ABSTRACT
Aims: The impact of the quality of warfarin therapy on cardiovascular outcomes excluding stroke is largely unknown. The aims of this study were to evaluate the association between the warfarin control and the incidence and outcome of myocardial infarction (MI) and to validate the predictive value of the CHA2DS2-VASc score for MI in atrial fibrillation (AF) patients taking warfarin. Methods and results: The nationwide FinWAF Registry consists of 54 568 AF patients (mean age 73.31 ± 10.7 years, 52% men) taking warfarin. The quality of warfarin therapy was assessed continuously by calculating the time in therapeutic range within a 60-day window using the Rosendaal method (TTR60). Adjusted Cox proportional hazards models were prepared for the incidence of MI and cardiovascular mortality in six different TTR60 categories. During the 3.2 ± 1.6 years of follow-up, the annual incidence of MI (95% confidence interval) was 3.3% (3.0-3.5%), 2.9% (2.6-3.3%), 2.4% (2.1-2.7%), 1.9% (1.7-2.2%), 1.7% (1.5-2.0%), and 1.2% (1.1-1.3%) among patients with TTR60 <40%, 40-50%, 50-60%, 60-70%, 70-80%, and >80%, respectively. Well-managed warfarin therapy (TTR60 > 80%) was associated also with a lower cardiovascular mortality, whereas a high CHA2DS2-VASc score correlated with poor outcome. Conclusion: Cardiovascular outcome was superior among AF patients with good warfarin control and in those with a low CHA2DS2-VASc score. The inverse association between the TTR60 and incidence of MI and cardiovascular mortality indicate that in AF patients the quality of warfarin therapy is critical not only for prevention of stroke but also with regard to cardiovascular outcome.
Subject(s)
Anticoagulants/therapeutic use , Atrial Fibrillation/drug therapy , Blood Coagulation/drug effects , Myocardial Infarction/epidemiology , Quality Indicators, Health Care , Warfarin/therapeutic use , Adolescent , Adult , Aged , Aged, 80 and over , Anticoagulants/adverse effects , Atrial Fibrillation/blood , Atrial Fibrillation/diagnosis , Atrial Fibrillation/mortality , Drug Monitoring/methods , Female , Finland/epidemiology , Humans , Incidence , International Normalized Ratio , Male , Middle Aged , Myocardial Infarction/diagnosis , Myocardial Infarction/mortality , Myocardial Infarction/prevention & control , Registries , Retrospective Studies , Risk Factors , Time Factors , Treatment Outcome , Warfarin/adverse effects , Young AdultSubject(s)
Arrhythmias, Cardiac , Heart , Africa , Cardiac Conduction System Disease , Cardiac Electrophysiology , HumansABSTRACT
AIMS: The aim of this analysis was to provide comprehensive information on invasive cardiac arrhythmia therapies in the European Society of Cardiology (ESC) area over the past 10 years. METHODS AND RESULTS: The European Heart Rhythm Association (EHRA) has collected data on invasive arrhythmia therapies since 2008. This year 53 of the 56 ESC member countries provided data for the EHRA White Book. Here we present updated data on procedure rates together with information on demographics, economy, vital statistics, local healthcare systems and training activities. Considerable heterogeneity in the access to invasive arrhythmia therapies still exists across the five geographical ESC regions. In 2016, the device implantation rates per million population were 3-6 times higher in the Western region than in the non-European and Eastern ESC member countries. Catheter ablation activity was highest in the Western countries followed by the Northern and Southern areas. In the non-European countries, atrial fibrillation ablation rate was more than tenfold lower than in the European countries. On the other hand, the growth rate over the past ten years was highest in the non-European and Eastern countries. In some Eastern European countries with relative low gross domestic product the procedure rates exceeded the average values. CONCLUSION: It was encouraging to note that during the past decade the growth in invasive arrhythmia therapies was greatest in the areas historically with relatively low activity. Nevertheless, there is substantial disparity and continued efforts are needed to improve harmonization of cardiac arrhythmia therapies in the ESC area.
