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Ventricular tachycardia [keywords]
- Ventricular Tachycardia due to Perinatal Asphyxia. [Journal Article]
- Indian Pediatr 2014 Mar 8; 51(3):227-8.
Perinatal asphyxia is known to precipitate myocardial dysfunction, rhythm abnormalities and congestive cardiac failure.A 2-day old neonate with perinatal asphyxia.He developed shock secondary to ventricular tachycardia, and required synchronized cardioversion for reversion of abnormal rhythm.Reversal of arrhythmia leading to recovery.Early identification and management of ventricular tachycardia in neonate with perinatal asphyxia can be life-saving.
- Entirely subcutaneous implantable defibrillator: safest option in a young girl with ventricular tachycardia and ebstein anomaly. [Journal Article]
- Circ Arrhythm Electrophysiol 2014 Apr 1; 7(2):358-9.
- Percutaneous hemodynamic support during scar-ventricular tachycardia ablation: is the juice worth the squeeze? [Journal Article]
- Circ Arrhythm Electrophysiol 2014 Apr 1; 7(2):192-4.
- Ganglionitis and genetic cardiac arrhythmias: more questions than answers. [Journal Article]
- Circ Arrhythm Electrophysiol 2014 Apr 1; 7(2):190-1.
- Re-examining Outcomes After Unsuccessful Out-of-Hospital Resuscitation in the Era of Field Termination of Resuscitation Guidelines and Regionalized Post-Resuscitation Care. [JOURNAL ARTICLE]
- Resuscitation 2014 Apr 12.
Dismal prognosis after failed out-of-hospital resuscitation has previously been demonstrated. Changes in resuscitation and post-resuscitation care may affect patient outcomes. We describe characteristics and outcomes of patients with out-of-hospital cardiac arrest (OOHCA) transported to specialty cardiac centers after failure of out-of-hospital interventions.In Los Angeles (LA) County, patients with non-traumatic OOHCA with return of spontaneous circulation (ROSC) are transported to specialized cardiac care centers. Outcomes are reported to a registry maintained by the LA County Emergency Medical Services (EMS) Agency. We report patient characteristics and outcomes for the subset of patients treated at these specialty centers in whom initial ROSC was achieved in the ED. The primary outcome was neurologically intact survival, defined by a Cerebral Performance Category (CPC) score of 1 or 2.105 patients transported to the SRC after failure to achieve ROSC with out-of-hospital resuscitation were successfully resuscitated in the ED. The median age was 68 years (IQR 57 to 78); 74 (70%) were male. The presenting rhythm was ventricular fibrillation or ventricular tachycardia in 40 patients (38%) and 86 (82%) were witnessed. Twenty-two patients (21%) survived to hospital discharge. Of the 103 patients with known CPC scores, 13 (13% [95% CI 7%-21%]) survived to hospital discharge with a CPC score of 1 or 2. No patient who survived with good neurologic outcome met criteria for termination of resuscitation in the field.Failure of out-of-hospital resuscitation is not universally predictive of poor neurologic outcome.
- Energy for Myocardial Ca2+ Handling per Beat Increases with Heart Rate in Excised Cross-circulated Canine Heart. [Journal Article]
- Tokai J Exp Clin Med 2014; 39(1):51-8.
Objective:Although tachycardia is well known to increase cardiac oxygen consumption (Vo2) per min, the relationship between Vo2 for excitation-contraction (E-C) coupling per beat and heart rate change over its full working range still remains controversial.
Methods:To elucidate this relationship, we varied heart rate over a reasonably wide range (60-180 beat/min) and studied the relationship between left ventricular (LV) Emax (load-independent contractility index), PVA (pressure-volume area)-independent Vo2, and basal metabolic Vo2 in nine excised, cross-circulated canine hearts.
Results:PVA-independent Vo2 per min significantly increased linearly with increasing heart rate while Emax remained unchanged. Basal metabolic Vo2 per min was measured under KCl arrest. E-C coupling Vo2 per min obtained by subtracting the constant basal metabolic Vo2 from the PVA-independent Vo2 also significantly increased linearly with increasing heart rate. However, PVA-independent Vo2 per beat significantly decreased with increasing heart rate. In contrast, E-C coupling Vo2 per beat, as well as that normalized to Emax, slightly but significantly increased with increasing heart rate. Conclusion; The E-C coupling energy for myocardial Ca2+ handling increases with heart rate despite constant contractility in the left ventricle of the excised cross-circulated canine heart.
