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Ventricular tachycardia [keywords]
- Catheter Ablation in Patients with Electrical Storm in Early Post Infarction Period (6 Weeks): A Single Centre Experience. [JOURNAL ARTICLE]
- Indian Pacing Electrophysiol J 2014 9; 14(5):233-239.
Electrical storm (ES) due to drug refractory ventricular tachycardia (VT) occurring within first few weeks of acute myocardial infarction (MI) has poor prognosis. Catheter ablation has been proposed for treating VT occurring late after MI, but there is limited data on catheter ablation in VT within first few weeks of MI.Five patients (4 males, mean age 54.2±12.11 years) between June 2008 to July 2012, referred for VT presenting as ES refractory to antiarrhythmic drugs in the early post infarction period (six weeks following MI) despite revascularization. Three patients had anterior wall MI and two inferior wall MI with left ventricular ejection fraction ranging from 26 to 35%.All underwent catheter ablation within 48 hours of being in VT except one who presented late. Clinical VT was induced in all five patients. Total number of VTs induced were 11 (2.2±1.09 per patient). Two patients needed epicardial ablation via pericardial puncture. Though acute success was 100%, one patient had recurrence of clinical VT the next day of procedure.One patient succumbed to sepsis with multiple organ failure. The remaining four patients are doing well without further clinical recurrence of VT over a period of 3.7 years of follow-up.Catheter ablation can be a useful adjunctive therapy for patients with recurrent VT in the early post infarction period. This procedure appears to be safe with acceptable success rate.
- Massive Purulent Pericardial Effusion Presenting as Atrial Fibrillation with Rapid Rate: Case Report and Review of the Literature. [JOURNAL ARTICLE]
- Am J Case Rep 2014.:504-507.
Background Although pericardial effusion with afib is not rare, the combination of purulent pericardial effusion presenting as afib is not a common occurrence particularly in the developing world.The more common symptoms associated with purulent pericardial effusion are fever, dyspenia, and tachycardia. Without prompt recognition followed by antibiotics and surgical drainage, tamponade, and shock can potentially lead to death. Case Report A 59-year-old male was transferred to our hospital for evaluation of afib with rapid rate associated with cough and dyspenia. He reported fevers, chills, cough and sputum for 1 week. Complaints included chest pain with relief upon lying down. Patient was afebrile with a pulse of 101 and blood pressure of 119/89. WBC 39,200 cells/ml. Chest X-RAY showed right lower lobe pneumonia and EKG revealed afib, rapid ventricular response, and secondary ST changes inferolaterally. Pericardial effusion and thickened pericardium were eveident on echo. Patient was treated for community acquired pneumonia, along with heparin and IV amiodarone. Both sputum cultures and pericardiocentesis revealed S. Pneumoniae. Cardioversion reestablished sinus mechanism. Intially pericardial effusion resolved, but later reaccumulated at which point it was decided to perform a subxiphoid pericardial window. Follow up showed no effusion and patient was asymptomatic. Conclusions Purulent pericardial effusion with atrial fibrillation and rapid ventricular rate needs to be recognized promptly. Because friction fub and chest pain are not present in every case, prompt management in the setting of pneumonia and minor hemodynamic derangements can aid in the treatment of this potentially life threating disease.
- Idiopathic left ventricular outflow tract ectopy: a single focus with extremely divergent breakouts. [JOURNAL ARTICLE]
- BMC Cardiovasc Disord 2014 Nov 18; 14(1):161.
Idiopathic ventricular tachycardia (VT) and/or premature ventricular contractions (PVCs) arise most commonly from the right ventricular outflow tract and less frequently from the left ventricular outflow tract (LVOT), either below or above the semilunar valves.We report a case of 24-year-old man with idiopathic ventricular tachycardia from a single focus in the supravalvular left ventricular outflow tract with two extremely divergent breakouts observed during the ablation procedure.Focal sources of ventricular arrhythmia in the aortic root may have different preferential exits and meticulous activation sequence mapping is the preferable strategy to delineate the site of origin.
- An unusual response to para-Hisian pacing: What is the mechanism? [JOURNAL ARTICLE]
- J Cardiovasc Electrophysiol 2014 Nov 18.
