Pub Date : 2019-09-01DOI: 10.1161/CIRCEP.119.007762
Michael Eskander, V. Pretorius, U. Birgersdotter-Green
Transvenous lead extraction (TLE) is a complex yet effective procedure to remove indwelling leads belonging to cardiac devices with a potential for serious complications. Consequently, the 2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction maintains that TLE be performed only at centers with an environment fully supportive of a lead extraction program, which includes a team-based approach, incorporating equipment and capable of managing all potential complications.1 An experienced center will evaluate the patient based on the current presentation and comorbid conditions, while incorporating the procedural and patient-related risks. Despite our best evaluation and preparation, however, a flawless risk stratification approach for those in consideration for TLE remains elusive. Patients with prior sternotomy (PS) is a group of interest due to theoretical mediastinal scarring which may protect against vascular tears and conversely increased adhesions and fibrosis which may delay precious life-saving surgical access after vascular complication from TLE. Historically, patients with PS have been shown to have increased operative morbidity and mortality. In a Swiss cohort undergoing coronary artery bypass grafting, postoperative mortality rate was 9.6% (57/594) in PS compared with 2.8% (87/3184) in those with no prior sternotomy (NPS). Low cardiac output syndrome, intraaortic balloon pump support, prolonged ventilatory support (>24 hours), hemorrhage and gastrointestinal complications were prominent features in those with PS as compared with those undergoing primary coronary artery bypass grafting. While some recently published data may suggest PS as a predictor of clinical success in the setting of TLE, there continues to be a significant risk of urgent cardiac surgery—which carries high mortality, and appropriate planning with cardiothoracic backup is crucial.3,4 In this issue, Tsang et al5 present a single-center experience with prior sternotomy on outcomes in transvenous lead extractions. Of 1480 patients undergoing TLE, 455 had PS and were more likely to be male and have more comorbid conditions (coronary artery disease, hypertension, diabetes mellitus, and chronic kidney disease) than those with NPS. Patients with PS were more likely to have defibrillator leads (70.1% versus 62.3%; P=0.004) and more leads extracted per case (2.1±1.0 versus 1.9±0.9; P=0.006) though mean lead dwell time was similar between patient groups. Despite some baseline differences, procedural success rates were similar in both groups, 97.6% in the PS versus 98.4% in the NPS group (P=0.257). Major complications occurred in 9 (2.0%) PS patients and 23 (2.2%) patients with NPS (P=0.746). Notably, patients with EDITORIAL
经静脉导联拔管(TLE)是一种复杂而有效的方法，用于去除属于心脏装置的留置导联，具有潜在的严重并发症。因此，2017年关于心血管植入式电子设备导联管理和拔管的HRS专家共识声明认为，TLE只能在完全支持导联拔管项目的中心进行，其中包括以团队为基础的方法，整合设备并能够管理所有潜在的并发症经验丰富的中心将根据患者目前的表现和合并症对患者进行评估，同时考虑手术风险和患者相关风险。然而，尽管我们进行了最好的评估和准备，对于那些考虑TLE的人来说，一个完美的风险分层方法仍然是难以捉摸的。先前胸骨切开术(PS)的患者是一个值得关注的群体，因为理论上的纵隔瘢痕可以防止血管撕裂，相反，粘连和纤维化的增加可能会延迟ttle血管并发症后宝贵的挽救生命的手术通路。从历史上看，PS患者的手术发病率和死亡率都有所增加。在瑞士接受冠状动脉旁路移植术的队列中，PS患者的术后死亡率为9.6%(57/594)，而没有胸骨切开术(NPS)的患者的术后死亡率为2.8%(87/3184)。低心输出量综合征、主动脉内球囊泵支持、延长通气支持时间(>24小时)、出血和胃肠道并发症是PS患者与初级冠状动脉旁路移植术患者相比的突出特征。虽然最近发表的一些数据可能表明，PS是TLE临床成功的一个预测指标，但仍然存在紧急心脏手术的重大风险，这带来了高死亡率，适当的计划与心胸后援是至关重要的。在这篇文章中，Tsang等人提出了一项单中心的经验，先前的胸骨切开术对经静脉铅提取的结果有影响。在1480名接受TLE治疗的患者中，455名患者患有PS，与NPS患者相比，这些患者更有可能是男性，并且有更多的合并症(冠状动脉疾病、高血压、糖尿病和慢性肾脏疾病)。PS患者更有可能使用除颤器导联(70.1%对62.3%;P=0.004)和更多的引线提取(2.1±1.0 vs 1.9±0.9;P=0.006)，但患者组间平均导联停留时间相似。尽管有一些基线差异，但两组的手术成功率相似，PS组为97.6%，NPS组为98.4% (P=0.257)。PS组9例(2.0%)，NPS组23例(2.2%)出现严重并发症(P=0.746)。值得注意的是，社论患者
{"title":"Prior Sternotomy in Transvenous Lead Extraction: Risk Analysis Tempered by Clinical Experience.","authors":"Michael Eskander, V. Pretorius, U. Birgersdotter-Green","doi":"10.1161/CIRCEP.119.007762","DOIUrl":"https://doi.org/10.1161/CIRCEP.119.007762","url":null,"abstract":"Transvenous lead extraction (TLE) is a complex yet effective procedure to remove indwelling leads belonging to cardiac devices with a potential for serious complications. Consequently, the 2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction maintains that TLE be performed only at centers with an environment fully supportive of a lead extraction program, which includes a team-based approach, incorporating equipment and capable of managing all potential complications.1 An experienced center will evaluate the patient based on the current presentation and comorbid conditions, while incorporating the procedural and patient-related risks. Despite our best evaluation and preparation, however, a flawless risk stratification approach for those in consideration for TLE remains elusive. Patients with prior sternotomy (PS) is a group of interest due to theoretical mediastinal scarring which may protect against vascular tears and conversely increased adhesions and fibrosis which may delay precious life-saving surgical access after vascular complication from TLE. Historically, patients with PS have been shown to have increased operative morbidity and mortality. In a Swiss cohort undergoing coronary artery bypass grafting, postoperative mortality rate was 9.6% (57/594) in PS compared with 2.8% (87/3184) in those with no prior sternotomy (NPS). Low cardiac output syndrome, intraaortic balloon pump support, prolonged ventilatory support (>24 hours), hemorrhage and gastrointestinal complications were prominent features in those with PS as compared with those undergoing primary coronary artery bypass grafting. While some recently published data may suggest PS as a predictor of clinical success in the setting of TLE, there continues to be a significant risk of urgent cardiac surgery—which carries high mortality, and appropriate planning with cardiothoracic backup is crucial.3,4 In this issue, Tsang et al5 present a single-center experience with prior sternotomy on outcomes in transvenous lead extractions. Of 1480 patients undergoing TLE, 455 had PS and were more likely to be male and have more comorbid conditions (coronary artery disease, hypertension, diabetes mellitus, and chronic kidney disease) than those with NPS. Patients with PS were more likely to have defibrillator leads (70.1% versus 62.3%; P=0.004) and more leads extracted per case (2.1±1.0 versus 1.9±0.9; P=0.006) though mean lead dwell time was similar between patient groups. Despite some baseline differences, procedural success rates were similar in both groups, 97.6% in the PS versus 98.4% in the NPS group (P=0.257). Major complications occurred in 9 (2.0%) PS patients and 23 (2.2%) patients with NPS (P=0.746). Notably, patients with EDITORIAL","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86787617","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 : 2019-09-01DOI: 10.1161/CIRCEP.118.007118
