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At least 253 records · Page 14Linked to original sources
PubMed1986

Detection of aortic insufficiency by standard echocardiography, pulsed Doppler echocardiography, and auscultation. A comparison of accuracies.

To determine the relative sensitivity and specificity of noninvasive methods for detecting aortic insufficiency, we compared the accuracy of auscultation, echocardiography, and pulsed Doppler echocardiography in detecting aortic insufficiency in 106 patients in whom the presence or absence of the lesion was shown by supravalvular aortography. The sensitivity and specificity for the diagnosis of aortic regurgitation was 96% and 96% for pulsed Doppler echocardiography, 73% and 92% for auscultation, 43% and 91% for two-dimensional echocardiography, 46% and 81% for anterior mitral leaflet flutter, and 9% and 96% for ventricular septal flutter, respectively. Auscultation was more sensitive than either M-mode or two-dimensional echocardiography in the diagnosis of aortic insufficiency (p less than 0.01). Pulsed Doppler echocardiography was significantly more sensitive than auscultation (p less than 0.0001) and was positive in 19 patients in whom no murmur was found. Thus, pulsed Doppler echocardiography is the optimal noninvasive marker for aortic insufficiency.

Adolescent↗
PubMed1996

[Sudden cardiac death: definition, mechanisms and risk factors].

Sudden cardiac death is defined as natural death due to cardiac causes, heralded by abrupt loss of consciousness within one hour after the onset of symptoms. The mechanisms are the following: 1. ventricular fibrillation, 2. ventricular tachycardia and flutter with subsequent ventricular fibrillation, 3. torsade de pointe, 4. bradyarrhythmias and asystolic arrest. White the main risk factor is the presence of coronary artery disease, any organic or functional disease of the heart can predispose for sudden cardiac death. To evaluate the risk of sudden cardiac death noninvasive (Holter, echocardiography, exercise test and signal averaged (ECG) and often invasive (electrophysiological study) tests are necessary. The therapy is based on drugs (mainly beta blockers and amiodarone), coronary revascularization, catheter ablation techniques and the implantation of a cardioverter defibrillator; the latter appears to be the most promising approach.

Adolescent↗
PubMed2001

Efficacy of dofetilide in the treatment of atrial fibrillation-flutter in patients with reduced left ventricular function: a Danish investigations of arrhythmia and mortality on dofetilide (diamond) substudy.

BACKGROUND: In patients with left ventricular dysfunction, atrial fibrillation and flutter (AF and AFl, respectively) are common arrhythmias associated with increased morbidity and mortality. The present study investigated the potential of dofetilide in AF-AFl patients with left ventricular dysfunction to restore and maintain sinus rhythm, which might reduce mortality and hospitalizations. METHODS AND RESULTS: In the Danish Investigations of Arrhythmia and Mortality ON Dofetilide (DIAMOND) studies, 506 patients were in AF-AFl at baseline. Over the course of study, cardioversion occurred in 148 (59%) dofetilide- and 86 (34%) placebo-treated patients. In these patients, the probability of maintaining sinus rhythm for 1 year was 79% with dofetilide versus 42% with placebo (P<0.001). Dofetilide had no effect on all-cause mortality, but restoration and maintenance of sinus rhythm was associated with significant reduction in mortality (risk ratio [RR], 0.44; 95% CI, 0.30 to 0.64; P<0.0001). In addition, dofetilide therapy was associated with a significantly lower risk ratio versus placebo for either all-cause (RR, 0.70; 95% CI, 0.56 to 0.89; P</=0.005) or congestive heart failure (RR, 0.69; 95% CI, 0.51 to 0.93; P</=0.02) rehospitalization. CONCLUSIONS: Dofetilide is safe and increases the probability of obtaining and maintaining sinus rhythm in patients with structural heart disease. The present study suggests that restoration of sinus rhythm is associated with improved survival.

Administration, Oral↗
PubMed1990

[Correlation of the results of high-amplification ECG and the cycle of induced ventricular tachycardia. Prognostic value].

Analysis of high amplification ECG results as a function of the results of programmed ventricular stimulation on the fate of 240 patients provides the following data: when programmed ventricular stimulation is negative, there are no late potentials since sudden cardiac death is probably due not to a disturbance in primary rhythm but to a disturbance in ischaemic rhythm; in the case of sustained ventricular tachycardia, cardiac mortality is highest (16 per cent) when due to sudden cardiac death or ventricular tachycardia and late potentials are usually present (14 times out of 15); ventricular fibrillation or flutter are accompanied by appreciable cardiac mortality (between 10 and 13 per cent), basically due to sudden cardiac death and, in this case, there are no late potentials. It is possible to observe late potentials which induce ventricular flutter in subjects during programmed stimulation and this might be a risk factor in the subsequent development of ventricular tachycardia.

