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Ventricular tachycardia [keywords]
- Renal Denervation for Treatment of Cardiac Arrhythmias: State of the Art and Future Directions. [JOURNAL ARTICLE]
- J Cardiovasc Electrophysiol 2014 Sep 18.
It has now been more than a quarter of a century since modulation of the sympathetic nervous system was proposed for the treatment of cardiac arrhythmias of different origins. But it has also been some time since some of the early surgical attempts have been abandoned. With the development of ablation techniques, however, new approaches and targets have been recently introduced that have revolutionized our way of thinking about sympathetic modulation. Renal nerve ablation technology is now being successfully used for the treatment of resistant hypertension, but the indication spectrum might broaden and new therapeutic options might arise in the near future. This review focuses on the possible impact of renal sympathetic system modulation on cardiac arrhythmias, the current evidence supporting this approach, and the ongoing trials of this method in electrophysiological laboratories. We will discuss the potential roles that sympathetic modulation may play in the future. This article is protected by copyright. All rights reserved.
- Cardiac Sarcoidosis: Clinical Review. [JOURNAL ARTICLE]
- J Cardiovasc Electrophysiol 2014 Sep 18.
Cardiac sarcoidosis can occur in up to 25% of patients with sarcoidosis in other organ systems and may present with conduction abnormalities, ventricular arrhythmias, or heart failure. This review will summarize the state of current knowledge and key questions that remain to be answered. Because cardiac sarcoidosis is a rare, complex disease, the most meaningful research will include interdisciplinary, multicenter collaborations. This article is protected by copyright. All rights reserved.
- Methamphetamine Use Associated With Monomorphic Ventricular Tachycardia. [JOURNAL ARTICLE]
- J Addict Med 2014 Sep 16.
- Ventricular Tachycardia Originating from the Septal Papillary Muscle of The Right Ventricle: Electrocardiographic and Electrophysiological Characteristics. [JOURNAL ARTICLE]
- J Cardiovasc Electrophysiol 2014 Sep 17.
Premature ventricular complexes (PVCs) and ventricular tachycardia (VT) arising from papillary muscles of both ventricles have recently been described. There is a lack of data on VT originating from the right ventricular papillary muscles. There have been no prior studies focused on the ECG features and ablation of PVC/VT arising from the septal papillary muscle of the right ventricle.Among 155 consecutive patients with normal structural heart who underwent catheter ablation of PVC/VT, 8 patients with PVC/VT from the septal RV papillary muscle were identified. The site of origin of the arrhythmias was identified through activation/pace mapping and intracardiac echocardiography. All patients underwent radiofrequency ablation of the arrhythmia.Data on 8 consecutive patients (2 men, age 42 ± 13 years old,) were collected. All patients had a preserved ejection fraction (60% ± 4%). Septal RV papillary muscle arrhythmias had a left superior axis and negative concordance or late R-wave transition in precordial leads. PVC were spontaneous in five cases, were induced by isoprotenerol in two cases and by isoproterenol plus phenylephrine in another one. PVC were never induced with calcium bolus and only rarely with burst pacing. Adenosine never terminated VT or suppressed the VT/PVCs. Radiofrequency, fluoroscopic and procedural time were respectively 10,3 ± 3, 36,4 ±11,3 and 76,3 ± 27,5 minutes. During a mean follow-up of 8 ± 4 months,mean PVC burden was reduced from 14 ± 3% pre-ablation to 0.1 ± 0.2% post-ablation.PVCs and VT originating from septal RV papillary muscle could have a typical ECG pattern due to the site of the muscle involved. Radiofrequency ablation of this anatomic area is feasible and effective. This article is protected by copyright. All rights reserved.
- Hypertrophic cardiomyopathy: Can the noninvasive diagnostic testing identify high risk patients? [Journal Article, Review]
- World J Cardiol 2014 Aug 26; 6(8):764-70.
Hypertrophic cardiomyopathy (HCM) is the most common cause of sudden cardiac death (SCD) in the young, particularly among athletes. Identifying high risk individuals is very important for SCD prevention. The purpose of this review is to stress that noninvasive diagnostic testing is important for risk assessment. Extreme left ventricular hypertrophy and documented ventricular tachycardia and fibrillation increase the risk of SCD. Fragmented QRS and T wave inversion in multiple leads are more common in high risk patients. Cardiac magnetic resonance imaging provides complete visualization of the left ventricular chamber, allowing precise localization of the distribution of hypertrophy and measurement of wall thickness and cardiac mass. Moreover, with late gadolinium enhancement, patchy myocardial fibrosis within the area of hypertrophy can be detected, which is also helpful in risk stratification. Genetic testing is encouraged in all cases, especially in those with a family history of HCM and SCD.
- Electrophysiology assessment and radiofrequency ablation of arrhythmias in adult patients with congenital heart defects: the Christchurch experience. [Journal Article]
- N Z Med J 2014; 127(1402):88-96.
