Circulation. Arrhythmia and electrophysiology
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Circ Arrhythm Electrophysiol · Nov 2018
Outcomes, Costs, and 30-Day Readmissions After Catheter Ablation of Myocardial Infarct-Associated Ventricular Tachycardia in the Real World.
Patients undergoing catheter ablation of myocardial infarction-associated ventricular tachycardia (VT) have significant comorbidities that can increase the risks of adverse outcomes. The rates of readmissions after VT ablation are unknown. We sought to examine in-hospital outcomes, costs, and 30-day readmissions after catheter ablation of myocardial infarction-associated VT. ⋯ Thirty-day readmissions after catheter ablation of VT occur in nearly 1 out of 5 cases, with the majority of readmissions being caused by recurrent VT or congestive heart failure. Baseline comorbidities are significant predictors of procedural mortality, complications, and readmissions. Strategies to reduce recurrent VT postablation by improving procedural success, optimizing postablation heart failure treatment, and ensuring close postdischarge follow-up may help reduce readmissions and healthcare costs.
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Circ Arrhythm Electrophysiol · Sep 2018
Slow/Fast Atrioventricular Nodal Reentrant Tachycardia Using the Inferolateral Left Atrial Slow Pathway: Role of the Resetting Response to Select the Ablation Target.
Background We describe a technique to localize the ablation target in patients with an unusual variant of slow/fast atrioventricular nodal reentrant tachycardia (AVNRT) using a slow pathway connecting to the basal inferolateral left atrium. Methods Consecutive patients with slow/fast AVNRT were included. During stable slow/fast AVNRT, a single late atrial extrastimulus (AES) was delivered at the inferolateral left atrium near the mitral annulus. ⋯ No recurrent tachycardia was noted at 1 year of follow-up. Conclusions The inferolateral left atrium slow pathway is used in a small subset of patients with slow/fast AVNRT. Accurate localization of the ablation target can be achieved by delivering late AES during AVNRT (resetting response).
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Circ Arrhythm Electrophysiol · Aug 2018
Outcome of Cardiac Sarcoidosis Presenting With High-Grade Atrioventricular Block.
Symptomatic high-grade atrioventricular block (AVB) is the most common and often the only presenting manifestation (lone AVB) of cardiac sarcoidosis. Implantation of an intracardiac cardioverter defibrillator instead of a pacemaker is recommended, but the true risk of fatal arrhythmia, one incident to lone AVB in particular, remains poorly known. ⋯ The risk of sudden cardiac death is significant in cardiac sarcoidosis presenting with high-grade AVB with or without ventricular tachycardia or LV dysfunction. The consensus recommendation to implant an intracardiac cardioverter defibrillator whenever permanent pacing is needed seems well-founded.
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Circ Arrhythm Electrophysiol · Jul 2018
Comparative StudyRisk Stratification of Type 2 Long-QT Syndrome Mutation Carriers With Normal QTc Interval: The Value of Sex, T-Wave Morphology, and Mutation Type.
Long-QT (LQT) syndrome mutation carriers have higher risk of cardiac events than unaffected family members even in the absence of QTc prolongation. Changes in T-wave morphology may reflect penetrance of LQT syndrome mutations. We aimed to assess whether T-wave morphology may improve risk stratification of LQT2 mutation carriers with normal QTc interval. ⋯ The risk of cardiac events in LQT2 carriers with normal QTc is associated with abnormal T-wave morphology in women and pore location of mutation in men. The findings further indicate sex-specific differences in phenotype and genotype relationship in LQT2 patients.
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Circ Arrhythm Electrophysiol · Jul 2018
Electrophysiological Characteristics of Bundle Branch Reentry Ventricular Tachycardia in Patients Without Structural Heart Disease.
The distinct electrophysiological features of bundle branch reentry ventricular tachycardia (VT) in patients without structural heart disease have not been systemically characterized. ⋯ Bundle branch reentry VT can occur in young patients with extensive conduction disturbances within HIS-Purkinje system. Ablation targeting at the distal left BB which bifurcates into left posterior and anterior fascicle can preserve the residual atrioventricular conduction, but intensive follow-up is needed.