The Experts below are selected from a list of 1986 Experts worldwide ranked by ideXlab platform
Stephen L Winters - One of the best experts on this subject based on the ideXlab platform.
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determinants of induction of Ventricular Tachycardia in Nonsustained Ventricular Tachycardia after myocardial infarction and the usefulness of the signal averaged electrocardiogram
American Journal of Cardiology, 1993Co-Authors: Stephen L Winters, Pramod Deshmukh, Alfred Deluca, Kathleen DanielsAbstract:Assessment of the implications of clinical and noninvasive variables, including the results of signal-averaged electrocardiography, was performed > or = 3 weeks after myocardial infarction in 57 patients with Nonsustained Ventricular Tachycardia (VT) who underwent programmed Ventricular stimulation to guide antiarrhythmic therapy. The clinical and noninvasive parameters assessed included ages, left Ventricular ejection fractions, sites of infarction, presence of akinetic or dyskinetic left Ventricular segments, history of syncope, history of coronary artery bypass surgery, and presence or absence of late potentials from signal-averaged electrocardiography. Other than the presence of late potentials, no clinical or noninvasive parameters identified such persons with a significantly higher likelihood of inducible VT. When assessed as positive if 1 or more variables were abnormal, 16 of 16 (100%) patients with versus 17 of 41 without inducible VT had late potentials (p < 0.002). With more stringent criteria required (defined as prolongation of the QRS vector complex duration and low root-mean-square voltage of the terminal 40 ms of the vector complex) 8 of 16 patients (50%) with and 4 of 41 (10%) without inducible VT had late potentials recorded (p < 0.002). Thus, the signal-averaged electrocardiogram may enable identification of persons with Nonsustained VT after myocardial infarction who are most likely to have VT induced at programmed Ventricular stimulation.
Kerry L Lee - One of the best experts on this subject based on the ideXlab platform.
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reply rapid rate Nonsustained Ventricular Tachycardia found on icd interrogation relationship of rr nsvt to outcomes in the scd heft trial
Journal of the American College of Cardiology, 2013Co-Authors: Jay Chen, Kerry L Lee, George Johnson, Anne S Hellkamp, Jill Anderson, Daniel B Mark, Gust H Bardy, Jeanne E PooleAbstract:We appreciate the interest in our paper and the opportunity to reply to Dr. Andraws' most thoughtful comments [(1)][1]. It is very difficult to isolate the different facets of the rapid-rate Nonsustained Ventricular Tachycardia (RR-NSVT) and inappropriate shock-mortality relationships. In fact, it
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rapid rate Nonsustained Ventricular Tachycardia found on implantable cardioverter defibrillator interrogation relationship to outcomes in the scd heft sudden cardiac death in heart failure trial
Journal of the American College of Cardiology, 2013Co-Authors: Jay Che, Kerry L Lee, Anne S Hellkamp, George Johnso, Jill Anderso, Daniel Mark, Gus H Ardy, Jeanne E PooleAbstract:Objectives The aim of this study was to examine rapid-rate Nonsustained Ventricular Tachycardia (RR-NSVT) during routine implantable cardioverter-defibrillator (ICD) evaluation in patients with heart failure and its relationship to outcomes. Background The clinical implications of RR-NSVT identified during routine ICD interrogation are unclear. In this study, the occurrence of RR-NSVT and its association with ICD shocks and mortality in SCD-HeFT (Sudden Cardiac Death in Heart Failure Trial) were examined. Methods The 811 patients who received ICDs in SCD-HeFT constituted the study population. The occurrence of RR-NSVT and its association with ICD shocks and mortality in SCD-HeFT were examined. Results RR-NSVT was documented on ICD interrogation in 186 of 811 patients (22.9%). The mean duration of RR-NSVT was 26.4 ± 9.1 beats (7.5 ± 2.6 s), with a mean cycle length of 259 ± 32 ms. Polymorphic RR-NSVT accounted for 56% of episodes. Compared with patients without RR-NSVT, those with RR-NSVT were less likely to be taking beta-blockers, statins, or aspirin at enrollment. After adjusting for other known predictors of mortality in SCD-HeFT, RR-NSVT was independently associated with appropriate ICD shocks (hazard ratio: 4.25; 95% confidence interval: 2.94 to 6.14; p Conclusions RR-NSVT identified on routine ICD interrogation should be considered an important clinical event. RR-NSVT during ICD interrogation is associated with appropriate ICD shocks and all-cause mortality. The clinical evaluation of patients with RR-NSVT should include intensification of medical therapy, particularly beta-blockers, or other appropriate clinical interventions. (Sudden Cardiac Death in Heart Failure Trial [SCD-HeFT]; NCT00000609 )
