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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The anatomy of the conduction system of the heart so relevant in the contemporary invasive cardiology is not fully understood. It has turned out that ablation procedures bring new information as to its structure and function, but in some cases can result in complete a-v block. Atrioventricular nodal artery located within the nodal-perinodal tissue can probably be damaged during the ablation procedures. Therefore, we decided to explore in detail the morphology and the topography of the atrioventricular nodal artery in healthy humans and in patients with clinical traits of a-v conduction disturbances requiring permanent pacing. The microscopic study was carried out on 30 normal human hearts specimens (17 F, 3 M) from 17 to 86 years of age, and on 20 hearts with conduction disturbances (11 F, 9 M) from 39 to 85 years of age. We found that the number of the atrioventricular node arteries is different and independent of the extent that induces block causing conduction disturbances. The topography of the artery in perinodal zone was consistent in normal hearts, yet in hearts with conduction disturbances we observed about 2% of deviations in its location. It might be the reason for generation of iatrogenic complications after invasive cardiological procedures. The morphology revealed changes in 50% of the examined hearts and their vessel walls, which was declared to be connected with ageing. This correlated with certain stages of atherosclerosis as well as hypertension characteristic of elderly patients. We observed that in 33% of hearts from control group small parietal thrombi were detected and in 60% of paced group respectively. Hence, it seems that the procedures in perinodal zone should be performed in its proximal part because of a minor probability of direct and indirect (through nodal artery) damage of the atrioventricular structure of the junction.
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PMID:Histologic evaluation of the atrioventricular nodal artery in healthy humans and in patients with conduction disturbances. 1097 82

To study the effects and characteristics of radiofrequency current catheter ablation (RFCA) in treatment of elderly patients with supraventricular tachycardia (PSVT), fifty-three elderly patients and fifty non-elderly patients with PSVT were included in this study. RFCA were performed in both groups. The group of elderly patients included 26 patients with atrioventricular nodal reentrant tachycardia and 27 patients with atrioventricular reentrant tachycardia due to 29 atrioventricular accessory pathways (Aps). Twenty-one patients were accompanied with hypertension and coronary heart diseases and 5 sick sinus syndrome cases in the elderly group. All patients in both groups were treated successfully with RFCA. The procedure time of ablation of slow pathway in elderly group was shorter than that of the non-elderly group (P < 0.01). A mild symptom of arterial thrombosis was found in 2 cases of the elderly group after treatment and was cured with aspirin. These results suggest that PFCA is very effective and safe in the treatment of elderly patients with PSVT, especially for patients accompanied with sick sinus syndrome.
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PMID:[Characteristics of radiofrequency current catheter ablation in the treatment of elderly patients with supraventricular tachycardia]. 1118 6

Principal conclusions of the Second European Workshop in Aviation Cardiology are summarized. European standards for routine medical scrutiny of cardiovascular health are presented and the evolution of the standards is reviewed. Both single and multiple crew operations are considered. The papers summarized examine three major subject areas: prediction of vascular risk, coronary artery disease, arrhythmias and conduction disorders. The review of predicting vascular risk examines variation of cardiovascular risk with age, sex, and coronary risk factors; attributable and absolute risk, benefits of treatment and options for treatment of hypertension, the impact of intervention for lipid abnormalities, non-insulin-dependent diabetes mellitus and cardiovascular risk, and the aging pilot. The review of coronary artery disease includes coronary artery ectasia, abnormal exercise electrocardiographic responses in the presence of a normal coronary circulation, prognostic importance of patency of the infarct related artery, coronary artery angioplasty and stenting, acceptable revascularization of the myocardium, and myocardial perfusion imaging in certification. The review of arrhythmias and conduction disorders examines atrial fibrillation and flutter, atrioventricular nodal re-entry, sinoatrial disease, vasovagal syncope, risks and benefits of anticoagulation, cardiac rehabilitation, outcome of the impaired left ventricle, and mitral valve repair.
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PMID:Introduction and summary of principal conclusions of the Second European Workshop in Aviation Cardiology. 1154 88

