[Multiple intracardiac hydatid cysts with clinical picture simulating mitral stenosis and inferior myocardial necrosis]. / Cisti intracardiache multiple da echinococco con quadro clinico simulante stenosi mitralica e necrosi miocardica inferiore.

We report the case of a young man who was hospitalized at the Department of Cardiology for palpitations and dyspnea. Standard ECG revealed the presence of Q waves and T negative waves in the inferior leads, suggestive of myocardial necrosis. Chest X-ray test detected a round mass in the lung. Two-dimensional echocardiography revealed three cardiac cystic masses. The biggest cyst was located in the left atrium and simulated a mitral stenosis; the second cyst was located in the posterosuperior right atrial wall and the third in the posterior wall of the left ventricle. The finding was confirmed by nuclear magnetic resonance imaging. Echinococcosis was suspected based on the patient's origin (Morocco) and the echocardiographic and MR imaging, and was confirmed by a positive hemagglutination test. This case is of particular interest because of the number of cysts and their unusual localization.

High impedance and low energy stimulation with bipolar ultrasmall electrode surface area steroid eluting lead (CapSure Z)

Thirty-five patients received a Capsure Z Medtronic bipolar model 5034 for the ventricle and 5534 for the atrium. These have 1.2 mm2 totally proprous, platinized, steroid eluting distal electrodes. The control group was repesented by 14 consective patients reciving CapSure SP medtronic model 5024 for the ventricle and 5524 for the atrium. At implant and during the follow-up period (6 months), CapSure Z and SP showed similar low pacing theresholds without early peaking in atrium (0.5 +/- 0.26 V vs 0 +/- 0.21 V at 0.5 msec P=NS., 0.06 +/- 0.01 msec at 1.6 V P=NS, respectively) and while Capsure Z showed a lewr value at six months in ventricle (0.3 +/- 0.1 V vs ).4 +/- 0.23 V P=NS, respectively) and while Capsure Z showed a lower value at six months in ventricle (0.3 +/- V vs 0.4 +/- 0.23 V P=NS at 0.5 msec, 0.07 +/- 0.03 msec. vs 0.1 +/- 0.02 msec. P<0.02 at 1.6V, repectively). P and R wave sensing of CapSure Z was better thant that of CapSure SP at implant (P wave + 5 +/- 2.5 mV vs 3.80 +/- 1.95 m;R wave = 15.2 +/- 6.4 mV vs 13.13 +/- 5.5 mV, respecitively) and during the follow-up period achieving statistical significance at the 6 th mont oly for P wave (P wave = 3.33 +/- 1.6 mV vs 2.61 +/- 1.05 mV P<0.05; R wave = 13.9 +/- 5.17 vs 10.8 +/- 5.75 mV, P=NS). CapSure Z atrial and ventricular pacing impedance were double than that of CapSure SP one at implant (atrium: 1050 +/- 214 vs 491 +/- 51; ventricle: 1296 +/- 236 vs 481 +/- 81, p< 0.0001) and during the follow-up period (atrium: 1081 +/- 185vs553 +/- 60; ventricle 1186 +/- 256 vs 656+/- 68, P< 0.0001).

[The prevention of nitrate tolerance in angina patients treated with transdermal nitroglycerin: a comparison of 2 therapeutic regimens (therapeutic outlook versus dosage reduction)]. / Prevenzione della tolerance ai nitrati in pazienti anginosi trattati con nitroglicerina per via transdermica: confronto di due schemi terapeutici (finestra terapeutica verso riduzione di dosaggio).

