scholarly journals Sustained ventricular tachycardia in cardiogenic shock

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
H Santos ◽  
T Vieira ◽  
J Fernandes ◽  
R Pinto ◽  
T Proenca ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Cardiogenic Shock ◽  
Clinical Signs ◽  
Mortality Rates ◽  
Left Ventricular ◽  
Sustained Ventricular Tachycardia ◽  
Left Ventricular Ejection ◽  
Previous Stroke ◽  
History Of ◽  
The Impact

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiogenic shock (CS) and the presence of sustained ventricular tachycardia (VT) are indicators of worse prognosis in hospitalized patients. In patients severely ill, like patients with CS, the registration of VT can be a stressful situation as well a life threatening condition. Purpose Evaluate the impact of cardiovascular previous history, clinical signs and diagnosis procedures at admission as predictors of VT in CS patients. Methods Single-centre retrospective study, engaging patients hospitalized for CS between 1/01/2014-30/10/2018. 222 patients with CS are included, 19 of them presented VT. Chi-square test, T-student test and Mann-Whitney U test were used to compare categorical and continuous variables. Multiple linear regression analysis was performed to evaluate predictors of new-onset AF in CS patients. Results CS patients without VT and with VT presented similar age, sex, cardiovascular history (namely arterial hypertension, diabetes, dyslipidemia, obesity, smoker status, alcohol intake, previous acute coronary syndrome, history of angina, previous cardiomyopathy), neoplasia history, cardiac arrest during the CS, clinical signs at admission (like heart rate, blood pressure, respiratory rate), blood results (hemoglobin, leucocytes, troponin, creatinine, C-Reactive protein), left ventricular ejection fraction and the culprit lesion. Curiously, history of previous stroke was higher in the group of VT in CS patients with a 6.9% (p = 0.021). Curiously, VT in CS patient had not impact in mortality rates. Multiple logistic regression reveals that previous stroke was a predictor of VT in CS patients (odds ratio 4.337, confident interval 1.363-13.799, p = 0.013). Conclusions History of previous stroke was a predictor of sustained VT in CS patients. The presence of this ventricular arrhythmia can have a hemodynamic impact, however, seems not influenced mortality rates.

scholarly journals New onset of atrial fibrillation in cardiogenic shock

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
H Santos ◽  
T Vieira ◽  
J Fernandes ◽  
AR Ferreira ◽  
M Rios ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiogenic Shock ◽  
Linear Regression Analysis ◽  
Clinical Signs ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome ◽  
The Impact ◽  
New Onset

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The development of cardiogenic shock (CS) is associated with worse prognosis, and can produce several hemodynamic manifestations. Then, is not surprised the manifestation of new-onset atrial fibrillation (AF) in these patients. Purpose Evaluate the impact of cardiovascular previous history, clinical signs and diagnosis procedures at admission as predictors of new-onset of AF in CS. Methods Single-centre retrospective study, engaging patients hospitalized for CS between 1/01/2014-30/10/2018. 222 patients with CS are included, 40 of them presented new onset of AF. Chi-square test, T-student test and Mann-Whitney U test were used to compare categorical and continuous variables. Multiple linear regression analysis was performed to evaluate predictors of new-onset AF in CS patients. Results CS patients without AF had a mean age of 61.08 ± 13.77 years old, on the other hand new-onset of AF patients in the setting of CS had a mean age of 67.02 ± 14.21 years old (p = 0.016). Nevertheless, no differences between the two groups was detected regarding the sex cardiovascular history (namely arterial hypertension, diabetes, dyslipidemia, obesity, smoker status, alcohol intake, previous acute coronary syndrome, history of angina, previous cardiomyopathy), neoplasia history, cardiac arrest during the CS, clinical signs at admission (like heart rate, blood pressure, respiratory rate), blood results (hemoglobin, leukocytes, troponin, creatinine, C-Reactive protein), left ventricular ejection fraction and the culprit lesion. New-onset of AF in CS patient had not impact in mortality rates. Multiple logistic regression reveals that only age was a predictor of new onset of AF in CS patients (odds ratio 1.032, confident interval 1.004-1.060, p = 0.024). Conclusions Age was the best predictor of new-onset AF in CS patients. The presence of this arrhythmia can have a hemodynamic impact, however, seems not influenced the final outcome.

