed: 12/01/2022] Open
Abstract
Background Left atrial (LA) function is linked to atrial fibrillation (AF) pathogenesis. AF catheter ablation decreases disease burden with potentially favorable effects on cardiac function. Atrial volume-pressure loops can optimally assess the LA function. Objective To investigate changes in LA function by volume-pressure loops after paroxysmal AF ablation and explored potential differences between the radiofrequency and cryoballoon ablation. Methods We analyzed 44 patients undergoing paroxysmal AF ablation from 2 centers, 22 treated with radiofrequency and 22 with cryoablation. Pre- and post-procedure, all patients underwent a real-time three-dimensional transthoracic ECG to evaluate LA volume, while simultaneously recording LA pressure following transseptal puncture. Volume-pressure loops pre- and post-procedure were created by paired data. Areas of A-loop (LA booster pump function) and V-loop (LA reservoir function), and the stiffness constant determining the slope of the exponential curve during LA filling were calculated. Results Average LA pressure, A-wave amplitude, and V-wave amplitude were increased post-procedurally (p < 0.001). Overall, A-loop area decreased (p = 0.001) and V-loop area tended to increase (p = 0.07). The change in both A-loop and V-loop areas was similar between radiofrequency- and cryoballoon-treated patients (p = 0.18 and p = 0.52, respectively). However, compared with cryoballoon-treated patients, radiofrequency-treated patients had higher increase in the stiffness constant (b = 0.059; 95% CI: 0.022–0.096; p = 0.006). Conclusion AF catheter ablation by the radiofrequency or cryoballoon is associated with the decrease of the booster pump function and increase of the reservoir function. Moreover, there is a post-procedural increase of LA pressure which is associated with an acute increase in LA stiffness in radiofrequency ablation, but not in cryoablation.
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Affiliation(s)
- Antonios Karanasos
- 1st Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece
| | - Konstantinos Tyrovolas
- Second Department of Cardiology, “Evangelismos” General Hospital of Athens, Athens, Greece
| | | | - Michalis Efremidis
- Second Department of Cardiology, “Evangelismos” General Hospital of Athens, Athens, Greece
| | - Athanasios Kordalis
- 1st Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece
- Athens Heart Centre, Athens Medical Centre, Athens, Greece
| | - Maria Karmpalioti
- 1st Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece
| | - Efstathia Prappa
- Second Department of Cardiology, “Evangelismos” General Hospital of Athens, Athens, Greece
| | | | - Constantina Aggeli
- 1st Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece
| | - Konstantinos Gatzoulis
- 1st Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece
| | - Dimitrios Tousoulis
- 1st Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece
| | - Costas Tsioufis
- 1st Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece
| | - Konstantinos P. Toutouzas
- 1st Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece
- *Correspondence: Konstantinos P. Toutouzas
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12
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Trachanas K, Sideris S, Arsenos P, Tsiachris D, Antoniou CK, Dilaveris P, Triantafyllou K, Xenogiannis I, Tsimos K, Efremidis M, Kanoupakis E, Flevari P, Vassilikos V, Sideris A, Korantzopoulos P, Tousoulis D, Tsioufis K, Gatzoulis K. Noninvasive risk factors for the prediction of inducibility on programmed ventricular stimulation in post-myocardial infarction patients with an ejection fraction ≥40% at risk for sudden cardiac arrest: Insights from the PRESERVE-EF study. Ann Noninvasive Electrocardiol 2021; 27:e12908. [PMID: 34873786 PMCID: PMC8916556 DOI: 10.1111/anec.12908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/05/2021] [Accepted: 10/11/2021] [Indexed: 11/29/2022] Open
Abstract
Background In the PRESERVE‐EF study, a two‐step sudden cardiac death (SCD) risk stratification approach to detect post‐myocardial infarction (MI) patients with left ventricle ejection fraction (LVEF) ≥40% at risk for major arrhythmic events (MAEs) was used. Seven noninvasive risk factors (NIRFs) were extracted from a 24‐h ambulatory electrocardiography (AECG) and a 45‐min resting recording. Patients with at least one NIRF present were referred for invasive programmed ventricular stimulation (PVS) and inducible patients received an Implantable Cardioverter ‐ Defibrillator (ICD). Methods In the present study, we evaluated the performance of the NIRFs, as they were described in the PRESERVE‐EF study protocol, in predicting a positive PVS. In the PRESERVE‐EF study, 152 out of 575 patients underwent PVS and 41 of them were inducible. For the present analysis, data from these 152 patients were analyzed. Results Among the NIRFs examined, the presence of signal averaged ECG‐late potentials (SAECG‐LPs) ≥ 2/3 and non‐sustained ventricular tachycardia (NSVT) ≥1 eposode/24 h cutoff points were important predictors of a positive PVS study, demonstrating in the logistic regression analysis odds ratios 2.285 (p = .027) and 2.867 (p = .006), respectively. A simple risk score based on the above cutoff points in combination with LVEF < 50% presented high sensitivity but low specificity for a positive PVS. Conclusion Cutoff points of NSVT ≥ 1 episode/24 h and SAECG‐LPs ≥ 2/3 in combination with a LVEF < 50% were important predictors of inducibility. However, the final decision for an ICD implantation should be based on a positive PVS, which is irreplaceable in risk stratification.
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Affiliation(s)
| | - Skevos Sideris
- State Department of Cardiology, Hippokrateion General Hospital, Athens, Greece
| | - Petros Arsenos
- First Department of Cardiology, Hippokrateion General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Dimitrios Tsiachris
- First Department of Cardiology, Hippokrateion General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Christos-Konstantinos Antoniou
- First Department of Cardiology, Hippokrateion General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Polychronis Dilaveris
- First Department of Cardiology, Hippokrateion General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | | | - Iosif Xenogiannis
- Second Department of Cardiology, Attikon General Hospital, National and Kapodistrian University of Athens School of Medicine, Chaidari, Greece
| | - Konstantinos Tsimos
- Department of Cardiology, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Michalis Efremidis
- Second State Department of Cardiology, Evangelismos Athens General Hospital, Athens, Greece
| | - Emmanuel Kanoupakis
- Department of Cardiology, Heraklion University Hospital, University of Crete, School of Medicine, Heraklion, Greece
| | - Panagiota Flevari
- Second Department of Cardiology, Attikon General Hospital, National and Kapodistrian University of Athens School of Medicine, Chaidari, Greece
| | - Vassilios Vassilikos
- Third Department of Cardiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Sideris
- Second State Department of Cardiology, Evangelismos Athens General Hospital, Athens, Greece
| | | | - Dimitrios Tousoulis
- First Department of Cardiology, Hippokrateion General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, Hippokrateion General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Konstantinos Gatzoulis
- First Department of Cardiology, Hippokrateion General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
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13
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Archontakis S, Sanidas E, Sideris K, Arsenos P, Gatzoulis K, Sideris S. Persistent left superior vena cava: is it an incidental pathology detected during pacemaker implantation or one of the causes of sick sinus syndrome?-Authors' reply. Europace 2021; 24:173-174. [PMID: 34792105 DOI: 10.1093/europace/euab290] [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] [Received: 10/23/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Stefanos Archontakis
- Department of Cardiology, Hippokration General Hospital, 114 Vasilisis Sofias Str, Athens, Greece
| | - Elias Sanidas
- Department of Cardiology, Laikon General Hospital, Ag Thoma Sq, Athens, Greece
| | - Konstantinos Sideris
- Department of Cardiology, Hippokration General Hospital, 114 Vasilisis Sofias Str, Athens, Greece
| | - Petros Arsenos
- First Cardiology Division, University of Athens, Medical School, Hippokration General Hospital, 114 Vasilisis Sofias Str, Athens, Greece
| | - Konstantinos Gatzoulis
- First Cardiology Division, University of Athens, Medical School, Hippokration General Hospital, 114 Vasilisis Sofias Str, Athens, Greece
| | - Skevos Sideris
- Department of Cardiology, Hippokration General Hospital, 114 Vasilisis Sofias Str, Athens, Greece
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14
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Konstantinou K, Xydis P, Antoniou CK, Magkas N, Manolakou P, Chrysohoou C, Dilaveris P, Gatzoulis K, Tsioufis K. Multipoint left ventricular pacing effects on hemodynamic parameters and functional status: HUMVEE single-arm clinical trial. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
The aim of this study was to assess the capacity of optimized multipoint pacing (MPP) over optimized cardiac resynchronization therapy (CRT), in terms of clinical, functional, and echocardiographic parameters among dyssynchronous heart failure patients.
Methods
Eighty patients (Caucasian, 77.5% male, 68.4±10.1 years, 53.8% ischemic cardiomyopathy) sequentially received optimized CRT and optimized MPP over 6 and 12-month periods, in a single-arm clinical trial. Clinical, laboratory and echocardiographic assessment was conducted at baseline and following completion of each step.
Results
Significant additive effects of optimized MPP over optimized CRT were noted regarding 6-minute walking distance (baseline/optCRT/optMPP: 293±120m vs 367±94m vs 405±129m, p<0.001), NYHA class (2.36 vs 2.19 vs 1.45, p<0.001), VTIlvot (14.25±3.2cm vs 16.2±4cm vs 17.5±3.4cm, p<0.001), stroke volume (48±13.5ml vs 55±15ml vs 59±15ml, p<0.001), LVEF (29%±7.1% vs 33%±7.3% vs 37%±7.7%, p<0.001), maximal left atrial volume (77.2±34.2ml vs 74.2±39.5ml vs 67.7±32ml, p=0.02), pulmonary artery systolic pressure (35.9mmHg vs 33.5mmHg vs 31mmHg, p<0.001), and right ventricular strain (−8.3%±6.9% vs −8.8%±6.6% vs −11.8%±6.1%, p=0.022). Regarding VAC SW and CP as percentages of maximal, there was significant difference detected compared to baseline for both CRT and MPP. Additive effects persisted only if suitable MPP dipoles were present. Exploratory analysis revealed that ischemic cardiomyopathy continued to exhibit significant differences favoring MPP, whereas nonischemic cardiomyopathy had similar findings regarding total left atrial strain and quality of life.
