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1.
Medicine (Baltimore) ; 100(25): e26372, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160410

RESUMO

RATIONALE: Idiopathic ventricular tachycardia (VT) occurs in individuals without structural abnormalities in the heart, accounts for approximately 10% of total VTs. Furthermore, approximately 70% of idiopathic VTs originate from Right ventricular outflow tract (RVOT). However, among perioperative arrhythmias, incidence of VT after surgery is extremely rare and most arrhythmias are atrial origin. PATIENT CONCERNS: A 69-year-old man with permanent pacemaker underwent colon surgery. DIAGNOSES: Patient suffered from low blood pressure and dizziness, sweating at post anesthetic care unit (PACU) and heart rate (HR) increased suddenly to 200 beats/min with monomorphic VT after bolus ephedrine administration and continuous dopamine infusion. INTERVENTIONS: Pacemaker interrogation followed by DC cardioversion was done. OUTCOMES: Patient's vital signs became normal and symptoms are subsided. LESSONS: RVOT VT can be caused by triggering activities, such as ephedrine, dopamine, and inadequate fluid management. These triggering activities are initiated by acceleration of HR from ventricles with infusion of catecholamine which lead monomorphic VT originating from RVOT.RVOT origin PVCs can be precipitated into monomorphic VT by administrating catecholamines such as ephedrine and dopamine even in patient with pacemaker. The mechanism of these VTs includes catecholamine induced acceleration of HR. Since RVOT PVCs can be recognize by 12 EKGs, we should be pay more attentions to the pre-operation EKG and be cautious using catecholamines.


Assuntos
Colectomia/efeitos adversos , Ventrículos do Coração/fisiopatologia , Complicações Pós-Operatórias/diagnóstico , Taquicardia Ventricular/diagnóstico , Idoso , Neoplasias do Colo/cirurgia , Ecocardiografia , Cardioversão Elétrica , Eletrocardiografia , Bloqueio Cardíaco/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Marca-Passo Artificial , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/fisiopatologia , Taquicardia Ventricular/terapia , Resultado do Tratamento
2.
Methodist Debakey Cardiovasc J ; 17(1): 13-18, 2021 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-34104315

RESUMO

Catheter ablation is an effective treatment method for ventricular arrhythmias (VAs). These arrhythmias can often be mapped and targeted with ablation from the left and right ventricular endocardium. However, in some situations the VA site of origin or substrate may be intramural or epicardial in nature. In these cases, the coronary venous system (CVS) provides an effective vantage point for mapping and ablation. This review highlights situations in which CVS mapping may be helpful and discusses techniques for CVS mapping and ablation.


Assuntos
Ablação por Cateter , Vasos Coronários/cirurgia , Frequência Cardíaca , Taquicardia Ventricular/cirurgia , Fibrilação Ventricular/cirurgia , Potenciais de Ação , Ablação por Cateter/efeitos adversos , Angiografia Coronária , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/fisiopatologia , Eletrocardiografia , Técnicas Eletrofisiológicas Cardíacas , Humanos , Flebografia , Valor Preditivo dos Testes , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatologia , Resultado do Tratamento , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/fisiopatologia
3.
Methodist Debakey Cardiovasc J ; 17(1): 19-23, 2021 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-34104316

RESUMO

Catheter-based radiofrequency (RF) ablation is an effective, well-established therapy for ventricular tachycardia (VT). However, a large number of patients still have recurrences, particularly those with substrates arising from intramural locations that are inaccessible through endo- or epicardial catheter approaches. Several unconventional ablation techniques have been proposed to treat RF-refractory VT, including transarterial coronary ethanol ablation and retrograde coronary venous ethanol ablation. We review the evidence regarding the mechanisms, procedural aspects, and alcohol ablation outcomes for ventricular arrhythmias.


