Ventricular Tachycardia Or Ventricular Fibrillation Research Articles

Arrhythmic Risk in Biventricular Pacing Compared With Left Bundle Branch Area Pacing: Results From the I-CLAS Study.

Left bundle branch area pacing (LBBAP) may be associated with greater improvement in left ventricular ejection fraction and reduction in death or heart failure hospitalization compared with biventricular pacing (BVP) in patients requiring cardiac resynchronization therapy. We sought to compare the occurrence of sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) and new-onset atrial fibrillation (AF) in patients undergoing BVP and LBBAP. The I-CLAS study (International Collaborative LBBAP Study) included patients with left ventricular ejection fraction ≤35% who underwent BVP or LBBAP for cardiac resynchronization therapy between January 2018 and June 2022 at 15 centers. We performed propensity score-matched analysis of LBBAP and BVP in a 1:1 ratio. We assessed the incidence of VT/VF and new-onset AF among patients with no history of AF. Time to sustained VT/VF and time to new-onset AF was analyzed using the Cox proportional hazards survival model. Among 1778 patients undergoing cardiac resynchronization therapy (BVP, 981; LBBAP, 797), there were 1414 propensity score-matched patients (propensity score-matched BVP, 707; propensity score-matched LBBAP, 707). The occurrence of VT/VF was significantly lower with LBBAP compared with BVP (4.2% versus 9.3%; hazard ratio, 0.46 [95% CI, 0.29-0.74]; P<0.001). The incidence of VT storm (>3 episodes in 24 hours) was also significantly lower with LBBAP compared with BVP (0.8% versus 2.5%; P=0.013). Among 299 patients with cardiac resynchronization therapy pacemakers (BVP, 111; LBBAP, 188), VT/VF occurred in 8 patients in the BVP group versus none in the LBBAP group (7.2% versus 0%; P<0.001). In 1194 patients with no history of VT/VF or antiarrhythmic therapy (BVP, 591; LBBAP, 603), the occurrence of VT/VF was significantly lower with LBBAP than with BVP (3.2% versus 7.3%; hazard ratio, 0.46 [95% CI, 0.26-0.81]; P=0.007). Among patients with no history of AF (n=890), the occurrence of new-onset AF >30 s was significantly lower with LBBAP than with BVP (2.8% versus 6.6%; hazard ratio, 0.34 [95% CI, 0.16-0.73]; P=0.008). The incidence of AF lasting >24 hours was also significantly lower with LBBAP than with BVP (0.7% versus 2.9%; P=0.015). LBBAP was associated with a lower incidence of sustained VT/VF and new-onset AF compared with BVP. This difference remained significant after adjustment for differences in baseline characteristics between patients with BVP and LBBAP. Physiological resynchronization by LBBAP may be associated with lower risk of arrhythmias compared with BVP.

Risk of ventricular arrhythmias following implantable cardioverter-defibrillator generator change in patients with recovered ejection fraction: Implications for shared decision-making.

Guidelines indicate primary-prevention implantable cardioverter-defibrillators (ICDs) for most patients with left ventricular ejection fraction (LVEF) ≤ 35%. Some patients' LVEFs improve during the life of their first ICD. In patients with recovered LVEF who never received appropriate ICD therapy, the utility of generator replacement upon battery depletion remains unclear. Here, we evaluate ICD therapy based on LVEF at the time of generator change, to educate shared decision-making regarding whether to replace the depleted ICD. We followed patients with a primary-prevention ICD who underwent generator change. Patients who received appropriate ICD therapy for ventricular tachycardia or ventricular fibrillation (VT/VF) before generator change were excluded. The primary endpoint was appropriate ICD therapy, adjusted for the competing risk of death. Among 951 generator changes, 423 met inclusion criteria. During 3.4 ± 2.2 years follow-up, 78 (18%) received appropriate therapy for VT/VF. Compared to patients with recovered LVEF > 35% (n = 161 [38%]), those with LVEF ≤ 35% (n = 262 [62%]) were more likely to require ICD therapy (p = .002; Fine-Gray adjusted 5-year event rates: 12.7% vs. 25.0%). Receiver operating characteristic analysis revealed the optimal LVEF cutoff for VT/VF prediction to be 45%, the use of which further improved risk stratification (p < .001), with Fine-Gray adjusted 5-year rates 6.2% versus 25.1%. Following ICD generator change, patients with primary-prevention ICDs and recovered LVEF have significantly lower risk of subsequent ventricular arrhythmias compared to those with persistent LVEF depression. Risk stratification at LVEF 45% offers significant additional negative predictive value over a 35% cutoff, without a significant loss in sensitivity. These data may be useful during shared decision-making at the time of ICD generator battery depletion.

