RESUMEN
Importance: Ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT) are the most treatable causes of out-of-hospital cardiac arrest (OHCA). Yet, it remains unknown if defibrillator pad position, placement in the anterior-posterior (AP) or anterior-lateral (AL) locations, impacts patient outcomes in VF or pVT OHCA. Objective: To determine the association between initial defibrillator pad placement position and OHCA outcomes for patients presenting with VF or pVT. Design, Setting, and Participants: This prospective cohort study included patients with OHCA and VF or pVT treated by a single North American emergency medical services (EMS) agency from July 1, 2019, through June 30, 2023. The study included patients with OHCA treated by a large suburban fire-based EMS agency that covers a population of 550â¯000. Consecutive patients with an initial EMS-assessed rhythm of VF or pVT receiving EMS defibrillation were included. Pediatric patients (younger than 18 years), interfacility transfers, arrests of obvious traumatic etiology, and patients with preexisting do-not-resuscitate status were excluded. Exposure: AP or AL pad placement. Main Outcomes and Measures: Return of spontaneous circulation (ROSC) at any time with secondary outcomes of pulses present at emergency department (ED) arrival, survival to hospital admission, survival to hospital discharge, and functional survival at hospital discharge (cerebral performance category score of 2 or less). Measures included adjusted odds ratios (aOR), multivariable logistic regressions, and Fine-Gray competing risks regression. Results: A total of 255 patients with OHCA were included (median [IQR] age, 66 [55-74] years; 63 females [24.7%]), with initial pad positioning documented as either AP (158 patients [62.0%]; median [IQR] age, 65 [54-74] years; 37 females [23.4%]) or AL (97 patients [38.0%]; median [IQR] age, 66 [57-74] years; 26 females [26.8%]). Patients with AP placement had higher adjusted odds ratio (aOR) of ROSC at any time (aOR, 2.64 [95% CI, 1.50-4.65]), but not significantly different odds of pulses present at ED arrival (1.34 [95% CI, 0.78-2.30]), survival to hospital admission (1.41 [0.82-2.43]), survival to hospital discharge (1.55 [95% CI, 0.83-2.90]), or functional survival at hospital discharge (1.86 [95% CI, 0.98-3.51]). Competing risk analysis found significantly greater cumulative incidence of ROSC among those at risk with initial AP placement compared with AL (subdistribution hazard ratio, 1.81 [95% CI, 1.23-2.67]; P = .003). Conclusions and Relevance: In this cohort study of patients with OHCA and VF or pVT, AP defibrillator pad placement was associated with higher ROSC compared with AL placement.
Asunto(s)
Desfibriladores , Paro Cardíaco Extrahospitalario , Humanos , Paro Cardíaco Extrahospitalario/terapia , Paro Cardíaco Extrahospitalario/mortalidad , Femenino , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Anciano , Desfibriladores/estadística & datos numéricos , Servicios Médicos de Urgencia/métodos , Servicios Médicos de Urgencia/estadística & datos numéricos , Fibrilación Ventricular/terapia , Resultado del Tratamiento , Cardioversión Eléctrica/estadística & datos numéricos , Cardioversión Eléctrica/métodos , Cardioversión Eléctrica/instrumentación , Taquicardia Ventricular/terapia , Reanimación Cardiopulmonar/métodosRESUMEN
The first symptoms of catecholaminergic polymorphic ventricular tachycardia (CPVT) usually occur in childhood and adolescence. 60% of patients experience syncope before the age of 40. Sudden cardiac death (SCD) is the first symptom of the disease in 30-50% of patients with CPVT. Early diagnosis is therefore crucial for the patient's prognosis. The diagnosis of CPVT is confirmed by a normal resting ECG, exclusion of structural heart disease, detection of bidirectional or polymorphic ventricular tachycardia (VT) in the stress ECG and/or detection of a pathogenic mutant in a gene associated with CPVT. Up to 60% of CPVT patients carry changes in the RYR2 gene. This gene encodes the cardiac ryanodine receptor, the most important Ca2+-releasing channel of the sarcoplasmic reticulum, which plays a central role in the contraction and relaxation of the heart muscle. If the function of the ryanodine receptor is impaired, too much calcium enters the cells, which triggers life-threatening arrhythmias. The overactive ryanodine receptor is therefore the main target for gene therapy methods. Even though the development of gene therapy is progressing, there is still no causal therapy available and it is all the more important to make a diagnosis as early as possible, which enables appropriate behavior and adequate symptomatic therapy. The decisive factor here is the evaluation of the genetic analysis in the context of the clinical findings. Based on this, recommendations can be made for preventive measures and the avoidance of specific triggers that could lead to life-threatening arrhythmias.
