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PubMed2005

[Predictive factors of maintenance of sinus rhythm after direct current (DC) cardioversion of atrial fibrillation/atrial flutter].

INTRODUCTION: Our aim was to determine the immediate and long-term outcome of direct current (DC) electrical cardioversion in patients with atrial fibrillation or flutter, and to determine factors predicting clinical outcome. MATERIALS AND METHODS: A retrospective one-year follow-up study of 220 patients with atrial fibrillation or flutter undergoing electrical cardioversion between September 1998 and April 2001 was done. RESULTS: Electrical cardioversion was successful in 82% of the patients. Multivariate analysis revealed that female gender was associated with successful cardioversion (p=0.008). Only 29% remained in sinus rhythm after the one-year follow-up. Maintenance of sinus rhythm was associated with anti-arrhythmic drug treatment (p=0.042). Relapse of atrial fibrillation was associated with reduced left ventricular ejection fraction (p=0.002). Complications occurred in 7.7% of the electrical cardioversions; of these, 1.2% were thromboembolic events. DISCUSSION: Less than one third of the patients remained in sinus rhythm after the one-year follow-up despite the use of anti-arrhythmic drugs. Electrical cardioversion is not without risk. Thorough consideration of choice of treatment in patients with atrial fibrillation or flutter is therefore important. According to Danish and international guidelines, electrical cardioversion should be considered primarily when symptoms of AF are unacceptable despite optimal frequency regulation or in patients with AF detected for the first time.

Adult↗
PubMed2001

Multicenter experiences with a single lead electrode for dual chamber ICD systems.

Monitoring of atrial signals improves the accuracy in identifying supraventricular tachyarrhythmias to prevent inappropriate therapies in patients with implantable ICDs. Since difficulties due to the additional atrial lead were found in dual chamber ICD systems with two leads, the authors designed a single pass VDD lead for use with dual chamber ICDs. After a successful animal study, the prototype VDD lead (single coil defibrillation lead with two additional fractally coated rings for bipolar sensing in the atrium) was temporarily used in 30 patients during a German multicenter study. Atrial and ventricular signals were recorded during sinus rhythm (SR), atrial flutter, AF, and VT or VF. The implantation of the lead was successful in 27 of 30 patients. Mean atrial pacing threshold was 2.5 +/- 0.9 V/0.5 ms, mean atrial impedance was 213 +/- 31 ohms. Atrial amplitudes were greater during SR (2.7 +/- 1.6 mV) than during atrial flutter (1.46 +/- 0.3 mV, P < 0.05) or AF (0.93 +/- 0.37 mV, P < 0.01). During VF atrial "sinus" signals had significantly (P < 0.01) lower amplitudes (1.4 +/- 0.52 mV) than during SR. The mean ventricular sensing was 13.3 +/- 7.9 mV and mean ventricular impedance was 577 +/- 64 ohms. Defibrillation was successful with a 20-J shock in all patients. In addition, 99.6% of P waves could be detected in SR and 84.4% of flutter waves during atrial flutter. During AF, 56.6% of atrial signals could be detected without modification of the signal amplifier. In conclusion, a new designed VDD dual chamber lead provides stable detection of atrial and ventricular signals during SR and atrial flutter. Reliable detection of atrial signals is possible without modification of the ICD amplifier.

Aged↗
PubMed2004

Acute effects of left atrial radiofrequency ablation on atrial fibrillation.

INTRODUCTION: Acutely, when left atrial ablation is performed during atrial fibrillation (AF), the AF may persist and require cardioversion, or it may convert to sinus rhythm or to atrial tachycardia/flutter. The prevalence of these acute outcomes has not been described. METHODS AND RESULTS: Left atrial ablation, usually including encirclement of the pulmonary veins, was performed during AF in 144 patients with drug-refractory AF. Conversion to sinus rhythm occurred in 19 patients (13%), to left atrial tachycardia in 6 (4%), and to atrial flutter in 6 (4%). In the 6 patients with a focal atrial tachycardia, the mean cycle length was 294 +/- 45 ms. The tachycardia arose in the left atrial roof in 3 patients, the left atrial appendage in 2, and the anterior left atrium in 1. In 3 of 6 patients, the focal atrial tachycardia originated in an area that displayed a relatively short cycle length during AF. In 6 patients, AF converted to macroreentrant atrial flutter with a mean cycle length of 253 +/- 47 ms, involving the mitral isthmus in 5 patients and the septum in 1 patient. All atrial tachycardias and flutters were successfully ablated with 1 to 15 applications of radiofrequency energy. CONCLUSION: When left atrial ablation is performed during AF, the AF may convert to atrial tachycardia or flutter in approximately 10% of patients. Focal atrial tachycardias that occur during ablation of AF may be attributable to driving mechanisms that persist after AF has been eliminated, whereas atrial flutter results from incomplete ablation lines.

