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Ventricular Tachycardia (ventricular + tachycardia)
Kinds of Ventricular Tachycardia Terms modified by Ventricular Tachycardia Selected AbstractsVerapamil-sensitive Ventricular Tachycardia in an InfantCONGENITAL HEART DISEASE, Issue 3 2006Christopher Snyder MD ABSTRACT Patients., We report on a 6-month-old patient with a right bundle, superior axis tachycardia at 197 beats per minute. The tachycardia was unresponsive to adenosine, propranolol, flecainide, or amiodarone, or synchronized cardioversion. Overdrive atrial pacing terminated the tachycardia and since initiating verapamil, no recurrences of his tachycardia have occurred. Conclusions., If an infant presents with a right bundle, superior axis ventricular tachycardia unresponsive to multiple antiarrhythmic medications and synchronized cardioversion, but responsive to overdrive atrial pacing, one must consider verapamil-sensitive ventricular tachycardia and initiate appropriate therapy. [source] Amiodarone or Procainamide for the Termination of Sustained Stable Ventricular Tachycardia: An Historical Multicenter ComparisonACADEMIC EMERGENCY MEDICINE, Issue 3 2010Keith A. Marill MD Abstract Objectives:, The objective was to compare the effectiveness of intravenous (IV) procainamide and amiodarone for the termination of spontaneous stable sustained ventricular tachycardia (VT). Methods:, A historical cohort study of consecutive adult patients with stable sustained VT treated with IV amiodarone or procainamide was performed at four urban hospitals. Patients were identified for enrollment by admissions for VT and treatment with the study agents in the emergency department (ED) from 1993 to 2008. The primary measured outcome was VT termination within 20 minutes of onset of study medicine infusion. A secondary effectiveness outcome was the ultimate need for electrical therapy to terminate the VT episode. Major adverse effects were tabulated, and blood pressure responses to medication infusions were compared. Results:, There were 97 infusions of amiodarone or procainamide in 90 patients with VT, but the primary outcome was unknown after 14 infusions due to administration of another antidysrhythmic during the 20-minute observation period. The rates of VT termination were 25% (13/53) and 30% (9/30) for amiodarone and procainamide, respectively. The adjusted odds of termination with procainamide compared to amiodarone was 1.2 (95% confidence interval [CI] = 0.4 to 3.9). Ultimately, 35/66 amiodarone patients (53%, 95% CI = 40 to 65%) and 13/31 procainamide patients (42%, 95% CI = 25 to 61%) required electrical therapy for VT termination. Hypotension led to cessation of medicine infusion or immediate direct current cardioversion (DCCV) in 4/66 (6%, 95% CI = 2 to 15%) and 6/31 (19%, 95% CI = 7 to 37%) patients who received amiodarone and procainamide, respectively. Conclusions:, Procainamide was not more effective than amiodarone for the termination of sustained VT, but the ability to detect a significant difference was limited by the study design and potential confounding. As used in practice, both agents were relatively ineffective and associated with clinically important proportions of patients with decreased blood pressure. ACADEMIC EMERGENCY MEDICINE 2010; 17:297,306 © 2010 by the Society for Academic Emergency Medicine [source] Patients with Scar-Related Right Ventricular Tachycardia: Determinants of Long-Term OutcomeJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 10 2009ADRIANUS P. WIJNMAALEN M.D. Introduction: Patients with established arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) based on task force (TF) criteria and ventricular tachycardia (VT) are at risk of VT recurrence and sudden death. Data on patients with VT due to right ventricular (RV) scar not fulfilling TF criteria are lacking. The purpose of this study was to assess the long-term arrhythmia recurrence rate and outcome in patients with scar-related right VT with and without a diagnosis of ARVC/D. Methods: Sixty-four patients (age 43.5 ± 15 years, 49 males) presenting with nonischemic scar-related VT of RV origin were studied. Scar was identified by electroanatomical mapping, contrast echocardiography, and/or magnetic resonance imaging (MRI). Patients were evaluated and treated according to a standard institute protocol. Results: Twenty-nine (45%) patients were diagnosed with