Paroxysmal Ventricular Tachycardia Research Articles

Causes and predictors of 30-day readmission after cardiovascular implantable electronic devices implantation: Insights from Nationwide Readmissions Database.

Readmissions are a burden on health care resources and have negative impact on patients. Cardiovascular implantable electronic devices (CIEDs) are frequently used in the management of rhythm disorders and advanced heart failure. We assessed 30-day readmissions in patients admitted for CIED implantation in a sample of United States patients. Data were extracted from Nationwide Readmissions Database for calendar year 2013. Patients admitted for CIED implantation were identified using ICD-9 codes. Patients<18years of age, with missing data, who died during hospitalization or discharged in December were excluded. Primary endpoint was all-cause 30-day readmission rate. Factors associated with 30-day readmissions were identified and examined using multivariate logistic regression. We identified 320,783 admissions for CIED implantations. After applying exclusion criteria, 290,420 patients were included in final analysis, out of whom 45,467 (15.7%) patients were readmitted within 30days. Readmitted patients were younger and had more comorbidities. Septicemia (5.1%), pneumonia (3.4%), CHF (2.35%), and paroxysmal ventricular tachycardia (2.3%) were common primary causes of 30-day readmission. Young age, female gender, key comorbidities, weekend admissions, and admission to medium and large size hospital were independent predictors of 30-day readmissions. In our study, 15.7% patients were readmitted within 30days of an index admission for CIED implantation. Most readmissions were due to infectious or cardiovascular causes. There is a need to identify patients at risk for readmission to improve outcomes and curb the cost of care.

Congenital absence of left atrial appendage in a patient with paroxysmal ventricular tachycardia and atrial fibrillation

Congenital absence of left atrial appendage in a patient with paroxysmal ventricular tachycardia and atrial fibrillation

Association of ventricular arrhythmia and in-hospital mortality in stroke patients in Florida: A nonconcurrent prospective study.

Stroke remains one of the leading causes of death in the United States. Current evidence identified electrocardiographic abnormalities and cardiac arrhythmias in 50% of patients with an acute stroke. The purpose of this study was to assess whether the presence of ventricular arrhythmia (VA) in adult patients hospitalized in Florida with acute stroke increased the risk of in-hospital mortality.Secondary data analysis of 215,150 patients with ischemic and hemorrhagic stroke hospitalized in the state of Florida collected by the Florida Agency for Healthcare Administration from 2008 to 2012. The main outcome for this study was in-hospital mortality. The main exposure of this study was defined as the presence of VA. VA included the ICD-9 CM codes: paroxysmal ventricular tachycardia (427.1), ventricular fibrillation (427.41), ventricular flutter (427.42), ventricular fibrillation and flutter (427.4), and other – includes premature ventricular beats, contractions, or systoles (427.69). Differences in demographic and clinical characteristics and hospital outcomes were assessed between patients who developed versus did not develop VA during hospitalization (χ2 and t tests). Binary logistic regression was used to estimate unadjusted and adjusted odds ratios and 95% confidence intervals (CIs) between VA and in-hospital mortality.VA was associated with an increased risk of in-hospital mortality after adjusting for all covariates (odds ratio [OR]: 1.75; 95% CI: 1.6–1.2). There was an increased in-hospital mortality in women compared to men (OR: 1.1; 95% CI: 1.1–1.14), age greater than 85 years (OR: 3.9, 95% CI: 3.5–4.3), African Americans compared to Whites (OR: 1.1; 95% CI: 1.04–1.2), diagnosis of congestive heart failure (OR: 2.1; 95% CI: 2.0–2.3), and atrial arrhythmias (OR: 2.1, 95% CI: 2.0–2.2). Patients with hemorrhagic stroke had increased odds of in-hospital mortality (OR: 9.0; 95% CI: 8.6–9.4) compared to ischemic stroke.Identifying VAs in stroke patients may help in better target at risk populations for closer cardiac monitoring during hospitalization. The impact of implementing methods of quick assessment could potentially reduce VA associated sudden cardiac death.

