Polymorphous ventricular tachycardia: Clinical features and treatment

Sclarovksy, Samuel; Strasberg, Boris; Lewin, Ruben F.; Agmon, Jacob

doi:10.1016/0002-9149(79)90326-6

Cited by 148 publications

(47 citation statements)

References 17 publications

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“…Concerning hospitalbased reports, Grenadier et al 21 reported nine patients with PVT-one of whom developed QT interval prolongation on the ECG prior to the VTwho were admitted to the CCU with AMI, representing a single case of TdP among 771 consecutive patients admitted with an acute coronary ischemic event. Sclarovsky et al 10 reported 34 patients with PVT, the majority of whom had QT prolongation, therefore carrying the rhythm diagnosis of TdP. Nguyen et al 25 described the clinical characteristics of 45 patients with the TdP variant of PVT; approximately 50% of this series of patients had an abnormal QT interval on the ECG immediately prior to or during episodes of recurrent PVT.…”

Section: Discussionmentioning

confidence: 99%

Prevalence, Therapeutic Response, and Outcome of Ventricular Tachycardia in the Out‐of‐hospital Setting: A Comparison of Monomorphic Ventricular Tachycardia, Polymorphic Ventricular Tachycardia, and Torsades de Pointes

Brady

DeBehnke²,

Laundrie

1999

Academic Emergency Medicine

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Abstract. Objective: To investigate out-of-hospital ventricular tachycardia (VT) cardiac arrest patients, comparing the prevalences and outcomes of the following VT subtypes among this population: monomorphic VT (MVT), polymorphic VT (PVT), and torsades de pointes (TdP, PVT with a prolonged QT interval). Methods: This was a retrospective review from a fire department-based paramedic system of nontraumatic VT cardiac arrest patients (January 1991 to December 1994) with a supraventricular perfusing rhythm (SVPR) at some time during out-ofhospital care, with a measurable QT interval. QT interval was measured from an SVPR, and corrected QT interval (QTc) was calculated and considered prolonged if > 0.45 sec. VT was classified as polymorphic or monomorphic. TdP was defined as PVT with a prolonged QT interval. Results: 196 patients were identified; six were excluded due to incomplete medical records, leaving 190 who met inclusion criteria and were used for data analysis. 117 (62%) patients had MVT, while 73 (38%) patients had PVT; of the 73 patients with PVT, 37 (51%) had normal QTc (non-TdP PVT) and 36 (49%) had prolonged QTc (TdP PVT). 97 (51%) patients had prolonged QTc (PQTc). Regardless of VT type (i.e., MVT vs PVT), 97 (51%) patients had prolonged QTc, with a mean QTc of 0.476 Ϯ 0.15 seconds prearrest and 0.464 Ϯ 12 seconds postarrest. Patients with PQTc were not more likely to have PVT (70 [37%] vs 76 [40%]; p = 0.705). No significant difference with respect to paramedic-witnessed arrests in each VT morphology group and each QT group was found. The overall hospital discharge rate was 28.4%. Regardless of VT type, patients had similar rates of out-of-hospital return of spontaneous circulation (ROSC) and hospital discharge; patients with PQTc were less likely to be discharged from the hospital (19.6% vs 37.6%; p = 0.01). 27.8% of TdP and 26.8% of non-TdP patients were discharged (p = 0.912). Conclusions: In this population of out-of-hospital VT arrest patients, MVT is the most common form of VT encountered; PVT and the subtype TdP are also seen in this population with approximately equal frequencies. All three rhythm types demonstrate similar responses to standard Advanced Cardiac Life Support therapy with equal rates of out-of-hospital ROSC and hospital discharge. PQTc may be a marker of poor clinical outcome in patients with out-of-hospital VT arrest. Key words: ventricular tachycardia; QT interval; polymorphic ventricular tachycardia; torsades de pointes; out-of-hospital; cardiac arrest. ACADEMIC EMERGENCY MEDICINE 1999; 6:609-617 S UDDEN cardiac death (SCD) represents a significant public health problem in the United States; ventricular tachycardia (VT) and ventricular fibrillation (VF) are frequently the car- 1,2 In many cases, VF is often preceded by VT; when classified from a morphologic perspective, VT is described as either monomorphic or polymorphic.2,3 Monomorphic VT (MVT) is frequently seen, easily diagnosed, and most often treated according to well-established guidelines in the out-of-hospital set...

