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

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

The diagnostic approach to cardiac arrhythmias should be logical and starts with the clinical history, which provides two types of information: (a) the presence of symptoms, and (b) the clinical context, including the presence of an underlying heart disease. Clinical history and examination are helpful in the choice of pertinent invasive or noninvasive tests. The tolerance of the arrhythmia is not helpful in determining the type of arrhythmia because ventricular tachycardia, for example, may be well tolerated or even asymptomatic. The electrocardiogram (ECG) in sinus rhythm may be suggestive of the origin or etiology of arrhythmia as the presence, for example, of the Wolff-Parkinson-White pattern. An essential step in the diagnostic approach to arrhythmia is the ECG documentation. Ambulatory Holter monitoring, radiotelemetry, intermittent recorders, exercise testing, and electrophysiological testing will help in this endeavor. The latter is particularly useful in paroxysmal circus movement tachycardias. Once the tachycardia is recorded, a number of clues, including the regularity of the RR interval and the width of the QRS complex, may facilitate the diagnosis. In tachycardias with wide QRS complexes, preexcitation has to be excluded. The first step is then to look for atrioventricular dissociation, which is diagnostic of ventricular tachycardia. Other diagnostic clues (QRS duration, axis deviation, QRS morphology) may be useful. In case of difficulty because of preexisting bundle branch block or aberrancy, esophageal, right atrial, or His bundle recordings are indicated. If the tachycardia is not well tolerated, prompt termination with electrical DC shock should be performed.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Diagnostic approach to cardiac arrhythmias. 172 14

Since the first successful surgical intervention for Wolff-Parkinson-White syndrome by W. C. Sealy, a surgical electrophysiological intervention has been developed for every single supraventricular arrhythmia. The surgical rationale is based on the site of the mechanism of the arrhythmia and associated pathology which characterizes the "arrhythmogenic substrate". Wolff-Parkinson-White syndrome is a congenital heart disease characterized by an accessory atrioventricular connection distinct from the AV node-His bundle system. It is associated with AV reentrant tachycardia and/or atrial fibrillation with fast ventricular responses via the accessory pathway. The current surgical management is ablation of the accessory pathway using either an endocardial dissection or epicardial approach. Surgical ablation is associated with high efficacy and low morbidity. Epicardial dissection of the accessory pathway on the beating heart has helped to localize variant accessory pathways associated with Coumel's tachycardia or Mahaim's fiber electrophysiological entity. AV nodal reentrant tachycardia can be cured using direct AV nodal dissection (or perinodal cryoablation). Atrial flutter can be interrupted by cryoablation of the arrhythmogenic substrate located in the coronary sinus orifice of the region modifying atrial inputs. Chronotropic atrial function abolished by chronic or paroxysmal idiopathic atrial fibrillation can be restored using the corridor operation (sinus node-AV node insulation). Surgery is an alternative in patients with resistant atrial tachycardias. Currently surgery is indicated only after other non-invasive EP interventions have been either attempted or rejected.
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PMID:Surgery for supraventricular tachyarrhythmias. 176 6

Two cases of paroxysmal supraventricular tachycardia in children are reported. Associated congenital heart disease were excluded by color-doppler echocardiogram. Electrocardiogram, holter monitoring and transesophageal study (in one case) suggested associated Wolf-Parkinson-White syndrome. The former case was successfully treated with digitalis, the latter, diagnosed "at risk" by transesophageal recording, was long term treated with propafenone. Clinical evaluation at follow-up confirmed the efficacy of the therapy.
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PMID:[Paroxysmal tachycardia in children: analysis of two clinical cases]. 178 16