Comparative Effectiveness of Amiodarone and Lidocaine for the Treatment of In-Hospital Cardiac Arrest

American Heart Association Advanced Cardiac Life Support (ACLS) guidelines support the use of either amiodarone or lidocaine for cardiac arrest caused by ventricular tachycardia or ventricular fibrillation (VT/VF) based on studies of out-of-hospital cardiac arrest. Studies comparing amiodarone and lidocaine in adult populations with in-hospital VT/VF arrest are lacking. Does treatment with amiodarone vslidocaine therapy have differential associations with outcomes among adult patients with in-hospital cardiac arrest from VT/VF? This retrospective cohort study of adult patients receiving amiodarone or lidocaine for VT/VF in-hospital cardiac arrest refractory to CPR and defibrillation between January 1, 2000, and December 31, 2014, was conducted within American Heart Association Get With the Guidelines-Resuscitation participating hospitals. The primary outcome was return of spontaneous circulation (ROSC). Secondary outcomes were 24h survival, survival to hospital discharge, and favorable neurologic outcome. Among 14,630 patients with in-hospital VT/VF arrest, 68.7%(n= 10,058) were treated with amiodarone and 31.3%(n= 4,572) with lidocaine. When all covariates were statistically controlled, compared with amiodarone, lidocaine was associated with statistically significantly higher odds of the following: (1) ROSC (adjusted OR [aOR], 1.15, P= .01; average marginal effect [AME], 2.3; 95%CI, .5-4.2); (2) 24h survival (aOR, 1.16; P= .004; AME, 3.0; 95%CI, 0.9-5.1); (3) survival to discharge (aOR, 1.19; P< .001; AME, 3.3; 95%CI, 1.5-5.2); and (4) favorable neurologic outcome at hospital discharge (aOR, 1.18; P< .001; AME, 3.1; 95%CI, 1.3-4.9). Results using propensity score methods were similar to those from multivariable logistic regression analyses. Compared with amiodarone, lidocaine therapy among adult patients with in-hospital cardiac arrest from VT/VF was associated with statistically significantly higher rates of ROSC, 24h survival, survival to hospital discharge, and favorable neurologic outcome.

Development of a clinical decision rule for the early prediction of Shock-Refractory Out-of-Hospital cardiac arrest

BackgroundNearly half of ventricular fibrillation or ventricular tachycardia (VF/VT) out-of-hospital cardiac arrest (OHCA) patients receive three or more shocks, often referred to as refractory VF/VT. Our objective was to derive a clinical decision rule (CDR) for the early stratification of patients into risk categories for refractory VF/VT. MethodsWe included adults with non-traumatic OHCA in the Resuscitation Outcomes Consortium Epistry (2011–2015) with ≥ 1 EMS shock. We used Classification and Regression Tree analysis for CDR building using variables known at initial EMS rhythm analysis including age, sex, witness, location, bystander interventions, initial EMS rhythm, obvious non-cardiac etiology, and dispatch to arrival times. The outcome was refractory VF/VT (≥3 shocks). We calculated sensitivity, specificity, area under the receiver operating curve (AUROC), and odds ratios (OR). The rule was validated using the Portland Cardiac Arrest Epidemiologic Registry (2018–2020). ResultsThere were 17,140 eligible patients and 8,146 (47.5%) had refractory VF/VT. The optimal CDR (AUROC = 0.671) defined three groups: high-risk were any patients requiring an EMS shock after a bystander AED shock; moderate-risk were any non-EMS witnessed arrests with shockable initial EMS rhythms; and the remainder were low-risk. Refractory VF/VT increased across the low (30.7%), moderate (58.5%) and high-risk (84.8%) groups. Compared to low-risk, being moderate-risk or higher (OR [95% CI]:3.37 [3.16–3.59]; sensitivity 72.7%; specificity 55.9%) or high-risk (OR:12.63 [9.89–16.13]; sensitivity 5.4%; specificity 99.1%) had higher odds of refractory VF/VT. Results was similar in the validation cohort (n = 765, AUROC = 0.672). ConclusionsPatients at higher risk for refractory VF/VT can be identified early in EMS care.

Bayesian analysis of amiodarone or lidocaine versus placebo for out-of-hospital cardiac arrest

ObjectiveClinical trials for patients with shock-refractory out-of-hospital cardiac arrest (OHCA), including the Amiodarone, Lidocaine or Placebo (ALPS) trial, have been unable to demonstrate definitive benefit after treatment with antiarrhythmic drugs....

