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  • 1
    Electronic Resource
    Electronic Resource
    Clinical and Electrophysiologic Predictors of Ventricular Tachyarrhythmia Recurrence in Patients with Implantable Cardioverter Defibrillators (2003)
    350 Main Street , Malden , MA 02148 , USA , and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Science Inc
    Journal of cardiovascular electrophysiology 14 (2003), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Introduction: Not all patients experience recurrent sustained ventricular tachyarrhythmias after placement of an implantable cardioverter defibrillator (ICD). We evaluated the clinical and electrophysiologic predictors of ventricular tachycardia (VT) and ventricular fibrillation (VF) recurrence following ICD implantation. Methods and Results: Consecutive patients (n = 133) underwent 4 ± 3 serial electrophysiologic studies (EPS) over 50 ± 26 months following ICD implantation. Sustained VT/VF could always be induced during follow-up EPS in 49 patients; sustained VT/VF was sometimes induced during follow-up EPS in 47 patients; and sustained VT/VF could never be induced during follow-up EPS in 37 patients. Spontaneous VT/VF requiring ICD therapy occurred in 107 patients during follow-up. Patients with sustained VT/VF that was always inducible or sometimes inducible during follow-up experienced more frequent episodes of VT/VF following ICD implant (20.5, 95% CI 12.7–33.0; and 17.8, 95% CI 11.3–28.1 episodes/patient respectively; vs 3.0, 95% CI 2.0–4.6 episodes/patient for patients with VT/VF never induced, P 〈 0.001 ). Inducibility of sustained VT/VF post-ICD implant (P 〈 0.001) and sustained VT as the presenting arrhythmia (P = 0.02) were independent predictors of spontaneous VT/VF recurrence. Conclusion: Reproducibly inducible VT/VF following ICD implantation predicts a high probability of VT/VF recurrence and identifies a cohort of patients who experience frequent episodes of VT/VF over time. Persistent noninducibility of sustained VT/VF identifies a group of patients who experience no or very few episodes of VT/VF recurrence. (J Cardiovasc Electrophysiol, Vol. 14, pp. 492-498, May 2003)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1540-8167.2003.02328.x
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  • 2
    Electronic Resource
    Electronic Resource
    Randomized Controlled Trial of Fixed Rate Versus Rate Responsive Pacing After Radiofrequency Atrioventricular Junction Ablation: (2003)
    350 Main Street , Malden , MA 02148-5018 , USA , and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Science Inc
    Journal of cardiovascular electrophysiology 14 (2003), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Introduction: Ablation of the AV junction is a widely accepted treatment of drug-refractory atrial fibrillation. Long-term pacing of the right ventricular (RV) apex following AV junction ablation can result in adverse cardiac remodeling. However, anecdotal studies report that pacing too slowly following AV junction ablation was associated with propensity to sudden cardiac death. The aim of this study was to provide information about the balance between measures of quality of life versus measures of electrical remodeling achieved by pacing with different rate modalities in a randomized pilot clinical trial. Methods and Results: Patients with permanent atrial fibrillation were randomized to VVI (80 beats/min) versus VVIR (minimum rate 80 beats/min), whereas patients with paroxysmal atrial fibrillation were randomized to DDI versus DDDR pacing at discharge from hospital. Serially, measurements of exercise capacity, quality of life, cycle length dependence of QT dispersion (QTdisp), RV refractoriness, and the incidence of nonsustained ventricular tachycardia were made in 28 patients over a 6-month follow-up period. Time-dependent increases in QTdisp were observed in patients randomized to the rate responsive mode (RR-ON) but only when paced at 40 beats/min. This was paralleled by time-dependent increases in RV refractoriness (270 ± 11 ms at baseline to 302 ± 5 ms at 6 months) in patients with RR-ON. RR-ON also was associated with trends to an increasing incidence of episodes of nonsustained ventricular tachycardia and worsening of some measures of quality of life. Exercise capacity was not substantially different in the randomized groups. Conclusion: Rate responsive pacing results in electrical remodeling of the ventricle following AV junction ablation, but exercise capacity was similar in groups with RR-ON or RR-OFF. (J Cardiovasc Electrophysiol, Vol. 14, pp. 1163-1170, November 2003)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1540-8167.2003.03168.x
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  • 3
    Electronic Resource
    Electronic Resource
    Paced QT Dispersion and QT Morphology After Radiofrequency Atrioventricular Junction Ablation: (2003)
    350 Main Street , Malden , MA 02148-5018 , U.S.A . : Blackwell Publishing Inc
    Pacing and clinical electrophysiology 26 (2003), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: RAJ, S.R., et al.: Paced QT Dispersion and QT Morphology After Radiofrequency Atrioventricular Junction Ablation: Impact of Left Ventricular Function. Catheter ablation of the atrioventricular junction (AVJ) is a widely accepted treatment for drug refractory atrial fibrillation. Unfortunately, there have been some reports of pause dependent ventricular arrhythmias associated with QT interval prolongation, mainly in patients with reduced LV function. The present investigation evaluates the association of LV function with QT dispersion in response to a sudden rate drop. ECGs were recorded on 20 patients (13 with normal LV function) on the day following AVJ ablation while paced at a range of ventricular rates (40–120 beats/min), and during a sudden drop from 80 to 40 beats/min. The maximum QT interval (QTmax), minimum QT interval (QTmin), and QT interval dispersion (QTdisp) were compared. In both groups, the QTmax and QTmin increased at slower paced heart rates while the QTdisp did not change. In response to a sudden rate drop from 80 to 40 beats/min, the QTmax increased in both groups of LV function (trend), while the QTmin increased in those with normal LV function (24 ± 22 ms) , but not in those with reduced LV function(0 ± 14 ms; P = 0.01). Consequently, the QTdisp increased significantly in those with reduced LV function(31 ± 23 ms)but not in normal LV function(−5 ± 29 ms; P = 0.01). Morphological QTU changes developed following the sudden rate drop in 67% of the reduced LV versus 8% of the normalLV (P = 0.02)function groups. Following AVJ ablation, QTdisp increased during a sudden rate drop in patients with reduced LV function, but not in patients with normal LV function. (PACE 2003; 26:662-–668)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.2003.00115.x
