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Biomedical subjects

F Furlanello

Publications and source records attributed to F Furlanello.

At least 37 records · Page 2Linked to original sources
PubMed1991

[Electropharmacological test with class-I C drugs in paroxysmal supraventricular re-entrant tachycardia: is a negative result with a drug predictive of the ineffectiveness of other drugs of the same class?].

UNLABELLED: Propafenone and flecainide, both I C class drugs, are first choice in the treatment of paroxysmal supraventricular reciprocating tachycardia. The aim of this study was to check whether a negative or paradoxical electropharmacological test with one of the two drugs was predictive of an equally negative or paradoxical test with the other drug. Thirty patients with disabling paroxysmal supraventricular reciprocating tachycardia, 16 M, 14 F, mean age 30.6 +/- 16 years, were studied with serial electropharmacological tests using esophageal approach. The reentry circuit was sustained by an anomalous pathway in 25 patients (83.5%) whereas it was idionodal in the other 5 (16.5%). Propafenone was tested in 13 patients (43.5%, group A) after flecainide had resulted negative or paradoxical in the first test. In 17 patients (56.5%, group B) flecainide was tested after propafenone had resulted negative or paradoxical. The second drug tested was also ineffective in 14 of the 30 patients (group A + group B) while it had positive results in 16 patients. Specifically, propafenone was positive in 6 of the 13 patients (group A) in whom flecainide had been negative, and flecainide was positive in 10 of the 17 patients (group B) with acute negative or paradoxical propafenone test. These "acute" results were confirmed in steady-state with esophageal study and in the follow-up (21.9 +/- 9.3 months). CONCLUSIONS: 53.5% of the patients who are "non responders" to the electropharmacological test with one of the two drugs (propafenone or flecainide) may be "responders" to the other drug. Thus the ineffectiveness of one of the two drugs is not predictive of ineffectiveness of the other.

Adolescent↗
PubMed1990

[Cardiac rhythm in athletes: a Holter study of top level and ex-professional football players].

The study we performed aimed at identifying the arrhythmological pattern in the football player. Between 1984 and 1989, 50 top level football players (group A) from the National Olympic team and from the National A team, average age 24.2 years (min. 19, max. 32), underwent Holter monitoring. The recordings were carried out in different environmental conditions according tot he programmes of the team and the number of recordings depended on how long each football player stayed in the National team. Moreover, 40 trainers (group B) from the Italian football teams, average age 38.4 years (min. 32, max. 57), all of whom had formerly been professional high-level football players practising intensive physical exercise for professional reasons, underwent one 24 h Holter monitoring. RESULTS. Group A: 2621 hours of monitoring were able to be analysed in 48/50 football players. Sinus node pauses greater than or equal to 1750 ms were found in 21/48 (43.7%) with a maximum of 3740 ms on altitude in 1/21, second degree atrioventricular block in 8/48 (16.7%) with a maximum of 5400 ms on altitude in 1/8, supraventricular ectopic beats in 13/48 (27%), ventricular ectopic beats in 26/48 (54.1%) which were complex (cl. Lown greater than or equal to 3) in 7/26. Group B: 882.30 hours of monitoring were able to be analysed in 39/40 former football players. Sinus node pauses greater than or equal to 1750 ms were found in 18/39 (46.1%) with a maximum of 2280 ms in 7/18, second degree atrioventricular block in 1/39 (2.6%) with a maximum of 2400 ms, supraventricular ectopic beats in 32/39 (82%), ventricular ectopic beats in 24/39 (61.5%) which were complex in 5/24.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Transesophageal electric atrial stimulation as an electro- pharmacological method of treatment of supraventricular tachycardia].

From 1985 to 1988 the authors performed 299 procedures of transesophageal atrial pacing in 162 patients with hyperkinetic supraventricular arrhythmias. The pacing abolition of atrial flutter had been mainly applied with an invasive technique. The employment of transesophageal atrial pacing received its large development, but simplified this, the probability of abolishing supraventricular tachycardia becoming lower.

