Recognition and Management of Cardiac Arrhythmias: Part II. Ventricular Arrhythmias and Bradyarrhythmias

This review discusses the treatment of ventricular arrhythmias and bradyarrhythmias. Recent studies addressing the management of nonsustained ventricular arrhythmias in patients with congestive heart failure and those recovering from myocardial infarction are discussed. Determination of the origin of wide QRS complex tachycardia is usually possible at the bedside and the diagnostic criteria are provided. Therapy to prevent recurrent ventricular tachycardia or ventricular fibrillation is difficult and controversial. A widely accepted approach based on electrophysiologic testing and implantable defibrillators appears to be the most effective. Recognition and management of common bradyarrhythmias including the indications for pacemakers are discussed.

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Myocardial infarction complicating management of congestive heart failure in a dog

Journal of the American Animal Hospital Association ◽

10.5326/15473317-32-1-68 ◽

1996 ◽

Vol 32 (1) ◽

pp. 68-72 ◽

Cited By ~ 3

Author(s):

TC DeFrancesco ◽

CE Atkins ◽

BW Keene

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Congestive Heart Failure ◽

Ventricular Tachycardia ◽

Mitral Valve Regurgitation ◽

Sudden Onset ◽

Left Ventricular ◽

Mixed Breed ◽

Rare Diagnosis ◽

Echocardiographic Evidence

A 7.5-kg, 10-year-old, spayed female, mixed-breed dog was evaluated for sudden onset of weakness, tachypnea, and an irregular cardiac rhythm. Congestive heart failure secondary to mitral valve regurgitation had been diagnosed six weeks earlier. The dog was stable on furosemide, enalapril, and hydralazine. Complex ventricular tachycardia, altered QRS conformation of sinus complexes, echocardiographic evidence of a hypokinetic left-ventricular free wall, and elevated creatine kinase suggested a diagnosis of myocardial infarction. Despite antiarrhythmic therapy, the dog developed ventricular fibrillation and died 36 hours after admission. Postmortem examination confirmed the myocardial infarction. Although a rare diagnosis in the veterinary patient, myocardial infarction must be considered in the differential diagnosis for sudden onset of weakness, tachypnea, and ventricular tachycardia.

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Abstract 16223: Cardiac Arrhythmias in Hospitalized Patients With COVID-19

Circulation ◽

10.1161/circ.142.suppl_3.16223 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Jae Hyung Cho ◽

Ali Namazi ◽

Richard Shelton ◽

Archana Ramireddy ◽

Ashkan Ehdaie ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Ventricular Fibrillation ◽

Interleukin 6 ◽

Cardiac Arrhythmias ◽

Ventricular Arrhythmias ◽

Sinus Tachycardia ◽

Sustained Ventricular Tachycardia ◽

Rhythm Disorder ◽

Baseline Characteristics

Introduction: Arrhythmias have been reported frequent in COVID-19 patients, but the incidence and nature have not been well characterized. Hypothesis: Atrial and ventricular arrhythmias are common complications of patients with COVID-19. Methods: Patients admitted with COVID-19 and monitored by telemetry were prospectively enrolled in the study. Baseline characteristics, hospital course, treatment and complications were collected from the patients’ medical records. Telemetry was monitored to detect the incidence of cardiac arrhythmias. The incidence and types of cardiac arrhythmias were analyzed and compared between survivors and non-survivors. Results: Among 143 patients admitted with telemetry monitoring, overall in-hospital mortality was 23.1% (33/143 patients) during the period of observation (mean follow up 19.9 ± 13.7 days). Survivors were younger (68.1 ± 17.2 vs. 77.6 ± 15.9 years old, p=0.006), had higher body mass index (28.1 ± 8.3 vs. 24.3 ± 6.2, p=0.019), were less tachycardic on initial presentation (heart rate 90.6 ± 19.4 vs. 99.8 ± 23.7 bpm, p=0.026) and had lower troponin (peak troponin 0.03 vs. 0.14 ng/ml. p=0.006) and interleukin-6 levels (peak interleukin-6 32 vs. 264 pg/ml, p=0.001). Sinus tachycardia, the most common arrhythmia (occurring in 39.9% [57/143] of patients), occurred more frequently in non-survivors (57.6% vs. 34.5% in survivors, p=0.018). Premature ventricular complexes occurred in 28.7% (41/143), and non-sustained ventricular tachycardia in 15.4% (22/143) of patients, with no difference between survivors and non-survivors. Sustained ventricular tachycardia and ventricular fibrillation were rare (seen only in 1.4% and 0.7% of patients, respectively). Conclusions: In this prospective observational study of hospitalized and monitored patients with COVID-19, sinus tachycardia was the most common rhythm disorder, and its presence was associated with higher mortality. Sustained ventricular tachycardia or ventricular fibrillation were infrequent, contradicting previous reports that malignant ventricular arrhythmias are commonly seen in patients hospitalized with COVID-19.

