Michael Ghannam, Jamie Simpson, Mohamed Al-Sadawi, Amrish Deshmukh, Jackson J Liang, Rakesh Latchamsetty, Thomas Crawford, Krit Jongnarangsin, Hakan Oral, Frank Bogun
Background: Cather ablation of parahisian premature ventricular complexes (PVCs) often requires ablation in multiple cardiac chambers, including the sinuses of Valsalva (SoV). The safety and efficacy of ablation within the right SoV to target parahisian arrhythmias has not been widely reported.
Objective: To report on the demographic and procedural characteristics of patients undergoing catheter ablation of PVCs who underwent ablation in the right SoV, and to examine the impact of late-gadolinium enhanced cardiac magnetic resonance (LGE-CMR) on procedural findings.
Methods: Consecutive patients undergoing ablation of parahisian PVCs and ablation in the right SoV with preprocedural LGE-CMR were included.
Results: Eleven patients were included in the study population (11 males (100%), median age: 68 ± 7 years, median ejection fraction: 53% ± 7%, PVC burden 23% ± 13%). Intramural LGE-CMR scar was present in all patients and involved the basal anteroseptum/outflow tract in nine patients. Ablation within the right SoV eliminated (n = 9) or suppressed (n = 2) PVCs in all patients. The successful SoV site displayed the absolute earliest presystolic activation time or matching pacemaps in only 44% and 55% of patients, respectfully. Transient heart block during right SoV ablation occurred in 1/11(9%) patients. The post procedure PVC burden decreased from 23% ± 13% to 7% ± 6%, procedural success was attained in 10/11(91%) of patients.
Conclusions: Parahisian PVCs ablated from the right SoV are often intramural, may require ablation in multiple chambers, and colocalize with intramural LGE-CMR scar. Traditional EGM markers of successful ablation sites were less frequently seen at successful site of SoV ablation, long term success was achieved in 91% of patients.
{"title":"Catheter Ablation of Parahisian Premature Ventricular Complexes From the Right Sinus of Valsalva.","authors":"Michael Ghannam, Jamie Simpson, Mohamed Al-Sadawi, Amrish Deshmukh, Jackson J Liang, Rakesh Latchamsetty, Thomas Crawford, Krit Jongnarangsin, Hakan Oral, Frank Bogun","doi":"10.1111/jce.16513","DOIUrl":"https://doi.org/10.1111/jce.16513","url":null,"abstract":"<p><strong>Background: </strong>Cather ablation of parahisian premature ventricular complexes (PVCs) often requires ablation in multiple cardiac chambers, including the sinuses of Valsalva (SoV). The safety and efficacy of ablation within the right SoV to target parahisian arrhythmias has not been widely reported.</p><p><strong>Objective: </strong>To report on the demographic and procedural characteristics of patients undergoing catheter ablation of PVCs who underwent ablation in the right SoV, and to examine the impact of late-gadolinium enhanced cardiac magnetic resonance (LGE-CMR) on procedural findings.</p><p><strong>Methods: </strong>Consecutive patients undergoing ablation of parahisian PVCs and ablation in the right SoV with preprocedural LGE-CMR were included.</p><p><strong>Results: </strong>Eleven patients were included in the study population (11 males (100%), median age: 68 ± 7 years, median ejection fraction: 53% ± 7%, PVC burden 23% ± 13%). Intramural LGE-CMR scar was present in all patients and involved the basal anteroseptum/outflow tract in nine patients. Ablation within the right SoV eliminated (n = 9) or suppressed (n = 2) PVCs in all patients. The successful SoV site displayed the absolute earliest presystolic activation time or matching pacemaps in only 44% and 55% of patients, respectfully. Transient heart block during right SoV ablation occurred in 1/11(9%) patients. The post procedure PVC burden decreased from 23% ± 13% to 7% ± 6%, procedural success was attained in 10/11(91%) of patients.</p><p><strong>Conclusions: </strong>Parahisian PVCs ablated from the right SoV are often intramural, may require ablation in multiple chambers, and colocalize with intramural LGE-CMR scar. Traditional EGM markers of successful ablation sites were less frequently seen at successful site of SoV ablation, long term success was achieved in 91% of patients.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Redo Ablation Slows the Decline in Atrial Strain From Natural Progression of Atrial Fibrillation","authors":"Jiawei Dong, Ravi Ranjan","doi":"10.1111/jce.16528","DOIUrl":"10.1111/jce.16528","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"36 2","pages":"544-545"},"PeriodicalIF":2.3,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Research on the impact of angiographically detected residual trabeculation after left atrial appendage closure (LAAC) is limited.