Ying Tian, E. Wittwer, S. Kapa, Christopher J. McLeod, P. Xiao, P. Noseworthy, S. Mulpuru, A. Deshmukh, Hon-chi Lee, M. Ackerman, S. Asirvatham, T. Munger, Xingpeng Liu, P. Friedman, Y. Cha
BACKGROUND Percutaneous stellate ganglion blockade (SGB) has been used for drug-refractory electrical storm due to ventricular arrhythmia (VA); however, the effects and long-term outcomes have not been well studied. METHODS This study included 30 consecutive patients who had drug-refractory electrical storm and underwent percutaneous SGB between October 1, 2013, and March 31, 2018. Bupivacaine, alone or combined with lidocaine, was injected into the neck with good local anesthetic spread in the vicinity of the left stellate ganglion (n=15) or both stellate ganglia (n=15). Data were collected for patient clinical characteristics, immediate and long-term outcomes, and procedure-related complications. RESULTS Clinical characteristics included age, 58±14 years; men, 73.3%; and left ventricular ejection fraction, 34±16%. At 24 hours, 60% of patients were free of VA. Patients whose VA was controlled had a lower hospital mortality rate than patients whose VA continued (5.6% versus 50.0%; P=0.009). Implantable cardioverter-defibrillator interrogation showed a significant 92% reduction in VA episodes from 26±41 to 2±4 in the 72 hours after SGB (P<0.001). Patients who died during the same hospitalization (n=7) were more likely to have ischemic cardiomyopathy (100% versus 43.5%; P=0.03) and recurrent VA within 24 hours (85.7% versus 26.1%; P=0.009). There were no procedure-related major complications. CONCLUSIONS SGB effectively attenuated electrical storm in more than half of patients without procedure-related complications. Percutaneous SGB may be considered for stabilizing ventricular rhythm in patients for whom other therapies have failed.
背景:经皮星状神经节阻滞(SGB)已被用于治疗室性心律失常(VA)引起的药物难治性电风暴;然而，其影响和长期结果尚未得到很好的研究。方法本研究纳入了2013年10月1日至2018年3月31日期间连续30例难治性电风暴患者经皮SGB。布比卡因单用或联用利多卡因颈部注射，局部麻醉良好，分布于左侧星状神经节附近(n=15)或双侧星状神经节附近(n=15)。收集患者临床特征、近期和长期结果以及手术相关并发症的数据。结果年龄:58±14岁;男性,73.3%;左室射血分数，34±16%。在24小时内，60%的患者没有VA。VA得到控制的患者的医院死亡率低于VA继续存在的患者(5.6%对50.0%;P = 0.009)。植入式心律转复除颤器审讯显示，在SGB后72小时内，VA发作从26±41次减少到2±4次，显著减少92% (P<0.001)。在同一住院期间死亡的患者(n=7)患缺血性心肌病的可能性更大(100%比43.5%;P=0.03)和24小时内VA复发(85.7% vs 26.1%;P = 0.009)。无手术相关的主要并发症。结论ssgb有效地减弱了半数以上患者的电风暴，无手术相关并发症。经皮SGB可用于稳定其他治疗失败的患者的心室节律。
{"title":"Effective Use of Percutaneous Stellate Ganglion Blockade in Patients With Electrical Storm.","authors":"Ying Tian, E. Wittwer, S. Kapa, Christopher J. McLeod, P. Xiao, P. Noseworthy, S. Mulpuru, A. Deshmukh, Hon-chi Lee, M. Ackerman, S. Asirvatham, T. Munger, Xingpeng Liu, P. Friedman, Y. Cha","doi":"10.1161/CIRCEP.118.007118","DOIUrl":"https://doi.org/10.1161/CIRCEP.118.007118","url":null,"abstract":"BACKGROUND\u0000Percutaneous stellate ganglion blockade (SGB) has been used for drug-refractory electrical storm due to ventricular arrhythmia (VA); however, the effects and long-term outcomes have not been well studied.\u0000\u0000\u0000METHODS\u0000This study included 30 consecutive patients who had drug-refractory electrical storm and underwent percutaneous SGB between October 1, 2013, and March 31, 2018. Bupivacaine, alone or combined with lidocaine, was injected into the neck with good local anesthetic spread in the vicinity of the left stellate ganglion (n=15) or both stellate ganglia (n=15). Data were collected for patient clinical characteristics, immediate and long-term outcomes, and procedure-related complications.\u0000\u0000\u0000RESULTS\u0000Clinical characteristics included age, 58±14 years; men, 73.3%; and left ventricular ejection fraction, 34±16%. At 24 hours, 60% of patients were free of VA. Patients whose VA was controlled had a lower hospital mortality rate than patients whose VA continued (5.6% versus 50.0%; P=0.009). Implantable cardioverter-defibrillator interrogation showed a significant 92% reduction in VA episodes from 26±41 to 2±4 in the 72 hours after SGB (P<0.001). Patients who died during the same hospitalization (n=7) were more likely to have ischemic cardiomyopathy (100% versus 43.5%; P=0.03) and recurrent VA within 24 hours (85.7% versus 26.1%; P=0.009). There were no procedure-related major complications.\u0000\u0000\u0000CONCLUSIONS\u0000SGB effectively attenuated electrical storm in more than half of patients without procedure-related complications. Percutaneous SGB may be considered for stabilizing ventricular rhythm in patients for whom other therapies have failed.","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84682608","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 : 2019-09-01DOI: 10.1161/CIRCEP.119.007278
D. Tsang, Adryan A Perez, T. Boyle, R. Carrillo
