Ventricular Tachyarrythmias Research Articles

Clinical impact of nocturnal ventricular tachyarrythmias in electrical storm.

The incidence of electrical storm (ES) is significantly higher during the daytime. However, the association between nocturnal ventricular tachyarrythmias during ES and prognosis remains unclear. Therefore, this study aimed to investigate the clinical characteristics and outcomes of ES with midnight ventricular tachyarrythmias. We included 48 consecutive patients who had an implantable cardioverter-defibrillator or cardiac resynchronization therapy defibrillator implanted between 2010 and 2020 and those who had experienced the onset of an out-of-hospital ES episode. According to the midnight (0:00 a.m.-6:00 a.m.) occurrence of ventricular arrythmia events consisting of ventricular tachycardia (VT) and ventricular fibrillation (VF), we divided them into two groups (with-midnight group: n=27, without-midnight group: n=21). The clinical characteristics and outcomes of the two groups were compared. The patients in the with-midnight group were mostly males, had longer QRS duration, and longer corrected QT-interval than those in the without-midnight group (p<.05). The incidence of all-cause death, especially heart failure death, was higher in the with-midnight group than in the without-midnight group (p<.01). Multivariate analysis showed that the presence of midnight VT/VF during ES was the only independent risk factors for heart failure death (HR=18.9, 95%CI=1.98-181, p=.011). The presence of midnight VT/VF during ES might be associated with the poor prognosis. The loss of a sympathetic circadian pattern of VT/VF distribution during ES might suggest advanced stages of the cardiac disease.

Abstract 13286: Ryanodine Receptor Inhibition Prevents Sudden Cardiac Death by Preserving Cardiac Repolarization Reserve in Stressed Arrhythmogenic Hearts

Introduction: Current therapies for preventing sudden cardiac death (SCD) are limited. Prior studies have shown that cardiac stress-induced ryanodine receptor (RyR2) hyperactivity increases sarcoplasmic calcium leak, leading to ventricular tachyarrythmias (VT) and SCD. We hypothesized that inhibition of RyR2 with dantrolene sodium (DS) reduces Ca 2+ leak and mitigates VT and SCD risk in pressure-overloaded arrhythmogenic hearts. Methods: We used an established guinea pig model that uniquely recapitulates key features of human SCD, including a high incidence of spontaneous VT in freely ambulating animals, randomized to placebo vs. DS treatment. We performed in vivo (e.g., VT/SCD incidence, ECG heart rate and QT variability, echocardiographic measures of cardiac function) and ex vivo (e.g., pressure-volume, electrophysiology) studies. We performed intention to treat analysis for 4-week VT-free survival. Results: About half the animals receiving placebo had SCD by 4 weeks. By contrast, dantrolene treatment reduced SCD incidence by 50%. Compared to placebo, dantrolene treatment preserved chronotropic competency during transient β-adrenergic challenge, and improved heart rate variability (SDNN: 11±1.1 vs 17±2.8 ms, p<0.05), reduced QT variability (0.52±0.13 vs 0.19±0.08 (log, ms, p<0.05), and improved cardiac function (fractional shortening: 26±1.9 vs 45±4.5 %, p<0.05). In perfused excised hearts, dantrolene treatment mitigated VT (induced by isoproterenol or burst pacing). Conclusion: Inhibition of RyR2 hyperactivity by dantrolene treatment prevents VT and SCD by increasing cardiac repolarization reserve. Dantrolene also improved overall cardiac electromechanical function in stressed arrhythmogenic hearts. Targeted inhibition of RyR2 hyperactivity may be an effective therapeutic strategy for preventing VT and SCD.

Left ventricular noncompaction and EcoScore: prognostic value of a new echographic risk score

