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Roukoz H, Tholakanahalli V. Epicardial ablation of ventricular tachycardia in ischemic cardiomyopathy: A review and local experience. Indian Pacing Electrophysiol J 2024; 24:84-93. [PMID: 38340957 PMCID: PMC11010455 DOI: 10.1016/j.ipej.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 10/29/2023] [Accepted: 02/07/2024] [Indexed: 02/12/2024] Open
Abstract
Myocardial scar in ischemic cardiomyopathy is predominantly endocardial, however, between 5% and 15% of these patients have an arrhythmogenic epicardial substrate. Percutaneous epicardial ablation should be considered in patients with ICM and VT especially if they failed an endocardial ablation. Simultaneous epicardial and endocardial ablation of VT in ICM may reduce short- and medium-term VT recurrence compared with an endocardial only approach. Cardiac imaging could be used to help guide patient selection for a combined epi-endo approach. Complications related to epicardial access can happen in up to 7% of patients. Epicardial ablation in these patients should be referred to experienced tertiary centers. We review the literature and share interesting cases.
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Deshmukh T, Kovoor JG, Byth K, Chow CK, Zaman S, Chong JJH, Figtree GA, Thiagalingam A, Kovoor P. Influence of standard modifiable risk factors on ventricular tachycardia after myocardial infarction. Front Cardiovasc Med 2023; 10:1283382. [PMID: 37942068 PMCID: PMC10628449 DOI: 10.3389/fcvm.2023.1283382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/27/2023] [Indexed: 11/10/2023] Open
Abstract
Background Inducible ventricular tachycardia (VT) at electrophysiology study (EPS) predicts sudden cardiac death because of ventricular tachyarrhythmia, the single greatest cause of death within 2 years after myocardial infarction (MI). Objectives We aimed to assess the association between standard modifiable risk factors (SMuRFs) and inducible VT at EPS early after MI. Methods Consecutive patients with left ventricle ejection fraction ≤40% on days 3-5 after ST elevation MI (STEMI) who underwent EPS were prospectively recruited. Positive EPS was defined as induced sustained monomorphic VT cycle length ≥200 ms for ≥10 s or shorter if hemodynamically compromised. The primary outcome was inducibility of VT at EPS, and the secondary outcome was all-cause mortality on follow-up. Results In 410 eligible patients undergoing EPS soon (median of 9 days) after STEMI, 126 had inducible VT. Ex-smokers experienced an increased risk of inducible VT [multivariable logistic regression adjusted odds ratio (OR) 2.0, p = 0.033] compared with current or never-smokers, with comparable risk. The presence of any SMuRFs apart from being a current smoker conferred an increased risk of inducible VT (adjusted OR 1.9, p = 0.043). Neither the number of SMuRFs nor the presence of any SMuRFs was associated with mortality at a median follow-up of 5.4 years. Conclusions In patients with recent STEMI and impaired left ventricular function, the presence of any SMuRFs, apart from being a current smoker, conferred an increased risk of inducible VT at EPS. These results highlight the need to modify SMuRFs in this high-risk subset of patients.
