PURPOSE: In some patients with an implantable cardioverter defibrillator (ICD), multiple episodes of electrical storm (ES) can occur. We assessed the prevalence, features, and predictors of ES in patients with ICD. MATERIALS AND METHODS: Eighty-five patients with an ICD were analyzed. ES was defined as the occurrence of two or more ventricular tachyarrhythmias within 24 hours. RESULTS: Twenty-six patients experienced at least one ES episode, and 16 patients experienced two or more ES episodes. The first ES occurred 209 +/- 277 days after ICD implantation. In most ES cases, the index arrhythmia was ventricular tachycardia (65%). There were no obvious etiologic factors at the onset of most ES episodes (57%). More patients with a structurally normal heart (p = 0.043) or ventricular fibrillation (VF) as the index arrhythmia (p = 0.017) were in the ES-free group. Kaplan-Meier estimates and a log-rank test showed that patients with nonischemic dilated cardiomyopathy (DCMP) (log-rank test, p = 0.016) or with left ventricular ejection fraction < 35% (p = 0.032) were more likely to experience ES, and that patients with VF (p = 0.047) were less affected by ES. Cox proportional hazard regression analysis showed that nonischemic DCMP correlated with a greater probability of ES (hazard ratio, 3.71; 95% confidence interval, 1.16-11.85; p = 0.027). CONCLUSION: ES is a common and recurrent event in patients with an ICD. Nonischemic DCMP is an independent predictor of ES. Patients with VF or with a structurally normal heart are less likely to experience ES.
Adult ; Aged ; Defibrillators, Implantable/*adverse effects ; Female ; Humans ; Male ; Middle Aged ; Tachycardia, Ventricular/*diagnosis/etiology ; Ventricular Fibrillation/*diagnosis/etiology

Systemic sclerosis (SS) is a connective tissue disease and cardiac involvement is common. Primary cardiac involvement such as conduction system disturbances and arrhythmias can also occur. However, reports of sustained ventricular tachycardia (VT) are rare. We report a case of catheter ablation of sustained ventricular tachycardia in a patient with systemic sclerosis using a conventional mapping system. A 64-yr-old woman with a 10-yr history of SS was referred for management of her ventricular tachycardia. There was no structural abnormality in cardiac chambers. However, electrophysiologic study revealed electrical substrate of ventricular tachycardia which could be ablated with pacemapping and substrate mapping. This case demonstrated successful conventional mapping and catheter ablation in a hemodynamically unstable patient with SS.
*Catheter Ablation ; Electrocardiography ; Female ; Humans ; Middle Aged ; Scleroderma, Systemic/*complications/*diagnosis ; Tachycardia, Ventricular/*etiology/physiopathology/*surgery

OBJECTIVESTo explore the clinical characteristics of cardiac syncope (CS) in children, and understand their significance in predicting the cardiac syncope.

METHODSTwenty-three patients were referred to our department for evaluation of syncope. The diagnosis of the above cases was cardiac syncope. Each patient was interviewed using a standard questionnaire. The clinical histories and standard baseline electrocardiogram were analyzed to identify the variables contributing to the diagnosis of CS in children.

RESULTSA cardiac cause was identified in 23 syncopal patients presenting to the Department of Pediatrics, Peking University First Hospital: sick sinus syndrome in 7, congenital long QT syndrome in 4, third degree atrioventricular block in 2, supraventricular tachycardia in 2, ventricular tachycardia in 1, atrial fibrillation in 1, pacemaker dysfunction in 1, idiopathic pulmonary hypertension in 3, hypertrophic cardiomyopathy in 1, and dilated cardiomyopathy in 1. The average age of CS patients was 9 years. In totally 23 patients, exertion related syncope spells were found in 14 cases (60.9%), syncope spells at various position 7/23 (30.4%), absence of prodromes in 12/23 (52.2%), syncope spells with incontinence in 4/23 (17.4%), history of heart disease in 4/23 (17.4%). Abnormal standard baseline electrocardiogram was found in 21 cases (91.7%).

CONCLUSIONSThe children with cardiac syncope have overt clinical features, especially abnormal findings in electrocardiogram and exertion related syncope spells are the most common clinical features.