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Muerte Súbita Cardíaca , Canal Liberador de Calcio Receptor de Rianodina , Taquicardia Ventricular , Humanos , Taquicardia Ventricular/genética , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/terapia , Muerte Súbita Cardíaca/etiología , Muerte Súbita Cardíaca/prevención & control , Canal Liberador de Calcio Receptor de Rianodina/genética , Adolescente , Niño , Electrocardiografía , Adulto , Pronóstico , Adulto JovenRESUMEN
In this systematic review and meta-analysis, we aim to evaluate the efficacy and safety of catheter ablation as the first-line treatment of ventricular tachycardia (VT) in patients with structural heart disease (SHD) and preserved left ventricular ejection fraction (LVEF). Patients with SHD are particularly susceptible to VT, a condition that increases the risk of sudden cardiac death (SCD). Implantable cardioverter-defibrillators (ICDs) can terminate VT and prevent SCD but do not prevent VT recurrence. The efficacy and safety of CA as a first-line treatment in SHD patients with preserved LVEF remain unclear. We searched PubMed/Medline, EMBASE, Web of Science, and Cochrane CENTRAL for studies reporting the outcomes of CA therapy in patients with VT and preserved LVEF, published up to January 19, 2023. The primary outcome was the incidence of SCD following catheter ablation as the first-line treatment of VT in patients with SHD and preserved LVEF. Secondary outcomes included all-cause mortality, VT recurrence, procedural complications, CA success rate, and ICD implantation after catheter ablation. We included seven studies in the meta-analysis, encompassing a total of 920 patients. The pooled success rate of catheter ablation was 84.6% (95% CI 67.2-93.6). Complications occurred in 6.4% (95% CI 4.0-9.9) of patients, and 13.9% (95% CI 10.1-18.8) required ICD implantation after ablation. VT recurrence was observed in 23.2% (95% CI 14.8-34.6) of patients, while the rate of sudden cardiac death (SCD) was 3.1% (95% CI 1.7-5.6). The overall prevalence of all-cause mortality in this population was 5% (95% CI 1.8-13). CA appears promising as a first-line VT treatment in patients with SHD and preserved LVEF, especially for monomorphic hemodynamically tolerated VT. However, due to the lack of direct comparisons with ICDs and anti-arrhythmic drugs, further research is needed to confirm these findings.
Asunto(s)
Ablación por Catéter , Volumen Sistólico , Taquicardia Ventricular , Humanos , Ablación por Catéter/métodos , Muerte Súbita Cardíaca/prevención & control , Desfibriladores Implantables , Taquicardia Ventricular/etiología , Taquicardia Ventricular/fisiopatología , Taquicardia Ventricular/terapia , Resultado del Tratamiento , Función Ventricular Izquierda/fisiologíaRESUMEN
BACKGROUND: While the guidelines acknowledge the anticipated benefits of using an implantable cardioverter defibrillator (ICD) in individuals with catecholaminergic polymorphic ventricular tachycardia (CPVT). However, the potential adverse effects have received less attention. METHODS AND ANALYSIS: To address this issue comprehensively, we will explore various databases such as the Cochrane Library, Web of Science, EMBASE and PubMed. Our study will include CPVT patients, both with and without ICD implantation. Two researchers will evaluate the eligible studies independently and gather pertinent data. The quality of the studies included will be assessed using either the Newcastle-Ottawa Scale or the Cochrane Risk of Bias Tool. Data analysis will be conducted using RevMan. ETHICS AND DISSEMINATION: Because this research depends exclusively on existing studies, obtaining patient informed consent and ethics approval is unnecessary. The results of this meta-analysis will be shared at conferences or in peer-reviewed journals. PROSPERO REGISTRATION NUMBER: CRD42022370824.
