1
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Heeger CH, Tilz RR. [Ventricular tachycardia-without structural heart disease: History]. Herzschrittmacherther Elektrophysiol 2024; 35:102-109. [PMID: 38407580 PMCID: PMC10923990 DOI: 10.1007/s00399-024-01007-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 02/27/2024]
Abstract
This article focuses on ventricular arrythmias without evidence for structural heart disease. There are many different reasons for this type of arrythmia and there is still a gap of knowledge. Starting with the first description of this disease, we present the diagnosis and management with medication, and finally catheter ablation procedures from the beginning to how it is currently treated and how it possibly will be treated in the near future.
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Affiliation(s)
- Christian-Hendrik Heeger
- Department für Rhythmologie, Abteilung für Kardiologie & Internistische Intensivmedizin, Asklepios Klinik Altona, Paul-Ehrlich-Straße 1, 22763, Hamburg, Deutschland.
| | - Roland Richard Tilz
- Klinik für Rhythmologie, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
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2
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Zhu W, Huang X, Mei L, Zhi L, Jiang S, Jin J, Zou C. The predictive value of Tp-Te interval, Tp-Te/QT ratio, and QRS-T angle of idiopathic ventricular tachycardia in patients with ventricular premature beats. Clin Cardiol 2023; 46:425-430. [PMID: 36807300 PMCID: PMC10106654 DOI: 10.1002/clc.23998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/24/2023] [Accepted: 02/01/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Identify idiopathic ventricular tachycardia in patients with ventricular premature beats was required to have effectively treatment. HYPOTHESIS The aim of this study is to investigate the predictive value of Tp-Te interval, Tp-Te/QT ratio, and QRS-T angle of idiopathic ventricular tachycardia in patients with idiopathic ventricular premature beats. METHODS One hundred and seventy-eight patients who had undergone premature ventricular complex/ventricular tachycardia (PVC/VT) ablation between January 1, 2020 and August 30, 2022 constituted our study population as ventricular arrhythmia group. Seventy-five healthy people were selected as control group. Patients with no episode of VT were classified as PVC group, while with any episode of VT that has the same morphology with PVC were classified as PVC with VT group. Patients in PVC with VT group were divided into two groups: nonsustained VT group (duration of any episode of VT below 30 s) and sustained VT group (duration of any episode of VT over 30 s). Tp-Te interval, Tp-Te/QT ratio and QRS-T angle were compared in groups. RESULTS Tp-Te interval, Tp-Te/QT ratio and patients with increased QRS-T angle in PVC with VT group were higher or more than those in PVC group (p < .001). The value of combined diagnosis of these indexes was higher. Tp-Te interval was longer in the sustained VT group compared to the nonsustained VT group (p = .009). CONCLUSION Tp-Te interval, Tp-Te/QT ratio, and QRS-T angle may have a predictive value of presence of idiopathic VT in patients with premature beats and the combined prediction of these indexes is more valuable. Tp-Te interval maybe helpful for prediction of sustained idiopathic VT.
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Affiliation(s)
- Wei Zhu
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xingmei Huang
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Lili Mei
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Liting Zhi
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Shili Jiang
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jianling Jin
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Cao Zou
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
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3
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Farré J, Rubio JM, Sternick EB. Confounding factors leading to misdiagnosing ventricular tachycardia as supraventricular in the emergency room. Indian Pacing Electrophysiol J 2022; 23:1-13. [PMID: 36473691 PMCID: PMC9880893 DOI: 10.1016/j.ipej.2022.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/30/2022] [Indexed: 12/11/2022] Open
Abstract
Studies conducted during the last 50 years have proposed electrocardiographic criteria and algorithms to determine if a wide QRS tachycardia is ventricular or supraventricular in origin. Sustained ventricular tachycardia is an uncommon reason for consultation in the emergency room. The latter and the complexity of available electrocardiographic diagnostic criteria and algorithms result in frequent misdiagnoses. Good hemodynamic tolerance of tachycardia in the supine position does not exclude its ventricular origin. Although rare, ventricular tachycardia in patients with and without structural heart disease may show a QRS duration <120 ms. Interruption of tachycardia by coughing, carotid sinus massage, Valsalva maneuver, or following the infusion of adenosine or verapamil should not discard the ventricular origin of the arrhythmia. In patients with regular, uniform, sustained broad QRS tachycardia, the presence of structural heart disease or A-V dissociation strongly suggest its ventricular origin. Occasionally, ventricular tachycardia can present with AV dissociation without this being evident on the 12-lead ECG. Cardiac auscultation, examination of the jugular venous pulse, and arterial pulse palpation provide additional clues for identifying A-V dissociation during tachycardia. This paper does not review the electrocardiographic criteria for categorizing tachycardia as ventricular but rather why emergency physicians misdiagnose these patients.
