Sudden Death Prevention With Implantable Devices

Passman, Rod; Kadish, Alan H.

doi:10.1161/circulationaha.106.655704

Cited by 48 publications

(26 citation statements)

References 101 publications

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“…Traditional antiarrhythmic therapies are aimed at modifying the abnormal electrophysiological substrate by focal injury (surgery or radiofrequency catheter ablation), 1 implantable devices, 2,3 or pharmacotherapy. The latter approach is hampered by the relatively low efficacy of most antiarrhythmic agents and by their global cardiac action that may result in life-threatening proarrhythmic effects.…”

mentioning

confidence: 99%

Cell Therapy for Modification of the Myocardial Electrophysiological Substrate

et al. 2008

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mentioning

confidence: 99%

Cell Therapy for Modification of the Myocardial Electrophysiological Substrate

et al. 2008

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“…Permanent pacemaker implantation is the last possible therapeutic option, combined with β-blocker therapy in patients with sinus bradycardia or pause-dependent TdP, but long-term follow-up studies still indicate an inappropriately high rate of SCD afterwards (36). Recent reports analyze focal radiofrequency ablation and gene-specific LQTS therapies as prospective therapeutic alternatives which appear to be promising.…”

Section: Therapeutic Considerationmentioning

confidence: 99%

Congenital long QT syndrome in children

Cerović¹,

Košutić²

2016

Medicinski podmladak

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ApstraktSindrom produženog QT intervala (engl. long QT syndrome, LQTS) je poremećaj repolarizacije komora miokarda koji se odlikuje produženjem QT intervala na elektrokardiogramu (EKG) i povećanim rizikom za nastanak ventrikularnih tahiaritmija i kardiogenih manifestacija. Može da bude stečeni ili kongenitalni, koji predstavlja skup kanalopatija usled mutacija u nekom od 15 do sada identifikovanih gena. Najčešći oblici kongenitalnog sindroma su LQT1, LQT2 i LQT3. Zbog produženja repolarizacije i, posledično, celog akcionog potencijala, stvaraju se uslovi za nastanak rane naknadne depolarizacije i izraženije transmuralne disperzije repolarizacije koje su, pojedinačno ili udruženo, osnova za nastanak Torsades de pointes ventrikularne tahikardije. Sindrom produženog QT intervala se klinički manifestuje palpitacijama, sinkopom, srčanim zastojem ili naprasnom srčanom smrću, a može da bude i asimptomatski. Provocirajući faktori za nastanak tegoba su specifični za određeni genotip. Ispitivanje LQTS obuhvata ličnu i porodičnu anamnezu sa naglaskom na karakteristične podatke (česte sinkope, iznenadna srčana smrt u porodici, nasledne aritmije), EKG u miru, test opterećenja i genetske analize, kao i druge dodatne metode (serijski EKG zapisi, 24h EKG holter, epinefrinski test). Za klinič-ko postavljanje dijagnoze koristi se Švarcov (Schwartz) skor, a kriterijumi za definitivno postavljanje dijagnoze zavise od Švar-covog skora, dužine QT intervala, postojanja mutacije i kliničke slike. Lečenje se zasniva na promeni životnih navika i terapiji β-blokatorima, a druge mogućnosti su ugradnja implantabilnog kardioverter-defibrilatora, permanentnog pejsmejkera ili hirurška simpatektomija. Sindrom produženog QT intervala je jedan od potencijalnih uzroka iznenadne srčane smrti koja čini 90% iznenadnih smrti mladih sportista. Kod dece sa LQTS preporuke za bavljenje sportom proizilaze iz preporuka za odrasle i podrazumevaju vrlo stroga ograničenja. Dalja istraživanja biće usmerena na bolje razumevanje genotip-fenotip korelacije kongenitalnih LQTS i očekuje se da će pružiti nove personalizovane terapijske mogućnosti i saznanja o ređim tipovima ovog sindroma, kao i jasnije preporuke za bavljenje fizičkom aktivnošću kod dece sa LQTS.Ključne reči: sindrom produženog QT intervala, deca, genetika, fizička aktivnost AbstractLong QT syndrome (LQTS) is a cardiac repolarization disorder characterized by prolonged QT interval on the electrocardiogram (ECG) and increased propensity to ventricular tachyarrhythmias and cardiac events. LQTS might be acquired or congenital, which presents a group of channelopathies that occur due to mutation in one of 15 so far identified genes. The most frequent types of congenital LTQS are LQT1, LQT2 and LQT3. Prolonged or delayed repolarization leads to the increase of action potential duration which predisposes early afterdepolarization, as well as the amplification of transmural dispersion of repolarization, both contributing to the development of Torsades de Pointes ventricular tachycardia. Clinical manifestatio...

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“…A number of other diagnostic tests have been proposed to improve the accuracy for selection of patients for ICD therapy. Currently available data, however, are not sufficient to routinely recommend additional risk-stratification methods for selection of patients for ICD therapy [6]. …”

Section: Patients After Myocardial Infarctionmentioning

confidence: 99%

“…Several studies have demonstrated that ICD therapy reduces mortality from ventricular arrhythmias in patients with ischemic heart disease [3,4,5,6]. The occurrence of ventricular tachycardia (VT) is a strong predictor of further arrhythmic events [7].…”

Section: Introductionmentioning

confidence: 99%

Prediction of Life-Threatening Arrhythmias – Still an Unresolved Problem

Haugaa¹,

Edvardsen²,

Amlie³

2011

Cardiology

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A major challenge in current cardiology is to predict who will die suddenly from ventricular arrhythmias. Ventricular arrhythmias are the most common cause of sudden cardiac death, occurring in about 1–2:1,000 inhabitants yearly, and is most frequently due to coronary artery disease. Patients with increased risk of ventricular arrhythmias can be offered medical treatment and ultimately an implantable cardioverter defibrillator (ICD). Left ventricular ejection fraction (EF) is currently the main risk stratification tool used to select patients for ICD therapy. However, EF is insufficient in predicting arrhythmic risk. A number of techniques have been presented to improve arrhythmic risk stratification without having reached clinical utility. Conduction abnormalities and dispersion of action potential duration forms the substrate for malignant ventricular arrhythmias in infarcted tissue as in several cardiomyopathies. The ability to assess electrical dispersion in patients noninvasively has been limited. Myocardial strain by echocardiography has been presented as an accurate tool for assessing myocardial function and timing. Inhomogeneous and dispersed myocardial contraction has been related to the occurrence of ventricular arrhythmias and seems to be a promising tool in risk stratification. This review focuses on arrhythmia mechanisms and novel echocardiographic tools for assessing risk of ventricular arrhythmias.

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Sudden Death Prevention With Implantable Devices

Cited by 48 publications

References 101 publications

Cell Therapy for Modification of the Myocardial Electrophysiological Substrate

Cell Therapy for Modification of the Myocardial Electrophysiological Substrate

Congenital long QT syndrome in children

Prediction of Life-Threatening Arrhythmias – Still an Unresolved Problem

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