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1.
JACC Clin Electrophysiol ; 8(4): 513-525, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35450607

RESUMO

OBJECTIVES: The goal of this study was to evaluate whether intermittent VNS reduces electrical heterogeneities and arrhythmia inducibility during sympathoexcitation. BACKGROUND: Sympathoexcitation increases the risk of ventricular tachyarrhythmias (VT). Vagal nerve stimulation (VNS) has been antiarrhythmic in the setting of ischemia-driven arrhythmias, but it is unclear if it can overcome the electrophysiological effects of sympathoexcitation in the setting of chronic myocardial infarction (MI). METHODS: In Yorkshire pigs after chronic MI, a sternotomy was performed, a 56-electrode sock was placed over the ventricles (n = 17), and a basket catheter was positioned in the left ventricle (n = 6). Continuous unipolar electrograms from sock and basket arrays were obtained to analyze activation recovery interval (ARI), a surrogate of action potential duration. Bipolar voltage mapping was performed to define scar, border zone, or viable myocardium. Hemodynamic and electrical parameters and VT inducibility were evaluated during sympathoexcitation with bilateral stellate ganglia stimulation (BSS) and during combined BSS with intermittent VNS. RESULTS: During BSS, global epicardial ARIs shortened from 384 ± 59 milliseconds to 297 ± 63 milliseconds and endocardial ARIs from 359 ± 36 milliseconds to 318 ± 40 milliseconds. Dispersion in ARIs increased in all regions, with the greatest increase observed in scar and border zone regions. VNS mitigated the effects of BSS on border zone ARIs (from -18.3% ± 6.3% to -2.1% ± 14.7%) and ARI dispersion (from 104 ms2 [1 to 1,108 ms2] to -108 ms2 [IQR: -588 to 30 ms2]). VNS reduced VT inducibility during sympathoexcitation (from 75%-40%; P < 0.05). CONCLUSIONS: After chronic MI, VNS overcomes the detrimental effects of sympathoexcitation by reducing electrophysiological heterogeneities exacerbated by sympathetic stimulation, decreasing VT inducibility.


Assuntos
Infarto do Miocárdio , Taquicardia Ventricular , Estimulação do Nervo Vago , Animais , Arritmias Cardíacas , Cicatriz , Coração , Frequência Cardíaca/fisiologia , Humanos , Infarto do Miocárdio/complicações , Infarto do Miocárdio/terapia , Suínos , Taquicardia Ventricular/terapia
2.
Crit Care Clin ; 38(2): 231-242, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35369945

RESUMO

The understanding and prevalence of cardiac channelopathies has grown over time. Many patients are asymptomatic but are at risk for malignant arrhythmias during high-acuity medical admissions. Long QT syndrome, Brugada syndrome, and catecholaminergic polymorphic ventricular tachycardia are discussed with specific consideration given for the role these medical conditions play during an intensive care unit admission-for either cardiac or noncardiac reasons.


Assuntos
Canalopatias , Taquicardia Ventricular , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/terapia , Canalopatias/diagnóstico , Canalopatias/genética , Canalopatias/terapia , Morte Súbita Cardíaca , Humanos , Unidades de Terapia Intensiva , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/terapia
3.
Tex Heart Inst J ; 49(2)2022 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-35395087

RESUMO

Continuous ganglion block is increasingly being used to help manage ventricular tachyarrhythmias. We present the cases of 2 patients in whom we used continuous left thoracic paravertebral block to achieve sympathetic denervation and improvement in drug-refractory ventricular tachyarrhythmias. Whether as destination therapy or bridging therapy, we conclude that the block is safe, improves patients' comfort, and is superior in several ways to stellate ganglion block and other single-injection techniques.


