scholarly journals Monomorphic Ventricular Arrhythmias in Athletes

2019 ◽  
Vol 8 (2) ◽  
pp. 83-89 ◽  
Author(s):  
Jeffrey J Hsu ◽  
Ali Nsair ◽  
Jamil A Aboulhosn ◽  
Tamara B Horwich ◽  
Ravi H Dave ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ventricular Arrhythmias ◽  
Comprehensive Evaluation ◽  
Arrhythmogenic Right Ventricular Cardiomyopathy ◽  
Sports Participation ◽  
Structural Heart Disease ◽  
Competitive Sports ◽  
Ventricular Cardiomyopathy ◽  
Electrical Heart Disease ◽  
Increase Risk

Ventricular arrhythmias are challenging to manage in athletes with concern for an elevated risk of sudden cardiac death (SCD) during sports competition. Monomorphic ventricular arrhythmias (MMVA), while often benign in athletes with a structurally normal heart, are also associated with a unique subset of idiopathic and malignant substrates that must be clearly defined. A comprehensive evaluation for structural and/or electrical heart disease is required in order to exclude cardiac conditions that increase risk of SCD with exercise, such as hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy. Unique issues for physicians who manage this population include navigating athletes through the decision of whether they can safely continue their chosen sport. In the absence of structural heart disease, therapies such as radiofrequency catheter ablation are very effective for certain arrhythmias and may allow for return to competitive sports participation. In this comprehensive review, we summarise the recommendations for evaluating and managing athletes with MMVA.

Ventricular arrhythmias

2019 ◽  
pp. 221-240
Author(s):  
Martin Borggrefe ◽  
Erol Tülümen ◽  
Josep Brugada
Keyword(s):  
Heart Disease ◽  
Ventricular Arrhythmias ◽  
Arrhythmogenic Right Ventricular Cardiomyopathy ◽  
Atrioventricular Node ◽  
Structural Heart Disease ◽  
Polymorphic Ventricular Tachycardia ◽  
European Society Of Cardiology ◽  
Ventricular Tachycardias ◽  
Current Guidelines

Ventricular arrhythmias are abnormal rhythms that originate from below the atrioventricular node. They include premature ventricular complexes, ventricular tachycardias, and ventricular fibrillation. Ventricular arrhythmias may occur in patients with structural heart disease (ischaemic heart disease, cardiomyopathies such as dilated cardiomyopathy, hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, etc.) or in patients with a structurally normal heart (genetic arrhythmia syndromes such as long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, or as idiopathic ventricular tachycardias). Symptoms depend on the frequency, duration, and haemodynamic effects of the arrhythmia. They may be asymptomatic or may cause symptoms, such as palpitations, shortness of breath, chest discomfort, dizziness, or syncope, or may present with cardiac arrest. This chapter is focused on the role of antiarrhythmic drugs in the management of ventricular arrhythmias. The recommendations are based on the current guidelines of the European Society of Cardiology for the management of patients with ventricular arrhythmias.

scholarly journals Irrigated Needle Ablation Compared to Other Advanced Ablation Techniques for Failed Endocardial Ventricular Arrhythmia Ablation

2021 ◽  
Author(s):  
Ryohsuke Narui ◽  
Shinichi Tanigawa ◽  
Ikutaro Nakajima ◽  
Kenichi Tokutake ◽  
Tomofumi Nakamura ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ventricular Arrhythmia ◽  
Right Ventricular ◽  
Arrhythmogenic Right Ventricular Cardiomyopathy ◽  
Structural Heart Disease ◽  
Mortality Rates ◽  
Ablation Techniques ◽  
Ventricular Cardiomyopathy ◽  
Epicardial Ablation ◽  
Major Complications