Assuntos
Técnicas de Ablação , Etanol/administração & dosagem , Taquicardia Ventricular/cirurgia , Técnicas de Ablação/efeitos adversos , Potenciais de Ação , Etanol/efeitos adversos , Frequência Cardíaca , Humanos , Taquicardia Ventricular/diagnóstico por imagem , Taquicardia Ventricular/fisiopatologia , Resultado do Tratamento
4.
Methodist Debakey Cardiovasc J ; 17(1): 24-35, 2021 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-34104317

RESUMO

Ventricular arrhythmias are potentially life-threatening disorders that are commonly treated with medications, catheter ablation and implantable cardioverter defibrillator (ICD). Adult patients who continue to be symptomatic, with frequent ventricular arrhythmia cardiac events or defibrillation from ICD despite medical treatment, are a challenging subgroup to manage. Surgical cardiac sympathetic denervation has emerged as a possible treatment option for people refractory to less invasive medical options. Recent treatment guidelines have recommendedcardiac sympathectomy for ventricular tachycardia (VT) or VT/fibrillation storm refractory to antiarrhythmic medications, long QT syndrome, and catecholaminergic polymorphic VT, with much of the data pertaining to pediatric literature. However, for the adult population, the disease indications, complications, and risks of cardiac sympathectomy are less understood, as are the most effective surgical cardiac denervation techniques for this patient demographic. This systematic review navigates available literature evaluating surgical denervation disease state indications, techniques, and sympathectomy risks for medically refractory ventricular arrhythmia in the adult patient population.


Assuntos
Frequência Cardíaca , Coração/inervação , Simpatectomia , Sistema Nervoso Simpático/cirurgia , Taquicardia Ventricular/cirurgia , Fibrilação Ventricular/cirurgia , Potenciais de Ação , Humanos , Complicações Pós-Operatórias/etiologia , Recidiva , Medição de Risco , Fatores de Risco , Simpatectomia/efeitos adversos , Sistema Nervoso Simpático/fisiopatologia , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/fisiopatologia
5.
Methodist Debakey Cardiovasc J ; 17(1): 36-42, 2021 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-34104318

RESUMO

The treatment of drug-refractory chronic ventricular tachycardia (VT) has undergone a revolution over the last 50 years. We now have automatic implantable cardioverter defibrillator therapy with pace-terminating capabilities, and catheter ablation of VT has refined mapping and improved methods of lesion generation. Between 1980 and 1993, Houston Methodist Hospital became a leader in the diagnosis and surgical ablation of VT and other arrhythmias. This is a brief account of that period and some of the experiences and lessons that have led to significant advances used today.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Frequência Cardíaca , Taquicardia Ventricular/cirurgia , Potenciais de Ação , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/história , Difusão de Inovações , Técnicas Eletrofisiológicas Cardíacas , História do Século XX , História do Século XXI , Humanos , Complicações Pós-Operatórias/etiologia , Recidiva , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/história , Taquicardia Ventricular/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
6.
Methodist Debakey Cardiovasc J ; 17(1): 65-67, 2021 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-34104323

RESUMO

Loperamide, a µ-opioid receptor agonist, can cause cardiotoxicity by inhibiting the potassium ion channel and slowing cardiomyocyte repolarization. This, in turn, can lead to frequent early afterdepolarizations, the most common mechanism of drug-induced long QT syndrome and torsades de pointes. Apical hypertrophic cardiomyopathy (AHCM) is a nonobstructive hypertrophic cardiomyopathy rarely associated with malignant arrhythmias. We present a case of loperamide-induced malignant ventricular arrhythmia revealing underlying AHCM in a 25-year-old woman with a history of sudden cardiac arrest (SCA) and opioid use. It is important to evaluate for structural heart disease in all patients presenting with SCA, regardless of presumed etiology such as drug-induced cardiotoxicity, to prevent missed opportunities for adequate treatment. Furthermore, the diagnosis of AHCM in SCA warrants further genetic evaluation for variances with a predilection for malignant arrhythmias.


