1
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Huang AL, MacNamara J, Link MS, Martinez M, Dearani JA, Cannon BC, Levine BD, Ackerman MJ. Asymptomatic Apical Hypertrophic Cardiomyopathy in an Elite Competitive Athlete. JACC Case Rep 2022; 6:101705. [PMID: 36704059 PMCID: PMC9871207 DOI: 10.1016/j.jaccas.2022.101705] [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: 07/20/2022] [Revised: 11/01/2022] [Accepted: 11/15/2022] [Indexed: 12/15/2022]
Abstract
A 17-year-old male elite athlete presented for evaluation after an abnormal pre-competitive college screening electrocardiogram. Subsequent evaluation revealed the presence of hypertrophic cardiomyopathy. He remained asymptomatic throughout four years of follow-up. Through shared decision making, he continued to play competitively and is now a professional athlete. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Athena L. Huang
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - James MacNamara
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mark S. Link
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | | | | | | | - Michael J. Ackerman
- Mayo Clinic, Rochester, Minnesota, USA,Address for correspondence: Dr Michael J. Ackerman, Mayo Clinic, Guggenheim Building, Room 501, 200 First Street SW, Rochester, Minnesota 55905, USA.
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2
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Fujito T, Nagahara D, Tsuzuki T, Kamiyama N, Mochizuki A, Miura T. High defibrillation threshold with right-sided ICD implantation was resolved by a dual coil lead via persistent left superior vena cava. J Cardiol Cases 2022; 25:262-265. [PMID: 35582083 PMCID: PMC9091524 DOI: 10.1016/j.jccase.2021.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/30/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022] Open
Abstract
Persistent left superior vena cava (PLSVC) can be problematic when device implantation is scheduled from the left side because of the technical difficulty in delivering leads. Right-sided implantation is an alternative method, but there is a risk of a high defibrillation threshold (DFT). Transvenous implantation of an implantable cardioverter defibrillator (ICD) was scheduled for a 54-year-old man with idiopathic dilated cardiomyopathy and monomorphic non-sustained ventricular tachycardia, but computed tomography revealed the presence of a PLSVC. Right-sided ICD implantation was performed first; however, an ICD shock at 35 J failed to terminate the induced ventricular fibrillation (VF). Re-implantation via the PLSVC by a left subclavian approach with a dual coil lead was performed next. The dual coil right ventricular lead was successfully implanted via the PLSVC, and the induced VF was terminated by a single shock at 25 J. In the present case, the proximal coil was located in the coronary sinus (CS) and it enabled an antero-posterior defibrillation vector across the left ventricle. In addition to the re-location of the ICD generator from the right side to the left side, the new positioning of the proximal coil inside the CS is likely to have contributed to the great improvement of the DFT. .
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Affiliation(s)
- Takefumi Fujito
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Daigo Nagahara
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Taro Tsuzuki
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Naoyuki Kamiyama
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Atsushi Mochizuki
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tetsuji Miura
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
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3
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Vaile JR, Rame JE, Alvarez RJ, Massey HT, Tchantchaleishvili V, Vishnevsky A, Rajapreyar IN, Brailovsky Y, Shah MK. 3 Cases of Superior Vena Cava Syndrome Following Percutaneous Right Ventricular Assist Device Placement. JACC Case Rep 2021; 3:1690-1693. [PMID: 34766020 PMCID: PMC8571785 DOI: 10.1016/j.jaccas.2021.09.005] [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: 04/27/2021] [Revised: 09/09/2021] [Accepted: 09/17/2021] [Indexed: 11/26/2022]
Abstract
We present 3 cases of superior vena cava (SVC) syndrome following percutaneous right ventricular assist device (RVAD) placement. Each case underscores the importance of early recognition of SVC syndrome in patients with percutaneous RVAD insertion via the internal jugular vein and calls for heightened awareness of device-associated complications. (Level of Difficulty: Advanced.)
