ABSTRACT
AIMS: Validating mapping systems that identify atrial fibrillation (AF) sources (focal/rotational activity) is confounded by the absence of ground truth. A key concern of prior mapping technologies is spatiotemporal instability, manifesting as poor map reproducibility. Electrographic flow (EGF) employs a novel algorithm that visualizes atrial electrical wavefront propagation to identify putative AF sources. We analysed both intra- (3â min) and inter- (>3 months) procedure EGF map reproducibility. METHODS AND RESULTS: In 23 persistent AF patients, after pulmonary vein isolation (PVI), EGF maps were generated from 3 serial 1â min recordings using a 64-electrode basket mapping catheter (triplets) at right and left atrial locations. Source prevalence from map triplets was compared between recordings. Per protocol, 12 patients returned for 3-month remapping (1 non-inducible): index procedure post-PVI EGF maps were compared with initial EGF remapping at 3-month redo. Intra-procedure reproducibility: analysing 224 map triplets (111 right atrium, 113 left atrium) revealed a high degree of map consistency with minimal min-to-min shifts: 97 triplets (43%), exact match of leading sources on all 3 maps; 95 triplets (42%), leading source within 1 electrode space on 2 of 3 maps; and 32 triplets (14%), chaotic leading source pattern. Average deviation in source prevalence over 60â s was low (6.4%). Inter-procedure reproducibility: spatiotemporal stability of EGF mapping >3 months was seen in 16 of 18 (89%) sources mapped in 12 patients with (re)inducible AF. CONCLUSION: Electrographic flow mapping generates reproducible intra- and inter-procedural maps, providing rationale for randomized clinical trials targeting these putative AF sources.
Subject(s)
Atrial Fibrillation , Catheter Ablation , Pulmonary Veins , Humans , Atrial Fibrillation/diagnosis , Atrial Fibrillation/surgery , Reproducibility of Results , Epidermal Growth Factor , Catheter Ablation/methods , Heart Atria , Pulmonary Veins/surgery , Treatment OutcomeABSTRACT
BACKGROUND: Premature ventricular complexes (PVCs) are prevalent and, although often benign, they may lead to PVC-induced cardiomyopathy. We created a deep-learning algorithm to predict left ventricular ejection fraction (LVEF) reduction in patients with PVCs from a 12-lead electrocardiogram (ECG). OBJECTIVES: This study aims to assess a deep-learning model to predict cardiomyopathy among patients with PVCs. METHODS: We used electronic medical records from 5 hospitals and identified ECGs from adults with documented PVCs. Internal training and testing were performed at one hospital. External validation was performed with the others. The primary outcome was first diagnosis of LVEF ≤40% within 6 months. The dataset included 383,514 ECGs, of which 14,241 remained for analysis. We analyzed area under the receiver operating curves and explainability plots for representative patients, algorithm prediction, PVC burden, and demographics in a multivariable Cox model to assess independent predictors for cardiomyopathy. RESULTS: Among the 14,241-patient cohort (age 67.6 ± 14.8 years; female 43.8%; White 29.5%, Black 8.6%, Hispanic 6.5%, Asian 2.2%), 22.9% experienced reductions in LVEF to ≤40% within 6 months. The model predicted reductions in LVEF to ≤40% with area under the receiver operating curve of 0.79 (95% CI: 0.77-0.81). The gradient weighted class activation map explainability framework highlighted the sinus rhythm QRS complex-ST segment. In patients who underwent successful PVC ablation there was a post-ablation improvement in LVEF with resolution of cardiomyopathy in most (89%) patients. CONCLUSIONS: Deep-learning on the 12-lead ECG alone can accurately predict new-onset cardiomyopathy in patients with PVCs independent of PVC burden. Model prediction performed well across sex and race, relying on the QRS complex/ST-segment in sinus rhythm, not PVC morphology.
