scholarly journals Alcohol Ablation for Ventricular Tachycardia

2021 ◽  
pp. 19-23
Author(s):  
Adi Lador ◽  
Akanibo Da-Wariboko ◽  
Liliana Tavares ◽  
Miguel Valderrábano
Keyword(s):  
Ventricular Tachycardia ◽  
Ventricular Arrhythmias ◽  
Ablation Techniques ◽  
Rf Ablation ◽  
Ethanol Ablation ◽  
Alcohol Ablation ◽  
Number Of Patients

Catheter-based radiofrequency (RF) ablation is an effective, well-established therapy for ventricular tachycardia (VT). However, a large number of patients still have recurrences, particularly those with substrates arising from intramural locations that are inaccessible through endo- or epicardial catheter approaches. Several unconventional ablation techniques have been proposed to treat RF-refractory VT, including transarterial coronary ethanol ablation and retrograde coronary venous ethanol ablation. We review the evidence regarding the mechanisms, procedural aspects, and alcohol ablation outcomes for ventricular arrhythmias.

scholarly journals Proarrhythmic Effect of RF ablation on the Right Ventricular Moderator Band

2021 ◽  
Author(s):  
Jonathan Willner ◽  
Parth Makker ◽  
Roy John
Keyword(s):  
Ventricular Tachycardia ◽  
Ventricular Fibrillation ◽  
Right Ventricular ◽  
Ventricular Arrhythmias ◽  
Conduction System ◽  
Rf Ablation ◽  
Moderator Band ◽  
Coupling Interval ◽  
The Right ◽  
Durable Suppression

The right ventricular moderator band (MB) is increasingly being recognized as a source for PVCs and PVC-mediated ventricular fibrillation. Monomorphic PVCs, non-sustained monomorphic VT and ventricular fibrillation are all documented arrhythmias originating from the MB. The benign PVCs usually have a coupling interval in excess of 400 msec. When PVCs trigger VF, coupling intervals are typically short, less than 300 msec. We report here a case of long-standing frequent monomorphic PVCs with a coupling interval of > 400 msec from the right ventricular distal conduction system embedded in the moderator band that progressed to non-sustained ventricular tachycardia. Following suppression of the arrhythmia with RF ablation, the arrhythmia recurred with PVCs at a shorter coupling interval (<300 msec), with frequent repetitive non-sustained polymorphic VT and triggering of sustained ventricular fibrillation. The use of a cryoballoon to ablate over the course of the moderator band resulted in complete and durable suppression of ventricular arrhythmias.

scholarly journals Mechanisms and Clinical Management of Ventricular Arrhythmias following Blunt Chest Trauma

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
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.

scholarly journals Long-term outcome of endocardial-only versus combined endocardial-epicardial homogenization of the scar for treatment of ventricular tachycardia in patients with ischemic cardiomyopathy

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Mohanty ◽  
C Trivedi ◽  
D G Della Rocca ◽  
C Gianni ◽  
B MacDonald ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Ischemic Cardiomyopathy ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Long Term Outcome ◽  
Obstructive Sleep ◽  
Number Of Patients ◽  
Group 2 ◽  
Group 1

Abstract Introduction We investigated the ablation success of scar homogenization with combined (epicardial + endocardial) versus endocardial-only approach for ventricular tachycardia (VT) in patients with ischemic cardiomyopathy (ICM) at 5 years of follow-up. Method Consecutive ICM patients undergoing VT ablation at our center were classified into group 1: endocardial scar homogenization and group 2: endocardial +epicardial scar homogenization. Patients with previous open heart surgery were excluded. All patients underwent bipolar substrate mapping with standard scar settings defined as normal tissue &gt;1.5 mV and severe scar &lt;0.5 mV. Non-inducibility of monomorphic VT was the procedural endpoint in both groups. Patients were followed up twice a year for 5 years with implantable device interrogations. Results A total of 361 (Group 1: 291 and group 2: 70) patients were included in the study (mean age: 67 years, male: 88.4%). At 5 years, significantly higher number of patients from group 2 remained arrhythmia-free (figure 1). Of those patients, 87 (45%) and 51 (89%) from group 1 and 2 respectively were off-anti-arrhythmic drugs (AAD) (p&lt;0.001). After adjusting for age, gender, hypertension, diabetes, and obstructive sleep apnea, scar homogenization using endo-epicardial approach was associated with 51% less recurrence compared to the endocardial ablation strategy (Hazard Ratio: 0.49, 95% CI: 0.27–0.89, p: 0.02). Conclusion In this series of patients with ischemic cardiomyopathy and VT, endo-epicardial scar homogenization was associated with a lower need for AAD and a significantly lower recurrence rate at 5-years of follow-up compared to the endocardial ablation alone. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

scholarly journals Transcoronary Ethanol Ablation for Recurrent Ventricular Tachycardia After Failed Catheter Ablation

