Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.669
Filtrar
1.
Int Heart J ; 61(5): 913-921, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32921668

RESUMO

Previous study has identified marked differences in patient characteristics and causes of inappropriate shock (IAS) between Japan and the Western societies in terms of subcutaneous implantable cardioverter-defibrillator (S-ICD). However, evidence of IAS in Asian populations including Japan has been limited to one observational study.Thus, we conducted a single-center registry study that tracks the postoperative course of 61 consecutive patients who received S-ICD from February 2016 to January 2020. Our findings showed that IAS occurred in 9.8% of the study population (6/61), which is comparable to the previously reported incidence. Remarkably, T-wave oversensing did not result in an IAS (0/6). Instead, myopotential oversensing was determined to have caused the most IAS events (4/6), while atrial fibrillation ranked second (2/6). A provocation maneuver (e.g., abdominal clench, push-ups, lifting a heavy item) reproduced myopotential noise disguised as R-waves, which should potentially trigger an IAS if uninterrupted. R-wave amplitude of the IAS group appeared relatively low compared to that of the non-IAS group although this finding was not tested significant. Furthermore, no temporal changes were noted in R-wave amplitude between the time of implantation and IAS events, suggesting that it is neither constantly low nor acutely dropped R-wave amplitude but a relatively high noise level that drives IAS. All the myopotential-IAS patients were found to be male. Right-sided lead implantation was associated with a higher incidence of IAS.This study highlights the fact that IAS continues to occur due to myopotential noise oversensing instead of T-wave oversensing. To minimize the risk of IAS, it is desirable to search and secure high R-wave voltage.


Assuntos
Desfibriladores Implantáveis , Cardioversão Elétrica/estatística & dados numéricos , Músculo Esquelético/fisiologia , Taquicardia Ventricular/diagnóstico , Fibrilação Ventricular/diagnóstico , Adolescente , Adulto , Idoso , Criança , Erros de Diagnóstico , Falha de Equipamento , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Taquicardia Ventricular/terapia , Fibrilação Ventricular/terapia , Adulto Jovem
4.
PLoS One ; 15(5): e0232529, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32357163

RESUMO

Electrical defibrillation is a well-established treatment for cardiac dysrhythmias. Studies have suggested that shock-induced spatial sawtooth patterns and virtual electrodes are responsible for defibrillation efficacy. We hypothesize that high-frequency shocks enhance defibrillation efficacy by generating temporal sawtooth patterns and using rapid virtual electrodes synchronized with shock frequency. High-speed optical mapping was performed on isolated rat hearts at 2000 frames/s. Two defibrillation electrodes were placed on opposite sides of the ventricles. An S1-S2 pacing protocol was used to induce ventricular tachyarrhythmia (VTA). High-frequency shocks of equal energy but varying frequencies of 125-1000 Hz were used to evaluate VTA vulnerability and defibrillation success rate. The 1000-Hz shock had the highest VTA induction rate in the shorter S1-S2 intervals (50 and 100 ms) and the highest VTA defibrillation rate (70%) among all frequencies. Temporal sawtooth patterns and synchronous shock-induced virtual electrode responses could be observed with frequencies of up to 1000 Hz. The improved defibrillation outcome with high-frequency shocks suggests a lower energy requirement than that of low-frequency shocks for successful ventricular defibrillation.


Assuntos
Cardioversão Elétrica/métodos , Taquicardia Ventricular/terapia , Fibrilação Ventricular/terapia , Animais , Modelos Animais de Doenças , Eletrodos , Fenômenos Eletrofisiológicos , Feminino , Ventrículos do Coração/fisiopatologia , Técnicas In Vitro , Modelos Cardiovasculares , Ratos , Ratos Sprague-Dawley , Taquicardia Ventricular/fisiopatologia , Interface Usuário-Computador , Fibrilação Ventricular/fisiopatologia , Função Ventricular , Imagens com Corantes Sensíveis à Voltagem/instrumentação , Imagens com Corantes Sensíveis à Voltagem/métodos
5.
J Cardiovasc Magn Reson ; 22(1): 32, 2020 05 11.
Artigo em Inglês | MEDLINE | ID: mdl-32389126

