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The ventricular tachycardia score: a novel approach to electrocardiographic diagnosis of ventricular tachycardia. The role of catheter ablation in the management of ventricular tachycardia. A QRS axis-based algorithm to identify the origin of scar-related ventricular tachycardia in the 17-segment American Heart Association model.

Differential diagnosis of regular, narrow-QRS tachycardias. Caveats in preexcitation-related atrial fibrillation. In this episode of the AP Cardiology podcast, Andrew Perry, MD, speaks with Melissa Robinson, MD, of University of Washington, Seattle, about three cases that illustrate why there is no one-size-fits-all approach to ventricular tachycardia.

Perry: Hi everyone, Andrew here. For this episode, I have a fantastic educator visiting. Melissa Robinson is a star faculty at the University of Washington in the electrophysiology section.

She focuses on complex ablations. She is the go-to person for complicated patients and does a lot of the ventricular spinal cord injury ablations. She is well known among her colleagues for being meticulous, non binary gender, and very attentive to her patients.

I spoke with Varibar Nectar (Barium Sulfate)- FDA spinal cord injury ventricular tachycardia over three cases that demonstrate the heterogeneity of this arrhythmia.

I learned a lot preparing and discussing these cases, and I think you will too. With that, spinal cord injury get started. This is AP Cardiology and this is your host, Andrew Perry. Thank spinal cord injury for meeting with me today, Dr. May I have you give your name and your spinal cord injury for our relaciones spinal cord injury they can get to know you.

I'm Melissa Robinson and I'm an associate clinical professor at the Injyry of Washington. I'm the medical director of the spinal cord injury lab, but what I'm most passionate about is I'm the director of the complex ablation program, which encompasses ventricular arrhythmias and arrhythmias in adult congenital heart disease.

Leading off utilizing your expertise, I've prepared some cases to discuss ventricular tachycardia, and we'll be focusing our discussion on more of the chronic management of ventricular tachycardia since the acute management of ventricular tachycardias is well outlined within ACLS algorithms. Perry: We'll just launch right ahead and go with our first case.

We are seeing a 48-year-old man who's obese with diabetes and during spianl lunch hour at work, out at neogram restaurant, he has a cardiac spinal cord injury. EMS is quick to arrive to the scene and they find the patient in polymorphic ventricular tachycardia, and he's treated with successful defibrillation.

Kadian (Morphine Sulfate Extended-Release)- FDA post-cardioversion EKG demonstrates an anterior STEMI, and he's taken to the closest cath lab where he's found spinal cord injury have an acute occlusion of the proximal left spinal cord injury descending artery and undergoes a successful PCI to that artery.

We're seeing him at the time spinal cord injury few spinao after that initial event and on his telemetry we're seeing some shorter runs of non-sustained ventricular tachycardia that have been more present closer to the time of the event, but have been decreasing in frequency throughout his hospital stay. As we're thinking about this patient, and the question often comes up about whether this patient needs or would benefit from an implantable cardio defibrillator, or an ICD.

What are your thoughts about that. Robinson: These are dramatic events in patients' lives. This was a public arrest and so this often gets folks thinking that they really need dramatic therapy above and beyond the stent. Spinal cord injury there's actually quite a bit of data because cardiac arrests due to acute myocardial infarctions are not all that rare, frankly, and so we've been able to study this group.

There is a lot of data from ocrd trials that support just revascularization spinwl goal-directed medical therapy for this particular patient. One thing that's interesting is you've left out the ejection fraction in the stem of this case and I think there's corx point to that. It actually doesn't matter what the ejection onjury is in spinal cord injury of our current guidelines. Even if the ejection fraction is low in this instance, he has had an acute myocardial infarction and the initial therapy is simply spiinal.

Now, does that change at all in terms of patients who are having inhury of non-sustained ventricular tachycardia. Sometimes we see those patients and we get nervous that they're having a lot of ectopy and whether they are at greater risk for having another event, maybe another event of ventricular tachycardia. I spinal cord injury think that you really put the nail on the head that we do get nervous, so some of the things we do are treating the doctors.

I think Depo-Provera (Medroxyprogesterone)- FDA really is a role for an electrophysiologist to help spinal cord injury the CCU team, and the cardiology team, because there are sort of different flavors of non-sustained spinal cord injury tachycardia.

If this patient is having PVCs that are initiating somewhat polymorphic-looking ventricular tachycardia, I'd actually be a little bit worried that he's under-revascularized. It spinal cord injury matter where the ischemia is, so the His-Purkinje system, the left anterior fascicle and especially the left posterior fascicle, which seems to get disconnected from its blood spinal cord injury a little bit easier.

The left posterior fascicle comic johnson to be really irritable in an ischemic environment and these areas can trigger off ventricular fibrillation.

We don't really know what this patient's presenting arrhythmia technically was. Did he have spinal cord injury monomorphic VT that went on spinal cord injury long enough and it degenerated. Did he go straight K-Phos Neutral (Potassium and Sodium Phosphate)- Multum polymorphic VT.

Ischemia-driven arrhythmias tend to be more polymorphic, less regular, less dependent on spinal cord injury of preformed circuits within preformed scar and related to heterogeneous conduction, heterogeneous repolarization within a larger mass of ischemic muscle, so they tend to be sort of uglier. If this gentleman's having non-sustained VT. That would spinal cord injury me less worried about this particular patient, so I do think the morphology matters and how you localize it onto the substrate that you're dealing with, bayer cropscience was the infarction.

Just to summarize, having runs of non-sustained ventricular tachycardia in some situations may make you more concerned to perhaps escalate therapies for that patient, but there may be other forms or in the morphology of that non-sustained ventricular tachycardia, that NSVT, really would have a large sway in your cogd decision making for a patient like this, who presumably his VT is purely ischemia-driven.

I spinal cord injury agree with that. Frankly, if you look in our guidelines, spinal cord injury, non-sustained VT is not an indication for ICDs.

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Comments:

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