No association between scar size and characteristics on T-wave alternans in post-myocardial infarction patients with relatively preserved ventricular function presented with nonsustained ventricular tachycardia

Yalın, Kıvanç; Gölcük, Ebru; Teker, Erhan; Yılmaz, Ravza; Dursun, Memduh; Bilge, Ahmet Kaya; Adalet, Kâmil

doi:10.5152/akd.2014.4918

Cited by 6 publications

(15 citation statements)

References 28 publications

(26 reference statements)

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“…Dinov et al showed a significant correlation between the surface of the endocardial scar and QRSf duration, while TWA levels were proportional to the size of the scar in simulation studies . In our study, none of the ECG, SA‐ECG, and TWA parameters were significantly correlated to the scar areas.…”

Section: Discussioncontrasting

confidence: 58%

“…Twenty‐two patients were enrolled in this study. All patients had a history of previous MI 14 ± 9 years before, median 13 . Clinical characteristics are depicted in Table .…”

Section: Resultsmentioning

confidence: 99%

“…Besides these multiple parameters and investigations, however, a very few works have been dedicated to the correlations between these non invasive risk markers and the scars characteristics in patients with structural heart disease, and to the modifications of these risk markers through ablation …”

Section: Discussionmentioning

confidence: 99%

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Correlations between arrhythmogenic substrate and noninvasive risk stratification in ischemic heart disease patients modifications by radiofrequency ablation

Voglimacci‐Stephanopoli

Rollin

Mondoly

et al. 2019

Cardiovasc electrophysiol

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Introduction Several noninvasive risk factors for ventricular arrhythmias have been described in postmyocardial infarction (MI) patients, whose relationships with scar characteristics and modifications by ablation are unknown. Methods Twenty‐two patients with previous MI referred for ventricular tachycardia ablation were prospectively included. ECG, heart rate variability (HRV), signal‐averaged ECG (SA‐ECG), and T wave alternans (TWA) were performed before and after radiofrequency ablation. Scar areas were correlated to preablation parameters. Pre and postablation parameters were furthermore compared. Results Left ventricular ejection fraction and some spectral and time‐domain HRV parameters were significantly correlated to the scar areas. QRS duration was larger after vs before ablation (120 ± 29 vs 105 ± 22 msec, P = .01). No significant modification in time or spectral domain of HRV was observed. There was no significant change in TWA and SA‐ECG before and after ablation. Borderline decreases in quantitative TWA parameters were noted in patients with positive TWA and successful ablation procedure. Conclusion Some noninvasive risk factors were linked to the scar areas, but few were significantly modified after ablation. Larger populations are needed to demonstrate significant differences or correlations.

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Section: Discussioncontrasting

confidence: 58%

“…Twenty‐two patients were enrolled in this study. All patients had a history of previous MI 14 ± 9 years before, median 13 . Clinical characteristics are depicted in Table .…”

Section: Resultsmentioning

confidence: 99%

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Correlations between arrhythmogenic substrate and noninvasive risk stratification in ischemic heart disease patients modifications by radiofrequency ablation

Voglimacci‐Stephanopoli

Rollin

Mondoly

et al. 2019

Cardiovasc electrophysiol

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“…There are several positive points in this manuscript (11). The aim of the study is very interesting and important from the clinical point of view.…”

mentioning

confidence: 98%

“…The Authors of the article entitled "No association between scar and characteristics on T-wave alternans in post-myocardial infarction patients with relatively preserved ventricular function presented with non-sustained ventricular tachycardia" published in this issue of Anatolian Journal of Cardiology tried to investigate important clinical issue concerning the relationship between electrical (TWA analyzed with the use of MMA method) and morphological (ECHO, CMR) results in a group of post-myocardial infarction patients (11). Of note, the link between electrical and morphological parameters of myocardium has been analyzed only in some experimental studies (12,13) and has not been clarified yet.…”

mentioning

confidence: 99%

No association between scar and characteristics on T-wave alternans in post-myocardial infarction patients with relatively preserved ventricular function presented with non-sustained ventricular tachycardia