We studied the long-term antianginal and anti-ischemic effects of two dosage regimens designed to prevent tolerance to transdermal nitroglycerin (TNTG): (1) 10 mg TNTG applied for 16 h with a 'nitrate-free' interval of 8 h; (2) 10 mg TNTG applied for 16 h followed by a 'nitrate-low' interval of 5 mg applied for 8 h. 129 patients completing a 3-month study period were evaluated by repeated exercise tests. Both regimens significantly increased maximum exercise duration at 3 months, from 699.1 +/- 23.4 to 833 +/- 21.9 s and from 686.1 +/- 20 to 789.6 +/- 22.6 s, respectively, reduced the number of patients with 1 mm S-T segment depression and increased the time duration to 1 mm S-T segment depression. Marked reductions in anginal attacks was observed in both groups: from 6.5 to 0.15 attacks per week and from 6.0 to 0.15 attacks per week, respectively. No statistically significant differences were found between the groups, and both regimens were well tolerated. In conclusion, our results demonstrate sustained antianginal efficacy, without tolerance, of either 'nitrate-free' of 'nitrate-low' interval therapy with transdermal nitroglycerin.

Acute and chronic electrophysiological effects of pentisomide on the sinus and AV nodal function, noninvasive evaluation by a pacemaker with temporary pacing inhibition.

The acute and chronic electrophysiological effects on sinus function and AV nodal conduction of pentisomide (Pen), a new antiarrhythmic agent, were studied in ten patients with sick sinus syndrome (SSS) (group I) and in ten patients with normal sinus function (group II) using a permanent pacemaker with temporary pacing inhibition (Symbios 7005 Medtronic, Inc.). We measured noninvasively the corrected sinus node recovery time (CSNRT), the sino-atrial conduction time (SACT), according to Narula's method and the Wenckebach point before and after Pen administration, acutely and orally for 10 days. In group I intravenous injection (4 mg/kg) and oral administration (450 mg bid) of Pen significantly prolonged the CSNRT (+217% and +149%, respectively) and the SACT (+63% and +49%, respectively). In group II only the intravenous injection of Pen provoked a significant modification of CSNRT (+12%) and SACT (+14%). No modification in AV nodal conduction was noted in any patient. These results suggest that Pen must be used with caution in patients with sinus nodal dysfunction.

[Transvenous cardioversion in the treatment of sustained ventricular tachycardia. Preliminary results in 3 patients with implantable cardioverter]. / La cardioversione transvenosa nel trattamento della tachicardia ventricolare sostenuta. Risultati preliminari in tre pazienti con cardioverter impiantabile.

The efficacy of intracardiac cardioversion was verified in 11 pts suffering from coronary heart disease and recurrent sustained VT. All pts were receiving anti-arrhythmic drugs. Tachycardia cycle length was between 280 and 400 msec. 65 episodes of VT (21 spontaneous and 44 induced) were treated with synchronized shocks of low energy between 0.27 and 2 J using the external cardioverter. Cardioversion was successful in 83% of VT episodes. VT acceleration occurred in one case; transient atrial fibrillation was induced six times. All pts tolerated shocks from 0.27 to 1 J with moderate discomfort; shocks exceeding 1.0 J were less well tolerated. CK levels were not increased. In three pts (VT cycle length of 320, 380 and 400 msec) a permanent Cardioverter (Medtronic Model 7210) was implanted and programmed to operate in non-automatic mode. Every month the pts underwent a follow-up visit to verify the electrophysiological features of VT in non invasively induced VT episodes and the efficacy of transvenous cardioversion. In a mean follow-up period of 9 months, respectively 5, 4 and 3 spontaneous VT episodes occurred. In two pts cardioversion resulted constantly effective, whereas in the third one provoked VT acceleration requiring DC-shock in the last spontaneous episode of VT.

[A new dual-chamber pacemaker with an automatic antitachycardia system in the treatment of the bradycardia-tachycardia syndrome]. / Un nuovo pacemaker a doppia camera con sistema antitachicardico automatico nel trattamento della sindrome bradicardia-tachicardia.

