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Alfred E Buxton - One of the best experts on this subject based on the ideXlab platform.
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THERAPY AND PREVENTION Ventricular Tachycardia
2016Co-Authors: David S. Poll, Alfred E Buxton, Francis E Marchlinski, John U Doherty, Harvey L. Waxman, E. JosephsonAbstract:Sustained Ventricular Tachycardia in patients with idiopathic dilated cardiomyopathy: electrophysiologic testing and lack of response to antiarrhythmic drug therap
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prediction of Sustained Ventricular Tachycardia inducible by programmed stimulation in patients with coronary artery disease utility of clinical variables
Circulation, 1999Co-Authors: Alfred E Buxton, Gail E Hafley, Michael H Lehmann, Michael R Gold, Michael F Otoole, Anthony Tang, James Coromilas, Bruce G Hook, Nicholas J StamatoAbstract:Background—Cardiologists often use clinical variables to determine the need for electrophysiological studies to stratify patients for risk of sudden death. It is not clear whether this is rational in patients with coronary artery disease, left Ventricular dysfunction, and nonSustained Ventricular Tachycardia. Methods and Results—We analyzed the first 1721 patients enrolled in the Multicenter UnSustained Tachycardia Trial to determine whether clinical variables could predict which patients would have inducible Sustained monomorphic Ventricular Tachycardia. The rate of inducibility of Sustained Ventricular Tachycardia was significantly higher in patients with a history of myocardial infarction and in men compared with women. There was a progressively increased rate of inducibility with increasing numbers of diseased coronary arteries. There was a significantly lower rate of inducibility in patients with prior coronary artery bypass surgery and in patients who also had noncoronary cardiac disease. The rate o...
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what is the risk of sudden cardiac death in patients presenting with hemodynamically stable Sustained Ventricular Tachycardia after myocardial infarction
Journal of the American College of Cardiology, 1996Co-Authors: Alfred E Buxton, Brian H Sarter, John K Finkle, Robert E GersztenAbstract:Abstract Objectives. This study sought to determine the long-term risk of sudden cardiac death in patients with hemodynamically stable Sustained Ventricular Tachycardia complicating coronary artery disease. Background. The prognosis and risk of sudden cardiac death in patients with a history of myocardial infarction and Ventricular tachyarrhythmias have not been clearly defined. Prior studies are limited by a short follow-up period and by inclusion of patients with heterogeneous cardiac diseases and presenting arrhythmias. Methods. A retrospective cohort analysis was performed on data from 124 patients, followed up for a mean of 36 ± 30 months, who received electrophysiologically guided therapy for hemodynamically stable Ventricular Tachycardia after remote myocardial infarction. Results. Seventy-eight patients were treated pharmacologically (medical group), and 46 patients underwent map-guided subendocardial resection (surgical group). Nine patients (7.3%) died suddenly, 5 (4.0%) died of noncardiac causes, 9 (7.3%) died of a perioperative complication, and 20 (23.4%) died of other cardiac causes. At 1, 2 and 3 years, sudden death occured at cumulative rates of 2 ± 1%, 3 ± 2% and 7 ± 3%, whereas total mortality was 20 ± 4%, 28 ± 4% and 32 ± 5% (mean ± SD). Sudden cardiac death (p = 0.047) and total mortality (p = 0.036) were higher in patients with multivessel disease and were similar for both treatment groups. Conclusions. Although the overall mortality in postinfarction patients presenting with hemodynamically stable Ventricular Tachycardia treated with electrophysiologically guided antiarrhythmic therapy is high, the risk of sudden death in these patients appears to be low (average 2.4%/year).
Anthony J Gomes - One of the best experts on this subject based on the ideXlab platform.
