[The value of continued dynamic electrocardiography in the sick sinus syndrome]. / Validità della elettrocardiografia dinamica continua nella sindrome del seno malato.

An assessment was made of the usefulness of continuous dynamic ECG (CDE) in diagnosis of the sick sinus syndrome (SSS). It was found that CDE has the following advantages: ready repeatability; control of patients during such physiological activities as sleep; recording of the possibly fleeting and intermittent pathological episodes that characterise SSS. The conclusion is drawn that CDE is the soundest technique for the investigation of SSS, whereas electrophysiological examination, albeit complementary, could be limited to cases whose interpretation proves more difficult.

[The prevalence of arrhythmias in subjects over 80 years old. The prognostic role of anamnestic symptomatology and the therapeutic directions]. / Prevalenza dei disturbi del ritmo in soggetti di oltre 80 anni. Ruolo predittivo della sintomatologia anamnestica e orientamenti terapeutici.

24-hour Holter monitoring was performed in 129 unselected subjects older than 80 years (69 women and 60 men) in order to evaluate arrhythmia incidence and to establish significance of symptoms; 56% patients had lipothymia and/or syncope, chest pain and palpitations, 44% were asymptomatic. All patients showed high incidence of hyperkinetic and hypokinetic arrhythmias; no significant differences between symptomatic and asymptomatic patients in arrhythmia incidence were seen. Moreover, no correlation could be seen of the symptoms reported by the patient to the incidence of any particular type of arrhythmia. In conclusion, these preliminary data suggest a criticism of the opportunity of indiscriminate and long term antiarrhythmic therapy. Nevertheless, Holter monitoring is useful in detecting hypokinetic arrhythmias of asymptomatic patients in whom pacemaker implantation is essential and curative.

[Heart and autonomic nervous system in connective tissue disorders]. / Cuore e sistema nervoso autonomo nelle connettiviti.

UNLABELLED: Heart rate variability (HRV) is a suitable diagnostic tool in identifying patients with autonomic nervous system (ANS) disorders even in pre-clinical stage. We have enrolled in this study all patients with large variety of connective tissue disorders, given the possibility of an involvement of ANS in these diseases. The study population consisted in eighty-five patients (68 females and 17 males), 35 of whom affected by systemic lupus erythematosus, 16 by rheumatoid arthritis, 14 by Sjögren syndrome, 12 by progressive systemic sclerosis, 3 by Behçet syndrome and 5 by antiphospholipid antibodies syndrome. The mean age ranged between 33.7 of patients with lupus erythematosus and 51.8 of those with Sjögren syndrome. As control, we enrolled healthy subjects of different age, divided into two groups, to rule out the aging as potential source of considered parameters alteration. The autonomic function has been evaluated by 24 hours ambulatory monitoring, using a Zymed 1210 Scanner with Zymed 3.74-PC 1990 software. We have considered: in the time domain, the standard deviation of the RR intervals average (SDNN) and the percentage of RR adjacent intervals differing each other more than 50 msec (pNN50); in the frequency domain, the low (LF) and high (HF) frequencies, the LF/HF ratio, and the total power (RT). The HRV parameters resulted abnormal in every type of the connective tissue diseases considered: particularly SDNN, pNN50, LF, HF and RT (p < or = 0.01). IN CONCLUSION: the results of our study suggest that autonomic neuropathy may be present in any kind of connective tissue disorders even in preclinical stage.

[Incidence and clinical significance of rhythm disorders in the elderly]. / Incidenza e significato clinico dei disturbi del ritmo nell'anziano.

The goal of this study was the evaluation of cardiac arrhythmias in an unselected population of elderly patients by 24-hour Holter electrocardiography. An elevated incidence of hyperkinetic (62%) and hypokinetic arrhythmias (22.7%) were detected. Following a critical review of the literature, the Authors conclude that even in hyperkinetic arrhythmias a conservative approach is advisable without indiscriminate therapeutic treatment. This review also confirmed the clinical utility of ambulatory monitoring in the detection of arrhythmias, otherwise underestimated, mainly in asymptomatic patients.

[Arrhythmias in the aged: prevalence and correlation with symptoms]. / Le aritmie nell'anziano: prevalenza e correlazione con la sintomatologia.