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Atrioventricular block as a predictor of major adverse cardiac events in acute coronary syndrome patients

EP Europace ◽

10.1093/europace/euab116.312 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

H Santos ◽

M Santos ◽

I Almeida ◽

H Miranda ◽

C Sa ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Congestive Heart Failure ◽

Cardiac Arrest ◽

Ventricular Tachycardia ◽

Blood Transfusion ◽

Cardiogenic Shock ◽

Sustained Ventricular Tachycardia ◽

Mechanical Complication ◽

Major Hemorrhage

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf Portuguese Registry of Acute Coronary Syndromes Background Atrioventricular block (AVB) can be a consequence of ischemia in acute coronary syndrome (ACS). Then, its expected, that AVB occurrence is associated with higher rates of major adverse cardiac events (MACE). Objective Evaluate if sustained AVB was a predictor of MACE in ACS hospitalized patients. Methods Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-3/05/2020. Patients were divided into two groups: A – patients without AVB, and B – patients that presented AVB. Were excluded patients without a previous cardiovascular history or clinical data regarding AVB occurrence. MACE was defined as re-infarction, congestive heart failure, cardiogenic shock, a mechanical complication of myocardial infarction, completed atrioventricular block, sustained ventricular tachycardia, cardiac arrest, stroke, major hemorrhage, transfusion and hospitalization death. Univariate logistic regression was performed to assess if AVB in ACS patients was a predictor of MACE. Results A total of 32157 patients was analyze and 23774 had information regarding AVB. From the group of patients that presented AVB, 214 (0.9%) had re-infarction, 3847 (16.2%) had congestive heart failure, 1018 (4.3%) had cardiogenic shock, 1069 (4.5%) had atrial fibrillation, 152 (0.6%) had a mechanical complication of myocardial infarction, 354 (1.5%) had sustained ventricular tachycardia, 706 (3.0%) had cardiac arrest, 152 (0.6%) had stroke, 364 (1.5%) had major hemorrhage, 353 (1.5%) had blood transfusion and 928 (3.0%) died. AVB did not predict re-infarction (p = 0.145), congestive heart failure (p = 0.334), atrial fibrillation (p = 0.171), mechanical complication of myocardial infarction (p = 0.465) and cardiac arrest (p = 0.142). Logistic regression revealed that AVB in ACS patients was a predictor of cardiogenic shock (odds ratio (OR) 2.350, p = 0.012, confidence interval (CI) 1.207-4.572), sustained ventricular tachycardia (OR 2.269, p = 0.013, CI 1.187-4.340), stroke (OR 2.231, p < 0.001, CI 1.779-5.852), major hemorrhage (OR 3.863, p < 0.001, CI 2.667-5.558), blood transfusion (OR 4.291, p < 0.001, CI 3.002-6.137) and hospitalization death (OR 2.699, p < 0.001, CI 1.725-4.222). Conclusions AVB in ACS patients predict MACE, namely cardiogenic shock, sustained ventricular tachycardia, stroke, major hemorrhage, blood transfusion and hospitalization death.

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Sustained ventricular tachycardia as a predictor of major adverse cardiac events in acute coronary syndrome patients

EP Europace ◽

10.1093/europace/euab116.330 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