Daniłowicz‐Szymanowicz¹

2014

Anadolu Kardiyol Derg

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No association between scar and characteristics on T-wave alternans in post-myocardial infarction patients with relatively preserved ventricular function presented with non-sustained ventricular tachycardia 448Sudden cardiac death (SCD) represents a major problem of clinical cardiology. According to statistical data, ca 250-300 thousand individuals die suddenly each year in the USA (1). The leading cause of SCD, responsible for 75-80% of cases, are malignant arrhythmias, including sustained ventricular tachycardia (VT) and ventricular fibrillation (VF). The risk is greatest in patients with history of a VT/VF episode. In patients without history of VT/VF episodes, the most important parameter identifying those at greatest SCD risk is left ventricular ejection fraction (LVEF) below 35-40%. It has been demonstrated, however, that patients with significantly impaired LVEF represent only ca 30% of the total number of SCD cases (2). The evidence to date unequivocally points to the fact that the number of SCD cases in patients with preserved or relatively preserved left ventricular systolic function is very high. Hence, the development of a new research projects that will focus not only on the patients with significant systolic dysfunction, may potentially have a major scientific impact.Among patients with preserved or relatively preserved left ventricular function, those who present with structural cardiac abnormalities, are of special importance with regard to SCD epidemiology. As reported by Chugh et al. (3), in as much as 95% of patients who died suddenly, morphological abnormalities in the heart were found on autopsy. With this regard, patients with ischemic heart disease represent a group of interest, as in those patients ischemic foci and moreover, post-infarct scarring may represent a potential source of ventricular arrhythmia. To date, risk factors for VT/VF and SCD in those patients have not been sufficiently elucidated.With regard to VT/VF risk factors in cardiovascular patients, it should be mentioned that the occurrence of ventricular arrhythmia is related to three pathophysiological components: the presence of arrhythmia substrate, triggers and modulators. Different diagnostic modalities may prove useful in the assessment of parameters reflecting each of the three components of the arrythmogenesis. Modalities used for arrhythmia substrate assessment include echocardiography and other imaging techniques (e.g. CMR-cardiac magnetic resonance). Triggering factors include ventricular extrasystole and episodes of non-sustained VT (nsVT) that can be found on Holter ECG recording. Modulators include microvolt T -wave alternans (TWA), as well as a number of parameters reflecting the autonomic system activity.Echocardiographic study is one of the most accessible diagnostic modalities in cardiology. Apart from prognostic value of LVEF, other echo-derived parameters carrying potential prognostic value for VT/VF and SCD occurrence can be pointed to, such as chamber size with special emphasis on the left ventricle, ma...

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Factors that predict ventricular arrhythmias in the late phase after acute myocardial infarction

Saito

Kondo

Takahashi³

et al. 2021

ESC Heart Failure

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Aims Little is known regarding factors that predict the occurrence of lethal ventricular arrhythmias (VAs) occurring after acute myocardial infarction (AMI). This observational cohort study aimed to identify factors that predicted lethal VAs during the late phase after AMI in patients with reduced left ventricular ejection fraction (LVEF). Methods and results Data were collected from our AMI database regarding consecutive patients with an LVEF of ≤40% after AMI (January 2012 to July 2018). The 'late phase' was defined as ≥7 days after AMI onset, and the primary endpoint was defined as lethal VAs in the late phase. The study included 136 patients (82% men; mean age: 66 ± 13 years). The average LVEF at admission was 32.7 ± 8.2%. During a mean follow-up period of 20.7 months, 14 patients (10%) experienced lethal VAs, including ventricular fibrillation (n = 8) and sustained ventricular tachycardia (n = 10). Univariate analyses revealed that lethal VAs were predicted by age and LVEF at admission. Receiver operating characteristic curve analysis indicated that the optimal cut-off value was 23% for using the LVEF at admission to predict the primary endpoint (area under the curve: 0.77, P < 0.0001). Multivariable analysis also demonstrated that LVEF at admission was an independent predictor of the primary endpoint (risk ratio = 7.12, P = 0.001). Conclusions Lethal VAs in the late phase are common in patients with AMI, and reduced LVEF and cardiac function at admission play a significant role in the risk stratification for future lethal VAs in this population.

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No association between scar size and characteristics on T-wave alternans in post-myocardial infarction patients with relatively preserved ventricular function presented with nonsustained ventricular tachycardia

Cited by 6 publications

References 28 publications

Correlations between arrhythmogenic substrate and noninvasive risk stratification in ischemic heart disease patients modifications by radiofrequency ablation

Correlations between arrhythmogenic substrate and noninvasive risk stratification in ischemic heart disease patients modifications by radiofrequency ablation

No association between scar and characteristics on T-wave alternans in post-myocardial infarction patients with relatively preserved ventricular function presented with non-sustained ventricular tachycardia

Factors that predict ventricular arrhythmias in the late phase after acute myocardial infarction

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