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

Electrophysiologic features and surgical results were examined in 55 pediatric patients who underwent surgical accessory pathway division for Wolff-Parkinson-White syndrome. There were 31 male and 24 female patients ranging in age from 4 months to 15 years (mean age, 9.8 +/- 4.2 years; 25 patients were less than 10 years old; 4 patients were less than 12 months). Eleven of these patients had associated congenital heart disease and underwent concomitant surgical procedures to treat those conditions. Preoperative effective refractory period of antegrade accessory pathways, the right atrium, atrioventricular node, and cycle length during reentrant tachycardia were shorter in pediatric patients than in adult patients. Antegrade accessory pathways showed right predominance more frequently in the pediatric group than in the adult group. Surgical techniques included an endocardial approach (an epicardial approach was used in 1 patient) and concomitant operation for combined heart disease. The early mortality rate was 3.6%, whereas no late deaths occurred during the follow-up period of 96.8 +/- 54.9 months (maximum follow-up, 205 months). The absolute cure rate was 92%. There were no significant differences in early and late mortality between pediatric and adult patients. Surgical treatment of the Wolff-Parkinson-White syndrome in pediatric patients is as safe and effective as in adults. Considering the potential complications from prolonged fluoroscopic exposure during catheter ablation, surgical division of accessory pathways in children is a promising modality for the treatment of Wolff-Parkinson-White syndrome in selected cases.
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PMID:Surgical treatment of Wolff-Parkinson-White syndrome in infants and children. 803 5

Our purpose was to assess the efficacy and safety of intravenous ATP for the acute termination of paroxysmal supraventricular tachycardia. There were 14 women and 10 men, aged 38 +/- 15 years. Three patients had evidence of structural heart disease (Ebstein's anomaly associated to atrial septal defect, operated mitral stenosis with insertion of a mechanical heart valve and CAD respectively). Twelve patients had Wolff-Parkinson-White syndrome and another had undergone surgical ablation of an accessory pathway. At the time of electrophysiologic testing, ATP was administered during episodes of paroxysmal supraventricular tachycardia, via a central vein, in incremental doses of 5, 10 and 20 mg followed by a flush of 10 c.c. of isotonic saline. The mechanism of the arrhythmia was orthodromic AV reentrant tachycardia in 19 (79%), AV nodal reentrant tachycardia in 4 (16.6%) and atrial tachycardia in one patient. The mean frequency of the tachycardia was 174 +/- 33 b.p.m. A dose of 5 mg was effective in 16 patients (66%), 5 required 10 mg and two required 20 mg for termination of the tachycardia. In the patient with atrial tachycardia ATP was not effective. The average time after injection to termination of the arrhythmia was 16 +/- 8 seconds. Orthodromic AV reentrant tachycardia was interrupted in the AV node limb in all but one patient and AV nodal reentry was terminated in the "slow-pathway" in three of the four patients. Nine patients had premature ventricular complexes, isolated or in couplets, after the termination of the SVT. Three patients had immediate recurrence of the SVT.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Efficacy and safety of adenosine triphosphate in the control of supraventricular paroxysmal tachycardia]. 804 86

From 1986 to 1989, seven children ranging in age from 5 months to 16 years underwent surgical treatment for the Wolff-Parkinson-White syndrome at the Shiga University of Medical Science. None of the patients had any other associated congenital heart disease. There was a right free wall accessory pathway in four patients and a left free wall accessory pathway in three. Surgical ablation of these accessory pathways was performed on eight occasions, using the endocardial approach three times and the epicardial approach five. All the children are alive and none has since had episodes of tachycardia. Only one patient had a recurrent delta wave, which was noted 18 months after the operation. Surgical ablation of the accessory pathway for the Wolff-Parkinson-White syndrome can be performed safely, even in infants and children; it is concluded that this useful procedure is capable of improving a patient's quality of life.
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PMID:Surgical treatment of the Wolff-Parkinson-White syndrome in children. 807 99

