Evolution of surface and endocavitary signals in patients with arrhythmogenic cardiomyopathy at 1 and 5 years

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: Private company. Main funding source(s): Small fee from Boston Scientific. BACKGROUND: The use of subcutaneous defibrillator (S-ICD) is a viable alternative to transvenous ICD in patients with Arrhythmogenic Cardiomyopathy (ACM). In transvenous ICD...

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Autores principales: Martignani, C, Spadotto, A, Graziosi, M, Massaro, G, Pollini, C, Angeletti, A, Ziacchi, M, Biagini, E, Biffi, M, Diemberger, I
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10207279/
http://dx.doi.org/10.1093/europace/euad122.434
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author Martignani, C
Spadotto, A
Graziosi, M
Massaro, G
Pollini, C
Angeletti, A
Ziacchi, M
Biagini, E
Biffi, M
Diemberger, I
author_facet Martignani, C
Spadotto, A
Graziosi, M
Massaro, G
Pollini, C
Angeletti, A
Ziacchi, M
Biagini, E
Biffi, M
Diemberger, I
author_sort Martignani, C
collection PubMed
description FUNDING ACKNOWLEDGEMENTS: Type of funding sources: Private company. Main funding source(s): Small fee from Boston Scientific. BACKGROUND: The use of subcutaneous defibrillator (S-ICD) is a viable alternative to transvenous ICD in patients with Arrhythmogenic Cardiomyopathy (ACM). In transvenous ICD recipients low sensing values may exist at the time of implantation and a progressive decline of signal amplitude may occur later on due to the progressive myocardial fibrofatty replacement. Similarly to what happens at the intracavitary level, in patients with ACM there is a progressive modification of the surface ECG over time. Data on the impact of ECG evolution on S-ICD sensing are still lacking, particularly for different ACM phenotypes. PURPOSE: This study aims to analyze the evolution of surface electrocardiogram (ECG), focusing on R-wave amplitude variation, and intracavitary electrograms (EGMs) in ACM different phenotypes during a 1-year and a 5 five-year follow-up. METHODS: This study is a retrospective analysis of the data of consecutive patients with ACM who were referred to our centre from January 1992 to October 2021. Using a dedicated software, the ECG analysis was performed in 7 leads: DI, DII, aVF (in view of the similar orientation with the three S-ICD vectors) and V1, V2, V3 and V5. RESULTS: We included 69 ACM patients: 28 patients (41%) had a right ventricular involvement (ARVC), 19 (27%) had a dominant LV involvement (ALVC) and 22 (32%) had biventricular involvement. 58 patients (84%) were ICD recipients; 45/58 patients (78%) had a transvenous ICD, and 13/58 (22%) had an S-ICD. During 5-year follow-up, in the whole ACM population, there were no significant changes in the amplitude of the R-wave, S-wave and T-wave. Phenotypic subgroups showed a different R-wave amplitude at baseline: biventricular ACM and ALVC patients had a lower R-wave amplitude in DII (p=0.04; p=0.05) and aVF (p=0.01; p=0.01) compared to ARVC patients. However, within each group, no difference was observed in R-wave amplitude at 1 and 5 years compared to baseline ECG (Figure 1). In the transvenous ICD recipients (45/69 patients) mean sensing decreased progressively over time (9,38 ± 4,24 mV at baseline, 7,70 ± 2,91 mV at 1 year, 1,85 ± 6,86 mV at 5 years). The reduction was not statistically significant at the first year of follow-up (p=0.239) but it reached significance at 5 years (p<0.001). Patients with biventricular ACM had lower sensing values at baseline than ARVC and ALVC (p<0,001). Sensing values in the biventricular patients did not decrease significantly during the 5-year follow-up (p=0.21), whereas in the ARVC and ALVC groups a reduction in sensing values was observed albeit not statistically significant in ALVC (p=0.01 in ARVC and p =0.06 in ALVC) (Figure2). CONCLUSIONS: These data suggest that surface ECG may be more stable over time compared to EGM, therefore if a patient is suitable for S-ICD implantation S-ICD sensing may remain stable over time. Despite these findings, further studies are needed to support these hypotheses. [Figure: see text] [Figure: see text]
