Sujet(s)
Fibrillation auriculaire , Cardiomyopathies , Défaillance cardiaque , Humains , Fibrillation auriculaire/complications , Cardiomyopathies/physiopathologie , Cardiomyopathies/étiologie , Cardiomyopathies/complications , Défaillance cardiaque/étiologie , Défaillance cardiaque/physiopathologieSujet(s)
Fibrillation auriculaire , Cardiomyopathies , Défaillance cardiaque , Humains , Fibrillation auriculaire/complications , Fibrillation auriculaire/physiopathologie , Cardiomyopathies/physiopathologie , Cardiomyopathies/étiologie , Cardiomyopathies/complications , Défaillance cardiaque/étiologie , Défaillance cardiaque/physiopathologie , Mâle , Femelle , Sujet âgé , Adulte d'âge moyen , Facteurs de risqueSujet(s)
Atrium du coeur , Défaillance cardiaque , Débit systolique , Humains , Défaillance cardiaque/physiopathologie , Défaillance cardiaque/diagnostic , Débit systolique/physiologie , Atrium du coeur/physiopathologie , Atrium du coeur/imagerie diagnostique , Cardiomyopathies/physiopathologie , Cardiomyopathies/diagnostic , Cardiomyopathies/complications , Cardiomyopathies/imagerie diagnostique , Mâle , Fonction auriculaire gauche/physiologie , Sujet âgé , Fonction ventriculaire gauche/physiologie , FemelleSujet(s)
Dysfonction ventriculaire gauche , Humains , Dysfonction ventriculaire gauche/physiopathologie , Dysfonction ventriculaire gauche/imagerie diagnostique , Cardiomyopathies/physiopathologie , Cardiomyopathies/complications , Cardiomyopathies/imagerie diagnostique , Non-compaction isolée du ventricule/complications , Non-compaction isolée du ventricule/physiopathologie , Non-compaction isolée du ventricule/imagerie diagnostique , SystoleRÉSUMÉ
Ventricular tachycardia (VT) is a rare but potentially fatal complication in pregnancy. We present a case of a pregnant woman with cardiomyopathy due to frequent premature ventricular complexes (PVCs) and VT originating from the left ventricular outflow tract. After presenting late in the third trimester, the decision was made to deliver the fetus after 4 days of medication titration due to continued sustained episodes of VT. After delivery, the patient continued to have frequent PVCs and VT several months after discharge, and she ultimately underwent a PVC ablation with dramatic reduction in PVC burden and improvement in cardiomyopathy. Multidisciplinary planning with a pregnancy heart team led to appropriate contingency planning and a successful delivery. This case highlights how multidisciplinary management is best practice in pregnancy complicated by VT and the need for better diagnostic guidelines for PVC-induced cardiomyopathy in the setting of pregnancy.
Sujet(s)
Cardiomyopathies , Complications cardiovasculaires de la grossesse , Tachycardie ventriculaire , Extrasystoles ventriculaires , Humains , Femelle , Grossesse , Tachycardie ventriculaire/thérapie , Tachycardie ventriculaire/étiologie , Cardiomyopathies/thérapie , Cardiomyopathies/complications , Complications cardiovasculaires de la grossesse/thérapie , Complications cardiovasculaires de la grossesse/diagnostic , Adulte , Extrasystoles ventriculaires/thérapie , Extrasystoles ventriculaires/diagnostic , Extrasystoles ventriculaires/étiologie , Période de péripartum , Ablation par cathéter , Électrocardiographie , Antiarythmiques/usage thérapeutique , Antiarythmiques/administration et posologieRÉSUMÉ
