Pub Date : 2019-11-25DOI: 10.1161/CIRCEP.118.006857
T. Kitamura, P. Maury, A. Lam, F. Sacher, P. Khairy, Ruairidh Martin, K. Vlachos, A. Frontera, M. Takigawa, Y. Nakatani, N. Thompson, G. Massouillie, G. Cheniti, Claire A. Martin, F. Bourier, J. Duchâteau, N. Klotz, T. Pambrun, A. Denis, N. Derval, H. Cochet, M. Hocini, M. Haissaguerre, P. Jais
BACKGROUND Various strategies for ablation of ventricular tachycardia (VT) have been described, but their impact on ventricular fibrillation (VF) is largely unknown. The aim of our study was to assess the effect of substrate-based VT ablation targeting local abnormal ventricular activity (LAVA) on recurrent VF events in patients with structural heart disease. METHODS A retrospective 2-center study was performed on patients with structural heart disease and both VT and VF, with incident VT ablation procedures targeting LAVAs. Generalized estimating equations with a Poisson loglinear model were used to assess the impact of catheter ablation on VF episodes. The change in VF events before and after catheter ablation was compared with matched controls without ablation. RESULTS From a total of 686 patients with an incident VT ablation procedure targeting LAVAs, 21 patients (age, 57±14 years; left ventricular ejection fraction, 30±10%) had both VT and VF and met inclusion criteria. A total of 80 VF events were recorded in the implantable cardioverter-defibrillator logs the 6 months preceding ablation. Complete and partial LAVA elimination was achieved in 11 (52%) and 10 (48%) patients, respectively. Catheter ablation was associated with a highly significant reduction in VF recurrences (P<0.0001), which were limited to 3 (14%) patients at 6 months. The total number of VF events thereby decreased from 80 to 3, from a median of 1.0 (range, 1-29) to 0.0 (range, 0-1) in the 6 months before and after ablation, respectively. The reduction in VF events was significantly greater in patients with catheter ablation compared with 21 matched controls during 6-month periods following and preceding a baseline assessment (Poisson β-coefficient, 1.39; P=0.0003). CONCLUSIONS Substrate-guided VT ablation targeting LAVAs may be associated with a significant reduction in recurrent VF, suggesting that VT and VF share overlapping arrhythmogenic substrates in patients with structural heart disease.
{"title":"Does Ventricular Tachycardia Ablation Targeting Local Abnormal Ventricular Activity Elimination Reduce Ventricular Fibrillation Incidence?","authors":"T. Kitamura, P. Maury, A. Lam, F. Sacher, P. Khairy, Ruairidh Martin, K. Vlachos, A. Frontera, M. Takigawa, Y. Nakatani, N. Thompson, G. Massouillie, G. Cheniti, Claire A. Martin, F. Bourier, J. Duchâteau, N. Klotz, T. Pambrun, A. Denis, N. Derval, H. Cochet, M. Hocini, M. Haissaguerre, P. Jais","doi":"10.1161/CIRCEP.118.006857","DOIUrl":"https://doi.org/10.1161/CIRCEP.118.006857","url":null,"abstract":"BACKGROUND\u0000Various strategies for ablation of ventricular tachycardia (VT) have been described, but their impact on ventricular fibrillation (VF) is largely unknown. The aim of our study was to assess the effect of substrate-based VT ablation targeting local abnormal ventricular activity (LAVA) on recurrent VF events in patients with structural heart disease.\u0000\u0000\u0000METHODS\u0000A retrospective 2-center study was performed on patients with structural heart disease and both VT and VF, with incident VT ablation procedures targeting LAVAs. Generalized estimating equations with a Poisson loglinear model were used to assess the impact of catheter ablation on VF episodes. The change in VF events before and after catheter ablation was compared with matched controls without ablation.\u0000\u0000\u0000RESULTS\u0000From a total of 686 patients with an incident VT ablation procedure targeting LAVAs, 21 patients (age, 57±14 years; left ventricular ejection fraction, 30±10%) had both VT and VF and met inclusion criteria. A total of 80 VF events were recorded in the implantable cardioverter-defibrillator logs the 6 months preceding ablation. Complete and partial LAVA elimination was achieved in 11 (52%) and 10 (48%) patients, respectively. Catheter ablation was associated with a highly significant reduction in VF recurrences (P<0.0001), which were limited to 3 (14%) patients at 6 months. The total number of VF events thereby decreased from 80 to 3, from a median of 1.0 (range, 1-29) to 0.0 (range, 0-1) in the 6 months before and after ablation, respectively. The reduction in VF events was significantly greater in patients with catheter ablation compared with 21 matched controls during 6-month periods following and preceding a baseline assessment (Poisson β-coefficient, 1.39; P=0.0003).\u0000\u0000\u0000CONCLUSIONS\u0000Substrate-guided VT ablation targeting LAVAs may be associated with a significant reduction in recurrent VF, suggesting that VT and VF share overlapping arrhythmogenic substrates in patients with structural heart disease.","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91464046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-01DOI: 10.1161/CIRCEP.119.007570
S. Hohmann, M. Rettmann, H. Konishi, Anna Borenstein, Songyun Wang, A. Suzuki, G. Michalak, K. Monahan, K. D. Parker, L. K. Newman, D. Packer
BACKGROUND Noninvasive electrocardiographic imaging (ECGi) is used clinically to map arrhythmias before ablation. Despite its clinical use, validation data regarding the accuracy of the system for the identification of arrhythmia foci is limited. METHODS Nine pigs underwent closed-chest placement of endocardial fiducial markers, computed tomography, and pacing in all cardiac chambers with ECGi acquisition. Pacing location was reconstructed from biplane fluoroscopy and registered to the computed tomography using the fiducials. A blinded investigator predicted the pacing location from the ECGi data, and the distance to the true pacing catheter tip location was calculated. RESULTS A total of 109 endocardial and 9 epicardial locations were paced in 9 pigs. ECGi predicted the correct chamber of origin in 85% of atrial and 92% of ventricular sites. Lateral locations were predicted in the correct chamber more often than septal locations (97% versus 79%, P=0.01). Absolute distances in space between the true and predicted pacing locations were 20.7 (13.8-25.6) mm (median and [first-third] quartile). Distances were not significantly different across cardiac chambers. CONCLUSIONS The ECGi system is able to correctly identify the chamber of origin for focal activation in the vast majority of cases. Determination of the true site of origin is possible with sufficient accuracy with consideration of these error estimates.
