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

Since the first successful surgical intervention for Wolff-Parkinson-White syndrome by W. C. Sealy, a surgical electrophysiological intervention has been developed for every single supraventricular arrhythmia. The surgical rationale is based on the site of the mechanism of the arrhythmia and associated pathology which characterizes the "arrhythmogenic substrate". Wolff-Parkinson-White syndrome is a congenital heart disease characterized by an accessory atrioventricular connection distinct from the AV node-His bundle system. It is associated with AV reentrant tachycardia and/or atrial fibrillation with fast ventricular responses via the accessory pathway. The current surgical management is ablation of the accessory pathway using either an endocardial dissection or epicardial approach. Surgical ablation is associated with high efficacy and low morbidity. Epicardial dissection of the accessory pathway on the beating heart has helped to localize variant accessory pathways associated with Coumel's tachycardia or Mahaim's fiber electrophysiological entity. AV nodal reentrant tachycardia can be cured using direct AV nodal dissection (or perinodal cryoablation). Atrial flutter can be interrupted by cryoablation of the arrhythmogenic substrate located in the coronary sinus orifice of the region modifying atrial inputs. Chronotropic atrial function abolished by chronic or paroxysmal idiopathic atrial fibrillation can be restored using the corridor operation (sinus node-AV node insulation). Surgery is an alternative in patients with resistant atrial tachycardias. Currently surgery is indicated only after other non-invasive EP interventions have been either attempted or rejected.
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PMID:Surgery for supraventricular tachyarrhythmias. 176 6

A 66 year-old woman with chronic Chagas's heart disease, presented palpitations, dizziness and chest pain. The His bundle electrograms revealed sick sinus syndrome. The left cineventriculography showed apical and inferior aneurysms of mammillary morphological aspect.
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PMID:[Apical and inferior mammillary aneurysm in chronic Chagas cardiomyopathy]. 187 27

Digoxin excess can produce characteristic bradyarrhythmias, tachyarrhythmias, and hyperkalemia. The bradyarrhythmias, which consist of disturbances in conduction and block at the level of the atrioventricular and sinus nodes, are mediated by a direct and vagotonic effect. The vagotonic effect of excess digoxin may also result in a marked slowing of the sinus rate in the setting of severe toxicity. Digoxin increases automatic and triggered electrical activity in atrial muscle, His-Purkinje system, and ventricular muscle, which predisposes to tachycardias. Many of the tachyarrhythmias are relatively specific for the toxic effects of digoxin. Atrial tachycardias with variable atrioventricular block, accelerated junctional rhythms (especially in the setting of atrial fibrillation), and fascicular tachycardias are characteristic digoxin toxic rhythms. Digoxin-specific antibody fragments should be considered the treatment of choice for any digoxin toxic arrhythmia associated with hemodynamic compromise or the threat of hemodynamic compromise. Hyperkalemia, when due to acute severe digoxin toxicity, is also an appropriate indication for digoxin-specific Fab fragment therapy. When assessing the risk:benefit ratio for using digoxin-specific Fab fragment therapy, one needs to determine, in addition to the electrocardiographic manifestations and patient's hemodynamic status (1) the severity of toxicity, as indexed by the amount ingested and/or the serum digoxin concentration; (2) the expected time course for reversal of toxicity, which is usually determined by the status of renal function; (3) the need for digoxin to provide ventricular rate control or improved ventricular contractility and therapeutic alternatives to digoxin; (4) the presence of a strong allergy history; (5) the presence of such factors as increased age and severity of heart disease that may predispose to digoxin toxicity.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Which cardiac disturbances should be treated with digoxin immune Fab (ovine) antibody? 199 18

His bundle cryosurgical ablation using a closed heart anterior septal approach was used in 6 patients. There were 3 men and 3 women, aged 24 to 73 years. Three patients had atrial fibrillation and 2 patients had atrial flutter (2 with combined episodes of atrial tachycardia). One patient had atrial tachycardia. Five patients had no structural heart disease and 1 patient had left ventricular dilatation (ejection fraction, 0.35). All patients undergoing His bundle cryosurgical ablation had permanent heart block without intraoperative complications (mean follow-up, 25 months). Closed heart anteroseptal cryoablation of the His bundle is effective and is an alternative to attempted catheter ablation.
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PMID:Closed heart cryoablation of the His bundle using an anterior septal approach. 201 21

Autopsy studies of arrhythmogenic right ventricular dysplasia (ARVD) have rarely been reported, and its etiology remains unknown. The present report describes a detailed histopathological study of two autopsied cases of ARVD. Case 1: This 21-year-old man experienced palpitation accompanied by syncope. He died after ventricular tachycardia of right ventricular origin. The heart weighed 365 g and the right ventricular cavity was markedly dilated. The distribution of fatty tissue was roughly limited to the middle layer of the free wall, replacing the myocardium with fatty degeneration. Medial hyperplasia of the small arteries within the fatty tissue was also observed. Fibroelastosis was observed in the left ventricular endocardium. In the conduction system, fatty tissue was found in the sinus node. In addition, medial hypoplasia was observed in the pulmonary arteries. Case 2: This 32-year-old man who had had an arrhythmia for 10 years died of ventricular tachycardia of right ventricular origin. His older brother also died of heart disease. His heart weighed 515 g and both the right and left ventricles were dilated. Fatty tissue, unlike that in Case 1, was shown to markedly infiltrate from the epicardium into both the right and left ventricular walls. In the right ventricular wall, muscle layers disappeared in some portions. In the conduction system, fatty tissue was observed in the sinus node. Although ARVD may be considered a syndromic entity, individual cases are different in terms of pathological morphology, with possible variations in the etiology and pathogenesis.
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PMID:[Two autopsied cases of arrhythmogenic right ventricular dysplasia]. 213 13

