scholarly journals Impact of COVID-19 Pandemic on Severe Ventricular Arrhythmia and Icd Therapy

2021 ◽  
Author(s):  
Abdulcebbar SİPAL ◽  
Mujdat AKTAS ◽  
Tayyar AKBULUT ◽  
Faysal SAYLIK
Keyword(s):  
Ventricular Fibrillation ◽  
Ventricular Arrhythmia ◽  
Ventricular Arrhythmias ◽  
Shock Therapy ◽  
Antitachycardia Pacing ◽  
Before And After ◽  
Life Threatening ◽  
Recorded Data ◽  
Ventricular Tachycardias

Abstract BACKGROUND AND OBJECTIVES: The regular clinical follow-up of the patient with the implantable cardioverter-defibrillator (ICD) device was seriously affected by the COVID-19 outbreak. Due to the high risk of contamination, patients didn’t admit to the clinics for the ICD device control. It has been observed that arrhythmic events increased during the COVID-19 outbreak. In this study, we aimed to investigate the frequency of severe ventricular arrhythmias and ICD device therapy in COVID-19 patients with ICD.METHODS: In this single center-observational study, we assessed severe ventricular arrhytmias and ICD therapies by analyzing recorded data of 33 patients (24 males, 72.7%) 3 months before and after getting COVID-19 during the COVID-19 pandemic in Van, Turkey, between 15 August 2020 and 15 January 2021. RESULTS: Before the diagnosis of COVID-19, 6 ventricular tachycardias and 1 ventricular fibrillation were observed. When we analyzed the records after the diagnosis COVID-19, 17 ventricular tachycardia and 3 ventricular fibrillation episodes were observed. Considering the the ICD device therapies, 5 of these severe tachyarrhythmias were terminated by antitachycardia pacing (ATP) and 2 with shock therapy before the diagnosis of COVID-19. After the COVID-19, 14 of them were terminated by ATP and 6 of them ere terminated by shock therapy.CONCLUSION: The effects of the COVID-19 pandemic, especially on ventricular arrhythmia, have not been reported sufficiently. In our study, it was observed that life-threatening ventricular arrhythmias and the ICD therapies were increased in patients with COVID-19, especially in the first month after the diagnosis COVID-19.

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

2019 ◽  
Vol 8 (10) ◽  
pp. 1582 ◽  
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.

scholarly journals Ventricular arrhythmia susceptibility in a new porcine model of heart failure (HF) with reduced ejection fraction

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
J Melka ◽  
A Helbert ◽  
L Lesage ◽  
K Moreau ◽  
K Romariz ◽  
...  
Keyword(s):  
Ventricular Fibrillation ◽  
Ejection Fraction ◽  
Ventricular Arrhythmia ◽  
Ventricular Arrhythmias ◽  
Sham Group ◽  
Pig Model ◽  
Vehicle Group ◽  
Electrical Remodeling ◽  
Reduced Ejection Fraction ◽  
Lv Remodeling

