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1.
Int Heart J ; 62(1): 135-141, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33518652

RESUMO

Although it is well known that patients with hypertrophic cardiomyopathy (HCM) have serious adverse events, such as life-threatening arrhythmia and heart failure, the prediction of such evens is still difficult. Recently, it has been reported that one of the causes of these serious adverse events is microvascular dysfunction, which can be noninvasively evaluated by employing cardiac magnetic resonance (CMR) imaging.We analyzed 32 consecutive HCM patients via CMR imaging and myocardial scintigraphy and divided them into two groups: ventricular tachycardia (VT) group and non-VT group. Myocardial perfusion studies were conducted quantitatively using the QMass® software, and each slice image was divided into six segments. The time-intensity curve derived from the perfusion image by CMR imaging was evaluated, and the time to 50% of the peak intensity (time 50% max) was automatically calculated for each segment.Although no difference was observed in various parameters of myocardial scintigraphy between the two groups, the VT group exhibited a higher mean of time 50% max and wider standard deviation (SD) of time 50% max in each segment than the non-VT group. The cutoff values were obtained by the receiver operating characteristic curves derived from the mean of time 50% max and SD of time 50% max. The two groups divided by the cutoff values exhibited significant differences in the occurrence of serious adverse events.CMR imaging may be useful for predicting serious adverse events of patients with HCM.


Assuntos
Cardiomiopatia Hipertrófica/diagnóstico por imagem , Imagem por Ressonância Magnética , Imagem de Perfusão do Miocárdio , Taquicardia Ventricular/diagnóstico por imagem , Adulto , Idoso , Cardiomiopatia Hipertrófica/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taquicardia Ventricular/etiologia
2.
BMJ Case Rep ; 14(1)2021 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-33495177

RESUMO

Pheochromocytoma occasionally engenders catecholamine-induced hypertension crisis. Pheochromocytoma is clinically identified in 0.1%-5.7% of patients with neurofibromatosis type 1 (NF1), which is 10 times more frequently than in healthy individuals. This report describes a case of newly diagnosed NF1 presenting with pheochromocytoma crisis, with severe electrolyte depletion and deteriorating recurrent ventricular tachycardia storm. Characteristic skin lesions such as café-au-lait macules and neurofibromas contributed to the diagnosis of NF1 and pheochromocytoma. No recurrence of electrolyte depletion was found after the adrenalectomy. Primary care physicians must distinguish the characteristic skin lesions of NF1, such as café-au-lait macules and neurofibromas and recognise the risk for pheochromocytoma.


Assuntos
Neurofibromatose 1/diagnóstico , Feocromocitoma/diagnóstico , Taquicardia Ventricular/terapia , Desequilíbrio Hidroeletrolítico/terapia , 3-Iodobenzilguanidina , Adrenalectomia , Alcoolismo/complicações , Catecolaminas/urina , Cloretos/sangue , Humanos , Hipopotassemia/etiologia , Hipopotassemia/metabolismo , Hipopotassemia/terapia , Hiponatremia/etiologia , Hiponatremia/metabolismo , Hiponatremia/terapia , Hipofosfatemia/etiologia , Hipofosfatemia/metabolismo , Hipofosfatemia/terapia , Masculino , Metanefrina/urina , Pessoa de Meia-Idade , Feocromocitoma/complicações , Feocromocitoma/metabolismo , Feocromocitoma/cirurgia , Cintilografia , Compostos Radiofarmacêuticos , Taquicardia Ventricular/etiologia , Desequilíbrio Hidroeletrolítico/etiologia , Desequilíbrio Hidroeletrolítico/metabolismo
3.
Praxis (Bern 1994) ; 110(1): 19-21, 2021 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-33406936

RESUMO

CME ECG 67/Answers: Arrhythmia on Exertion Abstract. Ventricular tachycardias are potentially life-threatening cardiac arrhythmias with a heart rate >100 beats/min, originating from the specific conduction system below the His or the ventricular myocardium. The morphology of the surface ECG can provide valid information about the underlying mechanism and the associated cardiac disorder. The according pathomechanism is of paramount importance for further management. This article is intended to provide an insight into the various causes and treatment options as well as the differential diagnosis of ventricular tachycardias.


