scholarly journals B-AB22-01 UTILITY OF PROLONGED DURATION ENDOCARDIAL ABLATION FOR SUCCESSFULLY TARGETING CHALLENGING VENTRICULAR ARRHYTHMIAS ORIGINATING FROM THE LEFT VENTRICULAR SUMMIT REGION

Heart Rhythm ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. S42
Author(s):  
Lohit Garg ◽  
Thomas Daubert ◽  
Aung N. Lin ◽  
Pasquale Santangeli ◽  
Robert D. Schaller ◽  
...  
Keyword(s):  
Ventricular Arrhythmias ◽  
Left Ventricular ◽  
Prolonged Duration ◽  
Summit Region

Myocardial Noncompaction

2018 ◽  
Vol 69 (8) ◽  
pp. 2209-2212
Author(s):  
Alexandru Radu Mihailovici ◽  
Vlad Padureanu ◽  
Carmen Valeria Albu ◽  
Venera Cristina Dinescu ◽  
Mihai Cristian Pirlog ◽  
...  
Keyword(s):  
Ventricular Arrhythmias ◽  
Specific Treatment ◽  
Left Ventricular ◽  
Left Ventricular Noncompaction ◽  
Ventricular Noncompaction ◽  
Genetic Transmission ◽  
Asymptomatic Patients ◽  
Increased Risk ◽  
Patients With Heart Failure

Left ventricular noncompaction is a primary cardiomyopathy with genetic transmission in the vast majority of autosomal dominant cases. It is characterized by the presence of excessive myocardial trabecularities that generally affect the left ventricle. In diagnosing this condition, echocardiography is the gold standard, although this method involves an increased risk of overdiagnosis and underdiagnosis. There are also uncertain cases where echocardiography is inconclusive, a multimodal approach is needed, correlating echocardiographic results with those obtained by magnetic resonance imaging. The clinical picture may range from asymptomatic patients to patients with heart failure, supraventricular or ventricular arrhythmias, thromboembolic events and even sudden cardiac death. There is no specific treatment of left ventricular noncompaction, but the treatment is aimed at preventing and treating the complications of the disease. We will present the case of a young patient with left ventricular noncompactioncardiomyopathy and highlight the essential role of transthoracic echocardiography in diagnosing this rare heart disease.

scholarly journals Is hypertensive left ventricular hypertrophy a cause of sustained ventricular arrhythmias in humans?

2021 ◽  
Author(s):  
R. Nadarajah ◽  
P. A. Patel ◽  
M. H. Tayebjee
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Ventricular Arrhythmias ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
Systemic Hypertension ◽  
Electrolyte Disturbance ◽  
Electrocardiographic Monitoring ◽  
Homogenous Distribution ◽  
Artery Disease ◽  
Asymptomatic Coronary Artery Disease

AbstractSudden cardiac death (SCD) is most commonly secondary to sustained ventricular arrhythmias (VAs). This review aimed to evaluate if left ventricular hypertrophy (LVH) secondary to systemic hypertension in humans is an isolated risk factor for ventricular arrhythmogenesis. Animal models of hypertensive LVH have shown changes in ion channel function and distribution, gap junction re-distribution and fibrotic deposition. Clinical data has consistently exhibited an increase in prevalence and complexity of non-sustained VAs on electrocardiographic monitoring. However, there is a dearth of trials suggesting progression to sustained VAs and SCD, with extrapolations being confounded by presence of co-existent asymptomatic coronary artery disease (CAD). Putatively, this lack of data may be due to the presence of more homogenous distribution of pathophysiological changes seen in those with hypertensive LVH versus known pro-arrhythmic conditions such as HCM and myocardial infarction. The overall impression is that sustained VAs in the context of hypertensive LVH are most likely to be precipitated by other causes such as CAD or electrolyte disturbance.

scholarly journals Minimising radiation exposure in catheter ablation of ventricular arrhythmias

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Matevž Jan ◽  
David Žižek ◽  
Tine Prolič Kalinšek ◽  
Dimitrij Kuhelj ◽  
Primož Trunk ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Radiation Exposure ◽  
Ventricular Arrhythmias ◽  
Major Complication ◽  
Structural Heart Disease ◽  
Left Ventricular ◽  
Complex Nature ◽  
Group 2 ◽  
Procedural Outcomes ◽  
Group 1