scholarly journals The prognostic value of pulmonary artery compliance in cardiogenic shock

2019 ◽  
Vol 9 (3) ◽  
pp. 204589401987716
Author(s):  
Maria F. Zorzi ◽  
Emmanuelle Cancelli ◽  
Marco Rusca ◽  
Matthias Kirsch ◽  
Patrick Yerly ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Cardiogenic Shock ◽  
Right Ventricular ◽  
Arterial Compliance ◽  
Prognostic Significance ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Pulmonary Hemodynamic ◽  
The Impact

The aim of this study was to evaluate the pathophysiological role and the prognostic significance of pulmonary artery compliance (CPA), a measure of right ventricular pulsatile afterload, in cardiogenic shock. We retrospectively included 91 consecutive patients with cardiogenic shock due to primary left ventricular failure, monitored with a pulmonary artery catheter within the first 24 h. CPA was calculated as the ratio of stroke volume to pulmonary artery pulse pressure, and we determined whether CPA predicted mortality and whether it performed better than other pulmonary hemodynamic variables. The overall in-hospital mortality in our cohort was 27%. Survivors and nonsurvivors had comparable left ventricular ejection fraction, systolic, diastolic and mean pulmonary artery pressure, transpulmonary gradient, diastolic pressure gradient, and pulmonary vascular resistance at 24 h. In contrast, CPA was the only pulmonary artery variable significantly associated with mortality in univariate and multivariate analyses. Mortality increased from 4.5% at the highest quartile of CPA (3.6–6.5 mL/mmHg) to 43.5% at the lowest quartile (0.7–1.7 mL/mmHg). In 64 patients with a PAC inserted immediately upon admission, we calculated the trend of CPA between admission and 24 h. This trend was positive in survivors (+0.8 ± 1.3 ml/mmHg) but negative in nonsurvivors (−0.1 ± 1.0 mL/mmHg). The lower CPA in nonsurvivors was associated with more severe right ventricular systolic dysfunction. In conclusion, a reduced compliance of the pulmonary artery promotes right ventricular dysfunction and is independently associated with mortality in cardiogenic shock. Future studies should evaluate the impact on pulmonary arterial compliance and right ventricular afterload of therapies used in cardiogenic shock.

Abstract 16057: First-line Ablation of Ventricular Tachycardia in Ischemic Cardiomyopathy: Stratification of Outcomes by Left Ventricular Function

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
David Briceno ◽  
Jorge Romero ◽  
Kavisha Patel ◽  
Juan C Diaz ◽  
Isabella Alviz ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Catheter Ablation ◽  
Medical Therapy ◽  
Ischemic Cardiomyopathy ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Strong Impact ◽  
First Line ◽  
Ventricular Ejection Fraction ◽  
The Impact

