scholarly journals Assessment of an ECG‐Based System for Localizing Ventricular Arrhythmias in Patients With Structural Heart Disease

2021 ◽  
Author(s):  
Shijie Zhou ◽  
Amir AbdelWahab ◽  
John L. Sapp ◽  
Eric Sung ◽  
Konstantinos N. Aronis ◽  
...  
Keyword(s):  
Heart Disease ◽  
Case Series ◽  
Premature Ventricular Contraction ◽  
Structural Heart Disease ◽  
Patient Specific ◽  
Localization Error ◽  
Localization Accuracy ◽  
Accurate Localization ◽  
Prospective Case Series ◽  
Pace Mapping

Background We have previously developed an intraprocedural automatic arrhythmia‐origin localization (AAOL) system to identify idiopathic ventricular arrhythmia origins in real time using a 3‐lead ECG. The objective was to assess the localization accuracy of ventricular tachycardia (VT) exit and premature ventricular contraction (PVC) origin sites in patients with structural heart disease using the AAOL system. Methods and Results In retrospective and prospective case series studies, a total of 42 patients who underwent VT/PVC ablation in the setting of structural heart disease were recruited at 2 different centers. The AAOL system combines 120‐ms QRS integrals of 3 leads (III, V2, V6) with pace mapping to predict VT exit/PVC origin site and projects that site onto the patient‐specific electroanatomic mapping surface. VT exit/PVC origin sites were clinically identified by activation mapping and/or pace mapping. The localization error of the VT exit/PVC origin site was assessed by the distance between the clinically identified site and the estimated site. In the retrospective study of 19 patients with structural heart disease, the AAOL system achieved a mean localization accuracy of 6.5±2.6 mm for 25 induced VTs. In the prospective study with 23 patients, mean localization accuracy was 5.9±2.6 mm for 26 VT exit and PVC origin sites. There was no difference in mean localization error in epicardial sites compared with endocardial sites using the AAOL system (6.0 versus 5.8 mm, P =0.895). Conclusions The AAOL system achieved accurate localization of VT exit/PVC origin sites in patients with structural heart disease; its performance is superior to current systems, and thus, it promises to have potential clinical utility.

Abstract 13184: A New Intraprocedural Automated System for Localizing Idiopathic Ventricular Arrhythmia Origin Sites

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Shijie Zhou ◽  
Amir AbdelWahab ◽  
John L Sapp ◽  
Eric Sung ◽  
Konstantinos Aronis ◽  
...  
Keyword(s):  
Ventricular Arrhythmia ◽  
Automated System ◽  
Patient Specific ◽  
Localization Accuracy ◽  
Accurate Localization ◽  
Ventricular Activation ◽  
Specific Geometry ◽  
Pace Mapping ◽  
Activation Mapping ◽  
Better Than

Introduction: Few intraprocedural localization systems have been developed to predict idiopathic ventricular arrhythmia (IVA) source sites. However, an accurate and bi-ventricular patient-specific automated site of origin localization system remains elusive. To address this issue, we have developed a new automatic arrhythmia origin localization (AAOL) system that determines the sites of earliest activation in both ventricles and provides superior accuracy. Hypothesis: We hypothesized that the AAOL system can use electroanatomic mapping (EAM) geometry and accurately localize IVA source sites on patient-specific geometry of LV, RV and neighboring vessels using 3-lead ECGs. Methods: Twenty patients undergoing IVA catheter ablation had a 12-lead ECG recorded during clinical arrhythmia and during pacing at various locations identified on EAM geometries. The AAOL system combined 3-lead (III, V2, V6) 120-ms QRS integrals and patient-specific EAM geometry with intracardiac pacing to predict the site of earliest ventricular activation. The predicted site was projected onto the EAM geometry using the EAM triangular-mesh site nearest to the tip of the predicted site. Results: Twenty-three IVA source sites were clinically identified by activation mapping and/or pace mapping (8 RV, 15 LV, including 8 from the posteromedial papillary muscle; 2 from the aortic root; and 1 from the distal coronary sinus). The new system achieved a mean localization accuracy of 3.6 mm for the 23 mapped IVAs (Figure 1D), better than that achieved by previous systems. Conclusions: The new AAOL system offers highly accurate localization of IVA source sites in both ventricles and neighboring vessels, which could facilitate ablation procedures for patients with IVAs.

