The Experts below are selected from a list of 162 Experts worldwide ranked by ideXlab platform
Edward P Gerstenfeld - One of the best experts on this subject based on the ideXlab platform.
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abstract 17531 importance of Programmed Stimulation under conscious sedation for patients referred for epicardial ventricular tachycardia ablation
Circulation, 2014Co-Authors: Babak Nazer, Nitish Badhwar, Christopher E Woods, Thomas A Dewland, Brian Moyers, Edward P GerstenfeldAbstract:Background: Many non-ischemic cardiomyopathy (NICMP) patients referred for catheter ablation undergo an up-front epicardial approach under general anesthesia (GA). However, GA may suppress inducibi...
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noninvasive Programmed ventricular Stimulation early after ventricular tachycardia ablation to predict risk of late recurrence
Journal of the American College of Cardiology, 2012Co-Authors: David S Frankel, Sanjay Dixit, Andrew E Epstein, Stavros E Mountantonakis, Erica S Zado, Elad Anter, Rupa Bala, Joshua M Cooper, Fermin C Garcia, Edward P GerstenfeldAbstract:Objectives The goal of this study was to evaluate the ability of noninvasive Programmed Stimulation (NIPS) after ventricular tachycardia (VT) ablation to identify patients at high risk of recurrence. Background Optimal endpoints for VT ablation are not well defined. Methods Of 200 consecutive patients with VT and structural heart disease undergoing ablation, 11 had clinical VT inducible at the end of ablation and 11 recurred spontaneously. Of the remaining 178 patients, 132 underwent NIPS through their implantable cardioverter-defibrillator 3.1 ± 2.1 days after ablation. At 2 drive cycle lengths, single, double, and triple right ventricular extrastimuli were delivered to refractoriness. Clinical VT was defined by comparison with 12-lead electrocardiograms and stored implantable cardioverter-defibrillator electrograms from spontaneous VT episodes. Patients were followed for 1 year. Results Fifty-nine patients (44.7%) had no VT inducible at NIPS; 49 (37.1%) had inducible nonclinical VT only; and 24 (18.2%) had inducible clinical VT. Patients with inducible clinical VT at NIPS had markedly decreased 1-year VT-free survival compared to those in whom no VT was inducible ( 80%; p = 0.001), including 33% recurring with VT storm. Patients with inducible nonclinical VT only, had intermediate 1-year VT-free survival (65%). Conclusions When patients with VT and structural heart disease have no VT or nonclinical VT only inducible at the end of ablation or their condition is too unstable to undergo final Programmed Stimulation, NIPS should be considered in the following days to further define risk of recurrence. If clinical VT is inducible at NIPS, repeat ablation may be considered because recurrence over the following year is high.
Francis E Marchlinski - One of the best experts on this subject based on the ideXlab platform.
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Effectiveness of Noninvasive Programmed Stimulation for Initiating Ventricular Tachyarrhythmias in Patients with Third‐Generation Implantable Cardioverter Definrillators
Pacing and Clinical Electrophysiology, 1994Co-Authors: Robert B Kleiman, David J Callans, Bruce G Hook, Francis E MarchlinskiAbstract:Previous generations of implantable cardioverter defibrillators (ICDs) required invasive electrophysiological testing to assess defibrillator function. Newer third-generation ICDs include the capability for performing noninvasive Programmed Stimulation (NIPS) and may reduce the need for invasive studies to assess tachycardia recognition and antitachycardia therapy algorithms. The effectiveness of ICD-based NIPS for the induction of ventricular arrhythmias has not, however, been formally assessed. Third-generation ICDs were implanted in 79 patients, who underwent a total of 166 postoperative defibrillator tests. NIPS with rapid ventricular pacing was performed in all patients in an attempt to induce ventricular fibrillation. In patients with prior sustained uniform ventricular tachycardia, Programmed Stimulation with up to three extrastimuli was performed in order to attempt to initiate the clinical ventricular tachcardia. Ventricular fibrillation was induced with NIPS in 146 of 166 studies (88%). Ventricular tachycardia was initiated with NIPS in 104 of 123 studies (85%). The type of defibrillator and the use of endocardial or epicardial rate sensing/ pacing leads did not influence the efficacy of NIPS. NIPS with third-generation ICDs is generally effective at inducing ventricular fibrillation and clinically relevant ventricular tachycardias, and reduces the need to perform invasive electrophysiological testing following device implantation. In a minority of patients temporary transvenous pacing catheters must still be used to facilitate arrhythmia induction.
