Ventricular tachycardia [keywords]
- Hypomagnesemia as a potentially life-threatening adverse effect of omeprazole. [Journal Article]
- Oxf Med Case Reports 2016 Jul; 2016(7):147-9.
Hypomagnesemia can be caused by a wide range of diseases (e.g. gastrointestinal disorders, kidney diseases or endocrine disorders), but it can also be a side effect of several drugs. It can be asymptomatic or cause many different clinical symptoms, and the clinical manifestations mainly depend on the rate of development rather than the actual serum magnesium concentration. We here present a 40-year-old female patient with Torsade de pointes ventricular tachycardia and cardiac arrest caused by severe hypomagnesemia as an adverse effect of the proton pump inhibitor omeprazole.
- Syncope in Primary Prevention Implantable Cardioverter Defibrillator Patients. [Journal Article]
- Isr Med Assoc J 2016 Jun; 18(6):318-21.
Syncope is a common clinical condition spanning from benign to life-threatening diseases. There is sparse information on the outcomes of syncopal patients who received an implantable cardiac defibrillator (lCD) for primary prevention of sudden cardiac death (SCD).To assess the outcomes and prognosis of patients who underwent implantable cardiac defibrillator (ICD) implantation for primary prevention of SCD and compare them to patients who presented with or without prior syncope.We compared the medical records of 75 patients who underwent ICD implantation for primary prevention of SCD and history of syncope to those of a similar group of 80 patients without prior syncope. We assessed the episodes of ventricular tachycardia (VT), ventricular fibrillation (VF), shock, anti-tachycardia pacing (ATP) and mortality in each group during follow-up.Mean follow-up was 893 days (810-976, 95% CI) (no difference between groups). There was no significant difference in gender or age. Patients with prior syncope had a higher ejection fraction rate (35.5 ? 12.6 vs. 31.4 8.76, P = 0.02), experienced more episodes of VT (21.3% vs. 3.8%, P = 0.001) and VF (8% vs. 0%, P = 0.01), and received more electric shocks (18.7% vs. 3.8%, P = 0.004) and ATP (17.3% vs. 6.2%, P = 0.031). There were no differences in inappropriate shocks (6.7% vs. 5%, P = 0.74), cardiovascular mortality (cumulative 5 year estimate 29.9% vs. 32.2%, P = 0.97) and any death (cumulative 5 year estimate 38.1% vs. 48.9%, P = 0.18).Patients presenting with syncope before ICD implantation seemed to have more episodes of VT/VF and shock or ATP. No differences in mortality were observed.
- Rare presentation of intralobar pulmonary sequestration associated with repeated episodes of ventricular tachycardia. [Journal Article]
- World J Cardiol 2016 Jul 26; 8(7):432-5.
Arterial supply of an intralobar pulmonary sequestration (IPS) from the coronary circulation is extremely rare. A significant coronary steal does not occur because of dual or triple sources of blood supply to sequestrated lung tissue. We present a 60-year-old woman who presented to us with repeated episodes of monomorphic ventricular tachycardia (VT) in last 3 mo. Radio frequency ablation was ineffective. On evaluation, she had right lower lobe IPS with dual arterial blood supply, i.e., right pulmonary artery and the systemic arterial supply from the right coronary artery (RCA). Stress myocardial perfusion scan revealed significant inducible ischemia in the RCA territory. Coronary angiogram revealed critical stenosis of proximal RCA just after the origin of the systemic artery supplying IPS. The critical stenosis in the RCA was stented. At 12 mo follow-up, she had no further episodes of VT or angina.
- [The wearable cardioverter/defibrillator : Temporary protection from sudden cardiac death]. [JOURNAL ARTICLE, ENGLISH ABSTRACT]
- Internist (Berl) 2016 Jul 27.
