Nine-year follow-up of balloon-expandable Palmaz-Schatz stent in patients with single-vessel disease.

The long-term effects of intracoronary stents in human are unknown. This is the first 9-year follow-up report of single-vessel-disease patients treated with the Palmaz-Schatz stent. Between March and December 1989, out of the 107 patients undergoing Palmaz-Schatz stent implantation, 71 (66%) had single-vessel disease. The average age of these patients was 58+/-9 years and 79% were men. At 9 years, follow-up was obtained for 90.1% and major adverse clinical events consisted of 4 deaths giving a global survival rate of 95.8%, 7 myocardial infarction, 3 bypass surgeries, and 16 repeat percutaneous revascularization procedures. The 9-year event-free survival rate was 60%, and 81.7% of the patients were free from death, myocardial infarction, and bypass surgery. Multivariate analysis showed that the only predictive factor of major adverse clinical events was the presence of diabetes mellitus (P<0.004). Cathet. Cardiovasc. Intervent. 50:170-174, 2000.

[Percutaneous coronary angioplasty via the radial artery. Feasibility and safety]. / Angioplastie coronaire percutanée par voie radiale. Faisabilité et innocuité.

The authors report the results of percutaneous coronary angioplasty using the radial approach with respect to feasibility and safety. Between February 1994 and December 1998, out of a total of 9,070 coronary angioplasties performed in our Institute, the radial arterial approach was chosen in 5,354 cases (59%). During this period, the proportion of procedures performed via the radial artery progressively increased to 78% of cases in 1998. Cannulation of the radial artery was successful in 5,244 cases (98%). Rotatory atherectomy was used in 96 cases (2%), the excimer laser in 38 cases (1%) and stenting was performed in 3,350 cases (64%). Angiographic success was obtained in 5,224 patients (99%). Serious cardiac complications occurred in 82 patients (1.5%), including 17 deaths (0.3%), 22 Q wave myocardial infarctions (0.4%), 28 non-Q wave infarcts (0.5%), 5 coronary bypass procedures (0.1%) and 10 sub-acute occlusions (0.2%). The vascular complications included 1 death due to an ischaemic cerebrovascular accident, 25 haematomas at the puncture site (0.5%) and 3 surgical arterial repairs. The radial pulse disappeared after the procedure in 4% of cases, all asymptomatic. Angioplasty by the radial artery in the hands of trained operators is feasible and associated with a relatively low rate of cardiac and vascular complications.

In-stent restenosis: long-term outcome and predictors of subsequent target lesion revascularization after repeat balloon angioplasty.

OBJECTIVES: We sought to evaluate the long-term clinical outcome of patients undergoing successful balloon angioplasty for in-stent restenosis, and to determine correlates of the need for subsequent target lesion revascularization (TLR). BACKGROUND: In-stent restenosis can be safely treated by repeat percutaneous intervention. Reported subsequent TLR rates have varied from 20% to 80% and seem related to the type of restenotic lesion. METHODS: The study population comprised 234 patients with follow-up data who were successfully treated with repeat balloon angioplasty for in-stent restenosis in 257 lesions between May 1995 and January 1998 at our institution. RESULTS: Clinical follow-up was available at 459 (286 to 693) days after the repeat procedure. Event-free survival was 78.5% and 74.6% at 12 and 24 months, respectively. Recurrent events occurred in 58 patients (24.8%), including 6 deaths (2.6%), 4 myocardial infarction (1.7%) and repeat target vessel revascularization in 50 patients (21.4%). Independent predictors of repeat TLR were time to in-stent restenosis <90 days (Hazard ratio 4.67, p < 0.001), minimal luminal diameter after repeat procedure (Hazard ratio 0.38, p = 0.034) and the angiographic pattern of in-stent restenosis (Hazard ratio 1.65, p = 0.036). CONCLUSIONS: Balloon angioplasty is an effective means of treating in-stent restenosis. The long-term results are acceptable particularly for focal restenotic lesions. Further restenosis is more common in patients with early initial recurrence, more proliferative lesions and a poorer angiographic result from repeat angioplasty.

