The use of implantable cardioverter defibrillator (ICD) in heart failure patients decreases the arrhythmic mortality with the cost of increasing the number of patients to be treated, and microvolt T-wave alternans (MTWA) testing can be used as a good criteria to better select the candidate for such a therapy. This ...

PURPOSE: Arrhythmias after an esophagectomy (most commonly atrial fibrillation) are a significant contributing factor to patient morbidity. However, the significance of an intraoperative arrhythmia is not completely understood. The aim of this retrospective study was to determine the occurrence and risk factors for developing intraoperative arrhythmias in patients undergoing an ...

INTRODUCTION: Idiopathic left ventricular tachycardia (VT) originating from the left posterior fascicle can be eliminated by ablation at sites with abnormal diastolic potentials (DPs) during sinus rhythm. We investigated whether such DPs can also be recorded in patients with structural heart disease and VT involving the left bundle-Purkinje system. METHODS ...

BACKGROUND: The impact of cardiac resynchronization therapy (CRT) on dispersion of repolarization is controversial. The benefit of CRT on sudden cardiac death has been demonstrated only after 3 years follow-up. OBJECTIVE: The purpose of this study was to explore the immediate effect of CRT on dispersion of repolarization and to ...

BACKGROUND: In patients with cardiac sarcoidosis, ventricular arrhythmias and/or conduction disturbances are frequently observed and sometimes fatal. However, few reports on disease activity and arrhythmic events in cardiac sarcoidosis are available. OBJECTIVE: The purpose of this study was to investigate the relationship between disease activity and arrhythmic events in cardiac ...

BACKGROUND: The outcomes of patients with ventricular assist devices (VADs) who undergo catheter ablation for ventricular tachycardia (VT) have not been reported. OBJECTIVE: The purpose of this study was to assess the feasibility, safety, and efficacy of endocardial VT ablation in patients with VADs. METHODS: We retrospectively reviewed three cases ...

STUDY OBJECTIVE: Routine ECG testing is recommended in the evaluation of syncope, although the value of such testing in young patients is unclear. For ECG testing, we assess the diagnostic yield (frequency that ECG identified the reason for syncope) and predictive accuracy for 14-day cardiac events after an episode of ...

AIMS: The aim of this study was to assess the frequency of vasovagal episodes over the day, week, month, and seasons. METHODS AND RESULTS: This study was part of the multi-centre International Study on Syncope of Uncertain Etiology-2 (ISSUE-2), which included patients, aged 30 years or older, with severe neurally ...

INTRODUCTION: We aim to evaluate the mortality benefit from defibrillator therapy in eligible elderly patients. Effective primary prevention of sudden cardiac death with implantable cardioverter defibrillators is well demonstrated in patients with coronary disease and depressed ventricular function. METHODS AND RESULTS: Among 1,232 patients enrolled with prior infarct and left ...

AIMS: We correlated the finding of cardioinhibitory carotid sinus hypersensitivity (CSH) with that observed during a spontaneous syncopal relapse by means of an implantable loop recorder (ILR). METHODS AND RESULTS: We included 18 consecutive patients with suspected recurrent neurally mediated syncope and positive cardioinhibitory response during carotid sinus massage (max ...

AIMS: This study assessed the prevalence and the prognostic impact of comorbidities in heart failure patients with implantatable cardioverter-defibrillator (ICD). METHODS AND RESULTS: We prospectively enrolled 146 patients with chronic heart failure, an ICD, and systolic dysfunction (mean ejection fraction 29 +/- 10%). Cardiac death was chosen as the primary ...

AIMS: Brugada syndrome (BS) is an ion channelopathy with the risk of sudden cardiac death. The role of programmed ventricular stimulation (PVS) in risk stratification has been controversially discussed. Therefore, we performed a meta-analysis on the prognostic role of PVS in BS. METHODS AND RESULTS: A Medline search until July ...

INTRODUCTION: There are several options to achieve a sufficient safety margin in a patient with a high defibrillation threshold (DFT), with varying and typically modest success. Programming fixed (millisecond) durations of both phases of a biphasic waveform in an implantable cardioverter defibrillator (ICD) has demonstrated utility. METHODS: We established an ...

