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Management of Complex Arrhythmias

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (25 May 2023) | Viewed by 43040

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Special Issue Editor

Dr. Jackson J. Liang

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Guest Editor

Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
Interests: ventricular tachycardia; atrial fibrillation; catheter ablation; novel therapies; complex arrhythmias
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

There have been numerous advances in the management of atrial and ventricular arrhythmias over the past several decades. With advances in cardiovascular care resulting in increased longevity of patients with heart disease, the incidence and prevalence of arrhythmias continues to increase. Therapies such as antiarrhythmic drugs, catheter ablation, autonomic modulation, and noninvasive ablation have been increasingly utilized to control arrhythmias.

There is a continued drive to identify novel therapies for management of complex arrhythmias to help to improve quality of life and reduce mortality. On these grounds, this Special Issue of the Journal of Clinical Medicine has as its main objective to gather papers focused on management of complex atrial and ventricular arrhythmias. Therefore, studies exploring multiple treatment strategies for arrhythmias (pharmacologic, procedural, noninvasive, etc.) that can advance the field are welcome in this Special Issue. Original investigations, review articles, and short communications are welcome. Case reports will not be considered.

In summary, this Special Issue aims to summarize the clinical treatment options for complex arrhythmias. Potential topics include but are not limited to the following:

Antiarrhythmic drug therapy;
Catheter ablation of atrial arrhythmias;
Catheter ablation of ventricular arrhythmias;
Novel ablation strategies;
Autonomic modulation;
Biophysics of ablation;
Surgical ablation;
Management of arrhythmias in high-risk patients with structural heart disease;
Arrhythmia management in patients with congenital heart disease;
Noninvasive radiation ablation for ventricular tachycardia.

Dr. Jackson J. Liang
Guest Editor

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Keywords

ventricular tachycardia
atrial fibrillation
catheter ablation
novel therapies
complex arrhythmias

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Published Papers (10 papers)

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Editorial

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3 pages, 186 KiB

Open AccessEditorial

Management of Complex Arrythmias: Optimal Timing of Catheter Ablation for Ventricular Tachycardia

by Anurut Huntrakul and Jackson J. Liang

J. Clin. Med. 2022, 11(17), 5123; https://doi.org/10.3390/jcm11175123 - 31 Aug 2022

Viewed by 1273

Abstract

The field of invasive cardiac electrophysiology has been rapidly advancing over the past several years [...] Full article

(This article belongs to the Special Issue Management of Complex Arrhythmias)

Research

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12 pages, 646 KiB

Open AccessArticle

Impact of Preoperative Sinus Rhythm on Concomitant Surgical Ablation’s One-Year Success in Patients with Atrial Fibrillation: A Prospective Registry Cohort Study

by Maximilian Vondran, Tamer Ghazy, Yeong-Hoon Choi, Taoufik Ouarrak, Bernd Niemann, Etem Caliskan, Nicolas Doll, Jochen Senges, Thorsten Hanke, Ardawan J. Rastan and CASE-AF Investigators

J. Clin. Med. 2024, 13(19), 5824; https://doi.org/10.3390/jcm13195824 - 29 Sep 2024

Viewed by 787

Abstract

Background: The surgical ablation (SA) of atrial fibrillation (AF) during cardiac surgery is performed in only 8–40% of patients. We performed a subgroup analysis of the 1-year follow-up from the German CArdioSurgEry Atrial Fibrillation (CASE-AF) registry to determine how preoperative sinus rhythm (SR) prior to SA affected the outcomes. Methods: The CASE-AF registry enrolled AF patients scheduled for cardiac surgery with concomitant SA. The in-hospital and one-year follow-up data were collected prospectively and analyzed retrospectively. Results: From September 2016 to August 2020, 964 patients were enrolled in the CASE-AF registry. Among them, 333 patients were in SR immediately before surgery (study cohort). A complete follow-up was achieved for 95.6%. Both the severity of the AF (modified European Heart Rhythm Association symptom classification, p < 0.001) and the frequency of AF symptoms (p = 0.006) were significantly reduced at one year compared to the preoperative baseline. Almost 90 percent of the patients underwent left atrial appendage occlusion (LAAO) during the procedure. The one-year mortality (4.1%) and stroke rates (3.2%) were low. SR was evident in 70.3% of the patients at the one-year follow-up. Conclusions: Patients with AF who have SR at the time of surgery should not be excluded from SA, as it appears to be a safe and effective procedure. Full article

(This article belongs to the Special Issue Management of Complex Arrhythmias)

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14 pages, 4443 KiB

Open AccessArticle

3D-Printed Biomaterial Testing in Response to Cryoablation: Implications for Surgical Ventricular Tachycardia Ablation

by Mara Candelari, Ida Anna Cappello, Luigi Pannone, Cinzia Monaco, Edoardo Bori, Giacomo Talevi, Robbert Ramak, Mark La Meir, Ali Gharaviri, Gian Battista Chierchia, Carlo de Asmundis and Bernardo Innocenti