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Affiliation(s)
- Jerónimo Farré
- Madrid Autonomous University, Spain,Corresponding author. Paseo de San Francisco de Sales 33, 28003, Madrid, Spain.
| | - José-Manuel Rubio
- Director of the Arrhythmia Unit, Fundación Jiménez Díaz University Hospital and Institute of Health Sciences Research, Madrid, Spain
| | - Eduardo Back Sternick
- Arrhythmia and Electrophysiology Department, Biocor Instituto, Rede Dor São Luis, Nova Lima, Minas Gerais, Brazil
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4
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Guber K, Zilinyi RS, Driggin E, Soroush A, Welinsky S, Nathanson J, Sethi A, Rubin D. Rare Complication of Endoscopic Variceal Therapy: Wide-Complex Tachycardia Associated With Embolization of Glue and Coil. JACC Case Rep 2022; 4:433-437. [PMID: 35693901 PMCID: PMC9175143 DOI: 10.1016/j.jaccas.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/09/2021] [Accepted: 11/15/2021] [Indexed: 06/15/2023]
Abstract
We present the case of a woman with upper gastrointestinal bleeding secondary to gastric varices requiring endoscopic cyanoacrylate glue and coil embolization. The procedure was complicated by regular, wide-complex tachycardia, with further investigation revealing cardiopulmonary migration of the glue and coil. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Kenneth Guber
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Robert S. Zilinyi
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Elissa Driggin
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Ali Soroush
- Division of Gastroenterology, Columbia University Irving Medical Center, New York, New York, USA
| | - Sara Welinsky
- Division of Gastroenterology, Columbia University Irving Medical Center, New York, New York, USA
| | - John Nathanson
- Division of Gastroenterology, Columbia University Irving Medical Center, New York, New York, USA
| | - Amrita Sethi
- Division of Gastroenterology, Columbia University Irving Medical Center, New York, New York, USA
| | - David Rubin
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
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5
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Ono K, Iwasaki YK, Akao M, Ikeda T, Ishii K, Inden Y, Kusano K, Kobayashi Y, Koretsune Y, Sasano T, Sumitomo N, Takahashi N, Niwano S, Hagiwara N, Hisatome I, Furukawa T, Honjo H, Maruyama T, Murakawa Y, Yasaka M, Watanabe E, Aiba T, Amino M, Itoh H, Ogawa H, Okumura Y, Aoki-Kamiya C, Kishihara J, Kodani E, Komatsu T, Sakamoto Y, Satomi K, Shiga T, Shinohara T, Suzuki A, Suzuki S, Sekiguchi Y, Nagase S, Hayami N, Harada M, Fujino T, Makiyama T, Maruyama M, Miake J, Muraji S, Murata H, Morita N, Yokoshiki H, Yoshioka K, Yodogawa K, Inoue H, Okumura K, Kimura T, Tsutsui H, Shimizu W. JCS/JHRS 2020 Guideline on Pharmacotherapy of Cardiac Arrhythmias. Circ J 2022; 86:1790-1924. [DOI: 10.1253/circj.cj-20-1212] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | - Yu-ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Masaharu Akao
- Department of Cardiovascular Medicine, National Hospital Organization Kyoto Medical Center
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine
| | - Kuniaki Ishii
- Department of Pharmacology, Yamagata University Faculty of Medicine
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoshinori Kobayashi
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital
| | | | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | | | | | - Tetsushi Furukawa
- Department of Bio-information Pharmacology, Medical Research Institute, Tokyo Medical and Dental University
| | - Haruo Honjo
- Research Institute of Environmental Medicine, Nagoya University
| | - Toru Maruyama
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital
| | - Yuji Murakawa
- The 4th Department of Internal Medicine, Teikyo University School of Medicine, Mizonokuchi Hospital
| | - Masahiro Yasaka
- Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center
| | - Eiichi Watanabe
- Department of Cardiology, Fujita Health University School of Medicine
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Mari Amino
- Department of Cardiovascular Medicine, Tokai University School of Medicine
| | - Hideki Itoh
- Division of Patient Safety, Hiroshima University Hospital
| | - Hisashi Ogawa
- Department of Cardiology, National Hospital Organisation Kyoto Medical Center
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Chizuko Aoki-Kamiya
- Department of Obstetrics and Gynecology, National Cerebral and Cardiovascular Center
| | - Jun Kishihara
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Eitaro Kodani
- Department of Cardiovascular Medicine, Nippon Medical School Tama Nagayama Hospital
| | - Takashi Komatsu
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University School of Medicine
| | | | | | - Tsuyoshi Shiga
- Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine
| | - Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women's Medical University
| | - Shinya Suzuki
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Yukio Sekiguchi
- Department of Cardiology, National Hospital Organization Kasumigaura Medical Center
| | - Satoshi Nagase
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Noriyuki Hayami
- Department of Fourth Internal Medicine, Teikyo University Mizonokuchi Hospital
| | | | - Tadashi Fujino
- Department of Cardiovascular Medicine, Toho University, Faculty of Medicine
| | - Takeru Makiyama
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Mitsunori Maruyama
- Department of Cardiovascular Medicine, Nippon Medical School Musashi Kosugi Hospital
| | - Junichiro Miake
- Department of Pharmacology, Tottori University Faculty of Medicine
| | - Shota Muraji
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | | | - Norishige Morita
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital
| | - Hisashi Yokoshiki
- Department of Cardiovascular Medicine, Sapporo City General Hospital
| | - Koichiro Yoshioka
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine
| | - Kenji Yodogawa
- Department of Cardiovascular Medicine, Nippon Medical School
| | | | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
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6
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Empiric catheter ablation of premature ventricular contractions when there is a >20% burden in an asymptomatic patient with normal left ventricular size and function-An argument for a conservative, do-less approach. Heart Rhythm O2 2021; 2:210-214. [PMID: 34113924 PMCID: PMC8183866 DOI: 10.1016/j.hroo.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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7
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Prognostic value of time dependent voltage abatement during remote magnetic navigation guided ablation in idiopathic right ventricular outflow tract arrhythmias. COR ET VASA 2021. [DOI: 10.33678/cor.2020.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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8
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Silva LTME, Vale PDD, Rocha JMD, Margalho CS, Maia HCDA. Belhassen Syndrome in Teenager Originating from Left Anterior Fascicle. JOURNAL OF CARDIAC ARRHYTHMIAS 2020. [DOI: 10.24207/jca.v33i4.3417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A 16-year-old female patient was hospitalized due to narrow QRS tachycardia suggestive of fascicular ventricular tachycardia. Initially, the differential diagnosis with supraventricular tachycardia can be challenging. The tachyarrhythmia is well controlled with medication, but electrophysiological study and ablation may be necessary in patients who remain symptomatic.
