Out-of-hospital cardiac arrest caused by transient left ventricular apical ballooning syndrome

We describe a case of out-of-hospital cardiac arrest due to ventricular fibrillation in a patient with transient left ventricular apical ballooning syndrome. Our report confirms that left ventricular apical ballooning may have the same complications of myocardial infarction, adding the early ventricular fibrillation to the previous findings of left ventricular wall rupture, ventricular arrhythmias during hospitalization and complete atrio-ventricular block. Moreover, left ventricular apical ballooning may have different and unusual clinical onsets, including sudden cardiac death due to ventricular tachyarrhythmias in the absence of associated symptoms. Therefore, in our opinion left ventricular apical ballooning may be considered as a possible cause of sudden death in otherwise healthy women.     

Ventricular fibrillation as primary presentation of takotsubo cardiomyopathy after complicated cesarean delivery

Takotsubo cardiomyopathy typically affects post-menopausal women under severe psychological or physical stress; it also has been reported to develop after medical procedures or surgery. We herein report the rare case of a 30-year-old woman who presented with an episode of ventricular fibrillation after a very complicated cesarean delivery and was successfully resuscitated. Subsequent electrocardiography and echocardiography showed a typical Takotsubo pattern. Within 3 wk, left ventricular systolic function returned to normal.     

Prior statin use and the incidence of in-hospital arrhythmia in acute coronary syndrome: A systematic review and meta-analysis

BackgroundThe benefit of prior statin use to reduce the incidence of arrhythmia in acute coronary syndrome (ACS) is still a matter of debate. Statins have multiple pleiotropic effects, which may reduce the incidence of in-hospital arrhythmia. A systematic review and meta-analysis were performed to evaluate prior statin use and the incidence of in-hospital arrhythmia in ACS.MethodsThis systematic review was conducted as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). We performed a literature search through Pubmed, Proquest, EBSCOhost, and Clinicaltrial.gov. A random-effect model was used due to moderate heterogeneity. Quality assessment was performed using Newcastle Ottawa Scale. Sensitivity analysis was performed by using leave one or two out method. PROSPERO registration number: CRD42022336402.ResultsNine eligible studies consisting of 86,795 patients were included. A total of 22,130 (25.5%) patients were in statin use before the index ACS event. The prevalence of old myocardial infarction, heart failure, hypertension, diabetes mellitus, and chronic renal failure and concomitant treatment with aspirin, clopidogrel, and beta blocker was higher in the prior statin group compared to no previous statin. Overall, prior statin use was associated with a significantly lower incidence of in-hospital arrhythmia during ACS compared to no previous statin (OR 0.60; 95% CI 0.49–0.72; P < 0.00001; I² = 54%, P-heterogeneity = 0.03). In subgroup analysis, previous statin use reduced the incidence of atrial fibrillation or atrial flutter (OR 0.64; 95% CI 0.43–0.95; P = 0.03; I² = 73%, P-heterogeneity = 0.01) and ventricular tachycardia or ventricular fibrillation (OR 0.57; 95% CI 0.49–0.65; P < 0.00001; I² = 8%, P-heterogeneity = 0.35).ConclusionsBased on aggregate patient data, prior statin use may reduce the incidence of in-hospital arrhythmia during ACS, particularly atrial fibrillation or atrial flutter and ventricular tachycardia or ventricular fibrillation.     

Long term risk of Wolff-Parkinson-White pattern and syndrome

For years, conventional wisdom has held that patients with asymptomatic ventricular pre-excitation (asymptomatic WPW or WPW pattern) were at low risk for adverse outcomes. This assumption has been challenged more recently in a number of observational/natural history studies as well as in prospective trials in which patients were more aggressively studied via invasive electrophysiology study (EPS) and more aggressively treated, in some cases, with pre-emptive catheter ablation, despite the lack of symptoms. In sum, the data do not definitively support one approach (early, up-stream EPS and/or ablation) vs. the other (watchful waiting with close monitoring). The most recent pediatric and adult guidelines reflect this ambiguity with a broad spectrum of approaches endorsed.     

