scholarly journals Electromechanical modeling of human ventricles with ischemic cardiomyopathy: numerical simulations in sinus rhythm and under arrhythmia

2021 ◽  
pp. 104674
Author(s):  
Matteo Salvador ◽  
Marco Fedele ◽  
Pasquale Claudio Africa ◽  
Eric Sung ◽  
Luca Dede’ ◽  
...  
Keyword(s):  
Sinus Rhythm ◽  
Numerical Simulations ◽  
Ischemic Cardiomyopathy ◽  
Electromechanical Modeling

scholarly journals A37-3 Linear ablation during sinus rhythm for life-threatening ventricular tachycardia in patients with ischemic cardiomyopathy using CARTO system

EP Europace ◽  
2003 ◽  
Vol 4 (Supplement_2) ◽  
pp. B57-B57
Author(s):  
A.M. Wnuk-Wojnar ◽  
C. Czerwinski ◽  
A. Hoffmann ◽  
S. Nowak ◽  
E. Konarska-Kuszewska ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Sinus Rhythm ◽  
Ischemic Cardiomyopathy ◽  
Linear Ablation ◽  
Life Threatening

scholarly journals Not Baseline Atrial Fibrillation but New-Onset Atrial Fibrillation and the Loss of Left Atrial Function Are Essential for Predicting Poor Outcomes in Non-ischemic Cardiomyopathy

2021 ◽  
Vol 8 ◽  
Author(s):  
Mana Okune ◽  
Masakazu Yasuda ◽  
Naoko Soejima ◽  
Kazuyoshi Kakehi ◽  
Takayuki Kawamura ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Poor Prognosis ◽  
Ischemic Cardiomyopathy ◽  
Cox Regression ◽  
Structure And Function ◽  
Major Adverse Cardiovascular Events ◽  
Prognostic Information ◽  
And Function ◽  
New Onset

Aims: The clinical impact of the type of atrial fibrillation (AF) has not been completely elucidated in non-ischemic cardiomyopathy (NICM). Although the structure and function of the left atrium (LA) provide prognostic information in patients with heart failure, the relationship of the AF type with LA structure and function in NICM is unclear.Methods: Consecutive patients with NICM who underwent cardiac magnetic resonance were evaluated and followed. Multivariable Cox regression models were used to estimate hazard ratios (HRs) for major adverse cardiovascular events (MACE) related to the AF type, such as paroxysmal AF, chronic AF, and new-onset AF (NOAF).Results: Among 625 patients with NICM (mean age, 64.4 ± 14.2 years; women, 39.7%), 133 had a history of AF at baseline; of these, 60 had paroxysmal AF. Each baseline AF type was associated with higher LA volume and lower LA emptying fraction but not with an increased incidence of MACE (p = 0.245). New-onset AF developed in 5.9% of patients with sinus rhythm over a median follow-up period of 609 days, and maximum LA volume was a strong and independent predictor [p < 0.001, area under the ROC curve (AUC): 0.795]. Maximum LA volume was superior to LA emptying fraction and B-type natriuretic peptide (AUC: 0.683 and 0.680, respectively). The use of β-blocker and the age of the patient were associated with the incidence of NOAF (HR: 0.37, 95% CI: 0.16–0.84 and HR: 1.05, 95% CI: 1.01–1.09, respectively). Kaplan–Meier analysis showed that patients with NOAF had a higher incidence of MACE than those with sinus rhythm or baseline AF (p = 0.002). NOAF and LA emptying fraction were independent predictors of MACE (HR: 2.28, 95% CI: 1.20–3.97 and HR: 0.98, 95% CI: 0.96–0.99, respectively) after adjusting for age, sex, body mass index, and diagnosis.Conclusions: Paroxysmal and chronic AF in patients with NICM were not associated with an increased incidence of MACE despite their association with LA volume and function. NOAF was independently associated with poor prognosis. Higher maximum LA volume predicted the onset and lower LA emptying fraction was independently associated with poor prognosis.