Adults with congenital heart disease (CHD) frequently have cardiac arrhythmias, many of which are best treated with radiofrequency ablation (RFA). We present our experience in this group.Retrospective chart based review of diagnosis, arrhythmia type, results of cardiac electrophysiological assessment, and procedural and long-term clinical success of radiofrequency ablation.Forty-five patients were identified with CHD and arrhythmias undergoing RFA; including surgically repaired atrial septal defects (21), Ebstein's anomaly (12), repaired transposition of the great arteries (3), repaired Tetralogy of Fallot (4), repaired ventricular septal defect (3), repaired coarctation (1) and unrepaired anomalous pulmonary venous anatomy (1). Arrhythmias were atrial flutter (24), atrial fibrillation (1), atrial tachycardia (3), atrioventricular nodal re-entrant tachycardia (5), and atrioventricular re-entrant tachycardia (12). Procedural success was ultimately obtained in 36 patients, with 6 having unsuccessful ablation and 3 an undetermined result. Twelve patients required a repeat procedure. One patient required a third procedure and had insertion of permanent pacemaker and atrioventricular nodal ablation. With follow-up (range 2-264 months) 31 patients (69%) remained in sinus rhythm, 9 have developed atrial fibrillation, 3 are in atrial flutter or atrial tachycardia, 1 patient reports ongoing palpitations with no documented arrhythmia and 1 patient has died. Procedural complications were major venous access bleeding (2), transient heart block during slow pathway ablation with late complete heart block (1).The majority of arrhythmias in adult patients with congenital heart defects can be successfully treated with radiofrequency ablation at a relatively low risk.
- Simplified Automated Right Ventricular Overdrive Pacing for Rapid Diagnosis of Supraventricular Tachycardia. [JOURNAL ARTICLE]
- Cardiology 2014 Sep 10; 129(2):93-102.
Objectives: The purpose of this study was to prospectively evaluate the feasibility and diagnostic value of right ventricular overdrive pacing (RVOP) during supraventricular tachycardia (SVT) using a 2-catheter approach with automatic pacing from the right ventricular inflow (RVIT) and outflow tract (RVOT). Methods: One hundred and thirty-six consecutive patients (with 138 arrhythmias, mean age 36 ± 20 years, range 4-95) were enrolled in this study. Only coronary sinus and ablation catheters were used. RVOP was delivered from RVIT and then from RVOT. Each attempt consisted of 10 synchronized beats delivered at a cycle length of 10-40 ms longer than the tachycardia cycle length. Results: RVOP was sufficient to confirm the transition zone within the first 9 beats in the majority of SVTs. Atrial perturbation (acceleration, delayed) in the transition zone was detected in all patients with orthodromic atrioventricular (AV) reentry. Patients with typical AV nodal reentry, atypical AV nodal reentry and atrial tachycardia did not show atrial timing perturbation during fusion complexes of RVOP. Conclusions: Synchronized RVOP from RVIT or RVOT is an easy and accurate method for the quick and reliable differential diagnosis of SVT in various clinical settings, particularly when only a limited number of catheters are used. © 2014 S. Karger AG, Basel.
- [Ablation of an idiopathic "ventricular rarity" - ventricular tachycardia originating from the crux cordis]. [English Abstract, Journal Article]
- Dtsch Med Wochenschr 2014 Sep; 139(39):1929-31.
A 62-year-old woman presented with history of repeat syncope and palpitations. She experienced aggravation of symptoms within the last few months. At referring hospital a ventricular tachycardia was already inducible during electrophysiological study. The patient was transferred to our hospital for VT ablation vs. ICD implantation.No evidence for structural heart disease was revealed during TTE nor was a coronary heart disease detectable during coronary angiography, only hypertension was verifiable. No ICD implantation so far.The patient underwent repeat EP study at our facility with induction of VT. Pace-mapping and mapping for earliest ventricular activation was performed. The middle-cardiac vein was revealed as site of earliest ventricular activation (50 ms) and good pace-map. Therefore, radiofrequency ablation at this site terminated successfully VT into sinus rhythm.Ablation of epicardial VT foci is successfully feasible via coronary sinus. With regard to typical ECG parameters an epicardial foci may be assumed precociously. The great cardiac vein is one of the most common sites of origin for epicardial foci, however, VT partially may originate from the crux cordis which is accessible for ablation via the middle cardiac vein with good ablation results.
- Idiopathic Ventricular Arrhythmia Originating from the Cardiac Crux or Inferior Septum: An Epicardial Idiopathic Ventricular Arrhythmia. [JOURNAL ARTICLE]
- Circ Arrhythm Electrophysiol 2014 Sep 15.
-Idiopathic ventricular arrhythmia (VA) can arise from the epicardium near the posteroseptal region (cardiac-crux). There are only two prior reports describing idiopathic-VA from the cardiac crux. The purpose of this study was to characterize the clinical and the electrocardiographic features of idiopathic crux-VA.-Crux-VA were identified in 18 patients undergoing catheter ablation. We divided patients into 2 groups, those with VA originating from the apical-crux (n = 9) and the basal-crux (n = 9). We described the clinical and electrocardiographic characteristics of crux-VA as well as the ablation results. Furthermore, we compared clinical features of crux-VA with other sites of idiopathic-VA. Fifteen crux-VA patients (83%) had sustained ventricular tachycardia and three patients required ICD implantation because of syncope. All patients had a left superior axis and 16 patients had R > S wave in V2. In apical crux-VA, all patients had a deep S wave in V6 and 8 patients (89 %) had R > S wave in aVR. All apical-crux patients underwent attempted ablation in the middle cardiac vein (MCV) without success. In 4 of these patients, epicardial ablation with subxiphoid approach was performed successfully. All basal crux-VA patients had either negative or isoelectric pattern in V1 and had R>S in V6. Patients had successful ablation within the MCV.-Apical vs basal crux-VA is identified as a new category of idiopathic-VA with distinctive electrocardiographic characteristics; ablation via the MCV is effective for eliminating basal crux-VA while apical crux-VA often requires a subxiphoid epicardial approach.