Since January 1984, 120 patients (78 male, 42 female; aged 3 to 66 years) with the Wolff-Parkinson-White (WPW) syndrome have been operated upon. The indication for surgery was documented recurrent, paroxysmal tachycardia refractory to medical treatment in 118 cases. Twenty-two patients (18%) had additional heart disease. One hundred and twenty patients had a total of 140 accessory pathways (AP). AP were localized at the left free wall in 63% (87 AP), at the right free wall in 24% (35 AP), and septally in 13% (18 AP). Sixteen patients (13%) had multiple AP (12 patients had two and four patients had three AP), 124 AP were known pre-operatively (88%), 133 were localized intra-operatively (94%) and seven were diagnosed during re-operation (6%). Surgery in 28 patients with left lateral AP was via the epicardial approach and the endocardial approach in 59. Of 15 patients with right lateral AP, the surgical approach was epicardial in two and transmural in 13. A cryosurgery was also used in 117 patients. Fifteen patients suffered recurrences, in 12 of whom repeat surgery was required. One hundred and thirty-six AP (97%) were dissected successfully, of which 14 (10%) were ablated during re-operation. All patients survived the initial operation, but two patients died after re-operation. One patient is pacer-dependent due to persisting postoperative atrioventricular (AV) block. We conclude that surgical dissection of accessory pathways can be offered as an alternative to non-surgical treatment modes, at a low risk and with a high success rate.
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PMID:Surgical treatment of the Wolff-Parkinson-White syndrome--experiences in 120 patients. 822 64

We treated 10 cases of thoracic malignancy accompanied with cardiovascular disease. Among thoracic malignancy, 7 cases were lung cancer and 3 were esophageal cancer. Accompanied cardiovascular diseases were ischemic heart disease (2 cases), valvular disease (3 cases), WPW syndrome (1 case), aortic aneurysm (4 cases). The mean age was 66, ranged from 51 to 79. The simultaneous occurrence of the two lesions were observed in 6 cases and thoracic malignancy was diagnosed after a varying interval of time following surgery of cardiovascular disease in 4 cases. In cases of thoracic malignancy accompanied with heart disease, the treatment of heart disease should precede the operation of malignant disease to reduce the risk of surgery. For the patient with esophageal cancer, posterior mediastinal esophagostomy should be applied who may have heart surgery in future. In cases of coexisting malignancy and aortic aneurysm, the priority of treatment should be determined considering the size of aneurysm. If the transverse diameter of aneurysm is larger than 7 cm, there is a high risk of rupture, so surgery for the aneurysm precedes operation of malignant diseases. It is desirable to avoid concomitant operation of malignancy and cardiovascular disease.
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PMID:[Treatment of thoracic malignancy accompanied with cardiovascular disease]. 823 Sep 1

Congenital heart disease complicates the management of most accessory pathway-mediated tachycardias and also increases the challenge of radiofrequency ablation. Since 1990, radiofrequency ablation of accessory atrioventricular (AV) pathways has been attempted in 10 patients (age range 3.5 months to 30 years) with congenital heart disease: Ebstein's anomaly (n = 5), heterotaxy with AV discordance (n = 3), tetralogy of Fallot (n = 1) and total anomalous pulmonary venous return (n = 1). Eight patients had manifest Wolff-Parkinson-White syndrome and 2 had concealed pathways. Five patients had multiple pathways including 4 of the 5 with Ebstein's anomaly. Of 16 pathways total, 15 were associated with the tricuspid valve including all pathways in the patients with Ebstein's anomaly and heterotaxy. The His bundle area was identified in all patients and involved an anterior AV node in 2 of 3 with heterotaxy. Ablation was performed on the atrial side of the AV ring in all cases. No instance of AV block was encountered. Complete success was achieved in 6 patients including the 3 with heterotaxy. In 2 patients, manifest preexcitation was eliminated and clinical symptoms were greatly modified. The procedure was transiently successful in 1 patient who later had surgical interruption of the accessory pathway during tetralogy of Fallot repair. Ablation was unsuccessful in 1 patient. Thus, the overall success was 80%.
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PMID:Radiofrequency ablation of accessory pathways associated with congenital heart disease including heterotaxy syndrome. 824 46

Cardiotoxicity of interferon-alpha or gamma, such as fatal arrhythmia and myocardial infarction, has been reported. Therefore cardiotoxicity of interferon should be seriously considered before administration for patients with a pre-existing heart disease. We treated a patient with chronic active hepatitis type B, coexisted with Wolff-Parkinson-White syndrome, who has had frequent attacks of paroxysmal atrial fibrillation. To prevent the occurrence of fatal arrhythmia with an interferon therapy in this patient, we performed radiofrequency catheter ablation of the Kent bundle. After the successful ablation, we could safely administered recombinant interferon alpha-2b for chronic hepatitis type B.
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PMID:[Interferon therapy after ablation of Kent bundle for a patient with chronic hepatitis type B complicated with WPW syndrome]. 833 9

