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Bernhard Maisch - One of the best experts on this subject based on the ideXlab platform.
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noninvasive Arrhythmia risk stratification in idiopathic dilated cardiomyopathy results of the marburg cardiomyopathy study
Circulation, 2003Co-Authors: Wolfram Grimm, Michael Christ, Jennifer Bach, Hanshelge Muller, Bernhard MaischAbstract:Background— Arrhythmia risk stratification with regard to prophylactic implantable cardioverter-defibrillator therapy is a completely unsolved issue in idiopathic dilated cardiomyopathy (IDC). Methods and Results— Arrhythmia risk stratification was performed prospectively in 343 patients with IDC, including analysis of left ventricular (LV) ejection fraction and size by echocardiography, signal-averaged ECG, Arrhythmias on Holter ECG, QTc dispersion, heart rate variability, baroreflex sensitivity, and microvolt T-wave alternans. During 52±21 months of follow-up, major arrhythmic events, defined as sustained ventricular tachycardia, ventricular fibrillation, or sudden death, occurred in 46 patients (13%). On multivariate analysis, LV ejection fraction was the only significant Arrhythmia risk predictor in patients with sinus rhythm, with a relative risk of 2.3 per 10% decrease of ejection fraction (95% CI, 1.5 to 3.3; P=0.0001). Nonsustained ventricular tachycardia on Holter was associated with a trend towa...
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programmed ventricular stimulation for Arrhythmia risk prediction in patients with idiopathic dilated cardiomyopathy and nonsustained ventricular tachycardia
Journal of the American College of Cardiology, 1998Co-Authors: Wolfram Grimm, Volker Menz, Jurgen Hoffmann, Kathrin Luck, Bernhard MaischAbstract:Abstract Objectives. This study investigated the role of programmed ventricular stimulation (PVS) for Arrhythmia risk prediction in patients with idiopathic dilated cardiomyopathy (IDC) and spontaneous nonsustained ventricular tachycardia (VT). Background. Nonsustained VT in patients with IDC has been associated with a high incidence of sudden cardiac death. Methods. Over the course of 4 years, 34 patients with IDC, a left ventricular (LV) ejection fraction ≤35%, and spontaneous nonsustained VT underwent PVS. All patients were prospectively followed for 24 ± 13 months. Results. Sustained ventricular Arrhythmias were induced in 13 patients (38%). Sustained monomorphic VT was induced in three patients (9%), and polymorphic VT or ventricular fibrillation (VF) in another 10 patients (29%). No sustained ventricular Arrhythmia could be induced in 21 study patients (62%). Prophylactic implantation of third-generation defibrillators (ICDs) with electrogram storage capability was performed in all 13 patients with inducible sustained VT or VF, and in nine of 21 patients (43%) without inducible sustained VT or VF. There were no significant differences between the additional use of amiodarone, d,I-sotalol, and beta-blocker therapy during follow-up in patients with and without inducible VT or VF. During 24 ± 13 months of follow-up, arrhythmic events were observed in nine patients (26%) including sudden cardiac deaths in two patients and ICD shocks for rapid VT or VF in seven patients. Arrhythmic events during follow-up occurred in four of 13 patients with inducible ventricular Arrhythmias compared with five of 21 patients without inducible ventricular Arrhythmias at PVS (31% vs. 24%, p = NS). Conclusion. PVS does not appear to be helpful for Arrhythmia risk stratification in patients with IDC, a left ventricular ejection fraction ≤35%, and spontaneous nonsustained VT. Due to the limited number of patients, however, the power of this study is too small to exclude moderately large differences in outcome between patients with IDC with and without inducible VT or VF.
Marc A Vos - One of the best experts on this subject based on the ideXlab platform.
