Peripartum Cardiomyopathy Presenting With Ventricular Tachycardia: A Rare Presentation

A 25-year-old previously asymptomatic pregnant woman at 36 weeks'' gestation was noticed to have repetitive monomorphic ventricular tachycardia. A dilated left ventricle with moderately reduced systolic function was found on echocardiographic examination. This is a very rare presentation of peripartum cardiomyopathy (PPCMP) presenting with repetitive monomorphic ventricular tachycardia.     

Right Ventricular Endomyocardial Fibrosis Presenting With Ventricular Tachycardia And Apical Thrombus - An Interesting Presentation

Endomyocardial fibrosis is a progressive disease of unknown origin affecting children and young adults. It involves inflow portion of right and/or left ventricle and apex. It may be associated with thrombus. Literature regarding right ventricular endomyocardial fibrosis with thrombus is scarce. Here we report a rare case of right ventricular endomyocardial fibrosis presenting as ventricular tachycardia and echocardiographic evidence of apical thrombus. Interestingly there was no pulmonary involvement or evidence of deep venous thrombosis. This case also underscores the importance of urgent echocardiography in diagnosis of obscure cases of ventricular tachycardia.     

Local Anaesthesia Suppressing Idiopathic Ventricular Tachycardia - A Cause of Non-inducible Arrhythmia During Electrophysiology Study

A 13 year old boy having idiopathic ventricular tachycardia had non-inducible tachycardia twice on electrophysiology (EP) study due to suppression of arrhythmia by local anaesthetic agent, lignocaine. This case report demonstrates a cause of non-inducibility or arrhythmia during EP study and effect of lignocaine in suppression of idiopathic ventricular tachycardia.     

Ventricular Tachycardia Precipitated by Short-long-short Sequence in a Patient with Implantable-cardioverter Defibrillator

Abrupt changes in heart rate, particularly short-long-short sequences in the ventricular cycle length (CL), might precede initiation of ventricular tachycardia/fibrillation (VT/VF). These changes may be facilitated or caused by pacing activity in patients with pacemakers or implantable-cardioverter defibrillators (ICDs). We describe a patient with two episodes of acquired VT precipitated by short-long-short sequences and diagnosed from the ICD recordings. In such cases, the knowledge of the device parameters is extremely important for a correct diagnosis and management.     

Verapamil Sensitive Ventricular Tachycardia Associated With A Cardiac Hemangioma In The Right Ventricular Outflow Tract

Primary tumors of the heart are rare, but they are often associated with refractory arrhythmias. Vascular tumors of the heart comprise a small minority of primary cardiac tumors. In patients with structurally normal hearts, ventricular tachycardia (VT) originating from the right ventricular outflow tract (RVOT) can be sensitive to adenosine, vagal maneuvers, and calcium channel blockers. In this report, we describe a case of ventricular tachycardia originating from within a hemangioma in the RVOT that was ultimately controlled with verapamil.     

Transmural “Scar-to-Scar” Reentrant Ventricular Tachycardia

We describe a scar-related reentrant ventricular tachycardia circuit with a proximal segment in an endocardial basal septal scar and an exit in a region of slow conduction in a non-overlapping region of epicardial basal lateral scar. The 12-lead EKG demonstrates criteria for a basal lateral epicardial VT, however the same morphology could be produced with a longer stim-latency with pace mapping or VT induction from the endocardial septal region of scar. A significant segment of myocardium demonstrated no endocardial or epicardial scar on electroanatomic mapping, suggesting the presence of a mid-myocardial isthmus. Further evidence was provided by assessment of unipolar settings. The epicardial VT that initially appeared to originate from the basal lateral epicardial region, was successfully treated with radiofrequency ablation of the lateral aspect of the endocardial septal scar.     

Sustained Ventricular Tachycardia In An Apparently Healthy Heart: A Very Localized Left Dominant Arrhythmogenic Cardiomyopathy

A 62-year-old man admitted for presyncope presented two symptomatic sustained ventricular tachycardia with right bundle branch morphology and inferior axis suggesting a pathology of the left ventricular lateral wall, the site where Cardiac Magnetic Resonance demonstrated a thinned, hypokinetic segment with fibro-fatty subepicardial infiltration. A very localized Left Dominant Arrhythmogenic Cardiomyopathy was diagnosed and an ICD implanted.     

