Diagnosis Of Ventricular Tachycardia Research Articles

Study on the feasibility of distinguishing ventricular and pre-excited arrhythmia rhythms by a new algorithm

BackgroundThe differentiation and diagnosis of ventricular tachycardia (VT) and pre-excited tachycardia (PXT) remains a challenging task, especially when typical AV dissociation is not present. The purpose of this article is to study the feasibility of a new theoretical algorithm for identifying ventricular arrhythmias (VA) and pre-excited arrhythmias (PA) rhythms (which can be used to distinguish VT from PXT, etc.). MethodThis study involved the deduction of a new algorithm by combining knowledge of cardiac anatomy, vectorcardiography, and cardiac electrophysiology. The new algorithm evaluated the diagnostic value through intracardiac electrophysiology in 205 cases of VA and PA. The new algorithm diagnoses VA based on the following 4-step process:1.The QRS complex in leads II, III, and aVF shows a unidirectional R wave, and lead aVR shows a QS pattern.2.S waves are predominant in two or more of leads I, aVF, and V6.3.Lead V2 shows ≥3 phase waves or returning branch notching (note: returning branch refers to the band of QRS complexes returning to the baseline).4.Lead V5 shows a negative wave in the initial portion or returning branch notching.If none of these criteria are met, the diagnosis is PA. The diagnostic value of the new algorithm is compared with the Steurer algorithm and the Vereckei algorithm (diagnosed based on the QRS waveform characteristics of the two algorithms during electrophysiological verification, excluding the diagnosis of atrioventricular dissociation). ResultsThe new algorithm showed significant advantages in terms of AUC value (0.83 vs. 0.61 vs. 0.57), sensitivity (83.6 % vs. 23.3 % vs. 24.8 %), and accuracy (82.9 % vs. 48.3 % vs. 46.3 %) compared to the Steurer algorithm and Vereckei algorithm based on QRS waveform characteristics for diagnosing VA (137 cases) and PA (68 cases). This indicates that the new algorithm is more accurate in identifying idiopathic VA. While there was a significant difference in specificity between the New algorithm and Steurer algorithm (82.3 % vs. 98.5 %, p < 0.05), the difference with Vereckei algorithm (82.3 % vs. 89.7 %) was not significant.In the New algorithm, the sensitivity and specificity for each step are as follows:-Step 1: Sensitivity 34.3 %, Specificity 94.1 %.-Step 2: Sensitivity 24.1 %, Specificity 98.5 %.-Step 3: Sensitivity 18.3 %, Specificity 100 %.-Step 4: Sensitivity 6.6 %, Specificity 89.7 %.Step 1 had the highest AUC value, indicating the best overall diagnostic performance among all steps. Step 2 and Step 3 also performed well, while Step 4 had relatively poorer diagnostic performance. ConclusionThe new algorithm is suitable for identifying the origin of VA and PA rhythms.

Interpretable Clinical Decision-Making Application for Etiological Diagnosis of Ventricular Tachycardia Based on Machine Learning.

Background: Ventricular tachycardia (VT) can broadly be categorised into ischemic heart disease, non-ischemic structural heart disease, and idiopathic VT. There are few studies related to the application of machine learning for the etiological diagnosis of VT, and the interpretable methods are still in the exploratory stage for clinical decision-making applications. Objectives: The aim is to propose a machine learning model for the etiological diagnosis of VT. Interpretable results based on models are compared with expert knowledge, and interpretable evaluation protocols for clinical decision-making applications are developed. Methods: A total of 1305 VT patient data from 1 January 2013 to 1 September 2023 at the Arrhythmia Centre of Fuwai Hospital were included in the study. Clinical data collected during hospitalisation included demographics, medical history, vital signs, echocardiographic results, and laboratory test outcomes. Results: The XGBoost model demonstrated the best performance in VT etiological diagnosis (precision, recall, and F1 were 88.4%, 88.5%, and 88.4%, respectively). A total of four interpretable machine learning methods applicable to clinical decision-making were evaluated in terms of visualisation, clinical usability, clinical applicability, and efficiency with expert knowledge interpretation. Conclusions: The XGBoost model demonstrated superior performance in the etiological diagnosis of VT, and SHAP and decision tree interpretable methods are more favoured by clinicians for decision-making.

Ventricular tachycardia ablation across age groups: Outcomes, trends and demographics. Insights from the National Inpatient Sample Database

