COVID-19 induced ventricular tachycardia storm unmasking a clinically silent cardiomyopathy: a case report

Background Coronavirus disease (COVID-19) is a systemic illness characterized by raging impact of cytokine storm on multiple organs. This may trigger malignant ventricular arrhythmias and unmask a clinically silent cardiomyopathy. Case summary A 57-year-old gentleman, known case of hyperthyroidism and diabetes, was referred to our emergency department with history of two ventricular tachycardia (VT) episodes requiring direct current cardioversion in last 3 h followed by another episode in our emergency department that was cardioverted. There was no past history of cardiac illness. His 12-lead electrocardiogram (during sinus rhythm) along with screening echocardiography suggested Arrhythmogenic right ventricular cardiomyopathy (ARVC). He was coincidentally found to be COVID-19 positive by reverse transcription-polymerase chain reaction (RT-PCR) as part of our routine screening. However, he had no fever or respiratory complaints. We noted raised systemic inflammatory markers and cardiac troponin T which progressively increased over the next 4 weeks paralleled by an increase in ventricular premature contraction burden and thereafter started decreasing and returned to baseline by 6th week when the patient became COVID-19 negative by RT-PCR. Subsequently, a single-chamber automated implantable cardioverter-defibrillator implantation was done following which there was a transient increase in these biomarkers that subsided spontaneously. The patient is asymptomatic during 6 weeks of follow-up. Discussion COVID-19-associated cytokine surge triggering VT storm and unmasking a clinically silent ARVC has not yet been reported. The case highlights a life-threatening presentation of COVID-19 and indicates a probable link between inflammation and arrhythmogenicity.

Using Three-Dimensional Lorenz Scatter Plots to Detect Patients with Atrioventricular Node Double Path Caused by Interpolated Ventricular Premature Systoles: A Case Study

A series of related electrophysiology phenomena can be caused by the occurrence of interpolated ventricular prematurecontraction. In our recent three-dimensional Lorenz R-R scatter plot research, we found that atrioventricular nodedouble path caused by interpolated ventricular premature contraction imprints a specific pattern on three-dimensionalLorenz plots generated from 24-hour Holter recordings. We found two independent subclusters separated from the interpolated premature beat precluster, the interpolated premature beat cluster, and the interpolated premature beat postcluster, respectively. Combined with use of the trajectory tracking function and the leap phenomenon, our results reveal the presence of the atrioventricular node double conduction path.

Utility of novel Omnipolar activation mapping for the detection of ventricular premature contraction origin

Background Bipolar electrograms are significantly influenced by direction of the propagating wavefront in relation to the recording bipole. Omnipolar voltage mapping may be superior to standard bipolar mapping since it obtains maximum voltage of all possible bipolar electrode orientations without the need for catheter rotation. Therefore, omnipolar maps can provide voltage maps with larger voltages as well as better defined boundaries. Purpose Whether omnipolar activation maps also describe better activation maps versus traditional bipolar maps during ventricular premature contraction (VPC) catheter ablation is unclear. Methods A high-density mapping catheter was advanced to the ventricular outflow tract and a high-resolution activation map was created. Each electrode along and across the splines of the catheter are 4mm apart. Bipoles were calculated along (MAP 2), across (MAP 3) and bidirectional (MAP 4) the splines while omnipoles (MAP 1) were derived from a right triangle clique. Within a square area, four omnipolar and two bipolar values along, across and bidirectional values were defined. Results Though the earliest activation site was vague by along and across maps (arrow), white color became evident by bidirectional map, and the VPC origin became distinct with omnipolar mapping. RF lesions were given via an open-irrigated ablation catheter targeting a lesion size index 5.0. The VPC was eliminated by radiofrequency ablation. Conclusion Omnipolar activation mapping may be more accurate than traditional bipolar mapping during ventricular premature contraction (VPC) catheter ablation. Figure 1 Funding Acknowledgement Type of funding source: None

A STUDY OF 100 CASES OF ARRYTHMIAS IN FIRST WEEK OF ACUTE MYOCARDIAL INFARCTION

BACKGROUND: Incidence of Arrhythmia in first week of Acute myocardial infarction. AIM To study the incidence of arrhythmias in the first week of Acute Myocardial Infarction (AMI) with respect to type of arrhythmia, age distribution, sex and location of infarction, various risk factors in a patient population from western India and to evaluate its prognostic value and relation of complications with incidence of arrhythmias. METHOD : Hundred cases of AMI with arrhythmia admitted in ICCU of G K GENERAL HOSPITAL – GAIMS , BHUJ were taken in the study. RESULT: • Among 100 cases, maximum incidence (40%) was found in 6th decade. Incidence of a rrhythmias was higher in males (81%) than females (19%). Anterior wall infarcts (61%) were more common than inferior wall (36%). Ventricular Premature Contraction (VPC) was the commonest arrhythmia is anterior wall MI (45.9%) and in inferior wall MI (19.4%). CONCLUSION : • Hence, in one of the largest study of this kind in a patient population of Western India, we established VPC’s as the most common arrhythmia in AMI patients. Older patients (sixth decade) and males are affected more commonly. Ventricular tachycardia is more fatal in acute inferior wall MI.

Chinese Herbal Medicine Dingji Fumai Decoction for Ventricular Premature Contraction: A Real-World Trial

Background. Chinese herbal medicine Dingji Fumai Decoction (DFD) is widely clinically used for ventricular premature contraction (VPC). This real-word trial was designed to assess the safety and effectiveness of DFD for VPC. Methods. This was a double-blinded, randomized placebo-controlled trial. Patients with VPC were randomized (1 : 1) to treatment with DFD combined with metoprolol (DFD arm) or metoprolol combined with placebo (MET arm). A primary end point was a composite of clinical symptoms and signs determined by the traditionalChinese medicine syndrome score and the number of VPC determined by the Holter examination. Second outcomes were adverse events, medication compliance, and laboratory examination. Results. 144 patients were randomized to DFD arm (76 patients) or MET arm (68 patients), and 136 cases (71 in DFD arm and 65 in MET arm) finally completed this trial. After a 12-week follow-up, DFD arm significantly decreased traditional Chinese medicine syndrome score and the number of VPC compared with MET arm (P=0.003 and 0.034, respectively). There was no adverse drug effect and patient medication compliance was good. Conclusions. Superiority with DFD arm for VPC was demonstrated over MET arm for both the safety and effectiveness end points.

Design of a Wearable 12-Lead Noncontact Electrocardiogram Monitoring System

A standard 12-lead electrocardiogram (ECG) is an important tool in the diagnosis of heart diseases. Here, Ag/AgCl electrodes with conductive gels are usually used in a 12-lead ECG system to access biopotentials. However, using Ag/AgCl electrodes with conductive gels might be inconvenient in a prehospital setting. In previous studies, several dry electrodes have been developed to improve this issue. However, these dry electrodes have contact with the skin directly, and they might be still unsuitable for patients with wounds. In this study, a wearable 12-lead electrocardiogram monitoring system was proposed to improve the above issue. Here, novel noncontact electrodes were also designed to access biopotentials without contact with the skin directly. Moreover, by using the mechanical design, this system allows the user to easily wear and take off the device and to adjust the locations of the noncontact electrodes. The experimental results showed that the proposed system could exactly provide a good ECG signal quality even while walking and could detect the ECG features of the patients with myocardial ischemia, installation pacemaker, and ventricular premature contraction.