We have reviewed the records of 65 children with paroxysmal supraventricular tachycardia (PST) without congenital heart disease followed a mean of 4 years, with a total of 121 episodes. PST appeared before 6 months of age in 42 (64.6%) children. Thirteen patients (20%) had a present factor which might predispose to PST in 66.2% of the patients who were younger than 6 months of age, and in only 4.3% of those over 6 months. Wolff-Parkinson-White syndrome was present on surface ECG during sinus rhythm in 26.1% of children younger than 6 months, and in 39.1% of those over 6 months. Digoxin was the initial treatment in 84.3% of the episodes with a success rate of 75% when were employed alone and of 84.2% when were employed in combination of quinidine. PST recurred at least once in 35 children (53.8%), the 90% within three months of the first episode. All patients were alive and 63 (96.9%) doing well. One patient developed cerebral anoxia and now has hemiparesia and another patient has incessant PST. We conclude that children with PST without congenital heart disease and without delay in diagnosis had a good outcome.
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PMID:[Supraventricular paroxysmal tachycardia without congenital heart disease: clinical, therapeutic aspects and course in 65 children]. 179 89

Paroxysmal supraventricular reciprocating tachycardias (PSRT) which are due to a different type of reentry including the atrioventricular reentry circuit of Wolff-Parkinson-White (WPW) syndrome, may disturb the professional career of an athlete. Moreover even severe episodes of preexcited atrial fibrillation of WPW may occur. PSRT in athletes may present various clinical consequences: unimportant symptoms, or severe hemodynamic effects on the athletic performance particularly during sports activity at intrinsic high risk. The athletes are evaluated by clinical protocol which includes Holter monitoring ergometric test, echocardiography study, thyroid check and transesophageal electrophysiologic study at rest and during exercise. The arrhythmological study should be carefully performed in order to exclude an underlying heart disease, to study electrophysiological mechanisms and possible hemodynamic effect sports activity relate of the inducible and clinical tachyarrhythmias. Sometimes, these PSRT may disappear after interruption of athletic activity because of modifications of electrophysiological conditions related to the sports activity.
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PMID:[Supraventricular reentry tachycardia and athletic fitness]. 181 65

Fetal echocardiographic examination was performed on 945 pregnant women (normal pregnancy: 291, high risk pregnancy: 654) since 1980. Of these, 39 fetuses (4.1%) were diagnosed as having cardiac arrhythmia. Fifteen fetuses had bradycardia, 7 tachycardia and 17 had an ectopic beat. These had been followed from 1 day to 8 years (mean 1 year and 6 months) soon after birth. Of the 15 cases with bradycardia (complete AV block; 8, 2:1 AV block; 3 and sinus bradycardia; 4), four resulted in an intrauterine fetal death, one was terminated and 5 died soon after birth. The remaining 5 cases are alive and 3 of these 5 have received an implanted pacemaker. Of these 15 cases with bradycardia 7 were associated with congenital heart disease, 6 of which died. Seven cases had tachycardia (supraventricular tachycardia: 3 and atrial flutter with 2:1 AV block: 3). Transplacental antiarrhythmic drug (digoxin and/or verapamil) administration was instituted in 5 cases and a conversion of the arrhythmia was achieved in 4. Paroxysmal tachycardia still remained after delivery in the other 3 cases. Two cases with supraventricular tachycardia (one of them with WPW syndrome type B) were resolved. One case has had persistent chaotic atrial rhythm for 7 years after birth. Of the 17 with an ectopic beat, 11 cases were diagnosed to have a supraventricular ectopic beat and 6 cases with a ventricular ectopic beat. A remaining arrhythmia was observed in 10 cases after delivery but all of these were resolved within 3 months after birth. Fetal tachycardia had relatively favorable prognosis because usually the intrauterine treatment was effective. However, fetal bradycardia had poor prognosis and further investigations to establish more effective treatments are essential.
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PMID:Fetal arrhythmias; intrauterine diagnosis and treatment. 184 Nov 76