Subject(s)
Cardiomyopathies , Deep Learning , Ventricular Premature Complexes , Adult , Humans , Female , Middle Aged , Aged , Aged, 80 and over , Stroke Volume , Ventricular Function, Left , Ventricular Premature Complexes/diagnosis , Ventricular Premature Complexes/surgery , Algorithms , Cardiomyopathies/complications , Cardiomyopathies/diagnosis , ElectrocardiographyABSTRACT
BACKGROUND: Interatrial block (IAB) is associated with thromboembolism and atrial arrhythmias. However, prior studies included small patient cohorts so it remains unclear whether IAB predicts adverse outcomes particularly in context of atrial fibrillation (AF)/atrial flutter (AFL). OBJECTIVES: This study sought to determine whether IAB portends increased stroke risk in a large cohort in the presence or absence of AFAF/AFL. METHODS: We performed a 5-center retrospective analysis of 4,837,989 electrocardiograms (ECGs) from 1,228,291 patients. IAB was defined as P-wave duration ≥120 ms in leads II, III, or aVF. Measurements were extracted as .XML files. After excluding patients with prior AF/AFL, 1,825,958 ECGs from 458,994 patients remained. Outcomes were analyzed using restricted mean survival time analysis and restricted mean time lost. RESULTS: There were 86,317 patients with IAB and 355,032 patients without IAB. IAB prevalence in the cohort was 19.6% and was most common in Black (26.1%), White (20.9%), and Hispanic (18.5%) patients and least prevalent in Native Americans (9.2%). IAB was independently associated with increased stroke probability (restricted mean time lost ratio coefficient [RMTLRC]: 1.43; 95% CI: 1.35-1.51; tau = 1,895), mortality (RMTLRC: 1.14; 95% CI: 1.07-1.21; tau = 1,924), heart failure (RMTLRC: 1.94; 95% CI: 1.83-2.04; tau = 1,921), systemic thromboembolism (RMTLRC: 1.62; 95% CI: 1.53-1.71; tau = 1,897), and incident AF/AFL (RMTLRC: 1.16; 95% CI: 1.10-1.22; tau = 1,888). IAB was not associated with stroke in patients with pre-existing AF/AFL. CONCLUSIONS: IAB is independently associated with stroke in patients with no history of AF/AFL even after adjustment for incident AF/AFL and CHA2DS2-VASc score. Patients are at increased risk of stroke even when AF/AFL is not identified.
Subject(s)
Atrial Fibrillation , Atrial Flutter , Stroke , Thromboembolism , Humans , Atrial Fibrillation/complications , Atrial Fibrillation/epidemiology , Interatrial Block/complications , Interatrial Block/epidemiology , Retrospective Studies , Electrocardiography , Stroke/epidemiology , Stroke/etiology , Atrial Flutter/complications , Atrial Flutter/epidemiology , Thromboembolism/epidemiology , Thromboembolism/etiologyABSTRACT
PURPOSE OF REVIEW: Current ablation approach for arrhythmias relies upon the use of radiofrequency (RF) and cryoablation catheters. Although there have been significant advances both in catheter design and in energy delivery approaches, limitations such as suboptimal efficacy and safety remain. Pulsed field ablation (PFA) has emerged as a novel approach to ablation that is distinct from RF and cryoablation by virtue of selective ablation of myocardial tissue. Preclinical and clinical reports have demonstrated lesion durability with an excellent safety profile. These findings need to be confirmed in prospective randomized trials that are currently ongoing. In this review, we describe efficacy and safety outcomes from both pre-clinical and clinical studies that have been performed so far and briefly discuss ongoing clinical trials and future investigations. RECENT FINDINGS: Data from pre-clinical and clinical research have shown PFA as a promising tool for ablation of cardiac arrhythmias. In addition to safety regarding mitigating the risk to surrounding structures such as the phrenic nerve, esophagus, PFA also offers an effective method for ablation. In this review, we summarize the currently published pre-clinical and clinical data evaluating the safety and efficacy of PFA for cardiac arrhythmias.