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Affiliation(s)
- John R Vaile
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - J Eduardo Rame
- Department of Heart Failure and Transplant, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Rene J Alvarez
- Department of Heart Failure and Transplant, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Howard T Massey
- Department of Cardiothoracic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | | | - Alec Vishnevsky
- Department of Interventional and Structural Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Indranee N Rajapreyar
- Department of Heart Failure and Transplant, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Yevgeniy Brailovsky
- Department of Heart Failure and Transplant, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Mahek K Shah
- Department of Heart Failure and Transplant, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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4
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Chilazi M, Gurakar M, Rosen N, Trivedi R, Vakil RM, Sharma G, Chrispin J. Sudden Cardiac Arrest Secondary to Early Repolarization Syndrome. JACC Case Rep 2021; 3:1422-1426. [PMID: 34557685 PMCID: PMC8446040 DOI: 10.1016/j.jaccas.2021.07.006] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/22/2021] [Accepted: 07/07/2021] [Indexed: 11/28/2022]
Abstract
A healthy 41-year-old man sustained cardiac arrest secondary to ventricular fibrillation. An extensive ischemic, structural, and genetic evaluation did not identify an attributable pathologic condition. Electrocardiograms were notable for early repolarization pattern. Here we review the diagnosis, prevalence, and prognostic significance of the early repolarization syndrome on sudden cardiac death. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Michael Chilazi
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Merve Gurakar
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Natalie Rosen
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Rishi Trivedi
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Rachit M Vakil
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Garima Sharma
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jonathan Chrispin
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland, USA
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5
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Affiliation(s)
- Mahwash Kassi
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
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6
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Vinas A, Roy D, Saunders C, Badin A, Panday MM, Pillarisetti J. A Tragic Case of Wearable Cardioverter-Defibrillator Failure. JACC Case Rep 2021; 3:322-326. [PMID: 34317528 PMCID: PMC8310987 DOI: 10.1016/j.jaccas.2020.12.016] [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: 05/15/2020] [Revised: 11/02/2020] [Accepted: 12/22/2020] [Indexed: 11/09/2022]
Abstract
The American College of Cardiology/American Heart Association guidelines recommend a wearable cardioverter defibrillator (WCD) for certain conditions or scenarios. WCD is felt to provide adequate protection against ventricular arrhythmias. This case highlights failure of a WCD to detect and deliver life-saving therapy and the need for improved detection algorithms. (Level of Difficulty: Beginner.)
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Affiliation(s)
- Ariel Vinas
- Department of Medicine and Division of Cardiology, UT Health San Antonio, San Antonio, Texas, USA
| | - Debanshu Roy
- Department of Medicine and Division of Cardiology, UT Health San Antonio, San Antonio, Texas, USA
| | - Cynthia Saunders
- Department of Medicine and Division of Cardiology, UT Health San Antonio, San Antonio, Texas, USA
| | - Auroa Badin
- Department of Medicine and Division of Cardiology, UT Health San Antonio, San Antonio, Texas, USA
| | - Manoj M Panday
- Department of Medicine and Division of Cardiology, UT Health San Antonio, San Antonio, Texas, USA
| | - Jayasree Pillarisetti
- Department of Medicine and Division of Cardiology, UT Health San Antonio, San Antonio, Texas, USA
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7
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Pérez-Riera AR, Yanowitz F, Barbosa-Barros R, Daminello-Raimundo R, de Abreu LC, Nikus K, Brugada P. Electrocardiographic "Northwest QRS Axis" in the Brugada Syndrome: A Potential Marker to Predict Poor Outcome. JACC Case Rep 2020; 2:2230-2234. [PMID: 34317146 PMCID: PMC8299847 DOI: 10.1016/j.jaccas.2020.07.037] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/13/2020] [Accepted: 07/22/2020] [Indexed: 02/07/2023]
Abstract
Conduction delay in the right ventricular outflow tract as manifested in the electrocardiogram constitutes a high-risk predictor of ventricular arrhythmias in patients with Brugada syndrome. We present a case with a right QRS axis between –90° and ±180°. This feature has never been reported in the context of Brugada syndrome. (Level of Difficulty: Advanced.)