Objectives
To investigate the incidence, characteristics, and clinical implications of angiographically detected residual trabeculation after LAAC using the WATCHMAN device.
Methods
We analyzed 1350 consecutive patients with atrial fibrillation undergoing LAAC using the WATCHMAN device from the OCEAN-LAAC registry, which is a prospective ongoing, multicenter Japanese registry. The inclusion criteria comprised patients who successfully underwent LAAC and whose presence or absence of residual trabeculation can be confirmed using a contrast medium. The clinical outcomes were compared between patients with and without angiographically detected residual trabeculation.
Results
Residual trabeculation was angiographically detected in 5.6% (75/1350 patients). At the procedure, the proportion of peri-device leak (PDL) was significantly higher in the residual trabeculation group than in the non-residual trabeculation group (20% vs. 5.1%, p < 0.001). However, the PDL and device-related thrombosis at 45 days and 1 year were comparable between the two groups (37% vs. 23%, p = 0.24; 28% vs. 31%, p = 0.84; 2.1% vs. 1.4%, p = 0.50; 6.9% vs. 6.0%, p = 0.69, respectively). The 3-year cumulative incidence of ischemic stroke, all cardiovascular death, and all-cause death were comparable between the two groups (5.7% vs. 5.5%, log-rank p = 0.96; 7.7% vs. 8.9%, log-rank p = 0.34, 31.4% vs. 22.3%, log-rank p = 0.71, respectively).
Conclusion
The angiographically detected residual trabeculation rate was 5.6%, and this population had a significantly higher prevalence of PDL at the procedure. However, the presence of residual trabeculation did not contribute to PDL or device-related thrombosis at follow-up or affect the clinical outcomes.
背景：关于左心房附件关闭（LAAC）后血管造影检测残余小梁影响的研究有限。目的：探讨使用WATCHMAN装置LAAC后血管造影检测到残余小梁的发生率、特点和临床意义。方法：我们分析了1350例连续的房颤患者，使用来自OCEAN-LAAC注册中心的WATCHMAN装置进行LAAC，这是一个前瞻性的、持续的、多中心的日本注册中心。纳入标准包括成功行LAAC的患者，其残余小梁的存在或不存在可以用造影剂确认。比较有和没有血管造影检测到残余小梁的患者的临床结果。结果：5.6%（75/1350）患者在血管造影检查中发现残余小梁。在手术过程中，残余小梁组的设备周围泄漏（PDL）比例明显高于非残余小梁组(20% vs. 5.1%， p结论：血管造影检测到残余小梁率为5.6%，该人群在手术过程中PDL的患病率明显高于非残余小梁组（20% vs. 5.1%）。然而，在随访中，残余小梁的存在并没有导致PDL或器械相关血栓形成，也没有影响临床结果。
{"title":"Impact of Angiographically Detected Residual Trabeculation After Left Atrial Appendage Closure Using the WATCHMAN Device: Insight From the OCEAN-LAAC Registry","authors":"Ryuki Chatani, Shunsuke Kubo, Naoki Nishiura, Kazunori Mushiake, Sachiyo Ono, Takeshi Maruo, Kazushige Kadota, Mitsuru Sago, Shuhei Tanaka, Masahiko Asami, Daisuke Hachinohe, Toru Naganuma, Yohei Ohno, Tomoyuki Tani, Hideharu Okamatsu, Kazuki Mizutani, Yusuke Watanabe, Masaki Izumo, Mike Saji, Shingo Mizuno, Hiroshi Ueno, Shinichi Shirai, Masaki Nakashima, Masanori Yamamoto, Kentaro Hayashida, OCEAN-LAAC investigators","doi":"10.1111/jce.16517","DOIUrl":"10.1111/jce.16517","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Research on the impact of angiographically detected residual trabeculation after left atrial appendage closure (LAAC) is limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To investigate the incidence, characteristics, and clinical implications of angiographically detected residual trabeculation after LAAC using the WATCHMAN device.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed 1350 consecutive patients with atrial fibrillation undergoing LAAC using the WATCHMAN device from the OCEAN-LAAC registry, which is a prospective ongoing, multicenter Japanese registry. The inclusion criteria comprised patients who successfully underwent LAAC and whose presence or absence of residual trabeculation can be confirmed using a contrast medium. The clinical outcomes were compared between patients with and without angiographically detected residual trabeculation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Residual