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PubMed1995

New horizons in catheter ablation.

Catheter ablation has evolved into the dominant therapeutic modality in the treatment of a variety of arrhythmias, particularly supraventricular arrhythmias with the mechanisms of atrioventricular (AV) nodal reentry and AV reciprocating tachycardia via an accessory pathway. The mode of catheter ablation used in the great majority of cases is radiofrequency (RF) catheter ablation. This technology is well-suited for the above arrhythmias because the targets and the RF lesions are both small and discrete. Using temperature monitoring may improve the outcome of these procedures by decreasing procedure time and incidence of coagulum formation on the catheter after a sudden rise in electrical impedance. New RF catheter designs and new modalities of creating catheter-induced focal myocardial injury will allow operators to have improved success with the ablation of less approachable arrhythmias, including atrial flutter and reentrant ventricular tachycardia. Studies are currently underway to create a catheter based "maze" procedure for the treatment of atrial fibrillation. As techniques and technologies evolve, a greater proportion of patients with symptomatic or threatening arrhythmias may be approached with catheter ablation as a curative or palliative procedure.

Catheter Ablation↗
PubMed2001

Perception and documentation of arrhythmias after successful radiofrequency catheter ablation of accessory pathways.

BACKGROUND: Some patients continue to have palpitations in spite of successful ablation of Wolff-Parkinson-White (WPW) syndrome. Recurrence of accessory pathways as well as unrelated arrhythmias may explain the symptoms. METHODS: We followed 194 consecutive patients after successful radiofrequency catheter ablation of overt (147) or concealed (47) WPW syndrome. The mean duration of symptoms was 16 +/- 13 years. Atrial fibrillation was documented in 54 patients (24%) prior to ablation. 185 patients responded to a questionnaire 24 +/- 12 months after ablation. RESULTS: The physical well-being was improved in 94%, unchanged in 5%, and deteriorated in 1%. However, 76 patients (39%) reported arrhythmia symptoms, in 40 patients causing pharmacological treatment (14 patients) and/or continued contact with their doctor. The underlying arrhythmias were orthodromic tachycardia (10), atrial fibrillation (12), premature beats (12), atrial flutter (1), and ventricular tachycardia (1), while in four patients no explanation was found. Minor symptoms in the other 36 patients were explained by premature beats in 29, while unexplained in 7. All patients with atrial fibrillation after ablation had atrial fibrillation before ablation. Ten relapses of WPW syndrome occurred: eight were known before the time of the questionnaire, two were confirmed at transesophageal atrial stimulation. CONCLUSION: 94% patients with a long history of tachyarrhythmias due to the WPW syndrome reported improved physical well-being after ablation, but palpitations were common during a 2-year follow-up period; 8% continued to use pharmacological antiarrhythmic treatment. Five percent had symptomatic relapses and in 6% atrial fibrillation episodes reoccurred, i.e., in half of those who had atrial fibrillation before ablation.

Adolescent↗
PubMed1986

Clinical outcome and circulatory effects of fetal cardiac arrhythmia.

By means of abdominal fetal ECG and non-invasive ultrasound blood flow studies 113 cases of fetal cardiac arrhythmia were classified according to the origin of arrhythmia. Pregnancy outcome was characterized by an increased frequency of fetal distress and heart malformation, and increased fetal and neonatal mortality. The following types of arrhythmia were identified: supraventricular extrasystoles (n = 84), paroxysmal tachycardia (n = 6), sinus bradycardia (n = 3), atrial flutter (n = 1), ventricular extrasystoles (n = 14), and atrioventricular block (n = 5). In 37 cases the combined Doppler and real-time ultrasound technique was used to measure fetal aortic blood flow as a means of studying the circulatory effects of the arrhythmia. Increased peak velocity, rising slope and acceleration were found in the first post-pausal beat after a supraventricular extrasystole or a missed beat; this supports the validity of Frank-Starling law for the fetal heart and suggests that a strong relationship exists between these variables and myocardial contractility. In two cases of intra-uterine heart failure, the effect of digoxin treatment in utero on the fetal aortic flow variables was studied, results indicating a positive inotropic effect of the drug on the fetal myocardium. The estimation of fetal aortic volume blood flow in cases of fetal cardiac arrhythmia is useful for early detection of fetal cardiac failure, and for monitoring the effects of intra-uterine treatment.