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short term variability of the qt interval can be used for the prediction of imminent ventricular Arrhythmias in patients with primary prophylactic implantable cardioverter defibrillators
Journal of the American Heart Association, 2020Co-Authors: Agnieszka Smoczynska, Vera Loen, David J Sprenkeler, Anton E Tuinenburg, Henk Ritsema J Van Eck, Marek Malik, G Schmidt, Mathias Meine, Marc A VosAbstract:Background Short-term variability of the QT interval (STVQT) has been proposed as a novel electrophysiological marker for the prediction of imminent ventricular Arrhythmias in animal models. Our aim is to study whether STVQT can predict imminent ventricular Arrhythmias in patients. Methods and Results In 2331 patients with primary prophylactic implantable cardioverter defibrillators, 24-hour ECG Holter recordings were obtained as part of the EU-CERT-ICD (European Comparative Effectiveness Research to Assess the Use of Primary Prophylactic Implantable Cardioverter Defibrillators) study. ECG Holter recordings showing ventricular Arrhythmias of >4 consecutive complexes were selected for the arrhythmic groups (n=170), whereas a control group was randomly selected from the remaining Holter recordings (n=37). STVQT was determined from 31 beats with fiducial segment averaging and calculated as [Formula: see text], where Dn represents the QT interval. STVQT was determined before the ventricular Arrhythmia or 8:00 am in the control group and between 1:30 and 4:30 am as baseline. STVQT at baseline was 0.84±0.47 ms and increased to 1.18±0.74 ms (P<0.05) before the ventricular Arrhythmia, whereas the STVQT in the control group remained unchanged. The arrhythmic patients were divided into three groups based on the severity of the Arrhythmia: (1) nonsustained ventricular Arrhythmia (n=32), (2) nonsustained ventricular tachycardia (n=134), (3) sustained ventricular tachycardia (n=4). STVQT increased before nonsustained ventricular Arrhythmia, nonsustained ventricular tachycardia, and sustained ventricular tachycardia from 0.80±0.43 ms to 1.18±0.78 ms (P<0.05), from 0.90±0.49 ms to 1.14±0.70 ms (P<0.05), and from 1.05±0.22 ms to 2.33±1.25 ms (P<0.05). This rise in STVQT was significantly higher in sustained ventricular tachycardia compared with nonsustained ventricular Arrhythmia (+1.28±1.05 ms versus +0.24±0.57 ms [P<0.05]) and compared with nonsustained ventricular Arrhythmia (+0.34±0.87 ms [P<0.05]). Conclusions STVQT increases before imminent ventricular Arrhythmias in patients, and the extent of the increase is associated with the severity of the ventricular Arrhythmia.
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Short-Term Variability of the QT Interval Can be Used for the Prediction of Imminent Ventricular Arrhythmias in Patients With Primary Prophylactic Implantable Cardioverter Defibrillators
'Ovid Technologies (Wolters Kluwer Health)', 2020Co-Authors: Smoczyńska A., Sprenkeler D.j., Tuinenburg A.e., Ritsema Van Eck, H.j., Malik M., Schmidt G., Meine M, Marc A VosAbstract:BACKGROUND: Short-term variability of the QT interval (STVQT) has been proposed as a novel electrophysiological marker for the prediction of imminent ventricular Arrhythmias in animal models. Our aim is to study whether STVQT can predict imminent ventricular Arrhythmias in patients. METHODS AND RESULTS: In 2331 patients with primary prophylactic implantable cardioverter defibrillators, 24-hour ECG Holter recordings were obtained as part of the EU-CERT-ICD (European Comparative Effectiveness Research to Assess the Use of Primary Prophylactic Implantable Cardioverter Defibrillators) study. ECG Holter recordings showing ventricular Arrhythmias of >4 consecutive complexes were selected for the arrhythmic groups (n=170), whereas a control group was randomly selected from the remaining Holter recordings (n=37). STVQT was determined from 31 beats with fiducial segment averaging and calculated as ∑ � �Dn+1−Dn � � ∕ � 30× √ 2 � , where Dn represents the QT interval. STVQT was determined before the ventricular Arrhythmia or 8:00 am in the control group and between 1:30 and 4:30 am as baseline. STVQT at baseline was 0.84±0.47 ms and increased to 1.18±0.74 ms (P
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circadian pattern of short term variability of the qt interval in primary prevention icd patients eu cert icd methodological pilot study
PLOS ONE, 2017Co-Authors: David J Sprenkeler, Anton E Tuinenburg, Henk Ritsema J Van Eck, Marek Malik, Markus Zabel, Marc A VosAbstract:Objective: Short-term variability of the QT-interval (STV-QT) was shown to be associated with an increased risk of ventricular Arrhythmias. We aimed at investigating (a) whether STV-QT exhibits circadian pattern, and (b) whether such pattern differs between patients with high and low Arrhythmia risk. Methods: As part of the ongoing EU-CERT-ICD study, 24h high resolution digital ambulatory 12-lead Holter recordings are collected prior to ICD implantation for primary prophylactic indication. Presently available patients were categorized based on their Arrhythmia score (AS), a custom-made weighted score of the number of arrhythmic events on the recording. STV-QT was calculated every hour in 30 patients of which 15 and 15 patients had a high and a low AS, respectively. Results: The overall dynamicity of STV-QT showed high intra- and inter-individual variability with different circadian patterns associated with low and high AS. High AS patients showed a prominent peak both at 08:00 and 18:00. At these times, STV-QT was significantly higher in the high AS patients compared to the low AS patients (1.22ms±0.55ms vs 0.60ms±0.24ms at 08:00 and 1.12ms±0.39ms vs 0.64ms±0.29ms at 18:00, both p < 0.01). Conclusion: In patients with high AS, STV-QT peaks in the early morning and late afternoon. This potentially reflects increased Arrhythmia risk at these times. Prospective STV-QT determination at these times might thus be more sensitive to identify patients at high risk of ventricular Arrhythmias.