Abstract 11977: Cardiac Resynchronization Therapy and the Risk of Ventricular Tachyarrhythmia

Introduction: Cardiac Resynchronization Therapy (CRT) was shown to be associated with clinically significant benefit by lowering mortality, heart failure hospitalizations, and improving quality of life in patients with reduced left ventricular function and a wide QRS. However, there are conflicting data on the effect of CRT on the risk of ventricular tachycardia or ventricular fibrillation (VT/VF) in implantable cardioverter defibrillator (ICD) recipients. Methods: The study population comprised 4531 patients enrolled in the 5 landmark ICD trials (MADIT-II, MADIT-CRT, MADIT-RIT, MADIT-RISK, and RAID) implanted with an ICD. Three patient groups were generated: ICD with a narrow QRS complex (n=2208), ICD alone with a wide QRS (n=1105), and patients with both ICD and a CRT (CRT-D) (n=2198). We compared the cumulative incidence of VT/VF in each group while accounting for the competing risk of non-arrhythmic mortality using the Fine and Gray Method. Results: Recipients of a CRT-D were more likely to be female, to use a beta blocker, and have a higher New York Heart Association Functional Class. The cumulative incidence of VT/VF at 4 years of follow-up in patients with a CRT-D was significantly lower (24%) as compared with patients with an ICD with or without a wide QRS (31% for both; p&lt;0.001 for the overall difference). Findings were consistent for the endpoints of appropriate ICD shocks and fast VT/VF (&gt;200 bpm). Multivariate analysis showed that compared to ICD-only therapy (with wide QRS), treatment with CRT-D was associated with a significant 20% (p=0.006), in the endpoint of VT/VF and 36% reduction in the endpoint of appropriate shock for VT/VF (p&lt;0.001). Conclusion: Our data from 5 landmark clinical trials suggest that cardiac resynchronization therapy exerts important antiarrhythmic properties, leading to a significant reduction in the risk of ventricular tachyarrhythmia and appropriate ICD shocks in patients implanted with an ICD for primary prevention.

Applicability of the AHA/ACC/HRS Guideline for Implantable Cardioverter Defibrillator Implantation in Japanese Patients With Cardiac Sarcoidosis.

This study aimed to assess, among Japanese patients with cardiac sarcoidosis (CS), the implantable cardioverter-defibrillator (ICD) recommendations from the 2017 American Heart Association/American College of Cardiology/Heart Rhythm Society (AHA/ACC/HRS) guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death (SCD). Although ICDs are used to prevent SCD from ventricular tachycardia or ventricular fibrillation (VT/VF) in patients with CS, the generalizability of the AHA/ACC/HRS guidelines for Japanese patients with CS remains unclear. This study examined 188 consecutive patients with CS in 2 tertiary hospitals between 1979 and 2020. Patients were followed for a primary outcome of VT/VF or SCD. During a median follow-up of 5.68 years, the primary outcome occurred in 44 patients (23%). Patients with a Class I recommendation for ICD implantation showed the highest incidence of the primary outcome among patients in whom the guideline recommendations for ICD implantation were used (log-rank test; p=0.03). However, compared with patients with left ventricular ejection fractions (LVEFs)≤35%, there was no significant difference in the incidence of the primary outcome among patients with LVEFs >35% and those who required a permanent pacemaker (p=0.31); similar results were observed in those with LVEFs >35% and late gadolinium enhancement during cardiovascular magnetic resonance imaging (p=0.22). The American guideline recommendations for ICD implantation might be applicable to Japanese patients with CS. Implantation of an ICD may need to be considered in these patients if they require a permanentpacemaker or have late gadolinium enhancement, regardless of LVEF.

Association of high serum soluble interleukin 2 receptor levels with risk of adverse events in patients with cardiac sarcoidosis

Abstract Background Sarcoidosis is a systemic granulomatous disease that affects multiple organs. Among these, the presence of cardiac involvement is recognised as a determinant of worse clinical outcomes. Soluble interleukin 2 receptor (sIL-2R) is a potentially useful biomarker in the diagnosis and evaluation of disease severity in patients with sarcoidosis. However, it remains to be seen whether sIL-2R is associated with the severity and activity of disease in patients with cardiac sarcoidosis (CS). Purpose The aims of this study were to investigate whether sIL-2R was associated with clinical outcomes and to clarify the relationship between sIL-2R levels and disease activity evaluated by 18F-fluorideoxyglucose in positron emission tomography/computed tomography (18F-FDG PET/CT) in patients with CS. Methods We examined 101 consecutive patients with CS who were admitted to our University HospitalbetweenMay 2003 and February 2020. Patients who had no data of serum sIL-2R levels before initiation of immunosuppressive therapy (n=18) were excluded. Ultimately, 83 patients were examined in this study. The primary outcome was a composite of advanced atrioventricular block (AVB), ventricular tachycardia or ventricular fibrillation (VT/VF), heart failure hospitalisation, and all-cause death. Inflammatory activity in the myocardium and lymph nodes were assessed by18F-FDG PET/CT. We used a published program to analyse the cardiac metabolic activity (CMA), and total lymph node glycolysis (TLyG), which are quantitative measures of FDG volume-intensity. Results During a median follow-up period of 2.96 (interquartile range 2.24–4.27) years, the primary outcome occurred in 24 patients (29%), including 1 advanced AVB, 13 VT/VF, 5 hospitalisations for heart failure, and 5 all-cause deaths. Kaplan-Meier analyses showed that the primary outcome occurred more frequently in patients with higher sIL-2R levels (&amp;gt;538 U/mL, the median) than in those with lower sIL-2R levels (Figure). A multivariable Cox regression analysis revealed that a higher sIL-2R level was independently associated with an increased subsequent risk of adverse events (hazard ratio 3.71, 95% confidence interval 1.63–8.44, p=0.002), even after adjustments for age, plasma B-type natriuretic peptide, estimated glomerular filtration rate, left ventricular ejection fraction, and late gadolinium enhancement, which are known to be strong determinants of worse clinical outcomes in patients with CS (Table). Furthermore, sIL-2R levels were significantly correlated with TLyG, the inflammatory activity in lymph nodes (r=0.346, p=0.003) but not with CMA, the inflammatory activity in myocardium (r=0.131, p=0.27). Conclusions Increased sIL-2R is associated with worse long-term clinical outcomes accompanied by increased systemic inflammatory activity in CS patients. These findings suggest the importance of assessing sIL-2R as a surrogate marker for further risk stratification in these patients. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Japan Society for the Promotion of Science