Conclusions
Optimized MPP showed significant improvements on hemodynamic parameters and ventricular function, in heart failure patients over optimized CRT. The beneficial effect was more prominent in men and in those with rather reduced LVEF, consistent with findings suggesting a beneficial trend in VAC and CP with the more homogenous depolarization offered by optimized MPP
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K Konstantinou
- 1rst Cardiology Clinic University of Athens, Athens, Greece
| | - P Xydis
- 1rst Cardiology Clinic University of Athens, Athens, Greece
| | - C K Antoniou
- 1rst Cardiology Clinic University of Athens, Athens, Greece
| | - N Magkas
- 1rst Cardiology Clinic University of Athens, Athens, Greece
| | - P Manolakou
- 1rst Cardiology Clinic University of Athens, Athens, Greece
| | - C Chrysohoou
- 1rst Cardiology Clinic University of Athens, Athens, Greece
| | - P Dilaveris
- 1rst Cardiology Clinic University of Athens, Athens, Greece
| | - K Gatzoulis
- 1rst Cardiology Clinic University of Athens, Athens, Greece
| | - K Tsioufis
- 1rst Cardiology Clinic University of Athens, Athens, Greece
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15
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Patsourakos D, Aggeli C, Gatzoulis K, Delicou S, Dimitroglou Y, Androulakis A, Tsioufis K. Left atrial deformation parameters among beta-thalassemia major patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.011] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
Atrial cardiomyopathy is present in a significant proportion of beta thalassemia major (β-TM) patients, complicating their clinical condition. The diagnosis of atrial cardiomyopathy is challenging using conventional echocardiographic techniques.
Purpose
In our study we aimed to identify the presence of atrial cardiomyopathy by applying novel echocardiographic techniques in these patients.
Methods
56 β-TM patients (mean age 39.3±9 years, 50% male sex) and 30, age and sex matched, healthy controls were examined by transthoracic echocardiography. Conventional echocardiographic parameters were estimated alongside with deformation indices (left atrial strain at reservoir (LASr), conduit (LAScd) and contraction (LASct) phase respectively as well as left ventricular global longitudinal strain (GLS)). T2* was calculated by cardiac magnetic resonance imaging in β-TM patients.
Results
LAVI, E/e' ratio, GLS and left atrial deformation parameters differed between patients and controls. In patient group, left atrial deformation indices were correlated with LAVI, E/e' ratio, GLS and T2* (Table 1). GLS was also correlated with LAVI, but not with T2* or E/e' ratio. T2* was correlated only with left atrial deformation indices. Patient with prior episodes of atrial fibrillation were older, had increased E/e' and LAVI and impaired left atrial deformation indices but did not differ in terms of GLS or T2* (Figure 1). Patients with iron overload differed only in terms of left atrial deformation parameters.
Conclusions
Atrial deformation indices could be of clinical use in the early detection of atrial cardiomyopathy. Impaired left atrial strain may be associated with silent atrial fibrillation and be indicative of myocardial iron overload.
Funding Acknowledgement
Type of funding sources: None. Correlation tableScatter plot of T2* and LASr
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Affiliation(s)
| | - C Aggeli
- Hippokration General Hospital, Athens, Greece
| | - K Gatzoulis
- Hippokration General Hospital, Athens, Greece
| | - S Delicou
- Hippokration General Hospital, Athens, Greece
| | | | | | - K Tsioufis
- Hippokration General Hospital, Athens, Greece
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16
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Archontakis S, Sanidas E, Sideris K, Arsenos P, Gatzoulis K, Sideris S. Optimal technique for right ventricular lead implantation in isolated persistent left superior vena cava. Europace 2021; 24:11. [PMID: 34270720 DOI: 10.1093/europace/euab111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/07/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stefanos Archontakis
- Department of Cardiology, Hippokration General Hospital, 114 Vasilisis Sofias str, Athens, Greece
| | - Elias Sanidas
- Department of Cardiology, Laikon General Hospital, Ag Thoma sq, Athens, Greece
| | - Konstantinos Sideris
- Department of Cardiology, Hippokration General Hospital, 114 Vasilisis Sofias str, Athens, Greece
| | - Petros Arsenos
- Department of Cardiology, First Cardiology Division, University of Athens, Medical School, Hippokration General Hospital, 114 Vasilisis Sofias str, Athens, Greece
| | - Konstantinos Gatzoulis
- Department of Cardiology, First Cardiology Division, University of Athens, Medical School, Hippokration General Hospital, 114 Vasilisis Sofias str, Athens, Greece
| | - Skevos Sideris
- Department of Cardiology, Hippokration General Hospital, 114 Vasilisis Sofias str, Athens, Greece
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17
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Trachanas K, Arsenos P, Xenogiannis I, Tsimos K, Triantafyllou K, Vlachos K, Antoniou CK, Dilaveris P, Korantzopoulos P, Kanoupakis E, Tsiachris D, Sideris S, Gatzoulis K, Tousoulis D, Tsioufis K. Noninvasive risk factors for the prediction of inducibility on programmed ventricular stimulation in post-MI patients with ejection fraction over 40% at SCD risk, insights from the PRESERVE EF study. Europace 2021. [DOI: 10.1093/europace/euab116.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Sudden cardiac arrest (SCA) in post myocardial infarction (post-MI) patients with a relatively preserved left ventricular systolic function (LVEF≥40%) has an annual incidence of 1%, in the absence of adequate risk stratification methods and guideline recommendations for primary prevention. In the PRESERVE-EF study we used a two-step SCA risk stratification approach to detect patients at risk for major arrhythmic events. Seven noninvasive risk factors (NIRFs) were extracted from ambulatory electrocardiography (AECG). Patients with at least one NIRF present were referred for invasive programmed ventricular stimulation (PVS). Inducible patients received an ICD.
Purpose
To assess the performance of NIRFs extracted from 24hr AECG, based on the PRESERVE EF criteria, in predicting inducibility.
Methods
The PRESERVE EF study enrolled 575 patients. Two hundred and four of them had at least one NIRF and an indication for PVS, but 52 of them declined. Finally, 41 out of 152 patients who underwent PVS were inducible. For the present analysis data from these 152 patients (mean age 60 ± 10years, LVEF 49 ± 6%, 89% males) were analyzed. Chi-square test, univariate logistic regression and areas under ROC curves were calculated for the PVS inducibility endpoint.
Results
Age, male gender and LVEF for the PVS inducible patients group (n = 41) and the noninducible patients group (n = 111) were, respectively: 61 ± 9years vs 59 ± 10years (p = 0.310), 98% vs 86% (p = 0.048), 45 ± 4% vs 51 ± 7% (p < 0.001). Among NIRFs examined, LVEF ≤ 50%, nsVT≥1/24hour and presence of LPs on SAECG presented high and significant Odds Ratios (ORs) for a positive PVS study end point. A simple risk score based on cutoff points of LVEF ≤ 50%, NSVTepisode≥1/24hour and presence of LPs missed only 1 out of the 41 inducible patients and yielded: OR 14.146 (p = 0.01) with a high sensitivity 98% but low specificity 26% for a positive PVS (AUC = 0.65).
Conclusion
Cut off points of LVEF ≤ 50%, nsVTepisode≥1/24hour and presence of LPs were important predictors of inducibility. A simple risk score based on these predictors achieves high sensitivity but low specificity. The final decision for an ICD implantation should be based on a positive PVS, which is irreplaceable in risk stratification.
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Affiliation(s)
- K Trachanas
- Hippokration General Hospital , State Department of Cardiology, Athens, Greece
| | - P Arsenos
- Hippokration General Hospital , First Department of Cardiology, Athens, Greece
| | - I Xenogiannis
- National & Kapodistrian University of Athens Medical School, Attikon Hospital, Second Department of Cardiology, Athens, Greece
| | - K Tsimos
- University of Ioannina Medical School, University Hospital, First Department of Cardiology, Ioannina, Greece
| | - K Triantafyllou
- Aristotle University of Thessaloniki, Hippokration Hospital, Third Department of Cardiology, Thessaloniki, Greece
| | - K Vlachos
- Evangelismos Hospital, Second State Department of Cardiology, Athens, Greece
| | - CK Antoniou
- Hippokration General Hospital , First Department of Cardiology, Athens, Greece
| | - P Dilaveris
- Hippokration General Hospital , First Department of Cardiology, Athens, Greece
| | - P Korantzopoulos
- University of Ioannina Medical School, University Hospital, First Department of Cardiology, Ioannina, Greece
| | - E Kanoupakis
- University of Crete, University Hospital of Heraklion, Department of Cardiology, Heraklion, Greece
| | - D Tsiachris
- Hippokration General Hospital , First Department of Cardiology, Athens, Greece
| | - S Sideris
- Hippokration General Hospital , State Department of Cardiology, Athens, Greece
| | - K Gatzoulis
- Hippokration General Hospital , First Department of Cardiology, Athens, Greece
| | - D Tousoulis
- Hippokration General Hospital , First Department of Cardiology, Athens, Greece
| | - K Tsioufis
- Hippokration General Hospital , First Department of Cardiology, Athens, Greece
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18
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Dilaveris P, Antoniou CK, Chrysohoou C, Xydis P, Konstantinou K, Manolakou P, Kordalis A, Gatzoulis K, Tsioufis C. Comparative Trial of the Effects of Left Ventricular and Biventricular Pacing on Indices of Cardiac Function and Clinical Course of Patients With Heart Failure: Rationale and Design of the READAPT Randomized Trial. Angiology 2021; 72:961-970. [PMID: 33938290 DOI: 10.1177/00033197211012520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Nonresponse to cardiac resynchronization therapy (CRT) has been related with right ventricular dysfunction. Ventriculoarterial coupling (VAC) assesses energy efficiency of the failing heart and stroke work maximization for a given contractility, for both systemic and pulmonary circulations. Preferential left ventricular pacing (pLVP) can overcome iatrogenic right ventricular dysfunction by achieving left ventricle resynchronization and by allowing for intrinsic activation of the right side, with ramifications extending beyond cardiac output and atrial fibrillation occurrence. In the present article, we detail the design of a single-center randomized clinical trial to evaluate the effects of a pLVP algorithm. More specifically, following randomization of 220 CRT-eligible patients to standard biventricular pacing and pLVP, their clinical course will be followed for 12 months, through echocardiography to study indices of systolic and diastolic function of ventricles, left and right side VAC to evaluate efficiency, and cardiopulmonary exercise test to objectively document improvements in functional status, as well as a self-reported quality of life questionnaire. Device programming will be based on echocardiography-evaluated maximization of stroke volume and subsequent interventricular and atrioventricular delay adjustments delegated to the device. Findings of this trial may provide evidence for alternative programming of the devices, linking pLVP to improved clinical outcomes.