{"title":"Spatial Accuracy of a Clinically Established Noninvasive Electrocardiographic Imaging System for the Detection of Focal Activation in an Intact Porcine Model.","authors":"S. Hohmann, M. Rettmann, H. Konishi, Anna Borenstein, Songyun Wang, A. Suzuki, G. Michalak, K. Monahan, K. D. Parker, L. K. Newman, D. Packer","doi":"10.1161/CIRCEP.119.007570","DOIUrl":"https://doi.org/10.1161/CIRCEP.119.007570","url":null,"abstract":"BACKGROUND\u0000Noninvasive electrocardiographic imaging (ECGi) is used clinically to map arrhythmias before ablation. Despite its clinical use, validation data regarding the accuracy of the system for the identification of arrhythmia foci is limited.\u0000\u0000\u0000METHODS\u0000Nine pigs underwent closed-chest placement of endocardial fiducial markers, computed tomography, and pacing in all cardiac chambers with ECGi acquisition. Pacing location was reconstructed from biplane fluoroscopy and registered to the computed tomography using the fiducials. A blinded investigator predicted the pacing location from the ECGi data, and the distance to the true pacing catheter tip location was calculated.\u0000\u0000\u0000RESULTS\u0000A total of 109 endocardial and 9 epicardial locations were paced in 9 pigs. ECGi predicted the correct chamber of origin in 85% of atrial and 92% of ventricular sites. Lateral locations were predicted in the correct chamber more often than septal locations (97% versus 79%, P=0.01). Absolute distances in space between the true and predicted pacing locations were 20.7 (13.8-25.6) mm (median and [first-third] quartile). Distances were not significantly different across cardiac chambers.\u0000\u0000\u0000CONCLUSIONS\u0000The ECGi system is able to correctly identify the chamber of origin for focal activation in the vast majority of cases. Determination of the true site of origin is possible with sufficient accuracy with consideration of these error estimates.","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89130576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-01DOI: 10.1161/CIRCEP.119.007484
Christopher M. Andrews, B. Cupps, M. Pasque, Y. Rudy
November 2019 1 Knowledge of the spatiotemporal relationship between electrical excitation and mechanical contraction in the human heart is essential for understanding cardiac physiology and disease. However, electromechanical data from nondiseased human hearts are currently lacking. The present study is the first to combine Electrocardiographic Imaging (ECGI; a noninvasive method for cardiac electrophysiology mapping) with tagged magnetic resonance imaging (MRI) to study the electromechanics of healthy adult hearts in situ. This also represents the largest ECGI study of healthy adults to date. We provide 3-dimensional data of the normal cardiac electrical and mechanical activation sequences, obtained from the same hearts under complete physiological conditions. These are important baseline data for studies and diagnosis of cardiac disorders and for constraining computer models of the human heart. Twenty healthy adults were enrolled at Washington University in St. Louis. Healthy volunteer demographics are provided in Table I in the Data Supplement. The study was approved by the Human Research Protection Office at Washington University in St. Louis. All participants provided written informed consent. Data are available upon reasonable request. The ECGI method, developed and validated in our laboratory, was described previously.1 A schematic of the procedure is presented in Figure I in the Data Supplement. The method consists of recording ≈250 simultaneous ECGs from the torso, using electrode strips. Heart-torso geometries of subjects were imaged using a navigated anatomic MRI sequence. Electrode positions were marked with MRIvisible capsules. ECG recordings were combined with the heart-torso geometries to construct epicardial potentials and unipolar epicardial electrograms. Local activation times were computed from electrograms using the minimum dV/dt during the QRS, and recovery times using the maximum dV/dt during the T wave. Activation-recovery intervals (ARIs), a surrogate of local action potential duration, were computed by subtracting the local activation time from the local recovery time. Activation and recovery maps were edited based on overall sequence and neighboring electrograms. Tagged MR images were obtained and analyzed using previously described methods.2 ECG-gated images were obtained in short-axis and long-axis views for a complete cardiac cycle beginning at end diastole. Tagged and nontagged images were acquired during the same breath hold to ensure similar anatomic positioning. Tag lines in the myocardium were tracked and 3-dimensional displacements were calculated from the movement of intramural tag surface intersection points during systole. StressCheck software (ESRD, Inc, St. Louis, MO) was used to compute strain values throughout the left ventricle. Additional details of the ECGI and tagged MRI analyses are provided in the Data Supplement. SPECIAL REPORT
1了解人类心脏电兴奋和机械收缩之间的时空关系对于理解心脏生理学和疾病至关重要。然而，目前缺乏来自未患病人类心脏的机电数据。本研究首次将心电图成像(ECGI;用标记磁共振成像(MRI)原位研究健康成人心脏的电力学。这也是迄今为止对健康成人进行的最大规模的ECGI研究。我们提供了在完全生理条件下从同一颗心脏获得的正常心脏电和机械激活序列的三维数据。这些是研究和诊断心脏疾病以及限制人类心脏的计算机模型的重要基线数据。20名健康的成年人在圣路易斯的华盛顿大学注册。健康志愿者的人口统计资料载于《数据补充》表一。这项研究得到了圣路易斯华盛顿大学人类研究保护办公室的批准。所有参与者均提供书面知情同意书。如有合理要求，可提供资料。ECGI方法，在我们的实验室开发和验证，前面有描述该过程的示意图见数据补充中的图1。该方法包括使用电极条从躯干同时记录约250个心电图。使用导航解剖MRI序列对受试者的心脏-躯干几何形状进行成像。用mri可见胶囊标记电极位置。心电图记录与心躯干几何形状相结合，构建心外膜电位和单极心外膜电图。局部激活时间用QRS期间最小dV/dt的电图计算，恢复时间用T波期间最大dV/dt的电图计算。激活-恢复间隔(ARIs)是局部动作电位持续时间的替代物，通过从局部恢复时间减去局部激活时间来计算。激活和恢复图是根据整个序列和邻近的电图编辑的。使用先前描述的方法获得标记的MR图像并进行分析心电门控图像在短轴和长轴视图获得完整的心脏周期从舒张末期开始。在同一屏气期间获得标记和未标记的图像，以确保相似的解剖定位。跟踪心肌内的标签线，并根据收缩期内标签面交点的运动计算三维位移。使用StressCheck软件(ESRD, Inc, St. Louis, MO)计算整个左心室的应变值。ECGI和标记MRI分析的更多细节见数据补充。特别报道
