1/101. Sinus escape-capture bigeminy and sinus extrasystolic bigeminy.Blocking conduction between the sinus node and the atria (SA block) can be responsible for symptomatic rhythm problems. However, in atrial escape-capture bigeminy with SA block, when atrial escape P waves originate in a site within or close to the sinus node, the diagnosis of SA block is not easy. Electrocardiograms were selected from 7 people with atrial bigeminy because (1) all atrial deflections (P waves) were almost the same in shape and in length of PR intervals, (2) comparatively long PP intervals alternated with comparatively short PP intervals, and (3) occasionally the atrial bigeminy changed to normal regular sinus rhythm in which 2 or more sinus P waves were found in succession. An attempt is made to clarify the mechanism for these cases. When regular sinus rhythm changed to bigeminal rhythm, the long PP interval introduced the bigeminy in 3 cases, indicating the presence of "sinus" escape-capture bigeminy; whereas the short PP interval introduced the bigeminy in the other 4 cases, indicating the presence of "sinus" extrasystolic bigeminy. In cases of sinus escape-capture bigeminy associated with SA block, the cases may occasionally be diagnosed wrongly as ordinary sinus arrhythmia not associated with SA block. Therefore, it seems that sinus escape-capture bigeminy is not so rare as is generally believed. patients with SA block often require implantation of the artificial pacemaker. Thus, the authors believe that differentiation of sinus escape-capture bigeminy from other forms of "sinus" bigeminy is clinically important.- - - - - - - - - - ranking = 1keywords = rhythm (Clic here for more details about this article) |
2/101. octreotide improved ventricular arrhythmia in an acromegalic patient.We saw a remarkable effect of octreotide, the long-acting somatostatin analogue, in reducing the number of ventricular premature complexes (VPCs) in a 59-year-old woman with acromegaly. Her basal GH and IGF-1 levels were up to 22.9 ng/ml and 934.9 ng/ml respectively. MRI revealed a 14 x 12 x 10 mm mass lesion in the pituitary gland. She had hypertension and echocardiography showed an increase in left ventricular wall thickness. Electric cardiography showed the presence of frequent VPCs and 24-h Holter monitoring revealed 24,277 beats of multifocal VPCs/24 h. She was treated with 300 microg/day of octreotide for four weeks before transsphenoidal surgery. After octreotide treatment, GH and IGF-1 were suppressed to 1.8 ng/ml and 145.3 ng/ml respectively, and the tumor size was remarkably reduced. Furthermore, the number of VPCs was also dramatically reduced to 2062 VPCs/24-h (8.5% of pretreatment) with 24-h Holter monitoring. This case shows that VPCs of acromegalic patients can be controlled by suppressing GH and IGF-1 with octreotide, and this agent is useful for reducing both tumor size and frequency of VPCs prior to surgery.- - - - - - - - - - ranking = 0.8keywords = rhythm (Clic here for more details about this article) |
3/101. Fetal and neonatal arrhythmia in one of the twins--a case history.There are a lot of publications about fetal arrhythmia in singletons, but up to now there are no published data about fetal arrhythmia in multiple pregnancies. In the present study a case history of fetal and neonatal arrhythmia in one of twins from two mothers treated with betamimetic agents due to imminent preterm labor is reported and discussed. A first case with fetal bradycardia due to complete A-V block had congenital cordis abnormalities (VSD and PFO). The second case with prenatal detected extrasystoles had normal heart anatomy. digoxin was administered to the mother, in the aim to treat fetal arrhythmia without success, because the baby had postnatal bradycardia. After hospitalisation in cardiology Department the described cases were successfully treated. In both cases the second twins were without neonatal arrhythmia and with no structural heart abnormalities. We summarise that in situation of detection fetal arrhythmia the complexity of the problems experienced may warrant early referral to a tertiary centre where the overall management of the mother, fetus and neonate, may be undertaken.- - - - - - - - - - ranking = 2keywords = rhythm (Clic here for more details about this article) |
4/101. atrial flutter in the recipient atrium induced by premature beats arising from the donor atrium 10 years after orthotopic heart transplantation.BACKGROUND: Several mechanisms for the genesis of supraventricular arrhythmias in patients after orthotopic heart transplantation have been reported. methods AND RESULTS: We describe a 58-year-old male patient in whom atrial flutter occurred 10 years after orthotopic heart transplantation. During an electrophysiological study, bidirectional conduction between the recipient and donor atria was found. atrial flutter in the recipient atrium was induced by programmed stimulation of the donor atrium using a single extrastimulus. The clinical symptoms were caused by atrial flutter arising from the recipient atrium with 1:1 to 3:1 conduction to the donor atrium. Mapping the anastomosis between the two atria indicated fragmented potentials at a discrete site of conduction. Delivery of radiofrequency energy at this site terminated conduction in both directions. Subsequent atrial pacing of the donor and recipient atria, respectively, demonstrated bidirectional conduction block. CONCLUSION: Symptomatic arrhythmias in patients after heart transplantation can indirectly originate from the donor atrium via bidirectional recipient-donor atrial conduction. This type of arrhythmia can be successfully treated with radiofrequency ablation.- - - - - - - - - - ranking = 0.6keywords = rhythm (Clic here for more details about this article) |