Subject(s)
Atrial Fibrillation , Catheter Ablation , Pulmonary Veins , Atrial Fibrillation/surgery , Catheter Ablation/methods , Humans , Prospective Studies , Pulmonary Veins/surgery , Treatment OutcomeABSTRACT
BACKGROUND: Data regarding the use of high-power short-duration (HPSD) radiofrequency (RF) in combination with half-normal saline irrigation for catheter irrigation are limited. OBJECTIVES: This study investigated the safety and efficacy of using HPSD RF ablation in combination with half-normal saline irrigation for the treatment of AF. METHODS: One hundred consecutive patients with AF underwent RF ablation using HPSD combined with half-normal saline for catheter irrigation. In addition, the following ablation strategies were used: 1 mm tags for the display of ablation lesions on the mapping system, high-frequency jet ventilation (HFJV), low contact force, pacing after ablation to verify areas of noncapture, atrial/ventricular pacing at 500 to 700 ms to aid in catheter stability, use of two skin electrodes to reduce impedance, and postablation adenosine infusion. Power was started at 40 to 45 W and was modulated manually based on impedance changes. RESULTS: The average age of patients was 65.2 years and 70% were male. Forty seven percent had paroxysmal AF and the average CHA2 DS2 -VASc score was 2.1 ± 1.6. The average power and lesion duration were 38.1 ± 3.3 W and 8.1 ± 2.3 s, respectively. During a median follow-up period of 321 ± 139 days, 89% of the patients remained free from any atrial arrhythmias after a single RF ablation procedure. No procedure-related death, stroke, pericardial effusion, or atrioesophageal fistula occurred during follow-up. CONCLUSIONS: Catheter ablation using HPSD RF lesions in combination with half-normal saline irrigation and is safe and effective, and results in high rate of freedom from AF.
Subject(s)
Atrial Fibrillation/therapy , Radiofrequency Ablation/methods , Saline Solution/administration & dosage , Therapeutic Irrigation/methods , Aged , Combined Modality Therapy , Female , Humans , MaleABSTRACT
Rarely, a left atrial appendage closure device may chronically migrate to an unfavorable position postoperatively, requiring removal. We present the details of a case in which a WATCHMAN™ device (Boston Scientific, Natick, MA, USA) implanted seven months prior was found to have migrated with protrusion 0.91 cm outside the left atrial appendage together with a 90º tilt and peridevice leakage. Adopting a femoral arterial retrograde approach, a 27-mm WATCHMAN™ device was temporarily positioned in the ascending aorta for cerebroembolic protection, never released from the connecting wire. Extraction of the original WATCHMAN™ device was performed using an endoscopic grasping tool, with subsequent device re-implantation of a new device and removal of the temporarily positioned device in the ascending aorta.
ABSTRACT
BACKGROUND: There are limited data on the comparative analyses of TightRail rotating dilator sheath (Philips) and laser sheath for lead extraction. OBJECTIVE: To evaluate the effectiveness and safety of the TightRail sheath as a primary or secondary tool for transvenous lead extraction (TLE). METHODS: Retrospective cohort analysis of 202 consecutive patients who underwent TLE using either TightRail sheath and/or GlideLight laser sheath (Philips) in our hospital. The study population was divided into three groups: Group A underwent TLE with laser sheath only (N = 157), Group B with TightRail sheath only (N = 22), and Group C with both sheaths (N = 23). RESULTS: During this period, 375 leads in 202 patients were extracted, including 297 leads extracted by laser sheath alone, 45 leads by TightRail sheath alone, and 33 by both TightRail sheath and laser sheaths. The most common indications included device infection (44.6%) and lead-related complications (44.1%). The median age of leads was 8.9 years. TightRail sheath (Group B) achieved similar efficacy as a primary extraction tool compared with laser sheath (Group A), with complete procedure success rate of 93.3% (vs. 96.6%, P = .263) and clinical success rate of 100.0% (vs. 98.1%, P = .513). Among 32 leads in which Tightrail was used after laser had failed (Group C), the complete procedure success rate was 75.8%. No significant difference in procedural adverse events was observed. CONCLUSION: Our single-center experience confirms that the TightRail system is an effective first-line and second-line method for TLE. Further investigation is required to guide the selection of mechanical and laser sheaths in lead extraction cases.
