Influence of myocardial scar on the response to frequent premature ventricular complex ablation

Penela, Diego; Martinez, M.; Fernández-Armenta, Juan; Aguinaga, Luis; Tercedor, Luís; Ordóñez, A; Acosta, Juan; Martí‐Almor, Julio; Bisbal, Felipe; Rossi, Luca; Borràs, Roger; Linhart, Markus; Soto‐Iglesias, David; Jáuregui, Beatriz; Ortiz-Pérez, Josè T.; Perea, Rosario J.; Bosch, Xavier; Mont, Lluís; Berruezo, Antonio

doi:10.1136/heartjnl-2018-313452

Cited by 14 publications

(11 citation statements)

References 20 publications

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“…Cardiac imaging is key to identify LV dysfunction and suspect the diagnosis of PVC-CM in patients with high PVC burden (≥10%) (Table 5). Cardiac MR with lategadolinium enhancement has the advantage of identifying scar and quantify scar burden, which in turn potentially predicts response to PVC suppression (84). Few clinical and animal studies have also demonstrated diastolic dysfunction after 12-weeks of chronic ventricular bigeminy (50,85).…”

Section: Clinical Presentation Diagnosis and Imaging Featuresmentioning

confidence: 99%

Arrhythmia-Induced Cardiomyopathy

Huízar

Ellenbogen

Tan

et al. 2019

Journal of the American College of Cardiology

241

124

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Section: Clinical Presentation Diagnosis and Imaging Featuresmentioning

confidence: 99%

Arrhythmia-Induced Cardiomyopathy

Huízar

Ellenbogen

Tan

et al. 2019

Journal of the American College of Cardiology

241

124

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“… 4 Importantly, a scar mass <9 g (cardiac magnetic resonance) predicts LV recovery. 51 Besides improving LV function, PVC ablation may also improve survival or long-term outcomes as suggested by the Congestive heart failure: Survival trial of antiarrhythmic therapy (CHF-STAT) study and the Grupo de Estudio de la Sobrevida en la Insuficiencia Cardiaca en Argentina (GESICA) trial. 40 , 52 Future clinical studies are clearly needed to better understand the clinical impact of PVC-CM and its treatment.…”

Section: Introductionmentioning

confidence: 99%

Electrical management of heart failure: from pathophysiology to treatment

Prinzen

Auricchio

Mullens

et al. 2022

European Heart Journal

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Electrical disturbances, such as atrial fibrillation (AF), dyssynchrony, tachycardia, and premature ventricular contractions (PVCs), are present in most patients with heart failure (HF). While these disturbances may be the consequence of HF, increasing evidence suggests that they may also cause or aggravate HF. Animal studies show that longer-lasting left bundle branch block, tachycardia, AF, and PVCs lead to functional derangements at the organ, cellular, and molecular level. Conversely, electrical treatment may reverse or mitigate HF. Clinical studies have shown the superiority of atrial and pulmonary vein ablation for rhythm control and AV nodal ablation for rate control in AF patients when compared with medical treatment. Ablation of PVCs can also improve left ventricular function. Cardiac resynchronization therapy (CRT) is an established adjunct therapy currently undergoing several interesting innovations. The current guideline recommendations reflect the safety and efficacy of these ablation therapies and CRT, but currently, these therapies are heavily underutilized. This review focuses on the electrical treatment of HF with reduced ejection fraction (HFrEF). We believe that the team of specialists treating an HF patient should incorporate an electrophysiologist in order to achieve a more widespread use of electrical therapies in the management of HFrEF and should also include individual conditions of the patient, such as body size and gender in therapy fine-tuning.

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“…The half-width full-maximal method was used to define scar; thresholds for scar core and total scar were 50% and >35% of the maximal signal intensity, respectively. Both volumes were quantified and expressed in cm 3 .…”

Section: Methodsmentioning

confidence: 99%

“…Demonstration of delayed enhancement by cardiac magnetic resonance imaging (DE-CMR) is the gold standard for identification of myocardial scar. 1 Identifying cardiac scar in patients with frequent premature ventricular contractions (PVCs) helps with risk stratification 2 , 3 and procedural planning. However, the prevalence and the predictors of cardiac scar among this population are unknown.…”

Section: Introductionmentioning

confidence: 99%

Factors predictive for delayed enhancement in cardiac resonance imaging in patients undergoing catheter ablation of premature ventricular complexes

Ghannam

Siontis²,

Kim³

et al. 2021

Heart Rhythm O2

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Background Patients undergoing ablation of premature ventricular complexes (PVCs) can have cardiac scar. Risk factors for the presence of scar are not well defined. Objectives To determine the prevalence of scarring detected by delayed enhancement cardiac magnetic resonance imaging (DE-CMR) in patients undergoing ablation of PVCs, to create a risk score predictive of scar, and to explore correlations between the scoring system and long-term outcomes. Methods DE-CMR imaging was performed in consecutive patients with frequent PVCs referred for ablation. The full sample was used to develop a prediction model for cardiac scar based on demographic and clinical characteristics, and internal validation of the prediction model was done using bootstrap samples. Results The study consisted of 333 patients (52% male, aged 53.2 ± 14.5 years, preablation ejection fraction 50.9% ± 12.2%, PVC burden 20.7 ± 13.14), of whom 112 (34%) had DE-CMR scarring. Multiple logistic regression analysis showed age (odds ratio [OR] 1.02 [1.01–1.04]/year, P = .019) and preablation ejection fraction (OR 0.92 [0.89–0.94]/%, P < .001) to be predictive of scar. A weighted risk score incorporating age and ejection fraction was used to stratify patients into low-, medium-, and high-risk groups. Scar prevalence was around 86% in the high-risk group and 12% in the low-risk group; high-risk patients had worse survival free of arrhythmia. Conclusions Cardiac scar was present in one-third of patients referred for PVC ablation. A weighted risk score based simply on patient age and preprocedural ejection fraction can help discriminate between patients at high and low risk for the presence of cardiac scar and worse arrhythmia outcomes.

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Influence of myocardial scar on the response to frequent premature ventricular complex ablation

Cited by 14 publications

References 20 publications

Arrhythmia-Induced Cardiomyopathy

Arrhythmia-Induced Cardiomyopathy

Electrical management of heart failure: from pathophysiology to treatment

Factors predictive for delayed enhancement in cardiac resonance imaging in patients undergoing catheter ablation of premature ventricular complexes

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