Ventricular tachycardia is a common arrhythmia in patients with structural heart disease and heart failure, and is now seen more frequently as these patients survive longer with modern therapies. In addition, these patients often have multiple comorbidities. While anti-arrhythmic drug therapy, implantable cardioverter-defibrillator implantation and ventricular tachycardia ablation are the mainstay of therapy, well managed by the cardiac electrophysiologist, there are many other facets in the care of these patients, such as heart failure management, treatment of comorbidities and anaesthetic interventions, where the expertise of other specialists is essential for optimal patient care. A coordinated team approach is therefore essential to achieve the best possible outcomes for these complex patients.
When the transvenous ICD initially came into use for primary and secondary prevention of sudden cardiac death, defibrillation threshold (DFT) testing was universally performed. However, DFT testing is no longer routinely recommended for transvenous ICD implantation except in certain situations. Risk scores can help guide the decision to perform DFT testing. The subcutaneous ICD represents an area of uncertainty, with limited data available regarding the role of DFT testing in these devices. Current guidelines give a class I recommendation for performing DFT testing at the time of implant. Further studies are needed before this recommendation can be safely dismissed.
Background: Little data exists describing the national burden of supraventricular tachycardia (SVT) related hospitalizations on US healthcare system. The objectives of this study are to examine the temporal trends of SVT-related hospitalizations in the United States and to compare patient characteristics, outcomes, and comorbid diagnoses. Methods: Using the Nationwide Readmission Database from 2010 through 2017, we identified adult (age >17 years) SVT-related hospitalizations using International Classification of Diseases, 9 th /10th Revision, Clinical Modification codes- 427.0/I47.1 as the principal discharge diagnosis. Results: There were 192,853 adult hospitalizations for SVT from 2010 to 2017 across United States. The number of hospitalizations increased from 22,313 in 2010 to 39,216 in 2017. Mean age was 63.9 years, 56.8% females and 55.8% Medicare insured. The proportion of comorbid diagnoses in overall cohort: hypertension 66.4%, diabetes 26.9%, hyperlipidemia 42.8%, coronary artery disease 31.6%, atrial fibrillation 30.0%, cerebrovascular disease 3.4%, renal disease 18.8%, liver disease 4.2% and chronic pulmonary disease 14.7%. From 2010 to 2017, following trends were observed: mean age (63.7 years to 64.1 years), females (59.5% to 54.4%), Medicare insured (53.8% to 57.0%), hypertension (62.2% to 70.0%), diabetes (25.3% to 27.5%), hyperlipidemia (39.6% to 45.0%), coronary artery disease (28.6% to 34.8%), cerebrovascular disease (3.0% to 3.3%), renal disease (12.9% to 23.0%), liver disease (4.5% to 2.8%) and chronic pulmonary disease (13.0% to 16.4%). The overall unadjusted in-hospital mortality was 0.6% and mean length of stay was 3.0 days. The trends of mortality and length of stay changed as follows: 0.5% in 2010 to 0.6% in 2017 and 2.9 days to 3.1 days respectively. Mean hospital charges (in USD) were 40,943 and increased from 31,755 in 2010 to 47,830 in 2017. Conclusions: The number of hospitalizations for SVT have increased among US adults from 2010 to 2017. The proportion of comorbid chronic diseases, in-hospital mortality and the hospitalization charges also increased during the period of analysis.
Introduction: Respiratory failure is a common cause of pulseless electrical activity (PEA) arrest in hospitalized patients, but how pathophysiologic changes in these conditions affect heart rate (HR) pre-arrest is not well described. We describe HR dynamics prior to in-hospital cardiac arrest (IHCA) among PEA/asystole arrest patients with respiratory etiology. Methods: In this retrospective descriptive study, we evaluated 67 patients with ≥3 hours of continuous ECG data recorded immediately preceding PEA/asystole IHCA in a single institution from 2010-2014. We identified respiratory arrest cases (eg. pneumonia, aspiration, pulmonary embolism, acute respiratory distress syndrome) by chart review and evaluated ECG patterns up to 24 hours prior to arrest to identify patterns of HR increase, HR decrease, sinus arrest, and escape rhythms. Results: We identified 31/67 patients with respiratory etiology (age 59±17 years, 52% male, 83% return of spontaneous circulation, 41% survived to discharge); of these 23/31(74%) fit an a priori model of HR response (Figure). Twelve cases demonstrated clear onset of HR increase at a median of 44 (IQR 28-507) minutes prior to arrest, while the remaining 11 cases started the monitoring period in sinus tachycardia. The mean peak HR was 120±20 bpm. An abrupt onset of HR decrease occurred at a median of 3.4 (IQR 2.3-5.9) minutes prior to arrest. Sinus arrest occurred during the HR decrease phase in 18/23 cases; the first escape rhythm was atrial in 11 (61%), junctional in 2 (11%) and ventricular in 3 (17%) cases. Conclusion: The majority of IHCA due to respiratory etiology (74%) follow a typical model of HR increase due to physiologic compensation to hypoxia, followed by rapid HR decrease leading to PEA arrest, likely from the vagal effect of hypoxia and sinus node suppression from acidosis. Understanding HR trends can aid clinical management as well as development of artificial intelligence models for prediction of IHCA.
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