BACKGROUND A history of open-heart surgery has been a heavily debated topic in transvenous lead extraction. This study evaluates the impact of prior sternotomy on transvenous lead extraction outcomes. METHODS Data for all patients undergoing transvenous lead extraction at a tertiary referral center were prospectively gathered from 2004 to 2017. Relevant clinical information was compared between patients with a history of sternotomy before transvenous lead extraction and those without. After considering baseline differences, multivariate regression, and propensity-matched analysis were performed. Outcome variables included major and minor complication rates, clinical success, and in-hospital mortality as defined by the 2017 Heart Rhythm Society consensus statement. RESULTS Of 1480 patients in the study period, 455 had a prior sternotomy. When compared with patients with no prior sternotomy, those with prior sternotomy were more likely to be older, male, and present with more comorbidities and leads targeted for extraction. No statistical differences were identified in major and minor complication rates (P=0.75, P=0.41), clinical success rate (P=0.26), and in-hospital mortality (P=0.08). In patients with prior sternotomy, there were no instances of pericardial effusion after extraction. Prior sternotomy was not an independent predictor of clinical or procedural outcomes. No associations were elucidated after propensity-matched analysis. CONCLUSIONS In a large, single-center series, no differences in clinical or procedural outcomes were elucidated between patients with a history of sternotomy and those without. Patients with sternotomies before lead extraction who experienced vascular or cardiac perforations clinically presented with hemothoraces rather than pericardial effusions.
{"title":"Effect of Prior Sternotomy on Outcomes in Transvenous Lead Extraction.","authors":"D. Tsang, Adryan A Perez, T. Boyle, R. Carrillo","doi":"10.1161/CIRCEP.119.007278","DOIUrl":"https://doi.org/10.1161/CIRCEP.119.007278","url":null,"abstract":"BACKGROUND\u0000A history of open-heart surgery has been a heavily debated topic in transvenous lead extraction. This study evaluates the impact of prior sternotomy on transvenous lead extraction outcomes.\u0000\u0000\u0000METHODS\u0000Data for all patients undergoing transvenous lead extraction at a tertiary referral center were prospectively gathered from 2004 to 2017. Relevant clinical information was compared between patients with a history of sternotomy before transvenous lead extraction and those without. After considering baseline differences, multivariate regression, and propensity-matched analysis were performed. Outcome variables included major and minor complication rates, clinical success, and in-hospital mortality as defined by the 2017 Heart Rhythm Society consensus statement.\u0000\u0000\u0000RESULTS\u0000Of 1480 patients in the study period, 455 had a prior sternotomy. When compared with patients with no prior sternotomy, those with prior sternotomy were more likely to be older, male, and present with more comorbidities and leads targeted for extraction. No statistical differences were identified in major and minor complication rates (P=0.75, P=0.41), clinical success rate (P=0.26), and in-hospital mortality (P=0.08). In patients with prior sternotomy, there were no instances of pericardial effusion after extraction. Prior sternotomy was not an independent predictor of clinical or procedural outcomes. No associations were elucidated after propensity-matched analysis.\u0000\u0000\u0000CONCLUSIONS\u0000In a large, single-center series, no differences in clinical or procedural outcomes were elucidated between patients with a history of sternotomy and those without. Patients with sternotomies before lead extraction who experienced vascular or cardiac perforations clinically presented with hemothoraces rather than pericardial effusions.","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80623046","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 : 2019-09-01DOI: 10.1161/CIRCEP.119.007707
B. Narasimhan, H. Tandri
The increasing use of implantable defibrillators for sudden death prevention and the recent advances in heart failure therapies have significantly altered the natural history of heart disease. An unfortunate consequence of this is the increasing incidence of refractory tachyarrhythmias. The most serious of ventricular arrhythmias (VA) is the electrical storm, defined as ≥3 episodes of sustained ventricular tachyarrhythmia over a 24-hour period.1 The annual incidence varies from 2% to 10% and is associated with a 2to 8-fold increase in mortality. This is most likely a testament to the severely compromised underlying myocardial substrate than to the electrical storm itself. It is well established that the sympathetic nervous system plays an integral role in initiating and driving electrical storm.2 Pharmacological approaches to sympathetic blockade using β-blockers though effective have several shortcomings. The sympathetic nervous system involves multiple nonadrenergic pathways and neuromodulators which are unaffected by these medications. Additionally, the β2 receptor which is untouched by the conventionally cardio-selective β-blockers appears to play an integral proarrhythmic role as well. These shortcomings are overcome by surgical approaches where the cardiac sympathetic supply in its entirety is decentralized. The earliest attempt at surgical sympathectomy was over a century ago when Jonnesco3 performed a left cardiac sympathetic denervation in a successful attempt to relieve refractory angina in syphilitic aortitis.2 Since that time the field has burgeoned with a number of interventions targeting multiple sites along the sympathetic chain. These range from thoracic epidural/general anesthesia, stellate ganglion blockade, renal artery denervation to surgical stellate ganglion resection. Cardiac sympathetic denervation is undeniably beneficial in certain conditions—however, consensus about where it fits into regular practice remains to be established. Percutaneous stellate ganglion blockade (PC-SGB) is currently the least invasive method available, and its role in management of electrical storm is comprehensively explored in this issue of Heart Rhythm by Tian et al.4 In the largest prospective study of PC-SGB to date, 30 patients presenting with drug-refractory electric storm between 2013 and 2018 were included (58±14 years, 73.3% males, mean left ventricular election fraction, 34±15). Ultrasound guidance was used in the majority of patients with half the study population undergoing a left-sided stellate block, with bilateral blockade in the remainder. An incremental approach was used with an initial left-sided SGB, and progression to bilateral block if recurrence of arrhythmia was noted within 10 minutes. Rise in ipsilateral arm temperature was used as a surrogate for efficacy of block, though the authors themselves indicate that the temperatures were inadequately measured. EDITORIAL
