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PubMed2005

[Five years (1995-2000) of coronary artery bypass surgery at the Odense University Hospital].

INTRODUCTION: A large-scale Danish study on late outcomes after coronary artery bypass surgery (CABS) has never been done. We therefore did a retrospective study and follow-up of 2,333 patients, accounting for 2,361 consecutive CABS operations over a five-year period. MATERIALS AND METHODS: The material consisted of 23.5% women and 76.5% men. The patients' median age was 63 years (32-85 years). The rate of response to the questionnaire was 95.3%. The median observation time was 26 months (3-63 months). In 94% of the patients, primary CABS had been undertaken, and 6% were reoperations. Ninty-three percent were elective operations, and 7% were acute. The risk score estimated 20% of the patients to be in high-risk groups, 22% in the 5% group and 53% in the low-risk group. There was three-vessel disease in 68% and left main stenosis in 24%. The EF was normal in 73% of the patients, while 4% had EF <30%. RESULTS: The total early mortality rate was 3%, the primary elective CABS rate was 2.6%, and we found a statistically significant higher mortality for elective reoperations (5.9%) and for acute CABS (7%). Comparison with the Danish background population indicates a better survival rate for the CABS patients. One-third developed atrial flutter or atrial fibrillation. Reoperation for bleeding was done in 6.9% and for mediastinitis 1.9%. About 10% were readmitted because of various complications. In the observation period, 99 patients (7,2%) died. Patients with EF <30% and those undergoing reoperations had a statistically significant higher late mortality rate. About 20% suffered from recurrent angina in the observation period, one-fourth had wound healing of the graft leg and 96% did not regret the operation. DISCUSSION: Apart from the rather high reoperation rate because of bleeding and the prolonged healing time of the graft leg, these results as well as the prognostic value of CABS in selected patient groups justifies the coronary artery bypass graft operation as a good treatment for angina pectoris.

Adolescent↗
PubMed1991

Surgical treatment of tachyarrhythmias.

Tachyarrhythmia surgery should be divided into two separate groups: supraventricular and ventricular. Supraventricular tachyarrhythmias (SVT): The first surgical cure of the Wolff-Parkinson-White syndrome (WPW) in 1968 led to a better understanding of the pathophysiology and anatomy of this syndrome. WPW should now be classified by its anatomical location as defined by the preoperative and intraoperative mapping. At present, there are two surgical approaches for WPW, endocardial or epicardial. Improvement of the surgical results has broadened the indications for surgery of WPW, making it the most commonly performed operation for SVT. Surgical treatment is briefly discussed for AV nodal reentrant tachycardia, ectopic (focal) atrial tachycardia, atrial flutter, and atrial fibrillation. Ventricular tachyarrhythmias (VT): Different types of direct operations have been applied to the treatment of VT in ischemic heart disease. Because of the fairly high mortality and recurrence rate of these major operations in patients with poor ventricular function, there is now a marked increase in the use of implantable cardioverter-defibrillators as an indirect surgical approach.

Arrhythmias, Cardiac↗
PubMed1991

Narrow complex tachycardias. Differential diagnosis and management.

Narrow complex tachycardias are a common clinical problem and can be divided into those in which the arrhythmic circuit is located exclusively in the atrium (pharmacologic treatment is oriented toward altering atrial electrophysiologic properties) and those that involve the AV node or an accessory pathway (pharmacologic therapy is directed toward slowing conduction or increasing refractoriness in these structures). The electrocardiographic diagnosis of the mechanism responsible for SVT includes the regularity of the RR interval; the AV conduction ratio; the presence of P waves, P wave morphology, and the relationship of the P waves to the QRS complexes; and the response of the arrhythmia and atrial activity to vagal maneuvers. Acute therapy includes cardioversion in hemodynamically unstable patients and vagal maneuvers and specific pharmacologic therapy for SVT based on the electrocardiographic diagnosis. There have been recent exciting advances in the nonpharmacologic treatments of SVT, most notably surgery and radiofrequency percutaneous catheter ablation for AV nodal reentry, AV reciprocating tachycardia, atrial flutter, and atrial tachycardias.

Anti-Arrhythmia Agents↗
PubMed1991

[Pathological modifications of the P wave due to probable primary changes in intra-atrial conduction].

