Significance of aborted cardiac arrest and sustained ventricular tachycardia in patients referred for treatment therapy of advanced heart failure

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf Portuguese Registry of Acute Coronary Syndromes Background Atrioventricular block (AVB) can be a consequence of ischemia in acute coronary syndrome (ACS). Then, its expected, that AVB occurrence is associated with higher rates of major adverse cardiac events (MACE). Objective Evaluate if sustained AVB was a predictor of MACE in ACS hospitalized patients. Methods Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-3/05/2020. Patients were divided into two groups: A – patients without AVB, and B – patients that presented AVB. Were excluded patients without a previous cardiovascular history or clinical data regarding AVB occurrence. MACE was defined as re-infarction, congestive heart failure, cardiogenic shock, a mechanical complication of myocardial infarction, completed atrioventricular block, sustained ventricular tachycardia, cardiac arrest, stroke, major hemorrhage, transfusion and hospitalization death. Univariate logistic regression was performed to assess if AVB in ACS patients was a predictor of MACE. Results A total of 32157 patients was analyze and 23774 had information regarding AVB. From the group of patients that presented AVB, 214 (0.9%) had re-infarction, 3847 (16.2%) had congestive heart failure, 1018 (4.3%) had cardiogenic shock, 1069 (4.5%) had atrial fibrillation, 152 (0.6%) had a mechanical complication of myocardial infarction, 354 (1.5%) had sustained ventricular tachycardia, 706 (3.0%) had cardiac arrest, 152 (0.6%) had stroke, 364 (1.5%) had major hemorrhage, 353 (1.5%) had blood transfusion and 928 (3.0%) died. AVB did not predict re-infarction (p = 0.145), congestive heart failure (p = 0.334), atrial fibrillation (p = 0.171), mechanical complication of myocardial infarction (p = 0.465) and cardiac arrest (p = 0.142). Logistic regression revealed that AVB in ACS patients was a predictor of cardiogenic shock (odds ratio (OR) 2.350, p = 0.012, confidence interval (CI) 1.207-4.572), sustained ventricular tachycardia (OR 2.269, p = 0.013, CI 1.187-4.340), stroke (OR 2.231, p < 0.001, CI 1.779-5.852), major hemorrhage (OR 3.863, p < 0.001, CI 2.667-5.558), blood transfusion (OR 4.291, p < 0.001, CI 3.002-6.137) and hospitalization death (OR 2.699, p < 0.001, CI 1.725-4.222). Conclusions AVB in ACS patients predict MACE, namely cardiogenic shock, sustained ventricular tachycardia, stroke, major hemorrhage, blood transfusion and hospitalization death.

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Sustained ventricular tachycardia as a predictor of major adverse cardiac events in acute coronary syndrome patients

EP Europace ◽

10.1093/europace/euab116.330 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

H Santos ◽

I Almeida ◽

H Miranda ◽

M Santos ◽

C Sa ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Atrial Fibrillation ◽

Congestive Heart Failure ◽

Cardiac Arrest ◽

Ventricular Tachycardia ◽

Atrioventricular Block ◽

Sustained Ventricular Tachycardia ◽

Mechanical Complication ◽

Coronary Syndrome

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf Portuguese Registry of Acute Coronary Syndromes Background Sustained ventricular tachycardia (VT) is a frequent rhythm disturbance during an ischemic event like acute coronary syndrome (ACS). VT was frequently associated with worse prognosis, then is expected, that its presence is related to a higher incidence of major adverse cardiac events (MACE). Objective Evaluate if sustained VT was a predictor of MACE in ACS hospitalized patients. Methods Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-4/09/2019. Patients were divided into two groups: A – patients without VT, and B – patients that presented VT on the hospitalization. VT was defined as a register or more of the VT with at least 30 seconds. Were excluded patients without a previous cardiovascular history or clinical data. MACE was defined as re-infarction, congestive heart failure, cardiogenic shock, a mechanical complication of myocardial infarction, completed atrioventricular block, sustained ventricular tachycardia, cardiac arrest, stroke and hospitalization death. Univariate logistic regression was performed to assess if VT in ACS patients was a predictor of MACE. Results A total of 29851 patients was analyze and 25725 had information regarding VT. From the group of patients that presented VT, 177 (1.1%) had re-infarction, 2415 (14.1%) had congestive heart failure, 816 (5.0%) had atrial fibrillation, 108 (0.7%) had a mechanical complication of myocardial infarction, 442 (2.7%) had completed atrioventricular block, 458 (2.8%) had cardiac arrest, 101 (0.6%) had stroke and 535 (3.3%) died. VT did not predict re-infarction (p = 0.071), mechanical complication of myocardial infarction (p = 0.979) and stroke (p = 0.500) in ACS hospitalized patients. Logistic regression revealed that VT in ACS patients was a predictor of congestive heart failure (odds ratio (OR) 2.304, p < 0.001, confidence interval (CI) 1.742-3.047), atrial fibrillation (OR 2.078, p < 0.001, CI 1.453-2.973), completed atrioventricular block (OR 1.831, p = 0.012, CI 1.145-2.928), cardiac arrest (OR 15.434, p < 0.001, CI 11.429-20.843) and hospitalization death (OR 6.472, p < 0.001, CI 4.484-9.342). Conclusions VT in ACS patients predict MACE, namely congestive heart failure, atrial fibrillation, completed atrioventricular block, cardiac rest and hospitalization death.

