The American journal of cardiology
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The modes of regression of very high degrees of atrioventricular nodal block (> or = 8:1) were studied in patients with atrial flutter and a specific variant of the tachycardia-bradycardia syndrome. The occurrence of reverse alternating Wenckebach periods, previously reported only in 2:1 atrioventricular block, emphasizes the complexities of multilevel block.
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Children with complete heart block following surgery for congenital heart diseases were prospectively followed to assess the timing for recovery of atrioventricular conduction, and to determine if there were clinical variables that reliably predict permanent heart block. Recovery of atrioventricular conduction occurred by postoperative day 9 in 97% of patients with transient heart block.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Impact of time to treatment with tissue plasminogen activator on morbidity and mortality following acute myocardial infarction (The second National Registry of Myocardial Infarction).
This study examines the association between time to treatment with thrombolytic therapy and hospital outcomes in patients with acute myocardial infarction (AMI) enrolled in a national registry. A total of 71,253 patients hospitalized with AMI from June 1994 to July 1996 who received tissue plasminogen activator (t-PA) therapy in 1,474 United States hospitals were studied. In this study sample, approximately 39% of patients presented to participating hospitals within 2 hours of acute symptom onset and received t-PA; 36% were treated within 2.1 to 4 hours, 12% between 4.1 to 6 hours, and the remaining 13% thereafter. ⋯ The incidence of sustained ventricular arrhythmias declined with progressively longer time to administration of t-PA. The results of this multihospital observational study suggest that patients with AMI treated earlier with t-PA are significantly more likely to survive the acute hospitalization than patients treated later. These data reinforce the benefits to be gained by treatment with t-PA as soon as possible following the onset of acute ischemic symptoms, and for community-wide efforts to reduce the duration of prehospital delay in patients with acute coronary disease.