Trigger factors and support mechanisms of arrhythmia аnd supra-ventricular tachyarrhythmias in non-pregnant and pregnant women

2015 ◽  
Vol 9 (1) ◽  
pp. 0-0
Author(s):  
Зиновьева ◽  
E. Zinoveva ◽  
Климова ◽  
S. Klimova ◽  
Рахматуллов ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Electrophysiological Study ◽  
Structural Heart Disease ◽  
Holter Monitoring ◽  
Ventricular Tachyarrhythmias ◽  
Trigger Factors ◽  
Support Mechanisms ◽  
Ventricular Conduction ◽  
Longitudinal Dissociation ◽  
Additional Channel

The frequency of occurrence, trigger factors, supporting mechanisms of arrhythmia and paroxysmal supra-ventricular tachyarrhythmias in non-pregnant and pregnant women were studied. The study involved 26 non-pregnant women aged 18 to 29 years (25,8+2.2 years) and 30 pregnant women from 20 to 32 years (25,6+2,8) without complaint and without structural heart disease. Holter monitoring of ECG and transesophageal electrophysiological study of the heart were performed in all patients. It is revealed that there are arrythmia and paroxysmal supra-ventricular tachycardia in pregnant women more often than in non-pregnant. Reducing the number of extrasystoles and paroxysmal supra-ventricular tachyarrhythmias occurs 6 months after birth. It is established that in non-pregnant and pregnant women there are four types of curves atrio-ventricular conduction (AVC): continuous, intermittent, continuous with the phenomenon of the "gap", intermittent with the phenomenon of the "gap". The continuous curve type of AVC is detected in non-pregnant women, in pregnant women – intermittent, in women six months after childbirth - continuous. It is proved that the electrophysiologi-cal substrate curves atrio-ventricular conduction is retrograde functioning additional channel and longitudinal dissociation of atrio-ventricular connections on the fast and slow ways.

scholarly journals Clinical and functional characteristics of children with ventricular arrhythmias depending on the ectopic focus localization

2021 ◽  
Vol 28 (4) ◽  
pp. 15-23
Author(s):  
O. V. Yeliseyeva
Keyword(s):  
Sinus Rhythm ◽  
Ventricular Arrhythmias ◽  
Contractile Function ◽  
Electrophysiological Study ◽  
Stress Test ◽  
Structural Heart Disease ◽  
Holter Monitoring ◽  
Free Wall ◽  
Functional Features ◽  
The Right

Aim. To determine the prevalence of ventricular arrhythmias (VA) among children with cardiac arrhythmias and to assess the clinical, functional, and electrophysiological characteristics of VA, depending on the localization of the ectopic focus.Methods. The study included 260 children, 153 (58,8%) boys, the mean age of patients was 13.4±3.1years. Based on clinical and anamnestic data, ECG, Holter monitoring, echocardiography, dosed exercise test, invasive electrophysiological study (EPS), radiofrequency ablation (RFA) a comparative assessment of the clinical and functional features of the most frequently diagnosed localizations of the ectopic focus in children with VA was carried out according to the data of invasive EPS, RFA.Results. According to invasive EPI, the most frequent localization of VA in children is the right ventricle outflow tract (RVOT) - 144 (55%), less often - the Valsalva sinuses - 52 (20%) and the RV free wall - 47 (18%). In most cases (255 children, 98%) there was a focal arrhythmia (trigger activity). The localization of ectopia in the RV free wall is characterized by the predominance of single ventricular premature beats (VPB) or in combination with a paired VPB (78,7%) and polymorphism of ventricular complexes (30%). The peculiarity of ventricular tachycardia in this localization is its stable character (17,0%) and low heart rate in volleys (idioventricular rhythm) (12,8%). When the focus was localized in the RVOT, as well as when it was localized in the RV free wall, single VPB or in combination with paired VPB prevailed (84,7%), but polymorphism of ventricular complexes was less often observed (10,4%). Differences in myocardial contractility at the sinus rhythm in right ventricular arrhythmias were revealed. Thus, the ejection fraction at the localization of the lesion in the RV free wall was significantly lower than in the RVOT (63.4±5.5% and 65.8±5.9%, respectively; p<0.01). Hemodynamic significance is characteristic for RV arrhythmias (21.3% and 16.0% of patients) and was practically not observed at the left-sided localization of the arrhythmogenic focus (3.8%; p<0.01). VA in patients without structural heart disease, regardless of the localization of the arrhythmic focus in children, is asymptomatic and is detected, in most cases, within the framework of clinical examination 206 patients, 79.2%. The prevalence of syncope in children with idiopathic VA is 15.8% (41 patients), and in most cases, they are of vaso-vagal origin. In most children (178, 70%), idiopathic VA is dependent on the level of parasympathetic influences on the heart, disappearing or significantly decreasing during exercise, which is revealed during the stress test confirming the high role of autonomic influences on the regulation of heterotopic rhythm in children with VA.Conclusion. VA is a common arrhythmia in children. Depending on the localization of the arrhythmogenic focus, characteristic features of the structure and density of the heart, as well as differences in the contractile function of the myocardium on the sinus rhythm and on the ectopic complex were revealed.

