scholarly journals Identification of patients at high risk for sudden cardiac death in cases with non-sustained ventricular tachycardia using ambulatory electrocardiogram.

1997 ◽  
Vol 17 (3) ◽  
pp. 274-283
Author(s):  
Hiroto Takeda ◽  
Kenji Owada ◽  
Eiichi Katohno ◽  
Masaaki Techigawara ◽  
Naoyuki Awano ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
High Risk ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Sustained Ventricular Tachycardia

Diabetes and arrhythmias

ESC CardioMed ◽  
2018 ◽  
pp. 941-944
Author(s):  
Heikki Huikuri ◽  
Lars Rydén
Keyword(s):  
Heart Failure ◽  
Ventricular Tachycardia ◽  
Sudden Cardiac Death ◽  
Vitamin K ◽  
Cardiac Death ◽  
Vitamin K Antagonists ◽  
Left Ventricular ◽  
Sustained Ventricular Tachycardia ◽  
Patients With Diabetes ◽  
Diagnostic Work

Cardiac arrhythmias are more common in subjects with diabetes mellitus (DM) than in their counterparts without diabetes. Atrial fibrillation (AF) is present in 10–20% of the DM patients, but the association between DM and AF is mostly due to co-morbidities of DM patients increasing the vulnerability to AF. When type 2 DM and AF coexist, there is a substantially higher risk of cardiovascular mortality, stroke, and heart failure, which indicates screening of AF in selected patients with DM. Anticoagulant therapy either with vitamin K antagonists or non-vitamin K antagonist oral anticoagulants is recommended for DM patients with either paroxysmal or permanent AF, if not contraindicated. Palpitations, premature ventricular beats, and non-sustained ventricular tachycardia are common in patients with DM. The diagnostic work-up and treatment of these arrhythmias does not differ between the patients with or without DM. The diagnosis and treatment of sustained ventricular tachycardia, either monomorphic or polymorphic ventricular tachycardia, or resuscitated ventricular fibrillation is also similar between the patients with or without DM. The risk of sudden cardiac death is higher in DM patients with or without a diagnosed structural heart disease. Patients with diabetes and a left ventricular ejection fraction less than 30–35% should be treated with a prophylactic implantable cardioverter defibrillator according to current guidelines. Beta-blocking therapy is recommended for DM patients with left ventricular dysfunction or heart failure to prevent sudden cardiac death due to arrhythmia.

Abstract 10947: Longer and Faster Non-sustained Ventricular Tachycardia in Hypertrophic Cardiomyopathy Patients Predicts for Implantable Cardioverter Defibrillator Shocks and Sudden Cardiac Death

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Weijia Wang ◽  
Zhesi Lian ◽  
Ethan Rowin ◽  
Martin Maron ◽  
Mark Link
Keyword(s):  
Ventricular Tachycardia ◽  
Hypertrophic Cardiomyopathy ◽  
Primary Prevention ◽  
Sudden Cardiac Death ◽  
Implantable Cardioverter Defibrillator ◽  
Cardiac Death ◽  
Medical Center ◽  
Multivariable Analysis ◽  
Sustained Ventricular Tachycardia ◽  
Cardioverter Defibrillator

Introduction: Non-sustained ventricular tachycardia (NSVT) may be underestimated in patients with hypertrophic cardiomyopathy (HCM). Its impact on the risk of sudden cardiac death (SCD) in HCM is controversial. There is no distinction made in the guidelines as to the length or rate of NSVT as a risk marker for SCD. Hypothesis: NSVT may be nearly universal in HCM patients with high risk of SCD and not found because of the limited time frame of monitoring. NSVT may be associated with appropriate Implantable Cardioverter Defibrillator (ICD) shocks and SCD. Methods: A retrospective study of 181 HCM patients who had an ICD and were followed for at least 6 months from 2000 to 2013 at Tufts Medical Center was performed. The pre-operative evaluations as well as routine ICD follow up notes were reviewed. Results: ICD was implanted in 175 (96.7%) patients as primary prevention and in 6 (3.3%) patients as secondary prevention for SCD. Ninety six (53.0%) patients total had NSVT, including 48 (26.5%) before and 77 (42.5%) after ICD implantation. The agreement for detecting NSVT between Holter monitoring and ICD interrogation was poor (Kappa=0.18, p=0.054). Eighteen (18.75%) patients with NSVT and 6 (7.06%) patients without NSVT had appropriate ICD shocks or SCD (Figure 1). In multivariable analysis, NSVT was independently associated with appropriate ICD shocks and SCD (OR 3.69, 95%CI: 1.31 - 10.43) and remained significant in the 175 patients who had ICD implanted as primary prevention (OR 3.86, 95%CI: 1.13 - 13.18). More rapid NSVT (Cl < 310ms) predicted appropriate ICD shocks and SCD (OR 7.7, 95%CI: 1.6, 36.8), and longer NSVT (> 18beats) also predicted appropriate ICD shocks and SCD (OR=23.7, 95%CI: 2.7, 204.9). Conclusion: The agreement for detecting NSVT between Holter and ICD interrogation is poor. NSVT is significantly associated with appropriate ICD shocks and SCD. Faster and longer NSVT are even more predictive. Extending rhythm monitor time merits consideration in HCM patients.

scholarly journals A validation study of the European Society of Cardiology guidelines for risk stratification of sudden cardiac death in childhood hypertrophic cardiomyopathy