Acute Disease↗
PubMed2002

Local electrogram assessment of unidirectional isthmus block is sufficient to predict the acute and long-term success of cavo-tricuspid isthmus ablation.

BACKGROUND: This study investigated whether a minimal approach to typical atrial flutter ablation using an 8 mm tip catheter with a 150 W generator with only the documentation of clockwise block by means of local criteria predicts a good long-term outcome. METHODS: Seventy patients underwent typical atrial flutter ablation. A multipolar catheter was inserted into the coronary sinus (CS) and an 8 mm tip ablation catheter was used to ablate and map the isthmus. The ablation line was performed in the posteroseptal region. The clockwise block was confirmed by recording a corridor of double potentials along the line and by counterclockwise activation of the portion of the isthmus just beyond the lesion line as demonstrated by measuring the conduction times during CS pacing. RESULTS: In case of block, the mean distance between the two split atrial electrograms was 129 +/- 31 ms. Acute isthmus block was achieved in all 70 patients. The median of the radiofrequency pulses was 10 (range 1-36). No immediate or late complications were noted. The long-term follow-up (19.5 +/- 4 months) revealed recurrence of typical atrial flutter in 2 cases (2.8%). CONCLUSIONS: Our results demonstrate that the acute success rate following typical atrial flutter isthmus ablation using an 8 mm tip catheter with a 150 W generator is high. No complications occurred. Moreover, the documentation of just the clockwise isthmus block using a minimal approach according to local electrogram criteria is a good predictor of the long-term success.

Atrial Flutter↗
PubMed1994

Effects of adenosine on atrial refractoriness and arrhythmias.

OBJECTIVE: Transient atrial fibrillation is sometimes observed following adenosine administration and adenosine is known to shorten atrial action potential duration and refractory period. This study was designed to characterise the dose-response relationship of adenosine on these variables relative to arrhythmia induction with single atrial premature stimuli. The effects of adenosine during sustained atrial flutter were also determined. METHODS: Intravenous bolus doses of adenosine were given to pentobarbitone anaesthetised dogs following cervical vagotomy and autonomic blockade with atropine and nadolol. Monophasic action potential catheter recordings were obtained from the right atrium and a programmable stimulator was used for pacing. RESULTS: Placebo had no effect on monophasic action potential duration (MAPD) or atrial effective refractory period (ERP) and no arrhythmias were observed. Adenosine (0.1-1.0 mg.kg-1) produced dose related decreases in MAPD and ERP and transient atrial fibrillation (5-122 s) was repeatedly and reproducibly induced in 12 dogs. In six dogs, intravenous dipyridamole (0.25 mg.kg-1) enhanced the effects of adenosine on MAPD and ERP and increased the incidence of atrial fibrillation. In another six dogs, 8-sulphophenyltheophylline (5.0 mg.kg-1, intravenously) markedly blunted the effects of adenosine, and atrial fibrillation could no longer be induced by premature stimuli. In a separate series of experiments the effects of adenosine were evaluated in seven dogs in which sustained atrial flutter could reproducibly be induced by rapid atrial pacing. Administration of placebo never caused termination of the arrhythmia, whereas intravenous boluses of adenosine (0.1-1.0 mg.kg-1) decreased and produced variation in atrial flutter cycle length, and then terminated the arrhythmia in all cases. These effects of adenosine were also enhanced by dipyridamole and antagonised by 8-sulphophenyltheophylline. CONCLUSIONS: Adenosine produces a receptor mediated shortening of monophasic action potential duration and refractoriness which increases vulnerability to transient atrial arrhythmias. During sustained atrial flutter, these effects may also contribute to destabilisation and termination of the arrhythmia.

Action Potentials↗
PubMedDate not supplied

[Pathophysiology of auricular flutter and fibrillation in patients with Wolff-Parkinson-White syndrome. A case successfully treated by fulguration of the bundle of His].