RESUMO

BACKGROUND: Data on the usefulness of cardiovascular magnetic resonance (CMR) imaging for clinical decision making in patients with an implanted cardioverter defibrillator (ICD) are scarce. The present study determined the impact of CMR imaging on diagnostic stratification and treatment decisions in ICD patients presenting with electrical instability or progressive heart failure symptoms. METHODS: 212 consecutive ICD patients underwent 1.5 T CMR combining diagnostic imaging modules tailored to the individual clinical indication (ventricular function assessment, myocardial tissue characterization, adenosine stress-perfusion, 3D-contrast-enhanced angiography); four CMR examinations (4/212, 2%) were excluded due to non-diagnostic CMR image quality. The resultant change in diagnosis or clinical management was determined in the overall population and compared between ICD patients for primary (115/208, 55%) or secondary prevention (93/208, 45%). Referral indication consisted of documented ventricular tachycardia, inadequate device therapy or progressive heart failure symptoms. RESULTS: Overall, CMR imaging data changed diagnosis in 40% (83/208) with a significant difference between primary versus secondary prevention ICD patients (37/115, 32% versus 46/93, 49%, respectively; p = 0.01). The information gain from CMR led to an overall change in treatment in 21% (43/208) with a similar distribution in primary versus secondary prevention ICD patients (25/115,22% versus 18/93,19%, p = 0.67). The effect on treatment change was highest in patients initially scheduled for ventricular tachycardia ablation procedure (18/141, 13%) with revision of the treatment plan to medical therapy or coronary revascularization. CONCLUSIONS: CMR imaging in ICD patients presenting with electrical instability or worsening heart failure symptoms provided diagnostic or management-changing information in a considerable proportion (40% and 21%, respectively).


Assuntos
Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Cardioversão Elétrica/instrumentação , Insuficiência Cardíaca/terapia , Imagem Cinética por Ressonância Magnética , Taquicardia Ventricular/terapia , Idoso , Ablação por Cateter , Tomada de Decisão Clínica , Progressão da Doença , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevenção Primária , Prevenção Secundária , Taquicardia Ventricular/diagnóstico por imagem , Taquicardia Ventricular/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda
7.
Circ Arrhythm Electrophysiol ; 13(5): e007669, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32281407

RESUMO

BACKGROUND: There is paucity of data regarding radiofrequency ablation for ventricular tachycardia (VT) in patients with cardiogenic shock and concomitant VT refractory to antiarrhythmic drugs on mechanical support. METHODS: Patients undergoing VT ablation at our center were enrolled in a prospectively maintained registry and screened for the current study (2010-2017). RESULTS: All 21 consecutive patients with cardiogenic shock and concomitant refractory ventricular arrhythmia undergoing bailout ablation due to inability to wean off mechanical support were included. Median age was 61 years, 86% were men, median left ventricular ejection fraction was 20%, 81% had ischemic cardiomyopathy, and PAINESD score was 18±5. The type of mechanical support in place before the procedure was intra-aortic balloon pump in 14 patients (67%), Impella CP in 2, extracorporeal membrane oxygenation in 2, extracorporeal membrane oxygenation and intra-aortic balloon pump in 2, and extracorporeal membrane oxygenation and Impella CP in 1. Endocardial voltage maps showed myocardial scar in 19 patients (90%). The clinical VTs were inducible in 13 patients (62%), whereas 6 patients had premature ventricular contraction-induced ventricular fibrillation/VT (29%), and VT could not be induced in 2 patients (9%). Activation mapping was possible in all 13 with inducible clinical VTs. Substrate modification was performed in 15 patients with scar (79%). After ablation and scar modification, the arrhythmia was noninducible in 19 patients (91%). Seventeen (81%) were eventually weaned off mechanical support successfully, but 6 (29%) died during the index admission from persistent cardiogenic shock. Patients who had ventricular arrhythmia and cardiogenic shock on presentation had a trend toward lower in-hospital mortality compared with those who presented with cardiogenic shock and later developed ventricular arrhythmia. CONCLUSIONS: Bailout ablation for refractory ventricular arrhythmia in cardiogenic shock allowed successful weaning from mechanical support in a large proportion of patients. Mortality remains high, but the majority of patients were discharged home and survived beyond 1 year.


