Sustained Ventricular Tachycardia In Patients Research Articles

Catheter ablation versus antiarrhythmic drug therapy for sustained ventricular tachycardia in patients with hypertrophic cardiomyopathy.

Ventricular tachycardia (VT) is the primary cause of sudden cardiac death in patients with hypertrophic cardiomyopathy (HCM). However, the strategy for VT treatment in HCM patients remains unclear. This study is aimed to compare the effectiveness of catheter ablation versus antiarrhythmic drug (AAD) therapy for sustained VT in patients with HCM. A total of 28 HCM patients with sustained VT at 4 different centers between December 2012 and December 2021 were enrolled. Twelve underwent catheter ablation (ablation group) and sixteen received AAD therapy (AAD group). The primary outcome was VT recurrence during follow-up. Baseline characteristics were comparable between two groups. After a mean follow-up of 31.4 ± 17.5 months, the primary outcome occurred in 35.7% of the ablation group and 90.6% of the AAD group (hazard ratio [HR], 0.29 [95%CI, 0.10-0.89]; P = 0.021). No differences in hospital admission due to cardiovascular cause (25.0% vs. 71.0%; P = 0.138) and cardiovascular cause-related mortality/heart transplantation (9.1% vs. 50.6%; P = 0.551) were observed. However, there was a significant reduction in the composite endpoint of VT recurrence, hospital admission due to cardiovascular cause, cardiovascular cause-related mortality, or heart transplantation in ablation group as compared to that of AAD group (42.9% vs. 93.7%; HR, 0.34 [95% CI, 0.12-0.95]; P = 0.029). In HCM patients with sustained VT, catheter ablation reduced the VT recurrence, and the composite endpoint of VT recurrence, hospital admission due to cardiovascular cause, cardiovascular cause-related mortality, or heart transplantation as compared to AAD.

Incidence and predictors of new-onset sustained ventricular tachycardia in patients with cardiac sarcoidosis and high-grade AV block as first cardiac symptom

Abstract Funding Acknowledgements Type of funding sources: None. Background Cardiac sarcoidosis (CS) is infrequently affecting the heart and may cause heart failure and dangerous arrhythmias. If left untreated, it usually progresses to end-stage heart failure or can cause sudden cardiac death. A frequent initial presentation is AV block, but malignant ventricular arrhythmias can occur in the course of the disease, as well. Ventricular tachycardia or fibrillation (VT/VF) can occur even in patients with normal or nearly normal ejection fraction. Therefore, the current guidelines recommend implantation of ICD devices whenever a pacemaker implantation is needed, such as in case of AV block, although there are little data supporting this opinion. Purpose The purpose of this study was to establish the risk for occurrence of VT/VF in patients with CS, initially presenting with AV block. Furthermore, we sought to establish possible predictors for occurrence of VT/VF. Methods We analyzed 128 patients diagnosed with CS according to the latest JCS criteria. Patients with AV block as initial cardiac presentation were selected and were followed for occurrence of VT/VF or death. We analyzed the differences between the baseline characteristics and the cardiac imaging between those with and without VT/VF. Results Out of 128 patients with CS, 30 (23%) patients (13 female, age 50 ± 10 y; EF 48 ± 12%) with high-grade AV Block as initial cardiac symptom were identified. In 7 of them, a permanent pacemaker had already been implanted. In 15 (50%) patients the diagnosis was confirmed histologically. Cardiac MRI showed presence of LGE in 10 patients with mean LGE volume of 14±8%, and RV involvement in 5 cases. 18FDG-PET showed abnormal tracer enhancement in 12 (40%) patients with SUVmax 9 ± 5. A new sustained VT/VF occurred during the follow up in 10 (30%) patients; and non-sustained VT in other 4. Death occurred suddenly in 2 patients, both without an ICD device. In the univariate analysis, the following baseline characteristics were not associated with occurrence of VT: age, LVEF, amount of LGE, SUVmax, ACE and sIL2-R. Patients with new VT/VF during FU had more frequently RV involvement ( 50% vs. 0 %); LGE in CMR (100% vs 50%) and positive PET ( 100% vs. 57%). Conclusions Patients with cardiac sarcoidosis and AV block as initial presentation have a very high risk of developing sustained VT/VF. Death occurred only in patients without an ICD. ICD implantation, instead of pacemaker, should be considered in all patients with AV block, especially in presence of LGE in CMR, abnormal 18FDG PET and RV involvement.

