Flecainide is a class IC antiarrhythmic agent with a controversial role in the treatment of ventricular arrhythmias following myocardial infarction after the publication of the Cardiac Arrhythmia Suppression Trial (CAST). To assess its utility in paroxysmal supraventricular tachycardia (PSVT), we evaluated the electrophysiologic effects and therapeutic efficacy of intravenous flecainide, administered in a dose of 2 mg per kg body weight in 26 patients of PSVT, studied by programmed electrical stimulation. The patients' age ranged from 18-49 years (mean: 27 +/- 8) and none had organic heart disease. The mechanism of PSVT was atrioventricular nodal reentry (AVNRT) with anterograde conduction through slow pathway and retrograde through fast pathway in 14, and atrioventricular reentry (AVRT) utilizing an accessory pathway in 12 patients. Flecainide was successful in terminating the tachycardia in all (100%) patients of AVNRT and 11 (92%) patients with AVRT. In both the types, the tachycardia was terminated by selective block in conduction through the retrograde limb of the reentry circuit. The drug also produced a complete anterograde block with abolition of preexcitation in 6 out of 8 patients with WPW syndrome. After the drug, the tachycardia was reinducible in one patient of AVNRT and 4 with AVRT. The cycle length of inducible tachycardia increased from 295 +/- 25 ms to 389 +/- 24.5 ms after flecainide (p < 0.001). There were no adverse haemodynamic effects of the drug. Our results, thus, showed that intravenous flecainide is a highly effective and safe antiarrhythmic drug for termination of PSVT mediated by atrioventricular nodal and atrioventricular reentry mechanisms without producing any adverse effects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMedDate not supplied

Ventricular tachycardia with left bundle branch block morphology in the absence of ischaemic heart disease--clinical and electrophysiological observations.

Clinical and electrophysiological features of 20 patients presenting with ventricular tachycardia (VT) of left bundle branch block (LBBB) morphology without evidence of coronary artery disease were studied. The mean age of the patients was 35.2 +/- 12 (range 15-57 years). The rate of VT varied between 140-240/min (182 +/- 80). Six (30%) patients experienced giddiness or syncope during palpitations. Structural heart disease was found in 10 (50%) of these patients, which included arrhythmogenic right ventricular dysplasia in five, submitral left ventricular (LV) aneurysm in one, anterolateral LV dyskinesis in one, dilated cardiomyopathy in one, endomyocardial fibrosis in one and nonobstructive hypertrophic cardiomyopathy in one case. Ten patients were free of structural heart disease. Electrophysiological study was done in all patients. VT with same morphology as spontaneous VT was inducible in only 14 patients. Seventeen patients were treated medically with total or partial amelioration of symptoms. In three patients, two with arrhythmogenic right ventricular dysplasia and one with structurally normal heart, who were unresponsive to drug therapy, the VT focus could be mapped in right ventricular outflow tract and successful electrical ablation was done. Thus in patients who present with VT with LBBB morphology, the heart is often structurally normal but organic disease is not uncommon, and should be carefully searched.

Adult↗

PubMedDate not supplied

Comparative evaluation of left ventricular function in sick sinus syndrome on different long-term pacing modes.

Single-chamber ventricular pacing has been implicated in the development or progression of congestive heart failure in patients with sick sinus syndrome (SSS). To define the exact role of pacing modality in causation of congestive heart failure, quantitative two-dimensional echocardiographic examination was performed in 51 consecutive patients with SSS who received an initial pacemaker from January 1979 to September 1989 and were free of any structural heart disease at the time of implant. Atrial or dual chamber pacemakers were implanted in 21 patients (Group I) and ventricular pacemakers in 30 (Group II). The two groups were matched for age, gender, paced rate, blood pressure and duration of pacing. After a mean follow-up of 64 +/- 34 months, congestive heart failure developed in one patient in group I and 3 in Group II. Patients in group II, had larger left atrium (41 +/- 5 vs 37 +/- 6 mm, p < 0.05) and left ventricular end-diastolic volume (64 +/- 18 vs 54 +/- 12 ml/m2, p < 0.01) but similar left ventricular end-systolic volume (27 +/- 12 vs 24 +/- 9 ml/m2, p = NS), ejection fraction (59 +/- 10 vs 57 +/- 8%, p = NS), left ventricular mass (84.8 +/- 31 vs 85.6 +/- 29.2 gm/m2, p = NS), meridian end-systolic wall stress (48.3 +/- 22.1 vs 49.8 +/- 25 Kdynes/cm2, p = NS) and wall stress/end-systolic volume ratio (1.27 +/- 0.94 vs 1.42 +/- 0.59, p = NS). Pacing mode does not appear to influence left ventricular systolic function in patients with SSS.