Two cases of variable changes in ECG P oscillation not due, as is usually the case, to familiar cardiac or respiratory conditions suggested a review of the literature on the subject. It is concluded that these anomalies are the result of changes in the intra-atrial conduction of the stimulus through preferential ways or to aberrant atrial conduction. These are situations of no little practical interest because they may be precursors of major rhythm disturbances such as atrial flutter or atrial fibrillation.

Electrocardiography↗
PubMed1989

Cardiac response to upper gastrointestinal endoscopy.

In 54 subjects, cardiac function was investigated during upper gastrointestinal endoscopy with a Holter electrocardiorecorder. The heart rate of patients who were premedicated with an anticholinergic agent increased more than did that of patients who received no premedication. In the group who received no anticholinergic premedication, sinus tachycardia was evident during endoscopy, but the only clinically important change was in one patient who converted to atrial flutter from atrial fibrillation. The heart rate increased during endoscopy among patients undergoing the procedure for the first time, but it did not increase in the patients who had previously undergone endoscopy. These results show that endoscopy is a relatively safe examination from the view point of cardiac risk when performed without the administration of an anticholinergic agent, but that cardiac patients should be monitored carefully. The endoscopist should also take into consideration the psychological state of the examinees.

Adult↗
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↗
PubMed1984

[Significance of a supraventricular arrhythmia precipitated during an electrophysiological study].

The clinical history and 24 hour Holter monitoring of 749 patients without ECG appearances of ventricular preexcitation were compared with the results of electrophysiological investigations to determine whether supraventricular arrhythmias initiated during endocavitary electrophysiological investigations had any pathological significance. Endocavitary studies were undertaken to investigate symptoms of dizziness, syncope and/or conduction defects except in the group of paroxysmal junctional tachycardia (PJT) where the indication was investigation of a tachycardia (78 cases). In 544 patients (Group I) no arrhythmias were initiated. Thirty five patients (6.4%) had supraventricular tachycardia (SVT), atrial flutter (AFI), atrial tachycardia (PAT), atrial fibrillation (AF) or PJT. The anterograde Wenckebach point (AV) was over 200/min in 22 cases (4%). In 400 patients the Wenckebach point or the retrograde Mobitz II (VA') point was 170/min in 56 patients (14%). In 28 patients with spontaneous SVT in whom retrograde conduction was studied, 3 had a Wenckebach 200/min (17.7%) and 9 had a Wenckebach point (VA') greater than 170/min (32%). In 86 patients (Group II) paired atrial stimulation induced PJT. Seventy nine patients (91.8%) had PJT : AV was greater than 200/min in 19 cases (22%) and VA was greater than or equal to 170/min in 69 cases (80.2%). In 119 patients (Group III) a supraventricular tachycardia (other than PJT) was induced. Manipulation of the catheter in the atrium led to AF, AFI or PAT in 9 patients. Eight patients had SVT (80.8%), AV was greater than 200/min in one case (11.1%) and VA' greater than or equal to 170/min in 5 of the 7 cases in which it was measured (71.4%). Paired atrial stimulation induced atrial echos in 63 patients; 47 presented spontaneous SVT : AV was greater than 200/min in 7 cases (11.2%) and VA' greater than or equal to 170/min in 23 of the 60 patients investigated (38.3%). Paired atrial extrastimuli triggered AF or PAT in 18 cases : 16 cases (88.8%) had spontaneous SVT. AV was greater than 200/min in 3 cases (16.6%), VA' was greater than or equal to 170/min in 10 of the 17 cases investigated (58.8%) : 11 of these patients also had atrial echos. Fixed atrial stimulation (less than 200/min) triggered AF or AFI in 14 patients. Nine had spontaneous SVT (64.3%) : AV was greater than 200/min in 2 cases (14.2%) and VA' greater than or equal 170/min in 2 of the 10 cases studied (20%). Ventricular stimulation induced SVT in 15 patients, 14 of whom had SVT (92%).(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMed1994

[Choice of the mode of stimulation after ablation of the bundle of His. Experience based on a retrospective survey of 192 patients].