J. Clin. Med. 2023, 12(3), 1036; https://doi.org/10.3390/jcm12031036 - 29 Jan 2023

Cited by 2 | Viewed by 1873

Abstract

Background: The lack of thermally and mechanically performant biomaterials represents the major limit for 3D-printed surgical guides, aimed at facilitating complex surgery and ablations. Methods: Cryosurgery is a treatment for cardiac arrhythmias. It consists of obtaining cryolesions, by freezing the target tissue, resulting in selective and irreversible damage. MED625FLX and TPU95A are two biocompatible materials for surgical guides; however, there are no data on their response to cryoenergy delivery. The study purpose is to evaluate the biomaterials’ thermal properties, examining the temperature changes on the porcine muscle samples (PMS) when the biomaterials are in place during the cryoablation. Two biomaterials were selected, MED625FLX and TPU95A, with two thicknesses (1.0 and 2.5 mm). To analyze the biomaterials’ behavior, the PMS temperatures were measured during cryoablation, firstly without biomaterials (control) and after with the biomaterials in place. To verify the biomaterials’ suitability, the temperatures under the biomaterial samples should not exceed a limit of −30.0 °C. Furthermore, the biomaterials’ geometry after cryoablation was evaluated using the grid paper test. Results: TPU95A (1.0 and 2.5 mm) successfully passed all tests, making this material suitable for cryoablation treatment. MED625FLX of 1.0 mm did not retain its shape, losing its function according to the grid paper test. Further, MED625FLX of 2.5 mm is also suitable for use with a cryoenergy source. Conclusions: TPU95A (1.0 and 2.5 mm) and MED625FLX of 2.5 mm could be used in the design of surgical guides for cryoablation treatment, because of their mechanical, geometrical, and thermal properties. The positive results from the thermal tests on these materials and their thickness prompt further clinical investigation. Full article

(This article belongs to the Special Issue Management of Complex Arrhythmias)

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10 pages, 818 KiB

Open AccessArticle

Holter ECG for Syncope Evaluation in the Internal Medicine Department—Choosing the Right Patients

by Ophir Freund, Inbar Caspi, Yacov Shacham, Shir Frydman, Roni Biran, Hytham Abu Katash, Lior Zornitzki and Gil Bornstein

J. Clin. Med. 2022, 11(16), 4781; https://doi.org/10.3390/jcm11164781 - 16 Aug 2022

Cited by 7 | Viewed by 3123

Abstract

Physicians use Holter electrocardiography (ECG) monitoring to evaluate some patients with syncope in the internal medicine department. We questioned whether Holter ECG should be used in the presented setting. Included were all consecutive patients admitted with syncope to one of our nine internal medicine departments who had completed a 24 h Holter ECG between 2018 and 2021. A diagnostic Holter was defined as one which altered the patient’s treatment and met ESC/ACC/AHA diagnostic criteria. A total of 478 Holter tests were performed for syncope evaluation during admission to an internal medicine department in the study period. Of them, 25 patients (5.2%) had a diagnostic Holter finding. Sinus node dysfunction was the most frequent diagnostic recording (13 patients, 52%). In multivariant analysis, predictors for diagnostic Holter were older age (OR 1.35, 95% CI 1.08–1.68), heart failure with preserved ejection fraction (OR 4.1, 95% CI 1.43–11.72), and shorter duration to Holter initiation (OR 0.73, 95% CI 0.56–0.96). There was a positive correlation between time from admission to Holter and hospital stay, r(479) = 0.342, p < 0.001. Our results suggest that completing a 24 h Holter monitoring during admission to the internal medicine department should be restricted to patients with a high pre-test probability to avoid overuse and possible harm. Full article

(This article belongs to the Special Issue Management of Complex Arrhythmias)

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8 pages, 217 KiB

Open AccessArticle

Effective Control of Supraventricular Tachycardia in Neonates May Requires Combination Pharmacologic Therapy