Radiofrequency catheter ablation of sustained ventricular tachycardia in patients with coronary artery disease and chronic heart failure with left ventricular systolic dysfunction. (One-year follow-up results)

Radiofrequency catheter ablation of sustained ventricular tachycardia in patients with coronary artery disease and chronic heart failure with left ventricular systolic dysfunction. (One-year follow-up results)

P5408Urinary 8-hydroxy-2-deoxyguanosine as a novel myocardial oxidative stress marker for sustained ventricular tachycardia in patients with active cardiac sarcoidosis

P5408Urinary 8-hydroxy-2-deoxyguanosine as a novel myocardial oxidative stress marker for sustained ventricular tachycardia in patients with active cardiac sarcoidosis

Incidence of Sustained Ventricular Tachycardia in Patients with Prolonged QTc After the Administration of Azithromycin: A Retrospective Study.

BackgroundAzithromycin has been associated with abnormalities of cardiac repolarization and development of torsades de pointes. Observational data suggest that the risk of death from cardiovascular causes is increased in patients taking azithromycin. Little is known regarding the risk of ventricular arrhythmia in patients with prolongation of the corrected QT interval who receive azithromycin.ObjectiveThe purpose of this study was to determine the incidence of sustained ventricular tachycardia in patients with prolonged corrected QT (QTc) who subsequently received azithromycin.MethodsWe performed a retrospective cohort analysis of the incidence of sustained ventricular tachycardia in patients with prolonged QTc (greater than 450 ms) who successively received intravenous (IV) and/or oral azithromycin. Patients hospitalized in a tertiary care teaching hospital between November 2009 and June 2012 were included in the study. The primary outcome was sustained ventricular tachycardia documented in patients on telemetry.ResultsOf the 103 patients enrolled in the study, only one patient experienced the primary outcome (0.97 %). The event occurred 1 day after the administration of a single dose of 500 mg IV azithromycin.ConclusionThe risk of sustained ventricular tachycardia was 0.97 % in our cohort of patients with prolonged QTc who subsequently received azithromycin. Given the small size of this study, additional research is needed to determine the true incidence of arrhythmia in the population.

Rare Incidence of Ventricular Tachycardia and Torsades de Pointes in Hospitalized Patients With Prolonged QT Who Later Received Levofloxacin: A Retrospective Study

ObjectiveTo determine the incidence of ventricular tachycardia and ventricular fibrillation in patients with prolonged corrected QT interval (QTc) who received levofloxacin through retrospective chart review at a tertiary care teaching hospital in the United States. Patients and MethodsWe selected 1004 consecutive hospitalized patients with prolonged QTc (>450 ms) between October 9, 2009 and June 12, 2012 at our institution. Levofloxacin was administered orally and/or intravenously and adjusted to renal function in the inpatient setting. The primary outcome measure was sustained ventricular tachycardia recorded electrocardiographically. ResultsWith a median time from the start of levofloxacin use to hospital discharge (or death) of 4 days (range, 1-94 days), only 2 patients (0.2%; 95% CI, 0.0%-0.7%) experienced the primary outcome of sustained ventricular tachycardia after the initiation of levofloxacin use. ConclusionIn this study, the short-term risk for sustained ventricular tachycardia in patients with a prolonged QTc who subsequently received levofloxacin was very rare. These results suggest that levofloxacin may be a safe option in patients with prolonged QTc; however, studies with longer follow-up are needed.