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Key Words
- AF, atrial fibrillation
- BrS, Brugada syndrome
- ECG, electrocardiogram
- EPS, electrophysiological study
- ICD, implantable cardioverter defibrillator
- RVOT, right ventricular outflow tract
- SCD, sudden cardiac death
- SSS, sick sinus syndrome
- VF, ventricular fibrillation
- VTA, ventricular tachyarrhythmia
- peripheral right blocks
- right distal blockages
- terminal conduction delay
- zonal right blocks
- zonal right conduction defect
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Affiliation(s)
- Andrés Ricardo Pérez-Riera
- Laboratório de Metodologia de Pesquisa e Escrita Científica, Centro Universitário Saúde ABC, Santo André, São Paulo, Brazil
| | - Frank Yanowitz
- Intermountain Medical Center, Intermountain Heart Institute, Department of Internal Medicine, The University of Utah, Salt Lake City, Utah
| | - Raimundo Barbosa-Barros
- Coronary Center of the Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
| | - Rodrigo Daminello-Raimundo
- Laboratório de Metodologia de Pesquisa e Escrita Científica, Centro Universitário Saúde ABC, Santo André, São Paulo, Brazil
| | - Luiz Carlos de Abreu
- Laboratório de Metodologia de Pesquisa e Escrita Científica, Centro Universitário Saúde ABC, Santo André, São Paulo, Brazil.,Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Kjell Nikus
- Heart Center, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Pedro Brugada
- Cardiovascular Division, Free University of Brussels (UZ Brussel) VUB, Brussels, Belgium
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8
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Roy S, Hong W, Wasilewski M, Ellenbogen KA. Cardiac Transplantation for Refractory Catecholaminergic Polymorphic Ventricular Tachycardia. JACC Case Rep 2020; 2:1757-61. [PMID: 34317051 DOI: 10.1016/j.jaccas.2020.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/15/2020] [Accepted: 07/01/2020] [Indexed: 11/22/2022]
Abstract
We present a patient with catecholaminergic polymorphic ventricular tachycardia who failed maximal antiarrhythmic drug therapy and bilateral sympathetic denervation, who presented with syncope and recurrent ventricular tachycardia for 11 min refractory to 21 shocks. She underwent cardiac transplantation as curative treatment for refractory ventricular arrhythmias in catecholaminergic polymorphic ventricular tachycardia. (Level of Difficulty: Advanced.).
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9
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Gambaro A, Ho HH, Kaier TE, Pires-Morais G, Patel JA, Ansari Ramandi MM. Management of Acute Coronary Syndrome in the COVID-19 Era: Voices From the Global Cardiology Community. JACC Case Rep 2020; 2:1429-1432. [PMID: 32835290 PMCID: PMC7280139 DOI: 10.1016/j.jaccas.2020.05.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Key Words
- ACS, acute coronary syndrome
- CCL, catheterization laboratory
- COVID-19
- COVID-19, coronavirus disease-2019
- ICD, implantable cardioverter defibrillator
- NSTE, non– ST-segment elevation
- PCI, percutaneous coronary intervention
- PPCI, primary percutaneous coronary intervention
- PPE, personal protective equipment
- SARS-CoV-2, severe acute respiratory syndrome coronavirus 2
- ST-segment elevation myocardial infarction
- STEMI, ST-segment elevation myocardial infarction
- fibrinolysis
- primary percutaneous coronary intervention
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Affiliation(s)
- Alessia Gambaro
- Cardiology Division, Department of Medicine, University of Verona, AOUI Verona, Verona, Italy
| | - Hee Hwa Ho
- Department of Cardiology, Tan Tock Seng Hospital, Singapore
| | - Thomas E. Kaier
- King’s College London BHF Centre, The Rayne Institute, St. Thomas’ Hospital, London, United Kingdom
| | - Gustavo Pires-Morais
- Cardiovascular Intervention Unit, Department of Cardiology, Gaia Hospital Center, Porto, Portugal
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10
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Agrawal A, Works-Fleming F, Isiadinso I, Ogunniyi MO. Syncope in a Pregnant Woman: Infiltrative Cardiomyopathy and Presumed Cardiac Sarcoidosis. JACC Case Rep 2020; 2:101-106. [PMID: 34316974 PMCID: PMC8301714 DOI: 10.1016/j.jaccas.2019.12.005] [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: 10/30/2019] [Revised: 12/01/2019] [Accepted: 12/02/2019] [Indexed: 06/13/2023]
Abstract
Cardiac involvement in sarcoidosis is an uncommon manifestation of the disease process. Diagnosis and treatment during pregnancy can be challenging due to life-threatening ventricular arrhythmias. We describe a case of a 43-year-old, 21-week pregnant woman who presented after 2 episodes of syncope and was diagnosed with presumed cardiac sarcoidosis. (Level of Difficulty: Beginner.).