Assuntos
Antidiarreicos/efeitos adversos , Cardiomiopatia Hipertrófica/genética , Canal de Potássio Kv1.5/genética , Loperamida/efeitos adversos , Mutação , Transtornos Relacionados ao Uso de Opioides/complicações , Taquicardia Ventricular/etiologia , Adulto , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/diagnóstico , Cardiomiopatia Hipertrófica/fisiopatologia , Cardiotoxicidade , Análise Mutacional de DNA , Eletrocardiografia , Feminino , Predisposição Genética para Doença , Humanos , Imageamento por Ressonância Magnética , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Fatores de Risco , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatologia
7.
Methodist Debakey Cardiovasc J ; 17(1): 8-12, 2021 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-34104314

RESUMO

Catheter ablation is an established treatment strategy for ventricular arrhythmias. However, the presence of intramural substrate poses challenges with mapping and delivery of radiofrequency energy, limiting overall success of catheter ablation. Advances over the past decade have improved our understanding of intramural substrate and paved the way for innovative treatment approaches. Modifications in catheter ablation techniques and development of novel ablation technologies have led to improved clinical outcomes for patients with ventricular arrhythmias. In this review, we explore mapping techniques to identify intramural substrate and describe available radiofrequency energy delivery techniques that can improve overall success rates of catheter ablation.


Assuntos
Ablação por Cateter , Sistema de Condução Cardíaco/cirurgia , Frequência Cardíaca , Taquicardia Ventricular/cirurgia , Fibrilação Ventricular/cirurgia , Potenciais de Ação , Ablação por Cateter/efeitos adversos , Eletrocardiografia , Técnicas Eletrofisiológicas Cardíacas , Sistema de Condução Cardíaco/diagnóstico por imagem , Sistema de Condução Cardíaco/fisiopatologia , Humanos , Imageamento por Ressonância Magnética , Valor Preditivo dos Testes , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatologia , Resultado do Tratamento , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/fisiopatologia
10.
Medicine (Baltimore) ; 100(14): e25370, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33832121

RESUMO

RATIONALE: Dual atrioventricular node non-reentrant tachycardia (DAVNNRT) is a rare arrhythmia. We present a case of inappropriate implantable cardioverter defibrillator (ICD) therapy caused by DAVNNRT. DAVNNRT is easily misdiagnosed as atrial fibrillation and is often identified as ventricular tachycardia (VT) by the supraventricular tachycardia-ventricular tachycardia (SVT-VT) discriminator of the ICD. PATIENT CONCERNS: A 73-year-old man with ischemic heart disease (IHD) presented with palpitations accompanied by dyspnea and syncope. Frequent multifocal premature ventricular beats and non-sustained ventricular tachycardia were observed on ambulatory electrocardiography. The left ventricular ejection fraction decreased to 32%. DIAGNOSIS: He was diagnosed with IHD, heart failure with reduced ejection fraction (HFrEF), and VT. INTERVENTIONS: : Initially, the patient received a single-chamber ICD implantation for secondary prevention of sudden death. He then suffered from inappropriate anti-tachycardia pacing (ATP)/shock therapy many times after the procedure. DAVNNRT was confirmed in an electrophysiology study (EPS), and radiofrequency ablation of the slow pathway successfully terminated this tachycardia. OUTCOMES: No episode of inappropriate ICD therapy or tachycardia occurred during the follow-up. LESSONS: In conclusion, it is essential to have a full understanding of DAVNNRT and eliminate slow pathways for patients with DAVNNRT and be prepared to implant an ICD.


Assuntos
Desfibriladores Implantáveis/estatística & dados numéricos , Insuficiência Cardíaca/diagnóstico , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/terapia , Idoso , Eletrofisiologia Cardíaca/métodos , Desfibriladores Implantáveis/efeitos adversos , Erros de Diagnóstico , Eletrocardiografia Ambulatorial/métodos , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Isquemia Miocárdica/complicações , Ablação por Radiofrequência/métodos , Volume Sistólico/fisiologia , Taquicardia Supraventricular/diagnóstico , Taquicardia Ventricular/fisiopatologia , Resultado do Tratamento , Função Ventricular Esquerda/fisiologia
11.
Clin Nucl Med ; 46(8): 681-682, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-33782296

RESUMO

ABSTRACT: An 84-year-old man was referred for the evaluation of a suspected gastrointestinal neoplasia. 18F-FDG PET/CT scan was performed showing, in addition to the physiological myocardial FDG uptake in the left ventricular wall, an unusual diffuse FDG uptake of the bilateral atrial walls. During his visit to the nuclear medicine unit, the patient became unwell, and an ECG was performed, suggestive of an atrioventricular nodal re-entrant tachycardia. Our case highlights the importance of including supraventricular arrhythmia such as atrioventricular nodal re-entrant tachycardia in the differential diagnosis of atrial FDG uptake.