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prognostic significance of Nonsustained Ventricular Tachycardia identified postoperatively after coronary artery bypass surgery in patients with left Ventricular dysfunction
Journal of Cardiovascular Electrophysiology, 2002Co-Authors: A Luis M D Pires, Kerry L Lee, E Gail M S Hafley, D John M D Fisher, E Mark M D Josephson, N Eric M D Prystowsky, E Alfred M D BuxtonAbstract:Post-CABG Nonsustained VT.Introduction: Nonsustained Ventricular Tachycardia (NSVT) occurs frequently in the postoperative period (≤30 days) after coronary artery bypass graft (CABG) surgery, a setting where many factors may play a role in its genesis. The prognosis of NSVT in this setting in patients with left Ventricular (LV) dysfunction is unknown. This study was designed to assess its significance. Methods and Results: We compared the outcome of untreated patients enrolled in the Multicenter Unsustained Tachycardia Trial with coronary artery disease (CAD), LV dysfunction, and NSVT identified postoperatively after CABG (n = 228; mean age 67 years, 84% males) versus nonpostoperative settings (n = 1,302; mean age 66 years, 85% males). Sustained monomorphic Ventricular Tachycardia was induced in 27% and 33% (P = 0.046) of patients with postoperative and nonpostoperative NSVT, respectively. The 2- and 5-year rates of arrhythmic events were 6% and 16%, respectively, in postoperative patients versus 15% and 29% in nonpostoperative patients (unadjusted P = 0.0020, adjusted P = 0.0082). The 2- and 5-year overall mortality rates were 15% and 36%, respectively, for postoperative patients versus 24% and 47% for nonpostoperative patients (unadjusted P = 0.0005, adjusted P = 0.027). Patients whose NSVT was identified early (<10 days) versus late (10–30 days) after CABG had significantly lower 2- (13% vs 23%) and 5-year (30% vs 52%) mortality rates (unadjusted P = 0.024, adjusted P = 0.018). Conclusion: In this population of patients with CAD and LV dysfunction, the occurrence of postoperative NSVT, especially within 10 days after CABG, portends a far better outcome than when it occurs in nonpostoperative settings. This suggests that in a such setting, NSVT represents a less specific risk factor for future events and should be considered when assigning risk and treatment of similar patients.
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differences in inducibility and prognosis of in hospital versus out of hospital identified Nonsustained Ventricular Tachycardia in patients with coronary artery disease clinical and trial design implications
Journal of the American College of Cardiology, 2001Co-Authors: Luis A Pires, Alfred E Buxton, Gail E Hafley, Michael H Lehmann, Kerry L LeeAbstract:OBJECTIVES The goal of this study was to describe the influence of the clinical setting (in-hospital vs. out-of-hospital) in which Nonsustained Ventricular Tachycardia (NSVT) is discovered on the rate of inducibility of sustained Ventricular Tachycardia (VT), arrhythmic events and survival in patients with coronary artery disease (CAD) and left Ventricular (LV) dysfunction. BACKGROUND In-hospital presentation of sustained VT is independently associated with lower long-term overall survival. The impact of the clinical setting in which NSVT is documented is unknown. METHODS In the Multicenter Unsustained Tachycardia Trial (MUSTT), designed to assess the benefit of randomized antiarrhythmic therapy guided by electrophysiologic testing in patients with asymptomatic NSVT, CAD and LV dysfunction, eligible patients were enrolled irrespective of the setting in which the index arrhythmia was discovered. In this retrospective analysis, we compared the rate of VT inducibility and outcome of MUSTT-enrolled patients with in-hospital versus out-of-hospital presentation of NSVT. RESULTS Monomorphic sustained VT was induced in 35% and 28% of the patients whose index NSVT occurred in-hospital and out-of-hospital, respectively (adjusted p = 0.006). Cardiac arrest or death due to arrhythmia at two- and five-year follow-ups were 14% and 28% for untreated patients with in-hospital-identified NSVT and 11% and 21% for the out-of-hospital group (adjusted p = 0.10). Overall mortality rates at two- and five-year follow-ups were 24% and 48% for inpatients and 18% and 38% for outpatients (adjusted p = 0.018). In patients randomized to antiarrhythmic therapy, there was no significant interaction between patient status (in-hospital vs. out-of-hospital) and treatment impact on the rates of total mortality (p = 0.98) and arrhythmic events (p = 0.08). CONCLUSIONS In patients with CAD and impaired LV function, asymptomatic NSVT identified in-hospital, compared with that identified out-of-hospital, is associated with a higher rate of induction of sustained VT and overall mortality. Therefore, in similar patients, the clinical setting in which NSVT is discovered should be taken into account when formulating patient risk, treatment and clinical trial design.