Assuntos
Bloqueio Nervoso Autônomo , Taquicardia Ventricular , Bloqueio Nervoso Autônomo/métodos , Humanos , Gânglio Estrelado , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/terapia
4.
Tex Heart Inst J ; 49(2)2022 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-35395088

RESUMO

Patients with left ventricular noncompaction (LVNC) are at risk of clinically significant arrhythmias and sudden death. We evaluated whether implantable loop recorders could detect significant arrhythmias that might be missed in these patients during annual Holter monitoring. Selected pediatric and adult patients with LVNC who consented to implantable loop recorder placement were monitored for 3 years (study duration, 10 April 2014-9 December 2019). Fourteen subjects were included (age range, 6.5-36.4 yr; 8 males). Of 13 patients who remained after one device extrusion, one underwent implantable cardioverter-defibrillator placement. Four patients (31%) had significant arrhythmias: atrial tachycardia (n=2), nonsustained ventricular tachycardia (n=1), and atrial fibrillation (n=1). All 4 events were clinically asymptomatic and not associated with left ventricular ejection fraction. In addition, a high frequency of benign arrhythmic patterns was detected. Implantable loop recorders enable continuous, long-term detection of important subclinical arrhythmias in selected patients who have LVNC. These devices may prove to be most valuable in patients who have LVNC and moderate or greater ventricular dysfunction.


Assuntos
Fibrilação Atrial , Desfibriladores Implantáveis , Cardiopatias Congênitas , Taquicardia Ventricular , Adolescente , Adulto , Fibrilação Atrial/diagnóstico , Criança , Eletrocardiografia Ambulatorial , Humanos , Masculino , Volume Sistólico , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/terapia , Função Ventricular Esquerda , Adulto Jovem
5.
Int J Mol Sci ; 23(8)2022 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-35457253

RESUMO

Cardiac diseases are the leading causes of death, with a growing number of cases worldwide, posing a challenge for both healthcare and research. Therefore, the most relevant aim of cardiac research is to unravel the molecular pathomechanisms and identify new therapeutic targets. Cardiac ryanodine receptor (RyR2), the Ca2+ release channel of the sarcoplasmic reticulum, is believed to be a good therapeutic target in a group of certain heart diseases, collectively called cardiac ryanopathies. Ryanopathies are associated with the impaired function of the RyR, leading to heart diseases such as congestive heart failure (CHF), catecholaminergic polymorphic ventricular tachycardia (CPVT), arrhythmogenic right ventricular dysplasia type 2 (ARVD2), and calcium release deficiency syndrome (CRDS). The aim of the current review is to provide a short insight into the pathological mechanisms of ryanopathies and discuss the pharmacological approaches targeting RyR2.


Assuntos
Canal de Liberação de Cálcio do Receptor de Rianodina , Taquicardia Ventricular , Displasia Arritmogênica Ventricular Direita , Cálcio/metabolismo , Sinalização do Cálcio , Humanos , Mutação , Canal de Liberação de Cálcio do Receptor de Rianodina/genética , Canal de Liberação de Cálcio do Receptor de Rianodina/metabolismo , Retículo Sarcoplasmático/metabolismo , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/metabolismo , Taquicardia Ventricular/terapia
6.
J Cardiovasc Electrophysiol ; 33(5): 1024-1031, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35245401

RESUMO

INTRODUCTION: Cardiac resynchronization therapy (CRT) and left ventricular assist devices (LVAD) improve outcomes in heart failure patients. Early ventricular arrhythmias (VA) are common after LVAD and are associated with increased mortality. The association between left ventricular pacing (LVP) with CRT and VAs in the early post-LVAD period remains unclear. METHODS: This was a retrospective study of all patients undergoing LVAD implantation from 1/2016 to 12/2019. Patients were divided into those with CRT and active LVP (CRT-LVP) immediately post-LVAD implant versus those without CRT-LVP. Implantable cardiac defibrillator electrograms were reviewed and early VAs were defined as sustained ventricular tachycardia (VT)/ventricular fibrillation occurring within 30 days of LVAD implantation. RESULTS: Of 186 included patients (mean age 53 years, 75% male, mean body mass index 28), 72 had CRT devices, 63 of whom had LV pacing enabled after LVAD implant (CRT-LVP group). Patients with CRT-LVP were more likely to have VA in the early postoperative period (21% vs. 4%; p = .0001). All 9 patients with CRT in whom LVP was disabled had no early VA. Among those with early VA, patients with CRT-LVP were more likely to have monomorphic VT (77% vs. 40%; p = .07). In multiple logistic regression, CRT-LVP pacing remained an independent predictor of early VA after adjustment for history of VA and AF. CONCLUSIONS: Patients with CRT-LVP after LVAD implant had a higher incidence of early VA (specifically monomorphic VT). Epicardial LV pacing may be proarrhythmic in the early postoperative period after LVAD.


