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Biomedical subjects

M Disertori

Publications and source records attributed to M Disertori.

At least 19 recordsLinked to original sources
PubMed1991

[Familial dissecting aortic aneurysm].

A family is described in which two brothers (44 and 48 years old) had aortic dissecting aneurysms (the first one died, the other one underwent surgical treatment and is still living) in the absence of clinical features of Marfan syndrome and of systemic hypertension. Two of the six living siblings have aortic dilation on echocardiography. Histologic examination of the aortic wall at autopsy or surgery revealed a loss of elastic fibers, deposition of mucopolysaccaride-like material and medionecrosis. We can postulate a genetically-determined disease of connective tissue usually described as "Marfan's forme fruste".

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↗
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↗
PubMed1986

[Electrophysiologic evaluation of athletes with Wolff-Parkinson-White syndrome: induction of supraventricular arrhythmia at rest and under exertion with transesophageal atrial electrostimulation].

The most suitable approach to the athletes with WPW is controversial. Therefore 66 symptom-free athletes with WPW and without heart disease (53 M, 13 F, mean age 21.98 yrs, min 12--max 44) underwent a study protocol whose end-point was the induction of supraventricular tachyarrhythmia, i.e. atrial fibrillation or, if not possible, atrial flutter or atrial tachycardia at rest and during ergometric stress test. The athletes with shortest R-R interval between preexcited beats less than or equal to 240 ms at rest and/or less than or equal to 210 ms during exercise were judged as being at risk i.e. no fit for sport activity. The end-point was reached in 64/66 athletes (in 62 atrial fibrillation). In 4 athletes with life threatening arrhythmia induced at rest the evaluation during exercise was not performed. According to the evaluation at rest we were able to identify only 18 athletes (28.1%) as being at risk, while according to the complete study protocol 26 athletes (40.6%) were judged as such. In 23/64 athletes (36%) this judgement was discordant with the usual non invasive evaluation (i.e. Holter monitoring, ergometric stress test, ajmaline test). During induced atrial fibrillation no significant difference, was found between the percentage of preexcited beats at rest and during exercise. On the average, 40 min. are required for performance of this study protocol (if the induced arrhythmia lasts less than 5 min.). According to our results we conclude: a) the non invasive assessment of the WPW athletes is unsatisfactory; b) the induction of atrial fibrillation during exercise gives a remarkable increase of the diagnostic power with respect to the assessment only at rest; c) since it is simple to perform and not expensive (in time, staff and cost) and because of its high diagnostic yield, we regard this protocol as fundamental for the electrophysiological evaluation of WPW athletes and also suitable for systematic study of WPW patients.

Adolescent↗
PubMed1985

[Ventricular hyperkinetic arrhythmias and circulatory arrest in idiopathic isolated complete atrioventricular block. Description of a clinical case].

Here we report on the case of a patient with idiopathic complete AV block and ventricular ectopic beats in basal state. The patient had been asymptomatic until the age of 50 and then suddenly began to suffer from relapsing episodes of syncope, related to "Torsade de Pointe" and Ventricular Fibrillation (hypokalaemia was present at the same time). We deal with the prognostic significance of ventricular ectopic beats and we make the hypothesis that hyperkinetic ventricular arrhythmias play a role in the origin of the symptoms of patients with congenital or idiopathic complete AV block. Finally, we discuss the limits of the therapeutic effectiveness of permanent pacing in these cases.

Cardiac Pacing, Artificial↗
PubMed1985

[Natural history of persistent atrial paralysis. Description of a case with familial and evolutionary characteristics].

We report a case of partial persistent atrial standstill from a group of patients with familial endemic complete or partial persistent atrial standstill. In this patient we observed the evolution from sinus rhythm (with episodes of uncommon atrial flutter treated by electrostimulation) to the typical clinical picture of partial persistent atrial standstill, which is described also in its electrophysiological features. Incomplete and complete persistent atrial standstill may represent different stages of the same disease of the atrial wall.

Adult↗
PubMed1985

[Sustained ventricular tachycardia in postinfarct ischemic heart disease: spontaneous polymorphism. Clinical, therapeutic and prognostic aspects].

