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11. ISE/ISHNE Expert Consensus Statement on ECG Diagnosis of Left Ventricular Hypertrophy: The Change of the Paradigm. The joint paper of the International Society of Electrocardiology and the International Society for Holter Monitoring and Noninvasive Electrocardiology

Author

Bacharova, Ljuba, Chevalier, Philippe, Gorenek, Bulent, Jons, Christian, Li, Yi-Gang, Locati, Emanuela T., Maanja, Maren, Pérez-Riera, Andrés Ricardo, Platonov, Pyotr G., Ribeiro, Antonio Luiz P., Schocken, Douglas, Soliman, Elsayed Z., Svehlikova, Jana, Tereshchenko, Larisa G., Ugander, Martin, Varma, Niraj, Zaklyazminskaya, Elena, and Ikeda, Takanori

Published
2023
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32. ISE/ISHNE expert consensus statement on the ECG diagnosis of left ventricular hypertrophy: The change of the paradigm

Author

Bacharova, Ljuba, primary, Chevalier, Philippe, additional, Gorenek, Bulent, additional, Jons, Christian, additional, Li, Yi‐Gang, additional, Locati, Emanuela T., additional, Maanja, Maren, additional, Pérez‐Riera, Andrés Ricardo, additional, Platonov, Pyotr G., additional, Ribeiro, Antonio Luiz Pinho, additional, Schocken, Douglas, additional, Soliman, Elsayed Z., additional, Svehlikova, Jana, additional, Tereshchenko, Larisa G., additional, Ugander, Martin, additional, Varma, Niraj, additional, Elena, Zaklyazminskaya, additional, and Ikeda, Takanori, additional

Published
2023
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38. ISE/ISHNE expert consensus statement on the ECG diagnosis of left ventricular hypertrophy: The change of the paradigm.

Author

Bacharova, Ljuba, Chevalier, Philippe, Gorenek, Bulent, Jons, Christian, Li, Yi‐Gang, Locati, Emanuela T., Maanja, Maren, Pérez‐Riera, Andrés Ricardo, Platonov, Pyotr G., Ribeiro, Antonio Luiz Pinho, Schocken, Douglas, Soliman, Elsayed Z., Svehlikova, Jana, Tereshchenko, Larisa G., Ugander, Martin, Varma, Niraj, Elena, Zaklyazminskaya, and Ikeda, Takanori

Abstract

The ECG diagnosis of LVH is predominantly based on the QRS voltage criteria. The classical paradigm postulates that the increased left ventricular mass generates a stronger electrical field, increasing the leftward and posterior QRS forces, reflected in the augmented QRS amplitude. However, the low sensitivity of voltage criteria has been repeatedly documented. We discuss possible reasons for this shortcoming and proposal of a new paradigm. The theoretical background for voltage measured at the body surface is defined by the solid angle theorem, which relates the measured voltage to spatial and non‐spatial determinants. The spatial determinants are represented by the extent of the activation front and the distance of the recording electrodes. The non‐spatial determinants comprise electrical characteristics of the myocardium, which are comparatively neglected in the interpretation of the QRS patterns. Various clinical conditions are associated with LVH. These conditions produce considerable diversity of electrical properties alterations thereby modifying the resultant QRS patterns. The spectrum of QRS patterns observed in LVH patients is quite broad, including also left axis deviation, left anterior fascicular block, incomplete and complete left bundle branch blocks, Q waves, and fragmented QRS. Importantly, the QRS complex can be within normal limits. The new paradigm stresses the electrophysiological background in interpreting QRS changes, i.e., the effect of the non‐spatial determinants. This postulates that the role of ECG is not to estimate LV size in LVH, but to understand and decode the underlying electrical processes, which are crucial in relation to cardiovascular risk assessment. [ABSTRACT FROM AUTHOR]

Published
2024
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41. Safety and efficacy of ablation for atrial fibrillation in combination with left atrial appendage occlusion in octogenarians

Author

Zhang, Peng‐Pai, primary, Zhao, Yan, additional, Sun, Jian, additional, Wang, Qun‐Shan, additional, Li, Wei, additional, Zhang, Rui, additional, Chen, Mu, additional, Mo, Bin‐Feng, additional, Yu, Yi, additional, Feng, Xiang‐Fei, additional, Liu, Bo, additional, Yu, Yi‐Chi, additional, Lu, Qiu‐Fen, additional, and Li, Yi‐Gang, additional

Published
2023
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48. Combined Radiofrequency Ablation and Left Atrial Appendage Closure in Atrial Fibrillation and Systolic Heart Failure.

Author

Sun, Jian, Zhang, Rui, Yang, Mei, Li, Wei, Zhang, Peng-Pai, Mo, Bin-Feng, Wang, Qun-Shan, Chen, Mu, and Li, Yi-Gang

Subjects
ATRIAL fibrillation, VENTRICULAR ejection fraction, HEART failure, CATHETER ablation, DISEASE risk factors
Abstract

Background: Managing patients with atrial fibrillation (AF) and comorbid heart failure (HF) with reduced (HFrEF) or mildly reduced ejection fraction (HFmrEF) is of clinical importance but a great challenge. This study aimed to evaluate the clinical benefit of the combined radiofrequency catheter ablation (RFCA) and left atrial appendage closure (LAAC) procedure in AF patients complicated with systolic HF. Methods: AF patients with HFrEF or HFmrEF who underwent the combined RFCA and LAAC procedure were prospectively enrolled in the LAACablation registry. The procedural complications and long-term outcomes were evaluated. Another cohort of AF patients with systolic HF who did not undergo either RFCA or LAAC were used for prognosis comparison. Results: Among 802 AF patients who underwent the combined procedure, 65 patients were comorbid with systolic HF (25 with HFrEF and 40 with HFmrEF). The overall procedural complication rate was 9.2%, which was mainly attributed to acute decompensated HF (6.2%). Accompanied with markedly reduced AF burden (from median [25th, 75th percentile]: 100 [100, 100] to 0 [0, 1.2]%, p < 0.001), upward trajectories of cardiac function were observed in 51 (78.4%) patients, showing improvement in New York Heart Classification (p < 0.01), natriuretic peptide levels (from 1492 [809, 3259] to 413 [163, 880] pg/mL, p < 0.001) and left ventricular EF (from 42.6 ± 5.3 to 53.8 ± 8.2%, p < 0.001). During the 27-month follow-up period, death, thromboembolism, major bleeding, and HF rehospitalization were observed in three, one, one, and four patients, respectively. The observed event rates showed a significant reduction compared with the non-procedure AF-HF cohort (n = 138; for composite endpoint: hazard ratio: 2.509, 95% confidence interval: 1.415–4.449, p = 0.002) and with the respective rates predicted by risk scores. Conclusions: Combining RFCA and LAAC achieves acceptable safety and credible long-term efficacy in AF patients with systolic HF. Further randomized studies are warranted in a larger patient cohort. [ABSTRACT FROM AUTHOR]

Published
2023
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