[Prevention of atrial fibrillation by atrial-based pacemaker implantation]. / A pitvari fibrilláció megelözése pitvari vagy pitvar-kamrai szekvenciális pacemaker-beültetéssel.

A large number of studies have demonstrated the long term disadvantage of single lead ventricular pacing in sick sinus syndrome. Ventricular pacing mode predicts chronic atrial fibrillation in patients with preimplant paroxysmal atrial fibrillation. The goal of the report was to study the effectiveness of single atrial and dual chamber (atrio-ventricular sequential) pacemaker treatment in the prevention of atrial fibrillation for patients with sick sinus syndrome complicated with paroxysmal atrial fibrillation. In our university hospital 16 atrial based 5 and dual chamber 11 pacemaker were implanted for treatment of patients with sick sinus syndrome (with or without AV conduction disturbances) complicated with paroxysmal atrial fibrillation. The mean age were 61 (24-78), nine males and seven females. Before or during pacemaker implantation sinus node and AV node function analysis, and echocardiography were performed. There were no surgical complications, lead and/or generator failure. All patients had routine follow-up performed at 4 weeks, 3 months, 6 months. Mean follow up was 31 +/- 8 months (range 3 to 93 months). The atrial based and dual chamber pacing were effective in 90% of our cases. In one patient the treatment had to be combined with propafenone. According to our result, the atrial based pacing may be used to reduce the incidence of atrial fibrillation with careful programming of the base atrial pacing rate, and it is associated with lower frequencies of thromboembolic complications and pacemaker syndrome.

[Lipid lowering treatment in secondary prevention following myocardial infarct]. / A lipidszintcsökkentó terápia helye a myocardialis infarctust követó szekunder prevencióban.

1081 patients treated with myocardial infarction between 1990-1995 were investigated retrospectively, 652 (60.3%) of the patients were male and 429 (39.7%) were female. 154 (14.2%) patients had an early, while 927 (85.5%) patients had late myocardial infarction. Of the patients with early myocardial infarction 52.3% were smokers, 45.2% had positive family history for ischaemic heart disease or acute myocardial infarction. The lipid parameters were analysed in detail, because 83.3% of the patients were hyperlipoproteinaemic. The mean cholesterol level was 6.91 +/- 1.2 mmol/l, the HDL-C level was 1.19 +/- 0.38 mmol/l, the triglyceride level was 2.66 +/- 1.8 mmol/l, the LDL-C level was 4.71 +/- 1.2 mmol/l. The serum LDL-C and the HDL-C levels of the patients with early myocardial infarction were compared to the desirable levels suggested for secondary prevention. Only 7.2% of the male patients had a cholesterol level below 5.2 mmol/l, while all female patients cholesterol levels were above 5.2 mmol/l. Of the male patients 53.6%, while 78.6% of females had lower triglyceride levels than 2.3 mmol/l 78,6% of the male patients had higher protective HDL-C level in the optimal range (> 1.1 mmol/l). 12.5 percent of the male patients had an LDL-C level lower than the value targeted by secondary prevention (3.0 mmol/l), while all of the female patients LDL-C levels were higher. The authors emphasize the importance of secondary prevention and a more widespread use of lipid lowering treatment for patients after acute myocardial infarction.

[Effect of lovastatin on serum lipids and lipoproteins. Hungarian multicenter, open-label study]. / Lovastatin kezelés hatása a serum lipidekre és lipoproteinekre. Hazai, nyitott, többcentrumos vizsgálat.