Atrial flutter and fibrillation are common in patients with Wolff-Parkinson-White syndrome. Pathophysiology of these arrhythmias is poorly understood. Treatment is empirical and oriented to symptomatology. Here we describe a patient with Wolff-Parkinson-White syndrome with paroxysmal reentrant orthodromic AV tachycardias and atrial flutter episodes that disappeared after His Bundle fulguration. This suggests that a complete AV reentry circuit favored the occurrence of atrial flutter in this patient.

Aged↗
PubMed1979

Uncontrolled ventricular rate in atrial fibrillation. A manifestation of dissimilar atrial rhythms.

A patient with coarse atrial fibrillation and a rapid ventricular response developed periods of high grade atrioventricular block interpersed with periods of rapid ventricular conduction after the administration of digitalis and propranolol. Intracardiac atrial recordings showed similar atrial rhythms of high right atrial flutter and left atrial fibrillation. The low right atrial recordings showed flutter during the periods of fast ventricular rates and fibrillation during periods of slower ventricular rates.

Adult↗
PubMed1996

Efficacy of ibutilide for termination of atrial fibrillation and flutter.

The clinical utility of ibutilide fumarate (Corvert) for the acute conversion of atrial tachyarrhythmias to normal sinus rhythm has been demonstrated in several randomized, placebo-controlled clinical trials. The efficacy of intravenous ibutilide for rapid conversion of atrial flutter is in the range of 50-70%, whereas its efficacy for conversion of atrial fibrillation is 30-50%. Approximately 80% of atrial tachyarrhythmias that terminate do so within 30 minutes from the initiation of the intravenous infusion. Ibutilide is more effective than either intravenous procainamide or intravenous sotalol for conversion of atrial fibrillation and atrial flutter to sinus rhythm. Age, presence of structural heart disease, gender and concomitant medication do not appear to influence the efficacy of ibutilide; however, shorter duration of atrial fibrillation is a strong predictor of successful termination. Plasma concentration of ibutilide and QTc interval prolongation are not directly correlated with the success rate for conversion of atrial tachyarrhythmias. Ibutilide's greater efficacy compared with other antiarrhythmic drugs may be related to its ability to cause greater prolongation of atrial monophasic action potential duration relative to atrial cycle length. Termination of atrial flutter with ibutilide was preceded by increased atrial cycle length variability. Ibutilide rapidly and effectively converts atrial fibrillation and atrial flutter to sinus rhythm when administered as a 1-mg total dose followed by a second 1-mg dose. It should be used in conjunction with continuous electrocardiographic monitoring for at least 4 hours after the termination of the infusion, or until the QTc interval returns to baseline. Hypokalemia and hypomagnesemia should be corrected before the start of the infusion. An external cardiac defibrillator, intravenous magnesium, and an external transcutaneous cardiac pacemaker should be readily available for immediate use in the event that palymorphic ventricular tachyarrhythmias occur. Ibutilide is a new intravenous agent that safely and rapidly converts atrial fibrillation and atrial flutter to sinus rhythm.

Anti-Arrhythmia Agents↗
PubMed2002

Bi-atrial mapping of atrial arrhythmias.

Cardiac mapping of atrial activation was originally performed in animals during open chest preparations, using epicardial electrodes. The development of endocardial egg-shaped multiple electrodes provided detailed assessment of the minimum number of wavelengths required to sustain atrial fibrillation (AF), as well as the role of interatrial connections during AF. Subsequently, several studies on bi-atrial epicardial high-density mapping in animals and humans also reported on the importance of interatrial connections, as well as the specific characteristics of the left atrium as compared with the right atrium during chronic AF. Endocardial bi-atrial mapping studies using electrode catheters were reported using basket-shaped catheters carrying 64 electrodes. Animal studies suggested that septal activation was asynchronous and discordant, while a human study outlined the multiple origins of atrial ectopic beats following DC cardioversion in patients with chronic atrial fibrillation. The advent of non-fluoroscopic mapping systems significantly changed our approach to percutaneous endocardial mapping. Simultaneous bi-atrial studies using electroanatomic mapping were performed in sinus rhythm as well as in atrial flutter. These studies demonstrated the predominance of interatrial conduction over Bachmann's Bundle and the coronary sinus-left atrial connection during respectively, sinus rhythm and atrial flutter. Simultaneous bi-atrial non-contact mapping was initially performed during porcine studies and later in humans, demonstrating asynchronous and discordant septal activation both during sinus rhythm or left lateral atrial pacing. Preliminary studies from simultaneous bi-atrial non-contact mapping in humans in whom AF occurred spontaneously or was induced suggests three main types of atrial activation, consisting of left atrial drivers causing the right atrium to fibrillate following conduction over interatrial connections, the right atrium independently sustaining AF, even after pulmonary vein disconnection, and both atria fibrillating independently without activation over interatrial connections. Bi-atrial mapping has been essential for our understanding of normal and abnormal atrial activation, and ultimately may provide new approaches for ablation of atrial fibrillation.