To study the age-related differences in Wolff-Parkinson-White syndrome an elderly group of 20 patients aged 40-65 years was compared to a younger group of 26 patients aged 18-39 years with respect to clinical profile and electrophysiological characteristics. The two groups were comparable in terms of the mechanism of reentry tachycardia, accessory pathway location, the number of patients reporting syncopal episodes, and the incidence of inducible and/or documented atrial flutter/fibrillation while only elderly patients had also atrial tachycardias. The elderly group was characterized by a higher incidence of associated organic heart disease and a significantly higher percentage of resuscitation from circulatory arrest. Cardiocirculatory arrest due to arrhythmias was the event leading to transferral to our hospital in 30% of elderly patients compared with 7.7% in the younger group. Analogous results were obtained when stratified according to the age at manifestation of tachyarrhythmias (< 30, > or = 30 years), a history of cardiopulmonary resuscitation being the only significant difference between the two groups. There was no difference in any electrophysiologic parameter between the two age groups or with respect to the age at manifestation of arrhythmias. It is concluded that elderly patients with the Wolf-Parkinson-White syndrome should be managed as aggressively as their younger counterparts. In particular, manifestation of arrhythmias due to Wolff-Parkinson-White syndrome beyond age 30 should not be regarded as a more benign variation of the syndrome. Explanations for the more frequent history of resuscitation in the elderly include the presence of organic heart disease with impairment of left or right ventricular function and differences in the management of these patients.
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PMID:Management of elderly patients with the Wolff-Parkinson-White syndrome: is less aggressive treatment justified? 837 43

Thirteen patients with paroxysmal supraventricular tachycardia (SVT) due to an accessory pathway were submitted to an electrophysiological study and radiofrequency ablation of the Kent bundle. There were 9 males and 4 females. The mean age was 22 years. Other than their SVT, none had any structural heart disease. Ten of them had Wolff-Parkinson-White syndrome, and three had concealed accessory pathways. Two different types of radiofrequency devices were used: one generating damped sinusoid waves, and two other generators producing pure continuous sinusoid waves. With the first type, two attempts were made: one patient with a concealed pathway and one with overt preexcitation. The successful ablation was not achieved because this wave type is 100 times more powerful, it desiccates the tissue, and thus does not produce the right kind of lesion. The other eleven patients were divided in three groups: I) With left overt preexcitation (7 pts) II) Concealed left Kent bundles (2 pts) III) Right Kent bundles. Ablation was 100% successful in group I, while in the other two groups, only one patient of each was successfully ablated. The overall successful rate of these 3 groups was 81.8%. Of the two patients that could not be treated, one had an anterior septal Kent bundle and the other had a concealed left Kent bundle. We believe that catheter ablation is a very promising therapeutic procedure for patients with SVT, besides being a extraordinary instrument that will enable us to be able to understand further clinical electrophysiology.
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PMID:[The radiofrequency ablation of accessory pathways. The initial experience in Mexico]. 846 63

Propafenone is a sodium channel blocking agent with a mild beta- and calcium channel-blocking activity. Several controlled and noncomparative studies have documented its efficacy in a variety of supraventricular arrhythmias in both adults and children. Propafenone is comparable with other Vaughan-William class I antiarrhythmic drugs for acute conversion of atrial fibrillation. It is also comparable with other drugs for prevention of recurrences in paroxysmal atrial fibrillation and for maintenance of sinus rhythm following successful cardioversion of chronic atrial fibrillation. Although propafenone is effective in the acute management of junctional reentrant tachycardias, the availability of safer drugs precludes its routine use for these arrhythmias. It may, however, be preferred for the acute management of haemodynamically well tolerated pre-excited atrial fibrillation in patients with the Wolff-Parkinson-White (WPW) syndrome. It also has documented efficacy in the long term therapy of patients with junctional tachycardias, and is a useful first-line drug in the management of arrhythmias in patients with the WPW syndrome, particularly when there is a short anterograde refractory period of the accessory pathway. Noncomparative studies were confirmed good efficacy and tolerability of propafenone in the short and long term management of paediatric supraventricular arrhythmias. It seems to be particularly effective for the treatment of ectopic atrial and junctional tachycardias, which are generally difficult arrhythmias to manage. Propafenone appears to have an acceptable adverse effect profile during both short and long term therapy. As with most other antiarrhythmic agents, there is a proarrhythmic potential. This has also been observed in children. There is a theoretical possibility that the beta-blocking properties of propafenone may protect against its proarrhythmic potential. However, this has not been confirmed in clinical studies. In conclusion, propafenone appears to be effective in the management of a wide spectrum of supraventricular arrhythmias. It should be considered among the first line drugs for management of these arrhythmias in patients without structural heart disease.
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PMID:Guidelines for the use of propafenone in treating supraventricular arrhythmias. 852 58


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