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

The purpose of this study was to systematically evaluate programmed ventricular stimulation in patients less than 21 years of age undergoing electrophysiologic testing. A standardized protocol was applied in 55 consecutive patients (mean age 14 years) with the following clinical presentations: sustained ventricular tachycardia (VT) (n = 17); ventricular fibrillation (VF) (n = 7); syncope with heart disease (n = 10); nonsustained VT (n = 6); and syncope with an ostensibly normal heart (n = 15). The stimulation protocol consisted of 1 and 2 ventricular extrastimuli during sinus rhythm, followed by 1 to 4 (S2, S3, S4, S5) extrastimuli during pacing at 2 ventricular sites. Of the 17 patients with sustained VT, 12 had induction of the arrhythmia (sensitivity = 71%). Overall, 18 of 55 patients had inducible sustained VT, with this response significantly enhanced by use of S4 or S5 protocols (p = 0.02). Although no syncope patients with an ostensibly normal heart had inducible sustained VT, 7 had polymorphic nonsustained VT in response to ventricular stimulation. The mean number of extra-stimuli preceding the induction of nonsustained or sustained VT or VF did not differ. The induction of VF in 5 cases during this study was preceded in each case by extrastimuli intervals less than or equal to 190 ms. Thus, data indicate that aggressive stimulation protocols appear to be required for induction of sustained VT in most young patients, nonsustained polymorphic VT as a response to aggressive programmed stimulation is of uncertain significance, and that coupling intervals less than or equal to 190 ms may correlate with the induction of VF.
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PMID:Analysis of programmed stimulation methods in the evaluation of ventricular arrhythmias in patients 20 years old and younger. 222 May 80

Survival rates for out-of-hospital cardiac arrest vary widely among locations. We surveyed the definitions used in published studies of out-of-hospital cardiac arrest. Data from 74 studies involving 36 communities showed survival rates ranging from 2% to 44%. There were five different case definitions and 11 different definitions of survivors. The absence of uniform definitions prevents meaningful intersystem comparisons, prohibits explorations of hypotheses about effective interventions, and interferes with the efforts of quality assurance. The most satisfactory numerator for a survival rate appears to be survival to hospital discharge; the most appropriate denominator appears to be witnessed adult cardiac arrest of presumed heart disease etiology, with ventricular fibrillation as the initial identified rhythm. Proposed definitions for the data emergency medical services systems should report as they examine their cardiac arrest survival rates are presented.
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PMID:Survival rates from out-of-hospital cardiac arrest: recommendations for uniform definitions and data to report. 224 Jul 20

Abnormalities in the fast Fourier transforms of signal-averaged electrocardiograms (ECGs) obtained during sinus rhythm appear to distinguish patients with ischemic heart disease and sustained monomorphic ventricular tachycardia from those without ventricular tachycardia. This study was performed to determine the power of frequency analysis to detect patients with a history of ventricular fibrillation, to determine the extent to which spectra of signal-averaged ECGs from patients with ischemic and nonischemic heart disease are comparable and to compare results of signal-averaged ECG analysis in patients with ventricular fibrillation with results of programmed ventricular stimulation. Signal-averaged ECGs were obtained during sinus rhythm from 60 patients with sustained ventricular tachycardia (Group I) and 34 patients with ventricular fibrillation (Group II). Results of signal-averaged ECG analysis were abnormal in 92% of patients with ventricular tachycardia and 85% of patients with ventricular fibrillation (p = NS). Abnormal spectra were detected in the signal-averaged ECGs from 90% of patients with ischemic and from 86% of patients with nonischemic heart disease (p = NS). In contrast, the results of programmed stimulation differed markedly between the two patient groups. Sustained ventricular arrhythmias were induced in 91% of the patients with ventricular tachycardia compared with only 46% of those with ventricular fibrillation (p less than 0.0001). Moreover, ventricular tachycardia was inducible in 81% of patients with ischemic heart disease compared with only 50% of those with nonischemic heart disease (p less than 0.02). Thus, abnormalities in the spectra of signal-averaged ECGs were found in the majority of patients with ventricular fibrillation and were detectable even in those whose arrhythmia was not inducible by programmed stimulation. These results broaden the potential clinical application of noninvasive interrogation of signal-averaged ECGs to include the prospective identification of patients with ischemic or nonischemic heart disease prone to ventricular tachycardia or ventricular fibrillation.
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PMID:Noninvasive detection of patients with ischemic and nonischemic heart disease prone to ventricular fibrillation. 225 50