Asunto(s)
Desfibriladores Implantables , Taquicardia Ventricular , Humanos , Proyectos de Investigación , Taquicardia Ventricular/terapia , Metaanálisis como Asunto , Revisiones Sistemáticas como AsuntoRESUMEN
The Anderson-Fabry disease (AFD) is a X-linked lysosomal storage disorder due to the deficiency in the α-galactosidase A enzyme. Cardiovascular mortality is a major cause of death in patients with AFD and sudden cardiac death (SCD) is one of the main causes of death. The storage of glycosphingolipid along with ionic channel impairment, inflammation and fibrosis are involved in the arrhythmogenesis. Some risk factors have been associated with ventricular tachycardia (VT)/ventricular fibrillation (VF) and SCD. Left ventricular hypertrophy (LVH), cardiac fibrosis, non-sustained VTs seem to be the most important. Older age and male gender might be associated with higher risk of ventricular arrhythmias and SCD. Currently, the implantable cardioverter-defibrillator (ICD) is recommended in patients with AFD who have survived a cardiac arrest secondary to VT/VF or who experienced sustained VT causing syncope or hemodynamic compromise, and have a life expectancy >1 year. ICD implantation is also recommended in patients considered to be at high risk (e.g., patients with severe LVH or fibrosis). The present review sought to summarize the risk of ventricular arrythmias in AFD, the indications for ICD, focusing on pathophysiology and analyzing the role of possible predictors of arrhythmias in preventing SCD, especially as primary prevention.
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Muerte Súbita Cardíaca , Enfermedad de Fabry , Prevención Primaria , Humanos , Enfermedad de Fabry/complicaciones , Muerte Súbita Cardíaca/prevención & control , Muerte Súbita Cardíaca/etiología , Prevención Primaria/métodos , Taquicardia Ventricular/etiología , Taquicardia Ventricular/terapia , Taquicardia Ventricular/prevención & control , Fibrilación Ventricular/prevención & control , Fibrilación Ventricular/etiología , Desfibriladores Implantables , Factores de RiesgoRESUMEN
ABSTRACT: The term "ventricular storm (VS)" is defined as the occurrence of two or more separate episodes of ventricular tachycardia or fibrillation (VT/VF) or three or more appropriate discharges of an implantable cardioverter defibrillator for VT/VF during a 24-h period. A patient in his early 40s was observed in the emergency department of our hospital and was admitted to the cardiac intensive care unit due to multiple episodes of VT. This led to the need for deep sedation with orotracheal intubation and mechanical ventilation. Intravenous lidocaine treatment was started; however, the patient had a recurrence of the episodes of VT. We decided to combine stellate ganglion block with epidural thoracic anesthesia. After the sympathetic block, there was no recurrence of the arrhythmic episodes. The patient was then transferred for ablation treatment. We demonstrated the efficacy of both techniques in managing a patient with multiple episodes of ventricular storm.
