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Biomedical subjects

G A Feruglio

Publications and source records attributed to G A Feruglio.

At least 37 records · Page 2Linked to original sources
PubMed1990

[Malignant ventricular arrhythmias in the subacute and late phases of myocardial infarction. Clinical arrhythmological characteristics and prognostic value].

The purposes of this study are as follows: 1) to describe the clinical and arrhythmological characteristics of 30 patients (23 male, 7 female, mean age: 61 years) who suffered from episodes of ventricular tachycardia and/or ventricular fibrillation between the 7th and the 90th day following acute myocardial infarction; 2) to evaluate the effectiveness of treatment with amiodarone also taking into account the results of electrophysiologic study; 3) to correlate our results with data from previous studies. The site of the acute myocardial infarction was anterior in 16 patients, inferior in 12, and anterior and inferior in 2. Twenty patients had early post-acute myocardial infarction complications (67%) such as cardiac failure (16), bundle branch blocks (9) and ventricular fibrillation in the first 48 hours (6). The mean ejection fraction was 33 +/- 8% and a left ventricular aneurysmatic evolution was observed in 13 patients (43%). The first episodes of spontaneous ventricular arrhythmias occurred after a mean interval of 32 +/- 24 days following acute myocardial infarction. These occurred in the form of ventricular fibrillation in 19 patients (63%) and of ventricular tachycardia in the other 11 (37%). The patients experienced 5.6 +/- 5 episodes of ventricular fibrillation or ventricular tachycardia. Of the 30 patients, 28 received amiodarone, 1 procainamide and 1 propafenone. Five of the 28 patients treated with amiodarone were also given either procainamide or propafenone due to the early recurrence of ventricular tachycardia or fibrillation. One patient underwent early left ventricular aneurysmatic resection due to refractory ventricular fibrillation. Two groups of patients were distinguished on the basis of the electrophysiologic study results obtained during anti-arrhythmic treatment: group A consisted of 17 cases in which a sustained ventricular tachycardia was inducible (57%), group B consisted of 13 cases in which a sustained ventricular tachycardia was not inducible (43%). During a mean follow-up period of 31.6 +/- 26 months the total mortality rate was 23% in group A and 46% in group B (p = ns), the incidence of sudden death was 17% in group A and 23% in group B (p = ns), the incidence of non fatal ventricular tachycardia or ventricular fibrillation recurrences was 24% in group A and 0% in group B (0.05 less than p less than 0.1). One group A patient successfully underwent a heart transplant. The negative predictive value of ventricular stimulation in relation to sudden death and to non-fatal arrhythmic recurrences was 77% and 100%; the positive predictive value was 17 and 28%.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1989

Long-term follow-up of patients with unexplained syncope and negative electrophysiologic study.

Fifty-eight patients (29 M, 29 F, mean age 60.8 +/- 16 years) with unexplained syncope at the end of a complete clinical and electrophysiological evaluation, were followed for a mean period of 36.6 +/- 20.5 months (median: 30.5 months). Structural heart disease was present in 32 patients (55.2%). The standard ECG was normal in 24 (41.4%) and showed sinus bradycardia (greater than 40 m-1) and/or first degree AV block and/or intraventricular conduction disturbances in 29 patients (50%). During follow-up, recurrences of syncope were observed in 11 of 43 untreated patients (25.6%), three of seven electrically treated patients (42.9%) and two of eight pharmacologically treated patients (25%). The cause of these recurrences was cardiac in one (1.7%), non-cardiac in 10 (17.2%) and remained undetermined in five (8.6%). Sudden death occurred in only one patient (1.7%), who was receiving chronic amiodarone therapy. These results indicate that (1) syncopal recurrences may occur in an appreciable percentage of patients with unexplained syncope and a negative electrophysiologic study during a relatively long-term follow-up, (2) syncopal recurrences, when they occur, are generally due to a non-cardiac cause, (3) sudden death is an occasional and rare event in this patient population and (4) empirical prophylactic treatment with a permanent pacemaker or antiarrhythmic drugs does not usually prevent complications during the follow-up.

Adult↗
PubMed1989

Right ventricular tachycardia with left bundle branch block and inferior axis morphology: clinical and arrhythmological characteristics in 15 patients.