Map-guided direct surgery was performed in 408 patients with various tachyarrhythmias at our institution. Of 355 patients with WPW syndrome, 5 had experienced an episode of ventricular fibrillation (Vf), 180 had atrial fibrillation with a rapid ventricular response, and 76 had other heart diseases. These patients were regarded as being at risk for sudden death. The shortest R-R interval between pre-excitation (215 +/- 38 msec) was significantly shorter than the antegrade effective refractory period (270 +/- 35 msec) of accessory pathway (ACP) in 126 patients (p less than 0.001). The shortest R-R interval of the patients with Vf was 200 msec or less. The ACP was successfully interrupted in 334 patients (94%). Simultaneous operations were carried out for other types of heart disease in 58 patients. Surgery was performed in 43 patients with ventricular tachycardia (VT), 39 non-ischemic and 4 ischemic, who were unresponsive to conventional antiarrhythmic therapy. Three patients with non-ischemic VT required emergency operation. The principle of surgery for non-ischemic was excision plus cryocoagulation of right ventricle and incision plus cryocoagulation of left ventricle. Thirty non-ischemic patients (76.9%) were cured of VT, while 7 still take medication prophylactically (3 for sporadic premature beats, and 4 for VT). All 4 patients with ischemic VT were also treated successfully. In conclusion, our results demonstrate the therapeutic value of map-guided direct surgery for life-threatening arrhythmias.
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PMID:Surgical management of life-threatening arrhythmias. 227 14

To assess the antiarrhythmic efficacy of oral d,l-sotalol, 68 patients with sustained monomorphic ventricular tachycardia (SMVT) (n = 62) or ventricular fibrillation (VF) (n = 6) were studied by programmed ventricular stimulation (PVS). Fifty-one patients had coronary artery disease with a previous myocardial infarction and there were 17 patients without coronary disease: 11 patients had right and/or left ventricular dysplasia, one patient an aortic-valve replacement, and five patients had no visible heart disease. Prior to sotalol patients were treated with a mean of 3.6 +/- 1.3 antiarrhythmic class I drugs. None of these drugs prevented SMVT or VF. During control PVS (PVS 1), VF was induced in 8 patients (12%), SMVT in 47 patients (69%), and nonsustained ventricular tachycardia (NSVT) in 13 patients (19%). After loading with oral d,l-sotalol (320 mg/day), PVS (PVS 2) was repeated 4.2 +/- 3.3 weeks after PVS 1. In one of the patients (1%) VF was inducible, in 15 patients (22%) SMVT was induced, and in 18 patients (26%) NSVT was induced. In 34 patients (50%) either no or a short ventricular response was inducible. Our data show that oral d,l-sotalol is an effective antiarrhythmic agent in patients with SMVT or VF.
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PMID:Sotalol in patients with life-threatening ventricular tachyarrhythmias. 227 75

Clinical and autopsy records were retrospectively reviewed for 105 patients between the ages of 1 and 39 years who came in to the emergency department with nontraumatic cardiac arrest. There were 65 male (62%) and 40 female patients (38%). Forty-eight percent of the patients were resuscitated. Long-term survival rate was 23%. The most common presenting rhythm was ventricular fibrillation (45%). Cardiac diseases constituted the most common cause of arrest (38%). Atherosclerotic coronary artery disease represented 50% of all cardiac causes. The second most common etiology was overdose or toxic exposure (21%). Witnessed arrest and an etiology of primary cardiac dysrhythmia for arrest were statistically significant factors related to favorable outcome. Asystole as the initial cardiac rhythm was a negative prognostic indicator. Age, sex, race, bystander cardiopulmonary resuscitation, and paramedic response time were not significant prognostic factors for long-term survival.
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PMID:Nontraumatic prehospital cardiac arrest ages 1 to 39 years. 230 89

