A 63-year-old man with diabetes and asymptomatic coronary artery disease developed refractory ventricular arrhythmia at 20 hours at rest after his second COVID-19 vaccine. Despite significant stenosis in the coronary ...A 63-year-old man with diabetes and asymptomatic coronary artery disease developed refractory ventricular arrhythmia at 20 hours at rest after his second COVID-19 vaccine. Despite significant stenosis in the coronary arteries, there was no evidence of acute or old myocardial infarction, heart failure, myocarditis or structural abnormalities on post-mortem to account for the substrate for the fatal arrhythmia. The refractory and incessant nature of the ventricular fibrillation and post-mortem finding of a grossly elevated unexplained IgE level (in the absence of acute myocardial infarction) suggested the possibility of Kounis Syndrome or allergic acute coronary syndrome.展开更多
Ventricular fibrillation (VF) is a malignant arrhythmia, usually initiated by a ventricular premature contraction (VPC) during the vulnerable period of cardiac repolarization. Ablation therapy for VF has been desc...Ventricular fibrillation (VF) is a malignant arrhythmia, usually initiated by a ventricular premature contraction (VPC) during the vulnerable period of cardiac repolarization. Ablation therapy for VF has been described and increasingly reported. Targets for VF triggers are VPCs preceded by Purkinje potentials or from the right ventricular outflow tract (RVOT) in structurally normal hearts, and VPC triggers preceded by Purkinje potentials in ischemic cardiomyopathy. During the session, mapping should be focused on the earliest activation and determining the earliest potential is the key to a successful ablation. However, suppression of VF can be achieved by not only the elimination of triggering VPCs, but also by substrate modification of possible reentry circuits in the Purkinje network, or between the PA and RVOT. The most important issue before the ablation session is the recording of the 12-lead ECG of the triggering event, which can prove invaluable in regionalizing the origin of the triggering VPC for more detailed mapping. In cases where the VPC is not spontaneous or inducible, ablation may be performed by pace mapping. Further studies are needed to evaluate the precise mechanisms of this arrhythmia.展开更多
BACKGROUND Inferior wall left ventricular aneurysms are rare,they develop after transmural myocardial infarction(MI)and may be associated with poorer prognosis.We present a unique case of a large aneurysm of the infer...BACKGROUND Inferior wall left ventricular aneurysms are rare,they develop after transmural myocardial infarction(MI)and may be associated with poorer prognosis.We present a unique case of a large aneurysm of the inferior wall complicated by ventricular tachycardia(VT)and requiring surgical resection and mitral valve replacement.CASE SUMMARY A 59-year-old male was admitted for VT one month after he had a delayed presentation for an inferior ST-segment elevation MI and was discovered to have a large true inferior wall aneurysm on echocardiography and confirmed on coronary computed tomography(CT)angiography.Due to the sustained VT,concern for aneurysm expansion,and persistent heart failure symptoms,the patient was referred for surgical resection of the aneurysm with patch repair,mitral valve replacement,and automated implantable cardioverter defibrillator insertion with significant improvement in functional and clinical status.CONCLUSION Inferior wall aneurysms are rare and require close monitoring to identify electrical or contractile sequelae.Coronary CT angiography can outline anatomic details and guide surgical intervention to ameliorate life-threatening complications and improve performance status.展开更多
Background: Peripartum cardiomyopathy (PPCM) is a rare disease that typically affects young, healthy women. Because PPCM is associated with significant mortality, timely diagnosis and management are essential. Ventric...Background: Peripartum cardiomyopathy (PPCM) is a rare disease that typically affects young, healthy women. Because PPCM is associated with significant mortality, timely diagnosis and management are essential. Ventricular tachycardia (VT) is a major complication and contributor to sudden death. Available data on VT in patients with PPCM are limited. Aim: This case report demonstrates the clinical presentation, antenatal care, and management of labor and delivery in a patient with PPCM complicated by VT. Case report: 36-year old patient G4P3 presents at 27 weeks gestation to the emergency department complaining of chest tightness, palpitations, and profuse sweating. Peripartum cardiomyopathy was diagnosed after her last pregnancy a few years prior. Ventricular tachycardia was diagnosed at this visit and treated successfully. The remainder of the pregnancy was uneventful until she had another episode of ventricular tachycardia during labor. Treatment using antiarrhythmics (diltiazem, amiodarone, adenosine) highlights the importance of prompt intervention and the need for a range of therapeutic options. Results: This case demonstrated successful VT management during pregnancy and labor, emphasizing multidisciplinary collaboration, influencing maternal and fetal outcomes positively, providing insights into optimal care strategies. Conclusion: Peripartum cardiomyopathy complicated by ventricular tachycardia is a life-threatening combination. This case highlights the importance of timely diagnosis and management with combined care between cardiologists, maternal fetal medicine specialists and anesthesiologists to prevent morbidities and sudden maternal death.展开更多
Objective To study the application of positron emission tomography (PET) in detection of myocardia metabolism in pig ventricular fibrillation and asphyxiation cardiac arrest models after resuscitation. Methods Thirt...Objective To study the application of positron emission tomography (PET) in detection of myocardia metabolism in pig ventricular fibrillation and asphyxiation cardiac arrest models after resuscitation. Methods Thirty-two healthy miniature pigs were randomized into a ventricular fibrillation cardiac arrest (VFCA) group (n=16) and an asphyxiation cardiac arrest (ACA) group (n=16). Cardiac arrest (CA) was induced by programmed electric stimulation or endotracheal tube clamping followed by cardiopulmonary resuscitation (CPR) and defibrillation. At four hours and 24 h after spontaneous circulation was achieved, myocardial metabolism was assessed by PET. 18F-FDG myocardial uptake in PET was analyzed and the maximum standardized uptake value (SUVmax) was measured. Results Spontaneous circulation was 200% and 62.5% in VFCA group and ACA group, respectively. PET demonstrated that the myocardial metabolism injuries was more severe and widespread after ACA than after VFCA. The SUVrnax was higher in VFCA group than in ACA group (P〈0.01). In VFCA group, SUVmax at 24 h after spontaneous circulation increased to the level of baseline. Conclusion ACA causes more severe cardiac metabol associated with less successful resuscitation. Myocardial sm injuries than VFCA. Myocardial dysfunction is stunning does occur with VFCA but not with ACA.展开更多
