ABSTRACT
The treatment of drug-refractory chronic ventricular tachycardia (VT) has undergone a revolution over the last 50 years. We now have automatic implantable cardioverter defibrillator therapy with pace-terminating capabilities, and catheter ablation of VT has refined mapping and improved methods of lesion generation. Between 1980 and 1993, Houston Methodist Hospital became a leader in the diagnosis and surgical ablation of VT and other arrhythmias. This is a brief account of that period and some of the experiences and lessons that have led to significant advances used today.
Subject(s)
Cardiac Surgical Procedures , Heart Rate , Tachycardia, Ventricular/surgery , Action Potentials , Cardiac Surgical Procedures/adverse effects , Cardiac Surgical Procedures/history , Diffusion of Innovation , Electrophysiologic Techniques, Cardiac , History, 20th Century , History, 21st Century , Humans , Postoperative Complications/etiology , Recurrence , Tachycardia, Ventricular/diagnosis , Tachycardia, Ventricular/history , Tachycardia, Ventricular/physiopathology , Time Factors , Treatment OutcomeSubject(s)
Death, Sudden, Cardiac/prevention & control , Defibrillators, Implantable/history , Tachycardia, Ventricular/history , Death, Sudden, Cardiac/etiology , History, 20th Century , History, 21st Century , Humans , Risk Factors , Tachycardia, Ventricular/complications , Tachycardia, Ventricular/therapyABSTRACT
Despite significant progress in understanding catecholaminergic polymorphic ventricular tachycardia (CPVT), there are still multiple uncertainties and gaps in our knowledge. Like the dark side of the moon, we cannot see them directly. Unfortunately, clinicians must make diagnostic and therapeutic decisions without solid evidence. Instead of summarising the current state of science and reiterating the guidelines, we review difficulties in understanding the disease mechanism, diagnosis and therapy. Highlighting these truths helps to avoid misconceptions, think clearly about our patients and direct future research efforts. It has become clear that CPVT encompasses more than just uniformly expressed ryanodine receptor mutations leading to bidirectional ventricular tachycardia, rather it is a disease caused by different genetic mutations, overlapping with other entities and possibly affecting not only the heart. Treatment in addition to beta blockers is often necessary: flecainide and left cardiac sympathetic denervation are therapies that come before consideration of defibrillator implantation and new treatment options are on the horizon.
Subject(s)
Mutation , Ryanodine Receptor Calcium Release Channel , Tachycardia, Ventricular , History, 20th Century , History, 21st Century , Humans , Ryanodine Receptor Calcium Release Channel/genetics , Ryanodine Receptor Calcium Release Channel/metabolism , Tachycardia, Ventricular/genetics , Tachycardia, Ventricular/history , Tachycardia, Ventricular/metabolism , Tachycardia, Ventricular/therapySubject(s)
Biomedical Research/history , Cardiac Electrophysiology/history , Tachycardia, Ventricular/history , Ablation Techniques/history , Diffusion of Innovation , Electrophysiologic Techniques, Cardiac/history , History, 20th Century , History, 21st Century , Humans , Tachycardia, Ventricular/diagnosis , Tachycardia, Ventricular/physiopathology , Tachycardia, Ventricular/surgerySubject(s)
Electric Countershock/history , Ventricular Fibrillation/history , Animals , Electric Countershock/methods , Electroshock/adverse effects , History, 20th Century , History, 21st Century , Humans , Sternum , Tachycardia, Ventricular/history , Tachycardia, Ventricular/therapy , United States , Ventricular Fibrillation/therapyABSTRACT
As extra-sístoles e as taquicardias ventriculares idiopáticas são arritmias com mecanismos e significado clínico que as diferenciam das arritmias ventriculares associadas a cardiopatias estruturais. Diferentemente dessas últimas, que apresentam risco de morte súbita em populações específicas, as arritmias idiopáticas geralmente são associadas a bom prognóstico, que mais as aproximam das arritmias supraventriculares. Apresentam padrão eletrocardiográfico bastante definido e o conhecimento dessas características eletrocardiográficas pelo cardiologista clínico é uma das premissas para um correto manuseio clínico desses pacientes. A resposta às drogas antiarrítmicas costuma ser adequada e ablação por cateter pode ter papel decisivo na cura definitiva de pacientes selecionados. Este artigo procura revisar as caracteristicas clínicas, eletrocardiográficas e terapêuticas as arritmias ventriculares idiopáticas.