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Affiliation(s)
| | - Paula Damasco do Vale
- Instituto Hospital de Base do Distrito Federal – Serviço de Eletrofisiologia – Brasília/DF – Brazil
| | - Jairo Macedo da Rocha
- Ritmocardio Serviço de Arritmia e Eletrofisiologia de Brasília – Brasília/DF – Brazil
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9
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Mattsson G, Magnusson P, Raatikainen P. Seventh time lucky-A case report of multiple radiofrequency ablations for right ventricular outflow tract tachycardia. Clin Case Rep 2020; 8:3189-3192. [PMID: 33363904 PMCID: PMC7752581 DOI: 10.1002/ccr3.3394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/03/2020] [Accepted: 09/07/2020] [Indexed: 11/08/2022] Open
Abstract
Right ventricular outflow tachycardia initially refractory to radiofrequency ablation may be successfully treated after radiofrequency ablation at multiple sites. Repeated radiofrequency ablations as well as cooperation across borders with referral to an international center of excellence may be required in complicated cases.
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Affiliation(s)
- Gustav Mattsson
- Centre for Research and DevelopmentUppsala University/Region GävleborgGävleSweden
| | - Peter Magnusson
- Centre for Research and DevelopmentUppsala University/Region GävleborgGävleSweden
- Cardiology Research UnitDepartment of MedicineKarolinska InstitutetStockholmSweden
| | - Pekka Raatikainen
- Department of Cardiology, Heart and Lung CenterHelsinki University HospitalHelsinkiFinland
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10
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Furiato A, Prestley A, Waheed A, Villanueva S. Recognizing Belhassen Ventricular Tachycardia and Preventing Its Misinterpretation as Supraventricular Tachycardia: An Unusual Case Report. Cureus 2020; 12:e9817. [PMID: 32953327 PMCID: PMC7495956 DOI: 10.7759/cureus.9817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Belhassen ventricular tachycardia (BVT), also known as verapamil-sensitive ventricular tachycardia, is an infrequent finding that can be fatal unless recognized early and treated in a prompt manner. Most patients have insignificant presentation suggestive of the disease, but on electrocardiography (EKG), BVT is characterized by a complete right branch block (RBB) and a right axis deviation (RAD). In this case report, we describe an unusual case of a 35-year-old male patient who presented to the emergency department (ED) complaining of acute palpitations of two-hour duration; subsequent diagnostic testing revealed BVT in the patient.
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Affiliation(s)
| | | | - Abdul Waheed
- Surgery, Sandeman Provincial Hospital, Quetta, PAK
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11
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Busch S, Eckardt L, Sommer P, Meyer C, Bonnemeier H, Thomas D, Neuberger HR, Tilz RR, Steven D, von Bary C, Kuniss M, Voss F, Estner HL. [Premature ventricular contractions and tachycardia in a structurally normal heart : Idiopathic PVC and VT]. Herzschrittmacherther Elektrophysiol 2019; 30:212-224. [PMID: 30767064 DOI: 10.1007/s00399-019-0607-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 01/21/2019] [Indexed: 06/09/2023]
Abstract
Premature ventricular contractions (PVC) are a common, often incidental and mostly benign finding. Treatment is indicated in frequent and symptomatic PVC or in cases of worsening of left ventricular function. Idiopathic ventricular tachycardia (VT) is mostly found in patients with a structurally healthy heart. These PVC/VT usually have a focal origin. The most likely mechanism is delayed post-depolarization. Localization of the origin is based on the creation of an activation map with or without combination of pace mapping. Idiopathic PVC/VT are most frequently located on the outflow tracts of the right and left ventricles, including the aortic root. Other typical locations include the annulus of the tricuspid or mitral valve, papillary muscles and Purkinje fibers. Catheter ablation is an alternative to antiarrhythmic medication in symptomatic monomorphic PVC/VT. The success rate is good whereby mapping and ablation can often represent a challenge. This article is the fifth part of a series dedicated to specific advanced training in the field of special rhythmology and invasive electrophysiology. It describes the pathophysiological principles, types and typical findings that can be obtained during an electrophysiological investigation.
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Affiliation(s)
- Sonia Busch
- II. Med. Klinik, Klinik für Kardiologie, Angiologie, Pneumologie, Klinikum Coburg, Ketschendorfer Str. 33, 96450, Coburg, Deutschland.
