Prediction of Life-Threatening Arrhythmias – Still an Unresolved Problem

Haugaa, Kristina H.; Edvardsen, Thor; Amlie, Jan P.

doi:10.1159/000327093

Cited by 17 publications

(7 citation statements)

References 79 publications

(56 reference statements)

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“…The understanding of impact of mechano-electrical feedback on electrical and mechanical activity has also been advanced greatly by the studies of mechanical dyssynchrony. Here mechanical inhomogeneity linked to ECG parameters of abnormal repolarisation is greater in ICM patients with documented arrhythmias and improves SCD prediction [104].…”

Section: Arrhythmia Substrates For Progression and Sustenance/maintenancementioning

confidence: 99%

Ventricular Arrhythmias in Ischemic Cardiomyopathy—New Avenues for Mechanism-Guided Treatment

Amoni

Dries

Ingelaere

et al. 2021

Cells

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Ischemic heart disease is the most common cause of lethal ventricular arrhythmias and sudden cardiac death (SCD). In patients who are at high risk after myocardial infarction, implantable cardioverter defibrillators are the most effective treatment to reduce incidence of SCD and ablation therapy can be effective for ventricular arrhythmias with identifiable culprit lesions. Yet, these approaches are not always successful and come with a considerable cost, while pharmacological management is often poor and ineffective, and occasionally proarrhythmic. Advances in mechanistic insights of arrhythmias and technological innovation have led to improved interventional approaches that are being evaluated clinically, yet pharmacological advancement has remained behind. We review the mechanistic basis for current management and provide a perspective for gaining new insights that centre on the complex tissue architecture of the arrhythmogenic infarct and border zone with surviving cardiac myocytes as the source of triggers and central players in re-entry circuits. Identification of the arrhythmia critical sites and characterisation of the molecular signature unique to these sites can open avenues for targeted therapy and reduce off-target effects that have hampered systemic pharmacotherapy. Such advances are in line with precision medicine and a patient-tailored therapy.

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Section: Arrhythmia Substrates For Progression and Sustenance/maintenancementioning

confidence: 99%

Ventricular Arrhythmias in Ischemic Cardiomyopathy—New Avenues for Mechanism-Guided Treatment

Amoni

Dries

Ingelaere

et al. 2021

Cells

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show abstract

“…For example, amiodarone is a common pharmacological option in patients with significant structural heart disease, but is known to have non-cardiac toxicities and is associated with increased mortality in patients with class III heart failure who do not have ICDs. 16 More broadly, although left ventricular ejection fraction is currently the main risk stratification tool used to select patients for ICD therapy, 41 the majority of SCD occurs in individuals with no known cardiac disease, 42,43 with ventricular fibrillation as the major underlying mechanism. 40 …”

Section: Discussionmentioning

confidence: 99%

Weather and triggering of ventricular arrhythmias in patients with implantable cardioverter-defibrillators

Nguyen

Laden

Link

et al. 2013

J Expo Sci Environ Epidemiol

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Outdoor ambient weather has been hypothesized to be responsible for the seasonal distribution of cardiac arrhythmias. Because people spend most of their time indoors, we hypothesized that weather-related arrhythmia risk would be better estimated using an indoor measure or an outdoor measure that correlates well with indoor conditions, such as absolute humidity. The clinical records of 203 patients in eastern Massachusetts, USA, with an implantable cardioverter-defibrillator were abstracted for arrhythmias between 1995 and 2002. We used case-crossover methods to examine the association between weather and ventricular arrhythmia (VA). Among 84 patients who experienced 787 VAs, lower estimated indoor temperature (odds ratio (OR) = 1.16, 95% confidence interval (CI) 1.05–1.27 for a 1 °C decrease in the 24-h average) and lower absolute humidity (OR = 1.06, 95% CI 1.03–1.08 for a 0.5 g/m3 decrease in the 96-h average) were associated with increased risk. Lower outdoor temperature increased risk only in warmer months, likely attributable to the poor correlation between outdoor and indoor temperature during cooler months. These results suggest that lower temperature and drier air are associated with increased risk of VA onset among implantable cardioverter-defibrillator patients.

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Section: Discussionmentioning

confidence: 99%

Weather and Triggering Ventricular Arrhythmias in Patients with Implantable Cardioverter Defibrillators

Nguyen¹,

Laden²,

Link³

et al. 2013

ISEE Conference Abstracts

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Outdoor ambient weather has been hypothesized to be responsible for the seasonal distribution of cardiac arrhythmias. Because people spend most of their time indoors, we hypothesized that weather-related arrhythmia risk would be better estimated using an indoor measure or an outdoor measure that correlates well with indoor conditions, such as absolute humidity. The clinical records of 203 patients in eastern Massachusetts, USA, with an implantable cardioverterdefibrillator were abstracted for arrhythmias between 1995 and 2002. We used case-crossover methods to examine the association between weather and ventricular arrhythmia (VA). Among 84 patients who experienced 787 VAs, lower estimated indoor temperature (odds ratio (OR) = 1.16, 95% confidence interval (CI) 1.05-1.27 for a 1 °C decrease in the 24-h average) and lower absolute humidity (OR = 1.06, 95% CI 1.03-1.08 for a 0.5 g/m 3 decrease in the 96-h average) were associated with increased risk. Lower outdoor temperature increased risk only in warmer months, likely attributable to the poor correlation between outdoor and indoor temperature during cooler months. These results suggest that lower temperature and drier air are associated with increased risk of VA onset among implantable cardioverter-defibrillator patients.ICDs record the onset date and time of arrhythmic events and the associated electrocardiograms (ECGs), which allows for subsequent objective review of the detected cardiac arrhythmias. Using ICD records of the date and time of arrhythmic events, we examined the association between weather and ventricular tachyarrhythmias among patients Nguyen et al.

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Prediction of Life-Threatening Arrhythmias – Still an Unresolved Problem

Cited by 17 publications

References 79 publications

Ventricular Arrhythmias in Ischemic Cardiomyopathy—New Avenues for Mechanism-Guided Treatment

Ventricular Arrhythmias in Ischemic Cardiomyopathy—New Avenues for Mechanism-Guided Treatment

Weather and triggering of ventricular arrhythmias in patients with implantable cardioverter-defibrillators

Weather and Triggering Ventricular Arrhythmias in Patients with Implantable Cardioverter Defibrillators

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