Ventricular Arrhythmias in Apparently Normal Hearts, An Issue of Cardiac Electrophysiology Clinics (eBook)

Frank M. Bogun, Thomas C. Crawford, Rakesh Latchamsetty (Autoren)

eBook Download: PDF | EPUB

2016 | 1. Auflage
100 Seiten
Elsevier Health Sciences (Verlag)
978-0-323-46273-0 (ISBN)

Infos

This issue of the Cardiac Electrophysiology Clinics entitled 'Ventricular Arrhythmias in Apparently Normal Hearts” is being edited by Drs. Frank M. Bogun, Thomas Crawford, and Rakesh Latchamsetty. The issue will cover topics including, the mechanisms of ventricular arrhythmias, the role of genetic testing, papillary muscle arrhythmias, fascicular arrhythmias, exercised induced VT, VF, and SCD in the normal heart, and various management techniques.

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This issue of the Cardiac Electrophysiology Clinics entitled "e;Ventricular Arrhythmias in Apparently Normal Hearts? is being edited by Drs. Frank M. Bogun, Thomas Crawford, and Rakesh Latchamsetty. The issue will cover topics including, the mechanisms of ventricular arrhythmias, the role of genetic testing, papillary muscle arrhythmias, fascicular arrhythmias, exercised induced VT, VF, and SCD in the normal heart, and various management techniques.

