[Sick sinus syndrome (extrinsic and intrinsic form) during long term observation]. / Obraz kliniczny zespolu chorego wezla zatokowego (postac czynnosciowa i organiczna) w czasie wieloletniej obserwacji.

UNLABELLED: The aim of the study has to be find, on basis of long term follow-up, an independent factors determining of pacemaker implantation in patients with intrinsic and extrinsic form of sick sinus syndrome. The second point was to find an independent risk factors of stroke and another serious complication in this group of patients (specially in paced group). The study group consisted 169 pts with sick sinus syndrome (in all pts abnormal electrophysiological tests--transoesophageal atrial stimulation). The form of sinus node dysfunction (extrinsic or intrinsic) was determined on basis of electrophysiological study after pharmacological denervation of the heart (propranolol and atropine i.v. in doses 0.2 and 0.04 mg/kg body weight respectively). The statistical analysis was performed on all pts (97 men and 72 women 48 +/- 16 yrs old) using Cox's model of proportional hazardous analysing. The follow-up period ranging from 14 to 84 months (mean 49.9 +/- 19). Pacemaker was implanted in 88 pts during observation period. Stroke signs were found in 7 pts including 6 pts after pacemaker implantation. There was 13 death (7 sudden or primary neurological death). CONCLUSIONS: 1) independent factors of pacemaker implantation were syncope, age and persistent bradycardia, 2) form of sinus node dysfunction was not an independent factor of this decision, 3) age (older), persistent after pacemaker implantation syncope and registered in transesophageal ecg ventriculo-atrial condition were independent risk factors of stroke in pts with VVI stimulation, 4) despite of pacemaker implantation (VVI mode) many patients have presyncopal or syncope attacks but life comfort in this group was much better then before implantation.

[Intravenous ablation of the atrio-ventricular junction in patients with supraventricular tachyarrhythmias]. / Przezzylna ablacja lacza przedsionkowo-komorowego u chorych z szybkimi arytmiami nadkomorowymi.

Since the first successful therapeutic DC ablation of the AV junction in 1986, we have treated 20 symptomatic patients with drug-refractory supraventricular tachyarrhythmias (average of 6 antiarrhythmic drugs prior to the ablation attempt). The primary rhythm disturbances necessitating ablation were: AV nodal reentrant tachycardia (50% of pts), atrial flutter or fibrillation, with an uncontrolled rapid ventricular response (40%), atrioventricular reentrant tachycardia using an accessory pathway (20%), atrial tachycardia (10%), and junctional reciprocating tachycardia (5%). Percutaneous catheter ablation of the AV junction was made by Gallagher's method. The USCI 4-polar catheter (7F) was used in 40% of pts, and bipolar Cordis catheter (5F) in the remaining 60%. 70% of pts received either one or two shocks, usually of 200 or 300 J during one session. Another 25% received stored cumulative energy from 800 to 1200 J (in two sessions), and one patient--1800 J (during three sessions). In 85% of pts, the immediate post-ablation conduction was third-degree AV block with the escape pacemaker, ranging from 20 to 50 beats/min., which was infra-His in 57%, and supra-His in 43% of pts. In 15% of pts were either first-degree AV block (10%) or normal AV conduction (5%). A His bundle deflection more than 0.2 mV was predictive of successful production of third-degree AV block. Except a mild and transient increase of indicating enzymes (CPK and CPK-MB) we did not observe any other serious complications directly related to the ablalation procedure. Follow-up study included 19 pts (time range from 2 to 56 months, mean 28).(ABSTRACT TRUNCATED AT 250 WORDS)

[The importance of the autonomic nervous system for sinus and atrioventricular node function in patients with sick sinus syndrome]. / Znaczenie ukladu wegetatywnego dla czynnosci wezlów zatokowego i przedsionkowo-komorowego, u chorych z zespolem chorego wezla zatokowego.