UNLABELLED: Fifteen patients (mean age 30) presenting with right ventricular tachycardia (VT) of the outflow tract type (left bundle branch block with inferior axis morphology), in the absence of obvious organic heart disease, were studied. Seven patients had palpitations, one presyncope and seven were asymptomatic. The echo and/or angiographic findings were normal in 11 patients (73%), suggesting arrhythmogenic right ventricular dysplasia (ARVD) in three (20%) and dubious in one (7%). The VT was sustained in three patients (20%), nonsustained (11 +/- 6 beats) in twelve (80%), inducible during exercise in two out of 15 patients (13%) and with ventricular stimulation in one out of eight (12.5%). Four patients were treated with sotalol, three with Class IC drugs and one with amiodarone. At follow-up of 36 +/- 30 months, only three patients had VT recurrences due to drug withdrawal. IN CONCLUSION: (1) abnormal echo and/or angiographic findings suggested that ARVD was observed in a minority of the patients (22%); (2) the low inducibility of VT and the good response to sotalol suggested a possible mechanism of abnormal automaticity; and (3) at a 3-year follow-up the prognosis appeared to be good in both patients with or without echo-angiographic signs suggestive of right ventricular dysplasia.

Adult↗
PubMed1989

[Diagnostic value of Q wave changes during the exercise test. Review of the literature and personal experience].

UNLABELLED: To test if a low Q wave voltage and its faulty increase after exercise is an additional sign of myocardial ischemia, 64 pts with no previous myocardial infarction, bundle branch block or left ventricular hypertrophy were studied by a treadmill test and coronary angiography. Nineteen had single vessel disease (SVD), 21 double vessel disease (DVD), 4 triple vessel disease (TVD) and 20 normal coronary arteries. Sensitivity (SENS), specificity (SPEC) and predictive value (P) of Q wave changes have resulted as follows: 84%, 55%, 80.4%, respectively, compared to 79.5%, 75%, 87.5% of ST modifications associated or not with angina. The SENS of Q wave changes was 72% in SVD and 92% in multivessel disease (p less than 0.05). In 68% of our pts ST and Q wave changes gave concordant results and their combination increased SENS, SPEC, PV to 90.1%, 80%, 90.3%. IN CONCLUSION: Q wave analysis can provide further evidence of myocardial ischemia and can increase SENS, SPEC of stress test. In our experience Q wave is a more sensitive finding than ST depression in multivessel disease.

Coronary Disease↗
PubMed1988

[Atrial involvement in arrhythmogenic right ventricular dysplasia: primary or secondary? Description of a case of occult ventricular dysplasia with right atrial enlargement and exclusively sinoatrial arrhythmia].

The atrial involvement in patients with arrhythmogenic right ventricular dysplasia is very rarely described. We here describe a patient with right atrial enlargement suffering from classical sinus and atrial electrical disease (tachycardia-bradycardia syndrome); the associated echo-angiographic aspects of the right ventricle are compatible, even in the absence of ventricular tachyarrhythmias, with a concealed form of right ventricular dysplasia. A common pathogenetic mechanism for the atrial and ventricular involvement is hypothetically considered.

Arrhythmias, Cardiac↗
PubMed1988

[Permanent idiopathic sinus tachycardia in pregnancy. Description of a case].

A 35 year old primigravida presented a rare arrhythmia defined as persistent idiopathic sinus tachycardia, which appeared strongly symptomatic during the first weeks of pregnancy. Based on electrophysiological evaluation and pharmacological tests, we retained that the pathogenetic mechanism was due to enhanced automaticity in the sinus node, or in a near "atrial ectopic focus", as a result of a localized autonomic dysfunction. The maternal-foetal prognosis resulted extremely favorable thanks to antiarrhythmic drug association during the last six months of pregnancy.

Adult↗
PubMed1987

GISSI trial: early results and late follow-up. Gruppo Italiano per la Sperimentazione della Streptochinasi nell'Infarto Miocardico.

In the GISSI trial, 11,712 patients with acute myocardial infarction were randomized to receive either standard care or standard care with 1.5 million units streptokinase intravenously. A highly significant reduction in mortality during hospitalization in streptokinase-treated patients was observed. The mortality at 1 year was determined in 98.3% of the patients who had been originally randomized; the 1 year mortality of patients discharged alive was similar in those patients treated with streptokinase and those who were not; that is, the beneficial effects of streptokinase treatment on survival that were observed in the hospital phase of the study persisted unchanged and with comparable statistical significance for 1 year. However, a higher incidence of reinfarction occurred in the treated versus the control groups both during the hospital phase and at the 6 month follow-up. Streptokinase treatment had no detectable effect in patients with a history of previous infarction.

Clinical Trials as Topic↗
PubMed1987

Electrophysiological effects of bisoprolol.

