Incessant nonreentrant atrioventricular nodal tachycardia due to multiple nodal pathways treated by radiofrequency ablation of the slow pathways.

In patients with dual AV nodal physiology, simultaneous anterograde fast and slow pathway conduction resulting in an unusual form of nonreentrant AV nodal tachycardia has been observed. We describe the case of a young patient with an incessant form of complex supraventricular tachycardia who underwent electrophysiologic evaluation, which showed simultaneous conduction via multiple AV nodal pathways that caused a unique form of incessant nonreentrant AV nodal tachycardia. Radiofrequency ablation of the spatially closed intermediate and slow pathways effectively treated the tachycardia. The electrophysiologic determinants of simultaneous conduction through the multiple nodal pathways and the apparently different behavior of the fast pathway before and after ablation are discussed.

[Transcatheter radiofrequency bundle branch ablation in bundle branch reentry ventricular tachycardia: report of a case]. / Ablazione transcatetere con radiofrequenza della tachicardia ventricolare da rientro tra le branche: descrizione di due casi.

Two patients with branch to branch ventricular tachycardia (BBVT) are reported: successful radiofrequency catheter ablation of BBVT was performed in both, delivering energy distally to the point where the maximum amplitude of His deflection occurred, so that a wide ventricular deflection was obtained without any atrial electrogram. No significant conduction delay appeared but a right bundle branch block. HV intervals during BBVT resulted equal or longer than in sinus rhythm: whether this was secondary to anatomical or functional variations or to the possibility that the His bundle may be "bystander" in BBVT, is discussed.

Cancer incidence and mortality in patients with heart disease. Effect of oral anticoagulant therapy.

Cancer incidence and mortality were reviewed in patients (683) who, during the period 1969-1988, had been attending the Cardiological Center of Pisa University for more than 1 year for valvular (494), ischemic (183), or myocardial (6) disease. Oral anticoagulant therapy (tromexan, acenocoumarol or warfarin) was administered to 312 of these 693 patients and regulated to prolong prothrombin time to a value between 20% and 40% of normal controls. The duration of treatment ranged from 1 to 14 years, with a mean of 4 years. As clinical and radiological controls were performed on all the patients at regular intervals (2-12 months), cancer incidence and mortality were recorded. Cancer incidence and mortality in the 312 patients treated with anticoagulants were compared with that of the 381 patients who did not receive this therapy. Furthermore, cancer mortality in the patients on anticoagulants was compared to that expected on the basis of national tumor registry rates. The age of the patients varied from 20 or under to 80 or over in both groups. The total observation period was 1415 patient-years (555 for males and 860 for females) in the former and 1617 patient-years (735 males and 882 females) in the latter. The proportion of the patient-years of the men over 45 (with the highest risk of cancer mortality) was higher in the group treated with anticoagulants (83%) than in the controls (72%) (p < .001). The proportion of the patient-years of the women over 45 was also higher in the former (84% vs 62%; p < .001). Six cancers were observed in the patients treated with oral anticoagulants (3 men, 3 women), while 12 cancers occurred in the control group (9 men, 3 women). There were 3 deaths in the former (1 man, 2 women) and 6 in the latter (5 men, 1 woman). On the basis of the national tumor registry rates, deaths expected in men and women on oral anticoagulants were 3 and 2. These data are compatible with the hypothesis that oral anticoagulants might reduce cancer incidence and mortality in humans.

[Late ventricular potentials and acute ischemia: study during percutaneous transluminal coronary angioplasty]. / Potenziali tardivi ventricolari ed ischemia acuta: studio durante angioplastica coronarica transluminale percutanea.