Autonomous nervous system (ANS) influence on sinus (SN) and atrioventricular (A-V N) nodes is still under investigation, especially in pathological states. We analysed role of ANS for SN and A-VN function in patients with different forms of sick sinus syndrome (SSS). From 310 patients (pts) after electrophysiological examinations before and after pharmacological denervation of the heart we selected 206 pts with SSS (group S) for further investigation. In group S were 124 men and 82 women from 17 years old (mean 46 +/- 16). Coronary heart disease was present in 102 pts (myocardial infarction in 7), mitral valve prolapse in 10, hypertrophic cardiomyopathy in 2. SSS was the only pathological finding in 75 pts. In 92 cases pacemaker was implanted (45%) of whole group S. Only sinus bradycardia was observed in 118 cases, tachycardia-bradycardia syndrome in 34 and sinus arrest or/and sinoatrial block in 53 cases. Electrophysiological examinations were performed using transesophageal stimulation of the left atrium before and after denervation of the heart. Pharmacological denervation of the heart was obtained by propranolol (i.v. 0.2 mg/kg body weight) and than atropine (i.v. 0.04 mg/kg body weight). We analysed sinus cycle length in basic state, after propranolol injection and after full denervation, maximal sinus nodes recovery time, maximal corrected sinus node recovery time, secondary pause, sino-atrial conduction time, Wenckebach point before and after full denervation. The whole group with SSS (group S) was divided: pts with normal (S1) and abnormal (S2) intrinsic properties of SN (104 and 102 pts respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical manifestations of extrinsic and intrinsic sinus node dysfunction (functional and organic factors)]. / Zespól niewydolnosci wezla zatokowego (postac czynnosciowa i organiczna). Obraz kliniczny.

UNLABELLED: We analysed the clinical data of 206 patients (pts) with sick sinus syndrome (group S). All the population was divided into two group; pts with normal (104 pts, group S1) and abnormal (102 pts, group S2) "intrinsic" properties of sinus node (SN). Intrinsic properties was defined as normal if intrinsic heart rate was normal and corrected sinus node recovery time after pharmacological heart denervation (propranolol 0.2 mg/kg body weight, atropine 0.04 mg/kg body weight) was no longer than 422 ms. In whole group S, in 131 pts we found organic heart disease (coronary heart disease, n = 102, hypertensive disease, n = 12, mitral valve prolapse, n = 10, history of myocarditis or mild mitral or aortic valve stenosis, n = 7). In groups S1 and S2 coronary heart disease was found in 31 and 71 pts, hypertensive disease in 6 and 6 pts respectively. All the patients with mitral valve prolapse were found in group S1. In 75 pts sinus node disease (SSS) was the only pathological finding, they were divided into group IS1 (n = 51) and IS2 (n = 24) according to the intrinsic properties of the SN. CONCLUSION: 1. In clinical practice sinus node dysfunction seems to be more frequent in men than in women, 2. In the large group of patients with sick sinus syndrome we analysed in this paper in about 36% we did not find any other diseases of the heart.(ABSTRACT TRUNCATED AT 250 WORDS)

[QT interval and the autonomic nervous system in coronary disease and sick sinus syndrome]. / Odstep QT elektrokardiogramu a uklad wegetatywny w chorobie wiencowej i niewydolnosci wezla zatokowego.

The autonomous nervous system influence on sinus node (SN) in both physiological and pathological states is the most important factor determining its function. There are only few publications about autonomous nervous system action on electrophysiological properties of the human heart (ventricles), specially in patients with different types of sick sinus syndrome (SSS). Electrocardiograms of 113 patients (pts) with coronary heart disease, suspected for SSS, recorded during transesophageal atrial pacing before and after pharmacological denervation of the heart, were analysed. For heart denervation propranolol (0.2 mg/kg body weights) and atropine (0.04 mg/kg body weights) intravenously were used. We analysed sinus cycle length (P-P), QT interval and QTc (QT interval corrected according to Bazett's formula) during both sinus and paced rhythm (100 bpm), before and after denervation of the heart. During clinical observations (including Holter monitoring) and after electrophysiological testing we excluded SSS in 28 pts (group A) and confirmed diagnosis of SSS in 85 pts (group B). Group B was divided in two parts; pts with normal (group B1) and abnormal (group B2) intrinsic properties of the SN. Group B1 included 23 pts (15 men and 8 woman from 36 to 74, mean 53 +/- 9) with normal sinus cycle length after denervation (according to Joses's formula) and maximal, corrected sinus node recovery time after denervation less than 422 ms. Group B2 included remaining 62 pts (26 men and 36 woman from 36 to 80, mean 59 +/- 9). In groups A and B1 denervation of the heart shortens P--P, QT, QT100 and QTc100 significantly. Only QTc in A and B1 and all parameters in group B2 didn't change significantly.(ABSTRACT TRUNCATED AT 250 WORDS)

