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Letsas KP, Saplaouras A, Mililis P, Kariki O, Bazoukis G, Archontakis S, Anagnostopoulos I, Triantafyllou S, Palaiodimou L, Chatziantoniou A, Lykoudis A, Mpatsouli A, Katsa G, Kadda O, Dragasis S, Cheilas V, Tsetika EG, Asvestas D, Korantzopoulos P, Poulos G, Maounis T, Kostopoulou A, Kossyvakis C, Xydonas S, Giannopoulos G, Papagiannis J, Tsoutsinos A, Sidiropoulos G, Vassilikos V, Fragakis N, Tzeis S, Deftereos S, Dilaveris P, Sideris S, Efremidis M, Tsivgoulis G. Diagnostic yield of implantable loop recorders: Results from the Hellenic registry. Hellenic J Cardiol 2024:S1109-9666(24)00108-8. [PMID: 38729347 DOI: 10.1016/j.hjc.2024.05.004] [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: 01/19/2024] [Revised: 03/20/2024] [Accepted: 05/03/2024] [Indexed: 05/12/2024] Open
Abstract
AIMS Implantable loop recorders (ILRs) are increasingly being used for long-term cardiac monitoring in different clinical settings. The aim of this study was to investigate the real-world performance of ILRs-including the time to diagnosis- in unselected patients with different ILR indications. METHODS AND RESULTS In this multicenter, observational study, 871 patients with an indication of pre-syncope/syncope (61.9%), unexplained palpitations (10.4%), and atrial fibrillation (AF) detection with a history of cryptogenic stroke (CS) (27.7%) underwent ILR implantation. The median follow-up was 28.8 ± 12.9 months. In the presyncope/syncope group, 167 (31%) received a diagnosis established by the device. Kaplan-Meier estimates indicated that 16.9% of patients had a diagnosis at 6 months, and the proportion increased to 22.5% at 1 year. Of 91 patients with palpitations, 20 (22%) received a diagnosis based on the device. The diagnosis established at 12.2% of patients at 6 months, and the proportion increased to 13.3% at 1 year. Among 241 patients with CS, 47 (19.5%) were diagnosed with AF. The diagnostic yield of the device was 10.4% at 6 months and 12.4% at 1 year. In all cases, oral anticoagulation was initiated. Overall, ILR diagnosis altered the therapeutic strategy in 26.1% in presyncope/syncope group, 2.2% in palpitations group, and 3.7% in CS group in addition to oral anticoagulation initiation. CONCLUSIONS In this real-world patient population, ILR determines diagnosis and initiates a new therapeutic management in nearly one fourth of patients. ILR implantation is valuable in the evaluation of patients with unexplained presyncope/syncope, CS and palpitations.
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Affiliation(s)
| | | | | | - Ourania Kariki
- Arrhythmia Unit, Onassis Cardiac Surgery Center, Athens, Greece
| | - George Bazoukis
- Arrhythmia Unit, Onassis Cardiac Surgery Center, Athens, Greece
| | - Stefanos Archontakis
- First Department of Cardiology, Hippokration University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Sokratis Triantafyllou
- Second Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens, Greece
| | - Lina Palaiodimou
- Second Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens, Greece
| | | | - Anastasios Lykoudis
- Second Department of Cardiology, Evangelismos General Hospital, Athens, Greece
| | - Athena Mpatsouli
- Second Department of Cardiology, Evangelismos General Hospital, Athens, Greece
| | - Georgia Katsa
- Arrhythmia Unit, Onassis Cardiac Surgery Center, Athens, Greece
| | - Olga Kadda
- Arrhythmia Unit, Onassis Cardiac Surgery Center, Athens, Greece
| | | | | | | | | | | | - George Poulos
- Arrhythmia Unit, Onassis Cardiac Surgery Center, Athens, Greece