Dogs poisoned with Nerium oleander fresh leaves: clinical and electrocardiographic findings

ABSTRACT: Nerium oleander is distributed worldwide, mainly in tropical and subtropical regions. These shrubs are frequently used as ornamental plants. However, they contain more than 30 cardiac glycosides that can cause serious toxic effects in dogs. The objective of this study was to report the clinical and electrocardiographic alterations in dogs experimentally poisoned with N. oleander. Ten adult, healthy, mixed-breed dogs weighing 10-25kg and aged 3-6 years were selected for the study. We orally administered 0.25g kg-1 of fresh ground leaves of N. oleander to the dogs. No dog died after the ingestion, but all exhibited signs of poisoning such as vomiting, sialorrhea, nausea, apathy, conjunctiva congestion, dehydration, abdominal pain, tremors, diarrhea, loss of appetite, and tenesmus. Electrocardiogram revealed occurrence of several types of arrhythmias: sinus bradycardia, second-degree atrioventricular block, paroxysmal ventricular tachycardia, and ventricular premature complexes. Systolic blood pressure, as well as heart rate, decreased in the first 24 hours. The present study concluded that a single dose of 0.25g kg-1 of N. oleander green leaves is sufficient to cause a moderate intoxication in dogs, with nonspecific clinical changes mainly related to the digestive system and heart rate, thus demonstrating the importance of this type of intoxication in the list of differential diagnoses of small animals routine.

Irreversible Electroporation Ablation of Liver Metastases Adjacent to the Heart Induces Ventricular Tachycardia: A Case Report

Irreversible electroporation (IRE) is a new non-thermal ablation therapy that is currently undergoing clinical investigation for treatment of malignant liver and lung tumors; however, there is emerging evidence that is method can interfere with heart function. Here we report the first case of a 61-year-old Malaysian woman who underwent IRE ablation on liver metastases from pancreatic cancer located adjacent to the heart. During IRE ablation, two electrodes were placed on the liver tumor, with minimum distances from the heart of 5.7 mm. Despite using a cardiac synchronization device during the IRE ablation, paroxysmal ventricular tachycardia was induced in this patient. Therefore, care must be taken when treating lesions located near the heart with IRE.

Prevalence of comorbidities and their influence on complications and outcomes of coronary bypass surgery for coronary heart disease in gender perspective

Aim. To study prevalence of cardiovascular, respiratory, urinary tract and gastrointestinal comorbidity for the improvement of prediction of complications and adverse outcomes in coronary bypass surgery in patients with coronary heart disease, incl. gender differences. Material and methods. We observed 127 patients (73,2% — males, 26,8% — females), operated for ischemic heart disease in Altai regional clinical hospital. Mean age at the moment of surgery was 58,9±6,3 y.o. Bypass operation was done as indicated, under on-pump conditions with pharmaco-cold cardioplegy. Results. Comorbidity index by Charlson (CIС) was 4,7 [4,1-5,3] points; in men — 3,6 [3,2-4,1], in women — 5,2 [4,7-5,6] (p5) у for women — 58,8% vs 36,6% (р=0,04). CIC correlated with the following operation complications: heart failure required inotropes for >5 days (r=0,73); perioperation myocardial infarction (r=0,71); acute disorder of brain circulation confirmed by computed tomography (r=0,56); heart rhythm disorders: atrial fibrillation, paroxysmal ventricular tachycardia (r=0,52); respiratory failure led to prolonged artificial ventilatory support >5 days. (r=0,48). Conclusion. CIC shows gender differences and is characterized by higher risk of adverse outcomes in women: survival 70 y.o., heart failure, diabetes, chronic kidney disease (≥III stage) and duration of on-pump period.