{"title":"Stellate Block in Refractory Ventricular Tachycardia: The Calm After the Storm.","authors":"B. Narasimhan, H. Tandri","doi":"10.1161/CIRCEP.119.007707","DOIUrl":"https://doi.org/10.1161/CIRCEP.119.007707","url":null,"abstract":"The increasing use of implantable defibrillators for sudden death prevention and the recent advances in heart failure therapies have significantly altered the natural history of heart disease. An unfortunate consequence of this is the increasing incidence of refractory tachyarrhythmias. The most serious of ventricular arrhythmias (VA) is the electrical storm, defined as ≥3 episodes of sustained ventricular tachyarrhythmia over a 24-hour period.1 The annual incidence varies from 2% to 10% and is associated with a 2to 8-fold increase in mortality. This is most likely a testament to the severely compromised underlying myocardial substrate than to the electrical storm itself. It is well established that the sympathetic nervous system plays an integral role in initiating and driving electrical storm.2 Pharmacological approaches to sympathetic blockade using β-blockers though effective have several shortcomings. The sympathetic nervous system involves multiple nonadrenergic pathways and neuromodulators which are unaffected by these medications. Additionally, the β2 receptor which is untouched by the conventionally cardio-selective β-blockers appears to play an integral proarrhythmic role as well. These shortcomings are overcome by surgical approaches where the cardiac sympathetic supply in its entirety is decentralized. The earliest attempt at surgical sympathectomy was over a century ago when Jonnesco3 performed a left cardiac sympathetic denervation in a successful attempt to relieve refractory angina in syphilitic aortitis.2 Since that time the field has burgeoned with a number of interventions targeting multiple sites along the sympathetic chain. These range from thoracic epidural/general anesthesia, stellate ganglion blockade, renal artery denervation to surgical stellate ganglion resection. Cardiac sympathetic denervation is undeniably beneficial in certain conditions—however, consensus about where it fits into regular practice remains to be established. Percutaneous stellate ganglion blockade (PC-SGB) is currently the least invasive method available, and its role in management of electrical storm is comprehensively explored in this issue of Heart Rhythm by Tian et al.4 In the largest prospective study of PC-SGB to date, 30 patients presenting with drug-refractory electric storm between 2013 and 2018 were included (58±14 years, 73.3% males, mean left ventricular election fraction, 34±15). Ultrasound guidance was used in the majority of patients with half the study population undergoing a left-sided stellate block, with bilateral blockade in the remainder. An incremental approach was used with an initial left-sided SGB, and progression to bilateral block if recurrence of arrhythmia was noted within 10 minutes. Rise in ipsilateral arm temperature was used as a surrogate for efficacy of block, though the authors themselves indicate that the temperatures were inadequately measured. EDITORIAL","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73611970","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 : 2019-09-01DOI: 10.1161/CIRCEP.119.007582
J. Kron, A. Mauro, A. Bonaventura, S. Toldo, Fadi N. Salloum, K. Ellenbogen, A. Abbate
September 2019 1 Cardiac sarcoidosis (CS) can occur in ≤25% of patients with sarcoidosis in other organ systems leading to life-threatening ventricular arrhythmias, heart block, heart failure, and death. An essential part of the innate immune system, the inflammasome is a macromolecular structure in the cell that responds to a danger signal by releasing IL (interleukin)-1β and amplifying the inflammatory response.1 IL-1β is indeed the prototypical proinflammatory cytokine processed within the inflammasome.1 A role for IL-1β in the pathogenesis of sarcoidosis has been proposed. IL-1β participates in the pathogenesis of granuloma formation in the mouse.2 The ratio of IL-1 receptor antagonist/IL-1β was a marker in predicting the persistence of pulmonary granulomatous lesions in patients.3 Importantly, the main mechanism of action of IL-1β is to activate the nuclear transcription factor NF-kB (nuclear factor-kappa B), also a target of glucocorticoids. We hypothesized that CS would lead to the formation of the inflammasome. We studied cardiac pathology specimens from 3 patients with a diagnosis of CS based on Heart Rhythm Society 2014 Consensus Statement Criteria4 obtained from the left ventricle during total artificial heart implantation in 1 patient and left ventricular assist device implantation and subsequent orthotopic heart transplant in 2 patients. The regions of the heart to be sampled were chosen based on abnormalities upon macroscopic inspection. The study was approved by the Institutional Review Board of the Virginia Commonwealth University, Richmond, VA. Patient No. 1 is a 59-year-old man with pulmonary sarcoidosis who presented with complete heart block, ventricular tachycardia, and left ventricular systolic dysfunction. The patient was treated with prednisone, mycophenolate mofetil, and hydroxychloroquine. Cardiac 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) 1 month before total artificial heart showed severe-intensity FDG uptake in the apical septum and inferior walls (Figure [A and B]). Because of progressive heart failure symptoms, he underwent total artificial heart followed 7 months later by orthotopic heart transplant. Patient No. 2 is a 60-year-old woman with biopsy-proven pulmonary sarcoidosis who presented with complete atrioventricular block and left ventricular systolic dysfunction. FDG-PET performed 2 months before left ventricular assist device showed moderate-intensity diffuse FDG uptake extending into the left ventricular apex (Figure [E and F]). She then underwent Heartmate II implantation followed 3 months later by orthotopic heart transplant. Patient No. 3 is a 64-year-old male with sinus node dysfunction and nonischemic cardiomyopathy. Cardiac PET showed FDG uptake concerning for CS and hilar and mediastinal lymphadenopathy. Carinal lymph node biopsy showed noncaseating granulomas. He was treated with prednisone and methotrexate. FDG-PET performed showed mild-intensity patchy hypermetabolic activity