Davendra Mehta - One of the best experts on this subject based on the ideXlab platform.
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primary prevention of sudden cardiac death in silent cardiac sarcoidosis role of programmed ventricular stimulation
Circulation-arrhythmia and Electrophysiology, 2011Co-Authors: Davendra Mehta, Neil Mori, Seth H Goldbarg, Steven A Lubitz, Juan P Wisnivesky, Alvin S TeirsteinAbstract:Background—Cardiac involvement in sarcoidosis is often silent and may lead to sudden death. This study was designed to assess the value of programmed electric stimulation of the ventricle (PES) for risk stratification in patients with sarcoidosis and evidence of preclinical cardiac involvement on imaging studies. Methods and Results—Patients with biopsy-proven systemic sarcoidosis but without cardiac symptoms who had evidence of cardiac sarcoidosis on positron emission tomography (PET) or cardiac MRI (CMR) were included. All patients underwent baseline evaluation, echocardiographic assessment of left ventricular function, and programmed electric stimulation of the ventricle. Patients were followed for survival and arrhythmic events. Seventy-six patients underwent PES of the ventricle. Eight (11%) were inducible for sustained ventricular Arrhythmias and received an implantable defibrillator. None of the noninducible patients received a defibrillator. Left ventricular ejection fraction was lower in patients with inducible ventricular Arrhythmia (36.44.2% versus 55.81.5%, P0.05). Over a median follow-up of 5 years, 6 of 8 patients in the group with inducible ventricular Arrhythmias had ventricular Arrhythmia or died, compared with 1 death in the negative group (P0.0001). Conclusions—In patients with biopsy-proven sarcoidosis and evidence of cardiac involvement on PET or CMR alone, positive PES may help to identify patients at risk for ventricular Arrhythmia. More importantly, patients in this cohort with a negative PES appear to have a benign course within the first several years following diagnosis. PES may help to guide the use of implantable cardioverter defibrillators in this population. (Circ Arrhythm Electrophysiol. 2011;4:43-48.)
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usefulness of programmed ventricular stimulation in predicting future arrhythmic events in patients with cardiac sarcoidosis
American Journal of Cardiology, 2005Co-Authors: Anthony Aizer, Eric H Stern, Anthony J Gomes, Alvin S Teirstein, Robert E Eckart, Davendra MehtaAbstract:The utility of programmed ventricular stimulation to predict future arrhythmic events in patients with cardiac sarcoidosis is unknown. Similarly, the long-term benefit of implantable cardioverter-defibrillators (ICDs) in cardiac sarcoidosis has not been established. Thirty-two consecutive patients with cardiac sarcoidosis underwent programmed ventricular stimulation. Patients with spontaneous or inducible sustained ventricular Arrhythmias (n = 12) underwent ICD insertion. All study patients were followed for the combined arrhythmic event end point of appropriate ICD therapies or sudden death. Mean length of follow-up to sustained ventricular Arrhythmia or sudden death was 32 ± 30 months. Five of 6 patients (83%) with spontaneous sustained ventricular Arrhythmias and 4 of 6 patients (67%) without spontaneous but with inducible sustained ventricular Arrhythmias received appropriate ICD therapy. Two of 20 patients (10%) with neither spontaneous nor inducible sustained ventricular Arrhythmias experienced sustained ventricular Arrhythmias or sudden death. Programmed ventricular stimulation predicted subsequent arrhythmic events in the entire population (relative hazard 4.47, 95% confidence interval [CI] 1.30 to 15.39) and in patients who presented without spontaneous sustained ventricular Arrhythmias (relative hazard 6.97, 95% CI 1.27 to 38.27). No patient with an ICD died of a primary arrhythmic event. In patients with spontaneous or inducible sustained ventricular Arrhythmias, mean survival from first appropriate ICD therapy to death or cardiac transplant was 60 ± 46 months, with only 2 patients dying or reaching transplant at study end. In conclusion, programmed ventricular stimulation identifies patients with cardiac sarcoidosis at high risk for future arrhythmic events. ICDs effectively terminate life-threatening Arrhythmias in high-risk patients, with significant survival after first appropriate therapy.
Alvin S Teirstein - One of the best experts on this subject based on the ideXlab platform.
