- Ventricular Tachycardia Storm After Standard Radiofrequency Pulmonary Vein Isolation. [Journal Article]Am J Case Rep 2019; 20:1536-1539AJ
- CONCLUSIONS: The incidence of ventricular ectopics after PVI ablation has been previously described, but a sustained monomorphic ventricular storm has not been reported before with RF ablation. We attribute the pathophysiology to an increase in myocardial excitability and/or ventricular autonomic modulation. This is a very rare phenomenon, but any subtle imaging abnormality before planning RF-PVI should be taken into consideration.
- StatPearls: Ventricular Premature Complexes [BOOK]StatPearls Publishing: Treasure Island (FL)BOOK
- Ventricular premature beats (VPBs), or premature ventricular complexes/contractions (PVCs), are ectopic beats that arise from within the ventricles. They are common and can occur in a wide variety of clinical scenarios and a diverse population. They can present in patients both with and without preexisting cardiac disease. Reports show that frequent VPBs can cause progressive left ventricular …
Ventricular premature beats (VPBs), or premature ventricular complexes/contractions (PVCs), are ectopic beats that arise from within the ventricles. They are common and can occur in a wide variety of clinical scenarios and a diverse population. They can present in patients both with and without preexisting cardiac disease. Reports show that frequent VPBs can cause progressive left ventricular (LV) dysfunction and dilation, which may return to normal after successful catheter ablation of the VPBs. The morphology of VPBs is highly variable, and it depends upon its place of origin, underlying structural disease, or the use of antiarrhythmic drugs. The VPBs usually originate from the ventricle that leads to a prolonged ORS complex duration greater than 120 ms because of the delay in the spread of activation to the contralateral ventricle through non-specialized myocardium. However, in certain instances, a QRS complex of duration less than 120 ms can occur, leading to activation of both ventricles "synchronously" because of electrical stimulus from one of the fascicles through a specific conduction system. Premature ventricular contractions classify according to coupling interval (early and delayed), QRS duration (wide and narrow), morphology, and complexity. The 12-lead EKG helps to identify the precise location of the origin of VPBs only by the morphology of ectopic beats. Those VPBs that originates in the left ventricle are usually associated with a right bundle branch block (RBBB), and VPBs that arise in the right ventricle show a left bundle branch block (LBBB) pattern.
- Temporal changes of noninvasive electrocardiographic risk factors for sudden cardiac death in post-myocardial infarction patients with preserved ejection fraction: Insights from the PRESERVE-EF study. [Journal Article]Ann Noninvasive Electrocardiol 2019; :e12701AN
- CONCLUSIONS: While the prevalence of the examined electrocardiographic NIRFs between the two examinations was similar on a population basis, some patients without NIRFs at baseline developed NIRFs at 1 year and vice versa, highlighting the need for risk factor reassessment during follow-up.
- Risk Stratification in Patients with Frequent Premature Ventricular Complexes in the Absence of Known Heart Disease. [Journal Article]Heart Rhythm 2019HR
- CONCLUSIONS: Preprocedural cardiac DE-CMR and programmed ventricular stimulation can be used to identify patients with frequent PVCs without apparent heart disease who are at risk of VT.
- Detection of concealed structural heart disease by imaging in patients with apparently idiopathic premature ventricular complexes: A review of current literature. [Review]Clin Cardiol 2019CC
- CONCLUSIONS: In selected subjects with PVCs and high-risk features for concealed arrhythmic substrate, traditional assessment to rule out the presence of heart disease, including surface ECG and transthoracic echocardiography, should be implemented with more advanced cardiovascular imaging modalities.
- Arrhythmias in Patients on Maintenance Dialysis: A Cross-sectional Study. [Journal Article]Am J Kidney Dis 2019AJ
- CONCLUSIONS: Arrhythmia monitoring limited to 48 hours; small sample size; heterogeneous nature of the population, risk for residual confounding.Arrhythmias, including clinically significant abnormal rhythms, were common. Tachyarrhythmias were more frequent during dialysis and the immediate postdialytic period. The relevance of these findings to clinical outcomes requires additional study.
