China
Africa
Explore chapters and articles related to this topic
Arrhythmias in Hypertrophic Cardiomyopathy and Their Management
Published in Srilakshmi M. Adhyapak, V. Rao Parachuri, Hypertrophic Cardiomyopathy, 2020
Tom Kai Ming Wang, Milind Y. Desai
Most of the risk factors for SCD are well established and part of contemporary guidelines (Table 11.2) [1, 2]. The strongest risk factor is of course previous history of resuscitated cardiac arrest, VF, and sustained VT [26]. The other traditional risk factors are family history of SCD, unexplained syncope, increasing left ventricular hypertrophy, NSVT, and abnormal exercise blood pressure response [27, 28]. Family history of SCD is especially important in first-degree relatives, multiple family members, and in younger age relatives below 40–50 years old [29]. Unexplained syncope is common in about 20% of HCM, and may be a result of arrhythmia or LVOT obstruction; however, those occurring in the previous six months and younger patients confer the highest risk [30]. Non-sustained ventricular tachycardia is quite common and most prognostic in younger patients under 30 years old [27]. Nearly one-third of HCM patients have abnormal blood pressure response to exercise, whether from insufficient diastolic filling and therefore stroke volume and/or LVOT obstruction, and both predict SCD in younger patients while having a high negative predictive value > 95% [31]. Atrial fibrillation itself is associated with SCD as reported in a meta-analysis of 76,009 patients, including in HCM patients [32]. The relationship between age and SCD in HCM is complex as, although SCD is more common in younger patients, it occurs in all age groups [33]. Further research is also necessary to test whether genetic factors independently correlate with SCD risk when taking into account other clinical and imaging factors [34].
Cardiovascular drug therapy in the elderly
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
William H. Frishman, Wilbert S. Aronow, Angela Cheng-Lai
Aronow et al. (76) performed a prospective study in 245 elderly patients (mean age 81 years) with heart disease (64% with prior MI and 36% with hypertensive heart disease), complex ventricular arrhythmias diagnosed by 24-hour ambulatory ECGs, and LV ejection fraction ≥40%. Nonsustained ventricular tachycardia occurred in 32% of patients. Myocardial ischemia occurred in 33% of patients. Mean follow-up was 30 months in patients randomized to propranolol and 28 months in patients randomized to no antiarrhythmic drug. Propranolol was discontinued because of adverse effects in 11% of patients. Follow-up 24-hour ambulatory ECGs showed that propranolol was significantly more effective than no antiarrhythmic drug in reducing ventricular tachycardia (>90%), in decreasing the average number of ventricular premature complexes per hour (>70%), and in abolishing silent ischemia.
Hypertrophic Cardiomyopathy
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Ahmad Masri, Stephen B. Heitner
Sudden cardiac death (SCD) is the most dreaded manifestation of HCM and is most frequently a result of ventricular fibrillation. Although overall it is rare (<1% per year), it is more frequent in younger patients. Because SCD is attributable to ventricular arrhythmias, it is preventable by appropriate use of ICDs. Subcutaneous ICDs can be used to reduce the intravascular hardware burden in selected patients.72 Currently, there is no evidence supporting a pharmacological treatment to prevent SCD in HCM. Antiarrhythmics are controversial in non-sustained ventricular tachycardia. Identifying patients at higher risk of SCD is a major challenge in HCM, since ICD implantation, especially in young patients, is by no means without consequence. Importantly, SCD risk re-stratification is necessary on an annual basis. Traditional risk factors include: (a) history of SCD or ventricular tachyarrhythmia (ventricular fibrillation, sustained ventricular tachycardia), (b) non-sustained ventricular tachycardia (>3 beats at >120 bpm on a Holter monitor); (c) massive hypertrophy (≥30 mm); (d) recent unexplained syncope; (e) first-degree relative with sudden unexplained death; and (f) a hypotensive/flat hemodynamic response to exercise.30 Despite these being well-proven and life-saving markers, many patients undergo unnecessary ICD placement. Refinement of SCD risk assessment has been a subject of intense research and has resulted in several evolving markers. Among these are the amount of fibrosis on CMR,37,73 LVOT gradient ≥30 mmHg,74 apical aneurysm,24 double or compound pathogenic sarcomeric gene variants, systolic dysfunction, and impaired coronary flow (myocardial ischemia).30,75 O'Mahoney et al. have published a risk calculator that utilizes established risk markers and age to calculate risk. This calculator is endorsed by the European Society of Cardiology,76 has been externally validated, especially for the extremes of risk,77 and is helpful when discussing risk with patients and family members.78 A shared decision model between the patient and the physician, taking into account the individual philosophy and risk tolerance, is essential.