[Atrio-ventricular conduction in patients with permanent right-ventricular stimulation. I. Possibilities of evaluation by the method of trans-esophageal electrocardiogram]. / Przewodzenie komorowo-przedsionkowe u chorych z przewlekla stymulacja prawokomorowa. Czesc I. Mozliwosc oceny metoda elektrokardiogramu przelykowego.

UNLABELLED: We analyzed 214 patients with permanent, VVI mode stimulation divided in 5 groups. Group I 89 patients (pts) with sick sinus syndrome (sss) (mean age 60 +/- 14 yrs), group II 21 pts with sss and atrioventricular (a-v) conduction disturbances (mean age 54 +/- 19 yrs), group III 72 pts with a-v block, but without intraventricular conduction disturbances (mean age 68 +/- 11 yrs), group IV 20 pts with a-v block and registered bundle branch block (mean age 67 +/- 7) and group V 12 pts after His bundle ablation (mean age 51 +/- 20 yrs). In all pts we recorded leads I, II, III, V1, V6 and oesophageal (oe) on Mingophon 7 (Siemens-Elema) with paper speed 50 mm/s. All recordings were performed during basic and magnetic rate of the pulse generator. We could analyzed ventriculo-atrial (v-a) conduction in group I-IV respectively in 89.9%, 95.3%, 84.7%, 100%, 83.3% and in all population in 89.2% cases. In 23 pts (10.8%) we could not analyzed v-a conduction due to atrial flutter or fibrillation. V-a conduction was present in groups I-IV in 61.2%, 35%, 21.4%, 45% and 10% cases respectively. CONCLUSIONS: 1. In group patients with sick sinus syndrome and VVI stimulation ventriculo-atrial conduction was recorded in most cases. 2. Ventriculo-atrial conduction was recorded in part of the population with atrio-ventricular block. 3. Frequency of ventriculo-atrial conduction phenomenon is dependent on degree of a-v block. 4. Transesophageal recording of ventriculo-atrial conduction phenomenon in patients with implantable VVI pacemaker is simple, noninvasive and useful method for clinical practice.

[Atrio-ventricular conduction in patients with permanent right- ventricular stimulation. II. Atrio-ventricular conduction time in patients with normal and impaired atrio-ventricular conduction]. / Przewodzenie komorowo-przedsionkowe u chorych z przewlekla stymulacja prawokomorowa. Czesc II. Czas przewodzenia komorowo-przedsionkowego u chorych z prawidllowym oraz uposledzonym przewodzeniem przedsionkowo-komorowym.

UNLABELLED: We analyzed transesophageal ECG recordings of 79 patients (42 men and women aged 17-85 mean 61 +/- 16 yrs) with present ventriculo-atrial conduction phenomenon during permanent VVI stimulation. All measurements we performed on basic and magnetic rate of the pulse generator. V-a conduction time was defined as mean (from 5 measurements) time from spike of the pulse generator to the first deflection of P wave recorded from esophagus and expressed in miliseconds. We compared v-a conduction time (v-act) on basic and magnetic rates of a stimulator and between groups with normal (group A, 49 pts) and prolonged a-v conduction time (group B, 30 pts). Group B was divided on group B-1 (19 pts without bundle branch blocks) and B-2 (11 pts with bundle branch blocks during observations). V-act during magnetic rate (cycle 596 +/- 70 ms) was significantly longer than during basic rate (cycle 834 +/- 66 ms) (191 +/- 48 ms vs 185 +/- 44 ms, p 0.05). V-act in patients with a-v block (group B) was significantly longer than in patients with normal a-v conduction (group B) (219 +/- 45 ms vs 190 +/- 47 ms, p 0.02). The longest v-act was observed in group B-2 (236 +/- 32 ms). CONCLUSIONS: 1. Ventriculo-atrial conduction time could be measured in patients with permanent VVI stimulation using esophageal ECG recording. 2. Shortening of the stimulation cycle prolonges ventriculo-atrial conduction time. 3. Ventriculo-atrial conduction time is longest in group with atrio-ventricular conduction disturbances, especially in group with registered bundle branch block.