Coronary stenting in diabetics: immediate and mid-term clinical outcome.

Balloon angioplasty in diabetics is associated with acceptable immediate results but with high rates of restenosis, target vessel revascularization, and late mortality. The impact of coronary stenting on the outcome of these patients remains controversial. We reported the immediate and mid-term clinical outcome of 272 consecutive diabetic patients, representing 12.5% of the population undergoing coronary stenting between May 1995 and April 1997. Diabetes mellitus was insulin-requiring in 58 patients and non-insulin-requiring in 214. Stenting performed on large vessels (mean diameter >/=3 mm) was successful in 99.2% of nondiabetic patients and in all cases in diabetics. During in-hospital stay, the complications rate, including mortality, nonfatal myocardial infarction, emergency coronary bypass surgery, and stent subacute thrombosis, was similar in nondiabetic patients, insulin-requiring, and non-insulin-requiring diabetics (2.55%, 0%, and 2.0%, respectively). No complication occurred in the insulin-requiring group. One patient (0.5%) died from myocardial infarction and another (0.5%) presented a nonfatal myocardial infarction (subacute stent thrombosis) in the non-insulin-requiring group. The clinical follow-up (mean length 13 +/- 8 months) was obtained in 93% and 97% of the insulin-requiring and non-insulin-requiring diabetics, respectively. Overall mortality was significantly higher in insulin-requiring patients (9.3% vs. 2.4%). Nonfatal myocardial infarction and target lesion revascularization rates were similar in the two groups (0% vs. 0.5% and 8.2% vs. 10.5%). These results suggest that coronary stenting in diabetics could be performed with acceptable immediate and mid-term results. Cathet. Cardiovasc. Intervent. 47:279-284, 1999.

Alpha-adrenergic blockade improves recovery of myocardial perfusion and function after coronary stenting in patients with acute myocardial infarction.

BACKGROUND: AMI reperfusion by thrombolysis does not improve TIMI flow and LV function. The role of infarct-related artery (IRA) stenosis and superimposed changes in coronary vasomotor tone in maintaining LV dysfunction must be elucidated. METHODS AND RESULTS: Forty patients underwent diagnostic angiography 24 hours after thrombolysis. Seventy-two hours after thrombolysis, the culprit lesion was dilated with coronary stenting. During angioplasty, LV function was monitored by transesophageal echocardiography. Percent regional systolic thickening was quantitatively assessed before PTCA, soon after stenting, 15 minutes after stenting, and after phentolamine 12 microg/kg IC (n=10), the alpha1-blocker urapidil 600 microg/kg IV (n=10), or saline (n=10). Ten patients pretreated with beta-blockers received urapidil 10 mg IC. Coronary stenting significantly improved thickening in IRA-dependent and in non-IRA-dependent myocardium (from 27+/-15% to 38+/-16% and from 40+/-15% to 45+/-15%, respectively). Simultaneously, TIMI frame count decreased from 39+/-11 and 40+/-11 in the IRA and non-IRA, respectively, to 23+/-10 and 25+/-7 (P<0.05). Fifteen minutes after stenting, thickening worsened in both IRA- and non-IRA-dependent myocardium (to 19+/-14% and 28+/-14%, P<0.05), and TIMI frame count returned, in both the IRA and non-IRA, to the values obtained before stenting. Phentolamine and urapidil increased thickening to 36+/-17% and 41+/-14% in IRA and to 48+/-11% and 49+/-17% in non-IRA myocardium respectively, and TIMI frame count decreased to 16+/-6 and to 17+/-5, respectively. Changes were attenuated with beta-blocker pretreatment. CONCLUSIONS: Our finding that alpha-adrenergic blockade attenuates vasoconstriction and postischemic LV dysfunction supports the hypothesis of an important role of neural mechanisms in this phenomenon.