Background - Options when endocardial ventricular arrhythmia (VA) ablation fails include epicardial, simultaneous two site unipolar radiofrequency (SURF) and transcoronary ethanol (TCE) ablation. Recently, investigational needle ablation has also been used, but how it compares to other advanced methods is not clear. This study sought to compare outcomes and complications for needle ablation versus other advanced ablation techniques in patients with structural heart disease, VA, and failed endocardial ablation. Methods - We retrospectively reviewed 136 procedures in 119 consecutive patients with structural heart disease (excluding arrhythmogenic right ventricular cardiomyopathy) who failed endocardial ablation and underwent ablation with either an investigational needle catheter (27 gauge, single end hole) or with other advanced techniques including epicardial, SURF or TCE ablation. Results - Of 136 procedures, needle ablation was performed in 58 procedures. In the remaining 78 procedures, 65 were epicardial ablation including 10 with SURF ablation from endocardial and epicardial sites, seven with SURF from both sides of the septum, one SURF and TCE ablation, and five TCE ablation procedures. Acute outcomes, 6-month VA recurrence, and mortality rates were not different between the two groups (49% vs 55%, P=0.54, 45% vs 46%, P=1.00, and 4% vs 3%, P=1.00, respectively). There were 22 major complications observed in 22 procedures with pericardial bleeding occurring less frequently with needle ablation (1.7% vs 12.8%, P=0.02). Conclusions - Ablation with an irrigated needle catheter compares favorably to other advanced ablation techniques.

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 Different Expressions of Pericardial Fluid MicroRNAs in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy and Ischemic Heart Disease Undergoing Ventricular Tachycardia Ablation

2021 ◽  
Vol 8 ◽  
Author(s):  
Aleksandr A. Khudiakov ◽  
Daniil D. Panshin ◽  
Yulia V. Fomicheva ◽  
Anastasia A. Knyazeva ◽  
Ksenia A. Simonova ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ventricular Tachycardia ◽  
Right Ventricular ◽  
Arrhythmogenic Right Ventricular Cardiomyopathy ◽  
Pericardial Fluid ◽  
Current Data ◽  
Biologically Active ◽  
Differentially Expressed ◽  
Ventricular Cardiomyopathy ◽  
Ventricular Tachycardia Ablation

Introduction: Pericardial fluid is enriched with biologically active molecules of cardiovascular origin including microRNAs. Investigation of the disease-specific extracellular microRNAs could shed light on the molecular processes underlying disease development. Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited heart disease characterized by life-threatening arrhythmias and progressive heart failure development. The current data about the association between microRNAs and ARVC development are limited.Methods and Results: We performed small RNA sequence analysis of microRNAs of pericardial fluid samples obtained during transcutaneous epicardial access for ventricular tachycardia (VT) ablation of six patients with definite ARVC and three post-infarction VT patients. Disease-associated microRNAs of pericardial fluid were identified. Five microRNAs (hsa-miR-1-3p, hsa-miR-21-5p, hsa-miR-122-5p, hsa-miR-206, and hsa-miR-3679-5p) were found to be differentially expressed between patients with ARVC and patients with post-infarction VT. Enrichment analysis of differentially expressed microRNAs revealed their close linkage to cardiac diseases.Conclusion: Our data extend the knowledge of pericardial fluid microRNA composition and highlight five pericardial fluid microRNAs potentially linked to ARVC pathogenesis. Further studies are required to confirm the use of pericardial fluid RNA sequencing in differential diagnosis of ARVC.

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.

Arrhythmias in pregnancy

ESC CardioMed ◽  
2018 ◽  
pp. 2868-2870
Author(s):  
Bozena Ostrowska ◽  
Barbara Kommata ◽  
Helena Malmborg ◽  
Carina Blomström Lundqvist
Keyword(s):  
Heart Disease ◽  
Supraventricular Tachycardia ◽  
Ventricular Arrhythmias ◽  
Structural Heart Disease ◽  
Symptomatic Bradycardia ◽  
First Time ◽  
In Pregnancy

The incidence of supraventricular tachycardia during pregnancy is low. The tachyarrhythmias are often well tolerated but may become more frequent, refractory, and symptomatic, and may even manifest for the first time during pregnancy even in the absence of structural heart disease. Arrhythmia requiring treatment develops in up to 15% of patients with structural heart disease during pregnancy. Ventricular arrhythmias and symptomatic bradycardia are rare.

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