{"title":"Inflammasome Formation in Granulomas in Cardiac Sarcoidosis.","authors":"J. Kron, A. Mauro, A. Bonaventura, S. Toldo, Fadi N. Salloum, K. Ellenbogen, A. Abbate","doi":"10.1161/CIRCEP.119.007582","DOIUrl":"https://doi.org/10.1161/CIRCEP.119.007582","url":null,"abstract":"September 2019 1 Cardiac sarcoidosis (CS) can occur in ≤25% of patients with sarcoidosis in other organ systems leading to life-threatening ventricular arrhythmias, heart block, heart failure, and death. An essential part of the innate immune system, the inflammasome is a macromolecular structure in the cell that responds to a danger signal by releasing IL (interleukin)-1β and amplifying the inflammatory response.1 IL-1β is indeed the prototypical proinflammatory cytokine processed within the inflammasome.1 A role for IL-1β in the pathogenesis of sarcoidosis has been proposed. IL-1β participates in the pathogenesis of granuloma formation in the mouse.2 The ratio of IL-1 receptor antagonist/IL-1β was a marker in predicting the persistence of pulmonary granulomatous lesions in patients.3 Importantly, the main mechanism of action of IL-1β is to activate the nuclear transcription factor NF-kB (nuclear factor-kappa B), also a target of glucocorticoids. We hypothesized that CS would lead to the formation of the inflammasome. We studied cardiac pathology specimens from 3 patients with a diagnosis of CS based on Heart Rhythm Society 2014 Consensus Statement Criteria4 obtained from the left ventricle during total artificial heart implantation in 1 patient and left ventricular assist device implantation and subsequent orthotopic heart transplant in 2 patients. The regions of the heart to be sampled were chosen based on abnormalities upon macroscopic inspection. The study was approved by the Institutional Review Board of the Virginia Commonwealth University, Richmond, VA. Patient No. 1 is a 59-year-old man with pulmonary sarcoidosis who presented with complete heart block, ventricular tachycardia, and left ventricular systolic dysfunction. The patient was treated with prednisone, mycophenolate mofetil, and hydroxychloroquine. Cardiac 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) 1 month before total artificial heart showed severe-intensity FDG uptake in the apical septum and inferior walls (Figure [A and B]). Because of progressive heart failure symptoms, he underwent total artificial heart followed 7 months later by orthotopic heart transplant. Patient No. 2 is a 60-year-old woman with biopsy-proven pulmonary sarcoidosis who presented with complete atrioventricular block and left ventricular systolic dysfunction. FDG-PET performed 2 months before left ventricular assist device showed moderate-intensity diffuse FDG uptake extending into the left ventricular apex (Figure [E and F]). She then underwent Heartmate II implantation followed 3 months later by orthotopic heart transplant. Patient No. 3 is a 64-year-old male with sinus node dysfunction and nonischemic cardiomyopathy. Cardiac PET showed FDG uptake concerning for CS and hilar and mediastinal lymphadenopathy. Carinal lymph node biopsy showed noncaseating granulomas. He was treated with prednisone and methotrexate. FDG-PET performed showed mild-intensity patchy hypermetabolic activity ","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83548750","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 : 2019-09-01DOI: 10.1161/hae.0000000000000043
{"title":"Correction to: Nonequilibrium Reactivation of Na\u0000 +\u0000 Current Drives Early Afterdepolarizations in Mouse Ventricle","authors":"","doi":"10.1161/hae.0000000000000043","DOIUrl":"https://doi.org/10.1161/hae.0000000000000043","url":null,"abstract":"","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74580820","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 : 2019-09-01DOI: 10.1161/CIRCEP.119.007337
B. Nazer, Tomos E. Walters, Thomas A. Dewland, Aditi Naniwadekar, J. Koruth, Mohammed Najeeb Osman, A. Intini, Minglong Chen, Jürgen Biermann, J. Steinfurt, J. Kalman, R. Tanel, Byron K. Lee, N. Badhwar, E. Gerstenfeld, M. Scheinman
BACKGROUND Nodofascicular and nodoventricular (NFV) accessory pathways connect the atrioventricular node and the Purkinje system or ventricular myocardium, respectively. Concealed NFV pathways participate as the retrograde limb of supraventricular tachycardia (SVT). Manifest NFV pathways can comprise the anterograde limb of wide-complex SVT but are quite rare. The purpose of this report is to highlight the electrophysiological properties and sites of ablation for manifest NFV pathways. METHODS Eight patients underwent electrophysiology studies for wide-complex tachycardia (3), for narrow-complex tachycardia (1), and preexcitation (4). RESULTS NFV was an integral part of the SVT circuit in 3 patients. Cases 1 to 2 were wide-complex tachycardia because of manifest NFV SVT. Case 3 was a bidirectional NFV that conducted retrograde during concealed NFV SVT and anterograde causing preexcitation during atrial pacing. NFV was a bystander during atrioventricular node re-entrant tachycardia, atrial fibrillation, atrial flutter, and orthodromic atrioventricular re-entrant tachycardia in 4 cases and caused only preexcitation in 1. Successful NFV ablation was achieved empirically in the slow pathway region in 1 case. In 5 cases, the ventricular insertion was mapped to the slow pathway region (2 cases) or septal right ventricle (3 cases). The NFV was not mapped in cases 5 and 7 because of its bystander role. QRS morphology of preexcitation predicted the right ventricle insertion sites in 4 of the 5 cases in which it was mapped. During follow-up, 1 patient noted recurrent palpitations but no documented SVT. CONCLUSIONS Manifest NFV may be critical for wide-complex tachycardia/manifest NFV SVT, act as the retrograde limb for narrow-complex tachycardia/concealed NFV SVT, or cause bystander preexcitation. Ablation should initially target the slow pathway region, with mapping of the right ventricle insertion site if slow pathway ablation is not successful. The QRS morphology of maximal preexcitation may be helpful in predicting successful right ventricle ablation site.