Present trends and controversies in the use of beta-blockers in cardiovascular diseases

In this paper we summarize present trends and controversies in the use of beta-blockers in cardiovascular diseases. Beta-blockers are catecolamine competitive inhibitors and act through alpha and beta adrenergic receptors blockade. Different agents have a dose-dependent affinity for different beta adrenergic receptors (beta 1, beta 2, beta 3) which is less with higher doses. The most important therapeutic effects of beta-blockers are on cardiovascular system, where they act as negative chronotropic and inotropic agents, lowering cardiac work and improving oxygen demand /supply ratio. Clinical indications are numerous. For their anti-ischemic activity beta-blockers are used as anti-anginal drugs and in acute and previous myocardial infarction for preventing total and cardiovascular mortality. Combined use of beta-blockers and ACE inhibitors slows down heart failure progression and reduces cardiovascular mortality. Beta-blockers are useful in treating focal atrial tachycardia and supra ventricular paroxysmal tachycardia, by reducing sinus node automaticity and delay atrio-ventricular conduction; they also prevent sudden cardiac death and ventricular tachycardia associated with increased sympathetic activity. There is no indication in treating primary non-complicated hypertension with beta-blockers as first-line drugs. Different metabolic effects of selective and non-selective beta-blockers are actually debated. In conclusion, beta-blockers have indication in the treatment of many cardiovascular diseases. Further studies are needed for better understanding the differences in cardiac and peripheral beta-blockers effects depending on their selectivity.

Radiofrequency ablation leading to ST-segment elevation: a case report.

We report the case of a 47-year old female patient in whom an electrophysiology study (EP) with 3D mapping system (CARTO) was performed due to paroxysmal idiopathic sustained ventricular tachycardia (VT). Anterograde as well as retrograde approach was used during the procedure and fascicular VT using left posterior fascicle was diagnosed, however it was rather non-sustained. After 90 minutes of mapping, patient complained of chest pain and sustained VT was recorded in 12-lead electrocardiogram. After short conversion to sinus rhythm an ST-segment elevation in anterior leads was noticed. The EP procedure was aborted and coronary angiography was performed. Coronary angiography showed dissection of ostial left anterior descending artery and percutaneous coronary intervention with implantation of 2 drug-eluting stents was performed. After 3 months follow up, echocardiography showed normal left ventricular systolic function (EF 60%) with mild hypokinesia of the anteroseptal region. With verapamil as antiarrhythmic therapy the patient was free of VT during 6 months and without heart failure symptoms.

Proarrhythmic Effects Of Antiarrhythmic Drugs: Case Study Of Flecainide Induced Ventricular Arrhythmias During Treatment Of Atrial Fibrillation.

Flecainide is a class 1C antiarrhythmic drug especially used for the management of supraventricular arrhythmia. Flecainide also has a recognized proarrhythmic effect in patients treated for ventricular tachycardia. It is used to treat a variety of cardiac arrhythmias including paroxysmal atrial fibrillation, paroxysmal supraventricular tachycardia and ventricular tachycardia. Flecainide has local anesthetic effects and belongs to the class 1C AADs that block sodium channels, thereby slowing conduction through the heart. It selectively increases anterograde and retrograde accessory pathway refractoriness. The action of flecainide in the heart prolongs the PR interval and widens the QRS complex. The proarrhythmic effects however noted are not widely reported. We report a case of paroxysmal atrial fibrillation with structurally normal heart who was treated with oral Flecainide. There were no adverse events and no QTc prolongation was noted on ECG. Despite subjective improvement a repeat Holter detected him to have multiple short non sustained ventricular arrhythmias. Development of ventricular arrhythmias, salvos and non-sustained ventricular tachycardia after a month of initiation of oral flecainide detected by 24 hours ECG Holter lead to discontinuation of flecainide and subsequent early electrophysiological studies and successful ablation. Initiation of oral Flecainide in a case of atrial fibrillation with subjective improvement and regular ECG monitoring, no QTc prolongation can still lead to development of dangerous ventricular arrhythmias. A cautious approach and thorough investigations and follow up are recommended.

