Defibrillator, Heart Failure and Tachycardia

Ventricular Fibrillation, ICD, LBBB, QRS of 210 ms, Positive Smith Modified Sgarbossa Criteria, and Pacemaker-Mediated Tachycardia

Dr. Smith's ECG Blog

APRIL 2, 2024

He was defibrillated, but they also noticed that he was being internally defibrillated and then found that he had an implantable ICD. He was unidentified and there were no records available After 7 shocks, he was successfully defibrillated and brought to the ED. Tachycardia exaggerates ST Elevation in LBBB and Paced rhythm 5.

Tachycardia

Tachycardia Pacemaker Cardiac Arrest Cardiomyopathy

Torsade in a patient with left bundle branch block: is there a long QT? (And: Left Bundle Pacing).

Dr. Smith's ECG Blog

JANUARY 2, 2025

Permanent pacer placement Later, a biventricular pacer was placed for " Cardiac Resynchronization Therapy (CRT) " (This is indicated for patients with LBBB and QRS duration > 130 ms and heart failure and vastly improves heart failure). Even with tachycardia and a paced QRS duration of ~0.16 J Am Coll Cardiol.

Tachycardia

Tachycardia Cardiomyopathy Blog Bradycardia

PO-01-037 EXTRACTION OF TWO RIGHT VENTRICULAR DEFIBRILLATOR LEADS WITH REIMPLANTATION OF A DEFIBRILLATOR LEAD INTO A DILATED CORONARY VEIN IN PREPARATION FOR TRANSCATHETER TRICUSPID VALVE REPLACEMENT

HeartRhythm

MARCH 31, 2025

Electrophysiology was consulted for lead management.

Defibrillator

Defibrillator Tricuspid Atrial Fibrillation Electrophysiology

Webinars

Bridging Innovation & Patient Care: The Growing Role of AI

MORE WEBINARS

PO-06-195 EFFICACY OF ATRIAL ANTI-TACHYCARDIA PACING IN PATIENTS WITH IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS: INSIGHTS FROM THE CERTITUDE REAL-WORLD DATABASE

HeartRhythm

MARCH 31, 2025

Atrial tachyarrhythmias (ATs) such as atrial flutter and fibrillation increase the risk of stroke, heart failure and mortality. In patients with implantable cardiac defibrillator (ICD), they may also lead to rapid stable ventricular rhythms that result in inappropriate therapies.

Defibrillator

Defibrillator Atrial Flutter Heart Failure Tachycardia

A 20-something woman with cardiac arrest.

Dr. Smith's ECG Blog

OCTOBER 18, 2023

The above ECGs show the initiation and continuation of a polymorphic ventricular tachycardia. Polymorphic ventricular tachycardia can be ischemic, catecholaminergic or related to QT prolongation. She spontaneously converted (Defibrillation was not performed). NT-pro-BNP peaked at 4831, consistent with heart failure.

Cardiac Arrest

Cardiac Arrest Tachycardia Cardiomyopathy Bradycardia

CRT-P and CRT-D

All About Cardiovascular System and Disorders

MAY 1, 2024

CRT is used in heart failure with reduced ejection fraction. According to the Universal Definition and Classification of Heart Failure, heart failure with reduced ejection fraction has left ventricular ejection fraction of 40% or less. CRT stands for cardiac resynchronization therapy.

Heart Failure

Heart Failure Arrhythmia Pacemaker Defibrillator

Overcoming Status Quo Bias: Embracing Evidence-Based Guidelines in Cardiometabolic Care

Cardiometabolic Health Congress

AUGUST 30, 2024

Arrhythmias : A leadless pacemaker-defibrillator system provides antitachycardia pacing for ventricular tachycardia in patients with subcutaneous ICDs. Coronary Heart Disease : Initiate beta-blockers in patients with acute MI and normal LVEF unless contraindicated or if they have heart failure.

Cardiac Rehabilitation

Cardiac Rehabilitation Heart Failure Quality of Life Aortic

Evaluation of JVP

All About Cardiovascular System and Disorders

MARCH 20, 2024

But while compressing here in a patient with heart failure, it can elicit pain because there could be tender hepatomegaly in patients with heart failure. That occurs in right heart failure and constrictive pericarditis. One is ventricular tachycardia with regular retrograde activation.

