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https://www.readbyqxmd.com/read/28645448/takotsubo-syndrome-presenting-as-syncope-in-a-patient-with-permanent-pacemaker
#1
Bharatraj Banavalikar, Sivasankaran Sivasubramonian, Narayanan Namboodiri, Krishna Kumar Mohanan Nair, Dibya Ranjan Behera, Ajitkumar Valaparambil
Takotsubo syndrome is an acute reversible heart failure syndrome triggered by physical or emotional stress, especially in postmenopausal women. Herein, we describe a case of a 31-year-old pacemaker dependent lady who presented with syncope after she was bereaved of her father. Electrocardiogram at admission revealed ventricular paced rhythm at 60/min, prolonged QT interval and frequent runs of torsades de pointes. Transthoracic echocardiogram and left ventriculogram revealed findings typical of Takotsubo syndrome...
May 18, 2017: Journal of Electrocardiology
https://www.readbyqxmd.com/read/28638664/torsade-de-pointes-induced-by-hypokalemia-from-imipenem-and-piperacillin
#2
Varun Kumar, Sandeep Khosla, Monica Stancu
Imipenem-cilastatin and piperacillin-tazobactam are two antibiotics with broad antimicrobial coverage. Besides the many well established adverse effects of these drugs, there have been few case reports of hypokalemia. Here we present an interesting case of resistant hypokalemia caused by these drugs leading to Torsades de Pointes which has never been reported in the past. Hypokalemia resolved with discontinuation of piperacillin.
2017: Case Reports in Cardiology
https://www.readbyqxmd.com/read/28624975/deleterious-acute-and-chronic-effects-of-bradycardic-right-ventricular-apex-pacing-consequences-for-arrhythmic-outcome
#3
T R G Stams, A Dunnink, W M van Everdingen, H D M Beekman, R van der Nagel, B Kok, M F A Bierhuizen, M J Cramer, M Meine, M A Vos
In the chronic complete atrioventricular (AV) block dog (CAVB) model, both bradycardia and altered ventricular activation due to the uncontrolled idioventricular rhythm contribute to ventricular remodeling and the enhanced susceptibility to Torsade de Pointes (TdP) arrhythmias. We investigated the effect of permanent bradycardic right ventricular apex (RVA) pacing on mechanical and electrical remodeling and TdP. In 23 anesthetized dogs, serial experiments were performed at sinus rhythm (SR), acutely after AV block (AAVB) and 3 weeks of remodeling CAVB at a fixed pacing rate of 60/min...
July 2017: Basic Research in Cardiology
https://www.readbyqxmd.com/read/28617967/holter-monitored-sudden-cardiac-arrest-after-atrioventricular-junction-ablation
#4
Victor Waldmann, Eloi Marijon, Nicolas Combes
We present a case of sudden cardiac arrest seven hours after radiofrequency ablation of the atrioventricular junction for symptomatic permanent atrial fibrillation unresponsive to medical therapy. The Holter monitoring revealed a progressive increasing of QT interval after the procedure, highlighting the repolarization instability after acute changes in heart rates associated with modification of ventricular activation, leading to occurrence of short coupling interval ventricular extra beats and finally to a "Torsade de Pointes"...
June 15, 2017: Pacing and Clinical Electrophysiology: PACE
https://www.readbyqxmd.com/read/28612303/additive-proarrhythmic-effect-of-combined-treatment-with-qt-prolonging-agents
#5
Gerrit Frommeyer, Christina Fischer, Christian Ellermann, Dirk G Dechering, Simon Kochhäuser, Philipp S Lange, Kristina Wasmer, Michael Fehr, Lars Eckardt
Drug combinations may elevate the risk of proarrhythmia. The aim of the present study was to investigate whether combinations of non-cardiovascular agents induce an additive increase in the proarrhythmic risk. In 12 female rabbit hearts, a drug combination of cotrimoxazole (300 µM), ondansetron (5 µM) and domperidone (1 µM) was infused after obtaining baseline data. In another 13 hearts, a combination of cotrimoxazole (300 µM), ondansetron (5 µM) and erythromycin (300 µM) was infused. Monophasic action potentials and ECG displayed a significant QT prolongation in all groups...
