scholarly journals Effective management of patients with electrical storm – networking and VT unit as essential parts for a successful outcome

2021 ◽  
Vol 30 (4) ◽  
pp. 583-588
Author(s):  
Elena Ene ◽  
Karin Nentwich ◽  
Phillipp Halbfaß ◽  
Kai Sonne ◽  
Arthur Berkovitz ◽  
...  
Keyword(s):  
Cardiac Death ◽  
Systolic Function ◽  
Clinical Status ◽  
Successful Outcome ◽  
Electrical Storm ◽  
Effective Management ◽  
General Hospitals ◽  
Long Term Prognosis ◽  
Ventricular Tachycardias

Ventricular tachycardias (VT) represents worldwide one of the leading causes of sudden cardiac death. The increasing number of implanted ICDs have reduced signifi cantly the number of sudden cardiac deaths SCDs); however recurrent VTs episodes might lead to a rapid deterioration of patient’s clinical status and systolic function. An early intervention after a successful patient stabilization in a dedicated VT unit is mandatory for the mid- and long term prognosis of the patient. Nevertheless, a tight collaboration between general hospitals and highly specialized centers in treatment of patients with electrical storm is essential for an effi cient and successful outcome.

Abstract 13882: Impact of Ischemic Mitral Regurgitation on Long-Term Prognosis in Patients With Acute Myocardial Infarction After Primary Percutaneous Coronary Intervention

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Kitae Kim ◽  
Shuichiro Kaji ◽  
Takeshi Kitai ◽  
Atsushi Kobori ◽  
Natsuhiko Ehara ◽  
...  
Keyword(s):  
Cardiac Death ◽  
Poor Prognosis ◽  
Coronary Intervention ◽  
Killip Class ◽  
Percutaneous Coronary ◽  
Long Term Follow Up ◽  
The Mean ◽  
Long Term Prognosis

Introduction: Ischemic mitral regurgitation (IMR) portends a poor prognosis during long-term follow-up and has been identified as an independent predictor of heart failure (HF) and reduced long-term survival. Despite the poor prognosis with chronic IMR, few studies report the impact of IMR on long-term prognosis in patients with acute myocardial infarction (AMI) who underwent primary percutaneous coronary intervention (PCI). Methods: We studied 674 consecutive patients with AMI from 2000 to 2006 who underwent emergent coronary angiography and primary PCI, and who were assessed by transthoracic echocardiography during index hospitalization. Primary outcomes were cardiac death and the development of HF during follow-up. Results: The mean age of the study patients was 65±12 years and 534 patients (79%) were men. Sixty patients (9%) had moderate or severe MR before hospital discharge. Patients with moderate or severe MR were older, more frequently non-smoker, and more likely to have Killip class ≥2, lower ejection fraction, larger left ventricular end-diastolic volume, compared with patients with no or mild MR. During the mean follow-up period of 5.7±3.6 years, 35 cardiac deaths and 53 episodes of HF occurred. Kaplan-Meier analysis revealed that patients with moderate or severe MR had significantly increased risk for cardiac death (P<0.001), and HF (P<0.001), compared with patients with no or mild MR. Multivariate analysis revealed that moderate or severe MR was the significant predictor of the development of cardiac death (P<0.001), and the development of HF (P=0.006), independently of age, gender, history of MI, Killip class ≥2, initial TIMI flow≤1, peak CPK level, ejection fraction. Conclusions: Moderate or severe IMR detected early after AMI was independently associated with adverse cardiac events during long-term follow-up in patients with AMI after primary PCI.

scholarly journals The Role of Catheter Ablation of Ventricular Tachycardias in the Treatment of Patients with Electrical Storm

2015 ◽  
Vol 1 (1) ◽  
pp. 8-11
Author(s):  
Astrid Hendriks ◽  
Tamás Szili-Török
Keyword(s):  
Catheter Ablation ◽  
Standard Of Care ◽  
Electrical Storm ◽  
Emergency Setting ◽  
Electrical Instability ◽  
Life Threatening ◽  
Internal Cardioverter Defibrillator ◽  
Short And Long Term ◽  
Long Term Prognosis ◽  
Ventricular Tachycardias

AbstractElectrical storm due to the development of repetitive sustained ventricular tachycardias (VT) is a potentially life-threatening clinical entity. Acute catheter ablation can be lifesaving. Electrical storm (ES) can be characterized as a period of severe cardiac electrical instability manifested by recurrent ventricular arrhythmias. ES adversely affects short and long term prognosis. The highest mortality risk is in the first 3 months after the occurrence of the index event as shown by the AVID trial. The appearance of a ventricular tachycardia (VT) storm is associated with a rather high mortality despite the presence of an internal cardioverter defibrillator. Catheter ablation (CA) in VT storm is evolving as a standard of care therapy. The increased utilization of CA is partly driven by data suggesting that ICD shocks may be associated with increased mortality, partly due to the limited possibilities and adverse events of medical therapy. The aim of this review is to summarize recent advances in CA of VTs in emergency setting.