Adult↗
PubMed2003

Anatomic stereotactic catheter ablation on three-dimensional magnetic resonance images in real time.

BACKGROUND: Targets for radiofrequency (RF) ablation of atrial fibrillation, atrial flutter, and nonidiopathic ventricular tachycardia are increasingly being selected on the basis of anatomic considerations. Because fluoroscopy provides only limited information about the relationship between catheter positions and cardiac structures and is associated with radiation risk, other approaches to mapping may be beneficial. METHODS AND RESULTS: An electromagnetic catheter positioning system was superimposed on 3D MR images using fiducial markers. This allowed the dynamic display of the catheter position on the true anatomy of previously acquired MR images in real time. In vitro accuracy and precision during catheter navigation were assessed in a phantom model and were 1.11+/-0.06 and 0.30+/-0.07 mm (mean+/-SEM), respectively. Left and right heart catheterization was performed in 7 swine without the use of fluoroscopy, yielding an in vivo accuracy and precision of 2.74+/-0.52 and 1.97+/-0.44 mm, respectively. To assess the reproducibility of RF ablation, RF lesions were created repeatedly at the identical anatomic site in the right atrium (n=8 swine). Average distance of the repeated right atrial ablations was 3.92+/-0.5 mm. Straight 3-point lines were created in the right and left ventricles to determine the ability to facilitate complex ablation procedures (n=6 swine). The ventricular lesions deviated 1.70+/-0.24 mm from a straight line, and the point distance differed by 2.25+/-0.63 mm from the pathological specimen. CONCLUSIONS: Real-time display of the catheter position on 3D MRI allows accurate and precise RF ablation guided by the true anatomy. This may facilitate anatomically based ablation procedures in, for instance, atrial fibrillation or nonidiopathic ventricular tachycardia and decrease radiation times.

Animals↗
PubMed2004

Antiarrhythmic and proarrhythmic properties of QT-prolonging antianginal drugs.

In recent years there has been a major reorientation of drug therapy for cardiac arrhythmias, its changing role, and above all, a radical change in the class of arrhythmia drugs because of their impact on mortality. The decline in the use of sodium-channel blockers has led to an ex panding use of beta-blockers and simple or complex class III agents for controlling cardiac arrhythmias. Success with these agents in the context of their side effects has spurred the development of compounds with simpler ion-channel blocking properties that have less complex adverse reactions. The resulting so-called pure class III agents, such as dofetilide or ibutilide, were found to have antifibrillatory effects in atrial fibrillation and flutter and in ventricular tachyarrhythmias. Such agents are effective and have diversity, but they have come into therapeutics with a price: the sometimes-fatal torsades de pointes. The drug amiodarone, a complex compound that was synthesized as an antianginal agent, has been an exception in this regard. Its therapeutic use is associated with a negligibly low incidence of torsades de pointes, even though the drug produces significant bradycardia and QT lengthening to 500 to 700 msec. Recent electrophysiologic studies suggest that this paradox is likely due to the differential block of ion channels in endocardium, epicardium, midmyocardial (M) cells, and Purkinje fibers in the ventricular myocardium. There is also clinical evidence suggesting that amiodarone reduces the "torsadogenic" effects of pure class III agents. Ranolazine was also synthesized for the development of antianginal properties that stem from a partial inhibition of fatty acid oxidation; it too has been found to have electrophysioloigic properties. These are somewhat similar to those of amiodarone on ion channels in endocardium, epicardium, M cells, and Purkinje fibers in the ventricular myocardium, but the drug does not prolong the QT interval to the same extent as amiodarone does. Thus, the drug produces modest increases in repolarization as judged by its effects on the action potential duration (APD) without the potential for the development of torsades de pointes. By virtue of its suppressant action on early afterdepolarizations and triggered activity in Purkinje fibers and M cells, the drug appears to have a powerful potential for reducing the torsadogenic proclivity of conventional class III antiarrhythmic compounds. The rationale for the therapeutic niche for amiodarone, and especially in the case of ranolazine, in the prevention of drug-induced torsades de pointes is discussed.

Angina Pectoris↗
PubMed1989

Nifedipine induced bradycardia in a patient with autonomic neuropathy.