Assuntos
Fluordesoxiglucose F18/metabolismo , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/metabolismo , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Taquicardia Ventricular/diagnóstico por imagem , Taquicardia Ventricular/metabolismo , Idoso de 80 Anos ou mais , Transporte Biológico , Diagnóstico Diferencial , Eletrocardiografia , Humanos , Masculino , Taquicardia Ventricular/fisiopatologia
12.
Am J Cardiol ; 148: 124-129, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33667448

RESUMO

The ECG findings during sudden collapse (syncope or sudden death) in severe aortic stenosis (AS) are not well defined. We conducted a comprehensive review of the literature for ECG data during sudden collapse in patients with AS and provided a case report of our own. There were 37 published cases of syncope or sudden death in patients with severe AS which were documented by ECG. Brady- or ventricular arrhythmias were documented in 34 cases (92%). Bradyarrhythmia (n = 24; 71%) was more common at the time of collapse than ventricular tachyarrhythmia (n = 10; 29%). There was slowing of the sinus rate before bradyarrhythmia in the vast majority of patients with bradyarrhythmia but not in those presenting with ventricular tachyarrhythmia (75% vs 0%; p <0.001). ECG evidence of ischemia (ST-segment depression or elevation) was present in most patients with bradyarrhythmia but not in those with ventricular tachyarrhythmia (75% vs 0%; p = 0.011). In conclusion, our findings suggest that left ventricular baroreceptor activation plays a dominant role in the pathophysiology of sudden collapse in patients with severe AS and suggest that ischemia may play a role as well.


Assuntos
Estenose da Valva Aórtica/fisiopatologia , Doença da Válvula Aórtica Bicúspide/fisiopatologia , Bradicardia/fisiopatologia , Morte Súbita Cardíaca , Isquemia Miocárdica/fisiopatologia , Síncope/fisiopatologia , Taquicardia Ventricular/fisiopatologia , Idoso , Estenose da Valva Aórtica/complicações , Doença da Válvula Aórtica Bicúspide/complicações , Bradicardia/etiologia , Eletrocardiografia , Ventrículos do Coração , Humanos , Masculino , Isquemia Miocárdica/etiologia , Pressorreceptores , Índice de Gravidade de Doença , Síncope/etiologia , Taquicardia Ventricular/etiologia
13.
Int Heart J ; 62(2): 427-431, 2021 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-33731522

RESUMO

In this study, we present a case of a 22-year-old female with a family history of syncope, suffering from recurrent syncope since childhood. She had an obvious prolonged QTc interval of up to 651 ms, a bifid T wave pattern on electrocardiogram, and torsade de pointes, corresponding to a syncope episode. Additionally, her echocardiogram showed left ventricular non-compaction in the apex. After treatment with mexiletine, the QTc interval has been observed to shorten immediately, and the T wave morphology recovered. A similar effect was also observed in her mother and young sister. Administration of propranolol prolonged her QTc interval. Target sequencing of candidate genes revealed a missense mutation in the pore area of the hERG protein, coded by KCNH2. We diagnosed this as a case of type 2 long QT syndrome in which mexiletine could be effective in shortening the QTc interval.


Assuntos
Eletrocardiografia/efeitos dos fármacos , Ventrículos do Coração/fisiopatologia , Síndrome do QT Longo/tratamento farmacológico , Mexiletina/farmacologia , Taquicardia Ventricular/complicações , Função Ventricular Esquerda/fisiologia , Antiarrítmicos/farmacologia , Ecocardiografia , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Síndrome do QT Longo/etiologia , Síndrome do QT Longo/genética , Linhagem , Taquicardia Ventricular/fisiopatologia , Adulto Jovem
14.
Cardiol Young ; 31(3): 344-351, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: covidwho-1101608

RESUMO

The COVID-19 pandemic has had a huge influence in almost all areas of life, affecting societies, economics, and health care systems worldwide. The paediatric cardiology community is no exception. As the challenging battle with COVID-19 continues, professionals from the Association for the European Paediatric and Congenital Cardiology receive many questions regarding COVID-19 in a Paediatric and Congenital Cardiology setting. The aim of this paper is to present the AEPC position on frequently asked questions based on the most recent scientific data, as well as to frame a discussion on how to take care of our patients during this unprecedented crisis. As the times are changing quickly and information regarding COVID-19 is very dynamic, continuous collection of evidence will help guide constructive decision-making.