Results of stenting of unprotected left main coronary artery stenosis in patients at high surgical risk.

From March 1994 to September 1996, 39 patients underwent stenting of the unprotected left main coronary artery because of high surgical risk. Stenting appeared to improve clinical outcome, but there was a significant mortality rate at long-term follow-up.

[Implantation of coronary stents in diabetic patients. Short- and medium-term clinical results]. / Implantation d'endoprothèses coronaires chez les patients diabétiques. Résultats cliniques à court et moyen terme.

Coronary balloon angioplasty is associated with a high incidence of restenosis in diabetics and of revascularisation of the culprit lesion and increased long-term mortality. The authors report the short and medium-term results of coronary stenting in diabetics. Between May 1995 and April 1997, 2,182 patients underwent coronary stenting. This population included 272 diabetics : 58 insulin-dependent and 214 non-insulin dependent (oral antidiabetics). Stents were implanted in vessels with mean diameters of 3 mm and over. During the hospital period, the complication rate (mortality, non-fatal myocardial infarction, emergency coronary bypass surgery, subacute thrombosis of the stent) was comparable in non-diabetics, insulin-dependent and non-insulin-dependent diabetics (2.55, 0 and 2.0% respectively). One patient (0.5%) died and another (0.5%) had non-fatal myocardial infarction (thrombosis of the stent) in the non-insulin-dependent group. No complications were observed in the insulin-dependent diabetic group. The mean clinical follow-up of 13 months (3-26 months) was respected in 93 and 97% of diabetics. The non-fatal myocardial infarction rate and revascularisation of the culprit lesion were comparable in the insulin and non-insulin-dependent groups (0 versus 0.5% and 8.2 versus 10.5% respectively) but global mortality was higher in the insulin-dependent diabetics (9.3 versus 2.4%).

Postischemic left ventricular dysfunction is abolished by alpha-adrenergic blocking agents.

OBJECTIVES: We sought to evaluate the efficacy of alpha-adrenergic blocking agents in counteracting left ventricular (LV) dysfunction occurring after transient ischemia in humans. BACKGROUND: The mechanisms underlying postischemic LV dysfunction are largely unknown. METHODS: Percutaneous transluminal coronary angioplasty (PTCA) provides a clinical model of ischemia and reperfusion. In 50 patients undergoing coronary stenting for 77+/-5% stenosis, LV function was monitored by transesophageal echocardiography during and 30-min after PTCA. Fifteen minutes after stenting, 15 patients received 12 microg/kg body weight of the alpha-blocker phentolamine intracoronarily, 15 patients received 600 microg/kg of the alpha1-blocker urapidil intravenously, 10 patients received the combination of phentolamine and 1.2 mg of propranolol intracoronarily, and 10 patients received saline. RESULTS: Fifteen minutes after successful coronary dilation, significant contractile dysfunction occurred in previously ischemic and nonischemic myocardium. LV dysfunction was accompanied by an increase in coronary resistance and diffuse vasoconstriction. Alpha-blockers counteracted LV dysfunction and coronary resistance and the increase in vasoconstriction. Phentolamine and urapidil increased global LV shortening from 34+/-9% to 45+/-8% and to 49+/-8%, respectively (p < 0.05). After the administration of propranolol combined with phentolamine, LV dysfunction remained unchanged (34+/-6%), as in control subjects. CONCLUSIONS: LV dysfunction occurs after PTCA, as described in animal models after ischemia. Alpha-blockers abolished LV, macrocirculatory and microcirculatory dysfunction, whereas the alpha-blocker effect was prevented by combining alpha- and beta-blockers. The evidence of diffuse rather than regional dysfunction, together with the opposite effects of alpha- and beta-blockade, supports the hypothesis of neural mechanisms eliciting postischemic LV dysfunction.

The alpha-1 adrenergic blocking agent urapidil counteracts postrotational atherectomy "elastic recoil" where nitrates have failed.