ARVC/D according to TF criteria (TF+) and 35 (55%) with RV scar of undetermined origin (TF,) at the end of follow-up (64 ± 42 months). Patients were treated with antiarrhythmic drugs, radiofrequency catheter ablation, and/or implantable cardioverter-defibrillator (ICD) implantation. VT recurrence-free survival for TF+ and TF, was 76% versus 74% at 1 year and 45% versus 50% at 4 years (P = ns). Patients with fast index VT (cycle length [CL], 250 ms, n = 31) were more likely to experience a fast VT during follow-up than patients with a slow index VT (CL > 250 ms, n = 33) (61% vs 3%, P < 0.001). Conclusions: Scar-related RV VTs have a high recurrence rate in TF+ and TF, patients. Patients presenting with a fast index VT are at high risk for fast VT recurrence and may benefit most from ICD therapy. [source] Mode of Induction of Ventricular Tachycardia and Prognosis in Patients with Coronary Disease: The Multicenter UnSustained Tachycardia Trial (MUSTT)JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 8 2009JONATHAN P. PICCINI M.D. Introduction: Programmed stimulation is an important prognostic tool in the evaluation of patients with an ejection fraction ,40% after myocardial infarction. Many believe that ventricular tachycardia (VT) requiring 3 ventricular extrastimuli (VES) for induction is less likely to occur spontaneously and has less predictive value. However, it is unknown whether the mode of VT induction is associated with long-term prognosis. Methods and Results: We analyzed a cohort of 371 patients enrolled in MUSTT who had inducible monomorphic VT and who were not treated with antiarrhythmic drugs or an implantable cardioverter defibrillator during the trial. Patients in whom sustained VT was induced with 1 or 2 VES or burst pacing (single VES n = 15, double VES n = 127, burst n = 7, total n = 149) were compared with those in whom VT was induced with 3 VES (n = 222). Compared with the others, patients requiring 3 VES were closer to their most recent myocardial infarction (17 vs 51 months, P = 0.035) and showed a trend toward a lower ejection fraction (26% vs 30%, P = 0.057). VT requiring 3 VES had a shorter cycle length (240 vs 260 ms, P < 0.001). Despite these findings, there was no difference in the incidence of arrhythmic death or cardiac arrest (HR 1.02; 95% CI 0.69-1.51) or all-cause mortality (HR 1.03; 95% CI 0.76-1.39) according to the mode of induction in adjusted analyses. Conclusions: The prognostic significance of VT induced by 3 VES is similar to that of VT induced by 1 or 2 VES, or burst pacing, in patients with coronary disease and abnormal LV function. [source] Quantitative Analysis of the Duration of Slow Conduction in the Reentrant Circuit of Ventricular Tachycardia After Myocardial InfarctionJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 9 2008YI-GANG LI M.D. Background: Few data are available to define the circuits in ventricular tachycardia (VT) after myocardial infarction and the conduction time (CT) through the zone of slow conduction (SCZ). This study assessed the CT of the SCZ and identified different reentrant circuits. Methods: During VTs, concealed entrainment (CE) was attempted. The SCZ was identified by a difference between postpacing interval (PPI) and VT cycle length (VTcl) ,30 ms. Since the CT in the normally conducting part of the VT circuit is constant during VT and CE, a CE site within the reentrant circuit with (S-QRS)/PPI , 50% was classified as an inner reentry in which the entire circuit was within the scar, and a CE site with (S-QRS)/PPI < 50% as a common reentry in which part of the circuit was within the scar and part out of the scar. Results: CE was achieved in 20 VTs (12 patients). Six VTs (30%) with a (S-QRS)/PPI ,50% were classified as inner reentry and 14 VTs (70%) with a (S-QRS)/PPI <50% during CE mapping as common reentry. The EG-QRS interval (308 ± 73 ms vs 109 ± 59 ms, P < 0.0001) was significantly longer and the incidence of systolic potentials higher (4/6 vs 0/12, P < 0.001) in the inner reentry group. For the 14 VTs with a common reetry, the CT of the SCZ was 348 ± 73 ms, while the CT in the normal area was 135 ± 50 ms. Conclusion: According to the proposed classification, 30% of VTs after myocardial infarction had an entire reentrant circuit within the scar. In VTs with a common reentrant circuit, the CT of the SCZ is approximately four times longer than the CT in the normal area, accounting