The value of the clinical history to assess prognosis of patients with ventricular tachycardia or ventricular fibrillation after myocardial infarction.

Multivariate analysis using 70 variables in 200 patients who suffered from ventricular tachycardia or ventricular fibrillation after myocardial infarction detected eleven variables that were associated with an increased risk of sudden arrhythmic death and cardiac death during a mean follow-up period of 2 years. Four of the 11 variables came from the patient's clinical history: (1) cardiac arrest at the time of the first spontaneous episode of arrhythmia, (2) New York Heart Association functional class for dyspnoea = III, (3) ventricular tachycardia or ventricular fibrillation occurring early (after 3 days and within 2 months) after myocardial infarction, (4) multiple myocardial infarctions before the first episode of ventricular tachyarrhythmia. Total mortality, incidence of sudden arrhythmic death and of non-sudden cardiac death increased with an increasing number (zero, one, two, three, four) of variables seen in individual patients.

Nonischemic sustained ventricular tachycardia: clinical outcome in 12 patients with arrhythmogenic right ventricular dysplasia.

The clinical course and long-term follow-up of 12 patients with arrhythmogenic right ventricular dysplasia causing ventricular tachycardia are presented. No patient had a history of congestive heart failure and the cardiothoracic ratio measured less than or equal to 0.5 in all patients.

Termination of ouabain-induced ventricular tachycardia by flunarizine in conscious dogs.

The ability of flunarizine to terminate ouabain-induced ventricular tachycardia was investigated in conscious dogs. These arrhythmias result from triggered activity based on delayed afterdepolarizations. Sustained ventricular tachycardia was induced by ouabain (48 +/- 6 micrograms/kg) and pacing in 13 animals with surgically induced complete atrioventricular block.

Nonischemic ventricular tachycardia. Clinical course and long-term follow-up in patients without clinically overt heart disease.

This report describes the clinical, laboratory, and electrophysiologic features of 52 patients with ventricular tachycardia (VT) who had no clinical evidence of heart disease. The mean age of patients was 36 years, cardiovascular collapse occurred in 18 patients (35%), and exercise-related symptoms were present in 24 of 49 patients (49%). There were 20 patients with sustained monomorphic VT, 11 with incessant VT, and 21 with nonsustained VT.

Ventricular fibrillation in six adults without overt heart disease.

Findings are described in six patients with no clinical evidence of heart disease who had documented ventricular fibrillation (five patients) or ventricular flutter (one patient). The mean age of the six patients, all men, was 34 years (range 26 to 43). Cardiovascular collapse occurred in all and was followed by successful cardioversion.

Transcoronary chemical ablation of ventricular tachycardia.

After identification of the artery supplying blood to the arrhythmogenic area, transcoronary chemical ablation of ventricular tachycardia was undertaken in three patients with incessant tachycardia in whom the other therapeutic options had failed. Sterile ethanol (96%) was given at a dose of 1.5 ml in two patients and a total of 6 ml in the third.

Angiographic and clinical characteristics of patients with unstable angina showing an ECG pattern indicating critical narrowing of the proximal LAD coronary artery.

One hundred eighty of 1260 patients consecutively admitted to the hospital because of unstable angina pectoris had the typical ST-T segment changes suggestive of a critical stenosis in the proximal LAD. In 108 patients the ECG abnormalities were present at the time of admission. In the remaining 72 patients they developed shortly thereafter.

Value of induction of pleomorphic ventricular tachycardia during programmed stimulation.

The morphology of the first documented, the recurrent and the induced ventricular tachycardia were studied in 41 patients with an old myocardial infarction and documented sustained ventricular tachycardia. During a mean follow-up of 29 +/- 11 months recurrent ventricular tachycardia was present in 24 of 41 patients with the same morphology as the first ventricular tachycardia in nine (37.5%) and a different morphology in 15 patients (62.

What do medical students know about in-hospital radiation hazards?

A questionnaire (eight multiple-choice questions) administered to 49 fourth-year medical students from the Limburg State University in the Netherlands shows that several misunderstandings, misconceptions, and erroneous beliefs exist in regard to in-hospital radiation hazards. The authors conclude that it is unlikely that ignorance about this subject is restricted to Dutch medical students.

Antiarrhythmic drugs for supraventricular tachycardia.

