Team Management of the Ventricular Tachycardia Patient

Tang, Pok‐Tin; H, Duc; Li, Anthony; Boyle, Noel G.

doi:10.15420/aer.2018.37.2

Cited by 18 publications

(17 citation statements)

References 90 publications

(65 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The type of VT can guide suitable pharmacological approach. Idiopathic outflow tract VT responds to beta-blockers, while adenosine can successfully terminate monomorphic right ventricular outflow tract (RVOT) VT. 2 , 11 American Heart Association/American College of Cardiology/Heart Rhythm Society (AHA/ACC/HRS) Guideline recommends Procainamide as a preferred option over Amiodarone. 12 However, Amiodarone is traditionally used as first option based on clinicians experience.…”

Section: Discussionmentioning

confidence: 99%

“… 12 However, Amiodarone is traditionally used as first option based on clinicians experience. 11 VM, a vagal manoeuvre, however, is not recommended by convention as part of VT treatment, partly due to lack of understanding in its mechanism in terminating certain types of VT in anecdotal cases. In this case report, VT-1 possesses the same ECG morphologies as RVOT VT (i.e.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A case report reappraising the usefulness of Valsalva manoeuvre in drug-refractory ventricular tachycardia

Lwin

Mitrakrishnan

Alama

et al. 2021

European Heart Journal - Case Reports

View full text Add to dashboard Cite

Background Ventricular tachycardia (VT) is often misdiagnosed as supraventricular tachycardia with aberrancy. Twelve-lead electrocardiogram remains a key diagnostic tool to differentiate them while providing insights to aid localization of VT. The use of Valsalva manoeuvre (VM) in terminating VT is not conventionally recommended due to lack of robust evidence of its effectiveness and poor understanding of its mechanism in terminating VT. Case summary A 74-year-old man with history of ischaemic heart disease was admitted with broad complex tachycardia. VT-1 was diagnosed following failed tachycardia termination by adenosine. Haemodynamic compromise necessitated synchronized cardioversion with successful reversion. However, a different VT-2 occurred after cardioversion. VM led to successful termination of VT-2. Subsequently, recurrent episodes of VT-2 occurred with consistent termination by VM. Transthoracic echocardiogram, cardiac magnetic resonance imaging, and a coronary angiogram were performed. Findings suggested that these are likely scar-related VT. VT-1 originated from an anteroseptal scar, whilst VT-2, responsive to VM, likely originated from the Purkinje fibres. Patient remained eurhythmic after Day 1 following amiodarone and beta-blocker initiation. An implantable cardioverter-defibrillator was implanted prior to discharge. Discussion VM is one of the vagal manoeuvres which are commonly used as initial management of supraventricular tachycardia. Its role in management of VT is obscure. Anecdotal case series recorded its successful use for managing particular VT. Exact mechanism remains elusive although postulated to involve change in cardiac size during strain and release of acetylcholine.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A case report reappraising the usefulness of Valsalva manoeuvre in drug-refractory ventricular tachycardia

Lwin

Mitrakrishnan

Alama

et al. 2021

European Heart Journal - Case Reports

View full text Add to dashboard Cite

show abstract

“…In cases of hemodynamically unstable sustained VT, the priority is stabilization and electrical cardioversion. Whereas, in cases of hemodynamically stable VT, treatment with antiarrhythmic medications should be initiated [9]. If the VT morphology suggests idiopathic outflow tract VT (left bundle pattern with inferior axis), treatment with intravenous beta-blockers or adenosine may terminate the arrhythmia.…”

Section: Discussionmentioning

confidence: 99%

Radiofrequency catheter ablation of ventricular tachycardia in pediatric patients

et al. 2020

View full text Add to dashboard Cite

Background Radiofrequency catheter ablation (RFCA) has been accepted as an efficient therapy for tachycardia, and substantial improvement in the outcomes of RFCA in pediatric patients has been seen. However, there is not enough data on the clinical outcomes of RFCA for ventricular tachycardia (VT) in pediatric patients. The objective of this study was to elucidate the efficacy and safety of RFCA for VT in pediatric patients. Methods We performed a retrospective study involving 35 consecutive pediatric VT ablation procedures in 28 patients at a single institution. Results The median age at ablation was 14.0 years (range 6.9–19.2 years). There were 24 patients with a structurally normal heart and four patients with congenital heart disease (CHD). The left ventricular posteroseptal area was the most common site of VT origin (22/28, 78.6%). However, there was an unusual case of VT which involved a papillary muscle as its origin. Acute success was achieved in 30 (85.7%) of 35 procedures. The recurrence rate after successful RFCA was 14.2% (5/35) at a median follow-up of 6.7 years (range 1.0–16.7 years). There were five procedural failures due to the inability to induce VT for complete mapping. Ultimately, long-term success was achieved in 27 patients (96.4%) after repeated procedures and no major complications occurred. Long-term success was associated with VT inducibility (p = < 0.001). Conclusions Difficulty in inducing VT for precise mapping was a significant obstacle to successful RFCA. RFCA was identified as safe and effective therapy to eliminate VT in the selected pediatric VT patients.

show abstract

“…Amiodarone is the drug of choice for rhythm control in the acute setting because of its broad spectrum of action and relatively modest negative inotropic impact on ventricular function. In case the patient is unstable, immediate cardioversion is performed [45]. Although currently less common, heart block is another serious complication that should be rapidly recognized and managed in the ED [46].…”

Section: Arrhythmiasmentioning

confidence: 99%

Thalassemia in the emergency department: special considerations for a rare disease

et al. 2020

View full text Add to dashboard Cite

Thalassemia is characterized by a defect in the synthesis of one or more of the globin subunits of hemoglobin. This defect results in imbalance in the α/β-globin chain ratio, ineffective erythropoiesis, chronic hemolytic anemia, and iron overload. With advances in diagnosis, treatment, and transfusion support, the prognosis of patients with thalassemia has improved over the past few decades. An increasing number of patients with thalassemia is living with long-term complications, including cardiomyopathy, chronic liver disease, endocrinopathy, and infections. In this paper, we review common complications that bring the patient with thalassemia to urgent or emergent medical attention. We also discuss the aspects of emergency care that are most relevant while caring for the patient with thalassemia in the emergency department.

show abstract

Team Management of the Ventricular Tachycardia Patient

Cited by 18 publications

References 90 publications

A case report reappraising the usefulness of Valsalva manoeuvre in drug-refractory ventricular tachycardia

A case report reappraising the usefulness of Valsalva manoeuvre in drug-refractory ventricular tachycardia

Radiofrequency catheter ablation of ventricular tachycardia in pediatric patients

Thalassemia in the emergency department: special considerations for a rare disease

Contact Info

Product

Resources

About