Assuntos
Esforço Físico , Taquicardia Ventricular , Arritmias Cardíacas/diagnóstico , Eletrocardiografia , Sistema de Condução Cardíaco , Humanos , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiologia
4.
Medicine (Baltimore) ; 100(1): e24225, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429817

RESUMO

RATIONALE: Primary cardiac lymphoma is a rare tumor, especially a tumor located in coronary sinus (CS). The most common symptom of cardiac tumors is dyspnea, accounting for 64%, followed by chest pain, accounting for 26%. However, the cases with paroxysmal supraventricular tachycardia (SVT) as a major clinical presentation are extremely rare. PATIENT CONCERNS: We report a 55-year-old female patient with primary CS lymphoma and paroxysmal SVT. DIAGNOSES: After the surgical resection, pathology revealed the evidence of diffuse large B-cell lymphoma. INTERVENTIONS: The patient underwent chemotherapy after CS tumor resection. OUTCOMES: The patient was disease-free during the 6-month follow-up. LESSONS: CS enlargement may be the cause of SVT. Echocardiography should focus on the CS section to arrive at the right diagnosis.


Assuntos
Seio Coronário , Linfoma de Células B/diagnóstico , Taquicardia Ventricular/diagnóstico , Diagnóstico Diferencial , Ecocardiografia , Feminino , Humanos , Linfoma de Células B/complicações , Linfoma de Células B/diagnóstico por imagem , Pessoa de Meia-Idade , Taquicardia Ventricular/etiologia
5.
Cardiovasc Pathol ; 50: 107267, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32818611

RESUMO

Congenitally corrected transposition of the great arteries (cc-TGA, also known as L-transposition) is a rare condition that represents approximately 0.5% of congenital heart disease. It is characterized by atrioventricular and ventriculoarterial discordance. Patients with cc-TGA are at risk for cardiac arrhythmias due to abnormalities of the conduction system. We present an autopsy case of a 49-year-old man with cc-TGA who died unexpectedly, likely as a result of a fatal arrhythmia. This case illustrates the cardiac pathology characteristic of cc-TGA and describes how to grossly identify inversion of the atrioventricular valves.


Assuntos
Transposição Congênita Corrigida de Grandes Artérias/patologia , Fibrilação Atrial/etiologia , Autopsia , Transposição Congênita Corrigida de Grandes Artérias/complicações , Morte Súbita Cardíaca/etiologia , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Taquicardia Ventricular/etiologia
6.
PLoS One ; 15(12): e0244533, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33370347

RESUMO

Arrhythmias have been reported frequently in COVID-19 patients, but the incidence and nature have not been well characterized. Patients admitted with COVID-19 and monitored by telemetry were prospectively enrolled in the study. Baseline characteristics, hospital course, treatment and complications were collected from the patients' medical records. Telemetry was monitored to detect the incidence of cardiac arrhythmias. The incidence and types of cardiac arrhythmias were analyzed and compared between survivors and non-survivors. Among 143 patients admitted with telemetry monitoring, overall in-hospital mortality was 25.2% (36/143 patients) during the period of observation (mean follow-up 23.7 days). Survivors were less tachycardic on initial presentation (heart rate 90.6 ± 19.6 vs. 99.3 ± 23.1 bpm, p = 0.030) and had lower troponin (peak troponin 0.03 vs. 0.18 ng/ml. p = 0.004), C-reactive protein (peak C-reactive protein 97 vs. 181 mg/dl, p = 0.029), and interleukin-6 levels (peak interleukin-6 30 vs. 246 pg/ml, p = 0.003). Sinus tachycardia, the most common arrhythmia (detected in 39.9% [57/143] of patients), occurred more frequently in non-survivors (58.3% vs. 33.6% in survivors, p = 0.009). Premature ventricular complexes occurred in 28.7% (41/143), and non-sustained ventricular tachycardia in 15.4% (22/143) of patients, with no difference between survivors and non-survivors. Sustained ventricular tachycardia and ventricular fibrillation were not frequent (seen only in 1.4% and 0.7% of patients, respectively). Contrary to reports from other regions, overall mortality was higher and ventricular arrhythmias were infrequent in this hospitalized and monitored COVID-19 population. Either disease or management-related factors could explain this divergence of clinical outcomes, and should be urgently investigated.


