RESUMO
BACKGROUND: Pulsed-field ablation (PFA) is a cutting-edge technique that employs non-thermal energy to cause cell death by inducing irreversible electroporation of cell membranes. This systematic review evaluates the PFA effectiveness as a potential alternative to radiofrequency and cryo-ablation for treating ventricular tachycardia. METHODS: PubMed, Embase, Scopus, and Web of Science were systematically searched using keywords related to ventricular tachycardia and pulsed-field ablation. Eligible Studies evaluating this therapeutic approach for ventricular tachycardia were included in the final analysis. RESULTS: We included six studies (five case reports and one case series) in our systematic review. Eight (88.8%) of procedures were successful with 100% long-term efficacy. No procedural complications or ventricular tachycardia (VT) recurrence were observed in the cases. CONCLUSION: The absence of complications, high effectiveness, and long-term success rate make PFAs a good VT treatment option. However, PFA safety and efficacy studies for VT treatment are scarce. Thus, larger investigations on this topic are urgently needed.
Assuntos
Taquicardia Ventricular , Humanos , Taquicardia Ventricular/cirurgia , Taquicardia Ventricular/terapia , Taquicardia Ventricular/fisiopatologia , Resultado do Tratamento , Ablação por Cateter/métodos , Pessoa de Meia-Idade , Masculino , FemininoRESUMO
BACKGROUND: Cardiac fibromas are extremely rare in adults. The preferred treatment is surgical resection, but antiarrhythmic medications or heart transplantation have also been used previously. The cardiac imaging, particularly MRI, can be useful to help delineate between primary cardiac tumors, and surgical factors such as the extent/size of the fibroma, involvement of the coronary arteries or mitral apparatus and amount of residual myocardium influence whether surgical resection is feasible. CASE PRESENTATION: A 42-year-old male presented with a wide-complex tachycardia, unresponsive to amiodarone. An echocardiogram was performed which showed a possible posterior wall mass. A cardiac MRI showed a well circumscribed lateral wall intracardiac fibroma, measuring 5.2 × 5.1 × 3.8 cm with preserved function. Surgical resection was successful, and he was discharged without a defibrillator. CONCLUSIONS: Cardiac fibromas are encapsulated tumors which do not infiltrate myocardium and should be surgically resected if possible.
Assuntos
Fibroma , Neoplasias Cardíacas , Taquicardia Ventricular , Humanos , Masculino , Adulto , Neoplasias Cardíacas/cirurgia , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/diagnóstico por imagem , Fibroma/cirurgia , Fibroma/complicações , Taquicardia Ventricular/cirurgia , Taquicardia Ventricular/etiologia , Imageamento por Ressonância Magnética , EcocardiografiaAssuntos
Ablação por Cateter , Taquicardia Ventricular , Complexos Ventriculares Prematuros , Humanos , Complexos Ventriculares Prematuros/cirurgia , Complexos Ventriculares Prematuros/fisiopatologia , Complexos Ventriculares Prematuros/diagnóstico , Ablação por Cateter/métodos , Taquicardia Ventricular/cirurgia , Taquicardia Ventricular/fisiopatologia , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiologia , Eletrocardiografia , Resultado do Tratamento , Sistema de Condução Cardíaco/fisiopatologia , Sistema de Condução Cardíaco/cirurgiaRESUMO
AIMS: The decisions about placing an ICD in a child are more difficult than in an adult due to longer expected lifespan and the complication risk. Young patients gain the most years from ICDs, despite higher risk of device-related complications. The secondary prevention ICD indication is clear, and device is implanted regardless of potential complications. For primary prevention, risk of sudden cardiac death and complications need to be evaluated. We aimed to compare outcomes for primary and secondary prevention ICDs. METHODS AND RESULTS: Retrospective nationwide cohort study including paediatric patients identified from the Danish ICD registry with ICD implanted at an age ≤ 15 from 1982-21. Demographics, complications (composite of device-related infections or lead-failure requiring re-operation, mortality because of arrhythmia, or unknown cause), and mortality were retrieved from medical charts. Endpoint was appropriate therapy (shock or anti-tachycardia pacing for ventricular tachycardia or fibrillation). Of 72 receiving an ICD, the majority had channelopathies (n = 34) or structural heart diseases (n = 28). ICDs were implanted in 23 patients for primary prevention and 49 for secondary prevention, at median ages of 13.8 and 11.6 years (P-value 0.01), respectively. Median follow-up was 9.0 (interquartile ranges: 4.7-13.5) years. The 10-year cumulative incidence of first appropriate therapy was 70%, with complication and inappropriate therapy rates at 41% and 15%, respectively. No difference was observed between prevention groups for all outcomes. Six patients died during follow-up. CONCLUSION: In children, two-thirds are secondary prevention ICDs. Children have higher appropriate therapy and complication rates than adults, while the inappropriate therapy rate was low.