trabeculation was angiographically detected in 5.6% (75/1350 patients). At the procedure, the proportion of peri-device leak (PDL) was significantly higher in the residual trabeculation group than in the non-residual trabeculation group (20% vs. 5.1%, <i>p</i> < 0.001). However, the PDL and device-related thrombosis at 45 days and 1 year were comparable between the two groups (37% vs. 23%, <i>p</i> = 0.24; 28% vs. 31%, <i>p</i> = 0.84; 2.1% vs. 1.4%, <i>p</i> = 0.50; 6.9% vs. 6.0%, <i>p</i> = 0.69, respectively). The 3-year cumulative incidence of ischemic stroke, all cardiovascular death, and all-cause death were comparable between the two groups (5.7% vs. 5.5%, log-rank <i>p</i> = 0.96; 7.7% vs. 8.9%, log-rank <i>p</i> = 0.34, 31.4% vs. 22.3%, log-rank <i>p</i> = 0.71, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The angiographically detected residual trabeculation rate was 5.6%, and this population had a significantly higher prevalence of PDL at the procedure. However, the presence of residual trabeculation did not contribute to PDL or device-related thrombosis at follow-up or affect the clinical outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"36 2","pages":"347-358"},"PeriodicalIF":2.3,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Reconsider the Indication of Implantable Cardioverter Defibrillator in Patients With Cardiac Amyloidosis","authors":"Naoya Kataoka, Teruhiko Imamura","doi":"10.1111/jce.16521","DOIUrl":"10.1111/jce.16521","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"36 2","pages":"546-547"},"PeriodicalIF":2.3,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Robert Whitehill, Allison C. Hill, Shankar Baskar, Lanier Jackson, Jonah Scheiber, Ja-Kyoung Yoon, Lily Dresner, Matthew Williams, Omar Meziab, Douglas Mah, Erick Jimenez, Audrey Dionne
Background
Atrial fibrillation and atrial flutter are relatively rare in young people and the incidence of thromboembolic complications is unknown. These issues contribute to the limited utility of present guidelines regarding anticoagulation in this population.
Objective
To report the number of thromboembolic complications in a cohort of pediatric and young adult patients presenting with atrial fibrillation (AFib) or atrial flutter (AFl) while also assessing anticoagulation practice in a multicenter cohort of young patients with these arrhythmias.
Methods
Multicenter, retrospective cohort of patients aged < 25 years old who presented with atrial flutter (AFl) or atrial fibrillation (AFib) between 2000 and 2019 to several large, quaternary pediatric centers, excluding episodes occurring within 30 days of an invasive cardiac procedure.
Results
There were 311 episodes of AFib/AFl among 210 patients with a median age of 17 (IQR 14, 20) years. Structural heart disease (SHD) was present in 120 patients (57%) and 20 patients (10%) had a primary cardiomyopathy. Twelve AFib/AFl episodes (8 with AFL, 4 with AFib) were associated with a thrombus, of which 8 (67%) patients had SHD, 2 (17%) had cardiomyopathy and 5 (42%) ventricular dysfunction. The CHADSVASc score was 0–3 for all patients with a thrombus. Of patients with no thrombus at presentation who were cardioverted, 102 (34%) patients were discharged on aspirin and 80 (27%) on anticoagulation. Two patients had symptoms concerning for a thromboembolic event on follow-up, but none had a newly documented thrombus.
Conclusions
Thromboembolic complications occur in children and young adults presenting with AFib/AFl. The majority are associated with SHD, cardiomyopathy, and/or ventricular dysfunction. CHADSVASc was calculated for each patient and was of limited utility. Thromboembolic complications at follow up after cardioversion are rare, and anticoagulation strategies at discharge varied.