A retrospective study of 192 patients centered on the outcome of supraventricular arrhythmias after catheter ablation of the atrioventricular junction provided some useful information concerning the choice of pacing mode in these patients. With the exception of atrioventricular bloc after ablation of the rapid nodal pathway where simple DDD pacing is adequate, rate adaptive pacing would seem to be essential. The VVIR mode should be the mode of choice in atrial flutter, permanent atrial fibrillation, poorly controlled atrial fibrillation and paroxysmal atrial fibrillation of elderly subjects (over 70 years) and/or of male sex, and/or complicating advanced cardiac disease (valvular, ischaemic or primary). The DDDR mode (with an algorithm to prevent endless loop tachycardia) is the mode of choice in sinus node dysfunction and/or in young patients (under 60), and/or females and/or in idiopathic arrhythmias and/or when retrograde VA conduction persists. When the pacemaker is replaced, the indication should be reviewed with respect to the outcome of the arrhythmia, which underlines the value of accurate implanted Holter systems.

Aged↗
PubMed1994

The cumulative risks of prolapsing mitral valve. 40 years of follow-up.

Prolapsing mitral valve is a common cardiac condition, occurring in approximately 16 million people in the United States alone. Primary prolapsing mitral valve may be familial or nonfamilial and may be associated with myxomatous degeneration of the mitral valve leaflets, such as occurs in Marfan syndrome and other connective tissue disorders. Secondary forms may be associated with such entities as rheumatic fever (especially after commissurotomy) and coronary artery disease (in the presence of ruptured chordae tendineae), and with such congenital conditions as interatrial defect and primary cardiomyopathy with outflow tract obstruction. Prolapsing mitral valve is characterized by late systolic murmur, mid-systolic click, or both. Arrhythmias occur in the form of benign premature atrial contraction, premature nodal contraction, and paroxysmal atrial tachycardia. As the patient ages, atrial flutter and atrial fibrillation tend to develop. In some chronic cases, especially those involving atrial fibrillation, systemic emboli may occur. Rare premature ventricular contractions may be largely benign, whereas more frequent premature ventricular contractions may lead to severe arrhythmic complexes such as ventricular tachycardia or ventricular fibrillation. With advancing age, atrioventricular conduction defects of varying degrees or sick sinus syndrome may necessitate a pacemaker installation. About one quarter of prolapsing mitral valve cases progress, with increasing mitral insufficiency and increasing enlargement of the left atrium and left ventricle, which at times leads to congestive heart failure. Coronary artery disease may occur with the severity commensurate with the patient's age group. About three quarters of patients with prolapsing mitral valve syndrome lead normal lives.

Disease Progression↗
PubMedDate not supplied

Procainamide: a perspective on its value and danger.

Procainamide remains one of the most widely used antiarrhythmic agents in clinical practice. Currently, it is widely used alone or in combination with class I agents (eg, mexiletine or tocainide) to prevent recurrent ventricular tachycardia or symptomatic nonsustained ventricular tachycardia. Procainamide is also used for short-term treatment of ventricular tachycardia and a variety of supraventricular tachycardias, primarily atrial flutter and atrial fibrillation. Long-term procainamide therapy is limited by a number of systemic side effects, primarily lupus-like syndrome, gastrointestinal disturbances, and autoimmune blood dyscrasias. Procainamide levels can be useful in initial dose titrations; however, QRS and QT interval measurements help prevent drug toxicity. It is recommended that patients being started on antiarrhythmic therapy with procainamide be admitted to the hospital for monitoring to ensure that their QT interval is not excessively prolonged.

Anti-Arrhythmia Agents↗
PubMed1978

[Allorhythmias (classification and differential diagnosis)].

Allorhythmia in the broad sense is defined as a regular sequence of similar groups of ECG-complexes associated with various disorders of cardiac rhythm and conduction. The following classification of allorhythmias is suggested. A. True allorhythmias. I. Due to extrasystoles: 1) noncomplicated; 2) complicated by disorders of conduction. II. Allorrhythmias due to ectopic rhythms with capture beats: 1) paroxysmal or nonparoxysmal ectopic tachycardia; 2) escaping rhythms. III. Allorrhythmias due to impulse conduction block: 1) II degree S--A block; 2) II degree A--V-block; 2, atrial flutter and atrial tachycardia with A--V-block 3 : 2, 4 : 2, etc. B. Pseudoallorrhythmias due to regular alterations in the shape of the QRS complex: 1) transient bundle-branch block; 2) transient WPW syndrome; 3) bidirectional tachycardia. Differential diagnosis of various types of allorrhythmia is of great importance in choosing the measures and methods for antiarrhythmic therapy.