In order to assess if acute ischemia induces ventricular late potentials (VLP), we have studied 35 patients during coronary angioplasty (PTCA), 15 (Group A) with previous myocardial infarction, 20 (Group B) without. VLP detection was performed by standard technique (in the time domain, with Simson algorithm, on 200 beats, using a 25 Hz filter) before, during and 24 hours after PTCA. This procedure was performed on: anterior descending artery (19 cases), circumflex artery (9 cases), right coronary artery (11 cases); four patients had PTCA on two vessels; in Group A patients, PTCA was performed in vessels related to the previous myocardial infarction. VLP were defined as present when at least two of three standard criteria of positivity were detected (QRSD > 115 ms, RMS40 < 25 microV, LPD > 32 ms). In all patients also left ventricular ejection fraction, end diastolic pressure, regional kinesis and amount of myocardium at risk (as measured by the "Duke University jeopardy score") had been assessed. Furthermore, the total and mean inflation time and the degree of induced acute ischemia were also considered. The following results were obtained: no patient had VLP at basal conditions, during PTCA in all patients of both groups we observed a significant prolongation of QRSD but only Group A patients developed VLP, in 56% of cases versus none of Group B. This event was transient: in fact, 24 hours after the procedure VLP were no more present. The two groups did not differ as regards to the values of all the other anatomic and functional above mentioned parameters. Probably the acute ischemia cannot evocate VLP by itself, but this "trigger" needs also a particular substrate with anatomical and functional abnormalities due to a previous myocardial infarction. Further investigations and long follow-up studies are requested to assess if these data could account for the presence of ventricular tachyarrhythmias in patients with acute coronary ischemia and previous myocardial infarction.

[Dynamic ECG in cerebral ischemic vasculopathies]. / L'ECG dinamico nelle vasculopatie cerebrali ischemiche.

Fifty-four subjects suffering from TIA or Stroke underwent normal ECG and Holter ECG ten days after ischemic cerebral event in order to point out cardiac dysrhythmias as possible causes of TIA or Stroke. Holter ECG proved positive in 70.3% of subjects versus 38.8% of normal ECG (p < 0.001). We underline the utility of cardiological valuation in patients suffering from TIA or Stroke in order to search for cardiac causes of ischemic cerebral events and to prevent relapses.

Platelet aggregation behaviour in patients treated with ticlopidine.

Thirty patients (18 women, 12 men) with permanent or paroxysmal atrial fibrillation were treated with a new antiplatelet drug, ticlopidine, in order to study platelet aggregation behaviour, to see whether the drug prevents thromboembolisms and to observe side-effects over a period of 6 months. A further comparative study of the effects of ticlopidine and dipyridamole + aspirin on platelet aggregation was carried out in 20 patients. All appropriate haematological parameters were tested every 3 months, while platelet aggregation curves with ADP were examined also after 15 days. At the end of the period an echocardiogram was performed to check for any sign of thrombosis. The reduction in the aggregation curves was statistically significant for all the ADP stimuli, except at low doses. In the comparison with dipyridamole + aspirin, ticlopidine gave better results; with the former there was no significant reduction in platelet aggregation. A more significant reduction was seen in patients who had showed hyperaggregation at the outset. Bleeding time was increased and platelet adhesivity was reduced. During the 6-month period a slight reduction in white blood cells and a slight increase in creatinine were observed, both remaining within the normal range. Some 33.3% of the patients experienced side-effects. No embolic event or thrombosis in the left atrium was seen. Ticlopidine seems to be an effective antiplatelet drug, especially for patients with hyperaggregation.

[Clinical, hemodynamic and cineangiocardiolographic findings in congestive cardiomyopathy]. / Rilievi clinici, emodinamici e contrastografici nella niocardiopatia congestizia.

Sixteen patients affected by congestive cardiomyopathy were studied by means of right and left cardiac catheterization and cineangiocardiography. Cardiac output and mean pulmonary circulation time were determined by the radiocardiographic method. Left ventriculograms were obtained in all the patients in the 45 degrees RAO projection; the left ventricular end diastolic and end systolic volumes were calculated both by the area-length and by the slice method. Among the several hemodynamic data (stroke index, mean pulmonary circulation time, left ventricular end diastolic pressure, left ventricular volumes and ejection fraction) the most early impaired and therefore usefull for an early diagnosis, were: the left ventricular end-systolic volume, the left ventricular end-diastolic volume and the left ventricular ejection fraction.