| | | | | | | | - Sotirios Xydonas
- Second Department of Cardiology, Evangelismos General Hospital, Athens, Greece
| | - Georgios Giannopoulos
- Third Cardiology Department, School of Medicine, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - George Sidiropoulos
- Third Cardiology Department, School of Medicine, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vassilios Vassilikos
- Third Cardiology Department, School of Medicine, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Fragakis
- Third Cardiology Department, School of Medicine, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stylianos Tzeis
- Department of Cardiology, Mitera Hospital, Hygeia Group, Athens, Greece
| | - Spyridon Deftereos
- Second Department of Cardiology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens, Greece
| | - Polychronis Dilaveris
- First Department of Cardiology, Hippokration University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Skevos Sideris
- First Department of Cardiology, Hippokration University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Georgios Tsivgoulis
- Second Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens, Greece
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Kariki O, Mililis P, Saplaouras A, Dragasis S, Patsiotis IG, Chatziantoniou A, Alexiou D, Cheilas V, Letsas KP, Efremidis M. Cryoablation versus hybrid radiofrequency with high- and very-high-power short-duration catheter ablation for the treatment of paroxysmal atrial fibrillation. Hellenic J Cardiol 2024:S1109-9666(24)00075-7. [PMID: 38554832 DOI: 10.1016/j.hjc.2024.03.014] [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: 01/11/2024] [Revised: 03/20/2024] [Accepted: 03/26/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND High-power short-duration (HPSD) and very-high-power short-duration (vHPSD-90 W/4 s) radiofrequency (RF) technology has reduced the procedure time of pulmonary vein isolation (PVI) using RF without compromising the efficacy of the technique. The current study compares the novel technology of HPSD/vHPSD with cryoablation (CRYO) in terms of efficacy, safety, and procedure time in a cohort of symptomatic patients with paroxysmal atrial fibrillation (pAF). METHODS This is a prospective, non-randomized trial. Patients with pAF received either CRYO or HPSD/vHPSD RF PVI. The primary endpoint of the study was arrhythmia recurrence in a 12 month follow-up period. Secondary endpoints included procedure time, fluoroscopy time, and safety. RESULTS 104 patients were included (45 in HPSD/vHPSD and 59 in CRYO), with comparable characteristics between groups. The follow-up was 12.4 ± 0.5 months. There was no significant difference regarding arrhythmia recurrences during the early post-procedural period of the first 3 months (8.9% recurrences in HPSD/vHPSD versus 5.1% in CRYO-p 0.463) and in the mid-term follow-up of 12 months (17.8% recurrences in HPSD/vHPSD versus 10.2% in CRYO-p 0.385). Safety was excellent for both procedures. CRYO was a procedure of significantly shorter duration (64.64 ± 8.94 min versus 75.29 ± 18.30 min, p = 0.0001) at the expense of longer fluoroscopy time (HPSD/vHPSD 5.34 ± 1.83 versus 7.89 ± 3.70 min CRYO, p 0.001). CONCLUSIONS HPSD/vHPSD and CRYO in pAF were comparable regarding the arrhythmia recurrence rates in a 12-month follow-up with excellent safety. The hybrid approach of HPSD/vHPSD has accelerated RF-PVI compared to conventional RF, but CRYO remains a procedure of significantly shorter duration at the expense of longer fluoroscopy time.