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Affiliation(s)
- Tejas Deshmukh
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
- Centre for Heart Research, Westmead Institute for Medical Research, University of Sydney, Westmead, Sydney, NSW, Australia
| | - Joshua G. Kovoor
- University of Adelaide, The Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - Karen Byth
- Research and Education Network, Western Sydney Local Health District, Westmead Hospital, Sydney, NSW, Australia
| | - Clara K. Chow
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
- Research and Education Network, Western Sydney Local Health District, Westmead Hospital, Sydney, NSW, Australia
| | - Sarah Zaman
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
- Research and Education Network, Western Sydney Local Health District, Westmead Hospital, Sydney, NSW, Australia
| | - James J. H. Chong
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
- Centre for Heart Research, Westmead Institute for Medical Research, University of Sydney, Westmead, Sydney, NSW, Australia
| | - Gemma A. Figtree
- Kolling Institute, Royal North Shore Hospital, Sydney, NSW, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Aravinda Thiagalingam
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
- Research and Education Network, Western Sydney Local Health District, Westmead Hospital, Sydney, NSW, Australia
| | - Pramesh Kovoor
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
- Research and Education Network, Western Sydney Local Health District, Westmead Hospital, Sydney, NSW, Australia
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Rao K, Danaila V, Bennett RG, Turnbull S, Campbell T, Kumar S. Correlation of exit sites of inducible ventricular tachycardia post-ST elevation myocardial infarction on electrophysiology study, with region of infarct. Intern Med J 2023; 53:1570-1580. [PMID: 36053941 DOI: 10.1111/imj.15891] [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: 03/30/2022] [Accepted: 07/18/2022] [Indexed: 09/26/2023]
Abstract
BACKGROUND Ventricular arrhythmia (VA) is the most common cause of sudden cardiac death post-ST elevation myocardial infarction (STEMI). Ventricular tachycardia (VT) may be inducible in electrophysiology studies (EPS) early (<40 days) post-STEMI. Whether it originates from the infarct site remains unknown. We examined the correlation between inducible VT and infarct location post-STEMI. AIMS To investigate the correlation between inducible VT and infarct location post-STEMI. METHODS We retrospectively analysed 46 patients from 2005 to 2017 with STEMI who underwent early programmed ventricular stimulation through EPS (>48 h post-STEMI and <40 days from admission). Gated heart pool scans were used to visualise infarct scar regions, and VT exit sites were derived from induction 12-lead electrocardiography. Patients were followed up for primary outcomes of recurrent VA and all-cause mortality. RESULTS Forty-six patients were included for analysis, with 50 uniquely induced VT exit sites. Mean left ventricular ejection fraction was 30 ± 8.7% and 22% had impaired right ventricular ejection fraction. Mean time from presentation to EPS was 16 ± 31.3 days. Of the induced VT, 44 (88%) were from within scar and scar-border regions, whereas 6 (12%) of the induced VT were found to be remote to imaging-derived scar. Over a median follow-up period of 75 months, 6 (13%) patients died, and 7 (15%) patients had recurrent VA. No deaths occurred in patients with remote VT. CONCLUSION The majority of early inducible post-infarct VT arises from acute myocardial scar; however, a small portion arises from sites remote from scars with a possible focal aetiology.
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Affiliation(s)
- Karan Rao
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
- Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Vlad Danaila
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Richard G Bennett
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
- Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Samual Turnbull
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
- Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Timothy Campbell
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
- Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
- Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
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Kovoor JG, Deshmukh T, von Huben A, Marschner SL, Byth K, Chow CK, Zaman S, Chong JJH, Thiagalingam A, Kovoor P. Optimizing electrophysiology studies to prevent sudden cardiac death after myocardial infarction. Europace 2023; 25:euad219. [PMID: 37470454 PMCID: PMC10374980 DOI: 10.1093/europace/euad219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/06/2023] [Accepted: 07/03/2023] [Indexed: 07/21/2023] Open
Abstract
AIMS This study assessed associations of minimum final extrastimulus coupling interval utilized within electrophysiology study (EPS) after myocardial infarction (MI) and possible site of origin of induced ventricular tachycardia (VT) with long-term occurrence of spontaneous ventricular tachyarrhythmia and long-term survival. METHODS AND RESULTS This prospective study recruited consecutive patients with left ventricular ejection fraction (LVEF) ≤ 40% who underwent EPS days 3-5 after MI between 2004 and 2017. Positive EPS was defined as sustained monomorphic VT cycle length ≥200 ms for ≥10 s or shorter duration if haemodynamic compromise occurred. Each of the four extrastimuli was shortened by 10 ms at a time, until it failed to capture the ventricle (ventricular refractoriness) or induced ventricular tachyarrhythmia. Outcomes included spontaneous ventricular tachyarrhythmia occurrence and all-cause mortality. Shorter coupling interval length of final extrastimulus that induced VT was associated with higher risk of spontaneous ventricular tachyarrhythmia (P < 0.001). Significantly higher rates of spontaneous ventricular tachyarrhythmia (65.2% vs. 23.2%; P < 0.001) were observed for final coupling interval at EPS <200 ms vs. >200 ms. Right bundle branch block (RBBB) morphology of induced VT, with possible site of origin from the left ventricle, was associated with all-cause mortality [hazard ratio (HR) 3.2, P = 0.044] and a composite of spontaneous ventricular tachyarrhythmia recurrence or mortality (HR 1.8, P = 0.043). CONCLUSION Ventricular tachycardia induced with shorter coupling intervals was associated with higher risk of spontaneous ventricular tachyarrhythymia on follow-up, indicating that the final extrastimulus coupling interval at EPS early after MI should be determined by ventricular refractoriness. Induced VT with possible origin from left ventricle was associated with increased risk of spontaneous ventricular tachyarrhythmia recurrence or death.
