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At least 19 recordsLinked to original sources
PubMed1977

Ventricular arrhythmias in acute myocardial infarction. A comparative study on some tests for ventricular arrhythmias.

A continuous ECG recording has been made in 31 myocardial infarction patients during the first 24 hours after admission to hospital. The number and severity of ventricular arrhythmias were recorded in great detail. Before discharge from hospital the patients were submitted to 20 hours of ECG tape recording, an exercise test on a bicycle ergometer and a static work test (handgrip). Another exercise test was performed one month after discharge. During the first day in the Coronary Care Unit (CCU) all 31 patients had ventricular arrhythmias and in 27 of them the arrhythmia was classified as major (calling for treatment according to Lown's criteria). At the exercise tests 23 patients showed ventricular arrhythmias, 12 of them considered as major. No antiarrhythmic therapy was given during the investigation. No correlation was found between the degree of arrhythmia during the first day in the CCU and during the exercise tests. Tape-recorded ECG's appeared to be inferior to dynamic exercise tests in the ability to disclose a latent tendency to ventricular arrhythmia. Static work did not provoke any ventricular arrhythmias. At a 2-year follow-up 5 patients had died, 4 of them suddenly. Examination of additional material on 11 patients with ventricular tachycardia or ventricular fibrillation during the CCU stay, showed that 2 had died, but only one suddenly. Frequency and severity of arrhythmias during the first day after the infarction seemed to correlate poorly to a persistent tendency to arrhythmias during the first day after the infarction seemed to correlate poorly to a persistent tendency to arrhythmias or to the risk of sudden death during the following 2 years. A dynamic exercise test performed before discharge would appear to be more effective in selecting patients in need of long-term prophylaxis. However, very few patients seem to need such a specific antiarrhythmic prophylaxis.

Acute Disease↗
PubMed1979

[Quantitative evaluation of the efficacy of anti-arrhythmia agents in chronic ventricular arrhythmia].

The authors describe a computer system for the analysis of ventricular arrhythmias and its use in the evaluation of anti-arrhythmic drugs. Provided the arrhythmia is stable, this method allows an estimation of the onset and duration of action of the drug and gives guidelines for the choice of an appropriate drug regimen. Using this system, a comparison can be made between different drugs based on quantification of their efficacy.

Amiodarone↗
PubMed1977

[Prognostic significance of arrhythmias in acute myocardial infarction (author's transl)].

Ventricular arrhythmias represent a common precursor of ventricular fibrillation in acute myocardial infarction in man. Frequent ventricular ectopic beats (greater than 5/min), multifocal ectopic beats, ventricular bigeminy, ventricular salvoes, ventricular tachycardia, and the R-on-T phenomenon have been considered as warning arrhythmias. However, recent studies have given rise to some doubt concerning the value of warning arrhythmias as predictors of ventricular fibrillation. In many a case there is no warning arrhythmia prior to ventricular fibrillation or these arrhythmias do not fulfill the criteria of warning arrhythmias. In other cases the warning arrhythmias develop so briefly before ventricular fibrillation that no prophylactic measure can be instituted. Warning arrhythmias may occur at equal frequency in patients with and without consecutive ventricular fibrillation. This also applies to the R-on-T phenomenon as a warning arrhythmia and as the initiating mechanism of ventricular fibrillation. In nearly half the cases ventricular fibrillation is initiated by a late ventricular ectopic beat. In view of these data of the literature, the so-called warning arrhythmias seem to have lost their predictive value. They represent a common phenomenon in acute myocardial infarction in man. However, ventricular fibrillation may also occur without any prior ventricular arrhythmias, above all during the first day of acute myocardial infarction. The frequency of ventricular fibrillation decreases in the course of infarction. Therefore the time during acute myocardial infarction may be a better guide whether to institute prophylactic antiarrhythmic therapy than the occurrence of ventricular arrhythmias. To date, the beneficial effect of prophylactic administration of lidocaine has remained controversial though a recent double-blind study has strongly suggested that lidocaine is able to prevent ventricular fibrillation. If these results should be confirmed by others, this would ask for routine administration of lidocaine in each case with acute myocardial infarction during the first day.

Acute Disease↗
PubMed1979

Intrapartum fetal cardiac arrhythmias.