Dronedarone for Recurrent Ventricular Tachycardia: A Real Alternative?

Sustained ventricular tachycardia (VT) is an important cause of morbidity and sudden death in patients with dilated cardiomyopathy. Although ICD effectively terminate VT episodes and improve survival, shocks reduce quality of life, and episodes of VT predict increased risk of heart failure and death despite effective therapy. Patients suffering recurrent VT episodes remain a challenge. Antiarrhytmic therapy reduces VT episodes, but it is associated with serious adverse events, and disappointing efficacy. Catheter ablation has emerged as an important option to control recurrent VT, but major procedure-related complications, and even death, are still issues to concern. And even with these armamentaria, some patients still have recurrent VT episodes and ICD shocks. We report on a patient with non-ischemic dilated cardiomyopathy and recurrent ventricular tachycardia resistant to multiple antiarrhytmic agents, in whom dronedarone was effective in completely suppressing ventricular tachycardia episodes.     

Brugada ECG Pattern Unmasked by IV Flecainide in an Individual with Idiopathic Fascicular Ventricular Tachycardia

A 45-year old man presents with stable monomorphic ventricular tachycardia. He had previously been diagnosed with idiopathic fascicular ventricular tachycardia. Intravenous flecainide results in termination of his tachycardia but unmasks a latent type 1 Brugada ECG pattern not seen on his resting ECG. We discuss his subsequent management and the need to consider an alternative diagnosis in individuals with a Brugada type ECG pattern who present with stable monomorphic ventricular tachycardia.     

Idiopathic fascicular ventricular tachycardia

Idiopathic fascicular ventricular tachycardia is an important cardiac arrhythmia with specific electrocardiographic features and therapeutic options. It is characterized by relatively narrow QRS complex and right bundle branch block pattern. The QRS axis depends on which fascicle is involved in the re-entry. Left axis deviation is noted with left posterior fascicular tachycardia and right axis deviation with left anterior fascicular tachycardia. A left septal fascicular tachycardia with normal axis has also been described. Fascicular tachycardia is usually seen in individuals without structural heart disease. Response to verapamil is an important feature of fascicular tachycardia. Rare instances of termination with intravenous adenosine have also been noted. A presystolic or diastolic potential preceding the QRS, presumed to originate from the Purkinje fibers can be recorded during sinus rhythm and ventricular tachycardia in many patients with fascicular tachycardia. This potential (P potential) has been used as a guide to catheter ablation. Prompt recognition of fascicular tachycardia especially in the emergency department is very important. It is one of the eminently ablatable ventricular tachycardias. Primary ablation has been reported to have a higher success, lesser procedure time and fluoroscopy time.     

Polymorphic Ventricular Tachycardia Due to Acute Coronary Ischemia: A Case Report

Acute myocardial ischemia can cause ventricular tachycardia (VT) in patients with structurally normal heart. Contrary to the fact that in patients with chronic myocardial scarring the ventricular tachycardia is monomorphic, in patients with acute ischemia the ventricular tachycardia is polymorphic and is reversible with coronary revascularization.We are reporting a 40 year old male who presented with recurrent syncope due to polymorphic ventricular tachycardia in the context of normal QT interval in baseline ECG and normal left ventricular function without any evidence of myocardial injury. Due to recurrent fatal ventricular arrhythmia despite medical management, urgent coronary angiography was done which showed critical obstruction of right coronary artery (RCA). Considering the critical obstruction of RCA responsible for polymorphic VT, emergency PCI of RCA was done. After successful PTCA and stenting to RCA, he had another episode of polymorphic VT which was terminated with intravenous phenytoin. Seven days after the PCI, 24 hours Holter monitoring was done which showed normal sinus rhythm with infrequent ventricular premature complexes and no evidence of VT. He was asymptomatic at six months follow-up.     

