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

Of 110 patients without organic heart disease undergoing electrophysiological evaluation, 72 patients (65%) manifested some form of repetitive ventricular response to ventricular stimulation. In 58 (53%) bundle branch re-entry was induced and in 19 patients (17%) intraventricular re-entry. In five patients (4%) both types of repetitive responses were initiated. The indication for study was documented as ventricular tachycardia or fibrillation in 13% of the patients, supraventricular tachycardia in 51% and Wolff-Parkinson-White syndrome, syncope or conduction disturbances in the remaining patients. The incidence of clinical and inducible ventricular tachycardia or fibrillation was 8 and 2% respectively, in the group of patients manifesting only bundle branch re-entry, 37 and 32% in patients with intraventricular re-entry and 8 and 11% in patients without repetitive ventricular responses during ventricular stimulation. The predictive value of intraventricular re-entry as an indicator of severe ventricular arrhythmias was 36%. We conclude that in our population of patients without organic heart disease, bundle branch re-entry is a frequent finding and is not related to ventricular arrhythmias, that intraventricular re-entry is less frequent and although it is associated with a higher incidence of ventricular tachycardia or fibrillation, it is a poor predictor of these arrhythmias in this study population.
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PMID:Repetitive responses to ventricular extrastimuli: incidence and significance in patients without organic heart disease. 685 71

Fifty-four spontaneous episodes of paroxysmal supraventricular tachycardia (PSVT) in 23 patients, varying in age from one day to fourteen years, were treated with intravenous verapamil according to a specific protocol. Stable sinus rhythm was obtained promptly with no side effects in 76% of episodes. There was no response in 9%; an unstable rhythm in 7.5%; and severe side effects (hypotension, sinus bradycardia and cardio-respiratory arrest) in 7.5%. All severe side effects were associated with larger than recommended doses of verapamil. Intravenous verapamil reverted 100% of all episodes of idiopathic PSVT in eight patients; 83% of episodes in five patients with congenital heart disease; and only 57% of episodes in nine patients with Wolff-Parkinson-White syndrome. It was ineffective in one neonate who had had intra-uterine SVT.
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PMID:Intravenous verapamil in the treatment of paroxysmal supraventricular tachycardia in children. 687 Jul

The findings in a 22-year-old man with Ebstein's anomaly of the tricuspid valve, Wolff-Parkinson-White syndrome, and a persistent left superior vena cava are reported. This is the first reported case of this combination of anomalies in which the atrial septum was intact and the left superior vena cava communicated with the left atrium. Uniquely, blood was shunted left to right via the left superior vena cava from the left atrium. Only one previous case of left-to-right shunting via a left superior vena cava (in the absence of mitral valvular disease or cor triatriatum) has been reported (associated with aortic coarctation). Angiograms demonstrated the left atrial connection of the left superior vena cava to be at the entrance of the right superior pulmonary vein into the left atrium. In the absence of demonstrable left-sided heart disease, this anatomic juxtaposition is suggested as a possible explanation for the direction of shunting.
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PMID:Left-to-right shunt via left superior vena cava communication with left atrium. 722 60

We reviewed the records of 217 children whose first episode of supraventricular tachycardia occurred before 18 years (median age 24 months). There were 112 males and 105 females. Of the 49 with congenital heart disease, SVT began before any operation in 26 and greater than 2 weeks postoperatively in 23. Wolf-Parkinson-White syndrome was present on surface ECG in 47/217 (22%). Congestive heart failure accompanied the first episode of SVT in 38% of the patients who were 4 months of age or younger, and in only 19% of those over 4 months (P less than 0.001). Treatment was successful in stopping SVT within 48 hours in 90/142 (63%). Successful short-term treatment included digoxin 57/184 (68%), cardioversion 12/20 (60%), vagal maneuvers 12/19 (63%), phenylephrine 3/9, and overdrive pacing 4/5. SVT recurred at least once in 83% of all patients. On follow-up (mean 4.6 years), episodes of SVT were still present in 56%. Three patients died--two from incessant SVT and one from a CVA after VSD repair. We conclude that long-term status was difficult to predict, but SVT was present in fewer patients whose age at onset was less than 4 months and in those with unoperated CHD. Early recurrence was not a poor prognostic sign. We recommended treatment for at least one year in all patients with SVT, whether or not the first episode terminates spontaneously.
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PMID:Supraventricular tachycardia in children: clinical features, response to treatment, and long-term follow-up in 217 patients. 722 88

This is a report of a 10-year-old child who underwent surgery for complex congenital heart disease consisting of corrected transposition of the great vessels, ventricular septal defect, patent ductus arterisus, severe left-sided atrioventricular (AV) valve insuffieicney (Ebstein's deformity) and Wolff-Parkinson-White syndrome. The site of his accessory AV connection was localized preoperatively at a left anterolateral site by isopotential body surface maps and by intracardiac electrophysiologic studies. He successfully underwent surgery for closure of the ventricular septal defect, ligation of the patent ductus arteriosus, replacement of the left-sided AV valve, and interruption of the accessory AV pathway. Unavoidable complete AV block acquired at surgery required subsequent permanent pacemaker therapy.
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PMID:Corrected transposition with severe intracardiac deformities with Wolff-Parkinson-White syndrome in a child. Electrophysiologic investigation and surgical correction. 737 Nov 40