Objective To describe the clinical characteristics of idiopathic ventricular fibrillation (IVF) with fragmented QRS complex (f-QRS) and J wave in resting electrocardiogram. Methods We reviewed data from 21 case su...Objective To describe the clinical characteristics of idiopathic ventricular fibrillation (IVF) with fragmented QRS complex (f-QRS) and J wave in resting electrocardiogram. Methods We reviewed data from 21 case subjects in our hospital who were resuscitated after cardiac arrest due to IVF and assessed the prevalence of f-QRS and J wave in resting electrocardiogram (ECG). All the case subjects were classified among three groups based on the electrocardiographic morphology: group I, both f-QRS and J wave were observed (n = 6), group II, only J wave was observed (n = 9), group III, neither f-QRS nor J wave was observed (n = 6). Population characteristics, history of syncope or sudden cardiac arrest, incidence of ventricular fibrillation (VF), and circumstance of VF were evaluated among the three groups. Results The incidence of index events (syncope, survived cardiac arrest and VF episodes recorded in implantable cardioverter defibrillator (ICD) or pacemakers) was 13.4 ~ 5.6 per-year in group I, 10.8 ~ 3.9 per-year in group II, and 9.8 -4- 4.2 per-year in group HI. There were significant differences in incidences among the three groups, the most frequent index events were observed in group I. The hazard ratio for incidence was 3.2 (95%CI, 1.1-7.9; P = 0.01). The history and circumstance of the index events were different among the groups. In group I, all the index events occurred during sleep in early morning. In group II, four subjects suffered VF during strenuous physical activities or agitation state, two during sleep in early morning, three in usual activity. In group III, one subject suffered VF during sleep in early morning, one in agitation state, four in usual activity. Conclusions This study suggests that the IVF patients with the combined appearance of f-QRS and J wave in the resting ECG suffer an increased risk of VF, this subgroup of IVF patients has a unique clinical feature.展开更多
Sudden cardiac death (SCD) from ventricular fibrillation (VF) during coronary artery disease (CAD) is a leading cause of total and cardiovascular mortality, and in more than half of SCD cases VF occurs as the fi...Sudden cardiac death (SCD) from ventricular fibrillation (VF) during coronary artery disease (CAD) is a leading cause of total and cardiovascular mortality, and in more than half of SCD cases VF occurs as the first symptom of CAD. Several epidemiological studies have shown that sudden death of a family member is a risk factor for SCD and VF during acute myocardial infarction (MI), independent of traditional risk factors including family history of MI, suggesting a genetic component in the susceptibility to VF. To prevent SCD and VF due to MI, we need a better understanding of the genetic and molecular mechanisms causing VF in this apparently healthy population. Even though new insights and technologies have become available, the genetic predisposition to VF during MI remains poorly understood. Findings from a variety of different genetic studies have failed to reach reproducibility, although several genetic variants, both common and rare variants, have been associated to either VF or SCD. For this review, we searched PubMed for potentially relevant articles, using the following MeSH-terms: "sudden cardiac death", "ventricular fibrillation", "out-of-hospital cardiac arrest", "myocardial infarction, myocardial ische- mia", "coronary artery disease", and "genetics". This review describes the epidemiology and evidence for genetic susceptibility to VF due to MI.展开更多
The core treatment of rapid arrhythmiainduced heart failure(HF)is to control the ventricular rate to an optimized lower level,which is usually achieved with various anti-arrhythmic drugs.However,arrhythmias may not re...The core treatment of rapid arrhythmiainduced heart failure(HF)is to control the ventricular rate to an optimized lower level,which is usually achieved with various anti-arrhythmic drugs.However,arrhythmias may not respond well to pharmaceutical treatment for various reasons.Iatrogenic atrioventricular(AV)node ablation needs to be performed under these extreme conditions to lower the patient’s heart rate.展开更多
Takotsubo cardiomyopathy typically affects post-menopausal women under severe psychological or physical stress; it also has been reported to develop after medical procedures or surgery. We herein report the rare case ...Takotsubo cardiomyopathy typically affects post-menopausal women under severe psychological or physical stress; it also has been reported to develop after medical procedures or surgery. We herein report the rare case of a 30-year-old woman who presented with an episode of ventricular fibrillation after a very complicated cesarean delivery and was successfully resuscitated. Subsequent electrocardiography and echocardiography showed a typical Takotsubo pattern. Within 3 wk, left ventricular systolic function returned to normal.展开更多
Early warning and detection of ventricular fibrillation is crucial to the successful treatment of this life-threatening condition. In this paper, a ventricular fibrillation classification algorithm using a machine lea...Early warning and detection of ventricular fibrillation is crucial to the successful treatment of this life-threatening condition. In this paper, a ventricular fibrillation classification algorithm using a machine learning method, random forest, is proposed. A total of 17 previously defined ECG feature metrics were extracted from fixed length segments of the echocardiogram (ECG). Three annotated public domain ECG databases (Creighton University Ventricular Tachycardia database, MIT-BIH Arrhythmia Database and MIT-BIH Malignant Ventricular Arrhythmia Database) were used for evaluation of the proposed method. Window sizes 3 s, 5 s and 8 s for overlapping and non-overlapping segmentation methodologies were tested. An accuracy (Acc) of 97.17%, sensitivity (Se) of 95.17% and specificity (Sp) of 97.32% were obtained with 8 s window size for overlapping segments. The results were benchmarked against recent reported results and were found to outper-form them with lower complexity.展开更多
The effect of a pure α-adrenergic agent, methoxamine on ventricularfibrillation (VF) amplitude and the relation between hemodynamic parameters andsurvival in a rodent cardiopulmonary resuscitation (CPR) model were st...The effect of a pure α-adrenergic agent, methoxamine on ventricularfibrillation (VF) amplitude and the relation between hemodynamic parameters andsurvival in a rodent cardiopulmonary resuscitation (CPR) model were studied.Our results suggested that: 1) VF amplitude decreased during untreated VF, butit increased during pericardial chest compression ; 2) methoxamine significantly increased the mean aortic pressure (MAP) and coronary perfusion pressure (CPP)but not VF amplitude, and the survival also increased due to elevation of CPP;and 3) all surviving animals with successful defibrillhtion had a higher VF ampli-tude.展开更多
Objectics: Implantable cardioverter-defibrillator (ICI)is an important mean for treating ventricular tachycardia (VT ) in patients with structural heart diseases .This report deals with our primary experiences in clii...Objectics: Implantable cardioverter-defibrillator (ICI)is an important mean for treating ventricular tachycardia (VT ) in patients with structural heart diseases .This report deals with our primary experiences in cliical application of transveneous implantable cardioverter defibrillator.Metgids: A 13- year-old male patient with right ventricular dysplasia (ARVD) ). who lhad a failed result from antiarrhythmic drug therapy was implanted with ICD transveneously. Results: During follow. up. the antitachycardia pacing (ATP) did not terminate the first 2 episodes of VT. The episodes of VT were reverted into sinus rhythm by 4 J shock. The patient had a strong uncomfortable sensation :After resettin ATP program . VTs of patient were automaticallly terminated by ICD with ATP therapy many times. Conclusion: ICD implantation is an effective approach for treating VT and reasonable resetting of ATP is needed.展开更多
Objective To evaluate the factors influencing the outcome of patients who suffered in-hospital ventricular fibrillation (IHVF). Methods Data of patients with IHVF in a single center were collected. Clinical characte...Objective To evaluate the factors influencing the outcome of patients who suffered in-hospital ventricular fibrillation (IHVF). Methods Data of patients with IHVF in a single center were collected. Clinical characteristics of patients were compared between those survived (n=112) and those died (n=94), and those with IHVF occurred in inpatient ward and in emergency center. Multiple logistic regression analysis was used to identify factors associated with survival. Results There were 206 events in the analysis. The most common underlying disease was coronary artery disease (CAD), especially acute myocardial infarction (AMI). On multiple logistic regression analysis, independent predictors for failure to survive were higher NYHA class (odds ratio 1.7, 95% CI, 1.3-2.2, P〈 0.001), lower serum potassium concentration ( [K+] ) (odds ratio, 2.9, 95% CI, 1.9-4.3, P--0.007) and adrenaline usage (odds ratio, 25, 95% CI 11.5-55.1, P〈 0.001). Emergency group have better NYHA class (P = 0.012), lower [K-] (P 〈 0.001) than in inpatient ward group. Hypokalemia (serum potassium level 〈4.5 mmol/L) was found in all patients with AMI in emergency group. In AMI sub-group, 56.9% of IHVF events occurred within the first day after AMI, and decreasing within 2 weeks. Patients with fight coronary artery as infarction related artery (IRA) oRen (8/9, 88.9~,5) had bmdycardia (R-R interval 〉 ls) before the occurrence of IHVF, while those with left anterior descending artery as IRA often showed tachycardia (R-R interval 〈 0.6s) (8/12, 66.7%). Conclusion The most common disease causing IHVF is CAD. Keeping [K+] above 4.5mmol/1 could prevent on-setting IHVF, especially to AMI patients. The worse heart function is associated with higher rate of IHVF and worse pmgnosis (J Geriatr Cardio12010; 7:21-24).展开更多
Background: Recent data suggest that beta-blockers can be beneficial in patients with chronic heart failure (CHF). Atrial fibrillation (AF) is present in a significant number of patients with CHF and is associateing w...Background: Recent data suggest that beta-blockers can be beneficial in patients with chronic heart failure (CHF). Atrial fibrillation (AF) is present in a significant number of patients with CHF and is associateing with significant morbidity and increasing mortality rates. Thus it is necessary to establish therapy to improve the poor prognosis in this high-risk population, but a specific benefit of beta-blockers to the subset with concomitant AF and CHF has been little demonstrated. Objective: To examine the effects of Bisoprolol (6 months treatment) on the ventricular function and hemodynamics in patients with AF and CHF. Methods: 84 patients with stable CHF (NYHA≤Ⅲ class) and AF were assigned to Treated Group( n = 37) or Control group Ⅰ ( n = 22, 24-hour heart mean rate < 70/min) or Control Group Ⅱ ( n = 25, 24-hour heart mean rate ≥ 70/min) . All patients were given the basic therapy for CHF, and Treated Group received Bisopolol. Clinical and echocardiographic variables were measured in 3 groups at baseline and after 6 months, and the results were compared . Results: After 6 months of treatment with Bisoprolol, left ventricular ejection fraction (LVEF) and NYHA class had significandy improved (P < 0.05), and a trend towards a reduction in combined end point of death or CHF hospitalization was also observed (P < 0.20) in Treated Group; The increase of LVEF in Treated Group were associated with a reduction in mitral regurgitation degree and left atrial volume; The heart rate in mean 24-hour and at peak exercise decreased in Treated Group, but were similar to that in Control Group Ⅰ. Conclusion: 6 months of Bisoprolol therapy resulted in an improvement in the NYHA class and LVEF, and also showed a trend towards a reduction in hospitalization or death. The beneficial effects of Bisoprolol on patients with AF and CHF may be partly mediated by improvement of ventricular diastolic function.展开更多
A 23-year-old female with Tetralogy of Fallot who is 30w6d pregnant presented with palpitations and syncope from an outside hospital.She was found to have ventricular tachycardia.Successful placement of a transvenous ...A 23-year-old female with Tetralogy of Fallot who is 30w6d pregnant presented with palpitations and syncope from an outside hospital.She was found to have ventricular tachycardia.Successful placement of a transvenous implantable cardiac defibrillator allowed for symptomatic control and a subsequent successful vaginal delivery.展开更多
BACKGROUND Systemic sclerosis is a rare connective tissue disease characterized by localized or diffuse skin thickening and fibrosis,which usually accumulates in various organs throughout the body.Tachyarrhythmia is a...BACKGROUND Systemic sclerosis is a rare connective tissue disease characterized by localized or diffuse skin thickening and fibrosis,which usually accumulates in various organs throughout the body.Tachyarrhythmia is a common clinical manifestation of cardiovascular damage in systemic sclerosis patients.However,few studies have reported the use of catheter ablation and an implantable cardioverter defibrillator in patients with systemic sclerosis complicated by ventricular tachycardia.CASE SUMMARY A 39-year woman with an 11-year history of systemic sclerosis was referred to our hospital due to three syncopal episodes in the past 6 mo.The results of an electrocardiogram and a transthoracic echocardiogram revealed ventricular tachycardia and left ventricular systolic and ventricular septum segmental motion abnormalities,respectively.The results of an electrocardiogram showed a sinus rhythm with complete blockage of the left bundle branch.In light of the progressive nature of systemic sclerosis,the presence of a left bundle branch block,and the decreased ejection fraction,a cardiac resynchronization therapydefibrillator was implanted.The patient’s clinical conditions improved,and at the3-mo follow-up,the patient was free of ventricular tachycardia and all cardiac symptoms.CONCLUSION We report the first case of systemic sderosis complicated by ventricular tachycardia that was successfully treated with a cardiac resynchronization therapy-defibrillator.展开更多
We present here the case of a 43-year-old female without any known past medical history who was brought into the emergency department (ED) by the emergency medical services (EMS) after receiving cardiopulmonary resusc...We present here the case of a 43-year-old female without any known past medical history who was brought into the emergency department (ED) by the emergency medical services (EMS) after receiving cardiopulmonary resuscitation (CPR) on the field. Per EMS, on arrival patient was found to be on ventricular fibrillation and was shocked 3 times. Patient had no past medical history. In the ED, EKG showed sinus rhythm and troponin was 23 which is slightly high compared to upper limit. Patient was taken to the cath lab immediately which showed small to medium caliber septal 1 branch severe mid segment disease with distal tapering suggestive of spontaneous coronary artery dissection. No stent was placed. Electrophysiology was consulted and an Implantable Cardioverter Defibrillator was placed. Spontaneous coronary artery dissection (SCAD) is a phenomenon where an epicardial coronary artery dissection occurs that is not related to atherosclerosis, trauma or iatrogenia. Patients with SCAD presenting with ventricular arrhythmias are not very common. In a Canadian registry analyzing 1056 patients with SCAD, only 84 of them presented with ventricular fibrillation (VF) or ventricular tachycardia (VT) and only 8 underwent ICD placement. They followed up the patients for 5 years and 8 patients suffered VT/VF. 5 of those 8 patients had VT/VF on initial SCAD presentation, and only 1 of them had undergone ICD insertion. There are no specific guidelines regarding ICD placement on patients with coronary artery dissection, but the AHA/ACC/HRS guidelines can help us make decisions. Our case underscores the importance of more prospective or retrospective studies to identify those patients with SCAD who would benefit from ICD placement for secondary prevention. The current guidelines for ventricular arrhythmias are an excellent tool for the electrophysiologist regarding the management of these arrhythmias in other specific scenarios but guidance on SCAD is still lacking.展开更多
BACKGROUND Apical hypertrophic cardiomyopathy(HCM)is considered to have a benign prognosis in terms of cardiovascular mortality.This serial case report aimed to raise awareness of ventricular fibrillation(VF)and sudde...BACKGROUND Apical hypertrophic cardiomyopathy(HCM)is considered to have a benign prognosis in terms of cardiovascular mortality.This serial case report aimed to raise awareness of ventricular fibrillation(VF)and sudden cardiac death(SCD)in apical HCM.CASE SUMMARY Here we describe two rare cases of apical HCM that presented with documented VF and sudden cardiac collapse.These patients were previously not recommended for primary prevention using implantable cardioverter-defibrillator(ICD)therapy based on current guidelines.However,both received ICD therapy for the secondary prevention of SCD.CONCLUSION These cases illustrate serious complications including VF and aborted sudden cardiac arrest in apical HCM patients who are initially not candidates for primary prevention using ICD implantation based on current guidelines.展开更多
Background:Right ventricular pacing disrupts atrioventricular synchrony and increases the risk of atrial fi brillation(AF).However,whether algorithms for minimizing ventricular pacing reduce the incidence of AF remain...Background:Right ventricular pacing disrupts atrioventricular synchrony and increases the risk of atrial fi brillation(AF).However,whether algorithms for minimizing ventricular pacing reduce the incidence of AF remains controversial.Therefore,we conducted a systematic review and meta-analysis to compare the incidence of AF between minimizing ventricular pacing and conventional pacing protocols in patients with pacemakers implanted.Methods:The PubMed,Embase,and Cochrane Library databases were searched up to August 1,2017,for randomized controlled trials that reported the incidence of AF in patients with and without the use of algorithms for minimizing ventricular pacing.Results:Eleven studies comprising 5705 participants(61%males,mean age 71 years[standard deviation 11 years])were fi nally included in the analysis.The mean follow-up duration was 24 months.Use of algorithms for minimizing ventricular pacing signifi cantly reduced the incidence of AF,with an odds ratio of 0.74(95%confi dence interval 0.55–1.00;P<0.05).There was moderate heterogeneity among studies(I 2=63%).Conclusions:The incidence of AF was reduced by 26%with use of algorithms for minimizing ventricular pacing.The incorporation of such algorithms in routine clinical practice should in theory lead to a decrease in AF-related morbidity and mortality.展开更多
Coronary artery dissection due to blunt chest trauma (traumatic coronary artery dissection [TCAD]) may heal spontaneously, and some surgeons believe that conservative or elective treat-ments are sufficient, provided t...Coronary artery dissection due to blunt chest trauma (traumatic coronary artery dissection [TCAD]) may heal spontaneously, and some surgeons believe that conservative or elective treat-ments are sufficient, provided that there are no progressing ischemic symptoms. However, we report a patient who experienced sudden ventricular fibrillation (VF) during initial medical care for trauma injuries. The 32-year-old woman was riding in a passenger car when an accident occurred, and was subsequently transported to our emergency department. Twelve-lead electrocardiography revealed ST segment elevation in leads II, III, and aVF, although her vital signs remained stable. Therefore, we prioritized assessing the trauma at other sites, and VF suddenly occurred. Coronary angiography was performed with repeated defibrillation and chest compressions, which resulted in recovery of spontaneous circulation. Occlusion was observed in the right coronary artery, which we treated with balloon angioplasty. However, intravascular ultrasonography (IVUS) subsequently revealed coronary artery dissection, a stent was placed, and the patient successfully recovered. Therefore, IVUS may be useful for diagnosing TCAD, and swift intervention is needed if TCAD is detected.展开更多
文摘A 63-year-old man with diabetes and asymptomatic coronary artery disease developed refractory ventricular arrhythmia at 20 hours at rest after his second COVID-19 vaccine. Despite significant stenosis in the coronary arteries, there was no evidence of acute or old myocardial infarction, heart failure, myocarditis or structural abnormalities on post-mortem to account for the substrate for the fatal arrhythmia. The refractory and incessant nature of the ventricular fibrillation and post-mortem finding of a grossly elevated unexplained IgE level (in the absence of acute myocardial infarction) suggested the possibility of Kounis Syndrome or allergic acute coronary syndrome.
文摘Ventricular fibrillation (VF) is a malignant arrhythmia, usually initiated by a ventricular premature contraction (VPC) during the vulnerable period of cardiac repolarization. Ablation therapy for VF has been described and increasingly reported. Targets for VF triggers are VPCs preceded by Purkinje potentials or from the right ventricular outflow tract (RVOT) in structurally normal hearts, and VPC triggers preceded by Purkinje potentials in ischemic cardiomyopathy. During the session, mapping should be focused on the earliest activation and determining the earliest potential is the key to a successful ablation. However, suppression of VF can be achieved by not only the elimination of triggering VPCs, but also by substrate modification of possible reentry circuits in the Purkinje network, or between the PA and RVOT. The most important issue before the ablation session is the recording of the 12-lead ECG of the triggering event, which can prove invaluable in regionalizing the origin of the triggering VPC for more detailed mapping. In cases where the VPC is not spontaneous or inducible, ablation may be performed by pace mapping. Further studies are needed to evaluate the precise mechanisms of this arrhythmia.
文摘BACKGROUND Inferior wall left ventricular aneurysms are rare,they develop after transmural myocardial infarction(MI)and may be associated with poorer prognosis.We present a unique case of a large aneurysm of the inferior wall complicated by ventricular tachycardia(VT)and requiring surgical resection and mitral valve replacement.CASE SUMMARY A 59-year-old male was admitted for VT one month after he had a delayed presentation for an inferior ST-segment elevation MI and was discovered to have a large true inferior wall aneurysm on echocardiography and confirmed on coronary computed tomography(CT)angiography.Due to the sustained VT,concern for aneurysm expansion,and persistent heart failure symptoms,the patient was referred for surgical resection of the aneurysm with patch repair,mitral valve replacement,and automated implantable cardioverter defibrillator insertion with significant improvement in functional and clinical status.CONCLUSION Inferior wall aneurysms are rare and require close monitoring to identify electrical or contractile sequelae.Coronary CT angiography can outline anatomic details and guide surgical intervention to ameliorate life-threatening complications and improve performance status.
文摘Background: Peripartum cardiomyopathy (PPCM) is a rare disease that typically affects young, healthy women. Because PPCM is associated with significant mortality, timely diagnosis and management are essential. Ventricular tachycardia (VT) is a major complication and contributor to sudden death. Available data on VT in patients with PPCM are limited. Aim: This case report demonstrates the clinical presentation, antenatal care, and management of labor and delivery in a patient with PPCM complicated by VT. Case report: 36-year old patient G4P3 presents at 27 weeks gestation to the emergency department complaining of chest tightness, palpitations, and profuse sweating. Peripartum cardiomyopathy was diagnosed after her last pregnancy a few years prior. Ventricular tachycardia was diagnosed at this visit and treated successfully. The remainder of the pregnancy was uneventful until she had another episode of ventricular tachycardia during labor. Treatment using antiarrhythmics (diltiazem, amiodarone, adenosine) highlights the importance of prompt intervention and the need for a range of therapeutic options. Results: This case demonstrated successful VT management during pregnancy and labor, emphasizing multidisciplinary collaboration, influencing maternal and fetal outcomes positively, providing insights into optimal care strategies. Conclusion: Peripartum cardiomyopathy complicated by ventricular tachycardia is a life-threatening combination. This case highlights the importance of timely diagnosis and management with combined care between cardiologists, maternal fetal medicine specialists and anesthesiologists to prevent morbidities and sudden maternal death.
基金supported by Beijing Science Foundation(C160203)Youth Science Foundation of Beijing Chaoyang Hospital
文摘Objective To study the application of positron emission tomography (PET) in detection of myocardia metabolism in pig ventricular fibrillation and asphyxiation cardiac arrest models after resuscitation. Methods Thirty-two healthy miniature pigs were randomized into a ventricular fibrillation cardiac arrest (VFCA) group (n=16) and an asphyxiation cardiac arrest (ACA) group (n=16). Cardiac arrest (CA) was induced by programmed electric stimulation or endotracheal tube clamping followed by cardiopulmonary resuscitation (CPR) and defibrillation. At four hours and 24 h after spontaneous circulation was achieved, myocardial metabolism was assessed by PET. 18F-FDG myocardial uptake in PET was analyzed and the maximum standardized uptake value (SUVmax) was measured. Results Spontaneous circulation was 200% and 62.5% in VFCA group and ACA group, respectively. PET demonstrated that the myocardial metabolism injuries was more severe and widespread after ACA than after VFCA. The SUVrnax was higher in VFCA group than in ACA group (P〈0.01). In VFCA group, SUVmax at 24 h after spontaneous circulation increased to the level of baseline. Conclusion ACA causes more severe cardiac metabol associated with less successful resuscitation. Myocardial sm injuries than VFCA. Myocardial dysfunction is stunning does occur with VFCA but not with ACA.
文摘Objective To describe the clinical characteristics of idiopathic ventricular fibrillation (IVF) with fragmented QRS complex (f-QRS) and J wave in resting electrocardiogram. Methods We reviewed data from 21 case subjects in our hospital who were resuscitated after cardiac arrest due to IVF and assessed the prevalence of f-QRS and J wave in resting electrocardiogram (ECG). All the case subjects were classified among three groups based on the electrocardiographic morphology: group I, both f-QRS and J wave were observed (n = 6), group II, only J wave was observed (n = 9), group III, neither f-QRS nor J wave was observed (n = 6). Population characteristics, history of syncope or sudden cardiac arrest, incidence of ventricular fibrillation (VF), and circumstance of VF were evaluated among the three groups. Results The incidence of index events (syncope, survived cardiac arrest and VF episodes recorded in implantable cardioverter defibrillator (ICD) or pacemakers) was 13.4 ~ 5.6 per-year in group I, 10.8 ~ 3.9 per-year in group II, and 9.8 -4- 4.2 per-year in group HI. There were significant differences in incidences among the three groups, the most frequent index events were observed in group I. The hazard ratio for incidence was 3.2 (95%CI, 1.1-7.9; P = 0.01). The history and circumstance of the index events were different among the groups. In group I, all the index events occurred during sleep in early morning. In group II, four subjects suffered VF during strenuous physical activities or agitation state, two during sleep in early morning, three in usual activity. In group III, one subject suffered VF during sleep in early morning, one in agitation state, four in usual activity. Conclusions This study suggests that the IVF patients with the combined appearance of f-QRS and J wave in the resting ECG suffer an increased risk of VF, this subgroup of IVF patients has a unique clinical feature.
文摘Sudden cardiac death (SCD) from ventricular fibrillation (VF) during coronary artery disease (CAD) is a leading cause of total and cardiovascular mortality, and in more than half of SCD cases VF occurs as the first symptom of CAD. Several epidemiological studies have shown that sudden death of a family member is a risk factor for SCD and VF during acute myocardial infarction (MI), independent of traditional risk factors including family history of MI, suggesting a genetic component in the susceptibility to VF. To prevent SCD and VF due to MI, we need a better understanding of the genetic and molecular mechanisms causing VF in this apparently healthy population. Even though new insights and technologies have become available, the genetic predisposition to VF during MI remains poorly understood. Findings from a variety of different genetic studies have failed to reach reproducibility, although several genetic variants, both common and rare variants, have been associated to either VF or SCD. For this review, we searched PubMed for potentially relevant articles, using the following MeSH-terms: "sudden cardiac death", "ventricular fibrillation", "out-of-hospital cardiac arrest", "myocardial infarction, myocardial ische- mia", "coronary artery disease", and "genetics". This review describes the epidemiology and evidence for genetic susceptibility to VF due to MI.
基金This study was supported by the National Natural Science Foundation of China(No.31700674).
文摘The core treatment of rapid arrhythmiainduced heart failure(HF)is to control the ventricular rate to an optimized lower level,which is usually achieved with various anti-arrhythmic drugs.However,arrhythmias may not respond well to pharmaceutical treatment for various reasons.Iatrogenic atrioventricular(AV)node ablation needs to be performed under these extreme conditions to lower the patient’s heart rate.
文摘Takotsubo cardiomyopathy typically affects post-menopausal women under severe psychological or physical stress; it also has been reported to develop after medical procedures or surgery. We herein report the rare case of a 30-year-old woman who presented with an episode of ventricular fibrillation after a very complicated cesarean delivery and was successfully resuscitated. Subsequent electrocardiography and echocardiography showed a typical Takotsubo pattern. Within 3 wk, left ventricular systolic function returned to normal.
文摘Early warning and detection of ventricular fibrillation is crucial to the successful treatment of this life-threatening condition. In this paper, a ventricular fibrillation classification algorithm using a machine learning method, random forest, is proposed. A total of 17 previously defined ECG feature metrics were extracted from fixed length segments of the echocardiogram (ECG). Three annotated public domain ECG databases (Creighton University Ventricular Tachycardia database, MIT-BIH Arrhythmia Database and MIT-BIH Malignant Ventricular Arrhythmia Database) were used for evaluation of the proposed method. Window sizes 3 s, 5 s and 8 s for overlapping and non-overlapping segmentation methodologies were tested. An accuracy (Acc) of 97.17%, sensitivity (Se) of 95.17% and specificity (Sp) of 97.32% were obtained with 8 s window size for overlapping segments. The results were benchmarked against recent reported results and were found to outper-form them with lower complexity.
文摘The effect of a pure α-adrenergic agent, methoxamine on ventricularfibrillation (VF) amplitude and the relation between hemodynamic parameters andsurvival in a rodent cardiopulmonary resuscitation (CPR) model were studied.Our results suggested that: 1) VF amplitude decreased during untreated VF, butit increased during pericardial chest compression ; 2) methoxamine significantly increased the mean aortic pressure (MAP) and coronary perfusion pressure (CPP)but not VF amplitude, and the survival also increased due to elevation of CPP;and 3) all surviving animals with successful defibrillhtion had a higher VF ampli-tude.
文摘Objectics: Implantable cardioverter-defibrillator (ICI)is an important mean for treating ventricular tachycardia (VT ) in patients with structural heart diseases .This report deals with our primary experiences in cliical application of transveneous implantable cardioverter defibrillator.Metgids: A 13- year-old male patient with right ventricular dysplasia (ARVD) ). who lhad a failed result from antiarrhythmic drug therapy was implanted with ICD transveneously. Results: During follow. up. the antitachycardia pacing (ATP) did not terminate the first 2 episodes of VT. The episodes of VT were reverted into sinus rhythm by 4 J shock. The patient had a strong uncomfortable sensation :After resettin ATP program . VTs of patient were automaticallly terminated by ICD with ATP therapy many times. Conclusion: ICD implantation is an effective approach for treating VT and reasonable resetting of ATP is needed.
文摘Objective To evaluate the factors influencing the outcome of patients who suffered in-hospital ventricular fibrillation (IHVF). Methods Data of patients with IHVF in a single center were collected. Clinical characteristics of patients were compared between those survived (n=112) and those died (n=94), and those with IHVF occurred in inpatient ward and in emergency center. Multiple logistic regression analysis was used to identify factors associated with survival. Results There were 206 events in the analysis. The most common underlying disease was coronary artery disease (CAD), especially acute myocardial infarction (AMI). On multiple logistic regression analysis, independent predictors for failure to survive were higher NYHA class (odds ratio 1.7, 95% CI, 1.3-2.2, P〈 0.001), lower serum potassium concentration ( [K+] ) (odds ratio, 2.9, 95% CI, 1.9-4.3, P--0.007) and adrenaline usage (odds ratio, 25, 95% CI 11.5-55.1, P〈 0.001). Emergency group have better NYHA class (P = 0.012), lower [K-] (P 〈 0.001) than in inpatient ward group. Hypokalemia (serum potassium level 〈4.5 mmol/L) was found in all patients with AMI in emergency group. In AMI sub-group, 56.9% of IHVF events occurred within the first day after AMI, and decreasing within 2 weeks. Patients with fight coronary artery as infarction related artery (IRA) oRen (8/9, 88.9~,5) had bmdycardia (R-R interval 〉 ls) before the occurrence of IHVF, while those with left anterior descending artery as IRA often showed tachycardia (R-R interval 〈 0.6s) (8/12, 66.7%). Conclusion The most common disease causing IHVF is CAD. Keeping [K+] above 4.5mmol/1 could prevent on-setting IHVF, especially to AMI patients. The worse heart function is associated with higher rate of IHVF and worse pmgnosis (J Geriatr Cardio12010; 7:21-24).
文摘Background: Recent data suggest that beta-blockers can be beneficial in patients with chronic heart failure (CHF). Atrial fibrillation (AF) is present in a significant number of patients with CHF and is associateing with significant morbidity and increasing mortality rates. Thus it is necessary to establish therapy to improve the poor prognosis in this high-risk population, but a specific benefit of beta-blockers to the subset with concomitant AF and CHF has been little demonstrated. Objective: To examine the effects of Bisoprolol (6 months treatment) on the ventricular function and hemodynamics in patients with AF and CHF. Methods: 84 patients with stable CHF (NYHA≤Ⅲ class) and AF were assigned to Treated Group( n = 37) or Control group Ⅰ ( n = 22, 24-hour heart mean rate < 70/min) or Control Group Ⅱ ( n = 25, 24-hour heart mean rate ≥ 70/min) . All patients were given the basic therapy for CHF, and Treated Group received Bisopolol. Clinical and echocardiographic variables were measured in 3 groups at baseline and after 6 months, and the results were compared . Results: After 6 months of treatment with Bisoprolol, left ventricular ejection fraction (LVEF) and NYHA class had significandy improved (P < 0.05), and a trend towards a reduction in combined end point of death or CHF hospitalization was also observed (P < 0.20) in Treated Group; The increase of LVEF in Treated Group were associated with a reduction in mitral regurgitation degree and left atrial volume; The heart rate in mean 24-hour and at peak exercise decreased in Treated Group, but were similar to that in Control Group Ⅰ. Conclusion: 6 months of Bisoprolol therapy resulted in an improvement in the NYHA class and LVEF, and also showed a trend towards a reduction in hospitalization or death. The beneficial effects of Bisoprolol on patients with AF and CHF may be partly mediated by improvement of ventricular diastolic function.
文摘A 23-year-old female with Tetralogy of Fallot who is 30w6d pregnant presented with palpitations and syncope from an outside hospital.She was found to have ventricular tachycardia.Successful placement of a transvenous implantable cardiac defibrillator allowed for symptomatic control and a subsequent successful vaginal delivery.
文摘BACKGROUND Systemic sclerosis is a rare connective tissue disease characterized by localized or diffuse skin thickening and fibrosis,which usually accumulates in various organs throughout the body.Tachyarrhythmia is a common clinical manifestation of cardiovascular damage in systemic sclerosis patients.However,few studies have reported the use of catheter ablation and an implantable cardioverter defibrillator in patients with systemic sclerosis complicated by ventricular tachycardia.CASE SUMMARY A 39-year woman with an 11-year history of systemic sclerosis was referred to our hospital due to three syncopal episodes in the past 6 mo.The results of an electrocardiogram and a transthoracic echocardiogram revealed ventricular tachycardia and left ventricular systolic and ventricular septum segmental motion abnormalities,respectively.The results of an electrocardiogram showed a sinus rhythm with complete blockage of the left bundle branch.In light of the progressive nature of systemic sclerosis,the presence of a left bundle branch block,and the decreased ejection fraction,a cardiac resynchronization therapydefibrillator was implanted.The patient’s clinical conditions improved,and at the3-mo follow-up,the patient was free of ventricular tachycardia and all cardiac symptoms.CONCLUSION We report the first case of systemic sderosis complicated by ventricular tachycardia that was successfully treated with a cardiac resynchronization therapy-defibrillator.
文摘We present here the case of a 43-year-old female without any known past medical history who was brought into the emergency department (ED) by the emergency medical services (EMS) after receiving cardiopulmonary resuscitation (CPR) on the field. Per EMS, on arrival patient was found to be on ventricular fibrillation and was shocked 3 times. Patient had no past medical history. In the ED, EKG showed sinus rhythm and troponin was 23 which is slightly high compared to upper limit. Patient was taken to the cath lab immediately which showed small to medium caliber septal 1 branch severe mid segment disease with distal tapering suggestive of spontaneous coronary artery dissection. No stent was placed. Electrophysiology was consulted and an Implantable Cardioverter Defibrillator was placed. Spontaneous coronary artery dissection (SCAD) is a phenomenon where an epicardial coronary artery dissection occurs that is not related to atherosclerosis, trauma or iatrogenia. Patients with SCAD presenting with ventricular arrhythmias are not very common. In a Canadian registry analyzing 1056 patients with SCAD, only 84 of them presented with ventricular fibrillation (VF) or ventricular tachycardia (VT) and only 8 underwent ICD placement. They followed up the patients for 5 years and 8 patients suffered VT/VF. 5 of those 8 patients had VT/VF on initial SCAD presentation, and only 1 of them had undergone ICD insertion. There are no specific guidelines regarding ICD placement on patients with coronary artery dissection, but the AHA/ACC/HRS guidelines can help us make decisions. Our case underscores the importance of more prospective or retrospective studies to identify those patients with SCAD who would benefit from ICD placement for secondary prevention. The current guidelines for ventricular arrhythmias are an excellent tool for the electrophysiologist regarding the management of these arrhythmias in other specific scenarios but guidance on SCAD is still lacking.
文摘BACKGROUND Apical hypertrophic cardiomyopathy(HCM)is considered to have a benign prognosis in terms of cardiovascular mortality.This serial case report aimed to raise awareness of ventricular fibrillation(VF)and sudden cardiac death(SCD)in apical HCM.CASE SUMMARY Here we describe two rare cases of apical HCM that presented with documented VF and sudden cardiac collapse.These patients were previously not recommended for primary prevention using implantable cardioverter-defibrillator(ICD)therapy based on current guidelines.However,both received ICD therapy for the secondary prevention of SCD.CONCLUSION These cases illustrate serious complications including VF and aborted sudden cardiac arrest in apical HCM patients who are initially not candidates for primary prevention using ICD implantation based on current guidelines.
文摘Background:Right ventricular pacing disrupts atrioventricular synchrony and increases the risk of atrial fi brillation(AF).However,whether algorithms for minimizing ventricular pacing reduce the incidence of AF remains controversial.Therefore,we conducted a systematic review and meta-analysis to compare the incidence of AF between minimizing ventricular pacing and conventional pacing protocols in patients with pacemakers implanted.Methods:The PubMed,Embase,and Cochrane Library databases were searched up to August 1,2017,for randomized controlled trials that reported the incidence of AF in patients with and without the use of algorithms for minimizing ventricular pacing.Results:Eleven studies comprising 5705 participants(61%males,mean age 71 years[standard deviation 11 years])were fi nally included in the analysis.The mean follow-up duration was 24 months.Use of algorithms for minimizing ventricular pacing signifi cantly reduced the incidence of AF,with an odds ratio of 0.74(95%confi dence interval 0.55–1.00;P<0.05).There was moderate heterogeneity among studies(I 2=63%).Conclusions:The incidence of AF was reduced by 26%with use of algorithms for minimizing ventricular pacing.The incorporation of such algorithms in routine clinical practice should in theory lead to a decrease in AF-related morbidity and mortality.
文摘Coronary artery dissection due to blunt chest trauma (traumatic coronary artery dissection [TCAD]) may heal spontaneously, and some surgeons believe that conservative or elective treat-ments are sufficient, provided that there are no progressing ischemic symptoms. However, we report a patient who experienced sudden ventricular fibrillation (VF) during initial medical care for trauma injuries. The 32-year-old woman was riding in a passenger car when an accident occurred, and was subsequently transported to our emergency department. Twelve-lead electrocardiography revealed ST segment elevation in leads II, III, and aVF, although her vital signs remained stable. Therefore, we prioritized assessing the trauma at other sites, and VF suddenly occurred. Coronary angiography was performed with repeated defibrillation and chest compressions, which resulted in recovery of spontaneous circulation. Occlusion was observed in the right coronary artery, which we treated with balloon angioplasty. However, intravascular ultrasonography (IVUS) subsequently revealed coronary artery dissection, a stent was placed, and the patient successfully recovered. Therefore, IVUS may be useful for diagnosing TCAD, and swift intervention is needed if TCAD is detected.