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ventricular arrhythmias guidelines

Andrea I Guaricci, Delia De Santis, Mark G Rabbat, Gianluca Pontone
: Implantable cardioverter defibrillators (ICDs) have proven to be the most effective preventive therapy of sudden cardiac death (SCD). Based on current guidelines, the indication for prophylactic ICD therapy is primarily based on a left ventricular ejection fraction (LVEF) less than 35%. However, patients with low LVEF may never have an arrhythmic event while patients with normal to moderately reduced LVEF, who are traditionally felt to be at lower risk, can experience SCD. Therefore, LVEF alone is not an ideal risk stratification parameter to determine ICD therapy...
March 19, 2018: Journal of Cardiovascular Medicine
Jim T Vehmeijer, Barbara Jm Mulder, Joris R de Groot
Sudden cardiac death (SCD), mainly caused by ventricular arrhythmias, is one of the leading causes of mortality in adult congenital heart disease (ACHD) patients. An implantable cardioverter defibrillator (ICD) may prevent SCD, but risk stratification remains challenging. In this review, we will address the current guideline recommendations for ICD implantation in ACHD patients, as well as review a recent study in which the discriminative ability for SCD of these guidelines is evaluated. In this study, the guideline recommendations were applied to patients who died of SCD and living controls...
March 13, 2018: Anatolian Journal of Cardiology
Amartya Kundu, Aditya Vaze, Partha Sardar, Ahmed Nagy, Wilbert S Aronow, Naomi F Botkin
PURPOSE OF REVIEW: Variant angina, which is characterized by recurrent chest pain and transient ECG changes along with angiographic evidence of coronary artery spasm, generally has a favorable prognosis. However, episodes of ischemia caused by vasospasm may lead to potentially life-threatening ventricular arrhythmias and cardiac arrest, even in patients with no history of prior cardiac disease. This review describes the epidemiology, pathogenesis, clinical spectrum, and management of variant angina, as well as outcomes in patients who present with aborted sudden cardiac death (ASCD)...
March 8, 2018: Current Cardiology Reports
Alessia Pepe, Maria R Gamberini, Massimiliano Missere, Laura Pistoia, Maurizio Mangione, Liana Cuccia, Anna Spasiano, Silvia Maffei, Christian Cadeddu, Massimo Midiri, Caterina Borgna, Antonella Meloni
We assessed whether male gender was associated with a higher risk of cardiac iron accumulation and fibrosis, heart dysfunction and complications in a large, multicentre cohort of thalassaemia major (TM) patients, in order to optimize the timing in cardiac follow-up. We considered 1711 TM patients (899 females, 31·09 ± 9·08 years), enrolled in the Myocardial Iron Overload in Thalassaemia Network. Clinical/instrumental data are recorded from birth to the first Cardiovascular Magnetic Resonance Imaging scan...
March 2018: British Journal of Haematology
Miriam Giovanna Colombo, Inge Kirchberger, Ute Amann, Lisa Dinser, Christa Meisinger
Background Challenging clinical practice guidelines that recommend serum potassium concentration between 4.0-5.0 mEq/L or ≥4.5 mEq/L in patients with acute myocardial infarction, recent studies found increased mortality risks in patients with a serum potassium concentration of ≥4.5 mEq/L. Studies investigating consequences of hypokalemia after acute myocardial infarction revealed conflicting results. Therefore, the aim of this systematic review and meta-analysis was to combine evidence from previous studies on the association of serum potassium concentration with both short and long-term mortality as well as the occurrence of ventricular arrhythmias...
January 1, 2018: European Journal of Preventive Cardiology
Biagio Sassone, Gaetano Nucifora, Donato Mele, Cinzia Valzania, Giovanni Bisignani, Giuseppe Boriani
: Cardiac resynchronization therapy (CRT) is an established treatment in patients with symptomatic drug-refractory heart failure and broad QRS complex on the surface ECG. Despite the presence of either mechanical dyssynchrony or viable myocardium at the site where delivering left ventricular pacing being necessary conditions for a successful CRT, their direct assessment by techniques of cardiovascular imaging, though feasible, is not recommended in clinical practice by the current guidelines. Indeed, even though there is growing body of data providing evidence of the additional value of an image-based approach as compared with routine approach in improving response to CRT, these results should be confirmed in prospective and large multicentre trials before their impact on CRT guidelines is considered...
February 20, 2018: Journal of Cardiovascular Medicine
Rayan Saab, Pradeep Bhambhvani, Ami E Iskandrian, Fadi G Hage
Cardiac sarcoidosis has long been an evasive diagnosis with a spectrum of clinical presentations that extend from asymptomatic to ventricular arrhythmias and sudden cardiac death. The diagnosis has traditionally relied on histology which suffers from the low sensitivity of endomyocardial biopsy due to the patchy nature of the disease in addition to its invasive nature. Due to significant advancements in imaging, it is now possible to accurately identify cardiac sarcoidosis using non-invasive imaging modalities even without histological confirmation...