Long-Term Prognostic Significance of Ventricular Repolarization Dispersion in Patients with Cardiac Sarcoidosis

Cardiac sarcoidosis (CS) is frequently complicated by fatal ventricular arrhythmias. T-peak to T-end interval to QT interval ratio (TpTe/QT) on electrocardiograms (ECG) was proposed as a marker of ventricular repolarization dispersion. Although this ratio could be associated with the incidence of ventricular arrhythmias in cardiovascular diseases, its prognostic implication in patients with CS is unclear. We sought to investigate whether TpTe/QT was associated with long-term clinical outcomes in patients with CS. Ninety consecutive patients with CS in 2 tertiary hospitals who had ECG data before initiation of immunosuppressive therapy between November 1995 and March 2019 were examined. The primary outcome was a composite of advanced atrioventricular block, ventricular tachycardia or ventricular fibrillation (VT/VF), heart failure hospitalization, and all-cause death. During a median follow-up period of 4.70 (interquartile range 2.06-7.23) years, the primary outcome occurred in 21 patients (23.3%). Survival analyses revealed that the primary outcome (p < 0.001), especially VT/VF or sudden cardiac death (p=0.002), occurred more frequently in patients with higher TpTe/QT (≥ 0.242, the median) than in those with lower TpTe/QT. Multivariable Cox regression analysis showed that a higher TpTe/QT was independently associated with increased subsequent risk of adverse events (hazard ratio1.11, 95% confidence interval 1.03-1.20, p=0.008) even after adjustment for the significant covariates. In conclusion, a higher TpTe/QT was associated with worse long-term clinical outcomes, especially fatal ventricular arrhythmic events, in patients with cardiac sarcoidosis, suggesting the importance of assessing TpTe/QT as a surrogate for risk stratification in these patients.

Portuguese National Registry on Cardiac Electrophysiology, 2017 and 2018

Abstract Introduction The authors present the results of the national cardiac electrophysiology registry of the Portuguese Association of Arrhythmology, Pacing and Electrophysiology (APAPE) and the Portuguese Institute of Cardiac Rhythm (IPRC) for 2017 and 2018. Methods The registry is annual, voluntary, and observational. Data are collected retrospectively. Developments over the years and their implications are analyzed and discussed. Results In the 22 electrophysiology centers, 3407 ablations were performed in 2017 and 3653 ablations in 2018. Atrial fibrillation (AF) ablation was the most frequently performed procedure: 1017 ablations in 2017 and 1222 procedures in 2018. Of the patients undergoing AF ablation, 63% were male, 60% were between 50 and 69 years old and 74% had paroxysmal AF. Clinically relevant complications were reported in 0.8% of the procedures. In 2017, 216 ventricular tachycardia or ventricular fibrillation (VT/VF) ablation procedures were performed in 15 centers. In 2018, 19 centers performed 249 TV/VF ablations. About 45% of VT/VF ablations were performed in patients with structural heart disease. Complications were reported in 3.2% of the procedures, including one death (0.2%). Conclusions The national electrophysiology registry showed a sustained increase in the number of catheter ablations. In addition, procedural complexity increased and AF ablation assumed a dominant position among the procedures performed.

