[Retrospective study of permanent cardiac stimulation in patients over 80 years of age].

Out of 833 pacemakers implanted between 1979 and 1983, 228 were in patients aged over 80 years (137 aged 80-84, 79 85-89, and 12 90-93). Indication for cardiac stimulation was high-grade atrioventricular (av) block in 47%, sick sinus syndrome in 38%, low ventricular response in atrial fibrillation in 13% and hypersensitivity of the carotid sinus in 1%. An average follow-up period of 29.

[Current strategy in the treatment of acute myocardial infarct].

Systemic thrombolysis significantly reduces mortality in acute myocardial infarction if the treatment is administered rapidly after the first symptoms become manifest. To optimize utilization of this new treatment, patients should be accepted for thrombolysis if they can be admitted to a hospital with intensive care units within less than three hours of first clinical signs of acute myocardial infarction evidenced by electrocardiogram. The patients should undergo coronary angiography only if chest pain or ischemic ECG changes at rest or under exercise can be documented after thrombolysis or in young patients with large infarct.

[Incidence and treatment of coronary restenosis in spite of the implantation of an endoprosthesis].

Between April 1986 and February 1988, 72 endoprosthesis implantations were carried out in the coronary arteries of 65 patients. The indication for implantation was either abrupt closure post angioplasty or prevention of restenosis. The first 3 cases of restenosis within the stented segment are reported.

[Acute coronary occlusion following transluminal angioplasty: the role of an implanted parietal support via transluminal route].

Acute coronary artery occlusion complicates some 5% of balloon angioplasty procedures and often makes emergency surgical revascularization necessary. Initial experience is reported with emergency implantation of endoluminal stents for acute vessel closure following coronary balloon angioplasty. 10 patients received one stent and 2 patients two stents during the study period.

Emergency stenting for acute occlusion after coronary balloon angioplasty.

Acute coronary artery occlusion complicates 2-12% of the balloon angioplasty procedures, and despite repeat angioplasty, emergency surgical revascularization is often necessary. We report our initial experience with the emergency implantation of endoluminal stents for acute vessel closure after coronary balloon angioplasty. Nine patients received one stent, and two patients received two stents during the study period.

Catheter ablation for recurrent tachyarrhythmias. Clinical experience with two different techniques of ablation in 21 patients.

Between 1984 and 1988, 21 patients underwent catheter ablation for drug refractory arrhythmias. Nine patients presented atrial flutter, atrial fibrillation or atrial tachycardia, nine had supraventricular tachycardia (one AV nodal reentrant tachycardia, one reciprocating tachycardia due to concealed accessory pathway and seven WPW syndrome). Three had ventricular tachycardia.

Single versus double chamber rate responsive cardiac pacing: comparison by cardiopulmonary noninvasive exercise testing.

A new double chamber rate responsive cardiac pacemaker (DDDMR) has been implanted in seven patients (four males and three females) with a mean age of 62 years. Indication for pacemaker treatment was complete AV block in two patients, complete AV block associated to sinus node disease in three patients and sinus node disease alone in two patients. Six patients underwent two maximal stress tests on a cycloergometer performed twice randomly starting with VVIMR or DDDMR.

Restoration of sinus rhythm with flecainide in patients with atrial fibrillation.

The efficacy of flecainide acetate for conversion of atrial fibrillation into sinus rhythm was assessed in 69 patients (mean age of 63 +/- 14 years). Mean duration of the arrhythmia was 49 +/- 45 days. Mean cardiothoracic index was 0.

Prevention of coronary restenosis by stenting.

Balloon angioplasty fails to provide acceptable long-term results for a significant proportion of patients. An intravascular mechanical support, developed with the aim of preventing restenosis and acute closure of diseased arteries after transluminal angioplasty, was implanted in 44 patients (39 male and five female), aged from 35 to 70 years (mean 56 years) with documented restenosis of native coronary artery (41 stents) and bypass grafts (12 stents). In the group of bypass graft patients there was no local restenosis and no major complication.

[Bradycardic arrhythmias and changes in the bradycardia-induced hemodynamics by electrical and drug treatment].