INTRODUCTION: Both atrial fibrillation (AF) and amyloidosis increase stroke risk. We evaluated the best anticoagulation strategy in AF patients with coexistent amyloidosis. METHODS: Consecutive AF patients with concomitant amyloidosis were divided into two groups based on the postablation stroke-prophylaxis approach; group 1: left atrial appendage occlusion (LAAO) in eligible patients and group 2: oral anticoagulation (OAC). Group 1 patients were further divided into Gr. 1A: LAAO + half-does NOAC (HD-NOAC) for 6 months followed by aspirin 81 mg/day and Gr. 1B: LAAO + HD-NOAC. In group 1 patients, with complete occlusion at the 45-day transesophageal echocardiogram, patients were switched to aspirin, 81 mg/day at 6 months. In case of leak, or dense "smoke" in the left atrium (LA) or enlarged LA, they were placed on long-term half-dose (HD) NOAC. Group 2 patients remained on full-dose NOAC during the whole study period. RESULTS: A total of 92 patients were included in the analysis; group 1: 56 and group 2: 36. After the 45-day TEE, 31 patients from group 1 remained on baby-aspirin and 25 on HD NOAC. At 1-year follow-up, four stroke, one TIA and six device-thrombus were reported in group 1A, compared to none in patients in group 1B (5/31 vs. 0/25, p = .03). No bleeding events were reported in group 1, whereas group 2 had five bleeding events (one subdural hematoma, one retinal hemorrhage, and four GI bleedings). Additionally, one stroke was reported in group 2 that happened during brief discontinuation of OAC. CONCLUSION: In patients with coexistent AF and amyloidosis, half-dose NOAC following LAAO was observed to be the safest stroke-prophylaxis strategy.
Sujet(s)
Amyloïdose , Anticoagulants , Auricule de l'atrium , Fibrillation auriculaire , Ablation par cathéter , Accident vasculaire cérébral , Humains , Fibrillation auriculaire/diagnostic , Fibrillation auriculaire/complications , Fibrillation auriculaire/imagerie diagnostique , Fibrillation auriculaire/chirurgie , Mâle , Femelle , Auricule de l'atrium/imagerie diagnostique , Auricule de l'atrium/physiopathologie , Auricule de l'atrium/chirurgie , Sujet âgé , Adulte d'âge moyen , Résultat thérapeutique , Accident vasculaire cérébral/prévention et contrôle , Accident vasculaire cérébral/étiologie , Accident vasculaire cérébral/diagnostic , Ablation par cathéter/effets indésirables , Anticoagulants/administration et posologie , Anticoagulants/effets indésirables , Facteurs de risque , Facteurs temps , Amyloïdose/complications , Amyloïdose/diagnostic , Amyloïdose/imagerie diagnostique , Hémorragie/induit chimiquement , Administration par voie orale , Études rétrospectives , Appréciation des risques , Acide acétylsalicylique/administration et posologie , Acide acétylsalicylique/effets indésirables , Calendrier d'administration des médicaments , Cardiomyopathies/imagerie diagnostique , Cardiomyopathies/complications , Cardiomyopathies/diagnosticRÉSUMÉ
BACKGROUND: Risk stratification for patients with non-ischemic cardiomyopathy (NICM) remains challenging as previous studies predicting life-threatening ventricular arrhythmia (LTVA) events were conducted before the establishment of the current standard treatment. We investigated the prognostic value of non-sustained ventricular tachycardia (NSVT) in NICM patients among recent studies. METHODS: MEDLINE, Embase were searched from January 2000 to October 2023. The risk of NSVT on LTVA and mortality was assessed using a random-effects model for patients with NICM. A meta-regression analysis was employed to identify sources of heterogeneity. The systematic review and meta-analysis were carried out according to the PRISMA guidelines. RESULTS: A total of 18 studies were identified, including 5238 pooled participants. Meta-analysis demonstrated that the presence of NSVT was considered a significant prognostic indicator for LTVA events [hazard ratio (HR): 2.90; 95â¯% CI; 2.31-3.64] with low heterogeneity (I2: 19â¯%) and for mortality (HR; 2.28; 95%CI; 1.26-4.13) with high heterogeneity (I2: 69â¯%). The prognostic value of NSVT for LTVA was not affected by either ejection fraction or medications at baseline. CONCLUSION: NSVT remained an important predictor of LTVA events even in patients receiving healthcare in contemporary eras. Detection of NSVT helps us to identify the high-risk patients with NICM.