Abstract Background Conventional fluoroscopy guided catheter ablation (CA) is an established treatment option for ventricular arrhythmias (VAs). However, with the complex nature of most procedures, patients and staff bare an increased radiation exposure. Near-zero or zero-fluoroscopy CA is an alternative method which could substantially reduce or even eliminate the radiation dose. Our aim was to analyse procedural outcomes with fluoroscopy minimising approach for treatment of VAs in patients with structurally normal hearts (SNH) and structural heart disease (SHD). Methods Fifty-two (age 53.4 ± 17.8 years, 38 male, 14 female) consecutive patients who underwent CA of VAs in our institution between May 2018 and December 2019 were included. Procedures were performed primarily with the aid of the three-dimensional electro-anatomical mapping system and intra-cardiac echocardiography. Fluoroscopy was considered only in left ventricular (LV) summit mapping for coronary angiography and when epicardial approach was planned. Acute and long-term procedural outcomes were analysed. Results Sixty CA procedures were performed. Twenty-five patients had SHD-related VAs (Group 1) and 27 patients had SNH (Group 2). While Group 1 had significantly higher total procedural time (256.9 ± 71.7 vs 123.6 ± 42.2 min; p < 0.001) compared to Group 2, overall procedural success rate [77.4% (24/31) vs 89.7% (26/29); p = 0.20)] and recurrence rate after the first procedure [8/25, (32%) vs 8/27, (29.6%); p = 0.85] were similar in both groups. Fluoroscopy was used in 3 procedures in Group 1 where epicardial approach was needed and in 4 procedures in Group 2 where LV summit VAs were ablated. Overall procedure-related major complication rate was 5%. Conclusions Fluoroscopy minimising approach for CA of VAs is feasible and safe in patients with SHD and SNH. Fluoroscopy could not be completely abolished in VAs with epicardial and LV summit substrate location.

scholarly journals Prognostic significance of cardiac magnetic resonance-based markers in patients with hypertrophic cardiomyopathy

2021 ◽  
Author(s):  
Zsofia Dohy ◽  
Liliana Szabo ◽  
Attila Toth ◽  
Csilla Czimbalmos ◽  
Rebeka Horvath ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Hypertrophic Cardiomyopathy ◽  
Magnetic Resonance ◽  
Myocardial Fibrosis ◽  
Ventricular Arrhythmias ◽  
Prognostic Significance ◽  
Strain Analysis ◽  
Left Ventricular ◽  
Icd Therapy ◽  
Lv Mass

AbstractThe prognosis of patients with hypertrophic cardiomyopathy (HCM) varies greatly. Cardiac magnetic resonance (CMR) is the gold standard method for assessing left ventricular (LV) mass and volumes. Myocardial fibrosis can be noninvasively detected using CMR. Moreover, feature-tracking (FT) strain analysis provides information about LV deformation. We aimed to investigate the prognostic significance of standard CMR parameters, myocardial fibrosis, and LV strain parameters in HCM patients. We investigated 187 HCM patients who underwent CMR with late gadolinium enhancement and were followed up. LV mass (LVM) was evaluated with the exclusion and inclusion of the trabeculae and papillary muscles (TPM). Global LV strain parameters and mechanical dispersion (MD) were calculated. Myocardial fibrosis was quantified. The combined endpoint of our study was all-cause mortality, heart transplantation, malignant ventricular arrhythmias and appropriate implantable cardioverter defibrillator (ICD) therapy. The arrhythmia endpoint was malignant ventricular arrhythmias and appropriate ICD therapy. The LVM index (LVMi) was an independent CMR predictor of the combined endpoint independent of the quantification method (p < 0.01). The univariate predictors of the combined endpoint were LVMi, global longitudinal (GLS) and radial strain and longitudinal MD (MDL). The univariate predictors of arrhythmia events included LVMi and myocardial fibrosis. More pronounced LV hypertrophy was associated with impaired GLS and increased MDL. More extensive myocardial fibrosis correlated with impaired GLS (p < 0.001). LVMi was an independent CMR predictor of major events, and myocardial fibrosis predicted arrhythmia events in HCM patients. FT strain analysis provided additional information for risk stratification in HCM patients.