An 80 year old diabetic male with evidence of peripheral and autonomic neuropathy was admitted with chest pain. He was found to have atrial flutter at a ventricular rate of 70/min which slowed down to 30-40/min when nifedipine (60 mg) in 3 divided doses, during which he was paced at a rate of 70/min. This is inconsistent with the well-established finding that nifedipine induces tachycardia in normally innervated hearts. However, in hearts deprived of compensatory sympathetic drive, it may lead to bradycardia.

Aged↗
PubMedDate not supplied

[Cardioversion and central hemodynamics in patients with arrhythmic and genuine cardiogenic shock].

Arrhythmic shock (AS) results primarily from many types of tachyarrhythmias: atrial fibrillation and flutter, supraventricular tachyarrhythmias, ventricular paroxysmal tachycardias. AS is distinguished from the stable course of the above arrhythmias by pronounced changes in central hemodynamics (CH) and by rapid and frequently negative manifestations. The status of CH is an important criterion when whether electrical cardioversion is performed is decided. CH was studied in 306 patients with genuine cardiogenic shock and in 32 patients with AS. In case of effective cardioversion, central hemodynamics in patients with AS underwent rapid changes: first of all, stroke volume and cardiac index increased and end systolic volume decreased. In case of effective of antishock measures, CH in patients with cardiogenic shock normalized only within 3-4 weeks of their stay at an intensive care unit, but ejection fraction also remained decreased at their discharge from hospital.

Adult↗
PubMed1991

[Acute myocardial infarction. Analysis of the activities of the ambulance "R"].

Frequency of emergency calls for ambulance help to patients with acute myocardial infarction (MI) as well as a number of infarct complications and the influence of immediate professional help on survival of prehospital phase of acute MI is reviewed. The diagnosis of acute MI was based on a typical history of chest pain and electrocardiographic findings. Acute MI was also diagnosed in all cases of sudden cardiac death. Out of 3674 calls for ambulance help, MI was diagnosed in 379 patients what amounts for 10.1% of all interventions in life-threatening cases and for 61% of patients with acute MI in the analysed period of time. Complicated MI was observed in 61.7% of all patients, including 70.5% of men and 49.3% of women. Arrhythmic complications occurred in 54.5% of patients. Ventricular ectopic activity was the most frequent arrhythmia and amounted to 46.6%. The II0 or III0 atrioventricular block occurred in 4.5% of patients. Haemodynamic complications occurred in 12.3% of cases. Sudden cardiac death occurred in 23.6% of patients with acute MI, including 21.9% cases of ventricular fibrillation or flutter and 1.7% of asystole. 28.5% of those patients were successfully resuscitated. 61% of patients died in the prehospital phase of acute MI including 63.4% of males and 57.2% of females. Out of 61% of patients who died before admission to the hospital, 53% had died before ambulance team arrived and 7.9 died being under the care of the ambulance team. 80% of patients who survived prehospital phase of acute MI were admitted to the hospital within 60 min after the call for the ambulance.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Clinical significance and treatment of cardiac arrhythmia in children].

Cardiac dysrhythmias during childhood are not infrequent. Often they are found in otherwise healthy children, sometimes in connection with myocarditis, cardiomyopathy, congenital heart defects or after cardiac surgery. Cardiac dysrhythmias may be subdivided in bradydysrhythmias (sinuatrial block, sinus arrest, atrioventricular block) and tachydysrhythmias (supraventricular extrasystoles, supraventricular tachycardia, atrial flutter, atrial fibrillation, ventricular extrasystoles, and ventricular tachycardia). Frequently, cardiac dysrhythmias in children do not need treatment; in other cases, treatment is necessary and effective while for some cases a satisfactory treatment is not available at present.

Anti-Arrhythmia Agents↗
PubMed1989

Electroencephalographical analysis of acute drug intoxication--SS Bron solution-W.

