Case Study 1 Mohammad Shenasa MD, PhD OConnor Hospital San Jose, - - PowerPoint PPT Presentation

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Aug 28, 2023 113 likes •386 views

Case Study 1 Mohammad Shenasa MD, PhD OConnor Hospital San Jose, CA Biblioteca-Alexandria Alexandria-Egypt Cardio Alex June 10-13, 2014 Etiologies of Electrical Storm 1.) Acute and Chronic Congestive Heart Failure (CHF) 2.) Acute and

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Case Study 1

Mohammad Shenasa MD, PhD

O’Connor Hospital San Jose, CA Biblioteca-Alexandria Alexandria-Egypt Cardio Alex June 10-13, 2014

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Etiologies of Electrical Storm 1.) Acute and Chronic Congestive Heart Failure (CHF) 2.) Acute and Chronic Ischemia 3.) Drug Induced (proarrhythmia effects) 4.) Post Cardiac Surgery 5.) Post Implantable Cardioverter Defibrillator (ICD) and Cardiac Resynchronization Therapy (CRT) 6.) Electrolyte and Metabolic Disturbances 7.) Idiopathic Ventricular Fibrillation (VF), Channelopathies (Brugada) 8.) Ventricular Arrhythmias after LV Assist Devices 9.) Unknown Causes

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Ventricular Arrhythmias in Patients with ICD

Patients with arrhythmia symptoms or ICD-

detected arrhythmias

Monomorphic vs. polymorphic VT
Therapy to reduce VT
MADIT-RIT Trial: Delayed ICD therapy

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MADIT RIT

Moss, A. NEJM

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12 lead ECG of a patient with Brugada syndrome. Note ST-Elevation of V1 (Red Arrow)

ICD implantation due to recurrent VT and syncope

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12 lead ECG of a patient with Brugada Syndrome and Ventricular Bigeminy

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Rapid VT with a heart rate of 248 bpm

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Rapid nonsustained VT

What would you do? 1.) Reprogram the ICD 2.) PVC ablation 3.) VT ablation 4.) Sedation 5.) Low-dose Quinidine

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Management of Electrical Storm

Eifling M, et al. Texas Heart Inst J 2011;38(2)111-21 Cardiac sympathetic denervation (Vaseghi M, et al. HR 2014;11:360- 366)

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Nakahara S et al. Circ Arrhythm Electrophysiol. 2013;6:648-654

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Management of isolated implantable cardioverter-defibrillator (ICD) shocks after ventricular assist device (VAD) implantation.

Nakahara S et al. Circ Arrhythm Electrophysiol. 2013;6:648-654

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Management of recurrent ventricular (RV) arrhythmias after ventricular assist device (VAD) implantation.

Nakahara S et al. Circ Arrhythm Electrophysiol. 2013;6:648-654

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Incessant VT in a patient with anterior wall myocardial infarction detected during Holter Monitoring.

32 year old male Questions: 1.) ICD implantation? 2.) Coronary angiography and PCI? 3.) EP study and ablation? 4.) IV amiodarone?

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Ibutilide induced polymorphic VT

62 year old female with Ibutilide for AF

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Ibutilide induced Torsades de Pointes

62 year old female with Ibutilide for AF What would you do: 1.) DC cardioversion for AF? 2.) DC Ibutilide? 3.) Consider Amiodarone? 4.) IV Mg?

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VT Storm in a patient with CHF

What would you do? 1.) IV amiodarone 2.) Aggressive HF therapy 3.) LV assist devices 4.) VT Ablation

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Case Study

87 year old male
Severe Aortic stenosis
AVR in 2009
Chronic RBBB
Admitted: Acute pneumonia in June 2014

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April 22, 2008 Pre Op

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March 13, 2009

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April 27, 2009

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87 year old post AVR (2009), admitted with pneumonia May 31 2014

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Same patient as above, EKG date 6/1/2014

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EGK Date June 2, 2014: Diagnosis: 1) AF 2) Atrial Flutter 3) Atrial Tachycardia 4) Sinus tachycardia with 1st degree AV block

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Same patient as above, EKG June 5, 2014

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What would you do?

1.) Follow up with Holter? 2.) Pacemaker implantation? 3.) EP study for cite of AV block