{"title":"Thromboembolic Complications From Atrial Fibrillation and Atrial Flutter in Pediatrics and Young Adults: A Multicenter Study","authors":"Robert Whitehill, Allison C. Hill, Shankar Baskar, Lanier Jackson, Jonah Scheiber, Ja-Kyoung Yoon, Lily Dresner, Matthew Williams, Omar Meziab, Douglas Mah, Erick Jimenez, Audrey Dionne","doi":"10.1111/jce.16518","DOIUrl":"10.1111/jce.16518","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Atrial fibrillation and atrial flutter are relatively rare in young people and the incidence of thromboembolic complications is unknown. These issues contribute to the limited utility of present guidelines regarding anticoagulation in this population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To report the number of thromboembolic complications in a cohort of pediatric and young adult patients presenting with atrial fibrillation (AFib) or atrial flutter (AFl) while also assessing anticoagulation practice in a multicenter cohort of young patients with these arrhythmias.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Multicenter, retrospective cohort of patients aged < 25 years old who presented with atrial flutter (AFl) or atrial fibrillation (AFib) between 2000 and 2019 to several large, quaternary pediatric centers, excluding episodes occurring within 30 days of an invasive cardiac procedure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 311 episodes of AFib/AFl among 210 patients with a median age of 17 (IQR 14, 20) years. Structural heart disease (SHD) was present in 120 patients (57%) and 20 patients (10%) had a primary cardiomyopathy. Twelve AFib/AFl episodes (8 with AFL, 4 with AFib) were associated with a thrombus, of which 8 (67%) patients had SHD, 2 (17%) had cardiomyopathy and 5 (42%) ventricular dysfunction. The CHADSVASc score was 0–3 for all patients with a thrombus. Of patients with no thrombus at presentation who were cardioverted, 102 (34%) patients were discharged on aspirin and 80 (27%) on anticoagulation. Two patients had symptoms concerning for a thromboembolic event on follow-up, but none had a newly documented thrombus.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Thromboembolic complications occur in children and young adults presenting with AFib/AFl. The majority are associated with SHD, cardiomyopathy, and/or ventricular dysfunction. CHADSVASc was calculated for each patient and was of limited utility. Thromboembolic complications at follow up after cardioversion are rare, and anticoagulation strategies at discharge varied.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"36 2","pages":"331-337"},"PeriodicalIF":2.3,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ksenia Sedova, Jan E. Azarov, Peter M. Van Dam, Lucie Necasova, Jan Kukla, Marek Sramko, Lukas Kryze, Josef Kautzner
Introduction
A variable proportion of non-responders to cardiac resynchronization therapy (CRT) warrants the search for new approaches to optimize the position of the left ventricular (LV) lead and the CRT device programming. CineECG is a novel ECG modality proposed for the spatial visualization and quantification of myocardial depolarization and repolarization sequences.
Objective
The present study aimed to evaluate CineECG-derived parameters in different pacing modes and to test their associations with acute hemodynamic responses in CRT patients.
Methods and Results
CineECG was used to construct the average electrical path within the cardiac anatomy from the 12-lead ECG. CineECG and LV dP/dt max were tested in 15 patients with nonischemic dilated cardiomyopathy and left bundle branch block (QRS: 170 ± 17 ms; LVEF: 26 ± 5.5%) under pacing protocols with different LV lead localizations. The CineECG-derived path directions were computed for the QRS and ST-T intervals for the anteroposterior (Xh), interventricular (Yh), and apicobasal (Zh) axes. In a multivariate linear regression analysis with adjustment for the pacing protocol type, the ST-T path direction Yh was independently associated with the increase in dP/dt max during CRT, [regression coefficient 639.4 (95% confidence interval: 187.9–1090.9), p = 0.006]. In ROC curve analysis, the ST-T path direction Yh was associated with the achievement of a 10% increase in dP/dt max (AUC: 0.779, p = 0.002) with the optimal cut-off > 0.084 (left-to-right direction) with sensitivity 0.67 and specificity 0.92.
Conclusion
The acute hemodynamic response in CRT patients was associated with specific CineECG repolarization sequence parameters, warranting their further testing as potential predictors of clinical outcomes.
