Pacing and clinical electrophysiology : PACE
-
Pacing Clin Electrophysiol · May 2012
Case ReportsVentricular tachycardia from remote blunt chest trauma: combined epicardial-endocardial right ventricular substrate characterization.
Ventricular tachycardia as a late complication of blunt chest trauma has never been reported. We present a case of combined endocardial and epicardial delineation of the right ventricular arrhythmogenic substrate, where other causes of cardiomyopathy were excluded. The epicardial scar was more extensive than endocardial scar, and the central isthmus was likely intramural. A history of blunt chest trauma should be considered in patients with right ventricular cardiomyopathy.
-
Pacing Clin Electrophysiol · May 2012
The use of advance directives among patients with implantable cardioverter defibrillators.
We aimed to determine the prevalence of advance directives (ADs) among patients with implantable cardioverter defibrillators (ICDs) and of ADs that addressed ICD management at the end of life. ⋯ About one-third of patients with ICDs had an AD, but only a couple ADs mentioned the ICD. These results suggest that clinicians should not only encourage patients with ICDs to complete an AD, but also encourage them to address ICD management specifically. Not addressing ICD management in an AD may result in ethical dilemmas during end-of-life care.
-
Pacing Clin Electrophysiol · May 2012
Case ReportsTwelve hours of sustained ventricular fibrillation supported by a continuous-flow left ventricular assist device.
Left ventricular assist device (LVAD) therapy improves survival and quality of life by mechanically unloading the left ventricle and maintaining hemodynamics in patients with end-stage heart failure. LVADs can also be lifesaving by maintaining hemodynamics during ventricular arrhythmia. ⋯ As presented here, a continuous-flow LVAD successfully provided hemodynamic support to a patient in sustained ventricular fibrillation for over 12 hours when the internal defibrillator was unable to terminate the arrhythmia. This case demonstrates that continuous-flow LVADs can be lifesaving in the setting of otherwise certain hemodynamic collapse from sustained ventricular fibrillation.