Abstract 4088: Isolated Potentials and Pace-Mapping to Guide Ablation for Ventricular Tachycardia in Patients with Non-Ischemic Cardiomyopathy

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Michael Kuhne ◽  
Jean-Francois Sarrazin ◽  
Darryl Wells ◽  
Nagib Chalfoun ◽  
Thomas Crawford ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Sinus Rhythm ◽  
Ischemic Cardiomyopathy ◽  
Low Voltage ◽  
Radiofrequency Energy ◽  
Target Sites ◽  
Group A ◽  
Group B ◽  
Pace Mapping

Background : Isolated potentials (IPs) during sinus rhythm are indicators of fixed scar in patients with prior infarcts. IPs in conjunction with pace-mapping (PM) have been helpful to guide ablation of post-infarction ventricular tachycardia (VT). The purpose of this study was to determine the value of IPs in conjunction with PM to guide VT ablation in patients with non-ischemic cardiomyopathy. Methods : 32 consecutive patients (23 male, age 56±13 years, ejection fraction 0.30±0.14) with VT and non-ischemic cardiomyopathy were analyzed. Thirty/32 patients had an implanted cardioverter defibrillator (ICD). Electroanatomic maps of the left (n=21) and right ventricle (n=13), the coronary sinus (n=3), and the epicardium (n=4) were obtained during baseline rhythm. PM was performed at sites with low voltage (<1.5mV). Radiofrequency energy was delivered at sites with concealed entrainment or matching pace-maps. Mean follow-up time was 10±9 months. Results : 173 VTs (cycle length 359±86 ms) were induced. Appropriate ablation sites with IPs during sinus rhythm were recorded in 19/32 patients (59%) (group A). In these patients, a total of 195 appropriate target sites were identified for 56/100 induced VTs (56%); 136/195 sites (70%) displayed IPs. In the remaining 13 patients, no target sites with IPs were identified (group B) despite combined endocardial and transcutaneous epicardial mapping in 3/13 patients. In these 13 patients, a total of 96 appropriate target sites were identified for 25/73 induced VTs (34%). Fifteen/19 patients (79%) in group A were non-inducible at the end of the procedure compared to 2/13 patients (15%) in group B. During a mean follow-up of 10±9 months, 15/19 patients (79%) in group A compared to 1/13 patients (8%) in group B remained arrhythmia free (p=0.0002). Conclusion : IPs in conjunction with PM are helpful in identifying critical isthmus areas for ablation of VT in patients with non-ischemic cardiomyopathy. Differences in the extent of fixed scar tissue may be the reason for differences in the prevalence of IPs, and this might explain better ablation results in some patients with non-ischemic cardiomyopathy.

Sinus Rhythm QRS Amplitude and Fractionation in Patients with Non-Ischemic Cardiomyopathy to Identify Ventricular Tachycardia Substrate and Location.

Heart Rhythm ◽  
2021 ◽  
Author(s):  
Martín R. Arceluz ◽  
Ioan Liuba ◽  
Cory M. Tschabrunn ◽  
David S. Frankel ◽  
Pasquale Santangeli ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Sinus Rhythm ◽  
Ischemic Cardiomyopathy

Left Ventricular and Left Atrial Thrombi in Sinus Rhythm Patients with Dilated Ischemic Cardiomyopathy

2012 ◽  
Vol 66 (3) ◽  
pp. 155 ◽  
Author(s):  
Aurora Bakalli ◽  
Ljubica GeorgievskaIsmail ◽  
Dardan Kocinaj ◽  
Nebi Musliu ◽  
Bedri Zahiti ◽  
...  
Keyword(s):  
Sinus Rhythm ◽  
Left Atrial ◽  
Ischemic Cardiomyopathy ◽  
Left Ventricular ◽  
Atrial Thrombi

Abstract 17172: Pre Ablation Voltage Mapping Can Alter VT Inducibility

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Asad A Al Aboud ◽  
Travis Richardson ◽  
Oluwaseun G Adeola ◽  
Benjamin B HOLMES ◽  
McHugh Julia ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Sinus Rhythm ◽  
Electric Stimulation ◽  
Ischemic Cardiomyopathy ◽  
Cycle Length ◽  
Type I ◽  
Type Ii ◽  
Transseptal Puncture ◽  
Voltage Mapping ◽  
Vt Ablation