Animals↗
PubMed1983

Clinical follow-up study of paroxysmal supraventricular tachyarrhythmias after operative repair of a secundum type atrial septal defect in adults.

Adults with isolated secundum atrial septal defect (ASD) may present with paroxysmal atrial tachyarrhythmias. The clinical course of these rhythmic disturbances after correction of the ASD is unknown. Of 188 patients aged 44 years old or older with isolated ASD, 27 (14%) (mean age 52.7 years, range 44 to 71) had documented paroxysmal atrial tachyarrhythmias preoperatively: 16 had paroxysmal atrial fibrillation, 2 had atrial flutter, and 9 had supraventricular tachycardia. Among these 3 groups, there were no differences in age, sex, New York Heart Association class, duration of preoperative symptoms, mean right atrial and pulmonary arterial pressures, shunt size, atrial size, or follow-up period. After operative repair, follow-up data were available in all patients for a mean of 12 years (range 1.5 to 25). Of the 16 patients with preoperative paroxysmal atrial fibrillation, 14 (88%) continued to have increasingly frequent paroxysmal atrial fibrillation, culminating in sustained atrial fibrillation. In 1 of the 2 patients with paroxysmal atrial flutter, sustained atrial fibrillation developed. Of the 9 patients with preoperative paroxysmal supraventricular tachycardia, 5 had no further episodes of this arrhythmia postoperatively.

Aged↗
PubMed1997

Intra-atrial reentrant tachycardia after palliation of congenital heart disease: characterization of multiple macroreentrant circuits using fluoroscopically based three-dimensional endocardial mapping.

INTRODUCTION: The anatomic substrate of intra-atrial reentrant tachycardia (IART) following congenital heart surgery is poorly understood, but is presumed to be different than common atrial flutter. METHODS AND RESULTS: To study the mechanisms of IART, we used a new technique for high-density endocardial mapping using recordings from a multipolar basket recording catheter (25 bipolar pairs). For each recording, biplane fluorographic reference points were digitized to obtain the spatial locations of electrode pairs, and activation times were calculated using temporal reference points from the surface ECG. Using custom software, data were combined to create three-dimensional atrial activation sequence maps, which were displayed as animated sequences. Using this technique, recordings were made in induced and/or spontaneous IART in 8 patients following congenital heart surgery (5 Fontan, 2 tetralogy of Fallot repair, 1 ventricular septal defect repair), and in 3 patients with normal intracardiac anatomy (1 with type I atrial flutter). Ten discrete IART activation sequences were recorded; 2 patients had 2 sequences each. IART maps were constructed using a median of 108 electrode positions (range 27 to 197) from a median of 6 recordings/sequence (range 3 to 11). Sinus or paced atrial rhythms were also recorded, and maps were created in a similar fashion. Visual analysis of activation sequences of sinus and paced rhythm were anatomically concordant with known mechanisms of atrial activation. IART sequences revealed diverse mechanisms; only 1 IART circuit was similar to that associated with common atrial flutter. Activation wavefront emergence from presumed zones of slow conduction, lines of conduction block, and apparent bystander activation were observed. CONCLUSIONS: High-density atrial activation sequence maps demonstrate that IART following congenital heart surgery utilizes diverse circuits and is distinct from common atrial flutter. The technique used to create these three-dimensional activation sequences may improve understanding of these complex atrial arrhythmias and assist in the development of ablative therapies.

Adolescent↗
PubMed2006

Use of fast fourier transform analysis of atrial electrograms for rapid characterization of atrial activation-implications for delineating possible mechanisms of atrial tachyarrhythmias.