{"title":"Electromechanics of the Normal Human Heart In Situ.","authors":"Christopher M. Andrews, B. Cupps, M. Pasque, Y. Rudy","doi":"10.1161/CIRCEP.119.007484","DOIUrl":"https://doi.org/10.1161/CIRCEP.119.007484","url":null,"abstract":"November 2019 1 Knowledge of the spatiotemporal relationship between electrical excitation and mechanical contraction in the human heart is essential for understanding cardiac physiology and disease. However, electromechanical data from nondiseased human hearts are currently lacking. The present study is the first to combine Electrocardiographic Imaging (ECGI; a noninvasive method for cardiac electrophysiology mapping) with tagged magnetic resonance imaging (MRI) to study the electromechanics of healthy adult hearts in situ. This also represents the largest ECGI study of healthy adults to date. We provide 3-dimensional data of the normal cardiac electrical and mechanical activation sequences, obtained from the same hearts under complete physiological conditions. These are important baseline data for studies and diagnosis of cardiac disorders and for constraining computer models of the human heart. Twenty healthy adults were enrolled at Washington University in St. Louis. Healthy volunteer demographics are provided in Table I in the Data Supplement. The study was approved by the Human Research Protection Office at Washington University in St. Louis. All participants provided written informed consent. Data are available upon reasonable request. The ECGI method, developed and validated in our laboratory, was described previously.1 A schematic of the procedure is presented in Figure I in the Data Supplement. The method consists of recording ≈250 simultaneous ECGs from the torso, using electrode strips. Heart-torso geometries of subjects were imaged using a navigated anatomic MRI sequence. Electrode positions were marked with MRIvisible capsules. ECG recordings were combined with the heart-torso geometries to construct epicardial potentials and unipolar epicardial electrograms. Local activation times were computed from electrograms using the minimum dV/dt during the QRS, and recovery times using the maximum dV/dt during the T wave. Activation-recovery intervals (ARIs), a surrogate of local action potential duration, were computed by subtracting the local activation time from the local recovery time. Activation and recovery maps were edited based on overall sequence and neighboring electrograms. Tagged MR images were obtained and analyzed using previously described methods.2 ECG-gated images were obtained in short-axis and long-axis views for a complete cardiac cycle beginning at end diastole. Tagged and nontagged images were acquired during the same breath hold to ensure similar anatomic positioning. Tag lines in the myocardium were tracked and 3-dimensional displacements were calculated from the movement of intramural tag surface intersection points during systole. StressCheck software (ESRD, Inc, St. Louis, MO) was used to compute strain values throughout the left ventricle. Additional details of the ECGI and tagged MRI analyses are provided in the Data Supplement. SPECIAL REPORT","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86682967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-01DOI: 10.1161/CIRCEP.119.007663
C. Houck, Stephanie F. Chandler, A. Bogers, J. Triedman, E. Walsh, N. D. de Groot, D. Abrams
BACKGROUND In contrast to the adult population with congenital heart disease (CHD), arrhythmia mechanisms and outcomes of ablation in pediatric patients with CHD in recent era have not been studied in detail. Aims of this study were to determine arrhythmia mechanisms and to evaluate procedural and long-term outcomes in pediatric patients with CHD undergoing catheter ablation. METHODS Consecutive patients <18 years of age with CHD undergoing catheter ablation over an 11-year period (2007-2018) were included. Procedural outcome included complete or partial success, failure or empirical ablation. Long-term outcome included arrhythmia recurrence and burden according to a 12-point clinical arrhythmia severity score. RESULTS The study population consisted of 232 patients (11.7 years [0.01-17.8], 33.5 kg [2.2-130.1]). The most common diagnoses were Ebstein's anomaly (n=44), septal defects (n=39), and single ventricle (n=36). Arrhythmia mechanisms included atrioventricular reentry tachycardia (n=104, 90 patients), atrioventricular nodal reentry tachycardia (n=33, 29 patients), twin atrioventricular nodal tachycardia (n=3, 2 patients), macroreentrant atrial tachycardia (n=59, 56 patients), focal atrial tachycardia (n=33, 25 patients), ventricular ectopy (n=10, 8 patients), and ventricular tachycardia (n=15, 13 patients). Fifty-six arrhythmias (39 patients) were undefined. Outcomes included complete success (n=189, 81%), partial success (n=7, 3%), failure (n=16, 7%), or empirical ablation (n=20, 9%). Over 3.6 years (0.3-10.7) arrhythmia recurred in 49%. Independent of arrhythmia recurrence, arrhythmia scores decreased from 4 (0-10) at baseline to 0.5 (0-8) at 4 years follow-up (P<0.001). In 23/51 repeat procedures (45%), a different arrhythmia substrate was found. Overall adverse event rate was 9.4%, although only 1.6% (n=4) were of major severity and 0.8% (n=2) of moderate severity. CONCLUSIONS Pediatric patients with CHD demonstrate a broad spectrum of arrhythmia mechanisms. Despite recurrence and emergence of novel mechanisms after a successful procedure, ablation can be performed safely and successfully resulting in decreased arrhythmia burden.