The importance of early and late ventricular arrhythmias detection and prediction in acute myocardial infarction

Abstract Background Malignant arrhythmias, ventricular tachycardia or ventricular fibrillation (VT/VF) in acute myocardial infarction (AIM) carry ominous prognosis including sudden cardiac death (SCD). It is not clear whether the timing of VT/VF occurrence always affects the poor prognosis of patients with AMI. Aim To investigate the prognosis of patients who undergoing primary percutaneous coronary intervention (PCI) in accordance with timing of VT/VF and to find the power predictors of their occurrence. Methods 307 consecutive patients in PREDICT-VT study (NCT03263949), 57.9±10.6 year old, 72.3% males were analysed. Of these patients, 27.7% had VT/VF from the symptoms onset, within 48 hours of AIM (early VT/VF group). 8.1% of patients had VT/VF after 48h, during one year follow up (late VT/VF group). Results The frequency of VT/VF occurrence was high between symptoms onset and the end of 2nd month and during 5th and 6th month of AIM. The parameters of conventional echocardiography were significantly impaired in late VT/VF group, as well as parameters of longitudinal strain (LS) (table). Moreover, the MACE (cardiovascular mortality, SCD, new infarction, emergency revascularisation, and hospitalized heart failure) was the highest in late VT/VF group (p=0.000). The most significant predictor of late VT/VF was systolic LS (cut off −12.72%, ROC 0.680, Sen 71%, Sp 64%, p=0.006). Conclusions Although late VT/VF occurrence after primary PCI were less frequent than early VT/VF occurrence, patients with late VT/VF had a very poor prognosis. The most power predictor of late VT/VF were systolic longitudinal strain. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Clinical Center of Serbia

Long-term prognostic significance of dispersion of ventricular repolarization in patients with cardiac sarcoidosis

Abstract Background Although the presence of cardiac involvement is recognised as a determinant of worse clinical outcomes in sarcoidosis patients, the determinants of adverse outcomes in patients with cardiac sarcoidosis (CS) have not been well understood. T-peak to T-end interval (TpTe) on the surface electrocardiogram (ECG) was proposed as a marker of dispersion of ventricular repolarisation. Prolonged TpTe to QT interval ratio (TpTe/QT) represents a period of potential vulnerability to reentrant ventricular arrhythmias. Notably, prolonged TpTe/QT has been associated with increased risk of mortality in hypertrophic cardiomyopathy, congenital long-QT syndrome, and Brugada syndrome. However, its prognostic implication in patients with CS is unclear. Purpose We sought to investigate whether TpTe/QT was associated with long-term clinical outcomes in patients with CS. Methods A total of 108 consecutive CS patients between August 1986 and March 2019 in two academic hospitals who had ECG data before initiation of immunosuppressive therapy were examined. We excluded patients who received pacemaker (n=15) or cardiac resynchronization therapy (n=3) at the time of ECG. Ultimately, 90 CS patients were included in this study. All standard 12-lead ECGs were recorded at 25 mm/s with an amplification of 10 mm/mV. TpTe was measured from the peak of T wave to the end of T wave which defined as the intersection of the tangent to the down slope of the T wave and the isoelectric line. Lead V5 was selected for the analyses. If V5 is not suitable for analyses, V4 was selected. The primary outcome was the composite of advanced atrioventricular block (AVB), ventricular tachycardia or ventricular fibrillation (VT/VF), heart failure hospitalisation and all-cause death. Results During a median follow-up period of 4.70 (interquartile range [IQR] 2.06–7.23) years, adverse events occurred in 21 patients (23.3%), including 2 advanced AVB, 12 VT/VF, 4 heart failure hospitalisation and 3 all-cause death. Events group had higher TpTe/QT compared to no events group (0.231 [IQR 0.193–0.261] vs. 0.282 [IQR 0.263–0.304] P&amp;lt;0.001). Kaplan-Meier analyses revealed that the primary outcome, especially VT/VF or sudden cardiac death more frequently occurred in patients with higher TpTe/QT (≥0.242, the median) compared to those with lower TpTe/QT (Figure 1). Multivariable Cox regression analysis showed that higher TpTe/QT was independently associated with increased subsequent risk of adverse events (hazard ratio 1.09, 95% confidence interval [CI] 1.02–1.17, P=0.014) even after adjustment for age, sex and left ventricular ejection fraction. Furthermore, the optimal cut-off value of TpTe/QT for the discriminatory of primary outcome was 0.257, and c-index was 0.77 (95% CI 0.64–0.89). Conclusions Higher TpTe/QT was associated with worse long-term clinical outcomes in patients with CS. Our findings indicate the importance of assessing TpTe/QT for risk stratification in patients with CS. Figure 1 Funding Acknowledgement Type of funding source: None

Predicting ventricular tachyarrhythmia in patients with systolic heart failure based on texture features of the gray zone from contrast-enhanced magnetic resonance imaging

