Gender differences in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy: Clinical manifestations, electrophysiological properties, substrate characteristics, and prognosis of radiofrequency catheter ablation
Chin‐Yu LinFa‐Po ChungYenn‐Jiang LinShih‐Lin ChangLi‐Wei LoYu‐Feng HuTa‐Chuan TuanTze‐Fan ChaoJo‐Nan LiaoYao-Ting ChangYun‐Yu ChenRohit WaliaAbigail Louise D. TeShinya YamadaShih‐Ann Chen
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Gender differences in the penetrance and clinical expression of genetic mutations have been reported in patients with arrhythmogenic right ventricular (RV) dysplasia/cardiomyopathy (ARVD/C). Our study aimed at clarifying the impact of gender on ventricular substrates and clinical outcomes after radiofrequency catheter ablation (RFCA).Patients with ARVD/C underwent RFCA for drug-refractory ventricular arrhythmias (VAs) were consecutively enrolled. Baseline characteristics, electrocardiograms, ventricular substrates, and VA recurrences after RFCA were extracted for comparison between genders.A total of 70 consecutive unselected patients with definite ARVD/C (36 men [51%], age 45±14years) were studied. Male patients had a higher incidence of sustained ventricular tachycardia and ventricular fibrillation or sudden cardiac arrest as initial manifestations. Electroanatomical mapping demonstrated that men with ARVD/C had a larger epicardial RV unipolar low-voltage zone, a larger endocardial and epicardial area with late potentials, and longer local abnormal ventricular activity. Cox regression analysis demonstrated that gender and late potential area predicted the recurrences of VAs.Patients with ARVD/C displayed different characteristics of VAs and substrate properties between men and women. Male gender and the presence of larger area of abnormal electrograms independently predicted VA recurrences after RFCA.Fibrillation
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Objectives To investigate the relationship between ventricular tachycardia(VT) and ventricular late potential(VLP) in patients with arrhythmogenic right ventricular dysplasia /cardiomyopathy(ARVD /C).Methods Patients with ARVD/C,aged(35±15) years,including 28 men and 10 women,were received signal-averaged electrocardiography to record total QRS duration(QRST),low potential terminal signals(LPS40),root mean square of the last 40 ms(RMS40) and 24 h-Holter monitoring for recording VT and premature ventricular complex.Results 1.Among 25 patients with VLP,eighteen suffered from VT;while 13 patients without VLP,only three suffered from VT,P =0.004.2.In the 21 patients with VT and 17 patients without VT,QRST was from 109 ms to 233 ms(M=147) and from 85 ms to 158 ms(M=104 ms),P=0.000;LPS40 was from 15 ms to 158 ms(M=53 ms) and from 6 ms to 63 ms(M=27 ms),P=0.001;RMS40 was from 1.6 μV to 6.0 μV(M=7.6μV) and from 8.2 μV to 163 μV(M=28 μV),P=0.000,respectively.Conclusions The VLP may be valuable to forecast the risk of ARVD /C.
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Development of ventricular fibrillation or pulseless ventricular tachycardia after an initial rhythm of pulseless electrical activity or asystole is associated with significantly increased cardiac arrest mortality.To examine differences in epinephrine administration during cardiac arrest between patients who had a secondary ventricular fibrillation or ventricular tachycardia develop and patients who did not.Data were collected for 2 groups of patients with in-hospital cardiac arrest and an initial rhythm of pulseless electrical activity or asystole: those who had a secondary ventricular fibrillation or ventricular tachycardia develop (cases) and those who did not (controls). Dosing of epinephrine during cardiac arrest and other variables were compared between cases and controls.Of the 215 patients identified with an initial rhythm of pulseless electrical activity or asystole, 51 (23.7%) had a secondary ventricular fibrillation or ventricular tachycardia develop. Throughout the total duration of arrest, including periods of return of spontaneous circulation, the dosing interval for epinephrine in patients who had a secondary ventricular fibrillation or ventricular tachycardia develop was 1 mg every 3.4 minutes compared with 1 mg every 5 minutes in controls (P= .001). For the total duration of pulselessness, excluding periods of return of spontaneous circulation during the arrest, the dosing interval for epinephrine in patients who had a secondary ventricular fibrillation or ventricular tachycardia develop was 1 mg every 3.1 minutes versus 1 mg every 4.3 minutes in controls (P= .001).More frequent administration of epinephrine during cardiac arrest is associated with development of secondary ventricular fibrillation or ventricular tachycardia.
