ABSTRACT
AIMS: To evaluate the cardiac mortality in patients suffering from a first episode of sustained monomorphic ventricular tachycardia (SMVT). METHODS: 100 patients less than 75 years old were evaluated during a 50-month follow-up period. Patients were classified into four groups: myocardial infarction, dilated cardiomyopathy, normal heart and miscellany. Seventeen patients underwent a cardioverter-defibrillator implantation, two heart transplant, three aneurysmectomy and 10 other types of cardiac surgical proceedings. RESULTS: Patients with a left ventricle ejection fraction (EF)> or =50% presented a cardiac mortality of 5% compared with 38% of those with EF<50%. Etiology of underlying cardiomyopathy with an EF> or =50% was associated with a cardiac mortality of 5% (normal heart), 5% (myocardial infarction) and 9% (miscellany) compared to those with EF<50%: 33% (dilated cardiomyopathy) and 40% (myocardial infarction). Patients who experienced syncope during the first episode of SMVT showed a cardiac mortality of 31% compared to those 14% (P < 0.05) who did not experience. Patients with syncope, myocardial infarction and EF<50% showed a cardiac mortality of 68%. CONCLUSION: The present study shows that survival after the first episode of SMVT is closely related to EF and the existence of syncope. Patients with myocardial infarction and EF<50% had a worse prognosis when the site was the inferior wall.
Subject(s)
Tachycardia, Ventricular/mortality , Tachycardia, Ventricular/physiopathology , Aged , Female , Humans , Male , Middle Aged , Prognosis , Risk Factors , Stroke Volume , Survival AnalysisABSTRACT
Pregnancy is related to an increased frequency of arrhythmias in asymptomatic patients with Wolff-Parkinson-White syndrome, which might lead to sudden death. A 40-year-old woman, with Wolff-Parkinson-White syndrome which was not diagnosed until pregnancy, presented in the 34th week with an atrial fibrillation, with high risk criteria for ventricular fibrillation. Intravenous ajmaline was given to convert the tachyarrhythmia to sinus rhythm. We obtained an excellent maternal control with no maternal or fetal adverse effects.
Subject(s)
Ajmaline/therapeutic use , Atrial Fibrillation/drug therapy , Pregnancy Complications, Cardiovascular/drug therapy , Wolff-Parkinson-White Syndrome/drug therapy , Adult , Electrocardiography , Female , Humans , Pregnancy , Wolff-Parkinson-White Syndrome/physiopathologyABSTRACT
In 27 patients with atrial fibrillation and/or reciprocating tachycardia, ablation of right-sided Kent bundles (23 in the right posterior paraseptal region and four of the right free wall) was performed. The anterograde refractory period of the accessory pathways was 253 +/- 70 msec and the shortest R-R interval during atrial fibrillation 211 +/- 47 msec. Cumulative energies of 589 +/- 396 J per patient were used, with 3 +/- 2 shocks and 195 +/- 312 J per shock. Accessory pathway ablation was effective in 16/27 patients (59%) during an 11 +/- 8 months of follow-up (in 15/16 pre-excitation disappeared; in nine of them the anterograde and retrograde conductions were abolished and in the other six the anterograde and retrograde conductions were severely altered; ablation was partially ineffective in 1/16 patients who remained asymptomatic on medical treatment and without inducible reciprocal rhythm). Ablation was ineffective in 11/27 patients. Three hours after ablation a patient died from electromechanical dissociation; during ablation a 200 J shock cancelled preexcitation, not being possible to produce reciprocal rhythm. The emergency echocardiography only showed a minimum posterior pericardial effusion. Ablation was effective in 15/23 patients (65%) right posterior paraseptal. Overall success in 1989 (10/27 patients) was 70% (7/10 patients). The success in 1989 was 70% (6/8 patients) right posterior paraseptal. The shortest RP' interval (was 82 +/- 19 msec) during the reciprocal rhythm, where the ablation was performed, was 82 +/- 19 msec (74 +/- 17 msec with success and 99 +/- 19 msec with failure).(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Atrial Fibrillation/surgery , Cardiac Catheterization , Heart Septum/surgery , Tachycardia/surgery , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , PrognosisABSTRACT
Eighty two patients diagnosed of the Wolff-Parkinson-White syndrome (WPW) underwent operation for the surgical section of the Kent-His bundle. In these cases, posteroseptal localization (PS) occurred in 32, left lateral (LL) in 25, right lateral (RL) in six, anteroseptal (AS) in one, posteroseptal and left lateral in 14, right and left posteroseptal in two, anteroseptal and left lateral in one, and left lateral and right and left posteroseptal in one. All of the patients presented an invalidating clinical of palpitations and/or loss of consciousness, and episodes of atrial fibrillation and/or reciprocal rhythm were registered in all cases. The mean anterograde refractory period in the accessory pathways was 244 +/- 60 msec, and the shortest RR in atrial fibrillation was 190 +/- 36 msec. A mitral commissurotomy was carried out in 3 patients during surgery, mitral prostheses were implanted in two, a double aorto-coronary bypass was made in three and an interventricular communication was closed in one. After a follow-up of 36 +/- 18 months, the surgical section of the Kent bundle was found to be effective in 77 out 82 patients (94%). (In 70 out of 77 cases, both anterograde and retrograde conduction were totally abolished and in seven out of 77 obtunded. All patients were asymptomatic during the follow-up period). In 5 out of 82 patients, surgical treatment was ineffective all five showed a PS Kent-His and two presented a second Kent-His fascicle (LL).(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Heart Conduction System/surgery , Wolff-Parkinson-White Syndrome/surgery , Adolescent , Adult , Cardiac Catheterization , Cardiac Pacing, Artificial , Chronic Disease , Electrocardiography , Female , Follow-Up Studies , Humans , Male , Methods , Middle Aged , Postoperative Complications/epidemiology , Wolff-Parkinson-White Syndrome/diagnosis , Wolff-Parkinson-White Syndrome/epidemiologyABSTRACT
We present a 36-year-old male without overt cardiac disease who suffered, since he was 15 years old, from sustained monomorphic ventricular tachycardia of left bundle branch block with a right axis, lasting for several hours; sometimes, syncope was a clinical form of manifestation. Electrophysiologic study, twenty-four hours Holter recording, cardiac catheterization and blood analysis were not useful in order to find its etiology. Efficacy of different drugs, like Mexiletil, Amiodarone, Atenolol and Verapamil (at a dose of 240 mg/day) were tested through multistaged graded-treadmill stress-testing using the Bruce protocol. Ventricular tachycardia was suppressed by administration of Lidocaine. Oral verapamil given at a dose of 360 mg/day prevented the induction of the arrhythmia, the efficacy was tested with maximal treadmill exercise and twenty-four hours Holter recording.