BackgroundPrevious research showed that gray zone detected by late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) imaging could help identify high-risk patients. In this study, we investigated whether LGE-CMR gray zone heterogeneity measured by image texture features could predict cardiovascular events in patients with heart failure (HF). MethodThis is a retrospective cohort study. Patients with systolic HF undergoing CMR imaging were enrolled. Cine and LGE images were analyzed to derive left ventricular (LV) function and scar characteristics. Entropy and uniformity of gray zones were derived by texture analysis. ResultsA total of 82 systolic HF patients were enrolled. After a median 1021 (25%–75% quartiles, 205–2066) days of follow-up, the entropy (0.60 ± 0.260 vs. 0.87 ± 0.28, p = 0.013) was significantly increased while the uniformity (0.68 ± 0.14 vs. 0.53±0.15, p = 0.016) was significantly decreased in patients with ventricular tachycardia or ventricular fibrillation (VT/VF). The percentage of core scar (21.9 ± 10.6 vs. 30.6 ± 10.4, p = 0.029) was higher in cardiac mortality group than survival group while the uniformity (0.55 ± 0.17 vs. 0.67 ± 0.14, p = 0.018) was lower in cardiac mortality group than survival group. A multivariate Cox regression model showed that higher percentage of gray zone area (HR = 8.805, 1.620−47.84, p = 0.045), higher entropy (>0.85) (HR = 1.391, 1.092−1.772, p = 0.024) and lower uniformity (≦0.54) (HR = 0.535, 0.340−0.842, p = 0.022) were associated with VT/VF attacks. Also, higher percentage of gray zone area (HR = 5.716, 1.379−23.68, p = 0.017), core scar zone (HR = 1.939, 1.056−3.561, p = 0.025), entropy (>0.85) (HR = 1.434, 1.076−1.911, p = 0.008) and lower uniformity (≦0.54) (HR = 0.513, 0.296−0.888, p = 0.009) were associated with cardiac mortality during follow-up. ConclusionsGray zone heterogeneity by texture analysis method could provide additional prognostic value to traditional LGE-CMR substrate analysis method.

Electrolyte Abnormalities in Patients Presenting With Ventricular Arrhythmia (from the LYTE-VT Study)

Electrolyte abnormalities are a known trigger for ventricular arrhythmia, and patients with heart disease on diuretic therapy may be at higher risk for electrolyte depletion. Our aim was to determine the prevalence of electrolyte depletion in patients presenting to the hospital with sustained ventricular tachycardia or ventricular fibrillation (VT/VF) versus heart failure, and identify risk factors for electrolyte depletion. Consecutive admissions to a tertiary care hospital for VT/VF were identified between July 2016 and October 2018 using the electronic medical record and compared with an equal number of consecutive admissions for heart failure (CHF). The study included 280 patients (140 patients in each group; mean age 63, 60% male, 59% African American). Average EF in the VT/VF and CHF groups was 30% and 33%, respectively. Hypokalemia (K < 3.5 mmol/L) and severe hypokalemia (K < 3.0 mmol/L) were present in 35.7% and 13.6%, respectively, of patients with VT/VF, compared to 12.9% and 2.7% of patients with CHF (p < 0.001 and p = 0.001, respectively, between groups). Hypomagnesemia was found in 7.8% and 5.8% of VT/VF and CHF patients, respectively (p = 0.46). Gastrointestinal illness and recent increases in diuretic dose were strongly associated with severe hypokalemia in VT/VF patients (odds ratio: 11.1 and 21.9, respectively; p < 0.001). In conclusion, hypokalemia is extremely common in patients presenting with VT/VF, much more so than in patients with CHF alone. Preceding gastrointestinal illness and increase in diuretic dose were strongly associated with severe hypokalemia in the VT/VF population, revealing a potential opportunity for early intervention and arrhythmia risk reduction.

Machine Learning Models Predicting the Survival of Abrupt Heart Attack in Cardiac Sarcoidosis Disease u sing the Wearable Device