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Affiliation(s)
- Akanksha Agrawal
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
- Division of Cardiology, Grady Health System, Atlanta, Georgia
| | | | - Ijeoma Isiadinso
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Modele O. Ogunniyi
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
- Division of Cardiology, Grady Health System, Atlanta, Georgia
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11
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Radwan HI. Relation between left atrial measurements and thromboembolic risk markers assessed by echocardiography in patients with nonvalvular atrial fibrillation: A cross-sectional study. Egypt Heart J 2018; 69:1-11. [PMID: 29622949 PMCID: PMC5839420 DOI: 10.1016/j.ehj.2016.05.004] [Citation(s) in RCA: 4] [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: 03/05/2016] [Accepted: 05/20/2016] [Indexed: 11/02/2022] Open
Abstract
Background Left atrium (LA) dilatation has been associated with adverse cardiovascular outcomes in patients with sinus rhythm and atrial fibrillation (AF). Aim of the study We aimed to evaluate the accuracy of left atrial (LA) size to predict transesophageal echocardiographic (TEE) markers of increased thromboembolic risk left atrial appendage (LAA) thrombus, low LAA velocities and dense spontaneous echocardiographic contrast (SEC), and also to assess the best method to evaluate LA size. Patients and methods Cross-sectional study included 64 patients with nonvalvular AF undergoing transthoracic and transesophageal echocardiographic (TTE and TEE) evaluation. LA size was measured on TTE by several methods including the following: anteroposterior diameter (AP), LA area in four and two apical chamber views and volumes by ellipsoid, single plane (1P) and biplane area-length (2P) formulas. All these measures were indexed to the body surface area (BSA). Thromboembolic markers including LAA thrombus, low LAA velocities, dense SEC and LA abnormality (LA ABN) which means the presence of one or more of the previous three parameters were evaluated by TEE. Results There was statistically significant increase in indexed and non-indexed LA parameters in patients with LA ABN compared to patients without LA ABN. According to ROC curve, the study found that all indexed LA parameters were predictive for LAA thrombus with the highest AUC was indexed LA 1P area length volume (AUC 0.91, CI 95% 0.81-1.01, p < 0.000), for LAA low flow velocity were indexed and non-indexed LA AP diameters with the highest AUC was indexed LA AP diameter (AUC 0.89, CI 95% 0.80-0.98, p < 0.000), for LA dense SEC were indexed LA ellipsoid volume (AUC 0.78, CI 95% 0.66-0.96, p = 0.002) and indexed LA 1P area length volume (AUC 0.78, CI 95% 0.66-0.90, p = 0.002) and for LA ABN were all LA parameters with the highest AUC was indexed LA 1P area length volume (AUC 0.87, CI 95% 0.79-0.96, p < 0.000). On multivariate logistic regression analysis of TEE parameters, the study found that the most predictive LA measurement for LAA thrombus was indexed LA AP diameter with cutoff 3 cm/m2 (OR 7.5, 95% CI 1.24-45.2, p = 0.02), for LAA low flow velocity was LA AP diameter with cutoff 6 cm (OR 17.6, 95% CI 3.23-95.84, p = 0.001), for LA dense SEC was indexed LA ellipsoid volume with cutoff 42 cm3/m2 (OR 6.5, 95% CI 1.32-32.07, p = 0.02), and for LA ABN was indexed LA ellipsoid volume with cutoff 42 cm3/m2 (OR 10.45, 95% CI 2.18-51.9, p = 0.008). Conclusion LA enlargement is suitable to predict thromboembolic markers in patients with non-valvular AF. The indexed and non-indexed LA AP diameter and indexed LA ellipsoid volume were the most accurate parameters for predicting thromboembolic markers.