scholarly journals P1481Impact of early arrhythmia recurrence on the long-term prognosis in patients treated for electrical storm

EP Europace ◽  
2017 ◽  
Vol 19 (suppl_3) ◽  
pp. iii302-iii302
Author(s):  
S. Morawski ◽  
P. Pruszkowska ◽  
O. Kowalski ◽  
R. Lenarczyk ◽  
Z. Kalarus ◽  
...  
Keyword(s):  
Electrical Storm ◽  
Long Term Prognosis

4939Clinical significance of global strain estimated by 3D speckle tracking acutely after onset of ST-elevation myocardial infarction on prediction of long term prognosis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
N Iwahashi ◽  
J K Kirigaya ◽  
M H Horii ◽  
E A Akiyama ◽  
K O Okada ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Cardiac Death ◽  
Speckle Tracking ◽  
Kaplan Meier ◽  
Global Strain ◽  
St Elevation ◽  
Long Term Prognosis ◽  
First Time

Abstract Background Three-dimensional (3D) speckle tracking echocardiography (STE) is a novel method for assessing cardiac function because of free form out-of-plane motion effects. Aim To explore the role of 3D-STE for prediction of the long term prognosis in patients with a first-time ST elevation acute myocardial infarction (STEMI). Methods A total of 238 patients (mean age 64.6 years) with a first-time STEMI treated with reperfusion therapy were enrolled in our study. Twenty four hours after admission, standard 2D echocardiography and 3D full volume imaging were obtained and strain parameters (GLS: global longitudinal strain, GCS: global circumferential strain) were calculated using 4D LV analysis. Infarct size was measured with single-photon emission computed tomography imaging 7 to 14 days after onset. We followed them for median 94 months (inter quartile range: 69–109 months). The primary end point was the major adverse cardiac and cerebrovascular events (MACE: cardiac death, non-fatal MI, heart failure requiring intravenous diuretics administration and stroke). The patients with persistent chronic atrial fibrillation, poor image quality, emergency bypass surgery were excluded. Results During follow up periods, 78 patients experienced MACE (26 cardiac death, 48 heart failure, 29 non-fatal MI, 5 stroke) and 48 patients died (22 non-cardiac death). In multivariate analysis, 3D-GLS was the strongest predictor for MACE. Kaplan-Meier Curve demonstrated that 3D-GLS >−11.4 was the independent predictor for MACE (Log-rank χ2=73.818, p<0.0001). When combined with 3D-GCS >−19.2, the patients with higher value both of 3D-GLS and 3D-GCS were extremely high risk. The figure shows the Kaplan-Meier curve according to the 4 groups based on the cut-off values determinded by ROC curves. Conclusions Global strain estimated by 3D-STE immediately onset of STEMI was useful tool for the prediction of long term prognosis. Acknowledgement/Funding None

scholarly journals Occipital cranioplasty using customized titanium prosthesis yields successful outcome in association with foramen magnum decompression in dogs suffering by Chiari-like malformation

2021 ◽  
pp. 1-8
Author(s):  
Alessia S. Colverde ◽  
Tommaso Nicetto ◽  
Cristian Falzone
Keyword(s):  
Clinical Status ◽  
Clinical Signs ◽  
Foramen Magnum ◽  
Adjunctive Treatment ◽  
Successful Outcome ◽  
Foramen Magnum Decompression ◽  
Mri Findings ◽  
Cranial Fossa

Abstract OBJECTIVE To describe the use of a customized 3–D-printed titanium prosthesis as adjunctive treatment for foramen magnum decompression (FMD) in dogs with Chiari-like malformation (CM) and syringomyelia (SM). ANIMALS 8 dogs with clinical signs and MRI findings of CM-SM. PROCEDURES 3-D reconstruction of CT images of the head was used to simulate an occipital craniectomy and design the prosthesis. FMD was performed, and the prosthesis was implanted. Follow-up was performed 1, 6, and 12 months later, and clinical status was scored. Repeated MRI images were compared to identify changes involving the neural structures, particularly the syrinx. RESULTS All prostheses were easily positioned based on the preoperative 3-D models, with no complications. At 12 months after surgery, 3 dogs were free of previous medications, 4 were still receiving steroid medications but at lower doses, and 1 was occasionally receiving acupuncture. MRI of 5 dogs 6 to 20 months after surgery revealed resolution of SM (n = 1), reduced size of SM (3), or worse SM (1). All dogs showed an increase in size of the caudal cranial fossa. Dogs with a longer presurgical duration of the clinical signs and wider syrinx generally had worse outcomes than other dogs. CLINICAL RELEVANCE Findings suggested that use of customized 3–D-printed titanium prosthesis and associated FMD can represent an adjunctive option to medically treated dogs with CM-SM. Although the small number of cases precludes definitive conclusions, early surgical treatment, particularly in dogs with a small syrinx, could ensure better long-term outcomes, as previously suggested.