BackgroundVentricular tachycardia ablation (VTA) is an important treatment option for ventricular tachycardia (VT), with increasing use across all age groups. However, age-related differences in outcomes remain a concern. ObjectiveThis study aims to investigate age-related trends in ventricular tachycardia ablation (VTA) procedures and their associated adverse events (AEs) across the United States from 2011 to 2021. The primary objective is to analyze VTA outcomes across different age groups. Secondary objectives include examining variation in VTA rate by sex and geographic regions. MethodsWe conducted a retrospective analysis of the National Inpatient Sample (NIS), focusing on adult patients (≥18 years) hospitalized with a primary diagnosis of VT. Patients were divided into three age groups: ≤59, 60-79, and ≥80 years. We evaluated VTA frequency, in-hospital mortality, and complications using propensity score matching to control for confounders. Secondary analyses examined sex and geographic differences. ResultsThe study included 95,913 VTA procedures. The mean age of patients undergoing VTA increased over time, with a growing proportion of procedures performed in older patients. While overall adverse events did not significantly differ across age groups, specific outcomes such as mortality and hemorrhage were significantly higher in patients aged ≥80 years. In-hospital mortality was highest in the ≥80 years group (5.1%), compared to 1.6% in the ≤59 years group and 2.7% in the 60-79 years group. Significant differences by sex and region were also observed. ConclusionsOur study demonstrates that while the overall incidence of adverse events with VTA did not significantly increase with age, specific severe outcomes, such as in-hospital mortality and hemorrhage, were more prevalent in older patients. These findings suggest that VTA can be safely performed across age groups, but careful consideration is essential for elderly patients. Future research should focus on understanding the impact of age-related physiological changes and comorbidities on VTA outcomes.

Sex, Race, and Rural-Urban Disparities in Ventricular Tachycardia Ablations

BackgroundVentricular ablation may be clinically indicated for patients with recurrent ventricular tachycardia (VT) and has been shown to decrease risk of recurrence and overall morbidity. However, the existence of disparities among patients receiving ventricular ablation has not been well characterized. ObjectivesIn this study, the authors examined patients hospitalized with VT to determine whether disparities exist among those receiving ablations. MethodsThe authors used the National Inpatient Sample to assess patients hospitalized with a primary diagnosis of VT in 2019 who did and did not receive catheter ablations. Multiple logistic regression was used to calculate risk factors for VT ablation based on age, sex, race/ethnicity, socioeconomic status, and hospital characteristics. ResultsAfter adjusting for baseline characteristics and comorbidities, female and Black patients hospitalized with VT had significantly lower odds of receiving ablations compared with male and White patients (OR: 0.835; 95% CI: 0.699-0.997; P = 0.047; and OR: 0.617; 95% CI: 0.457-0.832; P = 0.002, respectively). Additionally, patients at rural or nonteaching hospitals were significantly less likely to receive ablations compared with those at urban, teaching hospitals. No significant differences were noted based on income or insurance status in the adjusted models. ConclusionsThe authors identified significant disparities in the delivery of ventricular ablations among patients hospitalized with VT. Overall, patients who were female or Black as well as those who were hospitalized at rural or nonteaching hospitals were significantly less likely to receive VT ablations during hospitalization.

Clinical Decision Support Requirements for Ventricular Tachycardia Diagnosis Within the Frameworks of Knowledge and Practice: Survey Study.

Ventricular tachycardia (VT) diagnosis is challenging due to the similarity between VT and some forms of supraventricular tachycardia, complexity of clinical manifestations, heterogeneity of underlying diseases, and potential for life-threatening hemodynamic instability. Clinical decision support systems (CDSSs) have emerged as promising tools to augment the diagnostic capabilities of cardiologists. However, a requirements analysis is acknowledged to be vital for the success of a CDSS, especially for complex clinical tasks such as VT diagnosis. The aims of this study were to analyze the requirements for a VT diagnosis CDSS within the frameworks of knowledge and practice and to determine the clinical decision support (CDS) needs. Our multidisciplinary team first conducted semistructured interviews with seven cardiologists related to the clinical challenges of VT and expected decision support. A questionnaire was designed by the multidisciplinary team based on the results of interviews. The questionnaire was divided into four sections: demographic information, knowledge assessment, practice assessment, and CDS needs. The practice section consisted of two simulated cases for a total score of 10 marks. Online questionnaires were disseminated to registered cardiologists across China from December 2022 to February 2023. The scores for the practice section were summarized as continuous variables, using the mean, median, and range. The knowledge and CDS needs sections were assessed using a 4-point Likert scale without a neutral option. Kruskal-Wallis tests were performed to investigate the relationship between scores and practice years or specialty. Of the 687 cardiologists who completed the questionnaire, 567 responses were eligible for further analysis. The results of the knowledge assessment showed that 383 cardiologists (68%) lacked knowledge in diagnostic evaluation. The overall average score of the practice assessment was 6.11 (SD 0.55); the etiological diagnosis section had the highest overall scores (mean 6.74, SD 1.75), whereas the diagnostic evaluation section had the lowest scores (mean 5.78, SD 1.19). A majority of cardiologists (344/567, 60.7%) reported the need for a CDSS. There was a significant difference in practice competency scores between general cardiologists and arrhythmia specialists (P=.02). There was a notable deficiency in the knowledge and practice of VT among Chinese cardiologists. Specific knowledge and practice support requirements were identified, which provide a foundation for further development and optimization of a CDSS. Moreover, it is important to consider clinicians' specialization levels and years of practice for effective and personalized support.