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electrophysiologic and clinical effects of angiotensin converting enzyme inhibitors in patients with prior myocardial infarction Nonsustained Ventricular Tachycardia and depressed left Ventricular function
American Journal of Cardiology, 2001Co-Authors: Steven N Singh, Kerry L Lee, Pamela Karasik, Gail E Hafley, Karen S Pieper, George D Wyse, Alfred E BuxtonAbstract:Angiotensin-converting enzyme (ACE) inhibitors have been shown to reduce sudden cardiac death and all-cause mortality. They also may have direct antiarrhythmic properties. We retrospectively analyzed the data from the Multicenter UnSustained Tachycardia Trial (MUSTT), to determine the effects of ACE inhibitors on inducibility of sustained Ventricular Tachycardia and on sudden cardiac death and overall mortality in 2,087 patients with prior myocardial infarction, Nonsustained Ventricular Tachycardia, and depressed left Ventricular function. Results of electrophysiologic testing were compared by use of ACE inhibitors at baseline, and outcomes were compared between the 564 patients prescribed ACE inhibitors at discharge and the 1,523 patients who did not receive treatment. The inducibility of sustained Ventricular Tachycardia during electrophysiologic testing did not differ by baseline ACE inhibitor use (unadjusted p = 0.75). Patients discharged from hospital on ACE inhibitors had a lower ejection fraction, more extensive coronary artery disease, and fewer previous revascularizations at baseline. After adjustments for differences in baseline factors and initial hospitalization variables, there were no significant differences in total mortality (p = 0.47) or arrhythmic death or cardiac arrest (p = 0.51) with ACE inhibitor use at discharge over a median 43 months of follow-up.
Pramod Deshmukh - One of the best experts on this subject based on the ideXlab platform.
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determinants of induction of Ventricular Tachycardia in Nonsustained Ventricular Tachycardia after myocardial infarction and the usefulness of the signal averaged electrocardiogram
American Journal of Cardiology, 1993Co-Authors: Stephen L Winters, Pramod Deshmukh, Alfred Deluca, Kathleen DanielsAbstract:Assessment of the implications of clinical and noninvasive variables, including the results of signal-averaged electrocardiography, was performed > or = 3 weeks after myocardial infarction in 57 patients with Nonsustained Ventricular Tachycardia (VT) who underwent programmed Ventricular stimulation to guide antiarrhythmic therapy. The clinical and noninvasive parameters assessed included ages, left Ventricular ejection fractions, sites of infarction, presence of akinetic or dyskinetic left Ventricular segments, history of syncope, history of coronary artery bypass surgery, and presence or absence of late potentials from signal-averaged electrocardiography. Other than the presence of late potentials, no clinical or noninvasive parameters identified such persons with a significantly higher likelihood of inducible VT. When assessed as positive if 1 or more variables were abnormal, 16 of 16 (100%) patients with versus 17 of 41 without inducible VT had late potentials (p < 0.002). With more stringent criteria required (defined as prolongation of the QRS vector complex duration and low root-mean-square voltage of the terminal 40 ms of the vector complex) 8 of 16 patients (50%) with and 4 of 41 (10%) without inducible VT had late potentials recorded (p < 0.002). Thus, the signal-averaged electrocardiogram may enable identification of persons with Nonsustained VT after myocardial infarction who are most likely to have VT induced at programmed Ventricular stimulation.
Alfred Deluca - One of the best experts on this subject based on the ideXlab platform.