| | - Lars Eckardt
- Klinik für Kardiologie II - Rhythmologie, Universitätsklinikum Münster, Münster, Deutschland
| | - Philipp Sommer
- Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Deutschland
| | - Christian Meyer
- Klinik für Kardiologie mit Schwerpunkt Elektrophysiologie, Universitäres Herzzentrum Hamburg, Hamburg, Deutschland
| | - Hendrik Bonnemeier
- Klinik für Innere Medizin III, Kardiologie, Angiologie, Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - Dierk Thomas
- Department of Cardiology, Medical University Hospital, Heidelberg, Deutschland
- HCR (Heidelberg Center for Heart Rhythm Disorders), Heidelberg, Deutschland
- partner site Heidelberg/Mannheim, DZHK (German Center for Cardiovascular Research), Heidelberg, Deutschland
| | | | - Roland Richard Tilz
- Medizinische Klinik II (Kardiologie, Angiologie, Intensivmedizin) - Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Lübeck, Deutschland
| | - Daniel Steven
- Herzzentrum, Abteilung für Elektrophysiologie, Uniklinik Köln, Köln, Deutschland
| | - Christian von Bary
- Medizinische Klinik I, Rotkreuzklinikum München - Akademisches Lehrkrankenhaus der Technischen Universität München, München, Deutschland
| | - Malte Kuniss
- Abteilung für Kardiologie, Kerckhoff-Klinik GmbH, Bad Nauheim, Deutschland
| | - Frederic Voss
- Innere Medizin 3, Krankenhaus der Barmherzigen Brüder Trier, Trier, Deutschland
| | - Heidi L Estner
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität München (LMU München), München, Deutschland
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12
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Long-term mode and timing of premature ventricular complex recurrence following successful catheter ablation. J Interv Card Electrophysiol 2019; 55:153-160. [PMID: 30734139 DOI: 10.1007/s10840-019-00520-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 01/15/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Catheter ablation of premature ventricular contractions (PVCs) is highly successful and has become the hallmark treatment for symptomatic or highly prevalent cases. However, few studies exist that evaluate the outcomes of ablation and likely mechanisms of PVC recurrence beyond 1 year of follow-up. METHODS This study is a retrospective analysis of patients who underwent catheter ablation for symptomatic PVCs with acute procedural success and had clinical follow-up ≥ 12 months. RESULTS Forty-four patients (24 women; age 53.5 ± 4.8 years) following acutely successful PVC ablation with long-term follow-up were studied. At a mean of 36 ± 6 months, overall long-term ablation success was 75% (33/44 patients). Notably, recurrence of the targeted PVC focus was low (6.8%, 3/44 patients); the majority of recurrences were from a new source location (18.2%, 8/44 patients). The time course for targeted versus de novo PVC recurrences was significantly different: recurrence of a PVC similar to the targeted PVC morphology occurred at a mean of 5.0 ± 2.0 months, while recurrence of a PVC different from the index case occurred at a mean of 35.8 ± 17.1 months (p = 0.01). Non-ischemic cardiomyopathy was associated with increased risk of PVC recurrence (odds ratio [OR] 14.50 (95% confidence interval [CI] 1.92-109.33, p = 0.01)) and was a significant negative prognostic factor in multivariate analysis for PVC recurrence survival (hazard ratio [HR] 4.63, 95% CI 1.03-20.74, p = 0.04). CONCLUSIONS The majority of long-term PVC recurrences occur late in follow-up, at locations remote from the targeted PVC source or sources. Such sites may represent ongoing substrate evolution; additional work is required to determine the precise substrate alterations which promote such arrhythmogenic changes.
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13
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Nugraheni AP, Arso IA, Maharani E. Association of Tp-Te/QT Ratio With Ventricular Tachycardia in Patients With Idiopathic Outflow Tract Ventricular Premature Contraction. Cardiol Res 2018; 9:215-223. [PMID: 30116449 PMCID: PMC6089473 DOI: 10.14740/cr735w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 06/15/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Idiopathic outflow tract ventricular premature contraction (VPC) can evolve into ventricular tachycardia (VT) via triggered activity mechanism. Transmural dispersion of repolarization (TDR) might play a role in idiopathic outflow tract VT by inducing phase 2 early afterdepolarization (EAD) and serve as the functional substrate for VT. Tp-Te/QT ratio as an arrhythmogenesis index has been reported to be associated with the incidence of ventricular arrhythmia. This study aims to investigate the association between Tp-Te/QT ratio with VT incidence in idiopathic outflow tract VPC. METHODS Observational research with cross sectional design was conducted. VT episodes were retrospectively tracked from electrocardiogram (ECG), treadmill test (TMT), Holter monitor and electrophysiology study data in Sardjito Hospital of patients with idiopathic outflow tract VPC during September to October 2017. Tp-Te/QT was defined as the time from the peak of T wave to the intersection between the tangent and isoeectric line, divided with QT interval. Tp-Te/QT ratio measurement was performed in leads V4, V5 and V6 by single observer. Tp-Te/QT ratio was categorized into increased (> 0.25) and normal (< 0.25). Chi-square and logistic regression test were performed. RESULTS Out of 46 patients, there were 28 patients who had VT. Increased Tp-Te/QT ratio of lead V4 was found in 11 patients, the increased ratios in leads V5 and V6 were found in 13 patients. The prevalence ratio (PR) of Tp-Te/QT ratio to VT incidence in lead V4 was 2.059 (95% CI: 1.464 - 2.895; P = 0.007), while in leads V5 and V6 was 2.200 (95% CI: 1.514 - 3.197; P = 0.002). Tp-Te/QT ratios in leads V4, V5 and V6 were not significantly different and equally strong in predicting VT events (P < 0.001; 95% CI). Adjustment of confounding factor hypertension with multivariate test gave insignificant results (PR: 1.290; 95% CI: 0.444 - 3.747). CONCLUSIONS Increased Tp-Te/QT ratio in idiopathic outflow tract VPC patients was associated with higher prevalence ratio for VT, although this was affected by hypertension. Leads V4, V5 and V6 were equally strong in predicting VT events.