Assuntos
Morte Súbita Cardíaca , Desfibriladores Implantáveis , Prevenção Primária , Sistema de Registros , Prevenção Secundária , Humanos , Masculino , Criança , Estudos Retrospectivos , Prevenção Secundária/métodos , Adolescente , Feminino , Morte Súbita Cardíaca/prevenção & controle , Morte Súbita Cardíaca/epidemiologia , Dinamarca/epidemiologia , Resultado do Tratamento , Cardioversão Elétrica/instrumentação , Cardioversão Elétrica/efeitos adversos , Cardioversão Elétrica/mortalidade , Fatores de Risco , Pré-Escolar , Taquicardia Ventricular/terapia , Taquicardia Ventricular/prevenção & controle , Taquicardia Ventricular/mortalidade , Fatores de Tempo , Fatores Etários , Arritmias Cardíacas/terapia , Arritmias Cardíacas/mortalidade , Fibrilação Ventricular/prevenção & controle , Fibrilação Ventricular/terapia , Fibrilação Ventricular/mortalidade , Medição de RiscoRESUMO
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a family inherited cardiomyopathy associated with ventricular arrhythmias. With the development of molecular biology, histology, imaging, and other diagnostic techniques, the diagnosis rate and incidence of ARVC have gradually increased. However, ARVC remains rare in clinical practice. Currently, the diagnosis and management of ARVC is far from satisfactory in clinical practice. In the case report, we described a clinical case of radiofrequency ablation guided by voltage mapping and right ventriculography in the treatment of ARVC with ventricular tachycardia and discussed the relevant literatures.
Assuntos
Displasia Arritmogênica Ventricular Direita , Ablação por Cateter , Taquicardia Ventricular , Humanos , Displasia Arritmogênica Ventricular Direita/cirurgia , Displasia Arritmogênica Ventricular Direita/complicações , Displasia Arritmogênica Ventricular Direita/diagnóstico , Displasia Arritmogênica Ventricular Direita/diagnóstico por imagem , Taquicardia Ventricular/cirurgia , Taquicardia Ventricular/fisiopatologia , Ablação por Cateter/métodos , Masculino , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Eletrocardiografia , AdultoRESUMO
Isolated cardiac sarcoidosis (iCS) is increasingly recognized; however, its prognosis and the efficacy of immunosuppressive therapy remain undetermined. We aimed to compare the prognosis of iCS and systemic sarcoidosis including cardiac involvement (sCS) under immunosuppressive therapy.We retrospectively reviewed the clinical data of 42 patients with sCS and 30 patients with iCS diagnosed at Kyushu University Hospital from 2004 through 2022. We compared the characteristics and the rate of adverse cardiac events including cardiac death, fatal ventricular tachyarrhythmia, and heart failure hospitalization between the 2 groups. The median follow-up time was 1535 [interquartile range, 630-2555] days, without a significant difference between the groups. There were no significant differences in gender, NYHA class, or left ventricular ejection fraction. Immunosuppressive agents were administered in 86% of sCS and in 73% of iCS patients (P = 0.191). When analyzed only with patients receiving immunosuppressive therapy (sCS, n = 36; iCS, n = 21), the cardiac event-free survival was significantly lower in iCS than sCS (37% versus 79%, P = 0.002). Myocardial LGE content at the initial diagnosis was comparable in both groups. The disease activity was serially evaluated in 26 sCS and 16 iCS patients by quantitative measures of FDG-PET including cardiac metabolic volume and total lesion glycolysis, representing 3-dimensional distribution and intensity of inflammation in the entire heart. Although iCS patients had lower baseline disease activity than sCS patients, immunosuppressive therapy did not attenuate disease activity in iCS in contrast to sCS.iCS showed a poorer response to immunosuppressive therapy and a worse cardiac prognosis compared to sCS despite lower baseline disease activity.
