The Experts below are selected from a list of 213 Experts worldwide ranked by ideXlab platform
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, Mark E Josephson, Francis E Marchlinski, 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.
John C. Smulian - One of the best experts on this subject based on the ideXlab platform.
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Catecholaminergic Polymorphic Ventricular Tachycardia in Pregnancy.
Obstetrics and gynecology, 2016Co-Authors: Matthew P. Romagano, Joanne N. Quiñones, Amy M. Ahnert, Rafael E Martinez, John C. SmulianAbstract:Catecholaminergic polymorphic Ventricular Tachycardia is a genetic disorder in which Ventricular Tachycardia occurs in the absence of structural heart disease or a prolonged QT interval. If untreated, there is a high incidence of sudden cardiac death. Management of this cardiac condition during pregnancy merits a multidisciplinary approach. A nulliparous woman with catecholaminergic polymorphic Ventricular Tachycardia presented at 15 weeks of gestation. Her care involved a multidisciplinary team including cardiology, maternal-fetal medicine, obstetric nursing, cardiac nursing, and anesthesia. A simulation scenario was designed to prepare for cardiac events during labor. A term intrapartum cesarean delivery was performed for fetal indications. A multidisciplinary approach to the antepartum, intrapartum, and postpartum care of women with catecholaminergic polymorphic Ventricular Tachycardia is critical to a team-based successful pregnancy outcome.
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Catecholaminergic Polymorphic Ventricular Tachycardia in Pregnancy.
Obstetrics and gynecology, 2016Co-Authors: Matthew P. Romagano, Joanne N. Quiñones, Amy M. Ahnert, Rafael E Martinez, John C. SmulianAbstract:Background Catecholaminergic polymorphic Ventricular Tachycardia is a genetic disorder in which Ventricular Tachycardia occurs in the absence of structural heart disease or a prolonged QT interval. If untreated, there is a high incidence of sudden cardiac death. Management of this cardiac condition during pregnancy merits a multidisciplinary approach. Case A nulliparous woman with catecholaminergic polymorphic Ventricular Tachycardia presented at 15 weeks of gestation. Her care involved a multidisciplinary team including cardiology, maternal-fetal medicine, obstetric nursing, cardiac nursing, and anesthesia. A simulation scenario was designed to prepare for cardiac events during labor. A term intrapartum cesarean delivery was performed for fetal indications. Conclusion A multidisciplinary approach to the antepartum, intrapartum, and postpartum care of women with catecholaminergic polymorphic Ventricular Tachycardia is critical to a team-based successful pregnancy outcome.
Francis E Marchlinski - One of the best experts on this subject based on the ideXlab platform.
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ECG Clues for Diagnosing Ventricular Tachycardia Mechanism
Journal of cardiovascular electrophysiology, 2007Co-Authors: Michael P. Riley, Francis E MarchlinskiAbstract:Three mechanisms underlie the initiation and maintenance of Ventricular Tachycardia: automaticity, triggered activity, and reentry. As straightforward as these mechanisms are, assessing which mechanism is operative in a particular patient's Ventricular Tachycardia can be difficult. The optimal treatment strategy for Ventricular Tachycardia in a given patient can be influenced by the mechanism underlying the Ventricular Tachycardia. Appropriately counseling patients, choosing the optimal pharmacologic agent that maximizes efficacy while minimizing undesirable side effects, risks, and toxicities, as well as recommending and timing ablative therapy all hinge on identifying the probable mechanism of Ventricular Tachycardia. Much has been published regarding invasive electrophysiologic maneuvers that allow for correct diagnosis of Ventricular Tachycardia mechanism. The aim of this clinical review is to provide insight into VT mechanisms based on ECG clues of spontaneous arrhythmia events and the response to pharmacologic manipulation prior to invasive electrophysiologic evaluation.