Bundle-Branch Block↗
PubMed1993

[Atrial activity and its effects].

The initiation of cardiac impulse is located in the sinus node, in the upper anterior part of the right atrium. The importance of the atrium is not only linked to the regulation of heart rate, but also to its haemodynamic function. Indeed, atrial depolarization leads to atrial contraction which can be responsible for up to 30% of cardiac output by way of ventricular filling. Supraventricular arrhythmias are related to one of the following mechanisms: abnormal automaticity, triggered activity, and reentry. Most of supraventricular tachycardias are due to a reentrant phenomenon (intranodal reentrant tachycardia, orthodromic circusmovement tachycardia, atrial flutter and atrial fibrillation). At the onset of a supraventricular tachycardia, the loss of efficacious atrial contraction as well as the increased heart rate may abruptly decrease ventricular filling. As a consequence, stroke volume is reduced, leading to a decrease in cardiac output and in arterial blood pressure, explaining that the patient may experience syncope. Usually, blood pressure reduction resumes within 30 seconds after activation of the autonomic adrenergic nervous system. In case of an underlying heart disease, the supraventricular tachycardia may lead to acute cardiac failure. When reentry is concerned, the tachycardia is going around a specific circuit. The existence of such a circuit in most of supraventricular tachycardias has led to the development of ablation therapy, the goal of which is to destroy a critical portion of the circuit hence making the recurrence of reentrant tachycardia impossible.

Arrhythmias, Cardiac↗
PubMed1995

[Sedation and anesthesia in dogs and cats with cardiovascular disease. II. Anesthesia planning with respect to pathophysiology, heart arrhythmia].

The purpose of this study was to review the incidence of cardiac arrhythmias in 137 anesthetized dogs and 13 anesthetized cats with congenital or acquired heart disease that were referred for correction of following procedures: patent ductus arteriosus (PDA-ligation, 28%), cardiac catheterization with angiogram and angioplasty (22%), pacemaker implantation (18%), exploratory lateral thoracotomy (8.7%), correction of right aortic arch (ring anomaly, 3.3%), correction of subvalvular aortic stenosis (2.7%), correction of PDA with coil in patients with mitral regurgitation and congestive heart failure (2%), pericardectomy and removal of heart base tumor (2%), and palliative surgery for ventricular septal defect (VSD, 0.7%). The anesthetic plan considered the risks of anesthesia based upon the pathophysiology of cardiac lesions and the anesthetic drug effects on the cardiovascular system. Recommendations are made for dogs with decreased cardiac contractility, cardiac disease with volume overload, cardiac disease with pressure overload, and pericardial tamponade. The percentages of animals and their associated cardiac arrhythmias after premedication and during and after anesthesia were: sinus bradycardia (15.3%), sinus tachycardia (3.3%), atrial flutter (0.7%), atrial fibrillation (0.7%), premature ventricular contraction (14%), and ventricular tachycardia (1.3%). Prompt therapy was given to a percentage of animals in order to control arrhythmia and support cardiovascular system, by using atropine or glycopyrrolate (14%), lidocaine (17.3%), and dopamine (14.7%).(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia↗
PubMed2002

Embolic complications of direct current cardioversion of atrial arrhythmias: association with low intensity of anticoagulation at the time of cardioversion.

OBJECTIVES: The goal of this study was to identify the factors responsible for embolic complications of direct current (DC) cardioversion of atrial arrhythmias. BACKGROUND: Direct current cardioversion of atrial fibrillation (AF) carries a risk of thromboembolism, which is reduced, but not eliminated, by anticoagulation. The risk of embolism after conversion of atrial flutter is believed to be lower. No series to date has included enough patients receiving anticoagulants or enough patients with atrial flutter to estimate the risk in these groups. METHODS: We reviewed the case records of 1,950 patients who underwent 2,639 attempts at DC cardioversion. RESULTS: Cardioversion was performed within two days of the apparent onset of the arrhythmia in 443 episodes, 352 without subsequent prolonged anticoagulation with one embolic complication. Cardioversion was preceded by warfarin therapy for > or = 3 weeks in 1,932 instances. No embolic complication occurred in 779 attempts performed with an international normalized ratio (INR) of > or = 2.5 (95% confidence limits 0% to 0.48%). Of 756 cases in which the INR was <2.5 or was not measured before conversion, nine were complicated by thromboembolism. Embolism was significantly more common at an INR of 1.5 to 2.4 than at an INR > or = 2.5 (0.93% vs. 0%, p = 0.012). The incidence of embolism after conversion of atrial flutter or tachycardia was similar to that after cardioversion of AF (0.72% vs. 0.46%, p = NS). CONCLUSIONS: The INR should be > or = 2.5 at the time of cardioversion if the duration of AF is uncertain or >2 days. Cardioversion of atrial flutter presents similar risks and requires similar anticoagulation.

