Mode and Characteristics of Arrhythmia Initiation in Idiopathic Ventricular Fibrillation: A THESIS Substudy

Bernard Belhassen; Giulio Conte; Christian Steinberg; John Whitaker; Habib R Khan; Mikael Laredo; Florian Doldi; Reginald Ho; Rafik Tadros; Boris Dinov; Ehud Chorin; Simon Hansom; Xavier Waintraub; Lars Eckardt; Lior Jankelson; Petr Peichl; Greg Mellor; Raymond W Sy; Pattara Rattanawong; Stefan Stojkovic; Leonid Garber; Gonca Suna; Josef Kautzner; Kim Hoe Chan; Komandoor Srivathsan; Usha Tedrow; Stepan Havranek; Francis Murgatroyd; Ayelet Shauer; Bo Gregers Winkel; Stephen P Page; Anat Milman; Adi Lador; Romeo Ayou; Jean Marc Sellal; Philippe Chevalier; F Javier García-Fernández; Tobias Reichlin; Dipen Shah; Babak Nazer; Francisco Bermudez-Jimenez; Satoshi Nagase; Hiroshi Morita; Gi-Byoung Nam; Carlo Pappone; Pier D Lambiase; Bernhard Strohmer; Markus Stuehlinger; Estelle Gandjbakhch; Eric Schulze-Bahr; THESIS Investigators

doi:10.1016/j.jacep.2024.03.036

Mode and Characteristics of Arrhythmia Initiation in Idiopathic Ventricular Fibrillation: A THESIS Substudy

Bernard Belhassen^*, Giulio Conte, Christian Steinberg, John Whitaker, Habib R Khan, Mikael Laredo, Florian Doldi, Reginald Ho, Rafik Tadros, Boris Dinov, Ehud Chorin, Simon Hansom, Xavier Waintraub, Lars Eckardt, Lior Jankelson, Petr Peichl, Greg Mellor, Raymond W Sy, Pattara Rattanawong, Stefan StojkovicLeonid Garber, Gonca Suna, Josef Kautzner, Kim Hoe Chan, Komandoor Srivathsan, Usha Tedrow, Stepan Havranek, Francis Murgatroyd, Ayelet Shauer, Bo Gregers Winkel, Stephen P Page, Anat Milman, Adi Lador, Romeo Ayou, Jean Marc Sellal, Philippe Chevalier, F Javier García-Fernández, Tobias Reichlin, Dipen Shah, Babak Nazer, Francisco Bermudez-Jimenez, Satoshi Nagase, Hiroshi Morita, Gi-Byoung Nam, Carlo Pappone, Pier D Lambiase, Bernhard Strohmer, Markus Stuehlinger, Estelle Gandjbakhch, Eric Schulze-Bahr, THESIS Investigators

^*Corresponding author af dette arbejde

Afdeling for Hjertesygdomme HJE

6 Citationer (Scopus)

Abstract

BACKGROUND: There is limited information on the mode of arrhythmia initiation in idiopathic ventricular fibrillation (IVF). A non-pause-dependent mechanism has been suggested to be the rule.

OBJECTIVES: The aim of this study was to assess the mode and characteristics of initiation of polymorphic ventricular tachycardia (PVT) in patients with short or long-coupled PVT/IVF included in THESIS (THerapy Efficacy in Short or long-coupled idiopathic ventricular fibrillation: an International Survey), a multicenter study involving 287 IVF patients treated with drugs or radiofrequency ablation.

METHODS: We reviewed the initiation of 410 episodes of ≥1 PVT triplet in 180 patients (58.3% females; age 39.6 ± 13.6 years) with IVF. The incidence of pause-dependency arrhythmia initiation (prolongation by >20 ms of the preceding cycle length) was assessed.

RESULTS: Most arrhythmias (n = 295; 72%) occurred during baseline supraventricular rhythm without ambient premature ventricular complexes (PVCs), whereas 106 (25.9%) occurred during baseline rhythm including PVCs. Nine (2.2%) arrhythmias occurred during atrial/ventricular pacing and were excluded from further analysis. Mode of PVT initiation was pause-dependent in 45 (15.6%) and 64 (60.4%) of instances in the first and second settings, respectively, for a total of 109 of 401 (27.2%). More than one type of pause-dependent and/or non-pause-dependent initiation (mean: 2.6) occurred in 94.4% of patients with ≥4 events. Coupling intervals of initiating PVCs were <350 ms, 350-500 ms, and >500 ms in 76.6%, 20.72%, and 2.7% of arrhythmia initiations, respectively.

