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

Catheter ablation of an accessory atrioventricular connection using 500-kHz radiofrequency current was attempted in 10 children and adolescents aged between 6 and 15 years (mean 10.5 years). Six children had the Wolff-Parkinson-White syndrome and four had tachyarrhythmias related to a retrograde-only conducting ("concealed") accessory connection. No child had associated structural heart disease. Symptoms ranged from disabling palpitations to episodes of syncope (three patients) and cardiac arrest (one patient). Ablation was attempted from the left ventricle in all children; in one child, ablation of a second, right-sided pathway was attempted via a right atrial approach. Ten of the 11 accessory connections were interrupted successfully. A single complication was encountered in a 10-year-old girl in whom the procedure had to be terminated because a thrombotic occlusion of the right internal iliac artery had evolved. A simplification of the ablation procedure associated with reduced procedure duration and radiation exposure time was achieved in three children with the Wolff-Parkinson-White syndrome and a left free-wall accessory pathway when a single catheter placed in the left ventricle was used for pathway localization as well as ablation. It is concluded that catheter ablation using radiofrequency current is effective and safe and may supersede surgery as the curative treatment for children with serious symptoms mediated by an accessory atrioventricular connection.
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PMID:Radiofrequency current for catheter ablation of accessory atrioventricular connections in children and adolescents. Emphasis on the single-catheter technique. 157 6

Electrophysiologic study provides valuable information in the management of patients with known or suspected ventricular tachyarrhythmias. It should be used when there is uncertainty about the origin of a wide QRS tachycardia. It is useful in evaluating heart disease patients with unexplained syncope and in stratifying prognosis and guiding therapy in patients with malignant ventricular arrhythmias. All patients being considered for treatment of ventricular tachyarrhythmias with an electrical device should undergo thorough electrophysiologic study. Electrophysiologic study is also indispensable in guiding ablative therapy in patients with drug-refractory malignant ventricular arrhythmias.
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PMID:Indications for electrophysiologic study in patients with ventricular arrhythmias. 158 18

To examine the role of coronary artery spasm in patients with syncope after alcohol ingestion, we performed an intracoronary ergonovine provocation test in 7 male patients (39 to 73 years old, mean 54 years) with alcohol-related syncope which remained unexplained despite noninvasive cardiovascular and neurological examinations. No patients had structural heart disease or significant coronary artery stenosis. Ergonovine was continuously infused into each coronary artery at a rate of 10 micrograms/min for up to 5 min. Coronary artery spasm with ST-segment elevation was induced in 4 of 7 patients. Chest pain before syncope or history of chest pain were not present in 3 of 4 patients with a positive ergonovine test. Multivessel coronary artery spasm was induced in 3 patients. One patient presented with triple vessel coronary artery spasm progressing to near syncope as a result of profound hypotension and ventricular tachycardia during provocation. Coronary artery spasm was promptly relieved by intracoronary isosorbide dinitrate infusion. All patients with a positive ergonovine test were treated with calcium antagonist and did not experience syncope during follow-up. These results suggest that coronary artery spasm is one of the important causes of syncope after alcohol ingestion.
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PMID:Importance of coronary artery spasm in alcohol-related unexplained syncope. 159 45