Cardiac Pacing, Artificial↗

PubMedDate not supplied

Atrial contribution to left ventricular filling in mitral stenosis: effects of balloon mitral valvuloplasty.

Doppler echocardiographic contribution of atrial systole to left ventricular filling (AC) was studied in 20 patients with mitral stenosis and compared with that obtained from 15 matched controls in a prospective study. AC in mitral stenosis as a percentage of total filling volume was 8 +/- 2.8% compared to 12.5 +/- 3.3% in control subjects (p < 0.001) and was weakly correlated to diastolic filling period (r = -0.45), mitral valve orifice resistance (r = -0.36) and heart rate (r = 0.36). An increase in mitral valve orifice area following balloon mitral valvuloplasty (0.78 +/- 0.12 to 1.72 +/- 0.4 cm2, p < 0.0001) resulted in an increase in AC to near normal values (8 +/- 2.8% to 12.5 +/- 3.8%, p < 0.001) coupled with an increase in cardiac index and a significant decrease in diastolic filling period and left atrial size. In conclusion, AC in young patients with severe mitral stenosis is decreased proportionately less than that reported in the older patients, is weakly correlated to mitral orifice resistance and normalises following a successful mitral valvuloplasty.

Adult↗

PubMedDate not supplied

Comparative clinical and electrophysiologic effects of adenosine and verapamil on termination of paroxysmal supraventricular tachycardia.

The efficacy and electrophysiologic effects of adenosine and verapamil in termination of paroxysmal supraventricular tachycardia (SVT) were compared in 18 patients (age 18-48 years, mean 33 +/- 9 years) with recurrent sustained and inducible SVT. Ten patients had atrioventricular nodal reentrant tachycardia (AVNRT) and 8 had atrioventricular reentrant tachycardia involving a retrograde accessory pathway (cycle length of SVT 280-360 msec; mean 315 +/- 20 msec). Each patient served as his own control. After induction of SVT, adenosine was administered first (6 mg i.v. bolus). If the tachycardia was not terminated, a bolus of 12 mg was given. Ten minutes later, verapamil (5 mg i.v. over 30 sec) was administered after reinduction of SVT. If the tachycardia was not terminated, a 5 mg dose was repeated every 5 minutes upto 20 mg. Adenosine terminated the SVT in 16 cases (6 mg - 7 patients, 12 mg - 9 patients). Verapamil was effective in 11 patients (5 mg - 6 patients, 10 mg - 4 patients, 15 mg - 1 patient, 20 mg - nil). The overall efficacy of adenosine (89%) was significantly greater than that of verapamil (61%; p < 0.05). Adenosine terminated the tachycardia more quickly than verapamil (mean 24 +/- 11 sec versus 142 +/- 40 sec; p < 0.01). Termination of tachycardia by both drugs was related to antegrade block of the atrioventricular node in all patients except one with AVNRT in whom adenosine blocked the retrograde fast pathway. Ventricular premature beats were seen transiently in 5 patients following adenosine. Transient side effects such as flushing, burning and chest pain were frequently observed with adenosine and correlated with the termination of tachycardia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine↗

PubMedDate not supplied

Left ventricular volume overload in isolated rheumatic mitral stenosis.

Having shown the absence of chronic preload insufficiency as the mechanism of modestly depressed left ventricular ejection performance in patients with rheumatic mitral stenosis in our previous work, we sought to characterise a subset of patients with left ventricular volume overload. Echocardiographically determined ventricular load, ejection and contractile performance and left ventricular geometry were studied in 19 patients with mitral stenosis having left ventricular volume overload (end-diastolic volume > 90 ml/m2, Group I) and in 83 patients with normal volume (end-diastolic volume < 90 ml/m2, Group II). The two groups were well matched for age, gender, body size and mitral valve area. Left ventricular ejection fraction was similar in the two groups; however, the patients in Group I had higher end-diastolic volume (101 +/- 15 vs 58 +/- 18 ml/m2, p < 0.0001), end-systolic wall stress (81.7 +/- 17 vs 64 +/- 22 Kdynes/cm2, p < 0.0001), left ventricular mass (109 +/- 20 vs 82 +/- 19 gm/m2, p < 0.001) but lower relative wall thickness (26 +/- 6 vs 34 +/- 9%, p = 0.007), mass/volume ratio (1.1 +/- 0.23 vs 1.49 +/- 0.46 gm/ml, p < 0.001) and wall stress/end-systolic volume ratio (2.07 +/- 0.58 vs 2.65 +/- 0.92, p = 0.016). Of these 19 patients in Group I, seven had isolated volume overload while 12 had associated eccentric hypertrophy. Wall stress correlated well with fractional shortening in Group II (r = 0.75, p < 0.001) but not in Group I (r = 0.09).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMedDate not supplied