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Sustained Ventricular Tachycardia associated with sarcoidosis assessment of the underlying cardiac anatomy and the prospective utility of programmed Ventricular stimulation drug therapy and an implantable antiTachycardia device
Journal of the American College of Cardiology, 1991Co-Authors: Stephen L Winters, Marc Cohen, Steven Greenberg, Bernardo Stein, Jay Curwin, Anthony J GomesAbstract:Abstract The presentation, cardiac anatomy and utility of programmed Ventricular stimulation in seven patients with Sustained Ventricular Tachycardia associated with sarcoidosis are described. The mean patient age was 38 ± 8 years. Pulmonary involvement was apparent in three patients and no systemic manifestations of sarcoidosis were present in one patient. All patients had electrocardiographic abnormalities at rest and six had a left Ventricular ejection fraction Sustained Ventricular Tachycardia was easily induced in all patients. Spontaneous Sustained Ventricular Tachycardia was not prevented with corticosteroid administration. Despite antiarrhythmic drug therapy, two patients had sudden cardiac death and an additional four had recurrence of Ventricular Tachycardia. Four patients had an automatic cardioverter-defibrillator implanted and received drug therapy: all four received appropriate shocks. This report represents the largest descriptive series of consecutive patients with Sustained Ventricular Tachycardia associated with sarcoidosis. Antiarrhythmic drug therapy of Ventricular Tachycardia in patients with sarcoidosis, even when guided with programmed Ventricular stimulation, is associated with a high rate of arrhythmia recurrence or sudden death, or both. Thus, implantation of an automatic antiTachycardia device (cardioverter-defibrillator) should be considered as primary therapy in such patients. Furthermore, sarcoidosis should be excluded, with Kveim skin testing if necessary, in any patient with Sustained Ventricular Tachycardia of unknown origin.
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Sustained Ventricular Tachycardia associated with sarcoidosis assessment of the underlying cardiac anatomy and the prospective utility of programmed Ventricular stimulation drug therapy and an implantable antiTachycardia device
Journal of the American College of Cardiology, 1991Co-Authors: Stephen L Winters, Steven Greenberg, Bernardo Stein, Jay Curwin, Marc D Cohen, Anthony J GomesAbstract:The presentation, cardiac anatomy and utility of programmed Ventricular stimulation in seven patients with Sustained Ventricular Tachycardia associated with sarcoidosis are described. The mean patient age was 38 +/- 8 years. Pulmonary involvement was apparent in three patients and no systemic manifestations of sarcoidosis were present in one patient. All patients had electrocardiographic abnormalities at rest and six had a left Ventricular ejection fraction less than 45%. All seven patients had left Ventricular wall motion abnormalities and five had mitral valve dysfunction. Sustained Ventricular Tachycardia was easily induced in all patients. Spontaneous Sustained Ventricular Tachycardia was not prevented with corticosteroid administration. Despite antiarrhythmic drug therapy, two patients had sudden cardiac death and an additional four had recurrence of Ventricular Tachycardia. Four patients had an automatic cardioverter-defibrillator implanted and received drug therapy; all four received appropriate shocks. This report represents the largest descriptive series of consecutive patients with Sustained Ventricular Tachycardia associated with sarcoidosis. Antiarrhythmic drug therapy of Ventricular Tachycardia in patients with sarcoidosis, even when guided with programmed Ventricular stimulation, is associated with a high rate of arrhythmia recurrence or sudden death, or both. Thus, implantation of an automatic antiTachycardia device (cardioverter-defibrillator) should be considered as primary therapy in such patients. Furthermore, sarcoidosis should be excluded, with Kveim skin testing if necessary, in any patient with Sustained Ventricular Tachycardia of unknown origin.
Kimberlee Gauvreau - One of the best experts on this subject based on the ideXlab platform.