Anticoagulants↗
PubMed1996

Pacing therapy for atrial tachyarrhythmias.

The use of pacing techniques for the treatment of atrial tachyarrhythmias has been advocated for more than 30 years. Although it has played a beneficial role in the management of paroxysmal supraventricular tachycardia (PSVT) in drug-refractory patients, tachycardia acceleration and development of atrial fibrillation has been the major drawback. With the availability of radiofrequency catheter ablation therapy, the use of implantable antitachycardia devices for PSVT is currently negligible. From retrospective and small control studies it has been shown that atrial or dual-chamber pacing in patients with sick sinus syndrome has been associated with a lower incidence of paroxysmal atrial flutter or fibrillation than in those who received a ventricular pacemaker. Furthermore, recent studies have reported the potential benefit of reducing frequency of paroxysmal atrial flutter and fibrillation with multisite atrial pacing. As a result, there is a resurgence of research interest in antitachycardia pacing for prevention of atrial tachyarrhythmias. This paper briefly describes the basic aspects of antitachycardia pacing, reviews the data on the use of implantable antitachycardia devices for PSVT and the selection of patients, and assesses the current status of research on atrial pacing for prevention of paroxysmal atrial flutter and fibrillation.

Atrial Flutter↗
PubMedDate not supplied

[Radiofrequency ablation in the treatment of supraventricular tachyarrhythmia. Experience with 500 consecutive patients].

Several reports have demonstrated that radiofrequency catheter ablation provides effective control of a variety of supraventricular tachyarrhythmias. This report details the results of radiofrequency catheter ablation in 500 consecutive patients with a wide variety of supraventricular tachycardia treated at the Instituto Nacional de Cardiología "Ignacio Chaávez". Tachyarrhythmias were associated with the presence of an accessory pathway in 355 patients (71%). The accessory pathways were capable of both anterograde and retrograde conduction in 220 of cases (60%), only retrograde conduction in 146 (40%), dual accessory pathways were present in 11 patients (2.2%) giving a total of 366 accessory pathways. The mechanism of the arrhythmia was AV nodal reentrant tachycardia in 115 patients (23%). Ablation of the reentrant circuit of atrial flutter within the right atrium was attempted in 15 (15%) patients and a primary atrial tachycardia in 3 patients (0.7%). AV node ablation and permanent pacemaker implantation were performed in 11 patients (2%). Radiofrequency catheter ablation was successful in 312 of 355 (87.9%) patients with accessory pathways 312 of 366 (85.2%) pathways with a complication rate of 6/355 (2%) and a recurrence rate of (12.4%). AV nodal reentry was successfully abolished in 110 of 115 patients by selective ablation of the slow pathway in 92/96 (95.8%) patients and the fast pathway in 18/19 (94.7%) patients. The complication rate of this group was 7/115 (6.0%) with a recurrence rate of 16 patients (12%). The reentrant circuit of atrial flutter was ablated successfully in 13 of 15 patients with recurrent atrial flutter in (27%) patients. 2/3 (66%) primary atrial tachycardia were successfully ablated. Complete AV block was achieved in 11 of 11 patients with atrial fibrillation or flutter treated by AV nodal ablation without complications or recurrence. The results of this series of patients demonstrates the safety and efficacy of radiofrequency ablation for the treatment of a wide variety of supraventricular arrhythmias with high rate of success and low risk of complications.

Adolescent↗
PubMed1996

Comparison of the safety and efficacy of flecainide versus propafenone in hospital out-patients with symptomatic paroxysmal atrial fibrillation/flutter. The Flecainide AF French Study Group.