2011 ◽  
Vol 4 (6) ◽  
pp. 889-896 ◽  
Author(s):  
Michifumi Tokuda ◽  
Piotr Sobieszczyk ◽  
Andrew C. Eisenhauer ◽  
Pipin Kojodjojo ◽  
Keiichi Inada ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Catheter Ablation ◽  
Ethanol Ablation

Abuse of Combination Stimulants

1986 ◽  
Vol 7 (8) ◽  
pp. 234-254
Keyword(s):  
Weight Loss ◽  
Ventricular Tachycardia ◽  
Drug Abuse ◽  
Cerebral Hemorrhage ◽  
Ventricular Arrhythmias ◽  
Over The Counter ◽  
Adrenergic Effects

Over-the-counter preparations for weight loss have become very popular in this country during the last several years. Most of these preparations are combination stimulants containing phenylpropanolamine, ephedrine, and caffeine. They are widely advertised, readily available, and have become a major item for adolescent drug abuse. All of these substances have potent and direct adrenergic effects and catecholamine-releasing actions. Hypertension, cerebral hemorrhage, and psychosis have all been associated with use of phenylpropanolamine. Caffeine has been reported to cause ventricular arrhythmias, including ventricular tachycardia. There is a possibility that simultaneous ingestion of all of these drugs could increase the risk of toxicity from each. Propanolol is the treatment of choice for toxicity manifested by moderate symptomatic hypertension plus atrial or ventricular arrhythmias.

Abstract 16480: Characteristics and Outcomes of Patients With Papillary Muscle Ventricular Arrhythmias

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Carola Gianni ◽  
Luigi Di Biase ◽  
Sanghamitra Mohanty ◽  
Chintan Trivedi ◽  
Yalçin Gökoglan ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Ventricular Arrhythmias ◽  
Rf Ablation ◽  
Crista Terminalis ◽  
Remote Magnetic Navigation ◽  
Standard Procedures ◽  
Acute Success ◽  
The One

Introduction: We sought to investigate the characteristics and outcomes of patients who underwent RF ablation of PM ventricular arrhythmias (VA) in our center. Results: 26 patients were included, median age was 66 years (16 to 85), 46% female, all with normal LVEF. PM VAs were PVCs in 68% patients, and PVC + VT in 32%. Site of origin was the LV infero-septal PM in 73%, LV antero-lateral PM in 15% and right ventricular RV septal PM in 12%. 46% of patients showed other VAs in addition to the one originating from the PMs; in 33% of these patients, additional VAs were 2 or more. These VAs were mostly PVCs (92%), localized in the LVOT (64% - 56 % in the basal LV and 44% in the aortic cusps) and the septal RVOT (36%). The only additional VT was fascicular. All the PMs and mappable additional VAs were ablated with RF energy through an irrigated catheter and the aid of ICE; a remote magnetic navigation system (RMS) was used in half of the procedures. In one case, PVC suppression required additional epicardial ablation. Major complications occurred in 2 patients (8%): 1 pericardial effusion (the patient underwent ablation of a crista terminalis premature atrial complex in the same procedure) and 1 pseudoaneurysm. Acute success (PM VA suppression/non-inducibility) was achieved in 96% of patients (the patient with pericardial effusion could be anticoagulated further and the procedure was stopped). After a median follow-up period of 8 (4-14) months, long-term success (no PM VT recurrence or PVC burden reduced by 80% off antiarrhythmic drugs) was 92% after a single procedure, 96% after repeat procedures. When considering additional VAs, the only recurrence was a parahisian RVOT PVC. No difference in acute or overall long-term success was observed when comparing RMS-guided vs standard procedures (respectively 92% vs 100 % and 100% vs 92%; P = NS). Conclusion: PM VAs are most commonly PVCs originating from the LV infero-septal PM and are frequently (48%) associated with an additional ventricular focus (LVOT > RVOT >> fascicular VT). RF ablation is safe and effective in eliminating or significantly reduce the burden of PM VAs, as well the extra-PM foci that are commonly encountered in this population. RMS guided ablation is not inferior to standard ablation in this subset of patients.