UNLABELLED: Spontaneous Polymorphism (SP) is present when at least two episodes of Sustained Ventricular Tachycardia (SVT) occur spontaneously in the same patient (pt) with different bundle branch block pattern or with shifting of QRS axis by greater than or equal to 90 in the various episodes. We undertook this study in order to investigate the clinical significance of SP in SVT as well as therapeutic and prognostic implications. MATERIAL AND METHODS. From our global pts populations we chose those with SVT in chronic ischemic heart disease (CIHD) with previous myocardial infarction (PMI), they had to be already studied by electrophysiologic technique (EES). The pts were divided into two groups (Gr.): Gr. I: 13 SP pts (12 M, 1 F, mean age 57.5 +/- 13; mean follow-up 19.2 +/- 11 months); Gr. II: 15 no SP pts (14 M, 1 F, mean age 60 +/- 10; mean follow-up 9.9 +/- 13 months). RESULTS: The two Gr. are comparable in terms of symptoms, exercise tolerance, infarct site, intraventricular conduction disturbances (61.5% and 66.6% respectively), ventricular wells kinetics (38.4% and 26.6% respectively) and time interval between acute myocardial infarction the first episode of SVT (7.58 +/- 6.02 and 8.27 +/- 6.57 years respectively). 8 of the 10 alive Gr. I pts have been treated with Amiodarone (A) (2800-4200 mg/wk). All 9 alive Gr. II pts are on A (1400-4200 mg/wk). A serum level in 7 Gr. I pts was 1.7 +/- 0.65 mcg/ml and 1.61 +/- 0.67 in 5 Gr. II pts. 3/13 Gr. I pts died: 2 for sudden death (15.3%), 6/15 Gr. II pts died: 4 suffered sudden death (26.6%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

[Sustained ventricular tachycardia: low-energy transcatheter internal cardioversion. Efficacy, reliability and tolerance in comparison with ventricular burst].

The aim of this study is to evaluate the efficacy, reliability and patient tolerance of low-energy transcatheter intracardiac cardioversion in the treatment of Sustained Ventricular Tachycardia (VT), and to compare this method to ventricular burst. For this purpose 11 patients (pts) (10 M, 1 F, mean age 50.1 yrs, range 24-72) with 18 different types of VT (17 induced during Endocavitary Electrophysiological Study (EES), 1 "clinical"), who all underwent EES all but 1 with organic heart disease, were first treated by transcatheter intracardiac cardioversion and then, if possible, with ventricular burst at 125%-150% of VT rate. The Medtronic Cardioverter 5350 and the Medtronic catheter 6880 were used. The following results were obtained: transcatheter intracardiac cardioversion terminated 9/18 types of VT (8 types at least 3 times) in 6 pts. Cardioversion threshold was on average 1.31 J (range: 0.14-5). Transcatheter intracardiac cardioversion failed to terminate 9/18 types of VT (in 5 pts); VT acceleration or ventricular fibrillation occurred in 6/9 types. The mean cycle length of successfully cardioverted VT (382 +/- 61 msec.) was significantly longer (p = 0.05) than that of not successfully cardioverted VT (284 +/- 83 msec.) and of the VT in whom an acceleration or a degeneration into ventricular fibrillation was observed (240 +/- 55 msec.). In 4 pts it was necessary to use external DC shock and in 4 supraventricular hyperkinetic arrhythmia was induced. All pts complained of considerable discomfort at shocks greater than or equal to 0.5 J. In all the 7 types of successfully cardioverted VT as well as in 3 out of the 4 types of not successfully cardioverted VT in which it was possible to test ventricular burst, this latter proved to be effective. These results indicate that: the efficacy of transcatheter intracardiac cardioversion is not great at least in our pts (50%); moreover, the transcatheter intracardiac cardioversion is affected by a high incidence of acceleration of VT and degeneration into ventricular fibrillation (33.3%) and by the induction of supraventricular hyperkinetic arrhythmia (22.2%). Patient discomfort appears to be a major limitation to transcatheter intracardiac cardioversion. The VT cycle length is determinant for the success of the transcatheter intracardiac cardioversion and for the induction either of an acceleration of VT or of a degeneration into ventricular fibrillation (which are observed only in VT with cycle length less than or equal to 300 msec.).(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1984

Real-time beat-to-beat measurement of conduction intervals during cardiac electrophysiological studies.

The conduction times through different myocardial structures have been measured in real-time during clinical intracardiac investigations by means of a low-cost microprocessor-based system. Two endocavitary electrograms, a surface ECG and a pacemaker stimulus are analysed to detect the stimulus as well as atrial, His and ventricular waves and to measure, beat to beat, the time intervals between them. Measurements have been made in the course of 40 clinical studies, randomly chosen from about 500, and including different conditions such as sinus rhythm, acute drug tests and programmed atrial pacing. Our results show that the real-time measurement of the conduction intervals is feasible and may offer several advantages: it allows immediate data analysis which enables the investigator to better make decisions during the study; it reduces the time and effort required to perform and analyse the study; and it increases the quantity and quality of information gained on the cardiac status of the patient.

Adolescent↗