Arrhythmias in Hypertrophic Cardiomyopathy and Their Management
Srilakshmi M. Adhyapak, V. Rao Parachuri in Hypertrophic Cardiomyopathy, 2020
Other considerations are necessary prior to and after ICD implantation [2]. Patients need counseling regarding the complications of ICD, especially inappropriate shocks, as well as restrictions on driving, occupational, and other activities. Subcutaneous ICDs are now an alternative to transvenous systems in appropriate HCM patients without indications for pacing. Anti-tachycardia pacing may help terminating VT. The ICD’s VF shock zone should be set above 220/minute to prevent shocks from AF with rapid conduction. Device interrogation needs to be thorough, distinguishing supraventricular and ventricular arrhythmias, and may require device reprogramming. Options to consider in those with recurrent shocks and ventricular arrhythmias include beta-blockers, amiodarone, and electrophysiology study with catheter ablation as necessary.
Bradyarrhythmias and cardiac pacemakers in the elderly
Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich in Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
The diagnosis of SND requires documentation of sinus node pauses or sinus bradycardia. ECG and Holter monitor are useful for documentation when these episodes are frequent or persistent. Transient or reversible causes such as drug effect, especially beta-blockers, and electrolyte or endocrinologic abnormalities need to be excluded. An ambulatory event recorder or implantable loop recorder can be considered when clinical episodes are intermittent or infrequent. A treadmill or cycle exercise test is useful in evaluating the response of sinus rate to exercise. Invasive electrophysiology study is no longer routinely recommended for diagnosis of SND due to its low sensitivity and specificity. The inability to correlate symptoms to sinus node abnormalities induced by programmed stimulation is another limitation of electrophysiologic study for evaluation of SND.
Cardiovascular Disease
John S. Axford, Chris A. O'Callaghan in Medicine for Finals and Beyond, 2023
AVRT and AVNRT can usually be distinguished on the ECG, especially when the tachycardia of AVRT is conducted through the concealed pathway and retrogradely through the AV node (antidromic AVRT) where the QRS complexes are broad. If the tachycardia is in AF, then a characteristic broad complex tachycardia that is irregularly irregular develops (pre-excited AF). Both AVRT and AVNRT can be provoked by specific stimuli such as exertion, caffeinated drinks and alcohol. Treatment involves a cardiac electrophysiology study and ablation of the accessory pathway (in AVRT) or one arm of the dual AV node pathways (in AVNRT).
The challenges of an aging tetralogy of Fallot population
Published in Expert Review of Cardiovascular Therapy, 2021
Jennifer P. Woo, Doff B. McElhinney, George K. Lui
The utility of an electrophysiology study is in its ability to help risk stratify patients at intermediate risk for SCD. A large multicenter study demonstrated the significance of programmed ventricular stimulation in predicting future ventricular arrhythmias and SCD [82]. Eighty-nine percent of patients with negative EPS were event free from ventricular tachycardia at 10 years. Conversely, positive EPS with inducible monomorphic or polymorphic sustained ventricular tachycardia predicted future ventricular arrhythmias or SCD with an event-free survival rate of only 59% at 10 years. The positive and negative predictive values of programmed ventricular stimulation were 67% and 86%, respectively. Therefore, a negative EPS in an intermediate risk patient allows us to recategorize the patient to low risk, while a positive EPS would reclassify the patient to high risk.
Insertable cardiac monitors: current indications and devices
Published in Expert Review of Medical Devices, 2019
Rafi Sakhi, Dominic A.M.J. Theuns, Tamas Szili-Torok, Sing-Chien Yap
In patients with infrequent episodes of palpitations short-term ambulatory ECG monitoring is usually insufficient. In the RUP study, 50 patients with infrequent (≤1 episode per month), sustained (>1 min) palpitations and initial negative diagnostic workup were randomized to conventional strategy (24-h Holter recording, a 4-week period of ambulatory ECG monitoring with an external recorder, and electrophysiology study) or to an ICM (Reveal Plus, Medtronic) with 1-year monitoring [54]. The diagnostic yield was higher in the ICM group (73% versus 21%, p < 0.001). Palpitations were completely eliminated in the patients with an arrhythmic diagnosis using ablation, pacemaker, or drugs. Furthermore, the overall cost per diagnosis in the ICM group was lower compared to the conventional strategy group. There is a class IIa indication for an ICM in selected patients with severe infrequent symptoms when other ECG monitoring systems fail to document the underlying cause [55].
Leadless Micra pacemaker implantation in patient with previous Senning procedure for dextro-transposition of the great arteries
Published in Acta Cardiologica, 2023
Daniel Lancini, Corey Smith, Osama Elkhateeb, John Sapp, Ratika Parkash
As an adult, he developed multiple supraventricular tachyarrhythmias, including AV nodal re-entry tachycardia (AVNRT) treated with slow pathway ablation in 2010. This was performed retrogradely via a transaortic route to his subsystemic morphologic right ventricle. He later developed recurrent atrial flutter, with an electrophysiology study in 2011 suggesting an in-circuit response from both the inferior vena caval (IVC) and ventricular end of his cavo-tricuspid isthmus (CTI). CTI ablation was achieved from a combined retrograde aortic trans-tricuspid approach for the ventricular end of his CTI, and venous approach for the IVC end of his CTI. Recurrent atrial flutter in 2018 was managed with mapping and ablation of critical components within both the subpulmonic and subsystemic atrial compartments (via trans-baffle puncture).
Related Knowledge Centers
- Accessory Pathway
- Arrhythmia
- Cardiac Electrophysiology
- Catheter Ablation
- Vein
- Sinus Rhythm
- Heart
- Artery
- Minimally Invasive Procedure
- Catheter