scholarly journals Asymptomatic Ventricular Pre-excitation: Between Sudden Cardiac Death and Catheter Ablation

2018 ◽  
Vol 7 (1) ◽  
pp. 32 ◽  
Author(s):  
Josep Brugada ◽  
Roberto Keegan ◽  
◽  
Keyword(s):  
Catheter Ablation ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Accessory Pathway ◽  
Structural Heart Disease ◽  
Clinical Situation ◽  
Clinical Approach ◽  
Asymptomatic Patients ◽  
Real Risk ◽  
Based Medicine

Debate about the best clinical approach to the management of asymptomatic patients with ventricular pre-excitation and advice on whether or not to invasively stratify and ablate is on-going. Weak evidence about the real risk of sudden cardiac death and the potential benefit of catheter ablation has probably prevented the clarification of action in this not infrequent and sometimes conflicting clinical situation. After analysing all available data, real evidence-based medicine could be the alternative strategy for managing this group of patients. According to recent surveys, most electrophysiologists invasively stratify. Based on all accepted risk factors – younger age, male, associated structural heart disease, posteroseptal localisation, ability of the accessory pathway to conduct anterogradely at short intervals of ≤250 milliseconds and inducibility of sustained atrioventricular re-entrant tachycardia and/or atrial fibrillation – a shared decisionmaking process on catheter ablation is proposed.

scholarly journals Sudden Cardiac Death: The Most Feared but Potentially Preventable Presentation of Wolff-Parkinson-White Syndrome

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Ana Rita Pereira ◽  
Alexandra Briosa ◽  
Rita Miranda ◽  
Sofia Sequeira Almeida ◽  
Luís Brandão ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Life Support ◽  
Electrophysiological Study ◽  
Accessory Pathway ◽  
Haemodynamic Instability ◽  
White Syndrome ◽  
Asymptomatic Patients ◽  
Wolff Parkinson White Syndrome

Background. Wolff-Parkinson-White syndrome is an uncommon cardiac disorder characterized by the presence of one or more accessory pathways that predispose patients to frequent episodes of arrhythmias. The prognosis is usually good, but there is a lifetime risk of malignant arrhythmias and sudden cardiac death. Case Summary. A 25-year-old male presented a witnessed out-of-hospital cardiac arrest with ventricular fibrillation rhythm. Due to rapid initiation of prehospital advanced life support, return of spontaneous circulation was observed. During the transport to the hospital, an irregular wide complex tachycardia suggestive of preexcited atrial fibrillation with haemodynamic instability was also observed and a synchronized shock was applied. Baseline 12-lead electrocardiogram was compatible with sinus rhythm and ventricular preexcitation pattern. After clinical stabilization, an electrophysiological study was performed confirming the presence of a left anterolateral accessory pathway with a short antegrade effective refractory period. Successful radiofrequency catheter ablation was achieved. Discussion. The reported clinical case recalls fundamental features of the Wolff-Parkinson-White syndrome and outlines the increasing evidence and importance of the invasive risk stratification and even catheter ablation in asymptomatic patients who suffer from this uncommon disease that may have a dramatic and fatal initial clinical manifestation.

Sustained monomorphic ventricular tachycardia: the role of catheter ablation

ESC CardioMed ◽  
2018 ◽  
pp. 2279-2288
Author(s):  
Tilman Maurer ◽  
William G. Stevenson ◽  
Karl-Heinz Kuck
Keyword(s):  
Heart Disease ◽  
Ventricular Tachycardia ◽  
Catheter Ablation ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Therapeutic Option ◽  
Structural Heart Disease ◽  
Premature Ventricular Contractions ◽  
Monomorphic Ventricular Tachycardia ◽  
Premature Beats

Monomorphic ventricular tachycardia (VT) may occur in the presence or absence of structural heart disease. The standard therapy for patients with structural heart disease at high risk of sudden cardiac death due to VT is the implantable cardioverter defibrillator (ICD). While ICDs effectively terminate VT and prevent sudden cardiac death, they do not prevent recurrent episodes of VT, since the underlying arrhythmogenic substrate remains unchanged. However, shocks from an ICD increase mortality and impair quality of life. These limitations as well as continuous advancements in technology have made catheter ablation an important treatment strategy for patients with structural heart disease presenting with VT. Idiopathic ventricular arrhythmias include premature ventricular contractions and VT occurring in the absence of overt structural heart disease. In this setting, catheter ablation has evolved as the primary therapeutic option for symptomatic ventricular premature beats and sustained VTs and is curative in most cases. This chapter presents an overview of the principles of invasive diagnosis and treatment of monomorphic VTs in patients with and without structural heart disease and delineates the clinical outcome of catheter ablation. Finally, the chapter provides an outlook to the future, discussing potential directions and upcoming developments in the field of catheter ablation of monomorphic VT.

