Management of pacing system related complications in patients undergoing dynamic cardiomyoplasty.

Integrity of the electrical circuit is a necessary requirement for appropriate heart/wrapped skeletal muscle interaction to be achieved in cardiomyoplasty. This article describes the management of two different complications after a cardiomyoplasty procedure involving the electrical system (infection of the abdominal cardiomyostimulator pocket and intramuscular lead fracture). Minimal approaches were carried out, which ensured the successful treatment of the infective and of the mechanical insult, and represent useful strategy for solving such uncommon problems.

Cardiomyoplasty and implantable cardioverter defibrillator: efficacy and safety of concomitant device implantation: sudden death and cardiomyoplasty.

Sudden death represents a common event in the natural history of patients affected by chronic heart failure. Such an outcome also has been shown to characterize the follow-up of the cardiomyoplasty procedure. We report two cases of patients who had cardiomyoplasty and experienced witnessed episodes of ventricular arrhythmia at variable times after surgery (2 years and 2 months, respectively). In the first case, an implantable cardioverter defibrillator (ICD) was implanted subsequent to the arrhythmic episode, whereas the second patient had a combined cardiomyoplasty and ICD implantation procedure. In particular, this patient underwent a modified wrapping technique, herein described, because of a large left ventricular dilatation. In both cases, ventricular defibrillation did not affect the correct functioning of the implanted cardiomyostimulator. Our article confirms that ventricular arrhythmia is common in cardiomyoplasty patients. The combined use of a skeletal muscle stimulator and implantable defibrillator may therefore be effective in preventing arrhythmia-related sudden death without any concurrent effect on the correct functioning of the wrapped muscle/heart circuit, with likely benefit on long-term cardiomyoplasty patient survival.

[The electrotherapy of the arrhythmias in 3 cases of myotonic dystrophy (Steinert's disease)]. / Terapia elettrica delle aritmie in tre casi di distrofia miotonica (malattia di Steinert).

Myotonic dystrophy is a progressive multisystem disease with autosomal dominant inheritance. Cardiac involvement is an integral part of the disorder, the most prominent manifestations being various conduction defects and rhythm disturbances sometimes related to syncope or sudden cardiac death. We describe 3 cases admitted to our Centres. Two patients received a permanent pacemaker for atrioventricular block of different degree and in the third case an implantable cardioverter defibrillator with antibradycardia pacing was inserted for malignant ventricular tachyarrhythmias and advanced atrioventricular block during atrial flutter.

Implantable defibrillation and thromboembolic events.

In ICD patients thromboembolic events (TEEs) are described as possible complications at implant or during the follow-up. We report four cases of TEEs (two peripheral and two cerebral; 6.5% of patients) that occurred in our series during a mean follow-up of 19.4 months. The patients had chronic postinfarction LV aneurysm (3) and idiopathic dilated cardiomyopathy (1). None had previous embolisms nor evidence of left atrial or LV clots at standard preoperative transthoracic echocardiography. No paroxysms of atrial fibrillation were documented prior or after ICD implant. We discuss the possible causes of embolization and the suitability of anticoagulant therapy in ICD patients.

[Malignant ventricular arrhythmias: nonpharmacological therapies]. / Aritmie ventricolari maligne: terapie non farmacologiche.

In these last few years the indications for non pharmacological options in the therapy of malignant ventricular arrhythmias have been extended. Some of these approaches (antiarrhythmic surgery, cardiac transplant, automatic implantable cardioverter defibrillator) have an exact clinical collocation, some others are still experimental. Our personal experience and the recent literature have been analysed to explain the state of the art of these therapies. We undoubtedly think that these options are a valid alternative to drugs in non responder patients. The choice needs an accurate evaluation. The clinical picture, not only arrhythmic, and the specific aim of each procedure should be carefully considered.

Electrophysiological evaluation of the sinus node in patients with atrioventricular and/or intraventricular conduction defects.

The authors evaluated retrospectively sinoatrial conduction time (SACT), sinus node recovery time (SNRT), and corrected sinus node recovery time (CSNRT) in 272 patients with atrioventricular and/or intraventricular conduction defects without evidence of overt sinus node dysfunction. The study was designed to determine the prevalence of electrophysiologic sinus node abnormalities in patients with overt atrioventricular and/or intraventricular conduction defects. One or more sinus node electrophysiological abnormalities were observed in 133 cases (48.9%). There was a significant prevalence of electrophysiologic sinus node abnormalities only in patients older than 71 years of age. The data suggest that the involvement of the specialized conduction system is much more diffuse than one might expect simply observing the single recorded ECG defect and that the prevalence of associated defects of the conduction system increases with increasing age of patients.

[Enalapril and acebutolol in essential arterial hypertension. Comparison of the 2 drugs and evaluation of their combination]. / Enalapril ed acebutololo nell'ipertensione arteriosa essenziale. Confronto tra i due farmaci e valutazione della loro associazione.

The effects of a mid-term antihypertensive treatment with Acebutolol (A) 400 mg once-daily alone, Enalapril (E) 20 mg once-daily alone and their combination (A + E) in 12 hypertensive patients (pts.) have been evaluated. The diastolic (DBP) and systolic (SBP) blood pressure values have been evaluated in supine and upright position and at the end of an exercise test. Basic values obtained after 3 weeks of treatment with placebo have been matched with values observed after 3 months of each treatment (A; A + E; E). In order to evaluate the effectiveness of the combination, pts. were divided into two groups: the first group was given A, than A + E and finally E; in the second group the order was reversed. Our findings showed a more significant reduction of DBP in supine and upright position and after exercise (p less than .05) and of SBP in supine and upright position (p less than .05) after treatment with E. The addition of A to E did not produce a further significant reduction in blood pressure values except after exercise (p less than .01).

[Indications for cerebral revascularization surgery (author's transl)]. / Indicazioni agli interventi di rivascolarizzazione cerebrale.

Cerebrovascular diseases are among the most widespread. In the USA alone there is at any time a population of 1.6 million people with current stroke syndrome or the sequelae thereof. The most effective weapon to combat this disease is prevention, and here reference is made in particular to surgical prevention, especially through endoarterectomy of the extracranial internal carotid, and to vertebrobasilar circulatory failure.