Introduction: Randomized controlled trials (RCTs) have shown improved outcomes in patients undergoing first-line catheter ablation of ventricular tachycardia/ventricular fibrillation (VT/VF) in patients with ischemic cardiomyopathy (ICM). Nonetheless, the impact of Left ventricular ejection fraction (LVEF) on the outcomes after catheter ablation (CA) have not been studied. Hypothesis: LVEF has a strong impact on the outcome after CA for VT in patients with ICM. Methods: RCTs evaluating first-line ablation versus medical therapy in patients with VT and ICM were included. Risk estimates and 95% confidence intervals (CI) were measured. Results: Four RCTs with a total of 505 patients (mean age 66 ± 9 years, 89% male, 80% with previous revascularization) were included. Mean LVEF was 35 ± 8%. At a mean follow-up of 24 ± 9 months, a significant benefit in survival-free from appropriate ICD therapies was observed in all patients undergoing first-line catheter ablation compared to medical management (RR 0.70, 95% CI 0.56-0.86). In patients with moderately depressed LVEF (>30-50%), first line VT ablation was associated with a statistically significant reduction in the composite endpoint of survival-free VT/VF and appropriate ICD therapies (HR: 0.52, 95% CI: 0.36-0.76), whereas there was no difference in patients with severely depressed LVEF (</=30%) (HR: 0.56, 95% CI: 0.24-1.32). Funnel plots did not show asymmetry suggesting lack of bias. Conclusions: Patients with ICM and VT undergoing first-line ablation have a significant lower rate of appropriate ICD therapies without a mortality difference compared to patients receiving an initial approach based on medical therapy. The beneficial effect was only observed in patients with moderately depressed LVEF (>30-50%).

Left Dominant Arrhythmogenic Cardiomyopathy Causing Sustained Ventricular Tachycardia – A Case Report

2016 ◽  
Vol 02 (01) ◽  
pp. 37 ◽  
Author(s):  
Francesco Guglielmi ◽  
Sergio Cannas ◽  
Rocco Arancio ◽  
Nicolò Martini ◽  
Bortolo Martini ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Lateral Wall ◽  
Late Enhancement ◽  
Left Ventricular ◽  
Sustained Ventricular Tachycardia ◽  
Wall Thickening ◽  
Arrhythmogenic Cardiomyopathy ◽  
Right Ventricular Size ◽  
Gene Testing ◽  
History Of

A 56-year-old white man was admitted to hospital because of palpitations and dyspnoea. He had no family history of cardiomyopathy or sudden death, and the electrocardiograms (ECG) of his son and parents were normal. He had an history of palpitations, and in the emergency department ECG showed sustained ventricular tachycardia-flutter with inferior axis right bundle branch block (RBBB) in V1 and heart rate 250 beats per minute. His standard ECG showed a complete RBBB pattern with minor ST-T segment changes. 2D echo and coronary angiography were normal, while magnetic resonance imaging (MRI) revealed a reduction in left mid-lateral wall thickening with hypokinetic movement and mild reduction of ejection fraction. An Extensive sub-epicardial area of conspicuous left ventricular intra-myocardial fat and sub-epicardial left ventricular late enhancement in lateral wall, was also seen at MRI. No abnormalities of right ventricular size, function or tissue characterisation were detected. A diagnosis of atypical left dominant arrhythmogenic cardiomyopathy was made, based on clinical and images basis, as gene testing was not available.

P4527Cardiac resynchronization therapy in patients with non-ischemic cardiomyopathy and severe heart failure may influence the development of unstable ventricular tachycardia

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D I Lebedev ◽  
A I Mishkina ◽  
M V Lebedeva ◽  
S V Popov
Keyword(s):  
Heart Failure ◽  
Ventricular Tachycardia ◽  
Ischemic Cardiomyopathy ◽  
Left Ventricular ◽  
Functional Class ◽  
Walking Distance ◽  
Left Ventricular Ejection ◽  
Resynchronization Therapy ◽  
Ventricular Ejection Fraction ◽  
The Impact

