Evaluation of the Severity of Ventricular Rhythm Disturbances: Value of Electrophysiological Testing and Recording of Late Potentials
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Sudden Death
Fibrillation
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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.
Asystole
Pulseless electrical activity
Fibrillation
Sudden cardiac arrest
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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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Background: The potential benefits of implantable cardioverter-defibrillator (ICD) therapy in patients with sudden cardiac death (SCD) treated with therapeutic hypothermia (TH) have not been well studied. Methods: Incidence of recurrent non-sustained ventricular arrhythmia, ICD therapy, and death were ascertained in 64 consecutive survivors of SCD due to ventricular fibrillation or tachycardia, who were treated with TH. Follow-up was 31.5 +/- 3.3 months in 41 ICD recipients and 36.3 +/- 3.9 months in 23 patients who did not receive an ICD due to the presence of a reversible cause of cardiac arrest, an acute myocardial infarction in 87%. Results: Combined incidence of ventricular arrhythmia, ICD therapy, or death in patients who underwent ICD placement (21.9%) were similar to overall mortality in the patients who did not receive an ICD (21.7%, p = 0.752). ICD placement was associated with a significant mortality benefit; 95.1% survival in ICD recipients vs. 78.3% in the no-ICD group (p = 0.038). Electrocardiographic findings of ST segment elevation on admission were associated with increased event rate in ICD recipients (p = 0.039) and increased mortality in SCD patients who did not receive an ICD (p < 0.001). Other studied variables had no significant effect on the investigated outcomes. Conclusions: SCD survivors treated with TH are at increased risk for recurrent arrhythmic events and derive significant mortality benefit from ICD implantation. Increased mortality in revascularized SCD patients with acute coronary syndrome, thought to have a reversible cause of cardiac arrest, calls for prospective trials investigating utility of ICD in this vulnerable patient population.
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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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