Novel scoring system for predicting mortality in patients with ventricular arrhythmias: Analysis from a 24,000 patient cohort

Abstract Background Several scoring systems have been developed to predict mortality in ventricular tachycardias (VT) in selected populations (for example, patients undergoing ablation) with limited follow-up times. We aimed to develop a simple scoring system to predict all-cause mortality in a large cohort of VT patients followed up for &amp;gt;10 years. Methods We mined electronic data from 2008 to 2022 from a large suburban academic and community healthcare system, for the endpoint of all-cause mortality in adults diagnosed with ventricular tachycardia using the ICD 10 code of I47.2. We related the endpoint to covariates including sex, race, socioeconomic factors and comorbidities identified with standard ICD codes (prior to the diagnosis of VT) using cox-proportional hazards model. We then tested a scoring system using coefficients developed in the training cohort (70%) in an independent test cohort. Results We identified 24278 adult patients diagnosed with VT. Of these, 2921 (12%) died within 249 (23,1095) days of diagnosis. Figure 1 shows factors associated with mortality, adjusted for race, gender and ethnicity, which were: congestive heart failure [HR:1.78; (1.62,1.96)] chronic kidney disease [HR:1.75; (1.60,1.91)] ,atrial fibrillation[HR:1.53; (1.40,1.67)], diabetes [HR:1.47; (1.35,1.61)] , coronary artery disease [HR:1.57; (1.43, 1.72)] , peripheral arterial disease [HR:1.29; (1.17,1.42)] , hypertension [HR:1.39; (1.26,1.54) , COPD [HR:1.21,1.50)] , and hyperlipidemia [HR:-.87; (0.80 -0.95)] . The novel 9-point (CKAD(ICV)SHL) score predicts mortality with a C-index of 0.66. Conclusions In a population of over 20 thousand patients with ventricular arrhythmias, a scoring system based on heart failure, CKD, AF and other factors predicts mortality. This may form a basis for revised efforts for screening, risk stratification and trial design for ICD placement and guideline directed medical management.

Ventricular Tachycardia.

This scenario was developed to educate emergency medicine residents on the diagnosis and management of ventricular tachycardia (VT) that is refractory to single dose anti-arrhythmic management. Electrical storm, defined as three or more episodes of sustained VT, ventricular fibrillation, or appropriate shocks from an implantable cardioverter defibrillator within 24 hours,1 has a mortality rate up to 14% in the first 48 hours.2 Ventricular tachycardia may present in a heterogenous fashion, not only with stable versus unstable clinical presentations, but also with different electrocardiographic morphologies and etiologies.1 Understanding how to rapidly diagnose, treat, and utilize second or third-line treatments is vital in the setting of refractory ventricular tachycardia rather than relying on the success of first-line agents. Appreciation for what medications are readily available in your crash cart and medication dispensing cabinet is critical for timely management for refractory ventricular tachycardia. At the conclusion of the simulation session, learners will be able to: 1) identify the different etiologies of VT, including structural heart disease, acute ischemia, and acquired or congenital QT syndrome; 2) describe confounding factors of VT, such as electrolyte abnormalities and sympathetic surge; 3) describe how to troubleshoot an unsuccessful synchronized cardioversion, including checking equipment connections, increasing delivered energy, and changing pad placement; 4) compare and contrast treatments of VT based on suspected underlying etiology; 5) describe reasons to activate the cardiac catheterization lab other than occlusive myocardial infarction; and 6) identify appropriate disposition of the patient to the cardiac catheterization lab. This session was conducted using high-fidelity simulation, followed by a debriefing session and lecture on the diagnosis, differential diagnosis, and management of VT. Debriefing methods may be left to the discretion of participants, but the authors have utilized advocacy-inquiry techniques. This scenario may also be run as an oral board case. Our residents are provided a survey at the completion of the debriefing session so they may rate different aspects of the simulation, as well as provide qualitative feedback on the scenario. The local institution's simulation center's electronic feedback form is based on the Center of Medical Simulation's Debriefing Assessment for Simulation in Healthcare (DASH) Student Version Short Form3 with the inclusion of required qualitative feedback if an element was scored less than a 6 or 7. Twelve learners completed a feedback form. This session received 6 and 7 scores (consistently effective/very good and extremely effective/outstanding, respectively) other than three isolated 5 scores. The lowest average score was 6.67 for "Before the simulation, the instructor set the stage for an engaging learning experience." The highest average score was 7 for "The instructor helped me see how to improve or how to sustain good performance." The form also includes an area for general feedback about the case at the end. Illustrative examples of feedback include: "Excellent care and debrief." Specific scores are available upon request. This is a cost-effective method for reviewing VT diagnosis and management. The case may be modified for appropriate audiences, such as describing what medications may be readily available in a free-standing emergency department or pre-hospital setting. Medical simulation, ventricular tachycardia, cardiac emergencies, dysrhythmias, cardiology, emergency medicine.

Diagnosis and management of ventricular tachycardia

Ventricular tachycardia (VT) describes rapid heart rhythms originating from the ventricles. Accurate diagnosis of VT is important to allow prompt referral to specialist services for ongoing management. The diagnosis of VT is usually made based on electrocardiographic data, most commonly 12-lead echocardiography (ECG), as well as supportive cardiac telemetric monitoring. Distinguishing between VT and supraventricular arrhythmias on ECG can be difficult. However, the VT diagnosis frequently needs to be made rapidly in the acute setting. In this review, we discuss the definition of VT, review features of wide-complex tachycardia (WCT) on ECG that might be helpful in diagnosing VT, discuss the different substrates in which VT can occur and offer brief comments on management considerations for patients found to have VT.