Propranolol efficiency in prevention of sustained ventricular tachycardia in patients with implanted cardioverter-defibrillator: a case series

Propranolol efficiency in prevention of sustained ventricular tachycardia in patients with implanted cardioverter-defibrillator: a case series

Contemporary predictors of death and sustained ventricular tachycardia in patients with repaired tetralogy of Fallot enrolled in the INDICATOR cohort

ObjectivePatients with repaired tetralogy of Fallot (TOF) experience increased rates of mortality and morbidity in adulthood. This study was designed to identify risk factors for death and ventricular tachycardia (VT)...

Ablation of sustained ventricular tachycardia in patients with and without structural heart disease

Ablation of sustained ventricular tachycardia in patients with and without structural heart disease

The Potential Role of Iodine-123 Metaiodobenzylguanidine Imaging for Identifying Sustained Ventricular Tachycardia in Patients with Cardiomyopathy

Implantable cardioverter-defibrillators (ICDs) significantly reduce mortality in patients with depressed left ventricular ejection fraction (LVEF) and heart failure (HF). However, shortcomings of LVEF to accurately identify those at greatest risk of ventricular tachyarrhythmias have led to the pursuit of alternative means to refine qualification criteria for ICD implantation. It is well established that imaging the cardiac nervous system with123I meta-iodobenzylguanidine (123I-mIBG) provides incremental prognostic value in patients with HF beyond LVEF. Whether 123I-mIBG will also play an important role for identifying and/or predicting sustained ventricular tachyarrhythmias in patients with cardiomyopathy and determining those who may benefit from ICD implantation is currently under investigation. Novel imaging approaches that pinpoint the site of ventricular arrhythmias and guide ventricular tachycardia ablation are presented.

212 Late outcome of radio-frequency ablation for monomorphic sustained Ventricular tachycardia in patients with underlying heart disease without implantation of a defibrillator

212 Late outcome of radio-frequency ablation for monomorphic sustained Ventricular tachycardia in patients with underlying heart disease without implantation of a defibrillator

Usefulness of heart rate turbulence for predicting cardiac events in patients with nonischemic dilated cardiomyopathy

BackgroundFew studies have described the clinical value of heart rate turbulence (HRT), an autonomic risk stratification index, in stratifying patients with nonischemic dilated cardiomyopathy (NIDCM). We prospectively assessed the utility of HRT for cardiac events in patients with NIDCM. MethodsWe enrolled 134 consecutive patients with NIDCM. Heart rate turbulence was automatically measured using an algorithm based on 24-hour Holter electrocardiograms. In addition to HRT, other risk indices such as a reduced left ventricular ejection fraction of 30% or less, the presence of nonsustained ventricular tachycardia (VT), the use of medical treatment, and so on were assessed as well. The primary end point was defined as cardiac mortality and sustained VTs. ResultsOf the patients enrolled, 106 (79%) were used for HRT assessment. Heart rate turbulence was determined as positive in 26 patients (25%) and negative in 80 patients (75%). During a follow-up of 445 ± 216 days, 23 patients (23%) reached the primary end point. Among indices, documented presence of nonsustained VT and an HRT-positive outcome had significant values with the primary end point (P = .02 and P = .0001, respectively). On multivariate analysis, an HRT-positive outcome was the most significant predictor, with a hazard ratio of 4.5 (95% confidence interval, 2.0-10.4; P = .0004). ConclusionsHeart rate turbulence is a powerful risk stratification index for cardiac events defined as cardiac mortality and sustained VTs in patients with NIDCM.

