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Ventricular Arrhythmias in Heart Failure
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Antonis S. Manolis, Antonis A. Manolis, Theodora A. Manolis
Other tests, such as microvolt T-wave alternans, heart rate variability, baroreflex sensitivity, and/or late potentials, may contain some prognostic information, although their positive prognostic value remains low.1 Invasive EP studies with programmed ventricular stimulation (Figure 21.3) have an indication in ischemic CM, where demonstration of inducible monomorphic VT is associated with a high risk for SCD, but with a very limited clinical predictive value in NICM.15,54
Genetically Determined Ventricular Arrhythmias
Published in Andrea Natale, Oussama M. Wazni, Kalyanam Shivkumar, Francis E. Marchlinski, Handbook of Cardiac Electrophysiology, 2020
Houman Khakpour, Jason S. Bradfield
T-wave morphology can provide important additional diagnostic and prognostic clues (Figures 8.1 and 8.2): Macroscopic T-wave alternans—a marker of cardiac electrical instability—though infrequently seen, should prompt an evaluation for LQTS.14Extremely broad-based T-wave are seen in LQT1.Notches on the T-wave are typical of LQT2 and their presence (compared to genetically proven LQT2 without notching) is a marker for higher risk of arrhythmic events.15LQT3 show peaked T-waves preceded by a long, isoelectric ST segment.
Tp-Te interval and Tp-Te/QT ratio may be predictive of idiopathic ventricular tachycardia in patients with frequent outflow tract premature ventricular complexes
Published in Acta Cardiologica, 2021
Ayhan Kup, Abdulkadir Uslu, Serdar Demir, Kamil Gulsen, Mehmet Celik, Emrah Bayam, Batur Gonenc Kanar, Alper Kepez, Taylan Akgun
There is limited data in the literature regarding the repolarization abnormalities in patients with idiopathic ventricular tachycardias. Ducceschi et al. reported presence of inhomogeneous prolongation of ventricular repolarization in patients with idiopathic ventricular tachycardias [11]. They found increase in the initial part of repolarization in association with a shorter terminal phase. In contrary, Sakabe et al. did not find any value of T-wave alternans or corrected QT-interval dispersion for identification of patients with idiopathic VT [12]. The authors claimed that repolarization inhomogenity might not affect the pathogenesis of idiopathic VT. Waller et al. reported that there was no significant difference in QT dispersion values between children with idiopathic VT or benign PVCs compared to control subjects [13].
Prevention of sudden unexpected death in epilepsy: current status and future perspectives
Published in Expert Review of Neurotherapeutics, 2020
Max Christian Pensel, Robert Daniel Nass, Erik Taubøll, Dag Aurlien, Rainer Surges
The majority of monitored SUDEP cases result from a primary postictal apnea followed by bradycardia and asystole within minutes after seizure termination [24]. In line with this finding, potentially arrhythmogenic ECG changes were observed in a minority of seizures only during conventional EMU recordings [61–64]. However, in about 0.4% of patients during video-EEG monitoring, ictal bradycardia and asystole occur, which was in all cases self-limiting and most probably due to activation of vasovagal reflex pathways or impaired balance between sympathetic and parasympathetic branches of the autonomic nervous system [65]. Since ictal bradyarrhythmias may lead to syncopes and falls, a treatment with cardiac pacer devices is recommended in these cases if full seizure control cannot be achieved [65–67]. A small and maybe underestimated portion of SUDEP cases is caused by peri-ictal ventricular arrhythmias, some in the context of a Takotsubo cardiomyopathy, as described in a number of case reports [68–73]. Ventricular tachycardias, in turn, are facilitated by abnormalities of cardiac repolarization (e.g. prolonged QT intervals, increased QT dispersion, increased T wave alternans) which are commonly found in people with chronic epilepsy [74,75]. Valid ECG predictors for an increased SUDEP risk, however, were not convincingly reported to date [63,76].
Combination of low blood pressure response, low exercise capacity and slow heart rate recovery during an exercise test significantly increases mortality risk
Published in Annals of Medicine, 2019
Kalle Sipilä, Antti Tikkakoski, Sanni Alanko, Atte Haarala, Jussi Hernesniemi, Leo-Pekka Lyytikäinen, Jari Viik, Terho Lehtimäki, Tuomo Nieminen, Kjell Nikus, Mika Kähönen
Previously, several authors have investigated different combinations of parameters derived from the clinical exercise test. Mora et al. showed from a large prospective study that the combination of slow HRR and low EC yielded a substantially higher risk for all-cause and CV mortality than either of the risk factors alone [29]. Similar results have been reported from our cohort [16]. The latter study added T-wave alternans measurements to HRR and EC data reaching even higher predictive value for mortality. Kiviniemi et al. found in their population of patients with stable coronary artery disease that a risk score including EC, HRR and maximal chronotropic response enhanced the power of an exercise test to predict CV mortality [17]. Indeed, the combination of low EC and slow HRR yielded the highest predictive value for any combination of two risk factors also in our study.