Assuntos
Arritmias Cardíacas/etiologia , /complicações , Idoso , Arritmias Cardíacas/mortalidade , Eletrocardiografia/mortalidade , Feminino , Frequência Cardíaca/fisiologia , Mortalidade Hospitalar , Hospitalização , Humanos , Incidência , Masculino , Monitorização Fisiológica , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/mortalidade , Telemetria/mortalidade , Estados Unidos , Fibrilação Ventricular/etiologia , Fibrilação Ventricular/mortalidade
7.
Acta Med Indones ; 52(3): 290-296, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33020340

RESUMO

Since the first case was reported at the end of 2019, COVID-19 has spread throughout the world and has become a pandemic. The high transmission rate of the virus has made it a threat to public health globally. Viral infections may trigger acute coronary syndromes, arrhythmias, and exacerbation of heart failure, due to a combination of effects including significant systemic inflammatory responses and localized vascular inflammation at the arterial plaque level. Indonesian clinical practice guideline stated that (hydroxy)chloroquine alone or in combination with azithromycin may be used to treat for COVID-19. However, chloroquine, hydroxychloroquine, and azithromycin all prolong the QT interval, raising concerns about the risk of arrhythmic death from individual or concurrent use of these medications. To date, there is still no vaccine or specific antiviral treatment for COVID-19. Therefore, prevention of infection in people with cardiovascular risk and mitigation of the adverse effects of treatment is necessary.


Assuntos
Antiarrítmicos/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/complicações , Morte Súbita Cardíaca/prevenção & controle , Pneumonia Viral/complicações , Taquicardia Ventricular/prevenção & controle , Infecções por Coronavirus/epidemiologia , Morte Súbita Cardíaca/etiologia , Eletrocardiografia , Humanos , Pandemias , Pneumonia Viral/epidemiologia , Prognóstico , Taquicardia Ventricular/etiologia
8.
Am J Cardiol ; 134: 123-129, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-32950203

RESUMO

Abnormalities on cardiac magnetic resonance imaging (CMR) and positron emission tomography (PET) predict ventricular arrhythmias (VA) in patients with cardiac sarcoidosis (CS). Little is known whether concurrent abnormalities on CMR and PET increases the risk of developing VA. Our aim was to compare the additive utility of CMR and PET in predicting VA in patients with CS. We included all patients treated at our institution from 2000 to 2018 who (1) had probable or definite CS and (2) had undergone both CMR and PET. The primary endpoint was VA at follow up, which was defined as sustained ventricular tachycardia, sudden cardiac death, or any appropriate device tachytherapy. Fifty patients were included, 88% of whom had a left ventricular ejection fraction >35%. During a mean follow-up 4.1 years, 7/50 (14%) patients had VA. The negative predictive value of LGE for VA was 100% and the negative predictive value of FDG for VA was 79%. Among groups, VA occurred in 4/21 (19%) subjects in the LGE+/FDG+ group, 3/14 (21%) in the LGE+/FDG- group, and 0/15 (0%) in the FDG+/LGE- group. There were no LGE-/FDG- patients. In conclusion, CMR may be the preferred initial clinical risk stratification tool in patients with CS. FDG uptake without LGE on initial imaging may not add additional prognostic information regarding VA risk.