{"title":"CineECG Repolarization Gradients Predict Acute Hemodynamic Response in CRT Patients","authors":"Ksenia Sedova, Jan E. Azarov, Peter M. Van Dam, Lucie Necasova, Jan Kukla, Marek Sramko, Lukas Kryze, Josef Kautzner","doi":"10.1111/jce.16525","DOIUrl":"10.1111/jce.16525","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>A variable proportion of non-responders to cardiac resynchronization therapy (CRT) warrants the search for new approaches to optimize the position of the left ventricular (LV) lead and the CRT device programming. CineECG is a novel ECG modality proposed for the spatial visualization and quantification of myocardial depolarization and repolarization sequences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The present study aimed to evaluate CineECG-derived parameters in different pacing modes and to test their associations with acute hemodynamic responses in CRT patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>CineECG was used to construct the average electrical path within the cardiac anatomy from the 12-lead ECG. CineECG and LV dP/dt max were tested in 15 patients with nonischemic dilated cardiomyopathy and left bundle branch block (QRS: 170 ± 17 ms; LVEF: 26 ± 5.5%) under pacing protocols with different LV lead localizations. The CineECG-derived path directions were computed for the QRS and ST-T intervals for the anteroposterior (X<sub>h</sub>), interventricular (Y<sub>h</sub>), and apicobasal (Z<sub>h</sub>) axes. In a multivariate linear regression analysis with adjustment for the pacing protocol type, the ST-T path direction Y<sub>h</sub> was independently associated with the increase in dP/dt max during CRT, [regression coefficient 639.4 (95% confidence interval: 187.9–1090.9), <i>p</i> = 0.006]. In ROC curve analysis, the ST-T path direction Y<sub>h</sub> was associated with the achievement of a 10% increase in dP/dt max (AUC: 0.779, <i>p</i> = 0.002) with the optimal cut-off > 0.084 (left-to-right direction) with sensitivity 0.67 and specificity 0.92.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The acute hemodynamic response in CRT patients was associated with specific CineECG repolarization sequence parameters, warranting their further testing as potential predictors of clinical outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"36 2","pages":"338-346"},"PeriodicalIF":2.3,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jce.16525","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Steven A Muller, Giorgia Bertoli, Jianan Wang, Alessio Gasperetti, Moniek G P J Cox, Hugh Calkins, Anneline S J M Te Riele, Daniel P Judge, Mario Delmar, Richard N W Hauer, Gerard J J Boink, Marina Cerrone, J Peter van Tintelen, Cynthia A James
Arrhythmogenic cardiomyopathy (ACM) is a genetically heterogeneous inherited cardiomyopathy with an estimated prevalence of 1:5000-10 000 that predisposes patients to life-threatening ventricular arrhythmias (VA) and sudden cardiac death (SCD). ACM diagnostic criteria and risk prediction models, particularly for arrhythmogenic right ventricular cardiomyopathy (ARVC), the most common form of ACM, are typically genotype-agnostic, but numerous studies have established clinically meaningful genotype-phenotype associations. Early signs of ACM onset differ by genotype indicating the need for genotype-specific diagnostic criteria and family screening paradigms. Likewise, risk factors for SCD vary by genetic subtype, indicating that genotype-specific guidelines for management are also warranted. Of particular importance, genotype-specific therapeutic approaches are being developed. Results from a randomized controlled trial for flecainide use in ARVC patients are currently pending. Research in a plakophilin-2-deficient mouse model suggests this antiarrhythmic drug may be particularly useful for patients with likely pathogenic or pathogenic (LP/P) PKP2 variants. Additionally, the first gene therapy clinical trials in ARVC patients harboring LP/P PKP2 variants are currently underway. This review aims to provide clinicians caring for ACM patients with an up-to-date overview of the current literature in genotype-specific natural history of disease and management of ACM patients and describe scientific advances that have led to upcoming clinical trials.