INTRODUCTION: Different analysis techniques have been developed to help understand and characterize the mechanisms responsible for atrial arrhythmias. We tested the hypothesis that Fast Fourier Transform (FFT) analysis of recorded atrial electrograms (AEGs) will rapidly and accurately identify regular and irregular patterns of atrial activation, and, thereby, may provide evidence suggestive of underlying mechanisms of atrial tachyarrhythmias. METHODS AND RESULTS: During induced atrial tachyarrhythmias in both the canine sterile pericarditis model and canine rapid ventricular pacing-induced congestive heart failure model; 380-404 AEGs were recorded simultaneously from epicardial electrodes on both atria. From AEGs, atrial activation sequences were determined during atrial flutter (AFL), focal atrial tachycardia (AT), and atrial fibrillation (AF). Four-second recording segments of each AEG were subjected to FFT analysis. Frequencies found during FFT analyses in all studies precisely corresponded to the cycle lengths of the AEGs. In AFL and AT, one dominant frequency peak was found throughout both atria. In AF due to multiple unstable reentry circuits, multiple and broad frequency peaks were found in both atria. In AF due to a stable rapid rhythm (driver) in the left atrium with fibrillatory conduction to the rest of the atria, one dominant frequency peak in areas with 1:1 conduction from the driver, and multiple and/or broad frequency peaks in areas with fibrillatory conduction produced by the driver were found. Computation time for all FFT analyses took <5 minutes. CONCLUSION: FFT analysis accurately and rapidly identifies global atrial activation patterns during AFL, AT, and AF, thereby assisting in determining arrhythmia mechanisms.

Animals↗
PubMed1988

[Value of esophageal stimulation for decreasing auricular flutter].

The purpose of this study was to evaluate the effectiveness of trans-esophageal atrial stimulation in decreasing atrial flutters. 31 patients, aged between 26 and 86 years, underwent 38 esophageal stimulations between August 1986 and April 1987. Esophageal stimulation was carried out with a device delivering major stimuli (10 to 20 ms) as well as high voltages (10 to 20 volts). A bipolar probe of permanent intracardiac stimulation was placed behind the left atrium, via a trans-esophageal approach under ECG guidance. Stimulations were carried out at a slightly faster rhythm than that of the atrial flutter, for 1 to 30 seconds with a progressive increase of the stimulation frequency (280 to 960 impulses/min) until either a sinus rhythm or an atrial fibrillation was obtained. A sinus rhythm was obtained immediately (21 times out of 38; 55.3%) and at the 24th hour after temporary atrial fibrillation in 8 additional patients (21%). The reduction percentage at 24 hours was therefore 76.3 p. cent. In 6 patients (15.8%), esophageal stimulation failed and in 3 additional patients, after atrial fibrillation, there was either relapse into flutter, or persistence of atrial fibrillation at the 24th hour. Esophageal stimulation was well tolerated in all cases. There were no local or rhythm complications. In conclusion, trans-esophageal atrial stimulation appears to be effective, easy to implement, economical and well tolerated. Its primary use to decrease atrial flutter seems justified, permitting to avoid in 75 p. cent of the time, recourse to intracardiac atrial stimulation or external shock.

Adult↗
PubMed1992

[Accidental ventricular fibrillation during transesophageal atrial overdrive].

Transesophageal atrial overdrive stimulation is a widely used technique for the interruption of atrial flutter and supraventricular tachyarrhythmias. We describe a case of 60 year old man with a previous myocardial infarction, suffering from angina during effort after aortocoronary bypass who presented several episodes of atrial flutter treated with success by transesophageal atrial overdrive stimulation using swallowing electrodes. During the treatment of the last episode of atrial flutter, after a 5 s burst at 300 b/min ventricular fibrillation occurred and was promptly interrupted by DC shock. This is the first case in our experience and probably the first report of ventricular fibrillation induced by swallowing electrodes. Possible mechanisms as pharmacological interactions, accidental ventricular stimulation, etc, are discussed. In conclusion, even though the risk of dangerous arrhythmias is very low, transesophageal atrial overdrive stimulation should be performed by experts in an equipped room.

Angina Pectoris↗
PubMed1988

Interatrial conduction block and retrograde activation of the left atrium and paroxysmal supraventricular tachyarrhythmia.