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Key Words
- 1P, single plane
- 2P, biplane
- ABN, abnormality
- AF, atrial fibrillation
- AP, anteroposterior
- BMI, body mass index
- BSA, body surface area
- DM, diabetes mellitus
- EF, ejection fraction
- GFR, glomerular filtration rate
- HTN, hypertension
- ICD, implantable cardioverter defibrillator
- INR, international normalized ratio
- LA, left atrium
- LAA, left atrial appendage
- LV, left ventricle
- Left atrial size
- Nonvalvular atrial fibrillation
- SEC, spontaneous echocardiographic contrast
- TEE, transesophageal echocardiography
- TIA, transient ischemic attack
- TTE, transthoracic echocardiography
- Thromboembolic markers
- Transesophageal echocardiography
- Transthoracic echocardiography
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Affiliation(s)
- Hanan I Radwan
- Faculty of Medicine, Zagazig University, Cardiovascular Department, Egypt
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12
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Giammaria M, Quirino G, Alberio M, Parravicini U, Cipolla E, Rossetti G, Ruocco A, Senatore G, Rametta F, Pistelli P. Automatic atrial capture device control in real-life practice: A multicenter experience. J Arrhythm 2017; 33:139-43. [PMID: 28416982 DOI: 10.1016/j.joa.2016.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/27/2016] [Accepted: 06/06/2016] [Indexed: 11/20/2022] Open
Abstract
Background Device-based fully automatic pacing capture detection is useful in clinical practice and important in the era of remote care management. The main objective of this study was to verify the effectiveness of the new ACAP Confirm® algorithm in managing atrial capture in the medium term in comparison with early post-implantation testing. Methods Data were collected from 318 patients (66% male; mean age, 73±10 years); 237 of these patients underwent device implantation and 81 box changes in 31 Italian hospitals. Atrial threshold measurements were taken manually and automatically at different pulse widths before discharge and during follow-up (7±2 months) examination. Results The algorithm worked as expected in 73% of cases, considering all performed tests. The success rate was 65% and 88% pre-discharge and during follow-up examination (p<0.001), respectively, in patients who had undergone implantation. We did not detect any difference in the performance of the algorithm as a result of the type of atrial lead used. The success rate was 70% during pre-discharge testing in patients undergoing device replacement. Considering all examination types, manual and automatic measurements yielded threshold values of 1.07±0.47 V and 1.03±0.47 V at 0.2-ms pulse duration (p=0.37); 0.66±0.37 V and 0.67±0.36 V at 0.4 ms (p=0.42); and 0.5±0.28 V and 0.5±0.29 V at 1 ms (p=0.32). Conclusions The results show that the algorithm works before discharge, and its reliability increases over the medium term. The algorithm also proved accurate in detecting the atrial threshold automatically. The possibility of activating it does not seem to be influenced by the lead type used, but by the time from implantation.
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13
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Jimenez-Juan L, Karur GR, Connelly KA, Deva D, Yan RT, Wald RM, Singh S, Leung G, Oikonomou A, Dorian P, Angaran P, Yan AT. Relationship between right and left ventricular function in candidates for implantable cardioverter defibrillator with low left ventricular ejection fraction. J Arrhythm 2017; 33:134-8. [PMID: 28416981 DOI: 10.1016/j.joa.2016.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 06/29/2016] [Accepted: 07/04/2016] [Indexed: 11/20/2022] Open
Abstract
Background Indications for the primary prevention of sudden death using an implantable cardioverter defibrillator (ICD) are based predominantly on left ventricular ejection fraction (LVEF). However, right ventricular ejection fraction (RVEF) is also a known prognostic factor in a variety of structural heart diseases that predispose to sudden cardiac death. We sought to investigate the relationship between right and left ventricular parameters (function and volume) measured by cardiovascular magnetic resonance (CMR) among a broad spectrum of patients considered for an ICD. Methods In this retrospective, single tertiary-care center study, consecutive patients considered for ICD implantation who were referred for LVEF assessment by CMR were included. Right and left ventricular function and volumes were measured. Results In total, 102 patients (age 62±14 years; 23% women) had a mean LVEF of 28±11% and RVEF of 44±12%. The left ventricular and right ventricular end diastolic volume index was 140±42 mL/m2 and 81±27 mL/m2, respectively. Eighty-six (84%) patients had a LVEF <35%, and 63 (62%) patients had right ventricular systolic dysfunction. Although there was a significant and moderate correlation between LVEF and RVEF (r=0.40, p<0.001), 32 of 86 patients (37%) with LVEF <35% had preserved RVEF, while 9 of 16 patients (56%) with LVEF ≥35% had right ventricular systolic dysfunction (Kappa=0.041). Conclusions Among patients being considered for an ICD, there is a positive but moderate correlation between LVEF and RVEF. A considerable proportion of patients who qualify for an ICD based on low LVEF have preserved RVEF, and vice versa.
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14
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Aizawa Y, Takatsuki S, Kaneko Y, Noda T, Katsumata Y, Nishiyama T, Kimura T, Nishiyama N, Fukumoto K, Niwano S, Kurita T, Mitsuhashi T, Kamakura S, Shimizu A, Horie M, Aizawa Y, Fukuda K. Comparison of circadian, weekly, and seasonal variations of electrical storms and single events of ventricular fibrillation in patients with Brugada syndrome. Int J Cardiol Heart Vasc 2016; 11:104-10. [PMID: 28616534 DOI: 10.1016/j.ijcha.2016.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 05/02/2016] [Indexed: 02/07/2023]
Abstract
In patients with Brugada syndrome (BS), VF occurred predominantly during the nocturnal period. Some patients also developed ESs. In addition to the circadian rhythm, patients showed weekly and seasonal patterns. The patients with ESs had peak episodes of VF on Saturday and in the winter and spring, while episodes of VF in patients with single VF events occurred most often on Monday with smaller seasonal variation. Except for age, there was no difference in the clinical or ECG characteristics between the patients with ESs and those with single VF episodes.
