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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 9-year-old patient who had had a syncope was found to have atrial flutter in a resting electrocardiogram (ECG). Brief phases of sinus arrest had previously occurred after drug conversion to sinus rhythm. Structural heart disease was excluded by cardiac catheterization and angiography. Electrophysiologic study revealed a sick sinus syndrome, associated with diffuse impairment of the conduction system (supra-, infra-, and intrahisian block). Epimyocardial and an endocardial pacemaker implantation failed because of high stimulation threshold, after 3 years and 2 weeks, respectively. At the third implantation a steroid-eluting endocardial pacing lead was used and satisfactory pacing was still present 2 years later.
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PMID:Sick sinus syndrome and diffuse impairment of the conduction system in a child: successful pacing with a steroid eluting endocardial pacing lead. 173 68

The prevalence of supraventricular tachyarrhythmias in the general population is still a debated issue. This appears mainly due to the few works in the literature which correctly deal with the complex methodologic aspects of such a research. Data are often taken from different populations, with different methods for data recording. Moreover Holter monitoring, the most employed recording technique, lacks the desired sensitivity to this aim. However recent reports suggest that the prevalence of supraventricular tachyarrhythmias is higher than commonly thought. The prevalence of supraventricular premature beats increases with aging: they are found in 10%-20% of subjects less than 20 years, in 30%-60% of those between 20 and 60 years, in 90% of subjects older than 75 years. They are few (generally less than 100/24 hours) in people without an evident heart disease. In the Framingham study the incidence of the atrial fibrillation is 1.7%; it increases with aging, and is very rare in young. In 60% of the cases it is chronic, and in 40% it is paroxysmal. The true prevalence of the ectopic atrial tachycardia is not known; however it is frequent in older subjects with various types of heart disease, with sick sinus syndrome, with chronic pulmonary disease. The reentrant paroxysmal supraventricular tachycardia is reported in about 1% in the general population. Electrophysiologic studies have shown that in 70% of cases the reentrant circuit is entirely localized in the A-V junction whereas in the remaining 30% a concealed Kent bundle with only retrograde conduction is involved.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Classification and prevalence of supraventricular tachyarrhythmia]. 181 73

A 66 year-old woman with chronic Chagas's heart disease, presented palpitations, dizziness and chest pain. The His bundle electrograms revealed sick sinus syndrome. The left cineventriculography showed apical and inferior aneurysms of mammillary morphological aspect.
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PMID:[Apical and inferior mammillary aneurysm in chronic Chagas cardiomyopathy]. 187 27

Histopathologic findings of endomyocardial biopsy in 23 pediatric patients with arrhythmias or conduction disturbance were analyzed. ECG abnormalities consisted of atrioventricular block (AVB) in 11, ventricular arrhythmia including premature ventricular contractions (PVC) and ventricular tachycardia in 7, sick sinus syndrome (SSS) in 3, and bundle branch block in 2 cases. Biopsy specimens were obtained from the right ventricle in all cases and, additionally, from the right atrium in SSS cases. Biopsy revealed significant pathology in 19 cases (83%). Advanced histologic changes, including myocyte hypertrophy, disarrangement of muscle bundles, and interstitial fibrosis with or without myocyte degeneration, were observed in 7/11 AVB cases and 1/6 PVC cases. SSS cases showed interstitial fibrosis with disarrangement of muscle bundles in the right atrium, but no significant pathologic changes were seen in the right ventricle. There was no clinical evidence of hypertrophic or dilated cardiomyopathy, cardiac defects, or other heart disease in these patients. It is suggested that these cases may fall under the arrhythmia-conduction disturbance type of cardiomyopathy.
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PMID:Histopathologic findings of endomyocardial biopsies in pediatric patients with arrhythmias or conduction disturbances. 209 8