by Young Tae Lim, Yeo Hyang Kim and Jung Eun Kwon

J. Clin. Med. 2022, 11(12), 3279; https://doi.org/10.3390/jcm11123279 - 8 Jun 2022

Cited by 7 | Viewed by 3008

Abstract

Introduction: Supraventricular tachycardia (SVT) is one of the arrhythmias that can occur in newborns. Most SVT incidents in the neonatal period are spontaneously resolved around the first year of life, but since tachycardia can frequently occur before complete resolution, appropriate medication use is required. However, no clear guidelines or consensus on the treatment of neonatal SVT have been established yet. Methods: From January 2011 to December 2021, demographic data and antiarrhythmic medications used were retrospectively analyzed for 18 newborns diagnosed with SVT at a single center. Results: A total of four medications (propranolol, amiodarone, flecainide, and atenolol) were used as maintenance therapy to prevent tachycardia recurrence, and propranolol was the most used, followed by amiodarone. Thirty-nine percent of the patients were controlled with monotherapy, but the remainder required two or more medications. The median period from medication initiation after diagnosis to the last tachycardia event was 15.5 days, and the median total duration of medication use was 362 days. None of the patients experienced any side effects of antiarrhythmic medications. The total duration of medication use was statistically significant according to the mechanism of SVT, and the usage time of the increased automaticity group was shorter than that of the re-entry group. Conclusion: Since most neonatal SVT resolves within 1 year, it is significant to provide prophylactic medication to prevent tachycardia recurrence at least until 1 year of age, and depending on the patient, the appropriate combination of medications should be identified. Full article

(This article belongs to the Special Issue Management of Complex Arrhythmias)

Review

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20 pages, 10944 KiB

Open AccessReview

Idiopathic Ventricular Tachycardia

by Robert C. Ward, Martin van Zyl and Christopher V. DeSimone

J. Clin. Med. 2023, 12(3), 930; https://doi.org/10.3390/jcm12030930 - 25 Jan 2023

Cited by 5 | Viewed by 5651

Abstract

Idiopathic ventricular tachycardia (VT) is an important cause of morbidity and less commonly, mortality in patients with structurally normal hearts. Appropriate diagnosis and management are predicated on an understanding of the mechanism, relevant cardiac anatomy, and associated ECG signatures. Catheter ablation is a viable strategy to adequately treat and potentially provide a cure in patients that are intolerant to medications or when these are ineffective. In this review, we discuss special approaches and considerations for effective and safe ablation of VT arising from the right ventricular outflow tract, left ventricular outflow tract, left ventricular fascicles, papillary muscles, and moderator band. Full article

(This article belongs to the Special Issue Management of Complex Arrhythmias)

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11 pages, 1112 KiB

Open AccessReview

Evaluation and Catheter Ablation of Ventricular Arrhythmias in Cardiac Sarcoidosis

by Fatima M. Ezzeddine, Nicholas Tan and Konstantinos C. Siontis

J. Clin. Med. 2022, 11(22), 6718; https://doi.org/10.3390/jcm11226718 - 13 Nov 2022

Viewed by 2074

Abstract

Ventricular arrhythmias are a common clinical manifestation in patients with cardiac sarcoidosis (CS) and other arrhythmogenic inflammatory cardiomyopathies (AIC). The management of sustained ventricular arrhythmias in these patients presents unique challenges. Current therapies include immunosuppressive, antiarrhythmic agents, and catheter ablation. Significant progress has been made in deciphering the importance of patient selection for ablation, systematic preablation evaluation, and optimal ablation timing, as well as ablation approaches and techniques. In this overview, we discuss the evaluation and management of ventricular arrhythmias in patients with CS, focusing on catheter ablation, which has evolved into an effective approach in reducing the burden of ventricular arrhythmias in these patients in the context of multifaceted treatment along with medical therapies. Full article

(This article belongs to the Special Issue Management of Complex Arrhythmias)

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24 pages, 644 KiB

Open AccessReview

Pharmacologic Management for Ventricular Arrhythmias: Overview of Anti-Arrhythmic Drugs

by John Larson, Lucas Rich, Amrish Deshmukh, Erin C. Judge and Jackson J. Liang

J. Clin. Med. 2022, 11(11), 3233; https://doi.org/10.3390/jcm11113233 - 6 Jun 2022

Cited by 14 | Viewed by 17448

Abstract

Ventricular arrhythmias (Vas) are a life-threatening condition and preventable cause of sudden cardiac death (SCD). With the increased utilization of implantable cardiac defibrillators (ICD), the focus of VA management has shifted toward reduction of morbidity from VAs and ICD therapies. Anti-arrhythmic drugs (AADs) can be an important adjunct therapy in the treatment of recurrent VAs. In the treatment of VAs secondary to structural heart disease, amiodarone remains the most well studied and current guideline-directed pharmacologic therapy. Beta blockers also serve as an important adjunct and are a largely underutilized medication with strong evidentiary support. In patients with defined syndromes in structurally normal hearts, AADs can offer tailored therapies in prevention of SCD and improvement in quality of life. Further clinical trials are warranted to investigate the role of newer therapeutic options and for the direct comparison of established AADs. Full article

(This article belongs to the Special Issue Management of Complex Arrhythmias)