Abstract P3110: Sex Differences In Ventricular Tachycardia Ablation In-hospital Outcomes: An Analysis From The National Inpatient Sample Database

Background: There are limited data available comparing outcomes of ventricular tachycardia (VT) ablation in men versus women. Objectives: For patients undergoing ablation for VT, we sought to determine if sex-based differences in outcomes and procedural complications exist. Methods: We queried the National Inpatient Sample (NIS) database between 2016 and 2018 to identify patients aged ≥18 years hospitalized with a primary diagnosis of VT who underwent ablation. Patients with other cardiac arrhythmias or who had an implantable defibrillator/pacemaker placement were excluded. Multivariable logistic regression analysis was performed to assess independent predictors of any procedural complication. Results: Out of 7,200 identified admissions for VT involving VT ablation, 1,280 (18%) were women and 5920 (82%) were men. Men were older (mean age 64.8 vs 57.4 years in women, P&lt;0.01). Comorbidities as prior myocardial infarction (MI), prior CABG, Chronic kidney disease (CKD), COPD, prior cardiac pacemaker, chronic heart failure (CHF) and peripheral vascular disease (PVD) were all significantly more prevalent in men.The primary outcome of in-hospital mortality occurred in 3% of both men and women. Interestingly, the length of stay was longer in men (6.53±4.2 vs 5.26±2.5 days, p&lt;0.01). The incidence of acute MI, acute ischemic stroke, bleeding, need of blood transfusion, tamponade, complete heart block, pulmonary complications, vascular complications similar between men and women, however acute kidney injury occurred more in men (21% vs. 10%, p&lt; 0.001). The overall complication rate was significantly higher in men (28.8% vs 20.7 %, P= 0.0084). The presence of CKD, as well as CHF were independent predictors of any procedural complication (OR 1.27, 95% CI 1.19-1.36, P &lt;0.01) and (OR 1.08, 95% CI 1.03-1.14, P=0.001). Conclusion: Men had higher rates of in hospital complications following VT ablation which might be related to higher rates of comorbidities. There was no difference in in-hospital mortality between men and women. Women represented only 17.8% of VT ablation admissions. Further studies are needed to distinguish the sex-based differences in VT ablation referrals and to compare long term outcomes post ablation.

The Application of a New, Modified Algorithm for the Differentiation of Regular Ventricular and Pre-excited Tachycardias.

The three-step Brugada group algorithm is the only published electrocardiographical (ECG) algorithm for differentiating ventricular tachycardia (VT) from pre-excited tachycardia (PXT) as a cause of regular wide QRS complex tachycardia (WCT). This study aimed to improve the diagnostic accuracy of the Brugada group algorithm. This study modified the Brugada group algorithm by adding a new aVR lead criterion (initial positive deflection in lead aVR and the QRS complex area above the baseline is greater than the area below the baseline). The Brugada group algorithm and the new, modified four-step algorithm in 300 WCT ECGs (241 VTs, 59 PXTs) was applied. If any of the criteria were fulfilled, VT was diagnosed; if none were fulfilled, a diagnosis of PXT was established. The test accuracy, VT diagnosis sensitivity, and negative predictive value (NPV) of the new, modified algorithm were significantly greater than that of the Brugada group algorithm: test accuracy 220 of 300 (73%) vs 182 of 300 (61%); sensitivity 73% vs 55% (p<0.001 for both); NPV 40% vs 31% (p=0.0205). The VT diagnosis specificity of the Brugada group algorithm was greater than that of the new, modified algorithm (83% vs 75%; p=0.019). There was no significant difference between the new, modified and Brugada group algorithms in the positive predictive values (92% vs 93%, respectively) for a VT diagnosis, and positive and negative likelihood ratio values (2.87 vs 3.26; 0.36 vs 0.54, respectively). The new, modified algorithm proved to be more sensitive for the differentiation of VT from PXT than the Brugada group algorithm.

Outcomes of Ventricular Tachycardia Catheter Ablation in Patients Who Underwent Cardiac Defibrillator Implantation Nationwide Readmission Database Analysis

The timing of when to perform ventricular tachycardia (VT) ablation while receiving an implantable cardioverter defibrillator (ICD) during the same hospitalization has not been explored. This study aimed to investigate the use and outcomes of VT catheter ablation in patients with sustained VT receiving ICD in the same hospital stay. The Nationwide Readmission Database 2016 to 2019 was queried for all hospitalizations with a primary diagnosis of VT with subsequent ICD during the same admission. Hospitalizations were later stratified according to whether a VT ablation was performed. All catheter ablation of VT were performed before ICD implantation. The outcomes of interest were in-hospital mortality and 90-day readmission. A total of 29,385 VT hospitalizations were included. VT ablation was performed with subsequent ICD placement in 2,255 (7.6%), whereas 27,130 (92.3%) received an ICD only. No differences were found regarding in-hospital mortality (adjusted odds ratio [aOR] 0.83, 95% confidence interval [CI] 0.35 to 1.9, p=0.67) and all-cause 90-day readmission rate (aOR 1.1, 95% CI 0.95 to 1.3, p=0.16). An increase in readmission because of recurrent VT was noted in the VT ablation group (aOR 1.53, 8% vs 5% CI 1.2 to 1.9, p <0.01); the VT ablation group encompassed a higher number of patients with heart failure with reduced ejection fraction (p <0.01), cardiogenic shock (p <0.01), and mechanical circulatory support use (p <0.01). In conclusion, the use of VT ablation in patients admitted with sustained VT is low and reserved for higher risk patients with significant co-morbidities. Despite the higher risk profile of VT ablation cohort, no differences were found in the short-term mortality and readmission rate between the groups.