Subject(s)
Arrhythmias, Cardiac/therapy , Cardiac Resynchronization Therapy Devices/trends , Cardiac Resynchronization Therapy/trends , Cardiology/trends , Catheter Ablation/trends , Defibrillators, Implantable/trends , Electric Countershock/trends , Heart Conduction System/physiopathology , Action Potentials , Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/epidemiology , Arrhythmias, Cardiac/physiopathology , Cardiac Resynchronization Therapy/economics , Cardiac Resynchronization Therapy Devices/economics , Cardiology/economics , Catheter Ablation/economics , Defibrillators, Implantable/economics , Electric Countershock/economics , Electric Countershock/instrumentation , Europe/epidemiology , Health Care Costs/trends , Healthcare Disparities/trends , Heart Rate , Humans , Practice Patterns, Physicians'/trends , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: Atrial fibrillation (AF) is a common arrhythmia that causes numerous visits to emergency departments (ED). The aim of the FinFib2 study was to evaluate whether treatment of patients with AF in ED is consistent with the contemporary European Society of Cardiology (ESC) management guidelines. Here we report the results of antiarrhythmic drug therapy (AAD) in ED. METHODS: All patients within the two-week study period whose primary reason for the ED visit was symptomatic AF were included into this prospective multicentre study. Comprehensive data on factors contributing to the treatment of AF were collected, including a data of previous use of ADDs, and changes made for them during a visit in ED. RESULTS: The study population consisted of 1013 consecutive patients (mean age 70 ± 13 years, 47.6% female). The mean European Heart Rhythm Association (EHRA) symptom score was 2.2 ± 0.8. Rhythm control strategy was opt for 498 (63.8%) and 140 (64.5%) patients with previously and newly diagnosed AF, respectively. In patients with previously diagnosed AF the most frequently used AAD was a beta blocker (80.9%). Prior use of class I (11.4%) and III (9.1%) AADs as well as start or adjustment of their dosage (7.4%) were uncommon. Most of the patients with newly diagnosed AF were prescribed a beta blocker (71.0%) or a calcium channel antagonist (24.0%), and only two of them received class I or class III AADs. CONCLUSIONS: Our data demonstrated that in patients presenting to the ED with recurrent symptomatic AF and aimed for rhythm control strategy, the use of class I and class III AADs was rare despite ESC guideline recommendations. It is possible that early adaptation of a more aggressive rhythm control strategy might improve a quality of life for symptomatic patients and alleviate the ED burden associated with AF. Beta blockers were used by majority of patients as rate control therapy both in rate and rhythm control groups. TRIAL REGISTRATION: NCT01990105 . Registered 15 November 2013.
Subject(s)
Anti-Arrhythmia Agents/therapeutic use , Atrial Fibrillation/drug therapy , Emergency Service, Hospital , Adrenergic beta-Antagonists/therapeutic use , Adult , Aged , Aged, 80 and over , Atrial Fibrillation/complications , Atrial Fibrillation/diagnosis , Female , Finland , Guideline Adherence , Humans , Male , Middle Aged , Practice Guidelines as Topic , Prospective Studies , Young AdultABSTRACT
AIMS: The aim of this analysis was to provide comprehensive information on the access to and use of cardiac implantable electronic device (CIED) and catheter ablation therapy in the European Society of Cardiology (ESC) area. METHODS AND RESULTS: The European Heart Rhythm Association (EHRA) has been collecting descriptive and quantitative data on invasive arrhythmia therapies since 2008. This year 50 of the 56 ESC member countries provided data for the EHRA White Book. Up-to-date information on procedure rates for the last 5 years together with information on demographics, economy, vital statistics, local healthcare systems, and training activities is presented for each country and the 5 geographical ESC regions. Our analysis indicated that considerable heterogeneity in the access to arrhythmia therapies still exists across the ESC area. In 2015, the CIED implantation rates per million population were highest in the Western followed by the Southern and Northern European countries. The catheter ablation activity was largest in the Western followed by the Northern and Southern areas. Overall, the procedure rates were 3-10 times higher in the European than in the non-European ESC countries. Economic resources were not the only driver for utilization of arrhythmia therapies as in some Eastern European countries with relative low gross domestic product the procedure rates exceeded the average values. CONCLUSION: These data will help the healthcare professionals and stakeholders to identify and to understand in more depth the trends, disparities, and gaps in cardiac arrhythmia care and thereby promote harmonization of cardiac arrhythmias therapies in the ESC area.
