Analysis of the pattern of initiation of sustained ventricular arrhythmias in patients with implantable defibrillators

Eric Taylor, Ronald Berger, John D. Hummel, Jay L. Dinerman, Bruce Kenknight, Amelia M. Arria, Gordon F. Tomaselli, Hugh Calkins

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

Introduction: The purpose of this study was to analyze the pattern of initiation of sustained ventricular arrhythmias in patients with varying types of underlying structural heart disease. Methods and Results: The study group consisted of 90 patients with an implantable cardioverter defibrillator. Cardiovascular diagnoses included coronary artery disease in 64 patients (71%). The patients were divided into four groups based on the type and severity of structural heart disease. Two hundred sixty episodes of sustained ventricular arrhythmias were analyzed. The mean coupling interval of the initiating beat of all ventricular arrhythmias was 523 ± 171 msec. The coupling interval of the initiating beat was longer in patients with impaired ventricular function, particularly those with nonischemic dilated cardiomyopathy. The prematurity index was similar regardless of the type of underlying structural heart disease. However, the prematurity index was shorter in patients with polymorphic ventricular tachycardia (VT) compared to those with monomorphic VT. A pause was observed more commonly before the onset of polymorphic VT/ventricular fibrillation than sustained monomorphic VT. Two hundred twenty-two (85%) of the arrhythmia episodes were initiated by a late-coupled premature beat, 33 (13%) were initiated by an early-coupled premature beat, and 5 episodes (2%) were initiated with a short-long-short sequence. The pattern of initiation of the ventricular arrhythmias was similar in all patient groups and for both monomorphic and polymorphic tachycardias. Conclusion: These findings demonstrate that sustained ventricular arrhythmias typically are initiated by late-coupled ventricular premature depolarizations, regardless of the type or severity of underlying structural heart disease or resultant arrhythmia.

Original languageEnglish (US)
Pages (from-to)719-726
Number of pages8
JournalJournal of Cardiovascular Electrophysiology
Volume11
Issue number7
DOIs
StatePublished - Jan 1 2000
Externally publishedYes

Fingerprint

Implantable Defibrillators
Cardiac Arrhythmias
Ventricular Tachycardia
Heart Diseases
Premature Cardiac Complexes
Ventricular Function
Dilated Cardiomyopathy
Ventricular Fibrillation
Tachycardia
Coronary Artery Disease

Keywords

  • Implantable cardioverter defibrillator
  • Polymorphic ventricular tachycardia
  • Torsades de pointes
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Analysis of the pattern of initiation of sustained ventricular arrhythmias in patients with implantable defibrillators. / Taylor, Eric; Berger, Ronald; Hummel, John D.; Dinerman, Jay L.; Kenknight, Bruce; Arria, Amelia M.; Tomaselli, Gordon F.; Calkins, Hugh.

In: Journal of Cardiovascular Electrophysiology, Vol. 11, No. 7, 01.01.2000, p. 719-726.

Research output: Contribution to journalArticle

Taylor, Eric ; Berger, Ronald ; Hummel, John D. ; Dinerman, Jay L. ; Kenknight, Bruce ; Arria, Amelia M. ; Tomaselli, Gordon F. ; Calkins, Hugh. / Analysis of the pattern of initiation of sustained ventricular arrhythmias in patients with implantable defibrillators. In: Journal of Cardiovascular Electrophysiology. 2000 ; Vol. 11, No. 7. pp. 719-726.
@article{67f869b3a00749e3879111f3935ba9a8,
title = "Analysis of the pattern of initiation of sustained ventricular arrhythmias in patients with implantable defibrillators",
abstract = "Introduction: The purpose of this study was to analyze the pattern of initiation of sustained ventricular arrhythmias in patients with varying types of underlying structural heart disease. Methods and Results: The study group consisted of 90 patients with an implantable cardioverter defibrillator. Cardiovascular diagnoses included coronary artery disease in 64 patients (71{\%}). The patients were divided into four groups based on the type and severity of structural heart disease. Two hundred sixty episodes of sustained ventricular arrhythmias were analyzed. The mean coupling interval of the initiating beat of all ventricular arrhythmias was 523 ± 171 msec. The coupling interval of the initiating beat was longer in patients with impaired ventricular function, particularly those with nonischemic dilated cardiomyopathy. The prematurity index was similar regardless of the type of underlying structural heart disease. However, the prematurity index was shorter in patients with polymorphic ventricular tachycardia (VT) compared to those with monomorphic VT. A pause was observed more commonly before the onset of polymorphic VT/ventricular fibrillation than sustained monomorphic VT. Two hundred twenty-two (85{\%}) of the arrhythmia episodes were initiated by a late-coupled premature beat, 33 (13{\%}) were initiated by an early-coupled premature beat, and 5 episodes (2{\%}) were initiated with a short-long-short sequence. The pattern of initiation of the ventricular arrhythmias was similar in all patient groups and for both monomorphic and polymorphic tachycardias. Conclusion: These findings demonstrate that sustained ventricular arrhythmias typically are initiated by late-coupled ventricular premature depolarizations, regardless of the type or severity of underlying structural heart disease or resultant arrhythmia.",
keywords = "Implantable cardioverter defibrillator, Polymorphic ventricular tachycardia, Torsades de pointes, Ventricular tachycardia",
author = "Eric Taylor and Ronald Berger and Hummel, {John D.} and Dinerman, {Jay L.} and Bruce Kenknight and Arria, {Amelia M.} and Tomaselli, {Gordon F.} and Hugh Calkins",
year = "2000",
month = "1",
day = "1",
doi = "10.1111/j.1540-8167.2000.tb00040.x",
language = "English (US)",
volume = "11",
pages = "719--726",
journal = "Journal of Cardiovascular Electrophysiology",
issn = "1045-3873",
publisher = "Wiley-Blackwell",
number = "7",

