Journal of cardiovascular electrophysiology
-
J. Cardiovasc. Electrophysiol. · Jan 1999
Comparative StudyClinical profile of commotio cordis: an under appreciated cause of sudden death in the young during sports and other activities.
Not particularly well recognized are athletic field catastrophes in which virtually instantaneous cardiac arrest is produced by nonpenetrating chest blows in the absence of heart disease or identifiable morphologic injury to the chest wall or heart (commotio cordis). To better characterize the clinical profile of this syndrome, we have assembled 70 cases, including 34 occurring during organized competitive athletics and 36 others that occurred during informal recreational sports at home, school or the playground, or during nonsporting activities. Ages were 2 to 38 (mean age: 12) with 70% < 16 years old. ⋯ Eleven of the events (16%) occurred despite the presence of chest padding believed to be potentially protective. Four victims experienced modest chest blows while in circumstances completely unrelated to sports activities; three of the four individuals who delivered these blows were ultimately convicted of criminal acts within the justice system. An experimental model of low-energy chest wall impact demonstrates that commotio cordis events are due largely to the exquisite timing of blows during a narrow window within the repolarization phase of the cardiac cycle, 15 to 30 msec prior to the peak of the T wave.
-
J. Cardiovasc. Electrophysiol. · Jan 1999
Comparative StudyBezold-Jarisch-like reflex during radiofrequency ablation of the pulmonary vein tissues in patients with paroxysmal focal atrial fibrillation.
Information is lacking about the occurrence of ablation-related proarrhythmic events during application of radiofrequency (RF) energy at the pulmonary veins in patients with paroxysmal focal atrial fibrillation. The purpose of this study was to assess the theoretical risk of reflex bradycardia and hypotension response during RF ablation of these regions rich in endocardial nerve terminals. ⋯ RF catheter ablation of the pulmonary vein tissues could evoke a variety of profound bradycardia-hypotension responses. The Bezold-Jarisch-like reflex might be the underlying mechanism.
-
J. Cardiovasc. Electrophysiol. · Dec 1998
Verapamil-sensitive left anterior fascicular ventricular tachycardia: results of radiofrequency ablation in six patients.
Verapamil-sensitive left ventricular tachycardia (VT) with a right bundle branch block (RBBB) configuration and left-axis deviation has been demonstrated to arise from the left posterior fascicle, and can be cured by catheter ablation guided by Purkinje potentials. Verapamil-sensitive VT with an RBBB configuration and right-axis deviation is rare, and may originate in the left anterior fascicle. ⋯ Verapamil-sensitive VT with an RBBB configuration and right-axis deviation originates close to the anterior fascicle. RF catheter ablation can be performed successfully from the VT exit site or the zone of slow conduction where the Purkinje potential was recorded in the diastolic phase.
-
J. Cardiovasc. Electrophysiol. · Jun 1998
Case ReportsManagement of patients with the hereditary long QT syndrome.
The hereditary long QT syndrome is an inherited ion channel disorder with QT prolongation, morphologic changes in the T waves, and a relatively high frequency of syncope, T wave alternans, torsades de pointes-type ventricular tachycardia, and sudden death. Monotherapy with beta blockers is the treatment of first choice. In patients with recurrent syncope despite therapy with beta blockers, pacemakers and/or ganglionectomy may be useful in selected cases, with an implantable cardioverter defibrillator used as a fail-safe approach in high-risk patients.
-
J. Cardiovasc. Electrophysiol. · Mar 1998
Clinical TrialEndocardial and epicardial ablation guided by nonsurgical transthoracic epicardial mapping to treat recurrent ventricular tachycardia.
An epicardial site of origin of ventricular tachycardia (VT) may explain unsuccessful endocardial radiofrequency (RF) catheter ablation. A new technique to map the epicardial surface of the heart through pericardial puncture was presented recently and opened the possibility of using epicardial mapping to guide endocardial ablation or epicardial catheter ablation. We report the efficacy and safety of these two approaches to treat 10 consecutive patients with VT and Chagas' disease. ⋯ Epicardial mapping does not enhance the effectiveness of endocardial pulses of RF. Epicardial applications of RF energy can safely and effectively treat patients with VT and Chagas' disease.