Subject(s)
Arrhythmias, Cardiac/therapy , Cardiology/trends , Electrophysiologic Techniques, Cardiac/trends , Health Services Accessibility/trends , Healthcare Disparities/trends , Practice Patterns, Physicians'/trends , Africa, Northern , Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/physiopathology , Cardiac Pacing, Artificial/trends , Cardiac Resynchronization Therapy/trends , Cardiac Resynchronization Therapy Devices/trends , Catheter Ablation/trends , Defibrillators, Implantable/trends , Electric Countershock/instrumentation , Electric Countershock/trends , Europe , Health Care Surveys , Humans , Pacemaker, Artificial/trends , Predictive Value of Tests , Professional Practice Gaps/trends , Societies, Medical , Time Factors , Treatment OutcomeABSTRACT
AIMS: The aim was to provide comprehensive information on the use of cardiac implantable electronic device (CIED) and catheter ablation therapy in the European Society of Cardiology (ESC) area. METHODS AND RESULTS: The European Heart Rhythm Association (EHRA) has collected data on use of invasive arrhythmia managements since 2008. Fifty-one of the 56 ESC member countries provided data for the EHRA White Book 2015. This analysis is based on the current and previous editions of the EHRA White Book. Up-to-date information on procedure rates for the last 5 years together with information on economic resources, reimbursement systems, and training requirements are presented for each country and the five geographical ESC regions. In 2014, the CIED implantation rates per million population were highest in the Western followed by the Southern and Northern European countries. The catheter ablation activity was largest in the Western followed by the Northern and Southern areas. Altogether the procedure rates were lowest in the Eastern European and in the non-European ESC countries. In the European ESC countries, the procedure rates were 3-10 times higher than in the non-European ESC countries. However, in some countries with a relatively low gross domestic product the procedure rates exceeded the average values indicating that utilization of arrhythmia therapies was not driven merely by the economic factors. CONCLUSION: This analysis indicates that considerable heterogeneity in the availability and utilization of arrhythmia therapies still exist across the ESC area. The data will hopefully aid in directing future activities and promote harmonization of cardiac arrhythmia care in the ESC countries.
Subject(s)
Arrhythmias, Cardiac/therapy , Cardiac Resynchronization Therapy/trends , Catheter Ablation/trends , Defibrillators, Implantable/trends , Electrophysiologic Techniques, Cardiac , Cardiology , Europe , HumansABSTRACT
BACKGROUND: The Medical ANtiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation (MANTRA-PAF) is a randomized trial comparing radiofrequency catheter ablation (RFA) to antiarrhythmic drugs (AADs) as first-line treatment of paroxysmal atrial fibrillation (PAF). In order to eliminate the clouding effect of crossover we performed an on-treatment analysis of the data. METHODS AND RESULTS: Patients (n=294) were divided into three groups: those receiving only the assigned therapy (RFA and AAD groups) and those receiving both therapies (crossover group). The primary end points were AF burden in 7-day Holter recordings at 3, 6, 12, 18, and 24 months and cumulative AF burden in all recordings. At 24 months, AF burden was significantly lower in the RFA (n=110) than in the AAD (n=92) and the crossover (n=84) groups (90th percentile 1% vs. 10% vs. 16%, P=0.007), and more patients were free from any AF (89% vs. 73% vs. 74%, P=0.006). In the RFA, AAD and the crossover groups 63%, 59% and 21% (P<0.001) of the patients had no AF episodes in any Holter recording, respectively. Quality of life improved significantly in all groups. There were no differences in serious adverse events between the RFA, AAD and crossover groups (19% vs. 8% vs. 23%) (P=0.10). CONCLUSIONS: In the treatment of antiarrhythmic therapy naïve patients with PAF long-term efficacy of RFA was superior to AAD therapy. Thus, it is reasonable to offer RFA as first-line treatment for highly symptomatic patients who accept the risks of the procedure and are aware of frequent need for reablation(s).