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Affiliation(s)
- Arina Prihestri Nugraheni
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Gadjah Mada, Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Irsad Andi Arso
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Gadjah Mada, Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Erika Maharani
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Gadjah Mada, Dr. Sardjito General Hospital, Yogyakarta, Indonesia
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Sirichand S, Killu AM, Padmanabhan D, Hodge DO, Chamberlain AM, Brady PA, Kapa S, Noseworthy PA, Packer DL, Munger TM, Gersh BJ, McLeod CJ, Shen WK, Cha YM, Asirvatham SJ, Friedman PA, Mulpuru SK. Incidence of Idiopathic Ventricular Arrhythmias: A Population-Based Study. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.116.004662. [PMID: 28183845 DOI: 10.1161/circep.116.004662] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 12/19/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Ventricular tachycardia and premature ventricular complexes (PVCs) most frequently occur in the context of structural heart disease. However, the burden of idiopathic ventricular arrhythmias (IVA) in the general population is unknown. METHODS AND RESULTS We identified incident cases of IVA between 2005 and 2013 from Olmsted County, Minnesota, using the Rochester Epidemiology Project database. For PVC cohorts, we included those with frequent (defined as ≥100 PVC/24 hours) symptomatic PVCs. We defined IVA-associated cardiomyopathy as a drop in ejection fraction of ≥10% from baseline. Between 2005 and 2013, we identified 614 individuals with incident IVA (229 [37.3%] were male; average age was 52.1±17.2 years). Of these, 177 (28.8%) had idiopathic ventricular tachycardia, 408 (66.5%) had symptomatic PVCs, and 29 (4.7%) had IVA-associated cardiomyopathy. The age- and sex-adjusted incidence rates in 2005 to 2007, 2008 to 2010, and 2011 to 2013 were 44.9 per 100 000 (95% confidence interval [CI], 38.0-51.8), 47.6 per 100 000 (95% CI, 40.8-54.5), and 62.0 per 100 000 (95% CI, 54.4-69.6), respectively. In idiopathic ventricular tachycardia, there was an increase in incidence rate with ages (P<0.001) but not between sexes (P=0.12). The age-adjusted incidence of symptomatic PVC was higher in females than in males (46.2 per 100 000 [95% CI, 40.9-51.6] versus 20.5 per 100 000 [95% CI, 16.8-24.3]; P<0.001). The small number of individuals with IVA-associated cardiomyopathy precluded any formal testing. CONCLUSIONS The incidence of IVA is increasing. Furthermore, overall incidence increases with age. Although the rate of idiopathic ventricular tachycardia is similar across sexes, women have a higher incidence of symptomatic PVC.
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Affiliation(s)
- Surksha Sirichand
- From the Departments of Cardiovascular Diseases (S.S., A.M.K., D.P., P.A.B., S.K., P.A.N., D.L.P., T.M.M., B.J.G., C.J.M., W.-K.S., Y.-M.C., S.J.A., P.A.F., S.K.M.), Health Sciences Research (A.M.C.), and Pediatric and Adolescent Cardiology (S.J.A.), Mayo Clinic, Rochester, MN; and Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL (D.O.H.)
| | - Ammar M Killu
- From the Departments of Cardiovascular Diseases (S.S., A.M.K., D.P., P.A.B., S.K., P.A.N., D.L.P., T.M.M., B.J.G., C.J.M., W.-K.S., Y.-M.C., S.J.A., P.A.F., S.K.M.), Health Sciences Research (A.M.C.), and Pediatric and Adolescent Cardiology (S.J.A.), Mayo Clinic, Rochester, MN; and Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL (D.O.H.)
| | - Deepak Padmanabhan
- From the Departments of Cardiovascular Diseases (S.S., A.M.K., D.P., P.A.B., S.K., P.A.N., D.L.P., T.M.M., B.J.G., C.J.M., W.-K.S., Y.-M.C., S.J.A., P.A.F., S.K.M.), Health Sciences Research (A.M.C.), and Pediatric and Adolescent Cardiology (S.J.A.), Mayo Clinic, Rochester, MN; and Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL (D.O.H.)
| | - David O Hodge
- From the Departments of Cardiovascular Diseases (S.S., A.M.K., D.P., P.A.B., S.K., P.A.N., D.L.P., T.M.M., B.J.G., C.J.M., W.-K.S., Y.-M.C., S.J.A., P.A.F., S.K.M.), Health Sciences Research (A.M.C.), and Pediatric and Adolescent Cardiology (S.J.A.), Mayo Clinic, Rochester, MN; and Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL (D.O.H.)
| | - Alanna M Chamberlain
- From the Departments of Cardiovascular Diseases (S.S., A.M.K., D.P., P.A.B., S.K., P.A.N., D.L.P., T.M.M., B.J.G., C.J.M., W.-K.S., Y.-M.C., S.J.A., P.A.F., S.K.M.), Health Sciences Research (A.M.C.), and Pediatric and Adolescent Cardiology (S.J.A.), Mayo Clinic, Rochester, MN; and Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL (D.O.H.)
| | - Peter A Brady
- From the Departments of Cardiovascular Diseases (S.S., A.M.K., D.P., P.A.B., S.K., P.A.N., D.L.P., T.M.M., B.J.G., C.J.M., W.-K.S., Y.-M.C., S.J.A., P.A.F., S.K.M.), Health Sciences Research (A.M.C.), and Pediatric and Adolescent Cardiology (S.J.A.), Mayo Clinic, Rochester, MN; and Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL (D.O.H.)
