Syncopal monomorphic ventricular tachycardia with pleomorphism, sensitive to antitachycardia pacing in a patient with Brugada syndrome

Bertomeu‐González, Vicente; Ruiz‐Granell, Ricardo; García‐Civera, Roberto; Morell-Cabedo, Salvador; Ferrero, Àngel

doi:10.1093/europace/eul117

Cited by 25 publications

(8 citation statements)

References 6 publications

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“…Although life‐threatening arrhythmias and SCD in JWS are generally associated with slow heart rates, the potential therapeutic benefit for cardiac pacing at relatively fast rates remains largely unexplored …”

Section: Approaches To Therapy Of Jwsmentioning

confidence: 99%

J wave syndromes as a cause of malignant cardiac arrhythmias

Diego

Antzelevitch

2018

Pacing Clinical Electrophis

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The J wave syndromes, including the Brugada (BrS) and early repolarization (ERS) syndromes, are characterized by the manifestation of prominent J waves in the electrocardiogram appearing as an ST segment elevation and the development of life-threatening cardiac arrhythmias. BrS and ERS differ with respect to the magnitude and lead location of abnormal J waves and are thought to represent a continuous spectrum of phenotypic expression termed J wave syndromes. Despite over 25 years of intensive research, risk stratification and the approach to therapy of these two inherited cardiac arrhythmia syndromes are still rapidly evolving. Our objective in this review is to provide an integrated synopsis of the clinical characteristics, risk stratifiers, as well as the molecular, ionic, cellular, and genetic mechanisms underlying these two syndromes that have captured the interest and attention of the cardiology community over the past two decades.

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Section: Approaches To Therapy Of Jwsmentioning

confidence: 99%

J wave syndromes as a cause of malignant cardiac arrhythmias

Diego

Antzelevitch

2018

Pacing Clinical Electrophis

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“…18 It also has been demonstrated that standard ICD-EG morphology can accurately distinguish between 2 different sites of ventricular impulse formation as long as they are Ͼ2 cm apart. 19 Indeed, ICD-EG morphology has been used to distinguish between 2 different M-VTs in previous reports, such as in a patient with Brugada syndrome 30 or in patients with Chagas disease. 31 Although a …”

Section: Incidence Of Pl and MMmentioning

confidence: 99%

Incidence, Determinants, and Prognostic Implications of True Pleomorphism of Ventricular Tachycardia in Patients With Implantable Cardioverter-Defribillators

Hadid

Almendral

Ortiz

et al. 2011

Circ: Arrhythmia and Electrophysiology

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Background-The occurrence of monomorphic ventricular tachycardia (M-VT) with Ͼ1 QRS morphology during the same episode (pleomorphism [PL]) or in different episodes (multiple morphologies [MM]) has been described through ECG. Implantable cardioverter-defribillator (ICD) electrograms (EGs) provide the opportunity to analyze virtually all spontaneous M-VT episodes. We sought to study the incidence, determinants, and prognostic significance of PL and MM as assessed by ICD-EG in a prospective series of patients with ICDs. Methods and Results-Spontaneous episodes of M-VT were analyzed before ICD intervention. PL was defined as Ͼ1 ICD-EG morphology, each having Ն6 consecutive identical beats during the same VT episode, and MM as Ͼ1 ICD-EG morphology in different M-VT episodes in the same patient. We analyzed 1881 M-VT episodes from 315 patients followed for 17 months. PL and MM occurred in 6% and 19%, respectively, of the total population (16% and 62% of patients with M-VT). Recurrent M-VT as diagnosis for ICD indication predicted PL and MM. Patients with PL more frequently developed MM (85% versus 15%; PϽ0.001) compared to patients without PL. Total mortality (5%) was significantly higher in patients with PL (20%), in patients with MM (11.5%), and in women (12%). In multivariate analysis, only PL (odds ratio, 5.33; Pϭ0.009) and female sex (odds ratio, 3.1; Pϭ0.038) predicted mortality. Conclusions-In a prospective series of patients with ICDs, mostly indicated for secondary prevention, both PL and MM of VT, as judged by ICD-EG, were not uncommon and were strongly associated. Female sex and the development of PL VT were the only independent predictors of mortality. (Circ Arrhythm Electrophysiol. 2011;4:33-42.)

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“…Identification of the putative VT(s) exit sites is a key step of substrate‐based ablation approaches for unstable VT(s), and requires detailed pace mapping along the scar edge to reproduce the morphology of the clinical VT(s) on 12‐lead ECG . However, in a substantial proportion of patients, the 12‐lead ECG of the clinical arrhythmia is not available and stored IEGMs of the clinical event can been used as a surrogate for 12‐lead ECG to identify the clinical VT(s) . In this regard, IEGM morphological analysis plays an important role, as other parameters, such as the VT cycle length, typically show a considerable overlap between the clinical VT and other inducible nonclinical arrhythmias.…”

Section: Discussionmentioning

confidence: 99%

“…3 However, in a substantial proportion of patients, the 12-lead ECG of the clinical arrhythmia is not available and stored IEGMs of the clinical event can been used as a surrogate for 12-lead ECG to identify the clinical VT(s). 4,[7][8][9] In this regard, IEGM morphological analysis plays an important role, as other parameters, such as the VT cycle length, typically show a considerable overlap between the clinical VT and other inducible nonclinical arrhythmias.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6] Analysis of the IEGM morphology during pace mapping along the scar edge has been used as a surrogate for 12-lead ECG to approximate the clinical VT(s) exit sites and define the boundaries for a linear ablation strategy that could block exit to normal myocardium. 4 Previous studies have suggested that IEGM analysis provides valuable information for distinguishing clinical from previously undocumented VT. [7][8][9] The reliability of IEGM analysis in detecting distinct VT exit sites along the scar edge has not been previously investigated. The purpose of this study was to define the spatial resolution of IEGMs in identifying distinct exit sites of scar-related VT.…”

Section: Introductionmentioning

confidence: 99%

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Spatial Resolution of Defibrillator Electrograms to Detect Distinct Exit Sites of Scar‐Related Ventricular Tachycardia

Alcalde

Zado

Callans

et al. 2014

Pacing Clinical Electrophis

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Analysis of IEGM morphology with pacing around the edge of the scar is unable to distinguish distinct VT exit sites spaced <2 cm apart, with an average spatial resolution of 5 cm. Given the wide range of values observed, detailed pace mapping over a perimeter of 10-15 cm along the scar edge appears crucial to define the boundaries of a linear ablation strategy to target the VT exit site based on IEGM pace match alone.

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Syncopal monomorphic ventricular tachycardia with pleomorphism, sensitive to antitachycardia pacing in a patient with Brugada syndrome

Cited by 25 publications

References 6 publications

J wave syndromes as a cause of malignant cardiac arrhythmias

J wave syndromes as a cause of malignant cardiac arrhythmias

Incidence, Determinants, and Prognostic Implications of True Pleomorphism of Ventricular Tachycardia in Patients With Implantable Cardioverter-Defribillators

Spatial Resolution of Defibrillator Electrograms to Detect Distinct Exit Sites of Scar‐Related Ventricular Tachycardia

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