Abstracts Archive 2003

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Implantable Cardioverter-Defibrillator Therapy for Prevention of Sudden Death in Patients with Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia

In patients with ARVC/D, ICD therapy provided life-saving protection by effectively terminating life-threatening ventricular arrhythmias. Patients who were prone to ventricular fibrillation/flutter could be identified on the basis of clinical presentation, irrespective of programmed ventricular stimulation outcome.

Determinants of Sudden Cardiac Death in Individuals with the Electrocardiographic Pattern of Brugada Syndrome and No Previous Cardiac Arrest

Multivariate analysis identified the inducibility of a sustained ventricular arrhythmia (P<0.0001) and a history of syncope (P<0.01) as predictors of events. Logistic regression analysis showed that a patient with a spontaneously abnormal ECG, a previous history of syncope, and inducible sustained ventricular arrhythmias had a probability of 27.2% of suffering an event during follow-up.

Use of automated external defibrillator by first responders in out of hospital cardiac arrest: prospective controlled trial

Use of automated external defibrillators by first responders did not significantly increase survival to discharge from hospital, although it did improve return of spontaneous circulation and admission to hospital. Improved dispatch procedures should increase the success of programmes of first responders using external defibrillators.

Congenital Short QT Syndrome and Implantable Cardioverter Defibrillator Treatment: Inherent Risk for Inappropriate Shock Delivery

The congenital short QT syndrome constitutes a new clinical entity with an increased risk for sudden cardiac death. Currently, ICD treatment is the only therapeutic option.

Implantable Cardioverter Defibrillator Events in Patients with Asymptomatic Nonsustained Ventricular Tachycardia: Is Device Implantation Justified?

Patients with coronary disease and asymptomatic NSVT commonly receive appropriate defibrillator therapy. These results support the need for ICD implantation for primary prevention, with attention to careful programming of the detection rate to prevent inappropriate therapy.

Usefulness of ST-segment elevation in lead aVR during tachycardia for determining the mechanism of narrow QRS complex tachycardia

aVR ST-segment elevation during narrow QRS complex tachycardia favors the atrioventricular reentry through an accessory pathway as the mechanism of the tachycardia.

Total Atrioventricular Nodal Ablation Increases Atrial Fibrillation Burden in Patients with Paroxysmal Atrial Fibrillation Despite Continuation of Antiarrhythmic Drug Therapy

TAVN ablation increases AF burden and facilitates the development of persistent AF in patients with paroxysmal AF despite the continuation of antiarrhythmic drugs. Loss of AV and/or interventricular synchrony may lead to altered cardiac hemodynamics resulting in atrial stretch and increasing AF burden.

Left Atrial Radiofrequency Ablation During Cardiac Surgery in Patients with Atrial Fibrillation

Endocardial RF left atrial compartmentalization during cardiac surgery is effective in restoring sinus rhythm in many patients. This technique is easy to perform and reproducible. Rare RF ablation-related complications can occur. During follow-up, sinus rhythm persistence is good, and biatrial contraction is preserved in most patients.

Evaluation of the Appropriateness of Pacemaker Mode Selection in Bradycardia Pacing: How Closely are the ACC/AHA Guidelines Followed?

(1) elderly denied a dual chamber system with no clinical explanation and (2) selection of rate-modulated devices without any indication of chronotropic incompetence.

Optimal Pacing for Symptomatic AV Block: A Comparison of VDD and DDD Pacing

The lower cost, high reliability, and abbreviated implantation time suggest that VDD pacing is a viable alternative to DDD pacing in patients with high-degree AV block and normal sinus node function.  

Long-term effectiveness of cardiac resynchronization therapy in patients with refractory heart failure and “narrow” QRS

Cardiac resynchronization therapy determined clinical and functional benefit that was similar in patients with wide or “narrow” QRS. Cardiac resynchronization therapy may be helpful in patients with echocardiographic evidence of interventricular and intraventricular asynchrony and incomplete left bundle branch block.

Noninvasive Arrhythmia Risk Stratification in Idiopathic Dilated Cardiomyopathy: Results of the Marburg Cardiomyopathy Study

Reduced LV ejection fraction and lack of ß-blocker use are important arrhythmia risk predictors in IDC, whereas signal-averaged ECG, baroreflex sensitivity, heart rate variability, and T-wave alternans do not seem to be helpful for arrhythmia risk stratification.

