1/14. Extensive myocardial stunning showing transient regression of prolonged T wave inversion and prolonged sympathetic denervation.A 69-year-old woman was admitted to the hospital with palpitations. Although left ventriculography showed extensive akinesis except in the basal hyperkinetic segment, coronary angiography showed normal coronary arteries. 123I-metaiodobenzylguanidine (MIBG) accumulation was obviously reduced in the anteroseptal, apical and inferior areas. Inverted T waves developed on day 3 and disappeared on day 104 after transient regression. echocardiography showed normal left ventricular motion two weeks later. ergonovine provocation test showed no vasospasm and thallium-201 showed no perfusion defect on day 46. electrocardiography and MIBG returned to normal on day 216. These findings suggest prolonged sympathetic nerve injury in extensive myocardial stunning.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/14. Entrainment of ventricular tachycardia in arrhythmogenic right ventricular tachycardia.In two patients with arrhythmogenic right ventricular dysplasia (ARVD), sustained ventricular tachycardia (VT) was induced by programmed stimulations during serial drug testings. One patient had five and the other had two VT morphologies, and the sites of origin were determined by endocardial catheter mappings. When overdrive pacing was performed, constant fusion in the QRS complex was observed in the two patients. Constant fusion of a different degree was also observed at different paced cycle lengths. Both patients had dilated right ventricles and wall-motion abnormality, and the diagnosis of ARVD was further confirmed by the specimen resected at the site of origin of VT. Therefore, VT in ARVD can be entrained and reentry is the most likely mechanism of such VT.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
3/14. Artifact simulating ventricular and atrial arrhythmia.We describe a patient whose electrocardiograms showed ventricular tachycardia and atrial flutter which could be reproduced by arm movements. Careful review of the initiation and termination of the arrhythmia, the relation of the arrhythmia to body motion, and the associated symptoms and signs may be helpful to differentiate artifact from true arrhythmia.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/14. cryosurgery for ventricular bigeminy using a transaortic closed ventricular approach.Disabling monomorphic ventricular bigeminy has not been described as an indication for surgery. Three young patients with this arrhythmia sometimes deteriorating into ventricular tachyarrhythmias and in whom drug therapy failed completely were accepted for surgical ablation of the arrhythmogenic area. The earliest endocardial site of origin was located preoperatively by catheter mapping of the spontaneously occurring ventricular bigeminy in the left and right ventricles. For maximum preservation of myocardial muscle and function, the preoperative mapping and surgical procedure were performed through the aortic root; mapping by transaortic multipolar balloon was done during normothermic coronary perfusion and cryocoagulation was done during cardioplegic arrest. Cryocoagulation of the endocardial site was performed using the transaortic approach and epicardial cryocoagulation at the opposite site was done afterwards. In the two patients in whom the preoperative mapping results were consistent with those of preoperative catheter mapping, the arrhythmia could be abolished, as documented during long-term follow-up. In the only patient in whom the mapping results were not in agreement, the ventricular arrhythmia reoccurred and was the cause of death at five months after surgery. Postoperative wall-motion studies performed in the two surviving patients showed limited scars in the area of cryocoagulation and minor damage to the coronary arteries in that area. The transaortic approach can be considered as a new and important surgical option for endocardial mapping and cryocoagulation which prevents the damaging effects of a left ventriculotomy.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/14. A case of arrhythmogenic right ventricular dysplasia with prominent late potential.A case of arrhythmogenic right ventricular dysplasia with frequent episodes of ventricular tachycardia (VT) in a 57-year-old man is reported. His electrocardiogram showed a normal axis and inverted T waves in V1-V3 during sinus rhythm and a left bundle branch block pattern during VT. The VT could be terminated by either intravenous administration of lidocaine or procainamide or by cardioversion. Echocardiogram and right ventriculography showed reduced wall motion of the apex and infundibulum of the dilated right ventricle. No evidence of ischemic heart disease was found by left ventriculography, coronary arteriography and RI scintigraphy. A prominent late potential following the QRS complex was recorded by averaging and magnifying the surface electrocardiogram. The combination of oral mexiletine and disopyramide partially suppressed the VT attacks and relieved the subjective symptoms, however the late potential remained almost unchanged.