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primary prevention of sudden cardiac death in silent cardiac sarcoidosis role of programmed ventricular stimulation
Circulation-arrhythmia and Electrophysiology, 2011Co-Authors: Davendra Mehta, Neil Mori, Seth H Goldbarg, Steven A Lubitz, Juan P Wisnivesky, Alvin S TeirsteinAbstract:Background—Cardiac involvement in sarcoidosis is often silent and may lead to sudden death. This study was designed to assess the value of programmed electric stimulation of the ventricle (PES) for risk stratification in patients with sarcoidosis and evidence of preclinical cardiac involvement on imaging studies. Methods and Results—Patients with biopsy-proven systemic sarcoidosis but without cardiac symptoms who had evidence of cardiac sarcoidosis on positron emission tomography (PET) or cardiac MRI (CMR) were included. All patients underwent baseline evaluation, echocardiographic assessment of left ventricular function, and programmed electric stimulation of the ventricle. Patients were followed for survival and arrhythmic events. Seventy-six patients underwent PES of the ventricle. Eight (11%) were inducible for sustained ventricular Arrhythmias and received an implantable defibrillator. None of the noninducible patients received a defibrillator. Left ventricular ejection fraction was lower in patients with inducible ventricular Arrhythmia (36.44.2% versus 55.81.5%, P0.05). Over a median follow-up of 5 years, 6 of 8 patients in the group with inducible ventricular Arrhythmias had ventricular Arrhythmia or died, compared with 1 death in the negative group (P0.0001). Conclusions—In patients with biopsy-proven sarcoidosis and evidence of cardiac involvement on PET or CMR alone, positive PES may help to identify patients at risk for ventricular Arrhythmia. More importantly, patients in this cohort with a negative PES appear to have a benign course within the first several years following diagnosis. PES may help to guide the use of implantable cardioverter defibrillators in this population. (Circ Arrhythm Electrophysiol. 2011;4:43-48.)
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usefulness of programmed ventricular stimulation in predicting future arrhythmic events in patients with cardiac sarcoidosis
American Journal of Cardiology, 2005Co-Authors: Anthony Aizer, Eric H Stern, Anthony J Gomes, Alvin S Teirstein, Robert E Eckart, Davendra MehtaAbstract:The utility of programmed ventricular stimulation to predict future arrhythmic events in patients with cardiac sarcoidosis is unknown. Similarly, the long-term benefit of implantable cardioverter-defibrillators (ICDs) in cardiac sarcoidosis has not been established. Thirty-two consecutive patients with cardiac sarcoidosis underwent programmed ventricular stimulation. Patients with spontaneous or inducible sustained ventricular Arrhythmias (n = 12) underwent ICD insertion. All study patients were followed for the combined arrhythmic event end point of appropriate ICD therapies or sudden death. Mean length of follow-up to sustained ventricular Arrhythmia or sudden death was 32 ± 30 months. Five of 6 patients (83%) with spontaneous sustained ventricular Arrhythmias and 4 of 6 patients (67%) without spontaneous but with inducible sustained ventricular Arrhythmias received appropriate ICD therapy. Two of 20 patients (10%) with neither spontaneous nor inducible sustained ventricular Arrhythmias experienced sustained ventricular Arrhythmias or sudden death. Programmed ventricular stimulation predicted subsequent arrhythmic events in the entire population (relative hazard 4.47, 95% confidence interval [CI] 1.30 to 15.39) and in patients who presented without spontaneous sustained ventricular Arrhythmias (relative hazard 6.97, 95% CI 1.27 to 38.27). No patient with an ICD died of a primary arrhythmic event. In patients with spontaneous or inducible sustained ventricular Arrhythmias, mean survival from first appropriate ICD therapy to death or cardiac transplant was 60 ± 46 months, with only 2 patients dying or reaching transplant at study end. In conclusion, programmed ventricular stimulation identifies patients with cardiac sarcoidosis at high risk for future arrhythmic events. ICDs effectively terminate life-threatening Arrhythmias in high-risk patients, with significant survival after first appropriate therapy.
Carlo Vecchio - One of the best experts on this subject based on the ideXlab platform.
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value of programmed ventricular stimulation in predicting sudden death and sustained ventricular tachycardia in survivors of acute myocardial infarction
American Journal of Cardiology, 1996Co-Authors: Massimo Zoniberisso, Daniele Molini, G S Mela, Carlo VecchioAbstract:Abstract To assess the prognostic value of the response to programmed ventricular stimulation in selected post-acute myocardial infarction (AMI) patients identified at risk of sudden death and spontaneous sustained ventricular tachycardia (VT) (arrhythmic events) by noninvasive, highly sensitive testing, 286 consecutive patients were evaluated prospectively and followed for 12 months. One hundred three patients (group 1) with either left ventricular ejection fraction ≤40% or ventricular late potentials or spontaneous complex ventricular Arrhythmias were considered at risk of late arrhythmic events and eligible for programmed ventricular stimulation; the remaining 183 patients (group 2) were discharged without any further evaluation. Electrophysiologic study was performed 11 to 20 days after AMI utilizing up to 2 extrastimuli and rapid ventricular burst pacing. At the end of the follow-up period, 10 patients in group 1 and 2 in group 2 died of cardiac causes; in addition, 10 patients in group 1 and 1 in group 2 had arrhythmic events. Sustained monomorphic VT was the only inducible Arrhythmia related either to cardiac death (p
