Publications by authors named "Pier Lambiase"
Background: Atrial fibrillation (AF) prediction improves by combining clinical scores with a polygenic risk score (PRS) for AF (AF-PRS), but there are limited studies of PRS for ventricular arrhythmia (VA) prediction.
Objective: We assessed the value of including multiple PRS for cardiovascular risk factors (CV-PRS) for incident AF and VA prediction.
Methods: We used 158,733 individuals of European ancestry from UK Biobank to build 3 models for AF: CHARGE-AF (AF1), AF1 + AF-PRS (AF2), AF2 + CV-PRS (AF3).
Inappropriate Therapy and Shock Rates Between the Subcutaneous and Transvenous Implantable Cardiac Defibrillator: A Secondary Analysis of the PRAETORIAN Trial.
Circ Arrhythm Electrophysiol
December 2024
Article Synopsis
- Inappropriate therapy (IAT) is a significant issue associated with implantable cardiac defibrillator (ICD) therapy, particularly highlighted in early subcutaneous ICD (S-ICD) studies which showed high rates of inappropriate shocks (IAS).
- The PRAETORIAN trial, an international study with 849 patients, found no major differences in IAT and IAS rates between S-ICD and transvenous ICD (TV-ICD) groups, as both groups had similar cumulative incidences.
- Key predictors for IAT varied between the two groups, with TV-ICD patients experiencing IAT mainly from supraventricular tachycardias, while S-ICD patients faced issues from cardiac oversensing
Electrophysiological Phenotype-Genotype Study of Sustained Monomorphic Ventricular Tachycardia in Inherited, High Arrhythmic Risk, Left Ventricular Cardiomyopathy.
Circ Arrhythm Electrophysiol
December 2024
Background: Among inherited cardiomyopathies involving the left ventricle, whether dilated or not, certain genotypes carry a well-established arrhythmic risk, notably manifested as sustained monomorphic ventricular tachycardia (SMVT). Nonetheless, the precise localization and electrophysiological profile of this substrate remain undisclosed across different genotypes.
Methods: Patients diagnosed with cardiomyopathy and left ventricle involvement due to high-risk genetic variants and SMVT treated by electrophysiological study were recruited from 18 European/US centers.
Article Synopsis
- The S-ICD was created to eliminate lead-related issues found in the TV-ICD, as it is an external device that sits under the skin rather than using leads inside the body.
- This analysis comes from the PRAETORIAN trial, where patients were randomly assigned to either S-ICD or TV-ICD and assessed for quality of life through various questionnaires at different stages.
- Results showed no significant differences in physical and mental well-being between the groups, but patients who experienced a shock recently reported lower social functioning and emotional health compared to those who did not.
Article Synopsis
- - In nonagenarians with complete heart block, dual-chamber (DDD) pacing showed better physiological outcomes compared to single-chamber (VVI) pacing, although the effect on overall mortality is debated.
- - Among 168 patients studied, those with VVI pacing were older, frailer, and had higher rates of dementia compared to DDD recipients, but both groups had similar age and heart function at baseline.
- - After adjusting for factors like age and frailty, VVI pacing was linked to significantly higher risks of all-cause mortality and death from congestive cardiac failure, suggesting better long-term outcomes for DDD pacing in this population.
Background: Vector field heterogeneity (VFH) is a novel omnipolar metric to quantify local propagation heterogeneities that may identify functionally critical sites for ablation in scar-related ventricular tachycardia (VT).
Objective: This study aims to assess the diagnostic value of VFH to identify abnormal propagation patterns during ventricular substrate mapping and compare VFH in VT isthmus sites (IS), low-voltage bystander area (LVA) , and normal voltage areas (NVAa).
Methods: Substrate maps acquired with a 16-pole grid catheter in patients with scar-related VT were segmented into sites corresponding to IS, LVA, and NVA (defined as omnipolar voltages > and <1.
Article Synopsis
- Alterations in repolarization gradients contribute significantly to the development of ventricular arrhythmias, especially in patients with varying heart conditions.
- High-density repolarization mapping can enhance the understanding of these abnormalities and help localize arrhythmogenic areas more effectively during procedures like ablation.
- Despite its potential benefits, repolarization mapping faces practical and technical challenges that limit its routine use, necessitating further research and improvements to integrate it into standard clinical practices.
Background: Atrial fibrillation (AF) is more common in patients with hypertrophic cardiomyopathy (HCM) and is often highly symptomatic. The impact of catheter ablation (CA) may be under-reported when evaluated by long-term freedom from any atrial arrhythmia.
Objectives: This study aims to evaluate whether CA of AF in patients with HCM would significantly reduce AF burden and improve symptoms.
Background: In ventricular tachycardia (VT), optimal substrate mapping strategies identifying arrhythmogenic sites are not established.
Objectives: This study sought to evaluate multidirectional pacing on the distribution of specific conduction and repolarization metrics to localize re-entrant VT sites in a porcine infarct model.
Methods: Substrate maps were created in 13 pigs with chronic myocardial infarction using the Advisor HD Grid (Abbott) during right ventricular (RV), left ventricular, biventricular pacing (BIV), and sinus rhythm (SR).
Article Synopsis
- Brugada syndrome (BrS) is a hereditary cardiac disorder linked to sudden death in young adults, particularly prevalent in Southeast Asia, with certain genetic variants associated with the condition.
- Researchers conducted genome sequencing on individuals with BrS and matched controls in Thailand to find rare noncoding variants that are more common in BrS patients.