It has been previously demonstrated that radiofrequency (RF) energy can be safely applied to successfully eliminate accessory pathways in patients with the Wolff-Parkinson-White syndrome. This technique may also be used to successfully eliminate atrioventricular (AV) nodal reentrant tachycardia by elimination of either the fast or slow AV nodal pathways. However, RF energy has achieved only limited success in eliminating ventricular tachycardia (VT) in patients with structural heart disease, such as coronary artery disease and dilated cardiomyopathy. Direct-current catheter techniques have successfully eliminated VT in patients with and without structural heart disease, but this technique is limited by the risk of barotrauma and proarrhythmia. We used RF catheter ablation techniques to eliminate VT in patients without structural heart disease. Our results from the basis of this report. 16 patients (nine women and seven men; mean age 38; range 18 to 55 years) who did not have any identifiable structural heart disease by echocardiography where included in this study. These patients underwent RF catheter ablation to eliminate VT. Two patients had presented with syncope, nine with presyncope and five with palpitations only. The mean duration of symptoms was 6.7 years (range 0.5 to 20 years). VT was successfully eliminated by RF catheter techniques in 15 of the 16 patients (a 94% success rate). Importantly, successful ablation sites included regions other than the right ventricular outflow tract. Areas of VT origin therefore included the high right ventricular outflow tract (twelve patients), right ventricular septum near the tricuspid valve (three patients), and the left ventricular septum (one patient). The only ablation failure was in a patient whose VT arose from a region near the His bundle. Successful ablation occurred in patients in whom an accurate pace map could be obtained and early local endocardial activation was obtainable. Further, firm catheter contact with endocardium was required for successful elimination of VT. RF ablation did not cause any identifiable arrhythmia and produced a minimal cardiac enzyme rise. It also resulted in no detectable change in cardiac function by Doppler echocardiography. Based on these findings, we conclude that RF catheter ablation of VT in patients without structural heart disease was highly effective and safe. It may therefore be considered as early therapy in these patients.
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PMID:Catheter ablation of ventricular tachycardia using radiofrequency techniques in patients without structural heart disease. 163 37

Endocardial catheter ablation with direct current high voltage shocks was performed in a patient with recurrent syncope due to a catecholamine-sensitive ventricular tachycardia that was drug refractory and occurred in the absence of identifiable heart disease. Pace mapping and catheter activation mapping of the spontaneous and isoproterenol-induced ventricular tachycardia located the tachycardia origin in the right ventricular outflow tract. Ablation dramatically reduced spontaneous ventricular tachycardia and ectopic activity (from 50,000 to less than 100 ectopic beats/24 h). The patient has remained symptom free and without ventricular tachycardia recurrence for 3 years. These observations and review of previous studies suggest that catheter mapping can easily locate the arrhythmia focus in the right ventricular outflow tract and that catheter ablation can be performed at low risk. Catheter ablation is a viable option for the treatment of right ventricular catecholamine-sensitive tachycardias that are unresponsive to antiarrhythmic drugs.
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PMID:Treatment of catecholamine-sensitive right ventricular tachycardia by endocardial catheter ablation. 169 50

The follow-up and characteristics of 20 patients with ventricular tachycardia (VT) and no detectable heart disease is reported. These were 16 men and four women with a mean age of 44 years. Symptoms were present in 18 patients (eight had syncope and ten palpitations or dizziness), VT was sustained in 11 patients and a left bundle branch block morphology with inferior axis was found in 17 patients. In three patients, VT had a right bundle branch block morphology and left-axis deviation. The VT was inducible in 13 patients during the electrophysiological testing (EP) and was sustained in five patients. Medical treatment was introduced in 19 patients. During a mean follow-up of 10 years from the onset of the symptoms and 6 years from the EP testing, one patient died suddenly. He had stopped taking amiodarone 5 months before. In seven patients symptoms recurred and were due to discontinuation of therapy in two cases and inefficacy of previous effective treatment in five patients. After modification of the treatment (three cases), implantation of a pacemaker (one case) and catheter ablation (one case), all patients became asymptomatic. Eleven patients became asymptomatic with the first administered antiarrhythmic therapy. One patient continues to be asymptomatic in spite of discontinuation of his medical therapy. We conclude that patients with VT and no detectable heart disease have a good long-term prognosis and that appropriate therapy can be found in almost all patients.
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PMID:Ten-years follow-up of 20 patients with idiopathic ventricular tachycardia. 170 11