Drugs classified as calcium channel blockers (CHBs) are now among the most frequently prescribed drugs for the treatment of cardiovascular disease. Although the currently available CCBs have major differences in their structural and cardiovascular effects, they share the common property of blocking the transmembrane flow calcium ions through voltage gated L-type channels. These drugs have been approved for the treatment of hypertensive heart disease: they reduce left ventricular hypertrophy and improve its sequelae, such as ventricular dysrhythmias, impaired filling and contractility, and myocardial ischemia. Long-acting CCBs have been shown to reduce mortality and morbidity in elderly patients with systolic hypertension, appear to be extremely useful in patients with cyclosporin-induced hypertension, and can be used as alternatives to ACE inhibitors in patients with hypertension and concomitant diabetes mellitus, renal disease, Raynaud's phenomenon or migraine. Long-acting dihydropyridine have been shown to be effective and safe in the treatment classic angina pectoris and vasospastic angina, supraventricular arrhythmias, particularly reentrant AV-nodal tachycardia, others to be beneficial in patients with congestive heart failure, and all of them have potential for decreasing atherogenesis.
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PMID:[Calcium channel blockers in the treatment of cardiovascular disease]. 1157 40

Symptomatic bradyarrhythmia occurs most often in aged patients. Most of these patients have multiple coronary risk factors and present with angina-like symptoms. The coexistence of CAD not only has major effects on their prognosis but also influences the long-term care. This study was designed to evaluate the incidence of coexistent CAD in patients with symptomatic bradyarrhythmias and its relationship to conventional coronary risk factors in Chinese people. From May 1996 to April 1998, we prospectively studied all consecutive patients admitted to our institution for symptomatic bradyarrhythmias requiring permanent pacemaker implantation. Coronary angiographies were performed non-selectively at the same session of pacemaker implantation. Based on the presence or absence of CAD, patients were divided into two groups for analysis. Multivariate logistic regression analysis was performed to determine independent predictors of CAD including sex, age, diabetes mellitus (DM), hypertension, hypercholesterolemia, and smoking. The odds-ratio (OR) and 95% confidence interval (CI) were determined. A total of 113 patients [68 males and 45 females, mean age 70.4+/-8.2 years old (range 45-86)] were included in our study. The diagnosis was sick sinus syndrome in 69 patients (61%) and atrioventricular block in 44 patients (39%). The incidence of CAD based on coronary angiography was 20%. The nodal-related artery was seldom involved among patients with coexistent CAD and symptomatic bradyarrhythmias (9%), and most patients had significant stenosis over LAD (74%). The baseline characteristics and presenting symptoms were not different statistically between patients with or without CAD. Hypercholesterolemia (OR 6.6, 95% CI 2.0-22.2, p=0.002) and DM (OR 4.7, 95% CI 1.3-17.2, p=0.020) were the two most significant independent predictors of CAD. In our patients with symptomatic bradyarrhythmias requiring permanent cardiac pacing, the incidence of CAD was 20% as determined by coronary angiography (CAG). Hypercholesterolemia and DM were the two most significant independent predictors for CAD in these patients. The nodal artery was seldom involved in patients with coexistent CAD and symptomatic bradyarrhythmias.
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PMID:The incidence of coronary artery disease in patients with symptomatic bradyarrhythmias. 1169 78

A 30-year-old male was referred to our department during the examination and treatment for hypertension, because he had not achieved complete erection since the age of 26 years. After detailed examination, he was diagnosed to be suffering from nodal polyarteritis. Since erectile dysfunction persisted, the patient was hospitalized to investigate the cause of erectile dysfunction. Measurement of the penile brachial index (PBI) and cavernous infusion of papaverine hydrochloride strongly suggested the presence of arterial erectile dysfunction. Internal-pudendal angiography revealed multiple microaneurysms in the bilateral internal pudendal arteries, suggesting that nodal polyarteritis caused arterial erectile dysfunction.
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PMID:[Erectile dysfunction arising from polyarteritis nodosa: a case report]. 1251 38

A 73-year-old man had a fast atrioventricular (AV) nodal pathway accidentally ablated 4 years before, while attempting to ablate a septally located concealed accessory pathway (AP). After initiation of treatment with beta-blockers, because of systemic arterial hypertension, the patient presented to the emergency room complaining of a markedly diminished exercise tolerance. The 12 lead ECG showed an interesting AV nodal Wenckebach sequence, interrupted by P waves retrogradely conducted through the AP. The mechanisms explaining the ECG are discussed.
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PMID:Unusual form of AV nodal Wenckebach block. 1284 33