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Affiliation(s)
- Ourania Kariki
- Arrhythmia Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | | | | | | | - Ilias G Patsiotis
- Arrhythmia Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | | | - Dimitrios Alexiou
- Arrhythmia Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Vasileios Cheilas
- Arrhythmia Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | | | - Michael Efremidis
- Arrhythmia Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
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3
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Kariki O, Karyofyllis P, Mililis P, Saplaouras A, Dragasis S, Chatziantoniou A, Alexiou D, Patsiotis IG, Letsas KP, Efremidis M. Electrocardiographic changes after balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension: Data from the Hellenic Registry. J Electrocardiol 2023; 81:26-31. [PMID: 37506539 DOI: 10.1016/j.jelectrocard.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Balloon pulmonary angioplasty (BPA) has provided an effective invasive treatment for inoperable patients with chronic thromboembolic pulmonary hypertension (CTEPH). The hemodynamic improvement achieved by BPA has significantly increased the long-term prognosis of these patients, mostly by reversing the negative remodeling of the right ventricle (RV). MATERIALS AND METHODS In a cohort of 17 patients with symptomatic CTEPH hemodynamic data were collected before and after the completion of BPA sessions. After the confirmation of statistically significant hemodynamic improvement, we examined the changes in certain prespecified electrocardiographic (ECG) parameters (PR interval duration, QRS duration, QTc interval duration, R wave and S wave amplitude in lead I, R wave and S wave amplitude in precordial leads V1, V5 and V6) before the initiation and one month after the completion of BPA sessions. In addition, ECGs were qualitatively assessed before and after treatment for the presence of ECG abnormalities related to PH, proposed by the guidelines of the European Society of Cardiology (ESC). The term ESC criteria 1-6 was used for their description. RESULTS Statistically significant correlation (p < 0.05) was found between the reduction in mean pulmonary artery pressure (mPAP) and the decrease of the depth of the S wave in leads I (p 0.0069), V5 (p 0.0003), V6 (p 0.0011) and in the R wave amplitude in leads V5 (p 0.0122) and V6 (p 0.0185). From the ESC criteria, RV strain pattern was the commonest in the initial cohort, with significant improvement after therapies. CONCLUSION Hemodynamic improvement after BPA therapies is correlated with improved ECG amplitude parameters in leads I, V5 and V6. RV strain pattern is common among untreated patients with significant improvement after therapies.
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Affiliation(s)
- Ourania Kariki
- Division of Interventional Cardiology and Arrhythmia Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Panagiotis Karyofyllis
- Division of Interventional Cardiology and Arrhythmia Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Panagiotis Mililis
- Division of Interventional Cardiology and Arrhythmia Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Athanasios Saplaouras
- Division of Interventional Cardiology and Arrhythmia Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Stylianos Dragasis
- Division of Interventional Cardiology and Arrhythmia Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Anastasios Chatziantoniou
- Division of Interventional Cardiology and Arrhythmia Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Dimitris Alexiou
- Division of Interventional Cardiology and Arrhythmia Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Ilias G Patsiotis
- Division of Interventional Cardiology and Arrhythmia Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Konstantinos P Letsas
- Division of Interventional Cardiology and Arrhythmia Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece.
| | - Michael Efremidis
- Division of Interventional Cardiology and Arrhythmia Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece
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Letsas KP, Saplaouras A, Mililis P, Dragasis S, Patsiotis IG, Kariki O, Kadda O, Katsa G, Bazoukis G, Efremidis M. Cardioneuroablation for neurally-mediated syncope: Initial experience. Hellenic J Cardiol 2023; 74:87-89. [PMID: 37647986 DOI: 10.1016/j.hjc.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/14/2023] [Accepted: 08/24/2023] [Indexed: 09/01/2023] Open
Abstract
Cardioneuroablation is an emerging alternative therapeutic modality for young patients with severe neurally-mediated syncope. We present two images of cardioneuroablation performed in young patients who suffered from recurrent neurally-mediated syncope with asystole and functional atrioventricular block. The patients remain syncope-free during follow-ups.
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Affiliation(s)
- Konstantinos P Letsas
- Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece. https://twitter.com/K_Letsas
| | | | - Panagiotis Mililis
- Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Stylianos Dragasis
- Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Ilias G Patsiotis
- Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Ourania Kariki
- Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Olga Kadda
- Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Georgia Katsa
- Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - George Bazoukis
- Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Michael Efremidis
- Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
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Saplaouras A, Mililis P, Kariki O, Bazoukis G, Batsouli A, Antonakos V, Dragasis S, Patsiotis IG, Letsas KP, Efremidis M. An inappropriately-appropriate ICD therapy: What is the mechanism and what interventions can be done? Clin Case Rep 2023; 11:e8082. [PMID: 37881196 PMCID: PMC10593968 DOI: 10.1002/ccr3.8082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/29/2023] [Accepted: 10/07/2023] [Indexed: 10/27/2023] Open
Abstract
Key Clinical Message R-wave double counting is a rare cause of ventricular oversensing that can lead to inappropriate shocks. Optimizing device programming is essential for the avoidance of subsequent inappropriate therapies. Abstract R-wave double counting is a rare cause of ventricular oversensing that can lead to inappropriate shocks. We present the case of a female patient, 52-years-old with a history of end-stage hypertrophic cardiomyopathy. The patient suffered an implantable cardioverter-defibrillator (ICD) shock. Cardiac device interrogation revealed ventricular tachycardia (VT) with a cycle length of 420 ms that was misclassified in the ventricular fibrillation (VF) zone owing to R-wave double counting. Optimizing device programming is essential for the avoidance of subsequent inappropriate therapies. Possible therapeutic options are briefly presented in the case.
