The Experts below are selected from a list of 20457 Experts worldwide ranked by ideXlab platform
Bernhard Maisch - One of the best experts on this subject based on the ideXlab platform.
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long runs of non sustained ventricular tachycardia on 24 hour ambulatory electrocardiogram predict major Arrhythmic events in patients with idiopathic dilated cardiomyopathy
2005Co-Authors: Wolfram Grimm, Michael Christ, Bernhard MaischAbstract:This study examined the prognostic significance of the rate and length of non-sustained (NS) ventricular tachycardia (VT) on 24-hour ambulatory electrocardiograms (ECG) recorded in 343 patients with idiopathic dilated cardiomyopathy (IDC) in the prospective Marburg Cardiomyopathy study. NSVT was defined as >/=3 consecutive ventricular premature beats at >120 bpm. During 52 +/- 21 months of follow-up, major Arrhythmic events defined as sustained VT, VF, or sudden cardiac death occurred in 46 of 343 patients (13%). Patients with 3-4 beat runs of NSVT had a similar arrhythmia-free survival as patients without NSVT on baseline 24-hour ambulatory ECG. The incidence of major Arrhythmic events during follow-up increased significantly from 2% per year in patients without NSVT, to 5% per year in patients with 5-9 beat runs of NSVT, to 10% per year in patients with >/=10 beat runs of NSVT (P /=10 beat runs on ambulatory ECG was associated with a particularly high risk of major Arrhythmic events.
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arrhythmia risk stratification in idiopathic dilated cardiomyopathy based on echocardiography and 12 lead signal averaged and 24 hour holter electrocardiography
2000Co-Authors: Wolfram Grimm, Christina Glaveris, Jurgen Hoffmann, Volker Menz, Hanshelge Muller, G Hufnagel, Bernhard MaischAbstract:Abstract Background To date, considerable controversy exists regarding noninvasive arrhythmia risk stratification in idiopathic dilated cardiomyopathy (IDC). Methods and Results Between 1992 and 1997, 202 patients with IDC without a history of sustained ventricular tachycardia (VT) underwent echocardiography, signal-averaged electrocardiogram (ECG), and 24-hour Holter ECG in the absence of antiArrhythmic drugs. During 32 ± 15 months of prospective follow-up, major Arrhythmic events, including sustained VT, ventricular fibrillation, or sudden death, occurred in 32 (16%) of 202 patients. After adjusting for baseline medical therapy and antiArrhythmic therapy during follow-up, multivariate Cox regression analysis identified a left ventricular (LV) end-diastolic diameter ≥70 mm and nonsustained VT on Holter as the only independent arrhythmia risk predictors. The combination of an LV end-diastolic diameter ≥70 mm and nonsustained VT was associated with a 14.3-fold risk for future Arrhythmic events (95% confidence interval 2.3-90). To further elucidate the prognostic value of LV ejection fraction, multivariate Cox analysis was repeated with ejection fraction forced to remain in the model. In the latter model, an ejection fraction ≤30% combined with nonsustained VT on Holter was found to be a significant arrhythmia risk predictor with a relative risk of 14.6 (95% confidence interval 2.2-97). Conclusions The combination of an LV end-diastolic diameter ≥70 mm and nonsustained VT on Holter, and the combination of LV ejection fraction ≤30% and nonsustained VT on Holter, identify a subgroup of patients with IDC with a 14-fold risk for subsequent Arrhythmic events. These findings have important implications for the design of future studies evaluating the role of prophylactic defibrillator therapy in patients with IDC. (Am Heart J 2000;140:43-51.)
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programmed ventricular stimulation for arrhythmia risk prediction in patients with idiopathic dilated cardiomyopathy and nonsustained ventricular tachycardia
1998Co-Authors: Wolfram Grimm, Jurgen Hoffmann, Volker Menz, 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.
Manuel Martinezselles - One of the best experts on this subject based on the ideXlab platform.
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ventricular Arrhythmic storm after initiating sacubitril valsartan
2018Co-Authors: Lourdes Vicent, Miriam Juarez, Hugo Gonzalezsaldivar, Vanesa Bruna, Carolina Devesa, Iago Sousacasasnovas, Francisco Fernandezaviles, Irene Martin, Jorge Garcia, Manuel MartinezsellesAbstract:Objectives: Sacubitril/valsartan was approved recently for the treatment of patients with heart failure and reduced ejection fraction. We present 6 cases of ventricular arrhythmia, that occurred shortly after sacubitril/valsartan initiation, that required drug withdrawal. Other potential triggering factors of electrical storm were ruled out and, from the Arrhythmic perspective, all of the patients were stable in the previous year. Our aim is to describe the possible association of sacubitril/valsartan with Arrhythmic storm. Methods: This was an observational monocentric study performed in the first 7 months of sacubitril/valsartan commercialization in Spain (October 2016). All patients were included in the SUMA (Sacubitril/Varsartan Usado Ambulatoriamente en Madrid [Sacubitril/Valsartan Used in Outpatients in Madrid]) registry. Patients were consecutively enrolled on the day they started the drug. Ventricular Arrhythmic storm was defined as ≥2 episodes of sustained ventricular arrhythmia or defibrillator therapy application in 24 h. Results: From 108 patients who received the drug, 6 presented with ventricular Arrhythmic storm (5.6%). Baseline characteristics were similar in the patients with and without ventricular Arrhythmic storm. The total number of days that sacubitril/valsartan was administered to each patient was 5, 6, 44 (8 since titration), 84, 93, and 136 (105 since titration), respectively. Conclusions: Our data are not enough to infer a cause-and-effect relationship. Further investigations regarding a potential proArrhythmic effect of sacubitril/valsartan are probably needed.
Francesca N Delling - One of the best experts on this subject based on the ideXlab platform.