Abstract Introduction Sudden death secondary to ventricular arrhythmias is common in HF patients, with no effective treatment available outside of implantable cardiac defibrillators. While animal models are essential for the discovery of anti-arrhythmic drugs, no reliable large animal HF models with associated ventricular arrhythmias have been described so far. Objectives We aimed at evaluating ventricular remodeling and arrhythmia susceptibility in an HF pig model with reduced ejection fraction (EF) following myocardial infarction (MI). Methods MI was induced in 53 male Göttingen minipigs (12–15 months, 20–25 kg) by coronary embolization in mid-left anterior descending and mid-left circumflex coronary arteries using endovascular coils. Seven other pigs underwent sham operation and were used as control. Two weeks after surgery, cardiac function was assessed by echocardiography, and animals were included based on EF&lt;50% (n=15/53), assigned either to 12 weeks of vehicle (n=9) or perindopril (n=6, 1 mg/kg/d, per os) group. At the end of the study, their left ventricular (LV) electrical remodeling was studied by echocardiography/electrocardiography and a programmed-electrical stimulation protocol was performed to evaluate the susceptibility to develop ventricular arrhythmias. Results At the end of the study, animals in the vehicle group had a significant LV remodeling associated with a reduced EF (p&lt;0.05 vs. sham, see table). This remodeling was associated with cardio-pulmonary congestion, significant increases in LV end-diastolic pressure, left atrial volume, and lung mass (all p&lt;0.05 vs. sham, see table), fully prevented by perindopril treatment. They had also an electrical remodeling as evidenced by an increase in PR, QRS, and QTc intervals, as well as LV effective refractory period (+18%, 14%, 33%, and 13%, respectively, p&lt;0.05, compared to sham animals). Electrical changes were mitigated by perindopril treatment (p=NS vs. sham). LV mechanical dispersion measured with speckle-tracking echocardiography was significantly increased in vehicle group (58±5 vs. 22±1 ms in sham group, respectively) as well as in perindopril group. Programmed-electrical stimulations induced in 6/8 vehicle animals either non-sustained (n=3) or sustained (n=2) ventricular tachycardia, or ventricular fibrillation (n=1). In sham group only 1/7 animal had a ventricular fibrillation. No inducible ventricular arrhythmia was observed in animals treated with Perindopril. Conclusion In this new pig model of congestive HF with reduced EF, LV remodeling was associated with electrical remodeling and susceptibility to develop arrhythmias. Chronic angiotensin-converting enzyme inhibitor treatment prevented congestion, mitigated electrical remodeling, and suppressed arrhythmia susceptibility. FUNDunding Acknowledgement Type of funding sources: Private company. Main funding source(s): Servier Research Institute - CardioVascular & Metabolic Diseases Center for Therapeutic Innovation Table 1

1175Structural progression increases the risk of ventricular arrhythmias in patients with arrhythmogenic cardiomyopathy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Chivulescu ◽  
Ø.H Lie ◽  
H Skulstad ◽  
B A Popescu ◽  
R O Jurcut ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Ventricular Arrhythmias ◽  
Arrhythmogenic Cardiomyopathy ◽  
Cardioverter Defibrillator ◽  
Structural Progression ◽  
Life Threatening ◽  
Arrhythmic Event ◽  
History Of ◽  
Structural Disease

Abstract Background Arrhythmogenic cardiomyopathy (AC) is an inheritable cardiomyopathy with incomplete penetrance, variable phenotype severity and poorly described disease progression. It is characterized by high risk of life-threatening ventricular arrhythmias and sudden cardiac death in young individuals. Risk stratification and selection of patients presenting without history of life-threatening arrhythmic events for cardioverter-defibrillator implantation in primary prevention remains challenging. Purpose We aimed to assess the impact of disease progression on arrhythmic outcomes in AC patients. Methods We included consecutive AC probands and mutation-positive family members with at least one complete follow-up evaluation. Echocardiographic and electrical parameters were defined according to the 2010 Revised Task Force criteria at inclusion and at last follow-up. Structural progression was defined as development of new echocardiographic diagnostic criteria. Electrical progression was defined as the development of new diagnostic depolarization, repolarization and/or premature ventricular complex count criteria during follow-up. Non-sustained ventricular tachycardia or ventricular tachycardia occurring during follow-up defined incident ventricular arrhythmic events. Results We included a total of 144 patients (48% female, 47% probands, 40±16 years old). At inclusion, 54 patients (37%) had a history of arrhythmic events, 30 patients (21%) had overt structural disease and 114 (79%) had no or minor structural disease. During 7.0 (IQR: 4.5 to 9.4) years of follow-up, 49 patients (43%) with no or minor structural disease at inclusion developed new structural criteria being defined as progressors. Among 80 participants with no or minor structural disease and no arrhythmic history at inclusion, a first arrhythmic event occurred in 14 (17%). The incidence of arrhythmic events was higher in progressors (11/27, 41%) than in non-progressors (3/53, 6%) (p<0.001) (Figure). Structural progression was associated with higher risk of first arrhythmic events during follow-up when adjusted for sex, age at inclusion and follow-up duration, independent of electrical progression (7.6, 95% CI [1.5, 37.2], P=0.01). Incident arrhythmic events distribution Conclusion Almost half of patients without overt structural cardiac disease at genetic diagnosis develop new structural criteria during 7 years follow-up and 17% experienced their first ventricular arrhythmic event. Structural progression was independently associated with ventricular arrhythmic events during follow-up. These findings highlight the increased risk of arrhythmias when structural abnormalities are detected. Their finding may initiate the evaluation for primary prevention cardioverter-defibrillator implantation.