The optimal intensity of vitamin k antagonists in patients with mechanical heart valves: A meta-analysis

This meta-analysis shows that both aortic and mitral valves will benefit from a treatment strategy with a target INR higher than 3.0.

Clinical efficacy of cardiac resynchronization therapy using left ventricular pacing in heart failure patients stratified by severity of ventricular conduction delay

Left ventricular pacing significantly improves exercise tolerance and quality of life in patients with chronic HF, LV systolic dysfunction, and a QRS interval over 150 ms.

Routine vitamin supplementation to prevent cardiovascular disease: a summary of the evidence for the U.S. preventive services task force

The US Preventive Services Task Force (USPSTF) concluded the evidence is insufficient to recommend for or against use of supplements of vitamin A, C or E; multivitamins with folic acid or antioxidant combinations for the prevention of cancer or CV disease. The USPSTF recommends against use of beta carotene supplements alone or in combination for the prevention of either cancer or CVD.

Inflammation as a Risk Factor for Atrial Fibrillation

CRP is not only associated with the presence of AF but may also predict patients at increased risk for future development of AF.

Successful Catheter Ablation of Electrical Storm after Myocardial Infarction

Incessant ventricular tachyarrhythmias after MI may be triggered by VPBs. RF ablation of the triggering VPBs is feasible and can prevent drug-resistant electrical storm, even after acute MI.

Long QT syndrome patients may faint due to neurocardiogenic syncope

Syncope in LQTS can be of neurocardiogenic origin and is not necessarily due to TdP.

Use of enalapril to facilitate sinus rhythm maintenance after external cardioversion of long-standing persistent atrial fibrillation

The addition of enalapril to amiodarone decreased the rate of immediate and subacute arrhythmia recurrences and facilitated subsequent long-term maintenance of sinus rhythm after cardioversion of persistent AF.

Diazepam or midazolam for external DC cardioversion (The DORM Study)

Physician-led cardioversion of atrial arrhythmias using intravenous sedation is effective and well tolerated. Sedation with diazepam was associated with fewer minor adverse events and a quicker recovery time than midazolam.

Chronic periodontitis, a significant relationship with acute myocardial infarction

Patients who at routine dental visits demonstrate evidence of bone loss around several teeth can predictably be identified as being at risk for future AMI.

Walk test at increased levels of heart rate in patients with dual-chamber pacemaker and with normal or depressed left ventricular function

Increasing heart rate in presence of ventricular asynchrony induced by dual-chamber pacing has negative effect on cardiac contractility and does not improve CO at rest or during physical activity in patients with depressed LV function as occurs in those with normal function.

Comparison of effectiveness of implantable cardioverter defibrillator in patients with idiopathic dilated cardiomyopathy versus those with proved coronary heart disease

There were no differences in the type and probability of recurrences at follow-up.

Optimal duration of monitoring in patients with unexplained syncope

There is a low risk of syncope after 1 year of monitoring without an event.

Water Ingestion as Prophylaxis Against Syncope

Water enhances tolerance of upright posture. The effect of water is mediated by increased peripheral vascular resistance.

Prevention of atrial fibrillation recurrence by statin therapy in patients with lone atrial fibrillation after successful cardioversion

The use of statins was associated with a significant decrease in the risk of arrhythmia recurrence after successful cardioversion of AF.
 

A new oral therapy for long QT syndrome: Long-term oral potassium improves repolarization in patients with HERG mutations

Long-term oral potassium administration increases serum K+ in patients with LQT2. This can be achieved safely and results in improvement in repolarization.

 

Depressive symptoms and the risk of sudden cardiac death among the elderly

Depressive symptoms increase the risk of SCD, but not that of non-SCD and non-fatal MI among the elderly subjects.


 

QT-interval prolongation in right precordial leads: an additional electrocardiographic hallmark of Brugada syndrome

In accordance with the electrophysiological background, the typical ECG pattern of Brugada syndrome is also characterized by a considerable prolongation of the QT interval in right precordial leads.

Randomized Controlled Trial of Fixed Rate Versus Rate Responsive Pacing After Radiofrequency Atrioventricular Junction Ablation: Quality of Life, Ventricular Refractoriness, and Paced QT Dispersion

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.