Asunto(s)
Anestesia Epidural , Bloqueo Nervioso Autónomo , Ganglio Estrellado , Taquicardia Ventricular , Humanos , Masculino , Bloqueo Nervioso Autónomo/métodos , Anestesia Epidural/métodos , Adulto , Taquicardia Ventricular/terapia , Fibrilación Ventricular/terapia , ElectrocardiografíaRESUMEN
ABSTRACT: We present a case of cardiogenic shock secondary to refractory polymorphic ventricular tachycardia associated with coronary ischemia resulting in cardiac arrest. Following the return of spontaneous circulation, the patient was cannulated for peripheral venoarterial extracorporeal membrane oxygenation (V-A ECMO) in anticipation of high-risk "protected" percutaneous coronary intervention (PCI). Under full V-A ECMO support, inotropes and vasopressors were weaned off, and the patient underwent uneventful PCI of left circumflex and obtuse marginal lesions. After 48 hours, the patient was decannulated and could be discharged home alive 16 days after his initial cardiac arrest.
Asunto(s)
Oxigenación por Membrana Extracorpórea , Paro Cardíaco , Intervención Coronaria Percutánea , Taquicardia Ventricular , Humanos , Oxigenación por Membrana Extracorpórea/métodos , Taquicardia Ventricular/terapia , Masculino , Intervención Coronaria Percutánea/métodos , Paro Cardíaco/terapia , Paro Cardíaco/etiología , Choque Cardiogénico/terapia , Choque Cardiogénico/etiología , Choque Cardiogénico/cirugía , Persona de Mediana EdadRESUMEN
ABSTRACT: An electrical storm (ES) refers to multiple occurrences of ventricular arrhythmias within a short time. Catheter ablation is a treatment option for ES but can be challenging in unstable cardiovascular patients. We present the case of a 50-year-old patient with poor left ventricular function who experienced ES after emergency coronary artery bypass grafting (CABG). Despite maximal antiarrhythmic therapy, the patient had recurrent ventricular tachycardia and fibrillation (VT/VF), hindering catheter ablation. Elective venoarterial extracorporeal membrane oxygenation (ECMO) support was established, allowing a successful second catheter ablation attempt without complications. The patient was weaned off ECMO the following day and remained in normal sinus rhythm.
Asunto(s)
Ablación por Catéter , Puente de Arteria Coronaria , Oxigenación por Membrana Extracorpórea , Taquicardia Ventricular , Humanos , Oxigenación por Membrana Extracorpórea/métodos , Persona de Mediana Edad , Ablación por Catéter/métodos , Taquicardia Ventricular/terapia , Masculino , Puente de Arteria Coronaria/métodos , Fibrilación Ventricular/terapia , Fibrilación Ventricular/etiología , Complicaciones Posoperatorias/terapia , Complicaciones Posoperatorias/prevención & controlRESUMEN
Patients with chronic kidney disease face a high risk of sudden cardiac death, particularly in more advanced stages of renal dysfunction. Ventricular arrhythmias are prevalent and contribute to the heightened cardiovascular mortality. This review aims to explore the intricate interplay of disease-specific risk factors, arrhythmic triggers, and electrolyte disorders that amplify susceptibility to ventricular arrhythmias and sudden cardiac death in this population and influence the efficacy of available treatments.