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effectiveness of noninvasive Programmed Stimulation for initiating ventricular tachyarrhythmias in patients with third generation implantable cardioverter definrillators
Pacing and Clinical Electrophysiology, 1994Co-Authors: Robert B Kleiman, David J Callans, Bruce G Hook, Francis E MarchlinskiAbstract:Previous generations of implantable cardioverter defibrillators (ICDs) required invasive electrophysiological testing to assess defibrillator function. Newer third-generation ICDs include the capability for performing noninvasive Programmed Stimulation (NIPS) and may reduce the need for invasive studies to assess tachycardia recognition and antitachycardia therapy algorithms. The effectiveness of ICD-based NIPS for the induction of ventricular arrhythmias has not, however, been formally assessed. Third-generation ICDs were implanted in 79 patients, who underwent a total of 166 postoperative defibrillator tests. NIPS with rapid ventricular pacing was performed in all patients in an attempt to induce ventricular fibrillation. In patients with prior sustained uniform ventricular tachycardia, Programmed Stimulation with up to three extrastimuli was performed in order to attempt to initiate the clinical ventricular tachcardia. Ventricular fibrillation was induced with NIPS in 146 of 166 studies (88%). Ventricular tachycardia was initiated with NIPS in 104 of 123 studies (85%). The type of defibrillator and the use of endocardial or epicardial rate sensing/ pacing leads did not influence the efficacy of NIPS. NIPS with third-generation ICDs is generally effective at inducing ventricular fibrillation and clinically relevant ventricular tachycardias, and reduces the need to perform invasive electrophysiological testing following device implantation. In a minority of patients temporary transvenous pacing catheters must still be used to facilitate arrhythmia induction.
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polymorphic ventricular tachycardia induced by Programmed Stimulation response to procainamide
Journal of the American College of Cardiology, 1993Co-Authors: Alfred E Buxton, Francis E Marchlinski, Mark E Josephson, John M MillerAbstract:Objectives. This study was designed to evaluate the effects of procainamide on polymorphic ventricular tachycardia induced by Programmed Stimulation and to correlate the responses with heart disease, left ventricular endocardial activation abnormalities and the signal-averaged electrocardiogram (ECG). Background. Polymorphic ventricular tachycardia is induced frequently during electrophysiologic studies. In many patients this response is an artifact of Programmed Stimulation; in others, it appears to be clinically relevant. Previous observations have suggested that in some patients type IA antiarrhythmic agents can change the response to Programmed Stimulation from polymorphic to uniform ventricular tachycardia. Methods. Programmed right ventricular Stimulation was performed in the absence of antiarrhythmic drugs and after procainamide. Signal-averaged ECGs and left ventricular maps were performed during sinus rhythm in the absence of antiarrhythmic drugs. Results. We evaluated 79 consecutive patients undergoing clinical electrophysiologic studies, in whom polymorphic ventricular tachycardia was the only arrhythmia induced in the absence of antiarrhythmic drugs. After procainamide administration, uniform monomorphic ventricular tachycardia was induced in 24 patients (Group 1), inducible polymorphic ventricular tachycardia persisted in 30 patients (Group 2) and no ventricular tachycardia could be induced in the remaining 25 patients (Group 3). Twenty-three (96%) of 24 patients developing uniform ventricular tachycardia after procainamide administration had coronary artery disease compared with 63% of Group 2 and 48% of Group 3 patients (p = 0.003). Left ventricular aneurysms were also found more frequently (46%) in the patients developing uniform ventricular tachycardia after procainamide than in either Group 2 or Group 3 (13% and 0%, respectively, p < 0.008). Abnormalities of the signal-averaged ECG typically seen in patients with spontaneous reentrant sustained ventricular tachycardia were significantly more frequent in patients who developed inducible uniform ventricular tachycardia after procainamide than in those who did not. Similarly, patients developing uniform ventricular tachycardia after procainamide had more extensive abnormalities of left ventricular endocardial activation revealed by catheter maps during sinus rhythm. Conclusions. The conversion of inducible polymorphic ventricular tachycardia to uniform ventricular tachycardia after procainamide administration occurs almost exclusively in patients with coronary disease, previous myocardial infarction and abnormal left ventricular function. This response may permit activation mapping of tachycardias, allowing the appllcation of surgical or catheter ablation techniques that would otherwise not be possible in such patients.