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Affiliation(s)
| | | | - Christina Chrysohoou
- First University Department of Cardiology, Hippokration Hospital, Athens, Greece
| | - Panagiotis Xydis
- First University Department of Cardiology, Hippokration Hospital, Athens, Greece
| | | | - Panagiota Manolakou
- First University Department of Cardiology, Hippokration Hospital, Athens, Greece
| | - Athanasios Kordalis
- First University Department of Cardiology, Hippokration Hospital, Athens, Greece
| | | | - Costas Tsioufis
- First University Department of Cardiology, Hippokration Hospital, Athens, Greece
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19
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Patsourakos D, Aggeli C, Gatzoulis K, Delicou S, Dimitroglou Y, Androulakis A, Tsioufis C, Tousoulis D. The combined use of electrocardiography, echocardiography and cardiac magnetic resonance imaging in left atrium evaluation among beta-thalassemia patients. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.159] [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
Funding Acknowledgements
Type of funding sources: None.
Introduction
Beta-thalassemia major (β-TM) patients are subjected to iron overload as a consequence of chronic blood transfusions. The redundant iron affects, among other organs, the heart resulting in myocardial dysfunction. Iron deposition does not only affect ventricular myocardium but atrial myocardium as well. According to current practice, the overall myocardial iron status is estimated by calculating T2* at the middle section of the ventricular septum using cardiac magnetic resonance imaging (CMR). Current CMR technology limits the direct estimation of atrial iron status.
Purpose
The current study evaluates left atrial function by novel echocardiographic techniques and correlates these findings with CMR data.
Methods
37 β-TM patients (mean age 41.17 years (SD = 8.33), 51.4% male), were subjected to electrocardiography, echocardiography and CMR imaging and P wave axis, PR segment duration, left atrial volume index (LAVI), left atrial strain at reservoir phase (LASr) and T2* were measured.
Results
No correlation between T2* and LASr (r = 0.253, p = 0.131) or T2* and LAVI (r = 0.044, p = 0.796) were found. However, a correlation was found between the echocardiographic parameters LAVI and LASr (r = -0.676, p <0.001). P wave axis did not correlate with any other parameter, while PR segment duration was correlated with LASr (r = -0.399, p = 0.015). Regression analysis revealed correlation between LAVI and LASr (r2 = 0.457, p <0.001).
Conclusions
The current study suggests that despite the undisputed contribution of CMR in left ventricular iron load estimation, it may be less accurate in atrial iron status estimation. Considering the limitations of current CMR technology regarding the iron status of the thin atrial and right ventricular walls, our study highlights the role of speckle tracking in combination with CMR imaging for a more comprehensive evaluation of β-TM patients.
Correlation table P axis PR segment T2* LAVI LASr P axis 0,151 (p = 0,373) 0,112 (p = 0.,508) -0,140 (p = 0,410) -0,117 (p = 0,489) PR segment 0,151 (p = 0,373) 0,051 (p = 0,766) 0,278 (p = 0,096) -0,399 (p = 0,015) T2* 0,112 (p = 0.,508) 0,051 (p = 0,766) 0,044 (p = 0,796) 0,253 (p = 0,131) LAVI -0,140 (p = 0,410) 0,278 (p = 0,096) 0,044 (p = 0,796) -0,676 (p <0,001) LASr -0,117 (p = 0,489) -0,399 (p = 0,015) 0,253 (p = 0,131) -0,676 (p <0,001) T2*: obtained by cardiac magnetic resonance imaging LAVI left atrial volume index (ml/m2) LASr left atrial strain at reservoir phase Abstract Figure. Correlation between LASr and T2*
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Affiliation(s)
| | - C Aggeli
- Hippokration General Hospital, Athens, Greece
| | - K Gatzoulis
- Hippokration General Hospital, Athens, Greece
| | - S Delicou
- Hippokration General Hospital, Athens, Greece
| | | | | | - C Tsioufis
- Hippokration General Hospital, Athens, Greece
| | - D Tousoulis
- Hippokration General Hospital, Athens, Greece
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20
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Archontakis S, Pirounaki M, Aznaouridis K, Karageorgopoulos D, Sideris K, Tolios P, Triantafyllou K, Gatzoulis K, Tousoulis D, Sideris S. Transvenous extraction of permanent pacemaker and defibrillator leads: Reduced procedural complexity and higher procedural success rates in patients with infective versus noninfective indications. J Cardiovasc Electrophysiol 2020; 32:491-499. [PMID: 33345428 DOI: 10.1111/jce.14841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Transvenous lead extraction (TLE) is critical in the long-term management of patients with cardiac implanted electronic devices (CIEDs). The aim of the study is to evaluate the outcomes of TLE and to investigate the impact of infection. METHODS AND RESULTS Data of patients undergoing extraction of permanent pacemaker and defibrillator leads during October 2014-September 2019 were prospectively analyzed. Overall, 242 consecutive patients (aged 71.0 ± 14.0 years, 31.4% female), underwent an equal number of TLE operations for the removal of 516 leads. Infection was the commonest indication (n = 201, 83.1%). Mean implant-to-extraction duration was 7.6 ± 5.4 years. Complete procedural success was recorded in 96.1%, and clinical procedural success was achieved in 97.1% of attempted lead extractions. Major complications occurred in two (0.8%) and minor complications in seven (2.9%) patients. Leads were removed exclusively by using locking stylets in 65.7% of the cases. In the subgroup of noninfective patients, advanced extraction tools were more frequently required compared to patients with CIED infections, to extract leads (success only with locking stylet: 55.8% vs. 67.8%, p = .032). In addition, patients without infection demonstrated lower complete procedural success rates (90.7% vs. 97.2%, p = .004), higher major complication rates (2.4% vs. 0.5%, p = .31) and longer procedural times (136 ± 13 vs. 111 ± 15 min, p = .001). CONCLUSIONS Our data demonstrate high procedural efficacy and safety and indicate that in patients with noninfective indications, the procedure is more demanding, thus supporting the hypothesis that leads infection dissolves and/or prohibits the formation of fibrotic adherences.
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Affiliation(s)
| | - Maria Pirounaki
- Second Department of Medicine, University of Athens, Medical School, Hippokration General Hospital, Athens, Greece
| | - Konstantinos Aznaouridis
- First Cardiology Division, University of Athens, Medical School, Hippokration General Hospital, Athens, Greece
| | | | | | - Panagiotis Tolios
- Department of Cardiology, Hippokration General Hospital, Athens, Greece
| | | | - Konstantinos Gatzoulis
- First Cardiology Division, University of Athens, Medical School, Hippokration General Hospital, Athens, Greece
| | - Dimitrios Tousoulis
- First Cardiology Division, University of Athens, Medical School, Hippokration General Hospital, Athens, Greece
| | - Skevos Sideris
- Department of Cardiology, Hippokration General Hospital, Athens, Greece
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21
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Antoniou K, Chrysohoou C, Dilaveris P, Konstantinou K, Manolakou P, Xydis P, Magkas N, Antonakos V, Kakioris K, Gatzoulis K, Skiadas I, Tousoulis D. Optimization in cardiac resynchronization therapy with quadripolar leads offer improvement in cardiac energetics in heart failure patients compared with bipolar leads: HUMVEE Clinical Trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cardiac resynchronization therapy (CRT) is a well-established technique for symptomatic heart failure (HF) patients, producing significant clinical benefits. Recent studies have revealed the potential role of multipoint pacing (MPP) in improving response and clinical outcomes. The aim of this work from the Heart failUre study of Multisite pacing effects on VEntriculoartErial coupling (HUMVEE) trial was to evaluate the association between MPP of the left ventricle vs those of optimized biventricular pacing (optBVP) on: a) ventriculoarterial coupling (VAC) and energy efficiency of the failing heart. Both BVP and MPP mode were optimized according to the optimal VTI value of left ventricular outflow track.
Methods
HUMVEE is a single-center, prospective (13 months) trial (clinicaltrials.gov identifier NCT03189368), of 80 NYHA III patients (68±10 years; 75% men; 53% ischemic cardiomyopathy), under optimal tolerated therapy, with standard BVP indication, having being implanted with a CRT system able to deliver both modes of pacing. Echocardiographic measurements, including VAC calculation, 6-min-walking-test and quality of life (MLHF questionnaire) were measured at baseline, 6 months post BVP optimization (right before MPP activation) and at the end of follow-up (6 months post MPP optimization). Cardiac power (CP) was calculated according the equation: CP=Cardiac Output x Mean Aortic Pressure/451.
Results
23 patients (30%), due to inability to deliver MPP, remained in optBVP. Those in MPP had 45% ischemic cardiomyopathy vs. 65% in optBVP patients, (p=0.056); ejection fraction 26.5%, vs. 29.5%, p=0.05; while there was no significant difference in gender, age and baseline NYHA class. Both optBVP and MPP patients improved VAC (baseline: 1,26±0,3; CRT: 1.18±0.4; MPP: 1.07±0.06, p=0.07); but only MPP patients significant improved from baseline to 12-months (p=0.02); CP was improved in both groups (p=0.02 in optBVD and p=0.01 in MPP), with MPP patients showing improvement in CP by 30% vs 12% in optBVP (p=0.001); 6-min-walk test was improved in MPP patients by 42% from baseline (p=0.0001), compared to optBVP patients who showed improvement up to 30% (p=0.05) and during the first 6 months only. NtproBNP levels were decreased in all patients (p=0.05 for MPP and p=0.07 for optBVP). Only patients who achieved MPP showed improvement in the Quality of life score (baseline: 31.6±23; optBVD:20.1±17; MPP:15.8±12, p=0.002; while those remained in optBVP showed no significant improvement.