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MESH Headings
- Humans
- Stroke Volume/physiology
- Ventricular Function, Left
- Prospective Studies
- Defibrillators, Implantable/adverse effects
- Myocardial Infarction/complications
- Myocardial Infarction/diagnosis
- Cardiac Electrophysiology
- Tachycardia, Ventricular/diagnosis
- Tachycardia, Ventricular/etiology
- Tachycardia, Ventricular/prevention & control
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Death, Sudden, Cardiac/epidemiology
- Follow-Up Studies
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Affiliation(s)
- Joshua G Kovoor
- University of Adelaide, North Terrace, Adelaide, South Australia, 5005, Australia
- Queen Elizabeth Hospital, 28 Woodville Road, Adelaide, South Australia, 5011, Australia
| | - Tejas Deshmukh
- Centre for Heart Research, The Westmead Institute for Medical Research, The University of Sydney, 176 Hawkesbury Road, Westmead, Sydney, NSW, 2145, Australia
- Department of Cardiology, Westmead Hospital, Corner Darcy and Hawkesbury Roads, Sydney, New South Wales 2145Australia
| | - Amy von Huben
- Centre for Heart Research, The Westmead Institute for Medical Research, The University of Sydney, 176 Hawkesbury Road, Westmead, Sydney, NSW, 2145, Australia
- Department of Cardiology, Westmead Hospital, Corner Darcy and Hawkesbury Roads, Sydney, New South Wales 2145Australia
| | - Simone L Marschner
- Centre for Heart Research, The Westmead Institute for Medical Research, The University of Sydney, 176 Hawkesbury Road, Westmead, Sydney, NSW, 2145, Australia
- Department of Cardiology, Westmead Hospital, Corner Darcy and Hawkesbury Roads, Sydney, New South Wales 2145Australia
| | - Karen Byth
- Centre for Heart Research, The Westmead Institute for Medical Research, The University of Sydney, 176 Hawkesbury Road, Westmead, Sydney, NSW, 2145, Australia
- Department of Cardiology, Westmead Hospital, Corner Darcy and Hawkesbury Roads, Sydney, New South Wales 2145Australia
| | - Clara K Chow
- Centre for Heart Research, The Westmead Institute for Medical Research, The University of Sydney, 176 Hawkesbury Road, Westmead, Sydney, NSW, 2145, Australia
- Department of Cardiology, Westmead Hospital, Corner Darcy and Hawkesbury Roads, Sydney, New South Wales 2145Australia
| | - Sarah Zaman
- Centre for Heart Research, The Westmead Institute for Medical Research, The University of Sydney, 176 Hawkesbury Road, Westmead, Sydney, NSW, 2145, Australia
- Department of Cardiology, Westmead Hospital, Corner Darcy and Hawkesbury Roads, Sydney, New South Wales 2145Australia
| | - James J H Chong
- Centre for Heart Research, The Westmead Institute for Medical Research, The University of Sydney, 176 Hawkesbury Road, Westmead, Sydney, NSW, 2145, Australia
- Department of Cardiology, Westmead Hospital, Corner Darcy and Hawkesbury Roads, Sydney, New South Wales 2145Australia
| | - Aravinda Thiagalingam
- Centre for Heart Research, The Westmead Institute for Medical Research, The University of Sydney, 176 Hawkesbury Road, Westmead, Sydney, NSW, 2145, Australia
- Department of Cardiology, Westmead Hospital, Corner Darcy and Hawkesbury Roads, Sydney, New South Wales 2145Australia