Assuntos
Circulação Assistida , Ablação por Cateter , Oxigenação por Membrana Extracorpórea , Frequência Cardíaca , Choque Cardiogênico/terapia , Taquicardia Ventricular/terapia , Fibrilação Ventricular/terapia , Idoso , Antiarrítmicos/uso terapêutico , Circulação Assistida/efeitos adversos , Circulação Assistida/instrumentação , Circulação Assistida/mortalidade , Ablação por Cateter/efeitos adversos , Ablação por Cateter/mortalidade , Resistência a Medicamentos , Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/instrumentação , Oxigenação por Membrana Extracorpórea/mortalidade , Feminino , Frequência Cardíaca/efeitos dos fármacos , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Recidiva , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/mortalidade , Choque Cardiogênico/fisiopatologia , Volume Sistólico , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/mortalidade , Taquicardia Ventricular/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/mortalidade , Fibrilação Ventricular/fisiopatologia , Função Ventricular Esquerda
8.
Am J Emerg Med ; 38(7): 1481-1487, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32345562

RESUMO

BACKGROUND: Electrical storm is a dangerous condition presenting to the Emergency Department that requires rapid diagnosis and management. OBJECTIVE: This article provides a review of the diagnosis and management of electrical storm for the emergency clinician. DISCUSSION: Electrical storm is defined as ≥3 episodes of sustained ventricular tachycardia, ventricular fibrillation, or shocks from an implantable cardioverter defibrillator within 24 h. Patients may present with a wide array of symptoms. Initial evaluation should include an electrocardiogram with a rhythm strip and continuous cardiac monitoring, a medication history, assessment of hemodynamic stability, and identification of potential triggers. Management includes an antiarrhythmic and a beta blocker. Refractory patients may benefit from double-sequential defibrillation or more invasive procedures such as intra-aortic balloon pumps, catheter ablation and extracorporeal membrane oxygenation for critically ill patients. These patients will typically require admission to an intensive care unit. CONCLUSION: Electrical storm is a condition associated with significant morbidity and mortality. It is important for clinicians to be aware of the current evidence regarding the evaluation and management of these patients.


Assuntos
Desfibriladores Implantáveis , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/terapia , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/terapia , Agonistas Adrenérgicos beta/uso terapêutico , Antagonistas Adrenérgicos beta/uso terapêutico , Algoritmos , Antiarrítmicos/uso terapêutico , Diagnóstico Diferencial , Eletrocardiografia , Serviço Hospitalar de Emergência , Humanos , Anamnese , Exame Físico , Fatores de Risco , Taquicardia Supraventricular/diagnóstico
9.
Am J Cardiol ; 125(8): 1162-1169, 2020 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-32087999

RESUMO

The aim of the present study was to determine whether free thyroxine (FT4) and calculated thyroid parameters predict the incidence of ventricular arrhythmias in euthyroid heart failure patients with implantable cardioverter-defibrillators (ICD). In this open-label prospective cohort study, 115 consecutive euthyroid patients (mean age 62.9 ± 1.3 years; 87% male; ischemic cardiomyopathy 63%) scheduled for primary prevention ICD implantation or exchange were enrolled. Serum concentrations of thyrotropin (thyroid-stimulating hormone) and FT4 were measured 1 day before device operation. Primary and secondary end points were defined as occurrence of appropriate ICD therapy (AIT) and cardiovascular death, respectively. During a mean follow-up of 1,191 ± 35 days, 24 patients (21%) experienced AIT, and cardiovascular death was observed in 10 patients (9%). Patients with AIT had higher FT4 concentrations compared with those without AIT (18.9 ± 0.48 vs 16.2 ± 0.22 pmol/L, p <0.001). FT4 was an independent predictor of AIT in an adjusted Cox regression (hazard ratio = 1.47, p <0.001). Kaplan-Meier analysis demonstrated that Jostel's thyroid-stimulating hormone index, reflecting the central component of the hypothalamus-pituitary-thyroid loop, and SPINA-GT as surrogate markers for thyroid's secretory capacity predicted AIT incidences. None of the indices predicted cardiovascular death. In conclusion, FT4 concentration predicts an increased incidence of ventricular arrhythmias in euthyroid patients receiving ICDs for primary prevention. Our data suggest that both impending primary hyperthyroidism and an increased thyroid homeostasis set point may increase the rate of AIT in this patient population.


Assuntos
Cardiomiopatias/terapia , Isquemia Miocárdica/terapia , Taquicardia Ventricular/epidemiologia , Tireotropina/sangue , Tiroxina/sangue , Fibrilação Ventricular/epidemiologia , Idoso , Estimulação Cardíaca Artificial/estatística & dados numéricos , Cardiomiopatias/complicações , Estudos de Coortes , Desfibriladores Implantáveis , Cardioversão Elétrica/estatística & dados numéricos , Feminino , Humanos , Incidência , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/complicações , Prevenção Primária , Modelos de Riscos Proporcionais , Estudos Prospectivos , Medição de Risco , Taquicardia Ventricular/prevenção & controle , Taquicardia Ventricular/terapia , Fibrilação Ventricular/prevenção & controle , Fibrilação Ventricular/terapia
10.
Open Heart ; 7(1): e001155, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32076562