Subject(s)
Device Removal/instrumentation , Electrodes, Implanted , Defibrillators, Implantable , Equipment Design , Female , Humans , Lasers , Male , Middle Aged , Pacemaker, Artificial , Retrospective StudiesABSTRACT
Our knowledge of associated cardiotoxicities from novel therapeutics in oncology continues to expand. These include arrhythmias from cancer-therapy induced cardiomyopathy resulting from both direct and indirect effects on cardiomyocytes and other mechanisms that can adversely impact cardiovascular outcomes and overall mortality. In this review, we focus on both the arrhythmias of various classes of oncologic agents as well as the use of cardiac implantable electronic devices (cardioverter-defibrillators, permanent pacemakers, and cardiac resynchronization therapy) in cardio-oncology patients.
Subject(s)
Arrhythmias, Cardiac/therapy , Cardiac Resynchronization Therapy Devices , Cardiomyopathies/complications , Electrocardiography , Neoplasms/complications , Arrhythmias, Cardiac/etiology , Arrhythmias, Cardiac/physiopathology , Cardiomyopathies/physiopathology , HumansABSTRACT
Mitral valve prolapse (MVP) affects approximately 170 million people worldwide; however, phenotypically, there is a wide variety of heterogeneity. In particular subsets, the incidence of sudden cardiac death is calculated to be 998 per 100,000 person-years, which is significantly increased when compared with the general population of MVP patients. Individuals with high-risk features have been identified as young females with bileaflet MVP and electrocardiogram findings of frequent complex ectopy, ST-T wave changes, and inferior T wave inversions. Supplemental imaging modalities in this subgroup demonstrate redundant leaflets and chordae on 2-dimensional transthoracic echocardiography along with varying severity of mitral annular disjunction. Detailed morphologic assessment by 3-dimensional echocardiography provides a quantitative assessment of annular disjunction along with left ventricular longitudinal and basal circumferential strain patterns. Late gadolinium enhancement on cardiac magnetic resonance imaging identifies diffuse and isolated left ventricle fibrosis involving the fascicles and papillary muscles, which has been visualized in isolation during autopsy. Findings of this review propose that sudden cardiac death as a result of malignant arrhythmias arises from automaticity, complex ectopy, and reentry at the level of the fascicles and papillary muscles. The repetitive mechanical stress provides a nidus for the development of both micro- and macrofibrosis easily identified by late gadolinium enhancement on cardiac magnetic resonance imaging. Escalation to electrophysiology studies and early intervention could provide new targeted lifesaving therapies.
Subject(s)
Mitral Valve Prolapse , Contrast Media , Death, Sudden, Cardiac/epidemiology , Death, Sudden, Cardiac/etiology , Female , Gadolinium , Humans , Mitral Valve Prolapse/diagnosis , Mitral Valve Prolapse/diagnostic imaging , Papillary Muscles/diagnostic imagingABSTRACT
Atrial fibrillation (AF) and heart failure (HF) are the 2 emerging epidemics in global cardiovascular disease. AF remains the most common cardiac arrhythmia, affecting over 33 million adults worldwide, and continues to increase in prevalence as the populations of many nations age. The prevalence of HF also surges, now afflicting 37 million adults globally. Interestingly, these 2 disease processes share many of the same risk factors and stem from many of the same pathophysiologic derangements, with AF occurring in over half of all patients with HF and HF occurring in over one third of all patients with AF. Furthermore, exacerbation of one of these ailments often drives decompensation or compromises therapy of the other, and it has been widely reported that coexistence of AF in patients with HF portends a poorer prognosis. As a result, many clinicians now routinely face the problem of AF in the patient with HF. In this review, we highlight the fundamental pathologic forces embedded in the relationship between AF and HF and then proceed to a discussion on the management of these complex patients with a detailed exploration of the clinical data.
