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Arrhythmic Risk Stratification
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Arrhythmic Risk Stratification

A special issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425). This special issue belongs to the section "Electrophysiology and Cardiovascular Physiology".

Deadline for manuscript submissions: closed (15 January 2024) | Viewed by 9048

Special Issue Editors

Dr. Marisa Varrenti

E-Mail Website
Guest Editor
De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, 20126 Milan, Italy
Interests: arrhythmic risk stratification; sudden death; genetics; arrhythmogenic dysplasia; hypertrophic heart disease; inflammatory cardiomyopathy; dilated cardiomyopathy; ischaemic cardiomyopathy; channelopathies; cardiac magnetic resonance; late gadolinium enhancement; multiparametric evaluation; ventricular arrhythmias; heart failure; electrophysiological study; ventricular arrhythmia ablation
Special Issues, Collections and Topics in MDPI journals
Dr. Patrizio Mazzone

E-Mail Website
Guest Editor
De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, 20126 Milan, Italy
Interests: ventricular arrhythmias; sudden death; genetics; electrophysiology study; ablation of ventricular arrhythmias
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Sudden cardiac death is a relevant problem, accounting for 50% of all cardiovascular deaths. In 50% of cases, it is the first manifestation of the disease, with an increasing incidence with age.

The latest ESC 2022 guidelines emphasize the importance of a correct diagnostic evaluation and arrhythmia risk stratification in different clinical scenarios, with interesting updates regarding the role of cardiac magnetic resonance imaging and genetics. They also emphasize the importance of a multidisciplinary approach to the management of high-risk patients, involving clinical cardiologists, electrophysiologists, and cardiac imaging experts.

However, many patients still fall into a gray area for whom it can be difficult to make a right decision.

The aim of this Special Issue is to collect your experiences and ideas on "arrhythmic risk stratification" of patients with different forms of cardiomyopathy and channelopathy in review articles and clinical research articles, so that we can discuss this topic, which still raises many open questions, with the aim of improving the management of our patients.

Dr. Marisa Varrenti
Dr. Patrizio Mazzone
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Cardiovascular Development and Disease is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • cardiomyopathies
  • channelopathies
  • ventricular arrhythmias
  • sudden death
  • genetics
  • cardiac MRI
  • electrophysiology study
  • ablation of ventricular arrhythmias

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Published Papers (6 papers)

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Editorial

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3 pages, 176 KiB  
Editorial
Arrhythmic Risk Stratification—General Considerations in Specific Scenarios
by Marisa Varrenti and Patrizio Mazzone
J. Cardiovasc. Dev. Dis. 2024, 11(9), 282; https://doi.org/10.3390/jcdd11090282 - 7 Sep 2024
Viewed by 399
Abstract
Arrhythmic risk stratification is challenging for cardiologists managing patients with different forms of cardiomyopathy, ranging from post-ischemic or non-ischemic cardiomyopathies to systemic diseases with cardiac involvement such as neuromuscular disorders and infiltrative diseases [...] Full article
(This article belongs to the Special Issue Arrhythmic Risk Stratification)