Sujet(s)
Cardiomyopathies , Tachycardie ventriculaire , Humains , Tachycardie ventriculaire/étiologie , Tachycardie ventriculaire/mortalité , Cardiomyopathies/complications , Cardiomyopathies/étiologie , Cardiomyopathies/mortalité , Pronostic , Appréciation des risquesRÉSUMÉ
BACKGROUND: Catheter ablation of ventricular tachycardia (VT) typically requires radiation exposure with its potential adverse health effects. A completely fluoroless ablation approach is achievable using a combination of electroanatomical mapping and intracardiac echocardiography. Nonetheless, data in patients undergoing VT ablation are limited. OBJECTIVES: This study aimed to determine the feasibility, efficacy, and safety of VT ablation in patients with structural heart disease using a zero-fluoroscopy approach. METHODS: This multicenter study included consecutive patients with ischemic and nonischemic cardiomyopathy undergoing fluoroless VT ablation. Patients requiring epicardial access or coronary angiography were excluded. RESULTS: Between 2017 and 2023 a total of 198 patients (aged 66.4 ± 13.4 years, 76% male, 48% ischemic) were included. Most patients (95.4%) underwent left ventricular (LV) mapping and/or ablation, which was conducted via transseptal route in 54.5% (n = 103), via retrograde aortic route in 43.4% (n = 82), and using a combined approach in 2.1% (n = 4). Two-thirds of patients had a cardiac device, including a biventricular device in 15%; 2 patients had a LV assist device, and 1 patient had a mechanical aortic valve prosthesis. The mean total procedural time was 211 ± 70 minutes, and the total radiofrequency time was 30 ± 22 minutes. During a follow-up period of 22 ± 18 months, the freedom from VT recurrence was 80%, and 7.6% of patients underwent a repeated ablation. Procedural-related complications occurred in 6 patients (3.0%). CONCLUSIONS: Fluoroless ablation of VT in structural heart disease is feasible, effective, and safe when epicardial mapping/ablation is not required.
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Ablation par cathéter , Études de faisabilité , Tachycardie ventriculaire , Humains , Mâle , Femelle , Sujet âgé , Ablation par cathéter/méthodes , Ablation par cathéter/effets indésirables , Adulte d'âge moyen , Tachycardie ventriculaire/chirurgie , Radioscopie , Échocardiographie , Résultat thérapeutique , Cardiomyopathies/chirurgie , Cardiomyopathies/complicationsRÉSUMÉ
In patients with cardiac amyloidosis, pericardial involvement is common, with up to half of patients presenting with pericardial effusions. The pathophysiological mechanisms of pericardial pathology in cardiac amyloidosis include chronic elevations in right-sided filling pressures, myocardial and pericardial inflammation due to cytotoxic effects of amyloid deposits, and renal involvement with subsequent uremia and hypoalbuminemia. The pericardial effusions are typically small; however, several cases of life-threatening cardiac tamponade with hemorrhagic effusions have been described as a presenting clinical scenario. Constrictive pericarditis can also occur due to amyloidosis and its identification presents a clinical challenge in patients with cardiac amyloidosis who concurrently manifest signs of restrictive cardiomyopathy. Multimodality imaging, including echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging, is useful in the evaluation and management of this patient population. The recognition of pericardial effusion is important in the risk stratification of patients with cardiac amyloidosis as its presence confers a poor prognosis. However, specific treatment aimed at the effusions themselves is seldom indicated. Cardiac tamponade and constrictive pericarditis may necessitate pericardiocentesis and pericardiectomy, respectively.
