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.

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 Fever Associated with Gastrointestinal Shigellosis Unmasks Probable Brugada Syndrome

2009 ◽  
Vol 2009 ◽  
pp. 1-3 ◽  
Author(s):  
John N. Makaryus ◽  
Jennifer Verbsky ◽  
Scott Schwarz ◽  
David Slotwiner
Keyword(s):  
Brugada Syndrome ◽  
Ventricular Arrhythmias ◽  
Structural Heart Disease ◽  
Underlying Mechanism ◽  
Temperature Dependent ◽  
Bundle Branch Block ◽  
St Segment ◽  
Electrocardiographic Changes ◽  
Clinically Significant ◽  
The Right

Since it was first described approximately 15 years ago, the Brugada Syndrome has spurred a significant quantity of interest in its underlying mechanism and physiology. The Brugada electrocardiographic pattern is characterized by right bundle branch block morphology and ST segment elevations in the right precordial leads with an absence of identifiable underlying structural heart disease. The syndrome is clinically significant since these patients are at a higher risk of developing malignant ventricular arrhythmias. One of the mechanisms behind the disorder involves mutations in specific myocardial sodium channels. Furthermore, these electrocardiographic changes appear to be temperature dependent. We present the case of a 35-year-old male who presented with intestinal Shigellosis and was also found to have Brugada-type electrocardiographic changes on ECG. The electrocardiographic changes that were present when the patient was admitted and febrile resolved following antibiotic therapy and defervescence.

scholarly journals Arrhythmias from the Right Ventricular Moderator Band: Diagnosis and Management

2020 ◽  
Vol 8 (4) ◽  
pp. 294-299
Author(s):  
Megan Barber ◽  
Jason Chinitz ◽  
Roy John
Keyword(s):  
Ventricular Tachycardia ◽  
Right Ventricle ◽  
Ventricular Arrhythmias ◽  
Structural Heart Disease ◽  
Conduction System ◽  
Polymorphic Ventricular Tachycardia ◽  
Management Options ◽  
Premature Ventricular Contractions ◽  
Moderator Band ◽  
The Right

The moderator band in the right ventricle is being increasingly recognised as a source for arrhythmias in the absence of identifiable structural heart disease. Because it carries part of the conduction system from the right ventricle septum to the free wall, it is a source of Purkinje-mediated ventricular arrhythmias that manifest as premature ventricular contractions (PVC) or repetitive ventricular tachycardia. More importantly, short coupled PVCs triggering polymorphic ventricular tachycardia and VF have been localised to the moderator band and ablation of these Purkinje mediated PVCs can effectively prevent recurrent VF. The exact mechanism of arrhythmogenesis is still debated but stretch, fibrosis and ion channel alterations might be responsible. Arrhythmias originating in this region of the right ventricle may thus be another cause for idiopathic VF that is potentially treatable with catheter-based ablation techniques. Recognition of the typical PVC morphology can point to the moderator band as the source of idiopathic VF and an opportunity for timely intervention. The available data on the anatomy, electrophysiology and management options are reviewed.

P95412 lead Holter monitoring in Brugada syndrome

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
P Carvalho ◽  
C Gravinese ◽  
A Previti ◽  
G P Varalda ◽  
L Montagna
Keyword(s):  
Brugada Syndrome ◽  
Electrophysiological Study ◽  
Right Ventricular Outflow Tract ◽  
Holter Monitoring ◽  
The Other ◽  
Drug Induced ◽  
Premature Ventricular Contractions ◽  
Bundle Branch Block ◽  
The Right

Abstract Background 12 lead-Holter monitoring is commonly used for the assessment  of type 1 Brugada repolarization"s burden. However, data considering the prevalence and morphology of premature ventricular contractions (PVC) in these patients is lacking. Purpose. We investigated the prevalence of PVCs in subjects with Brugada syndrome (BRs) phenotype during 24-hour 12 lead-Holter monitoring (12-L Holter), trying to identify their origin according to morphology.  Methods. From January 2013 to September 2018, a total of 156 patients with type 1 BRs phenotype (spontaneous or drug induced) were screened for PVCs. In these patients we placed the right precordial leads at the second (V1-V2) and the forth (V3-V4) intercostal spaces.  Results. 83 subjects (53%) displayed PVCs. Their mean age was 50 years (range 21-73) and 63 (76%) were male. 14 subjects (17%) had a spontaneous type 1 repolarization whereas 69 (83%) presented a drug induced type 1. One patient had implanted an ICD as secondary prevention after an aborted sudden cardiac death. The others were mostly asymptomatic as only five of them (6%) had history of suspected cardiac syncope. 17 subjects (20%) had performed an electrophysiological study, which resulted positive in 3 cases (4%). The population without PVCs had similar baseline characteristics. In 59 (71%) patients PVCs were monomorphic, in the other 29% we analyzed the prevalent morphology. PVCs were classified according to their morphology as follows (i) left bundle branch block (LBBB)/inferior axis suggesting an origin from the right ventricular outflow tract (RVOT), that was shown in 40 (48%) subjects; (ii) right bundle branch block (RBBB)/left axis suggesting an origin close to the posterior fascicle of the left bundle branch in 36 (43%). The other 7 patients presented several morphologies. According to their number during the 24-hour monitoring, PVCs were arbitrarily classified as follows: (i) 1-59,present in 62 patients (75%); (ii) 60-749, present in 16 patients (19%); (iii) 750-9000, present in 4 patients (5%); (iv) &gt;9000, in only one patient (1%).  Conclusions. In our population of subjects with BRs phenotype the prevalence of PCVs is similar to that of the general population. Their morphologies suggest an origin from the RVOT or close to the posterior fascicle of the left bundle branch.