Assuntos
Antiarrítmicos/uso terapêutico , Anticoagulantes/uso terapêutico , Antivirais/uso terapêutico , Arritmias Cardíacas/tratamento farmacológico , COVID-19/tratamento farmacológico , Cardiopatias Congênitas/terapia , Fatores Imunológicos/uso terapêutico , Monofosfato de Adenosina/análogos & derivados , Monofosfato de Adenosina/uso terapêutico , Alanina/análogos & derivados , Alanina/uso terapêutico , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/fisiopatologia , Síndrome de Brugada/tratamento farmacológico , Síndrome de Brugada/epidemiologia , Síndrome de Brugada/fisiopatologia , COVID-19/epidemiologia , COVID-19/fisiopatologia , Procedimentos Cirúrgicos Cardíacos , Cardiologia , Cardiopatias Congênitas/epidemiologia , Cardiopatias Congênitas/fisiopatologia , Transplante de Coração , Humanos , Transmissão Vertical de Doenças Infecciosas , Síndrome do QT Longo/tratamento farmacológico , Síndrome do QT Longo/epidemiologia , Síndrome do QT Longo/fisiopatologia , Miocardite/epidemiologia , Miocardite/fisiopatologia , Miocárdio , Pediatria , Medição de Risco , SARS-CoV-2 , Sociedades Médicas , Síndrome de Resposta Inflamatória Sistêmica/tratamento farmacológico , Síndrome de Resposta Inflamatória Sistêmica/epidemiologia , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia , Taquicardia Ventricular/tratamento farmacológico , Taquicardia Ventricular/epidemiologia , Taquicardia Ventricular/fisiopatologia
15.
Cardiol Young ; 31(3): 344-351, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33407975

RESUMO

The COVID-19 pandemic has had a huge influence in almost all areas of life, affecting societies, economics, and health care systems worldwide. The paediatric cardiology community is no exception. As the challenging battle with COVID-19 continues, professionals from the Association for the European Paediatric and Congenital Cardiology receive many questions regarding COVID-19 in a Paediatric and Congenital Cardiology setting. The aim of this paper is to present the AEPC position on frequently asked questions based on the most recent scientific data, as well as to frame a discussion on how to take care of our patients during this unprecedented crisis. As the times are changing quickly and information regarding COVID-19 is very dynamic, continuous collection of evidence will help guide constructive decision-making.


Assuntos
Antiarrítmicos/uso terapêutico , Anticoagulantes/uso terapêutico , Antivirais/uso terapêutico , Arritmias Cardíacas/tratamento farmacológico , COVID-19/tratamento farmacológico , Cardiopatias Congênitas/terapia , Fatores Imunológicos/uso terapêutico , Monofosfato de Adenosina/análogos & derivados , Monofosfato de Adenosina/uso terapêutico , Alanina/análogos & derivados , Alanina/uso terapêutico , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/fisiopatologia , Síndrome de Brugada/tratamento farmacológico , Síndrome de Brugada/epidemiologia , Síndrome de Brugada/fisiopatologia , COVID-19/epidemiologia , COVID-19/fisiopatologia , Procedimentos Cirúrgicos Cardíacos , Cardiologia , Cardiopatias Congênitas/epidemiologia , Cardiopatias Congênitas/fisiopatologia , Transplante de Coração , Humanos , Transmissão Vertical de Doenças Infecciosas , Síndrome do QT Longo/tratamento farmacológico , Síndrome do QT Longo/epidemiologia , Síndrome do QT Longo/fisiopatologia , Miocardite/epidemiologia , Miocardite/fisiopatologia , Miocárdio , Pediatria , Medição de Risco , SARS-CoV-2 , Sociedades Médicas , Síndrome de Resposta Inflamatória Sistêmica/tratamento farmacológico , Síndrome de Resposta Inflamatória Sistêmica/epidemiologia , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia , Taquicardia Ventricular/tratamento farmacológico , Taquicardia Ventricular/epidemiologia , Taquicardia Ventricular/fisiopatologia
16.
Circ Arrhythm Electrophysiol ; 14(2): e008517, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33401923