Prognostic value of non-ischemic ring-like left ventricular scar pattern in patients with apparently idiopathic ventricular arrhythmias: a CMR imaging study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Nucifora ◽  
D Muser ◽  
S Castro ◽  
R Casado Arroyo ◽  
D Benhayon ◽  
...  
Keyword(s):  
Ventricular Arrhythmias ◽  
Prognostic Significance ◽  
Imaging Study ◽  
Left Ventricular ◽  
High Rate ◽  
Life Threatening ◽  
History Of ◽  
Group A ◽  
Group B

Abstract Background The presence of left ventricular (LV) late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR) has been correlated to life-threatening arrhythmic events in patients with apparently idiopathic ventricular arrhythmias (VAs). Aim of the present study was to investigate the prognostic significance of a specific LV-LGE phenotype characterized by a subepicardial/midmyocardial “ring-like” pattern of fibrosis. Methods Out of a total of 518 consecutive patients with apparently idiopathic VAs who underwent CMR study, 79 (15%) had evidence of LV-LGE. Of these, 23 (4%) patients had LV LGE with ring-like pattern, defined as subepicardial or midmyocardial LGE involving at least 3 contiguous segments in the same slice (group A), while 56 (11%) patients had LV LGE with no ring-like pattern (group B). The remaining 439 patients had no LGE (group C). The end-point of the study was a composite SCD, resuscitated cardiac arrest and nonfatal episodes of ventricular fibrillation or documented sustained ventricular tachycardia. Results Group A patients were more frequently males compared to groups B and C (96% vs. 79% vs. 52%; p&lt;0.01) and had more frequently a family history of SCD and/or cardiomyopathy (30% vs. 11% vs. 5%; p&lt;0.01). All patients in Group A showed VAs with a predominant RBBB morphology vs. 38 (68%) patients in Group B and 65 (15%) in Group C (p&lt;0.01). During a follow-up of 63±39 months, the composite outcome occurred in 13 patients (57%) in Group A vs. 11 (20%) in Group B and 2 (1%) in Group C (p&lt;0.01). Conclusion In patients with apparently idiopathic VAs, a nonischemic LV-LGE with a ring-like pattern at CMR is associated with a high rate of malignant arrhythmic events during follow-up. Funding Acknowledgement Type of funding source: None

scholarly journals High Risk of Sustained Ventricular Arrhythmia Recurrence After Acute Myocarditis

2020 ◽  
Vol 9 (3) ◽  
pp. 848
Author(s):  
Laurent Rosier ◽  
Amir Zouaghi ◽  
Valentin Barré ◽  
Raphaël Martins ◽  
Vincent Probst ◽  
...  
Keyword(s):  
High Risk ◽  
Ventricular Arrhythmia ◽  
Ventricular Arrhythmias ◽  
Acute Myocarditis ◽  
University Hospitals ◽  
Kaplan Meier ◽  
Acute Group ◽  
Very High ◽  
Over Time

Acute myocarditis is associated with cardiac arrhythmia in 25% of cases; a third of these arrhythmias are ventricular tachycardia (VT) or ventricular fibrillation (VF). The implantation of a cardiac defibrillator (ICD) following sustained ventricular arrhythmia remains controversial in these patients. We sought to assess the risk of major arrhythmic ventricular events (MAEs) over time in patients implanted with an ICD following sustained VT/VF in the acute phase of myocarditis compared to those implanted for VT/VF occurring on myocarditis sequelae. Our retrospective observational study included patients implanted with an ICD following VT/VF during acute myocarditis or VT/VF on myocarditis sequelae, from 2007 to 2017, in 15 French university hospitals. Over a median follow-up period of 3 years, MAE occurred in 11 (39%) patients of the acute myocarditis group and 24 (60%) patients of the myocarditis sequelae group. Kaplan–Meier MAE rate estimates at one and three years of follow-up were 19% and 45% in the acute group, and 43% and 64% in the sequelae group. Patients who experienced sustained ventricular arrhythmias during acute myocarditis had a very high risk of VT/VF recurrence during follow-up. These results show that the risk of MAE recurrence remains high after resolution of the acute episode.