Right Ventricular Outflow Versus Apical Pacing in Pacemaker Patients with Congestive Heart Failure and Atrial Fibrillation

In patients with CHF, LV dysfunction, and chronic AF, RVOT and dual-site RV pacing shorten QRS duration but after 3 months do not consistently improve QOL or other clinical outcomes compared with RVA pacing.

A Randomized Study of Prophylactic Catheter Ablation in Asymptomatic Patients with the Wolff–Parkinson–White Syndrome

Prophylactic accessory-pathway ablation markedly reduces the frequency of arrhythmic events in asymptomatic patients with the Wolff–Parkinson–White syndrome who are at high risk for such events.

Catheter Ablation for Paroxysmal Atrial Fibrillation Segmental Pulmonary Vein Ostial Ablation Versus Left Atrial Ablation

In patients undergoing catheter ablation for PAF, LACA to encircle the PVs is more effective than SOCA.

Report of erectile dysfunction after therapy with beta-blockers is related to patient knowledge of side effects and is reversed by placebo

The knowledge and prejudice about side effects of beta-blockers can produce anxiety, that may cause erectile function.

The Influence of High Versus Normal Impedance Ventricular Leads on Pacemaker Generator Longevity

Implantation of a high impedance lead for ventricular pacing results in a clinically relevant extension of generator longevity.

Death in patients with permanent pacemakers for sick sinus syndrome

After a median follow-up of 33 months, 404 (20%) patients died, including 198 (49%) of noncardiac causes. Patients treated with permanent pacemakers for sinus node dysfunction are elderly and have a substantial mortality rate, with more than half the classifiable deaths being noncardiac.  

Comparison of Standard Cardiopulmonary Resuscitation Versus the Combination of Active Compression-Decompression Cardiopulmonary Resuscitation and an Inspiratory Impedance Threshold Device for Out-of-Hospital Cardiac Arrest

Compared with S-CPR, ACD+ITD CPR significantly improved short-term survival rates for patients with out-of-hospital cardiac arrest. Additional studies are needed to evaluate potential long-term benefits of ACD+ITD CPR.

Orthostatic headaches without CSF leak in postural tachycardia syndrome

Orthostatic headaches are not always caused by CSF leak or supine intracranial hypotension. Occasionally they may be the major clinical manifestation of postural tachycardia syndrome or orthostatic intolerance.

Unexplained syncope in patients with structural heart disease and no documented ventricular arrhythmias: value of electrophysiologically guided implantable cardioverter defibrillator therapy

Syncope per se does not necessarily herald a bad prognosis. PVS identifies high-risk patients. Induction of ventricular fibrillation with double or triple extrastimuli is of limited value. Patients with poor left ventricular function and bad clinical condition benefit most from an ICD.

Long-Term Complication Rates in Ventricular, Single Lead VDD, and Dual Chamber Pacing

Operation time and complication rates of physiological pacing are reduced by VDD pacemaker implantation.

Seven-year outcome in the RITA-2 trial: coronary angioplasty versus medical therapy

An initial strategy of PTCA did not influence the risk of death or MI, but it improved angina and exercise tolerance. Patients considered suitable for PTCA or medical therapy can be safely managed with continued medical therapy, but percutaneous intervention is appropriate if symptoms are not controlled.

Predictors and Clinical Impact of Atrial Fibrillation After Pacemaker Implantation in Elderly Patients Treated with Dual Chamber Versus Ventricular Pacing

DDDR pacing mode protected against the development of AF.

Chronic Experiences with a Single Lead Dual Chamber Implantable Cardioverter Defibrillator System

The first experiences with the new VDD-ICD system show an increase of the specificity to detect ventricular tachycardias to a level comparable to dual chamber ICDs with two leads.

Coincidence of idiopathic ventricular outflow tract tachycardia and atrioventricular nodal reentrant tachycardia

Coincidence of idiopathic outflow tract VT and AVNRT was found in 15% of cases of clinically documented idiopathic VT.

Clinical and electrophysiological characteristics in patients with atrioventricular reentrant and atrioventricular nodal reentrant tachycardia

Patients with AVRT have a lower mean age at arrhythmia symptom onset compared with those with AVNRT and have fewer associated cardiac abnormalities. Clinical presentation is quite similar as well as their outcome after ablation.