Research

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12 pages, 1132 KiB  
Article
Sex Differences in Outcomes of Patients with an Implantable Cardioverter-Defibrillator for the Secondary Prevention of Sudden Cardiac Death
by Alwin B. P. Noordman, Michiel Rienstra, Yuri Blaauw, Bart A. Mulder and Alexander H. Maass
J. Cardiovasc. Dev. Dis. 2024, 11(4), 116; https://doi.org/10.3390/jcdd11040116 - 5 Apr 2024
Cited by 1 | Viewed by 1236
Abstract
Background: In patients with an implantable cardioverter-defibrillator (ICD) for secondary prevention, sex differences may exist in clinical outcomes. We sought to investigate sex differences in appropriate ICD therapy, appropriate and inappropriate shock, and all-cause mortality in this patient population. Methods: A total of [...] Read more.
Background: In patients with an implantable cardioverter-defibrillator (ICD) for secondary prevention, sex differences may exist in clinical outcomes. We sought to investigate sex differences in appropriate ICD therapy, appropriate and inappropriate shock, and all-cause mortality in this patient population. Methods: A total of 257 patients who received an ICD for a secondary prevention indication in the University Medical Centre Groningen (UMCG) between 1 January 2012 and 31 December 2018 were retrospectively included in a consecutive manner. Appropriate ICD therapy, comprising shock and antitachycardia pacing (ATP) for ventricular fibrillation (VF) or ventricular tachycardia (VT), was the primary outcome. Results: The patient population included 257 patients, of whom 45 (18%) were women and 212 (82%) were men. The median of the age was 64 (interquartile range (IQR) 53–72) years. During follow-up (median duration 6.2 (IQR 4.8–7.8) years), first appropriate device therapy took place in 10 (22%) patients for women and 85 (40%) patients for men. Female sex was negatively associated with the rate of appropriate ICD therapy, univariably (hazard ratio (HR) 0.48 [95% confidence interval (CI) 0.25–0.93]; p = 0.030) and multivariably (HR 0.44 [95% CI 0.20–0.95]; p = 0.036). Conclusions: Women with secondary prevention ICDs were less likely than men to receive appropriate ICD therapy. Full article
(This article belongs to the Special Issue Arrhythmic Risk Stratification)
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12 pages, 1483 KiB  
Article
Non-Invasive Risk Assessment and Prediction of Mortality in Patients Undergoing Coronary Artery Bypass Graft Surgery
by Ju-Youn Kim, Young-Jun Park, Kyoung-Min Park, Young-Keun On, June-Soo Kim, Seung-Jung Park and Young-Tak Lee
J. Cardiovasc. Dev. Dis. 2023, 10(9), 365; https://doi.org/10.3390/jcdd10090365 - 25 Aug 2023
Cited by 1 | Viewed by 1087
Abstract
Objectives: Heart rate turbulence (HRT) and T-wave alternans (TWA), non-invasive markers of cardiac autonomic dysfunction, and ventricular repolarization abnormality, reportedly, predict the risk of cardiovascular death after myocardial infarction. We investigated whether pre-operative assessment of HRT and/or TWA could predict long-term mortality following [...] Read more.
Objectives: Heart rate turbulence (HRT) and T-wave alternans (TWA), non-invasive markers of cardiac autonomic dysfunction, and ventricular repolarization abnormality, reportedly, predict the risk of cardiovascular death after myocardial infarction. We investigated whether pre-operative assessment of HRT and/or TWA could predict long-term mortality following coronary artery bypass graft (CABG) surgery. Methods: From May 2010 to December 2017, patients undergoing elective CABG and receiving 24 h ambulatory electrocardiogram monitoring 1 to 5 days prior to CABG surgery were prospectively enrolled. Pre-operative HRT and TWA were measured using a 24 h ambulatory electrocardiogram. The relative risk of cardiac or overall death was assessed according to abnormalities of HRT, TWA, or left ventricular ejection fraction (LV EF). Results: During the mean follow-up period of 4.6 ± 3.9 years, 40 adjudicated overall (5.9%/yr) and 5 cardiac deaths (0.9%/yr) occurred in 146 enrolled patients (64.9 ± 9.3 years; 108 males). Patients with abnormal HRT exhibited significantly higher relative risks of cardiac death (adjusted hazard ratio [HR] 24.9, 95% confidence interval [CI] 1.46–427) and all-cause death (adjusted HR 5.77, 95% CI 2.34–14.2) compared to those with normal HRT. Moreover, abnormal HRT plus abnormal TWA and LV EF < 50% was associated with a greater elevation in cardiac and overall mortality risk. The predictive role of abnormal HRT with/without abnormal TWA for all-cause death was likely more prominent in patients with mildly reduced (35 to 50%) or preserved (≥50%) LV EF. Abnormal HRT plus abnormal TWA and LV EF < 50% showed high negative predictive value in cardiac and overall mortality risk. Conclusions: Assessment of pre-operative HRT and/or TWA predicted mortality risk in patients undergoing elective CABG. Combined analysis of HRT, TWA, and LVEF enhanced the prognostic power. In particular, the predictive value of HRT was enhanced in patients with preserved or mid-range LV EF. Full article
(This article belongs to the Special Issue Arrhythmic Risk Stratification)
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11 pages, 5171 KiB  
Article
Subclinical Atrial Fibrillation on Prolonged ECG Holter Monitoring: Results from the Multicenter Real-World SAFARI (Silent Atrial Fibrillation ANCE-Sicily Research Initiative) Study
by Cesare de Gregorio, Antonino Di Franco, Antonio Vittorio Panno, Marco Di Franco, Giuseppe Scaccianoce, Francesca Campanella, Giuseppina Novo, Alfredo Ruggero Galassi, Salvatore Novo and the SAFARI Study Group
J. Cardiovasc. Dev. Dis. 2023, 10(8), 336; https://doi.org/10.3390/jcdd10080336 - 4 Aug 2023
Viewed by 2025
Abstract
Background: The detection of subclinical/silent atrial fibrillation (SAF) in the general population is of the utmost importance, given its potential adverse consequences. Incident AF has been observed in 30% to 70% of patients with implanted devices, but its prevalence may indeed be lower [...] Read more.
Background: The detection of subclinical/silent atrial fibrillation (SAF) in the general population is of the utmost importance, given its potential adverse consequences. Incident AF has been observed in 30% to 70% of patients with implanted devices, but its prevalence may indeed be lower in the general population. The prospective, multicentric, observational Silent Atrial Fibrillation ANCE Research Initiative (SAFARI) study aimed at assessing the SAF prevalence in a real-world outpatient setting by the means of a small, wearable, prolonged ECG Holter monitoring (>5 days) device (CGM HI 3-Lead ECG; CGM TELEMEDICINE, Piacenza, Italy). Methods: Patients ≥ 55 years of age at risk for AF were screened according to the inclusion criteria to undergo prolonged 3-lead ECG Holter monitoring. SAF episodes were classified as follows: Class A, <30 s; Class B, 30 to 299 s; and Class C, ≥300 s. Results: In total, 119 patients were enrolled (64 men; median age 71 (IQR 55–85) years). At a median of 13.5 (IQR 5–21) days of monitoring, SAF episodes were found in 19 patients (16%). A total of 10,552 arrhythmic episodes were registered, 6901 in Class A (n = 7 patients), 2927 in Class B (n = 3), and 724 in Class C (n = 9), (Class A vs. B and C, p < 0.001). This latter group had multiple (all-class) episodes, and two patients had >1000 episodes. There were no clinical, echocardiographic, or laboratory findings able to discriminate patients with SAF from those in sinus rhythm in univariate and multivariable analyses; of note is that the Class C patients showed a higher diastolic blood pressure, resting heart rate, and indexed LA volume. Conclusions. Over a median of 13 days of Holter monitoring, the SAFARI study confirmed the usefulness of small wearable devices in detecting SAF episodes in real-world outpatients at risk for, but with no prior history of, AF. Full article
(This article belongs to the Special Issue Arrhythmic Risk Stratification)
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Review