Adult↗
PubMed1990

[Stable ventricular tachycardia in arrhythmogenic dysplasia of the right ventricle in sportsmen].

Right ventricular arrhythmogenic dysplasia (RVAD) is a typical asymptomatic arrhythmogenic cardiopathy in athletes, which is occasionally concurrent with normal ventricular function and life-threatening arrhythmias. A total of 32 athletes (28 males and 4 females, mean age, 23 years, mean follow-up, 6.7 years) were examined for severe cardiac arrhythmias with left bundle branch block. The conclusive diagnosis of RVAD was established from clinical, echocardio-, and angiographic evidence. The protocol of the examination involved Holter monitoring, loading tests, electrophysiological study, two-dimensional echocardiography, cardiac angiography of the right and left ventricles, coronary angiography. The most severe arrhythmias were observed in athletes whose mean age was 23.4 years, 20 patients had sustained ventricular tachycardia (it occurred only in 19 who were indulging in sports), 6 presented with transient ventricular tachycardia, and 1 had ventricular fibrillation. They all had been considered fit for sports. The disease proceeded severely in 16 of 32 athletes (in 13 of 16 while indulging in sports), the conditions close to syncope were seen in 9 patients (8 had sustained ventricular tachycardias and 1 had transient ventricular tachycardias), syncopes were observed in 5 patients (sustained ventricular tachycardias).

Adult↗
PubMed1990

Electropharmacological test with pentisomide (CM 7857) in patients with sustained ventricular tachycardia.

Pentisomide (CM 7857) is a new class I antiarrhythmic drug whose effect on sustained ventricular tachycardia has only been slightly investigated to date. The aim of this paper is to examine the pentisomide action on selected patients with ventricular tachycardia inducible during intracavitary electrophysiological study. Thus, 12 patients (9 M, 3 F, mean age: 45.2 years, range: 24-78), all but two with detectable heart disease, underwent electropharmacological tests with pentisomide after they had resulted "non responders" (8 patients) or had had a proarrhythmic worsening effect (3 patients) to electropharmacological tests with amiodarone or flecainide or propafenone or mexiletine. After the inducibility and the reproducibility of ventricular tachycardia has been assessed in the basal state, all patients underwent several attempts to reinduce ventricular tachycardia, during the i.v. infusion of pentisomide 1.5 mg/kg/5 min followed by continuous infusion of 1 mg/kg/h, at the same time drug plasma level was assessed. Ventricular tachycardia inducibility was still inducible after pentisomide, but with a longer cycle length (446 +/- 88 versus 337 +/- 82 msec) than in the basal state (p less than 0.0025). No patients had proarrhythmic worsening effects. The pentisomide plasma level (available in 5 patients) ranged from 3.4 to 22.3 (mean 8.9 micrograms/ml). Four patients underwent chronic oral treatment (in 1 pt in association with amiodarone) with a good clinical outcome (mean follow-up 6.25 months, range 1-12). We stress the absence of proarrhythmic worsening effects and the powerful effect of the drug on ventricular tachycardia cycle length.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Transesophageal atrial pacing: a first-choice technique in atrial flutter therapy.

Here we report on a study of 181 episodes of spontaneous atrial flutter (AF) (mean atrial cycle length 250 +/- 32 msec) treated by transesophageal atrial pacing (TAP) in 138 patients (92 men and 46 women; mean age 59.5 +/- 12.6 years). TAP was effective in 163 episodes (90%); sinus rhythm resumption was immediate in 36 (19.9%) and followed a short period of atrial fibrillation in 64 (35.3%); in 63 episodes (34.8%) a stable atrial fibrillation was obtained. TAP was unsuccessful in 18 cases (10%). All the patients tolerated the procedure well. A statistical elaboration with the Fisher exact test did not evidence a correlation between efficacy and age, sex, atrial cycle length, or underlying heart disease but showed a significant correlation between efficacy and AF duration of less than 1 day (p less than 0.05) and absence of antiarrhythmic pharmacologic pretreatment (p less than 0.01). These data strongly support the immediate first-choice use of TAP in AF therapy.