Subject(s)
Anti-Arrhythmia Agents/therapeutic use , Atrial Fibrillation/drug therapy , Atrial Fibrillation/surgery , Catheter Ablation/methods , Aged , Atrial Fibrillation/diagnosis , Catheter Ablation/standards , Cross-Over Studies , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prospective Studies , Treatment OutcomeABSTRACT
AIMS: New evidence about first-line radiofrequency catheter ablation (RFA) in symptomatic atrial fibrillation (AF) has emerged. In a single study the comparative treatment effect is potentially diminished by the high rate of cross-over to the alternative therapy. Therefore, we conducted a systematic review and meta-analysis of the available data to further evaluate the efficacy and safety of RFA vs. antiarrhythmic drugs (AADs). METHODS AND RESULTS: Five databases were searched for randomized controlled trials comparing RFA and AAD therapy as first-line treatment of AF in August 2014. Three studies with 491 patients with recurrent symptomatic AF were included. The patients were relatively young and the majority of them had paroxysmal AF (98.7%) and no major comorbidity. Radiofrequency catheter ablation was associated with significantly higher freedom from AF recurrence compared with AAD therapy [risk ratio (RR) 0.63, 95% confidence interval (CI) 0.44-0.92, P = 0.02]. The difference in the rate of symptomatic AF recurrences was not statistically significant (RR 0.57, 95% CI 0.30-1.08, P = 0.09). There was one procedure-related death and seven tamponades with RFA, whereas symptomatic bradycardia was more frequent with AAD therapy. CONCLUSION: Radiofrequency catheter ablation seems to be more effective than medical therapy as first-line treatment of paroxysmal AF in relatively young and otherwise healthy patients, but may also cause more severe adverse effects. These findings support the use of RFA as first-line therapy in selected patients, who understand the benefits and risks of the procedure.
Subject(s)
Anti-Arrhythmia Agents/therapeutic use , Atrial Fibrillation/therapy , Catheter Ablation , Humans , Patient Selection , Treatment OutcomeABSTRACT
AIMS: There has been large variations in the use of invasive electrophysiological therapies in the member countries of the European Society of Cardiology (ESC). The aim of this analysis was to provide comprehensive information on cardiac implantable electronic device (CIED) and catheter ablation therapy trends in the ESC countries over the last five years. METHODS: The European Heart Rhythm Association (EHRA) has collected data on CIED and catheter ablation therapy since 2008. Last year 49 of the 56 ESC member countries provided data for the EHRA White Book. This analysis is based on the current and previous editions of the EHRA White Book. Data on procedure rates together with information on economic aspects, local reimbursement systems and training activities are presented for each ESC country and the five geographical ESC regions. RESULTS: In 2013, the electrophysiological procedure rates per million population were highest in Western Europe followed by the Southern and Northern European countries. The CIED implantation and catheter ablation rate was lowest in the Eastern European and in the non-European ESC countries, respectively. However, in some Eastern European countries with relative low gross domestic product procedure rates exceeded those of some wealthier Western countries, suggesting that economic resources are not the only driver for utilization of arrhythmia therapies. CONCLUSION: These statistics indicate that despite significant improvements, there still is considerable heterogeneity in the availability of arrhythmia therapies across the ESC area. Hopefully, these data will help identify areas for improvement and guide future activities in cardiac arrhythmia management.
Subject(s)
Atrial Fibrillation/therapy , Cardiac Resynchronization Therapy/statistics & numerical data , Catheter Ablation/statistics & numerical data , Defibrillators, Implantable/statistics & numerical data , Electrophysiologic Techniques, Cardiac/statistics & numerical data , Pacemaker, Artificial/statistics & numerical data , Certification , Data Collection , Europe , Europe, Eastern , Gross Domestic Product , Health Care Costs/statistics & numerical data , Humans , Socioeconomic FactorsABSTRACT
A 59-year-old female with structurally normal heart was admitted to our hospital for treatment of highly symptomatic, drug refractory atrial premature beats (APB). ECG revealed atrial parasystolic trigeminy. The arrhythmogenic focus was mapped and ablated using magnetic remote navigation and 3D electroanatomical mapping system. To our knowledge, this is the first report on successful ablation of frequent APBs in the non-coronary aortic cusp.
ABSTRACT
BACKGROUND: The FinPAC trial showed that the strategy of uninterrupted oral anticoagulation (OAC) was non-inferior to interrupted OAC for the primary outcome of bleeding and thromboembolic complications in patients undergoing cardiac rhythm management device (CRMD) implantation. METHODS: We conducted a post hoc analysis of the FinPAC data to explore the incidence and predictors of significant (> 100 cm(2)) pocket hematoma after CRMD implantation among the study population (n = 447). A total of 213 patients were on OAC, 128 were on aspirin, and 106 on no antithrombotic therapy. RESULTS: The incidence of significant pocket hematoma during hospital stay was significantly higher among patients using OAC (5.6%) and aspirin (5.5%) than in those with no antithrombotic medications (0.9%), but only one patient (0.8%) in the aspirin group needed revision of hematoma. Two patients (0.9%) in the OAC group and one (0.8%) in the aspirin group needed blood products. In multivariable regression analysis, no pre- procedural features predicted the significant hematoma in any of the groups. CONCLUSIONS: Clinically significant pocket hematoma is a rare complication after CRMD implantation in patients with ongoing therapeutic OAC. The incidence of significant pocket hematoma formation is similar in patients using OAC and those using aspirin.