[Late ventricular potentials and ventricular arrhythmia in patients with stable ischemic heart disease]. / Pózne potencjaly komorowe i arytmie komorowe u pacjentów ze stabilna choroba niedokrwienna serca.

Ischaemic heart disease especially after previous myocardial infarction can predispose to the life-threatening ventricular arrhythmias. Late potentials (LP) are confirmed parameters predicting patients prone to sudden cardiac death in ventricular arrhythmias mechanism. Late potentials registered noninvasively from the body surface were analysed in 86 patients with stable ischaemic heart disease (67 males and 19 females aged 35-67, mean 53 years). Registration of signal average electrocardiograms (SA-ECG) were performed by Simson technic (X, Y, Z orthogonal leads) using identical analysing systems and quantitative SA-ECG criteria in all three participating centers. In all patients ventricular arrhythmias detected on 24-hour ecg Holter monitoring were assessed. The localisation of previous myocardial infarction and echocardiographic assessment of left ventricular function were also analysed in each case. The results of SA-ECG were correlated with these clinical findings. Late potentials were detected (according to two or three accepted criteria) in 16 pts (19%), in 53 pts (61%) SA-ECG were normal but in other 17 pts (20%) abnormal SA-ECG (according to only one criterium) were registered. Out of these 17 pts with abnormal SA-ECG, 14 pts had prolonged filtered QRS duration as the only incorrect SA-ECG parameter. Comparative analysis between studied groups shows higher incidence of previous Q-wave myocardial infarctions in patients with LP and with abnormal SA-ECG than in patients with normal SA-ECG (63% and 71% vs 43% respectively; p less than 0.01). Ventricular arrhythmias observed in studied patients occurred with similar frequency in all groups however in patients with LP and with abnormal SA-ECG complex ventricular arrhythmias were more common than in group with normal SA-ECG (56% and 53% vs 49% respectively: NS).(ABSTRACT TRUNCATED AT 250 WORDS)

[Effect of selective and non-selective adrenergic beta receptor blockaders on selected electrophysiologic properties of the human heart]. / Wplyw selektywnej i nieselektywnej blokady receptorów adrenergicznych beta na wybrane wlasciwosci elektrofizjologiczne serca czlowieka.

Beta-2 adrenergic receptors were found in a human heart and their role in regulation of inotropic properties during last year was proved. The aim of our study was comparison of effects of selective (metoprolol) and nonselective (propranolol) beta-receptors blockade on cardiac electrophysiological properties. The study was carried out in 20 patients in the majority without organic heart injury and clinical symptoms of the sinus node dysfunction as well as atroioventricular conduction disorders. Method of the transoesophageal left atrial stimulation was utilized. Examinations were performed after drugs administrations in the same persons, during following days. Propranolol and metoprolol were intravenously administrated in a dose of 0.2 mg/kg b.w. Both drugs statistically significant lengthened sinus rhythm cycle time, sinus node recovery time, sinus node and a-v node effective refraction and lowered Wenckebach's point. They did not significantly effect on sinoatrial conduction and the atrial effective refraction. There were no significant differences between examined beta-blockers. Obtained results allowed us to conclude that: 1) eletrophysiologic properties of propranolol and metoprolol are similar, 2) it seems that in physiological conditions the effects of the adrenergic nervous system on electrophysiologic properties of sinus node, atrio-ventricular node and atrium is mainly realized by beta-1 adrenergic receptors.

[Implantation of an automatic cardioverter-defibrillator--case report]. / Wszczepienie automatycznego defibrylatora-kardiowertera serca--opis przypadku.

Authors present a case of a female patient with abundant attacks of rapid ventricular tachycardia and ventricular fibrillation, frequently resuscitated, who received an automatic cardioverter--defibrillator (AICD)--Ventak 1520 (CPI). Sooner 5-month pharmacotherapy with attainable drugs was deceptive. Operative and postoperative period was uncomplicated. During late 24-month follow-up 27 times a shock was delivered by the implanted cardioverter. Full patient's recovery was observed.