Comparison of the haemodynamic effects of right ventricular outflow-tract pacing with right ventricular apex pacing: A quantitative review

Right ventricular outflow-tract pacing may offer a modest but significant benefit over right ventricular apex pacing in patients selected for pacemaker implantation on the basis of symptomatic bradyarrhythmias.

Effects of Eplerenone, Enalapril, and Eplerenone/Enalapril in Patients With Essential Hypertension and Left Ventricular Hypertrophy The 4E–Left Ventricular Hypertrophy Study

Eplerenone was as effective as enalapril in LVH regression and blood pressure control. The combination of eplerenone and enalapril was more effective in reducing LV mass and systolic blood pressure than eplerenone alone.

Prolonged Atrial Action Potential Durations and Polymorphic Atrial Tachyarrhythmias in Patients with Long QT Syndrome

PolyAT appears to be a specific arrhythmia of LQTS reminiscent of an atrial form of "torsades de pointes."

QRS duration and prediction of mortality in patients undergoing risk stratification for ventricular arrhythmias

Prolonged QRS duration is a strong independent marker of long-term mortality in patients who undergo risk stratification for ventricular arrhythmias.

Non-sustained ventricular tachycardia in hypertrophic cardiomyopathy: an independent marker of sudden death risk in young patients

Non-sustained ventricular tachycardia is associated with a substantial increase in sudden death risk in young patients with HCM.

Sulfonylureas attenuate electrocardiographic ST-segment elevation during an acute myocardial infarction in diabetics

Sulfonylurea therapy appears to attenuate the magnitude of ST-segment elevation during an AMI, resulting in failure to meet criteria for thrombolytic therapy.

Significant gender-related differences in radiofrequency catheter ablation therapy

Women are referred for ablation later than are men, after a longer duration of symptoms, and after having been given more antiarrhythmic drugs.

Comparison of the haemodynamic effects of right ventricular outflow-tract pacing with right ventricular apex pacing: A quantitative review

Right ventricular outflow-tract pacing may offer a modest but significant benefit over right ventricular apex pacing in patients selected for pacemaker implantation on the basis of symptomatic bradyarrhythmias.

QRS duration: a simple marker for predicting cardiac mortality in ICD patients with heart failure

Within subgroups at highest risk of cardiac death, QRS duration—a simple non-invasive index—predicts outcome in ICD recipients in the presence of heart failure.

Ventricular Flutter Induced During Electrophysiologic Studies in Patients with Old Myocardial Infarction: Clinical and Electrophysiologic Predictors, and Prognostic Significance

The prognostic value of inducible ventricular flutter is comparable to that of SMVT.

Are Electrophysiological Studies Needed Prior to Defibrillator Implantation?

Based on these retrospective data, routine electrophysiological study prior to ICD implantation seems to be advisable.

Analysis of Implantable Cardioverter Defibrillator Therapy in the Antiarrhythmics Versus Implantable Defibrillators (AVID) Trial

An appropriate shock was delivered in 53%. The first arrhythmia treated in follow-up was diagnosed as VT (63%), VF (13%), supraventricular tachycardia (18%), unknown arrhythmia (3%), or due to ICD malfunction or inappropriate sensing (3%). Acceleration of an arrhythmia by the ICD occurred in 8%. 

Mitral Valve Surgery Can Now Routinely Be Performed Endoscopically

Endoscopic mitral valve surgery can be performed safely but definitely requires a learning curve. Good results and a high patient satisfaction are guaranteed.

Percutaneous Pericardial Instrumentation for Endo-Epicardial Mapping of Previously Failed Ablations

Epicardial instrumentation and ablation appeared feasible and safe and provided an alternative strategy for the treatment of patients with a variety of arrhythmias. 

Clinical and electrophysiological characteristics in patients with atrioventricular reentrant and atrioventricular nodal reentrant tachycardia

Patients with AVRT have a lower mean age at arrhythmia symptom onset compared with those with AVNRT and have fewer associated cardiac abnormalities. Clinical presentation is quite similar as well as their outcome after ablation. A correct diagnosis by standard ECG is more frequent in AVNRT.