{"title":"Arrhythmogenic Cardiomyopathy: Towards Genotype Based Diagnoses and Management.","authors":"Steven A Muller, Giorgia Bertoli, Jianan Wang, Alessio Gasperetti, Moniek G P J Cox, Hugh Calkins, Anneline S J M Te Riele, Daniel P Judge, Mario Delmar, Richard N W Hauer, Gerard J J Boink, Marina Cerrone, J Peter van Tintelen, Cynthia A James","doi":"10.1111/jce.16519","DOIUrl":"https://doi.org/10.1111/jce.16519","url":null,"abstract":"<p><p>Arrhythmogenic cardiomyopathy (ACM) is a genetically heterogeneous inherited cardiomyopathy with an estimated prevalence of 1:5000-10 000 that predisposes patients to life-threatening ventricular arrhythmias (VA) and sudden cardiac death (SCD). ACM diagnostic criteria and risk prediction models, particularly for arrhythmogenic right ventricular cardiomyopathy (ARVC), the most common form of ACM, are typically genotype-agnostic, but numerous studies have established clinically meaningful genotype-phenotype associations. Early signs of ACM onset differ by genotype indicating the need for genotype-specific diagnostic criteria and family screening paradigms. Likewise, risk factors for SCD vary by genetic subtype, indicating that genotype-specific guidelines for management are also warranted. Of particular importance, genotype-specific therapeutic approaches are being developed. Results from a randomized controlled trial for flecainide use in ARVC patients are currently pending. Research in a plakophilin-2-deficient mouse model suggests this antiarrhythmic drug may be particularly useful for patients with likely pathogenic or pathogenic (LP/P) PKP2 variants. Additionally, the first gene therapy clinical trials in ARVC patients harboring LP/P PKP2 variants are currently underway. This review aims to provide clinicians caring for ACM patients with an up-to-date overview of the current literature in genotype-specific natural history of disease and management of ACM patients and describe scientific advances that have led to upcoming clinical trials.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Exploring S-ICD Extraction Rates and Frequency in Modern Practice","authors":"Moied M. Al Sakan, Marwan M. Refaat","doi":"10.1111/jce.16520","DOIUrl":"10.1111/jce.16520","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"36 1","pages":"177-178"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Daniel A. Gomes, Ana Rita Bello, Pedro Freitas, Joana Certo Pereira, Daniel Nascimento Matos, Pedro Lopes, Gustavo Rodrigues, João Carmo, Francisco Gama, Sara Guerreiro, Pedro Galvão Santos, Francisco Moscoso Costa, Jorge Ferreira, Pedro Carmo, João Abecasis, Diogo Cavaco, Francisco Bello Morgado, António M. Ferreira, Pedro Adragão
Background
Left atrial (LA) remodeling plays a significant role in the progression of atrial fibrillation (AF). Although LA wall thickness (LAWT) has emerged as an indicator of structural remodeling, its impact on AF outcomes remains unclear. We aimed to determine the association between LAWT and AF recurrence after pulmonary vein isolation (PVI), as well as to evaluate the relationship between LAWT and LA fibrosis.
Methods
Single-center registry of patients enrolled for radiofrequency PVI from 2016 to 2018. In all cases, a pre-ablation CT was performed within less than 48 h. Mean LAWT was retrospectively measured by a semi-automated machine learning method (ADAS 3D). A subgroup of patients also underwent pre-ablation cardiac MRI. The primary endpoint was time to AF recurrence after a 3-month blanking period.
Results
A total of 439 patients (mean age 61 ± 12 years, 62% male, 78% with paroxysmal AF) were included. The mean LAWT was 1.4 ± 0.2 mm (0.9–1.9 mm). During a median follow-up of 5.8 (IQR: 4.9–6.6) years, 238 patients (54%) had an AF relapse. After adjusting for 8 clinical and imaging potential confounders, LAWT remained an independent predictor of time-to-recurrence (aHR: 4.25 [95% CI: 1.65–10.95], p = 0.003). AF recurrence rates were 11%, 15%, and 21%/year across terciles of increasing LAWT (log-rank p < 0.001). Additionally, the AF recurrence rate increased across the spectrum of LA structural remodeling, ranging from 8% (normal LAWT and LAVI) to 30%/year (LAWT and LAVI both increased). In the 62 patients who also underwent pre-ablation MRI, a moderate relationship between LAWT and fibrosis (assessed by late-gadolinium enhancement) was found (Spearman R 0.468; p < 0.001).
Conclusion
Mean LAWT, easily assessed by commercially available machine learning software, is an independent predictor of time to AF recurrence after PVI in the long term. Whether patients with increased LAWT should receive tailored therapy deserves further investigation.