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Affiliation(s)
| | | | - Ourania Kariki
- Arrhythmia UnitOnassis Cardiac Surgery CenterAthensGreece
| | - George Bazoukis
- Department of CardiologyLarnaca General HospitalLarnacaCyprus
- European University of CyprusMedical SchoolNicosiaCyprus
| | - Athena Batsouli
- Department of CardiologyEvangelismos General HospitalAthensGreece
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6
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Saplaouras A, Kariki O, Mililis P, Zygouri A, Gkouziouta A, Poulos G, Adamopoulos S, Efremidis M, Nyktari E, Letsas KP. Diagnostic and therapeutic dilemmas in a patient with myocarditis, Brugada syndrome and arrhythmic syncope. J Electrocardiol 2023; 80:45-50. [PMID: 37187131 DOI: 10.1016/j.jelectrocard.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023]
Abstract
We present a case of a previously healthy 23-year-old male who presented with chest pain, palpitations and spontaneous type 1 Brugada electrocardiographic (ECG) pattern. Positive family history for sudden cardiac death (SCD) was remarkable. Initially, clinical symptoms in combination with myocardial enzymes elevation, regional myocardial oedema with late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) and inflammatory lymphocytoid-cell infiltrates in the endomyocardial biopsy (EMB) suggested the diagnosis of a myocarditis-induced Brugada phenocopy (BrP). Under immunosuppressive therapy with methylprednisolone and azathioprine, a complete remission of both symptoms and biomarkers was accomplished. However, the Brugada pattern did not resolve. The eventually spontaneous Brugada pattern type 1 established the diagnosis of Brugada syndrome (BrS). Due to his previous history of syncope, the patient was offered an ICD that he declined. After his discharge he experienced a new episode of arrhythmic syncope. He was readmitted and received an ICD.
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Affiliation(s)
| | - Ourania Kariki
- Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Panagiotis Mililis
- Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Andromahi Zygouri
- Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | | | - George Poulos
- Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | | | - Michael Efremidis
- Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Evangelia Nyktari
- Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
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7
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Kariki O, Georgopoulos M, Katsillis N, Chatziantoniou A, Koskina S, Zygouri A, Saplaouras A, Bazoukis G, Gkouziouta A, Vlachos K, Dragasis S, Mililis P, Adamopoulos S, Efremidis M, Letsas KP. Contemporary management of ventricular arrhythmias in heart failure. Am J Cardiovasc Dis 2023; 13:207-221. [PMID: 37736352 PMCID: PMC10509449] [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] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 07/04/2023] [Indexed: 09/23/2023]
Abstract
Enhanced ventricular arrhythmogenesis is commonly experienced by patients in the end-stage of heart failure spectrum. A high burden of ventricular arrhythmias can affect the ventricular systolic function, lead to unexpected hospitalizations and further deteriorate the prognosis. Management of ventricular arrhythmias in this population is challenging. Implantable cardioverter-defibrillators are protective for the immediate termination of life-threatening arrhythmias but they have no impact in reducing the arrhythmic burden. Combination treatment with invasive (catheter ablation, mechanical hemodynamic support, sympathetic denervation) and noninvasive (antiarrhythmic drugs, medical therapy for heart failure, programming of implantable devices) therapies is commonly required. The aim of this review is to present the available therapeutic options, with main focus on recently published data for catheter ablation and provide a stepwise treatment approach.