Assuntos
Cardiomiopatias/diagnóstico por imagem , Morte Súbita Cardíaca/epidemiologia , Imagem por Ressonância Magnética , Tomografia por Emissão de Pósitrons , Sarcoidose/diagnóstico por imagem , Taquicardia Ventricular/epidemiologia , Fibrilação Ventricular/epidemiologia , Adulto , Idoso , Cardiomiopatias/complicações , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Cardioversão Elétrica , Feminino , Fluordesoxiglucose F18 , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Compostos Radiofarmacêuticos , Medição de Risco , Sarcoidose/complicações , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/terapia , Fibrilação Ventricular/etiologia , Fibrilação Ventricular/terapia
9.
Nat Commun ; 11(1): 4364, 2020 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-32868781

RESUMO

Pathophysiological roles of cardiac dopamine system remain unknown. Here, we show the role of dopamine D1 receptor (D1R)-expressing cardiomyocytes (CMs) in triggering heart failure-associated ventricular arrhythmia. Comprehensive single-cell resolution analysis identifies the presence of D1R-expressing CMs in both heart failure model mice and in heart failure patients with sustained ventricular tachycardia. Overexpression of D1R in CMs disturbs normal calcium handling while CM-specific deletion of D1R ameliorates heart failure-associated ventricular arrhythmia. Thus, cardiac D1R has the potential to become a therapeutic target for preventing heart failure-associated ventricular arrhythmia.


Assuntos
Arritmias Cardíacas/etiologia , Insuficiência Cardíaca , Miócitos Cardíacos/metabolismo , Receptores de Dopamina D1/metabolismo , Animais , Arritmias Cardíacas/prevenção & controle , Perfilação da Expressão Gênica/métodos , Humanos , Camundongos , Camundongos Transgênicos , Ratos , Receptores de Dopamina D1/genética , Análise de Sequência de RNA/métodos , Análise de Célula Única/métodos , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/prevenção & controle
10.
Am J Cardiol ; 132: 126-132, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32778337

RESUMO

Risk stratification for malignant arrhythmias and risk of sudden cardiac death in tetralogy of Fallot (TOF) remains challenging. We aimed to ascertain factors associated with life-threatening arrhythmic events. A multicenter retrospective case-control study including 72 TOF patients with documented cardiac arrest and/or sustained ventricular tachycardia, compared with 216 controls matched for era of surgery. The mean age at event in the cases was 27.3 ± 12.5 years. The majority (57%) presented with sustained ventricular tachycardia. Fatal events occurred in 9. Random forest analysis and a decision tree demonstrated surgical era specific risk factors (< vs ≥ 1980). For both eras, arrhythmic symptoms and left ventricular dysfunction were strongly associated with malignant arrhythmias. In addition, right ventricular dysfunction and age at repair ≥ 6.5 years preceded by a shunt were associated with a higher risk group in the early era, whereas a trans-annular patch type repair was associated with a lower risk group in the recent era. For the moderate and high-risk groups, the decision tree showed a sensitivity of 88.4% and specificity of 68.1%. An "importance factor" was calculated for each predictor, creating a risk score and 4 risk categories. In conclusions, this risk stratification scheme, based on clinical history and noninvasive testing, allows categorization of TOF patients at high risk of malignant arrhythmia. A multicenter prospective evaluation of the accuracy of this scoring system is now being planned.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Morte Súbita Cardíaca/etiologia , Medição de Risco/métodos , Taquicardia Ventricular/etiologia , Tetralogia de Fallot/complicações , Adulto , Canadá/epidemiologia , Estudos de Casos e Controles , Morte Súbita Cardíaca/epidemiologia , Feminino , Humanos , Incidência , Masculino , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Taquicardia Ventricular/epidemiologia , Tetralogia de Fallot/cirurgia , Estados Unidos/epidemiologia
11.
S D Med ; 73(8): 356-358, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32809294

