implantable cardioverter-defibrillator

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Research Letter

Treating Brugada Syndrome: A Case of Successful Radiofrequency Catheter Ablation

Mirella Esmanhotto Facin et al. Cristiano Faria Pisani Luciana Sacilotto Francisco Carlos da Costa Darrieux … Nelson Samesima Maurício Ibrahim Scanavacca

Introduction

Brugada syndrome (BrS) is a severe health condition characterized by a distinctive electrocardiographic pattern and an increased risk of life-threatening cardiac arrhythmias. Traditional therapy has been limited to implantable cardioverter defibrillators (ICD). In the past two decades, however, radiofrequency catheter ablation (RFCA) has emerged as a valuable treatment option, especially for those ineligible for ICD implantation or who have already undergone appropriate device therapy.^, Nevertheless, reports on medium to long-term success of this procedure are still scarce. We reported herein the case of a symptomatic patient with BrS who underwent RFCA after experiencing an appropriate ICD shock.

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ABC

Case Report

Family Screening in the Diagnosis of Short QT Syndrome after Sudden Cardiac Death as First Manifestation in Young Siblings

Guilherme Augusto Teodoro Athayde et al. Natália Quintella Sangiorgi Olivetti Francisco Carlos da Costa Darrieux Luciana Sacilotto … Gabrielle D’Arezzo Pessente Maurício Ibrahim Scanavacca

Introduction

In 2000, Gussak et al., published a case series in which atrial tachyarrhythmias, syncope, and sudden cardiac death (SCD) were associated with a short QT interval, being the first to correlate all of these finding in one single study. Since then, efforts have been made to better understand the behavior of and find alternatives to treat short QT syndrome (SQTS); however, researchers face the barrier of the rarity of the disease, the difficulty in establishing diagnostic parameters, and its complex clinical manifestation. This article reports on the case of young siblings with SCD and SQTS and discusses the syndrome’s diagnostic and therapeutic difficulties.

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IJCS

Review Article

Update on Sports Participation for Athletes with Implantable Cardioverter Defibrillators

Rachel Lampert

Abstract

Prior statements have recommended restriction from competitive sports participation for all athletes with ICDs. Recent data, however, suggests that many athletes can participate in sports without adverse events. In the ICD Sports Registry, 440 athletes, aged 8-60 years, 77 of which were high-level interscholastic athletes, who had continued to practice sports, were prospectively followed for 4 years, with no deaths or failures to defibrillate during practice, and no injuries related to arrhythmia or shock during sports. Shocks did occur, for ventricular and supraventricular arrhythmias. While more athletes received shocks during physical activity than at rest, there were no differences between competition or practice, versus other physical activity. Programming with higher rate cut-offs and longer durations was associated with fewer inappropriate shocks, with no increase in syncope. Based on this study, current recommendations now state that returning to competition may be considered for an athlete with an ICD. In considering this decision, the underlying disease and type of sport should be discussed, and shared decision-making between doctor, patient, and often family, is critical.

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Artigo Original

Clinical follow-up of patients with implantable cardioverter-defibrillator

Silvia Martelo Souza da Fonseca et al. Luiz Gustavo Belo Hécio Carvalho Nilson Araújo … Cláudio Munhoz Leonardo Siqueira Washington Maciel Eduardo Andréa Jacob Atié