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Affiliation(s)
- Ourania Kariki
- Department of Cardiology, Onassis Cardiac Surgery CenterAthens, Greece
| | | | - Nikitas Katsillis
- Department of Cardiology, Onassis Cardiac Surgery CenterAthens, Greece
| | | | - Stavroula Koskina
- Department of Cardiology, Onassis Cardiac Surgery CenterAthens, Greece
| | - Andromahi Zygouri
- Department of Cardiology, Onassis Cardiac Surgery CenterAthens, Greece
| | | | - George Bazoukis
- Department of Cardiology, Larnaca General HospitalLarnaca, Cyprus
| | | | | | | | | | | | - Michael Efremidis
- Department of Cardiology, Onassis Cardiac Surgery CenterAthens, Greece
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8
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Mililis P, Kariki O, Saplaouras A, Bazoukis G, Dragasis S, Patsiotis IG, Batsouli A, Vlachos K, Letsas KP, Efremidis M. Radiofrequency versus cryoballoon catheter ablation in patients with persistent atrial fibrillation: A randomized trial. J Cardiovasc Electrophysiol 2023; 34:1523-1528. [PMID: 37293822 DOI: 10.1111/jce.15965] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 04/13/2023] [Accepted: 05/29/2023] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Patients with persistent atrial fibrillation (AF) represent a challenging population for rhythm control therapies. Catheter ablation (CA) with pulmonary vein isolation (PVI) is an effective treatment option for the reduction of the arrhythmic burden. Data regarding the comparability between radiofrequency (RF) and cryoballoon ablation (CRYO) in persistent AF are limited. METHODS This is a prospective, randomized, single-center study designed to compare the efficacy in terms of rhythm control between RF and CRYO in persistent AF. Eligible participants were randomized 2:1 in two arms: RF and CRYO. The primary endpoint of the study was arrhythmia relapse in the early postprocedural period (first 3 months) and in the middle term follow-up (3 months to 12 months). Secondary endpoints included procedure duration, fluoroscopy time, and complications. RESULTS A total of 199 patients participated in the study (133 patients in the RF arm, 66 in the CRYO arm). No statistically significant difference occurred between the two groups regarding the primary endpoint (recurrences ≤3 months: 35.5% RF vs. 37.9% CRYO, p .755, recurrences >3 months: 26.3% RF vs. 27.3% CRYO, p .999). From the secondary endpoints, CRYO was a procedure of significantly shorter duration (75.15 ± 17.21 in CRYO vs. 136.6 ± 43.33 in RF group, p < .05). CONCLUSION CRYO and RF ablation appear to be equally effective for rhythm control in patients with persistent AF. CRYO ablation is advantageous in terms of procedure duration.
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Affiliation(s)
| | - Ourania Kariki
- Arrhythmia Unit, Onassis Cardiac Surgery Center, Athens, Greece
| | | | - George Bazoukis
- Department of Cardiology, Larnaca General Hospital, Larnaca, Cyprus
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, Nicosia, Cyprus
| | | | | | - Athena Batsouli
- Department of Cardiology, Evangelismos General Hospital, Athens, Greece
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9
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Vlachos K, Letsas KP, Srinivasan NT, Frontera A, Efremidis M, Dragasis S, Martin CA, Martin R, Nakashima T, Bazoukis G, Kitamura T, Mililis P, Saplaouras A, Georgopoulos S, Sofoulis S, Kariki O, Koskina S, Takigawa M, Sacher F, Jais P, Santangeli P. The value of functional substrate mapping in ventricular tachycardia ablation. Heart Rhythm O2 2023; 4:134-146. [PMID: 36873315 PMCID: PMC9975018 DOI: 10.1016/j.hroo.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
In the setting of structural heart disease, ventricular tachycardia (VT) is typically associated with a re-entrant mechanism. In patients with hemodynamically tolerated VTs, activation and entrainment mapping remain the gold standard for the identification of the critical parts of the circuit. However, this is rarely accomplished, as most VTs are not hemodynamically tolerated to permit mapping during tachycardia. Other limitations include noninducibility of arrhythmia or nonsustained VT. This has led to the development of substrate mapping techniques during sinus rhythm, eliminating the need for prolonged periods of mapping during tachycardia. Recurrence rates following VT ablation are high; therefore, new mapping techniques for substrate characterization are required. Advances in catheter technology and especially multielectrode mapping of abnormal electrograms has increased the ability to identify the mechanism of scar-related VT. Several substrate-guided approaches have been developed to overcome this, including scar homogenization and late potential mapping. Dynamic substrate changes are mainly identified within regions of myocardial scar and can be identified as local abnormal ventricular activities. Furthermore, mapping strategies incorporating ventricular extrastimulation, including from different directions and coupling intervals, have been shown to increase the accuracy of substrate mapping. The implementation of extrastimulus substrate mapping and automated annotation require less extensive ablation and would make VT ablation procedures less cumbersome and accessible to more patients.