We studied 16 patients with electrocardiographic evidence of advanced interatrial block and retrograde activation of the left atrium (P greater than or equal to 0.12 s, and diphasic (+/-) P waves in leads II, III, and VF). Eight patients had valvular heart disease, four had dilated cardiomyopathy and four had other forms of heart disease. Patients with valvular heart disease and cardiomyopathy were compared with a control group of 22 patients with similar clinical and echocardiographic characteristics, but without this type of interatrial block. Patients with advanced interatrial block and retrograde activation of the left atrium had a much higher incidence of paroxysmal supraventricular tachyarrhythmias (93.7%) during follow-up than did the control group, (27.7%) (P less than 0.001). Eleven of 16 patients (68.7%) with advanced interatrial block and retrograde activation of left atrium had atrial flutter (atypical in seven cases, typical in two cases, and with two or more morphologies in two cases). Six patients from the control group (27.7%) had sustained atrial tachyarrhythmias (five atrial fibrillation and one typical atrial flutter). The atrial tachyarrhythmias were due more to advanced interatrial block and retrograde activation of left atrium and frequent atrial extrasystoles than to left atrial enlargement, because the control group with a left atrium of the same size, but without advanced interatrial block and retrograde activation of left atrium and with less incidence of atrial extrasystoles, had a much lower incidence of paroxysmal tachycardia.

Aged↗
PubMed1989

Dose related efficacy of adenosine triphosphate in spontaneous supraventricular tachyarrhythmias.

Intravenous adenosine triphosphate has been proved to be useful for the treatment of supraventricular tachyarrhythmias. The optimal dose to be employed, however, has yet to be stated. Forty-two episodes of spontaneous paroxysmal supraventricular tachycardia, observed in 33 patients (16 men and 17 women, mean age 51 years) were treated with intravenous boluses. These were given in 10 mg increments at increasing doses from 10 to 50 mg at intervals of three minutes if the arrhythmia persisted despite the previous dose. When using a dose less than or equal to 40 mg, tachycardia was terminated in 37 of 42 episodes in less than 50 seconds. In four of the remaining five, atrial flutter and ectopic atrial tachycardia were diagnosed after administration of adenosine triphosphate. The other patient was subsequently found to have an atrioventricular reentrant tachycardia incorporating two accessory pathways. More than half of the treated episodes of supraventricular tachycardia terminated with the minimal dose of 10 mg and 7.1% required 40 mg. In five patients, arrhythmia ceased and reappeared despite the use of adenosine triphosphate. All the patients experienced an unpleasant feeling of dyspnoea or suffocation after injection of the drug. Sinus pauses and bradycardia following termination of the arrhythmia were directly correlated with the dose employed (P less than 0.05). We conclude that adenosine triphosphate is a useful, safe and effective drug at low dose in correctly diagnosed reentrant tachycardias involving the atrioventricular node. It is also useful as a diagnostic tool in patients with supraventricular tachyarrhythmias.

Adenosine Triphosphate↗
PubMed1994

[Results, complications and long-term follow-up of percutaneous ablation of atrioventricular conduction. Apropos of 85 cases].

This retrospective study reports the immediate and long-term results of percutaneous ablation of atrioventricular conduction. Between July 1983 and January 1992, 85 consecutive patients (51 men, age 64 +/- 10 years, range 43-84 years) presenting with supraventricular arrhythmias (atrial fibrillation n = 53; atrial flutter n = 50; atrial tachycardia n = 17; junctional tachycardia n = 6) resistant to antiarrhythmic therapy (number of drugs used: 4 +/- 1.3, range 1-6) underwent interruption of atrioventricular conduction by fulguration (n = 65) or radiofrequency energy (n = 13) or by an association of the two methods (n = 7). The 75 pacemakers implanted (10 patients had pacemakers before the procedure) comprised 55 VVIR, 11 VVI, 5 DDD and 4 DDDR units. The immediate results included two sudden deaths at the 4th and 7th day in patients undergoing fulguration and three complications with a favourable outcome (staphylococcal septicaemia, pulmonary embolism and haematoma at the site of implantation of the pacemaker). None of the patients was lost to follow-up and the average follow-up was 31 +/- 18 months (range 2-108 months). During follow-up, 15 patients died and there was a recurrence of symptoms in 11 patients after 1 to 9 months requiring a repeat procedure. In the 68 survivors, the follow-up is now 38 +/- 18 months (range 12-108 months). Sixty one patients have 2nd (2) or 3rd (59) degree atrioventricular block, giving 90% good electrocardiographic results.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