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Sympathetic nerve activity during non-sustained ventricular tachycardia in chronic heart failure

International Journal of Cardiology ◽

10.1016/j.ijcard.2012.10.088 ◽

2013 ◽

Vol 165 (2) ◽

pp. e15-e17 ◽

Cited By ~ 2

Author(s):

Ahmed M. Adlan ◽

Gregory Y.H. Lip ◽

Paul J. Fadel ◽

James P. Fisher

Keyword(s):

Heart Failure ◽

Ventricular Tachycardia ◽

Chronic Heart Failure ◽

Sympathetic Nerve ◽

Sympathetic Nerve Activity ◽

Sustained Ventricular Tachycardia ◽

Nerve Activity

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Coronary revascularization in patients with sustained ventricular tachycardia or cardiac arrest: Effects on inducibility and long-term follow-up

Journal of the American College of Cardiology ◽

10.1016/0735-1097(91)91337-e ◽

1991 ◽

Vol 17 (2) ◽

pp. A93 ◽

Cited By ~ 1

Author(s):

Anil Bhandari ◽

Cheryl Leon ◽

Joseph Ilvento ◽

David Cannom

Keyword(s):

Cardiac Arrest ◽

Ventricular Tachycardia ◽

Coronary Revascularization ◽

Sustained Ventricular Tachycardia ◽

Long Term Follow Up

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Diabetes and arrhythmias

ESC CardioMed ◽

10.1093/med/9780198784906.003.0221 ◽

2018 ◽

pp. 941-944

Author(s):

Heikki Huikuri ◽

Lars Rydén

Keyword(s):

Heart Failure ◽

Ventricular Tachycardia ◽

Sudden Cardiac Death ◽

Vitamin K ◽

Cardiac Death ◽

Vitamin K Antagonists ◽

Left Ventricular ◽

Sustained Ventricular Tachycardia ◽

Patients With Diabetes ◽

Diagnostic Work

Cardiac arrhythmias are more common in subjects with diabetes mellitus (DM) than in their counterparts without diabetes. Atrial fibrillation (AF) is present in 10–20% of the DM patients, but the association between DM and AF is mostly due to co-morbidities of DM patients increasing the vulnerability to AF. When type 2 DM and AF coexist, there is a substantially higher risk of cardiovascular mortality, stroke, and heart failure, which indicates screening of AF in selected patients with DM. Anticoagulant therapy either with vitamin K antagonists or non-vitamin K antagonist oral anticoagulants is recommended for DM patients with either paroxysmal or permanent AF, if not contraindicated. Palpitations, premature ventricular beats, and non-sustained ventricular tachycardia are common in patients with DM. The diagnostic work-up and treatment of these arrhythmias does not differ between the patients with or without DM. The diagnosis and treatment of sustained ventricular tachycardia, either monomorphic or polymorphic ventricular tachycardia, or resuscitated ventricular fibrillation is also similar between the patients with or without DM. The risk of sudden cardiac death is higher in DM patients with or without a diagnosed structural heart disease. Patients with diabetes and a left ventricular ejection fraction less than 30–35% should be treated with a prophylactic implantable cardioverter defibrillator according to current guidelines. Beta-blocking therapy is recommended for DM patients with left ventricular dysfunction or heart failure to prevent sudden cardiac death due to arrhythmia.

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First‐in‐man case of non‐invasive proton radiotherapy for the treatment of refractory ventricular tachycardia in advanced heart failure

European Journal of Heart Failure ◽

10.1002/ejhf.2056 ◽

2020 ◽

Author(s):

Veronica Dusi ◽

Viviana Vitolo ◽

Laura Frigerio ◽

Rossana Totaro ◽

Adele Valentini ◽

...

Keyword(s):

Heart Failure ◽

Ventricular Tachycardia ◽

Advanced Heart Failure ◽

Proton Radiotherapy ◽

Non Invasive

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Arrhythmogenic right ventricular cardiomyopathy: management of symptoms and prevention of sudden cardiac death

10.1093/med/9780198784906.003.0361 ◽

2018 ◽

Author(s):

Perry Elliott ◽

Alexandros Protonotarios

Keyword(s):

Heart Failure ◽

Ventricular Tachycardia ◽

Right Ventricular ◽

Ventricular Arrhythmias ◽

Ventricular Dysfunction ◽

Beta Blockers ◽

Arrhythmogenic Right Ventricular Cardiomyopathy ◽

Sustained Ventricular Tachycardia ◽

Carrier Status ◽

Ventricular Cardiomyopathy

Patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) have arrhythmia-related symptoms or are identified during screening of an affected family. Heart failure symptoms occur late in the disease’s natural history. As strenuous exercise has been associated with disease acceleration and worsening of ventricular arrhythmias, lifestyle modification with restricted athletic activities is recommended upon disease diagnosis or even identification of mutation carrier status. An episode of an haemodynamically unstable, sustained ventricular tachycardia or ventricular fibrillation as well as severe systolic ventricular dysfunction constitute definitive indications for implantable cardioverter defibrillator (ICD) implantation, which should also be considered following tolerated sustained or non-sustained ventricular tachycardia episodes, syncope, or in the presence of moderate ventricular dysfunction. Antiarrhythmic medications are used as an adjunct to device therapy. Catheter ablation is recommended for incessant ventricular tachycardia or frequent appropriate ICD interventions despite maximal pharmacological therapy. Amiodarone alone or in combination with beta blockers is most effective for symptomatic ventricular arrhythmias. Beta blockers are considered for use in all patients with a definite diagnosis but evidence for their prognostic benefit is sparse. Heart failure symptoms are managed using standard protocols and heart transplantation is considered for severe ventricular dysfunction or much less commonly uncontrollable ventricular arrhythmias.

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