Flecainide is a class IC antiarrhythmic agent with a controversial role in the treatment of ventricular arrhythmias following myocardial infarction after the publication of the Cardiac Arrhythmia Suppression Trial (CAST). To assess its utility in paroxysmal supraventricular tachycardia (PSVT), we evaluated the electrophysiologic effects and therapeutic efficacy of intravenous flecainide, administered in a dose of 2 mg per kg body weight in 26 patients of PSVT, studied by programmed electrical stimulation. The patients' age ranged from 18-49 years (mean: 27 +/- 8) and none had organic heart disease. The mechanism of PSVT was atrioventricular nodal reentry (AVNRT) with anterograde conduction through slow pathway and retrograde through fast pathway in 14, and atrioventricular reentry (AVRT) utilizing an accessory pathway in 12 patients. Flecainide was successful in terminating the tachycardia in all (100%) patients of AVNRT and 11 (92%) patients with AVRT. In both the types, the tachycardia was terminated by selective block in conduction through the retrograde limb of the reentry circuit. The drug also produced a complete anterograde block with abolition of preexcitation in 6 out of 8 patients with WPW syndrome. After the drug, the tachycardia was reinducible in one patient of AVNRT and 4 with AVRT. The cycle length of inducible tachycardia increased from 295 +/- 25 ms to 389 +/- 24.5 ms after flecainide (p < 0.001). There were no adverse haemodynamic effects of the drug. Our results, thus, showed that intravenous flecainide is a highly effective and safe antiarrhythmic drug for termination of PSVT mediated by atrioventricular nodal and atrioventricular reentry mechanisms without producing any adverse effects.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Electrophysiologic effects and therapeutic efficacy of intravenous flecainide for termination of paroxysmal supraventricular tachycardia. 755 90

The use of intravenous amiodarone was assessed during 23 episodes of paroxysmal supraventricular tachycardia in 15 children aged 9 days to 11 years. Five of the fifteen patients had congenital structural heart disease, and three had Wolf-Parkinson-White syndrome. Tachyarrhythmias were returned to sinus rhythm during 20 of the 23 episodes (87%). No major adverse effects occurred. Recurrence of tachycardia was not observed during short-term follow-up. In conclusion, intravenous amiodarone is an effective, safe antiarrhythmic drug for short-term treatment of supraventricular tachycardia in children.
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PMID:Efficacy and safety of intravenous amiodarone for short-term treatment of paroxysmal supraventricular tachycardia in children. 775 95

Radiofrequency (RF) catheter ablation has revolutionized the treatment of supraventricular tachycardia, particularly those caused by atrioventricular nodal reentry and Wolff-Parkinson-White syndrome. Recently, RF catheter ablation has also been used to treat atrial flutter (AFL), focal automatic atrial tachycardia, and intra-atrial reentrant tachycardia. Typical AFL is caused by reentry in the right atrium, with an area of slow conduction in the isthmus between the inferior vena cava and tricuspid valve annulus. Ablation of exit sites from the isthmus near the coronary sinus ostium, or the isthmus itself, may cure AFL in the majority of patients. Intra-atrial reentrant tachycardia also has an area of slow conduction where application of RF energy is curative in most patients. In this arrhythmia, which is particularly common after congenital heart disease surgery, the reentrant circuit may occur in the right or left atrium. Focal automatic atrial tachycardia is probably caused by abnormal automaticity and, although it may arise from the right or left atrium, is easily ablated in most patients. Thus, RF catheter ablation is a highly effective alternative to pharmacologic therapy for treating atrial tachycardia, and it is likely to be increasingly used as curative therapy in the future.
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PMID:Catheter ablation for the treatment of atrial tachycardia. 783 67

Radiofrequency catheter ablation techniques have enjoyed successful applications in patients with a wide variety of supraventricular tachycardias, especially the Wolff-Parkinson-White syndrome and atrioventricular nodal reentry. More recent reports have shown successful applications in patients with atrial tachycardias and atrial flutter. In addition to these, there are now reports of success during attempts to use radiofrequency techniques to eliminate ventricular tachycardia (VT), both in patients without structural heart disease (idiopathic VT) and patients with structural heart disease (primarily coronary artery disease). Techniques to map sites for ablation in patients with idiopathic VT usually include identifying early endocardial activation and using pace mapping. Success rates for ablation of idiopathic VT have been very high (over 90%) in patients with VT arising from the right ventricular outflow tract. Success rates have not been quite as high when VTs arising from sites other than the right ventricular outflow tract are targeted in the patient with idiopathic VT. In patients with VT caused by coronary artery disease, early endocardial activation and pace mapping can be unreliable. In these patients, searching for mid-diastolic potentials or showing concealed entrainment have proved more reliable. When these latter techniques are applied, success rates in eliminating a single focus of VT in a patient with coronary artery disease has been reported to be as high as 60% to 80%. Future therapies will include new energy sources, new (larger and/or cooled) electrodes, and multipoint catheter mapping, possibly using body surface mapping techniques.
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PMID:Ablative therapy for ventricular arrhythmias. 783 68

Although advances in diagnosis and therapy of congenital heart disease have received most of the attention, in the past few years advances in the more common troublesome problems of adolescents with syncope and palpitations have been as dramatic. Syncope may be due to a cardiac arrhythmia, but is more commonly due to an autonomic dysfunction of blood pressure control. In cases where the diagnosis is equivocal by history alone, autonomic testing, including head-up tilt table testing, may be useful. Treatment with a salt-enriched diet and a mineralocorticoid is usually effective in reducing or eliminating the incidence of syncope. In resistant cases beta-blockade, scopolamine, disopyramide, theophylline, or fluoxetine may be helpful. Palpitations are usually benign. When they are due to a supraventricular tachycardia, especially when associated with the Wolff-Parkinson-White syndrome, they may be annoying and, in those with a short refractory period, dangerous. Radiofrequency ablation of the abnormal pathway is being increasingly used to eliminate the arrhythmia and may be superior to a lifetime of pharmacologic suppression in symptomatic individuals.
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PMID:Advances in the diagnosis and therapy of syncope and palpitations in children. 795 55


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