scholarly journals Incremental value of feature-tracking cardiac magnetic resonance imaging in detecting myocardial dysfunction in patients with idiopathic ventricular arrhythmias

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
C Nikolaidou ◽  
C Kotanidis ◽  
J Leal-Pelado ◽  
K Kouskouras ◽  
VP Vassilikos ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Ventricular Arrhythmias ◽  
Feature Tracking ◽  
Myocardial Dysfunction ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Volume Index ◽  
Control Subjects ◽  
Cmr Imaging

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiac magnetic resonance (CMR) imaging can identify the underlying substrate in patients with ventricular arrhythmias (VAs) and normal echocardiography. Myocardial strain has emerged as a superior index of systolic performance compared to ejection fraction (EF), with an incremental prognostic value in many cardiac diseases. Purpose To assess myocardial deformation using 2-D feature-tracking CMR strain imaging (CMR-FT) in patients with frequent VAs (≥500 ventricular premature contractions (VPC)/24 hours; and/or non-sustained ventricular tachycardia), and structurally normal hearts on echocardiography without evidence of coronary artery disease. Methods Sixty-eight consecutive patients (mean age 46 ± 16 years; 54% female) and 72 healthy controls matched for age and body surface area were included in the study. CMR imaging was performed on a 1.5T Magnetom Avanto (Siemens, Erlangen, Germany) scanner using a standard cardiac protocol. Results CMR showed normal findings in 30 patients (44%), while 16 (24%) had previous myocarditis, 6 (9%) had a diagnosis of non-ischaemic cardiomyopathy (NICM), 15 (22%) were diagnosed with VPC-related cardiomyopathy, and 1 patient had subendocardial infarction [excluded from strain analysis]. Mean left ventricular EF (LVEF) in patients was 62% ± 6% and right ventricular EF 64% ± 6% (vs. 65% ± 3% and 66% ± 4% in controls, respectively). Compared to control subjects, patients with VAs had impaired peak LV global radial strain (GRS) (28.88% [IQR: 25.87% to 33.97%] vs. 36.65% [IQR:33.19% to 40.2%], p &lt; 0.001) and global circumferential strain (GCS) (-17.73% [IQR: -19.8% to -16.33%] vs. -20.66% [IQR: -21.72% to -19.6%], p &lt; 0.001, Panel A). Peak LV GRS could differentiate patients with previous myocarditis from patients with NICM and those with VPC-related cardiomyopathy (Panel B). Peak LV GCS could differentiate patients with previous myocarditis from patients with NICM (Panel C). Peak LV GRS showed excellent diagnostic accuracy in detecting patients from control subjects (Panel D). In a multivariable regression model, subjects with a low GRS (&lt;29.91%-determined by the Youden’s index) had 5-fold higher odds of having VAs (OR:4.99 [95%CI: 1.2-21.95]), after adjusting for LVEF, LV end-diastolic volume index, age, sex, BMI, smoking, hypertension, and dyslipidaemia. Peak LV global longitudinal strain (GLS) and RV strain indices were not statistically different between patients and controls. Conclusion Peak LV GRS and GCS are impaired in patients with frequent idiopathic VAs and can detect myocardial contractile dysfunction in patients with different underlying substrates. Our findings suggest that LV strain indices on CMR-FT constitute independent markers of myocardial dysfunction on top and independently of EF. Abstract Figure.

scholarly journals Diagnostic and prognostic impact of cardiac magnetic resonance, including scar quantification and strain imaging in patients with malignant ventricular arrhythmias and nonobstructed coronary arteries

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
L Szabo ◽  
V Bodi ◽  
CS Czimbalmos ◽  
ZS Dohy ◽  
V Horvath ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Coronary Arteries ◽  
Ventricular Arrhythmias ◽  
Left Ventricular ◽  
Myocardial Scar ◽  
Scar Formation ◽  
Structural Abnormality ◽  
Icd Therapy ◽  
All Cause Mortality