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Muerte Súbita Cardíaca , Insuficiencia Renal Crónica , Desequilibrio Hidroelectrolítico , Humanos , Desequilibrio Hidroelectrolítico/etiología , Desequilibrio Hidroelectrolítico/terapia , Desequilibrio Hidroelectrolítico/complicaciones , Desequilibrio Hidroelectrolítico/fisiopatología , Muerte Súbita Cardíaca/etiología , Muerte Súbita Cardíaca/prevención & control , Insuficiencia Renal Crónica/complicaciones , Taquicardia Ventricular/fisiopatología , Taquicardia Ventricular/etiología , Taquicardia Ventricular/terapia , Taquicardia Ventricular/complicaciones , Arritmias Cardíacas/etiología , Arritmias Cardíacas/fisiopatología , Arritmias Cardíacas/terapia , Medicina Basada en la Evidencia , Factores de Riesgo , Comorbilidad , Fibrilación Ventricular/etiología , Fibrilación Ventricular/fisiopatología , Fibrilación Ventricular/terapiaRESUMEN
Objective: To explore the role of mechanical hemodynamic support (MHS) in mapping and catheter ablation of patients with hemodynamically unstable ventricular tachycardia (VT), report single-center experience in a cohort of consecutive patients receiving VT ablation during MHS therapy, and provide evidence-based medical evidence for clinical practice. Methods: This was a retrospective cohort study. Patients with hemodynamically unstable VT who underwent catheter ablation with MHS at Beijing Anzhen Hospital, Capital Medical University between August 2021 and December 2023 were included. Patients were divided into rescue group and preventive group according to the purpose of treatment. Their demographic data, periprocedural details, and clinical outcomes were collected and analyzed. Results: A total of 15 patients with hemodynamically unstable VT were included (8 patients in the rescue group and 7 patients in the preventive group). The acute procedure was successful in all patients. One patient in the rescue group had surgical left ventricular assist device (LVAD) implantation, remaining 14 patients received extracorporeal membrane oxygenation (ECMO) for circulation support. ECMO decannulation was performed in 12 patients due to clinical and hemodynamic stability, of which 6 patients were decannulation immediately after surgery and the remaining patients were decannulation at 2.0 (2.5) d after surgery. Two patients in the rescue group died during the index admission due to refractory heart failure and cerebral hemorrhage. During a median follow-up of 30 d (1 d to 12 months), one patient with LVAD had one episode of ventricular fibrillation at 6 months after discharge, and no further episodes of ventricular fibrillation and/or VT occurred after treatment with antiarrhythmic drugs. No malignant ventricular arrhythmia occurred in the remaining 12 patients who were followed up. Conclusions: MHS contributes to the successful completion of mapping and catheter ablation in patients with hemodynamically unstable VT, providing desirable hemodynamic status for emergency and elective conditions.
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Ablación por Catéter , Hemodinámica , Taquicardia Ventricular , Humanos , Taquicardia Ventricular/cirugía , Taquicardia Ventricular/fisiopatología , Taquicardia Ventricular/terapia , Estudios Retrospectivos , Ablación por Catéter/métodos , Resultado del Tratamiento , Oxigenación por Membrana Extracorpórea/métodos , Corazón Auxiliar , Masculino , Femenino , Persona de Mediana EdadRESUMEN
Takotsubo syndrome (TTS), also known as stress-induced cardiomyopathy, is characterized by acute heart failure, reversible left ventricular dysfunction, and other complications such as life-threatening arrhythmias. The management of TTS is challenging due to its unpredictable clinical course and the lack of evidence-based treatment recommendations. In this case report, we present a 71-year-old female who developed TTS with ventricular tachycardia (VT) cardiac arrest following septic shock and an exploratory laparotomy for appendicitis. Despite the presence of VT cardiac arrest and a left ventricular ejection fraction of 30-35%, an implanted cardioverter-defibrillator (ICD) was not indicated due to the rapid and satisfactory recovery of the patient's ventricular function. This case highlights the importance of considering the clinical context and the transient nature of TTS in the decision-making process for ICD candidacy.