}

TY - JOUR

T1 - Analysis of the pattern of initiation of sustained ventricular arrhythmias in patients with implantable defibrillators

AU - Taylor, Eric

AU - Berger, Ronald

AU - Hummel, John D.

AU - Dinerman, Jay L.

AU - Kenknight, Bruce

AU - Arria, Amelia M.

AU - Tomaselli, Gordon F.

AU - Calkins, Hugh

PY - 2000/1/1

Y1 - 2000/1/1

N2 - Introduction: The purpose of this study was to analyze the pattern of initiation of sustained ventricular arrhythmias in patients with varying types of underlying structural heart disease. Methods and Results: The study group consisted of 90 patients with an implantable cardioverter defibrillator. Cardiovascular diagnoses included coronary artery disease in 64 patients (71%). The patients were divided into four groups based on the type and severity of structural heart disease. Two hundred sixty episodes of sustained ventricular arrhythmias were analyzed. The mean coupling interval of the initiating beat of all ventricular arrhythmias was 523 ± 171 msec. The coupling interval of the initiating beat was longer in patients with impaired ventricular function, particularly those with nonischemic dilated cardiomyopathy. The prematurity index was similar regardless of the type of underlying structural heart disease. However, the prematurity index was shorter in patients with polymorphic ventricular tachycardia (VT) compared to those with monomorphic VT. A pause was observed more commonly before the onset of polymorphic VT/ventricular fibrillation than sustained monomorphic VT. Two hundred twenty-two (85%) of the arrhythmia episodes were initiated by a late-coupled premature beat, 33 (13%) were initiated by an early-coupled premature beat, and 5 episodes (2%) were initiated with a short-long-short sequence. The pattern of initiation of the ventricular arrhythmias was similar in all patient groups and for both monomorphic and polymorphic tachycardias. Conclusion: These findings demonstrate that sustained ventricular arrhythmias typically are initiated by late-coupled ventricular premature depolarizations, regardless of the type or severity of underlying structural heart disease or resultant arrhythmia.

AB - Introduction: The purpose of this study was to analyze the pattern of initiation of sustained ventricular arrhythmias in patients with varying types of underlying structural heart disease. Methods and Results: The study group consisted of 90 patients with an implantable cardioverter defibrillator. Cardiovascular diagnoses included coronary artery disease in 64 patients (71%). The patients were divided into four groups based on the type and severity of structural heart disease. Two hundred sixty episodes of sustained ventricular arrhythmias were analyzed. The mean coupling interval of the initiating beat of all ventricular arrhythmias was 523 ± 171 msec. The coupling interval of the initiating beat was longer in patients with impaired ventricular function, particularly those with nonischemic dilated cardiomyopathy. The prematurity index was similar regardless of the type of underlying structural heart disease. However, the prematurity index was shorter in patients with polymorphic ventricular tachycardia (VT) compared to those with monomorphic VT. A pause was observed more commonly before the onset of polymorphic VT/ventricular fibrillation than sustained monomorphic VT. Two hundred twenty-two (85%) of the arrhythmia episodes were initiated by a late-coupled premature beat, 33 (13%) were initiated by an early-coupled premature beat, and 5 episodes (2%) were initiated with a short-long-short sequence. The pattern of initiation of the ventricular arrhythmias was similar in all patient groups and for both monomorphic and polymorphic tachycardias. Conclusion: These findings demonstrate that sustained ventricular arrhythmias typically are initiated by late-coupled ventricular premature depolarizations, regardless of the type or severity of underlying structural heart disease or resultant arrhythmia.

KW - Implantable cardioverter defibrillator

KW - Polymorphic ventricular tachycardia

KW - Torsades de pointes

KW - Ventricular tachycardia

UR - http://www.scopus.com/inward/record.url?scp=0033922672&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033922672&partnerID=8YFLogxK

U2 - 10.1111/j.1540-8167.2000.tb00040.x

DO - 10.1111/j.1540-8167.2000.tb00040.x

M3 - Article

VL - 11

SP - 719

EP - 726

JO - Journal of Cardiovascular Electrophysiology

JF - Journal of Cardiovascular Electrophysiology

SN - 1045-3873

IS - 7

ER -