CONCLUSIONS: Pause-dependent initiation occurred in more than a quarter of arrhythmic episodes in IVF patients. PVCs having long (between 350 and 500 ms) and very long (>500 ms) coupling intervals were observed at the initiation of nearly a quarter of PVT episodes.

Originalsprog	Engelsk
Tidsskrift	JACC. Clinical electrophysiology
Vol/bind	10
Udgave nummer	8
Sider (fra-til)	1794-1809
Antal sider	16
ISSN	2405-5018
DOI	https://doi.org/10.1016/j.jacep.2024.03.036
Status	Udgivet - aug. 2024

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10.1016/j.jacep.2024.03.036

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Belhassen, B., Conte, G., Steinberg, C., Whitaker, J., Khan, H. R., Laredo, M., Doldi, F., Ho, R., Tadros, R., Dinov, B., Chorin, E., Hansom, S., Waintraub, X., Eckardt, L., Jankelson, L., Peichl, P., Mellor, G., Sy, R. W., Rattanawong, P., ... THESIS Investigators (2024). Mode and Characteristics of Arrhythmia Initiation in Idiopathic Ventricular Fibrillation: A THESIS Substudy. JACC. Clinical electrophysiology, 10(8), 1794-1809. https://doi.org/10.1016/j.jacep.2024.03.036

Belhassen, B, Conte, G, Steinberg, C, Whitaker, J, Khan, HR, Laredo, M, Doldi, F, Ho, R, Tadros, R, Dinov, B, Chorin, E, Hansom, S, Waintraub, X, Eckardt, L, Jankelson, L, Peichl, P, Mellor, G, Sy, RW, Rattanawong, P, Stojkovic, S, Garber, L, Suna, G, Kautzner, J, Chan, KH, Srivathsan, K, Tedrow, U, Havranek, S, Murgatroyd, F, Shauer, A, Winkel, BG, Page, SP, Milman, A, Lador, A, Ayou, R, Sellal, JM, Chevalier, P, García-Fernández, FJ, Reichlin, T, Shah, D, Nazer, B, Bermudez-Jimenez, F, Nagase, S, Morita, H, Nam, G-B, Pappone, C, Lambiase, PD, Strohmer, B, Stuehlinger, M, Gandjbakhch, E, Schulze-Bahr, E & THESIS Investigators 2024, 'Mode and Characteristics of Arrhythmia Initiation in Idiopathic Ventricular Fibrillation: A THESIS Substudy', JACC. Clinical electrophysiology, bind 10, nr. 8, s. 1794-1809. https://doi.org/10.1016/j.jacep.2024.03.036

@article{84c93f264c6b4e56bf27219478e35f6d,

title = "Mode and Characteristics of Arrhythmia Initiation in Idiopathic Ventricular Fibrillation: A THESIS Substudy",

abstract = "BACKGROUND: There is limited information on the mode of arrhythmia initiation in idiopathic ventricular fibrillation (IVF). A non-pause-dependent mechanism has been suggested to be the rule.OBJECTIVES: The aim of this study was to assess the mode and characteristics of initiation of polymorphic ventricular tachycardia (PVT) in patients with short or long-coupled PVT/IVF included in THESIS (THerapy Efficacy in Short or long-coupled idiopathic ventricular fibrillation: an International Survey), a multicenter study involving 287 IVF patients treated with drugs or radiofrequency ablation.METHODS: We reviewed the initiation of 410 episodes of ≥1 PVT triplet in 180 patients (58.3% females; age 39.6 ± 13.6 years) with IVF. The incidence of pause-dependency arrhythmia initiation (prolongation by >20 ms of the preceding cycle length) was assessed.RESULTS: Most arrhythmias (n = 295; 72%) occurred during baseline supraventricular rhythm without ambient premature ventricular complexes (PVCs), whereas 106 (25.9%) occurred during baseline rhythm including PVCs. Nine (2.2%) arrhythmias occurred during atrial/ventricular pacing and were excluded from further analysis. Mode of PVT initiation was pause-dependent in 45 (15.6%) and 64 (60.4%) of instances in the first and second settings, respectively, for a total of 109 of 401 (27.2%). More than one type of pause-dependent and/or non-pause-dependent initiation (mean: 2.6) occurred in 94.4% of patients with ≥4 events. Coupling intervals of initiating PVCs were <350 ms, 350-500 ms, and >500 ms in 76.6%, 20.72%, and 2.7% of arrhythmia initiations, respectively.CONCLUSIONS: Pause-dependent initiation occurred in more than a quarter of arrhythmic episodes in IVF patients. PVCs having long (between 350 and 500 ms) and very long (>500 ms) coupling intervals were observed at the initiation of nearly a quarter of PVT episodes.",

