1,721,120 research outputs found
Electrocardiographic Risk Stratification in Primary Prophylactic Implantable Cardioverter Defibrillator Patients: Can Future Arrhythmias Correlating with Sudden Cardiac Death Be Predicted?
No full textFar-field oversensing of atrial signals: an unusual cause for very short V-V intervals and inappropriate implantable cardioverter defibrillator therapy
No full textInappropriate implantable cardioverter-defibrillator therapy during exercise: What is the mechanism?
No full textDouble left ventricular pacing following accidental malpositioning of the right ventricular electrode during implantation of a cardiac resynchronization therapy device
Full text linkAccidental malpositioning of a right ventricular (RV) electrode has not been previously reported in the context of cardiac resynchronization therapy (CRT). The case of a 75-year old male patient with dilative cardiomyopathy, left ventricular (LV) ejection fraction 23%, New York Heart Association functional heart failure status stage III, left bundle branch block (LBBB) with QRS width of 136 ms, and misplacement of the RV lead to the LV apex during implantation of a CRT defibrillator is described. Following unremarkable implantation, routine interrogation of the CRT device on the first day after the implantation revealed uneventful technical findings. The 12-lead surface electrocardiogram (ECG) showed biventricular stimulation featuring a narrow QRS complex with incomplete right bundle branch block (RBBB) and R>S in V1. The biplane postoperative chest X-ray was graded normal. On routine follow-up one month later, a transthoracic echocardiogram revealed an increased ejection fraction of 51% but the RV lead was placed in the LV apex. An additional transesophageal echocardiogram exhibited an Eustachian valve guiding the lead via the patent foramen ovale through the mitral valve into the LV apex. Operative revision was scheduled and the active fixation lead was uneventful removed from the LV. A new electrode was inserted and placed in the RV apex. Accidental malplacement of the RV electrode to the LV may be difficult to diagnose in the context of CRT patients as a stimulated biventricular ECG with incomplete RBBB appearance is expected in this situation. Careful analysis of lateral radiographic views during the operation is important to ensure correct lead positioning. As timely revision is the preferred procedure, early routine transthoracic echocardiography may be considered for detection of malplacement
Role of coronary angiography before radiofrequency ablation in patients presenting with paroxysmal supraventricular tachycardia
No full textDuring episodes of paroxysmal supraventricular tachycardia (PSVT), electrocardiograms frequently show ST-segment depressions, and patients may experience typical chest pain prompting invasive coronary angiography. We evaluated 114 patients presenting with PSVT for concomitant coronary artery disease (CAD). Patients were classified as to the type of PSVT, symptoms during PSVT, and cardiovascular risk factors. Maximum heart rate, extent of ST-segment depression, and cardiac troponin levels during PSVT were recorded. Patients were subjected to exercise testing and/or coronary angiography. During PSVT, symptoms suggestive of myocardial ischemia, including chest pain (31%), ST-segment depression (61%), and elevated troponin levels (12%), were common. Sixty-seven patients (59%) underwent coronary angiography. The overall prevalence of significant CAD was found to be low (4%) and did not correlate to symptoms during tachycardia. Routine coronary angiography cannot be recommended in patients with PSVT unless routine evaluation outside episodes of tachycardia suggests the presence of significant CAD
Sex differences in ICD benefit
No full textBackground: Implantable cardioverter defibrillators (ICD) have been demonstrated to improve survival, but a considerable number of patients never receive appropriate therapy. The influence of sex on ICD effectiveness in primary prophylactic ICD therapy is unclear. Summary: Until now, guideline recommendations are equal for men and women, yet only an average of 20% of enrolled patients in large randomized ICD studies were women. Epidemiological data from the Framingham Heart Study exhibit lower incidences of SCD in women (approximate to 50%). This difference is in only in part owed to less severe underlying cardiac disease or comorbidities but it persists after correction of confounding factors. Several of the large randomized studies have conducted gender substudies. In MADIT-II, the survival benefit for women was similar as for men, although the risk of appropriate ICD therapy was lower for women. In SCD-HeFT and DEFINITE, the survival benefits for women were less compared to men, or not existent Trends were contradictingly summarized by two meta-analyses. By this important post-hoc research, important hypotheses for prospective work in the ICD subgroup of women are generated. At the same time, it is undisputed that the complication rate of ICD implantations is higher in women. The largest ICD registry to date Ontario (Canada) confirms the lower appropriate shock rate in women but found no differences in total mortality. Conclusions: Further subgroup analyses of large ICD cohorts by sex are needed, as well as studies investigating the influence of sex on ICD treatment and potentially ICD indication prospectively. (C) 2014 Elsevier Inc. All rights reserved.European Community under EU-CERT-ICD [602299
Unusual cause for an increase of the sensing integrity counter in a patient with inappropriate implantable cardioverter-defibrittator therapy
No full textWe describe the case of a patient who presented with multiple implantable cardioverter-defibrillator (ICD) shock discharges 12 months after device implantation. Upon device interrogation, intermittent oversensing of electrical noise and potential ICD lead failure were suggested by a significant increase in the sensing integrity counter (SIC), a cumulative count of very short ventricular sensed intervals. Analysis of stored episodes, however, revealed that inappropriate ICD therapy had been caused by intermittent T-wave oversensing (TWO), and that the increase of the SIC resulted from the coincidence of TWO and premature ventricular complexes (PVCs). T-wave oversensing resolved and the SIC did not increase any more during follow-up after adjustment of ventricular sensitivity. The coincidence of TWO and PVCs should therefore be considered as an uncommon cause for short ventricular sensed intervals in ICD patients presenting with a suspect increase in the SIC
Pulmonary vein ablation in a patient with a large left common pulmonary vein joining a large right common trunk
No full textOpen-Access-Publikationsfonds 202
Supraventricular tachycardia with 'A-A-V' response upon ventricular entrainment and transient 2:1 AV conduction block
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