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Ventricular Contractions (ventricular + contraction)
Kinds of Ventricular Contractions Selected AbstractsMapping and Ablation of Trigger Premature Ventricular Contractions in a Case of Electrical Storm Associated with Ischemic CardiomyopathyPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 3 2007TARO OKADA M.D. We report a case of polymorphic ventricular tachycardia and ventricular fibrillation (PVT/VF) storm associated with ischemic cardiomyopathy (ICM). The electrocardiogram (ECG) monitor revealed frequent premature ventricular contractions (PVCs) initiated PVT/VF. Electroanatomic mapping revealed the plausible origins of PVCs were located in the scar border zone at the posterior septum of the left ventricle. Purkinje-like potentials (PLPs) always preceded PVCs and a decremental property for the PLPs and infarcted myocardium junction was observed. Ablation at these sites eliminated both PVCs and PVT/VF. [source] Quality of Life and Cost for Patients with Premature Ventricular Contractions by Radiofrequency Catheter AblationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 4 2006CONG-XIN HUANG Objective: To evaluate the quality of life (QoL), health-care resource utilization, and cost for the patients with premature ventricular contractions (PVCs) by radiofrequency catheter ablation (RFCA). Methods: RFCA was performed in 58 patients with symptomatic PVCs that were refractory/easy to medication. A 24-hour ambulatory electrocardiographic monitoring, QoL, health-care resources utilization, and cost were assessed at a screening visit and 3 and 12 months after RFCA. Results: RFCA was successfully performed in 56 patients (96.6%). This resulted in a significant improvement in the QoL at 3 and 12 months after the procedure. There were no major complications related to the procedure. Nine patients (15.5%) had residual arrhythmia. Seven of them underwent repeated ablation with successful results. It also improved the QoL and reduced health-care resource utilization and cost. Conclusions: RFCA is a safe and effective treatment for PVCs, and it is a viable alternative to drugs in the presence of disabling symptoms. [source] Rest Premature Ventricular Contractions on Routine ECG and Prognosis in Heart Failure PatientsANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 1 2010Vy-Van Le M.D. Background: Premature ventricular contractions (PVC) at rest are frequently seen in heart failure (HF) patients but conflicting data exist regarding their importance for cardiovascular (CV) mortality. This study aims to evaluate the prognostic value of rest PVCs on an electrocardiogram (ECG) in patients with a history of clinical HF. Methods and Results: We considered 352 patients (64 ± 11 years; 7 females) with a history of clinical HF undergoing treadmill testing for clinical reasons at the Veterans Affairs Palo Alto Health Care System (VAPAHCS) (1987,2007). Patients with rest PVCs were defined as having ,1 PVC on the ECG prior to testing (n = 29; 8%). During a median follow-up period of 6.2 years, there were 178 deaths of which 76 (42.6%) were due to CV causes. At baseline, compared to patients without rest PVCs, those with rest PVCs had a lower ejection fraction (EF) (30% vs 45%) and the prevalence of EF , 35% was higher (75% vs 41%). They were more likely to have smoked (76% vs 55%). The all-cause and CV mortality rates were significantly higher in the rest PVCs group (72% vs 49%, P = 0.01 and 45% vs 20%, P = 0.002; respectively). After adjusting for age, beta-blocker use, rest ECG findings, resting heart rate (HR), EF, maximal systolic blood pressure, peak HR, and exercise capacity, rest PVC was associated with a 5.5-fold increased risk of CV mortality (P = 0.004). Considering the presence of PVCs during exercise and/or recovery did not affect our results. Conclusion: The presence of PVC on an ECG is a powerful predictor of CV mortality even after adjusting for confounding factors. Ann Noninvasive Electrocardiol 2010;15(1):56,62 [source] ABSENCE OF CORRELATION BETWEEN QRS DURATION AND ECHOGRAPHIC PARAMETERS OF VENTRICULAR DESYNCHRONIZATION.ECHOCARDIOGRAPHY, Issue 2 2004CAN WE STILL TRUST THE ELECTROCARDIOGRAPHIC CRITERIA? Background: Identification of the responder candidates for multisite pacing is still difficult and severe heart failure, dilated left ventricle with reduced ejection fraction, prolonged QRS with left bundle branch block (LBBB) are