Verapamil-sensitive ventricular tachycardia demonstrating multiform QRS morphology in a patient with ischemic cardiomyopathy.
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ABSTRACT:
SUBMITTER: Kuroda S
PROVIDER: S-EPMC6926198 | biostudies-literature | 2019 Dec
REPOSITORIES: biostudies-literature
Publications
Verapamil-sensitive ventricular tachycardia demonstrating multiform QRS morphology in a patient with ischemic cardiomyopathy.
Kuroda Shunsuke S Mizukami Akira A Hayashi Tatsuya T Yoshioka Kenji K Suzuki Makoto M Matsumura Akihiko A
HeartRhythm case reports 20190906 12
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Project description:BackgroundTo develop a new algorithm to differentiate ventricular tachycardia (VT) from preexcited tachycardia (pre-ET) according to left bundle branch block (LBBB) and right bundle branch block (RBBB) patterns.MethodsThis study included 67 electrocardiograms (ECGs) with VT and 63 ECGs with pre-ET, collected from our hospital and through PubMed. Of those, 64 were allocated to the derivation cohort and the rest to the validation cohort. The diagnoses of the ECGs were confirmed using an electrophysiological study. Parameters and classifiers from prior algorithms along with the propagation speeds in the early portion of the QRS complex (initial deflection index) in leads V1, V6, aVR, II, and III were manually measured. The performance of the new algorithm was compared with that of prior algorithms.ResultsThe initial deflection index in lead III was the strongest predictor of pre-ET in LBBB-pattern wide-QRS tachycardia (p = 0.003, AUC 0.805). The initial deflection index in lead V1 was the most powerful predictor of pre-ET in RBBB-pattern wide-QRS tachycardia (p = 0.001, AUC 0.848). Compared to earlier algorithms, those using the initial deflection indexes: lead III in LBBB patterns (cutoff value >0.3) and lead V1 in RBBB patterns (cutoff value ≤0.48), demonstrated superior performance in screening VT, with AUC values of 0.828. The initial deflection indexes proved effective as discriminators between VT and pre-ET in the validation cohort.ConclusionsIn LBBB-pattern wide-QRS tachycardia, the early propagation speed of pre-ET was faster than that in VT. Conversely, in RBBB-pattern wide-QRS tachycardia, it was slower.
| S-EPMC10943251 | biostudies-literature
Project description:BackgroundArrhythmogenic right ventricular cardiomyopathy (ARVC) is a hereditary heart disease characterized by fatty infiltration, life-threatening arrhythmias, and increased risk of sudden cardiac death. The guideline for management of ARVC in patients is to improve quality of life by reducing arrhythmic symptoms and to prevent sudden cardiac death. However, the mechanism underlying ARVC-associated cardiac arrhythmias remains poorly understood.MethodsUsing protein mass spectrometry analyses, we identified that integrin β1 is downregulated in ARVC hearts without changes to Ca2+-handling proteins. As adult cardiomyocytes express only the β1D isoform, we generated a cardiac specific β1D knockout mouse model and performed functional imaging and biochemical analyses to determine the consequences of integrin β1D loss on function in the heart in vivo and in vitro.ResultsIntegrin β1D deficiency and RyR2 Ser-2030 hyperphosphorylation were detected by Western blotting in left ventricular tissues from patients with ARVC but not in patients with ischemic or hypertrophic cardiomyopathy. Using lipid bilayer patch clamp single channel recordings, we found that purified integrin β1D protein could stabilize RyR2 function by decreasing RyR2 open probability, mean open time, and increasing mean close time. Also, β1D knockout mice exhibited normal cardiac function and morphology but presented with catecholamine-sensitive polymorphic ventricular tachycardia, consistent with increased RyR2 Ser-2030 phosphorylation and aberrant Ca2+ handling in β1D knockout cardiomyocytes. Mechanistically, we revealed that loss of DSP (desmoplakin) induces integrin β1D deficiency in ARVC mediated through an ERK1/2 (extracellular signal-regulated kinase 1 and 2)-fibronectin-ubiquitin/lysosome pathway.ConclusionsOur data suggest that integrin β1D deficiency represents a novel mechanism underlying the increased risk of ventricular arrhythmias in patients with ARVC.
| S-EPMC7200284 | biostudies-literature
Project description:Despite the technical improvements made in recent years, the overall long-term success rate of ventricular tachycardia (VT) ablation in patients with ischemic cardiomyopathy remains disappointing. This unsatisfactory situation has persisted even though several approaches to VT substrate ablation allow mapping and ablation of noninducible/nontolerated arrhythmias. The current substrate mapping methods present some shortcomings regarding the accurate definition of the true scar, the modality of detection in sinus rhythm of abnormal electrograms that identify sites of critical channels during VT and the possibility to determine the boundaries of functional re-entrant circuits during sinus or paced rhythms. In this review, we focus on current and proposed ablation strategies for VT to provide an overview of the potential/real application (and results) of several ablation approaches and future perspectives.