| | - Pramesh Kovoor
- Centre for Heart Research, The Westmead Institute for Medical Research, The University of Sydney, 176 Hawkesbury Road, Westmead, Sydney, NSW, 2145, Australia
- Department of Cardiology, Westmead Hospital, Corner Darcy and Hawkesbury Roads, Sydney, New South Wales 2145Australia
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Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, Hirsch KG, Kudenchuk PJ, Kurz MC, Lavonas EJ, Morley PT, O’Neil BJ, Peberdy MA, Rittenberger JC, Rodriguez AJ, Sawyer KN, Berg KM, Arafeh J, Benoit JL, Chase M, Fernandez A, de Paiva EF, Fischberg BL, Flores GE, Fromm P, Gazmuri R, Gibson BC, Hoadley T, Hsu CH, Issa M, Kessler A, Link MS, Magid DJ, Marrill K, Nicholson T, Ornato JP, Pacheco G, Parr M, Pawar R, Jaxton J, Perman SM, Pribble J, Robinett D, Rolston D, Sasson C, Satyapriya SV, Sharkey T, Soar J, Torman D, Von Schweinitz B, Uzendu A, Zelop CM, Magid DJ. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2020; 142:S366-S468. [DOI: 10.1161/cir.0000000000000916] [Citation(s) in RCA: 371] [Impact Index Per Article: 92.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Deshmukh T, Zaman S, Narayan A, Kovoor P. Duration of Inducible Ventricular Tachycardia Early After ST-Segment-Elevation Myocardial Infarction and Its Impact on Mortality and Ventricular Tachycardia Recurrence. J Am Heart Assoc 2020; 9:e015204. [PMID: 32573328 PMCID: PMC7670508 DOI: 10.1161/jaha.119.015204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background The clinical significance of the duration of inducible ventricular tachycardia (VT) at electrophysiology study (EPS) in patients soon after ST‐segment–elevation myocardial infarction and its predictive utility for VT recurrence are not known. Methods and Results Consecutive ST‐segment–elevation myocardial infarction patients with day 3 to 5 left ventricular ejection fraction ≤40% underwent EPS. A positive EPS was defined as sustained monomorphic VT with cycle length ≥200 ms. The induced VT was terminated by overdrive pacing or direct current shock at 30 s or earlier if hemodynamic decompensation occurred. Patients with inducible VT duration 2 to 10 s were compared with patients with inducible VT >10 s. The primary end point was survival free of VT or cardiac mortality. From 384 consecutive ST‐segment–elevation myocardial infarction patients who underwent EPS, 29% had inducible VT (n=112, 87% men). After mean follow‐up of 5.9±3.9 years, primary end point occurred in 35% of patients with induced VT 2 to 10 s duration (n=68) and in 22% of patients with induced VT >10 s (n=41) (P=0.61). This was significantly different from the noninducible VT group, in which primary end point occurred in 3% of patients (n=272) (P=0.001). Conclusions This study is the first to show that in patients who undergo EPS early after myocardial infarction, inducible VT of short duration (2–10 s) has similar predictive utility for ventricular tachyarrhythmia as longer duration (>10 s) inducible VT, which was significantly different to those without inducible VT. It is possible that immediate cardioversion of rapid VT might have contributed to some of the short durations of inducible VT.