Introduction: VT inducibility is often used to assess the efficacy of VT ablation. Sinus rhythm voltage maps (VMs) are used to guide ablation of VT substrate, but catheter manipulation may mechanically traumatize critical sites, altering VT inducibility. We prospectively evaluated the effect of VM on VT inducibility. Methods: Twenty-nine patients (mean age 62, 70% ischemic cardiomyopathy) with planned VT ablation underwent initial programmed electric stimulation (PES). Fifteen patients then underwent VM followed by repeat PES and 14 patients underwent a waiting period with ICE imaging and transseptal puncture but no VM (imaging group) before repeat PES. Responses to repeat PES were categorized as type I if the same VT was induced, type II if a different VT was induced, and type III if no VT was inducible. Results: In the VM group, the same VT was inducible in 3 patients, a different VT in 9, and no VT in 3 patients (figure). In contrast, those in the imaging group had the same VT induced in 10 patients, a different VT in 3 and no VT in 1 patient. There was no difference in the number of extrastimuli needed to induce VT between the two PES in either group. VT cycle length in the VM group was shorter after mapping (295 vs 331ms), although this was not statistically significant. There was no difference between the groups in anesthesia method, time between initial and second PES, type of cardiomyopathy, or ejection fraction. Conclusions: The mechanical effects of VM can alter inducibility of VT independent of ablation. This may contribute to late recurrences of VT by preventing mapping of clinically relevant VT circuits, or falsely indicating effective ablation when PES is repeated only after ablation.

scholarly journals Microvolt T-Wave Alternans Is Modulated by Acute Low-Level Tragus Stimulation in Patients With Ischemic Cardiomyopathy and Heart Failure

2021 ◽  
Vol 12 ◽  
Author(s):  
Kanchan Kulkarni ◽  
Stavros Stavrakis ◽  
Khaled Elkholey ◽  
Jagmeet P. Singh ◽  
Kimberly A. Parks ◽  
...  
Keyword(s):  
Heart Failure ◽  
Sinus Rhythm ◽  
Nerve Stimulation ◽  
Ischemic Cardiomyopathy ◽  
Right Atrial ◽  
Left Ventricular Ejection ◽  
Atrial Pacing ◽  
Low Level ◽  
T Wave ◽  
T Wave Alternans

Aims: Microvolt T-wave alternans (TWA), an oscillation in T-wave morphology of the electrocardiogram (ECG), has been associated with increased susceptibility to ventricular tachy-arrhythmias, while vagus nerve stimulation has shown promising anti-arrhythmic effects in in vivo and ex vivo animal studies. We aimed to examine the effect of non-invasive, acute low-level tragus stimulation (LLTS) on TWA in patients with ischemic cardiomyopathy and heart failure.Methods: 26 patients with ischemic cardiomyopathy (left ventricular ejection fraction &lt;35%) and chronic stable heart failure, previously implanted with an automatic implantable cardioverter defibrillator (ICD) device with an atrial lead (dual chamber ICD or cardiac resynchronization therapy defibrillator), were enrolled in the study. Each patient sequentially received, (1) Sham LLTS (electrode on tragus, but no stimulation delivered) for 5 min; (2) Active LLTS at two different frequencies (5 and 20 Hz, 15 min each); and (3) Active LLTS, during concomitant atrial pacing at 100 bpm at two different frequencies (5 and 20 Hz, 15 min each). LLTS was delivered through a transcutaneous electrical nerve stimulation device (pulse width 200 μs, frequency 5/20 Hz, amplitude 1 mA lower than the discomfort threshold). TWA burden was assessed using continuous ECG monitoring during sham and active LLTS in sinus rhythm, as well as during atrial pacing.Results: Right atrial pacing at 100 bpm led to significantly heightened TWA burden compared to sinus rhythm, with or without LLTS. Acute LLTS at both 5 and 20 Hz, during sinus rhythm led to a significant rise in TWA burden in the precordial leads (p &lt; 0.05).Conclusion: Acute LLTS results in a heart-rate dependent increase in TWA burden.

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