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  • 4
    Electronic Resource
    Electronic Resource
    Conduction Time Oscillations Precede the Spontaneous Termination of Human Atrioventricular Reciprocating Tachycardia (2000)
    Springer
    Journal of interventional cardiac electrophysiology 4 (2000), S. 231-239 
    Details
    ISSN: 1572-8595
    Keywords: accessory pathway ; reentry ; Wolff-Parkinson-White Syndrome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Prior clinical research indicates that conduction slowing is the primary mechanism leading to the spontaneous termination of reentrant tachycardia in humans. Yet, some experimental models indicate that cycle length oscillations and enhanced conduction are important prerequisites. The role of oscillations in conduction times and enhanced conduction in the spontaneous termination of human reentrant tachycardia has not been adequately investigated. The electrophysiologic features preceding the spontaneous termination of orthodromic atrioventricular (AV) reciprocating tachycardia (RT) were evaluated in 21 patients, each of whom had a sustained (〉60 seconds) and a spontaneously terminating (≥10 beats and ≤60 seconds) episode of AVRT during the same electrophysiologic study. Atrio-His, His-ventricular, interventricular, ventriculoatrial and atrial conduction times were measured for each beat of spontaneously terminating AVRT and for paired beats of sustained AVRT. Beats of spontaneously terminating and sustained tachycardia were pooled and Hadi multivariate outlier analysis was used to identify whether significant beat-to-beat alterations in conduction times preceded the spontaneous termination of reentry. Cycle lengths of sustained (348±62 msec) and spontaneously terminating AVRT (351±70 msec) were similar. Significant beat-to-beat oscillations in conduction times preceded the spontaneous termination of AVRT in 10 of the 21 (48%) patients. An apparent enhancement in atrio-His or ventriculoatrial conduction times immediately preceded the spontaneous termination of AVRT in 11 patients (52%), while an apparent conduction delay occurred in only 2 patients (10%). Moreover, significant oscillations in conduction times were present in 9 of the 11 patients (82%) with enhanced conduction, but only in 1 of the 10 (10%) remaining patients (p=0.002. Conduction time oscillations, which are related to apparent enhancement in atrio-His or ventriculoatrial conduction, frequently precede the spontaneous termination of reentry in humans.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1009821830582
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  • 5
    Electronic Resource
    Electronic Resource
    Divergence of Endocardial QT Interval Components during Programmed Electrical Stimulation Including Observations during Induction of Sustained Ventricular Tachyarrhythmias (1997)
    Springer
    Journal of interventional cardiac electrophysiology 1 (1997), S. 23-31 
    Details
    ISSN: 1572-8595
    Keywords: programmed stimulation ; invasive clinical electrophysiologic testing ; ventricular tachyarrhythmias ; coronary heart disease
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Measurements were made in 12 normal subjects and during induction ofsustained ventricular tachyarrhythmias in 31 patients with remote myocardialinfarction. QT interval measurements were made semiautomatically withcomputer assistance and the total QT interval was divided into early (QT 1 )and late (QT 2 ) components. QT intervals and QT interval dispersion betweentwo right ventricular endocardial sites were plotted against the degree ofprematurity of the last extrastimulus (S 2 , S 3 , or S 4 ). In the controlgroup, total QT and QT 1 intervals shortened with increasing prematurity ofthe last extrastimulus (p , 0.001). Slopes (positive) were steeper withfaster pacing rates (600, 500, or 400 ms) and more extrastimuli (1 to 3).The relationship between QT 2 intervals and prematurity of the lastextrastimulus was flat, but the slope was slightly negative (p=0.05to,0.001) and did not vary with changes in pacing cycle length or number ofextrastimuli. QT interval dispersion in the control group was minor(95% CI 0-40 ms). During induction of sustained ventriculartachyarrhythmias, total QT and QT 1 intervals were longer (y intercepts)than in the control group (p , 0.05 at 400-ms pacing cycle length) and theirdispersion was increased (p , 0.05). Generally, QT 2 intervals were shorter(p , 0.05 at 600-ms pacing cycle length) during induction of ventriculararrhythmias in comparison with the control group but dispersion wasincreased (p , 0.05 at 400-ms pacing cycle length). QT intervals and QTinterval dispersion show an orderly and predictable relationship withprematurity of the last extrastimulus in normal subjects. These patternsdiffer during induction of sustained ventricular tachyarrhythmias. Suchdifferences may be exploited to derive clinically predictive and usefulmeasurements.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1009706516217
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  • 6
    Electronic Resource
    Electronic Resource
    Antiarrhythmic Drug Combination Therapy (1998)
    Springer
    Cardiac electrophysiology review 2 (1998), S. 142-146 
    Details
    ISSN: 1573-725X
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1009967429873
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