- Temporal patterns of premature atrial complexes predict atrial fibrillation occurrence in bradycardia patients continuously monitored through pacemaker diagnostics. [Journal Article]Intern Emerg Med 2019IE
- The frequency of premature atrial complexes (PACs) has been related with atrial fibrillation (AF) occurrence and adverse prognosis. Research objective was to evaluate whether temporal patterns of PACs are directly associated with AF onset in pacemaker patients with continuous monitoring of the atrial rhythm. Overall, 193 pacemaker patients (49% female, 72 ± 9 years old), enrolled in a national re…
The frequency of premature atrial complexes (PACs) has been related with atrial fibrillation (AF) occurrence and adverse prognosis. Research objective was to evaluate whether temporal patterns of PACs are directly associated with AF onset in pacemaker patients with continuous monitoring of the atrial rhythm. Overall, 193 pacemaker patients (49% female, 72 ± 9 years old), enrolled in a national registry, were analyzed. Frequency of daily PACs was measured in a 14-day initial observation period, during which patients were in sinus rhythm. In the following period, temporal occurrence and frequency of daily PACs and eventual onset of AF were derived by pacemaker diagnostics. In the run-in period, median PACs frequency was 614 PACs/day (interquartile range 70-3056). Subsequently, in a median follow-up of 6 months, AF occurred in 109 patients, in particular in 37/96 (38.5%) patients with a PAC rate < 614 PACs/day and in 72/97 (74.2%) patients with PAC rate ≥ 614 PACs/day (p < 0.001). In patients with AF occurrence, the number of daily PACs, normalized by dividing for the average of PACs in ten preceding days, progressively increased in the 5 days preceding AF. Cox model predictive analysis showed that the risk of AF was significantly higher in patients with a relative increase of the daily PACs higher than 30% compared with PACs average number in ten preceding days [hazard ratio (95% confidence interval) 3.67 (2.40-5.59), p < 0.001]. PACs frequency increases in the 5 days preceding AF onset. A relative increase of the daily PACs is significantly associated with the risk of AF occurrence.
- Diagnostic Accuracy of a Smartphone-Operated, Single-Lead Electrocardiography Device for Detection of Rhythm and Conduction Abnormalities in Primary Care. [Journal Article]Ann Fam Med 2019; 17(5):403-411AF
- CONCLUSIONS: In a primary care population, a smartphone-operated, 1L-ECG device showed excellent diagnostic accuracy for AF/AFL and good diagnostic accuracy for other rhythm abnormalities. The 1L-ECG device was less sensitive for conduction abnormalities.
- Ventricular Dysrhythmias During Long-Term Follow-Up in Patients With Inherited Cardiac Arrhythmia. [Journal Article]Am J Cardiol 2019; 124(9):1436-1441AJ
- Reports on development of frequent ventricular premature complexes (fVPC), (non)sustained ventricular tachycardias ([n]sVT), or ventricular fibrillation (VF) and their interrelationship in patients with different inherited cardiac arrhythmia (ICA) have sofar not been reported. The aim of this study is therefore to examine incidences and recurrences rates of sVT and VF ("malignant ventricular tach…
Reports on development of frequent ventricular premature complexes (fVPC), (non)sustained ventricular tachycardias ([n]sVT), or ventricular fibrillation (VF) and their interrelationship in patients with different inherited cardiac arrhythmia (ICA) have sofar not been reported. The aim of this study is therefore to examine incidences and recurrences rates of sVT and VF ("malignant ventricular tachyarrhythmias, VTA") in addition to the incidence of fVPC and nsVT ("ventricular dysrhythmias, VDR") in patients with various ICA during long-term follow up. Patients (N = 167, 88 male, age 45 ± 15 years) with ICA including definite/borderline arrhythmogenic right ventricular cardiomyopathy (ARVC, N = 47), Brugada syndrome (BrS, N = 71), catecholaminergic polymorphic ventricular tachycardia (CPVT, N = 7), long QT syndrome (LQTS, N = 41) or short QT syndrome (SQTS, N = 1) who had frequent 24-hour Holter monitoring during a follow-up period of 4.6 ± 4.4 years. During the initial screening visit, 15 patients had a history of malignant VTA. fVPC and nsVT was observed in respectively 19% (OHCA/VF/sVT: N = 9) and 13% (OHCA/VF/sVT: N = 4) of all patients. Compared with the ARVC group, patients with BrS and LQTS had less frequent fVPC and nsVT (fVPC: odds ratio [OR] 0.20, 95% confidence interval [CI] 0.08 to 0.49, p <0.000 and OR 0.09, 95% CI 0.02 to 0.33, p <0.000; nsVT:OR 0.17, 95% CI 0.06 to 0.50, p = 0.001 and OR 0.09, 95% CI 0.02 to 0.46, p = 0.003). The recurrence rate of malignant VTA was 33%. In conclusion, variety of VDR and malignant VTA were found during long-term follow-up in patients with ICA. During nearly a 5 years follow-up period, the recurrence rate of malignant VTA was considerable. fVPC, nsVT, and malignant VTA were most often found in patients with an ARVC.
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- Ablation using 3D maps adjusted for spatial displacement of premature ventricular complexes relative to sinus beats: Improving precision by correcting for the shift. [Journal Article]J Cardiovasc Electrophysiol 2019JC
- CONCLUSIONS: During electroanatomic mapping of PVCs using the Carto 3 system, points mapped during PVCs are spatially displaced relative to their location in sinus rhythm. Electrophysiologists should recognize this phenomenon and account for the shift to guide accurate delivery of ablation lesions.