Primary Squamous Cell Lung Cancer With Frequent Episodes of Sustained Ventricular Tachycardia due to Myocardial Metastasis

Myocardial metastasis from lung cancer rarely occurs. We encountered a patient with squamous cell lung cancer who was diagnosed with myocardial metastasis before death and sustained ventricular tachycardia during the course of the disease. The patient was a 56-year-old woman. A tumor was noted in the apex area of the left lung and was diagnosed as stage IVA of squamous cell lung cancer after a detailed examination. She underwent concurrent chemoradiotherapy with weekly treatment of carboplatin + paclitaxel. A 12-lead electrocardiogram performed upon admission for additional chemotherapy showed negative T waves in leads III, aVF, and V1-4. Transthoracic echocardiography and computed tomography showed a tumor lesion in the right ventricular wall, which was diagnosed as myocardial metastasis from lung cancer. During the course of the disease, the patient had frequent episodes of sustained ventricular tachycardia, which were refractory to treatment with antiarrhythmic drugs. However, the sinus rhythm was restored with cardioversion. Subsequently, the patient received palliative treatment and eventually died 4 months after the diagnosis of cardiac metastasis and 3 weeks after the diagnosis of ventricular tachycardia. Myocardial metastasis might reflect poor prognosis due to serious arrhythmia or some other complications. Therefore, the early diagnosis and appropriate treatment of cardiac metastasis by chemotherapy, cardiac radiotherapy, or surgery, are necessary prior to the development of symptoms in tolerant cases. J Med Cases. 2023;14(4):111-117 doi: https://doi.org/10.14740/jmc4066

Incidence and predictors of cardiac arrhythmias in patients with systemic sclerosis

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Heart involvement in systemic sclerosis patients is frequent and represents a negative prognostic factor with around 25% of SSc patients dying from cardiovascular related causes. Cardiac arrhythmias represent 6% of the overall causes of death in SSc patients. Not only a plethora of conditions typical of the disease seem to favour the presence of an arrhythmic substrate such as microvascular disease or fibrosis but autoimmunity itself has been recognized as a pathogenic mechanism for cardiac arrhythmias. Purpose The aim of our study was to investigate the incidence of arrhythmias in patients with systemic sclerosis and identify potential predictors. Methods Prospective longitudinal study enrolling all consecutive patients with a diagnosis of SSc and no overt cardiac disease nor pulmonary hypertension. Echocardiographic parameters and GLS were obtained at baseline and at each follow up as well as 12 lead ECG. Presence of atrial fibrillation (AF), atrial tachycardia (AT), ventricular ectopic beats &amp;gt;1000/24 h (VEB), supraventricular ectopic beats (SVEB), bundle branch block (BBB) and atrioventricular block (AVB) was registered. Results 160 patients (144 females, 90%, mean age 59±14 years) were enrolled from June 2016 to December 2021. At enrolment, 11.3% of patients with SSc presented a previous history of supraventricular arrhythmia (5.6% supraventricular ectopic beats, 3.1% atrial fibrillation, 2.5% atrial flutter) and 5.6% a history of ventricular arrhythmia (5.0% ventricular ectopic beats, 0.6% ventricular tachycardia). After a median follow-up of 3.1 years (95% CI 1.4-4.8 years), five patients (3.1%) died of cardiovascular causes, of which three (1.8%) experienced a sudden cardiac death. During the same period, 16 patients (10%) presented a new diagnosis of supraventricular arrythmia (8.7% atrial fibrillation, 1.3% atrial flutter) and two patients (1.2%) a new diagnosis of ventricular tachycardia. PR interval significantly increased during the 3.1-year follow-up (154±27 vs. 178±32 ms; p=0.013), as well as corrected QT interval (420±23 vs. 436±19 ms; p=0.001). New diagnosis of complete right and left bundle branch block was made in 18 (11.2%) and two (1.2%) of all SSc patients. Diagnosis of pulmonary arterial hypertension was associated with a 4-fold and a 10-fold increased risk of supraventricular and ventricular arrhythmias, respectively (Figure 1). A diffuse SSc variant (p=0.049), indexed right (p=0.020) and left atrial volumes (p=0.035), and E/E’ ratios (p=0.016) were all associated with an increased risk of supraventricular arrhythmias. TAPSE (p=0.040), as well as right (p=0.030) global longitudinal strain were associated with an increased risk of ventricular arrhythmias. Conclusions Ssc patients are often by an arrhythmic profile with an increased risk of supraventricular and ventricular events as well as sudden cardiac death. A comprehensive cardiological work up may help in lowering the risk of arrhythmic complications.