RESUMO

Objective: Catheter ablation is an important treatment for ventricular tachycardia (VT) that reduces the frequency of episodes of VT. We sought to evaluate the cost-effectiveness of catheter ablation versus antiarrhythmic drug (AAD) therapy. Methods: A decision-analytic Markov model was used to calculate the costs and health outcomes of catheter ablation or AAD treatment of VT for a hypothetical cohort of patients with ischaemic cardiomyopathy and an implantable cardioverter-defibrillator. The health states and input parameters of the model were informed by patient-reported health-related quality of life (HRQL) data using randomised clinical trial (RCT)-level evidence wherever possible. Costs were calculated from a 2018 UK perspective. Results: Catheter ablation versus AAD therapy had an incremental cost-effectiveness ratio (ICER) of £144 150 (€161 448) per quality-adjusted life-year gained, over a 5-year time horizon. This ICER was driven by small differences in patient-reported HRQL between AAD therapy and catheter ablation. However, only three of six RCTs had measured patient-reported HRQL, and when this was done, it was assessed infrequently. Using probabilistic sensitivity analyses, the likelihood of catheter ablation being cost-effective was only 11%, assuming a willingness-to-pay threshold of £30 000 used by the UK's National Institute for Health and Care Excellence. Conclusion: Catheter ablation of VT is unlikely to be cost-effective compared with AAD therapy based on the current randomised trial evidence. However, better designed studies incorporating detailed and more frequent quality of life assessments are needed to provide more robust and informed cost-effectiveness analyses.


Assuntos
Antiarrítmicos/economia , Antiarrítmicos/uso terapêutico , Cardiomiopatias/complicações , Ablação por Cateter/economia , Custos de Cuidados de Saúde , Isquemia Miocárdica/complicações , Taquicardia Ventricular/economia , Taquicardia Ventricular/terapia , Idoso , Antiarrítmicos/efeitos adversos , Cardiomiopatias/diagnóstico , Cardiomiopatias/economia , Cardiomiopatias/terapia , Ablação por Cateter/efeitos adversos , Análise Custo-Benefício , Desfibriladores Implantáveis/economia , Custos de Medicamentos , Cardioversão Elétrica/economia , Cardioversão Elétrica/instrumentação , Medicina Baseada em Evidências/economia , Feminino , Humanos , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Modelos Econômicos , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/economia , Isquemia Miocárdica/terapia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto/economia , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiologia , Resultado do Tratamento
11.
JACC Cardiovasc Interv ; 13(4): 539-541, 2020 02 24.
Artigo em Inglês | MEDLINE | ID: mdl-32081249
13.
Circulation ; 141(11): 877-886, 2020 03 17.
Artigo em Inglês | MEDLINE | ID: mdl-31896278

RESUMO

BACKGROUND: The likelihood of neurologically favorable survival declines with prolonged resuscitation. However, the ability of extracorporeal cardiopulmonary resuscitation (ECPR) to modulate this decline is unknown. Our aim was to examine the effects of resuscitation duration on survival and metabolic profile in patients who undergo ECPR for refractory ventricular fibrillation/ventricular tachycardia out-of-hospital cardiac arrest. METHODS: We retrospectively evaluated survival in 160 consecutive adults with refractory ventricular fibrillation/ventricular tachycardia out-of-hospital cardiac arrest treated with the University of Minnesota (UMN) ECPR protocol (transport with ongoing cardiopulmonary resuscitation [CPR] to the cardiac catheterization laboratory for ECPR) compared with 654 adults who had received standard CPR in the amiodarone arm of the ALPS trial (Amiodarone, Lidocaine, or Placebo Study). We evaluated the metabolic changes and rate of survival in relation to duration of CPR in UMN-ECPR patients. RESULTS: Neurologically favorable survival was significantly higher in UMN-ECPR patients versus ALPS patients (33% versus 23%; P=0.01) overall. The mean duration of CPR was also significantly longer for UMN-ECPR patients versus ALPS patients (60 minutes versus 35 minutes; P<0.001). Analysis of the effect of CPR duration on neurologically favorable survival demonstrated significantly higher neurologically favorable survival for UMN-ECPR patients compared with ALPS patients at each CPR duration interval <60 minutes; however, longer CPR duration was associated with a progressive decline in neurologically favorable survival in both groups. All UMN-ECPR patients with 20 to 29 minutes of CPR (8 of 8) survived with neurologically favorable status compared with 24% (24 of 102) of ALPS patients with the same duration of CPR. There were no neurologically favorable survivors in the ALPS cohort with CPR ≥40 minutes, whereas neurologically favorable survival was 25% (9 of 36) for UMN-ECPR patients with 50 to 59 minutes of CPR and 19% with ≥60 minutes of CPR. Relative risk of mortality or poor neurological function was significantly reduced in UMN-ECPR patients with CPR duration ≥60 minutes. Significant metabolic changes included decline in pH, increased lactic acid and arterial partial pressure of carbon dioxide, and thickened left ventricular wall with prolonged professional CPR. CONCLUSIONS: ECPR was associated with improved neurologically favorable survival at all CPR durations <60 minutes despite severe progressive metabolic derangement. However, CPR duration remains a critical determinate of survival.