In the majority of cases sudden cardiac death (SCD) is caused by ventricular tachyarrhythmia. Implantable cardioverter-defibrillators (ICD) represent an evidence-based and established method for prevention of SCD. For patients who do not fulfill the criteria for guideline-conform implantation of an ICD but still have an increased, e.g. transient risk for SCD, a wearable cardioverter-defibrillator (WCD) vest was developed to temporarily prevent SCD. Numerous studies have shown the safety and efficacy of the WCD, although there is still a gap in evidence concerning a reduction in overall mortality and improvement in prognosis. This article gives an overview on the currently available literature on WCD, the indications, potential risks and complications.
- Gender Discrepancy in Diabetic Patients Hospitalized With Heart Failure: Does Age Matter? [Journal Article]
- Crit Pathw Cardiol 2016 Sep; 15(3):126-30.
Gender discrepancy in the cardiovascular diseases has been evaluated in several studies. We studied the impact of gender disparity on the presentation and outcome of diabetic heart failure (DHF) patients.A retrospective analysis was conducted including all DHF patients admitted to the Heart Hospital between 1991 and 2013. Patients' demographics, presentation, management, and hospital outcomes were analyzed and compared based on gender and age.Out of 8266 HF patients, 4684 (56.7%) were diabetic, of whom 1817 (39%) were females. Mean age was comparable in both genders. DHF female patients were more likely to be hypertensive (79% vs. 65%, P = 0.001) and obese (13% vs. 4.6%, P = 0.001). DHF females were less likely to receive beta-blockers and angiotensin-converting-enzyme inhibitors/angiotensinogen-receptor blockers (25% vs. 30%, P = 0.001, 54% vs. 57%, P = 0.01, respectively), but were more likely to be on insulin therapy (21% vs. 16%, P = 0.001). In-hospital atrial fibrillation (P =0.90), ventricular tachycardia (P = 0.07), stroke (P = 0.45), and cardiac arrest (P = 0.26) were comparable. Overall in-hospital mortality was comparable in both genders (P = 0.83). In age ≤50 years, male gender was associated with a 3-fold increase in death (13% vs. 4%, P = 0.01), however, this mortality difference disappeared in DHF patients aged >50 years (P = 0.62).In DHF, female gender is characterized by having a high prevalence of metabolic syndrome components. Also, females are more likely to have better Left ventricular ejection fraction but less likely to receive cardiovascular evidence based medications. There is no significant difference in the overall hospital mortality between both genders, however, in the younger age; males have a significantly higher mortality.
- Improved cardiac filling facilitates the postprandial elevation of stroke volume in Python regius. [JOURNAL ARTICLE]
- J Exp Biol 2016 Jul 21.
To accommodate the pronounced metabolic response to digestion, pythons increase both heart rate and elevate stroke volume, where the latter has been ascribed to a massive and fast cardiac hypertrophy. However, numerous recent studies show that heart mass rarely increases even upon ingestion of large meals, and we therefore explored the possibility that a rise in mean circulatory filling pressure (MCFP) serves to elevate venous pressure and cardiac filling during digestion. To this end, we measured blood flows and pressures in anaesthetised Python regius The anaesthetised snakes exhibited the archetypal tachycardia as well as a rise in both venous pressure and MCFP that fully account for the approximate doubling of stroke volume. There was no rise in blood volume and the elevated MCFP must therefore stem from increased vascular tone, possibly by means of increased sympathetic tone on the veins. Furthermore, while both venous pressure and MCFP increased during volume loading, there was no evidence that postprandial hearts were endowed with an additional capacity to elevate stroke volume. In vitro measurements of force development of paced ventricular strips also failed to reveal signs of increased contractility, but the postprandial hearts had higher activities of cytochrome oxidase and pyruvate kinase, which probably serves to sustain the rise in cardiac work during digestion.
- Supraventricular and Ventricular Arrhythmias are Related to the Type of Myotonic Dystrophy but not to Disease Duration or Neurological Status. [JOURNAL ARTICLE]
- Pacing Clin Electrophysiol 2016 Jul 22.
