Ventricular arrhythmias detected after transvenous defibrillator implantation in patients with a clinical history of only ventricular fibrillation: Implications for use of implantable defibrillator

The early repolarisation (ER) pattern is a common ECG finding. Most individuals with the ER pattern are at minimal risk for arrhythmic events. In others, ER increases the arrhythmic risk of underlying cardiac pathology. Rarely ER syndrome will manifest as a primary arrhythmogenic disorder causing ventricular fibrillation (VF). ER syndrome is defined as syncope attributed to ventricular arrhythmias or cardiac arrest attributed to ER following systematic exclusion of other etiologies. Some ECG features associated with ER portend a higher risk. However, clinically useful risk-stratifying tools to identify the asymptomatic patient at high risk are lacking. Patients with asymptomatic ER and no family history of malignant ER should be reassured. All patients with ER should continue to have modifiable cardiac risk factors addressed. Symptomatic patients should be systematically investigated, directed by symptoms.

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The atherosclerosis of the sinus node artery is associated with an increased history of supra-ventricular arrhythmias: A retrospective study on 541 standard coronary angiograms

10.7287/peerj.preprints.1204v1 ◽

2015 ◽

Author(s):

Michele M Ciulla ◽

Matteo Astuti ◽

Stefano Carugo

Keyword(s):

Retrospective Study ◽

Coronary Angiography ◽

Ventricular Arrhythmias ◽

Coronary Circulation ◽

Sinus Node ◽

Clinical History ◽

Positive History ◽

Sinus Node Artery ◽

History Of ◽

Coronary Angiograms

BACKGROUND: The ischemic damage of the sinus node (SN) is a well known cause of cardiac arrhythmias and can be a consequence of any flow abnormality in the sinus node artery (SNA). Accordingly we aimed this retrospective study to: 1. evaluate the suitability of the standard coronary angiography to study the SNA and 2. determine if the percentage of subjects with a positive retrospective history of supra-ventricular arrhythmias (SVA) differs in patients with normal and diseased SNA ascertained at the time of coronary angiography. METHODS and RESULTS: out of the 541 coronary angiograms reviewed the SNA was visible for its entire course in 486 cases (89.8%). It was found to arise from the right side of the coronary circulation in 266 cases (54.7%) slightly more often than from the left, 219 cases (45.1%). One patient had 2 distinct SNA arising from either side of the coronary circulation. For the second objective we studied the 333 patients with: a. coronary artery disease (CAD), b. properly evaluable SNA and c. complete clinical history available. In 51 (15.3%) a SNA disease was found, the 41.2% of them had a positive SVA history, mainly atrial fibrillation (AF), whereas only the 7.4% of patients with a positive history of SVA could be found in the non-SNA diseased. This difference was statistically significant (P< 0.001). CONCLUSIONS: 1- The evaluation of the SNA is feasible in clinical practice during a standard coronary angiography; 2- this may be relevant since angiographically detectable SNA disease was significantly associated with a positive history of SVA .

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Role of the implantable defibrillator among elderly patients with a history of life-threatening ventricular arrhythmias

European Heart Journal ◽

10.1093/eurheartj/ehl438 ◽

2007 ◽

Vol 28 (14) ◽

pp. 1746-1749 ◽

Cited By ~ 103

Author(s):

Jeffrey S. Healey ◽

Al P. Hallstrom ◽

Karl-Heinz Kuck ◽

Girish Nair ◽

Eleanor P. Schron ◽

...

Keyword(s):

Elderly Patients ◽

Ventricular Arrhythmias ◽

Implantable Defibrillator ◽

Life Threatening ◽

History Of

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The atherosclerosis of the sinus node artery is associated with an increased history of supra-ventricular arrhythmias: A retrospective study on 541 standard coronary angiograms

10.7287/peerj.preprints.1204 ◽

2015 ◽

Author(s):

Michele M Ciulla ◽

Matteo Astuti ◽

Stefano Carugo

Keyword(s):

Retrospective Study ◽

Coronary Angiography ◽

Ventricular Arrhythmias ◽

Coronary Circulation ◽

Sinus Node ◽

Clinical History ◽

Positive History ◽

Sinus Node Artery ◽

History Of ◽

Coronary Angiograms

BACKGROUND: The ischemic damage of the sinus node (SN) is a well known cause of cardiac arrhythmias and can be a consequence of any flow abnormality in the sinus node artery (SNA). Accordingly we aimed this retrospective study to: 1. evaluate the suitability of the standard coronary angiography to study the SNA and 2. determine if the percentage of subjects with a positive retrospective history of supra-ventricular arrhythmias (SVA) differs in patients with normal and diseased SNA ascertained at the time of coronary angiography. METHODS and RESULTS: out of the 541 coronary angiograms reviewed the SNA was visible for its entire course in 486 cases (89.8%). It was found to arise from the right side of the coronary circulation in 266 cases (54.7%) slightly more often than from the left, 219 cases (45.1%). One patient had 2 distinct SNA arising from either side of the coronary circulation. For the second objective we studied the 333 patients with: a. coronary artery disease (CAD), b. properly evaluable SNA and c. complete clinical history available. In 51 (15.3%) a SNA disease was found, the 41.2% of them had a positive SVA history, mainly atrial fibrillation (AF), whereas only the 7.4% of patients with a positive history of SVA could be found in the non-SNA diseased. This difference was statistically significant (P< 0.001). CONCLUSIONS: 1- The evaluation of the SNA is feasible in clinical practice during a standard coronary angiography; 2- this may be relevant since angiographically detectable SNA disease was significantly associated with a positive history of SVA .