Gioia Turitto - One of the best experts on this subject based on the ideXlab platform.
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risk stratification for arrhythmic events in patients with nonischemic dilated cardiomyopathy and nonsustained ventricular tachycardia role of Programmed ventricular Stimulation and the signal averaged electrocardiogram
Journal of the American College of Cardiology, 1994Co-Authors: Gioia Turitto, Edward B. Caref, Ratan K Ahuja, Nabil ElsherifAbstract:Abstract Objectives . This study investigated prediction of arrhythmic events by the signal-averaged electrocardiogram (ECG) and Programmed Stimulation in patients with nonischemic dilated cardiomyopathy. Background . Risk stratification in patients with nonischemic dilated cardiomyopathy remains controversial. Methods . Eighty patients with nonischemic dilated cardiomyopathy and spontaneous nonsustained ventricular tachycardia underwent signal-averaged electrocardiography (both time-domain and spectral turbulence analysis) and Programmed Stimulation. All patients were followed up for a mean of 22 ± 26 months. Results . Sustained monomorphic ventricular tachycardia was induced in 10 patients (13%), who all received amiodarone. The remaining 70 patients were followed up without antiarrhythmic therapy. Of the 80 patients, 15% had abnormal findings on the time-domain signal-averaged ECG, and 39% had abnormal findings on spectral turbulence analysis. Time-domain signal-averaged electrocardiography had a better predictive accuracy for induced ventricular tachycardia than spectral turbulence analysis (88% vs. 66%, p Conclusions . In patients with nonischemic dilated cardiomyopathy, 1) there is a strong correlation between abnormal findings on the time-domain signal-averaged ECG and induced ventricular tachycardia, but both findings are uncommon; and 2) normal findings on the signal-averaged ECG, as well as failure to induce ventricular tachycardia, do not imply a benign outcome.
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The Signal Averaged Electrocardiogram and Programmed Stimulation in Patients with Complex Ventricular Arrhythmias
Pacing and Clinical Electrophysiology, 1990Co-Authors: Gioia Turitto, Nabil El-sherifAbstract:TURITO, G., ET AL.: The Signal Averaged Electrocardiogram and Programmed Stimulation in Patients with Complex Ventricular Arrhythmias.The signal averaged electrocardiogram (SA-ECG), Programmed electrical Stimulation (PES), and left ventricular ejection fraction (EF) studies were utilized for risk stratification and management of patients with complex ventricular arrhythmias and nonsustained ventricular tachycardia (VT). The study population included 90 patients (63 with coronary artery disease and 27 with dilated cardiomyopathy). Sustained monomorphic VT was induced in 22 cases (24%), ventricular fibrillation (VF) in 10 (11%), and no sustained VT/VF in 58 (64%). An abnormal SA-ECG was recorded in 23 patients (26%) and was more common in patients with than in those without induced sustained VT (68% vs 12%, p < 0.0001). None of 33 patients with normal SA-ECG and EF ≥ 40% had induced VT. Patients were followed-up for 2.5 ± 0.8 years off antiarrhythmic therapy, unless they had induced sustained VT. The 3-year sudden death rate was 19% in the group with induced sustained VT, 0 in that with induced VF, and 9% in that without induced VT/VF (P = NS). The 3-year total cardiac mortality was higher in patients with than in those without EF < 40% (27% vs 7%, p < 0.05). It is concluded that patients with organic heart disease and spontaneous nonsustained VT may not need PES or antiarrhythmic therapy if SA-ECG is normal and EF is ≥ 40%, since their risk of induced VT and sudden death is low. On the other hand, patients with abnormal SA-ECG and/or EF < 40% may require PES, since their risk for induced VT is high. Antiarrhythmic therapy may also be considered in these patients. (PACE, Vol. 13, December, Part II 1990)
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The signal averaged electrocardiogram and Programmed Stimulation in patients with complex ventricular arrhythmias.