Patients with myotonic muscular dystrophy (dystrophia myotonica, DM) are at risk of sudden cardiac death due to diverse arrhythmias, especially progressive atrioventricular (AV) conduction abnormalities. However, there is limited data on supraventricular and potentially life-threatening ventricular arrhythmias, especially according to type 1 and type 2 DM.A group of 94 unselected consecutive patients with genetically confirmed DM and 45 healthy controls underwent electrocardiography, echocardiography and 24-h Holter monitoring. DM1 was diagnosed in 51, while DM2 in 43 patients (with mean age of 37.3±12.5 and 48.3±13.3 years, respectively).DM1 subjects presented more frequently intraventricular conduction defects (29.4 vs 6.6%, p = 0.0003) and 1(st) degree AV block (25.0 vs 4.6%, p = 0.008) than DM2 patients. Non-sustained supraventricular tachycardia (37.2 vs 3.8%, p = 0.001) and non-sustained ventricular tachycardia and/or R-on-T ventricular beats (23.2 vs 7.8%, p = 0.04) were more frequently observed in DM2 than in DM1. No relationship between disease duration and neurological status and occurrence of arrhythmias was observed. Multivariate analysis showed that independent predictor for bradyarrhythmias occurrence was DM1 only (OR 6.4, 95%CI 2.0-20.8, p = 0.002), while for supraventricular or ventricular arrhythmias occurrence it was DM2 (OR 4.1, 95%CI 1.5-11.4, p = 0.007) and increased age (OR 1.09, 95%CI 1.05-1.15, p<0.0001).In the relatively large groups of DM1 and DM2 patients we observed frequent various arrhythmias which warrant their close cardiac monitoring. DM1 subjects when compared to DM2 presented more frequently intraventricular and AV conduction defects. However, all types of tachyarrhythmias (except atrial fibrillation) were more frequently observed in DM2 patients. This article is protected by copyright. All rights reserved.
- Voltage mapping for ventricular tachycardia ablation: we can work it out. [EDITORIAL]
- Heart Rhythm 2016 Jul 18.
- The use of dronedarone for recurrent ventricular tachycardia: a case report and review of the literature. [Journal Article]
- BMC Res Notes 2016; 9(1):370.
Dronedarone is a benzofuran derivative resembling amiodarone that was intended to reduce the iodine-associated tissue deposition and organ toxicity seen with the latter. The utility of dronedarone for patients with ventricular arrhythmias has not been thoroughly evaluated. We present our experience with its use to treat refractory ventricular tachycardia storm and review the literature.An 85 year-old gentleman with multiple medical comorbidities including ischemic and non-ischemic cardiomyopathy with severe biventricular systolic dysfunction presented with ventricular tachycardia storm. Therapeutic options were limited given his frail medical status, failures of sotalol, mexilitine, and catheter ablation therapies along with drug-toxicities from amiodarone. Dronedarone was thus considered as off-label use following informed consent. The patient unfortunately developed fatal multisystem organ failure including acute severe hepatotoxicity from dronedarone.Novel therapies for drug-refractory ventricular arrhythmias are long overdue given the limitations of available pharmacologic and non-pharmacologic options. Off-label use of antiarrhythmic agents such as dronedarone is considered a treatment of last-resort in patients who otherwise have no therapeutic options. Given the paucity of reported cases regarding dronedarone for the treatment of ventricular tachyarrhythmias, no conclusive recommendations can be made at this time aside from words of caution. Despite the potential ventricular antiarrhythmic effects of dronedarone, careful patient evaluation is required to identify those at greatest risk of drug-related adverse events particularly in those patients with significant comorbidities such as advanced hepatic, renal, and cardiovascular disease.
- [Redetection of tachycardia in severe ventricular undersensing]. [JOURNAL ARTICLE, ENGLISH ABSTRACT]
- Herzschrittmacherther Elektrophysiol 2016 Jul 26.
In a 50-year-old patient with arrhythmogenic right ventricular cardiomyopathy (ARVC) and implantable cardioverter defibrillator (ICD) two shock discharges occurred after several ineffective attempts with antitachycardia pacing. The analysis of the stored electrograms shows a peculiarity of shocks with low energy, a problem of ICD therapy in ARVC, and the impact of committed shocks as opposed to non-committed shocks.