Assuntos
Cardiomiopatias , Imunossupressores , Sarcoidose , Humanos , Masculino , Feminino , Sarcoidose/tratamento farmacológico , Sarcoidose/complicações , Pessoa de Meia-Idade , Cardiomiopatias/tratamento farmacológico , Cardiomiopatias/fisiopatologia , Estudos Retrospectivos , Imunossupressores/uso terapêutico , Idoso , Prognóstico , Adulto , Tomografia por Emissão de Pósitrons/métodos , Taquicardia Ventricular/tratamento farmacológicoRESUMO
BACKGROUND: Stereotactic arrhythmia radioablation (STAR) is a therapeutic option for ventricular tachycardia (VT) where catheter-based ablation is not feasible or has previously failed. Target definition and its transfer from electro-anatomic maps (EAM) to radiotherapy treatment planning systems (TPS) is challenging and operator-dependent. Software solutions have been developed to register EAM with cardiac CT and semi-automatically transfer 2D target surface data into 3D CT volume coordinates. Results of a cross-validation study of two conceptually different software solutions using data from the RAVENTA trial (NCT03867747) are reported. METHODS: Clinical Target Volumes (CTVs) were created from target regions delineated on EAM using two conceptually different approaches by separate investigators on data of 10 patients, blinded to each other's results. Targets were transferred using 3D-3D registration and 2D-3D registration, respectively. The resulting CTVs were compared in a core-lab using two complementary analysis software packages for structure similarity and geometric characteristics. RESULTS: Volumes and surface areas of the CTVs created by both methods were comparable: 14.88 ± 11.72 ml versus 15.15 ± 11.35 ml and 44.29 ± 33.63 cm2 versus 46.43 ± 35.13 cm2. The Dice-coefficient was 0.84 ± 0.04; median surface-distance and Hausdorff-distance were 0.53 ± 0.37 mm and 6.91 ± 2.26 mm, respectively. The 3D-center-of-mass difference was 3.62 ± 0.99 mm. Geometrical volume similarity was 0.94 ± 0.05 %. CONCLUSION: The STAR targets transferred from EAM to TPS using both software solutions resulted in nearly identical 3D structures. Both solutions can be used for QA (quality assurance) and EAM-to-TPS transfer of STAR-targets. Semi-automated methods could potentially help to avoid mistargeting in STAR and offer standardized workflows for methodically harmonized treatments.
Assuntos
Radiocirurgia , Planejamento da Radioterapia Assistida por Computador , Humanos , Planejamento da Radioterapia Assistida por Computador/métodos , Radiocirurgia/métodos , Taquicardia Ventricular/radioterapia , Taquicardia Ventricular/diagnóstico por imagem , Software , Tomografia Computadorizada por Raios X , Imageamento Tridimensional , Masculino , Feminino , Reprodutibilidade dos TestesAssuntos
Morte Súbita Cardíaca , Países em Desenvolvimento , Domperidona , Humanos , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/etiologia , Domperidona/uso terapêutico , Domperidona/efeitos adversos , Idoso , Arritmias Cardíacas/epidemiologia , Taquicardia Ventricular , Antieméticos/uso terapêutico , Masculino , Paquistão/epidemiologia , FemininoRESUMO
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.