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Affiliation(s)
- Konstantinos Vlachos
- Cardiac Pacing and Electrophysiology Department, Hôpital Cardiologique du Haut Lévêque, Pessac, France
- Electrophysiology Department, Onassis Cardiac Surgery Center, Athens, Greece
- INSERM U1045, Institut hostpialo-universitaire–L’institut de rythmologie et modélisation cardiaque, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Pessac, France
- Address reprint requests and correspondence: Dr Konstantinos Vlachos, Onassis Cardiac Surgery Center, Electrophysiology Department, Syggrou Avenue 356, PC 176 74, Athens, Greece.
| | | | - Neil T. Srinivasan
- Department of Cardiac Electrophysiology, Essex Cardiothoracic Centre, Basildon, United Kingdom
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Antonio Frontera
- Cardiac Pacing and Electrophysiology Department, Hôpital Cardiologique du Haut Lévêque, Pessac, France
- INSERM U1045, Institut hostpialo-universitaire–L’institut de rythmologie et modélisation cardiaque, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Pessac, France
| | - Michael Efremidis
- Electrophysiology Department, Onassis Cardiac Surgery Center, Athens, Greece
| | - Stelios Dragasis
- Electrophysiology Department, Onassis Cardiac Surgery Center, Athens, Greece
| | - Claire A. Martin
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, Nicosia, Cyprus
| | - Ruaridh Martin
- Cardiac Pacing and Electrophysiology Department, Hôpital Cardiologique du Haut Lévêque, Pessac, France
- INSERM U1045, Institut hostpialo-universitaire–L’institut de rythmologie et modélisation cardiaque, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Pessac, France
| | - Takashi Nakashima
- Cardiac Pacing and Electrophysiology Department, Hôpital Cardiologique du Haut Lévêque, Pessac, France
- INSERM U1045, Institut hostpialo-universitaire–L’institut de rythmologie et modélisation cardiaque, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Pessac, France
| | - George Bazoukis
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, Nicosia, Cyprus
- Department of Cardiology, Larnaca General Hospital, Larnaca, Cyprus
| | - Takeshi Kitamura
- Cardiac Pacing and Electrophysiology Department, Hôpital Cardiologique du Haut Lévêque, Pessac, France
- INSERM U1045, Institut hostpialo-universitaire–L’institut de rythmologie et modélisation cardiaque, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Pessac, France
| | - Panagiotis Mililis
- Laboratory of Cardiac Electrophysiology, General Hospital of Athens Evangelismos, Athens, Greece
| | | | - Stamatios Georgopoulos
- Laboratory of Cardiac Electrophysiology, General Hospital of Athens Evangelismos, Athens, Greece
| | - Stamatios Sofoulis
- Electrophysiology Department, Onassis Cardiac Surgery Center, Athens, Greece
| | - Ourania Kariki
- Electrophysiology Department, Onassis Cardiac Surgery Center, Athens, Greece
| | - Stavroula Koskina
- Electrophysiology Department, Onassis Cardiac Surgery Center, Athens, Greece
| | - Masateru Takigawa
- Cardiac Pacing and Electrophysiology Department, Hôpital Cardiologique du Haut Lévêque, Pessac, France
- INSERM U1045, Institut hostpialo-universitaire–L’institut de rythmologie et modélisation cardiaque, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Pessac, France
| | - Frédéric Sacher