Measure twice, cut once: pitfalls in the diagnosis of supraventricular tachycardia

In atrioventricular nodal and atrioventricular reentrant tachycardia, the relative timing of atrial and ventricular activation may sometimes be very similar, even during electrophysiological studies, and this may lead to an erroneous diagnosis and inappropriate treatment. As examples, we describe two cases that were recently referred to our hospital for a second opinion and treatment of paroxysmal supraventricular tachycardia. In both, the original diagnosis of the referring centres was commontype atrioventricular nodal reentrant tachycardia. Catheter ablation in those centres was unsuccessful. During our electrophysiological studies, however, an atrioventricular reentrant tachycardia was demonstrated, using a concealed accessory pathway for retrograde conduction in both patients. The accessory atrioventricular connection was successfully ablated and on follow-up both patients remained free of symptoms without medication. These findings illustrate the importance of complete electrophysiological analysis even for apparently simple supraventricular arrhythmias. (Neth Heart J 2010;18:78–84.)     

Long-Standing Undiagnosed Sheehan Syndrome Presenting as Polymorphic and Monomorphic Ventricular Tachycardia: A Case Series of 2 Patients

ObjectiveTo describe 2 cases of Sheehan syndrome presenting with ventricular tachycardia.MethodsIn this case series, we present 2 cases of Sheehan syndrome presenting with ventricular tachycardia, which is an extremely rare complication of Sheehan syndrome. We review the literature for cases of panhypopituitarism presenting with ventricular tachycardia and also review the pathophysiologic mechanisms underlying development of ventricular tachycardia in these patients.ResultsTwo female patients presented with ventricular tachycardia. One patient had monomorphic and the other had polymorphic ventricular tachycardia. On further workup, both patients were found to have panhypopituitarism. Due to past history of postpartum hemorrhage, both patients were suspected of having Sheehan syndrome as the cause of panhypopituitarism. Electrocardiogram revealed prolonged QT interval. Both patients were started on hormone replacement therapy. Both patients responded well initially and were discharged home. One of the patients is alive and healthy at the time of this report. However, the other patient was readmitted with seizures a few days after discharge and unfortunately died of sudden cardiac arrest.ConclusionUntreated cases of Sheehan syndrome can present with fatal ventricular tachycardia. Hormone replacement in these patients can treat and prevent fatal arrhythmias. (Endocr Pract. 2014;20:e211-e214)     

Premature Ventricular Contractions and Non-sustained Ventricular Tachycardia: Association with Sudden Cardiac Death,Risk Stratification,and Management Strategies

Premature ventricular contractions (PVCs) and non-sustained ventricular tachycardia (NSVT) are frequently encountered and a marker of electrocardiomyopathy. In some instances, they increase the risk for sustained ventricular tachycardia, ventricular fibrillation, and sudden cardiac death. While often associated with a primary cardiomyopathy, they have also been known to cause tachycardia-induced cardiomyopathy in patients without preceding structural heart disease. Medical therapy including beta-blockers and class III anti-arrhythmic agents can be effective while implantable cardiac defibrillators (ICD) are indicated in certain patients. Radiofrequency ablation (RFA) is the preferred, definitive treatment in those patients that improve with anti-arrhythmic therapy, have tachycardia-induced cardiomyopathy, or have certain subtypes of PVCs/NSVT. We present a review of PVCs and NSVT coupled with case presentations on RFA of fascicular ventricular tachycardia, left-ventricular outflow tract ventricular tachycardia, and Purkinje arrhythmia leading to polymorphic ventricular tachycardia.     

Catheter Ablation of Hemodynamically Unstable Ventricular Tachycardia in a Patient with Dextro - Transposition of the Great Arteries and Mustard's Repair

Introduction

A patient with D-TGA and surgical repair (Mustard''s procedure) presented with appropriate ICD shocks due to monomorphic ventricular tachycardia, refractory to antiarrhythmic medications.

Methods and Results

The patient underwent an electrophysiological study and catheter ablation for the VT. Substrate and pace mapping techniques, with the help of an electroanatomical mapping system, was used to localize and ablate the tachycardia successfully.

Conclusions

In patients with D-TGA and Mustard''s repair, scar tissue resulting from VSD repair can act as a substrate for recurrent VT. Catheter ablation of VT is useful in management of VT that occurs despite antiarrhythmic therapy and/or when it is unstable.     