Disturbances of the central nervous system due to abuse of SS Bron solution-W (B-solution), an antitussive and expectorant containing dihydrocodeine and other constituents, were studied in rabbits. Animals were given 20 ml/kg of B-solution orally at 4 hour intervals for 8 hours or more, and changes in the electroencephalograms (EEGs) from the reticular formation(RF), hippocampus(Hpc) and sensorimotor cortex(Cm) were examined. The following results were obtained. About 3 hours after administration of B-solution, the EEG from the Hpc showed low voltage, slow wave, the heart rate decreased rapidly, and the respiratory rate increased. After about 7 to 7.5 hours, the EEG from the Cm showed slow wave hypersynchrony and stimulation of the RF with square pulses of 2.0 V induced slight arousal reactions in the Cm and Hpc. The blood pressure and respiratory rate decreased, and ECG changes indicated atrial flutter-fibrillation and ventricular tachycardia. Power-spectrum array analysis indicated increase of slow frequency discharges in the EEGs from all regions. The slow wave hypersynchrony of the EEG from the Cm and slow wave, low voltage of the EEG from the Hpc seemed to be associated with hallucination and delusion.

Animals↗
PubMed1989

Current concepts in the use of digitalis.

After more than two centuries of administration of digitalis glycosides to patients with cardiac disease, empirical observation and tradition remain the basis for much of the clinical application of these drugs. Many questions remain, and the role of digitalis in the management of congestive heart failure and cardiac rhythm disturbances is changing with improvement in our understanding of the pathophysiology of these conditions and the availability of newer effective agents that may have less potential to cause life-threatening toxicity. Nevertheless, digitalis glycoside therapy is a familiar therapeutic intervention for the majority of physicians and remains appropriate in carefully selected patients. The development of digoxin-specific Fab fragments has led to improvement in treatment of advanced and refractory digitalis toxicity and opens up the possibility of improvement in diagnosis of less clinically obvious cases of digitalis intoxication. The role of digitalis glycosides in the management of supraventricular tachyarrhythmias and congestive heart failure in the presence of sinus rhythm should now be revised. In each of these clinical circumstances, alternative drugs or other modes of therapy have been developed that reduce the dependence of clinicians on digitalis as the sole or primary approach to management. In the immediate management of paroxysmal reentrant supraventricular tachyarrhythmias, verapamil has largely replaced digoxin as the drug of choice, although digoxin has an ancillary role, especially in patients with impaired ventricular function. In the management of patients with atrial fibrillation or atrial flutter with a rapid ventricular response, verapamil or diltiazem and beta-adrenergic-blocking drugs will effectively slow the ventricular response, thus reducing the likelihood of approaching the threshold of digitalis toxicity to achieve adequate rate control. In the treatment of patients with congestive heart failure and normal sinus rhythm, one must now recognize a subset of patients with diastolic rather than systolic dysfunction who are best treated by correcting underlying causes of left ventricular hypertrophy or ischemia rather than inotropic support with cardiac glycosides. Symptomatic patients with dilated ventricles and impaired contractile function should undergo correction of abnormalities of preload with vasodilators acting on the venous bed as well as diuretics, and reduction of elevated afterload with vasodilators that reduce arteriolar resistance and thus improve ventricular emptying.(ABSTRACT TRUNCATED AT 400 WORDS)

Digitalis Glycosides↗
PubMedDate not supplied

Antiarrhythmic effects of verapamil given in sublingual way.

In order to eliminate the first pass through the liver where the drug is deactivated, 80 mgs verapamil was given in sublingual way in a) 10 patients with supraventricular tachycardias where in 7 instances sinus rhythm was obtained after 15-30 minutes, b) in 18 patients with atrial fibrillation and in 5 with atrial flutter with rapid ventricular rate, where a significant slowing down of ventricular rate was obtained after 20 minutes. The sublingual way of verapamil administration is a simple, effective and safe procedure in the treatment of tachyarrhythmias.

Administration, Sublingual↗
PubMed1987

[The effectiveness of trapidil and trapidil derivatives on drug-induced heart arrhythmias in the rat and guinea pig].

Trapidil and some selected derivatives of trapidil were investigated in ouabain induced arrhythmia in guinea-pigs and in aconitine induced arrhythmia in rats. In both models trapidil exerted a marked antiarrhythmic effect. Investigations on ouabain induced arrhythmia showed that three derivatives were more effective than trapidil concerning the threshold for premature ventricular beats and flutter. One derivative only was able to decrease the sensitivity for fibrillation in the same order of magnitude as trapidil. On aconitine induced arrhythmia all derivatives of trapidil were less effective in elevating the threshold of arrhythmia than trapidil itself, but three derivatives showed antiarrhythmic properties.