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Affiliation(s)
- Tejas Deshmukh
- Department of Cardiology Westmead Hospital Sydney Australia.,University of Sydney Australia
| | - Sarah Zaman
- Monash University Melbourne Australia.,Monash Cardiovascular Research Centre Monash Heart Melbourne Australia
| | - Arun Narayan
- Department of Cardiology Westmead Hospital Sydney Australia
| | - Pramesh Kovoor
- Department of Cardiology Westmead Hospital Sydney Australia.,University of Sydney Australia
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7
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Nelson T, Garg P, Clayton RH, Lee J. The Role of Cardiac MRI in the Management of Ventricular Arrhythmias in Ischaemic and Non-ischaemic Dilated Cardiomyopathy. Arrhythm Electrophysiol Rev 2019; 8:191-201. [PMID: 31463057 PMCID: PMC6702467 DOI: 10.15420/aer.2019.5.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 04/25/2019] [Indexed: 02/07/2023] Open
Abstract
Ventricular tachycardia (VT) and VF account for the majority of sudden cardiac deaths worldwide. Treatments for VT/VF include anti-arrhythmic drugs, ICDs and catheter ablation, but these treatments vary in effectiveness and carry substantial risks and/or expense. Current methods of selecting patients for ICD implantation are imprecise and fail to identify some at-risk patients, while leading to others being overtreated. In this article, the authors discuss the current role and future direction of cardiac MRI (CMRI) in refining diagnosis and personalising ventricular arrhythmia management. The capability of CMRI with gadolinium contrast delayed-enhancement patterns and, more recently, T1 mapping to determine the aetiology of patients presenting with heart failure is well established. Although CMRI imaging in patients with ICDs can be challenging, recent technical developments have started to overcome this. CMRI can contribute to risk stratification, with precise and reproducible assessment of ejection fraction, quantification of scar and 'border zone' volumes, and other indices. Detailed tissue characterisation has begun to enable creation of personalised computer models to predict an individual patient's arrhythmia risk. When patients require VT ablation, a substrate-based approach is frequently employed as haemodynamic instability may limit electrophysiological activation mapping. Beyond accurate localisation of substrate, CMRI could be used to predict the location of re-entrant circuits within the scar to guide ablation.
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Affiliation(s)
- Tom Nelson
- Sheffield Teaching Hospitals NHS Foundation TrustSheffield, UK
- Department of Immunity, Infection and Cardiovascular Disease, University of SheffieldSheffield, UK
| | - Pankaj Garg
- Sheffield Teaching Hospitals NHS Foundation TrustSheffield, UK
- Department of Immunity, Infection and Cardiovascular Disease, University of SheffieldSheffield, UK
| | - Richard H Clayton
- INSIGNEO Institute for In-Silico Medicine, University of SheffieldSheffield, UK
- Department of Computer Science, University of SheffieldSheffield, UK
| | - Justin Lee
- Sheffield Teaching Hospitals NHS Foundation TrustSheffield, UK
- Department of Immunity, Infection and Cardiovascular Disease, University of SheffieldSheffield, UK
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Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kastrati A, Lenzen MJ, Prescott E, Roffi M, Valgimigli M, Varenhorst C, Vranckx P, Widimský P. [2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation.]. Eur Heart J 2018; 39:119-177. [PMID: 29457615 DOI: 10.1093/eurheartj/ehx393] [Citation(s) in RCA: 6074] [Impact Index Per Article: 1012.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Borja Ibanez
- Department of Cardiology, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain.