Subject(s)
Anticoagulants/adverse effects , Hematoma/etiology , Postoperative Complications/chemically induced , Prosthesis Implantation/adverse effects , Aged , Aged, 80 and over , Anticoagulants/administration & dosage , Aspirin/adverse effects , Female , Finland/epidemiology , Humans , Incidence , Male , Middle Aged , Pacemaker, Artificial , Platelet Aggregation Inhibitors/adverse effects , Postoperative Complications/epidemiology , Randomized Controlled Trials as TopicSubject(s)
Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/therapy , Arrhythmias, Cardiac/physiopathology , Electrocardiography , Europe , Heart Diseases/complications , Heart Rate/physiology , Humans , Prognosis , Psychophysiologic Disorders/complications , Substance-Related Disorders/complicationsABSTRACT
AIMS: Current guidelines recommend discontinuation of oral anticoagulation treatment (OAT) and switch to heparin 2-5 days before catheter ablation of atrial fibrillation (AF). However, increasing evidence leans against the 'bridge therapy' and support continuation of OAT during the procedure. METHODS AND RESULTS: We evaluated the safety of AF ablation among patients with therapeutic OAT. The study population comprised 193 consecutive patients who underwent 228 AF ablation procedures guided by electroanatomical mapping. Periprocedural international normalized ratio was <2 (1.6 ± 0.3) in 103 cases (Group 1) and ≥2 (2.4 ± 0.4) in 125 cases (Group 2). Heparin (5000 IU bolus followed by continuous infusion through an open-irrigated ablation catheter) was used in both groups. No intracardiac echocardiographic guidance was used and activated clotting time (ACT) was not monitored. The incidence of major (intracranial bleeding, tamponade, bleeding that required surgical intervention, or blood transfusion) and minor bleeding complications and all thrombo-embolic events were registered during the 3-month follow-up. There was no statistical difference in major (P = 1.0) and minor complications (P = 0.74) between the groups. The bleeding complications included one surgically corrected groin haematoma in both groups (0.9%), 25 small haematomas at the puncture site (11 in Group 1 (10.7%) and 14 in Group 2 (11.2%), P = 0.90), and two minor pericardial effusions in Group 1. In Group 2, one patient had ischaemic stroke 16 days after the procedure. CONCLUSION: Transseptal puncture and AF ablation can be performed safely in patients with ongoing OAT without intracardiac echocardiographic guidance and ACT monitoring.
Subject(s)
Anticoagulants/administration & dosage , Atrial Fibrillation/surgery , Catheter Ablation/methods , Postoperative Complications/prevention & control , Thrombosis/prevention & control , Warfarin/administration & dosage , Administration, Oral , Anticoagulants/adverse effects , Female , Follow-Up Studies , Hemorrhage/chemically induced , Heparin/administration & dosage , Heparin/adverse effects , Humans , Incidence , Male , Middle Aged , Postoperative Complications/chemically induced , Treatment Outcome , Warfarin/adverse effectsABSTRACT
Pharmacotherapy of atrial fibrillation (AF) is demanding, because currently available antiarrhythmic drugs have low efficacy and many side effects. In drug development, the focus has been on amiodarone-like multichannel blockers, atrial-specific ion channel blockers, and novel non-channel agents targeting atrial remodelling. Dronedarone, an amiodarone analogue without iodine, was recently approved for treatment of AF. It is less effective than amiodarone, but serious adverse events are rare. Vernakalant, an atrial-selective drug with low proarrhythmic risk, is effective in cardioversion and it may also prevent AF recurrences. So-called upstream therapy with angiotensin converting enzyme and angiotensin receptor inhibitors, statins and omega-3 fatty acids needs further clinical validation.