for more than 70% of VTcl. [source] The Proarrhythmic Effect of Incomplete Pulmotricuspid Isthmus Ablation in a Patient with Sarcoid-Related Ventricular Tachycardia?JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 8 2008ARASH ARYANA M.D. Proarrhythmia is relatively common after extensive atrial ablation for atrial fibrillation, but has not been frequently documented after catheter ablation of ventricular tachycardia (VT). In theory, this phenomenon could occur if an incomplete ablation line is created between two nonconducting structures, such as dense scar or valvular annuli. This report illustrates the possible proarrhythmic effect of ablation in a patient with sarcoid-related VT and extensive right ventricular (RV) myopathy who presented with slow incessant VT one month after an ablation procedure including ablation at the pulmotricuspid isthmus (PTI). The extensive preexisting RV myopathy appeared to be an important substrate in the pathogenesis of this patient's incessant VT. This case suggests that the PTI region may serve as a critical tachycardia isthmus if sufficiently modified with an incomplete ablation line in the setting of significant myocardial scarring. [source] The Morphology Changes in Limb Leads after Ablation of Verapamil-Sensitive Idiopathic Left Ventricular Tachycardia and Their Correlation with RecurrenceJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 3 2008SHU-YUAN YAO Ph.D Objectives: This study was designed to explore the morphology changes in limb leads of ECGs after successful ablation of verapamil sensitive idiopathic left ventricular tachycardia (ILVT) and their correlation with tachycardia recurrence. Methods: Between January 2001 and December 2006, 116 patients who underwent successful ablation of ILVT were included in the study. Twelve-lead surface ECG recordings during sinus rhythm were obtained in all patients before and after ablation to compare morphology changes in limb leads. Results: The ECG morphology changes after ablation were divided into two categories: one with new or deepening Q wave in inferior leads and/or disappearance of Q wave in leads I and aVL, and the other without change. The changes in any Lead II, III, or aVF after ablation occurred significantly more in patients without recurrence of ventricular tachycardia (VT) (P < 0.0001, 0.002, and 0.0001, respectively). The patients with recurrence of VT tended to have no ECG changes, compared with those without recurrence of VT (P = 0.009). The sensitivity of leads II, III, and aVF changes in predicting nonrecurrence VT were 66.7%, 78.7%, and 79.6%, specificity were 100%, 75%, and 87.5%, and nonrecurrence predictive value of 100%, 97.7%, and 98.9%, respectively. When inferior leads changes were combined, they could predict all nonrecurrence patients with 100% specificity. Conclusions: Successful radiofrequency ablation of ILVT could result in morphology changes in limb leads of ECG, especially in inferior leads. The combined changes in inferior leads can be used as an effective endpoint in ablation of this ILVT. [source] Predictors of All-Cause Mortality for Patients with Chronic Chagas' Heart Disease Receiving Implantable Cardioverter Defibrillator TherapyJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 12 2007AUGUSTO CARDINALLI-NETO M.D., Ph.D. Background: Implantable Cardioverter Defibrillators (ICD) have sporadically been used in the treatment of either Sustained Ventricular Tachycardia (VT) or Ventricular Fibrillation (VF) in Chagas' disease patients. This study aimed at determining predictors of all-cause mortality for Chagas' disease patients receiving ICD therapy. Methods and Results: Ninety consecutive patients were entered the study. Mean left ventricular ejection fraction was 47 ± 13%. Twenty-five (28%) patients had no left ventricular systolic dysfunction. After device implantation, all patients were given amiodarone (mean daily dose = 331, 1 ± 153,3 mg), whereas a B-Blocking agent was given to 37 (40%) out of 90 patients. Results: A total of 4,274 arrhythmias were observed on stored electrogram in 64 (71%) out of 90 patients during the study period; SVT was observed in 45 out of 64 (70%) patients, and VF in 19 (30%) out of 64 patients. Twenty-six (29%) out of 90 patients had no arrhythmia. Fifty-eight (64%) out of 90 patients received appropriate shock, whereas Antitachycardia Pacing was delivered to 58 (64%) out of 90 