still considered the principal indicators of ventricular desynchronization. The aim of the study was to assess if echographic ventricular desynchronization parameters measured in patients with dilated cardiomyopathy and severe heart failure are correlated with the duration of the QRS on surface electrocardiogram. Methods: This study included 51 patients aged 58.8 ± 7.4 years with idiopathic DCM. The following parameters were measured: QRS duration; effective contraction time (ECT) measured as the interval between QRS onset and closure of aortic valve, interventricular delay (IVD) measured as the time between onset of aortic and pulmonary flow, left ventricular mechanical delay (LVD) as the time from maximal interventricular septum contraction and posterior wall contraction, posterior (P), lateral (L), and posterolateral (PL) wall delays, as the time from QRS onset to maximal wall contraction. Regional post-systolic contraction was defined in a given wall as the difference (contraction delay , ECT)> 50 ms. Results: 29 patients presented complete LBBB, 22 patients had QRS duration < 120 ms. 39 patients had a post-systolic contraction of the PL wall (32 patients of the L wall and 26 patients of the P wall). 16 patients with QRS duration <120 had a post-systolic contraction of the PL wall (as for the LBBB the rest of 39 patients). In 40 patients the sequence of regional ventricular contraction was: P-L-PL wall (16 patients with QRS < 120). LVD was > 100 ms in 36 patients (26 patients with LBBB and 10 with QRS < 120). 27 patients with LBBB and 6 with QRS < 120 ms presented IVD > 30 ms. There was no correlation between the QRS duration and the parameters listed above. Conclusions: In a population of patients with severe heart failure and dilated cardiomyopathy there is no correlation between the duration of the QRS and echocardiographic parameters of ventricular desynchronization. These results show that mechanical ventricular desynchronization can be observed in patients with a QRS duration < 120 ms. Further studies are needed to evaluate if this population could beneficiate of multisite pacing therapy. [source] Fetal and offspring arrhythmia following exposure to nicotine during pregnancyJOURNAL OF APPLIED TOXICOLOGY, Issue 1 2010Yu Feng Abstract Although recent studies have demonstrated prenatal nicotine can increase cardiovascular risk in the offspring, it is unknown whether exposure to nicotine during pregnancy also may be a risk for development of arrhythmia in the offspring. In addition, in previous studies of fetal arrhythmia affected by smoking, only two patterns, bradycardia and tachycardia, were observed. The present study examined acute effects of maternal nicotine on the fetal arrhythmia in utero, and chronic influence on offspring arrhythmia at adult stage following prenatal exposure to nicotine. Nicotine was administered to pregnant ewes and rats. In the fetal sheep, intravenous nicotine not only induced changes of fetal heart rate, but also caused cardiac cycle irregularity, single and multiple dropped cardiac cycles. Although maternal nicotine had no influence on fetal blood pH, lactic acid, hemocrit, Na+, K+ levels and plasma osmolality, fetal blood PO2 levels were significantly decreased following maternal nicotine in ewes. In offspring rats at 4,5 months after birth, prenatal exposure to nicotine significantly increased heart rate and premature ventricular contraction in restraint stress. In addition, arrhythmias induced by injection of nicotine were higher in the offspring prenatal exposure to nicotine in utero. The results provide new evidence that exposure to nicotine in pregnancy can cause fetal arrhythmia in various patterns besides tachycardia and bradycardia, the possible mechanisms for nicotine-induced fetal arrhythmia included in utero hypoxia. Importantly, following exposure to nicotine significantly increased risk of arrhythmia in the adult offspring. The finding offers new insight for development of cardiac rhythm problems in fetal origins. Copyright © 2009 John Wiley & Sons, Ltd. [source] Iso-S -petasin, a hypotensive sesquiterpene from Petasites formosanus, depresses cardiac contraction and intracellular Ca2+ transients in adult rat ventricular myocytesJOURNAL OF PHARMACY AND PHARMACOLOGY: AN INTERNATI ONAL JOURNAL OF PHARMACEUTICAL SCIENCE, Issue 1 2003Lucy B. Esberg ABSTRACT Petasites formosanus is an indigenous species of the medicinal plant Petasites which has