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2.
J Electrocardiol ; 85: 50-57, 2024 Jun 08.
Article in English | MEDLINE | ID: mdl-38852223

ABSTRACT

BACKGROUND: Differentiation between ventricular tachycardia (VT) and supraventricular tachycardia (SVT) with aberrancy based on the 12­lead ECG alone can be imprecise. Implantable cardiac defibrillators (ICD) may be inserted for presumed VT, particularly in patients with syncopal presentation or atypical aberrancy patterns. Accurate diagnosis of these patients facilitated by an electrophysiology study (EPS) may alter diagnosis and management. METHODS: We present a prospective collection of cases across 3 cardiac centers of consecutive patients with WCT presumed to be VT who were referred for consideration of an ICD, and in whom further evaluation including an EPS ultimately demonstrated SVT with aberrancy as the culprit arrhythmia. RESULTS: 22 patients were identified (17 male, mean age 50±13 years. Available rhythm data at the time of referral was presumptively diagnosed as monomorphic VT in 16 patients and polymorphic VT in 6 patients. Underlying structural heart disease was present in 20 (91%). EPS resulted in a diagnosis of SVT with aberrancy in all cases: comprising AV nodal re-entry tachycardia (n=10), orthodromic reciprocating tachycardia (n=3), focal atrial tachycardia (n=3), AF/AFL (n=3) and 'double fire' tachycardia (n=2). 21 (95%) patients underwent successful ablation. All patients remained free of arrhythmia recurrence at a median of 3.4 years of follow-up. ICD insertion was obviated in 18 (82%) patients, with 1 patient proceeding to ICD extraction. CONCLUSION: SVT with atypical aberrancy may mimic monomorphic or polymorphic VT. Careful examination of all available rhythm data and consideration of an EPS can confirm SVT and obviate the need for ICD therapy.

3.
Heart Rhythm ; 2024 Jun 03.
Article in English | MEDLINE | ID: mdl-38842966
6.
Heart Rhythm ; 2024 May 10.
Article in English | MEDLINE | ID: mdl-38734227

ABSTRACT

Establishing the precise mechanism of cardiac arrhythmias in the electrophysiology laboratory is one of the main requisites for a successful and safe ablation. This article provides an organized approach to the differential diagnosis of narrow and wide complex tachycardias based on the analysis of electrical activation patterns, followed by specific pacing maneuvers in each case.

8.
JACC Case Rep ; 29(12): 102363, 2024 Jun 19.
Article in English | MEDLINE | ID: mdl-38779552

ABSTRACT

We present an unusual case of alternating left anterior and left posterior fascicular block. Given the known risk for progression to complete atrioventricular block with alternating right bundle and left bundle branch block, we performed an electrophysiological study. Findings were consistent with infra-Hisian disease, and the patient underwent pacemaker implantation.

9.
Heart Rhythm ; 21(5): 519-520, 2024 May.
Article in English | MEDLINE | ID: mdl-38692816
12.
JAMA Intern Med ; 184(3): 326-327, 2024 Mar 01.
Article in English | MEDLINE | ID: mdl-38315468

ABSTRACT

This case report describes a patient in their 70s with hypertension and heart failure presenting to the emergency department with chest discomfort, nausea, anorexia, and weakness.


Subject(s)
Digoxin , Heart Failure , Humans , Digoxin/adverse effects , Cardiotonic Agents/adverse effects , Heart Failure/chemically induced , Heart Failure/drug therapy
13.
J Electrocardiol ; 83: 26-29, 2024.
Article in English | MEDLINE | ID: mdl-38295539

ABSTRACT

BACKGROUND: Alcohol consumption is associated with a higher increased risk of atrial fibrillation (AF), but the acute effects on cardiac electrophysiology in humans remain poorly understood. The HOw ALcohol InDuces Atrial TachYarrhythmias (HOLIDAY) Trial revealed that alcohol shortened pulmonary vein atrial effective refractory periods, but more global electrophysiologic changes gleaned from the surface ECG have not yet been reported. METHODS: This was a secondary analysis of the HOLIDAY Trial. During AF ablation procedures, 100 adults were randomized to intravenous alcohol titrated to 0.08% blood alcohol concentration versus a volume and osmolarity-matched, masked, placebo. Intervals measured from 12­lead ECGs were compared between pre infusion and at infusion steady state (20 min). RESULTS: The average age was 60 years and 11% were female. No significant differences in the P-wave duration, PR, QRS or QT intervals, were present between alcohol and placebo arms. However, infusion of alcohol was associated with a statistically significant relative shortening of the JT interval (r: -14.73, p = 0.048) after multivariable adjustment. CONCLUSION: Acute exposure to alcohol was associated with a relative reduction in the JT interval, reflecting shortening of ventricular repolarization. These acute changes may reflect a more global shortening of refractoriness, suggesting immediate proarrhythmic effects pertinent to the atria and ventricles.


Subject(s)
Atrial Fibrillation , Electrocardiography , Adult , Female , Humans , Male , Middle Aged , Blood Alcohol Content , Heart Atria , Randomized Controlled Trials as Topic
16.
Circ Arrhythm Electrophysiol ; 17(1): e012072, 2024 01.
Article in English | MEDLINE | ID: mdl-38099441

ABSTRACT

Although there is consensus on the management of patients with Brugada Syndrome with high risk for sudden cardiac arrest, asymptomatic or intermediate-risk patients present clinical management challenges. This document explores the management opinions of experts throughout the world for patients with Brugada Syndrome who do not fit guideline recommendations. Four real-world clinical scenarios were presented with commentary from small expert groups for each case. All authors voted on case-specific questions to evaluate the level of consensus among the entire group in nuanced diagnostic and management decisions relevant to each case. Points of agreement, points of controversy, and gaps in knowledge are highlighted.


Subject(s)
Brugada Syndrome , Heart Arrest , Humans , Brugada Syndrome/diagnosis , Brugada Syndrome/therapy , Electrocardiography , Heart Arrest/diagnosis , Heart Arrest/therapy , Death, Sudden, Cardiac/etiology , Death, Sudden, Cardiac/prevention & control , Consensus
17.
Circulation ; 148(23): 1907-1910, 2023 12 05.
Article in English | MEDLINE | ID: mdl-38048393
20.
Heart Rhythm ; 20(11): 1586-1588, 2023 11.
Article in English | MEDLINE | ID: mdl-37914496
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