Subject(s)
Tachycardia, Ventricular/drug therapy , Verapamil/therapeutic use , Adult , Cardiac Pacing, Artificial , Chronic Disease , Drug Evaluation , Electrocardiography, Ambulatory/drug effects , Exercise Test/drug effects , Humans , Male , Tachycardia, Ventricular/diagnosisABSTRACT
OBJECTIVES: In order to study the efficiency of oral dose of propafenone in preventing childhood supraventricular tachycardias, we have treated 38 children without left ventricular dysfunction. METHODS: The mean age has been 8 +/- 4.7 years old. All of them had suffered at least two episodes of supraventricular tachycardia, and eleven had undergone a previous antiarrhythmic treatment. The initial dose of propafenone has been 6.5 +/- 2.1 mg/kg/24 h (in 3 doses), which has been increased in case of inefficacy. RESULTS: We have not advised neither side-effects, nor proarrhythmic effects, during a follow-up of 13 +/- 6 months. Propafenone has been efficient in preventing supraventricular tachycardias in all patients. The initial dose has been efficient in 17 patients, and we have increased the initial dose up to 11.1 +/- 3.7 mg/kg/24 h in 21 patients. The mean effective dose has been 8.9 +/- 3.6 mg/kg/24 h. We stopped treatment in 14 patients after been 6 months without supraventricular tachycardias. CONCLUSION: From our study, we conclude that propafenone has been efficient in preventing supraventricular tachycardias in childhood with a dose of 8.9 mg/kg/24 h. We have not found side-effects.
Subject(s)
Propafenone/administration & dosage , Tachycardia, Supraventricular/prevention & control , Administration, Oral , Adolescent , Child , Child, Preschool , Drug Evaluation , Echocardiography, Doppler/drug effects , Electrocardiography/drug effects , Female , Humans , Infant , Infant, Newborn , Male , Propafenone/adverse effects , Recurrence , Tachycardia, Supraventricular/diagnosisABSTRACT
We report four new cases of exercise-induced atrio-ventricular block (appearing during treadmill exercise testing). The mechanism was ischemia in two patients and the conduction disturbance disappeared after coronary artery bypass grafting. The literature on this matter is reviewed. Also the etiology, the natural history and management are discussed in these cases.
Subject(s)
Heart Block/diagnosis , Electrocardiography , Exercise Test , Female , Heart Block/etiology , Heart Block/physiopathology , Heart Block/therapy , Humans , Male , Middle AgedABSTRACT
Since the International Liaison Committee on Resuscitation approved the use of automated external defibrillators (AEDs) in children, efforts have been made to adapt AED algorithms designed for adult patients to detect paediatric ventricular arrhythmias accurately. In this study, we assess the performance of two spectral (A(2) and VFleak) and two morphological parameters (TCI and CM) for the detection of lethal ventricular arrhythmias using an American Heart Association (AHA) compliant database that includes adult and paediatric arrhythmias. Our objective was to evaluate how those parameters can be optimally adjusted to discriminate shockable from nonshockable rhythms in adult and paediatric patients. A total of 1473 records were analysed: 751 from 387 paediatric patients (
Subject(s)
Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/pathology , Electrocardiography , Adolescent , Adult , Algorithms , Arrhythmias, Cardiac/physiopathology , Child , Databases, Factual , Defibrillators , Equipment Design , Humans , ROC Curve , Sensitivity and SpecificitySubject(s)
Coronary Vasospasm/diagnosis , Amlodipine/therapeutic use , Angina Pectoris/diagnosis , Coronary Vasospasm/complications , Coronary Vasospasm/drug therapy , Diagnosis, Differential , Follow-Up Studies , Humans , Male , Middle Aged , Myocardial Ischemia/drug therapy , Myocardial Ischemia/etiology , Nitroglycerin/therapeutic use , Ventricular Fibrillation/etiology , Ventricular Fibrillation/therapySubject(s)
Arrhythmias, Cardiac/diagnosis , Electrocardiography, Ambulatory , Arrhythmias, Cardiac/complications , Arrhythmias, Cardiac/therapy , Cardiac Surgical Procedures/adverse effects , Child , Contraindications , Electrocardiography, Ambulatory/instrumentation , Exercise Test/instrumentation , Exercise Test/methods , Heart Block/diagnosis , Humans , Postoperative Complications/diagnosis , Postoperative Complications/etiologyABSTRACT
Brugada syndrome in a patient with Wolff-Parkinson-White syndrome. We report a 32-year-old man with orthodromic atrioventricular (AV) reciprocating tachycardia using a right posterior accessory pathway. However, his ECG showed ST segment elevation in leads V1 to V3. After successful radiofrequency ablation of his accessory pathway a cardioverter defibrillator was implanted.