patients. There were 31 (34%) deaths during the study period. Five patients were lost to follow up. Sudden cardiac death affected 2 (7%) out of 26 patients, whereas pump failure death was detected in the remaining 24 (93%) patients. Number of shocks per patient per 30 days was the only independent predictor of mortality. Conclusion: Number of shocks per patient per 30 days predicts outcome in Chagas' disease patients treated with ICD. [source] Ventricular Tachycardia in Heterotopic Heart TransplantationJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 4 2007AXEL DE LABRIOLLE M.D. No abstract is available for this article. [source] Human Histopathology of Electroanatomic Mapping After Cooled-Tip Radiofrequency Ablation to Treat Ventricular Tachycardia in Remote Myocardial InfarctionJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 11 2005THOMAS DENEKE M.D. Introduction: Catheter ablation of ventricular tachycardia (VT) in remote myocardial infarction (MI) often requires excessive mapping procedures. Documentation of the electrical substrate via electrogram amplitude may help to identify regions of altered myocardium resembling exit areas of reentrant VTs. Methods and Results: A patient with multiple symptomatic monomorphic VTs (biventricular ICD, remote MI) underwent electroanatomic substrate mapping (CARTOÔ) for VT ablation. Regions of scar (bipolar electrogram amplitudes ,0.5 mV), normal myocardium (,1.5 mV), and "altered" myocardium (0.5,1.5 mV) were identified. Ablation was directed to regions with "altered" myocardium based on pace map correlation. After ablation the clinical VT did not reoccur. The patient died due to worsening of heart failure 7 days afterward. During postmortal evaluation specified sites of electroanatomic mapping were correlated to histopathological findings. Annotated scar areas were documented to consist of areas with massive fibrosis (,80% of mural composition). Ablations were found to span through regions with intermediate fibrosis (21,79%) mapped as "altered" myocardium. Ablation produced transmural coagulation necrosis of mesh-like fibrotic tissue with interspersed remnants of myocardial cells up to a maximum depth of 7.0 mm. Subendocardial intramural bleedings were universal findings 7 days after ablation. Conclusions: Electroanatomic substrate mapping for VT ablation sufficiently identified regions of scar and normal myocardium. Regions with bipolar electrogram amplitudes between 0.5 and 1.5 mV were found to correlate to areas of "intermediate" fibrosis (21,79%) with only remnant strands of myocardial cells and were identified as target region for ablation. Cooled-tip endocardial radiofrequency ablation lead to transmural coagulation necrosis up to a depth of 7.0 mm. [source] Epicardial Mapping and Ablation Techniques to Control Ventricular TachycardiaJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 4 2005EDUARDO SOSA M.D. First page of article [source] Termination of Epicardial Left Ventricular Tachycardia by Pacing without Global CaptureJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 1 2005ASEEM D. DESAI M.D. It is generally accepted that the diagnosis of an epicardial origin of ventricular tachycardia (VT) can be made indirectly by observing VT termination during ablation on the epicardial surface of the heart. There is a caveat, however, which is that termination of VT during radiofrequency current application on the epicardial surface could be due to extension of the lesion beyond the epicardium. Therefore, successful ablation of VT using an epicardial approach does not necessarily prove the reentrant circuit is located superficially. We present a case of a 44-year-old man with VT storm who demonstrated successful termination of VT with radiofrequency current application on the epicardial surface of the heart. This site corresponded to a site where pacing during VT resulted in termination of VT without global capture. Isolated mid-diastolic potentials were only seen at this site as well. We hypothesize that the finding of termination of VT by pacing without global capture supports the argument that the site of pacing is a critical part of the VT circuit. [source] Catheter Ablation of Ventricular Tachycardia in Remote Myocardial Infarction:JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 7 2003Substrate Description Guiding Placement of Individual Linear Lesions Targeting Noninducibility Introduction: The aim of this study was to describe the arrhythmogenic substrate in postinfarction patients with ventricular tachycardia (VT) guiding the placement of individual strategic linear lesions transecting all potential isthmuses using target area maps with limited mapping points to allow short procedure times. Methods and Results: In 28 patients with pleomorphic, unstable, and/or incessant VT, electroanatomic voltage mapping was performed in conjunction with limited sinus rhythm mapping, pace mapping, and activation mapping. Radiofrequency (RF) energy was applied directly within the low-voltage areas of the chronically infarcted areas or in the border zone. Ablation lines typically were perpendicular to the course of the presumed central common pathways. The maps consisted of 63 ± 30 mapping points. An average lesion line length of 46 ± 21 mm was placed with 17 ± 7 RF pulses. Twenty-two (79%) of the 28 patients were rendered completely noninducible at the end of the procedure. Procedure time measured 134 ± 41 minutes. No major complications were observed. Six (27%) of 22 patients who were rendered completely noninducible experienced VT recurrence during follow-up versus 4 (67%) of 6 patients who were still inducible after ablation (P = 0.06). Conclusion: Individually tailored substrate description guiding the placement of linear lesion lines transecting potential isthmuses rendered 80% of the patients completely noninducible. The construction of regional target area maps allowed short procedure times, with a resulting low incidence of complications in these critically ill patients. (J Cardiovasc Electrophysiol, Vol. 14, pp. 675-681, July 2003) [source] Gender Differences in Various Types of Idiopathic Ventricular TachycardiaJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 7 2002MIKIKO NAKAGAWA M.D. Gender Differences in Idiopathic VT.Introduction: The aim of this study was to evaluate gender differences in the incidence and age distribution of various types of idiopathic ventricular tachycardia (VT). Methods and Results: We conducted a search of the medical literature on idiopathic VT. According to their site of origin, we divided the VTs into three types: right ventricular outflow tract (RVOT-VT), left ventricular outflow tract (LVOT-VT), and left ventricular (LV) septum (LV-VT). We reviewed 68 articles and a total of 748 patients. Among RVOT-VT patients, there were more females than males (311 vs 153, male/female ratio 0.49). In LV-VT, males prevailed over females (175 vs 52, male/female ratio 3.37), whereas LVOT-VT was distributed almost equally between males (n = 33) and females (n = 24). To determine the age distribution, we assessed 419 patients from 51 studies. In both males and females, the highest incidence of RVOT-VT occurred in the third to fifth decade of life (males, mean 43.5 ± 18.7; females, mean 40.9 ± 13.8 years). LV-VT occurred at a younger age in both males and females than did RVOT-VT (mean 33.0 ± 13.9 and 25.7 ± 12.0 years, respectively, P < 0.0001 vs RVOT-VT). LV-VT occurred at a younger age in females than males (P < 0.005). Conclusion: Gender-specific differences exist in the incidence and age distribution of the various types of idiopathic VT. Studies on gender-specific differences in arrhythmia will lead to a better understanding of its mechanism(s) and provide valuable information for the development of optimal treatment strategies. [source] Gender Differences in Idiopathic Ventricular Tachycardia: Enhancing the DifferencesJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 7 2002FILIPPO LAMBERTI M.D. [source] Long-Term Follow-Up After Radiofrequency Catheter Ablation of Ventricular Tachycardia: A Successful Approach?JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 5 2002ALIDA E. BORGER VAN DER BURG M.D. RF Catheter Ablation of VT.Introduction: Radiofrequency ablation (RFCA) of ventricular tachycardia (VT) is a potential curative treatment modality. We evaluated the results of RFCA in patients with VT. Methods and Results: One hundred fifty-one consecutive patients (122 men and 29 women; age 57 ± 16 years) with drug-refractory VT were treated. Underlying heart disease was ischemic heart disease in 89 (59%), arrhythmogenic right ventricular cardiomyopathy (ARVC) in 32 (21%), and idiopathic VT in 30 (20%; left ventricle in 9 [30%]; right ventricle in 21 [70%]). Ablation was performed using standard ablation techniques. Three