Objective of our study was to evaluate the prevalence of arrhythmias as well as their correlation with the reported anamnestic symptomatology in the elderly population. With 24 hour ambulatory electrocardiography (Holter ECG) 913 patients, (440 males and 473 females, range 60-89 years, mean age 71) were consecutively studied and subdivided according to the following criteria: (1) age (3 classes: 60-69 [I], 70-79 [II], > or = 80 [III]; (2) presence/absence of "guide" symptoms (syncope/faintness, chest pain, palpitation), and (3) Holter electrocardiography results. We have demonstrated a high prevalence of arrhythmias: 72% (657), which was significantly higher in age classes II (80.5%) and III (79.1%) in comparison to class I (60.6%). A notably higher prevalence of tachyarrhythmias is documented compared to bradyarrhythmias (5:1). With a higher age the prevalence of supraventricular tachyarrhythmias increases significantly, while bradyarrhythmias do not have the same trend. We have a similar prevalence of arrhythmias between symptomatic (77.4%) and asymptomatic patients (63.6%) and no significant correlation between anamnestic symptoms and presence of arrhythmias are observed. Considering the high prevalence of arrhythmias during Holter ECG we think that the clinical importance and prognosis should be evaluated with caution.

[The left ventricle in mitral valve insufficiency: echocardiographic evaluation and hemodynamic correlations]. / II ventricolo sinistro nell'insufficienza mitralica: valutazione ecocardiografica e correlazione emodinamica.

We have assessed the value of echocardiographic measurements of left ventricular dimensions, as compared to the standard angiographic calculations, in patients (pts) with mitral regurgitation (MR). Of 126 such pts who had undergone echocardiography and cardiac catheterization, 57 were excluded because of associated congenital cardiac malformations, additional significant valvular disease(s) and technically unsatisfactory echocardiographic study. Of the remaining 69 pts, 24 had rheumatic MR (14 with associated mild stenosis); ischemic heart disease was the cause of MR in 1 pts; myxomatous degeneration was found in 12 and congestive cardiomyopathy in 7. The pts were further subdivided in 3 groups according to the severity of MR. Although in all groups echocardiography consistently underestimated left ventricular volumes, there was a statistically significant correlation for end-diastolic volumes, end-systolic volumes and stoke volumes in all three groups. The best correlation was obtained in the calculation of ejection fraction (r = 0.87; P less than 0.001 in mild MR. r = 0,82; P less than 0,001 in moderate MR. r = 0,81; P less than 0,001 in severe MR). The measurement of left ventricular volumes by M-mode echocardiography is generally unsatisfactory in patients with MR. The echo-calculated ejection fraction however, appears to be reliable.

Twenty-four-hour heart rate variability to assess autonomic function in Parkinson's disease.

OBJECTIVES: To evaluate the autonomic dysfunction in Parkinson's disease patients by means of a 24-h heart rate variability (HRV) method. MATERIAL AND METHODS: Thirteen patients with a diagnosis of Parkinson's disease were compared with 13 age-matched healthy persons (control group). The 13 patients had a mean age of 70.5 years, and mean disease duration of 10.9 years. The autonomic function was evaluated by HRV analysis using a continuous 24-h ECG. The parameters of SDNN (standard deviation of the normal-to-normal intervals between adjacent QRS complexes), of LF (power in low frequency) and of HF (power in high frequency) were studied during the following 3 periods: 24 h, night and day. RESULTS: The data show a statistically significant difference between groups for SDNN and LF in all the periods, while for HF parameters the difference is statistically significant only in the night period. CONCLUSION: The use of the 24-h HRV method can provide more accurate and reproducible data than other conventional cardiovascular tests.

Heart rate variability in Parkinson's disease patients treated with tolcapone.

Following the introduction of tolcapone, a potent, reversible Catechol-O-methyltransferase (COMT) inhibitor, it has been possible to optimise the management of Parkinson's disease (PD) patients in chronic Levodopa (L-dopa) therapy. The interaction between tolcapone and the endogenous metabolism of catecholamines points to a possible influence on autonomic cardiovascular function.Cardiovascular reflexes have been analysed in a group of seven PD patients (four males, three females; mean age 69.7years, mean disease duration 14.1years) by means of the heart rate variability (HRV) method using a continuous 24-h ECG (ECGD), before and after six months of treatment with tolcapone (in addition to L-dopa).We have observed no statistically significant differences in HRV parameters, nor any changes in the incidence of hyperkinetic and hypokinetic arrhythmias, which suggest that autonomic cardiovascular function in PD patients is not influenced by six months of treatment with tolcapone.