Assuntos
Acidose Láctica/etiologia , Reanimação Cardiopulmonar/métodos , Oxigenação por Membrana Extracorpórea , Hipercapnia/etiologia , Hipóxia/etiologia , Parada Cardíaca Extra-Hospitalar/terapia , Suporte Vital Cardíaco Avançado , Amiodarona/uso terapêutico , Dano Encefálico Crônico/etiologia , Dano Encefálico Crônico/prevenção & controle , Reanimação Cardiopulmonar/efeitos adversos , Estudos de Coortes , Método Duplo-Cego , Cardioversão Elétrica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto/estatística & dados numéricos , Parada Cardíaca Extra-Hospitalar/complicações , Parada Cardíaca Extra-Hospitalar/mortalidade , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Estudos Retrospectivos , Taxa de Sobrevida , Taquicardia Ventricular/complicações , Taquicardia Ventricular/terapia , Fatores de Tempo , Resultado do Tratamento , Fibrilação Ventricular/complicações , Fibrilação Ventricular/terapia
14.
Circ Cardiovasc Interv ; 13(2): e008540, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31973555

RESUMO

BACKGROUND: The temporal occurrence of arrhythmic complications after alcohol septal ablation (ASA) is unclear. As a result, the appropriate time to monitor patients after ASA is controversial. The purpose of this study is to determine the temporal occurrence of complete heart block (CHB) and ventricular tachyarrhythmia (VT) after ASA to better understand when patients can be safely discharged. METHODS: Consecutive patients treated with ASA for hypertrophic cardiomyopathy from 2003 to 2019 at a tertiary referral center were reviewed retrospectively. The incidence and timing of CHB or sustained VT within 30 days post-ASA were assessed. RESULTS: A total of 243 patients were included in this study. Mean maximal septal thickness was 19.0±3.9 mm, and total volume of ethanol injected was 1.7±0.6 mL. CHB occurred in 59 (24.3%) patients, including transient CHB in 33 (13.6%) and permanent in 26 (10.7%). The initial episode of CHB occurred within 24 hours post-ASA in 51 (21.0%) patients, between 24 and 48 hours in 3 (1.2%), between 48 and 72 hours in 3 (1.2%), and after 72 hours in 2 (0.8%). New permanent pacemaker was placed in 46 (18.3%). Presence of baseline bundle branch block and age ≥70 were significantly associated with CHB but not CHB presenting after 24 hours. VT occurred in 3 (1.2%) patients, including 1 (0.4%) within 24 hours, 1 (0.4%) between 24 and 48 hours, and 1 (0.4%) after 72 hours. VT required cardioversion in 2 patients and new implantable cardioverter-defibrillator placement in 2. CONCLUSIONS: The incidence of CHB or VT presenting after 72 hours post-ASA was low. These findings suggest that timely discharge of patients without evidence of early conduction disturbances after ASA can be considered as a potentially safe management strategy, especially in patients without preexisting conduction abnormalities.


Assuntos
Técnicas de Ablação/efeitos adversos , Cardiomiopatia Hipertrófica/cirurgia , Etanol/efeitos adversos , Bloqueio Cardíaco/epidemiologia , Taquicardia Ventricular/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Estimulação Cardíaca Artificial , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Cardiomiopatia Hipertrófica/epidemiologia , Desfibriladores Implantáveis , Cardioversão Elétrica/instrumentação , Etanol/administração & dosagem , Feminino , Bloqueio Cardíaco/diagnóstico , Bloqueio Cardíaco/terapia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Minnesota/epidemiologia , Marca-Passo Artificial , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/terapia , Fatores de Tempo , Resultado do Tratamento
15.
J Cardiovasc Electrophysiol ; 31(1): 185-195, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31840870