A 68-year-old woman with history of HTN and DM presented to our Electrophysiology (EP) Laboratory for EP study and catheter ablation of symptomatic supraventricular tachycardia (SVT). At baseline, 12-lead ECG showed normal sinus rhythm with normal PR interval and no manifest ventricular preexcitation. This article is protected by copyright. All rights reserved.
- Traumatic Tension Pneumothorax as a Cause of ICD Failure: A Case Report and Review of the Literature. [Journal Article]
- Case Rep Cardiol 2014.:261705.
Background.Tension pneumothorax can infrequently cause ventricular arrhythmias and increase the threshold of defibrillation. It should be suspected whenever there is difficulty in defibrillation for a ventricular arrhythmia.
Purpose.To report a case of traumatic tension pneumothorax leading to ventricular tachycardia and causing defibrillator failure. Case. A 65-year-old African-American female was brought in to our emergency department complaining of dyspnea after being forced down by cops. She had history of mitral valve replacement for severe mitral regurgitation and biventricular implantable cardioverter defibrillator inserted for nonischemic cardiomyopathy. Shortly after arrival, she developed sustained ventricular tachycardia, causing repetitive unsuccessful ICD shocks. She was intubated and ventricular tachycardia resolved with amiodarone. Chest radiograph revealed large left sided tension pneumothorax which was promptly drained. The patient was treated for congestive heart failure; she was extubated on the third day of admission, and the chest tube was removed.
Conclusion.Prompt recognition of tension pneumothorax is essential, by maintaining a high index of suspicion in patients with an increased defibrillation threshold causing ineffective defibrillations.
- Genetic and toxicologic investigation of Sudden Cardiac Death in a patient with Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) under cocaine and alcohol effects. [JOURNAL ARTICLE]
- Int J Legal Med 2014 Nov 16.
Cocaine and alcohol toxicity is well known, especially when simultaneously abused. These drugs perform both acute and chronic harmfulness, with significant cardiac events such as ventricular arrhythmias, tachycardia, systemic hypertension, acute myocardial infarction, ventricular hypertrophy, and acute coronary syndrome. The present report refers about a patient who died after a documented episode of psychomotor agitation followed by cardiac arrest. At the autopsy investigation, arrhythmogenic right ventricular cardiomyopathy (ARVC) was diagnosed and confirmed by postmortem molecular analysis revealing a mutation in the DSG2 gene. Postmortem toxicological analysis demonstrated a recent intake of cocaine, and the death was attributed to cardiac arrhythmias. The detection of cocaine and cocaethylene in hair samples proved chronic simultaneous intake of cocaine and alcohol at least in the last month. The authors discuss the role of these drugs and genetic predisposition of the ARVC in causing the death of the patient.
- Assessment of atrial fibrillation and vulnerability in patients with wolff-Parkinson-white syndrome using two-dimensional speckle tracking echocardiography. [Journal Article]
- PLoS One 2014; 9(11):e108315.
The aim was to assess atrial fibrillation (AF) and vulnerability in Wolff-Parkinson-White (WPW) syndrome patients using two-dimensional speckle tracking echocardiography (2D-STE).All patients were examined via transthoracic echocardiography and 2D-STE in order to assess atrial function 7 days before and 10 days after RF catheter ablation. A postoperative 3-month follow-up was performed via outpatient visit or telephone calls.Results showed significant differences in both body mass index (BMI) and supraventricular tachycardia (SVT) duration between WPW patients and DAVNP patients (both P<0.05). Echocardiography revealed that the maximum left atrial volume (LAVmax) and the left ventricular mass index (LVMI) in diastole increased noticeably in patients with WPW compared to patients with DAVNP both before and after ablation (all P<0.05). Before ablation, there were obvious differences in the levels of SRs, SRe, and SRa from the 4-chamber view (LA) in the WPW patients group compared with patients in the DAVNP group (all P<0.05). In the AF group, there were significant differences in the levels of systolic strain rate (SRs), early diastolic strain rate (SRe), and late diastolic strain rate (SRa) from the 4-chamber view (LA) both before and after ablation (all P<0.05). In the non-AF group, there were decreased SRe levels from the 4-chamber view (LA/RA) pre-ablation compared to post-ablation (all P<0.05).Our findings provide convincing evidence that WPW syndrome may result in increased atrial vulnerability and contribute to the development of AF. Further, RF catheter ablation of AAV pathway can potentially improve atrial function in WPW syndrome patients. Two-dimensional speckle tracking echocardiography imaging in WPW patients would be necessary in the evaluation and improvement of the overall function of RF catheter ablation in a long-term follow-up period.