Assuntos
Desfibriladores , Parada Cardíaca Extra-Hospitalar , Humanos , Parada Cardíaca Extra-Hospitalar/terapia , Parada Cardíaca Extra-Hospitalar/mortalidade , Feminino , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Idoso , Desfibriladores/estatística & dados numéricos , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/estatística & dados numéricos , Fibrilação Ventricular/terapia , Resultado do Tratamento , Cardioversão Elétrica/estatística & dados numéricos , Cardioversão Elétrica/métodos , Cardioversão Elétrica/instrumentação , Taquicardia Ventricular/terapia , Reanimação Cardiopulmonar/métodosRESUMO
Ventricular arrhythmias are commonly associated with hypertrophic cardiomyopathy with and without midventricular obstruction. Although the overall prognosis is relatively good with an annual mortality rate <1%, the propensity to potentially fatal ventricular arrhythmias (ventricular tachycardia) is the most feared complication. Electrical storms are a severe manifestation of ventricular arrhythmias, with poor outcomes. In this report, we present a case of a young patient with non-obstructive hypertrophic cardiomyopathy who presents after a syncopal episode and is found to have an electric storm that is refractory to medical therapy.
Assuntos
Cardiomiopatia Hipertrófica , Eletrocardiografia , Complexos Ventriculares Prematuros , Humanos , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/fisiopatologia , Complexos Ventriculares Prematuros/etiologia , Complexos Ventriculares Prematuros/complicações , Complexos Ventriculares Prematuros/fisiopatologia , Masculino , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/terapia , Síncope/etiologia , Adulto , Desfibriladores ImplantáveisRESUMO
BACKGROUND: Sustained ventricular tachycardia (VT) in cardiac amyloidosis is uncommon, and the substrate and outcomes of catheter ablation are not defined. METHODS: We included 22 consecutive patients (mean age, 68±10 years; male sex, 91%) with cardiac amyloidosis (ATTR [transthyretin], n=16; light chain, n=6) undergoing catheter ablation for VT/ventricular fibrillation (VF) between 2013 and 2023 in a retrospective, observational, international study. The primary efficacy outcome was recurrent VT/VF during follow-up, while the primary safety end point included major procedure-related adverse events. RESULTS: The indication for ablation was drug-refractory VT in 17 patients (77%), and premature ventricular complex-initiated polymorphic VT/VF in 5 patients (23%). Catheter ablation was performed using endocardial (n=17.77%) or endo-epicardial approaches (n=5.23%). Complete endocardial electroanatomical voltage maps of the left and right ventricles were obtained in 17 (77%) and 10 (45%) patients, respectively. Each patient had evidence of low-voltage areas, most commonly involving the interventricular septum (n=16); late potentials were recorded in 16 patients (73%). A median of 1 (1-2) VT was inducible per patient; 12 of the 26 mappable VTs (46%) originated from the interventricular septum. Complete procedural success was achieved in 16 patients (73%), with 4 (18%) major procedure-related adverse events. After a median follow-up of 32 (14-42) months, sustained VT/VF recurrence was observed in 9 patients (41%); survival free from VT/VF recurrence was 56% (95% CI, 36%-86%) at 36-month follow-up, and most patients remained on antiarrhythmic drugs. A significant reduction in per patient implantable cardioverter defibrillator therapies was noted in the 6-month period after ablation (before: 6 [4-9] versus after: 0 [0-0]; P<0.001). In multivariable analysis, complete procedural success was associated with reduced risk of recurrent VT/VF (hazard ratio, 0.002; P=0.034). CONCLUSIONS: Catheter ablation can achieve control of recurrent VT/VF in more than half of patients with cardiac amyloidosis, and the reduction in VT/VF burden post-ablation may be relevant for quality of life. Septal substrate and risk of procedure-related complications challenge successful management of patients with cardiac amyloidosis and VT/VF.