Inhalt

Front Cover 1
Ventricular Arrhythmias in Apparently Normal Hearts 2
Copyright 3
Contributors 4
CONSULTING EDITORS 4
EDITORS 4
AUTHORS 4
Contents 8
Foreword: A Matter of Definition 8
Preface: Ventricular Arrhythmias in Apparently Normal Hearts 8
Premature Ventricular Complexes in Apparently Normal Hearts 8
Role of Genetic Testing in Patients with Ventricular Arrhythmias in Apparently Normal Hearts 8
Nonsustained Ventricular Tachycardia in the Normal Heart: Risk Stratification and Management 8
Outflow Tract Premature Ventricular Contractions and Ventricular Tachycardia: The Typical and the Challenging 9
Spectrum of Ventricular Arrhythmias Arising from Papillary Muscle in the Structurally Normal Heart 9
Spectrum of Fascicular Arrhythmias 9
Polymorphic Ventricular Tachycardia/Ventricular Fibrillation and Sudden Cardiac Death in the Normal Heart 9
Exercise-induced Ventricular Tachycardia/Ventricular Fibrillation in the Normal Heart: Risk Stratification and Management 10
Dynamics and Molecular Mechanisms of Ventricular Fibrillation in Structurally Normal Hearts 10
Ventricular Arrhythmias in Apparently Normal Hearts: Who Needs an Implantable Cardiac Defibrillator? 10
Sustained Ventricular Tachycardia in Apparently Normal Hearts: Ablation Should Be the First Step in Management 10
Sustained Ventricular Tachycardia in Apparently Normal Hearts: Medical Therapy Should be the First Step in Management 11
CARDIAC ELECTROPHYSIOLOGY CLINICS 12
FORTHCOMING ISSUES 12
December 2016 12
March 2017 12
June 2017 12
RECENT ISSUES 12
June 2016 12
March 2016 12
December 2015 12
Foreword:A Matter of Definition 14
Preface:Ventricular Arrhythmias in Apparently Normal Hearts 16
Premature Ventricular Complexes in Apparently Normal Hearts 18
Key points 18
PREMATURE VENTRICULAR COMPLEXES IN STRUCTURALLY NORMAL HEARTS: PRESENTATION AND DETECTION 18
Symptoms 19
Diagnostic Evaluation 19
HIGH-RISK FEATURES/MALIGNANT 20
PREMATURE VENTRICULAR COMPLEX–INDUCED VENTRICULAR FIBRILLATION 20
PREMATURE VENTRICULAR COMPLEX–INDUCED CARDIOMYOPATHY 21
Causes and Mechanism 21
Risk Factors and Prevalence 21
Treatment and Reversibility of Premature Ventricular Complex–Induced Cardiomyopathy 21
TREATMENT OPTIONS FOR PREMATURE VENTRICULAR COMPLEX 22
Medical Therapies 22
?-Blockade and calcium channel blockade 22
Antiarrhythmic medications 22
Catheter Ablation 23
Indications 23
Techniques for ablation 23
Complications of ablation 23
Difficulties and limitations of ablation 24
Prognosis of right ventricular outflow tract ablation 25
Prognosis of premature ventricular complex–induced cardiomyopathy ablation 25
PROGNOSIS OF PREMATURE VENTRICULAR COMPLEX–INDUCED VENTRICULAR FIBRILLATION 25
SUMMARY 26
REFERENCES 26
Role of Genetic Testing in Patients with Ventricular Arrhythmias in Apparently Normal Hearts 30
Key points 30
INTRODUCTION 30
THE MECHANISM OF ELECTROPHYSIOLOGY AND ELECTROPHYSIOLOGIC ABNORMALITIES 31
MOLECULAR GENETICS OF LONG QT SYNDROME 31
The Role of Genetic Testing in Long QT Syndrome 31
BRUGADA SYNDROME 32
The Role of Genetic Testing in Brugada Syndrome 32
CATECHOLAMINERGIC POLYMORPHIC VENTRICULAR TACHYCARDIA 32
The Role of Genetic Testing in Catecholaminergic Polymorphic Ventricular Tachycardia 35
SHORT QT SYNDROME 35
IDIOPATHIC VENTRICULAR FIBRILLATION 35
CONDUCTION DISEASE 35
EARLY REPOLARIZATION SYNDROME 35
DISCUSSION: HOW TO JUDGE THE VARIANTS 36
REFERENCES 36
Nonsustained Ventricular Tachycardia in the Normal Heart 40
Key points 40
INTRODUCTION 40
APPROACH TO EVALUATION OF NONSUSTAINED VENTRICULAR TACHYCARDIA 41
Overview 41