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Development and Innovation Fund of Hungary, National Research, Development and Innovation Office Background In case of malignant ventricular arrhythmias (VA) and nonobstructed coronary arteries, the differential diagnosis of the  underlying diseases is still challenging, due to the board spectrum of possible causes. Cardiac magnetic resonance (CMR) provides functional, morphological and tissue specific information, including necrotic and scar-tissue.  Aims   We aimed to assess the diagnostic and prognostic implications of CMR parameters including global strain values and myocardial scar in patients after ventricular fibrillation (VF) or sustained ventricular tachycardia (SVT) and nonobstructed coronary arteries. Methods Between 2011 and 2019, 99 patients (42 ±17 years, 54 male) presenting with VF or SVT and nonobstructed coronary arteries, who underwent CMR examination before secondary prevention implantable cardioverter defibrillator (ICD) implantation were included in our study. Post-processing included feature-tracking strain analysis and left ventricular (LV) scar quantification. Patients were followed for the combined endpoint of all-cause-mortality and appropriate ICD therapy. Results CMR examination proved structural myocardial disease in 72%: dilated (n = 21), arrhythmogenic (n = 11), hypertrophic cardiomyopathy (n = 7) and other cardiomyopathies (n = 3). We found LGE patterns showing chronic myocardial infarction (n = 4), suggesting chronic myocarditis (n = 4) and aspecific nonischemic scar formation (n = 14). In 7 cases aspecific structural alterations without scar formation were detected. Overall, myocardial scar was found in 52%, with an average extent of 12 ± 8% of the LV myocardium. The CMR examination changed the clinical diagnosis in 55% of the patients.  During a median follow-up at 2 years, 6 patients died and 42 experienced appropriate ICD therapy. We found an association between cardiac events and the presence of structural abnormality and myocardial scar (logrank: 4,553, p &lt; 0.05 and 8.375, p &lt;0.01).  On Cox proportional-hazards modell LV ejection fraction, LV stroke volume index, the presence of structural abnormality, the presence and extent of  myocardial scar, global LV strain parameters including longitudinal and circumferential strain, and a global left ventricular dssynchrony parameter (mechanical dispersion) were univariate predictors of the combined endpoint of all-cause-mortality and appropriate ICD therapy(p &lt; 0.05).  Conclusion CMR performed in patients after malignant VA and nonobstructed coronary arteries not only establishes the diagnosis in a high proportion of patients, but may also provide additional prognostic factors. This may indicate that CMR could play a complementary role in the risk stratification in this patient population. Abstract Figure.

Ventricular arrhythmias associated with left ventricular noncompaction: Electrophysiologic characteristics, mapping, and ablation

Heart Rhythm ◽  
2017 ◽  
Vol 14 (2) ◽  
pp. 166-175 ◽  
Author(s):  
Daniele Muser ◽  
Jackson J. Liang ◽  
Walter RT Witschey ◽  
Rajeev K. Pathak ◽  
Simon Castro ◽  
...  
Keyword(s):  
Ventricular Arrhythmias ◽  
Left Ventricular ◽  
Left Ventricular Noncompaction ◽  
Ventricular Noncompaction

Les facteurs cliniques qui influencent le pronostic post-infarctus à un an

1993 ◽  
Vol 18 (1) ◽  
pp. 63-79
Author(s):  
Sylvie Robichaud-Ekstrand
Keyword(s):  
Ventricular Arrhythmias ◽  
Prognostic Value ◽  
Left Ventricular ◽  
Cardiac Events ◽  
Mortality And Morbidity ◽  
St Segment Elevation ◽  
St Segment ◽  
Prognostic Stratification ◽  
History Of ◽  
Exercise Induced

Many clinical factors influence the 1-year prognosis in myocardial infarction (MI) patients. The most important clinical determinants are the left ventricular dysfunction, myocardial ischemia, and complex ventricular arrhythmias. Some authors have found an independent prognostic value of complex ventricular arrhythmias, while others consider that ventricular arrhythmias predict future cardiac events only if associated with low ejection fractions. Other factors that have 1-year prognostic value are the following: a previous MI, a history of angina at least 3 months preceding the infarct, postmyocardial angina, and the criteria that indicate to the practitioner whether MI patients are medically ineligible for stress testing. There still remain controversies in regard to the predictive value of certain variables such as the site, type, and extension of the MI, the presence of complex ventricular arrhythmias, exercise-induced hypotension, ST segment elevation, and the electrical provocation of dangerous arrhythmias. Key words: cardiac rehabilitation, postinfarct mortality and morbidity, cardiac events predictors, postinfarct prognostic stratification

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