Adult↗
PubMed1989

Arrhythmia patterns in athletes with arrhythmogenic right ventricular dysplasia.

Arrhythmogenic right ventricular dysplasia (ARVD) is a typical 'silent' arrhythmogenic cardiomyopathy in athletes, with the possibility of normal ventricular performance and life-threatening arrhythmias. We studied 32 athletes (28 M, 4 F), mean age 23 years, follow-up 6.7 years, all previously declared fit for sports activity. They were studied for significant ventricular arrhythmias with LBBB with a final diagnosis of ARVD based on accepted clinical, echocardiographic and angiographic criteria. The study protocol included Holter monitoring (HM), stress test (ST), electrophysiological endocavitary study (EES), 2D echocardiography, RV and LV cardioangiography and coronarography. The most serious arrhythmia appeared at a mean age of 23.4 years, 20 had clinical sustained ventricular tachycardia (VT) (19/20, 95% during sports activity), six non-sustained VT and one ventricular fibrillation (VF). Severe symptoms occurred in 16/32 athletes (50%) during sports activity in 13/16 (81%): presyncope in nine (non-sustained VT in one, sustained VT in eight); syncope in five (sustained VT); aborted sudden death (SD) in one, SD (follow-up) in one. The reproducibility (HM, ST, EES) of clinically severe arrhythmic manifestations which occurred during sports activity was not high. In fact, during sport many factors are at work which may activate several arrhythmogenic mechanisms not easily reproducible in the laboratory. We conclude that a cardioarrhythmological study is mandatory in suspected right ventricular arrhythmias, including morphological study of the RV, to avoid arrhythmic risk during athletic activity.

Adult↗
PubMed1989

[Arrhythmogenic implications of non-iatrogenic thyroid dysfunction].

We studied all patients with hyperkinetic and hypokinetic arrhythmias, who were recovered in the Cardiology Department and Arrhythmologic Centre of S. Chiara Hospital in Trento between 1983 and 1987. From these we selected all the patients who, on admission, had clinical and biochemical symptoms of dysthyroidism. Of the 2465 patients with cardiac arrhythmias, 93 (3.8%) had an evident thyroid pathology which was due to chronic amiodarone treatment in 42 (44.6%) and was primary and non-iatrogenic in 51 (55.4%). In the latter the thyroid pathology consisted of hyperthyroidism in 43 cases (toxic nodular goitre or Graves' disease), and of hypothyroidism in 8. As regard the types of arrhythmias, hyperthyroidism is predominant in patients with atrial fibrillation (70%) and in those with paroxysmal supra-ventricular reciprocating tachycardia (11.5%), but it is also present in patients with hyperkinetic ventricular arrhythmias (14%). Hypothyroidism is found in patients with hyperkinetic ventricular arrhythmias (25%), atrial fibrillation (37.5%) and atrio-ventricular block (37.5%). The average age of the hyperthyroid population with atrial fibrillation is higher than that of patients with paroxysmal supraventricular reciprocating tachycardia. The control of the thyroid pattern, especially as regards atrial fibrillation and paroxysmal supraventricular reciprocating tachycardia results in absence of arrhythmic episodes even without treatment in 40% of cases, and in an easier drug control in the other cases. Our study indicates that it is necessary to carry out systematic research of a thyroid dysfunction in all patients with cardiac arrhythmias, especially as regards women, atrial fibrillation and paroxysmal supraventricular reciprocating tachycardia. It is also evident that in order to achieve long-term control over hyperkinetic arrhythmia it is very important to overcome hyperthyroidism.

Adolescent↗
PubMed1989

[Transvenous bidirectional shock with a triple electrode system: a promising step in the electrical management of ventricular tachyarrhythmias].

