[Myocardial revascularization in chronic coronary artery disease. State of art].

The review addresses debatable issues of myocardial revascularization in chronic forms of ischemic heart disease, shows major differences between percutaneous coronary intervention and coronary artery bypass grafting in terms of long-term prognosis, and the dependence of the results on the clinical profile of the disease. The review of current publications demonstrates advantages of open surgery in long-term survival and prevention of adverse outcomes in target groups of patients.

Estudo multicêntrico comparativo de quatro diferentes tipos de sensores: atividade, acelerômetro, temperatura e período de pré-ejeçäo / Comparative study with different rate adaptive pacing systems

Recentemente diferentes princípios têm sido utilizado para estimular o coraçäo na tentativa de recuperar o débito cardíaco. Neste estudo multicêntrico, foram comparadas as respostas à estimulaçäo por 4 tipos de sensores, sendo 3 tipos de resposta de alça aberta (atividade física, acelerômetro e temperatura venosa central) implantados em 30 (SSIR-8 e DDDR-22), 9(SSIR-5 e DDDR-4) e 12 (SSIR) pacientes respectivamente. Um outro sensor do tipo alça fechada, sensível às variaçöes do sitema nervoso autôno, foi implantado em 57 pacientes, todos no modo DDDR. Os resultados obtidos durante a realizaçäo de atividade física diária, de teste ergométrico e de Holter de 24 horas foram comparados sendo possível observar uma maior fidelidade na curva de resposta de frequência frente a atividade física, nos pacientes submetidos à estimulaçäo de alça fechada

Prophylactic implantable defibrillator patches in patients at high risk for malignant ventricular dysrhythmias.

The indications for prophylactically placing implantable cardioverter defibrillator (ICD) patches at cardiac surgery are unclear. Over the past 4 years, 25 patients have undergone placement of prophylactic ICD patches at the authors' institution. Indications were severe coronary artery disease with ventricular tachycardia (VT) (n = 14) or ventricular fibrillation (VF) (n = 2), and left ventricular aneurysmectomy and/or subendocardial resection (SER) (n = 9). Four patients died in-hospital, three from refractory VT (which could be transthoracically cardioverted until recurrence was unremitting), and one from congestive heart failure (CHF). All of the remaining 21 patients underwent post-operative electrophysiologic studies (EPS), and 12 had inducible VT (8/14 CABG, 4/7 SER). Eight of the 12 inducible patients had generators implanted, whereas 3 patients were controlled medically. One patient refused generator implantation and died at home from sudden cardiac death, and one initially non-inducible patient required late ICD generator placement, yielding a total of nine patients who received generators. All nine of these patients are currently alive at 14 +/- 7 months follow-up, and five have subsequently received appropriate ICD discharges. In patients undergoing cardiac surgery considered preoperatively or intraoperatively to be at increased risk for VT/VF and too unstable for preoperative EPS, prophylactic ICD patches should be considered.

Surgical treatment of symptomatic, drug-resistant ventricular bigeminy and other forms of complex ventricular ectopy (ventricular allorhythmias).

This article describes 18 patients with drug-resistant ventricular bigeminy and other forms of complex ventricular ectopy (allorhythmias) associated with recurrent syncope. Particular emphasis is placed on the electrophysiologic methods used to characterize the basis of these arrhythmias and to accomplish isochronous mapping to identify their site of origin. A malignant course of drug-resistant bigeminy in combination with other rhythm disorders was accepted as indications for surgical intervention. Cryosurgery was the method used most frequently for the ablation of arrhythmogenic myocardium. All 18 patients underwent postoperative electrophysiologic studies and Holter monitoring to determine the efficacy of the operation. Fifteen of the 18 patients were cured of their symptomatic arrhythmia. Thus surgical intervention is an effective method for the treatment of patients with symptomatic, drug-resistant ventricular allorhythmias.