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

The arrhythmias in competitive athletes may be classified as "benign," "paraphysiological" due to prolonged athletic training, or "pathological" due to hemodynamic effects on the athletic performance-risk-arrhythmogenic substratum. Pathological arrhythmias include life-threatening forms that are severe enough to produce symptoms (presyncope, syncope, cardiac arrest) during athletic activity. These forms are in particular rapid VT, VF, torsades de pointes, preexcited atrial fibrillation, sinus atrial and AV block. Our study population includes 766 competitive athletes, mean age 21.1 years (74 top international level), investigated with a cardioarrhythmological work-up for symptoms and for arrhythmias from 1974 to June 30, 1991. Three leading categories, represented by 16 aborted sudden death, 8 sudden death, and 7 induced VF (by EES or TAP) athletes, are described. All athletes with life-threatening arrhythmias, previously as asymptomatic or with minor symptoms had an arrhythmogenic substratum due to underlying silent cardiopathy or primary arrhythmic disorders. Athletic activity can be regarded as a trigger of electrical destabilization.
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PMID:Life-threatening tachyarrhythmias in athletes. 138 4

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

We followed 37 patients with myotonic dystrophy for a mean of 6 years. Two developed atrial flutter or fibrillation, 6 developed a new bundle branch block, 1 developed complete heart block requiring a pacemaker, and another with progressive 1st-degree heart block and a widening QRS interval had a sudden death. Most patients had predictable, gradually progressive disease of their cardiac conduction system. We recommend that patients with progressive atrioventricular block or widening QRS interval due to myotonic heart disease have yearly ECGs and be questioned about syncope or presyncope to determine the need for a cardiac pacemaker.
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PMID:Myotonic heart disease: a clinical follow-up. 154 47

Programmed ventricular stimulation with up to 3 extrastimuli at the right ventricular apex was performed in 52 patients with spontaneous nonsustained ventricular tachycardia (VT) associated with coronary artery disease. There were 44 men and 8 women, aged 66 +/- 9 years (range 45 to 86). The mean left ventricular ejection fraction was 41 +/- 14%. Nonsustained VT was asymptomatic in 10 patients (19%), while the arrhythmia was detected during evaluation of palpitations in 5 patients (10%), presyncope in 11 (21%) and syncope in 26 patients (50%). All patients were tested in the drug-free state and were classified as having no inducible arrhythmia (31 patients, group I), or an inducible arrhythmia (21 patients, group II). The age, gender, type of heart disease, symptoms and left ventricular ejection fraction were similar in both groups. Group I patients had a higher overall incidence of syncope. Group I patients received no therapy, while group II patients received antiarrhythmic therapy guided by electropharmacologic testing. At 21 +/- 17 months there was no sustained VT in either group. There were 3 deaths in group I patients, including 1 sudden, 1 nonsudden cardiac and 1 noncardiac death. In group II patients 6 deaths occurred including 4 nonsudden cardiac and 2 noncardiac deaths. In patients with nonsustained VT and coronary artery disease undergoing programmed ventricular stimulation, the incidence of significant arrhythmic events is low in those without therapy with no inducible arrhythmia, and in those with an inducible arrhythmia with therapy guided by electrophysiologic testing.
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PMID:Value of programmed ventricular stimulation in the evaluation and management of patients with nonsustained ventricular tachycardia associated with coronary artery disease. 229 89

Ambulatory electrocardiographic monitoring and the frequent use of stress electrocardiography have been important tools in characterizing the prevalence and prognostic importance of ventricular ectopic activity in both healthy persons and patients with organic heart disease. These studies have demonstrated that ventricular ectopy is not uncommon in persons with no evidence of heart disease. However, it is rarely of high density or repetitive, and even when frequent or repetitive, or both, carries little, if any, risk of sudden death in patients without syncope. However, in patients with organic heart disease and in certain clinical settings, frequent and repetitive ventricular ectopy identifies a population at high risk for arrhythmia-induced syncope or sudden death. These rhythm disturbances have particular prognostic importance in ischemic heart disease with depressed left ventricular function and hypertrophic cardiomyopathy. Patients with presyncope or syncope and structural heart disease who demonstrate frequent and repetitive ventricular ectopy are also a high-risk group. Therefore, individual risk stratification is important in deciding whether and how to treat patients with ventricular ectopy.
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PMID:Ventricular ectopic activity: prevalence and risk. 248 Jul 10