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Ablation of Unstable Ventricular Tachycardia
Cardiac Arrhythmias 2003, 2004Co-Authors: Francis E Marchlinski, David Lin, Hemal M. Nayak, Andrea M. Russo, Henry H. Hsia, Sanjay Dixit, Edward P. Gerstenfeld, David J. Callans, Ward Pulliam, SiddiqueAbstract:It is critical to begin any discussion on ablation of unstable Ventricular Tachycardia with background information supporting the importance of the effort. First, stable, mappable Ventricular Tachycardias represent the tip of the arrhythmia iceberg. In order for any arrhythmia to be mappable it must be reliably inducible and hemodynamically tolerable. The Ventricular Tachycardia must also be stable in response to the catheter manipulation and pacing required to identify the appropriate site for ablative therapy during activation and entrainment mapping [1–4]. In a consecutive series of “ideal” patients presenting with hemodynamically tolerated Ventricular Tachycardia and referred for catheter ablation, 30% had only unmappable VT at the time of electrophysiological evaluation [5]. Secondly, ICD event monitoring after device implantation has documented rapid unmappable VT in most patients regardless of the clinical indication for initial device therapy [6–8]. Finally, in looking to the future, a strategy for prevention of sudden cardiac death that uses ablative therapy must target the substrate for unmappable Ventricular Tachycardia [9].
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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, Mark E Josephson, Francis E Marchlinski, 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.
Matthew P. Romagano - One of the best experts on this subject based on the ideXlab platform.
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Catecholaminergic Polymorphic Ventricular Tachycardia in Pregnancy.
Obstetrics and gynecology, 2016Co-Authors: Matthew P. Romagano, Joanne N. Quiñones, Amy M. Ahnert, Rafael E Martinez, John C. SmulianAbstract:Catecholaminergic polymorphic Ventricular Tachycardia is a genetic disorder in which Ventricular Tachycardia occurs in the absence of structural heart disease or a prolonged QT interval. If untreated, there is a high incidence of sudden cardiac death. Management of this cardiac condition during pregnancy merits a multidisciplinary approach. A nulliparous woman with catecholaminergic polymorphic Ventricular Tachycardia presented at 15 weeks of gestation. Her care involved a multidisciplinary team including cardiology, maternal-fetal medicine, obstetric nursing, cardiac nursing, and anesthesia. A simulation scenario was designed to prepare for cardiac events during labor. A term intrapartum cesarean delivery was performed for fetal indications. A multidisciplinary approach to the antepartum, intrapartum, and postpartum care of women with catecholaminergic polymorphic Ventricular Tachycardia is critical to a team-based successful pregnancy outcome.
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Catecholaminergic Polymorphic Ventricular Tachycardia in Pregnancy.
Obstetrics and gynecology, 2016Co-Authors: Matthew P. Romagano, Joanne N. Quiñones, Amy M. Ahnert, Rafael E Martinez, John C. SmulianAbstract:Background Catecholaminergic polymorphic Ventricular Tachycardia is a genetic disorder in which Ventricular Tachycardia occurs in the absence of structural heart disease or a prolonged QT interval. If untreated, there is a high incidence of sudden cardiac death. Management of this cardiac condition during pregnancy merits a multidisciplinary approach. Case A nulliparous woman with catecholaminergic polymorphic Ventricular Tachycardia presented at 15 weeks of gestation. Her care involved a multidisciplinary team including cardiology, maternal-fetal medicine, obstetric nursing, cardiac nursing, and anesthesia. A simulation scenario was designed to prepare for cardiac events during labor. A term intrapartum cesarean delivery was performed for fetal indications. Conclusion A multidisciplinary approach to the antepartum, intrapartum, and postpartum care of women with catecholaminergic polymorphic Ventricular Tachycardia is critical to a team-based successful pregnancy outcome.
Alfred E Buxton - One of the best experts on this subject based on the ideXlab platform.
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Narrow QRS Complex Ventricular Tachycardia
Cardiac Electrophysiology, 2020Co-Authors: Amole Ojo, Alfred E BuxtonAbstract:Ventricular Tachycardia is rarely considered in the differential diagnosis of narrow QRS complex Tachycardias. However, in young people with idiopathic Ventricular Tachycardia, the QRS complex may be relatively narrow. We present a patient with Ventricular Tachycardia with QRS duration 110 ms.
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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, Mark E Josephson, Francis E Marchlinski, 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.