A new dual-chamber pacemaker with automatic tachycardia terminating system was used in three patients with bradycardia-tachycardia syndrome. This pacemaker (Medtronic Symbios 7008) is a multiprogrammable, bipolar device with bidirectional telemetry and six permanent pacing modes (DDD-DVI-VVI-DOO-VOO-AOO). The antitachycardia system can be programmed in two different modes: underdrive dual demand and overdrive atrial burts (1 to 16 stimuli with selectable coupling interval from 135 to 360 msec). The pacing modes are automatically activated when five consecutive R-R cycles shorter than the tachycardia detection interval are sensed. The pacemaker may sense the ventricle (when set on VVI or DVI mode) or sense both the atrium and the ventricle (in DDD mode). The pacemaker was programmed on DVI mode in all three patients, and the overdrive atrial burst program was used for tachycardia termination, with promptly and costantly effective results. The underdrive dual demand program was tested after the implantation, but it did not show constant results because inefficacy or late termination of tachycardias.

[Effects of digitalis on the parameters of sinus function in sick sinus syndrome. Evaluation using a multiprogrammable permanent atrial pacemaker with temporary inhibition]. / Effetti della digitale sui parametri di funzione sinusale nella sindrome del seno malato. Valutazione mediante pacemaker atriale definitivo (AAI) multiprogrammabile ad inibizione temporanea.

A non invasive electrophysiological study was performed in eight patients with sick sinus syndrome using a multiprogrammable AAI pacemaker (Medtronic Spectrax Sxt) with temporary pacing inhibition. We measured the corrected sinus node recovery time and sino-atrial conduction time (Narula method) before and after digoxin administration (acutely iv and orally for 10 days). Digitalis lengthened both the corrected sinus node recovery time and the sino-atrial conduction time; in particular, after the long-term oral treatment sinus function worsened markedly. The prolongation of the sino-atrial conduction time seems to be related to an indirect effect of the drug, since its disappears after atropine administration. Our results suggest that patients with the sick sinus syndrome need permanent pacing when long-term treatment with digitalis is requested; the pacemaker we used permits a non-invasive long-term evaluation of sinus function in such patients.

[New method of percutaneous implantation of a definitive pacemaker]. / Nuova tecnica di impianto percutaneo di pacemaker definitivo.

The Authors present a new method for the installation of a definitive pacemaker with a percutaneous puncture in the sub-clavian vein. According to the Authors, this method is reserved, in alternative to the other stimulations, to the subjects with the venous anomalies or with difficulties of the electrocatheter introduction through the usual ways or for defect of disponibility of the venous vessels already sacrificed in previous operations. This allows to reduce the number of patients to send to the cardiosurgeon for a myoepicardic stimulation.

[Use of esophageal leads in the diagnosis of myocardial infarct with a postero-inferior site]. / Utilità delle derivazioni esofagee nella diagnosi di infarto miocardico di sede postero-inferiore.

The electrocardiographic diagnosis results from the verification of a anomalous waves in one or more derivations. There are, however, some cases of infarct in which the electrocardiogram appears regular and there are other different situations in which a more less profound "a" wave can appear in the D3 and aVF derivations. The Authors have considered four groups of patients, in which only the oesophageal ecgraphic has allowed to obtain the right diagnosis, succeeding in filling the gaps of the diagnostic possibilities of the standard ecgraphic.

[Validity of the radiofrequency programmed stimulation in the treatment of the sick sinus syndrome. (author's transl)]. / Validita' della stimolazione programmata a radiofrequenza nel trattamento della sindrome bradi-tachicardia.

It is presented a patient sick sinus syndrome with the periods of the sinus bradycardia and of the superventricular tachycardia, treated with the implanted of a permanent ventricular inhibited pacemaker and a passive radio- receiver connected with a ventricular electrocatheter. The tachycardia was interrupted by ventricular way with a discharge of beaths high frequency, utilizing a radiofrequency device connected with a exterior programmed stimulation. It is solicited a more large employment of the radiofrequency stimulation's system in the relapsing and persistent tachycardia, alternately with the pharmacologyc therapy and the DC shock.