The authors studied the effects of lovastatin on the parameters of serum and lipoprotein lipids in an open multicenter trial. 160 patients with hypercholesterolemia participated in the study, 151 of whom completed the trial. After a 4 week period of dietary measures, the patients were treated with lovastatin for 12 weeks while combining standard lipid lowering diet. The initial dose of the drug was 20 mg, this was increased until serum cholesterol level decreased under 5.2 mmol/l, or to a maximal daily dose of 80 mg. By the end of the 12th week, serum cholesterol level was reduced by an average of 33% (p < 0.001), LDL-cholesterol by an average of 45% (p < 0.001), serum triglyceride concentration by an average of 22% (p < 0.001) and HDL-cholesterol increased by an average of 13% (p < 0.001). Lovastatin showed a very good safety profile, therapy had to be cancelled due to the occurrence of adverse events only in 4 cases.

[Clinical cardiac electrophysiological studies in carotid sinus syndrome]. / Klinikai szív-elektrofiziológiai vizsgálatok carotis sinus syndromában szenvedö betegekben.

The aim of the present study was to evaluate the impact of electrophysiological study in the diagnosis and treatment of carotid sinus syndrome. The indications for the study include (1) attempting to exclude other cardiogenic causes of syncope; block, tachyarrhythmia, (2) diagnosing a vasodepressor response in the presence of cardioinhibitory type of carotid sinus syndrome, (3) determination of the optimal pacing mode in patients who need pacemaker implantation for treatment. 51 patients, 40 male (78%) and 11 female (22%) with an average age of 62 years suffering from carotid sinus hyperaesthesia--3000 ms ventricular asystole on carotid sinus massage--were investigated with electrophysiological study. The A-H interval in 8 patients (16%), the H-V interval in 5 pts (10%) were prolonged in the His bundle electrocardiogram. In 39 patients (76%) sinoatrial block, in 12 patients (24%) A-H block was found during carotid sinus massage. Early A-H Wenckebach block occurred in 8 patients (16%). Retrograde (V-A) conduction was present in 36 patients (70%) at a frequency of 65-85 bpm, and 22 pts (43%) at a frequency of 120-180 bpm. Sinus node disease was found in 10 patients (20%) according to the sinus node recovery time and sinoatrial conduction time. In 8 patients (16%) supraventricular and in 4 patients (8%) ventricular tachyarrhythmia was induced during study. The atrial stimulation could not prevent the occurrence of A-V block during carotid sinus massage in any of the 51 patients. In 2 patients (4%) the vasodepressor reaction with ventricular stimulation was determined.(ABSTRACT TRUNCATED AT 250 WORDS)

[Management of drug-resistant supraventricular tachycardia using AV-junction radiofrequency ablation]. / Gyógyszer rezisztens supraventricularis tachycardia kezelése az AV-junctio radiofrekvenciás ablációjával.

The closed chest His bundle ablation is a worldwide accepted therapeutic method for the treatment of drug resistant supraventricular tachycardias. In the first years high-energy DC shock was applied for achieving the needed therapeutic effect. Reducing the complications caused by the DC shock, radiofrequency energy was introduced into the clinical practice. Authors describe the first successful human application of radiofrequency ablation of AV junction in Hungary.

[The role of thoracic radiography in the intensive care unit of a department of internal medicine]. / Helyszíni mellkasfelvételek alkalmazása belgyógyászati intenzív osztályon.

Authors review the main principles of chest X-ray examination methodology and analyse their one-year material. During this time 225 chest X-ray films were taken by means of a mobile X-ray unit. The majority of patients were treated for cardiac disorders (e.g. AMI). Authors analyse the distribution of patients according to their illnesses, the correlation between the clinical and the radiological diagnoses and the quality of the X-ray films. Authors emphasize the importance of the correct collaboration between the staff of the intensive care unit and the radiological department.

Incidence of rhythm disorders in hyperthyrosis with special respect of old age form.