RESUMO

Cardiac sarcoidosis is a rare clinical diagnosis, but can be identified in autopsy in up to a quarter of patients with sarcoidosis. Bradycardia, heart block, and syncope are often the presenting arrhythmias associated with sarcoidosis, but ventricular tachycardia can also occur. We present a patient presenting in ventricular tachycardia, later found to have multi-organ system involvement of sarcoidosis. The patient required pacemaker, implantable cardioverter-defibrillator, and immunosuppression for management of cardiac sarcoidosis. Patients with cardiac sarcoidosis are at elevated risk for arrhythmias, and patients with ventricular tachycardia and reduced ejection fraction should be evaluated for implantable cardioverter-defibrillator. In conclusion, sarcoid cardiomyopathy can present as ventricular tachycardia, and requires evaluation and management targeted at prevention of sudden cardiac death.


Assuntos
Cardiomiopatias , Desfibriladores Implantáveis , Sarcoidose , Taquicardia Ventricular , Morte Súbita Cardíaca , Humanos , Sarcoidose/complicações , Sarcoidose/diagnóstico , Taquicardia Ventricular/etiologia
12.
J Investig Med High Impact Case Rep ; 8: 2324709620948407, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32762368

RESUMO

Recent reports have suggested an increased risk of QT prolongation and subsequent life-threatening ventricular arrhythmias, particularly torsade de pointes, in patients with coronavirus disease-2019 (COVID-19) treated with hydroxychloroquine and azithromycin. In this article, we report the case of a 75-year-old female with a baseline prolonged QT interval in whom the COVID-19 illness resulted in further remarkable QT prolongation (>700 ms), precipitating recurrent self-terminating episodes of torsade de pointes that necessitated temporary cardiac pacing. Despite the correction of hypoxemia and the absence of reversible factors, such as adverse medication effects, electrolyte derangements, and usage of hydroxychloroquine/azithromycin, the QT interval remained persistently prolonged compared with the baseline with subsequent degeneration into ventricular tachycardia and death. Thus, we highlight that COVID-19 illness itself can potentially lead to further prolongation of QT interval and unmask fatal ventricular arrhythmias in patients who have a prolonged QT and low repolarization reserve at baseline.


Assuntos
Betacoronavirus , Infecções por Coronavirus/fisiopatologia , Síndrome do QT Longo/fisiopatologia , Pneumonia Viral/fisiopatologia , Taquicardia Ventricular/fisiopatologia , Idoso , Azitromicina/uso terapêutico , Infecções por Coronavirus/complicações , Infecções por Coronavirus/dietoterapia , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/metabolismo , Evolução Fatal , Feminino , Humanos , Hidroxicloroquina/uso terapêutico , Síndrome do QT Longo/tratamento farmacológico , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/dietoterapia , Taquicardia Ventricular/etiologia
13.
Asian Cardiovasc Thorac Ann ; 28(8): 504-506, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32757654

RESUMO

Congenital left ventricular aneurysm or diverticulum is very rare. Most congenital left ventricular aneurysms are asymptomatic but some cause systemic embolization, left ventricular free wall rupture, or ventricular arrhythmias causing sudden cardiac death. A 29-year-old woman with congenital left ventricular aneurysm and nonsustained ventricular tachycardia underwent surgical plication of the aneurysm with left ventricular reshaping to improve heart failure symptoms, prevent rupture of the aneurysm wall and the possibility of thrombus formation, and excise the fibrotic tissue of the left ventricular aneurysm, which could be a trigger for left ventricular aneurysm arrhythmias. The postoperative course was unremarkable.


