Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The signal averaged electrocardiogram (SA-ECG), programmed electrical stimulation (PES), and left ventricular ejection fraction (EF) studies were utilized for risk stratification and management of patients with complex ventricular arrhythmias and nonsustained ventricular tachycardia (VT). The study population included 90 patients (63 with coronary artery disease and 27 with dilated cardiomyopathy). Sustained monomorphic VT was induced in 22 cases (24%), ventricular fibrillation (VF) in 10 (11%), and no sustained VT/VF in 58 (64%). An abnormal SA-ECG was recorded in 23 patients (26%) and was more common in patients with than in those without induced sustained VT (68% vs 12%, P less than 0.0001). None of 33 patients with normal SA-ECG and EF greater than or equal to 40% had induced VT. Patients were followed-up for 2.5 +/- 0.8 years off antiarrhythmic therapy, unless they had induced sustained VT. The 3-year sudden death rate was 19% in the group with induced sustained VT, 0 in that with induced VF, and 9% in that without induced VT/VF (P = NS). The 3-year total cardiac mortality was higher in patients with than in those without EF less than 40% (27% vs 7%, P less than 0.05). It is concluded that patients with organic heart disease and spontaneous nonsustained VT may not need PES or antiarrhythmic therapy if SA-ECG is normal and EF is greater than or equal to 40%, since their risk of induced VT and sudden death is low. On the other hand, patients with abnormal SA-ECG and/or EF less than 40% may require PES, since their risk for induced VT is high. Antiarrhythmic therapy may also be considered in these patients.
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PMID:The signal averaged electrocardiogram and programmed stimulation in patients with complex ventricular arrhythmias. 170 10

The aim of this study was to investigate the efficacy and the side effects of a long-term treatment with amiodarone. We analyzed the data of 41 patients in whom amiodarone therapy had been initiated between 1974 and 1984. Twenty-one patients had dilative cardiomyopathy, 14 patients had chronic myocardial infarction, four patients suffered from WPW syndrome with intermittent atrial fibrillation, one patient had aortic valve surgery, whereas in one patient there was no clinical evidence of a heart disease. All patients had salvos of ventricular extrasystoles, ventricular tachycardia or documented intermittent ventricular fibrillation. There have been seven drop-outs up to the present time. In each patient, the lowest antiarrhythmically effective dose was applied, which was generally higher in patients with low ejection fraction. Effective treatment of the ventricular tachycardia was achieved in 55-92% of patients and did not depend on the duration of treatment. In 10 patients in whom amiodarone therapy had to be stopped for various reasons. Sudden cardiac death was slightly more frequent than in the 24 patients treated with amiodarone, though the difference was not significant. In cases with a history of syncope the prognosis was poor, even with amiodarone therapy. Due to side effects, a dosage reduction or discontinuation of amiodarone treatment became necessary in 14 patients. Amiodarone proved to be an effective drug also for the long-term treatment of ventricular tachycardia, and possibly for the prevention of sudden cardiac death. With the exception of blue skin color, there was no accumulation of side effects, even during long-term treatment of several years.
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PMID:[Long-term treatment with amiodarone]. 171 39

Nine patients (eight males) are reported with one or more episodes of circulatory collapse in the absence of overt heart disease or other known causes of arrhythmias; sudden arrhythmic death occurred in one of these patients. Age at first episode ranged from 16 to 41 (mean, 28) years. In seven patients, ventricular fibrillation was documented at the time of resuscitation. One patient had ventricular flutter. In the remaining patient, documentation of the arrhythmia during the collapse was not available. Four patients had frequent early ventricular premature beats, and in three of these patients, they were accompanied by episodes of rapid nonsustained polymorphic ventricular tachycardia. Failure to suppress this ectopic activity by drug therapy seems to be of prognostic significance. Of the three patients showing persistence of frequent early ventricular premature beats, one died suddenly, and two had recurrences of symptomatic arrhythmic episodes. The value of noninvasive and invasive tests in the management of these patients is not clear, with the exception of exercise testing in patients with exercise-related arrhythmias and long-term electrocardiographic monitoring in patients with frequent spontaneous ventricular ectopic activity. Follow-up varied from 21 to 192 (mean, 84) months. One patient died suddenly 21 months after his first collapse. Selection of antiarrhythmic drug therapy was largely empirical. In view of the relative rarity of sudden arrhythmic death in the absence of heart disease and the many uncertainties about its mechanism(s) and management, a worldwide registry of these patients is suggested.
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PMID:Sudden arrhythmic death without overt heart disease. 172 10