Calcium antagonist pretreatment and intracoronary high doses of nitrates (9 mg of isosorbide dinitrate) do not counteract coronary vasoconstriction occurring after rotational atherectomy. In 30 patients undergoing Rotablator atherectomy, intracoronary injection of the alpha 1-sympathetic blocker urapidil abolished or prevented significant vasoconstriction occurring 15 minutes after the procedure despite repeated injections of nitrates.

Ticlopidine and aspirin pretreatment reduces coagulation and platelet activation during coronary dilation procedures.

OBJECTIVES: It is unknown whether a therapeutic combination of aspirin (ASA) and ticlopidine might effectively decrease activation of hemostasis. BACKGROUND: Percutaneous transluminal coronary angioplasty (PTCA), rotational atherectomy and stent implantation are procedures that fracture or ablate endothelium and plaque, a situation that activates hemostasis. METHODS: In 85 patients undergoing PTCA for a 77.8 +/- 1% stenosis, we measured markers of coagulation and platelet activation (thrombin-antithrombin complexes [TAT], prothrombin fragment 1 + 2 [F1 + 2] serotonin and the presence of circulating activated platelets reacting with monoclonal antibodies against glycoproteins exposed on platelet membranes). Blood samples were drawn from a peripheral vein and from the coronary ostium before the procedures. Both immediately and 10 min after angioplasty, and 10 min afterward, samples were collected from a probing catheter (0.018 in, [0.46 cm]) positioned beyond the stenosis. All patients were being treated with antianginal drugs and ASA, 250 mg/day. Seventy of them had taken ticlopidine, 250 mg, twice daily for < or = 1 day (< or = 24 h) (n = 28) or for > or = 3 days (> or = 72 h) (n = 42). Heparin (150 U/kg) was administered before angioplasty. Thirty patients underwent PTCA; 15 of them were not treated with ticlopidine and 15 were given ticlopidine (> or = 72 h). Thirty-five patients had stent implantation, 20 rotational atherectomy. RESULTS: Before and during the procedures, there was greater thrombin generation (expressed by higher TAT and F1 + 2 plasma levels) in patients not taking ticlopidine or taking it for < or = 24 h (p < 0.05). Platelet activation and plasma serotonin levels were also significantly higher in the no ticlopidine or < or = 24-h ticlopidine groups. CONCLUSIONS: The combined use of ticlopidine, ASA and heparin effectively controls activation of coagulation in patients with stable or unstable angina undergoing coronary dilation.

[The short-term results and angiographic predictors of subacute thrombosis in the coronary implantation of the Palmaz-Schatz endoprosthesis]. / Resultados a corto plazo y predictores angiográficos de trombosis subaguda en la implantación coronaria de la endoprótesis de Palmaz-Schatz.

INTRODUCTION AND OBJECTIVES: Intracoronary stenting has been proposed as an adjunct to balloon angioplasty in order to improve the immediate and long-term results. The purpose of this study was evaluate the short-term results, subacute closure rate and to try to identify angiographic predictors of subacute thrombotic after Palmaz-Schatz stent implantation. METHODS: Through a prospective registry, we have evaluated in 500 patients the safety and efficacy of Palmaz-Schatz stent implantation (580 in total) in coronary arteries and saphenous vein grafts. The identification of clinic and angiographic predictors of subacute closure have been evaluated with the assistance of a BMDP statistical software using an univariate and multivariate statistical analysis (logistic regression). The determination of diameter and stenosis has been achieved by electronic caliper. RESULTS: The stent was implanted successfully in 98.6% of the patients. There was no abrupt closure (< or = 1 day), however 36 patients (7.2%) developed subacute thrombotic closure (among 2nd-21st day after stenting). The major complications were: death 9 patients (1.8%), bypass surgery 7 patients (1.4%) and myocardial infarction 21 patients (4.2%). The predictors of subacute thrombotic closure through univariate statistical were: stenting for bail-out (S.T.: 27%; p < or = 0.0001), multiple stenting (S.T.: 24.1%; p < or = 0.0001), final diameter stent < or = 3.25 mm (S.T.: 12.6%; p < or = 0.013), and left ventricular ejection fraction < or = 45% (S.T.: 15.7%; p < or = 0.022). We showed with logistic regression that final diameter stent < or = 3.25 mm; p < or = 0.0030, left ventricular ejection fraction < or = 45%; p < or = 0.0012, stenting for bail-out; p < or = 0.0195 and multiple stenting; p < or = 0.0252, were predictors of subacute thrombotic closure. CONCLUSIONS: The Palmaz-Schatz coronary stenting will preferably realize in those arteries bigger than 3.25 mm and left ventricular ejection fraction > 45%, showing multiple stenting and stenting for bail-out greater subacute thrombotic closure rate.