Assuntos
Aneurisma Cardíaco/congênito , Miocárdio Ventricular não Compactado Isolado/complicações , Adulto , Feminino , Aneurisma Cardíaco/diagnóstico por imagem , Aneurisma Cardíaco/cirurgia , Insuficiência Cardíaca/etiologia , Humanos , Miocárdio Ventricular não Compactado Isolado/diagnóstico por imagem , Miocárdio Ventricular não Compactado Isolado/cirurgia , Taquicardia Ventricular/etiologia , Resultado do Tratamento , Disfunção Ventricular Esquerda/etiologia
14.
Circ Arrhythm Electrophysiol ; 13(8): e008307, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32657137

RESUMO

BACKGROUND: In patients with an ischemic cardiomyopathy (ICM), the combination of late potential (LP) abolition and postprocedural ventricular tachycardia (VT) noninducibility is known to be the desirable end point for a successful long-term outcome after VT ablation. We investigated whether LP abolition and VT noninducibilty have a similar impact on the outcomes of patients with non-ICMs (NICM) undergoing VT ablation. METHODS: A total of 403 patients with NICM (523 procedures) who underwent a VT ablation from 2010 to 2016 were included. The procedure end points were the LP abolition (if the LPs were absent, other ablation strategies were undertaken) and the VT noninducibilty. RESULTS: The underlying structural heart disease consisted of dilated cardiomyopathy (DCM, 49%), arrhythmogenic right ventricular dysplasia (ARVD, 17%), postmyocarditis (14%), valvular heart disease (8%), congenital heart disease (2%), hypertrophic cardiomyopathy (2%), and others (5%). The epicardial access was performed in 57% of the patients. At baseline, the LPs were present in 60% of the patients and a VT was either inducible or sustained/incessant in 85% of the cases. At the end of the procedure, the LP abolition was achieved in 79% of the cases and VT noninducibility in 80%. After a multivariable analysis, the combination of LP abolition and VT noninducibilty was independently associated with free survival from VT (hazard ratio, 0.45 [95% CI, 0.29-0.69], P=0.0002) and cardiac death (hazard ratio, 0.38 [95% CI, 0.18-0.74], P=0.005). The benefit of the LP abolition on preventing the VT recurrence in patients with ARVD and postmyocarditis appeared superior to that observed for those with DCM. CONCLUSIONS: In patients with NICM undergoing VT ablation, the strategy of LP abolition and VT noninducibilty were associated with better outcomes in terms of long-term VT recurrences and cardiac survival. Graphic Abstract: A graphic abstract is available for this article.


Assuntos
Potenciais de Ação , Cardiomiopatias/complicações , Ablação por Cateter , Frequência Cardíaca , Taquicardia Ventricular/cirurgia , Adulto , Idoso , Cardiomiopatias/diagnóstico , Cardiomiopatias/fisiopatologia , Ablação por Cateter/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Medição de Risco , Fatores de Risco , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
15.
J Interv Cardiol ; 2020: 4386841, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32549801

RESUMO

Background: Voltage mapping allows identifying the arrhythmogenic substrate during scar-related ventricular arrhythmia (VA) ablation procedures. Slow conducting channels (SCCs), defined by the presence of electrogram (EGM) signals with delayed components (EGM-DC), are responsible for sustaining VAs and constitute potential ablation targets. However, voltage mapping, as it is currently performed, is time-consuming, requiring a manual analysis of all EGMs to detect SCCs, and its accuracy is limited by electric far-field. We sought to evaluate an algorithm that automatically identifies EGM-DC, classifies mapping points, and creates new voltage maps, named "Slow Conducting Channel Maps" (SCC-Maps). Methods: Retrospective analysis of electroanatomic maps (EAM) from 20 patients (10 ischemic, 10 with arrhythmogenic right ventricular dysplasia/cardiomyopathy) was performed. EAM voltage maps were acquired during sinus rhythm and used for ablation. Preprocedural contrast-enhanced cardiac magnetic resonance (Ce-CMR) imaging was available for the ischemic population. Three mapping modalities were analysed: (i) EAM voltage maps using standard (EAM standard) or manual (EAM screening) thresholds for defining core and border zones; (ii) SCC-Maps derived from the use of the novel SCC-Mapping algorithm that automatically identify EGM-DCs measuring the voltage of the local component; and (iii) Ce-CMR maps (when available). The ability of each mapping modality in identifying SCCs and their agreement was evaluated. Results: SCC-Maps and EAM screening identified a greater number of SCC entrances than EAM standard (3.45 ± 1.61 and 2.95 ± 2.31, resp., vs. 1.05 ± 1.10; p < 0.01). SCC-Maps and EAM screening highly correlate with Ce-CMR maps in the ischemic population when compared to EAM standard (Lin's correlation = 0.628 and 0.679, resp., vs. 0.212, p < 0.01). Conclusion: The SCC-Mapping algorithm allows an operator-independent analysis of EGM signals showing better identification of the arrhythmogenic substrate characteristics when compared to standard voltage EAM.