June 13, 2017: Cardiovascular Toxicology
https://www.readbyqxmd.com/read/28607621/epicardially-placed-implantable-cardioverter-defibrillator-for-a-child-with-congenital-long-qt-syndrome
#6
Hirotaro Sugiyama, Motomi Tachibana, Hiroshi Morita, Nobuhiro Nishii, Akihito Miyoshi, Hiroyasu Sugiyama, Koji Nakagawa, Atsuyuki Watanabe, Kazufumi Nakamura, Hiroshi Ito
A 7-year-old boy presented at our hospital with syncope. At birth, electrocardiography had shown a long QT interval with torsade de pointes (TdP). Congenital long QT syndrome (LQTS) had been diagnosed by genetic testing, and was successfully controlled with oral propranolol. At age 7, TdP had recurred with syncope. Electrocardiography revealed a prominent long QT interval with T-wave alternans. The propranolol dose was increased, but TdP remained uncontrolled. A cardioverter-defibrillator (ICD) was implanted epicardially, and TdP completely resolved with atrial pacing...
June 2017: Journal of Arrhythmia
https://www.readbyqxmd.com/read/28606196/prescribing-an-automated-external-defibrillator-for-children-at-increased-risk-of-sudden-arrhythmic-death
#7
Karen A McLeod, Eileen Fern, Fiona Clements, Ruth McGowan
BACKGROUND: Automated external defibrillators can be life-saving in out-of-hospital cardiac arrest. OBJECTIVE: Our aim was to review our experience of prescribing automated external defibrillators for children at increased risk of sudden arrhythmic death. METHODS: We reviewed all automated external defibrillators issued by the Scottish Paediatric Cardiac Electrophysiology Service from 2005 to 2015. All parents were given resuscitation training according to the Paediatric Resuscitation Guidelines, including the use of the automated external defibrillator...
June 13, 2017: Cardiology in the Young
https://www.readbyqxmd.com/read/28590366/effect-of-gwas-identified-genetic-variants-on-maximum-qt-interval-in-patients-with-schizophrenia-receiving-antipsychotic-agents-a-24-hour-holter-ecg-study
#8
Junzo Watanabe, Naoki Fukui, Yutaro Suzuki, Takuro Sugai, Shin Ono, Nobuto Tsuneyama, Mami Saito, Misuzu Tajiri, Toshiyuki Someya
BACKGROUND: Users of antipsychotics (APs) have a risk of sudden cardiac death (SCD). Sudden cardiac death in such patients is thought to be largely due to drug-induced QT prolongation. It has been reported that many subjects with drug-induced torsades de pointes (TdP) have risk alleles associated with subclinical congenital long QT syndrome. METHODS: We investigated the effects of the risk alleles associated with long QT on the QT interval in patients receiving APs using 24-hour Holter electrocardiograms to take into account the circadian fluctuation of QT intervals...
June 5, 2017: Journal of Clinical Psychopharmacology
https://www.readbyqxmd.com/read/28583014/evaluation-of-the-effects-of-quetiapine-on-qtc-prolongation-in-critically-ill-patients
#9
Kevin M Dube, Jeremy DeGrado, Benjamin Hohlfelder, Paul M Szumita
Quetiapine, an atypical antipsychotic used in the intensive care unit (ICU) to manage delirium, has a possible adverse effect of corrected QT (QTc) interval prolongation. The objective of this analysis was to describe the impact of quetiapine on QTc interval prolongation in critically ill patients. This was a single-center, prospective cohort analysis of ICU patients who received quetiapine between October 2015 and February 2016. The major end point was the incidence of QTc prolongation greater than 60 milliseconds above baseline during therapy...
January 1, 2017: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/28576628/incidence-of-torsade-de-pointes-in-a-tertiary-hospital-population
#10
Eline Vandael, Bert Vandenberk, Joris Vandenberghe, Hilde Pincé, Rik Willems, Veerle Foulon
BACKGROUND: Multiple risk factors play a role in the development of QTc-prolongation and Torsade de Pointes (TdP). Cases of TdP are underreported and data on the incidence of TdP is scarce. The aim of this study was to investigate the incidence of TdP in a Belgian university hospital and describe the characteristics of TdP-cases using a risk score. METHODS: All cases from 2011 till 2013 coded with the ICD-9 code 427.1 in the University Hospitals of Leuven were selected...
