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2018 DEC 29 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- A new study on Heart Disorders and Diseases - Heart Attack is [...]

The aim of this study was to analyze the long-term clinical outcome of 60 prospectively studied patients with documented sustained ventricular tachyarrhythmia that was not inducible during baseline programmed ventricular stimulation: 39 with cardiac arrest due to noninfarction ventricular fibrillation (VF) and 21 with mild hemodynamically compromising sustained ventricular tachycardia (VT). Left ventricular ejection fraction was 55 [+ or -] 14% in the VF group and 50 [+ or -] 13% in the VT group (difference not significant). Patients were discharged without conventional antiarrhythmic drugs and received only empirical [beta]-blocker therapy. During a mean follow-up period of 21 [+ or -] 16 months (mean [+ or -] SD), 10 of 60 patients (17%) died suddenly. The actuarial incidence of sudden death at 1 and 4 years was similar in both groups (VF group, 10 and 20%; VT group, 16 and 16%) (p = 0.48). The actuarial incidence of sudden cardiac death was significantly higher in patients with left ventricular ejection fraction [is less than or equal to] 40% than in those with >40% (1-year incidence in VF group, 40 vs 0%; VT group, 50 vs 0%) (p = 0.005 and p = 0.01, respectively). Multivariate regression analysis identified left ventricular ejection fraction [is less than or equal to] 40% and previous myocardial infarction as the only independent predictor of sudden cardiac death. The occurrence of frequent ventricular pairs during Holter monitoring was the only independent predictor of sustained VT recurrences. It is concluded that patients with sustained ventricular tachyarrhythmia in whom arrhythmia was noninducible during baseline ventricular stimulation and not treated with antiarrhythmic therapy have a favorable outcome if left ventricular ejection fraction is high. However, reduced left ventricular ejection fraction identifies a subgroup at high risk of sudden cardiac death. Patients with mild hemodynamically compromising sustained VT have a similar risk of dying suddenly as those resuscitated earlier from cardiac arrest.

Of 150 consecutive patients with sustained monomorphic ventricular tachycardia (VT) (n = 116) or ventricular fibrillation (VF) (n = 34) late after acute myocardial infarction, 17 had reproduction of their sustained monomorphic VT during exercise testing. Data from these patients (group I) were compared with data from patients without exercise-induced VT (group II). No statistical difference was found between groups I and II with relation to age, sex, number of vessels with >70% stenosis, left ventricular ejection fraction, number of previous myocardial infarctions, inducibility during programmed stimulation and total mortality during follow-up. In group I, only 1 patient (60%) developed ST depression during exercise compared with 47 patients (35%) in group II (p

Ventricular tachycardia (rapid, abnormal heart rhythms) during exercise usually causes great concern, suggesting serious heart disease with a very poor prognosis. More recently ventricular tachycardia during exercise testing in seemingly healthy people has been considered to be of no consequence. This study of 3,351 patients undergoing exercise testing attempted to determine the prevalence and the meaning of ventricular tachycardia. It was found that transient exercise-induced ventricular tachycardia during routine treadmill testing does not indicate an increased risk of heart attack or other events, either during testing or within two years afterward. Episodes of ventricular tachycardia were uncommon and usually were not repeated. Mortality among patients with tachycardia was 3.6 percent, compared with 5.1 percent in the total population. The prognosis was not worse even for those patients with coronary artery disease. The five patients with sustained ventricular tachycardia were treated, and no conclusions were drawn because of the small number. Nonsustained ventricular tachycardia is uncommon during treadmill testing, and the prognosis is a result of other factors, such as ventricular function, ischemia (reduced blood flow), and other symptoms. Treatment should be based on the other symptoms present, not on the episode of nonsustained ventricular tachycardia. (Consumer Summary produced by Reliance Medical Information, Inc.)