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Paro cardiorrespiratorio intraoperatorio en un paciente con síndrome de Brugada

Revista Chilena de Anestesia ◽

10.25237/revchilanestv49n04-15 ◽

2020 ◽

Vol 49 (4) ◽

pp. 571-575

Author(s):

Ignacia López L. ◽

Claudio Pacheco C. ◽

Francisco Cruzat R.

Keyword(s):

Nitrous Oxide ◽

Cardiac Arrest ◽

Ventricular Fibrillation ◽

General Anesthesia ◽

Female Patient ◽

Surgical Procedure ◽

Implantable Defibrillator ◽

St Segment ◽

History Of ◽

A Minor

A 61-year-old female patient with history of hipertension is scheduled to undergo a minor ginecological procedure (endoscopic endometrial polipus resection) with general anesthesia. She received standard monitorization, induction with midazolam, propofol and fentanyl. Ventilated with laringeal mask. Anesthesia was maintained with sevoflurane, nitrous oxide and oxygen. During surgical procedure, the patient received atropine and ephedrine associated with two episodes of bradycardia without hemodinamic disturbances. The surgery ended without problems. During the weaking up process she presented characteristical waves of ventricular fibrillation, recuperating sinusal rhythm secondary to defibrillation with 360 J. There was no clear cause for cardiac arrest at that moment so patient was translated to the ICU for observation, monitoring and study. Postoperative EKG presented an ascending ST segment in V to V derivations without hemodynamic alterations associated. The possible diagnosis of Brugada’s Syndrome was proposed. The patient received an implantable defibrillator. The mechanisms and anesthetic implications are discussed and reviewed.

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Component resolved diagnostics in peanut sensitized children with and without a history of clinical reaction

Allergy and Asthma Proceedings ◽

10.2500/aap.2020.41.200061 ◽

2020 ◽

Vol 41 (5) ◽

pp. 336-340

Author(s):

Yasmin Hamzavi Abedi ◽

Cristina P. Sison ◽

Punita Ponda

Keyword(s):

Retrospective Chart Review ◽

Clinical History ◽

Specific Ige ◽

Exact Test ◽

Ara H 1 ◽

Sige Level ◽

History Of ◽

Laboratory Procedures ◽

Ige Mediated ◽

The Relationship

Background: Serum Peanut-specific-IgE (PN-sIgE) and peanut-component-resolved-diagnostics (CRD) are often ordered simultaneously in the evaluation for peanut allergy. Results often guide the plans for peanut oral challenge. However, the clinical utility of CRD at different total PN-sIgE levels is unclear. A commonly used predefined CRD Ara h2 cutoff value in the literature predicting probability of peanut challenge outcomes is 0.35kUA/L. Objective: To examine the utility of CRD in patients with and without a history of clinical reactivity to peanut (PN). Methods: This was a retrospective chart review of 196 children with PN-sIgE and CRD testing, of which, 98 patients had a clinical history of an IgE-mediated reaction when exposed to PN and 98 did not. The Fisher's exact test was used to assess the relationship between CRD and PN-sIgE at different cutoff levels, McNemar test and Gwet’s approach (AC1 statistic) were used to examine agreement between CRD and PN-sIgE, and logistic regression was used to assess differences in the findings between patients with and without reaction history. Results: Ara h 1, 2, 3, or 9 (ARAH) levels ≤0.35 kUA/L were significantly associated with PN-sIgE levels <2 kUA/L rather than ≥2 kUA/L (p < 0.0001). When the ARAH threshold was increased to 1 kUA/L and 2 kUA/L, these thresholds were still significantly associated with PN-sIgE levels of <2, <5, and <14 kUA/L. These findings were not significantly different in patients with and without a history of clinical reactivity. Conclusion: ARAH values correlated with PN-sIgE. Regardless of clinical history, ARAH levels are unlikely to be below 0.35, 1, or 2 kUA/L if the PN-sIgE level is >2 kUA/L. Thus, if possible, practitioners should consider PN-sIgE rather than automatically ordering CRD with PN-sIgE every time. Laboratory procedures that allow automatically and reflexively adding CRD when the PN-sIgE level is ≤5 kUA/L can be helpful. However, further studies are needed in subjects with challenge-proven PN allergy.

