Circulation. Arrhythmia and electrophysiology
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Circ Arrhythm Electrophysiol · Jun 2013
Multicenter Study Comparative StudyEfficacy of implantable cardioverter defibrillators in young patients with catecholaminergic polymorphic ventricular tachycardia: success depends on substrate.
The effectiveness of implantable cardioverter-defibrillator (ICD) therapy for the management of catecholaminergic polymorphic ventricular tachycardia (VT) in young patients is not known. ICD discharges are not always effective and inappropriate discharges are common, both resulting in morbidity and mortality. ⋯ ICD efficacy in catecholaminergic polymorphic VT depends on arrhythmia mechanism. Episodes of ventricular fibrillation were uniformly successfully treated, whereas polymorphic and bidirectional VT did not demonstrate successful primary termination. Inappropriate shocks, electrical storm, and ICD complications were common.
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Circ Arrhythm Electrophysiol · Jun 2013
Randomized Controlled Trial Comparative StudyA randomized study of cardiac resynchronization therapy defibrillator versus dual-chamber implantable cardioverter-defibrillator in ischemic cardiomyopathy with narrow QRS: the NARROW-CRT study.
Current recommendations require a QRS duration of ≥120 ms as a condition for prescribing cardiac resynchronization therapy (CRT). This study was designed to test the hypothesis that patients with heart failure (HF) of ischemic origin, current indications for defibrillator implantation, and QRS <120 ms may benefit from CRT in the presence of marked mechanical dyssynchrony. ⋯ URL: http://clinicaltrials.gov. Unique identifier: NCT01577446.
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Circ Arrhythm Electrophysiol · Jun 2013
Comparative StudyOutcome of ventricular tachycardia ablation in patients with nonischemic cardiomyopathy: the impact of noninducibility.
Ablation failure and recurrence rates after ventricular tachycardia (VT) ablation in nonischemic cardiomyopathy are high and the optimal procedural end point is not well defined. This study assessed the outcome after ablation, the impact of noninducibility, and other potential predictors of VT recurrence. ⋯ Although 53% of patients had VT during follow-up, the 6-month VT burden was decreased by ≥75% in 79%. Recurrence rates are low after complete procedural success, but high after both partial success and failure. Non-complete procedural success was the strongest predictor of VT recurrence.
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Circ Arrhythm Electrophysiol · Jun 2013
Comparative StudyUse of dabigatran for periprocedural anticoagulation in patients undergoing catheter ablation for atrial fibrillation.
Pulmonary vein isolation (PVI) for atrial fibrillation is associated with a transient increased risk of thromboembolic and hemorrhagic events. We hypothesized that dabigatran can be safely used as an alternative to continuous warfarin for the periprocedural anticoagulation in PVI. ⋯ Our study found no evidence to suggest a higher risk of thromboembolic or hemorrhagic complications with use of dabigatran for periprocedural anticoagulation in patients undergoing PVI compared with uninterrupted warfarin therapy.
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Circ Arrhythm Electrophysiol · Jun 2013
Comparative StudySudden cardiac death with autopsy findings of uncertain significance: potential for erroneous interpretation.
The sudden death of young individuals is commonly attributed to inherited cardiac disorders, and familial evaluation is advocated. The identification of pathognomonic histopathologic findings, or the absence of cardiac pathology (sudden arrhythmic death syndrome [SADS]) at postmortem, directs familial evaluation targeting structural disorders or primary arrhythmogenic syndromes, respectively. In a proportion of autopsies, structural abnormalities of uncertain significance are reported. We explored the hypothesis that such sudden cardiac deaths represent SADS. ⋯ Familial evaluation after sudden cardiac deaths with autopsy findings of uncertain significance identified a similar proportion of primary arrhythmogenic syndromes to a contemporary series of SADS. Our study highlights the need for accurate interpretation of autopsy findings to avoid erroneous diagnoses, with potentially devastating implications.