Computed tomography for cardiac morphology, function, and valve disease

ESC CardioMed ◽  
2018 ◽  
pp. 560-565
Author(s):  
Victoria Delgado
Keyword(s):  
Computed Tomography ◽  
Heart Disease ◽  
Valvular Heart Disease ◽  
Imaging Technique ◽  
Three Dimensional ◽  
Structural Heart Disease ◽  
Patient Specific ◽  
Cardiac Morphology ◽  
Imaging Tool ◽  
Transcatheter Interventions

Computed tomography (CT) has become an important imaging tool to evaluate cardiac anatomy. This three-dimensional, isotropic imaging technique provides volumetric datasets with submillimetre tissue resolution that can be post-processed to define the cardiac structures. CT has become the mainstay imaging technique for selection of patients for, and planning of, transcatheter interventions for structural heart disease. Electrocardiographic-gated CT permits acquisition of cardiac datasets along the cardiac cycle enabling assessment of left and right ventricular function and valvular heart disease. In addition, the advent of three-dimensional printing technologies, which use three-dimensional patient-specific models frequently obtained from CT datasets, has opened a myriad of possibilities in terms of development of anatomical teaching tools, functional models to assess vessel and valve function, planning surgical or transcatheter interventions, and designing of transcatheter cardiac devices. This chapter reviews the role of CT in assessing cardiac morphology and function and valvular heart disease.

5207Bilateral cardiac sympathetic denervation in structural heart disease

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
V Dusi ◽  
L Pugliese ◽  
I Passarelli ◽  
R Camporotondo ◽  
M Driussi ◽  
...  
Keyword(s):  
Heart Disease ◽  
Nyha Class ◽  
Case Series ◽  
Structural Heart Disease ◽  
Median Number ◽  
Sympathetic Denervation ◽  
Icd Shock ◽  
Vt Ablation ◽  
Cardiac Sympathetic Denervation

Abstract Background Left cardiac sympathetic denervation (LCSD) is an established therapy for refractory ventricular arrhythmias (VAs) in channelopathies. A multicentric American and Indian case series suggested a greater efficacy of bilateral denervation (BCSD) in patients with structural heart disease (SHD). Purpose To describe our single-center experience with BCSD in SHD. Methods Nine patients (78% male, mean 55±18 yrs, mean LVEF 31±14%) with SHD and refractory VAs underwent BCSD. All had a Video-Assisted Thoracoscopic Surgery (VATS), in 2 cases associated with the robotic technique. The underlying cardiomyopathy (CMP) was non-ischemic (NICMP) in most cases (n=5, 55%), ischemic in 2 cases, arrhythmogenic right ventricular (ARVC) in one and related to lamin A/C deficiency in one. All patients had an ICD, 44% (n=4) a CRT-D. NYHA functional class I was present in 4 patients, the rest were in NYHA class II (n=3) or III (n=2). Three patients were candidates to heart transplant/LV assistance device. The arrhythmic burden pre BCSD included in 7 pts (78%) a history of electrical storm (ES); the median number of shocks/patient in the 12 months before BCSD was 5 (IQ range 3–18). Except for 2 patients with previous thyrotoxicosis, the remaining were either on amiodarone (n=6) or on sotalol (n=1) before BCSD. Main BCSD indications were represented by drug refractory fast VT in 7 pts (cycle <250 msec) and by recurrent monomorphic VT episodes (mean cycle 351 msec) after endocardial VT ablation in 2 patients. Results No major complication occurred. One patient (NICMP, NYHA II), has an uneventful follow up (FU) of less than 1 month and was excluded from the efficacy analysis. The median FU in the remaining 8 patients is 10 months (IQ range 6–19), during which the median number of shocks/patients was 0.5 (IQ range 0–3). Overall, 4 patients (50%) had ICD shock recurrences. Two cases (mean LVEF 17.5%, NYHA class III) had an ES during severe hemodynamic instability and subsequently died because of cardiogenic shock respectively 1 and 7 months after BCSD. One case had three, not consecutive ICD shocks 20 months after BCSD in the setting of severe amiodarone-induced thyrotoxicosis. Finally, one patient received a single intra-hospital ICD shock 5 days after BCSD before reintroduction of full-dose beta-blockers. The figure summarizes ICD shocks burden in the 6 months before and after BCSD. Among the 5 patients with NICMP/ARVC (4 in NYHA class I), only 1 had a single ICD shock recurrence. ICD shocks pre versus post BCSD, n=8 Conclusions Our case series, although numerically small, has a good follow-up and is the first reported in Europe. The results are in agreement with the suggested remarkable efficacy of BCSD in patients with good functional capacity and fast VAs. Therefore, cardiac sympathetic denervation should always be considered in patients with SHD and refractory ventricular tachyarrhythmias, especially in case VT ablation is either not indicated or fails.