{"title":"Arrhythmia Mechanisms and Outcomes of Ablation in Pediatric Patients With Congenital Heart Disease.","authors":"C. Houck, Stephanie F. Chandler, A. Bogers, J. Triedman, E. Walsh, N. D. de Groot, D. Abrams","doi":"10.1161/CIRCEP.119.007663","DOIUrl":"https://doi.org/10.1161/CIRCEP.119.007663","url":null,"abstract":"BACKGROUND\u0000In contrast to the adult population with congenital heart disease (CHD), arrhythmia mechanisms and outcomes of ablation in pediatric patients with CHD in recent era have not been studied in detail. Aims of this study were to determine arrhythmia mechanisms and to evaluate procedural and long-term outcomes in pediatric patients with CHD undergoing catheter ablation.\u0000\u0000\u0000METHODS\u0000Consecutive patients <18 years of age with CHD undergoing catheter ablation over an 11-year period (2007-2018) were included. Procedural outcome included complete or partial success, failure or empirical ablation. Long-term outcome included arrhythmia recurrence and burden according to a 12-point clinical arrhythmia severity score.\u0000\u0000\u0000RESULTS\u0000The study population consisted of 232 patients (11.7 years [0.01-17.8], 33.5 kg [2.2-130.1]). The most common diagnoses were Ebstein's anomaly (n=44), septal defects (n=39), and single ventricle (n=36). Arrhythmia mechanisms included atrioventricular reentry tachycardia (n=104, 90 patients), atrioventricular nodal reentry tachycardia (n=33, 29 patients), twin atrioventricular nodal tachycardia (n=3, 2 patients), macroreentrant atrial tachycardia (n=59, 56 patients), focal atrial tachycardia (n=33, 25 patients), ventricular ectopy (n=10, 8 patients), and ventricular tachycardia (n=15, 13 patients). Fifty-six arrhythmias (39 patients) were undefined. Outcomes included complete success (n=189, 81%), partial success (n=7, 3%), failure (n=16, 7%), or empirical ablation (n=20, 9%). Over 3.6 years (0.3-10.7) arrhythmia recurred in 49%. Independent of arrhythmia recurrence, arrhythmia scores decreased from 4 (0-10) at baseline to 0.5 (0-8) at 4 years follow-up (P<0.001). In 23/51 repeat procedures (45%), a different arrhythmia substrate was found. Overall adverse event rate was 9.4%, although only 1.6% (n=4) were of major severity and 0.8% (n=2) of moderate severity.\u0000\u0000\u0000CONCLUSIONS\u0000Pediatric patients with CHD demonstrate a broad spectrum of arrhythmia mechanisms. Despite recurrence and emergence of novel mechanisms after a successful procedure, ablation can be performed safely and successfully resulting in decreased arrhythmia burden.","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79941293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-01Epub Date: 2019-11-15DOI: 10.1161/CIRCEP.119.008022
Neal K Bhatia, Wouter-Jan Rappel, Sanjiv M Narayan
{"title":"Response by Bhatia et al to Letter Regarding Article, \"Wavefront Field Mapping Reveals a Physiologic Network Between Drivers Where Ablation Terminates Atrial Fibrillation\".","authors":"Neal K Bhatia, Wouter-Jan Rappel, Sanjiv M Narayan","doi":"10.1161/CIRCEP.119.008022","DOIUrl":"10.1161/CIRCEP.119.008022","url":null,"abstract":"","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7365521/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78369232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-01DOI: 10.1161/CIRCEP.119.008019
J. Silva, G. V. Van Hare
Arrhythmias in pediatric patients with congenital heart disease (CHD) represent a significant cause of morbidity and mortality in these vulnerable children. Unfortunately, to date, there has been no systematic depiction of the arrhythmic substrates and median term clinical outcome measurements in these patients in the more recent era of catheter ablation. In this issue of Circulation: Arrhythmia and Electrophysiology, Houck et al1 present a detailed retrospective 2-institution review of consecutive pediatric patients with CHD who underwent transcatheter ablation from 2007 to 2018, collecting a cohort of 232 patients. Greater than 75% of the patients presented had 2-ventricle substrates or surgical repairs, with Ebstein anomaly being the most common substrate. Accessory pathways were the most common electrophysiological substrate identified, followed by macroreentrant atrial tachycardias. Complete or partial procedural ablation success was achieved in 84% of cases with an adverse event rate of 9.4%. By 3.6 years follow-up, there were recurrent arrhythmias observed in 49% of patients. Importantly, recurrent arrhythmias following initial ablation were found to represent a different or new electrophysiological substrate in 26% of patients who underwent repeat electrophysiology studies. We congratulate the authors on reporting their ablation results such a large group of children with CHD, who for most programs represent a small minority of the total ablation population. There are several noteworthy takeaways. Acute procedural success rates for patients with CHD have remained rather steady in the current area of ablation. Recent data from the Multicenter Pediatric and Congenital EP Quality Initiative registry2 compiled acute procedural success rates across 12 centers with an acute success rate of 84% in patients with CHD. Papagiannis et al3 published a comprehensive retrospective study of over 100 patients with CHD from 16 centers specifically with atrioventricular nodal reentrant tachycardia and showed success rates of ≥82% with long term success of ≥86% at 3.2 years. This is particularly interesting because 22 patients (20%) presented with atypical atrioventricular nodal reentry tachycardia, which is known to have higher rates of procedural failure likely secondary to abnormal anatomy coupled with displaced conduction tissue and challenging access to the slow pathway. Looking at earlier reports from 2004, Hebe et al4 report acute success rates in CHD ablations of 88%. Despite the technological advances made in the field of cardiac ablation over the past 15 years that have demonstrated improvements in procedural success rates for certain patient cohorts, outcomes have not markedly EDITORIAL