Rule out conditions that may mimic ventricular tachycardia 41
Artifact 42
Paced rhythm 42
Supraventricular tachycardia with aberrancy 43
Differentiate monomorphic from polymorphic ventricular tachycardia 44
Further evaluation and therapy based on type of ventricular tachycardia and clinical circumstances 45
Evaluation of nonsustained polymorphic ventricular tachycardia 45
Evaluation of nonsustained monomorphic ventricular tachycardia 49
Idiopathic Ventricular Tachycardia 50
Outflow tract ventricular tachycardia 50
Malignant form of outflow tract ventricular tachycardia 52
Fascicular ventricular tachycardia 52
Papillary muscle ventricular tachycardia 53
Nonsustained ventricular tachycardia in patients with hypertension 53
Nonsustained ventricular tachycardia in athletes 54
Exercise-induced nonsustained ventricular tachycardia 54
SUMMARY 55
REFERENCES 55
Outflow Tract Premature Ventricular Contractions and Ventricular Tachycardia 60
Key points 60
INTRODUCTION 60
ANATOMY OF THE OUTFLOW TRACT 61
The Epicardial Outflow Tract 61
ELECTROCARDIOGRAM LOCALIZATION OF ORIGIN OF OUTFLOW TRACT ARRHYTHMIAS 62
ELECTROPHYSIOLOGIC TESTING AND MAPPING 63
ABLATION OF OUTFLOW TRACT VENTRICULAR ARRHYTHMIAS 64
Right Ventricular Outflow Tract 64
Aortic Root 65
Aortomitral Continuity 65
Epicardial and Perivenous Foci 65
THE CHALLENGING CASES 66
OUTCOMES AND COMPLICATIONS OF CATHETER ABLATION FOR OUTFLOW TRACT ARRHYTHMIAS 66
SUMMARY 67
REFERENCES 67
Spectrum of Ventricular Arrhythmias Arising from Papillary Muscle in the Structurally Normal Heart 70
Key points 70
INTRODUCTION 70
ANATOMIC CORRELATION AND PHYSIOLOGIC CONSIDERATION 71
CLINICAL MANIFESTATIONS 71
DIFFERENTIAL DIAGNOSIS 71
Electrocardiography 72
Imaging 72
Electrophysiologic Characteristics 73
TREATMENT AND PROGNOSIS 73
Catheter Ablation Techniques 74
Efficacy of Ablation 77
MALIGNANT VENTRICULAR ARRHYTHMIAS 77
Maintaining Circuits for Ventricular Fibrillation 77
Ventricular Fibrillation Triggered by Papillary Premature Ventricular Contractions 78
Malignant Mitral Valve Prolapse Syndrome 78
SUMMARY 78
ACKNOWLEDGMENTS 78
SUPPLEMENTARY DATA 78
REFERENCES 78
Spectrum of Fascicular Arrhythmias 82
Key points 82
INTRODUCTION 82
Historical Background 82
Mechanisms of Fascicular Arrhythmias 84
Clinical Presentation of Fascicular Arrhythmias 84
Intrafascicular Reentry 84
Ablation of Intrafascicular Reentrant Ventricular Tachycardia 87
Upper Septal–Dependent Interfascicular Reentry 87
Ablation of Upper Septal or Interfascicular Ventricular Tachycardia 91
Focal Mechanism of Fascicular Arrhythmias 91
Ablation of Focal Fascicular Arrhythmias 93
SUMMARY 93
REFERENCES 93
Polymorphic Ventricular Tachycardia/Ventricular Fibrillation and Sudden Cardiac Death in the Normal Heart 96
Key points 96
INTRODUCTION 96
OVERVIEW OF MANAGEMENT 97
MAPPING AND ABLATION OF POLYMORPHIC VENTRICULAR TACHYCARDIA/VENTRICULAR FIBRILLATION 97
Idiopathic Ventricular Fibrillation 97
Purkinje arborization 98
Characteristics of culprit premature ventricular ectopic beats 98
Outcome of ablation 99
Long QT Syndrome 100
Brugada Syndrome 100
Catecholaminergic Polymorphic Ventricular Tachycardia 101
Short QT Syndrome 101
Abnormal Early Repolarization Syndrome 102
LATEST INSIGHTS FROM NONINVASIVE MAPPING OF CLINICAL POLYMORPHIC VENTRICULAR TACHYCARDIA/VENTRICULAR FIBRILLATION 103
REFERENCES 105
Exercise-induced Ventricular Tachycardia/Ventricular Fibrillation in the Normal Heart 108
Key points 108
INTRODUCTION 108
ARRHYTHMOGENIC EFFECTS OF EXERCISE 109
IDIOPATHIC MONOMORPHIC VENTRICULAR TACHYCARDIA 109