To assess the cardiac and extracardiac safety and efficacy of flecainide versus propafenone in patients suffering from episodes of paroxysmal atrial fibrillation (AF) or atrial flutter, 97 patients were enrolled in a randomized, open-label, long-term, parallel, comparative multicenter study. The diagnosis of paroxysmal AF or atrial flutter had to be fully documented prior to inclusion in the study. Of the 97 patients enrolled in the study, 48 patients (25 men, 23 women, mean age 62.4 +/- 12.3 years) received flecainide; 49 patients (26 men, 23 women, mean age 63.6 +/- 12.2 years) received propafenone. The initial dose of flecainide was 50 mg twice daily, and this could be increased in steps of 50 mg twice daily every 4 days to a maximum of 300 mg/day. The initial dose of propafenone was 300 mg twice daily and this could be increased in steps of 300 mg every 4 days to a maximum of 1200 mg/day. At each visit, medical events, vital sign measurements (blood pressure, pulse rate), concomitant medications, adverse experiences, and study drug dosage changes were evaluated. Routine clinical laboratory tests were evaluated at the month 6 visit, and a 24-hr Holter recording was obtained at the month 1 visit. Almost half (45) of the patients were discontinued from the study before completing 1 year of therapy. The probability of successful treatment versus time--i.e., the proportion of patients who remained on therapy over the course of 1 year therapy--was 0.619 for the flecainide group and 0.469 for the propafenone group (p = 0.079; difference not significant). The difference is largely attributed to the higher proportion of patients in the propafenone group (9) than in the flecainide group (2) who experienced side effects important enough to stop the treatment. (The incidence of side effects was not statistically different between treatment groups, although it was higher in the propafenone group.) The proportion of patients who discontinued treatment due to inadequate response was similar in the 2 groups: 11 patients (22.9%) in the flecainide group and 12 patients (24.4%) in the propafenone group withdrew from the study, primarily because of an inadequate response, i.e., they experienced an increase in duration, frequency, and severity of attacks of AF or atrial flutter. Neurologic signs, central and peripheral, were mostly encountered in the flecainide group (8.5%), and, gastrointestinal effects were more often reported in the propafenone group (16.7%). In paroxysmal AF and paroxysmal atrial flutter, flecainide and propafenone are equally effective. However, in this study the probability of a patient's staying on flecainide after 1 year had a tendency to be higher than the probability of staying on propafenone, due to a greater proportion of secondary effects with propafenone.

Adult↗
PubMed2003

Chronic experiences with a single lead dual chamber implantable cardioverter defibrillator system.

Monitoring of atrial rhythm in patients implanted with ICDs may improve accuracy in identifying supraventricular arrhythmias and, therefore, prevent inappropriate therapies. Since difficulties were found in dual chamber ICDs with separate leads, a new designed single lead dual chamber ICD system was tested. Twenty-five patients implanted with a Deikos A+ (single coil defibrillation lead with two atrial sensing rings combined with a dual chamber ICD with a high amplifying atrial channel) were tested. Atrial and ventricular signals were analyzed during sinus rhythm (SR) and sinus tachycardias (STs), atrial flutter and AF, and VT or VF. Follow-ups were performed after 1, 3, 6, 9, and 12 months after implantation. Analysis of EGM amplitudes of stored episodes revealed that atrial signals during atrial flutter (2.1 +/- 0.51 mV) were comparable to those of ST (2.2 +/- 0.5 mV). Atrial amplitudes during AF were significantly lower (0.81 +/- 0.5 mV, P<0.01). During VF atrial "sinus" signals (2 +/- 0.8 mV) were stable. Ventricular parameters did not differ from a standard ICD lead; defibrillation threshold was 11.4 +/- 4.5 J (16 patients). During intraoperative and prehospital discharge measurements, 97.1% of SR-P waves and 99.2% of atrial flutter waves were detected correctly. In AF 91.11% of atrial signals were detected. Analysis of 505 stored episodes showed that 96.8% of ST and 100% of atrial flutter and 100% of AF episodes have been classified correctly and no underdetection of VT/VF was found. The first experiences with the new VDD-ICD system show an increase of the specificity to detect ventricular tachycardias to a level comparable to dual chamber ICDs with two leads. The reliability of this system has to be proven in a prospective randomized study.

Defibrillators, Implantable↗