Tricuspid

Tricuspid Pericarditis VSD Heart Failure

Distractions

EMS 12-Lead

MARCH 19, 2023

He denied any known medical history, specifically: coronary artery disease, hypertension, dyslipidemia, diabetes, heart failure, myocardial infarction, or any prior PCI/stent. Despite immediate chest compressions, and multiple rounds of defibrillation, he could not be resuscitated. Breath sounds were clear in all lung fields.

Myocardial Infarction

Myocardial Infarction STEMI Coronary Angiogram Coronary Artery Disease

PO-02-168 EVALUATION OF IMPLANTABLE CARDIOVERTER DEFIBRILLATOR ALGORITHM ACCURACY IN DIFFERENTIATING SUPRAVENTRICULAR TACHYCARDIA FROM ATRIAL FIBRILLATION.

HeartRhythm

APRIL 30, 2024

For the past four decades, implantable cardioverter defibrillator (ICD) therapy has become the standard of care for preventing sudden cardiac death in high-risk individuals. Patients with ICDs who experience atrial fibrillation (AF) have a higher risk of stroke, heart failure, and mortality.

Atrial Fibrillation

Atrial Fibrillation Defibrillator Sudden Cardiac Death Tachycardia

Why is an Implantable Defibrillator NOT Useful Soon After Myocardial Infarction?

All About Cardiovascular System and Disorders

MARCH 17, 2024

Here is the transcript of the video: Implantable defibrillator is an important life saving device. Then, why is it mentioned that, implanting a defibrillator soon after an acute myocardial infarction, in those with left ventricular dysfunction and prone for ventricular arrhythmias and sudden cardiac death, is not useful?

Myocardial Infarction

Myocardial Infarction Defibrillator Sudden Cardiac Death Arrhythmia

Age‐related penetrance of phospholamban p.Arg14del cardiomyopathy

European Journal of Heart Failure

APRIL 22, 2025

ECG, electrocardiogram; ICD, implantable cardioverter-defibrillator; LVAD, left ventricular assist device; LVEF, left ventricular ejection fraction; MRI, magnetic resonance imaging; PVC, premature ventricular contraction; SCD, sudden cardiac death; VF, ventricular fibrillation; VT, ventricular tachycardia. Arg14del) carriers.

Cardiomyopathy

Cardiomyopathy Sudden Cardiac Death Risk Factors Electrocardiogram

PO-01-133 ACTIVE ARRHYTHMIA PATTERN: A NOVEL PREDICTOR OF ICD SHOCKS AND MAJOR CARDIOVASCULAR EVENTS. A SUB ANALYSIS FROM THE PARTITA STUDY

HeartRhythm

APRIL 30, 2024

In the PARTITA trial antitachycardia pacing (ATP) predicted the occurrence of implantable cardioverter-defibrillator (ICD) shocks. Catheter ablation of ventricular tachycardia after the first shock reduced the risk of death or worsening heart failure (wHF).

Defibrillator

Defibrillator Heart Failure Arrhythmia Tachycardia

Preventive catheter ablation for ventricular arrhythmias in patients with end‐stage heart failure referred for heart transplantation evaluation: Rationale for and design of the CASTLE‐VT trial

European Journal of Heart Failure

NOVEMBER 11, 2024

Aims Timely referrals for transplantation and left ventricular assist device (LVAD) play a key role in favourable outcomes in patients with advanced heart failure (HF). Cardiovascular mortality, driven by sudden cardiac death, is the main reason for dying while waiting for heart transplantation (HTx).

Heart Transplant

Heart Transplant Transplant Heart Failure Ablation

See what happens when a left main thrombus evolves from subtotal occlusion to total occlusion.

Dr. Smith's ECG Blog

OCTOBER 20, 2024

The arrhythmia spontaneously converted before defibrillation was achieved. The patient spent a couple of days in the cardiac intensive care unit receiving treatment for acute heart failure and aspiration pneumonia. How did the Queen of Hearts do on today's ECGs? Long term follow up is not available.

Cardiogenic Shock

Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest

STEMI with Life-Threatening Hypokalemia and Incessant Torsades de Pointes

Dr. Smith's ECG Blog

APRIL 8, 2016

At cath, he immediately had incessant Torsades de Pointes requiring defibrillation 7 times and requiring placement of a transvenous pacer for overdrive pacing at a rate of 80. See here for management of Polymorphic Ventricular Tachycardia , which includes Torsades. Heart failure leading to death was related to all subclasses of PVC.