been used to treat hypertension. Both S -petasin and its isoform iso-S -petasin have been shown to be the effective ingredients in P. formosanus. However, their effect on heart function has not been revealed. This study was to examine the effect of iso-S -petasin on cardiac contractile function at the myocyte level. Ventricular myocytes were isolated from adult rat hearts and were stimulated to contract at 0.5 Hz under 1.0 mm extracellular Ca2+. Contractile properties were evaluated using an lonOptix MyoCam system including peak shortening (PS), time to PS (TPS), time to 90% re-lengthening (TR90) and maximal velocity of shortening/re-lengthening (±dL/dt). Intracellular Ca2+ properties were assessed by fura-2 and presented as Ca2+ -induced Ca2+ release (CICR) and intracellular Ca2+ decay. Acute application of iso-S -petasin (10,7 to 10,4 M) elicited a concentration-dependent inhibition in PS and CICR, with maximal inhibitions of 51.0% and 31.0%, respectively. iso-S -petasin also induced a concentration-dependent inhibition of ± dL/dt without affecting TPS, TR90, baseline intracellular Ca2+ level or intracellular Ca2+ decay. Elevation of extracellular Ca2+ from 1.0 mm to 2.7 mm significantly antagonized the iso-S -petasin-induced depression in PS and CICR. These results demonstrated a direct depressant action of iso-S -petasin on ventricular contraction, which may work in concert with its antihypertensive action to reduce the cardiac load. The iso-S -petasin-induced decrease in CICR may play a role in its cardiac depressant effect. [source] Addition of a Left Ventricular Lead to Conventional Pacing Systems in Patients with Congestive Heart Failure: Feasibility, Safety, and Early Results in 60 Consecutive PatientsPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 8 2002CINDY M. BAKER BAKER, C.M., et al.: Addition of a Left Ventricular Lead to Conventional Pacing Systems in Patients with Congestive Heart Failure: Feasibility, Safety, and Early Results in 60 Consecutive Patients. Left bundle branch block worsens congestive heart failure (CHF) in patients with LV dysfunction. Asynchronous LV activation produced by RV apical pacing leads to paradoxical septal motion and inefficient ventricular contraction. Recent studies show improvement in LV function and patient symptoms with biventricular pacing in patients with CHF. The aim of this study was to determine the feasibility, safety, acute efficacy, and early effect on symptoms of the upgrade of a chronically implanted RV pacing system to a biventricular system. Sixty patients with NYHA Class III and IV underwent the upgrade procedure using commercially available leads and adapters. The procedure succeeded in 54 (90%) of 60 patients. Acute LV stimulation thresholds obtained from leads placed along the lateral LV wall via the coronary sinus compare favorably to those reported in current biventricular pacing trials. The complication rate was low (5/60, 8.3%): lead dislodgement (n = 1), pocket hematoma (n = 1), and wound infections (n = 3). During 18 months of follow-up (16.7%) of 60 patients died. Two patients that died failed the initial upgrade attempt. At 3-month follow-up, quality of life scores improved 31 ± 28 points (n = 29), P < 0.0001). NYHA Class improved from 3.4 ± 0.5 to 2.4 ± 0.7 (P = < 0.0001) and ejection fraction increased from 0.23 ± 0.8 to 0.29 ± 0.11 (P = 0.0003). Modification of RV pacing to a biventricular system using commercially available leads and adapters can be performed effectively and safely. The early results of this study suggest patients may benefit from this procedure with improved functional status and quality of life. [source] Adenosine-Induced Ventricular Arrhythmias in Patients with Supraventricular TachycardiasANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 4 2008Cagatay Ertan M.D. Background: Adenosine is widely used for the diagnosis and the termination of supraventricular arrhythmias. There are many case reports and few series about the proarrhythmic potential of adenosine. We sought to evaluate the proarrhythmic potential of adenosine used to terminate the supraventricular arrhythmias. Methods: The records of all patients that received adenosine for the termination of supraventricular tachycardia were reviewed retrospectively and those with a continuous electrocardiographic (ECG) recording during adenosine administration were included to the study. Results: Our search identified 52 supraventricular