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preoperative predictors of death and Sustained Ventricular Tachycardia after pulmonary valve replacement in patients with repaired tetralogy of fallot enrolled in the indicator cohort
Circulation, 2018Co-Authors: Tal Geva, Barbara J M Mulder, Kimberlee Gauvreau, Sonya V Babunarayan, Rachel M Wald, Kelsey Hickey, Andrew J Powell, Michael A Gatzoulis, Anne Marie ValenteAbstract:BACKGROUND: Risk factors for adverse clinical outcomes have been identified in patients with repaired tetralogy of Fallot before pulmonary valve replacement (PVR). However, pre-PVR predictors for post-PVR Sustained Ventricular Tachycardia and death have not been identified. METHODS: Patients with repaired tetralogy of Fallot enrolled in the INDICATOR cohort (International Multicenter TOF Registry), a 4-center international cohort study, who had a comprehensive preoperative evaluation and subsequently underwent PVR were included. Preprocedural clinical, ECG, cardiovascular magnetic resonance, and postoperative outcome data were analyzed. Cox proportional hazards multivariable regression analysis was used to evaluate factors associated with time from pre-PVR cardiovascular magnetic resonance until the primary outcome: death, aborted sudden cardiac death, or Sustained Ventricular Tachycardia. RESULTS: Of the 452 eligible patients (median age at PVR, 25.8 years), 36 (8%) reached the primary outcome (27 deaths, 2 resuscitated death, and 7 Sustained Ventricular Tachycardia) at a median time after PVR of 6.5 years. Cox proportional hazards regression identified pre-PVR right Ventricular ejection fraction <40% (hazard ratio, 2.39; 95% CI, 1.18-4.85; P=0.02), right Ventricular mass-to-volume ratio ≥0.45 g/mL (hazard ratio, 4.08; 95% CI, 1.57-10.6; P=0.004), and age at PVR ≥28 years (hazard ratio, 3.10; 95% CI, 1.42-6.78; P=0.005) as outcome predictors. In a subgroup analysis of 230 patients with Doppler data, predicted right Ventricular systolic pressure ≥40 mm Hg was associated with the primary outcome (hazard ratio, 3.42; 95% CI, 1.09-10.7; P=0.04). Preoperative predictors of a composite secondary outcome, postoperative arrhythmias and heart failure, included older age at PVR, pre-PVR atrial tachyarrhythmias, and a higher left Ventricular end-systolic volume index. CONCLUSIONS: In this observational investigation of patients with repaired tetralogy of Fallot, an older age at PVR and pre-PVR right Ventricular hypertrophy and dysfunction were predictive of a shorter time to postoperative death and Sustained Ventricular Tachycardia. These findings may inform the timing of PVR if confirmed by prospective clinical trials.
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relation of biVentricular strain and dyssynchrony in repaired tetralogy of fallot measured by cardiac magnetic resonance to death and Sustained Ventricular Tachycardia
American Journal of Cardiology, 2015Co-Authors: Tal Geva, Kimberlee Gauvreau, Anne Marie Valente, Thomas J Moon, Nadine ChoueiterAbstract:Ventricular strain and dyssynchrony can be measured in patients with repaired tetralogy of Fallot (TOF), but their effect on clinical outcomes is poorly understood. The purpose of this study was to investigate if Ventricular strain and dyssynchrony measured by cardiac magnetic resonance feature tracking are associated with death and Sustained Ventricular Tachycardia. Patients with TOF who died or had Ventricular Tachycardia (TOF case, n = 16) were compared with age-matched patients with TOF with no adverse outcome (TOF control, n = 32). For each patient, midVentricular short-axis and 4-chamber cine steady-state free precession images were analyzed using cardiac magnetic resonance feature-tracking software. Peak left Ventricular (LV) and right Ventricular (RV) global circumferential and longitudinal strain and indexes of dyssynchrony were compared between groups. Compared with the TOF control group, median strain values were significantly lower for the TOF case group for both the LV (circumferential: 17% vs 23%, p = 0.003; longitudinal: 13% vs 18%, p
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Ventricular size and function assessed by cardiac mri predict major adverse clinical outcomes late after tetralogy of fallot repair