Effect of cardiac resynchronization therapy on ventricular tachycardias in patients with dilated cardiomyopathy and severe heart failure

The aim of the study was to elucidate the effects of cardiac resynchronization therapy (CRT) on ventricular tachycardias in patients with dilated cardiomyopathy and to analyze the prospects of radionuclide diagnostic methods for prediction of life-threatening arrhythmias in the presence of therapy. The study included 70 patients (mean age 55 12 years) aged 32 to 75 years with dilated cardiomyopathy, NYHA FC III heart failure, left ventricular (LV) ejection fraction (EF) of 30.1 3.8%, and end-diastolic volume (EDV) of 220.7 50.9 mL. Group 1 comprised 35 patients (50%) diagnosed with paroxysms of ventricular tachycardia, while Group 2 consisted of 35 patients (50%) without episodes of ventricular tachycardia. After one year of CRT, positive clinical changes were documented in all patients: LV EF increased to 42.8 4.8% (p 0.001); functional class of heart failure decreased to II; LV EDV decreased to 197.9 47.8 mL (p 0.005). The patients whose EF increased by 14% and EDV decreased by 35 mL during one-year CRT had no episodes of ventricular tachycardia. The patients, whose paroxysms of ventricular tachycardia persisted during the entire period of the study, showed EF increase by 9% and EDV decrease by 13 mL. The second stage of the study consisted in evaluating the effects of myocardial metabolism defects (MMD). No ventricular tachycardia episodes were registered in patients whose MMD became less than 15% during CRT; if the size of DMM exceeded 15%, paroxysms of ventricular tachycardia were observed. Thus, efficacious CRT in patients with dilated cardiomyopathy results in a statistically significant reduction of the number of ventricular tachycardia episodes. The improvement of fatty acid metabolism contributes to a decrease in the number of ventricular tachycardia episodes in the course of CRT.

Paroxysmal supraventricular tachycardia following DTP and poliomyelitis immunization

Arrhythmias including paroxysmal supraventricular tachycardia (SVT), ventricular tachycardia and auricular fibrillation after vaccinations have rarely been reported in the literature [1,2]. Herein, we report on an infant with paroxysmal SVT, which developed following DTP (diphtheria, tetanus toxoids and pertussis), and poliomyelitis immunization because of very rare presentation. A previously healthy 4-month-old girl was admitted to our hospital with fever, vomiting, and dyspnea. Three days before admission, DPT and oral poliomyelitis immunization were administrated. Aforementioned symptoms initiated about five hours after immunization and the symptoms gradually increased. The personal and family history was unremarkable. On physical examination fever was 35.5◦C; pulse rate 220/min; and respiratory rate 100/min. Arterial pressure was too low to be measured. She was in lethargic. She had generalized cutis marmorata, severe respiratory distress, tachycardia, tachypnea, intercostal, subcostal and suprasternal retractions and 3-cm hepatomegaly. On laboratory investigation, hemoglobin was 10 g/dL; leuko-

Recurrent syncope attributed to left main coronary artery severe stenosis.

Patients with acute coronary syndrome (ACS) rarely manifest as recurrent syncope due to malignant ventricular arrhythmia. We report a case of a 56-year-old Chinese male with complaints of paroxysmal chest burning sensation and distress for 2 weeks as well as loss of consciousness for 3 days. The electrocardiogram (ECG) revealed paroxysmal multimorphologic ventricular tachycardia during attack and normal heart rhythm during intervals. Coronary angiograph showed 90% stenosis in left main coronary artery and 80% stenosis in anterior descending artery. Two stents sized 4.0∗18 mm and 2.75∗18 mm were placed at left main coronary artery and anterior descending artery, respectively, during percutaneous coronary intervention (PCI). The patient was discharged and never had ventricular arrhythmia again during a 3-month follow-up since the PCI. This indicated that ventricular tachycardia was correlated with persistent severe myocardial ischemia. Coronary vasospasm was highly suspected to be the reason of the sudden attack and acute exacerbation. PCI is recommended in patients with both severe coronary artery stenosis and ventricular arrhythmia. Removing myocardial ischemia may stop or relieve ventricular arrhythmia and prevent cardiac arrest.