February 8, 2018: Journal of Nuclear Cardiology: Official Publication of the American Society of Nuclear Cardiology
Jonathan W Waks, Alfred E Buxton
Sudden cardiac death (SCD) accounts for ∼50% of mortality after myocardial infarction (MI). Most SCDs result from ventricular tachyarrhythmias, and the tachycardias that precipitate cardiac arrest result from multiple mechanisms. As a result, it is highly unlikely that any single test will identify all patients at risk for SCD. Current guidelines for use of implantable cardioverter-defibrillators (ICDs) to prevent SCD are based primarily on measurement of left ventricular ejection fraction (LVEF). Although reduced LVEF is associated with increased total cardiac mortality after MI, the focus of current guidelines on LVEF omits ∼50% of patients who die suddenly...
January 29, 2018: Annual Review of Medicine
Alexander Fürnkranz, Hisaki Makimoto
Idiopathic ventricular tachycardia: Frequent monomorphic premature ventricular contractions or non-sustained ventricular tachycardia without underlying structural heart disease is not a rare condition and may cause significant symptoms. A subgroup of patients develops IVT-associated cardiomyopathy. Current ESC guidelines recommend primary catheter ablation in symptomatic patients with right ventricular outflow tract IVT. Catheter ablation is also recommended in symptomatic patients with a left ventricular outflow tract (or other rare) origin, if antiarrhythmic drugs are ineffective or not desired...
February 2018: Deutsche Medizinische Wochenschrift
Zaher Fanari, Prasad C Gunasekaran, Arslan Shaukat, Sumaya Hammami, Buddhadeb Dawn, Mark Wiley, Peter Tadros
BACKGROUND: The ACC/AHA guidelines recommend low-dose dobutamine challenge for hemodynamic assessment of the severity of AS in patients with low flow, low gradient aortic stenosis with reduced ejection fraction (EF) (LFLG-AS; stage D2). Inherent pitfalls of echocardiography could result in inaccurate aortic valve areas (AVA), which have downstream prognostic implications. Data on the safety and efficacy of coronary pressure wire and fluid-filled catheter use for low dose dobutamine infusion is sparse...
October 5, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Philippe Charron, Perry M Elliott, Juan R Gimeno, Alida L P Caforio, Juan Pablo Kaski, Luigi Tavazzi, Michal Tendera, Carole Maupain, Cécile Laroche, Pawel Rubis, Ruxandra Jurcut, Leonardo Calò, Tiina M Heliö, Gianfranco Sinagra, Marija Zdravkovic, Aušra Kavoliuniene, Stephan B Felix, Jacek Grzybowski, Maria-Angela Losi, Folkert W Asselbergs, José Manuel García-Pinilla, Joel Salazar-Mendiguchia, Katarzyna Mizia-Stec, Aldo P Maggioni
Aims: The Cardiomyopathy Registry of the EURObservational Research Programme is a prospective, observational, and multinational registry of consecutive patients with four cardiomyopathy subtypes: hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), and restrictive cardiomyopathy (RCM). We report the baseline characteristics and management of adults enrolled in the registry. Methods and results: A total of 3208 patients were enrolled by 69 centres in 18 countries [HCM (n = 1739); DCM (n = 1260); ARVC (n = 143); and RCM (n = 66)]...
January 24, 2018: European Heart Journal
Fabio Guarracino, Pietro Bertini, Michael R Pinsky
Hemodynamic monitoring is essential during the treatment of the critically ill in order to address the hemodynamic alterations and assess the response to treatment. Traditionally classified causes of shock and underlying pathophysiological mechanisms are often neglected by resuscitative strategies included in the guidelines. Most of hemodynamic management focuses on the ability to early recognise patients susceptible to increase cardiac output (CO) and mean arterial pressure (MAP) after a defined fluid challenge by eliciting Starling's law of the heart, and less is known of the ones presenting in shock and not volume responsive...
January 16, 2018: Minerva Anestesiologica
Eleanor C Wicks, Leon J Menezes, Anna Barnes, Saidi A Mohiddin, Neha Sekhri, Joanna C Porter, Helen L Booth, Emily Garrett, Riyaz S Patel, Menelaos Pavlou, Ashley M Groves, Perry M Elliott
Aims: Cardiac death is the leading cause of mortality in patients with sarcoidosis, yet cardiac involvement often remains undetected. Cardiovascular magnetic resonance imaging (CMR) and 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) have been used to diagnose cardiac sarcoidosis (CS) yet never simultaneously in a cohort. This study sought to assess the diagnostic and prognostic utility of simultaneous hybrid cardiac PET/MR. Methods and results: Fifty-one consecutive patients with suspected CS (age 50 ± 13 years, 31 males) underwent simultaneous PET/MR following a high-fat/low-carbohydrate diet and 12-h fast...