Subject(s)
Atrial Fibrillation , Heart Failure , Atrial Fibrillation/complications , Atrial Fibrillation/epidemiology , Atrial Fibrillation/therapy , Heart Failure/complications , Heart Failure/epidemiology , Heart Failure/therapy , Humans , Prevalence , Prognosis , Risk FactorsABSTRACT
The overall incidence of Out-of-hospital Cardiac Arrest (OHCA) is decreasing worldwide due to emergency responses, but there are gender and racial differences in the incidence of OHCA, which remain under investigation. Our aim was to identify the incidence, gender, and racial disparities in patients admitted with OHCA. The National Inpatient Sample Database is one of the largest all-payer inpatient database. It was queried to identify patients 18 years or older who were hospitalized with the principal diagnosis of OHCA. There was a total of 85,988 patients who were discharged with a diagnosis classified as OHCA using the ICD-9 code for a period of 2 years. The mean age of the patients who had presented to the hospital with OHCA was 64.3 (±18.5 years). Overall, a greater number of males suffered from OHCA were compared with female population of (48,635 vs 37,366; P < 0.0001). The incidence of OHCA was higher among Caucasians as compared with African Americans (54,812, 63.8% vs 13,787, 16%; P < 0.0001). In-hospital deaths after OHCA were 43,024 (50%). But African Americans had higher mortality than Caucasians after hospitalization for OHCA (adjusted odds ratio, 1.23; 95% confidence interval, 1.18-1.26; P < 0.01). We observed significant differences in gender and racial factors in the patients who were admitted to the hospital with a diagnosis of OHCA based on an analysis of the national inpatient database.
Subject(s)
Cardiopulmonary Resuscitation , Out-of-Hospital Cardiac Arrest , Aged , Aged, 80 and over , Female , Hospitalization , Humans , Incidence , Male , Middle Aged , Out-of-Hospital Cardiac Arrest/epidemiology , Out-of-Hospital Cardiac Arrest/therapy , Patient DischargeABSTRACT
A 67-year-old female with prior medical history of HTN and asthma presented with acute-onset dyspnea and nausea for 4 days prior to admission. Upon initial encounter in the emergency room, she was found to have findings of abnormal pulmonary infiltrates and consequent workup revealed COVID-19. During further hospital course, the patient developed abnormal EKG and echocardiographic findings consistent with stress-induced cardiomyopathy.
ABSTRACT
This clinical review focuses on both current devices approved by the United States Food and Drug Administration and investigational devices available for left atrial appendage (LAA) closure. Specifically, the article describes the anatomical considerations that are particularly relevant from a procedural standpoint. In addition, we have also focused on the technical aspects of the procedure.
ABSTRACT
Hypertrophic cardiomyopathy (HCM) is 1 of the most frequent genetic cardiovascular diseases affecting 1 out of every 500 individuals in general population. Atrial Fibrillation incidences were 3.8% per 100 patients per year and overall prevalence among HCM patients are 27.09%. Higher risk of death noted in HCM patients with atrial fibrillation. Stroke and other thrombo embolic risks are increased in such patients. Medical management using mainly betablockers or amiodarone produced variable results and high rate of recurrence. Catheter ablation reduced symptom burden and complications despite moderate recurrence. Patients with multiple repeated procedures found to have better success rate and outcomes. The complications are not high leading to increased feasibility of the procedure. More research using latest techniques in catheter ablation need to be studied.