Abstract 13327: Prediction of Upcoming Therapeutic Episodes of ICD Through Routine Data in Routine Device Clinic of ICD Patients

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Tamami Fujiishi ◽  
Shinichi Niwano ◽  
Masami Murakami ◽  
Hironori Nakamura ◽  
Tazuru Igarashi ◽  
...  
Keyword(s):  
Routine Data ◽  
Shock Therapy ◽  
Device Management ◽  
Icd Therapy ◽  
Electrical Instability ◽  
Significant Difference ◽  
Life Threatening ◽  
Near Future ◽  
Spontaneous Rhythm

Background: Although implantable cardioverter-defibrillator (ICD) prevents sudden death of patients with life-threatening arrhythmia, prediction of upcoming ICD therapy, if possible, would be an important issue in device management. In the present study, the relationship between ICD therapeutic episodes and preceding routine device data was evaluated to clarify the predictors for ICD actuation in near future. Methods: The study population consisted of 100 consecutive ICD patients. All patients were followed up in the device clinic in every 4-month period, and their total follow-up periods of 22.8±4.1 months were divided into 734 4-month observation windows. The common data in device clinic including 12-lead ECG, chest X-ray, and interrogated device data were compared between patients with and without ICD therapeutic episodes during upcoming 4-month windows. To avoid inappropriate weighting on data of specific cases, such as unusual data in cases with frequent shock therapy, sampling number was limited 4-8 times in one case, and all data were evaluated as change during preceding 4 months, e.g., QTc calculated by subtracting 4 month preceding QTc from the recent QTc. Results: During 3.2±1.3 month follow-up, among 734 observation windows, appropriate and inappropriate ICD therapies appeared in 54 (ATP: 29, shock: 25) and 20 (ATP: 11, shock: 9) windows. When the patients were divided into spontaneous rhythm and paced-rhythm groups (n=558 and 170), spontaneous rhythm group did not show any significant difference in parameters between the windows with and without therapeutic episodes. In contrast in paced-rhythm group, RV lead impedance was significantly lower in the windows with therapeutic episodes in comparison with those without (-19.8±43.5Ω vs. 7.4±44.7Ω, p=0.047). Conclusions: Upcoming ICD therapy in near future might be able to be predicted by change in RV lead impedance at least in cases with paced-rhythm in ICD patients. It might reflect the electrical instability in cases with ICD therapeutic episodes.

Ifosfamide induced encephalopathy in a child with osteosarcoma

2020 ◽  
pp. 107815522096354
Author(s):  
Hakan Sarbay ◽  
Ülkü F. Demir ◽  
Güliz Yılmaz ◽  
Abdullah A. Atay ◽  
Barış Malbora
Keyword(s):  
Methylene Blue ◽  
Case Report ◽  
Treatment Protocol ◽  
Supportive Therapy ◽  
Neurological Findings ◽  
Electrolyte Disturbances ◽  
Before And After ◽  
Life Threatening ◽  
Reversible Encephalopathy

Background Ifosfamide (IFO) is an alkylating agent used to treat broad range of malignancies. One of the life-threatening toxic effects is reversible neurotoxicity. In this report; we presented a case report of ifosfamide induced encephalopathy (IIE) in a child with osteosarcoma in order to emphize that it is important to continue ifosfamide treatment as well as the importance of this potentially fatal complication. Case report Following the 20th week of ifosfamide treatment, the patient's follow-up with the diagnosis of osteosarcoma developed neurological findings. Laboratory analyzes before and after ifosfamide infusion were normal. No pathological findings were seen on MR imaging. Hypoglycemia, electrolyte disturbances, encephalitis, meningitis, metastasis and posterior reversible encephalopathy syndrome (PRES) were not considered. Electroencephalography was found compatible with neuronal hyperexcitability originating from the left hemisphere. With the diagnosis of ifosfamide induced encephalopathy, prophylaxis with methylene blue was received before the next infusion of ifosfamide. Neurological findings were not observed in the patient's follow-up. Conclusion Patients who develop IIE can continue their treatment protocol with methylene blue prophylaxis and supportive therapy.

