The initial part of polymorphic ventricular tachycardia as a clue for the sustainability of tachycardia and ablation success: A varying degree of purkinje–Myocardial complicity?

The cardiac Purkinje system is capable of very rapid burst activity suggestive of its potential role in being a driver of polymorphic ventricular tachycardia (VT) (PMVT) or ventricular fibrillation (VF). It plays a pivotal role, however, not only in the triggering of but also the perpetuation of ventricular arrhythmias. A varying degree of Purkinje–myocardial complicity has been blamed in determining not only the sustained or non-sustained nature of PMVT but also the pleomorphism of the non-sustained runs. The initial part of PMVT before cascading to the whole ventricle to establish disorganized VF can give important clues for ablation of PMVT and VF. We present a case of an electrical storm after acute myocardial infarction that was successfully ablated after identifying Purkinje potentials that triggered polymorphic, monomorphic, and pleiomorphic VTs and VF

An Overview to Dobutamine Stress Echocardiography: A Single Center Experience

Amaç: Bu çalışmada, kliniğimizde yapılan dobutamin stres ekokardiyografi (DSE) tetkikleri endikasyon, güvenlik, yan etki, komplikasyonlar ve sonuçları açısından değerlendirildi. Ayrıca, DSE sayısı ve maliyeti miyokard perfüzyon sintigrafisi (MPS)’ninki ile karşılaştırıldı. Gereç ve Yöntem: Ocak 2007 ile Mayıs 2013 tarihleri arasında yapılan DSE tetkikleri geriye dönük olarak tarandı. Verilerine ulaşılan 1880 hastanın demografik özellikleri, DSE endikasyonu, işlem sırasında gelişen yan etkiler, komplikasyonlar ve DSE sonuçları değer- lendirildi. Aynı yıllarda yapılan MPS sayıları hastane bilgi sisteminden elde edildi. Bulgular: Çalışmaya DSE yapılan 1880 hasta ile MPS yapılan 1862 hasta dahil edildi. Yıllara göre DSE sayısı gittikçe artarken MPS sayısının azaldığı görüldü. MPS'nin toplam maliyeti DSE'nin toplam maliyetinden 5,4 kat fazla bulundu. DSE'nin 1307 hastada (%69,5) miyokard iskemisi, 527 hastada (%28,1) canlı doku, 46 hastada (%2,4) kapak patolojisi değerlendirmek için yapıldığı görüldü. DSE'ye bağlı ölüm, ventrikül fibrilasyonu, devamlı ventriküler taşikardi gibi komplikasyonlar hiç bir hastada görülmez iken 1 hastada (%0,05) akut miyokard enfarktüsü, 28 hastada ventriküler taşikardi (%1,5), 52 hastada (%2,8) atriyal fibrilasyon görülmüştü. Kalp dışı semptomlar %19,7 oranı ile en fazla görülen yan etki idi. Sonuç: DSE, düşük yan etki ve komplikasyon oranı ile güvenle uygulanabilecek maliyet etkin bir tetkiktir.Aim: In this study, dobutamine stress echocardiography (DSE) examinations performed in our clinic were analyzed according to indications, safety, side effects, complications, and outcomes. Also, the number and cost of DSE was compared with that of myocardial perfusion scintigraphy (MPS). Material and Method: DSE examinations performed between January 2007 and May 2013 were analyzed retrospectively. Demographic characteristics of 1880 patients whose data were available, indications of DSE, the adverse effects during the procedure, complications and DSE results were evaluated. The number of the MPS performed during the same period was obtained from the hospital information system. Results: 1880 patients who were performed DSE and 1862 patients undergoing MPS were included in our study. It was observed that the number of DSE performed was gradually increasing while the numbers of MPS was decreasing by the time. The total cost of MPS was 5.4 times higher than the total cost of DSE. DSE was performed to assess myocardial ischemia in 1307 patients (69.5%), viable tissue in 527 patients (28.1%), valve pathology in 46 patients (2.4%). While Complications such as DSE-related death, ventricular fibrillation, sustained ventricular tachycardia were not seen in any patients, myocardial infarction in 1 patient (0.05%), ventricular tachycardia in 28 patients (1.5%), atrial fibrillation in 52 patients (2.8%) were observed. Noncardiac symptoms were the most common side effects with a rate of 19.7%. Conclusion: DSE is a cost effective test which can be applied safely with low side effect and complication ratio