背景：左房（LA）重构在房颤（AF）的进展中起重要作用。虽然LA壁厚度（LAWT）已成为结构重塑的指标，但其对房颤结局的影响尚不清楚。我们的目的是确定LAWT与肺静脉隔离（PVI）后房颤复发之间的关系，以及评估LAWT与LA纤维化之间的关系。方法：对2016年至2018年接受射频PVI治疗的患者进行单中心登记。所有病例均在48小时内进行预消融CT检查。采用半自动机器学习方法（ADAS 3D）回顾性测量平均LAWT。一个亚组患者也接受了消融前心脏MRI检查。主要终点是3个月空白期后房颤复发的时间。结果：共纳入439例患者（平均年龄61±12岁，男性62%，阵发性房颤78%）。平均LAWT为1.4±0.2 mm （0.9-1.9 mm）。在中位随访5.8 （IQR: 4.9-6.6）年期间，238例患者（54%）发生房颤复发。在调整了8个临床和影像学潜在混杂因素后，LAWT仍然是复发时间的独立预测因子（aHR: 4.25 [95% CI: 1.65-10.95], p = 0.003）。结论：平均LAWT可以通过市售的机器学习软件轻松评估，是PVI术后AF复发时间的长期独立预测因子。LAWT升高的患者是否应该接受量身定制的治疗值得进一步研究。
{"title":"Left Atrial Wall Thickness Measured by a Machine Learning Method Predicts AF Recurrence After Pulmonary Vein Isolation","authors":"Daniel A. Gomes, Ana Rita Bello, Pedro Freitas, Joana Certo Pereira, Daniel Nascimento Matos, Pedro Lopes, Gustavo Rodrigues, João Carmo, Francisco Gama, Sara Guerreiro, Pedro Galvão Santos, Francisco Moscoso Costa, Jorge Ferreira, Pedro Carmo, João Abecasis, Diogo Cavaco, Francisco Bello Morgado, António M. Ferreira, Pedro Adragão","doi":"10.1111/jce.16515","DOIUrl":"10.1111/jce.16515","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Left atrial (LA) remodeling plays a significant role in the progression of atrial fibrillation (AF). Although LA wall thickness (LAWT) has emerged as an indicator of structural remodeling, its impact on AF outcomes remains unclear. We aimed to determine the association between LAWT and AF recurrence after pulmonary vein isolation (PVI), as well as to evaluate the relationship between LAWT and LA fibrosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Single-center registry of patients enrolled for radiofrequency PVI from 2016 to 2018. In all cases, a pre-ablation CT was performed within less than 48 h. Mean LAWT was retrospectively measured by a semi-automated machine learning method (ADAS 3D). A subgroup of patients also underwent pre-ablation cardiac MRI. The primary endpoint was time to AF recurrence after a 3-month blanking period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 439 patients (mean age 61 ± 12 years, 62% male, 78% with paroxysmal AF) were included. The mean LAWT was 1.4 ± 0.2 mm (0.9–1.9 mm). During a median follow-up of 5.8 (IQR: 4.9–6.6) years, 238 patients (54%) had an AF relapse. After adjusting for 8 clinical and imaging potential confounders, LAWT remained an independent predictor of time-to-recurrence (aHR: 4.25 [95% CI: 1.65–10.95], <i>p</i> = 0.003). AF recurrence rates were 11%, 15%, and 21%/year across terciles of increasing LAWT (log-rank <i>p</i> < 0.001). Additionally, the AF recurrence rate increased across the spectrum of LA structural remodeling, ranging from 8% (normal LAWT and LAVI) to 30%/year (LAWT and LAVI both increased). In the 62 patients who also underwent pre-ablation MRI, a moderate relationship between LAWT and fibrosis (assessed by late-gadolinium enhancement) was found (Spearman R 0.468; <i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Mean LAWT, easily assessed by commercially available machine learning software, is an independent predictor of time to AF recurrence after PVI in the long term. Whether patients with increased LAWT should receive tailored therapy deserves further investigation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"36 2","pages":"323-330"},"PeriodicalIF":2.3,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nikhil Sharma, Kristie M. Coleman, Gregory Cunn, Jeremy Kleiman, Andrew Kossack, Tia Bimal, Umair Ansari, Bo Yang, James Gabriels, Haisam Ismail, Amir Gandomi, Joanna Fishbein, Stavros E. Mountantonakis
Introduction
Ventricular premature depolarizations (VPDs) in the setting of acute coronary syndrome (ACS) were associated with increased hospital mortality in the early revascularization era.
Objective
Examine the predictive value of VPDs and their morphology for hospital and post-discharge mortality in patients admitted for ACS.
Methods
We identified patients admitted with ACS across 13 Northwell Health Hospitals from 2015 to 2021 and had VPDs captured on a 12-lead ECG or full disclose telemetry. We characterized and reported descriptively the VPDs based on bundle branch block pattern (right or RBBB vs. left or LBBB), frontal (inferior vs. superior) and horizontal (leftward vs. rightward) axis, QRS width, and coupling interval (CI). Hierarchical generalized linear mixed modeling was used to assess the association between VPDs and hospital mortality, while Cox regression was used for post-discharge mortality.