High prevalence of right ventricular involvement in endurance athletes with ventricular arrhythmias

Complex ventricular arrhythmias do not necessarily represent a benign finding in endurance athletes. An electrophysiological study is indicated for risk evaluation, both by defining inducibility and identifying the arrhythmogenic mechanism. Endurance athletes with arrhythmias have a high prevalence of right ventricular structural and/or arrhythmic involvement. Endurance sports seems to be related to the development and/or progression of the underlying arrhythmogenic substrate.

Proportion and prognosis of healthy people with coved or saddle-back type ST segment elevation in the right precordial leads during 10 years follow-up

The average proportion of healthy subject who had coved or saddle-back type of ST elevation in the right precordial leads without family history of sudden death was 1.22% and the risk of fatal arrhythmias was low (1/393.5 subject-years).

INR Self-Management Permits Lower Anticoagulation Levels After Mechanical Heart Valve Replacement

Early onset INR self-management under oral anticoagulation after mechanical heart valve replacement enables patients to keep within a lower and smaller INR target range.

Effect of Modern Pacing Algorithms on Generator Longevity: A Predictive Analysis

Two algorithms: Capture Management and Search AV, have clinical relevance in the extension of PG longevity.

Radiofrequency Ablation of Probable Atrioventricular Nodal Reentrant Tachycardia in Children with Documented Supraventricular Tachycardia Without Inducible Tachycardia

In selected patients, empiric slow pathway modification may be offered as a potential cure in children with recurrent paroxysmal SVT who are not inducible at electrophysiological study. Elimination of slow pathway conduction may serve as a surrogate endpoint, though is not necessary for long-term success.

Mapping and Ablation of Ventricular Fibrillation Associated With Long-QT and Brugada Syndromes

Triggers from the Purkinje arborization or the right ventricular outflow tract have a crucial role in initiating ventricular fibrillation associated with the long-QT and Brugada syndromes. These can be eliminated by focal radiofrequency ablation.


 

Prediction of sudden cardiac death after myocardial infarction in the beta-blocking era

The common arrhythmia risk variables, particularly the autonomic and standard ECG markers, have limited predictive power in identifying patients at risk of SCD after AMI in the beta-blocking era.

A Randomized Prospective Study of Single Coil Versus Dual Coil Defibrillation in Patients with Ventricular Arrhythmias Undergoing Implantable Cardioverter Defibrillator Therapy

No significant advantage of a dual coil lead system over a single coil system in terms of lead values and defibrillation thresholds.

Ablate and pace revisited: long term survival and predictors of permanent atrial fibrillation

Ablate and pace is associated with a low overall mortality. No predictors of permanent atrial fibrillation were identified, but 48% of patients were still in sinus rhythm at 72 months. These results support the use of dual chamber pacing for paroxysmal atrial fibrillation patients after ablate and pace.

Short QT Syndrome A Familial Cause of Sudden Death

The short QT syndrome is characterized by familial sudden death, short refractory periods, and inducible ventricular fibrillation. It is important to recognize this ECG pattern because it is related to a high risk of sudden death in young, otherwise healthy subjects.

A randomized comparison of atrial and dual-chamber pacing in 177 consecutive patients with sick sinus syndrome: Echocardiographic and clinical outcome

During a mean follow-up of 2.9 ± 1.1 years, DDDR pacing causes increased LA diameter, and DDDR pacing with a short atrioventricular delay also causes decreased LVFS. No changes occur in LA or LV diameters or LVFS during AAIR pacing. Atrial fibrillation is significantly less common during AAIR pacing. 

Comparison of monophasic and biphasic shocks for transthoracic cardioversion of atrial fibrillation

A protocol using monophasic waveform shocks in a 200–360 J sequence has the same efficacy (90%) as a protocol using rectilinear biphasic waveform shocks in a 120–200 J sequence.

A new pacemaker algorithm for the treatment of atrial fibrillation: Results of the Atrial Dynamic Overdrive Pacing Trial (ADOPT)

Overdrive atrial pacing with the AF Suppression Algorithm decreased symptomatic AF burden significantly in patients with sick sinus syndrome and AF. The decrease in relative AF burden was substantial (25%), although the absolute difference was small (2.50% control vs. 1.87% treatment).