A 34 year old female had a history of dizziness and presyncope. She had many risk factors for atherosclerosis including smoking 30 packs of cigarettes/year, using oral contraceptives (OCs) for almost 10 years, somewhat elevated blood sugars, strong family history of heart disease and diabetes, and hypertension. During an examination in 1983, she had an elevated blood pressure in the right arm but a reading could not be found in the left arm. The physician heard a grade III rough, blowing systolic bruit over the right subclavian artery moving into the right carotid artery. Pulses of both carotid arteries were normal. Heart sounds were normal. While the right brachial and radial pulses were fine, there were none on the left side. Laboratory tests showed a serum cholesterol of 258 mg/dl, a fasting blood sugar of 92 mg/dl, a white blood cell count of 8400, and a normal differential count. The arch aortogram showed a 50-60% stenosis beginning at the innominate artery and a completely occluded left subclavian artery at its origin. Physicians performed an aortoinnominate bypass operation using a Dacron prosthetic graft. This operation alleviated the symptoms, but 2 years later she had bilateral dysesthesias in her upper arms and vertigo returned. Her right arm became more and more limp while her left arm did so mildly. The aortoinnominate graft and the left subclavian artery were occluded. Physicians did coronary angioplasty using the right transfemoral route and corrected both lesions in her brachiocephalic system. they used a technique which eased safe crossing of the occluded subclavian segment (covering the catheter tip with a J curve guidewire). Following the operation, the patient had superb brachial and radial pulses in both arms. Physicians advised her to discontinue using OCs and tobacco products. At months 1 and 5, the symptoms were gone and vital signs were fine.
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PMID:Percutaneous transluminal angioplasty for innominate artery stenosis and total occlusion of subclavian artery in Takayasu's-type arteritis. 256 38

A prospective assessment of several clinical variables, left ventricular function indexes, Holter recording characteristics and signal-averaged electrocardiogram (ECG) for their value in predicting the inducibility of sustained ventricular tachyarrhythmias was carried out in a consecutive series of 105 patients with nonsustained ventricular tachycardia (VT). The patients were divided into 3 groups based on the results of programmed electrical stimulation: group 1, 22 patients with induced sustained monomorphic VT; group 2, 14 patients with induced ventricular fibrillation (VF) and group 3, 69 patients with no induced sustained VT/VF. Left ventricular ejection fraction less than 0.40, history of syncope/presyncope and abnormal signal-averaged ECG were significantly more common in group 1 than in group 3. No significant difference was found between groups 2 and 3. The sensitivity, specificity and predictive accuracy of the signal-averaged ECG for the induction of sustained monomorphic VT were 64, 89 and 84%, respectively. Using stepwise discriminant function analysis, the signal-averaged ECG was found to be the single most accurate screening test to predict the inducibility of sustained VT in patients with nonsustained VT and its value was independent of the etiology of heart disease and the length of spontaneous runs. Because of the very high specificity and negative predictive accuracy, patients with normal signal-averaged ECGs may not require invasive evaluation.
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PMID:Value of the signal-averaged electrocardiogram as a predictor of the results of programmed stimulation in nonsustained ventricular tachycardia. 337 85