Assuntos
Terapia de Ressincronização Cardíaca , Insuficiência Cardíaca , Coração Auxiliar , Taquicardia Ventricular , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/terapia , Terapia de Ressincronização Cardíaca/efeitos adversos , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Coração Auxiliar/efeitos adversos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/epidemiologia , Taquicardia Ventricular/terapia , Resultado do Tratamento , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/epidemiologia , Fibrilação Ventricular/terapia
7.
BMJ Open ; 12(3): e058151, 2022 03 09.
Artigo em Inglês | MEDLINE | ID: mdl-35264369

RESUMO

OBJECTIVES: To evaluate sex differences in demographic and clinical characteristics, treatments and outcomes for patients with diagnosed obstructive hypertrophic cardiomyopathy (oHCM) in the USA. SETTING: Retrospective observational study of administrative claims data from MarketScan Commercial Claims and Encounters Database from IBM Watson Health. PARTICIPANTS: Of the 28 million covered employees and family members in MarketScan, 9306 patients with oHCM were included in this analysis. MAIN OUTCOME MEASURES: oHCM-related outcomes included heart failure, atrial fibrillation, ventricular tachycardia/ fibrillation, sudden cardiac death, septal myectomy, alcohol septal ablation (ASA) and heart transplant. RESULTS: Among 9306 patients with oHCM, the majority were male (60.5%, p<0.001) and women were of comparable age to men (50±15 vs 49±15 years, p<0.001). Women were less likely to be prescribed beta blockers (42.7% vs 45.2%, p=0.017) and undergo an implantable cardioverter-defibrillator (1.7% vs 2.6%, p=0.005). Septal reduction therapy was performed slightly more frequently in women (ASA: 0.08% vs 0.05%, p=0.600; SM: 0.35% vs 0.18%, p=0.096), although not statistically significant. Women were less likely to have atrial fibrillation (6.7% vs 9.9%, p<0.001). CONCLUSION: Women were less likely to be prescribed beta blockers, ACE inhibitors, anticoagulants, undergo implantable cardioverter-defibrillator and have ventricular tachycardia/fibrillation. Men were more likely to have atrial fibrillation. Future research using large, clinical real-world data are warranted to understand the root cause of these potential treatment disparities in women with oHCM.


Assuntos
Fibrilação Atrial , Cardiomiopatia Hipertrófica , Desfibriladores Implantáveis , Taquicardia Ventricular , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/etiologia , Fibrilação Atrial/terapia , Cardiomiopatia Hipertrófica/epidemiologia , Cardiomiopatia Hipertrófica/terapia , Morte Súbita Cardíaca , Desfibriladores Implantáveis/efeitos adversos , Feminino , Humanos , Masculino , Estudos Retrospectivos , Caracteres Sexuais , Taquicardia Ventricular/epidemiologia , Taquicardia Ventricular/terapia , Resultado do Tratamento , Fibrilação Ventricular
8.
Resuscitation ; 174: 16-19, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35276312