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spelling pubmed-102072792023-05-25 Evolution of surface and endocavitary signals in patients with arrhythmogenic cardiomyopathy at 1 and 5 years Martignani, C Spadotto, A Graziosi, M Massaro, G Pollini, C Angeletti, A Ziacchi, M Biagini, E Biffi, M Diemberger, I Europace 14.2 - Implantable Cardioverter-Defibrillator (ICD) FUNDING ACKNOWLEDGEMENTS: Type of funding sources: Private company. Main funding source(s): Small fee from Boston Scientific. BACKGROUND: The use of subcutaneous defibrillator (S-ICD) is a viable alternative to transvenous ICD in patients with Arrhythmogenic Cardiomyopathy (ACM). In transvenous ICD recipients low sensing values may exist at the time of implantation and a progressive decline of signal amplitude may occur later on due to the progressive myocardial fibrofatty replacement. Similarly to what happens at the intracavitary level, in patients with ACM there is a progressive modification of the surface ECG over time. Data on the impact of ECG evolution on S-ICD sensing are still lacking, particularly for different ACM phenotypes. PURPOSE: This study aims to analyze the evolution of surface electrocardiogram (ECG), focusing on R-wave amplitude variation, and intracavitary electrograms (EGMs) in ACM different phenotypes during a 1-year and a 5 five-year follow-up. METHODS: This study is a retrospective analysis of the data of consecutive patients with ACM who were referred to our centre from January 1992 to October 2021. Using a dedicated software, the ECG analysis was performed in 7 leads: DI, DII, aVF (in view of the similar orientation with the three S-ICD vectors) and V1, V2, V3 and V5. RESULTS: We included 69 ACM patients: 28 patients (41%) had a right ventricular involvement (ARVC), 19 (27%) had a dominant LV involvement (ALVC) and 22 (32%) had biventricular involvement. 58 patients (84%) were ICD recipients; 45/58 patients (78%) had a transvenous ICD, and 13/58 (22%) had an S-ICD. During 5-year follow-up, in the whole ACM population, there were no significant changes in the amplitude of the R-wave, S-wave and T-wave. Phenotypic subgroups showed a different R-wave amplitude at baseline: biventricular ACM and ALVC patients had a lower R-wave amplitude in DII (p=0.04; p=0.05) and aVF (p=0.01; p=0.01) compared to ARVC patients. However, within each group, no difference was observed in R-wave amplitude at 1 and 5 years compared to baseline ECG (Figure 1). In the transvenous ICD recipients (45/69 patients) mean sensing decreased progressively over time (9,38 ± 4,24 mV at baseline, 7,70 ± 2,91 mV at 1 year, 1,85 ± 6,86 mV at 5 years). The reduction was not statistically significant at the first year of follow-up (p=0.239) but it reached significance at 5 years (p<0.001). Patients with biventricular ACM had lower sensing values at baseline than ARVC and ALVC (p<0,001). Sensing values in the biventricular patients did not decrease significantly during the 5-year follow-up (p=0.21), whereas in the ARVC and ALVC groups a reduction in sensing values was observed albeit not statistically significant in ALVC (p=0.01 in ARVC and p =0.06 in ALVC) (Figure2). CONCLUSIONS: These data suggest that surface ECG may be more stable over time compared to EGM, therefore if a patient is suitable for S-ICD implantation S-ICD sensing may remain stable over time. Despite these findings, further studies are needed to support these hypotheses. [Figure: see text] [Figure: see text] Oxford University Press 2023-05-24 /pmc/articles/PMC10207279/ http://dx.doi.org/10.1093/europace/euad122.434 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle 14.2 - Implantable Cardioverter-Defibrillator (ICD)
Martignani, C
Spadotto, A
Graziosi, M
Massaro, G
Pollini, C
Angeletti, A
Ziacchi, M
Biagini, E
Biffi, M
Diemberger, I
Evolution of surface and endocavitary signals in patients with arrhythmogenic cardiomyopathy at 1 and 5 years
title Evolution of surface and endocavitary signals in patients with arrhythmogenic cardiomyopathy at 1 and 5 years
title_full Evolution of surface and endocavitary signals in patients with arrhythmogenic cardiomyopathy at 1 and 5 years
title_fullStr Evolution of surface and endocavitary signals in patients with arrhythmogenic cardiomyopathy at 1 and 5 years
title_full_unstemmed Evolution of surface and endocavitary signals in patients with arrhythmogenic cardiomyopathy at 1 and 5 years
title_short Evolution of surface and endocavitary signals in patients with arrhythmogenic cardiomyopathy at 1 and 5 years
title_sort evolution of surface and endocavitary signals in patients with arrhythmogenic cardiomyopathy at 1 and 5 years
topic 14.2 - Implantable Cardioverter-Defibrillator (ICD)
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10207279/
http://dx.doi.org/10.1093/europace/euad122.434
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