The use of pacemakers has been a major advance in the treatment of different forms of bradycardias and tachyarrhythmias. The main objectives for cardiac pacing in heart block are to improve the chances of survival and to prevent disabling symptoms, especially Stokes-Adams attacks. The long-term follow-up results of cardiac pacing are affected by different factors, in particular age and underlying heart disease; major technical aspects include pulse generator, lead and electrode longevity, and the pacing mode (VVI, atrioventricular sequential pacing, rate response stimulation, etc.). - Sinoatrial dysfunction is a relatively benign condition. Hence, pacing should probably not be adopted as a routine measure but should be reserved for patients with clinical (troublesome) symptoms. Based on earlier studies it can be concluded that patients with complete heart block and second degree atrioventricular block (Mobitz Type II) should be treated with pacemakers from the prognostic point of view. During chronic rate-responsive pacing improvement of exercise capacity can be expected in patients with sinus node disease and after His-bundle ablation. In patients with complete AV-block or bradycardia rate-responsive pacing can increase exercise tolerance and improve clinical symptoms as well. The automatic implantable cardioverter/defibrillator prevents sudden death over a long-term follow-up period in a high risk group of patients suffering from life-threatening ventricular tachyarrhythmias.
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PMID:[Long-term follow-up of pacemaker therapy]. 218 Feb 29

An electrophysiologic study has been performed in 7 patients with giant stable inversion of the T waves in the precordial ECG leads and without any organic heart disease. The study was particularly directed to evaluate the specific properties of the conductive system. The main results of the study point out the presence of absolute (prolonged HV interval, delay of ventricular activation time) or relative (RRP of the left bundle branch greater than RRP of the right one) conduction delays already in basic conditions or occurring after ajmaline (1 mg/Kg iv). Moreover, repolarization normalized during repetitive high rate atrial extrastimuli in the beats where ventricular activation time shortened and not during regular pacing. On the other hand, repolarization worsened whenever an impairment of infra or intrahisian conduction occurred. During His bundle pacing an inversion of the T waves preceded a left bundle branch conduction delay. The present data make us to hypothesize that, in these patients with pseudoischemia, a delay of activation of the initial vectors of the QRS in the left side, by amplifying the electrical gradient between the 2 ventricles, can be the underlying mechanism causing the repolarization abnormalities.
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PMID:[Pseudoischemic T waves: a possible electrophysiologic mechanism]. 224 24

Two families having secundum atrial septal defect (ASD) were reported. In one family, a 31-year-old male and his 60-year-old mother had secundum ASD without PR prolongation. His 38-year-old brother was diagnosed as having ASD. His grandmother, who had died at the age of 51, was suspected of having congenital heart disease. From early childhood she was noticed to have heart murmur. It was suspected that this was a case of familial ASD without PR prolongation, because it was consistent with the dominant trait of the defect. In the other family, a 16-year-old female had secundum ASD and her 18-year-old brother was also suspected of having ASD. Her 25-year-old brother had been operated on for tetralogy of Fallot, and her sister had died of an unknown congenital heart disease. All of these family members had mental retardation. Her 22-year-old brother was suspected of having a congenital heart disease, because of heart murmur from his early childhood. The parents, who were blood relations (cousins), had neither heart disease nor mental retardation. The children of this family were considered to be cases of congenital heart disease with ASD, associated with mental retardation. It was also suspected that the cause of the defect was a deleterious autosomal recessive gene.
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PMID:[Secundum atrial septal defect in two families]. 230 32

Patients with reentrant atrioventricular (AV) tachycardia have an accessory connection in addition to the normal conduction pathway, AV node and His-Purkinje system. This pathway predisposes some patients to recurrent, disabling supraventricular tachyarrhythmias. Although it is found with other associated cardiac conditions, most patients are healthy with no underlying structural heart disease. Interest has developed in surgically dividing the accessory pathway in patients with arrhythmias poorly controlled with medications or at risk for potentially fatal tachyarrhythmias. Surgery is safe and effective and should be considered for patients with rapid AV conduction during atrial fibrillation, those refractory to pharmacologic therapy, and young patients who otherwise would require lifelong antiarrhythmic therapy. This report describes surgical correction of reentrant AV tachycardia in five patients ranging in age from six months to 23 years.
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PMID:Correction of reentrant atrioventricular tachycardia by surgical ablation of accessory pathways. 230 56

With the purpose to call attention to the clinical utility of fulguration of the His bundle (a therapeutic procedure somewhat neglected in Italy) 3 new cases are presented. All patients had a long history of supraventricular tachyarrhythmias refractory to conventional treatment. Patients 1 and 2, in whom surgical correction of tetralogy of Fallot and mitral valve replacement, respectively, had been performed several years before, had chronic atrial tachycardia with congestive heart failure. Patient 3 suffered from persistent atrial flutter, in the absence of demonstrable organic heart disease. Three shocks of 320 J were necessary to induce complete AV block in patient 1 and 2. In patient 3, a single discharge (320 J) resulted in interruption of AV conduction. Twenty-four hours after the procedure, a rate-responsive ventricular pacemaker was implanted in all patients. The success of the procedure was confirmed 3 months later, during transitory pacemaker inhibition. Patients 1 and 3 exhibited atrial tachycardia and atrial flutter, respectively, but complete AV block was still present, with junctional escape rhythm at a rate of 40 and 45 b/min; in patient 2 atrial tachycardia with high degree AV block, and a mean ventricular rate of 75 b/min, were observed. Refinement of transcatheter ablative techniques is desirable. However, even in the present status, catheter ablation of the His bundle is an effective, low-risk procedure for patients with refractory supraventricular tachyarrhythmias.
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PMID:[Fulguration of the bundle of His. Description of 3 new cases]. 237 54


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