{"title":"Variable Presentations and Ablation Sites for Manifest Nodoventricular/Nodofascicular Fibers.","authors":"B. Nazer, Tomos E. Walters, Thomas A. Dewland, Aditi Naniwadekar, J. Koruth, Mohammed Najeeb Osman, A. Intini, Minglong Chen, Jürgen Biermann, J. Steinfurt, J. Kalman, R. Tanel, Byron K. Lee, N. Badhwar, E. Gerstenfeld, M. Scheinman","doi":"10.1161/CIRCEP.119.007337","DOIUrl":"https://doi.org/10.1161/CIRCEP.119.007337","url":null,"abstract":"BACKGROUND\u0000Nodofascicular and nodoventricular (NFV) accessory pathways connect the atrioventricular node and the Purkinje system or ventricular myocardium, respectively. Concealed NFV pathways participate as the retrograde limb of supraventricular tachycardia (SVT). Manifest NFV pathways can comprise the anterograde limb of wide-complex SVT but are quite rare. The purpose of this report is to highlight the electrophysiological properties and sites of ablation for manifest NFV pathways.\u0000\u0000\u0000METHODS\u0000Eight patients underwent electrophysiology studies for wide-complex tachycardia (3), for narrow-complex tachycardia (1), and preexcitation (4).\u0000\u0000\u0000RESULTS\u0000NFV was an integral part of the SVT circuit in 3 patients. Cases 1 to 2 were wide-complex tachycardia because of manifest NFV SVT. Case 3 was a bidirectional NFV that conducted retrograde during concealed NFV SVT and anterograde causing preexcitation during atrial pacing. NFV was a bystander during atrioventricular node re-entrant tachycardia, atrial fibrillation, atrial flutter, and orthodromic atrioventricular re-entrant tachycardia in 4 cases and caused only preexcitation in 1. Successful NFV ablation was achieved empirically in the slow pathway region in 1 case. In 5 cases, the ventricular insertion was mapped to the slow pathway region (2 cases) or septal right ventricle (3 cases). The NFV was not mapped in cases 5 and 7 because of its bystander role. QRS morphology of preexcitation predicted the right ventricle insertion sites in 4 of the 5 cases in which it was mapped. During follow-up, 1 patient noted recurrent palpitations but no documented SVT.\u0000\u0000\u0000CONCLUSIONS\u0000Manifest NFV may be critical for wide-complex tachycardia/manifest NFV SVT, act as the retrograde limb for narrow-complex tachycardia/concealed NFV SVT, or cause bystander preexcitation. Ablation should initially target the slow pathway region, with mapping of the right ventricle insertion site if slow pathway ablation is not successful. The QRS morphology of maximal preexcitation may be helpful in predicting successful right ventricle ablation site.","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75576851","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 : 2019-09-01DOI: 10.1161/CIRCEP.119.007500
K. Okubo, A. Frontera, C. Bisceglia, G. Paglino, A. Radinovic, L. Foppoli, F. Calore, P. Della Bella
BACKGROUND A new grid mapping catheter (GMC)-allowing for bipolar recordings of the electrograms in each orthogonal direction-became available. The aim of the current study is to evaluate the utility of the GMC in creating substrate and ventricular tachycardia (VT) activation maps during VT ablation procedures. METHODS From December 2017 to July 2018, 41 consecutive patients undergoing a VT ablation procedure using a GMC were studied. During the substrate mapping, 3 different maps were created using the 3 GMC bipolar configurations (along the spline, across the spline, HD wave solution); the low voltage area and late potential areas were compared. In case of inducible VTs, the GMC was used to create the VT activation maps focusing on the diastolic interval. The relation between diastolic activities during VT and substrate abnormality during sinus rhythm was also investigated. RESULTS The median low-voltage area drawn by the HD wave configuration was 28.9 cm2, 13% and 15% smaller than the low-voltage areas identified by the along and across configuration, respectively (33.1 and 33.9 cm2; P<0.0001). The late potential areas obtained with the 3 GMC configuration did not differ (P>0.05). VT activation mappings using the GMC were performed in 40 VTs, visualizing the full diastolic pathway in 22 (55%) of them. While the latest late potential areas were included in VT diastolic pathway in 17 VTs, the other 6 VTs showed mismatching of them. Identifying the full diastolic pathway led to a higher ongoing VT termination rate during the ablation than in case of partial recordings (88% versus 45%; P=0.03); furthermore, in the former situation, the noninducibility of the targeted VTs was achieved in all cases. CONCLUSIONS The GMC is a useful tool for performing substrate and VT activation mappings during the VT ablation procedure, precisely identifying the low-voltage areas and quickly visualizing the diastolic pathways.