{"title":"Catheter Ablation in Pediatric Congenital Heart Disease: A Modern Perspective.","authors":"J. Silva, G. V. Van Hare","doi":"10.1161/CIRCEP.119.008019","DOIUrl":"https://doi.org/10.1161/CIRCEP.119.008019","url":null,"abstract":"Arrhythmias in pediatric patients with congenital heart disease (CHD) represent a significant cause of morbidity and mortality in these vulnerable children. Unfortunately, to date, there has been no systematic depiction of the arrhythmic substrates and median term clinical outcome measurements in these patients in the more recent era of catheter ablation. In this issue of Circulation: Arrhythmia and Electrophysiology, Houck et al1 present a detailed retrospective 2-institution review of consecutive pediatric patients with CHD who underwent transcatheter ablation from 2007 to 2018, collecting a cohort of 232 patients. Greater than 75% of the patients presented had 2-ventricle substrates or surgical repairs, with Ebstein anomaly being the most common substrate. Accessory pathways were the most common electrophysiological substrate identified, followed by macroreentrant atrial tachycardias. Complete or partial procedural ablation success was achieved in 84% of cases with an adverse event rate of 9.4%. By 3.6 years follow-up, there were recurrent arrhythmias observed in 49% of patients. Importantly, recurrent arrhythmias following initial ablation were found to represent a different or new electrophysiological substrate in 26% of patients who underwent repeat electrophysiology studies. We congratulate the authors on reporting their ablation results such a large group of children with CHD, who for most programs represent a small minority of the total ablation population. There are several noteworthy takeaways. Acute procedural success rates for patients with CHD have remained rather steady in the current area of ablation. Recent data from the Multicenter Pediatric and Congenital EP Quality Initiative registry2 compiled acute procedural success rates across 12 centers with an acute success rate of 84% in patients with CHD. Papagiannis et al3 published a comprehensive retrospective study of over 100 patients with CHD from 16 centers specifically with atrioventricular nodal reentrant tachycardia and showed success rates of ≥82% with long term success of ≥86% at 3.2 years. This is particularly interesting because 22 patients (20%) presented with atypical atrioventricular nodal reentry tachycardia, which is known to have higher rates of procedural failure likely secondary to abnormal anatomy coupled with displaced conduction tissue and challenging access to the slow pathway. Looking at earlier reports from 2004, Hebe et al4 report acute success rates in CHD ablations of 88%. Despite the technological advances made in the field of cardiac ablation over the past 15 years that have demonstrated improvements in procedural success rates for certain patient cohorts, outcomes have not markedly EDITORIAL","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84874725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-01DOI: 10.1161/CIRCEP.119.007930
A. Ganesan, D. Dharmaprani, A. McGavigan
November 2019 1 Anand N. Ganesan, MBBS, PhD Dhani Dharmaprani, BEng Andrew D. McGavigan, MD To the Editor: Leef et al1 present an important study using wavefront field mapping to reveal a physiological network between drivers in cases where atrial fibrillation terminates. The directed vector approach utilized to demonstrate the connection of counterchiral spiral waves recalls the topological restrictions on phase singularities (PSs), outlined by Gray et al2: (1) phase lines cannot intersect; (2) PSs are joined by other isophasic lines to PS of opposite chirality or nonconducting boundaries; (3) PSs form and terminate as oppositely rotating pairs. Given the intrinsic topological connectedness of counter-chiral spiral waves via isophasic lines, it would be interesting to study these phenomena in cases where termination did not occur because these may also be present in the absence of AF termination. This is certainly a feature observable in the phase maps presented by Child et al.3 A further point addressed during the study is fluctuating nature of PS, which the authors postulated occurs via undefined mechanisms.1 In fact, the fluctuation of PS may potentially be an intrinsic topological property. Because each PS creates zones where all phases of the cycle are simultaneously present, the timing of incoming waves is likely to stochastically encounter tissue in the critical phase for new wavebreak and thus cause a new PS to form.4 This creates an endless cycle of PS regeneration that is a feature of the perpetuation of AF and VF.5 A final point made by Winfree4 and Gray et al2 is on the nature of PS termination. For topological reasons, PS termination can only occur via fusion with a wave emanating from a migrating spiral or migration to a boundary. The ability to terminate the arrhythmia at a distance from the PS observed by Leef et al could equally be consistent with the notion that AF termination is a form of stochastic ergodicity breaking, rather than via a direct effect on individual PS. The interesting approach presented by Leef et al points to the need for further studies of the mechanisms of AF and VF termination.
2019年11月1 Anand N. Ganesan, MBBS, Dhani Dharmaprani博士，BEng Andrew D. McGavigan医学博士致编辑:Leef等人1提出了一项重要的研究，使用波前场映射来揭示心房颤动终止病例中驾驶员之间的生理网络。用于证明反手性螺旋波的连接的有向矢量方法使人想起了Gray等人提出的相位奇点(ps)的拓扑限制:(1)相位线不能相交;(2) PS通过其他等相线连接到具有相反手性或不导电边界的PS;(3) ps形成和终止为反向旋转对。考虑到反手性螺旋波通过等相线的固有拓扑连通性，在没有发生终止的情况下研究这些现象将是有趣的，因为这些现象也可能存在于没有AF终止的情况下。这当然是Child等人提出的相位图中可以观察到的一个特征。3研究中进一步提到的一点是PS的波动性，作者认为这是通过未定义的机制发生的事实上，PS的波动可能是一种内在的拓扑性质。因为每一个PS都产生了一个区域，在这个区域内所有周期的相位都同时存在，所以入射波的时间很可能在新波破裂的关键阶段随机遇到组织，从而导致新的PS形成这创造了一个无限的PS再生循环，这是AF和VF.5永久存在的特征。Winfree4和Gray等人提出的最后一点是PS终止的本质。由于拓扑原因，PS终止只能通过与从迁移螺旋或迁移到边界发出的波融合而发生。Leef等人所观察到的在离心室远的地方终止心律失常的能力也可能与心房颤动终止是一种随机的遍历性中断的形式，而不是通过对个体心室颤动的直接影响这一概念相一致。Leef等人提出的有趣方法指出，需要进一步研究心房颤动和心室颤动终止的机制。