RESUMO

BACKGROUND: European resuscitation guidelines describe several acceptable placements of defibrillator pads during resuscitation of cardiac arrest. However, no clinical trial has compared defibrillation efficacy between any of the different pad placements. Houston Fire Department emergency medical system (EMS) used anterior-posterior (AP) defibrillator pad placement before becoming a study site in the circulation improving resuscitation care trial (CIRC). During CIRC, Houston Fire EMS used sternal-apical (SA) pad placement. METHODS: Data from electronic defibrillator records was compared between a pre-CIRC dataset and patients in the CIRC trial receiving manual cardiopulmonary resuscitation (CPR). Only shocks from patients with initial ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) were included. Measured outcome was defibrillation efficacy, defined as termination of VF/VT. The general estimatingequations model was used to study the association between defibrillation efficacy rates in the AP vs SA group. RESULTS: In the pre-CIRC dataset, 207 included patients received 1023 shocks with AP pad placement, compared with 277 patients from the CIRC trial who received 1020 shocks with SA pad placement. There was no significant difference in defibrillation efficacy between AP and SA pads placement (82.1 % vs 82.2 %, p = 0.98). CONCLUSION: No difference was observed in defibrillation efficacy between AP and SA pad placement in this study. A randomized clinical trial may be indicated.


Assuntos
Reanimação Cardiopulmonar , Serviços Médicos de Emergência , Parada Cardíaca , Choque , Taquicardia Ventricular , Desfibriladores , Cardioversão Elétrica , Humanos , Taquicardia Ventricular/terapia , Fibrilação Ventricular/complicações , Fibrilação Ventricular/terapia
9.
Am J Emerg Med ; 55: 232.e3-232.e4, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35272901

RESUMO

Bupropion is an atypical antidepressant often used in the treatment of depression, tobacco cessation, seasonal affective disorder, and off label for ADHD. Its primary mechanism of action is by blocking dopamine and norepinephrine reuptake and it is structurally similar to amphetamines. Toxic effects include, most notably and classically, seizures as well as tachycardia, agitation, nausea and vomiting, QT prolongation, QRS widening, hypertension/hypotension. It has a narrow therapeutic window with maximal daily dosing being 450 mg daily. We are reporting the case of a 14-year-old female who ingested 15 g of extended-release bupropion resulting in agitation, status epilepticus, prolonged QT devolving into pulseless Ventricular Tachycardia and briefly V Fib, requiring a total of 5 cardioversions and 1 defibrillation. The QT interval eventually narrowed after supportive care and lidocaine drip. The patient was able to be extubated just two days later with full cognitive function and echocardiogram without cardiac dysfunction. Seizure and cardiotoxicity (including prolonged QT) have been previously described with massive bupropion overdoses. To our knowledge, deterioration to Ventricular Tachycardia and Ventricular Fibrillation with successful treatment and shortening of QT interval with lidocaine bolus and drip has not been reported. Cardiotoxicity related to bupropion has previously been primarily supportive and avoidance of QT prolonging antiarrhythmics such as amiodarone, and at times requiring VA ECMO. Lidocaine has previously been used in tox cases to shorten QT intervals. The hope is for this information to be helpful to other EM and Critical Care providers when placed in similarly difficult circumstances.


Assuntos
Antidepressivos de Segunda Geração , Overdose de Drogas , Síndrome do QT Longo , Estado Epiléptico , Taquicardia Ventricular , Adolescente , Bupropiona , Cardiotoxicidade , Overdose de Drogas/terapia , Feminino , Humanos , Lidocaína , Síndrome do QT Longo/induzido quimicamente , Síndrome do QT Longo/terapia , Convulsões , Estado Epiléptico/induzido quimicamente , Estado Epiléptico/terapia , Taquicardia Ventricular/induzido quimicamente , Taquicardia Ventricular/terapia
10.
JAMA Cardiol ; 7(4): 445-449, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35171197

