scholarly journals Polymorphic Ventricular Tachycardia: Terminology, Mechanism, Diagnosis, and Emergency Therapy

Circulation ◽  
2021 ◽  
Vol 144 (10) ◽  
pp. 823-839
Author(s):  
Sami Viskin ◽  
Ehud Chorin ◽  
Dana Viskin ◽  
Aviram Hochstadt ◽  
Arie Lorin Schwartz ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
The Other ◽  
Polymorphic Ventricular Tachycardia ◽  
Ventricular Tachyarrhythmias ◽  
Diagnosis And Therapy ◽  
Emergency Therapy ◽  
Malignant Arrhythmias

Polymorphic ventricular tachyarrhythmias are highly lethal arrhythmias. Several types of polymorphic ventricular tachycardia have similar electrocardiographic characteristics but have different modes of therapy. In fact, medications considered the treatment of choice for one form of polymorphic ventricular tachycardia, are contraindicated for the other. Yet confusion about terminology, and thus diagnosis and therapy, continues. We present an in-depth review of the different forms of polymorphic ventricular tachycardia and propose a practical step-by-step approach for distinguishing these malignant arrhythmias.

Catecholaminergic polymorphic ventricular tachycardia

2014 ◽  
Author(s):  
Demosthenes G. Katritsis ◽  
Bernard J. Gersh ◽  
A. John Camm
Keyword(s):  
Ventricular Tachycardia ◽  
Catecholaminergic Polymorphic Ventricular Tachycardia ◽  
Polymorphic Ventricular Tachycardia ◽  
Diagnosis And Therapy

Diagnosis and therapy of catecholaminergic polymorphic ventricular tachycardia are discussed.

Characterization of arrhythmic presentation in patients with arrhythmogenic cardiomyopathy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Chargeishvili ◽  
A Mazzanti ◽  
D Kukavica ◽  
S Marelli ◽  
A Trancuccio ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Advanced Disease ◽  
Task Force ◽  
Fibrous Tissue ◽  
Molecular Medicine ◽  
Polymorphic Ventricular Tachycardia ◽  
Funding Source ◽  
Ventricular Tachyarrhythmias ◽  
Arrhythmogenic Cardiomyopathy ◽  
Arrhythmic Event

Abstract Background/Introduction Arrhythmogenic cardiomyopathy (ACM) is one of the most arrhythmogenic conditions known to man. ACM is caused by desmosomal mutations in most cases, resulting in progressive replacement of the myocardium by adipose and fibrous tissue. It comes as no surprise that ACM is one of the leading causes of sudden cardiac death (SCD). Nonetheless, the characteristics of arrhythmic manifestations have not dissected after the release of most recent criteria. Purpose This study investigates different types of ventricular tachyarrhythmias which had occurred at first arrhythmic event in patients with ACM. Methods We investigated 91 consecutive patients with documented evidence of sustained ventricular tachyarrhythmias from 291 ACM patients followed at our center up to this date. Diagnosis of ACM was made using 2010 Task Force Criteria, and patients were defined as having an advanced disease if they had more than 4 TFC points at diagnosis. Presenting ventricular tachyarrhythmias were divided into (1) life-threatening arrhythmic event (LAE; ventricular fibrillation or hemodynamically unstable polymorphic ventricular tachycardia) and (2) hemodynamically stable monomorphic ventricular tachycardia (MMVT). Right ventricular (RV) involvement was defined as a presence of RV wall motion abnormalities and RV dilation at transthoracic echocardiography or cardiac magnetic resonance. Results Our study population was constituted of a predictably higher number of males (n=68; 75%), with an average age at the first arrhythmic event of 38±15 years of age. At first documented arrhythmia, majority of patients studied experienced a stable MMVT (n=53; 58%), while 38 patients experienced an LAE (n=38; 42%). The patients suffering an LAE as first arrhythmic event were slightly younger than the patients who experienced a stable MMVT (35±14 years vs. 40±15 years; p=0.076) but there were no statistically significant gender differences (28/38 males with LAE vs. 40/53 males with stable MMVT; p= n.s.). Interestingly, patients who presented with stable MMVT were more likely to have an advanced disease at diagnosis (OR=6.52; 95% CI 2.02–20.99; p=0.002). This is supported by the fact that RV involvement was significantly more common in patients presenting with stable MMVT (OR=4.38; 95% CI 1.26–15.26; p=0.021). Additionally, patients with stable MMVT were more commonly carriers of variants on PKP2 gene (OR=3.6; 95% CI 1.1–11.91; p=0.021). Conclusions Our data suggest that two types of arrhythmia reflect the two different stages of the disease. The early stage of the ACM is characterized by LAE in absence of RV structural involvement; while, stable MMVT is typical of PKP2 carriers and advanced stage of ACM with RV involvement. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): The Italian Ministry of Research and University Dipartimenti di Eccellenza 2018–2022 grant to the Molecular Medicine Department (University of Pavia)

