scholarly journals Outpatient evaluation and management of patients with ventricular premature beats or non-sustained ventricular tachycardia

EP Europace ◽  
2012 ◽  
Vol 14 (2) ◽  
pp. 294-296 ◽  
Author(s):  
J. H. Svendsen ◽  
A. Goette ◽  
D. Dobreanu ◽  
G. Marinskis ◽  
P. Mabo ◽  
...  
Author(s):  
Nam Van Tran ◽  
Samuel Rotman ◽  
Patrice Carroz ◽  
Etienne Pruvot

Abstract Background We report an unusual case of non-sustained ventricular tachycardia (NSVT) from the epicardial part of the right ventricular outflow tract (RVOT). Case summary A 37-year-old woman who underwent in 2006 an ablation for idiopathic ventricular premature beats (VPBs) from the RVOT presented with pre-syncopal NSVT in 2016. A cardiac workup showed no coronary disease, normal biventricular function, and no enhancement on cardiac magnetic resonance imaging. A metabolic positron emission tomography scan excluded inflammation. Biopsies revealed normal desmosomal proteins. An endocardial mapping revealed an area of low voltage potential (<0.5 mV) at the antero-septal aspect of the RVOT corresponding to the initial site of ablation from 2006. Activation mapping revealed poor prematurity and pace-mapping showed unsatisfactory morphologies in the RVOT, the left ventricle outflow tract and the right coronary cusp. An epicardial map revealed a low voltage area at the antero-septal aspect of the RVOT with fragmented potentials opposite to the endocardial scar. Pace-mapping demonstrated perfect match. An NSVT was induced and local electrocardiogram showed mid-diastolic potentials. Ablation was applied epicardially and endocardially without any complication. The patient was arrhythmia free at 4-year follow-up. Discussion Cardiac workup allowed to exclude specific conditions such as arrhythmogenic cardiomyopathy, tetralogy of Fallot, sarcoidosis, or myocarditis as a cause for NSVT from the RVOT. The epi and endocardial map showed residual scar subsequent to the first ablation which served as substrate for the re-entrant NSVT. This is the first case which describes NSVT from the epicardial RVOT as a complication from a previous endocardial ablation for idiopathic VPB.


PEDIATRICS ◽  
1981 ◽  
Vol 68 (1) ◽  
pp. 58-66
Author(s):  
D. P. Southall ◽  
A. M. Johnson ◽  
E. A. Shinebourne ◽  
P. G. B. Johnston ◽  
D. G. Vulliamy

Of 3,383 apparently healthy newborn infants studied in one region of England, 33 showed cardiac arrhythmias or preexcitation on a standard ECG. Twenty-six infants had multiple atrial or ventricular premature beats. One infant had atrial flutter, two had multifocal atrial tachycardia, and two had supraventricular tachycardia. Two infants showed the ECG pattern of the Wolff-Parkinson-White syndrome, but did not demonstrate cardiac arrhythmias. Performance of 24-hour ECG recordings on 15 of the 26 subjects with premature beats showed additional supraventricular or ventricular tachycardia in five cases. In one of two infants with multifocal atrial tachycardia, 24-hour recordings also demonstrated long episodes of rapid supraventricular tachycardia. Follow-up recordings (standard and 24-hour ECG) showed that in the majority of infants arrhythmias or preexcitation could not be demonstrated after 12 weeks of age. One infant with atrial premature beats, one infant with ventricular premature beats and ventricular tachycardia, and one infant with multifocal atrial tachycardia showed persisting arrhythmias. Four infants received antiarrhythmic therapy which probably influenced the natural history of their arrhythmias. Disorders of cardiac rhythm and conduction occur in apparently healthy infants. This study provides a basis for further prospective research into their natural history.


Cardiology ◽  
2020 ◽  
Vol 145 (12) ◽  
pp. 795-801
Author(s):  
Danielle M. Haanschoten ◽  
Kevin Vernooy ◽  
Rypko J. Beukema ◽  
Tamas Szili-Torok ◽  
Rachel M.A. ter Bekke ◽  
...  

<b><i>Background:</i></b> Symptomatic idiopathic ventricular arrhythmias (VA), including premature beats (VPB) and nonsustained ventricular tachycardia (VT) are commonly encountered arrhythmias. Although these VA are usually benign, their treatment can be a challenge to primary and secondary health care providers. Mainstay treatment is comprised of antiarrhythmic drugs (AAD) and, in case of drug intolerance or failure, patients are referred for catheter ablation to tertiary health care centers. These patients require extensive medical attention and drug regimens usually have disappointing results. A direct comparison between the efficacy of the most potent AAD and primary catheter ablation in these patients is lacking. The ECTOPIA trial will evaluate the efficacy of 2 pharmacological strategies and 1 interventional approach to: suppress the VA burden, improve the quality of life (QoL), and safety. <b><i>Hypothesis:</i></b> We hypothesize that flecainide/verapamil combination and catheter ablation are both superior to sotalol in suppressing VA in patients with symptomatic idiopathic VA. <b><i>Study Design:</i></b> The Elimination of Ventricular Premature Beats with Catheter Ablation versus Optimal Antiarrhythmic Drug Treatment (ECTOPIA) trial is a randomized, multicenter, prospective clinical trial to compare the efficacy of catheter ablation versus optimal AAD treatment with sotalol or flecainide/verapamil. One hundred eighty patients with frequent symptomatic VA in the absence of structural heart disease or underlying cardiac ischemia who are eligible for catheter ablation with an identifiable monomorphic VA origin with a burden ≥5% on 24-h ambulatory rhythm monitoring will be included. Patients will be randomized in a 1:1:1 fashion. The primary endpoint is defined as &#x3e;80% reduction of the VA burden on 24-h ambulatory Holter monitoring. After reaching the primary endpoint, patients randomized to one of the 2 AAD arms will undergo a cross-over to the other AAD treatment arm to explore differences in drug efficacy and QoL in individual patients. Due to the use of different AAD (with and without β-blocking characteristics) we will be able to explore the influence of alterations in sympathetic tone on VA burden reduction in different subgroups. Finally, this study will assess the safety of treatment with 2 different AAD and ablation of VA.


1997 ◽  
Vol 36 (04/05) ◽  
pp. 257-260 ◽  
Author(s):  
H. Saitoh ◽  
T. Yokoshima ◽  
H. Kishida ◽  
H. Hayakawa ◽  
R. J. Cohen ◽  
...  

Abstract:The frequency of ventricular premature beats (VPBs) has been related to the risk of mortality. However, little is known about the temporal pattern of occurrence of VPBs and its relationship to autonomic activity. Hence, we applied a general correlation measure, mutual information, to quantify how VPBs are generated over time. We also used mutual information to determine the correlation between VPB production and heart rate in order to evaluate effects of autonomic activity on VPB production. We examined twenty subjects with more than 3000 VPBs/day and simulated ran-( dom time series of VPB occurrence. We found that mutual information values could be used to characterize quantitatively the temporal patterns of VPB generation. Our data suggest that VPB production is not random and VPBs generated with a higher value of mutual information may be more greatly affected by autonomic activity.


2007 ◽  
Vol 62 (2) ◽  
pp. 163-169 ◽  
Author(s):  
S. WU ◽  
W.F. KERWIN ◽  
C.T. PETER ◽  
E.S. GANG ◽  
H. MA

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