RESUMO

IMPORTANCE: Autonomic neuromodulation provides therapeutic benefit in ventricular tachycardia (VT) storm. Transcutaneous magnetic stimulation (TcMS) can noninvasively and nondestructively modulate a patient's nervous system activity and may reduce VT burden in patients with VT storm. OBJECTIVE: To evaluate the safety and efficacy of TcMS of the left stellate ganglion for patients with VT storm. DESIGN, SETTING, AND PARTICIPANTS: This double-blind, sham-controlled randomized clinical trial took place at a single tertiary referral center between August 2019 and July 2021. The study included 26 adult patients with 3 or more episodes of VT in 24 hours. INTERVENTIONS: Patients were randomly assigned to receive a single session of either TcMS that targeted the left stellate ganglion (n = 14) or sham stimulation (n = 12). MAIN OUTCOMES AND MEASURES: The primary outcome was freedom from VT in the 24-hour period following randomization. Key secondary outcomes included safety of TcMS on cardiac implantable electronic devices, as well as burden of VT in the 72-hour period following randomization. RESULTS: Among 26 patients (mean [SD] age, 64 [13] years; 20 [77%] male), a mean (SD) of 12.7 (10.3) episodes of VT occurred within the 24 hours preceding randomization. Patients had recurrent VT despite taking a mean (SD) of 2.0 (0.6) antiarrhythmic drugs (AADs), and 11 patients (42%) required mechanical hemodynamic support at the time of randomization. In the 24-hour period after randomization, VT recurred in 4 of 14 patients (29% [SD 47%]) in the TcMS group vs 7 of 12 patients (58% [SD 51%]) in the sham group (P = .20). In the 72-hour period after randomization, patients in the TcMS group had a mean (SD) of 4.5 (7.2) episodes of VT vs 10.7 (13.8) in the sham group (incidence rate ratio, 0.42; P < .001). Patients in the TcMS group were taking fewer AADs 24 hours after randomization compared with baseline (mean [SD], 0.9 [0.8] vs 1.8 [0.4]; P = .001), whereas there was no difference in the number of AADs taken for the sham group (mean [SD], 2.3 [0.8] vs 1.9 [0.5]; P = .20). None of the 7 patients in the TcMS group with a cardiac implantable electronic device had clinically significant effects on device function. CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, findings support the potential for TcMS to safely reduce the burden of VT in the setting of VT storm in patients with and without cardiac implantable electronic devices and inform the design of future trials to further investigate this novel treatment approach. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04043312.


Assuntos
Taquicardia Ventricular , Adulto , Antiarrítmicos/uso terapêutico , Feminino , Coração , Humanos , Fenômenos Magnéticos , Masculino , Pessoa de Meia-Idade , Taquicardia Ventricular/tratamento farmacológico , Taquicardia Ventricular/terapia , Resultado do Tratamento
11.
Clin Res Cardiol ; 111(5): 475-478, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35179615

RESUMO

Implantable cardioverter defibrillators (ICDs) have been shown to reduce the risk of sudden cardiac death in primary or secondary prevention with thousands of ICDs implanted every year worldwide. Whilst ICD are more commonly implanted transvenously (TV), this approach carries high risk of peri- and post-procedural complications. Subcutaneous ICD (S-ICD) have been introduced to overcome the intravascular complications of TV system by placing all metalware outside the chest cavity for those with an indication for a defibrillator and no pacing requirements. In conclusion, a review of the current guidelines recommendations regarding S-ICD may be needed considering the emerging evidence which shows high efficacy and safety with contemporary devices and programming algorithms. A stronger recommendation may be developed for selective patients who have an indication for single-chamber ICD in the absence of negative screening, recurrent monomorphic ventricular tachycardia, cardiac resynchronization therapy, or pacemaker indication. These criteria encapsulate a large proportion (around 70%!) of all ICD eligible patients.


Assuntos
Terapia de Ressincronização Cardíaca , Desfibriladores Implantáveis , Marca-Passo Artificial , Taquicardia Ventricular , Terapia de Ressincronização Cardíaca/efeitos adversos , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis/efeitos adversos , Humanos , Marca-Passo Artificial/efeitos adversos , Taquicardia Ventricular/complicações , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/terapia
13.
CJEM ; 24(2): 174-184, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35066789