- Contact force-sensing catheters. [JOURNAL ARTICLE]
- Curr Opin Cardiol 2014 Nov 11.
The purpose of this review is to highlight recent research findings in contact force-sensing radiofrequency ablation catheters.Contact force parameters evaluated during pulmonary vein isolation for treating atrial fibrillation correlated well with the presence of gaps in the wide area circumferential ablation lines at 3 months, decreased procedural times, and improved clinical outcome at 1 year. The contact force during pulmonary vein isolation should be a target of 10-20 g of force and a minimum force-time integral of 400 g/s for each new lesion. In the ventricle, contact force varied depending on whether a transseptal versus retrograde aortic approach was utilized: contact force use yielded more visible ablation lesions at necropsy.Contact force-sensing catheters have demonstrated improved outcome after catheter ablation of atrial fibrillation. Future studies will focus on ventricular tachycardia ablation; preliminary data suggest more durable lesions with contact force-sensing catheters. Contact force catheters may enhance academic training by giving real-time feedback regarding catheter contact, increase safety, and may lead to a resurgence in remote navigation ablation systems. VIDEO ABSTRACT:
- Sudden death of a horse with supraventricular tachycardia following oral administration of flecainide acetate. [JOURNAL ARTICLE]
- J Vet Emerg Crit Care (San Antonio) 2014 Nov 11.
To describe a case of supraventricular tachycardia and sudden death in a horse following administration of flecainide acetate.An 8-year-old Hanoverian warmblood gelding was treated for chronic, naturally occurring, supraventricular tachycardia with digoxin, procainamide hydrochloride, quinidine sulfate, and flecainide acetate. After oral administration of flecainide, polymorphic ventricular tachycardia (torsades de pointes) and ventricular fibrillation developed, leading to cardiovascular collapse and death.Atrial fibrillation is the most commonly diagnosed dysrhythmia associated with poor performance in horses, while atrial tachycardia is rarely documented. Here, we describe a case of sudden death in a horse with atrial tachycardia following the oral administration of flecainide acetate, after the lack of response to other antiarrhythmic drugs. Information provided in this case report is new and will make clinicians aware of the potential complications of flecainide alone or in combination with other drugs, in horses with cardiac dysrhythmias.
- Atrial Fibrillation Ablation in Systolic Dysfunction: Clinical and Echocardiographic Outcomes. [JOURNAL ARTICLE]
- Arq Bras Cardiol 2014 Nov 11.
Background: Heart failure and atrial fibrillation (AF) often coexist in a deleterious cycle. Objective: To evaluate the clinical and echocardiographic outcomes of patients with ventricular systolic dysfunction and AF treated with radiofrequency (RF) ablation. Methods: Patients with ventricular systolic dysfunction [ejection fraction (EF) <50%] and AF refractory to drug therapy underwent stepwise RF ablation in the same session with pulmonary vein isolation, ablation of AF nests and of residual atrial tachycardia, named "background tachycardia". Clinical (NYHA functional class) and echocardiographic (EF, left atrial diameter) data were compared (McNemar test and t test) before and after ablation. Results: 31 patients (6 women, 25 men), aged 37 to 77 years (mean, 59.8±10.6), underwent RF ablation. The etiology was mainly idiopathic (19 p, 61%). During a mean follow-up of 20.3±17 months, 24 patients (77%) were in sinus rhythm, 11 (35%) being on amiodarone. Eight patients (26%) underwent more than one procedure (6 underwent 2 procedures, and 2 underwent 3 procedures). Significant NYHA functional class improvement was observed (pre-ablation: 2.23±0.56; postablation: 1.13±0.35; p<0.0001). The echocardiographic outcome also showed significant ventricular function improvement (EF pre: 44.68%±6.02%, post: 59%±13.2%, p=0.0005) and a significant left atrial diameter reduction (pre: 46.61±7.3 mm; post: 43.59±6.6 mm; p=0.026). No major complications occurred. Conclusion: Our findings suggest that AF ablation in patients with ventricular systolic dysfunction is a safe and highly effective procedure. Arrhythmia control has a great impact on ventricular function recovery and functional class improvement.