Journal of cardiovascular electrophysiology
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J. Cardiovasc. Electrophysiol. · Feb 2007
Randomized Controlled TrialObesity as a risk factor for sustained ventricular tachyarrhythmias in MADIT II patients.
Obesity, as defined by body mass index > or =30 kg/m(2), has been shown to be a risk factor for cardiovascular disease. However, data on the relationship between body mass index (BMI) and the risk of ventricular arrhythmias and sudden cardiac death are limited. The aim of this study was to evaluate the risk of ventricular tachyarrhythmias and sudden death by BMI in patients after myocardial infarction with severe left ventricular dysfunction. ⋯ Our findings suggest that in nondiabetic patients with ischemic left ventricular dysfunction, a BMI > or =30 kg/m(2) is an independent risk factor for ventricular tachyarrhythmias.
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J. Cardiovasc. Electrophysiol. · Feb 2007
Case ReportsSuccessful catheter ablation of two types of ventricular tachycardias triggered by cardiac resynchronization therapy: a case report.
We report a case of a patient with nonischemic dilated cardiomyopathy and implantable cardioverter-defibrillator, in whom an upgrade to biventricular pacing triggered multiple episodes of ventricular tachycardias (VTs) of two morphologies. First VT presented as repetitive nonsustained arrhythmia of the same morphology as isolated ectopic beats, suggesting its focal origin. Second VT was reentrant and was triggered by the former ectopy, leading to a therapy from the device. ⋯ Radiofrequency catheter ablation successfully abolished both VTs. After the procedure, biventricular pacing was continued without any recurrences during a period of 24 months. The report emphasizes the role of catheter ablation in management of VTs triggered by cardiac resynchronization therapy.
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J. Cardiovasc. Electrophysiol. · Jan 2007
ReviewCommotio cordis--sudden cardiac death with chest wall impact.
Commotio cordis (CC), sudden death as a result of a blunt, often innocent-appearing chest wall blow, is being reported with increasing frequency. The clinical spectrum is diverse; however, a substantial number of cases occur in youth athletics. In events that occur during sport, victims are struck by projectiles regarded as standard implements of the game. ⋯ The generation of inward current via mechano-sensitive ion channels likely results in augmentation of repolarization and nonuniform myocardial activation, and is the cause of premature ventricular depolarizations that are triggers of VF in CC. While softer-than-standard safety baseballs reduce the risk of CC, commercially available chest protectors are ineffective in preventing CC. The development of more effective chest protectors and more widespread use of automated external defibrillators at youth sporting events are needed.
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J. Cardiovasc. Electrophysiol. · Jan 2007
Case ReportsPercutaneous endocardial and epicardial ablation of hypotensive ventricular tachycardia with percutaneous left ventricular assist in the electrophysiology laboratory.
Ventricular tachycardia (VT) in the setting of structural heart disease is challenging to treat with percutaneous catheter ablation due to the presence of complex substrate, multiple morphologies, hemodynamic instability, and epicardial circuits. When substrate-based approaches fail, however, it may be impossible to map and ablate hemodynamically unstable arrhythmias. We describe a novel approach to endocardial and epicardial mapping and ablation of hypotensive VT using a percutaneous left ventricular assist device in the electrophysiology laboratory, permitting near-surgical access to cardiac structures.
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QT interval prolongation is a common electrophysiological abnormality in patients with cirrhosis. As QT interval varies with the heart rate, many QT correction formulas have been proposed, the Bazett's one being the most criticized because it over-corrects the QT interval and may be misleading. This study focused on the QT-RR relationship in patients with cirrhosis to derive a population-specific QT correction formula. ⋯ Bazett's correction should be avoided in patients with cirrhosis because it still provides a rate-dependent QTc value and might be misleading, particularly when assessing the overall preoperative cardiac risk and the effect of drugs affecting the QT interval. In its place, our formula or that of Fridericia can be confidently employed.