January 8, 2018: European Heart Journal Cardiovascular Imaging
Haripriya Santhanam, LinQi Yang, Zhaojin Chen, Bee-Choo Tai, Dimple D Rajgor, Swee-Chye Quek
BACKGROUND: While transcatheter device closure of ventricular septal defects (VSDs) is gaining popularity, concerns remain about adverse events; particularly heart block in peri-membranous VSDs (pmVSDs). The aim of this study is to ascertain outcomes of transcatheter device closure of pmVSDs through a meta-analysis of current literature. METHODS: A PubMed and Scopus search for studies in English on device closure of pmVSDs published till end-February 2017 was performed...
December 7, 2017: International Journal of Cardiology
Nikhil Mehta, Robert Vannozzi
Lithium has been used for the treatment of bipolar disorder for more than 6 decades. Reports of cardiac side effects resulting in both benign electrocardiographic (ECG) changes and near fatal arrhythmias have been reported in the literature. A systematic literature search was conducted on 2 electronic databases-PubMed and Medline-for the time period between January 1970 and March 2016 using the key word "lithium," along with "electrocardiography" or "ECG." All articles and their references were then screened by title for relevance by 2 authors and a librarian...
December 16, 2017: Clinical Cardiology
Peter Magnusson, Stellan Mörner
INTRODUCTION: Hypertrophic cardiomyopathy (HCM) is a heterogeneous disease associated with sudden cardiac death (SCD) mainly due to ventricular tachycardia (VT) or fibrillation even though life-threatening bradycardia occurs. Risk stratification takes several variables into consideration including non-sustained VT (NSVT). An implantable cardioverter defibrillator effectively prevents SCD.Atrial fibrillation (AF) is common among patients with HCM and warrants anticoagulation even without conventional risk factors according to European guidelines...
December 12, 2017: BMJ Open
A Schlitt, M Guha, M Noutsias, H H Klein, H U Klein
Assessment of a permanent risk of life-threatening ventricular arrhythmia in patients with severely reduced left ventricular ejection fraction (LVEF <35%), e. g. after myocarditis, dilated cardiomyopathy, acute myocardial infarction, in patients with postpartum cardiomyopathy or implantable cardioverter-defibrillator (ICD) and cardiac resynchronization treatment plus defibrillator (CRT-D) infection with temporary explantation of the system is a medical challenge. This is time-consuming and unsafe because life-threatening ventricular arrhythmias may occur during the time of risk assessment...
December 12, 2017: Herz
Axel Van Damme, Tine De Backer, Philippe Vanderheeren
Introduction Swallow syncope is a neurally mediated syncope. Multiple causes have been described in literature. A rare cause is arrhythmias. Only a limited amount of cases present the association of swallow syncope and third degree AV-block. Case presentation A 39-year-old man presented with episodes of presyncope while eating. Further medical history, physical examination, resting 12-lead ECG, cyclo-ergometry, transthoracic echocardiography and MRI of the heart were normal. 24 h Holter monitoring demonstrated high-grade third-degree atrioventricular (AV) block...
December 5, 2017: Acta Clinica Belgica
C G K Amiyangoda, H Wimalaratna, S Bowatte
BACKGROUND: Prosthetic valve endocarditis (PVE) due to methicillin resistant Staphylococcus aureus (MRSA) is a rare disease with significant mortality and morbidity. With the emerging resistance and adverse effect profile of vancomycin which is the standard treatment, there is a compelling necessity of an effective alternative for vancomycin. Linezolid is proved as such an agent for infections caused by MRSA in other sites. However to-date the evidence for successful use of linezolid for MRSA prosthetic valve endocarditis is limited only for few case studies...
November 9, 2017: BMC Research Notes
Gregor Fahrni, Mathias Wolfrum, Giovanni Luigi De Maria, Florim Cuculi, Sam Dawkins, Mohammad Alkhalil, Niket Patel, John C Forfar, Bernard D Prendergast, Robin P Choudhury, Keith M Channon, Adrian P Banning, Rajesh K Kharbanda
BACKGROUND: Early risk stratification after primary percutaneous coronary intervention (PPCI) for ST-segment-elevation myocardial infarction is currently challenging. Identification of a low-risk group may improve triage of patients to alternative clinical pathways and support early hospital discharge. Our aim was to assess whether the index of microcirculatory resistance (IMR) at the time of PPCI can identify patients at low risk of early major cardiac complications and to compare its performance against guideline-recommended risk scores...
November 7, 2017: Journal of the American Heart Association
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