The effect of successful catheter ablation of overt accessory pathways on the incidence of atrial fibrillation (AF) was studied in 129 symptomatic patients with (n = 75) or without (n = 54) previous documented AF. Fourteen had had ventricular fibrillation. Factors predictive of recurrence were examined, including electrophysiologic parameters. Atrial vulnerability was defined as induction of sustained AF (greater than 1 minute) using single, then double, atrial extrastimuli at 2 basic pacing cycle lengths. When compared to patients with only reciprocating tachycardia, patients with clinical AF included more men (77 vs 54%, p = 0.008) and were older (35 +/- 12 vs 29 +/- 12 years, p = 0.01). They had a significantly shorter cycle length leading to anterograde accessory pathway block (252 +/- 42 vs 298 +/- 83 ms, p less than 0.001), greater incidences of atrial vulnerability (89 vs 24%, p less than 0.001) and subsequent need for cardioversion (51 vs 15%, p less than 0.001). After discharge, the follow-up period was 35 +/- 12 months (range 18 to 76); 7 patients with previous spontaneous AF (9%) had recurrence at a mean of 10 months after ablation. Age, presence of structural heart disease accessory pathway location, atrial refractory periods and accessory pathway anterograde conduction parameters were not predictive of AF recurrence. Persistence of atrial vulnerability after ablation was the only factor associated with further recurrence of AF. Atrial vulnerability was observed after ablation in only 56% of patients with previous AF versus 89% before ablation. It is concluded that successful catheter ablation of accessory pathways prevents further recurrence of AF in 91% of patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Frequency of recurrent atrial fibrillation after catheter ablation of overt accessory pathways. 173 13

To evaluate the effect of sympathetic activation on the efficacy of the implantable cardioverter-defibrillator (ICD) in converting ventricular tachycardia (VT) or ventricular fibrillation (VF), 32 patients who received an ICD because of life-threatening VT/VF underwent 1 week postimplant ICD testing both before and after infusion of 25 (16 patients) or 50 (16 patients) ng/kg/min of epinephrine for greater than or equal to 12 minutes. These infusion rates are known to result in plasma epinephrine concentrations comparable to mild-moderate stress. The patients' mean age was 63 +/- 10 years; 26 had coronary artery disease, 2 had dilated cardiomyopathy and 4 had no evidence of structural heart disease. VT and VF were induced in 16 patients each by programmed stimulation or alternating current. Among the 16 patients with VT, the first ICD discharge (26 to 30 J) was effective in 15 patients in the baseline state and in all 16 patients during epinephrine infusion. Among patients with VF, the first ICD discharge (26 to 30 J) terminated VF in all patients in the baseline state, compared with 12 of 16 patients during epinephrine infusion (p less than 0.05). In 4 patients, VF was terminated during epinephrine infusion only by the second or third ICD discharge (30 J). In conclusion, physiologic increases in the plasma epinephrine concentration may increase the number and energy of shocks needed to terminate VF.
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PMID:Effect of epinephrine on the efficacy of the internal cardioverter-defibrillator. 173 16

213 patients who received in-hospital cardiopulmonary resuscitation (CPR) were studied over a period of five years (1985-89) to determine hospital and long-term survival. The following factors were evaluated in determining outcome: age, ECG on admission, clinical history, year, month, hour of admission. A 5-year survival table was complied for all discharged from hospital. The results showed that age, clinical history, month and hour of admission were not influencing factors; asystole as opposed to ventricular fibrillation was however associated with significantly higher in-hospital mortality (p less than 0.005). Hospital survival was 14.6% with an ascendant range from 1986 to 1989 (p less than 0.05); all the patients were discharged mentally unimpaired with over 50% surviving 1.5 years after discharge and 33% 5 years after. The study shows that the highest cause of cardiac arrest is ischaemic cardiopathy in male patients with an average age of 60 years. Total neurological recovery after CPR was confirmed to be a determinant predictor factor of survival.
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PMID:[Survival of 213 patients who recovered in resuscitation from cardiac arrest]. 175 74

Sudden death usually affects individuals with severe heart disease. A more dramatic phenomenon is the sudden unexpected death of individuals with no evidence of heart disease. It has been described mainly in young healthy males under severe stress. We present a 32 year old man who presented ventricular fibrillation during sleep and was resuscitated by his wife. Recurrent episodes of VF occurred in the following hours. The study, including coronary angiography, revealed a normal heart. Endomyocardial biopsy showed minimal alterations with scarce areas of atrophy and fibrosis. Electrophysiologic evaluation showed an extremely short refractory period of the right ventricle, but the arrhythmia could not be induced by electrical stimulation. An internal cardioverter defibrillator was implanted since the risk of recurrent VF was high. A review of the literature concerning this unusual entity is offered.
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PMID:[Sudden unexpected nocturnal death: report of a case and review of the literature]. 184 95