199 Late outcome of radio-frequency ablation for monomorphic sustained ventricular tachycardia in patients with underlying heart disease without implantation of a defibrillator

Monomorphic sustained ventricular tachycardia (MSVT) in structural heart disease (SHD) carries poor prognosis and usually needs ICD implantation. Whether successful RF ablation of VT in this setting could avoid the need of ICD implantation is largely unknown. 105 successive with SHD (88 men, age 64 ± 16) were followed after RF ablation of MSVT. An ICD was not implanted either because of end stage extra cardiac pathology, advanced age or well-tolerated MSVT and preserved EF. 33% were on amiodarone and 51% on beta-blockers. 128 procedures were performed (1,2/pt) in 4 centers. Coronary artery disease was present in 54%, right ventricular dysplasia in 10%, dilated cardiomyopathy in 10% and various SHD in 26%. Mean EF was 48 ± 12% (14% with EF < 0,35). VT was well tolerated in 77% (169 ± 32 bpm) with syncope or near-syncope in 23%. 11% presented with electrical storm. Ablation was performed using various techniques and end points. Complete acute success was considered achieved in 80% and undetermined in 5 pts. Not any VT was induced in 92% at the end of the procedure. Complications were arterial dissection/occlusion (2 pts), tamponnade (1 pt), AV block (1 pt) and hematomas (4 pts). Patients were discharged on beta-blockers (63%) and amiodarone (29%). Mean follow-up was 21 ± 16 months. VT recurred in 14% (7 ± 5 months) without compromise of the vital status. Mortality rate was 11% (no SD) (16 ± 15 months). Additional RF ablations were performed again in 14 pts with recurring VT and VT further recurred in 4 while SD occurred in 2. Final VT recurrence rate including redo precedures was 14%. An ICD was finally implanted in 5 pts. There was no difference in VT recurrence rate according to the cardiopathy, clinical variables, EF, VT rate and tolerance or to residual VT inducibility. RF ablation for VT occurring in pts with SHD without ICD appears safe and efficient and might be now proposed as an alternative for ICD implantation because of associated morbidity, advanced age or when VT is well tolerated and does not occur in the context of advanced heart disease.

202 Late Outcome of Radio-frequency ablation for monomorphic sustained Ventricular tachycardia in patients with underlying heart disease without implantation of a defibrillator

Introduction Sustained ventricular tachycardia (VT) in structural heart disease (SHD) is usually an indication for ICD implantation. Whether successful RF ablation of VT in this setting could avoid the need of ICD implantation is unknown. Methods We report our initial experience of VT ablation in 27 successive non-implanted pts (22 men, 62 ± 18 yo) presenting with sustained monomorphic VT and SHD. An ICD was not implanted either because of debilitating or end stage extra cardiac pathology, advanced age or because the VT was well tolerated and EF was preserved. Amiodarone failed to control VT in 33% and beta-blockers in 73%. Results 33 procedures were performed (1.2/pt). Seventeen pts had ischemic heart disease, four had ARVD, 2 dilated cardiomyopathy, 1 congenital and three had non-categorized SHD. Mean EF was 44 ± 13% (5 pts with EF Conclusions RF ablation for VT occurring in pts with SHD without ICD appears relatively safe and efficient and may be considered in some cases when ICD therapy is not desired because of associated morbidity, advanced age or when VT is well tolerated and does not occur in the context of advanced heart disease.

The Characteristics and Distribution of the Scar Tissue Predict Ventricular Tachycardia in Patients with Advanced Heart Failure

Contrast-enhanced magnetic resonance imaging (CMR) identifies scar tissue as hyperenhanced areas. We sought to clarify the relationship between the scar characteristics and occurrence of sustained ventricular tachycardia (VT) in patients with advanced heart failure. CMR was performed in 29 patients with dilated cardiomyopathy (DCM group) and 18 patients with ischemic cardiomyopathy (ICM group). The characteristics, volume, and distribution of the hyperenhanced areas were analyzed by CMR. The CMR parameters and clinical arrhythmic events were compared between the two groups. In the DCM group, almost all hyperenhanced areas were nontransmural, and presented frequently in the midwall layer. The volume of the hyperenhanced areas and total number of hyperenhanced segments were greater in patients with sustained VT than in those without. On the other hand, in the ICM group, transmural or subendocardial hyperenhanced areas were detected in the territory of the coronary arteries. The volume of the hyperenhanced areas and total number of transmural hyperenhanced segments in patients with sustained VT were unexpectedly smaller than in those without. However, the percentage of nontransmural hyperenhanced segments was greater in patients with sustained VT than in those without. The presence and magnitude of the nontransmural scar tissue may predict sustained VT in patients with advanced heart failure. There was the possibility that a recruitment bias was responsible for the finding of the smaller scars in the ICM patients with sustained VT.