Asunto(s)
Desfibriladores Implantables , Paro Cardíaco , Cardiomiopatía de Takotsubo , Humanos , Cardiomiopatía de Takotsubo/terapia , Cardiomiopatía de Takotsubo/diagnóstico , Cardiomiopatía de Takotsubo/complicaciones , Femenino , Anciano , Paro Cardíaco/terapia , Paro Cardíaco/etiología , Taquicardia Ventricular/terapia , Taquicardia Ventricular/etiología , Taquicardia Ventricular/diagnósticoRESUMEN
We studied the respiratory activity of mitochondria in peripheral blood leukocytes from 36 patients with coronary heart disease (CHD) and a history of ventricular tachyarrhythmias required cardioverter-defibrillator implantation. The measurements were carried out in incubation buffers with different oxidation substrates (succinate and pyruvate-malate mixture). In pyruvate-malate incubation buffer, oxygen consumption rate and respiratory control coefficients in patients with triggered device did not differ significantly from those in patients without cardioverter-defibrillator triggering. At the same time, respiratory control coefficients were below the reference values. In succinate buffer, values of mitochondrial parameters were significantly lower in patients with triggered devices. Our findings indicate that mitochondria of patients with non-triggered cardioverters-defibrillators have better functional and metabolic plasticity. It was concluded that activity of respiratory processes in mitochondria could be an indicator that should be taken into the account when assessing the risk of developing ventricular tachyarrhythmias.
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Enfermedad Coronaria , Desfibriladores Implantables , Consumo de Oxígeno , Humanos , Masculino , Persona de Mediana Edad , Enfermedad Coronaria/fisiopatología , Enfermedad Coronaria/terapia , Consumo de Oxígeno/fisiología , Femenino , Mitocondrias/metabolismo , Anciano , Taquicardia Ventricular/fisiopatología , Taquicardia Ventricular/terapia , Ácido Pirúvico/metabolismo , Ácido Succínico/metabolismo , Malatos/metabolismo , Mitocondrias Cardíacas/metabolismoRESUMEN
Genetic arrhythmia disorders are rare diseases; however, they are a common cause of sudden cardiac death in children, adolescents, and young adults. In principle, a distinction can be made between channelopathies and cardiomyopathies in the context of genetic diseases. This paper focuses on the channelopathies long and short QT syndrome, Brugada syndrome, and catecholaminergic polymorphic ventricular tachycardia (CPVT). Early diagnosis of these diseases is essential, as drug therapy, behavioral measures, and if necessary, implantation of a cardioverter defibrillator can significantly improve the prognosis and quality of life of patients. This paper highlights the pathophysiological and genetic basis of these channelopathies, describes their clinical manifestations, and comments on the principles of diagnosis, risk stratification and therapy.
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Arritmias Cardíacas , Síndrome de Brugada , Canalopatías , Humanos , Arritmias Cardíacas/genética , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/terapia , Arritmias Cardíacas/fisiopatología , Canalopatías/genética , Canalopatías/diagnóstico , Canalopatías/terapia , Síndrome de Brugada/genética , Síndrome de Brugada/diagnóstico , Síndrome de Brugada/fisiopatología , Síndrome de Brugada/terapia , Taquicardia Ventricular/genética , Taquicardia Ventricular/terapia , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatología , Adolescente , Niño , Síndrome de QT Prolongado/genética , Síndrome de QT Prolongado/diagnóstico , Síndrome de QT Prolongado/terapia , Síndrome de QT Prolongado/fisiopatología , Muerte Súbita Cardíaca/prevención & control , Muerte Súbita Cardíaca/etiología , Adulto , Desfibriladores Implantables , ElectrocardiografíaRESUMEN