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Key Words
- BS, Brugada syndrome
- Brugada syndrome
- CRBBB, complete right bundle branch block
- ECG, electrocardiogram
- ES, electrical storm
- Electrical storm
- ICD, implantable cardioverter defibrillator
- IVF, idiopathic ventricular fibrillation
- MRI, magnetic resonance imaging
- Rhythmicity
- SD, standard deviation
- Sudden death
- VF, ventricular fibrillation
- VT, ventricular tachycardia
- Ventricular fibrillation
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15
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Mizusawa Y. Recent advances in genetic testing and counseling for inherited arrhythmias. J Arrhythm 2016; 32:389-397. [PMID: 27761163 PMCID: PMC5063262 DOI: 10.1016/j.joa.2015.12.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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: 09/09/2015] [Revised: 12/01/2015] [Accepted: 12/17/2015] [Indexed: 12/19/2022] Open
Abstract
Inherited arrhythmias, such as cardiomyopathies and cardiac ion channelopathies, along with coronary heart disease (CHD) are three most common disorders that predispose adults to sudden cardiac death. In the last three decades, causal genes in inherited arrhythmias have been successfully identified. At the same time, it has become evident that the genetic architectures are more complex than previously known. Recent advancements in DNA sequencing technology (next generation sequencing) have enabled us to study such complex genetic traits. This article discusses indications for genetic testing of patients with inherited arrhythmias. Further, it describes the benefits and challenges that we face in the era of next generation sequencing. Finally, it briefly discusses genetic counseling, in which a multidisciplinary approach is required due to the increased complexity of the genetic information related to inherited arrhythmias.
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Key Words
- ARVD/C, arrhythmogenic right ventricular dysplasia/cardiomyopathy
- BrS, Brugada syndrome
- CHD, coronary heart disease
- CPVT, catecholaminergic polymorphic ventricular tachycardia
- Cardiac ion channelopathies
- Cardiomyopathies
- DCM, dilated cardiomyopathy
- GWAS, genome wide association study
- Genetic counseling
- Genetic testing
- HCM, hypertrophic cardiomyopathy
- HF, heart failure
- ICD, implantable cardioverter defibrillator
- Inherited arrhythmias
- LQTS, long QT syndrome
- NGS, next generation sequencing
- SCD, sudden cardiac death
- VA, ventricular arrhythmia
- VF, ventricular fibrillation
- WES, whole exome sequencing
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Affiliation(s)
- Yuka Mizusawa
- Department of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, Room K2-115, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
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Miller AC, Evans AC, Revenaugh J, Weiss JP, Reid BB, Kfoury AG. Combined use of TandemHeart percutaneous ventricular assist device and Stereotaxis magnetic navigation during cardiac ablation procedure. HeartRhythm Case Rep 2015; 2:14-16. [PMID: 28491622 PMCID: PMC5412668 DOI: 10.1016/j.hrcr.2015.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Andrew C Miller
- Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah
| | - Annicka C Evans
- Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah
| | - James Revenaugh
- Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah
| | - J Peter Weiss
- Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah
| | - Bruce B Reid
- Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah
| | - Abdallah G Kfoury
- Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah
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17
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Tuohy S, Ryan P, Galvin J. Turning a blind eye to the far field: Are we burying the evidence? A case of abrupt catastrophic implantable cardioverter defibrillator lead failure causing sudden death. HeartRhythm Case Rep 2015; 2:6-10. [PMID: 28491620 PMCID: PMC5412663 DOI: 10.1016/j.hrcr.2015.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Key Words
- ATP, antitachycardia pacing
- Defibrillator
- EF, ejection fraction
- EGM, electrogram
- ICD therapy
- ICD, implantable cardioverter defibrillator
- LV, left ventricle
- Lead fracture
- RV, right ventricle
- RVLND, right ventricular lead noise discrimination
- SVC, superior vena cava
- Sudden death
- TWOS, T-wave oversensing
- VF, ventricular fibrillation
- VT, ventricular tachycardia
- Ventricular fibrillation
- bpm, beats per minute
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Affiliation(s)
- Stephen Tuohy
- Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Republic of Ireland
| | - Paul Ryan
- Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Republic of Ireland
| | - Joseph Galvin
- Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Republic of Ireland
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