Zeitschrift für Kardiologie
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Radiofrequency catheter ablation has been established as a first line therapy for the curative treatment of patients with atrioventricular nodal reentrant tachycardia and atrioventricular tachycardia encompassing accessory pathways as well as for ablation of the "normal" AV-junction. For these indications, the success rates exceed 90%. Acute complications during ablation of accessory pathway and ablation of the "normal" AV-junction occur in approximately 2-5% of patients treated. ⋯ In addition, first clinical results indicate that modification of anterograde AV-nodal conduction properties in patients with atrial fibrillation and fast ventricular rate by radiofrequency application to postero- and midseptal sites might be a useful therapeutic tool to slow ventricular rate. Because of the high success-rate and the relative low incidence of severe procedure related complications, the indications of radiofrequency ablation procedures for the treatment of supraventricular tachycardias will be extended in the future. In addition, it might be reasonable to expect that during the next years, all types of supraventricular tachycardia, except atrial fibrillation, can be targeted and cured by radiofrequency ablation in the majority of cases.
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This study reports on 16 patients suffering from cardiogenic shock in the setting of acute myocardial infarction (11 men, five women; average age: 52.5 +/- 14 years) treated by means of primary coronary angioplasty: These 16 patients were part of a total population of 261 patients suffering from acute myocardial infarction at the time of admittance to the Wuppertal Heart Center, who were consecutively treated during the period from 1/90 to 6/94 by primary coronary angioplasty without having received any prior thrombolytic therapy. For all patients, primary re-opening of the vessel infarcted was successful. The period of time between onset of pain until re-opening of the vessel averaged 176 +/- 49 min. ⋯ By now, one of the patients has received elective aorto-coronary bypass grafting; for another one, multi-vessel PTCA of non-infarcted arteries is being employed; 77% of the patients state that they are satisfied with the quality of their lives. These results demonstrate that rapid revascularization using coronary angioplasty in cardiogenic shock following acute myocardial infarction substantially improves the prognosis for survival and favorably influences long-term outcome. Thus, primary PTCA is the method of choice for treating cardiogenic shock; any patient-and particularly those resistant to lyse therapy-should immediately receive this treatment.
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The term accelerated idioventricular rhythm describes an ectopic ventricular rhythm with 3 or more consecutive ventricular premature beats with a rate faster than the normal ventricular intrinsic escape rate of 30 to 40 beats per minute, but slower than ventricular tachycardia. Accelerated idioventricular rhythm differs from ventricular tachycardia by additional features such as the onset with a long coupling interval, the end by a gradual decrease of the ventricular rate or increase of the sinus rate and, last but not least, by a good prognosis. Clinically, accelerated idioventricular rhythm can occur in any form of structural heart disease and occasionally in adults or children without structural heart disease. ⋯ Its occurrence after thrombolysis during acute myocardial infarction is a marker of successful reperfusion. Since accelerated idioventricular rhythm is usually hemodynamically well tolerated and not associated with malignant ventricular tachycardias; as a rule, no specific treatment other than care of the underlying heart disease is necessary. The present overview discusses electrocardiographic criteria, possible mechanisms, and the clinical significance of accelerated idioventricular rhythms.
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Experience with oral sotalol, a beta-blocker with class III-antiarrhythmic properties, is limited in the pediatric population. Sotalol was administered to 32 patients with a mean age of 8.7 years (range 1 day-19.9 years). Mean dosage was 4.6 (1.5-9.4) mg/kg or 122.1 (52-306) mg/m2, respectively. ⋯ Symptomatic hypotension was noted in two patients, in whom therapy had to be stopped. Sotalol was a very effective agent for the treatment of various pediatric cardiac dysrhythmias. However, incidence of proarrhythmic effects warrants close electrocardiographic monitoring.
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With the advent of ultrafast Magnetic Resonance Imaging (MRI), it is now possible to produce images with high temporal resolution. This gives the opportunity to record the passage of the paramagnetic contrast material Gadolinium-DTPA through the tissue of the heart muscle, yielding information on regional myocardial perfusion. We assessed the accuracy of MRI to detect and quantify reductions in coronary flow secondary to stenosis in dogs and patients. ⋯ A third-order polynominal fit showed a good correlation for the parameter Q* and MTT, whereas T and SImax were found to have a poor correlation. The linear regression analysis for a limited range of < 2 ml/min/g showed a superior estimation of myocardial perfusion for the parameter Q* than MTT. Blood flow > 2 ml/min/g was significantly underestimated by the MRT-measurements, but the parameter Q* showed the smallest amount of the divergent changes.(ABSTRACT TRUNCATED AT 400 WORDS)