BACKGROUND: For many patients, sudden cardiac arrest (SCA) risk is elevated temporarily. Wearable cardioverter-defibrillators (WCDs) can monitor and treat SCA during these temporary periods. Traditional WCDs can be uncomfortable, require frequent maintenance, and cannot be used when showering, resulting in poor compliance and avoidable SCA deaths. The Jewel is a novel, water-resistant patch-wearable cardioverter-defibrillator (P-WCD) with a machine learning detection algorithm designed to improve compliance and protection against SCA. OBJECTIVES: This study aims to demonstrate the safety and clinical effectiveness of a novel P-WCD. METHODS: The Jewel IDE Study, a prospective, single-arm study conducted at 30 U.S. sites, enrolled patients at SCA risk due to ventricular tachycardia/ventricular fibrillation who were not candidates for or refused an implantable defibrillator. The primary safety endpoint was <15% patients with clinically significant cutaneous adverse device effects and the primary effectiveness endpoint was <2 inappropriate shocks/100 patient-months. Secondary endpoints were ≥1 successful ventricular tachycardia/ventricular fibrillation conversion and wear time compliance of >14.1 h/d. RESULTS: A total of 305 patients (mean age: 57.9 years; 30.2% female, 27.9% non-White) were enrolled, of which 290 had available device data. The clinically significant cutaneous adverse device effect rate was 2.30% (upper 1-sided 98% CI: 4.80); none were severe. No device-related deaths or serious adverse events were reported. The inappropriate shock rate was 0.36/100 patient-months (upper 1-sided 98% CI: 1.53). Of 11 shocks in 9 patients, 9 shocks were adjudicated to be appropriate. Eight of 9 shocks were successful with a single shock. Median wear time compliance was 23.5 (20.7-23.9) h/d. CONCLUSIONS: The novel P-WCD is a safe and effective WCD with high patient compliance. There were no deaths due to noncompliance and a high number of successful conversions (Jewel IDE study [A Clinical Evaluation of the Jewel P-WCD in Subjects at High Risk for Sudden Cardiac Arrest]; NCT05201495).
Asunto(s)
Muerte Súbita Cardíaca , Desfibriladores , Dispositivos Electrónicos Vestibles , Humanos , Muerte Súbita Cardíaca/prevención & control , Muerte Súbita Cardíaca/epidemiología , Muerte Súbita Cardíaca/etiología , Femenino , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Anciano , Taquicardia Ventricular/terapia , Fibrilación Ventricular/terapia , Diseño de Equipo , Adulto , Cooperación del PacienteRESUMEN
AIMS: Wearable cardioverter-defibrillators (WCDs) are indicated in patients at risk of sudden cardiac arrest who are not immediate candidates for implantable defibrillator therapy. Limitations of existing WCDs include poor compliance and high false alarm rates. The Jewel is a novel patch-WCD (P-WCD) that addresses these limitations with an adhesive-based design for near-continuous wear and a machine learning algorithm designed to minimize inappropriate detections. This was a first-in-human study of the Jewel P-WCD conducted in an electrophysiology (EP) lab to determine the safety and effectiveness of the device in terminating ventricular tachycardia/ventricular fibrillation (VT/VF) with a single shock. The aim was to evaluate the safety and effectiveness of terminating VT/VF with a single shock using the Jewel P-WCD. METHODS AND RESULTS: This was a first-in-human, prospective, single-arm, single-centre study in patients scheduled for an EP procedure in which VT/VF was expected to either spontaneously occur or be induced. The Jewel P-WCD was placed on consented patients; upon confirmation of VT/VF, a single shock (150 J) was delivered via the device. A group sequential design and Pocock alpha spending function was used to measure the observed proportion of successful VT/VF single-shock terminations. The endpoint was achieved if the lower confidence limit exceeded the performance goal of 62%, using a one-sided lower 97.4% exact confidence bound. Of 18 eligible subjects, 16 (88.9%, 97.4% confidence bound: 65.4%) were successfully defibrillated with a single shock, exceeding the primary endpoint performance goal with no adverse events. CONCLUSION: This first-in-human evaluation of the Jewel P-WCD demonstrated the safety and effectiveness of terminating VT/VF. CLINICAL TRIAL REGISTRATION: URL: https://clinicaltrials.gov/; Unique identifier: NCT05490459.