Assuntos
Cardiomiopatias , Ablação por Cateter , Recidiva , Taquicardia Ventricular , Humanos , Masculino , Feminino , Idoso , Taquicardia Ventricular/cirurgia , Taquicardia Ventricular/fisiopatologia , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiologia , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Estudos Retrospectivos , Cardiomiopatias/fisiopatologia , Cardiomiopatias/cirurgia , Cardiomiopatias/complicações , Pessoa de Meia-Idade , Resultado do Tratamento , Fatores de Tempo , Neuropatias Amiloides Familiares/cirurgia , Neuropatias Amiloides Familiares/complicações , Neuropatias Amiloides Familiares/fisiopatologia , Neuropatias Amiloides Familiares/mortalidade , Frequência Cardíaca , Fibrilação Ventricular/fisiopatologia , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/cirurgia , Fibrilação Ventricular/etiologia , Potenciais de Ação , Fatores de RiscoRESUMO
BACKGROUND: Cardiac magnetic resonance imaging (CMR)-defined ventricular scar and anatomic conduction channels (CMR-CCs) offer promise in delineating ventricular tachycardia substrate. No studies have validated channels with coregistered histology, nor have they ascertained the histological characteristics of deceleration zones (DZs) within these channels. We aimed to validate CMR scar and CMR-CCs with whole-heart histology and electroanatomic mapping in a postinfarction model. METHODS: Five sheep underwent anteroseptal infarction. CMR (116±20 days post infarct) was postprocessed using ADAS-3D, varying pixel intensity thresholds (5545, 6040, 6535, and 7030). DZs were identified by electroanatomic mapping (129±12 days post infarct). Explanted hearts were sectioned and stained with Picrosirius red, and whole-heart histopathologic shells were generated. Scar topography as well as percentage fibrosis, adiposity, and remaining viable myocardium within 3 mm histological biopsies and within CMR-CCs were determined. RESULTS: Using the standard 6040 thresholding, CMR had 83.8% accuracy for identifying histological scar in the endocardium (κ, 0.666) and 61.4% in the epicardium (κ, 0.276). Thirty-seven CMR-CCs were identified by varying thresholding; 23 (62%) were unique. DZs colocalized to 19 of 23 (83%) CMR-CCs. Twenty (87%) CMR-CCs were histologically confirmed. Within-channel histological fibrosis did not differ by the presence of DZs (P=0.242). Within-channel histological adiposity was significantly higher at sites with versus without DZs (24.1% versus 8.3%; P<0.001). CONCLUSIONS: Postprocessed CMR-derived scars and channels were validated by histology and electroanatomic mapping. Regions of CMR-CCs at sites of DZs had higher adiposity but similar fibrosis than regions without DZs, suggesting that lipomatous metaplasia may contribute to arrhythmogenicity of postinfarction scar.
Assuntos
Cicatriz , Modelos Animais de Doenças , Miocárdio , Taquicardia Ventricular , Animais , Cicatriz/patologia , Cicatriz/fisiopatologia , Cicatriz/diagnóstico por imagem , Cicatriz/etiologia , Miocárdio/patologia , Taquicardia Ventricular/fisiopatologia , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/patologia , Fibrose , Sistema de Condução Cardíaco/fisiopatologia , Ovinos , Infarto do Miocárdio/patologia , Infarto do Miocárdio/fisiopatologia , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/complicações , Imageamento por Ressonância Magnética , Técnicas Eletrofisiológicas Cardíacas , Valor Preditivo dos Testes , Biópsia , Reprodutibilidade dos TestesRESUMO
BACKGROUND: Idiopathic ventricular arrhythmias (IVAs) arising from different portions of the communicating vein of the left ventricular summit (summit-CV) are not a rare phenomenon. Whereas its electrocardiographic (ECG) and electrophysiological characteristics are not fully investigated. OBJECTIVE: This study aimed to identify distinct ECG and electrophysiological features of IVAs originating from different portions of summit-CV. METHODS: Nineteen patients confirmed arising from summit-CV were included in this study. RESULTS: The 19 patients were divided into proximal and distal portion groups based on their target sites in summit-CV. In the proximal portion group, 100% (11/11) VAs showed dominant negative (rs or QS) waves in lead I, while in the distal portion group, 87.5% (7/8) showed dominant positive waves (R, Rs or r) (p < 0.000). In lead V1, 100% (11/11) of the proximal portion group showed dominant positive waves (R or Rs), while 62.50% (5/8) of the distal portion group showed positive and negative bidirectional or negative waves (RS or rS) (p < 0.005). RI>4mV, SI<3.5mV, RV1<13mV, SV1>3.5mV, RI/SI>0.83, and RV1/SV1< 2.6 indicated a distal portion of summit-CV with the predictive value of 0.909, 1.000, 0.653, 0.972, 0.903, 0.966, respectively. A more positive wave in lead I and a more negative wave in lead V1 indicated more distal origin in summit-CV. Target sites in proximal and distal summit-CV groups showed similar electrophysiological characteristics during mapping. CONCLUSIONS: There were significant differences in ECG characteristics of VAs at different portions of summit-CV, which could aid pre-procedure planning and facilitate radiofrequency catheter ablation (RFCA) procedures.