- Cardiac Pacing and Electrophysiology Department, Hôpital Cardiologique du Haut Lévêque, Pessac, France
- INSERM U1045, Institut hostpialo-universitaire–L’institut de rythmologie et modélisation cardiaque, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Pessac, France
| | - Pierre Jais
- Cardiac Pacing and Electrophysiology Department, Hôpital Cardiologique du Haut Lévêque, Pessac, France
- INSERM U1045, Institut hostpialo-universitaire–L’institut de rythmologie et modélisation cardiaque, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Pessac, France
| | - Pasquale Santangeli
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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10
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Xintarakou A, Kariki O, Doundoulakis I, Arsenos P, Soulaidopoulos S, Laina A, Xydis P, Kordalis A, Nakas N, Theofilou A, Vlachopoulos C, Tsioufis K, Gatzoulis KA. The Role of Genetics in Risk Stratification Strategy of Dilated Cardiomyopathy. Rev Cardiovasc Med 2022. [DOI: 10.31083/j.rcm2309305] [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: 11/06/2022] Open
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11
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Kariki O, Kontonika M, Miliopoulos D, Bazoukis G, Vlachos K, Dragasis S, Gouziouta A, Letsas KP, Efremidis M, Voudris V. Contrast-induced early repolarization pattern and ventricular fibrillation. Clin Case Rep 2021; 9:e04630. [PMID: 34430003 PMCID: PMC8364931 DOI: 10.1002/ccr3.4630] [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] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/06/2021] [Indexed: 01/24/2023] Open
Abstract
Malignant arrhythmias during coronary angiography consist a complication of the procedure. Clinicians should be aware that intracoronary infusion of contrast medium can lead to physiological changes that lower the ventricular fibrillation threshold.
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Affiliation(s)
- Ourania Kariki
- Department of CardiologyOnassis Cardiac Surgery CenterAthensGreece
| | | | | | - George Bazoukis
- Department of CardiologyOnassis Cardiac Surgery CenterAthensGreece
| | | | | | | | | | | | - Vassilis Voudris
- Department of CardiologyOnassis Cardiac Surgery CenterAthensGreece
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12
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Liatakis I, Prappa E, Gouziouta A, Pantou MP, Gourzi P, Vlachos K, Mililis P, Kariki O, Degiannis D, Efremidis M, Letsas KP. RBM20 mutation and ventricular arrhythmias in a young patient with dilated cardiomyopathy: a case report. Am J Cardiovasc Dis 2021; 11:398-403. [PMID: 34322310 PMCID: PMC8303033] [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] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/30/2021] [Indexed: 06/13/2023]
Abstract
Gene mutations in RBM20 have been identified in a minority of familial and sporadic dilated cardiomyopathy cases. Recent studies of carriers of RBM20 mutations not only highlight the aforementioned association with dilated cardiomyopathy but also indicate a link with increased incidence of ventricular arrhythmias. Herein we describe a case of 17-year-old female patient with dilated cardiomyopathy carrying a p.(Arg634Trp) RBM20 mutation and presenting with frequent premature ventricular contractions and episodes of non-sustained ventricular tachycardia.