{"title":"Letter by Ganesan et al Regarding Article, \"Wavefront Field Mapping Reveals a Physiologic Network Between Drivers Where Ablation Terminates Atrial Fibrillation\".","authors":"A. Ganesan, D. Dharmaprani, A. McGavigan","doi":"10.1161/CIRCEP.119.007930","DOIUrl":"https://doi.org/10.1161/CIRCEP.119.007930","url":null,"abstract":"November 2019 1 Anand N. Ganesan, MBBS, PhD Dhani Dharmaprani, BEng Andrew D. McGavigan, MD To the Editor: Leef et al1 present an important study using wavefront field mapping to reveal a physiological network between drivers in cases where atrial fibrillation terminates. The directed vector approach utilized to demonstrate the connection of counterchiral spiral waves recalls the topological restrictions on phase singularities (PSs), outlined by Gray et al2: (1) phase lines cannot intersect; (2) PSs are joined by other isophasic lines to PS of opposite chirality or nonconducting boundaries; (3) PSs form and terminate as oppositely rotating pairs. Given the intrinsic topological connectedness of counter-chiral spiral waves via isophasic lines, it would be interesting to study these phenomena in cases where termination did not occur because these may also be present in the absence of AF termination. This is certainly a feature observable in the phase maps presented by Child et al.3 A further point addressed during the study is fluctuating nature of PS, which the authors postulated occurs via undefined mechanisms.1 In fact, the fluctuation of PS may potentially be an intrinsic topological property. Because each PS creates zones where all phases of the cycle are simultaneously present, the timing of incoming waves is likely to stochastically encounter tissue in the critical phase for new wavebreak and thus cause a new PS to form.4 This creates an endless cycle of PS regeneration that is a feature of the perpetuation of AF and VF.5 A final point made by Winfree4 and Gray et al2 is on the nature of PS termination. For topological reasons, PS termination can only occur via fusion with a wave emanating from a migrating spiral or migration to a boundary. The ability to terminate the arrhythmia at a distance from the PS observed by Leef et al could equally be consistent with the notion that AF termination is a form of stochastic ergodicity breaking, rather than via a direct effect on individual PS. The interesting approach presented by Leef et al points to the need for further studies of the mechanisms of AF and VF termination.","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75731186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-01DOI: 10.1161/CIRCEP.119.007661
Ayelet Shapira-Daniels, M. Barkagan, H. Yavin, J. Sroubek, V. Reddy, P. Neužil, E. Anter
BACKGROUND Ventricular tachycardia ablation is often limited by insufficient lesion creation. A novel radiofrequency catheter with an expandable lattice electrode has a larger surface area capable of delivering higher currents at a lower density to potentially increase lesion dimensions without overheating. METHODS This 8F bidirectional irrigated catheter (Sphere-9, Affera Inc) has a 9 mm spherical lattice tip ("lattice") with an effective surface area 10-fold larger than standard linear catheters. Nine surface thermocouples provide temperature feedback to a proprietary high-current generator operating in a temperature-controlled mode. Ex vivo phase: in 11 bovine hearts, unipolar ablation at 30, 60, and 120 seconds was compared between the lattice (Tmax60°C) and a standard linear irrigated-tip catheter (40 W) at contact force of 10 g. In 5 porcine hearts, bipolar ablation was compared between the catheters (Tmax60°C versus 40 W; 60 seconds). In vivo phase: in 9 swine, ventricular ablation at Tmax60°C versus 40 W was performed for 60 seconds. In addition, direct tissue temperature at 3- and 7-mm tissue depth was measured in a thigh muscle preparation. RESULTS Ex vivo: lattice produced deeper lesions at 30, 60, and 120 seconds application duration (6.7±1.3 versus 4.8±1.2 mm; 8.3±1.4 versus 5.4±0.8 mm; 10.0±1.6 versus 6.1±1.6 mm, respectively, P≤0.001 for all). Bipolar lesions were deeper (15.8±4.1 versus 10.5±1.4 mm, P<0.001) and more likely to be transmural (80% versus 0%, P=0.002). In vivo: lattice produced deeper lesions (10.5±1.4 versus 6.5±0.8 mm, P≤0.001). Tissue temperature at 7 mm was higher with the lattice (+15.1±2.4°C; P<0.001). The steam-pop occurrence was lower with the lattice (total: 4% versus 18%, P=0.02; in vivo 0% versus 14.2%, P=0.13). CONCLUSIONS This novel radiofrequency system produces larger ventricular lesions compared with standard irrigated catheters and at a lower risk of tissue overheating. This may improve the efficacy of ventricular tachycardia ablation procedures while reducing the number of applications and procedural duration.
背景:室性心动过速消融常因病变产生不足而受限。一种具有可膨胀晶格电极的新型射频导管具有更大的表面积，能够以更低的密度输送更高的电流，从而潜在地增加病变尺寸而不会过热。方法该8F双向冲洗导管(Sphere-9, Affera Inc .)具有9mm的球形点阵尖端(“点阵”)，有效表面积比标准线性导管大10倍。九个表面热电偶提供温度反馈到一个专有的在温度控制模式下运行的大电流发电机。离体阶段:在11个牛心脏中，比较了晶格(Tmax60°C)和标准线性冲洗尖端导管(40 W)在接触力为10 g时30、60和120秒的单极消融。在5个猪心脏中，比较了导管的双极消融(Tmax60°C与40w;60秒)。体内阶段:在9头猪中，在Tmax60°C和40w下进行心室消融60秒。此外，在3和7毫米的组织深度直接组织温度被测量在大腿肌肉准备。结果:体内:晶格在30,60和120秒的应用时间内产生更深的病变(6.7±1.3 vs 4.8±1.2 mm;8.3±1.4 vs 5.4±0.8 mm;分别为10.0±1.6 mm和6.1±1.6 mm, P≤0.001)。双极病变更深(15.8±4.1对10.5±1.4 mm, P<0.001)，更有可能是跨壁的(80%对0%，P=0.002)。体内:晶格产生更深的病变(10.5±1.4 vs 6.5±0.8 mm, P≤0.001)。7 mm处组织温度较高，为+15.1±2.4℃;P < 0.001)。蒸汽爆裂的发生率较晶格低(总数:4% vs 18%， P=0.02;体内0% vs 14.2%， P=0.13)。结论:与标准冲洗导管相比，这种新型射频系统可产生更大的心室损伤，且组织过热的风险更低。这可能提高室性心动过速消融手术的疗效，同时减少应用次数和手术时间。
{"title":"Novel Irrigated Temperature-Controlled Lattice Ablation Catheter for Ventricular Ablation: A Preclinical Multimodality Biophysical Characterization.","authors":"Ayelet Shapira-Daniels, M. Barkagan, H. Yavin, J. Sroubek, V. Reddy, P. Neužil, E. Anter","doi":"10.1161/CIRCEP.119.007661","DOIUrl":"https://doi.org/10.1161/CIRCEP.119.007661","url":null,"abstract":"BACKGROUND\u0000Ventricular tachycardia ablation is often limited by insufficient lesion creation. A novel radiofrequency catheter with an expandable lattice electrode has a larger surface area capable of delivering higher currents at a lower density to potentially increase lesion dimensions without overheating.