Ventricular arrhythmias are most common in patients with cardiovascular disease. However, they can occur in healthy individuals and athletes. Ventricular arrhythmias are classified as either benign, prognostically significant, or malignant. Benign ventricular arrhythmias involve ventricular premature beats and nonsustained ventricular tachycardia (NSVT, an increase in heart rate that lasts less than 30 seconds) without symptoms, and no underlying heart disease. Prognostically significant arrhythmias have the same features as benign arrhythmias, but in addition involve ventricular dysfunction and heart disease. Malignant ventricular arrhythmias are the most severe and are characterized by episodes of ventricular tachycardia lasting longer than 30 seconds (sustained); they are accompanied by ventricular fibrillation (rapid and irregular contraction of the heart ventricles), and involve significant heart disease and severe ventricular dysfunction. In healthy individuals, NSVT is uncommon during exercise and is considered to be benign. In a study involving 922 healthy individuals, only 1.1 percent experienced NSVT during exercise. During a two-year follow-up period, none of the subjects developed heart disease. In another study, 73 healthy individuals with frequent episodes of ventricular arrhythmia were evaluated. NSVT was diagnosed in 26 percent of the subjects. After follow-up evaluation (mean of 6.5 years), it was concluded that the long-term prognosis for subjects with asymptomatic ventricular arrhythmia is the same as for the healthy population. Sudden cardiac death syndrome (SCD) is uncommon in young people, and is caused by ventricular fibrillation. Athletes with a history of myocardial infarction (heart attack), sustained ventricular tachycardia, or heart valve disease have an increased risk for developing SCD. Malignant ventricular arrhythmias are treated with drugs or surgery. But no therapy is required for NSVT in patients without evidence of heart disease upon medical evaluation, as is illustrated by a case report of a 40-year-old man training for a triathlon. (Consumer Summary produced by Reliance Medical Information, Inc.)

Seventeen patients with coronary artery disease, idiopathic dilated cardiomyopathy or no organic heart disease who presented with incessant ventricular tachycardia (VT) were studied and followed for a mean period of 51 [+ or -] 35 months. in these patients the incessant VT included [is greater than or equal to] 3 episodes of sustained VT at a rate of [is greater than or equal to] 120 beats/min and frequent episodes of nonsustained VT over a 24-hour period. No patient had electrolyte disorder, prolonged QT interval, drug-induced arrhythmia or myocardial infarction (Am J Cardiol 1990;66:831-836), Ventricular tachycardia (VT), a rapid heartbeat that originates in the contractile fibers of the ventricles, may cause sudden death. This abnormal rhythm must be suppressed immediately with anti-arrhythmic drugs. Because of the possibility of incessant (recurring) VT, physicians continue treatment even though these drugs have serious side effects, the most dangerous being proarrhythmia (worsening of the abnormal heart rhythm). Two anti-arrhythmic agents, flecainide and encainide, have been associated with increased mortality. Side effects, such as dizziness and palpitations, tend to worsen over time, and treatment is sometimes terminated when they become intolerable. The authors monitored 17 patients who met stringent criteria for a diagnosis of incessant VT. Six of the patients died; four from sudden death and two from heart attack. Anti-arrhythmic drugs were discontinued by six patients, five of whom remained in remission during the follow-up period. Three of these patients were found to be in remission one week after incessant VT was diagnosed; a fourth patient discontinued anti-arrhythmic medication because of pregnancy; and the fifth patient discontinued therapy after developing symptoms of congestive heart failure. On that basis, attempts were made to discontinue anti-arrhythmic treatment in the remaining five patients; four achieved remission of incessant VT. Nine of the 11 surviving patients, most of whom had previous episodes of ventricular arrhythmia, went into remission during the follow-up period. It is possible that some patients went into remission much earlier than when the drugs were discontinued. In these cases, suppression of the incessant VT was attributed to the anti-arrhythmic agent. A strong case can be made for attempting to terminate treatment. In addition to the serious side effects, the price of these drugs, and the frequent medical visits and tests are a considerable burden on patients. Based on this study of a small group of patients with incessant VT, termination of anti-arrhythmic treatment should be considered. A trial discontinuation should be conducted in a hospital setting where patients can be monitored, and close out-patient follow-up should be maintained during anti-arrhythmic treatment. Patients with a short history of ventricular arrhythmia before the onset of incessant VT seem to have a better chance of remission. (Consumer Summary produced by Reliance Medical Information, Inc.)

Marino Leonardi, MD(*) and Philip Varriale, MD. Division of Cardiology, Cabrini Medical Center, New York, NY. PURPOSE: A one year observational study of the causes of polymorphic ventricular tachycardia (PVT) [...]

WASHINGTON -- Ischemic dilated cardiomyopathy is associated with a poorer prognosis when accompanied by nonsustained ventricular tachycardia. Patients with ischemic dilated cardiomyopathy and nonsustained ventricular tachycardia (NSVT) had a lower [...]