Catheter ablation of short-coupled variant of torsade de pointes

Steinfurt, Johannes; Nazer, Babak; Aguilar, Martín; Moss, Joshua D.; Higuchi, Satoshi; Zarse, Markus; Trolese, Luca; Gressler, Alexander; Faber, Thomas; Odening, Katja E.; Zehender, Manfred; Bode, Christoph; Scheinman, Melvin M.; Tedrow, Usha B.; Bogossian, Harilaos

doi:10.1007/s00392-021-01840-z

Cited by 12 publications

(3 citation statements)

References 26 publications

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“…If, however, investigations in humans also indicate preferred focal origins, these locations could prove important ablation targets for patients suffering from LQTS. Indeed, Steinfurt et al (2021) successfully performed catheter ablation of focal source locations in a short-coupled variant of TdP. Similarly, Pappone et al (2023) found localized structural electrophysiological abnormalities in high-risk LQTS patients and ablation of these abnormal locations prevented recurrence of ventricular arrhythmias.…”

Section: Discussionmentioning

confidence: 96%

Directed graph mapping shows rotors maintain non-terminating and focal sources maintain self-terminating Torsade de Pointes in canine model

Abeele¹,

Hendrickx²,

Nieuwenhuyse³

et al. 2023

Front. Physiol.

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Torsade de Pointes is a polymorphic ventricular tachycardia which is as yet incompletely understood. While the onset of a TdP episode is generally accepted to be caused by triggered activity, the mechanisms for the perpetuation is still under debate. In this study, we analysed data from 54 TdP episodes divided over 5 dogs (4 female, 1 male) with chronic atrioventricular block. Previous research on this dataset showed both reentry and triggered activity to perpetuate the arrhythmia. 13 of those TdP episodes showed reentry as part of the driving mechanism of perpetuating the episode. The remaining 41 episodes were purely ectopic. Reentry was the main mechanism in long-lasting episodes (>14 beats), while focal sources were responsible for maintaining shorter episodes. Building on these results, we re-analysed the data using directed graph mapping This program uses principles from network theory and a combination of positional data and local activation times to identify reentry loops and focal sources within the data. The results of this study are twofold. First, concerning reentry loops, we found that on average non-terminating (NT) episodes (≥10 s) show significantly more simultaneous reentry loops than self-terminating (ST) TdP (<10 s). Non-terminating episodes have on average 2.72 ± 1.48 simultaneous loops, compared to an average of 1.33 ± 0.66 for self-terminating episodes. In addition, each NT episode showed a presence of (bi-)ventricular loops between 10.10% and 69.62% of their total reentry duration. Compared to the ST episodes, only 1 in 4 episodes (25%) showed (bi-)ventricular reentry, lasting only 7.12% of its total reentry duration. This suggests that while focal beats trigger TdP, macro-reentry and multiple simultaneous localized reentries are the major drivers of long-lasting episodes. Second, using heatmaps, we found focal sources to occur in preferred locations, instead of being distributed randomly. This may have implications on treatment if such focal origins can be disabled reliably.

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Section: Discussionmentioning

confidence: 96%

Directed graph mapping shows rotors maintain non-terminating and focal sources maintain self-terminating Torsade de Pointes in canine model

Abeele¹,

Hendrickx²,

Nieuwenhuyse³

et al. 2023

Front. Physiol.

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“…As a result, TdP is unlikely to occur. Also, verapamil is the first-line treatment for sc-TdP ( 37 ). There are other HCM treatments that can prolong the QTc interval, such as disopyramide and amiodarone, but these two treatments were not included in this network study due to data limitations.…”

Section: Discussionmentioning

confidence: 99%

Comparing the efficacy and safety of medications in adults with hypertrophic cardiomyopathy: a systematic review and network meta-analysis

Mi,

Wu,

et al. 2023

Front. Cardiovasc. Med.

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BackgroundHypertrophic cardiomyopathy (HCM) is the most common genetic heart disease. The purpose of this study was to evaluate the efficacy and safety of several medications and recommend better drug treatments for adults with HCM.MethodsA review of PubMed, Embase, the Cochrane Controlled Register of Trials (CENTRAL), ClinicalTrials.gov and CNKI databases was conducted for studies on the efficacy and safety of drugs for adults with HCM. A frequentist random effects model was used in this network analysis.ResultsThis network meta-analysis included 7 studies assessing seven medications, 6 studies evaluating monotherapy and 1 study evaluating combination therapy. Based on the network meta-analysis results, xiaoxinbi formula plus metoprolol (MD −56.50% [−72.43%, −40.57%]), metoprolol (MD −47.00% [−59.07%, −34.93%]) and mavacamten (MD −34.50% [−44.75%, −24.25%]) significantly reduced the resting left ventricular outflow tract gradient (LVOTG) in comparison with placebo. Resting LVOTG could also be reduced with N-acetylcysteine (NAC). The incidence of adverse drug reactions was not significantly different between the placebo group and the treatment group.ConclusionFor adults with HCM, the top 4 treatments included xiaoxinbi formula plus metoprolol, metoprolol, mavacamten and NAC.Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=374222], identifier [CRD42022374222].

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“…Furthermore, 3D-mapping and intracardiac echocardiography showed that sc-TdP predominantly originated from MB free wall and its PF network [24].…”

Section: Arrhythmogenic Mechanismsmentioning

confidence: 96%

Moderator Band and Ventricular Tachycardia: Structural or Functional Substrate?

Landra

Marallo

Santoro

et al. 2023

JCDD

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The moderator band (MB) is an intracavitary structure of the right ventricle composed of muscular fibers encompassing specialized Purkinje fibers, separated each other by collagen and adipose tissue. In the last decades, premature ventricular complexes originating within the Purkinje network have been implicated in the genesis of life-threatening arrhythmias. However, right Purkinje network arrhythmias have been much less reported in the literature compared to the left counterpart. The MB has unique anatomical and electrophysiological properties, which may account for its arrhythmogenicity and may be responsible for a significant portion of idiopathic ventricular fibrillation. MB embodies autonomic nervous system cells, with important implications in arrhythmogenesis. Some idiopathic ventricular arrhythmias, defined as the absence of any identifiable structural heart disorder, can begin from this site. Due to these complex structural and functional peculiarities strictly interplayed each other, it is arduous to determine the precise mechanism underlying MB arrhythmias. MB-related arrhythmias should be differentiated from other right Purkinje fibers arrhythmias because of the opportunity for intervention and the unusual site for the ablation poorly described in the literature. In the current paper, we report the characteristics and electrical properties of the MB, their involvement in arrhythmogenesis, clinical and electrophysiological peculiarities of MB-related arrhythmias, and current treatment options.

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Catheter ablation of short-coupled variant of torsade de pointes

Cited by 12 publications

References 26 publications

Directed graph mapping shows rotors maintain non-terminating and focal sources maintain self-terminating Torsade de Pointes in canine model

Directed graph mapping shows rotors maintain non-terminating and focal sources maintain self-terminating Torsade de Pointes in canine model

Comparing the efficacy and safety of medications in adults with hypertrophic cardiomyopathy: a systematic review and network meta-analysis

Moderator Band and Ventricular Tachycardia: Structural or Functional Substrate?

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