Wearable technology has countless prospects of remodelling healthcare establishment and also medical education. Cardiac sarcoidosis disease (CS) is a sporadic illness in which white blood cells (WBC) clusters known as granulomas, form as heart tissue. Cardiac sarcoidosis disease (CS) Patients are at high threat of ventricular tachycardia or ventricular fibrillation (VT/VF). Wearable cardioverter defibrillator device is introduced which helps to alleviate the abrupt heart attack risk amid patients of cardiac sarcoidosis. A reflective evaluation of the commercial record acknowledged patients of cardiac sarcoidosis disease who sported the wearable cardioverter defibrillator (WCD). ML models are applied to get accurate predictions to motivate WCD wear ability. The wearable device cardioverter defibrillator (WCD) was worn by forty six patients of cardiac sarcoidosis disease in which 22(48%) female, male 24 (52%). The wearable cardioverter defibrillator (WCD) was sported hours about 23.6 median daily. Nearby eleven ventricular tachycardia or ventricular fibrillation (VT/VF) incidents occur in ten patients (22%). Ventricular tachycardia or ventricular fibrillation (VT/VF) happened over a series of (1-79) days, median of twenty-four days. 1st- heart attack success for ventricular tachycardia or ventricular fibrillation (VT/VF) conversion was hundred percent. Survival of Patient in twenty four hours after treatment of attack was hundred percent. To regulate the discontinuing cause for wearable device cardioverter defibrillator (WCD) use specified that among seven attacked patients received ICD, one patient was died two weeks later discontinuing the use of wearable cardioverter defibrillator device (WCD), and two patients were absent to track. Sixteen were not attacked patients, who obtained an implantable cardioverter defibrillator (ICD) while seven of them attained and improved left ventricular ejection fraction (LVEF). Abrupt heart attack (HA) management amongst patients of cardiac sarcoidosis disease (CS) was assisted by wearable device cardioverter defibrillator (WCD) ensuing in positive ventricular tachycardia or ventricular fibrillation (VT/VF) termination upon attack delivery. In this paper, the dataset is retrieved from google dataset search and evaluated on various ML models to predict the survival of the patients Receiving ICD while wearing WCD as well as evaluating the developed model performance and to identify the best applicable model. Dataset is primarily processed and nursed to many machine learning classifiers like KNN, SVM, Perceptron, Random Forest, Decision Trees (DT), Logistic Expression, SGD, and Naïve Basis. Cross-validation is smeared, training is performed so that new machine learning models are established and verified. The outcomes found are assessed on many factors such as Accuracy, Misclassification Rate, True Positive Rate, True Negative Rate, Precision, Prevalence, False Positive rate taken to build the model. Result analysis reveals that among all the classifiers SVM and KNN best model acquiescent high and precise outcomes.

TIMING OF CORONARY ANGIOGRAPHY IN PATIENTS PRESENTING WITH OUT-OF-HOSPITAL CARDIAC ARREST WITHOUT STEMI

The ideal management of patients presenting with out-of-hospital cardiac arrest (OHCA) secondary to ventricular tachycardia or ventricular fibrillation (VT/VF) without evidence of STEMI on post return of spontaneous circulation (ROSC) EKG remains elusive; specifically, an active area of research is

Abstract 113: Temporal Trends in the Use of Therapeutic Hypothermia for Out-of-Hospital Cardiac Arrest: Insights From the CARES Registry

Background: Despite evidence that therapeutic hypothermia improves patient outcomes for out-of-hospital cardiac arrest, use of this therapy remains low. It is unknown if the use of therapeutic hypothermia and patient outcomes have changed following publication of a trial that supported more lenient temperature management. Methods: In the Cardiac Arrest Registry to Enhance Survival (CARES), we identified 45,935 U.S. patients who experienced out-of-hospital cardiac arrest and survived to admission at 649 hospitals between 2013 and 2016. Using segmented hierarchical logistic regression, we determined risk-adjusted trends in the use of therapeutic hypothermia overall and stratified by presenting rhythm of ventricular tachycardia or ventricular fibrillation (VT/VF) vs pulseless electrical activity or asystole (PEA/asystole). We used mediation analysis to assess the impact of temporal trends in the use of therapeutic hypothermia on risk-adjusted survival trends at a patient- and hospital-level. Results: Overall use of therapeutic hypothermia was 46.4%. In unadjusted analyses, the use of therapeutic hypothermia dropped from 52.5% in the last quarter of 2013 to 46.0% in the first quarter of 2014 after publication of a trial that supported more lenient temperature management. Use of therapeutic hypothermia remained at or below 46.5% through 2016. After risk-adjustment, these trends in use persisted (see Figure). Compared with the last quarter of 2013, the risk-adjusted odds of therapeutic hypothermia was 18% lower in the first quarter of 2014 (OR 0.82, 95% CI 0.71, 0.94, P=0.006). Similar findings were observed in analyses stratified by presenting rhythm (see Figure). Overall risk-adjusted patient survival was 36.9% in 2013, 37.5% in 2014, 34.8% in 2015, and 34.3% in 2016 (P for trend&lt;0.001). Trends in hypothermia use did not explain trends in survival. Conclusions: In a U.S. registry of out-of-hospital cardiac arrest, the use of therapeutic hypothermia decreased after publication of a study supporting more lenient temperature thresholds. Concurrent to this change, overall risk-adjusted survival of cardiac arrest decreased, but was not attributed to lower use of therapeutic hypothermia.

