The HFpEF Electrical Pathway Less Traveled? Arunthamakun, Justin; Patel, Parin J.; Ravichandran, Ashwin K.
The American journal of cardiology,
11/2023, Letnik:
207
Journal Article
Coronavirus disease 2019 (COVID-19) is a global pandemic that is wreaking havoc on the health and economy of much of human civilization. Electrophysiologists have been impacted personally and ...professionally by this global catastrophe. In this joint article from representatives of the Heart Rhythm Society, the American College of Cardiology, and the American Heart Association, we identify the potential risks of exposure to patients, allied healthcare staff, industry representatives, and hospital administrators. We also describe the impact of COVID-19 on cardiac arrhythmias and methods of triage based on acuity and patient comorbidities. We provide guidance for managing invasive and noninvasive electrophysiology procedures, clinic visits, and cardiac device interrogations. In addition, we discuss resource conservation and the role of telemedicine in remote patient care along with management strategies for affected patients.
Introduction
Substrate‐based ablation for ventricular tachycardia (VT) using Ripple map (RM) is an effective treatment strategy for patients with ischemic cardiomyopathy but has yet to be evaluated ...in patients with nonischemic cardiomyopathy (NICMO). The aim of this study is to determine the feasibility and effectiveness of an RM‐based ablation for NICMO patients.
Methods and Results
This was a single‐center, retrospective study including all NICMO patients undergoing VT ablation at St Vincent Hospital between January 1, 2018 and January 12, 2019. Retrospective RM analysis was performed on those that had a substrate‐based ablation to identify the location and number of Ripple channels as well as their proximity to ablation lesions. Thirty‐three patients met the inclusion criteria and had a median age of 65 (58, 73.5) with 15.2% of the population being female, and were followed for a median duration of 451 (217.5, 586.5) days. Of these patients, 23 (69.7%) had a substrate‐based ablation with a median procedural duration of 196.4 (186.8, 339) min, 1946 (517, 2750) points collected per map, and 277 (141, 554) points were within the scar. Two (8.6%) procedural complications occurred, and 7 (30.4%) patients had VT recurrence during follow‐up. RM analysis revealed an average of two Ripple channels and the patients without VT recurrence had ablation performed closer to the Ripple channels: 0 (0, 4.7) versus 14.3 (0, 23.5) cm; p = .02.
Conclusion
An RM‐based substrate ablation can be performed in NICMO patients and ablation within Ripple channels is a predictor of VT freedom.
A Ripple‐mapped‐based substrate ablation can be performed in nonischemic cardiomyopathy patients and ablation within Ripple channels is a predictor of ventricular tachycardia freedom.
Objectives This study examined an anti-inflammatory property of high-density lipoprotein (HDL) in subjects with acute coronary syndrome (ACS) and stable coronary artery disease (CAD) compared with ...control subjects. Background HDL has anti-inflammatory properties in vitro, but its relationship to coronary disease in humans is unclear. The high-density lipoprotein inflammatory index (HII) measures the ability of HDL to mitigate oxidation of low-density lipoprotein; this function may be impaired in ACS and/or CAD. Methods We measured HII in 193 patients undergoing angiography for symptoms of CAD. Control subjects (n = 99) had no angiographic CAD, chronic CAD subjects (n = 51) had ≥70% vessel stenosis, and ACS subjects (n = 43) had ≥20% vessel stenosis and ischemia or infarction. We also examined HII in a cohort of healthy subjects randomly assigned to a statin or placebo. Results Subjects who had ACS had higher HII (less antioxidative capacity) compared with controls (1.57 vs. 1.17, p = 0.005) or those with chronic CAD (1.57 vs. 1.11, p = 0.006). HII was not different in subjects with stable CAD compared with controls. Furthermore, those subjects with higher HII were more likely to have ACS than no CAD (quartile 4 vs. 1, odds ratio OR: 1.74, p = 0.008). In a multivariate logistic regression model, HII was associated with ACS after adjusting for traditional cardiac risk factors (OR: 3.8, p = 0.003). There was a small improvement in HII after statin therapy compared with placebo (−14%, p = 0.03). Conclusions HDL has less anti-inflammatory capacity as assessed by HII in the setting of ACS compared with controls or subjects with chronic CAD.