One hundred nineteen patients with unexplained syncope (82%) or presyncope (18%) underwent complete electrophysiologic study (EPS). Symptoms were recurrent in 72% of the patients. Fifty-two percent of the patients had structural heart disease. Forty-one patients had normal EPS results and 78 had electrophysiologic abnormalities (ventricular tachycardia in 31, induced atrial flutter/fibrillation in 17, vasovagal syncope in 8, hypersensitive carotid sinus syndrome in 7, supraventricular tachycardia in 6, heart block in 5 and sick sinus syndrome in 4). The presence of structural heart disease (p = 0.0033) and previous myocardial infarction (p = 0.05) were the only clinical or electrocardiographic predictors of a positive EPS response. Therapy was guided by EPS and patients were followed for 27 +/- 20 months (mean +/- standard deviation). In the patients with negative EPS results, 76 +/- 11% (mean +/- standard error) were symptom-free at follow-up, compared to 68 +/- 10% in the group with positive EPS responses. No clinical variables helped to predict remission in the absence of therapy. One patient in the negative EPS response group and 2 patients in the EPS positive group died suddenly (cumulative survival 94 +/- 4%). Total cardiovascular mortality was 13% in the positive EPS response group, and 4% in the negative EPS response group. Thus, certain clinical characteristics are helpful in selecting patients for study. Electrophysiologically guided therapy is associated with a recurrence and sudden death rate similar to an untreated control group.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Electrophysiologic evaluation and follow-up characteristics of patients with recurrent unexplained syncope and presyncope. 397 12

Two hundred twenty-four patients underwent ventricular programmed stimulation (VPS) without prior documentation of the clinical occurrence of sustained ventricular tachycardia (VT) or ventricular fibrillation-flutter (VF). Indications for VPS were: palpitations or nonsustained VT during ambulatory monitoring (85 patients), syncope or presyncope (137 patients), and a family history of sudden death (two patients). Sustained VF requiring transthoracic defibrillation was initiated by VPS in 18 patients (8.0%). Four patients were treated for inducible VF with antiarrhythmic agents directed by electropharmacologic testing; five patients were treated empirically; nine patients received no therapy. No patient has had a cardiac arrest or sudden death during a follow-up period 25.2 +/- 13.8 months (mean +/- standard deviation). VF was initiated by two ventricular extrastimuli in three patients and by three extrastimuli in 15 patients. The incidence of VF was similar in patients with and without previous symptoms (8.8% vs 6.9%) or heart disease (7.1% vs 9.6%). It was significantly higher when VPS at three ventricular sites with a current of 5 mA (pulse width 2 msec) was compared to programmed stimulation at two ventricular sites with a current twice diastolic threshold (pulse width 2 msec) (15.2% vs 3.0%, p less than 0.05). VF initiated by VPS in patients without prior VT or VF appears to be a nonspecific finding. Antiarrhythmic therapy for VF may not be necessary in these patients.
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PMID:Clinical significance of ventricular fibrillation-flutter induced by ventricular programmed stimulation. 399 30

Thirty-three patients with ventricular tachycardia (VT) (3 or more beats, less than 30 seconds in duration, rate more than 100 per minute) on 24-hour Holter monitoring and no history of clinical arrhythmia (presyncope, syncope or sudden death) were studied using programmed electrical stimulation (PES). PES induced VT in 14 patients (42%), sustained VT in 7 (21%) and nonsustained VT in 7 (21%). Inducible VT was associated with underlying heart disease in 9 of 19 patients with coronary artery disease, 3 of 6 patients with idiopathic dilated cardiomyopathy and 2 of 4 patients with mitral valve prolapse. Patients without structural heart disease did not have inducible VT. Ejection fraction (EF) was not significantly different in patients with or without inducible VT. Twenty-three patients were discharged with drug therapy and 10 patients without therapy. At 23 +/- 16 months (mean +/- standard deviation) follow-up, 28 patients (85%) were alive, 4 (12%) had died from a cardiac cause (EF 49 +/- 17% vs 28 +/- 20%, p less than 0.03). Another patient died from cerebrovascular accident. Twenty-six patients (79%) were free of clinical arrhythmia and 7 patients (21%) had arrhythmic events (EF 49 +/- 18% vs 31 +/- 17%, p less than 0.04). Two of 8 patients with noninducible VT who were discharged without drug treatment had clinical arrhythmic events and neither of 2 patients with inducible VT discharged off drugs had such events.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Programmed electrical stimulation and long-term follow-up in asymptomatic, nonsustained ventricular tachycardia. 402 71


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