Assuntos
Displasia Arritmogênica Ventricular Direita/diagnóstico , Displasia Arritmogênica Ventricular Direita/fisiopatologia , Ablação por Cateter , Taquicardia Ventricular/etiologia , Adulto , Idoso , Arritmias Cardíacas/cirurgia , Displasia Arritmogênica Ventricular Direita/cirurgia , Cicatriz/patologia , Cicatriz/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taquicardia Ventricular/diagnóstico
16.
Anaesth Crit Care Pain Med ; 39(3): 393-394, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32562808
18.
J Card Surg ; 35(7): 1708-1710, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32436599

RESUMO

BACKGROUND: Recurrent ventricular tachycardia (VT) can occur after left ventricular assist device (LVAD) implantation. In this case, medical treatment might be insufficient. We report a case of a left-sided thoracoscopic sympathectomy as a feasible treatment escalation in intractable VT. CASE REPORT: A 72-year-old patient underwent an internal cardioverter defibrillator (ICD) implantation as primary prophylaxis for VTs in the setting of staged heart failure therapy. Afterwards, due to a progressive dilative cardiomyopathy he underwent a minimal-invasive LVAD implantation (HeartWare, Medtronic). After an uneventful minimal-invasive LVAD-implantation the patient was discharged to a rehabilitation program. However, after 7 weeks he developed recurrent VTs which were successfully terminated by ICD shocks deliveries leading to severe discomfort and frequent hospitalizations. Eventually, the patient was admitted with an electrical VT storm. Successful endocardial catheter ablation of all inducible VTs were performed combined with multiple rearrangements of his oral antiarrhythmic medication. However, all these treatments could not suppress further occurrence of VTs. After an interdisciplinary discussion the patient agreed to a left-sided video-assisted thoracoscopic sympathectomy. After a follow up of 150 days the patient was free from VTs apart from one short event. CONCLUSION: We believe video-assisted thoracoscopic sympathectomy might be a surgical treatment option in patients with intractable recurrent VTs after catheter ablation of VT reentrant substrate even after minimal-invasive LVAD implantation.


Assuntos
Insuficiência Cardíaca/cirurgia , Ventrículos do Coração/cirurgia , Coração Auxiliar/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Implantação de Prótese/efeitos adversos , Simpatectomia/métodos , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Idoso , Insuficiência Cardíaca/etiologia , Humanos , Masculino , Insuficiência da Valva Mitral/complicações , Recidiva , Resultado do Tratamento
19.
Am J Trop Med Hyg ; 103(2): 745-751, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32431281