Abstract Introduction Left Ventricular Non-Compaction (LVNC) is a rare and underdiagnosed cardiomyopathy, characterized by hypertrabeculation of the left ventricle. This disease is associated with high rates of morbidity and mortality; however, its main adverse prognostic factors are not well established. Aim To create a risk score for LVNC based on echocardiographic criteria (EcoScore) to predict the occurrence of adverse events. Methods The authors included patients with the diagnosis of LVNC, according to the Jenni Criteria. Clinical and echocardiographic data were evaluated and the occurrence of the following adverse events was reported: hospitalizations due to supraventricular or ventricular tachyarrythmias and heart failure, acute myocardial infarction, stroke, heart transplant and death. The follow-up time was 24 months. ROC curves to predict the occurrence of at least one adverse event were constructed for each echocardiographic parameter. The optimal cut-off obtained from each ROC curve was then used to attribute points (1 point per parameter). The EcoScore resulted from the sum of the obtained points. The authors finally created a ROC curve to predict the occurrence of any adverse event for the EcoScore. The statistical analysis was performed in SPSS. p value <0.05 was considered statistically significant. Results 33 patients (48.5% male, age at diagnosis 45.9±21 years) were included in this study. The optimal cut-offs for each parameter obtained from the ROC curves were the following: left ventricle dyastolic diameter >55mm, left atrial diameter >40mm, pulmonary artery systolic pressure >22mmHg and left ventricle ejection fraction <40%. The area under the curve for the EcoScore to predict any adverse event was 0.850 (p=0.017) and an EcoScore >1 had a sensibility of 85.7% and a specificity of 70%. Conclusion The EcoScore accurately predicted the occurrence of at least one adverse event in this population. Thus, it could be a good tool in the daily practice to select patients who may benefit from a more aggressive surveillance and treatment. Funding Acknowledgement Type of funding sources: None.

Investigating Novel Electrocardiographic Ventricular Repolarization Markers in Scleroderma Patients

Aim: Ventricular repolarization involves the J-wave, ST-segment, T-wave, and U-wave on the surface electrocardiography (ECG). QT dispersion, Tp-e interval, Tp-e/QT, Tp-e/QTc, Tp-e/JT, and Tp-e/JTc ratios are some indices that predict ventricular tachyarrythmias. Although studies, evaluating repolarization abnormalities in scleroderma have frequently focused on Tp-e interval, QT, and Tp-e/QT, in our study, we aimed to investigate the risk of ventricular arrhythmia by using Tp-e/JT and Tp-e/JTc ratios, which are relatively new parameters.Methods: The study comprised 42 patients with scleroderma (mean age: 50.8 ± 7.3 years; 38 women and 4 men) and 40 healthy controls (mean age: 47.9 ± 5.5 years; 37 women and 3 men). We leveraged a standard 12-lead ECG recording to measure Tp-e interval, Tp-e/JT, Tp-e/JTc, Tpe/QTc, and Tp-e/QT parameters for each patient.Results: Compared to the scleroderma patients electrocardiographic repolarization parameters including Tp-e (90.8 ± 10.9 vs 77.0 ± 10.2, p

Abstract 15480: Twiddler’s Syndrome in a Subcutaneous Implantable Cardioverter-Defibrillator

Introduction: Twiddler’s syndrome refers to deliberate or unintentional twisting of pulse generator in device pocket resulting in lead migration, which can present as malfunction of pacemaker or implantable cardioverter-defibrillator (ICD). In the past 50 years, twiddler’s syndrome with transvenous ICD and pacemaker has been well-described and thoroughly studied. However, there are very little data on twiddler’s syndrome with subcutaneous ICD (S-ICD). Case presentation: The patient is a 50-year-old male with a past medical history of hypertrophic cardiomyopathy, cardiac MRI showing left ventricular hypertrophy with a wall thickness of 24 mm, non-sustained ventricular tachycardia and evidence of late gadolinium enhancement scar, who underwent implantation of S-ICD for primary prevention. First follow-up 2 weeks post-implant showed appropriate device function. Two weeks later, remote monitor documented atrial fibrillation and ICD shocks. Surface ECG showed reduced R wave and delivered shock impedance was 7 ohms. Patient reported no symptoms and was clapping hands to music when it occurred. Chest X-Ray revealed S-ICD lead dislodged and retracted with coiling around the generator in the left lateral chest wall (Figure 1). Subsequently patient underwent lead revision and device replacement. To reduce the risk of future dislodgement, during re-implantation, the tip of the ICD lead was secured with 0-Silk. Conclusion: Twiddler’s syndrome is a rare complication after ICD implantation, not only with transvenous-ICDs but also involving S-ICDs. Risk factors include advanced and younger ages, redundant skin, obesity, oversized pocket, and psychiatric disorder. It can be a potentially dangerous and even fatal due to undetected or unsuccessful therapy for ventricular tachyarrythmias. Therefore, it is of paramount importance to diagnose and intervene early to avoid morbidity and mortality in these patients.