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Amyloïdose , Épanchement péricardique , Humains , Amyloïdose/complications , Amyloïdose/diagnostic , Épanchement péricardique/étiologie , Épanchement péricardique/diagnostic , Tamponnade cardiaque/étiologie , Tamponnade cardiaque/diagnostic , Péricardite constrictive/diagnostic , Péricardite constrictive/étiologie , Cardiomyopathies/diagnostic , Cardiomyopathies/étiologie , Cardiomyopathies/complications , Cardiomyopathies/thérapie , Échocardiographie , IRM dynamique/méthodes , Péricarde/imagerie diagnostique , Péricarde/anatomopathologieRÉSUMÉ
BACKGROUND: Left bundle branch area pacing (LBBAP) is an alternative to biventricular pacing (BVP) for cardiac resynchronization therapy (CRT). However, despite the presence of left bundle branch block, whether cardiac substrate may influence the effect between the 2 strategies is unclear. OBJECTIVES: This study aims to assess the association of septal scar on reverse remodeling and clinical outcomes of LBBAP compared with BVP. METHODS: We analyzed patients with nonischemic cardiomyopathy who had CRT indications undergoing preprocedure cardiac magnetic resonance examination. Changes in left ventricular ejection fraction (LVEF) and echocardiographic response (ER) (≥5% absolute LVEF increase) were assessed at 6 months. The clinical outcome was the composite of all-cause mortality, heart failure hospitalization, or major ventricular arrhythmia. RESULTS: There were 147 patients included (51 LBBAP and 96 BVP). Among patients with low septal scar burden (below median 5.7%, range: 0% to 5.3%), LVEF improvement was higher in the LBBAP than the BVP group (17.5% ± 10.9% vs 12.3% ± 11.8%; P = 0.037), with more than 3-fold increased odds of ER (OR: 4.35; P = 0.033). In high sepal scar subgroups (≥5.7%, range: 5.7%-65.9%), BVP trended towards higher LVEF improvement (9.2% ± 9.4% vs 6.4% ± 12.4%; P = 0.085). Interaction between septal scar burden and pacing strategy was significant for ER (P = 0.002) and LVEF improvement (P = 0.011) after propensity score adjustment. During median follow-up of 33.7 (Q1-Q3: 19.8-42.1) months, the composite clinical outcome occurred in 34.7% (n = 51) of patients. The high-burden subgroups had worse clinical outcomes independent of CRT method. CONCLUSIONS: Remodeling response to LBBAP and BVP among nonischemic cardiomyopathy patients is modified by septal scar burden. High septal scar burden was associated with poor clinical prognosis independent of CRT methods.
Sujet(s)
Thérapie de resynchronisation cardiaque , Cicatrice , Humains , Femelle , Mâle , Sujet âgé , Adulte d'âge moyen , Cicatrice/physiopathologie , Cicatrice/imagerie diagnostique , Septum du coeur/imagerie diagnostique , Septum du coeur/physiopathologie , Échocardiographie , Cardiomyopathies/physiopathologie , Cardiomyopathies/thérapie , Cardiomyopathies/complications , Bloc de branche/physiopathologie , Bloc de branche/thérapie , Résultat thérapeutique , Débit systolique/physiologie , Remodelage ventriculaire/physiologie , Défaillance cardiaque/physiopathologie , Défaillance cardiaque/thérapieSujet(s)
Cardiomyopathies , Défaillance cardiaque , Tachycardie par réentrée intranodale , Humains , Tachycardie par réentrée intranodale/physiopathologie , Tachycardie par réentrée intranodale/diagnostic , Tachycardie par réentrée intranodale/complications , Défaillance cardiaque/physiopathologie , Défaillance cardiaque/mortalité , Défaillance cardiaque/complications , Cardiomyopathies/physiopathologie , Cardiomyopathies/complications , Cardiomyopathies/mortalité , Facteurs de risque , Mâle , ÉlectrocardiographieRÉSUMÉ
This case report examines peripartum cardiomyopathy (PPCM), a rare variant of heart failure with reduced ejection fraction, which manifests at the end of labor or puerperium. The frequency of this pathology varies globally, and its association with risk factors such as genetic disorders, autoimmune diseases, viral infections, suggests a multifactorial etiology. Diagnostic criteria include: Heart failure secondary to left ventricular systolic dysfunction, manifested in the puerperium or at the end of pregnancy and lack of other identifiable causes of heart failure. The case presents a patient with no significant personal pathological history, who, 17 days post cesarean section developed acute symptoms, including abdominal pain, dry cough and dyspnea. Clinical findings revealed hypoxemia, alterations in blood tests and an echocardiogram that confirmed an atrial septal defect. Multidisciplinary management resulted in successful treatment and the patient was discharged without complications. This case highlights the importance of MCPP, a disease with high maternal mortality. The connection between atrial septal defect and PPCM, as well as the involvement of pulmonary thromboembolism.