Abstract Objective The aim of the study was to determine the effect of cardiac resynchronization therapy (CRT) on the development of unstable ventricular tachycardia in patients with non-ischemic cardiomyopathy (CMP) and to analyze the potential of radionuclide methods in predicting life-threatening arrhythmias in the background of CRT. Materials and methods The study included 100 patients with non-ischemic cardiomyopathy aged from 32 to 75 years (55±12 years). Patients had III functional class of heart failure (HF); left ventricular ejection fraction (LV) (EF) 30.1±3.8%; 6 minutes walk at a distance of 290.5±64.3 m; and the final diastolic volume of the left ventricle (EDV) is 220.7±50.9 ml. Before implantation of the device with CRT and after 1 year, all patients underwent a 24-hour ECG monitoring. Patients were divided into two groups depending on the presence or absence of paroxysms of unstable ventricular tachycardia. The 1st group included 55 patients (55%) with registered paroxysms of unstable ventricular tachycardia with adequate doses of antiarrhythmic drugs. Group 2 consisted of 45 patients (45%) without reported episodes. Prior to CRT, myocardial metabolism defect (MMD) was evaluated in all patients using radionuclide methods. Results Control tests were performed 1 year after the onset of CRT and showed positive clinical dynamics: the left ventricular EF increased from 30.1±3.8% to 42.8±4.8% (p≤0.001); functional class decreased from III to II; The 6-minute walking distance increased from 290.5±64.3 m to 377.2±45.3 m (p≤0.001); and LV EDV decreased from 220.7±50.9 ml to 197.9±47.8 ml (p≤0.005). During 1 year of observation in the first group: 48 patients (80%) had no episodes of unstable ventricular tachycardia; In 7 patients (20%), episodes of unstable ventricular tachycardia were recorded. Evaluation of the effect of increasing EF and reducing EDV on the development of VT paroxysms was performed after the distribution of patients with CRT into subgroups based on the presence or absence of VT episodes. The data showed that in patients whose EF increased by 14%, and EDV decreased by 35 ml during 1 year of CRT, there were no VT episodes, even if VT paroxysms were recorded before CRT. Patients who had VT paroxysms showed an increase in EF of only 9% and a decrease in EDV of only 13 ml. Phase 2 of the study was to assess the impact of MMD changes. In the presence of CRT in patients with less than 15% MMD, there were no VT episodes. VT paroxysms were reported in patients whose MMD exceeded 15%. Conclusions (1) Effective CRT in patents with non-ischemic cardiomyopathy significantly reduces the number of VT episodes. (2) Improving fatty acid metabolism (LVD MMD less than 15%) in patients with non-ischemic cardiomyopathy reduces the incidence of VT episodes against the background of CRT.

scholarly journals Comparative study on In-hospital Improvement of left Ventricular Ejection Fraction after PCI

1970 ◽  
Vol 3 (2) ◽  
pp. 60-62
Author(s):  
Md Mukhlesur Rahman ◽  
Md Abu Siddique ◽  
KMHS Sirajul Haque ◽  
Md Mahmudur Rahman Siddiqui ◽  
Md Khurshed Ahmed ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Percutaneous Coronary ◽  
Cardiac Centre ◽  
History Of ◽  
The University ◽  
Medical University ◽  
The Impact

The purpose of the study was to identify the impact of percutaneous coronary interventions (PCI) on ejection fraction between patients prior MI and without prior MI. This study was carried out at the University Cardiac Centre, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, during the period between January 2006 to July 2006. Patients without history of prior MI experienced significant improvement of echo EF following PCI (62.30 ± 5.52 vs. 46.63 ± 6.43%, p < 0.001). In short term follow up remarkable improvement of LVEF is observed in patients of PCI who do not have prior MI in compared to patients having prior MI. (University Heart Journal 2007; 3 : 60-62)

scholarly journals Genetic risk factors for dilated cardiomyopathy

2021 ◽  
Vol 26 (10) ◽  
pp. 4628
Author(s):  
T. G. Vaikhanskaya ◽  
L. N. Sivitskaya ◽  
O. D. Levdansky ◽  
T. V. Kurushko ◽  
N. G. Danilenko
Keyword(s):  
Risk Factors ◽  
Ventricular Tachycardia ◽  
Ventricular Fibrillation ◽  
Dilated Cardiomyopathy ◽  
Left Ventricular ◽  
Sustained Ventricular Tachycardia ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Life Threatening