Adolescent ; Child ; Child, Preschool ; Diagnosis, Differential ; Female ; Heart Diseases ; complications ; Humans ; Male ; Retrospective Studies ; Syncope ; diagnosis ; etiology ; Tachycardia, Ventricular ; complications

Coronary-subclavian steal through the left internal mammary graft is a rare cause of myocardial ischemia in patients who have had a coronary bypass surgery. We report a 70-year-old man who presented with sustained monomorphic ventricular tachycardia 5 years after the surgical creation of a left internal mammary to the left anterior descending artery. Cardiac catheterization illustrated that the left subclavian artery was occluded proximally and that the distal course was visualized by retrograde filling through the left internal mammary graft. Clinical ventricular tachycardia was reproducibly induced with a single ventricular extrastimulus, and antitachycardia pacing terminated the tachycardia. Restoration of blood flow by way of a Dacron graft placed between the descending aorta and the subclavian artery resulted in the total relief of symptoms. Ventricular tachycardia could not be induced during the control electrophysiologic study after surgical revascularization.
Aged ; Coronary Artery Bypass/adverse effects ; Coronary Artery Disease/*diagnosis/etiology/*pathology ; Humans ; Male ; Postoperative Complications/diagnosis/etiology ; Subclavian Steal Syndrome/*diagnosis/etiology/*pathology ; Tachycardia, Ventricular/*pathology

No abstract available.
Aged ; Cardiovascular Agents/therapeutic use ; Echocardiography ; Electrocardiography ; Female ; Humans ; Stress, Psychological/*complications ; Tachycardia, Ventricular/diagnosis/drug therapy/*etiology ; Takotsubo Cardiomyopathy/diagnosis/drug therapy/*etiology ; Treatment Outcome

Malignant lymphoma can involve the cardiac cavity or myocardium as a mass. Clinical symptoms of its cardiac involvement are usually absent or nonspecific, making the diagnosis of the cardiac involvement very difficult before death. We experienced a patient with secondary myocardial non-Hodgkin's lymphoma presenting with sustained ventricular tachycardia (VT) as a primary clinical problem. A 39-yr-old woman visited our hospital because of dyspnea and palpitation for 7 days. Physical examination revealed rapid heart beat with variable intensity of the first heart sound and soft mass in the lower abdomen. VT with a cycle length of 480 msec was recorded in resting 12-lead electrocardiogram. Two well-circumscribed hypo-echogenic round masses were demonstrated in the interventricular septum and left ventricular posterior wall. Cytological examination of aspirated pericardial fluid and percutaneous needle biopsy of the abdominal mass revealed a diffuse large cell type non-Hodgkin's lymphoma. Myocardial masses and ventricular tachycardia resolved with chemotherapy using cyclophosphamide, adriamycin, vincristine and prednisone regimen. To our best knowledge, the same case as ours has not been reported previously.
Abdominal Neoplasms/secondary ; Adult ; Biopsy, Needle ; Bundle-Branch Block ; Echocardiography ; Electrocardiography ; Female ; Heart Neoplasms/*pathology ; Humans ; Lymphoma, Non-Hodgkin/*complications/diagnosis/*pathology ; Myocardium/*pathology ; Tachycardia, Ventricular/*etiology/physiopathology

Mushroom exposures are increasing worldwide. The incidence and fatality of mushroom poisoning are reported to be increasing. Several new syndromes in mushroom poisoning have been described. Rhabdomyolytic mushroom poisoning is one of new syndromes. Russula subnigricans mushroom can cause delayed-onset rhabdomyolysis with acute kidney injury in the severely poisoned patient. There are few reports on the toxicity of R. subnigricans. This report represents the first record of R. subnigricans poisoning with rhabdomyolysis in Korea, describing a 51-year-old man who suffered from rhabdomyolysis, acute kidney injury, severe hypocalcemia, respiratory failure, ventricular tachycardia, cardiogenic shock, and death. Mushroom poisoning should be considered in the evaluation of rhabdomyolysis of unknown cause. Furthermore, R. subnigricans should be considered in the mushroom poisoning with rhabdomyolysis.
Acute Kidney Injury/*etiology ; Basidiomycota/isolation & purification/*pathogenicity ; Electrocardiography ; Heart Ventricles/physiopathology ; Humans ; Male ; Middle Aged ; Mushroom Poisoning/*diagnosis/microbiology/mortality ; Rhabdomyolysis/*etiology ; Shock, Cardiogenic/*etiology ; Tachycardia, Ventricular/etiology