Ablation strategies for the management of symptomatic Brugada syndrome: A systematic review

Ablation approaches have been described for the management of symptomatic ventricular arrhythmias in patients with Brugada syndrome, but this treatment is still considered experimental. We aimed to perform a systematic review of the current evidence on the use of catheter ablation in Brugada syndrome. MEDLINE, Embase, and Scopus were searched for articles describing the use of catheter ablation for ventricular arrhythmia management in Brugada syndrome. We included 11 case series and 11 case reports including a total of 233 patients. Ablation strategies included epicardial mapping with substrate modification (n = 180; 77.3%), endocardial-only mapping with substrate modification (n = 17; 7.3%), ventricular fibrillation (VF)-triggering premature ventricular complex ablation (n = 5; 2.1%), and mixed approaches (n = 31; 13.3%). During a 2.5- to 78-month follow-up period, the success rates in preventing ventricular tachycardia or VF (VT/VF) were 96.7%, 70.6%, and 80% with epicardial, endocardial, and triggering premature ventricular complex ablation approaches, respectively. Among patients who underwent both epicardial and endocardial mapping, there was no identifiable endocardial substrate in 92.9% of cases. Elimination of type 1 Brugada-pattern electrocardiogram was attained in 98.3% and 34.8% of the epicardial and endocardial ablation groups, respectively. VT/VF occurred in 7 of 9 patients (77.8%) who had persistent or recurrent J-ST elevation and in none of the 24 patients with complete resolution during follow-up. Pharmacologic provocation augmented the abnormal area. Epicardial substrate modification appears to be more effective than endocardial-only approach in preventing VT/VF. Persistent or recurrent J-ST elevation appears to represent a marker of failure of ablation. Ablation seems to be an acceptable strategy for patients with Brugada syndrome and VT/VF.

Outcomes of rescue cardiopulmonary support for periprocedural acute hemodynamic decompensation in patients undergoing catheter ablation of electrical storm

In patients with ventricular tachycardia or ventricular fibrillation (VT/VF) electrical storm (ES) undergoing catheter ablation (CA), hypotension due to refractory VT/VF, use of anesthesia, and cardiac stunning due to repeated implantable cardioverter-defibrillator shocks might precipitate acute hemodynamic decompensation (AHD). We evaluated the outcomes of emergent cardiopulmonary support with extracorporeal membrane oxygenation (ECMO) to rescue AHD in patients undergoing CA of ES. Between January 1, 2010 and December 31, 2016, 21 patients with ES (VT in 11 and premature ventricular complex-triggered VF in 10) were referred for CA and had periprocedural AHD requiring emergent ECMO support. In 14 patients, AHD occurred a mean of 1.5 ± 1.7 days before the procedure. In the remaining 7 patients, AHD occurred during or shortly after the procedure. ECMO was started successfully in all patients. Ablation was performed in 18 patients (9 with VF and 9 with VT). In patients with VF, premature ventricular complex suppression was achieved in 8 of 9 (89%). In those with VT, noninducibility was achieved in 7 of 9 (78%). After a median follow-up of 10 days, 16 patients died (13 during the index admission). Death was due to refractory VT/VF in 4 patients, heart failure in 11, and noncardiac cause in 1 patient. Seven patients survived beyond 6 months postablation; 5 remained free of VT/VF and 3 ultimately received a destination therapy (heart transplantation in 2 and left ventricular [LV] assist device in 1). In patients with ES undergoing CA, the outcomes of ECMO support as rescue intervention for AHD are poor. The majority of these patients die of refractory heart failure in the short-term. Strategies to prevent AHD including preemptive use of hemodynamic support may improve survival.

Electrical Storm in ICD Recipients with Arrhythmogenic Right Ventricular Cardiomyopathy.

Implantable cardioverter defibrillator (ICD) is the most important management for prevention of sudden cardiac death (SCD) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). However, some patients may receive multiple ICD therapies in a short period, a condition referred as "electrical storm" (ES). This study aimed to determine the prevalence, therapeutic options, and prognostic implications of ES in ARVC patients with an ICD. We retrospectively analyzed the baseline and follow-up data of 39 ARVC patients with an ICD. ES was defined as three or more separated episodes of ventricular tachycardia or ventricular fibrillation (VT/VF) within a 24-hour period. During a median follow-up of 49 months (range 6-225), 12 of 39 (31%) patients suffered at least one episode of ES. The interval between the first ES and the initial ICD implantation ranged from 1 month to 109 months, and ES was the first ICD discharge in three patients. The median number of VT/VF events per ES was four (range 3-39). Five patients experienced 20 episodes of ES that were treated by antitachycardia pacing only, while the other seven patients suffered shock therapies during ES. In three patients, ES required emergency hospitalization, and the repeatedly occurred VT/VF was finally subsided by intravenous amiodarone. There was no significant difference in actual survival between patients with and without such an event. ES is not rare in ARVC patients with an ICD for prevention of SCD, but it does not independently confer increased mortality. Intravenous amiodarone is effective in management of ES when VT/VF repeatedly occurred.