[Value of serial electropharmacologic tests in the treatment of sustained ventricular arrhythmias]. / Valore dei tests elettrofarmacologici seriati nel trattamento delle tachiaritmie ventricolari sostenute.

The value of electropharmacological testing in patients (pts) with sustained ventricular tachyarrhythmias was studied in 46 consecutive pts (24 with sustained ventricular tachycardia (SVT) and 22 with cardiac arrest due to a ventricular tachyarrhythmia. Forty-two pts underwent a baseline electrophysiological study. The ventricular stimulation protocol included up to 3 extrastimuli during spontaneous rhythm and during paced ventricular rhythm at 100/min, 130/min, 160/min and brief bursts pacing at 2 ventricular sites. Ventricular tachycardia was induced in 37/42 pts (88%) (sustained in 32 pts and non sustained in 5 pts). Twenty nine pts underwent 79 trials of different drug regimens (mean 2.72 per pt, range 1-8). A totally successful drug regimen was found in 15/29 pts (51.7%) and a partially successful drug regimen in 11/29 pts (37.9%). Twenty-three pts were discharged on a drug regimen successful during serial electropharmacological testing (Group I) and 23 pts were discharged on an empiric drug regimen (Group II). Each pt was followed-up for a mean period of 15 months (range 1-74). Group I pts had fewer arrhythmia recurrence (SVT and/or sudden death) than Group II pts (2/23 vs 13/23 p less than 0.01). In conclusion electropharmacological testing is an useful tool in the therapy of pts with sustained ventricular tachyarrhythmias.

[Post-ischemic inversion of the T wave]. / L'inversione post-ischemica dell'onda T.

The significance of new T wave inversion (so called post-ischemic T wave inversion) in the basal electrocardiogram of patients suffering from unstable angina is still controversial. Some AA suggest that the patients who develop this ecg pattern represent a subgroup with poor prognosis, particularly when to deep negative T waves (greater than 3 mm) a long QT interval is associated (giant negative T waves). On the contrary other AA suggest that there is not a different prognosis between patients which develop and which do not develop post-ischemic T waves (post-I T waves). We studied 113 patients with unstable angina: 95 patients were reviewed retrospectively (group I), 18 patients were studied perspectively (group II). In group I 63/95 developed post-I T waves (49 in anterior, 9 in inferior and 5 in both anterior and inferior leads) while 32/95 did not develop post-ischemic T waves. In group II all 18 patients developed post-ischemic T waves according to the characteristics of giant negative T waves. Follow up periods were 62 +/- 36 months in group I and 11 +/- 7 months in group II. In 61 cases (45 of group I and 16 of group II) the electrocardiogram was registered during anginal pain. ST increase and/or pseudonormalization of T wave from negative to positive, indicating transmural ischemia, was observed in 59% of patients with post-ischemic T waves vs 30% of pts without post-ischemic T waves (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)