Many patients who survive an acute myocardial infarction (AMI) remain at risk of recurrent cardiac events and sudden cardiac death after discharge, despite optimal medical treatment. Assessment of the degree of left ventricular dysfunction and residual myocardial ischaemia is useful to identify the patients at greatest risk. In addition, there is increasing evidence that a number of other cardiovascular tests can be used to detect autonomic dysfunction and myocardial substrate abnormalities postAMI that increase the risk of life-threatening ventricular arrhythmias. These investigations include ECG-based tests (signal averaged ECG and T-wave alternans), Holter-based recordings (heart rate variability and heart rate turbulence) and imaging techniques (echocardiography and cardiac magnetic resonance), as well as invasive electrophysiological testing. This article reviews the current evidence for the use of these additional cardiac investigations among survivors of AMI to aid in their risk stratification for malignant ventricular arrhythmias and sudden cardiac death.
Age Factors ; Death, Sudden, Cardiac ; etiology ; Echocardiography ; Electrocardiography ; Electrocardiography, Ambulatory ; Electrophysiologic Techniques, Cardiac ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Myocardial Infarction ; complications ; Risk Assessment ; Sex Factors ; Tachycardia, Ventricular ; complications ; diagnosis ; Ventricular Dysfunction, Left ; complications ; diagnosis

Medically refractory ventricular tachycardia (VT) storm can be controlled with radiofrequency catheter ablation (RFCA), however, it may be difficult to control in some patients with hemodynamic overload. We experienced a patient with intractable VT storm controlled by hemodynamic unloading. The patient had mid-septal hypertrophic cardiomyopathy with an implantable cardioverter defibrillator (ICD) back-up. Because of the severe mid-septal hypertrophy, his left ventricle (LV) had an hourglass-like morphology and showed apical ballooning; the focus of VT was at the border of apical ballooning. Although we performed VT ablation because of electrical storm with multiple ICD shocks, VT recurred 1 hour after procedure. As the post-RFCA monomorphic VT was refractory to anti-tachycardia pacing or ICD shock, we reduced the hemodynamic overload of LV with beta-blockade, hydration, and sedation. VT spontaneously stopped 1.5 hours later and the patient has remained free of VT for 24 months with beta-blockade alone. In patients with VT storm refractory to antiarrhythmic drugs or RFCA, the mechanism of mechano-electrical feedback should be considered and hemodynamic unloading may be an essential component of treatment.
Cardiomyopathy, Hypertrophic/complications/diagnosis/*physiopathology/therapy ; Catheter Ablation ; Electrocardiography ; Gated Blood-Pool Imaging ; Heart Catheterization ; Humans ; Male ; Middle Aged ; Tachycardia, Ventricular/diagnosis/etiology/*physiopathology/therapy ; Takotsubo Cardiomyopathy/complications/diagnosis/*physiopathology/therapy

OBJECTIVEWe retrospectively analyzed the causes, diagnosis, clinical characteristics, treatment and prognosis of 17 patients with rhabdomyolysis.

METHODSRhabdomyolysis cases diagnosed from January 2005 to March 2014 in our department were included.

RESULTSA total of 17 rhabdomyolysis patients (male 13, mean age (60.4 ± 15.7) years) were analyzed.Four cases had coronary heart disease combined with hypertension, hyperlipaemia, atrial fibrillation, 10 cases had dilated cardiomyopathy combined with coronary heart disease, hyperlipaemia, atrial fibrillation, 8 cases had atrial fibrillation combined with hypertension, coronary heart disease, hyperlipaemia, 1 patient had pulmonary embolism combined with hyperlipaemia, 1 patient had aortic dissection combined with hypertension, 10 hypertension patients were combined with coronary heart disease, hyperlipaemia, atrial fibrillation, aortic dissection and 1 patient with ventricular tachycardia was combined with depression.Various degrees of liver and kidney dysfunction, reduced hemoglobin and myoglobinuria were found in all patients.Fever was found in 7 cases, relevant neurological signs in 5 cases. Digestive tract discomfort and muscle weakness or muscle pain symptoms were seen in all patients during hospitalization. All cases underwent renal replacement therapy and respirator was used in 14 patients to support breathing. Post therapy, 10 cases improved but 7 cases died. All 17 patients had history of statin use.

CONCLUSIONStatin may be the major cause of rhabdomyolysis in these patients, and the mortality of rhabdomyolysis is high despite various therapy stratigies.

Adult ; Aged ; Atrial Fibrillation ; Cardiomyopathy, Dilated ; Coronary Artery Disease ; Coronary Disease ; Female ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; adverse effects ; Hypertension ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Rhabdomyolysis ; diagnosis ; etiology ; pathology ; therapy ; Tachycardia, Ventricular