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Affiliation(s)
- Ioannis Liatakis
- Second Department of Cardiology, Evangelismos General Hospital of AthensGreece
| | - Efstathia Prappa
- Second Department of Cardiology, Evangelismos General Hospital of AthensGreece
| | | | - Malena P Pantou
- Molecular Immunopathology and Histocompatibility Unit, Division of Genetics, Onassis Cardiac Surgery CenterAthens, Greece
| | - Polyxeni Gourzi
- Molecular Immunopathology and Histocompatibility Unit, Division of Genetics, Onassis Cardiac Surgery CenterAthens, Greece
| | - Konstantinos Vlachos
- Arrhythmia Unit, Laboratory of Cardiac Electrophysiology, Onassis Cardiac Surgery CenterAthens, Greece
| | - Panagiotis Mililis
- Second Department of Cardiology, Evangelismos General Hospital of AthensGreece
| | - Ourania Kariki
- Arrhythmia Unit, Laboratory of Cardiac Electrophysiology, Onassis Cardiac Surgery CenterAthens, Greece
| | - Dimitrios Degiannis
- Molecular Immunopathology and Histocompatibility Unit, Division of Genetics, Onassis Cardiac Surgery CenterAthens, Greece
| | - Michael Efremidis
- Arrhythmia Unit, Laboratory of Cardiac Electrophysiology, Onassis Cardiac Surgery CenterAthens, Greece
| | - Konstantinos P Letsas
- Arrhythmia Unit, Laboratory of Cardiac Electrophysiology, Onassis Cardiac Surgery CenterAthens, Greece
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13
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Mavrogeni SI, Bacopoulou F, Markousis-Mavrogenis G, Giannakopoulou A, Kariki O, Vartela V, Kolovou G, Charmandari E, Chrousos G. Cardiovascular Magnetic Resonance as Pathophysiologic Tool in Diabetes Mellitus. Front Endocrinol (Lausanne) 2021; 12:672302. [PMID: 34194393 PMCID: PMC8237858 DOI: 10.3389/fendo.2021.672302] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/12/2021] [Indexed: 01/02/2023] Open
Abstract
Diabetes mellitus can independently contribute to cardiovascular disease and represents a severe risk factor for premature development of cardiovascular disease. A three-fold higher mortality than the general population has been observed in type 1 diabetes mellitus whereas a two- to four-fold increased probability to develop cardiovascular disease has been observed in type 2 diabetes mellitus. Cardiovascular magnetic resonance, a non-radiative modality, is superior to all other modalities in detecting myocardial infarction. The main cardiovascular magnetic resonance sequences used include a) balanced steady-state free precession (bSSFP) for function evaluation; b) T2-W for oedema detection; c) T1 W for ischemia detection during adenosine stress; and d) late gadolinium enhanced T1-W images (LGE), evaluated 15 min after injection of paramagnetic contrast agent gadolinium, which permit the diagnosis of replacement fibrosis, which appears white in the middle of suppressed, nulled myocardium. Although LGE is the technique of choice for diagnosis of replacement fibrosis, it cannot assess diffuse myocardial fibrosis. The application of T1 mapping (native or pre contrast and post contrast) allows identification of diffuse myocardial fibrosis, which is not detectable my other means. Native T1 and Contrast-enhanced T1 mapping are involved in the extracellular volume fraction (ECV) calculation. Recently, 1H-cardiovascular magnetic resonance spectroscopy has been applied to calculate the amount of myocardial triglycerides, but at the moment it is not part of the routine assessment of diabetes mellitus. The multifaceted nature of cardiovascular magnetic resonance has the great potential of concurrent evaluation of function and myocardial ischemia/fibrosis in the same examination and represents an indispensable tool for accurate diagnosis of cardiovascular disease in diabetes mellitus.
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Affiliation(s)
- Sophie I. Mavrogeni
- Department of Cardiology, Onassis Cardiac Surgery Center, Kallithea, Greece
- University Research Institute of Maternal and Child Health and Precision Medicine, and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, Athens, Greece
- *Correspondence: Sophie I. Mavrogeni,
| | - Flora Bacopoulou
- University Research Institute of Maternal and Child Health and Precision Medicine, and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, Athens, Greece
| | | | | | - Ourania Kariki
- Department of Cardiology, Onassis Cardiac Surgery Center, Kallithea, Greece
| | - Vasiliki Vartela
- Department of Cardiology, Onassis Cardiac Surgery Center, Kallithea, Greece
| | - Genovefa Kolovou
- Department of Cardiology, Onassis Cardiac Surgery Center, Kallithea, Greece
| | - Evangelia Charmandari
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, Athens, Greece
- Division of Endocrinology and Metabolism, Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - George Chrousos
- University Research Institute of Maternal and Child Health and Precision Medicine, and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, Athens, Greece
- Division of Endocrinology and Metabolism, Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
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