Journal of cardiovascular electrophysiology
-
J. Cardiovasc. Electrophysiol. · Aug 1993
ReviewRole of radiofrequency ablation in the management of supraventricular arrhythmias: experience in 760 consecutive patients.
Several reports have demonstrated that radiofrequency catheter ablation provides effective control of a variety of supraventricular tachycardias. However, the efficacy, complications, risk of arrhythmia recurrence, and follow-up survival analysis have not been reported in a large series of consecutive patients with supraventricular arrhythmias with diverse electrophysiologic mechanisms. This report details the results of radiofrequency catheter ablation in 760 consecutive patients (386 males, 374 females) with a wide variety of supraventricular tachycardias treated at one center. ⋯ Thus, the results of this large series of patients demonstrates the safety and efficacy of radiofrequency ablation for the treatment of a wide variety of supraventricular arrhythmias. It also appears that increasing experience with these procedures increases the rate of successful ablation and decreases the risk of complications.
-
J. Cardiovasc. Electrophysiol. · Jun 1993
ReviewCardiac arrhythmias and the autonomic nervous system.
The multiple facets of cardiac arrhythmias and their relationship with the autonomic nervous system can be investigated by studying the spontaneous heart rate behavior through ambulatory ECG recordings, an approach that complements the limitations of invasive electrophysiologic investigations. Information obtained from heart rate behavior is more reliable in the absence of structural heart disease and ventricular hypertrophy/failure, during which compensatory mechanisms involving the autonomic nervous system tend to limit reflex changes in heart rate. Thus, in such situations, less marked sinus rhythm variations preceding the arrhythmia onset do not imply a more limited influence of the autonomic nervous system, and the sensitivity of the electrophysiologic substrate may otherwise vary. ⋯ In the presence of heart disease and, in particular, heart failure, the autonomic nervous system behavior is more difficult to assess than in the absence of structural heart disease. This does not mean that its role is less crucial. In this situation the beneficial effects of beta blockers may be as important as in normal hearts although physicians should be more cautious when heart failure is present.
-
Torsade de pointes is an uncommon and unique type of ventricular tachycardia. It differs from other forms of ventricular tachycardia by its morphological features, underlying mechanism, and modes of therapy. Recognizing torsade de pointes is of major clinical importance, as standard antiarrhythmic regimens might not only be ineffective in abolishing this life-threatening arrhythmia but may aggravate it. ⋯ By acceleration of the heart rate, the QT interval is shortened, thus preventing the recurrence of the arrhythmia. Treatment of torsade de pointes includes: isoproterenol infusion, cardiac pacing, and intravenous atropine. Intravenous magnesium sulfate, a relatively new mode of therapy for torsade de pointes, was proven to be extremely effective and is now regarded as the treatment of choice for this arrhythmia.