| | - Suraj Kapa
- From the Departments of Cardiovascular Diseases (S.S., A.M.K., D.P., P.A.B., S.K., P.A.N., D.L.P., T.M.M., B.J.G., C.J.M., W.-K.S., Y.-M.C., S.J.A., P.A.F., S.K.M.), Health Sciences Research (A.M.C.), and Pediatric and Adolescent Cardiology (S.J.A.), Mayo Clinic, Rochester, MN; and Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL (D.O.H.)
| | - Peter A Noseworthy
- From the Departments of Cardiovascular Diseases (S.S., A.M.K., D.P., P.A.B., S.K., P.A.N., D.L.P., T.M.M., B.J.G., C.J.M., W.-K.S., Y.-M.C., S.J.A., P.A.F., S.K.M.), Health Sciences Research (A.M.C.), and Pediatric and Adolescent Cardiology (S.J.A.), Mayo Clinic, Rochester, MN; and Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL (D.O.H.)
| | - Douglas L Packer
- From the Departments of Cardiovascular Diseases (S.S., A.M.K., D.P., P.A.B., S.K., P.A.N., D.L.P., T.M.M., B.J.G., C.J.M., W.-K.S., Y.-M.C., S.J.A., P.A.F., S.K.M.), Health Sciences Research (A.M.C.), and Pediatric and Adolescent Cardiology (S.J.A.), Mayo Clinic, Rochester, MN; and Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL (D.O.H.)
| | - Thomas M Munger
- From the Departments of Cardiovascular Diseases (S.S., A.M.K., D.P., P.A.B., S.K., P.A.N., D.L.P., T.M.M., B.J.G., C.J.M., W.-K.S., Y.-M.C., S.J.A., P.A.F., S.K.M.), Health Sciences Research (A.M.C.), and Pediatric and Adolescent Cardiology (S.J.A.), Mayo Clinic, Rochester, MN; and Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL (D.O.H.)
| | - Bernard J Gersh
- From the Departments of Cardiovascular Diseases (S.S., A.M.K., D.P., P.A.B., S.K., P.A.N., D.L.P., T.M.M., B.J.G., C.J.M., W.-K.S., Y.-M.C., S.J.A., P.A.F., S.K.M.), Health Sciences Research (A.M.C.), and Pediatric and Adolescent Cardiology (S.J.A.), Mayo Clinic, Rochester, MN; and Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL (D.O.H.)
| | - Christopher J McLeod
- From the Departments of Cardiovascular Diseases (S.S., A.M.K., D.P., P.A.B., S.K., P.A.N., D.L.P., T.M.M., B.J.G., C.J.M., W.-K.S., Y.-M.C., S.J.A., P.A.F., S.K.M.), Health Sciences Research (A.M.C.), and Pediatric and Adolescent Cardiology (S.J.A.), Mayo Clinic, Rochester, MN; and Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL (D.O.H.)
| | - Win-Kuang Shen
- From the Departments of Cardiovascular Diseases (S.S., A.M.K., D.P., P.A.B., S.K., P.A.N., D.L.P., T.M.M., B.J.G., C.J.M., W.-K.S., Y.-M.C., S.J.A., P.A.F., S.K.M.), Health Sciences Research (A.M.C.), and Pediatric and Adolescent Cardiology (S.J.A.), Mayo Clinic, Rochester, MN; and Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL (D.O.H.)
| | - Yong-Mei Cha
- From the Departments of Cardiovascular Diseases (S.S., A.M.K., D.P., P.A.B., S.K., P.A.N., D.L.P., T.M.M., B.J.G., C.J.M., W.-K.S., Y.-M.C., S.J.A., P.A.F., S.K.M.), Health Sciences Research (A.M.C.), and Pediatric and Adolescent Cardiology (S.J.A.), Mayo Clinic, Rochester, MN; and Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL (D.O.H.)
| | - Samuel J Asirvatham
- From the Departments of Cardiovascular Diseases (S.S., A.M.K., D.P., P.A.B., S.K., P.A.N., D.L.P., T.M.M., B.J.G., C.J.M., W.-K.S., Y.-M.C., S.J.A., P.A.F., S.K.M.), Health Sciences Research (A.M.C.), and Pediatric and Adolescent Cardiology (S.J.A.), Mayo Clinic, Rochester, MN; and Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL (D.O.H.)
| | - Paul A Friedman
- From the Departments of Cardiovascular Diseases (S.S., A.M.K., D.P., P.A.B., S.K., P.A.N., D.L.P., T.M.M., B.J.G., C.J.M., W.-K.S., Y.-M.C., S.J.A., P.A.F., S.K.M.), Health Sciences Research (A.M.C.), and Pediatric and Adolescent Cardiology (S.J.A.), Mayo Clinic, Rochester, MN; and Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL (D.O.H.)
| | - Siva K Mulpuru
- From the Departments of Cardiovascular Diseases (S.S., A.M.K., D.P., P.A.B., S.K., P.A.N., D.L.P., T.M.M., B.J.G., C.J.M., W.-K.S., Y.-M.C., S.J.A., P.A.F., S.K.M.), Health Sciences Research (A.M.C.), and Pediatric and Adolescent Cardiology (S.J.A.), Mayo Clinic, Rochester, MN; and Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL (D.O.H.).