Confirmation of maximal hyperemia by the incremental dose of intracoronary papaverine.

We investigated the effect of the papaverine dose increment method to confirm maximal hyperemia for fractional flow reserve (FFR) measurements. We evaluated 115 consecutive patients involving 200 lesions. FFR was measured after intracoronary papaverine injection into the left (12mg) and right (8mg) coronary arteries as standard doses. Except for 2 patients who had ventricular tachyarrythmia (VTA), we administered a higher papaverine dose (2mg added to the standard dose). We compared the FFR values after using different papaverine doses. VTA incidence and electrocardiogram parameters were compared according to the papaverine doses used. The QTU interval and corrected QTU were significantly prolonged after using a higher dose compared with a standard dose. VTA occurred in one patient (0.9%) at the higher dose. There was no significant difference with a strong correlation between the FFR values in the 2 doses (r = 0.963, P < 0.001). Maximal hyperemia was achieved in most patients at the standard papaverine dose. However, 19 lesions changed ischemic diagnosis at the higher dose (12 lesions changed from ischemia negative to positive, and 7 lesions changed from positive to negative). Therefore, to confirm the appropriate ischemia diagnosis for borderline FFR values, it may be favorable to perform another FFR measurement at an incremental papaverine dose.

Heart rate variability reduction as a non-ivasive predictor of ventricular tachyarrythmias in patients with coronary artery disease

Highlights. The implantation of cardioverter-defibrillator is the most effective method for preventing sudden cardiac death. However, almost 25% patients have normally functioning CD at the 5-years follow-up. This has necessitated the search for new non-invasive diagnostic methods for detecting patients at high risk of ventricular tachyarrhythmias. Aim. To evaluate whether the estimated heart rate variability may be used as a predictor for ventricular arrhythmias (VTA) in patients with coronary artery disease. Methods . 51 patients (mean age of 65.4±8.4 year; 41 male patients (80,3%)) with coronary artery disease (CAD) and indications for cardioverter-defibrillator (ICD) implantation were included to the study. The 6-minute walk distance, echocardiography, heart rate variability (HRV) were assessed and compared between the groups. The statistical analysis was performed using the Statistica 10.0, StatSoft (USA) and MedCalc statistical software (USA). Results . 43 (84.3%) patients with VTA within the 18-months follow-up were assigned to Group 1, and 8 (15.7%) patients without VTA during the 18-month follow-up were assigned to Group 2. The univariate ROC-analysis showed that a reduction in the average NN interval less than 1130 ms (p = 0.0282), root mean square of successive differences less than 18 ms (p = 0.0037) and high frequency spectral component less than 770 ms (p = 0.0001) contributed to the onset of of VTA. Multivariate ROC-analysis demonstrated that the end-diastolic index (p = 0.0185) and standard deviation of NN interval (p = 0.0370) were independent predictors of VTA. An increase of the VTA predictive index (calculated according to the presented predictive model) by &gt;0.5613 suggested the onset of VTA (AUC = 0.927; p = 0.0001). Conclusion . Reduced HRV may be a non-invasive VTA predictor in patients with CAD. The combined use of echocardiography and HRV analysis allows identifying a group of patients with high risk of sudden cardiac death.

Arrythmia in Congenital Heart Diseases, Where Are We?

Background: Arrythmia is a major cause of cardiovascular morbidity and mortality in patients with congenital heart diseases. It has multifactorial predisposing factor as congenitally malformed or displaced conduction system, hemodynamic, mechanical or hypoxic stress and residual or postoperative sequelae. Methods: This was a prospective observational study involving all patients who were following up or referred to congenital and structural heart disease unit in our department over a period of 42 months and were discovered to have significant symptomatic cardiac arrhythmia. A detailed custom-made sheet was applied to all eligible patients to collect demographic data, underlying congenital heart disease, type of arrhythmia and possible management and/or outcome. Results: The study population included 107 patients with different congenital heart diseases with mean age 20.47+/- 13.2. Bradyarrhythmia were more common (67%) than tachyarrhythmia. Post-operative CHB was the most common bradyarrythmia. One third of the patients had atrial or ventricular tachyarrythmia. Post Fallot repair patients developed ventricular tachycardia while patients with Ebstein anomaly more commonly developed atrial tachycardias, flutter or SVT. Patients with CHB were managed with transvenous pacing (51%), epicardial pacing (16%), two patients with CCTGA with impaired RV functions underwent CRT implantation, two patients post Fallot repair underwent ICD implantation. Conclusion: Patients with CHD are subjected to wide range of arrhythmias. Postoperative complete heart block was the commonest arrhythmia in this registry especially in patients with L-TGA, AVSD and VSD. Tachyarrythmias accounted for one third of the patients. Atriotomy incisions, sutures, and conduit is a major risk factor for post-operative atrial tachycardia. The use of ICDs and CRT in patient with congenital heart diseases have proven relative efficacy.