RESUMO

INTRODUCTION: While wide complex tachycardia (WCT) is potentially lethal, little is known about its incidence in the ED or about expertise of ED physicians in diagnosing and treating it. We sought to compare WCT ED cases that were primary arrhythmias versus those with rapid heart rate secondary to medical issues, as well as the accuracy of ED diagnosis and appropriateness of treatment. METHODS: We conducted a health records review at a large academic hospital ED staffed by 95 physicians and included consecutive patients over 28 months (2018-2020) with WCT (heart rate ≥ 120 bpm and QRS ≥ 120 ms). Cases were adjudicated for the accuracy of ECG diagnosis versus the cardiology read and for correctness of treatment as per guidelines by two ED physicians and one cardiologist. RESULTS: We identified 306 eligible cases (0.2% of all ED visits): mean age 73.9 years, male 66.0%, admitted 53.3%, died in ED 2.3%. Primary arrhythmias and secondary tachycardias were each 50.0% (95% CI 44.4-55.6%). ED physicians correctly interpreted 81.2% of ECGs. The most common presenting arrythmias and % correct were: atrial fibrillation 42.7% (95.0%), atrial flutter 22.2% (63.5%), sinus tachycardia 12.0% (78.6%), and supraventricular tachycardia (SVT) 11.1% (68.0%). Treatments were judged optimal in 84.3% of primary WCT and 86.9% in secondary WCT. Treatments were suboptimal for: inappropriate drug (3.9% for primary versus 1.3% for secondary), failure to reduce heart rate < 100 prior to discharge home (9.1% for primary versus 34.4% for secondary), and not treating the underlying cause in 5.9% of secondary WCT. CONCLUSIONS: WCT cases were evenly split between primary arrhythmias and secondary cases. ED physicians interpreted the ECG correctly in 81% but over-called atrial flutter and SVT. They implemented appropriate care in most cases but sometimes failed to adequately control heart rate or to treat the underlying condition, suggesting opportunities to improve care of WCT in the ED.


RéSUMé: INTRODUCTION: Bien que la tachycardie à complexe large (wide complex tachycardia WCT) soit potentiellement mortelle, on sait peu de choses sur son incidence aux urgences ou sur l'expertise des médecins des urgences en matière de diagnostic et de traitement. Nous avons cherché à comparer les cas WCT aux urgences qui étaient des arythmies primaires par rapport à ceux avec une fréquence cardiaque rapide secondaire à des problèmes médicaux, ainsi que la précision du diagnostic des urgences et la pertinence du traitement. MéTHODES: Nous avons effectué un examen des dossiers médicaux dans les urgences d'un grand hôpital universitaire où travaillent 95 médecins et avons inclus des patients consécutifs sur 28 mois (2018-2020) présentant un WCT (fréquence cardiaque ≥120 bpm et QRS ≥120 ms). Les cas ont été jugés par deux médecins des urgences et un cardiologue pour l'exactitude du diagnostic ECG par rapport à la lecture cardiologique et pour l'exactitude du traitement conformément aux directives. RéSULTATS: Nous avons identifié 306 cas éligibles (0,2 % de toutes les visites aux urgences) : âge moyen 73,9 ans, hommes 66,0 %, admis 53,3 %, décédés aux urgences 2,3 %. Les arythmies primaires et les tachycardies secondaires étaient chacune de 50,0 % (IC 95 % 44,4-55,6 %). Les médecins des urgences ont interprété correctement 81,2 % des ECG. Les arythmies les plus fréquentes et les pourcentages d'interprétation correcte étaient les suivants : fibrillation auriculaire 42,7 % (95,0 %), flutter auriculaire 22,2 % (63,5 %), tachycardie sinusale 12,0 % (78,6 %) et tachycardie supraventriculaire (TSV) 11,1 % (68,0 %). Les traitements ont été jugés optimaux dans 84,3 % des WCT primaires et 86,9 % des WCT secondaires. Les traitements étaient sous-optimaux pour les raisons suivantes : médicament inapproprié (3,9 % pour le primaire contre 1,3 % pour le secondaire), incapacité à réduire la fréquence <100 avant le retour à domicile (9,1 % pour le primaire contre 34,4 % pour le secondaire) et absence de traitement de la cause sous-jacente dans 5,9 % du WCT secondaire. CONCLUSIONS: Les cas de WCT étaient répartis uniformément entre les arythmies primaires et les cas secondaires. Les médecins du service d'urgence ont correctement interprété l'ECG dans 81 % des cas, mais ont surévalué le flutter auriculaire et la TSV. Ils ont mis en œuvre des soins appropriés dans la plupart des cas, mais n'ont pas toujours réussi à contrôler adéquatement la fréquence cardiaque ou à traiter la maladie sous-jacente, ce qui laisse entrevoir des possibilités d'améliorer les soins de WCT au service d'urgence.