H Santos ◽

I Almeida ◽

H Miranda ◽

M Santos ◽

C Sa ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Atrial Fibrillation ◽

Congestive Heart Failure ◽

Cardiac Arrest ◽

Ventricular Tachycardia ◽

Atrioventricular Block ◽

Sustained Ventricular Tachycardia ◽

Mechanical Complication ◽

Coronary Syndrome

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf Portuguese Registry of Acute Coronary Syndromes Background Sustained ventricular tachycardia (VT) is a frequent rhythm disturbance during an ischemic event like acute coronary syndrome (ACS). VT was frequently associated with worse prognosis, then is expected, that its presence is related to a higher incidence of major adverse cardiac events (MACE). Objective Evaluate if sustained VT was a predictor of MACE in ACS hospitalized patients. Methods Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-4/09/2019. Patients were divided into two groups: A – patients without VT, and B – patients that presented VT on the hospitalization. VT was defined as a register or more of the VT with at least 30 seconds. Were excluded patients without a previous cardiovascular history or clinical data. MACE was defined as re-infarction, congestive heart failure, cardiogenic shock, a mechanical complication of myocardial infarction, completed atrioventricular block, sustained ventricular tachycardia, cardiac arrest, stroke and hospitalization death. Univariate logistic regression was performed to assess if VT in ACS patients was a predictor of MACE. Results A total of 29851 patients was analyze and 25725 had information regarding VT. From the group of patients that presented VT, 177 (1.1%) had re-infarction, 2415 (14.1%) had congestive heart failure, 816 (5.0%) had atrial fibrillation, 108 (0.7%) had a mechanical complication of myocardial infarction, 442 (2.7%) had completed atrioventricular block, 458 (2.8%) had cardiac arrest, 101 (0.6%) had stroke and 535 (3.3%) died. VT did not predict re-infarction (p = 0.071), mechanical complication of myocardial infarction (p = 0.979) and stroke (p = 0.500) in ACS hospitalized patients. Logistic regression revealed that VT in ACS patients was a predictor of congestive heart failure (odds ratio (OR) 2.304, p < 0.001, confidence interval (CI) 1.742-3.047), atrial fibrillation (OR 2.078, p < 0.001, CI 1.453-2.973), completed atrioventricular block (OR 1.831, p = 0.012, CI 1.145-2.928), cardiac arrest (OR 15.434, p < 0.001, CI 11.429-20.843) and hospitalization death (OR 6.472, p < 0.001, CI 4.484-9.342). Conclusions VT in ACS patients predict MACE, namely congestive heart failure, atrial fibrillation, completed atrioventricular block, cardiac rest and hospitalization death.

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Impact of Sacubitril/Valsartan on the Long-Term Incidence of Ventricular Arrhythmias in Chronic Heart Failure Patients

Journal of Clinical Medicine ◽

10.3390/jcm8101582 ◽

2019 ◽

Vol 8 (10) ◽

pp. 1582 ◽

Cited By ~ 7

Author(s):

Ibrahim El-Battrawy ◽

Christina Pilsinger ◽

Volker Liebe ◽

Siegfried Lang ◽

Jürgen Kuschyk ◽

...

Keyword(s):

Heart Failure ◽

Ventricular Tachycardia ◽

Ventricular Fibrillation ◽

Ejection Fraction ◽

Ventricular Arrhythmias ◽

Left Ventricular Ejection ◽

Before And After ◽

Term Data

Background: Sacubitril/valsartan decreased the risk of sudden cardiac death (SCD) in patients suffering from heart failure with reduced ejection fraction (HFrEF). However, long-term data are sparse. Objective: The aim of the present study was to compare the incidence of life-threatening arrhythmias consisting of ventricular tachycardia and/or ventricular fibrillation before and after initiation of sacubitril/valsartan treatment. Methods: Out of 12,000 patients with HFrEF from 2016–2018, 148 patients were newly prescribed sacubitril/valsartan, but the long-term data of only 127 patients were available and included in this study. Results: Patients with an average age of 66.8 ± 12.1 had a median left ventricular ejection fraction (LVEF) of 25% (interquartile range (IQR) 5.00–45.00) and 30% (IQR 10.00–55.00, p < 0.0005) before and after sacubitril/valsartan treatment, respectively. Systolic blood pressure decreased from 127.93 ± 22.01 to 118.36 ± 20.55 mmHg (p = 0.0035) at 6 months of follow-up. However, in 59 patients with a long-term outcome of 12 months, ventricular arrhythmias persistently increased (ventricular fibrillation from 27.6 to 29.3%, ventricular tachycardia (VT) from 12% to 13.8%, and nonsustained VT from 26.6 to 33.3%). Conclusions: Sacubitril/valsartan does not reduce the risk of ventricular tachyarrhythmias in chronic HFrEF patients over 12 months of follow-up.

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Successful Refractory of Acute Myocardial Infarction-induced Electrical Storm by Defibrillations and Amiodarone: A Case Report

10.21203/rs.3.rs-39555/v1 ◽

2020 ◽

Author(s):

Huanhuan Guo ◽

Quan Gan

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Acute Myocardial Infarction ◽

Ventricular Tachycardia ◽

Case Report ◽

Ventricular Arrhythmias ◽

Electrical Storm ◽

Case Presentation ◽

Cardioverter Defibrillator ◽

Progressive Heart Failure

Abstract Background: Acute myocardial infarction (AMI) often complicated with multiple arrhythmias, especially ventricular arrhythmias, including sustained ventricular tachycardia (SVT) and ventricular fibrillation (VF) are often presages progressive heart failure in 48 hours. The present study reports a case of electrical storm (ES) occurring in an 84-year-old woman with acute myocardial infarction (AMI).Case presentation: With the defibrillations or amiodarone, the recurrence of ventricular tachycardia inhibited and the electrocardiographic pattern normalized.Conclusions: The results suggest that defibrillations and amiodarone may be able to improve the survival rate of patients with ES with AMI and would be considered as an alternative treatment for implantable cardioverter defibrillator (ICD) and invasive catheter ablation in the management of cardiac ES.

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