An interactive assistant for patients with cardiac implantable electronic devices: A study protocol of the LUCY trial.

Patients with chronic heart failure (CHF) and reduced left ventricle ejection fraction benefit from cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillator (ICD). However, increasing numbers of patient with CRT and ICD devices produce overload of cardiology centers where patients are admitted to ambulatory visits. This study aims to find multivariate model predicting the requirement for ambulatory follow-up of cardiac implantable electronic devices (CIEDs).The LUCY study is an observational, cohort, prospective, 2-stage trial. As equal number of patients (300) will be included in the first and the second part of the study, finally, 600 patients will be included in the study. The inclusion criteria will be: age between 18 and 90 years, CHF (New York Heart Association classes I–III) and implanted ICD or CRT at least 30 days before study inclusion. The exclusion criteria will be dementia and other conditions impeding cooperation during the study. All patients included in the study will undergo standard ambulatory visit. Primary endpoint will be defined as any ambulatory visit qualified as necessary due to patient's condition or device malfunction diagnose by the cardiologist: any change in pharmacotherapy related to patient's clinical status assessed during the visit, any change in tachyarrythmia counter or discriminator status, any change in tachyarrythmia threshold, presence of ventricular undersensing or oversensing, presence of atrial or ventricular ineffective pacing, or device's pocket infection. Secondary endpoint will be defined as any ambulatory visit qualified as necessary due to the alarm identified via Medtronic CareLink Express (MCLE): sustained or treated ventricular tachyarrythmia, any not previously diagnosed supraventricular tachyarrythmia, or elective replacement indicator.Our study is the first attempt of implementation of the machine learning and elements artificial intelligence in health care optimization of patients with CIED. The LUCY will be an open product, available for additional testing and improvement with supplementary functionalities: quality of life assessment, teleconsultation, video-streaming, automated imagine recognizing.

Idiopathic short-coupled ventricular tachyarrhythmias: Systematic review and validation of electrocardiographic indices.

IntroductionIdiopathic short-coupled ventricular tachyarrhythmias make up a considerable proportion of ventricular tachyarrhythmias in structurally normal hearts and are the cause of 5–10% of unexpected sudden cardiac deaths. There is disparity in the literature regarding their description and a lack of formal diagnostic criteria to define them.ObjectiveTo validate ECG indices for the diagnosis of these ventricular tachyarrythmias and to subsequently unify their differing descriptions in the literature under a new terminology: Idiopathic Short-Coupled Ventricular Tachyarrhythmias.MethodsWe conducted a systematic review of all published studies describing short-coupled torsades de pointes, idiopathic ventricular fibrillation and polymorphic ventricular tachycardia. Published tracings were analysed using a standard set of criteria to define the different ECG intervals. Previously proposed diagnostic indices were validated using a control group of previously published long-coupled torsades de pointes cases.ResultsValidation of the ECG indices revealed that a coupling interval < 400 ms was the most reliable measurement (sensitivity 100%, specificity 97%), followed by a coupling interval/QT < 1 (sensitivity 96%, specificity 100%).ConclusionIdiopathic short-coupled ventricular tachyarrhythmias encompass all previous descriptions of this tachyarrhythmia including idiopathic ventricular fibrillation, short-coupled torsades de pointes, Purkinje-related torsades de pointes and idiopathic polymorphic ventricular tachycardia. This arrhythmia can be diagnosed by newly proposed criteria with high sensitivity and specificity.