scholarly journals Wide complex tachycardia in a patient with COVID-19 treated with chloroquine/azithromycin

2021 ◽  
Vol 2021 (1) ◽  
Author(s):  
Abraham Edgar Gracia-Ramos ◽  
Antonio Cortes-Ortiz
Keyword(s):  
Ventricular Tachycardia ◽  
Ventricular Arrhythmias ◽  
Transplant Patient ◽  
The Other ◽  
Polymorphic Ventricular Tachycardia ◽  
Kidney Transplant Patient ◽  
Off Label ◽  
Wide Complex Tachycardia ◽  
Prolonged Qt

ABSTRACT Azithromycin and chloroquine/hydroxychloroquine are being used internationally off-label to treat patients with coronavirus disease 2019 (COVID-19) based on in vitro and weak studies involving humans. However, the evidence about the benefit of these drugs is very uncertain and on the other hand, information regarding possible harms is on the rise. There are increasing reports associating chloroquine/hydroxychloroquine with/without azithromycin with prolonged QT and ventricular arrhythmias (monomorphic or polymorphic ventricular tachycardia) in COVID-19 patients. We present the case of a severe acute respiratory syndrome coronavirus 2-infected kidney transplant patient for which he received treatment with chloroquine plus azithromycin and on Day 4 of therapy, the patient suddenly developed a wide complex tachycardia. Because of the increasing reports of adverse effects related to these drugs, their use should be avoided until further evidence of clinical benefit is available.

Targeting intracellular calcium cycling in catecholaminergic polymorphic ventricular tachycardia: a theoretical investigation

2011 ◽  
Vol 301 (4) ◽  
pp. H1625-H1638 ◽  
Author(s):  
Ruey J. Sung ◽  
Chu-Pin Lo ◽  
Pi Yin Hsiao ◽  
Hui-Chun Tien
Keyword(s):  
Ventricular Tachycardia ◽  
Intracellular Calcium ◽  
Markov Models ◽  
Catecholaminergic Polymorphic Ventricular Tachycardia ◽  
Polymorphic Ventricular Tachycardia ◽  
Ventricular Tachyarrhythmias ◽  
Adrenergic Stimulation ◽  
Calcium Cycling ◽  
M Cell ◽  
Release Channel