Trends in treated ventricular fibrillation out-of-hospital cardiac arrest: A 17-year population-based study

OBJECTIVES: The aims of this study were to describe the trends of ventricular fibrillation (VF) out-of-hospital cardiac arrest in Rochester, Minnesota, since 1985 and to determine coexistent trends in implantable cardioverter defibrillator (ICD) placement and termination of potentially lethal ventricular arrhythmias that might explain, at least in part, a declining incidence trend. BACKGROUND: The incidence of VF out-of-hospital cardiac arrest treated by emergency medical services (EMS) personnel has declined over the past decade. Because VF out-of-hospital cardiac arrest occurs primarily in the setting of severe coronary artery disease, primary and secondary prevention strategies may account in part for the decline. In particular, ICD use in large primary and secondary prevention clinical trials in patients at high risk of sudden death has demonstrated that these devices improve survival. METHODS: All residents of the City of Rochester, Minnesota, who presented with a VF out-of-hospital cardiac arrest from 1985 to 2002, identified and treated by EMS, were included in the study. In addition, residents of the City of Rochester who received their first ICD implant from 1989 to 2002 were identified. From the ICD records, general demographics, etiology of heart disease, comorbid medical disease, and indication for ICD placement were abstracted. Follow-up data obtained from this population included ICD shocks, the underlying rhythm disturbance, and death. RESULTS: The overall incidence of EMS-treated VF out-of-hospital cardiac arrest in Rochester during the study period was 17.1 per 100,000 [95% confidence interval (CI) 15.1-19.4]. The incidence has decreased significantly (P < 0.001) over the study period: 1985-1989: 26.3/100,000 (95% CI 21.0-32.6), 1990-1994: 18.2/100,000 (95% CI 14.1-23.1), 1995-1999: 13.8/100,000 (95% CI 10.4-17.9), 2000-2002: 7.7/100,000 (95% CI 4.7-11.9). One hundred ten patients received an ICD. The placement of ICDs also has increased dramatically over the past 10 years: 1990-1994: 5.0/100,000 to 2000-2002: 20.7/100,000 (P < 0.001). ICDs terminated VF or fast ventricular tachycardia (<270 ms) in 22 patients. Termination of these potentially fatal arrhythmias has shown a trend toward an increase over the study period: 1990-1994: 1.1/100,000 to 2000-2002: 3.5/100,000 (P = 0.06). CONCLUSIONS: The incidence of VF out-of-hospital cardiac arrest is declining. In contrast, the rates of ICD placement and ICD termination of ventricular tachycardia or VF are markedly increasing. Sudden death preventive strategies are multifactorial. These observations suggest that ICD termination of potentially lethal ventricular arrhythmias may contribute to the lower incidence of VF out-of-hospital cardiac arrest.     

Nifekalant in the treatment of life-threatening ventricular tachyarrhythmias

The aim of the present study is to review the literature and discuss nifekalant’s potential use as a first aid drug in an emergency care setting.The PubMed database was used to identify papers,using Keywords nifekalant,MS-551,amiodarone and lidocaine.Nifekalant hydrochloride,formally known as MS-551,is a classⅢ antiarrhythmic agent which acts only by increasing the time course of myocardial repolarization.It was developed and is currently being used only in Japan for the treatment of ventricular tachyarrhythmias.It is a non-selective K+channel blocker without any β-blocking actions.Administration of nifekalant suppressed sustained ventricular tachyarrhythmias in acute coronary syndrome patients,and in cardiac arrest victims as well as during or after cardiac surgery.The major adverse effect of nifekalant is QT interval prolongation and occurrence of torsades de pointes which requires frequent monitoring of the QT interval during nifekalant infusion with adequate dose adjustment.Nifekalant is a possible effective antiarrhythmic agent for refractory ventricular tachyarrhythmias.Further clinical studies are required before nifekalant is routinely used in the emergency care setting.