Assuntos
Potenciais de Ação , Ablação por Cateter , Eletrocardiografia , Frequência Cardíaca , Ventrículos do Coração , Valor Preditivo dos Testes , Humanos , Ablação por Cateter/efeitos adversos , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Resultado do Tratamento , Ventrículos do Coração/fisiopatologia , Ventrículos do Coração/cirurgia , Taquicardia Ventricular/fisiopatologia , Taquicardia Ventricular/cirurgia , Taquicardia Ventricular/diagnóstico , Técnicas Eletrofisiológicas Cardíacas , Estudos Retrospectivos , IdosoRESUMO
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.
Assuntos
Desfibriladores Implantáveis , Taquicardia Ventricular , Humanos , Projetos de Pesquisa , Taquicardia Ventricular/terapia , Metanálise como Assunto , Revisões Sistemáticas como AssuntoRESUMO
Cardiac electrophysiology involves the diagnosis and management of arrhythmias. CT and MRI play an increasingly important role in cardiac electrophysiology, primarily in preprocedural planning of ablation procedures but also in procedural guidance and postprocedural follow-up. The most common applications include ablation for atrial fibrillation (AF), ablation for ventricular tachycardia (VT), and for planning cardiac resynchronization therapy (CRT). For AF ablation, preprocedural evaluation includes anatomic evaluation and planning using CT or MRI as well as evaluation for left atrial fibrosis using MRI, a marker of poor outcomes following ablation. Procedural guidance during AF ablation is achieved by fusing anatomic data from CT or MRI with electroanatomic mapping to guide the procedure. Postprocedural imaging with CT following AF ablation is commonly used to evaluate for complications such as pulmonary vein stenosis and atrioesophageal fistula. For VT ablation, both MRI and CT are used to identify scar, representing the arrhythmogenic substrate targeted for ablation, and to plan the optimal approach for ablation. CT or MR images may be fused with electroanatomic maps for intraprocedural guidance during VT ablation and may also be used to assess for complications following ablation. Finally, functional information from MRI may be used to identify patients who may benefit from CRT, and cardiac vein mapping with CT or MRI may assist in planning access. ©RSNA, 2024 Supplemental material is available for this article.
Assuntos
Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios X , Humanos , Tomografia Computadorizada por Raios X/métodos , Imageamento por Ressonância Magnética/métodos , Ablação por Cateter/métodos , Taquicardia Ventricular/diagnóstico por imagem , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/cirurgia , Técnicas Eletrofisiológicas Cardíacas/métodos , Arritmias Cardíacas/diagnóstico por imagemAssuntos
Flutter Atrial , Taquicardia Ventricular , Verapamil , Humanos , Flutter Atrial/tratamento farmacológico , Flutter Atrial/fisiopatologia , Taquicardia Ventricular/tratamento farmacológico , Taquicardia Ventricular/fisiopatologia , Verapamil/uso terapêutico , Antiarrítmicos/uso terapêutico , EletrocardiografiaRESUMO
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.