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Ventricular tachycardia [keywords]
- Insights into the Problem of Alarm Fatigue with Physiologic Monitor Devices: A Comprehensive Observational Study of Consecutive Intensive Care Unit Patients. [JOURNAL ARTICLE]
- PLoS One 2014; 9(10):e110274.
Physiologic monitors are plagued with alarms that create a cacophony of sounds and visual alerts causing "alarm fatigue" which creates an unsafe patient environment because a life-threatening event may be missed in this milieu of sensory overload. Using a state-of-the-art technology acquisition infrastructure, all monitor data including 7 ECG leads, all pressure, SpO2, and respiration waveforms as well as user settings and alarms were stored on 461 adults treated in intensive care units. Using a well-defined alarm annotation protocol, nurse scientists with 95% inter-rater reliability annotated 12,671 arrhythmia alarms.A total of 2,558,760 unique alarms occurred in the 31-day study period: arrhythmia, 1,154,201; parameter, 612,927; technical, 791,632. There were 381,560 audible alarms for an audible alarm burden of 187/bed/day. 88.8% of the 12,671 annotated arrhythmia alarms were false positives. Conditions causing excessive alarms included inappropriate alarm settings, persistent atrial fibrillation, and non-actionable events such as PVC's and brief spikes in ST segments. Low amplitude QRS complexes in some, but not all available ECG leads caused undercounting and false arrhythmia alarms. Wide QRS complexes due to bundle branch block or ventricular pacemaker rhythm caused false alarms. 93% of the 168 true ventricular tachycardia alarms were not sustained long enough to warrant treatment.The excessive number of physiologic monitor alarms is a complex interplay of inappropriate user settings, patient conditions, and algorithm deficiencies. Device solutions should focus on use of all available ECG leads to identify non-artifact leads and leads with adequate QRS amplitude. Devices should provide prompts to aide in more appropriate tailoring of alarm settings to individual patients. Atrial fibrillation alarms should be limited to new onset and termination of the arrhythmia and delays for ST-segment and other parameter alarms should be configurable. Because computer devices are more reliable than humans, an opportunity exists to improve physiologic monitoring and reduce alarm fatigue.
- Carbamazepine induced atrial tachycardia with complete AV block. [Journal Article]
- Hippokratia 2014 Apr; 18(2):185-6.
Carbamazepine, a widely used antiepileptic drug that has been used for the treatment of both partial and generalized seizures, for trigeminal neuralgia, as a mood stabilizer and for treatment of neuropathic pain syndromes, may have negative chronotropic and dromotropic effects on the cardiac conduction system.We report a case of cardiac syncope due to atrial tachycardia combined with complete atrioventricular block as a consequence of carbamazepine administration for trigeminal neuralgia.Although sinus tachycardia is the most frequently observed cardiac side effect of carbamazepine, sinus and nodal bradycardia, atrioventricular block, premature ventricular contractions, ventricular tachycardia and junctional escape rhythms have been reported in patients due to carbamazepine toxicity.
- Benefit of cardiac sonography for estimating the early term survival of the cardiopulmonary arrest patients. [Journal Article]
- Hippokratia 2014 Apr; 18(2):125-9.
Cardiopulmonary resuscitation (CPR) is the most important intervention that connects the cardiopulmonary arrests (CPA), to life. Ultrasonography (USG) is used to detect the presence of cardiac activity during CPR.Files of the patiens, admitted to Kayseri Training and Research Hospital during one calendar year (2011) and suffered CPA were retrospectively evaluated by using hospital information management system. Patients enrolled in the study should have arrival electrocardiogram and cardiac ultrasound performed and recorded.A total of 410 patients were included in the study. When we examined the cardiac rhythm on arrival, 290 patients (70.7%) had asystole, 45 (11%) patients had ventricular fibrillation/ pulseless ventricular tachycardia (VF/pVT) and 75 (18.3%) patients had pulseless electrical activity (PEA). Twenty-four hour survival rates of the groups that the cardiac activity was detected with USG on arrival to the Emergency Department were: 2 patients in asystole group, 35 patients in VF/pVT group and 44 patients in PEA group.Usage of USG during CPR in order to evaluate cardiac contractility, increases the success rate of accomplished CPR.
- Wideband late gadolinium enhanced magnetic resonance imaging for imaging myocardial scar without image artefacts induced by implantable cardioverter-defibrillator: a feasibility study at 3 T. [JOURNAL ARTICLE]
- Europace 2014 Oct 21.
Late gadolinium enhanced (LGE) magnetic resonance imaging (MRI) is a useful tool for facilitating ventricular tachycardia (VT) ablation. Unfortunately, most VT ablation candidates often have prophylactic implantable cardioverter-defibrillator (ICD) and do not undergo cardiac MRI largely due to image artefacts generated by ICD. A prior study has reported success of 'wideband' LGE MRI for imaging myocardial scar without image artefacts induced by ICD at 1.5T. The purpose of this study was to widen the availability of wideband LGE MRI to 3T, since it has the potential to achieve higher spatial resolution than 1.5T.We compared the performance of standard and wideband LGE MRI pulse sequences in phantoms and canines with myocardial lesions created by radiofrequency ablation. Standard LGE MRI produced image artefacts induced by ICD and 49% accuracy in detecting 97 myocardial scars examined in this study, whereas wideband LGE MRI produced artefact-free images and 94% accuracy in detecting scars. The mean image quality score (1 = nondiagnostic, 2 = poor, 3 = adequate, 4 = good, 5 = excellent) was significantly (P < 0.001) higher for wideband (3.7 ± 0.8) than for standard LGE MRI (2.1 ± 0.7). The mean artefact level score (1 = minimal, 2 = mild, 3 = moderate, 4 = severe, 5 = nondiagnostic) was significantly (P < 0.001) lower for wideband (2.1 ± 0.8) than for standard LGE MRI (4.0 ± 0.6). Wideband LGE MRI agreed better with gross pathology than standard LGE MRI.This study demonstrates the feasibility of wideband LGE MRI for suppression of image artefacts induced by ICD at 3T.
- Right ventricular cavity near obliteration in neonatal severe biventricular hypertrophic cardiomyopathy. [Journal Article]
- BMJ Case Rep 2014.
A newborn presenting with cyanosis at day 9 of life was admitted to the local hospital. Initial local echocardiography confirmed a cardiac issue and the patient was transferred to a tertiary cardiac hospital. Further imaging confirmed a rare presentation of cardiomyopathy with severe right ventricular outflow tract obstruction. Surgery was performed but with postoperative haemodynamic instability complicated by incessant ventricular tachycardia. Following discussion with the family, care was withdrawn. Postmortem demonstrated a rare form of hypertrophic cardiomyopathy with right ventricular outflow tract obstruction not previously described in a neonate.
- Response to letter by chhabra and spodick regarding article, "influence of steroid therapy on the incidence of pericarditis and atrial fibrillation following percutaneous epicardial mapping and ablation for ventricular tachycardia" by dyrda et Al. [Letter]
- Circ Arrhythm Electrophysiol 2014 Oct; 7(5):992.
- Elimination of ventricular arrhythmias originating from the anterior interventricular vein with ablation in the right ventricular outflow tract. [Journal Article]
- Circ Arrhythm Electrophysiol 2014 Oct; 7(5):984-5.
- Editor's Perspective: In the Middle. [Journal Article]
- Circ Arrhythm Electrophysiol 2014 Oct; 7(5):982-3.
- Intramural outflow tract ventricular tachycardia: anatomy, mapping, and ablation. [Journal Article]
- Circ Arrhythm Electrophysiol 2014 Oct; 7(5):978-81.