Fifteen cases of fetal cardiac arrhythmia were detected by direct fetal electrocardiogram (FECG) during intrapartum fetal monitoring. The frequency of arrhythmia of 12.4/1000 monitored births. Thirteen of the arrhythmias were supraventricular. Atrial bigeminy was the most commonly observed arrhythmia, followed by atrial trigeminy. Two cases of ventricular arrhythmia were noted, one of which was a case of ventricular tachycardia. Arrhythmias were not related to drug treatment or to stage of labor. Variable decelerations occurred in association with arrhythmias in 73% of the cases. There were no nuchal cords seen at delivery, nor were there any instances of intrapartum fetal distress, fetal acidosis, or low Apgar scores associated with any arrhythmia. All arrhythmias resolved spontaneously without treatment. The neonatal course was uncomplicated in all cases. Intrapartum fetal arrhythmia is best detected by direct FECG. Appropriate management should include close observation for ominous fetal heart rate (FHR) patterns and fetal acid-base-studies. At present, there is no indication for drug treatment of intrapartum arrhythmia.

Arrhythmias, Cardiac↗
PubMed1975

Arrhythmias following cardiac surgery: relation to serum digoxin levels.

Arrhythmias were analyzed in 50 patients undergoing cardiac surgery: 27 with valve surgery, 15 with coronary artery bypass (CAB), 5 with CAB and valve surgery, and 3 with miscellaneous procedures. The role of electrolyte abnormalities, pericarditis, serum osmolarity, digoxin level, and the type of surgery performed was evaluated. Thirty-seven out of 50 patients (74 per cent) had a postoperative arrhythmia, and a total of 78 different arrhythmias were noted. Twenty-six out of 27 patients with valve surgery had an arrhythmia vs. six out of 15 patients with CAB (p less than 0.001). Atrial fibrillation was the most common arrhythmia in all groups. Although postoperative hypocalcemia, hypomagnesemia, pericarditis, and wide shifts in osmolarity were common, they did not correlate with arrhythmias. Seventeen patients developed postoperative arrhythmias compatible with digitalis toxicity, including junctional rhythm, atrioventricular dissociation, or atrial tachycardia with block. However, the range of serum digoxin levels in these patients was zero to 2.80 ng. per milliliter. This suggests increased sensitivity to digitalis glycosides or the effects of surgical trauma as the etiology of arrhythmia in many patients. The distinction between digitalis-induced arrhythmia and spontaneously occurring arrhythmia cannot be made with certainty in most postoperative patients. Therapy should reflect an awareness of the potential for postoperative digitoxicity.

Aortic Valve↗
PubMed1977

Sleep-induced apnea syndrome. Prevalence of cardiac arrhythmias and their reversal after tracheostomy.

Cardiac arrhythmias during wakefulness and sleep in 15 patients with sleep-induced obstructive apnea, and the effect of atropine and tracheostomy on these arrhythmias were studied by continuous overnight Holter electrocardiographic, respiratory and electroencephalographic recordings. Sleep was characterized by marked sinus arrhythmia in 14, extreme sinus bradycardia ( less than 30 beats/minute) in six, asystole of 2.5 to 6.3 seconds in five, second degree atrioventricular (A-V) block in two, and ventricular arrhythmias--complex premature ventricular beats in 10 and ventricular tachycardia in two. Arrhythmias during wakefulness were limited to premature ventricular beats in six. Atropine administration was partially and tracheostomy highly effective in preventing the majority of these arrhythmias during sleep. Marked sinus arrhythmia during sleep is characteristic of the syndrome of obstructive sleep apnea and is frequently accompanied by potentially life-threatening tachy- and bradyarrhythmias. Possible mechanism of production of these arrhythmias, the mode of action of tracheostomy and atropine, and the probable role of similar arrhythmias in the sudden infant death syndrome are discussed.

Apnea↗
PubMed1975

Comparison of arrhythmia computer and conventional monitoring in coronary-care unit.

Conventional methods of monitoring arrhythmias impose heavy demands on staff and are unreliable. On-line arrhythmia computers have been developed to overcome these problems, but there has been no critical evaluation of the functioning of such a system in a clinical setting. A comparison was made of the efficacy of two methods of monitoring in detecting arrhythmias in sixty-four patients in a coronary-care unit. Half the patients were monitored by a commercially available arrhythmia computer; the other half were monitored by conventional means with a rate-triggered alarm system. More than 99 percent of episodes of potentially serious ventricular arrhythmias were detected by the computer; 95 percent of patients with these arrhythmias were treated immediately. In those monitored by conventional means, a large proporation of such arrhythmias were unrecognised: only 17 percent of affected patients received immediate antiarrhythmic therapy. In 30 percent, treatment was delayed for several hours, and none was given in 52 percent. False alarms occurred with both systems but were more readily recognised as such in the computer-monitored patients. It is concluded that an arrhythmia computer improves the standards of arrhythmia detection, leads to quicker institution of treatment, and diminishes the demand on skilled staff.

Adult↗