EP Europace ◽  
2019 ◽  
Vol 21 (10) ◽  
pp. 1559-1565 ◽  
Author(s):  
Gabrielle Norrish ◽  
Tao Ding ◽  
Ella Field ◽  
Karen McLeod ◽  
Maria Ilina ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Hypertrophic Cardiomyopathy ◽  
Sudden Cardiac Death ◽  
Risk Stratification ◽  
European Society ◽  
Cardiac Death ◽  
Left Ventricular ◽  
Sustained Ventricular Tachycardia ◽  
Rank Test ◽  
European Society Of Cardiology

Abstract Aims Sudden cardiac death (SCD) is the most common cause of death in children with hypertrophic cardiomyopathy (HCM). The European Society of Cardiology (ESC) recommends consideration of an implantable cardioverter-defibrillator (ICD) if two or more clinical risk factors (RFs) are present, but this approach to risk stratification has not been formally validated. Methods and results Four hundred and eleven paediatric HCM patients were assessed for four clinical RFs in accordance with current ESC recommendations: severe left ventricular hypertrophy, unexplained syncope, non-sustained ventricular tachycardia, and family history of SCD. The primary endpoint was a composite outcome of SCD or an equivalent event (aborted cardiac arrest, appropriate ICD therapy, or sustained ventricular tachycardia), defined as a major arrhythmic cardiac event (MACE). Over a follow-up period of 2890 patient years (median 5.5 years), MACE occurred in 21 patients (7.5%) with 0 RFs, 19 (16.8%) with 1 RFs, and 3 (18.8%) with 2 or more RFs. Corresponding incidence rates were 1.13 [95% confidence interval (CI) 0.7–1.73], 2.07 (95% CI 1.25–3.23), and 2.52 (95% CI 0.53–7.35) per 100 patient years at risk. Patients with two or more RFs did not have a higher incidence of MACE (log-rank test P = 0.34), with a positive and negative predictive value of 19% and 90%, respectively. The C-statistic was 0.62 (95% CI 0.52–0.72) at 5 years. Conclusions The incidence of MACE is higher for patients with increasing numbers of clinical RFs. However, the current ESC guidelines have a low ability to discriminate between high- and low-risk individuals.

scholarly journals Intra-QT Spectral Coherence as a Possible Noninvasive Marker of Sustained Ventricular Tachycardia

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Gianfranco Piccirillo ◽  
Federica Moscucci ◽  
Alessandro Persi ◽  
Daniele Di Barba ◽  
Maria Antonella Pappadà ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Sustained Ventricular Tachycardia ◽  
Spectral Coherence ◽  
Responsible Mechanism ◽  
Patients At Risk ◽  
Qt Variability ◽  
Noninvasive Marker ◽  
The One

Sudden cardiac death is the main cause of mortality in patients affected by chronic heart failure (CHF) and with history of myocardial infarction. No study yet investigated the intra-QT phase spectral coherence as a possible tool in stratifying the arrhythmic susceptibility in patients at risk of sudden cardiac death (SCD). We, therefore, assessed possible difference in spectral coherence between the ECG segment extending from theqwave to theTwave peak (QTp) and the one fromTwave peak to theTwave end (Te) between patients with and without Holter ECG-documented sustained ventricular tachycardia (VT). None of the QT variability indexes as well as most of the coherences and RR power spectral variables significantly differed between the two groups except for theQTp-Tespectral coherence. The latter was significantly lower in patients with sustained VT than in those without (0.508±0.150versus0.607±0.150,P<0.05). Although the responsible mechanism remains conjectural, theQTp-Tespectral coherence holds promise as a noninvasive marker predicting malignant ventricular arrhythmias.

scholarly journals Targeted ablation of cardiac sympathetic neurons reduces the susceptibility to ischemia-induced sustained ventricular tachycardia in conscious rats

2010 ◽  
Vol 298 (5) ◽  
pp. H1330-H1339 ◽  
Author(s):  
Heidi L. Lujan ◽  
Gurunanthan Palani ◽  
Lijie Zhang ◽  
Stephen E. DiCarlo
Keyword(s):  
Ventricular Tachycardia ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Ventricular Arrhythmias ◽  
Antiarrhythmic Drugs ◽  
Sympathetic Neurons ◽  
Left Ventricular ◽  
Sustained Ventricular Tachycardia ◽  
Conscious Rats ◽  
Stellate Ganglia

The Cardiac Arrhythmia Suppression Trial demonstrated that antiarrhythmic drugs not only fail to prevent sudden cardiac death, but actually increase overall mortality. These findings have been confirmed in additional trials. The “proarrhythmic” effects of most currently available antiarrhythmic drugs makes it essential that we investigate novel strategies for the prevention of sudden cardiac death. Targeted ablation of cardiac sympathetic neurons may become a therapeutic option by reducing sympathetic activity. Thus cholera toxin B subunit (CTB) conjugated to saporin (a ribosomal inactivating protein that binds to and inactivates ribosomes; CTB-SAP) was injected into both stellate ganglia to test the hypothesis that targeted ablation of cardiac sympathetic neurons reduces the susceptibility to ischemia-induced, sustained ventricular tachycardia in conscious rats. Rats were randomly divided into three groups: 1) control (no injection); 2) bilateral stellate ganglia injection of CTB; and 3) bilateral stellate ganglia injection of CTB-SAP. CTB-SAP rats had a reduced susceptibility to ischemia-induced, sustained ventricular tachycardia. Associated with the reduced susceptibility to ventricular arrhythmias were a reduced number of stained neurons in the stellate ganglia and spinal cord (segments T1-T4), as well as a reduced left ventricular norepinephrine content and sympathetic innervation density. Thus CTB-SAP retrogradely transported from the stellate ganglia is effective at ablating cardiac sympathetic neurons and reducing the susceptibility to ventricular arrhythmias.

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