Fish Consumption Is Associated With Lower Heart Rates

Fish consumption is associated with decreased heart rate in men. Because heart rate is positively associated with risk of sudden death, this association may explain, at least in part, the lower risk of sudden death among fish consumers.

Effect of 7-Year Infancy-Onset Dietary Intervention on Serum Lipoproteins and Lipoprotein Subclasses in Healthy Children in the Prospective, Randomized Special Turku Coronary Risk Factor Intervention Project for Children (STRIP) Study

The 7-year intervention favorably influenced not only the serum total and LDL cholesterol concentrations but also the LDL particle size in boys.

Effects of initiating carvedilol in patients with severe chronic heart failure. Results from the COPERNICUS study

These data suggest that, in clinically euvolemic patients, the relation of benefit to risk during early initiation of treatment with carvedilol is similar to that seen during long-term therapy with the drug. These findings should provide the reassurance needed to encourage the high levels of use that are warranted by the results of long-term clinical trials.

The risks of β-blockade have been significantly overestimated and the benefits underappreciated. Benefits from carvedilol began to appear about 21 days after its initiation, supporting both the importance of prompt initiation of therapy and the benefit of even low doses of carvedilol (as seen in an earlier study of mild to moderate heart failure). At this point, the safety criteria utilized in COPERNICUS (clinical euvolemia, no intravenous inotrope or vasodilator within the prior 4 days) remain a reasonable guideline for initiation of therapy.

Complications of inappropriate use of spironolactone in heart failure: when an old medicine spirals out of new guidelines

Complications of hyperkalemia, hyponatremia and renal insufficiency were far more common in this study of patients treated with spironolactone in clinical practice compared to patients in the RALES trial. The RALES investigators reported serious hyperkalemia (K≥6.0 mEq/L) in 2% of the patients treated with spironolactone, and did not report less serious degrees of hyperkalemia.  

Inhaled beta-2 adrenergic receptor agonists and primary cardiac arrest

A two-fold increase in the risk of cardiac arrest. The increase risk of cardiac arrest is eliminated by the concomitant use of inhaled steroids.

There are several possible mechanisms by which inhaled β-agonists may increase the risk of cardiac arrest, including: precipitation of ischemia in coronary artery disease; lowering of the ventricular fibrillation threshold; triggering of ventricular tachycardia in susceptible patients (e.g., prior myocardial infarction, idiopathic ventricular tachycardia, long-QT syndrome).

Epinephrine unmasks latent mutation carriers with LQT1 form of congenital long-QT syndrome

Although the sample sizes were fairly small, the results suggest that an epinephrine challenge may be an excellent screening tool for family members of a patient identified to have the LQT1 form of LQTS. If these results are confirmed in larger studies, the decision to institute prophylactic therapy for family members of probands could be based simply on the response to epinephrine, rather than on the more expensive and lengthy process of gene analysis.

Risk stratification in the long-QT syndrome

The risk of cardiac events in the LQTS is affected by the genotype and is the lowest in patients with LQTS1. Asymptomatic patients at highest risk of a cardiac event consist of males or females with LQTS1 and a QTc ≥500 ms, males with LQTS2 and a QTc ≥500 ms, females with LQTS2 (regardless of the QTc) and all patients with LQTS3.

Complete heart block: determinants and clinical impact in patients with hypertrophic obstructive cardiomyopathy undergoing nonsurgical septal reduction therapy

14% developed CHB after the procedure. Multivariate logistic regression analysis showed that female gender, bolus injection of ethanol, injecting more than one septal artery, the presence of left bundle branch block, and first-degree AV block on the baseline ECG are independent predictors of CHB after NSRT. Patients with CHB after NSRT derive similar clinical and hemodynamic benefit to patients who did not require permanent pacing.

Maintenance of sinus rhythm in patients with atrial fibrillation: An AFFIRM substudy of the first antiarrhythmic drug

62% were successfully treated with amiodarone, compared with 23% taking class I agents . In 256 patients randomized between amiodarone and sotalol, 60% versus 38% were successfully treated, respectively. In 183 patients randomized between sotalol and class I agents, 34% versus 23% were successfully treated, respectively.
 

Are lipid-lowering drugs also antiarrhythmic drugs? an analysis of the antiarrhythmics versus implantable defibrillators (AVID) trial