Coronary vasoconstriction after percutaneous transluminal coronary angioplasty is attenuated by antiadrenergic agents.

BACKGROUND: Vasoconstriction occurs after percutaneous transluminal coronary angioplasty (PTCA) along the dilated vessel. The vasomotor changes, initiated by the mechanical stretch of the stenotic region, are thought to be due to various mechanisms but whether the sympathetic nervous system plays a role in this phenomenon remains unknown. METHODS AND RESULTS: Quantitative angiography (ARTREK) was performed in 45 patients undergoing an epicardial vessel PTCA for a stenosis of 76 +/- 1% (1) in basal conditions, (2) after PTCA, and (3) 30 minutes after PTCA (vasoconstriction). In 14 control patients, the same measurements were obtained up to 60 minutes after PTCA. Coronary diameters were measured along the PTCA vessel at the narrowest stenosis level and at a level peripheral to stenosis. In 36 patients two diameters were also measured at a proximal segment and at a distal segment along a nonmanipulated vessel. Thirty minutes after PTCA the dilated segment underwent a -31 +/- 2% (mean +/- SEM, ANOVA, P < .05) reduction in diameter when compared with PTCA values, and the segment peripheral to stenosis showed a reduction of -17 +/- 2% (P < .05). In all patients a significant vasoconstriction also was observed along the control vessel (proximal segment, -14 +/- 3%; P < .05 versus basal; and distal segment, -17 +/- 2%). At the time of maximal vasoconstriction (30 minutes after PTCA), the patients (treatment groups) received (1) 18 micrograms/kg IC phentolamine (Phe, n = 7), (2) 14 micrograms/kg IC yohimbine (YO, n = 7), (3) 16 micrograms/kg IC propranolol (Pro) followed by 18 micrograms/kg IC phentolamine (Pro+Phe, n = 7), and (4) 0.2 mg/kg IC bretylium (Bre, n = 10). In 14 patients (control groups) an intracoronary injection of warm saline was given. After drug injections, angiograms were repeated at 5-minute intervals for 20 minutes and ended after a 300-micrograms intracoronary trinitroglycerin injection. At stenosis level, Phe and Bre counteracted vasoconstriction, inducing a dilatation of +19 +/- 3% and +22 +/- 6%, respectively, while Pro+Phe caused a dilatation of +16 +/- 9% above the PTCA values (P < .05 versus PTCA). YO only partially reversed vasoconstriction (from -33 +/- 4% to -12 +/- 4%, P = NS versus PTCA). At peripheral-to-stenosis level, vasoconstriction was abolished by Phe (+26 +/- 7%, P < .05 versus basal), while it was still present after Pro+Phe (-23 +/- 2%) and Bre (-18 +/- 4%). In addition, Phe and Bre dilated the control vessel at the proximal segment (+17 +/- 6% and +8 +/- 4%, respectively, P < .05 versus basal), while YO and Pro+Phe only counteracted vasoconstriction (from -15 +/- 3% to +7.6 +/- 1% and from -16 +/- 3% to +4 +/- 5%, respectively, P = NS versus basal). At the distal segment only Phe produced a vasodilatation of +23 +/- 1%; YO counteracted constriction (from -16 +/- 2% to +9 +/- 6%, P < .05 versus basal), whereas after Pro+Phe and Bre, the vasoconstriction persisted. CONCLUSIONS: The mechanical stretch and ischemia caused by balloon inflation induced vasoconstriction mediated by alpha-adrenergic receptors (mainly alpha 1), overcoming a beta-mediated dilatation. The use of different antiadrenergic drugs showed that Phe counteracts post-PTCA vasoconstriction, and the simultaneous use of alpha- and beta-receptor blocking agents (Pro+Phe and Bre) reveals the presence of a peripheral, predominant beta-mediated dilatation. The presence of vasoconstriction also along the control vessels not branching from the stretched ramus provides evidence for the existence of neural sympathetic vasoconstrictor reflexes.