Heart, 2008Co-Authors: Alison L Knauth, Kimberlee Gauvreau, Andrew J Powell, Michael J Landzberg, Edward P Walsh, James E Lock, P J Del Nido, Tal GevaAbstract:Background: Factors associated with impaired clinical status in a cross-sectional study of patients with repaired tetralogy of Fallot (TOF) have been reported previously. Objectives: To determine independent predictors of major adverse clinical outcomes late after TOF repair in the same cohort during follow-up evaluated by cardiac magnetic resonance (CMR). Methods: Clinical status at latest follow-up was ascertained in 88 patients (median time from TOF repair to baseline evaluation 20.7 years; median follow-up from baseline evaluation to most recent follow-up 4.2 years). Major adverse outcomes included ( a ) death; ( b ) Sustained Ventricular Tachycardia; and ( c ) increase in NYHA class to grade III or IV. Results: 22 major adverse outcomes occurred in 18 patients (20.5%): death in 4, Sustained Ventricular Tachycardia in 8, and increase in NYHA class in 10. Multivariate analysis identified right Ventricular (RV) end-diastolic volume Z ⩾7 (odds ratio (OR) = 4.55, 95% confidence interval (CI) 1.10 to 18.8, p = 0.037) and left Ventricular (LV) ejection fraction Conclusions: In this cohort, severe RV dilatation and either LV or RV dysfunction assessed by CMR predicted major adverse clinical events. This information may guide risk stratification and therapeutic interventions.
James A Reiffel - One of the best experts on this subject based on the ideXlab platform.
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letter by reiffel regarding article unique ecg during sinus rhythm in a patient with a postmyocardial infarction Sustained Ventricular Tachycardia
Circulation, 2018Co-Authors: James A ReiffelAbstract:I read with great interest the report by Drs Farre and Wellens.1 In it, the authors presented a surface electrocardiogram (ECG) in a patient with a previous myocardial infarction and Sustained Ventricular Tachycardia that displayed late potentials, which they noted “in patients with ischemic scars are only exceptionally reflected on the surface …
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prognostic significance of postprocedural Sustained Ventricular Tachycardia or fibrillation in patients undergoing primary percutaneous coronary intervention from the horizons ami trial
American Journal of Cardiology, 2012Co-Authors: Rajendra H Mehta, James A Reiffel, Jonathan P Piccini, James E Tcheng, Michael E Farkouh, Martin Fahy, Roxana Mehran, Gregg W StoneAbstract:The prognostic significance of postprocedure Sustained Ventricular Tachycardia or Ventricular fibrillation (VT/VF) in patients undergoing primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) has rarely been studied, although a previous study has suggested that its occurrence portends decreased survival. We examined outcomes from the prospective large-scale multicenter randomized HORIZONS-AMI trial to evaluate the incidence, clinical correlates, and outcomes of in-hospital Sustained VT/VF after PPCI. Of 3,485 patients undergoing PPCI in whom VT/VF did not occur before or during the procedure, 181 patients (5.2%) developed VT/VF after PPCI. Most postprocedural VT/VF episodes (85%) occurred in the first 48 hours. Patients with postprocedural VT/VF were more likely men with Killip class >I on presentation but had a lower prevalence of hypertension and diabetes. Patients with postprocedural VT/VF were also less frequently taking β blockers and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers at admission. Mean door-to-balloon time was shorter and Thrombolysis In Myocardial Infarction grade 0 flow before PPCI was more common in patients with VT/VF, although Thrombolysis In Myocardial Infarction grade 3 flow rates after PPCI did not vary. There were no significant differences in adjusted 3-year rates of mortality (hazard ratio 0.73, 95% confidence interval 0.30 to 1.79) or composite major adverse clinical events (death, myocardial infarction, target vessel revascularization, or stroke; hazard ratio 0.71, 95% confidence interval 0.44 to 1.15) in patients with versus without postprocedural Sustained VT/VF. In conclusion, Sustained VT/VF after PPCI in the HORIZONS-AMI trial was not significantly associated with 3-year mortality or major adverse clinical events. Further studies are required to address the prognostic significance of VT/VF in patients with STEMI undergoing PPCI.
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