Conclusions
MPP is a new, promising biventricular pacing modality offering additive effects on myocardial energy balance, cardiac power, systolic and diastolic ventricular function and aortoventricular coupling. HUMVEE trial illustrates those clinical, imaging and biochemical divergences of MPP from even opt BVP that confer significant improvement in quality of life reflecting better myocardial energy handling in patients with advanced HF and cardiac dysychronization.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- K Antoniou
- 1rst Cardiology Clinic University of Athens, Athens, Greece
| | - C Chrysohoou
- 1rst Cardiology Clinic University of Athens, Athens, Greece
| | - P Dilaveris
- 1rst Cardiology Clinic University of Athens, Athens, Greece
| | - K Konstantinou
- 1rst Cardiology Clinic University of Athens, Athens, Greece
| | - P Manolakou
- 1rst Cardiology Clinic University of Athens, Athens, Greece
| | - P Xydis
- 1rst Cardiology Clinic University of Athens, Athens, Greece
| | - N Magkas
- 1rst Cardiology Clinic University of Athens, Athens, Greece
| | - V Antonakos
- 1rst Cardiology Clinic University of Athens, Athens, Greece
| | - K Kakioris
- 1rst Cardiology Clinic University of Athens, Athens, Greece
| | - K Gatzoulis
- 1rst Cardiology Clinic University of Athens, Athens, Greece
| | - I Skiadas
- 1rst Cardiology Clinic University of Athens, Athens, Greece
| | - D Tousoulis
- 1rst Cardiology Clinic University of Athens, Athens, Greece
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22
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Arsenos P, Gatzoulis K, Doundoulakis I, Dilaveris P, Antoniou C, Sideris S, Tousoulis D. Arrhythmic risk stratification in heart failure mid-range ejection fraction patients with a non-invasive guiding to programmed ventricular stimulation two-step approach. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0765] [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: 11/13/2022] Open
Abstract
Abstract
Background
Although some post myocardial infarction (post-MI) and dilated cardiomyopathy (DCM) patients with mid-range ejection fraction heart failure (HFmrEF = 40–49%) face an increased risk for arrhythmic Sudden Cardiac Death (SCD), current guidelines do not recommend an implantable cardioverter-defibrillator (ICD).
Purpose
To assess the accuracy of a novel multifactorial two-step approach, with noninvasive risk factors (NIRFs) leading to programmed ventricular stimulation (PVS), for SCD risk stratification of hospitalized HFmrEF patients.
Methods
Forty-eight patients (male=83%, age = 64±14 years, LVEF = 45±5%, ischemic coronary disease = 69%) underwent a NIRF presence screening first step with ECG, SAECG, echocardiography and 24 hour ambulatory ECG (Holter). Thirty-two patients with presence of one out of three NIRFs (SAECG ≥2 positive criteria for late potentials, ventricular premature beats ≥240/24 hours, and ≥1 episode of non-sustained ventricular tachycardia on Holter) were further stratified with PVS. Patients were classified as either low (Group 1, n=16, NIRFs−), moderate (Group 2, n=18, NIRFs+ /PVS−) or high risk (Group 3, n=14, NIRFs+/PVS+). All Group 3 patients received an ICD.
Results
After 41±18 months, 9 out of 48 patients experienced the major arrhythmic event (MAE) endpoint (clinical ventricular tachycardia/fibrillation = 3, appropriate ICD activation = 6). The endpoint occurred more frequently in Group 3 (7/14, 50%) than in Groups 1 & 2 (2/34, 5.8%). A logistic regression model adjusted for PVS, age and LVEF revealed that PVS was an independent MAE predictor (OR: 21.152, 95% CI: 2.618–170.887, p=0.004). Kaplan Meier curves diverged significantly (p logrank <0.001) while PVS negative predictive value was 94%.
Conclusion
In hospitalized HFmrEF post-MI and DCM patients, a NIRFs leading to PVS two-step approach efficiently detected the subgroup at increased risk for MAEs.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- P Arsenos
- Hippokration General Hospital, First Department of Cardiology, Athens, Greece
| | - K Gatzoulis
- Hippokration General Hospital, First Department of Cardiology, Athens, Greece
| | - I Doundoulakis
- Hippokration General Hospital, First Department of Cardiology, Athens, Greece
| | - P Dilaveris
- Hippokration General Hospital, First Department of Cardiology, Athens, Greece
| | - C.K Antoniou
- Hippokration General Hospital, First Department of Cardiology, Athens, Greece
| | - S Sideris
- Hippokration General Hospital, State Department of Cardiology, Athens, Greece
| | - D Tousoulis
- Hippokration General Hospital, First Department of Cardiology, Athens, Greece
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23
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Patsourakos D, Aggeli C, Gatzoulis K, Delicou S, Dimitroglou Y, Androulakis A, Tousoulis D. Electrocardiographic parameters among beta-thalassemia major patients. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0378] [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/Introduction
The majority of beta thalassemia major (β-TM) patients suffer from cardiac disorders, while a significant proportion of them die suddenly. Twelve-lead and signal-averaged electrocardiography are simple, inexpensive, readily available tools for identifying an unfavorable arrhythmiological substrate by detecting the presence of arrhythmias, conduction abnormalities and late potentials (LPs) in these patients.
Methods
47 β-TM patients and 30 healthy controls were submitted to twelve-lead and signal-averaged electrocardiography. Basal rhythm, heart rate, PR interval duration, QRS complex duration and morphology, QTc interval duration and prevalence of LPs were recorded.
Results
β-TM patients demonstrated a more prolonged PR segment (167.74 msec vs. 147.07 msec) (p=0.043), a higher prevalence of PR prolongation (21.05% vs. 0%) (p=0.013) and a higher prevalence of LPs (18/47, 38.3% vs. 2/30, 6.7%) (p=0.002) compared with controls. In particular, every single SAECG parameter significantly differed among patients compared with controls. Among patients, left ventricular ejection fraction was marginally lower and QTc more prolonged among LPs positive subgroup compared with LPs negative subgroup. The prevalence of atrial fibrillation among b-TM patients was estimated at 10.64%.
Conclusions
β-TM patients have a higher prevalence of a prolonged PR segment, atrial fibrillation and LPs. Twelve-lead and SAECG performance was feasible in all subjects and constitutes a readily available tool for assessing myocardial electrophysiological alterations in this patient group, that could have significant impact on survival and quality of life with timely application of appropriate treatment.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - C Aggeli
- Hippokration General Hospital, Athens, Greece
| | - K Gatzoulis
- Hippokration General Hospital, Athens, Greece
| | - S Delicou
- Hippokration General Hospital, Athens, Greece
| | | | | | - D Tousoulis
- Hippokration General Hospital, Athens, Greece
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24
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Archontakis S, Sfendouraki E, Sideris K, Leontsinis I, Laina A, Gatzoulis K, Koumallos N, Triantafyllou K, Tousoulis D, Sideris S. The importance of lead management in the young paced patient. The case of a 22-year-old female with congenital complete heart block. Hellenic J Cardiol 2020; 62:306-308. [PMID: 32861764 DOI: 10.1016/j.hjc.2020.08.005] [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] [Received: 07/01/2020] [Revised: 08/09/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- Stefanos Archontakis
- First Cardiology Division, University of Athens, Hippokration General Hospital, 114 Vasilisis Sofias str, Athens, Greece
| | - Elisavet Sfendouraki
- Department of Cardiology, Hippokration General Hospital, 114 Vasilisis Sofias str, Athens, Greece
| | - Konstantinos Sideris
- Department of Cardiology, Hippokration General Hospital, 114 Vasilisis Sofias str, Athens, Greece
| | - Ioannis Leontsinis
- Department of Cardiology, Hippokration General Hospital, 114 Vasilisis Sofias str, Athens, Greece
| | - Ageliki Laina
- Department of Cardiology, Hippokration General Hospital, 114 Vasilisis Sofias str, Athens, Greece
| | - Konstantinos Gatzoulis
- First Cardiology Division, University of Athens, Hippokration General Hospital, 114 Vasilisis Sofias str, Athens, Greece
| | - Nikolas Koumallos
- Department of Cardiac Surgery, Hippocration General Hospital, 114 Vasilisis Sofias str, Athens, Greece
| | | | - Dimitrios Tousoulis
- First Cardiology Division, University of Athens, Hippokration General Hospital, 114 Vasilisis Sofias str, Athens, Greece
| | - Skevos Sideris
- Department of Cardiology, Hippokration General Hospital, 114 Vasilisis Sofias str, Athens, Greece.
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25
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Antoniou CK, Manolakou P, Arsenos P, Dilaveris P, Gatzoulis K, Tousoulis D. Antithrombotic Treatment after Atrial Fibrillation Ablation. Curr Pharm Des 2020; 26:2703-2714. [DOI: 10.2174/1381612826666200407154329] [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] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/17/2020] [Indexed: 01/06/2023]
Abstract
:Atrial fibrillation is a major cause of debilitating strokes and anticoagulation is an established and indispensable therapy for reducing their rate. Ablation of the arrhythmia has emerged as a putative means of disrupting its natural course by isolating its triggers and modifying its substrate, dependent on the chosen method. An important dilemma lies in the need for continuation of anticoagulation therapy in those previously receiving it following an, apparently, successful intervention, purportedly preventing arrhythmia recurrence with considerably high rates. Current guidance, given scarcity of high-quality data from randomized trials, focuses on established knowledge and recommends anticoagulation continuation based solely on estimated thromboembolic risk. In the present review, it will be attempted to summarize the pathophysiological rationale for maintaining anticoagulation post-successful ablation, along with the latter’s definition, including the two-fold effects of the procedure per se on thrombogenicity. Available evidence pointing to an overall clinical benefit of anticoagulation withdrawal following careful patient assessment will be discussed, including ongoing randomized trials aiming to offer definitive answers. Finally, the proposed mode of post-ablation anticoagulation will be presented, including the emerging, guideline-endorsed, role of direct oral anticoagulants in the field, altering cost/benefit ratio of anticoagulation and potentially affecting the very decision regarding its discontinuation.