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18 pages, 4070 KiB

Open AccessReview

Developing a Mechanistic Approach to Sudden Death Prevention in Mitral Valve Prolapse

by Brian P. Kelley, Abdul Mateen Chaudry and Faisal F. Syed

J. Clin. Med. 2022, 11(5), 1285; https://doi.org/10.3390/jcm11051285 - 26 Feb 2022

Cited by 8 | Viewed by 3904

Abstract

Sudden cardiac death (SCD) from ventricular fibrillation (VF) can occur in mitral valve prolapse (MVP) in the absence of other comorbidities including mitral regurgitation, heart failure or coronary disease. Although only a small proportion with MVP are at risk, it can affect young, otherwise healthy adults, most commonly premenopausal women, often as the first presentation of MVP. In this review, we discuss arrhythmic mechanisms in MVP and mechanistic approaches for sudden death risk assessment and prevention. We define arrhythmogenic or arrhythmic MVP (AMVP) as MVP associated with complex and frequent ventricular ectopy, and malignant MVP (MMVP) as MVP with high risk of SCD. Factors predisposing to AMVP are myxomatous, bileaflet MVP and mitral annular disjunction (MAD). Data from autopsy, cardiac imaging and electrophysiological studies suggest that ectopy in AMVP is due to inflammation, fibrosis and scarring within the left ventricular (LV) base, LV papillary muscles and Purkinje tissue. Postulated mechanisms include repetitive injury to these regions from systolic papillary muscle stretch and abrupt mitral annular dysmotility (excursion and curling) and diastolic endocardial interaction of redundant mitral leaflets and chordae. Whereas AMVP is seen relatively commonly (up to 30%) in those with MVP, MVP-related SCD is rare (2–4%). However, the proportion at risk (i.e., with MMVP) is unknown. The clustering of cardiac morphological and electrophysiological characteristics similar to AMVP in otherwise idiopathic SCD suggests that MMVP arises when specific arrhythmia modulators allow for VF initiation and perpetuation through action potential prolongation, repolarization heterogeneity and Purkinje triggering. Adequately powered prospective studies are needed to assess strategies for identifying MMVP and the primary prevention of SCD, including ICD implantation, sympathetic modulation and early surgical mitral valve repair. Given the low event rate, a collaborative multicenter approach is essential. Full article

(This article belongs to the Special Issue Management of Complex Arrhythmias)

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Other

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13 pages, 1705 KiB

Open AccessSystematic Review

Outcome of In-Hospital Cardiac Arrest among Patients with COVID-19: A Systematic Review and Meta-Analysis

by Dhan Bahadur Shrestha, Yub Raj Sedhai, Sagun Dawadi, Bishal Dhakal, Jurgen Shtembari, Karan Singh, Roshan Acharya, Soney Basnyat, Irfan Waheed, Mohammad Saud Khan, Mohammed Kazimuddin, Nimesh K. Patel, Gautham Kalahasty, Prashant Dattatraya Bhave, Patrick Whalen and Ghanshyam Shantha

J. Clin. Med. 2023, 12(8), 2796; https://doi.org/10.3390/jcm12082796 - 10 Apr 2023

Viewed by 1958

Abstract

Background: Outcomes following in-hospital cardiac arrest (IHCA) in patients with COVID-19 have been reported by several small single-institutional studies; however, there are no large studies contrasting COVID-19 IHCA with non-COVID-19 IHCA. The objective of this study was to compare the outcomes following IHCA between COVID-19 and non-COVID-19 patients. Methods: We searched databases using predefined search terms and appropriate Boolean operators. All the relevant articles published till August 2022 were included in the analyses. The systematic review and meta-analysis were conducted as per Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. An odds ratio with a 95% confidence interval (CI) was used to measure effects. Results: Among 855 studies screened, 6 studies with 27,453 IHCA patients (63.84% male) with COVID-19 and 20,766 (59.7% male) without COVID-19 were included in the analysis. IHCA among patients with COVID-19 has lower odds of achieving return of spontaneous circulation (ROSC) (OR: 0.66, 95% CI: 0.62–0.70). Similarly, patients with COVID-19 have higher odds of 30-day mortality following IHCA (OR: 2.26, 95% CI: 2.08–2.45) and have 45% lower odds of cardiac arrest because of a shockable rhythm (OR: 0.55, 95% CI: 0.50–0.60) (9.59% vs. 16.39%). COVID-19 patients less commonly underwent targeted temperature management (TTM) or coronary angiography; however, they were more commonly intubated and on vasopressor therapy as compared to patients who did not have a COVID-19 infection. Conclusions: This meta-analysis showed that IHCA with COVID-19 has a higher mortality and lower rates of ROSC compared with non-COVID-19 IHCA. COVID-19 is an independent risk factor for poor outcomes in IHCA patients. Full article

(This article belongs to the Special Issue Management of Complex Arrhythmias)

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