hundred six different VTs were treated (cycle length 334 ± 87 msec, 2.0 ± 1.4 VTs per patient). Procedural success (noninducibility of VT after RFCA) was achieved in 126 (83%) patients (70 ischemic heart disease [79%]; 28 ARVC [88%]; 27 idiopathic VT [93%]). Procedure-related complications (< 48 hours) occurred in 11 (7%) patients: death 3 (2.0%), cerebrovascular accident 2 (1.3%), complete heart block 4 (2.6%), and pericardial effusion 3 (2.0%). Thirty-three (22%) patients received an implantable cardioverter defibrillator (because of hemodynamic unstable VT, failure of the procedure, or aborted sudden death). During follow-up (34 ± 11 months), VT recurrences occurred in 38 (26%) patients (recurrence rate: 19% in successfully ablated patients and 64% in nonsuccessfully ablated patients; P < 0.001). During follow-up, 12 (8%) patients died (heart failure 8, unknown cause 1, noncardiac cause 3). Conclusion: RFCA of VT can be performed with a high degree of success (83%). The long-term outcome of successfully ablated patients is promising, with a 75% relative risk reduction compared with nonsuccessfully ablated patients. During follow-up, only one patient died suddenly, supporting a selective ICD placement approach in patients with hemodynamically stable VT. [source] Management of Patients with Hemodynamically Stable Ventricular Tachycardia in the Setting of Structural Heart DiseaseJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 5 2002BEHZAD B. PAVRI M.D. [source] Radiofrequency Catheter Ablation of Idiopathic Ventricular Tachycardia Originating in the Main Stem of the Pulmonary ArteryJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 3 2002CARL TIMMERMANS M.D. Idiopathic Pulmonary Artery Ventricular Tachycardia. We report the case of a patient in whom successful radiofrequency catheter ablation of an idiopathic ventricular tachycardia (VT) originating in the main stem of the pulmonary artery was performed. After successful ablation of the index arrhythmia, which was an idiopathic right ventricular outflow tract VT, a second VT with a different QRS morphology was reproducibly induced. Mapping of the second VT revealed the presence of myocardium approximately 2 cm above the pulmonary valve. Application of radiofrequency energy at this site resulted in termination and noninducibility of this VT. After 6-month follow-up, the patient remained free from VT recurrences. [source] Entrainment of Ventricular Tachycardia by Sinus RhythmJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 2 2002JOHN M. MILLER M.D. [source] Benefit of Pacing and Beta-Blockers in Idiopathic Repetitive Polymorphic Ventricular TachycardiaJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 11 2001NICASIO PÉREZ-CASTELLANO M.D. Pacing and Beta-Blockers in Repetitive Polymorphic VT. An 18-year-old woman presented with recurrent exercise-induced syncopal episodes and severe systolic dysfunction. ECG monitoring disclosed repetitive polymorphic ventricular complexes, paroxysms of bidirectional ventricular tachycardia, and nonsustained bursts of slow polymorphic ventricular tachycardia that increased in length and rate during exercise. Ventricular arrhythmias were refractory to medical treatment, which included verapamil and beta-blockers. Addition of permanent atrial pacing to beta-blocker therapy suppressed the arrhythmias and reversed systolic impairment in the following months. [source] Radiofrequency Catheter Ablation of Postinfarction Ventricular Tachycardia from the Proximal Coronary SinusJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 3 2001JOSEF KAUTZNER M.D., Ph.D. VT Ablation from the Coronary Sinus. Optimum strategy for radiofrequency (RF) catheter ablation of ventricular tachycardia (VT) after inferior wall myocardial infarction (MI) that originates from the posteroseptal process of the left ventricle is not known. We describe a case report of a 57,year-old man who developed recurrent post-MI VT with ECG morphology consistent with this type of VT (i.e., left bundle branch block pattern with predominant R waves from V2 to V6 and left-axis deviation). Endocardial mapping and entrainment during VT demonstrated a critical isthmus of the reentrant circuit in the proximal coronary sinus. RF application terminated VT and rendered it noninducible. [source] Endocardial Noncontact Activation Mapping of Idiopathic Left Ventricular TachycardiaJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 