Forty patients (36 men and 4 women) with life-threatening arrhythmia received an implantable cardioverter defibrillator (ICD). Mean age was 63 years (range, 46 to 80 years). All patients had structural heart disease, with coronary artery disease in 32 patients, idiopathic cardiomyopathy in 7 patients, and hypertensive heart disease in 1 patient. Mean left ventricular ejection fraction was 29 +/- 13%. The clinical arrhythmia was out-of-hospital cardiac arrest in 14 patients (35%), symptomatic sustained ventricular tachycardia in 21 patients (53%), and episodes of syncope without documented spontaneous ventricular arrhythmia but ventricular tachycardia that was easily provoked at the time of electrophysiologic testing in 5 patients (13%). Sustained ventricular tachycardia was induced in 37 patients (93%) at basic electrophysiologic testing. The average number of drug failures was 2.9 +/- 1.4 per patient. One patient (2.5%) died perioperatively because of intractable ventricular tachycardia and ventricular fibrillation. During a median follow-up period of 5.5 months (range 2-21 months) 2 sudden deaths occurred. No patient had a serious complication during the follow-up period. Ten patients (25%) received antiarrhythmic drugs to suppress spontaneous ventricular tachycardia. Appropriate shock treatment was received by 18 patients (45%), and inappropriate shock treatment was received by 2 patients (5%). Several issues regarding use of the ICD must be considered, but the device seems to be useful, and it is associated with an acceptable rate of complications and good long-term success at the present time.
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PMID:Clinical experience in patients with implantable cardioverter defibrillators. 188 Aug 99

Operative mortality was studied in 939 consecutive patients undergoing initial implantation of an automatic implantable cardioverter-defibrillator (AICD) at 15 hospitals. Twenty-nine (3.1%) patients died during the first 30 days after surgery. Among patients who survived beyond the first 30 postoperative days, ejection fraction data were available in 219; compared with the mortality group, these survivors had a significantly higher ejection fraction (34 +/- 15 vs 26 +/- 10%, respectively, p less than 0.001), despite similar age, sex, underlying heart disease, type of presenting arrhythmia and prevalence of concomitant surgery. The causes of perioperative death were sudden in 7 (24%), tachyarrhythmic/nonsudden in 5 (17%), cardiac nonarrhythmic in 9 (31%), and noncardiac in 8 (28%). Twenty-four (83%) of the deaths occurred before hospital discharge, and in all 9 instances of in-hospital sudden and tachyarrhythmic/nonsudden death, the initial recorded rhythm was sustained ventricular tachycardia or fibrillation; in 5 (56%) of these 9 patients the AICD had been in a deactivated state since implantation. Other possible contributory factors in the 12 sudden or tachyarrhythmic/nonsudden deaths included acute myocardial ischemia or infarction in 2 (17%), and "device proarrhythmia" in 3 (25%) that were AICD-related in 2 and secondary to an antitachycardia pacemaker in another; defibrillation threshold testing was not performed in 3 patients (1 of whom had terminal ventricular fibrillation). Thus, in this multicenter experience with thoracotomy requiring AICD implantation, operative (30-day) mortality was 3.1% and correlated inversely with left ventricular ejection fraction.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Operative mortality with implantation of the automatic cardioverter-defibrillator. 195 Nov 23

Implantable cardioverter defibrillators (ICD's) are effective for reducing mortality in refractory malignant ventricular arrhythmias (MVA). Second generation ICD's (Telectronics Guardian 4202/4203) were implanted in 7 patients (all male, mean age 58.1 years) with ventricular fibrillation (VF) in 2, ventricular tachycardia (VT) in 1, and both VF and VT in 4. Underlying heart disease was coronary artery disease in 4 patients, and valvular heart disease, dilated cardiomyopathy and no obvious cause (documented primary VF, reproducible at electrophysiologic study) in 1 patient each. Mean ejection fraction was 40 +/- 14%. Mean defibrillation threshold of the two epicardial patches at implantation by means of median sternotomy was 18 +/- 9 joule, and patch impedance 35 +/- 7 ohms. Post defibrillation bradypacing via epicardial electrode was programmed in 5 patients (70%). Mean follow-up was 10.1 months (1-25 months). Successful defibrillation of 28 spontaneous VT/VF episodes was noted in 2 patients, while the other 5 have had no further episodes of MVA so far. One device was explanted following tissue necrosis at the battery site after a MVA-recurrence-free interval of 15 months. The reconfirmation algorithm prevented false shock delivery in 2 patients.
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PMID:[Clinical experience with a second-generation cardioverter-defibrillator]. 195 43


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