scholarly journals Outcome by Sex in Patients With Long QT Syndrome With an Implantable Cardioverter Defibrillator

2020 ◽  
Vol 9 (19) ◽  
Author(s):  
Arwa Younis ◽  
Mehmet K. Aktas ◽  
Spencer Rosero ◽  
Valentina Kutyifa ◽  
Bronislava Polonsky ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Ventricular Fibrillation ◽  
Implantable Cardioverter Defibrillator ◽  
Long Qt Syndrome ◽  
Syndrome Type ◽  
Long Qt ◽  
Cardioverter Defibrillator ◽  
Life Threatening ◽  
Qt Syndrome

Background Sex differences in outcome have been reported in patients with congenital long QT syndrome. We aimed to report on the incidence of time‐dependent life‐threatening events in male and female patients with long QT syndrome with an implantable cardioverter defibrillator (ICD). Methods and Results A total of 60 patients with long QT syndrome received an ICD for primary or secondary prevention indications. Life‐threatening events were evaluated from the date of ICD implant and included ICD shocks for ventricular tachycardia, ventricular fibrillation, or death. ICDs were implanted in 219 women (mean age 38±13 years), 46 girls (12±5 years), 55 men (43±17 years), and 40 boys (11±4 years). Mean follow‐up post‐ICD implantation was 14±6 years for females and 12±6 years for males. At 15 years of follow‐up, the cumulative probability of life‐threatening events was 27% in females and 34% in males (log‐rank P =0.26 for the overall difference). In the multivariable Cox model, sex was not associated with significant differences in risk first appropriate ICD shock (hazard ratio, 0.83 female versus male; 95% CI, 0.52–1.34; P =0.47). Results were similar when stratified by age and by genotype: long QT syndrome type 1 (LQT1), long QT syndrome type 2 (LQT2), and long QT syndrome type 3 (LQT3). Incidence of inappropriate ICD shocks was higher in males versus females (4.2 versus 2.7 episodes per 100 patient‐years; P =0.018), predominantly attributed to atrial fibrillation. The first shock did not terminate ventricular tachycardia/ventricular fibrillation in 48% of females and 62% of males ( P =0.25). Conclusions In patients with long QT syndrome with an ICD, the risk and rate of life‐threatening events did not significantly differ between males and females regardless of ICD indications or genotype. In a substantial proportion of patients with long QT syndrome, first shock did not terminate ventricular tachycardia/ventricular fibrillation.

scholarly journals Resistant Ventricular Arrhythmia and the Role of Overdrive Pacing in the Suppression of the Electrical Storm

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Mohamed Magdi ◽  
Mahmood Mubasher ◽  
Hakam Alzaeem ◽  
Tahir Hamid
Keyword(s):  
Myocardial Infarction ◽  
Ventricular Arrhythmia ◽  
Ventricular Arrhythmias ◽  
Coronary Intervention ◽  
Electrical Storm ◽  
Electrical Instability ◽  
Percutaneous Coronary ◽  
Life Threatening ◽  
Overdrive Pacing ◽  
Antiarrhythmic Medications

Ventricular arrhythmia storm is a state of cardiac instability characterized by multiple ventricular arrhythmias or multiple ICD therapies within a 24-hour duration. Management of this life-threatening state depends on the reversal of the cause besides either electrical or medical management of the arrhythmia. We report a case of a 54-year-old male who underwent a percutaneous coronary intervention following massive acute myocardial infarction. Afterwards, he developed frequent life-threatening ventricular arrhythmias that required multiple shocks and antiarrhythmic medications. Despite all these interventions, it was very difficult to control the electrical instability, but after overdrive ventricular pacing, the storm subsided and within a few days the case was stabilized. Overdrive pacing is an easy temporary modality to control the resistant arrhythmia following myocardial infarction.

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