Aconitine↗
PubMed1985

[Effect of sodium selenite on the course of acute experimental myocardial infarct].

The effect of sodium selenite on experimental myocardial infarction was investigated in 47 domestic pigs, with a major emphasis on the hemodynamic antiarrhythmic effects of selenium. Intravenous sodium selenite administered in a dose of 1-2 mg/kg body weight produced a favorable pharmacologic effect. The hemodynamic action consisted in an increase of heart rate, and the maximum aortic flow rate, cardiac output, minute volume of the heart and coronary flow, as well as a decrease in total peripheral resistance. Selenium's antiarrhythmic effect was manifested in reduced occurrence of ventricular extrasystoles and flutter, and the disappearance of "late potentials" in the peri-infarction area.

Acute Disease↗
PubMed1984

Double-blind crossover randomized trial of intravenously administered verapamil. Its use for atrial fibrillation and flutter following open heart surgery.

Fourteen patients with onset of atrial fibrillation (11) or flutter (three) and ventricular rate over 120 beats per minute following cardiac surgery were treated with intravenous (IV) doses of verapamil hydrochloride or placebo in a double-blind crossover protocol. Patients with poor left ventricular function, hypotension, atrioventricular block, and taking beta-blockers and disopyramide were excluded. The dosages were 0.075 mg/kg and 0.15 mg/kg given 15 minutes apart, with termination of study on achieving an end point (conversion to sinus rhythm or slowing of ventricular rate to below 100 beats per minute). None reached the end point with placebo but all with verapamil. Baseline ventricular rate was 144 +/- 20 beats per minute, after placebo 143 +/- 16 beats per minute, and after verapamil 89 +/- 7 beats per minute (mean +/- SD). Thus, IV verapamil briefly slows the ventricular rate of atrial tachyarrhythmias following cardiac surgery.

Adult↗
PubMed1996

[Transesophageal pacing and recording].

Identification of P wave is essential for the diagnosis of various arrhythmias. The transesophageal ECG is useful for obtaining the relationship of atrial-ventricular activation when P wave is difficult to recognize on the surface ECG. Transesophageal pacing is also helpful to evaluate the function of the conduction system and to clarify the mechanism of arrhythmias. Thus, transesophageal pacing and recording can be used as beside electrophysiologic studies in patients with sick sinus syndrome, atrial-ventricular block, atrial flutter, and paroxysmal supraventricular tachycardia.

Arrhythmias, Cardiac↗
PubMed1997

[Sotahexal pharmacodynamics in patients with ischemic heart disease].

Therapeutic and prophylactic antiarrhythmic efficacy of sotalol hydrochloride (Sotahexal, "Hexal", Germany) and its effects in intracardiac hemodynamics and ECG parameters were evaluated in 95 patients with ischemic heart disease (IHD). The highest response to the drug was observed in ventricular extrasystoles, arterial flutter and fibrillation. Acute episodes of arrhythmia are managed by bolus administration of Sotahexal [correction of Hexal]. In this case greater risk of side effects exists. It is desirable to decide on the drug dose, mode of administration on the individual basis with due consideration of the risks and dangers which could be avoided in case of adequate instrumental control.

Adrenergic beta-Antagonists↗
PubMed1998

[Subarachnoid hemorrhage and the heart].

Electrocardiographic abnormalities had been reported, in patients with subarachnoid hemorrhage, with variable percentage from 2% to 91%, according to several studies. The most common changes are T wave inversion, ST segment elevation or depression, QT prolongation, U waves, atrial flutter and fibrillation, ventricular fibrillation, supraventricular tachycardia, premature atrial and ventricular contractions. These findings occur within the first forty-eight hours after the onset of the symptoms; they usually are benign and transient. In a small percentage of cases generally in severe ESA, the ECG changes are associated with ventricular asynergy, coronary vasospasm or subendocardic necrosis. The arrhythmias could be produced either by autonomic discharges to the heart, during increased sympathetic activity due to ESA, or by a damage of cerebral areas with arrhythmogenic capacity. The importance of ECG abnormalities towards mortality and morbidity in patients with ESA has not yet been cleared; however, a careful monitoring is recommended to prevent severe cardiac complications and to obtain an indirect, further evaluation of the neurologic pathology.

Electrocardiography↗