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9
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Gorenek B, Blomström Lundqvist C, Brugada Terradellas J, Camm AJ, Hindricks G, Huber K, Kirchhof P, Kuck KH, Kudaiberdieva G, Lin T, Raviele A, Santini M, Tilz RR, Valgimigli M, Vos MA, Vrints C, Zeymer U, Kristiansen SB. Cardiac arrhythmias in acute coronary syndromes: position paper from the joint EHRA, ACCA, and EAPCI task force. EUROINTERVENTION 2015; 10:1095-108. [PMID: 25169596 DOI: 10.4244/eijy14m08_19] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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10
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Orvin K, Eisen A, Goldenberg I, Gottlieb S, Kornowski R, Matetzky S, Golovchiner G, Kuznietz J, Gavrielov-Yusim N, Segev A, Strasberg B, Haim M. Outcome of contemporary acute coronary syndrome complicated by ventricular tachyarrhythmias. Europace 2015; 18:219-26. [DOI: 10.1093/europace/euv027] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 01/27/2015] [Indexed: 11/14/2022] Open
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Manolis AS. The clinical challenge of preventing sudden cardiac death immediately after acute ST-elevation myocardial infarction. Expert Rev Cardiovasc Ther 2014; 12:1427-37. [PMID: 25382137 DOI: 10.1586/14779072.2014.981159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Unfortunately, of all patients experiencing acute myocardial infarction (MI), usually in the form of ST-elevation MI, 25-35% will die of sudden cardiac death (SCD) before receiving medical attention, most often from ventricular fibrillation. For patients who reach the hospital, prognosis is considerably better and has improved over the years. Reperfusion therapy, best attained with primary percutaneous coronary intervention compared to thrombolysis, has made a big difference in reducing the risk of SCD early and late after ST-elevation MI. In-hospital SCD due to ventricular tachyarrhythmias is manageable, with either preventive measures or drugs or electrical cardioversion. There is general agreement for secondary prevention of SCD post-MI with implantation of a cardioverter defibrillator (ICD) when malignant ventricular arrhythmias occur late (>48 h) after an MI, and are not due to reversible or correctable causes. The major challenge remains that of primary prevention, that is, how to prevent SCD during the first 1-3 months after ST-elevation MI for patients who have low left ventricular ejection fraction and are not candidates for an ICD according to current guidelines, due to the results of two studies, which did not show any benefits of early (<40 days after an MI) ICD implantation. Two recent documents may provide direction as to how to bridge the gap for this early post-MI period. Both recommend an electrophysiology study to guide implantation of an ICD, at least for those developing syncope or non-sustained ventricular tachycardia, who have an inducible sustained ventricular tachycardia at the electrophysiology study. An ICD is also recommended for patients with indication for a permanent pacemaker due to bradyarrhythmias, who also meet primary prevention criteria for SCD.
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12
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Gorenek B, Blomström Lundqvist C, Brugada Terradellas J, Camm AJ, Hindricks G, Huber K, Kirchhof P, Kuck KH, Kudaiberdieva G, Lin T, Raviele A, Santini M, Tilz RR, Valgimigli M, Vos MA, Vrints C, Zeymer U, Kristiansen SB, Lip GY, Potpara T, Fauchier L, Sticherling C, Roffi M, Widimsky P, Mehilli J, Lettino M, Schiele F, Sinnaeve P, Boriani G, Lane D, Savelieva I. Cardiac arrhythmias in acute coronary syndromes: position paper from the joint EHRA, ACCA, and EAPCI task force. Europace 2014; 16:1655-73. [DOI: 10.1093/europace/euu208] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Bulent Gorenek
- Department of Cardiology, Aarhus University Hospital, Denmark
| | | | | | - A. John Camm
- Department of Cardiology, Aarhus University Hospital, Denmark
| | | | - Kurt Huber
- Department of Cardiology, Aarhus University Hospital, Denmark
| | - Paulus Kirchhof
- Department of Cardiology, Aarhus University Hospital, Denmark
| | - Karl-Heinz Kuck
- Department of Cardiology, Aarhus University Hospital, Denmark
| | | | - Tina Lin
- Department of Cardiology, Aarhus University Hospital, Denmark
| | - Antonio Raviele
- Department of Cardiology, Aarhus University Hospital, Denmark
| | - Massimo Santini
- Department of Cardiology, Aarhus University Hospital, Denmark
| | | | | | - Marc A. Vos
- Department of Cardiology, Aarhus University Hospital, Denmark
| | | | - Uwe Zeymer
- Department of Cardiology, Aarhus University Hospital, Denmark
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