scholarly journals Premature Ventricular Complex Causing Ice-Pick Headache

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Selcuk Ozturk ◽  
Ertan Yetkin
Keyword(s):  
Heart Disease ◽  
Chest Pain ◽  
Premature Ventricular Contraction ◽  
Headache Disorder ◽  
Structural Heart Disease ◽  
Ventricular Myocardium ◽  
Benign Disease ◽  
Premature Ventricular Complex ◽  
Ventricular Contraction ◽  
Premature Ventricular Contractions

Ice pick headache is a momentary, transient, repetitive headache disorder and manifests with the stabbing pains and jolts. The exact mechanism causing this disease is unknown. Premature ventricular contractions are early depolarization of the ventricular myocardium and in the absence of a structural heart disease, it is considered to be a benign disease. In this report, we describe a male patient presenting with the symptom of momentary headache attacks accompanied with instant chest pain which is associated with premature ventricular contraction.

scholarly journals 3D-printed, patient-specific DIEP flap templates for preoperative planning in breast reconstruction: a prospective case series

Gland Surgery ◽  
2021 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
Michael P. Chae ◽  
David J. Hunter-Smith ◽  
Ru Dee Chung ◽  
Julian A. Smith ◽  
Warren Matthew Rozen
Keyword(s):  
Breast Reconstruction ◽  
Preoperative Planning ◽  
Case Series ◽  
Patient Specific ◽  
Diep Flap ◽  
3D Printed ◽  
Prospective Case Series

scholarly journals Catheter ablation of ventricular tachycardia in structural heart disease — case series

2014 ◽  
Vol 9 (9-10) ◽  
pp. 371-371
Author(s):  
Vedran Velagic ◽  
Borka Pezo Nikolic ◽  
Davor Puljevic
Keyword(s):  
Heart Disease ◽  
Ventricular Tachycardia ◽  
Catheter Ablation ◽  
Case Series ◽  
Structural Heart Disease ◽  
Disease Case

scholarly journals Prospective Assessment of an Automated Intraprocedural 12-Lead ECG-Based System for Localization of Early Left Ventricular Activation

2020 ◽  
Vol 13 (7) ◽  
Author(s):  
Shijie Zhou ◽  
Amir AbdelWahab ◽  
B. Milan Horáček ◽  
Paul J. MacInnis ◽  
James W. Warren ◽  
...  
Keyword(s):  
Population Based ◽  
Left Ventricular ◽  
Specific Site ◽  
Patient Specific ◽  
Localization Error ◽  
Localization Accuracy ◽  
Localization System ◽  
Contact Mapping ◽  
Ventricular Activation ◽  
Site Localization

