Electrophysiological studies in patients with chronic recurrent ventricular tachycardia.

Denes, Pablo; Wu, Delon; Dhingra, Ramesh C.; Amat-y-Leon, R; Wyndham, Christopher; Mautner, Richard K.; Rosen, Kenneth M.

doi:10.1161/01.cir.54.2.229

Cited by 149 publications

(18 citation statements)

References 20 publications

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“…1978) have demonstrated that VT can be successfully initiated by programmed electric stimulation in a considerably high frequency in patients suffering from chronic recurrent VT . Contrariwise, a more recent study (Denes et al 1976) has concluded that VT could not be repro ducibly induced in these patients by such techniques . Hence, a method of experimentally producing VT in animals with 100% incidence has not yet been reported, whereas the present study demonstrates the feasibility of this rather simple technique.…”

Section: Discussionmentioning

confidence: 88%

An experimental production of ventricular tachycardia by hyperosmotic solutions in dogs.

Abe¹

1980

Tohoku J. Exp. Med.

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injections into the left anterior descending (LAD) and left circumflex (LCX) coronary arteries were separately performed in twenty dogs using various hyperosmotic solutions. Ventricular tachycardia (VT) was induced in all dogs studied, by injections of solutions having higher osmolality, whereas solutions with relatively lower osmolality did not produce VT. VT was induced in 100% of trials by injections of 30% saline into the LAD. Injections into the LCX of both 10% and 30% saline also elicited VT in 100%. The VT was produced under classic total cardiac denervation combined with intravenous propranolol (0.6 mg/kg) and atropine (0.15 mg/kg). Atrioventricular (A-V) block caused by surgical section of the distal part of the His bundle did not effectively block the production of VT. Reliability of this rather simple technique appears to provide us with a new experimental model. ventricular tachycardia; intracoronary injection; hyperosmolality; cardiac denervation In a previous paper (Abe 1979), this author reported successful production of VT with injections of hyperosmotic solutions into the left main coronary artery (LMC) of the canine heart, in which the LMC was separated from both the LAD and LCX by aorta (Ao)-LAD and Ao-LCX bypass grafting. In this laboratory, the effects of selective injections of hyperosmotic solutions into the LAD and LCX were subsequently investigated in anesthetized dogs, and it was observed that VT could be induced with this technique in all the dogs studied. The characteristics of VT thus elicited are described in this report. Although certain techniques inducing VT in clinical cases with a considerably high frequency have been reported by Wellens, Josephson and others (Wellens et al. 1972(Wellens et al. , 1974(Wellens et al. , 1976Wellens 1975;Josephson et al. 1978), a reliable method to produce VT in experimental animals has not been reported. The present papar demonstrates the feasibility of this rather simple technique. METHODSTwenty mongrel dogs weighing between 19 and 42 kg (average, 25.9 kg) were anesthetized with intramuscular pentobarbital sodium (35 mg/kg), intubated with a cuffed

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Section: Discussionmentioning

confidence: 88%

An experimental production of ventricular tachycardia by hyperosmotic solutions in dogs.

Abe¹

1980

Tohoku J. Exp. Med.

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“…[16][17][18] VAs occurring in the absence of structural heart disease or transient or reversible arrhythmogenic factors (ie, electrolyte disorders or myocardial ischemia) are considered idiopathic or of unknown cause; absence of structural heart disease is usually suggested when routine diagnostic work-up (including 12-lead ECG, transthoracic echocardiography, and noninvasive or invasive test to rule out significant coronary artery disease) is normal. 2 There is increased interest in examining whether cMRI, which may allow identification of otherwise unrecognized myocardial abnormalities, is useful for the diagnostic work-up of patients presenting with unexplained VAs.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Prognostic Value of Concealed Structural Abnormalities in Patients With Apparently Idiopathic Ventricular Arrhythmias of Left Versus Right Ventricular Origin