scholarly journals Old stuff still trending. Use of propafenone as a safety net until catheter ablation in a patient with documented pre-excited atrial fibrillation and Wolff-Parkinson-White syndrome—a classic case report

2021 ◽  
Author(s):  
Dimitrios Karelas ◽  
John Papanikolaou ◽  
Charalampos Kossyvakis ◽  
Dimitrios Platogiannis
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Sudden Cardiac Death ◽  
Sinus Rhythm ◽  
Cardiac Death ◽  
Accessory Pathway ◽  
Safety Net ◽  
White Syndrome ◽  
Rr Interval ◽  
Wolff Parkinson White Syndrome

Abstract Background Atrial Fibrillation in Wolff-Parkinson-White syndrome may result in life-threateningly rapid antegrade conduction over a bypass tract, manifested by an irregular broad-complex (pre-excited) tachycardia that can degenerate to ventricular fibrillation. Shortest pre-excited RR interval below 250msec during atrial fibrillation predicts increased risk of sudden cardiac death. Case summary We report a case of a 43-year-old man with unremarkable cardiac history who presented due to sudden-onset feeling of palpitations and pre-syncope after strenuous lifting. Electrocardiography depicted fast pre-excited atrial fibrillation. The shortest pre-excited RR interval was estimated at 160msec, indicating an accessory pathway with short antegrade refractory period at risk for mediating sudden cardiac death. Direct current cardioversion restored sinus rhythm unraveling delta-waves. The patient was put on propafenone 450 mg/day having an uneventful clinical course. On day-10 post-admission, electrophysiological study induced rapid atrial fibrillation but the shortest pre-excited RR interval was substantially increased to 264msec. A left anterolateral accessory pathway was ablated. The patient remained symptom-free until his latest follow-up in the third month post-ablation without manifest pre-excitation on surface electrocardiogram. Discussion Treatment options of pre-excited atrial fibrillation include anti-arrhythmic agents but mainly electrical cardioversion. Cardioversion can safely restore sinus rhythm, while use of anti-arrhythmics often requires ICU monitoring due to risk of QT prolongation. Catheter ablation is the mainstay of therapy for symptomatic patients. Our rare report highlights the direct impact of propafenone on prolonging the refractoriness of the accessory pathway, effectively and safely, and reappraises propafenone’s worthiness as a protective measure following pre-excited atrial fibrillation episode until ablation.

scholarly journals SUDDEN CARDIAC DEATH AND WOLFF-PARKINSON-WHITE ELECTROCARDIOGRAPHIC PATTERN: A REVIEW

2014 ◽  
Vol 5 (4) ◽  
pp. 60-72
Author(s):  
S E Mamchur ◽  
A V Ardashev
Keyword(s):  
Catheter Ablation ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Radiofrequency Catheter Ablation ◽  
Electrophysiological Study ◽  
White Syndrome ◽  
Accessory Pathways ◽  
Asymptomatic Patients ◽  
Wolff Parkinson White Syndrome

The causes of sudden cardiac death in patients with Wolff-Parkinson-White syndrome are considered; necessity of endocardial electrophysiological study and radiofrequency catheter ablation is discussed, including asymptomatic patients with accessory pathways.

Classification and treatment of non-sustained ventricular tachycardia

ESC CardioMed ◽  
2018 ◽  
pp. 2259-2265
Author(s):  
Alfred E. Buxton
Keyword(s):  
Heart Disease ◽  
Ventricular Tachycardia ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Total Mortality ◽  
Structural Heart Disease ◽  
Clinical Situation ◽  
Sustained Ventricular Tachycardia ◽  
Death Risk ◽  
Sudden Cardiac Death Risk