Pacing and clinical electrophysiology : PACE, 1990Co-Authors: Gioia Turitto, Nabil El-sherifAbstract:The signal averaged electrocardiogram (SA-ECG), Programmed electrical Stimulation (PES), and left ventricular ejection fraction (EF) studies were utilized for risk stratification and management of patients with complex ventricular arrhythmias and nonsustained ventricular tachycardia (VT). The study population included 90 patients (63 with coronary artery disease and 27 with dilated cardiomyopathy). Sustained monomorphic VT was induced in 22 cases (24%), ventricular fibrillation (VF) in 10 (11%), and no sustained VT/VF in 58 (64%). An abnormal SA-ECG was recorded in 23 patients (26%) and was more common in patients with than in those without induced sustained VT (68% vs 12%, P less than 0.0001). None of 33 patients with normal SA-ECG and EF greater than or equal to 40% had induced VT. Patients were followed-up for 2.5 +/- 0.8 years off antiarrhythmic therapy, unless they had induced sustained VT. The 3-year sudden death rate was 19% in the group with induced sustained VT, 0 in that with induced VF, and 9% in that without induced VT/VF (P = NS). The 3-year total cardiac mortality was higher in patients with than in those without EF less than 40% (27% vs 7%, P less than 0.05). It is concluded that patients with organic heart disease and spontaneous nonsustained VT may not need PES or antiarrhythmic therapy if SA-ECG is normal and EF is greater than or equal to 40%, since their risk of induced VT and sudden death is low. On the other hand, patients with abnormal SA-ECG and/or EF less than 40% may require PES, since their risk for induced VT is high. Antiarrhythmic therapy may also be considered in these patients.
John M Miller - One of the best experts on this subject based on the ideXlab platform.
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polymorphic ventricular tachycardia induced by Programmed Stimulation response to procainamide
Journal of the American College of Cardiology, 1993Co-Authors: Alfred E Buxton, Francis E Marchlinski, Mark E Josephson, John M MillerAbstract:Objectives. This study was designed to evaluate the effects of procainamide on polymorphic ventricular tachycardia induced by Programmed Stimulation and to correlate the responses with heart disease, left ventricular endocardial activation abnormalities and the signal-averaged electrocardiogram (ECG). Background. Polymorphic ventricular tachycardia is induced frequently during electrophysiologic studies. In many patients this response is an artifact of Programmed Stimulation; in others, it appears to be clinically relevant. Previous observations have suggested that in some patients type IA antiarrhythmic agents can change the response to Programmed Stimulation from polymorphic to uniform ventricular tachycardia. Methods. Programmed right ventricular Stimulation was performed in the absence of antiarrhythmic drugs and after procainamide. Signal-averaged ECGs and left ventricular maps were performed during sinus rhythm in the absence of antiarrhythmic drugs. Results. We evaluated 79 consecutive patients undergoing clinical electrophysiologic studies, in whom polymorphic ventricular tachycardia was the only arrhythmia induced in the absence of antiarrhythmic drugs. After procainamide administration, uniform monomorphic ventricular tachycardia was induced in 24 patients (Group 1), inducible polymorphic ventricular tachycardia persisted in 30 patients (Group 2) and no ventricular tachycardia could be induced in the remaining 25 patients (Group 3). Twenty-three (96%) of 24 patients developing uniform ventricular tachycardia after procainamide administration had coronary artery disease compared with 63% of Group 2 and 48% of Group 3 patients (p = 0.003). Left ventricular aneurysms were also found more frequently (46%) in the patients developing uniform ventricular tachycardia after procainamide than in either Group 2 or Group 3 (13% and 0%, respectively, p < 0.008). Abnormalities of the signal-averaged ECG typically seen in patients with spontaneous reentrant sustained ventricular tachycardia were significantly more frequent in patients who developed inducible uniform ventricular tachycardia after procainamide than in those who did not. Similarly, patients developing uniform ventricular tachycardia after procainamide had more extensive abnormalities of left ventricular endocardial activation revealed by catheter maps during sinus rhythm. Conclusions. The conversion of inducible polymorphic ventricular tachycardia to uniform ventricular tachycardia after procainamide administration occurs almost exclusively in patients with coronary disease, previous myocardial infarction and abnormal left ventricular function. This response may permit activation mapping of tachycardias, allowing the appllcation of surgical or catheter ablation techniques that would otherwise not be possible in such patients.
Paul Clopton - One of the best experts on this subject based on the ideXlab platform.
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comparability of noninvasive microvolt t wave alternans versus invasive ventricular Programmed Stimulation to guide implantable cardioverter defibrillator implantation in patients at risk of sudden death
Journal of the American College of Cardiology, 2009Co-Authors: Gregory K Feld, Paul CloptonAbstract:In this issue of the Journal , Costantini et al. ([1][1]) publish a study comparing noninvasive microvolt T-wave alternans (MTWA) with invasive electrophysiological study with ventricular Programmed Stimulation (EPS) to identify patients at risk of sudden cardiac death (SCD) who might benefit from