Many antiarrhythmic drugs are available for treatment of supraventricular tachycardia. Selection of the appropriate drug is helped by the identification of the site of origin, mechanism and pathway of the arrhythmia. For most types of supraventricular tachycardia greater than 1 antiarrhythmic drug is available.

Spectrum of supraventricular tachycardias.

The term "supraventricular tachycardia" includes a wide variety of arrhythmias with very different clinical and prognostic significance. Each supraventricular tachycardia has unique characteristics and each patient, even when similar arrhythmias are present, remains a person with specific manifestations. In 1988, physicians should not be satisfied with the diagnosis of supraventricular tachycardia.

[Ventricular tachycardia and ventricular fibrillation following myocardial infarct: determinants of prognosis and disease course].

To assess the risk of sudden death 79 patients (pts) with sustained monomorphic ventricular tachycardia (SMVT) and 37 patients with ventricular fibrillation (VF) after myocardial infarction (MI) were studied by coronary angiography, ambulatory monitoring, and programmed electrical stimulation. Mean follow-up was 28 +/- 12 months. Total mortality was significantly higher in pts with VF (13/37, 35%) than in pts with SMVT (15/79, 19%) (p less than 0.

Modern pacemakers: implantable artificial intelligence?

For over twenty years computer programs have been written for applications in cardiology. Approximately one decade ago the first Expert Systems using knowledge on cardiology were built. The use of Expert System shells enabled a breakthrough.

The role of collateral blood supply in ventricular tachycardia after myocardial infarction.

The hypothesis that collateral or anterograde blood supply to an infarcted area maintains blood supply to cells responsible for ventricular tachycardia after myocardial infarction was studied in six patients. All patients had suffered a myocardial infarction and developed spontaneous episodes of sustained monomorphic ventricular tachycardia. The arrhythmia was paroxysmal in three patients and incessant in the other three.

Termination of tachycardias by interrupting blood flow to the arrhythmogenic area.

The hypothesis that production of ischemia or cooling of an arrhythmogenic area or pathway could interrupt tachycardias was tested by subselective catheterization of the coronary artery supplying the site of origin of ventricular tachycardia (9 patients), the accessory pathway (2 patients) and the site of origin of atrial tachycardia (1 patient). Ventricular tachycardia was reproducibly terminated and reinduction temporarily prevented in 8 of the 9 patients by occlusion of the artery or administration of iced isotonic saline. Block in the accessory pathway was obtained in 1 of the 2 patients with Wolff-Parkinson-White syndrome.

Mechanisms of supraventricular tachycardia.

Programmed electrical stimulation of the heart in combination with intracardiac recordings has contributed a wealth of new information on the mechanisms and pathways of supraventricular tachycardia in humans. This knowledge has resulted in better treatment approaches to these patients. Questions still remain, however, about the mechanisms of atrial flutter and fibrillation and of some types of atrial tachycardia.

Effects of thrombolytic therapy in unstable angina: clinical and angiographic results.

The incidence of intracoronary thrombus and the effects of thrombolytic therapy were studied in 41 patients with unstable angina. All patients underwent coronary angiography 2 to 69 h (mean 19) after their last attack of chest pain. Immediately after angiography, 21 patients received intracoronary streptokinase (250,000 IU in 45 min) and were retrospectively analyzed.

Pacemaker syndrome with AAI rate variable pacing: importance of atrioventricular conduction properties, medication, and pacemaker programmability.

A patient who received an AAI Activitrax rate variable pacemaker for treatment of symptomatic sinus bradycardia is described. disopyramide prolonged the anterograde effective refractory period of the fast conducting atrioventricular (AV) nodal pathway to such an extent, that conduction switched to the slow AV nodal pathway at low atrial pacing rates. This gave rise to symptoms of the pacemaker syndrome during moderate exercise because the paced atrial event was conducted with a long, spike to Q interval with occurrence of the paced atrial event just after the preceding QRS complex.

Prognosis of patients with ventricular tachycardia and ventricular fibrillation: role of the underlying etiology.

The prognosis of 149 patients with ventricular tachycardia (n = 108) or ventricular fibrillation (n = 41) was analyzed to assess the importance of the underlying etiology of the arrhythmia. Seventy-three patients (Group I) had a previous myocardial infarction and documented late sustained monomorphic ventricular tachycardia. Thirty-five (Group II) also had a previous myocardial infarction but had late ventricular fibrillation.