STEMI

STEMI Myocardial Infarction Cardiac Arrest Arrhythmia

Incidence, risk assessment and prevention of sudden cardiac death in cardiomyopathies

European Journal of Heart Failure

NOVEMBER 14, 2023

ABSTRACT Cardiomyopathies are a significant contributor to cardiovascular morbidity and mortality, mainly due to the development of heart failure and increased risk of sudden cardiac death (SCD). Syncope, LGE on CMR, inducible sustained VT at PES, pathogenic mutations in LMNA, PLN, FLNC, and RBM20.

Sudden Cardiac Death

Sudden Cardiac Death Cardiomyopathy Risk Factors Heart Failure

What is this rhythm? And why rhythm problems are easier for the Emergency Physician than acute coronary occlusion (OMI).

Dr. Smith's ECG Blog

MARCH 6, 2025

Smith comments : Wide complex tachycardia. The differential diagnosis of WCT is: 1) Sinus tachycardia with "aberrancy" (in this case RBBB and LAFB), but there are no P-waves and the QRS morphology is not typical of simple RBBB/LAFB. Also, if the rate is constant, not wavering up and down, it is highly unlikely to be sinus tachycardia.

Tachycardia

Tachycardia Dysrhythmia ICU Pulmonary

Patient is informed of her husband's death: is it OMI or it stress cardiomyopathy?

Dr. Smith's ECG Blog

MARCH 8, 2025

Several 200 J shocks did not terminate the VF, so a second defibrillator was applied for double sequential defibrillation with 400 J. She was defibrillated perhaps 25 times. In addition to profound acute heart failure, the patient suffered from electrical storm. Was her outcome to be expected for ostial RCA OMI?

Cardiomyopathy

Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia

Cardiovascular Update

Ventricular Fibrillation, ICD, LBBB, QRS of 210 ms, Positive Smith Modified Sgarbossa Criteria, and Pacemaker-Mediated Tachycardia

Torsade in a patient with left bundle branch block: is there a long QT? (And: Left Bundle Pacing).

PO-01-037 EXTRACTION OF TWO RIGHT VENTRICULAR DEFIBRILLATOR LEADS WITH REIMPLANTATION OF A DEFIBRILLATOR LEAD INTO A DILATED CORONARY VEIN IN PREPARATION FOR TRANSCATHETER TRICUSPID VALVE REPLACEMENT

Webinars

PO-06-195 EFFICACY OF ATRIAL ANTI-TACHYCARDIA PACING IN PATIENTS WITH IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS: INSIGHTS FROM THE CERTITUDE REAL-WORLD DATABASE

A 20-something woman with cardiac arrest.

CRT-P and CRT-D

Overcoming Status Quo Bias: Embracing Evidence-Based Guidelines in Cardiometabolic Care

Evaluation of JVP

Distractions

PO-02-168 EVALUATION OF IMPLANTABLE CARDIOVERTER DEFIBRILLATOR ALGORITHM ACCURACY IN DIFFERENTIATING SUPRAVENTRICULAR TACHYCARDIA FROM ATRIAL FIBRILLATION.

Why is an Implantable Defibrillator NOT Useful Soon After Myocardial Infarction?

Age‐related penetrance of phospholamban p.Arg14del cardiomyopathy

PO-01-133 ACTIVE ARRHYTHMIA PATTERN: A NOVEL PREDICTOR OF ICD SHOCKS AND MAJOR CARDIOVASCULAR EVENTS. A SUB ANALYSIS FROM THE PARTITA STUDY

Preventive catheter ablation for ventricular arrhythmias in patients with end‐stage heart failure referred for heart transplantation evaluation: Rationale for and design of the CASTLE‐VT trial

See what happens when a left main thrombus evolves from subtotal occlusion to total occlusion.

STEMI with Life-Threatening Hypokalemia and Incessant Torsades de Pointes

Incidence, risk assessment and prevention of sudden cardiac death in cardiomyopathies

What is this rhythm? And why rhythm problems are easier for the Emergency Physician than acute coronary occlusion (OMI).

Patient is informed of her husband's death: is it OMI or it stress cardiomyopathy?

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