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determinants of induction of Ventricular Tachycardia in Nonsustained Ventricular Tachycardia after myocardial infarction and the usefulness of the signal averaged electrocardiogram
American Journal of Cardiology, 1993Co-Authors: Stephen L Winters, Pramod Deshmukh, Alfred Deluca, Kathleen DanielsAbstract:Assessment of the implications of clinical and noninvasive variables, including the results of signal-averaged electrocardiography, was performed > or = 3 weeks after myocardial infarction in 57 patients with Nonsustained Ventricular Tachycardia (VT) who underwent programmed Ventricular stimulation to guide antiarrhythmic therapy. The clinical and noninvasive parameters assessed included ages, left Ventricular ejection fractions, sites of infarction, presence of akinetic or dyskinetic left Ventricular segments, history of syncope, history of coronary artery bypass surgery, and presence or absence of late potentials from signal-averaged electrocardiography. Other than the presence of late potentials, no clinical or noninvasive parameters identified such persons with a significantly higher likelihood of inducible VT. When assessed as positive if 1 or more variables were abnormal, 16 of 16 (100%) patients with versus 17 of 41 without inducible VT had late potentials (p < 0.002). With more stringent criteria required (defined as prolongation of the QRS vector complex duration and low root-mean-square voltage of the terminal 40 ms of the vector complex) 8 of 16 patients (50%) with and 4 of 41 (10%) without inducible VT had late potentials recorded (p < 0.002). Thus, the signal-averaged electrocardiogram may enable identification of persons with Nonsustained VT after myocardial infarction who are most likely to have VT induced at programmed Ventricular stimulation.
Jeanne E Poole - One of the best experts on this subject based on the ideXlab platform.
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reply rapid rate Nonsustained Ventricular Tachycardia found on icd interrogation relationship of rr nsvt to outcomes in the scd heft trial
Journal of the American College of Cardiology, 2013Co-Authors: Jay Chen, Kerry L Lee, George Johnson, Anne S Hellkamp, Jill Anderson, Daniel B Mark, Gust H Bardy, Jeanne E PooleAbstract:We appreciate the interest in our paper and the opportunity to reply to Dr. Andraws' most thoughtful comments [(1)][1]. It is very difficult to isolate the different facets of the rapid-rate Nonsustained Ventricular Tachycardia (RR-NSVT) and inappropriate shock-mortality relationships. In fact, it
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rapid rate Nonsustained Ventricular Tachycardia found on implantable cardioverter defibrillator interrogation relationship to outcomes in the scd heft sudden cardiac death in heart failure trial
Journal of the American College of Cardiology, 2013Co-Authors: Jay Che, Kerry L Lee, Anne S Hellkamp, George Johnso, Jill Anderso, Daniel Mark, Gus H Ardy, Jeanne E PooleAbstract:Objectives The aim of this study was to examine rapid-rate Nonsustained Ventricular Tachycardia (RR-NSVT) during routine implantable cardioverter-defibrillator (ICD) evaluation in patients with heart failure and its relationship to outcomes. Background The clinical implications of RR-NSVT identified during routine ICD interrogation are unclear. In this study, the occurrence of RR-NSVT and its association with ICD shocks and mortality in SCD-HeFT (Sudden Cardiac Death in Heart Failure Trial) were examined. Methods The 811 patients who received ICDs in SCD-HeFT constituted the study population. The occurrence of RR-NSVT and its association with ICD shocks and mortality in SCD-HeFT were examined. Results RR-NSVT was documented on ICD interrogation in 186 of 811 patients (22.9%). The mean duration of RR-NSVT was 26.4 ± 9.1 beats (7.5 ± 2.6 s), with a mean cycle length of 259 ± 32 ms. Polymorphic RR-NSVT accounted for 56% of episodes. Compared with patients without RR-NSVT, those with RR-NSVT were less likely to be taking beta-blockers, statins, or aspirin at enrollment. After adjusting for other known predictors of mortality in SCD-HeFT, RR-NSVT was independently associated with appropriate ICD shocks (hazard ratio: 4.25; 95% confidence interval: 2.94 to 6.14; p Conclusions RR-NSVT identified on routine ICD interrogation should be considered an important clinical event. RR-NSVT during ICD interrogation is associated with appropriate ICD shocks and all-cause mortality. The clinical evaluation of patients with RR-NSVT should include intensification of medical therapy, particularly beta-blockers, or other appropriate clinical interventions. (Sudden Cardiac Death in Heart Failure Trial [SCD-HeFT]; NCT00000609 )