Previous studies of the value of electrophysiologic studies in patients with nonsustained ventricular tachycardia (VT) have been hampered by the inclusion of a small number of patients with various types of heart disease. This retrospective study was designed to assess the value of programmed stimulation in 205 asymptomatic patients who had had an acute myocardial infarction greater than 1 month before study. Inclusion was based on 24-hour Holter monitoring during which patients had to manifest greater than or equal to 3 consecutive ventricular beats at a rate greater than 135 beats/min. Forty-seven (23%) patients had normal, 70 (34%) mildly impaired and 88 (43%) severely impaired left ventricular function. Programmed stimulation, using up to 3 extrastimuli, was used in each. Seventy-five patients (36%) were noninducible, 59 (29%) had nonsustained VT (less than 30 seconds), 67 (33%) had sustained monomorphic VT and 4 (2%) had either polymorphic VT or ventricular fibrillation. Eighty-two patients were not treated with antiarrhythmic drugs, 57 others were placed on a program selected empirically and 66 had therapy guided by electrophysiologic testing. Satisfactory follow-up information was gathered in 187 of the 205 patients, with a mean follow-up of 18 months. One hundred forty-two patients are alive and well, 39 had sustained VT or sudden death and 6 others had a cardiac death. Only left ventricular function discriminated those who had a sustained arrhythmia or died from those who did not. Thus, programmed stimulation did not have independent predictive value in patients with nonsustained VT. However, definitive conclusions can be reached only with a large prospective study carried out in untreated patients.
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PMID:Value of electrophysiologic testing in patients with previous myocardial infarction and nonsustained ventricular tachycardia. Philadelphia Arrhythmia Group. 199 Aug 3

The sensitivity and specificity of a new protocol of programmed ventricular stimulation were evaluated in 71 consecutive patients who were divided into 2 groups: group 1 included 41 patients, of whom 25 had sustained ventricular tachycardia (VT) not associated with cardiac arrest and 16 had ventricular fibrillation (VF) not precipitated by any obvious factor; group 2 included 30 patients without demonstrable heart disease and no suspected or documented sustained ventricular tachyarrhythmias. The study consisted of a standard protocol (up to 2 extrastimuli given only once for each extrastimulus prematurity, 2 right ventricular sites and 3 basic pacing cycle lengths, as well as rapid ventricular pacing) in which double extrastimulation at the shortest coupling intervals that allowed ventricular capture was repeated 10 times. A stimulus current of 3 mA was used. Sustained ventricular tachyarrhythmias were induced in 23 of 25 (92%) patients who presented with sustained VT, 14 of 16 (88%) patients who presented with VF and 2 of 30 (7%) group 2 patients. Eighteen of 25 (72%) patients with sustained VT but only 4 of 16 (25%) with VF had arrhythmias inducible at "immediate" trials of single or double extrastimulation (p less than 0.01). Repetition of double extrastimulation increased the yield of inducible sustained ventricular tachyarrhythmia to 92% in patients with sustained VT (+20%, p = 0.14) and 75% (+50%, p = 0.013) in patients with VF. Rapid right ventricular pacing added a 13% increase in the overall yield in patients with VF. This new protocol of programmed ventricular stimulation has both high sensitivity (90%) and specificity (93%) for induction of sustained VT.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Programmed ventricular stimulation using up to two extrastimuli and repetition of double extrastimulation for induction of ventricular tachycardia: a new highly sensitive and specific protocol. 230 31

Out-of-hospital ventricular tachyarrhythmia has a high mortality. Most patients sustaining this type of arrhythmia have an organic heart disease. In this case report we present a patient with recurrent ventricular fibrillation with the clinical appearance of syncope, where no relevant organic heart disease could be found at autopsy performed 40 years later.
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PMID:Self-terminating idiopathic ventricular fibrillation presenting as syncope: a 40-year follow-up report. 231 29

The purpose of this study was to investigate, if besides the hypocontractility, which is the main finding in Primary Cardiomyopathy (PDC) there was some other mechanism in the development of heart failure and if this fact could influence in it's prognosis. We studied 13 patients with PDC in the hemodynamic cardiac laboratory from January 1982 to January 1988, these with systemic arterial hypertension. Coronary heart disease, myocarditis, primary valvular lesion, infiltrative disease, nephropathy, congenital heart disease, diabetes and alcoholism, were excluded. The control group was formed by 12 healthy subjects, which were studied for another purpose. We analyzed nine variables, including ejection fraction, peripheral vascular resistance, systolic and diastolic circumferential stress, left ventricular mass, left ventricular end diastolic and systolic volumes as well as force-velocity and force-fiber length relationship. The patients were followed up from 8 to 60 months (average 39 months). The cases with PDC were divided in two groups, "compensated" and "decompensated". The last ones with low ejection fraction and significantly increases systolic stress. We investigated which was the mechanism of compensation and decompensation through the force-velocity and force-fiber length relation. We found that compensation is associated with great increase of the after-load forces, the more end systolic volume at the end of the systole is not only controlled by the "force", but the decompensation is developed when the hypocontractility is added to the incompetence to compensate the after load. We found that the three deaths in this study had these hemodynamic characteristics, being the cause of death: the presence of heart failure in two patients and ventricular fibrillation in one.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Prognostic indexes in primary dilated cardiomyopathy]. 234 26


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