Sinus tachycardia and atrial fibrillation are frequent features in hyperthyrosis while sinus node dysfunction is regarded as a rare complication. Bradycardia may cause diagnostic problems mainly in atypical hyperthyrosis of the old age. The authors analysed distribution and age related association of the rhythm disorders in hyperthyrosis. In case of the appearance of Sick Sinus Syndrome (SSS), parameters representing the function of sinus node were studied by electrophysiological investigations. Above the age of 50 years incidences of atrial fibrillation and SSS were significantly increased. The abnormal sinus node function proved to be reversible in a portion of the cases. In old age, in case of occurrence of the symptoms of SSS, possibility of hyperthyrosis also should be considered, especially when indication of permanent pacemaker is established.

[Atrioventricular block caused by tick bite--Lyme's carditis]. / Kullancs csípés okozta atrioventricularis blokk--Lyme carditis.

The authors present the case of a 44-year-old patient who was admitted to the hospital because of AV block of degree III. Six weeks earlier a tick was removed from the left foot of the patient. Two weeks later an erythema of 8 cm in diameter, spreading peripherally as well as painful inguinal lymphadenitis developed at the site of the bite with transient arthralgia and myalgia in the region of the waist and left lower limb. After the temporary use of pacemaker, steroid and atropine therapy applied because of the pronounced bradycardia the block became of degree I on the 4th day however negative T-waves appeared in leads III, aVF, V3. By the 14th day the AV time returned to normal and the pathological signs of repolarization disappeared. Serological examinations revealed increased Borrelia burgdorferi antibody level. Lyme's carditis may be prevented by starting the antibiotic therapy at the time of the chronic erythema migrans. Upon medication the patient may recover from the carditis without remaining symptoms.

Temporary pacing in complete heart block due to Lyme disease: a case report.

The authors present the case of a 44-year-old man who was admitted with complete heart block and signs of severe bradycardia. After steroid administration and temporary pacemaker treatment the complete heart block resolved. During this therapy transient ST segment and T wave abnormalities occurred. The positive Borrelia burgdorferi antibody titer arrived only after therapy had been completed. This is regarded as the first case of Lyme carditis with complete heart block diagnosed in eastern Europe. Carditis resolved without antibiotic treatment and has not recurred.

Complex arrhythmia analysis in uraemic haemodialysed patients.

Impulse formation and conduction disturbances of the heart were investigated in 23 uraemic patients with transvenous and oesophageal electrodes. Utilizing regular atrial pacing the sinoatrial conduction time (SACT) was obtained and sinus automaticity was evaluated by measurement of the sinus node recovery time (SNRT). The atrial effective refractory period and the Wenckebach point were also determined. The effects of regular haemodialysis treatment on impulse formation and propagation disorders caused by uraemia were observed. In 16 patients transitory or permanent cardiac stimulation had to be carried out because of 2nd and 3rd degree AV block. No complication was observed during simultaneous haemodialysis and pacemaker treatment. It is concluded that the non-invasive, simple bedside oesophageal atrial stimulation method is a good alternative and should be used in the exact diagnosis of heart conduction disturbances of haemodialysed patients.

Lithium carbonate in the management of intractable congestive heart failure.

Lithium carbonate was administered to 11 patients with advanced congestive heart failure resistant to the usual forms of therapy. Abundant diuresis, consecutive regression of oedema, loss of weight and clinical improvement ensued in response to lithium therapy. Doses ensuring a serum level of 0.5 to 1.0 mmol/l are regarded as optimal in heart disease. Within this range lithium produces no clinical or ECG signs of cardiotoxicity, provided the serum Na and K levels remain normal. The side-effects observed are reported in detail and attention is drawn to the necessity of follow-up and especially of checking the serum lithium level.

Goodpasture's syndrome: haemodialysis, pacing and extrapulmonary oxygenation.

Two cases of Goodpasture's syndrome are reported. Intensive therapy, extracorporeal oxygenation by haemodialysis, assisted respiration and short-term pacing were applied together with immunosuppressive treatment and repeated exchange transfusions. By this treatment combined with bilateral nephrectomy a few weeks' remission was attained in a young female patient. An intensive therapy of this kind is recommended in rapid progressive glomerulonephritis of other types as well.