Aim. To study the diagnostic significance of genetic testing in patients with dilated cardiomyopathy (DCM), identify predictors of life-threatening ventricular tachyarrhythmias (VTAs) and assess adverse clinical outcomes in different genetic groups.Material and methods. The study included 126 unrelated patients with verified DCM as follows: 70 (55,6%) probands with criteria for familial DCM and 56 (44,4%) individuals with a probable hereditary component. All patients (age, 43,1±11,3 years; men, 92 (73%); left ventricular ejection fraction, 30,6±8,43%; left ventricular enddiastolic diameter, 68,3±8,36 mm; follow-up period — median, 49 months) receive a complex of diagnostic investigations, including genetic screening using nextgeneration sequencing, followed by verification of variants by the Sanger method.Results. Pathogenic and likely pathogenic genetic variants were found in 61 (48,4%) of 126 patients with DCM. The dominant mutations were titin-truncating variants (TTNtvs), identified in 16 individuals (12,7%), and variants of lamin A/C (LMNA), identified in 13 probands (10,3%). Mutations in the other 19 genes were found in 32 (25,4%) patients. The following primary endpoints were assessed: sudden cardiac death (SCD), episodes of VTA (sustained ventricular tachycardia/ventricular fibrillation) and appropriate shocks of implanted cardiac resynchronization therapy (CRT)/cardioverter defibrillators (CVD) devices. As a result of ROC analysis, the following independent risk factors for SCD were identified: mutations in the LMNA gene (AUC, 0,760; p=0,0001) and non-sustained ventricular tachycardia (cut-off heart rate ≥161 bpm: AUC, 0,788; p=0,0001). When comparing the phenotypes and genotypes of DCM, TTNtv genotype was associated with a lower prevalence of complete left bundle branch block (χ2=7,46; p=0,024), a lower need for CRT/CVD implantation (χ2=5,70; p=0,017) and more rare episodes of sustained ventricular tachycardia/ventricular fibrillation (χ2=30,1; p=0,0001) compared with LMNA carriers. Kaplan-Meier analysis showed the worst prognosis in carriers of LMNA mutations both in relation to life-threatening VTA (log rang χ2=88,5; p=0,0001) and in achieving all unfavorable outcomes (χ2=27,8; p=0,0001) compared with groups of genenegative individuals, carriers of TTNtv and other genotypes.Conclusion. The phenotypes of DCM with TTNtv did not significantly differ in the incidence of VTAs and adverse outcomes compared with the gene-negative group and other genotypes (with the exception of LMNA). The contribution of the associations of LMNA mutations with VTAs on prognosis was confirmed, which shows the important role of LMNA genotype diagnosis for SCD risk stratification in patients with DCM.

scholarly journals Clinical history of acute myocarditis in patients with preserved left ventricular ejection fraction

2019 ◽  
Vol 26 (3) ◽  
pp. 62-68
Author(s):  
V. M. Kovalenko ◽  
E. G. Nesukay ◽  
S. V. Cherniuk ◽  
R. M. Kirichenko ◽  
N. S. Titova ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Cardiac Rhythm ◽  
Acute Myocarditis ◽  
Left Ventricular ◽  
Sustained Ventricular Tachycardia ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