| S-EPMC6788471 | biostudies-literature
Project description: Not available
| S-EPMC7064801 | biostudies-literature
Project description:Introduction: Patients with non-ischemic cardiomyopathy (NICM) are at risk for ventricular arrhythmias, but diagnosis and treatment planning remain a serious clinical challenge. Although computational modeling has provided valuable insight into arrhythmic mechanisms, the optimal method for simulating reentry in NICM patients with structural disease is unknown. Methods: Here, we compare the effects of fibrotic representation on both reentry initiation and reentry morphology in patient-specific cardiac models. We investigate models with heterogeneous networks of non-conducting structures (cleft models) and models where fibrosis is represented as a dense core with a surrounding border zone (non-cleft models). Using segmented cardiac magnetic resonance with late gadolinium enhancement (LGE) of five NICM patients, we created 185 3D ventricular electrophysiological models with different fibrotic representations (clefts, reduced conductivity and ionic remodeling). Results: Reentry was induced by electrical pacing in 647 out of 3,145 simulations. Both cleft and non-cleft models can give rise to double-loop reentries meandering through fibrotic regions (Type 1-reentry). When accounting for fibrotic volume, the initiation sites of these reentries are associated with high local fibrotic density (mean LGE in cleft models: p< 0.001, core volume in non-cleft models: p = 0.018, negative binomial regression). In non-cleft models, Type 1-reentries required slow conduction in core tissue (non-cleftsc models) as opposed to total conduction block. Incorporating ionic remodeling in fibrotic regions can give rise to single- or double-loop rotors close to healthy-fibrotic interfaces (Type 2-reentry). Increasing the cleft density or core-to-border zone ratio in cleft and non-cleftc models, respectively, leads to increased inducibility and a change in reentry morphology from Type 2 to Type 1. Conclusions: By demonstrating how fibrotic representation affects reentry morphology and location, our findings can aid model selection for simulating arrhythmogenesis in NICM.
| S-EPMC10986182 | biostudies-literature
Project description: Not available
| S-EPMC6926257 | biostudies-literature
Project description:Introduction: Pericardial fluid is enriched with biologically active molecules of cardiovascular origin including microRNAs. Investigation of the disease-specific extracellular microRNAs could shed light on the molecular processes underlying disease development. Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited heart disease characterized by life-threatening arrhythmias and progressive heart failure development. The current data about the association between microRNAs and ARVC development are limited. Methods and Results: We performed small RNA sequence analysis of microRNAs of pericardial fluid samples obtained during transcutaneous epicardial access for ventricular tachycardia (VT) ablation of six patients with definite ARVC and three post-infarction VT patients. Disease-associated microRNAs of pericardial fluid were identified. Five microRNAs (hsa-miR-1-3p, hsa-miR-21-5p, hsa-miR-122-5p, hsa-miR-206, and hsa-miR-3679-5p) were found to be differentially expressed between patients with ARVC and patients with post-infarction VT. Enrichment analysis of differentially expressed microRNAs revealed their close linkage to cardiac diseases. Conclusion: Our data extend the knowledge of pericardial fluid microRNA composition and highlight five pericardial fluid microRNAs potentially linked to ARVC pathogenesis. Further studies are required to confirm the use of pericardial fluid RNA sequencing in differential diagnosis of ARVC.
| S-EPMC8017144 | biostudies-literature
Project description: Not available
| S-EPMC8441204 | biostudies-literature
Project description:BackgroundWide QRS complex tachycardia (WCT) differentiation into ventricular tachycardia (VT) and supraventricular wide complex tachycardia (SWCT) remains challenging despite numerous 12-lead electrocardiogram (ECG) criteria and algorithms. Automated solutions leveraging computerized ECG interpretation (CEI) measurements and engineered features offer practical ways to improve diagnostic accuracy. We propose automated algorithms based on (i) WCT QRS polarity direction (WCT Polarity Code [WCT-PC]) and (ii) QRS polarity shifts between WCT and baseline ECGs (QRS Polarity Shift [QRS-PS]).MethodsIn a three-part study, we derive and validate machine learning (ML) models-logistic regression (LR), artificial neural network (ANN), Random Forests (RF), support vector machine (SVM), and ensemble learning (EL)-using engineered (WCT-PC and QRS-PS) and previously established WCT differentiation features. Part 1 uses WCT ECG measurements alone, Part 2 pairs WCT and baseline ECG features, and Part 3 combines all features used in Parts 1 and 2 RESULTS: Among 235 WCT patients (158 SWCT, 77 VT), 103 had gold standard diagnoses. Part 1 models achieved AUCs of 0.86-0.88 using WCT ECG features alone. Part 2 improved accuracy with paired ECGs (AUCs 0.90-0.93). Part 3 showed variable results (AUC 0.72-0.93), with RF and SVM performing best.ConclusionsIncorporating engineered parameters related to QRS polarity direction and shifts can yield effective WCT differentiation, presenting a promising approach for automated CEI algorithms.
| S-EPMC11688452 | biostudies-literature
Project description:BackgroundUhl's anomaly is a rare congenital heart disease characterized by 'Paper-like thinning of the right ventricular (RV) wall'. Since most patients with Uhl's anomaly die in infancy or childhood, the adult cases of this disorder have been limitedly reported and there were no past report describing this anomaly with ventricular tachycardia (VT), in which catheter ablation was successfully performed.Case summaryWe report the case of a 43-year-old man with a suggested Uhl's anomaly and VT. He underwent a catheter ablation of the recurrent VT. An electrophysiological study showed the VT (cycle length = 460 ms) with a right bundle branch block pattern and inferior axis represented QRS alternans. Concealed entrainment by pacing from the anterior right ventricle (RV) suggested the mechanism of this VT was re-entry and the QRS alternans was simultaneously reproduced during the pacing. Furthermore, the intracardiac electrograms exhibiting local conduction blocks were documented on the RV free wall near the apex. The electrograms seen in a 2:1 ratio were coincident with slurs in the initial QRS on the 12-lead electrocardiogram. Since the anterior RV wall was considered to be a part of the VT circuit, a linear ablation in that area was performed resulting in VT termination.DiscussionThe local conduction blocks near the RV apex were related to the mechanism of the QRS alternans during the VT in this case. That might be based on the variations in the myocardium lying in the RV, which is the specific feature of Uhl's anomaly.
| S-EPMC6439377 | biostudies-literature