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Recent studies have been performed on feature selection for diagnostics between non-ventricular rhythms and ventricular arrhythmias, or between non-ventricular fibrillation and ventricular fibrillation. However they did not assess classification directly between non-ventricular rhythms, ventricular tachycardia and ventricular fibrillation, which is important in both a clinical setting and preclinical drug discovery. In this study it is shown that in a direct multiclass setting, the selected features from these studies are not capable at differentiating between ventricular tachycardia and ventricular fibrillation. A high dimensional feature space, Fourier magnitude spectra, is proposed for classification, in combination with the structured prediction method conditional random fields. An improvement in overall accuracy, and sensitivity of every category under investigation is achieved.
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Objective To report the clinical oberservation of 50 patients with implantable cardioverter defibrillator(ICD).Methods Observe the patients with ICD from May,1998 to Nov.2005.Results There were more than a thousand episodes of ventricular tachycardia ventricular fibrillation(VT/VF) detected and terminated by ICD devices.Conclusions ICD with tiered therapy function has high efficacy on the termination of ventricular tachyarrhythmias.It is important to follow up the patients and dynamically optimize the system of ICD.
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Implantable cardioverter defibrillators (ICD) are usually implanted in patients with malignant ventricular tachyarrhytmias. Aim of this study was to investigate the recurrence of minor ventricular arrhythmias to predict the occurrence of ventricular fibrillation episodes in patients with ICD. The study design was a retrospective analysis of 237 patients, whose ICD was programmed to deliver electrical therapy only for ventricular fibrillation (VF) but not for ventricular tachycardia (VT). We calculated the number, the mean duration and the mean ventricular cycle of the non-sustained ventricular tachyarrhythmias (NST) and of the sustained ventricular tachyarrhythmias (ST). We found that VF patients had a significant higher incidence of ventricular tachycardia compared to the no-VF patients.In addition, the mean VT episodes duration was higher in patients of the VF group than in patients free from ventricular fibrillation and the ventricular cycle length resulted to be significantly shorter in VF patients.
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The implications of ventricular fibrillation induced during elect rophysiologic testing are unclear. To determine the profile of patients in whom this arrhythmia occurs and to determine whether it has any prognostic value, follow‐up data were obtained on all patients in whom this arrhythmia was in duced in our laboratory during a ventricular stimulation protocol over an 18‐month period. Of 836 patients tested, 29 (27 men and 2 women) had inducible ventricular fibrillation. Most (52%) had coronary disease and 12 (41%) had suffered a prior myocardial infarction. All but 3 had some form of heart disease. Sixteen (55%) had abnormal left ventricular function. Eleven (38%) presented with spontaneous sustained ventricular tachycardia or ventricular fibrillation. Eight others had a history of nonsustained ventricular tachycardia.Follow‐up was obtained for a mean of 12 months. In spite of therapy, 2 patients died an arrhythmic death, 1 was resuscitated from ventricular fibrillation, 1 had spontaneous sustained ventricular tachycardia, 4 had inducible sustained ventricular tachycardia, 2 continued to have inducible ventricular fibrillation at second study, and 1 had recurrent syncope. Five patients had ventricular fibrillation induced on multiple occasions. Ventricular fibrillation induced during electraphysiologic study was found primarily in patients with structural heart disease and appeared reasonably reproducible. When reproducible, ventricular fibrillation appears to indicate a poor prognosis rather than an aspecific finding. The clinical profile of our poor prognosis group includes a history of prior ventricular tachycardia or ventricular fibrillation and the presence of coronary artery disease.
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