episodes of 46 patients with a continuous ECG recording during adenosine administration. Following adenosine administration, premature ventricular contraction (PVC) or ventricular tachycardia (VT) developed in 22 (47.8%) patients and in 26 (50%) tachycardia episodes. No patient had a sustained VT. Nonsustained VT developed in eight (17.4%) patients. All VT episodes were polymorphic, short, and self-terminating. When the basal and demographic properties of patients with PVC or VT and those without PVT or VT were compared, there was no significant difference. Conclusions: Adenosine is a quite safe and effective drug for the termination of narrow QRS complex tachycardia but it often induces nonsustained VT or PVC that are clinically insignificant in the absence of other accompanying heart disease. [source] Idiopathic Ventricular Tachycardia Originating from the Posteroseptal Mitral Annulus: A Case ReportJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 12 2006KEIICHI ASHIKAGA M.D. We describe a 71-year-old man with a ventricular tachycardia (VT) originating from the mitral annulus. A sustained VT was induced by exercise or an isoproterenol administration, but not by pacing. Frequent premature ventricular contractions (PVCs) with the same QRS as the VT were transiently suppressed by an adenosine triphosphate injection, suggesting that it was due to cyclic-AMP mediated triggered activity. The PVCs and VT were all abolished by radiofrequency catheter ablation guided by the earliest activation and a perfect pace map, which was located at the posteroseptal mitral annulus. The patient has been free from any symptoms for 2 years. [source] Site-Specific Arrhythmogenesis in Patients with Brugada SyndromeJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 4 2003HIROSHI MORITA M.D. Introduction: It has been believed that electrophysiologic abnormality of the epicardial region of the right ventricular free wall may play an important role in arrhythmogenesis of phase 2 reentry in Brugada syndrome, but clinical evidence of the occurrence of ventricular arrhythmias at the right ventricular free wall has not been evaluated. In this study, we evaluated the site-specific inducibility of ventricular fibrillation (VF) and the origin of spontaneous premature ventricular contractions (PVCs) in patients with Brugada syndrome. Methods and Results. Forty-five patients with Brugada-type ECG were enrolled in this study. Spontaneous PVCs were recorded in 9 patients. Programmed electrical stimulation (PES) was performed at the right ventricular apex (RVA), the free wall and septal region of the right ventricular outflow tract (RVOT), and the left ventricle (LV). The inducibility of PVT/VF was evaluated at each ventricular site, and the origin of PVC was determined by pace mapping. Sustained VF was induced in 17 patients. VF was induced in all 17 patients by PES at RVOT. Although PES at the septal region of the RVOT induced VF in only 5 patients (29%), PES at the free-wall region of the RVOT induced PVT/VF in 13 patients (76%). PES at RVA induced VF in only 2 patients (12%), and PES at LV failed to induce any arrhythmic events. Ventricular pace mapping showed that 64% of PVCs occurred at the free-wall region of the RVOT, 18% at the septal region of the RVOT, 9% at RVA, and 9% at LV. Conclusion: VF in patients with Brugada syndrome frequently is induced at the free-wall region of the RVOT area. The origin of PVC appears to be related to the site of PVT/VF induction by PES.(J Cardiovasc Electrophysiol, Vol. 14, pp. 373-379, April 2003) [source] Fetal arrhythmia: Prenatal diagnosis and perinatal managementJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 4 2009Yasuki Maeno Abstract The importance of managing fetal arrhythmia has increased over the past three decades. Although most fetal arrhythmias are benign, some types cause fetal hydrops and can lead to fetal death. With the aim of improving the outcome in such cases, various studies for prenatal diagnosis and perinatal management have been published. Detailed analysis of the type of arrhythmia in utero is possible using M-mode and Doppler echocardiography. In particular, a simultaneous record of Doppler waveform at the superior venous cava and the ascending aorta has become an important and useful method of assessing the interval between atrial and ventricular contractions. Common causes of fetal tachycardia (ventricular heart rate faster than 180 bpm), are