Looking above the heart: A rare cause of ventricular tachycardia (original) (raw)
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Chest, 1992
Myocardial hypertrophy and interstitial fibrosis are common in acromegalic hearts and may induce left ventricular (LV) dysfunction. The transmitral flow pattern was exammed by pulsed-wave Doppler in 20 patients with active acromegaly and nine with acromegaly cured by pituitary microsurgery. Control groups consisted of 25 normal subjects and 13 patients with systemic hypertension. We related Doppler indices of LV filling (E and A peak velocities and EtA ratio) to the duration of acromegalic disease, the GH plasma levels and LV mass. The LV mass/BSA was significantly greater in active acromegaly (187 ± 53 g/sq m) and systemic hypertension groups (161 ± 48 g/sq m) than in cured acromegaly (125 ± 35 g/sq m) and the normal control group (109 ± 36 g/sq m) (p<O.Ol for both). No differences were found in the E peak velocity, A peak velocity, and EtA ratio in the groups with active acromegaly
LEFT VENTRICULAR STRUCTURAL AND FUNCTIONAL CHARACTERISTICS IN ACROMEGALY
Journal of Hypertension, 2004
This study was designed to evaluate left ventricular (LV) anatomy and function in patients with Cushing&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s syndrome. A high prevalence of LV hypertrophy and concentric remodeling has been reported in Cushing&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s syndrome, although no data have been reported on LV systolic and diastolic function. Forty-two consecutive patients with Cushing&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s syndrome and 42 control subjects, matched for age, gender, and blood pressure, were studied. Left ventricular mass index (LVMI) and relative wall thickness (RWT) were measured by echocardiography, endocardial and midwall fractional shortening (FS) were assessed, and diastolic filling was measured by Doppler transmitral flow. The RWT was significantly greater in Cushing patients than in controls. Left ventricular hypertrophy and concentric remodeling were observed in 10 and 26 patients with Cushing&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s syndrome, respectively. In Cushing patients, midwall FS was significantly reduced compared with controls (16.2 +/- 3% vs. 21 +/- 4.5%, p = 0.01). The ratio of transmitral E and A flow velocities was reduced and E deceleration time was prolonged in Cushing patients compared with controls (p = 0.03 and p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001, respectively). In patients with Cushing&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s syndrome, cardiac structural changes are associated with reduced midwall systolic performance and with diastolic dysfunction that may contribute to the high risk of cardiovascular events observed in these patients.
Journal of Cardiovascular Electrophysiology, 2005
originating from the right ventricular outflow tract (RVOT-VT) and idiopathic RVOT-extrasystoles are generally considered benign arrhythmias. We described three cases who originally presented with typical "benign looking" RVOT-extrasystoles or RVOT-VT but developed malignant polymorphic VT during follow-up. The unusual aspect of their RVOT-extrasystoles was their coupling interval, which appears to be intermediate between the ultra-short coupling interval of idiopathic VF and the long coupling interval seen in the truly benign RVOT-VT. (J Cardiovasc Electrophysiol, Vol. 16, pp. 912-916, August 2005) ventricular tachycardia, ventricular fibrillation, right ventricular outflow tract Ventricular tachycardias (VTs) occurring in patients without organic heart disease are conventionally categorized as "idiopathic monomorphic" or "idiopathic polymorphic" VTs. 1 The right ventricular outflow tract (RVOT) area is the site of origin of the most common type of idiopathic monomorphic VT 1 ; this RVOT-VT has a distinctive morphology (QRS complexes with left bundle branch block pattern and tall R waves in the inferior leads) and, in general, does not lead to hemodynamic decompensation. Therefore, recording of ventricular extrasystoles that appear to originate from the RVOT, in patients presenting with palpitations, is reassuring. This follows the assumption that any sustained arrhythmia originating from the RVOT-if it ever occurs-will be well tolerated. Recently, Haissaguerre et al. called our attention to the fact that the RVOT area may also be the site of origin of malignant polymorphic arrhythmias. 2,3 Indeed, ventricular fibrillation (VF) originating from the RVOT has been described in patients with Brugada syndrome 2 and idiopathic VF. 3 Nevertheless, distinguishing patients with benign idiopathic monomorphic RVOT-VT from those with these malignant polymorphic forms has not been a clinical problem. This is because the former group generally presents with palpitations that have been present for months to years and have frequent RVOT-extrasystoles with a long coupling interval. In contrast, patients in the latter group present with syncope or cardiac arrest and have rare extrasystoles with a uniquely short coupling interval. 2-5 This coupling interval is so short that idiopathic VF has also been referred to as the "shortcoupled variant of torsade de pointes." 5 We now present patients who-based on their clinical presentation and frequent RVOT-extrasystoles-were initially given the diagnosis of
Journal of the American College of Cardiology, 2005
The aim of this study was to assess the clinical characteristics and the efficacy of radiofrequency catheter ablation (RFCA) for idiopathic ventricular fibrillation (VF) and/or polymorphic ventricular tachycardia initiated by ventricular extrasystoles originating from the right ventricular outflow tract (RVOT). BACKGROUND Ventricular fibrillation and/or polymorphic ventricular tachycardia are occasionally initiated by ventricular extrasystoles originating from the RVOT in patients without structural heart disease. METHODS Among 101 patients without structural heart disease in whom RFCA was conducted for idiopathic ventricular tachyarrhythmias arising from the RVOT, we examined the clinical characteristics and the efficacy of RFCA in 16 patients with spontaneous VF and/or polymorphic ventricular tachycardia initiated by the ventricular extrasystoles originating from the RVOT. RESULTS Among 16 patients, spontaneous episodes of VF were documented in 5 patients, and 11 patients had prior episodes of syncope. Holter recordings showed frequent isolated ventricular extrasystoles with the same morphology as that of initiating ventricular extrasystoles, and non-sustained polymorphic ventricular tachycardia with short cycle length (mean of 245 Ϯ 28 ms) in all 16 patients. Radiofrequency catheter ablation by targeting the initiating ventricular extrasystoles eliminated episodes of syncope, VF, and cardiac arrest in all patients during follow-up periods of 54 Ϯ 39 months. CONCLUSIONS Our data suggest that the malignant entity of idiopathic VF and/or polymorphic ventricular tachycardia was occasionally present in patients with idiopathic ventricular arrhythmias arising from the RVOT. Radiofrequency catheter ablation was effective as a treatment option for this entity.
Heart Rhythm, 2009
Idiopathic ventricular tachycardia (VT) originating from the right ventricular outflow tract (RVOT) in patients without structural heart diseases is generally considered as a benign ventricular arrhythmia (VA). However, "malignant" VA, ventricular fibrillation (VF), and/or polymorphic VT are occasionally initiated by VT or ventricular premature contraction (VPC) originating from the RVOT. In this review article, previous reports describing the malignant form of idiopathic RVOT VT are reviewed , and it is discussed how to distinguish the malignant form from the "benign" form of idiopathic VT originating from the RVOT.
Ventricular tachycardia in acromegaly
Revista portuguesa de cardiologia : orgão oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology, 2011
Cases of sudden cardiac death have been reported in patients with acromegaly. Malignant ventricular arrhythmias may play an important role in this fatal complication, but the exact mechanisms are not well understood. We report on an acromegalic patient presenting with documented recurrent syncopal ventricular tachycardia.