RESUMO

BACKGROUND: The accurate separation of undifferentiated wide complex tachycardias (WCTs) into ventricular tachycardia (VT) or supraventricular wide complex tachycardia (SWCT) using conventional, manually-applied 12-lead electrocardiogram (ECG) interpretation methods is difficult. PURPOSE: We sought to devise a new WCT differentiation method that operates solely on automated measurements routinely provided by computerized ECG interpretation software. METHODS: In a two-part analysis, we developed and validated a logistic regression model (ie, VT Prediction Model) that utilizes routinely available computerized measurements derived from patients' paired WCT and baseline ECGs. RESULTS: The derivation cohort consisted of 601 paired WCT (273 VT, 328 SWCT) and baseline ECGs from 421 patients. The VT Prediction Model, composed of WCT QRS duration (ms) (P < .0001), QRS duration change (ms) (P < .0001), QRS axis change (°) (P < .0001) and T axis change (°) (P < .0001), yielded effective VT and SWCT differentiation (area under the curve [AUC]: 0.924; confidence interval [CI]: 0.903-0.944) for the derivation cohort. The validation cohort comprised 241 paired WCT (97 VT, 144 SWCT) and baseline ECGs from 177 patients. The VT Prediction Model's implementation on the validation cohort yielded effective WCT differentiation (AUC: 0.900; CI: 0.862-0.939) with overall accuracy, sensitivity, and specificity of 85.0%, 80.4%, and 88.2%, respectively. CONCLUSION: The VT Prediction Model is an example of how readily available ECG measurements may be used to distinguish VT and SWCT effectively. Further study is needed to develop and refine newer WCT differentiation approaches that utilize computerized measurements provided by ECG interpretation software.


Assuntos
Potenciais de Ação , Técnicas de Apoio para a Decisão , Eletrocardiografia , Frequência Cardíaca , Taquicardia Supraventricular/diagnóstico , Taquicardia Ventricular/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Taquicardia Supraventricular/fisiopatologia , Taquicardia Supraventricular/terapia , Taquicardia Ventricular/fisiopatologia , Taquicardia Ventricular/terapia , Fatores de Tempo , Adulto Jovem
16.
Circ J ; 84(2): 226-234, 2020 01 24.
Artigo em Inglês | MEDLINE | ID: mdl-31875585

RESUMO

BACKGROUND: Left ventricular non-compaction (LVNC) is a cardiomyopathy characterized by prominent trabeculae and intertrabecular recesses. We present the cases of 3 girls with the sameryanodine receptor type 2(RYR2) mutation who had phenotypes of both catecholaminergic polymorphic ventricular tachycardia (CPVT) and LVNC .Methods and Results:Clinical characteristics and genetic background of the 3 patients were analyzed retrospectively. Age at onset was 5, 6, and 7 years, respectively. Clinical presentation included syncope during exercise in all 3 patients and cardiac arrest in 2 patients. LVNC diagnosis was confirmed on echocardiography according to previously defined criteria. Exercise stress testing provoked ventricular arrhythmia in two of the patients. Beta-blockers (n=3) and flecainide (n=2) were given, and an implantable cardioverter defibrillator was used in 1 patient. Genotyping identified the sameRYR2-R169Q missense mutation and no other CPVT- or LVNC-related gene mutations. Functional analysis of the mutation using HEK293 cells with single-cell Ca2+imaging and [3H]ryanodine binding analysis, indicated a gain of function: a reduced threshold for overload-induced Ca2+release from the sarcoplasmic reticulum and increased fractional Ca2+release. CONCLUSIONS: The rare association of LVNC and CPVT phenotypes withRYR2mutations is less likely to be coincidental. Screening for life-threatening arrhythmias using exercise or pharmacologic stress tests is recommended in LVNC patients to prevent sudden cardiac death in those with preserved LV function.