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/14. Five cases of arrhythmogenic left ventricular aneurysm unrelated to coronary occlusion.Five among 19 cases of sustained ventricular tachycardia (VT) treated in the last two years had left ventricular aneurysms, but the patients denied any previous attack of chest pains that would indicate acute myocardial infarction. Laboratory findings including serum electrolytes were normal and no signs of inflammation were found. Coronary angiograms were normal but the left ventriculograms showed aneurysms in four patients and akinetic to aneurysmal wall motion in one patient. Electrophysiologic studies (EPS) were done in four patients. VT was induced reproducibly by programmed electrical stimulation in three patients and it was terminated by programmed stimulation within 30 seconds. The foci of VT were determined by EPS. One case who showed acceleration of the VT rate following the second induction of VT developed a fulminant course; Adams-Stokes attacks from VT, more than ten times a night in spite of intravenous administration of a large dose of procainamide, were terminated by DC shock. VT was determined to originate from the aneurysm that was resected operatively. In the other two cases, the foci were resected and the intraoperative EPS confirmed the preoperative foci. The postoperative EPS showed no inducibility of VT in three surgical cases. Though the induction of VT may not be indicated in every case of VT, we believe that EPS is required to determine the focus for the operation and to evaluate the precise drug efficacy in rapid VT. It is further stressed that the sustained VT of our patients including the present five, lasted for several hours until it was terminated in the hospital.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
7/14. Cardiac tachyarrhythmias in hereditary long QT syndromes presenting as a seizure disorder.patients with hereditary long QT disorders--romano-ward syndrome and Jervell Lange-Nielsen Syndrome--sometimes present with seizures due to cardiac tachyarrhythmias. Two such patients are presented, emphasizing diagnostic clues--syncope, seizures with onset in early life, precipitation of attacks by emotional or physical stress, positive family history of sudden death and/or seizures, normal EEG and prolonged QT interval on ECG. Treatment is usually with adequate doses of sympathetic betablockers.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
8/14. Catecholamine induced double tachycardia: case report in a child.A six-year-old girl with syncope in association with atrial flutter-fibrillation and ventricular tachycardia produced by exercise or emotion is presented. The tachycardias could be reproduced by low-dose isoproterenol infusion and were blocked by high dose propranolol therapy. Catecholamine-induced tachyarrhythmias should be suspected in children with unexplained syncope in association with exercise or emotion.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
9/14. On-line epicardial mapping of intraoperative ventricular arrhythmias: initial clinical experience.An on-line automatic mapping system was developed for beat by beat display of epicardial activation during ventricular tachycardia induced at the time of cardiac surgery. A sock array of 110 button electrodes was used to record and display local activation on a video monitor at 8.3 ms intervals. On instant replay in slow motion, epicardial pacing sites were accurately localized to the nearest electrode. Local unipolar electrograms were also recorded, first from the sock array, then from an array of 16 transmural needle electrodes. The epicardial display was verified by retrospective manually derived maps using the recorded epicardial electrograms. In four patients with coronary artery disease and recurrent inducible ventricular tachycardia, earliest epicardial activation was located on slow motion replay within 1 minute. Subendocardial sites of early activation were located within 10 minutes by replay of electrograms from the needle array before ventriculotomy. Transmural and endocardial resection of these sites prevented inducibility of the tachycardia on postoperative electrophysiologic study in three of the four patients. There has been no clinical recurrence of ventricular tachycardia after 3 to 14 months of follow-up despite cessation of antiarrhythmic therapy in three of the patients. This technique has unique advantages over existing mapping methods. It provides beat by beat display of activation sequences so that clinical tachycardias that are short in duration or pleomorphic in configuration now become amenable to mapping. In addition, it markedly shortens total time on cardiopulmonary bypass.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
10/14. Phase quadrature shift between left and right ventricles during a ventricular tachycardia attack.Equilibrium gated nuclear angiography was performed on a patient during an attack of ventricular tachycardia and then after conversion to sinus rhythm. Global and regional wall motion was assessed by means of isocontours, Fourier phase analysis and factor analysis. Ventricular phase histograms showed a 100 degrees difference between ventricles: left ventricular filling time occurred during right ventricular contraction. The earliest phase was located in the septum and the sequence of activation showed a large delay of left ventricular activation. After conversion to sinus rhythm, a right bundle branch block was observed, being almost the inverse of the latter situation.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
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