Abstract 13719: Long Qt Associated Ventricular Tachycardia Caused by Sex Hormone Therapy

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Bina Kviatkovsky ◽  
mohammad abureesh ◽  
Samer Saouma ◽  
Michael P Cinelli ◽  
Philippe Akhrass ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Ventricular Tachycardia ◽  
Hormone Therapy ◽  
Membrane Trafficking ◽  
Cardiac Repolarization ◽  
Long Qt ◽  
Case Presentation ◽  
First Case ◽  
Number Of Patients ◽  
Hormonal Therapies

Introduction: Increasing number of patients are currently receiving hormonal therapies for a variety of conditions. Modulation of cardiac repolarization by sex hormones resulting in VT remains controversial. Anastrozole is an aromatase inhibitor (ANI), used as an anti-estrogen medication in women with breast cancer or as replacement therapy for hypogonadism. Arrhythmias associated with ANI are extremely rare and hence ANI is considered relatively safe to use. Case Presentation: We report two cases receiving ANI who presented with VT and long QT (LQT). Case 1, 71 year old female with breast cancer on ANI recently started on levofloxacin 750 mg qd, presented with monomorphic VT. Post-conversion ECG showed sinus rhythm (SR) QT 0.48s/QTc 0.56s. Case 2, 50 year old male with hypogonadism on ANI and clomiphene (CL) presented with monomorphic VT, post conversion ECG showed SR with QT 0.65s/QTc 0.59s. Both patients had normal electrolytes and coronaries. Discussion: Studies have shown that levofloxacin is not associated with significant LQT, however, a relationship between its concentration and the extent of LQT has been demonstrated. LQT in our first case can be explained by an increase in levofloxacin level resulting from inhibition of CYP by ANI. CL is a HERG inhibitor however has not been shown to prolong QT. ANI lower the estradiol level which blocks the membrane trafficking of KCNH2 channels, potentially lengthening the QT. LQT in the second case can be explained by the additive effect of both HERG and KCNH2 inhibition. Conclusion: Although reported as safe, ANI hormone therapy can be arrhythmogenic if combined with agents that potentially affect potassium currents. We recommend QT monitoring in such patients to prevent lethal arrhythmias.

Emergency catheter ablation of refractory ventricular tachycardia

1989 ◽  
Vol 9 (5) ◽  
pp. 36-40 ◽  
Author(s):  
LL Stevens ◽  
RM Redd ◽  
TA Buckingham
Keyword(s):  
Ventricular Tachycardia ◽  
Catheter Ablation ◽  
Ventricular Arrhythmias ◽  
Pharmacologic Therapy ◽  
Emergency Therapy

Catheter ablation, in extreme cases, can be used successfully as emergency therapy for VT in the CCU. In the hands of a physician experienced in electrophysiologic procedures, catheter ablation may prove to be an alternative to surgical or pharmacologic therapy in acutely ill patients with refractory ventricular arrhythmias.

P1603Nicorandil suppresses ischemia-induced cardiac interstitial norepinephrine enhancement and ventricular arrhythmia in hypertrophic hearts

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Kobara ◽  
N Naseratun ◽  
Y Watanabe ◽  
H Toba ◽  
T Nakata
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Ventricular Tachycardia ◽  
Ventricular Arrhythmia ◽  
Ventricular Arrhythmias ◽  
Sham Group ◽  
Cardiac Tissue ◽  
Norepinephrine Release ◽  
Norepinephrine Concentration ◽  
Ischemic Period