Background: To facilitate ablation of ventricular tachycardia (VT), an automated localization system to identify the site of origin of left ventricular activation in real time using the 12-lead ECG was developed. The objective of this study was to prospectively assess its accuracy. Methods: The automated site of origin localization system consists of 3 steps: (1) localization of ventricular segment based on population templates, (2) population-based localization within a segment, and (3) patient-specific site localization. Localization error was assessed by the distance between the known reference site and the estimated site. Results: In 19 patients undergoing 21 catheter ablation procedures of scar-related VT, site of origin localization accuracy was estimated using 552 left ventricular endocardial pacing sites pooled together and 25 VT-exit sites identified by contact mapping. For the 25 VT-exit sites, localization error of the population-based localization steps was within 10 mm. Patient-specific site localization achieved accuracy of within 3.5 mm after including up to 11 pacing (training) sites. Using 3 remotes (67.8±17.0 mm from the reference VT-exit site), and then 5 close pacing sites, resulted in localization error of 7.2±4.1 mm for the 25 identified VT-exit sites. In 2 emulated clinical procedure with 2 induced VTs, the site of origin localization system achieved accuracy within 4 mm. Conclusions: In this prospective validation study, the automated localization system achieved estimated accuracy within 10 mm and could thus provide clinical utility.

scholarly journals Guideline-Concordant Antiarrhythmic Drug Use in the Get With The Guidelines: Atrial Fibrillation Registry

2021 ◽  
Author(s):  
Michael E. Field ◽  
DaJuanicia N. Holmes ◽  
Richard L. Page ◽  
Gregg C. Fonarow ◽  
Roland A. Matsouaka ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Antiarrhythmic Drug ◽  
Temporal Trends ◽  
Structural Heart Disease ◽  
Primary Diagnosis ◽  
Geographic Region ◽  
Patient Specific ◽  
Specific Patient ◽  
Get With The Guidelines

Background - Antiarrhythmic drug (AAD) therapy for atrial fibrillation (AF) can be associated with both proarrhythmic and noncardiovascular toxicities. Practice guidelines recommend tailored AAD therapy for AF based on patient-specific characteristics, such as coronary artery disease and heart failure, to minimize adverse events. However, current prescription patterns for specific AADs and the degree to which these guidelines are followed in practice are unknown. Methods - Patients enrolled in the Get With The Guidelines-AFIB registry with a primary diagnosis of AF discharged on an AAD between 1/2014 and 11/2018 were included. We analyzed rates of prescription of each AAD in several subgroups including those without structural heart disease. We classified AAD use as guideline-concordant or non-guideline concordant based on six criteria derived from the AHA/ACC/HRS AF Guidelines. Guideline concordance for amiodarone was not considered applicable, since its use is not specifically contraindicated in the guidelines for reasons such as structural heart disease or renal function. We analyzed guideline-concordant AAD use by specific patient and hospital characteristics, and regional and temporal trends. Results - Among 21,921 patients from 123 sites, the median age was 69 years, 46% female, and 51% had paroxysmal AF. The most commonly prescribed AAD was amiodarone (38%). Sotalol (23.2%) and dofetilide (19.2%) were each more commonly prescribed than either flecainide (9.8%) or propafenone (4.8%). Overall guideline-concordant AAD prescription at discharge was 84%. Guideline-concordant AAD use by drug was as follows: dofetilide 93%, sotalol 66%, flecainide 68%, propafenone 48%, and dronedarone 80%. There was variability in rate of guideline-concordant AAD use by hospital and geographic region. Conclusions - Amiodarone remains the most commonly prescribed AAD for AF followed by sotalol and dofetilide. Rates of guideline-concordant AAD use were high and there was significant variability by specific drugs, hospitals, and regions, highlighting opportunities for additional quality improvement.

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