Results
Of 18 009 patients admitted for ACS, we identified 627 patients with VPDs with complete data (65.7% RBB, 49.9% superior, and 63.4% leftward axis). Mean VPD QRS width and CI were 175 ± 30 and 523 ± 157 ms, respectively. Hospital mortality was higher in the VPD group (7.8% vs. 4.9%, p < 0.001) with most common mode of death being arrhythmic (28.1% vs. 14.5%). After adjusting for clinical covariates, only VPDs with RBBB patterns were associated with hospital mortality (OR 2.26, 95% CI 1.06−4.82). Conversely, age-adjusted post-discharge mortality was higher only for patients with superior axis VPDs (HR 1.59, 95% CI 1.13−2.24).
Conclusion
Among patients with VPDs during an ACS admission, presence of RBBB pattern predicts hospital mortality, whereas superior axis is associated with post-discharge mortality.
导论：急性冠脉综合征（ACS）患者的心室过早去极化（VPDs）与早期血运重建时期住院死亡率增加有关。目的：探讨vpd及其形态学对ACS住院患者住院及出院后死亡率的预测价值。方法：我们确定了2015年至2021年在13家Northwell健康医院入院的ACS患者，并通过12导联心电图或全披露遥测捕捉vpd。我们基于束支阻滞模式（右或RBBB vs左或LBBB）、额轴（下轴vs上轴）和水平轴（左轴vs右轴）、QRS宽度和耦合间隔（CI）来描述和报道vpd。分级广义线性混合模型用于评估vpd与医院死亡率之间的关系，Cox回归用于评估出院后死亡率。结果：在18009例因ACS入院的患者中，我们发现627例vpd数据完整（65.7%为RBB， 49.9%为优越，63.4%为左轴）。平均VPD QRS宽度和CI分别为175±30和523±157 ms。VPD组的住院死亡率更高（7.8% vs. 4.9%）， p结论：在ACS入院的VPD患者中，RBBB模式的存在预测住院死亡率，而上轴与出院后死亡率相关。
{"title":"Hospital and Post-Discharge Mortality in Patients With Acute Coronary Syndrome and Ventricular Ectopy","authors":"Nikhil Sharma, Kristie M. Coleman, Gregory Cunn, Jeremy Kleiman, Andrew Kossack, Tia Bimal, Umair Ansari, Bo Yang, James Gabriels, Haisam Ismail, Amir Gandomi, Joanna Fishbein, Stavros E. Mountantonakis","doi":"10.1111/jce.16497","DOIUrl":"10.1111/jce.16497","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Ventricular premature depolarizations (VPDs) in the setting of acute coronary syndrome (ACS) were associated with increased hospital mortality in the early revascularization era.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Examine the predictive value of VPDs and their morphology for hospital and post-discharge mortality in patients admitted for ACS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We identified patients admitted with ACS across 13 Northwell Health Hospitals from 2015 to 2021 and had VPDs captured on a 12-lead ECG or full disclose telemetry. We characterized and reported descriptively the VPDs based on bundle branch block pattern (right or RBBB vs. left or LBBB), frontal (inferior vs. superior) and horizontal (leftward vs. rightward) axis, QRS width, and coupling interval (CI). Hierarchical generalized linear mixed modeling was used to assess the association between VPDs and hospital mortality, while Cox regression was used for post-discharge mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 18 009 patients admitted for ACS, we identified 627 patients with VPDs with complete data (65.7% RBB, 49.9% superior, and 63.4% leftward axis). Mean VPD QRS width and CI were 175 ± 30 and 523 ± 157 ms, respectively. Hospital mortality was higher in the VPD group (7.8% vs. 4.9%, <i>p</i> < 0.001) with most common mode of death being arrhythmic (28.1% vs. 14.5%). After adjusting for clinical covariates, only VPDs with RBBB patterns were associated with hospital mortality (OR 2.26, 95% CI 1.06−4.82). Conversely, age-adjusted post-discharge mortality was higher only for patients with superior axis VPDs (HR 1.59, 95% CI 1.13−2.24).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Among patients with VPDs during an ACS admission, presence of RBBB pattern predicts hospital mortality, whereas superior axis is associated with post-discharge mortality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"36 2","pages":"314-322"},"PeriodicalIF":2.3,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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