Significance of r-on-t phenomenon in early ventricular tachyarrhythmia susceptibility after acute myocardial infarction in the thrombolytic era

Chiladakis, John; Karapanos, George; Davlouros, Periklis; Aggelopoulos, George; Alexopoulos, D.; Manolis, Antonis S.

doi:10.1016/s0002-9149(99)00734-1

Cited by 19 publications

(5 citation statements)

References 26 publications

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“…The concept of R-on-T is classically associated with arrhythmia risk, but, as we show here, it is not sufficient to explain VF initiation. Also, in the setting of ischemia, R-on-T PVCs may occur frequently without inducing arrhythmias ( 21 ). Conversely, SCA is frequently initiated in the absence of R-on-T ( 22 ), but it is currently unknown whether the premature beat may then be on top of clinically concealed repolarization abnormalities of sufficient magnitude.…”

Section: Discussionmentioning

confidence: 99%

Noninvasive detection of spatiotemporal activation-repolarization interactions that prime idiopathic ventricular fibrillation

et al. 2021

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Section: Discussionmentioning

confidence: 99%

Noninvasive detection of spatiotemporal activation-repolarization interactions that prime idiopathic ventricular fibrillation

et al. 2021

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“…Asynchronous pacing is used with scanning a pacemaker dependent patient. In those patients with an underlying rhythm who are not bradycardic, a ventricular rate competing with the asynchronous pacing could lead to pacing during ventricular repolarization, potentially causing an R on T phenomenon leading to life threatening ventricular arrhythmias [36,107,108]. …”

Section: Introductionmentioning

confidence: 99%

Magnetic resonance imaging in patients with cardiac pacemakers: era of “MR Conditional” designs

Shinbane

Colletti

Shellock

2011

Journal of Cardiovascular Magnetic Resonance

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Advances in cardiac device technology have led to the first generation of magnetic resonance imaging (MRI) conditional devices, providing more diagnostic imaging options for patients with these devices, but also new controversies. Prior studies of pacemakers in patients undergoing MRI procedures have provided groundwork for design improvements. Factors related to magnetic field interactions and transfer of electromagnetic energy led to specific design changes. Ferromagnetic content was minimized. Reed switches were modified. Leads were redesigned to reduce induced currents/heating. Circuitry filters and shielding were implemented to impede or limit the transfer of certain unwanted electromagnetic effects. Prospective multicenter clinical trials to assess the safety and efficacy of the first generation of MR conditional cardiac pacemakers demonstrated no significant alterations in pacing parameters compared to controls. There were no reported complications through the one month visit including no arrhythmias, electrical reset, inhibition of generator output, or adverse sensations. The safe implementation of these new technologies requires an understanding of the well-defined patient and MR system conditions. Although scanning a patient with an MR conditional device following the strictly defined patient and MR system conditions appears straightforward, issues related to patients with pre-existing devices remain complex. Until MR conditional devices are the routine platform for all of these devices, there will still be challenging decisions regarding imaging patients with pre-existing devices where MRI is required to diagnose and manage a potentially life threatening or serious scenario. A range of other devices including ICDs, biventricular devices, and implantable physiologic monitors as well as guidance of medical procedures using MRI technology will require further biomedical device design changes and testing. The development and implementation of cardiac MR conditional devices will continue to require the expertise and collaboration of multiple disciplines and will need to prove safety, effectiveness, and cost effectiveness in patient care.

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“…Despite this limitation, our findings are similar to those of two prior studies. Chiladakis and co‐workers (2000) examined 24‐h Holter recordings in acute MI patients treated with thrombolysis and found that R‐on‐T was rarely observed, and they were not associated with VT and/or VF. Likewise, Fries et al (2003) found that R‐on‐T type PVCs rarely precipitated sustained VT in patients with an implanted cardioverter‐defibrillator.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of premature ventricular complexes during in‐hospital ECG monitoring as a predictor of ventricular tachycardia in an intensive care unit cohort

Suba

Hoffmann

Fleischmann

et al. 2023

Research in Nursing & Health

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In-hospital electrocardiographic (ECG) monitors are typically configured to alarm for premature ventricular complexes (PVCs) due to the potential association of PVCs with ventricular tachycardia (VT). However, no contemporary hospital-based studies have examined the association of PVCs with VT. Hence, the benefit of PVC monitoring in hospitalized patients is largely unknown. This secondary analysis used a large PVC alarm data set to determine whether PVCs identified during continuous ECG monitoring were associated with VT, in-hospital cardiac arrest (IHCA), and/or death in a cohort of adult intensive care unit patients. Six PVC types were examined (i.e., isolated, bigeminy, trigeminy, couplets, R-on-T, and run PVCs) and were compared between patients with and without VT, IHCA, and/or death. Of 445 patients, 48 (10.8%) had VT; 11 (2.5%) had IHCA; and 49 (11%) died. Isolated and run PVC counts were higher in the VT group (p = 0.03 both), but group differences were not seen for the other four PVC types. The regression models showed no significant associations between any of the six PVC types and VT or death, although confidence intervals were wide. Due to the small number of cases, we were unable to test for associations between PVCs and IHCA. Our findings suggest that we should question the clinical relevance of activating PVC alarms as a forewarning of VT, and more work should be done with larger sample sizes. A more precise

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Significance of r-on-t phenomenon in early ventricular tachyarrhythmia susceptibility after acute myocardial infarction in the thrombolytic era

Cited by 19 publications

References 26 publications

Noninvasive detection of spatiotemporal activation-repolarization interactions that prime idiopathic ventricular fibrillation

Noninvasive detection of spatiotemporal activation-repolarization interactions that prime idiopathic ventricular fibrillation

Magnetic resonance imaging in patients with cardiac pacemakers: era of “MR Conditional” designs

Evaluation of premature ventricular complexes during in‐hospital ECG monitoring as a predictor of ventricular tachycardia in an intensive care unit cohort

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