Dual AV Nodal Nonreentrant Tachycardia Resulting in Inappropriate ICD Therapy in a Patient with Cardiac Sarcoidosis

Dual atrioventricular nodal nonreentrant tachycardia (DAVNNT) occurs due to concurrent antegrade conduction over fast and slow atrioventricular nodal pathways and is treated by slow pathway modification. We describe a unique case of a patient with cardiac sarcoidosis who received inappropriate ICD shocks for DAVNNT. Atrial and ventricular device electrograms satisfied both rate and V>A criteria for ventricular tachycardia. We postulate that alterations in refractoriness and conduction as is seen in cardiac sarcoidosis (CS) may have contributed to occurrence of DAVNNT.     

Cardiomyopathy induced by incessant ventricular tachycardia originating in the vicinity of the His bundle

A 04-year-old boy was referred to our institution with severe, progressive heart failure of 4-months duration associated with a persistent wide QRS tachycardia with left bundle branch block and severe left ventricular dysfunction. Because of incessant wide QRS tachycardia refractory to antiarrhythmic drugs, he was referred for electrophysiological study. The ECG was suggestive of VT arising from the right ventricle near the His area. Electrophysiological study revealed that origin of tachycardia was septum of the right ventricle, near His bundle, however the procedure was not successful and an inadvertent complete atrioventricular conduction block occurred. The same ventricular tachycardia recurred. A second procedure was performed with a retrograd aortic approach to map the left side of the interventricular septum. The earliest endocardial site for ablation was localized in the anterobasal region of left ventricle near His bundle. In this location, one radiofrequency pulse interrupted VT and rendered it not inducible. The echocardiographic evaluation showed partial reversal of left ventricular function in the first 3 months. The diagnosis was idiopathic parahisian left ventricular tachycardia leading to a tachycardia mediated cardiomyopathy, an extremely rare clinical picture in children.     

心血管危重症继发交感风暴37例临床分析

目的:探讨心血管危重症继发交感风暴的病因分布特点和治疗方法。方法:回顾性分析我院2001年-2011年37例心血管危重症继发交感风暴临床资料。结果:37例心血管危重症继发交感风暴患者,其中男性22例,女性15例,年龄55-82岁,平均68.25岁。病因分布为:心肌梗死29例,心衰3例,扩张性心肌病2例,电解质紊乱2例,Brugada综合征1例。治疗方法包括β受体阻滞剂、胺碘酮、利多卡因、电除颤等。其中,17例因反复发作室颤,经抗心律失常药物和电除颤治疗无效死亡,余20例病情得到控制。结论:心血管危重症继发交感风暴临床病因多样,病情凶险,应用β受体阻滞剂及抗心律失常药物,同时积极针对病因及诱因治疗,可以改善临床症状和预后。     

Ventricular Tachycardia Caused by Mesothelial Cyst

A 27 year-old- lady was evaluated due to recurrent ventricular tachycardia. After performing echocardiography and cardiac MRI, she was found to have large pericardial cyst. Pathologic examination confirmed it as mesothelial pericardial cyst. Up to our knowledge it is the first presentation of simple pericardial cyst as ventricular a tachycardia.     

特发性右心室流出道室性心律失常射频消融术后复发因素分析

目的:探讨特发性右心室流出道室性心律失常射频消融术后,患者室性心律失常复发的原因,旨在为进一步降低复发率提供线索。方法:1999年12月至2009年12月,在解放军总医院老年心血管内科住院行导管射频消融的特发性右心室流出道室性心律失常患者共145例(男55例,女90例),治疗终点为室性心律失常消失,不能被心室电刺激和静滴盐酸异丙肾上腺素诱发,术后1天复查动态心电图并电话随访观察疗效。结果:在145例患者中,即刻成功136例,成功率为93.8%。随访23.8±6.7月,共有9例患者复发,复发率为6.62%。9例复发患者再次行射频消融术的靶点局部激动(34.0±7.6 ms)明显早于第一次射频消融术(30.4±8.5 ms)(P<0.05);靶点起搏与自发心律失常体表心电图QRS波形的符合数(11.8±0.45)大于第一次射频消融术(11.1±0.78)(P<0.05);复发患者第一次手术在最早激动点处单极标测r波的出现比例大于第二次手术(P<0.05),再次手术均成功。结论:导管射频消融治疗特发性右心室流出道室性心律失常是有效、可行的方法。靶点标测欠精确是术后复发的主要原因。