Nucifora

Muser

Masci

et al. 2014

Circ: Arrhythmia and Electrophysiology

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Background-Routine diagnostic work-up occasionally does not identify any abnormality among patients with monomorphic ventricular arrhythmias (VAs) of left ventricular (LV) origin. Aim of this study was to investigate the value of cardiac MRI (cMRI) for the diagnostic work-up and prognostication of these patients. Methods and Results-Forty-six consecutive patients (65% males; mean age, 44±15 years) with monomorphic VAs of LV origin and negative routine diagnostic work-up were included. Seventy-four consecutive patients (60% males; mean age, 40±17 years) with apparently idiopathic monomorphic VAs of right ventricular origin served as control group. Both groups underwent comprehensive cMRI study and were followed-up for a median of 14 months (25th-75th percentiles, 7-37 months). The outcome event was an arrhythmic composite end point of sudden cardiac death or nonfatal episode of ventricular fibrillation or sustained ventricular tachycardia requiring external cardioversion or appropriate implantable cardioverter defibrillator therapy. The 2 groups of patients did not differ in age (P=0.14) and sex (P=0.57). No significant difference was observed between patients with VAs of LV origin and VAs of right ventricular origin about biventricular volumes and systolic function. cMRI demonstrated myocardial structural abnormalities in 19 (41%) patients with VAs of LV origin versus 4 (5%) patients with VAs of right ventricular origin (P<0.001). The outcome event occurred in 9 patients; myocardial structural abnormalities on cMRI were significantly related to the outcome event (hazard ratio, 41.6; 95% confidence interval, 5.2-225.0; P<0.001). identification of concealed cardiac abnormalities in patients with apparently idiopathic LV arrhythmias. Moreover, scarce data are available about the prognostic value of concealed structural abnormalities detected by cMRI in these patients. Accordingly, the aim of this study was 2-fold: (1) to investigate the value of comprehensive cardiac magnetic resonance tissue characterization imaging, including T1-weighted imaging, T2-weighted imaging, and late gadolinium enhancement (LGE) imaging, for the detection of structural changes in patients with monomorphic VAs of LV versus RV origin and negative routine diagnostic work-up; and (2) to determine the prognostic value of concealed structural abnormalities detected by cMRI in these patients. Conclusions-Myocardial Methods Patient PopulationA total of 46 consecutive patients with monomorphic VAs of LV origin (ie, frequent premature ventricular beats [PVBs] >1000/24 hours, nonsustained ventricular tachycardia [NSVT], or sustained ventricular tachycardia [SVT] with right bundle branch block [RBBB] morphology) and negative routine diagnostic work-up were included in the study. Negative routine diagnostic work-up was defined on the basis of (1) absence of systemic diseases, arterial hypertension, and diabetes mellitus; (2) absence of plasma electrolyte abnormalities; (3) normal 12-lead ECG; (4) normal 2-dimensional echocardiography; and (5) absenc...

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“…Denes et al 89 reported on their inability to initiate ventricular tachycardia in patients showing frequent episodes of ventricular bigeminy and short-lasting, selfterminating attacks of ventricular tachycardia. This has also been our experience.…”

Section: Ventricular Tachycardiamentioning

confidence: 99%

Value and limitations of programmed electrical stimulation of the heart in the study and treatment of tachycardias.

Wellens¹

1978

Circulation

284

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A review is given on the use of programmed electrical stimulation of the heart in patients suffering from tachycardia. The application of this technique makes it possible to evaluate mechanisms of tachycardia directly in the human heart. By repeating the same stimulation program following drug administration the effect of drugs on arrhythmia mechanisms can be studied. There are several factors, however, that influence the amount of information on mechanism and pathway of tachycardia and selection of appropriate therapy that can be obtained during the study. These factors as well as how information obtained programmed electrical stimulation of the heart has resulted in a better use of the 12-lead electrocardiogram as a diagnostic tool are discussed.

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Electrophysiological studies in patients with chronic recurrent ventricular tachycardia.

Cited by 149 publications

References 20 publications

An experimental production of ventricular tachycardia by hyperosmotic solutions in dogs.

An experimental production of ventricular tachycardia by hyperosmotic solutions in dogs.

Prevalence and Prognostic Value of Concealed Structural Abnormalities in Patients With Apparently Idiopathic Ventricular Arrhythmias of Left Versus Right Ventricular Origin

Value and limitations of programmed electrical stimulation of the heart in the study and treatment of tachycardias.

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