Ablation of sustained ventricular tachycardia in patients with and without structural heart disease

Non-sustained ventricular tachycardia (NSVT) is classified in a variety of ways, depending on the clinical situation. The two primary distinctions are whether the arrhythmia occurs in the presence or absence of structural heart disease, and whether or not the arrhythmia causes symptoms. The prevalence of NSVT is highest in patients with structural heart disease. NSVT in patients with heart disease rarely causes symptoms, but may be associated with increased total mortality and sudden cardiac death risk. However, sudden cardiac death risk is usually not elevated out of proportion to the increased total mortality risk, suggesting that NSVT is merely a marker of sicker patients, rather than having a mechanistic relation to arrhythmias causing cardiac arrest. Furthermore, no trial has demonstrated that suppression of NSVT reduces mortality. In contrast, patients with symptoms due to NSVT usually do not have underlying structural heart disease. In these patients, treatment may be necessary to relieve symptoms and improve quality of life. Appropriate treatment of NSVT in this setting also does not improve mortality, because NSVT in the absence of structural heart disease is not associated with increased mortality or sudden death risk (excepting patients with ion channelopathies, such as long QT syndrome). The exception to this rule is the recognition that ventricular dysfunction may be caused by frequent or incessant episodes of NSVT. In this case, treatment of the arrhythmia may not only improve symptoms, but presumably also improve survival.

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Electrophysiological study

The ESC Textbook of Sports Cardiology ◽

10.1093/med/9780198779742.003.0014 ◽

2019 ◽

pp. 116-119

Author(s):

Matthias Antz

Keyword(s):

Atrial Fibrillation ◽

Risk Assessment ◽

Heart Disease ◽

Ventricular Tachycardia ◽

Brugada Syndrome ◽

Electrophysiological Study ◽

Structural Heart Disease ◽

Sustained Ventricular Tachycardia ◽

Ectopic Beats

An electrophysiological (EP) study is performed for diagnostic reasons, for risk assessment, and for therapy of arrhythmias. It can be useful in athletes with palpitations or documented arrhythmias of unclear origin, in non-sustained ventricular tachycardia, structural heart disease, or electrical abnormalities such as the Brugada syndrome, and for treatment of ectopic beats, supraventricular or ventricular tachycardia, and atrial fibrillation.

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Faculty Opinions recommendation of Long-term Outcomes of Ventricular Tachycardia Ablation in Different Types of Structural Heart Disease.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726122471.793533528 ◽

2017 ◽

Author(s):

Brian Olshansky

Keyword(s):

Heart Disease ◽

Ventricular Tachycardia ◽

Structural Heart Disease ◽

Long Term Outcomes ◽

Ventricular Tachycardia Ablation ◽

Different Types

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Mechanisms and Clinical Management of Ventricular Arrhythmias following Blunt Chest Trauma

Cardiology Research and Practice ◽

10.1155/2016/7270247 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Daniel H. Wolbrom ◽

Aleef Rahman ◽

Cory M. Tschabrunn

Keyword(s):

Heart Disease ◽

Ventricular Tachycardia ◽

Ventricular Arrhythmias ◽

Blunt Chest Trauma ◽

Chest Trauma ◽

Motor Vehicle ◽

Structural Heart Disease ◽

Chest Injury ◽

Chronic Stage ◽

Chest Wall Injury

Nonpenetrating, blunt chest trauma is a serious medical condition with varied clinical presentations and implications. This can be the result of a dense projectile during competitive and recreational sports but may also include other etiologies such as motor vehicle accidents or traumatic falls. In this setting, the manifestation of ventricular arrhythmias has been observed both acutely and chronically. This is based on two entirely separate mechanisms and etiologies requiring different treatments. Ventricular fibrillation can occur immediately after chest wall injury (commotio cordis) and requires rapid defibrillation. Monomorphic ventricular tachycardia can develop in the chronic stage due to underlying structural heart disease long after blunt chest injury. The associated arrhythmogenic tissue may be complex and provides the necessary substrate to form a reentrant VT circuit. Ventricular tachycardia in the absence of overt structural heart disease appears to be focal in nature with rapid termination during ablation. Regardless of the VT mechanism, patients with recurrent episodes, despite antiarrhythmic medication in the chronic stage following blunt chest injury, are likely to require ablation to achieve VT control. This review article will describe the mechanisms, pathophysiology, and treatment of ventricular arrhythmias that occur in both the acute and chronic stages following blunt chest trauma.

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Identification and prognostication of the substrate of ventricular arrhythmia with cardiac magnetic resonance (CMR) imaging in patients with normal echocardiography

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.372 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

S Younus ◽

H Maqsood ◽

A Gulraiz ◽

MD Khan ◽

R Awais

Keyword(s):

Heart Disease ◽

Ventricular Tachycardia ◽

Cardiac Magnetic Resonance ◽

Chest Pain ◽

Magnetic Resonance ◽

Ventricular Arrhythmia ◽

Heart Diseases ◽

Sustained Ventricular Tachycardia ◽

Structural Heart Diseases ◽

Cmr Imaging

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Self Introduction Malignant ventricular arrhythmia contributes to approximately half of the sudden cardiac deaths. In common practice, echocardiography is used to identify structural heart diseases that are the most frequent substrate of VA. Identification and prognostication of structural heart diseases are very important as they are the main determinant of poor prognosis of ventricular arrhythmia. Purpose : The objective of this study is to determine whether cardiac magnetic resonance (CMR) may identify structural heart disease (SHD) in patients with ventricular arrhythmia who had no pathology observed on echocardiography. Methods : A total of 864 consecutive patients were enrolled in this single-center prospective study with significant ventricular arrhythmia. VA was characterized as >1000 ventricular ectopic beats per 24 hours, non-sustained ventricular arrhythmia, sustained ventricular arrhythmia, and no pathological lesion on echocardiography. The primary endpoint was the detection of SHD with CMR. Secondary endpoints were a composite of CMR detection of SHD and abnormal findings not specific for a definite SHD diagnosis. Results : CMR studies were used to diagnose SHD in 212 patients (24.5%) and abnormal findings not specific for a definite SHD diagnosis in 153 patients (17.7%). Myocarditis (n = 84) was the more frequent disease, followed by arrhythmogenic cardiomyopathy (n = 51), ischemic heart disease (n = 32), dilated cardiomyopathy (n = 17), hypertrophic cardiomyopathy (n = 12), congenital cardiac disease (n = 08), left ventricle noncompaction (n = 5), and pericarditis (n = 3). The strongest univariate and multivariate predictors of SHD on CMR images were chest pain (odds ratios [OR]: 2.5 and 2.33, respectively) and sustained ventricular tachycardia (ORs: 2.62 and 2.21, respectively). Conclusion : Our study concludes that SHD was able to be identified on CMR imaging in a significant number of patients with malignant VA and completely normal echocardiography. Chest pain and sustained ventricular tachycardia were the two strongest predictors of positive CMR imaging results. Abstract Figure. Distribution of different SHD

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