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Conventional mapping and ablation of focal ventricular tachycardias in the healthy heart. Herzschrittmacherther Elektrophysiol 2017; 28:187-192. [PMID: 28484842 DOI: 10.1007/s00399-017-0505-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 04/12/2017] [Indexed: 10/19/2022]
Abstract
Ventricular tachycardias (VT) in the healthy heart, also known as idiopathic VTs, often have a focal origin. Triggered activity due to delayed after-depolarization is the most likely mechanism of focal VTs. Localization of the site of origin of focal VTs is based on activation mapping with or without combination with pace mapping. The characteristic anatomic site of origin of idiopathic VTs is the right and left outflow tract. Other sites include the tricuspid and mitral annulus, the papillary muscles, and Purkinje fibers. Catheter ablation is indicated for monomorphic symptomatic VT and can be an alternative to antiarrhythmic drugs. Success rates are high, but mapping and ablation can be challenging. We review the main electrophysiological findings and the important clues for ablation of focal VTs. Specific considerations for each location are considered.
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16
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Deng Y, Naeini PS, Razavi M, Collard CD, Tolpin DA, Anton JM. Anesthetic Management in Radiofrequency Catheter Ablation of Ventricular Tachycardia. Tex Heart Inst J 2016; 43:496-502. [PMID: 28100967 DOI: 10.14503/thij-15-5688] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Radiofrequency catheter ablation is increasingly being used to treat patients who have ventricular tachycardia, and anesthesiologists frequently manage their perioperative care. This narrative review is intended to familiarize anesthesiologists with preprocedural, intraprocedural, and postprocedural implications of this ablation. Ventricular tachycardia typically arises from structural heart disease, most often from scar tissue after myocardial infarction. Many patients thus affected will benefit from radiofrequency catheter ablation in the electrophysiology laboratory to ablate the foci of arrhythmogenesis. The pathophysiology of ventricular tachycardia is complex, as are the technical aspects of mapping and ablating these arrhythmias. Patients often have substantial comorbidities and tenuous hemodynamic status, necessitating pharmacologic and mechanical cardiopulmonary support. General anesthesia and monitored anesthesia care, when used for sedation during ablation, can lead to drug interactions and side effects in the presence of ventricular tachycardia, so anesthesiologists should also be aware of potential perioperative complications. We discuss variables that can help anesthesiologists safely guide patients through the challenges of radiofrequency catheter ablation of ventricular tachycardia.
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Tovia-Brodie O, Belhassen B, Glick A, Shmilovich H, Aviram G, Rosso R, Michowitz Y. Use of New Imaging CARTO® Segmentation Module Software to Facilitate Ablation of Ventricular Arrhythmias. J Cardiovasc Electrophysiol 2016; 28:240-248. [PMID: 27763695 DOI: 10.1111/jce.13112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 09/27/2016] [Accepted: 10/10/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION A new imaging software (CARTO® Segmentation Module, Biosense Webster) allows preprocedural 3-D reconstruction of all heart chambers based on cardiac CT. We describe our initial experience with the new module during ablation of ventricular arrhythmias. METHODS AND RESULTS Eighteen consecutive patients with idiopathic ventricular arrhythmias or ischemic ventricular tachycardia (VT) were studied. In the latter group, a combined endocardial and epicardial ablation was performed. Of the 14 patients with idiopathic arrhythmias, 12 were ablated in the outflow tract (OT), 1 in the midseptal left ventricle, and 1 at the left posterior fascicular area; acute successful ablation was achieved in 11 (78.6%) patients. The procedure was discontinued due to close proximity of the arrhythmia origin to the coronary arteries (CA) in 2 patients. Acute successful uncomplicated ablation was achieved in all 4 patients with ischemic VT. During ablation in the coronary cusps commissures, the CARTO® Segmentation Module accurately defined the cusps anatomy. The precise anatomic location provided by the module assisted in successfully ablating when information from activation mapping was not optimal, by ablating at the opposite side of the cusps. In addition, by demonstrating the precise location of the CA, it allowed safe ablation of arrhythmias that originated in close proximity to the CA both in the OT area and the epicardium, eliminating the need for repeat angiography. CONCLUSIONS The CARTO® Segmentation Module is useful for accurate definition of the exact anatomic location of ventricular arrhythmias and for safely ablating them especially in close proximity to the CA.
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Affiliation(s)
- Oholi Tovia-Brodie
- Department of Cardiology, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Bernard Belhassen
- Department of Cardiology, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Aharon Glick
- Department of Cardiology, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Haim Shmilovich
- Department of Cardiology, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Galit Aviram
- Department of Radiology, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Raphael Rosso
- Department of Cardiology, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yoav Michowitz
- Department of Cardiology, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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18
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Saeid AK, Klein GJ, Leong-Sit P. Sustained Ventricular Tachycardia in Apparently Normal Hearts: Medical Therapy Should be the First Step in Management. Card Electrophysiol Clin 2016; 8:631-639. [PMID: 27521096 DOI: 10.1016/j.ccep.2016.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Sustained monomorphic ventricular tachycardia or repetitive premature ventricular complexes can be seen in patients with structurally normal hearts. Among these types of patients, the prognosis is predominantly benign and the treatment mostly focused on elimination of symptoms rather than improving survival or reduction of mortality. This article focuses on the pharmacologic options for management and compares them with invasive options. Based on the current literature, we demonstrate that medical therapies should be used as first-line management and favored over invasive therapies. Understanding the arrhythmia mechanism is critical in choosing the appropriate medication among the wide variety of antiarrhythmic drugs available.