RESUMO

Chronic Chagas disease can progress to myocardial involvement with intense fibrosis, which may predispose patients to sudden cardiac death through ventricular arrhythmia. The associations of myocardial fibrosis detected by cardiac magnetic resonance (CMR) parameters with non-sustained ventricular tachycardia (NSVT) were evaluated. This cross-sectional study included patients in early stages of Chagas disease (n = 47) and a control group (n = 15). Patients underwent cardiac evaluation, including CMR examination. Myocardial fibrosis assessment by CMR with measurement of late gadolinium enhancement (LGE), native T1, and extracellular volume (ECV) was performed. There was an increase in myocardial fibrosis CMR parameters and ventricular arrhythmias among different stages of Chagas disease, combined with a decrease in the left ventricular ejection fraction (LVEF) by CMR and also in the right ventricular systolic function by S' wave on tissue Doppler. Fibrosis mass and ECV were associated with the Rassi score, ventricular extrasystole, and E/e' ratio in a logistic regression model adjusted for age and gender. The ECV maintained an association with the presence of NSVT, even after adjustments for fibrosis mass and LVEF assessed by CMR. The receiver-operating characteristic area under the curve for global ECV (0.85; 95% CI: 0.71-0.99) and NSVT was greater than that for fibrosis mass (0.75; 95% CI: 0.54-0.96), although this difference was not statistically significant. Extracellular volume could be an early marker of increased risk of ventricular arrhythmia in Chagas disease, presenting an independent association with NSVT in the initial stages of chronic Chagas cardiomyopathy, even after adjustment for fibrosis mass and LVEF.


Assuntos
Cardiomiopatia Chagásica/fisiopatologia , Coração/diagnóstico por imagem , Taquicardia Ventricular/fisiopatologia , Idoso , Área Sob a Curva , Estudos de Casos e Controles , Cardiomiopatia Chagásica/complicações , Cardiomiopatia Chagásica/diagnóstico por imagem , Doença de Chagas/complicações , Doença de Chagas/diagnóstico por imagem , Doença de Chagas/fisiopatologia , Estudos Transversais , Ecocardiografia , Eletrocardiografia Ambulatorial , Espaço Extracelular , Feminino , Fibrose , Humanos , Modelos Logísticos , Imagem por Ressonância Magnética , Imagem Cinética por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Miocárdio/patologia , Tamanho do Órgão , Curva ROC , Volume Sistólico , Taquicardia Ventricular/etiologia , Função Ventricular Direita
20.
BMC Cardiovasc Disord ; 20(1): 192, 2020 04 22.
Artigo em Inglês | MEDLINE | ID: mdl-32321432

RESUMO

BACKGROUND: The condition of anomalous aortic origin of the right coronary artery (AAORCA) with an interarterial course leads to few, if any, clinical problems. Malignant presentation of the often non-significant AAORCA associated with conduction system abnormalities is a rare finding. Surgical repair, even for highly symptomatic patients, is still controversial. However, in this case, the surgery brought a paradigm shift in treatment modality, improving the symptoms of this patient. CASE PRESENTATION: We report a case of a 52-year-old man with severe chest pain and recurrent electrical storms with an implanted cardiac resynchronization therapy defibrillator (CRT-D) device. Coronary angiography and computed tomography (CT) revealed the rare anomalous aortic origin of the right coronary artery (AAORCA) with a high interarterial course between the aorta and the pulmonary trunk. As symptoms typically develop on exertion, placing the patient at an increased risk of ischemic distress, a stress myocardial perfusion imaging study helped to identify his high-risk status. Although patient-specific, a surgical repair was the only concrete step agreed upon after multiple collaborative discussions with the cardiac surgeons. Surgery significantly improved the symptoms, with the patient reporting resolution of his chest pain, as well as no documented inappropriate defibrillator activity on follow-up appointments. CONCLUSION: One purpose of reporting the case study was to underscore the risk factors associated with AAORCA, challenging claims of its benign nature. This case complements existing findings demonstrating that ischemic distress consequent to the right coronary artery (RCA) compression may precede the rare incidence of an electrical storm. Importantly, the case-study emphasizes the significance of integrated multimodality imaging in clinical practice as well as providing real-world evidence for the efficacy of surgical repair in highly symptomatic patients with AAORCA with an interarterial course.


Assuntos
Anomalias dos Vasos Coronários/complicações , Taquicardia Ventricular/etiologia , Terapia de Ressincronização Cardíaca , Dispositivos de Terapia de Ressincronização Cardíaca , Procedimentos Cirúrgicos Cardíacos , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/cirurgia , Desfibriladores Implantáveis , Cardioversão Elétrica/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/terapia , Resultado do Tratamento
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