Treatment of tachyarrhythmias in a patient with the long QT syndrome by autotransplantation of the heart and sinus node-triggered atrial pacing.

The case history of a 37-year-old woman with the long QT syndrome and drug-refractory paroxysmal ventricular tachyarrhythmias is reported. She was resuscitated eight times between 1980 and 1987. The duration of these attacks increased from a few minutes to 8 hours and the interval between them decreased from 2 years to 4 weeks. An autotransplantation was performed of the anatomically and hemodynamically normal heart. She has had normal QT intervals and has been free of tachyarrhythmias since the operation in June 1987. Because of a slow escape low atrial rhythm, she was treated with a dual-chamber pacemaker programmed in the VDD mode with a coupling interval of 15 msec. The pacemaker wires were connected to the nontransplanted atrial cuff ("atrial" wire) and the transplanted atrium ("ventricular" wire). The hemodynamic effect of the resultant sinus node-driven low atrial pacing was restoration of normal values. This is the first report of successful autotransplantation of the heart for ventricular tachyarrhythmias caused by the long QT syndrome.

Effect of slow-release ISDN on cardiac function in patients with coronary heart disease during bicycle ergometry.

In 10 patients with coronary heart disease (CHD), the effect of a single doses of slow-release isosorbide dinitrate (ISDN) on cardiac function was investigated. Haemo-dynamics was examined by right heart catheterization and thermodilution measurement of cardiac output. After placebo and after 2 and 6 hours with 40 mg ISDN, the heart rate (HR), cardiac index (CI), pressure values in the pulmonary artery (PASP, PAMP, PAEDP) and in the aorta (AoSP, AoMP, AoEDP) and systemic vascular resistance (SVR) were measured at rest and during bicycle ergometry. At rest, PASP and PAMP were significantly reduced only 6 hours after ISDN. Under exercise conditions, significantly reduced pressure values in the pulmonary artery were found 2 and 6 hours after ISDN. AoSP was likewise reduced 2 and 6 hours after ISDN. HR, CI and SVR showed no significant differences compared with placebo values. Thus, an effective reduction of left ventricular preload and afterload was seen in patients with CHD during bicycle ergometry.

[Function of the left ventricle in pacing-induced angina pectoris]. / Funktion des linken Ventrikels unter frequenzinduzierter Angina pectoris.

In 48 patients with angiographically ascertained coronary arteriosclerosis and 15 patients with unconspicuous cardiac findings a complete pressure-flow-volume-analysis of the left ventricle in rest and under artificial atrial tachycardia (atrial pacing) was carried out. In 26 patients with coronary arteriosclerosis a typical angina pectoris could be induced, however, in this group a specific constellation of the findings of the initial values was not present. Under influence of angina pectoris an increase of the disturbances of the regional contraction, connected with a significant decrease of the ejection fraction and of the isovolumetric contractibility parameter Vpm. Apart from this a significant increase of the enddiastolic ventricular pressure and of the quotient deltaP/deltaV in the diastole as a sequel of a decreased distensibility of the ventricle was found. In one part of the patients as an expression of the efficacy of the Frank-Starling-mechanism also the enddiastolic volume increased. Altogether a broad spectre of the functional changes was the result, the direction and degree of severity of which could not be foreseen according to the adequate findings in rest.

[Evaluation of asynergies in the left ventricle using various metric methods. I. Findings in patients with normal heart function]. / Bewertung von Asynergien des linken Ventrikels durch verschiedene metrische Verfahren. I. Mitteilung: Befunde bei Patienten mit normaler Herzfunktion.

The delimitation of regional disturbances of contraction of the left ventricle (asynergies) demands knowledge of the behaviour of the contraction of the normal left ventricle. For the exact recognition of asynergies and for scientific inquiries in these cases the use of objective metrical methods is necessary. Therefore, in 14 patients without organic heart disease the behaviour of the regional contraction of the left ventricle was determined on the basis of the cineventriculography according to three different metrical methods (semiaxis, surface and angular method). For all 3 methods in the first oblique projection of 30 degree a larger mean amplitude of the contraction of the anterior wall was the result in contrast to the posterior wall. Consequently, different borderline regions for the anterior wall and the posterior wall must be established for the delimination of asynergies.

[Measurement of left ventricle asynergy by various measuring procedures. II. Findings in patients with post-infarction states]. / Bewertung von Asynergien des linken Ventrikels durch verschiedene metrische Verfahren. II. Mitteilung: Befunde bei Patienten mit Postinfarktzustand.

In 30 patients with postinfarction condition (11 infarctions of the posterior wall, 11 infarction of the anterior wall, 8 aneurysms of the anterior wall) the regional contraction of the left ventricle was analysed by 3 different metrical methods (semiaxis, surface and angular method) on the basis of the kineventriculogramme in the 1st oblique diameter. With all 3 methods a significant reduction of the mean contraction amplitude could be proved in the affected ventricular region. Using the semiaxis method, in all 30 patients an asynergy could be identified. By the surface method 2 patients with infarction of the posterior wall and 1 patient with infarction of the anterior wall, by the angular method 3 patients with infarction of the posterior wall and 1 patient with infarction of the anterior wall were not established. According to the disturbance of the entire function of the ventricle the number of the segment with disturbed contraction was largest in the group with aneurysm of the anterior wall and smallest in the group with infarction of the posterior wall. Even here the semiaxis method showed the greatest and the angular method the smallest sensitivity.