paroxysmal supraventricular tachycardia (SVT) with 1:1 atrioventricular (AV) relation and atrial flutter with 2:1 AV relation. Of fetal SVT, short ventriculo-atrial (VA) interval tachycardia due to atrioventricular reentrant tachycardia is more common than long VA interval. Most fetuses with tachycardia are successfully treated in utero by transplacental administration of antiarrhythmic drugs. Digoxin is widely accepted as a first-line antiarrhythmic drug. Sotalol, flecainide and amiodarone are used as second-line drugs when digoxin fails to achieve conversion to sinus rhythm. Fetal bradycardia is diagnosed when the fetal ventricular heart rate is slower than 100 bpm, mainly due to AV block. Approximately half of all cases are caused by associated congenital heart disease, and the remaining cases that have normal cardiac structure are often caused by maternal SS-A antibody. The efficacy of prenatal treatment for fetal AV block is limited compared with treatment for fetal tachycardia. Beta stimulants and steroids have been reported as effective transplacental treatments for fetal AV block. Perinatal management based on prospective clinical study protocol rather than individual experience is crucial for further improvement of outcome in fetuses with tachycardia and bradycardia. [source] Real-time Integration of Intracardiac Echocardiography and Electroanatomic Mapping in PVCs Arising from the LV Anterior Papillary MusclePACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 9 2009Ph.D., TAKUMI YAMADA M.D. A 54-year-old woman with idiopathic premature ventricular contractions (PVCs) underwent electrophysiological testing. Three-dimensional (3D) geometries of the papillary muscles and chamber of the left ventricle (LV) were reconstructed using a CARTO-based 3D ultrasound imaging system (Biosense Webster Inc., Diamond Bar, CA, USA) during the PVCs. Activation mapping in the LV was then performed during the PVCs and the activation map revealed the earliest ventricular activation on the anterior papillary muscle. An irrigated radiofrequency current delivered at that site with guidance from that system eliminated the PVCs. This case may suggest that the guidance system may be feasible and useful for catheter ablation of PVCs arising from uncommon sites. [source] Role of Left Ventricular Scar and Purkinje-Like Potentials During Mapping and Ablation of Ventricular Fibrillation in Dilated CardiomyopathyPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 3 2009ANIL-MARTIN SINHA M.D., D.Phil. Background: Purkinje-like potentials (PLPs) have been described as important contributors to initiation of ventricular fibrillation (VF) in patients with normal hearts, ischemic cardiomyopathy, and early after-myocardial infarction. Methods: Of the 11 consecutive patients with VF storm, nonischemic cardiomyopathy (68 ± 22 years, left ventricular ejection fraction 28 ± 8%) who were given antiarrhythmic drugs and/or heart failure management, five had recurrent VF and underwent electrophysiology study (EPS) and catheter ablation. Results: At EPS, frequent monomorphic premature ventricular contractions (PVC) and/or ventricular tachycardia did not occur. With isoproterenol, VF was induced in three patients, and sustained monomorphic PVCs were induced in one patient. Three-dimensional electroanatomical mapping using CARTO (Biosense-Webster Inc., Diamond Bar, CA) revealed posterior wall scar in four of the five patients. PLP in sinus rhythm were recorded around the scar border in these four patients, and radiofrequency ablation targeting PLP was successfully performed at these sites. The patient without PLP did not undergo ablation. During follow-up (12 ± 5 months), only the patient without PLP had four VF recurrences requiring implantable cardioverter-defibrillator (ICD) shocks. Conclusion: In patients with VF and dilated cardiomyopathy, left ventricular posterior wall scar in the vicinity of the mitral annulus seems to be a common finding. Targeting PLP along the scar border zone for ablation seems to efficiently prevent VF recurrence in these patients. [source] Mapping and Ablation of Trigger Premature Ventricular Contractions in a Case of Electrical Storm Associated with Ischemic CardiomyopathyPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 3 2007TARO OKADA M.D. We report a case of polymorphic ventricular tachycardia and ventricular fibrillation (PVT/VF) storm associated with ischemic cardiomyopathy (ICM). The