The aim of this work is to assess the reliability of transvenous high energy bi-directional shock with a triple electrode system as the initial step in implanting the automatic cardioverter defibrillator by thoracotomy. During the electrophysiological study on 12 patients, 16 different types of sustained ventricular tachycardia were treated with a 25 J bi-directional QRS synchronized shock delivered through a right ventricular apical cathode and 2 anodes, i.e., the superior vena cava-right atrium and skin patch electrode placed just above the left nipple. A Medtronic 6880 catheter, placed in the right ventricular apex, and a cutaneous patch (CRS, 50 cm2 in surface area) were connected by a cable to a Medtronic model 5350 external cardioverter defibrillator. All but one patient had coronary disease with previous myocardial infarction. The mean VT cycle length was 299 msec (min 200, max 380 ms); 5 VT types had left and 2 had right bundle branch block pattern; 9 had a "bizarre" pattern. The tachycardia was interrupted in 14 types; in 1 type (cycle length 360 msec with "bizarre" morphological pattern) ventricular fibrillation was induced by a well synchronized shock; in 1 type (cycle length 200 msec with "bizarre" morphological pattern) a badly synchronized shock induced a sustained ventricular tachycardia with a longer cycle length (360 msec); this was subsequently stopped by another shock. The transvenous high energy bi-directional shock was quite well tolerated by the patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

[Arrhythmologic study of 50 patients with arrhythmogenic disease of the right ventricle: prognostic implications].

UNLABELLED: Arrhythmogenic right ventricular disease is a syndrome which involves a wide spectrum of anatomo-clinical features. It is characterised by different levels of right ventricle anomaly, and by life-threatening "right" hyperkinetic ventricular arrhythmias. Fifty consecutive pts were retrospectively examined at the Arrhythmological Centre in Trento between 1977 and 1988. The results of rigorous arrhythmological, echocardiographic and angiographic criteria showed that all pts were affected by arrhythmogenic right ventricular disease. CASE STUDY: 39/50 (78%) males, 11/50 (22%) females; age 30.6 years (11-78) at the time of the first study. METHODS: clinical history in 50/50 pts, electrocardiogram in 50/50 pts, Holter monitoring in 50/50 pts, ergometric test in 49/50 pts, non-invasive analysis using signal-averaging QRS in 17/50 pts, 2D echocardiogram in 50/50 pts, angiography in 38/50 pts, electrophysiological endocavitary study in 35/50 pts. RESULTS: familial 2/50 (4%); 1/50 (2%) was in class II NYHA; first arrhythmia at 24.6 years (8-60); most severe arrhythmia at 27.7 years (9-74). Forty-three out of fifty patients (86%) were symptomatic for arrhythmias: 28/50 (56%) as a result of stress; 20/50 (40%) had life-threatening symptoms; 6/50 (12%) had aborted sudden death. Arrhythmogenic right ventricular disease was "localized" in 42/50 (84%) and "diffused" in 8/50 (16%) and was associated with anomalies of the left ventricle in 30/50 (60%). Electrocardiogram showed: right bundle branch block in 10/50 (20%), negative T wave on the right precordial leads in 19/50 (38%), delayed ventricular potentials in 4/17 (23.5%). Using the electrocardiogram, Holter monitoring and electrophysiological endocavitary study the following were documented: a) clinical ventricular tachycardia in 40/50 (80%): non-sustained ventricular tachycardia in 10/50 (20%), sustained ventricular tachycardia in 30/50 (60%); b) electrically induced ventricular tachycardia in 26/35 (74.2%): non-sustained ventricular tachycardia in 8/35 (22.8%), sustained ventricular tachycardia in 18/35 (51.4%) (clinical sustained ventricular tachycardia in 18/18); c) multiform ventricular tachycardia in 12/50 (24%) (diffused arrhythmogenic right ventricular disease in 3/12 and associated anomalies of the left ventricle in 11/12); d) pleomorphic sustained ventricular tachycardia in 9/30 (30%) (diffused arrhythmogenic right ventricular disease in 2/9, and associated anomalies of the left ventricle in 8/9). Forty-two out of fifty patients (84%) underwent antiarrhythmic treatment. When the study was carried out 6.6 years (1 month-22 years) had passed since the first symptom; follow-up was 2.1 years (1 month-11 years) while the interval between the first symptom and the last check-up was 8.4 years (1-30 years); 2/50 dropped out and 2/50 died suddenly.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1988

Induction of supraventricular tachyarrhythmia at rest and during exercise with transoesophageal atrial pacing in the electrophysiological evaluation of asymptomatic athletes with Wolff-Parkinson-White syndrome.