To the Editor: The role of niacin in the era of widespread statin use has been called into question by 2 recent clinical trials, AIM-HIGH (Atherothrombosis Intervention in Metabolic Syndrome With Low ...HDL/High Triglycerides: Impact on Global Health) and HPS2-THRIVE (Treatment of HDL to Reduce the Incidence of Vascular Events), indicating no added benefit when niacin was added to standard low-density lipoprotein (LDL) reduction therapy with simvastatin and ezetimibe (1). Mass-based assessment of high-density lipoprotein cholesterol (HDL-C) levels may not fully capture substantial variability in HDL functional properties.
Purpose
Atrial fibrillation (AF) ablation is a common procedure to reduce cardiovascular morbidity but is limited by recurrence. The objective of this study was to determine if post-ablation acute ...surface P wave morphology and other electrocardiographic parameters correlate with AF recurrence.
Methods
The Avoiding Bladder Catheters During AF ablation (ABCD-AF) trial was a randomized, prospective trial in 160 subjects undergoing AF ablation. The present study examined correlation between AF recurrence in follow-up and acute post-ablation electrocardiographic P wave parameters.
Results
Median follow-up was 255 (188, 306) days. The ABCD-AF cohort had a mean age of 62.7 ± 12.8 with 32.1% being females. Rate of recurrent AF was 35.8%, with a median time to AF of 135 (109, 182) days. There was no baseline demographic associated with AF recurrence. There was more AF recurrence in those with longer follow-up (
p
= 0.001). Lead 2 PR interval, lead 2 P wave duration/PR (Pdur/PR), lead V1 PR interval, and lead V1 Pdur/PR were all significantly associated with recurrent AF (
p
= 0.03, 0.02, 0.01, 0.01). Longer PR and shorter Pdur/PR predicted AF recurrence. In a multivariable model, lead V1 Pdur/PR provided the best predictor of AF recurrence, with an odds ratio of 0.018 (
p
= 0.016) per standard deviation change.
Conclusions
Shorter P wave duration combined with longer AV node delay, as measured by proportion of the PR that the P wave occupies, was the best predictor of AF recurrence post-ablation.
Aims
Various pathological changes lead to the development of heart failure (HF). HDL is dysfunctional in both acute coronary syndrome, as measured by the HDL inflammatory index (HII) assay, and ...stable coronary disease, as measured by cholesterol efflux capacity. We therefore hypothesized that these functions of HDL are also impaired in subjects with ischaemic cardiomyopathy.
Methods and results
A case–control study was performed on subjects in the University of Pennsylvania Catheterization Study (PennCath) cohort of patients with angina. Cases had EF <50% and angiographic CAD (≥70% stenosis of any vessel; n = 23); controls included those with EF ≥55% and no CAD (n = 46). Serum from subjects was apolipoprotein‐B depleted to isolate an HDL fraction. To measure HDL anti‐oxidative capacity, the HDL fraction was incubated with LDL and a reporter lipid that fluoresces when oxidized. To measure cholesterol efflux capacity, the HDL fraction was also incubated with macrophages and tritium‐labelled cholesterol. Mean HII was higher and efflux capacity lower in subjects with ischaemic cardiomyopathy (HII 0.26 vs. –0.028; efflux 0.80 vs. 0.92; P < 0.05). In a multivariable logistic regression model, both high HII and low efflux capacity were significant risk factors for HF HII odds ratio (OR) 2.8, 95% confidence interval (CI) 2.0–3.9, P = 0.002; efflux OR 2.1, 95% CI 1.5–3.0, P = 0.03. These effects persisted after adjustment for covariates and traditional risk factors for HF.
Conclusion
Subjects with reduced EF from ischaemia have lower HDL concentration and also impaired HDL function. HDL is a versatile lipoprotein particle with various anti‐inflammatory and vasoprotective functions, whose impairment may contribute to ischaemic heart failure.
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