Bilateral spontaneous pneumothoraces in osteogenic sarcoma and extragonadal germ cell tumour.

Bilateral spontaneous pneumothoraces are uncommon complications of metastatic pulmonary disease especially antedating frank metastases or developing as a complication of chemotherapy. It is seen more often in osteogenic sarcoma and uncommon in extra gonadal germ cell tumour. It may correct spontaneously or need tube drainage.

Adolescent↗

PubMedDate not supplied

Left ventricular function and geometry in juvenile mitral stenosis.

The purpose of this study was to investigate possible differences between juvenile and adult variety of mitral stenosis (MS) with regard to left ventricular preload, afterload, contractile function and geometry by two-dimensional echocardiography. Thirty six consecutive children and adolescents with MS (Group 1, mean age +/- 1 standard deviation 16 +/- 3 yrs) were compared with an equal number of adults with MS of comparable mitral valve area (Group II, mean age 30 +/- 8 yrs). Patients with juvenile versus adult MS had similar left ventricular ejection fraction (0.57 +/- 0.09 vs 0.57 +/- 0.11, p = not significant (NS)), end-systolic wall stress (64.8 +/- 21 vs 64.3 +/- 25 Kdynes/cm2, p = NS), wall stress to end-systolic volume ratio (2.6 +/- 1.2 vs 2.71 +/- 0.9, p = NS) and mass (77 +/- 19 vs 83 +/- 26 gm/m2 p = NS) but the former had greater end diastolic volume (68 +/- 16 vs 57 +/- 18 ml/m2, p = 0.008) and sphericity index (0.62 +/- 0.19 vs 0.50 +/- 0.19, p = 0.01) and lower mass to volume ratio (1.01 +/- 0.32 vs 1.36 +/- 0.42, p (0.01). Compared to normal controls, adult patients with MS had similar end-diastolic volume (58 +/- 13 vs 57 +/- 18 ml/m2), mass (84 +/- 20 vs 83 +/- 26 gm/m2), mass to volume ratio (1.45 +/- 0.4 vs 1.36 +/- 0.42) but greater wall stress (45.6 +/- 11.7 vs 64.3 +/- 25 Kdynes/cm2, p < 0.001) and lower ejection fraction (0.66 +/- 0.07 vs 0.57 +/- 0.11, p < 0.001). Thus patients with juvenile MS have significantly altered left ventricular geometry and increased preload in response to comparably elevated afterload due to compensatory adaptive process.

Adolescent↗

PubMedDate not supplied

Long term performance of atrial leads.

Long term performance of 163 atrial leads implanted in 158 patients between July 1981 and June 1993 was evaluated. There were 122 DDD and 36 AAI units, with 125 (77%) polyurethane and 38 (23%) silicone leads. One hundred and nine (67%) unipolar and 54 (33%) bipolar leads were used. Patients were followed in the Pacemaker Clinic for 6 to 124 months (mean 50 +/- 39 months). Five patients were lost to follow up. Transient malfunction was observed in 18 cases (sensing 13, pacing 5) within the first 2 weeks. In 13 cases failure to sense subsided spontaneously and in 4 pacing malfunction could be corrected by reprogramming. Lead dislodgement occurred in 4 patients (2.5%), all within the first week. After the 1st month malfunction was uncommon. Between 1 and 12 months undersensing occurred in 4 (2.5%). In 3 cases it could be corrected by reprogramming. In the first year, reoperation was performed in 5 cases for lead related problems (3 dislodgements, 2 insulation failures). Beyond 12 months complications were as follows: failure to sense-8 (5%), failure to pace-3 (2%), insulation break -1 (0.6%). Majority of these problems could be managed by reprogramming. Reoperation was performed in 1 case with insulation break. The pacing mode had to be changed in 5 (3%) patients with dual chamber units who had loss of P wave sensing. During follow-up 98%, 98%, 96%, 95% and 83% of the leads were working satisfactorily at 1,2,3,4 and 9 years respectively. Thus atrial leads have excellent long term performance and an acceptable rate of late malfunction.