Usefulness of insertable cardiac monitors for risk stratification: current indications and clinical evidence
Published in Expert Review of Medical Devices, 2023
Amira Assaf, Dominic AMJ Theuns, Michelle Michels, Jolien Roos-Hesselink, Tamas Szili-Torok, Sing-Chien Yap
In patients with a structural or electrical heart disease, risk stratification for SCD is usually based on a disease-specific multiparametric model [3–10] (Table 1). For many heart diseases, the occurrence of syncope, especially arrhythmogenic syncope, is an important risk factor and may guide the decision to implant an ICD [3,5–7,10,11]. Another important risk factor is the presence of (recurrent) nonsustained ventricular tachycardia (NSVT) which is usually detected during Holter monitoring or exercise testing [3,5,12]. The decision to implant an ICD can be difficult, especially in young patients, considering the potential life-long complications of device therapy including lead failure, device-related infection, inappropriate shocks, need for lead extraction and psychological burden [13–16]. In general, the guidelines recommend (class I) an ICD for patients who experience aborted SCD or sustained ventricular tachycardia (VT) that is not hemodynamically tolerated [17,18].
Prevalence and prognostic role of nonsustained ventricular tachycardia in cardiac amyloidosis
Published in Amyloid, 2022
Francesco Cappelli, Alberto Cipriani, Domitilla Russo, Giacomo Tini, Mattia Zampieri, Chiara Zocchi, Giulio Sinigiani, Luigi Tassetti, Luca Licchelli, Federico Perfetto, Camillo Autore, Maria Beatrice Musumeci
Non-sustained ventricular tachycardia (NSVT) is frequently detected during 24-h electrocardiographic (ECG) monitoring in cardiomyopathies and heart failure (HF) patients representing a challenging concern for physicians. Few data are available about the prevalence and significance of NSVT detected at ECG monitoring in cardiac amyloidosis (CA), and are mostly limited to light-chain (AL) CA [1–4]. Aim of this study was to determine prevalence, predictors and prognostic implications of NSVT detected during 24-h ECG monitoring in a multicentric cohort of patients with all subtypes of CA. We retrospectively analysed data from 24-h ECG monitoring of 181 patients (67% male, age: 74.6 ± 9 years) followed in three Italian amyloidosis referral centres (Rome, Florence, Padua). Fifty-one (28.2%) patients had AL, 105 (58%) wild-type transthyretin amyloidosis (ATTRwt) and 25 (13.8%) mutated transthyretin amyloidosis (ATTRv, Supplementary Material). Clinical and instrumental data were collected at the nearest visit (within 3 months) to 24-h ECG monitoring. Median follow-up (time from ECG monitoring to last evaluation or death) was 12 (range 1–93) months. This study was approved by the Careggi Ethical Commitee, Florence (15291_oss). All patients were managed in accordance with the Declaration of Helsinki and signed an informed consent for the processing of personal data for scientific research purposes.
Cardiac rehabilitation testing of a high-intensity performance athlete firefighter after myocardial infarction, placement of stents and an implantable cardioverter-defibrillator
Published in Baylor University Medical Center Proceedings, 2022
The patient’s ICD implant site, hemodynamics, and continuous three-lead electrocardiogram were evaluated throughout each session. In-person device interrogation was performed by the ICD manufacturer representative at the first and last sessions. Thereafter, the ICD was interrogated and monitored remotely by the manufacturer. While the patient wore a weighted vest, both cardiovascular intensity and weight loads were gradually increased, starting at 15 pounds, with increments of 10 pounds added every session until the weight mirrored his turnout gear (Table 1). During HIPT, the patient’s hemodynamics remained within acceptable ranges (means, 152/70–160/70 mm Hg and 172–181 beats/min), and the mean peak rate-pressure product (27,552 ± 1408) was within the 36,000 threshold.12 A functional capacity of 12.1 METs was achieved on the final metabolic stress test, with occasional premature ventricular contractions and asymptomatic episodes of nonsustained ventricular tachycardia, with a rate of 142 to 181 beats/min in 3- to 6-second duration over a period of 2 minutes 6 seconds observed.