May 19, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28574954/short-term-variability-of-repolarization-is-superior-to-other-repolarization-parameters-in-the-evaluation-of-diverse-antiarrhythmic-interventions-in-the-chronic-atrioventricular-block-dog
#11
Alexandre Bossu, Rosanne Varkevisser, Henriette D M Beekman, Marien J C Houtman, Marcel A G van der Heyden, Marc A Vos
Short-term variability (STV), to quantify beat-to-beat variability of repolarization, is a surrogate parameter that reliably identifies proarrhythmic risk in preclinical models. Examples include not only the use in the chronic atrioventricular block (CAVB) dog model whereby it was developed but also in vulnerable patients with heart failure or drug-induced long QT syndrome. In the CAVB dog model, STV can specifically distinguish between safe and unsafe drugs in proarrhythmic screening. Conversely, this dog model also offers the possibility to evaluate antiarrhythmic strategies in a setting of Torsades de Pointes (TdP) induction with a standard IKr inhibitor...
June 2017: Journal of Cardiovascular Pharmacology
https://www.readbyqxmd.com/read/28562421/ventricular-fibrillation-and-long-qt-syndrome-due-to-panhypopituitarism
#12
Milena Aste, Cesare Capellini, Elisabetta Schiappacasse, Gianluigi Devoto, Michele Brignole
: A 68-year-old man presented with ventricular fibrillation and acquired long QT due to panhypopituitarism that disappeared completely within 48 h from replacement hormonal therapy. Panhypopituitarism is not well recognized as a reversible cause of ventricular fibrillation and long-QT syndrome in medical literature. In the present case, pituitary apoplexy exhausted an already chronically hypofunctioning pituitary gland, causing QT prolongation, torsades de pointes and several cardiac arrests due to ventricular fibrillation...
May 29, 2017: Journal of Cardiovascular Medicine
https://www.readbyqxmd.com/read/28550094/safety-of-outpatient-initiation-of-disopyramide-for-obstructive-hypertrophic-cardiomyopathy-patients
#13
Arnon Adler, Dana Fourey, Adaya Weissler-Snir, Waseem Hindieh, Raymond H Chan, Michael H Gollob, Harry Rakowski
BACKGROUND: Disopyramide is effective in ameliorating symptoms in patients with hypertrophic cardiomyopathy; however, its potential for proarrhythmic effect has raised concerns about its use in the ambulatory setting. The risk of initiating disopyramide in this manner has never been evaluated. METHODS AND RESULTS: All charts of patients seen in the outpatient hypertrophic cardiomyopathy clinic between 2010 and 2014 were screened for initiation of disopyramide and data were extracted...
May 26, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28547743/unremodelled-and-bradycardic-heart-of-the-anaesthetized-rabbit-is-applicable-for-detection-of-drug-induced-torsades-de-pointes-arrhythmias
#14
Mihoko Hagiwara, Seiji Shibuta, Kazuhiro Takada, Ryuichi Kambayashi, Misako Nakajo, Megumi Aimoto, Yoshinobu Nagasawa, Akira Takahara
BACKGROUND AND PURPOSE: Several rabbit proarrhythmia models have been recently developed by genetic or pharmacological methods to suppress the slow component of delayed rectifier K(+) currents in the ventricle, leading to reduction of the repolarization reserve. The present study was designed to characterize a novel rabbit in vivo proarrhythmia model with severe bradycardia caused by acute atrioventricular block (AVB). EXPERIMENTAL APPROACH: Bradycardia was induced in isoflurane-anaesthetized rabbits by creation of AVB using catheter ablation, and the ventricle was electrically driven at 60 beats min(-1) throughout the experiment except when extrasystole appeared...
May 26, 2017: British Journal of Pharmacology
https://www.readbyqxmd.com/read/28534204/-ventricular-arrhythmias-in-ion-channel-diseases
#15
REVIEW
Christian Wolpert, Mara Vogel, Christian Nagel, Claudia Herrera-Siklody, Norman Rüb
In patients with ion channel disease the predominant arrhythmias are polymorphic ventricular tachycardias (VT), torsade de pointes tachycardia and ventricular fibrillation (VF). In only extremely rare cases is very rapid monomorphic ventricular tachycardia observed. This is why implantable cardioverter-defibrillators (ICDs) should always be programmed for treatment of VF only with high detection rates to avoid inappropriate discharges. In idiopathic VF and catecholaminergic polymorphic ventricular tachycardia (CPVT), no baseline electrocardiographic abnormalities can be detected, whereas in Brugada syndrome, long QT syndrome, early repolarisation syndrome and Anderson-Tawil syndrome alterations of the baseline ECG are very important to identify patients at risk...