{"title":"Grid Mapping Catheter for Ventricular Tachycardia Ablation.","authors":"K. Okubo, A. Frontera, C. Bisceglia, G. Paglino, A. Radinovic, L. Foppoli, F. Calore, P. Della Bella","doi":"10.1161/CIRCEP.119.007500","DOIUrl":"https://doi.org/10.1161/CIRCEP.119.007500","url":null,"abstract":"BACKGROUND\u0000A new grid mapping catheter (GMC)-allowing for bipolar recordings of the electrograms in each orthogonal direction-became available. The aim of the current study is to evaluate the utility of the GMC in creating substrate and ventricular tachycardia (VT) activation maps during VT ablation procedures.\u0000\u0000\u0000METHODS\u0000From December 2017 to July 2018, 41 consecutive patients undergoing a VT ablation procedure using a GMC were studied. During the substrate mapping, 3 different maps were created using the 3 GMC bipolar configurations (along the spline, across the spline, HD wave solution); the low voltage area and late potential areas were compared. In case of inducible VTs, the GMC was used to create the VT activation maps focusing on the diastolic interval. The relation between diastolic activities during VT and substrate abnormality during sinus rhythm was also investigated.\u0000\u0000\u0000RESULTS\u0000The median low-voltage area drawn by the HD wave configuration was 28.9 cm2, 13% and 15% smaller than the low-voltage areas identified by the along and across configuration, respectively (33.1 and 33.9 cm2; P<0.0001). The late potential areas obtained with the 3 GMC configuration did not differ (P>0.05). VT activation mappings using the GMC were performed in 40 VTs, visualizing the full diastolic pathway in 22 (55%) of them. While the latest late potential areas were included in VT diastolic pathway in 17 VTs, the other 6 VTs showed mismatching of them. Identifying the full diastolic pathway led to a higher ongoing VT termination rate during the ablation than in case of partial recordings (88% versus 45%; P=0.03); furthermore, in the former situation, the noninducibility of the targeted VTs was achieved in all cases.\u0000\u0000\u0000CONCLUSIONS\u0000The GMC is a useful tool for performing substrate and VT activation mappings during the VT ablation procedure, precisely identifying the low-voltage areas and quickly visualizing the diastolic pathways.","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75285504","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 : 2019-09-01DOI: 10.1161/CIRCEP.119.007393
W. Barake, Chance M. Witt, Vaibhav R. Vaidya, Y. Cha
September 2019 1 Left bundle branch block (LBBB) is associated with left ventricular dysfunction, heart failure, and increased mortality in patients with/without cardiac diseases.1–3 In our previous study of 1436 patients with mild to moderately reduced left ventricular ejection fraction (LVEF) and LBBB, the clinical outcomes were significantly worse than those of patients without conduction disease.3 Current data on incidence of LBBB-induced cardiomyopathy remain sparse. We further studied adult patients with LBBB and baseline normal LVEF of >50% from 1994 to 2014. Institutional Review Board approval was obtained for this study. Informed consents were waived given the retrospective aspect of the study and the minimal risks involved. Categorical variables were compared with the χ2 test and continuous variables with the ANOVA test. All statistical analysis was performed using JMP software (SAS Institute, Cary, NC). Only 549 patients who had baseline and follow-up echocardiograms were included out of a total 2235 patient with LBBB and baseline LVEF >50%. Patients who had a significant drop in LVEF (>10%) to less than 50% were reviewed to determine the cause of cardiomyopathy. The study cohort consisted of 549 patients (age 66.7±11.0 years; 55% females) with a LBBB, normal LVEF (>50%) at baseline, and a follow-up echocardiogram. Of these, 134 (24.4%) had a significant drop in LVEF. The baseline characteristics were comparable between patients with and without drop in the LVEF except for sex and hyperlipidemia (Table). Patients who had a drop in LVEF were more likely to be males (P=0.02) and more likely to be hyperlipidemic (P=0.04). The majority of patients who developed LV dysfunction had clearly identifiable causes of worsening LVEF (Figure). It is important to note that patients with other potential causes of cardiomyopathy may, in fact, have developed LV dysfunction due the LBBB. Nevertheless, to limit potential confounders, we did not consider the LBBB as the cause unless there were no other causes. Ischemic heart disease was the most common condition associated with LVEF drop (10%). The cause of cardiomyopathy in the remaining 29 patients (5.3%) was potentially related to the LBBB itself. All patients with suspected LBBB-induced cardiomyopathy had been evaluated with advanced imaging (cardiac MRI and cardiac positron emission tomography /computed tomography) to rule out other etiologies. Patients with possible LBBB-induced cardiomyopathy were more likely to be younger (average of 59.8 versus 66.6 years, P=0.02). Mean baseline LVEF was 56% and dropped to a low EF of 31% at an average of 4.6 years. Of this group, 83% developed new onset of heart failure; 30% died at an average of 7.2 years from the drop in EF. The EF was ≤35% in 24 (83%) patients, with cardiac resynchronization therapy instituted in only 7 (24%). In these patients, there was a significantly greater improvement in EF in those receiving cardiac resynchronization therapy compared w