Regional myocardial sympathetic denervation may contribute for the genesis of sustained ventricular tachycardia in patients with chronic Chagas cardiomyopathy

Regional myocardial sympathetic denervation may contribute for the genesis of sustained ventricular tachycardia in patients with chronic Chagas cardiomyopathy

Can Amiodarone Prevent Sudden Cardiac Death in Patients with Hemodynamically Tolerated Sustained Ventricular Tachycardia and Coronary Artery Disease?

One of the most important challenges in today's cardiology is prevention of sudden cardiac death in high risk patients with coronary artery disease (CAD). Sustained hemodynamically tolerated ventricular tachycardia (HTVT) comprises up to 30% of all cases of monomorphic ventricular tachycardia in patients with CAD. While there is a consensus on treatment of hemodynamically unstable sustained ventricular tachycardia in patients with CAD, some controversies regarding the proper treatment of HTVT exist. We re-examined existing clinical evidence, controversies and current guidelines on the treatment of HTVT in patients with CAD and demonstrated that compared to implantable cardioverter-defibrillator, amiodarone is not an acceptable therapeutic option in patients with ischemic heart disease who suffer from HTVT.

P-195 Linear and non-linear indices of heart rate variability preceding non sustained ventricular tachycardia in patients with coronary artery disease and depressed left ventricular function

P-195 Linear and non-linear indices of heart rate variability preceding non sustained ventricular tachycardia in patients with coronary artery disease and depressed left ventricular function

P-195 Linear and non-linear indices of heart rate variability preceding non sustained ventricular tachycardia in patients with coronary artery disease and depressed left ventricular function

P-195 Linear and non-linear indices of heart rate variability preceding non sustained ventricular tachycardia in patients with coronary artery disease and depressed left ventricular function

Management of the patient who has been resuscitated from sudden cardiac death.

CD is a 68-year-old man who had an anterior myocardial infarction 6 months ago. Evaluation at that time demonstrated an occluded left anterior descending artery, which was successfully stented with no other significant lesions. Left ventricular ejection fraction was 35%. He had no recurrent angina or heart failure symptoms. Early one morning he lost consciousness. Paramedics verified ventricular fibrillation (VF) and provided effective defibrillation within 5 minutes; spontaneous circulation returned before transfer to the hospital. Sudden cardiac death claims 300 000 to 450 000 lives a year in the United States and represents approximately 50% of all cardiac death.1–3⇓⇓ Despite recent declines in age-adjusted cardiac mortality and sudden death risk, the overall incidence has remained relatively stable as our population ages.3 Coronary heart disease is present in the majority (70% to 80%) of patients with sudden death, but cardiac arrest is the first manifestation of this underlying process in 50%.4 Resuscitation rates are very low, averaging from 1% to 3% in most major cities.2,5⇓ There are some data to suggest that focused attempts to reduce the time to effective defibrillation, with improved training of first responders or more widespread availability of automatic external defibrillators, provide some hope for the future. It is a widely held belief that the majority of sudden death events are due to ventricular tachycardia (VT) that degenerates into VF (Figure 1).6 This idea may well reflect our greater experience in observing patients with structural heart disease and prior myocardial infarction. Acute severe ischemia may cause primary polymorphic VT even in the absence of preexisting structural heart disease. Autopsy studies document acute changes in coronary morphology (such as plaque rupture, thrombus, etc) in >50% of sudden death events.7 Severe bradyarrhythmias or electromechanical dissociation probably represent an important …