Adolescent↗

PubMedDate not supplied

Amlodipine monotherapy in chronic stable angina.

The efficacy and safety of amlodipine was evaluated in 20 patients with stable exertional angina. Patients with > or = 3 anginal attacks per week in the placebo run-in phase were admitted into a 4 weeks active treatment phase. Amlodipine was administered at a starting dose of 5 mg once daily at bed time, which could be adjusted after 2 weeks to 10 mg once daily if the patient continued to have even a single anginal attack/week. Four weeks of treatment with amlodipine produced a significant (p < 0.05) reduction from baseline in both the mean (+/- SE) number of anginal attacks/week (from 13.3 +/- 1.5 to 1.6 +/- 0.5) and the mean (+/- SE) number of isosorbide dinitrate tablets consumed per week (12.1 +/- 1.5 to 2.6 +/- 0.8). Eighty three percent of patients required an increase in dose to 10 mg daily. No significant change in heart rate, blood pressure, ECG and laboratory results were observed. One patient was withdrawn because of deteriorating angina and sinus tachycardia secondary to beta blocker withdrawal. Worsening of ankle odema was reported in 2 (10%) patients, which was tolerated and disappeared on completing therapy. Thus amlodipine is safe and effective when used as monotherapy in the treatment of chronic stable angina.

Adult↗

PubMedDate not supplied

Miliary mottling in non-Hodgkins lymphoma.

Pulmonary parenchymal involvement and mediastinal lymphadenopathy are less common manifestations of non-Hodgkin's lymphoma as compared to Hodgkin's lymphoma. The pattern of pulmonary disease varies with histological type of non-Hodgkin's lymphoma. We are presenting an uncommon case of diffuse histiocytic lymphoma having miliary mottling who responded well to chemotherapy.

Humans↗

PubMedDate not supplied

Fine needle aspiration biopsy of pediatric orbital tumors. An immunocytochemical study.

Specific antibodies against neuron-specific enolase, leukocyte common antigen and desmin were assessed for their usefulness in the cytodiagnosis of 23 cases of pediatric orbital round cell tumors (10 cases of orbital recurrence of retinoblastoma, 11 cases of embryonal rhabdomyosarcoma and 2 cases of inflammatory pseudotumor). Alcohol-fixed, Papanicolaou-stained smears were decolorized and stained with monoclonal antisera using the peroxidase-antiperoxidase procedure. Twenty of 23 aspirates were positively immunostained with antisera against leukocyte common antigen, desmin and neuron-specific enolase. Eight of 10 cases of clinically diagnosed orbital recurrence of retinoblastoma showed strong monotypic staining with anti-neuron-specific enolase antiserum. More than 50% of tumor cells in 9/11 cases of embryonal rhabdomyosarcoma were also immunopositive with this antiserum. Desmin positivity was seen in 10/11 cases of embryonal rhabdomyosarcoma, whereas immunopositivity with leukocyte common antigen was detected in both cases of inflammatory pseudotumor. These results indicate that the use of a panel of monoclonal antibodies on aspirate smears is imperative for establishing the diagnosis and classification of pediatric round cell orbital tumors.

Adolescent↗

PubMedDate not supplied

Amlodipine monotherapy in mild to moderate hypertension.

The efficacy and safety of amlodipine was evaluated in 20 patients of mild to moderate hypertension in a single blind, placebo controlled, noncomparative study. Patients with a baseline diastolic blood pressure of > 90 and < 115 mmHg while on placebo were admitted to a 4 week active treatment phase. Amlodipine produced a significant (p < 0.05) reduction in mean systolic (177 mmHg to 145 mmHg) and diastolic blood pressure (106 mmHg to 84 mmHg) after 4 weeks treatment in all patients. 95% of the patients had their diastolic blood pressure reduced to < or = 90 mmHg by the end of the study period. There was no significant change in heart rate or in the laboratory parameters with amlodipine therapy. Seven patients reported mild to moderate adverse events which did not require discontinuation of therapy. This combination of efficacy and tolerability, together with convenience of once daily dosing, should ensure the usefulness of amlodipine in the treatment of hypertension.

Adult↗