Subject(s)
Adrenergic beta-Antagonists/therapeutic use , Amiodarone/therapeutic use , Anti-Arrhythmia Agents/therapeutic use , Atrial Fibrillation/therapy , Cardiomyopathy, Hypertrophic/physiopathology , Catheter Ablation/methods , Atrial Fibrillation/complications , Atrial Fibrillation/physiopathology , Cardiomyopathy, Hypertrophic/complications , Diastole/physiology , Fibrosis , Humans , Mitral Valve Insufficiency/physiopathology , Postoperative Complications/epidemiology , Recurrence , Stroke/etiology , Stroke/prevention & control , Thromboembolism/etiology , Thromboembolism/prevention & controlABSTRACT
OBJECTIVES: The aim of this study was to assess the variations in ventricular arrhythmia (VA) occurrence according to seasons, months of the year, days of the week, and the time of day in a large implantable cardioverter-defibrillator patient population. BACKGROUND: Limited data exist on how VA occurrence varies as a function of time. METHODS: Data from 6 prospective studies were pooled to assess VA frequency over time. All adjudicated episodes of VAs ≤500 ms were included. VA distribution as a function of hour, day, month, and season were assessed through the construction of 4 negative binomial models. The models included a random patient effect and offset for days spent in each time period. RESULTS: Among 3,969 patients, 7,126.8 cumulative device-years with an average follow-up duration of 1.8 ± 1.4 years/patient were analyzed. VA occurrence was higher in the spring than the summer (0.86% vs. 0.70%; p = 0.009) but not significantly different from the fall (0.74%; p = 0.069) or winter (0.84%; p = 0.732). The estimated probability of occurrence of at least 1 VA episode in each 1-h block during the hours of 8 am to 10 pm over 365 days (0.10% to 0.12%) was higher (estimated 35% to 63% higher) than the referent period of midnight to 1 am (0.07%). No significant variations in VA occurrence were observed according to weekday and individual months of the year. CONCLUSIONS: Significantly higher VA occurrence in the spring and during the hours of 8 am to 10 pm were observed. Additional studies are needed to further understand the reasons for these observations, which may involve variations in temperature or differences in catecholamine triggers.
Subject(s)
Arrhythmias, Cardiac/epidemiology , Circadian Rhythm/physiology , Defibrillators, Implantable , Aged , Arrhythmias, Cardiac/physiopathology , Female , Heart Ventricles/physiopathology , Humans , Male , Middle Aged , Retrospective Studies , SeasonsABSTRACT
BACKGROUND: Drug induced long QT syndrome is quite common in daily clinical practice but its impact is unknown. METHODS: PubMed and EMBASE databases (until May 2, 2017) were searched to identify studies reporting drug induced long QT syndrome and followed the PRISMA guidelines. The main outcomes measured in these studies were QTc prolongation, ventricular arrhythmias, torsade de pointes (TdP) and death. RESULTS: Out of 176 non-duplicate reports, 36 studies satisfied inclusion criteria and provided data on patients exposed to drugs that can potentially cause long QT. Totally, 14,756 patients were exposed and 930 patients (6.3%) were found to have QTc prolongation. The number of males was 6,400 and females were 5,723 patients. The mean age of the patients was 43.8 ± 9.36 years. Ventricular arrhythmias were found in 379 patients (2.6%), 26 patients were found to have premature atrial contractions (PACs) and premature ventricular contractions (PVCs). TdP was found in 49 patients (0.33 %), sudden cardiac death (SCD) was found in five patients and 586 patients were found to have all-cause mortality. CONCLUSIONS: Around 6% of patients have risk of QT prolongation when exposed but only 0.3% developed TdP and 2.6% developed ventricular arrhythmias. Risk of developing arrhythmias is higher with concomitant use of multiple QT prolonging drugs.