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Affiliation(s)
| | - Panagiota Manolakou
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokrateion Hospital, Athens, Greece
| | - Petros Arsenos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokrateion Hospital, Athens, Greece
| | - Polychronis Dilaveris
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokrateion Hospital, Athens, Greece
| | - Konstantinos Gatzoulis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokrateion Hospital, Athens, Greece
| | - Dimitrios Tousoulis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokrateion Hospital, Athens, Greece
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26
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Karanasos A, Toutouzas K, Tsiachris D, Kordalis A, Tyrovolas K, Efremidis M, Karmpalioti M, Aggeli C, Karagiannis S, Prappa E, Stefanadis C, Gatzoulis K, Tousoulis D. P5432Invasive assessment by atrial volume-pressure loops of the acute changes in left atrial function induced by pulmonary vein antral isolation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Atrial volume-pressure loops are considered the best method to assess left atrium (LA) function. Changes in atrial function induced by pulmonary vein (PV) antral isolation of atrial fibrillation (AF) have not been documented thus far using this approach.
Purpose
We aimed to evaluate changes in LA function in patients with paroxysmal atrial fibrillation (PAF) undergoing catheter ablation by atrial volume-pressure loops.
Methods
Patients undergoing for the first time catheter ablation of PAF by PV antral isolation and PV-LA junction ablation, as clinically indicated, were enrolled from 2 centers. Each center enrolled consecutive patients undergoing PV antral isolation using the same method i.e. radiofrequency or cryoballoon ablation. Patients with severe mitral stenosis or regurgitation, any prosthetic valve, left atrial thrombus or severe systolic or diastolic dysfunction of the left ventricle were excluded. Before and after the procedure, all patients underwent real-time three-dimensional transthoracic echocardiogram to evaluate volume changes of the LA during an entire cardiac cycle, while simultaneously recording LA pressure by a 6F angiographic catheter following transseptal puncture. After the procedure, LA volume and pressure recordings were gated offline by ECG, and were used to plot the LA pressure as a function of LA volume, thus creating a volume-pressure loop. The A loop area is a measure of the booster pump function of the LA. The V loop area expresses the reservoir function of the LA. Pressure and volume data at the clockwise ascending limb of the volume-pressure loop were fitted to the exponential function P = bxea·V, where P = instantaneous LA pressure; V = LA volume; a is the passive elastic chamber stiffness constant (cm–3) that determines the slope of the exponential curve, and b is the elastic constant (mm Hg).
Results
34 patients with PAF were analysed, 12 treated with radiofrequency ablation and 22 with cryoablation. The procedure was uneventful in all cases. Mean LA pressure, A-wave amplitude, and V-wave amplitude were all significantly increased post-procedurally (p<0.001 for all). The area of the A-loop decreased (Post: 40.69 ml·mm Hg [IQR 13.7–71.3] vs. Pre: 64.2 ml·mm Hg [IQR 30.9–86.9]; p=0.001), whereas the area of the V-loop increased (Post: 96.5 ml·mm Hg [IQR 45.1–230.5] vs. Pre: 79.2 ml·mm Hg [IQR 46.9–149.7]; p=0.016). Although the elastic constant increased (p<0.001), there was no significant difference in the passive chamber elastic constant (p=0.30).
Conclusion
Volume-pressure loops can assess procedural changes in LA function. Catheter ablation of AF is associated with a decrease the LA booster pump function of the LA, and in increase in the left atrial reservoir function. Moreover, there is an increase in LA pressures that is observed in the absence of change in LA stiffness.
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Affiliation(s)
- A Karanasos
- Hippokration Hospital, University of Athens, Athens, Greece
| | - K Toutouzas
- Hippokration Hospital, University of Athens, Athens, Greece
| | | | | | - K Tyrovolas
- Evangelismos General Hospital of Athens, Athens, Greece
| | - M Efremidis
- Evangelismos General Hospital of Athens, Athens, Greece
| | - M Karmpalioti
- Hippokration Hospital, University of Athens, Athens, Greece
| | - C Aggeli
- Hippokration Hospital, University of Athens, Athens, Greece
| | | | - E Prappa
- Evangelismos General Hospital of Athens, Athens, Greece
| | | | - K Gatzoulis
- Hippokration Hospital, University of Athens, Athens, Greece
| | - D Tousoulis
- Hippokration Hospital, University of Athens, Athens, Greece
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27
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Karanasos A, Toutouzas K, Tyrovolas K, Efremidis M, Tsiachris D, Kordalis A, Karmpalioti M, Aggeli C, Prappa E, Karagiannis S, Stefanadis C, Gatzoulis K, Tousoulis D. P1910Impact of pulmonary vein antral isolation by radiofrequency catheter or cryoballoon on left atrial function assessed by volume-pressure loops. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0657] [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: 11/13/2022] Open
Abstract
Abstract
Background
Atrial volume-pressure loops are used to assess left atrium (LA) function. Catheter ablation of paroxysmal atrial fibrillation (PAF) by pulmonary vein (PV) antral isolation can be performed either with radiofrequency (RF) catheter or with cryoballoon and might affect LA function.
Purpose
We explored a potential difference in changes in LA function by volume-pressure loops between patients with PAF undergoing either RF catheter or cryoballoon ablation.
Methods
Patients undergoing for the first time catheter ablation of PAF by PV antral isolation and PV-LA junction ablation, as clinically indicated, were enrolled from 2 centers. Each center enrolled consecutive patients undergoing PV antral isolation using the same method ie RF or cryoballoon ablation. Patients with severe mitral stenosis or regurgitation, any prosthetic valve, left atrial thrombus or severe systolic or diastolic dysfunction of the left ventricle were excluded. Pre and post procedure, all patients underwent real-time 3D transthoracic echocardiogram to evaluate volume changes of the LA during an entire cardiac cycle, while recording LA pressure by a 6F angiographic catheter following transseptal puncture. After the procedure, LA volume and pressure recordings were gated offline by ECG, and were used to plot the LA pressure as a function of LA volume, thus creating a volume-pressure loop. The A loop area is a measure of the LA booster pump function. The V loop area expresses the LA reservoir function. Pressure and volume data at the clockwise ascending limb of the volume-pressure loop were fitted to the exponential function P = bxea·V, where P = instantaneous LA pressure; V = LA volume; a is the passive elastic chamber stiffness constant (cm–3) that determines the slope of the exponential curve, and b is the elastic constant (mm Hg).
Results
34 patients with PAF were analysed, 12 treated with RF ablation and 22 with cryoablation. The procedure was uneventful in all cases. In the overall cohort, mean LA pressure, A-wave and V-wave amplitude were all increased post-procedurally (p<0.001); A-loop area decreased (p=0.001), whereas V-loop area increased (p=0.016). Although the elastic constant increased (p<0.001), there was no significant difference in the passive chamber elastic constant (p=0.30).
Changes in both A-loop and V-loop areas were similar between RF and cryoablation (p=0.18 and p=0.36, respectively). However, compared to cryoablation, RF ablation had a lower increase in the elastic constant (b=-2.24; 95% CI: −10.56 to −1.78), and a higher increase in the passive elastic chamber stiffness constant (b=0.078; 95% CI: 0.016 to 0.140).
Conclusion
Both in RF- and cryo-ablation and in a similar extent, the LA booster pump function is decreased, and LA reservoir function is increased. LA pressure is increased in RF ablation mainly due to an acute increase in LA stiffness, whereas in cryoablation this increase is observed in the absence of change in LA stiffness.
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Affiliation(s)
- A Karanasos
- Hippokration Hospital, University of Athens, Athens, Greece
| | - K Toutouzas
- Hippokration Hospital, University of Athens, Athens, Greece
| | - K Tyrovolas
- Evangelismos General Hospital of Athens, Athens, Greece
| | - M Efremidis
- Evangelismos General Hospital of Athens, Athens, Greece
| | | | | | - M Karmpalioti
- Hippokration Hospital, University of Athens, Athens, Greece
| | - C Aggeli
- Hippokration Hospital, University of Athens, Athens, Greece
| | - E Prappa
- Hippokration Hospital, University of Athens, Athens, Greece
| | - S Karagiannis
- Hippokration Hospital, University of Athens, Athens, Greece
| | | | - K Gatzoulis
- Hippokration Hospital, University of Athens, Athens, Greece
| | - D Tousoulis
- Hippokration Hospital, University of Athens, Athens, Greece
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Antoniou CK, Konstantinou K, Chrysohoou C, Dilaveris P, Magkas N, Skiadas J, Antonakos V, Kakioris K, Gatzoulis K, Tousoulis D. P4529Atrioventricular optimization in cardiac resynchronization therapy with quadripolarleads, improves energy handling and quality of life in heart failure patients: HUMVEE Trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0922] [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: 11/15/2022] Open
Abstract
Abstract
Background
Cardiac resynchronization therapy (CRT) is a well-established technique for symptomatic heart failure (HF) patients, producing significant clinical benefits. Recent studies have revealed the potential role of multipoint pacing (MPP) in improving response and clinical outcomes. The aim of Heart failUre study of Multisite pacing effects on VEntriculoartErial coupling (HUMVEE) trial was to evaluate the association between MPP of the left ventricle vs those of standard biventricular pacing (BVP) on: a) ventriculoarterial coupling (VAC) and energy efficiency of the failing heart, b) diastolic function, c) quality of life, and d) NT-proBNP levels.