OBJECTIVES: The aim of the study was to compare the diagnostic yield and the costs of implantable loop recorder (ILR) with those of the conventional strategy in patients with unexplained palpitations. BACKGROUND: In patients with unexplained palpitations, especially in those with infrequent symptoms, the conventional strategy, including short-term ambulatory electrocardiogram ...

Individuals with lupus anticoagulants (LA) are at risk for thromboembolism (TE). Chronic inflammation is an important characteristic in LA patients which may dispose for TE. Platelets play a key role in inflammation and TE. We therefore investigated gene polymorphisms as well as plasma levels of platelet receptors as predictors of ...

BACKGROUND: Microvolt T-wave alternans (TWA) have been accepted as a tool for assessing vulnerability to ventricular tachyarrhythmias. There is lack of data concerning prospective temporal variations in TWA measurements after acute myocardial infarction (AMI). We analysed the temporal patterns of TWA in post-AMI patients. METHODS AND RESULTS: TWA tests were ...

Alerting stimuli causing arousal have been shown to elicit a reproducible transient inhibition of muscle sympathetic nerve activity (MSNA) in healthy subjects. The aim of the present study was to test whether this inhibitory response to arousal is exaggerated in patients with a history of vasovagal syncope. We studied 24 ...

BACKGROUND: T-wave alternans (TWA) and electrophysiology study (EPS) are used for risk stratification for sudden death. OBJECTIVE: The purpose of the study was to determine the effect of bundle branch block or intraventricular conduction delay on TWA and EPS. METHODS: 386 patients with coronary artery disease, nonsustained ventricular tachycardia, and ...

INTRODUCTION: Continuous mobile cardiac outpatient telemetry (MCOT) may have several advantages over traditional ambulatory monitoring systems in the diagnostic evaluation of symptoms such as palpitations, dizziness, and syncope. However, only limited published data are available showing its advantages. METHODS AND RESULTS: We reviewed the records of 122 consecutive patients evaluated ...

BACKGROUND: As heart disease is increasingly recognized in women and as important studies have elucidated the benefit of implantable cardioverter defibrillators (ICDs) in patients with nonischemic cardiomyopathy (NICM), little is known regarding the effect of gender difference on arrhythmic risk in this population. We sought to determine if there are ...

BACKGROUND: Ventricular tachyarrhythmia is one of the most important factors determining the prognosis of patients with heart failure and sudden death can be observed even during stable therapy controlling clinical heart failure. In this study, the usefulness of electrophysiologic study (EPS) for the prediction of a future arrhythmic event was ...

OBJECTIVE: Several investigations have found that anxiety disorders often develop in patients with an implantable cardioverter-defibrillator (ICD). This study investigated the inter--and intraindividual stability of anxiety and its relation to ICD activity in patients with an ICD. METHODS: Changes in the psychopathology of 35 patients with an ICD were assessed ...

BACKGROUND: Some patients with Brugada syndrome experience an electrical storm of ventricular fibrillation (VF). OBJECTIVE: The purpose of this study was to investigate the clinical, laboratory, electrocardiographic, and electrophysiologic characteristics, acute and subsequent chronic treatment, and follow-up data of patients with Brugada syndrome associated with electrical storm of VF. METHODS: ...

AIMS: The implantable defibrillator (ICD) reduces arrhythmic and all-cause mortality in patients with a history of life-threatening ventricular arrhythmias. However, its effectiveness in elderly patients is uncertain, given their competing risk of non-arrhythmic death. METHODS AND RESULTS: Individual patient data from all three secondary prevention trials comparing the ICD to ...

INTRODUCTION: Detection of self-terminating arrhythmias by implantable cardioverter-defibrillators (ICDs) causes unnecessary battery depletion and unnecessary shocks. Our goal was to estimate the effect of the programmed number of intervals to detect (NID) ventricular fibrillation (VF) on ICD temporal episode rate, unnecessary shocks, and delay in detection of VF. METHODS AND ...