Assuntos
Fibrilação Atrial , Flutter Atrial , Taquicardia Paroxística , Taquicardia Supraventricular , Taquicardia Ventricular , Idoso , Fibrilação Atrial/diagnóstico , Flutter Atrial/diagnóstico , Flutter Atrial/epidemiologia , Flutter Atrial/terapia , Diagnóstico Diferencial , Eletrocardiografia , Serviço Hospitalar de Emergência , Humanos , Masculino , Taquicardia Ventricular/terapia
14.
Can J Cardiol ; 38(4): 439-453, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34979281

RESUMO

Electrical storm, characterized by repetitive ventricular tachycardia/ventricular fibrillation over a short period, is becoming more common with widespread use of implantable cardioverter defibrillator (ICD) therapy. Electrical storm, sometimes called "arrhythmic storm" or "ventricular tachycardia storm," is usually a medical emergency requiring hospitalization and expert management, and significantly affects short- and long-term outcomes. This syndrome typically occurs in patients with underlying structural heart disease (ischemic or nonischemic cardiomyopathy) or inherited channelopathies. Triggers for electrical storm should be sought but are often unidentifiable. Initial management is dictated by the hemodynamic status, whereas subsequent management typically involves ICD interrogation and reprogramming to reduce recurrent shocks, identification and management of triggers like electrolyte abnormalities, myocardial ischemia, or decompensated heart failure, and antiarrhythmic drug therapy or catheter ablation. Sympathetic nervous system activation is central to the initiation and maintenance of arrhythmic storm, so autonomic modulation is a cornerstone of management. Sympathetic inhibition can be achieved with medications (particularly ß-adrenoreceptor blockers), deep sedation, or cardiac sympathetic denervation. More definitive management targets the underlying ventricular arrhythmia substrate to terminate and prevent recurrent arrhythmia. Arrhythmia targeting can be achieved with antiarrhythmic medications, catheter ablation, or more novel therapies, such as stereotactic radiation therapy, that target the arrhythmic substrate. Mechanistic studies point to adrenergic activation and other direct consequences of ICD shocks in promoting further arrhythmogenesis and hypocontractility. In this report, we review the pathophysiologic mechanisms, clinical features, prognosis, and therapeutic options for electrical storm. We also outline a clinical approach to this challenging and complex condition, along with its mechanistic basis.


Assuntos
Ablação por Cateter , Desfibriladores Implantáveis , Taquicardia Ventricular , Antiarrítmicos/uso terapêutico , Ablação por Cateter/efeitos adversos , Humanos , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/terapia , Resultado do Tratamento , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/etiologia , Fibrilação Ventricular/terapia
17.
Orphanet J Rare Dis ; 17(1): 6, 2022 01 06.
Artigo em Inglês | MEDLINE | ID: mdl-34991670

RESUMO

BACKGROUND: Fabry disease (FD) is a treatable X-linked condition leading to progressive cardiac disease, arrhythmia and premature death. We aimed to increase awareness of the arrhythmogenicity of Fabry cardiomyopathy, by comparing device usage in patients with Fabry cardiomyopathy and sarcomeric HCM. All Fabry patients with an implantable cardioverter defibrillator (ICD) implanted in the UK over a 17 year period were included. A comparator group of HCM patients, with primary prevention ICD implantation, were captured from a regional registry database. RESULTS: Indications for ICD in FD varied with 72% implanted for primary prevention based on multiple potential risk factors. In FD and HCM primary prevention devices, arrhythmia occurred more frequently in FD over shorter follow-up (HR 4.2, p < 0.001). VT requiring therapy was more common in FD (HR 4.5, p = 0.002). Immediate shock therapy for sustained VT was also more common (HR 2.5, p < 0.001). There was a greater burden of AF needing anticoagulation and NSVT in FD (AF: HR 6.2, p = 0.004, NSVT: HR 3.1, p < 0.001). CONCLUSION: This study demonstrates arrhythmia burden and ICD usage in FD is high, suggesting that Fabry cardiomyopathy may be more 'arrhythmogenic' than previously thought. Existing risk models cannot be mutually applicable and further research is needed to provide clarity in managing Fabry patients with cardiac involvement.