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left ventricular mechanical dispersion predicts Arrhythmic risk in mitral valve prolapse
2019Co-Authors: Simon Ermakov, Radhika Gulhar, Dwight Bibby, Qizhi Fang, Nelson B. Schiller, Theodore P Abraham, Francesca N DellingAbstract:Objective Bileaflet mitral valve prolapse (MVP) with either focal or diffuse myocardial fibrosis has been linked to ventricular arrhythmia and/or sudden cardiac arrest. Left ventricular (LV) mechanical dispersion by speckle-tracking echocardiography (STE) is a measure of heterogeneity of ventricular contraction previously associated with myocardial fibrosis. The aim of this study is to determine whether mechanical dispersion can identify MVP at higher Arrhythmic risk. Methods We identified 32 consecutive Arrhythmic MVPs (A-MVP) with a history of complex ventricular ectopy on Holter/event monitor (n=23) or defibrillator placement (n=9) along with 27 MVPs without Arrhythmic complications (NA-MVP) and 39 controls. STE was performed to calculate global longitudinal strain (GLS) as the average peak longitudinal strain from an 18-segment LV model and mechanical dispersion as the SD of the time to peak strain of each segment. Results MVPs had significantly higher mechanical dispersion compared with controls (52 vs 42 ms, p=0.005) despite similar LV ejection fraction (62% vs 63%, p=0.42) and GLS (−19.7 vs −21, p=0.045). A-MVP and NA-MVP had similar demographics, LV ejection fraction and GLS (all p>0.05). A-MVP had more bileaflet prolapse (69% vs 44%, p=0.031) with a similar degree of mitral regurgitation (mostly trace or mild in both groups) (p>0.05). A-MVP exhibited greater mechanical dispersion when compared with NA-MVP (59 vs 43 ms, p=0.0002). Mechanical dispersion was the only significant predictor of Arrhythmic risk on multivariate analysis (OR 1.1, 95% CI 1.02 to 1.11, p=0.006). Conclusions STE-derived mechanical dispersion may help identify MVP patients at higher Arrhythmic risk.
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
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
Wolfram Grimm - One of the best experts on this subject based on the ideXlab platform.
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long runs of non sustained ventricular tachycardia on 24 hour ambulatory electrocardiogram predict major Arrhythmic events in patients with idiopathic dilated cardiomyopathy
2005Co-Authors: Wolfram Grimm, Michael Christ, Bernhard MaischAbstract:This study examined the prognostic significance of the rate and length of non-sustained (NS) ventricular tachycardia (VT) on 24-hour ambulatory electrocardiograms (ECG) recorded in 343 patients with idiopathic dilated cardiomyopathy (IDC) in the prospective Marburg Cardiomyopathy study. NSVT was defined as >/=3 consecutive ventricular premature beats at >120 bpm. During 52 +/- 21 months of follow-up, major Arrhythmic events defined as sustained VT, VF, or sudden cardiac death occurred in 46 of 343 patients (13%). Patients with 3-4 beat runs of NSVT had a similar arrhythmia-free survival as patients without NSVT on baseline 24-hour ambulatory ECG. The incidence of major Arrhythmic events during follow-up increased significantly from 2% per year in patients without NSVT, to 5% per year in patients with 5-9 beat runs of NSVT, to 10% per year in patients with >/=10 beat runs of NSVT (P /=10 beat runs on ambulatory ECG was associated with a particularly high risk of major Arrhythmic events.
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arrhythmia risk stratification in idiopathic dilated cardiomyopathy based on echocardiography and 12 lead signal averaged and 24 hour holter electrocardiography
2000Co-Authors: Wolfram Grimm, Christina Glaveris, Jurgen Hoffmann, Volker Menz, Hanshelge Muller, G Hufnagel, Bernhard MaischAbstract:Abstract Background To date, considerable controversy exists regarding noninvasive arrhythmia risk stratification in idiopathic dilated cardiomyopathy (IDC). Methods and Results Between 1992 and 1997, 202 patients with IDC without a history of sustained ventricular tachycardia (VT) underwent echocardiography, signal-averaged electrocardiogram (ECG), and 24-hour Holter ECG in the absence of antiArrhythmic drugs. During 32 ± 15 months of prospective follow-up, major Arrhythmic events, including sustained VT, ventricular fibrillation, or sudden death, occurred in 32 (16%) of 202 patients. After adjusting for baseline medical therapy and antiArrhythmic therapy during follow-up, multivariate Cox regression analysis identified a left ventricular (LV) end-diastolic diameter ≥70 mm and nonsustained VT on Holter as the only independent arrhythmia risk predictors. The combination of an LV end-diastolic diameter ≥70 mm and nonsustained VT was associated with a 14.3-fold risk for future Arrhythmic events (95% confidence interval 2.3-90). To further elucidate the prognostic value of LV ejection fraction, multivariate Cox analysis was repeated with ejection fraction forced to remain in the model. In the latter model, an ejection fraction ≤30% combined with nonsustained VT on Holter was found to be a significant arrhythmia risk predictor with a relative risk of 14.6 (95% confidence interval 2.2-97). Conclusions The combination of an LV end-diastolic diameter ≥70 mm and nonsustained VT on Holter, and the combination of LV ejection fraction ≤30% and nonsustained VT on Holter, identify a subgroup of patients with IDC with a 14-fold risk for subsequent Arrhythmic events. These findings have important implications for the design of future studies evaluating the role of prophylactic defibrillator therapy in patients with IDC. (Am Heart J 2000;140:43-51.)
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programmed ventricular stimulation for arrhythmia risk prediction in patients with idiopathic dilated cardiomyopathy and nonsustained ventricular tachycardia
1998Co-Authors: Wolfram Grimm, Jurgen Hoffmann, Volker Menz, 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.