RESUMEN
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
Asunto(s)
Ablación por Catéter , Taquicardia Ventricular , Complejos Prematuros Ventriculares , Electrofisiología Cardíaca , Consenso , Humanos , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/cirugíaRESUMEN
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
Asunto(s)
Electrofisiología Cardíaca , Ablación por Catéter , Técnicas Electrofisiológicas Cardíacas/métodos , Taquicardia Ventricular , Complejos Prematuros Ventriculares , Electrofisiología Cardíaca/organización & administración , Electrofisiología Cardíaca/normas , Electrofisiología Cardíaca/tendencias , Ablación por Catéter/instrumentación , Ablación por Catéter/métodos , Ablación por Catéter/normas , Consenso , Sistema de Conducción Cardíaco/patología , Sistema de Conducción Cardíaco/fisiopatología , Sistema de Conducción Cardíaco/cirugía , Cardiopatías/clasificación , Cardiopatías/complicaciones , Humanos , Cooperación Internacional , Mejoramiento de la Calidad/organización & administración , Sociedades Médicas , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiología , Taquicardia Ventricular/fisiopatología , Taquicardia Ventricular/cirugía , Resultado del Tratamiento , Complejos Prematuros Ventriculares/diagnóstico , Complejos Prematuros Ventriculares/etiología , Complejos Prematuros Ventriculares/fisiopatología , Complejos Prematuros Ventriculares/cirugíaRESUMEN
BACKGROUND: Despite cardiac resynchronization therapy (CRT), some patients with heart failure progress and undergo left ventricular assist device (LVAD) implantation. Management of CRT after LVAD implantation has not been well studied. The purpose of this study was to determine whether RV pacing or biventricular pacing measurably affects acute hemodynamics in patients with an LVAD and a CRT device. METHODS AND RESULTS: Seven patients with CRT and LVAD underwent right heart catheterization. Pressures and oximetry were measured and LVAD parameters were recorded during 3 different conditions: RV pacing alone, biventricular pacing, and intrinsic atrioventricular conduction. Paired t tests were used to evaluate changes within subjects. There were no significant changes in right atrial pressure, pulmonary arterial pressures, pulmonary capillary wedge pressure, cardiac index, or any LVAD parameter (P > .05). CONCLUSIONS: Our data suggest that CRT probably has no acute hemodynamic effect in patients with LVADs, but further study is needed.
Asunto(s)
Estimulación Cardíaca Artificial/métodos , Insuficiencia Cardíaca/terapia , Corazón Auxiliar , Hemodinámica/fisiología , Adulto , Anciano , Cateterismo Cardíaco , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoAsunto(s)
Potenciales de Acción , Displasia Ventricular Derecha Arritmogénica/diagnóstico , Electrocardiografía , Frecuencia Cardíaca , Taquicardia Ventricular/diagnóstico , Adolescente , Displasia Ventricular Derecha Arritmogénica/fisiopatología , Displasia Ventricular Derecha Arritmogénica/cirugía , Diagnóstico Diferencial , Trasplante de Corazón , Humanos , Masculino , Valor Predictivo de las Pruebas , Recurrencia , Taquicardia Ventricular/fisiopatología , Taquicardia Ventricular/cirugía , Factores de Tiempo , Resultado del Tratamiento , Función Ventricular DerechaAsunto(s)
Consumo de Bebidas Alcohólicas/efectos adversos , Consumo de Bebidas Alcohólicas/fisiopatología , Electrocardiografía/tendencias , Consumo de Bebidas Alcohólicas/sangre , Electrocardiografía/efectos de los fármacos , Humanos , Hipopotasemia/sangre , Hipopotasemia/etiología , Hipopotasemia/terapia , Masculino , Persona de Mediana EdadAsunto(s)
Hemodinámica , Miocarditis/complicaciones , Choque/etiología , Electrocardiografía , Humanos , Lactante , Masculino , Miocarditis/diagnóstico , Miocarditis/fisiopatología , Miocarditis/terapia , Recuperación de la Función , Resucitación , Choque/diagnóstico , Choque/fisiopatología , Choque/terapia , Resultado del TratamientoAsunto(s)
Electrocardiografía , Taquicardia por Reentrada en el Nodo Atrioventricular/diagnóstico , Taquicardia Supraventricular/diagnóstico , Potenciales de Acción , Ablación por Catéter , Niño , Diagnóstico Diferencial , Técnicas Electrofisiológicas Cardíacas , Femenino , Frecuencia Cardíaca , Humanos , Valor Predictivo de las Pruebas , Taquicardia por Reentrada en el Nodo Atrioventricular/fisiopatología , Taquicardia por Reentrada en el Nodo Atrioventricular/cirugía , Taquicardia Supraventricular/fisiopatología , Taquicardia Supraventricular/cirugía , Resultado del TratamientoAsunto(s)
Bloqueo Atrioventricular/diagnóstico , Ablación por Catéter/efectos adversos , Electrocardiografía , Enfermedad Iatrogénica , Taquicardia Supraventricular/cirugía , Fascículo Atrioventricular Accesorio/fisiopatología , Potenciales de Acción , Bloqueo Atrioventricular/etiología , Bloqueo Atrioventricular/fisiopatología , Frecuencia Cardíaca , Humanos , Masculino , Valor Predictivo de las Pruebas , Recurrencia , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/fisiopatología , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenAsunto(s)