Abstract 1715: Prognosis of Patients Under Chronic Clopidogrel Therapy while Suffering an Acute Coronary Syndrome

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Laurent Bonello ◽  
Axel de Labriolle ◽  
Gilles Lemesle ◽  
Probal Roy ◽  
Daniel H Steinberg ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiac Death ◽  
Major Adverse Cardiovascular Events ◽  
Coronary Syndrome ◽  
Clopidogrel Therapy ◽  
Artery Disease ◽  
Long Term Prognosis ◽  
Worse Prognosis

Background: Chronic clopidogrel therapy (CCT) has been shown to be beneficial in decreasing the frequency of major adverse cardiovascular events (MACE) in coronary artery disease. However, some patients suffer an acute coronary syndrome (ACS) despite CCT. Objective : To assess the prognosis of patients suffering an ACS while on CCT compared to patients naive to clopidogrel. Method: Retrospective analysis of propensity matched cohorts of patients undergoing PCI for an ACS was performed. Patients under CCT before the ACS were matched 1:2 with patients not under CCT before the ACS. The primary endpoint was a composite of cardiac death and myocardial infarction (MI) at 1-year follow-up. A cohort of 2325 patients undergoing PCI for an ACS was studied. Among them, 256 patients were taking CCT for > 1 month at the time of the ACS and 2069 weren’t taking clopidogrel prior to the ACS. After propensity score matching 1:2, the 2 groups included, respectively, 84 and 168 patients. Results: Patients in both groups had similar rates of previous MI (no CCT vs CCT 47.6 vs 48.8%; p = 0.86) or PCI (40.5 vs 40.5%; p = 1). There was no difference in drug use on discharge between the 2 groups; in particular for thienopyridines (94 vs 96.4%; p = 0.6). At 1-year follow-up, patients under CCT before the ACS exhibited a worse prognosis than patients who were not under CCT prior to the ACS, with a higher rate of cardiac death and MI (14.2 vs 5.5%; p = 0.015). Conclusions: This study suggests that patients suffering an ACS while under CCT have a poor long-term prognosis, which could be linked to clopidogrel low response.

scholarly journals Loss of Ventricular Function After Bidirectional Cavopulmonary Connection: Who Is at Risk?

2020 ◽  
Vol 41 (8) ◽  
pp. 1714-1724
Author(s):  
Marie Vincenti ◽  
M. Yasir Qureshi ◽  
Talha Niaz ◽  
Drew K. Seisler ◽  
Timothy J. Nelson ◽  
...  
Keyword(s):  
Ventricular Function ◽  
Systolic Function ◽  
Survival Curve ◽  
Fontan Procedure ◽  
Cardiac Events ◽  
Transient Phenomenon ◽  
Long Term Prognosis ◽  
Cavopulmonary Connection ◽  
Bidirectional Cavopulmonary Connection

AbstractDecline of single ventricle systolic function after bidirectional cavopulmonary connection (BDCPC) is thought to be a transient phenomenon. We analyzed ventricular function after BDCPC according to ventricular morphology and correlated this evolution to long-term prognosis. A review from Mayo Clinic databases was performed. Visually estimated ejection fraction (EF) was reported from pre-BDCPC to pre-Fontan procedure. The last cardiovascular update was collected to assess long-term prognosis. A freedom from major cardiac event survival curve and a risk factor analysis were performed. 92 patients were included; 52 had left ventricle (LV) morphology and 40 had right ventricle (RV) morphology (28/40 had hypoplastic left heart syndrome (HLHS)). There were no significant differences in groups regarding BDCPC procedure or immediate post-operative outcome. EF showed a significant and relevant decrease from baseline to discharge in the HLHS group: 59 ± 4% to 49 ± 7% or − 9% (p < 0.01) vs. 58 ± 3% to 54 ± 6% or − 4% in the non-HLHS RV group (p = 0.04) and 61 ± 4% to 60 ± 4% or − 1% in the LV group (p = 0.14). Long-term recovery was the least in the HLHS group: EF prior to Fontan 54 ± 2% vs. 56 ± 6% and 60 ± 4%, respectively (p < 0.01). With a median follow-up of 8 years post-BDCPC, six patients had Fontan circulation failure, four died, and three had heart transplantation. EF less than 50% at hospital discharge after BDCPC was strongly correlated to these major cardiac events (HR 3.89; 95% Cl 1.04–14.52). Patients with HLHS are at great risk of ventricular dysfunction after BDCPC. This is not a transient phenomenon and contributes to worse prognosis.

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