Assuntos
Miocárdio Ventricular não Compactado Isolado/genética , Mutação de Sentido Incorreto , Canal de Liberação de Cálcio do Receptor de Rianodina/genética , Taquicardia Ventricular/genética , Antagonistas Adrenérgicos beta/uso terapêutico , Antiarrítmicos/uso terapêutico , Sinalização do Cálcio , Criança , Pré-Escolar , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Cardioversão Elétrica/instrumentação , Feminino , Flecainida/uso terapêutico , Predisposição Genética para Doença , Células HEK293 , Hereditariedade , Humanos , Miocárdio Ventricular não Compactado Isolado/diagnóstico por imagem , Miocárdio Ventricular não Compactado Isolado/metabolismo , Miocárdio Ventricular não Compactado Isolado/terapia , Linhagem , Fenótipo , Estudos Retrospectivos , Canal de Liberação de Cálcio do Receptor de Rianodina/metabolismo , Retículo Sarcoplasmático/metabolismo , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/metabolismo , Taquicardia Ventricular/terapia
17.
Am J Med ; 133(7): 857-864, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31883773

RESUMO

BACKGROUND: Milrinone infusion is one of a few select "non-device" therapies for patients with New York Heart Association (NYHA) class IV, stage D heart failure, which has been associated with an increase in ventricular tachyarrhythmia and atrial fibrillation. Milrinone improves hemodynamics and provides symptomatic relief. Many patients with end-stage heart failure die from cardiac pump failure, and the impact of ventricular tachyarrhythmia and atrial fibrillation on their mortality is unclear. METHODS: This is a retrospective study of 98 consecutive patients receiving outpatient milrinone in a single center from 2008 to 2016. The primary endpoint of the study was overall survival on milrinone. Secondary endpoints were incidence of post-milrinone implantable cardioverter defibrillator (ICD) shocks and development of ventricular tachyarrhythmia or atrial fibrillation. RESULTS: Median survival was 581 ± 96 days with no difference between those with prior ventricular tachyarrhythmia and those without at 1 month (92% vs 97%, P = 0.34), 6 months (67% vs 73%, P = 0.75), and 12 months (67% vs 61%, P = 0.88). Seven out of 12 (58%) patients with prior ventricular tachyarrhythmia had ICD shocks, as compared to 5 out of 78 (6.4%) (P <0.001). Thirty-five patients had atrial fibrillation prior to starting milrinone, which decreased to 72% (P <0.05) by the third follow-up time period (7-9 months). Amiodarone use was protective against new onset atrial fibrillation. CONCLUSIONS: Patients with stage D heart failure with a history of ventricular tachyarrhythmia have similar survival on outpatient milrinone compared to those without. However, those with prior ventricular tachyarrhythmia received more ICD shocks for more ventricular tachyarrhythmias. Milrinone remains a viable therapy for patients with stage D heart failure with limited therapeutic options.


Assuntos
Fibrilação Atrial/complicações , Desfibriladores Implantáveis , Insuficiência Cardíaca/terapia , Milrinona/administração & dosagem , Taquicardia Ventricular/complicações , Idoso , Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/terapia , Cardiotônicos/administração & dosagem , Relação Dose-Resposta a Droga , Feminino , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/mortalidade , Humanos , Infusões Intravenosas , Masculino , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Taquicardia Ventricular/fisiopatologia , Taquicardia Ventricular/terapia
18.
Medicine (Baltimore) ; 98(49): e18080, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804316

RESUMO

BACKGROUND: Tpeak-Tend interval (TpTe), a measurement of transmural dispersion of repolarization (TDR), has been shown to predict ventricular tachyarrhythmia in cardiac resynchronization therapy with defibrillator (CRT-D) patients. However, the ability of TpTe to predict ventricular tachyarrhythmia and mortality for heart failure patients with a cardioverter-defibrillator (ICD) is not clear. The purpose of this study was to assess the predictive ability of TpTe in heart failure patients with ICD. METHODS AND RESULTS: We enrolled 318 heart failure patients treated after ICD. Patients were divided into 3 groups according to their post-implantation TpTe values and were evaluated every 6 months. The primary endpoint was appropriate ICD therapy. The secondary endpoint was all-cause mortality. During long-term follow-up, the TpTe > 110 ms group (n = 111) experienced more VT/VF episodes (45%) and all-cause mortality (25.2%) than the TpTe 90-110 ms group (n = 109) (26.4%, 14.5%) and TpTe < 90 ms group (n = 98) (11.3%, 11.3%) (overall P < .05, respectively). In Cox regression, longer post-implantation TpTe was associated with an increased number of VT/VF episodes [HR: 1.017; 95% CI: 1.008-1.026; P < .001], all-cause mortality [HR: 1.015; 95% CI: 1.004-1.027; P = .010] and the combined endpoint [HR: 1.018; 95%CI: 1.010-1.026; P < .001]. CONCLUSIONS: Post-implantation TpTe was an independent predictor of both ventricular arrhythmias and all-cause mortality in heart failure patients with an implanted ICD.


