Decremental conduction properties in overt and concealed atrioventricular accessory pathways.

AIM: Most atrioventricular accessory pathways (AV-APs) exhibit Kent bundle physiology characterized by fast and non-decremental conduction properties. In contrast, atriofascicular APs, which are only capable of reaching slow levels of long antegrade decremental conduction, are uncommon. The aim of this study was to describe antegrade and/or retrograde AV-APs with unusual decremental properties. METHODS AND RESULTS: Five patients with unusual decremental AV-APs underwent electrophysiological evaluation and radiofrequency catheter ablation for symptomatic tachycardias. Three were found to have structural heart disease, and three latent decremental AV-APs in the anterograde and/or retrograde direction that could not be demonstrated by routine electrophysiological testing. In Case 1, a right posteroseptal AV-AP with bidirectionally latent decremental conduction was associated with clinical antidromic circus movement tachycardia (CMT) mimicking ventricular tachycardia and orthodromic CMT, the latter inducible only with isoprenaline. In Case 2, incessant orthodromic CMT was due to a latent retrograde left posterolateral AV-AP. In both cases, double atrial responses to a single paced ventricular beat, initiating orthodromic CMT, were observed. In Case 3 with latent preexcitation unmasked by adenosine and atrial pacing, retrograde latent decremental conduction over a right posteroseptal AV-AP could be shown only with isoprenaline. This patient and the remaining two with overt preexcitation demonstrated anterograde decremental AP conduction that was discontinuous over a right posteroseptal AV-AP in Cases 3 and 4 and was continuous over a midseptal AV-AP in Case 5. In the latter case, the site of decremental conduction could be localized at the proximal AP origin. All five AV-APs were successfully ablated at the annulus level. CONCLUSION: AV-APs with unusual decremental properties that are either latent, demonstrable only during CMT or overt, exhibiting functional longitudinal dissociation are described. These APs could be identified and successfully ablated after detailed electrophysiological analysis.

[A survey of the medical and psychosocial status of 140 workers 32 months following myocardial infarct]. / Eine Befragung zur medizinischen und psychosozialen Situation von 140 Arbeiterinnen 32 Monate nach Myokarderstinfarkt.

We suspected there could be different social, psychological, and medical problems for women after a first myocardial infarction than those affecting men. 140 women (56.4 +/- 7 years) were interviewed by questionnaire 32 +/- 8.7 months after myocardial infarction; 83% (n = 119) responded (8.8% of the sample group had died), 12% suffered a reinfarction, and 11% underwent aortocoronary bypass surgery. For 84% of those responding it was harder to do their housework after myocardial infarction, but 73% did it without help. 51.5% showed a mood change that included increasing depression, anxiousness, and insecurity. In 12.5% of the women their relationship with their husband was adversely affected; in 6.6% their relationship with their children worsened. 83% (n = 89) saw their infarction as a result of stress. 45% could not relieve their stress after 32 months. A subjective feeling of stress decrease in 54% was achieved with a quieter life, in 39.5% by resigning their jobs, and in 6.5% by the death of the husband. Concerning somatic risk factors 74% of the smokers stopped smoking; oral contraceptives were discontinued in all cases. 90.5% (n = 97) of the women said they had their serum lipid values checked regularly, but these were only under control in 35%. We conclude the rehabilitation process does not end when patients leave a rehabilitation clinic. Patients should acquire household help, and their family situation should be discussed during their stay in the rehabilitation clinic. Concerning the somatic risk factors, women who survive myocardial infarction require better care and information.