- Chemotherapy and QT Prolongation: Overview With Clinical Perspective. [Journal Article]
- Curr Treat Options Cardiovasc Med 2014 May; 16(5):303.
Cardiotoxic adverse events are of concern to physicians treating cancer patients; they are encountered with a variety of agents. Cardiac events may delay the approval of new drugs or impose burdensome monitoring requirements as either part of the pre-approval process or in the daily use of these agents. Among the cardiac issues are the development of QT prolongation and the fear of torsades de pointes (TdP), an unusual yet potentially fatal form of ventricular tachycardia associated with QT prolongation. Several risk factors, including electrolyte imbalance and polypharmacy with concomitant QT prolonging agents use can increase the risk of TdP in cancer patients; separating the individual contributions of the various triggers for TdP remains problematic. Understanding the individual risk of QT prolongation associated with particular chemotherapies can better differentiate between those shown to have higher risk vs. those with lower risk potential. Cardiac monitoring and electrocardiogram analysis require recognition of the common challenges with regard to the precise measurement of the QT interval such as the presence of U waves, intraventricular conduction delays, and heart rate correction. Rapid identification and treatment of QT prolongation and TdP is critical in mitigating the risk of sudden cardiac death in cancer patients. A multidisciplinary treatment approach among cardiologists and oncologists should be employed to help facilitate an appropriate balance between oncologic efficacy and adverse cardiac events.
- Sotalol: A rescue drug in the face of life-threatening refractory ventricular tachycardia. [Journal Article]
- Ann Card Anaesth 2014 Apr-Jun; 17(2):170-2.
We describe postoperative refractory ventricular tachycardia (VT) in a patient following aortic and mitral valve replacement. Following an uneventful separation from cardiopulmonary bypass with dobutamine, the patient developed recurrent VT, 4 hours into the postoperative period. The VT did not respond to standard doses of xylocard, magnesium and amiodarone. Electrolyte and acid base parameters were normal. Multiple cardioversions failed to revert back to a stable rhythm. Intra-aortic balloon pumping was instituted and overdrive right ventricular pacing was unsuccessful. Following intravenous sotalol 80 mg, the VT came under control and reverted to a nodal rhythm, which required atrial pacing for the next 8 hours. Oral sotalol therapy was continued at 40 mg daily. The VT did not recur.
- Safety of Radiofrequency Catheter Ablation Without Coronary Angiography in Aortic Cusp Ventricular Arrhythmias. [JOURNAL ARTICLE]
- Heart Rhythm 2014 Apr 11.
Ventricular arrhythmias (VAs) originating from the aortic root are common. Coronary angiography is typically recommended prior to catheter ablation to document proximity of the ablation catheter to the coronary ostia.We sought to investigate how often catheter ablation in the aortic root could be guided by phased-array intracardiac echocardiography (ICE) and electroanatomic mapping without requiring aortography or coronary angiography.We reviewed consecutive patients referred for aortic root VAs to operators experienced with use of ICE at a single center. ICE and a 3.5mm irrigated ablation catheter were used in all cases, and the need for angiography prior to ablation was documented. Acute success and acute and 30-day complications were noted.35 patients (age 58 +/- 13 years; 74% male) were referred for ablation of VAs; 32/35 (91%) underwent ablation using ICE and 3D mapping without the need for coronary angiography. Successful acute ablation was achieved in 29/35 (83%). In all cases, the catheter tip was directly visualized with ICE >1cm from the coronary ostia. The site of origin of the earliest VA was left cusp 17/35 (49%), right cusp (9/35, 26%), right/left cusp junction (8/35, 23%), or right/non-coronary cusp junction (1/35, 3%). There were no cases of coronary injury, embolic stroke, aortic root perforation, worsening of aortic regurgitation or death acutely or at 30 days.Radiofrequency ablation of VAs originating from the aortic root may be safely performed using ICE and electroanatomic mapping in the majority of cases without the need for coronary angiography.