Ventricular arrhythmias in patients of atrial fibrillation treated with flecainide: A case report

Purpose: Flecainide is a class 1C antiarrhythmic drug, especially used for the management of supraventricular arrhythmia. Flecainide also has a recognized proarrhythmic effect in all age groups of adult patients treated for ventricular tachycardia. It is used to treat a variety of cardiac arrhythmias including paroxysmal fibrillation, Paroxysmal Supraventricular tachycardia and ventricular tachycardia. Flecainide works by regulating the flow of sodium in the heart, causing prolongation of the cardiac action potential. The proarrhythmic effects however noted are not widely reported. Case report: We report a case of paroxysmal atrial fibrillation with structurally normal heart who was treated with oral Flecainide. Despite subjective improvement and no adverse events [QTc prolongation] a repeat holter detected him to have multiple short non sustained ventricular arrhythmias. Results: Development of ventricular arrhythmias, salvos &non sustained ventricular tachycardia after a month of initiation of oral Flecainide detected by 24 hours ECG holter lead to discontinuation of Flecainide and subsequent early electro physiological studies and successful ablation. Conclusion: Initiation of oral Flecainide in a case of atrial fibrillation with subjective improvement and regular ECG monitoring, no QTc prolongation can still lead to development of dangerous ventricular arrhythmias. A cautious approach and thorough investigations and follow up are recommended.

Flecainide Induced Ventricular Arrhythmias in Atrial Fibrillation

Purpose: Flecainide is a class 1C antiarrhythmic drug especially used for the management of supraventricular arrhythmia. Flecainide also has a recognized proarrhythmic effect in patients treated for ventricular tachycardia. It is used to treat a variety of cardiac arrhythmias including paroxysmal fibrillation, Paroxysmal Supraventricular tachycardia and ventricular tachycardia. Flecainide works by regulating the flow of sodium in the heart, causing prolongation of the cardiac action potential. The proarrhythmic effects however noted are not widely reported. Method: We report a case of paroxysmal atrial fibrillation with structurally normal heart who was treated with oral Flecainide. Despite subjective improvement and no adverse events [QTc prolongation] a repeat holter detected him to have multiple short non sustained ventricular arrhythmias. Results: Development of ventricular arrhythmias, salvos & non sustained ventricular tachycardia after a month of initiation of oral Flecainide detected by 24 hours ECG holter lead to discontinuation of Flecainide and subsequent early electro physiological studies and successful ablation. Conclusion: Initiation of oral Flecainide in a case of atrial fibrillation with subjective improvement and regular ECG monitoring, no QTc prolongation can still lead to development of dangerous ventricular arrhythmias. A cautious approach and thorough investigations and follow up are recommended.

GW24-e0344 The prospective study of esmolol in the treatment of rapid ventricular arrhythmia

ObjectivesTo investigate the effect and safety of esmolol in treating ventricular arrhythmiasMethodsWe gave intravenous injection of esmolol either alone or along with electrical defibrillation, electrical cardioversion, to 48 ventricular arrhythmias...

GW24-e3035 Diagnostic performance of cardiac magnetic resonance imaging in identifying potential structural abnormalities in patients with ventricular arrhythmia before ablation

ObjectivesEchocardiography is routinely recommended to evaluate structural abnormalities in patients with ventricular tachycardia. However, the performance of cardiac magnetic resonance imaging (MRI) in the evaluation of patients with hemodynamic stable...