1左束支传导阻滞(LBBB)与有/无心脏病患者的左心室功能障碍、心力衰竭和死亡率增加有关。1-3在我们之前对1436例轻至中度左室射血分数(LVEF)和LBBB降低的患者的研究中，临床结果明显差于无传导疾病的患者目前关于lbbb引起的心肌病发病率的数据仍然很少。我们进一步研究了1994 - 2014年LBBB和基线正常LVEF >50%的成人患者。本研究获得了机构审查委员会的批准。考虑到该研究的回顾性和所涉及的最小风险，我们放弃了知情同意。分类变量比较采用χ2检验，连续变量比较采用ANOVA检验。所有统计分析均使用JMP软件(SAS Institute, Cary, NC)进行。在2235例LBBB和基线LVEF >50%的患者中，只有549例有基线和随访超声心动图的患者被纳入研究。对LVEF显著下降(>10%)至50%以下的患者进行复查，以确定心肌病的原因。研究队列包括549例患者(年龄66.7±11.0岁;55%女性)，LBBB，基线LVEF正常(>50%)，随访超声心动图。其中，134个(24.4%)的LVEF显著下降。除性别和高脂血症外，LVEF下降和未下降患者的基线特征具有可比性(表)。LVEF下降的患者多为男性(P=0.02)，高脂血症患者多(P=0.04)。大多数发生左室功能障碍的患者都有明确的LVEF恶化原因(图)。值得注意的是，患有其他潜在心肌病原因的患者实际上可能由于左脑屏障而发生左室功能障碍。然而，为了限制潜在的混杂因素，除非没有其他原因，否则我们不认为LBBB是病因。缺血性心脏病是与LVEF下降相关的最常见疾病(10%)。其余29例(5.3%)患者的心肌病病因可能与LBBB本身有关。所有疑似lbbb引起的心肌病患者都进行了高级影像学评估(心脏MRI和心脏正电子发射断层扫描/计算机断层扫描)，以排除其他病因。可能由lbbb诱发的心肌病的患者更年轻(平均年龄59.8岁vs 66.6岁，P=0.02)。平均基线LVEF为56%，在平均4.6年时降至31%的低EF。在这一组中，83%的人出现了新发心力衰竭;30%的人死于平均7.2年的EF下降。24例(83%)患者EF≤35%，只有7例(24%)患者接受了心脏再同步化治疗。在这些患者中，与未接受心脏再同步化治疗的患者相比，接受心脏再同步化治疗的患者EF有更大的改善(平均绝对LVEF增加16%对4%，P=0.001)。接受心脏再同步化治疗的患者最近的LVEF平均为41%。研究信
{"title":"Incidence and Natural History of Left Bundle Branch Block Induced Cardiomyopathy.","authors":"W. Barake, Chance M. Witt, Vaibhav R. Vaidya, Y. Cha","doi":"10.1161/CIRCEP.119.007393","DOIUrl":"https://doi.org/10.1161/CIRCEP.119.007393","url":null,"abstract":"September 2019 1 Left bundle branch block (LBBB) is associated with left ventricular dysfunction, heart failure, and increased mortality in patients with/without cardiac diseases.1–3 In our previous study of 1436 patients with mild to moderately reduced left ventricular ejection fraction (LVEF) and LBBB, the clinical outcomes were significantly worse than those of patients without conduction disease.3 Current data on incidence of LBBB-induced cardiomyopathy remain sparse. We further studied adult patients with LBBB and baseline normal LVEF of >50% from 1994 to 2014. Institutional Review Board approval was obtained for this study. Informed consents were waived given the retrospective aspect of the study and the minimal risks involved. Categorical variables were compared with the χ2 test and continuous variables with the ANOVA test. All statistical analysis was performed using JMP software (SAS Institute, Cary, NC). Only 549 patients who had baseline and follow-up echocardiograms were included out of a total 2235 patient with LBBB and baseline LVEF >50%. Patients who had a significant drop in LVEF (>10%) to less than 50% were reviewed to determine the cause of cardiomyopathy. The study cohort consisted of 549 patients (age 66.7±11.0 years; 55% females) with a LBBB, normal LVEF (>50%) at baseline, and a follow-up echocardiogram. Of these, 134 (24.4%) had a significant drop in LVEF. The baseline characteristics were comparable between patients with and without drop in the LVEF except for sex and hyperlipidemia (Table). Patients who had a drop in LVEF were more likely to be males (P=0.02) and more likely to be hyperlipidemic (P=0.04). The majority of patients who developed LV dysfunction had clearly identifiable causes of worsening LVEF (Figure). It is important to note that patients with other potential causes of cardiomyopathy may, in fact, have developed LV dysfunction due the LBBB. Nevertheless, to limit potential confounders, we did not consider the LBBB as the cause unless there were no other causes. Ischemic heart disease was the most common condition associated with LVEF drop (10%). The cause of cardiomyopathy in the remaining 29 patients (5.3%) was potentially related to the LBBB itself. All patients with suspected LBBB-induced cardiomyopathy had been evaluated with advanced imaging (cardiac MRI and cardiac positron emission tomography /computed tomography) to rule out other etiologies. Patients with possible LBBB-induced cardiomyopathy were more likely to be younger (average of 59.8 versus 66.6 years, P=0.02). Mean baseline LVEF was 56% and dropped to a low EF of 31% at an average of 4.6 years. Of this group, 83% developed new onset of heart failure; 30% died at an average of 7.2 years from the drop in EF. The EF was ≤35% in 24 (83%) patients, with cardiac resynchronization therapy instituted in only 7 (24%). In these patients, there was a significantly greater improvement in EF in those receiving cardiac resynchronization therapy compared w","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87967508","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 : 2019-08-27DOI: 10.1161/CIRCEP.119.007284
Z. Attia, P. Friedman, P. Noseworthy, F. Lopez‐Jimenez, Dorothy J. Ladewig, Gaurav Satam, P. Pellikka, T. Munger, S. Asirvatham, C. Scott, R. Carter, S. Kapa
Supplemental Digital Content is available in the text.
补充数字内容可在文本中找到。
{"title":"Age and Sex Estimation Using Artificial Intelligence From Standard 12-Lead ECGs","authors":"Z. Attia, P. Friedman, P. Noseworthy, F. Lopez‐Jimenez, Dorothy J. Ladewig, Gaurav Satam, P. Pellikka, T. Munger, S. Asirvatham, C. Scott, R. Carter, S. Kapa","doi":"10.1161/CIRCEP.119.007284","DOIUrl":"https://doi.org/10.1161/CIRCEP.119.007284","url":null,"abstract":"Supplemental Digital Content is available in the text.","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"430 1","pages":"e007284 - e007284"},"PeriodicalIF":0.0,"publicationDate":"2019-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76639118","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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