Abstract Background Myocardial infarction (MI) is a major cause of death in western countries and Japan, and hypertension is a major risk factor of MI. In hypertensive heart, acute myocardial infarction often leads to lethal ventricular arrhythmia. Nicorandil, an ATP sensitive potassium channel (KATP) opener, is usually used in the treatment of acute myocardial infarction. The effects of nicorandil on ischemic myocyte are fully defined. On the other hand, KATP in neuroterminals is known to regulate norepinephrine release, but the effect of nicorandil on ischemic norepinephrine release in cardiac tissue has remained unexplored. Purpose We examined whether nicorandil suppressed norepinephrine release via neuronal KATP and ventricular arrhythmia during acute ischemia in pressure overload-induced hypertrophic hearts. Methods SD Rats were divided into two groups; abdominal aortic constriction (AAC) group and sham-operated (Sham) group. Four weeks after constriction, cardiac geometry and function were examined using echocardiography. Then, myocardial ischemia was induced by the left anterior descending artery occlusion for 100 minutes in the presence or absence of intravenous infusion of nicorandil. Cardiac interstitial norepinephrine concentration in ischemic region was measured using the microdialysis method and concentration of cyclic AMP, a second messenger of norepinephrine, in cardiac tissue was measured by ELISA. Ventricular arrhythmias were monitered by ECG during whole ischemic period. Results Four weeks after constriction, remarkable left ventricular wall thickening was observed in AAC group. Before ischemia, ventricular arrhythmia was not found in both groups. Number of ventricular arrhythmia, including ventricular tachycardia and ventricular fibrillation, was increased in early ischemic period (- 40 min) in both groups, and was grater in AAC group. Before ischemia, interstitial norepinephrine concentration in cardiac tissue was higher level in AAC group than in Sham group. Ischemia obviously increased norepinephrine concentration in both groups time dependently and AAC further increased norepinephrine than Sham group. Concentration of cyclic AMP in cardiac tissue was raised in early ischemic period (- 40 min) and then gradually decreased. Nicorandil significantly suppressed the number of ventricular arrhythmias, and abolished the ventricular tachycardia and fibrillation without hemodynamic alterations. Nicorandil also attenuated norepinephrine and cAMP enhancement in acute ischemic period in both groups. Conclusion Ischemia-induced ventricular arrhythmia was more frequent and severe in hypertrophic hearts and interstitial norepinephrine enhancement may play a role in this ischemic arrhythmia. Nicorandil suppressed ischemia-induced interstitial norepinephrine release by neuronal KATP opening, which attenuated ventricular arrhythmias in normal and hypertrophic hearts.

VENTRICULAR TACHYCARDIA AND FIBRILLATION DETECTION USING DWT AND DECISION TREE CLASSIFIER

2019 ◽  
Vol 19 (03) ◽  
pp. 1950008
Author(s):  
MONALISA MOHANTY ◽  
PRADYUT BISWAL ◽  
SUKANTA SABUT
Keyword(s):  
Ventricular Tachycardia ◽  
Decision Tree ◽  
Ventricular Arrhythmias ◽  
Ventricular Tachyarrhythmia ◽  
Support Vector ◽  
Svm Classifier ◽  
Discrete Wavelet ◽  
Time Frequency ◽  
Tree Classifier ◽  
Frequency Features

Ventricular tachycardia (VT) and ventricular fibrillation (VF) are the life-threatening ventricular arrhythmias that require treatment in an emergency. Detection of VT and VF at an early stage is crucial for achieving the success of the defibrillation treatment. Hence an automatic system using computer-aided diagnosis tool is helpful in detecting the ventricular arrhythmias in electrocardiogram (ECG) signal. In this paper, a discrete wavelet transform (DWT) was used to denoise and decompose the ECG signals into different consecutive frequency bands to reduce noise. The methodology was tested using ECG data from standard CU ventricular tachyarrhythmia database (CUDB) and MIT-BIH malignant ventricular ectopy database (VFDB) datasets of PhysioNet databases. A set of time-frequency features consists of temporal, spectral, and statistical were extracted and ranked by the correlation attribute evaluation with ranker search method in order to improve the accuracy of detection. The ranked features were classified for VT and VF conditions using support vector machine (SVM) and decision tree (C4.5) classifier. The proposed DWT based features yielded the average sensitivity of 98%, specificity of 99.32%, and accuracy of 99.23% using a decision tree (C4.5) classifier. These results were better than the SVM classifier having an average accuracy of 92.43%. The obtained results prove that using DWT based time-frequency features with decision tree (C4.5) classifier can be one of the best choices for clinicians for precise detection of ventricular arrhythmias.

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