National Trends In The Utilization Of Short-term Mechanical Circulatory Support Devices During Ventricular Tachycardia Ablation Related Hospitalizations

Background : Sparse data exists describing the characteristics of patients utilizing short term mechanical circulatory support (MCS) devices (intra-aortic balloon pumps, percutaneous ventricular assist devices, extracorporeal membrane oxygenation devices) during ventricular tachycardia (VT) ablation related hospitalizations. The purpose of this study was to characterize the demographics, in-hospital mortality, length of stay and hospital charges for MCS use. Methods : In this serial cross-sectional study, we analyzed all VT ablation related hospitalizations who received short-term MCS in the United States from 2010 to 2017 by using the Nationwide Readmission Database. Results : Among 384,742 hospitalizations with primary diagnosis of VT, 41,075 (10.7%) underwent ablation procedures (4,919 in 2010 to 5,349 in 2017). For those undergoing VT ablation procedures: mean age was 63.1 years, 22.5% were females, 56.9% Medicare insured, 31.0% private insured, 27.0% were elective admissions, unadjusted in-hospital mortality was 2.4%, mean length of stay was 6.6 days and mean hospitalization charge was $147,837. Among 41, 075 VT ablation hospitalizations, 2,479 (6.0%) required use of short term MCS and the utilization increased from 211 (4.3%) in 2010 to 364 (6.8%) in 2017, p<.05 (Figure 1). For these MCS requiring hospitalizations: mean age was 64.9 years, 9.7% were females, 67.1% Medicare insured, 22.1% private insured, 35.0% were elective admissions, unadjusted in-hospital mortality was 15.1%, mean length of stay was 12.9 days and mean hospitalization charge was $335,456. From 2010 to 2017, MCS group had following trends: mean age increased (63.4 years to 64.7 years), proportion of females decreased (14.7% to 6.6%), Medicare insured increased (64.9% to 69.0%), private insured decreased (28.6% to 22.9%) and proportion with elective admission status decreased (38.4% to 38.0%). From 2010 to 2017, unadjusted in-hospital mortality increased from 10.5% to 12.6% (p<.05), mean length of stay changed from 16.8 days to 11.2 days (p<0.05) and mean hospital charges increased from $251,637 to $386,952 (p<.05). Conclusions : Use of short-term MCS during VT ablation related hospitalizations in the United States increased rapidly and in-hospital mortality has remained high. Systematic and longitudinal collection of data in this high-risk group of patients is warranted to ensure improved outcomes in the future. : Sparse data exists describing the characteristics of patients utilizing short term mechanical circulatory support (MCS) devices (intra-aortic balloon pumps, percutaneous ventricular assist devices, extracorporeal membrane oxygenation devices) during ventricular tachycardia (VT) ablation related hospitalizations. The purpose of this study was to characterize the demographics, in-hospital mortality, length of stay and hospital charges for MCS use. : In this serial cross-sectional study, we analyzed all VT ablation related hospitalizations who received short-term MCS in the United States from 2010 to 2017 by using the Nationwide Readmission Database. : Among 384,742 hospitalizations with primary diagnosis of VT, 41,075 (10.7%) underwent ablation procedures (4,919 in 2010 to 5,349 in 2017). For those undergoing VT ablation procedures: mean age was 63.1 years, 22.5% were females, 56.9% Medicare insured, 31.0% private insured, 27.0% were elective admissions, unadjusted in-hospital mortality was 2.4%, mean length of stay was 6.6 days and mean hospitalization charge was $147,837. Among 41, 075 VT ablation hospitalizations, 2,479 (6.0%) required use of short term MCS and the utilization increased from 211 (4.3%) in 2010 to 364 (6.8%) in 2017, p<.05 (Figure 1). For these MCS requiring hospitalizations: mean age was 64.9 years, 9.7% were females, 67.1% Medicare insured, 22.1% private insured, 35.0% were elective admissions, unadjusted in-hospital mortality was 15.1%, mean length of stay was 12.9 days and mean hospitalization charge was $335,456. From 2010 to 2017, MCS group had following trends: mean age increased (63.4 years to 64.7 years), proportion of females decreased (14.7% to 6.6%), Medicare insured increased (64.9% to 69.0%), private insured decreased (28.6% to 22.9%) and proportion with elective admission status decreased (38.4% to 38.0%). From 2010 to 2017, unadjusted in-hospital mortality increased from 10.5% to 12.6% (p<.05), mean length of stay changed from 16.8 days to 11.2 days (p<0.05) and mean hospital charges increased from $251,637 to $386,952 (p<.05). : Use of short-term MCS during VT ablation related hospitalizations in the United States increased rapidly and in-hospital mortality has remained high. Systematic and longitudinal collection of data in this high-risk group of patients is warranted to ensure improved outcomes in the future.