From July 1986 to January 1991, 123 patients with Wolff-Parkinson-White syndrome underwent operation for ablation of aberrant conduction pathways. There were 85 male and 38 female patients ranging in age from 11 months to 68 years. Associated anomalies included Ebstein's anomaly, sudden death syndrome, coronary artery disease, cardiomyopathy, abdominal aortic aneurysm, neurofibromatosis, other arrhythmias, or other complex congenital heart disease. Forty-one patients had multiple accessory pathways. Operative results showed a 7% initial failure rate, which dropped to 3% after reoperation. One patient had undergone previous operation for Wolff-Parkinson-White syndrome at another institution. Procedures performed concomitantly included mitral or tricuspid valve repair or replacement (6), right ventricular conduit replacement, subaortic resection, Fontan repair, corrected transposition repair, coronary artery bypass, and placement of an automatic internal cardioverter defibrillator. There was no operative mortality. Late follow-up is 27 +/- 16 months, and complications included mitral regurgitation and myocardial infarction. By comparison, in the last 12 months 124 patients with the Wolff-Parkinson-White syndrome underwent catheter ablation using radiofrequency current. There were 9 patients with multiple pathways. One hundred twelve patients (90%) had all accessory atrioventricular connections ablated and have remained free of symptomatic tachycardia. There have been 12 failures (10%), of which 5 have had operation and 7 are being treated medically. Mean follow-up is 7 +/- 5 months, and complications included circumflex coronary artery occlusion, excessive bleeding, valve perforation, and cerebral vascular accident.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Current treatment for Wolff-Parkinson-White syndrome: results and surgical implications. 189 33

The ventricular rate and percent of pre-excited QRS complexes during atrial fibrillation were compared in two groups of patients with the Wolff-Parkinson-White syndrome. Group A consisted of 22 patients whose anterograde effective refractory period of the accessory pathway was longer than that of the atrioventricular (AV) node. Group B consisted of 23 patients in whom this relation was reversed. No patient had organic heart disease. Both groups had a similar effective refractory period of the accessory pathway (288 +/- 37 vs. 280 +/- 26 ms), whereas that of the AV node was shorter in group A than group B (242 +/- 25 vs. 285 +/- 27 ms, p = 0.0001). Patients in group A had a lower percent of pre-excited QRS complexes during atrial fibrillation (39 +/- 43% vs. 93 +/- 20%, p = 0.0001). In the 21 patients whose refractory period was measured, the difference was plotted against the percent of pre-excited QRS complexes; there was a significant correlation between the two (r = -0.83, p less than 0.001). In patients in whom pre-excited RR intervals were present, the pre-excited RR intervals were compared between the two groups. Both groups had similar effective refractory periods of the accessory pathway (265 +/- 22 vs. 280 +/- 27 ms) and ventricle (200 +/- 17 vs. 211 +/- 26 ms). The effective refractory period of the AV node was shorter in group A (248 +/- 22 vs. 285 +/- 28 ms, p = 0.0005). The shortest pre-excited RR interval did not show any difference (244 +/- 37 vs. 265 +/- 41 ms). However, both the average (328 +/- 39 vs. 397 +/- 56 ms, p = 0.001) and longest (495 +/- 109 vs. 666 +/- 205 ms, p = 0.02) pre-excited RR intervals were shorter in group A.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pre-excited RR intervals during atrial fibrillation in the Wolff-Parkinson-White syndrome: influence of the atrioventricular node refractory period. 196 Mar 20

Ventricular fibrillation (VF) is a well-known but rare complication of the Wolff-Parkinson-White syndrome (WPW). Clinical and electrophysiological data of 23 patients with spontaneous VF were compared with data from 100 consecutive patients with WPW without VF but with symptomatic supraventricular tachycardia. The 23 patients were collected in a multicentre retrospective study in seven European centres. VF occurred in only one patient who was receiving antiarrhythmic drugs, and was the first manifestation of the syndrome in six. No significant differences were found between those with VF and without VF in age, complaints of palpitations, syncope, and presence of structural heart disease. The retrograde effective refractory period of the accessory pathway, the atrial refractory period and the fastest atrial pacing rate with 1:1 anterograde conduction over the accessory pathway were similar in both groups. Significant differences were found for sex, permanent pre-excitation on the electrocardiogram, type of documented supraventricular tachyarrhythmias, shortest RR interval less than or equal to 220 ms during spontaneous atrial fibrillation (AF), inducibility of supraventricular tachycardias, ventricular effective refractory period less than or equal to 190 ms, mean shortest RR interval during induced AF less than or equal to 180 ms and presence of multiple accessory pathways.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Ventricular fibrillation in the Wolff-Parkinson-White syndrome. 204 47


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