TYPE II BRUGADA SYNDROME SYNCOPAL SEIZURE: A DIAGNOSTIC DILEMMA

Type II Brugada syndrome is a rare entity that can present as syncope, sudden cardiac death, palpitations and nocturnal agonal respiration as a manifestation of ventricular tachyarrythmia. Although patients can experience a syncopal seizure, the dilemma between epileptic seizure and syncopal seizure

A multiplex PCR strategy to screen for known mutations in families with sudden cardiac death burden.

Ventricular tachyarrythmia occurring in ischemic heart disease, dilated/hypertrophic cardiomyopathies or rare monogenic mutations of cardiac ion channels or associated proteins belong to the most frequent causes of sudden cardiac death (SCD). In further decades, next generation sequencing and bioinformatic analysis will become the gold standard of SCD risk stratification. At the moment, Sanger-sequencing is still obligatory in genetic diagnosis. A multiplex polymerase chain reaction (PCR) assay detecting eight SCD mutations in one reaction-tube was developed. To test the general validity of the assay, it was used with 12 patients, who had one or two of the eight mutations (LMNA, p.V256V; SCN5A, p.R1583C; RYR2, p.G1885E; MYH7, V606M; DSG2, p.T335A; KCNJ8, p.S422L; MYBPC, p.E441K; TNNT2, A38V). Thereafter, we tested the multiplex assay in a real diagnostic environment within a high risk family of several past SCD cases. This method allows efficient discrimination of multiple mutations by allele-specific PCR with standard PCR conditions. It relies on obtaining a PCR product specific to the mutation or wildtype—using primers that have the 3′end base complementary to the DNA template site, i.e. a specific primer only permits amplification to take place when its 3′terminal nucleotide matches with its target sequence. The PCR products are further analyzed by length, with Tape Station®(Agilent Technologies, Germany), a high-fidelity capillary chromatography test. The novel multiplex PCR assay strategy could be a good additional test used for SCD risk stratification. Advantages of the test are high velocity and ease of implementation, low price and flexibility of application within cardiomyopathy families for screening purposes.

Spinal cord stimulation reduces ventricular arrhythmias during acute ischemia by attenuation of regional myocardial excitability.

Myocardial ischemia creates autonomic nervous system imbalance and can trigger cardiac arrhythmias. We hypothesized that neuromodulation by spinal cord stimulation (SCS) will attenuate local cardiac sympathoexcitation from ischemia-induced increases in afferent signaling, reduce ventricular arrhythmias, and improve myocardial function during acute ischemia. Yorkshire pigs (n = 20) were randomized to SCS (50 Hz at 200-μs duration, current 90% motor threshold) or sham operation (sham) for 30 min before ischemia. A four-pole SCS lead was placed percutaneously in the epidural space (T1-T4), and a 56-electrode mesh was placed over the heart for high-resolution electrophysiological recordings, including activation recovery intervals (ARIs), activation time, repolarization time, and dispersion of repolarization. Electrophysiological and hemodynamic measures were recorded at baseline, after SCS/sham, during acute ischemia (300-s coronary artery ligation), and throughout reperfusion. SCS 1) reduced sympathoexcitation-induced ARI and repolarization time shortening in the ischemic myocardium; 2) attenuated increases in the dispersion of repolarization; 3) reduced ventricular tachyarrythmias [nonsustained ventricular tachycardias: 24 events (3 sham animals) vs. 1 event (1 SCS animal), P < 0.001]; and 4) improved myocardial function (dP/dt from baseline to ischemia: 1,814 ± 213 to 1,596 ± 282 mmHg/s in sham vs. 1,422 ± 299 to 1,380 ± 299 mmHg/s in SCS, P < 0.01). There was no change in ventricular electrophysiology during baseline conditions without myocardial stress or in the nonischemic myocardium. In conclusion, in a porcine model of acute ventricular ischemia, SCS reduced regional myocardial sympathoexcitation, decreased ventricular arrhythmias, and improved myocardial function. SCS decreased sympathetic nerve activation locally in the ischemic myocardium with no effect observed in the normal myocardium, thus providing mechanistic insights into the antiarrhythmic and myocardial protective effects of SCS.NEW & NOTEWORTHY In a porcine model of ventricular ischemia, spinal cord stimulation decreased sympathetic nerve activation regionally in ischemic myocardium with no effect on normal myocardium, demonstrating that the antiarrhythmic effects of spinal cord stimulation are likely due to attenuation of local sympathoexcitation in the ischemic myocardium and not changes in global myocardial electrophysiology.

