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

Based on the outcomes of surgical treatment in 127 children suffering from tachycardias, three clinical groups were identified: Group 1: an uncomplicated course; Group 2: tachycardias concurrent with congenital heart disease; Group 3: life-threatening tachyarrhythmias. The results of surgical treatment were the following by the groups: Group 1 showed its efficacy in 96.5% and a tachycardial relapse in 3.5%, Group 2 displayed it in 81.0%, deaths in 19.0%, Group 3 exhibited it in 93%, deaths in 7%. In the surgical treatment of the Wolff-Parkinson-White syndrome, the method of choice is epicardial fulguration of the accessory atrioventricular pathway (100% versus 89.4% for the W. Sealy procedure).
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PMID:[Surgical treatment of tachycardia in children]. 208 35

The use of intravenous tetrandrine on paroxysmal supraventricular tachycardia (PSVT) in 32 episodes of 27 cases were studied. The single blind test was done by injecting normal saline as placebo for self-control. Ambulatory ECG was recorded continuously. The dose of tetrandrine ranged from 0.12 to 0.21 g. The success rates of conversion of the placebo and tetrandrine were 3.1% and 83.9% respectively, being statistically significant (P less than 0.001). The efficacy of tetrandrine was comparable to that of verapamil (85%). In 4 cases of WPW syndrome one was converted by the placebo, the other 3 by tetrandrine. Those who did not respond to tetrandrine were mostly suffering from organic heart disease and were supposed to have automatic atrial tachycardia. The time needed for conversion ranged from immediacy after intravenous injection to 20 minutes, with an average of 4.6 minutes. The ECG changes of the termination of PSVT were similar to that of verapamil and can be explained as the effect of slow channel antagonists. Tetrandrine may be an alternative to verapamil in the treatment of PSVT.
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PMID:Intravenous tetrandrine in terminating acute episodes of paroxysmal supraventricular tachycardia. 211 58

These findings permit the following conclusions on cardiac changes induced by high-performance sports and high levels of training. Sinus bradycardia and AV block can frequently be observed in athletes, but they do not require attention as long as they are asymptomatic or do not produce pauses exceeding 4 seconds. Persistent rather than transient second-degree AV block or Mobitz second- or third-degree AV block is an extremely unusual finding even in athletes and should be considered a sign of organic lesions until proved otherwise. Supraventricular and AV node ectopic beats are not more frequent in athletes than in the general population except for atrial fibrillation. WPW syndrome is of particular importance, since rapid conduction to the ventricle via the accessory AV pathway is possible, especially if there is a tendency toward atrial fibrillation. Likewise caution is required in athletes with hypertrophic cardiomyopathy. Here hemodynamic deterioration must be anticipated with the occurrence of supraventricular tachycardia. Simple ventricular arrhythmias occur among athletes with the same frequency as in the general population, but they usually disappear with exercise. The occurrence of complex ventricular forms of arrhythmia should always prompt cardiologic examination in search of underlying cardiac disease, particularly hypertrophic or dilated cardiomyopathy. The presence of ventricular arrhythmias without evidence of underlying heart disease does not indicate a special or increased risk of sudden cardiac death. A higher incidence of right and/or left ventricular hypertrophy, exercise-reversible ST elevation, and exercise-reversible changes in T waves (T negativity, sharp and/or excessive T waves) can be considered physiologic changes in the ECGs of athletes. These changes correlate closely with the type of sports activity and degree of training and are reversible when the activity is stopped. Horizontal ST segment depression are by contrast very rare in athletes and should always be clarified by cardiologic examination. Exercise-induced sudden cardiac death in athletes is unusual without preexisting heart disease. The cause of sudden cardiac death among athletes less than 40 years of age can be predominantely ascribed to congenital heart diseases (such as hypertrophic cardiomyopathy or coronary anomalies). In athletes more than 40 years of age and with increasing age, coronary heart disease is the most frequent autopsy finding. A corresponding risk stratification should take these partial dangers into account.
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PMID:ECG variants and cardiac arrhythmias in athletes: clinical relevance and prognostic importance. 219 78