keywords = "Adult, Catheter Ablation, Electrocardiography, Female, Humans, Male, Middle Aged, Tachycardia, Ventricular/physiopathology, Ventricular Fibrillation/epidemiology, Young Adult, pause-dependency, idiopathic ventricular fibrillation, long-coupled ventricular arrhythmias, short-coupled ventricular arrhythmias, polymorphic ventricular tachycardia",

author = "Bernard Belhassen and Giulio Conte and Christian Steinberg and John Whitaker and Khan, {Habib R} and Mikael Laredo and Florian Doldi and Reginald Ho and Rafik Tadros and Boris Dinov and Ehud Chorin and Simon Hansom and Xavier Waintraub and Lars Eckardt and Lior Jankelson and Petr Peichl and Greg Mellor and Sy, {Raymond W} and Pattara Rattanawong and Stefan Stojkovic and Leonid Garber and Gonca Suna and Josef Kautzner and Chan, {Kim Hoe} and Komandoor Srivathsan and Usha Tedrow and Stepan Havranek and Francis Murgatroyd and Ayelet Shauer and Winkel, {Bo Gregers} and Page, {Stephen P} and Anat Milman and Adi Lador and Romeo Ayou and Sellal, {Jean Marc} and Philippe Chevalier and Garc{\'i}a-Fern{\'a}ndez, {F Javier} and Tobias Reichlin and Dipen Shah and Babak Nazer and Francisco Bermudez-Jimenez and Satoshi Nagase and Hiroshi Morita and Gi-Byoung Nam and Carlo Pappone and Lambiase, {Pier D} and Bernhard Strohmer and Markus Stuehlinger and Estelle Gandjbakhch and Eric Schulze-Bahr and {THESIS Investigators}",

year = "2024",

month = aug,

doi = "10.1016/j.jacep.2024.03.036",

language = "English",

volume = "10",

pages = "1794--1809",

journal = "JACC. Clinical electrophysiology",

issn = "2405-5018",

publisher = "Elsevier USA",

number = "8",

}

TY - JOUR

T1 - Mode and Characteristics of Arrhythmia Initiation in Idiopathic Ventricular Fibrillation