electrocardiogram (ECG) monitor revealed frequent premature ventricular contractions (PVCs) initiated PVT/VF. Electroanatomic mapping revealed the plausible origins of PVCs were located in the scar border zone at the posterior septum of the left ventricle. Purkinje-like potentials (PLPs) always preceded PVCs and a decremental property for the PLPs and infarcted myocardium junction was observed. Ablation at these sites eliminated both PVCs and PVT/VF. [source] Relationship Between Global Myocardial Index and Automatic Left Ventricular Border Detection Pattern to Identify Biventricular Pacing CandidatesPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2007DRAGOS COZMA M.D., Ph.D. Objective of the Study: to evaluate the relation between global myocardial index (GMI) and the pattern of left ventricular (LV) volume curves variation, using automatic border detection (ABD), and their role in assessing LV asynchrony. Methods: We studied 52 patients (mean age = 55 ± 17 years) with dilated cardiomyopathy. QRS duration (QRSd) and GMI were measured. Currently accepted TDI and M-mode parameters were used to indicate LV dyssynchrony. On-line continuous LV volume changes were recorded using ABD. Ejection time (ET ABD) was measured from the ABD wave-forms as time interval between maximal and minimal volume variation during LV electromechanical systole. We derived the ejection time index (ETiABD) as the ratio between ET ABD and RR interval (ETiABD = ET/RR). Results: 31 patients had a QRSd >120 ms and 21 patients had a QRSd <120 ms. Ventricular dyssynchrony was observed in 39 patients (29 patients had a QRSd > 120 ms). GMI was significantly higher in patients with, than in patients without ventricular dyssynchrony (1.06 ± 0.18 vs 0.73 ± 0.13, P = 0.0001), while ETABD was significantly smaller (233 ± 39 ms vs 321 ± 28 ms, P = 0.0001). The corresponding difference for ETiABD was 26.9 ± 6.8% vs 6.3 ± 4%, P < 0.0001. By simple regression analysis an inverse linear correlation was observed between GMI and ETiABD (r2=,0.51, P < 0.0001). The pattern of ABD waveforms showed increased isovolumic contraction and relaxation times in patients with LV asynchrony, similar to the GMI pattern. Conclusions: Regional delays in ventricular activation cause uncoordinated and prolonged ventricular contractions, with lengthening of the isovolumic contraction and relaxation times and shortening of the time available for filling and ejection. GMI explores these parameters and together with ABD might be useful to identify patients with ventricular asynchrony. [source] Quality of Life and Cost for Patients with Premature Ventricular Contractions by Radiofrequency Catheter AblationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 4 2006CONG-XIN HUANG Objective: To evaluate the quality of life (QoL), health-care resource utilization, and cost for the patients with premature ventricular contractions (PVCs) by radiofrequency catheter ablation (RFCA). Methods: RFCA was performed in 58 patients with symptomatic PVCs that were refractory/easy to medication. A 24-hour ambulatory electrocardiographic monitoring, QoL, health-care resources utilization, and cost were assessed at a screening visit and 3 and 12 months after RFCA. Results: RFCA was successfully performed in 56 patients (96.6%). This resulted in a significant improvement in the QoL at 3 and 12 months after the procedure. There were no major complications related to the procedure. Nine patients (15.5%) had residual arrhythmia. Seven of them underwent repeated ablation with successful results. It also improved the QoL and reduced health-care resource utilization and cost. Conclusions: RFCA is a safe and effective treatment for PVCs, and it is a viable alternative to drugs in the presence of disabling symptoms. [source] Rest Premature Ventricular Contractions on Routine ECG and Prognosis in Heart Failure PatientsANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 1 2010Vy-Van Le M.D. Background: Premature ventricular contractions (PVC) at rest are frequently seen in heart failure (HF) patients but conflicting data exist regarding their importance for cardiovascular (CV) mortality. This study aims to evaluate the prognostic value of rest PVCs on an electrocardiogram (ECG) in patients with a history of clinical HF. Methods and Results: We considered 352 patients (64 ± 11 years; 7 females) with a history of clinical HF undergoing treadmill testing for clinical reasons at the