Wide Complex Tachycardia

Wide-complex tachycardias (WCTs) should always alert the emergency physician to a potentially immediate or rapidly developing, life-threatening scenario. The approach to these patients should follow general emergency medicine principles. The review covers the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes of WCT. Figures show a basic electrocardiogram (ECG) tracing, an ambulatory monitoring strip of a patient with recurrent presyncope showing repetitive monomorphic ventricular tachycardia, a 12-lead ECG of a rapid wide QRS tachycardia due to an antidromic atrioventricular reciprocating tachycardia in a patient with Wolff-Parkinson-White (WPW) syndrome, an example of pacemaker-mediated tachycardia, ventricular tachycardia occurring in the context of QT prolongation consistent with torsades de pointes, a 12-lead ECG in a patient with WPW syndrome showing a rapid, irregular ventricular rate and wide QRS complexes of atrial fibrillation with a short refractory period, an ECG representative of tricyclic antidepressant overdose, and an algorithm for identifying patients with systolic heart failure and left ventricular ejection fraction less than or equal to 35% who are candidates for an implantable cardioverter-defibrillator. Tables list causes of regular WCT, causes of prolonged QT interval, common medications with potential QT prolongation activity, pharmacologic treatment options for stable patients with WCT, Kindwall and colleagues’ criteria for ventricular tachycardia, Brugada and colleagues’ criteria for ventricular tachycardia, Vereckei and colleagues’ aVr algorithm for the diagnosis of ventricular tachycardia, and a comparison of self-reported sensitivities, specificities, and test accuracies of the algorithms presented by Kindwall, Brugada, and Vereckei and their colleagues. Key words: prolonged QT interval, supraventricular tachycardia, ventricular tachycardia, wide-complex tachycardias This review contains 8 highly rendered figures, 8 tables, and 59 references.

Validation of a Simple Electrocardiographic Algorithm for Detection of Ventricular Tachycardia.

ResumoFundamentoO diagnóstico diferencial de taquicardia de QRS largo, entre taquicardia ventricular (TV) ou taquicardia supraventricular com condução aberrante (TSV-A) é algumas vezes difícil de ser feito na sala de emergência.ObjetivoAvaliar a acurácia de um algoritmo novo e simples para a detecção de TV no eletrocardiograma (ECG) em pacientes com taquicardia de QRS largo.MétodosECGs de 12 derivações para detecção de taquicardia de QRS largo foram obtidos prospectivamente de 120 pacientes durante estudo eletrofisiológico. Seis médicos com diferentes experiências analisaram os ECGs, e fizeram o diagnóstico com base no algoritmo D12V16, que envolve a análise da polaridade predominante do complexo QRS nas derivações I, II, V1 e V6. O diagnóstico foi comparado com os obtidos pelo algoritmo tradicional de Brugada e pelo estudo eletrofisiológico, o qual é considerado padrão ouro. Adotou-se um nível de significância de 5% (p<0,05) nas análises estatísticas.ResultadosDe acordo com o estudo eletrofisiológico, 82 ECGs eram de TV e 38 de TSV-A. Doenças cardíacas estruturais estavam presentes em 71 (86,6%) dos pacientes com TV e em oito (21,1%) com TSV-A. O algoritmo de Brugada teve uma maior sensibilidade global (87,2%), enquanto o algoritmo D12V16 apresentou maior especificidade global (85,1%) para TV. Tanto o algoritmo D12V16 como o de Brugada apresentou um alto valor preditivo positivo (90,9% vs. 85,8%, respectivamente) e acurácia similar (73,8% vs. 81,4%, respectivamente) para o diagnóstico de TV. Nos avaliadores experientes, a acurácia foi maior utilizando o algoritmo de Brugada que o algoritmo D12V16, mas a acurácia dos dois algoritmos foi similar segundo os avaliadores menos experientes.ConclusãoO algoritmo simplificado pode ser um método útil para reconhecer TV no ECG, principalmente para médicos menos experientes. (Arq Bras Cardiol. 2021; [online].ahead print, PP.0-0)

CME ECG 67/Answers: Arrhythmia on Exertion

CME ECG 67/Answers: Arrhythmia on Exertion Abstract. Ventricular tachycardias are potentially life-threatening cardiac arrhythmias with a heart rate >100 beats/min, originating from the specific conduction system below the His or the ventricular myocardium. The morphology of the surface ECG can provide valid information about the underlying mechanism and the associated cardiac disorder. The according pathomechanism is of paramount importance for further management. This article is intended to provide an insight into the various causes and treatment options as well as the differential diagnosis of ventricular tachycardias.