Methods
HUMVEE is a single-center, prospective (13 months) trial (clinicaltrials.gov identifier NCT03189368), of 54 NYHA III patients (69±9 years; 79% men; 50% dilated cardiomyopathy), under optimal tolerated medical therapy, with standard BVP indication, having being implanted with a CRT system able to deliver both modes of pacing. Creatinine and NT-proBNP levels and echocardiographic measurements (VAC calculation, strain rate, diastolic function assessment), as well as 6-min-walking-test and quality of life (MLHF questionnaire) were measured at baseline, 6 months post BVP optimization (right before MPP activation) and at the end of follow-up (6 months post MPP optimization). Cardiac power (CP) was calculated according the equation: CP=Cardiac Output x Mean Aortic Pressure/451.
Results
Both CRT and MPP improved 6-min-walk (differences at baseline/6 mo/end of FU: 277±27 vs. 345±27 vs 363±27 m, p=0.07); left ventricular ejection fraction (24,2% vs 30,6%vs, 32%, p=0.05); end -diastolic diameters of left ventricle (65±1,4 vs. 63±1.7 vs. 61±1.1, p=0.03); end-systolic volume (150±15 vs. 140±10 vs. 131±13, p=0.08); stroke volume (41.6±9 vs. 53.6±14 vs. 62±9, p=0.0001 for MPP); left atrial volume (76±5 vs. 74±10 vs 61±6, p=0.001 for MPP), E/Emv (14±5 vs. 12±4 vs. 11±3, p=0.05 for MPP); NtproBNP (2782±1000 vs. 2080±2500 vs. 2000±1000, p=0.05 for MPP). VAC was reduced from 1.14±0.27 to 1.1±0.17 (p=0.1) while CP increased from 564.2±142 to 768±103 (p=0.009). Quality of life score (the lower the better) improved from 23.75±17 at baseline to 17.25±10 at end of FU (p=0.05).
Conclusions
MPP is a new, promising pacing modality with the potential to improve HF patients' outcome, offering additive effects on myocardial energy balance, cardiac power, systolic and diastolic ventricular function and aortoventricular coupling, especially in ischemic patients. HUMVEE trial illustrates those clinical, imaging and biochemical divergences of MPP from standard BVP that reflect significant improvement in quality of life in patients with advanced HF and cardiac dysychronization.
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Affiliation(s)
- C K Antoniou
- 1rst Cardiology Clinic University of Athens, Athens, Greece
| | - K Konstantinou
- 1rst Cardiology Clinic University of Athens, Athens, Greece
| | - C Chrysohoou
- 1rst Cardiology Clinic University of Athens, Athens, Greece
| | - P Dilaveris
- 1rst Cardiology Clinic University of Athens, Athens, Greece
| | - N Magkas
- 1rst Cardiology Clinic University of Athens, Athens, Greece
| | - J Skiadas
- 1rst Cardiology Clinic University of Athens, Athens, Greece
| | - V Antonakos
- 1rst Cardiology Clinic University of Athens, Athens, Greece
| | - K Kakioris
- 1rst Cardiology Clinic University of Athens, Athens, Greece
| | - K Gatzoulis
- 1rst Cardiology Clinic University of Athens, Athens, Greece
| | - D Tousoulis
- 1rst Cardiology Clinic University of Athens, Athens, Greece
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29
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Dilaveris P, Antoniou CK, Manolakou P, Tsiamis E, Gatzoulis K, Tousoulis D. Biomarkers Associated with Atrial Fibrosis and Remodeling. Curr Med Chem 2019; 26:780-802. [PMID: 28925871 DOI: 10.2174/0929867324666170918122502] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 12/16/2016] [Accepted: 12/23/2016] [Indexed: 12/22/2022]
Abstract
Atrial fibrillation is the most common rhythm disturbance encountered in clinical practice. Although often considered as solely arrhythmic in nature, current evidence has established that atrial myopathy constitutes both the substrate and the outcome of atrial fibrillation, thus initiating a vicious, self-perpetuating cycle. This myopathy is triggered by stress-induced (including pressure/volume overload, inflammation, oxidative stress) responses of atrial tissue, which in the long term become maladaptive, and combine elements of both structural, especially fibrosis, and electrical remodeling, with contemporary approaches yielding potentially useful biomarkers of these processes. Biomarker value becomes greater given the fact that they can both predict atrial fibrillation occurrence and treatment outcome. This mini-review will focus on the biomarkers of atrial remodeling (both electrical and structural) and fibrosis that have been validated in human studies, including biochemical, histological and imaging approaches.
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Affiliation(s)
- Polychronis Dilaveris
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Panagiota Manolakou
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleftherios Tsiamis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Gatzoulis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Tousoulis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Sideris S, Archontakis S, Latsios G, Lazaros G, Toutouzas K, Tsiamis E, Vavuranakis M, Vlachopoulos C, Gatzoulis K, Tsioufis C, Tousoulis D. Biomarkers Associated with Bleeding Risk in the Setting of Atrial Fibrillation. Curr Med Chem 2019; 26:824-836. [PMID: 28721832 DOI: 10.2174/0929867324666170718124742] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 11/20/2017] [Accepted: 11/28/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Prevention of thromboembolic disease, mainly stroke, with oral anticoagulants remains a major therapeutic goal in patients with atrial fibrillation. Unfortunately, despite the high efficacy, anticoagulant therapy is associated with a significant risk of, frequently catastrophic, and hemorrhagic complications. Among different clinical and laboratory parameters related to an increased risk of bleeding, several biological markers have been recognized and various risk scores for bleeding have been developed. OBJECTIVES/METHODS The aim of the present study is to review current evidence regarding the different biomarkers associated with raised bleeding risk in atrial fibrillation. RESULTS Data originating from large cohorts or the recent large-scale trials of atrial fibrillation have linked numerous individual biomarkers to an increased bleeding risk. Such a relation was revealed for markers of cardiac physiology, such as troponin, BNP and NT-proBNP, markers of renal function, such as GFR and Cystatin or hepatic function, markers involving the system of coagulation, such as D-dimer and Von Willebrand factor, hematologic markers, such as low haemoglobin or low platelets, inflammatory markers, such as interleukin-6, other factors such as GDF-15 and vitamin-E and finally genetic polymorphisms. Many such biomarkers are incorporated in the bleeding risk schemata developed for the prediction of the hemorrhagic risk. CONCLUSIONS Biomarkers were introduced in clinical practice in order to better estimate the potential risk of haemorrhage in these patients and increase the prognostic impact of clinical risk scores. In the last years this concept is gaining significant importance.
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Affiliation(s)
- Skevos Sideris
- 1st Cardiology Department, Athens Medical School, Athens, Greece
| | | | - George Latsios
- 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - George Lazaros
- 1st Cardiology Department, Athens Medical School, Athens, Greece
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31
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Tsiachris D, Giannopoulos G, Deftereos S, Kossyvakis C, Tsioufis C, Siasos G, Oikonomou E, Gatzoulis K, Tousoulis D, Stefanadis C. Biomarkers Determining Prognosis of Atrial Fibrillation Ablation. Curr Med Chem 2019; 26:925-937. [DOI: 10.2174/0929867325666180320122930] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 12/29/2016] [Accepted: 12/29/2016] [Indexed: 11/22/2022]
Abstract
Catheter ablation for rhythm control is recommended in specific patient populations
with paroxysmal, persistent, or long-standing persistent atrial fibrillation. Pulmonary
vein isolation is the cornerstone of the ablative therapy for atrial fibrillation. However, relapse
is still common since the single procedure efficacy of atrial fibrillation ablation was estimated
to be 60-80% in paroxysmal and 50-70% in persistent atrial fibrillation. It is important to
identify predictors of successful atrial fibrillation patients ablation. In the present review, we
will assess the role of available biomarkers to predict responders of an initial atrial fibrillation
catheter ablation. Emphasis has been given on the role of myocardial injury biomarkers, natriuretic
peptides and traditional inflammatory markers. Novel inflammatory markers, oxidative
stress biomarkers and microRNAs have also been examined as predictors of a successful atrial
fibrillation procedure. Notably, the impact of procedural and short-term administration of
steroids, as well as the role of colchicine on preventing atrial fibrillation recurrence after ablation
is thoroughly presented.
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Affiliation(s)
| | | | - Spyridon Deftereos
- 2nd Department of Cardiology, 'Attikon' University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Charis Kossyvakis
- Department of Cardiology, 'Georgios Genimmatas' General Hospital of Athens, Athens, Greece
| | - Constantinos Tsioufis
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, Greece
| | - Gerasimos Siasos
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, Greece
| | - Evangelos Oikonomou
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, Greece
| | - Konstantinos Gatzoulis
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, Greece
| | - Dimitris Tousoulis
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, Greece
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Archontakis S, Sideris K, Aggeli K, Gatzoulis K, Demosthenous M, Tolios P, Lozos V, Koumallos N, Limperiadis D, Tousoulis D, Kallikazaros I, Sideris S. Percutaneous lead extraction and repositioning: An effective and safe therapeutic strategy for early ventricular lead perforation with dislocation both inside and outside the pericardial sac following a cardiac device implantation. J Cardiovasc Electrophysiol 2018; 30:299-307. [DOI: 10.1111/jce.13804] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/17/2018] [Accepted: 11/21/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Stefanos Archontakis
- First Cardiology DivisionUniversity of Athens, Hippokration General HospitalAthens Greece
| | | | - Konstantina Aggeli
- First Cardiology DivisionUniversity of Athens, Hippokration General HospitalAthens Greece
| | - Konstantinos Gatzoulis
- First Cardiology DivisionUniversity of Athens, Hippokration General HospitalAthens Greece
| | | | - Panagiotis Tolios
- First Cardiology DivisionUniversity of Athens, Hippokration General HospitalAthens Greece
| | - Vasilios Lozos
- First Cardiology DivisionUniversity of Athens, Hippokration General HospitalAthens Greece
| | - Nikolas Koumallos
- Department of Cardiac SurgeryHippokration General HospitalAthens Greece
| | | | - Dimitrios Tousoulis
- First Cardiology DivisionUniversity of Athens, Hippokration General HospitalAthens Greece
| | | | - Skevos Sideris
- Department of CardiologyHippokration General HospitalAthens Greece
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33
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Anastasakis A, Papatheodorou E, Ritsatos K, Protonotarios N, Rentoumi V, Gatzoulis K, Antoniades L, Agapitos E, Koutsaftis P, Spiliopoulou C, Tousoulis D. Sudden unexplained death in the young: epidemiology, aetiology and value of the clinically guided genetic screening. Europace 2018; 20:472-480. [PMID: 28177452 DOI: 10.1093/europace/euw362] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 10/26/2016] [Indexed: 11/14/2022] Open
Abstract
Aims To determine the incidence and the causes of sudden death (SD) in persons aged 1-35 years old and the diagnostic yield of clinically guided genetic screening in the sudden arrhythmic death syndrome (SADS) victims' families. Methods and results Incidence and causes of SD in the Attica region of Greece in 2002-10 were determined using death certificates and autopsy reports. We evaluated clinically consecutive families of SADS victims and if a clinical diagnosis was established, we proceeded to targeted genetic analysis. Out of 6030 deaths, 56% were due to traumatic or violent causes, 40.5% were natural deaths, and 3.3% were of undetermined cause. There were 349 SD cases. Cardiovascular causes accounted for 65%, non-cardiovascular causes for 17%, and SADS for 18%. Clinical evaluation identified an inherited heart disease in 5/20 SADS families (25%). Targeted genetic analysis identified a causative mutation in all of the five screened families and reconfirmed the diagnosis in three of five proband victims. Clinical and genetic evaluation of 28 family members identified eight affected carriers and eight non-affected carriers. Molecular autopsy failed to identify any of these families. Conclusion Sudden death in the young is of cardiovascular origin in the majority of cases. A considerable rate of SD cases remains of unknown cause on post-mortem. Apart from channelopathies, subclinical forms of inherited structural heart diseases would appear to be implicated in SADS. Clinically guided genetic screening has a significant diagnostic yield and identifies affected families that would have been missed by the current suggested molecular autopsy panel.