12 2000JASBIR SRA M.D. Mapping of Idiopathic Ventricular Tachycardia. Idiopathic left ventricular tachycardia with a right bundle, left-axis deviation is thought to originate from posterior fascicles. Recently, there has been considerable interest in the anatomic and mechanistic basis of this arrhythmia. We report our experience with a 26-year-old man in whom new noncontact mapping technology was used to acquire detailed data from the left ventricle, identify the mid-diastolic potential and part of the ventricular tachycardia circuit, and perform successful ablation. This information helped define the physiologic aspects of this unique tachycardia. [source] Relationship of Specific Electrogram Characteristics During Sinus Rhythm and Ventricular Pacing Determined by Adaptive Template Matching to the Location of Functional Reentrant Circuits that Cause Ventricular Tachycardia in the Infarcted Canine HeartJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 4 2000EDWARD J. CIACCIO Ph.D. Localization of Reentrant Circuits. Introduction: It would be advantageous, for ablation therapy, to localize reentrant circuits causing ventricular tachycardia by quantifying electrograms obtained during sinus rhythm (SR) or ventricular pacing (VP). In this study, adaptive template matching (ATM) was used to localize reentrant circuits by measuring dynamic electrogram shape using SR and VP data. Methods and Results: Four days after coronary occlusion, reentrant ventricular tachycardia was induced in the epicardial border zone of canine hearts by programmed electrical stimulation. Activation maps of circuits were constructed using electrograms recorded from a multichannel array to ascertain block line location. Electrogram recordings obtained during SR/AP then were used for ATM analysis. A template electrogram was matched with electrograms on subsequent cycles by weighting amplitude, vertical shift, duration, and phase lag for optimal overlap. Sites of largest cycle-to-cycle variance in the optimal ATM weights were found to be adjacent to block lines bounding the central isthmus during reentry (mean 61.1% during SR; 63.9% during VP). The distance between the mean center of mass of the ten highest ATM variance peaks and the narrowest isthmus width was determined. For all VP data, the center of mass resided in the isthmus region ocurring during reentry. Conclusion: ATM high variance measured from SR/AP data localizes functional block lines forming during reentry. The center of mass of the high variance peaks localizes the narrowest width of the isthmus. Therefore, ATM methodology may guide ablation catheter position without resorting to reentry induction. [source] Exercise-Induced Nonsustained Ventricular Tachycardia: A Significant Marker of Coronary Artery Disease?JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 3 2002MARTIN FEJKA M.D. Diagnostic exercise stress testing is commonly performed in patients with known or suspected cardiovascular disease. The significance of an ischemic response, manifested as significant ST-segment depression, angina pectoris, transient myocardial perfusion abnormalities, or combinations thereof, is well established. However, the diagnostic implications of exercise-induced nonsustained VT are uncertain, especially as an isolated finding. The patient had threatening ventricular arrhythmias at peak exercise without an ischemic response. Subsequent cardiac catheterization revealed significant CAD requiring percutaneous coronary intervention. [source] Anterior Mitral Valve Length is Associated with Ventricular Tachycardia in Patients with Classical Mitral Valve ProlapsePACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 10 2010MURAT AKCAY M.D. Background: The aim of this study was to investigate the electrocardiographic and echocardiographic predictors of ventricular tachycardia (VT) in patients with classical mitral valve prolapse (MVP). Methods: Thirty patients (nine men and 21 women; mean age, 41.5 ± 15 years) in sinus rhythm with mitral valve prolapse who had VT in 24-hour Holter analysis and 30 patients with MVP without VT (eight men and 22 women; mean age, 43 ± 16 years) were included in this study. Transthoracic echocardiography, QT analyses from 12-lead electrocardiography, and 24-hour Holter electrocardiogram recordings were performed. Results: Mitral posterior leaflet thickness (0.48 ± 0.03 cm vs 0.43 ± 0,08 