Abstract 17371: In-Hospital Outcomes of Ablation for Ventricular Tachycardia in Heart Failure With Reduced Ejection Fraction

Introduction: Ventricular tachycardia (VT) is a significant cause of morbidity and mortality in patients with heart failure with reduced ejection fraction (HFrEF). Hypothesis: Data on efficacy, safety, and outcomes of catheter ablation for VT in HFrEF have not been studied well. Methods: The 2002-2014 Nationwide Inpatient Sample (NIS) was used to identify all hospitalizations with a principle diagnosis of VT (International Classification of Diseases, Ninth Edition, Clinical Modification [ICD-9-CM] code 427.1) and a secondary diagnosis of HFrEF. Patients who underwent catheter ablation were identified using ICD-9-CM procedure code 37.34. Results: Of 228,557 patients with HFrEF &amp; VT, 5845 (2.56%) underwent catheter ablation. The prevalence of Diabetes Mellitus (DM) and Chronic Kidney disease (CKD) was higher in the reference population contrary to a higher prevalence of prior myocardial infarction (MI), coronary bypass and AICD in those undergoing CA. The frequency of complications in the ablation group was 19.47%, the most common being post-operative hemorrhage (8.3%). This was followed by myocardial infarction (5.34%), pericardial complications (3.38%), and neurological complications (2.14%) (Figure 1.). The odds of in-hospital mortality were lower in the CA group compared to the reference group (5.08% vs 9.42%, p&lt;0.05). Conclusions: Compared to medical therapy, VT ablation in HFrEF is associated with lower mortality though with significant complication rate. This suggests a need for future studies identifying the safety measures in VT ablations and instituting appropriate interventions to improve overall VT ablation outcomes.

Real-world characteristics and readmissions among patients undergoing ablation for ventricular tachycardia: a retrospective database analysis of commercially insured patients in the USA.

BackgroundRadiofrequency catheter ablation is an effective treatment to alleviate symptoms and reduce recurrent implantable cardioverter-defibrillator (ICD/CRT-D) shocks in patients with ventricular tachycardia (VT).ObjectiveTo assess the characteristics and outcomes (complications, inpatient readmissions) of commercially insured patients in the USA undergoing ablation for ischaemic or non-ischaemic VT.MethodsPatients aged 18–64 years with a primary diagnosis of VT who underwent ablation between 2006 and 2015 were identified using the IBM MarketScan Commercial Database. The rate of complications including vascular complications, pericarditis, pulmonary embolism and pericardial tamponade over a 30-day post-ablation period (including index admission) was examined. Inpatient readmissions (VT-related, heart failure (HF)-related and non-VT arrhythmia-related) over the 12-month post-ablation period were examined. A Cox regression model was used to determine factors associated with inpatient readmissions.Results5242 patients (488 with ischaemic and 4754 with non-ischaemic VT) met the study criteria. The majority of VT ablations occurred in an outpatient setting (57% for ischaemic and 66% for non-ischaemic VT). Among complications, vascular complications were most frequent (2.05% among ischaemic and 1.6% among non-ischaemic VT patients) over the 30-day post-ablation period. Among ischaemic VT patients, 17%, 7.6% and 4.7% had VT-related, HF-related and non-VT arrhythmia-related inpatient readmissions, respectively in the 12-month post-ablation period. For non-ischaemic VT patients, these numbers were 7.5%, 1.7% and 3.1%, respectively. Inpatient setting (vs outpatient), baseline ICD/CRT-D implantation, HF comorbidity and ≥2 prior hospitalisations were associated with a higher risk of post-ablation VT-related inpatient readmissions among ischaemic VT patients. Similar factors also were associated with a higher risk of post-ablation VT-related inpatient readmission among non-ischaemic VT patients.ConclusionSetting of ablation and comorbidity status were found to influence readmission rates. Complication and readmission rates following VT ablation were low indicating towards the favourable safety profile of VT ablation.

Cardiac sarcoidosis and ventricular arrhythmias. A rare association of a rare disease. A retrospective cohort study from the National Inpatient Sample and current evidence for management.

Sarcoidosis is an increasingly recognized multi-systemic condition. Cardiac sarcoidosis is associated with ventricular arrhythmias and higher mortality rates. Little epidemiological data is available regarding the disease and associated ventricular arrhythmias. Data from the National Inpatient Sample (NIS) database 2012-2014, were reviewed. Dis-charges associated with sarcoidosis were identified as the target population using relevant ICD-9-CM codes. Primary outcome was a diagnosis of ventricular tachycardia (VT) in the sarcoidosis population. Secondary outcomes include rate of ventricular fibrillation (VF) and cardiac arrest. Subgroup analyses were performed to examine the association of VT with multiple potential confounding clinical variables. Of 18,013,878 health encounters, 46,289 (0.26%) subjects had a diagnosis of sarcoidosis. VT and VF were more prevalent among patients with sarcoidosis compared to those without a diagnosis of sarcoidosis (2.29% vs. 1.22%; p < 0.001 and 0.25% vs. 0.21%; p < 0.001, respectively). Sarcoidosis was also associated with a higher prevalence of cardiac arrest (0.72% vs. 0.6%; p < 0.001). In unadjusted analyses, all examined comorbidities were significantly more common in those with sar-coidosis, including diabetes mellitus (31.6% vs. 21.25%; p < 0.001), hypertension (65.2% vs. 51.74%; p < 0.001), chronic kidney disease (21.09% vs. 14.02%; p < 0.001), heart failure (24.87% vs. 15%; p < 0.001) and acute coronary syndrome (4.32% vs. 3.35%; p < 0.001). The present study showed that sarcoidosis was associated with increased rates of ven-tricular tachyarrhythmia, which can affect the overall disease morbidity and mortality.