Cardiología/normas , Muerte Súbita Cardíaca/prevención & control , Taquicardia Ventricular/terapia , Fibrilación Ventricular/terapia , Complejos Prematuros Ventriculares/terapia , American Heart Association , Consenso , Medicina Basada en la Evidencia/normas , Humanos , Factores de Riesgo , Taquicardia Ventricular/complicaciones , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/mortalidad , Resultado del Tratamiento , Estados Unidos , Fibrilación Ventricular/complicaciones , Fibrilación Ventricular/diagnóstico , Fibrilación Ventricular/mortalidad , Complejos Prematuros Ventriculares/complicaciones , Complejos Prematuros Ventriculares/diagnóstico , Complejos Prematuros Ventriculares/mortalidadAsunto(s)
Cardiología/normas , Muerte Súbita Cardíaca/prevención & control , Taquicardia Ventricular/terapia , Fibrilación Ventricular/terapia , Complejos Prematuros Ventriculares/terapia , American Heart Association , Consenso , Medicina Basada en la Evidencia/normas , Humanos , Factores de Riesgo , Taquicardia Ventricular/complicaciones , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/mortalidad , Resultado del Tratamiento , Estados Unidos , Fibrilación Ventricular/complicaciones , Fibrilación Ventricular/diagnóstico , Fibrilación Ventricular/mortalidad , Complejos Prematuros Ventriculares/complicaciones , Complejos Prematuros Ventriculares/diagnóstico , Complejos Prematuros Ventriculares/mortalidadRESUMEN
INTRODUCTION: Although several ECG criteria have been proposed for differentiating between left and right origins of idiopathic ventricular arrhythmias (VA) originating from the outflow tract (OT-VA), their accuracy and usefulness remain limited. This study was undertaken to develop a more accurate and useful ECG criterion for differentiating between left and right OT-VA origins. METHODS AND RESULTS: We studied OT-VAs with a left bundle branch block pattern and inferior axis QRS morphology in 207 patients who underwent successful catheter ablation in the right (RVOT; n = 154) or left ventricular outflow tract (LVOT; n = 53). The surface ECGs during the OT-VAs and during sinus beats were analyzed with an electronic caliper. The V2S/V3R index was defined as the S-wave amplitude in lead V2 divided by the R-wave amplitude in lead V3 during the OT-VA. The V2S/V3R index was significantly smaller for LVOT origins than RVOT origins (P < 0.001). The area under the curve (AUC) for the V2S/V3R index by a receiver operating characteristic analysis was 0.964, with a cut-off value of ≤1.5 predicting an LVOT origin with an 89% sensitivity and 94% specificity. In the AUC and accuracy, the V2S/V3R index was superior to any previously proposed ECG criteria in an analysis of all OT-VAs. This advantage of the V2S/V3R index over the V2 transition ratio and other indices also held true for a subanalysis of 77 OT-VAs with a lead V3 precordial transition. CONCLUSION: The V2S/V3R index outperformed other ECG criteria to differentiate left from right OT-VA origins independent of the site of the precordial transition.
Asunto(s)
Electrocardiografía , Ventrículos Cardíacos/fisiopatología , Taquicardia Ventricular/diagnóstico , Función Ventricular Izquierda , Función Ventricular Derecha , Complejos Prematuros Ventriculares/diagnóstico , Complejos Prematuros Ventriculares/cirugía , Adulto , Anciano , Área Bajo la Curva , Ablación por Catéter , Diagnóstico Diferencial , Femenino , Ventrículos Cardíacos/cirugía , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Curva ROC , Estudios Retrospectivos , Taquicardia Ventricular/etiología , Taquicardia Ventricular/fisiopatología , Taquicardia Ventricular/cirugía , Resultado del Tratamiento , Complejos Prematuros Ventriculares/etiología , Complejos Prematuros Ventriculares/fisiopatologíaAsunto(s)
Diarrea/fisiopatología , Náusea/fisiopatología , Síncope/fisiopatología , Anciano , Colecalciferol/administración & dosificación , Clonazepam/administración & dosificación , Diarrea/complicaciones , Diarrea/tratamiento farmacológico , Esomeprazol/administración & dosificación , Femenino , Fluconazol/administración & dosificación , Humanos , Náusea/complicaciones , Náusea/patología , Ondansetrón/administración & dosificación , Combinación Piperacilina y Tazobactam/administración & dosificación , Síncope/complicaciones , Síncope/tratamiento farmacológico , Torsades de Pointes/fisiopatología , Vancomicina/administración & dosificaciónAsunto(s)
Antiarrítmicos/efectos adversos , Flecainida/efectos adversos , Frecuencia Cardíaca/efectos de los fármacos , Taquicardia Ventricular/inducido químicamente , Potenciales de Acción/efectos de los fármacos , Administración Intravenosa , Anciano , Electrocardiografía , Femenino , Humanos , Bicarbonato de Sodio/administración & dosificación , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/tratamiento farmacológico , Taquicardia Ventricular/fisiopatología , Factores de TiempoRESUMEN
A 70-year-old man with atrial flutter (AFL) following pulmonary vein (PV) isolation (PVI) underwent electrophysiologic testing. The AFL exhibited positive P waves in the inferior leads and lead V1. Left atrial activation mapping revealed 2 remote sites with early activation that were located at the antrum of the left superior PV roof and the left inferior PV bottom. A single irrigated radiofrequency ablation targeting the earliest PV activation at the left PV carina eliminated the AFL. This case demonstrated that PV carina tachycardia with multiple conduction gaps and inter-PV conduction after PVI might mimic double focal atrial tachycardias.