Death, Sudden↗
PubMed1989

Efficacy and safety of intravenous diltiazem for treatment of atrial fibrillation and atrial flutter. The Diltiazem-Atrial Fibrillation/Flutter Study Group.

This study evaluates the effectiveness and safety of intravenous diltiazem for the treatment of atrial fibrillation and atrial flutter. A double-blind, parallel, randomized, placebo-controlled protocol was used, and 6 large, urban hospitals, both university-affiliated and private, participated. The study involved 113 patients with atrial fibrillation or flutter, a ventricular rate greater than or equal to 120 beats/min and systolic blood pressure greater than or equal to 90 mm Hg without severe heart failure. The dose of intravenous diltiazem (or identical placebo) was 0.25 mg/kg/2 minutes followed 15 minutes later by 0.35 mg/kg/2 minutes if the first dose was tolerated but ineffective. If a patient did not respond, the code was broken and the patient was allowed to receive open-label diltiazem if placebo had been given. Of 56 patients, 42 (75%) randomized to receive diltiazem responded to 0.25 mg/kg and 10 of 14 responded to 0.35 mg/kg, for a total response rate of 52 of 56 patients (93%), whereas 7 of 57 patients (12%) responded to placebo (p less than 0.001). After the double-blind protocol, 49 of the 57 patients who received placebo were then given diltiazem; 47 of 49 responded, for an overall response rate of 99 of 105 patients (94%) with diltiazem. The median time from the start of drug infusion to the maximal decrease in heart rate was 4.3 minutes. Side effects occurred in 14 patients, 7 of whom had asymptomatic hypotension not requiring intervention. Thus, intravenous diltiazem was rapidly effective for slowing the ventricular response in most patients with atrial fibrillation or atrial flutter. Blood pressure decreased slightly. Side effects were mild.

Aged↗
PubMed1990

Antiarrhythmic treatment with flecainide (Tambocor). Clinical experience from 107 patients.

The long-term clinical effect of oral flecainide treatment was evaluated in 107 pts (10-82 yrs). Indications for treatment were: atrial fibrillation 38%, atrial flutter 16%, ventricular tachycardia 24%, ventricular ectopic beats 10% and supraventricular tachycardia 12%. Daily flecainide dosage was 200 (100-400) mg. Follow-up period 3 mths (15 days-15 mths). Based on the history and ECG flecainide had been effective in 51 pts. The improvement was most pronounced in pts suffering from supraventricular tachycardia involving an accessory bypass tract (84-92%). Flecainide had been discontinued in 50 pts due to: insufficient effect in 28, side effects in 17 and for other reasons in 5. The side effects indicating flecainide withdrawal (pts) were: cerebral symptoms (4), gastrointestinal complaints (2), bradyarrhythmias (2), heart failure (3) and suspected pro-arrhythmia (4). (Ventricular tachycardia in 3, 1:1 AV-conducting during atrial flutter in 1).

Administration, Oral↗
PubMed2000

[Usefulness and pitfalls in clinical electrophysiological studies].

Clinical electrophysiological studies(EPS) have become useful tools for specific cardiac arrhythmias. However, these studies are expensive and occasionally cause major as well as minor complications such as serious arrhythmias, cardiac tamponade or thromboembolism. It is important to consider guidelines for clinical application of invasive studies. The indications for clinical electrophysiological studies have been categorized into three classes. Class 1: All experts agree that EPS is useful and important for patients treatment and patients with these condition benefit from EPS. Class 2: There is less certainty about usefulness of the information from EPS. Class 3: EPS does not provide useful information. EPS should be performed by trained cardiologist in adequately equipped laboratory. Such studies are performed either by intracardiac pacing and recording or esophageal pacing and recording, and evaluate electrophysiological properties such as automaticity, conduction and refractoriness; initiate and terminate tachycardias; mechanism of tachycardia by activation mapping and pace mapping; evaluate for antiarrhythmic drug, catheter ablation, and intracardiac defibrillator. EPS is useful tool for analysis of bradyarrhythmias and tachyarrhythmias and bring us useful information for the choice of treatment but has its limitation and pitfalls. In general, EPS is not so important to determine the indication of pacemaker for bradyarrhythmias such as sick sinus syndrome or atrioventricular(AV) block. But, it is very useful to analysis tachyarrhythmias and indicate antiarrhythmic drugs or catheter ablation for patients with Wolf-Parkinson-White(WPW) syndrome, AV nodal reentrant tachycardia, atrial tachycardia, atrial flutter, or ventricular tachycardia to cure the tachyarrhythmias.

Arrhythmias, Cardiac↗