The aim – to investigate the dynamic changes of the structural and functional state of the heart and the persistence of cardiac rhythm disorders in patients with acute myocarditis with preserved left ventricular ejection fraction (LV EF) during 6 months of follow-up. Materials and methods. 54 patients with acute myocarditis and preserved LV EF (> 40 %) of the left ventricle (LV) were screened. The examination was performed twice: in the first month from the debut of myocarditis and in 6 months of follow-up. Results and discussion. According to data obtained by CMR, in the 1st month from the disease onset, the early contrast on T1-weighted images and/or the high intensity of the signal on T2 images were detected in all patients, with their percentage being 66.6 % and 62.9 % respectively, and late enhancement was observed in 14.8 % of cases. After 6 months of observation, edema and myocardial hyperemia were detected only in 7.4 and 9.2 % of cases, and fibrotic changes were in 37.0 % of patients, while 59.2 % of patients had no pathological changes on CMR at all. The average number of affected by inflammatory changes LV segments in the 1st month was 2.33±0.23, and after 6 months it decreased to 1.43±0.17 segments (р<0.01). The value of LV EF increased from 47.3±2.3 % in the 1st month to 56.2±2.5 % after 6 months (р<0.05) of follow-up, and detection of non-sustained ventricular tachycardia (NSVT) episodes decreased from 20.4 % cases in the 1st month to 7.4 % of cases after 6 months. According to the results of the correlation analysis, a strong direct correlation was established between the number of LV segments involved in the inflammatory process in the 1st month from the myocarditis onset (r=0.81, р<0.01) as also after 6 months (r=0.72; р<0.01) and the presence of NSVT episodes, that was also confirmed by determining the exact Fisher criterion (p=0.019), statistically reliable correlations of the same direction were also established between the presence of NSVT episodes and fibrotic changes on cardiac MRI. Conclusions. For patients with acute myocarditis with a preserved LV EF, the absence of severe violations of the LV contractile function is characterized by a small amount of inflammatory lesions of myocardium. Clinically significant cardiac rhythm disorders, in particular episodes of non-sustained ventricular tachycardia, can be observed in these patients in the absence of significant violations of the structural and functional heart state and are associated with a greater number of LV segments affected by inflammatory and fibrotic changes.

scholarly journals Catheter Ablation in Patients With Cardiogenic Shock and Refractory Ventricular Tachycardia

2020 ◽  
Vol 13 (5) ◽  
Author(s):  
Jad A. Ballout ◽  
Oussama M. Wazni ◽  
Khaldoun G. Tarakji ◽  
Walid I. Saliba ◽  
Mohamed Kanj ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Ventricular Arrhythmia ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Mechanical Support ◽  
Ventricular Ejection Fraction ◽  
Intra Aortic Balloon Pump ◽  
Membrane Oxygenation

Background: There is paucity of data regarding radiofrequency ablation for ventricular tachycardia (VT) in patients with cardiogenic shock and concomitant VT refractory to antiarrhythmic drugs on mechanical support. Methods: Patients undergoing VT ablation at our center were enrolled in a prospectively maintained registry and screened for the current study (2010–2017). Results: All 21 consecutive patients with cardiogenic shock and concomitant refractory ventricular arrhythmia undergoing bailout ablation due to inability to wean off mechanical support were included. Median age was 61 years, 86% were men, median left ventricular ejection fraction was 20%, 81% had ischemic cardiomyopathy, and PAINESD score was 18±5. The type of mechanical support in place before the procedure was intra-aortic balloon pump in 14 patients (67%), Impella CP in 2, extracorporeal membrane oxygenation in 2, extracorporeal membrane oxygenation and intra-aortic balloon pump in 2, and extracorporeal membrane oxygenation and Impella CP in 1. Endocardial voltage maps showed myocardial scar in 19 patients (90%). The clinical VTs were inducible in 13 patients (62%), whereas 6 patients had premature ventricular contraction–induced ventricular fibrillation/VT (29%), and VT could not be induced in 2 patients (9%). Activation mapping was possible in all 13 with inducible clinical VTs. Substrate modification was performed in 15 patients with scar (79%). After ablation and scar modification, the arrhythmia was noninducible in 19 patients (91%). Seventeen (81%) were eventually weaned off mechanical support successfully, but 6 (29%) died during the index admission from persistent cardiogenic shock. Patients who had ventricular arrhythmia and cardiogenic shock on presentation had a trend toward lower in-hospital mortality compared with those who presented with cardiogenic shock and later developed ventricular arrhythmia. Conclusions: Bailout ablation for refractory ventricular arrhythmia in cardiogenic shock allowed successful weaning from mechanical support in a large proportion of patients. Mortality remains high, but the majority of patients were discharged home and survived beyond 1 year.

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