Subject(s)
Anti-Arrhythmia Agents/therapeutic use , Atrial Fibrillation/drug therapy , Drug Design , Membrane Transport Modulators/therapeutic use , Amiodarone/analogs & derivatives , Amiodarone/therapeutic use , Anisoles/therapeutic use , Dronedarone , Electric Countershock/methods , Humans , Pyrrolidines/therapeutic useABSTRACT
BACKGROUND: Knowledge about the incidence of cardiac arrhythmias after acute myocardial infarction has been limited by the lack of traditional ECG recording systems to document and confirm asymptomatic and symptomatic arrhythmias. The Cardiac Arrhythmias and Risk Stratification After Myocardial Infarction (CARISMA) trial was designed to study the incidence and prognostic significance of arrhythmias documented by an implantable cardiac monitor among patients with acute myocardial infarction and reduced left ventricular ejection fraction. METHODS AND RESULTS: A total of 1393 of 5869 patients (24%) screened in the acute phase (3 to 21 days) of an acute myocardial infarction had left ventricular ejection fraction ≤40%. After exclusions, 297 patients (21%) (mean±SD age, 64.0±11.0 years; left ventricular ejection fraction, 31±7%) received an implantable cardiac monitor within 11±5 days of the acute myocardial infarction and were followed up every 3 months for an average of 1.9±0.5 years. Predefined bradyarrhythmias and tachyarrhythmias were recorded in 137 patients (46%); 86% of these were asymptomatic. The implantable cardiac monitor documented a 28% incidence of new-onset atrial fibrillation with fast ventricular response (≥125 bpm), a 13% incidence of nonsustained ventricular tachycardia (≥16 beats), a 10% incidence of high-degree atrioventricular block (≤30 bpm lasting ≥8 seconds), a 7% incidence of sinus bradycardia (≤30 bpm lasting ≥8 seconds), a 5% incidence of sinus arrest (≥5 seconds), a 3% incidence of sustained ventricular tachycardia, and a 3% incidence of ventricular fibrillation. Cox regression analysis with time-dependent covariates revealed that high-degree atrioventricular block was the most powerful predictor of cardiac death (hazard ratio, 6.75; 95% confidence interval, 2.55 to 17.84; P<0.001). CONCLUSIONS: This is the first study to report on long-term cardiac arrhythmias recorded by an implantable loop recorder in patients with left ventricular ejection fraction ≤40% after myocardial infarction. Clinically significant bradyarrhythmias and tachyarrhythmias were documented in a substantial proportion of patients with depressed left ventricular ejection fraction after acute myocardial infarction. Intermittent high-degree atrioventricular block was associated with a very high risk of cardiac death. Clinical Trial Registration- URL: http://www.ClinicalTrials.gov, Unique identifier: NCT00145119.
Subject(s)
Arrhythmias, Cardiac/diagnosis , Electrocardiography, Ambulatory/instrumentation , Electrocardiography, Ambulatory/methods , Myocardial Infarction/complications , Ventricular Function, Left , Acute Disease , Aged , Arrhythmias, Cardiac/epidemiology , Arrhythmias, Cardiac/etiology , Arrhythmias, Cardiac/prevention & control , Disease Susceptibility , Female , Follow-Up Studies , Humans , Incidence , Male , Middle Aged , Myocardial Infarction/therapy , Prognosis , Risk Assessment , Time FactorsABSTRACT
A 38-year-old man with history of unsuccessful catheter ablation of paraseptal accessory pathway (AP) and cardiac arrest was referred for reablation. Coronary sinus (CS) venography and detailed three-dimensional electroanatomical mapping demonstrated a large diverticulum near the CS ostium. A single radiofrequency ablation at the neck of the diverticulum eliminated conduction in the AP completely.