P2533Prospective randomized study on implanted cardiac rhythm recorders in pregnant women with symptomatic arrhythmia and/or structural heart disease

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C A Viljoen ◽  
K Sliwa ◽  
F Azibani ◽  
M R Johnson ◽  
J Baard ◽  
...  
Keyword(s):  
At Risk ◽  
Heart Disease ◽  
Pregnant Women ◽  
Standard Care ◽  
Low Birthweight ◽  
Structural Heart Disease ◽  
Holter Monitoring ◽  
Study Groups ◽  
Direct Result ◽  
The Impact

Abstract Background Cardiac arrhythmia is an important cause of maternal morbidity and mortality in pregnancy, but is difficult to diagnose. Purpose The aim of this single-centre, prospective, randomized pilot study was to compare the implantable loop recorder (ILR) with standard assessment of arrhythmia (12-lead ECG; 24-hour Holter ECG) in terms of acceptability, detection of arrhythmias and impact on outcome in pregnant women with symptomatic arrhythmias and/or structural heart disease (SHD). Methods The study recruited 40 consecutive patients from a weekly, dedicated cardiac obstetric clinic. Inclusion criteria: symptoms of arrhythmia and/or having SHD at risk of arrhythmia. Patients were randomized to either standard care (SC) or standard care plus ILR (SC-ILR). ILR recordings were read at the monthly visits and/or when presenting with symptoms. Results There were no demographic differences between the study groups. Seventeen patients consented to ILR insertion, all of whom found the procedure acceptable. No arrhythmias were recorded by the 12-lead ECGs. Holter monitoring detected arrhythmias in 10 of 23 patients (43%) from the SC group. In the SC-ILR group, 8 of 17 patients (47%) had arrhythmias detected by Holter, whereas 13 of 17 patients (76%) patients had arrhythmias detected by ILR (p=0.157). One of 4 patients with supraventricular tachycardia, 2 of 3 patients with premature ventricular complexes and 2 patients with paroxysmal atrial fibrillation (AF) recorded by ILR did not have the arrhythmias detected by Holter monitoring (Figure 1A shows a scatter plot of the variable R-R intervals seen in AF and 1B a rhythm strip of AF with irregular RR intervals and the absence of P waves, both downloaded from the ILR). Four of these 5 patients (80%) had a change in management as a direct result of their ILR recordings. There were no maternal deaths up to 42 days postpartum in either of the study groups. Nine babies were born with a low birthweight (<2500g), 5 stillbirth/neonatal deaths and 1 pregnancy termination occurred (5 in the Holter group and 1 in ILR group, p=0.37). Figure 1 Conclusion(s) This study suggests that an ILR is an acceptable diagnostic modality in pregnant women with a suspected or at risk of arrhythmia. The ILR increased the diagnostic yield to detect arrhythmias that were not detected by routine ECG and Holter monitoring which led to a change in management in the SC-ILR group and was associated with better maternal and neonatal outcomes. The impact of ILR monitoring should be further assessed in larger studies with longer follow up.

scholarly journals P967 Profile of arrhythmia in pregnant women with different WHO class is similar

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Wisniowska-Smialek ◽  
A Lesniak-Sobelga ◽  
M Kostkiewicz ◽  
P Rubis ◽  
K Holcman ◽  
...  
Keyword(s):  
Heart Disease ◽  
Pregnant Women ◽  
Structural Heart Disease ◽  
Holter Monitoring ◽  
Cardiac Complications ◽  
P Value ◽  
Conduction Disturbances ◽  
Foetal Mortality ◽  
Group 2 ◽  
D 20