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Desfibriladores , Cardioversión Eléctrica , Taquicardia Ventricular , Fibrilación Ventricular , Dispositivos Electrónicos Vestibles , Humanos , Masculino , Femenino , Fibrilación Ventricular/terapia , Fibrilación Ventricular/diagnóstico , Cardioversión Eléctrica/instrumentación , Cardioversión Eléctrica/efectos adversos , Persona de Mediana Edad , Taquicardia Ventricular/terapia , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatología , Estudios Prospectivos , Resultado del Tratamiento , Anciano , Diseño de Equipo , Adulto , Muerte Súbita Cardíaca/prevención & controlAsunto(s)
Ablación por Catéter , Taquicardia Ventricular , Humanos , Taquicardia Ventricular/cirugía , Taquicardia Ventricular/fisiopatología , Taquicardia Ventricular/terapia , Ablación por Catéter/métodos , Resultado del Tratamiento , Catéteres Cardíacos , Masculino , Diseño de Equipo , Persona de Mediana Edad , FemeninoRESUMEN
BACKGROUND: Purkinje fibers play an important role in initiation and maintenance of ventricular fibrillation (VF) and polymorphic ventricular tachycardia (PMVT). Fascicular substrate modification (FSM) approaches have been suggested to treat recurrent VF in case reports and small case series. OBJECTIVES: The aim of this study was to investigate outcomes of catheter-based FSM to treat VF and PMVT. METHODS: Of 2,212 consecutive patients with ventricular arrhythmia undergoing catheter ablation, 18 (0.81%) underwent FSM of the Purkinje fibers as identified with high-density mapping during sinus rhythm. Fascicular substrate and VF initiation were mapped using a multipolar catheter. The endpoint of the ablation was noninducibility of VF and PMVT. In select patients, remapping revealed elimination of the targeted Purkinje potentials. Demographic, clinical, and follow-up characteristics were prospectively collected in our institutional database. RESULTS: A total of 18 patients (mean age 56 ± 3.8 years, 22% women) were included in the study. Of those, 11 (61.1%) had idiopathic VF, 3 (16.7%) had nonischemic cardiomyopathy, and 4 (22.2%) had mixed cardiomyopathy. The average left ventricular ejection fraction was 42.5%. At least 2 antiarrhythmic drugs had failed preablation. At baseline, all patients had inducible VF or PMVT. At the end of the procedure, no patient demonstrated new evidence of fascicular block or bundle branch block. There were no procedure-related complications. After a median follow-up period of 24 months, 16 patients (88.9%) were arrhythmia free on or off drugs: 11 of 11 patients (100%) with idiopathic VF vs 5 of 7 patients (71.4%) with underlying cardiomyopathy (P = 0.06). CONCLUSIONS: Catheter ablation of human VF and PMVT with FSM is feasible and safe and appears highly effective, with high rates of acute VF noninducibility and long-term freedom from recurrent VF.
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Ablación por Catéter , Ramos Subendocárdicos , Fibrilación Ventricular , Humanos , Fibrilación Ventricular/cirugía , Fibrilación Ventricular/terapia , Fibrilación Ventricular/fisiopatología , Femenino , Masculino , Persona de Mediana Edad , Ablación por Catéter/métodos , Ramos Subendocárdicos/fisiopatología , Ramos Subendocárdicos/cirugía , Taquicardia Ventricular/cirugía , Taquicardia Ventricular/fisiopatología , Taquicardia Ventricular/terapia , Resultado del Tratamiento , AncianoRESUMEN
Ventricular tachycardia (VT) is a rare but potentially fatal complication in pregnancy. We present a case of a pregnant woman with cardiomyopathy due to frequent premature ventricular complexes (PVCs) and VT originating from the left ventricular outflow tract. After presenting late in the third trimester, the decision was made to deliver the fetus after 4 days of medication titration due to continued sustained episodes of VT. After delivery, the patient continued to have frequent PVCs and VT several months after discharge, and she ultimately underwent a PVC ablation with dramatic reduction in PVC burden and improvement in cardiomyopathy. Multidisciplinary planning with a pregnancy heart team led to appropriate contingency planning and a successful delivery. This case highlights how multidisciplinary management is best practice in pregnancy complicated by VT and the need for better diagnostic guidelines for PVC-induced cardiomyopathy in the setting of pregnancy.