Assuntos
Cardiomiopatia Hipertrófica , Desfibriladores Implantáveis , Doença de Fabry , Taquicardia Ventricular , Arritmias Cardíacas , Cardiomiopatia Hipertrófica/terapia , Humanos , Fatores de Risco , Taquicardia Ventricular/terapia
19.
Can J Cardiol ; 38(4): 454-464, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35074416

RESUMO

Ventricular tachycardia (VT) is a potentially fatal cardiac rhythm disorder. Implantable cardioverter defibrillators (ICDs) are the primary management strategy for VT and have been shown to reduce the incidence of death but, ICDs do not reduce VT recurrences. Further, mounting evidence indicates that high VT burden, defined as the cumulative number of recurrent VTs or ICD shocks, is associated with an elevated risk of death; however, it is unclear if high VT burden is a cause of death or a marker of severe heart disease. Proposed mechanisms for a causal pathway suggest that multiple VT episodes or potential deleterious effects from ICDs might alter the myocardium of the ventricles to induce worsening heart disease, which might translate to an increased risk of mortality. In this review, we present the evidence to support association and causation hypotheses for the relationship between VT burden and risk of mortality and indicate potential gaps in evidence. Overall, there is insufficient evidence to prove causal hypotheses for the relationship between VT burden and mortality. Consistent definitions for VT burden, randomized controlled trials that assess the relationship between VT burden and mortality, and observational studies that capture VT burden are warranted to investigate if a potential causal relationship exists.


Assuntos
Desfibriladores Implantáveis , Taquicardia Ventricular , Causalidade , Desfibriladores Implantáveis/efeitos adversos , Humanos , Taquicardia Ventricular/epidemiologia , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/terapia
20.
J Emerg Med ; 62(2): 254-259, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35058095

RESUMO

BACKGROUND: Early recognition and management of ventricular dysrhythmia (VD) are among the top priorities in the medical field, and are very important in cases of suspected acute coronary syndrome (ACS). Here we present a case of ventricular tachycardia (VT), which should be considered in ACS. CASE REPORT: A 59-year-old man with unstable vital signs visited the emergency department (ED) after a syncopal episode associated with chest discomfort. Initial electrocardiography (ECG) revealed wide complex tachycardia, which was considered monomorphic VT. After successful cardioversion, ST-segment elevation was observed on subsequent ECG with reciprocal ST-segment depression. Immediate pharmacological treatment and coronary angiography were performed because of suspected acute myocardial infarction; however, normal coronary arteries were observed. On subsequent ECG analysis, a small blip at the end of the QRS complex termed an epsilon wave, which is a characteristic finding in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C), was detected in the V1 lead. A borderline diagnosis of ARVD/C was made based solely on ECG findings, and the definite diagnosis was confirmed using echocardiography. An implantable cardioverter-defibrillator was inserted soon after, and the patient reported no further events. Why Should an Emergency Physician be Aware of This?: ARVD/C is a critical disease entity that is commonly associated with life-threatening VA. However, presentations of ARVD/C resembling ACS are exceptionally rare. Accordingly, accurate diagnosis of ARVD/C in ED settings is clinically challenging. A high clinical suspicion is required to identify ARVD/C and avoid further life-threatening episodes.


Assuntos
Displasia Arritmogênica Ventricular Direita , Desfibriladores Implantáveis , Taquicardia Ventricular , Displasia Arritmogênica Ventricular Direita/complicações , Displasia Arritmogênica Ventricular Direita/diagnóstico , Displasia Arritmogênica Ventricular Direita/terapia , Desfibriladores Implantáveis/efeitos adversos , Cardioversão Elétrica , Eletrocardiografia , Humanos , Masculino , Pessoa de Meia-Idade , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/terapia
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