Abstract Background Arrhythmia is the most common cardiac complications during pregnancy especially in women with structural heart disease. Methods: Since January 2015 till December 2018 the consecutive 150 pregnant women with different maternal cardiovascular risk according to WHO classification: 100 in WHO I and II (gr 1);50 in WHO II-III, III, IV were enrolled. Each woman had 24-hour Holter- ECG monitoring during at least 2 trimester. Results: Except mild ventricular arrhythmia i.e ventricular extrasystole &gt; 1000 per 24 hour, which occured more often in group1, we did not observe any significant differences in arrhythmic profile of pregnant women with different WHO risk classification (table 1). Delivery: Caesarean section was more frequent in gr 2 (86% vs 62%) but rate of stillbirths were similar among groups. Maternal death did not occurred, there was 2 (4%) foetal mortality in gr 2. Mean duration of pregnancy, children length and birthweight were significantly higher in gr 1(table1).Conclusion: Arrhythmias during pregnancy occurred particularly on the substrate of structural heart disease. According to our observation pregnant women with potentially higher risk of maternal cardiovascular events did not reveal significant arrhythmia including conduction disturbances in comparison to women in WHO class I or II. Holter monitoring resultes Parameter Group 1; no 100 Group 2, no 50 P value Age 31(27-34) 31(28-33) 0,36 NYHA 1,34 1,32 0,76 SVE &gt; 1000/d 2(2,15%) 2(5,88%) 0,28 VE &gt; 1000/d 20(19,23%) 3(5,88%) 0,03 SVT 6(6,5%) 4(11,43%) 0,35 sVT 1(1%) 0 0,65 nsVT 8(8,79%) 3(8,57%) 0,96 AF/AT 0 2(4%) 0,54 AV I 5(5%) 3(6%) 0,32 AV II Mobitz I 1(1,1%) 1(2%) 0,53 AV III 0 1(2%) 0,41 Duration (weeks) 39(38-40) 37,1 0,017 Weight (grams) 3220+-641 2840+-767 g 0,02 Caesareon section 54(62%) 33(86%) 0,00 Stillbirths 22(21,57% 8(17,78%) 0,6

scholarly journals Successful Ablation of Ventricular Arrhythmia Without Fluoroscopy Guided by Carto 3 System in Pregnant Woman Without Structural Heart Disease

2020 ◽  
Vol 8 (2) ◽  
pp. 236-238
Author(s):  
Ayan Abdrakhmanov ◽  
Aliya Smagulova ◽  
Bayan Ainabekova
Keyword(s):  
Heart Disease ◽  
Pregnant Woman ◽  
Catheter Ablation ◽  
Pregnant Women ◽  
Electrophysiological Study ◽  
Harmful Effect ◽  
Structural Heart Disease ◽  
Interventional Treatment ◽  
Navigation Systems ◽  
Premature Ventricular Contractions

Introduction: Arrhythmias can take place in any period of pregnancy. In addition, the incidence of life-threatening ventricular arrhythmias in a pregnant woman without the organic pathology of the heart is rare. Interventional treatment should be carried out in cases of severe arrhythmias and drug resistance. The radiation exposure during ablation carries a potentially harmful effect on the mother and fetus although data on the zero-fluoroscopy ablation of arrhythmias in pregnant women is limited. Case Presentation: A 26-year-old female without structural heart disease at the gestation period of 26-28 weeks was admitted to a hospital due to severe symptoms of ventricular tachycardia (VT) and premature ventricular contractions. In this regard, the conservative therapy of β-blockers was ineffective and accompanied by a decrease in blood pressure to 60/40 mm Hg. Results: An intracardiac electrophysiological study and non-fluoroscopic catheter ablation were carried out considering the drug refractory and severe symptoms of VT. The ablation of the arrhythmia substrate was successfully performed using the Carto 3 System without fluoroscopy. Based on the results, the procedure was not associated with any maternal or fetal complications. Conclusions: In general, the non-fluoroscopic catheter ablation guided by electro-anatomical mapping and navigation systems is safe and applicable in the treatment of pregnant women with severe types of arrhythmias.

scholarly journals Use of Routine Echocardiographic Screening for Structural Heart Disease in At-Risk Pregnant Women in India

2020 ◽  
Author(s):  
Amisha Patel ◽  
Lauren S. Ranard ◽  
Nicole Aranoff ◽  
Hussein Rahim ◽  
Roja Vanukuru ◽  
...  
Keyword(s):  
At Risk ◽  
Heart Disease ◽  
Pregnant Women ◽  
Structural Heart Disease ◽  
Women In India

Natural History of the ECG Abnormalities in FAP Portuguese Type: A Follow-Up Study with ECG, Holter Monitoring and Intracardiac Electrophysiological Study

1988 ◽  
pp. 453-457 ◽  
Author(s):  
Luiz Maciel ◽  
D. Cunha ◽  
A. Oliveira ◽  
J. Campos ◽  
Falcão de Freitas
Keyword(s):  
Natural History ◽  
Electrophysiological Study ◽  
Type A ◽  
Holter Monitoring ◽  
Follow Up Study ◽  
History Of ◽  
Ecg Abnormalities

scholarly journals Preliminary Study of Coupling Intervals of Premature Ventricular Complexes in Dogs With Different Cardiac Diseases