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Affiliation(s)
- Aris Anastasakis
- Inherited Cardiovascular Diseases Unit, 1st Department of Cardiology, University of Athens Medical School, 99, Michalakopoulou Ave 11527 Athens, Greece
| | - Efstathios Papatheodorou
- Inherited Cardiovascular Diseases Unit, 1st Department of Cardiology, University of Athens Medical School, 99, Michalakopoulou Ave 11527 Athens, Greece.,Cardiovascular and Cell Sciences Research Institute, Jenner Wing, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK
| | - Konstantinos Ritsatos
- Inherited Cardiovascular Diseases Unit, 1st Department of Cardiology, University of Athens Medical School, 99, Michalakopoulou Ave 11527 Athens, Greece
| | - Nikos Protonotarios
- Inherited Cardiovascular Diseases Unit, 1st Department of Cardiology, University of Athens Medical School, 99, Michalakopoulou Ave 11527 Athens, Greece
| | - Vasiliki Rentoumi
- Inherited Cardiovascular Diseases Unit, 1st Department of Cardiology, University of Athens Medical School, 99, Michalakopoulou Ave 11527 Athens, Greece
| | - Konstantinos Gatzoulis
- Inherited Cardiovascular Diseases Unit, 1st Department of Cardiology, University of Athens Medical School, 99, Michalakopoulou Ave 11527 Athens, Greece
| | | | - Emmanuel Agapitos
- Department of Pathology, Medical School, University of Athens, Athens, Greece
| | | | - Chara Spiliopoulou
- Department of Forensic Medicine and Toxicology, School of Medicine, University of Athens, Athens, Greece
| | - Dimitrios Tousoulis
- Inherited Cardiovascular Diseases Unit, 1st Department of Cardiology, University of Athens Medical School, 99, Michalakopoulou Ave 11527 Athens, Greece
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Sideris S, Archontakis S, Vaina S, Stroumpouli E, Koumallos N, Gatzoulis K, Trachanas K, Leontsinis I, Sfendouraki E, Sotiropoulos I, Tousoulis D, Kallikazaros I. Leadless pacing systems: A valuable alternative for patients with severe access problems. Hellenic J Cardiol 2017; 59:36-39. [PMID: 29126950 DOI: 10.1016/j.hjc.2017.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 10/27/2017] [Accepted: 11/01/2017] [Indexed: 10/18/2022] Open
Affiliation(s)
- Skevos Sideris
- State Department of Cardiology, Hippokration Hospital, 114 Vasilisis Sofias Street, 11528, Athens, Greece.
| | - Stefanos Archontakis
- First Cardiology Division, University of Athens, Medical School, Hippokration Hospital, 114 Vasilisis Sofias Street, 11528, Athens, Greece.
| | - Sophia Vaina
- First Cardiology Division, University of Athens, Medical School, Hippokration Hospital, 114 Vasilisis Sofias Street, 11528, Athens, Greece.
| | - Evangelia Stroumpouli
- Department of Radiology, Hippokration Hospital, 114 Vasilisis Sofias Street, 11528, Athens, Greece
| | - Nikolas Koumallos
- Department of Cardiac Surgery, Hippocration Hospital, 114 Vasilisis Sofias Street, 11528, Athens, Greece
| | - Konstantinos Gatzoulis
- First Cardiology Division, University of Athens, Medical School, Hippokration Hospital, 114 Vasilisis Sofias Street, 11528, Athens, Greece.
| | - Konstantinos Trachanas
- State Department of Cardiology, Hippokration Hospital, 114 Vasilisis Sofias Street, 11528, Athens, Greece.
| | - Ioannis Leontsinis
- State Department of Cardiology, Hippokration Hospital, 114 Vasilisis Sofias Street, 11528, Athens, Greece
| | - Elissavet Sfendouraki
- State Department of Cardiology, Hippokration Hospital, 114 Vasilisis Sofias Street, 11528, Athens, Greece.
| | - Ilias Sotiropoulos
- State Department of Cardiology, Hippokration Hospital, 114 Vasilisis Sofias Street, 11528, Athens, Greece
| | - Dimitrios Tousoulis
- First Cardiology Division, University of Athens, Medical School, Hippokration Hospital, 114 Vasilisis Sofias Street, 11528, Athens, Greece.
| | - Ioannis Kallikazaros
- State Department of Cardiology, Hippokration Hospital, 114 Vasilisis Sofias Street, 11528, Athens, Greece.
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Chrysohoou C, Dilaveris P, Antoniou CK, Skiadas I, Konstantinou K, Gatzoulis K, Kallikazaros I, Tousoulis D. Heart failure study of multipoint pacing effects on ventriculoarterial coupling: Rationale and design of the HUMVEE trial. Ann Noninvasive Electrocardiol 2017; 23:e12510. [PMID: 29034563 DOI: 10.1111/anec.12510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 09/20/2017] [Indexed: 02/06/2023] Open
Abstract
Cardiac resynchronization therapy (CRT) is an established therapy for symptomatic heart failure (HF). Unfortunately, many recipients remain nonresponders. Studies have revealed the potential role of multipoint pacing (MPP) in improving response and outcomes. The aim of this study is to compare the effects of MPP against those of standard biventricular pacing (BVP) on (i) ventriculoarterial coupling (VAC) and energy efficiency of the failing heart, (ii) diastolic function, (iii) quality of life, and (iv) NT-proBNP levels and glomerular filtration rate (GFR) during a follow-up of 13 months. HUMVEE is a single-center, prospective, observational, crossover cohort study. Seventy-six patients with BVP indication will be implanted with a system able to deliver both pacing modes. BVP will be activated at implantation and optimized 1 month after. At 6 months postoptimization MPP will be activated and optimized. Optimization will be performed based on stroke volume maximization, as assessed by ultrasound. Laboratory measurements (GFR and NT-proBNP) and echocardiographic studies (VAC calculation, strain rate, diastolic function) will be performed at implantation, 6 months post-BVP optimization and at the end of 13 months of follow-up (6 months post-MPP optimization). Potential reduction in arrhythmogenesis by MPP will also be assessed. MPP is a pacing modality with the potential to improve HF patients' outcomes. The HUMVEE trial will attempt to associate any potential added beneficial effects of MPP over standard BVP with alterations in VAC and energy efficiency of the heart, thus uncovering a novel mechanistic link between MPP and improved outcomes in HF.
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Affiliation(s)
- Christina Chrysohoou
- First University Department of Cardiology, Hippokration Hospital, Athens, Greece
| | | | | | - Ioannis Skiadas
- State Department of Cardiology, Hippokration Hospital, Athens, Greece
| | | | | | | | - Dimitrios Tousoulis
- First University Department of Cardiology, Hippokration Hospital, Athens, Greece
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36
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Poulidakis E, Aggeli C, Sideris S, Felekos I, Sfendouraki E, Koutagiar I, Polytarhou K, Giannoulis E, Koukos M, Triantafyllou K, Dilaveris P, Gatzoulis K, Kappos K, Stefanadis C, Tousoulis D. P6138Patient selection for cardiac resynchronization therapy using dobutamine stress echocardiography and dyssynchrony assessment. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6138] [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: 11/13/2022] Open
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37
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Dilaveris P, Gatzoulis K, Georgopoulos S, Antoniou CK, Anastasakis A, Theopistou A, Sideris S, Tsiachris D, Arsenos P, Tousoulis D. P944Prospective study of implantable cardioverter-defibrillator activation in hypertrophic cardiomyopathy patients in greece. Europace 2017. [DOI: 10.1093/ehjci/eux151.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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38
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Antoniou CK, Bournellis H, Papadopoulos A, Tsiachris D, Arsenos P, Dilaveris P, Diakogiannis I, Sideris S, Kallikazaros I, Gatzoulis K, Tousoulis D. P460Increased prevalence of late potentials on signal-averaged electrocardiogram in psychiatric patients. Europace 2017. [DOI: 10.1093/ehjci/eux141.183] [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: 11/12/2022] Open
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39
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Antoniou CK, Gatzoulis K, Georgopoulos S, Anastasakis A, Theopistou A, Sideris S, Dilaveris P, Arsenos P, Tsiachris D, Tousoulis D. 649Reappraisal of the value of electrophysiological study in sudden cardiac death risk stratification in hypertrophic cardiomyopathy. Europace 2017. [DOI: 10.1093/ehjci/eux145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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40
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Dilaveris P, Antoniou CK, Gatzoulis K, Tousoulis D. T wave axis deviation and QRS-T angle - Controversial indicators of incident coronary heart events. J Electrocardiol 2017; 50:466-475. [PMID: 28262257 DOI: 10.1016/j.jelectrocard.2017.02.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 12/04/2016] [Indexed: 11/29/2022]
Abstract
Abnormal orientation of the T-wave axis and increased angle between the QRS complex (depolarization) and the T-wave (repolarization) have long been assumed to provide a global measure of repolarization abnormality, and have been used to assess ventricular repolarization. The ability of the T wave axis deviation and the QRS-T angle to predict incident coronary heart events was examined in several studies. However, conflicting results have led to significant controversy in the literature concerning their purported ability. Potential explanations involve true variation between study populations, non-standardized cut-off values, different baseline cardiovascular risk levels or different patterns of confounding by other concomitant cardiovascular risk factors. In the present article we will attempt to briefly present the rationale and pathophysiology behind these indices, summarize existing knowledge regarding their prognostic significance and their correlation with established cardiovascular disease risk factors. Further prospective studies are necessary to confirm or refute whether T-wave axis deviation, QRS-T angle and ventricular gradient may in the future serve as indicators of incident coronary heart events and mortality, both in populations with higher prevalence of subclinical advanced atherosclerotic heart disease and in apparently healthy subjects.
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Affiliation(s)
- Polychronis Dilaveris
- First Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece.
| | | | - Konstantinos Gatzoulis
- First Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece
| | - Dimitrios Tousoulis
- First Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece
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Antoniou CK, Dilaveris P, Manolakou P, Galanakos S, Magkas N, Gatzoulis K, Tousoulis D. QT Prolongation and Malignant Arrhythmia: How Serious a Problem? Eur Cardiol 2017; 12:112-120. [PMID: 30416582 DOI: 10.15420/ecr.2017:16:1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
QT prolongation constitutes one of the most frequently encountered electrical disorders of the myocardium. This is due not only to the presence of several associated congenital syndrome but also, and mainly, due to the QT-prolonging effects of several acquired conditions, such as ischaemia and heart failure, as well as multiple medications from widely different categories. Propensity of repolarization disturbances to arrhythmia appears to be inherent in the function of and electrophysiology of the myocardium. In the present review the issue of QT prolongation will be addressed in terms of pathophysiology, arrhythmogenesis, treatment and risk stratification approaches. Although already discussed in literature, it is hoped that the mechanistic approach of the present review will assist in improved understanding of the underlying changes in electrophysiology, as well as the rationale for current diagnostic and therapeutic approaches.
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Affiliation(s)
| | | | - Panagiota Manolakou
- First Department of Cardiology, Korgialenion-Benakion/Hellenic Red Cross Hospital Athens, Greece
| | - Spyridon Galanakos
- First University Department of Cardiology, Hippokration Hospital Athens, Greece
| | - Nikolaos Magkas
- First University Department of Cardiology, Hippokration Hospital Athens, Greece
| | | | - Dimitrios Tousoulis
- First University Department of Cardiology, Hippokration Hospital Athens, Greece
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Dilaveris P, Aggeli C, Synetos A, Skiadas I, Antoniou CK, Tsiamis E, Gatzoulis K, Kallikazaros I, Tousoulis D. Sustained ventricular tachycardia as a first manifestation of hypertrophic cardiomyopathy with mid-ventricular obstruction and apical aneurysm in an elderly female patient. Ann Noninvasive Electrocardiol 2016; 22. [PMID: 28012232 DOI: 10.1111/anec.12422] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Sustained ventricular tachycardia complicating left ventricular apical aneurysms has been reported previously solely in middle-aged patients with hypertrophic cardiomyopathy and mid-cavity obstruction. We report a case of an elderly female patient who presented with incessant ventricular tachycardia as the first clinical manifestation of hypertrophic cardiomyopathy with mid-ventricular obstruction and apical aneurysm.
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Affiliation(s)
| | - Constantina Aggeli
- 1st University Department of Cardiology, Hippokration Hospital, Athens, Greece
| | - Andreas Synetos
- 1st University Department of Cardiology, Hippokration Hospital, Athens, Greece
| | - Ioannis Skiadas
- State Department of Cardiology, Hippokration Hospital, Athens, Greece
| | | | - Eleftherios Tsiamis
- 1st University Department of Cardiology, Hippokration Hospital, Athens, Greece
| | | | | | - Dimitrios Tousoulis
- 1st University Department of Cardiology, Hippokration Hospital, Athens, Greece
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Kyrlagkitsis S, Papaioannou TG, Gialafos E, Vavuranakis M, Siasos G, Hatzis G, Kokkou E, Gatzoulis K, Karamanou M, Stefanadis C, Tousoulis D. Relationships between heart rate variability and aortic hemodynamic variables in healthy subjects. Hellenic J Cardiol 2016; 57:359-362. [DOI: 10.1016/j.hjc.2016.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 03/24/2016] [Indexed: 11/29/2022] Open
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Korantzopoulos P, Sideris S, Dilaveris P, Gatzoulis K, Goudevenos JA. Infection control in implantation of cardiac implantable electronic devices: current evidence, controversial points, and unresolved issues. Europace 2016; 18:473-478. [DOI: 10.1093/europace/euv260] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Sideris S, Drakopoulou M, Oikonomopoulos G, Gatzoulis K, Stavropoulos G, Limperiadis D, Toutouzas K, Tousoulis D, Kallikazaros I. Left Ventricular Pacing through Coronary Sinus Is Feasible and Safe for Patients with Prior Tricuspid Valve Intervention. Pacing Clin Electrophysiol 2016; 39:378-81. [PMID: 26769172 DOI: 10.1111/pace.12815] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 12/23/2015] [Accepted: 12/23/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND In the presence of tricuspid valve intervention, right ventricular lead implantation is associated with the potential risk of tricuspid valve malfunction leading to a tricuspid regurgitation. Few cases have been reported with successful left ventricular pacing via the coronary sinus (CS) after tricuspid valve replacement or repair. In this retrospective study, we present the long-term clinical outcomes of 17 patients who underwent CS lead implantation and left ventricular pacing. METHODS Seventeen consecutive patients referred to our institution with an indication of postprocedural pacemaker (PM) implantation after tricuspid valve intervention were retrospectively included in the study. The indication for device implantation in all patients was atrial fibrillation with a symptomatic pause ≥ 3.0 seconds. Thus, all devices implanted were ventricular rate responsive (VVIR). RESULTS All device implantations were successful and uncomplicated. Mean operation time was 60 ± 8 minutes. Mean fluoroscopy time was 8.3 ± 2.1 minutes. Mean R-wave sensing was 7.5 ± 2.0 mV with a mean slew rate of 2.2 V/s. A mean pacing threshold of 1.9 ± 0.3 V/0.4 ms was accepted as patients were not PM-dependent. The pacing impedance was 743.5 ± 109.71 Ohm. At 2-year follow-up, pacing sensing, threshold, and impedance values were unchanged and no lead dislodgement has been noted. CONCLUSIONS In patients with tricuspid valve intervention, left ventricular pacing might be the treatment of choice for permanent ventricular pacing, with all the advantages of the endovenous route as a minimally invasive approach.
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Affiliation(s)
- Skevos Sideris
- Cardiology Department, Hippokration Hospital, Athens, Greece
| | - Maria Drakopoulou
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | | | - Konstantinos Gatzoulis
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | | | | | - Konstantinos Toutouzas
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | - Dimitris Tousoulis
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
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Sideris S, Trachanas K, Kelesidis I, Gatzoulis K, Arsenos P, Tousoulis D, Kallikazaros I. Cardiac Resynchronization Therapy: A Review of Pathophysiology and Clinical Applications. Hellenic J Cardiol 2015; 56:451-460. [PMID: 26685290] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Affiliation(s)
- Skevos Sideris
- State Cardiology Division, Hippokration General Hospital, Athens, Greece
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Dilaveris P, Tsioufis C, Gatzoulis K, Tousoulis D. Extreme prolongation of sinus node recovery time in a coronary artery disease patient. Int J Cardiol 2015; 190:260-1. [DOI: 10.1016/j.ijcard.2015.04.184] [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] [Received: 04/19/2015] [Accepted: 04/21/2015] [Indexed: 11/24/2022]
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Sideris S, Benetos G, Lazaros G, Gatzoulis K, Lymperiadis D, Stavropoulos G, Toutouzas K, Manakos K, Traxanas K, Trantalis G, Tousoulis D, Kallikazaros I. An unexpected complication during percutaneous pacemaker lead extraction unveiled by transesophageal echocardiography. Int J Cardiol 2014; 177:e125-7. [DOI: 10.1016/j.ijcard.2014.09.077] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 09/20/2014] [Indexed: 11/16/2022]
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Trachanas K, Sideris S, Aggeli C, Poulidakis E, Gatzoulis K, Tousoulis D, Kallikazaros I. Diabetic cardiomyopathy: from pathophysiology to treatment. Hellenic J Cardiol 2014; 55:411-421. [PMID: 25243440] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
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Dilaveris P, Koutagiar I, Alexopoulos N, Tsiachris D, Gatzoulis K. Secondary prevention of sudden cardiac death in a 65 year untreated ALCAPA patient. Int J Cardiol 2014; 176:e73-4. [PMID: 25125005 DOI: 10.1016/j.ijcard.2014.07.262] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 07/27/2014] [Indexed: 11/29/2022]
Affiliation(s)
| | - Iosif Koutagiar
- 1st University Department of Cardiology, Hippokration Hospital, Athens, Greece
| | | | - Dimitris Tsiachris
- 1st University Department of Cardiology, Hippokration Hospital, Athens, Greece
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