Monogenec Arrhythmic Syndromes: From Molecular and Genetic Aspects to Bedside

The abrupt cessation of effective cardiac function that is generally due to heart rhythm disorders can cause sudden and unexpected death at any age and is referred to as a syndrome called "sudden cardiac death" (SCD). Annually, about 400,000 cases of SCD occur in the United States alone. Less than 5% of the resuscitation techniques are effective. The prevalence of SCD in a population rises with age according to the prevalence of coronary artery disease, which is the most common cause of sudden cardiac arrest. However, there is a peak in SCD incidence for the age below 5 years, which is equal to 17 cases per 100,000 of the population. This peak is due to congenital monogenic arrhythmic canalopathies. Despite their relative rarity, these cases are obviously the most tragic. The immediate causes, or mechanisms, of SCD are comprehensive. Generally, it is arrhythmic death due to ventricular tachyarrythmias - sustained ventricular tachycardia (VT) or ventricular fibrillation (VF). Bradyarrhythmias and pulseless electrical activity account for no more than 40% of all registered cardiac arrests, and they are more often the outcome of the abovementioned arrhythmias. Our current understanding of the mechanisms responsible for SCD has emerged from decades of basic science investigation into the normal electrophysiology of the heart, the molecular physiology of cardiac ion channels, the fundamental cellular and tissue events associated with cardiac arrhythmias, and the molecular genetics of monogenic disorders of the heart rhythm (for example, the long QT syndrome). This review presents an overview of the molecular and genetic basis of SCD in the long QT syndrome, Brugada syndrome, short QT syndrome, catecholaminergic polymorphic ventricular tachycardia and idiopathic ventricular fibrillation, and arrhythmogenic right ventricular dysplasia, and sudden cardiac death prevention strategies by modern techniques (including implantable cardioverter-defibrillator).

16-59: Long-term experience of remote monitoring in a population with cardiac implantable electronic devices for the treatment of ventricular tachyarrythmias

16-59: Long-term experience of remote monitoring in a population with cardiac implantable electronic devices for the treatment of ventricular tachyarrythmias

947Clinical and cardiac magnetic resonance characteristics at admission and follow-up in acute myocarditis

Objetives: Determine the clinical and cardiac magnetic resonance (CMR) characteristics at admission and during follow-up in patients hospitalized with an acute myocarditis. Methods: We developed a prospective registry of patients admitted to a tertiary hospital from June 2008 to Decembre 2012 with an acute myocarditis, diagnosed if they presented acute chest pain, raised troponin and fulfilled CMR imaging criteria (myocardial edema and / or late gadolinium enhancement (LGE), both with a typical distribution in the CMR). Results: We included 35 patients, 91% male, mean age 35 ± 13 years. All presented with chest pain (13 typical, 22 atypical), 24 had had a recent infectious disease and 16 had fever at presentation. Most of them had some ECG abnormality (94%) being the most frequent difusse ST elevation (49%). Only 12 patients underwent cardiac catheterization and coronary arteries were normal in all of them. None had heart failure. CMR was displayed at 3 ± 1 days after admission and mean LVEF, ventricular volume and ventricular mass were normal (60 ± 6%; 70 ± 18 ml/m; 76 ± 21 g/m2). Only 7 patients had depressed LVEF (<55%); 31% had regional regional systolic dysfunction; myocardial edema was present in 83% and LGE in 97%, which in most cases was inferior-lateral location (79%). The type of LGE was predominantly subepicardial (74%), and none subendocardial. During admission, 3 patients had non sustained ventricular tachyarrythmia and one patient died for ventricular arrythmia. A control CMR was performed in 25 patients at 11 ± 6 months (minimum 4 months). At follow-up 2 patients had pericarditis and 1 myocarditis. We found an increase in mean LVEF (61 ± 6 vs 65 ± 6%, p = 0.03). All patients had a normalization of regional systolic function and disappeared myocardial edema. A patient had ligth dilated VI and depressed FEVI. The average number of segments with LGE decreased (5.4 ± 3.0 vs 2.0 ± 2.4, p <0.001), with disappearance of LGE in 9 patients. Conclusions: Although inflammation and myocardial damage detected by CMR is widespread in many cases, the functional impact is limited. In the control CMR during follow-up, normalization of LVEF occurred in all of them and in more than one third of our population, LGE disappeared. CMR is a useful tool for the diagnosis and the evaluation of the repercussion after an acute myocarditis.