\u0000\u0000\u0000METHODS\u0000This 8F bidirectional irrigated catheter (Sphere-9, Affera Inc) has a 9 mm spherical lattice tip (\"lattice\") with an effective surface area 10-fold larger than standard linear catheters. Nine surface thermocouples provide temperature feedback to a proprietary high-current generator operating in a temperature-controlled mode. Ex vivo phase: in 11 bovine hearts, unipolar ablation at 30, 60, and 120 seconds was compared between the lattice (Tmax60°C) and a standard linear irrigated-tip catheter (40 W) at contact force of 10 g. In 5 porcine hearts, bipolar ablation was compared between the catheters (Tmax60°C versus 40 W; 60 seconds). In vivo phase: in 9 swine, ventricular ablation at Tmax60°C versus 40 W was performed for 60 seconds. In addition, direct tissue temperature at 3- and 7-mm tissue depth was measured in a thigh muscle preparation.\u0000\u0000\u0000RESULTS\u0000Ex vivo: lattice produced deeper lesions at 30, 60, and 120 seconds application duration (6.7±1.3 versus 4.8±1.2 mm; 8.3±1.4 versus 5.4±0.8 mm; 10.0±1.6 versus 6.1±1.6 mm, respectively, P≤0.001 for all). Bipolar lesions were deeper (15.8±4.1 versus 10.5±1.4 mm, P<0.001) and more likely to be transmural (80% versus 0%, P=0.002). In vivo: lattice produced deeper lesions (10.5±1.4 versus 6.5±0.8 mm, P≤0.001). Tissue temperature at 7 mm was higher with the lattice (+15.1±2.4°C; P<0.001). The steam-pop occurrence was lower with the lattice (total: 4% versus 18%, P=0.02; in vivo 0% versus 14.2%, P=0.13).\u0000\u0000\u0000CONCLUSIONS\u0000This novel radiofrequency system produces larger ventricular lesions compared with standard irrigated catheters and at a lower risk of tissue overheating. This may improve the efficacy of ventricular tachycardia ablation procedures while reducing the number of applications and procedural duration.","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73964880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-01DOI: 10.1161/CIRCEP.119.007600
B. Kheiri, Mahmoud Barbarawi, Yazan Zayed, Michael Hicks, M. Osman, L. Rashdan, H. Kyi, Ghassan Bachuwa, Mustafa Hassan, E. Stecker, B. Nazer, Deepak L. Bhatt
BACKGROUND In patients with an implantable cardioverter-defibrillator (ICD), shocks are associated with increased morbidity and mortality. Therefore, we conducted this study to evaluate the efficacy and safety of antiarrhythmic drugs and catheter ablation (CA) in the treatment of ventricular tachyarrhythmias (VT) in patients with an ICD. METHODS An electronic database search for randomized controlled trials that evaluated antiarrhythmic drugs and CA in patients with ICD was conducted. The primary outcome was recurrent VT. Secondary outcomes were ICD shocks and any deaths. Bayesian and frequentist network meta-analyses were performed to calculate hazard ratios (HRs) and 95% credible intervals (CrIs)/CIs. RESULTS Twenty-two randomized controlled trials were identified (3828 total patients; age 64.3±11.4; 79% males). The use of amiodarone was associated with a significantly reduced rate of VT recurrence compared with control (HR=0.34 [95% CrI=0.15-0.74]; absolute risk difference=-0.23 [95% CrI=-0.23 to -0.09]; number needed to treat=4). Sotalol was associated with increased risk of VT recurrence compared with amiodarone (HR=2.88 [95% CrI=1.35-6.46]). Compared with control, amiodarone (HR=0.33 [95% CrI=0.15-0.76]; absolute risk difference=-0.17 [95% CrI=-0.32 to -0.06]; number needed to treat=6) and CA (HR=0.52 [95% CrI=0.30-0.89; absolute risk difference=-0.12 [95% CrI=-0.24 to -0.03]; number needed to treat=8) were associated with significantly reduced ICD shocks. Compared with amiodarone, sotalol was associated with significantly increased ICD shocks (HR=2.70 [95% CrI=1.17-6.71]). The rate of death was not significantly different between the competing strategies. The node-splitting method showed no inconsistency. CONCLUSIONS Among patients with an ICD, amiodarone significantly reduced VT recurrence and ICD shocks, while CA reduced ICD shocks. Sotalol significantly increased VT recurrence and ICD shocks compared with amiodarone. The long-term side effects of amiodarone and early complications of CA should be weighed carefully according to specific patient characteristics.
{"title":"Antiarrhythmic Drugs or Catheter Ablation in the Management of Ventricular Tachyarrhythmias in Patients With Implantable Cardioverter-Defibrillators: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"B. Kheiri, Mahmoud Barbarawi, Yazan Zayed, Michael Hicks, M. Osman, L. Rashdan, H. Kyi, Ghassan Bachuwa, Mustafa Hassan, E. Stecker, B. Nazer, Deepak L. Bhatt","doi":"10.1161/CIRCEP.119.007600","DOIUrl":"https://doi.org/10.1161/CIRCEP.119.007600","url":null,"abstract":"BACKGROUND\u0000In patients with an implantable cardioverter-defibrillator (ICD), shocks are associated with increased morbidity and mortality. Therefore, we conducted this study to evaluate the efficacy and safety of antiarrhythmic drugs and catheter ablation (CA) in the treatment of ventricular tachyarrhythmias (VT) in patients with an ICD.\u0000\u0000\u0000METHODS\u0000An electronic database search for randomized controlled trials that evaluated antiarrhythmic drugs and CA in patients with ICD was conducted. The primary outcome was recurrent VT. Secondary outcomes were ICD shocks and any deaths. Bayesian and frequentist network meta-analyses were performed to calculate hazard ratios (HRs) and 95% credible intervals (CrIs)/CIs.\u0000\u0000\u0000RESULTS\u0000Twenty-two randomized controlled trials were identified (3828 total patients; age 64.3±11.4; 79% males). The use of amiodarone was associated with a significantly reduced rate of VT recurrence compared with control (HR=0.34 [95% CrI=0.15-0.74]; absolute risk difference=-0.23 [95% CrI=-0.23 to -0.09]; number needed to treat=4). Sotalol was associated with increased risk of VT recurrence compared with amiodarone (HR=2.88 [95% CrI=1.35-6.46]). Compared with control, amiodarone (HR=0.33 [95% CrI=0.15-0.76]; absolute risk difference=-0.17 [95% CrI=-0.32 to -0.06]; number needed to treat=6) and CA (HR=0.52 [95% CrI=0.30-0.89; absolute risk difference=-0.12 [95% CrI=-0.24 to -0.03]; number needed to treat=8) were associated with significantly reduced ICD shocks. Compared with amiodarone, sotalol was associated with significantly increased ICD shocks (HR=2.70 [95% CrI=1.17-6.71]). The rate of death was not significantly different between the competing strategies. The node-splitting method showed no inconsistency.\u0000\u0000\u0000CONCLUSIONS\u0000Among patients with an ICD, amiodarone significantly reduced VT recurrence and ICD shocks, while CA reduced ICD shocks. Sotalol significantly increased VT recurrence and ICD shocks compared with amiodarone. The long-term side effects of amiodarone and early complications of CA should be weighed carefully according to specific patient characteristics.","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88897232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-01DOI: 10.1161/CIRCEP.119.007499