2021 ◽  
Author(s):  
Liza Sally Koster ◽  
Jonathan Abbott
Keyword(s):  
Heart Disease ◽  
Arrhythmogenic Right Ventricular Cardiomyopathy ◽  
Structural Heart Disease ◽  
Holter Monitoring ◽  
Antiarrhythmic Therapy ◽  
Premature Ventricular Complex ◽  
Coupling Interval ◽  
Familial Cardiomyopathy ◽  
Preliminary Study ◽  
Group 2

Abstract Coupling interval (CI), the time (ms) from the onset of a sinus QRS to the onset of the following premature ventricular complex (PVC), and their variability (CIV) might predict mortality and elucidate mechanisms of arrhythmogenesis. There has been limited investigation of CIV in dogs. Therefore, we determined CIV and prematurity index (PI) in three groups of dogs with ventricular arrhythmias that were subject to 24 hour ambulatory electrocardiographic (Holter) monitoring. Dogs in group 1 had presumptive arrhythmogenic right ventricular cardiomyopathy (ARVC), those in group 2 had structural heart disease in which patients with valvular heart disease predominated, and those in group 3 had a dilated cardiomyopathy (DCM) either phenotype or presumed familial cardiomyopathy. In this preliminary study, we did not find significant differences in indices of CIV between groups. Median PI was lower in dogs treated with antiarrhythmic therapy. Severity of cardiac remodeling, except for left atrial to aortic ratio, were not correlated with CIV. It was not possible to determine the mechanism of arrhythmias in ARVC, DCM phenotype or structural heart disease groups and re-entry, triggered activity, and abnormal automaticity are possible etiologies. The effect of antiarrhythmic therapy demonstrated potential drug effect on CIV. Risk for malignant arrhythmias and sudden cardiac death were not examined. A larger study would be needed to determine if differences exist; if present, this would give insight into possible mechanisms and optimal antiarrhythmic therapy.

Sustained and non-sustained ventricular tachycardia and no associated heart disease (idiopathic ventricular tachycardia)

ESC CardioMed ◽  
2018 ◽  
pp. 2288-2293
Author(s):  
Victor Bazan ◽  
Enrique Rodriguez-Font ◽  
Francis E. Marchlinski
Keyword(s):  
Heart Disease ◽  
Ventricular Tachycardia ◽  
Drug Therapy ◽  
Catheter Ablation ◽  
Beta Blockers ◽  
Young Patients ◽  
Structural Heart Disease ◽  
Holter Monitoring ◽  
Severe Arrhythmia ◽  
The Right

Around 10% of ventricular arrhythmias (VA) occur in the absence of underlying structural heart disease. These so-called ‘idiopathic’ VAs usually have a benign clinical course. Only rarely do these “benign” arrhythmias trigger polymorphic ventricular tachycardia (PVT) and idiopathic ventricular fibrillation (VF). Due to their focal origin and to the absence of underlying myocardial scar, the 12-lead ECG very precisely establishes the right (RV) or left (LV) ventricular site of origin of the arrhythmia and can help regionalizing the origin of VT for ablation. A 12-lead ECG obtained during the baseline rhythm and 24-hour ECG Holter monitoring are indicated in order to identify structural or electrical disorders leading to PVT/VF and to determine the VA burden. The most frequent origin of idiopathic VAs is the RV outflow tract (OT). Other origins include the LVOT, the LV fascicles (fascicular VTs), the LV and RV papillary muscles, the crux cordis, the mitral and tricuspid annuli and the RV moderator band. Recognizing the typical anatomic sites of origin combined with a 12 lead ECG assessment facilitates localization.  Antiarrhythmic drug therapy (including use of beta-blockers) or catheter ablation may be indicated to suppress or eliminate idiopathic VAs, particularly upon severe arrhythmia-related symptoms or if the arrhythmia burden is high and ‘tachycardia’-induced cardiomyopathy is suspected. Catheter ablation is frequently preferred to prevent lifelong drug therapy in young patients.

scholarly journals Effectiveness of Implanted Cardiac Rhythm Recorders With Electrocardiographic Monitoring for Detecting Arrhythmias in Pregnant Women With Symptomatic Arrhythmia and/or Structural Heart Disease

2020 ◽  
Vol 5 (4) ◽  
pp. 458 ◽  
Author(s):  
Karen Sliwa ◽  
Feriel Azibani ◽  
Mark R. Johnson ◽  
Charle Viljoen ◽  
Johann Baard ◽  
...  
Keyword(s):  
Heart Disease ◽  
Pregnant Women ◽  
Cardiac Rhythm ◽  
Structural Heart Disease ◽  
Electrocardiographic Monitoring
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