Sujet(s)
Défaillance cardiaque , Communications interauriculaires , Troubles du postpartum , Embolie pulmonaire , Humains , Femelle , Communications interauriculaires/complications , Communications interauriculaires/diagnostic , Embolie pulmonaire/complications , Embolie pulmonaire/étiologie , Embolie pulmonaire/thérapie , Grossesse , Défaillance cardiaque/étiologie , Adulte , Troubles du postpartum/étiologie , Troubles du postpartum/diagnostic , Troubles du postpartum/thérapie , Cardiomyopathies/étiologie , Cardiomyopathies/thérapie , Cardiomyopathies/diagnostic , Cardiomyopathies/complications , Période de péripartum , Complications cardiovasculaires de la grossesse/thérapie , Complications cardiovasculaires de la grossesse/diagnostic , Complications cardiovasculaires de la grossesse/physiopathologie , CésarienneRÉSUMÉ
BACKGROUND: Recurrent ventricular tachycardia (VT) in patients with prior myocardial infarction is associated with adverse quality of life and clinical outcomes, despite the presence of implanted defibrillators (ICDs). Suppression of recurrent VT can be accomplished with antiarrhythmic drug therapy or catheter ablation. The Ventricular Tachycardia Antiarrhythmics or Ablation In Structural Heart Disease 2 (VANISH2) trial is designed to determine whether ablation is superior to antiarrhythmic drug therapy as first line therapy for patients with ischemic cardiomyopathy and VT. METHODS: The VANISH2 trial enrolls patients with prior myocardial infarction and VT (with one of: ≥1 ICD shock; ≥3 episodes treated with antitachycardia pacing (ATP) and symptoms; ≥5 episodes treated with ATP regardless of symptoms; ≥3 episodes within 24 hours; or sustained VT treated with electrical cardioversion or pharmacologic conversion). Enrolled patients are classified as either sotalol-eligible, or amiodarone-eligible, and then are randomized to either catheter ablation or to that antiarrhythmic drug therapy, with randomization stratified by drug-eligibility group. Drug therapy, catheter ablation procedures and ICD programming are standardized. All patients will be followed until two years after randomization. The primary endpoint is a composite of mortality at any time, appropriate ICD shock after 14 days, VT storm after 14 days, and treated sustained VT below detection of the ICD after 14 days. The outcomes will be analyzed according to the intention-to-treat principle using survival analysis techniques RESULTS: The results of the VANISH2 trial are intended to provide data to support clinical decisions on how to suppress VT for patients with prior myocardial infarction. CLINICALTRIALS: gov registration NCT02830360.