BACKGROUND: Amiodarone is a very effective antiarrhytmic drug. However its use may be accompanied by side effects. Hyperglobulinemia was not described in association with amiodarone treatment. MATERIALS AND METHODS: Fifteen patients, who developed hyperglobulinemia while on amiodarone therapy, were identified among the patients hospitalized in our hospital. Serum globulin concentration ...

Successful treatment of cough syncope depends on the correction of various pathogenetic mechanisms among different patients. The valsalva maneuver (VM), which elicits hemodynamic responses mimicking coughs, has potential for investigating the individual pathogenesis of cough syncope. Eighteen consecutive patients suffering from cough-induced syncope were examined. All patients were asked to ...

AIMS: To analyse the follow-up data of implantable cardioverter-defibrillator (ICD) therapy in Brugada syndrome (BS). METHODS AND RESULTS: We conducted a retrospective, single centre study of 47 patients (mean age: 44.5 +/- 15 years) with BS, who underwent primary prophylactic ICD implantation. All patients had baseline spontaneous (23 patients) or ...

BACKGROUND: The clinical manifestations of the Korean patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) are not well known. METHODS: The clinical data of Korean patients who met the Task Force Criteria for ARVC were analyzed. RESULTS: Thirty-seven patients (41.2+/-14.8 years old, 19 males) were diagnosed with ARVC. The commonest presenting ...

Brugada syndrome is an arrhythmogenic disease characterized by an ECG pattern of ST-segment elevation in the right precordial leads and an increase risk of sudden cardiac death. Risk stratification for the life-threatening arrhythmic events in Brugada syndrome is not yet established. In the present study, we report our experience in ...

Background: We have previously reported that the defibrillation success rate of intravenous nifekalant hydrochloride (NIF), a pure IKr-channel (IKr: the rapid components of the delayed rectifier potassium current) blocker, was more than 75% for lidocaine-resistant ventricular tachycardia and fibrillation (VT/VF) in patients with out-of-hospital cardiopulmonary arrest (CPA). However, there was ...

OBJECTIVE: Our aim was to identify sub-groups of right ventricular outflow tract morphology that would be suitable for percutaneous pulmonary valve implantation and to document their prevalence in our patient population. MATERIALS AND METHODS: Eighty-three consecutive patients with right ventricular outflow tract dysfunction (5-41 years, 76% tetralogy of Fallot) referred ...

The redesigned HeartMate II, an axial-flow left ventricular assist device, is simpler, smaller, and easier to operate than are pulsatile pumps. These design characteristics should make the HeartMate II more reliable and durable and broaden the eligible population base. We implanted the HeartMate II in 43 patients (average age, 42 ...

BACKGROUND: The efficacy of dual-chamber ICD arrhythmia classification algorithms is crucial to prevent inappropriate shocks. We report our experience from a meta-analysis of five prospective clinical studies with inclusion phases ranging between 1997 and 2003. METHODS: Dual-chamber ICD using standard dual-chamber arrhythmia classification algorithms were implanted in 802 patients (mean ...

BACKGROUND: The characteristic features of QRST integral mapping in the Brugada-type resting ECG of patients at a high risk for life-threatening ventricular arrhythmias were examined. METHODS AND RESULTS: QRST integral mapping was performed in 11 Brugada-type ECG patients with histories of aborted sudden death, spontaneous ventricular tachycardia and fibrillation (VT/VF) ...

BACKGROUND: Sudden death is common in end-stage renal disease (ESRD). Cardiac arrhythmia is observed frequently in patients with ESRD and is thought to be responsible for this high rate of sudden death. This study investigated the prevalence and the predictors of arrhythmia in patients on maintenance dialysis. METHODS: Ninety-four patients ...

OBJECTIVES: This study sought to assess whether implantable cardioverter-defibrillators (ICDs) have different mortality benefits among patients with ischemic cardiomyopathy who screen negative and non-negative (positive and indeterminate) for microvolt T-wave alternans (MTWA). BACKGROUND: Microvolt T-wave alternans has been proposed as an effective tool for risk stratification. However, no studies have ...

Nifekalant hydrochloride (NIF) is a novel intravenous class-III antiarrhythmic agent with a pirimidinedione structure that purely blocks the K+ channel without inhibiting beta-adrenergic receptors. The authors investigated the efficacy of NIF for refractory ventricular tachycardia/fibrillation (VT/VF). They studied 30 patients treated with an intravenous infusion of NIF [ 26 men, ...