cm, P = 0.025), mitral anterior leaflet length (3.2 ± 0.24 cm vs 2.9 ± 0.36, P < 0.001), mitral posterior leaflet length (2.2 ± 0.3 cm vs 1.9 ± 0.35 cm, P = 0.01), left atrium anteroposterior diameter (4.2 ± 0.8 cm vs 3.5 ± 0.5 cm, P = 0.001), and mitral annulus circumference (15.7 ± 1.3 cm vs 14.6 ± 1.6 cm, P = 0.004) were increased significantly in MVP cases with VT. No significant difference was found between the cases with and without VT in terms of frequency- and time-domain analysis. QT dispersion (72 ± 18 ms vs 55 ± 15 ms, P = 0.0002) and corrected QT dispersion (QTcD) (76 ± 18 ms vs 55 ± 15 ms, P = 0.0002) were significantly increased in cases with VT compared with those without VT. Based on logistic regression analysis for MVP cases, in the case of VT, an enhancement in QTcD (P = 0.01) and the mitral anterior leaflet length (P = 0.003) were the independent predictors of VT. Conclusion: Mitral anterior leaflet length and enhanced QTcD are closely related with VT in patients with classical MVP. (PACE 2010; 33:1224,1230) [source] Recurrent Ventricular Tachycardia in Patient with Friedreich's Ataxia in the Absence of Clinical Myocardial DiseasePACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 1 2010NIDAL ASAAD M.B.B.S. We report a 33-year-old man with recurrent loss of consciousness due to ventricular tachyarrhythmia with a history of Friedreich's ataxia. The patient's symptom was improved after implantation of a single-lead implantable cardiac defibrillator. The clinical, genetic, echocardiographic, and electrocardiographic features are discussed in brief. (PACE 2010; 33:109,112) [source] Implantable Cardioverter-Defibrillator Discharges Despite Successful Termination of Ventricular Tachycardia by Antitachycardia PacingPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 6 2009REGINALD T. HO M.D. No abstract is available for this article. [source] Nontransmural Scar Detected by Magnetic Resonance Imaging and Origin of Ventricular Tachycardia in Structural Heart DiseasePACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2009MIKI YOKOKAWA M.D. Background: Contrast-enhanced magnetic resonance imaging (CMR) identifies scar tissue as an area of delayed enhancement (DE). The scar region might be the substrate for ventricular tachycardia (VT). However, the relationship between the occurrence of VT and the characteristics of scar tissue has not been fully studied. Methods: CMR was performed in 34 patients with monomorphic, sustained VT and dilated cardiomyopathy (DCM, n = 18), ischemic cardiomyopathy (ICM, n = 10), or idiopathic VT (IVT, n = 6). The VT exit site was assessed by a detailed analysis of the QRS morphology, including bundle branch block type, limb lead polarity, and precordial R-wave transition. On CMR imaging, the transmural score of each of the 17 segments was assigned, using a computer-assisted, semiautomatic technique, to measure the DE areas. Segmental scars were classified as nontransmural when DE was 1,75% and transmural when DE was 76,100% of the left ventricular mass in each segment. Results: A scar was detected in all patients with DCM or ICM. Nontransmural scar tissue was often found at the VT exit site, in patients with DCM or ICM. In contrast, no scar was found in patients with IVT. Conclusions: CMR clarified the characteristics and distribution of scar tissue in patients with structural heart disease, and the presence and location of scar tissue might predict the VT exit site in these patients. [source] Making Sense of the New ICD Algorithms for the Treatment of Fast Ventricular TachycardiaPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2 2009S. SERGE BAROLD M.D. First page of article [source] Coexisting Idiopathic Left Ventricular Tachycardia and Atrioventricular Reentrant Tachycardia in a Patient with Wolff-Parkinson-White SyndromePACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2 2009HONG EUY LIM M.D., Ph.D. We report a patient with Wolff-Parkinson-White syndrome who presented with two distinct tachycardias that represented atrioventricular reentrant tachycardia utilizing left lateral accessory pathway (AP) and idiopathic left ventricular tachycardia (ILVT). Two tachycardias with a complete separate mechanism occurred spontaneously as well as following atrial or ventricular pacing. Successful ablation of the left AP and ILVT resulted in a cure of the double tachycardia. [source] | ||||||||||||||||||||||||||||