[Effects of carbamazepine on heart conduction in young patients: a serial study using ambulatory ECG]. / Effetti della carbamazepina sull'eccitoconduzione cardiaca in soggetti giovani: studio seriato con ECG-dinamico.

BACKGROUND: Carbamazepine (CBZ) is a first-line drug in the treatment of epileptic seizures and neuralgia. CBZ is also a cardioactive drug and sometimes induces sinusal dysfunction or AV conduction defects. METHODS: In order to investigate the effect of CBZ on sinus node function and AV conduction, long-term ECG recording (24 hours) and determination of plasma concentration of CBZ were carried out in 10 epileptic patients without heart disorders (5 males and 5 females, mean age 31 years), in the basal state, during steady-state (7th day) and after 30th day of CBZ treatment. The number of total cardiac beats, mean heart rate, P-Q and Q-T interval, sinus-atrial node and atrioventricular dysfunction and intraventricular conduction delay were evaluated. RESULTS: Plasma CBZ concentration was always in the therapeutic range (5-12 micrograms/ml): 9.5 micrograms/ml in the 7th day and 7.8 micrograms/ml in the 30th day. No significant differences in the number of cardiac beats, or P-Q and Q-T intervals were found; there was no depression of sinus node function nor delay of AV conduction. In the basal state, ectopic supraventricular beats (105 +/- 20/24 hours) were observed in 7 patients and repetitive in five of them. In the first Holter ECG recording during CBZ treatment, a strong reduction of ectopic supraventricular beats (6 +/- 3/24 hours) and disappearance of the bursts was observed. In the second control, when the CBZ concentration was lower, the number of ectopic supraventricular beats were moderately increased (30 +/- 8/24 hours) and in one patient supraventricular tachycardia reappeared. CONCLUSIONS: In young epileptic subjects without signs of heart disease, CBZ seems to have no significant effect on conduction, yet has a possible antiarrhythmic effect.

Incidence of systemic thromboembolic lesions in acute myocardial infarction.

In a series of 1277 cases of acute myocardial infarction, 30 episodes of systemic, noncerebral, thromboembolic lesions in 22 patients have been detected. Locations most frequently involved were the extremities (60%), kidneys (16.6%), spleen (13.3%), and mesentery (10%). The incidence of thromboembolism has been higher in patients over the age of 60. In the great majority of cases, the myocardial infarction has been anterolateral, often with a superimposed pump failure. Mortality has been very high (54.5%), perhaps in relation to the advanced age of the patients and to the extension of the infarction. Embolism at the extremities has been well treated with Fogarty's catheter. Among patients whose postmortem examination has been performed a high incidence of ventricular aneurysm (3 of 7) and mural thrombosis (5 of 7) has resulted. In the cases of ventricular aneurysm, episodes of atrial fibrillation have always occurred.