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

The mode of onset of 103 episodes of atrial fibrillation lasting greater than or equal to 30 s was studied in 79 patients with the Wolff-Parkinson-White syndrome during electrophysiologic study. No patient had organic heart disease, and 31 had clinical atrial fibrillation before study. These 79 patients were then compared with a control group of 53 patients with Wolff-Parkinson-White syndrome in whom atrial fibrillation could not be induced. Ninety-five of the 103 episodes were technically suitable for analysis. Atrial fibrillation invariably began with rapid atrial tachycardia that became progressively disorganized within 10 to 20 cycles. It was initiated during right atrial stimulation (n = 52), right ventricular stimulation (n = 8), reciprocating tachycardia (n = 33) and spontaneously (n = 2). Most episodes started at a high right atrial site regardless of accessory pathway location, with only 19% of episodes starting at the electrode closest to the accessory pathway. During reciprocating tachycardia (n = 33), either atrial (n = 8) or ventricular (n = 5) extrastimuli initiated atrial fibrillation. Atrial fibrillation started at the accessory pathway site in 6 of 20 episodes occurring spontaneously during reciprocating tachycardia. Patients with atrial fibrillation had a longer PA interval (54 +/- 14 versus 42 +/- 12 ms, p less than 0.0001), shorter atrial functional refractory period (226 +/- 38 versus 240 +/- 30 ms, p = 0.049) and shorter anterograde effective refractory period of the accessory pathway (279 +/- 26 versus 304 +/- 75 ms, p = 0.03). Clinical reciprocating tachycardia was documented with equal frequency in both the atrial fibrillation and control groups (59.5% versus 52.9%, p = 0.58).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Mode of onset of atrial fibrillation in the Wolff-Parkinson-White syndrome: how important is the accessory pathway? 231 62

Since January 1984, 87 patients (pts) (57 male, 30 female; age 3 to 64 years) with Wolff-Parkinson-White syndrome were operated upon. The indication for surgical treatment was documented recurrent, paroxysmal tachycardia refractory to medical treatment in 85 cases. Eleven pts (13%) had additional heart disease. 87 pts had a total of 103 accessory pathways (AP). AP was localized at the left free wall in 68% (70 AP), at the right free wall in 16% (16 AP), and localized septally in 17% (17 AP). Thirteen pts (15%) had multiple AP (10 pts had two and three pts had three AP). 87 AP were known preoperatively, 96 were localized intraoperatively, and seven were diagnosed during reoperation. Twenty-seven pts were left lateral AP were operated by the epicardial approach and 37 pts by the endocardial approach. Patients with right lateral AP were approached by an epicardial technique in six cases, and by a transmural technique in five. Cryotechnique was applied additionally in 85 pts. Twelve pts suffered recurrences, 11 were reoperated. 101 AP (98%) were dissected successfully, of which 13 (13%) were ablated during reoperation. All pts survived the initial operation. Two pts died after reoperation. One pt is pacemaker-dependent due to a persisting postoperative AV block. We conclude that surgical dissection of accessory pathways can now be offered as an alternative to the non-surgical treatment modes, with low risk and yielding a high success rate.
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PMID:[Surgical treatment of Wolff-Parkinson-White syndrome--experiences with 87 surgically treated patients]. 231 76

Between September 1980 and June 1984 we assessed the specificity of induction of ventricular tachycardia (VT) with one or two ventricular extrastimuli in a consecutive series of 148 patients undergoing electrophysiological assessment for the Wolff-Parkinson-White (WPW) syndrome by standard electrophysiological techniques. Fifteen patients (10%) had six or more beats of VT induced by one ventricular extrastimulus after a ventricular drive (9 patients), two ventricular extrastimuli during reciprocating tachycardia (6 patients), and during a single atrial extrastimulus (1 patient). None of the six men and nine women, aged 16-61 years, had apparent heart disease. VT lasted for 20 +/- 14 (mean +/- standard deviation) cycles with a cycle length of 235 ms +/- 27 and was generally polymorphic. One patient had ventricular fibrillation. These patients were compared to 15 age- and sex-matched patients studied in the same time period. There was no difference in anterograde effective refractory period of the accessory pathway (316 +/- 92 vs 319 +/- 68 ms), ventricular effective refractory period (218 +/- 12 vs 227 +/- 23), shortest pacing cycle length maintaining 1:1 anterograde conduction over the accessory pathway (306 +/- 132 vs 320 +/- 67) or minimum R-R interval between preexcited beats during atrial fibrillation (280 +/- 68 vs 294 +/- 105). All patients are alive and well over a follow-up interval of 20 +/- 11 months on no antiarrhythmic therapy (13 patients) or on propranolol (2 patients).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Nonclinical ventricular tachycardia in the Wolff-Parkinson-White syndrome. 241 49