OBJECTIVE: To report appropriate (AT) and inappropriate (IT) ICD therapies in patients with ischemic and nonischemic heart disease, as well as early and late procedure-related complications. METHODS: One hundred and fifty-five patients (119 male and 36 female), mean age 47 years (21-88), who underwent ICD implantation between 1994 and March 2003 were analyzed. Patients were divided into the following groups: Group I – Post-AMI patients (n = 80); Group II – Patients with nonischemic heart disease and LV ejection fraction < 40% (n = 45), Chagas disease (n = 18), idiopathic dilated cardiomyopathy (n= 12), hypertensive disease (n = 8), hypertrophic cardiomyopathy (n = 4) and valvular heart disease (n = 3); Group III – Patients with arrhythmogenic right ventricular dysplasia (n = 13); and Group IV – Patients with channelopathies: Brugada Syndrome (n = 8) and idiopathic ventricular arrhythmias (n = 9). All patients underwent electrophysiological study (EPS) with induction of sustained ventricular arrhythmia ICD implantation. RESULTS: During the 26-month mean follow up, a high rate of appropriate ICD therapies (antitachycardia pacing and/or shock) was observed (46%) in the four groups, with no statistically significant difference. The four groups did not differ in either overall (8.4%) or arrhythmic mortality (1.3%). There was no correlation between appropriate ICD therapies and initial clinical presentation or inducible ventricular arrhythmia at EPS, and a 4% incidence of early and late procedure-related complications was found. CONCLUSION: The high incidence of appropriate ICD therapy and low rate of sudden death in the patients studied suggest that ICD is a valuable strategy in the management of ischemic and nonischemic patients previously selected by means of EPS.

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Artigo Original

Hypertrophic cardiomyopathy: the importance of arrhythmic events in patients at risk for sudden cardiac death

Paulo de Tarso Jorge Medeiros et al. Martino Martinelli Filho Edmundo Arteaga Roberto Costa … Sérgio Siqueira Charles Mady Leopoldo Soares Piegas José Antonio Franchini Ramires

OBJECTIVE: It is controversial the correlation between complex ventricular arrhythmia of hypertrophic cardiomyopathy and cardiac sudden death (CSD). In patients with hypertrophic cardiomyopathy and at risk for CSD that have been undergone implantable cardioverter-defibrillator (ICD) implantation, we evaluated: a- occurrence of arrhythmic events; b- clinical event occurrence and its correlation with arrhythmic events; c- ICD shock therapy occurrence and clinical-functional correlation; d- prognosis clinical-functional predictors. METHODS: Twenty-six patients have been studied. They presented hypertrophic cardiomyopathy and risk factors for CSD. These patients underwent ICD implantation, period May, 2000 through January, 2004 (average follow-up – 19 months). Fourteen patients (53.8%) were female and the mean age was 42.7. Sixteen patients (61.5%) ICD was performed due to primary prevention for sudden death and ten (38.5%) secondary prevention. Twenty patients (76.9%) had had syncope, previus to ICD implantation, half of them associated with ventricular fibrillation or sustained ventricular tachycardia; 15 had had family sudden death; 12 patients (46.2%) presented non-sustained ventricular tachycardia at 24-hour Holter and 5 (19.2%) showed the ventricular septum thickness larger than 30 mm. RESULTS: During the follow-up, 4 shocks therapy were recorded by ICD in potentially lethal arrythmias (3 sustained ventricular tachycardia and 1 ventricular fibrillation). There was one death, due to likely stroke. Four patients had syncope recurrence, with no arrhythmic event recorded by ICD. The statistical analysis has showed precocity significance of ICD shock, in patients whose ventricular septum thickness was larger than 30 mm. CONCLUSION: 1- arrhythmic events have occurred in 50% of the patients. Most of those events (62%) were ventricular tachycardia, 31% sustained tachycardia and 31% non-sustained ventricular tachycardia. The remainders had supraventricular tachycardia. 2- recurrent syncope in only 16% of the patients. Nevertheless, they were not related to the presence of arrhythmic events. 3- the presence of ventricular septum larger than 30mm, at Echocardiogram, was associated with early shock therapy occurence (p = 0.003). 4- absence of clinical or functional predictors.

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Treating Brugada Syndrome: A Case of Successful Radiofrequency Catheter Ablation

Introduction

Family Screening in the Diagnosis of Short QT Syndrome after Sudden Cardiac Death as First Manifestation in Young Siblings

Introduction

Update on Sports Participation for Athletes with Implantable Cardioverter Defibrillators

Abstract

Clinical follow-up of patients with implantable cardioverter-defibrillator

Hypertrophic cardiomyopathy: the importance of arrhythmic events in patients at risk for sudden cardiac death

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