OBJECTIVE: To describe the clinical course of a patient with multiple ICD shocks in the setting of advanced renal failure and hyperkalemia. METHODS: The patient was brought to the Electrophysiology Laboratory where the ICD was interrogated. RESULTS: The patient was found to be hyperkalemic (serum potassium 7.6 mg/dl). Analysis of ...

BACKGROUND: Syncope accounts for 5% of all hospital admissions. The etiology of syncope varies broadly, and nonselective, inpatient diagnostic evaluations to determine the cause of syncope are often inconclusive. We analyzed the yield of inpatient diagnostic tests for syncope, comparing patients with and without an initial suspected diagnosis of vasovagal ...

AIMS: For ablation of ventricular tachycardia (VT) in patients after myocardial infarction, a three-dimensional mapping system is often used. We report on our overall success rate of VT ablation using CARTO in 47 patients, with a subgroup analysis comparing VT mapping with the results of mapping that had to be ...

Flecainide is an antiarrhythmic considered safe in patients who have no structural cardiopathy, and frequently used in the prevention of atrial fibrillation. However, in patients with a history of infarction and/or severe conduction disorders, its proarrhythmicity may be lethal. Torsade-de-pointes type tachycardia is not included as one of these proarrhythmic ...

AIMS: To investigate outcome and complications of implantable cardioverter defibrillators (ICDs) in adults with congenital heart disease (CHD) and to identify predictors of (in-) appropriate shocks. METHODS AND RESULTS: Sixty-four CHD patients >/= 18 years at first ICD implantation [63% tetralogy of Fallot (TOF) and age at implantation 37 +/- ...

OBJECTIVES: The purpose of this study was to determine whether QRS duration or morphology increased the risk of adverse outcome in the DAVID (Dual Chamber and VVI Implantable Defibrillator) trial. BACKGROUND: The DAVID trial found an increased risk of the combined end point of death and new or worsening congestive ...

OBJECTIVES: The InSync ICD Registry evaluated patients indicated for cardiac resynchronization therapy with defibrillation. BACKGROUND: Cardiac resynchronization therapy with defibrillation systems are prescribed for both primary and secondary prevention of sudden cardiac death in patients with heart failure with both ischemic and nonischemic etiology. The characterization of ventricular tachyarrhythmias detected ...

This report illustrates the case of a patient with an implantable cardioverter defibrillator (ICD) who during physiotherapy with transcutaneous electrical stimulation of the lumbar musculature perceived a shock discharge by the ICD. Analysis of the stored electrogram showed inappropriate therapy due to electromagnetic interference with the external stimulation. Patients as ...

To determine the degree of neurocognitive dysfunction after placement of internal cardioverter defibrillators (ICD) and its relationship to the extent of neuronal injury, we studied 42 patients undergoing ICD (n = 21) or pacemaker (PM) insertion (control patients, n = 21). The Mini Mental State Examination, the Trailmaking A test ...

INTRODUCTION: Inappropriate implantable cardioverter defibrillator (ICD) therapy (IT) is a common complication in patients with ICD. IT is commonly triggered by supraventricular tachycardias (SVT). Dual chamber ICDs (D-ICDs) may distinguish SVT from ventricular tachycardia/ventricular fibrillation better than single chamber ICDs (S-ICDs) and may be associated with a smaller incidence of ...

Myotonic dystrophy type 1 (MD1) is the most common muscular dystrophy of adult life. Cardiac involvement is characterized by disorders of atrioventricular conduction, ventricular arrhythmias, and sudden death. Heart rate turbulence (HRT) is a noninvasive risk predictor in patients affected by ischemic heart disease. The aim of our study is ...

BACKGROUND: Unexplained syncope is a relatively frequent symptom, mostly caused by a neurocardiogenic reaction. The purpose of this study was to determine predictors of response to head-up tilt testing (HUTT) in patients with unexplained syncope or presyncope. METHODS: HUTT was done in 640 consecutive patients with unexplained syncope or presyncope ...