The aim of this study was the electrophysiological evaluation of bisoprolol, a new highly cardioselective beta blocker, void of intrinsic sympathomimetic activity and without significant membrane stabilizing action. 10 patients (4 males and 6 females, mean age 67.5 years) with cardiac arrhythmias or syncopes of undetermined origin underwent His bundle recording with incremental as well as programmed atrial and ventricular pacing in an electrophysiological study. Electrophysiological parameters were measured at basal conditions and at 15 and 30 minutes after the infusion of bisoprolol 5 mg (for patient 1 to 5) and 10 mg (for patient 6 to 10). All electrophysiological parameters were within normal range at basal evaluation. Bisoprolol prolongs significantly sinus cycle length, corrected sinus node recovery time, AH interval, cycle length inducing AV-node block, effective and functional refractory periods of the AV-node. All these parameters remained within normal limits and were modified to about the same extent by 5 and 10 mg of the drug. No drug-related changes of QT interval were observed. Bisoprolol have been confirmed to have strictly beta-blocking properties.

Adrenergic beta-Antagonists↗
PubMed1987

Particularities of dual chamber pacemaker therapy in patients after orthotopic heart transplantation.

Since August 1981, 33 orthotopic heart transplantations were performed in our hospital. Three of these patients (9%) had sinus bradycardias with rates as low as 30 beats/min; they were treated by implantation of a dual chamber pacemaker. These patients had two atria as a result of orthotopic heart transplantation, but only the donor atrium was suitable for positioning the atrial lead. In the postoperative period, some nonsurgical complications were observed in one patient who developed atrial fibrillation which we treated with drugs. A cyclosporin-evoked tremor produced several asystoles due to false inhibition by myopotential interference in the VVI mode. During an episode of acute rejection combined with renal insufficiency, loss of atrial and ventricular sensing occurred. The other patients showed no pacemaker-related complications. Our findings in this unique population of pacemaker patients are discussed.

Adult↗
PubMed1987

[Usefulness of ambulatory ECG in the follow-up of patients with pacemakers].

In order to evaluate the diagnostic efficacy of Holter monitoring in the follow-up of pacemaker patients, the recordings of 122 patients were reviewed. Indications for monitoring were: evaluation of pacemaker function in 23.6% of the cases; sporadic appearance of arrhythmias in 26.7%; total or partial unconsciousness in 9.7%; a variety of symptoms such as palpitation (12.7), dizzy-spells (9.7%) and irregular pulse (4.2%). Prolonged monitoring of cardiac activity allowed us to exclude pacemaker malfunction in 87.5% of cases of syncope and 88.6% of cases of palpitation, dizzy-spells and irregular pulse; while it disclosed defects of electrostimulation in 11.4% of cases in loss of consciousness in 12.5% of patients with various symptoms and none in cases of arrhythmias. It allowed us to evaluate the therapeutic efficacy of used drugs in 18.2% of cases. Given the variety of clinical and instrumental problems of pacemaker patients, Holter monitoring proved to be a very essential diagnostic means in the follow-up of such patients.

Adolescent↗
PubMed1987

[Usefulness of the electrophysiologic study in the prognostic evaluation of patients with syncope of uncertain origin].

UNLABELLED: Recurrent, sudden temporary loss of consciousness is a common clinical problem: in the absence of electrocardiographic monitoring during a syncopal episode (S), abnormalities demonstrated by an electrophysiological study (ES) may suggest the etiology of S. We have performed a complete ES in 53 Pts (M. 38-F. 15, mean age 63 y.) with recurrent unexplained S (3.8 S/pt) by means of a standardized protocol. Group I: 30 Pts (mean age 65 y, 3.6 S/pt) with structural heart disease. Thirteen of these had abnormal ES findings: inducible ventricular tachycardia in 6, prolonged HV interval in 7 (with bundle branch block), very fast atrial flutter in one. Group II: 23 Pts (mean age 61 y., 3, 9 S/pt), without organic heart disease. The ES was abnormal in 14 Pts showing a prolonged HV interval in 11 (with bundle branch block), an intrahisian block in 1 and an inducible AV nodal tachycardia with heart rate greater than 200/m' in one. Only the Pts with abnormal ES were treated according to their condition with amiodarone or with an implantable pacemaker. Three PTs with C.H.D. and normal ES successfully underwent by-pass surgery. During the follow-up (20 months) therapy based on ES provided symptomatic relief (no S) in 25 of 26 Pts with abnormal electrophysiological study. Syncope persisted in 4 of 26 Pts in whom ES did not define a mechanism of S. No sudden death in any Pt. CONCLUSIONS: ES was, therefore, of diagnostic value in more than half of the patients with syncope of unknown cause and long-term treatment based on ES was successful in the prevention of S (remission rate of 93% in patients treated with amiodarone or pacemaker).

Adult↗