5/101. Clinical implications of fetal magnetocardiography.OBJECTIVES: To test the usefulness and reliability of fetal magnetocardiography as a diagnostic or screening tool, both for fetuses with arrhythmias as well as for fetuses with a congenital heart defect. methods: We describe 21 women with either a fetal arrhythmia or a congenital heart defect discovered during prenatal evaluation by sonography. Four fetuses showed a complete atrioventricular block, two an atrial flutter, nine ventricular extrasystole, and one a complete irregular heart rate. Five fetuses were suspected to have a congenital heart defect. In all cases magnetocardiograms were recorded. RESULTS: Nine fetuses with extrasystole showed a range of premature atrial contractions, premature junctional beats or premature ventricular contractions. Two fetuses with atrial flutter showed typical flutter waves and four fetuses with complete atrioventricular block showed an uncoupling of P-wave and QRS complex. One fetus showed a pattern suggestive of a bundle branch block. In three of four fetuses with confirmed congenital heart defects the magnetocardiogram showed abnormalities. CONCLUSION: Fetal magnetocardiography allows an insight into the electrophysiological aspects of the fetal heart, is accurate in the classification of fetal arrhythmias, and shows potential as a tool in defining a population at risk for congenital heart defects.- - - - - - - - - - ranking = 0.6keywords = rhythm (Clic here for more details about this article) |
6/101. Postpausal ventricular fibrillation analyzed by Holter-ECG: a case report.A 70-year-old male patient with a myocardial infarction, 3 months previously, happened to be wearing a Holter monitor at cardiac arrest during micturition. The patient had ventricular fibrillation (VF) and was successfully resuscitated by means of defibrillation. Analysis of the Holter tape revealed atrial fibrillation and secondary ventricular premature beats (VPB), i.e., VPBs dependent upon a relatively long interval between the two preceding heartbeats. The VF was preceded by an especially long R-R interval (1.45 sec) following a run of especially short R-R intervals implying the sharpest deceleration of the ventricular rate during 1 hour Holter recording preceding the cardiac arrest. A peculiar large alteration of the T wave configuration was also found to precede the VF.- - - - - - - - - - ranking = 4.3749548761519E-6keywords = hour (Clic here for more details about this article) |
7/101. Triggered activity as the proposed mechanism of left atrial tachycardia induced by premature ventricular beats.In a 57-year-old woman with complex ventricular ectopy, a paroxysmal supraventricular tachycardia initiated by premature ventricular beats is presented. She underwent an electrophysiologic study. The tachycardia origin was localised to the left atrium. At the presence of retrograde dual atrioventricular nodal pathway, the atrial tachycardia was induced by programmed ventricular stimulation. Triggered activity was shown to be the likely mechanism of both atrial and ventricular arrhythmias.- - - - - - - - - - ranking = 0.2keywords = rhythm (Clic here for more details about this article) |
8/101. Ashman's phenomenon--a source of nonsustained wide-complex tachycardia: case report and discussion.The refractory period of the right bundle branch is increased when the R-R interval between the prior two conducted impulses is long. Thus, an impulse that arrives soon after the second of two impulses separated by a long R-R interval may be aberrantly conducted with a right bundle branch block morphology on electrocardiogram. This aberrant conduction is termed "Ashman's phenomenon" and is often responsible for isolated wide QRS complexes in the presence of underlying atrial fibrillation. This process may also produce runs of wide QRS complexes that must be distinguished from nonsustained ventricular tachycardia. A case of such multibeat Ashman's phenomena is presented, and the characteristics used to identify this phenomenon are discussed. A brief review of several recent studies on the differentiation of sustained ventricular tachycardia from supraventricular tachycardia with aberrancy in the setting of a regular underlying rhythm is given as well.- - - - - - - - - - ranking = 0.2keywords = rhythm (Clic here for more details about this article) |
9/101. Ventricular extrasystoles with syncopal episodes, perodactyly, and Robin in sequence in three generations: a new inherited MCA syndrome?We observed the combination of the Robin sequence with perodactyly (hypoplasia and/or agenesis of the distal phalanx of the toes) and cardiac arrhythmia (ventricular extrasystoles occurring as bigemini or multifocal tachycardia with syncopal episodes) in 6 relatives in 3 generations. This familial association has not been reported before and probably represents a previously unrecognized heritable malformation syndrome.- - - - - - - - - - ranking = 0.2keywords = rhythm (Clic here for more details about this article) |
10/101. Radiofrequency ablation of symptomatic but benign ventricular arrhythmias.Two cases are presented where ablation of severely symptomatic ventricular arrhythmias not responding to medical therapy was accomplished with radiofrequency current application. After a routine programmed stimulation protocol, a quadripolar ablation catheter with a 4-mm tip was advanced percutaneously into the left ventricle in one case and into the right ventricle in the second case; and after precise pace mapping, the arrhythmogenic focus was successfully ablated using radiofrequency current. The postablation ambulatory recording revealed virtual eradication of ventricular ectopy in both cases. In conclusion, in severely symptomatic cases of "benign" ventricular arrhythmias, radiofrequency ablation offers an effective therapeutic alternative.- - - - - - - - - - ranking = 1.4keywords = rhythm (Clic here for more details about this article) |
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