Cardiac output depends at first on heart rate and second on contractility. Chronotropic incompetence means inappropriate adaptation of rate to metabolic demands and in this condition increase of cardiac output is only made possible by increase of contractility and stroke volume. The old, insufficient, or ischemic heart cannot control cardiac output appropriately by increasing contractility.

Intravenous thrombolytic treatment for acute myocardial infarction. Effects of early intervention and early examination.

Intravenous thrombolytic treatment (streptokinase or anisoylated plasminogen streptokinase activator complex (APSAC) was given to 50 consecutive patients within 3 hours after onset of symptoms of acute myocardial infarction. Left heart catheterisation with coronary angiography and simultaneous double view left ventriculography were performed approximately 4 hours after start of thrombolytic treatment. This examination showed that the acute infarct-related coronary artery was open in 36 patients (72%) and closed in 14 patients (28%).

Infusion of atrial natriuretic peptide to patients with congestive heart failure.

Atrial natriuretic peptides (ANP) exert vasodilating and natriuretic actions. The present study was undertaken to test the effect of low dose infusions of synthetic ANP on hemodynamic and humoral variables of patients with severe heart failure. Eight patients, aged 26 to 71 years, with severe congestive heart failure due to ischemic heart disease or idiopathic dilated cardiomyopathy were included in the study.

Effect of amiodarone on sinus node function in patients with sick sinus syndrome.

The effect of amiodarone on sinus node function has been studied in 9 patients with symptomatic sick sinus node as documented by Holter-ECG. All patients had programmable dual-chamber pacemakers. Sinus node activity was assessed by intermittently inhibiting the pacemakers before and after four weeks of oral amiodarone treatment.

Implanted atrial pacemakers for paroxysmal atrial flutter. Long-term efficacy.

Five patients with drug-resistant paroxysmal atrial flutter received permanent burst atrial pacemakers for the treatment of tachycardia. All patients had extensive electrophysiologic evaluations to determine the safety and efficacy of atrial pacing. The absence of prolonged spontaneous or electrically induced atrial fibrillation was also documented in all patients.

[Multiple peripheral emboli resulting from thrombosis of a St. Jude aortic valve prosthesis].

Although thrombosis of St. Jude valve prosthesis is rare, we report a case of multiple thromboembolism in a patient who had stopped anticoagulant therapy. The consequences were very severe since two abdominal operations (colonic resection) were necessary.

Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty.

Occlusion and restenosis are the most common reasons that transluminal balloon angioplasty may fail to provide long-term benefit. An intravascular mechanical support was therefore developed with the aim of preventing restenosis and sudden closure of diseased arteries after angioplasty. The endoprosthesis consists of a self-expandable stainless-steel mesh that can be implanted nonsurgically in the coronary or peripheral arteries.

[When should ventricular extrasystole be treated?].

Arrhythmias can be variable in their clinical symptoms and are mostly even asymptomatic. Suppression of arrhythmias is usually not very difficult, but the clinical value of the intervention is questionable. Only in the case of a history of myocardial infarction does treatment with beta-blockers appear to improve the prognosis, but the mechanism does not appear to be related to the suppression of arrhythmias.

[Treatment of arrhythmia by intracardiac electrocoagulation].

Since July 1982, 12 patients have undergone catheter ablation for refractory arrhythmias. The ablated pathway was the His bundle in 8 patients, an accessory pathway in 3 patients and a ventricular reentrant circuit in 1 patient. The 8 patients in whom the His bundle was ablated comprised 3 cases of atrial flutter, 3 cases of atrial fibrillation, 1 case of atrio-ventricular tachycardia and 1 case of junctional reentrant tachycardia.

Rate responsive dual chamber pacing.

We report about a new pacemaker, which simultaneously offers dual chamber pacing in DDD Mode and activity controlled rate response. The system also uses activity-sensing to differentiate true sinus tachycardia from ectopic atrial activity or atrial fibrillation and therefore prevents pacemaker mediated arrhythmias. The clinical experience proves appropriate functioning of all technical aspects of the device.