[Direct angioplasty without previous fibrinolytic treatment during the 1st hours following myocardial infarction]. / Angioplastie directe, sans traitement fibrinolytique préalable, dans les premières heures de l'infarctus du myocarde.

Direct coronary angioplasty as an emergency procedure in the first hours of myocardial infarction without prior thrombolytic therapy requires a heavy infrastructure. The different results reported in the literature show a recanalisation rate of 90% with an average hospital mortality of 7%, an acceptable risk given the inclusion of patients of over 75 years of age in these series and cases of cardiogenic shock. The reocclusion rate in the hospital phase is between 10 and 15%. At medium term, the survival rates of single vessel disease are excellent but the mortality is higher in multivessel disease (78% survival at 2 years). Angioplasty performed in the first three hours after the onset of symptoms is associated with an improvement in global an regional left ventricular function in patients with anterior infarction and altered initial left ventricular function. The preliminary results of a randomised multicenter trial comparing direct angioplasty with intravenous thrombolytic therapy with rt-PA (PAMI) seem to show in favour of angioplasty with a lower rate of complications in the hospital phase. The results of this multicenter trial should provide information as to the exact role of direct angioplasty in the initial phase of infarction, a procedure reserved for well-equipped cardiological centres with highly trained invasive cardiologists.

Intracoronary stent implantation: new approach using a monorail system and new large-lumen 7F catheters from the brachial route.

In this brief report we describe a case of successful multivessel PTCA with intracoronary stent implantation using a new large-lumen 7F catheter from the left brachial approach. The application of this technique should be considered for intravascular stent implantation when anticoagulation ideally should not be interrupted or in anatomical situations limiting femoral vascular access.

[Topographic aspects of threatened extension of transmural myocardial infarction. Electrocardiographic and coronarographic data]. / Aspects topographiques de la menace d'extension d'infarctus du myocarde transmural. Données électrocardiographiques et coronarographiques.

The topographical and physiopathological aspects of the danger of extension of infarction of the myocardium are defined with the aid of data collected by electrocardiogram and coronarography in 50 patients. The danger of extension in situ, observed in 64% of the cases, is the most frequent and complicates particularly the progression of anterior infarcts. In fact, it is located in the same area as the initial infarct in 91% of the cases for anterior infarcts and in 40% of the cases for inferior infarcts. It is expressed by an elevation of the ST segment in 84% of the cases and corresponds to a monotruncular attack in 63% of the cases. The downstream bed of the vessel destined for the infarcted area and threatened secondarily remains permeable in the anterograde sense. Apart from infarcts, the danger of extension is less frequent, found in 36% of the cases, and complicates preferentially the progression of inferior infarcts. It finds expression in a depression of the ST segment in 77% of the cases and the coronary attack is always pluritruncular. The mortality in one month is 35% of 17 patients treated medically and 3% of 33 patients who have been equipped with a shunt or angioplasty. In situ the danger of extension denotes the presence of cellular islets, which are still healthy, in the region of an infarcted myocardial zone, the viability of which may be threatened secondarily by a phenomenon of coronary occlusion, which is intermittent and repeated. Except for an infarct, the danger of extension implies the diffusion of an atheromatous effect. The good results of surgical treatment or dilatation argues in favour of an early coronarographic exploration.