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19 pages, 1990 KiB  
Review
Arrhythmic Risk Stratification in Cardiac Amyloidosis: A Review of the Current Literature
by Eleonora Bonvicini, Alberto Preda, Chiara Tognola, Raffaele Falco, Roberto Gidiucci, Giulio Leo, Sara Vargiu, Marisa Varrenti, Lorenzo Gigli, Matteo Baroni, Marco Carbonaro, Giulia Colombo, Alessandro Maloberti, Cristina Giannattasio, Patrizio Mazzone and Fabrizio Guarracini
J. Cardiovasc. Dev. Dis. 2024, 11(7), 222; https://doi.org/10.3390/jcdd11070222 - 14 Jul 2024
Viewed by 1047
Abstract
Cardiac amyloidosis is the most frequent infiltrative disease caused by the deposition of misfolded proteins in the cardiac tissue, leading to heart failure, brady- and tachyarrhythmia and death. Conduction disorders, atrial fibrillation (AF) and ventricular arrhythmia (VA) significantly impact patient outcomes and demand [...] Read more.
Cardiac amyloidosis is the most frequent infiltrative disease caused by the deposition of misfolded proteins in the cardiac tissue, leading to heart failure, brady- and tachyarrhythmia and death. Conduction disorders, atrial fibrillation (AF) and ventricular arrhythmia (VA) significantly impact patient outcomes and demand recognition. However, several issues remain unresolved regarding early diagnosis and optimal management. Extreme bradycardia is the most common cause of arrhythmic death, while fast and sustained VAs can be found even in the early phases of the disease. Risk stratification and the prevention of sudden cardiac death are therefore to be considered in these patients, although the time for defibrillator implantation is still a subject of debate. Moreover, atrial impairment due to amyloid fibrils is associated with an increased risk of AF resistant to antiarrhythmic therapy, as well as recurrent thromboembolic events despite adequate anticoagulation. In the last few years, the aging of the population and progressive improvements in imaging methods have led to increases in the diagnosis of cardiac amyloidosis. Novel therapies have been developed to improve patients’ functional status, quality of life and mortality, without data regarding their effect on arrhythmia prevention. In this review, we consider the latest evidence regarding the arrhythmic risk stratification of cardiac amyloidosis, as well as the available therapeutic strategies. Full article
(This article belongs to the Special Issue Arrhythmic Risk Stratification)
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13 pages, 642 KiB  
Review
Comprehensive Cardiovascular Management of Myotonic Dystrophy Type 1 Patients: A Report from the Italian Neuro-Cardiology Network
by Vincenzo Russo, Giovanni Antonini, Roberto Massa, Carlo Casali, Alfredo Mauriello, Anna Maria Martino, Roberto Marconi, Matteo Garibaldi, Pasquale Franciosa, Massimo Zecchin, Carlo Gaudio, Antonello D’Andrea and Stefano Strano
J. Cardiovasc. Dev. Dis. 2024, 11(2), 63; https://doi.org/10.3390/jcdd11020063 - 16 Feb 2024
Cited by 2 | Viewed by 2668
Abstract
Myotonic dystrophy is a hereditary disorder with systemic involvement. The Italian Neuro-Cardiology Network-“Rete delle Neurocardiologie” (INCN-RNC) is a unique collaborative experience involving neurology units combined with cardio-arrhythmology units. The INCN facilitates the creation of integrated neuro-cardiac teams in Neuromuscular Disease Centers for the [...] Read more.
Myotonic dystrophy is a hereditary disorder with systemic involvement. The Italian Neuro-Cardiology Network-“Rete delle Neurocardiologie” (INCN-RNC) is a unique collaborative experience involving neurology units combined with cardio-arrhythmology units. The INCN facilitates the creation of integrated neuro-cardiac teams in Neuromuscular Disease Centers for the management of cardiovascular involvement in the treatment of myotonic dystrophy type 1 (MD1). Full article
(This article belongs to the Special Issue Arrhythmic Risk Stratification)
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