RESUMO

BACKGROUND: Implantable cardioverter defibrillators (ICD) are recommended for secondary prevention after sudden cardiac arrest (SCA). The outcomes of pediatric patients receiving an ICD after SCA remain unclear. The objective of this study is to evaluate outcomes, future risk for appropriate shocks, and identify characteristics associated with appropriate ICD therapy during follow-up. METHODS: Multicenter retrospective analysis of patients (age ≤21 years) without prior cardiac disease who received an ICD following SCA. Patient/device characteristics, cardiac function, and underlying diagnoses were collected, along with SCA event characteristics. Patient outcomes including complications and device therapies were analyzed. RESULTS: In total, 106 patients were included, median age 14.7 years. Twenty (19%) received appropriate shocks and 16 (15%) received inappropriate shocks (median follow-up 3 years). First-degree relative with SCA was associated with appropriate shocks (P<0.05). In total, 40% patients were considered idiopathic. Channelopathy was the most frequent late diagnosis not made at time of presentation. Neither underlying diagnosis nor idiopathic status was associated with increased incidence of appropriate shock. Monomorphic ventricular tachycardia (hazard ratio, 4.6 [1.2-17.3]) and family history of sudden death (hazard ratio, 6.5 [1.4-29.8]) were associated with freedom from appropriate shock in a multivariable model (area under the receiver operating characteristic curve, 0.8). Time from diagnoses to evaluation demonstrated a nonlinear association with freedom from appropriate shock (P=0.015). In patients >2 years from implantation, younger age (P=0.02) and positive exercise test (P=0.04) were associated with appropriate shock. CONCLUSIONS: The risk of future device therapy is high in pediatric patients receiving an ICD after SCA, irrelevant of underlying disease. Lack of a definitive diagnosis after SCA was not associated with lower risk of subsequent events and does not obviate the need for secondary prophylaxis.


Assuntos
Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Cardioversão Elétrica/instrumentação , Prevenção Primária/métodos , Medição de Risco/métodos , Prevenção Secundária/métodos , Taquicardia Ventricular/terapia , Adolescente , Criança , Pré-Escolar , Morte Súbita Cardíaca/epidemiologia , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Taquicardia Ventricular/mortalidade , Taquicardia Ventricular/fisiopatologia , Resultado do Tratamento , Estados Unidos/epidemiologia
17.
Circ Arrhythm Electrophysiol ; 14(2): e008887, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33417473

RESUMO

BACKGROUND: Periaortic fibrotic ventricular tachycardia (VT) substrate is common in nonischemic cardiomyopathy (NICM), often intramural, and difficult to ablate. We sought to better characterize normal and abnormal periaortic voltage map parameters and NICM periaortic VTs. METHODS: In 15 patients without heart disease, the 5th percentile of endocardial voltage for increasing distance from the aortic valve ring was determined. In 53 consecutive patients with NICM (64±11 years; left ventricular ejection fraction 31±10%) undergoing ablation of recurrent VT, periaortic electrogram voltage and VT characteristics were analyzed. RESULTS: In healthy patients, the fifth percentile of the bipolar voltage increased proportional to the distance from the aortic valve ring, from 1.0 mV at 1 cm to 1.5 mV at 1.5 cm; the corresponding unipolar voltage cutoffs were 5.0 and 7.5 mV. A total of 160 VTs were induced in 53 patients with NICM, of which 28 VTs in 20 patients had periaortic origins. Periaortic VTs were associated with similar periaortic bipolar voltage, but lower UVs consistent with intramural fibrosis as an important substrate. Periaortic VTs could be divided into left and right bundle branch block forms with mapping showing right septal and lateral exits. Left bundle branch block VTs were more often acutely abolished with ablation (100% versus 69%; P=0.034), but with a 23% incidence of heart block. Greater extent of low voltage was associated with more induced VTs and worse acute outcome. CONCLUSIONS: Adjusting voltage parameters based on distance from the aortic valve may improve definition of left ventricular outflow tract arrhythmia substrate. Periaortic VTs are common in NICM, often associated with intramural substrate and can be divided into left bundle branch block and right bundle branch block types associated with different ablation outcomes and risks.