T2 - A THESIS Substudy

AU - Belhassen, Bernard

AU - Conte, Giulio

AU - Steinberg, Christian

AU - Whitaker, John

AU - Khan, Habib R

AU - Laredo, Mikael

AU - Doldi, Florian

AU - Ho, Reginald

AU - Tadros, Rafik

AU - Dinov, Boris

AU - Chorin, Ehud

AU - Hansom, Simon

AU - Waintraub, Xavier

AU - Eckardt, Lars

AU - Jankelson, Lior

AU - Peichl, Petr

AU - Mellor, Greg

AU - Sy, Raymond W

AU - Rattanawong, Pattara

AU - Stojkovic, Stefan

AU - Garber, Leonid

AU - Suna, Gonca

AU - Kautzner, Josef

AU - Chan, Kim Hoe

AU - Srivathsan, Komandoor

AU - Tedrow, Usha

AU - Havranek, Stepan

AU - Murgatroyd, Francis

AU - Shauer, Ayelet

AU - Winkel, Bo Gregers

AU - Page, Stephen P

AU - Milman, Anat

AU - Lador, Adi

AU - Ayou, Romeo

AU - Sellal, Jean Marc

AU - Chevalier, Philippe

AU - García-Fernández, F Javier

AU - Reichlin, Tobias

AU - Shah, Dipen

AU - Nazer, Babak

AU - Bermudez-Jimenez, Francisco

AU - Nagase, Satoshi

AU - Morita, Hiroshi

AU - Nam, Gi-Byoung

AU - Pappone, Carlo

AU - Lambiase, Pier D

AU - Strohmer, Bernhard

AU - Stuehlinger, Markus

AU - Gandjbakhch, Estelle

AU - Schulze-Bahr, Eric

AU - THESIS Investigators

PY - 2024/8

Y1 - 2024/8

N2 - BACKGROUND: There is limited information on the mode of arrhythmia initiation in idiopathic ventricular fibrillation (IVF). A non-pause-dependent mechanism has been suggested to be the rule.OBJECTIVES: The aim of this study was to assess the mode and characteristics of initiation of polymorphic ventricular tachycardia (PVT) in patients with short or long-coupled PVT/IVF included in THESIS (THerapy Efficacy in Short or long-coupled idiopathic ventricular fibrillation: an International Survey), a multicenter study involving 287 IVF patients treated with drugs or radiofrequency ablation.METHODS: We reviewed the initiation of 410 episodes of ≥1 PVT triplet in 180 patients (58.3% females; age 39.6 ± 13.6 years) with IVF. The incidence of pause-dependency arrhythmia initiation (prolongation by >20 ms of the preceding cycle length) was assessed.RESULTS: Most arrhythmias (n = 295; 72%) occurred during baseline supraventricular rhythm without ambient premature ventricular complexes (PVCs), whereas 106 (25.9%) occurred during baseline rhythm including PVCs. Nine (2.2%) arrhythmias occurred during atrial/ventricular pacing and were excluded from further analysis. Mode of PVT initiation was pause-dependent in 45 (15.6%) and 64 (60.4%) of instances in the first and second settings, respectively, for a total of 109 of 401 (27.2%). More than one type of pause-dependent and/or non-pause-dependent initiation (mean: 2.6) occurred in 94.4% of patients with ≥4 events. Coupling intervals of initiating PVCs were <350 ms, 350-500 ms, and >500 ms in 76.6%, 20.72%, and 2.7% of arrhythmia initiations, respectively.CONCLUSIONS: Pause-dependent initiation occurred in more than a quarter of arrhythmic episodes in IVF patients. PVCs having long (between 350 and 500 ms) and very long (>500 ms) coupling intervals were observed at the initiation of nearly a quarter of PVT episodes.

AB - BACKGROUND: There is limited information on the mode of arrhythmia initiation in idiopathic ventricular fibrillation (IVF). A non-pause-dependent mechanism has been suggested to be the rule.OBJECTIVES: The aim of this study was to assess the mode and characteristics of initiation of polymorphic ventricular tachycardia (PVT) in patients with short or long-coupled PVT/IVF included in THESIS (THerapy Efficacy in Short or long-coupled idiopathic ventricular fibrillation: an International Survey), a multicenter study involving 287 IVF patients treated with drugs or radiofrequency ablation.METHODS: We reviewed the initiation of 410 episodes of ≥1 PVT triplet in 180 patients (58.3% females; age 39.6 ± 13.6 years) with IVF. The incidence of pause-dependency arrhythmia initiation (prolongation by >20 ms of the preceding cycle length) was assessed.RESULTS: Most arrhythmias (n = 295; 72%) occurred during baseline supraventricular rhythm without ambient premature ventricular complexes (PVCs), whereas 106 (25.9%) occurred during baseline rhythm including PVCs. Nine (2.2%) arrhythmias occurred during atrial/ventricular pacing and were excluded from further analysis. Mode of PVT initiation was pause-dependent in 45 (15.6%) and 64 (60.4%) of instances in the first and second settings, respectively, for a total of 109 of 401 (27.2%). More than one type of pause-dependent and/or non-pause-dependent initiation (mean: 2.6) occurred in 94.4% of patients with ≥4 events. Coupling intervals of initiating PVCs were <350 ms, 350-500 ms, and >500 ms in 76.6%, 20.72%, and 2.7% of arrhythmia initiations, respectively.CONCLUSIONS: Pause-dependent initiation occurred in more than a quarter of arrhythmic episodes in IVF patients. PVCs having long (between 350 and 500 ms) and very long (>500 ms) coupling intervals were observed at the initiation of nearly a quarter of PVT episodes.

KW - Adult

KW - Catheter Ablation

KW - Electrocardiography

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Tachycardia, Ventricular/physiopathology

KW - Ventricular Fibrillation/epidemiology

KW - Young Adult

KW - pause-dependency

KW - idiopathic ventricular fibrillation

KW - long-coupled ventricular arrhythmias

KW - short-coupled ventricular arrhythmias

KW - polymorphic ventricular tachycardia

UR - http://www.scopus.com/inward/record.url?scp=85197068713&partnerID=8YFLogxK

U2 - 10.1016/j.jacep.2024.03.036

DO - 10.1016/j.jacep.2024.03.036

M3 - Journal article

C2 - 38842971

SN - 2405-5018

VL - 10

SP - 1794

EP - 1809

JO - JACC. Clinical electrophysiology

JF - JACC. Clinical electrophysiology

IS - 8

ER -

Mode and Characteristics of Arrhythmia Initiation in Idiopathic Ventricular Fibrillation: A THESIS Substudy

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