Subject(s)
Humans , Arrhythmias, Cardiac/physiopathology , Arrhythmias, Cardiac/therapy , Tachycardia, Ventricular/diagnosis , Tachycardia, Ventricular/history , Catheter Ablation , Verapamil/pharmacologyABSTRACT
In these short historical notes, we describe the early history of polymorphic ventricular tachycardia. Polymorphous ventricular tachycardia was probably first noted in 1918 by Wilson and Robinson. In a publication describing complete heart block and ventriculophasic arrhythmia, they noted a tachyarrhythmia characterized by multiple extrasystoles of different types at a rapid rate. Also, we briefly discuss the earliest recognized torsades de pointes by Dessertenes in 1966 and the first description of catecholaminergic polymorphic ventricular tachycardia, by Reid in 1977.
Subject(s)
Tachycardia, Ventricular/history , Torsades de Pointes/history , History, 20th Century , Humans , Tachycardia, Ventricular/diagnosis , Torsades de Pointes/diagnosisSubject(s)
Body Surface Potential Mapping/history , Body Surface Potential Mapping/methods , Cardiac Pacing, Artificial/history , Cardiac Pacing, Artificial/methods , Electrophysiology/history , Tachycardia, Ventricular/diagnosis , Tachycardia, Ventricular/history , Body Surface Potential Mapping/trends , Cardiac Pacing, Artificial/trends , Electrophysiology/methods , Electrophysiology/trends , Forecasting , History, 20th Century , History, 21st Century , Humans , Tachycardia, Ventricular/physiopathology , Tachycardia, Ventricular/therapySubject(s)
Cardiac Pacing, Artificial/history , Catheter Ablation/history , Electrophysiologic Techniques, Cardiac/history , Tachycardia, Ventricular/history , Anti-Arrhythmia Agents/history , Anti-Arrhythmia Agents/therapeutic use , History, 20th Century , Humans , Tachycardia, Ventricular/physiopathology , Tachycardia, Ventricular/therapySubject(s)
Arrhythmias, Cardiac/surgery , Arrhythmias, Cardiac/history , Arrhythmias, Cardiac/therapy , Atrial Fibrillation/history , Atrial Fibrillation/surgery , Heart Aneurysm/history , Heart Aneurysm/surgery , History, 20th Century , Humans , Tachycardia, Ectopic Atrial/history , Tachycardia, Ectopic Atrial/surgery , Tachycardia, Paroxysmal/history , Tachycardia, Paroxysmal/surgery , Tachycardia, Sinoatrial Nodal Reentry/history , Tachycardia, Sinoatrial Nodal Reentry/surgery , Tachycardia, Ventricular/history , Tachycardia, Ventricular/surgery , Wolff-Parkinson-White Syndrome/history , Wolff-Parkinson-White Syndrome/surgeryABSTRACT
The past 15 years have witnessed a substantial commitment to the understanding and surgical cure of postinfarction ventricular tachycardia, and the results of treatment have steadily improved. However, outside influences have had a negative impact on the use of this modality. With the widespread availability of implantable defibrillators, this has become an attractive alternative therapy to the sometimes difficult definitive surgical treatment. Meanwhile, early thrombolytic therapy for the management of evolving myocardial infarctions has been found to create a postinfarction electrical substrate that does not appear to be arrhythmogenic. As a result, clinical efforts to develop and refine definitive ventricular tachycardia surgical treatments have all but ceased. The intent of this article is to review the events that took place in this apparently transient era.