Even today there is controversy as regards the best approach to asymptomatic or slightly symptomatic athletes with the WPW syndrome as regards fitness for sports activity, especially in some countries where the doctor is responsible for certifying sports fitness. This study concerns 84 asymptomatic or slightly symptomatic athletes (66 males, 18 females, mean age 21.7 years, range 12-44 years) who underwent a stimulation protocol the end-point of which was the induction of atrial fibrillation (or, if not possible, atrial tachyarrhythmia) in the basal state and during bicycle stress test with transesophageal atrial pacing. The 81 athletes in whom the end-point was reached were divided into two groups: Group I includes the 32 athletes with the shortest R-R interval between pre-excited beats less than or equal to 240 ms in the basal state and/or less than or equal to 210 ms during bicycle ergometer test, Group II includes the other 49 patients. The evaluation during exercise was not carried out in four athletes because of serious haemodynamic compromise due to the arrhythmia induced in the basal state. Only 21/32 athletes would have been included in Group I if only evaluated in the basal state. In 30/81 athletes (37%), there was discrepancy between the result of stimulation and the result of the usual non-invasive evaluation (Holter monitoring, ergometric stress test, ajmaline test). On average, 40 min are required for the performance of the study protocol except when the induced arrhythmia lasts more than 5 min.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

On-line interval measurement during invasive cardiac electrophysiologic testing.

A microprocessor-based timer has been developed for routine and research use in cardiac electrophysiologic studies. The cycle length (A-A) and the conduction times through the right atrium (A(HRA)-A(HIS], the AV node (A-H) and the His-Purkinje system (H-V) can be automatically measured beat-to-beat in real-time both during sinus rhythm and during atrial pacing. The design has been refined during three years of use in over 80 clinical studies. A comparison between manual and automatic measurements has been executed for randomly chosen portions of 10 studies. With the manual measurements as reference procedures the sensitivities of the automatic measurements of the A, H and V waves were 0.98, 0.88 and 0.92, respectively, while the specificities were 0.93, 0.92 and 0.93, respectively. For the true positive measurements the correlation coefficients of the intervals were r(A-A) = 0.9998, r(A-H) = 0.987 and r(H-V) = 0.988. The statistical analysis of the differences between manual and automatic readings for the intervals A-A, A-H and H-V yielded mean values of -1 ms, -0.8 ms and 0.6 ms and standard deviations of 3 ms, 4 ms and 4 ms which are smaller than the accuracy of the common manual measurements.

Ajmaline↗
PubMed1987

Flecainide and encainide.

Flecainide and encainide (class IC) are presently under clinical evaluation in Italy. They prolong the duration of the QRS but not the period of ventricular repolarisation: the prolongation of QT is due solely to the prolongation of the Q-J. Flecainide and encainide are extremely powerful and are suitable for the treatment of reciprocating supraventricular paroxysmal tachycardia and of persistent reciprocating tachycardia, the prophylaxis of WPW atrial fibrillation including cases with a short anterograde refractory period of the anomalous pathway and the treatment of ventricular ectopic beats and ventricular tachycardia. Both drugs are probably effective for the treatment of atrial fibrillation. However, in the case of atrial flutter they are of little effect of sinus rhythm cardioversion; on the other hand they significantly prolong the duration of the A-A interval, with variable results on ventricular rate. Flecainide and encainide have 'parodoxical' arrhythmogenic effects, related to administration dosages, severity of the arrhythmia and seriousness of cardiopathy. Encainide shows peculiar pharmacokinetics due to hepatic oxidating metabolisation and to production of metabolites; among these the O-demethylencainide and the 3-methoxy-O-demethylencainide have an antiarrhythmic activity, which is probably more important than the encainide parent and is longer-lasting. There are 'extensive', 'poor' and 'non-metaboliser' subjects. This results in wide pharmacokinetic inter- and intraindividual variability which must be taken into account during clinical treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Anilides↗