Assuntos
Cardiomiopatias/complicações , Eletrocardiografia , Frequência Cardíaca/fisiologia , Taquicardia Ventricular/diagnóstico , Função Ventricular Esquerda/fisiologia , Idoso , Cardiomiopatias/diagnóstico , Cardiomiopatias/fisiopatologia , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/fisiopatologia
18.
Ann Thorac Surg ; 111(4): e295-e296, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33419566

RESUMO

Cardiac sympathetic denervation (CSD) for refractory ventricular tachycardia (VT) has been shown to decrease VT recurrence and defibrillator shocks in patients with ischemic and nonischemic cardiomyopathy. Here and in the accompanying Video, we demonstrate the technique for minimally invasive CSD, highlight important technical points, and report surgical outcomes. CSD is accomplished through bilateral resection of the inferior one-third to one-half of the stellate ganglion en bloc with T2-T4 sympathectomy. Despite the high potential for perioperative risk, most patients do not have serious complications. We find that surgical CSD can be performed safely in an attempt to liberate patients from refractory VT.


Assuntos
Ganglionectomia/métodos , Sistema de Condução Cardíaco/fisiopatologia , Frequência Cardíaca/fisiologia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Taquicardia Ventricular/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Taquicardia Ventricular/fisiopatologia , Vértebras Torácicas
19.
Arch Cardiovasc Dis ; 114(2): 140-149, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33478860

RESUMO

Ventricular tachycardia has a significant recurrence rate after ablation for several reasons, including inaccessible substrate. A non-invasive technique to ablate any defined areas of myocardium involved in arrhythmogenesis would be a potentially important therapeutic improvement if shown to be safe and effective. Early feasibility studies of single-fraction stereotactic body radiotherapy have demonstrated encouraging results, but rigorous evaluation and follow-up are required. In this document, the basic concepts of stereotactic body radiotherapy are summarized, before focusing on stereotactic arrhythmia radioablation. We describe the effect of radioablation on cardiac tissue and its interaction with intracardiac devices, depending on the dose. The different clinical studies on ventricular tachycardia radioablation are analysed, with a focus on target identification, which is the key feature of this approach. Our document ends with the indications and requirements for practicing this type of procedure in 2020. Finally, because of the limited number of patients treated so far, we encourage multicentre registries with long-term follow-up.


Assuntos
Ventrículos do Coração/efeitos da radiação , Radiocirurgia , Taquicardia Ventricular/radioterapia , Potenciais de Ação , Idoso , Idoso de 80 Anos ou mais , Animais , Feminino , Frequência Cardíaca , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Radiocirurgia/efeitos adversos , Fatores de Risco , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatologia , Resultado do Tratamento
20.
Asian Cardiovasc Thorac Ann ; 29(2): 122-124, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32938204

RESUMO

Management of ventricular tachycardia storm requires multimodal aggressive therapeutic interventions for a successful outcome. A 39-year-old man with dilated cardiomyopathy and severe left ventricular dysfunction presented with refractory ventricular tachycardia unresponsive to conventional treatment. He underwent an electrophysiology study and radiofrequency ablation with 3-dimensional mapping with partial control of the ventricular tachycardia. Further left sympathetic ganglion block followed by left cardiac sympathetic denervation also did not totally control the ventricular tachycardia. Right cardiac sympathetic denervation resulting in bilateral cardiac sympathetic denervation controlled the ventricular tachycardia.


Assuntos
Cardiomiopatia Dilatada/complicações , Ablação por Cateter , Frequência Cardíaca , Coração/inervação , Gânglio Estrelado/cirurgia , Simpatectomia , Taquicardia Ventricular/cirurgia , Disfunção Ventricular Esquerda/complicações , Adulto , Cardiomiopatia Dilatada/diagnóstico por imagem , Cardiomiopatia Dilatada/fisiopatologia , Terapia Combinada , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Cardioversão Elétrica/instrumentação , Humanos , Masculino , Recidiva , Gânglio Estrelado/fisiopatologia , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/fisiopatologia , Resultado do Tratamento , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda
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