A SYSTEMATIC REVIEW FOR SUDDEN CARDIAC DEATH IN HYPERTROPHIC CARDIOMYOPATHY PATIENTS WITH MYOCARDIAL FIBROSIS: A CMR LGE STUDY

Hypetrophic Cardiomyopathy is the most common genetic cardiac disease that affects cardiac sarcomere, resulting in myocardial disarray. Affected patients have an predisposition for malignant ventricular tachyarrythmias and consequently, sudden cardiac death(SCD). In some single center studies, late

Concomitant Left Ventricular Assist Device Placement and Cryoablation for Treatment of Ventricular Tachyarrhythmias Associated With Heart Failure

Refractory ventricular tachyarrythmias (VTs) are potentially life-threatening rhythms in patients with cardiomyopathies, particularly when they result in hemodynamic instability. Here we report two cases of patients with intractable ventricular tachyarrythmias that were unresponsive to anti-arrhythmic medications and repeated catheter ablation, and for whom concomitant cryoablation and left ventricular assist device implantation was successfully performed. Both patients tolerated the procedure well with no complications and were free from ventricular tachyarrythmias postoperatively. Concomitant surgical ventricular ablation at the time of left ventricular assist device surgery may be a reasonable approach for this subset of patients as it provides excellent visualization and the ability to ablate both epicardial and endocardial sites.

ACUTE MYOCARDIAL INFARCTION

Background:- Magnesium, the second most abundant intracellular cation have several critically important roles in human body. In addition to energy production and maintenance of electrolyte balance, magnesium (Mg++) is essential for normal neuromuscular function, excitation contraction coupling maintenance of vessel tone, blood coagulation as well as Ca++ and K+ transport across the plasma membrane.Study Design: Case control study. Material and Methods:- A total of 125 subjects enrolled for this study, 88 were AMI patients having their first episode. 37 subjects were taken as control group. These patients were classified into three groups depending on the age of the subjects. Aims and objectives:- To find out serum magnesium and electrolyte levels in AMI patients at presentation to Emergency Department. Discussion:-Hypomagnesaemia is a common clinical finding in cases of acute myocardial infarction at their presentation to the emergency department of Punjab Institute of Cardiology, Lahore. It is very critical as ventricular tachyarrythmias cardiac arrest, sudden cardiac death, re-infarction are the usual outcome. Conclusion:-There is Hypomagnessemia (P&lt;0.001) in all the subgroups while for Na+ and K+ (P&gt;0.05). Our result explains thecontribution of hypomagnesaemia as a minor risk factor for AMI. Therefore it is suggested that serum magnesium should be estimated in each case of AMI patient. Importance may be given to Mg++ supplementation where needed. The dosage should not be empirical but be based on individual patient requirement.

Manglende modning av venstre ventrikkels myokard

Noncompaction of the left ventricular myocardium is recently described as a cause of left ventricular dysfunction. In the article, we describe epidemiological and clinical aspects of this condition, which presents clinically at any age. This article is based on a review of articles from our own literature archive and relevant references in these articles. Ventricular noncompaction results from an arrest in the normal endomyocardial embryogenesis, and often leads to heart failure, thrombo-embolic events and/or ventricular arrhythmias. The disorder is diagnosed by two-dimensional echocardiography or magnetic resonance imaging of the heart. The changes are typically seen in the apex and distal and middle segments of the inferior and lateral walls of the left ventricle. The affected segments of the myocardium have a two-layered structure: a compacted thin epicardial layer and an endocardial layer consisting of a prominent trabecular meshwork with deep intertrabecular spaces. The condition can be isolated with or without extracardiac disorders, or can be associated with other cardiac malformations. It is essential not to miss the findings of noncompaction, as the condition may lead to serious heart failure, thrombo-embolic events, ventricular tachyarrythmias or death. Early recognition of noncompaction may give better follow-up and management of patients with this condition.