- A specific rare variant was identified that disrupts a transcription factor binding site, causing reduced gene expression and reduced sodium current in heart cells, contributing to the high prevalence of BrS in the region and identifying at-risk individuals.
Importance: The emergence of novel programming guidelines that reduce premature and inappropriate therapies along with the availability of new implantable cardioverter-defibrillator (ICD) technologies lacking traditional endocardial antitachycardia pacing (ATP) capabilities requires the reevaluation of ATP as a first strategy in terminating fast ventricular tachycardias (VTs) in primary prevention ICD recipients.
Objective: To assess the role of ATP in terminating fast VTs in primary prevention ICD recipients with contemporary programming.
Design, Setting, And Participants: This global, prospective, double-blind, randomized clinical trial had an equivalence design with a relative margin of 35%.
Article Synopsis
- The study investigates the unclear pathophysiology of atrial fibrillation (AF), focusing on how scar tissue and conduction velocity (CV) affect electrical wavefronts in sinus rhythm (SR) and AF.
- Researchers analyzed data from 60 patients, finding that local activation times and voltage levels correlate, with enhanced CV heterogeneity often found in areas of low voltage.
- The findings suggest that CV dynamics influenced by scar tissue lead to varying wavefront propagation in SR and increased rotational activity during AF, highlighting potential new targets for ablation treatment.
Article Synopsis
- The heart condition atrial fibrillation (AF) is linked to problems like atrial fibrosis and changes in nerve signals, which can affect how fast electrical signals move through the heart's atrium.* -
- Doctors studied data from 54 patients to see how different factors including heart voltage and nerve stimulation affected the speed of these signals and where they changed direction, known as pivot points.* -
- The findings showed that the type of heart tissue and nerve activity can slow down these signals and create more areas where the signals change direction, helping us understand how AF works better.*
Importance: There are concerns that pulmonary vein isolation for atrial fibrillation may have a profound placebo effect, but no double-blind randomized clinical trials have been conducted.
Objective: To determine whether pulmonary vein isolation is more effective than a sham procedure for improving outcomes in atrial fibrillation.
Design, Setting, And Participants: Double-blind randomized clinical trial conducted at 2 tertiary centers in the UK between January 2020 and March 2024 among patients with symptomatic paroxysmal or persistent atrial fibrillation.
Article Synopsis
- The study investigates the relationship between serum calcium levels and ventricular repolarization time, specifically the QT and JT intervals, which are important for heart health.
- Researchers conducted large-scale genome-wide analyses to explore potential interactions between calcium levels and genetic variants associated with QT and JT intervals, using over 122,000 participants.
- The results showed limited evidence for the hypothesized calcium interaction effects, suggesting that other factors, such as rare genetic variations or environmental influences, likely play a larger role in the unexplained heritability of QT and JT intervals.
Patients with hypertrophic cardiomyopathy (HCM) are at risk for lethal ventricular arrhythmia, but the electrophysiological substrate behind this is not well-understood. We used non-invasive electrocardiographic imaging to characterize patients with HCM, including cardiac arrest survivors. HCM patients surviving ventricular fibrillation or hemodynamically unstable ventricular tachycardia (n = 17) were compared to HCM patients without a personal history of potentially lethal arrhythmia (n = 20) and a pooled control group with structurally normal hearts.
View Article and Find Full Text PDFPatient selection, ventricular tachycardia substrate delineation and data transfer for stereotactic arrhythmia radioablation. A Clinical Consensus Statement of the European Heart Rhythm Association (EHRA) of the ESC and the Heart Rhythm Society (HRS).
Europace
August 2024
Stereotactic arrythmia radioablation (STAR) is a novel, non-invasive and promising treatment option for ventricular arrythmias (VA). It has been applied in highly selected patients mainly as bail-out procedure, when (multiple) catheter-ablations, together with anti-arrhythmic drugs, were unable to control the VAs. Despite the increasing clinical use there is still limited knowledge of the acute and long-term response of normal and diseased myocardium to STAR.
View Article and Find Full Text PDFCan an S3 Extrastimulus Light the Way for More Targeted VT Substrate Ablation?
JACC Clin Electrophysiol
July 2024
Catheter ablation in Brugada syndrome: are we missing an opportunity.
Eur Heart J Qual Care Clin Outcomes
November 2024
Article Synopsis
- The study investigates mitral annulus disjunction (MAD) using cardiac MRI in a group of 222 patients with an average age of 49.2 years, primarily male (56.8%).
- MAD is identified by a separation of 2 mm or more between the left ventricular myocardium and the mitral annulus, and the study analyzes late gadolinium enhancement (LGE) patterns and ventricular arrhythmias (VA).
- Results show that although non-sustained ventricular arrhythmias were more common in patients with greater MAD extent, no strong relationship between LGE and MAD severity was found, with no observed sustained VAs during the follow-up period of approximately 4 years.
An elevated resting heart rate (RHR) is associated with increased cardiovascular mortality. Genome-wide association studies (GWAS) have identified > 350 loci. Uniquely, in this study we applied genetic fine-mapping leveraging tissue specific chromatin segmentation and colocalization analyses to identify causal variants and candidate effector genes for RHR.
View Article and Find Full Text PDFBackground: Drug development for atrial fibrillation (AF) has failed to yield new approved compounds. We sought to identify and prioritise potential druggable targets with support from human genetics, by integrating the available evidence with bioinformatics sources relevant for AF drug development.
Methods: Genetic hits for AF and related traits were identified through structured search of MEDLINE.