Non-sustained ventricular tachycardia (NSVT) is classified in a variety of ways, depending on the clinical situation. The two primary distinctions are whether the arrhythmia occurs in the presence or absence of structural heart disease, and whether or not the arrhythmia causes symptoms. The prevalence of NSVT is highest in patients with structural heart disease. NSVT in patients with heart disease rarely causes symptoms, but may be associated with increased total mortality and sudden cardiac death risk. However, sudden cardiac death risk is usually not elevated out of proportion to the increased total mortality risk, suggesting that NSVT is merely a marker of sicker patients, rather than having a mechanistic relation to arrhythmias causing cardiac arrest. Furthermore, no trial has demonstrated that suppression of NSVT reduces mortality. In contrast, patients with symptoms due to NSVT usually do not have underlying structural heart disease. In these patients, treatment may be necessary to relieve symptoms and improve quality of life. Appropriate treatment of NSVT in this setting also does not improve mortality, because NSVT in the absence of structural heart disease is not associated with increased mortality or sudden death risk (excepting patients with ion channelopathies, such as long QT syndrome). The exception to this rule is the recognition that ventricular dysfunction may be caused by frequent or incessant episodes of NSVT. In this case, treatment of the arrhythmia may not only improve symptoms, but presumably also improve survival.

scholarly journals Towards a better risk stratification for sudden cardiac death in patients with structural heart disease

2009 ◽  
Vol 17 (3) ◽  
pp. 101-106 ◽  
Author(s):  
K. Kraaier ◽  
P. M. J. Verhorst ◽  
P. F. H. M. van Dessel ◽  
A. A. M. Wilde ◽  
M. F. Scholten
Keyword(s):  
Heart Disease ◽  
Sudden Cardiac Death ◽  
Risk Stratification ◽  
Cardiac Death ◽  
Structural Heart Disease

Short Term Variability of Repolarization Predicts Ventricular Tachycardia and Sudden Cardiac Death in Patients with Structural Heart Disease

Heart Rhythm ◽  
2010 ◽  
Vol 7 (11) ◽  
pp. 1720-1721
Author(s):  
Peter Oosterhoff ◽  
Larisa G. Tereshchenko ◽  
Marcel A.G. van der Heyden ◽  
Raja N. Ghanem ◽  
Paul J. De Groot ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ventricular Tachycardia ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Structural Heart Disease ◽  
Short Term ◽  
Short Term Variability

P1392Next generation sequencing in lone atrial fibrillation patients

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
I Rudaka ◽  
D Rots ◽  
O Kalejs ◽  
L Gailite
Keyword(s):  
Atrial Fibrillation ◽  
Sudden Cardiac Death ◽  
Genetic Variants ◽  
Cardiac Death ◽  
Structural Heart Disease ◽  
Missense Variant ◽  
Lone Atrial Fibrillation ◽  
Excessive Alcohol Consumption ◽  
Pathogenic Variants ◽  
Rare Genetic Variants

Abstract Background. Minor part of atrial fibrillation (AF) patients develops the disease without any well-known risk factors, which is a particular form of the disease, known as a lone AF. Rare genetic variants were described as causative for lone AF. The aim of this study was to investigate occurrence of rare genetic variants in lone AF patients. Material and Methods. We performed Mendeliome sequencing for 21 lone AF patients. Lone AF was defined as AF in individuals younger than 65 years in the absence of cardiovascular or structural heart disease, endocrinologic or pulmonary disease, chronic kidney disease, obesity and excessive alcohol consumption. Data analysis was performed by current laboratory pipeline. We analyzed 453 cardiomyopathy, arrhythmias and sudden cardiac death related genes. Results. In eight out of 21 (38%) lone AF patients rare likely pathogenic variants were found (Table 1.). Seven rare truncating TTN variants and one LMNA missense variant were observed. Four unrelated patients were positive for the same TTN variant c.13696 C > T; p.(Gln4566Ter). The same variant was previously found in ARVC patient in our laboratory. Segregation analysis and phenotyping of relatives is ongoing. Conclusions. Rare genetic variants are common causes of the lone atrial fibrillation. TTN gene variant c.13696C > T; p.(Gln4566Ter) is a potential founder variant in the Baltic population. Table 1. Genetic variants in lone AF Gender Age of AF onset Genetic variant Family history Male 53 LMNA: p.(Ser326Thr) AF in mother Male 11 TTN: p.(Trp31854Ter) AF in father Male 30 TTN: p.(GLn4566Ter) AF in uncle Female 45 TTN: p.(GLn4566Ter) Negative Male 37 TTN: p.(GLn4566Ter) AF in father Male 25 TTN: p.(GLn4566Ter) AF in father, maternal and paternal grandmother Female 60 TTN: p.(Arg27414Ter) Sudden cardiac death at the age of 50 in grand father Female 52 TTN: p.(Arg1012Ter) AF in mother

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