RISK STRATIFICATION AND MANAGEMENT 110
MALIGNANT ARRHYTHMOGENIC RIGHT VENTRICULAR CARDIOMYOPATHY VERSUS BENIGN RIGHT VENTRICULAR OUTFLOW TRACT VENTRICULAR TACHYCARDIA 111
EXERCISE-INDUCED VENTRICULAR TACHYCARDIA AND BRUGADA SYNDROME 112
EXERCISE-INDUCED POLYMORPHIC VENTRICULAR TACHYCARDIA 112
SUMMARY/DISCUSSION 113
REFERENCES 113
Dynamics and Molecular Mechanisms of Ventricular Fibrillation in Structurally Normal Hearts 116
Key points 116
INTRODUCTION 116
MODERN CONCEPTS ON VENTRICULAR FIBRILLATION MECHANISMS 117
FIBRILLATORY CONDUCTION 117
SCALING LAW OF VENTRICULAR FIBRILLATION FREQUENCY 118
THE GUINEA PIG HEART MODEL OF VENTRICULAR FIBRILLATION 118
ACTION POTENTIAL DURATION ABBREVIATION AND RAPID ROTATION FREQUENCY 119
AN IONIC MECHANISM FOR STABLE ROTORS AND VENTRICULAR FIBRILLATION 120
MOUSE GENETICS, INWARD RECTIFIER POTASSIUM CURRENT AND VENTRICULAR FIBRILLATION 121
MOLECULAR MECHANISMS THAT CONTROL VENTRICULAR FIBRILLATION FREQUENCY 123
SUMMARY 125
REFERENCES 125
Ventricular Arrhythmias in Apparently Normal Hearts 128
Key points 128
INTRODUCTION 128
PREVALENCE OF MALIGNANT VENTRICULAR ARRHYTHMIAS AND POTENTIAL IMPLANTABLE CARDIAC DEFIBRILLATOR BURDEN 129
PROPOSED MECHANISM FOR MALIGNANT ARRHYTHMIAS 129
RISK FACTORS FOR MALIGNANT VENTRICULAR ARRHYTHMIAS 130
History of Aborted Sudden Death or Syncope 131
Shorter Coupling Interval of the First or Second Premature Ventricular Complex Beat 131
Shorter CL 131
QRS Duration of Ventricular Tachycardia 131
Prematurity Index 131
Disorganized Morphology 131
CANDIDATES FOR IMPLANTABLE CARDIAC DEFIBRILLATOR THERAPY 131
Survivors of Cardiac Arrest: Implantable Cardiac Defibrillator or Ablation? 131
History of Syncope and Nonsustained Ventricular Tachycardia 133
Asymptomatic with Nonsustained Ventricular Tachycardia with Malignant Electrocardiogram Criteria 133
Premature Ventricular Complex–Induced Cardiomyopathy and Implantable Cardiac Defibrillators 133
Influence of a Mixed Substrate on Implantable Cardiac Defibrillator Therapy 134
SUGGESTED APPROACH TO IMPLANTABLE CARDIAC DEFIBRILLATOR RISK STRATIFICATION 134
SUMMARY 135
REFERENCES 135
Sustained Ventricular Tachycardia in Apparently Normal Hearts 138
Key points 138
COMMON TYPES OF VENTRICULAR TACHYCARDIA IN STRUCTURALLY NORMAL 139
THE CASE AGAINST IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR AS FIRST-LINE THERAPY 140
THE CASE AGAINST ANTIARRHYTHMIC MEDICATIONS AS FIRST-LINE THERAPY 141
EXTRAPOLATION OF DATA IN STRUCTURAL HEART DISEASE 142
PATIENTS WITH INAPPARENT OR “CONCEALED” STRUCTURAL HEART DISEASE 142
SUMMARY 143
REFERENCES 144
Sustained Ventricular Tachycardia in Apparently Normal Hearts 146
Key points 146
INTRODUCTION 146
CURRENT GUIDELINES 146
IDIOPATHIC VENTRICULAR TACHYCARDIA HAS A FAVORABLE PROGNOSIS 147
MEDICAL THERAPIES FOR IDIOPATHIC VENTRICULAR TACHYCARDIA ARE REASONABLY EFFECTIVE 148
MEDICAL THERAPIES ARE SAFE 148
CATHETER ABLATION FOR MANY FORMS OF IDIOPATHIC VENTRICULAR TACHYCARDIA IS INEFFECTIVE 148
THERE ARE REAL RISKS WITH CATHETER ABLATION 149
CHOOSING MEDICAL THERAPIES AS A FIRST-LINE STRATEGY FOR IDIOPATHIC VENTRICULAR TACHYCARDIA DOES NOT MEAN ELIMINATING THE RO ... 151
APPARENT EXCEPTIONS TO THE RULE 151
SUMMARY 151
REFERENCES 151

Produkt-Details

• Erscheint lt. Verlag: 27.8.2016
• Sprache: englisch
• Themenwelt: Medizinische Fachgebiete ► Innere Medizin ► Kardiologie / Angiologie
• Themenwelt: Studium ► 2. Studienabschnitt (Klinik) ► Anamnese / Körperliche Untersuchung
• ISBN-10: 0-323-46273-1 / 0323462731
• ISBN-13: 978-0-323-46273-0 / 9780323462730