[Anti-arrhythmia and electrophysiological effects of encainide in supraventricular tachycardias]. / Effets électrophysiologiques et anti-arythmiques de l'encaïnide dans les tachycardies supraventriculaires.

In order to assess the electrophysiologic effects and anti-arrhythmia effects of encainide after acute IV injection and chronic oral therapy, a group of 10 patients (mean age 54) with recurrent supraventricular tachycardia was studied. Seven patients had more than 2 attacks per month, and supraventricular tachycardia (SVT) resulted in severe symptoms in the three remaining SVT was due to AV nodal re-entry in 6 patients and to concealed accessory pathway in 4. After a control study, SVT was initiated, and encainide (0.75 mg/kg) was infused intravenously in attempt to stop the tachycardia. A second study was achieved. After 4 days of oral therapy (25 or 50 mg T.I.D.) a third study was performed, including SVT initiation attempts. Encainide depressed conduction in all cardiac tissues, and this effect was more evident after oral administration. Antegrade I:I conduction cycle length increased of 13.9% (p less than 0.05), and the same parameter in retrograde conduction increased of 30.03% (p less than 0.05). IV injection interrupted 2 of 10 SVT only. However, after 30 minutes, 5 re-initiated SVT were nonsustained, and mean cycle length increased from 326 +/- 21 to 397 +/- 51 (p less than 0.01). After oral therapy, SVT was initiated in 4 of 10 patients, nonsustained in 3. During long term follow-up (one year or more), no severe adverse effect has been reported. Three patients are still experiencing short events of well-tolerated SVT. Hence, moderate or low doses or oral encainide may safely control recurrent supraventricular tachycardia.

[Oral propafenone in resistant auricular arrhythmia]. / Etude de la propafénone orale dans les arythmies auriculaires rebelles.

Paroxysmal episodes of atrial frequently cause severe functional disturbance because of their recurrent nature. Propafenone (Rythmol) is a very active anti-arrhythmic at the ventricular level which acts by decreasing the rate of atrio-ventricular and intra-ventricular conduction and by prolonging the refractory period of the right atrium and the accessory pathways. The authors conducted an open study of this drug in 20 cases with resistant, recurrent atrial fibrillation. All of the patients were known to have recurrent episodes of atrial fibrillation which could not be prevented by a variety of antiarrhythmic agents. They performed a clinical, electrocardiological and laboratory evaluation of these patients. Holter monitor recordings were performed prior to entry into the study, during the first week of treatment, between the 4th day and the 8th day, on the 20th day, at the 2nd month and between the 3rd and 6th months. Propafenone was prescribed at a dose of 900 mg per day and the initial dose was reduced to 600 mg after the 3rd month of treatment. Five patients can be classified as therapeutic failures, as the arrhythmia recurred. These patients presented a "vagal" atrial fibrillation preceded by an episode of bradycardia. 15 patients can be considered to have obtained a successful result, as no recurrences were detected during the 6 month observation period. The electrical and laboratory tolerance was satisfactory. The most frequent side effects were minor transient gastrointestinal disturbances.

[Myocardial revascularization in the developing phase of myocardial infarction using intracoronary thrombolytic therapy]. / Revascularización miocárdica en fase de constitución del infarto de miocardio por tratamiento trombolítico intracoronario.

The author's experience on intracoronary thrombolysis on 71 patients that underwent coronary angiography in the first six hours of myocardial infarction is presented. The coronary artery responsible for the infarction was totally occluded in 66 cases and presented a subtotal occlusion in the remaining 5 cases. The protocol included the intracoronary injection of 2 mg isosorbide dinitrate and 78.000-385.000 U of streptokinase. An early reperfusion occurred in 66% of the patients, without mortality in the acute phase. ST-segment returned to normal in 41 of the 47 reperfused cases, but a Q wave developed in 42 cases. Hospital mortality was 6,4%, and the reocclusion rate was 17%.