VT mapping | ischemic cardiomyopathy
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This medical document discusses a patient with ischemic cardiomyopathy and reduced ejection fraction of 30% who has an implantable cardioverter-defibrillator for ventricular tachycardia. Mapping of the left and right ventricles was performed which identified late potentials on activation mapping and bipolar voltages between 0.5-1.5 mV.
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2) Catheter ablation is successful in eliminating the accessory pathway in 93-95% of cases. Localization of the pathway involves analyzing electrocardiogram patterns and effective sites are identified using techniques like accessory pathway conduction block.
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1) The document defines wide complex tachycardia as a rhythm with a QRS duration ≥120ms and heart rate >100 bpm.
2) The main causes listed are ventricular tachycardia (80% of cases) and supraventricular tachycardia with aberrancy.
3) Key features that can help differentiate the underlying rhythm include QRS duration, axis, morphology, and the presence or absence of AV dissociation on electrocardiogram.
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This document provides an overview of the approach to evaluating and diagnosing wide complex tachycardias. It begins with definitions of terms like wide complex tachycardia, ventricular tachycardia, and supraventricular tachycardia. It then discusses the importance of making an accurate diagnosis to avoid inappropriate treatment. Various ECG criteria are presented to help distinguish ventricular from supraventricular rhythms based on features like AV dissociation, QRS morphology, axis, and precordial patterns. Specific criteria for right bundle branch block and left bundle branch block morphologies are also outlined. The document emphasizes taking a stepwise approach and considering clinical history in narrowing the differential diagnosis of wide complex tachycardias.
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1) O documento discute se a restituição do ritmo sinusal deve ser buscada rotineiramente em pacientes com fibrilação atrial persistente. 2) Estudos como o AFFIRM não mostraram benefícios de manter o ritmo sinusal em termos de prognóstico. 3) No entanto, fatores como os efeitos colaterais das medicações antiarrítmicas e a falta de adesão completa ao tratamento de ritmo sinusal podem ter mascarado benefícios.
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