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Section: Discussionmentioning

confidence: 99%

Prevalence, Therapeutic Response, and Outcome of Ventricular Tachycardia in the Out‐of‐hospital Setting: A Comparison of Monomorphic Ventricular Tachycardia, Polymorphic Ventricular Tachycardia, and Torsades de Pointes

Brady

DeBehnke²,

Laundrie

1999

Academic Emergency Medicine

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“…However, changes ofthe Q-T interval have been reported to be associated with or precede polymorphous ventricular tachycardia (15) or even serious ventricular arrhythmias as reported in cases of organophosphorus insecticides poisoning (16).…”

Section: Discussionmentioning

confidence: 99%

Quantitative Evaluation of ECG Components of Workers Exposed to Carbon Disulfide

Kamal

Ahmed

Saied

et al. 1991

Environmental Health Perspectives

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“…In addition, the time to completion of local activation was indexed by the total electrogram duration and was defined as the time from the stimulus artifact to the end of the local electrogram recorded at a fixed gain setting of was used during simultaneous pacing the same ventricular tachycardia was induced over the same range of coupling intervals. Additionally, in all three trials in which the effect of current strength was assessed, high current strength pacing at the site of origin proved effective, even though pacing at twice diastolic threshold was not effective (figure 4). Effect of current strength on local refractoriness and conduction.…”

Section: Methodsmentioning

confidence: 99%

Prevention of ventricular tachycardia induction during right ventricular programmed stimulation by high current strength pacing at the site of origin.

Marchlinski¹,

Buxton²,

Miller³

et al. 1987

Circulation

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To determine whether high current strength pacing at the site of origin of ventricular tachycardia (VT) could prevent induction of VT, we studied 11 VTs in 10 patients with In five of the 1 1 trials, no VT could be initiated; in one trial, the VT induction zone was decreased from 80 to 10 msec; in three trials, only VT of a different morphology and a distinct (> 4 cm distant) site of origin was initiated; and in two trials, VT of the same morphology was initiated. In four of the five trials in which all VT was prevented by simultaneous pacing with a high current strength at the site of origin, simultaneous pacing at a lower current strength (twice diastolic threshold) at the site of origin (three VTs) or with equally increased current strength (10 to 20 mA) at nonsites of origin (two VTs) did not prevent initiation. We conclude that: (1) high current strength pacing at the site of origin during the drive train can inhibit VT induction with extrastimuli and, (2) successful prevention of VT may depend on the pacing site being the site of origin and the current strength used during pacing.Circulation 76, No. 2, 332-342, 1987. PACING TECHNIQUES in the management of ventricular tachyarrhythmias have been used almost solely as a means for arrhythmia termination.`Only in the management in preventing ventricular tachyarrhythmias of patients with the long QT syndrome has pacing proven effective with any degree of consistency.`The purpose of this study was to determine whether high current strength ventricular pacing at the site of origin

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Polymorphous ventricular tachycardia: Clinical features and treatment

Cited by 148 publications

References 17 publications

Prevalence, Therapeutic Response, and Outcome of Ventricular Tachycardia in the Out‐of‐hospital Setting: A Comparison of Monomorphic Ventricular Tachycardia, Polymorphic Ventricular Tachycardia, and Torsades de Pointes

Prevalence, Therapeutic Response, and Outcome of Ventricular Tachycardia in the Out‐of‐hospital Setting: A Comparison of Monomorphic Ventricular Tachycardia, Polymorphic Ventricular Tachycardia, and Torsades de Pointes

Quantitative Evaluation of ECG Components of Workers Exposed to Carbon Disulfide

Prevention of ventricular tachycardia induction during right ventricular programmed stimulation by high current strength pacing at the site of origin.

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