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Stepping up detection, response, preparedness and readiness measures for “COVID-19”- A Pandemic

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11ispl1.3442 ◽

2020 ◽

Vol 11 (SPL1) ◽

pp. 1042-1047

Author(s):

Khushbu Balsara ◽

Deepankar Shukla

Keyword(s):

Health Care ◽

Health Care Workers ◽

Clinical History ◽

Frontline Workers ◽

Diagnostic Assays ◽

Care Workers ◽

Short Period ◽

History Of ◽

Detection Response ◽

Care Worker

In a very short period of time, “COVID-19” has seized the consciousness globally by making remarkable changes in our day to day living and has superintended as a public health emergency globally. It has high radar of transmission, affecting an individual at work to frontline workers. The measures and planning for a response plays a key role from drawing up an emergency committee and this follows an equation which broadly deals with epidemiological to clinical history of the patient, management steps from isolation, screening, diagnostic assays for identification and treatment. The application of an organized plan with secure structure aids in better performance, increases efficacy of management and saves time. Also saves time for a health care worker to g through routine levels of channels of administration if already a familiar way of operation is known for such situations. Thus, planning and developing a ‘blueprint of approach’ towards management of patient while facing such situation is a must. This review provides an insight to the measures for detection, response and preparedness of the hospital and health care workers should largely be inclusive of; also highlights the measures to be taken at every step after coming in contact with a positive case of “COVID-19”.

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Persistent vegetative state: an overview

Egyptian Journal of Neurosurgery ◽

10.1186/s41984-021-00111-3 ◽

2021 ◽

Vol 36 (1) ◽

Author(s):

Gabriel Alexander Quiñones-Ossa ◽

Yeider A. Durango-Espinosa ◽

Tariq Janjua ◽

Luis Rafael Moscote-Salazar ◽

Amit Agrawal

Keyword(s):

Intensive Care ◽

Vegetative State ◽

Persistent Vegetative State ◽

Clinical History ◽

Main Body ◽

Disorder Of Consciousness ◽

Family Perspective ◽

Patient Status ◽

History Of ◽

State Diagnosis

Abstract Background Disorder of consciousness diagnosis, especially when is classified as persistent vegetative state (without misestimating the other diagnosis classifications), in the intensive care is an important diagnosis to evaluate and treat. Persistent vegetative state diagnosis is a challenge in the daily clinical practice because the diagnosis is made mainly based upon the clinical history and the patient behavior observation. There are some specific criteria for this diagnosis, and this could be very tricky when the physician is not well trained. Main body We made a literature review regarding the persistent vegetative state diagnosis, clinical features, management, prognosis, and daily medical practice challenges while considering the bioethical issues and the family perspective about the patient status. The objective of this overview is to provide updated information regarding this clinical state’s features while considering the current medical literature available. Conclusions Regardless of the currently available guidelines and literature, there is still a lot of what we do not know about the persistent vegetative state. There is a lack of evidence regarding the optimal diagnosis and even more, about how to expect a natural history of this disorder of consciousness. It is important to recall that the patients (despite of their altered mental state diagnosis) should always be treated to avoid some of the intensive care unit long-stance complications.

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Catheter Ablation of Life-Threatening Ventricular Arrhythmias in Athletes

Medicina ◽

10.3390/medicina57030205 ◽

2021 ◽

Vol 57 (3) ◽

pp. 205

Author(s):

Nicola Tarantino ◽

Domenico G. Della Rocca ◽

Nicole S. De Leon De La Cruz ◽

Eric D. Manheimer ◽

Michele Magnocavallo ◽

...

Keyword(s):

Catheter Ablation ◽

Ventricular Arrhythmias ◽

Individual Factors ◽

Substantial Part ◽

Arrhythmogenic Substrate ◽

Life Threatening ◽

History Of ◽

Anatomic Distribution ◽

Artery Disease ◽

Surveillance Analysis

A recent surveillance analysis indicates that cardiac arrest/death occurs in ≈1:50,000 professional or semi-professional athletes, and the most common cause is attributable to life-threatening ventricular arrhythmias (VAs). It is critically important to diagnose any inherited/acquired cardiac disease, including coronary artery disease, since it frequently represents the arrhythmogenic substrate in a substantial part of the athletes presenting with major VAs. New insights indicate that athletes develop a specific electro-anatomical remodeling, with peculiar anatomic distribution and VAs patterns. However, because of the scarcity of clinical data concerning the natural history of VAs in sports performers, there are no dedicated recommendations for VA ablation. The treatment remains at the mercy of several individual factors, including the type of VA, the athlete’s age, and the operator’s expertise. With the present review, we aimed to illustrate the prevalence, electrocardiographic (ECG) features, and imaging correlations of the most common VAs in athletes, focusing on etiology, outcomes, and sports eligibility after catheter ablation.

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