Doppler echocardiographic evaluation of the contribution of atrial contraction to left ventricular filling, its determinants and relationship with early diastolic filling was studied in 20 patients with sick sinus syndrome without structural heart disease on AAI pacing over a wide range of physiological atrioventricular delays (PR intervals). The results were compared with 20 normal controls matched for age, sex and heart rate. Left ventricular filling pattern, and the contribution of left atrial contraction to diastolic filling, were similar in the two groups. AAI pacing restores the physiological dynamics of left ventricular filling in patients with sick sinus syndrome without organic heart disease.
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PMID:Contribution of atrial contraction to left ventricular filling in patients with sick sinus syndrome on AAI pacing. 239 24

The incidence of autoantibodies against human conducting tissue was studied in 45 pacemaker patients with sick sinus syndrome (SSS), in 17 patients with bradyarrhythmia, and five patients with hypersensitive carotid sinus syndrome. Antibodies against the human sinus node were demonstrated in 29% of patients with SSS and in 24% of patients with bradyarrhythmia; a tenfold risk of SSS could be calculated in patients with this antibody as compared to age-matched controls. At least two subtypes of anti-sinus node antibodies were demonstrated: an antibody absorbable and another one not absorbable with ventricular myocardium. Patients with SSS and prior myocarditis of rheumatic fever have a threefold incidence of that antibody, demonstrating that anti-conducting tissue antibodies are etiologic indicators for former inflammatory heart disease. These antibodies may play a role in the secondary immunopathogenesis of sick sinus syndrome. This hypothesis emerges as an interesting new pathogenetic concept.
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PMID:Antibodies to human sinus node in sick sinus syndrome. 243 16

Transvenous atrial pacing is the preferred method for control of both brady and tachyarrhythmias in the postoperative pediatric patient with normal atrioventricular conduction. We reviewed our experience with the use of permanent atrial pacing for the control of bradycardia and tachycardia in the Fontan patient. We then compared this pacing experience to atrial pacing data compiled for postop Transposition of the Great Arteries (TGA) patients. Out of twenty-five Fontan patients followed at the Medical University of South Carolina, six patients have had atrial arrhythmias necessitating pacing (24%). Underlying congenital heart disease included tricuspid atresia physiology in three and single ventricle in three. The indications for atrial pacing was brady-tachy syndrome in four patients and sick sinus syndrome in two. Pacers were inserted immediately post-op in three patients and 1.5 years, 2 years, and 8 years post Fontan in the other three. These six patients have required a total of nine pulse generator implantations. Five of the nine pacers were inserted transvenously and four via thoracotomy. In contrast to our experience with permanent atrial pacing in post TGA patients, dysrhythmia control with atrial pacing in the Fontan patient has been more difficult to achieve. The Fontan patients have a higher incidence of symptomatic dysrhythmias, hospitalizations, and antidysrhythmic medication requirements after pacer insertion. Implantation thresholds of the Fontan patients are higher than those of the transposition group. While successful atrial demand pacing is attainable in both groups, antitachycardia pacing is more reliable in the post-op TGA patient. The Fontan procedure seems to present a new set of obstacles for successful atrial pacing in the pediatric post-op patient.
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PMID:Problems with permanent atrial pacing in the Fontan patient. 246 16

It is still a matter of controversy as to whether the patients paced for atrioventricular block (AVB) have different prognosis and survival rates than those paced for Sick Sinus Syndrome (SSS). We have compared the survival rates of 962 AVB patients (group A) with that of 283 SSS patients (group B) who underwent pacemaker implantation during the period January 1968 to December 1986. The survival rate graphs of the examined groups were calculated using the actuarial method and the differences in the survival rates between the groups were evaluated using the Logrank test. Our results show that SSS patients have a higher survival rate than AV block with a difference on the rate of survival between the two groups reaching the borderline of statistical significance. Multivariate discriminant analysis was then used to assess that of the parameters (i.e., age at the time of implantation, sex, electrophysiological indication to pacing, etiology or pacing mode) could have had the main influence upon mortality and the different pattern of the survival rate graph within the two groups of patients. Our data show that survival is mostly related to age, pacing mode and, although more slightly, to underlying heart disease; the electrophysiological indication to pacing, instead, does not significantly influence it.
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PMID:Survival rates after pacemaker implantation: a study of patients paced for sick sinus syndrome and atrioventricular block. 247 42