scholarly journals Electrocardiographic Criteria for Differentiating Left from Right Idiopathic Outflow Tract Ventricular Arrhythmias

2021 ◽  
Vol 10 (1) ◽  
pp. 10-16
Author(s):  
Marco V Mariani ◽  
Agostino Piro ◽  
Domenico G Della Rocca ◽  
Giovanni B Forleo ◽  
Naga Venkata Pothineni ◽  
...  
Keyword(s):  
Ventricular Arrhythmias ◽  
Right Ventricular Outflow Tract ◽  
Structural Heart Disease ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Premature Ventricular Contractions ◽  
Left Ventricular Outflow ◽  
The Right ◽  
Ecg Criteria

Idiopathic ventricular arrhythmias are ventricular tachycardias or premature ventricular contractions presumably not related to myocardial scar or disorders of ion channels. Of the ventricular arrhythmias (VAs) without underlying structural heart disease, those arising from the ventricular outflow tracts (OTs) are the most common. The right ventricular outflow tract (RVOT) is the most common site of origin for OT-VAs, but these arrhythmias can, less frequently, originate from the left ventricular outflow tract (LVOT). OT-VAs are focal and have characteristic ECG features based on their anatomical origin. Radiofrequency catheter ablation (RFCA) is an effective and safe treatment strategy for OT-VAs. Prediction of the OT-VA origin according to ECG features is an essential part of the preprocedural planning for RFCA procedures. Several ECG criteria have been proposed for differentiating OT site of origin. Unfortunately, the ECG features of RVOT-VAs and LVOT-VAs are similar and could possibly lead to misdiagnosis. The authors review the ECG criteria used in clinical practice to differentiate RVOT-VAs from LVOT-VAs.

P5560Assessing etiology in a cohort of patients with myocarditis presenting with complex ventricular arrhythmias: can the percutaneous endomyocardial biopsy help?

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Dello Russo ◽  
M Casella ◽  
A Gasperetti ◽  
C Basso ◽  
L Bianchini ◽  
...  
Keyword(s):  
Ventricular Arrhythmia ◽  
Ventricular Arrhythmias ◽  
Electrophysiological Study ◽  
Virus Genome ◽  
Disease Etiology ◽  
Barr Virus ◽  
Wide Range ◽  
Ebstein Barr Virus ◽  
Magnetic Resonance Imaging Mri ◽  
The Right

Abstract Background Myocarditis represents a common but often under-diagnosed disease, with a wide range of clinical presentations; diagnosis is often presumptive and a clear etiology leading to a specific therapeutic approach is usually not identified. Purpose To describe and assess disease etiology in a cohort of myocarditis patients (pts) with arrhythmic presentation undergoing an invasive diagnostic work-up. Methods All pts with myocarditis presenting with ventricular arrhythmias undergoing an electro-anatomical mapping (EAM) guided endo-myocardial biopsy (EMB) at our institution were enrolled. All enrolled pts also underwent cardiac magnetic resonance imaging (MRI) and an electrophysiological study (EPS). Demographics, arrhythmic presentation, MRI data, arrhythmic inducibility at EPS, EAM and EMB biopsy data were retrieved and analyzed. Molecular biology testing for cardio-tropic virus genome as well as leukocyte immunohistochemical typization were routinely performed on all EMB samples. Results Twenty-six pts were enrolled (85% male, 39±6 y.o.). Clinical presentation was an organized ventricular arrhythmia in 16 (62%) pts (n=3 non-sustained ventricular arrhythmia; n=9 sustained ventricular arrhythmia; n=4 ventricular fibrillation) while frequent (>10.000) premature ventricular complexes (PVCs) in the remaining 10 (38%) pts. MRI showed a late gadolinium enhancement (LGE) pattern consistent with myocarditis in all pts (35% left LGE; 65% right LGE). At the EPS, 10 (38%) pts showed inducibility for SVTs and underwent an intra-cardiac defibrillator (ICD) implant, while 4 (16%) more were implanted for secondary arrhythmic prevention. EAM was performed in 18 (70%), 6 (22%) and 2 (8%) pts in the right, left and in both ventricle respectively; in all cases, abnormal myocardial voltages were retrieved in the area showing LGE at MRI. Extensive myocardial scarring was detected in 7 (27%) pts. All EMB were performed without peri-procedural complications; inflammatory infiltrate and substrate alteration consistent with myocarditis were retrieved in 100% of the bioptic samples. Viral genome was identified in 13 (50%) samples (n=5 Human Herpes Virus 6; n=2 Parvovirus B 19; n=3 Adenovirus; n=1 Ebstein Barr Virus; n=1 Cytomegalovirus; n=1 Rhinovirus) and specific human immunoglobulin treatment was undergone by a single pt; eosinophilic infiltration was found in 2 (8%) patients; lymphocite invasion and auto-antibodies consistent with auto-immune myocarditis were detected in 2 (8%) patients and appropriate immunosuppressive therapy was started, while a myocardial band contraction pattern typical of toxic myocarditis was found in a single (4%) patient [Figure 1]. Different Myocarditis Etiology Rates Conclusion In our myocarditis cohort, EMB confirmed viruses to represented the first myocarditis etiological agent. Despite an invasive work-out, 31% of the cohort etiology still remains unclear.

Sign in / Sign up

Export Citation Format

Share Document