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Antiarythmiques , Cardiomyopathies , Ablation par cathéter , Ischémie myocardique , Tachycardie ventriculaire , Humains , Tachycardie ventriculaire/thérapie , Antiarythmiques/usage thérapeutique , Ablation par cathéter/méthodes , Cardiomyopathies/complications , Cardiomyopathies/thérapie , Ischémie myocardique/complications , Mâle , Femelle , Défibrillateurs implantables , Adulte d'âge moyen , Amiodarone/usage thérapeutique , Résultat thérapeutique , Sotalol/usage thérapeutique , Association thérapeutiqueSujet(s)
Amyloïdose , Accident vasculaire cérébral ischémique , Humains , Accident vasculaire cérébral ischémique/étiologie , Accident vasculaire cérébral ischémique/imagerie diagnostique , Accident vasculaire cérébral ischémique/complications , Amyloïdose/complications , Amyloïdose/diagnostic , Amyloïdose/imagerie diagnostique , Mâle , Cardiomyopathies/étiologie , Cardiomyopathies/imagerie diagnostique , Cardiomyopathies/diagnostic , Cardiomyopathies/complications , Sujet âgé , FemelleRÉSUMÉ
BACKGROUND: The limited ability of enzyme replacement therapy (ERT) in removing globotriaosylceramide from cardiomyocytes is recognized for advanced Fabry disease cardiomyopathy (FDCM). Prehypertrophic FDCM is believed to be cured or stabilized by ERT. However, no pathologic confirmation is available. We report here on the long-term clinical-pathologic impact of ERT on prehypertrophic FDCM. METHODS AND RESULTS: Fifteen patients with Fabry disease with left ventricular maximal wall thickness ≤10.5 mm at cardiac magnetic resonance required endomyocardial biopsy because of angina and ventricular arrhythmias. Endomyocardial biopsy showed coronary small-vessel disease in the angina cohort, and vacuoles in smooth muscle cells and cardiomyocytes ≈20% of the cell surface containing myelin bodies at electron microscopy. Patients received α-agalsidase in 8 cases, and ß-agalsidase in 7 cases. Both groups experienced symptom improvement except 1 patients treated with α-agalsidase and 1 treated with ß-agalsidase. After ERT administration ranging from 4 to 20 years, all patients had control cardiac magnetic resonance and left ventricular endomyocardial biopsy because of persistence of symptoms or patient inquiry on disease resolution. In 13 asymptomatic patients with FDCM, left ventricular maximal wall thickness and left ventricular mass, cardiomyocyte diameter, vacuole surface/cell surface ratio, and vessels remained unchanged or minimally increased (left ventricular mass increased by <2%) even after 20 years of observation, and storage material was still present at electron microscopy. In 2 symptomatic patients, FDCM progressed, with larger and more engulfed by globotriaosylceramide myocytes being associated with myocardial virus-negative lymphocytic inflammation. CONCLUSIONS: ERT stabilizes storage deposits and myocyte dimensions in 87% of patients with prehypertrophic FDCM. Globotriaosylceramide is never completely removed even after long-term treatment. Immune-mediated myocardial inflammation can overlap, limiting ERT activity.
Sujet(s)
Cardiomyopathies , Maladie de Fabry , Cardiopathies , Myocardite , Trihexosylcéramide , Humains , Maladie de Fabry/complications , Maladie de Fabry/traitement médicamenteux , Maladie de Fabry/anatomopathologie , alpha-Galactosidase/usage thérapeutique , alpha-Galactosidase/métabolisme , Thérapie enzymatique substitutive/méthodes , Cardiomyopathies/étiologie , Cardiomyopathies/complications , Myocytes cardiaques/métabolisme , Myocardite/induit chimiquement , Angine de poitrine/complications , Cardiopathies/complications , Inflammation/métabolismeRÉSUMÉ
AIMS: Primary prevention patients with ischaemic cardiomyopathy and chronic total occlusion of an infarct-related coronary artery (CTO) are at a particularly high risk of implantable cardioverter-defibrillator (ICD) therapy occurrence. The trial was designed to evaluate the efficacy of preventive CTO-related substrate ablation strategy in ischaemic cardiomyopathy patients undergoing primary prevention ICD implantation. METHODS AND RESULTS: The PREVENTIVE VT study was a prospective, multicentre, randomized trial including ischaemic patients with ejection fraction ≤40%, no documented ventricular arrhythmias (VAs), and evidence of scar related to the coronary CTO. Patients were randomly assigned 1:1 to a preventive substrate ablation before ICD implantation or standard therapy with ICD implantation only. The primary outcome was a composite of appropriate ICD therapy or unplanned hospitalization for VAs. Secondary outcomes included the primary outcome's components, the incidence of appropriate ICD therapies, cardiac hospitalization, electrical storm, and cardiovascular (CV) mortality. Sixty patients were included in the study. During the mean follow-up of 44.7 ± 20.7 months, the primary outcome occurred in 5 (16.7%) patients undergoing preventive substrate ablation and in 13 (43.3%) patients receiving only ICD [hazard ratio (HR): 0.33; 95% confidence interval (CI): 0.12-0.94; P = 0.037]. Patients in the preventive ablation group also had fewer appropriate ICD therapies (P = 0.039) and the electrical storms (Log-rank: P = 0.01). While preventive ablation also reduced cardiac hospitalizations (P = 0.006), it had no significant impact on CV mortality (P = 0.151). CONCLUSION: Preventive ablation of the coronary CTO-related substrate in patients undergoing primary ICD implantation is associated with the reduced risk of appropriate ICD therapy or unplanned hospitalization due to VAs.