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Landreville JM, Joubert GI, Welisch E, Helleman K, Poonai NP. Atypical Presentation of Right Ventricular Outflow Tract Ventricular Tachycardia. J Emerg Med 2015; 49:432-435. [PMID: 26194529 DOI: 10.1016/j.jemermed.2014.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 03/26/2014] [Accepted: 06/30/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Ventricular tachycardia (VT) in the pediatric population is rare, has a wide differential diagnosis, and can present in numerous ways. In the absence of underlying heart disease, VT is considered idiopathic and is associated with an excellent prognosis. Right ventricular outflow tract ventricular tachycardia (RVOT-VT) represents the most common form of idiopathic VT. The differential diagnosis, mechanism, presentation, management, and prognosis of RVOT-VT in the pediatric population will be discussed. CASE REPORT We report a case of RVOT-VT that was incidentally discovered in an 11-year-old girl during an emergency department workup for severe headache. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: It is essential for emergency physicians to have an approach to pediatric VT and appreciate the wide range of potential presentations. Differentiating idiopathic VT, such as RVOT-VT, from more malignant forms of VT can be challenging and requires expert consultation for further diagnostic workup and management.
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Affiliation(s)
- Jeffrey M Landreville
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Gary I Joubert
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Pediatrics, Western University, London, Ontario, Canada; Division of Emergency Medicine, Western University, London, Ontario, Canada
| | - Eva Welisch
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Pediatrics, Western University, London, Ontario, Canada
| | - Krista Helleman
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Pediatrics, Western University, London, Ontario, Canada; Division of Emergency Medicine, Western University, London, Ontario, Canada
| | - Naveen P Poonai
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Pediatrics, Western University, London, Ontario, Canada; Division of Emergency Medicine, Western University, London, Ontario, Canada
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Scanavacca M, Lara S, Hardy C, Pisani CF. How To Identify & Treat Epicardial Origin Of Outflow Tract Tachycardias. J Atr Fibrillation 2015; 7:1195. [PMID: 27957159 DOI: 10.4022/jafib.1195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 02/13/2015] [Accepted: 03/15/2015] [Indexed: 11/10/2022]
Abstract
The right ventricle outflow tract (RVOT) is the most common site of origin of idiopathic ventricular arrhythmias. The typical outflow tract arrhythmias pattern on ECG is an inferior axis deviation and left bundle branch block when originated on the RVOT and right bundle branch block morphology when originated on the left ventricular outflow tract (LVOT). There are several ECG tricks for different locations of origin. An increased Maximum Deflection Index (MDI) suggests epicardial origin of arrhythmia. In general the result of ablation is very good, but sometimes there are difficult and unsuccessful procedures. The origin in the aortic cusps and epicardium are the reason for failure in some cases. When they are epicardial, the arrhythmias can be accessed by the venous system or by subxiphoid epicardial mapping.
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Affiliation(s)
- Mauricio Scanavacca
- Arrhythmia Clinical Unit - Heart Institute - University of São Paulo Medical School
| | - Sissy Lara
- Arrhythmia Clinical Unit - Heart Institute - University of São Paulo Medical School
| | - Carina Hardy
- Arrhythmia Clinical Unit - Heart Institute - University of São Paulo Medical School
| | - Cristiano F Pisani
- Arrhythmia Clinical Unit - Heart Institute - University of São Paulo Medical School
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Abstract
Sudden cardiac death in the young is a relatively uncommon but marked event usually related to congenital diseases or anomalies. Despite the prevalence of each condition being variable, most common causes include primary myocardial diseases and arrhythmic disorder, frequently with inheritance pattern. Sudden cardiac death is usually preceded by symptoms, thus making personal and family history fundamental for its prevention. Nevertheless, in more than 50% of cases, sudden cardiac death is the first manifestation of the disease. In this review, we describe the different causes of sudden cardiac death, their incidence, and currently used preventive strategies.
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Pedersen CT, Kay GN, Kalman J, Borggrefe M, Della-Bella P, Dickfeld T, Dorian P, Huikuri H, Kim YH, Knight B, Marchlinski F, Ross D, Sacher F, Sapp J, Shivkumar K, Soejima K, Tada H, Alexander ME, Triedman JK, Yamada T, Kirchhof P, Lip GY, Kuck KH, Mont L, Haines D, Indik J, Dimarco J, Exner D, Iesaka Y, Savelieva I. EHRA/HRS/APHRS expert consensus on ventricular arrhythmias. J Arrhythm 2014. [DOI: 10.1016/j.joa.2014.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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Pedersen CT, Kay GN, Kalman J, Borggrefe M, Della-Bella P, Dickfeld T, Dorian P, Huikuri H, Kim YH, Knight B, Marchlinski F, Ross D, Sacher F, Sapp J, Shivkumar K, Soejima K, Tada H, Alexander ME, Triedman JK, Yamada T, Kirchhof P, Lip GYH, Kuck KH, Mont L, Haines D, Indik J, Dimarco J, Exner D, Iesaka Y, Savelieva I. EHRA/HRS/APHRS expert consensus on ventricular arrhythmias. Europace 2014; 16:1257-83. [PMID: 25172618 DOI: 10.1093/europace/euu194] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Safety of radiofrequency catheter ablation without coronary angiography in aortic cusp ventricular arrhythmias. Heart Rhythm 2014; 11:1117-21. [DOI: 10.1016/j.hrthm.2014.04.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Indexed: 11/19/2022]
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Sex Differences in Cardiac Electrophysiology and Clinical Arrhythmias: Epidemiology, Therapeutics, and Mechanisms. Can J Cardiol 2014; 30:783-92. [DOI: 10.1016/j.cjca.2014.03.032] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 03/23/2014] [Indexed: 11/30/2022] Open
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