Change of the main parameters of 24-hour ekg monitoring in patients with myocardial infarction associated with ventricular arrhythmias

Aim. To study the change of the main parameters of 24-hour EKG monitoring over time in patients with myocardial infarction associated with ventricular arrhythmias of different grades. Methods. The change of the echocardiography parameters, heart rhythm variability, corrected QT interval duration and dispersion, late ventricular potentials, heart rhythm turbulence were examined in 70 adult men (mean age 52.6±1.3 years) with primary Q-wave myocardial infarction on 10-14th day of the disease and after 6 months. Patients were assigned into 3 groups depending on ventricular arrhythmias severity (according to Lown classification modified by Ryan): А1 (n=29) - grade 1-2, А2 (n=23) - grade 3-4, А3 (n=18) - patients with paroxysmal ventricular tachycardia. Results. Presence of late ventricular potentials and pathologic heart rhythm turbulence in patients in acute period of myocardial infarction suggested high grade of ventricular arrhythmia. Ventricular arrhythmias were associated with severe sympathicotonia, prolongation of corrected QT interval and QT dispersion. 6 months after Q-wave myocardial infarction an autonomic imbalance increased and no positive changes of myocardial homogenicity parameters, late ventricular potentials and pathologic heart rhythm turbulence were observed with increasing ventricular arrhythmia grading and heart rate frequency. A relationship between left ventricle ejection fraction, myocardium mass and myocardial electric non-stability values was revealed. In patients with Q-wave myocardial infarction ventricular arrhythmias are mediated by several mechanisms: systolic and autonomic disorder, repolarization abnormalities, late ventricular potentials pathologic heart rhythm turbulence. The severity of abnormalities is marked by the ventricular arrhythmias grade. Conclusion. 6 months after myocardial infarction (in healing stage) the significant positive changes are found only in patients with 1-2 grades ventricular arrhythmias. The significant non-homogeneity of myocardial electrophysiological features still persists in patients with life-threatening ventricular arrhythmias.

Multiple Thrombosis Caused by Arrhythmogenic Right Ventricular Cardiomyopathy

A 68-year-old man was transferred emergently to our department because of multichamber intracardiac thrombosis. Enhanced computed tomography revealed multichamber thrombosis in the right atrial appendage, right ventricular outlet tract. and left atrial appendage, with localized aneurysm of a much enlarged right ventricle. He underwent thrombectomy and valve repair. Here we report a rare case of arrhythmogenic right ventricular cardiomyopathy with multichamber intracardiac thrombosis.

Utility of cardiac magnetic resonance imaging in identifying the potential structural heart disease for ventricular arrhythmia before ablation

Background Cardiac magnetic resonance imaging (CMR) is a powerful tool to identify the arrhythmia substrate in patients with ischemic or non-ischemic cardiomyopathy. However, the performance and diagnostic yield of CMR in pre-ablation evaluation for ventricular arrhythmia in patients without known structural heart disease was still unknown. In the present study, we sought to investigate the performance of CMR in identifying the potential structural heart disease or substrate for ventricular arrhythmia in pre-ablation patients. Methods CMR was performed in a series of consecutive patients (average age 45.8±16.9 years) with premature ventricular contraction or paroxysmal ventricular tachycardia referred for trans-catheter ablation. None of the patients had any known structural heart disease. CMR protocol included regular cine, rest perfusion and late gadolinium enhancement imaging. CMR image was interpreted by two experienced experts who were blinded to the echocardiography findings and clinical diagnosis. Results

Case 5/2013 - A Four-Year-Old Boy with a Rhabdomyoma-Type Cardiac Tumor in Both Ventricles and Repeated Ventricular Tachycardia

Clinical data: Chest radiography performed during upper respiratory tract infection at 5 months of age suggested heart disease because of a deformity observed in the ventricular arch. At that time, echocardiography confirmed the presence of two tumor masses in both ventricles. At nine months of age, the patient started to present with episodes of paroxysmal ventricular tachycardia, with a heart rate of approximately 200 bpm, accompanied by diaphoresis and paleness, all reverted after electrical cardioversion. The episodes recurred for five times, despite the systematic use of antiarrhythmic medication comprising propranolol and amiodarone. Physical examination: Active, eupneic, mucous membranes pink, normal pulses. Weight: 17 kg. Height: 97 cm. BP: 90/52-61 mmHg. HR: 100 bpm. Aorta non-palpable in the suprasternal notch area. No deformities were observed in the precordium; the apical impulse was not palpable and there were no systolic impulses. The heart sounds were normal with no murmurs. The liver was not palpable.