Subject(s)
Catheter Ablation/methods , Coronary Sinus/diagnostic imaging , Heart Conduction System/surgery , Phlebography/methods , Ventricular Fibrillation/surgery , Adult , Electrocardiography , Heart Conduction System/diagnostic imaging , Heart Conduction System/physiopathology , Humans , Male , Ventricular Fibrillation/diagnostic imaging , Ventricular Fibrillation/physiopathologySubject(s)
Anti-Arrhythmia Agents/adverse effects , Atrial Fibrillation/chemically induced , Heart Rate/drug effects , Pulmonary Veins/drug effects , Verapamil/adverse effects , Anti-Arrhythmia Agents/therapeutic use , Atrial Fibrillation/drug therapy , Atrial Fibrillation/etiology , Atrioventricular Node/drug effects , Heart Atria/drug effects , Heart Atria/innervation , Heart Atria/pathology , Humans , Pulmonary Veins/innervation , Pulmonary Veins/pathology , Verapamil/therapeutic useABSTRACT
AIMS: To assess the association of electrocardiographic repolarization and depolarization patterns to vulnerability to ventricular tachyarrhythmias. METHODS: In the present case-control study, a 12-lead ECG, signal-averaged ECG (SAECG), T-wave and QRS morphology, and T-wave alternans (TWA) were analyzed in post-MI patients with and without documented sustained ventricular tachycardia (VT) or fibrillation (VF) (VT/VF group, n=40, Non-VT/VF group, n=37, respectively) and healthy subjects (n=41). RESULTS: The QRS complex duration, measured from standard ECG (128 +/- 32 ms vs. 102 +/- 21 ms, p<0.001) or SAECG (125 +/- 25 ms vs. 99 +/- 20 ms, p<0.001), was significantly longer in the VT/VF than Non-VT/VF group. Several T-wave morphology variables, e.g., the total cosine of the angle between the main vectors of T-wave and QRS loops (TCRT), were different in the VT/VF (-0.13 +/- 0.58) and Non-VT/VF group (-0.11 +/- 0.48) compared to the healthy controls (0.47 +/- 0.50, p<0.001). However, there were no significant differences in any of the T-wave morphology variables including TWA between the two post-MI groups. CONCLUSION: Abnormalities in ventricular depolarization are more common among post-MI patients with prior VT/VF than in those without documented ventricular tachyarrhythmias. Abnormal T-wave morphology and TWA seem to reflect the heart disease rather than specifically vulnerability to VT/VF.
Subject(s)
Electrocardiography , Heart Conduction System/physiopathology , Myocardial Infarction/complications , Tachycardia, Ventricular/etiology , Ventricular Fibrillation/etiology , Aged , Case-Control Studies , Chi-Square Distribution , Female , Finland , Humans , Logistic Models , Male , Middle Aged , Myocardial Infarction/physiopathology , Predictive Value of Tests , ROC Curve , Tachycardia, Ventricular/physiopathology , Time Factors , Ventricular Fibrillation/physiopathologyABSTRACT
We present a case of a 73-year-old man with implantable cardioverter-defibrillator pocket erosion and Staphylococcus aureus infection who was admitted to our hospital for lead extraction. During the mechanical extraction procedure, the 12-year-old lead broke and the distal coil was trapped in the right ventricle. After several attempts to grasp the coil using a femoral workstation and various snaring tools failed, a steerable transseptal sheath was placed into the right ventricle via the right femoral vein. The sheath allowed better positioning of the basket retriever and the lead remnant was successfully grasped and extracted with direct traction.
Subject(s)
Defibrillators, Implantable/adverse effects , Device Removal/instrumentation , Electrodes, Implanted/adverse effects , Foreign Bodies/etiology , Foreign Bodies/surgery , Heart Ventricles/injuries , Heart Ventricles/surgery , Aged , Device Removal/methods , Humans , Male , Treatment OutcomeABSTRACT
AIMS: To determine whether risk stratification tests can predict serious arrhythmic events after acute myocardial infarction (AMI) in patients with reduced left ventricular ejection fraction (LVEF < or = 0.40). METHODS AND RESULTS: A total of 5869 consecutive patients were screened in 10 European centres, and 312 patients (age 65 +/- 11 years) with a mean LVEF of 31 +/- 6% were included in the study. Heart rate variability/turbulence, ambient arrhythmias, signal-averaged electrocardiogram (SAECG), T-wave alternans, and programmed electrical stimulation (PES) were performed 6 weeks after AMI. The primary endpoint was ECG-documented ventricular fibrillation or symptomatic sustained ventricular tachycardia (VT). To document these arrhythmic events, the patients received an implantable ECG loop-recorder. There were 25 primary endpoints (8.0%) during the follow-up of 2 years. The strongest predictors of primary endpoint were measures of heart rate variability, e.g. hazard ratio (HR) for reduced very-low frequency component (<5.7 ln ms(2)) adjusted for clinical variables was 7.0 (95% CI: 2.4-20.3, P < 0.001). Induction of sustained monomorphic VT during PES (adjusted HR = 4.8, 95% CI, 1.7-13.4, P = 0.003) also predicted the primary endpoint. CONCLUSION: Fatal or near-fatal arrhythmias can be predicted by many risk stratification methods, especially by heart rate variability, in patients with reduced LVEF after AMI.