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Ablation par cathéter , Occlusion coronarienne , Défibrillateurs implantables , Ischémie myocardique , Prévention primaire , Humains , Mâle , Femelle , Adulte d'âge moyen , Sujet âgé , Occlusion coronarienne/mortalité , Occlusion coronarienne/thérapie , Occlusion coronarienne/prévention et contrôle , Occlusion coronarienne/complications , Résultat thérapeutique , Études prospectives , Ischémie myocardique/complications , Ischémie myocardique/mortalité , Tachycardie ventriculaire/prévention et contrôle , Tachycardie ventriculaire/thérapie , Tachycardie ventriculaire/mortalité , Cardiomyopathies/mortalité , Cardiomyopathies/complications , Cardiomyopathies/thérapie , Mort subite cardiaque/prévention et contrôle , Mort subite cardiaque/étiologie , Facteurs de risque , Défibrillation/instrumentation , Défibrillation/effets indésirables , Défibrillation/mortalité , Infarctus du myocarde/mortalité , Infarctus du myocarde/prévention et contrôle , Infarctus du myocarde/complications , Maladie chronique , Facteurs tempsRÉSUMÉ
AIMS: The ultra-low-temperature cryoablation (ULTC) ablation system using -196°C N2 cryogen has been reported to create lesions with freeze duration-dependent depth titratable to over 10â mm with minimum attenuation by scar. Cryocure-VT (NCT04893317) was a first-in-human clinical trial evaluating the safety and efficacy of a novel, purpose-built ULTC catheter in endocardial ablation of scar-dependent ventricular tachycardias (VTs). METHODS AND RESULTS: This prospective, multi-centre study enrolled patients referred for de novo or second ablations of recurrent monomorphic VT of both ischaemic and non-ischaemic aetiologies. Primary safety and efficacy endpoints of the study were freedom from device- or procedure-related major adverse events (MAEs) up to 30 days post-ablation, acute non-inducibility of clinical VTs at the end of the procedure, and freedom from sustained VT or implantable defibrillator intervention at 6 months. Ultra-low-temperature cryoablation was performed in 64 patients (age 67 ± 11 years, 78% ischaemic, ejection fraction = 35 ± 10%) at 9 centres. The primary acute effectiveness endpoint was achieved in 94% (51/54) of patients in whom post-ablation induction was attempted. There were no protocol-defined MAEs; four procedure-related serious adverse events resolved without clinical sequelae. At 6-month follow-up, 38 patients (60.3%) remained VT-free, and freedom from defibrillator shock was 81.0%, with no significant difference between ischaemic and non-ischaemic cohorts. In 47 patients with defibrillator for at least 6 months prior to the ablation, the VT burden was reduced from median of 4, inter-quartile range (IQR, 1-9) to 0, IQR (0-2). CONCLUSION: In this first-in-human multi-centre experience, endocardial ULTC ablation of monomorphic VT appears safe and effective in patients with both ischaemic-cardiomyopathy and non-ischaemic-cardiomyopathy. CLINICAL TRIAL REGISTRATION: NCT04893317.