Veterans Affairs Palo Alto Health Care System (VAPAHCS) (1987,2007). Patients with rest PVCs were defined as having ,1 PVC on the ECG prior to testing (n = 29; 8%). During a median follow-up period of 6.2 years, there were 178 deaths of which 76 (42.6%) were due to CV causes. At baseline, compared to patients without rest PVCs, those with rest PVCs had a lower ejection fraction (EF) (30% vs 45%) and the prevalence of EF , 35% was higher (75% vs 41%). They were more likely to have smoked (76% vs 55%). The all-cause and CV mortality rates were significantly higher in the rest PVCs group (72% vs 49%, P = 0.01 and 45% vs 20%, P = 0.002; respectively). After adjusting for age, beta-blocker use, rest ECG findings, resting heart rate (HR), EF, maximal systolic blood pressure, peak HR, and exercise capacity, rest PVC was associated with a 5.5-fold increased risk of CV mortality (P = 0.004). Considering the presence of PVCs during exercise and/or recovery did not affect our results. Conclusion: The presence of PVC on an ECG is a powerful predictor of CV mortality even after adjusting for confounding factors. Ann Noninvasive Electrocardiol 2010;15(1):56,62 [source] Electrocardiographic Evaluation in Patients with Systemic Scleroderma and without Clinically Evident Heart DiseaseANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 3 2009Anna Bie, Ph.D., ous-Wilk M.D. Background: In patients with systemic scleroderma (SSc), clinically evident cardiac involvement is recognized to be a poor prognostic factor. The aim of the study was to evaluate electrocardiographic changes, parameters of heart rate variability (HRV), and heart rate turbulence (HRT) in patients with SSc without evident symptoms of heart disease. Methods: A group of 27 patients with SSc were subjected to standard electrocardiography (ECG) examination and 24-hour Holter monitoring. Analysis of HRV in time and frequency domains, HRT, and echocardiography were also performed. Results: Holter monitoring revealed a larger number of premature supraventricular contractions (PSVCs), as well as premature ventricular contractions (PVCs) in the patients with systemic scleroderma, as compared with the control group. Moreover, the SSc patients showed decreased parameters of time and frequency domains, as referred to the controls, especially during night hours. In four patients, abnormal HRT values were present. On echocardiography, only slight changes were found, however in five patients left ventricle diastolic dysfunction was diagnosed. Conclusions: The noninvasive electrocardiographic methods seems to be useful for detecting early heart involvement in course of SSc and could be recommended for routine used in clinical practice. Significance of HRT analysis in patients with SSc needs further elucidation. [source] Positional premature ventricular contractions due to lead tractionCLINICAL CARDIOLOGY, Issue 10 2006Karl-Heinrich Scholz M.D. No abstract is available for this article. [source] Effects of intravenous dofetilide in patients with frequent premature ventricular contractions: A clinical trialCLINICAL CARDIOLOGY, Issue 6 2000Peter E. Pool M.D. Abstract Background: Although suppression of premature ventricular contractions (PVCs) is not a predictor of mortality over the long term, the extent of PVC suppression is an important characteristic of any antiarrhythmic drug. Hypothesis: This study was undertaken to determine whether intravenous (IV) dofetilide has the ability to suppress PVCs in patients who have frequent occurrences. Methods: Subjects were men and women, aged 18 to 75 years, with > 30 PVCs/h on two consecutive 24-h Holter recordings while drug free, and > 50 PVCs/h during a 2-hour telemetric electrocardiogram. The study was randomized, double-blind, and placebo controlled. Subjects received a single-blind, IV infusion of placebo and were randomized (3:1) to receive a double-blind second infusion of placebo or an infusion of dofetilide (a 15-min loading infusion of 4 g/kg followed by a 60-min maintenance infusion of 3.5 g/kg, for a total dose of 7.5 g/kg). Results: Dofetilide produced an 82.6% and placebo a 2.9% median reduction in PVCs. Drug responder rate, defined as 80% reduction in PVCs, was 50% in the dofetilide group and 0% in the placebo group. Conclusion: Intravenous dofetilide significantly reduced PVCs in patients who had > 30 PVCs/h at baseline, and it produced , 80% reduction in PVCs in 50% of all subjects. [source] | ||||||||||