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a malignant arrhythmogenic disorder linked to mutations in the cardiac ryanodine receptor (RyR2) and calsequestrin, predisposing the young to syncope and cardiac arrest. To define the role of β-adrenergic stimulation (BAS) and to identify potential therapeutic targeted sites relating to intracellular calcium cycling, we used a Luo-Rudy dynamic ventricular myocyte model incorporated with interacting Markov models of the L-type Ca2+ channel ( ICa,L) and RyR2 to simulate the heterozygous state of mouse RyR2 R4496C mutation (RyR2R4496C+/−) comparable with CPVT patients with RyR2 R4497C mutation. Characteristically, in simulated cells, pacing at 4 Hz or faster or pacing at 2 Hz under BAS with effects equivalent to those of isoproterenol at ≥0.1 μM could readily induce delayed afterdepolarizations (DADs) and DAD-mediated triggered activity (TA) in RyR2R4496C+/− but not in the wild-type via enhancing both ICa,L and sarcoplasmic reticulum (SR) Ca2+ ATPase ( IUP). Moreover, with the use of steady state values of isolated endocardial (Endo), mid-myocardial (M), and epicardial (Epi) cells as initial data for conducting single cell and one-dimensional strand studies, the M cell was more vulnerable for developing DADs and DAD-mediated TA than Endo and Epi cells, and the gap junction coupling represented by diffusion coefficient ( D) of ≤0.000766*98 cm2/ms was required for generating DAD-mediated TA in RyR2R4496C+/−. Whereas individual reduction of Ca2+ release channel of SR and Na-Ca exchanger up to 50% was ineffective, 30% or more reduction of either ICa,L or IUP could totally suppress the inducibility of arrhythmia under BAS. Of note, 15% reduction of both ICa,L and IUP exerted a synergistic antiarrhythmic efficacy. Findings of this model study confirm that BAS facilitates induction of ventricular tachyarrhythmias via its action on intracellular Ca2+ cycling and a pharmacological regimen capable of reducing ICa,L could be an effective adjunctive to β-adrenergic blockers for suppressing ventricular tachyarrhythmias during CPVT.

Diagnosis and Ablation of Fascicular Tachycardia

2011 ◽  
Vol 3 (1) ◽  
pp. 67
Author(s):  
Akihiko Nogami ◽  
Keyword(s):  
Ventricular Tachycardia ◽  
Right Bundle Branch Block ◽  
Axis Deviation ◽  
Exit Site ◽  
Rare Form ◽  
Bundle Branch Block ◽  
Diagnosis And Therapy ◽  
Narrow Qrs ◽  
Left Posterior ◽  
Qrs Morphology

Verapamil-sensitive fascicular ventricular tachycardia (VT) is the most common form of idiopathic left VT. According to the QRS morphology and the successful ablation site, left fascicular VT can be classified into three subgroups: left posterior fascicular VT, whose QRS morphology shows right bundle branch block (RBBB) configuration and superior axis (common form); left anterior fascicular VT, whose QRS morphology shows RBBB configuration and right-axis deviation (uncommon form), and upper septal fascicular VT, whose QRS morphology shows narrow QRS configuration and normal or right-axis deviation (rare form). Posterior and anterior fascicular VT can be successfully ablated at the posterior or anterior mid-septum with a diastolic Purkinje potential during VT or at the VT exit site with a fused pre-systolic Purkinje potential. Upper septal fascicular VT can also be ablated at the site with diastolic Purkinje potential at the upper septum. Recognition of the heterogeneity of this VT and its unique characteristics should facilitate appropriate diagnosis and therapy.

scholarly journals Methadone-Induced Polymorphic Ventricular Tachycardia Complicated by Takotsubo Cardiomyopathy in a Malnourished Patient

2021 ◽  
Vol 9 ◽  
pp. 232470962110051
Author(s):  
Mohammed Ali ◽  
Omeralfaroug Adam ◽  
Ahmed Subahi ◽  
Abdalaziz Awadelkarim ◽  
Lubna Fatiwala ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ventricular Tachycardia ◽  
Coronary Disease ◽  
Takotsubo Cardiomyopathy ◽  
Myocardial Dysfunction ◽  
Polymorphic Ventricular Tachycardia ◽  
Malnourished Patient

Takotsubo cardiomyopathy (TC) is a syndrome characterized by acute and transient regional systolic myocardial dysfunction. TC often mimics myocardial infarction without obstructive coronary disease. We present a case of a 48-year-old woman who developed TC following the onset of polymorphic ventricular tachycardia in the setting of methadone intoxication.

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