Sujet(s)
Cardiomyopathies , Ablation par cathéter , Cryochirurgie , Tachycardie ventriculaire , Sujet âgé , Humains , Adulte d'âge moyen , Cardiomyopathies/complications , Cardiomyopathies/diagnostic , Cardiomyopathies/chirurgie , Ablation par cathéter/effets indésirables , Cicatrice/complications , Cryochirurgie/effets indésirables , Études prospectives , Tachycardie ventriculaire/diagnostic , Tachycardie ventriculaire/étiologie , Tachycardie ventriculaire/chirurgie , Température , Résultat thérapeutiqueSujet(s)
Fibrillation auriculaire , Cardiomyopathies , Fibrose , Hypertension artérielle , Serine endopeptidases , Populations d'Asie du Sud , Adulte , Femelle , Humains , Allèles , Troubles du rythme cardiaque/génétique , Fibrillation auriculaire/génétique , Cardiomyopathies/complications , Cardiomyopathies/génétique , Fibrose/génétique , Atrium du coeur/anatomopathologie , Atrium du coeur/imagerie diagnostique , Hypertension artérielle/génétique , Mutation perte de fonction/génétique , Serine endopeptidases/génétique , Populations d'Asie du Sud/génétiqueRÉSUMÉ
BACKGROUND: Hypocalcaemia is a rare, but reversible, cause of dilated cardiomyopathy causing heart failure. Several case reports have been reported on reversible cardiomyopathy secondary to hypocalcaemia. CASE PRESENTATION: We report a case of 54-year-old female Sri Lankan patient who presented with shortness of breath and was diagnosed with heart failure with reduced ejection fraction due to dilated cardiomyopathy. The etiology for dilated cardiomyopathy was identified as hypocalcemic cardiomyopathy, secondary to primary hypoparathyroidism, which was successfully treated with calcium and vitamin D replacement therapy. CONCLUSION: This adds to literature of this rare cause of reversible cardiomyopathy secondary to hypocalcemia reported from the South Asian region of the world. This case highlights the impact of proper treatment improving the heart failure in patients with hypocalcemic cardiomyopathy.
Sujet(s)
Cardiomyopathies , Cardiomyopathie dilatée , Défaillance cardiaque , Hypocalcémie , Femelle , Humains , Adulte d'âge moyen , Hypocalcémie/complications , Hypocalcémie/traitement médicamenteux , Cardiomyopathie dilatée/complications , Cardiomyopathie dilatée/diagnostic , Calcium/usage thérapeutique , Cardiomyopathies/complications , Défaillance cardiaque/complicationsRÉSUMÉ
INTRODUCTION: Septic shock is a severe form of sepsis that has a high mortality rate, and a substantial proportion of these patients will develop cardiac dysfunction, often termed septic cardiomyopathy (SCM). Some SCM patients may develop frank cardiac failure, termed sepsis-related cardiogenic shock (SeRCS). Little is known of SeRCS. This study describes baseline characteristics of patients with SCM and SeRCS compared to patients with septic shock without cardiac dysfunction. We compare clinical outcomes among SCM, SeRCS, and septic shock, and identify risk factors for the development of SCM and SeRCS. METHODS: Septic patients admitted to the ICU with an echocardiogram obtained within 72 hours were included. Left ventricular ejection fraction of ≤55% was used to define SCM, and cardiac index ≤2.1 L/min/m2 among patients with SCM defined SeRCS. Machine learning was used to identify risk factors for development of SCM and SeRCS. Logistic regression was used to compare mortality among groups. RESULTS: Among 1229 patients, 977 patients had septic shock without cardiac dysfunction, 207 had SCM, and 45 had SeRCS. In patients with septic shock, the strongest predictor for developing SCM and SeRCs was a prior history of cardiac dysfunction. Mortality did not significantly differ among the three groups. CONCLUSIONS: SCM and SeRCS affect a minority of patients with septic shock, disproportionately affecting individuals with a history of cardiac disease. We did not identify a mortality difference associated with SCM or SeRCS. Additional work is needed to define further subtypes and treatment options for this patient population.