Assuntos
Terapia de Ressincronização Cardíaca/métodos , Eletrocardiografia , Insuficiência Cardíaca/mortalidade , Taquicardia Ventricular/terapia , Adulto , Idoso , Desfibriladores Implantáveis , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Taquicardia Ventricular/etiologia
19.
BMC Cardiovasc Disord ; 19(1): 298, 2019 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-31847799

RESUMO

BACKGROUND: Patients with some mutations in the lamin A/C (LMNA) gene are characterized by the presence of dilated cardiomyopathy (DCM), conduction abnormalities, ventricular tachyarrhythmias (VT), and sudden cardiac death (SCD). Various clinical features have been observed among patients who have the same LMNA mutation. Here, we show a family with cardiac laminopathy with a c.475G > T, p.E159* LMNA mutation, and a family history of conduction disorder, DCM, VT, and SCD. CASE PRESENTATION: A proband (female) with atrial fibrillation and bradycardia was implanted with a pacemaker in her fifties. Twenty years later, she experienced a loss of consciousness due to polymorphic VT. She had a serious family history; her mother and elder sister died suddenly in their fifties and sixties, respectively, and her nephew and son were diagnosed as having DCM. Genetic screening of the proband, her son, and nephew identified a nonsense mutation (c.475G > T, p.E159*) in the LMNA gene. Although the proband's left ventricular ejection fraction remained relatively preserved, her son and nephew's left ventricular ejection fraction were reduced, resulting in cardiac resynchronization therapy by implantation of a defibrillator. CONCLUSIONS: In this family with cardiac laminopathy with a c.475G > T, p.E159* LMNA mutation, DCM, SCD, and malignant VT occurred. Clinical manifestation of various atrial and ventricular arrhythmias and heart failure with reduced ejection fraction occurred in an age-dependent manner in all family members who had the nonsense mutation. It appears highly likely that the E159* LMNA mutation is related to various cardiac problems in the family of the current report.


Assuntos
Doença do Sistema de Condução Cardíaco/genética , Cardiomiopatia Dilatada/genética , Morte Súbita Cardíaca/etiologia , Sistema de Condução Cardíaco/fisiopatologia , Lamina Tipo A/genética , Mutação , Síndrome do Nó Sinusal/genética , Taquicardia Ventricular/genética , Potenciais de Ação , Adulto , Idoso , Doença do Sistema de Condução Cardíaco/diagnóstico , Doença do Sistema de Condução Cardíaco/fisiopatologia , Doença do Sistema de Condução Cardíaco/terapia , Cardiomiopatia Dilatada/diagnóstico , Cardiomiopatia Dilatada/fisiopatologia , Cardiomiopatia Dilatada/terapia , Morte Súbita Cardíaca/prevenção & controle , Feminino , Predisposição Genética para Doença , Frequência Cardíaca , Hereditariedade , Humanos , Masculino , Pessoa de Meia-Idade , Linhagem , Fenótipo , Prognóstico , Fatores de Risco , Síndrome do Nó Sinusal/diagnóstico , Síndrome do Nó Sinusal/fisiopatologia , Síndrome do Nó Sinusal/terapia , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatologia , Taquicardia Ventricular/terapia
20.
Medicine (Baltimore) ; 98(44): e17790, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689853

RESUMO

RATIONALE: Stellate Ganglion Block (SGB) provides a blockade of sympathetic signals from the sympathetic chain and appears to be a promising method of controlling refractory ventricular arrhythmias, but there are scanty data in the literature. PATIENT CONCERNS: Herein, we describe a 59-year-old male patient with a history of non-ischemic cardiomyopathy and suffering from frequent VT episodes, who received ICD implantation and regular amiodarone medication control. DIAGNOSES: Monomorphic VT refractory to standard medication control and focal extensive catheter ablation. INTERVENTIONS: Left Stellate Ganglion Block (LSGB) was performed under ultrasound-assisted injection at the C6 level using a 10 ml solution of 0.4% lidocaine and 0.5% bupivacaine. OUTCOMES: In our case, refractory VT subsided and sinus rhythm was retained immediately after LSGB. There were no VT episodes for at least 3 hours during the inter-hospital transfer, which did not involve any specific complications. LESSONS: LSGB may provide effective VT control and play an important role in rescue and bridge therapy before catheter ablation.


Assuntos
Bloqueio Nervoso Autônomo/métodos , Cardiomiopatias/terapia , Gânglio Estrelado , Taquicardia Ventricular/terapia , Cardiomiopatias/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Taquicardia Ventricular/complicações , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA