OBJECTIVES: We investigated the electrocardiographic(ECG) and electrophysiologic characteristics of ventricular tachycardia(VT) originating within the pulmonary artery(PA). BACKGROUND: Radiofrequency catheter ablation...OBJECTIVES: We investigated the electrocardiographic(ECG) and electrophysiologic characteristics of ventricular tachycardia(VT) originating within the pulmonary artery(PA). BACKGROUND: Radiofrequency catheter ablation(RFCA) is routinely applied to the endocardial surface of the right ventricular outflow tract(RVOT) in patients with idiopathic VT of left bundle branch block morphology. It was recently reported that this arrhythmiamay originate within the PA.METHODS:Activation mapping and ECG analysis were performed in 24 patients whose VTs or ventricular premature contractions(VPCs) were successfully ablated within the PA(PA group) and in 48 patients whose VTs or VPCs were successfully ablated from the endocardial surface of the RVOT(RV-end-OT group). RESULTS: R-wave amplitudes on inferior ECG leads, aVL/aVR ratio of Q-wave amplitude, and R/S ratio on lead V2 were significantly larger in the PA group than in the RV-end-OT group. On intracardiac electrograms, atrial potentials were more frequently recorded in the PA group than in the RV-end-OT group(58%vs. 12%; p < 0.01). The amplitude of local ventricular potentials recorded during sinus rhythm within the PA was significantly lower than that recorded from the RV-end-OT(0.62±0.56 mV vs. 1.55±0.88 mV; p < 0.01). CONCLUSIONS: Ventricular tachycardia originating within the PA has different electrocardiographic and electrophysiologic characteristics from that originating from the RV-end-OT.When mapping the RVOT area, the catheter may be located within the PA if a low-voltage atrial or local ventricular potential of < 1-mV amplitude is recorded. Heightened attention must be paid if RFCA is required within the PA.展开更多
Background -In the setting of acute coronary syndromes(ACS), nonwhite patients are less likely to undergo invasive cardiac procedures and may have worse clinical outcomes than white patients. Whether the disparate out...Background -In the setting of acute coronary syndromes(ACS), nonwhite patients are less likely to undergo invasive cardiac procedures and may have worse clinical outcomes than white patients. Whether the disparate outcomes exist independently of potential biases in treatment patterns remains unclear. Methods and Results -We examined the association between race and outcome in the Treat Angina with Aggrastat and Determine Cost of Therapy With an Invasive or Conservative Strategy-Thrombolysis in Myocardial Infarction 18 study(TACTICS-TIMI 18), a randomized trial of invasive versus conservative treatment strategy in patients with non-ST-elevation ACS. There were 1722 white and 461 nonwhite patients. After adjustment for differences in medical characteristics, nonwhite patients were at significantly increased risk for death, MI, or rehospitalization for ACS(hazard ratio[HR], 1.54; P=0.003). Rates of protocol-guided angiography and revascularization were similar in both groups. For non-protocol-guided care, however, we found significant disparities, with nonwhite patients less likely to be taking their cardiac medications at follow-up(odds ratio[OR], 0.59; P=0.0002), to undergo non-protocol-mandated angiography(OR, 0.40; P=0.03), to receive a stent if undergoing percutaneous coronary intervention(OR, 0.55; P=0.045), and to have less procedural success after percutaneous coronary intervention(acute gain, 1.40±0.83 versus 1.81±0.92mm; P=0.004). Nonetheless, an invasive strategy was similarly efficacious in white(HR, 0.66; 95%CI, 0.50 to 0.88) and nonwhite(HR, 0.85; 95%CI, 0.52 to 1.39) patients(Pinteraction=0.52), especially in those with troponin elevation or ST deviation. Conclusions -After adjustment for baseline characteristics, nonwhite patients had a significantly worse prognosis than white patients, regardless of treatment approach. In the absence of protocol guidance, important disparities emerged between the care given the 2 groups. An early invasive strategy is beneficial in and should be considered for all patients, regardless of race.展开更多
文摘OBJECTIVES: We investigated the electrocardiographic(ECG) and electrophysiologic characteristics of ventricular tachycardia(VT) originating within the pulmonary artery(PA). BACKGROUND: Radiofrequency catheter ablation(RFCA) is routinely applied to the endocardial surface of the right ventricular outflow tract(RVOT) in patients with idiopathic VT of left bundle branch block morphology. It was recently reported that this arrhythmiamay originate within the PA.METHODS:Activation mapping and ECG analysis were performed in 24 patients whose VTs or ventricular premature contractions(VPCs) were successfully ablated within the PA(PA group) and in 48 patients whose VTs or VPCs were successfully ablated from the endocardial surface of the RVOT(RV-end-OT group). RESULTS: R-wave amplitudes on inferior ECG leads, aVL/aVR ratio of Q-wave amplitude, and R/S ratio on lead V2 were significantly larger in the PA group than in the RV-end-OT group. On intracardiac electrograms, atrial potentials were more frequently recorded in the PA group than in the RV-end-OT group(58%vs. 12%; p < 0.01). The amplitude of local ventricular potentials recorded during sinus rhythm within the PA was significantly lower than that recorded from the RV-end-OT(0.62±0.56 mV vs. 1.55±0.88 mV; p < 0.01). CONCLUSIONS: Ventricular tachycardia originating within the PA has different electrocardiographic and electrophysiologic characteristics from that originating from the RV-end-OT.When mapping the RVOT area, the catheter may be located within the PA if a low-voltage atrial or local ventricular potential of < 1-mV amplitude is recorded. Heightened attention must be paid if RFCA is required within the PA.
文摘Background -In the setting of acute coronary syndromes(ACS), nonwhite patients are less likely to undergo invasive cardiac procedures and may have worse clinical outcomes than white patients. Whether the disparate outcomes exist independently of potential biases in treatment patterns remains unclear. Methods and Results -We examined the association between race and outcome in the Treat Angina with Aggrastat and Determine Cost of Therapy With an Invasive or Conservative Strategy-Thrombolysis in Myocardial Infarction 18 study(TACTICS-TIMI 18), a randomized trial of invasive versus conservative treatment strategy in patients with non-ST-elevation ACS. There were 1722 white and 461 nonwhite patients. After adjustment for differences in medical characteristics, nonwhite patients were at significantly increased risk for death, MI, or rehospitalization for ACS(hazard ratio[HR], 1.54; P=0.003). Rates of protocol-guided angiography and revascularization were similar in both groups. For non-protocol-guided care, however, we found significant disparities, with nonwhite patients less likely to be taking their cardiac medications at follow-up(odds ratio[OR], 0.59; P=0.0002), to undergo non-protocol-mandated angiography(OR, 0.40; P=0.03), to receive a stent if undergoing percutaneous coronary intervention(OR, 0.55; P=0.045), and to have less procedural success after percutaneous coronary intervention(acute gain, 1.40±0.83 versus 1.81±0.92mm; P=0.004). Nonetheless, an invasive strategy was similarly efficacious in white(HR, 0.66; 95%CI, 0.50 to 0.88) and nonwhite(HR, 0.85; 95%CI, 0.52 to 1.39) patients(Pinteraction=0.52), especially in those with troponin elevation or ST deviation. Conclusions -After adjustment for baseline characteristics, nonwhite patients had a significantly worse prognosis than white patients, regardless of treatment approach. In the absence of protocol guidance, important disparities emerged between the care given the 2 groups. An early invasive strategy is beneficial in and should be considered for all patients, regardless of race.