M. Regouski, O. Galenko, Jason Doleac, A. Olsen, Victoria Jacobs, D. Liechty, K. White, T. Bunch, Pamela M Lee, H. Rutigliano, I. Polejaeva, M. Cutler
BACKGROUND There is increasing evidence that endurance exercise is associated with increased risk of atrial fibrillation (AF). However, it is unknown if the relationship between endurance exercise and AF is dependent on an atrial myopathy. METHODS Six cardiac-specific TGF (transforming growth factor)-β1 transgenic and 6 wild-type (WT) goats were utilized for these studies. Pacemakers were implanted in all animals for continuous arrhythmia monitoring and AF inducibility. AF inducibility was evaluated using 5 separate 10 s bursts of atrial pacing (160-200 ms). Three months of progressive endurance exercise (up to 90 minutes at 4.5 mph) was performed. Quantitative assessment of circulating microRNAs and inflammatory biomarkers was performed. RESULTS Sustained AF (≥30 s) was induced with 10 s of atrial pacing in 4 out of 6 transgenic goats compared with 0 out of 6 WT controls at baseline (P<0.05). No spontaneous AF was observed at baseline. Interestingly, between 2 and 3 months of exercise 3 out of 6 transgenic animals developed self-terminating spontaneous AF compared with 0 out of 6 WT animals (P<0.05). There was an increase in AF inducibility in both transgenic and WT animals during the first 2 months of exercise with partial normalization at 3 months (transgenic 67%; 100%; 83% versus WT 0%; 67%; 17%). These changes in AF susceptibility were associated with a decrease in circulating microRNA-21 and microRNA-29 during the first 2 months of exercise with partial normalization at 3 months in both transgenic and WT animals. Finally, MMP9 (matrix metallopeptidase 9) was increased during the second and third months of exercise training. CONCLUSIONS This study demonstrates a novel transgenic goat model of cardiac fibrosis (TGF-β1 overexpression) to demonstrate that endurance exercise in the setting of an underlying atrial myopathy increases the incidence of spontaneous AF. Furthermore, endurance exercise seems to increase inducible AF secondary to altered expression of key profibrotic biomarkers that is independent of the presence of an atrial myopathy.
背景:越来越多的证据表明，耐力运动与房颤(AF)风险增加有关。然而，目前尚不清楚耐力运动和房颤之间的关系是否依赖于心房肌病。方法选用6只心脏特异性TGF(转化生长因子)-β1转基因山羊和6只野生型山羊进行实验。所有动物均植入起搏器，用于持续监测心律失常和AF诱导。采用5次单独的10 s心房起搏(160-200 ms)评估心房颤动诱发性。进行了三个月的渐进式耐力锻炼(以4.5英里/小时的速度长达90分钟)。定量评估循环microrna和炎症生物标志物。结果6只转基因山羊中有4只在10秒心房起搏后诱发持续性房颤(≥30秒)，而对照组6只中0只(P<0.05)。基线时未观察到自发性房颤。有趣的是，在2至3个月的运动期间，6只转基因动物中有3只发生了自终止性自发性房颤，而6只WT动物中没有发生(P<0.05)。在运动的前2个月，转基因和WT动物的AF诱导率都有所增加，3个月时部分正常化(转基因67%;100%;83% vs WT 0%;67%;17%)。这些AF易感性的变化与运动前2个月循环microRNA-21和microRNA-29的减少有关，转基因和WT动物在运动后3个月部分恢复正常。最后，MMP9(基质金属肽酶9)在运动训练的第二和第三个月增加。结论:本研究建立了一种新的转基因山羊心肌纤维化模型(TGF-β1过表达)，证明了在潜在心房肌病的情况下，耐力运动增加了自发性房颤的发生率。此外，耐力运动似乎增加了诱导性房颤，继发于与心房肌病存在无关的关键纤维化生物标志物的表达改变。
{"title":"Spontaneous Atrial Fibrillation in Transgenic Goats With TGF (Transforming Growth Factor)-β1 Induced Atrial Myopathy With Endurance Exercise.","authors":"M. Regouski, O. Galenko, Jason Doleac, A. Olsen, Victoria Jacobs, D. Liechty, K. White, T. Bunch, Pamela M Lee, H. Rutigliano, I. Polejaeva, M. Cutler","doi":"10.1161/CIRCEP.119.007499","DOIUrl":"https://doi.org/10.1161/CIRCEP.119.007499","url":null,"abstract":"BACKGROUND\u0000There is increasing evidence that endurance exercise is associated with increased risk of atrial fibrillation (AF). However, it is unknown if the relationship between endurance exercise and AF is dependent on an atrial myopathy.\u0000\u0000\u0000METHODS\u0000Six cardiac-specific TGF (transforming growth factor)-β1 transgenic and 6 wild-type (WT) goats were utilized for these studies. Pacemakers were implanted in all animals for continuous arrhythmia monitoring and AF inducibility. AF inducibility was evaluated using 5 separate 10 s bursts of atrial pacing (160-200 ms). Three months of progressive endurance exercise (up to 90 minutes at 4.5 mph) was performed. Quantitative assessment of circulating microRNAs and inflammatory biomarkers was performed.\u0000\u0000\u0000RESULTS\u0000Sustained AF (≥30 s) was induced with 10 s of atrial pacing in 4 out of 6 transgenic goats compared with 0 out of 6 WT controls at baseline (P<0.05). No spontaneous AF was observed at baseline. Interestingly, between 2 and 3 months of exercise 3 out of 6 transgenic animals developed self-terminating spontaneous AF compared with 0 out of 6 WT animals (P<0.05). There was an increase in AF inducibility in both transgenic and WT animals during the first 2 months of exercise with partial normalization at 3 months (transgenic 67%; 100%; 83% versus WT 0%; 67%; 17%). These changes in AF susceptibility were associated with a decrease in circulating microRNA-21 and microRNA-29 during the first 2 months of exercise with partial normalization at 3 months in both transgenic and WT animals. Finally, MMP9 (matrix metallopeptidase 9) was increased during the second and third months of exercise training.\u0000\u0000\u0000CONCLUSIONS\u0000This study demonstrates a novel transgenic goat model of cardiac fibrosis (TGF-β1 overexpression) to demonstrate that endurance exercise in the setting of an underlying atrial myopathy increases the incidence of spontaneous AF. Furthermore, endurance exercise seems to increase inducible AF secondary to altered expression of key profibrotic biomarkers that is independent of the presence of an atrial myopathy.","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88247769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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