ABSTRACT
PURPOSE OF REVIEW: Recent evidence has suggested that implantable defibrillator (ICD) in non-ischemic cardiomyopathy (NICM) may not offer mortality benefit in the presence of guideline-directed medical therapy (GDMT) and cardiac resynchronization therapy (CRT). RECENT FINDINGS: Despite significant benefits of GDMT and CRT, current evidence is derived from ICD trials that rely predominantly on reduced left ventricular ejection fraction alone (LVEF). The majority of patients with sudden cardiac death (SCD) have LVEF > 30% indicating that LVEF by itself is an inadequate predictor of SCD. The Danish study to assess the efficacy of ICD in patients with non-ischemic systolic heart failure on mortality (DANISH) highlights the importance of better risk stratifying NICM patients for ICD implantation. Assessment of life expectancy, comorbidities, presence of advanced heart failure, etiology of NICM, and the presence of myocardial fibrosis can help risk stratify ICD beyond LVEF. Genetics and biomarkers can be of further assistance in risk stratification.
Subject(s)
Cardiomyopathies/surgery , Death, Sudden, Cardiac/prevention & control , Defibrillators, Implantable , Evidence-Based Medicine , Primary Prevention , Cardiomyopathies/diagnosis , Cardiomyopathies/physiopathology , Early Diagnosis , Humans , Practice Guidelines as Topic , Primary Prevention/methods , Prosthesis Implantation , Randomized Controlled Trials as Topic , Risk AssessmentABSTRACT
We investigated the rates and reasons for crossover to alternative treatment strategies and its impact on mortality in patients who were enrolled in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial. Over a mean follow-up period of 3.5 years, 842 patients underwent crossover to the alternative treatment arms in AFFIRM. The rate of crossover from rhythm to rate control (594/2,033, 29.2%) was more frequent than the rate of crossover from rate to rhythm control (248/2,027, 12.2%, P < 0.0001). The leading reasons for crossover from rhythm to rate control were failure to achieve or maintain sinus rhythm (272/594, 45.8%) and intolerable adverse effects (122/594, 20.5%). In comparison, the major reasons for crossover from rate to rhythm control were failure to control atrial fibrillation symptoms (159/248, 64.1%) and intolerable adverse effects (9/248, 3.6%). This difference in crossover pattern was statistically significant (P < 0.0001). There was a significantly decreased risk of all-cause mortality (adjusted HR: 0.61, 95% CI: 0.48-0.78, P < 0.0001) and cardiac mortality (adjusted hazard ratio [HR]: 0.61, 95% confidence interval [CI]: 0.43-0.88, P = 0.008) in the subgroup of patients who crossed over from rhythm to rate control as compared to those who continued in rhythm control. There was a nonsignificant trend toward decreased all-cause (adjusted HR: 0.76, 95% CI: 0.53-1.10, P = 0.14) and cardiac mortality (adjusted HR: 0.70, 95% CI: 0.42-1.18, P = 0.18) in patients who crossed over from rate to rhythm control as compared to those who continued rate control.
Subject(s)
Adrenergic beta-Antagonists/therapeutic use , Anti-Arrhythmia Agents/therapeutic use , Anticoagulants/therapeutic use , Atrial Fibrillation/drug therapy , Calcium Channel Blockers/therapeutic use , Aged , Atrial Fibrillation/mortality , Atrial Fibrillation/physiopathology , Cross-Over Studies , Drug Therapy, Combination , Female , Heart Rate/physiology , Humans , Male , Treatment OutcomeABSTRACT
Premature ventricular contractions (PVCs) are common arrhythmias noticed in the clinical setting because of premature depolarization of the ventricular myocytes. Although often thought to be reflective of underlying disease rather than intrinsically harmful, PVCs have recently been linked with worse outcomes in patients without significant cardiac disease. Long-term exposure to a high PVC burden can lead to the development of PVC-induced cardiomyopathy. The pathogenesis of this condition is poorly understood at the current time. Many studies have suggested that catheter ablation of these PVCs may result in reversal of the PVC-induced cardiomyopathy. This article will go over the natural history of PVCs and PVC-induced cardiomyopathy, as well as review the current literature on the role of catheter ablation in treating PVC-induced cardiomyopathy.