Clinical data of patients with cardiac arrhythmias managed between May 1986 and March 1988 were reviewed to determine their mode of presentation and clinical course. Of the 5,768 admissions, 62 (1.07%) patients had arrhythmias. During the same period, 21 patients were managed as outpatients with 13 being new referrals. Thirty-eight patients had undergone corrective cardiac procedures, 8 others had congenital heart lesions, 3 were associated with acquired cardiac pathology and the remaining had isolated arrhythmias. The cardiac arrhythmias were: right bundle branch block 36, premature atrial and ventricular contractions 15, supraventricular tachycardia (SVT) 15, atrioventricular (AV) block 7, sinus bradycardia 3, atrial fibrillation 2, ventricular tachycardia and fibrillation 2, Wolff-Parkinson-White syndrome without SVT 2, bradytachyarrhythmia 1. There were 3 patients with foetal SVT, one persisting till day 1. High grade AV block occurred in 2 patients post-surgically and needed pacing. Only 2 others were symptomatic. Other than the 38 patients who underwent corrective procedures (2 had balloon valvuloplasty for pulmonary stenosis), 8 others had structural heart disease. There was 1 sudden death and 5 died from their primary heart disease.
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PMID:Cardiac arrhythmias in paediatric practice. 247 68

Among 226,464 ambulatory subjects who underwent medical check-ups over a 15-year period, 270 were found to have Wolff-Parkinson-White syndrome (1.2 case in 1,000). The syndrome was more frequent in men (181 cases, 1.4 p. 1,000) than in women (89 cases, 0.9 p. 1,000). 222 subjects were aged from 20 to 49 years (1.4 p. 1,000) and only 48 were between 50 and 80 years of age (0.7 p. 1,000). 197 subjects were re-evaluated: 119 (60.4 p. 100) complained of palpitations and 78 (39.6 p. 100) were asymptomatic. Palpitations began at all ages, even after 50 years, and usually proceeded in short attacks lasting a few seconds or minutes, with a mean recurrence rate of 5 attacks per annum (76.4 p. 100). This constant pattern sometimes was interrupted for months or years. Conversely, in a minority of cases (23.5 p. 100) an unexpected accentuation occurred which lasted for hours or days. As years went by, palpitations tented to decrease and disappear. The pre-excitation area and its degree of fusion with the normal ventricular activation had no influence on the origin and frequency of palpitations. In contrast, sustained tachycardia seemed to be more frequent in cases with lateral and posterior left pre-excitation. Among 270 subjects with pre-excitation syndrome, 7 died including 4 whose death was not due to a cardiac disease, 2 who died suddenly and 1 who succumbed to ventricular tachycardia after a road accident. None of these patients had an associated heart disease. These last 3 cases might contribute to alter the usually favourable prognosis of Wolff-Parkinson-White syndrome.
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PMID:[The natural history of 270 cases of Wolff-Parkinson-White syndrome in a survey of the general population]. 250 88

The purpose of this presentation is to report the first endocardial catheter ablation in Mexico of a right posteroseptal accessory pathway. The patient, without structural heart disease, had a Wolff Parkinson White syndrome with recurrent episodes of paroxysmal supraventricular tachycardia and atrial fibrillation with a fast ventricular response, through the accessory pathway (Shorter RR interval less than or equal to 190 msec). Previous antiarrhythmic drug therapy had failed to control the tachyarrhythmias. An electrophysiologic study was performed and the right posterior septal accessory pathway was localized by direct mapping of the auriculoventricular junction. Two sessions of electrofulguration with energy shocks ranging from 200 to 250 joules were delivered. There were no complications during the two procedures. Three months afterwards the patient is asymptomatic without tachyarrhythmic episodes, and no drug therapy is necessary. The fulguration prolonged the anterograde accessory pathway conduction. Therefore, the risk of sudden cardiac death due ventricular fibrillation has been reduced.
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PMID:[Electrofulguration of a pre-excitation zone by the bundle of Kent]. 260 86


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