Thirty nine cases, in which sudden cardiac death (SCD) was suspected, were studied to evaluate the mechanism and the prediction of SCD in arrhythmia-patients using electrophysiological studies (EPS). The 39 cases (28 male and 11 female) were located by surveying 2098 patients who underwent EPS for the evaluation of arrhythmias. Age at time of EPS ranged from 4 to 86 years, average 50.5 years. Time from EPS to death was 2 to 163 months, average 27.9 months. Underlying heart disease was: dilated cardiomyopathy in 11, old myocardial infarction in 5, ischemic heart disease in 5, hypertensive heart disease in 5, valvular heart disease in 3, hypertrophic cardiomyopathy in 2, arrhythmogenic right ventricular dysplasia in 1, myocarditis in 1, sarcoidosis in 1, cor pulmonale in 1, and no obvious heart disease in 4. Fifteen had a permanent pacemaker implanted. SCD in cases without a permanent pacemaker (24 cases): 2 had chronic complete A-V block (one BH block, one HV block), 1 had advanced A-V block (HV block), 3 had bundle branch block with first degree HV block, 9 had ventricular tachycardia (VT), 3 had sick sinus syndrome (SSS), 3 had paroxysmal atrial flutter, 1 had WPW syndrome and paroxysmal atrial fibrillation, 1 had paroxysmal atrial tachycardia, and 3 had premature ventricular beats and first degree HV block. SCD in cases with permanent pacemaker (15 cases): 5 had SSS, and 10 had A-V block. In 3 of the 5 with SSS and 7 of the 10 with A-V block, VT was found before pacemaker implantation. In our study, brady and tachyarrhythmias coexisted in 25 cases (64%).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Mechanism and prediction of sudden cardiac death in arrhythmia patients using electrophysiological studies. 263 27

To evaluate the mechanism of sudden death in childhood and the physical activity levels at the onset of sudden death, we studied the following items: (1) the incidence and the circumstances surrounding sudden death at school in Kanagawa Prefecture, (2) high risk heart diseases detected among healthy school children by heart disease screening, (3) sudden cardiac death or near miss seen in outpatients with heart disease except congenital heart disease. Among total 15,156,346 school children, sudden death was observed in 97 subjects (M:77, F:20). Annual incidence of sudden death was 6.4 per 10(6). Of the 97 subjects, acute heart failure of unknown etiology was found in 60 (62%), cardiovascular disease in 18 (19%), cerebral vascular accidents in 14 (14%) and heat stroke in 5 (5%). Of the 78 subjects (M:64, F:14) considered as sudden cardiac death, 62 (79%) died during sports activities, and 16 (21%) died at rest. Of the 62 subjects, 29 died during track and field activities and 7 while swimming, both in physical education classes. Eighteen died during athletic club activities and 8 during extracurricular activities. Consequently, 54 subjects (87%) died in the presence of a school teacher. Of the 18 subjects with cardiovascular disease, 9 (hypertrophic cardiomyopathy in 3, myocarditis in 3, Kawasaki disease in 2 and long QT in one) were diagnosed initially by the autopsy study. Latent high risk heart diseases, detected among presumably healthy school children by the heart disease screening program, were the following: hypertrophic cardiomyopathy, long QT syndrome, Kawasaki disease and some arrhythmias (ventricular tachycardia, sick sinus syndrome, A-V block and atrial fibrillation). Follow-up observations of outpatients with heart disease revealed the same results as the heart disease screening program. In order to prevent sudden death at school, the following recommendations should be observed: 1) sports directors should learn "sports medicine in childhood", including primary cardiovascular resuscitation, 2) an accurate heart disease screening program should be operated to detect latent high risk heart diseases, advise on adequate medical treatment, and help ensure an appropriate selection of sports activities, 3) comprehensive autopsy studies should be performed.
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PMID:Sudden cardiac death in childhood. 263 28


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