Atrial fibrillation is the most common arrhythmia in the general population and is frequently associated with organic heart disease. beta-adrenoceptor antagonists (b-blockers) are very effective in preventing atrial fibrillation after coronary artery bypass surgery. It has been shown recently that the beta-blocker metoprolol controlled release/extended release (CR/XL) is also effective in maintaining sinus rhythm after conversion of atrial fibrillation. There is concern that class I antiarrhythmic drugs, such as quinidine, disopyramide, and flecainide in particular, may increase mortality. The risk of proarrhythmia associated with beta-blocker treatment is very low. Therefore b-blockers, such as metoprolol CR/XL, may be the first line of treatment to maintain sinus rhythm, especially after myocardial infarction and in patients with chronic heart failure and in those with arterial hypertension. In patients with persistent atrial fibrillation, AV-nodal conduction-slowing drugs, such as calcium channel antagonists and beta-blockers are used to control the ventricular rate during atrial fibrillation. Several studies clearly show that beta-blockers alone, or in combination with digoxin are very effective in controlling the ventricular rate at rest and during exercise. beta-blockers are effective in maintaining sinus rhythm and controlling the ventricular rate during atrial fibrillation. Given these effects and their favorable effects on mortality, beta-blockers should be considered as first-line agents in the management of patients with atrial fibrillation.
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PMID:Use of beta-blockers in atrial fibrillation. 1472 97

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with substantial cardiovascular morbidity and mortality. The arrhythmia can be initiated and/or maintained by rapidly firing foci, single- and multiple-circuit reentry. Once initiated, AF alters atrial electrical and structural properties (atrial remodeling) in a way that promotes its own maintenance and recurrence and may alter the response to antiarrhythmic drugs. Thus, initial episodes of paroxysmal (self-terminating) AF lengthens to the point where the arrhythmia becomes persistent (requires cardioversion to restore sinus rhythm) and permanent. AF usually requires a trigger for initiation and a favorable electrophysiological and/or anatomical substrate for maintenance. The substrate includes both cardiovascular (coronary artery disease, valvular heart disease, heart failure, hypertension, dilated cardiomyopathy) and non cardiovascular diseases (thyrotoxicosis, pulmonary diseases). Accordingly, the initial step in patients with AF requires a careful assessment of symptoms and identification of underlying reversible triggers and potentially modifiable underlying structural substrate and treat them aggressively. In contrast to other cardiac arrhythmias, antiarrhythmic drugs (ADs) are the mainstay of therapy. Long-term treatment of AF is directed to restore and maintain the sinus rhythm with class I and III ADs (rhythm-control) or to allow AF to persist and ensure that the ventricular rate is controlled (rate-control) with atrioventricular nodal blocking drugs (digoxin, beta-blockers, verapamil, diltiazem) and prevent thromboembolic complications with anticoagulants. However, the long-term efficacy of ADs for preventing AF recurrence is far from ideal, because of limited efficacy (AF recurs in at least one-half of the patients) and potential side effects, particularly proarrhythmia. Thus, the choice of the appropriate AD will depend on the temporal pattern of the arrhythmia, the presence of associated diseases, easy of administration and adverse effects profile, particularly the risk of proarrhythmia. The recent finding that angiotensin converting enzyme inhibitors and beta-blockers reduce the incidence of AF in patients post myocardial infarction with left ventricular dysfunction confirmed the importance of targeting the underlying arrhythmogenic substrate. This review focuses on the mechanisms underlying AF and the mechanism of action and the efficacy and safety profile of the ADs used in the treatment of atrial fibrillation. The advantages and disadvantages of rhythm and rate control, the role pill in a pocket concept and the role of the new ADs are dicussed.
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PMID:Pharmacological approaches in the treatment of atrial fibrillation. 1475 23

We encountered a 91-year-old woman with atrial fibrillation complicating bradycardia while she was receiving therapy with an L/N-type calcium channel blocker, cilnidipine, for hypertension, which is an unusual observation for the dihydropyridine class of calcium channel blockers. Therefore, we compared the dromotropic effect of cilnidipine with that of an L-type calcium channel blocker, nicardipine, which has a similar hypotensive activity. The canine isolated, blood-perfused atrioventricular node preparation was used. Cilnidipine as well as nicardipine slowed atrioventricular nodal conduction in a dose-related manner. However, the dromotropic action of cilnidipine was about five times less potent than that of nicardipine. These experimental results may suggest that we experienced an atypical clinical event of cilnidipine in a very old woman; otherwise one can speculate that the N-type calcium channel inhibitory component of cilnidipine might have played a role in exerting the negative dromotropic effect in this patient.
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PMID:Comparison of the direct negative dromotropic effect of a new calcium channel blocker, cilnidipine, with that of nicardipine. 1591 7


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