The incidence and the direct cause of syncope in ventricular tachycardia (VT) among patients with old myocardial infarction (OMI, n = 48), dilated cardiomyopathy (DCM, n = 18) and no evidence of heart disease (IVT, n = 43) were compared. The presence or absence of syncope in each patient was surveyed by a standardized questionnaire and a variety of electrocardiographic parameters for aggravating arrhythmias were measured. Syncope occurred in 19 of 43 OMI patients (40%), in 5 of 18 DCM patients (28%) and 6 of 43 IVT patients (14%) and significantly more often in OMI than IVT (p less than 0.01). Ventricular fibrillation (VF) was confirmed in 14 of the 19 OMI patients with syncope, in 3 of the 5 DCM patients with syncope and 1 of 6 IVT patients with syncope. The incidence of VF was significantly higher in OMI than in IVT (p less than 0.01). Mean VT cycle lengths (VTRR'm) in OMI patients with and without syncope were 0.35 +/- 0.07 sec and 0.42 +/- 0.10 sec, respectively (p less than 0.05). VTRR'ms in DCM patients with and without syncope were 0.43 +/- 0.10 sec and 0.42 +/- 0.10 sec, respectively (NS). VTRR'ms in IVT patients with and without syncope were 0.27 +/- 0.04 sec and 0.41 +/- 0.10 sec, respectively (p less than 0.01). The results show that the high frequency of VT rate was the main cause of syncope in IVT, while VF was the main cause of syncope in OMI.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Evaluation of ventricular tachycardia with respect to syncope in patients with old myocardial infarction, dilated cardiomyopathy and no overt heart disease. 170 81

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

Invasive electrophysiological testing has contributed importantly to the objective evaluation and management of patients at high risk for sudden cardiac death. The clinical application of the technique is based on the hypothesis that the reproducible induction of ventricular arrhythmias by programmed cardiac stimulation constitutes a marker of risk for spontaneous ventricular arrhythmias and sudden death as well as an objective end point to guide the selection of antiarrhythmic therapy. The value of electrophysiological testing is well established in patients with ischemic heart disease and a history of sustained ventricular tachycardia or fibrillation and in some subsets of patients with unexplained syncope. More recently, the technique has been used by some investigators to identify individuals at high risk for sudden death among patients with recent myocardial infarction and those with left ventricular dysfunction and recurrent nonsustained ventricular tachycardia. The predictive value of the technique in patients with nonischemic heart disease is unknown. In addition to its use as an objective end point in the selection of antiarrhythmic drug therapy, invasive electrophysiological testing has advanced our knowledge of the mechanisms of life-threatening ventricular arrhythmias and contributed importantly to the development of new therapies, such as implantable arrhythmia control devices and catheter ablation techniques.
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PMID:Role of invasive electrophysiological testing in the evaluation and treatment of patients at high risk for sudden cardiac death. 172 98

Sudden death in children as in adults is usually due to cardiac disease. Sudden death in the pediatric population may be divided into the sudden infant death syndrome, sudden death in previously apparently healthy children, and sudden death in patients with known cardiac disease. The sudden infant death syndrome is not proved to be due to a cardiac cause and may well be due to central nervous system and/or pulmonary causes. However, interest remains in the cardiac hypothesis. Recent work from our laboratory shows that screening for prolonged QT interval in normal infants is not likely to detect those prone to sudden infant death syndrome. In children with apparently normal hearts, symptoms of syncope or palpitation should be given close attention. Detailed electrocardiography and echocardiography will detect many, but not all, children with subtle forms of heart disease. Vigorous treatment may prevent sudden death in many of these children. Some sort of screening program should be devised for varsity athletes. Children with congenital heart defects are now, for the most part, corrected early in life, so that the congenital heart defect itself rarely causes sudden, unexpected death. The residua and sequelae of the heart defect and the surgery to repair it, however, may lead to sudden death. Improvements in surgical technique and earlier repair of congenital cardiac defects will ameliorate this problem. Prospective evaluation of postoperative patients and attention to dysrhythmias can prevent sudden deaths in those who are prone to them.
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PMID:Sudden cardiac death in the pediatric population. 172 7


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