May 22, 2017: Herzschrittmachertherapie & Elektrophysiologie
https://www.readbyqxmd.com/read/28527921/drug-induced-fatal-arrhythmias-acquired-long-qt-and-brugada-syndromes
#16
REVIEW
Isik Turker, Tomohiko Ai, Hideki Itoh, Minoru Horie
Since the early 1990s, the concept of primary "inherited" arrhythmia syndromes or ion channelopathies has evolved rapidly as a result of revolutionary progresses made in molecular genetics. Alterations in genes coding for membrane proteins such as ion channels or their associated proteins responsible for the generation of cardiac action potentials (AP) have been shown to cause specific malfunctions which eventually lead to cardiac arrhythmias. These arrhythmic disorders include congenital long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, short QT syndrome, progressive cardiac conduction disease, etc...
May 17, 2017: Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/28525920/torsade-de-pointes-arrhythmias-arise-at-the-site-of-maximal-heterogeneity-of-repolarization-in-the-chronic-complete-atrioventricular-block-dog
#17
Albert Dunnink, Thom R G Stams, Alexandre Bossu, Veronique M F Meijborg, Jet D M Beekman, Sofieke C Wijers, Jacques M T De Bakker, Marc A Vos
Aims: The chronic complete atrioventricular block (CAVB) dog is highly sensitive for drug-induced torsade de pointes (TdP) arrhythmias. Focal mechanisms have been suggested as trigger for TdP onset; however, its exact mechanism remains unclear. In this study, detailed mapping of the ventricles was performed to assess intraventricular heterogeneity of repolarization in relation to the initiation of TdP. Methods and results: In 8 CAVB animals, 56 needles, each containing 4 electrodes, were inserted in the ventricles...
May 1, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/28522677/synergistic-effect-of-dofetilide-and-mexiletine-on-prevention-of-atrial-fibrillation
#18
Guizhi Liu, Xiaolin Xue, Chuanyu Gao, Jiaqi Huang, Datun Qi, Yanzhou Zhang, Jian-Zeng Dong, Chang-Sheng Ma, Gan-Xin Yan
BACKGROUND: Although atrial fibrillation (AF) is the most common abnormal heart rhythm and its prevalence continues to rise, there is a marked paucity of effective and safe antiarrhythmic drugs for AF. This study was done to test whether combined use of dofetilide and mexiletine exhibits not only a synergistic effect on AF suppression but also a safer profile in drug-induced ventricular proarrhythmias. METHODS AND RESULTS: The effects of dofetilide plus mexiletine on atrial effective refractory period (ERP), AF inducibility, QT, and QT-related ventricular arrhythmias were studied using the isolated arterially perfused rabbit atrial and ventricular wedge preparations...
May 18, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28516454/a-multiscale-computational-modelling-approach-predicts-mechanisms-of-female-sex-risk-in-the-setting-of-arousal-induced-arrhythmias
#19
Pei-Chi Yang, Laura L Perissinotti, Fernando López-Redondo, Yibo Wang, Kevin R DeMarco, Mao-Tsuen Jeng, Igor Vorobyov, Robert D Harvey, Junko Kurokawa, Sergei Y Noskov, Colleen E Clancy
Female sex is a risk factor for inherited and acquired Long-QT associated Torsade de Pointes (TdP) arrhythmias, and sympathetic discharge is a major factor in triggering TdP in female Long-QT syndrome patients. We used a combined experimental and computational approach to predict 'the perfect storm' of hormone concentration, IKr block, and sympathetic stimulation that induces arrhythmia in females with inherited and acquired Long-QT. More specifically, we developed mathematical models of acquired and inherited Long-QT syndrome in male and female ventricular human myocytes by combining effects of a hormone and a hERG blocker dofetilide or hERG mutations...
May 18, 2017: Journal of Physiology
https://www.readbyqxmd.com/read/28511997/thorough-qt-tqt-studies-concordance-with-torsadogenesis-and-an-evolving-cardiac-safety-testing-paradigm
#20
Barbara Wiśniowska, Zofia Tylutki, Sebastian Polak
Since 2005, when the International Conference on Harmonisation (ICH) E14 guideline was adopted, no drug has been withdrawn because of QTc prolongation or torsade de pointes arrhythmia. There are, however, costs associated with this success. In addition to the time and money invested, thorough QT (TQT) studies have limited the efficiency of the drug development pipeline. In this paper, we discuss the relevance of TQT trials as a tool for proarrhythmic risk prediction as a part of the debate regarding their usefulness...
May 13, 2017: Drug Discovery Today
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